Healing Insanity: a Study of Igbo Medicine in Contemporary Nigeria

By Patrick E. Iroegbu

Healing Insanity: A Study of Igbo Medicine in Contemporary Nigeria is an original and in-depth study on endogenous medical system in an African society. It is craftily written and provides solid insight, through case studies and theory, into how insanity affects patients and the society. Particularly, it explores various collective representations and strategies regarding insanity and healing as it examines the healing institutions, healers, and ritual cults. The central question is, given the patterns of healing, how do the Igbo shape the incidence and symptoms of insanity, define its aetiology, and provide healers with culture-specific resources and skills to address this illness? The focus became increasingly centred on bodily semantics and endogenous knowledge systems and practices. Dr. Patrick Iroegbus work is a very valuable and rare study and has appeared at a desirable time. It is, for an African society, a comprehensive study of the many ways Igbo people, in their practical, routinelike attitudes and body-centred experiences, as well as in their more reflective aetiologic knowledge and healing institutions, relate to the phenomenon of insanity, or ara, in the cultural parlance. As the first of its kind, reminiscent of, and assured by, the various remarks of Igbo scholars and leaders at various meetings and discourses, the task this work has set out to accomplish is a very brave one. The authors account of his fieldwork experiences and adopted techniques illustrates his initiation, revealing him as a genuine ethnographer who is a friend of people and at ease with his field. With both the far-seeing and inspiring analysis of Igbo medicine, life, and culture accounted for in the work, the book stands out for ethnographers, teachers, students, leaders, policymakers, and the general public. This is a book that deserves to be read as it shapes the critical path toward understanding ways of healing insanity in a culture-specific context, crosscutting perspectives for a relationship between indigenous healing and the biomedical sphere.
Prof. Ren Devisch (Africa Research Centre, University of Leuven)
This book is written with a clear purpose for everyone to readto understand and heal insanityand indeed provides a thick piece of cultural philosophy and vernacular of Igbo medicine in hopes of putting cultural wisdom in pursuit of integral health care development.
Prof. Pantaleon Iroegbu (Professor of Philosophy, Major-Seminary, Ekpoma, January 2006)
To read this book, as I did, is to get the benefit of Dr. Patrick Iroegbus ethnographic insight for an archetypical African healing system in Igboland. It offers a fascinating theory of symbolic release that speaks of African symbolic action and knowledge system.
Dr. Paul Komba, Esq. (University of Cambridge)

• Language: English
• Publisher: Xlibris US
• Release date: Jun 8, 2010
• ISBN: 9781450096294

Patrick E. Iroegbu

Patrick Iroegbu (PhD) is a social and cultural medical anthropologist and lectures anthropology at Grant MacEwan University; and formerly at Taylor University College and Seminary. He is the author of Marrying Wealth, Marrying Poverty (2007) and Introduction to Igbo Medicine and Culture in Nigeria (2010). His articles have also widely appeared in book chapters, journals, and Web sites: “Culture, Colonialism and Development” (2009), “Harvesting Herbal Resources and Development of Practitioners in Nigeria” (2006), “Migration and Diaspora: Origin, Significance and Challenges for Development at Home” (2006, 2007), “Threat to Life: Understanding HIV/AIDS and Combative Ways in Nigerian Society” (2005), and “Dynamics of Poverty as Culture in an African World: Implications for Nigeria’s Vulnerable Population” (2009). He also co-ordinates the Kpim Book Series Project of the Father Prof. Pantaleon Foundation in Nigeria. Research interests include approaches to cultures and healing, endogenous knowledge systems, gender issues, development, migration, and race relations in local and global centres. Contact: [e-mail]

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Healing Insanity

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A Study of Igbo Medicine in Contemporary Nigeria

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Patrick E. Iroegbu

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Studies in Endogenous Medicine, Culture, and Development

Copyright © 2010 by Patrick E. Iroegbu.

Library of Congress Control Number:              2010906817

ISBN:                    Hardcover                            978-1-4500-9628-7

                              Softcover                              978-1-4500-9627-0

                              Ebook                                   978-1-4500-9629-4

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Contents

ACKNOWLEDGEMENTS

DEDICATION

FOREWORD

PREFACE

PART ONE

Ethnography and Igbo Society

CHAPTER 1

CHAPTER 2

CHAPTER 3

PART TWO

Insanity, Ara

CHAPTER 4

CHAPTER 5

CHAPTER 6

PART THREE

Healing Practices

CHAPTER 7

CHAPTER 8

CHAPTER 9

CHAPTER 10

CHAPTER 11

GENERAL CONCLUSION

SELECTED BIBLIOGRAPHY

ACKNOWLEDGEMENTS

As I complete the writing of this book, I express my gratitude to many people and institutions for the immense support received throughout its realisation. I am first indebted to the Catholic University of Leuven, which through a scholarship of the Interfaculty Council for Development Co-operation (IRO), has sustained my research stay in Leuven and at home. I give special thanks to Professor René Devisch, who promoted this work and relentlessly gave time and inspiration to every step of my research. Putting great trust in the ongoing research, he visited me twice in the field and helped deepen my anthropological curiosity and insights into Igbo medicine and related critical development issues. I do appreciate the many discussions, suggestions, and corrections. The Africa Research Centre (ARC), which he directs with Prof. Filip De Boeck, initiated very many stimulating and path-breaking seminars for (post) doctoral researchers and most stimulating interactions with my friends-colleagues too. Thanks are also due to the Pascal Decroos Fund for Special Journalism for financing a visit to Igboland in the company of Journalist Frank de Moor, editor in chief of Knack magazine. This visit also resulted in an engaging presswork focusing on African cultures and healing published in the Knack magazine.

Many people in Nigeria granted me their hospitality and expertise. I thank specially all of my informants, including Chiefs Dibianta Joseph Iheanacho, Ike Sabastian, Sunday Iroabuchi, as well as Nze John Duru, Linus Ekigwe, Nathaniel Ahuzien, Rosanna Nwagwu, Beatrice Ajonuma, Clement Anwueri, Venatius Iwu, Ebirim Ezeala Calistus, and Lambert Opara. Their unmatched commitment and assistance through various initiations, healing sessions and collaborations remain deeply appreciated. I thank Camilus Onuoha at the Ehime Mbano Local Government Welfare Office as well as Mr. Christian Abazie, Gabriel Agbiogwu and Richard Chukwu for showing special interest and giving me access to some patients and healers. I sincerely recall the co-operation from the staff and patients of Mgboko Psychiatric Hospital and Okpala Psychiatric Rehabilitation Centre. I also appreciate Dr. Joyceline and the staff of Joe-health Psychiatric Nursing Iho for their collaboration and discussions.

