Psychoanalytic Understanding of Ritual Cure and Prophylaxis

Psychoanalysis, Freud tells us, is a mode of treatment of mental illness, a method on which that treatment is based, and a theory built on the results of that method. Let us begin with the mode of treatment.

If psychoanalysis can provide a treatment that cures neurosis in our own culture, then it must also be possible, using psychoanalytic theory, to understand the successes of native therapies in other cultures. To the extent that shamanic cures (Freeman, 1967; Toffelmeier & Luomala, 1936), healing by curanderos or diviners (Turner, 1961/1972, 1967, chapters 6 and 10), cures of spirit possession by trance, and cures through "sings," or other ritual means are effective in overcoming symptoms— psychoanalysis may be able to provide some understanding of their process of cure. In a case I have discussed with David Szanton, a girl was taken to 16 different babaylans (a kind of curer in the Philippines) for episodes of violent symptoms. Only the seventeenth was able to relieve her, at least for a time. She did this by identifying an intense emotional issue in the family that had remained submerged: the mother had had a call to be a babaylan but the father would not permit her to do so (Guthrie & Szanton, 1972). Sudhir Kakar (1982, chapters 2 and 3) was able to interview patients visiting a Muslim pir (saint) and a healing shrine, to understand their problems and some of the ways in which the cure helped them.

Such cures need not be limited to hysterical or purely psychosomatic symptoms, or illnesses traditionally regarded as having a psychological component. It is becoming increasingly evident that the effective working of the immune system and the body's combating of illness respond strongly to emotional states, so that the seemingly astonishing cures by faith healing or other ritual methods may be attributed, in some cases at least, to the effect of belief on the sick person's ability to combat disease.

Although not generally considered a psychoanalytic anthropologist, Claude Lévi-Strauss has provided the best comparison I know of between healing ritual and the psychoanalytic process, and an excellent formulation of the nature of psychoanalytic treatment. His 1949 article "The Effectiveness of Symbols," gives a brilliant demonstration of the healing effectiveness of a Cuna shamanic ritual to deal with difficult childbirth, and a comparison with psychoanalytic cure. He shows that the Cuna ritual (in Panama) works through reproducing, in a shaman's song, a Cuna mythic landscape, creating an identification between the woman's own internal "landscape" (her birth canal), as subjectively perceived by her, and the cosmo-logical landscape of the myth. By naming the pains to the suffering woman—"presenting them to her in a form accessible to conscious or unconscious thought"—the shaman's song "renders acceptable to the mind pains which the body refuses to tolerate" (Lévi-Strauss, 1963, p. 197). "In our view," Lévi-Strauss concludes, "the song constitutes a psychological manipulation of the sick organ, and it is precisely from the manipulation that a cure is expected" (p. 192; italics in original). Conversely, Lévi-Strauss suggests that psychoanalysis works by taking a "personal myth" constructed by the patient from his own past, and recreating it as a new personal myth incorporating previously repressed memories of the patient's. While some psychoanalytic anthropologists object to Lévi-Strauss's reformulation of the psychoanalytic cure (Bernard Juillerat, personal communication), I am not alone in considering it a brilliant formulation of the psychoanalytic process. The French psychoanalyst Jacques Lacan, whose theoretical formulations of psychoanalysis owe a great deal to Lévi-Strauss, borrowed the concept of "the individual myth of the neurotic" in his reformulation of psychoanalytic theory of treatment (Lacan, 1953).

A number of psychoanalytic anthropologists have looked at treatments for aberrant states of mind—mental illness—in "primitive" or nonwestern cultures. Anthony Wallace, for example, in several articles discussed traditional Iroquois dream interpretation rituals as a way of dealing with the psychic conflict expressed in dreams. The requirement that the dream be acted out, literally or symbolically, provided a kind of catharsis, he suggested, which prevented the conflicts in the dream from fulminating under repression into a full blown mental disorder. He compared this method to Freud's early "cathartic method" of hypnotic treatment that preceded the full development of psychoanalysis (Wallace, 1958, 1959). Yoram Bilu, an Israeli psychoanalytic anthropologist, has also shown parallels between the interpretations given by an early 20th-century mystic healer in Baghdad, Iraq, and some of Freud's dream interpretations (Bilu, 1979).

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