CHANGE IN AFRICAN THERAPEUTIC SYSTEMS

The contrast between the closed intellectual system of traditional African thought and the open one of Western science is misleading as applied to medicine. Since the seventeenth century in Europe, the range of therapeutic alternatives has narrowed. Recent work on Africa shows a broad therapeutic pluralism in both the explanations of misfortune and treatments of illness. The breadth of therapeutic pluralism had been obscured by studies elucidating particular theories of causation, then assuming that one theory was equivalent to the thought of an entire society. The only way to insure a full picture of the varieties of therapy is to define disease from outside the cultural and social system, and then find all the ways of dealing with it. In comparing the decline of pluralism in seventeenth century England and the situation in contemporary Africa, two mechanisms for selecting among alternative therapies lead to two processes of change in health care patterns. In the first, each segment of the population tends to choose its own appropriate kind of therapy. If one segment grows more rapidly, its preferred therapy will carry greater weight. In the second, the therapy managing group of the sick person's kinsfolk and neighbors select the therapy. Here therapy will change with the managers' changing perception of threats to health and of the efficacy of competing therapies. Both approaches must be analyzed with regard to a society's productive base, and the manner in which therapeutic resources and decisions are linked to units of production. © 1979.