CHAPTER 4:
HEALTH, DISEASE and WHOLENESS
The emphasis upon healing in the Independent churches has proved a challenge to the mission churches, which have largely rejected healing practices. African Christian theologians have responded to this challenge by speaking positively of healing practices in traditional Africa and the AICs, with a view towards incorporating these practices into the mainline churches. That Africans at the grassroots level gravitate towards a Christ as deliverer from all oppressive forces is evident in the AICs. O. Imasogie goes so far as to say that the mainstream churches are superficial largely because they fail to consider seriously these realities in the lives of everyday Africans. The concern of the people over health is evidenced in a 1980 survey which indicated that 75% of the population stated that health is their greatest concern, even above family (48%) and job security (33%).(1) Given the high level of importance which traditional Africa gives to the family this is all the more surprising and significant.
We shall address the theological response more fully in a later section. To understand more fully the context in which the African scholars write, it is helpful for us first to devote the following section to one aspect of the social construction of disease and health in Africa. This section deals with African conceptions of mental health and with the ethnocentrism of western reactions to it.
1: Ethnocentrism and African Healing
The question I shall explore in this section is, to what extent is western ethnocentrism and the divergence of worldview between traditional Africa and the west at the root of an ethical dilemma in the treatment of certain forms of disease? The problem of ethnocentrism and the inadequacy of the western scientific paradigm lies at the root of a wide range of medical problems. One example which brings it out in a striking manner is the instance of mashawe. Reports come from all parts of Africa regarding the widespread belief in illness thought to be caused by witchcraft or sorcery: cf. Daneel (1970) on reports from Zimbabwe; Shorter (1985, 34) on reports from all over East Africa, and Last (1976, 118) on the Hausa of Northern Nigeria. These illnesses take varying forms and are known by many names, but share many characteristics throughout Africa and the rest of the world. One ethnic group refers to its local variety as mashawe (sometimes mashave). Shorter (1985, 188) relates Bishop Milingo's desire to treat mashawe while the hospitals and doctors had refused to consider it a disease. The Shona refer to this disease as caused by the midzimu (spirits).
Witchcraft attack or "soul attack" has a wide variety of symptoms: anxiety attacks, grave fear, the symptoms of nervous breakdown and even death. A study of Nigerian students studying in England who had suffered from nervous breakdowns revealed that over 90% explained the cause of their illness as witchcraft (Lambo, 1964). Using psychiatric terminology, Kiev categorizes this phenomenon under the headings "phobic states" (Kiev 1972, 75) and "dissociative states"(86). This condition is widespread: Lambo's research led him to the following conclusion: "Anxiety, which is the most common and crippling psychiatric disorder in Africa, also forms the central core of other neurotic reactions in the African."(Lambo 1964, 450).
The local hospitals do not treat mashawe, for the doctors, who are of western background or training, do not see this condition as a "disease" in the sense in which western medical science understands that term (Cf. Milingo 1984, Daneel 1970, and Shorter 1985, 34). Mainline churches also avoid involving themselves in treatment of this phenomenon. However, the belief in this disease is persistent, and still paralyses many, even causing death in some cases (Shorter 1985, 34). I contention is that the tendency to dismiss or down-play the importance of a condition which is regarded with great fear and anxiety on the part of the masses should be understood as a dilemma for modern medical ethics. If one says that modern medical science is "scientific" and therefore may only deal with diseases known to have some empirical reality, it should be pointed out that western doctors are known to give placebos to hypochondriacal patients, merely because they know that the patient will not rest until some kind of "treatment" has been offered. Yet mashawe sufferers do not receive even a placebo at the hands of western medicine. Bishop Milingo said:
Many missionaries have never accepted mashawe as a disease worth healing, since they call it by their own name as a hysterical, and psychosomatic disease. They therefore consider anyone engaged in it as an imbecile who chases the wind. It is the problem of inculturation, much more [than] the refusal to plunge into it. (Quoted in Shorter 1985, 190).
