AFFLICTION: AN OVERVIEW

Men, but more so women, have frequently viewed themselves as the victims of unsolicited and malevolent attention from the spirit world. Sometimes such affliction is thought to come out of the blue or to result from some quite trivial misdemeanor. More often it is thought to result from disputes or transgressions committed by the victim or by a relative. The outward signs of affliction are not uniform or obvious. They range from grossly stigmatizing conditions such as leprosy or madness, through trance, to a subjective malaise or a feeling that one has not received one's just deserts. The mechanics of attack vary. Some victims are able to describe the details of the method of attack with great precision. Others show no interest either in the reason for attack or in the method deployed. In the course of fieldwork in Maharashtra this author was told, "We are all laymen where witchcraft is concerned." In other words, no one likes to admit to a familiarity with the techniques of witchcraft for fear of being suspected a witch oneself.

Affliction is thought to be the result of human agency in some cases, divine in others. Under the rubric of divine agency lies a whole gamut of gods and spirits who are thought to take an interest in human affairs. The divine agents who interfere and cause damage in human lives have been described as peripheral to the central religious concerns of the society in question. This nomenclature is more fully discussed by I. M. Lewis in Ecstatic Religion (1971). Children's ailments in particular tend to be attributed to possession by a deity. In Nepal, for instance, there are three deities, Hartimata, Bhat Bhateni, and Swayambuth, whose special sphere of interest and activity is the diseases of children. In India smallpox is commonly attributed to the Hindu goddesses Sitala and (in some regions) Chechak. In such cases it is important to identify the deity responsible for illness or misfortune in order that he or she may be appeased and further damage averted. This is not the case where the afflicting agent is a spirit: in such instances victims and their families express a relative indifference concerning the exact identity of their adversary.

More often, however, affliction is thought to result from the malevolent machinations of another human being. This involves either capturing a spirit and directing it to possess the victim or else attacking the victim less circuitously by magical means. In either event the afflicted feels circumscribed by malice. Social anthropologists have often advocated a distinction between sorcery and witchcraft. The basis for the alleged distinction is that sorcery involves some physical manipulations and its efficacy depends upon learning the appropriate skills or techniques to achieve its ends, whereas witchcraft depends upon the possession of appropriate powers that transform malevolent desires into reality. (For a fuller discussion of this distinction see Middleton and Winter, 1963.) In practice this distinction appears to be more important to anthropologists than to those who bear the brunt of attack by witchcraft or sorcery. Far more important in terms of the severity of the illness, its prognosis, treatment options, and eventual outcome is the source of the affliction—in other words, whether it has been wrought by divine or human agency. It is widely held that where the afflicting power is of human origin the illness is of a more serious nature and less amenable to treatment, whereas illnesses of divine origin on the whole respond more readily to treatment. The idea that humans are less tractable and less persuadable than gods may seem strange from a Western perspective. However, whereas a dialogue can be initiated with a possessing spirit, witchcraft represents an irredeemable breakdown of human relationships: One may plead with the gods but not with an angry relative. In Maharashtra women who have lost status through, for example, divorce or barrenness interpret their plight in terms of attack by witchcraft. This observation appears to be borne out by literature from other parts of the world: Where society fails to care for an individual in the sense of allocating him or her a proper place, there witchcraft is held responsible for the stigmatized circumstances of the individual.

How is spiritual affliction identified and distinguished from natural illness? In some societies certain conditions are synonymous with spiritual affliction. For example, trance is well-nigh universally held to have a spiritual etiology, madness and leprosy widely so. Other symptoms are not so easy to place. In some societies categorization is made easier by immediate recourse to a healer who makes the diagnosis on behalf of the patient. In Nepal, for instance, the bulk of the population initially consult a healer in order to determine the causation of symptoms and to ascertain whether consultation with a medical doctor would be appropriate. The healer will determine whether or not the illness is likely to respond to Western medicine and, if so, when would be an auspicious time to consult the doctor. Failure to consult at a proper time and day may jeopardize one's chances of recovery. In practice, once the healer is consulted, few patients are turned away, as the healer's province of practice is all-embracing. Where the individual alone assesses the etiology of his or her illness, criteria for distinguishing spiritually caused from naturally caused illness are less clear-cut. Spiritual affliction is suspected if Western medicine and treatment fail to make one better, or even make one worse. Sometimes the quality of a pain has a distinctive and unusual flavor that raises instant suspicions in the patient's mind. Respondents are hard put to describe the precise quality of this distinctiveness, however confident they themselves may be of identifying it correctly. In other cases it may be the circumstances, such as an earlier dispute or envious comments, that alert the patient to the possibility of a nonnatural causation of his illness. In Nepal, among people who make use of both traditional healers and of doctors, there is a tendency to take routine ailments such as fevers and diarrhea to the doctor and more unusual or serious complaints to healers. Quite how such treatment choices are made remains to be studied.

