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

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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)

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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

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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

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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

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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

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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

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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

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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).

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