It is universally observed that such sufferers inevitably seek help at the only places remaining which will offer it: at the abode of a local "native doctor" or ng'anga (often referred to as "witchdoctor") or perhaps that of a practitioner of one of the African Independent churches, some of whose practices resemble those of the ng'anga. David Barrett estimated the number of African Independent Church denominations in 1968 to be over six thousand (Barrett 1968). Since then, the number has grown dramatically and the Independent churches account for a sizable minority of all African church-goers. They combine many aspects of African traditional life, such as belief in the spirit world and magic with an organizational structure resembling western churches. Sheila Walker (1979, 1980) describes the healing centre at Bregbo in the Ivory Coast, a centre built by the Harrist Church (an Independent church dating from World War I) to cure witchcraft diseases in particular.
It is the belief of western trained doctors that such cases should be referred to a psychiatrist, as treatment of a disease without a discernible physical cause lies outside the scope of non-psychiatric medicine. This, however, is not an available option in most African hospitals, as very few psychiatrists practice there at present. It is reported that the entire nation of Malawi has only one psychiatrist in residence. The University of Jos Teaching Hospital in Plateau State, Nigeria, was considered relatively advanced in 1985 to be able to provide as many as two psychiatric practitioners for a general population of several million. In any case, the general attitude of doctors trained in universities of western orientation towards such conditions has already ensured that the populace do not look to them for answers. Una Maclean (1976, 306) reports: "Some people declared that 'hospitals can treat all diseases except smallpox and madness'." Some members of the general population warned of the inadvisability of taking to hospital patients whose illness was "due to the action of witches and wizards", and some prescribed prophylactic soaps to secure the goodwill of such potential evildoers. Virtually all the herbalists (some of whom were also diviners) claimed proficiency in this sphere. Maclean concludes (1976, 315): "mental illness, however defined, is deemed unsuitable for hospital care; here again the local judgement of the capabilities of general hospitals is justified."
It is our thesis that the ethnocentrism of western techno-rationality issues in a wide range of problems for the practice of medicine as a whole. The manifestation of this wider problem which I shall address specifically here is the western scientific tendency to dismiss or merely "write off" such conditions as mashawe. I shall not argue that western medical practice should adopt uncritically all the approaches and treatments of the African ng'angas. Rather, western medicine could benefit from an infusion of the more holistic, social, and spiritual perspective of the African lifeworld with regard to conceptions of wholeness and disease. In so far as the disjuncture of worldviews is at the heart of the problem, it is to that disjuncture that I shall turn first.
2: African Lifeworld: the Unity of Religion and Medicine
There is not just one African "worldview". Each ethnic group sees and describes reality in its own way. Within each group there is increasing differentiation, and the perception of the peasant farmer is not necessarily the same as that of the witchdoctor.(2) Yet there are certain statements which can be made. Anthropologists and other students of African culture and religion report that in the African traditional world, there is an integral unity between religion and medicine (cf. Glick 1967, 32). To think of them as separate spheres is inconceivable. This is so, as part of the larger conception that life itself is a whole, with no distinction between "sacred" and "secular" such as one finds in the west.
(i) Disjuncture, Real and Imagined
In the latter half of the nineteenth century, Europeans viewed things African with increasing disdain. Theories of evolution, both social (Herbert Spencer) and biological (Darwin,) held that human progress was smooth, unilinear and inevitable, and belief in the innate racial superiority of Europeans was increasingly assumed by the intelligentsia of the day. In the twentieth century, scientific rationality has continued to function as a means for assertion of racial superiority, even after biological science has disproved the idea of racial superiority. The discipline of anthropology has increasingly enabled us to see the inadequacy of previous definitions, though it had been anthropologists and sociologists such as Spencer, Sumner and others who had originally largely contributed to it. By the 1960's many scholars had rejected earlier definitions, such as Lévy Bruhl's "primitive mentality", and Placide Temples' "vital force", and were searching for an entirely new approach. Leonard Glick, in 1967, wrote that the word "medicine" in many ethnographies was defined according to western criteria:
One is, for example, confronted with so-called medicines that have nothing to do with illness, that may in fact be used to cause illness (cf. Nadel 1954: 132ff.). One reads of curers who cause illness as often as they cure it (hence the term "witchdoctor"); indeed at times a man may cure the very illness he has caused. One finds only occasional associations of particular illnesses and treatments, the more common premise being that whatever cures, cures everything. And so on, until the paucity of meaningful correspondences is so obvious that the ethnographer is reduced to placing many of his key terms - medicine, treatment, doctor, diagnosis - in quotation marks (Glick 1967, 32).