I am, moreover, indebted to the various traditional healers’ associations, in particular at Mba Asaa, as well as to the Imo State and local government health ministries, particularly to Dr. Chinelo Echeruo, Imo State health commissioner, for their encouragement. Profuse thanks are also directed to the University of Nigeria, Nsukka, the Abia State University, the Alvan Ikoku College of Education, the Imo State University, the Imo State Library, and the Statesman Newspapers Ltd., for allowing me to use their institutional facilities and contacts.

My gratitude goes to His Royal Highness Eze Theodore Ogoke and his family for the wonderful encouragement and discussions on Igbo medicine. You honoured me with the title of chief. You also extended the same chieftaincy title to my promoter, Prof. Dr. René Devisch, in 1998 for his intellectual contributions, in particular for devoting a career to the development of African medicine.

I should also thank Prof. Em. Michel Norro and his family, Louis Delahaye, Suzane and Lulu François, André Binon, Dr. Lieve Coene, as well as (Apotheek) Jean-Pierre Baeck and family, for their invaluable love and support.

I also feel indebted to Dr. Paul Komba, Dr. Paulin Bekambo, Fr. Dr. John Bosco Ekanem, Peter Crossman (who translated some Dutch texts), Stella Nyanchama-Okemwa, Dr. Alexis Tengan, Dr. Koen Stroeken and Dr. Steven Van Wolputte for contributing so much to the improvement of this work.

I thank my family for tolerating my time away from family life. My heartfelt and deep appreciation to my parents and brothers, particularly to Fr. Prof. Pantaleon Iroegbu, for showing me through hero modelling another dimension of reflecting on life. By mentoring me in critical philosophy and cultural reflections on being well, he quickly opened up for me this important cultural dimension of life. I am thankful for their having given me the best they could. If I have reached this stage, it is because their full backing made me feel that learning is good, and indeed, so important to share knowledge and experiences of life with others.

Patrick Iroegbu

DEDICATION

This exceptional book is dedicated to all future researchers in this field and to all those in my home area who are ill, so that it may contribute to opening up paths to recovery and development as needed.

FOREWORD

Healing Insanity: A Study of Igbo Medicine in Contemporary Nigeria is for African society an original work, which largely brings out a novel anthropological study of Igbo medicine and culture in Southeastern Nigeria. Dr. Patrick Iroegbu’s work on Igbo medicine is a very valuable and rare study and has appeared at a most desirable time. The book provides a comprehensive and in-depth study of the many ways Igbo people, in their practical, routinelike attitudes and body-centred experiences, as well as in their more reflective aetiologic knowledge and healing institutions, relate to the phenomenon of insanity, or ara, in the cultural parlance. As the first of its kind, reminiscent of, and assured by, the various remarks of Igbo scholars and leaders at various meetings and discourses, the book is concerned with a highly sensitive issue: mainly, why do so many Igbo people, urbanized and Christian included, not only consult medical doctors, but also rely on centuries-old traditional health care in cases of lasting illness and, in particular, insanity. Observably, there exists some basic Igbo understanding that human life of today is in continuity not only with that of the ancestors, but also with that of the life source, the afterlife (although the latter is infinitely more perfect in peacefulness).

First, this research is fascinating in view of the wealth, complexity, and beauty of Igbo culture into which the book initiates readers. There is to be found wide-ranging ethnographic illuminations and strengths patterning to insanity, culture, and healing, in line with the classical perspective of the first generation of medical anthropology in the 1980s. This starting point is worked out with Arthur Kleinman’s argument that sickness and distress are not simply individual experiences that arise out of the contingency of physical life and threaten to disrupt a known world centred on the individual subject. Sickness, in particular insanity, in one form or another, is actively created, defined, and distributed by the social order. Second, there is a broadening stance of the sickness perspective, and even far beyond, as it appears to me up to today, for any medical-psychiatric mental-health notions. In line with the more recent work of Arthur Kleinman and others, the focus on illness as culturally constituted experiences of misfortune is—as people see it—a result of an effect of bewitchment or intergenerational retaliation in the canvas of kinship and ancestral cults. From this cultural perspective, the work, moreover, argues that both traditional Igbo medicine and, on some level, biomedicine are so-called ethnomedicines; that is, they entail culture-specific modes of illness causation, aetiology, and treatment.

The analytic approach adopted for the work, to me, is innovative inasmuch as it approaches insanity as an event of mixedness, unboundedness, breaks—very much in line with that very same epistemic mood at the market that is found in a rotation all over Igboland. For thinking and treating insanity, the market realm offers a paradigm beyond the narrative of order, mastery, or restoration. It is a realm of both excess and probing, thus engaged in exploring or deciphering new avenues, goods, productions, healing techniques, or enabling procedures by those who know both too much and too little. Like insanity, the market is a space-time vertigo: here, many views or concepts become dislocated, change, or lose their meaning and are directed towards another use or a solution that is yet to come. Igbo culture considers insanity largely as a complexity, a blurring at the edge of language and world, pushing the limits of reflexivity, knowledge, truth profiles, pragmatics, meaning-making, and subject formation.

Third, as it is critically presented, the ethnographically fascinating chapters, especially (among others) chapters 10 and 11, deal with community-oriented forms of healing insanity. The book, moreover, shows how the healing churches, biomedical health care, and the economic reality of commoditization seem to overlook the complex community-based cultural and social dynamics that contribute to and shape symptoms of insanity and condition vulnerability, and more important, prefigure the cultural responses to mental illness, and people’s therapy choice and satisfaction.

Fourth, the work moves reasonably towards the culturally sensitive application of anthropology in community-based health care policy. It heads towards rethinking concrete policies and the organization of public-health services in view of a genuine and integrative form of community medicine. Indeed, mental health problems account for at least one-fifth of the total global burden of disease. As an anthropologist, the author shows a future action-research direction in this African society. Chiefly, such research will engage in mediating issues of culture and power between the community and public health officials, or between healers and medical staff. The intention of the present work and approach, he argues, is to efficaciously design and initiate culture-sensitive activities, which, with the public domain of the state, may promote a culturally adequate position for the healers alongside with that of medics.

The task is an enormous one. Up until today, formal community health-care policy-making in Igboland is still solely conceived from the perspective of biomedical, hospital-based, and pharmaceutical treatment. This is, in fact, the conventional psychiatric hospital treatment that colonial medicine, and then, in the 1970s and early 1980s, the developmentalist project of the nation-state, introduced. However, such biomedical public-health approaches to insanity overlook endogenous social and cultural specificities and resources. Yet it is made clear how, presently, the biomedical institutions and civil societies (through associations, for example, of the healers) are searching for opportunities to link up with both international health-policy developments as well as with local needs, endogenous cultural resources, and models.

