Sylvia Marcos - Parallel Medicine: Popular Potentials for Mental Health
*Editors note: The following text comes from Manicomios y Prisiones,edited by Sylvia Marcos. It is one of her contributions to the volume.
Parallel Medicine: Popular Potentials for Mental Health
All medical action is, at the same time, a technical and symbolic act, intimately linked with the conceptions and world view of a given society.
Curanderismo is one of the vital expressions of all indigenous and mestizo cultures of the continent. It is threatened at the same time by forces of nationalization, by the acculturated influence of science and by the etiquette of “ignorance” and “superstition” that adjudicates any expression of culture outside western society.
The people of America have been systematically subjected to humiliation, exploitation and oppression. Fortunately, the exploitation of class has been widely analyzed and denounced. Intellectuals, researchers and even political activists that fight for a more just social order have been insensitive to ethnocide. By ethnocide I do not mean the physical destruction of persons–that is genocide–but the destruction of their cultural, social and symbolic world.
World view, the conception of time and space, the methods of healing, interpersonal and interfamilial relations, all have been the object of mockery, joke, and derision, sponsored by the “scientificity” of its advocates. I believe that the moment has come to denounce and analyze, as another type of oppression, the dispossession of the symbolic world suffered by the immense majorities of Latin America.
The critique of psychological, psychiatric and psychoanalytic technicians has revolved around some key points of questioning: normalization, social control, individualism, and the subjectivity of these technicians, the relations of power between the analyst and the analyzed, etcetera.
When applying these critiques to a Mexican context, I find a type of healing or therapy that this critique obviously does not apply to. I am referring to curanderismo. Its mark of reference is outside the technicians of control that we critique.
My proposition is not to make a panegyric of curanderismo, nor to present it as an alternative par excellence, nor the only solution for the world. I will mention three reasons it interests us.
Autonomous control by the community of its symbolic world. Because the expression of a social reality where “difference” and “the different” serves to give meaning is the essence of its structure and, therefore, is not linked with segregation and isolation.
Because it is the expression of an evolutionary ( cultural) syncretism through which colonized groups manage to survive in a hostile environment.
Because the relation that is established between “therapy” and “the patient” inspires some alternatives for Latin America.
Are we claiming that curanderismo is outside of social control?
There is an apparent aporia. Are we questioning the technicians of social control or of all social control per se? And doesn’t curanderismo have its own form of “social control”?
Curanderismo is not unlinked to the social structure in which it was born. As Toynbee (1) says, there are three ways in which minorities relate to the dominant group: a) the minority indiscriminately accepts the values of the majority; v. gr.: a migrant that absorbs the norms of dominant society in an even stricter way that those that belong their own culture. The minority, in this case, is condemned to destruction and death. b) The minority radically rejects the propositions of the dominant group, doesn’t establish any relation of exchange and is also condemned to its annihilation. c) The minority makes an exchange with the values of the dominant classes, reaching a new synthesis between theirs and the other, creating a new system.
It is this that I am going to speak on. I don’t intend to deal with a prehispanic curanderismo. The only thing we can deal with is “indoamerican cultures in progress” (2). Therefore, the phenomena I will attempt to break down as a process, as continuous change, as cultural evolution by which the urban curandero (healer) is one of many indicators.
Raymond Klibansky has defined culture as a set of transgressible limits (3). This concept allows us to clarify how the practices of the curandero (healer) differentiate themselves from service and from social control exercised by psychologists and psychiatrists. Seen through our social concepts, curanderismo appears also as a service of social control. Nevertheless, we can add that as a “service” it is not individualist and as “social control” it does not subjugate the patient to an arbitrariness of the therapist.
