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The anthropological dimension of a patient's treatment: a response to Prof. Bernard Ugeux.

A. Issues raised by Bernard Ugeux

Ugeux identifies a number of truths about the relationship of culture, health, ill health and healing:

1. Culture determines how health, ill health and healing are understood in a particular context. It offers explanations and specific therapies depending on a given case.

2. A health care system is the product of a culture. Each culture has a health and management system imprinted with its own vision of the person, his or her relationship to other persons, to the cosmos, the environment and invisible reality.

3. Health and illness have several dimensions that include the individual/physical, social, cosmic and spiritual dimensions.

4. Western biomedicine generally ignores the transcendental/spiritual dimension, unlike indigenous healing systems.

5. Generally, regardless of cultural background, people hold subjective explanations for their experiences of illness, which people interpret from their own culture.

6. Healing implies a reconstruction of one's mental and psychological universe, and the religious and cultural reconstruction of disease. It is a reconstruction of meaning.

7. For effective therapeutic interventions, healers should enter into the patient's explanatory systems, i.e. his/her own coherence. This is because every culture has its own system of meaning, with its own internal coherence.

8. Though Western biomedicine has made tremendous strides in finding cures for complicated illnesses, it raises unrealistic expectations, especially the demand for immediate results.

9. There are three spheres of health care, namely, the popular, traditional and professional sectors. Each sector has well defined approaches on aetiology, remedies, and the definition of healer and patient and their roles.

B. My response to Ugeux

I agree with the issues raised in Ugeux's presentation, and would like to explore their application and manifestation within the context of the understanding of health, ill health and healing in African Instituted Churches (AICs). These are churches that are inculturated in the African context and seem to operate more from within the "African map of the universe". Africans have reflected on health issues at various stages of their encounter with Christianity, especially since the 19th and 20th centuries.

Included in these inculturated churches are what have been labelled as "Spiritual/Zionist" AICs and charismatic churches. Although the former churches are said to be declining due to the challenges posed by charismatic churches, they still persist in the rural and urban areas, and often draw their clientele from the older and poorer populations, as, for example, happens in Kenya. In some countries like Nigeria and South Africa the churches have large memberships, and some have reinvented themselves to cope with modern globalizing changes and the aforementioned challenges.

One major characteristic of these churches that is at the core of their appeal is their concern with healing. They understand, interpret and mediate health and healing from an African cultural and biblical perspective. Ill health is also understood from within the churches' worldview. Dynamic African cultures today are a mixture of traditional value systems, beliefs and practices, and of new value systems imbibed from foreign cultures.

In African understanding, health is a state that entails mental, physical, spiritual, social and cosmic (environmental) harmony. Having health implies equilibrium in all these dimensions. Health is associated with all that is positively valued in life. It is also a sign of a correct relationship between people and their environment, with one another and with God. Illness is viewed not just as a physical condition, but a religious matter as well. As Pobee argues "A traditional African assumes a metaphysical aspect to health and its absence and healing." (l) This perception points to the religious epistemology and ontology of the African people.

This attitude is manifested in not only the illiterate but also among the educated, whether they are Christian or not. It is this perspective that is generally absent in the healing ministry of mainline churches, but is catered for in charismatic churches and other AICs, especially in their response to culturally related illnesses. These are the illnesses that Ngubane calls the "sickness of the African people." (2) They occur as a result of the breakdown of human relationships both with the living and ancestors, who are the living dead. These are the illnesses attributed to personal forces or evil.

The acknowledgement of a metaphysical dimension to ill health implies that the search for healing must also include appeals to the spiritual. In the African mindset, healing is a quest for the power of God and the goodwill of other spirit beings under God, who mediate various aspects of life and death. This perception is evident in the names of some charismatic churches, e.g. God's Power Church, Hope Restoration Centre, Victory Tabernacle, Jesus Power upon the World, and Voice of Salvation Church.

Such a perception of healing sees illnesses as culturally bound and having psycho-cultural aetiologies. (3) Illnesses usually manifest themselves because of psycho-cultural and social reasons, such as relational problems within the family and community. Interventions in such illnesses/problems require a composite, multidisciplinary and holistic response. It is not enough to label such beliefs as superstitious or irrational. What is needed is for the healer to enter into the patient's explanatory system/his or her own world. As Milingo points out, healing that does not take the African cosmology seriously cannot be totally successful in Africa. (4)

Cultural interpretation of healing in AICs

As demonstrated by Ugeux, notions of health, ill health and healing are affected by culture. This is because, "Disease and illness are explanatory concepts rather than entities in themselves. They can be understood only within defined contexts of meaning and social relationships." (5)

Culture, therefore, influences the patterning of sick roles in a society, and sickness has a different social significance within different cultures. In some cultures, illness may be seen as punishment for wrongdoing or possession by an alien spirit.

