The infancy of Edward Shelonga Part IV (References and Postscript on Cognition) an extended case study in medical and religious anthropology from the Zambia Nkoya Wim van Binsbergen |
to Part 0 (Abstract)
to
Part I (Problem and Method; Background)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
References
Ademuwagun,
Z.A.
1974-75
The meeting point of orthodox health personnel and traditional
healers/midwives in Nigeria: The pattern of utilization of health
services in Ibarapa division. In Harrison and Dunlop 1974-75:
55-77.
Apthorpe,
R.J.
1968a
(ed.) Rhodes-Livingstone Communication Number Fifteen. Lusaka:
Rhodes-Livingstone Institute (1959) 1968.
1968b
Introduction. In Apthorpe 1968a: i-vii.
Barnes,
H.F.
1949
The birth of a Ngoni child. Man 49, 118:87-9
Beattie,
J. and J. Middleton
1969
(eds.) Spirit mediumship and society in Africa. London: Routledge
and Kegan Paul.
Blankhart,
D.M.
n.d.
Report on a visit to Zambia 1 May 13 July 1966. Amsterdam:
Royal Tropical Institute. Mimeo.
Boswell,
D.M.
1965
Escorts of hospital patients: A preliminary report on a social
survey undertaken at Lusaka Central Hospital from July-August
1964. Rhodes-Livingstone Communication no. 29 Lusaka:
Rhodes-Livingstone Institute.
Central
Statistical Office
1975
Inter-regional variations in fertility in Zambia. Lusaka:
Government Printer.
Clay,
G.
1946
History of the Mankoya district. Rhodes-Livingstone Communication
No. 4. Lusaka: Rhodes-Livingstone Institute.
Colson,
E.
1969
Spirit possession among the Tonga of Zambia. In Beattie and
Middleton 1969: 69-103.
1977
A continuing dialogue: Prophets and local shrines among the Tonga
of Zambia. In Werbner 1977: 119-39.
Conco,
W.Z.
1971
Problems of communications and traditional practice of medicine
in Africa. In La Recherche multidisciplinaire appliquée dans le
Tiers Monde, Développements et Civilisations 45-46: 151-65.
Craemer,
W. de , and R.C. Fox
1968
The emerging physician: A sociological approach to the
development of a Congolese medical profession. Stanford: Hoover
Institution Studies, 19.
Davies,
D.H.
1971
(ed.) Zambia in Maps. London: University of London Press.
De
Jonge, K.
1974
Fertility: a dependent variable. Kroniek van Afrika 1974/1:
61-71.
De
Kadt, E., and G. Williams
1974
(eds.) Sociology and development. London: Tavistock.
Epstein,
A.L.
1967
(ed.) The craft of social anthropology. Manchester: Manchester
University Press.
1969
The network and urban social organization. In Mitchell 1969:
77-116.
Erasmus,
C.J.
1961
Man takes control. Minneapolis: University of Minnesota Press.
Evans,
A.J.
1950
The Ila V.D. campaign Rhodes-Livingstone Journal/Human Problems
in British Central Africa 9: 40-47.
Fendall,
N.R.E.
1965
Medical planning and the training of personnel in Kenya. Journal
of Tropical Medicine and Hygiene 68: 12f.
Foster,
G.M.
1962
Traditional cultures and the impact of technological change. New
York: Harper and Row.
Frankenberg,
R.
1969
Man, society and health: Towards the definition of the role of
sociology in the development of Zambian medicine. African Social
Research 8: 573-87.
Frankenberg,
R. and J. Leeson
1974
The sociology of health dilemmas in the post-colonial world:
Intermediate technology and medical care in Zambia, Zaïre and
China. In De Kadt and Williams 1974: 255-78.
1976
Disease, illness and sickness: Social aspects of the choice of
healers in a Lusaka suburb. In London 1976: 223-58.
Gerold-Scheepers,
T., and W.M.J. van Binsbergen
1978
Marxist and non-marxist approaches to migration in tropical
Africa. In Van Binsbergen and Meilink 1978: 21-35.
Gilges,
W.
164
Some African poison plants and medicines in Northern Rhodesia.
Occassional Paper No.11. Livingstone: Rhodes-Livingstone Museum.
2nd edition.
Gonzalez,
N.S.
