The quest for therapy in Lower Zaire

Description

The holistic description of a medical system should describe the full range of practices in a society, and it should explain how these practices coexist in a changing structure of customs and social relationships. Few historians, sociologists, or other specialists have yet approximated these goals, and until now no anthropologist has attempted to describe a medical system in this manner. Herein lies the originality of The Quest for Therapy in Lower Zaire by John Janzen. In scale, complexity, and analytic cohesiveness it sets new standards for research in medical anthropology. Books as rich in facts and ideas as this resist labels. It is an anthropological study, with the qualifying adjectives social, medical, humanistic, and applied. Because it describes a region of Zaire, it could also be classified among African studies books. But it will interest those who are neither anthropologists nor Africanists, for it is written so any reader, layman or specialist, who particularly wants to know how medical systems work, can understand and learn from it. It does this by inviting the reader to compare his own experience and knowledge with the facts reported here. The invitation is implicit in the concepts Janzen uses. His central concept is that of the lay therapy managing group consisting of kinsmen and friends, which is mobilized when illness strikes an individual, and which acts to define the situation and to search for a remedy. The size and composition of the group varies according to circumstances. Though Janzen is describing a region in Zaire, readers will readily see comparisons with therapy management groups that exist in other societies they know about. Because the concept includes an aspect of events that can be observed in any society, and because Janzen uses it well, his description of particular facts in Kongo society reveal general truths about whole systems of action. Books as rich as this one resist summary. The lay therapy management group is only one of its many concepts, all of which have in common Janzen’s effort to describe the historical structure of medical pluralism. With the possible exception of a few small and very isolated societies, all medical systems in the world today are pluralistic. As the degree and organization of this pluralism varies, the central problem for a comparative study of medical systems is to develop theoretical paradigms to describe it. In our own culture the influence of biomedical science and of doctors is such that it is essential to distinguish health systems from medical systems in order to define Janzen’s subject, and to understand that medical systems, defined objectively, include all forms of practice. This book is not about the health system in Lower Zaire. If it were, it would analyze the adaptive and dysfunctional relationships between the human population and its parasites, the patterns of nutrition, fertility, mortality, and so on. It would be an epidemiological and ecological study about the interrelationships between species as they affect the normal functions of human beings. It might use social categories, but its fundamental theories and perspective would be drawn from clinical medicine, biology, and the cultural norms of medical practitioners. Quite the contrary—this book has a different perspective and theoretical structure, for it describes a regional medical system. [ from the foreword ] The Quest for Therapy: Medical Pluralism in Lower Zaire Contents List of Illustrations FIGURES 1. Inhabitants per medical doctor in several countries 2. Western medical personnel and facilities per inhabitants in Luozi Territory and Zaire Nationally 3. Kinship relations in Luzayadio’s case 4. Structure of confession and accusation in Luzayadio’s case 5. Close kin marriage types in matrilineal context 6. Kinship relations in case of Axel and Cécile 7. Kinship relations of Nsundi and Kinkanga-Kituma clans 8. Partial genealogy in cases of Lwezi and Mbumba 9. Formation of therapy managing group in case Studies 132-133 10. Social components constituting therapy managing group 11. Correlation of social context of decision and therapy choice 12. Co-occurrence of therapies and specialist’s (or group therapist’s) roles in case studies 152-153 13. Correlation of distance travelled by clients with cost and role of therapist consulted 14. Diagrams of the body 15. Correlation of therapy actions and problems handled by banganga 16. Correlation of therapy actions and problems handled by kinship therapy and bangunza 210-211 17. The course of therapy summarized PLATES (Between pages 106 and 107) 1. Out patients at Kibunzi dispensary, Lower Zaire. 2. Patients receiving medicine, Kibunzi dispensary. 3. Nurse examining child, Kibunzi hospital. 4. Family therapy managers outside ward, IME-Kimpese. 5. Orthopedic ward, IME-Kimpese. 6. Major surgery, IME-Kimpese. 7. Muscle massage in fracture case, nganga lunga’s treatment. 8. Asperge of oily herbal ointment on place of fracture. 9. Application of bamboo mat “cast.” 10. Obtaining medicine from finger cactus tree. 11. Medicines, big market, Kinshasa. 12. Modern herbalist preparing vial for injection. 13. Treatment for kink in back, nganga nkisi. 14. Massage of disturbed patient, nganga mbuki. 15. Cupping horn treatment, nganga nkisi. 16. Croix Koma Mass being sung by nganga nkisi. 17. Intraclan divining session with prophet. 18. Interclan reunion to resolve differences in illness dispute. 19. Restraining disturbed patient in village center. 20. Kimbanguist rite, laying on of apostle’s hand. 21. Weighing the Spirit, Church of the Holy Spirit. 22. Healing, Church of the Holy Spirit. 23. Nzoamambu, nganga nkisi, detaching bark from tree. 24. Fly whisk inherited by Nzoamambu from grandmother. 25. Medicine spoon inherited by Nzoamambu from grandmother. 26. Crockery mug inherited by Nzoamambu from grandmother. MAPS 1. Lower Zaire. 2. Territory of Luozi, Manianga. 3. Manselele, near Mbanza Mwembe: Nzoamambu’s garden village. 164-165 Foreword by Charles Leslie Preface PART I: THE AREA OF STUDY 1. The Human Setting of Healing in Lower Zaire 2. A History of Medical Pluralism in Lower Zaire PART II: STUDIES IN KONGO ILLNESS AND THERAPY 3. Disease of God, Disease of Man 4. Strife in the Family As Cause of Child’s Illness 5. A History of Madness 6. The Professional as Kinsman 7. Marriage and the Father’s Blessing 8. The Clan as Patient PART III: THE LOGIC OF THERAPEUTIC SYSTEMS 9. The Jural Status of Therapy in Kongo Society 10. Interpreting Symptoms 11. Contemporary Systems of Popular Medicine in Lower Zaire 12. Toward an Integrated Medicine Appendix A. Episodes of Case Studies Reported in Chapters 3-8 Appendix B. Herbarium of Medicinal Plants Bibliography of Works Cited Glossary-Index