The Shaman's Needle: Development, Shamanic Agency, and Intermedicality in Aguaruna Lands, Peru

the shaman's needle: development, shamanicagency, and intermedicality in Aguaruna Lands, Peru

SHANE GREENE—University of Chicago

Medicine has played a complicit role in European imperial expansion since the verybeginnings of colonial ventures around the globe (see Comaroff and ComarorY 1992; Fanon1978; Latour 1988:111-145; Macleod and Lewis 1988; Paul 1978). Such complicity, termed a"medical conquest" by Kay (1987), is historically present in Latin America. There is evidencein even the earliest Spanish efforts aimed at facilitating the containment, control, and conversionof native populations of the New World through royal ordinances demanding the creation ofnucleated "orderly" townships, termed reducciones, in the colonies.' As with cathedrals,hospitals were centrally located, physically and socially constructed monuments integral toestablishing a sense of Spanish colonial order and facilitating the subjugation of nativepopulations. In the modern era, the existence of Western-style, biomedically based healthcenters and services that are often overly specialized for what "developing" countries arepermitted to afford in the global economy points to the influence Western societies hold: it is,concomitantly, political, economic, cultural, and medical.

A recent manifestation of the continuing collusion between medicine and Western neocolo-nial, capitalist interests is the role that medicine plays in Western development schemes for theso-called Third World. As a whole, development is in fact often conceptualized in overtlymedicalized terms; health and sickness are employed as analogies for "developed" and"underdeveloped" or "developing" countries respectively (Escobar 1995:30; Nandy and Vis-vanathan 1990:146). Western biotechnologies and biomedical practice take on the sameinternationally valued status in development as have science, high technology, and capitalismmore generally. During the late 1970s and early 1980s, the status of ethnomedicine indeveloping countries underwent simultaneous reexamination on two fronts: in the developmentof medical anthropology and in the medical sphere of "development" of the Third World. Aconsideration of the former is necessary for a reconsideration of the latter.

In this article I juxtapose and integrate three distinct but interrelated lines ofanalysis: (V a critique of "development" with respect to its (misconceptions ofethnomedicines as epistemologically and practically (that is, culturally) static; (2)an explication of how shamanic curing epitomizes such perceived stasis; and (3)an ethnographic analysis of a specific shamanic session (originally presented byBrown [1988]) conducted by an Aguaruna shaman whose discourse and practice,when contextual ized and fully explored, undermine (misconceptions of stasis. Thearticle employs a notion of intermedicality to examine medical development,demonstrating the important social agency executed on the part of native practi-tioners. I discuss implications for theorizing indigenous culture and the importanceof an ethnographic approach, [development, shamanism, ethnomedicine, culturechange, medical anthropology, Amazonia]

American Ethnologist 25(4):634-658. Copyright © 1998, American Anthropological Association.

634 american ethnologist

developing a medical anthropology of development

A proliferation of publications over the past 20 years has contributed to the development ofa specifically anthropological cross-cultural approach to medicine (see Young 1982). Fosterand Anderson's Medical Anthropology in 1978 was a pioneering publication, synthesizingmodern medical anthropology as a distinct social scientific subdiscipline. Anthropologicalinvestigation before the mid-to-late 1970s had by no means overlooked indigenous medicines.2

These early accounts of then so-called "primitive medicine," however, were almost invariablydiscussed in very well-trodden anthropological categories (now cliches): ritual, religion, witch-craft, magic, supernatural ism, and so forth (Foster and Anderson 1978: ch.1). Because of a soleconcentration on "primitive medicine" as essentially a magico-religious phenomenon based onlocal traditions conceived as being culturally and historically static, these earlier investigationseffectively ruled out the possibility of finding any type of medicality present in these medicines.Always in contrast to Western biomedicine, "primitive medicine" was considered pre- ornonmedicine in typical socioevolutionist fashion.3 A familiar Western indulgence in asymmetricbinaries was the template to these early anthropologies of ethnomedicine:

bio- or modern medicinesciencemodern

versusversusversus

primitive medicinemagic/religiontraditional

all of which fall directly in line with:

progress versus stasis

The rise of medical anthropology, however, generated a recognition of ethnomedicines (theterm presently in vogue for what was glossed as "primitive medicine" 25 or 30 years ago) asalternative and culturally legitimate medicines (or medical systems). Medical anthropologistsacknowledged healing and sickness beliefs in indigenous cultures as phenomena that could beunderstood as more than solely ritualistic and magical beliefs and practices. Medical anthro-pology deemed ethnomedicine "worthy" of the status of a legitimate medicine. I do not meanto imply that ritualistic or magical accounts of ethnomedicine have been rejected or evenneglected; indeed, they are still integral to much work on ethnomedicine. Rather, in thisinchoate development of medical anthropology scholars were refuting banal conceptions ofethnomedicine as simply "abracadabra": futile magical or ritualistic actions based on ostensiblystatic mythic beliefs in native communities which were essentialized as therefore nonmedical.

Conceptions of medicine (or medical systems) were expanded by anthropologists taking heedof the cultural and historical context in which a medicine exists. Because ethnomedicine isrecognized as more explicitly social in nature, it meant that the social aspects of sickness andits treatment became important in understanding how medicines operated in particular contexts.This, in turn, inevitably meant that Western biomedicine would also come under anthropolog-ical scrutiny. Medical anthropology turned to uncovering the social implications of biomedicinewhich remain largely concealed by biomedicine's explicit technological focus, its proclivity tomaintain an unmediated distinction between the natural and the social, and its excessivelynarrow focus on the individual patient.

Leslie's editorial synthesis in Social Science and Medicine sums up this analytical development:

Our first analytical task [as medical anthropologists] is to realize that the concept of a medical system,which appears simple and straight-forward, is in fact loaded with historical assumptions. The concept isan artifact of the division of labor in nation states with Departments and Ministries of Health, and oflegislators, physicians and other specialists who claim the legal responsibility for supervising the healthstatus of populations. The generic conception of a medical system is thus based on a single, historicallyrecent system: a bureaucratically ordered set of schools, hospitals, clinics, professional associations,companies and regulatory agencies that train practitioners and maintain facilities to conduct biomedicalresearch, to prevent or cure illness and to care for or rehabilitate the chronically ill. From this perspective

the shaman's needle 635

other forms of health care are outside the medical system and they are usually ignored. When they arenot ignored they are derogated as curiosities, or as fringe medicine, quackery and superstition. (1980:191 ]

This epistemological shift sanctions a new kind of anthropological analytic. Viewed from thisnew ground, medical systems are always and everywhere complexes of knowledge and practicewhich are media for ideological and symbolic expression (Comaroff 1982) and as such areinseparable from socioideological interests (Young 1981), as well as from the transformationalprocesses of cultural change (Comaroff 1981).

Thus the reconceptualization of "primitive medicine" facilitated a dismantling of the ideologyimplicit in biomedicine—that peculiarly Western mystification that reifies sickness and medi-cine as components of an exclusively technical and thus nonsocial and noncultural ("natural")process (Taussig 1980). As Young insists, "the proper study of African medicine is simultane-ously the study of our knowledge about medicine. To forget this is to accept what is perhapsthe most influential ideological belief of our time, that is, that scientific inquiry gives access toideology-free knowledge" (1981:386).

Within this shift from "primitive medicine" to ethnomedicine are the necessary roots of aconcept that logically followed and then quickly became (and remains) a central analyticaltrope in medical anthropology, virtually all discourses of medical development, and cross-cul-tural research of healing systems: medical pluralism.4 Biomedicine was no longer conceived asthe only viable medical system. The legitimation of ethnomedicine helped pave the way fornew waves of research aimed at determining the nature of this medically plural context andexploring possibilities for employing ethnomedicines as alternative health care resources—whatwould be termed the "integration" or "collaboration" of ethnomedicine and biomedicine(Akerele 1987; Bastien 1982, 1992a; Neumann and Lauro 1982).

medical development and the myth of collaboration

This medical anthropological perspective, both on ethnomedicine and reflexively on bio-medicine, affords a critical analysis of the problems of medical development. An expandedunderstanding of medicines as implicated in ideology and situated sociocultural and historicalprocesses is necessary in order to examine critically how medical development conceivesethnomedicine—and to determine to what social effects that conception is liable. In roughlythe same period in which medical anthropology established its status as a new approach,Western developers' conventional wisdom about medicine and health care improvementchanged as well, partly as a result of the cognizance of anthropological literature on eth-nomedicine. Development discourse, however, did not follow the same direction as thecritically minded medical anthropology to which I have alluded. This analysis of medicaldevelopment requires attention to political economy and its intersections with medicine, giventhat the language of economy and capital drive the ideology behind Third World developmentin virtually all its forms (Escobar 1995: ch. 3). Clearly, the problems of medical developmentare inseparable from the economic asymmetries extant between world regions (see Bastien1982; Bryant 1980; Elling 1981 a, 1981 b; Frankenberg 1980; McDonald 1981). Early 20th-cen-tury Rockefeller Foundation public health programs served as models for medical developmentin Latin America. It is clear that certain neocolonial and capitalist interests were part of theseprograms (E. R. Brown 1978). As Cueto (1994) demonstrates, such interests, along with a historyof missionization, produced the asymmetric "developmental" vision to which the United Statesadhered throughout its involvements in Latin America.

In a critique of the expansion of biomedicine in Third World countries, Ashis Nandy and ShivVisvanathan (1990:146) argue that development, as ideology and practice, entails extirpatingethnomedicines and replacing them with biomedicine. Perhaps this rings true for the periodbefore the changes I have discussed, when Western interests conceived development as a full


replacement of indigenous with Western culture. Medical developers—international public

health researchers (see Neumann and Lauro 1982) and global health policy makers of the World

Health Organization (WHO) (see Akerele 1987)—nevertheless began to recognize medical

plurality and also began to call for an integration between ethnomedicine and biomedicine.

Unfortunately, developers continue to embrace a very old and misguided set of conceptions

about ethnomedicines (and, by implication, about indigenous cultures and peoples). The most

urgent questions now concern when and on whose terms this collaboration is to take place,

and what political role these misconceptions play.

In 1978 the WHO declared a policy of "Health for All by the Year 2000," citing the need for

worldwide access to a comprehensive primary health care system (Bryant 1980). Implicit in this

policy is the assertion that the "macrosystem" of primary health care, to use Bryant's term, should

and will be provided under biomedical-bureaucratic supervision. Under this policy, further

medical development should be organized, directed, regulated, and controlled by an extensive

(international and national) systemization of health care resources in developing countries with

the WHO as ultimate overseer.

The WHO'S call for "integration" in conjunction with the "Health for Al l" effort requires close

scrutiny. A critical distinction must be made between biomedical resources (services, products,

biotechnologies—expensive health care items) and biomedically based international political

influence (health policy, organization, and research). The former may be limited (as in South

American countries) while the latter continues to expand (especially in South America). Perhaps

another way of articulating the distinction is to differentiate between biomedical medicine and

biomedical power. In the Third World, biomedical resources are relatively scarce and of poor

quality (because of economic relations); international biomedical and scientific political

influence and interest, however, are not.Collaboration may indeed be seen as a way to utilize all health care resources available and

as an attempt to further legitimate ethnomedical practices that have for so long been demonizedor disregarded. Officially employing ethnomedicine in the "Health for AH" development effort,however, also becomes a way of circumventing the problem of providing more extensivebiomedical resources that arises from economic constraints while continuing with "develop-ment." Summarizing some of the fundamental ideas that led to the "Health for Al l" concept,Bryant writes,

Appropriate technology, that is, recognition of the limitations and disadvantages of high technology andthe importance of less complex, lower cost technology appropriate to local needs and capabilities.Awareness of the distorting effects of an over-emphasis on curative medicine, especially on hospital-based,specialty-oriented, technologically sophisticated care, and consequent emphasis on more balanced ap-proaches to prevention and to lower cost, technologically simplified modes of medical care. . . .

