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DATE DUE DATE DUE DATE DUE MSUhAnNflnnawe‘ ' ’1 ”‘rr '1' "‘" _.______._____._____ _ ‘- 11 - u I‘ {m . . . LIBRARY . This is to certify that the thesis entitled GENDERz POWER! AND ILLNESS IN AN EGYPTIAN VILLAGE presented’hy ' 'Soheir A. Morsy has been accepted towards fulfillment of the requirements for Ph.D. degree in Anthropology flfli 7&2 / Mair! ofessor Dari/M7? "gremlins MIDI nonsv mm er my. '- 1W8 GENDER, POWER AND ILLNESS IN AN EGYPTIAN VILLAGE By Soheir A. Morey A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Anthropology 1978 ABSTRACT GENDER, POWER, AND ILLNESS IN AN EGYPTIAN VILLAGE By Soheir Morey " x- ian village. In considering gender as a dependent variable, In View of the identity of the inhabitants of the research as peasants, it is deemed necessary to trace the determinant so— ijzegarded as but one element of mini-dimensional social flassociated power relations, which influence the preci- -. Soheir Mbrsy SYaIB cultural prescriptions for controlled deviance, are conceptua- 4:33 superstructural elements which bear a dialectical relation to , #5 ‘uctural contradictions and attendant power differentials. . fighihia presented in this study derives from field work conducted ‘ fifha period of one year in an Egyptian Nile Delta village. The the administration of tests and questionnaires. In addition, the ; conclusions drawn from the present study have a direct bearing Litheoretical issues related to the anthropological study of areles. Data presented in this thesis undermines universalistic e and private domains. It suggests the definition of power fix Soheir Mbrsy ‘335: comparison of one situation of power differential with another. :v the study community, the developmental cycle of the family is Q ifisd as a significant framework for the analysis of the dynamics :duats of the social environment. Additionally, male control over ‘4 :igifihfli instruments of production and the products of agricultural J. , ,' -QV ‘ '*The focus on the medical system in the latter part of the study t‘: ‘ g'significance of the analysis of the medical system, the detailed 3is of its various dimensions has yielded a variety of data of ‘n emphasizes the dynamics of treatment choice and undermines ; ical premises of the conceptual dissonance argument found in cal anthropological studies of therapeutic strategies. Finally, a a holistic orientation for the study of medical systems by : the~necessity of considering structural constraints imposed ;,; social structures in studies of health care at the micro TABLE OF a1 Aim of the Study . tical Perspective. . of Data Collection CONTENTS Organization of the Study. fiends in the Study of Gender Roles . : mm ILLNESS :AS AN INDEPENDENT VARIABLE: J : m w.m" I O O O O O 12 17 18 21‘ 32 59 63 '75 '78 Page plasmas in the Village ...... . . . . . . . 110 .:e Society as a Structural Type . . . . . '. . . 140 '3 THE MEDICAL SYSTEM 34. m awn sour f1. introductory Remarks ........ . . . . . . . . 162 O O U 0 I O 166 M Structure and Function ....... . ..... 197 . . . ..... 210 Mducmrynemarks................230 SystemTypologies..............235 " -etic Indices and Domains of Medical ""i in FatiHE e u I o e I a n l a a a o u I o 239 {icity of Illness Explanations. . . . . . . . . 273 g Explanations and Power Relations: 34o fledicalTreatment............. 344 GentsredTreatment............347 Specialists.'.............. 349 (Io-118.. goo-I litan Medical Treatment . . . . . . 373 Page .1: . - “'4': of mam‘t 0110109 I I I I I I I I I I I I 376 illness Concepts and Treatment Choice. . . . . . 3'79 4 ' . W of Resort to Curative “2" -3 , flicGSI I I I I I I I I I I I I I I I I I I I 384 ‘ M-.51‘i‘.. Polar Relations and Medical Treatment. . . . . . 392 minszons 416 IN; a .438 LIST OF TABLES Distribution of Census Households According to Cultivated Land Area ...... . . . . . . Percentage Frequency Distribution of Census Survey of Illness Causation ...... Culture-Specific Illness Causation: ‘fi 1 Somatic vs. Psychosocial Causes. . . . . . . . E‘th Illness of Tarba: Illness Dimensions Illness of ‘uzr: Illness Dimen- Aaaociations . . . . . . . . . . . . . . Distribution of Land Holdings in FatiHa. . . . . Isolation Ratings According to SES . . . . . . . : gillnesa Reporting in Census Survey . . . . . . . Page . 220 I .241 . . 242 . 246 . . 268 . . 283 . . 324 . . 326 A fl?“ Percentage Frequency Distributions of . ”Metric Ratings: Role Expectations . Mae of RawHaniya's Concensus on Ill- ‘nosa Dimensions Associations . . . . . . 1? Degree of Non-practitioners' Concensus , on Illness Dimensions Associations . . . Mtioners'_ and Non-Practitioners ' “spouses to Shreder's Test. . . . . . . 3. Utilisation of Different Forms of 1"TiflbtiiealTreatment. 328 363 365 371 383 LIST OF FIGURES . Page I" _Mation of Menstrual/Post-Partum Isolation According to SES. . . . . . . . . . . . 221 1:; s9: ' ‘.: 3 than of Medical Treatment Available 3“ zipfig’tgggillagers of FatiHa. . . . . . . . . . . . 345 3.7;}: Wiellegitimation and the Hierarchy Yu’f’kasort in Therapeutic Practices. . . . . . . . 400 ~ \e. INTRODUCTION 3.. v . ffoféfzheral Aim of the Stu- ‘ gs?» ;}*Efie study of social differentiation and categorization necessi- ,u.' is the dissection of these complex socio-cultural phenomena into _ religion, as well as a variety of others which are products tjeific-social systems and historical developments. Examination gfiéuctural regularities. This dissertation describes a research ";'which focuses on one such element, gender, and its associated :ybman's role in Society has been undertaken by anthro- different theoretical persuasions (Stack et a1 1975). El@{;ption. In considering gender, and its associated power differn- ;358, as dependent variables, the present study rejects universal, -': chical oppositions as explanatory schemes. Instead, an under- g of male-female power relations is sought in light of a histor- - specific social formation. Male-female power differentials are ‘ The analysis of power relations focuses on principles of con— cfiion between social categories rather than on the opposition of eta between individuals. '~ :ihile the present study is based primarily on an empirical analysis ~5¢ roles, power relations, and their consequences in a localized 7e peasants. Peasants' class identity is regarded as _ussion of role constraints and choices. Clarifying 1. :f"Ih the treatment of gender roles, and associated power differen- l aféis, as independent variables, the present study focuses attention . 733the medical system. In the course of this analysis, the dialectical '.4~tl&tion between gender and other elements of social identity related H: 7:j§power differentials is probed. Gender is thus regarded as but one :ECJ;n$ of multi-dimensional social identities, and associated power “Tzations, which influence the precipitation of and response to ill- The selective concern of this study with the medical system in '7}gtreatment of gender role as a dependent variable may be clarified -— rifles must study the "well" in order to understand the "sick" ;:m 7 study the "ill" to understand what is hidden and latent -: “.5111 the "healthy", since what is explicit in illness is im- {pflicit in health. Deviation from the norm is a guide to -- norm thro h its distortion and exa eration....the _ ons p etween llness and health sd alectical... EEBuItural role ideology may create a dichotomy between "them to protect the boundary separating them, but role iformance reveals the relationship between them.... health~illness model is a single expression of the “tion between norm and deviance....the "sick role" be "healthy role" (are) dialectically and neces- 'related, the former constituting the antistructural and the latter constituting the structural pole ‘"1976: 117-119; original emphasis). tiune themselves. In the present study, definitions of illness, ' are cultural prescriptions for controlled deviance, are con— ") gander identity) and attendant power differentials. 5; Vin.the cross-cultural study of health and illness, important con- I ;;«ggsg for focusing research inquiry include "medical system" and ,. - ”g-d as" (Mitchell 1977). The use of these terms in the present , P ,ineeds clarification at the outset. "Medical system" is an im— | ..' fjffn incorporated in a cross-cultural analytical framework without a ;‘ as symptoms or conditions" (Robinson l97l:l). The present ":ana1ysis of the condition of illness, but the be: I-f ‘“5eyjkr y consequential aspects of illness which are deemed sig- rt for the purposes of the present study. In fact, these be- tial dimensions of illness are themselves utilized to probe other figender identity. ..;»filn considering the behavioural correlates of illness conditions, pn:1 health, manifested by changes in social, psychological, and/or l":( states. In short, the present analysis of illness focuses 37gyechanic has termed "illness behaviour". This entails the 7H_gn of primary consideration to "the way in which given symptoms _u§y is based on field work conducted over a period of " pen August 1974 and July 1975 in the Egyptian Nile Delta fix H {ties of both males and females. The author's awareness of the :fiin choice of informants, particularly her critical posture 3718 male anthropologists who provide us with information derived Finale informants only, was a constant reminder to correct her lural" propensity to women. Conformity to local codes of modesty aggédress and behaviour earned her the respect and trust of both males .. it": ‘ecfemales. Contrary to prior expectations, she faced no difficulty w .,49; Beaver in discussing a wide range of topics, including those .fka :ining to sexual matters, with male informants. Both males and B“, ' é ‘f‘ea of the community have different expectations of urban women l’ma_the author than they do of their local women. They had been itzsed to the female physicians in the hospital of the nearby town éthe female dentist whom many of them frequent. The author's city as an urban woman from Alexandria was not alien to their ex— Her incessant interest in their culture and their wel- pguantitative data was collected. Informal interviews were J .l/ iIipent observation was also instrumental in the collection of ;re1ated to altered states of health. Additionally, the latter " of the research period was devoted mainly to structured inter- ;'and the administration of tests and questionnaires. ’5{ Since socioeconomic status and attendant power relations within izvillage are defined primarily in terms of control of agricultural o" .“fifid, size of land holdings was the primary criterion for the selec- H,— ' 133;} of a representative sample of the population for close investi- u I r . ~. To insure proper representation of population subgroupings, V‘E w.~ -.;§f?iif1ed random sampling of the study population was undertaken. “isocioeconomic subgroups, the percentages of families indicated e I were used as a guide to randomly select the appropriate I. three households from each of the three named areas of and four households from one such named area. The final ion of Land Holdings in FatiHa 1 of Total of Number of Families 460 Families 1 0.2 l 0.2 11 2.1 11 2.1 6 1.3 170 36.7 79 17.1 121 26.3 60 13.0 "u _ ,y'lfi'igfrisr Number of Households :g-fland Area Cultivated in Census r V—r‘rv Uri-v , firm :, p..§1._______feddans 1 .7112 . far-S. 1 . g 3 ., 4-3! 5 32,-: 37 ' ‘ ~- 1-_1§ 1'7 .5Si34tvfi '-..xfi _.1/8-3/4 25 13 10 : ‘ of nearly two months. However, its utility for building .: .with members of the community was absolutely indispensible. "her, it yielded a variety of quantitative data related to the 'ttical emphasis of the study. These include household composi- 3; differential ownership of property by men and women, types of ' structures, marriage patterns, educational level of males and Eyes, patterns of menstrual isolation, as well as medical data {ted to the differential incidence of illness among men and women, licenceptualizations of illness, and the illness referral system. bbtained through the census formed the basis for further investi— _J;yi during the remaining months of field work. ’4} P Ebroughout the study period particular attention was placed on 1, role differentiation and its relation to different facets of *\nca1 activities were made. Information on the cultural evaluation 11 way of structured and informal interviews with male and female ’2 era and traditional medical practitioners, data on illness ,tion and various medical practices was collected. Structured 13'” Mews were used to assess differential illness behaviour associated ‘ ’th males and females and the different forms of medical treatment :Wed to members of the two groups. Several interviews were also 4}; Mutated with male and female traditional practitioners in the vil- égge and its vicinity to compare their healing power and ethnomedical ,. WIedge. Structured interviews and tests were administered to these _, k#c‘trlstioners to evaluate the basis of their healing powers and their m over an extended period of several weeks. Persons affected by I u dent of the folk medical system, persons affected by the were also subjected to professional medical examination and ical testing. Finally, in view of the importance of male and fictive functions as a basis for gender differentiation informal interviews with males and females, and the obser- '_.midwives, resulted in the collection of data on beliefs and related to the reproductive process, .r -\ a - n l2 x"3f§;..gnizing what has been termed the anthropologist's "limits Effifiqéérety"4, this author secured the aid of a physician and a psycholo— .’: , 5 ” *kdnring various stages of field work. The physician's familiarity ‘} local linguistic variations and medical problems proved very help- t igin.the modification of the Cornell Medical Index5 which was ad- astered to over 350 male and female respondents. Psychiatric inter- "ittions of the responses to the CMI were made by the psychologist 33.also constructed and analyzed the Hakky personality test6 which 11§'35 administered by the author. :3 _. and delineates its main theoretical assumptions. Part II (Chapter 13 ~ 4 the study, relevant dimensions of the medical system and a qr are linked to the relations of power differentials b '2‘” A :gaséociated with gender) introduced in preceding #11" the concluding part of the study serves to sum- . TWorfindings and their theoretical implications. a . T‘ ‘\, 1* l4 NOTES 1The choice of gender roles and the medical system as foci of research is explainable in terms of the author's academic and personal back- grounds. She has had a long standing interest in matters related to health and illness through her earlier academic training in Bacteri- ology and graduate studies in Medical Anthropology. Having grown up in the Middle East, her interest in the study of Woman's role in Society was initially stimulated by exposure to biased Western characterizations of women's roles in that area. This preliminary concern then developed into a serious interest in the cross-cultural variation of gender identity during the earlier part of her graduate education. Throughout the course of graduate training, this interest was maintained and in- tensified. 2The utility of retaining the concept of medical system for the pur- pose of cross—cultural analysis is by no means a point of agreement among medical anthropolologists. Thus, Mitchell (1977), for example, while recognizing Glick's redefinition of medicine as a "generic con- cept for encompassing every imaginable kind of belief and practice related to illness", and while appreciating its significance in the attempt to "counter a tendency towards ethnocentrism" (Ibidzl7), has reservations about its utility in cross-cultural research. He rejects Glick's formulation on the grounds that it refers to "an extravagant array of often logically contradictory ideas and practices (naturalis— tic and supernaturalistic ideas and practices about illness)". In— stead, he proposes that if such divergent ideas and practices are to be subsumed under a single rubric, it is just as appropriate to refer to them as 'magical systems' as it is 'medical systems'. Alternatively, he recommends the use of the concept "curvative system". Accordingly, a "medical system" would be considered "a t e of curvative system that emphasizes naturalistic rationales and pract1ces" (Ibid; original emphasis). In noting Mitchell's proposed modification, one may recognize his attempt at cleansing the term "medical" of its Western cultural implications, but it is important to point out the restrictiveness of his proposed modification. It places selective emphasis on a ecific component of the illness experience, namely the curative figmension. The conceptual model suggested by Mitchell may itself be regarded as ethnocentric in that it denies the importance of illness causation and illness prevention, which are significant components of various non-western medical systems, including that associated with the research community of the present study. . 15 .-g . «ing to the recent review of the Madical Anthropological litera- ‘ ‘by Colson and Selby (1977: 246), the concern of ethnomedicine is with “disease" but with "illness and illness behaviour as a cul- ‘ category" In his discussion of this analytic distinction as -by Fabrega, Mitchell (1977) has rightly argued that the term case is a technical concept of biomedicine which is not helpful _ the cross cultural analysis of altered states of health. Thus, . “e recognizing the utility of the "disease" concept for physical u'shfihropological and epidemiologically oriented anthropological studies, 1 has rejects its use in the anthropological quest to document and com- - ~ medical systems cross-culturally (Ibid). Mitchell is also cor- '.rect in noting that unlike epidemiologists who are concerned with the ~§hme disease entities in a variety of societies, cultural anthropolo— gflsts do not have a consistent data base. Their arena of inquiry . 2‘13' udes ALL societies, thereby underscoring the need for generalized Aancepts and terms. The term "illness" fits this need. To quote '1‘1ifltche11 on this point, "By opting for this '1oose' term, we optimize 1hepossibility'that the ethnographic facts about a society's forms of _ tf" -tive intervention - whether ritual, surgical or physical - will ' ‘élnster around the relevant ethnographic beliefs, not Western ideas 03‘ medical taxononU" (Ibid: l9). 1. . fie;ke Devons and Gluckman 1968. v,as5 GMI in its modified version consists of 186 questions which elicit ‘ 3ical and emotional symptoms of respondents. } Hakky personality test (Hakky 1974, Ein Shams Univ. Ph. D. Disser- gun) is a projective test developed by the psychologist involved in s research project. It consists of a series of 20 photographs with 1: as from four possible responses to each illustration, including .‘ "on-lately non-restrictive response in which the respondent is given .alternative to provide his/her own evaluation of the situation Ited in the picture. Each of the four responses is given a num— '1 score which is an estimation of the degree of personality mal- t. CHAPTER 1 ANTHROPOIOGICAL PERSPECTIVES ON GENDER ROLES introducto ' Relarks g-In this chapter, gender is considered as a dependent variable and :fiuamination of anthropological explanations of male-female power 7- ens is undertaken. Section B devotes attention to the sociology Lhropological studies of gender in Section C. Having noted the :tions imposed by this perspective on the study of women's roles, P 1 is concluded with Section D which shifts our attention to iheoretical trends in the study of gender roles. A critique unrealistic explanatory schemes of male-female relations, pixgogical individualisml, and the current differentiation of power Aeemity is undertaken. A statement of the theoretical orientation esent study concludes this section. It suggests the analysis fljrodes, not in terms of alleged universal oppositions, but r i 17 l8 "v:“Ccntext of Discove " PIThe theoretical issues with which this study is concerned cannot ;3i5fn11y understood without a discussion of the epistemological frame- '¥::fram which they derive. Even the most superficial examination of :.literature on the sociology of knowledge discloses the dialogue ;~een Science and Society and demonstrates that reality is socially astructed (Berger and Luckmann 1966). Indeed, it has been noted that ,;. s which account for their everyday existence as members of 1»80ciety and an academic tradition. Anthropology itself cannot “ a history of its development as reflective of the domination Lient groups by European and North American societies. In —;cfuLevi-Strauss, M §ylogy is daughter of this era of violence: Its ty to assess more objectively the facts pertaining )human condition reflects, on the epistemological “a state of affairs in which one part of mankind be other as an object. (Levi-Strauss as quoted Liir;974:61) ,e of a discipline devoted to "the study of primitive l9 ”3“} stinctive other" tradition. This practice finds justification “ fls'tf-v-the anthropological myth of objectivity. According to this direc- nl|' , ‘ ’-Ta..(the anthropologist) must behave as if he had no judgment, , 7 -fas if his experience were inconsequential: as if the contra— '“§:WaIctibns between his origins and his vocation'did not exist. Qt," ‘lbreover, he will imagine that he has no politics, and he .‘g‘, spill consider that a virtue. (Diamond 1974:94) ‘;5"' to this philosophy, outsiders are Judged better qualified x—rion of observers' social identity and its relation to theo- rrzormulations is practiced under the guise of scientific “tical interpretations of the world are not immune from ~ of the cultural contexts in which they are formulated fal’ identities of those who propagate them, be they "cut- :fi‘ips‘iders", men or women. In fact, it may be argued that 20 ‘ -.b v.5uate definition of an anthropological study should not only ;te its obJect, but also the social identity of its subject, the ‘239-1ogist. "It is by virtue of his individuality that the ~1--ologists' social identities and culturally conditioned ideo- 135;; s, but by the comparison of these different culturally conditioned '{lé ical interpretations of reality4. The utility of such compari- - gflhs recent changes in the study of Women's roles in Society consti— ‘4- vs turned to anthropology to derive the empirical evi- : 'supports their politically motivated analyses. 21 ”The Male Bias in Anthro-oloa Theoretical generalizations are intimately linked to the type of ions raised by anthropological investigators. These in turn “.taarive from the cultural milieu of Anthropology and its practitioners, tiaasknoted above. The questions raised grow out of the socio-cultural Reasontext in which anthropology and its practitioners exist (Linton 1971: ‘.J9). In this regard, anthropological studies of gender roles have been 1. Qqued by a major methodological flaw - a one sided male orientation. 1 .‘1 ffihyna Reiter' 8 description of main stream anthropological accounts of firemen is representative of recent criticisms of this orientation: Too often women and their roles are glossed over, underanalyzed, or absent from all but the edges of the description. What . women do is perceived as household work and what they talk about is called gossip, while men's work is viewed as the . economic base of society and their information is seen as ; important social communication. Kinship studies are usually - centered on males, marriage systems are analyzed in terms of the exchanges men make using women to weave their net- -. works, evolutionary models explain the origin and develop- ' ment of human society by giving enormous weight to the male role of hunting without much consideration of female i‘gathering. These are all instances of a deeply rooted male orientation which makes the anthropological discourse sus- J“Kraft. All our information must be filtered through a {‘5 critical lens to examine the biases inherent in it. Theory always underlies the way we collect, analyze, and present .7data, it is never neutral (Reiter 1975: 12-13) "“ogist. Up to the present, the majority of anthropologists men, or women trained by men. Their work propagates the is of male dominance which clearly reflect the asymmetrical of the sexes in their own societies and academic circles. 22 Mere importantly, the anthropologists' academic training, or sex, or both, set limits on the type of questions which they raise and/or the type of direct information which is accessible to them. This of course is particularly true if a male anthropoligst happens to work in a society where segregation of men and women is pronounced. Under these circumstances, the male anthropologist, in seeking information on women, turns to the males of their society. In some instances this option may not even present itself since such an act may be a serious breach of custom. This would be the case in FatiHa, the setting of the present study. Males' descriptions of females may be considered useful as ideolo- gical declarations. But the reduction of socio-cultural behaviour to ideology runs counter to the anthropological commitment to holism. As ideological statements, male informants' description of women reveal superstructural elements which legitimate social relations and power differentials. They do not describe the infra-structures (the economic bases, the distinct system of relations of production) with which these superstructural elements are dialectically associated. In other words, male informants' statements to male anthropologists (in addition to being responsses to anthropologists' culturally condi- tioned elicitations) inform us of the manner in which existing (or presumed) power relations between males and females are justified and replicated through time. They do not provide us with a description of the social relations of production for which ideological elements are articulated by informants. The theoretical limitation of this methodological bias are serious indeed. As superstructure, males' 23 views of females are likely to be mystifications of underlying social relations (O'Laughlin 1975:348). Ideologies, whether related to gender or not, are not simply direct reflections of underlying socio-cultural processes. The relationship between ideological elements and their sustaining social relations is dialectical (Murphy 1971). In fact the discrepancies between ideals verbalized by informants and actual behaviour are so common that anthropologists find it important to differentiate between "real" and "ideal" culture and between "etic" and "emic" categories of analysisfi. A number of recent studies have revealed the distortion which derive from according the "male factor" central significance and re- garding the "female factor" as subordinate or insignificant in studies by male anthropologists. In a study designed to compare the findings of male and female anthropologists about Australian aboriginal women, Ruby Rohrlich-Leavitt et a1 (1975) have shown how male anthropologists' "etic" emphasis represents societies as male dominated with.women in a subordinate degraded status. Citing Phyllis Kaberry's "Aboriginal women" (1939) and Jane Goodale's Tiwi Wives (1971), the authors show the development of these two female anthropologists' enthnographies from a combination of etic categories and the actual lives and world view of the people they study. In contrast, reference is made to C. W. H. Hart, a male anthropologist who states that in studying the Tiwi of Northern Australia he deliberately ignored their subsistence activi- ties because they "bored him" (Ibid). This neglect is by no means insignificant. Australian aboriginal women have been shown by female anthropologists to play a central role in economic activities, moreover, .Iv 24 this role is acknowledged and valuedirltheir societies. Citing Ka- berry's work of nearly four decades ago, Rohrlich—Leavitt et a1 write, ...the tools which the women make and use satisfy the bulk of nutritional needs of the group. It is by virtue of their essential economic contribution that the women are respect- ed, and assured of just and good treatment. women have a right to their own property, and they trade many of the articles they make with both male and female partners in the system of economic exchanges. With their female part- ners they also exchange secret corroborees and, like the men, the women practice sorcery against undependable part— ners. (Ibid:572) Male anthropologists' descriptions of aboriginal women as pawns which are exchanged in male alliance systems, as "currency" whose control affords men prestige and influence, as "domesticated cows", and as "slaves" who are forced to do the heavier work by the "brutal" half of the society are contradicted by female anthropologists accounts. According to Kaberry, ...it is just as incumbent on the man to contribute this (meat) whenever possible, as it is for the woman to go out for roots and tubers....If it was compulsory to search for food, at least they did not travel like beasts of burden, with timorous docility and bovine resignation. They were not driven forth by the men; they departed just as leisurely, chose their own routes, and in this department of economic activities, were left in undisputed sway. If it was left to them alone to pro- vide certain goods, at least it was a province in which they were their own mistresses, acquired their skill from the older women, and served no weary apprenticeship to an exacting hus- band or father (Ibid:57l). Male "brutality" as exemplified by wife beating is also illuminated by Kaberry, .."but there is no question of her accepting punishment for unwifely conduct"...Every woman has her fighting stick, which she wields with great skill, and when the man is unlucky in the hunt or the wife thinks he is just plain lazy, she may attack him 'with both tongue and tomahawk'....0n the whole, however, there is very real economic cooperation between husband and wife, 'an expected and recognized feature of marital life' (Ibid:572). 25 While male anthropologists have depicted Tiwi women as invest- ment commodities and have insisted that marriage arrangements are en- tirely in men's own interest, Tiwi social organization appears in an entirely different light from the perspective of a female anthropolo- gist who emphasizes the benefits and powers which women derive from the marriage system: Goodale (1971:52) points out that the tie between the son- in-law and his future mother-in-law is 'one of the most im- portant and enduring social relationships that either may have'. In return for the promise of her future daughter, the son-in-law becomes responsible for providing for the needs and wants of his mother-in-law until his or her death. ...Mbreover, if the son-in-law does not serve his mother- in-law to her satisfaction, she may void the contract. A girl's father does not have the right to void such a con- tract...(Ibid:574) Not only do Tiwi mothers have the authority to void their daughters' marriages, but they also might agree to exchange sons (Ibid). Distortions arising from the male bias in anthropology have also been revealed in Elizabeth Faithorn's study of the Kafe of Highland New Guinea where she undertakes a reexamination of the allegation that beliefs in the polluting power of women reflect female inferior- ity. Her study reveals that both women and men may be considered polluting. Women are not the only polluters and men are not the only victims of pollution: After sexual intercourse, both men and women are required to wash themselves thoroughly to avoid contaminating others with semen and other substances produced by their bodies during copulation. If a couple has had intercourse during the night, the next morning they must both refrain from cooking food for themselves or others as semen might be transmitted to the food and ingested. The illness that results, should this occur, is the same as that caused by the ingestion of mens- trual blood (Faithorn 1975:137). 26 The myth of female inferiority is also challenged by Faithorn: ...women as polluters are depicted (in the literature on Highland New Guinea) as weak, disgusting, and inferior to men, who as potential victims of pollution are portrayed as naturally pure and strong. This does not accurately represent the way the Dafe themselves regard women. They say that women are also strong and important in the func- tioning of society. As one Kafe man put it, women work so hard and so constantly that they are like machines. An- other man explained that if it weren't for women, nothing would get done, and society would fall apart. women them- selves regard their strengths and weaknesses as different from those of men, but they do not view themselves as inherently inferior or less important. (Ibid:139). The mix of androcentrism and ethnocentrism reflected in the above examples is also noted in the African literature. Taking the early accounts of African societies as exemplary, it is evident that British colonial officers with their Victorian values about women's roles ignored native female political institutions. Although they made an effort to understand the indigeneous political systems as far as these related to men, for the purpose of manipulating them in their system of native administration, they ignored women's institutions almost completely (Van Allen 1972). In the anthropological litera- ture, African women have been described as transacted in a kinship system of exchange. Rubin describes the general conceptualization of this exchange as follows: It is women who are being transacted, then it is the men who give and take them who are linked, the woman being a conduit of a relationship rather than a partner to it... If women are the gifts, then it is the men who are the exchange partners. And it is the partners, not the presents upon whom reciprocal exchange confers its quasi-mystical power of social linkage...As long as the relations specify that men exchange women, it is men who are the beneficiaries of the product of exchanges - social organization (Rubin 1975:174 in Sacks 1976:566) ,- 27 In this Levi-Straussian structralist perspective, the world is dichoto- mized into male actors and female gifts. The Nuer have recently been cited by Sacks to show how the re- interpretation of the Nuer marriage by two female anthropologists, Kathleen Cough (1971) and Alice Singer (1973) suggest greater flex- ibility and equality in the actual structure of marriage as well as greater equality in the conceptualizations held by the Nuer themselves than the above noted structural opposition suggests (Sacks op. cit. p. 566). Cough and Singer's studies show a great variation in women's roles. They show how Evans—Pritchard's functionalist preoccupation with idealized rules of marriage and property transfer are useful only as descriptions for wealthy and socially dominant lineages: For the rest of the population descent is actually not traced through men nor is marriage often patrilocal. More- over, the patrilineal is only one of many socially accepted types of union. ‘Many do not involve the transfer of cattle, and in these, women 'are under the legal guardianship of no man in respect to their work and domestic services. Often, in fact, they own cattle, and always they are separate legal personalities'...almost half the Nuer women of childbearing age lived in unions which gave them legal autonomy. A fre- quent pattern among nonwealthy Nuer was for the woman's family to transfer cattle to the man's linearge. In return the husband lived in his wife's village, and she and her family gained rights to his domestic services (Ibid). The hierarchical opposition between actors and gifts is thus contra- dicted by Cough and Singer's description of mostly egalitarian struc- tural arrangements while inegalitarian relations do not seem to favour either sex systematically (Ibid). Gender is clearly portrayed in these reinterpretive studies as one element in a multi-dimensional social identity. Women's and men's behaviour does not fall into .1 F-u 28 neatly differentiated, immutable categories. Studies of the Nuer and the Lovedu cited by Sacks show that men and women are both actors and gifts: Both sexes then take on actor and enabling gift roles at some point in life...it appears that making gender an immutable category which has to be either actor 3:; gift skews reality. That paradigm has both the seduc- tiveness and the fallacy of a stereotype: it contains some truth and much error...its truth lies in the notion that gifts create alliances, that marriage has gift-like and transactor-like roles, and that these may be unequal roles. The error lies in attaching those roles and in- equalities rigidly and universally to gender. It often does not fit the variety of roles and statuses held, or legitimate relationships entered into by men and women in both actor/ascendant, and gift/subordinate roles at various points in, or aspects of life, it does not seem very productive for analyses to attach dominance or subordination to gender (Ibid:567). The presentation of universal hierarchically ranked spheres of activ- ities is understandable in light of anthropological androcentrism and ethnocentrism. As reinterpretations of women's roles and new data on women's activities are brought to light, they pose a challenge to traditional analytical categories and interpretations of gender roles. The general neglect of women's activities in the anthropological literature noted throughout this section is also valid for the Middle East. In view of the traditional segregation of men and women in this region and the reality that the majority of anthropologists working there were men, the female domain of activities remained off limits to anthropology. Hence the relative scarcity of systematic observa— tions of women's behaviour and activities. Consequently, (with the exception of earlier studies concerned with the volutionary priority 6 of female descent and classical studies by the female anthropologists Hilma Cranquist7 and Winifred Blackman8) scholars have often relied ... k. K. 29 on religious literary sources and their interpretations thereof to infer the behaviour of female members of Nfiddle Eastern societies. In the absence of systematic empirical research focusing on women, anthropologists' interpretations of prescriptions derived from literary text provided a convenient substitute. Women's behaviour in the Middle East has been reduced to ideology and ideology to theology, specifically Islamic theology. But as Nadia Abu Zahra has noted in her critique of Richard Antoun's work among Lebanese peasants, these illiterate rural dwellers have minimal knowledge of Quaranic literary texts (Abu Zahra 1970). Abu-Zahra's assertion is corroborated by the present study where the author noted a great discrepancy between the prescriptions regulating male-female relations in Islamic literary accounts and those accepted by the members of the study community. The Quaranic stipulation of equal potential piety of men and women (Sura IX, 71) and the common nature of all Beleivers (Sura IV), is contradicted by villagers' belief that "women are lacking in mind and religion". The Islamic laws of inheritance are not always followed and women may not be allowed to inherit from their fathers. ‘More- over, the Islamic prohibition of female infanticide is contradicted by benign neglect of female infants which is reflected in the high mortality rate of female infants in Egypt (Valaoras (1972). No amount of reading of Islamic literary texts can be substituted for empirical studies of the roles of women in the Middle East. For as Carol Fluehr- Lobban (1973) has noted, Islam is not the monolith of values and social structure it is often considered to be...Islam was overlaid on a variety of cultures...Enormous political differences sep- arate reactionary countries like Saudi Arabia from.places 30 where revolutionary struggles have been fought in the past and continue to be waged...While Saudi Arabian women are shielded behind veils and in houses from outside influences, Dhofari women to the south fight alongside their male com- rades for liberation from reactionary oil rich sultans who are supported by British imperialist oil interests. It is evident from studies in the Middle East and elsewhere that Islamic ideology has been adapted to the numerous and varied socio-cultural settings where it was embraced. At various historical periods and in different settings, Islam, in one version or another, has been used by opposing factions either to advocate the oppression of women or their liberation (Morsy 1972). In this regard it is use- ful to note Harris' characterization of ideology. He writes, thoughts must be subject to constraints; that is they have causes and are made more or less probable in individuals and groups of individuals by prior conditions (Harris 1968: 231). It is to these conditions and the more empirically grounded subsystems of Middle Eastern culture that female anthropologists have access and from which they are gradually lifting the veil of mystery surrounding the role of women in that part of the world. A marked shift is noted in the recent literature on the role of women in the Middle East (Nelson 1973, 1974). Patai's reference to the "old established Muslim view of the God given inferior nature of women", typical of the older literature, is overcast by a current trend typified by Fatma Mernissi (l975: xvi). Based on her research in Morrocco, she writes, The existing inequality does not rest on an ideological or biological theory of women's inferiority, but is the outcome of specific social institutions designed to res- train her power. Female anthropologists, including this author, have the opportunity to make unique contributions towards understanding women's roles in f. T... .. .. a... L. .. u; .. .. ._ .... xi? a... J \ .. \ ..... ...x -. ... x \a... .. ,. . 31 Middle Eastern communities such as the setting of the present study. Privileged access to female spheres of activities and awareness of earlier biases which led to neglect of women's roles will undoubtedly enrich the improverished substantive and theoretical literature on gender in the Nfiddle East. To summarize this section, some male anthropologists' assertion that "women everywhere have always been subordinate to men in running society and the household" (Evans Pritchard, Cf. Sacks l97l:2) is increasingly being challenged by studies which accord central signif- icance to the female factor in society. The recent descriptive docu- mentations of the realities of female social life by female anthro- 9 have emphasized the variability of roles and statuses. pologists The variety of disciplinary and inter-disciplinary literature on the subject of women's roles is a reflection of the accretion of this grand idée. However, our present knowledge of gender roles probably represents only an increment of a wider range of cultural elaborations of the biological differences between men and women. The male bias in anthropology and ethnocentricity have undoubtedly obstructed our perspective and dulled our sensitivity to the activities of women, particularly those whose roles do not fit the cultural standards of the investigators of their societies. Anthropologists, by and large the products of Euro-American culture accept male dominance and may even assume its inevitability, especially if they themselves happen to be men. As the recently generated interest in rectifying the androcentric bias of anthropology is translated into serious scientific analysis, 11 'b . ._‘ 32 it ushers the occasion of evaluating existing theoretical concepts and methodological procedures. As in other cases of theoretical re- organization (Kuhn op. cit.), this recent change has followed a di- alectical mode: What once seemed necessary and natural has begun to look arbitrary and unwarranted. What once could be assumed, ignored or tacitly acknowledged now seems problematic and difficult to explain (Rosaldo and Lamphere l974zl). It is becoming evident that the newly revived study of the role of women in Society is not simply a means of providing a more balanced and complete descriptive account of Culture. It is in fact a means of reassessing anthropological theoretical categories. Thus, theo- retical concepts and perspectives such as power and authority, choice and cultural constraints, evolutionism and functionalismlo are once again brought under close scrutiny in the male-female domains of social organization. D. Recent Trends in the Study of Gender Roles As illustrated in the foregoing discussion, the recent litera- ture on gender roles indicates methodological/theoretical develop- ments which have set the stage for reorienting the study of Nhn.towards the study of Humankind. However, interpretive barriers continue to influence the analysis of gender roles. Anthropologists, socialized in the Western academic tradition and affected by what Karen Sacks refers to as the "state bias" (Sacks 1976), have assumed the universal ap- plicability of their cultural dichotomies and have proceeded to explain male-female power relations in terms of these structural oppositions '2 33 and hierarchies. Nfisinterpretations also arise from a tendency towards emphasis of individual goals and actions and assumptions about society as the outcome of individual choices, the maximization of self interest, and competition for power. The proponents of universalistic schemes argue that "insofar as woman is universally defined in terms of a largely maternal and domestic role, we can account for her universal subordination" (Rosaldo and Lamphere l974:7). Following the same line of argument, Rosaldo contends that woman's maternal roles leads to a universal opposition between "domestic" and "public" roles that is necessarily asymmetrical; women, confined to the domestic sphere, do not have access to the sort of authority, prestige, and cultural value that are the prerogative of men (Ibidz8). Similarly, Hammond and Jablow write, "WOmen's work is always "private" while "roles within the public sphere are the province of men" (in Leacock 1975:606). Ortner also reasons that since women's bodies and their activities are considered by all societies as closer to nature, it follows that this identification accounts for their devalued social role which is characterized as a "true universal" (Ortner l974)ll. The above interpretations seem to be most closely applicable to male-female power differentials in certain sectors of state level societies. The alleged universality of the oppositions and hierarchies which they portray is questionable: It is not clear that primitive peoples dichotomize their world into power domains. Coming from an extremely hier- archial cultural milieu, we tend to construct categories to contain social differences, and then rank them in terms of power. we build master theories out of such notions of difference, but we do not know if the oppositions and 34 hierarchies we construct are universal or simply reflect our own experience in a class-stratified society (Reiter, op. cit. p. 15). In examining the proposed oppositions between the private (house- hold and kinship oriented) and the public (non-kin based areas of activities which concern the community at large) domains, certain methodological/theoretical problems may be noted. While the proposed dichotomy rightly seeks to uncover the structural relations which underly empirical reality, it denies historical variation. Structural oppositions are held constant for the human species in its entirety. Contradictions are regarded as immutable, their qualitative variation with the historical development of material structures is neglected. The structural bases for women's alleged universal subordination are stressed but the substantive conditions which underlie their emergence and continuity remain undefined. Once the dimensions of time and space are introduced into the structuralist paradigm its historically specific applicability becomes evident. As Eleanor Leacock has argued in her critique of universalistic schemes which oppose the public and private domains, The...problem with such statements is their lack of historical perspective. To generalize from cross-cultural data gathered almost wholly in the twentieth century is to ignore changes that have been taking place for anywhere up to five hundred years as a result of involve- ment, first with European mercantilism, then with full-scale colonialism and imperalism. Indeed, there is almost a kind of racism involved, an assumption that the cultures of the Third WOrld peoples have virtually stood still until destroyed by the recent mushrooming of urban indus- trialism. Certainly, one of the most consistent and widely documented changes brought about during the colonial period was a decline of the status of women relative to men. The causes were partly indirect, as the introduction of wage 35 labor for men, and the trade of basic commodities, speeded up processes whereby tribal collectives were breaking up into individual family units, in which women and children were becoming economically dependent on a single man. The process was aided by the formal allocation to men of what- ever public authority and legal right of ownership was allowed in colonial situations by missionary teachings and by the persistence of Europeans in dealing with men as the holders of all formal authority...The common use of some polar dimension to assess woman's position, and to find that everywhere men are "dominant" and hold authority over women, not only ignores the world's history but trans- mutes the totality of tribal decision-making structures (Leacock 1975:605). The bifurcation of public spheres is a scheme which may be traced to the Aristotelian state power politics paradigm (Elshtain 1974). The state itself is not a universal feature of human society. It represents a phase of social evolution which contrasts with relatively egalitarian social relations more typical of primitive societies. Lawrence Krader has recently articulated this contrast; he writes, The common root of human society is life in the community, in which the opposition of the private and the public is not to be found, or is found only in a modest degree. The transition of political society, however, the emergence of the class of new men, whose ends are at once individual and class-individual introduces the opposition between the private and public sector...The surplus product is collected by the new class of private men, who are the public officers...Human beings had lived hitherto into an undifferentiated mass, without distinctions of wealth and power. Out of the disruption of this community of interest, the opposition of the public and private sphere emerge...The state,...(an) organ of the ruling class functions...(to) dominate...the entire society, of the poor class of people, of the direct workers on the land, in mines, and workshops, together with their families...(Krader 1975:246, 248). The opposition between the private and public spheres is the out- come of specific relations of production characteristic of historic- ally specific modes of production and systems of appropriation of .n‘ -.q .._ 7. ,0 36 surplus. The opposition between the private and public domains and concomitant opposition between the interest of the ruling class in state societies and the "direct workers" and their families, men and women alike, is well illustrated in a study of a.Nfiddle Eastern com- munity. In her study of a Lebanese urban lower-class municipality, Saud Joseph undermines the validity of the assumed universal existence of distinct public and private spheres which divide men and women into different power realms (Joseph 1975). Her data on the male workers of Burj Hamoud indicate that their mere participation in public activi— \/ ties does not confer upon them power over women. Moreover, she des- cribes female "public" activities in which women are the primary participants and which have a definite effect on their own lives as well as those of their male relatives. Joseph's conclusion regarding the Lebanese community are equally applicable to the peasant community of the present study. The power of the ruling elite in the study area, derives not simply from an opposition between private and public domains, but from the control exercised by the state and its benefactors over the "immediate pro- ducers in society" (The Egyptian peasants and workers). It is the private interests of ascendant social groups crystallized in the public apparatus of the state that are opposed to the common interest of subjugated men and women. The comparative studies of female-male power differentials by Sutton et al (1975) among the Black rural proletariat of Barbados also indicate that the gender identities of males and females are by no means determinants of the private-public differentiation: 37 There is among the black rural proletariat of Barbados considerable equality between the sexes. WOmen and men hold positions of comparable status in the economy and the local community. But as a legacy of Barbado's slave plantation past, the community has little autonomy, and the group as a whole - women and men - has little control over economic and political resources (Ibid:584). Like the case of the Lebanese urban proletariat (Joseph op. cit.) and the Egyptian peasants of the present study, the major contradiction is not between the men and women of the subordinate social groups but between them as a group and those who control economic and political resources: For the Barbadian rural workers of Eneavor, ...the world of work and political power is located outside their community. The community lacks autonomy and villagers have little control over the basic resources upon which they depend for a livelihood. The island's economy remains in the hands of a resident white elite and jural-political institutions are now managed by a black middle class. In this public domain, villagers hold a subordinate position...Power...is imposed on both sexes. The concept of dominance in social rela— tions is not identified with either sex,_but with those who holdgpositions of power and authority out- side the villageg(Ibid:59l, 593, emphasis added). Sutton et al have also described the egalitarian power relations among the Tlingit Indians of Alaska. Here, as in other cases, the insignificance of the public-private dichotomy for relations between men and women is understandable in terms of social relations of pro- duction. The traditional Tlingit economy was highly seasonal, based on fishing. Labor was divided between men who fished during the summer and women who then processed the perishable food for year-round consumption and trade. Trade was an extremely important activity and women were traders, playing a key role in negotiations and exchanges with other groups of Indians and with Europeans. Today, women and men continue to be actively involved in economic N 38 activities outside the household, and the tradi- tional sexual division of labour still operates in the commercial realm of fishing and processing. In the new occupations of the modern economy, women have a higher rate of year-round employ- ment... Consequently} Not only do Tlingit women and men equally occupy positions of high status in the public domain, but husbands and wives operate in this sphere independently. (Ibid:588, 589). If the opposition between public and private domains and their Iuerarchial differentiation is questionable for certain spheres of state level societies, it is truly meaningless for non-state collec- tivities. Ethnohistorical data collected by Brown (1975), Leacock (1975) and Sacks (1976) show that in non-state societies in Africa and the New WOrld men and women shared authority through the collec- tive functions and dispersed nature of decision making: The authority structure of egalitarian societies where all individuals were equally dependent on a collective larger than the nuclear family, was one of wide dispersal of decision making among mature and elder women and men, who essentially made decisions...Taken together, these constituted the "public" life of the group (Leacock 1975:611). Reconstructed history of North American Indian groups shows the breakdown of such egalitarian relations as described above. As trade and wage labour undermined the collective economy, men of influence began to perform leadership, authoritarian functions out of line with the traditional egalitarianism. With these develop- ments, the masculine "authority" of ethnographic accounts took shape (although doubtless exaggerated, as largely male . 0... 39 ethnographers recorded the views and experiences of largely male informants). Under colonial conditions, the "public" and "pri- vate" sphere became divided, as had not been the case when the "household" WAS the "community", and the public sphere became invested with a semblance of the female power it represents in state-organized society (Ibid:6lO). While ethnohistorical data reveal the absence of the presumed uni- versal opposition between public and private domains, they also re- veal role differentiation between men and women. But this differentia- tion itself is not synonomous with subordination of one gender to the authority of the other. As Karen Sacks has argued in her discussion of the state bias in anthropological analysis of gender, It is erroneous to assume that if men and women play differ- ent T0188, one sex must be socially dominant...In nonstate societies men and women, or some of the roles they occupy, can be sharply segregated, or socially differentiated, and yet it may make more sense objectively to see them as equal. And, it may also be the case that the question of which sex is socially more valued has no meaningful answer to members of those societies (Sacks 1976:565). Sack's position is corroborated by Brown's description of 18th century Iroquois women where differentiation of roles did not entail their hierarchial ranking. Iroquois women represented authority figures in the household and were also considered equal partners with men in social and political authority (Brown 1975). The separation of male and female forms of authority (men as council members initiated and executed policy concerning war and peace while women as matrons exercised veto power through withholding food for council delibera- tions and war parties and had the authority to dispose councillors) did not hinder the effectiveness of either. This differentiation is represented by Brown as complementary rather than hierarchical. In sum, substantive cross-cultural data challenge the contention a .4 40 that female subordination which is regarded as universal derives from the presumed, equally universal, opposition between the public and private spheres. This opposition itself represents a historically specific social formation and particular relations of production. Under different relations of production such as those cited in the above examples of non-state societies, the opposition between the public and private domains is insignificant. WOmen derived authority from their participation in collective social production in a use economy (Sacks 1974). Another alleged universal dichotomy advanced to account for the subordination of women is that between Nature and Culture. Ortner (op. cit.) has expanded the Levi-Straussian opposition between women as gifts and men as actors (elaborated above). She argues that males are universally associated with the domain of Culture while women are linked with the opposite domain of Nature. Furthermore, the claim is made that all_societies symbolize culture as dominant over Nature, and by extension, all cultures regard males as dominant over females whose reproductive functions symbolize their closeness to Nature and hence their relative devaluation. In considering Ortner's claim, one should note Sacks' remark that it is not of universal validity but more illustrative of a "current kind of 'state bias' in theory making (Sacks 1976:565). The male (Culture)-female(Nature) dichotomy is cast as "inalterably unequal". A.number of ethnographic illustrations contradict the assertion that women's "universal" subordination derives from their natural produc- tive functions and their consequent association with the domestic 41 domain and nurturance. In contrasting the tendency in Western culture to define women as weak and needing protection since they bear children, Carol Hoffer writes: In west Africa the same biological facts are given a V different cultural interpretation. The bearing of children demonstrates that women are strong and active agents in society, capable of holding political office. In the Mende ethnic area of Sierra Leone,...(women's) nurturing role is also consciously valued in this geo- graphical area of high infant mortality...Women paramount chiefs in this area are seen as mothers writ large, calling into question any theoretical dichotomy in women's influence between the domestic and the juro-political domains (Hoffer 1974:173). The debasement of female reproductive functions seems to rest, not on a universal structural opposition with undefined functional correlates, but on specific social relations of production. Karen Sacks' comparative study of four African societies shows that among the Mhuti who consider children as social members rather than private heirs, mensturation and pregnancy are not surrounded by restrictions on women's activities. By contrast, menstrual and pregnancy restric- tions on women's activities operate to separate women's reproductive functions from contact with the social production of exchange goods among the Lovedu, Pondo and Canda. Unlike the case of the Mbuti, children in these three societies are potential heirs who inherit property and continue the family line. Thus women's reproductive potential is private. Sacks' comparative study suggests that menstural and pregnancy restrictions are related to private property. Such restrictions seem to symbolize a contradiction between social pro— duction of exchange goods and private or familial appropriation. This interpretation is reinforced by the fact that restrictions imposed 1 r. 4 /, 42 on women have a corresponding form among men who are also involved in the reproductive process and are subject to the same contradic- tions. Among the Lovedu, Pondo, and Canda there is imposed a separa- tion between men's sexual relations and their participation in social production for exchange. For Mbuti men, by contrast, the hunt is regarded as an ideal time for sexual liaisons (Sacks 1974:217-218). The devaluation of women's "natural" reproductive functions is by no means universal. A great sense of respect and awe for female reproductive functions is demonstrated among privitive groups. Among the Kimberly tribes, Kaberry shows that "Where (a woman) does bear children, they do not anchor her the more securely in a position of inferiority, nor circumscribe her activities" (Kaberry op. cit. p. 156). In the tropical forest of South America, the couvade reflects the "cultural" association of males with the "natural" female repro- ductive functions: Customarily the husband repairs to his hammock for several days during his wife's labor and immediately after she has given birth to a child...He behaves as if he had undergone the birth experience, and the geneology of the child is underscored by his actions. But, more signifi- cantly, the couvade is a visible symbol of a complex shift in the relationships involved in childbirth, centering on the male as a point of reckoning. Childbirth transforms the respective roles of and relationships between the sexes. ..... The focus on the male not only compensates for the absence of a sharply defined critical event in his life, but also engages the woman in the meaning of the male experi- ence - which includes the continuity of his connection with the child - just as he had been directed to the meaning of her experience during pregnancy and its immediate aftermath. Like other rituals which center on one sex, it also epitomizes shifts in the behaviour of the other, even when the latter transformation is less public. The couvade, then, can be understood as a crises rite socially expressing an existen- tial transition experienced as risky and formidable within 43 the cultural context of a given people. The contrast with the conventionally disengaged and disoriented male in similar situations in our society hardly needs to be remarked (Diamond: 1974:41). In this primitive society, the natural opposition between male and fe- male reproductive functions is not hierarchially differentiated, it is "shared, understood, and socially structured" (Ibid). In considering the proposed immutable association of women with Nature and their opposition to Culture, it may be noted that women's own "cultural" elaborations afford them control of their "natural" reproductive functions. The culturally sanctioned practice of abor- tion among primitive groups shows that women in these societies have greater control over their bodies and reproductive functions than their counterparts in civilized society (Ruby Rohrlich-Leavitt et a1 op. cit. p. 576). Finally, an increasing number of studies and empirical data pose a challenge to the allegedly universally valid assertion that "Everywhere we find that women are excluded from certain crucial economic and political activities, that their roles as wives and mothers are associated with fewer powers and prerogatives than the roles of men" (Rosaldo l974:3)12. Researchers unhindered by ethnocentric blinders have shown that women's marital and maternal roles do not necessarily define their status in society or confine them to the domestic sphere (Sutton et al op. cit. p. 599). These activities themselves are differently evaluated cross-culturally. The asser- tion that sexual asymmetry is rooted in the reproductive activities of women as bearers and nourishers of children cannot be accepted as universally valid. The nature and intensity of asymmetrical power relations between males and females appear to vary widely from \l H u 44 society to society. A realistic assessment of the presumed constran— ing effect of female reproductive functions and attendant maternal roles necessitates detailed consideration of the relationship between female reproductive functions, the social division of labour, and gender power relations in specific cases. Realistic generalizations may be derived from the comparative study of structural types, not the human species in its entirety. Human beings do not learn and adapt to nature as a species, but only through the traditions of particular groups (Krader op. cit. p. 240), i.e., through specific relations between people and between people and nature. Still another trend in the recent study of gender roles is the reintroduction of women into the arena of Anthropology, not as role performers, but as social actors engaged in the manipulation of their environment and the exercise of choise (Lamphere 1975, Raphael 1975). As a reaction to the limitations of the structural functional approach with its emphasis on the "functional" utility of normative role be- haviour, there has occurred a shift in emphasis of anthropological studies of gender from concern with structures to an emphasis on the adaptive strategies of social actors. Through the extension of this logical scheme, prior descriptions of male dominance have been re- formulated in terms of the distinction between power and authoritle, i.e. between "the ability to gain compliance and the recognition that it is right" (Rosaldo 1974:21). Fundamentally, these two pairs of distinctions derive from Firth's more general discrimination between social structure as the normative pattern of social behaviour and social organization as the acting out of this assigned pattern. As 45 such, one can recognize their descriptive utility and their potential for undermining lop-sided descriptions of sex-roles, but their explan- atory value is minimal. Granted that variations in role behaviour are regular features 14 of social discourse , the range of choices and power available to individuals is defined by the structural framework within which choices and power are exercised, As Alvi has pointed out, ...individual action...is not free. It is constrained by the social situation which an individual inherits...