1

Discuss the political aspects of cultural constructions of sickness and healing.

Political activity may be defined as the manipulation of power differentials

amongst conscious beings. Power may be defined as the ability to make someone

else do your will, it is not a stable thing. Many forms and sources of power and

always changing and moving.

By Matthew Bluck

Student ID : 08596042

2

Discuss the political aspects of cultural constructions of sickness and healing.

Sickness as experienced by an individual or a group of individuals is understood as an

“ unwanted condition within themselves” (Hann 1995 : 6) and the definition of the

experience is culturally constructed (Hann 1995 : 6) which involves culturally

specific ideas of what constitutes the mind, body, soul, connection to the world and

social relations. Thus the diagnosis of sickness and how it is redressed via healing

(Brown 1995 : 37) will involve the salient discourses associated with the medical

domain present within the culture (Dutta and Zoller 2008 : 31). The discourses present

within the culture will feature specific ideas of relations between the various roles

individuals play in the experience of sickness and healing and thus the performance of

various forms of power through these relations.

Power can be defined as “ the ability to influence others while resisting their attempts

to influence” (Vaughan & Hogg 1995 : 123) and the French and Raven 1965 model of

social power has sought to identify power as having six social bases which are

described as,

1. Reward, the perceived ability to give positive consequences or remove negative

consequences

2. Coercive power, the perceived ability to inflict harm

3. Legitimate power, based on the perception of the individual having the right to

impose prescribed behaviour.

4. Referent power, a source of influence based on identification, individual

attractiveness or achieved respect

5. Expert Power, power based on the perception of possessing distinctive knowledge,

ability or skills

6. Informational Power, power based on the ability to control information needed by

others.

Figure 1 : Forms of social power and their bases (Vaughan & Hogg 1995 : 123)

3

To function as healers the individuals involved in the healing process are making

authority claims (Murphy et al 2008 : 275) that are supported by the manipulation of

power differentials, such as the social bases of power described by the French and

Raven 1965 model, examples of this can be found in Don Handelman’s The

Development of a Washo Shaman (Handelman 1977) and Levi-Strauss’s The

Sorcerer and his Magic (Levi-Strauss 1967). In these two articles the shaman’s claim

to authority are composed of expert power by his ability and experience in healing,

informational power by access to knowledge controlled by a group and referent power

through their personal qualities such as charisma. Reward and coercive power are

associated with their ability to heal and harm, shamans are traditionally feared in

some contexts as described by Handelman (Handelman 1997 : 437) and Levi-Strauss

(Levi-Strauss 1967 : 178) due to their ability to invoke the supernatural. The forms of

power described by the French and Raven 1965 model are capable of being discussed

consciously by the individuals engaged in the discourse, they can be invoked by the

participants as “conscious intentional” strategies (Wilce 1997 : 366) thus is part of

their discursive consciousness (Giddens 1979 : 5, 73 & 203). As healers the

individuals involved in the process of healing are involved in the creation and

maintenance of meaning, making sense of suffering and finding ways for individuals

to continue (Kirkmeyer 2006 : 583) and in doing this the individuals are providing a

cluster of statements that define and simultaneously constrain the ways in which the

sickness gets talked about. Thus they facilitate the reproduction of a particular

discourse, the cultural construction of sickness and its modes of healing that will

define the experience of sickness and healing. In the French and Raven 1965 model

this influence would be described as a component of a legitimate form of social power

and inherent within discourses are the social structures within which they are

constituted.

The cultural constructions of sickness can be classified using terminology developed

by Kleinman, Eisenberg and Good (1978) (Hann 1995 : 28) into Disease accounts,

Illness accounts and Disorder accounts and the performance of healing is part of these

accounts. Disease accounts focus on the body of the patient as the source of sickness

and bodily interventions are used as the principle means to heal (Hann 1995 : 28) this

is the predominant mode of discourse in western biomedicine (Wilce 1997 : 336).

Illness accounts consider not only the body but also the person and their social

4

environment as a source of sickness thus consider the experience of unwanted

changes in states of being and in social function. Healing in this context tends to

require attention to persons and their environments, the Ndembu studied by Victor

Turner explain sickness as caused by sorcery and thus their diviners heal by finding

the social cause for the malign intention (Turner 1968 : 175) and the Kalahari

Ju|’hoansi hunter gathers use a healing dance to heal the social causes of sickness

(Katz et al 1997 : 17) . A current illness account in western medicine is the belief in

sickness due to stress induced by the social environment (Hann 1995 : 28). Disorder

accounts regard the source and locus of sickness as in the universe at large, as well as

in the patients person or body, an example of this would be the theory component of

traditional chinese medicine (Hann 1995 : 28). Although the descriptions of the

healing dances of the Ju|’hoansi feature sickness as part of the body and the idea of

drawing out the sickness from the patient into the healer and expelling, its cause is

understood as originating from social causes, such as conflict and imbalances of

power (Katz et al 1997 : 48).