The emergence of primary health care, emphasizing preventive, promotive and curative servicesavailable at or very close to communities in culturally acceptable patterns, and at locally affordable costs.[1980:383]

Bryant repeatedly constructs oppositions between "high technology" and "technologically

sophisticated" health services (of the kind one would find in urbanized highly industrialized

countries) and "less complex" and "lower cost technology" health services that are "appropriate

to local needs and capabilities" (of the kind one would find in underdeveloped countries).

Within these oppositions lie the beginnings of an ideology according to which the "cost" of

medical development is an issue that can no longer be denied, allied to a complacency with

the idea that nothing can be done. This implicit realism about economic constraint on medical

development points toward the restricted role that biomedical resources will necessarily play

in future medical development—and opens up a space for an alternative, a "less complex,"

more "technologically simplified" alternative health resource in the guise of ethnomedicine.

The prose of public health researchers calls attention to this ideological shift explicitly:


Thus, for some planners and international health workers who formerly disdained any perpetuation oftraditional medicine, some linkage of the two systems may become essential. For the moment, one thingthat is made clear by an assessment of the money and biomedical resources at hand is that modernmedicine and all its trappings simply cannot be made available to all the world's people in the foreseeablefuture. [Neumann and Lauro 1982:1818]

Ethnomedicine is viewed as a medical resource that permits the WHO and other developers tocontinue expanding Western development policy making and biopolitical supervision withoutany commitment to address the global economy's serious asymmetries even though thesedirectly affect any health effort that might provide improved biomedical resources to developingcountries. Such a commitment further mystifies the capitalistic yearnings of biomedicine; itallows organizations such as the WHO to continue expanding political influence over medicalissues with the understanding that nothing can or will be done about the economic factorsinfluencing the distribution of health care resources among world regions.

Further, Akerele instructs that the WHO "is fulfilling its constitutional responsibility to act asthe directing and coordinating authority" on all efforts to link ethnomedicine into the healthcare system with biomedicine in developing countries (1987:177). "The most needed field ofendeavor" in this regard, Akerele says, is to subject ethnomedicine to a thorough "evaluation"in order to place it on a "scientific basis" (1987:1 78); scientifically competent health researchers(those sufficiently familiar with the biomedical view) should determine what elements ofethnomedicine are worthy of inclusion and which should be discarded. It becomes clear laterin the article that this scientific "evaluation" essentially means ethnomedicine is best used as aresource for pharmaceutical research: "the examination of all these [ethnomedical systems]shows that they hold great promise of a rich harvest that can benefit mankind, especially in thefield of ethno-pharmacology" (Akerele 1987:178-179, emphasis mine). Akerele does notaddress the issue of how a harvest of indigenous plant knowledge and resources will benefit allof mankind. (Will it benefit mankind or the capitalist kind of man?) Three things become clear:(1) no mention is made of indigenous resource or intellectual property rights, nor economic (orany other kind of) compensation of indigenous peoples, for their knowledge of medicinal plants;(2) the WHO encourages developing nations to scientifically research and utilize such plants;and (3) the WHO itself will keep abreast of all such research and will "stand ready to be anactive partner" (Akerele 1987:179).5

What should become clear from all of this is that the idea of collaboration betweenethnomedicine and biomedicine is for health developers a result of the realization that replacingthe former with the latter (as was assumed would happen) is economically impossible. Theinherently capitalist commitment of biomedicine restrains the proliferation of costly resources,but does not then preclude opportunistic expansion of biomedical political influence (emanat-ing from the West) through control, regulation, direction of and scientific research on eth-nomedicine. Nor does it preclude opportunistic exploitation of indigenous medical knowledgeand resources (much less protect against it) through international ethnopharmaceutical re-search—a Western biomedical-capitalist practice that has really only been brought to interna-tional attention in the 1990s and no doubt remains unresolved (Greaves 1994; Posey 1990).

Ethnobotanical research on medicinal plants, utilizing indigenous knowledge resources andlabor in various capacities, proliferated during the 1980s and has expanded further in the 1990s.Following earlier discourses of the WHO and others which predicted its importance in furtherdevelopment, medical ethnobotany, though often academic in practice, has fallen into thedevelopment discourse and is now simultaneously gaining renewed support from private (andpowerful) pharmaceutical interests (see Cox and Balick 1994). As one can easily gather fromrecent compilations of summary literature, ethnobotanical research represents for many the keyto this development style of "collaboration" between indigenous and Western medicines:shamans helping scientists in the "search for new drugs" (Prance et al. 1994). Due to manyrecent protests from indigenous groups around the globe, the source countries of research


(usually Third World), and some political advocates within the West, it is now more difficult fordevelopers, ethnobotanists, and pharmaceutical companies to ignore indigenous rights to someform of property protection and economic compensation for the use of their medical knowledge.It is not necessarily more difficult for them to side-step practices, however, that address the issuein good faith.

Formed in 1992, the International Cooperative Biodiversity Croup (ICBC) is a NationalInstitutes of Health (NIH), National Science Foundation (NSF), and United States Agency forInternational Development (USAID) partnership administrated by NIH that helps fund fivelarge-scale ethnobotanical projects. Rosenthal's (1996:2) summary of ICBC goals demonstratesclearly that the ideas of collaboration, compensation, and international development are neatlywoven together in its ethnobotanical projects. To give deserved credit, ICBC rhetoric isprogressive in some respects, intending a mutual benefit for researchers and indigenous groups,and intending bioprospecting to recirculate benefits to support development of the communitiesinvolved. Yet one must also note the ultimately corporate control over the implementation ofsuch mutually beneficial "partnerships." In this regard, it is worth nothing that all of the ICBCresearchers are also funded by private sponsors with capital interests. Further, the federalgovernment agencies involved "are prohibited by U.S. Federal law from stipulating specificcontractual terms" (Rosenthal 1996:3). We must look more closely at what happens on theground to determine if practice follows from rhetoric.

Let me be specific to the Aguaruna.6 An ethnobotanical team from Washington University,St. Louis, currently holds funds from the ICBC program for an ethnopharmaceutical projectamong the Aguaruna in the Alto Maranon region of Peru. Further funding is being provided bythe research and development giant Monsanto-Searle Company (a pharmaceutical interest) sothat Monsanto-Searle may acquire sample extracts to test for bioactivity. Despite the progressiverhetoric of the ICBC program, the ICBC-Aguaruna project has in fact involved three years oftense and highly politicized negotiations, which resulted in an international conflict with oneAguaruna federation, the Consejo Aguaruna y Huambisa (CAH), and the salvage of the projectwith another, the Confederation de Nacionalidades Amazonicas del Peru (CONAP). The detailsof the conflict remain murky and vary according to the interests of the person relaying the story.Nevertheless, several of the details have been made public knowledge by the Rural Advance-ment Foundation International, a watchdog group on indigenous rights issues (RAFI 1995).

What is clear about the conflict is that after a preliminary agreement the Consejo becamedissatisfied with the manner in which they were being treated. The Consejo eventually leveleda host of strong accusations at Washington University's team, one of the more serious being theteam's refusal to translate the contract to be signed with Monsanto-Searle from English toSpanish. A letter of Aguaruna accusations, together with the demand that the team withdrawfrom Aguaruna territory, was sent to the director of the Washington University team and theNIH office that administrates the ICBG program in March of 1995/ NIH decided to temporarilyfreeze the project (see RAFI 1995). The political turmoil is now abating following the renego-tiation of the ICBC project with CONAP, an interethnic indigenous federation often incompetition for Aguaruna member support.

The intensity of political problems stemming from the ICBC project, notwithstanding the factthat the Aguaruna are hardly politically unified under their current system of competingindigenous federations, points to a web of political complexities and controversy—nothing sosimplistic and egalitarian as medical "collaboration." The current political climate in Peru andelsewhere is one of indigenous protest against past expropriation of medical knowledge andpresent demand for equitable treatment in current ethnopharmaceutical prospecting, issueswhich continued to surface even in the "successful" renegotiation of the ICBC project withCONAP. This climate is further complicated by the legal, economic, and ethical commitmentsof ethnobotanists and especially their private sector sponsors. These commitments remain


unresolved and mostly unarticulated, especially when viewed in practice. In such a climate, a"collaborative" medical development project in which the true interest isethnopharmaceuticalprospecting (that is, potential profit making) will necessarily entail as much conflict as collabo-ration, if not more. The problem of medical "collaboration" is another instance of thedisjuncturebetween rhetoric and action, policy and practice, so common to the development domain.

It is essential to note the way in which this process of collaboration is conceptualized by thedevelopment sector. The resurgence of familiar Western constructions of cultural progress(represented by science, highly "developed" nations, Western culture itself) and cultural stasis(represented by tradition, "underdeveloped" nations, indigenous cultures) emerges. Akerele writes,

Traditional medicine comprises those practices based on beliefs that were in existence, often for hundredsof years, before the development and spread of modern scientific medicine and which are still in usetoday. . . . Generally speaking, however, traditional medicine has been separated from the mainstreamof modern medicine. A basic approach, therefore, has been to promote the bringing together of modernscientific medicine with the proven useful traditional practices within the framework of the local healthcare system. [1987:177-178]

The nuances of contraposition in this passage are worth examining. Traditional medicine ispredicated as a static phenomenon that is "in existence" continuously over some unexploredpast of at least "hundreds of years," well before the "development" and "spread" (note the activeterms) of Western biomedicine. The conception that guides Akerele's statement is thattraditional medicine is a dormant and passive phenomenon (it is "in existence" and continuouswith the past), whereas modern medicine is an agential and active phenomenon (it "develops"and "spreads" and transcends tradition): stasis versus progress.

With this cultural stasis counterposed to progress construction as a template to his under-standing, Akerele invokes the need for the scientific evaluation and manipulation of eth-nomedicine by biomedical researchers. "The proven useful traditional practices" constitutethose practices that biomedical researchers deem "scientifically" worthy as a health resource.Here too there is an element of passivity (stasis and tradition) versus activity (change and science)corresponding, respectively, to ethnomedicine and biomedicine. This conception imbuesbiomedicine and science with a necessarily hierarchically superior cultural-symbolic position,as the agent of change that activates (through scientizing) an otherwise stagnant (and necessarilyunscientific) ethnomedicine. In and of themselves, ethnomedicines (indigenous peoples) aredevoid of agency; only biomedical and scientific influence (Western peoples) can activateethnomedicine. It is this culturally constructed biomedical-scientific activation of eth-nomedicine, this "bringing together" of the medicines, that leads to Akerele's revealing phrasingof what collaboration in medical development means, which is, in his own words, "bringingtraditional medicine up to date" (1987: subtitle of article).8

Ethnobotanists fall prey to the same misconception. Walter Lewis, the principal investigatorof the ICBC project with the Aguaruna, is a prominent example. His own understanding of theJivaro ethnic groups (including the Aguaruna) posits their way of life as "culturally intact,"implicitly denying the obvious influence of the West in Jivaro cultures, and conceives of jfvaromedicine as a body of knowledge in stasis, stating that they "use plants now as they have forperhaps thousands of years" (Lewis and Lewis 1994:61). But this language is typical of that usedby ethnobotanists to represent indigenous culture and medicine. I am suggesting that suchlanguage reflects a limited understanding of the people with whom ethnobotanists "collaborate."

