© 2014 Zeljko Jokic
2014 – № 1 (7)
Abstract: This paper compares and contrasts biomedical and shamanistic approaches to health and illness among the Yanomami of the Venezuelan Upper Orinoco region. The author is a medical anthropologist who spent many years working with the Yanomami populations. The main intention of the author is to counteract some claims influenced by Cartesian mind-body dichotomy that doctors treat physical bodies while shamans work on patient’s psyche. The main argument is that the Yanomami shamans in their attempts to restore patient’s health treat their bodies against fever, pain and general discomfort as common somatic manifestations of illnesses.
Key words: shamanism, biomedicine, body, Amazonia, Yanomami, Upper Orinoco, cosmology
Yanomami (or Yanomamö) is the name commonly used to refer to members of an entire ethnic group of 25,000 people living in approximately 350 villages in the border region of Brazil and Venezuela. But, in fact, they are one of four culturally and linguistically related subgroups (the others are Yanomam, Ninam and Sanema), together forming a unique linguistic family. The Yanomami, who are the focus of this study, number around 13,500; they are the most numerous subgroup in Venezuela. The fieldwork for this research was carried out during 1999-2000 in Platanal – a health post and a Salesian Mission centre established on the Orinoco riverbank in 1950. Platanal is nowadays a meeting place for many Yanomami coming to exchange trade items and visit their relatives. There is a bilingual school for children, a rural health clinic with a doctor in charge and an adjacent hospital building.
Ever since the Venezuelan government established health posts and a sustained presence of medical personnel with permanent health programmes in the Upper Orinoco region, the Yanomami have had to get used to a new type of relationship with doctors and new methods of treatment. While they accepted that certain aspects of Western medicine could effectively reduce symptoms and ease suffering as well as cure certain introduced diseases, they continued to rely heavily on their shapori (shamans) for consultation and treatment. In most cases, the western aetiological disease categories and corresponding symptoms do not reflect the Yanomami understanding of these health disturbances.
Doctors and some anthropologists working among the Yanomami population often liken shamans to psychotherapists, assuming that they play an important psychological, emotional and socially integrative role in healing by resolving personal and social conflicts in patients through catharsis without the ability to eliminate organic disorders. When patient recovers after shaman’s healing treatment, they often ascribe the positive outcomes to placebo effect. In other words, they interpret shamanistic healing as having effects on person’s psyche while for them doctors treat the physical organism. However, such views influenced by the Cartesian mind-body divide fail to acknowledge that not all health problems that shamans confront are located in the psychosocial sphere thus requiring social reintegration of a patient. Shamans in their healing treatments also treat physical complaints such as fever, headache and body cramps. Mindful of the fact that psychosomatic component may play an important role in ritual healing, in this paper I argue that most if not all illnesses, regardless of their underlying causes, have certain somatic manifestations through symptoms such as fever, headache and lack of respiration, among others. They are primarily bodily experiences per se, which the shamans attempt to relieve.
Shamanism and Biomedicine: Compatibility and Differences
At Platanal health post, biomedical and conventional shamanistic cures coexist without any significant degree of syncretism between them. The Yanomami do not see biomedical therapies and conventional shamanistic healing methods as mutually exclusive but complementary practices. Should one method fail, the Yanomami will resort to the other method. They can additionally opt for herbal remedies and massages to help an ailment such as a fever, diarrhoea or an eye infection. For the bulk of patients who visit the Platanal clinic, the cognitive model of Western medicine remains largely obscure and without influencing any epistemological change in attitudes and beliefs regarding health and illness. At the same time, the conventional shamanistic method entrenched within their cosmological framework continues to provide a supportive structure and a coherent system of explanation that the Yanomami patients understand and readily accept. Instead of substituting one system of cure for another, the Yanomami incorporate biomedical practices into their existing cosmo-shamanistic system of understanding disease and the cures, interpreting them in light of their traditional knowledge.
For the Yanomami do not accept the recently introduced tools of modern medicine, its goods and services, as individual methods distinct from their own medical system. The qualities of any new method are modelled according to their own pre-existing conceptual system, so that it fits into the internal logic of their system of curing. (Alès and Chiappino 1985: 84)
Rather than saying that in Platanal there is a plurality of therapeutic systems, it is more appropriate to say that the Yanomami maintain a pluralistic approach in using them.
