Volume 126, February 2015, Pages 9–16
Latent and manifest empiricism in Q'eqchi' Maya healing: A case study of HIV/AIDS
Highlights
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- Develops a framework for understanding the empirical nature of Indigenous healing.
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- Argues for compatibility of traditional medicine and biomedicine.
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- Presents ethnographic case study of treatment of HIV/AIDS by Q'eqchi' Maya healers.
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- Argues the need for communication between traditional medicine and biomedicine.
Abstract
This
paper presents a case study of the traditional treatment of a Q'eqchi'
Maya man in southern Belize in 2011 who is suffering from AIDS-related
sickness. The purpose is to detail the empirical nature of Q'eqchi' Maya
medicine, distinguishing between manifest and latent empiricism, as
evidenced in the healers evolving attempts to treat the patient in the
absence of knowledge of his biomedical diagnosis. The paper argues for a
more complete understanding of the empirical nature of much Indigenous
healing, which parallels aspects of scientific medicine, and for better
collaboration among traditional healers and biomedical practitioners in
strongly Indigenous areas.
Keywords
- Belize;
- Maya;
- Indigenous healing;
- HIV/AIDS;
- Biomedicine;
- Collaboration
The
purpose of this paper is to demonstrate, via a case study of a Q'eqchi'
Maya patient in the Toledo District of Belize, how a traditional
healing system is empirically invoked when a problem is encountered that
confounds existing knowledge, in this case in the treatment of a
patient already under the care of the biomedical system for
HIV/AIDS-related medical problems but whose diagnosis is not initially
revealed to the healers who treat him. The case provides an opportunity
to see a traditional medical system “at work,” so to speak, as it
confronts the challenges of serial- and co-morbidity that do not fit
neatly into the existing nosology and broader medical epistemology. A
concurrent goal of the article is to demonstrate the need for dialogue
between traditional and biomedical systems, a search for areas of
compatibility, and greater efforts expended toward collaboration in the
treatment of specific medical problems.
1. Latent and manifest empiricism
“Empiricism” is a general term that refers, broadly, to the accumulation of knowledge through experience and observation (Lett, 1997).
Here we refine the notion of empiricism as it exists within traditional
medical systems as well as within biomedicine, by distinguishing
between “latent” and “manifest” empiricism. We take “latent” empiricism
to refer to the existing, collectively-held medical knowledge pertaining
to diagnoses or treatment, and the standard against which clinical
efficacy is judged. In biomedical terms, this is characterized by both
scientifically-derived “textbook” knowledge learned by clinicians in
formal educational settings and the knowledge previously accumulated
through experience with specific medical cases. It is knowledge that can
be consciously recalled and explicated, as in the traditional use of a
specific plant or medicine, or a diagnostic procedure. It is also the
“tacit” knowledge at embodied, non-conscious levels that forms the
“background” of a practice or activity (Heidegger, 1996 and Polanyi, 1966).
Latent empiricism is the collection of professional or procedural
knowledge that, after sufficient practice, experts possess. It provides
the form, model or “paradigm” through which and by which a particular
case is observed, “the entire constellation of beliefs, values,
techniques, and so on shared by the members of a given community” (Kuhn, 1970, p. 175), in this case, the healing fraternity.
Latent
empiricism can be couched in the language of “tradition.” But while an
appeal to tradition may represent a default to a more-or-less fixed body
of knowledge, as is the case with Traditional Chinese Medicine (Quah, 2003)—which
has parallels with biomedicine's textbook knowledge—for the most part
this represents evolving knowledge handed down, often orally, from
healer to apprentice, from generation to generation. Craig (2012)
quotes a Tibetan traditional doctor who aptly describes this process:
“In our tradition, discoveries have been made based on individual
experience and what we might call qualitative methods, rather than
methods that can be reproduced in the same way in different
environments,” as is the goal of science (p. 92). In both biomedicine
and traditional medicine, latent empiricism refers to the knowledge,
whatever its source and however transmitted, that provides the lens
through which the clinician approaches a specific case, knowledge which
is accepted as accurate and trustworthy because of its time-testedness
even where the origin of the knowledge is unknown to the practitioner (Kirmayer, 2004).
In this sense, biomedicine and those systems often characterized as
“traditional” are both “traditional” knowledge systems. The accumulation
of latent empirical knowledge, like Kuhn's (1970)
notion of “paradigm,” is the “prerequisite to perception itself” (p.
113): it informs the clinician what the problem “sounds like,” or “looks
like” as they commence their clinical investigation.
Manifest
empiricism, in turn, refers to the application of this generalized
latent knowledge to particular cases, how this knowledge is tested
against the case and challenged for its accuracy and effectiveness, with
diagnosis and treatment adjusted accordingly in an effort to cure the
patient or achieve some other standard of efficacy (Waldram, 2000 and Waldram, 2013).
Manifest empiricism as praxis is most visible, then, in the clinical
treatment of patients. As latent empiricism is closely involved with
processes of perception, manifest empiricism is closely involved with
the processes of interpretation. Manifest empiricism is the point at
which a specific medical sign or symptom is observed and where the
hermeneutical decisions are made in clinical time regarding their
significance. From a narrative perspective then, manifest empiricism is
about “therapeutic emplotment” (Mattingly, 1994),
the process of “reading” clinical signs and determining the most
appropriate treatment regimen to follow, which is based on or informed
by the accumulated knowledge of prior cases, i.e., latent empiricism.
Neither form of empiricism is, strictly speaking, “science.” They highlight the art of clinical decision-making that is therapeutically pragmatic ( Barnes, 2005, Quah, 2003 and Waldram, 2015),
a “practical reasoning [which] seeks the best answers possible under
the circumstances … enables the reasoner to distinguish, in a given
situation, the better choice from the worse … [and] is inescapably
particular and interpretable” ( Montgomery, 2006,
p. 43–44). Arguing that Indigenous or traditional approaches to
medicine or healing are “scientific” represents a conflation of ideas of
empiricism with ideas of structured, purposeful and controlled inquiry
that represents science, and misses the nuances by which traditional
knowledge is collected through both processes of gnosis – the collection
of knowledge through spiritual means – and those of practical
engagement with the material world ( Bates, 1995).
What we demonstrate in this article is how Q'eqchi' Maya healers
approach particular cases through both forms of empiricism, and
constructively employ gnostic and material evidence as they do so.
Our
intent is to offset common notions that “traditional” or Indigenous
forms of medicine, because they are not scientifically-based, are little
more than the rote application of what we are calling latent empiricism
at best, and primitive or magical thinking at worst, and therefore
incompatible with biomedicine. The ubiquitous references to “beliefs”
rather than “knowledge,” with liberal references to “folk” medicine,
that have characterized medical anthropology's engagement with
non-western medical systems have created a deep-seated bias in how these
systems are best understood (Foster and Anderson, 1978 and Good, 1994). Young's (1979)
caution that traditional medical practices may exist not because they
are effective but simply because there is no better option, or Kirmayer's (2004)
notion that traditional practices characterized as “healing” are
primarily symbolic and metaphoric, and endure primarily because of
dissatisfaction with biomedicine rather than patient confidence in
efficacy, need to be balanced by deeper examinations of the empirical
and medical basis of much “traditional” healing. Manifest empiricism
particularizes and problematizes the clinical case, and we argue this is
inherent in Q'eqchi' Maya clinical treatment.