The very task of critically articulating biomedicine with locally situated health knowledge, practices, and resources at the level of Igbo communities and healers’ associations will never be finished. That is, the task this work is setting out to accomplish is a very brave one. The author’s account of his fieldwork experiences and adopted techniques illustrates his own initiation into the healing arts and reveals him as a genuine ethnographer who is a friend of people. Indeed, the ethnographer/fieldworker needs a great moral strength, an enormous enthusiasm, and a restless intellectual curiosity: these are also qualities of this author, judging by this piece of work. The author was so much at ease with healers, and they with him. The ethnographer or anthropologist engages in an endeavour of restlessly experiencing people’s views, emotions, queries, anxieties, and the like in his or her own person. He or she must therefore sense what is lying in their minds, their unspoken hopes, for it is this that tracks latent issues and interlaces specialized concepts, emotions, and concealed values and strategies of senior people to be further explored. He or she delves into these deep layers through conversations, observations, and in particular, by analysing the symbolic practices that are a unique form of world-making. Having been able to surpass his Western-style gaze and develop again a keen sense of life with his people, I think a useful outline providing Igbo medicine with a background is well worth the effort. Dr. Iroegbu’s analysis of the data is not only visionary, but also inspiring. I strongly recommend this book to ethnographers, teachers, students, policymakers, and the general public. This is a book that deserves to be read as it aims at understanding ways of healing insanity in a culture-specific context that crosscuts perspectives for a relationship between indigenous healing and the biomedical sphere in an African society.

Prof. Dr. René Devisch

K.U. Leuven and Africa Research Centre/

Institute of Africa Research Academy (ARC/IARA)

PREFACE

This book, Healing Insanity: A Study of Igbo Medicine in Contemporary Nigeria, grew out of a thesis exploring the dynamics of endogenous medicine and culture in Igboland of Nigeria. Its purpose has been determined by a large literary gap on the subject of Igbo medicine, life, and culture. The motivation, focus, and standpoint of the research evolved as a response to an ethnographic knowledge search to facilitate awareness and, indeed, take action regarding health care and development needs. For the most part, Igbo medicine is neither examined nor institutionalized side by side with the state health organizations. Yet it fosters health care for approximately 80 per cent of the population. The critical situation illustrates that, in countries where biomedicine is largely established, folk medicine has continued to flourish. Our initial reaction of surprise and disbelief at the lack of literature in the field of Igbo medical knowledge, systems, and practices stemmed from, among others, some postgraduate anthropological studies. Given the series of research work we engaged in, we wanted to work on topics focusing on Igbo systems of healing but found a great dearth of detailed or relevant resources. It quickly became obvious to us that this disparity was in critical need of scholarly attention. Indeed, in gaining an understanding of the ways in which Igbo medicine is conceived, commonly used, and made sense of, the large number of clients relying on it to heal health and social problems will, as a matter of course, be equally equipped to speak to the human condition more meaningfully. An in-depth study such as this places Igbo medicine in the context of culture and, moreover, presents comprehensive information about the many ways insanity is represented and cured in an African society.

A major concern of the book is to gain, and provide, insight by laying bare the background of ethnographic charting of Igbo medicine and culture, with particular reference to insanity. As the first of its kind, the production of the book has been supported by the remarks of various Igbo scholars and leaders, including Prof. Anezionwu at the Scholarly Annual Ahiajoku Lectures—Chukwu ka Dibia—in 1988, as well as Ezeliora’s Traditional Medicine in Amesi (her own community) in 1994. By playing the gender card in ethnomedical research, Ezeliora was publicizing the initiative of a woman in writing about that which Igbo men and scholars had previously ignored. This was further confirmed by one of our recent participations in an International Symposium held at Owerri (October 1-4, 2003) at the Whelan Research Academy. With the theme Harvesting and Sharing Indigenous Knowledge in Africa, the symposium specifically represented Igbo medicine and its practitioners, thereby stressing the need for scholarly attention in this area.

The study began with over eighteen months of immersion in Igboland. While being initiated into the knowledge related to traditional healing arts in the domain of insanity (ara), we were able to gather from the healers plenty of case studies and multiple firsthand accounts of the practices, medicines, symbols, and ritual objects involved. As our research went deeper, our focus centred increasingly on bodily semantics and endogenous knowledge systems and practices. Taking everything into account and being mindful of a sense of balance, it struck us that it would be profitable to question the place and meaning of Igbo medicine, how its healers are formed, and how they operate face-to-face or side by side with the biomedical approach. Specifically, we wanted to know why Igbo medicine is persisting rather than petering out, and why patients rely on it to address and heal their divergent health and social problems. Moreover, we wanted to understand why the Igbo medical approach faces the prejudice it does: Why it is classified and derogated with such labels as primitive and pagan, and why it is, for all intents and purposes, considered unscientific and unreliable by modern health-care practitioners and westernized Igbo scholars, bureaucrats, and leaders? Finally, we also wanted to explain Igbo medicine and culture as seen through a specific illness so that we might make sense of the whole of ethnocultural resources, beliefs, and practices as they pertain to a changing African society and policy issues surrounding the diversity and integration of the health care system.

In referring to anthropological study of Igbo medicine (ogwu igbo), we mean the cultural practices and the reasoning and empowerment involved when people are faced with the diverse, everyday realities of illness. Additionally, it entails the various skills and expertise implied in healing as well as the healer’s understanding of world order, particularly with respect to the causes of misfortunes, and including what is to be done to regain normality. In their art of healing, Igbo healers help their clients make sense of their own social and world order, while outlining the cultural system that underlies the very constitution and renewal of their society. Insanity constitutes an all-inclusive illness and, apparently, stands as the most problematic of all sorts of impairments. Its impact on people’s lives hits on many themes in the Igbo worldview—what they think, what they know, what they say, feel, and do about insanity on the level of their own personal world order.

Our main objective, therefore, is to offer insight, through case studies and by applying Arthur Kleinman’s explanatory and related models of cultural context of understanding illness and healing, into the question of how insanity (ara), a core issue in Igbo, affects the lives of patients and society as a whole. The study not only considers the social and cultural significance of insanity, but also examines the various forms of collective representations and strategies regarding its healing. In Igbo society, insanity is considered a severe illness insomuch as it leads the afflicted to behave in ways that are contrary to conventional codes of conduct, modes of life, and communication, thus resulting in the belittlement, dishonour, shame, and isolation of both patients and their families. This work examines the relevant healing institutions and ritual cults within the broader context of Igbo society and culture. The central question of the research is this: Given the patterns of healing among the Igbo, how does Igbo culture shape the incidence and symptoms of insanity, define the aetiology, and provide healers with culture-specific resources with which to efficiently address this damaging illness?

