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Healing and Medicine: An Overview

HEALING AND MEDICINE: AN OVERVIEW

Healing occupies a singular and prominent place in religious experience throughout the world. Often the most important figure or symbol in any given religious tradition is the source of healing, and illness tends to function as a magnet for many and varied ritual responses. In addition, the existence of personal suffering in the world may serve as a springboard for theological and mythological exploration and explanation.

The aims of religious healing are consonant with the overall goals of religious life in a culture. Healing may be directed toward reestablishing ritual order, life in abundance, the expulsion of disorder and evil, redemption from condemnation, salvation from guilt and sin, liberation from existence, or extinction of existence itself. Sickness reminds religious beings to assume their peculiar role in the world, one cognizant of sacred realities and coordinated with the cosmos. Rituals of healing redress the fragmented social, personal, temporal, physical, and metaphysical tissues constituting the whole of the universe. All this is possible because the human body and its experiences comprise a knowable world of physical, spiritual, mental, cognitive, and emotional forces that reveal supernatural structures of creation. Religious healing clarifies the ways in which the individual human body lies at the center of sacred meaning.

The meaning and value of ideas and experiences associated with healing become most clear in the specific religious contexts in which they arise. Thus, for example, the passion of physical suffering has different meanings in the self-sacrifice of the Buddhist Bodhisattva Ksemadatta who burned his own hand to become a living lamp; in the crucifixion of Christ, necessary for those who believe in him to gain everlasting life; and in the death of al-allāj (d. 922), the Muslim mystical poet who saw the human condition in both its love and painful separation of absence and death as a mirror of the divine nature and its attributes.

The following discussion deals with religious healing from a comparative perspective. The outline roughly follows the hypothetical contours of an incident of sickness and cure, moving from the origins of the disease and techniques of cure through the discovery of symptoms, their diagnosis, choice of therapy, the actions of cure, and the aftereffects of healing. Information on healing in particular religious traditions and culture areas can be found in the articles immediately following this overview.

Myths of the Origins of Disease

Images and symbols of the origins of disease help justify and rationalize sickness and exculpate (or blame) the victim of illness. They also help the community to think about the condition of sickness. However, the importance of myths of the origins of disease goes beyond the social and cognitive in that they help locate sickness as an ontological conditiona mode of being.

The supreme being itself may send afflictions. In keeping with their absolute and total character, celestial supreme beings dispatch people with summary diseases and capital punishments. The Semang of Kedah (Malaysia), for example, believe that the supreme being Kari, who created most of the universe, is omniscient and sees every offense from his dwelling place on high. He punishes wrongdoers by dropping a flower from a mysterious plant on them. Wherever the flower falls, fatal lightning strikes. Often, congenital diseases are attributed to the creator. The Mondari of southern Sudan attribute the origin of certain nervous disorders and mental sickness to Ngun Ki (Spirit-of-the-Above). Symptoms of such diseases include sudden onset, an indication that the power from above has fallen hard and swiftly. Alternately, mental incapacity that appears to be congenital is also attributed to the authorship of the creator, for the afflicted are considered bad creations that were broken or spoiled in the making.

Supreme beings and creators not only set in motion fatal and incurable diseases, they can indirectly unleash a flood of pathogenic substances on the world. This is especially the case when creators destroy their own creations through universal flood, fire, petrifaction, darkness, or earthquake. These catastrophes generally leave toxic residues. Left over and only partially destroyed, such fragments of the primordial world cause disease in those who come into contact with them (if these fragments should be inert substances like poisons, ashes, or brackish primordial waters) or who are attacked by them, as in the case of leftover primordial monsters continuing to devour victims in today's world.

In the northwest Amazon area of South America, in the upper Río Negro region, the Baniwa people believe that many diseases originated when the culture hero Kuai was consumed by the fire that swept through the world at the beginning of time. From Kuai's mouth and other body orifices streamed saliva and fluids that became the poisons of this world, and from the fur on his body came the pathogenic darts and slivers that invade human beings.

At times, a co-creator, one who competes with or thwarts the efforts of the divine creative partner, introduces disease into the world. According to the Mazdean theology of the Iranian Dēnkard (9.37.5), the world was once perfect, immortal, and immaterial (menog ). Even the material creation (getig ) made by Ōhrmazd, the good creator, was perfect. Only when Ahriman creates finite space does he corrupt the world with evil and sickness, a state of confusion (gumezishn ) that will endure until the end of time. Ahriman's demonic creations inhabit human bodies, where they lodge themselves as diseases.

Often a more ambiguous divine figure introduces disease. Divine culture heroes or mythical tricksters collaborate in creation with the supreme being. However, they are rarely equal in power or status with the high god. They are usually deputies commissioned to carry out the will of the creator. In the course of discharging their duties, however, they bungle the job or meet with misadventure that lets loose disease. Bauro, the hero of Tucano-speakers of southern Colombia, for example, was entrusted with the gourd of night. This gourd would allow people to dream and to perform ceremonies if it was opened with due care. Unfortunately, the hero was unable to prevent meddlers from opening the container prematurely. Its contents flooded the earth with penetrating darkness, accompanied by the diseases of noxious vermin, stinging insects, and venomous reptiles.

