Healing and Religion in Africa. Therapy Management Group and Cosmology Among the BaKongo

Table of Contents

Introduction

1. Setting the Scene: The BaKongo in Lower Zaire

2. The case of Lwezi
2.1 Lwezi’s pregnancy and marriage
2.2 Ten Different Healers Consulted

3. Medical System of the BaKongo
3.1 BaKongo Concept of Illness Causality and Diagnosis
3.1.1 Therapy Management Group
3.1.2 Illness of God - Illness of Human Origin
3.1.3 Divination and Diagnosis as Rituals
3.1.4 Drum-Therapies (ngoma)
3.2 BaKongo Healers
3.2.1 Bayindula
3.2.2 Mama Marie Kukunda
3.2.3 Luamba Zablon

4. Medical Knowledge of Preindustrial Peoples and of the Western World
4.1 Western medicine
4.2 The Role of Medical Missionaries

5. Theological Reflection: The Paternal Blessing
5.1 Creation Theology
5.2 Sacramental Theology - Nuptial Blessing
5.3 Spirituality - Dynamic Image of God
5.4 Liturgical Theology
5.5 Moral Theology

6. Conclusion

Bibliography

Introduction

There can be no doubt that the medical practices of the Western world provide a great service in the field of health in African countries by attempting to prevent and control diseases. Modern techniques and Western medical training have enabled the building of hospitals, dispensaries and health centres, and their professional staffing. My own background is of such origin. I trained as a laboratory technician in Germany. Since then, I worked in hospitals in East-Africa. There I experienced the clash between the highly developed technological medical world of the West and the traditional healing methods of pre-industrial tribes such as the Barbaig, the Nyaturu and Masai in Central Tanzania, the Baganda in Uganda and the Turkana in Northern Kenya. My work experience in East Africa has made me face the conflict between scientific Western medicine and traditional African healing practices, which are often based on religious beliefs. During my time in East-Africa I listened to Western health workers complaining that the indigenous peoples underutilize or over-delay in seeking Western treatment. On the other hand, I observed patients who as users of both the customary East-African practices and Western medicine did not seem to differentiate between the two. To them the two systems were not in competition, in conflict or incompatible.

In this essay I will look at the medical system of the people of Kongo in Lower Zaire. My account is based on the fieldwork done by John M. Janzen among the BaKongo in the late 60s, early 70s. He offers a concrete description of six cases and examines them. I chose a typical case of these, namely patient Lwezi. Diagnosis and treatment of a BaKongo patient are skillfully directed by the institution of therapy management group, a group made up of the kin of the patient, which takes care of the well-being of the ill. This institution is strongly influenced by the cosmology of the BaKongo and is vital for the therapy. The major features in Lwezi’s healing-process were the therapy management group, the paternal blessing and the payment of the bride price, each of which I will refer to in the following sections.

Many people think that the healing practices of traditional societies are irrational, but I will show that for the BaKongo medical practices must engage with the supernatural in order to guarantee healing. To anthropologists and many non-BaKongo, the medical system in Lower Zaire appears to consist of various medical traditions, be it the traditional BaKongo therapies or the Western conventional medicine. The general perception is that the latter is not only universally applicable but might eventually replace traditional medical practices. I will show that only by taking into account the BaKongo way of healing, especially the therapy management group with its unique perception of illness and healing, is successful cure of these people possible.

The cosmology of the BaKongo plays a vital role for the therapy management group. The beliefs of the tribe determine the steps taken in the treatment. Western medicine does not alone supply adequate and sufficient remedies, since it ignores these important components of the BaKongo therapies. Experience reveals that illness and suffering lead the indigenous population to look for their own sources of help, the traditional healers. I suggest that the best strategy to implement is a complementary one, in which both conventional and traditional healing practices are adapted.