Shamanistic and biomedical approaches to health and illness are incompatible and incommensurable in their respective worldviews and methodologies, but from the Yanomami perspective, doctors’ biomedical means of curing are to some extent complementary rather than opposed to the healing activities of their shapori. For them, biomedicine and shamanism accomplish similar ends, namely to cure and care for the sick. In some aspects, both approaches bear more similarities than initially noticeable but they also contain certain fundamentally profound epistemological and ontological differences. Analysis of an extensive bibliography and field data compiled from various indigenous groups in Venezuela, including the Yanomami (Perrera and Rivas 1997), demonstrate that similarities between biomedicine and traditional healing practices are more prevalent than differences. In both approaches, illness is considered an abnormal transitory state of rupture of healthy equilibrium that can be corrected. Both doctors and shamans strive to identify the cause of an illness by means of their respective methods and apply relevant therapeutic procedures aimed at restoring health. In both instances the cure is not always successful. In both approaches, the patient is a passive recipient of treatment, although within the context of Yanomami shamanistic healing sessions an adult male patient may often take the yopo (psychoactive snuff) together with the shapori. With regards to aetiology, from both shamanistic and biomedical viewpoints, illness generally occurs when something external invades or contaminates the body (or in the indigenous view also damages or takes away its vital essence) and causes corporeal disequilibrium. The biomedical explanatory model of illness is primarily based on the concept of germs and contagiosity and does not take into account a socio-cosmic dimension. From a biomedical perspective, the intruding agents of sickness are harmful, impersonal pathogens (bacteria, viruses or parasites) that provoke a physiological malfunction of the body, which is manifested through the onset of distinctive symptoms. Perceived through the eyes of scientific determinism, according to which all natural phenomena shows a strict causal connection, disease is thus decontextualised and viewed as an outcome of some biological body alteration, which can be detected through a scientific method.
The [Western biomedical] theory holds itself to be exhaustive; that is, all diseases located in the tissues and organs of the body can only be diagnosed by examination of the body, and can only be cured by treatments which act on the body. (Carrier 1989: 167)
As a result of a pervading physical reductionism entrenched within the biomedical scientific paradigm, the physical body is treated in isolation. As part of the physical world, the body thus becomes ‘knowable as a bounded material entity’ (Rhodes 1996: 167) and the primary focus for the treatment of diseases, which are likewise perceived as physical entities occurring in specific bodily locations. From the shamanistic perspective, illness is not merely a bodily concern but also an outcome of temporary socio-cosmic disharmony. Illness or death within the Yanomami cosmo-shamanistic framework is primarily but not exclusively an outcome of the deliberate, hostile acts of human and non-human agents, such as a sorcerer, an enemy shapori sending shawara illnesses and spirit darts or invading bodies directly by means of his Hekura spirit helpers, or else a ghost or some other intruding spirit denizen taking away a person’s vital essence:
In both systems of thought, misfortune, illness or symptoms are produced by an agent which has a characteristic way of acting. But to the Yanomami, this agent also has an origin and a will of its own. (Alès and Chiappino 1985: 86)
Thus, while illness is considered an abnormal state of corporeal disharmony on both sides, for shapori the primary cause of illness is not to be encountered inside but outside of the body.
Both doctors and shamans must first diagnose the nature of a particular ailment before applying the appropriate treatment. When Yanomami patients approach doctors for help, they expect their bodies to be examined on the outside as well as the inside and to be asked questions about their symptoms as well as their general well-being. Due to the language barrier between Yanomami patients and medical practitioners, clinical communication between them is minimal and basic. When doctors ask patients about their symptoms they use certain key words in the Yanomami language that point to fever, pain, diarrhoea, a cough, etc., and expect a positive or a negative response. If doctors wish to obtain more detailed information, which requires more complex descriptions, they request assistance from a Yanomami interpreter. They generally conduct check-ups of Yanomami patients as other medical practitioners do in other parts of the world – by examining the patient’s overall appearance, and specific body parts if appropriate. Doctors also resort to various medical devices such as microscopes for detecting harmful malaria parasites in blood samples, stethoscopes, thermometers, spatulas etc. In Platanal, laboratory diagnostics are limited to blood analysis for malaria. In cases where additional analysis is needed – a urine or stool sample – samples are collected and sent to La Esmeralda or Puerto Ayacucho. In more serious or suspicious cases when patients require X-rays or doctors are unsure about their condition, they send them to these places for further examination, treatment or hospitalisation.
Upon identifying the problem, doctors proceed with appropriate treatments by administering tablets, injections, cough syrups, eye drops, an intravenous infusion or by orally rehydrating them. Depending on the nature of the ailment, doctors resort either to causal or symptomatic biomedical therapeutic procedures or combine the two. In the first instance, they administer drugs such as antibiotics, antiparasitics or antimalarial tablets to eliminate microorganisms as the main cause of an illness. In the second instance, they give patients analgesics, eye drops or anti-inflammatory drugs to relieve the symptoms of the illness indicated by the patient but these do not eliminate the original cause. Doctors provide Yanomami patients with simple instructions in their language telling them which medicaments are for what and when to take them.
