Ethnicity and folk healing in Honolulu, Hawaii

ETHNICITY AND FOLK HEALING HONOLULU, HAWAII

IN

PATRICIA SNYDER Honolulu. Hawaii Ahstrmct-This paper examines the significance of ethnicity in relation to folk healing within the context of a muhiethnic urban setting. The principal findings that heaiers and clients are often not of the same ethnicity, that healers’ practices are eclectic, and that healers and clients attempt to accommodate to one another’s ethnicities are discussed. Imnhcations of these findings for professional health care and general

research are considered.

Folk healing has been studied virtually around the world but almost always within the context of one particular group of people. Notable exceptions to this unidimensional view are the research by Chen [I] in Malaysia and Kunstadter [Z] in Thailand. Both found that in times of illness people of one ethnic group might utilize practitioners or techniques of other ethnic groups. The extent to which this phenomenon occurs has not been thoroughly investigated since the primary focus of studies has generally been on the health behavior of single groups of people. Research on this subject has been even more limited within the United States, although there are reports which allude to people crossing ethnic lines for help. For example, Scott [33 has described research among five ethnic groups in Miami, Florida where there is some evidence of the crossing of ethnic boundaries to receive folk healing. Harwood [4] mentions that Hispanic and Black faith healers were available along with Puerto Rican spiritists in the latter’s neighborhoods and that some clients went to more than one type of practitioner for help. Snow [SJ states that she observed Blacks, American Indians, and Mexican Americans all consulting a Black healer in a southwestern United States city. Landy [6] found that a Tuscarora Indian healer was visited by middle and lower class Caucasians from Niagara Falls and Buffalo. New York. Significance is attached to these observations only in the last study where it is noted that the treatment of Caucasians partially accounted for the maintenance of the healer’s social status in the face of Western medicine. Settings in which ethnic groups are not geographically or socially isolated provide oppo~unities for healers to serve members of other ethnic groups and for clients to seek help outside their own ethnic context. Both possibilities, however, require accommodations to one another’s cultural patterns and presume either that the participants are flexible in their orientations or that they do not rigidly adhere to exclusive practices in the first place. There has, in fact, been some attention paid to the heterogeneity of healers and their work, although not with reference to their serving clients from other ethnic groups. Both Ramano [7] and Press [S] have criticized the stereotypic descriptions of folk healers which tend to imply that a11 those of one label (e.g. 125

are the same. Press [93 has also suggested that this heterogeneity may be especially characteristic of urban settings. In an earlier study, Edgarton er al. [IO] found that the urban healer contacted by them in southern California had less drama and ceremony in her work than did similar healers described in Texas and Mexico. During the course of a study of folk healing in Honolulu, Hawaii, it was possible to investigate the significance of ethnicity both in terms of the healers’ practices and beliefs and in terms of their relationships with clients. curanderos)

THE SETTING

The research was conducted on Oahu, one of the seven inhabited islands of Hawaii. Although it has only loO/, of the state’s total land area and ranks third in size, it contains approximately 80% of the population and is the commercial and gove~ment center for the islands. Over hatf of the population reside within the capital city of Honolulu and its surrounding suburban areas which constituted the primary site for this study. The features of this multiethnic population are exceedingly complex. Following Barth’s definition [II], ethnicity in this paper is discussed in terms of the ascribed status noted by one’s self and others. The following table from the OEO 1975 Census Update Survey [12] indicates the approximate ethnic distribution on Oahu. The categorizations are important because they are not the way in which the US. census reports Hawaii’s population, but they are the way in which people in Hawaii classify themselves (Table 1). A few explanations will clarify this table. Because military personnel are included in the survey, the figures for some groups, most notably Caucasians, are inflated. Statistics from a 1976 study [13] indicate that approximately 30”/, of the Caucasian population are military personnel, and if their numbers are excluded, Japanese are the largest permanent resident ethnic group. Secondly, this is one of the few surveys which allowed an individual to specify an identity of Portuguese. In every day conversation, a person is not considered Caucasian if it is known that he is Portuguese, although some of the latter have chosen not to publicize their heritage because other Caucasians have tra-