Arising from this central question, the endeavour analyses cases of insanity in the context of social and cultural paradoxes and multiple levels of meaning embedded in illustrative examples of the illness. Relying on the accounts of patients and healers, the work discerns what ara means to the patient, the family, and the community. More specifically, the following questions are asked: What behaviour and life problems are evocative of insanity? What sense does ara make? Answering these questions necessitates relating the complex phenomenon of insanity to the community’s perception and experience of mental affliction—its agencies, such as extrahuman forces, its processes, and its assigned spaces, such as markets. To scrutinize these issues in detail, our anthropological approach and perspective developed as follows:

First, as motivations are concerned (that is, to gain insight as well as to provide a case study that would illuminate the frame of Igbo medicine), we sought to fill the gap in the ethnographic material about Igbo medicine in general and insanity in particular. In doing so, we endeavoured to show how medical anthropological understanding might respond to the dire need to bring public health-care policy to the grassroots level. This task consisted of examining how things currently stand and exploring the reasons behind the perceptions and representations entailed in the healing process.

Second, the text examines how bodily symbolism informs the narrative of the illness, while recognizing the derogatory setting created by colonial encounters and postcolonial alienation. The argument is that postcolonial overemphasis on economic development, as well as the all-too-dominant Christian religious outlook, has overshadowed awareness of ethnocultural dimensions of health care and well-being. Observations about local knowledge and action systems in regard to health care, combined with practitioners’ strong traditions, suggest that a large portion of the population still rely on folk medicine to cure afflictions. That people in Igboland have grown eager to use indigenous treatments is indicative of disillusionment with the state’s existing, one-way focused, mediocre, expensive, and alien biomedical health care, which rarely offers a satisfactory cure. Patients and healers whom we consulted repeatedly stated that insanity is not cured in hospitals.

The book is organized in three parts, consisting of eleven chapters in total. Part 1 offers an overview of the ethnographic research, with chapter 1 discussing the various techniques applied during fieldwork—such as action research, participant observation, initiations, and in-depth interviews. Chapter 2 sketches the theoretical perspective adopted to interpret our data. Chapter 3 proceeds with the study of the key social, political, and economic institutions and organizations in which illness and healing are embedded, these institutions being the main canvas for social norms and networks that may diminish, as opposed to enhance, people’s ability to cope when afflictions occur.

Part 2 of the book focuses on the aetiologic representations of insanity as it relates to the multiple factors surrounding the affliction, such as ancestral wrath, spirit forces, transgressions, and other forms of human malfeasance. The aetiology essentially narrows down the geography or force fields of the illness to shrines and markets, which are seen as hot spots, where various forces effectively intermingle and interact to significantly affect the insane.

Chapters 4-6 examine and elaborate on the agencies and processes of illness causation—that is, main body cults and aetiologic patterns. These show how shrine and market spaces interact with the mood of insanity as it is evoked and depicted through important metaphors and themes through which Igbo people mirror themselves and represent impairment as the most threatening way of undoing Igbohood. Such a depiction entails core metaphors of the cosmology and the body, as transmitted by cults (chap. 4), the body of personhood, identity, power, and status. This depiction re-enacts and strengthens the cultural shaping of insanity (chap. 5) and is followed by an exploration of the aetiologic categories of insanity (chap. 6).

Part 3 explores the wide range of healing methods among the Igbo. Chapter 7outlines various healing techniques and treatment modalities, including counselling, incantations, administration of herbal remedies, hair shaving, long day-walks, ritual music and dance, sacrifice, and purification rituals. Essentially, this wide range of techniques allows healers to face almost any instance of insanity.

Chapter 8 delves into the formation of healers, illustrating how the deity of medicine and divination (the agwu deity), in line with ancestral transmission of healing knowledge, calls up healers from either the agnatic or uterine line. We are struck here not only by the burden of authenticating the calling, but also by the long training involved. This training involves an abundance of rituals for building trust between an apprentice and his or her master and for acquiring therapeutic knowledge, and entails a deep sense of secrecy in the form of family identity, initiation systems, and competition in the health care market.

Chapter 9 investigates the diagnostic mechanism—the divinatory consultation.Here, various divinatory devices are discussed, which are both stunning and staggering. Healers, by their own accounts, state that extrahuman forces are far more knowledgeable than humans and so provide aetiologic guidance, a cosmic order of reality, instruction on objects used, and symbolic patterns of the thought process involved—all of which form a life-making system of knowledge.

Chapter 10 unravels symbolic release—the ritual healing of insanity proper. Here, we explore the various tying and untying rituals used to deal with sources of affliction, stave off sources of disturbance, and create room for other levels of therapy. Also analysed are colours and symbols of strength and weakness as they apply to insanity.

Chapter 11 explains various processes and stages of applying vegetal and animal (herbal and medicinal) resources used in healing, including faith healing. Each healing episode brings out several issues, namely, (1) a literal meaning of affliction as discerned by ordinary members of the society, (2) a moral meaning and social construction of the affliction as understood by the elders, and (3) an anagogic-symbolic and mythical meaning as can only be discerned by expert healers. The research also contends that herbalism assigns how spaces of normality are oriented in the cosmological order, as well as shaping the identities of persons engaged in different stages of healing. In addition, the properties of the plants and animals are used to transform the thought patterns of therapeutic application into reality so as to remobilize and remould the insane person’s body, life, and social realm.

Among others, there are two major findings from the research. First, the study of Igbo medicine brings to light culture specifics in the three basic efficacious modes of healing insanity, namely, symbolic release, herbal treatment, and faith healing. In view of the conflicts surrounding the affliction of insanity, an articulate theory of the application of symbolic release is enforced, allowing the extrahuman forces—ancestral, spiritual, communal, etc.—to manifest themselves and create spaces of normality and reintegration of those concerned in the crisis. In this respect, Igbo medicine draws on human and extrahuman resources, as channelled by deities, ancestral spirits, and the realms of water and forests.

Second, the art of healing not only seeks to address genuine causes, but also creates empowerment through remobilization of categories and meanings, healing forces, voices, moralities, and ways of intersubjectivity to counteract forces of disruption in people’s sense of the world and sense of belonging. Therapeutic satisfaction, however, may be mitigated by the fact that the very institution of healing remains inadequate in a rapidly changing society and public health settings.

The work shows how the practice-oriented dimension of research should work towards increasing the mutual understanding of healers and psychiatrists, providing opportunities for collaboration between healers and biomedics for the good of patients and keeping concrete development as a primary goal. It is our view, and our hope, that this book will be useful to policymakers, researchers, teachers, students, and the general public. The debate surrounding traditional healing as part of a total health care system has been central to anthropological theory for the past several decades, and focusing on Igbo-specific ways of understanding and healing insanity provides a significant contribution to the ethnocultural health-development paradigm of an African society in a changing world.