Medical anthropologists make a distinction between "curing disease" and "healing illness." While disease is the "malfunctioning of biological and/or physical processes", illness is perceived as "the psycho-social experience and meaning of perceived disease". (6) Hence, people usually have a disease before they become ill. It is only when people perceive that they are unwell that illness occurs. This explanatory model is useful in providing insights into what actually happens in religious and cultural healing, which is also referred to as "folk healing", "faith healing", or "symbolic healing", (7) under which descriptions healing in AICs falls.

How is culture expressed through the healing process in AICs? Bates asserts that despite the fact that the sickness/healing paradigm is expressed differently in various cultures, there are certain common elements in the process from sickness to healing regardless of whether the model used is a Western biomedical or cultural/religious one. Some of the common elements are emotion transfer, use of ritual, the importance of faith, and evidence of a trance/altered status of consciousness. (8)

i). Emotion transfer

Healing processes involve emotion transfer. This implies "the transition from negative emotions of feeling unwell to more positive emotions of feeling better". (9) This is effected by the healer through the use of symbols within the cultural framework to manipulate the emotions and psyche of the patient. The cultural framework provides the medium through which suggestions can be transcended. The mechanisms used for emotion transfer are catharsis, exorcism, counselling and prophecy. For healing to occur, it is crucial that the patient and healer share the same worldview and explanatory model for illness and healing. This may explain why AIC healing is found efficacious by the churches' adherents, because it incorporates both the traditional African worldview and spirituality, and also biblical notions. This kind of healing results in coming to understanding by the patient, and her/his community, which eliminates fear and anxiety. It also leads to the acquisition of a new identity through conversion, and gaining a sense of purpose in one's life. Healing facilitates the shaping of identity and building up of group cohesion and solidarity.

ii). The ritual process

Ritual is central to any healing process, and especially religious healing. Through ritual and symbolism, healing becomes a means of communicating with God and the group through the use of symbolic patterns and gestures. These symbols and rituals provide participants with a vision and meaning for their lives. Healing rituals include experiences as diverse as going to hospital, being exorcised, anointing the sick, laying on of hands on sick parts of the body, use of Bible, washing with and drinking holy water, and fortifying oneself with "weapons of the Spirit". (10) These symbols, which are "carriers of power", are accepted by both the patient and healer as signs of healing.

Through manipulation of these symbols, which arise from a shared worldview, the patient is brought into a new understanding of the problem. The deep root of the problem that explains the 'Why?' of the illness is arrived at through the help of the healer. The healing rituals therefore provide "a release of tension through a cathartic ritual and belief that heighten the hope of the members." (11)

iii). The role of faith

Faith in the healer and in the healing process is central to all types of healing. Faith covers expectancy, suggestion, personality structure and status. Faith also includes hope of a positive outcome. Without faith, the healer cannot successfully manipulate the symbols of healing that are required for effective emotion transfer. This may explain why in religious healing sceptics cannot be healed, for they do not share in the same assumptive world of the healer. Apparent success in AIC healing can be attributed to the shared belief system and explanatory models of AIC healers and their patients/adherents.

iv). Trance/altered states of consciousness

Experiences of trance, spirit possession or some form of altered state of consciousness are regarded as necessary for some forms of religious or spiritual healing. This is widespread in Africa and has individual and communal dimensions. Spirits are believed to be responsible for illness and misfortunes, as well as the provision of curative remedies and the calling of people to be diviners, mediums and medicine persons. These beliefs and experiences are also evident in spiritual AICs.

However, whereas in traditional African experience spirit possession may have been experienced as oppressive and disempowering, in AICs possession is experienced as the liberating power of the Holy Spirit, who mediates healing. Possession that induces dissociative states, especially when it occurs in the context of singing and dancing in congregational healing rituals, provides emotional catharsis: "a sense of renewal and an improved capacity of dealing with reality". (12)

The experience of possession is linked to the elevation of social status in that the victim is provided with a safe space to express social discontent and negotiate remedies without inviting recrimination. This experience is real for most spiritual AICs that are churches of the poor because these churches are communities of affirmation, healing, solidarity and communion.