(he/she) ...must operate within the framework of a given set of norms and rules, whether 'informal' in their existence or embodied in a legal system (Alvi 1973:42) Methodological individualism with its emphasis on individual behaviour has clear limitations. It undermines the fact that as a social being, an individual is not a free agent. He/she exercises choice and makes decisions within the confines of structural constraints, not only within his/her immediately social environment, but often far beyond it. The case of the Egyptian male and female peasants of the present study is illustrative of this point. While individual "organizational choices" are no doubt a social reality, it is imperative to stress { the fact that an individual is never an autonomous unit. To the con- trary, people individuate themselves only in society and each indivi- dual is the embodiment of a particular set of social relations. Society cannot be understood as an aggregate of individuals exercising choices, but only as a totality of social relations (O'Laughlin op. cit. p. 346). As social beings, persons must be recognized, not in isolation of, but in the context of their relationship to the struc- tured social whole, as a sum of productive forces and a historically . . I 46 created set of relations of individuals to one another and to Nature (Ibid). The social realm and the individual social being cannot be defined independently of their dialectical inter-relationship: The human individual has no essence, and exists only as a means of social relations; the essential core of humanity is nothing other than the set of human relations in society. The society in turn is not a passive category into which the hyman relations are poured, the society is the nexus of individual relations, just as the indivi- dual is the nexus of social relations (Krader op. cit. p. 242). While individual actions no doubt illustrate the range of varia- tions in social behaviour, they cannot form the sole basis for general- izations about social behaviour or for explaining it. Moreover, methodological individualism does not constitute a predictive model of behaviour enshrined in a nomothetic framework (as scientific generalizations should). As such, its limitations for the formulation of anthropological generalizations is obvious. Anthropology seeks to explain patterned behaviour, it is concerned with the evolution of so- cial forms, not in terms of individual organisms, but as it pertains to social collectivities. Individual choices should never be the goal_ of a science of patterned behaviour. They are only useful mggns of providing us with a perspective for the identification of structural elements. They allow us to estimate the range of variations on the pattern of prescribed behaviour and to correlate this variation with specific situational variables. The value of methodological individual- ism.lies in its descriptive function, not in its explanatory utility. It helps us recognize the existence of variation (and its correlates), it does not constitute a fruitful explanation of such variation. While the recent literature on gender roles has emphasized the \ "\ \ 47 "choice" and "power" exercised by women, scrutiny of descriptions of thepowerful, choice making females described in the literature reveals that their power and capacity for choice are ultimately regulated by structural principles similar to those which underlie male positions of power in their respective socities. Hence the reference to women's economic power base (Rieglehaupt 1967), to the land that constitutes their dowry (Friedl 1967), or to their class identity (Mohsen 1974). Even studies which focus on women's manipulative strategies concede that "where a woman has access to economic resources, her ability to influence those in authority is increased" (Lamphere op. cit. p. 126). For the power base of Middle Eastern women, not unlike the case of their men, reference is made to their control of property and its products, to their actions as mediators, to their contact with the supernatural, and to their religious knowledge (Nelson 1974). Again, as for men, reference is made to derivative power associated with patron-client, kinship, and friendship ties (Joseph op. cit.). Finally, women capable of wielding power have been described in terms of their noble descent (Beck 1975), their position as mothers of sons (Aswad 1967), and their reliance on the support of kinsmen through relinquish- ing their right to inherited property (Rosenfeld 1960, 1975). At the present phase of the study of sex roles, the debate should no longer be in terms of whether women exercise choice and power or not. Power, (defined as the "control one party exercises over the environment of another" (Adams l967:32)), is available to both parties in any social relationship. Following Adams' formulation, it may be noted that in any relationship there is inherently involved a relative 48 control of the environment by each of the parties to the relation- ship. Even in extreme cases of subordination, the subordinate party holds some threat to the environment of the superordinate party. In such cases the differential power is great, but as Adams emphasizes, it is a differential and not total control. Thus, subordinate women End_men do wield power, but only in the sense that they hold some threat over the environment of others. The point to be stressed, however, is that, as inferiors, they are subject to binding decisions by dominant parties while they themselves may only beg, suggest, or request. Changes in their possible alternatives (short of organized revolutionary action) are subject to the discretion of dominant men and women. To imagine that women are simply manipulative social actors dis- regards the inequality of statuses (both among women as a group and between men and women) and its attendant differential control of culturally valued resources. Such an emphasis undermines what Alavi refers to as the "structurally determined differences between interests and aspirations" of different groups of society. Thus, methodological individualism falls into a trap opposite to that of structural func- tionalism when it focuses on individual actions outside the matrix of the social whole (Alavi op. cit. p. 41). Structural functionalism emphasized the functional utility of normative behaviour without serious consideration of the "more functional" fundamental structures which maintain the system. IMethodological individualism stresses the transgression of prescribed behaviour but ignores the structural bases which allow for such transgression. ..q “a 49 Some recent studies which distinguish power from authority proceed from the assumption that authority is a male prerogative, while wo- men are said to exercise informal power (Rosaldo op. cit.). According to this orientation women's individual manipulative behaviour and competition for power are accorded primary emphasis. This emphasis poses serious limitations to the comparative study of power relations even within a single society, not to mention cross-cultural comparison. By framing male/female power relations in purely relativistic or individualistic terms, we have no basis for comparing one situation of power differential with another. Comparison entails going beyond the recognition of a differential to its description in terms of in- dices that may be used as reference points in the examination of specif- ic power relations. It is therefore imperative that comparisons be based on the control that one actor exercises over culturally mean- ingful parts of the environment of another. It is this control and not terms of the structural determinants, the bases, of authority in specific cultural contexts and under varying circumstances related to social dynamics. Thus, although we may agree with Rosaldo that "women are far from helpless...(that)...women...(through gossiping or yelling, playing sons against brothers, running the business or refusing to cook) may have a good deal of informal influence and 22333" (Rosaldo 0p. cit. p. 21), we have no basis for assuming that all the options listed by Rosaldo are equally available to 223.35E331 and at_all_timg§, Neither can we assume that some of these tactics are not equally available to men. Similarly, in noting Lamphere's reference to women's power in terms of building loyalty in their sons, 5O resort to gossip, access to economic resources, ability to withdraw services, and even sheer defiance (Lamphere op. cit. p. 128), one must stress the differential cultural significance of these strategies. Thus, for the Middle East, the nature and duration of power that a woman acquires through her contributions of sons to the labour force, and the layalty which she instills in them, cannot be equated with the power which women are said to derive from gossip. Neither can the potential of withholding services be equated with power based on control of economic resources. Mbreover, women who lack control over culturally recognized power bases and who become defiant to the point of withdrawing services risk humiliation or even divorce. Men who succumb to the charms and manipulations of their wives risk ridicule by their mothers and female relatives in private and their comrades in public. By contrast, a mother-in-law is likely to favour a son's wife who brings property or its products to the extended family. In sum, reference to individual manipulations and individual cases of wielding power, whether in the private or public domain, under the auspices of cultural sanctions or through informal channels is in- : complete without parallel attempts to isolate structural regularities E associated with the availability and exercise of power. In the pursuit i of the latter goal, it must be stressed that women, like men, have identities which are multidimensional. Emphasis of this reality in the analysis of gender roles will help integrate variables outside the narrow confines of gender identities. Moreover, this emphasis is necessary to explain patterned power differential among women of differing class identities, age groups, or family structures. 51 Finally, theoretical statements about power relations cannot be ab- stracted from random, individual choices, manipulations, or influences, but must be based on those which fall into patterns. Such statements should go beyond the enumeration of choices and the exercise of power towards isolating their determinants. In sum, We should be aware that the range of choices open to an individual in a given society are always contained within a matrix provided by the structure itself.... But to say all of this is to pose the problem and not to provide an explanation of it. The choices and decisions that interest anthropologists are those that have social meaning or content - they are not the random choices and decisions of individuals but the ones that seem to fall into patterns. Since this is so we would want to know what it is that determines that choices will be patterned in one way rather than another (Kaplan and Manners op. cit. p. 104). Studies of power relations should allow us to predict situations where power is likely to be exercised by males or females. Pre- dictive capacity is an essential attribute of any scientific generali- zation; it cannot be attained by reference to individual manipulations. By way of summary and further specification, the theoretical or- ientation which guides the present study, in considering gender as a dependent variable, rejects invariant, hierarchical oppositions as explanatory schemes in the study of gender roles. Instead, an under- standing of male-female power relation is sought in light of a his- V torically specific social formationl5 (Leacock 1975). As such, it derives from the assumption that production and reproduction16 deter- mine the dynamic structure of human society (gender status, and power relations, included). Male-female power differentials are conceptu- alized as the outcome of a distinct production structure associated with a superstructural apparatus which is necessary for its v. .. 52 replication through time. Thus in explaining male-female power relations, society is viewed as a totality of social relations. The emphasis is on the social character of the process of production and reproduction. The analysis of power relations therefore focuses on \/ principles of contradiction between social categories rather than on the opposition of interest between individuals (Asad 1972). In FatiHa, the family constitutes the framework of production relational? and role differentiations. Since the economy of the vil- lage is expressed through family relations, the developmental cycle of the family is a convenient framework for the analysis of relations of production and their consequences for power relations. According to this scheme, variables which surpass the narrow limits of gender roles are brought into focus. These include variation in age, varia- tion in relation to the household head, variation in contribution to the propagation of the means of production (through the birth of child- ren), and variation of the relation of family members to groups out- side the family (Morsy 1977). This approach has the benefit of iden- tifying not only the dynamics of power relations between men and women but also among women themselves. Finally, having defined authority in terms of control over culturally valued resources (and not in terms of legitimacy) we are not forced to confine, a priori, the attribution of authority to males, but instead, move to consider the ba§i§_of its exercise. While the present study is based primarily on an empirical analysis of gender roles, power relations, and their consequences in a localized setting, a peasant community, the village cannot be K 53 realistically considered an adequate unit of analysis. It cannot be treated as a "primitive isolate", a_society, or a_cu1ture (Wle 1977). It is necessary to trace the determinant social relations that affect the peasants of FatiHa and which extend beyond the confines of the study community. Indeed, the various dimensions of village social organiza- tion in FatiHa, as in the case of other Egyptian peasant communities is subject to external controls which determine fundamental features of the peasants' daily lives (Ayrout 1968). The village itself is a product of a long historical development of Egyptian society, its inhabitants, like other Egyptian peasants carry the burden of the nation's economy. They are party to a relation of exploitation18 which is enforced and maintained by a superstructural apparatus (the state apparatus) which insures the reproduction of relations of ex- ploitation (Legros 1977:32). The recognition of the relation of structural asymmetry between the village and the larger society is essential in understanding the roles of female ang_male peasants. With the exception of anthropo- logists using Marxist analysis in approaching the study of women's roles, the class19 identity of women has not figured prominantly in anthropological studies of gender roles. Recognition of peasant women's (and men's) class identity is crucial to any discussion of role constraints and choices so central in the current literature on gender. Tracing of ties between the village and superordinate power domains reveals the greater opposition and conflict of interest be- tween the politically, socially, and economically differentiated -( 54 groups of the urban dominant class and rural peasants than is the case between males and females within either of these sectors. This fact is relevant to demonstrate that women are not just females. Their identities are multi-dimensional. Clarifying the subordinate position of the peasant (male and female alike) is also important in terms of formulating generalizations (in terms of structural types) and isolating determinants of female status associated with different social relations of production in Middle Eastern society. The dif- ference between females like those described in this study and that of the "beauties" portrayed on petroleum corporation magazines (See Aramco World Magazine Vol. 22(2), 1971) or the "modern" women described by some anthropologists (Mbhsen 1974) derive from the asymmetrical relations between the rural and urban domains of Egyptian society. Finally, it is significant to note that historically, changes in the role of Egyptian women in encapsulated communities has been contingent upon transformations in the larger society (Hammam 1977). 55 NOTES 1See Alavi 1973:42 for a description of this orientation which focuses on individual choices and action in social analysis. 2This perspective contrasts with studies which discuss male-female power relations in terms of alleged universal structural oppositions and hierarchies, e.g., public vs private domains, nature vs culture, and power vs authority (Rosaldo and Lamphere 1974). 3Despite the recent revival and increasing legitimacy of women's studies, Jane Bujra writes, "Those of us who have carried out research relating to women have noted the contempt with which male anthropologists greet our work and the condescension with which.we are treated as researchers" (Bujra 1975:552-53). 4The present study derives from a political commitment to egalitarian relations between males and females. It perceives women's liberation in the study area (Egypt) as an integral part of the broader struggle against oppressive institutions and power differentials which are the bases of the continued exploitation of men and the oppression of women. Hence the emphasis on the identity of men and women of the research community as peasants occupying the lowest tier in a power hierarchy. 5It is generally agreed that adequate ethnographic presentation con- sists of some combination of emic and etic categories (Kaplan and Manners 1972:186). But as Ruby Rohrlich-Leavitt et a1 (op. cit.) have pointed out, in male ethnographies, the anthropologist's or etic categories predominate. Neglecting local significance of women's roles, male anthropologists present societies as male dominated with women in a subordinate, degraded status. 6e.g., Robertson Smith's study of Kinship and.Mbrriage in Early Arabia (1885). 7See Marriage Conditions in a Palestinian Village (1935) and Birth and Childhood Among the Arabs (1947). 8See the Fellahin of Upper Egypt (1921). 9The theory and methodology of female anthropologists seems to "stem from 'double consciousness'...as women in a society that is also sexist, (they)...have the special sensitivity that members of sub— ordinated groups must, if they are to survive, develop to those who control them, at the same time as they are fully aware of the 56 day reality of their oppression; a quality that the superordinate group lack" (Rohrlich-Leavitt et al op. cit. p. 569). Thus women anthro- pologists special sensitivity is not of mystical origin but derives from their own existential positions. loSome British social anthropologists have argued for the functional necessity of inferred female subordination (Evans-Pritchard Cf. Sacks lO7l:2). Nhlinowski, in reference to marriage, also stresses its function but does not attempt to explain the basis of male dominance within conjugal relations (Ibid). Functional formulations may lead us to speculate on the value or "functions" of gender roles within one society or another. But within this framework we cannot move from a presentation of the postulated consequences of these cultural prescriptions to explaining their bases. In explaining gender role differentiation then, it is imperative that our attention be directed to core institutions which differentiate one type of society (and gender identities within this society) from another. Movement in this direction is reflected in recent works which emphasize the heuristic importance of structural types. These include analyses of gender roles which are guided by the Marxist concept of mode of pro- duction (Leacock 1972, 1975, O'Laughlin 1974, Sacks 1975). Other studies which have retained more traditional anthropological categories have utilized a developmental typology borrowed from Steward's concept of "levels of sociocultural integration" (e.g. Gonzalez 1974, Martin and Voorhies 1975, Friedl 1975). Indeed, the evolutionary perspective, once a dominant orientation in nineteenth century studies of women's roles, is now again an important research directive. Some of the issues concerning the role of women which were raised in the 19th century are new subject to debate in feminist and anthropological circles. The validity of nineteenth century claims of the one time existence of matriarchy has prompted an examination of the evidence for an era of female dominance. Many anthropologists however, continue to argue for the universality of patriarchal systems, they insist that even in matrilineal, matrilocal societies, it is not the women but their brothers who wield political power. The confusion surrounding this debate stems from the confusion of the egalitarian status between men and women in societies with a "stage" of matriarchy, envisioned as a mirror image of patriarchy. But as Eleanor Leacock has pointed out, "...(to)...argue a position of 'matriarchy' as a 'stage' of social evolution is but the other face of the male dominance argument. Pleasant for a change, to be sure, but not the true story. For what (ethnohistorical) data reveal is the DISPERSED NATURE OF DECISION 'MAKING IN PRE-CLASS SOCIETIES - the key to understanding how such so- cieties functioned as 'collectives' (Leacock 1975:607). 11Since the publication of these universalistic explanations of gender roles, numerous ethnographic illustrations and theoretical arguments have been put forward to undermine their validity. While the present study follows this trend, it recognizes the utility of these theoretical formulations in the long term progress of studies ... 57 of gender roles. In this regard it is instructive to quote Steward who noted, "...facts exist only as they are related to theories, and theories are not destroyed by facts, they are replaced by new theories which better explain the facts". 12Conceptualizing male-female relations in terms of such universal categories reflects the strong Western bias of viewing gender differ- ences as part of the "natural order" (Sutton et a1 1975). Consequently, studies which are motivated by a rejection of the male bias and up supporting sexist philosophies which proclaim the inevitability of female subservience to male authority. Thus, "a twentieth-century notion of 'universal roles and functions' replaces a nineteenth-cen- tury notion of 'anatomy' as the explanation of female destiny" (Ibid: 596 . 13This dichotomy derives from the alleged opposition between private and public domains and the association of women with the former and men with the latter. It is argued that since legitimate power (authority) is exclusively a male prerogative, "women can exert in— fluence outside the family only indirectly through their influence (power) on their kinsmen (Hammond and Jablow op. cit.). 14Role prescriptions cannot be equated with actual individual be- haviour. Not only do males and females actually trancend culturally stipulated boundaries inherent in role definitions, there even exists institutionalized mechanisms which regulate such transgressions. Illness constitutes one such mechanism. However, even the utilization of privileged dispensation acquired through illness is ultimately regulated by structural constraints and situational variables. l5Social formations are generally defined as "relational systems com- posed of superstructure and a determinant economic base which may it- self be a complex articulation of more than a single mode of produc- tion" (O'Laughlin op. cit. p. 350). 16In the course of social production, social groups also reproduce the conditions of their existence. In other words, there exists a dialectical relation between the productive system (the economic base or infrastructure) and juridical-political ideological relations (superstructure). These superstructural elements function to mediate contradictions within the productive system. They "appear then as the political and ideological conditions of the orderly reproduction of the relations of production" (Terray 1975:90). 17In this case, the determinant role of the economy is not in contra- diction to the dominant role of kinship but is expressed by means of it (Godelier 1966 in Codelier 1975:24). 58 18A relation of exploitation may be defined as "the specific form in which unpaid labour is extorted from the direct producers" (Terray op. cit. p. 89). 19Classes are defined as "groups of people one of which can approp- riate the labour of another owing to the different places they occupy in a definite system of social economy" (Lenin 1971:231. Cf. Terray, op. cit. p. 87). CHAPTER 2 GENDER AS AN INDEPENDENT VARIABLE: POWER AND ILLNESS A. Introductory Remarks This chapter treats gender as an independent variable and pro- ceeds to detail the present study's theoretical perspective regard- ing the consequences of gender identity and its attendant power rela- tions on the experience of illness and related behaviour. In doing so, the dialectical relation between gender and other independent variables related to power differentials is stressed. In other words, gender is regarded as but one component of multi-dimensional social identities and power relations which influence the precipitation of and responses to illness. Thus, the earlier discussion of the bases of female social status is linked, theoretically, to the study of illness. The selective concern with illness in the treatment of gender role as an independent variable in this chapter may be understood in light of the fact that cultural definitions of illness are intimately related to deviations from culturally prescribed role behaviour. The notion that unfulfilled culturally prescribed functions could be patho- genic (SmitheRosenberg and Rosenberg 1973) is indicative of the close linkage between definitions of social role and evaluations of health status. In fact, the sick role may be viewed as a substitute for those whose access to socially approved status and its attendant 59 I. ru- ‘I. 60 power base is blocked (Rubel 1964, O'Nell and Selby 1968, Cole and Lejeune 1972). The study of illness therefore, may serve as a device for illuminating and suggesting patterns of social articulation, power differentials (Click 1967), and social stress. By careful examination of the deviations from role expectations associated with illness, we are better able to understand role expectations themselves and the limits of their transgression. B. Illness as Probe Patterned behaviour associated with illness in different socio- cultural contexts is embedded in fundamental premises pertaining to the nature of reality and of social relations. The study of such patterned behaviour is a means of understanding the structure of socio—cultural systems themselves. The usefulness of ethnomedical data as a probe into other aspects of social life is exemplified by Rubel's statement in reference to the study of illness among Mexican Americans. He notes, The empirical data indicate that when one focuses attention on topics of illness and health he discovers a new and intriguing vantage point from which to view the social system and the emotional qualities found within (Rubel 1966:155). Thus, the attention devoted to illness and related behaviour in this study not only illuminates the consequences of gender roles but also clarifies gender roles themselves. This is possible in view of the fact that medical wisdom itself is instrumental in legitimizing and maintaining certain role prescriptions (Rosenberg-Smith and Rosenberg op. cit.). 61 Definitions of illness and descriptions of illness causation are intimately related to deviations from culturally prescribed role behaviour. Non-conformity to dominant social values and role expec- tations may earn a person the label "sick". Thus Kenney notes for Spain that "a female sexual deviant may be described as mad" (Kenney 1962:284). Definitions of healthy practices and environments may also be related to role prescriptions. A nineteenth century female physi- cian, writing in opposition to her male colleagues' claims of the medical dangers of coeducation, pointed out that no one worked harder or in unhealthier conditions than the washer women of her time. Yet the would be male saviors of American womanhood did not advise against this abuse. Washing, she noted, unlike education, is after all ap- propriate work for women. Other medical views of the same period, pertaining to birth control in this case, opposed expanded roles for the middle class women, and physicians warned against the use of contraceptive devices which they claimed would cause a varied assort- ment of ills. Moreover, the anatomical characteristics of women were linked to illness. According to the medical wisdom of 19th century American physicians, The uterus...was connected to the central nervous system, shocks to the nervous system might alter the reproductive cycle, might even mark the gestating fetus...while changes in the reproductive cycle shaped emotional states...Doctors connected not only the paralyses and headaches of the hysteric to uterine disease but also ailments in virtually every part of the body...physicians often contended that far greater difficulties could be expected in childless women. ‘Motherhood was woman's normal destiny and those fe— males who thwarted the promise immanent in their body's design must expect to suffer. The maiden lady, many physicians argued, was fated to greater incidence of both physical and emotional disease '5 \. u. n. 5.- 62 than her married sister and to a shorter life span. (Smith-Rosenberg and Rosenberg op. cit.). The notion that unfulfilled culturally prescribed functions could be pathogenic is indicative of the close linkage between defini- tions of social role and evaluation of health status. Studies have shown that people resort to illness to justify their failure in fulfilling prescribed role obligations. In fact the sick role has been described as offering a substitute status for those whose access to socially approved status is blocked. Illness provides a cultural dispensation from normal role obligations. Behaviour ordinarily thought unfit for certain status-role complexes is allowed during the illness episode. Thus, Nelson notes that through the gar_ceremony, "the woman can express herself in ways that are not open to her or even acceptable in the larger social structure" (Nelson 1971:19). Similarly, El-Shamy's work among Egyptian peasants suffering from spirit possession indicates that the patient is allowed to do certain things which are ordinarily denied him or her (El-Shamy 1972:21). Studies of hospital mental patients also reveal that behaviour which is ordinarily classified as "antisocial" in the outer world is considered "social" in the hospital due to the higher degree of tolerance and suspension of judgment among the patients (Caudill 1953:787). The role of illness in the legitimation of failure has been re- ported in a variety of cultural contexts. In discussing women's roles in the U.S., Marilyn Salsman—Webb (1971:20) writes that "...when (their) roles fail to satisfy, as they do, women resort to the solves of all oppressed groups. They take to drugs and drink, and if they can afford it, to psychiatry". In another study of welfare mothers in 63 the U.S. where welfare recipients occupy a stigmatized status, welfare women who accept the dominant cultural view that welfare is a result of personal failure were found to be prone to adopting the sick role in order to legitimize their perceived failure (Cole and Lejeune op. cit.). Similarly, a study of culture bound neurosis among Qatari women reveals that this chronic syndrome occurs mostly in females who do not satisfy the criteria of women's role fulfillment according to its Qatari definition (El-Islam 1975). Finally, one may also refer to the relationship between role conflict and hysteria. Of her study on hysteria as a social role within the nineteenth century American family, Carroll Smith-Rosenberg writes, It was a period when...socia1 and structural change had created stress within the family and when, in addition, individual domestic role alternatives were few and rigidly defined. From this perspective hysteria can be seen as an alternate role option for particular women incapable of accepting their life situation. Hysteria thus serves as a valuable indicator both of domestic stress and of the tactics through which some individuals sought to resolve that stress. Thus, through analysis of the function of hysteria within the family and the interaction of the hysteric, her family, and physician, ill- ness is utilized as a probe which sheds light upon the role of women and male-female relations within nineteenth century American society. C. Gender Roles and Illness Health survey researchers consistently show for women higher rates of physical and mental symptoms than is the case for men (Nathanson 1975, Fabrega 1974:19). Anthropological studies of culture bound syndromes (folk illnesses) also point to the higher incidence 64 of sickness among women (e.g., O'Nell and Selby op. cit., Uzzell 1974: 370, 374, El-Shamy op. cit. p. 23, Lewis 1971). Since current knowl- edge does not validate a biological basis for this difference, a number of explanations which rely on socio-cultural variables associated with gender role performance have been advanced to account for this phen- omenon. Nathanson (op. cit.) has recently summarized three major explanatory models which have been advanced to account for gender dif- ferences in illness occurrence. All three types of etiological hypotheses derive from the assumption that women's illness, and be— haviour associated with it, is a response to or reflection of their "situation as women", i.e., their gender role identities. These models are summarized as follows: 1) WOmen report more illness than men because it is culturally more acceptable for them to be ill - 'the ethic of health is masculine'. 2) The sick role is relatively compatible with women's role responsibilities, and incompatible with those of men . 3) WOmen's assigned social roles are more stressful than those of men; consequently, the have more illness (Ibid:59). The argument that "the ethic of health is masculine", cannot be accepted as universally valid. Cultural and ethnic groups vary in their perceptions of physical conditions and in their expression of a state of illness. A number of empirical studies have dealt with the relationship between varying socio-cultural identities and various aspects of illness behaviour. The data provided by medical sociology reveals the existence of a variety of subcultural beliefs about ill- ness and behaviour responses to it (Segal 1976). Thus the validity of this argument within American culture itself is questionable. For 1'1 u 65 the setting of the present study, and Middle Eastern society in general, the validity of this "ethic" is certainly questionable. In a society where the linguistic equivalent of "how are you?" is translated as "how is your health?", neither males nor females are ever reluctant to discuss their health or to voice complaints of their illnesses. The second explanatory model, which accounts for gender dif- ferences in illness on the ground that the sick role is relatively compatible with women's roles and incompatible with men's culturally defined responsibilities, is also subject to debate. While some authors have suggested that the relative flexibility of female roles offers ample opportunities for women to adopt the sick role, others have stressed the disruptive effect of women's illness on family life. MOre importantly, while this model may explain differential sick role behaviour, it does not shed light on the social structural elements which precipitate the illness gri§§§_it§alf and prompt the adoption of the sick role in the first place. Like the first explanatory scheme, this hypothesis treats the behaviour associated with the sick role rather than the illness itself, and its attendant perceived stress as a dependent variable. The third mode of explanation which is based on a stress model attributes higher rates of illness among women to the female role. WCmen's assigned social roles are evaluated as more stressful than those of men. This difference in.rgla expectation is identified as the crucial element underlying the higher frequency of illness among women. According to the logic of this explanation, the impairment in women's capacity to perform their prescribed roles is the "single most “I w. 1.. '\ 66 salient factor" associated with illness (Cohler et a1 l974:7). In such cases of impairment of social role, "one way to adapt to social role performance is to become ill" (Insel and Moos 1974:9). Thus, stressfulness is vaguely defined as an attribute of women's 532531 and illness is basically represented as a form of culturally sanctioned deviant behaviour which is functional. This third explanatory mode has certain limitations. It suffers from drawbacks typical of the structural-functional framework. The focus of the analysis is on female 3213§_and the illness role is regarded as functional for the maintenance of the social system. While illness is described as a mechanism of social control, no attempt is made to explain why some roles are more stressful than others in the first place. No serious attention is directed to the structural con- straints, to the objective social conditions, the structural bases, the asymmetrical power relations which underlie conditions of stress— fulness and which are attributes of female roles. Consequently, the model, by taking female rela_as its central explanatory element, cannot adequately account for variations among women, all of whom clearly share the "female role". Not only does this perspective obscure struc- tural elements which affect groups of women, and not others, and which some women also share with men in subservient positions of power- lessness, it also ignores the dynamics of female role within a group of women. In short, the concern with women's social roles has led to a neglect of societal constraints and power relations which are stress- ful for women agd_men. As Rayan has pointed out in his critique of studies which focus on social roles and ignore the larger system in N 67 which the elements of social role operate, "What is glaringly missing from the picture are the elements of...class and power" (Rayan 1976: l56)1. In fact, stress itself may be defined in terms of asymmetrical power relations, in terms of the inability to influence one's environ- ment to one's own benefit (Ibid:159), i.e. in terms of relative power- lessnessz. Since powerlessness is not an exclusive attribute of the female role, stress among women and men should be defined, not in terms of gender role, but in terms of the elements of powerlessness in varying societal contexts. Studies of illness (defined in terms of social and psychological elements) in the Middle East also reveal higher frequency among women (Maher 1974, El-Islam 197, Nelson 1971, Kennedy 1967). Emotional fac- tors related to the stressful female role and to role conflict have been implicated in the precipitation of certain mental illnesses and specific culture bound syndromes. El-Sendiony, in testing a hypothe- sis which stipulates that the schizophrenic rate of hospitalized pa- tients would be higher in areas of maximal stress than in areas of minimal stress, isolates female status as a significant area of stress. On the basis of a psychiatric epidemiological survey, he concludes that Psychoneuroses occur more frequently in the female; that suicide is higher in the female than in the male category; that extremely overt manifestations of psychopathology prevail more frequently among hospitalized women patients than among men patients, and finally, that the death rate of women patients is significantly higher than that of men (El-Sendiony 1972:iii). The author attributes this high rate of morbidity among Egyptian women to "high sociocultural stress" which he defines in terms of the female 68 role. Studies of folk illness also attribute higher incidence of culture bound syndromes among women to female identity. In his study of spirit possession in Egypt, Kennedy attributes the higher frequency of the illness among women to "low female status" (Kennedy, op. cit. p. 189). He emphasizes the functional utility of illness among women. Illness is described as a socially sanctioned "safety valve" (Ibid). Like other explanations which derive from a functionalist perspective and which stress the functional utility of the illness role for women, Kennedy's is clearly tautological. It claims that the element "ill- ness" is functional because it has a necessary function in the total system - it functions as a mechanism of social control. What this perspective ignores is that it is the system itself which defines the \/t necessary functions of its elements (gender roles and illness, both). To treat the elements of gender roles and illness independently of the system does not explain the continued existence of these elements. Functional considerations identify the rationality of the elements while ignoring the rationality of the system (Freidman 1971:459). These elements operate within certain structural constraints: specific systems of material production, social relation of production, and superstructural elements which give continuity to stressful roles among women and men. This stressfulness is controlled through the sick role. The sick role is the socially sanctioned concrete manifestation of structural constraints affecting women and men. The limitation of focusing on "low female status" is clarified when one notes that Kennedy's study is confined to comparison of women 69 as a group to men as a group. It does not attempt to identify the variation am22g_women or amogg_men. Since Kennedy and others report spirit possession in Egypt among both.males and females, the occur- rence of illness among women cannot be attributed to an inherent bio- logical predisposition. Neither can gender role be considered the only sociocultural correlate. The stressfulness of afflicted women and men is related, not to gender roles as such, but, more fundamen- tally, to a common origin of pewerlessness and its attendant absence of control over culturally valued elements of the social environment. Relations of power differentials are not confined to male-female inter- actions. women may find themselves subordinated to the authority of females and mean are likely to fall victims to the domination of more powerful males or females. Another type of explanation for the occurrence of illness in the Nfiddle East is that it results from stressfulness associated with the inability to approximate culturally prescribed role expectations. El-Islam (op. cit.), in his study of culture bound neurosis among Qatari women, emphasizes deviation from culturally prescribed role expectations as a precipitant of stress which prompts the adoption of the sick role. While this assumption is generally considered accurate, it is so only as a redefinition of illness, not an explanation of its occurrence. Illness is by definition a deviation from prescribed behaviour. One may correctly anticipate stressfulness and adoption of the illness role under conditions of deviation from culturally pres- cribed role performance, but only when such performance is a culturally valued source of status enhancement, i.e. power3. In certain 7O situations the culturally prescribed roles themselves are stressful, in the sense that they define the person as powerless4. In these cases, it is conformity to role prescriptions (and attendant powerlessness) which iszasource of stress. The sick role allows temporary dispensa- tion from positions of powerlessness which result from conformity to prescribed role behaviour. In short, stressfulness and adoption of the sick role should be explained, not simply in terms of deviation or conformity to role prescriptions, but in terms of whether these roles themselves allow control over culturally valued elements, i.e. whether these roles allow the exercise of power. In fact, powerful persons may deviate from culturally defined roles without the neces- sity of resorting to the sick role. This is illustrated in the study community by the case of a barren bride from a relatively wealthy family who, unlike other childless women did not seek the label "ill" from local diagnosticians and whose mother-in-law never rediculed overtly as is generally the case. This is a situation where one form of power (wealth) compensates for another (the maternal role). To conclude, in some recent studies of gender roles, illness has been cited as a strategy of indirect control (Friedl 1975). It is regarded as a manipulative strategy open to women in their attempt to circumvent male authority. Rather than regarding illness as an index of power or manipulative behaviour on the part of women, this study assumes that illness is an index of powerlessness. It regards the sick role as a mechanism which ensures the maintenance of pres- cribed social roles, their attendant asymmetrical power relations, and stressfulness. The sick role is regarded as an instrument of social 71 control which mediates inherent contradictions in social life. It regards definitions of illness which are cultural prescriptions for controlled deviance as superstructural elements bearing a dialectical relation to infrastructural contradictions and attendant power differ- entials. As waitzkin and Waterman have emphasized, The sick role...(is)...a convenient tool to maintain the status quo. For individuals who encounter oppressive qualities of the social roles...which are part of the objective conditions under which they must live, the sick role permits temporary deviance from usual role- expectations. It also isolates the deviant and prevents the group formation (such as the organization of dissident individuals) which would be needed for fundamental social change. In this sense, the sick role "cools out" the opposition...illness behaviour represents an adaptive response to social structures which are to a greater or lesser degree, oppressive (Waitzkin and waterman 1976:11, 21). In the context of the present study, it is not gender role per se which is assumed to precipitate illness. The emphasis is on stress- ful situations (defined in terms of power differentials), which are related to gender roles. Since stressful situations are not unique to women, one may also expect stressfulness to precipitate illness in men. Moreover, sub-groups of women may be expected to vary in their experience of stressful situations. Indeed, some stages of the life cycle and the developmental cycle of the family expose individuals to variable types and degrees of stress. Furthermore, one may expect some women to approximate the expected role behaviour (which is a source of power) more than others, with deviants representing the most extreme cases of role conflict and powerlessness. The same is expected to hold true for men. Hence, we may expect variation in the frequency of illness amogg women (and among men) as well as between women and 72 men. Validation of the assumption that higher frequency of illness among women results from stress should involve, not only a demonstration of higher frequency of illness (or perceived stress) among females than males (this would be a restatement of the proposition), but more fundamentally, it should show that a higher frequency of illness should occur among women who are identified as being under greater stress than their cohorts. Finally, just as concentration on gender roles obscures the bases of male-female power relations, it also obscures the bases of stress associated with those roles. To explain gender roles or stress as- sociated with them, one must move, conceptually, outside the analytic boundaries of roles themselves to consider the structural elements which maintain these roles. We must consider the fundamental means of human adaptation - production and social reproduction, and their relation to role, power, and illness. 73 NOTES 1In his critique of American psychiatry and the propensity of mental health workers to "blame the victim", William Ryan writes: The purpose of thinking exclusively about status is to avoid thinking about money and power...to locate the cause of disorder largely inside the poor person is to absolve the surrounding society of the sins it has committed against him..." (Ryan op. cit. p. 161). 2Ryan provides a good summary of studies of mental health in the U.S., which clearly reveals the direct relation between stress and social class and powerlessness. 3e.g. stressfulness of childless mothers in a society where children are desirable sources of labour, or stressfulness in spinsters in societies where social adulthood and its attendant prestige accrues only to married women. 4e.g. younger brother in extended family households, daughter-in-law in extended family households where incoming brides are subservient to the authority of older males and females, or the agricultural labourer whose only source of livelihood is his dependence on wage labour, or plantation workers whose stressful condition derives from their con- tinued existence as slaves. PART II: THE STUDY AREA 74 CHAPTER 3 GENDER IDENTITY, PEASANT STATUS AND POWER IN FATIHA A. Introductory Remarks The major focus of this chapter is on the village community and on gender roles within the village. But in accordance with the theo- retical premises of the study which were stated in Chapter 1, equal attention is devoted to the relations between the local mode of pro- duction and the encompassing social formation of which it partakes. Section B provides a general account of the study community, noting the general features of its physical setting, history, and to a greater extent, its social organization. Elements of social organization introduced in this section are taken up in greater detail when con- sideration in relation to gender roles in Section C and when relevant to our discussion of the study community as a peasant society in Section D. Section C of the chapter deals with gender roles in the village of FatiHa as they relate to the central theme of power relations. Themes covered in this section include differential valuation of male and female infants, early age socialization, adolescence, and cul- turally defined adult gender roles. In considering the roles of adult males and females in the village, it is noted that while gender role ascriptions related to the technical relations of production is subject to minimal differentiation, control over valued instruments 75 76 of production and the products of agricultural labour is vested in males. It is such control which is deemed the basis of male-female power asymmetry in the village. Factors which inhibit such control by women are examined. Since the family in FatiHa constitutes the framework of production relations, and gender role differentiation as well, the developmental cycle of the family is utilized as a frame- work for the description of gender role differentiation, relations of production, and their consequences for power relations between, and among, men and women. Having noted the dynamics of male-female power relations in light of the developmental cycle of the family, an ex- amination of power relations which transcend the household is under- taken. Note is made of the insignificance in FatiHa of the alleged universal opposition between a private, domestic and a public, extra- familial political sphere. Further assessment of gender status in the village in Section C proceeds by examination of the differential degree of autonomy and decision making power. Finally, an examination of superstructural elements of village culture reveals ideas and beliefs about males' and females' physical and mental attributes, which legitimize the power asymmetry related to gender identity. The concluding section of this chapter (Section D) relates the conclusion of male dominance derived from our accounts of gender roles in Section C to the theoretical premises of the study which were introduced in Chapter 1. Rather than viewing male dominance in the village as a validation of the alleged universality of female sub- ordination to male authority, the contention is made that this mode 77 of male-female power relations is representative of a specific struc- tural type, namely peasant society. The distinguishing elements of the peasants' semi-capitalist mode of production and the social forma- tions of which it partakes is contrasted with nonexploitative social formations where the differences between males and females are not socially converted into inequalities. This is explained in light of the differing relations of production associated with these contrast- ing social formations. Details of the local social relations of pro- duction are then outlined and the articulation of the study village with the encompassing society is shown to conform to the general elements of the structural type "peasant society". The impact of the encompassing society on the lives of Egyptian peasants, including those of the study community is illuminated in light of the agrarian reform program. Finally, reference is made to a number of mechan- isms imposed by the larger society, which initiate and perpetuate female subordination in the rural areas of Egypt by providing privileged access of males to productive resources (land), wage labour, and educa- tion, thus supporting the maintenance of women's dependent status. The remaining part of the chapter is devoted to an elaboration of the above noted theme through a historical analysis of the im- pact of changes in the larger society on the lives of rural women. Contrary to assertions of Western social scientists who contend that the underdevelopment of Third World countries and the "inferiority" of their women would be obliterated with the flow of Western capital and the diffusion of western values, respectively, the Egyptian ex- perience reveals the inhibitory role of western colonial domination 78 on the industrial development of Egypt and the prolitarianization of her women. B. The Research Locale: An Overview FatiHa, the research setting of this study, is a village of 3,200 persons. It is located in the province of Kafr i1 Shikh in the north- western corner of the Egyptian Nile Delta, nearly midway between Alexandria and Cairo (130 Km to Cairo and 105 Km to Alexandria). The village is connected to these major urban centers and to the capi- tal of the province by a transportation network which includes rail- roads, government operated buses, and private cabs. Administratively, the village is part of the district (markag) of Kallin. It is in this . town of Kallin that the government-operated hospital and private physicians' clinics are located. Villagers also frequent this ad- ministrative center for a variety of official business and for the purchase of goods which are not ordinarily available in the village. They reach Kallin by foot, walking for a period of nearly twenty ndnmmes. Like other parts of the Delta, the village climate is charac- terized by a two-season year. The cool winter (mean maximum tempera- ture of 20°C and mean minimum temperature of 7.200) extends from November to April and the hot Summer from May to October (mean maximum temperature of 34.7OC and mean minimum temperature of 19°C). Rain- fall is confined to the winter months and amounts to a low average annual precipitation of below six inches. These climatic conditions 79 permit the cultivation of various crops (including cotton, corn, and wheat) throughout the year. This is accomplished through the re- liance on a perrenial irrigation system involving the extensive use of canals. Beyond the mention of the village in the Egyptian Geographic Dictionary as "a rural community of ancient origin", no recorded history of the village exists. A composite account of a few older informants (including an 84 year old descendant of slaves who were originally brought to FatiHa by the ruling Turkish elite), describes the origins of the village as follows: Our village was a vacant wilderness which was taken over by Hiddar Pasha. It was given to him as a gift for his services to the army of the Sultan...Later on it was given to a Turkish Mamluke by the name of X...About a hundred and fifty years ago, X came from Albania with MuHamad Ali. He was employed as a ruler in Disuk (a nearby provincial town). He was given our village to settle and to bring under cultivation. X gave up his administrative post, turned to religion, and set- tled in FatiHa. He built the mosque and a maDyafa (a tradi- tional guest house). He owned all of the 550 feddans which were granted to him by the descendants of MoHamad Ali Pasha ...He retained the village population which had formerly been under the iltizam system (a system of tax farming) and which was doing public work. He also distributed land for sharecropping by half...He imported peasants fleeing from the hardships of the tax system imposed by MoHamad Ali. Under MoHamad Ali, all the land was under the miri system. Land was parcelled to families for sharecropping with the landlord, each paying half the expense...(yes) X was a multazim (tax farmer). Under Ismail, all the land became mulk (private property) of X. Under Tawfik (the Egyptian Khedive), land which was not distributed was sold to peasants. Other a‘yan (land owning) families as the house of A. A, Sh., N., etc... who originally came as labourers then accumulated land which the descendants of X sold. It is evident from these older informants' accounts that slave labour was also employed by X. D.N., herself a descendant of a Sudanese slave described slavery at the time of X as follows: 80 X bought black and white slaves. Black slaves were not employed as agricultural labourers but as domestic ser- vants since they didn't know the ways of the fellaHin and they were lazy...X married some of the slave women to local peasants as an encouragement to work the land. The peasants were forced to marry slave women to produce children to work in the X household. The man was given two feddans and the slave woman was given a house and became free...they (her ancestors) had no right to leave the X household...he made them marry among each other so that the slave children would remain black and remain under the authority of the X family. In recalling the history of the village, the headman, a descendant of the X family noted, "In earlier generations we never used to marry from the fillaHin, and only with few exceptions we did not marry the black slaves. But I have broken this rule. Now you know how important education is. My own daughter married the son of a fillaH, but he is of course educated (agricultural engineer)". The belief in the function of education as a substitute for aSl (descent) is shared by other villagers. However, not all who are descendants of the ruling elite subscribe to this belief. They note that nothing can be substituted for good breeding and aSl. In terms of the physical layout of the community, the village of FatiHa, like other villages of the Nile Delta is composed of nucleated compounds surrounded by fields. The zawya (a religious shrine) which houses the tomb of the village patron saint, Sayida Z. (a female descendant of the traditional Turkish elite) is con- sidered the center of the village. Close by is the local mosque where Friday prayers for males only are held. These two major build- ings of the village are adjacent to the house of the village head- man and to that of a relative. Both of these houses differ in their construction from the mud, sun baked houses of the peasants. This 81 central part of the village houses two grocery stores and a barber shop and is surrounded by the dwellings of the villagers which are in turn surrounded by their fields. Village houses usually consist of anywhere from four to eight rooms, including animal sheds. One room is usually reserved for sleeping but may also be used for food preparation and the entertain- ment of guest, depending of the size of the family occupying the household. A storage room usually contains large bins made of mud and used to store wheat or corn for the while year after harvest. Toilet facilities in the houses are usually absent. When a toilet is found in the house it is simply a small hole which leads to a very large reservoir inside the house courtyard. The toilet room, when available, always has a small window for ventilation. When no toilet facilities are available inside people's houses, they defecate in the animal sheds or out in the fields, or as an informant noted, "any— where where it is convenient". Some people who not themselves own land defecate in the fields of their neighbours who view such an act with favour, given the valuation of natural fertilizers. Excreta are left exposed and are usually the locus of hordes of flies. In the village dwellings, all the rooms usually have windows for ventilation and the dahiig_(the center of the house) also has a manwar (a spot through which direct sunlight enters the house). The dahliz also has stairs which lead to the roof of the house where straw and dried wood are stored for use in the ovens for baking. The area of the house used for baking is usually not well ventilated and women generally complain of sore eyes and difficulty in breathing. They 82 attribute both of these ailments to the smoke. Sleeping arrangements inside the house depend on the size of the family. Among nuclear fandlies, the whole family may sleep in a single room. In extended family households, the mother and father-in-law may sleep in the same room with all their grand children, while each of the married sons of the older couple shares a room with his wife. Among nuclear families where parents share their rooms with their offsprings, it is known that children are exposed to the practice of sexual relations between their parents at a very early stage of their lives. It is also said that sometimes young siblings may try to immitate the parents' actions during their hours of play. The long hours of field work during har- vest time are also believed to afford young adults the opportunity for sexual foreplay. Sanitation is the responsibility of individual households. No public system of sanitation exists in the village. People simply clean the area in front of their own houses. When the author naively asked informants how they dispose of their garbage they simply laughed. One person noted, "we have no garbage here, we even sell the dirt. we bake and burn and heat our garbage...we even use our own waste. we pile what comes from.the bi: (pit, i.e. toilet reservoir) in the ziriba (animal shed) and we use it as fertilizer for the corn and wheat...". water supply for the village is obtained from.two sources: the canals and the two large taps of water, one at each end of the village. About six houses in the village have running water. water supply from the public taps installed by the government is intermittent and 83 villagers often resort to filling their air (water storage pot) dir- ectly from canals. When available, water from the public taps is used extensively by the women for cooking and drinking but washing of clothes is usually carried out at the side of canals. When people are working out in the fields they are also often forced to drink out of irrigation ditches. Contaminated water supplies are respon- sible for Schistosomiasis, a disease transmitted by fresh water mol- lusks. Repeated infections are difficult to avoid in view of villagers' constant contact with polluted water during the course of daily work in the fields. The use of polluted water for drinking and bathing adds to the spread of infection. Polluted water also accounts for widespread enteric diseases and dysenteries which are known to be the major causes of death. High infant mortality in the rural areas of Egypt is usually attributed to diarrhea which results from poor sani- tation and polluted water supplies. The villagers themselves are well aware of the potential hazards of canal water and its effects on their health but they note that it is their fate as peasants to work in, and drink, dirty water. Turning to the economic organization of the village, it is noted that FatiHa is a community of small landholders. As was described in the Introduction, the range of land distribution in the village is rather narrow, varying between zero and eight feddans. Wage labour provides the only source of income for approximately 10-15% of the people of FatiHa. Both males and females work by the day in the fields of people in the village or are part of migratory labour forces which may be away from the village for as long as one or two months. Males 84 and single females to on such TaraHIl (migratory) trips.l Married women usually do not join such groups alone. However a woman who is separated from her husband or divorced from him may leave her children with her mother and go on a TarHila, this seldom happens, however. Occupational specialization in FatiHa is minimal. With the ex- ception of the village barber and the carpenter, all the inhabitants of the village are cultivators who work the land themselves or as in the case of a minority of families, hire laborers or rent their land to others. Land is a highly prized possession and the peasants of FatiHa seize every opportunity to convert any form of accumulated wealth, including their wives' jewelry (often against the objection of the latter, unless they are made co-owners) into land. Of the nearly 90 feddans owned by non-peasants (the descendants of the traditional Turkish elite, who reside in the major urban centers of Cairo and Alexandria), the greatest part is rented out to peasants. The few plots which are not rented out are left under the guardianship of a ‘gagir_(overseer) who supervises the total process of cultivation, harvesting, turning in the required government surplus, and selling of the agricultural products, in return for a stipulated portion of the products of the land. Sharecropping in such cases is usually by half (shirka bilngiSf). This involves the equal sharing of crops. The overseer contributes the labour and the owner provides the use of the land. Aside from private ownership, utilization of land may proceed according to any of three forms of rent: Naq_, shirka, and garia waHda. In the nagd or cash form of rent, the rent is fixed by the 85 government at seven times the tax per feddan (amounting to approxi- mately 23—26 L.E./feddan/year). This provision followed the 1952 land reform measures which were designed to establish security of tenancy. According to these provisions, land can only be rented to a tenant who will farm it himself. The tenant is expected to pay a defense tax, a road tax, a national security tax, all of which amount to ap- proximately 4 L.E./feddan/year. In the shirka_ (partnership) type of tenancy (also known as muzar‘a or planting together), sharecropping proceeds by half. The owner provides the land and half the seeds and chemicals. The products are also shared by half. The tenant cannot at any time be removed from the land unless he forfeits any of the terms of the agreement. When this occurs a local council settles the dispute. Payment of taxes on the land are shared equally by the land owner and the tenant. In the case of zar‘a waHda (one plant- ing only) type of tenancy, the owner has greater control over his land, although in some cases the tenant may go ahead with a second planting and the consequent sharing of the harvest products. The most common form of tenancy in FatiHa is the naqd, In general rent on khalaS (even) is the form practiced by owners who reside outside the village while rent by shirka (sharing) is the more common form among those who reside in the village. Beyond the formalized sharing associated with shirka tenancy, there exists in FatiHa a form of exchange labour known as Eamala (partnership). According to this mutual, non-contractual form of cooperation, people help their friends, neighbours, and relatives with a variety of agricultural work. Men help.each other in the 86 digging of cotton or the harvesting of wheat and corn, or in ploughing, where a person borrows another's draft animals. It is believed that this form of cooperation is undertaken by those who cannot afford to hire wage labourers. It is noted that "the person whose arms are wide does not become a partner, he hires labourers". Women engage in zamala for the purpose of baking, and to a certain extent for child- care. For some of the older village women who take care of children whose parents do not have the opportunity to reciprocate by providing for these older women the same kind of service, they may send the older woman small gifts of bread or some rice or sugar. Younger unmarried women also cooperate with their female friends during time of plant- ing and harvest. Villagers are also obligated to a collective sharing of major disasters befalling fellow villagers. This is evident when a farm animal is killed at times when its death seems inevitable. Villagers buy meat from the owner of the animal as a way of compen- sating for his/her major loss. Other disasterous occassions when co- operation among villagers is expected are deaths and extended illness. On several occassions people borrow a variety of items from each other. Neighbours and relatives borrow from each other food items such as corn or rice or wheat until they harvest their own crops and then they return the borrowed amounts. People develop reputations for their generosity (or otherwise) in lending fellow villagers in their time of need. On an almost daily basis several other food items such as sugar, onions, or tea are borrowed and equivalent amounts are returned at a later time. People may also use each others' ovens, and if a woman has no time to bake she asks her neighbour to lend her 87 a specific number of loaves which she returns when she bakes. When animals are borrowed, the person who borrows them is responsible for feeding them. Borrowing of money does not involve the payment of interest. Older informants remark that since the establishment of the agricultural cooperatives with their credit system, villagers no longer have to resort to money lenders who years earlier used to charge the peasants exuberant interest rates, sometimes reaching as high as ten percent. However, a disguised form of charging interest does exist through the pre-harvest sale of the anticipated crop yield which is then collected and sold by the lender at a higher price and with a substantial profit. Resort to such forms of borrowing results from the peasants' chronic shortage of cash. Thus, people may purchase salt, rice, or corn in exchange for other agricultural products. Ser- vices may also be paid for in kind rather than in cash. WOmen who help others bake take home with them some of the baked bread as a pay- ment for their services when there is no intention of reciprocating these services. During the harvest season agricultural products are exchanged for a variety of goods and services ranging from children's sweets to the payment for field labourers, to help in baking, to the circumcision of a child, or the recitation of the Quran at funeral services. Aside from reciprocal exchange of goods and services, donations are given, particularly around harvest time. Such donations as gakat_ ii arD_(alms of the land) are given to those who are considered needy, around the time of harvesting of corn, wheat, and rice. EESE.