126

PATRICIASNYDER Table 1. Ethnic groups on Oahu

Ethnic group Black, Negro Caucasian, not Portuguese Portuguese Chinese Filipino Hawaiian Part-Hawaiian Japanese Korean Puerto Rican Samoan Mixed (not part-Hawaiian) Other Total Estimated population

Percent 1.4 27.9 2.6 5.6 10.2 0.9 14.4 24.6 1.5 0.6 1.0 8.2 1.4 100.3 678,979

held a higher socioeconomic status in Hawaii. The usual label for Caucasians is haole from the Hawaiian word for foreigner, but since the early sugar plantation days, Portuguese have not been included in this designation [14]. Thirdly, there remain very few people of exclusively Hawaiian ancestry, and part-Hawaiian has become the label for people who have any Hawaiian heritage. Finally, because of the substantial number of intermarriages, approximately 8% of the population are designated “mixed” in these statistics. Generally, the specific heritages are identified such as CaucasianFilipino. The local practice of referring to an individual as Japanese or Chinese when it is meant that the person is of that ancestry will be followed throughout this paper. Similarly, in common parlance, partHawaiians are often called Hawaiians and will be here since no full Hawaiians were identified in this study. Although people’s labelled ethnicity in Hawaii is based primarily on their background, there may be selective emphasis placed on it depending upon the social situation. Thus Cohen’s emphasis [15] on the dynamic quality of ethnicity can also be observed. A brief description of the ethnic group interaction in Hawaii provides a basis for understanding the factors observed in folk healing. Often promoted as the Aloha State, from the Hawaiian word meaning love, affection, and greetings, Hawaii does have a history of embracing people from Polynesian, Oriental. European, and American heritages and of encouraging them to live in harmony. Although there are conflicts between the various ethnic groups, charges of discrimination in hiring practices, occasional clashes in the schools, and considerable stereotyping of one another, there is little overt fear or violence. One of the key factors in this benign situation is that there is no majority group in the state. The definition of minority status is thus dependent upon the social or economic context under discussion, and every ethnic group is able to claim some experience as a minority. Today. the newer immigrants of all ethnic groups often experience the most problems and prejudices both from within their own group and from others. ditionally

People in Hawaii tend to ditTcrentiate themsel\rs from those of the same ethnicit) in their countr) of origin and in the continental Cnitcd States. Thus. contrast themsrl\es to “Japan “local Japanese” “mainland Icontinental U.S.) Japanese” and Japanese”. Because many groups nho settled in Hawaii in the 1800’s brought with them traditions which have subsequently changed m their country of origin, recent immigrants are sometimes surprised to find quaint words and antiquated customs being perpetuated in Hawaii. At the same time. because some groups have achieved an economic and social status unmatched by their counterparts in other states. they have influenced the cultural patterns and lifestyle in Hawaii. Some observers discern a trend tokvard a “locaf’ culture and identity which will ovcrridr one’s particular ancestry. While the designation of a person as “local” may at times refer onI> to non-Caucasians and does not yet have clear referents. its use is indicative of some blending of the various cultures into a new entity. There is considerable sharing of foods. nonEnglish words, and customs. such as most people following the Japanese pattern of removing their shoes before entering a home. There is also a local dialect of standard English. commonly called “pidgin English”. which is learned by most children regardless of ethnicity. The interactions in substantially integrated neighborhoods. schools. and places of employment have weakened rigid boundaries between ethnic groups, and there is considerable familiarity with one another as associates it not tiiends. Still, Hawaii is not a melting pot where ethnic differences are overlooked. A person mentioned in conversation is frequently described by his or her ethnicity, and there is a general willingness to identify one’s background. The extent to which individuals keep track of their heritage has resulted in people reporting that they are. for example. “Hawaiian. German, English, and Chinese”. In all official statistics. such people are counted as “part-Hawaiian.” It is also not uncommon for a person of mixed heritage to be considered a member of one group but to attribute a special skill to his inheritance from another. For example. a person who is labeled part-Hawaiian and therefore stereotypically indolent. may make a successful business transaction and jokingly attribute this to “the Chinese in me”. Hawaii. with the peoples’ high degree of awareness of ethnic identities and \+ith their sharing of experiences. though not without some contlict. brings into relief such issues as the relevance of ethnicit) in health care. Although there is not alua)s compatability between practitioner and client. and although ethnic groups are not represented In proportion to their population among the various health professionals and paraprofessionals. services in H:iwaii are. as a general rule. sensitive to the needs of this multiethnic population. Most major ktcllities h:tve staff from several ethnic groups. and pro\ idcrs arc accustomed to serving people from a varlet\ of backgrounds. Language itself does not seem to be :I malor problem because of the general av;tll;lhlllt! of \omcone to translate and hccausc of the widc\pread use of English. It is rstlmated that :ipproxlmatelq 9?.?“,) of the adult population tztsily undcrhtand this language [ 161.