1. Setting the Scene: The BaKongo in Lower Zaire

In his book, The Quest for Therapy, Medical Pluralism in Lower Zaire John M. Janzen looks at coexistent therapies, and develops theoretical paradigms to describe medical pluralism.¹ His focus is on the Kongo people or the BaKongo, their language being Ki-Kongo. Their cultural heritage is rich and diverse, and associated with the ancient kingdom of Kongo. Today, three to four million strong, they live in rural and urban areas in Western Zaire, the Republic of Congo, and Angola (4-7 decrees south latitude to 11-14 decrees east longitude).²

Janzen describes the medical system of the BaKongo. By definition, medical systems include all forms of healing practice. In the six described cases he analyses co-existent therapies, some are of indigenous origins, others derive from Western medicine. His interests lie in the practical issues of medical decision-making in an African context, the cultural content of symptoms, and the dynamics of medical pluralism, i.e., the existence in a single society of differently designed and conceived medical systems.

The process of therapy management consists of three elements: diagnosis of illness, selection of therapy, and evaluation of treatment. Various healers are involved: a native doctor, an inspirational diviner, a prophet called banganga or gagunza, a herbalist called nganga, ³ and the doctors coming from the background of Western medicine. An essential role is played by the kin of the patient who together with friends and associates make up the therapy management group, which is basically "a community of persons who take responsibility for the sufferer and enter into brokerage relationships with specialists."⁴ The doctor-patient relationship becomes more complex once the therapy management group is involved.

Janzen explains the cosmology of the Kongo people and their concept of illness. Cosmologies are cultural constructs that offer systematic appraisals of the order in which disease insinuates itself to inspire disorder. Sullivan clarifies that "[b]y locating the powers and processes of sickness and health in relation to the cosmic forces in the space of the world or the body, cosmology . . . offer[s] a systematic source for understanding the religious meaning of disease and cure."⁵ The BaKongo distinguish between the illness of God (kimbevo kia Nzambi) which is natural in cause and the illness of human origin (kimbevo kia muntu) resulting out of human causes.⁶ Aware of certain scepticism towards one another, Janzen sets up the debate between imported Western medicine criticized for its ignorance of the social network and the context of the illness, and the indigenous therapeutic traditions thought of as being superstitious. Yet both are inseparably intertwined.

According to Janzen, "Kongo and Western therapy systems are closed systems . . . members of African society learn Western culture with ease, but cannot with equal ease reduce African culture to Western categories, or vice versa."⁷ He retells various cases in which patients consulted healers about their disease. I choose case No. 5 (chapter 7), the "most complex example of a quest for therapy."⁸ I will take a close look at the case, investigate its use of therapies, and then try to make sense out of it. Here I will draw from the reflections of Janzen and those of other anthropologists. One of them being Victor Turner with his outstanding cultural study of medical practices among the Ndembu. He brought medical, anthropological and religious symbolism together and emphasized how "symbolic actions can be conveyors of meaning."⁹ The fieldwork of both Janzen and Turner has illustrated that the analysis of curative ritual formulas reveals cultural values (e.g. family tradition, parental blessing). This will become clear in the following essay.

In fact, according to Sullivan, the rites of diagnosis and cure open horizons of knowledge and the experience of humanity to new realms. Illness frequently awakens people to their communal and individual past, to the meaning of their intentions, ideas, and emotions, and to the wider horizons of their physical and spiritual world. The knowledge gained from illness may not be ordered into a unitary system . . . but may be 'piecemeal and uneven.'¹⁰