(VOWS) in the form of agricultural products or in the form of money are also 88 given to poor members of the community. As one such person commented, "I was given many things by people whom I do not even know. They simply give to ahl_AiIah (the people of God)". While there is a high value placed on generosity and sharing with needy fellow villagers, this does not undermine the importance which villagers attribute to thrift and saving, all for the final goal of accumulating agricultural land. Women, who can afford to, accumulate cash through the buying of some chicks and selling their products (eggs), or the grown chickens themselves, for a profit. When enough money has accumulated from this undertaking, a woman may invest in a goat whose kids are eventually sold at what is generally considered a large sum of approximately ten Egyptian pounds (L.E.). Goat milk may be consumed by the woman's family or she may turn it into cheese which is either used by members of her household or sold for profit. The same venture may be undertaken for the buying and selling of water buffaloes or cows. WOmen who can afford to undertake such profitable deals are those who have a little money of their own and which they are able to invest in the feeding and upkeep of animals. Others who do not have access to such private cash cannot maintain such a chain of savings. Their husbands and older affines expect them to either utilize the products of purchased animals for the direct consumption by household members or to sell them and buy necessary goods for the family. Accumulated cash may be wrapped inside a rag and buried in a wall in the house and covered over with mud. As soon as a woman accumulates enough cash, she may supplement it by the sale of her jewelry which was provided by her family to her when she was 89 a bride, she then turns to invest her savings in land. Similarly for males who are able to accumulate some cash from the income derived from.products of their land, they turn to investment in land when- ever the opportunity arises. In short, any accumulated savings are ultimately placed in land. Even those who buy jewelry but it is only as an intermediate step to buying land. They buy gold when it is cheap and sell it when it is expensive. Social status is based pri- marily on land ownership. Opportunity for savings among the majority of peasants in the village is very limited indeed. Rather than accumulation of wealth one notes the fragmentation of property through its division upon inheritance. The limited opportunities available for villagers to accumulate wealth makes them reluctant to invest their savings in any undertaking which is not considered fail proof. Purchase of land and its cultivation with the standard crops of cotton, wheat, and corn is the general rule. Innovation entailing the planting of flowers for the international market has been undertaken by relatively richer cultivators from the nearby village. The family which introduced the planting of flowers was the same one which introduced the cultiva- tion of potatoes as a cash crop in the area. Villagers recognize that it is only the well to do who can take such risks and who can experiment with new crops. Ideally, accumulated wealth is passed from one generation to the other according to the Islamic 3322a, In actual practice, however, the terms of the aggga may be violated. Items which get inherited include houses, land, and farm animals. If a woman dies, her husband 9O inherits her jewelry and her parents take her clothes. If she leaves land, her husband and children take her land. If she is childless her husband and her siblings inherit from her. Her husband inherits half and her siblings inherit the other half. When a man dies, his wife and children inherit his property. His female offsprings inherit half the share of their brothers. The female is said to receive a kum (pile) and the males kumin (two piles). His wife inherits the timin (1/8 of the total property). Disputes over inheritance are com- mon in the village and a lot of the time of the Shikh il'balad (a lo- cal official charged with the maintenance of law and order at the vil- lage level) is known to be spent over the settlement of such disputes. He recounted his role in such a settlement as follows: I have a case of a man who is threatening his wife and her brothers that he would divorce her if her brothers do not give her the share of her father's inheritance. Some people do not follow the shari‘a (Islamic law) and will for the boys only and exclude the girls. In this particular case, before the father died, he sold over the land to his sons and kept the registration with a friend to ensure that his sons would not abuse him during his lifetime. When his daughter's husband found out about it after his father- in-law's death, he came to me. There is not much that I can do except try to tell the woman's brothers to fear God and give her her rightful share. I have only one girl and I even gave her kumin. As was noted earlier, agricultural production is the basis of livelihood in FatiHa. Cultivation of the land proceeds through family centered labouring in private or rented plots and through hiring of wage labourers to work privately owned land. The only form of col- lective ownership associated with agriculture production is that of the sagya (waterwheel which is used to draw water from low levels and bring it up to the levels of the channels dug out in the fields). 91 The sagya, which may cost up to L.E. 350, a sum beyond the means of the majority of the villagers, is owned and maintained by a party of 5-6 families. People who cultivate adjacent fields and who collec- tively own and operate a aagya take turns watering their land by opening up the appropriate channels. an are generally responsible for this task, and those with adjacent fields are known to cooperate with their neighbours in watering each other's fields. The procedure for establishing turns for watering the fields is generally informal and amiable. However, occasional acts of violence may occur when people fail to wait for their turn. In cases of such disputes, the famda (village headman) is resorted to for the resolution of differences and for bringing about a reconciliation. Collective responsibility also pertains to the yearly cleaning of the village ponds. Families are expected to contribute labour according to the number of feddans which they plant, the stipulation being one person per feddan. Follow— ing drumming to announce the beginning of work, people join the work parties. Those who fail to do so are charged according to the amount of land they cultivate, L.E. 0.25/day/oerson. Cleaning of the maSarif (major channels) is the responsbiility of the government which accome plishes this task through the employment of migratory wage labourers. Cultivation is a strenuous exercise which involves hours of back- breaking work from sunrise to sunset, with a short break for lunch in the fields. Villagers usually complain of pains in their backs, legs, and wrists and many of them use a wide woolen belt to tie around their waist for the purpose of supporting the back. Many people are found with woolen string tied around their wrist and ankles to minimize A ) 92 pain and give support to the bones. Cultivation is a year-round undertaking involving continuous work centering around the preparation of the soil, planting, irriga- tion, harvesting and processing of agricultural products. Cotton is considered the most important crop and one which needs lots of servic- ing. When cultivated, cotton covers a third of the total planted area of the village fields. The land for planting cotton is ploughed three times, this is usually considered the work of men. Eight days after the watering of the soil (tamliya), the seeds are planted by male and female children. Like other agricultural activities, the planting of cotton is regulated by the Coptic calendar. As in the case of all other planted crops, the growth of cotton depends on irrigation. Twelve days after the planting of the cotton seed the stem is expected to make its appearance. The cotton remains in the ground for six months. Following heroic efforts by the peasants to keep the plant free of parasitic organisms, the harvesting of the cotton crop starts in September. Men, women, and children join harvesting parties. During this period wage labourers may be paid as much as 0.40 L.E. per day as opposed to the usual daily wage of 0.25 L.E. The land which is planted with cotton is not replanted with this crop until two years later. Cotton harvesting is then followed by wheat. Spreading of the wheat seeds is usually undertaken by men. Harvesting of wheat in May involves labour input from all members of the family. Villagers rent machines either from private owners or from.the agricultural cooperative to separate the wheat kernels from the straw. Planting of rice follows the wheat harvest. 93 Shitla (sprouts) of rice are prepared in a small portion of the field and then transferred and spread throughout the entire field by men, women, and children, who stand almost knee deep in muddy water for hours. Weeding keeps all family members busy until the time of the rice harvest around October when all members of households, except older persons (and the relatively well to do) participate in the bar- vesting. The rice crop is in turn replaced by alfalfa which is har- vested four times. The cattle are fattened at this time and they produce lots of milk which is either sold, consumed, or turned into cheese. The planting of corn then completes the agricultural cycle. The significance of landownership is evident in villagers' rank- ing of fellow villagers. Following the descendantsof the Turkish elite, villagers who own larger amounts of lands, and their families, are consistently ranked by villagers higher than those who have small- er amounts or no land at all. In noting the significance of wealth as a measure of social worth, people note, "if you have a millim (l/lOOO of a L.E.) you are worth a millim. If you have a pound, you are worth a pound". However, possession of cash is not considered as a reliable basis of prestige. It is land which is said to be reliable. Thus, while landless peasants with many children are known to make more money and are even said to eat better than families who cultivate privately owned or rented plots, it is also recognized that such families of landless labourers are most insecure. An informant expressed this perceived insecurity in her account of the life of her landless neighbour. She remarked,"...she has no land at all. But she is not any poorer than people who have a feddan or less. She has 95 no better substitute. Prestige in the community rested on the amount of land controlled by a given family and the number of men it produced. The prestige of females in particular rested (and still does) on the number of male offsprings. Literacy in the village was limited to members of the Turkish elite group. They attended school in the near- by town or were sent off to be educated in Cairo or Alexandria. Some villagers frequented the kutab_(traditional school for religious instruc- tions and reading and memorization of the Quran). According to Shikhs Z. and G., who have been teachers in the Kutab for many years, male children became literate through reading and memorization of the Quaran. Both these teachers noted that in the old days the children who attended the Kaiab_came from well to do families. They came from families who could spare the labour of one or more of their children in return for the prestige gained from having a religious and learned member in the family, whose baraka (blessing) would shadow the whole family. Other attendants of the kutab were boys who had a physical handicap, particularly blindness, and whose families had chosen for them the career of reciters of the Quran. According to the village headman, literacy has increased in the village and school attendance has become a desire of parents for their children. He contrasted this eagerness to earlier resistance by the villagers to sacrifice the labour of their children for edu- cational training which they were fully aware could not be realistic- ally completed in view of their dire poverty. According to article 19 of the 1923 Egyptian constitution, elementary education (6 years) was deemed compulsory for boys and girls. In accordance with this l'h 96 ilzami (compulsory) scheme of education, the school in FatiHa was established in 1934. The incompatibility of school education with the general life style and economic constraints of the community was an important deterrent to the acquisition of a formal education by the children of peasants. Children were sent to school occasionally, only to avoid the fine for lack of compliance with the regulation im- posed by the government. Thus, while children were legally registered in the village school, most of them seldom attended. Those who did attend were absent for many days during the periods of heavy agri- cultural work. Consequently many of the children never learned to read or write, although they had attended school for a few years. Thus, census information collected for the 214 female and 193 male adult occupants of a sample of 100 households in the village shows that those who had attended school under the ilzami_system never ac- tually acquired the basic skills of reading and writing. Today, in spite of the eagerness on the part of village parents to enroll their children in school, the economic constraints on the family mitigate against the fulfillment of such a desire. Only a minority of school age children ever complete even the elementary level of school educa- tion. Fewer still ever complete secondary school. The census survey of level of formal education shows 114 males and 171 females as illiterate and as having never attended school. 42 males and 44 females are illiterate in spite of having been register- ed in school for periods varying from one to six years. Only 18 males of the sample population and 6 females have completed a secondary education. Six males and 2 females have High School Certificates, 97 11 males and only one female have completed intermediate level educa- tion and technical institutes. One male and no females has attended the university and the same male has entered graduate school. This man is the object of extraordinary respect from fellow villagers, including his parents, and his mother in particular. She never refers to him by his name but instead uses the honourific title of Eatag. The relatively limited education of females reflected in the census data remains the general trend in the village over the past few years. Village records show that enrollment of girls for the school year 1971/72 was 65 for girls as compared to 181 for boys. In the year 1972/73 the proportion of girls was even lower, with 51 registered females as opposed to 229 males. Finally for the academic year 1973/74 62 girls and 163 boys were enrolled in the village elementary school. Prestige acquired through education or through any other cultur- ally valued means is important not only to the person directly con- V cerned but to members of his entire family, be they close or distant relatives. In this regard it is important to note that as the in- dividual's actions reflect on his family, conversely, the individual c/ him/herself derives identity primarily in terms of family affiliation. Individuality is not a culturally valued trait and the author usually had a difficult time explaining the concept to informants. In response to an inquiry about indivuality and about how villagers strive to promote personal interest informants noted, we never think of ourselves as just persons alone. we make ourselves closer and closer to relatives...if a man does not have relatives he picks a wife who will give him good affines...A man stays close to relatives and picks affines to make a ‘izwa (support group) for himself, as they say, 98 one hand does not clap along. wala waHdani yikid rigal (a single person never impresses men)...the woman who has a ‘izwa is supported by her relatives. She is courageous in her relations with women and with men, including her husband and his family. The importance of derivative power for women who can rely on the sup- port of their families was underscored by a female informant who noted, Even though I came from a wealthy family, my father was poor, so I cannot rely on him (i.e. for support), so I am good with my husband. I control my tongue and I never go to them (her family) when I am in trouble with him. A woman who has wid (support) from her family complains to them and they talk to her husband; they may even hit him... Beyond villagers' prescribed obligations to the state (See sec- tion D below), the basic framework of social organization, notably production relations is based on kinship ties. Members of nuclear, extended, or fraternal joint families collectively cultivate private or rented plots of land and share the products of their collective labour. Among families who depend on wage labour, income is derived from the labour of all family members, including very young children. A survey of the sample population of 100 households in the village shows the predominance of nuclear family households. 0f the 100 house- holds surveyed, those headed by males included 40 nuclear family house- holds, 4 two person households (of these three are occupied by child- less couples and one by a couple whose female children had all married out), 17 nuclear families with one or more adult relative, 14 extended families (parents or parent substitutes, married sons with their wives and children, and unmarried siblings), 9 fraternal joint families (brothers, wives, children, unmarried siblings, one parent - mother -, 99 also occasionally older relatives). Of the female headed households, 8 are occupied by matrifocal families consisting of widowed mothers and their children and 3 by extended families (consisting of mothers, married sons, wives and children and mo's unmarried children). The remaining 5 households headed by females included 3 two three-person households (2 mo and so, 1 wi, wifa, hu) and two single occupant house- holds (2 widows). In FatiHa, relatives who reside together in the same household are considered the primarily socially significant unit of an individual member. The arabic word :ayla (derived from the verb yajil, meaning to help or to support) is used interchangeably with the word 923. (household) to refer to a family. In accordance with the developmental cycle of the family, the size and the composition of the basic social group around which an individuals' life is centered (i.e. the family) changes. Phases of the developmental cycle of the family produce three major types of families, the nuclear family, the extended family, and the fraternal joint family. In each of these cases, these kinship units form the framework of village centered production relations, only if their members occupy the same household. In few cases, however, members of extended and fraternal families may continue to occupy a room in the family household but may have their separate ma‘isha (livelihood). As is typical of the Delta region in general, kinship units beyond fraternal or extended families have no lasting corporate identity. Tribal loyalties are absolutely non-existent in the village and terms for larger kinship units such as Hamulat or Qabail (clans) are alien to the majority of villagers. Genealogies are remarkably lOO shallow and most informants cannot recall the names of ancestors beyond great grandparents. Support for distant patrilateral or matri- lateral relatives occurs only on ceremonial occasions related to mar- riages and deaths, or on the occasion of the breakout of such dis- asterous events as fire or violent disputes. The villagers are all said to become yad waHda (one hand, i.e. unified) in disputes with outsiders. In this regard an informant remarked, "If someone from our village is in conflict with an outsider over women or even over the use of the aagya (waterwheel), the people of FatiHa take the side of ibg_il_balad_(the son of the village). In these cases we are all considered ahl (kin). People say, 'my brother and I against my cousin and my cousin and I against the stranger'." This sense of 533222 (kinship) is believed to extend to all Muslims. When an in- formant was asked about the relation of villagers to the rest of the Egyptian people, she responded, "we are all Muslims and we are all one". The villagers of FatiHa differentiate between garaba_(kinship) and nassab (affinity). It is said that the garaba (a word derived from the arabic word garib meaning near) is from the :aagab_(the lower back of the man from which the semen is believed to descend and cause pregnancy) and that naaaab_(derived from the arabic word yagaib, mean- ing to relate to) is from the ma:ua (a term used to refer to part of the reproductive system of women). Informants generally believe that the relatives who are from the :aaaab_are closer than those from the mafiug, It is said that the paternal uncle is a father and that the paternal counsin is a brother. It is also believed that during times 101 of trouble one expects the support of patrilateral relatives as a duty. But beyond formalized expectations of support from patrilateral relatives, people say that the real test of kinship relations is wid; (support and amiable relations). Following this logic, people refer to the fact that matrilateral relatives (who are considered more distant relatives) are kinder than relatives from the father's side. As in the case of father's brother and father's sister, it is also said that the maternal uncle is a father and the maternal aunt is a mother. Thus while it is verbalized that a person has more dalai_ (i.e. has more right to support) from his paternal relatives, it is recognized that women tie the families together and that the kha1_ (maternal uncle) plays an important role in the raising of his sisters' children. The maternal uncle also plays an important role as an adviser and mediator in cases of marriages and disputes. Of a person who is illbehaved, it is said that he has no 52213 meaning that he has no one to teach him politeness. The ideal amiable relations between the khal_and his sister's son is believed to be an extension of the idealized relation of a brother as a protector and comforter of his sister. According to a local proverb, "a brother is like an arm, if it falls, it can never be compensated for". However, it is also recognized that once a brother is married, he becomes subject to the control of his wife. Another proverb expresses this belief: "a brother is the brother of his wife and the naive one (i.e. his sister) swears by his life". In summarizing villagers' differential expectations from paternal and maternal relatives, one may note that in case of the former, 102 these are seen as obligated to support an individual family member. They are regarded as the group from which an individual derives his/ her primary social identity and material possessions. By contrast, maternal relatives are regarded as the locus of emotional comfort and sentimental attachment. Marriage is considered the basis of all types of kinship rela- tions. Various functions are attributed to marriage but villagers generally consider the production of offsprings to be a primary func- tion. Marriage is also considered a supernaturally ordained means of satisfying what are considered natural human sexual desires. Infor- mants note that the world would cease to exist if people did not get married and that marriage is God's preparation for the birth of child— ren. While male and female informants agree about this general func- tion of marriage, they differ in their characterization of additional functions. women note that men marry for their'gggaj_(mood or dis— position). A female informant remarked...,"they marry us to take their ghiya (desire) from us", i.e. to satisfy their sexual desires. Other women believe that men marry for their comfort and others say that, in addition, men marry women to serve them and to serve their mothers. While some male informants also reiterated the function of marriage as a means of satisfying sexual desire, those who were reluctant to admit this to the author simply referred to marriage as a.§u§§a_(lslamic practice). Beyond unions which are considered incestuous (e.g. unions be- tween members of a nuclear family other than the parents, between children and siblings of parents, and between sons and daughters- in-law and the parents of their spouses)2 marriage may take place 103 between any of the members of the community. While some men and women from the village have married outsiders, one notes a general trend of preferential village endogamy. As one informant noted, "...in the village we are all kin and affines; brides from outside do not fare well." Mothers of adult males are particularly opposed to the mar- riage of their sons to urban women. It is remarked that if a man marries a woman of equal or lower status she would obey him, but if he marries one of higher status (notably an urbanite) she would not make him comfortable and would not obey his mother. A grandmother expressed her sentiments on this subject as follows: "I educated my grandchild- ren and I sold everything I owned for them. My grandson who used to live with me decided to take someone who is lower than him so that she can obey me. NW'other grandson who works in the South refused to marry a woman who is employed and drives a car. We are fillaHin (peasants); we are different from the people in the city. That's why we don't want to have our children marry from them". Within the village, marriage to close relatives is the ideal. It is said "those whom you know are better than those whom you do not know." In actual practice however, marriage to close relatives is not the predominant form. Of the 124 marriages recorded in the census, the largest proportion of 86 marriages occurred between distant or non kin from the village, and only 20 FaBrDa marriages were recorded. Nine MoBrDa marriages, 2 MbSiDa marriages, and one FaSiDa marriage were also recorded. Village exogamy occurred in only 6 cases of marriage. Beyond the sample population, 8 cases of polygamous mar- riages are recorded for the entire village. Taking a second wife 104 occurred among older men who ranged in age from 40 to 66 years. Their first marriage ranged in duration from 3 to 22 years. These males gave a variety of reasons for taking a second wife. These included, "beauty and love", "arrogance of the first and beauty of the second", "barreness of the first", "love of change and incompatibility", "wealth. beauty, and ‘uzuwa (support)", "love and affection", "beauty and the body", "wealth and some beauty". IMarriage is generally considered one of the most important under— takings in a person's life. In view of the significance of the selec- tion of a marriage partner, the process is not considered solely the responsibility of the future marriage partners but is generally con— sidered a family undertaking. The man's mother takes a leading role in the selection of a bride and her approval is accorded culture sanc- tion. The significance assigned to the mother's approval of a poten- tial bride is rationalized by reference to the fact that "she is the one who will be with her at home". Informants generally agree that a good bride must be polite, a good worker, healthy and beautiful. In defining the quality of beauty a female informant remarked, "...a woman's beauty is in her cleverness. She should be able to withstand hard work in the sun. All our women look alike, they are all related, they only differ in their capacity for hard work". In defining beauty, a group of male informants gave a different definition. They referred to a beautiful woman as one with fair skin or one who is dark skinned and has beautiful features. They generally agreed that a woman's beauty is more important than her politeness. One of them remarked, "a woman's appearance cannot be changed but politeness can be forced 105 upon a woman". In addition to her beauty, good nature, abilities as a domestic worker, and her a§I_(origin or descent), informants define virginity as a necessary quality for a bride. It is said that only a very poor man will accept to marry a woman who is not a virgin (al- though she has not been married before). Such men are recognized as not being able to afford the payment of mahr_(bride wealth). It is also said that a man will knowingly marry a woman who is not a virgin if he loves her very much. In this case he marries her for love and Satra_(protection, i.e. protection of her honour and that of her family). The relative devaluation of women who are not virgins (in- cluding those who had been legally married at one time), is reflected in the differential payments of bridewealth (mahr). For women who are virgins, the standard mahr_in the village is about 100 L.E. For a woman who is aayib (loose, i.e. not a virgin), including divorced and widowed women, people do not pay more than 30 L.E., and in some cases such women will not be provided with a mahr at all. The birth of children is generally believed to cement matri- monial ties. Adoption is never considered a substitute for the cul- turally prescribed female role of producing children. In fact, adop- tion in the sense of extending social recognition of parenthood to a child is non existent in the village. Barren women may keep the children of relatives in their households for extended periods of time, feed them, clothe them, and generally treat them like their own. The children may even refer to such women by the kinship term for mother (agga). However, this relationship is recognized as transient and such children are eventually claimed by their parents. Unable to 106 substitute for what is generally considered a handicap, the barren woman faces the threat of divorce. While additional causes for ter- mination of matrimonial unions were noted for the 21 divorce cases recorded for the period between 1966 and 1974 (including marital in- fidelity, disobedience of wife, to her husband or her mother-in-law, and stinginess of the husband), barreness in women and sterility in men are generally regarded as legitimate grounds for divorce. Marital disputes, which do not require court settlements are usually resolved within the family or with the help of the local head- man (‘umda) and the two Shikh balad. In addition to the settlement of such disputes these local government officials are charged with the maintenance of public order. In this undertaking they are aided by the _s_h_i_k_h_ _i_l_ M and his men. Them and the two shikh balad (elders of the village) settle most disputes within the village, only conflicts involving injuries or those which can only be settled in court are referred to the markag_(district) officials. Disputes brought to the attention of these officials range from those related to utilization of land to conflicts between women and their husbands. In his account of his latest settlement of a conflict between a mar- ried couple, one all-1kg ba_1ag_ remarked, ...women are hard headed. They are naturally this way. It is impossible to convince them that they are wrong. So, at least on the surface, I try to place the blame on the man, but we men understand each other. If a woman is egged on by her family, she feels that she has support and becomes very stubborn...When a man and a woman have no children, it is very difficult to convince them to stay together. People stay together even when there are differences because they are held together by children...Wbmen like to have child- ren. If their husbands cannot have children, the women roam around and become pregnant. Even when the man knows that the child is not his, he shuts his mouth because his wife's pregnancy is a proof of his own manhood. p..— 107 The two ahikh;balad, one representing each of the two sections (gigs) of the village and the‘u_m_c_i_a are elected official of the local government system. The two mashayikh are each elected by the vill- agers who inhabit their respective sections of the village. Assump- tion of the duties of the post is subject to the approval of a gover- nate level committee and ratification by the Egyptian Ministry of the Interior. Thefgmda_is also elected by the villagers. Eligibility for this post entails ability to read and write, age of over 25 years, and the ownership of land. These criteria are not determined by the villagers themselves but are drawn up by the Ministry of Interior. The villagers' choice is subject to approval by a governate level com- mittee and to final conformation by the Nfinister of Interior himself. In 1960, the present ‘L_1_m_da was the only candidate for the post. In January of 1975, the Nfinistry of Interior found it unnecessary for new elections to be held since no opposing candidate stepped forward for consideration. The present Ends is a descendant of the traditional Turkish elite. In view of the high esteem in which villagers hold urban mannerisms and personal acquaintances to officials in urban centers, they value the ”£92 as a representative of their village. While many of the villagers believe that the general misery of their life will not be greatly affected by one ‘_u1_n_da or another and that government officials are primarily concerned with their own interests and not those of the villagers, supporters of the'ymda take pride in his identity and his a§l_(descent). One such supporter remarked, ". ..we all know that there is no better 112513 for this village. He is ibn aSl (a son of superior origin). He is not like the other 108 In addition to his function as the villagers' representative vis-a-vis higher levels of government bureaucracy and his entrust- ing with implementation of government directives, thefumda_carries a variety of local level administrative functions. He supervises all elections and referenda related to local and national representa- tion. He is responsible for delivering young men requested for military service to the proper authorities. Thefumda also undertakes the registration of births, deaths, marriages, and divorces. He also supervises public health services in the village and immunization clinics are held in the courtyard of his house. 'Mobilization of vil- lagers for the control of the cotton crop parasites is also a res- ponsibility of the 31.1199.- As a descendant (khalifa) of the village patron saint, them also has certain religious functions. On the day of the muiid_(pat- ron saint's day), following the noon prayer, the ‘1_1_m£_a_, seated on a horse and dressed in traditional village attire, leads a procession through the village streets. He is accompanied by an entourage of sword holders, drummers, and singers who chant the praise of God and the Prophet. During the day of the maiid_peasants from nearby vil- lages are hosted by the people of FatiHa who donate food for the enter- tainment of their guests in large open space on the outskirts of the village. Those who come to visit the shrine of the Sayida Zinab come to fulfill vows to the patron saint or to ask for her help in the resolution of various misfortunes, including the cure of illness. While the karamat (miracles) of the patron saint are marvelled 109 at by those who support her descendants, many villagers say that the baraka of God is above everything else. In this regard, they share the sentiment of their Muslim Egyptian countrymen/women in the urban areas. The villagers identify themselves as being "of the religion of MuHammad". They define the practice of Islam as a series of rituals which include fasting, prayer, and the payment of Eakat_(alms). Pil- grimage to Mecca is a highly desired goal which is fulfilled only by a few older villagers who guard their life savings for this long await- ed journey. While most adult males and females fast during the month of Ramadan, the majority of villagers do not pray. Those who do are mostly men. Collective religious practices, including the weekly Friday noon prayer, are confined to males. The majority of men turn out for this event. In FatiHa, the illiterate peasants have minimal knowledge of orthodox Islam. For the villagers, Islam includes a variety of un- orthodox practices and beliefs, many of which are related to illness (e.g. vows to venerated saints who are utilized as intermediaries to solicit the grace of God, the use of charms and amulets, and the joining of Sufi_orders). In short, Islam in the village of FatiHa is an infusion of orthodox beliefs and practices and a variety of popular values and customs which may be traced to the pre-Islamic dynasties of ancient Egypt (Cf. Blackmann 1927). But no matter the origin of beliefs and practices which are labelled "augga", Islamic values are always cited for the legitimation of a variety of village practices and ideals, notably those related to gender roles. 110 0. Gender Roles in the Village As the saying goes, one is not born a woman. In FatiHa, the process of "becoming" begins almost immediately after birth. On the occasion of the birth of a male there is much rejoicing in the family and the child's face is covered from those whose evil eye is feared. The family may even say that the newborn is a female in order to avoid the envy of others. If a woman is divorced while she is pregnant, the birth of a son prompts her husband to seek reconciliation and he requests her immediate return to his extended family house- hold. When a male is born, the infant's maternal grandfather prepares a large pan of food and the maternal uncle gives money to the child in his hand. When a female child is born to a woman, her kinsmen are not obligated to provide her with the traditional nagta_(gift). When a female is born, the outburst of joy characterizing the birth of a son is absent. If the birth of the female infant is part of a series of earlier births of daughters to the mother, members of the household are actually saddened and the mother may even cry. WOmen who give birth to many daughters are scorned by their mothers- in-law. On such an occasion, the paternal grandmother may sing, "why did you come 0 girl when we wished for a boy? Take the galla_(urn) and fill it from the sea, may you fall into it and drown". Mothers, while lamenting their bad fortune for not being blessed with a son, still sing to their infant daughters and say, "When they said it is a girl, I said the loved one has arrived. She will sweep for me and fill (the urn with.water) for me and when I die she will cry for me". 111 The corresponding song for a son expresses the sense of pride and en- hancement of status experienced by the mother. She sings, "When they said it is a boy, his father's back became erect and he rose. (Then) they brought me the eggs, heaped with butter. When they said it is a boy, they sent the midwife out of the village. (Then) they brought me stuffed poultry and on it a heap of butter. 0 boy, you are your mother's only possession, O ornament of her hair. If your father gets angry at your mother, they will count you as part of her mahr-(bride- wealth)". As in birth, so in death, one notes the differential valua- tion of male and female infants.3 In comforting a woman who has lost her ten month old daughter, her husband and relatives said, "don't do this to yourself, it is only a bit of a girl (Hitit_bit). What (more) would you have done if she were a boy?" The seventh day after birth (gibu:) is always celebrated for a boy. It is said that the boy will pull the donkeys and help his father in the field but the girl will be taken by another man for whom she will work and by whom her father will be cursed4. 0n the occasion of the birth of a girl, friends and relatives say to the parents, "may God make it up to you by granting you a brother for her". This expression of sympathy is diametrically op- posed to the hearty congratulations and repetitions of the word mabrfik (blessed) directed to the parents on the birth of a male. People simply say to the mother of a new daughter, "Hamdillah ‘ala salamtik (thank God for your safety)". In congratulating the father of a newborn son, on the other hand, people say, "mabrfik, you were blessed with a dahr (back). Now you have a sanad (support)". 112 During the early years of life there is little differentiation except in terms of feeding and general care. Mothers, in justifying the preferential treatment and feeding of sons say, "we want our son to grow up quickly so that he will help his father in the field". Physical punishment is about the same for boys and girls in the first few years of life; hitting of children is usually severe. Division of labour during these early years is not pronounced. Many villagers aspire to educate their sons and some families send pre-school age children to the local Kutab (traditional Quranic school) to learn to read. But although public education in the village is free of charge, few families can actually afford to sacrifice the labour of their children even at this very early age. Even those who eventually attend school for variable periods, their absence from classes during periods of heavy agriculture work is noticeable. As noted earlier, education of children is an important status symbol among the villagers. Educa- tion of girls, in particular, is truly a mark of their families' rela- tive wealth. Boys between four and six years of age load donkeys and feed the animals which they also accompany back and forth from the fields. A child of this age may also help his father spread crops during the planting season. In case a boy does not have any older sisters, he may take care of younger siblings. If his mother sends him on an errand related to domestic affairs he may refuse, but if his father orders him to perform any task related to agriculture, he will promptly comply. At a comparable age a girl sweeps, cleans the cooking utensils, fetches water for household needs, accompanies animals and their loads 113 to the fields, and helps her mother in baking and childcare. After the ages of six to seven, fathers are very harsh with their sons in particular. They often beat them without mercy for the slightest offense. While beating their sons, fathers often utter the state- ment, "Are you a woman, boy?". Girls of a similar age are expected to acquire the symbols of female modesty in dress and behaviour and are usually discouraged from playing with boys. Socialization of children in the first ten years of their lives proceeds through constant instructions (from their parents, older relatives, and senior fellow villagers) on what is believed to be proper behaviour for boys and for girls. Children are said to learn from their parents. Daughters are believed to follow in the foot- steps of their mothers while boys are expected to grow up like their fathers. Children's play activities are clearly preparatory for adult gender roles. Little girls are seen playing with pieces of dough given to them by their mothers while they are baking and little boys play with a whip-like toy and imitate men driving oxen during plough- ing, which is generally considered a male activity. By ages 8-13 children are well indoctrinated with villagers' gender role expecta- tions and have definite ideas about power relations between males and females. This internalization of gender role expectations, along with children's self perception was reflected in children's responses to a story completion test. This test was administered to boys and girls in the village. The children were asked to complete stories which were composed by the author and which depicted events which are meaningful to village children. The incomplete stories and children's 114 responses were as follows: STORY 1 Once there was a girl walking in the village street. She found a crowd of people watching a girl and a boy being beaten. When she asked the bystanders who was hitting the girl and boy, and why, the people told her: Girls' Responses: "...their father is hitting them because they are fighting together". "...they said it's their father. (Why) They have done some— thing. (What?) They could have disobeyed their mother or did not want to go to school". "...their father (Why?) because they were fighting together." "...they said her father is hitting him. (Who was the boy?) He is her brother. (Why was he being hit?) Because he insulted her." "...they said their older brother is hitting them because of what they did. (What did they do?) They insulted him". "...my father was hitting them. (Why?) Because they would not obey their mother". "...they said they disobeyed their father. (Who was hitting them?) Their father.." Boys Responses: "...the man hit the two children because they were quarreling". "...they told her that the kids are hitting each other in the street and a man who was standing in the street started to take them apart and hit them both". "...they were fighting and so their father came and hit them". "...they said they were fighting together and their father hit them". "...their father is hitting them because they are hitting each other". "...their father is hitting them. (Why?) Because they are fight- ing in the street and making a spectacle of themselves - making the whole village see them". 115 "...they were walking acting silly. They walk for a while and stop for a while and so their father hit them". These responses clearly indicate the role of males, particularly fathers, as disciplinarians. It is also evident that disobedience of the mother does not necessarily prompt punishment by the mother her- self. She is likely to refer children to her husband for the neces- sary punishment. Indeed, children do recognize the relative sub- servience of their mothers and in some cases may even insult them (especially by reference to their families). A mother may chase her children with a stick but she usually does not hit them severely. Moreover, mothers are often heard threatening their children by telling them that they would complain to their fathers. STORY 2 Once there was:1girl called Zinab, she had a twin brother whose name was MoHammad. They were both in the village school. One morning as they were getting ready to go to school their father stopped them and said "your mother must go to the market today. One of you must stay home with your younger brother". They answered... Girls' Responses: "...her brother went to school and his sister stayed home. (Why?) Because her brother is a boy and will not do any work in the house". "...they said 'no we will go to school' (But their father insisted that one of them.must stay home and take care of their young brother). They said 'no, you stay, otherwise they (the teachers) will hit us in school'. (But does their father know how to take care of children?) Yes he can just sit and hold him. He does not have to do the housework". "...Zinab will stay. (Why?) Because MoHammed does not know how to take care of their brother". "...Zinab said I will take care of my brother and I will not go to school today. (Why?) Because she is the one who can take care of the child, because she is a girl. ' 116 ". . .they said no we will go to school (But their father said that one of them must stay) They said 'no we will go to school, we have lessons.’ (But he still insisted that one of them must stay home). They decided that Zinab would stay. (Why?) Because she is a girl and she has more tenderness for her young brother." '.'. . .they said Zinab will stay. (Why?) Because she is a girl". ". . .they said no we have to go. (But their father said one of them must stay) Zinab. (Why?) Because she is a girl". Boys' Responses ". . .they said we have to go to school to get an education. (But their father insisted that one of them must stay) The girl said I will stay and take care of my brother". ". ..they told him 'we want to learn in school' (But he insisted that one of them stay). Zinab stayed and took care of her brother". ". . .Zinab decided to stay and take care of her brother. (Why?) Because she is a girl". ". . .MoHammad went to school and his sister stayed home. (Why?) So that she would work in the house and sweep it". ". . .Zinab stayed and Monad went to school. (Why) That's the way it should be". ". . .They said Zinab will stay. (Why?) Because Zinab is a girl and she will take care of her brother and do the house work. (Doesn't the boy know how to take care of the house?) No." ". . .They said 'MoHammad has to go to school' and her father told Zinab that she has to stay and take care of her brother. These responses clarly indicate the great valuation of education by both male and female children. In fact it is evident that children are sometimes willing to defy the authority of their father out of fear of the wrath of their teachers. However, education is regarded by both girls and boys as of secondary importance for female children. Their primary functions are conceived to be domestic and maternal. 117 STORY 3 One day Zinab and her brother were helping their father pick cotton. In the middle of the rows of cotton they found a magic lamp. As they sat looking at it and holding it, a 'inniya came out and said "Shubik lubik 'abdak bin idik, ish tiTlub (standard phraseology of_Egyptian fairy tales according to which the jinniya asks for the children's demands which she would promptly fulfill). The jinniya told them "ask for anything that you or your brother want to be or to have, your wish will be granted. Zinab said... Girls' Responses: "...She said no, I want to leave. (Why?) Because she was afraid". "...She was afraid of her because she does not know her. She found that she is not human. She probably wanted to kill Zinab. She may only have wanted to freighten her". "...Build me a palace and build me all I want. For my brother, make him a teacher". "...Zinab said I want to be a teacher and my brother also". "...She said, 'leave me alone'. (Why?) So that she can help her father". "...She said 'bring me clothing, bring my brother a pair of pajamas'". "...She said 'bring me a dress and bring my brother a suit". Boys' Responses: "...Zinab said '1ight the lantern'. She said 'make us help our father with his work'." "..Zinab said, 'I want my brother to be a doctor and an officer in the college'." "...She said 'I want my brother to be a teacher and I want to be a teacher. I want my brother to be a soldier'." "...She said, 'no', and went home to have lunch. (Why?) Because she was afraid of the jinniya. (Why?) She was afraid that she would catch her". "...Zinab said 'I want my brother to be a soldier and I want to be a teacher'." "...Zinab said 'I want to go to college and my brother should be an aviation engineer'." 118 3:3:1 addition to reflecting children's fears of supernatural beings, ~tgr1000~Qwom so mmm. 222 at all. SES 1 indicates the highest land holding, SES 6 indicates the lowest. In the Nfiddle EAstern literature, it is only recently that a serious attempt has been made to explain the prevalence of menstrual and post- partum taboos. In reference to the isolation of menstruating women, Shiloh notes, "...It is understood that this isolation of these restric- tions function ideally within the society possessing an extended family" (Shiloh 1962:282). Contrary to Shiloh's assumption, the custom is also reported in adjacent areas to the Middle East in Mediterranean Europe where extended kinship units do not prevail. iMoreover, Shiloh makes no attempt to correlate specific structural features of the extended family with the maintenance of the custom. He implies that the iso- lation of females is possible when others are available to take over their tasks. It may be argued however, that it is the SES of an ex- tended family unit rather than its physical structure which allows the sacrifice of female labour. On the basis of participant observa— tion and structured interviews in the village of FatiHa, it is hypo- thesized that enforcement of rules of isolation of impure women would prevail in families whose livelihood is based on private production and whose members appropriate sufficient surplus to make female labour dispensable. In this case, potential surplus value derived from female labour is sacrificed for culturally valued social prestige and family honour. In concluding this section, it must be stressed that ideas about ritual pollution in the village of FatiHa show that substances associat- ed with both females and males, out of proper context, are thought to 223 be dangerous. Moreover, it should be noted that pollution, whether it pertains to a male or to a female, is not simply dangerous to others. It is advised that ritual cleansing be undertaken also for hygienic purposes. Hence the emphasis on male circumcision, which, like bath- ing after ejaculation, sexual intercourse, menstruation, and post partum bleeding, is considered a measure for maintaining Tahara (clean- liness). The process of purification is not simply regarded as a means of ending the body's danger to others but also as a way of maintaining the body's own cleanliness and health. 224 NOTES lThe beliefs described in this Part of the Dissertation apply to the general shared knowledge among the villagers of FatiHa. Where mean- ingful differences in understanding exist between males and females, midwives and non-specialists, healers/diagnosticians and non—practi- tioners, this will be indicated at the appropriate junctures. Some quotations in this part are composites of representative statements made by informants. 2Sexual intercouse is deemed necessary for the occurrence of concep- tion. When asked about Virgin birth informants noted that "if a woman does not unite with the man, she never becomes pregnant". An older informant who is familiar with the Quranic narrative of the Birgin birth of Christ cited this as an example possible only "for prophets, by the command of Allah". 3Menstrual blood is generally believed to originate in the back of the woman. The word for menstruation is dahri, meaning "my back". 4Ideally, sexual intercourse during menstruation is prohibited. This prohibition is given religious sanction. Deviation from this idea is recognized by the villagers who concede that "the peasants are ignorant, they don't follow the word of God". When conception occurs during menstruation, the child is said to always be born with a skin rash. 5The difference in knowledge between midwives and lay individuals was explained by the midwives themselves by reference to knowledge which was passed on to them from older relatives, some of whom were official mid- wives. Around the turn of the century there was a program in rural Egypt to train traditional practitioners, including barbers and mid- wives under the supervision of practicing physicians and certify them to practice in the rural areas. Since the period after world war II, with the increased, and in the opinion of this author misplaced, emphasis on modern medicine, such programs have been terminated and the surviving knowledge from the earlier trainees is rapidly vanish- ing. 6In spite of the importance which is attributed to the male bizra, it is the wife who is implicitly, if not explicitly blamed for the birth of a daughter. A disappointed husband, although recognizing that "it is the will of God", may add, "she is the one who is carrying it". The oldest midwife in the village recalls a time when village women "thought they could interfere in God's will by spreading themselves from the inside with lemon juice so that they become pregnant with a son". 225 7A8 mentioned earlier, this condition is treated by the use of the marwad, a long iron wire wrapped with wool and soaked in an extract of herbs and used to cover what is referred to as "the face of the vagina on the inside". Some women said that they would never subject themselves to this treatment because they had heard that it may cause excessive bleeding which results in death. 8After sexual intercourse a man and a woman are considered in a state of ritual uncleanliness, nagasa. Bathing from head to toe is necessary for restoration to a state of ritual purity (tahara). 9The valuation of children in village society makes women to to any length to counteract their barreness. A practice, not carried in the study community, but by no means unknown there, was described in a national newspaper as it occurred in a nearby village. El-Ahram (December 9, 1974) reported the story of a woman who in her despera— tion to become pregnant followed the recommendations of a traditional medical practitioner and stole the corpse of an infant from a grave- yard. Bathing in water in which a child's dead body is washed was suggested by the practitioner as a means of neutralizing the desperate woman's barreness. Unsympathetic towards the "peasants' ignorance", the local police arrested the "suspect". 10Although the peasants of FatiHa and midwives recognize the practicality of contraception, it is generally believed that the number of children that any given woman may bear is pre-ordained by supernatural power. It is said that "...the children to the mother are like bunches of grapes with God. It is already decided how many children she will have when she is born". 11As a resident physician in one of the rural health units outside of Cairo, a friend of this author noted that she came across numerous cases of erosion of the cervix as a result of women's use of aspirin which they insert up their vagina prior to intercourse. The physician remarked that the women preferred this method to birth control pills in spite of her warnings. They said that it is better than swallowing something which they did not know anything about. 12Other informants regard the placenta simply as a protective envelope. 13As noted in an earlier chapter, a man's right to the sexual services of his wife is indisputable. This right remains valid throughout the period of pregnancy. One midwife is referring to the "animal nature" of male peasants noted that they do not observe the religiously pres- cribed abstention from sexual intercourse during menstruation and post- partum bleeding. She went on to relate a story where a man went so far as to assert his right to the sexual services of his wife when she 226 was in labour prior to the birth of her child. None of the other informants confirmed such an occurrence. However, informants, including women recognize men's insistance on unobstructed, continuous access to their wives' sexual services as indicative of men's power over women. The linguistic expression of the act of sexual intercourse is also used to denote superordinate-subordinate power relations. l4Informants emphasized these differences outside the context of the author's questioning about pregnancy and the human body. They point to such differences in ordinary conversation to stress their belief that male-female differentiation in social roles are natural (tab‘) In pointing to women's secretive character they note that a male child. is light and turns at the fifth month of pregnancy but a girl is heavier and does not turn until the sixth month. 15Mothers, later on in life, refer to this belief to account for the differential feeding of male and female children. A boy is said to require more nourishment to make up for his fraility during pregnancy. 16An informant noted, "if a woman is pregnant and does not want the child she lifts very heavy things and suppresses her breathing or she may climb a high wall and jump. She may also drink a laxative. Tar and feathers are heated and the woman sits over the vapour coming out of them, I pushed a child down this way once". Abortion is socially detested and there are supernatural sanctions which are cited to deter women who want to practice it. In addition to the "wrath of God", a woman who intends to abort is made fearful of supernatural beings' revenge against her living children. It is said that supernatural subterranean spirits would make a woman's surviving children ill or even kill them. 17The actual time does not seem to be the critical factor which influences this decision. Judgment is made on the basis of whether the birth is the woman's first and on the basis of "her general strength". 