It is widely held, but only partially true, that the spiritually afflicted are predominantly women. Informants themselves, both women and men, readily acknowledge that women are more vulnerable to spirit possession. Most often reference is made to women's alleged lack of willpower and alleged emotional liability. Frequently, mention is made of the greater risks run by women during menstruation. At such times women are held to be more vulnerable to attack by spirits. Members of the spirit possession and healing cults of northeast Africa described by Lewis (1971) are, indeed, almost exclusively female. Lewis has been most explicit and influential in his exposition of a specific epidemiology peculiar to spirit possession. Briefly, he argues that deprived women in a harshly repressive masculine culture succumb to spirit possession, particularly if they are embroiled in some personal dispute with their husbands. However, there is danger in extrapolating from these zar cults of Muslim societies to healing cults in other parts of the world.

Much of the literature in this area has concerned itself with an interpretation of the healer's art and an exegesis of the symbolism of healing rituals. For example, Larry Peters's Ecstasy and Healing in Nepal (1981) provides a uniquely literal interpretation of participant observation and is written from the perspective of a shaman's apprentice in the Kathmandu Valley. As such it provides an extraordinary account of shamanistic theory and practice but conveys predictably little information on the healer's clientele. Bruce Kapferer's study (1983) of demon possession in southern Sri Lanka likewise demonstrates through analysis of symbols why healing rituals may be therapeutically efficacious. A study by the Indian psychoanalyst Sudhir Kakar (1982) suggests that while most of the patients afflicted by bhūt (spirit) at a healing temple in Rajasthan were young women, affliction tended to shift between different family members. In other words, the original affliction may well have affected a male member of the family and may then have been transferred to a woman in the course of her caring for the patient. Similarly, studies of illness behavior in England show that women take on the burden of care and support for the sick. This author's study of a healing temple in Maharashtra (Skultans, 1986) finds that women attended the temple in gratitude for past cures, in lieu of another family member, or to accompany an afflicted person. Some women who were themselves afflicted came unaccompanied. All of these cases contributed toward creating a female majority. Similarly, in an earlier study of Welsh spiritualists (Skultans, 1974), this author found that although the spiritually afflicted were for the most part women, the problems that beset them were common to the family. It seems, therefore, that the afflicted are giving voice to wider problems that beset the entire family.

Affliction is most often a family affair or even a community affair. Its social structure is superbly described in John M. Janzen's highly esteemed account The Quest for Therapy in Lower Zaire (1978). The family is important in managing the patient and his affliction (Janzen uses the term therapy managing group ) and is also implicated in the causation of the affliction. The affliction is thus seen as being in large part the responsibility of family and community. While the onus for making major treatment decisions lies with the kin therapy group, so does the obligation to resolve interpersonal conflicts and rivalries within the group. It has become well-nigh a truism that illness—spiritual affliction in particular—provides an opportunity for demonstrating social solidarity through a reassertion of mutual loyalties and common values, and most studies appear to bear this theory out. The very act of reintegrating the afflicted individual into his social group serves as a reminder of the group's identity.

In the course of fieldwork for a Maharashtrian study the author of this article uncovered a complex web of family involvement. Although initially one particular family member would be singled out as in need of help, it would soon be found that the entire family was afflicted. The typical pattern of affliction developed thus: Mothers, or sometimes wives, would bring their psychotic or mentally handicapped sons or husbands to the temple. A short while after arrival the patient's chief caretaker, usually the mother, would start going into a state of trance. Such trance was seen as a diagnostic tool whereby a dialogue could be initiated with the possessing spirit that would provide information concerning the nature of the illness. Trance invariably revealed that the source of the sufferer's affliction was witchcraft (karni ) or possession by a spirit (bhūt ). This malevolent power was directed at the whole family because of some dispute, rivalry, or envy, and the son or husband was seen as happening to be its unfortunate victim. It was thought that the original affliction might be deflected away from the first victim if the mother or some other person took over the burden of illness and that, since the family was the target of attack, any one member could substitute for another. While this belief augured well for the prognosis of individual affliction, it meant also that the individual's cure in no way signified an end to family distress. Informants cited patterns of family illness in support of this interpretation wherein affliction assumed a hydra-headed quality striking different members of the family in different ways. Sometimes one person, most often a woman, would pray that the burden of family affliction be transferred to her. If and when her prayers were thought to be answered she would begin to experience trance regularly and to decline into chronic ill health. Thus female sacrifice plays a central role in the maintenance of family health. A significant feature of this theory of affliction is the shared concern and responsibility it generates for conditions that might otherwise be perceived as extremely annoying. Typically a number of courses of action are open to the afflicted, which can be grouped under the categories of community care and specialist care.