The healing mission in AICs

In view of the foregoing, we can conclude that AICs operating from their cultural framework and biblical understanding perceive healing in various dimensions. The central belief is that God, who is the source of healing, continues to heal today through the church community, and endows spiritual gifts to individuals whom he uses as channels of his healing power. Prayer is crucial to healing and so is confession of sin, repentance, forgiveness and reconciliation. Healing in AICs is done in the name of the triune God and occurs in the context of the faith community. Healing is also contextual for it addresses contextual realities, whether social, environmental, cultural, economic, spiritual or political.

The healing process, as we have seen, is a transformation of identity in a person as a result of a change in the socialization process. It involves the reconstruction of a person's identity in terms of the more positive symbol of the new social or religious grouping in which the person is healed. The patient is socialized into the new world and this is experienced as healing. Identity change is always a transcendental process since it involves giving up one's identity so that a new identity and a new self-understanding can emerge. (13) The church becomes a protective and healing community, where the healed are immune from attacks by Satan and evil spirits. The healed experience this as liberation. Healing is therefore a quest for salvation and is holistic because it covers the whole person and his/her context. Healing aims at restoring harmony within and between individuals. The quest for health and healing in AICs is a quest for the biblical "shalom", the fundamental meaning of which is totality. In contrast to traditional theology, which viewed healing as separate from and subordinate to salvation, AICs perceive and accept healing as a blessing from God. This is a free gift, and when a person is healed he/she is saved and enters into a special relationship with the healer, ,Jesus Christ.

Health as salvation covers bodily well being, which includes proper and harmonious functioning and spiritual soundness. The healing ministry thus brings the gospel back to the church and restores a person to his/her original wholeness and dignity. This means removing obstacles that are inimical to achieving fullness of life. Not only is the healing in AICs communal, it is also concerned with the welfare of the person. This is especially enhanced by the relationship of the healer and patient. Healing is also usually done in the context of congregational worship, which implies that every person participates in the process. During prayer for the sick, the patient's body is touched. There is confession of guilt and specifics are prescribed. Even the subconscious sphere of the person is touched when dreams are related and explained by the healer.

In conclusion, we reiterate that the church universal needs to evolve a theology of healing that takes into account local understandings of health, illness and healing. She needs to critique cultural elements that are incompatible with the gospel and retain those that are life affirming. Concern for the person and healing of communities in a holistic sense should be the focus of healing activities. The gospel imperative of healing, teaching and preaching is the core of the church's mission.

(1) John S. Pobee, "Health, Healing and Religion: An African View", in Internatianal Review of Mission, Vol. XC, Nos. 356/357, January/April 2001, p. 58.

(2) Harriet Ngubane, Body and Mind in Zulu Medicine, Academic Press, London, 1971, pp. 22-23.

(3) Stuart C. Bate, "Does Religious Healing Work?", in Grace and Truth, Vol. 12, No. 2, August 1995, p. 8.

(4) Emmanuel Milingo, The World in Between: Christian Healing and the Struggle for Spiritual Survival, Hurst and Co., London, 1984, pp 23-24.

(5) Arthur Kleinman, Patients and Healers in the Context of Culture. University of California Press, Berkeley, 1980, p. 73.

(6) Ibid., p. 72.

(7) James Dow, "Universal Aspects of Symbolic Healing: A Theoretical Synthesis", American Anthropologist, Vol. 88, No. 1, p. 56.

(8) Stuart C Bate, 'The Mission to Heal in a Global Context", International Review of Mission, Vol. XC, Nos. 356/357, January/April 2001, pp. 75-77.

(9) Ibid.

(10) J.P. Kiernan, "Weapons of the Spirit" Journal of Religion in Africa, Vol. X(1), 1979, p. 13.

(11) Kofi Appiah--Kubi, Man Cures, God Heals,: Religion and Medical Practice amonq the Akan of Ghana, Friendship Press, New York, 1981, pp. 81-83.

(12) A. Kiev, Magic, Faith and Healing, Collier Macmillan, London, 1964, p. 29, cited in Stuart C. Bate, "The Mission to Heal in a Global Context", p. 76.

(13) G. Easthope, Healers and Alternative Medicine: A Sociological Examination, Gower, Aldershot, U.K., 1986, p. 133.

Philomena Njeri Mwaura

Philomena Njeri Mwaura is a senior lecturer in the Department of Philosophy and Religious Studies, Kenyatta University, Kenya
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Author:Mwaura, Philomena Njeri
Publication:International Review of Mission
Geographic Code:1USA
Date:Jan 1, 2006
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