The healer also sees illness as a transgression of a boundary peculiar to his or her culture. For example, the medicine of "hot and cold" is used to correct violations of dietary errors; "cool" substances are remedies for hot illnesses, and vice versa. But it is not always a matter of sanctioning or correcting transgressions. Some are incurable, such as being visited by premonitory dreams or being struck by lightning and surviving. In these cases, the healer relocates the deviation in such a way that it illuminates the transgressed boundary from the outside. This is how certain deviations "from the norm" are recognized as talents and gifts. Gifts that in turn, oblige the recipient and place them as "out of the ordinary" and at the service of the community. The very distinction commits them to being accessible to others. Transgression here can establish the deviant as a new guardian of (new) limits. This explains, from the perspective that completes that of Toynbee, the evolutionary character of syncretism by which the urban curandero (healer), and to lesser extent the rural curandero (healer), belong to.
Modern therapy, on the other hand, is incapable of giving meaning to deviation. Madness – like criminality and, to a certain extent, holiness(3) – is a category that segregates the deviant in such a way that he only experiences impotence.
This apartheid, rather than social control, characterizes modern industrial society and the psychotherapists are no more than a gear in this machine of social control and exclusion. We live in a society apparently tolerant, but behind the relaxation of ethical normas exists a threat: any talent, the genius of any one can be diagnosed as deviation and therefore impeded from being a source of creativity.
Madness is no more than one of those hygienic “protecting” wrappers–here at the social “service”–at the rest of society from contagion.
Despite such trumpeting of “moral tolerance,” the therapist is prevented, for their nosological categories, from discovering in his or her patient a talent or “power” analogous to his or her own. In the united states, 30% of the population regularly take psychiatric drugs prescribed by doctors, almost all of those intoxicated are potential deviants.
In our latin american countries, despite widespread political repression, there exists, in daily life, more tolerance for difference. For example, I know a youth in Cuernavaca that stands at intersections and whistles as if he was a traffic cop. It has never occurred to anyone to bother him and neither have men in white coats dragged him to an asylum. We tolerate atypical behavior much better than Europeans and North Americans.
The greater the industrial development of a country, the more centralized its power, the less its tolerance,the greater the apartheid that punishes atypical behavior.
Unfortunately, even in our environment, labelling and diagnostic techniques are expanded. For example, ten years ago in Mexico there did not exist the category of child “learning problems” (a category that is applied today to almost any restless child). Nor the necessity of some psychologists to mattress so many other “bad behaviors” of the human being. This clearly signals that we are immersed in a process by which institutional critique becomes more and more relevant.
Upon promoting that critique in Latin America, we must take into account our cultural wealth. With the critique of psychiatric hospitals and all the decentralized ploys that they intend to import to our lands from the equivalents of the secteur or of Community Mental Health, we must reserve a space for the defense of curanderismo. Not to integrate hip chimerical psychotherapies into our medicine cabinet allied with the elucidations of Timothy Leary or the mushrooms of María Sabina, but to protect it where it continues to exist. Because curanderismo, as an ideal type or as syncretic reality, is a takeover of the symbolic world and/or the therapy of minority groups and communities.
The curandero (healer) is traditionally that which “reestablishes the equilibrium” knowing the right measure, that which escapes the eyes of the profane. In Aztec México, this idea of measure could be in contradiction with the excess of the gods, similar to how in ancient Greece, there existed a notion of an independent measure of anger, of envy, or the lust of the gods. More than the modern doctor, I want to compare the american curandero (healer) to the ancient medicus or med-dicus; he that pronounces, says, the right measure. Benveniste (4) tells us that in ancient italy, two dialectical variations of the same word (med-dicus y med-dix), designated, in old villages, personalities as distinct as the doctor and the judge. In Greece, medon, another word derived from the same root, signifies the military chief. Benveniste knew how to find the common concept between two apparently disparate functions. The “med-dicus” (or med-dix, or medon) the one which is able to apply with authority (root dic, he who speaks, compared to the aztec root tlat) a chosen measure in a traditional repertoire and adequate to the present situation. If one were to define the curandero (healer), they would choose between the mascot of the modern doctor and the broad range of the ancient med-dicus, and as defined by Benviste, one would choose the second definition, well aware of all the difference between ancient europe and our America. In both worlds there are personalities capable of conjuring up chaos by authoritatively applying measures inspired by a tradition shared by the community.
