Friday, January 05, 2007

Is there a Ndembu Witch Doctor in the House?

Every winter I spend here in sunny AZ, I wonder how I survived Chicago's annual fimbulwinter and the attendant depressive hyperactive internal ruminations that the lack of sunlight and endless grey days appeared to produce.

In particular I am reminded of the melancholic winter discussions I used to have with H, who was one of my good college buddies, about the treatment of the suite of mental illnesses that can be best summed up as, "does not play well with others" but not extreme enough for jail and/or a padded cell.

By way of background, I was an anthropology major and H was a psychology major who almost double-majored (had Chicago allowed that sort of thing) in anthropology. H went on to get her PhD in clinical psychology and is even now dealing with mostly male prisoners in a high security prison. She's an adorable petite blond, so I imagine her dealing with Hannibal Lector type situations often.

H and I got to know one another well on an archaeological field school in the Cantabrian region of Spain digging a Lower Paleolithic cave site (if there’s something more boring than the Lower Paleolithic, it’s the Upper Paleolithic) so we had plenty of need for distractions. We spent hours together talking about the anthropological components of how less extreme mental aberrations are dealt with in different societies.

Anyone who has attended an archaeological field school will understand why the subject of anti-social behavior and mental illness was on our minds. Field schools in general would make for another blog entirely as they really are their own unique “lord of the flies” style venue.

Let me be clear, we were not discussing the normal amounts of sub-divisions and cliques that develop in all communities (like the archetypal American High School jocks versus band geeks or something like that). We were discussing cases where there are consistent problems of getting along with any social group, no matter how specialized and/or marginal due to serious behavioral problems.

I had learned a little about the social aspects of treatment and diagnoses in mental illness while taking a class titled, Medicine and Culture, taught by Jean Comaroff, at U of Chicago. H always had interesting perspectives to add from psychology in which clinical treatment is often put into practice under specific cultural parameters. By this, I mean that certain treatments, like therapy, are designed to help individuals meet and maintain “normal” social relationships and hence are overtly culturally imbedded.

H and I mostly discussed the personality disorders as described by the controversial Diagnostic and Statistical Manual of Mental Disorders. These are basically mental disorders that lead people to think that they are fantastically brilliant, powerful, sexually attractive, and able to write poetry and read French even when they are sober.

As an aside I wonder if there isn’t something to the so-called mental “stages” of development that make everyone suffer from some form of so-called “personality disorders” before we grow up enough to know better. For example, I remember a time when I was about four, that I thought that marrying me would be just about the highest compliment anyone could get. Years of socialization have, alas, convinced me this is not the case. (Mr. Pretzel Bender believes that I still harbor such feelings but have grown wily enough to conceal them from the public. No comment.)

Cynically, I view a lot of the personality disorders much like I view the so-called “personality types”. I think they’re a bunch of heuristic sorting devices masquerading as real types with predictive power. The “bad” traits are lumped under empirically messy “groups” called separate personality disorders that cannot be linked directly to specific brain conditions or chemical imbalances. This point is driven home by the fact that psychologists themselves often assign multiple and overlapping personality disorders to folks. The disclaimers the professionals typically use are that they are useful for “research purposes” which is a funny way of justifying reifications!

This is not to say that there aren’t real brain disorders that manifest in personality “problems”. Folks may exhibit many symptoms found among the personality disorders due to medical conditions and in lesser cases, therapy may help them develop coping strategies even if it does not address the chemical imbalance issues directly…but I digress.

Basically, the personality disorder “types” main function is to provide a neat label for insurance claims and treatment approaches. And I concede that the labels make it easier to soft pedal the harsh critique of the different negative traits as it’s easier to say “you have histrionic personality disorder” instead of, “you’re an attention whore who thinks too highly of yourself and it’s causing people to dislike you and lovers to leave you so get over your bad self”. Of course, if they look up the personality disorder traits, it’s pretty obviously a direct translation.