In the discourse of western biomedicine infectious diseases are caused by non-sentient

agents and it can be argued that in modern western society the medical domain is

significantly differentiated from other cultural domains such as religion, politics and

the rest of social life. Disease is caused by pathological processes (Weiss & Lonnquist

2006 : 30) and patients are treated as individuals, this is consistent with the disease

processes and expectations of the patients themselves. Sicknesses as unwanted

conditions have pathological features such as the disturbance in the capacity for

independence (Hann 1995 : 4) and the ability to engage in productive work (Waitzkin

1986 : 135). The capacity for interdependence is also part of the western medical

discourse in the context of behavioural functioning in psychology and psychiatry

(Hubert 2002 : 128) but is not a normal component of the medical domain, that is

something that belongs to the patients own personal lives. The comparative increased

importance in the value of interdependence is present as a diagnostic feature for the

Ju|’hoansi .

The Ju|’hoansi are described by Richard Katz in Healing Makes Our Hearts Happy

(Katz et al 1997 : 12) as existing in egalitarian power structures and possess

communal values that encourage the sharing of resources. Ju|’hoansi women are

5

honoured for providing the majority of the diet and population densities were low, 37

square kilometres per person, which is required for the long term survival of hunter

gatherer bands. The traditional territories of Ju|’hoansi hunter gatherer bands are

called n!ore, plural n!oresi, and a n!ore is the required territory to support a Ju|’hoansi

hunter gatherer band through the seasonal cycles of a year (Katz et al 1997 : 15).

Group relations between n!oresi are established through intermarriage and extended

land use rights and the co-operative reciprocal interactions allow access to essential

resources in a often changing environment (Katz et al 1997 : 16). Much of the

Ju|’hoansi institutions and social practices can be seen as social technologies that

allow them to resolve conflict that could potentially compromise their ability to

acquire basic necessities available through social networks in times of need (Katz et al

1997 : 16). It is a common subsistence strategy for the Ju|’hoansi to share resources of

their territories as local surpluses occur seasonally, reciprocity provides stability, thus

for the Ju|’hoansi “ ownership is the ability to share” (Katz et al 1997 : 17). The

institution of the healing dance is the dominant traditional method for treating

sickness and is used for medical, psychological and political disturbances. During the

healing dance Ju’hoansi healers make body contact by touching with hands, use

vibrating hand motions, hugging and engage in a performance that conveys the idea of

the sickness being an entity residing inside the patients body. Performance and

symbols are important representations of expert and legitimate power, functional

utilitarian objects acquire a multiplicity of meanings that provide cues for the various

actors in the situation. A comparable script would be patients in a clinic, surrounded

by posters of medical information, plastic moulds of parts of human anatomy, the

functional paraphernalia of a medical clinic that also conveys the cultural awe of

biomedicine (Weiss & Lonnquist 2006 : 30) .

The Ju|’hoansi dance is described by Richard Katz as away of resolving conflict and

tension within the community, the dance brings people of the camps together in

communal activity that serves in actuality and as a metaphor (Katz et al 1997 : 138)

for their contribution to the group life of the community (see figure 2). A practical

example of group healing process taking place in a Ju|’hoansi dance is described by

Richard Katz. It involved a dispute between two women with accusations of

stinginess and bad manners and initially the two women sat at opposite end of two

lines of people attending the dance (Katz et al 1997 : 105). Eventually they sit next

6

two each other and the lines form into a circle and the camp moves on with the dance

with a more pleasant change of mood.

Figure 2. Ju|’hoansi healing dance includes men, women, young and old

(Katz et al 1997 : Preface 16)

Healing in the context of the Ju|’hoansi dance can be understood as the resolution of

conflict and the prevention of conflict within the community by maintaining

relationships and mitigating imbalances of power. The legal institutions present in

western society are specialised into culturally specified domains and possess

legitimate authority to resolve disputes which is representative of the more

hierarchical power structures present in western society. Healing in western societies

tends to feature adjustment of the individual to the situation or adjustment within the

institutional context (Waitzkin 1986 : 135). An example of this is the illness account

of stress, it is treated in a manner consistent with a disease account, an individual

takes steps to relieve it within themselves. The Ju|’hoansi discourse on sickness and

healing is composed of an illness account that is strongly centred on the experience of

community, the sick person is understood as being sick due to tension in the

7

community (Katz et al 1997 : 48). There is no legal component with a legitimate

authority to impose a resolution, the people have to derive a resolution themselves and

resources are looked after and shared through their relationships.