In some cases, the divine or supernatural body itself gives rise to disease. This is especially true among mythic figures whose slain cadavers are dismembered to bring into being various species of plants or animals. Consumptive realities (i.e., substances to be consumed) appear not only in the forms of food but in the guise of diseases.

Ancient Daoist texts (Huainanzi, chaps. 2, 4; Zhuangzi, chap. 9; and Shanhai jing, chap. 13) describe the origins of madness. Ancient gods of the time of paradise drummed their bellies and created a rumble-guts of thunder and lightning, shattering the world with a primordial deluge. The belly is the location of the Yellow Court, the center of meditative techniques and mystical experiences that transmute the body, rid it of impurities, and reconceive the individual as a holy and immortal embryo. The individual who suffers madness in this way is said to know with his or her belly the ancestral gods who drummed at the time of creation.

Many diseases result from the incomplete condition of creation. According to a myth reporting the emergence of the Navajo peoples at the beginning of time, colors were kept separate from one another in different world levels and in the baskets located at each of the cardinal directions. In the center of the universe was placed a covered basket containing whooping cough, smallpox, nervous disorders, and all manner of sickness. The basket also contained the first human being and his companions. When the mythical people emerged through the various layers of the primordial world and ascended into this one, they gradually accumulated a riot of confused colors collected from all the various world layers they had passed through. They also brought along the basket of ills. Creation, increasingly complicated over time, maintains its order only with difficulty. In the Navajo case, the failure to intercalate the myriad orders of sounds, colors, directions, supernatural beings, plants, stones, and qualities of light accumulated during the ascent through multiple worlds, brings on disorder reflected in the body as sickness.

Finally, disease can enter the world through the disobedience of a creature. Instructed by the supreme being, creator, or culture hero to keep silent, maintain vigil, stand motionless, or observe dietary restrictions, the first people disobeyed. For example, consider the story in chapter 3 of the book of Genesis, in which Adam and Eve fall into sin and death because of their disobedience to Yahweh.

These mythic scenarios do not exhaust the kinds of episodes portraying the origins of disease. The point is that religious healing rarely, if ever, confronts a merely biological disorder located exclusively in the body of the patient. Religious healing encounters a primordial reality: battles with supernatural forces that have existed from the beginnings of time. Healing must be an act of recreation, corrective creation, or cosmic battle waged to triumph over or annihilate miscreant primordial powers. The healer must be cognizant of the origins and nature of the realities he or she confronts through the experience of the patient. Disease forces the religious healer to reckon with the creation of the world.

Proximate Causes of Illness

The mythic origins of illness serve as the ideological background for the diagnostic procedures that determine the proximate causes of illness in specific instances. In most cases, the proximate causes of illness are more immediately relevant for the diviner or diagnostician and certainly more relevant for the patient. After all, these causes are specific and individual and can be treated in the here and now. The immediate causes of the disease may be due to the castigating action of ancestors or Gods as a response to sin or moral failing of the individual. This castigation often is construed as educational in value: The affliction causes the individual to change his or her behavior for the better. In these instances, the illness may be construed as a spiritual "wake-up call" or as an opportunity to make amends and start over.

Sometimes illness is caused by the hidden malevolence of neighbors or relatives or by nasty ghosts or spirits. In traditional European societies, the evil eye was believed to cause a variety of illnesses and other misfortunes. Those who give others the evil eye often are understood to behave out of envy, although that envy sometimes is unintentional rather than purposefully malicious.

Another frequent proximate cause of illness is the poor performance of ritual acts, such as inattention to ancestors or incorrect ceremonial etiquette. Paul, for example, pointed out to the Christians of Corinth this cause of their illnesses: "For any one who eats and drinks without discerning the body eats and drinks judgment upon himself. That is why so many of you are weak and ill and others of you have died" (1 Cor. 11:2930). Impurity is another frequent cause of illness. Impurity sometimes is the result of ritual failings, but often is the consequence of contamination of one sort or another. Inappropriate sexuality and contact with strangers, certain animals, menstruating women, and the dead are common sources of impurity.

A particularly common cause of illness falls into the general category of bad social relations. Illness may be construed as triggered by anger or jealousy or as a manifestation of overly strong emotions. In cultures characterized by rigid gender hierarchies, illness in women often is interpreted as triggered by their rebellion or disrespect toward their husbands, fathers, or other socially dominant men.

The Malays believe that human beings are composed of minds, bodies, souls, and two other elements: semangat, the universal spirit that dwells in all creation and when startled may leave its container, and angina, the Inner Winds inherited from one's parents. These Inner Winds govern individual talent and personality. If strong Winds are not expressed in daily life, they accumulate in the body, causing physical and emotional pain. Stifled Inner Winds are suspected to be the cause of intractable illness that has not responded to straightforward medicine or simple spells.

Diagnosis

When people fall ill and suspect that their affliction has a supernatural cause, they seek expert advice. In many social settings there is an informal but ordered network of people who help the sick person choose the best course of action. Such a therapy management group often consists of relatives, friends, neighbors, and local authorities. The group helps decide how serious the crisis is and how to face it. Should the illness endure, interrupting the productive relations of the individual and the community, special assistance is sought from someone familiar with the meaning of the symptoms. The individual who diagnoses sickness may serve as a referral center to medical practitioners specializing in one disease or another. Alternately, the diagnostician may both discern the disease and cure it. The diagnostician reads the signs of the disease manifest as symptoms and reconstructs both the mythic and social history of the sickness.