The curandero (healer) is such a character, he brings together "natural" authority, science of the correct measure capable of restoring balance in the community and knowledge of tradition.
Another aspect by which curanderismo radically distinguishes itself from modern therapy is the relationship between the curandero (healer) and the symbolic world of his community. The ritual that serves as a frame for the cure is neither absurd nor outside of the community. The curandero (healer)–unlike the doctor or the psychotherapist–belongs to the same group and the same social class to the one who asks for their help. It has been proven that among the “spiritualists”–adherents of a very popular form of religious syncretism–of the Mexican capital, 30-40% of the people that receive “cures” or “cleanses” belong to the extended family of the healer. In these groups, the proportion of people with gifts of healing is one for every four adults.
The “expert” curandero (healer) differs from its homolog psychiatrist or psychoanalyst in that he has been selected by the members of his community. They have given him the power of healing them. The apparent hierarchy in the relation is inverted and reinterprets itself. Whoever makes themselves a curandero (healer) is not a student, that, in the search of a mode of subsistence, chooses a profession, still not even a profession of “helping others”, as are the psychoscientists. He can not decide arbitrarily and say “I will heal others.” The function comes to him in an intermittent game, multiple and complex, where the principal variable is the trust in his healing abilities handed in by the group. If this does not exist, it is impossible to call oneself a therapist. This is unique to occidental societies where profit is also the main goal of professionals.
As much as the curandero (healer)–whether he be called shaman, granicero, sagurín or huesero–his therapeutic function does not imply profits. It is a privilege, and at times an onerous duty, but never an instrument of economic power; with all the nuances of a basic tone that distributes itself in a disparate and unequal form through the country and the city, sometimes he receives grain, domestic animals, other times a little bit of money. The client generally establishes the payment. He, the one who chooses to heal, works the land, takes care of the livestock, waves fabric and embroiders them for his survival.
In the urban margins the curandero (healer) begins to charge. His function and syncretic personality includes sometimes in his treatments, patent medicine and fee collection. These will be statistically as efficient as those of the doctor or psychologist and will never reach the stratospheric price quotas of the “scientific” services. The service to the community is the predominant note of his action.
Additionally, the curandero (healer) knows his limits. He knows that he is not able to exercise his healing power in every potential client that presents themselves to him. He knows how to measure his forces, he does not have “manipulative therapeutic strategies” to submit his “patient” to his analytic therapeutic game, paradoxical or otherwise. He concedes that there are others with more power than him and recognizes them instantly. An integral part of his healing knowledge consists in recognizing and accepting his therapeutic limits.
The healing sciences of the west, whether they be biochemical, philosophical, or psychological, considers that every subject–turned into a mold or pattern–always reacts in a similar way before similar stimuli.
The human essence is outlined to be able to manage it, it is reduced to a thing to be comprehended, it is synthesized to prevent its changes. This is how the first general principles that constitute our “science” arrive, those invariable variables that allow us suppose that it doesn't matter who, nor how, nor when, nor where a drug is applied, or a sensorial stimulation, or the reach of a psychoanalytic interpretation in reaching –in this universal indistinct human being where latitude, time, history or culture is not important–only the cure.
The pretension of objectivity is questionable also. The aseptic therapist, the distant analyst that pretends to be a wall where the patients reflects “their” problematic, that believes in not intervening, given that he only emits monosyllabes once in a while, that cuts off his life and all personal feeling from the relationship with the patient, is a clear exponent of a individualist, narcissistic and egocentric society: the society of the “spheres.”
The dissociation between the subjective, emotional and peculiarity of the therapist and the world of his client, patient user, is inappropriate and inefficient. It would occur to no style of curanderismo to separate the personality of the curandero (healer)–which is the most precise instrument of healing–from the one in pain searching for relief. The artificial division between the subject and the object has been rejected philosophically and methodologically by Sarte and Lefevre (6) among others. In this sense, even Jay Haley admits that psychotherapy is always an art (7).