PART ONE

Ethnography and Igbo Society

Ethnographic Research in Igbo Society

Since I was a child, let’s call it the irrational age of thinking and acting, I had been trying to find an order behind what presents itself to us as a disorder within the pragmatics of illness and health (cf. Claude Levi-Strauss in the evolution of contemporary French thought known as structuralism and a wild mode of thought at the heart of human society) (in Weisman and Groves 1997:1). we cannot escape the development of private health care sector in order to heal in African system at large.

This part of the book has three major chapters. The first chapter focuses on the way in which culture is constitutive of health and health care. It also points out how much this very cultural situation may be overlooked in the formulation and implementation of social and health policy. We intend to bring together the central questions the research sets out to discuss in relation to insanity (ara) among the Igbo. The importance of this chapter also lies in the fact that it gives a general account of our findings and the strategies adopted to obtain them.

Chapter two sketches the theoretical focus of our investigations, in the broader context of Igbo society and culture. It discusses the influences of colonial and postcolonial cultural antecedents on madness and its portrayals in an encountered African society. Chapter three presents an ethnographic profile of the Igbo, in particular of their values and identity. Our goal is, moreover, to understand and describe the grounds of Igbo medicine and insanity, and offer the required background information so as to lead Igbo medicine to its proper level of productive endogenous knowledge and for further multidisciplinary research and development.

Broadly speaking, the overall part defines the critical position of indigenous health care and discusses core issues for public health planning that draw also on the healers’ strong traditions. The part shows how we wanted to know more about what comprises local knowledge of insanity and its healing. How we sensed that there were mysteries to be explored, that there were realms of knowledge to discover, and that these would in addition alter our experience and notions of insanity and Igbo medicine in the development context. Since the text books did not address these anthropological issues, but we believed they existed and could be studied and understood. So as a graduate student, it fell on us as a task, and as Winnifred B. Cutter once stated in 1991, to discover, and to make a contribution to knowledge. Our argument is that the postcolonial overemphasis of economic development and the all too dominant Christian religious scene have ignored, if not crushed, awareness of the ethnocultural dimensions of health and health care. The body of this ethnography hints at the enormous power of the pattern of cultural forces that provoke illness and a person or group to be implicated and restored by the same. The repercussions of the power of culture on illness and healing are examined throughout this book.

In seeking to understand the issues, one will determine the importance of focusing on representations, help-seekers’ initiatives and institutions which act as mediators to negotiate and translate between different health care practices. Our goal also is that readers and decision-makers may come to understand better the field of Igbo medicine, and its practitioners so as to improve the health of the mentally disturbed. In other words, issues of insanity and its healing entail cultural questions about the definition of illness and spaces of normality. As such, one constructive aspect of medical anthropology is that it provides multiple ways of examining questions of illness and good health.

CHAPTER 1

The Igbo Understanding of Insanity

Mental health cannot be developed in a social (cultural) vacuum. Powerful factors operate against it, as our present society is constituted . . . Mental health can only be achieved in an environment which provides opportunities for self-expression, socio-economic usefulness, and the attainment of human satisfaction (Rennie and Woodward 1948:385).

The Problem and Significance

This chapter contains the general framework within which our study evolves by outlining the major questions we intend to address. We will also indicate the main issues and the substantive results that emerged from our intensive fieldwork. This will imply directing the reader to the bases of the contribution of our work. Building from a normative commitment to use social and cultural science to understand Igbo medicine, the chapter therefore throws a glance at the main issues surrounding the framing of this book, the product of a doctoral research spanning the author’s childhood and growing-up experiences, with the perceptions of indigenous healing and the position of healers and healing in the contemporary alignment of plural health care in Nigeria.

The Main Issues

In 1978, the World Health Organisation (WHO) specifically acknowledged and recognised traditional medicine as a primary resource. It subsequently urged African governments to make use of folk practitioners, in particular in primary health care. Since this pronouncement, the divisions between Igbo healers and other Nigerian Western-trained doctors have remained deep. Finding a common track for understanding and collaboration is, by far, the most difficult question. Many doctors have not taken this recommendation by the WHO with ease for consideration. Most of these medical doctors are spurred with outrage and so feel undignified. Yet healers have over the centuries cared for people and sustained their lives in Igboland. Today, millions of people do increasingly rely on them for the care and cure of different health problems. Undoubtedly, the work of the African healer provides essential health care services and, in many areas, complements that of the hospital. Indeed, each health system functions side by side in its own distinct sphere and sociologic (Fyfe 1987:4; Maclean and Fyfe 1986). In spite of its flourishing knowledge and expanding techniques, biomedicine[1] in Igboland and the rest of Nigeria is in a critical condition. Biomedical health care does not provide enough. Many among those who are even most likely to need care are least likely to have it because of lack of infrastructure, lack of means, and more basically because of a cultural gap. Indeed, what care is provided proves commonly unsatisfactory for givers as well as recipients—though often for different reasons. Biomedicine suffers from the patients’ frustrations, false expectations, lost faith, and mistrust (Hahn 1995:262). This is even more so in the field of psychiatric care.

In Nigeria as a whole, Abati (2008) situates the call for mental health test for public office by Mrs. Waziri and Mad Nigerian Leaders and argues that "a common sociological explanation of mental issue is that it is difficult to have a lower rate of mental illness in the face of excruciating poverty and uncertainties. This is more so when one is living among the rich persons and economic systems but cannot access the opportunities to live well. Nigerians are going mad and behaving badly because nobody knows tomorrow anymore. There are no jobs, too many young persons have no sense of fulfilment, and there is no security in the land; so people resort to desperate means and adopt even more desperate measures in order to remain alive. As a consequence, the average Nigerian is trapped in a stress-inducing environment that makes him or her prone to one form of mental disorder or mild neurosis," notes Abati.[2]

Basically, the insane and his or her healer inevitably conceive of psychiatric illness and the world, communicate and behave in ways that are very genuine to the illness, and so different from other forms of impairment. Culture is very much sharply at the base of the aetiology and care of insanity. As Lock and Gordon (1988) had stated, anthropology is advocated as an instrument for both the examination and understanding of medical systems; Hahn (1995:266) shows how much it is a vital approach by which fundamental problems of healing practices may be resolved.