Prior to Christian evangelization, the Kaluli people of the tropical forest north of Mount Bosavi on the island of New Guinea believed the forest around them was coincident with an invisible world of spirits with whom human beings could communicate through mediums. Spirit séances would be held to cure the sick, investigate witchcraft, uncover the cause of death, or locate lost pigs. According to Edward Schieffelin (1996), Kaluli believe illness to be caused when the invisible spirit-counterpart of a person's body is dismembered by a witch or injured by other circumstances in the spirit world. The person can be treated by asking the spirits, through a medium, to locate the patient's body-counterpart in the spirit world and repair the damage.

The competence of the diagnostician may stem from his or her personal experiences of sickness from similar diseases, from innate gifts or talents (e.g., clairvoyance), acquired techniques (e.g., special objects of power), or familiarity with spirits. Diviners sometimes master elaborate symbolic schemes accounting for the elemental substances, forces, and processes at work throughout the cosmos. Such systems of correspondence reduce the infinitely complex circumstances of mythic, cosmic, social, and personal history to a relatively few combinations of symbolic items. Some African systems of correspondence have given evidence of astounding complexity. Reputedly revealed by divinities at the beginning of time, Yoruba divinatory techniques reveal the correspondences that exist between patterns of nuts or shells cast on the ground and hundreds of lengthy, enigmatic verses memorized by the diviner. The diviner must know the nuances of meaning in the poems and be expert in applying them to new situations. The verses allude to mythic personages and events that shaped the world. The current condition of the patient is brought into line with some primordial condition of creation revealed in the poem. The sickness, its origin, and the conditions of its cure are revealed when the diviner recognizes the suitable pattern of shells, the proper verse, and its fitting interpretation. Versions of this elaborate system of correspondence have spread throughout West Africa and the Americas. Not only do diviners have keen memories and sharp intuitions; they are shrewd social analysts whose probing questions unveil the patient's medical history and uncover sources of tension and anxiety in the community.

In the Peruvian Andes, diviners use mesas to diagnose sickness. Mesas are ground cloths, tables, or boards whose divisions reflect the principle structures of the universe, namely, the three levels of the world (the heavenly realm, the inner earth, and the central world inhabited by humans) as well as the elemental structures of time (the seasons, years, night, day, and hours). On the mesa, the diviner locates objects representing and embodying supernatural forces with which he or she is familiar. During a nightlong ceremony in which he asks the patient a series of questions concerning the sick person's physical and social condition, the diviner arrives at a judgment concerning the nature of the sickness and the course of therapy. By successfully locating the patient in space and time, he or she defines the key supernatural relations that condition the patient's existence, including the current illness.

Other systems of correspondence use the symbolism of colors, sounds, movements, or the disposition of sacrificed body parts such as lungs, liver, or bones. They may also use dreams and other experiences of the diviner or patient to connect the hidden conditions of the sick person to the more legible outward signs of the manifest world. The point is that all creation is isomorphic; each part bears the same arrangement of forces, qualities, and substances. If the diviner can clarify the working order or disorder of any one part of creation, he or she can see more clearly the same conditions obtaining in other areas of existence such as the affected space of the patient's body.

Myths of the Origins of Cure

The time of creation also proves to be important for the origins of techniques of cure. These myths of origin play a directly therapeutic role in episodes of sickness and healing. Thus, for example, in healing a newborn infant, a specialist among the Manus fisher folk of the Admiralty Islands intones the origin myths of the ginger and aromatic herbs that he passes around from one person to another during the ceremony. The myths of origin of these herbs is rather lengthy. It is sung several times, tracing the history of the curative substances from the beginning of time to the more recent period when it was acquired by the medical specialist who does the singing.

Myths of the origins of cure are often recited in the presence of the ailing patient, for only then can the therapy be effective. The rite of cure clarifies the mythic origins of the medicine that is always embedded in a cosmogonic myth. A formulaic chant-remedy for toothache in ancient Assyria begins with the time when Anu, the creator, made the heavens. In their turn, the heavens created the earth; the earth, the rivers; the rivers, the canals; and the canals made smaller pools. Eventually, the pools gave birth to the Worm of Sickness. Weeping with hunger, this pathogenic Worm went to ask the supernatural beings Shamash and Ea for something to consume. No fruits of the earth would do; the Worm would satisfy itself only with human teeth. Even while the worm is given license to devour human teeth and cause decay, it is cursed and destroyed by Ea. In times of need, the myth was recited in a ritual fashion to reenact the origins of the world and the origins of toothache and its cure. As sure as the world and dental decay exist, so too does the power, made present through the performance of the myth, to overcome the pain and its corrosive cause.

The important issue is that, at some time in the mythic past, a supernatural power of cure has vanquished the power of affliction in question. Not only does this sacred act set a precedent for healing the disease, through recitation of the myth of cure, the healer makes present once again the ancient supernatural powers and events that conquered the disorder at the beginning of time. Thus, the healer's words and deeds are effective.