Ethnicity and folk healing in Honolulu There is also per! good geographic and financial accessibilit> to professtonal health care. Ambulatory medical care is uidcl! available: no hospital restricts its admissions to a particular geographic area. and the entire state is divided into mental health catchment areas with state supported clinics. Finall!. Hauail has a umque state law requiring employers to provide comprehensive state approved health insurance for an! regular empioyee. It is estimated that this Prepaid Health Care Act alorg with other sources such as federal and state assistance programs. enables approximateI> 9X”,, of Hawaii’s population to have hualth insurance [ 17). Folk healing is primarit! an adjunct to the man! professional services available. and it is not restricted to any one ethnic group.

Table 2. Ethnic group representation of Oahu population and healers interviewed

Ethnic group Caucasian Japanese and Okinawan Hawaiian and part-Hawaiian Filipino Chinese Portuguese Korean Other Total

There are man! vla!‘s of defining a folk healer, but for this stud! an attempt was made to take into account the context of an urban United States area. Thus. a folk healer was defined as an unlicensed individual with a public identit! who practiced outside the realm of professional healing by helping people with physical and or psychosocial problems. A review of these criteria will ctarif! the restrictive nature of this definition. Unlicensed means that onh those people who had not obtained ofliclal recogn%ion of their practices were included. .Acupuncturists, for example. who have been licensed in Hawaii since 1974 were excluded. as were masseurs. The significance of licensure as evidence of a move toward legitimation has been discussed bx Cobb [IX] m a study of chiropractors. The status and protectton which licensure offers was recognized h!, some folk healers in Hawaii who obta&ed massage and ministerial licenses. TWO healers. in fact. volunteered. as evidence of their legitimat?. that the! had hcenses. but these were revealed to be general excise licenses which are essentially for tax purposes in the operation of a business. The healer of Interest was also an individual acting in his or her own behalf. Neither representatives of nationwide personal growth or deveiopment groups which offer some counseling. nor clergy who represent particular churches and promote healmg as an ancillary service at their church were included. While

several identified healers did offer religious services for their clients.

hut not for the general public, their primar! public identlt! was as an individual healer, not a priest or minister. The public nature of their identity was a fourth criterion. Oni! those people who treated strangers as well as farnil! and friends were considered folk healers. There are countless people who know a particular remed) or \vill offer advice to a relative or well known neighbor. hut these people have no identity as a healer outslde a smali circle of acquaintances and do not offer a ser\icr to the pubiic. Finall!. folk healers were seen as those who were not part of the professional health sector. A few practitioners such as medical and psychiatric social workers are not licensed in Hawaii. but they are wideI> recognized ah members of the professional