Part of the explanations given by Richard Katz for the sustainability of the

egalitarianism of the Ju|’hoansi are the nature of their tool kits and skill bases, in

essence each individual of their community posses similar tool kits and skill bases as

part of a nomadic hunter and gather band ( Katz et al 1997 : 13). Many young

Ju|’hoansi seek to learn the difficult task of healing, half the men and one third of the

women are successful (Katz et al 1997 : 25) which suggests that healing can be

considered as a part of the tool kit. Traditionally learning in the Ju|’hoansi is by doing

(Katz et al 1997 : 74), the learning of how to do healing involves mimesis (Pinto 2004

: 350), they learn the institutionalised power relationships, which for the Ju|’hoansi

are comparatively egalitarian (Katz et al 1997 : 25). Some healers are understood as

being better than others and this does suggest a political dimension as authority claims

based on expert power are dependant on what the community will accept as true

(Murphy 2008 : 278).

For the Ju|’hoansi their healers are stewards of the social group and in the traditional

discourse associated with the Ju|’hoansi healers, they are able to enter into an

advanced state of consciousness described as !aia and function as conduits of a

spiritual healing power termed N|om (Katz et al 1997 : 133). The Ju|’hoansi idea of

N|om is used in the context of things of power, such as medicine or the vapour trail of

a jet (Katz et al 1997 : 18) and is located in people or a song , it is locatable by its

effects and actions. Ju|’hoansi healers are understood as being able to see and sense

N|om, which allows them to engage in a diagnostic function. In the discourse

associated with a Ju|’hoansi healing dance a healer can see sickness and remove it,

concentrating it in the top of the spine and expel it with a particular shriek (Katz et al

1997 : 142) and argue with the gods on the outcome for the patient. In this context the

Ju|’hoansi healers have access to reward, expert, legitimate and referent social bases

of power for the purpose of creating connectedness and community, Richard Katz has

translated this as “ opening their hearts” to access N|om (Katz et al 1997 : 141). This

connectedness can suggest a different reformulation of power as not the ability to

influence others but as a set of relations where the person in the community performs

8

power to achieve productive goals (Mills 2003 : 36), this is foucaults idea of power

relations and is an attempt to move away from Marxist concepts of power as

“competitive and dominating” (Mills 2003 : 36) and concentrated in institutions in

society. Given Ju|’hoansi societies traditional absence of institutions, value of

extreme tolerance and what outsiders have called rugged individualism this idea of

power through a system of relations may be more salient approach than describing

power as the ability to influence. The function of the Ju|’hoansi healing dance may not

be just to resolve imbalances of power, but to maintain the relations of power as well

and in this way has a political function as it does involve the manipulation of power

differentials by maintaining relations. There are issues with this idea, Robert Katz in

Healing Makes Our Hearts Happy (Katz et al 1997 : 12) has not actively shown

examples of competitive aspects and ingroup-outgroup dynamics in the Ju|’hoansi

healing dance, it can be argued that this would be due to the practice of extreme

tolerance, egalitarian value system and community maintaining practices of the

Ju|’hoansi healing dance but the point made is that these are addressing particular

issues so what happens when the healing dance fails?

The concept of No|m has a pragmatic utility in that it describes insights different from

Victor Turners description of diviners use of analytical symbols in Ndembu

Divination and its Symbolism that features seeing sickness in individuals and

transcendental consciousness that is described as a journey to gods village (Katz et al

1997 : 99), because they possess an insight into the conflicts of interests and share the

values of their communities (Giddens 1979 : 109) their experience is understood as

true by the community.

Part of this insight has lead to healers taking up leadership roles in contact with

Herero & Tswana pastoralists and Botswana and Nambian government institutions

including schools, medical clinics and capitalist economies. The healers to provide

meaning have to respond to the changing cultural situations, these feature contact and

desire with products of capitalist economies which included sugar, tobacco and

alcohol (Katz et al 1997 : 40) and through medical clinics exposure to western

biomedical discourse with its attendant power structures, for the Ju|’hoansi the

cultural authority of western biomedicine is registered with an impression of its

institutional permanence (Katz et al 1997 : 85). This gives a potential answer to the

9

question what happens when the healing dance fails? As the Ju|’hoansi are exposed to

western economies, education and alcohol there is a perception of the healing dances

being less effective, the dances become shorter in duration and the sense of

community is decreased. At present there are less cross camp dances ( Katz et al

1997 : 103) and the dances are more focused on curing specific illnesses than with

fostering community. This could be in part to the western biomedicine but there has

always been a recognition of selfishness and hoarding as negative aspects of the

values of sacrifice and sharing (Katz et al 1997 : 138).

Western biomedical discourse is orientated towards the individual with attendant

values of a competitive autonomy and different standards of truth. Thus western

biomedical discourse would undermine the expert power basis for the Ju|’hoansi

healers ability to engage in the manipulation of power differentials within their

community. For something to constitute knowledge it must be recognised as truth by

the community (Murphy et al 2008 : 278).

