The infancy of Edward Shelonga Part IV (References and Postscript on Cognition)
an extended case study in medical and religious anthropology from the Zambia Nkoya
Wim van Binsbergen
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The infancy of Edward Shelonga Part IV (References and Postscript on Cognition) an extended case study in medical and religious anthropology from the Zambia Nkoya Wim van Binsbergen |
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to Part 0 (Abstract)
to
Part I (Problem and Method; Background)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
References
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POSTCRIPT: THE ROLE OF COGNITION
In
his introduction to the collection In search
of health: Essays in medical anthropology
(1979), where the present study appeared for the first time, Van
der Geest point at what he claims to be a major weakness in my
contribution: the fact that I have ignored the role of cognition
as a determinant of the selection of specialist healers. I am
grateful for this opportunity to explain my position more fully.
When,
like in the contemporary Nkoya situation, patients and their
sponsors are confronted with a plurality of medical systems, the
problem of which specialist healer they select, when, and why, is
of obvious theoretical and practical interest. Many medical
anthropologists[1]
have dealt with this selection problem as follows. Participants
are said to impose their cultural classifications upon the
diseases they suffer from. These classifications interpret the
nature of each disease, and imply the specialist agent (if any)
capable of curing it. Where cosmopolitan health care is available
along with forms of indigenous medicine, people allegedly tend to
classify some diseases as ‘suitable for hospital
treatment’, and others as ‘to treated by
non-cosmopolitan healers’. In my own analysis I did largely
ignore this cognitive approach, and instead interpreted the
participants’ switching forward and backward between
cosmopolitan and other healers as the outcome of a sustained,
complex social process — a process which had little to do
with the specific nature of the diseases involved, and which
could be understood retrospectively but could hardly be
predicted.
The
data as presented in my paper provide support for my view that
among the Nkoya there is no one-to-one relationship between
certain somatic (or mental) symptoms, and the choice in favor of
cosmopolitan or non-cosmopolitan medicine. In the case of Edward,
the same few symptoms (coughing, fever, emaciation, lack of
appetite, inflamed eyes, retarded motoric development) , which
recurred over a period of 11/2 years, were subject to a shifting
labeling process. Sometimes his relatives imposed cognitive
categories such as shipelo (an unborn child’s attack on his
immediately preceding sibling), lizina (illness springing from a
name which the bearer’s ancestors do not approve of), or
mpashi (illness caused by an ancestor who is angry because of a
violation of kinship obligations between living kinsmen). I
suggested how in each instance the particular labeling could be
understood as the result of the ongoing social process in which
the boy and his relatives were involved; and I described this
process in detail. When the labels mentioned were applied, the
boy’s condition was not considered amenable to cosmopolitan
treatment, and local, ritual cures were pursued instead. At other
times the relatives accepted the possibility that the very same
somatic symptoms, in the same boy, might be within the realm of
cosmopolitan medicine. They took the boy to hospitals and
clinics, where such cosmopolitan diagnostic categories as
pneumonia, malnutrition and conjunctivitis were pronounced,
without the relatives opposing these diagnoses or rejecting the
modern treatment that was indicated.
Edward’s
case does not stand on its own. Our field-work involved us deeply
in the health problems of our Nkoya informants. Not only did we
collect people’s statements on illnesses, their categories,
and explanations — in many cases we also examined the
patients and tried to treat them. Malaria, gastro-enteritis,
respiratory tuberculosis, bilharzia, hookworm and various forms
of conjunctivitis are among the most frequent diseases in Chief
Kahare’s area. The attendant somatic symptoms are (with the
exception of hookworm), fairly unmistakable, and as easy to
discuss in the Nkoya language as they are in English. However,
when it came to labeling a particular combination of symptoms
with a Nkoya category diagnostic labels to the same set of
symptoms. Moreover, these labels had again widely different
implications as to the alleged illness-causing agent, and as to
the healer to be selected. Similarly, the same diagnostic labels,
such as wulozi,
‘sorcery’; mashika,‘cold’;
and mulutu, ’(hot)
body’, were used to describe such different disease patterns
as malaria, gastro-enteritis, and respiratory tuberculosis. This
finding is rather at variance with Symon’s (1968)
description of the medical system or the Nkoya and neighboring
groups: without any semantic analysis or methodological
discussion, Symon’s crude listing or local disease names and
treatments suggests a one-to-one relationship between local
diagnostic terms and those of cosmopolitan medicine.
In
essence, however, Nkoya diagnostic categories form an idiom to
discuss, in a more or less coded and symbolic for, the social
relationships surrounding the patient. For instance, if these
relationships are currently in a state of intense conflict, and
if in the patient’s social environment there is a strong
interest, among one faction or another, to bring this conflict in
the open and force the issue, then the diagnosis of wulozi
(‘sorcery’) is likely to be made by that faction. (For
a case in point, cf. Van Binsbergen 1977b: 50f) Rival factions
thus implicitly accused of evil practices, or this parties who
have an interest in playing down the conflict, will instead
propound alternative diagnostic labels: e.g. bituma
(a spirit affliction unrelated to human aggression; cf. Van
Binsbergen 1977a); wulweli ya Nyambi
(‘illness sent by God’, i.e. regardless of human
deeds); wulweli wa Bamukuwa
(‘Europeans’ illness’, i.e. amenable to
cosmopolitan treatment); etc. Typically, the various parties
involved try, through display of formal authority, gossip, and
rumors, to influence the patient, sponsors, and public opinion in
general, so as to have their own interpretation of the disease
prevail. This struggle is in itself part of the social process in
which the patient, and the surrounding parties, are involved, and
its outcome depends on their relative strength. Once the patient
and his sponsors have accepted one diagnostic category as the
most applicable one, they thereby commit themselves to a
particular type of healer[2]
until further developments take place in the social process,
necessitating a new interpretation of the same patient’s
complaints. Edward’s case provides illuminating examples of
this.
Thus it would seem as if, in the Nkoya case, the cognitive
approach cannot in itself throw light upon the selection problem.
There is no denial that Nkoya medicine, like any other medical
system in the world, is also a cognitive system; and I should
have described this system more systematically and in greater
detail. This cognitive system, with all its obscure symbolic
implications, sets the boundaries within which Nkoya health
action can take shape, and defines basic fears as well as the
possibilities for mutual identification within the community and
across the urban-rural divide. For this reason cognition
constitutes one of the pivotal elements of Nkoya society. But
between the cognitive system, and actual health action, stands
the ongoing social process, which determines which elements in
this cognitive system will be selected for action. Where
medico-anthropological studies have so far ignored the social
process, I still feel justified in concentrating on it.
References
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Binsbergen, W.M.J.
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[1]Cf.
Lieban 1973: 1056 f. and references cited there. Lieban is
however rather critical of the accepted views.
[2]My
emphasis is on the cognition of the patients and their sponsors;
the specialist healers each use a diagnostic system that tends to
be more technical, elaborate, idiosyncratic, and orientated
towards somatic symptoms, than are the laymen’s diagnostic
categories on which the patients and sponsors base their choice
of healers in the first place.
to Part 0
(Abstract)
to
Part I (Problem and Method; Background)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
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