Personhood and Illness among the Kulina Author(s): Donald Pollock Source: Medical Anthropology Quarterly, New Series,

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ARTICLES AND COMMENTARIES

DONALD POLLOCK

of Department Anthropology Universityat Buffalo

Personhood and Illness among the Kulina

This article offers both a contribution to the ethnography of ethnomedicine among the Kulina Indians of western Amazonia-a region in which there has been little ethnomedical research-and an extended illustration of the value of the concept of "personhood" in the analysis of ethnomedical beliefs and practices. I argue that the current medical anthropological fixation on the Body is neither good ethnography nor productive theory, and I use the Kulina example to illustrate how the cultural dimensions of personhood provide a more satisfactory framework for the understanding of illness. Kulina conceptions of illness are closely linked to the substances and processes through which personhood is acquired, expressed, and transformed. I consider the two major categories of illness in Kulina ethnomedicine, andfocus special attention on the more serious of these: potentially fatal illnesses that are linked to witchcraft and to the violations of prohibitions. I suggest how these illnesses serve as languages for the simultaneous negotiation of social

issues and personhood. [ethnomedicine, Amazonian Indians, personhood]

of ne of the moreconspicuousgaps in the ethnography indigenouslowland South America is the broadcategoryof ethnomedicine,includingnotions of aboutthe cause, nature,and treatment illness. While the more dramatic and publicly ritualizedaspects of shamanismare describedin many ethnographic accounts,only a few anthropologists workingin this regionhave exploredin detail of indigenousunderstandings sickness as an experience,or culturalcategoriesthat correspondmore or less roughly to "illness"or "medicine"(e.g., Conklin 1989, 1994; Langdon 1974; Mussolini 1980; Pollock 1988, 1994; Von Martius 1979). Nonetheless, it is clear from various accounts that, for South AmericanIndians, discoursefor variousstatesof personal illness forms a highly public, multipurpose
MedicalAnthropologyQuarterly10(3):319-341. Copyright? 1996 AmericanAnthropologicalAssociation. 319

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and social distress, a powerfully meaningful code through which the mundane of interactions people can take on deep significance. In this article I present an overview of Kulina notions about sickness and illness-Kulina ethnomedicine-focusing on both the culturaldimensionsof illness beliefs andpractices,andthe social contextsin which illness is recognizedand related to illness are closely linked to Kulina conceptions of "person,"of the fundamental natureof bodies, souls, and social practicesthat areheld to comprise persons.And becauseKulinapersonsareeminentlysocial beings,emergingin and definedby social contexts,Kulinaideas aboutillness arenotlimitedto beliefs about bodies and souls as aspects of individuals;bodies and souls are believed also to sharesubstancesand qualitiesof social processes. Personhood and Illness The notion of "personhood"has been used in a variety of ways in the anthropologicalliterature,from Mauss's (1950) analysis of the emergence of conscious self-awarenessto Kirkpatrick's (1983) ethnosemanticanalysis of Marquessancategoriesof humanness. own use of the termis closer to thatproposed My of by Grace Harrisin her conceptualreformulation the field comprisinga variety of analyticallyambiguousconcepts such as "self' and"individual" (Harris1989). Moreover,althoughI adoptthe notionof personhoodas an analyticdevice, my use an of the term incorporates explicitly culturaldimension in thatthe Kulina themselves use a comparable notion. I consider "persons"to be agents of meaningful action or, perhaps more precisely, beings who are assumed to possess the capacityto be agents of meaningful action. I assume that this agentive capacity is at least implicit in every
culture's evaluation of sociability, the potential for certain beings to be authors of its treatment is undertaken. My perspective is that Kulina beliefs and practices

meaningfulaction. My use of the conceptof personis also a tacticalresponseto an ethnomedical that to literature threatens become overwhelmedby perspectivesof "theBody"or, "theSelf."I capitalizethese termsto indicatethe strikingessentialism alternatively, that saturates much of the writing about them.' Perhaps most notable is the given that serves assumption,often implicit,thatthe Body is a kind of precultural eitheras a repositoryof potentialsignifiers(or signifieds) in social tropes(Douglas 1966, 1970b; T. Turner 1995), or as the locus of authentic experience whose "embodied" realityis supposedlyhiddenor distortedby such culturalpracticesas mind/bodydualism(e.g., Csordas1990, 1993;Lock 1993). The difficultywithsuch literature there that a perspectiveis the suspicionone gains from the ethnographic notion of the body, that even if all culturesendow their is no single pancultural memberswith bodies, these bodies differ from cultureto culture.Fortesnoted, in a seminalarticleon the notionof the personamong the Tallensi, thatsome kind of but body was requiredfor access to the statusof "person," it could be a crocodile on as easily as a humanbody (Fortes 1973). Much of the literature the Self body presents a related but opposite difficulty, denying the universalityof a Western boundedthing,andeven challengingthe universality notionof the Self as a unitary, of self-otherdistinctions(Kondo 1990; but see Spiro 1993). My concernaboutthis literatureis not that it promotesa single, universalizednotion of the Self, but that

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it so often conducts the discussion of the Self outside of the context of specific culturalconceptionsand specific forms of practice.As David Murrayhas recently argued,any assumptionthatone can drawa simplecontrastbetweena WesternSelf anda non-Western Self is inherentlysuspect(Murray1993; see also Munck 1992), and Spiro has cautioned that anthropologicaldescriptions of various forms of selfhood tend to confuse several notions of the Self: as a culturalconceptionof the personor individual;as a culturalconceptionof some innerpsychic stateor process withinthe individual;as reflexive self-awareness;and so on (Spiro 1993:114). My tactic is thus to shift the analytic discourseto the notion of personhood, which requiresfocusing attentionon the ways persons are understoodand constructed in any particularculture. While a discourse of the Body implies an and essentialist,precultural materiality, a discourseof the Self implies an essentialist, preculturalphenomenology, a discourse of personhood requires only the possibility of a culturalsemanticsof action.Moreover,a discourseof personhood, far from generalizinga particular culturalontology of action, necessarilyimplies multipleculturalontologies, in which bodies, minds, selves, personalities,or souls may have salience, certainly will have variablesalience, or may not exist at all. Laderman'swork on Malay conceptions of illness and its treatmentnicely illustratesthe extremevariabilityof such culturalontologies of personhood.She notes thather Malay informantsconceive of persons not only as possessing bodies and cultural minds,but also multiplespirits(Laderman1991, 1992), and the particular salience accordedto these spirits in illness underminesany simplisticreductionof Malay persons to the Body or the Self.2 I proposethat,for the Kulina,illness is a particular conditionof persons.That is, Kulina understandillness to be a condition that affects those aspects of their culturally constituted essential being that comprise the culturally constituted beliefs groundfor theirqualificationas persons.Indeed,I suspectthatethnomedical aboutand approachesto illness have this character any culture,and though the in comprehensivepursuitof this point is beyond the scope of this article, the point can be illustratedin a tentativeway througha briefdiscussion of familiarWestern ethnomedicalconceptionsof illness. The fundamental bifurcationof persons in Americancultureinto bodies and minds surely forms the culturaland historicalgroundfor the parallelfundamental bifurcation illnesses into thephysicalandthemental,andof professionalmedical of specialtiesinto physicalmedicine andpsychiatry/clinical psychology. Withineach of these spheres of medicine, conceptions of illness as well as forms of practice tendto reflectandreproduce basic aspectsof Americanpersonhood.This pointhas been made in a slightly differentform with regardto Americanassumptionsabout the mentalmakeupof persons. Lutz, for example,has noted thatAmericansposit an essential differencebetween emotion andthought,a culturalassumptionthatis elevated to "scientific"salience as "affect"versus "cognition"(Lutz 1988). This culturalbifurcation only attributes personscertainqualitiesthatin turnshape not to the social fields in which those personsareordered(as in genderdifference),it also achieves pathological salience as the difference between affective disordersand thought disorders,two major categories of psychiatricillness whose differences seem to emerge primarilywithin the culturalsettings of Western,and especially And while the increasingreductionof physical illness to a American,psychiatry.3