Having studied the history and diffusion of Kongo rites of cure in central Africa over nearly three hundred years, Janzen's methodology and approach makes him focus on the "fixtures that the historical traditions preserved as well as on the spontaneous innovations brought by each creative community that enacted the rites."¹¹ In my analysis I hope to adapt his finely tuned observational skill and look at how the individual steps of the diagnosis- and healing-process show traditional elements besides the creativity of each party involved. Thus, it is necessary to recall exactly what happened to the patient Lwezi, so to examine the approach to illness among the BaKongo. I then will analyse their medical system by looking at the concepts of illness causality and diagnosis (3.1), and the various BaKongo-healers who were involved (3.2). After that I will draw comparisons between the BaKongo- and the Western medical system. Here I will examine the medical knowledge of pre-industrial peoples and of the Western world (4). The last section, my theological reflection (5) on the healing system of the BaKongo, links the therapy management group and the healers with the cosmological elements of their tribe. My focus is on the paternal blessing, which is the key to the cure and forms an integral part in Lwezi’s treatment. Having studied her case in detail I arrive at an unexpected conclusion, which gives rise to further contemplation on how to successfully combine traditional and Western practices into a medical system.

2. The case of Lwezi

2.1 Lwezi’s pregnancy and marriage

Lwezi was a woman of 23 years when Janzen met her first (1969) in Manianga. She was an unmarried mother of two children, staying in her mother's home in her matrilineal clan village. Because of the fact of having had children as well as male labour emigration, she had difficulties in finding a husband. Family pressures to do so as well as her own behaviour and health, gave rise to anxiety and tension to those concerned. She was the sixth of her parents’ seven children. They formed a close family but there were conflicts among them due to Lwezi’s prolonged and problematic illness.¹² Lwezi's father Bola was the only resident adult male in his clan village and thus was its headman. It was his responsibility to resolve the problems of the clan and to defend its interests in court.

Lwezi's therapy management group was composed of her mother, her brothers and her maternal uncles. “In most instances of prolonged sickness in African societies the diagnosis and decisions relating to the course of therapy - the 'quest for therapy' - are in the hands of a lay managing group made up of kin.”¹³ Lwezi's illness was diagnosed with the help of such a group. Her parents, and a joint set of maternal and paternal kin cared for Lwezi. Her spouse’s only role in the therapy consisted of the obligation to pay the bride price.¹⁴

The therapy management group is an ordered network of people who help the patient decide in any given situation what to do next, and how to handle the affliction. In a serious case as Lwezi’s, they consult specialists, i.e. healers who can interpret the symptoms. Because of various ranks and statuses in the society the members of Lwezi’s kin group were at times quite divided with regards to their opinions. The maternal clan was rooted in the rural agricultural customs, while the paternal, more urbanized, family members rejected some traditional beliefs, influenced by the missionary teaching of the Swedish Covenant Mission in the area.¹⁵

While working as a nurse aide at this mission dispensary she became pregnant, having had an affair with one of the workers there. Unable to pay the dowry, the father of the child left Lwezi with the baby. She then travelled to Congo Brazzaville to visit a maternal uncle and aunt. There she was introduced to a man who had already two wives. He wanted to marry her and she consented. The bridegroom paid the uncle "the token 'wine for the request of the bride' (malavu ma ngyuvudulu a nkento) and Lwezi moved in with him. The bride payment and marriage ceremony were deferred."¹⁶

2.2 Ten Different Healers Consulted

One month later, Lwezi fell ill. She got abdominal pains and was brought first to a missionary dispensary. In order to list the individual healers consulted, I will attribute letters to them, thus the missionary dispensary will be marked with ‘A’. The next medical advice was sought in the Luozi hospital (B) where a dilation and a curettage were done on her uterus. No significant changes in the healing process happened.

According to the BaKongo custom, the father of Lwezi consents to the union between her and her suitor by giving her a paternal blessing in exchange for a gift from the latter. But neither happened. Bola refused to bless his daughter and disagreed with the maternal family members who advised her to return to Congo Brazzaville. However, Lwezi went against the will of her father and returned to her spouse.¹⁷ Soon after that she became pregnant again. Lwezi's boyfriend asked Bola for permission to marry his daughter but did not send any dowry.

