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THOMAS J. CSORDAS
Elements of Charismatic
Persuasion and Healing
Therapeuticefficacyin religious healing is typicallyanalyzedby extrapolatingfrom ritualprocedure to expectedeffect, withoutspecifyingconditionsfor success orfailure in termsof the concrete experienceof participants. Takingsuch experientialdata as primary in therapeuticprocess should allow for definitionof minimalconditionsof therapeuticefficacy, including incremental change and inconclusive results. Two
cases of CatholicPentecostalritualhealing are discussed, withemphasis
on participants' reports of therapeuticprocess. The analyticfocus includes the orientationof participantswithinthe healing system, their experience of the sacred, the negotiation of possibilities, and the actualization of change. Alongside the anthropologicalquestionof how meaning shapes the illness experience, I pose the clinical question:how may
religious encountersinfluencean illness career? Considerationof these
questionssuggests thatdetailed experientialanalysis of therapeuticprocess can lead to a more balanced and pragmatic conceptualizationof
healingthanis available in studiesthatemphasizeeitherritualor clinical
dimensionsof healing.
he problemof efficacy appearsrepeatedlyat the center of debate aboutreligious healingpractices.Althoughotherreviewershave chosen to treatthe
diverse and voluminousliteratureon this problem(cf. Bourguignon1976;
Dow 1986; Moerman 1979), my purposehere is to develop an approachthat is
sensitive to incrementaland inconclusive effects that define the lowest threshold
of efficacy. It is by now commonplaceto observe that efficacy is contingenton
the natureof the problems addressedby different forms of healing, how those
problemsaredefinedin culturalpractice,andwhatcounts in culturaltermsas their
successfulresolution.Given these observations,however, we are left with a lack
of analyticspecificity to the concept.
A firststep is to be awareof which of threeaspects, implicit in most discussions of healing practice, is the focus of analysis. The first is procedure, or who
does what to whom with respect to medicines administered,prayersrecited, objects manipulated,alteredstatesof consciousness inducedor evoked. The second
aspectof healing practiceis what we may call process, referringto the natureof
participants'experience with respect to encounterswith the sacred, episodes of
insight, or changes in thought, emotion, attitude, meaning, behavior. Third is
outcome, or the final disposition of participantsboth with respect to their ex121
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conferencesessions evolved into the publichealing service, in which healingministers of some reputationattractCatholics who may not otherwise participatein
the CharismaticRenewal. Healingprayersor petitionsfor self andothersmay also
occur in a segment of smaller weekly prayermeetings. Following these prayer
meetings,prayerfor individualsupplicantsmay be conductedin a separate"healing room" by a specially chosen team of healing ministersfrom withinthe group.
Moreintensivegrouphealing also occurs in smallerday-long or weekendretreats
and "days of renewal." Private sessions may be arrangedwith an experienced
healingministeror healingteam. Some of those who practicein the privatesetting
also have professionaltrainingin counselingor psychotherapyand integratethese
practiceswith ritualhealing. In addition,privatehealingprayersometimesoccurs
over the telephone. Finally, healing prayerfor oneself or othersmay be practiced
in the solitudeof privatedevotion.
Methods
The discussion presentedhere is based on a largerstudy of therapeuticprocess in Catholic Pentecostal ritual healing. Of the 75 healing ministers interviewed in the first phase of the research, six were recruitedto participatein an
intensive phase, in which their private healing sessions were observed and recorded. Healerrecruitmentwas based on willingness to participate,a reputation
within the movement as experienced and reliable, and an adequatecase load.
Healingministersparticipatedin recruitmentof subjects, making initial contacts
to determinetheirwillingness to participate.Both to protectindividualswho may
have been particularlyvulnerableand to enhancehealer-researcherrapport,healing ministerswere given discretionin determiningwhich individualsto exclude.
For each personrecruited,up to five healing sessions were recordedon cassette tape with the researcherpresent.2Duringa subsequentinterview, each participantwas asked to identify the most importantor meaningfulevent within the
session. These events were played back, and commentarieswere elicited for each
person, using an adaptedform of the InterpersonalProcess Recall (IPR) method
developed by psychotherapyprocess researchers(Elliott 1984, 1986). An additional backgroundinterview covered basic life history and medical/psychiatric
history,natureandlevel of involvementin the CharismaticRenewal, andattitudes
and expectationsof religious healing. In orderto confirmpresenceor absence of
psychiatricdisorder,this interviewincludedan adaptedand shortenedform of the
Scheduleof Affective Disordersand Schizophrenia(SADS).