The accounts of the origins of cure open up the universe of meaning that binds a culture and stimulates its creativity in the face of sickness. Each category of materia medica has its own origin. For centuries, Qolla-huaya healers in the Bolivian Andes, for example, have been remarkable herbal curers. They possess a pharmacopoeia of nearly nine hundred medicinal plants, carefully classified according to local symbolic orders. This extraordinary feat seems motivated and organized by the fact that the plants are vehicles for the fluids, especially fat, blood, and water, that come from the body of Pachamama (Mother Earth), who is a divine being. She gives life to the human offspring who dwell on her mountainside. Curative powers are transferred from the body of Mother Earth to the circulatory systems of her children through the various species of plants. They are gifts of Mother Earth, and their energies are released when the plant leaves are steeped in water as a tea and drunk by the patient.

Rattles, drums, costumes, songs, and the implements and techniques of cure may have mythic origins that account for their power. In Eurasia, for example, drums are a part of the religious healer's curing practice. The studies of L. P. Potapov (1968), S. I. Vajnstejn (1968), and Marcell Jankovics (1984) show that the myths of origins of these drums and the powers that fill them when they are played take concrete expression in their structural design and in the drawings depicted on the hides of the drumhead. The drums of Altaic peoples, such as the Shor, Teleut, and Kumandin, often depict mythic beings associated with constellations of the zodiac. Uralic peoples, such as the Selkup, Ket, Dolgans, Nganasani, Evenki, and Eveny, draw maps of the sky, centered often on the Milky Way, the supernatural path along which the healer travels to enter the original world of celestial powers. These skymaps illustrate a mythic geography and locate the principal powers pertinent to the ecstatic healer's practice.

Healing Techniques

Just as myths of the origin of disease are given immediate meaning via specific understandings of the cause of particular illness episodes, myths of the origin of cures are actualized through a variety of healing techniques. Given the avidity with which human beings seek out healing and the diversity of understandings of the origins and proximate causes of illness, a comprehensive list of ritual healing techniques and procedures would be an impossibility. There are, however, several categories that can, in one form or another, be identified in many cultural settings. Although this is far from a hard and fast rule, it often is the case that the pursuit of healing begins with simpler or more straightforward (less expensive, less elaborate, less specialized) rituals and progressively moves on to more complex ones.

First, one of the simpler clusters of healing techniques centers on the manipulation of sacred or symbolic objects. This cluster was addressed prominently in the writings of early anthropologists who identified subcategories of contagious magic (i.e., contact with objects understood to carry particular power) and sympathetic magic (i.e., the use of objects understood to resemble the desired effect). Although the pejorative meanings often associated with the term magic are not particularly useful, the recognition that objects are ritually manipulated in particular ways is quite useful. Contagious magic may include ritual healing techniques such as wearing an amulet that has been written, blessed, or manufactured by a saint or other holy person. Sympathetic magic may include ritual healing techniques such as the use of milagros (charms with tiny legs, arms, hearts, etc.) representing the body parts or organs in need of healing that are placed into receptacles at Catholic shrines and churches in Mexico and Texas.

A second category of healing relates particular saints to specific illnesses. In towns and villages on the north coast of Portugal, different saints are connected to the healing of different parts of the body. Saint Bras is called on for a sore throat; Saint Bento, to cure warts and rashes; and Saint Luzja, for eye diseases. Lena Gemzoe relates this explanation given her by a woman in one small town:

Not long ago I had an illness, it was chicken-pox; that came all over. I got it and very, very badly. First my children, then since I was with them, it struck me. I was very, very sick because I had sores on my head, on my back, on my legs. I clung to Saint Bento and asked: "Oh, blessed Saint Bento, liberate me, God, from become scarred"because it looks so ugly. If he would clean my whole body and clean my children, when the day of his feast comes I will go there and I will offer, for example a head of wax or a bust of a woman or I asked for my children, I would give an entire child, two entire children of wax. (Gemzoe, 2000, p. 81)

Another cluster of healing techniques centers on prayer and meditation. The variations within this cluster are many. Who praysthe individual in need of healing or someone else on that individual's behalf? Is the prayer spontaneous and idiosyncratic, or does it follow a set liturgical formula? Is the prayer understood to be effective because it elicits divine response, or because it calms the emotions or centers the mind of the person who prays or meditates? Is the ritual silent and private or recited aloud? In contemporary American society, healing prayers occur privately, recited under the breath by millions of people going into surgery, as part of public extravaganzas, like revival meetings of various sorts, and electronically, over the internet and on television.

A third cluster of healing rituals have to do with removing the object, experience, emotion, force, spirit, or person that is understood to cause illness. Roughly speaking, this cluster includes confession, exorcism, and purification of various sorts. In many settings the removal is verbal, narrative, metaphorical, or symbolic. Public and privateand voluntary and forcedconfessions of sins and misdeeds are other manifestations of extraction techniques: The sickness-causing information, guilty feeling, or wicked or aberrant thought is removed from inside the individual and, in one sense or another, dissipated or neutralized.