The private sector in the sphere of folk healing contributes for 80 per cent of the health care coverage.[3] This sector is actually the most preferred source of care in many parts of Nigeria (Madubuike 1996).[4] Apart from the fact that it has always been the practice of Igbo people to seek care from folk healers, Igbo indigenous psychiatric practices are fundamentally symbolic. They entail various cosmological explanations and representations. In this sense, a study of Igbo life and culture should not continue to be conceived narrowly as the impact of what holds normal on the Igbo. The impact of what is abnormal is the other side of the cultural equation, which has sadly been neglected by biomedicine. It is because of this neglect that this book endeavours to examine Igbo life and culture from what is abnormal behaviour, in particular in the context of insanity (ara). The thesis of this book is mainly concerned with the cultural rationale underlying the Igbo understanding of insanity, thus with the cultural shaping of insanity. There is much to it and much to learn from the other side of the equation, that is, from what falls outside the cultural codes that reproduce well-being in the social order. Insanity, moreover, is a normative term denoting a state of worthlessness with reference to the social norms. This pertains directly also to the affected person being able to function well with life and occupational skills and others in the view of society members. A person considered to be insane is one who is not capable of controlling his or her actions in line with social and cultural norms and who has lost touch with commonly acknowledged imperatives of ordinariness. However, medical science and psychiatry narrow the notion of insanity down to mental disorder or disturbance in the individual taken as a monad. We will show how the Igbo conceive of ara or insanity as something far beyond that reductionism.

Given the immense political and economic investments and budgetary capitalisations on biomedical health care issues, healing mental illness has remained the most elusive. Across the world, the phenomenon of psychiatric illness has continued to overwhelm its practitioners despite promises and high investments to find its causes and render proper remedy. Psychiatric assessment within psychiatric practice is more than ever under sharp reproach for failing to make certain the real causes of mental disturbance. This is, in part, due to finding the real causes of mental problems has not happened; as such, indigenous healing approaches are ever more culturally significant to most of its users. Assessing this problematic situation of aetiology and healing, The Citizens Commission on Human Rights International of the Church of Scientology in its edition captioned—Betraying Society: Psychiatry Committing Fraud in the Name of Mental Healing, states the following:

Modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. People with real or alleged psychiatric behavioural disorders are being misdiagnosed and harmed to an astonishing degree. They are put on drugs, put in institutions, and sent into a limbo from which they may never return (1999:16-17).

Going further (in p. 20), it casts the light of doubt wider. Moreover, in 1995, Dr. Rex Cowdry, the director of the U.S. National Institute of Mental Health, who testified before a House Representatives Appropriations Committee Hearing, stated the following:

"Over five decades, research supported and conducted by NIMH has defined the core symptoms of the severe mental illness . . . However, we do not know the causes. We do not have the methods of ‘curing’ these illnesses yet" (1999:20).

He implied that the symptoms identified and documented under the mental health diagnostic manuals constitute merely the opinions and not yet somewhat proven science of psychiatry. The implications here come near the fact that not all the answers to mental health problems can come from biological-psychosomatic science. In like manner, Time magazine reported in its June (1999) edition that there are no cures for mental illness, only lifelong management, and treatment is highly unpredictable. Admission of no success even after pouring into biomedical research huge sums of fund is now challenging medical anthropologists to think more boldly of alternative and complementary ways to find answer to the perplexing situation as mental health cases create senseless violence in society.[5] The true cost of continuing challenges of mental health is not only in financial expenses but more profoundly the people’s lives also.

Insanity holds well for the popular imagination, myth, and social forces. According to Goldstein (1967/1969), insanity is at the same time part of a complex of cultural forces that keeps alive the moral beliefs, lessons, and pernicious assumptions. Insanity, moreover, represents culturally ordered condemnation of split personality and stigma, as well as serves as a symbolic function of the unimaginable illustrious thinker.

Until recently, the cultural components of good or ill health have suffered great neglect, if not rejection in public biomedical health management. In many African states, this neglect continues, because many people do rely on both indigenous medicine and biomedicine. And yet the many resolutions passed by the WHO at various levels indicate, among others, that the workforce represented by the practitioners of African traditional medicine is a potentially important resource for the delivery of community health care (Sofowora 1993:22).

Attempts to analyse how representatives of particular non-literate cultures actually respond to problems of ill health, through illness explanation and treatment modes, are yet to be achieved regarding Igboland, that is, how local societies organise themselves when they judge an illness to be in their midst, and above all how various actions taken in lines with local categories of meaning may affect members biologically (Fabrega and Silver 1973:126; Hughes 1963; Vayda and Rappaport 1968).

The Nigeria Natural Medicine Development Agency was only recently established—in 1997. Its goals include health care research, with a mandate to improve and integrate traditional and alternative medicine into the health care delivery system in the country. It is also to provide facilities for training and research activities. Like any other public institution in Nigerian educational and health care realm, little or nothing has been achieved. The systems are still grossly standing as an overdog and underdog to one another.

So far, our research on insanity and indigenous medicine has led us to some surprising observations:

1. Local knowledge and action systems, folk or ritual healing, faith healing, and cosmopolitan medicine as well as Westerntype development programmes in Igboland, alike also the dynamics of migration to towns, seem to, an alarming degree, be developing in disconnected ways. These various dynamics seem embedded in different sociologics; i.e., they operate according to different aetiologic, transactional, and solidarity registers, as well as according to different views on (the origins of) good health, sickness, or illness.

2. Systematicity in Igbo indigenous health care is to be found in the practices (proper to the afflicted family, the lay therapy management group, the healers, and the initiatory cults) rather than in a systematic body of expert knowledge or a quasi-science.

3. Literature on Igbo folk-medical culture has all too much been swathed in half-truths. On the one hand, it entails a strong Christian if not dismissive bias defining Igbo indigenous medicine as antithetical to the new faith of the formal Christian or the healing churches. On the other hand, there is scant reliable information for setting up a formal public health policy in view of upgrading folk healing and exploring or strengthening its complementarity with biomedicine.

Along with the depressing socio-economic conditions of the masses and of the State Community Health Care, the medics in general as well as the leaders of prophetic or charismatic healing churches have contributed in no small measure to slow down or counter the development and integration of indigenous healing on both the levels of state and the national primary health care development policies. This marginalisation of folk medicine has frustrated the efforts of the traditional healers associations in search of a formal recognition and co-operation in the health care delivery.

4. Moreover, sociocultural and class differences between the great majority of people and state or church authorities, including the university-trained elite, exacerbate the communication gap between indigenous and cosmopolitan medicine at least on the institutional and policy-making level. Both systems fundamentally differ in their premises about the nature of health, disease causation, and remedy.

5. And still, Igbo folk medicine is increasingly being relied upon and utilised by about 80 per cent of the population. There is an important decrease of in-patients in psychiatric hospitals (such as Mgboko Psychiatric Hospital, in Obioma Ngwa Local Government Area in Abia State). The current situation of severe socio-economic crisis and social rupture forces the afflicted to rely more on local networks in their neighbourhood. Many formal, urban organisations (linked with the state, paid labour, cash economy) are dwindling in favour of much personalised networks.