Both individualswhose cases are presentedhere were followed from beginning to end of their involvement with one of the participatinghealing ministers.
They representprecisely the kind of incrementaland inconclusive process that I
suggestedabove as characterizingthe lowest limits of therapeuticefficacy in ritual
healing, and it is for that reason they were chosen as the focus of this analysis.
Before discussing them, however, I shall introducethe healer with whom I followed these cases.
A Minister of Charismatic Healing
FatherFelix, an experiencedCharismatichealing minister, is a 60-year-old
Catholicpriest, ordainedas a memberof a religious order in 1952. He holds a
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inquiry,the healerexplainedthather "gift of discernment' revealedthatthe healing processhad alreadystarted.Margoreportedbeing confusedandbaffled, since
"if the healing has alreadystarted,personallyI don't feel any different."
Margocalled FatherFelix to ask for help, and he advised that she attendhis
public healing service. At thatevent she requestedprayerfor severe depression,
and the priest instructedhis assistantsto pray for expulsion of a "spirit of Darkness." He then suggested that she come to him for privatehealing sessions. At
the initial session he recounted previous situations of successful healing, and
statedthathe felt she could be healedquickly. He "corrected"heridea thatprayer
wouldbe moresuccessful if she madeher mindblankwhile he prayed,explaining
that she should expect spontaneousmental imagery to emerge from her unconscious duringthe course of prayerand thatGod did not need her assistancefor the
prayerto be successful. He also "corrected" her view that she should cease
weekly psychotherapywhile undergoingritualhealing.
Duringthe second session, Margo told FatherFelix of a disturbingexperience she had had repeatedlyfor several monthsprior to the onset of her illness.
As she was driftingoff to sleep, she "could feel anotherpresence in my room. I
could feel someone actuallysit down on the end of my bed." She had never mentioned this to her psychiatristor psychologist, for fear that they would think her
crazy. FatherFelix agreed that she was right not to have told them, but that he
himself was quite familiarwith such experiences:it was an evil spirit. This confirmedwhat she had suspected, and reassuredher that it was a phenomenonwith
which FatherFelix could deal.4
Duringthe periodof silent prayer,perhapsin responseto FatherFelix's advice to allow thoughtsto come to her mind, Margoexperienceda series of ideas
"coming from all directions." Three issues emerged:the difficulties she experienced in her past administrativejob, whetheror not to change doctors (she had
been told that everythinghad been tried yet nothing seemed to help), and a disappointingrelationshipwith an older man. The lattersituationwas one in which
the man, who lived in a differentcity, had courtedher for a period of time until
she discoveredthathe was married.She cared for him, but was very angry, and
felt conflict abouther desire to be with him in spite of a conviction that it would
be morallywrongto do so. None of these issues was subsequentlydiscussedwith
the healer. FatherFelix simply told Margo to make note of what came into her
mindduringprayerbecause "it would be important"for her.
A final event thatunfoldedover two sessions had to do with the priest's advice thatone can verballyaddressnegative emotions and commandthem to leave
in the nameof JesusChrist.This event was explicitly identifiedas most significant
by Margoin a subsequentinterview. She interpretedthe advice to mean that the
problemis "all in the way thatyou're thinking." InvokingGod indicatesthatHe
does not want her to feel as she does, and if she has the strengthand faith to say
"leave" in His name, the negativeemotionsof anxietyanddepressionshouldgo.
Duringthe following session, FatherFelix discoveredthatthis techniquehad
not been successful in achieving the goal of changingher attitude.The following
key exchangetook place:
M: I had thoughtslike, you know, I'm slowly going to wither away. Almost
like having some form of cancer. It doesn't leave me. It hauntsme. It never
leaves me. It won't go away. I can't get rid of it. I don't know how to get
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rid of it. It's driving me crazy. It's driven me crazy. It's overtakenmy
whole life. And I...
