There are few subject areas in anthropology untouched by the seminal thought of the late Professor Claude Lévi-Strauss. Though he published only two or three essays concerned expressly with medical subject matter, his theorization in those places of the role of myth and shamanistic authority in symbolic/magical healing opened up questions with lasting significance. I would like to briefly review his ideas with the aim of proposing an alternative reading of them, particularly as they may be applied to contemporary debates in psychiatric anthropology.

“The Effectiveness of Symbols” and the often-anthologized essay, “The Sorcerer and His Magic”, both published in 1949 and appearing in English in Structural Anthropology in 1963, have been cited in connection with the following concepts. First, in seeking to explain the efficacy of certain magical healing practices, Lévi-Strauss posited a “shamanistic complex”, consisting of

First, the sorcerer’s belief in the effectiveness of his techniques; second, the patient’s or victim’s belief in the sorcerer’s power; and, finally, the faith and expectations of the group, which constantly acts as a sort of gravitational field within which the relationship between sorcerer and bewitched is located and defined. [1963:168]

For a discipline devoted to studying the influence of cultural and intersubjective contexts in the healing process, this construction is a useful one. Michael Taussig writes of “the complicated mystification present in healing in any culture, but which in our own modern clinical setting perniciously cannibalizes the potential source of strength for curing which reposes in the inter-subjectivity of patient and healer” (1992:100). And in connection with the placebo response—renamed along these lines “the meaning response” (Moerman 2002)—Andrew Lakoff cites Lévi-Strauss to say “the structured communication between doctor and patient activates a therapeutic potentiality that exists within individuals. Accordingly, in the therapeutic setting, the drug is both substance and symbol, and this duality is one of a number of elements that cannot be neatly untangled” (2002).

A second Lévi-Straussian idea that tickled the medical anthropological imagination particularly when psychotherapy was still predominant was the comparison of the psychoanalyst to the shaman. Notwithstanding certain differences, such as that we may be comparing physical and psychological cures or that “the psychoanalyst listens, whereas the shaman speaks” (1963:199), there are striking similarities. Note, at length, his discussion of a curing ritual performed among the Cuna Indians of Panama in the event of a difficult childbirth:

The cure [consists] in making explicit a situation originally existing on an emotional level and in rendering acceptable to the mind pains which the body refuses to tolerate. That the mythology of the shaman does not correspond to an objective reality does not matter… [The patient] accepts these mythical beings or, more accurately, she has never questioned their existence. What she does not accept are the incoherent and arbitrary pains which are an alien element in her system but which the shaman, calling upon myth, will reintegrate within a whole where everything is meaningful… In both cases [shamanism and psychoanalysis] the purpose is to bring to a conscious level conflicts and resistances which have remained unconscious, owing either to their repression by other psychological forces or—in the case of childbirth—to their own specific nature… In both cases also, the conflicts and resistances are resolved, not because of the knowledge, real or alleged, which the sick woman progressively acquires of them, but because this knowledge makes possible a specific experience, in the course of which conflicts materialize in an order and on a level permitting their free development and leading to their resolution. This vital experience is called abreaction in psychoanalysis. [1963:198]

What stands out in the above is less (to borrow Marshall Sahlins’ language, 1982) the mythical realities availed in the shamanistic healing process, than the implied historical (or autobiographical) metaphors unwittingly deployed in psychoanalytic attempts at psychological cures. Lévi-Strauss continues:

Both cures aim at inducing an experience, and both succeed by recreating a myth which the patient has to live or relive (1963:199).

That Lévi-Strauss believed in the healing capacities of psychotherapy appears to be beyond question (much has been written on this), and he says himself that by the above he meant no offense to that discipline. Nor did Lévi-Strauss seem to question the validity of the transference as a mechanism. But he maintained that it was, in the end, a propounded myth that facilitated the cure:

Many psychoanalysis would refuse to admit that the psychic constellations which reappear in the patient’s conscious could constitute a myth. These represent, they say, real events which it is sometimes possible to date and whose authenticity can be verified by checking with relatives or servants. We do not question these facts. But we should ask ourselves whether the therapeutic value of the cure depends on the actual character of remembered situations, or whether the traumatizing power of those situations stems from the fact that at the moment when they appear, the subject experiences them immediately as living myth. [1963:202]

In the transformation to industrial civilization, Lévi-Strauss says, mankind has sacrificed “mythical time”. Medicine, or at least psychological medicine, has not, in the bargain, lost its capacity to heal by this mechanism, however, it has lost touch with the true sources of its efficacy:

Psychoanalysis can draw confirmation of its validity, as well as hope of strengthening its theoretical foundations and understanding better the reasons for its effectiveness, by comparing its methods and goals with those of its precursors, the shamans and the sorcerers. (1963:204)

Notwithstanding Lévi-Strauss’s respect for the universal power of myth as well as his deference to psychoanalysis, the implication of the above is that psychoanalysts are mystified by their own scientific paradigm. This false consciousness might, if we follow to logical conclusions, in fact operate in the same way myths do, which is by masking a deeper structured reality—a reality that might reveal itself only in the application of a different sort of science—the anthropologist’s science, which will trump psychoanalysis by unearthing its deeper meanings.

In contrast with scientific explanation, the problem here is not to attribute confused and disorganized states, emotions, or representations to an objective cause, but rather to articulate them into a whole or system. The system is valid precisely to the extent that it allows the coalescence or precipitation of these diffuse states… (1963:182)

Finally, in regard to the shamanistic complex, Lévi-Strauss’s emphasis on the healer rather than the patient (“The experiences of the sick person represent the least important aspect of the system” [1963:180]), makes sense in the traditional context he is describing for two reasons. First, it is the shaman who is doing the talking, singing the songs, reciting the myths, and performing the actions, while the patient is more or less a passive recipient of treatment. Second, the initiation, training and trustworthiness of the shaman are material to his effectiveness as a healer.