18Midwives, like other informants refer to the harmful effects of a menstruating woman on a newborn child. They say that "if a woman who is menstruating looks at a baby, he becomes listless and yawns until he grows up. He remains this way until his brain grows and sometimes he remains this way even when he is full grown. 19The author's observations of the birth process confirms this state- ment. In the presence of the midwife, all other women, including older ones are subordinate to her directions. 227 2OAnother midwife disagrees with the administration of water to a woman in labour. She attributed the death of a village woman during childbirth a few years ago to a "midwife's ignorance", the midwife attending that birth had given the expectant mother water while the placenta was still inside her. According to the midwife informant, "the khalaS swam up to her heart and suffocated her." While this midwife disagrees with giving water to a woman in labour, other informants and this author's observations confirm that it is a widely accepted practice. 2lMidwives do not use any special herbs during delivery. 22Maternal deaths from childbirth are very low in the village of FatiHa. According to the village death records, the most recent case occurred five years ago. 23The services of the midwife of the Health Department are also avail- able to village women, but are almost never utilized. This official is informed by the delivering midwife or by the village clerk to regis- ter the birth of a new child. The official daya only sees the mother sometime after birth to examine the child. women shun the midwife of the Health Department. It is said that women prefer bint balad (daughter of the village). They relate their ex- perience with midwives who are outsiders and express their distrust of them. They say, "we had a woman in the village with training (by the Health Department) but no one liked her, her entry is misfortune. She was very ugly (something that a pregnant mother would certainly avoid looking at lest her child turn out ugly). People used to call her after the child was born. They had to tell her because she was the only one who could register the child with the government". 24Research Egyptian physicians indicates loss of sexual sensitivity in women who have been subjected to clitoridectomy (Meinardus 1970). 25According to a village proverb, "al ‘agl al salim fi al ism.al salihfl (a healthy mind in a healthy body). This statement FEfIEcés the—a5- sence of body-mind dualism among the villagers of FatiHa. The body and the mind are regarded as interdependent components of an integrated system, the proper functioning of which surpasses its own immediate structure and depends on the articulation of that structure with both the natural and social environment of an individual. 26Good eating is usually described in terms of amount of food con- sumed. This is not to say that different qualities of foods are not recognized but it reflects the villagers reliance on standard staples with minimal variation in quality. 228 27The body's production of natural substances ranging from nursing milk to semen, to menstrual blood, is said to depend on nutritional status. Aging women attribute the cessation of menstruation to weak- ness of old age. A "good" flow of menstrual blood is attributed to heat in the body, which is said to derive from good food and physical strength. 28This statement, in addition to reflecting the significance of proper nutrition, also refers to the importance of the heart as a crucial organ of the body. 29women are accused of (and admit to) sneaking food on any occasion they can. Some women, in complaining about their mothers-in-law's stinginess openly admit to friends and relatives that on market days they buy food and eat it before getting back to their homes. 30In Egypt, popular jokes, including those alluding to politigal matters, are known to originate in such gatherings of Hashashin. 31Hashish is known as an aphrodisiac. Women say that it makes a man "like a bull". 321t is interesting to note that it is said jokingly, that women have seven gall bladders (marara). This denotes that they can withstand a lot of frustration. They are said to be able to cause frustration to others who cannot reciprocate effectively. 33It is interesting to note that for purposes of social welfare the traditional modesty of women may be temporarily suspended and women may practice this curative procedure on males without any sense of shame. Similarly, a woman may expose her breats without any inhibition to nurse her child. 34The belief in the ritual pollution of women after birth extends to animals. The water buffalo of a peasant died about a week after giving birth. A female informant expressed her reluctance to aid the animal's owner by buying some of its meat. She said that the gamusa is considered zifra for forty days after delivery and people should not eat its meat. A.ggmu§g_which is killed prior to this period is considered Taziyg (the same expression used to describe women after delivery) and its whole body, like a woman, is said to be "opened", i.e., the bones are not tightly held together as a result of the expansion of the birth area and the tremendous physical effort involved in birth. The meat of the gamusa which is Tariya is believed to cause diarrhea because its meat is zifra. 229 35In this regard it may be noted that women themselves complain of back pains and pressure around the eyes during menstruation. Menstrua- tion is also believed to affect the emotional state of women. An informant also noted, "I have a headache before it comes but I become revived and revitalized after it comes". 36While most informants agree that women are likely to bleed for forty days after delivering, some villagers reflect the differential valuation of male and female infants by noting that the birth of a female child is more painful and causes bleeding for forty days while bleeding after the delivery of a boy lasts for only eight days. 37The term zifra which is used to refer to an impure woman also applies to the description of odours especially in relation to fish, meat, and eggs. CHAPTER 5 MEDICAL THEORY A. Introductory Remarks This chapter is devoted to an examination of village medical theory. Section B undertakes a general discussion of the comparative study of medical systems in terms of the classification of diverse medical theories and beliefs. This entails an examination of anthro- pologists' medical systems typologies. Note is made of earlier dichotomous typologies which were based on the differentiation of primitive and modern medicine and which conceived the former as es- sentially magical or religious and the latter as "rational". In reject- ing the bifurcation of modern-primitive systems of medicine, reference is made to the work of contemporary anthropologists who have offered more generalized classificatory schemes, designed to accommodate diverse medical systems (whether primitive or modern) on the basis of diagnostic criteria (e.g., Glick 1967), therapeutic classifications (e.g., Young 1976a), and groups' taxonomies of illness (e.g., Fabrega 1976). Section C of this chapter proceeds to examine medical theory in the study locale in terms of diagnostic indices and domains of medical taxonomy. It shows that the people of FatiHa have various explanations of illness. Causation is shown to be accorded primary significance in the process of diagnosis. Symptoms of illness and its severity 230 231 are important as manifestations of the operation of causal factors. Of minimum significance as diagnostic indices are the physical/anatomical processes associated with illness, i.e., the pathology of illness. The concept of levels of causation is deemed useful for ordering multi- causal explanations implicated in an illness episode. In dealing with illness causation at the most general level, ill- ness is described in terms of supernatural power. However, more im- mediate causes are shown to be recognized by the people of FatiHa. Generally, the ultimate determinant of health and illness in villagers' worldly environment is defined in terms of social interpersonal rela— tions. As the people of FatiHa regard their individual lives and physical well being as inextricable from their social context, they also define illness, which is manifested in individual behaviour, as an outcome of social relations. This is not to say that illness is explained solely in terms of social interaction, but explanations of illness ultimately lead to the social environment of the sick. In dealing with natural causation, villagers clearly follow a prospective path to diagnosis. In cases of supernatural causation, on the other hand, diagnosis is always retrospective. When illness symptoms mani- fest themselves, they are traced to significant episodes of emotional distress and/or social relations which may be associated with much earlier time periods. In dealing with illness explanations in Section B, a description of some culture bound illnesses is undertaken and their critical diagnostic indices are noted. ‘Section D of this chapter is devoted to a discussion of the specificity of illness explanations. It is noted that while the 232 static account of medical beliefs provided in Section C informs us of the underlying logic of villagers' medical taxonomy, it does not ade- quately reflect the actual use to which that taxonomy is put in specific illness cases. Neither does it illuminate the social processes sur- rounding an illness occurrence. Through reference to specific illness episodes and the social dynamics surrounding their occurrence, Section D shows the variability of illness explanations and the process of negotiation related to claims of the illness role. In FatiHa, selec- tion of a specific cause to explain an illness occurrence is a function of the duration of the affliction, its physical and behavioural mani- festations, its response to certain types of treatment, and, of par— ticular importance, the types of social interpersonal relations which surround the affected person and his/her significance to others. The present chapter is concluded with Section E which focuses on case studies of the illness of £253. This culture bound illness is selected for in depth analysis which links illness causation to the dialectics of social life, particularly in terms of power relations and gender roles. In nothing the multiple levels of causation as- sociated with reported and observed cases of :ugr interpersonal rela- tions, including those associated with powerlessness, and those in- volving deviation from culturally valued behaviour, are identified as ultimate causes of the affliction. Diagnosis of the illness of :uzr is believed to be outside the range of competence of physicians. Physicians' examination of ma‘zurih (persons affected by'lpgg) consistently ignore "ultimate causes" of illness which the ma‘zur-i-n themselves (and/or their families) 233 consider crucial for the diagnosis of the illness. In presenting cases Of.:EE£! the telescoping of explanations of illness is noted and the legitimization of deviance through the social granting of the illness label is shown. Therapeutic strategies associated with the illness are regarded as a means of controlling it, not eliminating it altogether. Indeed, from an etic perspective, the persistence of the illness is consistent with the relative stability of the structural power relations with which it is associated. In describing the illness of fuzz, reference is made to the belief in the differential susceptibility of males and females to the illness. Women, who are believed to have half the nerves (algab) of men, are said to be more susceptible to severe attacks of £223: As ideology, this belief legitimizes, while it mystifies, the actual power differen- tials between males and females. Some informants reiterate a similar understanding of the social basis of :2EE.When they note that "the ':223 of women is heavier than that of men because they are bossed". Case studies of juzr_in Section D also show that, as its very name suggests, the illness of £323 (excuse) is a legitimate form of deviance. The compensatory value of the illness role is noted in case studies of the illness. It is evident that the illness role (when considered legitimate), mediates asymmetrical power relations and allows a temporary dispensation from expected role behaviour. However, the discussion in Section E indicates that the social sanc- tion which allows temporary transgression of role behaviour and/or positions of relative powerlessness, is itself subject to negotia- tion. 234 Descriptions of case studies of :uzr_involving children, in Sec- tion E show that the labelling of :33: in children is undertaken by adults. In such cases, the legitimization of deviance associated with the illness label is deemed more significant for the adults themselves. In this regard it is noted that the label of ‘uzr for a child may some- times be a means of avoiding acknowledgment of physicians' shameful label of maraD ‘aSSabi (illness of nerves). This divergenary practice is also noted for adult cases of mental illness. The label ma‘zur/a is thus shown to be a generalized illness category associated with powerlessness whether this is defined in terms of subordination to the authority of more powerful males or females (e.g., mother-in-law/ daughter-in—law relations), deviation from culturally valued role expectations (e.g., barrenness in women and sterility in men), or the social stigma attached to physicians' label of mental illness. Section E is concluded with the testing of a hypothesis linking the incidence of the illness of jug: and patterned power differentials. Finally, data which illuminate the patterned incidence of stress and illness as functions of asymmetrical power relations are presented and psychiatric ratings derived from the Cornell Medical Index are employed to illuminate structural principles associated with perceived stress and subservient status. In concluding Section E of this chapter, it is noted that the sick role, like other manipulative strategies adopted by the powerless, when accessible, brings about only a temporary en- hancement of social position. It is not a stable, culturally valued power base which can induce permanent modification. 235 B. Medical System Typologies The comparative study of medical systems requires the develop- ment of a suitable frame of reference for classification of diverse medical theories and beliefs, and the medical care strategies which logically follow from these theories and beliefs. Such a framework would necessarily have to accommodate extremely diverse explanations of persons' physical constitutions and psychosocial states, and how and why these become transformed as a result of illness. In examining studies of medical systems by anthropologists, it is noted that these have always assumed that medical practices derive from and make sense in terms of underlying medical beliefs and explanations of illness. Medical theory, therefore, has always been selected as a basis for the construction of medical system typologies. In a recent survey of theoretical orientations in medical anthropology spanning the last half century, nglgn (1977) has summarized these typologies: The earliest attempt at comparative analysis of medical systems by anthropologists is attributed to Rivers whose classificatory scheme was based on what he referred to as groups' "attitude towards the world". His typology differentiated between magical, religious, and naturalis- tic explanations of illness causation. Following the same assumptions as Rivers, Clements (in his Primitive Concepts of Disease 1932) dif— ferentiated disease-causation concepts among primitive groups into five categories (sorcery, breach of taboo, intrusion by a disease object, intrusion by a spirit, and soul loss)l. The ensuing work by Ackerknecht was characterized by the cultural relativism typical of 236 British functionalism. Thus, although sharing River's and Clements' logic by postulating that medicine is best understood in terms of cultural beliefs, and by emphasizing the institutional functions of medical systems, Ackerknecht did not make an attempt to classify medi- cal systems. In addition to their general emphasis on medical beliefs as a basis for understanding and/or differentiating medical systems, the studies by Rivers, Clements, and Ackerknecht, all viewed primitive and modern medicine in dichotomous termsz. In describing the works of these early scholars, Willin writes, Each of the three viewed primitive and modern medicine in dichotomous terms. Conceived the former as essentially magical or religious, focused on it to the virtual exclu- sion of modern or "rational" medicine (Ibid:57). The limitation of dichotomous typologies has also been noted by Glick (1967). In rejecting the bifurcation of modern-primitive systems of medicine, he offers a scheme for dealing with medicine as an ethno- graphic category. According to this scheme, diverse medical systems (whether primitive or modern) may be differentiated on the basis of the criteria which underlie the explanations of illness, i.e., on the basis of diagnostic criteria. As Glick explains this classificatory framework, some medical systems emphasize illness manifestations or evidence (i.e., whatever is evident about an illness to observers or to the sufferer, e.g., "signs and symptoms" or severity of illness), others accord significance to process (i.e., what is actually happen- ing to the human body which produces the manifestations of illnessB). Still others accord primary significance to causation, which addresses the question of how illness was brought about, or what did so, and 237 perhaps why this happened (Glick 1963:110). Glick describes his medical system typology as follows: ...any diagnostic statement about illness may take into consideration three dimensions which I call evidence, process, and cause. Each dimension may support a system or part of a system of diagnostic terms. I would argue that the third is always present as a critical considera- tion, and moreover, is of central importance to comparative studies...Evidence is whatever is taken as empirical indi- cation of the existence of an illness...Process is what is actually happening to produce evidence of illness. In the absence of understanding of disease process, the diagnosis may resolve into conclusions about causation inferred from evidence, that is, the dimension of process may be over- looked altogether, or it may be relegated to strictly secondary significance. Like Glick, other students of comparative medical systems have emphasized the importance of formulating cross-culturally valid diag- nostic and therapeutic classifications (Young 1976a). In noting the limitations of earlier classificatory schemes, it has been argued that the comparative study of medical systems requires the classification of a whole range of medical theories, beliefs, and practices, includ- ing those assoCiated with modern medicine (Young 1976b). Fabrega, in a recent article seems to have abandoned, at least momentarily, his own tendency to describe medical systems in dichotomous terms and has proposed the classification of all medical systems on the basis of groups' taxonomies of illness4. According to this scheme, taxonomy represents a group's rationale and way of naming and explaining illness in terms of its sources and/or causes. Fabrega thus proposes the classification of medical taxonomies according to types of entities and processes which establish contact with the person. He suggests three types of "broad semantic domains" which are implicated, to vary- ing degrees in explanations of illness and its treatment. These are 238 the region of the person, the region comprising the wordly environment (which consists of both the natural and social elements), and the other wordly, or supernatural, worlds. According to Fabrega, explana- tions of illness may then be regarded as formulas which contain measures derived from each of the three semantic regions (Fabrega l976:200)6. Medical systems are thus differentiated on the basis of the extent to which any given type of explanation is accorded priority by the medical system's theoretical framework. While proposing the quantitative determination of the predominance of one "domain" or "region" over another, Fabrega does not illustrate how this is to be done in actual case studies. Unlike Fabrega's quantitative scheme, Glick (1967) has suggested the analytic concept of levels of causation which is easily operation- alized in the ordering of explanations of illness found within a given culture7. According to Glick, an analytical distinction is made between instrumental cause, efficient cause, and ultimate cause. He describes these conceptual categories as follows: An instrumental cause is what is done or what is used; an efficient cause, who does it or uses it. The latter, the agents of illness, are, with a few arguable exceptions, persons; they are part of the same socio-cultural system as the sick individual and they demand consideration in this wider context. Gaining an understanding of why they act, of what induces them to bring on illnesses, leads the ethnographer byond the medical system proper and into the realm of ultimate causes - kinship and political relations, property and inheritance disputes, jealousy, envy, rancor, and spite (Glick 1967:37). 7 Glick's concept of levels of causation for determination of priority of one type of explanation of illness over another may be regarded as complementary to Fabrega's typology. Moreover, one may note clear 239 areas of overlap between Glick's and Fabrega's medical system typolo- gies. Thus, Fabrega's "region of the person" indicates similar criteria for differentiation as Glick's category of "process". Fabrega's "re- gion of wordly environment (as it pertains to the social environment) corresponds to Glick's "ultimate cause". Finally, Fabrega's "super- natural environment" is included in Glick's broad category of "cause", or more specifically, "efficient cause". In view of these similarities and the complementary relation of one scheme to the other, a combina- tion of elements, derived from both medical typologies will be utilized in the ensuing analysis of medical theory in the study community. C. Diagnostic Indices and Domains of Medical Taxonomy in FatiHa In attempting to analyze the medical system of FatiHa within the above noted classificatory schemes, it is evident that illnessB, no matter its cause, manifestations, or social consequences is regarded by the people of FatiHa as an individual-centered experience. The human body experiences the pain of illness and the individual deviates from a normal psychosocial state. But while the human body is identi- fied as the depository of illness and while manifestations of illness are also described in terms of physical symptoms, the impact of illness, described in terms of specific physiological and anatomical changes is blatantly absent. There is relatively little attention paid to the physical processes associated with an illness occurrence. For while illness is manifested in particular individuals, its ultimate cause usually lies outside the individual him/her-self. Pathology is the 240 least elaborated part of the village medical systemg. The effects of illness on the body (rather than failure of body organs resulting in illness), are usually described by the villagers in terms of generalized complaints such as headaches, weakness, dizzi- ness, aches all over, trembling, hot-cold spells, chills, nausea, weight loss, pains in joints, and swelling, rather than by reference to alterations in specific organs of the body. Mostly gross, diffuse symptomatic indicators are noted in reference to an illness state. Illness causes collected in a census survey of the adult occupants of 100 households also indicate minimum attention to physical processes. Ta- ble 5.1 summarizes these causes and indicates that causes implicated in illness precipitation are generally seen as external to the body's physical structure. Bodily changes are generally regarded as manifes- tations of illnesses, not their causes. Emotional distress, interper— sonal tension, and supernatural powers cause illnesses which become manifest in physical discomfort. Even in cases of illness of named body organs, i.e., _M_a_13_D_-i_l__g_al_b (heart illness) and mggfl (stone in the kidney), external factors related to emotional distress and interpersonal conflict are advanced as causes of illness. In another survey in which a selected sample of (55) informants were asked to link specific causes to the four culture-bound illnesses Of.IE£E§ (fright), Hassad (envy or the Evil Eye), :323 (a local variant of spirit intrusion), and ‘amal bil maraD (the illness of sorcery), physical constitution was selected by only a minority of respondents, as indi- cated by their percentages in Table 5.2.In examining these percentages, it will be noted, as will also become apparent in other tables of this 241 Table 5.1. Census Survey of Illness Causation. Cause # of Reported Cases God's Will 22 Hassad (Evil Eye) :amal_(sorcery) Smoking Sexual Intercourse Overwork bCDNNI—‘UI Living Creatures Sadness l2 Fright Blow Contraceptives Nb.) Poverty Natural Environment 36 Smoke Inhalation Old Age Chemicals Fever \fi b~ u) v: F! _Pregnancy 242 Table 5.2. Culture-Specific Illness Causation: Somatic vs. Psychosocial Causes. N=55. Somatic Causes Psychosocial Causes Illness % Respondents % Respondents Tarba 25.5 96.4 Hassad O 98.2 ‘uzr 3.6 94.6 ‘amal O 92.7 243 chapter, that they do not add up to 100%. This results from the non- specificity and variability of illness explanations, which characterizes the village medical system. The only minor exception to the above noted tendency to deemphasize physical constitution and physical processes in the explanation of illness is related to illnesses which are considered hereditary (wiratha) and those known as "inborn" (khilgg). In these cases, physi- cal constitution is accorded primary consideration in the explanation of illness. Thus, an inborn physical defect ("from God") may be im- plicated in cases of £12231 (idiocy) and Em (insanity). It is said that "the person's brain may be small from birth and as he grows up it does not grow like the rest of his body and he remains ahballo. Afflictions which are believed to be transmitted by this mechanism include inks}; (sugar illness or diabetes), 1% (asthma), _ur_a_: (hair loss), and shalal_(paralysis). Some informants believe that damage to the tufial (spleen) is also inherited. They note "if the person has tgflal, his children will have tuHal and some children who are just born have bilharzia"ll. While informants emphasize somatic explanations in cases where illness is attributed specifically to khilga (inborn physical consti- tution) or to wiratha (inherited physical defects), the precise physi- cal mechanisms associated with these conditions are not elaborated. In fact, there is no complete agreement among informants on which stage of physical development is associated with the wiratha (inheritance) of illness. There seems to be minimal differentiation between inheri- tance of illness and transmission of illness through contact between 244 family members. Thus, an informant stated ahat "Asma and the chest illness (TB) are wiratha (inherited). When a person who has any of these illnesses coughs or spits his children also get the illness. It is in the sputum. Children are particularly susceptible to illness". From this description it is clear that the wiratha occurs after_birth, as a result of contact rather than through transmission during the period of foetal development. Some informants assert that "the child never becomes ill when he is in his mothers womb or when he is nursing". By contrast, others believe that illness or the propensity towards certain illnesses, especially mental illness is inherited from the father during foetal development. Thus, although mentally deficient persons in FatiHa (as in other Egyptian villages, see El Sendiouny 1972:23-26) are treated kindly by fellow villagers and may even be thought to be possessed of baraka (supernatural blessing power), they are neverthe- less a source of shame to their families. Thus while the family of a mghbul (idiot) may put him by himself in a dark room in the hope that "the shock would bring him back his mind", other informants explain this action on the part of the family by reference to their shame. It is said that "the family members of the mahbul do not want to be ashamed in front of other people. It means that the family must have people who are mahabil (idiots), either the father or the father's father, or the father's father's father. It must be a relative from the :ESEb (the back of the man from.which semen is believed to descend)." Although the "region of the person" is recognized in explanations of illness in FatiHa, one notes minimal elaboration of this domain of medical taxonomy. Instead, illness in FatiHa is defined in terms 245 of behavioural and generalized physical changes apparent in the affect- ed individual, and interpreted as correlates of certain diagnostic units. The system of diagnosis rests primarily on the specific causes believed to underlie these manifestations of illness. The exact physio- logical processes and anatomical changes leading to illness manifes- tations do not seem to have much significance in the villagers' illness conceptualization. In short, as in the case of other tribal and peasant societies (Glick 1963, 1967, Fabrega 1976, Foster 1977, Young 1977), it is illness causation rather than process which is the basis of the system of illness taxonomy in FatiHa.. In dealing with illness causation at the most general level, it is evident that the villagers of FatiHa believe that illness, like every other misfortune which befalls an individual, is under supernatural control. During the early interviews, when confronted with the ques- tion "what is the cause of X's illness or his/her death?", informants invariably responded, "1_n_i_n' £11211" (from God). But while probing beyond such rhetorical statements, it became clear that the peasants of FatiHa recognize more immediate causes of illness and link these to a variety 0f illness states (see Table 5.3 for a listing of illnesses reported in the census survey)l2. These beliefs about illness causation may be differentiated, for analytical purposes, according to three etiological categories: natural, social, and supernatural. In discussing each of these types of causes, it will be evident that in FatiHa, the roles of natural, social, and supernatural elements, which are external to the human body, are accorded greater elaboration than is the case for bodily structures and functions associated with illness. 246 Table 5.3. Illness Reporting in Census Survey. Illness # of Reported Cases Rheumatism Heartburn Allergy Headache Tonsillitis Weakness Backpain Fever Stomachache Cold Asthma Diabetes Kidney Bilharzia Malaria Paralysis Pain in Joints Pain in Reproductive Organs Heart Dizziness Chest Pains Shortness of Breath Spleen Nausea Menstrual Cramps Dysentary Eye Irritation Appendicitis Liver Psychological Shock ‘uzr Tarba ...a A) FJCDF‘F‘F‘F’F‘&)FJRJAJGJFJ\JFJ~3F4A)AJM)FJR)b-O‘F‘O‘C)U1b~u)FJb~ b.) [—J 247 In terms of natural causal elements, among the people of FatiHa a variety of natural causes are implicated in the occurrence of various illness conditionslB. Illness is attributed to such natural causes as bad food, bad water, worms, insect bites, sunstroke, and humidity. Unsanitary living conditions associated with dirty water and flies are thus implicated in the occurrence of bilharzia (Schistos- omiasis) and eye infections, respectively. People also refer to bil: hargia_as being caused by worms which enter the skin of people as they work barefooted in dirty Water. Village school children have a good understanding of the parasite's life cycle and much of this informa- tion is proudly exhibited in front of parents and other villagers. The villagers attribute the continued proliferation of the illness to their conditions as peasants whose livelihood depends on the continued contact with the earth and river. In enumerating illness causes associated with the natural environment, the peasants also recognize mosquito bites as the cause of malaria, which is believed to cause death, if not treated by a physician. Malaria is also believed to cause miscarriage in pregnant women. In relating her daughter's mis- carriage and eventual death from malaria, an informant noted, "...when one gets malaria, there is a lot of heat in the body, the heat was too much for the child". Fever is believed to be caused by sunstroke or by ruTuba (moisture) in the air. As a result of long exposure to the hot sun, "a person's body gets more heat than it needs and the person becomes ill". Similarly, extended exposure to ruTuba (moisture) is believed to induce hot-cold spells, which, like fever in the body, causes the affected person to 248 be weak, or reduce his/her tolerance), and dampens his/her appetite for foodl4. Moisture from the air or from cold chills is also said to cause duzentaria (dysentery) and rumatizm (rheumatism). An informant described the effect of moisture on the body as follows: I was working early in the morning. The ruTuba (cold moisture) settled in my head and my heart. My headache caused my eyesight to fail me. The moisture entered my body through my cold feet in the water. It travelled through my knees and up my heart to my head. It took ten months to reach my head. It entered my bones and in spite of many medicines, I was not healed. Once moisture enters the body, it does not leave the person. It is also believed that a chill experienced as early as the first year of life shows up years later in the form of rheumatism during old age. Other naturalistic causes of illness extended by the inhabitants of FatiHa as explanations of illness include excessive indulgence related to food, work, and sex. Such excesses are said to exhaust the body and cause discomforts and weakness. Over eating is believed to cause ziHam (crowding) and thus bring about the discomforts of indigestion. Over indulgence in sexual activity by a man, particu- larly with a woman other than his wife, is also extended as a cause of illness. A man is said to become very sick as a result of such encounters because he ejaculates in fear and guilt and without much sexual excitementl5. The idea of contagion is also reflected in villagers' beliefs of natural causes of illness. It is stated that, Fever is mu‘diya (contagious)...The heat from one body transfers to the body of the other who sits near him... Influenza is contagious, it has bad air which goes to other people through sham (inhaling)...The-illness of the chest (TB) is contagious and the doctor must treat the people who have marad il_SaDr (the illness of 249 the chest) immediately or else they make all those around them sicklé...Dirt can also cause illness and if I drink after a person who is sick... While the people of FatiHa refer to elements of the natural en- vironment as dipggp causes of illness, in some cases, the natural en- vironment may be cited as an indirect cause of illness. Thus, the dark- ness which falls upon the village at night, the roaring winds and swaying tree branches, or the dark low clouds, are believed to cause severe frights which induce the culture-bound illness of TEEEE|(fright)l7. The various dimensions of this illness, including cause, symptoms, severity, age relatedness, and sex relatedness, are recorded in Table 5.4 which indicates the degree of concensus (presented in percentage) among a sample of 55 informants who were instructed to associate the illness of 22323 with various illness dimensions. In some cases, 22322 may predispose a person to the more severe illness :EEE.(3 local variant of spirit possession which will be described shortly) in which the body is affected by supernatural powers. The people of FatiHa also believe that the turbulent waters of the Nile and the dark, deso- late fields, harbour supernatural beings which, through a lam§a_(touch) may gain access to the human body and precipitate illness. Illnesses thus inflicted are believed to be the consequences of stressful emo- tional experiences and/or conflict-ridden social relations, and ex- periences associated with powerlessness. Under these conditions, emotional distress predisposes the individual to attacks by super- natural beings which inhabit the natural environment. Although both the natural and social environments are implicated in illness causation, the social dimension of the environment is 250 Table 5.4. The Illness of Tarba: Illness Dimensions Associations. N=55. Illness Z Positive Illness % Positive Dimension Association Dimension .Association A. Cause 17. cannot fulfill duty as wife 2 §%7 32:?r:::¥:?1& subs. l6 18. cannot do housework 5 2. phys. constitution 25 53. yawns often k h 2 3. spt. intrus. (malbus) O ’ oes no spea muc 3 4. Hassad (gaze) O b. pphysical 5. ‘amal (sorcery) O l. weakness 95 2. headache 91 p.g§§icient 20 3. aches all over 87 2. Hassid (witch) 2 4' trembles 6: 3. assyad (spirits) O 2' 2::;§°1d spells 19 4. §g__£_(sorcerer) O 7. chills 13 c. ultimate 8. nausea 5 IT5 sadness 2 9. weight loss 42 2. anger 4 10. vomiting 13 3. jealousy O 11. swelling 5 4. hatred 2 12. loss of balance 40 5. punishment by God 4 13. diff. in breathing 31 6. fear 96 14. lump in throat l3 l5. diarrhea 27 B' Symptoms 16. fever 13 a. behavioural l7. pain in joints 53 I. sleeps more 9 l8. earache ll 2. insomnia 93 19. watery eyes 20 3. eats less 76 20. rash 4 4. loss of consciousness 9 21. backpain 45 5. tayih (in a daze) 42 22. dizziness 75 6. cannot bear himself 80 23. chest pains 15 7. makes no sense talk. 15 24. stomachache l6 8. disrespect. to super 5 25. excess blood in body 2 9. does not socialize 27 26. excess water in body 2 10. depressed & unhappy 84 27. drying of blood 11. cries 38 in body parts 76 12. cannot run after bread 15 C Severity 13' czggigrgiscipline 2 1} minor illness 80 14. cannot unite with wife 9 2' significant 111' 33 15. cannot pray 2 3. heavy illness 36 16. cannot fulfill mater. 4' atal resp. 0 ' Table 5.4. Continued. 251 Illness % Positive Dimension Association Illness Dimension % Positive Association Age Relatedness \nmeI—‘rxi Own-hwmI—‘U children only children mostly adults only adults mostly older people only older people mostly Sex Relatedness females only females mostly males only males mostly both males and females 61 61 16 4O 15 4O 252 accorded greater significance. Thus, as the villagers attribute an illness to a sunstroke, chills, bad food, or worms, in a typical holis- tic posture, they also refer to the social identity of the peasants which forces them to be exposed to natural elements, with little pro- tection to their bodies, either externally (by proper clothing) or internally (through proper feeding). Similarly, while a woman's poor health during pregnancy is attributed to her poor nutrition which causes weakness, informants are always quick to point out the social bases of this condition by pointing to her husband's poverty, to her mother—in-law's stinginess, or to her condition as a fallaHa (peasant woman). In terms of levels of causation, aside from rhetorical ref- erence to "the Will of God", extended case studies show that for the villagers of FatiHa, the ultimate cause of illness is social. Even in cases where villagers attribute illness to supernatural beings and powers (e.g., spirit intrustion, sorcery, and the Evil Eye), the ulti- mate cause of illness is social. Supernatural causation is important, to the extent that it mediates interpersonal social relations. For while illness is manifested in particular individuals, its ultimate cause lies outside the individual him/her self. In short, the charac- teristic mark of village medical theory is its concern with social problems which are related to illness occurrences. The body is seen to display social problems and tensions. Illness then is considered primarily a social occurrence. In explaining illness by reference to the social dimension of the wordly environment, diagnosis is a retrospective exercise. As is the case among other social groups whose interpretation of illness is 253 intimately linked to socially significant relations and events (e.g. Glick 1963, Rubel 1964, Fabrega 1974), illness cause is inferred from manifestations which are promptly linked to meaningful social occur- rences. In this regard, it is important to stress informants' regular reference to emotional distress, particularly that which results from interpersonal conflict, as a cause of illness. Three culture specific illness, :333 or excuse (caused byopggga 239113 - a gaze from the ground) Hassad or the Evil Eye (caused by nazra insaniya - a human gaze - which reflects feelings of jealousy), the 23322 or fright (caused by any frightening experience) are all associated with emotional etiologies. Thus, the first is precipitated by emotional distress, the second in- volves feelings of jealousy and envy towards others, and the third illness is caused by a frightening experiencelg. Informants regularly reveal the centrality of emotions, including fright, sadness, quarrels and rage, in their explanations of illness. Psychological state is constantly linked to physical well being or deviations thereof. The body-mind duality characteristic of industrial societies is contrasted by the conceptualization of these aspects of a person as parts of an integrated existence. Moreover, the indigenous medical system does not elaborate the differentiation between mental and physical illness states (excepting mental deficiencies which are khilga). Psychological disposition is believed to affect physical functions and physical dis- comforts, reciprocally, affect psychological outlook. In FatiHa, disturbing emotional experiences are cited as causes for the occurrence of different types of afflictions ranging from falling out of hair to heart trouble and diabetis, to certain culture- 254 specific illnesses. In case of the latter, impotency in men or barren- ness in women may be attributed to Tarba (fright) or a person may be diagnosed maTrub (frightened) when his/her behaviour, in terms of work habits, social relations, food intake, and other general activities are not up to normal standards of performance. The term.ngpa_refers to the experience of fright as well as to the illness which results from this disturbing emotional experience. But while fright may pre- cipitate the illness 22:23, it may also predispose a person to other more serious illnesses. Disturbing emotional experiences are said to shake the body, thereby reducing the person's defense against illness or precipitating certain specific types of illnesses which result from the "boiling of blood". Distressful emotional experiences are implicated in the illness of Haswa.fil'kila_(stone in the kidney). It is said that "sadness and rage cause fawran.dam (boiling over of the blood) and as the blood settles, it causes sand to settle in the kidney and gradually a stone is formed. Brostata (illness of the prostate gland) is also believed to be caused by excitement resulting from sexual intercourse. In- formants note "when the man unites with his wife, his blood boils be- cause of sexual excitement and as the blood cools it forms sand which accumulates and settles and then he gets the illness and may eject blood instead of semen". While emotional distress is said to cause illness, it is also believed that restraining one's emotions also causes illness. As one informant noted, "if a person tells others of what is bothering him, he gets relief". It is also significant to note that the effect 255 of emotional distress and the severity of the resultant illness are mediated by the physical state of the affected person. Informants refer to the tap: (nature) of persons as determining the severity of exper- ienced illness. Since it is believed that women have half the a:§ap (nerves) of men, it is remarked that the identical emotional blow is likely to have a more deleterious effect on a woman than on a man. Similarly, children are believed particularly susceptible to emotional distress. These beliefs are reflected in Table 5.4 where 15% of respon- dents associated the illness Of.EEEEE.With the category "males mostly", while 40% and 61% linked the affliction to "females mostly" and "child- ren mostly", respectively. As emotional distress which results from interpersonal tension is advanced to explain illness, feelings of jealousy and envy are also cited as causes of illness. This theme is elaborated in the culture- bound illness of EEEEEQ (envy or the Evil Eye)20. Table 5.5 summarizes various dimensions of this illness state. Belief in Hassad among the people of FatiHa, although pre-Islamic in origin, is legitimized by reference to Quranic descriptions21 of the malevolent power of the Hassid (possessor of the Evil Eye). The power of a gaze by a person who possesses this form of witchcraft is believed to be a great source of danger to humans, animals, plants, and even inanimate objects. The power of the fiayp_(eye) is by far the most common element advanced to explain almost any type of misfortune, including illness, and even death. It is believed that the malevolent power of an envious gaze brings about a sure destruction to the object of that gaze, be it a human body, another living creature, or an 256 Table 5.5. The Illness of Hassad: Illness Dimensions Associations. N=55. Illness % Positive Illness % Positive Dimension Association Dimension. Association A. Cause 17. cannot fulfill duty a. instrumental as Wife 2 I} nat. envir. & subs. 0 19. cannot g: housework 92 2. phys. constitution O 20' gawns 0t en k h 5 3. spt. intrus. (malbus) 2 ’ oes no spea muc 3 4. Hassad (gaze) 98 b. gphysical 5. ‘amaI (sorcery) O l} weakness 98 2. headache 100 EL» Sigicient 7 3. aches‘all over 96 2. Hassid (witch) 96 ‘5’ firemblis 11 :3 3. assyad (spirits) 2 '6. cgtéfio d spe S 7 4. SEHir (sorcerer) 0 7. chills 16 c. ultimate 8. nausea 16 1T3 sadness O 9. weight loss 31 2. anger ll 10. vomiting 2 3. jealousy 100 ll. swelling 9 4. hatred 96 12. loss of balance 38 5. punishment by God 0 13. diff. in breathing 44 6. fear 0 14. lump in throat 18 15. diarrhea 29 B' Symptoms 16. fever 40 a. behavioural 1?. pain in joints 55 l. sleeps more 18 18. earache 20 2. insomnia 85 19. watery eyes 42 3. eats less 80 20. rash 7 4. loss of consciousness 7 21. backpain 4O 5. tayih (in a daze) 29 22. dizziness 18 6. cannot bear himself 80 23. chest pains l8 7. makes no sense talk. 13 24. stomachache 18 8. disrespect. to super. 5 25. excess blood in body 4 9. does not socialize 15 26. excess water in body 2 10. depressed & unhappy 65 27. drying of blood in body 11. cries 38 parts 60 12. cannot run after bread 11 C Severity 13. cannot discipline 1} minor‘illness 60 children 2 2 significant 111 4'7 14. cannot unite with wife 7 ’ ' 3. heavy illness 69 15. cannot pray 4 4 fatal 73 16. cannot fulfill mater. ’ resp. 4 Table 5.5. Continued. 257 Illness % Positive Dimension Association Age Relatedness \nwal—‘rrj mmkwml—‘U children only children mostly adults only adults mostly older people only older people mostly Sex Relatedness *females only females mostly males only males mostly both males and females 91 36 O‘N bow-NO 258 inanimate object. In fact, villagers emphasize the danger of the eye by reference to Islamic narrations which describe the destruction of stone by an envious glance. But although people constantly refer to others' covetousness as causes of illness, the mechanism of action of the :EEE (Evil Eye) is conceived as supernatural and the actual pro- cesses by which illness is inflicted do not receive elaboration from informants. Neither is the power of the evil eye linked to a specific organ of the human body. As in the case of other culture bound ill- nesses, diagnosis is based primarily on causation which is traced retrospectively and linked to persons whom the maflspd (person affected by the evil eye) or members of his/her family consider envious. Nbre- over, as indicated in Table 5.5, illness manifestations, behaviour as as well as physical symptoms of the illness, are generalized and are not unique to EEEEEQ (compare symptoms of Hassad in Table 5.5 to those of Tagpg_in Table 5.4). In fact, with the exception of yawning (which as Table 5.5 indicates, is associated with the illness by the majority of informants) symptoms of Hassad are also indicators of afflictions by other illnesses. Neither is the severity of the illness considered a principal diagnostic indicator. "The eye" may cause illness states ranging in severity from slight to fatal. In this respect it is similar to other types of culture bound illnesses, the effect of which may vary from slight incapacitation to death. In short, cause (defined in terms of interpersonal relations) is the single most important factor in the diagnosis of Hagggd, In comparing the degree of consensus among in- formants linking the cause pagza_(envious gaze) to the illness Hggggd with those linking this etiological element to other culture bound 259 illnesses, the results were as follows: Illness Tarba Hassad ‘uzr Amal bil maraD % Positive Association 2 96 20 O In the case of the illness of £233, a gaze may be isolated as an in- direct cause of the illness. A mgfiggd (someone affected by the evil eye) becomes sad and depressed, thus predisposing him/her-self to lapse (touch) by supernatural beings which cause the illness of :222: With regards to the characteristics attributed to the villagers to those who possess the evil eye, such persons are described in terms of their insatiable desire to possess whatever others have. Nbreover, it is said that they make no attempt to hide their envy of others' fortune. This is indicated by their constant self pitying sighs and their lingering, longing gazes at desirable objects. Some informants assert that they can identify those who possess the evil eye by their gaze. Of such proprieters of witchcraft, others remark that "the black of their eye is actually yellow, this is the mark of those who have the evil eye, this is khilga (inborn)". But such assertions are made in reference to persons who are in fact suspected in actual cases of misfortune. While some people who do not control culturally valued resources (i.e., who are powerless) may be accused of Hassad, it is generally agreed that anyone can have the evil eye. In FatiHa, "some men are known for their evil eye, some women are this way too". In- formants also note that barren women do not necessarily have the evil eye;'bome women who have many children, even male children, also have 260 the evil eye". Such women may be pointed out as the cause of illness by persons who resent them for one reason or another. For while the evil eye is an important etiological category among the peasants of Fati- Ha, it is clearly a measure of interpersonal relations. Attributing an illness to a given person's Hassad is at once a reflection of and a justification for hostile attitudes towards that person. Accusations of possession of the evil eye are dependent, not on culturally specific characteristics of persons, but on the nature of interpersonal relations. Thus, although some barren women are indeed believed to possess the evil eye (as is the case in other parts of the Middle East (See Spooner 1970)), barrenness is by no means a definitive criterion for possession of the evil eye. Accusations of the evil eye are situationally determined. In fact, one person may be perceived as a possessor of the evil eye by another but not necessarily so labelled by a third party. The evaluation is directly related to the nature of social relations which obtain between people. The case of Z. is instructive in this regard: Z., a 45 year old blind woman who is also barren is considered mabruka (possessing blessing power) by many of the village women (as is the case for other people who are mentally or ‘ physically deficient). They bring their infants to her so that she can caress them and transfer some of her baraka (super- natural blessing power) to them. In contrast, her sister-in- law, with whom Z resides, and who considers Z. a burden, says that she is a source of trouble and has the evil eye. Such accusations are not uncommon among members of extended families who reside in the same household (for reasons elaborated upon earlier in Chapter 3). But as Rubel has noted for Mexican Americans (Rubel 1966:204), there is no indication of such accusations by one member 261 of a nuclear family against another, although informants jokingly remark "ma yiHsid 11 gal 113 suHabu" (no one envies the wealth except its owners). The power of the evil eye may be triggered by the feeling of envy on the part of the onlooker. The persons who induce this feeling are therefore likely to possess certain desirable qualities such as beauty, health, wealth, happiness, youth, or power. Children, es- pecially males (who are recognized as culturally valued power bases) are said to be particularly sensitive to the effects of the evil eye22. Some informants also believe that older people are more susceptible to the evil eye because they are usually richer and have many children. It is also said that "if a woman's child is beautiful, he may be seen by someone who fills her vision and then the child would fall ill". People are said, not only to envy others' children, but particularly educated children. In referring to her son's regular illness at the beginning of the school year and towards its end, an informant attribu- ted his illness to the evil eye. She said, "people never leave us alone, they always say, 'look, they have their children in school and they also have land'. There is no month that passes without one of us being sick". Another woman related the death of her sons from the evil eye as follows: The youngest one which I lost was only ten days old. There was something wrong with him since birth, he was very large, but his looks were so good. Of course he was affected by the evil eye. He was a boy after two girls. The next child that I lost was almost three years old. There was this woman who only had sons. Since this son was beautiful, I used to cover him. I left him with this woman, thinking that since she had only sons, she would not envy him. But when she saw him she said, 262 'how beautiful, how can the son of black people have such beautiful hair?'. And that was that. He died less than a week later. He fell sick. I gave him rice water instead of my milk, like older people told me. But he had diarrhea and he remaind this way and then died. As in other cases of illness explanations, one notes the emphasis on causation in this account of the infants' death. ‘Moreover, one may distinguish different levels of causation: an ultimate cause (envy), an efficient cause (the possessor of the evil eye), and an instrumental cause (the longing gaze). Accusations of the evil eye are significant, not only in revealing the logic of the village medical taxonomy, but for identifying culturally valued power bases, be these male status, possession of land, or educa- tion. The significance of male status and related differential valua- tion of males and females is reflected in Table 5.5. This is indicated by the greater consensus among respondents that males are the more likely objects of envy (29% of respondents) than females (4% of res- pondents). The examination of the village medical system also,reveals its close relation to the religious domain of village culture. Villagers' ideas about illness, its cause, prevention, and cure, are closely tied to beliefs regarding the supernatural and to religious rituals. Most generally, explanation of illness in terms of supernatural causation entails reference to "His Will". Both health and illness are believed to be under God's control. As He is the source of life, He also de- termines its crises (including illnesses) and its termination point. It is said that no one lives byond the time that is written (maktfib) for him/her by God. In comforting a dead man's widow, his relative 263 said, "Allah mish Hayigayar Hpkmp.fi_riDa ‘abdu" (God will not change his command to please his slave). Villagers also believe that illness may be a reflection of God's wrath. In other words, illness is sometimes regarded as supernatural sanction by God for wong doing on the part of His human creatures. It is said that "God can also punish people by making them ill". The attributing of illness to zapb_(wrong doing) in K.'s statement when she noted that F's brother's wife' mother got leprosy only two weeks after she had refused to give her sick relative some of the food she had cooked. Her relative pleaded to God that she may never be able to hold anything with her hands. It should be emphasized that illness resulting from God's punishment is given as an explanation for illness only in case of other people, not in case of one's self or in case of one's loved relatives or friends. Thus when the author tried to sub- stantiate the above noted account of illness with the afflicted person's daughter by asking about the cause of her mother's leprosy, she denied that her mother suffered from this form of illness. Moreover, she did not attribute the illness to God's revenge, as did the other informant. Instead she said that, like any illness, her mother's came from God. In another case of illness which occurred during the author's pres- ence in the village, several informants explained T's illness, and his hospitalization for surgery, as a revenge of God for his exploitation of F.A.A.'s poverty, innocence, and ignorance. It is said that under T's pressure and intentional misguidance, F. put her stamp of approval (not knowingly of course) to a document which waived her former hus- band's obligation to support her and her infant son. It is believed 264 by some informants that T (the village clerk) was bribed by the woman's former husband who is said to have paid him five pounds for this service. More than one informant (none of whom are known to be friends of T) noted that only three days after T had done this evil deed, God's punishment came and F. was avenged, "he was on the operating table in no time". 3 Beyond the generalized attribution of illness to God2 , villagers implicate supernatural powers in cases of illness by reference to sub- terranean beings. As in the case of orthodox muslims, the peasants of FatiHa believe in the dipp, Such supernatural beings are referred to by various names, including ‘afarit (ghosts), assyad (masters), awlad il_g£2 (children of the ground), karin/karina (male/female relative), ikwatna (our siblings), and ghl_il_a£d_(the people of the ground). Such beings, which are identified as causes of certain illnesses, when controlled by sorcerers, also cause illness (or cure) on command. A local diagnostician describes the community of subterranean super- natural beings as follows: Just as there is the life of the inss (adamites), there is also the world of the jinn. This is stated in the Quran and the Hadith (he quotes from saurt i1 jinn) our karin (relatives) are not all muslim. Some are christian. Some heard the word of God and became muslims and some did not...They live every- where. They do everything we do. They have sexual intercourse, they eat, sleep, but they live longer. They can also do super- human acts. They can cause illness or cure it...‘uzr (spirit intrusion) is spontaneous,...but siHr (sorcery) is by use of jinn in causing illness, this is of course different. In siHr, the jinn is prepared (summoned) by a saHir (sorcerer). There are good saHara (sorcerers) who for example remedy situations between lovers and if someone is ill he is cured. This saHir (sorcerer) is called ‘ilwi (from above). This means that he uses khudam (supernatural servants-jinn) from above. These are angels. He is a good person who prays. He reads the oath 265 which says 'in the name of God the compassionate and the merci- ful, may prayer and peace descend on the most honourable of messengers (The Prophet), our master MuHammad. I swear on you on Simamail (the name of the jinn) to be present this h hour and to do for me such and such By the right of what is written on the forehead of ‘azrail (the jinn of death). I' beg your speed this hour. God's blessing in you and on you'. Il_jinn i1 sufli (lower jinns) are used (commanded) for evil deeds, including the causing of illness, e.g., blindness and hemmorrhage and discord like divorce. It is interesting to note that while good jinns are believed to be all males, among the sufli (lower) jinn, some are males and some are fe- males. Another informant (a diagnostician) also referred to the super- natural relatives (karin/karina) in the explanation of illness. He noted, I was called by Halag il_siHa (the barber of the health depart- ment - a paramedic) to see His two year old son. He had been very ill, he would not eat. They had been with him to the doctor several times. When I saw him, I threw the rosary (a diagnostic procedure) and found that he had fallen. I asked them why they did not come to me sooner. I found that there is no use because he had been hit by his karina (super- natural relative) because she was taking revenge from his mother in him. I knew that he was going to die but I did not tell them. Such punitive actions by the supernatural karin/karina, as noted in the above case, are explained as emanating from the subterranean beings' concern for the welfare of their earthly relatives. It is said that people do not always act in their own self interest, either by neglecting their children (a culturally valued power base), by over exerting themselves in work, or by being sad, to the detriment of their health. The karin/karina act promptly to remedy imbalances or distorted priorities in people's lives. Initially they may give warning signals, such as illness. If these are left unheeded, they 266 act more ferociously and may even cause the death of unheeding mothers' beloved children. This action is illustrated in the following account by a woman who was relating the death of her child. She said, "My son died when I left him in the room by himself; his sister bit him". When the author pointed out that the woman had just told her that she has no daughters, she said, "it'shi's sister from the ground who killed him. Everyone of us has a sibling from the inhabitants of the earth. His sister bit him.because I did not spread any salt (a symbol of appeasement to supernatural beings). A woman should not leave her infant alone24 when he is a week old and she should spread the salt in the house". As she related this account, this informant blamed her luck of living with her husband's family, whose constant demands of her in terms of housework as well as agricultural tasks forced her to abandon her child unattended, and whose "stinginess" prevented her from spreading the protective salt. While some informants intepret the punitive action of awlad.il_§32_ (children of the ground) as being inflicted in the best interest of the affected person or meaningful others in his/her family, other informants remark that not all subterranean beings are so motivated. It is said that "the jipp can see us but we cannot see them. Some are good and some are bad. The bad ones bother the adamites. He may hit one of us with a stone and cause us illness — $9.831 21.19.11? (touch from the ground)". Other informants, including healers, also describe a more elaborate classification among spkapflil.g£2 (the inhabi- tants of the ground) and associate the action of inflicting illness among differentiated groups with specific triggering behaviour on the 267 part of human beings. This form of division of labour was described as follows: When a woman is pregnant and she is upset with her husband, and doesn't eat (an action believed to be deleterious to the foetus), the karina of ahl_il ard tiltush il ganin (strikes the foetus). The karina is from beneath the earth, she comes in the shape of a farm animal and hits the woman and forces the foetus down.25 As ad (masters) come under fright or sadness or sorcery, but the karina (sister) only comes to a woman when she is upset with her husband or his mother, when the sadness is minor. Supernatural causation of illness by subterranean beings may be differentiated into two broad categories: direct and indirect. Direct causation involves these supernatural creatures as efficient causes of illness. This is illustrated in the culture bound illness of _‘1_.1_z_r; which will be discussed in detail in Section D. Briefly, the illness may be considered a variant of what anthropologists refer to as spirit intrusion. Disturbing emotional experiences, including those associated with powerlessness, are identified as the ultimate cause of the result- ing illness. The indirect action of supernatural subterranean beings is manifest when they are controlled and manipulated by other efficient causes of illness, namely sorcerers. The resulting illness is known as figmal_bil.ma£ap (deed for illness or illness of sorcery). Several dimensions of this illness category and informants' degree of consensus about linking these dimensions to the illness states are summarized in Table 5.6. The efficient causes of jgmal.bil_ma£§2 are humans, who, through their religious knowledge control the actions of supernatural beings and direct them to execute specified commands, including the infliction of illness26. Sorcerers are mostly likely to be males who have 268 Table 5.6. The illness of ‘amal bil maraD: Illness Dimensions Associa- tions. N=55. Illness % Positive Illness % Positive Dimensions Association Dimension Association A. Cause 17. cannot fulfill duty a. instrumental as wife 76 1. nat. envir. & subs. 2 i3' cannot g: housework 3; 2. phys. constitution O 20’ gawns 0t en k h 45 3. spt. instrus. (malbus) O ' oes no spea muc 4. Hassad (gaze) O b. Aphysical 5. ‘amal (sorcery) 96 ‘13 weakness 95 . 