FF: What did I tell you last time? I guess you forgot. About taking authority
over these things within yourself. You take authorityin the name of Jesus
Christ,andyou commandthem to just get the heck out. They have to obey.
M: I have said thatto myself at differenttimes. Like this whole past week while
I was at mass. I had the tremorsand the shakes real bad. You know, the
fears aroundotherpeople being there, whatever. And I kept saying that to
myself over and over again.
FF: Whatdid you say?
M: I kept saying, you know, "In the name of Christ, leave me, leave me."
Tryingto force the way thatI thoughtinto anotherdirection,morepositive.
And ...
FF: Let me clue you in to something. If you say, for instance, "In the name of
Jesus," right?There's an evil spiritthatcalls itself "Jesus" . . . but it's a
false Jesus. You've got to rememberthat. Some people get caught upit's like conjuringup a spirit, and they're confrontingthe evil spirit [that]
calls himself "Jesus." So I always use the name "Jesus Christ" or "Jesus
of Nazareth," you know? That Jesus. Oh, yeah, hundredsof [Spanishspeaking]people call themselves Jesus.
In this interaction (identified as significant by Margo herself), the directive
to specify the name Jesus Christ was more than a move by the healer to cover the
technique's lack of success. For the failure to command one's emotions indicates
in the logic of the healing system that more than one's emotions are involved. A
powerful force must be standing in the way, blocking the path to healing. In a
follow-up interview, Margo acknowledged surprise at learning both the subtlety
of the religious technique and the demonic cause of her problem. She recalled
Father Felix's original invocation of the "spirit of Darkness" during her first public healing service. She intimated that she had always "thought [about her problem] along those lines" and that the idea of evil forces being involved "struck
home." With respect to how this interaction helped her, she responded that it was
"to give me courage and more strength, and more faith. Faith-wise, to know that
this is not of God. And how prayer can build your faith. It can build your
strength."
In addition to having a home mass for healing of ancestry, Margo attended
a total of three private sessions with Father Felix. Instead of going to her fourth
session, she kept an appointment with her psychopharmacologist, who decided
that since no other treatment had worked, she should be admitted for electroconvulsive therapy (ECT). She indicated that she would have resumed the sessions
after discharge, but this was precluded by Father Felix's departure for a long
sabbatical.
Case 2
Ralph is a 25-year-old man who has finished high school and spent a short
period in college. He now lives with his parents and brother, a year his junior,
and is under medical and psychiatric treatment for a variety of problems. The
diagnostic portion of our interview confirmed a complex situation revolving
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Ralph'spost-session interviewsreveal his perceptionof the therapeuticprocess as unsatisfactory.Two types of comments indicate that the healer at times
either overinterpretedor misunderstoodRalph's experience in ways that weakened the rhetoricalimpactof the healing.
One of FatherFelix's overinterpretationsoccurred when he was trying to
convince Ralphthatby dwelling on his nervousnesshe would perpetuateit, just
as someone who repeatsto himself "don't thinkaboutthe color green" is in fact
thinkingaboutgreen. Duringthe period of prayerwith laying on of handswhich
followed this conversation, Ralph saw the color green in addition to his usual
purple. FatherFelix attributedsignificanceto this, pointing out that green is the
color of hope in liturgicalsymbolism. Ralph rejectedthe interpretation,attributing his vision of green to the suggestion plantedby the previous advice, rather
thanto divine inspiration.In anotherexample, FatherFelix asked if he could invite two women fromthe local Charismaticprayergroupto help him in the healing
prayerin orderto expose Ralphto female influence, which he felt was inadequate
in his client's life, andapparentlyalso in responseto Ralph'sfearof being thought
a homosexual. Ralph's response to this therapeuticmove was to list a variety of
women he knew, rejectingthe idea thathis exposureto female presencewas deficient. Finally, FatherFelix attemptedto portrayas positive Ralph's uncharacteristicattendanceat mass and visit to a restaurantwith his grandfather.Ralph's
responsewas that he had attendedmass only once, and that going to a restaurant
never made him as nervousas did being in a groupof people.