Sometime later Lwezi received a letter signed with Bola's name but forged. Bola presumed it came from the maternal side, informing Lwezi about her mother Nwelo's death and requesting her to come home. Although she was eight months pregnant, she journeyed home, only to find out that her mother was still alive. She stayed in her mother's village and gave birth to a healthy baby during an easy delivery. Bola and the maternal uncles now decided on completing the marriage and demanded a dowry, after which the father's blessing would be bestowed and she could return to her suitor. But the payments never came; thus, causing more tension in the community. Lwezi fell ill and was brought to Sundi Hospital (C) with the following complaints: urinary tract infection, periodic fever, chills, back pain which radiated to her neck, pain of her joints, loss of appetite, and general malaise. She ended up spending two months in hospital during which time she got ten medications.¹⁸

There were different beliefs about the cause of the illness. One of Lwezi's brothers thought that she was under the influence of the fetish planted by one of her co-wives, or by clan members with also chronic diseases. Other members of the therapy management group saw the disturbed relationship between Bola and Lwezi as the cause of the illness and demanded the payment of the bride price. But Lwezi's suitor did not make a move, and Bola insisted that unless he was paid, he would not bestow the blessing on Lwezi. After all she took up quite an amount of money for her school fees. The offer of the brothers to pay on behalf of the 'husband' of Lwezi, so that she would receive the blessing was rejected, "it would set Lwezi free . . . to become a public woman."¹⁹

Still no improvement in Sundi hospital, another person was consulted, namely Bayindula, a nganga nkisi (herbal doctor; D) who was popular for treating psychological illnesses. Lwezi underwent a combined therapy: morning and evening worship together with the other patients of Bayindula, and private counselling session at which the members of the therapy management group were present. Razor-blade incisions were done on her body, and then Bayindula rubbed a preparation of plants into the wounds and sucked the blood with a cupping horn "to remove the bad blood."²⁰ Bayindula then chanted "his eclectic adaptation of the Croix Koma Mass, derived in turn from the Catholic Mass."²¹ He urged the kin group to bring the marriage formulaties to completion, and to return to him in three weeks time. But the maternal clan elders felt that the cost of Bayindula's treatment was extravagant, so Lwezi did not return.

Her next step on her way to healing was the examination done by Arkinstall (E), Janzen's colleague, who confirmed the chronic urinary infection, and diagnosed psychosomatic muscular weakness and musculoskeletal pains.

After Arkinstall, the therapy management group brought Lwezi to the Prophet Marie Kukunda (F). After Silwa, Lwezi's clan headman and a member of the delegation of the therapy management group, filled her in on the procedures undergone so far, a prolonged dialogue took place involving the laying on of hands and constant interrogation and responses between Marie Kukunda, Lwezi and her relatives. It was helpful for all the participants. Though the tension lessened, the pains of Lwezi reoccurred. The fundamental problem of having not paid the bride payment in exchange for the paternal blessing was still unresolved.

Three further consultations followed. The first was with a prophet called Luamba Zablon (G) whose treatment consisted of soothing noninvestigative rituals such as baths, prayers, laying on of hands, anointment with scented oil, and counsel.²² Due to severe pains during this treatment, Lwezi discontinued with it and was brought to the dispensary (H) by her family. Again, like the previous time when she spent several months in the clinic, she underwent various laboratory tests and received a generous variety of medications.²³ After spending a month in the dispensary, Lwezi’s family took her to the hospital at the IME-Kimpese (I) where she was examined by two American missionary doctors. Blood test results were negative, and the nonspecific diagnosis of polyarthritis was made. After this treatment in the hospital at the IME-Kimpese, Lwezi lived with her brother in Kimpese. Meanwhile her suitor paid the bride price to Bola and the maternal uncles, and Lwezi had received the blessing from her father. But she never returned to her husband to Congo Brazzaville.

This so far is the description of the diagnosis and treatment of Lwezi's illness. What follows now is the analysis of the same. By focusing on various theoretical terms like illness causality, diagnosis, and healers, it will become clear that the therapy only makes sense when seen against its cultural background. Thus, the claim that African traditional healing practices deserve credibility and are valuable because they are integrated into the social and religious context, will be proven.