Development ideas about integration are caught in a morass of Western constructions thaterase ethnomedical practitioners' (and indigenous peoples') social agency—the ability to effectsocial and cultural, thus medical, change—via the maintenance of this ideology that definesstasis as the negative counterpart of progress. This ideology, in turn, bolsters the very justificationof further development and valorizes development as the sole embodiment of "progress" itself.Although acknowledgment that ethnomedicine has not died out (as previously expected) iswidespread, ethnomedicine is rarely understood explicitly in terms of acf/ve indigenous cultural

640 amerlcan ethnologist

survival. Although ethnomedicine is derided less and to a certain extent legitimated as analternative and useful medical resource, it is done so only to the extent that it is manipulableby the actions, governance, and economics of the Western biomedical science research andhealth policy community. Ethnomedicine is useful in development only insofar as it is scientizedinto action through biomedically centered means. The flourishing medical research of Westernethnobotanists, inevitably backed by corporate pharmaceutical interests, is a preeminentexample of a very Western, asymmetric style of collaboration. Meanwhile, the "progress" onindigenous rights to and just compensation for appropriated medical knowledge flounders atthe level of rhetoric. This should make us aware that the problems with the idea of "collabora-tion" are problems of great consequence for indigenous populations. I further address theseshortcomings by challenging their underlying (rigid) premise that values the progressive agencyof "scientific" medicine by devaluing the agency of indigenes through construction of eth-nomedicine as a category resonant with stasis and passivity. I suggest, instead, the notion ofintermedicality—a contextualized space of hybrid medicines and sociomedically consciousagents—in South America. For this, we must understand why shamanism makes an appropriateethnomedical example and then turn again, with more detail, to Aguaruna medicine.

shamanism and the Western ante-self

Virtually all of the characteristics of earlier anthropological attitudes toward ethnomedicinediscussed above—the perceptions of ethnomedicine as chicanery and superstition, the concen-tration on ethnomedicine as essentially a magico-religious phenomenon, the delegitimated"medical" status of ethnomedicine—are particularly true of shamanism's reception in the Westbecause shamanism is predicated on a "nonempirical" worldview. South American shamansare healers who address sickness as more than a physical condition of the individual body(though this is also the case); they address it as an inherently sociopolitical and cosmologicalcondition. Shamans are consulted as a means of determining the presence of infracommunityand intercommunity sorcery-caused sickness as well as afflictions caused by the actions ofspirits, deceased ancestors, and natural forces. These causes are not seen as mutually exclusivebut intersecting. Shamanism has often been viewed as that ethnomedicine most radically alterto Western biomedicine, especially when compared to other more "scientifically" plausibleethnomedical practices in South America like herbalism (Bastien 1992a:93).

As pleas for collaboration with ethnomedicine continue to surface, however, shamanism toois invoked as a possible health care resource and to some extent legitimated as a medicalpractice (see Bastien 1992a, 1992b; Mehl 1988). The last 15 years have seen a tremendousexpansion of the New Age movement with Michael Harner's "shamanic renaissance" (1990:xi)playing no small part. Further, the climate of therapeutic intrigue surrounding the possibleefficacy of "alternative" healing methods, a multimillion dollar industry operating in the UnitedStates, has even the NIH interested and distributing research monies (Trachtman 1994). Certainbreeds of New Age exoticism, romantic environmental ism, and government-sanctioned re-search into "alternative" healing continue to intermingle with conceptions of ethnomedicinethat are true holdovers from a "development" vision and the colonial vision before; at least, allshare the vision of primitive stasis. Such related conceptions are ultimately conflated in atwo-page article about efforts to "recover" the ancient medical and plant lore of the shamansbefore the indigenous people disappear. This article was published in the New York Timesunder the headline "Shamans and Their Lore May Vanish with the Forests" (Coleman 1991).

More generally, in making predictions for the integration of biomedicine and ethnomedicine,Neumann and Lauro hypothesize that "governments will give more attention particularly to theclassification and analysis of herbal and other traditional remedies while the study of the practiceof indigenous medicine will remain of interest primarily from an anthropological point of view"


(1982:1824). Once again, we see what is truly of interest to developers: ethnopharmacologicalbenefit from the materia medica known and employed by indigenous peoples. No attentionwill be paid by developers to ethnomedical practices as sociocultural institutions. If this mustbe done it shall remain of marginal interest to that esoteric group of academics, the anthropolo-gists. My point is that it is precisely an anthropological understanding of ethnomedicine as acomplex of knowledge and practices already developing (with its own agency) that is neededto promote the right type of development. A more politically and culturally sensitive medicaldevelopment would gauge and promote the agency of ethnomedical knowledge and practiceas already in place, rather than presuppose it as culturally and historically static.

As Akerele's (1987:178) article intimates, nonempirical practices like shamanism wouldcome under the most stringent scrutiny and manipulation in the WHO'S aims to scientizeethnomedicine. The distinction between herbalism and shamanism is not an altogether tidyone; though herbalists may not typically cure through appeal to otherwordly sources of power,shamans often have a vast knowledge of plants used for herbal curing. This is something thatethnobotanists and developers interested in the benefits of including shamans in medical"collaboration" realize. There is a strong scientific compulsion to validate shamanic knowledgeand practice when it deals with empirical plant knowledge but to discourage it when it dealswith causation that Western health researchers do not acknowledge as legitimate, for example,other-natural or sorcerous sickness. Such confrontations of knowledges reveal their vulnerabilityto distortion and fracture.9

Farquhar (1994:17-19) argues that Western scientizing of traditional Chinese medicinearbitrarily and necessarily fragments it in a way that is inconsistent with its own historically andculturally developed knowledge and practice. The same might be said of South Americanshamanism. For example, Jean Jackson (1995:313-314) analyzes—in terms similar to Far-quhar's—the failure of a Tukanoan shaman workshop intended by its organizers to evaluateand discuss shamanic knowledge and practices. Jackson argues that attempts to evaluateshamanic medicine in "objective" terms are apt to decontextualize shamanism and fragmentthe multiple integrated social roles that the shaman plays in South American Indian societies.

Further, the shaman is often mythologized by Western health researchers, anthropologistsincluded, as a necessarily culturally conservative figure of indigenous societies. The shamanremains essentialized as an indigenous preserver of cultural tradition in many forms: as resisterto Christian influence, as upholder of (unchanged) pre-Columbian traditions, and, importantly,as resister or obstacle to biomedicine and medical "progress." These common Westernperceptions of shamanism as a static cultural form engender a pattern consistent with that ofhealth development researchers' views of ethnomedicine generally, discussed above. Againand again, studies of shamanism substitute the past for the present. This perspective looksbeyond the modern practices of shamans to find a trace of, not that mythical first shamanimagined by the shaman himself, but that primordial, mythological first shaman of the Westernimagination. And so the shaman becomes the quintessential embodiment of pre-Westernness,pre-modernness: what I term—in contrast to Taussig's (1987) shaman as colonial "anti-self"—the West's historically and temporally subordinated ante-self, that perennial prior selfdoomed to the temporal stasis of primitivity.

(Western) mythologies of the shaman

Mircea Eliade's (1964) essentialist cross-cultural account is emblematic of the Western

reception of shamanism. He emphasizes the uniqueness of the shaman as that highly esoteric,

individualistic figure in "primitive" societies—mystic, magical healer, ecstatic technician of an

archaic tradition, and so on. Although Eliade discusses the fact that the shaman engages in

radical interactions with the sacred—magical flight, communication with spirits and the dead,

642 american ethnoloqist

battles with sorcerers and the like—he nevertheless conceives the shaman as a conservativemystic, or, perhaps better said, a conserver of the mystic: keeper of the "archaic" traditions. Theshaman, as he says, "guards" the very "soul" of the primitive community (Eliade 1964:8).

It is this Western-conceived first shaman—primordial and culturally static on all ac-counts—who makes only slightly variant appearances again and again in shamanic studies.Holger Kalweit's representational strategy is an example of this familiar maneuver. In hisopening chapter, titled "The First Shamans of the Golden Age," Kalweit (1992:9) recounts localmythologies behind the first shaman among various "traditional" peoples from around the worldin order to assert the necessary connection that these mythical beings have with current-dayshamanic practitioners in these same communities. It is by no means misguided to think thatsocieties with practicing shamans perceive them as individuals with the ability to make contactwith other-natural forces, ancestors from the past, and so forth. Rather, what is problematic hereis the way shamans generally are cast in a timeless and mythic role to serve Westernmythology—or to say the same thing another way, to reproduce Western ideology. Thisoveremphasis on some essential connection that shamans might share with the past—a pastconstructed as timeless, primordial, mythic—represents shamanism as a culturally stagnantform: not only connected to some timeless past but exemplifying it (see Fabian 1983). It isprecisely this mythological first shaman of the Western imagination that many anthropologistsand developers alike take as their archetype—an archetype that effaces the actual social andhistorical contexts in which shamans exist and act (Flaherty 1992:208-212).

Ironically, this representation has been reproduced and remystified by a series of anthropo-logical researchers attempting to account for the obvious foreign (that is, colonial European)elements present in extant South American shamanism (Kreimer 1988; Ramfrez de Jara andPinzon Castano 1992; Wright and Hill 1992). These researchers assert that these neocolonialelements (often allusions to Christian icons and imagery, but also to Western medicine andtechnology) are simply a superficial and superimposed veneer atop an underlying indigenouscultural form that remains part of a stable foundation of preconquest Indian cultures. Kreimerillustrates this general position:

The presence of Catholic and other western symbols in the ritual of Peruvian shamans has resulted in thecharacterization of this culture as a new syncretic product. In the course of my research into traditionalmedicine I have encountered in shamanic discourse and ritual practice, a philosophy of the developmentof events and a way of interpreting socio-political processes, which would lead us to question syncretismas an explanatory category for contemporary Andean culture. Furthermore, it takes us to think aboutAndean Traditional medicine in terms of a reservoir of cultural identity and continuity against the syncreticinterpretation of today's Andean shamanism. [1988:22]

This line of analysis posits shamanism as a cultural "reservoir." Kreimer (1988) argues for thisline of reasoning with terms like cultural survival, while Ramirez de Jara and Pinzon Castanocall it the preservation of "traditional content" through the guarding of "cultural specificity"(1992:287). Practicing shamans come to embody this reservoir of preconquest ethnic identity,precolonial traditions, pre-Western culture, and pre-Columbian Indianness—again, as iftimeless, mythic, prehistoric, primordial. All of these aspects of identification are in metonymicrelation to this Western-imagined cultural stasis of shamanic practice they simultaneously construct.

These researchers present themselves as explorers of a still intact native worldview by refutingsyncretic arguments and those popular laments of the (assumed) inevitable decline of theshaman (and the "primitive" more generally).10 They are at least attempting to move away fromthe idea that shamanism has been corrupted by Western influence and is therefore necessarilydoomed to extinction in the wake of Western expansion. The result, however, is a replicationof the same familiar, very Western, mythic-ideological view of indigenous cultural forms—asstatic, nonagential, and closed-off systems: that ideological myth that simultaneously bolstersthe very viewthey claim to be refuting. Both sides propel their arguments, in like fashion, througha silent quest for rediscovery of the "pristine archaic phenomenon," as Flaherty phrases it


(1992:208): the one through lamenting shamanism's corruption and decline from a "pure"primitive state; the other through denying the significance of change in shamanic complexesunder European colonialism.

medical mythologies and shamans as textual tools

Just preceding an evolutionary contrast to "modern" medical practices in Western cultures,Krippner summarizes the primordial role of the shaman: "shamans were the world's first healers,first diagnosticians, first psychotherapists, first religious functionaries, first magicians, firstperforming artists, and first storytellers" (1988:101, emphasis added)." Clearly, the mythicideology surrounding shamanism as specifically a medical practice is fueled by persistingconflations with virtually all of the expansive Western-imagined aspects of primitivism, tradi-tionalism, primordialism, and the nonmedicalnessofethnomedicines I have thus far described.This is by no means only a recent process. As Flaherty (1992:97-98) notes, it is part of a Westernhistory of medical fascination with the shaman stretching at least as far back as the 18th century.

