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)
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.
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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.
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1978 Marxist and non-marxist approaches to migration in tropical Africa. In Van Binsbergen and Meilink 1978: 21-35.
164 Some African poison plants and medicines in Northern Rhodesia. Occassional Paper No.11. Livingstone: Rhodes-Livingstone Museum. 2nd edition.
1966 Health behavior in cross-cultural perspective: A Guatemalan example. Human Organization 25:122-5
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1976 (eds.) Medical anthropology The Hague/Paris: Mouton.
1974 Farmaceutische mijmeringen in en over Zambia. Pharmaceutisch weekblad 109, 49: 1202-3.
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1974-75 (eds.). Traditional healers: Use and non-use in health care delivery. Rural Africana 26.
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1977 Limits to medicine. Medical nemesis: the expropriation of health. Harmondsworth: Pelican Books.
1976 Annual Report 1976, Public Health Services. Kaoma district: Department of Health Mimeo.
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.
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.
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.
1966 Medical care in developing countries. Nairobi: Oxford University Press.
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.
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1977 The patients of traditional doctors in Lusaka. African Social Research 23:217-233.
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1969 Maternity care in a Zambian district. Amsterdam: Jacob van Campen.
1973 Medical anthropology. In Honigmann 1973: 1031-72.
1976a Introduction. In Loudon 1976b: 1-48.
1976b (ed.) Social anthropology and medicine. A.S.A. Monography 13. London:Academic Press.
1971 Hospital or healers: An attitude survey in Ibadan. Human Organization 25:131-9.
1951 The southern Lunda and related peoples. Ethnographic Survey of Africa. London: International African Institute.
1965 Sorcery in its social setting. Manchester: Manchester University Press.
1975 Femmes, greniers et capitaux. Paris: Maspero.
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1945 A problem in sanitation: Lala childbirth. NADA 22: 50-2.
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1974 Nutrition Status Survey. Rome: UNDP.
1932 Report on investigation of disease Mumbwa-Kasempa July-August 1932, Enclosure in file ZA1/9/28/21/1. Zambia National Archives, Lusaka. Typescript.
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.
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1976 Health survey of Mwaziona and Matero in the city of Lusaka
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Ohadike, P.O., and H. Tesfaghiorghis
1975 The population of Zambia. n.p.: CICRED series.
1962 Health and human behavior: Areas of interest common to the social and medical sciences. Current Anthropology 3: 159:205.
1976 Warning: The milk in this package may be lethal for your infant. In Grollig and Haley 1976:129-36.
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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.
1977 (ed.) Law and the family in Africa. Paris/The Hague: Mouton.
n.d. (ed.) Guardians of the Land: Essays on Central African Territorial cults. Gwelo: Mambo Press (in press).
1976 Land use in Zambia. Part I: The basically traditional land-use systems and their regions. München: Weltforum Verlag.
1971-72 Uneven geographical distribution of medical care: A Ghanaian case study. Journal of Development Studies 8:205-22.
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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.
1964 Social and ritual life of the Ambo of Northern Rhodesia. London: International African Institute.
1971 Medical facilities: Health and the prevention of disease. In Davies 1971: 100-3, 127.
1968 Notes on the preparation and use of African medicine in the Mankoya district Northern Rhodesia. In Apthorpe 1968: 21-77.
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.
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1962 Comment. In Polgar 1962:187-8.
1977 (ed.) Regional cults. ASA Monograph 16. London: Academic Press.
1975 (ed.) Psychological Anthropology. The Hague: Mouton.
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 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 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.
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.
1973 Medical Anthropology. In Honigmann 1973: 1031-72.
Roberts, S.A. (ed.)
1977 Law and the Family in Africa. Paris/The Hague: Mouton.
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.
Cf. Lieban 1973: 1056 f. and references cited there. Lieban is however rather critical of the accepted views.
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)
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