In additionto these overinterpretations,FatherFelix appearsto have misunderstoodRalphon a numberof occasions. In a segment duringwhich the two
discussed whether Ralph's nervousness would prevent him from attending a
party,FatherFelix statedthathe thoughtmingling with people would be just the
thingRalphneeded. In responseto Ralph's statementthathe was too nervous, the
healer said that if you think nervous, you'll be nervous. Ralph objected, "No,
I'm not thinkingnervous, I am nervous!" In the follow-up interview, he stated
specificallythathe felt misunderstood,and that with paranoiaone cannot simply
tell oneself to do something. In anothersegment Ralphmentionedthathis father
encouragedhim to "be like him" and not care what others think. FatherFelix
interpretedthis as an expression of the father's insecurity, indicatingthat he did
not feel in control of his life and really did care about others' opinions. In the
follow-up interview, Ralph took exception to this, arguing that his father had
madethis statementonly once or twice, in the context of encouragingRalph, and
wasn't guilty of "denial." He felt thatFatherFelix's basic point aboutpeople in
general was correct, but that he was inaccuratein attributingsuch denial to his
father.Finally, in a session when Ralphstatedthatno changes had occurredsince
the previous session, FatherFelix turnedto the researcherand asked if in fact I
could not observe any changes. Ralph interpretedthis attemptto solicit impressions of observablebehavioralchange as an outrightcontradictionof his reportof
no internalexperienceof change. He statedthatthis made him angry, althoughit
"didn't have anythingto do with the praying" as a form of treatment.
In spite of this apparentwillingness to separatethe religious effects of the
prayerfrom the perceivedmissteps of the healing minister, successive overinterpretationsand misunderstandingsappearto have underminedthe therapeuticprocess. Ralph terminatedhis involvement after five sessions and a healing-of-
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anxiety and depressionas "diminishing" from day to day. Her positive disposition was enhanced by the reassurancethat an apparitionat her bedside, about
which she had never told her secular therapist,was not a sign of mental illness
but a frequentand fully understandablemanifestationof an evil force. Finally, in
one session she took the initiativeof askingthe priestif he had spiritually"picked
up" or "discerned' anythingparticularabout her problemwhile he prayedover
her. This anticipationof divine empowermentin fact caughtFatherFelix by surprise, but he was able to summarizeseveral "fears" about which he had been
"led" to pray, thus reinforcingMargo's alreadystrongdisposition.
Ralph, in contrast, enteredthe process with ambivalence:he expressed agnosticism but acknowledgeda preoccupationwith religion that emerged both in
his poetryand even occasionally in prayingby repeatingthe name "Jesus." Like
Margo, he had been exposed to the practices of the CharismaticRenewal, althoughhe had not been involved for at least eight years and then only briefly. In
addition,he had enteredhealing underthe assumptionthat his sessions with Father Felix would consist not of prayerbut of counseling. Nevertheless, his disposition duringthe process was favorableenough that he prayedalong with the
priestduringthe first several sessions. Yet this level of participationdiminished,
with the final resultthathe discountedthe healing process as cultlike.
Experience of the Sacred
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posed to Ralph's vague sense of divine presence, heat, and color that received
only minimalinterpretationby the healing minister. The observermight surmise
thatthe healercould have workedwith this experienceeitherby interpretingit as
a mystical companionwho could protectthe young man from pathologicalnervousness in social situationsor by using it as an experientialwedge into Ralph's
agnosticism,therebyfacilitatinggreaterdispositiontowardhealing. FatherFelix
might also have taken the occasion to induce behavioraland attitudinaltransformationthroughhis statedpriorityof getting to the "root" of Ralph's problems.
Instead, any potential content of Ralph's experience remainedunelaboratedas
insight, interpretation,or direction. It is unclear whetherthis did not occur because the healer was unawareof Ralph's experience of "presence" or because
such a strategywould be unacceptable.
Margo's experiences of empowermentwere substantiallydifferent, rich in
biographicalmeaning(suddenemergence of thoughtsaboutherjob, doctor, and
formerboyfriend). For her, the experience was a moment not of abstractbut of
concretetranscendence.As pointed out by Kapferer, "A ritual fixed in a transcendentmoment is empoweredto act on contexts external to the performance
and to transformthem in accordancewith the rearrangementor reorderingwhich
the transcendentmoment of the rite expresses" (1979:17). Unless the concrete
rhetoricwithin such momentsis identified,the phrase"in accordancewith" posits no morethanan abstracthomology between elementsof ritualandelementsof
a distressedlife. The concrete experience of the sacred is not an experience of
"the supernatural"but a transformedway of attendingto the humanworld. For
Margobut not for Ralph, the link between transcendenceand the reorderingof
life was forged in the biographicalcontentof her transcendentmoment.