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molecular biological level may seem to argue against any direct relationshipto Americannotionsof personhood,it shouldbe notedthatAmerican culturalassumptions aboutthe natureof behaviorare undergoinga parallelreduction.The belief that, for example, alcoholism is a genetic disease, that violent crime can be attributed directlyto hormonalchanges duringPMS or to extra Y chromosomes, or that chronic fatigue must be caused by a viral infection, suggest how the discoursefor the biologiincreasingbiologizationof illness drawsupon a broader zation of behavior. As a component of personhood, the Western "mind" is a bifurcatedarrayof qualities that are differentiallyascribedto kinds of persons. field Similarly,theBody is not a single, undifferentiated fortheinscriptionof status, or resistance;bodies are also a complex, swarmingstew of genes, oppression, microbes,hormones,organs,andfluids thatcomprisemuchof a single lexicon for our moderndiscourseon both behaviorand illness: thatis, on personhoodand its in transformation illness (Martin1987, 1991). Indeed,the postmodernnotion of a a Body-without-Organs, pure exteriority serving only as a field for inscription (Deleuze and Guattari 1988), seems to be merely the (ironic) reification and fetishizing of the body as a productof Western intellectualwork (cf. T. Turner 1994). Thus my intention in this article is, first, to describe Kulina notions of personhoodbriefly, at least at a level of detail that, second, allows me to indicate how Kulinaethnomedicalbeliefs and practicesmay be readas particular kinds of conditionsof the fundamental featuresof kinds of Kulinapersons. The Kulina The Kulinaare an Arawaklanguage-speakinggrouptotalingbetween 2,500 and 3,000 individuals living in villages scattered along the banks of rivers in westernAmazonia,the majorityin Brazil,severalhundred two villages in eastern in Peru. The researchon which this article is based was conductedin the village of Maronaua a bankof the upperPurusRiver in Acre, westernBrazil, in the Area on Indigena (AI) Alto Purus. At the time of my original researchin 1981-82, this village was composedof approximately160 people who subsistedon huntingand horticulture slash-and-burn supplementedby fishing and gathering.The AI Alto Purusnow comprisesroughly 12 Kulinavillages, andthe populationof Maronaua is approximately 60-70 individuals;the decline in populationresultedfrom many formervillage members'moving to othervillages, particularly Sobral,a former the rubber-tapping camp (seringal) near Maronaua.My research in 1981-82 was conductedover a 14-monthperiod, 12 of which were spent in Maronaua proper;I returnedin 1990 and 1992 for shortvisits of 1 montheach. My original research focused on Kulina shamanism and ethnomedicine in the context of a broad methods ethnographic studyof this group.I used standard participant-observational extensive interviewswith severalwell-informedinformants.My supplemented by work in 1990 and 1992 focused more narrowly on the health consequences of environmental change in the region; the complex of Kulina ethnomedicalbeliefs and practicesI discuss here remainedintact. As I have describedelsewhere (Pollock 1988), the overallhealthof the adult population at Maronauaappearedto be fairly good at the time of my original research,andremainsso. The village enjoys access to relativelyabundant game in

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the surrounding forest, adequategardens,and fish. The AI Alto Purusis not in a malarial area, and so village members do not suffer from chronic or recurrent malaria.Two individualsappearedto be sufferingfrom tuberculosisin 1981, and a local Kulina man (not a resident of Maronaua)was treatedfor gonorrhea.But while thehealthof adultsis good, the healthstatusof childrenis often compromised by nutritionaldeficiencies. Eating patternsallow adult men first access to meat; women normallyhave sufficientleftover meat, but childrenoften get little or none and are not thoughtto requiremeat as much as adults.Nursinginfantsarehealthy and well fed, but their older siblings often struggle with diets based mainly on manioc andplantains,which providemore bulk than nutrition. Extendedbellies, a combination of protein insufficiency and occasional parasitic infestation, are common in childrenfrom about age three to ten (Pollock 1988). The health of the populationat Maronauais generally good, particularly in contrastto that of the other majorvillage of Kulina in the AI Alto Purus, Santo Amaro. AlthoughI lack precise data or measuresof health statusfor thatvillage, my impressionfrom several shortvisits is thatchildrenand adultsat Santo Amaro suffer moresevere,chronicproteinshortages.This circumstance theresultof the is of SantoAmaro(which is at the confluence of the Chandlessand Purus proximity rivers) to a settlement of Brazilians (locally called "Os Peruanos"from their historicalorigins before Acre was annexedby Brazil), whose aggressivehunting and commercialfishing has depleted much of the game and fish in the area.I was told that the primarysource of animalprotein at Santo Amaro was fish, and that largerfish were becomingincreasinglydifficult to find due to intensivenet fishing by local Brazilians.The shortageof protein appearedto have opened the Kulina populationto higher rates of illness, especially among children,but also among adults (Pollock 1988:29). Kulina Persons I translate Kulinatermmadihaas "person," the recognizingthatits polysemic nature unfolds throughsuccessively wider ranges of semantic contrast:Kulina persons versus nonpersons; Kulina versus other Indians (indio); indio versus non-Indian(karia);humanversus nonhuman;and so on. At each level of contrast the notionof madihaconveys the sense of being an agentof meaningfulaction.But I will use it here,for convenience, in the markedsense in which it refersto Kulina as opposed to otherkinds of humanbeings, and to what might be called potential persons, especially Kulina infants, whose capacities for meaningful action are developing.This sense of the notion of madihaexcludes beings whose actions fail to conformnot simply to Kulina standards proprietybut to fundamental condiof tions of meaningfulness. will outlinea few important I aspectsof the Kulinanotion of personhood,and will allow a deeperdiscussion of Kulinapersonsto emerge in the context of illness beliefs and practices. Kulina, in their talk about persons, refer to two concepts they contrast as "wild"(wadi)and"sociable"(ettedi,the verbalform also meaning"domesticate"). The distinctionis expressed in the contrastbetween, for example, the wild forest and the sociable village, solitaryversus collective activity,huntingandgardening, men and women, silence and speech. Wildness and sociabilityare associatedwith andto some extentattributable the possession of bodily substances. wildness to The