This Western fetishization of the primordial shamanic healer is precisely the target of Taussig's(1987, 1992) massive postcolonial critique. Although interesting, his account, too, providesonly a (decon)textualized presentation of shamanic healing. Evidently primarily concerned todeconstruct colonial representations of shamanism—assuming the few "actually existing"shamans he discusses constitute some disorderly, anticolonial force (and possibly little else)—heconstructs a reading of colonial texts and shamanism in literary Marxist terms. Having destroyed"our" old colonial representations of shamanism, Taussig then gives us the opportunity toconstruct a new one, this time with the shaman as anticolonial (and disorderly postmodern)hero. But to which shaman is he referring? What of the local social context—the ethnographic"there," as Ceertz would say? There is no "there" there (as Gertrude Stein might say). He failsto provide a fully invested ethnographic understanding, that is, a project that takes seriously theeveryday social context in which shamanism is socially produced and locally understood byspecific actors. Although Taussig presents a textually interesting portrayal of shamans as criticsof colonialism (agents ofdisorder disrupting the ostensible colonial order), his analysis falls shortin providing the ethnographic details of the local, social, and cultural logic according to whichshamans practice their craft and patients seek it. His play with the text dominates his ethno-graphic sensibility for the context. In this article, I take issue with that void, proposing ways ofbridging critique of discursive misrepresentations of shamanism as a static form with anethnographic concern for contextualized local understandings of shamanic practice. I offer thisby turning now, with strict attention to the voice—and to the contextual ized knowledge andpractice—of one significant lowland South American shaman: an Aguaruna Jivaro shamanwhom anthropologist Michael Brown (1988) calls Yankush.

shamanism in lowland Peru

Before delving into the presentation and analysis of Brown's transcript of one of Yankush's

healing sessions, a few preliminary remarks must be made about Jivaro shamanism. I do not

intend to make a comprehensive review of shamanism.12 Rather, my aim is to highlight a few

features of the shamanic complex extant in this area of Peru and salient in my analysis. Most of

these features are applicable to shamanism throughout northwest Amazonia.

Shamanism and sorcery are fused components of a complex that socializes sickness and

health for Amazonian Indians. The shaman is important for his ability to appropriate effectively

power from places distant from the social world (Harner 1972:119-125; Taylor

1981:672-673):13 principally the natural world, the otherworld (spiritual and ancestral realm),


and from other sorcerers and shamans. Jfvaro shamans also call on the power of forest spiritshamans (called p&i//r by the Aguaruna). Shamans channel appropriated power into a sociallyconstituted system of ideas about the reasons for, etiology of, and answer to illness.

This co-opted shamanic power, however, is more appropriately described as a form of powerand knowledge according to Jean Langdon (1992). Increased shamanic knowledge is increasedshamanic power. This is no analytical abstraction; the shaman's power and knowledge arebeatable. Langdon says that the amount of power shamans have is directly correlated with theamount of experience they have had with hallucinogenic trance states and specifically theintensity of the hallucinogenic agent (1992:46-47). This power and knowledge (called tsentsakby the Jfvaro) is also actively traded between shamans, typically through shamanic apprentice-ships. Tsentsak acts as a number of spirit helpers in shamanic healing. When projected fromthe shaman's body these materialize in various forms, as animals, insects, stones, and teeth, butmost often in the form of darts (like the darts hunters use in blow guns). Thus, sorcerers (whohave similar powers but use them antisocially instead of positively) cause sickness by propellingthese sorcerous darts into the body of the intended victim. In curing rituals, the shaman attemptsto extract the darts from the patient, sucking on the afflicted body part and purging them fromhis mouth, using his own tsentsak for protection. Although he is not always able (or willing) toexpose the responsible sorcerer, the shaman is nevertheless fully conscious that an attempt atdoing so is part of the curing endeavor.

Brown (1988, 1989) argues that the analytical notion of a strict distinction between benevo-lent curing shamans and nefarious sorcerers is an oversimplification. What becomes clear fromhis analysis is that in shamanic healing sessions where the curing shaman is ostensiblyreintegrating the social world by combatingthe antisocial forces of a sorcerer, the curing shamandoes not necessarily escape social scrutiny. There is potential for both harm and good giventhat the shaman's power is derived from the same sources as the sorcerer's; either can beco-opted. Shamans are understood not as fixedly beneficial agents of society, but rather associopolitical agents who must negotiate continually to prove themselves benevolent actors inlocal social relations. Their successes in times of crisis increase social faith in their personalcu/ing powers and thus add to their credibility. Because shamanic healing is antisorcery,however, curing also must revalidate social belief in sorcery as the cause of sickness. Thus therepersists an ambivalence between shamanism and sorcery within the shaman's own curative practice.

Yankush in practice: the healing session

The particular healing session I examine in this section occurred on January 18, 1978, andwas recorded by Michael Brown during his fieldwork among the Aguaruna (see Brown 1986,1988,1989).14 In addition to Yankush, the presiding shaman, two female patients (Chapaik andYamanuanch), their respective husbands (Katan and Shimpu) (all four distantly related toYankush), Yankush's wife (Tumus), and several other interested community members andrelatives were present. Also present were two anthropologists: Michael Brown and MargaretVan Bolt. I use the ethnographic present as does Brown.

During the session, Yankush is in contact with his shamanic power and knowledge (pasuk),but this does not preclude ongoing interaction among Yankush, the patients' husbands, andcertain other people present. Yankush is engaged in a performance for which shamans arerenowned, a multileveled discursive practice that includes talking, chanting, and singing invarious shamanic "registers," as Brown calls them:

Yankush's utterances encompass several distinctive styles or, as I shall call them, "registers": 0 ) a normaldiscursive register consisting of simple declarative statements; (2) a normal shamanic register, performedas song, which includes divinatory and metaphorical statements presented in a compressed style still


intelligible to other participants; and (3) a cryptic shamanic register, also sung, employing an esotericlexicon. [1988:105]

This shamanic singing or chanting in both socially intelligible and unintelligible languages is,

as Brown notes, not unlike that described by Sherzer (1983) in his discourse analysis of Cuna

healers who perform chants while curing. These registers are important because they actually

increase the efficacy of shamanic power and knowledge: "verbal control is magical control"

(Sherzer 1983:133). But this verbal and magical "control" is by no means incontestable, as the

"polyphonic" nature of Brown's transcript illustrates (1988:105).

In reading the transcript, close attention should be paid to the manner in which biomedicine

is invoked by Yankush and what relation he draws between biomedicine and the acknowledged

presence of sorcery. Brown introduces the transcript with an evocation of the scene. After a

series of informalities, Yankush "yawns in a drawn-out fashion, indicating that pasuk are entering

his body. He begins to shake the fan [of sampi leaves]. He takes off his sweater, then combs his

hair, still facing away from the participants" (1988:106):

1 Yankush: "I, I, I, I, I. With Tsunki [spirit being of aquatic realm and ultimate source of shamanistic2 power] / am seated." He falls silent. He spits, then shakes his fan while breaking into wordless3 song. He stands up, still facing the wall.4 Katan, shouting: "Let's listen! He's intoxicated now, so let's listen!" Yankush sits down again, still5 singing. His daughter brings him a small bottle of an unidentified liquid. He rubs this liquid on6 his neck.7 Katan: "Sing to your own body so that others won't bewitch you."8 Utijat: "Others know you are curing. They can hurt you. Be careful.1" Yankush faces participants.9 Katan brings in two large banana leaves. Shimpu moves the lantern to put Yankush in shadow.

10 Yankush [to Katan]: "Mother's brother, bring your wife." Both patients come forward and sit in front11 of Yankush. They take off their dresses but remain covered with blankets below the waist. One12 woman turns over to lie on her stomach.13 Katan: "Take the darts out. See where the sickness is!"14 Shimpu [indicating Yamanuanch]: "She can't eat. Her throat hurts."15 Utijat: "Think powerfully!" Yankush looks at Chapaik, sucks on her back, and spits. He drinks from16 a bottle [later identified as kistian ampi, "mestizo medicine"], faces toward wall, and vomits.17 Katan: "If you can't cure her, tell me the truth. Throw it [the sorcery substance] out! . . . Look, stand18 up to the intoxication. If you cure her, I'll always receive you well in my house. Throw it [sorcery19 substance] away!" Yankush turns to face Yamanuanch. Shimpu and other begin to shout.20 Various: "Show him where it hurts!" Yankush appears to suck on chest of Yamanuanch.21 Yamanuanch: "My throat hurts too."22 Yankush: "You'll get well." Yankush takes off his shirt, facing the wall again. He turns to look at23 Yamanuanch.24 Katan: "Sit well, think well!"25 Yankush [shaking fan in direction of Yamanuanch]: "Her chest is bad [i.e., diseased]." He sucks the26 afflicted spot and spits noisily. He turns quickly to Chapaik.27 Various men: "Tell him where it hurts!"28 Yankush: "You can give her an injection."29 Katan: "Nephew, look at all the places that hurt!"30 Yankush: "Give her an injection. She will recover. She is not sick with sorcery, but a cold in her31 throat." He sucks on Chapaik's back, spits, then sings above Chapaik. He yawns noisily, then32 kneels to suck on her back. He hawks noisily and spits.33 Yankush: "You can give her an injection of wichu [unidentified; probably a corruption of the name34 of a pharmaceutical product]. You can give her three injections. She will get well."35 Katan: "Tomorrow I'll get the medicine."36 Yankush: "With various injections she'll get better." Turns to Yamanuanch. "She has sickness in her37 stomach."38 Shimpu: "Is she going to die? If so, tell me!" Yankush leans over Yamanuanch, sucks, and spits.39 Katan: "Why would they want to bewitch me? I always give people food when they come to visit.40 Why bewitch my wife? I'm angry."41 Yankush [stands singing over Yamanuanch. He drinks from the bottle of "mestizo medicine." He42 sings over Yamanuanch for several minutes]: "If my enemies want to bewitch me, here I am.43 They can't hurt me. f see everything. She had darts in her stomach, and I took them out."44 Utijat: "See well in order to cure!"45 Yankush:" Your throat is sore from vomiting. I will heal you. Your stomach hurts right there. I'll heal46 it. When I first began curing, few people came. Now many come because I can cure. If they47 are weak, I can heal them. If they have rheumatism, I can cure them. You will return to your