2. headache 95 E’ SigiCIent 4 3. aches all over 95 ' . trembles 6O 2. Hassid (witch 0 4 3. §§§1§E (spirits 2 5. hot-cold spells 35 -EH§L- 6. coughs 4 4. s r (sorcerer) 93 7. chills 9 c. ultimate 8. nausea 22 l. sadness 0 9. weight loss 78 2. anger 47 10. vomiting 35 3. Jealousy 91 11 . swelling 29 4. hatred 95 12. loss of balance 73 5. punishment by God 0 13. diff. in breathing 55 6. fear 0 l4. lump in throat 35 15. diarrhea 24 B“ Symptoms 16. fever 29 a. behavioural l7. pain in joints 67 IT’ sleeps more 49 18. earache 36 2. insomnia 82 l9. watery eyes 44 3. eats less 91 20. rash 7 4. loss of consciousness 42 21. backpain 65 5. tayih (in a daze) 8O 22. dizziness 87 6. cannot bear himself 93 23. chest pains 38 7. makes no sense talk, 45 24. stomachache 38 8. disrespect. to sup. 44 25. excess blood in body 18 9. does not socialize 44 26. excess water in body O 10. depressed & unhappy 45 27. drying of blood in 11. cries 73 body parts 55 12. cannot run after bread 84 C Severity 13. cannot discipline 1. minorlillness 13 children 58 2 1 'fi t illn 9 14. cannot unite with wife 93 ' S gnl can ess 15. cannot pray 38 3. heavy illness 91 . fatal 82 16. cannot fulfill matern. 4 ~ resp. 6O 269 Table 5.6. Continued. Illness % Positive Dimension Association D. Age Relatedness 1. children only 0 2. children mostly 2 3. adults only 2 4. adults mostly 89 5. older people only 0 6. older people mostly 7 E. Sex Relatedness 1. females only 0 2. females mostly 25 3. males only 2 4. males mostly l3 5. both males and females 53 270 knowledge of the Quran. Their status as males, who are more likely to be educated than females, predisposes them to control yet another form of power, that derived from literacy and religious knowledge. While the power of sorcerers rests on their control over supernatural beings and while females may in some cases have access to such control, the proper manipulation and ultimate command over supernatural beings rests, not only upon proper knowledge of the Quran, but more importantly, on knowledge of appropriate passages which are read for different types of required commands. To the extent that females have limited or no knowledge of the Quran, and to the extent that male sorcerers are more likely to pass on their secret knowledge to male offsprings or other male relatives, women's prestige as sorcerers is limited. Exceptions do exist, however, and some villagers of FatiHa are known to take their complaints to a female sorcerer in a nearby village. This woman is known to recite the Quran and has been on pilgrimage to Mecca more than once. In the village of FatiHa itself however, only males are known as sorcerers. The instrumental cause of ‘a_1_rla_l_ E M is usually a form of imitative magic, induced through the supernatural beings commanded by a sorcerer. Although informants also refer to illness object intrustion when describing the "drinking of fiiEI (magic), the harmful effect of the §2H5_is not defined in terms of its induction of specific physical and anatomical alterations in the internal body. It is des— cribed in terms of the supernatural power of the primary instrumental cause - the khadim (supernatural servant), which becomes manifest in altered social, psychological, and physical behaviour. Sorcery is said to be effective through a variety of supernatural 271 acts, known only to sorcerers themselves. But informants describe some forms of imitative magic as characteristic of sorcerers' activities. An informant noted, SiHr can be made on an egg on which reading is done and a hole is pierced in the egg. It keeps dripping and the person keeps bleeding and bleeding, sometimes even to death. It was made for me; I think it was my neighbour. Once I kept bleeding for two months, and once for a month. The doctor said I had a miscarriage, but I know I was not pregnant. I know it was a ‘amal (sorcerer's deed) and after this my period never came again. The sorcerer's magic may also be performed on the intended victim's aTar (a word derived from classical Arabic, meaning effect or remains). This may be anything which came in touch with the intended victim's body or derived from it. aTar may be in the form of an article of clothing, hair, a finger nail, or a rag used to wipe a person's sweat, blood, semen, or excreta. Any of these items is acquired by the sorcerer through persons on whose behalf harm, including illness, is to be inflicted on a specified victim. The sorcerer "concentrates his determination" (yi‘azim) on the aTar by reading appropriate Quranic passages, thus summoning the khadim (supernatural servant), the instru- mental cause, to bring about the specified form of harm on the intended victim. The diagnosis of ‘amal bil maraD extends primary emphasis to the ultimate cause, the social relations which prompt the use of sorcer— ers' services, not to physiological, anatomical processes involved in the precipitation of illness. Neither does diagnostic procedure seek to identify the sorcerer him/her-self. The sorcerers, whose services V are compensated with money, does not act on his/her own, but performs 272 his/her magic at the request of others. Sorcery accusations clearly reflect strained social relations and ‘amal bil maraD is considered a form of revenge. H.T. related how the people who had originally wanted to marry their daughter to her cousin's bridegroom "tied" the groom (i.e., rendered him sexually impotent through sorcery) on his wedding night. He was "released" (itfak) after three whole days of constant Quranic readings. She also related the story of a man who was known to engage in extra-marital sexual activities. His wife had him "tied" for other women, but not for herself. This account reflects the social control function of sorcery. According to H.T., the husband stopped frequenting other women when he heard what his wife had done for him, "for fear that he would be embarrassed in front of them (his lovers)". Sorcery was also implicated in other cases of male impotency. A woman who had taken a married man from his first wife of several years related her husband's case of sexual impotence as follows: Fifteen days ago he was tied, then Shikh Z released him. But now S is marbfit (tied) again. He says that his first wife wrote for Him. He knows that from seeing his aTar (a diagnos- tic procedure) with Shikh Z (a local diagnostician). The Shikh wrote Quranic words in two ceramic plates and made S. drink water from these plates. He (8.) said that after drink- ing from the second plate, he felt numbness coming down through his body and it went out from his toe. He was cured. Then he was tied again, he would get an erection but as soon as he approached me, he would loose his erec- tion....(two weeks later)...He told S.N. about his condi- tion. S.N. attributed it to excessive consumption of Hashish and advised him to abstain from Hashish and his Wife for two days. He did as he was advised and when F. came to see me today in the morning, she found me bathing (i.e., after engaging in sexual intercourse). The results of sorcerers' magic are also illustrated in the case of N. It is said that, 273 First she was married to MJM.'s brother and then fell in love with a man called Shikh I.Z. who wrote for her (per— formed sorcery) to be divorced from her husband. After this, she went to him and told him to marry her. He mar- ried her and her first husband started to write for her in D. (a nearby religious centre). She became crazy and they sent her to the palace in Hilwan (a mental institu— tion outside of Cairo). Still another illustrative case of sorcery is that of R., the daughter of MLK. It is said that MiK.'s cousin wanted to marry him. But R. objected since her (sick) mother was still living. The father's pur- sing bride wrote for B and she became ill. She lost all her hair, she had very severe knee pains and eventually she could not walk. She re- mained this way for four months until they found a Shikh in a nearby town who could untie (yifuk) the deed (‘amal). Finally, another case of ‘amal bil maraD was described as follows: She used to be fat and beautiful. Now she is skinny and ugly. She looks like a shadow. She is pale and weak. She drank siHr...probably from her husband's relatives. She had a big fight with them and they probably wrote for her bil mukraha (for hatred, i.e., so that her hus- band would hate her). They tricked her and made her drink the siHr27. D. Specificity of Illness Explanations Examination of the village medical system reveals the primacy of causation as a diagnostic index as well as villagers' emphasis on the social componet of the wordly environment as ultimate causation. But while the static account of medical beliefs informs us of the underlying logic of villagers' medical taxonomy, it does not ade- quately reflect the actual use to which that taxonomy is put in specific illness cases. Neither does it illuminate the social 274 processes surrounding an illness occurrence (Cf. Fabrega 1976). Selec- tion of one or another of the recognized causes of illness to explain a given illness condition is neither pre-determined nor random. Nbdi- cal theory is important as a probe into the dynamics of social life. Elements of the system of illness taxonomy are tied to actual episodes. Consideration is extended to sociocultural factors including social role, the developmental cycle of the family, and interpersonal power relations. In FatiHa, selection of cause is contingent upon duration of an illness, its behavioural and physical manifestations, and the social dynamics of interpersonal relations perceived to be associated with a case of illness. Thus, if a child falls ill, a natural cause may be extended to explain his/her condition. Reference may be made to poor appetite, over exertion in work or play, or to sunstrokes. But a child may be labelled Maggpd (affected by the evil eye), retrospectively, after he has been "seen" (itnazar) by someone who is disliked or feared. The label mafiggd may also be assigned to the child if the illness is considered to have occurred suddenly or if it lingers on beyond the period generally associated with the illness level assigned during an earlier phase. In such cases, cause is also determined retrospectively. Thus, a child may feel tired and irritable, but if his/her condition persists, one or more members of the family may recall that earlier during the week, or even as long ago as a month or more, the child had been "seen" by a person whom the family perceives as possessing the evil eye. This "telescoping" of illness explanations, which has also been described for culture-bound illnesses elsewhere (Rubel 1964 Cf. 275 Uzzell 1974), also holds true for other illnesses in FatiHa. Its operation in relation to the illness of :pgg is noted below. The situational determination of illness causation is also illus- trated by cases where informants may attribute someone else's illness to the wrath of God as a punishment for wrong doing to other members of the community. By contrast, other informants who are friends of the sick person, or his/her relatives, will explain the illness in terms of a number of other, diametrically opposed, causes, including his/ her overwork on behalf of community welfare. Still another illustration of illness explanations is related to sorcery. Thus a wife may explain her husband's impotency by reference to sorcery because she might have taken him from another woman who is expected to take revenge for such action. Similarly, a man may be interested in marrying a particular woman but is rejected by her family. Enraged by the insult, he may resort to sorcery and "write" that the desired bride remain unmarried, fall ill, or even die. In short, the social conditions for implicating sorcery must exist in people's percep= tion of interpersonal relations so that sorcery may be selected as an explanation of a case of illness. Furthermore, the actual verbalization of witchcraft or sorcery accusations follow a culture specific eti- quette. Accusations of these supernatural acts are never communicated to the suspected person/s directly. The difference in informants' description of the motivation of éhl.31.232 (people of the ground), noted in Section B, also points to the situational variations of illness explanations. Persons who are themselves the victims of supernaturally caused illness are 276 likely to interpret the action of supernatural beings as emanating from a sense of concern. One such person in relating her case of lamsa ardiya (touch from the ground or ‘uzr) noted, When my husband died he left me with three girls. They were all little. I took my share (of father's inheritance) and I brought my daughters up. I got them all married. Two are outside (her household). My second daughter's husband is very poor so he lives with me. I became ill about five years ago when my daughter got married and I became sad because I have no son or husband, and my brother, God forgive him, would not help me. My sadness turned to illness. My sister took me to the doctor, but the more of the doctor's medicine I took, the worse off I became. So people said that I am ma‘zura (afflicted by the illness of ‘uzr). The assayed Imasters, i.e., supernatural beings) talked. They said that they are from Saudia, from the land of the Prophet. They told everybody that when I am not happy they make all my body blue. They knew that my brother was not saying the truth when he refused to help me. The assyad from Saudia knew that I needed help. So in order to show my brother that I needed help, they spoke to them all through me and made them know that I need their help. When this ma‘zura's brother (who according to village norms is expected to help his sister financially) was questioned of his sister's :355’ he stressed the malevolent power of EEE.E$.E£2 and even condoned their punitive actions, of which he regarded a "greedy woman" deserving. In considering medical taxonomies, one must be aware that illness beliefs, when considered as isolated cognitive domains (Frake 1961), differ from actual responses to illness. This reality is further underscored by the case of a village government employee who consistently rejected the "nonsense" of supernatural explanations of illness by other villagers, only to extend such an explanation himself when physicians failed to cure his own daughter. Additionally, structured interviews reveal that when presented with hypothetical cases of 277 illness, there is no complete agreement among informants about their associated illness dimensions (Cf. Fabrega 197 ). For the study com- munity, the lack of complete consensus is reflected in Section B of Table 5.4, 5.5, 5.6, and 5.7. These summaries of the evaluation of degree of consensus among a sample of 55 informants, who were asked to associate different illness indicators with the illnesses of Tarba, Hassad, % DEM, and :u_z£, respectively, indicate lack of complete agreement and show that the members of village society do not all share a unified, standard body of knowledge about illness. The incomplete consensus indicated among the total sample population (and summarized in the above noted Tables), is also evident when the sample population is differentiated into subgroups of practitioners and non-practi- tioners. This point will be pursued in greater detail in the follow- ing chapter. In considering the situational variation of explanations of ill— ness, it is also important to note that, as for hypothetical cases in actual cases of claims of illness, the very identification of ill- ness is not always the subject of complete agreement. Through observa- tions and interviews in FatiHa, it became evident that the definition of illness entails a subjective evaluation. Thus, in census taking, a common discrepancy was noted between mothers-in-law's evaluation of their daughters—in-law's health and the descriptions of these daughter-in-law's own health status. When a mother-in—law was asked about the health of one of her daughters-in-law, she sometimes asserted that it was normal by labelling her "as strong as a horse", or "like a ‘afrita (supernatural being)". When some daughters-in-law themselves 278 were interviewed directly, they sometimes verbalized complaints which their older affines never even hinted at. When asked if they had fallen ill within the past year, many of these young women responded by saying, "yes", "of course", or "illness never leaves me". By contrast, a mother-in-law may identify her favourite daughter-in-law, or her own daughter's limited contribution to the family work force by labelling her sick28 ( "weak", at her end in pregnancy", or "overworked"). While the illness role provides legitimacy for deviation from role expectations (Parsons, op. cit.), the dispensation of such legitimacy is itself subject to social constraints related to power relations. Thus, a woman may claim illness, only to be contradicted and overruled by her more powerful mother-in-law, husband, or older brother/sister- in-law. Only under conditions of socially agreed-upon illness is it considered permissible to subordinate the collective interest of the extended family to that of an individual member. Manipulative be- haviour and strategies of indirect control by individual females are not feasible alternatives in the face of lack of control over culturally valued power bases. Adoption of the sick role is primarily subject to institutional structural constraints (including power relations), not the "tendency to adopt the sick role" (Mechanic op. cit.). It is not only the individual "tendencies" of daughters-in-law (or other relatively powerless social groups) which determines their adoption of the sick role; it is also the reality of their relative powerless- ness. In extended family households, an individual, powerless woman's self interest is subordinated to the collective interest, defined by the powerful figures in the collectivity. Any deviation from such a 279 state needs legitimization and illness provides such justification, but only when feasible. Moreover, illness does not alter the bagig power differentials. It simply mediates (momentarily) the contradic- tions inherent in the social relations of production, characteristic of extended families, and their attendant superstructural elements which define and justify relations of sub-super-ordination among family members. Since the explanation of a declared illness state may vary from the assertion of stressful experience by the afflicted person (and his/her supporters) to the outright dismissal of his/her behaviour as "faking" (3213:) by a non-sympathetic household member, an independent opinion from an expert, a diagnostician, must be sought. Such an opinion extends legitimacy to a contested claim of illness. The traditional medical practitioners, as one of them told the author, willingly dis- pense the label of legitimacy, they even anticipate the types of prob- lems which people of different social statuses themselves perceive as the basis of their illness. If for one reason or another this label is not given by one practitioner, it is sought from another. Antagon- istic persons may even quarrel about which diagnosis is the "correct" one. When diagnostic labels fail to match affected persons' (or their families') socially defined complaints, alternate diagnoses are sought. This is precisely what happens in the village when a sick person or members of'his/her family reject the physician's diagnosis (which does not take into account the person's social/psychological needs, or positions of relative subservience, in explanations of illness) and 280 seek explanations which are compatible with the sick person's social reality and emotional state. If there is no reason to assume super- natural etiology and if the sick person and members of his/her im- mediate social group believe that illness emanates from a natural cause, they will continue to frequent the physician and abide by his/her advice as long as they can afford to pay the fees and purchase the prescribed medicines. To summarize, the foregoing discussion, it is noted that medical taxonomies do not inform us that illness explanations are highly op- portunistic. As static classifications they do not inform us of the social process of selection of illness causes and ensuing labelling of illness occurrences. They ignore sociocultural dynamics. As Fabrega has pointed out, "The taxonomy is literally a cultural device for assigning meaning to an ambiguous and potentially ominous occurrence and members of a group can differ in terms of how they use such devices" (Fabrega, 1976:208). Actual explanations of illness depend on the afflicted person and his significant others' perception of social reality at any given point in the duration of the illness. In FatiHa, selection of a specific cause to explain an illness occurrence (and the appropriate treatment strategy associated with that explanation) is a function of the duration of the affliction, its physical and behavioural manifestations, its response to certain types of treat- ment, and, of particular importance, the types of social interpersonal relations which surround the affected person and his/her significant others. In trying to understand why explanations of.illness (and its 281 consequent treatment) do not always correspond perfectly to specific beliefs about illness or the appearance of specific symptoms, it should be realized that in FatiHa, illness is not a socially isolated cate- gory of negative experiences (Cf. Kleinman 1977). Illness, broadly conceived, belongs to a general category of misfortunes which trans- cends a sharply delineated "medical" domain (as characteristic of bio- medicine). Illness in FatiHa is to be understood, not simply in terms of physical constitutionzg, but more importantly, in terms of social dynamics, including social conflict and social control. It is through the critical examination of actual illness episodes that the medical system can be effectively utilized as a probe into social life, includ- ing the dynamics of gender roles and power relations. The following section undertakes this task through an in depth examination of the culture-bound illness of ‘uzr. E. Illness Explanations and Power Relations: The Illness of ‘uzr From the foregoing discussion of illness theory, it is clear that interpersonal relations are central aspects of illness explanations among the people of FatiHa. But as noted in Section C, the impor- tance of medical theory as a probe into the dynamics of social life is realized only when elements of medical explanations are tied to actual illness occurrences. In pursuing this task in the present study, the illness of :353_has been selected for in depth analysis which links causation to the dialectics of social life, particularly in terms of power relations and gender roles. 282 The choice of :pg£_rests on the author's contention that this illness is particularly relevant to power relations and to (gender) role behaviour. This judgment, is shared by the people of FatiHa them- selves. They view :Eg£_as an indicator of asymmetrical power rela- tions. Beyond the village, cross—cultural studies have shown that possession trance (of which :p§£_is a local variant), is more likely to be found in societies with differentiated levels of jurisdictional hierarchy than in societies in which power relations take on a more egalitarian form (Bourguignon 1968, Cf. Bourguignon 1972:11). In terms of role behaviour, the onset of the illness is accompanied by a more marked departure from culturally stipulated role behaviour than is the case with some other culture bound illnesses. Thus, a woman who has been affected by the Evil Eye, for example, may feel headachy and drowsy, but she does not withdraw from social life, and ordinarily, goes on about her business of fulfilling her maternal responsibilities (compare the dimensions "does not socialize" and "cannot fulfill maternal responsibilities" for Ha§§2d_- Evil Eye - in Table 5.5 to those for Lug£_in Table 5.7). This is in sharp contrast to the condition of a female informant who suffers from.:pg£, She refuses to nurse her son (a most unusual form of behaviour among village women) and her participation in neighbourhood social intercourse is minimal. The social significance of :EEE is also marked when it is contrasted with another culture bound illness, £522 (typing or rendering sexually impotent through sorcery). In case of the latter, although the conse- quences of the state of illness involve a drastic deviation from expected role behaviour, they are of a more private nature. The strikingly 283 Table 5.7. The Illness of ‘uzr: Illness Dimensions Associations. N=55. Illness % Positive Illness % Positive Dimension Association Dimension .Association A. Cause 17. cannot fulfill duty as wife 76 3. Instrumental 18. cannot do housework 93 l. nat. envir. & subs. 2 l9. yawns often 45 2. phys. constitution 4 20. does not speak much 45 3. spt. instrus. (malbus) 95 b.p_physica1 4. Hassad (gaze) 2O 5 ‘Emai—isorcery) O 1' weakness 93 ' ————-— 2 headache 95 b. Efficient 3. aches all over 95 1. God 20 4. trembles 62 2. Hassid (witch) 20 5. hot-cold spells 20 3. Assyad (spirits) 87 6. coughs 20 4. saHir (sorcerer 5 7. chills 24 8 nausea 36 c. Ultimate 9. weight loss 69 l. sadness 87 10. vomiting 27 2. anger 89 ll. swelling 31 3. jealousy 7 12. loss of balance 73 - 4' hatred 9 1 diff 1 b tin '75 5. punishment by God 2 3' ' n rea g 8 5 6. fear 82 14. lump in throat 5 l5. diarrhea 20 B. Symptoms l6. fever 38 a. behavioural i8. pain in joints Z: l. sleeps more 56 ' earac e 19. watery eyes 54 2. insomnia 73 20. rash ll 3. eats less 84 21 b in 71 4. loss of consciousness 85 22' diggizess 87 5. tayih (in a daze) 85 ° 6. cannot bear himself 85 32' chest fi:::: 2% 7. makes no sense talk. 82 ' S omac 25. excess blood in body 7 8. disrespect. to super. 71 26 excess water in body 2 9. does not socialize 8O 27' d 1 f bl d in 10. depressed and unhappy 89 ' bry ngagt 0° 58 ll. cries 91 ody p S 12. cannot run after bread 89 C. Severity 13. cannot discipline ’1. minorfiillness 9 children 69 2. significant illness 7 14. cannot unite with wife 80 3. heavy illness 80 15. cannot pray 71 4. fatal 67 16. cannot fulfill maternal resp. 75 284 Table 5.7. Continued. Illness % Positive Dimension Association Age Relatedness children only children mostly adults only adults mostly 8 older people only older people mostly Sex Relatedness females only females mostly 4 males only males mostly both males and females 3 \ONxo-FQO VII-\WNHFII Omwal-‘U HQNxON 285 more public or social nature of :25: is also reflected in the thera- peutic efforts to pacify the illness causing spirits. Such rituals are often performed in a public arena, in full view of an audience of relatives and other fellow villagers. Moreover, the very term :pgp (excuse) provides the illness with a social definition. It offers the mazEr/a (excused) a temporary dispensation from the requirements of social canons. The alternative term.m§lp§§ (worn or possessed), which more explicitly, refers to the pathology of the illness, is used more frequently by practitioners, but seldom utilized by the majority of villagers. The condition which inhabitants of FatiHa describe as :253 is clearly a variant of a world wide phenomenon generally referred to as spirit possession. While the local form is interpreted and dealt with accord- ing to culturally specific assumptions (see Table 5.7), it partakes of the general patterns described in the literature on spirit possession (Lewis 1971; Oesterreich; 1974; Walker 1972). As in other forms of possession states, :Eg£_entails the invasion of a person's body by a spiritual agency. Disturbing emotional experiences are incriminated in the incidence of the ensuing illness. Both physical and behavioural symptoms are used as diagnostic indices. Thus, in addition to correlat- ing :pgp with non-specific bodily symptoms, informants regularly referred to impaired social behaviour in terms of interpersonal rela- tions and to deviations from culturally recognized role behaviour. The onset of the sumptoms of :p§£_cannot be attributed to a single case. Instead, informants' interpretations of the onslaught of the illness disclose more than one level of causation. One is 286 able to isolate an efficient cause, an instrumental cause, and an ulti- mate cause (Glick 1967). Supernatural beings (gwlad.il.2£D 23.§§§Z§§)' the efficient cause, are believed to be the agents of the illness. Their actions are usually explained in terms of their concern for the welfare of the persons whom they possess.- Their seemingly contradic- tory conduct of inflicting illness upon such individuals is rationalized by both the mdbur/mabura (possessed male/female) and sympathetic mem- bers of his/her family. It is said that the spirits, by inflicting harm on humans, exert pressure on them and force them to evaluate their detrimental practicesBO. The assyad's concern for the well being of their victims is reflected in the case of a female informant, whose sayid "arrived" during the course of an interview with the author. She stopped talking suddenly and said, "I feel heavy, I feel he is coming now". Her voice changed and sounded more masculine. The new voice said, "I have been coming to U. for fifteen years because she was screaming. When the author inquired, "why did you make her ill?", the voice answered, "We make her ill so that she can tell them that she cannot go to the doctor...We are from Saudia, the land of the Prophet and when good people are present we come. When she is not happy we make her whole body blue and when she regains her consciousness we make our demands which are for her. We ask for perfume. When she is unhappy we become unhappy too and so we punish her by making her ill... because we love her". The specific mechanism by which the assyad affect the body is not a point of agreement among informants, including diagnosticians. Some people believe that illness may be precipitated by the actual invasion 287 of patients' bodies by the spirits. Others indicate that it is brought about simply by their touch (lgmsg) or through their winds (SIZE§)' Since the 33y§H_or the jipp’(g§§yad) are not stationary, once they enter the body, the pain associated with 3223 is mobile. This is a distinguishing diagnostic criterion which affected persons theme selves emphasize and which is communicated to healers and recognized as a basis of their diagnosis. It is a distinguishing diagnostic index which differentiates this maraD rawhani (spiritual illness) from.maraD gpssmani (physical illness). The pains of :22; are not allowed (by the spirits) to subside until measures are taken to rectify patients' situations of distress. Thus, the ultimate cause of :223 is sought in affected persons' social relations. The affliction is known to be induced by a variety of negative emotional experiences, including those associated with subordination, sadness, fright, quarrels, anger, and generally, interpersonal conflict. The illness of :pz£_may also be considered a secondary illness which results from an untreated case of 92232 insaniya (human gaze, i.e. the evil eye). It is noted that if a person who is maH§3d_(af- fected by the evil eye) does not get immediate treatment (through.£§gwg — the recitation of Quranic verses), then he/she gets a :pg£_which results from his/her state of depression which was brought about by the evil eye. This secondary precipitation of :pgg_may be detected by a diagnostician when he summons the ggsygd: When the ggsygd speak, they indicate that they came EEEENEEEEE (under a wish, the wish of longing). :25; is also believed to be the outcome of :EEEl.EilhEEEEE (the illness of sorcery). As in the case of the evil eye, it is said 288 that the writing of sorcery causes sadness and the person becomes ill and lies down all day. He/she does not want to be bothered or talked to by anyone. This depression makes the §§§X29.°°me to the person and he/she then becomes ma‘zfir/a. Representative cases of reported accounts of :233 will help i1- 1ustrate the role of emotional distress and interpersonal conflict in the precipitation of the affliction. I.N., a male household head who had gotten his first attack of i2§3_as a child emphasized a frighten- ing experience as the cause of his original :223: He also emphasized the role of sadness in prompting the assyad's return many years later. In describing his case he said, Eighteen years ago I was swimming in the river. I fell into the deep part of the water and got frightened. Suddenly I felt that my body was hurting. My bones were hurting and the pain kept moving around. First it came in my joints and moved around. I stayed in the bedding and could not sleep...I ate everything, the ‘uzr does not prevent one from eating. It is other types of illnesses which make people lose their appetites. They (members of his household) made me a tabwika (a treat- ment for moisture in the body). They took me to the Hadra3l and my body reacted to one of the Tariga32. They (the assyad) talked and they said they wanted supper. They never come any more, they never came until today, I feel they are back. Now they came because they know I am sad, they know that my daugh- ter wants to leave us alone and live with her husband in an- other house. Now I get the same pain all over. It starts in my head and then moves all over my body. The Shikha A (a local healer) talked to my daughter and tried to put some sense into her and she said she will make us a sulHa (a reconciliation ceremony to pacify the assyad). A few days after I.N. gave the above account he said that he was cured. The Shikha A. had talked to his daughter and had performed a The case of S.A.E., a married female residing in an extended family household, in addition to identifying the evil eye as an indirect 289 cause of :EEE’ also implicates sadness. It also shows how asymmetrical power relations between a woman and her husband are the bases of such sadness, which is in turn advanced to explain the occurrence of :pgp. S.A.E. described her condition as follows: My ‘uzr came in the field when I fell after some people gave me nazra (gaze). In this instance the khawaga (foreigner) possessed me. If I do anything Islamic, i? I pray, if I fast, or if I give alms, he makes me ill. He makes my head pound. My body becomes feverish and I cannot sleep well. He comes when people upset me. Then he told those with me in the house that if they upset me he would kill them and would provide me with money to live in another room. He told my husband, if he hit me again he will take his revenge from them and he asked my husband not to hit me. He forced my husband to forgive me. A few months after the above account was given, S.A.E. got another attack following a fight with her older brother-in-law's wife. S.A.E.'s husband hit her again. Her account of the incident is indicated below in an interview with the author: Q. I heard that the assyad came to you yesterday. What did they say? A. Yes, the khawaga came and also Mariya (a name given to a foreign - European - woman). I did not feel anything. They (members of the household) say that the khawaga caught my husband from the neck and told him, "I will kill you if you lay a hand on her again". Q. So what will you do now? A. I feel very weak and so I will wait till next week to go to the Hadra. I feel my whole body is heavy and I don't want to touch any food, and for awhile my head hurts then the pain moves all over my body. My breath goes completely. Q. Why don't you come with me to the doctor? Maybe he will give you some migawiyat (strengthening substances)? A. I know there is no use going to the doctor. He does not know anything about ‘uzr. But I will come with you just to change the scenary. Q. Do you want to forget your troubles? Let me show you some- thing that will keep you occupied for awhile (the author then turned to administer the Hakky personality test to her). 290 S.A.E. was consequently given a physical examination by the project physician and the personality test administered to her was analyzed by the psychologist. The results were as follows: Physician's Diagnosis: B.P.: 130/70 (normal) Chest: Chronic infectious bronchitis Abdomen: Umbilical Hernia Psychologist's Diagnosis: Severe Hypochondria. It should be noted that while the physician's diagnosis explains what S.A.E. referred to as "my breath goes completely" by labelling her condition "chronic infectious bronchitis", it fails to explain her 'Sadness". It is the latter condition which S.A.E. considers critical and therefore finds the physician's diagnosis "incorrect". Moreover, she refers to the physician's diagnosis (which is similar to those communicated to her by other physicians) as still another proof of doctors' ignorance of :3333 The case of F.A.A., a young divorcee living with her widowed mother, also illustrates how emotional distress and asymmetrical power relations are implicated in the occurrence of :3353 The following account was provided by F.A.A.'s mother in her daughter's presence. The latter was extremely shy and would not answer any of the author's questions and simply smiled back in response to the probing questions. The mother related the daughter's case as follows: When she was young she was in school and wanted to leave during the recess. But while she was stealing her books and getting ready to leave, the teacher caught her and F. screamed. She was about nine years old. She fell unconscious. Two years later her father scolded her and she fell unconscious. Her father made a zar (ceremony to entice the assyad). In the zar, Shikh Ibrahim, who was possessing her, spoke and said, "I've been 291 with her since the day of the school incident". He asked for silk and shoes when she (F.) was in the Hadra. So we had to dress her very well. By the time she was sixteen, she was en- gaged. The Shikh Ibrahim came again when she got married. He said that he would take care of her and when she went to her husband's home in a village near us and her mother-in-law gave her lots of work, he (the possessing spirit) said that he would help her with the housework...because no human being by herself could do the work. Everything went well with her husband and his mother at first. She became pregnant and had a daughter. When her daughter died she got a shock from crying too much and she became malbusa (worn) by new assyad. This time they were two Christian assyad. She would fall asleep while she is sitting and sometimes she would sleep all day long and at night she would shiver all over her body. When I asked them (the Chris- tian ass ad) to salute Allah (yiwahidu allah) they still would not stop making F. shiver). So I realized that they must be Christians. I took her to several healers. The first one touched her forehead and took her to the Hadra but nothing happened. I took her to many shikhs, i.e., traditional heal- ers. One of the healers suggested that I take her to a physician for electric shocks. So I took her to the doctor after she had been rude and mean with us and refused to nurse her son. Her husband told me that he has no use for her so I brought her here with me. When I took her to the doctor, he gave her three sittings of electric shocks. But this did no good. People suggested for me to take her to a church in a village near us. I paid the Christian healer 3 pounds. The Christian priest asked the Christian assyad to leave her and when they wouldn't, they beat her and ironed on her body and put a burning cloth near her nose. But they would not come out. She was in great pain. The sessions with the Christian priest lasted for a number of hours for three consecutive days during which three men (assist- ants of the healer) beat her with bamboo sticks, but all this was to no avail. When we returned home she would sleep and she would still refuse to nurse her child. Whenever I tell her to take care of her son she shivers and losses consciousness and goes to sleep. After F. had been living with her mother her husband paid them a visit. Seeing that there was no improvement in her condition, he told the mother that he would divorce her daughter and marry another woman from his own village. Following this visit, the mother informed the author that F. had gotten the 923 (the round) again and that she had been crying and shivering at night. During the following warmer months, F. usually sat outside her house while her sister and mother 292 worked in the fields as day labourers. F. was entrusted with the house- work and the care of her son while the other women were away but her mother complained that she slept a lot. The author managed to administer the Hakky personality test to F. It was very difficult to get her to answer the questions. It took her much longer than any other person to whom the test was ad- ministered. She answered the questions with great reluctance. F. was also subjected to a physical exam by the physician following her dur. The diagnoses of her condition are as follows: Physician's Diagnosis: B.P. 130/70 (normal) Chest: Bronchitis Heart: Free Liver: Free Spleen: Free N.S.: Psychic Depression, most probably due to accident or sorrow from husband's behaviour Psychologist's Diagnosis: Paranoid (persecutory) F.'s neighbours and acquaintances all agree that she is ma‘zfira. They attribute her :32; to lonliness, because she was married outside the village. They say that the people of her husband's village are "without religion" (without compassion) and her mother-in-law was mean to her and that is why the gssygd came to her. When asked if F.'s condition is improving at all, a neighbour noted, "of course not. This illness needs money. Her mother is a poor woman and she cannot fulfill the demands of the gggygd, F. is like you have seen, she does not work in the fields and she cannot even take care of her son". While the women in F.'s immediate neighbourhood did not express any fear of her, a distant acquaintance of the family did express 293 fear of violence on the part of F. She said, "you saw her joking around with me with that knife in her hand. I was scared to death. Her mother is afraid that she would kill her own son. She sometimes holds him very hard and has nearly smothered him to death on several occasions". If this claim is true, then F.'s mother's insistence that her daughter's condition is due to :2333 may be interpreted as a way of avoiding the shame of having a daughter who bears the physician's diagnosis of marad ‘asabi (sickness of the nervous system). This point will re- ceive further elaboration below. Finally, the case of F.E.D. gives further illustration to the role of emotional distress in the affliction of :223: F.E.D. related her case as follows: They forced me to marry my husband. He was married to the sister of my mother. When she died they put pressure on me to marry him. After two months of marriage, I was sleeping one night and in the middle of the night I found in my dress a bunch of cats and mice. I kept saying "Ya Allah", "Ya Allah" and then fell off the bed. I ran out of the house and told him (her husband who works as a night watchman) that if he doesn't come and spend the night in the house, I would go back to my father's house. My husband answered, "is there anyone who is afraid of her own house?" and he came and sat beside me on the bed. we both stayed in the bed for forty days. He felt very headachy and his whole body was aching with a fever. He only ate water and sugar and milk. He was cured from the barber's injections. As for me, I felt pressure on my throat and I hallucinated. Sometimes I was happy and sometimes I used to scream and yell. I felt that my whole body was aching, I felt in a daze. I used to drink water and sugar and I don't know what else I used to eat. My husband took me to the doctor. The doctor told him that I only have a slight fever. But I knew that it was not a fever at all. I had a ‘uzr. (Where did your ‘uzr come from?). (It came) from Sidi Ibrahim and from the Sayid il Badawi (shrines of two saints in two privincial towns which are considered two of the major religious centres in Egypt). The Sayid il Badawi and Sidi-Ibrahim (two saints) came to me in the form of cats and mice. When they saw my aTar (a diagnostic procedure), the Shikh 294 (diagnostician) in B. said that I am malbhsa (worn) by two men, one from Sidi i1 Sayid, and one irom Sidi Ibrahim. (How did this happen?). I was bathing and a woman passed me by and I had so much soap on my body. The woman said, "you have enough soap on for a full day's laundry", and that is how I became ma‘zfira. I was unhappy and this is what caused all this ill- ness...My body was affected by her eye and there was no one around to recite for me because I was by myself. My state of sadness made the assyad come to me. (Did you go back to the doctor for your i1 ess?). In the beginning I did. But what does the doctor know about this? When I go to see him I feel fine and he says there is nothing wrong with me. After many visits to the doctor, my husband and our neighbours told me that I should give up on doctors and there is no sense spend- ing money on doctors who know nothing of this illness anyway. The doctor said that I need an operation for my barrenness but I know that my childlessness is from nazra arDiya fi bit 11 wild (subterranean gaze in house of chiId). '__'_—-'—- Many people in the village feel sorry for F.E.D. because she is mar- ried to S.N. (who is said to be old enough to be her grandfather). Her friends agree with her explanation of her barrenness in terms of her :223: Some of them also blame her husband's old age. R., her older sister-in-law, on the other hand, feels that F.E.D.'s barren- ness is khilg§_(inborn) and that "she would never set her eyes on children". Although R. herself once suffered from :2233 she does not believe that F.E.D. is so affected and says that she is only making up excuses because "she cannot give her husband a little child for him to enjoy in his old age". On one of the visits to the E5922. by F.E.D. and the author, F.E.D. announced that R. would accompany us. She said, "maybe when she sees my condition in the H3933 she will have pity on me and her tongue will stop playing (i.e., she will stop her gossip). I want her to hear from Shikh M; when he sees my 2323." The appeal to the authority of the diagnostician to lend legitimacy to her claim of ‘uzr is clear in this statement. 295 About three months prior to the author's departure from the village, F.E.D. suspected that she might be pregnant. She was examined by the project physician whose diagnosis indicated, "enlarged uterus of two months gestation". Following this announcement, F.E.D. stopped going to the.§2§£2: On occasion, during the author's presence, she even advised some women that the traditional diagnosticians are swindlers. It is also interesting to note that F.E.D. took R. (her arch enemy) with her to the doctor's office on the second visit "to make sure that she hears the doctor say that I am pregnant". To resume our description of the illness of :pgg, it is noted that apart from shamanistic diagnostic practices, the identification of :22: seems to rest primarily on behavioural changes and on the chang— ing loci of physical discomforts reported by the ma‘zfir/a. While there are definite signs of withdrawal from social life and deviations from social role behaviour, the symptoms of :pgg are anything but specific. Behavioural correlates of the illness may include such contradictory conducts as excessive sleep and insomnia. The most significant diag- nostic physical symptom is mobile pain. Other physical indicators of :35: are variable and may include any combination of a variety of symp- toms. This variability of physical and behavioural symptoms mitigates against isolation of a specific illness yndrome. Moreover, a valid explanation for the occurrence of :253 is not always readily avail- able at the time of the adoption of the illness role. It is possible for a person to be labelled.m§§u£_by reference to a disturbing emo- tional experience which occurred several years prior to the manifes- tation of symptomsBB. The case of F. illustrates this telescoping 296 effect of illness explanations. F. lives with her mother-in-law in an extended family household. Her mother-in-law was described by a neigh- bour as "unbearable". The neighbour also noted that because F. is ma‘zhra, she is allowed to go to the Hgdgg in the nearby village. This informant noted that this departure by F. from the household was the only occasion in which she "could breath" (i.e., feel free from the control of her mother-in-law). The telescoping of illness explanation is reflected in the mother-in—law's account of F.'s :253. She said, F. was working cleaning the wheat, she fell. But the EEEEEEi did not cause her any illness right away. Two years later she became ill. She complained that her whole body hurt and she kept sleeping all day long. We took her to two doctors but the more of the injections they gave her the worse she got. Finally her father took her to a shikh in B. who made her a Higgb (charm). The death of her son caused all this. She used to cry a lot during the night. This fluidity of the symtomatology of :EEE and its causation, makes it a convenient, readily available, illness role, contingent upon social legitimation of the ma‘zEr/a's claim of illness. The general course of :pg£_therapy conforms to the procedures outlined in both contemporary and ancient accounts of therapeutic rituals of spirit possession (El-Shamy 1972; Lewis 1974; Oesterreich 1974). The basic objective of the shaman is to establish communica- tion with the assyad. In the context of a §23_ceremony, the matur/a is the vehicle of communication. Having reached an altered state of consciousness through the stimulations of a variety of musical instru- ments and through the rhythmic, exhaustive, swaying of dancing to a rapid beat, the afflicted person starts to speak in an unfamiliar tone of voice. The sound is immediately recognized as the assyad's 297 response to the shikh's (shaman's) calling. Speaking through the mouth of the ma‘zhr/a, the assyad then proceed to explain the circume stances which led to their association with their host. They also set the conditions for reconciliation and for sparing their host from the ravishes of illness. Many of their demands are directed to the patient's personal advantage. Another ceremony, a sle§_(reconciliation), may be performed and at this time the wishes of the gssygd are granted. Sacrificial offer- ings may be made and expensive items of jewelry and/or clothing may be worn by the patient. The affected person may also be reminded to honour his/her :ghd_(promise) to the assyad. He/she is asked to re- iterate his/her commitment to paying regular visits to the EEEEE. and joining the tagiga of the possessing spirit in the dance arena. Once a s21§g_is performed, the gssygd no longer cause physical discomforts to their host. They are said to make him/her out of sorts only pgflt.g§:lg (when he/she becomes sad). Thus the assygd never leave their host/ess but the symptoms indicative of the association remain dormant and surface only when the person has another unpleasant emotional experience with which he/she cannot cope adequately. Hence, once a person has experienced :pgp, the other members of the house- hold become particularly sensitive to his/her needs. Care is taken to avoid the precipitation of another illness crisis, and by extension an emotional and economic crisis. This cautious treatment of the ma‘zEr/a is indicated in AJM.E.'s account of her i222! She said, About three or four years ago it started. I was very sad and then I started crying. Now I feel bored and I know it must be the ‘uzr. When my children upset me or.if anybody tells 298 me an unkind word I become said immediately. I know it is a ‘uzr because I lose consciousness. Four days ago I did not ieel myself at all. I did not even know where I was sitting, it lasted for awhile. It is mostly from the children that I get upset. My husband knows that I am.ma‘zfira and so he doesn't like to upset me34. The case of a young adult, I.S.T. also reflects the family's special treatment of the ma‘zhr. His brother described I.S.T.'s condition as follows: Some years ago when he was playing in the street some kids hit him. When he came complaining to his mother, she hit him too. He fell in the doorway of the house. He kept crying and when we transferred him to the bed, he kept shaking. The following morning he had a fever. He became very hot. we took him to the doctor. He was cured. But every time after this, when- ever anyone upsets him, he would get the dur (behavioural cycle) again. His head would shake. We took him to Shikh A.H. and he made him a Higab (charm) and he became better. But until now, whenever he becomes upset he starts shaking and so we have to be very careful with him. The Shikh had said that when he was hit over the doorway, because it is inhabited, (i.e., by super- natural beings), he became malbuss (worn or possessed). The necessity of special treatment of the ma‘zfir/a is understandable in terms of people's view of the nature of curative procedure connect- ed with his/her illness. Informants, including traditional practi- tioners note that efforts to control ‘uzr involve attempts at eliminat- ing the symptoms of the illness, not its cause. Indeed, from an etic perspective, the persistence of the illness is consistent with with relative stability of the structural power relations with which it is associated. While the potential harm of ‘uzr35 is feared by all adults in FatiHa, informants also recognized variable susceptibility to the effect of supernatural forces in general, the illness of ‘uzr included. It is said that "there are bodies which are not touched by awlad 11. arD (children of the ground) but the good body gets noticed 299 (yitnizir)...it is only the beautiful which gets affected by the lgyp (eye) or the gssygd". Moreover, as one diagnostician noted, "the gggygd, they go to those who have pure blood, they do not go to people who have gill gig}; (polluted blood), 29.19. gill; is k_h_i_l_g_a_ (inborn), people who have it are born this way; even the devil himself does not come to them". When asked how one can distinguish people who have pure blood from those who do not, it is simply noted that "the EEZEE. (winds) come only to people who are pure". The definition of "pghggg" (purity)vs. "pggggg" (impurity) is clearly dependent on the nature of interpersonal relations. People who are resented by others and considered tyranical are described as being "filled with.dam;pigi§§". Such a remark may be interpreted as a resentment of those whose con- trol over culturally valued power bases is considered stable and rela- tively indestructible. To intrude upon an area where spirits are likely to roam is a necessary but not sufficient condition for infliction of illness. The person's own psychological constitution is considered an important intervening factor. Since women are considered emotionally weaker than men, informants generally agree that women are more likely to be affected by';2§3_than men (See Sex Relatedness section in Table 5.7). As one female informant said, "Men get ju§£_because they are more exposed to going out at night. But women get :pg3_by less frightening experiences than men, it's because women's emotions are limited. You know women have half the _a_'_'_§_§_a_1_) (nerves) of men". Thus, although emo- tional distress is generally associated with the occurrence of the illness of ‘uzr, when cases of the illness among males were related 300 to the author, there was often an overemphasis on the frightening ef- fect of the experience which precipitated the illness. In the case of women, the affliction was usually attributed to crying in the dark or sadness. When asked if the same emotionally disturbing experience produces :pgp_equally in males and females, a male medical practitioner indignently answered, "don't you know that women have half the azsggp (nerves) of men. Men get :2§3_because they are more exposed to going out at night, but women get it from the slightest fright or sadness. women's emotions are limited". As indicated, females are believed to be more susceptible to ':u§3 due to their weakness, which is believed to be Tap:_(in one's nature). As ideology, this belief legitimizes, the power differentials between males and females, including those which prompt the illness of .:355' .Although this characterization of village social organization may be regarded as "etic", it is not different from some informants' own evaluation of the basis of what is conceived to be a higher rate of incidence of the illness of :p§g_among females. In addition to informants' generalized belief about females' greater susceptibility to :253, some (men and women) refer to a social basis for the differen- tial occurrence of the illness. As one informant noted, "the :p§£_ of women is heavier than that of the men because they are marhmin (bossed). If a man tells her to do something and she refuses, he will hit her and make her sad". Another informant generalized this state- ment to all village women, he said, "women in the village have no opinion. A man forces his (will) on her because he is dominant, so she sleeps and says that she is ma"zhra. The conceptualization of 301 'fiug£_as indicative of generalized powerlessness was also indicated by an informant, who in response to the author's question, "what is the meaning of the word ma:2§:?", answered, "gpz§§_means someone who is ill and because originally he wanted certain things which could not be fulfilled, he sleeps and does not get up". It is also interesting to note that outside of the context of illness the term "fl" is used to refer to someone who is short of money and, in a more general sense to a person whose behaviour is judged as legitimate. As its very name suggests, the illness of :pg£_(excuse)36 is a legitimate form of deviance. Even further acceptance of the ma‘iEr/a is provided by the belief which stipulates that :22; comes only to those who are of pure (tghiz) blood. It is said that people whose blood is gi£i£_(polluted) do not get affected by :255. This applies to persons who are judged as mean, stingy, and generally, do not ap- proximate the cultural ideal of a person who is judged as Tayip_(i.e., kind hearted and good to others). In reference to such persons of undesirable qualities, it is said, "how can (he/she) become affected by the jipn_when (he/she) is a jipp (him/herself). When the author confronted informants with a question regarding a hypothetical case of illness and raised the possibility that the mat§§:_may actually be faking and tricking other people, the answer was that "the :p§£_comes only to the pure, it does not come to people who trick others". In light of our earlier discussion of the specificity of illness explana- tions in Section C, one cannot realistically anticipate this type of evaluation in all cases when claims of :p§£_are made. The compensatory value of ‘uzr for persons who are particularly 302 susceptible to social stresses and role conflict has also been re- corded in cross-cultural studies of possession cults (Lewis 1970, 1971, 1974; Maher l974:25,97; Walker 1974). In FatiHa, although the ma‘zEr/a does not belong to an established institution of the type associated with traditional cults, the illness role itself forces attention to personal grievances and distress and induces a temporary enhancement of social position. The illness role (when considered legitimate), mediates asymmetrical power relations and allows a temporary dispensa- tion from expected role behaviour. The case of N.S. shows how the label m§2232_permits a daughter to contradict the judgment of her father, an ordinarily deplorable be- haviour. N.S. related her case of :pg£_as follows: I was engaged at the time. My father had hit me. I did not want to marry him (the groom). My father hit me very hard. They tell me that I slept for three days. I did not eat. They found out that I have a ‘uzr when they took my aTar to the shikh S. I went to the Hadra and they made me a sulHa. The shikh Abdil Salam il asmar was the sayid who was wearing me. Because of my father's hitting in the dark, the sa id came over me. He came to save me from my father's hitting. en my parents saw me in this bad state, they said that it was not necessary for me to marry the man who wanted to marry me. When I was cured, I married another person... Powerlessness associated with deviation from culturally valued role expectations is an important correlate of the illness of ‘uzr. The case of A.S.I., a married man who resides in the household of his wife's family illustrates the association of ‘uzr with absence of control over culturally valued power bases: The author was first informed of A.S.I.'s condition by a neighbour of his wife's family. On arriving at the house of the sick man, the author was met by his wife and her mother and led into a room where the wife served the 303 traditional tea. In response to the author's inquiry about her hus- band's condition, the wife said, You heard about his doings from M.? Last night he made us the show of the whole village. We found him sitting crying. For a while he kept crying and then started singing at the top of his voice and saying '22 lili y§_‘ayp ' (a melancholic singing expression). All our neighbours came over to see what is wrong. We did not sleep for a single minute. My mother suspected that he may be ma‘zur and we were afraid to leave him alone or else they will take advantage of him (i.e., the assyad would take advantage of his loneliness and inflict great harm upon him). So after he calmed down and stopped crying and singing he fell asleep and I kept sitting beside him. By this morning when we woke up he did not remember a single thing of what happened last night. When he opened his eyes and found me sitting there, he turned to me and said, 'why are you looking at me with pity like that?'. I did not want to remind him and so I kept quiet. Following the wife's description, and upon the author's request, we moved to another room in the house where A.S.I. was lying down in a corner covered with a heavy blanket, in spite of the heat. He apolo- gized for not getting up to greet the author and said that his legs were too weak to carry him. He said that he was feeling very cold and gets very dizzy when he tries to stand on his legs. When asked about the cause of his illness, he responded, "allah hua a‘lam" (only God knows). When questioned about whether he plans to go out to work in the fields he replied in the negative and said, "il_baraka £1 Hamaya" (the blessings of my father-in-law, i.e., his father-in-law would carry the entire responsibility of work in the fields). During the remain- ing part of our conversation he agreed to see the physician. Apart from.reference to A.S.I.'s blind eye and to Bilharziasis (a wide spread parasitic infection reported throughout the rural areas of Egypt), the physician judged the ma‘zhr's health as "normal". The Hakky person- ality test (which was administered to the maahr when he started feeling 304 better, about two weeks after his initial attack) was analyzed by the psychologist and her diagnosis was "hypochondriac neurotic". Following his examination by the physician and the consumption of the vitamin tonic which was prescribed to him, A.S.I. still complained of weakness. He did not go to the field and slept for most of the day. His wife and mother-in-law both reported that he would refuse to eat most of the time, and when he did, he would "only take a bite". His singing and laughing-crying session was not repeated but he continued to complain of general weakness, headache, and shivering. When no noticeable improvement in his condition was seen by the family, his father-in-law suggested that he accompany him to see a diagnostician. When A.S.I. refused to accompany his father-in-law, the latter took the sick man's EEEE.t° a diagnostician. The mother-in-law's suspicion of :pgg was confirmed. When the ma‘zhr's father-in-law related the diagnostician's findings he said, "when shikha A. (a female diagnos- tician) asked the Egsygd they told her that they came to him when he was in the fields and he left the farm animals, and started quarrel- ing with his brothers about the inheritance". At this point the mother-in-law interferred and said, "His sister owed him money and would not give it to him. Everybody kept telling him to leave the money to his sister because she has orphan children but he also needs the money". The wife then commented, "he wants to get it (the money) from her (his sister) so that we can attend to our concerns. we cannot live here (in her father's household) forever". Following the diagnosis of AiS.I.'s condition as m3:g§:> the shikha performed a sulHa for him. His sister contributed five pounds 305 (a large sum of money by village standards) to buy the sacrificial poultry demanded by the gsgyad, When the assyad spoke through A.S.I.'s mouth during the splgg, in addition to reiterating the father-in-law's account of the circumstances which prompted them to come to A.S.I., they said that they had come p§Hp_ngp§_(under fright). They had come when he became frightened as he turned around while speaking to his brothers about the inheritance and found the draft animal falling into a ditch. During the following two weeks A.S.I. did not go out to the field with his father-in—law and still complained of weakness, but he could now get up and move around in the house and even sat outside the house and chatted with friends and neighbours who constantly stopped by to inquire about his health. During our conversations he did acknowledge his condition of :pgg_but referred to it only when specific inquiries about his health were addressed to him. Reference to his condition of :pgp_and to the diagnostician's labelling of mgzgfip seemed to be more crucial to his mother and father-in-law. While his wife showed minimum interest in convincing others of his condition as ma:§§r, encouraged him to continue to take the doctor's ndgawiyat (strengthen- ing substances), and, in private, even suggested to the author that the Higgp_(charm) which the shikha had instructed her husband to wear was "gag M'Monsense). Her parents behaved differently. The labelling m§z§:_seemed to be more crucial to his mother and father- in-law, both of whom needed to legitimize the financial dependence of their son-in-law and clearly wanted to force his family's atten- tion (particularly that of his sister) on his unhappy condition. 