H had similar views herself, and commented further on the phenomenon in which a person, upon reading the Diagnostic Manual on Mental Disorders, would begin to see them everywhere (not entirely unlike me and my sister’s reaction to reading Camus’s The Plague in high school where we became suspicious that every cough could be a symptom, however unlikely, of the deadly pneumonic form of the bubonic plague). H would doubtless be amused by The Onion’s take on the tendency towards amateur mental health diagnoses in this article.

Our favorite topic led us into a discussion of cross-cultural therapy, or more appropriately, methods for dealing with social problems through “social medicine”. One book that I particularly enjoyed in the Medicine and Culture class was Victor Turner’s The Forest of Symbols: Aspects of Ndembu Ritual.

Turner’s book is a series of ten essays about ritual among the Ndembu people of Zambia in central Africa. Originally compiled in the 1960s, Turner’s book continues to be referenced so it must continue to be of value to Africanists.

The bit that I remember most vividly from this book concerns the Ilhamba cult, which I recalled in shorthand as the Ndembu tooth extraction ritual. I believe that Turner’s theoretical perspective informed his view of various ritual and medicine cults as means of providing social cohesion in the mobile and politically unstable village units. At the time I was more fascinated by his interpretation of witch doctor practice as therapy than his social theories.

As an aside, although he has been labeled as being a member of the structural functionalist theory camp (don’t ask, anthros like labels), upon reading him again, I find that he is hard to pigeonhole. He combines ethnographic narratives with anthropological syntheses in well-written essays which, although informed by notions of social “functionality” of ritual form, never descend into caricature. There’s no substitute for good old-fashioned data gathering is there?

According to Turner, Ilhamba refers to the upper central incisor tooth of a deceased hunter. A hunter’s incisors in particular bear a special meaning and power among the Ndembu. One usage concerns inheritance of the teeth as charms for hunters. The second usage is the notion of hunter teeth as potential escapees, wandering teeth in search of flesh that, once theoretically embedded in unfortunate victims, can cause all matter of harm. This harm can be inflicted by unhappy dead relatives or outside sorcerers or witches working their influence from outside. The Ilhamba affliction is the cause of the tooth extraction ritual, which as Turner describes it, amounts to social group therapy. As he puts it, the witch doctors who undertake the cure of Ilhamba are, “well aware of the benefits of their procedures for group relationships, and they go to endless trouble to make sure that they have brought into the open the main sources of latent hostility in group life.” (1967: 367).

One case study described a man named K who did not get on well with his community. K was a bit high-handed, a little too certain of his extreme importance in the world and was apparently unable to live up to social expectations of his behavior in terms of reciprocation, social duties, etc.

Even the outside observer anthropologist seems under whelmed by the patient describing him in generally unfavorable terms, “he was more snobbish than most”…”he [K] felt that, ‘people were always speaking things against’ him”…”withdrew from village affairs and shut himself up in his hut for long periods of time”.

K wasn’t liked and he wasn’t happy about it.

What to do?

Well, call the witch doctor of course!

The witch doctor in K’s case first took charge by interviewing K and many of his associates to assess the general social situation. Next, the performance of the Ilhamba extraction was undertaken. K required several different extractions based on the judgment of the witch doctor of the complexity of his case.

During the performance the whole community is present and the witch doctor makes incisions on the patient, and places cupping devices (animal horns) on the incisions which in addition to being suctioned on the body are actually sucked on themselves (they have the small end cut off) so that during the ceremony, blood will come out of them. The whole thing takes several hours with periodic checking of the horns to see if the human tooth of the hunter shade causing the problems has appeared in one of them. During each break, when the tooth has failed to appear, the witch doctor explains reasons for why the Ilhamba won’t come basically detailing the history of the patient and inter-community problems. Community members are then exhorted to come forward and confess any hidden ill-will towards the patient and the patient is likewise encouraged to confess his or her feelings of ill-will and grudges.

At the center of it all is the witch doctor, who includes people strategically into all parts of the drama to manage community conflict. At the end, after everyone has had their say, a real human tooth appears in one of the horns removed from one of the swollen and bloody incisions to much rejoicing.