48 bouse. I see your soul dancing there, getting drunk at parties. Perhaps you've been given an49 injection. This makes your stomach hurt. There are a few darts there."50 Chimi: "If there are any darts there when she gets back home, they may say that Yankush put them51 there. So take them all out!"52 Katan: "There are no sorcerers there [in the patient's community]. Who will have done this53 bewitching? If my wife dies, I could kill any man out of anger. Little nephew, cure my wife54 well. I don't want to be bothering you here. I live far away."55 Ajues: "Why hasn't Uyum [a kinsman in a distant community] come? Is he making war?" (Here Ajues56 is calling on the shaman's visionary powers to see events in a distant location.]57 Yankush: "Did your wife ever have colic [kuliku] before?"58 Shimpu: "No, never."59 Yankush: "Now colic wants to grab her. You can give her ten drops of a medicine for colic . . . [still60 singing over Yamanuanch]. Colic wants to grab her. Her body is weak, sick." He sucks noisily,61 spits. "Colic does not heal quickly. It gets better, then comes again. I will cure it completely.62 In this part {indicating throat?] there is no sickness. You vomited so much that a piece of a63 sorcery dart is stuck in your throat. I'll remove it." He sucks on her throat and spits. "How have64 you been bewitched!' Sometimes it is done so that a person will be sick for years but not die.65 / can cure this. If you have a piece of dart in your throat, the vomiting has made it more painful.66 / can take it out." [Speaking now] "Before you had much sorcery inside you. Now I'm taking67 it all out. You are better. Receive an injection, and you'll get better." He sucks and spits.68 Utijat: "Make her well! You are a good curer."69 Yankush: "I'll see everything. Nothing will remain."70 Katan: "\i she has a lot of illness and you can't take all of it out, take out half so that I can cure her71 easily with medicine. You are a curer, you can do this for me." Yankush sucks on Chapaik and72 spits. He yawns loudly, and looks at Chapaik.73 Yankush: "In Achu they killed a person. A sorcerer was killed."74 Others: "Who could it be?" Yankush drinks from the bottle of "mestizo medicine," then puts it down75 on the floor. He looks at Chapaik, touching her with his left hand. He sucks, spits, then vomits.76 Katan: "Cure well! You are a shaman!"77 Yankush: "When I'm intoxicated, I cure well. Don't say that I wasn't intoxicated enough."78 Katan: "There are others who are not as brave as I" [alluding to his anger if his wife dies of sorcery].79 Yankush: "On a piece of iron I walk on tiptoes . . . " (rest of segment of curing song is inaudible].80 Katan: "Cure well! Don't let her be sick!" Yankush stands over Chapaik, fanning her with his leaf-fan.81 He touches her back with his left hand. He sucks and spits noisily, then begins to sing. [Segment82 is indecipherable on tape.]83 Katan: "Blow the sickness away!" [To Chapaik] "You said that your head and neck hurt. Tell him84 where so that he will cure you."85 Yankush [turning to Yamanuanch, shaking his leaf-fan]: "If she has illness, I will see it and take it86 out."He sucks on Yamanuanch's stomach and spits. "She can't die. I will heal her."87 Katan: "She can't die, because I have few family left. We will be few if she dies."88 Yankush: "Tumus [Yankush's wife] is sick [with natural illness], not bewitched."89 Utijat: "Once I was sick like that, but after taking medicine I got well. I almost died."90 Utijat and Katan: "Fan her! Blow the sickness away!"91 Yankush: "Her stomach is stuck together inside. I'm going to loosen it. /'// take out the sickness."91 Sucks, spits. "Sickness has hit several times, but I've removed it so that it will heal." He begins93 to sing, facing the wall behind his stool.94 Katan: "You all, don't talk so much! If you speak, the healer won't be able to see. Be quiet, or he'll95 make a mistake!"96 Yankush: "There is a war in another place and they've killed someone. His kinsmen return crying."97 He faces Yamanuanch and begins to sing. "This person is weak inside. I'll make her well and98 strong. The earth never dies. When I heal her, she will be the same, never dying. You are well.99 You lack only a little treatment to be completely healed. I'm taking out the darts. Afterwards

100 you should have an injection, but you will recover slowly. Take off your blanket so that I can101 see your chest. Stains or wounds come out on your breast. Have you had this before?"102 Yamanuanch: "Yes."103 Yankush: "Can you give her an injection?"104 Shimpu: "Yes, I can."105 Utijat: "See how the birth of the woman's child will be."106 Yankush: "I can't see that." To the patient: "I'll return to you again." [Turns to Chapaik.]107 Utijat: "Look at me to see if I should take the name 'Tobacco.' " [People laugh because Utijat is known108 in the village by several humorous nicknames, some of which he invented for himself.]109 Katan: "Look there! She says that her liver hurts. Show him where it hurts. In her stomach it is hard.110 There's a line of pain there. Look there first, look where the ya/; tells you. Her chest is tight. It111 won't let her breathe." Yankush sucks on Chapaik's stomach, then spits. Those present remark112 that there is much kaag [the sorcerer's special saliva] in the saliva that Yankush spits out.113 Katan: "It's understandable that a stranger might want to fight with me, but why bewitch my wife?114 Yankush says that there is something in her body. Since he has strength, he shouId look carefully


115 and blow away the sickness." To Yankush: *ff there's only a little, take it out. If there is sickness,116 see it. Look to see what will cure her as fast as possible. Cure it! Cure it! See what will happen117 next! This woman came far to be cured. Some women don't want to live, and they take their118 own lives with poison. She doesn't want to die. Who can cure her? Look at them [i.e. the119 patients]. Many come here and leave recovered. Sometimes shamans can't see. But look120 carefully anyway! Look!"121 Utijat: "Look to see if my soul is married to a mestizo woman!" [laughter]122 Katan: Show him where it hurts in your liver."123 Yankush: "She could get well fast, but the "tobacco" [i.e. curer] hasn't discovered the sickness yet124 Her body is weak."125 Katan: "Now that you are with yaji, look well! Throw out the sickness!"126 Unidentified woman: "She says she has tsuak [a powerful hallucinogen, Brugmansia sp., sometimes127 used for self-cures]. Can she take it?"128 Yankush: "You can take two injections, then you can take tsuak"129 Katan: "After looking into her, you should tell us what medicine to buy."130 Yankush [indicating Chapaik]: "She doesn't have much, just a little sickness."131 Katan: "Can I give her injections for her liver?"132 Yankush: "Yes, that's all right." To Chapaik: "Mother, I'll fan you. I'm concentrating to throw out133 sickness, like a tireless jaguar. My song continues, continues. With my help she will become134 like the tapir, which doesn't know how to refuse any kind of food."135 Katan: "It's true that tapirs never reject food. When I eat tapir it tastes good. Delicious!" [Tapir is136 traditionally a prohibited food item for the Aguaruna, though it is now increasingly eaten in137 the Alto Mayo because game is scarce.]138 Yankush: "When she gets well she can eat the monkey wajiam. The pains in your stomach have made1 39 you weak. But with this fanning you will get better. We'll see how it will turn oul. I speak to140 you like the mankup [species of bear], which never gets sick."141 Katan: "Tell him if you don't have pains in your head. Little nephew, she says that her head seems142 to swell, then her ears close up tight."143 Yankush: "From here in her head I took out darts and threw them away. Tomorrow I will see all, and144 then we can leave this curing."145 Chapaik [getting up]: "I want you to see into me again on Saturday, and when I come again."146 Yankush: "When you come again, bring me a gift of cloth. With another healing session you will147 recover."148 Yamanuanch: "What kind of injection should I get?"149 Yankush: "An injection for colic. You can take drops of Diafa [apparently a commercial medicine]150 in water several times. You can take drops of Diafa without an injection. This is the only sickness151 that is hurting you." [ToShimpu] "There was something sticky in her body, but I took it all out.1 52 Only a little colic remains there. She'll get well soon. This colic made her body weak."153 Shimpu: "Can she eat wajiam [a species of monkey]?"154 Yankush: "She can eat it when she's better, after a week. Through her body I say the sickness will not1 55 continue. The agile dog never tires, hopping about. She could be this way. I say that her stomach1 56 should never reject food, as the tapir never rejects food. It's all right. She won't die. It's nothing."157 Katan: "How are the grandchildren I left behind in Shimpiyacu?"158 Yankush: "All right. They're fine."159 Katan: "Will I arrive home safely?"160 Yankush: "Yes. Don't worry any more." Mariana helps Tumus lie down in front of Yankush. Others161 are saying goodbye and leaving.162 Mariana: "Tell him to fan your head. Lie down. Show him where your liver hurts most."163 Yankush: "She has sugku. [In this context, sugku means "natural" or "epidemic" illness as opposed164 to sorcery-induced illness.] After much suffering, she'll get better."165 Others: "Surely she will die of suffering!"166 Yankush: "Her other sickness is gone. Now another illness has grabbed her, the same that infected167 the others. The offspring of the tapir never becomes ill. Be like this." Chimi and Utijat take their168 leave. All the others have left except Yankush, his wife Tumus, and Tumus's mother Mariana.169 The anthropologists leave. It is 9:05 p.m.

[Brown 1988:106-111]

reanalysis: the presence of a hybrid knowledge and practice

The presence of Western biomedical elements is abundantly clear in the transcript. For my

purposes, the most important elements are:

Yankush demonstrates an ability for dual diagnosis. He determines the source of sickness as

either sorcery or a natural nonsorcerous process, made explicit when he refers to his wife's

affliction (line 163). An essential part of his healing task is to determine the presence or absence


of sorcery. Sorcery is referred to by Yankush in its materialized form as "darts" (lines 43, 49, 65,99), as a "sticky" substance (line 151), and alluded to by the onlookers by reference to kaag,the sorcerer's saliva (line 112). Yankush does not take the presence of sorcery for granted butrather actively searches for the sorcerous substance in light of other possible causes of theaffliction (lines 25-31). Yankush tacks back and forth continually throughout the session, tryingto see into the patient, to discern the source(s) of this sickness as either sorcerous, natural, orboth (lines 59-66, 149-152).

The coexistence of sorcerous and nonsorcerous sickness in patients is well noted for otherSouth American Indians (see Langdon and MacLennan 1979:214). Especially interesting in thetranscript is the manner in which these dual diagnoses take on associations with biomedicalremedies. Yankush makes persistent prescriptions for biomedical products and procedures forthese patients' conditions. He makes reference to pharmaceuticals (lines 33, 149) and itbecomes clear from both Katan's (lines 129,131) and Yamanuanch's (line 148) statements thathis clients and community respect him as medically competent in the prescription of biomedi-cally derived medicines. He also repeatedly mentions or prescribes injections for his patients(lines 28, 30, 33-34, 36, 67, 100,103, 128, 149), sometimes in conjunction with the prescriptionof pharmaceuticals (lines 149-152).15

Further, as Brown (1988:106) records, Yankush has taken the hallucinogen yajito arrive athis shamanic trance state.16 However, as Brown witnesses throughout the session, Yankush alsodrinks from an unidentified substance referred to as kistian ampi, "mestizo medicine" (lines 16,41,74). Unfortunately, we do not know the nature of this particular bottle of "mestizo medicine,"but from Brown's (1986:175-176) discussion of medicines that fall under this rubric, it appearsto be a generic reference to all medicine originating from contact with whites (hence thecognative Aguaruna term kistian for Christian [often interchangeable with white] or mestizo[Christianized Indian]).17 The category kistian ampi incorporates all biomedically derivedproducts and procedures that the Aguaruna community acquire in trade with non-Aguaruna,or that they purchase themselves; pharmaceuticals and injections fall into this category.Yankush's ingestion of this medicine during healing sessions indicates that not only is yajiimportant to his shamanic trance state but also "mestizo medicine," as Brown translates it inthe transcript.

While combating sorcery to heal patients through shamanic trance, shamans are particularlyvulnerable to the attacks of sorcerers themselves. This is evidenced in the text when Katan (line7) and Utijat (line 8) both warn Yankush to be mindful of the fact that other sorcerers arecognizant of his curing and might decide to challenge his shamanic power. Indeed, it isnecessary to understand the significance and power that Yankush and the Aguaruna generallyattribute to "mestizo medicine." I interpret Yankush's repeated ingestion of some type of"mestizo medicine" throughout the session as indicating that this medicine is meant to bolsterhis shamanic power, perhaps even protect him against possible sorcerers' attacks.

This is evidently a hybrid healing session; however, the significance at its core can beappreciated only with an understanding of shamanic appropriation and the power of thehypodermic needle.

reanalysis: needles, power, ambivalence

Yankush's constant reference to injections and pharmaceuticals, and the various clients'requests for Yankush's advice on such matters reflectthe generally "high regard" of the Aguarunatoward biomedicine, or Christian medicine (Brown 1986:174). Biomedicine is ascribed a roleof culturally symbolic import by the Aguaruna, and this points to the ways in which pharma-ceuticals, injections, and shamanism are imbricated in the practice of a hybridized eth-nomedicine. Brown writes:


Christians also introduced a powerful symbol of therapeutic intervention, the hypodermic needle.Injections mesmerize the Aguaruna. Hypodermic kits are found in every Alto Mayo village, where theyare used with appalling frequency. Traditional illness theories link the intromission of substances into thebody with sorcery and sudden death. Perhaps because injections so dramatically invert traditionalknowledge (just as Christian norms invert Aguaruna customs in so many ways), they possess great symbolicforce. Kisticin impi, "Christian medicine," is meant to be injected, and whenever possible it is. Injectioninstantiates its power. To use a syringe is to perform an act at once unquestionably instrumental andprofoundly expressive. [1986:175-176, emphasis added]

The profound symbolism of the biomedical procedure of injecting medicines into the body asan enactment of medical power is not restricted to the Aguaruna (or even to South America—seeReeler 1990); nor is it a restricted notion that injection resembles a sorcery dart that becomeslodged beneath the sick person's skin. Bastien notes that the Andeans in Bolivia make similar parallels(1982:801,1992a: ch. 8).