Negotiation of Possibilities
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fortableand alien. The attributionof the technique's ineffectiveness to interference by an evil spirit not only "raised the stakes" to a cosmological level, but
confirmedher feeling that anxiety and depressionwere alien to her naturalstate.
The story for Ralph can be summedup more briefly. There were simply no
possibilitiesgeneratedfor him in the healingprocess. As with Margo, FatherFelix
offered methods-relaxation, developing a positive attitude, attending social
events-but Ralphnever perceivedthem as realistic.
Actualizationof Change
Whatcounts as change, as well as the degree to which thatchange is seen as
significantby participants,cannotbe taken for grantedin comparativestudies of
therapeuticprocess. This insight is all the more importantfor this discussion,
where no definitive outcome exists and where our concern is to define minimal
elementsof efficacy.
The principalevidence for incrementalchange in Margo's healing is her reportof a decision to shareher troubleswith a youngersister-in-law.While a reason for this decision did not explicitly emerge in follow-up interviews, it can be
suggestedthat the healer's discourse on "Fear-of-Being-Found-Out"may have
plantedthe idea of seeking supportfrom othersratherthan attemptingto hide her
difficultiesfrom them. Attributingher formerbehaviorto a fear that is not only
negativebut may also representthe activity of an evil spiritis in this instancethe
key featureof the rhetoricof transformation.Whereasthe desire to hide her distresshadled to increasingsocial withdrawal,its linkageto the idea of an evil spirit
now motivated Margo to make her distress itself the occasion for social
engagement.
Failureto actualizechange in Ralph's healing is evident in his explicit rejection of whateverFatherFelix offered as evidence of therapeuticchange. Attending mass with his grandfatherwas discounted because it only happenedonce,
going to a restaurantwith his grandfatherwas not significantbecause he customarilydid such things withoutconsequence anyway, and anotherperson's opinion
aboutwhetherhe had changed was discountedboth because he had no indication
fromothersthatthis was so and especially because what matteredto him was that
he felt no different.When the researcherasked whetherhis recentlack of trouble
with uncontrolledeye movement was a possible result of healing prayer, Ralph
did not rejectthe possibility outrightbut greeted it with ambivalence,precluding
its classificationas an experienceof transformation.The healer's perceptionof a
positive change in Ralph's fatherdoubtless had minimal effect, since fatherand
son alreadyhad a close relationship.Similarly, the parents' reportof change in
his brotherhadminimaleffect, since strainedrelationsbetweenbrotherspersisted
to the point where they were unableto live in the same house.
In sum, the therapeuticprocess for Margo was characterizedby an initially
positive disposition;experiences of divine power with discrete, intelligible content; the elaboration of viable possibilities; and significant, if incremental,
changes. Ralph exhibited ambivalent disposition, diminishing empowerment,
nonrecognitionof possibilities, and rejectionof change, with a strongperception
of being misunderstoodby the healing minister.In these terms, healing was more
successful for Margothan for Ralph, and the analysis thus sheds light on the dif-
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ferentmodes in which the two terminatedtheir sessions. Ralph left the religious
healingprocess to find apparentlygreatersatisfactionfrom a psychiatrist/hypnotist, with no sense of continuityfrom his Charismatichealing encounter.Margo,
who was initially demoralizedaboutpsychiatryand psychotherapy,left the healing processto try an additionalinpatientpsychiatrictreatmentandprobablywould
have continued religious healing if the priest had not left the area for an extended
period.