Thus the cultural construction of healing and sickness is consistent with the

predominant values of a culture, sickness as unwanted states will involve the

impairment of attributes that are valued by the individual and the community and as

such is related to the social structures in which they are constituted. Ideas of healing

and sickness can constitute part of a greater set of statements concerning power

relationships and thus constitutes part of a discourse. For healers it is necessary to

establish their knowledge as true in their community and this is achieved by utilising

the various basis of social power. The French and Raven 1965 model of social power

represents an approach to categorise forms of social power but invariably there are

more sophisticated approaches. The discourse associated with the Ju|’hoansi healing

dance features an illness account that has a significant community focus on healing

and suggests another political aspect to healing. The Ju|’hoansi healing dance can be

described as facilitating the formation and maintenance of power relations that can

achieve productive goals consistent with the values of the community (Mills 2003 :

36). This approach can apply to western biomedicine as well, although medical

discourse focuses on the individual as a disease account, one of the goals of western

biomedicine is to maintain the functioning of an individual in society (Waitzkin 1986

: 136).

10

Bibliography

Brown, Phil. (1995). Naming and Framing : The Social Construction of Diagnosis

and Illness. In the Journal of Health and Social Behaviour, 1995. Pages 34 to 52.

Dutta, Mohan J & Zoller, Heather M. (2008). Popular discourse and constructions of

health and healing: Introduction. In Emerging Perspectives in Health Communication:

Meaning, Culture and Power. (Edited by Heather M. Zoller and Mohan J. Dutta).

Published by Routledge. Printed in New York. Page 31.

Katz, Richard; Biesele, Megan & St Denis, Verna. (1997). Healing makes our hearts

happy: spirituality and cultural transformation amongst the Kalahari Ju|’hoansi.

Published by Inner Traditions International. Printed in Hong Kong. Pages 11 to 163.

Kirkmeyer. Lawrence J. (2006). Toward a medicine of the Imagination. In New

Literary History. Book 36. Pages 583 to 605.

Giddens, Anthony. (1979). Central Problems in Social Theory. Action, Structure and

Contradiction in Social Analysis. Published by Macmillian Press Ltd. Printed in Great

Britain. Pages 109.

Hahn, Robert. (1995). Sickness and Healing. An Anthropological Perspective.

Published by Yale University Press. Printed New Haven and London. Pages 6

Handleman, Don. (1977/ 1967). “The development of a Washo shaman” in Culture

Disease and Healing: studies in medical anthropology. ( Edited by David Landy).

Published by New York: Macmillan. Pages 427 to 438

Hubert, Susan J. (2002). Questions of Power: The Politics of Womens Madness

Narratives. Published by Rosemost Publishing & Printing corporation. Page 127.

11

Levi-Strauss, Claude. ( 1967). “ The Sorcerer and his Magic,” in Structural

Anthropology. Published by Doubleday Anchor Books. Printed in Garden City, New

York. Pages 167 to 185.

Mills, Sarah. ( 2003). Michael Foucault. Published by Routledge. Printed in Great

Britain, London. Pages. Pages 33 to 51.

Murphy, Alexandra; Eisenberg, M; Wears, Robert & Perry, Shawna. (2008).

Contested streams of action: Power and deference in emergency medicine. In

Emerging Perspectives in Health Communication: Meaning, Culture and Power. (

Edited by Heather M. Zoller and Mohan J. Dutta). Published by Routledge. Printed in

New York. Pages 275 to 293.

Pinto, Sarah. (2004). Development without Institutions: Ersatz Medicine and the

Politics of the Everyday life in Rural North India. In the Journal of Cultural

Anthropology, Volume 19, Issue 3. Pages 337 to 364.

Turner, Victor. (1977/ 1968). “ Ndembu divination and its symbolism” in ” in Culture

Disease and Healing: studies in medical anthropology. ( Edited by David Landy).

Published by New York: Macmillan. Pages 175 to 183.

Vaughan, Graham and Hogg, Michael. ( 1995). Introduction to Social Psychology.

Published by Prentice Hall. Printed in Australia. Pages 122 to 124.

Waitzkin, Howard. (1986). Micropolitics of medicine: Theoretical Issues. In Medical

Anthropology Quarterly, Vol 17, No 5, ( Nov 1986). Pages 134 to 136.

Weiss, Gregory L and Lonnquist, Lynn E. ( 2006). The Sociology of Health, Healing

and Illness. (Sixth Edition). Published by Pearson Education Inc. Printed in Upper

Saddle River, New Jersey. Pages 29 to 31.

Wilce, James. (1986). Discourse, Power and the Diagnosis of Weakness:

Encountering Practitioners in Bangladesh. In Medical Anthropology Quarterly,

Volume 11, Number 3, Pages 352 to 374.

12