The statistics of effectiveness from the multiplicity of theoretical frameworks, techniques, and therapeutic methods, indicate the same percentage of improvement... would it not be more logical to see in this numerical data a compelling proof that it is not the conceptual framework of the subject, sickness, prognosis and cure, nor the techniques of labelling and/or diagnosis, nor even the methods of therapeutic intervention that generate the (improvement) change. Rather, one would think of that unrepeatable and singular characteristic: the personality of the therapist as well as the unrepeatable, undefinable and affectionate relationship that transmits strength and clarity to the confused and suffering other.
Differentiating the social and symbolic (or cultural) integration of the healer or the doctor includes also the perception of a radical difference between western industrial capitalist society and the other (preindustrial, non-western)(8). The first appears as a juxtaposition of seperate domains, of almost autonomous “spheres”, each with its own laws: “the public”, “the private”, “the religious”, “the economic”, “education”, “health”, etcetera. These spheres present themselves as unembedded or detached from the social fabric. The economy, for example, comes to function apparently according to “universal laws” independent of the relations between men. We owe Karl Polyanyi (9) the ability to reconstruct this detachment, this “automization” of apparently autoregulatory spheres that constitutes the specificity of western society. It is the essence of the “great transformation” that preceded and prepared the industrial revolution.
Our language is impregnated to such a point that this logic of spheres and the enunciation of its “laws” has been radically altered by this process of detachment and has come to constitute one of the largest obstacles for the comprehension of societies that are not detached.
This constitutes the largest difficulty in getting closer to curanderismo. Certain aspects of the healings call to mind some psychotherapeutic practices. But it would be particularly disingenuous to establish a list of parallelisms between curanderismo and psychotherapy. It would be a formalist fallacy that consists in projecting our nosological categories towards the other to diminish it. It would be better to search, in societies that aren’t detached such as the Aztecs or the Bororo, for our own spheres in embryonic states: the “economy”, “education”, the “church”, or “sexual education.”
The domain of curanderismo–the space where the acts of the healer manifest themselves–has little to do with our sphere of “mental health”, although certain acts of the healer can be contemplated with a “medical” interpretation. These same actions would also be able to be interpreted as or religious expressions (10), popular or “political” methods, apt to reestablish order in the community (11).
The majority of the studies on Traditional Medicine base themselves in the search for parallels. With good intentions, to “defend” “apocryphal” medicine, they develop a supposedly exhaustive list of equivalents between herbalism and patent medicine, minerals and vegetal chemical compounds, that are the basic component of psychopharmaceuticals.
They believe like this they will save “traditional medicine” or “parallel” the suspicion of superstition. What they brush over is the entire social context in which these therapies are embedded: concepts of health, of illness, of the subject and its interplay with the social, with family, romantic and religious life.
The healer sometimes leans on symbolic mechanisms that, for western listeners, have truly pejorative connotations. George Foster describes that in almost all societies “of limited goods” envy can function as a social regulator (12).
The ancient americans, the indigenous communities previous to the age of the ISSSTE and the syncretic communities of the urban margins, share a certain notion of wellbeing and of health. It expresses itself in poetry and song, and anthropologists travel to transcribe it by the metaphor of a multidimensional equilibrium. Whoever threatens this equilibrium of dimensions threatens society and puts themselves in the danger of its members. There exists a repertoire of resources–some technical, many of them symbolic, to conjure up chaos. Curanderos (healers) recognize these resources and have authority to apply them.
There exists an irreducibility of American health to industrial capitalist society’s concept of health. Reading the Nahua singers in Miguel León Portilla’s translation, one discovers in Aztec poetry and song an expression of the fragility of life and the definition of health as the unique utterance of a face, of a heart.
