The efficacy of traditional medicine is an issue that continues to vex medical anthropology. This article critically examines how the efficacy of traditional medicine has been conceived, operationalized, and studied and argues that a consensus remains elusive. Efficacy must be seen as fluid and shifting, the product of a negotiated, but not necessarily shared, understanding by those involved in the sickness episode, including physicians/healers, patients, and members of the community. Medical anthropology needs to return to the field to gather more data on indigenous understandings of efficacy to counteract the biases inherent in the utilization of biomedical understandings and methods characteristic of much previous work.
What can an exploration of contemporary Aboriginal healing programs such as those offered in Canadian prisons and urban clinics tell us about the importance of history in understanding social and psychological pathology, and more significantly the salience of the concept of "historical trauma"? The form of Aboriginal "healing" that has emerged in recent decades to become dominant in many parts of the country is itself a reflection of historical processes and efforts to ameliorate the consequences of what is today often termed "historical trauma." In other words, contemporary notions of "healing" and the social, cultural, medical, and psychological disruption and distress caused by colonialism and captured in the term "historical trauma" have coevolved in an interdependent manner. I also argue that there is a tension between the attribution of this distress to both specific (e.g., residential schools) and generalized (e.g., colonialism) historical factors, as evident in the "historical trauma" concept, and the prevailing emphasis in many healing programs to encourage the individual to take personal responsibility for their situation and avoid attributing blame to other factors. I conclude that "historical trauma" represents an idiom of distress that captures a variety of historical and contemporary phenomena and which provides a language for expressing distress that is gaining currency, at least among scholars, and that the contemporary Aboriginal healing movement represents an effort to deal with the absence or failure of both "traditional" Aboriginal healing and government-sponsored medical and psychological services to adequately deal with this distress of colonialism.
In this article the author addresses two basic questions found at the intersection of ethics and qualitative research methodology: Why are some people reluctant to share their stories? and Are there some people whose stories ought not to be heard? Focusing on imprisoned sexual offenders, the author argues that the establishment of trust in the research relationship is essential to creating safe places for people living with "problem experiences" to tell their stories. He also argues that however repugnant, the stories of society's worst offenders must be heard if we as a society are to better understand their actions and protect ourselves.
Symbolic healing is a complex phenomenon that is still relatively poorly understood. This paper documents a process of symbolic healing which is occurring in Canadian penitentiaries, and which involves Aboriginal offenders in cultural awareness and educational programs. The situation is compounded, however, by the existence of offenders from diverse Aboriginal cultural backgrounds with differing degrees of orientation to Aboriginal and Euro-Canadian cultures. Participants must first receive the necessary education to allow them to identify with the healing symbols so that healing may ensue, and both the healers and the patients must engage in a process of redefining their cultures in search of a common cultural base.
Employing a framework at the intersection of psychological anthropology and narrative theory, I provide a critique of Cognitive Behavior Therapy (CBT) approaches to sexual offender rehabilitation. I demonstrate that what forensic psychologists refer to as a “cognitive distortion” or “thinking error” is often embedded within a broader narrative, and that these narratives reveal the existence of identifiable strategies designed to communicate something salient, enduring, and moral about the offender. Through the examination of narratives offered by imprisoned sexual offenders, several such narrative strategies containing the seeds of moral agency are identified. It is suggested that CBT's current focus on cognitive distortions effectively eliminates this narrative context and thus serves to disguise and even eradicate the positive, moral notions of self that most offenders exhibit in some form or another. A rehabilitative approach that works with narrative, facilitating development of shared narratives among offenders and therapists, would allow for the emergence of a plan for morally agentive living, transcending what is currently possible within the hostile, challenging framework of CBT. [narrative theory; cognitive behavior therapy; moral agency; sexual offenders; prisons]
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