This book explores notions of culture, identity and power in the bodily experiences and medical choices of patients in Southern Chile. The ethnographic material consists of case stories of patients, both Mapuche and mestizo, who combine biomedical treatment with the traditional medicine of the Mapuche. During recent decades the practice of Mapuche healers—shamans and herbalists—has been revitalized and become a very popular medical choice among Mapuche and mestizo, especially near urban centres (Bacigalupo 2001). With a population of about 1.7 million or about 10% of the total population, the Mapuche constitute the largest ethnic minority in modern Chile.1 Most Chileans, however, refer to themselves as mestizo, which means that they have mixed indigenous and European roots.
The main question explored is why actors perceive a certain medicine as effective, a question born out of my observation that health problems—as well as the knowledge and experience of illness and the use of medicines—were often-discussed topics among members of the family, neighbours and colleagues. Such conversations frequently touched upon illnesses that involved symptoms with no apparent organic pathology; in particular, people shared stories of “strange” afflictions with quite similar symptoms. Typically these included psychological symptoms like anxiety, lack of energy, loss of memory and a constant desire to cry, combined with diffuse physical symptoms such as dizziness, nausea, swellings or intense pain; most often manifested in the head or stomach, they also had a tendency to move location within the body. Some cases discussed, however, also involved serious, and often terminal, diseases which had a biomedical diagnosis; the most common was cancer.
In these stories people also reported strange incidents in their houses, mentioning things that had started to disappear, move around or simply crack. Some heard footsteps and felt watched by a presence. Others commented that they were not feeling like themselves, that they often lost control of their body, typically their tongue or legs, and some even felt that an alien presence had physically invaded them (often depicted as an insect or a lizard, which then fed off the body). These stories were accompanied by complaints that recent social changes and modernity in general had not brought much that was good, while many people expressed a general feeling of being stuck in a rut without many opportunities to change the current social and economic situation. Others said they felt “crushed” and that they did not feel “alive”. In addition, people complained of the cost of biomedical treatment and the long wait to be examined, as well as the frequent failure of biomedical doctors to detect a disease. A fundamental part of these stories was the evaluation they contained of the medical diagnosis and treatment that the patients had received from their biomedical doctors, as well as Mapuche healers.
The underlying assumption of this work, stemming from observations expressed in these conversations, is that these medical dialogues encapsulate issues that do not relate only to health problems; notions of power and identity in relation to social and political processes also seem to be implied. In their work on multiple personality disorder, Ian Hacking and Paul Antze argue that categories have the capacity to “make up” people (Hacking 1995, 1996; Antze 1996). In a social context categories take on a life of their own; they become entities which people come to inhabit, and through which they invoke meaning in their lives (Antze 1996: 3). Antze further poses the following question: What happens to people who come to live inside a discourse, who use it to make sense of their life? One way of answering this question, he suggests, is by analysing the stories that people tell about themselves, arguing that even trivial anecdotes can be considered highly interesting when told in the course of social interaction. He consequently proposes that stories “might be the chief means by which grand cultural discourses like Christianity or psychoanalysis find their way into something resembling self-knowledge” (Antze 1996: 6); in other words, stories reflect how people experience, articulate and negotiate the self and personhood in relation to the languages available in a given context.
The bodily afflictions encompassed in this work, which are shared in medical dialogues and diagnosed by patients and practitioners within alternative or indigenous medical traditions, have been referred to as “folk illnesses”, idioms of distress (Nichter 1981; Kaiser et al. 2015) or “culture-bound syndromes” (Simons and Hughes 1985) in the anthropological and biomedical literature (Panter-Brick and Eggerman 2017). Locally they are referred to as Mapuche illnesses or spiritual illnesses, as alternative and Mapuche practitioners often explain illnesses through the Mapuche worldview. Indigenous disease categories are part of a general repertoire of folk knowledge. Here the distinction between, on the one hand, natural illness, such as colds, wounds, infections and flu, and, on the other, spiritual (or supernatural) illness reflects popular talk on health matters. To the latter category of spiritual illness belong those types of afflictions in which an external agent—a spirit, ancestor or witch—is believed to have affected both the body of the patient and his or her surroundings, causing physical, psychological and social imbalances.
I was puzzled by the fact that many urban modern citizens—mestizo and Mapuche—diagnosed and treated themselves with Mapuche medicine for “strange” afflictions, the so-called Mapuche illnesses or spiritual illnesses. Did they have a biomedical condition which the doctors had not discovered? Or was something else going on? And what happened in those cases where patients actually did have a biomedically diagnosed disease, but still insisted they had a spiritual or a Mapuche illness? Consequently, the aim of this book is to explore stories of folk or Mapuche illness by following the patients’ articulation and management of afflictions in a context in which both the diagnosis and treatment take place within a pluralistic medical system: in other words, where the patient attends a variety of practitioners such as doctors, psychiatrists and Mapuche healers. The patient might accept a biomedical diagnosis of cancer while at the same time consulting a shaman in search of both the cause of, and the cure for, the illness, indicating that the patient holds a pluralistic and complex view of his or her identity, culture and body. In this way medical choices and dialogue can serve as a lens through which complex identities and social and political processes can be analysed.
Who Cured Wanglen?
The case of Wanglen,2 a young Mapuche girl, serves to raise some of the issues explored in this book, meanwhile illustrating my navigation in the field between medical practitioners, patients and their therapy management groups. Wanglen’s case is interesting, both because her illness was familiar to many people in the area and therefore often discussed and commented upon by patients I met during my fieldwork, and also because it challenges a common assumption within anthropology that folk illness is primarily connected to psychological and social distress (Nichter 1981; Rubel et al. 1984). Wanglen lived with her parents in a rural area about one hour away from Temuco. Her parents were Mapuche and quite successful, working as consultants for a governmental programme for indigenous peoples. Wanglen was, at the time of my fieldwork in 2004, a 6-year-old girl who had suddenly collapsed and entered a state of coma, although at first nobody knew the cause of her strange condition. I first heard of the case from a herbalist, Maria, who worked at the medical centre of a Mapuche pharmacy in Temuco. She told me that Wanglen’s parents had arrived at her consultation in the medical centre the day after the girl had become comatose, when Wanglen was hospitalized in the intensive care unit (ICU) for children in the hospital in Temuco.
Maria had visited the girl in the hospital and, by touching her pulse, had diagnosed her as suffering from trafentun—also referred to as susto—which occurs when the soul or vital force has been captured by spirits, or when a part of the soul has been lost due to a startling or frightening event. Maria was sure that the soul of the girl could be recovered with Mapuche medicine and that she could, thereby, be healed, but that as a herbalist ( lawentuchefe ) she herself did not have sufficient spiritual power to undertake the cure, since her expertise was in medicinal plants, not in the rituals that are necessary to regain parts of the soul that had been lost. She gave Wanglen an antidote (contra) and a cleansing medicine (sahumerio), but recommended that Wanglen’s parents consult a powerful shaman by the name of Sebastian, who also worked in the medical centre of the Mapuche pharmacy. The parents never arrived at Sebastian’s consultation, however, and nor did they...