3. Medical System of the BaKongo

Before treating various theoretical terms in the area of illness and healing, I wish to define ‘theory’ as a term. In the strict sense of the word, it is a set of propositions, “of lawlike generalizations which is employed to explain and predict empirical phenomena, [h]owever few such theories (if any) exist in the social sciences, where the term is usually employed interchangeably with model.”²⁴ ‘Theory’ derives from the Greek word theoria meaning viewing, speculation, or contemplation, and provides principles of analysis or explanation of a subject matter. In the following I will apply some theoretical terms to Lwezi’s case, and see how these help analyze the medical system of the BaKongo. First I will look at their concept of illness causality and diagnosis, secondly at the traditional healers involved.

3.1 BaKongo Concept of Illness Causality and Diagnosis

3.1.1 Therapy Management Group

The therapy management group decides on the treatment and seeks to deal with conflicts and the disequilibrium in the community with the hope of reintegrating the afflicted individual into the group and to re-establish its identity. This way of diagnosis is an essential feature of Kongo therapy. It has been variously identified. Kongo psychiatrist Bazinga's term calls it the 'triangle of truth.' Bazinga brings to attention the relationship between the sick and their friends and antagonists, who in turn have a relationship with each other. He writes:

Only by discerning such a triangle in its totality can one avoid getting caught in society's 'traps.' . . Therapy in the 'triangle of truth' confronts role contradictions playing upon individuals and groups. The most serious contradictions derive from modern conditions of labor migration, distribution of wages, and sources of prestige, which divide families on a host of daily issues in Zairian life.²⁵

Most of Lwezi's problems derived from the rural population imbalance due to labor migration. Large numbers of BaKongo people left for the urban centres, Brazzaville being one of them. Lwezi’s maternal uncle and aunt lived there. Through them she met her suitor, an encounter which had serious consequences. Health problems arising in such cases can be resolved on an individual basis, but unfortunately as seen with Lwezi, these resurfaced at a later stage. Yet, temporary therapy granted her some relief. Her story with the involved therapy management group has been described as a highly esteemed account in which the family plays an important role in managing the patient and the affliction as well as its causation.²⁶

We in the Western world find such a concept of illness and healing difficult to understand because of the breakdown of community, the lack of identity with a certain group and the emphasis on the individual rather than the group. Turner contrasts the Western individualism and the African corporateness, pointing out how in the West prestige and goods replaced the African ideals of comradeship, reciprocity and generosity.²⁷ Increased specialization resulting in hospitalization and professional treatment does not consult family members (or if so only with regards to the family medical history, e.g. hereditary diseases). The voice of the kin is rarely considered. It is primarily the professional personnel²⁸ who makes the decisions on the patient's therapy. Among the BaKongo, the decisions are in the hands of the patient’s kin, who are strongly influenced by the cosmology of the tribe. The following section explains the BaKongo concept of the origin of affliction.

3.1.2 Illness of God - Illness of Human Origin

It is important to know how the origins of disease are perceived in each tribal setting with its specific social, medical and religious tradition. Sullivan points out that “the images and symbols of the origins of disease help justify and rationalize sickness and exculpate the victim of illness, . . . [and] help the community to think about the condition of sickness, . . . help locate sickness as an ontological condition, a mode of being.”²⁹ In the course of the search for the origins of diseases beliefs and customs upheld in the community play an important role. In Lwezi's case the importance of the paternal blessing is revealed. Her disease is a manifestation of what happens when such a blessing does not take place, i.e. when this important cultural element is not observed. Her behaviour and that of her suitor, as well as Bola’s response to it, point out that Lwezi’s affliction was of human origin.

[...]

¹ cf. John M. Janzen, The Quest for Therapy, Medical Pluralism in Lower Zaire, with the collaboration of William Arkinstall, M.D. (London: University of California Press, 1978), xviii.