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of men, for example,is attributable partto theirpossession of semen, while the in sociabilityof womenis relatedto theirbreastmilk,4andlife-cycle stagesareordered partlyby referenceto these substances.Adolescence, for example, is signaled for Kulina by the developmentof semen in boys, and for girls by the appearanceof breasts. Semen, being a particularly wild substance, causes adolescent boys (dzabitso) to act in especially wild ways, and Kulina grant adolescent boys considerablelicense for behaviorthatwould be unacceptable both childrenand in adults. Adolescent girls (dzuato) are also felt to exist in a state of more or less substantialimbalance,and consequentlythey too are expectedto behave improperly, even wildly, thoughnot so much as boys.5 The principlemanifestationof the improprietyof these adolescents is their sexual behavior,which is felt to be unregulated,vaguely animalistic, and wild. Marriagetames or domesticatesboth adolescentboys and girls by regulatingand legitimatingtheirsexualconduct,butalso by creatingfood production, preparation, and exchangerelationsthatare the preeminentdisplays of propersociability. The regulationof sexual behaviorfor adolescentboys who undergotrainingto become shamansactually begins before marriage.Toward the end of adolescence, boys have implantedin their flesh a mystical substancecalled dori, the dori of senior, adultshamans,a substancethatcomes to permeatetheirown flesh and links them to the spiritscalled tokorime,which are themselves spiritforms of dori possessed by variousanimals.The complex symbol dori might in this context be considered an objectification the wild naturesof men, a view thatis also consistentwith the of Kulinabelief thatthe novice shamanmustremaincelibate;he would lose his newly acquireddori, along with his semen, in illicit sexual relations.In my discussion of illness I will focus on the mannerin which notions suchas wildnessandsociability, core symbols of personhoodfor Kulina, underliea wide varietyof ethnomedical beliefs and practices,and I will expand on Kulina notions of personhoodin that context. Kulina persons also possess spirits (kurime),which they acquireduringthe period of infancy through the consumption of meat. Briefly, the kurime of a deceasedindividual realmof spirits(namibudi),where journeysto theunderground it is eatenby andbecomes transformed a white-lippedpeccary.These peccaries into are called up into the forest by shamans,where they arehunted,andthe consumption of theirmeat,saturated with the kurimespirit,is reincarnated, a quite literal in sense, as the kurimeof the living consumer(see Pollock 1993). It is the interface of Kulinabodies andkurimethatcomprisesthe locus of agency for persons, and it is at this interfacethatillness manifestsitself in variousforms.It is notable,in this culturalontologyof persons,thatthereis no distinctcategoryor conceptof "mind" or the "mental,"no "mentalillness," no "embodiedminds and mindful bodies" and (Scheper-Hughes Lock 1987). Kulina Sickness and Illness Kulinaareregularlyafflictedby a varietyof sicknesses,fromsmall skin sores that are usually ignoredto life-threatening witchcraftattackstreatedby shamans. However, Kulina lack a general term that could be translated unambiguouslyas "illness," one that would provide a gloss for the full range of these conditions. Kulinaunderstand Portuguesetermdoenca to encompassa wide rangeof bodily the

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disorders,but do not themselves synthesize varied forms of sickness into a single concept of illness. The term kidza, for example, refers to the subjective state of feeling "sick"but not to the causes of that sick state. Bodily pain is identifiedby the root kumaand may be furtherqualified by mention of the specific body part, for example, owede kumatani,"back pain." But while pain may be a sufficient conditionfor being sick, it is not a necessaryone. Indeed,othersigns may indicate the presence of illness, the most common being diarrhea(mimihi) and fever (dzamakuma). The lack of a general Kulina category for the range of experiences and conditions we would label illness is consistent with what might be termed the of "practice sickness"for Kulina.Inparticular, Kulinasicknesses areof two general sorts, distinguishedby differentcauses and treatments.The first variety of sicknesses are those that are felt to occur on the outside of the body, in particular on the skin; I call this categoryexternalillness. The second category is composedof those illnesses that occur within the body and have a "mystical"origin, such as witchcraftillness. I call this categoryinternalillness. AlthoughKulinalack specific terms to label and distinguishsuch categories,it appearsclear thatsome differentiationbetweentwo broadtypes of illness is made, in ways thatI describebelow. External Illness The class of externalillness consists of those that are believed to affect the skin. In general they are consideredto be mild, and are cured with relativeease. The majorexception to this generalizationis poisoning from snake bite; although life threatening, is nonethelessincludedin the categoryof externalillness because it its mode of sickening and its appropriate treatmentare identical to otherexternal illnesses. Indeed, snake bite might be viewed as the limiting case defining this category,an illness thatmightbe placed in the moredangerouscategoryof internal illness, except for its similarityto some of the basic featuresof the milderclass of externalillness. Externalillnesses include a wide range of conditions, includinginsect bites, cuts, boils, rashes, and sores that, because they appearexternally,have an overt, publicquality.Thereis oftenlittle speculationon the causesof theseillnesses;either the cause is obvious, as in a wasp sting, or it is assumedthatpeople simplycontract them withoutexcessive speculationon the immediatecause. Externalillnesses are treatedwith plants, usually the leaves, eitherby chewing the leaves into a kind of poultice or by soakingor boiling them to make an infusion thatis applieddirectly to the affected area.Plants are selected on the basis of their smell; plants that are said to have a good smell (maho bika) are assumedto be curative.Indeed,it is the smell of the plantthatis curative,becausesmells are believed to have the abilityto the penetratethe skin and transform individual. In general,good smells moderatewildness (wadi), while bad smells intensify wildness. People wear good-smelling leaves to make themselves attractiveto the oppositesex, not simplyby becominggood smellingthemselves,butby undergoing the more fundamental transformative effect of good smells. Corpses,for example, are rubbedwith good-smelling substancesto reduce the dangersposed by a body after its soul has permanentlyseparated from it-a body that has, in effect, withdrawnfrom social life (Pollock 1993).

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The use of good smells in curingthus suggestsan associationbetweenillness and wildness; good smells transformboth. This associationmay be relatedto at of least two characteristics externalillness. First,the sick role itself is describedas fromnormal a temporary, asocial, wild statein the sense thatit entailsa withdrawal social interactionsand a rejectionof the gregarioussociabilitynormallyexpected of persons.Thus the conceptualwildness of the sick role is symbolically "cured" through good smells. In this sense, curative plant smells not only affect the the physiological conditionof the sick person, they also transform antisocialsick role. The second association between illness and wildness is suggested by the natureof those things that are presumedto cause externalillness. These things, includingmembersof the categoryof "poisonous,biting, stinging things"(wasps, snakes,scorpions, stingrays,spiny fish, thornyplants,etc.), are manifestationsof the wildness of the forest beyond the sociable village. From this perspective, of externalillnesses might be viewed as a form of penetration the wildness of the forest into the skin of the victim. Poisonous snakebites producethe one seriousillness amongthese otherwise benign and nonthreateningillnesses. For Kulina, the snake is an ambiguous creature, possibly a memberof the categoryof things causing externalillness, but of exhibitingcharacteristics thingsassociatedwithmoredeadlyinternalillness. For example,Kulinadebatedthe locus of the illnessproducedby the snake's bite; some of my informants throughthe skin andlodge arguedthatthe snake'sfangspenetrate theirpoison in the flesh of the victim. Othersarguedthatit was the skin itself that was the site of the poisonousdamage.They pointedto thefact thatsnakebites often occur on the soles of the feet, where heavy calluses often prevent the bite from harmingthe victim. Kulinaagreed,however, thatplantmedicationswere the only availablecure. Another part of the ambiguity of snake poisoning lies in the natureof the animalitself. Snakesarethoughtto pass freelythroughholes betweenthe earthand the the underworld, nami budi associatedwith spiritsof the dead who reside there. of Snakesthushave some of the dangerousproperties spiritbeings and substances that move between these two realms. Moreover,snakes are especially wild creatures;they eat meat and are unable to producesounds (that is, they lack speech, even of an animal variety), and they are solitary hunters. Such a creature is essentially ambiguous,dangerous,and threateningfor Kulina, and snake bite is treatedas equally ambiguousand dangerous. The primarylocus of externalillnesses is the skin, the most public portionof the body, and one that reflects and displays the social statusof the person (cf. T. in Turner1980). AlthoughI cannotdevelop theargument greatdetailhere,I suggest contacts these externalillness conditionsto reflectimproper thatKulinaunderstand wild natureof the forest. A woman who develops a sore or with the threatening, rash may recall a recent time when she steppedoff of a well-defined path in the animal species. The forest. A man may recall an encounterwith a "prohibited" of such boundariesbetween sociable and wild spaces is the interpretransgression tive frameworkof many externalillnesses, just as their locus-the skin-is the boundarybetween the sociable outside of persons and their mystical interiors. Nonetheless, it should be emphasized that virtually all external illnesses are

