Remembering to Live: Illness at the Intersection of Anxiety and Knowledge in Rural Indonesia

5. Naming an Illness

5  Naming an Illness The important part is knowing what the illness is. If it is known what it is, the medicine will work. But if the name does not ‹t, the medicine will not work. —Amaq Mol, September 1994 Every illness occurrence, in other words, has a name; the problem is to ‹nd the correct name, since this usually dictates the responses to the occurrence . . . —Horatio Fabrega The Importance of a Name Getting the name right for an illness is the essential ‹rst step in successfully coping with its presence. The ef‹cacy of treatment depends upon it. As we saw in chapter 2, Sasaks generally are not interested in knowing about the body and its workings for its own sake. Their interests are motivated by particular vulnerabilities and illness episodes. Likewise the interest in names—in diagnoses and etiologies of illness— is motivated by and only discussed with reference to a particular illness .1 This chapter does not include tables with lists of illnesses, symptoms, and treatments. Tables would imply a de‹nitive one-to-one correspondence among these three when actually the meanings of illness names seem to have a more ›uid and contingent character. Moreover, we are
186  1. This pragmatic approach to health care is very common among nonspecialists who often use syncretic blends of medical ideas and treatments (e.g., Kleinman 1980, 93ff.). interested in how people cope with their health concerns, which involves looking not for one-to-one associations but for processes of dealing with illness. How does one name an illness? That is, how does one give a salient label to particular perceived conditions that identify an origin or category ? The process of giving illness names is actually quite curious.2 The ‹rst trick is to identify when a person is sick. As Lieban notes, “Health and illness constitute a continuum, and when one becomes the other is often vague” (1992, 187). This vagueness is pronounced among rural Sasaks who are perpetually less than healthy, forever seeking out medicine to become fatter, stronger, and more virile. The line between being less than healthy and being ill often depends on whether or not the ailments can be given a speci‹c name. Naming itself is the second trick. Names are important. A name legitimates an illness and can become both a personal symbol of experience and a social symbol motivating actions and meaning-making. Yet, one can not base a name solely on a person’s experience of pain and illness, because persons’ experiences are individually different.3 Moreover, as we have seen for Sasaks, each person has unique understandings of his or her body, unique experiences of vulnerability, unique social relationships and motivations, and unique constellations of knowledge. Even from a biomedical perspective, bodies are not homogeneous; each is genetically and biologically different. Yet, somehow, despite this diversity, people are able to assign particular perceived conditions with categories and names of illness. The question is how. Most Sasaks assume that if an illness can be correctly named, treatment will “meet” the illness and make it leave. Looking at the naming processes, I suggest that naming is always a matter of more or less creatively connecting persons, situations, symptoms, and vulnerabilities. In the end, Sasak ethnomedicine is personalistic: that is, who a person is and the vulnerabilities he senses are more important than the symptoms he exhibits. naming an illness
187  2. I use the word name—a translation of the Sasak term—which does not mean that each illness is identi‹ed with a speci‹c, already known diagnostic name such as ketemuq (illness from meeting a ghost) or barak (a swelling illness). Sometimes what Sasaks call an illness name refers to an explanation or etiology rather than a distinct, one-word identi‹cation. Thus I use illness name as a shorthand for a discrete interpretation or understanding of an illness. 3. For the symbolic nature of illness names see, e.g., Lieban 1992; Turner 1967. For works on the experience of illness see, e.g., Finkler 1994a; Good et al. 1992. remembering to live Definitions How are we to study and understand the largely nonorderly actions of people in pluralistic medical settings? Here and in the next two chapters we address this question by examining the processes through which people come up with, decide on, and follow through on knowledge that they use to cope with illness. To...