² John M. Janzen, "Kongo Religion," in The Encyclopedia of Religion, Volume 8, ed. Mircea Eliade (New York: MacMillan Publishing Company, 1987), 362;

³ Janzen, "Kongo Religion," 364. [Definition of nganga: "the nganga (specialized priests and doctors) are diviners, religious specialists skilled in manipulating spirits, humans and symbols; agents of power who inaugurate offices of authority; and healers who deal with sicknesses of mind and body. They use esoteric codes relating the visible realm of plants as substances and apply them to the invisible realm of emotions, society, and the beyond. These mediatory roles of the nganga (as well as those of chiefs, prophets, and other powerful people) require legitimation from the 'white' otherworld (mpemba), the realm of ancestors and spirits."]

⁴ Janzen, The Quest for Therapy, 7.

⁵ Lawrence E. Sullivan, "Diseases and Cures," in The Encyclopedia of Religion, Volume 4, 368.

⁶ Janzen, The Quest for Therapy, 8.

⁷ Ibid., 38.

⁸ Ibid., 101.

⁹ Sullivan, "Diseases and Cures," 369.

¹⁰ Ibid.

¹¹ Ibid.

¹² cf. Janzen, The Quest for Therapy, 102.

¹³ Vieda Skultans, "Affliction," in The Encyclopedia of Religion, Volume 1, 56.

¹⁴ cf. Janzen, The Quest for Therapy, 130.

¹⁵ Janzen, "Kongo Religion," 364. [Janzen comments: "Missionary Christianity . . . has given rise to many schools, hospitals, seminaries, and other specialized institutions. Furthermore, it has brought about the far-reaching Christianization of the Kongo populace. Many Kongo-speakers in the late twentieth century are nominal Christians. However, paradoxically, most Kongo Christians still subscribe to the fundamental tenets of the Kongo religion and worldview."]

¹⁶ Janzen, The Quest for Therapy, 103.

¹⁷ Janzen, "Kongo Religion," 364. [Lwezi was just one of the many who were part of the large numbers of Kongo people migrating to urban centers such as Brazzaville or Kinshasa. "Yet," Janzen writes: "reverence for lineage ancestors and offerings made to them continue to be integrally tied to the maintenance of lineage land estates and to the guardianship of the matrilineal kin unity."]

¹⁸ Janzen, The Quest for Therapy, 104. ["Four antibiotics, two analgesics, a stimulus of ephedrine, an intravenous of glucose and electrolyte solution for two days, an intramuscular injection of quinine, and intermittent vitamins."]

¹⁹ Ibid., 107.

²⁰ Ibid., 105.

²¹ Ibid.

²² cf. Ibid., 111.

²³ cf. Ibid.: [". . . including 100 mg each of dolatine and gardinal (strong analgesics) by injection on arrival; intramuscular penicillin, two injections per day for a week; vitamins for a month; a five-day cure of nivaquine; timavon (a muscle relaxant); and 50 mg phenergan ( a sedative and antiallergic compound twice for an itch").]

²⁴ Charlotte Seymour-Smith, ed., "Theory," in MacMillan Dictionary of Anthropology (London: MacMillan Press Ltd., 1986), 277.

²⁵ Janzen, The Quest for Therapy, 144-145.

²⁶ cf. Skultans, "Affliction," 53.

²⁷ Victor Turner, The Drums of Affliction, A Study of Religious Processes among the Ndembu of Zambia (New York: Cornell University Press, 1968), 23.

²⁸ David Landy, ed., "Role Adaptation: Traditional Curers under the impact of Western Medicine," in Culture, Disease and Healing, Studies in Medical Anthropology (New York: MacMillan Publishing Co., Inc., 1977), 477. [Landy writes: "The label 'professional' should not be confined to scientifically trained personnel, though obviously the ideology, technology, and recruitment of personnel of scientific medicine are different in many respects from that of nonscientific medicine."]

²⁹ Lawrence E. Sullivan, “Healing” in The Encyclopedia of Religion, Volume 6, 227.