6. Unlike other culture-specific medical systems in Nigeria (Ademuwagun 1979b; Buckley 1985; Lambo 1963; Maclean 1971, 1978; Ajanuaga 1980; Oyebola 1986; Pearce 1980, 1989; Simpson 1980; Stock 1985; Uyanga 1979; Wall 1988), there is no insight into how Igbo medicine is changing in orientation and in its response to current needs and demands.

7. The uniqueness of humans alike the Igbo is that they adapt, or fail to adapt, to the survival challenges of their environments through genetic, developmental—that is, physiological changes during the life span, as well as the embodied cultural means (cf. Alland 1977; Joralemon 2006:39).[6] The point is, a well-adapted society is reached through biological and cultural means, and we could see the Igbo well in this biocultural health mix of features of somaticism (bodily, physical) and extrasomaticism (behavioural).

8. Following the scope of our observations, Igbo medicine retains the thread of oral tradition and worldview in line with the ancestral institutional practice, with the coverage of biomedicine remaining low (cf. Anezionwu 1988). Most practitioners of Igbo medicine emphasised that the healing which they offer has largely maintained its integrity vis-à-vis the consequences of the nineteenth-century slave trade, the Christian hostility, and the hassle of biomedicine. Its persistence, despite the various threats of extermination in the past, stands as an important resource in the management of health care needs.

9. We were absorbed by the fact that Igbo medicine lies in illustrating it through its cultural frame showing how diseases are known, consciously and somatically, by sufferers and healers alike and how all are involved and packed with cultural content (Baer and Susser 1997:22).

10. As a medical system, nevertheless, we could decipher and appreciate the insights about anthropological research on health and disease as outlined by Joralemon (2006).

• That it is important to understand the cultural embeddedness of medical knowledge and practice; the dynamics of the healer’s role, the impact of general political and economic forces on the health of individuals and communities, and the interplay between social structures (namely political and economic arrangements), ecological settings, kinship network, and disease-causing agents.

• That biology and culture matter equally in the human experience of disease. Every aspect of illness experience (from recognition of symptom to assessment of treatment outcome) is shaped by the cultural frameworks of the sufferer and of those to whom he or she turns for help. Thus, a biocultural perspective is essential to avoid reductionist views of disease.

• That the political economy is a primary epidemiological factor in that a society’s economic system and its structures have a critical role in the kinds of health risks and available treatment resources that the individuals choose and face.

• That ethnography is an essential tool to understand human suffering owing to illness and misfortunes rendered in their own voice accounts and experiences. Both as the foundation of culture-specific and cross-cultural data, as well as a research method, ethnography is the sine qua non for a holistic understanding of illness and healing in a cultural context.

• That medical anthropology can help in health system development and alleviation of human suffering. Involvement in planning, execution, and evaluation of health interventions by providing sociocultural information on the community and individuals implicated, as well as on the healing practitioners and health care institutions that undertake such effective interventions will be critical in theory and moving healing forward.

The above state of affairs concurs to the rather desperate calls from a few Igbo scholars and leaders (among others, at the 1988 Ahiajoku Lectures), affirming that though Igbo people do possess precious ethnomedical resources, the ecological situated healing resources are still devoid of scholarly attention. As Anezionwu (1988:40-41) points out, The body of traditional medicine in Nigeria has remained largely outside the culture of writing in any language. Why should this remain so? Is it because of doubtful monopoly of our medical secrets? We can demonstrate the authenticity, validity, and verifiability of the system. The fact that these traditions have been interpreted by many Christianised intellectuals as evil and devilish and consequently have been left with reckless abandon today throws a challenge to researchers so as to rectify the bias. On their behalf, Igbo leaders now refer to these traditions as a matter of Igbo identity and a dignifying way of life that have to be rediscovered. Challenging Igbo men and scholars also for this neglect, Ezeliora (1994), who described Traditional Medicine in Amesi—her own community, stated that what they (referring to the men) have failed to write about, a woman has started it.

It is to be acknowledged that folk and biomedical discourses and practices are of a very different, and possibly complementary, nature (Ademuwagun 1979a; Akerele 1987; Aryee 1983; Bibeau 1981; de Jong 1987; Feierman 1985; Feierman and Janzen 1992; Good 1987; Last and Chavunduka 1986; Low 1985). Ritual healing is basically concerned with the social and cultural dimensions, including the ancestral foundation of its art and the ancestral compliance. Its view on the body and its practices and use of plants entail a proper symbolic approach regarding the co-shaping of individual body, social life, and the lifeworld (Devisch 1993). In this relation, traditional management of misfortune and healing sharply differs from the diagnostic and curative practices of biomedically trained health workers whose disease theory and physical manipulation of the body are based on biochemical and physical premises.

In view of understanding Igbo medicine, we found it necessary to make a survey of the prevailing illnesses in the larger social context. It has transpired that insanity is about the most pervasive and all-inclusive illness category in Igbo life and living. There is, therefore, a fundamental sense to approach the Igbo socioculture through its genuine medical views, representations, and practices in the domain of insanity. Igbo folk-medical perspectives and practices are seen to portray and pragmatically deliberate in some significant way the group’s difficulties in daily life and the ways of coping with them. This is most articulate in the ritual, body-centred healing practices, resonant with the way in which the insane give form to their crisis. These practices aim at the regeneration of the life force of both the patient and his or her support therapy management group as well as at the re-patterning of the patients’ social identity and networks. The indication here is that social dimension in therapy is a highly valued process of recovery and of stabilising the society and its members.

Up until now, efforts to unravel the structure and functioning of the ethnomedical health care in Igboland tend to focus on either a Christian or a medical perspective with all the accompanying bias. From the late 1970s, the WHO (1976, 1978, 1990) has recognised that modern health workers and policymakers should be properly informed, schooled, and addressed with insights and knowledge that are essential to understanding the local cultures, their patients’ experience of illness, and their health-seeking behaviour. Modern health care workers have been invited to acknowledge the major reasons and implications why the function, skill, and reputation of folk healers are highly patronised by people and so cannot be marginalised, insofar as their services are useful at large. But for Igboland, no systematic study has been done in an effort to assess their relevance and rationality and to find a meeting point or collaboration between biomedical and folk medicine to advance health care at the base. And this work seeks to cross and span the gap.