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and with which they are associconsideredmild and transitory, the transgressions ated are comparablymild. They serve as an interpretiveframeworkfor underconditions standingthe wide range of commonly experiencedmild but irritating thatregularlyafflict Kulina. Internal Illness The category of illnesses I call internalincludes two major types: dori and epetuka'i.The first strikeschildrenand adultswhile the latterafflicts infantsonly. They are caused by intrusive life-threateningsubstances, also called dori and epetuka'i.Dori is said to be caused by witches, hostile shamanswho inject some of theirown dori substanceinto the bodies of theirvictims. Epetuka'iis not caused or by witches but, like dori, is provoked by a supernatural mystical cause in the violation of food taboos.
Infant Internal Illness: Epetuka'i

Kulina attribute epetuka'iin infantsto the consumptionof male animalmeat abdominal by parents.The signs of the illness are variableand include diarrhea, or constipation;in short, virtually any gastrointestinaldistress can be swelling, as interpreted epetuka'i.However, the diagnosis of epetuka'i relies less upon the overt symptomsexperiencedby the infant-who may display the same symptoms without a diagnosis of epetuka'i-than it does upon social circumstanceswithin the infant'shousehold.I will describethe culturallogic of the illness first and then discuss the social logic of its context. Kulinaattribute epetuka'ito the consumptionby the infant'sparentsof certain kinds of male animal meat. Male animals of many species are said to have the epetuka'isubstancein theirflesh, which can harmthe infantwhenthe meatis eaten by its parents.Eating the meat of male animals of other species is said to cause infantdiarrhea.Consequently,Kulinaprohibitthe eating of male animalmeat by parentsduring the child's infancy. The taboo lasts, at its ideal extreme, until the child is capableof producingspeech and is walking, a time at which it is no longer considered an infant (nono) but rather a "child" (ehedeni). To understandthis in prohibitionit is necessaryto considerhow childrenare "formed" the process of a reproduction, process thatis conceptuallydivided into two phases separatedby the birthevent. In the firstphasethe fetus is formedexclusively of male semen that accumulates in the mother's womb; in the second phase the newborn infant is "completed" throughthe consumptionof mother'smilk and othermild andgoodsmelling foods such as the cultivatedplant foods grown by women. During each of thesetwo phasesthe fetus/infant subjectto potentiallyharmfulinfluencesfrom is its parents.Indeed, that it is subject to harm through such indirectmeans is an indication of the infant's lack of the capacities of personhood,and this danger disappearsonly after the child has consumed sufficient mild substances to be completelyformedas a person.The ethnophysiologicalprocessparallelsthe social process, requiringthatthe child not only display the social signs of personhoodcompetenthearingandunderstanding, speech,andmobility-but also thatthechild be formedof properlymale and female substances.During infancy,the consump-

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tion of male animal meat thus endangers the child, producing illness through the

excess of male substance. The Epetuka'iis said to be "likehavinga dungbeetle in the abdomen."6 image of the dungbeetle is apt:it forms small balls of fecal matterthatit uses to block the entranceto its burrowin the ground.In the same way, epetuka'iis conceived to be the the a substancethatdisrupts passageof foods andfeces through abdomen,either inhibitingthe process and causing constipationand abdominalswelling, or speeding it up and causingdiarrheaand wasting away. The minimalsubstancesthatform the child are semen andmother'smilk, the primaryexemplarsof thetwo categoriesof substancesthatalso includemale animal meat eaten duringpregnancy,and female animalmeat and cultivatedfoods eaten of afterbirth.The characteristics these categoriesalso link the ethnophysiological of to of reproduction the social character marriageand to the households process in which it takes place. Exchange of foods is a centralmetaphorof marriagefor Kulina.Men huntto providemeat;women tendgardensto providecultivatedplant and itself is thoughtof as a commensalarrangement is often termed foods. Marriage Moreover,marriageimplies a process in whichmen bring wild, "eatingtogether." these through substancesinto householdsand womentransform "strong-smelling" cooking into "mild,"good-smelling edible substances. Marriagealso implies a them comparableprocess in which women "tame"adolescentboys, transforming into sociable adultmen. The process of forming a child is thus similar to that of forming a marital relationship.But while the formerinvolves a kind of single pairof contributions and made over a long duration, is focused on the child, the latterinvolves a kind of repeateddirectexchange focused on meals. The terms of the exchange are nonetheless similarinasmuchas both relationshipsdraw upon the metaphorsof substances that comprise contrastingcategories of male and female substances.The relationsas exchangesor proviof Kulinametaphors marriageand intrahousehold sion of appropriatetypes of food imply that impropermarriagerelations are foods. The provisionof male animal equivalentto the provision of inappropriate when an infant is presentin a household, and the meat is said to be inappropriate illness thatis caused by this improperfood also signals the presenceof improper relations.Conversely,improper marriageor marriagerelationsor intrahousehold relationscreate a context in which infantillness can be interpreted intrahousehold food. as the provisionof inappropriate An examinationof cases of infantinternalillness-epetuka'i-shows this to be the case. In the 12 cases about which I have detailed information,each was to attributed and explainedas the improperconsumptionof male meat by parents, and each was precededby some disruptionof relationswithin the infant's housetook severalforms,andall wererecognizedandcommented hold. Thesedisruptions upon publicly.They includedchargesof adulteryandhabitualneglect of duties by husbands/fathersor wives/mothers, but also included open conflicts between sons-in-law and fathers-in-law. Interestingly,Kulina do not, as far as I have been able to determine,draw a conscious connection between intrahouseholdconflicts and the epetuka'i that
afflicts an infant within the household. The illness is always attributed to the