In the same year Robin Horton wrote his seminal article entitled "African Traditional Thought and Western Science" which challenged, on a wider level, the whole group of assumptions on the part of western people about the differences between scientific thinking and African traditional thinking. He proposed that in practice, African traditional modes of approaching such problems as the diagnosis of illness are not so very different from that of western medicine, but westerners do not perceive this fact, for they are not attuned to the language and symbol structure in which these actions are carried out. Horton's article was carefully qualified and well argued. He did not try to say, as some have done, that western science and African thought are merely two versions of the same thing, the differences being merely superficial. But he did seriously challenge many comfortable assumptions about the manner in which scientific thought proceeds as opposed to non-scientific thought, most importantly the "closed - open predicament". Due to the influence of Karl Popper's philosophy of science, it had usually been claimed that prescientific thought is "closed': it cannot conceive of any explanation for why an event happens other than the traditionally received one; whereas modern science (it is supposed) is "open": it conceives of alternative explanations (see Popper 1966). Horton concluded that most westerners living within a supposedly scientific worldview in reality live most often in a closed situation, and the only time the open situation actually functions is during those rare moments when the most brilliant scientists on the cutting edge of discovery creatively work out a new explanation which constitutes a radically new departure, a "paradigm shift" as T. Kuhn called it (Kuhn 1970).
In Kuhn's thought, paradigm shifts do not happen every day, but when they do, scientists make the new paradigm the accepted explanation (Kuhn 1970). This explanation is then accepted by the masses as the only acceptable explanation of that occurrence, thus returning us, ironically, to the closed situation, at least until the next paradigm shift happens. Horton's article sparked a flurry of controversy, and if one judges by the number of journal citations, it shows no signs of abating today. Frankenberg and Leeson, among others, have further developed Horton's argument to say that the African situation is not "closed" at all. Their work, in Lusaka, Zambia, reported that sick Africans had "a wide range of options and that they behaved empirically."(Frankenberg and Leeson 1976, 226). They elaborate further (1976, 227):
Douglas 1970, Turner 1964 and Van Velsen 1964 and others have long since demolished the deterministic model of beliefs even in village African society. There is always a choice of norms available to the actor to cope with the emergencies of life.
However, it is possible that their argument does not precisely address Horton's understanding of the "closed situation" in Africa.
Glick's article was concerned more specifically with "Medicine as an Ethnographic Category". A pioneer in the effort to sort out a more ethnically unbiased and scientific framework for the understanding of disease and curing, he complained that although it should have been logical to assume that responses to illness (treatments) would be the logical outcome of ideas about illness (diagnosis), the ethnographic literature seldom spells out this relation: "it is not made apparent that ideas and actions are complementary facets of a cultural system...[One misses] especially [the] relationship between medicine and religion..."(Glick 1967, 32). Glick's insistence that we see African ideas about illness as part of a cultural system leads to the essential observation that there is a disjuncture between the African traditional worldview and that of modern science. African theologian Osadolor Imasogie in his 1983 work Guidelines for Christian Theology in Africa holds that the shallowness and ineffectiveness of much church life in Africa (which characteristically results in reversion to the traditional African religion in times of crisis) are due to the disjuncture between the scientific worldview of the missionaries and that of traditional Africa. Traditional Africa, he says, resembles the European middle ages or ancient Israel in many respects. There, the world was thought to be inhabited by myriads of spirits, and miracles of healing and other signs or "works of power" were, if not commonplace, at least events that fit easily into the overall belief pattern.