Percentage of Oahu population

Percentage of healers interviewed

28 25 15 10 6 3 2 11 100

29 29 17 6 11 3 6 0 I01

In contrast, folk healers are neither seen by themselves nor others as part of professional healing. Thirty-five healers from 8 ethnic groups were included in the study. It is unknown how many healers exist in Honolulu because they are a fairly well hidden segment of the medical system. However, it is estimated that the number located represent approximately half of the actively practicing ones, and they probably are the more accessible. As shown in Table 2, the percentage of healers interviewed in each ethnic group approximates the group’s representation in the Oahu population. Data were collected primarily through semi-structured interviews with clients and healers who were identified by my asking friends and acquaintances for referrals. Although most of the research took place between 1977-1979, contact with several healers and clients has continued to the present. Interviews with healers generaliy took place during the course of several visits over a period of months and focused on 13 broad topics which included demographic characteristics of the healers; their qualifications; their sources of referral; their diagnosis, treatment, and prevention techniques and beliefs; and descriptions of their clients. Interviews with clients followed a similar format with emphasis on their experiences with particular healers. Information from interviews was supplemented with that obtained from participant observations. It was not always possible to observe treatment processes because of healer and client preference for privacy and because clients were often unavailable when the healers were visited. However, 16 healers were observed providing treatment. and these occasions suggested that there was a close correlation between what the healers said they did and what they actually did. One reason for this is that most healers had specific rituals or techniques which they used. Their advice and counseling were subject to much more individualization with each client, but samples of this type of intervention were obtained through interviews with healers and clients when the processes were not observed. In 12 instances healers volunteered to perform their services on me. Some felt that this was the only way I could understand their techniques, and others simply felt that their ministrations would be beneficial even if I had no complaints.

community. METHOD

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PATRICIA SNYDER

128

Participant observation also included attendance at classes, religious services, gatherings, and fund raising events provided by the healers. Several group sessions were attended on a regular basis. I participated in the weekly religious services of an Okinawan healer for four continuous months and periodically into the present. A Japanese healer offered religious services three times a month and meditation and Buddhism classes weekly which were both attended for 7 months. One Hawaiian held what might best be called a weekend “open house” at which people sat and talked or sought treatment. I participated in these sessions on a biweekly basis for approximately 10 months. Lastly, I worked for a Hawaiian healer 1 day a week for 2 years. He was one of only two healers who had an office, and I was his Saturday receptionist. My duties included answering the telephone, making appointments, collecting payments, keeping records of attendance at classes, and providing general assistance to him. In general, healers and clients were quite cooperative, although secrecy was an important consideration for all participants, and this was respected. The establishment of an ongoing working relationship in which healers and clients felt comfortable in revealing their experiences and beliefs, took precedent over a structured gathering of statistics. Thus, when it did not seem feasible to ask a subject his exact age, this information was not obtained, except perhaps through inference.

GENERAL

CHARACTERISTICS

HEALERS

60-79 years. Twenty-two. or 635;. were women. This is related to their predominance in the 60-79 years age bracket since there was an equal number of males and females in the lower ages. Traditional patterns of women healers among Orientals may partially account for their large number, but economic considerations are also an important factor. Because they were older and not the main support of families. the women, as a group, were better able to engage in a potentially nonlucrative venture. No healer’s economic status could be determined by his or her healing alone. Thirteen worked part or full time in other employment to sustain themselves, and the remaining 22 relied on additional income from family, pensions, and savings. With one possible exception, healers were not becoming wealthy from their healing. One individual encouraged large contributions towards the construction of a church, but the funds received were committed to this, and it seems doubtful that they could have been collected if they had gone toward personal living. The single most damaging and common criticism of a healer was that he or she was “too commercial” or “expected too much money”. Twenty-seven of the 35 healers worked within their own homes which ranged from crude make-shift shacks in isolated areas to attractively furnished large homes in wealthy residential neighborhoods. Of the remaining eight, two Chinese worked in herb shops; one Hawaiian and one Japanese rented offices; one Chinese, one Hawaiian, and one Japanese typically made visits to their clients’ homes: and one Korean saw most people in a shop unrelated to health which she owned and operated. In terms of education, there was an extensive range from one who was illiterate to nine who were college graduates. This latter group included 6 Caucasians, two of whom had masters degrees in non-health related subjects; one Chinese; and two Hawaiians. Seven healers were immigrants from non-English speaking areas including: China, Japan, Korea, Okinawa, and the Philippines, but of these, only three had such limited English that interpreters were needed if a client did not speak the healer’s native language. While the majority of healers had limited formal schooling, they made substantial efforts to increase their knowledge through self education in their chosen field.