Yankush prescribes pharmaceuticals and injections in a professional tone: pharmaceuticalsand injections become shamanized in his discourse. Recalling Brown's distinction between thethree shamanic "registers," we see occasions when the references to injections occur in thesung (second or third) register (lines 36, 48-49). The fact that Yankush pays discursive attentionto injections not only in his spoken responses and recommendations to his clients but also inhis personalized shamanic singing leaves little room for doubt that Yankush is conscious of thepresence of Western medicine as more than simply a practically useful product or procedure.18

By chanting about injections {"With various injections she'll get better" [line 36]), instead ofsimply prescribing them, Yankush incorporates biomedicine into his exclusive shamanicdiscourse. Using verbal as magical control, he appropriates the foreign power that biomedicineholds for the Aguaruna, channelling that power into his own shamanic repertoir of knowledgeand practice. If, as Brown says, injection instantiates the power of biomedicine, and if, as Bastiensays, the hypodermic needle is perceived as "the ultimate tool" (1992b:138) of the biomedicalprofession, then Yankush has determined a means of actively tapping into the source of thatpower for the express purpose of empowering his own shamanic technique.

This power is attributed to biomedicine precisely because it is a foreign medicine that doesnot originate within the Aguaruna social world. As is evidenced in Yankush's sung discourse,socially distant (that is, natural and supernatural) beings constitute the source of shamanicpower. The session begins with his calling on the progenitive power of Tsunki, the aquaticoriginating source of shamanic power for the Aguaruna (lines 1-2). Later he calls on the powerof the jaguar (line 133) and the mankup (line 140). All of these beings reside at the peripheryof the Aguaruna social world, and it is for precisely that reason that they are conceived aspowerful. Shamans do retain a sense of this power and knowledge inside their bodies as Langdon(1992) notes in her discussion of Siona shamanism. Yet, the origins of shamanic power lie insources not within but without: in sources "outside" of or at a distance from the particularshaman's social world. Indeed, shamans deal in distant power: they are mediators between theinside and outside and the social and natural continuums that construct Aguaruna life. Searchingfor a means to channel curative power from the realm of the socially distant into the realm ofthe socially near is the shaman's specialty.

We would do well to juxtapose Sherzer's insight (cited above) that "verbal control is magicalcontrol" with Yankush's appropriation of biomedical power through the shamanizing of injectionsin his personalized discourse. Shamanic appropriation is facilitated by hallucinogenic trance but isenacted or activated in shamanic singing and chanting. Drawing on several distant powers of thenatural realm, Tsunki, the jaguar, and the mankup, Yankush also recognizes the power sociallyascribed to Western medicine—the medicine of social outsiders (such as mestizos, Christians, andwhites)—and activates these through a similar co-opting maneuver in his shamanic chanting.

Brown claims (in quote above) that the power of injections lies in the fact that injections"invert traditional knowledge" about sorcery-sickness causation. This would mean that theAguaruna revere injection because it is a practice that is procedurally similar to sorcery (in that


both introduce a substance into the body without damage to the skin) but results in the oppositeeffect of sorcery—assuaging maladies whereas sorcery inflicts them. I find, however, that thereis something a bit more subtle yet vitally important in the Aguaruna social and shamanic aweof this biomedical procedure.

Bastien's work attests to the fact that the injection procedure is received ambivalently inBolivia: both revered and feared. Andean Indians, he says, are prone to "feel cheated unlessthey get an injection" (Bastien 1982:801) because they ascribe such power to the procedure.Yet, he notes in another text that Andeans also believe "these injections ma[ke] people sick andsterile, a not uncommon belief" (Bastien 1992b:139). Suspicion and fear of biomedicine inSouth America is further evidenced by the widespread belief in pishtacos, creatures that manifestas gringo phantasms, missionaries, the occasional anthropologist, and, significantly, as "doctors. . . who, with their instruments, [remove] the fat from people" (Bastien 1992b:141). A pishtacoattack causes at the least a dreadful affliction, sometimes leading to death, at the worstimmediate death alone in the forest.19 The Aguaruna have imported this same notion, traceableto the era of conquistadors, and applied it to a most interesting set oi Westerners: "Fear ofpishtacos has moved down from the sierra, doggedly following development projects through-out the Peruvian jungle. A group of scientists involved in medical research among the Aguarunawere rumored to be taking blood samples to determine people's body-fat content" (Brown1986:183). No need to wonder what doctor's instrument was used in collecting those bloodsamples. Suspicions about gringos-bearing-needles in search of Indian blood and fat—the vitalsources of strength, beauty, and intelligence for the Aguaruna—was recently reconfirmed duringmy visit to Aguaruna communities in 1997.

Consider this simultaneous reverence and suspicion of the needle with respect to Yankush'shealing discourse. Throughout the session, Yankush's many references to injections are typicallyoffered as prescriptions (lines 28, 30, 33-34, 36, 67, 100). Yankush makes explicit that theinjection is a curative measure: "Receive an injection, and you'll get better" (line 67). However,at one point he overtly gestures to the belief that injections not only cure but also cause sickness,and that this sickness can in fact be attributed to sorcerous actions: "Your throat is sore fromvomiting. I will heal you. Your stomach hurts right there. I'll heal it.. .. Perhaps you've beengiven an injection. This makes your stomach hurt. There are a few darts there" (lines 45-49).

This is sung shamanic discourse and thus is not necessarily intelligible to the listeners.Yankush is not in the midst of a simple statement about the affliction but in a state ofcommunication with a shamanic power source, searching for the possible causes of this patient'scondition. In these three short lines, he divines that there are signs of sorcery (darts) present inher stomach, and that the reason her stomach hurts is because she was given an injection.Injections do not simply cure pain; they can also cause it. And the pain these injections causemay well manifest signs of antisocial sorcerous actions.

Thus, the connection between injections and sorcery is even more inextricable than Brownmay have at first indicated. Yankush's shamanized discourse here illustrates that this connectionbetween injections and sorcery may in fact be not an inverse relation but a parallel one. Andthis parallel relation depends precisely on the profound ambivalence ascribed to needleinjections themselves. The sources from which shamans appropriate power are generallyattributed an ambivalent quality—the power to create and destroy, integrate and disrupt, andhence, the power both to heal and afflict. This is why a sorcerer is able to appropriate powerfrom the same sources as a curing shaman. The power source is raw, socially unformed, andthus ambivalent. Its moral and political (that is, social) direction is determined by the moral andpolitical action ofthe social (shaman) or antisocial (sorcerer) agent. Determining how that powerwill be socially channeled and socially directed is the appropriative skill of both the shamanand the sorcerer. Further, shamans may also invert power sources considered to be predomi-nantly destructive or disintegrative in order to channel them for positive curative means as a


social act. Sorcerers, on the other hand, drawing from a similar source, would simply direct itwith its already destructive potential to cause sickness as an antisocial act.

In other words, both sorcerers and shamans draw power from common sources that can beappropriated for antisocial intentions just as for socially positive ones. Western medicine,epitomized in the injection procedure, stands out as another raw power source to whichshamans may appeal, but one with particular medical-symbolic significance (because of theway injection analogizes sorcery) and particular sociopolitical resonance (because of theculturally powerful West with which this medicine is inextricably identified).

The Aguaruna are in awe of injections partly due to "the efficacy of vaccinations," as Brownargues (1986:175). Yet the explicit terms of that medical efficacy must be defined fully inanthropological analysis. Freed from a narrow biotechnological view, medical efficacy doesnot have to mean efficaciously curative. The efficacy of medical procedures is simultaneouslysymbolic and political because it is socially produced as such in Yankush's practice. Arguingotherwise is to remain complicit with a biomedical view that effaces the social by positingmedicine as an exclusively (asocial) technical knowledge and practice, isolating it as a narrowlydefined, one-way, cause-effect process that transcends or obviates the symbolic and sociopoli-tical elements of medicine and sickness—which shamanism clearly does not do. FromYankush's session we can see the necessary connection between medical efficacy, the medi-cal-symbolic, and the ethno-politics of the Aguaruna social situation vis-a-vis their powerfulnon-Aguaruna neighbors. The needle's medical efficacy is defined ambivalently by theAguaruna. It is revered to the extent that it is socially constituted as a power that is amenableto being directed in a socially positive manner, as when shamanically prescribed as a curativemeasure by Yankush. The needle's medical efficacy is feared and suspect to the extent that itis socially constituted as a power that is also amenable to being directed in an antisocial mannerby the surreptitious actions of a sorcerer or some other malicious agent: pishtacos, Westernmedical researchers included. This is made explicit when Yankush expresses a cognizance ofsorcerers who may use the needle's power to cause sickness.

What is important then to understanding this shamanic appropriation of a biomedicalprocedure is context—the socially ascribed symbolic and political meaning of the needle'sambivalent power. This is crucial to realizing that this shamanic appropriation, this (re)creationof a hybrid shamanic medicine, actually revalidates social belief in both shamanism and sorceryamong the Aguaruna. Yankush has proven a way to appropriate biomedical power and reworkit for the purposes of his shamanic healing craft. The existence of these biomedical elements inYankush's shamanic knowledge and practice does not threaten his shamanism with extinction,as those observers obsessed with the idea that Western culture and medicine corrupt a staticand unchanging shamanism (and primitivism) might insist. Instead, Yankush's session demon-strates that a hybrid ethnomedicine can in fact reinforce the social validity of shamanism. It cando so because of the way in which this type of shamanic appropriation of outside power isunderstood by the Aguaruna, and the way this shaman constructs socially relevant andoverlapping symbolic, political, and medical meanings for a medicine that his communityunderstands as sociopolitically other. It highlights the fact that Yankush's shamanism is part ofan agential expansion of Aguaruna social consciousness, a hyperawareness of the interethnicand intermedical political situation in which they find themselves. Further, it is precisely throughacting on this awareness that Yankush advances the likelihood of the successful socialreproduction, through active sociocultural readjusting, to indigenous knowledge and practices.

postcolonial hybrids, intermedical spaces, and (re)developed places

While developers contend that ethnomedical practices are actively useful to the extent they

can be scientized by biomedical research and policy, I present for radical contrast the knowledge


and practice of Yankush who shamanizes science (in the form of biomedicine) by appropriatingthe ambivalent power of the needle and incorporating pharmaceuticals into his curing. I haveargued that implicit in development efforts to scientize ethnomedicine is a misconception thatfuels a culturally and medically exploitative ideology, even when presented as a call for"collaboration." I justify my interest in exploring shamanic ethnomedicine by exposing a furthermisconception, central to mainstream Western representations, that places shamans at the apexof this cultural stasis. Drawing on critical ethnography, I develop a radical juxtaposition betweenthis knowledge and these practices, reanalyzing one particular shaman's discourse withattention to the ethnographic detail of his local context, as guided by my earlier critique.

Yankush's shamanism takes on a significance that must be understood in light of whatneocolonial contact has engendered in South America, and that is a historically constitutedintercultural, interethnic, and what I call intermedical relation. The significance is that Yankushand many other shamans now appropriate much of their shamanic power from what areultimately Western sources, including scientific biomedicine. Taylor explains this type ofshamanic appropriation among the Achuar (an Ecuadorian Jivaro group):

The shaman, uwishin, is a specialist in symbolic relations with the outside.. . Shamans mediate symbolicbonds and seek to control other groups... . Nowadays such power is derived primarily from whitespheres.... The ideological basis of prestige and value ascribed to foreignness is today epitomized bythe "white world." [1981 -.672-673]

We must realize that indigenous South American societies, including their shamans, understandbiomedicine in relation to a socially distant, at times nefarious, and powerful foreign identity(connected to the West) that postcolonial history has made an everyday part of their socialconsciousness—just as Westerners understand ethnomedicine and shamanism, particularly inrelation to a subjected indigenous South American identity.20 That identity has been continuallymisconceived ideologically facilitating further imposition—further capitalist-inspired development,including biomedical domination.