306 In fact, one neighbour said, "tomorrow (meaning in the future), he will get his share (of inheritance) and there will be no one like him ..so that K. (the mother—in-law) will be satisfied". Another neigh- bour responded, "mg:§§:, or not, who else would have agreed to marry their ugly daughter. She must be at least ten years older than him". It seems that the daughter herself was aware of this fact and did not conceive her husband's inability to live up to male role expectations as a shortcoming, in view of her own culturally defined inadequacies. The function of the labelling ma‘zfira as a culturally sanctioned form of deviance is also illustrated by the case of Z. The author's initial acquaintance with her condition came during visits with two local diagnosticians. During a visit to shikh M9, he described Z.'s condition to the author as follows: There is a woman, she is about eighteen years old. She is mar- ried...I went to see her...They said her health is not well. Her thigh was swollen. They said they had taken her to two doc- tors but she got worse from the injections. I threw the rosary and found that she is ma‘zhra, she has piH_(winds) and when the assyad are on people they do not like injections and stuff like that. I gave the rosary to her mother-in-law and she whispered to the rosary to show the reason for the illness. I then spread the rosary and read its signs they (the assyad) had come to her taHt z‘la (under sadness). The doctor had told them that the veins in her thigh were plugged up. I told them.to take her to E.S. (a nearby village). Shikh M. (a prayer writer) made her a Higab (a charm, the term derives from a classical Arabic word, meaning shield), although I told them that she needed the dagga (drumming of the Egg). If the pain had not been so irregular and so mobile, maybe the Higab would have worked. The assyad were still new and so they could have been pacified and they may have left her alone completely. It is when the as ad have been in her blood for a long time that they do not Ieave...they (the assyad) do not settle in any of the important part of_the body except if the sick person is denied the status of ma‘zur by his family or in cases where they iron on him... It all started because her mother-in-law had accused her of laxness in her work and spending too much time at her father's 307 house after childbirth. She became sad and she probably went inside a dark room and cried. The woman who has given birth is like the bride, she is susceptible to the assyad. Another traditional practitioner, a diagnostician/healer who was also consulted by Z.'s family gave the following account of her case: She is about twenty years old. She has been married two years. She had a child and he died when he was two months. She was very sad. She became very weak; she could not eat, she could not walk. She went to her father's house because her mother- in-law could not stand her any more. They took her to many doctors. They gave her the injections but nothing happened. The pain had started in her arms first and moved to her head, and now it has moved to her legs. They came to me yesterday. The sayid on her talked last night. He said he had come because of her sadness when she screamed in the doorway when her son died. He has not made any demands yet. Tonight or tomorrow night they will drum for her. (Will you organize the drumming ceremony for her?) No, I will not go,1hey will call someone else. I do not do this type of thing any more. WOmen move a- round and expose themselves; it is not my status. At night the author went to Z.'s father's house following a rather reluctant invitation by the father himself. During an earlier conversa- tion with him, he had firmly denied the reality of ‘uzr and had referred to the condition as "nonsense" which reflected the peasants' ignorance. As he greeted the author at the door, he promptly referred to that (this is God and this is his command). "what can one do?". In a room lighted with a kerosene lantern (a mark of relative wealth), Z. lay on the floor covered with a blanket and surrounded by her mother, sisters, and their children. The whole family's attention was clearly concentrated on her. Her sister's husband came in the room, sat near her head, and started feeding her an orange which she ate reluctantly. A little while later, her mother-in-law came over to inquire about her health and referred to her presence as substituting for that of 308 her son (Z.'s husband) who was away from the village in the army. Z.'s sister explained that Z. left her husband's parents' household when her illness became incapacitating. She explained that it is customary for a woman to go to her father's house when she becomes ill for a long time and sometimes when she delivers her first child. Z. looked very pale and tired. She could hardly sit up and eat and members of her family took turns propping her up in a sitting position to be fed. Conversations with members of the family, including the mother-in—law, indicated that they had at that time dismissed the doctor's diagnosis, which they said, attributed her swollen thigh to a blood clot. In a later conversation with the physician, he indicated to the author his diagnosis of Z.'s condition as "post partum throms bophlibitis". He said that Z. had suffered from an occlusion and inflamation in the fumeral vein and expected her healing from this condition to extend over a period of a few weeks. Having failed to bring about the desired improvement in Z.'s condition and having ignored her emotional distress as an important cause of her state of ill health, the physician's diagnosis and consequent treatment were judged as in- adequate. Everyone present at Z.'s father's house during the author's first visit, was convinced that the doctor had failed to recognize the *uzr. Z.'s mother said that they had taken her to two doctors who prescribed many medicines which.brought no improvement over a period of two weeks. Her father turned to the author and said, "you.never believe these things until they happen to someone you love. I would not have believed it myself if I had not heard the Shikh MuHammad from the Sayida Zinab speak last night. He was speaking through my daughter's 309 mouth. He said that he had come to Z. because she cried a lot in the dark after her son died. He said he wants a white dress, white shoes, and a gold ring". As we sat surrounding the ma‘zhra, she intermittently gave a few whimpers to which her family responded with comforting, loving words. A knock on the door was responded to by Z.'s father who ushered in Shikh.M; (who had diagnosed Z.'s condition). Shikh M1 was accompanied by shikh M. from the nearby village of E.S. and the latter's assistant. These men were received warmly by the family. They had been called over to the house because Z. herself could not be transferred over to the nearby village to attend the Hgdgg, The shikh and his party sat down to an elaborate meal. Then the drumming and music from the salamiya (a local wind instrument) started and shikh M. started the chanting of the different tariga(s). Everyone's attention was con- centrated on Z. to see which.pgziga_her body would react to. Finally there came the tariga of Sayid il Badawi and her body started to sway from side to side. Two of her sisters pulled her up and she kept shaking her head from side to side and waving her arms. Her head- kerchief became untiled and her long hair became undone from its neat braids. She kept up this dancing for about five minutes and fell exhausted into her sisters' arms. They put her down on the Hasira (reed mat) and covered her with blankets. She said that she was very cold and started crying. She complained of her thigh, which she shamelessly exposed in front of the men in the room. It showed a large swollen red blotch. Shikh ML said that the pain is now very severe because the assyad are HaDrin (present). He said that she can 310 rest now and later they would have a splfia_when they prepare the items which the assyad had demanded. Z. fell asleep and all the visitors left her father's house. The following day, Z. was in great pain, her mother said that she could hardly move her thigh. Relatives and friends advised Z.'s par- ents to bring another shikh from S., a nearby village. One of Z.'s father's friends noted that the shikh from S. is a learned man who knows the Quran, "not just a drummer like shikh Mg". In the afternoon the Shikh from S. was summoned to Z.'s father's household. Her father informed him of Z.'s illness progression, emphasizing the emotional distress to which she had been exposed as a result of the death of her son and also emphasizing the pain from her swollen thigh, her poor appetite, and her inability to do any housework. In elaborating the latter behaviour, he noted, "this, as you know, is not tolerated by the family of the husband, they made her psychological condition worse. The shikh from S. listened attentively but did not touch Z. or examine her thigh. He said it was wrong to have her descend to the E5932: He said that this simply excites the gggygd and gets them in the habit of wanting to hear the drumming. When he did not make any visible sign of attempting to diagnose Z.'s illness, the author asked him if he will take her §T§£_to make sure that she is ma'zhra. He responded rather abruptly and said, "if saHibit El E2222 (the owner of the ill- ness) says that she is ma‘zhra and her family have heard the Eggygd, so how can anyone say otherwise?". He then turned to Z.'s anxious parents and told them that he would prepare a Higgp_for her to shield her from the pain inflicted by the assyad (since the Higab contains 311 inscriptions of Quranic verses). He was ushered into another room which he asked to have darkened and as Z.'s father prepared to close the door, the shikh asked him about Z.'s full name and that of her mother (since it is said that the mother is maDmEha - certain - while the real father may be anyone). He emerged from the room about half an hour later with a Higgp with a piece of white cloth enveloping it. He told Z.'s father that the assygd who are with her include a child (reminiscent of Z.'s own dead child whose loss caused her :pgg). The shikh was then ushered into Z.'s room again. Her mother supported her into a propped up position to listen to the shikh's instructions. He told her to keep wearing the Higgp and not to take it off for two weeks. He said that she can take it off after two weeks but she should wear it immediately whenever she starts to feel depressed. He then turned to her mother and said, "I don't have to tell you, feed her well and let her bathe every day with rose water". On the days following the shikh's visit to Z. her condition started improving gradually. She had been following the shikh's instructions and bathing every day and eating well. As a matter of fact, she was getting the choice food in her father's household - poultry and baked rice. She said that she was starting to feel better, and she showed the author how the swelling in her thigh had started to subside. In fact, only two days after the shikh's visit, she was attempting to walk without anyone's assistance. She apologized to the author for not being too hospitable during the earlier days of her illness. She said, "I was lost (pgyhg), I did not even know what was going on around me". During our conversations, it became clear that Z. was 312 convinced that the shikh's Higab had fulfilled its intended function and was the reason for her improved health. She said that as a pre- cautionary measure she would still hold a §2l§§.f°r the 2§§y2d_when her father is in a position to buy the gold ring that the ggsyad had requested. Z. remained in her father's household for three months until her husband returned to the village. Prior to her return to her husband's extended family household, whenever the author asked Z. when she would return to live with her mother-in-law, she would make such remarks as, "my condition now cannot bear it", or "you know how it is in the husband's home, the family of the husband has no pity, or "she (her mother-in-law) wants us all to work all the time. She seems to have forgotten what it was like when she was our age. She sure takes good care of her own health". During the months that Z. remained in her father's household, she was up and around but was still the object of pampering by her parents and older sisters. She was still considered ma‘zhra by her family and friends. On the occasion of a visit by the author, Z.'s mother said that her daughter would remain with her until she is completely cured from.her illness. She remarked, "the house of the man (Z.'s husband), (they) do not pity..., I would sell myself to make my daughter comfortable". Z. interrupted and said, "once they see me up on my feet they will expect me to work...the sgyid (she was referring only to the child.§Eyid) is still with me. The Higgp_is just to make him happy. The shikh said that he may come once or twice a month but he won't make me uncomfortable like before. I could not sleep from him 313 and he would try to talk to my parents all night long but they could not understand the talk of the child. Now I think he will probably come once or twice a month only". On her husband's return to the village, Z. returned to his father's extended family household and started going to the £2232. about once a month, in spite of her mother—in—law's objections. Z. said that her mother-in—law takes her son's needs into account and is not too demanding of her in terms of housework as she used to be. This shift in the mother-in-law's treatment is obviously related to the presence of her son, a relatively educated villager, deserving of the respect of fellow villagers, including his own mother. The foregoing illustrative account of a case of :13 reveals the mediating function of the illness role in asymmetrical social relations. According to established cultural norms, Z. is expected to be obedient to her mother-in-law. Like other daughters-in-law, she is held res- ponsible for a variety of domestic chores which should be completed to the older woman's satisfaction. When Z.'s husband was away from the village for a period of three months she was expected to go on living in his extended family household. Under the labelling ma‘zhra, these cultural injunctions were temporarily suspended. Z.'s neglect of her domestic duties, her disrespectful attitude towards her mother- in-law, her eventual abandonment of her husband's home, and her resi- dence in her father's house, were all considered legitimate forms of behaviour. This shift from one category of socially sanctioned action to an opposite, but equally approved form of behaviour, needed justi— fication. In Z.'s case, the vindication is epitomized in the tragedy 314 of her child's death. This shocking and emotionally devastating ex- perience explained heraffliction, and by extension, her deviant be- haviour. Under ordinary conditions, such behaviour would have had some dire consequences, possibly her divorce. It is important to note how- ever, that without the support of her father, (whose power in the vil- lage rested on his status as a respected government employee and the owner of a few feddans of land in the village), such legitimized de- viance from role expectations may not have been so easily granted. In FatiHa, the legitimization of deviance by the labelling ma‘zhr/a is not confined to women. Powerless men are also accorded temporary exemptions from positions of subordination through the social legiti- mization of illness characteristic of the illness role. The argument that "the ethic of health is masculine" (Nathanson 1975) is not a valid generalization for FatiHa. Neither can one consider the labelling of :pg£_simply an attribute of "low female status" (Kennedy, op. cit.), Women 22d men in positions of relative powerlessness, when granted the social sanction of the illness role, are allowed temporary deviance from culturally prescribed role expectations and/or transgression of their positions of relative powerlessness. The case of A.E.Z., a married man illustrates this point. A.E.Z. related the experience of his :32; as follows: I was in the TarHila (migratory labour tour) and found a bunch of dates on the-TEEE'of the water. I went into the water to pick the dates. After I touched it, it disappeared from my hand. I screamed and so I got a laTah (supernatural touch). Ny'body became worn (possessed). -The_safina (ship, one of the forms in which supernatural beings appea?_i5'humans). If it is upset, it drowns a person in the mud, but if it is docile, it simply makes the person ma‘zhr or takes him down with her for a few days. Some times it comes to people in the form of 315 food, and sometimes in the form of jewelry. It came to me in the form of_the dates. At the time I was only twelve years old. The safina (the ship, so named because it inhabits the waters of the river) is still with me until now. When I go to the zikr37 she comes out and talks through my mouth. Whenever I am upset and if I get into an argument with anyone, she comes out and gives hell to everyone. After the argument when I come to (my senses), I apologize to everyone for what she did, they understand and forgive me...(she came to me)...during the mulid (village patron saint's day - about two weeks earlier -) I was in the zikr. She said through my mouth that she wants to be happy, and she made me faint. That day I had been very upset with my wife. She had hit the child, although I had told her not to. Through interviews with other informants, including the ma‘zfir's wife, another component of reality emerged. During the mulid he had beaten his wife severely and her screams draw the neighbours, some of whom went over to her relatively affluent father's household and informed the family of what was happening to their daughter. The wife's brothers went over to A.E.Z.'s house and ordered their sister to col- lect her clothes and leave with them. A.E.Z. pleaded with his brothers- in-law not to take their sister and said that it was not he who hit her. He said that he was tayih (lost, i.e., unconscious), he attributed his uncontrolled actions to the spirit possessing him. A.E.Z. kept crying and asking forgiveness but the men insisted on taking their sister along. Informants who supported the wife's brothers' action noted that they belong to a family which is mabsuTa (happy, meaning wealthy) and will not allow their sister to be exposed to such deg- redation (bahdala). In response to the author's question, "why is A.E.Z. afraid of his wife's brothers?", an informant responded, "money talks". Another said, "di_‘aliha Tin (she has mud, i.e., she owns land) and he has his eye on it". The illustrative examples of cases of ‘uzr presented in this 316 section show that the function of the illness role as a legitimized form of deviance and as a strategy of indirect control is itself subject to constraints. While illness of :pgp denotes a position of relative powerlessness, the social sanction which allows temporary transgression of such a position of powerlessness is itself subject to negotiation. Thus far, our discussion of :p§£_has centered around adults. In fact, the illness is generally considered an affliction of adults (See Table 5.7 under Age Relatedness). The illness is manifested in departure from culturally defined role expectations. Since children's obligations are not strictly defined, in their case, the label Eéégi is not as significant for the reproduction of social relations and as a mechanism of controlling departures from culturally defined roles expectations. Thus the label ma'zEr/a when used'oy adults who define younger children as ill, may be considered more a :EE£_(excess for the adults themselves). This is clearly illustrated in cases where a child's illness is diagnosed by a physician as maggd"assabi (illness of nerves, or mental illness), which is considered shameful by the child's family and fellow villagers. Thus, while one of the author's informants defines her son's illness as :p§3_(although the physician defines it as epilepsy), the child (a student) does not believe that he is m§:§§:_and reiterates the physician's diagnosis by attributing his seizures to a "nervous condition". The case of G., a child of about 13 years of age illustrates adults' role in defining a child's illness as :22£.and the fluidity of this illness label in covering a variety of culturally devalued forms of 317 behaviour, including what physicians refer to as ma£§2_‘assabi (illness of nerves). Upon hearing of G.'s condition, the author, accompanied by an acquaintance of the family, went over to G.'s house. we found the child sitting alone in front of the house, her mother was not home and her siblings were all out in the fields. The child looked very unhappy. She looked pale and more undernourished than most of the village children her age. She responded to the author's question of her mother's wherebouts in a barely audible voice and showed a degree of deference unequalled by any of the village children of comparable age. She had her head leaning against the mall as she sat and had her hand covering the part of her face exposed to us. The next door neigh— bour came out and told us that G.'s mother was out in the field and would be home shortly. As we sat waiting for the mother's arrival, the author tried to talk to G., but to no avail. She kept covering her face and turning towards the wall. The neighbour said, "leave her alone, don't bother yourself with her, she has gsgygd with her and they are making her very unhappy, the poor thing". Shortly the mother ar- rived. In spite of her relatively old age she still works in the field to support her orphaned children after the death of her husband a number of years earlier. When the author asked the mother about what is wrong with her daughter, she said, "It seems that she has assyad with her. Her brother had taken her to work as a servant n Cairo. She worked for his superior who had promised him a promotion. The lady of the house used to frighten her and hit her at night". The mother then turned to her daughter and asked, "what did she used to do to you?, tell them". The child for the first time since our arrival in their house, raised her voice to an audible level and said, "she used to hit me with a long stick and a long hose". The 318 mother then continued, "when her brother went to visit her over there to take her monthly wages, she held on to him and she kept crying and saying that she wants to go with him. Her brother took the lady's permission and told her that he would take her to visit us for a few days and would bring her back. When she came back, she kept crying and saying that she will never go back. Her brother kept imploring her (to go back to Cairo) because he said that he will get thepromotion very soon, but she kept crying and did not want to eat or drink. On the third day of her arrival she was sitting with us and all of a sudden we found her misurgah khaliS (completely unconscious). She remained this way or nearly an hour. We tried to revive her but she would not answer us. We put cold water on her face and rubbed her hands and legs, they were like ice. Finally she woke up and could not remember any of the things which happened to her. Our neighbour was here and she said that she had a brother who used to do just like that and he was ma‘zhr, so we knew that she has assyad with her but they may be mute...No they have not spoken yet or asked for anything. The author then asked the mother, "Does G. know that she is ma‘zhra? Did she tell you that the assyad are with her?". The mother responded, "No she did not say anything, they haven't talked yet, but we knew it. She's been like this for four days now. After they (the assyad) come, she does not eat and she insults us, and when we tell her to go to the fields with her siblings, she says no. Her brother said, well then, let her rest. Her ways have changed; she used to be very clever and used to be a very hard worker. It (the ‘uzr) is probably from her crying when the lady hit her in Cairo." In following G.'s condition over the following two weeks, it was observed that it remained unchanged. She remained at home, refusing to join her brothers and sisters in work in the fields. As she sat outside the house alone, she maintained the posture of facing the wall and spoke to no one. Her mother continued to report the episodes of complete loss of consciousness, but none were observed directly by the author. During this period, G. was subjected to a physical ex- amination by the physician. His report was as follows: Heart: Free Chest: Free Abdomen: No palpable organ Stool: O.K. Urine: O.K. Nervous System: Epilepsy, petit mal (absence of convulsion accompanying the state of loss of consciousness) 319 The physician's diagnosis of "maggD"assabi" was rejected out- right by G.'s mother. She said that the doctor does not specialize in illnesses like :pgp_and therefore cannot recognize the illness. In trying to prove her own evaluation of her daughter's illness condi- tion she noted, "now she complains of her hands and knees and head and she refuses to work. It is just as I told you, the pain is moving". To legitimize her claim of her daughter's condition as :pgg_ the mother asked the author to accompany her to a local diagnostician, shika A. G. did not accompany us on this visit and the mother took along only her 2233, The shika's diagnosis was indeed as the mother had predicted, 1751' The shika said that G. had gotten a 131133 gr_di_y£ (touch from the ground) since Ramadan (the fasting month which had passed about three months earlier). She said that 2§§y§d_came to G. Tgflp_ggll§_ (under sadness). The similarity of the shika's diagnosis to that of G.'s mother and her precision in defining Cairo as the place where the illness was initially precipitated is understandable in light of the conversaé tion which transpired between us and the diagnostician prior to her "seeing" the 2223. When we first arrived at the shika's shouse she had turned to the author and asked, "How are your children". The author responded that they are fine. The shika then said, "the children and their father and his family are what causes all our problems, us women". She then turned to G.'s mother and said, "isn't that right my sister". G.'s mother then responded,"yes of course, why do you think we came to you, it's about my daughter, she was in Cairo and the lady hit her and it seems that she has asgyad with her..." In studying G.'s case, it was clear that the labelling of ma‘zfira 320 was constantly being reiterated by the mother. The power differential between the mother and G.'s oldest brother was evident. He works in the city and has thus earned the prestige and authoritative role concomitant with exposure to urban ways. The mother needed to validate her little girl's resistance to carry out a command which was clearly in the brother's self interest. The son expected G. to go back to work as a servant for his superior. As ma‘zhra, the child's rejection to obey her brother's wishes, mediated by her mother's evaluation of her state, serves as a socially sanctioned avenue for rejecting the relatively powerful brother's demands. This is particularly apparent in light of fellow villagers urgent pleas to the brother not to take his sister, who is ma‘zhra back to Cairo. As one neighbour of the family commented, "this would be H23 2 (sinful), you take her there (to Cairo) and she will be alone. Then they (the assyad) will take advantage of her- (H _a_ yistifradu bihah). The mother's advancement of the label ma’zhra is also important in relation to her rejection of the physician's diagnosis of G.'s condition as epilepsy. In this regard, it may be noted that the labelling of :pgg is also sought by adults who reject the labelling of mental illness and its shameful implications. This is the case for N., a middle aged barren woman. The author learned from a number of villagers, including the village headman that both N. and her brother had once been committed to a mental institution. N. her- self believes that her committment to the mental institution was a nfistake on the part of the physician who could not recognize her :EE£° Her friends support this explanation but those who dislike her say that she is crazy (maggfiha) and that is why she was sent to the khankha 321 (mental institution). They say that "light mindedness" runs in her family. In the foregoing account of :2532 emphasis has been placed on linking the affliction to positions of relative powerlessness. As is the case for other forms of illness (which are defined in terms of culturally relevant causes and socially mediated responses), the ulti- mate cause of :EEE is tracable to asymmetrical power relations. The illness forces attention to personal grievances and distress and in- duces a temporary enhancement of social position among subservient persons who are subject to social stress, including those suffering from role conflict. Thus, barren women, sterile and economically dependent males, who have no access to culturally valued power bases, legitimize their departure from expected role behaviour by reference to their affliction by spirits. Similarly, a subservient daughter-in-law, or younger brother, may acquire a temporary dispensation from the authority of more powerful persons. In light of our discussions of power differentials, stress, ill- ness, and village social organization in earlier chapters, the study of :pg£_provided here derives from the assumption that it is not gender status only which is likely to precipitate the illness. Instead, the study of this affliction in the village focuses on stressful situations, includipg those associated with power differentials which are related to gender role expectations. Since stressful situations are not unique to women, one may expect stressfulness and role conflict to precipitate the :pgg_syndrome in men also. Moreover, one may hypothesize that sub- groups of women will vary in their experience of stress. Indeed, some 322 stages of the life cycle and the developmental cycle of the family expose individuals to variable types and degrees of stress. Further- more, one may expect some women to approximate the expected role be- haviour more than others, with deviants representing the most extreme cases of role conflict and its resulting stress. The same is expected to hold true for men. Hence, we may expect variation in the frequency of the affliction 22225 women (and among men) as well as between men and women. In view of women's relative position of subservience (which, as indicated in an earlier chapter, derives from their limited control over culturally valued power bases), it would be expected that women, in particular, would fall victim to culture bound syndromes resulting from emotional validation of the assumption that higher frequency of illness among women results from stress should involve, not only a demonstration of a higher frequency of illness among females than males, but, more fundamentally, it should show that a higher frequency of ill- ness occurs among women who are identified as less powerful and as experiencing greater stress than their cohorts. According to a survey designed to identify the incidence of some folk illnesses and the social characteristics of persons who become afflicted with these illnesses, 34 cases of :pgg_were collected for the adult occupants of a sample of 100 households in the village. The distribution of Lp£3_among 166 males and 202 females as a function of sex and persons' status within the household (defined by relation to household head) is summarized in Table 5.8. Predictably, one notes a somewhat higher frequency of the illness among females than males. When other dimensions of persons' identities are taken into account by 323 reference to status within the household, the significance of power differentials beyond those associated with gender identity are brought into focus. Thus, the higher frequency of :Egg_among the male category of brother of household head contrasts with the low frequency of the illness among relatively powerful females, notably the mothers of married sons. Also noteworthy is the difference among groups of women, particularly mothers of married sons as opposed to sons' wives. Of the five affected household heads recorded in Table 8, two had gotten their first attack as children, two were sterile males, and one had been diagnosed epileptic by the project physician. Among the six wives of household heads, four were barren women. The three cases of :22; reported for daughters occurred among young women who were being forced into marriage against their will. The four cases of brothers of household heads were reported for younger brothers who were economically dependent on their older siblings. The only case reported for a mother- in-law involved an elderly and physically weak woman who was at the mercy of her son's wife after the breakup of her extended family. The single case of :22: which was reported for a daughter's husband occurred to a man who resided with his wife's family since he did not have the support of his own kinsmen and had no independent means to live separately. Finally, by far the largest percentage of afflictions was reported for sons' wives in extended family households, a predictable outcome in view of the subservience of this group of women to the authority of both senior males and females. 324 Table 5.8. Percentage Frequency Distribution of ‘uzr Cases: Gender and Relation to Household Head. Total # of N _p§£_Cases % Affected Persons Gender males 166 13 7.8 females 202 21 10.4 Relation to HHH HHH him/herself 94 5 5.3 Wi 74 6 8.1 Da 42 3 7.1 So 61 l 1.6 Br 16 4 25.0 Si 9 1 11.1 BrWi 8 1 12.4 BrDa 10 1 10.0 Mb married sons 32 l 3.1 DaHu 2 1 50.1 SoWi 30 10 33.1 325 Power Differentials and Psychological Stress: The Cornell Medical Index In pursuing the study of power differentials and concomitant per- 38 ceived social stress, the Cornell Medical Index was utilized as an independent diagnostic instrument39 of structural arrangements that may be stressful to individuals (Scotch and Geiger 1963). The CMI (a symptom questionnaire designed to reflect various system disorders) was administered to the same sample population of adult occupants of the 100 households noted above. The scores (i.e., the number of symptoms reported by respondents) related to psychological symptoms of the CMI section of each respondent were rated on a scale of 1-4 by the project psychologist. These CNH psychiatric ratings of subgroups of the sample population, differentiated on the basis of the same social criteria mentioned for the differential incidence of :253 (sex and relation to household head) are summarized in the form of percent frequency distributions in Table 5.9. As predicted for the incidence of :pgp, which is precipitated by asymmetrical power relations and emotional distress, higher psychiatric ratings (indicative of perceived social stress) are expected to be positively correlated with greater perceived stress and positions of subservience among the various differentiated subgroups of the sample population. The results summarized in Table 5.9 bear a close similarity to those provided for the distribution of :EEE: Higher psychiatric ratings (3 and 4) occur somewhat more frequently among women than among men. This limited difference in the reporting of symptoms suggests that the 326 Table 5.9. Percentage Frequency Distributions of Psychiatric Ratings: Gender and Relation to Household Head. Rating 1 2 3 4 Gender males 33.7% 34.9% 22.9% 8.4% females 27.7 34.7 23.8 13.4 Relation to HHH HHH him/herself 28.7 30.9 25.5 14.9 Wi 27.0 41.9 23.0 8.1 Hu 0 50.0 0 50.0 Da 28.6 38.1 .5 23.8 So 34.4 32.8 26.2 6.6 Br 37.5 56.3 6.3 O Si 22.2 55.6 22.2 0 BrWi 50.0 0 12.5 37.5 BrSo 100.0 0 0 0 BrDa 66.7 33.3 0 O SoWi 16.7 36.7 46.7 0 Mo married sons 46.9 31.3 15.6 6.3 327 notation of "the ethic of health is masculine" (Nathanson 1975:59) does not have universal validity. Perceived social stress and subservient status are not simply a function of sex. Higher ratings among relatively larger proportions of husbands of female household heads, brothers' wives in fraternal joint households and sons' wives suggest the impor- tance of intervening variables related to the developmental cycle of the family and role expectations. Hence the relatively low psychiatric rat- ings (in Table 5.10) among higher proportions of mothers of married sons and the higher ratings among males and females who deviate from culturally stipulated role prescriptions, notably economically dependent males and childless males and females. To conclude, the distribution of :223 cases and psychiatric ratings summarized above reflect social relations of power differentials affect- ing both males and females. While women as a group report a somewhat higher incidence of illness, it is significant to note the patterned incidence of illness (and reporting of symptoms) and its attendant power differential in relation to the developmental cycle of the family. The data suggest that the incidence of the illness and perceived stress are related to power relations associated with subservient status and deviation from culturally stipulated role behaviour. Finally, the low incidence of :pg3_(34 cases) among the sample population (of 368 persons) implies that even the adoption of this culturally sanctioned strategy of indirect control is subject to structural constraints4o. The sick role, like other manipulative strategies adopted by the powerless, when accessible, brings about only a temporary enhancement of social position. It is not a stable culturally valued power base which can induce a permanent modification. 328 Table 5.10. Percentage Frequency Distributions of Psychiatric Ratings: Role Expectations. Ratings 1 2 3 4 Economic Role standard (male, "bread-winner") 35.0% 36.3% 21.7% 7.0% deviant (male, ec. dependent) O O 40.0 60.0 standard (female, ec. dependent) 28.3 35.3 24.9 11.0 complementary (female, access to ec. resources 36.8 42.1 15.8 5.3 Sexual/Reproductive Role standard (father 36.1 34.8 21.3 7.7 deviant (sterile male) 0 30.0 50.0 20.0 Fa daughters only 18.8 37.5 37.5 .3 Fa sons 35.6 33.3 21.8 9.2 standard (mother) 31.4 36.6 22.3 9.1 deviant (barren female) 3.7 22.2 33.3 40.7 Mb daughters only 17.4 30.4 26.1 26.1 Mb sons 30.9 31.8 28.2 8.2 329 NOTES 1While some anthropologists have hailed Clements' classical work (Caudill 1953:722; Cf. Glick 1968:36), others see it as a "conceptual morass" (Willin 1977). Willin writes, "To be sure it includes traits that can be categorized as causes - sorcery and breach of taboo. However, the remaining three - disease-object intrusion, spirit intrusion, and soul loss - are not causes but mechanisms; each is a result of effect at— tributed to human, supernatural, or other causative action" (Ibid:51). Even earlier than Willids criticism is the objection to Clements' typology raised by Glick (1963) who noted its limitations and referred to an even earlier critique of Clements published by Hallowel as early as 1935. 2Foster (1977) has recently restated this bifurcation of medical typology in his study of the cross-cultural patterning underlying non—western medical systems. Following Hughes, he differentiates ethnomedicine (which is defined as "those beliefs and practices relating to diseases which are the products of indigenous culture") from the medical system which derives from the conceptual framework of modern medicine. 3This emphasis is typical of biomedicine with its stress on disease pathology. 4A taxonomy is regarded as "a culturally specific way of ordering and specifying a particular domain" and it "also reflects (and may be taken to embody) a theo about how that domain is structured and works" (Fabrega 1976:195). 5Fabrega's distinction between body—centered and environment related explanations bears resemblance to Young's differentiation between inter- nalizing, non-personalistic, physiological systems and externalizing, personalistic, and etiological systems (Young 1976b). 6Fabrega represents his formula as follows: I1 = S + N f P where I1 is the total amount of cultural information entailed by an explanation of an illness, i, S, N, and P represent the amount of information re- lated to the Supernatural, Natural, and Person regions of the taxonomy, respectively (Fabrega 1976:200). 7The concept of levels of causation is not original with Glick and he himself traces it to the work of Rivers (in.Medicine, Magic, and Religion) who distinguished agents of disease from the means employed and from their reasons for acting (Glick 1963:111). The concept was accorded further attention in the work of Hallowel who differentiated three aspects of causation ("proximate cause", "technique", and "agent"), 330 which he emphasized, cannot be considered as distinct causes but must be "related in some explicit and comprehensive scheme" (Hallowell 1935: 366; Cf. Glick 1963:111). 8The villagers of FatiHa also recognize accidents, and ailments which affect the external body, e.g., wounds, fractures, insect bites, tooth- aches, and strained muscles from overwork. To the extent that these have causes and effects which are socially inconsequential, they will not be elaborated upon in this chapter. 9Weakness associated with old age is identified as the gradual break- down or withering away of persons' physical strength, referred to as the "ripening" of the body. This is considered a condition of general debility rather than failure of specific organs of the body. In this regard, it must be stressed that villagers do not consider old age an illness. The weakness of old age make the body more susceptible to illness. 10It is also believed that habal may be caused by a dog which is mahbul. It is said that the "bdteof the dog causes the person to become mahbul and he barks like a dog". It is also believed that if a person s bitten by a wolf, his/her brain goes to the wolf and the human howls like the wolf. llUnlike these illnesses, maladies of supernatural cause are not be- lieved to be passed on by inheritance. 12Although eye diseases and blindness are common. little or no attention is given to such afflictions which are taken for granted. Only two cases of eye irritation was reported in the census when inquiries about illness were made. It is also significant to note the under-reporting of culture-bound illnesses (e. g. , Tarba, ‘uzr, Hassad, and ‘amal bil maraD. During the early weeks of field work when —in?ormants had—limited ac- quaintance with the author, some of them viewed her as a physician who accordingly "would not be interested in the nonsense of the fellahIh". 13The villagers of FatiHa are familiar with a variety of illness labels used by the physician, ranging from influenza to rheumatism, to illnesses of the spleen, jaundice, liver, and heart. But they simply refer to their cause by reference to the afflicted organ and its resultant state in terms of external causation. 14In fact, it is said that if a feverish person eats a normal meal, his/her fever increases. A feverish person is also expected to avoid the ingestion of cold foods such as watermelon or ice. This is equates to "putting a burning rod in cold water. It gives the body a shock". 331 15The significance of this belief for purposes of social control is obvious. 16Some of the older informants still recall the precautionary measures related to the cholera epidemic of the late 1940's. l7Tarba is also believed to be caused by supernatural beings which are said to appear in the shape of animals, including wild dogs, and cows. Spirits are also believed to appear to people in visions and frighten them during their sleep. 18There is no general agreement among informants, including healers as to the actual mechanism through which these supernatural beings actually inflict illness. Illness in such cases is attributed to their presence or to their supernatural effect on the body as such, not to alterations in the functioning of specific internal body parts and disruption of body processes. 19Emotional disturbances resulting from interpersonal conflict are incriminated in the incidence of a variety of other misfortunes, including injuries to the external body. E.S. who is a horse carriage driver had a fight with his wife. He then left the house very upset and set out to the station in the nearby town where he was loading flour. His father said that because B. was not paying proper attention to his work, since he was thinking about his wife and her rudeness, he did not tie the horses securely and they moved, causing him to slip and break his foot. 20The people of FatiHa have two labelled illness stateswwhich clearly illustrate Evans-Pritchards's classic distinction between witchcraft and sorcery and which identify persons possessing inherent power to harm (witches) and differentiates them from those who harm by tapping outside power (sorcerers). In FatiHa, the evil eye exemplifies the first. 21The dialogue between religion and medicine has been part of the Middle Eastern scene for a long time. The saying that "cleanliness (as a means of preventing the onset of illness) is next to godliness" originates from Talmudic teachings and Jewish laws of hygiene which originated in the area a few thousand years ago. With the rise of Christianity in the area, the healing miracles of Christ were particularly appealing to the sick and suffering. Similarly for Islam, the ancient association between medicine and religion was also part of the Islamic tradition. This association is reflected in a saying attributed to the Prophet MMHammad who said, "science is twofold, the science of religion (theology) and the science of the body (medicine) (Hamarneh 1967:14). Islamic medicine reflected the Muslim philosophy of tawHid (unification) by viewing humans 332 as total beings in whom bodies and souls are combined and closely inter- twined. In ancient Egypt, the acts performed by the priest, physician, and magician, all had a common goal; they were only different means of pro- tecting the individual against dangers which threatened his/her life. Among the ancient Egyptians, priests were also physicians and "hospitals" were temples of healing where the process of curing involved spiritual as well as physical purification. In fact, in the library of the temple of Horus at Edfu there was a book containing prescriptions for driving away the evil eye (Blackman 1929:314). 22Gifford attributes the veiling of women and their seclusions in the Middle East to the evil eye. He suggests that the custom of seclusion was initially associated with beautiful women and eventually spread because of its complementary implications (Cameron 1960:349). 23Supernatural power, including the ability to cause illness and to bring about cure, is also attributed to the village patron saint, a descendant of the once powerful Turkish elites of the village, who now still legitimize their quest for controlling village political life by reference to their pious predecessors. Informants, who favour these descendants, refer to the baraka (blessing power) of the patron saint and her karamat (blessings or miracles). The patron saint is also believed to play an important role in other catastrophic events besides illness. She brings about crises to rival villagers and towns- people in the nearby areas, as well as to awlad il balad (children of the village) who mock her powers and show disrespect-to her descendants. The implications of such beliefs for the status of her descendants in the village are obvious. Having lost their material power base in the village, male as well as female members of this once wealthy group try to maintain their control over villagers (in varying degrees) by em- phasizing their supernatural power base. Thus far, this trial seems to have succeeded and the village headman for the last few decades has remained a member of that family. His power in the village is augmented by his kinship ties to high post government officials in Cairo and to relatively wealthy families in the village itself. 24Death from fire among crawling young children who are left unattended is also attributed to their supernatural siblings who punish the mothers for leaving the child unattended. Two such occurrences took place during the study period. 25This is also a punishment for the husband (who caused his wife's sadness) since men are known to long for children. 26Informants distinguish between different types of ‘amal (deeds). They refer to ‘amal bil maraD (deed for illness), ‘amal bil kurh (deed for hatred), ‘amaI bil nazif (deed for hemorrhage), ‘amal bil maHaba (deed 333 for love), etc. Illness may be brought about through the supernatural manipulations of a sorcerer. "He (or she) may write (yiktib) (Quranic verses) with loss of hair, hemmorhage, back pain, impotency, hatred (e.g., between a woman and her husband), habal (craziness where a person looses self control and hits others). 27In addition to reference to drinking siHr, people describe poisoning (which they refer to but say that no one now uses it on people) which people also use to take revenge. Poisoning, whether magical or not, is traced to hatred between people (ultimate cause). The person who is entrusted with the poisoning process itself is considered the ef- ficient cause and the poisonous substance or the means of introducing it into a persons body is but the instrumental cause of illness. Even poisoning is accidental, as was the case in the death of a whole family, through their accidental use of pesticide on their food. The poisonous substance was recognized as the instrumental cause of death. A child's ignorance was isolated as the efficient cause. An ultimate cause was described in terms of the mother's involvement in more work situations than she could handle, because of her poverty. 8Illness legitimizes a range of actions contrary to gender role ideal expectations. WOmen, who do not ordinarily smoke use cigarettes as "remedy" for minor respiratory ailments. The sniffing of nishfig (a mixture of ground spices and tobacco) which causes sneezing, is also taken up by women to expel the moisture in the chest and the head, which is believed to cause the cold. Illness as a means of legitimizing deviance from normal role expecta- tions is also reflected in A.Z.'s statement to F. when the latter was trying to convince her to go to the doctor who may remedy her blindness. Z. noted, "I would be ashamed to look people in the eye and to be able to see them, then everybody would expect me to work and be like I used to (before becoming blind)". Some of Z's acquaintances seem to believe that she is actually content with her state of blindness. In this condition, she obligates a variety of people to look after her and she enjoys the rather left handed compliment of being an invalid. 29Informants in explaining an illness may simultaneously refer to the diagnosis of a physician and that of a traditional diagnostician. 30The patterned opposition between the sexes is reflected in the fact that females become possessed by male spirits while males succumb to the affliction of female spirits. 31The term Hadra and zar are usually used interchangeably to refer to a ceremonial—T55m of diagnosis/treatment where possessing spirits are enticed, this being a phase in the course of treatment which is formally terminated with a SulHa (reconciliation ceremony) where the demands of the possessing spirits are granted. 334 32During the zar a variety of musical melodies are performed, each of these melodies—is said to represent a specific supernatural being. When a Tariga is drummed, it is beligyed that the corresponding spirit, couched in the body of the ma‘zur/a induces its host/ess to react by dancing, often to the point of complete exhaustion and collapse. 331n describing the maraD rawhani (spiritual illness), a diagnostician noted, "The person with maraD rawhani does not necessarily become ill right after he is touched, that is why people do not remember". 34In commenting about this ma‘zura's case a female acquaintance of hers privately said to the author, ”It is because she is Jealous for her husband, she is afraid that he will marry another. He is like a bull and she is yellow (pale) and ugly". 35Seasonal variation of the incidence of the illness was noted by one diagnostician who said that more cases of ‘uzr occur in the summer "because il gary kitir (the running about is a lot) and people are out late. In winter it seldom happens because people are sheltered in their homes and they watch themselves when they move". This account was the only reference to seasonal variation, all other diagnosticians and healers, as well as non-practitioners note that ‘uzr can occur to any one at any time. 36In questioning informants about whether it is shameful to be affected by ‘uzr, they generally agreed that it is not. One informant noted, "People who know God understand that it can happen to anyone". Another said, "how can it be shameful, ‘uzr comes only to those whose bodies are pure." 37Persons Joining such processions sway in a rhythmic fashion to the loud singing of praises to God and the Prophet. 38Modification and evaluation of the Cornell Nbdical Index question- naire was undertaken with the help of a physician and a psychologist provided interpretations of the relevant sections of the CMI. Some CMI questions had to be eliminated on the basis of their non relevance or conceptual disjunction with local culture. Others required certain terminological modifications in order to be rendered intelligible to potential respondents. The CMI in its modified form consists of some 186 questins which collect extensive medical and psychiatric data corresponding to those elicited in a general medical history (Scotch and Geiger 1963:305). This health survey instrument which has been used in cross-cultural health survey research has been known to yield accurate general medical and psychiatric diagnostic evaluations of patients (Broadman et al 1951). CMI raw scores may be utilized for cross—cultural comparison. For the purpose of this chapter, however, the psychiatric ratings are confined to the sample population of the present research locale. 335 39As noted earlier, explanations of a declared illness state may vary from the assertion of stressful experience by the afflicted person to dismissal of his/her behaviour as faking by a non sympathetic house- hold member. In light of this discrepancy, for the purpose of this portion of the study, a person's own perceived stress was deemed the more im- portant judgment. The CMI (Section dealing with emotions) was therefore administered to obtain a measure of perceived stress. 40When a diagnostician was asked by the author how many cases of ‘uzr he gets during a year, he responded, "not more than four or five". When the author exclaimed, "is that all?", he responded, "yes, what more do you want, otherwise the whole village would come to a standstill". CHAPTER 6 MEDICAL CARE IN FATIHA: RESPONSE TO ILLNESS A. Introductory_Remarks The prevention of illness and its treatment are closely associated with medical theory and with culturally significant manifestations of illness. In the preceding chapter the explanatory aspects of the medical system and villagers' definitions of illness were accorded primary emphasis. In the present chapter we turn to an examination of villagers' methods of coping with illness. Preventive measures des— cribed in Section B, not only denote mechanical procedures associated with the avoidance of illness, but also reveal the differential valua- tion of persons to whom these procedures are administered, and the sig- nificance of associated events. When actual cases of illness occur, the symptomatic persons, and/or significant others who attribute to them the label "sick", may avail themselves of one or more forms of treatment. Forms of treatment avail- able to the people of FatiHa are summarized in Figure 6.1. Some are readily accessible through family members, neighbours and relatives, and through the druggist and herbalist in the nearby towna Nbre serious cases of illness are directed towards specialized medical treatment of both the indigenous and cosmopolitan variety, Medical specialists of the indigenous variety are readily available in the village. Their failure to bring about the desired relief prompts the sick person 336 337 and/or his significant others to seek this form of medical treatment in the nearby villages and provincial towns. If necessary, indigenous practitioners located as far away as Tanta, Cairo, and Alexandria may be visited. The same pattern of gradual movement away from the village is noted in the utilization of cosmopolitan forms of medical treatment. When cure does not result from treatment by the village paramedic known as galag_il_§i§a_or by the physicians available in the nearby towns, villagers seek this form of treatment in larger urban centers. Unlike physicians and the practitioners of Tip Tabi:i_(natural medicine), the power of the rawHaniya (indigenous practitioners of spiritual medicine) does not rest on their control over specialized knowledge about illness. Structured interviews designed to compare shared knowledge about illness among rawHaniya and laypersons indicate that the rawHaniya do not deal with illness through reliance on specialized, exclusive knowledge. The power of the rawHaniya is derived primarily from their culturally valued control over elements of the supernatural environment. This lends an authoritative, legitimizing character to their diagnosis of illness. The exercise of their diagnostic role is contingent upon their familiarity with local culture. Finally, the administration of Shweder's cognitive capacity test reveals the raw: Haniya's greater capacity (than lay persons) to impose order on ill- defined situations. This characteristic is consistent with their ex- pected role of imposing explanation when confronted with the confusion of illness and its associated deviant behaviour. Following the enumeration of forms of treatment available to the people of FatiHa in Section C, attention is turned to factors which 338 influence their choice of treatment. Section D presents a discussion of the role of illness concepts and of the situationally variable hier- archy of resort to curative practices. It underscores the complemen- tarity of indigenous and cosmopolitan forms of medical treatment and points to significant factors which influence choice of treatment (e.g., progression of illness and its response to certain forms of treatment, the social identity of the affected person, the nature of interpersonal relations between the sick person and the medical practitioner, and the economic requirements of different therapeutic strategies). Section D—a undertakes a critique of what the African anthropologist Omafume Onoge has referred to as the "socioculturalism" of medical anthropology with its emphasis on the inhibitory role of "LOCAL IDEAS about health" in theutilization of cosmopolitan medical care (Cf. Onoge 1975:221). A survey of forms of medical treatment obtained from a sample of village adults reveals the physician to be the first choice of the villagers (See Table 6.4). Section D-b, through the presentation of illustrative examples of differential utilization of indigenous and cosmopolitan forms of treatment lends support to the contention that choice of medical treatment rests on the immediate requirements of cure rather than on the conceptual compatibility of logical categories underlying different forms of treatment. Generally, villagers utilize cosmopolitan health care facilities for symptomatic relief whereas disorders which are Judged to be directly related to socially significant ultimate causes are viewed as requiring the expertise of indigenous spiritual medical practitioners. In Section D-c attention is devoted to our central theme of power relations as it relates to medical treatment. In addressing this issue 339 and in considering the social status of the symptomatic person, the first part of Section D-c probes the more fundamental question of social legitimization of the sick role, upon which initiation of treatment is contingent. The remaining part of the chapter is then devoted to an examination of the differential allocation of valued resources for the treatment of persons of different social identities. A limited quanti— tative survey of medical treatment, participant observation, and informal interviews prompt the conclusion that gender identity influences forms of treatment extended to symptomatic persons. However, as was noted for the differential incidence of illness of supernatural etiology in Chapter 5, gender identity is mediated by the dynamics of the develop- mental cycle of the family. Beyond the micro-level of analysis associated with village social organization considered in the first part of Section D-c, attention is directed to the macro level of social articulation (Cf. Janzen 1976) in the latter part of the same Section. Asymmetrical power relations between the dominant urban sector of Egyptian society and the subservient rural domain (of which the village is part), is deemed an important constraint which affects peasants' choice of medical treatment. The relation between social identity and form of treatment, and their mediation by power relations may be diagrammed as follows: SYMPTOMATIC PERSONS Nficro Analysis Village Social Organization (SES, Gender, Dynamics of the developmental cycle of the family) Nbcro Analysis Peasant Status (financial constraints, sub- servient social status, limited availability of cosmopolitan health care facilities) power relations FORM OF TREATMENT 340 B. Prevention In FatiHa, strategies of health care involve not only the curing of illness but also its prevention. The maintenance of health and the prevention of illness are perceived as complementary to therapeutic procedures. In fact, indigenous healers whose services are secured to cure illness are also frequented at times for the sole purpose of pre- venting illness. Beyond seeking such specialized services for the maintenance of good health, the people of FatiHa show a constant aware- ness of the threat of illness. The villagers' perception of the potential threat of loss of health is reflected in daily conversations. It is said, "health, protect it, it will protect you" (21 Sifia, S3222, tiSunak). A variety of idiomatic expressions denote constant awareness on the part of villagers of the potential threat of illness. These include such phrases as "may you be spared the bad fortune of illness" (yikfik shar_il_:aya), "do not be sinful, spare yourself, i.e., rest yourself either physically or emo- tionally" (Haram ‘alik, irHam nafsak), "may good health protect you" - verbalized in response to a standard salutation.- §a_'alit |‘alikninl; :afiya, "strength, or good health" - a standard form of greeting - (:awafi), "may God give you strength, or good health" - used in response to the greeting M - (a_ll;§ flfl). A variety of precautionary measures are pursued by the villagers of FatiHa to prevent the onset of illness. In Chapter 4 note was made of villagers' belief in the necessity of proper nutrition, rest, avoidance of over indulgence in food, drink, and sexual activity for the preservation 341 of the proper functioning of the body. In addition to these precau- tionary measures which are advised to avoid illnesses which are attribu- ted to natural etiology, villagers also rely on the periodic ingestion of medicinal plants and pharmaceuticals for the maintenance of good health. Infusions of boiled herbs or inorganic salts (which are pur- chased from the pharmacy) are taken occasionally to "flush out" the body and get rid of undesirable elements, including worms and salts which are believed to accumulate and form kidney stones. The avoidance of the latter condition is also undertaken through the occasional drinking of herbal teas which are believed to purify the blood and remove any "cloud- ing" which causes the precipitation of salts. In avoiding illnesses of natural (as opposed to supernatural) origin, villagers also avail themselves of the vaccination clinic Which is held periodically in the village headman's court yard in the presence of a physician from the ministry of health and an assistant. On such occas- ions, children are vaccinated against the common childhood diseases, although the precise mechanism by which the vaccine prevents illness is not understood by the parents who bring their infants to this make- shift clinic. As one informant noted, "it has a positive effect (maSlaHa), doesn't it? That's all I have to know". Another complex of preventive measures are employed to avoid the onset of illness which are defined as being the outcome of supernatural causes (e.g., the evil eye and sorcery). The "word of God" is generally regarded as a most effective preventive measure, a protection (Riga) from a variety of misfortunes, including various types of illness. Utterance of Quranic phrases is a widely used preventive measure. 