1966
Health behavior in cross-cultural perspective: A Guatemalan
example. Human Organization 25:122-5
Grollig,
F.X., and H.B. Haley
1976
(eds.) Medical anthropology The Hague/Paris: Mouton.
Hage-Noël,
G.L.M.-A.
1974
Farmaceutische mijmeringen in en over Zambia. Pharmaceutisch
weekblad 109, 49: 1202-3.
Harrison,
I.E., and D.W. Dunlop
1974-75
(eds.). Traditional healers: Use and non-use in health care
delivery. Rural Africana 26.
Honigmann,
J.J.
1973
(ed.) Handbook of social and cultural anthropology. Chicago: Rand
McNally College Publishing Company.
Illich,
I.
1977
Limits to medicine. Medical nemesis: the expropriation of health.
Harmondsworth: Pelican Books.
Imasiku,
H.L.
1976
Annual Report 1976, Public Health Services. Kaoma district:
Department of Health Mimeo.
Imperato,
P.J.
1974-75
Traditional medical practitioners among the Bambara of Mali and
their role in the modern health care delivery system. In Harrison
and Dunlop 1974-75:41-53.
Janzen,
J.M.
1975
The dynamics of therapy in the lower Zaire. In Williams
1975:441-63.
1978
The quest for therapy in lower Zaire. Berkeley, etc.: University
of California Press.
Jayaraman,
R.
1970
The professional medical assistant in Zambia: A study of the
social background and occupation role of medical assistants in
the Lusaka teaching hospital. Paper read at the East Africa
Social Sciences Conference, Dar es Salaam.
King,
M.
1966
Medical care in developing countries. Nairobi: Oxford University
Press.
Leeson,
J.
1969
Paths to medical care in Lusaka, Zambia: Some preliminary
findings. African Urban Notes 4, 2:8-19.
1970
Traditional medicine: Still plenty to offer. Africa Report 15(7),
Oct. 1970: 24-5.
1972
Lusaka children and their mothers. Medical Journal of Zambia
6:173f.
Leeson,
J., and R. Frankenberg
1977
The patients of traditional doctors in Lusaka. African Social
Research 23:217-233.
Le
Nobel, C.J.P.
1969
Maternity care in a Zambian district. Amsterdam: Jacob van
Campen.
Lieban,
R.W.
1973
Medical anthropology. In Honigmann 1973: 1031-72.
Loudon,
J.B.
1976a
Introduction. In Loudon 1976b: 1-48.
1976b
(ed.) Social anthropology and medicine. A.S.A. Monography 13.
London:Academic Press.
Maclean,
C.M.U.
1971
Hospital or healers: An attitude survey in Ibadan. Human
Organization 25:131-9.
McCulloch,
M.
1951
The southern Lunda and related peoples. Ethnographic Survey of
Africa. London: International African Institute.
Marwick,
M.
1965
Sorcery in its social setting. Manchester: Manchester University
Press.
Meillassoux,
C.
1975
Femmes, greniers et capitaux. Paris: Maspero.
Mitchell,
J.C.
1969
(ed.) Social networks in urban situations: Analyses of personal
relationships in Central African towns. Manchester: Manchester
University Press.
Kaoma
Rural Council
n.d.
Minutes of the general meetings 1965-77. Kaoma. Mimeo
Munday,
M.C.
1945
A problem in sanitation: Lala childbirth. NADA 22: 50-2.
National
Food and Nutrition Programme, Zambia
1974
Nutrition Status Survey. Rome: UNDP.
Newson,
Dr.
1932
Report on investigation of disease Mumbwa-Kasempa July-August
1932, Enclosure in file ZA1/9/28/21/1. Zambia National Archives,
Lusaka. Typescript.
Northern
Rhodesia
1930
Blue Book for the year ended 31st December 1929. Livingstone:
Government Printer.
1955
African Affairs Annual Report 1954. Lusaka: Government Printer.
1956
Native Affairs Annual Report 1955. Lusaka: Government Printer.
Nur,
A.M., J.R. Wray and J.W. Kibukamusoke
1976
Health survey of Mwaziona and Matero in the city of Lusaka
Medical Journal of Zambia 10, 2:34-41.
Ohadike,
P.O., and H. Tesfaghiorghis
1975
The population of Zambia. n.p.: CICRED series.