Exploring Yankush's shamanic appropriation of Western culture, however, opens up apotentially new conception of shamanism and ethnomedicine generally, as well as theintermedical space it shares with biomedicine. To some extent, I agree with Kreimer (1988) thatthe continuing practice of shamanism can be understood as a means of indigenous "culturalsurvival," but our agreement is superficial. I disagree with her conceptualization of that culturalsurvival and the ideological assumptions underlying it, which posit shamanism as a passive"reservoir" of pre-Columbian traditions (Kreimer 1988:22). I also disagree with the idea thatshamanism is a "traditional" medicine meant to passively "preserve cultural institutions"(Neumann and Lauro 1982:1817), and an unchanged resource of "culturally intact" (Lewis andLewis 1994:61) plant knowledge, as so many health developers and their ethnobotanicalpartners understand it to be.

Yankush demonstrates that shamanism is a creative and dynamic ethnomedical knowledgeand practice, not a static conservative one. His shamanism shows his keen acknowledgmentand understanding of the realities of his interethnic and intermedical social situation. He actsfrom within that situation to renegotiate what shamanism is for the Aguaruna—an activelyproduced hybrid medicine.21 Yankush's shamanic appropriation of biomedicine is itself theprocess by which he asserts his shamanic ethnic social agency and affects cultural and medicalchange among his community. Because of his appropriation of biomedicine Yankush was"highly regarded" among colonists, but Brown adds that "his fame among colonists seemed toraise rather than lower his standing among the Aguaruna" (1988:104-105). Yankush's abilityto renegotiate actively the constitution of his knowledge and practice is not a corrosive effectbut precisely what is needed to assure its "cultural survival/'

Indigenous cultural survival is too often espoused in implicit rescue terms, the constantrediscovery oi yet another slightly different version oi the untouched, primordial, pristine—and


therefore static—indigenous identity: what I call the ante-self. Indigenous culture, eth-nomedicine included, must be understood "in a truly dynamic and agential way" (Jackson1994:304). This cannot be achieved except by positing indigenous peoples as essentialcontributors to such change.

It strikes me that it is only through a simultaneous critique of Western mythic ideologicalmisconceptions of ethnomedicine and highlighting of ethnomedical practitioners who contra-dict it in local practice that medical development can be rethought and further exploitationthwarted. Ethnomedical practitioners, too, are agents of change. An attempt to redevelop theWest's understanding of ethnomedicine must come from examining the ways indigenouspeoples develop these medicines themselves. It is such an examination that allows a reflexivedemystification of the political, social, and medical asymmetries that Western development ofthe Third World, with its colonial legacy, engenders. Until such attempts are the rule and notthe exception, one must approach the topic as warily as the local shaman, divining who exactlyit is—sorcerer or scientist—wielding the suspicious power of the needle.

notes

Acknowledgments. I am grateful to the Tinker Foundation for a travel grant that supported part of thisresearch. The article benefited greatly from the (ever) insightful input of Kathleen Lowrey. Special thanksshould also go to Terence Turner who supported the article's original production and to Michael F. Brownwhose work makes the article possible in the first place and whose comments I considered essential beforesubmission. I am grateful to the editors ofMedicalAnthropology Quarterly for permission to use the extendedquote from Michael Brown's (1988) article. I would like to further thank Jean Comaroff, T. M. S. Evens, JeanJackson, and Janet Morford for their time spent giving extremely thoughtful and useful comments andcriticisms, and Michael Herzfeld for his editorial counsel. Le agredezco al Dr. Marcos Cueto del Institutode Estudios Peruanos por todo sus comentarios y especialmente su advertencia que la idea de "colabo-racion" ya no existe solamente como un problema entre la biomedicina y la etnomedicina sino tambiencomo un problema entre los acadeYnicos norteamericanos y los academicos latinomericanos. EdwardHammond of Rural Advancement Foundation International provided helpful information about the ICBG-Peru project. I remain grateful for all these contributions but of course I am fully accountable for the ideaspresented here.

1. The ordinances pertaining to the construction of reducciones include mandates for the constructionof European-style hospitals (Crouch etal. 1982:15; ordinance 121). For a more detailed examination of thepolicies regarding reducciones and their implications in colonialism, see Fraser 1990:40-45, 75-81.

2. Representative examples of this kind of earlier "medical anthropology" are Ackerknecht 1942,Evans-Pritchard 1937, Rivers 1924, and Turner 1967.

3. There is in fact at least one example where ethnomedicines are referred to explicitly as nonmedicine,as when Press refers to "urban curandero" practices as "non-medical" services (1971:749).

4. For examples of the use of "medical pluralism" as an analytical trope see Bastien 1992a, Cosminsky1983, Crandon 1986, Crandon-Malamud 1991, Frankenberg 1980, and Leslie 1980.

5. Neuman and Lauro (1982) describe expanding ethnopharmaceutical research on indigenous plantknowledge as a primary benefit of linking biomedicine and ethnomedicine. They do not mention intellectualproperty rights or compensation for indigenous peoples.

6. The Aguaruna are a group of lowland Indians of the Jivaro linguistic group. The Jivaro region stretchesacross the southern fringe of the Ecuadorian and north-central Peruvian lowlands. Harner's ethnography(1972) gives an adequate introduction to Jfvaroan cultural life.

7. The author holds a copy of the Consejo's protest letter to NIH and the principal investigator ofWashington University's research team. It is dated March 10, 1995 and contains a detailed account of theConsejo's claims against the Washington University team, as well as a demand that the research team leaveAguaruna-Huambisa territory. Portions of the letter have been translated and reprinted publicly by RAFI(1995).

8. I see clear connections between this Western conception of cultural stasis and cultural progress withthe Western conception of history and myth which Turner (1988) criticizes. His argument systematicallyrefutes the idea that indigenous Amazonian societies operate solely under a mythic (as opposed to ahistorical) social consciousness, delineating the ways in which myth and history coexist and cooperate inKayapo discourse. In doing so, he also refutes the ubiquitous Western idea that before contact withEuropeans indigenous peoples had no sense of history. The opposition that Turner discusses between historyand myth is conflated with these similar oppositions of stasis and progress (or change), tradition and science,and, I would argue, ethnomedicine and biomedicine. Similarly, these oppositions, when correlated withthe opposition between Western culture and indigenous culture, serve as a justification of further Western


imposition under the illusion of bringing or giving indigenous peoples history, change, progress, anddevelopment, of which they are ostensibly incapable by themselves.

9. We would do well to remember the imaginative name of the California-based ethnopharmaceuticalresearch firm, "Shaman Pharmaceuticals," which demonstrates such an interest in shamanic plant knowl-edge. According to King (1994), Shaman Pharmaceuticals has a great interest in promoting indigenousproperty rights and compensation for indigenous plant knowledge. Yet, the very appropriation of the wordshaman for use in ethnopharmacological research indicates to me that this sort of scientifically fragmentedunderstanding of and interest in shamanism is rampant.

10. For laments of the disappearance of the shaman, see Reichel-Dolmatoff 1975 and Perrin 1987.11. This sort of contrast between "modern" biomedicine, with its technological-scientific basis, and

shamanism, represented as the primordial healing practice, functions similarly in Achterberg's (1985: ch.1, 3) discussion of "The Shaman and the Scientist."

12. Given that I do not have space for an expanded description of shamanism in lowland South America,some general knowledge about shamanism must be taken for granted. For a more extensive introduction toJfvaro shamanism, see Harner 1972: ch. 4, 1973, and Brown 1986:60-65, 1988. Another text that gives afuller picture of shamanic practices in the lowland region of South America is the edited volume by Langdonand Baer (1992).

13. Brown (1988:103,117, n. 2) notes that Jivaro shaman ism is an almost exclusively male-gendered venture.14. This session was originally presented and analyzed by Brown (1988). For Brown's background about

the session, see 1988:105-106. The transcript is on pages 106-111. It is important to note that the text ofthis transcript is quoted directly and precisely. The line numbering has changed due to the different journalformats. I present the second and third registers (that is, the sung/chanted verse) of Yankush's shamanicdiscourse in italics in order to make them distinguishable from the first (spoken) register. In Brown's originalthe second and third registers are presented in boldface; I replace this with italics due to format restraints.All text within brackets is Brown's narration or explanation. In the original some of the narrative orexplanatory text was also in parentheses; in this article this text is enclosed in brackets for consistency. Ireproduce the transcript for my own publication with permission from the author and Medical AnthropologyQuarterly.

15. Lest it be a concern that Yankush is a rare exception in his incorporation of Western medical elementsinto his practice, there is evidence of this kind of appropriation from many other sources, some as early as1974 (see Bastien 1992a:161; Kensinger 1974:287; Langdon 1988:53; Ramfrez dejara and Pinzon Castano1992:294). There is also evidence of this appropriation in other folk medical practices in South America(see Langdon 1988:49; Taussig 1987: ch.16), as well as all over the world (see Reeler 1990).

16. This hallucinogen is used in much shamanic practice in South America and is typically referred toas either yaji (or yage) or ayahuasca.

17. The most popular conception of the ethnic category of mestizo is a person of mixed race (that is, amix of European and Indian). However, mestizo is also sometimes applied to other groups who are notnecessarily of mixed race but speak Spanish and have converted to Christianity (with varying degrees ofactual participation in Christian services, some may only be nominally Christian). The categories of"Christian," "white," and "mestizo" are often used interchangably by Aguaruna, at least to the extent ofsignifying someone who is non-Aguaruna.

18. Whether or not this singing is intelligible to the onlookers remains to be seen given that Brown doesnot (or perhaps cannot) distinguish between the second and third registers.

19. South American Indians believe that fat is extracted in order to be sold ultimately to the elite class,to tourists, and to North Americans. It is thought to be used for generating electricity for North America. Fora fuller explanation of pishtaco beliefs see Ansion 1989 and Crandon-Malamud 1991.

20. And within South America the lowland Amazonian region has become the particular locus of"authentic" shamanism as Taussig (1987), Salomon (1983), and Rogers (1994) all discuss.

21. What should also become clear in my reading of Yankush is that the tendency to overemphasize theindividualized uniqueness of the shaman only further obscures the importance of the social relations inwhich shamans are inextricably involved and on which they inevitably have strong impact. This attempt tomove toward a better social understanding of shamans is also discussed by Atkinson (1992) and touchedon by Overing Kaplan (1984).

references cited

Achterberg, Jeanne1985 Imagery in Healing: Shamanism and Modern Medicine. Boston: New Science Library.

Ackerknecht, Erwin H.1942 Problems of Primitive Medicine. Bulletin of the History of Medicine xi:503-521.

Akerele, Olayiwola

1987 The Best of Both Worlds: Bringing Traditional Medicine Up to Date. Social Science and Medicine24(2):177-181.

Ansion, Juan, ed.1989 Pishtacos: De Verdugos a Sacaojos. Lima: Tarea.


Atkinson, Jane1992 Shamanisms Today. Annual Review of Anthropology 21:3O7-33O.

Bastien, Joseph1982 Exchange between Andean and Western Medicine. Social Science and Medicine 16:795-803.1992a Drum and Stethoscope. Salt Lake City: University of Utah Press.1992b Shaman versus Nurse in an Aymara Village: Traditional and Modern Medicine in Conflict. In

Andean Cosmologies through Time. Robert Dover, Katharine Seibold, and John McDowell, eds. Pp.137-165. Bloomington: Indiana University Press.