consumptionof maleanimalmeatby theparents.Thecureof theillness by a shaman

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consequentlyleads to greatercautionon the partof the parents,who more scrupuof lously thanbeforeavoidprohibitedfoods. The publicnature the social disruption that provided the context for the illness leads also to enough open censure and comment that the parties involved resolve their dispute, or at least try to hide it more successfully. AlthoughKulinado not explicitly link epetuka'iamonginfantsto intrahousehold conflicts, it may be speculatedif they neverthelessrecognizethis relationship implicitly.Parentsof infantsdo not in my experienceavoid eatingthe meatof male animalsfor more thana few days or a week following the birthof a child. When I suggested that this violation of the normal prohibition could cause epetuka'i, informants usuallyrepliedcasually thata shamancould easily curethe illness, and thatparentsdid not need to be concernedaboutthe foods they ate.This attitudewas possibly conditioned by a sensitivity to the relationship implied between food strife:in the absenceof conflict, food prohibitions prohibitionsand intrahousehold lost theirsignificance, and a healthy infantwas a sign of properparenting.7 To complete this discussion of infant internalillness, I shouldpoint out that Kulina sometimes attribute simple diarrhea(mimihi) to the eatingof male animal meatanddo notdiagnosethe conditionas epetuka'i.Again, bothculturaland social issues inform this condition. When diagnosed only as mimihi, infant diarrheais considered relatively mild, and the child is not treatedby a shaman. Although simple diarrheais also caused when the infant's parentseat the meat of male animals,epetuka'iresults only when parentseat the meat of male animalsthatare of consideredtokorimespirits.Animalsthatare not the manifestations these spirits do not cause epetuka'i,but only the milder condition, diarrhea.My data suggest that thereis a sociological differencebetween the contexts of simple diarrhea and epetuka'i.It is my impressionthat epetuka'i is diagnosed when parentsof a sick infantarechargedwith adultery. However,whenparentsof a sick infantarecharged with some neglect of duties, simple diarrheais diagnosed.Thus Kulina associate most serious breachesof maritalrelations such as adulterywith serious illness, epetuka'i (and the ethnomedicaltheory of epetuka'i points to male animals that have an essentiallypowerfulsupernatural nature).Less seriousbreachesof marital responsibilities such as laziness, unproductivity,or failure to be appropriately deferentialto in-laws are associated with the less serious illness of diarrhea(and the ethnomedicaltheory of diarrheapoints to male animals that are not spirit beings). AdultInternalIllness: Dori The etiology of dori,in theKulinaview, is relativelysimple;the illness results when a witch, an evil shaman(dzupinahe),injects a portionof his dori substance into the body of the victim. Witchcraft attacksare not entirelyrandom,but witches need no special motives for attackinga victim, and anyone is a potentialvictim. But, for reasons that I discuss below, dori is more likely to be diagnosed among adultmen thanwomen, and is not common among children. As simple as the dori illness etiology may be, it is nonetheless a complex concept. Dori is a substancethatpermeatesthe flesh of shamans,giving them the ability to cure as well as to injure others. It is notable that among the Kulina, shamansarealways men, andthoughonly abouthalf of the adultmen in Maronaua

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today are shamans, Kulina said that in the past all men were shamans. The ideological associationof men and shamanismhas at least one importantimplication for contemporary Kulina:any adultmancan be considereda shamanor, more important,can be considered a witch. This possibility allows Kulina to consider any adult man, particularlythose from other villages, to be potential witches. Although witchcraftaccusationsare most often leveled against well-known shamans in neighboringvillages, certaincircumstances requirethatKulinadiscover a witch within theirown village. The view thatany adultman can be a witch allows accusationsto be broughtagainstindividualswho are socially marginal,and thus The vulnerable.8 substancedori is also possessed by tokorimespirits.In one sense it is the possession of dori that makes a tokorime spirit, and thus even human shamansmay be spokenof as tokorime,the adzabatokorime, as all spiritsmay just be called dzupinahe,or shaman.The termtokorimenormallyrefers to the spiritas such, while the term dzupinaherefers to the physical embodimentof the spirit, normallyhuman,but sometimes animal. Dori causes illness by lodging in the flesh of the victim, sometimesby growing cases, by growing fasterthan it can there,and in the most serious, life-threatening be extracted.The severityof the illness is associatedwith differentvarietiesof dori. For example, dori makoko, "very red dori," is the most dangerous. All shamans/witchespossess all types of dori,andthey aresaid to use each type depending upon whethertheirintentionis to kill or simply to sicken. As in the case of infantinternalillness, dori is diagnosedas an illness only in certainsocial contexts.Invariably,these involve open hostility or conflict between membersof differenthouseholds. And, as in the case of infantillness, Kulina do not consciously make the association between this conflict and the dori illness. Conflicts between members of different households typically take the form of violent argumentsor fighting between men, often between potential affines, but occasionally also occur between closer kin, even brotherswho reside in different households.Thereappearsto be no relationshipbetween the natureof the conflict and the natureof the subsequentillness; rather,conflict between households is regularlyfollowed by the diagnosis of some sickness of unknowncause as dori. Moreover,the severity of the sickness is largely irrelevantto dori diagnosis; even a very mild sickness will be diagnosed as dori following public interhousehold conflict. Moreover,sicknesses are not diagnosedas dori in the absence of public conflict. interhousehold Two cases illustratethe social contextof dori. Alfredo was a man roughly between 55 and 60 who experiencedrecurring stomachpains and periodicallyvomited blood, caused by what I believe to have been a gastriculcer. His sickness was of long duration,beginningwell before my in Whentherewereno publichostilitiesbetweenhouseholds firstarrival Maronaua. in the village, most residents ignoredAlfredo's attacksof pain and vomiting. He often requestedWesternmedicationsfor his sickness, but duringtimes of village peace no one suggestedthathis conditioncould be treatedby a shaman.However, following virtually every case of open, public tension in the village, Alfredo's sickness was interpretedto be the result of witchcraft, and he was treated by shamansin the traditionalcuring ritual.Thus episodes of the same sickness were variablydiagnosedas dori andnot dori.The variablethataccountsfor the different

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diagnoses was the social context-hostility or harmonybetweenhouseholdsin the village. In a second, notablecase, a child contractedwhat I believe to have been the mumps:she hada painfulswollen glandin herthroatandswallowedwith difficulty. Although the swelling in her neck was consistent with the culturallyprescribed effects of dori, village shamansdismissedthe possibility thatshe was the victim of a witchcraft attack. No other diagnosis was made, and her parents requested Western medications.No tensions or hostilities existed among village members or priorto her illness. I thus suggest thatdori was not an appropriate meaningful diagnosis. The process of dori diagnosis incorporatesa feature that is absent in other illness diagnoses: the identificationof a witch. Kulina identify first a witch in the anothervillage, normallya headmanor othervillage leader.In Maronaua witch most often accused was Doho, a headmanof the village called Santo Amaro, a If had village with which the residentsof Maronaua frequentinteraction. the illness is successfully cured,the accusationis validated,but no additionalactionis taken. accusationsin a numberof othersocieties, where This processresembleswitchcraft the accusations serve to define and maintain group boundaries(e.g., Douglas 1970a). Such an explanationis relevantto the case of Santo Amaro,where close interactionswith Maronaua, may threatento blur includingregularintermarriage, the distinctiveness of each group. Such extragroupwitchcraftaccusations also direct village residents' hostilities outward and project feelings of outrage or Doho was not revengeonto membersof othervillages beyondthe rangeof reprisal. really threatenedin any serious way when he was accused of causing dori in assuredthemselvesthattheywould never but Maronaua, theresidentsof Maronaua harmeach other. When dori illness proves fatal, the focus of accusationsshifts to an individual within the village. The following example is illustrative. a infectionthatdeclined Katorewas an elderlymanwho contracted respiratory into pneumonia;he died following lengthy efforts of village shamansto save him. At the outset of his illness his condition was diagnosed as dori, and Doho was accused of bewitching him. As Katore's condition worsened, however, and it became obvious thathe would soon die, the accusationshifted to anotherelderly man who had been visiting Katorefrom a village on the EnviraRiver. On the day following Katore'sdeath,this witch was killed in retaliation.Significantly,Doho had been informedof the impendingdeath, and in an effort to assertpublicly that he would never use his witchcraftactuallyto kill the membersof anothervillage, with a groupof followers and assisted the local shamansin he came to Maronaua treatingthe epidemic of secondarydori thatbroke out afterKatore'sdeath. Again, whendoriis fatal,the witch is soughtwithinthe village of thedeceased. of manis identified,eithera nonmember/non-kin the Typically,a socially marginal (as in the case of Katore's killer), or an individual who is "worthless" group (tabakora,someone who consistentlyignores social obligations). The ritualprocess of curing dori offers some insight into the natureof the illness. Dori is treatedin a ritual called tokorime, during which shamans, who appearas varioustokorimespirits, suck out the dori from the body of the patient. The curingritualtakesplace at night andmay last for hours,or even untildawn. A