Polgar,
S.
1962
Health and human behavior: Areas of interest common to the social
and medical sciences. Current Anthropology 3: 159:205.
Raphael,
D.
1976
Warning: The milk in this package may be lethal for your infant.
In Grollig and Haley 1976:129-36.
Republic
of Zambia, Ministry of Health
1969
Annual Report for the Year 1967. Lusaka: Government Printer.
1972
Annual Report for the Year 1968. Lusaka: Government Printer.
1976
Annual Report for the Year 1972. Lusaka: Government Printer.
Roberts,
S.A.
1977
(ed.) Law and the family in Africa. Paris/The Hague: Mouton.
Schoffeleers,
J.M.
n.d.
(ed.) Guardians of the Land: Essays on Central African
Territorial cults. Gwelo: Mambo Press (in press).
Schültz,
J.
1976
Land use in Zambia. Part I: The basically traditional land-use
systems and their regions. München: Weltforum Verlag.
Sharpston,
M.J.
1971-72
Uneven geographical distribution of medical care: A Ghanaian case
study. Journal of Development Studies 8:205-22.
Shattock,
F.M.
n.d.
The provision of primary health care in a developing country:
Lusaka, with special reference to the Teaching Hospital Filter
Clinic and the Matero Clinic Complex. Department of Community
Health, University of Zambia, n.p. (Lusaka, c. 1974). Mimeo.
Spring
Hansen, A.
1971
Fertility, marriage and ritual participation among the Luvale of
North-Western Province, Zambia. Seminar paper, Institute for
African Studies, University of Zambia, Lusaka. Mimeo.
1978
Faith and participation in traditional versus cosmopolitan
medical systems in Northwestern Zambia. Paper presented at the
Twenty-first Annual Meeting, African Studies Association,
Baltimore.
Stefaniszyn,
D.
1964
Social and ritual life of the Ambo of Northern Rhodesia. London:
International African Institute.
Stein,
L.
1971
Medical facilities: Health and the prevention of disease. In
Davies 1971: 100-3, 127.
Symon,
S.A.
1968
Notes on the preparation and use of African medicine in the
Mankoya district Northern Rhodesia. In Apthorpe 1968: 21-77.
Turner,
V.W.
1957
Schism and continuity in an African society: A study of Ndembu
village life. Manchester: Manchester University Press.
1961
Ndembu divination: Its symbolism and techniques.
Rhodes-Livingstone Paper no. 31. Manchester: Manchester
University Press.
1962
Chihamba: The White Spirit. Rhodes-Livingstone Paper No. 33.
Manchester University Press.
1967a
Lunda medicine and the treatment of disease. In Turner 1967c:
299-358.
1967b
A Ndembu doctor in practice. In Turner 1967c: 359-93.
1967c
The forest of symbols. Ithaca: Cornell University Press.
1968
The drums of affliction. Oxford: Clarendon Press.
Van
Binsbergen, W.M.J.
1975
Ethnicity as a dependent variable: The Nkoya ethnic identity and
inter-ethnic relations in Zambia. Paper read at the 34th Annual
Meeting, Society of Applied Anthropology, Amsterdam.
1976a
The dynamics of religious change in Western Zambia. Ufahamu 6, 3:
69-87.
1976b
Ritual, class and urban-rural relations: Elements for a Zambian
case study. Cultures et Développement 8,2:195-218.
1977a
Regional and non-regional cults of affliction in Western Zambia.
In Werbner 1977: 141-75.
1977b
Law in the context of Nkoya society. In Roberts 1977: 39-68.
1978a
A simple statistical method to disguise published quantitative
data in order to protect ethnographic privacy. African Studies
Centre, Leiden, Typescript.
1978b
Class formation and the penetration of capitalism in a Zambian
rural district. Paper read at the Seminar on class formation and
social stratification in Africa. Leiden, African Studies Centre.
n.d.(a)
Explorations in the history and sociology of territorial cults in
Zambia. In Schoffeleers n.d.
n.d.
(b) Ritual, class and urban-rural relations: The Nkoya of Zambia.
Forthcoming.
Van
Binsbergen, W.M.J. and H.A. Meilink
1978
(eds.) Migration and the transformation of modern African
society. African Perspectives 1978/1. Leiden: African Studies
Centre.