Sucking is a widespread technique of cure. The healer may use some technical device such as a goat's horn for cupping or a leech for drawing out blood. More often, the healer sucks out the intruding pathogen with his or her own mouth. In such cases, the healer's mouth is a medical instrument, a womb of transformation that changes the sickening substance into something harmless or even helpful. Sucking can be a stunning spectacle. Several investigators have commented on the violence, noise, and aggressive suction that draws blood from different places on the patient's body. The healer's mouth, throat, and stomach possess special powers. The Tapirape healer of Brazil, for example, intoxicates himself with great gulps of tobacco smoke from his pipe. He deliberately makes himself sick so that he begins to vomit, but he sucks his own vomitus and accumulated saliva into his mouth. Throughout this noisy performance, he stops intermittently to suck on the body of his patient. Finally he vomits up the entire mess and searches for the intrusive object that has provoked sickness. Sometimes several healers carry on cures of this sort in joint practice and at the same time. On these occasions the sound of violent vomiting reverberates throughout the village.

Purification techniques include physical cleansing practices such as washing and spiritual practices such a meditation that eliminates impure thoughts. Often, the physical and spiritual aspects of purificatory rituals are inseparable as in the case of biblical laws of ritual immersion after menstruation or contact with the dead. Clearly, immersion in water washes away blood and other bodily effluvia. Yet the immersion also is understood to transform the individual into a spiritual state in which he or she can participate in the religious life of the community. When outsiders are targeted as the source of sickness in the body social, as has happened historically in response to some immigrant groups, the larger collective may erupt into violence and adopt ritualized forms of quarantine or expulsionoften unjustlywith the idea of purifying and healing itself.

A fourth cluster of healing techniques involve inserting something into the person in need of healing. The most obvious examples in this cluster involve the ingestion of medicine of one sort or another. The ritual aspects of this cluster take a variety of forms: techniques of ingestion, techniques of collecting or preparing the medicine, and so on. In some instances the substance that is ingested or inserted is clearly material in nature and understood to work on fairly straightforward biological principles as with an herbal tea, for example. In other instances, the substance has both material and spiritual aspects (e.g., drinking water in which a paper with a verse from the Qurʾān, a Buddhist sūtra, or the Bible has soaked). Even substances that may seem to be material can be understood to work in a nonmaterial way, such as homeopathy in which the pills that are ingested are understood to work on an energetic level. The insertion of devices like acupuncture needles adds an additional tangibility to the concept of insertion, coupled with energy manipulation, and occurs in the context of a set process. The practitioner reads the patient's pulse, looks at his or her tongue, and listens to the narrative of symptoms prior to needling.

A fifth cluster of techniques involve touch. At the most basic level, touch simply is the common human act of rubbing a body part that hurts. At the other end of the spectrum, touch is done on the astral or energetic level rather than through direct contact with the patient's skin. Reiki healing is a good example of nonphysical touch. As a healing technique, touch is particularly multivalent. Its effectiveness can be understood in physical terms such as relaxing muscles or increasing blood flow, in emotional or social terms such as creating warm and healing interpersonal connections, and in spiritual terms such as channeling the power of divine entities.

A sixth, and one of the largest, cluster of healing techniques has to do with the induction of trance and other altered states of consciousness. In many cultures either the sick individual or the healer carries out some sort of practice that results in the elicitation of healing dreams (in which the dream itself heals or healing knowledge is revealed in the dream). Healing trance and spirit possession as in, for example, the zaar rituals in parts of Africa are elicited through drumming and dancing. In other contexts, altered states of consciousness in the healer, the patient, or both are elicited through substances such as mushrooms or tobacco, sleep or sensory deprivation, repetitive or hypnotic types of motions, singing or chanting, or meditation.

A final cluster of ritual techniques highlight some form of cognitive restructuring (i.e., practices that encourage the patient or other participants to see or construe their affliction in a new or healthier way). Storytelling often is the means by which the cognitive restructuring is effected. Through the recitation of myths and tales that have cultural or spiritual resonance, the patient comes to see his or her own suffering as a part of a larger cosmic unfolding. Christian Science offers a clear example of cognitive restructuring: The work of the Christian Science healer is to help the patient understand that his or her suffering is not real.

Healers

The power of healers often is associated with a god or culture hero who introduced healing techniques or is understood to be the prototypical healer. In the Christian tradition, the miraculous cures of Jesus are the distinctive sign that the Messiah has come and that the new age of the kingdom of God has dawned (Mt. 4:2325; 10:1; 10:78; 11:45). As the divine physician, Jesus instructs his disciples how to cure all kinds of diseases, especially by casting out unclean spirits. Any given culture may recognize a range of religious healing specialists. The diversity of religious healers is an outgrowth of the intricate and varied sets of relationships with supernatural beings who are subtly different from one another and a reflection of power relations and the importance of social hierarchies in particular settings.

The types of religious healers are many in number and diverse in style. Some are specialists in simple instrumental cure such as bonesetting, herbal remedies, and dietary prescriptions. They master a finite canon of pharmacopoeia or therapeutic protocols. Their training is often scholastic and routinized. Of greater religious significance are the healers specialized in confronting disease through symbolic dramas, especially rituals of cure. Such healers are called to their vocations through a number of different means. Sickness is often a sign of election by a supernatural agent of cure. The isolation of serious illness, the sufferings that the candidates endure, and the deliriums they undergo can all be interpreted as an initiation to the office of healer.