Community Care

The afflicted person may join a community or cult of the afflicted. Here the emphasis is on learning to accommodate the affliction rather than removing it. Where the affliction involves trance, this means regularizing the times of trancing. The affliction is thus transformed from a sudden, unintelligible outburst into a routine and usually mild handicap carrying with it a number of secondary benefits. Foremost among these is the companionship of the similarly afflicted. Such communities do not usually offer specialist treatment, but they are run by veterans who have themselves experienced and learned to live with the full spectrum of affliction. Indeed, cults of affliction share many of the features of Western forms of group therapy.

Specialist Care

From a treatment perspective, healers can be categorized according to the amount of time they are able to devote to individual cases. Some healing rituals are lengthy affairs spanning several days. Social anthropologists have demonstrated the therapeutic goal, if not the effect, of such rituals. An important ingredient of all such rituals is the symbolic representation of internal conflicts and the process of their resolution; the rituals thus come to symbolize the newly reconstituted self. They are public and involve a large audience. Such demonic healing rituals have been particularly well described by Kapferer in the study already cited.

Most often, however, the confrontation between healer and afflicted is of a more fleeting and less intense nature. Healers who have acquired a reputation for the successful management of the afflicted attract a huge clientele. The more popular a healer becomes, the less time he is able to devote to any one patient. This results in the paradoxical situation that the elaborate healing rituals described in loving detail by social anthropologists are carried out by those healers who have relatively few patients. Such time constraints on treatment are evident in Arthur Kleinman's description of the practice of a popular Taiwanese shaman (Kleinman and Sung, 1979). This shaman is described as spending an average of five minutes with each patient and only two minutes on busy nights. No doubt such restrictions on consultation time inhibit the performance of healing rituals. Thus, it seems, the price one pays for consultation with a prestigious healer is the whittling away of healing rituals. However, the abbreviation and attenuation of contact between healer and patient do not appear to diminish the popularity of the healers or, indeed, their reputation for success in curing affliction. Perhaps, therefore, the power to alleviate the affliction lies as much in the circumstances surrounding the consultation as in the actual consultation itself. Family support for the victim, as well as an explanation of the affliction that lays the burden of responsibility on the family rather than the individual, may play a part in the recovery of the patient.

Psychiatrists have suggested various explanations of trance (the most frequent manifestation of affliction), but none is entirely satisfactory. The most commonly held view, derived from Freud, is that trance is akin to hysteria, a view that unwittingly reinforces the stereotype of trance as a female affliction. Freud himself made the much-publicized claim that he had restored dignity to patients who would in an earlier age have been branded as possessed by the devil. Certainly, there are similarities between the clinical description given of the convulsive attacks of hysterical patients and the behavior of people in certain kinds of trance. The anesthesia of hysterics and the occurrence of anesthetic and nonbleeding areas on alleged witches provide a further point of similarity. Jung views neuroses and possession states as sharing a common etiology, namely, moral conflict, which he claims derives from the impossibility of affirming the whole of one's nature. This state then gives rise either to symptoms that are in some sense foreign to the self or to possession by a foreign being. Both conditions involve an inability to express an essential part of oneself, which is thereupon suppressed and which demands alternative expression. The rudiments of this psychoanalytic approach to possession and trance have become incorporated into many later accounts. However, while having considerable explanatory power, such approaches fail to take into account the element of learning in trancing behavior. In many contexts trance is viewed in a positive, beneficial light and is consciously sought after.

Affliction has a variety of meanings. It may signal the start of a career as a religious specialist. It may usher in an entirely different lifestyle as a member of a cult of the afflicted. It may entail a round of consultations with various specialists who may or may not be able to lift the affliction. Or it may simply be a marker for one of the expected ailments of childhood or hazards of later life.

See Also

Exorcism; Healing and Medicine; Spirit Possession; Witchcraft.

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