Van
Velsen, J.
1964
The politics of kinship: A study in social manipulation among the
Lakeside Tonga. Manchester: Manchester University Press.
1967
The extended-case method and situational analysis. In Epstein
1967: 129-49.
Von
Mering, O.
1962
Comment. In Polgar 1962:187-8.
Werbner,
R.P.
1977
(ed.) Regional cults. ASA Monograph 16. London: Academic Press.
Williams,
T.R.
1975
(ed.) Psychological Anthropology. The Hague: Mouton.
Zeller,
D.L.
1974-75
Traditional and western medicine in Buganda: Coexistence and
complement. In Harrison and Dunlop 1974-75:91-103.
POSTCRIPT: THE ROLE OF COGNITION
In
his introduction to the collection In search
of health: Essays in medical anthropology
(1979), where the present study appeared for the first time, Van
der Geest point at what he claims to be a major weakness in my
contribution: the fact that I have ignored the role of cognition
as a determinant of the selection of specialist healers. I am
grateful for this opportunity to explain my position more fully.
When,
like in the contemporary Nkoya situation, patients and their
sponsors are confronted with a plurality of medical systems, the
problem of which specialist healer they select, when, and why, is
of obvious theoretical and practical interest. Many medical
anthropologists[1]
have dealt with this selection problem as follows. Participants
are said to impose their cultural classifications upon the
diseases they suffer from. These classifications interpret the
nature of each disease, and imply the specialist agent (if any)
capable of curing it. Where cosmopolitan health care is available
along with forms of indigenous medicine, people allegedly tend to
classify some diseases as suitable for hospital
treatment, and others as to treated by
non-cosmopolitan healers. In my own analysis I did largely
ignore this cognitive approach, and instead interpreted the
participants switching forward and backward between
cosmopolitan and other healers as the outcome of a sustained,
complex social process a process which had little to do
with the specific nature of the diseases involved, and which
could be understood retrospectively but could hardly be
predicted.
The
data as presented in my paper provide support for my view that
among the Nkoya there is no one-to-one relationship between
certain somatic (or mental) symptoms, and the choice in favor of
cosmopolitan or non-cosmopolitan medicine. In the case of Edward,
the same few symptoms (coughing, fever, emaciation, lack of
appetite, inflamed eyes, retarded motoric development) , which
recurred over a period of 11/2 years, were subject to a shifting
labeling process. Sometimes his relatives imposed cognitive
categories such as shipelo (an unborn childs attack on his
immediately preceding sibling), lizina (illness springing from a
name which the bearers ancestors do not approve of), or
mpashi (illness caused by an ancestor who is angry because of a
violation of kinship obligations between living kinsmen). I
suggested how in each instance the particular labeling could be
understood as the result of the ongoing social process in which
the boy and his relatives were involved; and I described this
process in detail. When the labels mentioned were applied, the
boys condition was not considered amenable to cosmopolitan
treatment, and local, ritual cures were pursued instead. At other
times the relatives accepted the possibility that the very same
somatic symptoms, in the same boy, might be within the realm of
cosmopolitan medicine. They took the boy to hospitals and
clinics, where such cosmopolitan diagnostic categories as
pneumonia, malnutrition and conjunctivitis were pronounced,
without the relatives opposing these diagnoses or rejecting the
modern treatment that was indicated.
Edwards
case does not stand on its own. Our field-work involved us deeply
in the health problems of our Nkoya informants. Not only did we
collect peoples statements on illnesses, their categories,
and explanations in many cases we also examined the
patients and tried to treat them. Malaria, gastro-enteritis,
respiratory tuberculosis, bilharzia, hookworm and various forms
of conjunctivitis are among the most frequent diseases in Chief
Kahares area. The attendant somatic symptoms are (with the
exception of hookworm), fairly unmistakable, and as easy to
discuss in the Nkoya language as they are in English. However,
when it came to labeling a particular combination of symptoms
with a Nkoya category diagnostic labels to the same set of
symptoms. Moreover, these labels had again widely different
implications as to the alleged illness-causing agent, and as to
the healer to be selected. Similarly, the same diagnostic labels,
such as wulozi,
sorcery; mashika,cold;
and mulutu, (hot)
body, were used to describe such different disease patterns
as malaria, gastro-enteritis, and respiratory tuberculosis. This
finding is rather at variance with Symons (1968)
description of the medical system or the Nkoya and neighboring
groups: without any semantic analysis or methodological
discussion, Symons crude listing or local disease names and
treatments suggests a one-to-one relationship between local
diagnostic terms and those of cosmopolitan medicine.
