Moral Worlds and Therapeutic Quests: A Study of Medical Pluralism and Treatment-Seeking in the Lower Amazon.

摘要

This dissertation is about the social and psychocultural dimensions of medical pluralism and treatment seeking in Santarem, a rapidly growing municipality in the Brazilian Amazon. Based on a year-and-a-half of ethnographic fieldwork in urban and rural settings, it comparatively examines how popular religions and cosmopolitan health institutions define and manage (or fail to manage) sickness, psychosocial impairment, and emotional distress. It also reveals lived experiences of informants who seek out these therapeutic options and the processes through which quests for healing shape personal understandings of affliction and selfhood.;This study contributes to emerging scholarship in anthropology that theorizes medical pluralism, not in terms of discrete cultural systems set in opposition to one another (e.g., traditional versus cosmopolitan medicine), but rather as an open system of dynamic relations between institutions and between institutions and care-seekers. This dissertation situates these processes within broader historical trends in the Amazon that have lead to significant patterns of urbanization, migration, and sociocultural complexity, contrary to popular stereotypes of the region. In this context, religious institutions such as Pentecostalism, Spiritism, Candomble, and Umbanda have flourished and, along with secular health institutions, provide diverse social and symbolic resources for the needs of care-seekers. However, an examination of the ways that santarenos in these communities cognize illness and distress and seek care reveals how blurred the boundaries are between institutional ideologies and therapeutic practices. These domains are characterized as much by complementarity as by contradiction. In similar light, individual treatment seeking efforts do not unfold in any clear-cut fashion. Rather, informants find themselves caught up within epistemic entanglements, as they navigate moral worlds oriented to medicalized care, ritual forms of healing, and spirit mediumship. Case studies convey personal dilemmas that emege from these entanglements, in which individuals strive to regain control of symptoms, of self- and social efficacy, and moral development. Psychocultural theories, including the work of culture and embodiment, provide a framework for understanding how differing cultural idioms articulate with these life-course themes, emotions, and sensory experiences, which together underpin expressions of flexibility in selfhood in response to social conditions of pluralism.