OF

AND CLIENTS

Although no healers refused to answer any questions asked, some were known to be reluctant to discuss certain aspects of their personal lives. Occasionally, they were heard giving misleading or evasive answers to clients’ probings, and many clients knew few facts about the healers they saw. Table 3 reports the age and sex of the healers by ethnic group. With the exception of the Caucasians, who were a much younger group, 92% of the remaining 25 healers were over 40 years of age, and the only age range which had all ethnic groups represented was that of

Table 3. Age and sex of healers by ethnic group 20-39 years Ethnic group Caucasian Chinese Filipino Hawaiian Japanese Korean Okinawan Portuguese Total * Includes

M

F

35

Total

M

8

F

Total

M

1

1 3

1

3

1 1

5

5

one age estimated

6&79 years

4&59 years

F

Total

1

1 1

1

1

2 2 2 2 I

2 2 2 2 I I2

1

2

1

I

1

4f

3 5

IO

6

6

12

I

without

substantial

evidence

and may belong

I1

80+ years M

F

Total

1

1

M

F

Total

4 3

6

10 4 2 6 8 2 2 I 35

1

3 2

I

0

I

in next older category

13

1 1

3 6 2 2 I 22

Ethnicity

and folk healing

in Honolulu

129

Table 4. Healers’ bases for treatment by ethnic group

Ethmc

Religious tradition

group

Caucasian Chinese Filipino

I Taoist

Hawaiian

3 Protestant

Physical intervention 3 3

Spiritual intercession I

Physical and religious

1 Protestant 2 Catholic I Hawaiian 1 Protestant

Physical and spiritual

Total

5

10 4 2

1

6

3 Buddhist Japanese Korean Okinawan Portuguese Total

2 Protestant 1 Protestant 2 Buddhist 12

1

7

Examples of approximately 350 client-healer contacts were obtained from healers. from clients themselves. and from personal observations. However. the sensitivity of healers and clients alike to being interviewed and the healers’ lack of complete data on many clients. resulted in only partial information being available. The missing data is. however. randomized throughout the total number of cases. and a general description of clients can be provided. Clients represented a wide spectrum in age. education. income. and ethnicity. Every commonly identified ethnic group in Hawaii, including those with small populations and not part of this study, was represented. Approximately 70”, were women. and the vast majority were adults. ranging from those of college age to those in their seventies. In terms of their socioeconomic status. most clients had skilled or professional occupations and at least a high school education. There were welfare recipients who visited healers. and especially the older clients had limited formal education, but neither of these groups represented the typical client. Similarly, very wealthy and highly educated clients were in the minority. but they also constituted a proportionately small percentage of the total Oahu population. Interestingly. many types of health professionals were clients including: physician. psychiatrist, osteopath, chiropractor. dentist. nurse, acupuncturist, psychologist, and social worker. The presenting complaints of these people and their reasons for seeking help from folk healers did not differ from those of other clients. They were unique among their colleagues only because they believed other types of healing than those with which they were associated might be effective. Some also held beliefs in the influence of supernatural factors, either of a religious or a non-religious nature. which they thought might affect their lives. Clients generally determined. according to their own needs. the frequency and number of visits to healers. Thus. there was wide variation from a single visit to several times per week. Additionally. people might visit healers without clearly being a client. Their status could. instead. be former client who continued to visit. student. or church member, Of the 35 healers, six Caucasians. two Hawaiians. and four Japanese. offered classes in personal growth

2

8

I

2 2 1 35

4

1 Catholic 6

6

and development or in specific techniques such as body manipulations. herbs, or meditation. Four, including one Hawaiian, two Japanese, and one Okinawan, provided religious services. People who attended classes might or might not be active clients. while those who attended religious services were at least former clients, but perhaps not currently obtaining specific advice or treatment. An estimate is that the busiest healer saw, in individual consultations, 20 people per week with onefourth of these being new clients, and the average healer’s practice was limited to about five clients per week. All indications were that healers were not busy by the standards of any orthodox medical practice, and this was the major reason that they were unable to derive a substantial income from their work. While a few healers advertised, this was an ineffective way of attracting clients, and the vast majority of people were referred by word of mouth. Their presenting complaints covered both physical illnesses and psychosocial problems. An analysis of 100 presenting complaints of physical problems revealed that 90% of these had been taken first to a physician, and in all instances of major illnesses such as diabetes, heart disease, and cancer, the clients continued treatment with their physicians and supplemented it, usually secretly, with treatment by a healer. In contrast, a review of 100 psychosocial presenting complaints showed that 90% were taken first to a healer. However, these were every day adjustment type problems at home or work, and most notably, with a spouse, girl friend, or boy friend. There were no ethnic differences found in the type of problem presented. its treatment, or its outcome. Nor were there ethnic differences in client characteristics. The role ethnicity did play in healing encounters can best be presented in terms of the following categorizations: ethnicity in matching healer and client. ethnicity in the healer’s work, and accommodations by healers and clients to ethnic factors. ETHNKITY HEALER

