By Paul Brodwin. Cambridge University Press, NY, 1996. 201 pp.
ISBN #: 0521-57029-8 (hard bound)
ISBN #: 0521-57434-5 (paper)
Reviewed by Bob Corbett
For those of us in the U.S. or other developed nations there is basically one primary mode of healing: western medicine with hospitals, doctors, nurses, all sorts of fancy technological devices and medicines manufactured by huge concerns and overseen by the government. This medicine Paul Brodwin calls biomedicine.
There are other options available to us westerners: homeopathic, chiropractic, herbalist, even Asian healing practices including acupuncture. However, these are clearly not mainstream practices of healing for those of us in the developed world. We tend to have one general procedure for serious illness: seek a physician and follow the pattern to which that leads. What is so characteristic is the lack of thought one needs to put into it. After all, the doctor knows best.
No so in Haiti. Brodwin, a medical anthropologist, recounts his fieldwork in a village in the southwestern part of Haiti in which he documented the healing practices of many people in some 18 months of field research. He tells a tale of such complexity that it boggles the mind to even follow the patterns which he details, to say nothing of the sophistication it would take for a sick person to follow these diverse patterns, making so many decisions along the way.
On Brodwin's account there are two primary categories of decision: one is a medical decision: What treatment shall I seek? The other is a moral decision: To what extent is my own behavior responsible for this illness? Each of these questions must be negotiated, decided upon and the proper course of action taken.
There actually is another obvious issue which Brodwin touches upon but doesn't say much about: money and availability of biomedicine. Brodwin allows that virtually every one would prefer biomedicine at the outset. But both money and availability of services limit that option for most people, particularly rural Haitians. Nonetheless, to follow the logic of what Brodwin uncovers, we must assume that first and foremost one begins with biomedical healers. We need to start here since the first distinction uses biomedicine as the deciding test of what sort of illness this is.
There are two sorts of illness: Illness of God and illness of Satan. The criterion that separates the two is can biomedicine cure the illness? If so it is an illness of God and the best way to treat it is with biomedicine if one can afford it and if it is available. If not, one must attempt to come as close as one can with other sorts of healers who in some sense imitate biomedicine -- herbalists, bonesetters, injectionists, midwives and itinerant medicine sellers.
Illnesses of God are, if I correctly understand Brodwin's argument, rather morally neutral. These are illnesses of nature which anyone might get, and for which no blame falls to the sick person for his or her illness. But, illnesses of Satan are another matter altogether. These cannot be healed by biomedicine (what the criterion really means is that with some reasonable chance to try biomedicine on a short-term basis, biomedicine has not in fact cured the malady, thus the illness is now regarded by the patient, family and even local community, as an illness of Satan). The patient will now have to choose among three dominant manners of treating the illness:
Thus not only does one have to choose a particular healing regime to enter into, but one must decide the moral status of one's self in relation to the sickness, and in relation to one's general moral goodness or wickedness.
What I describe above is, as best I follow the complex story Brodwin weaves, the general pattern which the patient follows or faces when one is seriously ill. What sort of illness is it? And, if an illness of Satan, what is one's moral status, and which healing strategy ought one follow?
Actually Brodwin points out that it is not at all unusual for people to be trying several healing strategies at the same time including strategies of both illnesses of God and illnesses of Satan. That is truly mind boggling. Think of the complexity and the expense of such an array of medical options.
I came away from Brodwin's book feeling I'd learned a great deal, but with many questions. What stuck me as the most puzzling thing was that his account is quite different from many accounts I have read in other authors who have written about healing in Haiti. Michel Laguerre, Alfred Metreaux, Karen McCarthy Brown, Gerry Murray among others, come to mind. The picture that I normally got from these sources was this:
A person came down with an illness and immediately assumed that the illness was probably caused by a lwa because the person had neglected the lwa. On previous accounts I have read "sending sickness" was allowed as a possible source of illness, but of a much less common origin than the more typical source which was neglect of one's duties toward family spirits or the more cosmic spirits.
These reports had always left me with a sneaking suspicion that something was being left out, or that I was missing something. I've been to Haiti more than 40 times in that past 13 years and spent a great deal of time in rural Haiti. The dominant talk I had heard was of the desire for biomedicine, the more the better. Thus I was most sympathetic to Brodwin's initial account which fits very much with my own experience, that first and foremost, people wanted biomedicine, which, of course, was not going to attribute the illness to the neglect of the lwa.