In
essence, however, Nkoya diagnostic categories form an idiom to
discuss, in a more or less coded and symbolic for, the social
relationships surrounding the patient. For instance, if these
relationships are currently in a state of intense conflict, and
if in the patients social environment there is a strong
interest, among one faction or another, to bring this conflict in
the open and force the issue, then the diagnosis of wulozi
(sorcery) is likely to be made by that faction. (For
a case in point, cf. Van Binsbergen 1977b: 50f) Rival factions
thus implicitly accused of evil practices, or this parties who
have an interest in playing down the conflict, will instead
propound alternative diagnostic labels: e.g. bituma
(a spirit affliction unrelated to human aggression; cf. Van
Binsbergen 1977a); wulweli ya Nyambi
(illness sent by God, i.e. regardless of human
deeds); wulweli wa Bamukuwa
(Europeans illness, i.e. amenable to
cosmopolitan treatment); etc. Typically, the various parties
involved try, through display of formal authority, gossip, and
rumors, to influence the patient, sponsors, and public opinion in
general, so as to have their own interpretation of the disease
prevail. This struggle is in itself part of the social process in
which the patient, and the surrounding parties, are involved, and
its outcome depends on their relative strength. Once the patient
and his sponsors have accepted one diagnostic category as the
most applicable one, they thereby commit themselves to a
particular type of healer[2]
until further developments take place in the social process,
necessitating a new interpretation of the same patients
complaints. Edwards case provides illuminating examples of
this.
Thus it would seem as if, in the Nkoya case, the cognitive
approach cannot in itself throw light upon the selection problem.
There is no denial that Nkoya medicine, like any other medical
system in the world, is also a cognitive system; and I should
have described this system more systematically and in greater
detail. This cognitive system, with all its obscure symbolic
implications, sets the boundaries within which Nkoya health
action can take shape, and defines basic fears as well as the
possibilities for mutual identification within the community and
across the urban-rural divide. For this reason cognition
constitutes one of the pivotal elements of Nkoya society. But
between the cognitive system, and actual health action, stands
the ongoing social process, which determines which elements in
this cognitive system will be selected for action. Where
medico-anthropological studies have so far ignored the social
process, I still feel justified in concentrating on it.
References
Apthorpe,
R.J. (ed.)
1968
Rhodes-Livingstone Communication no. 15 Lusaka:
Rhodes-Livingstone Institute (1959).
Honigmann,
J.J. (ed.)
1973
Handbook of Social and Cultural Anthropology Chicago: Rand
McNally College Publishing Company.
Lieban,
R.W.
1973
Medical Anthropology. In Honigmann 1973: 1031-72.
Roberts,
S.A. (ed.)
1977
Law and the Family in Africa. Paris/The Hague: Mouton.
Symon,
S.A.
1968
Notes on the Preparation and Use of African Medicine in the
Mankoya District, Northern Rhodesia. in Apthorpe 1968: 21-77.
Van
Binsbergen, W.M.J.
1977a
Regional and non-religious Cults of Affliction in Western Zambia.
In Werbner 1977: 141-75.
1977b
Law in the Context of Nkoya Society. In Roberts 1977: 39-68.
Werbner,
R.P. (ed.)
1977
Regional Cults. ASA Monograph 16. London: Academic Press.
[1]Cf.
Lieban 1973: 1056 f. and references cited there. Lieban is
however rather critical of the accepted views.
[2]My
emphasis is on the cognition of the patients and their sponsors;
the specialist healers each use a diagnostic system that tends to
be more technical, elaborate, idiosyncratic, and orientated
towards somatic symptoms, than are the laymens diagnostic
categories on which the patients and sponsors base their choice
of healers in the first place.
to Part 0
(Abstract)
to
Part I (Problem and Method; Background)
Part
II (The extended case; Ethics)
Part
III (Interpretation; Conclusion)
page last modified: 20-04-13 12:31:43 | ||