We should mention at this point that even the term "worldview" is one conceived in an ethnocentrically western framework: as translation of the German Weltanschauung it evokes the idea of a systematically ordered picture of reality, which could reliably be conveyed in a philosophical mode of expression. Although one can appreciate the efforts of Fr. Placide Tempels, A. Kagamé and others to articulate the "Bantu philosophy" as efforts to show that Africa does, in fact, have something of value to offer the world in the field of philosophy, it is now generally recognised that these efforts have been more expressions of the individual perception of the author, than an objective account of how Africans themselves would explain reality (cf. Mbiti 1969, 10).
A Weltanschauung, then, is a concept foreign to traditional Africa, as well as to ancient Israel or medieval Europe. Some modern scholars have suggested that the term "life-world" is more appropriate for these societies, as it evokes the everyday life in which people work and live and think, rather than a speculative system. The African life-world is today still inhabited by the magical and the miraculous.
(ii) Disease Causation
Theories of disease causation in Africa are multifarious: some are empirical, some are ecological, and some are social. Minor ailments, such as mosquito bites, are not usually thought to have any particularly significant cause. But more serious ailments are often attributed to malevolent forces, particularly to a person who has reason to bear a grudge against the afflicted individual (Daneel 1970, 22). In many cases, relatives of the afflicted person are suspected, because they may stand to gain an inheritance, or bear a grudge because the father did not favour them in some way (de Rosny 1985, 74). Although in many cases the people may be well aware of scientific theories which link germs in an infected water supply with intestinal disorders, the affected individual reasons that everyone drinks the same water; why then does only this person, or only that person become afflicted with the intestinal problem? They then look for more personal causes.
While the personal element of causation may seem absurdly "unempirical" to doctors trained in the western scientific medical tradition, the element of ethnocentrism in such judgements must be acknowledged. Note that in the 1850's, when western medical science did not yet clearly understand the cause of malaria, the famous explorer Sir Richard Burton made his famous disparaging remark about the Somali "superstition" that mosquitoes cause malaria (Burton 1966 [1856]: 53). Only a few short years later modern medical science "discovered" that, in fact, the Anopheles mosquito is the carrier of malaria. Although it may be correct to say that this type of categorization is the exception rather than the rule, it must not be forgotten that African beliefs concerning disease causation are often based on observations which are equally (and sometimes more) empirical than western observations. In some cases, African empiricism has observed causation where western medical science has missed it, perhaps sometimes because the latter has not yet had ample opportunity to make careful observations. Lévi-Strauss observed:
The experiences of the sick person represent the least important aspect of the system, except for the fact that a patient successfully treated by a shaman is in an especially good position to become a shaman in his own right, as we see today in the case of psychoanalysis. In any event, we must remember that the shaman does not completely lack empirical knowledge and experimental technique (Lévi-Strauss 1967, 36).
This observation serves both to illustrate our point concerning the use of empirical observation and experimental technique, and other similarities between African and western medical technique. Of course, the parallel that is drawn is between African medicine and psychiatry rather than general medical practice. Here, some of the more strict philosophers of science would hold, with Karl Popper, that modern psychiatry, being based on the theories of Freud and others, has never had its foundational assumptions empirically verified, and is therefore not a science in the proper sense at all, but a pseudoscience (see Popper, 1968). However, Popper's claim rests on his notion of the closed - open predicament, which we have already seen has been demonstrated to be erroneous.
Disease causation as a product of "chance" may actually be an assumption more common to modern western people than to Africans. De Rosny reports that in the Douala language the words musima and bonam, commonly translated into French or English as "chance" or "luck" are properly translated as "grace" and "blessing." He says: "they are first and foremost the result of a favorable intention, not the fruit of chance."(de Rosny 1985, 81). He adds that the Douala are acquainted with the idea of chance, but it is non-functional in daily living, and is left as the province of diviners. The Douala see luck, however, as a grace bestowed by God: "I don't think one can add more luck to the luck God has given to each one," says Elimbi, de Rosny's informant (de Rosny 1985, 81). One may contrast African views with the secular viewpoint of twentieth century western culture which sees the predominance of random chance in the cosmos, though scientific rationality makes some sense out of disease causation through germ theory.