On the other hand, I was (and am) suspicious of Brodwin's account which virtually ignores the question of illnesses of Satan being illnesses attributed to ignoring spirits, rather than illnesses which are "sent" by another human being out of jealousy, meanness or covetousness. I wish Brodwin had at least addressed the fact that his findings differed so much from what seems so common in previous popular literature on healing in Voodoo, and perhaps speculated as to why he reports such a different account from these other authors.
In some ways he does -- and this is the source of another discomfort I have with Brodwin's very different account. He allows that when a person has an illness of Satan and chooses the houngan (they must not have had a single mambo where he worked; to the best of my memory none is ever mentioned), the sorts of curing that the houngan employs does not normally involve ceremonies and animal sacrifices and so on, but concentrates more on locating the person (or preferably) the houngan who sent the sickness and working to counteract the curse or sickness in this manner. Brodwin does allow that in some rare cases this might involved sacrificing a cock to the lwa, and in extreme cases even holding some form of ceremony, but this is quite unusual. He further acknowledges that this is quite different from normal accounts one reads in well known sources from such people as those I mentioned above. But he rather weakly writes them off as primarily writing about Voodoo healing as practiced in and around Port-au-Prince and not in the country side. However, the extensive writings of Gerry Murray on these topics can certainly not be considered as writings coming from Port-au-Prince, but are every bit as rural as Brodwin's own sample.
On the other hand, something about Brodwin's account again rings true of my own informal and non-anthropologist experience: in many visits with people in the remote countryside of the Plateau Central, I was always amazed at how much the houngan and mambo were relied upon for healing, and how very seldom the healing practices used the more formal religious rites of the Voodoo services, but used practices much like Brodwin described, that is, attempts to work one on one with the patient rather than through a more thorough going service. However, again, in my own limited experience, I heard more talk about illnesses being caused by neglect of the lwa than from some human being sending a sickness.
Actually in most of the literature on Voodoo which I have read the distinction between illnesses from neglecting the lwa and illnesses connected with sent sickness, also involved the distinction between houngans and mambos practicing Rada rites, on the one hand, and those who work with sent sickness, the bokors (virtually always men) in the Petro rites on the other. I am prepared to believe that this rather standard picture is wrong, but I do wish Brodwin had acknowledged it and addressed it.
All of these cautions and puzzles are details. Interesting details to me, but not claims that Brodwin has erred or that the book is weak. Quite the contrary. It is so interesting and strong precisely because he seems to challenge the more standard accounts and presents a picture of healing in Haiti that is incredibly more detailed and complex than any other account I have ever read.
In fact it is all much more complex than I report. I've only skimmed the surface and tried to gather the central details or I would have had to go on for many more pages. To sum up, then, the central picture which Brodwin presents is this:
I do have one other puzzle concerning the central section of the book which is on healing in Haiti. But it is about practices allowed to anthropologists. I was quite surprised that Brodwin nonchalantly announces that he several times paid for a sick person to consult a houngan so that he could attend the consultation to observe the pattern. Additionally, he allows that he paid for other medical treatment, sometimes just to help the sick person, but on other occasions, a central motivation was to observe the process. I would assume that many of you on this list have been to rural Haiti and have engaged in some charity work or some development work. If so, I am sure that one's experience would be much like mine. As soon as aid or money is forthcoming from me, many things change and I get the distinct sense that life is not going on in the village like it normally does, and I am the primary reason. Things change in order to take advantage of what I have to offer, and thus I get a somewhat unrealistic picture of village life. This worried me in Brodwin's work. Now perhaps the fact that he lived for an entire year at one point, and then two three month stretches at other times meant that he stayed in the village long enough that real village life dominated. But, it is a puzzling phenomenon to me. I was also a bit taken aback that such helping-the-subject-as-a-mode-to-access is an acceptable practice in anthropological inquiry. It seems like a practice that sets one up to be deceived.
What I have described above is what I take to be the guts of Brodwin's account, and the report for which he has 18 months of field work and extensive interviewing, participating in healing activities and just being in and listening to what was going on in a rural Haitian village. It is extremely provocative and an account which I hope Brodwin will elaborate upon in the future, particularly addressing more head on the seemly radical differences in his observations and that of many others who have written on the subject. I even like this section so much that I wish I could just end my remarks here.
But, the middle section is not the entire of the book. Of the 201 pages of text, the report of his field work and his interpretation of what it all means are contained between pages 56 and 189. The initial chapter was one I found much less persuasive or well-argued, at least in part. It begins well enough. Brodwin does a fascinating mini-history of the coming of biomedicine to Haiti, and traces how it develops from a relatively rare phenomenon, to a major factor in healing in Haiti.