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successful cure is followed by a second ritual (or a second phase of the same ritual)

the following night in which the entire village dances in a large circle and sings songs about beauty and harmonyin the world, thereby signaling the end of the witchcraftthreat. The tokorimeritualnormallytakes place in the center of the village, in the ritual area between the two rows of houses. The ritual begins when the village women form a small semicircle and sing to the shamans/spirits come into the to village to treatthe patient,who sits nearbyon a stool or in a hammock.The shamans emerge from the forest in the guise of tokorime spirits. They wear palm fiber costumes consisting of long veil-like headdressesthat cover their head and upper body, and a skirt extending from the waist to the feet. Facing the semicircle of women, the shamanssing one at a time anddance in small, stylized steps. Women give each shamantobacco snuff, which he inhales nasally. The shamanthen feels the afflicted area of the patient's body and, upon discovering the dori, sucks strongly on the site. The dori may also be extractedby suction from the cupped hands, which the shamanthen rubs on his chest. In both techniquesthe shaman takes the dori into his own body andthen vomits and spits it out. He retiresto the forest, andthe second shamantakeshis place. The shamansalternate, repeatingthe until the dori is felt to be extractedfully. performance Tobacco is a vital partof the curingritual.In one instance,when tobacco was while unavailablein the village, a particularly long curing ritual was interrupted several men set out on a canoe trip of several days to find tobacco from local of Brazilians.In Kulinamyth,inhalation tobaccocauses death,whereuponthedead into an animal,the animalform for a tokorime spirit (see, person is transformed e.g., Adams 1962:125-131). The effect is similarin curingritual:the tobacco snuff into causes the shamanto become transformed the tokorimespirits that will suck out the patient's dori. Tobacco is one of two cultivatedplants grown by men; the other is a varietyof hot pepper.Both are cultivatedby men because they are very strong smelling; indeed, the very strongsmell of tobacco is only moderatedby a comparablyextremeform of "cooking"-the reductionof tobacco to an ash that forms the snuff. The smell of tobacco thus works in a mannersimilar to that of the othersmells, penetrating body to producea change in the person,in this case a into kind of symbolic deathand transformation a spirit. All tokorimespiritssing in the curingritual,but only some of these spiritsare saidto actuallycure;the othersaresaidto "helpsing."Singingitself is an important aspect of the ritual. Shamans take pride in the beauty of their songs, and they compose new songs regularly. Singing has two related characteristicsthat are centralto its role in curing ritual.First, singing is a particularlycompelling form of verbaldisplay for Kulina,amongwhom speech styles have directiveforce. The most potent style of normalspeech is used by adult men in communalmeetings. Singing may be viewed as an especially enhancedform of directivespeech, used, men to hunt when meat is scarce in the for example, by village women to "order" village (Pollock 1985, 1992:35; Ruf 1972; cf. Siskind 1973:96-104). The songs used in curingritualsaremaximallycompellingin theirdirectiveforce, consonant with the seriousnessof the curingtask. Second, singing creates or defines rituals. Every Kulinaritualrevolves aroundsinging;songs are felt to form the core of the ritual.Thus songs define an event as a ritualand compel action duringit.

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Curingritualsongs have several generalthemes and components.First, they of often employ soundscharacteristic theanimalspiritthatis supposedto be singing the song; these sounds publicly identify the tokorimespirit. Second, these songs tell abouta searchby the spiritfor urucu(achiote)or genipapofor facial decoration. The spiritmay sing thathis face is painted,or thathe has come to find facial paint. Third,they often describethe consumptionor searchfor the manioc drinkkoidza.9 The spirit sings thathe is drinkingkoidza, or thathe has come to find it. In many a songs thesethemesareintertwined; song may begin with the soundsof the animal spiritandthendescribehis paintedface as he tells of coming for the maniocdrink. Koidza is symbolically the primaryfemale food productfor Kulina on the Purus River. Manioc (po'o) is the principle cultivated food and the primary a subsistencecontribution womanmakesto her household.While othercultivated foods are seasonal or are eaten moreor less accordingto whim, manioc accompanies every meal year-round.In this regard,manioc is similar to meat, the most importantmale contribution.The symbolic role of koidza is also linked to the in processthroughwhich it is produced, whichcookedmaniocis chewed by women and spit back into the pot, where it fermentsslightly; koidza is not only cooked, which producesgood-smelling, "tamed" food, it is also mixed with the saliva of women, which enhancesthe tamingeffect. I have elsewhere drawnattentionto the role of food and food exchanges for creatinganddisplaying sociabilityand amicabilityamong Kulina (Pollock 1985). The referenceto koidza in the curingritualalso drawsupon the social implications of such exchange by engenderingsociability throughthe offering and consuming of this food in song. In the curingritualit is the tokorimespirits who are enjoined to enter into amicable relations with the village through the medium of food, obliging the tokorime spirits to cure the sick individual. The spirits also offer themselves as food; the curingritualcalls forth spiritsfrom the underworld realm of tokorime,and their physical embodimentslaterremainin the forest as animals thatare huntedfor meat. of This interpretation the Kulinatokorimecuringrituallinks two conceptual domains that are separatein the West: the subjective state of the sick person and the relationalstate of the community.I have suggested that in many cases the subjectivestatesof individuals-here, the sensationsof feeling sick-have little or no relevanceto the identificationof dori in the communityandperformance the of tokorime ritual. In this regard,Kulina conceptions of sickness and illness may resemble Ndembu notions of illness and "affliction"discussed by Victor Turner (1967, 1968), in which sickness served primarilyas a sign of such deep social relational disorder within a community that individual illness was sometimes ignoredas the illness discourseshiftedto a social level. Since much of the medical anthropologicalliteraturein recent years has subtly (and sometimes explicitly) incorporatedthe Western assumptionthat illness is "about"the experience of individualsand the individualexperienceof sickness, it may be useful to contest this taken-for-granted point of view with a few additionalcomments about the social contexts of curing. I havestressedthatthe tokorimeis notperformed merelybecauseanindividual experiences the subjective pains or discomfortsthat might be signs of dori. The inverse also appearsto be true,thatthe tokorimecan be performedeven when no

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individualis experiencingthe pains or discomfortsthatmight be the signs of dori. On at least two occasions duringmy researchamong Kulina, mock curingrituals were held without a specific individualpatient.As I have noted, Kulina are not explicit about a relationshipbetween the performanceof the tokorime and the of disruption social relationswithinthe village, and so in neitherof these two mock in tokorimeritualsdid people accountfor theperformance a way thatovertlylinked tensionsand the ritual.In the firstcase, when I asked who was sick, interhousehold to the village headman respondedthatthe tokorimewas being performed "practice" new songs, a response that I later understoodto be a way of deflecting prying questionsfrom a nosy visitor.In the second case, when I raisedthe same question, severalmen explainedsimply thatit was "againstdori,"and theirbewildermentat why thereneedn'tbe a specific sick individualsuggested my failureto understand thatit was my Westernassumptionaboutthe natureof illness thatwas the problem. In short, if the sickness of individualsneedn't be diagnosed as dori illness, neitherdoes dori illness need a sick individualto be diagnosed. Or, to put it in mildly functionalistterms, if the relationshipI have suggested between the toktensionsis productive,then the presenceof orime curingritualand interhousehold such tensions will provokethe ritualresponse,even in the absenceof sickness that can be diagnosed as dori. I have elsewheresuggested thatour inabilityto conceptualize"social"disorderswithina diseasediscourseyields discursivepracticesthat as locate "illness"withinindividualsanddistinguishes"socialdisorder" a different kind of condition, as merely metaphoricillness (Pollock 1992). The Kulina conof ceptionof personhooddoes not yield the radicalseparation individualandsocial fields. In theircase, the social andtheindividualaremutuallyinscribed,so to speak, throughthe sharingof corporealsubstanceand spirit(cf. Seeger et al. 1979). If illness andpersonhoodaremutuallyconstituted throughthe same signifying practices,at least one additionaldiscursivefield remains to be explored. For the Kulina, illness reveals a moral dimension to personhood in which individuals
become the victims of social disorders and the exemplary, if unnecessary, locus of