342 When the gaze of covetousness typical of the evil eye is noticed, the victim (or his/her adult relative in the case of children) immediately murmers to him/herself a specific Quranic verse which seeks the protec- tion of God against the evil eye. People also verbalize such phrases as "in the name of God the merciful and the compassionate" (bism allah El raHman.il“£a§zm) on numerous occasions throughout the day. They pronounce such words on entering a house, on entering a dark room, on looking at a child or an admirable object, or even on looking at their own or other people's animals or farm products. People who fail to recall the name of God before entering the Nile predispose themselves to the attack of the supernatural subterranean beings which inhabit the waters of the river. The written form of the Quran is also believed to protect its carrier from the devastation of illness. Literate healers in the village and elsewhere are frequented for the writing of charms (gigab) which are made up of folded paper in which Quranic verses are inscribed and which are worn by children as well as adults. Preventive measures involving the use of the Quran are standard procedures which are associated with culturally marked life cycle events, including circumcision ceremonies for boys, birth, the graduation of a son or daughter from elementary or secondary school, and marriage ceremonies. Thus it is almost standard procedure among bridegrooms to obtain a Quranic charm, also known as Tanita (fence) before their wedding night. Bridegrooms, in addition to obtaining such charms to prevent rabl_(tying or rendering sexually impotent through sorcery), often invite a village traditional medical practitioner who is known to be a sorcerer. This man is well fed and entertained by the family 343 of the groom in an effort to neutralize his potential harm and to compete with others who might commission his services to inflict illness on the young man and/or his bride. In view of the pervasive danger of the evil eye, several other prophylactic measures are employed as deterrents to the harmful influence of the eye (:ayn). In their efforts to protect their children from the evil eye, one notes among mothers greater care in taking precautionary protective measures for young male children than for females. This indicates the differential valuation of male and female children in village society. Aside from this difference in degree of pursuing means of preventing illness for male and female children, one notes that parents, in their efforts to avoid the harmful effects of the evil eye on their children constantly understate their positive assets. Thus, children are often purposely left running around ragged and dirty, Mothers constantly complain about their children's ill health, their loss of appetite and every other conceivable negative quality that may be associated with a child. A mother, in response to the author's inquiry about her daughter's eyes noted, "no (I cannot wash her face), she has beautiful eyes, that would attract people's attention". Since male children are more desirable than females, boys are often dressed like girls, have their hair left to grow long, and are called by girls' names. Charms are also used to ward off the effect of the evil eye. Such charms include the verbal recitations noted above as well as object charms or amulets. The blue bead and the five fingered hand (which means that the giver of the covetous glance should have five fingers cast in his/ her eye) are used to ward off the evil eye from children as well as 344 valued farm animals. iMinor rituals may also be performed by fumigation of a child with the smoke from burning alum and tar with the azar_from the suspected giver of the evil glance. This form of imitative magic is a widespread measure to counteract a suspected gaze (nazra) before its harmful effect induces illness. The bursting crystals of alum and the melting tar symbolize the destruction of the evil eye. The potential threat of the evil eye for adults is also guarded against. One general means of doing so is to avoid flaunting one's positive assets, including good health. As one informant stated, "if I have health (siga), I do not expose it in front of people or else I will be affected by the evil eye and I will lose it". She then went on to relate the story of a man who had lost his miriwa (health) through its reckless exposure. She said, "A.ELM. had lots of miriwa but he showed it off in front of everybody. He even placed bets with men to eat a glass jar and since that day he had been in great pains. He went to many doctors until he got to the army and they operated on him". C. Types of Nbdical Treatment In response to perceived deviation from a state of normal health, the villagers of FatiHa avail themselves of a number of forms of medical treatment. These are summarized in Figureéxl. For organizational pur- poses we may distinguish two major categories of forms of treatment: family centered forms of treatment and specialized medical treatment. The first category of treatment forms are readily accessible through family members, neighbours and relatives and through the druggist and herbalist in the nearby town. More serious cases of illness are directed 345 Figure 6.1. Types of Medical Treatment Available to the Villagers of II. FatiHa. FAMILY CENTERED MEDICAL TREATMENT home remedies, minor religious rituals, use of pharmaceuticals and herbs, visits to religious shrines MEDICAL SPECIALISTS A. Indigenous a. Tib Tabi‘i (natural medicine) treatment of any type of physical ailment which is defined as originating from a natural cause, including headaches, rheumatism, barreness, poor eye sight, hernia, and fright (Tarba) Tib RawHani (supernatural medicine) treatment of supernaturally caused illness, e.g., sorcery, evil eye, spirit intrusion 1- siegeee’sieiees diagnosis of illness through practitioner's possessing spirit. Prestige of diagnostician proportional to length of affliction period. Forms of divination include use of rosary, opening of cards, and visions of precipitating causes of illness. Relatively limited power in dissolution (fak) of sorcery. 2. zar organizers performers of da a (drumming) and, in some cases, SulHa (reconciliation). Least prestigious of the raw- Haniya 3. Quranic diviners/healers usually males who undertake diagnosis and treatment of illnesses of supernatural etiology through knowledge of the Quran and control over supernatural khudam (servants). Also practice sorcery and utilize their khudam for the dissolution of sorcery. Prestige and power Based on literacy and manipulation of Quranic information. 346 Figure 6.1 - Continued. B. Cosmopolitan Medical Treatment Diagnosis and cure of naturally caused illness a. private physicians b. public clinic physicians c. Halag SiHa traditional trained paramedic undertakes informal consulta- tions, prescription of medicines, and administration of injections 347 towards specialized medical treatment. Within this latter category, the villagers distinguish between the indigenous forms of diagnostic and curative procedures (*ilag baladi) and the cosmopolitan form of medical treatment which they refer to as the cure of the physician (:Elgg.il_ Hakim). Medical specialists of the indigenous variety are readily available within the village itself but their failure to bring about the desired relief prompts the sick person and/or his significant others to week this form of medical treatment in the nearby villages and provincial towns. If necessary, indigenous practitioners located as far away as Tanta, Cairo, and Alexandria may be visited. The same pattern of gradual movement away from the village is noted in the utilization of cosmopoli- tan forms of medical treatment. When cure does not result by the village paramedic known as galag_il_§i§a_or by the physicians available in the nearby towns, villagers seek this form of treatment in larger urban centers. a. Family Centered Treatment In their initial response to illness the people of FatiHa relied on various forms of lay, family centered treatments. These include home remedies, the knowledge of which is generally shared by adult males and females, although it is women who are held responsible for dispensing such remedies and for the general well being of family members. Home remedies are also freely suggested by and'exchanged between members of a neighbourhood and between relatives. Knowledge of home remedies is not confined to a specific group in the village and even children are aware of the curative functions of herbal infusions and drugs. Herb- alists in the nearby town also give advice on home remedies to those 348 who frequent their shops to purchase curative herbs. Home remedies used directly by the sick person or his/her family without the intervention of medical specialists include massaging with oill, following an appro- priate diet2 , the use of a variety of ointments and natural products for surface injuries (e.g., ground coffee or mud to stop bleeding of a wound), and the practice of informal religious rites for the curing of the evil eye (e.g., Eggwa). Independent, family—centered medical treatment also involves the use of drugs purchased from the two pharmacies in the nearby town and aspirin from the local grocery store. The pharmacies are frequented by villagers who seek diagnosis of their own ailments or those of their family by describing the symptoms to the pharmacist who then recommends an appropriate medication. The pharmacist is also frequented by villagers who, having diagnosed their illness, either on their own, or with the aid of relatives, come to purchase the required medication. A variety of antibiotics can be purchased by the villagers without prescriptions. In response to the author's question about how he treats his illness, an informant noted, "I just go down and buy a couple of penicillin in- jections and have galag'il_§i§g_give them to me". Treatment of a sick person by his/her family may also involve re- liance on the curing power associated with sacred places. As in other parts of the Middle East, FatiHa villagers and their families, in seek- ing cure for illness visit the shrines of dead holy men/women (211322). It is believed that the mere presence of a person near the burial place of a holy £221.15 enough to transfer baraka to his/her ailing body. In case the sick person is unable to visit shrines which are believed 349 to be efficacious in effecting cures, a member of his/her family makes a pad; (vow) on his/her behalf. When cure is granted through the wall who is believed to act as an intermediary between the sick person (and his family) and God, it is said that the saint has "answered" (istagab) the request of the sick person and his/her family. The shrine of Sidi Ibrahim il Disuki in the nearby religious center of Desuk is the object of visits by villagers from FatiHa seeking cures of illnesses and a variety of other misfortunes. The pagaka_of saints (231313) like Sidi Ibrahim is deemed to be effective even tens and hundreds of years after their death. Their power is recognized as eternal. Thus villagers from FatiHa who desire to become recipients of the waliL§)blessings (bazaka) go and serve in his shrine during the saint's day celebration (mplid). A barren female informant noted that she would go to serve in the mplid_ so that the 233252 of Sidi Ibrahim may come on her and she would get pregnant. Of this £311, other villagers say that "if a sick person goes to visit him, he need only touch his tomb (22335) with his hand and he would be cured". Similar healing powers are attributed to the local female saint, a member of the one time Turkish rulers of the village. b. Medical Specialists (i) Indigenous - Beyond the family context, the villagers of FatiHa identify two major forms of indigenous medical treatment: Natural medicine (T§p_zapi:i), which bears some resemblance to the ancient humoral traditions of the Nbditerranean and Islamic words and super- natural medicine (Tip RawHani). The first form of indigenous medical treatment known as natural medicine (Tib Tabi‘i) is practiced in FatiHa 350 by a female praCtitioner of bedouin origin. The curing role3 associated with this practitioner is deemed significant for any type of physical ailment which is defined as originating from a natural cause. People who frequent this healer may come complaining from any of a variety of illnesses which include headaches, rheumatism, barreness, poor eye sight, hernia, and fright (22323). Her services as a bone setter are also sought by villagers and she is also known for her practice of midwifery. Unlike some other types of healers in the village, this practitioner of natural medicine (T§p_Tapi:i) does not claim any communication with the supernatural world and neither does she attribute her healing abili- ties to supernatural powers (baraka). However, the people of FatiHa themselves attribute baraka to this healer and they explain this by ref- erence to the fact that she is a good Muslim, and not in terms of in- herited supernatural abilities to heal. In her own description of her curing role she emphasizes her control of specialized knowledge about the functioning of the body. She described her curing role as follows: I treat people who are sick and I also help deliver babies. I cut the umbilical cord and use some of the blood to push up the child's roof of the mouth so that he can eat properly, this is repeated after the fortieth day...I inherited my mother's pro- fession. My mother originally came from Libya. I used to watch my mother and I learned. For the person whose head hurts and who has tears coming down from his eyes, I use a nail (which she showed the author), a hot nail in the middle of his head, then I put a piece of castor leaf on the burn. This stops the headaches and the tears. This headache could be from zaha (sadness or de— pression) and this brings about fewaran (boiling) of the blood. The blood expands and rises into the head and it plugs up the eyes. When I iron on (cauterize) the head, the nash‘ (watery secretion) from the burn brings out the excess pressure and the person is relieved...(Do you cure *uzr?)...This is not my specialization, I only take care of natural cures. Every- body these days goes to the doctor, but they come to me after the doctor cannot cure them. I never charge them anything but when they are cured they give me a Halawa 351 (gift)...All illness is from God. A person may get moisture when he is young and when he gets older the chill shows up as rheuma- tism and weakness. Dirt can also cause illness and people who eat or drink after a sick person also get sick. But illness is usually caused by zahag (sadness or depression). When people get upset all sorts of illness can come to them in many parts of their bodies. First they may go to the doctor or sometimes, if they have had experience with me, they come to me first. If the person's eye hurts, it is because the main vein in the head has excess blood and so I lift the vein and tie a thread around the person's ear. If the person has clouding over the eyes and cannot see well, I pass a thread in the back of the ear and this relieves pressure from one part of the body; pressure then has to be relieved from an- other part of the body. So if a tiny boy comes with an en- larged testicle because of trapped air from neglect and being left alone uncovered and crying, I do the same thing. The pressure on his lower body part is relieved by the thread in the back of the ear. When the doctor tries to relieve the pressure from an enlarged testicle he cuts the boy open and when he does this he may cut the vein of birth. As for me, if the two testicles are affected, I treat the two ears to relieve the pressure. For grown men of course I cannot examine them, so I ask. If it is the left testicle I take the left ear and if it is the right testicle I take the right ear. The men get this pressure from carrying heavy loads. If a person comes to me with a broken bone, I heat water. I feel the bone and I use hot pads to push the bones to- gether. I use an egg and flour dough and I put a layer of this between a layer of rags. When this mixture dries it becomes just like the gibss (calcium carbonate used by the physician) of the doctor. But the doctor's treatment can harm the veins. On the third day I go to see the broken person. I use a spoon with oil to soften the dough, this moistens the veins and it allows the blood to run freely in the veins. If a person gets frightened (matrub) I can know by looking at the lower lip, if it is yellowish I know that he is marh (frightened). The blood disappears from this area ecause of the shock and he may even be unable to father children. The blood dries up and he weakens very much. If he passes semen it is just like water. There is a cure for this. I iron on ‘aDmit il zar“ (the bone of planting). (She showed the author-the lower vertebra of her back and made her feel it). The person should not have intercourse for forty days so that he should not bathe because if he bathes the water will heal the wound. we want the wound to stay for a long time so that it will bring puss and pull out the yellow water from his body. 352 Indigenous healers who cure illnesses of "natural causes" are also sought out by the villagers of FatiHa at patron saints days celebrations in nearby villages and particularly at the nearby religious centre of Disuk, the burial place of a highly revered saint. In Disuk, during the celebration of the mplid_(birth) of Sidi Ibrahim i1 Disuki, the local patron saint, a variety of healers set up stalls in the large square surrounding the mosque of the patron saint. The author had the oc- casion to interview some of these practitioners of 322.2221:13 including the famous Shikh E.B., who along with his brothers and patrilateral male cousins is known for his practice of indigenous natural medicine. They specialize in curing "naturally caused illnesses", including rheumatism, male impotency, male and female sterility, and illness of the spleen (Tpgal). Shikh E.B. described his diagnosis and treatment of illness as follows: The sick person's description of his ailment is the basis of our diagnosis. He points to the part of the body which causes him discomfort...Rheumatism is caused by cold and moisture. High fever causes the illness of TuHal (spleen) and sterility may be caused by Tarba (fright), so we try to relax the nerves by getting rid of the fawaran (boil- ing) of the blood by ironing...I look a piece of coconut shell like this (he showed the author his tool kit which contained pieces of coconut shells, long nails which are heated till they are red hot and used to iron on different parts of the body, and pieces of woolen string used to tie around wrists or other sore joints) and then I place it on the affected area...We use ironing (cauterizing), it relaxes the state of excitement of the blood. It re- lieves headaches, eye pain, and nervousness. we also use ironing on the back (lower back) of men who are sterile. For women who are barren we give them Sufa mabruka (blessed piece of wool) which they wear Before uniting with their husbands...We inherited the baraka (power) from our grandfather and we transfer our baraka to the sick persons. The coconut shell is particularly strong for this purpose. Our inherited baraka comes from our bodies and our learning and training allows 353 us to perfect the art of healing. But the baraka (blessing power) is the important basis of our healing abilities. Our grand- father ironed for_a man who was separated from him by the sea. Spitting on the kay (ironed part of the body) is itself baraka from us...The illness will never return to the person again after he has received our baraka, but only if he follows the special dietary routine which we prescribe. People with rheuma- tism should not eat eggs, fish, salty, or spicy foods. Those who suffer from sterility should eat good rich food such as meat and fish and eggs and butter and milk. The second major form of indigenous medical treatment, known as supernatural medicine (Tab rawHani) is represented in the village by six diagnosticians and/or healers. This group undertakes the diag- nosis of illness through the practice of different forms of divination which include the "opening of the book" (the Quran), the utilization of a rosary and playing cards, as well as other forms based on astrology and calculations based on the letters of the alphabet contained in the name of the sick person and that of his/her mother4. The practitioners of supernatural medicine (Tib rawHani) who cure illness are believed to do so through shamanistic power. These curing abilities are also sought by villagers in areas which transcend the immediate vicinity of the village. Some patients and their families frequent shamans in nearby villages, in the religious centers of Disuk and Tanta, and some even go so far as Alexandria and Cairos. In fact the prestige of heal- ers seems to be related to the location of their practice. When attempts of the local and nearby curers fail to bring about the desired result, the peasants of FatiHa seek help from traditional healers (and physi- cians) in the provincial towns. More desperate cases may be taken to the larger cities of Tanta, Cairo, and Alexandriaé. In contrast to the direct treatment of the body which is practiced by the practitioners of Tib Tabi‘i (natural medicine), the 354 practitioners of Tip_rawHani (spiritual medicine), known as rawHaniya (spiritualists), practice diagnosis and induce symptomatic relief through the manipulation of supernatural forces. Their concern with the mech- anisms of body functions is minimal and they specialize in the diagnosis and/or curing of illness of supernatural etiologies, e.g., :pgg, :gmgl, and Hassad. During visits to rawHaniya, the interaction between the healer and the sick person may be minimal and the dialogue often goes on between the healer and the older person, male or female, who accom- panies the sick person on his/her visit to the rawHani. The rawHani makes no attempt to examine the body of the sick person. In some cases, the healer does not even see the sick person. Only the latter's 2135 (remenant) is taken over to the diagnostician's residence and serves as the object of divination. Among the practitioners of Tip_rawHani, one may distinguish sub- groups. One group consists of diagnosticians. Within this group one finds people who themselves are ma‘zurin but whose possessing spirit have been pacified and do not cause them physical pain any longer. With the aid of the possessing spirits this group undertakes the diagnosis of illness. As a member of this group noted, "the :pgp_knows another ‘uzr". Thus, while the healing power of practitioners who are literate and who have memorized the Quran is generally acknowledged as being greater than those who do not, some diagnosticians claim that in the diagnosis of the spiritual illness of :EEE! "it is the :ngpwhich can recognize another :pgp". In other words, it is believed that a person who him/herself has been.mg:§§23 and has maintained his/her control over the afflicting spirits, is the most qualified to diagnose the 355 illness of :223: As one rawHani noted, "this is why the doctor can- not identify the :223, because he himself is not ma:gfirfl. RawHaniya who maintain control over their possessing spirits also claim that they can command their assyad_to search the past and even predict the future. Diagnosis of illness of supernatural etiology proceeds through various forms of divination. Among diagnosticians who have limited or no knowl- edge of the Quran, divination is based on communication with possessing spirits, the use of a rosary, and the use of cards. One diagnostician who relies on supernaturally inspired visions in the diagnosis of illness described his method of diagnosis as follows: When the sick person comes, I ask him where the pain is. I also ask if the pain moves around from one place to another. If it does, then I know that it is ‘uzr. I ask, 'did you go to the doctor?‘ Then the patient says yes. So I take her handkerchief and I keep it under my head for a night only on Monday and Fridays because these are nights which are mabrfika (blessed). These are nights when the awliya roam the world. When I have the aTar, I get a vision after my prayer. The vision is like a television screen. I can see exactly what caused the patient's illness. It could be that she could have had a disagreement with her husband. If he hits her in a dark area, she may scream and become malbfisa (worn, i. e. ., possessed by a subterran- ean being). Sukan il arD (inhabitants of the underground) then enter her body. _They do not remain in one place. This spiritual wind (31H rawHani) enters all her blood system. A female practitioner in the village combines the tasks of diagnos- ing illnesses of natural cause and supernatural divination. She des- cribed her method as follows: When someone is ill they come to me. I separate the egg white and yolk. I put the yolk on the body of a child and where the pain is the egg spreads out. This is in case the child was not held properly. The yolk spreads from the heat because this area is inflamed...My mother was also a healer and taught me. I have visions of my patients before they come. My mother had learned the trade from her family; they were Arabs who used to iron and cure...My patients are mostly 356 children and women. I am a widow and so if men come to me other people will talk. But if a woman's husband is not well she tells me his symptoms and I tell her what to do for him after the vision. Still another form of divination is that practiced through the uti- lization of cards. One female diagnostician who practices this form of divination said, "If someone is magi} or has nazra, I can tell from the cards. I only know how to identify the ‘uzr but I do not know how to cure it. I send people to the specialists".8 Another form of diag- nosis of illnesses of supernatural causation was described by a rawHani as follows: The person goes to the doctor first. If the doctor's medicine does not bring about the desired cure he turns to the tari a al_raWHani a (the spiritual method, i.e., of curing). His fam 1y says take him to a spiritualist so one or more members of his family take him to a ‘araf (a knowledgeable person, a religious medical practitioner). The ‘araf takes the aTar in which is wrapped some money. The ‘araf measures the hand- kerchief after reading a ‘azIma (concentration)...This involves concentration while reading the Quran, any sura of the Quran... the Quran is all baraka. The change in the length of the handkerchief determines the type of illness. If it becomes short it means that the illness is from the inn, it is from lamsa ardi a. If it becomes long, the cause 8 from the inss (human , th s means nazra insaniya (human gaze, i.e., the evil eye). If it remains the same then the illness is from Allah; it means that the illness is due to bodily disfunctions which are natural. If it is nazra ardi a, the pain is mobile. In this case a zar ceremony Is per ormed and the person descends the Hadra (presence, i.e., presence of the possessing spirits) on a specific tariga (path) or on any tariga. After two or three Hadra(s) the assyad start to talk through the mouth of the affected person. At this time the pain becomes more severe and the as ad start to make their demands known. If the cause of the illness is nazra insani a, the pain is localized, not necessarily in any specific part of the body. A similar form of diagnosis practiced by the rawHaniya in FatiHa described by the Shikh as follows: The person's aTar is brought to me and I read a ‘azima on it and I summon Al Maynur, the chief of khudam (spiritual 357 servants) of the p§p£§t_(a plural form of 2223). Then I mea- sure the aTar with three fingers. I then tie the handkerchief (in which—the'person's aTar and the shikh's payment is placed) tightly. Then I ask tEEEEHadim (supernatural servant), 'if it (the illness or other EE§?6?tune) is from a human, make it (the handkerchief) longer, if it is from 1122? make it shorter, and if it is from Allah, leave it as 13'. Once a person's illness has been diagnosed as spiritual (rawHani), diagnosticians may recommend differing forms of treatment by other in- digenous medical specialists and some may administer the treatment themselves. Some diagnosticians recommend to their patients to go to the E2932.(223)9' Sometimes a diagnostician may accompany an affected person to the E2922: When the affected person's body responds (yihim) to one of the musical tunes representing the supernatural servants (khpdam) of the different saints (alliya), and he/she gets up to dance until she/he reaches a point where she is believed to reach an altered state of consciousness, the shikh proceeds to ask the possessing spirit where he/she comes from and what his/her demands are. The spirit res- ponds by saying that he/she comes from one of the shrines of the famous saints, which are found throughout Egypt. Speaking through the mouth of the afflicted person, he/she/they describe(s) the circumstances under which he/she/they came to the sick person and make(s) demands for a.§pl§a (conciliation). In association with the gap_ceremony one may distinguish a sub- group of rawHaniya (which is not represented in FatiHa but found in the nearby village), consisting of persons who organize gag ceremonies or private drumming sessions (9352) if the sick person is unable to go to 10 the Hadra . Usually, the zar ceremony is recommended by a diagnosti- cian but in some cases, members of this second group may themselves 358 be diagnosticians of illness. Relying on the power of spirits which possess them they may also be the ones who perform the S21H2.(reconcilia- tion ceremony where the spirits' demands are met). A third subgroup of practitioners of Tip_rawHani are those who are not necessarily ma‘zurih themselves but command supernatural servants (522222) through their knowledge of the Quran. Members of this group command their khpdam_to diagnose illness (and to cause it in cases where they practice sorcery). They are also known for their abilities to prevent illness through their functions as prayer writers and to counter the harmful physical effects of possessing spirits of ma‘zurih. Members of this literate group of practitioners who have studied and memorized the Quran consider themselves the only true practitioners of $12.32!? Hapi_and refer to the otherpractitioners as "nothing but musicians" (said in reference to those who organize za£_ceremonies). In an attempt to undermine the power of indigenous practitioners who rely on possess- ing spirits, a H§£E1_QE£ p (bearer of the Quran, i.e., someone who has studied and memorized the Quran and who utilizes it for the purpose of diagnosis and curing of illness) noted, "It is true that Lpgg is recog- nized by another lpgg_but the power (papaka) of the Quran is above every- thing else". Knowledge of the Quran and its utilization for the manipulation of supernatural spirits is not confined to the healing of illness but is also known to be used by some practitioners of Tip_rawHahi who are com- missioned to inflict illness through the practice of sorcery. Diagnos- ticians of magaD.rawHaniya (supernaturally caused illnesses) are known to be able to command their possessing spirits to dissolve (yifuk) the 359 effect of illness causing sorcery, but they are generally recognized as possessing relatively limited power for the practice of sorcery to induce illness. Among such practitioners who have no proper knowledge of the Quran, dissolution of sorcery is brought about through a form of imitative magic. Shika A. described her method of dissolving (fak) sorcery and said, "I melt the lead in a pan of water over the head of the person for whom the ‘amal (deed, i.e., sorcery) was done. This (treatment) dissolves the 'amal...no I tell the person that he has a ‘amal made for him but I do not say by whom". Although the treatment of ‘amal bil maraD (illness of sorcery) is sometimes undertaken by medical practitioners who are ma‘zurin and who command their possessing spirits to diagnose the illness, it is generally assumed that rawHaniya with knowledge of the Quran are better able to dissolve sorcery (yifult‘amal). One such practitioner recalled his latest case of dissolution of sorcery (fak ‘ama1) as follows: She had a hemorrhage. She went to Dr. S. and stayed in his clinic for ten days, but to no avail. She came back here (to the village) and got worse. They sent for me. I knew right away that it must be siHr (magic)...continued bleeding after injections indicates siHr. I wrote her three papers (i.e., Quranic charms). She wore one in the hem of her dress, another in the back, and a third under her belly button. Within less than an hour the bleeding stopped... I cannot knOW'WhO did it (the sorcery). Only with fatH il_mandal one can find out...This means that I bring a cup With a drop of olive oil and a child, a male, who has not reached puberty. The child looks in the cup and the rawHani reads a ‘azIma and the child sees the khadam and they show him a VieW'of who did it...(Why didn't you do this?) I don't want to try because it brings hatred between people. When the shikh's account was checked with the woman who had suffered from the severe case of bleeding, she confirmed his description and noted that the bleeding did indeed stop less than an hour after the 360 shikh's E25222 (charms) touched her body. Unlike the Shikh, she showed no reluctance in levying accusations of sorcery against her future mother-in-law. She did not blame the rawHani for not attempting to reveal the identity of those who commissioned the act of sorcery against her. The necessity of keeping the identity of such persons secret is generally recognized by the patients of practioners. As one informant noted, "He never tells people who made the :amal for them. Otherwise people will all start killing each other, and he will be blamed. People of course can guess who is the one who went to a shikh for :amal_against them". Villagers generally believe that the diagnosis of spiritual illness (£3322 rawHani) can be undertaken by anyone who has been himself/herself ma‘zur/a and who maintains control over possessing spirits, but the cur- ing of spiritual illness (95332 rawHaniya), including those caused by sorcery, is believed to be done more effectively by those who have good knowledge of the Quran. In terms of the implications of this belief for the perceived power of male and female practitioners of Tip_rawflani, it is generally true that for practitioners who are illiterate, their power derives from their ability to diagnose illness. The healing powers of practitioners who are learned in the teachings of the Quran are deemed more efficacious in the healing of illnesses precipitated by spirit intrustion and sorcery. Since women are generally illiterate female practitioners seldom enjoy the prestige of literate males. The basis of their relative devaluation is not their gender per se, but an attribute (illiteracy) which is generally linked to that gender identity. Exceptions do occur. This is particularly evident in the 361 case of female healers in the nearby religious centre, who are also learned in the teachings of the Quran. The greater prestige accorded to literate healers was verbalized by one of them as follows: "The people who make the gag simply by drumming do not have the same ability as the others who write aggipg_(Quranic charms) and who have knowledge of the Quran and its use". In rating of healers according to their power, it is generally be- lieved that, "the longer a spirit possesses a person, the stronger it becomes. It matures in the body of the person. The strength of the healer depends on the strength of the assyad_that are possessing him". Clearly, the prestige accorded to the maturity and wisdom of old age in village system of social organization is replicated in informants' evalua- tion of the creatures of the supernatural realm. As the indigenous practitioners of Tip_rawHani practice different forms of divination, they also differ in their knowledge of illness and, with the exception of knowledge of illness causation, do not share a unified view of illness symptomatology. Following Fabrega and Silvers' example of determining the extent of shared medical knowledge about illness manifestations among h'iloletik and laypersons in Zinacantan (Fabrega and Silvers 1973), a questionnaire was administered to the six practitioners of Tip_rawHani in the village and to a control group con- sisting of an equal number of non-practitioners matched for age and socio-economic status. The percentages of respondents, in each group, who provided positive associations between illness dimensions (related to illness causation and physical manifestations) and three culture bound states of illness (Hassad, 'uzr, and amal bil maraD) are summarized in 362 Tables and . As in the case of the indigenous Indian h'loletik of Zinacantan, the rawHaniya of FatiHa do not rely on specialized, ex- clusive knowledge about illness and its manifestations. In contrast to the relatively high degree of consenus about illness causation between and among practitioners and non-practitioners (illustrated in Tables 6.1 and 6.2), the practitioners as well as non-practitioners disagree to a considerable extent about the association of physical symptomatology with the selected illness labels. The specific mechanism by which the assyad_cause the illness of :EEE.iS also by no means a point of complete agreement among indigenous diagnosticians and healers. While one diagnostician may assert that the spirit itself does not actually reside in the ma‘ZEr/a's body ("or else it would burn it completely"), and that it is simply the "wind" (agygfl) which actually enters the human body, another practitioner provides a diametrically opposed description. When asked about the process by which the assyad inflict physical pain on the ma‘zfirza, and whether it is only the wind of these spirits which is responsible for the pain, a female diagnostician responded, "Of course it's not only the wind, they themselves come inside the person and control the person and put him in a daze. People cannot feel themselves. The a§§y39_move from one place of the body to another. They go from the head to the heart, to every part of the body. The doctor doesn't know them. No doctor will ever know them. People become well only in happiness". The people of FatiHa themselves, while they recognize the special power of rawHaniya for diagnosing and curing supernatural illness, be- lieve that the diagnosis of supernaturally caused illnesses on the 363 Table 6.1. Degree of RawHapiya's Concensus on Illness Dimensions Associations. % Positive % Positive % Positive Illness Association Association Association Dimension Hassad ‘uzr ‘amal pil_maraD A. Cause a. instrumental 1. nat. envir. & subs. O O O 2. phys. constitution O 17 O 3. spt. intrus. (malbus) O 100 O 4. Hassad (gaze 100 17 O 5. ‘amal (sorcery) O O 100 b. efficient 1. God 0 O O 2. Hassid (witch 100 17 O 3. assyad (spirits) O 100 O 4. saHir (sorcerer) O O 100 c. ultimate l. sadness O 100 O 2. anger O 83 67 3. jealousy 100 17 100 4. hatred 100 O 100 5. punishment by God 0 O O 6. fear 0 84 O B. Physical Symptoms l. weakness 100 100 100 2. headache 100 100 100 3. aches all over 100 100 100 4. trembles 67 5O 33 5. hot-cold spells 550 33 33 6. cough 17 5O 17 7. chills 17 5O 17 8. nausea 33 5O 5O 9. weight loss 67 100 100 10. vomiting 33 5O 17 11. swelling OO 5O l7 12. loss of balance 33 5O 50 13. diff. in breathing 67 67 l7 l4. lump in throat 5O 67 O 15. diarrhea O O O 364 Table 6.1. Continued. % Positive % Positive % Positive Illness Association Association Association Dimension Hassad ‘uzr I‘amal bil maraD l6. fever 67 33 l7 l8. earache 33 67 5O 19. watery eyes 67 5O 5O 20. rash 0 17 O 21. back pain 50 67 100 22. dizziness 67 83 83 23. chest pains 17 67 17 24. stomachache 17 67 17 25. excess blood in body 0 O O 26. excess water in body 0 O O 27. drying of blood in body parts 67 83 100 365 Table 6.2. Degree of Non-practitioners' Concensus on Illness Dimen- sions Associations. % Positive % Positive % Positive Illness Association Association Association Dimension Hassad ‘uzr ‘amal pil_maraD A. Cause a. instrumental 1. nat. envir. & subs. O 5 5 2. phys. constitution O 9 O 3. spt. intrus. (malbus) 5 100 O 4. Hassad (gaze) 95 19 O 5. tamaI (sorcery) O O 100 b. efficient 1. God 5 l4 5 2. Hassid (witch) 100 23 O 3. assyad (spirits) 0 90 O 4. saHir (sorcerer) O 5 100 c. ultimate l. sadness O 100 O 2. anger 10 9O 57 3. jealousy 100 10 95 4. hatred 100 10 100 5. punishment by God O O O 6. fear O 86 O B. Physical Symptoms l. weakness 100 100 100 2. headache 100 100 100 3. aches all over 100 100 100 4. trembles 43 52 57 5. hot-cold spells l9 19 29 6. cough 5 l4 5 7. chills 5 29 15 8. nausea 10 33 24 9. weight loss 29 76 95 10. vomiting 14 24 19 ll. swelling 5 33 29 12. loss of balance 29 71 71 13. diff. in breathing 43 71 48 14. lump in throat 19 57 24 15. diarrhea O 5 29 16. fever 38 43 38 17. pain in joints 62 9O 67 Table 6.2. Continued. 366 % Positive % Positive % Positive Illness Association Association Association Dimension Hassad ‘uzr ‘amal pil_maraD 18. earache 19 67 48 19. watery eyes 43 71 52 20. rash 5 l4 14 21. backpain 48 86 76 22. dizziness 76 95 86 23. chest pains 14 57 38 24. stomachache 10 57 33 25. excess blood in body O 10 10 26. excess water in body 0 5 O 27. drying of blood in body parts 57 67 76 367 basis of illness symptomatology can also be done by lay persons. Thus when an informant told the author that her neighbours had advised her to go to the Had£a_(zap) and when the author inquired about how her neigh- bours were able to diagnose her illness, she responded, "Because the same cases have happened to many other people before me and everybody knows these symptoms and what they mean". In some cases, frequenting the rawHaniya may be looked upon as an attempt on the part of the patient and his/her family to legitimize the illness role by obtaining a re- affirmation of their own evaluation of the illness state. In fact, it is possible to actually start the process of pacification of the spirits through the attendance of the Had£a_without the services of a rawHani. The legitimizing function of the formal diagnosis and the subsequent participation in the Had32_is evident on the latter occasion when the musicians of the Hadga sing a song entitled lamfipi_(they blamed me), which is sung by some of the ma‘zurin who descend the Hadpa_and is aimed to dispell suspicions on the part of those who may describe the behaviour of the ma‘zurin as faking. The singers say, "why do you blame me? Oh free one, oh free one, what is your concern with me. Tomorrow (i.e., in the future) you will see what will befall you and what happened to me will happen to you". The power of the rawHaniya clearly does not rest on their specialized knowledge of illness causation and manifestationsll. Their power does not derive from their control over specific types of medical information which differs from lay persons', but from.their reputation of contact with supernatural beings, their control over religious knowledge, and importantly, their culturally valued role of extending legitimacy to 368 deviations from social role expectations associated with illnesslz. Moreover, it should be noted that the rawHaniya accumulate a tremendous amount of information about the members of their community, they make very good listeners. Their familiarity with local culture, along with this eagerness to inquire about "the well being" of fellow villagers allows them to anticipate the types of problems which people of different social standings in the village are likely to bring to their attention as the basis of their stress and their subsequent illness. Finally, it is evident that the rawHaniya are not reluctant to change their diagnosis of illness as the need arises. This change is prompted by new information about patients which comes to the attention of the diagnosticians. Thus while shikha A. had attributed F.'s barreness to :Ez£_on the occasion of the author's first visit to her with F., a few months later when rumours of F.'s pregnancy spread through the village, Shikha A. assured F. that the assyad have been barred (inHagazfi) from her and that she would have a child within the year. In sum, the power of the rawHaniya does not rest on their specialized knowledge of illness causation or symptomatology of illness, nor even on a shared view of the mechanisms of illness precipitationlB. It is derived from their culturally valued control over elements of the Super- natural realm which lends their diagnosis of illness its authoritative legitimizing character. When the author asked a rawHani practitioner about whether any one can read a :azima_(Quranic passage) on a sick person's aTg£_to diagnose illness, she responded, "only people like me can because I have shikh Y (the possessing spirit with whose help she established contact with the supernatural world). In addition to this 369 supernaturally acquired power, indigenous practitioners are tuned to local culture and the potential stresses of social relations of power differential which precipitate illness. Moreover, it is evident that the rawHaniya's role as diagnosticians and healers is associated with their greater capacity to impose order and control over the deviant be- haviour and the uncertainties associated with an illness occurrence (Cf. Fabrega and Silver 1973:78—79). A rawHani, like other indigenous practitioners whose power is supernaturally based, "provides a response, interprets the uninterpreted, and orders the occurrence in terms of accepted patterns of meaning" (Shweder, l968:1). This capacity of paw; Hapiya_to impose order on ambiguous situations was assessed through the administration of a modified form of Shweder's cognitive capacity test to all the rawHaniya in the village and to a control group of non-practi- tioners. Richard Shweder (Ibid) has provided an experimental procedure where- by the cognitive capacities of traditional healers could be system- atically compared with those of lay individuals partaking of the same cultural tradition. Following this procedure, all six of the village rawHaniya and twelve non-practitioners, matched for sex, age, and socio- economic status, were presented with four series of photographs de- picting objects and scenes which are familiar to the local population. Each of the respondents was shown four series (A,B,C,D) of photographs (of a £3523 (water wheel), a field of cotton, a man ploughing, and a party of cotton pickers). Each series had been developed through six different stages of clarity ranging from a complete blur in the #1 photo- graph of each series to a well focused scene in the #6 photograph. All 370 the pictures were arranged and presented to respondents as six consecu- tive rounds. The first round included all #1 photographs of each of the four scenes. The second round included all the #2 photographs of each of the four series and so on, with the last round being composed of the perfectly focused photographs of each of the four scenes. For photo- graphs of Series A and C, respondents were told to describe what they saw in each photograph, only if they were sure of what each of the photo- graphs represented. They were instructed to give the answer, "I don't I'm—7. know" in cases where they were not sure of the representations in the photograph. In case of Series B and D, respondents were presented with alternative answers. For the gagya of the B series, respondents were told that the photograph may represent a stack of hay, the dome of a mosque, or a sagya, Similarly, in case of series D, the scene of a man ploughing, respondents were asked to choose between the alternatives of an animal turning the sagya, a bridge, a man ploughing. As in the case of series A and C, respondents were asked to describe what they saw only if they were sure; they were instructed to say "I don't know" if they were not. The objective of the test was to determine which group (practitioner or non-practitioner) was more inclined to impose form and order on the blurred and ill-defined scenes illustrated in the photo- graphs and which would provide the response, "I don't know" more readily. As in the case of Shweder's h'loletik, the rawHaniya offered the response "I don't know" less frequently (See Table 6. 3). For the photo- graphs where alternative choices were offered, the rawHaniya, when they did not provide the right answer, showed a greater inclination for guessing rather than saying, "I don't know". Moreover, in providing 371 Table 6.3. Practitioners'* and Non-Practitioners'** Responses to Shweder's Test. % Respondents' Response "I don't know" Imposed Structure Photograph P N.P. P N.P. Series A 1 5O 75 5O 25 2 33.3 75 66.6 25 3 16.6 50 83.4 50 4 O 18.3 100 81.7 5 O O 100 100 6 O O 100 100 Series C 1 50 58.4 50 41.6 2 16.6 50 83.4 50 3 O 16.7 100 83.3 4 O 8.3 100 91.7 5 O O 100 100 6 O O 100 ' lOO Correct Answer Guess "I don't know" P N.P. P N.P. P N.P. Series B 1 16.6 8.3 50 50 33.3 41.6 2 O 16.6 83.4 25 16.6 58.3 3 50 41.5 50 8.3 O 49.8 4 66.6 58.3 33.3 25 O 16.6 5 83.4 83.4 16.6 16.6 0 O 6 100 100 O O O O 372 Table 6.3. Continued. “"__1 Correct Answer Guess "I don't know" P N.P. P N.P. P N.P. Series D l O O 66.6 50 33.3 50 2 O 16.6 83.4 58.3 16.6 25 3 66.6 41.6 33.3 58.3 0 O 4 66.6 75 33.3 25 O O 5 100 100 O O O O 6 100 100 O O O O * P ** NP 373 such guesses, in some cases, they also provided answers which were not included in the alternative choices of the experimental procedure. This greater inclination on the part of the rawHaniya to impose order on the ill-defined representations of the photographs is consistent with their expected role behaviour of imposing explanation when the deviant behaviour and confusion of illness experiences are presented to them. ii. Cosmopolitan Medical Treatment - Within the village, cosmopoli- tan medical treatment is available to the people of FatiHa from a local paramedic known as Halag.il_§ifla_who has received informal training at the hands of physicians. Cosmopolitan medical treatment is also ob- tained by the villagers from private physicians and the government health clinic and hospital in the nearby town and in other provincial towns. The most desirable form of cosmopolitan medical treatment which the peasants aspire to is that associated with a private physician. The most accessible cosmopolitan medical services, including those of private physicians are located in the nearby town, about three kilome eters from the village. Two physicians and a dentist in this town are frequented by the people of FatiHa. Through extended interviews and observations in the clinic of a physician who operates a private prac- tice, information about the most prevalent diseases among the peasants of FatiHa and their approximate differential distribution by age and sex was obtained. The clientelle of Dr. E. is composed of approximately 25% women, 25% children, and 50% men. This distribution is largely a reflection of the peasants' greater willingness to invest resources for the curing 374 of men than women. It is said that men are the bread winners and if they are not healthy the life of the whole family falls apart. From an etic perspective, this rationalization is a reflection of the power differential between men and women and the differential valuation of males and females. Although the physician himself could not provide an estimate about the proportions of female and male children who are brought to this clinic, the author's own observations in the village indicate parents' greater willingness to allocate scarce cash for the cure of male as opposed to female children. Among children, the physician notes that the most common ailments in the summer are due to enteritis. Intestinal inflammations due to bacterial and protozoan sources are more prevalent in the cases of young children than is the dysentry due to parasitic worms. In winter, bronchial inflammations are the most frequent afflictions. It is esti- mated by the physicians that between 20-30% of the sick children brought to his clinic are diagnosed as suffering from severe malnutrition. Con- junctivitis is also said to be prevalent among children in the summer. Among adults, approximately 20% are said to suffer from Pellagra, and bronchial asthma is widespread.14 The distribution of Belharzeasis reaches nearly 100% according to Dr. E. Liver and spleen enlargement and cancer of the bladder is diagnosed frequently in males by physicians. It is a secondary effect of Belharzia parasitosis. Common among males also are a variety of renal ailments and urine disturbances which are also identified by the physician as secondary effects of Belharzeasis. Among older adults, the physician reports a large proportion of his clientele suffering from artereoscorosis, bronchitis (in the winter) -fl1_ 375 and diarrhea. In all age groups in the summer, nearly 70% of all cases examined by the physician are diagnosed as malaria. Around the time of insecticide spraying in the village, people visit the physician's clinic with complaints of vomiting and diarrhea. In addition to the services of private physicians, cosmopolitan medi- cal treatment is available to the people of FatiHa from a government operated hospital and an associated maternal and child health clinic in the nearby town. The 80 bed hospital is staffed by a physician-director, 2 surgeons, two interns, an endemic disease specialist, 2 dentists, and a nursing staff trained in the provincial school for second grade nurses (Hakimat). Medical facilities housed by the hospital include x-ray, a clinical laboratory, and a child and maternal health center and the school health unit. The official fee charged for examination and dis- pensation of medication is 3 P.T. (3/100 L.E.) and surgery is performed free of charge. In spite of the material advantages offered by this government operated facility, some informants who utilize its services out of necessity complain of the unpleasant treatment by staff members and their mockery of the peasants' garb and language. The maternal and child health center which is connected to the hospital is staffed by a physician, a pharmacist, one senior nurse and seven junior nursing staff members. According to the senior nurse, the majority of village women do not come to the center until around the fourth month of pregnancy. Due to a paper shortage, each is asked to buy a note book in which her record is placed. The information in the note book is recorded by the nurse who includes such data as pregnancy history, weight of expectant mother, her hemoglobin count, blood pressure, and family health (which the nurse complains is very difficult to obtain). 376 Cases of TB are transferred to the hospital in the capital of the prov- ince. Check-ups for pregnant women are available once a week. The women are encouraged to come whenever they can and as often as possible. Once their name is registered with the child care center, they have the right to request a birth assistant who would go out to the village and supervise the birth, cut the umbilical cord, administer the neces- sary eye care procedure, and periodically check on the mother and child until the fortieth day after delivery. As long as the mother and child's name is on record in the health unit, the staff informs the mother, through the village headman, of the time and place for the child's vac- cinations during the first five years of age. After this age the child becomes the responsibility of the school health unit (§i§a_él_madrassiya) which is assigned the task of providing regular stool and urine analyses and supervises school children's health in general. D. ,Dynamics of Treatment Choice In Sections B and C we have provided an account of the types of preventive measures and the various forms of medical treatment avail- able to the people of FatiHa. In doing so, reference was made to both indigenous forms of prevention and treatment and those which are as- sociated with the cosmopolitan medical tradition. It was noted that the villagers have three main categories of treatment alternatives with varying underlying local explanations: Tip Tapi:§_(natural medicine which derives from explanations of illness in terms of natural causa- tion and psychological stress, which induce failure of proper body functioning), Tib rawHani (supernatural medicine - which derives from 377 explanations of illness in terms of supernatural etiology associated with socially significant ultimate causation), and cosmopolitan medical treatment (which, although sharing with the Tip_Tapi:i_the general explanation of illness in terms of natural factors, differs from that indigenous medical tradition in its emphasis on pathology rather than cause and its general neglect of psychological stress as a significant etiological element). The mere enumeration of forms of medical treatment undertaken in the preceding sections does not give us access to the dynamics of treat- ment choice. For this purpose one must examine the factors which prompt people in specific situations to choose one form of treatment over another. It is therefore necessary to survey the variety of di- alectically related elements of the village sociocultural system and inquire about the determinants of people's choices within a medical care system which includes a variety of explanations of illness and a corres- ponding variety of possible treatment stra egies. When anthropologists have undertaken this type of analysis they have often emphasized the determinant role of local illness concepts. This tendency is exempli- fied in the work of George Foster who writes, It appears as if ph§_mg§£_important categories of culture that should be more or less completely understood to carry out successful health and hygiene programs are local ideas about health, welfare, illness, their causes ana'EEEaEEEfiE' (Foster 1955:20 as cited in Bonfil Batalla 1970:2483 original emphasis). While one cannot realistically discount the role of local concepts of illness as irrelevant to treatment choice, it is the contention of this author that selection of medical treatment is situationally de— termined and cannot be predicted from information about local ideas 378 of illness. Just as the necessity of integrating illness explanations into the social structure has been shown in Chapter 5, it is similarly necessary to examine the dynamics of treatment choice. This is particu- larly important if the medical system is to be utilized as an efficient tool of anthropological analysis, i.e., as a probe into the dialectics of social life. As noted in our discussion of the specificity of illness explanations in Section C of the preceding chapter, selection of appropriate treat- ment is neither random, nor does it follow straight forwardly from an underlying logic of culturally shared categories of illness explanations. As explanations of illness are not simply based on physical symptomatology, but take into account the social structural context of illness episodes, forms of treatment are also selected accordingly. Choice of the appro- priate treatment strategy is affected by the progression of the illness itself, its response to certain types of treatment, and the social iden- tity of the affected person him/herself. In considering the latter category, one may point to such elements of social constraint as the power position of the a-fected person and how this is related to his/her access to resources which persons in positions of power may or may not choose to expend for the medical treatment of a sick person or group of persons (e.g., daughter-in-law in an extended family household and peasants in a centralized state society with characteristic social stratification and associated power differentials.). One may also note the nature of interpersonal relations between the sick person of a certain social standing and the practitioners of different therapeutic traditions, as well as the economic requirements of the different ”“71. 379 therapeutic practices. In short, one must consider factors which clearly extend beyond the system of medical beliefs or explanations of illness in the analysis of choice of medical treatment strategies. This theme is pursued in the remaining part of the chapter, which undertakes a critique of the theoretical position which accords casual priority to conceptual factors in the choice of medical treatment, describes the pattern of hierarchy of resort to curative practices in FatiHa, and under- scores the significance of power relations (at both the micro and macro levels of analysis) for medical treatment choice. a. Illness Concepts and Treatment Choice Anthropological studies of therapeutic strategies have often assumed that these derive automatically from beliefs about illness in any given culture. A recent critique of this theoretical orientation characterizes anthropologists' analysis of therapeutic strategies as follows: Anthropologists have often asserted that there are conflicts between...traditional (illness) classifi- cations and their associated theories of cause and cure on the one hand, and the modern western, or cosmopolitan medical practice on the other. The usual form of argument is that when western practice applies treatment which is perceived or classified as inappropriate in the local system for the category in which the disease is logically placed, treatment will be rejected because of the "cultural conflict" or "cognitive dissonance" generated in the patient (Kunstadter 1975:376). Contrary to the supporters of the "cultural conflict" or "cognitive dissonance" explanation, it may be argued that it is always appropriate to look for the alternative systems of explanation of illness and actions for its resolution as a normal part of any social subsystem (Ibid), whether this subsystem is associated with a multi-ethnic society (as 380 Kunstadter's study shows) or whether it relates to a peasant community which is integrated into a broader social constellation, as exempli- fied by the research community of the present study. ‘Moreover, it must be emphasized that as evident in our description of the variety of explanations of illness in FatiHa alternative therapeutic traditions are not simply the result of the intrusion of "western" medicine. Reports of the hierarchy of resort in precontact societies have also been noted in cross-cultural studies (Schwartz 1968). As Kunstadter points out, the above noted "cognitive dissonance" argument derives from the assumption that people ordinarily intellec- tualize their behaviour in the sense of making everything consistent and "rational". But while one may recognize the rationality of human behaviour and people's constant strive to consistency between goals and actions, and the constant modification of the latter to fit the former, it must be noted that human goals themselves are not immutable categories which are associated with definite appropriate actions. Individual goals and actions are not insulated from their social sur- roundings, and in their dialectical interaction with these surround- ings, goals and actions are in a constant state of flux. To quote Kunstadter once more, "the ordinary human game, is 22} the intellectual one of conforming to a single set of rules, applicable in all situa- tions, to reach a single goal. Rather, it involves multiple rules applicable in some but not all situations, and requires balancing between several simultaneously desired goals or values" (Ibid). For FatiHa, as for other communities described in the literature, this argument is supported by the actual existence of a variety of explanations 381 such as spirit intrusion, natural causation, the evil eye, and re- lated forms of treatment such as the zar ceremony, the consumption of medicinal salts, or the fumigation with aromatic incense, do not conform to a single theory of illness. The cosmopolitan form of illness explanation and treatment is but one additional alternative, the concep- tual inconsistency of which does not undermine its situation-specific utility and evident desirability. The validity of this argument is further augmented when one notes the equally real fact of anything but complete agreement about illness explanations and forms of treatment among the villagers of FatiHa themselves, who presumably share a common "cog- nitive map" or "ethpgfmedical" theoretical perspective. This variability was more clearly demonstrated in the case studies of illness presented in the earlier chapter. As Kleinman has recently written, "the sickness taxonomies elicited by ethnoscientists can seriously distort our under— standing of lay beliefs about sickness if those taxonomies are divorced from the setting of actual sickness episodes and from their E§e_as prac- tical guides in the health seeking process of choosing among avail- able treatment alternatives" (Kleinman 1977). Illness classifications as isolated cognitive domains differ from actual responses to illness episodes. The sharply differentiated "formal taxonomic categories contrast with what Kleinman has referred to as "the loose, and overlapping semantic networks", which mediate between beliefs about illness causation and situational variables associated with cases of actual procurement of medical treatment. In fact, the hierarchies of resort practiced in the setting of the present study (see subsection b. below), and frequently reported in the 382 anthropological literature on medical treatment, reveal that the under- lying classificatory elements associated with actual cases of medical treatment may in fact be contradictory. It is evident that choice of medical treatment rests on the immediate requirements of cure rather than on the conceptual compatibility of logical categories underlying dif- ferent forms of treatment. In a survey of responses to illness over a one year period among the adult inhabitants of 100 households in the village of FatiHa, it was evident that in seeking medical care byond the family context, the physician was by far the number one choice of the villagers (See Table 6.4). One may note with marvel such a result if one supports a position which requires complete consonance between the underlying logic of ill- ness explanations and treatment strategies. The physician's medical logic which derives from a naturalistic theory of illness in which body— mind duality is pronounced, contrasts with local medical theory with its integrative emphasis as well as its naturalistic 22d supernaturalistic explanatory elements. But clearly, what is important for the villagers in choosing the physicians treatment, when they do, is not its under— lying logic, but the Obvious fact that such treatment is effective15 for certain types of ailments. The choice of the physician is not based on the internalization of the theoretical assumptions underlying his/her treatment forms, but more importantly, on the basis of these treatments' effectivenesslé. The overwhelming selection of the physician by the people of FatiHa shows clearly that one need not be competent in medical school physiology and anatomy nor an ardent supporter of the germ theory of disease in order to seek treatment by a physician whose 383 Table 6.4. Utilization of Different Forms onMedical Treatment. iMedical Personnel Order of Choice or Treatment (lst, 2nd, 3rd) Number of Patients Physician lst 69 2nd 25 3rd 0 Halag SiHa lst 15 2nd 4 3rd 0 RawHaniya lst 1 2nd 12 3rd 1 Government Hospital lst 2nd 3 3rd 384 diagnosis of illness and its treatment rests on the principles of a naturalistic theory of diseaselV. Conceptual consonance is undermined by pragmatic considerations and by evidence of the situationally deter- mined utility of therapeutic strategies. This point receives further elaboration below. b. The Hierarchy of Resort to Curative Practices The variation in the evaluation of illness according to contrasting conceptual schemes is evident in the villagers' hierarchy of resort to curative practices, which involves the selective and situationally var- iable utilization of the main types of medical treatments (indigenous and cosmopolitan) available to the sick person and his/her familyla. The choice of a specific treatment depends, among other things, on what the type of medical treatment can do at any given point in the treat- ment procedure and the duration of illness. The selection of various forms of treatment may be understood in terms of situationally deter- mined goals of the patient and his/her family. Villagers, including indigenous medical practitioners recognize the inadequacy of the indig- enous medical care system in the treatment of illnesses where the physical dimension of malfunction is most pronounced. In this case, the physician is recognized as being most qualified for dealing with the perceived relevant underlying causes of illness. In case of the indigenous practitioners whose concern extends beyond the purely physi— cal manifestations of illness to ultimate cause, his/her success is measured not simply by reference to relief of physical symptoms of ill- ness, but also by patients' improved psychological disposition, work habits, and ability to fulfill culturally prescribed role functions. 