Discussion
While moving in the rightdirection, this analysis still does not establishthe
significance of these transformationsin comparison to what clinical thinking
would call a cure. Whatis strikingin the examples presentedis their incremental
character,with no guaranteethatthey will be permanentlyintegratedinto the person's life. The incrementaland open-ended process of religious healing may
prove to be an essential characteristicthat requires some religious cures to be
"symbiotic" (Crapanzano1973): perhapsthere is no therapeuticoutcome, only
therapeuticprocess. CatholicPentecostalhealing can include the symbioticgoal,
encouragingsupplicantsto incorporatereligiousmeaningandinhabita religiously
defined community. Yet in the socioculturalsetting of late 20th-centuryNorth
America, we may readily discern factors that contributeto the fragmentaryand
inconclusivenatureof the healing process which do not pertainin the traditional
societies from which the bulk of ethnographicknowledge comes.
First, consider FatherFelix's attempt to draw the families of Margo and
Ralph into the healing process throughthe healing-of-ancestrymass. If there is
anythingunique about FatherFelix's healing practice in comparisonto that of
otherCatholicPentecostalhealingministers,it is his practiceof enteringthe home
and mobilizing family supportthroughparticipationin this event. Most Charismatichealing is based on the model of the individualencounter,and it is not unknownfor a womanto be in the healingprocess to the displeasureof her husband.
Even when the healertakes the initiativein mobilizing social support,his authority is not such thathe can intervenein the way sometimesdescribedfor traditional
healers. Margo's father was pointedly absent from her ancestry mass, as was
Ralph's brotherfrom his. Ralph's fatherparticipatedenthusiasticallyin several
privatesessions of his own with the priest, but he discontinuedthem withoutresolution, simply failing to make anotherappointment.Thus social support,often
cited as one of the hallmarksof ritualhealing, is by no means automatic.Support
from the family and supportfrom the community of religious believers are not
identicalor necessarily even compatible. Supportfrom either may be less emphatic than might be expected from the cases commonly reportedin the ethnographicliterature.
Consider, in addition, the ease with which people may enter and leave the
healing process in these examples. In cross-cultural perspective, this kind of mo-
bility among healing resourcesseems to be a function of both the numberof resources available and the exclusivity of each healing form. Finkler (1985) observed a distinction among Mexican Spiritualists between those who were devotees and those who made casual or periodic use of Spiritualist healing; Crapanzano
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a symbioticcure and otherswho received a "one-shot" exorcistic cure. As Catholic Pentecostalismhas developed over the past two decades, its healing forms
have become moreaccessible to those with only a marginalexposureto the movement.9Like Ralph and Margo, they are less likely to become involved in a total
"symbioticcure" and will more likely experiencethe kinds of incrementaltransformationsdocumentedhere. Thus, little understandingwill result if researchis
directedtowarddefinitivetherapeuticoutcome, ratherthantowardthe ambiguities
and partialsuccesses (and failures)embeddedin therapeuticprocess.
Furthermore,if their diagnoses are correct, Ralph suffers from a serious
schizophrenicillness characteristicallyassociatedwith psychotherapeuticfailure,
while Margo's problemsof depressionand panic typically respondwell to a varietyof psychotherapeuticinterventions.Researchin traditionalsocieties is often
complicatedby the fact that the anthropologistdoes not have comparablediagnostic information;on the other hand, researchin contemporarysociety can be
complicatedby the fact that the informantdoes have this information.Ralph's
rejectionof FatherFelix's comment, "If you think nervous, you'll be nervous, '
was based on his conceptionthat clinical paranoiacannot simply be banishedby
a changeof attitude.In contrast,Margo's willingness to tell abouther experience
of an apparitiononly to the priestand not to her psychotherapistwas based on her
concernthat she might receive a diagnosis thatto her was worse thandepression
and panic disorder.
One might say thatthe religious healingencountersof both supplicantswere
conditionedby previous encounters with mental health professionals, in terms
both of knowledge about their conditions and, especially for Margo, of insights
gained from previouspsychotherapy.This interpretationwould representethnographicmyopia, however. More accuratefor both Margo and Ralph, religious
healing was an interludein a history of encounterswith the mental health establishment. Herein lies both the clinical and anthropologicalsignificance of these
cases: anthropologically,in terms of how the interactionof both religious and
clinical meaningsshapethe illness experience;and clinically, in termsof how the
religious encountermay influence the trajectoryof the illness. How did Ralph's
previous hospitalizationand interactionwith mental health professionals affect
the encounterwith FatherFelix, and how did the experience with FatherFelix
influenceRalph'ssubsequentencounterwith the psychiatristusing hypnotherapy?