IN MATCHING AND CLIEIVT

In keeping with the common practice in Hawaii of identifying people by their ethnicity, all healers were known by the ethnic group to which they belonged. All. however. reported that they treated members of

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PATRICIASNYDER

ethnic groups which were different from their own in addition to clients who shared their ethnicity. In some instances clients were especially attracted to a healer because of his ethnic identification. For example, some sought Hawaiians on the basis of what they had read or heard about the power of these healers. Further, some healers identified their services in advertisements as an ancient Hawaiian or a Japanese healing art. A particular ethnic identity could, then, be useful for a healer, but the primary determinant in client selection of healers was a recommendation by a trustworthy friend or relative who knew about or had seen the healer. Thus, two Chinese healers reported that the majority of their clients were Japanese because their reputations happened to have spread among a group of people all in the same ethnic group who knew one another. One of these healers had been told by a client that someone had phoned a Japanese talk show program on a radio station and reported good results from seeing him. Other callers then phoned the station and were given the herbalist’s name. He thought that it probably was an advantage having Japanese clients because they were likely to be more hesitant in questioning his technique than were Chinese. In another instance, a Japanese woman who had entered into practice only a short time before the research began, was somewhat surprised that Portuguese Catholics and Hawaiian Protestants would want her to offer Buddhist prayers for their recovery from illnesses. Others who had practiced for many years were quite accustomed to seeing people from various ethnic groups come to them for help. Those who offered regular Buddhist services for clients who chose to attend, had a majority of Japanese at these meetings. However, this was not an exclusive membership. The largest group, and the only one to identify itself as a church, although all of its members were clients, had as its president, a Mexican-American who had been a Catholic. In another group, a Chinese person who regularly visited a Chinese temple and who understood no Japanese had been attending the services of a non-English speaking Okinawan healer for over 20 years. While some healers seemed to feel more comfortable with clients who might more readily share the same language and have some knowledge about basic beliefs or rituals, this did not lead them to exclude people from other ethnic backgrounds. A client’s ethnicity was not elicited by the healer and was not always known. Healers might speculate occasionally on a client’s ethnicity based on his name or physical characteristics, but if it were not obvious because of mixed heritage, or a woman’s married name, or unusual physical features, there were no questions asked. The healer. however, often took the client’s presumed ethnicity into account in talking with him or her. and usually there was at least indirect confirmation or invalidation of these assumptions during the course of treatment. ETHNICITY

IN THE HEALERS

WORK

Table 4 summarizes the work of the 35 healers in terms of the major services offered.

All ethnic groups had healers who relied on a religious tradition. Although they were designated by themselves and others as followers of a specific faith. they were not necessarily affiliated with a church or formal organization. Treatment by the 12 who based their work primarily on a religion included the basic elements of prayer; psychic knowledge by the healer. who might claim to be only an instrument of a deity; and recommendations for action on the part of the client. The latter might entail offerings of food to ancestors or deities, prayers to be said for specified periods of time, and/or specific behavioral changes to improve relationships with others. The six who combined religion with physical intervention might or might not include prayers depending on the client’s and their own disposition. Their physical techniques did not differ significantly from the seven who emphasized physical intervention alone in the form of herbs, body manipulation. or diet prescriptions. The 10 healers who relied on spiritual intercessions. either with or without physical interventions, were those who did not adhere to any specific religion, nor did they pray or practice religious rituals. They did. however, acknowledge the influence of supernatural forces in the form of spirits or energy from an internal or external source. The categorizations provided here result in an omission of details and an incomplete picture of any one healer’s work, but they are a way of conceptualizing the services offered by a broad spectrum of highly individualized practitioners, While it is clear that distinctions cannot be made on the basis of ethnicity, traces of the healer’s ethnic heritage could be identified in most of their work. For example, massage and prayers in front of Christian statues associated with the Catholic Church were the basic practices of the Filipinos, and massage techniques based on Western European and United States teachings were the primary offerings of the Caucasians. As was indicated in Table 3, the healers were generally an older population who had been exposed for many years to their own groups’ cultural traditions. Still, their practices did not rigidly follow traditions, and their beliefs and supporting philosophies were even more subject to variation. Many of the medical practices and beliefs of the ancient Hawaiians were tied to their religion which was disrupted in the early 1800’s and substantially destroyed under the impact of Christianity. Thus. much of the original knowledge is lost and imperfectly known by the Hawaiian healers of today. But other healers, too, indicated abandonment of more traditional beliefs. For example. a considerable amount of the underlying Chinese philosophy was no longer held important by the herbalists treating people. Variations were found both within any one ethnic group and within possible types of healing. For example, it would not be possible to characterize easily a Japanese healer. Among the eight interviewed. three were Buddhists. two were Christians, two were believers in a non-religious but spiritual technique, and one was a practitioner of a therapeutic massage developed in the United States, but with similarities to Oriental massage. Again, among five Japanese and Okinawan healers