Quesalid did not become a great shaman because he cured his patients; he cured his patients because he had become a great shaman. [1963:180]

The potential challenge to psychoanalytic authority embedded in Lévi-Strauss’s theory would never have been countenanced by the profession—not, at least, outside of France, where the ungrounded ideas of intellectual psychoanalysts such as Jacques Lacan were fashionable. Yet it is possible to take Lévi-Strauss’s ideas even further in the direction of psychoanalytic critique. I credit Mikkel Borch-Jacobsen’s 2009 book, Making Minds and Madness, as being an example of how such a critique might be constructed. Borch-Jacobsen does not cite Lévi-Strauss, but we can easily see from the following quote how the shamanistic complex Lévi-Strauss identified and which has oft been credited for its healing potentials, in Borch-Jacobsen’s conception might well be blamed for the opposite:

“As I see it, it is probably a chicken-and-egg problem to try to determine whether Freud’s statements regarding his patients’ scenes refer to actual ‘reproductions’ or to speculative interpretations and reconstructions on his part. Both processes were at work simultaneously: Freud’s constructions prompted ‘confirmations’ from the patients which prompted other constructions, and so forth… My larger claim is that this is the only kind of ‘evidence’ that one is likely to get in psychoanalysis… Freud’s seduction theory was clearly a folie à deux, or rather a folie à plusieurs, but so too is orthodox psychoanalysis, cognitive-behavioral therapy, and even the most rigorous experimental psychology. Each of these disciplines produces the evidence on which it rests, which means that it is pointless to try to disconfirm them” (2009:57).

Lévi-Strauss was not interested in the scientific veracity of the healer’s art but in its efficacy, which hinges on faith: “The efficacy of magic implies a belief in magic” (1963:168). Because it is he who says so, we can apply the same yardstick to psychoanalysis and perhaps, with qualifications too intricate to enumerated here, psychotherapy in general: It “works” because psychologists/analysts, patients, and society at large believe in its moral narrative. As M.L. Gross asserted long ago, “It makes little difference that each of the psychotherapies has different faith. It is faith itself, not the doctrine, that is the healing agent” (1978).

We may never ascertain the empirical extent of shamanic success at healing, among the Cuna of Levi-Strauss’s example or elsewhere, although there is an anthropological and cultural psychiatric literature worth perusing on the subject. In our society, in the age of evidence-based medicine, the claim that the mentally ill are cured by their psychotherapists has been widely vitiated by lack of clinical evidence supporting it. The edifice of the DSM (and biopsychiatry generally) is taken by its adherents to be the arc de triumph standing over the defeated field of psychoanalysis and the gateway to the profession’s scientific future. Not that biomedical psychiatry’s effectiveness, such as it is, lies outside the realm of rhetoric; here, too, professional legitimacy derives not from the discovery of organic causes but from the educing of indirect, nonspecific evidences that often win slender victories over placebo. The irreducible remainder in this debate about efficacy is the unsolved epistemological quandary of the variance and unacknowledged overlaps between narrative and scientific truths, vis-à-vis which the entire psy field may be, as LC usefully suggested in this connection, a boundary object.

In conclusion, I return to the alternative reading of Lévi-Strauss’s take on shamanism and psychoanalysis suggested by Borch-Jacobsen’s thesis that the encounter between therapist and patient is the site of creation of illness rather than cure. This analysis easily allies with earlier critiques of (principally American) psychotherapeutic practice that depict it as devoid of rational clinical function and sometimes deleterious to the patient, but which thrives upon an “isomorphism with cultural values” including market and political ideology (Epstein 1995). These, combined with the increasingly incontrovertible claims about psychiatric disease mongering (Lane 2007, Healy 2008, e.g.), might tempt us to say rather more globally that much of what psychiatry produces today are not cures, but mental illnesses themselves. Hysteria and multiple personality disorder in the heyday of psychoanalysis, and social anxiety disorder and pediatric bipolar disorder in the biopsychiatric era, are equally “transient mental illnesses,” in Ian Hacking’s phrase, or folie à plusieurs whose facticity is grounded in the discursive encounter in the society at large but also directly in the clinical setting where trust is the conveyance for belief. As such, contemporary psychiatric practice may be more than ever the subject matter for Lévi-Straussian medical anthropology, but for different reasons than those he specified or that we have applied.

References:

Borch-Jacobsen, M. 2009. Making Minds and Madness: From Hysteria to Depression. Cambridge: Cambridge University Press.

Epstein, William. 1995. The Illusion of Psychotherapy. New Brunswick: Transaction.

Gross, M.L. 1978. The Psychological Society. New York: Random House.

Healy, David. 2008. Mania: A Short History of Bipolar Disorder. Baltimore: Johns Hopkins University Press.

Lakoff, A. 2002. “The Mousetrap: Managing the Placebo Effect in Antidepressant Trials.” Molecular Interventions 2:72-76.

Lane, Christopher. 2007. Shyness: How Normal Behavior Became a Sickness. New Haven: Yale University Press.

Lévi-Strauss, C. 1963. Structural Anthropology. New York: Basic Books.

Moerman, DE. 2002. Meaning, Medicine and the Placebo Effect. Cambridge: Cambridge University Press.

Sahlins, M. 1982. Historical Metaphors and Mythical Realities: Structure in the Early History of the Sandwich Islands Kingdom. Ann Arbor: University of Michigan Press.

Taussig, M. 1992. The Nervous System. New York: Routledge.