While doctors primarily draw on their own medical knowledge and expertise, shapori rely entirely on their personal hekura assistants to make a correct diagnosis and will engage them in follow-up treatment. Since a shapori and his patients share the same cultural and cosmological milieu, in the course of shamanistic healing they are able to communicate extensively. During his diagnostic procedure, a shapori carefully examines the patient’s body via his hekura assistants and may ask him or her certain questions to find out if they broke a rule or taboo; for example, they may have eaten something poisonous by accident or been into the forest at the wrong time of day.
Later, in the course of healing, a shapori will tell patients what the cause of their malady is. Thus, shaporis’ diagnostic procedures and follow-up treatments are rather different from those of doctors. What both type of practitioners have in common is their access to the body’s interiority, albeit by different means and on different ontological levels (Kelly 2011). When making a diagnosis, a shapori will crouch in front of a patient, touch various parts of his or her body and look intensely into their chest. At first sight it may appear as if the shapori is only examining the patient’s outward appearance when in fact his conscious intentionality is directed at the patient’s interiority. He is able to penetrate the body with his gaze because he can transform into one of his assisting hekura and look through their eyes. A shapori, with his special sight, is able to reach different levels of perception and detect if a patient’s vital essence is missing, if they are contaminated by shawara illnesses or if there is a pathogenic spirit dart or an enemy hekura inside their body. Eventually, through their hekura helpers they are also able to identify who is responsible for the affliction. A shapori involved in healing mobilises his auxiliary hekura through song and dance, engaging them concurrently in fighting various forms of aggression, extracting intangible pathogenic objects or else expelling the intruding hekura. The hekura manipulate the patient’s body using the shapori hands or by using the shapori to suck out and vomit the sickness agent.
The shapori’s curative treatment often contains a degree of uncertainty with unpredictable outcomes that sometimes result in death. Akin to the doctor, the shapori first has to identify the cause of illness and then work towards restoring the somato-cosmic balance. In cases where a soul component is stolen by a ghost, once the perpetrator is identified and then defeated, the soul component is restored to its proper condition, which should reduce the fever and general malaise. The sufferer may experience temporary relief and the alleviation of symptoms, which indicates that the shapori’s intervention was successful. If necessary, the shapori will repeat his treatment until the sufferer is cured, just like the doctor who will repeat medication. This brings us to a key point of perceived fundamental difference between doctors and shamans in their respective healing methods. The prevailing anthropological understanding of the main difference between shamanism and biomedicine, from an indigenous perspective, is that the former deals directly with causes of illness while the latter only tackles its effects or symptoms (Buchillet 1991; Kelly 2011). Whilst this distinction may at first seem entirely applicable and accurate, the matter, in my view, is more complex, at least with regards to the Yanomami. When a shapori expels the intruding hekura or pathogenic spirit dart or else fights and wins over the entity responsible for stealing a missing soul component, he certainly eliminates the cause of illness and restores the personal integrity of a patient. However, when they attempt to heal patients suffering from fever or pain with their hekura assistants they are also working directly on alleviating the symptoms of malaise, akin to doctors. Furthermore, apart from working on elimination of symptoms, doctors also work towards eliminating harmful pathogens, by administering relevant drugs. For them, pathogens are the cause of an illness while a fever or malaise is its effects or symptoms. In cases of malaria, for example, antimalarial tablets eliminate the cause of illness and antipyretics would tackle its symptoms – the fever. From the scientific perspective, the trajectory of sickness is linear. It progresses from the build-up phase, peaks at the critical phase and is followed by a period of improvement that culminates in restored health. The person is considered cured when the body is finally free of microorganisms. During this course, however, the fever may return, in which case the doctor will again prescribe anti-fever tablets. The tablets work on the cause of illness as well as on its symptoms.
For the shapori, spirits that intrude people’s bodies or ghosts that snatch souls are real and they confront them with their auxiliary hekura. Biomedical method demonstrates that pathogenic microorganisms are equally real for which doctors administer the appropriate medicaments. Only the shapori is able to deal with the problem of the missing soul or an intruding hekura, and only doctors with their biomedical procedures are capable of eliminating the microorganisms. With regards to fever, both methods work equally well towards restoring bodily equilibrium by reducing the body temperature. While the shapori qua his assisting hekura clearly does not have any power over microbes, doctors are equally unable to employ the same means of healing that shapori do. The main difference thus between their respective approaches to illness and health is in the level of conscious perception and in an ontological sphere of action.