The Aztec at the time of the Spanish conquest distinguished among several medical specialties. A number of sixteenth-century texts document these specialties and their procedures. The tetonalmacani, tetonaltiqui, or tetonallaliqui cared for those patients, especially young children, who had lost their tonalli, a species of soul. The teapatiani ("healer of the crown of the head") applied pressure to the palate of infants, massaging it in such a way as to close the fontanel in a propitious manner. Another practitioner designed figures on the body of the patient before bleeding the victim suffering dysentery. Some healers sucked out sickness and transformed the intruding pathogen into a piece of parchment, flint, pebble, or some other object. Other Aztec clinicians included bonesetters and curers of scorpion bites, gynecological disorders, and sicknesses suffered during the rites of passage through the life cycle.

Aztec mystical healers were called to their vocation when struck by lightning. Midwives demonstrated their power by dancing publicly during the great religious feasts. Deep massagers cured by warming their feet directly in fire and then walking on the affected muscles of the patient. The most esteemed specialist in the Aztec tradition was the herbalist, and the most despised was the tetlaxiliqui, the abortionist. In their dreams and visions, shamans of the Tunguz, Buriats, and other Siberian peoples see their own bodies tortured, pierced, cut into pieces with knives, boiled down to their bones, and then reconstituted. This mystical experience of death and resurrection qualifies them as future healers. In a concrete way, their own body has overcome death and disease. Traveling to other worlds in their ecstasies, these healers bring back medical materials (crystals, herbs, rattles, pieces of bones) as signs of their powerful relationship with sacred beings. One Siberian shaman, for example, fashioned a drum from three boughs he took from the mythical tree growing at the center of the world. That cosmic tree transects every spatial and temporal layer of the universe. During treatment, the sound of the drum transports the patient's soul through space and time to the moment and place where creation began.

The retrieval of the lost soul of the sick person is a dangerous task requiring that the healer's soul exit his or her body and travel to the margins of the universe, to the heights of heaven, or to the depths of the underworld. Ecstatic healers are frequently clairvoyants. Their vision penetrates the opaque matter of the patient's body and of the material world during their quest for the lost soul. Perilous ordeals that jeopardize the soul of the healer fill the journey to fetch back the soul. Often, the battles that take place in the outer regions of the cosmos are acted out in the center of the healing arena or, if the healer has fallen dead while his soul journeys on high, the epic adventure is recounted in exciting detail later.

Exorcists also have previous acquaintance with spirits afflicting their patients. Although they may not have contracted the disease, they have encountered the supernatural beings who possess the sick. In their initial confrontation, exorcists learn to recognize the voice of the pathogenic spirit. That first meeting of the exorcist and the spirit of affliction amounts to a time of trial in which he or she exercises the techniques needed to expel the possessing spirit. Very frequently exorcists establish a dialogue with the disease-bearing being. In the course of the conversation and interrogation, the possessor reveals its identity either through its voice or by announcing its name. During the dialogue, the spirit also reveals to the exorcist the manner in which it may be expelled. Often the sounds of exorcism that the healer recites are the very sonic structures of the afflicting spirit. The names, songs, babbling sounds, or poems are the outward manifestations of invisible forces.

The mau tham ("experts in reciting words") are exorcists in the Buddhist communities of northeast Thailand. They specialize in magic uses of sacred sound. During apprenticeship, they fall into trance, trembling and losing consciousness, while sacred Buddhist words are recited. While entranced, their teacher interrogates them and learns which sacred verses the disciples need to know to expel spirits. The spirits (phi ) become identified with the totally incomprehensible sounds, which represent verses from Buddhist texts. The mau tham lives a life of strict observance and restriction. Should he or she eat forbidden foods, the knowledge inside him or her, in the form of sonic images of words, would turn into the afflicting enemies that he battles and exorcises in his patients. Exorcism has a slight twist to it because the phi, the possessing spirit, actually inhabits the body of a neighbor in the village. From the body of its host, it attacks the patient of the exorcist. During the ceremony, the exorcist forces the patient to pronounce the name of the person in whom the afflicting spirit resides. Then the mau tham, recognizing the spirit in question, forces it to leave by reciting its sounds.

In many situations, the relationship between the healer and the patient is dramatically hierarchical (although this hierarchy does not necessarily carry over into other aspects of life). Healing hierarchy can be expressed in various ways: The healer is healthy, and the patient is sick; the healer has inherent healing powers, and the patient does not; the healer has acquired specialized healing knowledge (in a variety of ways), and lay people do not have this knowledge; and the healer has a special ability to communicate with the gods or to channel divine energy, and lay people do not. The high ritual status of the healer is made known through diplomas, lingo, insignia, special clothing, and honorific titles. In many ways, the Western biomedical physician epitomizes this mode. Years of specialized training and apprenticeship induct him or her into the culture of biomedicine, in which he or she acquires the knowledge and skills related to the practice of medicinehow to "work up" a patient, formulate a case history, arrive at a differential diagnosis, manage a case, work within a medical team, and assume the mantle of authority conferred on physicians, symbolized in the white coat. What differentiates the biomedical physician from some other types of healer is the careful distancing, on the part of biomedicine as a whole, from the notion that the physician taps into communication with the sacred. What takes its place is the power of physical evidence, understood to hold sway even as it is susceptible to the surfacing of new and more compelling data. As a concept, however, evidence functions as a quasi-absolute.

In other situations the relationship between the patient and healer is quite egalitarian with the healer serving as more of a facilitator of the patient's own healing powers than as an expert who actually carries out the healing. A contemporary example of this mode comes from the world of hospices, hospital chaplains, and congregational nurses, many of whom describe their work as a "ministry of presence"as simply "being there" with the one who is ill. In this minor mode, the healer accompanies patient, witnesses patient's suffering, and supports the patient in his or her healing process.