Beginning with the missionary and colonial activities in Igboland and Nigeria from about the sixteenth century onwards, followed by the forecasts that traditional therapy would disappear, events have shown that rather than folk medicine disappearing, it has strongly co-existed with biomedicine. Its forecast to disappear has not happened, and as such folk healing has been inaccurately perceived (cf. Devisch 1993; Bibeau et al. 1979; Good 1979; Feierman 1979; Janzen 1978). The WHO has, in 1978, recaptured an enlarged view of the utility of indigenous medicine when it stated inter alia the following:

Since traditional medicine has been shown to have intrinsic utility, it should be promoted and its potential developed for the wider use and benefit of mankind. It needs to be evaluated, given due recognition, and developed so as to improve its efficacy, safety, availability, and wider application at low cost. It is already the people’s own health care system and is well accepted by them. It has certain advantages over imported systems of medicine in any setting, because as an integral part of the people’s culture, it is particularly effective in solving certain cultural health problems. It can and does freely contribute to science and universal medicine. Its recognition, promotion, and development would secure due respect for people’s culture and heritage (WHO 1978:13).

As we clearly have said, Igbo people’s health needs are not covered by biomedicine alone. Health policymakers are most outspoken on this matter. Sadly enough, only lip service has been paid towards promoting indigenous medicine. From our observation, traditional birth attendants and bonesetters are being put in the primary health care (PHC) programme.[7] This step raises the question as to why these particular specialists have been chosen? There are many other areas deserving attention apart from the inclusion of traditional birth attendants and bonesetters, which seem to have been preferred for practical easiness and collaboration with biomedicine. Our investigations point out that the healing art of the bonesetters and birth attendants is equally culturally generated and sustained. They practise in conjunction with other indigenous healers who rely on the ancestral art, knowledge, and skills. The wide range of care that indigenous psychiatric practitioners provide is, perhaps, about the least understood. There is, moreover, a considerable ignorance in public policy-making regarding the health seekers’ daily health-related behaviour and practices, all too often dismissed allegedly as prescientific tradition. As a result, the neglect to promote Igbo medicine in community health care programmes stems from both prejudiced and inadequate knowledge of the cultural dimension: illness and healing are interconnected with the culture and develop in line with its rationality, institutions, and basic symbolic systems (cf. Comaroff 1985; Devisch 1993; Janzen 1978; Kleinman 1980; Sargent 1982).

Against this background, our research is intended as a somewhat desperate response to a lack of encompassing ethnography and anthropological reflection on Igbo medicine, life, and culture. Our first aim is to gain insight into how Igbo medicine is conceptualised and practised, in particular in the domain of insanity.

The word culture is here being employed with hope (Devisch 1993; Frankenberg 1988), with regard to the creative potential in culture and the transformative capacity of its symbols and cults. Yet we are aware of the danger of a possible overestimation of the local cultures and cults’ healing efficacy or of painting them up with what they are not. Indeed, such overestimation is not being wished in the pursuit, knowing well that Igbo people stand in great need of efficient medical support. Biomedical health care centres exist, but are all too often very inadequate in infrastructure, facilities, and medical personnel; hence they are of no easy access and unaffordable.

The Alma Ata conference, as we have footnoted above, was also concerned with this observation when it stated inter alia that medical services in poor countries and communities cannot be improved solely by training more physicians and building more hospitals in view of the solution, because the majority of health risks faced by people who live in poverty are not complex medical problems for which highly educated and expensive medical doctors are required. Implied in this is that public health measures and basic prevention techniques as well as strengthening people’s cultural modes can be effective in their various contexts of care.

Antecedents to Choice of Study

The choice for the study stems from our long-standing interest in the field of culture and development. That interest has also been intensified by our other university formation in community development, economics, and management, as well as by our more recent (advanced) master’s training in anthropology. At the University of Leuven, our anthropological studies have greatly given us a chance to deepen and sharpen our interest in indigenous health care conceptions, healing practices, and sociocultural development, as well as in intercultural relations. The one thing for which our initial training and education did not prepare us is the lack of analytical tools to understand the workings of culture. Within the framework of social and cultural anthropology, we have become very much captivated by the symbolic anthropological approach to culture and to the body-centred metaphoric ways in which people build out their lifeworld and society (De Boeck 1991a, 1991b; Devisch 1993).

Having grown up with a strong Igbo background, we have been fascinated by our people’s ideas, beliefs, and practices towards health issues as well as their changing world of everyday life. How people understand and relate to social disorder, disability, impairment, misfortune, and illness have continued to itch on us for explanation. How do they blend ethnomedical healing and representations and practices? How do help-seekers express their satisfaction or dissatisfaction in line with the local culture, as well as the accessibility through interconnecting various local social networks for the insane? Anthropology has offered us this analytical key to study the medical culture and practices of Igbo people.

Besides, at a younger age, I had the opportunity to carry our grandfather’s (Dede Iroegbu) medicine bag. I can well recall the many times he used to send me and other boys to catch a lizard (alika) or collect one root (mgborogwu) or another. We had often laughed off such activities under the label of ikwa aja (making sacrifice). That mockery arose out of ignorance and of the westernising trends conveyed through school education. During our early years of school and religious formation, we became alienated from participation in such healing rituals. Most of us who had parents or grandparents with the occupation as medicine people were ridiculed at school and at religious meetings. Those who were given deity and ancestral reincarnation names, such as Oparannu, Ebummiri, Urashi, Dimonyeka, and Uwahemu were mostly taunted as links to the devil. To be addressed with such names provoked insult and fighting. We recall one of our teachers preaching once against the annual ritual of killing fowls and the massive gathering of parents and children to appease, honour or offer ritual and praise Oparannu, the deity of life regeneration. School children were used as instruments to fight the outmoded local cultural practices so as to confirm their conversion to the colonial and Christian profile. Catholic religious retreats were meant to forcefully attack in our minds the medical tradition and practices, especially divination (iga n’ ajuju, igba aja). Within many circles, healers were ridiculed and frowned upon as agents of backwardness, if not destruction. Their successes in healing were never mentioned; or rather laughed at, cajoled and twisted. Our alienation increased with our coming to Europe for further studies. But courses in symbolic and medical anthropology reawakened our cultural roots and close connection with Igbo healing tradition, hence our motivation for fieldwork at home in the domain of Igbo medicine and culture.

The book aims at a symbolic anthropological study of the culture-specific and community health resources among the Igbo of Southeastern Nigeria. The focus is on ara or insanity. It addresses in particular the people’s relevant representations and many forms of health-seeking behaviours, the aetiology and illness categorisations by the specialists and the people as well as the culture-bound idioms of distress, used by both common people and specialists. An important research objective concerns the identification of the health demands and needs expressed and lived by the help-seekers and their communities in the context of the profound changes at the level of sociocultural institutions over the last decades. On which grounds do patients prefer medical or folk treatment for the various forms of insanity? Wherein does