Dynamics of Doctor-Shapori-Patient Interaction
Doctors and medical students generally respect shaporis’ healing methods without interfering, except in a critical, life-threatening situation when they either work with them side-by-side or insist on the primacy of their therapy. They consider shapori an important component in the overall healing process without actually understanding the Yanomami worldview or believing in shaporis’ knowledge and effectiveness to effect a cure. Since their biomedical methods are fundamentally different to those of shapori, diagnostic and therapeutic procedures of shapori are viewed as ‘mystical’ by doctors, who are primarily guided by a mechanistic explanatory model of diseases with its aetiology grounded in biology and scientific reasoning. Since the late 1980s onwards, however, there has been a shift in attitude among academic circles of the School of Medicine of the Central University of Venezuela (UCV) and among the SACAICET medical personnel, who nowadays recognise the socio-cultural importance of illness among indigenous populations and primarily view health in a more holistic manner as ‘a situation of general wellbeing – physical, psychological, emotional and social’ (Jauregui 1993: 31). Nevertheless, the guiding principle for most of the doctors is biomedical model with its focus on the physical body and a scientific understanding of sickness. Some doctors working among the Yanomami population believe that shapori play an important psychological, emotional and socially integrative role in healing by resolving personal and social conflicts among patients through catharsis. They liken shapori to psychotherapists and when a patient recovers after a shapori’s healing treatment, doctors ascribe the outcome to a placebo effect (see also Kelly 2011: 147).
Akin to medical professionals, some anthropologists believe that shamans do not have the ability to eliminate organic disorders but primarily attempt to restore emotional and psychosocial disharmony (e.g., Lizot 1998; Peters 1979). They interpret shamanistic healing as having a positive effect on a person’s psyche while the doctors treat the physical problem. ‘In Western medicine a distinction is made between what is physical and what is psychological. The Yanomami however do not view the body as separated from the “soul”’ (Alès and Chiappino 1985: 85). Such views, influenced by the Cartesian mind-body divide, fail to acknowledge that not all health problems that shamans confront are located in the psychosocial sphere and thus require social reintegration of a patient. As we have seen, shapori in their healing treatments also treat physical complaints such as fever, headache and body cramps. Mindful of the fact that a psychosomatic component may play an important role in ritual healing, I argue that most if not all illnesses, regardless of their underlying causes, have certain somatic manifestations through symptoms such as fever, headache and difficulty breathing, among others. They are primarily bodily experiences per se, which the shapori attempts to relieve. The following example of a shapori’s successful treatment of an ulcer after many failed attempts by doctors is significant because it challenges the aforementioned assumptions that shapori are not capable of curing physical ailments. Lay missionary Howard from Platanal told me that he was once suffering from a severe leg ulcer for about six months. Several doctors attempted to cure it to no avail. Finally, the ulcer disappeared after a shapori’s intervention. He showed me a round scar on his left leg where, according to him, there used to be a persistently infected hole. The doctor in charge of the clinic gave him some antibiotics and repeatedly sanitised the lesion without any curative success. The doctors in Caracas could not help him either. Finally, he approached several shapori, who all told him that the ulcer had been inflicted by the ghost (pore) of a man who drowned in the lagoon on the Orinoquito River – Orinoco’s right tributary situated further up from Platanal. He lives in the lagoon in an underwater cave and is guardian of the nearby Orinoquito rapids. Howard was astonished because he recalled swimming once in a lagoon near the Orinoquito rapids, despite some words of advice from the Yanomami of Hasupiwei-theri that he should have first asked the ghost guardian for permission. He dismissed their warnings and went swimming anyway. Be that as it may, the shapori he approached could not help but recommended that he see a prominent shapori from Ocamo, who subsequently managed to cure his ulcer. I asked him about the likelihood that the ulcer disappeared as a result of his body’s self-healing system, but he shook his head in negation. He was convinced that the shapori had cured him.
Shapori, for their part, generally appreciate a doctor’s ability to treat various types of wounds and abscesses and reduce fever and pain. With their holistic approach to health and healing, shapori do not see biomedicine as serious competition. On the contrary, in some instances when shapori are unable to help patients they send them to see the doctor, which shows that over the years the Yanomami have developed a certain degree of trust in them. By and large, they value medicaments, especially antipyretic and analgesic drugs because they bring quick relief. The shapori Makowë from Platanal once commented that tablets have the same effects as shamanism as they break down pain or excessive body heat. In fact, he sometimes told patients who were not seriously ill to take tablets because of their effectiveness in reducing fever or pain and therefore generating less work for him.
In conclusion, ever since the Venezuelan health authorities established a permanent medical presence in the Upper Orinoco region, the Yanomami shamans have been working alongside doctors. While their respective approaches bear lots of similarities they also contain some fundamental fundamentally profound epistemological and ontological differences. While both aim to cure and care for the sick, the main difference is in their respective worldviews. For the doctors, physical body is a primary locus of action while for the shapori, illness also has a socio-cosmic dimension. While shamans akin to doctors attempt to cure the body of a patient, they also attempt to restore socio-cosmic disharmony. In that regard, doctors and some anthropologists ascertain compare the work of shapori to psychotherapists. However, as I argued in this paper, most illnesses, regardless of their causes, have certain somatic manifestation of somatic symptoms such as fever, pain, and weakness, which shapori aim at relieving.
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