the dori illness that social disorderprovokes.I have describedthe inverse of this relationship,in which illness and its cure takeplace withouta sick individual.It is formsof reversalof this relationshipas well. possible to identifyseveraladditional into In these, the practicesthatcause illness can be transformed practicesthatcure illnesses. metaphorical Shortly after dawn one morning early in my fieldwork, I found a group of Kulinain the centerof the village, milling arounda large frog that had been tied, spread-eagled,to four stakes about two feet off the ground.Underneaththe frog was a pile of glowing coals, and as the frog slowly roasted,alive and squirming,it exuded a thick,milky white fluid from its skin.10 Mara,a prominentvillage leader, draggedhis son-in-law Awano over to the frog. Awano was a young man, about 22, marriedwith two childrenwho lived in his father's house. Maratouched the end of a piece of rope to the hot coals until it smoldered;he thentouchedAwano's arm with the burningrope, scrapedsome of the milky sweat from the skin of the frog, and rubbedit into the burn.The frog's poisonous secretionshad an almost immediatetoxic effect on Awano, who begansweatingwithina couple of minutes. and His eyes bulged out, he startedhyperventilating, he kneeled over and began He complainedof his bodyachingfor therestof the day.Awano vomitingviolently.

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was not the only victim of this peculiartreatment;several adolescent boys were also broughtforward,burned,andpoisoned by the senior men in the village. describedthisprocedure a techniqueto improvethevictim's as My informants or luck, using a term-dzukenainanaihini-that I understoodto hunting ability mean literally "acquirethe ability to kill." It may be evident why adolescentboys would be subjected to this treatment,but I was not aware of any deficiency in huntingskill on Awano's part,andhe was clearly the majorfocus of the treatment. As I became more deeply acquaintedwith the communityI realized that Awano was a paradoxicalfigure who presenteda social dilemmathatthe communitytried to resolve in severalways, includingthe use of the frog poison. Awano was in many regardsan overly successful youngman, whose rubber tappingwas highly producof tive, and who had developed sufficientunderstanding the economic practicesof local tradersto convert the surplusproductsof his labor into a quantityof trade But goods that was locally remarkable. his accumulatedwealth was not used for the benefit of the village; resentmentsdriftedfrom household to household with successive acts of stinginess. His hardwork and productivity,however, protected him from suffering the ultimatesanctionsthat might have been pressed againsta lazier man. Among these Kulinait is normallyexpected thatyoung men will live with their fathers-in-law,who have a claim on their labor and political support. Awano lived with his father.But Awano's father-in-lawlived in a kind of self-imposed exile on the opposite bank of the river across from the village. For every charge that Awano was not fulfilling his obligations as a son-in-law, there was a grudging recognition that Mara'shousehold was itself not fulfilling the broader obligationsof communitysociability. My informantsdiscussedAwano's moral failings as less the intentionalevil performedby a witch than as lapses of properjudgmentand performance, lapses that were attributed his havingbecome too Brazilianized.The primarycommuto nity focus of concernover his behaviorderivedfromactivitiesthatwere considered specifically Brazilian in natureand excessive in degree-rubber tapping,possession of a battery-powered recordplayer,residencewith his father.The curefor this Brazilianizationwas a kind of reinitiationas an adultKulina man. The treatment to which Awano was subjectedmust be understoodwithin the set of practicesthat include shamanism and witchcraft, and the treatmentof internal illness. The insertionof a wild, poisonous substancethroughthe skin, into the flesh, parallels the acquisitionof dori by adolescentboys as they become shamans(Pollock 1992); the paradoxicalnatureof dori, which representsthe special wildness of men that rendersthem potentially dangerouswitches and successful hunters,parallelsthe Awano presentedto the village. Awano's resocializationas paradoxicalcharacter a proper adult man began with the reacquisitionof the dangerous, poisonous, powerful dori substance all adult men possess, in this case in the very dramatic form of the frog exudate. Note too that the appearanceof the viscous white frog poison is neatly consistentwith the Kulinaassociationof dori and semen. The second case of a metaphorical illness that extends this interpretation of Kulina ethnomedicine is infertility. I have discussed infertility in the broader context of Kulina shamanism(Pollock 1992), but a discussion of this example in the context of Kulina ethnomedicineand notions of personhoodmay be useful. Briefly, infertilityis said to be a conditionthatwomen themselvescause by having

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a substancecalled awabono placed at the entranceto the womb, where it blocks the flow of semen into the womb andthuspreventsthe accumulation semen that of forms a fetus. A woman wishing to avoid pregnancysolicits the assistance of a shaman,who places the awabonoin her througha kind of reversalof the tokorime curing ritual.Marriedwomen who are completely infertile are guilty-at least in the view of Kulina men-of intentionallyfailing to perform as proper female obligapersons,and the shamanswho assist women in avoidingtheirreproductive tions arefelt to be actingessentiallyin the antisocialmannerof witches.' Infertility thus drawsupon the same culturallogic as illness. Even thoughit involves taking into the body a mystical shamanicsubstancethatproducesa condition that is not an illness in our conventionalWesternsense, it is nonethelessconceived by Kulina to be a kindof social illness: a refusalofreproductivity. treatment infertility, The for shoulda womanwish it, is the familiarprocessof shamanicextractionin the context of the tokorimeritual,which again suggests thatinfertilityis linked to the Kulina notion of illness by forms of social performance ratherthanindividualsubjective states. Western Medicine Although traditionalKulina curative techniques are based on plants and shamanicextraction,Kulina have been receptive to the medicationsprovided by The use of local Brazilians,governmentagents,missionaries,andanthropologists. such medications,collectively called hemedzi(fromthe Portuguesetermremedio), a confirmsfor Kulinatheir view of illness, and thus warrants brief discussion. Westernmedicationsare normallysoughtfor externalillnesses or for internal pains at an early stage, before they might be diagnosedas dori or epetuka'i.Once an illness has been identified as dori or epetuka'i,Westernmedicationsarefelt to Westernmedicationsto work in the same way as be ineffective. Kulinaunderstand curativesubstances,althoughin ways thatmay not be obvious. theirown traditional For example, local Brazilianspreferinjectablemedications,and Kulinahave been quick to embrace injection as the primarymode of medication delivery; in the Kulina view needles penetrate the skin and deposit medication directly at the precise site where many illnesses arebelieved to occur:in the flesh. Oralmedications are felt to be less effective because they are thoughtto undergoa change in the gastrointestinalsystem. On one occasion, an Italianmissionaryorganization sent a shipment of antibiotics that ultimately were delivered to Maronaua;the Kulinawere puzzled by theirform-they were all anal suppositories-and were at first amusedandthenratherhorrifiedwhen I explainedhow they were used. If oral are medications are felt by the Kulina to be ineffective, their anal counterparts to be perverse.12 thought Several particularmedications are highly valued, particularlyfor external and illnesses on the skin. Both mercurochrome gentianviolet are said to be strong and good-smelling substances,and thus to have curativeproperties(cf. Conklin 1994). Moreover,each of these substancescolors the skin to match the red urucu and blue/blackgenipapo that are appliedto the face and arms during periods of liminality.The colorationof the skin resultingfrom the use of these medications is thus also consistentwith, and becomes a sign of, the liminalityof the sick role.