The Social Body

With all of these techniques, the practice of religious medicine becomes public theater. The fallen condition of the physical body serves the cause of high religious drama. On the tragic or comic outcome hangs the fate of individuals and communities. Furthermore, the symbolic actions of curethe episodic structure of the healing séance marked by shifts in music, style, color symbolism, body postures, and changes in symptomsreveal the meaning of the sacred as it impinges on concrete existence. For this reason, religious healing rituals are well-attended event, spectacles from which flow important symbolic languages used to understand and order the world.

The role played by the community in healing rituals is highly variable. In contemporary American twelve-step programs, the community is essential to the healing process. It is the very fact of the community gathering together that effects the healing. In this maximal mode, illness in the individual often is conceptualized as a reflection of illness in the social body, thus healing must occur at the communal level. The notion that gathering in community is necessary for healing to take place has been well developed by Edith Turner and Victor Turner.

In the Mediterranean area, Western Europe, and the Balkans of Eastern Europe, medicinal dances performed by the entire community heal the sick. The whole group becomes a manifestation of the sacred displayed at their public ceremony. In quite different ways, ūfī brotherhoods of Morocco, the Macedonian Rusalija, Serbian Kraljice-Rusalje, Romanian Calus, and peasants of southern Italy, from the classical period of Magna Graecia into the twenty-first century, cure through the power of group dances that battle with supernatural causes of disease and death. At times, the sick patient is forced to arise and dance and, in that way, manifests the healing power in his or her own body. Curative dancing practices are ancient among these cultures. Similar group therapies exist throughout the world. Musicians, especially drummers and percussionists, play a key role. Using their ability to discern the movements of spirits, accompanists guide the community through the episodes of the cure, carefully judging the endurance of the dancers, the emotional state of the ensemble, the mood of the spectators, the nature of the supernatural powers present, and the reactions of the ailing patient.

Janet Hoskins has studied healing among the Kodi people of Sumba in eastern Indonesia. At the time of her fieldwork in the 1980s, the majority of the fifty thousand Kodi people were followers of the indigenous religion that centered on the worship of ancestors, spirits, and deities who live in the tombs, gardens, and houses along the western coast of the island. Kodi society is characterized by intense attention to exchange obligations stretching back into the past. These obligations often become the cause of social tension. Hoskins notes, "Some forms of illness and injury are diagnosed as 'social diseases'" (Hoskins, 1996, p. 273). Cure of these diseases requires elaborate performances that involve a network of kin and affines. Healers whose work is aimed at resolving these kinds of diseases enact what Hoskins calls

"talking cure" whereby all the possible causes [of the disease] are exposed in a divination, as spirits are interrogated in turn and the reasons for their anger are determined. Divination occurs in a group setting, usually with all family members sitting near the right front pillar of the house, as the diviner constructs his interpretation of the spirits' anger. In many ways, his role seems more that of the catalyst for a group-therapy session that than of an independent diagnostician, since after each revelation he goes back to the family members, who discuss and evaluate it and provide him with more information to continue the [divination]. (Hoskins, 1996, pp. 275276)

The fact that the community gathers together does not necessarily mean that the role of the community is to support the patient. Although in many instances all family members gather around the bedside of one who is about to pass over into the next world and the family presence eases and facilitates that final healing, in many other instances, the role of the community is accusative. The American Christian evangelical anti-gay movement, like other deprogramming settings, falls within this category.

The role of disease and cure in reorganizing personal and social experience often leads to the reshaping of worldviews and recasting of social orders. Because sickness is regarded as an adverse form of change, resulting from the ambivalent presence of a new or unwelcome mode of being, the language of disease and cure frequently inserts itself into attempts at innovation or reappraisal of tradition. In the 1560s, for example, local divinities in the Peruvian Andes reportedly swept down from the sky or rose out of their earthen shrines to enter the native population and afflict them with uncontrollable dancing diseases. The frenzied dance was expected to bring on the end of the world, overthrow Spanish overlordship, and restore power to local people and gods. By the thousands, Andean Indians became savior-gods incarnate and danced the Taqui Onqoy ("the dance of the Pleiades"). After nearly a decade, Spanish authorities crushed the movement and condemned some eight thousand leaders to corporal punishment or exile.

Because powers of affliction strike their victims without their consent, disease becomes a vehicle of social change, resistance, and unrest for which the restless cannot be held accountable, for they are victims themselves. In this way, symptomatology and epidemiology can indicate far-reaching social stirrings and help pinpoint latent motives for them. Conversely, cults of disease can be ways of carrying forward ancient religious traditions or sociopolitical structures in the face of the overwhelming power of a dominant religion or political authority. This is the light in which Ernesto de Martino (1957) interprets certain folk diseases and rites of musical cure in rural Italy.