Frankenberg and Leeson report that to sociologists, anthropologists and ng'angas, though not to western medical personnel, it is obvious that "becoming sick is a social process"[emphasis mine](1976, 232). Many scholars have made the observation that an understanding of the social dimension of illness and health is one contribution Africa can make to the world (Frankenberg and Leeson 1976, and Shorter 1985, 56ff...). The manner in which family and friends relate to the sick person, then, is taken into account in traditional African medicine. An African ng'anga in questioning a patient, rather than asking questions about food intake and bowel movements, will be more likely to ask about how the patient's relationship to her or his family is.(3)
The ng'anga is well acquainted with the frequent jealousies and vendettas within the familial structure in African societies, and the psycho-physical damage these can do. He or she works to alleviate these problems.
The difference in paradigms also issues in a different perception of the physical basis of illness: one researcher reports that in terms of bodily orifices western medicine focuses on the mouth and anus, while African medicine focuses on the genitals. The difference of perception naturally leads to a different manner of treatment, to which I now turn.
(iii) Treatments
A number of scholars have pointed out the similarities between treatments offered by shamans and modern psychoanalytic approaches (Cf. Lévi-Strauss 1967, 36). Sometimes this comparison is merely a scholarly way of baiting the psychiatric profession, rather than an affirmation of the integrity of African shamans. When this motive predominates, ethnocentrism is evidenced, but some scholars show a genuine desire to appreciate and revalue African culture on its own terms.
A consistently recurring theme in the practice of many ng'angas is the goal of strengthening the ego of the patient. Clients come to ng'angas even to cure the problem of unemployment, a misfortune to which the ng'anga's treatment strategy is to strengthen the ego, the self-confidence of the patient. This strategy is frequently successful. The success of this approach is further evidence of the relative failure of western medicine and churches to meet the wider range of needs of the populace.
In the early 1960s Dr. Raymond Prince of McGill University discovered in his research amongst Yoruba native doctors that rauwolfia plant had been used to treat schizophrenia for centuries there (Prince 1964). Modern medical science had just, at that time, discovered that the extract of rauwolfia plant is beneficial in treating schizophrenia (Prince 1964). This discovery, along with a large number of similar such discoveries seriously call into question some of the assumptions often made about the "empirical" nature of western science as opposed to the supposed "nonempirical" or "irrational" status of African folk beliefs.
African treatments vary greatly, and some medicine men use a wider variety of methods for construction of treatments than others. The literature abounds with descriptions of these and we need not rehearse them here. Our point is to observe that anthropology now acknowledges that African traditionalists employ empirical observation and testing as one method among many in the diagnosis and treatment of disease. The scientist points out that purity of motive, or monocausal explanations, are what science always looks for (Horton 1977). Horton acknowledges that the search for purity of motive is the chief feature that distinguishes modern science from African traditional thought, but he points out that this is also what has robbed the west of any sense of mystery about humanity and about life, and has made western life relatively unpoetic and flat (Horton 1977, 170). But beyond the result of stripping our world of mystery, scientific techno-rationality has resulted in the serious error of reductionistic explanations of humanity. Even Max Weber was greatly concerned about this particular tendency of modernity. He feared that the modern tendency was producing a flat, mechanistic world in which people in need of the mysterious are fleeing to "mysticism", but instead get mere mystification. Social analysts and philosophers have in recent years started to see this as a serious flaw in the project called "modernity".
Scholars such as those of the Frankfurt school, Jürgen Habermas, et. al. have made a penetrating critique of "scientism", in so far as it has become the new religion. Habermas wants us to retain scientific method, but to reduce the claim that scientific truth is congruent to Truth itself to more modest proportions, so that other modes of discovering truth may be accepted as equally valid. Scholars in diverse other schools of thought, such as Hans-Georg Gadamer (1985), Alasdair MacIntyre (1984), and Richard Bernstein (1985) have also decried this aspect of modernity and each has proposed his own solution to it.
Even after acknowledging the occurrence of such errors as Burton's, one may still argue that either medical science is right, or the sorcerer is right; because they cannot both be right, we choose whatever is most effective. The efficacy criterion, however, has also been shown to be operative in traditional medicine. This is merely an extension of the central category in magical systems, which many anthropologists report is "power". Power and efficacy are also seen as central categories in modern scientific approaches; in fact many critics hold that these are at the very centre of the dynamic of western civilization today. Jacques Ellul, for example, holds that Technique is the central category of western culture, exerting its own rationale and dynamic in every situation in life (see Ellul 1964). We may see the drive for mastery, or power over nature, then, as another element which magic and modern science share.