Ethnicity

who were labeled bv themselves and others as Buddhists, one also received messages from Jesus Christ; one had an altar with 37 different gods represented and thought that one of the most important was Pele, a locally well known Hawaiian goddess associated with volcanoes: one emphasized karma while another believed karma had no meaning. and the fifth had little knowledge of Buddhism as a philosophy. Finally. there were differences in the way these five structured their practices. Two had no religious training but offered regular religious services for clients, and one of these followed each service with individual readings of the clients present. Of the two who had been trained as priests in Japan, one never performed such services and restricted her help to individual sessions. The other offered services with occasional testimonials. but no consultations took place at this time and had to be scheduled on other days. The fifth was the only one who had no altar in her home. While clients could and did change healers, they could not be assured that the practices or beliefs of healers in one ethnic group would be the same or that all those ostensibly following a particular teaching would be the same. Indeed, clients were known to, for example. leave one Hawaiian healer and try another whose ideas seemed more compatible with their own. They also were known to visit a healer of one ethnicity and if dissatisfied, go to another of a different ethnicity when they learned about him or her. There were many sources for the variations and eclecticism in the healers’ work. Most had acquired their knowledge over many years but not through apprenticeship. Rather, they had read, prayed, and thought. or gleaned ideas from discussions with clients and other interested people and from experiences at, for instance, churches or classes on special techniques. There was evidence that healers were continually adding to, or reworking, especially the explanatory basis for the particular rituals or procedures which they followed. Many were familiar with popular literature or news articles on parapsychology and supernatural phenomena. They then incorporated references to ESP. spirit guides, vibrations, or other concepts into their discussions with clients, especially if the latter expressed familiarity with and interest in these ideas, The most active and popular healers were the ones who most obviously added current ideas in their conversations, but all healers seemed to make adaptations in their work to meet their clients’ perceived preferences. ACCOMMODATIONS CLIENTS

BY HEALERS

TO ETHNIC

AND

FACTORS

Healers were, of course, keenly aware of their dependence on clients for their continued existence in their chosen work. As described earlier, none was busy or financially secure in his or her practice, and there were strong practical reasons for accommodating as many clients as possible. At the same time, all the healers seemed genuinely to believe that they had an ability or technique which could be helpful to people. and they wanted to share it. While a healer’s sensitivity to clients varied, there were many instances of healers either trying to find SS.M15Zn--”

