Why Do Healers Appeal to Patients?

Why do healers of different kinds attract people in so many places all over the world?

In some sites, both healers and self-treatment are popular because biomedical therapeutic options are unavailable or difficult to access. However, even in countries with well-developed healthcare infrastructures, so-called complementary and alternative medicine (CAM) remains popular and non-biomedical practitioners, including ‘traditional’ healers, are widely consulted. Generally, we tend to apply the term ‘healer’ to practitioners who use religious and spiritual methods of treatment, but also, for example, to bone-setters or herbalists whose practices are based on folk/traditional medicine.

The vague term CAM embraces a vast array of diverse practices and knowledge, and can appear in a wide variety of configurations. Particular branches of CAM, such as homeopathy, may be a recognised form of treatment in one country whereas within other socio-political contexts they remain marginal or are deemed ineffective or even harmful. Practices of healers are regulated in diverse ways and the process of their legitimisation varies in different settings. In addition, a complex interplay of political, economic and sociocultural factors influence people’s treatment choices, so that there cannot be a simple answer to the above question.

People’s interest in non-biomedical therapies is not necessarily congruent with governmental attitudes and regulations. Healers are more often regarded as complementary, rather than alternative, to biomedical treatment. Social scientists usually explain their popularity in terms of: dissatisfaction with biomedical institutions and interventions; expectations of more individualised and holistic care from CAM practitioners; and the adoption of consumption practices as a way to build individual identity. However, if we are to understand the factors which influence people’s use of healers and other CAM practitioners, we should be more clearly aware of the impact of particular cultural settings.

Kazakhstan and Kyrgyzstan: a case study

My own anthropological research on complementary medicine and people’s health-seeking strategies in Central Asia shows the importance of a contextual approach. During ethnographic fieldwork in post-Soviet Kazakhstan and Kyrgyzstan, I noted the popularity of shamans and other ‘spiritual healers’ whose power was based on their alleged contacts with spirits. Despite so many years of Soviet atheisation, such practices were not completely eradicated and after the collapse of the USSR this kind of healing has become more and more popular, including in large cities such as Almaty and Bishkek, where I conducted my studies.

Official attitudes to ‘traditional medicine’ in the newly independent Central Asian countries were generally positive and even supportive, especially during the 1990s, when the new states searched for legitimisation through references to their cultural heritage. In Kazakhstan and Kyrgyzstan, as in the whole region, promotion of the richness of culture and the historical roots of the titular nations served as justification for their newly achieved sovereignty. Folk/traditional medicine was perceived as the part of this national cultural heritage. Therefore, the position of healers was strengthened: in Almaty in the second half of the 1990s, healers obtained certificates and worked, sometimes together with medical doctors, in various centres of ‘folk’ or ‘Eastern’ medicine. However, in the last decade, when I carried out research in Bishkek, the capital of Kyrgyzstan, governmental policy towards ‘folk’ healers has changed and their professionalisation has been interrupted, although they can still work freely in the market. The loss of official support can be explained by a more general shift in policies aimed at exposing the state’s modernising efforts, an image that could be threatened by such ‘figures from the past’ as traditional healers. However, since the state is permanently confronted with serious political, economic and social problems, the issue of controlling and regulating healers’ activities has been left for the future.

This change has not greatly reduced the popularity of such practitioners. One extreme case is that of a healer from Bishkek whose practices were not only suspicious but evidently harmful and which were highlighted last year and widely discussed in the media, but attempts to stop his activities drew protests from patients. So, why do people trust healers in Kyrgyzstan? Although many factors contribute to their popularity, two are particularly important: first, the distrust of medical doctors; and second, the persistence of many elements of the traditional Kyrgyz worldview.

Firstly, inhabitants of Kyrgyzstan experienced a rapid deterioration in their healthcare system after the collapse of the Soviet Union, and despite wide-ranging and at least partly successful reforms, they are still dissatisfied with medical services. However, what is particularly striking is the commonly expressed deep distrust of doctors. According to these very critical assessments, physicians are undereducated, incompetent and have low moral standards. Patients give numerous examples of doctors’ misbehaviour and such stories are often horrifying. I heard many times that ‘good doctors died or left the country’. There has been a massive economic migration of medical personnel from Kyrgyzstan, especially to Russia and Kazakhstan, and the shortages in healthcare professionals affect inhabitants of remote regions of the country in particular. In addition, corruption is widespread not only in healthcare, but also in educational institutions, resulting in the poor quality of medical training. Although some of my interlocutors admitted that they, eventually, managed to find a ‘good’ doctor, distrust and caution prevailed. Incompetency, together with greed, were seen as a particularly dangerous ‘mixture’, leading to misdiagnosis and inappropriate treatment, or unnecessary and even life-threatening surgery. In my article elaborating on the reasons for people’s common negative opinions about physicians, I argue that such attitudes and fears can lead to people avoiding encounters with doctors unless it is inevitable, and this in turn may extend the appeal of healers.

Secondly, beliefs about the role of spirits in people’s lives, as well as perceptions of health and illness, greatly contribute to the popularity of healers. There are ailments such as ‘fright’ or ‘porcha’ (caused by black magic) which, in popular view, can only be healed by ‘traditional’ healers who have close connections with the spirit world, or by Muslim religious specialists – `mullahs’. In addition, healers offer a ‘holistic’ treatment, as they help not only in the case of illness, but also in family problems, business failure and other kinds of misfortune. They also provide spiritual assistance and strive to revive a patient’s religiosity. Healers themselves are considered pious persons and their extraordinary abilities are treated as a gift from spirits and from God. I expand on perceptions of health, illness and healing as the factors strongly influencing healers’ position in the Kyrgyz society in an article recently published in the WHO journal Public Health Panorama, vol. 3, issue 1, 2017.

These are not the only conditions which influence the popularity of healers in today’s Kyrgyzstan; many others could be mentioned, including economic and political factors, social relations and traditional hierarchies. Despite frequent statements such as ‘it is no use in economising on your health’, economic factors remain important for people’s health-seeking choices. Therapies offered by healers and other complementary practitioners are generally cheaper than biomedical treatment, or at least perceived as such, which is a strong incentive to choose the former. Health-related decision making is also considerably affected by extended family relations, still marked by traditional hierarchies that, for example, enable the Kyrgyz mother-in-law to exert influence over her daughter-in-law and grandchildren in matters of health and illness.

It is not possible to provide an in-depth analysis of the results of my research here. However this brief account shows that the particular socio-cultural context should be carefully investigated if we want to explain why, in a given place and time, healers’ help is sought by people. This research also highlights the crucial role of cultural contexts in shaping people’s health-related strategies and choices.

This article was written by Dr Danuta Penkala-Gawęcka, Associate Professor, Department of Ethnology and Cultural Anthropology, Adam Mickiewicz University in Poznań, Poland