The Quest for Therapy Medical Pluralism in Lower Zaire John M. Janzen COMPARATIVE STUDIES OF HEALTH SYSTEMS AND MEDICAL CARE General Editor john M. Janzen Founding Editor Charles Leslie Editorial Board Don Bates, M.D., McGill University Frederick L. Dunn, M.D., University of California, San Francisco Kris Heggenhougen, Harvard University Brigitte Jordan, Michigan State University Shirley Lindenbaum, The Graduate School and University Center of the City University of New York Patricia L. Rosenfield, The Carnegie Corporation of New York Paul U. Unschuld, University of Munich Francis Zimmermann, Centre National de la Recherche Scientifique, Paris For a complete list of titles in this series, please contact the Sales Department University of California Press 2120 Berkeley Way Berkeley, CA 94720 The Quest for Therapy: Medical Pluralism in Lower Zaire JOHN M. JANZEN with the collaboration of William Arkinstall, M.D. Foreword by Charles Leslie UNIVERSITY OF CALIFORNIA PRESS Berkeley - Los Angeles - London University of California Press Berkeley and Los Angeles, California University of California Press, Ltd. London, England Copyright © 1978 by The Regents of the University of California First Paperback Printing 1982 ISBN 0-520-04633-1 Library of Congress Catalog Card Number: 76-19982 Printed in the United States of America The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANS] Z39.48-1984. This book is a print-on-demand volume. It is manufactured using toner in place of ink. Type and images may be less sharp than the same material seen in traditionally printed University of California Press editions. Contents List of I llustrations Vil Foreword by Charles Leslie Xl Preface XVii PART I: THE AREA OF STUDY 1. The Human Setting of Healing in Lower Zaire The Management of Illness and Therapy The Society and Its History Disease, Modern Medicine, and Health Methodology of Study 2. A History of Medical Pluralism in Lower Zaire 37 Kisi-Nsi and Kimundele in a Single Society Colonial Medical Policy and Action The Evolution of Kisi-Nsi Definition and Control of the Art of Healing Since the Second World War Postcolonial Legitimization of Kisi-Nsi PART II: STUDIES IN KONGO ILLNESS AND THERAPY An Introductory Note 3. Disease of God, Disease of Man 67 vi / Contents Strife in the Family As Cause of Child’s Illness 75 A A History of Madness SI N NA The Professional as Kinsman Marriage and the Father’s Blessing 101 n o The Clan as Patient 114 C PART III: THE LOGIC OF THERAPEUTIC SYSTEMS An Introductory Note 9. The Jural Status of Therapy in Kongo Society 129 The Conveyance of Rights in Litigation, Ceremony, and Therapy Consensus and Dissension in Therapeutic Decision-Making Categories of Therapeutic Choice 10. Interpreting Symptoms 1$7 Nzoamambu’s Medical Cosmology Diagnostic Ideas Il. Contemporary Systems of Popular Medicine in Lower Zaire 193 The Art of the Nganga Kinship Therapy Purification and Initiation Western Medicine The Therapy Course Reconsidered 12. Toward an Integrated Medicine 223 Appendix A. Episodes of Case Studies Reported in Chapters 3-8. 231 Appendix B. Herbarium of Medicinal Plants 243 Bibliography of Works Cited 251 Glossary-Index 258 Illustrations FIGURES 1. Inhabitants per medical doctor in several countries. 29 Western medical personnel and facilities per inhabitants in Luozi Territory and Zaire Nationally. 30 Kinship relations in Luzayadio’s case. 70 Y Structure of confession and accusation in Luzayadio’s B case. 7I Close kin marriage types in matrilineal context. 74 Y Kinship relations in case of Axel and Cécile. 78 A Kinship relations of Nsundi and Kinkanga-Kituma clans. 94 I. Partial genealogy in cases of Lwezi and Mbumba._ 115 W C. Formation of therapy managing group in case Studies. 132-133 Io. Social components constituting therapy managing group. 140 Il. Correlation of social context of decision and therapy choice. 149 12. Co-occurrence of therapies and specialist’s (or group therapist’s) roles in case studies. 152-153 13. Correlation of distance travelled by clients with cost and role of therapist consulted. 154 14. Diagrams of the body. 159 15. Correlation of therapy actions and problems handled by banganga 204 vill / Illustrations 16. Correlation of therapy actions and problems handled by kinship therapy and bangunza_ 210-211 17. The course of therapy summarized 220 PLATES (Between pages 106 and 107) . Out patients at Kibunzi dispensary, Lower Zaire. . Patients receiving medicine, Kibunzi dispensary. ND . Nurse examining child, Kibunzi hospital. W. Family therapy managers outside ward, IME-Kimpese. H . Orthopedic ward, IME-Kimpese. NA. Major surgery, IME-Kimpese. Muscle massage in fracture case, nganga lunga’s treatment. NO. Asperge of oily herbal ointment on place of fracture. . Application of bamboo mat “‘cast.”’ oC . Obtaining medicine from finger cactus tree. O . Medicines, big market, Kinshasa. = l . Modern herbalist preparing vial for injection. S N . Treatment for kink in back, nganga nkisi. W . Massage of disturbed patient, nganga mbuki. = hH . Cupping horn treatment, nganga nkisi. = OF AMA. Croix Koma Mass being sung by nganga nkisi. . Intraclan divining session with prophet. = = TI~OC. Interclan reunion to resolve differences in illness dispute. ~ OO. Restraining disturbed patient in village center. NW ©. Kimbanguist rite, laying on of apostle’s hand. . Weighing the Spirit, Church of the Holy Spirit. NW |= . Healing, Church of the Holy Spirit. NW H. Nzoamambu, nganga nkisi, detaching bark from tree. YNW MW h.. FMleyd icwihinsek sipnohoenr itiendh erbyi teNd zobya mNazmobaum afmrboum gfrraonmd mother. WwWa grandmother. wv ON . Crockery mug inherited by Nzoamambu from grandmother. Illustrations | 1x MAPS I. Lower Zaire. 10 2. Territory of Luozi, Manianga. 14 3. Manselele, near Mbanza Mwembe: Nzoamambu’s garden village. 164-165