Ick. Actual wounds and blood! (Turner comments that the tooth appearance though obviously faked, does not make the ceremony any less significant.)

In the case that Turner describes, K ‘s extractions allowed him to rejoin the community with many of his old problems and village tensions resolved. In visiting a year after his observation of the ceremony, Turner found that K was ostensibly doing better and more or less fitting in.

Turner concludes that the real task of the Ndembu witch doctor was not to cure K’s individual ills or to tell K what he was doing wrong; rather, it was to heal the corporate group and allow K to interact positively with the whole, which required everyone’s participation. Turner also notes that the Ilhamba ritual took time to deal with K’s delicate interpersonal relationships and problems. H and I noted that the ritual also allowed K some amount of absolution in that he was not required to “take blame” for his Ilhamba affliction, although he was required to listen to his misdeeds and even offer criticisms of his own. And it was all backed by a powerful belief system.

H and I found this fascinating. H claimed that like the Ndembu tooth extraction ritual, American therapy really wasn't designed to “tell people the truth" reason (among many) that I would make a terrible therapist.

For example, I would have the almost overpowering urge to say, “Well, actually, your relationship problems stem from your [insert negative character trait here]; these traits, combined with infractions [e.g., cheating, boozing, neglect, etc.] have proven fatal in every case so just stop doing it already."

Apparently, American therapy is not about telling folks who they really are or how they are actually perceived by society at large.

Instead, it's all about behavior modification.

Therapists are highly trained manipulators.

They are there to help you, as H euphemistically put it, "interact positively with others". People are typically in therapy because they’ve recognized that they have a problem in their interpersonal interactions and/or in how they treat themselves/their body (addiction, etc.). Or their families and friends tell them they need it.

The therapist in this NYTimes article appears to agree with H’s take on therapy, further noting that people's need to find reasons (they had a terrible childhood, etc.) is less important than that they find a way to change their behavior and that folks finding redemptive reasons for “why” were actually detracting from the point of their therapy, which was to enact personal change not grant absolution.

It seems that American therapists in this case may underestimate people's need for absolution. It's not many people that can take on their own weaknesses and faults head-on. What they really want to hear is that somehow it's not their fault.

Metaphysical absolution is apparently easier to achieve than the acceptance of peers and lovers through social negotiation.

But seriously, after the Ndembu example, simple supernatural redemption seems like a cop-out to me. Clearly the downside of American therapy is that there are few mechanisms for group re-integration other than relying on the individual’s own personal abilities and impetus to socialize. I fear this means that only those with relatively tractable behavioral maladies will have the ability to gain acceptance and form better social connections with therapeutic help as it currently stands.

The rest will flounder with no communally understood and accepted means of re-integration.

Our way seems a bit cold-hearted to me!

Serious social problems, even in complex societies like ours, which tolerate deviance better than Ndembu villages, carry their own terrible built-in penalties in the form of social isolation, whether self-imposed or socially imposed.

The Ilhamba cult, because it allowed for both absolution (the patient is not blamed for the Ilhamba affliction) while simultaneously insisting on open airing of bad feelings and behavioral problems with a re-integrative resolution, appealed to me and H as a preferred method.

However, Turner himself was cynical as to the efficacy of such therapeutic cult practice without the religious belief system backing it up. He ends his essay on the Ilhamba cult by concluding, “Stripped of its supernatural guise, Ndembu therapy may well offer lessons for Western clinical practice. For relief might be given to many sufferers from neurotic illness if all those involved in their social networks could meet together and publicly confess their ill will toward the patient and endure in turn the recital of his grudges against them. However, it is likely that nothing less than the ritual sanctions for such behavior and belief in the doctor’s mystical powers could bring about such humility and compel people to display charity toward their suffering “neighbor”!” (1967:393).

Unfortunately, these sorts of things rely on the tractability of all parties as well as an adept practitioner of the witch doctor therapy cure!

Bring on the Ndembu witch doctors!