The element of ethnocentrism in western medical judgements of African traditional medicine is still real today, and prohibits the appropriation of a potentially fuller understanding of disease and wholeness. Although it may be simplistic to ascribe all such judgements to ethnocentrism (spiritism occurs amongst Caucasians as well, as seen in the New Age movement) nevertheless the paternalistic character of many of the assumptions regarding the inferiority of traditional medicine often takes on ethnically biased undertones. Even when this is not the case, the closed approach emphasizing the superiority of western techno-rationality prevents the acquisition of potentially valuable tools for healing. In I. Polunin's words:
Modern medicine is so rich in diagnostic, therapeutic and bureaucratic practices that the patient's point of view tends to be ignored...I suggest that tribal medical systems are sufficiently simple for us to understand the ways by which they satisfy human needs, and sufficiently different from ours to provide new insights. (Polunin 1977, 18).
One reference point could be the work of Gadamer, who suggests an "hermeneutical turn" towards a whole new paradigm. His approach would see the doctor-patient relationship in a way in which the agency of the patient is taken seriously and the whole can be interpreted by the doctor. In a different vein, Alasdair MacIntyre would have us look at life in its "narrative unity". He points out that it is a feature of modern life that it is atomistic; it looks at only one aspect of a person's life in isolation from others, thus destroying the narrative unity of life from its beginning to its end (MacIntyre 1984, 204ff). He emphasizes the seriousness of the implications for ethics that this disruption of life into atomistic compartments produces. Here again, traditional Africa may have something to offer the rest of the world by way of a therapy which sees life as a unity, not atomized into multitudinous fragments. The theme of narrative unity has obvious affinities for the still largely oral and story-telling cultures of Africa, where there is no division between "secular" and "sacred", and life is perceived wholistically. In oral narrative, there is a definite sense that each good story has a beginning and an ending, and a sense of purpose pervades the story. It is where this "narrative unity" breaks down that life comes to be understood as meaningless, anomic, and thus suicidal. I discuss orality further in later chapters.
While this survey has shown that we may not make simplistic generalizations about traditional healing methods, nor romanticize them, these methods hold significant potential for a major contribution to western understanding of health and wholeness. The traditionalist's resistance to modern scientific reductionism provides him or her with a source of strength in the search to recover health and wholeness in a more all-encompassing framework than western medicine has provided up to the present, taking into account realities and symbols which are meaningful from the patient's point of view. The integrated nature of the African religio-social-medical complex is such that any attempt by westerners to appropriate the better insights from Africa will require more than a piecemeal approach: a shift of life-world, which can accommodate the transcendent and shun reductionism.(4)
3: Witchcraft
Witchcraft is clearly still much feared in Africa. Hopkins (1980) has written an article entitled "Theological Students and Witchcraft Beliefs", which illustrates this fact through the use of surveys. Mbiti (1969), in his section on witchcraft mentions the fear connected with witchcraft. Idowu made the following comments, which reflect the widespread feelings of African theologians:
In Africa, it is idle to begin with the question whether witches exist or not...To Africans of every category, witchcraft is an urgent reality...in speaking or writing about witchcraft, the actual belief of Africans must come first. African concepts about witchcraft consist in the belief that the spirits of living human beings can be sent out of the body on errands of doing havoc to other persons in body, mind, or estate; that witches have guilds or operate singly, and that the spirits sent out of the human body in this way can act either invisibly or through a lower creature - an animal or bird (Idowu 1973, 175).
That the fear of witchcraft pervades African societies is further evidenced by the proliferation of witchfinding movements. Chakanza has documented large numbers of witchfinding movements in his home country, Malawi, as a study preliminary to the identification of patterns in the development of such movements.