Brown, E. Richard1978 Public Health in Imperialism: Early Rockefeller Programs at Home and Abroad. In The Cultural

Crisis of Modern Medicine. John Ehrenreich, ed. Pp. 252-270. New York: Monthly Review Press.Brown, Michael F.

1986 Tsewa's Gift. Washington, DC: Smithsonian Institution Press.1988 Shamanism and Its Discontents. Medical Anthropology Quarterly 2:102-120.1989 Dark Side of the Shaman. Natural History, November:8-10.

Bryant, John H.1980 WHO's Program of Health for all by the Year 2000: A Macrosystem for Health Policy Making—A

Challenge to Social Science Research. Social Science and Medicine 14a:381-386.Comaroff, Jean

1981 Healing and Cultural Transformation: The Tswana of Southern Africa. Social Science andMedicine 15b:367-378.

1982 Medicine: Symbol and Ideology. In The Problem of Medical Knowledge. Peter Wright and AndrewTreacher, eds. Pp. 49-68. Edinburgh: Edinburgh University Press.

Comaroff, John, and Jean Comaroff1992 Medicine, Colonialism, and the Black Body. In Ethnography and the Historical Imagination. Pp.

21 5-233. Boulder, CO: Westview Press.Cosminsky, Sheila

1983 Medical Pluralism in MesoAmerica. In Heritage of Conquest: Thirty Years Later. Carl Kendall, JohnHawkins, and Laurel Bossen, eds. Pp. 159-173. Albuquerque: University of New Mexico Press.

Cox, Paul, and Michael Balick1994 The Ethnobotanical Approach to Drug Discovery. Scientific American, June.

Crandon, Libbet1986 Medical Dialogue and the Political Economy of Medical Pluralism: A Case from Rural Highland

Bolivia. American Ethnologist 13:463-476.Crandon-Malamud, Libbet

1991 From the Fat of Our Souls. Berkeley: University of California Press.Crouch, Dora, Daniel Garr, and Axel Mundigo.

1982 Spanish City Planning in North America. Cambridge: Massachusetts Institute of Technology Press.Cueto, Marcos

1994 Visions of Science and Development. In Missionaries of Science. Marcos Cueto, ed. Pp. 1-22.Bloomington: Indiana University Press.

Eliade, Mircea1964 Shamanism: Archaic Techniques of Ecstasy. Willard Trask, trans. Princeton, NJ: Princeton Univer-

sity Press.El I ing, Ray

1981a Introduction: Relations between Traditional and Modern Medical Systems. Social Science andMedicine 15a:87-88.

1981 b Political Economy, Cultural Hegemony, and Mixes of Traditional and Modern Medicine. SocialScience and Medicine 15a:89-99.

Escobar, Arturo1995 Encountering Development. Princeton, NJ: Princeton University Press.

Evans-Pritchard, E. E.1937 Witchcraft, Oracles, and Magic among the Azande. Oxford: Clarendon Press.

Fabian, Johannes1983 Time and the Other. New York: Columbia University Press.

Fanon, Frantz1978 Medicine and Colonialism. In The Cultural Crisis of Modern Medicine. John Ehrenreich, ed. Pp.

229-251. New York: Monthly Review Press.Farquhar, Judith

1994 Knowing Practice: The Clinical Encounter of Chinese Medicine. Boulder, CO: Westview Press.Flaherty, Gloria

1992 Shamanism and the Eighteenth Century. Princeton, NJ: Princeton University Press.Foster, George M., and Barbara G. Anderson

1978 Medical Anthropology. New York: John Wiley and Sons.Frankenberg, Ronald

1980 Medical Anthropology and Development: A Theoretical Perspective. Social Science and Medicine14b:197-207.


Fraser, Valerie1990 The Architecture of Conquest. Cambridge: Cambridge University Press.

Coleman, Daniel1991 Shamans and their Lore May Vanish with the Forest. New York Times, June 11: C1, C6-C7.

Greaves, Thomas, ed.1994 Intellectual Property Rights for Indigenous Peoples: A Source Book. Oklahoma City, OK: Society

for Applied Anthropology.Harner, Michael

1972 The jivaro: People of the Sacred Waterfalls. Garden City, NY: Anchor Books.1990 Preface to the Third Edition. In The Way of the Shaman 1980. Pp. xi-xv. San Francisco: Harper.

Jackson, jean E.1995 Preserving Indian Culture: Shaman Schools and Ethno-Education in the Vaupes, Colombia.

Cultural Anthropology 10(2):302-329.1994 Becoming Indians: The Politics of Tukanoan Ethnicity. In Amazonian Indians: From Prehistory to

the Present. Anna Roosevelt, ed. Tucson: University of Arizona Press.Kalweit, Holger

1992 Shamans, Healers, and Medfcine Men. Michael Kohn, trans. Boston: Shambhala.Kay, Margarita

1987 Lay Theory of Healing in Northwestern New Spain. Social Science and Medicine24(12):1051-1060.

Kensinger, Kenneth1974 Cashinahua Medicine and Medicine Men. In Native South Americans. Patricia J. Lyon, ed. Pp.

283-288. Boston: Little, Brown.King, Steven

1994 Establishing Reciprocity: Biodiversity, Conservation and New Models for Cooperation betweenForest-Dwelling Peoples and the Pharmaceutical Industry. In Intellectual Property Rights for IndigenousPeoples: A Source Book. Thomas Greaves, ed. Oklahoma City: Society for Applied Anthropology.

Kreimer, Elizabeth1988 An Andean View of History and a Strategy of Cultural Survival, in Otra America en Construccion.

Carlos Pinzon and Rosa Suarez, eds. Pp. 22-43. Amsterdam: University of Amsterdam.Krippner, Stanley

1988 Shamans: The First Healers. In Shaman's Path. Gary Doore, ed. Pp. 101-114. Boston: Shambhala.Langdon, E. Jean

1988 Interethnic Processes Affecting the Survival of Shamans: A Comparative Analysis. In Otra Americaen Construccion. Carlos Pinz6n and Rosa Suarez, eds. Pp. 44-65. Amsterdam: University of Amster-dam.

1992 Dau: Shamanic Power in Siona Religion and Medicine. In Portals of Power. E. Jean Langdon andGerhard Baer, eds. Pp. 41-62. Albuquerque: University of New Mexico Press.

Langdon, E. Jean, and Gerhard Baer, eds.1992 Portals of Power. Albuquerque: University of New Mexico Press.

Langdon, E. Jean, and Robert MacLennan1979 Western Biomedical and Sibundoy Diagnosis: An Interdisciplinary Comparison. Social Science

and Medicine 13b:211 -220.Latour, Bruno

1988 The Pasteurization of France. Alan Sheridan and John Law, trans. Cambridge, MA: HarvardUniversity Press.

Leslie, Charles1980 Medical Pluralism in World Perspective. Social Science and Medicine 14b:191-195.

Lewis, Walter H., and Memory P. Lewis1994 Basic, Quantitative, and Experimental Research Phases of Future Ethnobotany with Reference to

the Medicinal Plants of South America. In Ethnobotany and the Search for New Drugs. Ghillean T.Prance, Derek Chadwick, Joan Marsh, eds. Pp. 60-76. New York: John Wiley and Sons.

Macleod, Roy, and Milton Lewis, eds.1988 Disease, Medicine, and Empire. London: Routledge.

McDonald, Catherine1981 Political-Economic Structures—Approaches to Traditional and Modern Medical Systems. Social

Science and Medicine 15a:101-108.Mehl, Lewis E.

1988 Modern Shamanism: Integration of Biomedicine with Traditional World Views. In Shaman's Path.Gary Doore, ed. Pp. 127-138. Boston: Shambhala.

Nandy, Ashis, and Shiv Visvanathan1990 Modern Medicine and Its Non-Modern Critics: A Study in Discourse. In Dominating Knowledge.

Frederique Apffel Marglin and Stephen Marglin, eds. Pp. 143-184. Oxford: Clarendon Press.Neumann, A. K., and P. Lauro

1982 Ethnomedicine and Biomedicine Linking. Social Science and Medicine 16:1817-1824.


Overing Kaplan, Joanna1984 Shamanism in Lowland South American Societies: A Problem of Definition. In Past and Present

in the Americas. John Lynch, ed. Pp. 167-171. Manchester, UK: Manchester University Press.Paul, James A.

1978 Medicine and Imperialism. In The Cultural Crisis of Modern Medicine. John Ehrenreich, ed. Pp.271-286. New York: Monthly Review Press.

Perrin, Michel1987 The Way of the Dead Indians. Michael Fineberg, trans. Austin: University of Texas Press.

Posey, Darrell1990 Intellectual Property Rights: What Is the Position of Ethnobiology? Journal of Ethnobiology

10:93-98.Prance, Gnillean T., Derek Chadwick, and }oan Marsh

1994 Ethnobotany and the Search for New Drugs. New York: John Wiley and Sons.Press, Irwin

1971 The Urban Curandero. American Anthropologist 73:741-756.RAFI (Rural Advancement Foundation International)

1995 RAFI Communique. Sep/Oct 1995. Electronic document at http;//www.charrn.net/~rafi/19955.html,Ramirez de Jara, Maria C , and Carlos E. Pinzon Castafio

1992 Sibundoy Shamanism and Popular Culture in Columbia. In Portals of Power. E Jean. Langdon andGerhard Baer, eds. Pp. 287-304. Albuquerque: University of New Mexico Press.

Reeler, Anne V.1990 Injections: A Fatal Attraction? Social Science and Medicine 31:1119—1125.

Reichel-Dolmatoff, Gerardo1975 The Shaman and the Jaguar. Philadelphia: Temple University Press.

Rivers, W. H. R.1924 Medicine, Magic, and Religion. New York: Harcourt Brace.

Rogers, Mark1 994 Images of Power and the Power of Images: Identity and Place in Ecuadorian Shamanism. Ph.D.

dissertation, University of Chicago.Rosenthal, Joshua

1996 Equitable Sharing of Biodiversity Benefits: Agreements on Genetic Resources. Paper presented atOECD International Conference on Biodiversity Incentive Measures. Cairns, Australia: March 25-28.

Salomon, Frank1983 Shamanism and Politics in Late-Colonial Ecuador. American Ethnologist 10:413-428.

Sherzer, Joel1983 Kuna Ways of Speaking. Austin: University of Texas Press.

Taussig, Michael1980 Reification and the Consciousness of the Patient. Social Science and Medicine 14b:3-13.1987 Shamanism, Colonialism, and the Wild Man: A Study in Terror and Healing. Chicago: University

of Chicago Press.1992 Homesickness and Dada. In The Nervous System. Pp. 149-182. New York: Routledge.

Taylor, Anne-Christine1981 God-Wealth: The Achuar and the Missions. In Cultural Transformations and Ethnicity in Modern

Ecuador. Norman E. Whitten jr., ed. Urbana: University of Illinois Press.Trachtman, Paul

1994 NIH Looks at the Implausible and the Inexplicable. Smithsonian, September:110-123.Turner, Terence

1988 History, Myth, and Social Consciousness among the Kayapo of Central Brazil. In RethinkingHistory and Myth. Jonathan Hill, ed. Pp. 195-213. Urbana: University of Illinois Press.

Turner, Victor1967 The Forest of Symbols. Ithaca, NY: Cornell University Press.

Wright, Robin, and Jonathan Hill1992 Venancio Kamiko: Wakue"nai Shaman and Messiah. In Portals of Power. E. Jean Langdon and

Gerhard Baer, eds. Pp. 257-286. Albuquerque: University of New Mexico Press.Young, Allan

1981 The Creation of Medical Knowledge: Some Problems in Interpretation. Social Science andMedicine. 15b:379-386.

1982 The Anthropologies of Illness and Sickness. Annual Review of Anthropology 11:257-285.

submitted September 30, 1996accepted May 27, 1997


Documents

The Shaman's Needle: Development, Shamanic Agency, and Intermedicality in Aguaruna Lands, Peru