Brodwin points out that biomedicine was present during the French colonial period, but in extremely limited form and place. It was only in the major towns, and then usually in a single hospital whose task was primarily to care for military personnel and wealth citizens. But, since slaves were such valuable property their medical needs had to be met. Thus each plantation had to provide its own medical facility, and given the dire shortage of biomedical practitioners, this system of many sorts of healing began to develop in the absence of any concentrated option to biomedicine.
On Brodwin's persuasive account this dual system continued to be dominant until U.S. occupation of the 1915-1934 period. During that first occupation the U.S. encouraged and funded the penetration of biomedicine into most of Haiti, albeit on a modest scale.
However, as Brodwin traces this interesting history, he accompanies it with a highly speculative and heavily ideological thesis of what this meant (and continues to mean) to Haiti. Absent here is the complexity that Brodwin found in his field research. The world is reduced to a nice and simple neo-colonialist plot theory presented in such a preachy manner that it almost made me put the book down. I am so happy I didn't. I soon arrived at the very concrete experiences in the second section which rewarded me for waiting it out.
While the history of the first chapter is fascinating, what struck me was the total lack of complexity that existed in Brodwin's plot theory analysis. Biomedicine is seen as invasive and virtually the source of all evil in Haiti. Brodwin choose to ignore the fact that by any measure one can propose, biomedicine is the most successful strategy of healing used in Haiti. He also ignores the obvious fact that virtually every Haitian person would prefer this system of healing to any other and that the primary reason it is not the dominant system of healing as it is in the developed world, is that it is too expensive and not as widely available. Rather, his summary position is this:
"The narrow physical emphasis of Western medicine, it is claimed, has a powerful effect on individual subjectivity (see Gordon 1988). By locating pathology in the individual, and treatment in private settings divorced from everyday life, biomedicine weakens alternate accounts of the social sources of suffering and health. Biomedical knowledge de-socializes disease, and thereby authorizes the particular 'truth' that diseases are biological events, arising through impersonal, natural laws, rather than social ties and interests. Biomedicine thus helps construct the individual as an autonomous subject -- a center of cognition and feeling -- who exists against a background of facts and material objects (Comaroff 1982). This form of subjectivity -- in facts, produced by both biomedicine and Christian conversion -- advances colonial rule. It subverts pre-colonial forms of consciousness, instills habits of self-reliance, efficiency, and work discipline, and hence paves the way for wage labor and other forms of colonial capitalism. (e.g. Ranger, 1992)." (p. 53-54).
After the interesting history and disappointing ideological preaching of the first chapter, the long middle section of the book was a delightful high for me. Unfortunately, the last chapter, the conclusion, was a great let down. But, in no way do I fault Brodwin for my disappointment. It is much more personal. As a non-anthropologist, I just come to this book as a person with a passionate interest in Haiti. I didn't read the book as a book on medical anthropology (which it is), but as a book about healing in Haiti. In this regard, however, I think I am like most readers of this list. As such, I'd suggest you simply skip the last chapter: the conclusion. Here Brodwin reveals that this wasn't really done as a study of Haiti for the sake of elucidating the situation of healing in Haiti. Rather, Haiti was a convenient subject to study to shed some light on epistemological problems within the profession of medical anthropology. Again, I have no quarrel with Paul Brodwin on that. He is a professional medical anthropologist and he has every right to want to make contributions to that profession, and, he at least convinced this lay person that he indeed did as he set out to do. Further, I haven't the slightest doubt from his book and other writings and contribution to this list, that Paul Brodwin is deeply interested in and caring toward Haiti.
But, as a Haiti enthusiast who had just finished reading 166 pages of very informative and challenging material about Haiti, it was a great led down to read the conclusion and discover that this was primarily an exercise in epistemology. The implication, of course, is that had the situation been right in Bali, Dominica or New York City to illustrate the needed epistemological point, well, it would have made little difference. We who want to learn about Haiti were just lucky that some things of epistemological interest to medical anthropology could be found in Haiti. Clearly, this is not Brodwin's problem, it is mine! But, writing to this group, I may well not be the only one who will be disappointed. So, careful with the conclusion. You might not want what you get!
Perhaps I have been too harsh in my treatment of the first and last chapters of this marvelous book. It's just that they stand out as so different from the middle longest section where Brodwin deals with empirical data that leads him to see complexities and entire patterns which few others have written about, and which has so enriched my views of healing in Haiti. In fact, I am so attracted to what he writes there that I have adopted this book as one of the three texts I will be using in my fall course on Haitian Voodoo. I recommend the book to anyone who has an interest in understanding a huge potion of life in rural Haiti.
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