We permit ourselves to recognize their singularities, to respect them as emergences of the masses and accept the innovative therapeutic dimension that they provide.
citations:
(1)TOYNBEE, A. A Study of History, VVOLS.1-6 London, Oxford University Press. 1954.
(2)ARIZPE, L. “Los Indígenas el Retorno Imposible”, en: NEXOS, Mexico, 1981.
(3)Citado por Illich I. “On StypeL the root of Disidence, Deviance, and Delinquincy”, “en CIDOC DOCUMENTA, I/V, No. 83, Cuernavaca (apdo. 479) 1973. P26 1-9.
Retomando el argumento de Klibansky, Illich escribe “Concibo las culturas como sistemas totalmente diferenentes de cualquier otro sistema. Las culturas como sistemas pertenecen a una clase aparte, porque son constituidas de reglas que pueden ser transgredidas y cuya transgresión es parte de sistema”.
(4)BENVISTE, E. Le vocabulaire des institutions indo-européennes, Vol2. Paris, Les Editions de Minuit, 1969, p 123 ss.
Sobre los dos conceptos de medida y sus equivalentes en los idiomas indo-europeos.
MARCOS, S. “Curanderismo.... Potencial Popular para la Salud mental”
Contribución al cuadragésimo primer Congreso de Americanistas, Vancouver, agosto 1980.
(4)Problemas de Método. Jean Paul Sartre en R.D. Laing, D.F. Cooper.
(5)Razon y Violencia. PAidós. Buenos Aires, 1973.
(6)LEFEBVRE, H. De lo Rural a lo Urbano. Barcelona. Ediciones Península, 1973.
(7)HALEY, J. Strategies of Psychotherapy. New York. Grune & Stratton, 1963.
(8) Para una exposición de lo que diferencia radicalmente la sociedad insturial occidental, de todas las que la precedieron y de todas las que lograron escapar a la occidentalizaciónˆver:
ILLICH, I. Gender, New York, Pantheon, 1982.
Ver tambien:
Dumont, L. Homo aequalis, Paris, Gallimard, 1977.
(9) POLYANI, K. The Great Transformation. Boston, BEacon PRess (1957 1944)
(10) Sobre la religiosidad, en tanto que se opone a la religión, ver:
ILLICH, I. Gender, op. Cit. nota 117, p. 161,
“El estudio de la religiosidad popular es algo distinto de estudio de la religión al cual se dedican la ciencias religiosas”
(11)Sobre métodos vernáculos de hacer justicia sin la intervención de las instituciones oficiales, ver:
SOUSA SANTOS, B. de “Law against law”, en CIDOC DOCUMENTA I/V No. 82, Cuernavaca (APdo. 479), México, 1973, p. 17 /1-23.
Sobre los orígenes aztecas de la medicina vernácula mexicana, ver:
LOPEZ AUSTIN, A. Medicina náhuatl,∫ México 1971, SepSestentas. Contiene, además de numerosas vistas originales, un excelente comentario crítico de Foster.
(12) FOSTER, G, ,. “The anatomy of envy, a study in symbolic behavior”, en: Current Anthropology 13 (2) abril 1972, pp. 165-202.
Foster, G. “Peasant society and the image of limited goods”, en: American Anthropologist, 67, 1965.
Reprimida hipócritamente por la cultura occidental–donde aparece bajo formas peores–la envidia es, en las sociedades indoamericanas, un poderoso–y doloroso–regulador social que se opone a la acumulación exagerada y garantiza una cierta igualdad entre miembros de una comunidad. Ver también:
FOSTER, G. M. “Peasant Soceity and the Image of Limited Goods”.
Sobre la hipócritica represión de la envidia por la sociedad occidental y su reaparición larvada, ver: SHOECK, H. Envy, a theory of social behavior.
New York, Harcourt, Brace and World Inc., 1969.
(13) BORREMANS, V. Theinverse of Manages Health. En Tecno Politica. Cuernavaca, junio 1977.