Illness Is a Weapon: Indigenous Identity and Enduring Afflictions

4. Medical Systems and Illness Experience

ChApteR 4 Medical Systems and Illness Experience D espite the almost ubiquitous presence of biomedicine around the globe, a great deal of treatment occurs outside of clinical confines. Indigenous practices are invariably contrasted with those of biomedicine . In the extensive literature that exists, the former is characterized as traditional and grounded in cultural beliefs, while the latter is considered scientific. As a result, medical beliefs and treatments are often conceptualized in terms of medical systems—internally coherent structures of meaning that encompass ideas, treatments, technologies, and values (Janzen 1978; Press 1980). Cast as the product of cultural difference , Indigenous medical systems are commonly portrayed as static and homogenous within a medical context (Kleinman and Benson 2006b, 835). Furthermore, Indigenous beliefs and practices are generally viewed as limiting, rather than encouraging, health outcomes (Gordon 1988; Taylor 2007). Through medical narratives, Indigeneity becomes essentialized , reified, and cast as fundamentally different from, and at odds with, clinical treatment. This is particularly evident in Australia where researchers, medical professionals, and health advocates often assume that two contrasting and incommensurate medical systems exist: Aboriginal and biomedical. Aboriginal healing beliefs are widely characterized as concerned about the social health of the group, while biomedicine is thought to concentrate on the biological individual (Mobbs 1991; Nathan and Leichleitner 1983). Portrayed as reductionist and impersonal, clinical treatment is cast as focusing solely on physical and environmental factors (Devanesen 1985, 33; Morgan, Slade, and Morgan 1997, 589). As a result, Aboriginal and biomedical systems are believed to be “vastly different in philosophy and practice” (Nathan and Leichleitner 1983, 72), and are compared in terms of a “stark contrast” (Mobbs 1991, 302) or “cultural gap” (Eastwell 1973, 1012). “Competing” (Nathan and Leichleitner 1983, 70), 82 “poor compatibility” (Maher 1999, 234) and “clash” (Sutton 2005, 1) are common ways of characterizing the relationship between the two medical approaches. These differences are widely believed to create barriers to effective biomedical care (Heil 2006; Mobbs 1991; Public Accounts Committee 1996; Saggers and Gray 1991). The division between allopathic and Aboriginal medicine with respect to ideas about illness and healing is not confined to health researchers and medical professionals. It is one that Aboriginal people themselves widely recognize (Maher 1999, 234; Nathan and Leichleitner 1983, 133; Reid 1983, 134). During discussions with Warlpiri people, I was often told that two distinct medical traditions and treatment systems existed: yapa-kurlangu and kardiya-kurlangu. Residents asserted that the former included ngangkari and bush medicines, while the latter included biomedical techniques and technologies. Furthermore, I was informed that only ngangkari could treat a yapa-kurlangu disease, such as spiritual illness . Consequently, it appeared as if these two healing options were discrete . In practice, however, I found this was not the case. While many statements focusing on illness beliefs made by Lajamanu residents highlighted and contrasted the differences between Aboriginal and non-Aboriginal etiologies and therapies, the practical way in which people sought care for a specific illness was far more integrated. I discovered that individuals concurrently employed numerous healing aids and technologies, a trend that has been—and continues to be—widely documented (Beck 1985, 84; Cawte 1974, 43; Cutter 1976, 38; Devitt and McMasters 1998; Dussart 2009; Gray 1979, 172; Skov 1994, 20; Tonkinson 1982, 229). Similar to narratives surrounding hunting and gathering, I came to notice that generalized statements did not always hold true in practice. Diagnoses often changed, as did treatment choice. Despite declarations stressing the incommensurability of kardiya and yapa techniques, a variety of treatments were utilized without a clash. Consequently, I believe the assumption that biomedicine and Indigenous healing beliefs are invariably conflicting and incompatible needs to be re-evaluated. Notions of distinct medical systems seem to reproduce perceptions of ethnic and racial identity rather than accurately reflecting the everyday reality of treatment behavior. Statements touting the discord between Indigenous and biomedical systems tend to disregard that illness is both an experience and an idiom. On one hand, it is lived—uncertainty, stress, discomfort, and pain often MedICAl systeMs ANd IllNess expeRIeNCe 83 suffuse the experience of illness. On the other hand, narratives of illness provide an interpretation of the natural and social world. When researching Indigenous responses to ill health, a great deal of attention has centered on the idiom, whereas the day-to-day experience of disease is often overlooked. There has been a tendency to draw conclusions based almost exclusively on notional representations such as those that...