There are variations in the specifics of witch beliefs: for example, some ethnic groups, such as the Tiv of central Nigeria, believe that witchcraft is an actual substance, which may be found growing on the liver of a witch. Other groups say it is a spiritual substance only. But these differences are of a relatively minor nature in the context of the fear of witchcraft which remains pervasive in modern African society.
Related to witch belief is belief regarding ng'angas, or "medicine men" (or "women"), sometimes called "shamans". The precise terminology varies according to local custom, and terms considered incorrect in one locality or according to certain authors, may be considered quite acceptable in another. Several theologians have written extensively on African traditional psychiatry as practised by ng'angas (see Mpolo, Kirwen, de Rosny, Shorter). This has pastoral implications, which they draw out. Several recent works suggest the ng'anga paradigm is actually the most obvious one as parallel to Christ (Schoffeleers 1989, 1990).
4: African Theological Response
As early as 1932 a leader of an AIC, Ade Aina, wrote a pamphlet to defend the oft-criticised practice of healing in the AICs. This published work, rare from an Independent churchman, was reprinted in Parratt's 1987 collection (Aina 1987). The response of African Christian theologians to the question of sickness and healing has been varied. Some African theologians, such as Masamba ma Mpolo (1984), have written in depth on the integration of traditional therapies; one of his articles is entitled "Kindoki as Diagnosis and Therapy". Other African theologians to write on African ethnopsychiatry include Udobata Onunwa (1990). Wambutda (1976) has written a biblical study on healing. Mthethwa (1989) has written on yet another aspect of healing practices: "Music and Dance as Therapy in African Traditional Societies".
Others, such as Kofi Appiah-Kubi in his (1981) book entitled Man Cures, God Heals: Religion and Medical Practice Among the Akan of Ghana have also included the traditional use of herbs and plants with a view towards fully integrating the traditional healers into the existing modern medical care system. Appiah-Kubi had pointed out (1976, cited in Parratt 1987, 76) that modern technological health services in Africa do not reach more than twenty per cent of the population. In the years following his editing one of the most important volumes in African Theology, African Theology Enroute (1979), he did original research on medicinal plants and plants with protein content as a supplementary protein source. His last job before his death in Feb. 1992 was for the Ghana Ministry of Health, working together with the traditional healers towards their fuller integration into the health system of Ghana, truly a pioneering work.
From the preceding survey, several things become apparent. Virtually all African theologians have spoken positively of the value of African traditional medicine and have sought to reappropriate it, at least at the theoretical level. Some have written only a few brief sentences on the need in the mainstream churches for healing practices similar to those found in the AICs and/or African charismatic churches, while others have written more extensive treatments of specialized areas within the topic. Relatively few, however, have sought to put health care into its wider socio-economic background as part of a comprehensive social critique. This is the task which Jean-Marc Éla's (1985) work pioneered. In the (1988) English translation the chapter is entitled "The Health of Those Without Dignity" in My Faith as an African (1988). The Guinean theologian Cécé Kolié, working from a manuscript from Éla, developed Éla's critique further. Here, the insights of the two paradigms of inculturation and liberation are combined in an adroit manner. I quote a few excerpts at length:
Today the medicines available on the market are inaccessible to the popular masses, village hospitals and infirmaries are only centers for the distribution of prescriptions. Only the upper class can receive decent medical attention.
While physicians leave their hospitals to make house calls for the colds or constipation of governors or ministers, hundreds of peasants walk for miles to the hospital, to be greeted with contempt and sent on their way with a prescription for something their meagre purchasing power cannot obtain - if it exists! While the peasant masses have no drinking water or suitable shelter in the potopotos, the slums, CHUs are built that swallow the bulk of the health budget; when members of the senior administrative class (10 per cent) fall ill they are sent to the hospitals and clinics of Paris, London, or Washington with the tax money collected from the ninety per cent, the peasantry.
In a word, we are dealing with a medical practice confiscated by the hierarchy of political appointees. There are no popular health organizations. Foreign medical assistance in medicines and personnel, unfortunately, tends to maintain paternalism and underdevelopment. What good is treatment without health education at the grass-roots? (Kolié 1991, 140).