At times, the language of disease and cure appears to be a vehicle for the creation of new religious forms and experiences. The spontaneity of disease, circumventing the process of institutional permissions, prompts lay people to experiment with new religious forms and combine elements of traditions that appear to be quite disparate. Many of the independent Christian churches of Africa provide an important forum for the religious interpretation of disease and rites of cure. These churches maintain long-standing traditions of African religiosity while, at the same time, they give new life and meaning to the Christianity brought by European missionaries. In Douala, Cameroon, a growing group of devotees follow two prophetic women leaders. The two prophetesses call their disciples the "sick ones of the Father" and divide them into groups, according to the categories of the sick mentioned in the Gospels: the blind, the paralyzed, the epileptic, the deaf, and the dumb, although the disciples do not actually manifest these symptoms. Eric de Rosny (1986) points out that many of them do not appear to be sick at all, but, deep within themselves, they must identify with these diseases in their inner being to qualify for participation in the group of the elect. The two prophetesses deliver lengthy discourses that reweave the imagery and understanding of traditional African and Christian belief. It is the experience of their peculiar illnesses that provides the basis for this social reshaping and rethinking.

See Also

Affliction, overview article; Drums; Exorcism; Fall, The; Health and Religion; Incantation; Medical Ethics; Psychology, article on Psychotherapy and Religion; Shamanism, overview articles; Soteriology.

Bibliography

Overviews

Barnes, Linda L., and Susan S. Sered. Religion and Healing in America. New York, 2004.

Kiev, Ari, ed. Magic, Faith, and Healing: Studies in Primitive Psychiatry Today. New York, 1964.

Kinsley, David. Health, Healing, and Religion: A Cross-Cultural Perspective. Upper Saddle River, N.J., 1996.

Kleinman, Arthur. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. Berkeley, Calif., 1980.

Laderman, Carol, and Marina Roseman, eds. The Performance of Healing. New York, 1996.

Numbers, Ronald, and Darrel Amundsen, eds. Caring and Curing: Health and Medicine in the Western Religious Traditions. Reprint. Baltimore, 1998.

Sullivan, Lawrence E., ed. Healing and Restoring: Healing and Medicine in the World's Religious Traditions. New York, 1989.

Works on Specific Religious Traditions

Bastien, Joseph W. "Qollahuaya-Andean Body Concepts: A Topographical-Hydraulic Model of Physiology." American Anthropologist 87 (1985): 595611.

Buxton, Jean. Religion and Healing in Mandari. Oxford, 1973.

Eliade, Mircea. Shamanism: Archaic Techniques of Ecstasy. Rev. ed. New York, 1964.

Gemzoe, Lena. Feminine Matters: Women's Religious Practices in a Portuguese Town. Stockholm, 2000.

Gifford, Edward S. The Evil Eye. New York, 1958.

Girardot, N. J. Myth and Meaning in Early Taoism: The Theme of Chaos. Berkeley, Calif., 1983.

Girault, Louis. Kallawaya: Guérisseurs itinérants des Andes. Mémoires de l'Institut Français de Recherches Scientifiques pour le Développement en Coopération, vol. 107. Paris, 1984.

Hoskins, Janet. "From Diagnosis to Performance: Medical Practice and the Politics of Exchange in Kodi, West Sumba." In The Performance of Healing, edited by Carol Laderman and Marina Roseman, pp. 271290. New York, 1996.

Jankovics, Marcell. "Cosmic Models and Siberian Shaman Drums." In Shamanism in Eurasia, vol. 1, edited by Mihály Hoppál, pp. 149173. Göttingen, Germany, 1984.

Kligman, Gail. Calus: Symbolic Transformation in Romanian Ritual. Chicago, 1981.

Laderman, Carol. "The Poetics of Healing in Malay Shamanistic Performances." In The Performance of Healing, edited by Carol Laderman and Marina Roseman, pp. 115142. New York, 1996.

Lewis, I. M. Ecstatic Religion. London, 1971.

Martino, Ernesto de. La terra del rimorso. Milan, 1957.

Potapov, L. P. "Shaman's Drums of Altaic Ethnic Groups." In Popular Beliefs and Folklore Tradition in Siberia, edited by Vilmos Diószegi. Budapest, 1968.

Rosny, Eric de. "Mallah et Marie-Lumière, guérisseuses africaines." Études 364 (1986): 473488.

Sárközi, A. "A Mongolian Text of Exorcism." In Shamanism in Eurasia, edited by Mihály Hoppál, vol. 1, pp. 325343. Göttingen, Germany, 1984.

Schieffelin, Edward. "On Failure and Performance: Throwing the Medium Out of the Séance." In The Performance of Healing, edited by Carol Laderman and Marina Roseman, pp. 5990. New York, 1996.

Turner, Victor. "An Ndembu Doctor in Practice." In Magic, Faith, and Healing: Studies in Primitive Psychiatry Today, edited by Ari Kiev, pp. 230263. New York, 1964.

Turner, Victor. The Drums of Affliction: Religious Processes among the Ndembu of Zambia. Oxford, 1968.

Vajnstejn, S. I. "The Tuvan (Soyot) Shaman's Drum and the Ceremony of Its 'Enlivening.'" In Popular Beliefs and Folklore Tradition in Siberia, edited by Vilmos Diószegi. Budapest, 1968.

Wagley, Charles. Welcome of Tears: The Tapirape Indians of Central Brazil. New York, 1977.

Zimmermann, Francis. La jungle et le fumet des viandes: Un thème écologique dans la médecine hindoue. Paris, 1982.

Lawrence E. Sullivan (2005)

Susan Sered (2005)

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