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Otherwise,Kulina tend to view Westernmedicationsas largely undifferentiated. The termpenisilina covers virtuallyall injectible medications,and the term hemedziis used for these and all othermedicationswithoutfurthercategorization. Thus Kulinatend to treatWesternmedicationson the model of curativeplants,all such as a of which derive theircurativepropertiesfrom generalizedcharacteristics smell (Pollock 1988). The presumptionof basic similarityamong all medigood cations is also suggestedto the Kulinaby the practiceof the Braziliangovernment all supplierof distributing drugsin identicalpackages,bottles, and pharmaceutical vials. (Kulinacould not read the labels thatdistinguishedthese drugs.)The claim made by Braziliansthat some of these medications are illness specific does not challenge the basic Kulina belief thatthey are all similar.Kulinaassume that,like some plants, certain medications are merely stronger versions of others, and for thereforeappropriate more seriousillness. One additionalaspect of Western medicine that also reinforces traditional Kulinaviews aboutthe natureof illness is worthmentioninghere. My informants mentionedthatlocal Brazilianssufferhigh ratesof infantmortality,andspeculated that thatthese non-Kulinawere not awareof the food prohibitions new parentsmust Brazilianinfants, in other words, are assumed to be dying of epetuka'i, an obey. and illness that Kulina understand know how to cure. I do not have comparative data to confirm the Kulina impression of high infant mortality among local Brazilians,but several Brazilianvisitors to Maronauahave volunteeredthe same were betteradaptedto the forest environment, view, and speculatedthat"Indians" and thus had greaterreproductivesuccess. Indeed, althoughlocal BraziliansridiKulinabeliefs, they occasionallybroughtsick infantsto the culed many traditional village for curing. missionariesof the SummerInstitute Finally,it shouldbe notedthatProtestant of Linguistics (SIL) at the Kulinavillage of San Bernardoon the Peruvianside of shamanism the PurusRiver are reportedto have bannedthe practiceof traditional or for curing,andhave traineda Kulinamanas a "nurse" sanitdriofor the village.'3 The ban on shamanisticcuringappearsto have had little effect on local practices; at the very least, individualswho need traditionaltreatmentby shamanscome to Maronauaor anothervillage on the Brazilian portion of the river. Surprisingly, however, the infirmarycreated by the SIL for dispensing Western medications requires village members to pay for their treatment.The interest of Protestant missionariesin creatingsmall-scalemarketeconomies in indigenouscommunities is well known; the purchaseof healthcare is obviously rationalfrom this western of capitalistperspective.However,the notion of paying for the treatment illness is so antitheticalto fundamentalKulina ideas about the imperativesof kinship and in participate this system largely village coresidencethatresidentsof San Bernardo I believe because they do not yet understandthe natureof money or its role in mediating social relations. Conversationswith members of the San Bernardo may serve to village also suggest the possibility thatthe sale of illness treatments dramatizethe fact that the SIL missionariesare not truly village members. Conclusions In this articleI have providedan overview of Kulinaethnomedicalbeliefs and practices,emphasizinghow they derive from and articulatewith theirconceptions

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of personhood. If traditional Kulina beliefs have a very tenacious quality, it is because they are so closely connected to Kulina ideas about bodies and spirits, how these are made or acquired, and how they are transformed in a wide variety of social contexts from birth to death. In short, there is a cultural logic to Kulinaethnomedical beliefs and practices that links them closely to the broader context of the practice of personhood. I have also emphasized that Kulina ethnomedical beliefs and practices are played out in a kind of dialogue with a variety of social processes. In this regard Kulina illness beliefs are an "idiom of distress" with social as well as bodily and spirit referents. As in many other cultures, illness among the Kulina is not merely a social commentary on bodily states and processes, it is also a kind of commentary bodies and spirits make on social processes.

NOTES

Acknowledgments. My research among Kulina has been supportedby a variety of sources,most recentlyby a ResearchDevelopmentFundgrantfrom SUNY-Buffalo (1990) and a MacArthur Foundationgrant(1992). 1. Thus I distinguishthe Body from a body. The capitalizedentity has emergedin the literatures anthropology, of sociology, history,andliterarytheory,amongothers,as a single abstract to thing, usually (if implicitly)with universalapplicability all culturesat all times. The lowercasedbody is of variablecomposition, extension, and social significance both and cross-culturally across history. 2. MarinaRoseman's work on Temiarethnomedicinemakes a parallelpoint (1991); in a discussion of that work, RosemancommentedthatTemiarnotions of personhoodare more accurately describedas "ensoulment" ratherthan"embodiment" (personalcommunication, 1990), a point that nicely challenges the culturalgeneralizabilityof the notion of embodiment. 3. I have in mindresearchthatindicatesthatAmericanpsychiatrists more likely to are thanarepsychiatristsin othercultures,even otherWesterncultures. diagnoseschizophrenia Other research that suggests that the difference between schizophrenia and affective, especially bipolar,disordersmay be more a matterof degree thanof kind. 4. I have elsewhere describedhow the attribution these and otherqualitiesto foods of rationalizesthe Kulinadivision of laborand indeedconstructsgenderin practice. 5. In my articleon food andsexual identityamongthe Kulina(Pollock 1985) I pointed to the differencethat my informantsstressed for me between the wildness of men and the relativetamenessof women. ClaireLorrainhas remindedme thatall Kulina, men as well as women, consider themselves "wild" (wadi), and so I want to emphasize that my formulation the differencebetween men and women in this regardis one of degree, not of of absolutes. 6. Claire Lorrain(personalcommunication,1992) reportsthat among the Kulina of the JuruaRiver, epetuka'iis said to be associatedwith the presenceof a real dung beetle in the infant'sbelly just below the skin. 7. An alternative,cultural ecological explanationfor this failure to obey the food prohibitionmightargue thatwhen game animalsare relativelyabundant,as they are in the forestsurrounding the is Maronaua, prohibition notnecessaryto regulatetheuse of otherwise scarceproteinresources.Although this may be the case, my interesthere is on the cultural of understanding the prohibitionproposedby Kulina. 8. See my articleon Kulinashamanism(Pollock 1992) for an extended description. 9. ClaireLorraininformsme thatamong the Kulinaon the JuruaRiver, koidza (there called patsini) is actuallyconsumedby shamansduringthe curingritual.

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10. The frog (akawa in Kulina) was the large Dendrobates histrionicus Berthold. Katharine Milton(1994) has discusseda similaruse of frog skinexudateamongthePeruvian Mayoruna,using the tree frog Phyllomedusabicolor. 11. I should note that women who have had numerouspregnanciessometimes seek out awabono as a form of birth control, with the approvalof their husbands and without as communitydisapproval.Indeed,menopauseis interpreted the resultof awabono, understood to be a consciously intentionalend to reproductivity ratherthan a "natural" process beyond intentionalcontrol. 12. At least a couple of my informants,in an effort to understand suppositories,asked me if Italianswere "upside-down." 13. Thomas Headland (1994) of SIL has objected to my description of the San Bemardo village, though as far as I am aware he has never visited the village and has not offered an alternativecharacterization. view of the sensitivity of such SIL members to In what they take to be criticism of theirwork, I want to emphasizethat my comments about San Bernardoare based on reports from numerousresidents of that village, including a Kulinalay pastor,and not on my own firsthandresearch.
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