Margowas seeing both a psychiatristand a psychologist before meeting Father
Felix, who suggestedthatshe switch to a Christianpsychotherapistwhile she continuedwith healingprayer.In the end she appearedcommittedto both psychiatric
treatmentandreligioushealing. But were these independentcommitmentsor did,
for example, religious healing influenceMargo's willingness to submitto ECT?
The clinicianshouldfindthis kind of informationvaluable,but it is not likely
to be volunteeredby the patient. Like Ralphand Margo, both of whom refusedto
permitme to contact their physicians, many of those who have recourseto religious healing undoubtedlybelieve they are betteroff not informingtheir physicians unless or until some dramaticchange occurs for which they want medical
documentationof a miraculoushealing. Medical prejudice-real or perceived
againstreligious conviction may create a criticalblind spot in the clinical picture
of the large numberof people who find religious healing congenial.
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the relationship among social, self, and somatic levels is characterized as analogous to that of a "thermostat," such that "it is possible to affect processes in the
self and unconscious-somatic systems through the manipulation of symbolic parameters at the social level" (Dow 1986:63). The thermostat analogy is entirely
too mechanistic. What is needed at this stage in the development of a theory of
healing is specification of how therapeutic process effects transformation in existential states.
An approach grounded in participants' own experience and perceptions of
change may arrive at a more pragmatic conceptualization of healing as a cultural
process. This should be a goal not only on a conceptual, theoretical level but also
on the level of interaction between medical and sacred aspects of complex health
care systems, as illustrated by the two cases analyzed here. Having chosen a type
of religious healing that is formally and experientially different from psychotherapy, yet sufficiently similar for systematic comparison, I suggest the possibility
of a theory of the healing process that will not only include other, more seemingly
exotic forms but also permit a rethinking of healing in cosmopolitan biomedicine.
NOTES
Acknowledgments.Thanksare due to ArthurKleinman, Byron Good, Janis Jenkins,
RobertElliott, and Nancy Wood for valuable comments and criticisms offered in the developmentof this article. The researchwas supportedby NIMH grant#5R01 MH 4047302.
Correspondencemay be addressedto the authorat the Departmentof Social Medicine
and HealthPolicy, HarvardMedical School, 25 ShattuckStreet, Boston, MA 02115.
'A notableexception to this tendencyis the discussion in Good et al. (1982) of transference and countertransferencein a collaborationbetween traditionalhealers and mental
healthprofessionals.
were contactedpriorto the firstsession observedfor purposesof explain2Participants
ing the study, obtaininginformedconsent, and initiatingrapport,so that the researcher's
presencewould not be perceivedas disruptive.Healing ministerswere presentedwith the
optionof recordingsessions withoutthe researcher'spresence, but all invariablydeclined.
Althoughseveral participantswere somewhatnervous in early sessions, rapportwas successfully achieved, and none chose to terminateinvolvement with the project. Except for
rareoccasions, one of which is reportedhere, the researcherwas not drawninto the proceedings in any way. The importanceof this method is that it allows observationof nonverbalbehaviorin the healing sessions and adds to informant-researcher
rapport.
The researcherwith access to the intimacyof the healing session is, however, no mere
fly on the wall. Indeed, inevitably some topics discussed in researchinterviews are recycled back into the healing process. The act of listening to the tapes of the sessions raises
thoughtsand emotions thatmay otherwiseremainunexamined.These issues of reflexivity
are too large for adequatediscussion here and will be addressedin futurereports.
3Hermedicationsat the time of the study, a tranquilizer(Clonipan) and an antidepressant(Nardil), appearto confirmthis diagnosis.
4FatherFelix never explored the possible experientialconnectionbetween the frightening presenceand the earlierdeathof Margo's brother,since the occurrenceof thatevent
neveremergedin the sessions.
5Accordingto Ralph and his parents, various physicians disagreed over whetherhe
was in fact diagnosableas paranoidschizophrenicandwhetherhe in fact had a brainlesion,
but his primarymedicationsincludedan antipsychotic(Mellaril), an anticonvulsant(Tegretol), and an antidepressant(Elavil).
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