Kolié then goes on, in a section entitled "Political Power and Health" to unmask the power relations involved in the practice of medicine in his country. He says (141): "One need only pay a visit to the hospitals of Guinea...in order to realize that diseases are divided by social category and that new diseases have made their appearance."
The work of Éla, picked up by Kolié, indicates further, then, the "mixing" of paradigms, or the deeper integration of the insights of the two major paradigms of inculturation and liberation, a feature that I have indicated earlier is one of the marks of the "third phase" of academic African theology. In the economic climate of the "new world order", this type of critique is liable to gain momentum, and to be heard more widely as the social conditions which give rise to it continue to worsen. By 1986, when Kolié writes his article (later translated into English for Schreiter's 1991 volume), the "third phase" is already well under way. The insights of the adaptation and incarnational phases are fully incorporated, but sociological analysis of and critique of the current situation on the ground are now part of the mix, squarely addressing the everyday realities most Africans must deal with in the present. There is an urgency here and an impatience with what Kolié feels are overly intellectualizing or antiquarianizing approaches, which he feels marks the work of many African theologians. He concludes his essay with the following words:
We may ask ourselves, today, when the problems of the order of the day in Africa go by the name of famine, dictatorships, unemployment, emigration, corruption, embezzlement of public funds, and so forth, if our theological culturalism is not still back in "negro" times. One has the impression of a gap between theological language and the current discourse or concerns of our peoples. At all events, meanwhile, we are surely obliged to acknowledge that the face of Christ in Africa today is more that of the ill than of a healer. (Kolié 1991, 149).
Kolié emphasizes the importance of the risen Lord, whom he feels is a stranger to Africans in practical terms. Here again, there is an emphasis more similar to the Christus Victor model of classical Christology, woven together with the Christ as "liberator" model more familiar to modern liberation theologians. He points out: "Latin American popular piety celebrates Good Friday with more fervor than Easter Sunday. Shall we be seeing the same thing in Africa?" (Kolié 1991, 149, n22). The weakness of the crucified Christ of popular devotion, to Kolié, is what makes him remote to Africans. He wants a strong Lord, capable of delivering his people from all of the forces which oppress them, including sickness, disease, evil spirits and the exploitative social structures which produce them. In this, his Christology has much in common with the various grassroots organizations I have mentioned above, growing rapidly throughout Africa in the 'eighties and 'nineties, and whose growth constitutes one of the challenges facing African theologians in that period.
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1. Jeune Afrique (March 12, 1980).
2. One such differentiation might be evidenced by one of de Rosny's informants, an apprentice to a witchfinder, who stated his fears thus: "When you believe down deep inside in what a ng'anga does, it has too much of an effect...When you believe in them completely, you don't believe in God anymore."(de Rosny 1985, 79). Perhaps the informant means "belief" more in the sense of "trust" here. In either case, the statement seems to contradict much of the literature which often speaks of the African belief that magical powers are originally derived from God and that their practitioners have profound belief in God. The implications are far-reaching, but in so far as a detailed treatment of this subject would take us into the ethical implications of monotheism in general I shall merely direct the reader to other sources which cope with that topic more fully.
3. Surveys from diverse parts of Africa report that women constitute a large majority of persons reporting illness. In a survey amongst the Maguzawa Hausa in Northern Nigeria, the proportion was over ninety per cent (Last 1976, 110-114).
4. In conjunction with my Zaïrean colleague, Diafwila-dia-Mbwangi, I originally presented the section on African psychiatry and ng'angas to a seminar on medical ethics at McGill University in 1988. The main bodies of our essays covered two separate aspects of medicine in Africa, but we concluded our joint project with the following three recommendations: (1) Medical education both in Africa and the west should take the disjuncture of worldviews seriously and direct itself towards the elimination of ethnocentric and paternalistic attitudes. More stress could be laid on appropriation of proven therapeutic techniques of African traditional healers. (2) Health care funds should be shifted from the acquisition of high technology equipment for large urban hospitals to primary care in rural areas, upgrading the training, employing the services of, and making referrals to African traditional healers. Some African countries have already embarked upon such programmes. (3) Scientific education should make note of the inadequacy of the modern western scientistic paradigm, of which our survey gives additional evidence.