131

and folk healing in Honolulu

analogous explanations of rituals in the experiences of the client’s own ethnic group or of actually changing some rituals for the client. For example. several times on the telephone I was mistaken for a Japanese person. A Hawaiian healer whom I contacted. talked about her work and likened many of her practices to elements in Japanese martial arts, emphasizing that a master of one such art had come to her for help with physical complaints. When she learned that I was not Japanese but Caucasian. she immediately launched into a discussion of the missionaries in Hawaii and the importance of Christian teachings. In another instance, an Okinawan Buddhist healer, who typically recommended that clients pray before a Buddhist altar and make offerings to ancestors. told Filipino Catholics to offer wine to Jesus Christ. Similarly, there was evidence that clients made intellectual adjustments in order to follow a healer’s advice. One way was through selective compliance. A Japanese person who had found impractical some rules set forth by a Hawaiian healer used other statements made by him as rationalizations for disregarding the rules and simply did not mention that she was not following all of his advice. There was also reinterpretation of events. One Caucasian who was interviewed at what was objectively a Buddhist service blithely stated “it’s not really Buddhist because there is one God with everyone else as helpers”. This person did not consider himself a Buddhist and denied the existence of many elements in the service. but he had been attending regularly for several years and was successfully obtaining help for a psychosocial problem. A third way found useful by some clients was to identify analogous beliefs or practices common in their own ethnic group. Specific concepts such as spirits or “energy” and specialized techniques and rituals such as massage, offerings, and prayers, can all be translated into one’s most familiar idiom and context without too much distortion. In some cases, subleties were lost anyway because the healer and client spoke different languages. A member of the healer’s family or the client’s friend or relative might serve as interpreter. or there was dependence on minimal English. These solutions did not allow for sophisticated verbal exchanges, but they did foster the client’s reliance on his own beliefs or ideas.

CONCLL’SION

To the extent that Honolulu represents multiethnic settings, especially in United States cities, this study suggests that one cannot assume that people seeking help from folk healers are seeking it only within their own ethnic group. In so far as groups interact with one another in social situations, it is likely that they will also do so for health problems. The healers in Hawaii who had the broadest representation of ethnic groups and the greatest number of clients outside their own group were the part-Hawaiians who also have intermarried at the highest rate and have traditionally been open to interactions with others. In no case, however, was the crossing of ethnic lines considered a rare phenomenon. and the examples presented here are not unique but clear illustrations

132

PATRICIA SNYDER

of the types of interactions in the folk healing encounters studied. The need for clients and professional or folk healers to have shared world views, especially perhaps in psychotherapeutic endeavors as delineated by Torrey [I93, cannot be underestimated, but this sharing is clearly not bound within one’s ethnic group. There would seem to be common elements shared by participants in folk healing regardless of ethnicity, and an identification of the factors which need to be shared might be more worthwhile than attempts to match healers and clients by ethnicity. This is further supported by the second finding that healers’ practices and beliefs, while having some basis in their ethnic backgrounds, are quite heterogeneous and ecfectic. The common assumptions that people are attracted to folk healers because of a compatability based on their ethnic heritage and that exotic ethnic services are being rendered bear reevaluation. Similarly, clients cannot be thought of as purists anymore than healers can be. In urban multiethnic setrings, where there is exposure to different peoples and dissemination of information through mass media, there is an especially strong impetus towards change in the traditional knowledge about health matters. Kay [ZO] notes that among Mexican-Americans in an urban area of the United States, many of the folk concepts about illness had changed from those reported in the literature less than 10 years earlier and that even when the words were the same, some of the meanings were different. Thus, the compatability clients are seeking with healers may not be based on ethnicity or common knowledge about their own ethnic group practices. Finally, the findings with regard to accommodations by healers and clients lend support to the possibility that folk and professional healers can successfully establish therapeutic relationships with people of differing ethnic backgrounds. The healers’ general willingness and their abilities to modify their practices and provide palatable explanations for events or prescriptions were undoubtedly increased by their interactions with other groups in a multiethnic setting. Similarly, the clients’ tolerance for advice which ‘was not always congruent with their own beliefs was probably heightened by their experiences in handling such events in every day living. Still, the accommodations made by both providers and recipients in folk healing emphasize a process that can and does occur in many medical treatment situations. Here the vast majority of clients with physical complaints had already consulted a physician, and only those with every day adjustment type problems chose to go first to a healer rather than a mental health professional. Thus, this study highlights the accommodation process because the participants were not forced into dealing with each other by a medical urgency or by unavailable aiternatives. The relevance of ethnicity as a variable in people’s health behavior, in the relationships established between practitioners and clients, and in the services offered by folk and professional healers cannot be dismissed as insignificant. It is necessary, however. to

analyze exactly what role ethnicity is playing in these situations without assuming that there is a one to one correspondence between one’s ethnicity and health beliefs, practices. or preferences.

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