385 Generally, villagers utilize modern health care facilities for sympto- matic relief whereas disorders which are judged to be directly related to socially significant ultimate causes are viewed as requiring the expertise of an indigenous healer. In this regard, it should also be emphasized that, unlike the physician whose domain is strictly medical, indigenous diagnosticians and healers are frequented for a variety of misfortunes, ranging from loss of prized possessions, to marital conflict, to barreness and sterility, along with a variety of problems involving interpersonal conflicts and tensions. These interpersonal problems are not differentiated from a person's state of health which is seen as influenced by any such distressful event and conflicts in daily life. It is clear that villagers do not perceive cosmopolitan medicine to be in conflict with their indigenous medical care system. They note that these different forms of health care meet different needs and ex- pectations. In other words, villagers note the complementarity of the two systems. In some cases villagers continue to take the migawiyat (strengthening substances) of the physician, wear the Higap_(charm) of the Shikh, and visit the shrine of a gal; or even a Christian church, all in the pursuit of the reversal of a state of ill-health. It is also significant to note that the social context in which the illness label is to be publicized is an important consideration in the selection of healers who provide legitimacy for illness. A.barren woman may frequent a healer to obtain such legitimatization. An agricultural worker em? ployed by the government, on the other hand, necessarily seeks the dis— pensation from his role obligations and failure to report to work from the physician. Legitimation depends on the specific power domain in 386 which the label of illness is to be displayed. The resort to indigenous healers may be understood in terms of the types of illnesses perceived by the sick person or his/her family as well as in terms of the social functions of indigenous healers them- selves. The types of illnesses which indigenous healers, as opposed to physicians, are believed to be expert in, are usually chronic and masked minor psychological disorders. A similar situation has been described for Taiwan (Kleinman 1975). These illnesses may be described as involving "somatization" of personal and interpersonal problems (Ibid). The in- digenous diagnostician or healer give legitimacy to claims of illness arising from interpersonal conflict, a function which the physician, with his/her emphasis on biomedical dimensions of illness, does not dispense. Unlike the case of the physician whose curing abilities are defined in terms of his success in eliminating, completely or partially, the physical symptoms of discomfort, in case of the indigenous rawHaniya, their success may be gauged in terms of identifying or labelling the socially defined illness, thus lending legitimacy to the sick person's claim of stress and discomfort, and even allowing a temporary enhancement of social status (a momentary suspension of relative powerlessness). In examining the hierarchy of resort in curative practices, it is interesting to note that indigenous healers of the village themselves recognize the above noted division of labour between Tip_rawHani and cosmopolitan medical care and in cases of severe mental illness they may advise their patients to visit a physician. Furthermore, they them- selves frequent physicians for the cure of what they perceive to be acute, physically based disorders. One of them described her recent 387 hospitalization as follows: I vomited and then they sent me the ambulance. Three doctors checked me and said that I must take injections. Dr. X (the director of the hospital) said I'll let you stay but don't take my business from me. The shikh Y (her possessing spirit) came and Dr. X asked him if I can take injections and medicine, he said "yes". They gave me hospital clothes to wear but my body could not stand them. Then they agreed to let me wear my clothes. I stayed for twelve days...all my loved ones from your village came to visit me. This rawHaniya also claims that Dr. X believes in the above noted division of labour between physicians and rawHaniya and that he recommends to some of his friends from the city to visit her. The differentiation of tasks of rawHaniya and physicians is noted in informants' descriptions of the types of illness which each is ex- pected to successfully cure. Tib rawHani is deemed useful for the identification and cure of illnesses which become manifest gradually and the duration of which stretches over a long period of time. The physi- cian's curing abilities, on the other hand, are recognized as being use- ful for the treatment of afflictions which are sudden and severe. The somatic intervention associated with the physician's treatment in the form of medications is described as adequate for what is perceived as primarily somatic disorders which are only indirectly linked to ultimate causes. By contrast, it is deemed necessary to seek super- natural intervention in treating the relatively chronic states of ill- ness which are directly linked to emotional distress and interpersonal con- flict, including those associated with power differentials. As it is a supernatural power which is believed to precipitate the physical pain associated with the latter form of distress, a supernatural form of intervention is believed necessary for their legitimation. The 388 distinction between the expertise of indigenous medical practitioners and physicians is reflected in villagers' differential expectations of the two groups of medical care specialists. Thus, when Dr. 0. was called to examine S's daughter and did not prescribe any medicine and said that the daughter should visit the H2932, her mother became furious. She refused the physician's advise and said, "I am bringing a doctor, not a shikh, I expect you to prescribe medicine". Treatment by an indigenous rawHani involves attending to a variety of the patient's personal concerns which, according to the conceptual framework of the physician, are ordinarily considered outside the "medi- cal" domain. The transaction between the indigenous practitioner and his/her patient involves matters byond what the physician defines as strictly medical issues. To the extent that the sick person's illness is perceived to be linked to social, supernatural, or interpersonal factors, the services of the indigenous practitioners are "rational choices". When naturalistic causation is believed to underlie a state of illness, the physician's services (if economically feasible) are eagerly secured. The interaction of the physician with the villagers is quite different from that of a traditional practitioner. In inter- actions with the latter, there is no sense of inhibition in expressing beliefs which may be considered "backwards". The physician's probing questions center around the body, with minimal, if any, consideration of interpersonal relations and psychological state. If the physician's treatment brings about the desired improvement in health, the illness label is shed and the sick person is once again reintegrated into the social domain as an active member. In case a cure does not result, 389 then the physician's treatment is abandoned and an alternative thera- peutic strategy is pursued. Failure of the physician's treatment does not induce its condemnation by the people but leads them to try an alternative treatment strategy. It is not the physician's curing ability which is questioned, but rather, it is the validity of his diagnosis which becomes the central issue. The villagers hold the physician in a position of power and reverence. His failure prompts them to a dif- ferent formulation of the basis of their illness rather than to question- ing his curing abilities. If a patient and his/her family turn to 222. rawHani after treatment by a physician, they, like the rawHani him/her- self refer to the physician's failure to cure the patient as a basis for the diagnosis of the yet uncured illness state as supernaturally pre- cipitated. Illness treatment may be conceptualized as progressing through dif- ferent phases. The data collected through the census reveals that the physician is the first choice of the majority of people in the village, males and females alike. It is in cases that the physician's treatment fails to bring about the desired cure, and when circumstances of inter- personal conflict and serious departure from culturally defined role prescription continue, that people turn to rawHaniya who rely on super- natural curing skills. Thus, K who is barren, was operated upon by a physician but to no avail. When she gave up on the doctor she started frequenting a number of rawHaniyalg. In doing so, she secured the diagnostician's validation to her claims of supernatural causation which she described as being beyond the physician's knowledge. In such cases, while the physician does not endorse failure to fulfill cultural 390 role expectation, the rawHaniya provide legitimacy for deviant behaviour. The very fact that a patient is taken to a traditional diagnostician is an indication of the type of diagnosis being expected, or in some cases, the diagnosis being sought to justify deviation related to economic, maternal, or other age or gender related social role. While it is true that the diagnostician will help identify the specific spirit and the circumstances under which it affected the ma‘zfirza or the method of sorcery used for theinfliction of illness, his main task is to bring the semblance of order to a situation of disorder. His/her diagnosis pro- vides people with a framework for explaining otherwise unexplainable behaviour. In some cases indigenous diagnositicians/healers may be frequented after a physician has been consulted and no positive results are produ- ced, simply because people in desperation are willing to try any and every type of treatment in the hope that health will be restored. This rationale is illustrated in the case of Z.G.'s dying husband. Z.'s hus- band had died about three years ago following an illness which lasted for a year. He first vomited and defacated blood. He informed his wife when this happened to him for the first time. His wife then consulted her brother who decided that the situation was extremely dangerous and took the ailing man to the hospital. Z.'s husband's condition improved after returning home and taking the physician's medicine. After being told by the physician that her husband's illness is not curable, Z.G. went to a variety of traditional curers. They attributed his illness to the fact that he drank cold water when his body was warm. She said that on her part, she believed that what the indigenous healers 391 said was a lot of nonsense and that they are nothing but swindlers. She said that she went to them just to please her dying desperate hus- band. She added, "I took him there SO'that I will have done all I can". In concluding our discussion of the selectivity of therapeutic strategies and the division of labour between physicians and indigenous medical practitioners, it may be noted that the latter are speciali in the treatment of illnesses which are principally defined in terms of psychosocial criteria (ultimate causation). These are usually chronic disorders (which derive from stable interpersonal relations, including power differentials) which are reflected psychologically and projected publicly through what Kleinman has referred to as "somatic masks". In contrast, physicians are entrusted with the treatment of life threat- ening acute illnesses defined in terms of underlying pathological pro- cesses, to which neither lay persons nor indigenous practitioners claim any expertise. But physicians may also be utilized as one point along the path of legitimation of socially rather than biomedically defined illnesses. Finally, in noting' social scientiests' increasing interest in attempting to determine the differential efficacy of indigenous practi— tioners' and physicians' treatment by reference to the former's come patibility with local social life and symbolic structures (Good 1976), it is evident that in the case of FatiHa, as in other parts of the Middle East, the argument can be made that choice of practitioners in response to illness is indeed intimately related to patients' perceptions of relevant dimensions of their affliction. But it must be stressed that relevant dimensions are not immutable and are situationally determined. 392 0. Power Relations and Medical Treatment Initiation of medical treatment and/or the choice between different forms of therapeutic strategies does not rest simply on rigid categories of cognition and local perceptions of illness, or the underlying logic of illness explanations. In the foregoing discussion note was made of the variability of theoretical assumptions associated with the procure- ment of medical diagnosis and cure and the coexistence and differential utilization of medical care strategies with differing underlying concep- tual frameworks. Additional factors (including those associated with power relations20), beyond ideological elements must be considered in understanding the basis of choice of one form of treatment over another and the more fundamental initial process of negotiation of the sick role and the extension of legitimacy to claims of illness by symptomatic per- sons. In Chapter 5 it was briefly noted that power differentials linked to aspects of village social organization influence the legitimation of illness explanations and, by extension, may be expected to affect the behaviour of symptomatic persons. Thus, the specific form of illness behaviour of a daughter-in-law and her access to the sick role was said to be largely determined by persons who hear a superordinate power relation to her (e.g., her mother-in-law). The influence of power differentials in the labeling of illness and the consequent behaviour of a symptomatic person is equally profound in the realm of medical treatment. As power relations influence illness behaviour, they also determine whether sig- nificant diagnosis and treatment of individually perceived stress (physical or psychosocial) will be initiated at all. Just as the social label "sick" and the associated sick role do not automatically follow 393 individually experienced stress and claims to the illness role, but is influenced by the elements in the social environment of a symptomatic person, including his/her power status, diagnosis and eventual treatment are similarly influenced. As noted earlier, the presentation of symptoms does not automatically grant a person the status "sick". In fact, two persons may present identical symptoms and one would be denied the label sick while the other would be granted it readily. Neither is the severity of the symptomatic person's condition as perceived by him/herself a guarantee that the illness labeling would be granted and the necessary curative regimens pursued. In fact, it is evident that people whose social roles (and health) are highly valued may be granted the label "ill" even with the presentation of the slightest symptoms indicative of ill health. Women consistently identify their husbands as ill more readily than they do themselves or other female members of the household and prompt them to seek medical treatment at the slightest sign of ill-health. It is often said that the hquand is the bread winner and that his health should be protected for the benefit of the whole family. In the cases of the relatively powerless members of village house- holds, it is evident that while powerlessness induces stress and pre- cipitates individually perceived illness, less than complete subordination to the authority of others is a prerequisite for access to the sick role. Thus, while women, because of their relative powerlessness are likely to experience and communicate about stressful situations, their positions of relative powerlessness itself mitigates against their prompt access to the illness role and the social validation of their claims 394 of illnesle. But as indicated in our introductory theoretical discus- sion of power relations in Chapter 1, one cannot realistically refer to an individual who is partner to any social relation as completely power- less. Even in extreme cases of subordination, the subordinate party exercises some control over the environment of the superordinate party. Subordinate persons do wield power, but only in the sense that they hold some threat over the environment of others. A powerless person's claim to the‘sick role may continue to be denied by persons in superordinate relations of power to him/her, but this denial may eventually prove to be antithetical to the needs of the powerful person him/herself, if the subordinate person is left neg- lected to the point of reaching functional incapacitation. When this If? happens, the continued denial of the powerless person's claim to the sick role by his/her superordinate social partner(s) may prove to be dis- asterous to the latter, whose power is in fact based on the continued performance (work, subordination, obedience, etc.) of the less powerful partner. This amounts to the powerful person's destruction of his/her own power base,/ Thus, while the granting of legitimacy for claims of illness may be enhanced by derivative power accessible to the sick person who occupies a subordinate power position (as in the case of Z.'s i255 discussed in Chapter 5), the superordinate person him/herself may also grant the legitimacy of illness to subordinate partners to ensure their continued survival and performance of culturally defined role functions (which are deemed to be the power base of the superordinate person him/ herself) in the future. Once this decision is reached, medical diag- nosis is initiated and treatment undertaken to reintegrate the now 395 deviant sick person into his/her culturally defined social roles, includ- ing its dimension of subordination to more powerful social partners. In sum, validation of the status "sock" is not a spontaneous occurrence. It is situationally determined (Cf. Robinson l97l:l2) and is influenced by power relations associated with social statuses and the performance of roles complementary with these statuses. Denial of claims to the illness role may be reversed once illness is viewed as interfering with the performance of essential social roles. Persons in positions of power who can lend legitimacy to illness claims may determine that in the long run legitimation of a subordinate person's claim to illness may be beneficial. Consequently, measures may be promptly undertaken to correct the now legitimized deviation from ex- pected role performance in order to reintegrate the sick person into the established framework of role prescriptions, including that of subordina- tion to the superordinate significant others with whom the legitimation of illness rests. One obvious question comes to mind: why doesn't the powerless person present his/her significant others with behaviour indicative of inability to perform according to role expectations and earn a temporary dispensation from role obligation through claims to the sick role? Why does he or she not simply show functional incapacitation? In answering this question one must take into account elements of social status which are not immediately apparent in the study of an illness episode. This point is illustrated in the case of a woman, B., who lives in an extended family household. As the mother of female child- ren only, her powerlessness is explicited by her mother-in-law who works her and her female children to the point of exhaustion. B.'s appearance 396 indicates severe malnutrition, which is attributed by the people of her neighbourhood to her mother-in-law's "tight fist". In gatherings with other women of her age B. complains of weakness and always refers to her chronic condition of illness and the continued denial of her claim of ill health by her mother-in-law. She says that she has stopped com— plaining to her mother-in-law and has simply accepted her fate although she feels sometimes that she will simply fall and die one day. When B.'s friends advise her to defy her mother-in-law and have her own husband take her to the doctor who would keep her in the hospital so that she would rest (an arrangement which her husband can set up readily, in view of his acquaintance with many of the government officials in the nearby town), she resists their recommendations. In response, she refers to the possibility of even more disasterous consequences that may result from her defiance of her mother-in-law. Specifically, she dreads her mother- in—law's suggestion to her son that he marry another woman. Her mother- in-law herself complains of her junior subordinate's miserable appearance and her "ugly yellow face" and underscores the latter's powerlessness by reference to her devalued status as the mother of females. She says, "will it be from all", implying that if the only useful thing that the daughter-in-law does is her work, and if even that is abandoned because of illness, she will have nothing remaining to justify the continuation of her marriage to the older woman's son. Being aware of the reality of her lack of control over culturally valued resources, which underlie her powerlessness, the daughter-in-law continues to suffer in silence, especially in view of the fact that the mother-in—law is known to have been the direct reason for her son's earlier divorces. B. has therefore 397 chosen to forego the illness role to ensure the maintenance of her role as wife. She has apparently chosen to sacrifice the short range gain associated with the illness label for the long term, culturally signi- ficant status of married women. In cases where the legitimation of the sick role is denied to a symptomatic person, the stressfulness continues to affect him/her but he/she continues to perform his/her tasks as stiuplated by more powerful persons in whose hands the control of legitimation remains. The denial of the legitimation label is itself an additional source of distress which burdens the person whose claim to illness was initially denied. As B. described her condition, she felt that she is simply wasting away. As the mother of female children she was constantly scorned by her mother- in-law, she had no support from her own family and she looked emaciated and remained chronically depressed. By contrast to B.'s case, persons whose claims to illness are ac- corded social legitimacy are provided with socially approved exemptions from role obligations. The person thus treated is accorded certain privileges including a reduced work load, preferential treatment in the allocation of choice food, and even the right of being disrespectful to persons who are ordinarily considered in superordinate power relations to him/her. In addition, the emotional support of the family is mobilized and the claims of expressed discomfort are attended to with great care and concern by family members and others included in the sick person's network of social relations, be they neighbours or relatives. The initial phase of treatment, which.begins with the recognition of the patient's claim.and labeling as "sick", is often confined to the 398 context of the family and the immediate social network of the sick person. Sometimes, depending on the perceived severity of the illness and the resources at the disposal of the family, treatment of the ill may go beyond emotional support, privileged access to prized food, and treatment with home remedies such as herbal infusions, prayers, and other minor religious rituals. If the patient's condition is judged as calling for expert treatment, a more formalized therapeutic strategy is initiated and pursued. As illustrated in Table 6.4, in seeking medical treatment beyond the family context and non-specialized cures, the number one choice of the villagers is the physician. People who cannot afford the doctor but whose explanation of the illness condition is in terms of natural causation may frequent the government clinic or the local Halag. il.§ifia_(barber) who may prescribe any of a number of standard drugs prescribed by physicians or he may administer an antibiotic treatment in the form of an injection. The latter form of treatment is regarded as particularly effacious since the drug is recognized as being intro- duced directly into the body and not through the slower path associated with the ingestion of pills. The barber, in addition to administering antibiotic treatment is also likely to prescribe some form or another of migawiyat (strengthening substances) which include a range of vitamin tonics and injections of calcium. Availability of funds, valuation of the sick person's social role and life, and perceived danger in the condition of a sick person by his/her significant others prompts them to take him/her to the doctor's clinic. Given the expense involved in such a visit, it may be judged as an added index of social legitimation of the patient's claim to 399 illness. In fact, the trip to the physician's office is clearly a status symbol and a reaffirmation on the part of the family of their commitment to the welfare of the symptomatic person. The physician's diagnosis, no matter its specific content, is an additional step in the reaffirmation of a legitimized state of illness. In case the family maintains a naturalistic explanation of the patient's condition, the doctor's diagnosis confirms their belief. The number of medicines prescribed by the physician is taken as an index of the severity of the illness and clearly a further sealing of the patient's claim to dis- comfort. In case the explanation of illness shifts to the supernatural domain, the physician's diagnosis of "normal health", or "just strained nerves" is still maintained as a support to patients' or their signifi- cant others' claim of supernatural etiology, which the physician cannot recognize. To conclude our discussion of the differential access to the sick role and the subsequent initiation and pursuit of treatment, it is evident that these do not rest simply on claims of illness by symptomatic persons nor on rigid categories of cognition and explana- tions of illness by the villagers of FatiHa. The process of negotiation of the sick role and the treatment of illness is summarized in diagram form in Figure 6.2. As consideration of the circumstances of the social life of the symptomatic person, including his/her social identity was deemed neces- sary for understanding the basis of the differential access to the sick role, it is also true that social identity influences the type of treat- ment extended to a sick person whose claim to the illness role has been legitimized. Conversely, types of treatment, differentiated according 400 Figure 6.2. Illness Legitimation and the Hierarchy of Resort in Thera- peutic Practices SYMPTOMATIC PERSON stress (physical or psychosocial) INDIVIDUAL CLAIM TO THE SICK ROLE SOCIAL DENIAL OF CLADM SOCIAL LEGITIMATION OF TO THE SICK ROLE THE SICK ROLE FURTHER DETERIORATION OF HEALTH PHASE I DIAGNOSIS -Family‘L Centered- FUNCTIONAL INCAPACITATION Deviation From Culturally Defined Role Behaviour TREATMENT -Family Centered- CONTINUED DENIAL OF LEGITIMATION OF CLAIM TO THE SICK THE SICK ROLE CONTINUED DISTRESS R0 E FURTHER DETERIORATION REINSTITUTION PHASE II DIAGNOSIS OF HEALTH OF CULTURALLY -Specialists' DEFINED ROLE validation of BEHAVIOUR claim to the sick role HIERARCHY OF RESORT COSMOPOLITAN MED TREATMENT \TIB RAWHANI TIB TABI‘I Supernatural Causation Centrality of Ultimate Natural Causation Causation Immediate Treatment L—CURE CONTINUED CM PROTRACTED DISTRESS TREATMENT 401 to the expenditure of culturally valued resources and according to the promptness of their administration to a sick person, may themselves be utilized as an index of a sick person's social standing and his/her power status in a given social context. On the basis of this logic a survey was undertaken in the village to determine the nature and extent of differential treatment of family members of a selected sample of households in FatiHa. In attempting to determine the form of treatment extended to family members of differing social identities in terms of gender and relation to household head, a group of sixteen families was selected from the sample of 100 households making up the sample population. Informants were asked to describe the specific forms of treatment extended to sick members of the family, their order, and their cost during biweekly inter- views over a period of nearly four months. Data obtained from this survey shows that the symptoms described for the reported cases of ill- ness were generalized and diffuse (e.g., weakness, aches all over, depres- sion, etc.) and generally did not differ significantly from.one case of illness to another. While differences in symptoms were not the primary bases for evaluation of severity of reported illness conditions and urgency of treatment, the status of the symptomatic person clearly was. The highly valued and expensive services of private physicians were systematically provided to members of the household whose health re- ceives culturally defined higher valuation. The average cost of treatment for illness cases reported for females was L.E. 1.50, while that for males was L.E. 2.20. In noting the order of resort to different types of treatment (beyond home remedies), it 402 was evident that males resorted to the more expensive treatment of the physician more readily than females, with 37% of the males selecting the private physician as their first choice as opposed to 10% of the females. When person's making up the sample was differentiated accord- ing to relation to household head (HHH), the data show that of the six male HHH who were treated for illness, four selected a private physician as their first choice. For one male HHH, the physician was the second choice, and the remaining one resorted to the public physician of the government clinic. The average cost of treatment for this group of male HHH was L.E. 3.75. Among the corresponding group of female HHH, expendi- ture for treatment of illness was more modest. Among three female HHH, none selected the physician as their first resort and one chose him as the second resort. The average cost of treatment among this group was L.E. 1.00. Of the eight wives of HHH who were treated for illness, only one utilized the private physician as the first form of treatment. The average cost of treatment for this group was L.E. 2.13. Mothers of mar- ried sons reported 3 cases of illness with an average cost of treatment of L.E. 2.83. Two women of this group were taken to private physicians on their initial expression of discomfort. Comparison of treatment type and expense extended to Da and BrDa of HHH on the one hand and So an; BrSo of HHH on the other, shows the higher expenditure on the treatment of males than their female counter- parts. The average cost of treatment for the seven sons was L.E. 1.73, as compared to L.E. 0.92 for daughters. Among the male group, one was taken to a private physician on the first trial at cure. Two were examined by private physicians on the third trial at cure, and the 403 remaining sons were treated with independently purchased drugs and one was taken to the government clinic in the nearby town. Comparatively, among the five daughters treated for illness, only one was taken to a private physician. In the one case that the private physician was con- sulted, this occurred at the second attempt at cure. The lowest average cost of treatment is associated with young female affines of the sampled households, namely SoWi and BrWi. In the case of this group of three women, the average cost of treatment amounted to only L.E. 0.18 and none of them was taken to a private physician at any phase of their illness. Beyond the limited data obtained during structured interviews with informants of the above noted survey, informal interviews and partici- pant observation reveal that the form of medical treatment and investment of resources for the cure of family members is definitely a function of the afflicted person's social identity. Thus, when the author inquired from Z. about her daughter's ill-health and emaciated appearance, the mother noted that the young girl's poor health resulted from neglect when her now deceased father (Z.'s husband) was ill. She said, "...he was seriously ill. Of course I used every millim;(penny) for his medical treatment. I figured his health is much.more important to us than this bit of a girl. All the time that he was ill I would beg men to look after his work in the field. I would do some of the work myself, and sometimes I would even hire men to do it. I wish she (her daughter) had died instead of him. Now we wouldn't be this way and he would have kept the house open for us. As you see, all my children are girls. At least if I had a son he would have kept his father's house open". The importance of the HHH's health in the maintenance of the family 404 was also emphasized by other women. In justifying the expenditure of large sums of money for the treatment of their husbands women would make such statements as "he is our man. We had to pay to hire a labourer for three days (to do the field work ordinarily carried out by the husband)". By contrast, and in view of women's relatively devalued work contributions, when informants were asked about the consequences of female illness, they undermined the negative effect of such an event on family welfare. One male informant responded, "...one of the neighbours comes over and takes care of things, or her (the sick woman's) relatives will come over. If the husband knows how to do the chores of the woman, he will do them". Finally, the reluctance of investment of valued resources for the treat- ment of sons' wives was particularly evident. When a sons' wife asked to consult a physician, her mother-in-law mockingly remarked, "you would think that my son married a princess...she wants us to wait on her". While gender identity and relation to HHH (which varies according to the developmental cycle of the family) affect the allocation of valued resources for medical treatment, other variables must also be considered in examining the differential utilization of available forms of medical treatment. Note has already been made of the hierarchy of resort and the situational variation of cognition related to explanations of ill- ness. Deterrent to the utilization of cosmopolitan health care facili- ties include the financial burden imposed by private consultations and the long hours of waiting in the public clinic, along with exposure to humiliation at the hands of the personnel at public health care facilities. The expense of cosmopolitan medical care is particularly burdensome when one realizes that the average yearly income of a peasant family owning 405 one feddan of land is L.E. 120 and that a visit to a private physician costs at least L.E. 1. In this regard a female informant noted, "We do not go to Dr. X because he writes a prescription the length of my arm. How can we afford to buy all this medicine?" Expense is clearly an important deterrent to the peasants' utiliza- tion of cosmopolitan health care facilities. Contrary to public pro- nouncements that health care in rural Egypt is free of charge, in reality peasants often have to pay for such services. As a peasant from Minia described to an Egyptian reporter, "The private payment for services in the public health unit is well known to all the people...I would (still) rather pay a private fee to the doctor instead of bringing another doctor from the town for a large fee, in addition to providing him with trans- portation" (SabaH 11 Khir #10061, 1975). Like the peasants of FatiHa, peasants in other parts of Egypt find it necessary to pay for medical care since "the cheap has no use" (Ibid). In this regard it should be noted that the peasants' desire for the physician's care is so great that they are sometimes willing to forego their limited savings and valued possessions to pay the physician's fee and the price of his/her medicine. Payment of a private fee to the physician by the needy peas- ants obtains, not only better treatment at the hands of this public ser- vant, but also the receipt of the appropriate medication and additional vitamin tonics and drugs of general use (Ibid). Recognizing the problem.of payment to government supported physicians who are expected to provide services to the public, free of charge, the government has started an experimental plan in some parts of Egypt where- by payment for the fees of the physician is recognized as legal. 0f b; 406 the fee paid by the clients to the health care unit, 20% is officially granted to the physician. This plan has not deterred physicians in public clinics from charging patients over the prescribed 20% (Ibid). Clearly, this solution does not benefit the powerless health care con- sumers; it attends to the complaints of the physicians who are required to serve in the rural areas. It is an official recognition that health care is for those who can afford it. This is indeed the reality of cos- mopolitan health care in rural Egypt. It is not the peasants' lack of awareness of the benefits of cosmopolitan medicine, but their lack of resources which is the primary impedement to the utilization of cos- mopolitan health care facilities, when these are available. The limited access to resources and the inferior quality of cosmopolitan health care services available to the people of FatiHa and other rural dwel is explainable in terms of their status as peasants who are the mainstay of the national economy and who reap minimal compensation for their efforts from a hierarchially differentiated authority structure. In addition to the major obstacle of expense, limited utilization of government health care clinics may be attributed to time loss. Hours may be spent waiting to see a physician. Contrary to the flexible schedule of indigenous healers who may be disturbed at any time of the day or night, peasants are expected to report to the clinic during its working hours, which coincide with their own working hours. Moreover, the time expended in going to the health care center is not always re- warded with a meeting with a physician. A general problem recognized throughout rural Egypt is that of chronic abseentism among health care unit physicians who go back to the city for business (private) or 407 pleasure and leave their posts unattended for emergency or even for regularly scheduled work hours (Ibid). Additionally, peasants who fre- quent the public health facilities complain of maltreatment at the hands of medical personnel. In this regard a female informant noted that it is all right for her to go to the clinic but that she would rather pay for her husband to go to a private physician "to perserve his dignity". The problems which the people of FatiHa encounter in their utiliza- tion of government sponsored health care services is typical of other rural areas. In his study of rural development in Egypt, James Mayfield (1974: 82,83) writes, After careful analysis of some 250 interviews with officials, fellahin, and private citizens, I have come to the conclusion that the vast majority of the combined units, social centers, and other government-sponsored rural development programs - in terms of effectiveness, ability to stimulate change, and success in generating enthusiasm and commitment to the goals of development - have largely failed to reach their projected aims. This rather harsh statement is substantiated by several Egyptian sources who have objectively analyzed the rural pro- grams presently functioning in Egypt. Thus, most of the evaluation teams...generally reached the same conclusion as AHmad Tawfiq who laments over the fact that the 'combined unit, which is the center of all government services for the villagers, rarely has any peasants in it for they never go there unless it is absolutely necessary'...It is apparent that out of more than 5,000 villagers in Egypt, less than 2,000 have some form of medical service available within their borders - the one service that is the most easily accepted by the fellahin. A number of obstacles mitigate against the utilization of even these limited available services. Note has already been made of the waste of valuable time and the expenditure of limited funds. Additionally, it is significant to note that, unlike the case of indigenous practitioners where the knowledge gap between them and lay persons in the village is limited, this is not the case for physicians and villagers. The power 408 differential which results from such a gap, and which is compounded by the physician's identity as a member of the urban elite, is exploited by the physician and his assistants who overtly redicule the "ignorance of the peasants". The limited availability of health care facilities in the rural areas of Egypt noted by Mayfield is understandable in view of the power relations between the dominant urban sector and the subservient rural domain. Investment in the rural camp is made only to the extent that it helps reproduce the peasants as peasants, i.e., as subservient pro- ducers of primary commodities deemed necessary by the state which determines national priorities. In sum, medical care strategy is dependent, not simply on conceptual consonence or its absence, but must also be understood in terms of the social organization of the community and the power relations between its members. Additionally, the social status of the peasant and the constraining function of this identity must also be considered. Con- trary to popular explanations, it is not peasants' "ignorance" of the benefits of cosmopolitan medicine which limits their utilization of modern health care facilities. Medical care for the peasants of FatiHa, like the rural inhabitants of other parts of Egypt cannot be divorced from the sociopolitical superordinate power relations which direct every facet of their lives. One must consider elements of social organization beyond those associated with the village itself and turn to what Jensen has termed the macro-level of analysis of medical systems (Jensen 1976). The peasants of FatiHa do not live an isolated, independent existence; they are part of a stratified sociopolitical entity. Their subservient 409 power status within the nation state mitigates against independent planning of their lives in their own best interest but leaves them subject to the imposed planning and priorities of the ruling power elite. 410 CHAPTER 6 NOTES le.g. massaging with camphor oil or castor oil for joint pains including rheumatism. 2e.g., "light eating" for fever, eating mint, watercress for heartburn, drinking extracts of cumin for intestinal disorders, consumption of honey and milk for weakness, lemonade guava leaves tea, and extracts of gum arabic for coughs, ingesting sukar nabat (crystalline sugar) and Kabrit (sulphur) for jaundice, drifikifig coca-cola for indigestion, as well as the consumption of water in which fava beans have been soaked in TaSiT ll Tarba (the pan of fright) to cure fright (Tarba). 3There is no specific term which the villagers use in reference to indigenous healers. They simply refer to them.by their names preceeded by the title Shikh (an honourific title) and specify the curing pro- cedure which they practice. 4The name of the mother and not that of the father is used in the pro- cess of diagnosis. It is said that the mother is more maDmuna (certain) whereas the father may be anyone. 5The most famous practitioners of Tib rawHani are located in the larger cities of Egypt. Some of them even advertise their services in national newspapers. 6In attempting to examine how the indigenous practitioners of $32.32!? Hani who reside in the larger provincial towns differ from those who inhabit the village and its immediate vicinity, the author interviewed some of the practitioners of Tip_rawHani in the religious center of Disuk. Through these interviews and the observation of these healers with some of their patients, it was evident that one cannot discern any special qualifications or practices which are unique to these town healers except their fame, especially in terms of their association with a major religious center. Their recruitment to the healing role did not differ from that described for the village indigenous healers who practice Tip rawHani and only one impressed the author with his more abundant knowledge of the Quran. 7In describing to the author what these awliva are, the shikh said, "These are people like the Sidi Ibrahim e1 Disuki and Sidi Ahmad il Badawi. They are good people, they are descendents of the Prophet MuHammad. They gathered together and divided their karamat (baraka or power of good fortune) on different parts of the world. They roam 411 their individual corners of the earth on Monday and Friday. Each has a khadim (servant) who has known his tariga (path, i.e., religious teach- ings) and these khudam (servants) are themselves filled with baraka... The awli a (saints) and their khudam reside in the shrines (e.g., at the rel g ous centres of Sidi Ibrahim in Disuk, Sidi El-Sayid in TanTa, and Sidi Mursi Abu il 'abass in Alexandria) and from there they roam the world on Mondays and Fridays. The sir (secret, i.e., baraka) of the different awli a is diffuse throughSfii'the sphere of inTIuence of each wali (saint). For example, if you have an illness and I make a nadr (vow) to Sidi Ibrahim, if for example my nadr is a duck, I send out a duck during the mulid of Sidi Ibrahim. The darawish (dervishes) at the shrine of Sidi Ibrahim are khudam to Sidi IbraHim...They include men and women. The women are not ififiibited; they join the zikr, just like the men do and they sleep in the midst of men during the mulid. I am a follower of Sidi Ibrahim. In order to be a follower, one has to pray and have a special devotion to Sidi Ibrahim. When I went to Cairo, I met shikh Abu i1 Magd il Shahawi who is a descendant of Shikh Ibrahim il Desuki and he registered me as a follower of the tari a 11 Burhamdya (he showed the author his I.D. card with his picture, which indicated that he is an official follower of the Shikh Ibrahim II Disuki)". 8It is interesting to note that indigenous practitioners refer sick persons not only to other indigenous practitioners but also to physi- cians. 9One of the well publicized ceremonies in the anthropological litera- ture on indigenous medical practices in the Middle East is the 223. (literally, visit, i.e., visit by supernatural beings). During the course of field work the author had the opportunity to observe several za£_ sessions in the nearby village and the religious centre of Disuk. (No public zar was held in FatiHa). The following observations were recorded following the attendance of a zar in the first week of field work: we entered a peasant house of three rooms. Each of the three rooms were packed with people. Two rooms were packed with people taking part in the zar. The third room.was filled with people who had accompanied some of tHe-participants. F. (the author's companion) paid her five piasters and when the author was asked if she would participate, following F.'s advise, she said that she would be just a listener (sami‘a). Towards the far end of one of the rooms stood a group of two men and a woman who sung, played the drum, and a flute. The shikh, who supervises the zar and also acts as a diagnostician when needed, started to sing the different tari as and the men and women's bodies (segregated in the two separate rooms swayed with the music. Their appearance reminded the author of MSU students dancing at the local taverns on Saturday nights. The author sat next to the women's room but had a clear view of the men's room. Next to the author sat a young woman of about 25 years of age accompanied by her mother-in-law. She had her head tied with a woolen scarf and was holding her head and complained of a headache. When asked about the cause of the young woman's illness, the mother-in-law responded 412 that she had been ill for a month. She said that her daughter-in-law has been complaining of headaches and she wants to remain in the bedding and does not want to do any work. When the author jokingly said, "are you a good mother-in-law, I hope you are not the reason for her illness", she responded, "Of course not, I care for her more than her own mother, after all she helps me when she is well, doesn't she?" She went on to say how they had taken the daughter-in-law to the doctor and said that in the beginning they did not know that she has assyad with her. The mother- in-law explained that the doctor does not understand these types of ill- nesses (supernaturally caused) and that the doctor's cure makes things worse. She said, "the more of those pills he gave her the worse she felt." Another woman sitting by said that she gets very violent pains every time she has her period. She said that she too has been to the doctor whom she said didn't know the real cause of her illness and gave her only some vitamins. When some of the people in the audience were asked how the shikh diag- noses and heals their illness, one woman responded that he himself (the shikh) is affected by assyad and that he is in touch with the supernatural through his reading of the Kuran. She identified the shikh's dual role of diagnostician and healer. She did not attribute any power to him as a person; but noted that he is simply a mediator between her and the assyad. She viewed the function of the shikh to be that of making the wishes of the assyad known to human beings who do not have the capacity to see them or hear them. Like the others interviewed during this en- counter, she said that she too had been to a doctor before comdng to the shikh and suffered increased pains and discomforts from taking the doctor's medicine. The shikh moved out of the women's room to give them a rest and went to that of the men who duplicated the women's performance. As far as the number of participants, male vs. female, who were in attendance, it was evident that the men's room was definitely larger than the women's and was at least as crowded. Men's gestures during their dance and state of semiconsciousness did not differ in any way from that of the women. In the "waiting room", the author interviewed a male patient who complained of abdominal pains and stiffening of his body. He said that he had been coming to the shikh and had already had a SulHa (con- ciliation) but the assyad started making him sick again. 10The HaDra is another word used to refer to the zar. It denotes the arena where the possessing spirits of the ma‘zfira_?eveal their presence when the sick person goes into a trance after having reached a heightened state of excitement which is induced by the drumming and other musical instruments which are used to accompany the singing of the different tari as which represent supernatural spirits from the shrines of the awli a (saints). 11Not only do practitioners resemble lay persons in their knowledge of the symptomatology of illness, but, with the exception of literate prac- titioners, the rawHaniya resemble other peasants in their social and 413 economic characteristics. None of the village medical practitioners are full time specialists. With the exception of one, who is the school master of the kutab (a traditional school for Quranic instructions), they are all peasants who till the land. The amount of land they own is typical of the majority of peasants in the village. The male prac- titioners are married and have children. The female rawHaniya are all widowed. One of them explained that their status as Widowed women is probably coincidental but she remarked that when a woman is younger, she is more occupied with her young children and if men come to her house (to be diagnosed for illness), people may talk. Another female practi- tioner remarked that when a woman gets older she becomes more mature (rasya, i.e., settled or more reflective on her actions), "like a man". 12 It is important to note that spiritual healers and sorcerers are not themselves the locus of supernatural power. Instead, they perceive them- selves and are perceived by others as mediators between supernatural and human life. The most prestigous channel of such mediation is religious learning. 13The rawHani a themselves do not claim any specific body of knowledge about the functioning of the body. When a rawHaniya was questioned about the function of the human body, he responded, "I do not know anything about these things, I only know about maraD rawHaniya (supernatural ill- nesses). This (knowledge of the functions of the human body) is the work of the doctor. The doctor does not know the symbols of the rosary (a form of divination used by this practitioner in the diagnosis of maraD rawHani a...The doctor recognizes the physical illnesses which come on suddenly. Spiritual illness come on gradually. The person with maraD rawHani does not necessarily become ill right after the assyad come to HIE, that is why people do not remember". 141n the surrounding villages, informants from FatiHa report that the incidence of TB has increased in areas where jasmine and riHan (an aro- matic plant) have been planted. When the physician was consulted about this problem, he noted that he had not made the correlation himself. He explained that one possible association between jasmine and riHan planting and TB may be due to sensitivity or allergy to the strong scent of the flowers which causes irritations in the mucous linings of the chest resulting in lowered resistance to infection in general, including that by the tubercullin bacillus. Informants who are familiar with villages in which the planting of flowers for commercial purposes (export to France for perfume industries) has been intensified over the past few years notethat the picking of flowers is a relatively devalued task which is taken up by women and children who work as wage labourers, and it is among this group of poor landless labourers that they notethe increasing incidence of TB. To encourage the workers to remain on the job, some landlords dispense rations of milk to their labourers on a daily basis. 414 15The pragmatism of village informants in the selection of medical treat- ment is evident in a local proverb whiclltranslates as "illness comes from a mountain and health comes from the eye of a needle". 16As Kunstadter notes, in referring to the "fad" of acupuncture which became popular in the West, roughly simultaneously with President Nixon's visit to Peking, "Surely this has nothing to do with classificatory consonance in our medical culture". 17Among the educated elite of the Nfiddle East who are well acquainted with the germ theory of disease, such cognition, although clearly con— tradictory to the underlying logic of illness causation through witch- craft, does not deter their use of amulets, fumigation, and Quranic verses to repel the potential danger of the witchcraft of the evil eye. 18It is evident that in western society where the utilization of cosmo- politan medical care is high, this occurs in spite of the cognitive gap between physicians and laypersons. In this regard Robinson (op. cit. p. 39-40) notes, "People seeking care and those from.whom they seek it may have divergent and, at times conflicting interests. Some patients may be more concerned with primary symptoms, pain and social incapacitation than with underlying organic diseases. They may be oriented towards a speedy return to normal or minimum social functioning rather than complete physiological health. iMembers of the medical profession, on the other hand, may be likely to concentrate more on clinical illness than on the physical discomforts of its symptoms or its social consequences". 1giMembers of the community with a secondary level or higher level of education often stated at the initial meetings with the author that they do not believe or ever frequent indigenous healers. When the author pressed the point by referring to the psychological relief brought about by such practices, these educated members of the community finally started to reveal their own personal experiences with indigenous rawHani a and even quoted from the Quran to substantiate their belief in e power of sorcerers. 2OClearly, power relations are not the only factors which influence the legitimation of illness. One may refer to other elements such as type of behavioural and physical manifestations of illness, the degree of functional incapacitation, or the timing of the claim to illness. An illustration of the operation of the last variable in FatiHa would be the reluctance to grant legitimacy to claims of illness at times of heavy agricultural work, e.g., planting and harvesting. Additionally, one may note that in evaluating the significance of reported symptoms in a given person, consideration of his/her age, his/her gender, are also evident. Thus, an older person complaining of weakness is not considered ill, but simply "showing his/her age". Similarly tiredness among junior women, including sons' wives is not necessarily considered a sign of 415 illness. It is a fact of life for young adults who work in the fields. But to the extent that the interest of this study focuses on power rela- tions and their affect on illness behaviour, emphasis is placed on this variable with the recognition that the condition of illness is pre- cipitated by a variety of influences and that illness behaviour is also subject to multifactorial socially significant stimuli. 21This is not unlike another situation of power differential involving management and workers in industrial settings where the powerful members of the management class are easily granted social validation for their unsubstantiated claims of illness while members of the working class are required to produce professional validation for their claims, although as relatively powerless members of a stratified community, the members of the latter groups are more susceptible to stress and symptomatic ill- ness (Cf. Ryan 1976). SUMMARY AND CONCLUSION Theoretical formulations in Anthropology are affected by the cultural milieux in which they are constructed and the social identities of those who propagate them. The anthropological enterprise surpasses the self- imposed and unrealistic claim of total abjectivity and assertions of studying what occurs and explaining it (Hymes 1974:14). Exemplary of the dialogue between Science and Society is the recent change in the study of women's roles under the stimulus of the women's Movement. In Chapter 1 of this study several examples were noted to indicate the dis- tortion which derives from according the "male factor" central signifi- cance and regarding the "female factor" as subordinate and insignificant. Recent reinterpretations of women's roles and the presentation of new data on women's activities, usually undertaken by female anthropologists, have challenged traditional analytical categories and generalizations about gender roles. But whether undertaken by male or female anthro- pologists, theoretical analyses of the world are not immune from the effects of the social identities of those who undertake such interpre- tations. Theoretical progress, as evident by recent studies of gender roles, rests, not on the denial of anthropologists' social identities and ideologies, but on comparison and reconsideration of these culturally conditioned theoretical interpretations of reality. It is not only the social identity of the anthropologist which influences the issues which he/she defines as the object of study, but one may also note the characteristics of the culture in which anthro- pological research is undertaken as being significant in this regard. 416 417 In Middle Eastern socieites, for example, where women are not likely to be accessible as informants to males who are foreign to their com- munities, long term participant observation and recording of women's behaviour by male anthropologists would not be a realistic endeavor. In light of this limitation, female anthropologists have the opportunity to make unique contributions towards understanding women's roles in Nfiddle Eastern communities. Their privileged access to female spheres of activities will undoubtedly enrich the improverished substantive and theoretical literature on gender roles in the Middle\East. As illustrated in Chapter 1, the recent literature on gender roles indicates methodological/theoretical developments whichhave set the stage for reorienting the study of Man towards the study of Humankind. However, interpretive barriers continue to influence the analysis of gender roles. Universalistic explanatory schemes partaking of what Karen Sacks has termed the "state bias", along with a tendency towards emphasis of individual goals and actions and individual competitions for power, continue to appear in the anthropological literature on gender roles. A critique of these explanatory modes has been presented in Chapter 1. Their limitation was defined in terms of their lack of historical perspective, their tendency to undermine the differentia- tion of human societies according to structural types, and their prone- ness to equate role differentiation in primitive socities with the sub- ordination of one gender to the authority of the other, which is typi— cal of state societies. The underlying basis of the assumed universality of male dominance emphasized in some studies of gender roles is the contention that 418 "woman's maternal roles lead to a universal opposition between 'dqmestic' and 'public' roles that is necessarily asymmetrical; women confined to the domestic sphere, do not have access to the sort of authority, pres- tige, and cultural value that are the prerogative of men" (Rosaldo and Lamphere l974z8). The validity of the assumed universal existence of distinct public and private spheres which assign men and women to dif- ferent power realms has been undermined by ethnohistorical studies and studies of contemporary Middle Eastern societies. For the village of FatiHa, the setting of the present study, this presumed universal dichotomy and its attendant power differentials is equally invalid. In Chapter 3 note was made of the insignificance of the alleged opposi- tion between a private, domestic and a public, extra-familial, political sphere in FatiHa. In the study community political concerns are anything but extra-familial and it is not women's association with the private sphere (in the few cases of those who can afford it) which limits their public political participation. In general, political participation in this peasant community is limited for both_men and women. Males of limited means do not participat in public political contests. By contrast, the educated female clerk of the agricultural cooperative is an "active member" (zugwauigmgya) of the Arab Socialist Union. Male and female villagers are well aware of their relative powerlessness vis—a-vis ex- ternal political control. Such control rests with urban elites whose patronage is actively sought by the local inhabitants (male and female) in their pursuit of personal goals. As in the case of the Lebanese urban proletariat studied by Joseph and cited in Chapter 1, for the men of FatiHa, their mere participation 419 in public activities does not confer upon them power over women. Con- versely, the confinement of women to the domestic sphere (which the pro- ponents of the above noted universalistic scheme contend is the basis for women's lack of access to authority) cannot be realistically defined as the basis of their relative powerlessness. In fact, the rise of women's power in the family occurs at a stage of its developmental cycle where a woman becomes the mother of married sons, a stage which is correlated with the increased confinement of her activities to the domestic sphere. In questioning the universality of the private-public dichotomy in Chapter 1, examples were provided to show that the opposition between public and private domains and their hierarchical differentiation is truly meaningless for non-state collectivities. The study of gender roles in FatiHa shows that this alleged universal opposition is also not applicable for certain spheres of state level societies. The in- significance of the public-private dichotomy for relations between men and women in the village of FatiHa is illuminated once we consider their status as peasants. As was pointed out in Chapter 3, the power of the ruling elite in the study area derives from control exercised by the state and its benefactors over the immediate producers in Egyptian society, the Egyptian peasants, including those of the study community. The males of FatiHa are not partners to this control. It is the private interests of ascendant social groups, crystallized in the public appa- ratus of the state, that are opposed to the common interests of subju- gated men and women of the peasantry. In pursuing our enumeration of recent trends in the study of gender roles in Chapter 1, we emphasized the differentiation between power 420 and authority and their association with females and males, respectively, in some studies of gender roles. This differentiation follows logi- cally from th rivate-public opposition noted above. Through the exten— sion of thepresumed universal opposition between the private and public domains, prior descriptions of male dominance have been reformulated in terms of the distinction between power and authority, i.e., between what has been defined as "the ability to gain compliance and the recogni: tion that itis right", respectively. Thus, women are recognized as subject to male dominance but are said to counter male authority through the informal manipulation of their social environment and the exercise of choice. In pointing to the limitation of this alleged universal opposition in Chapter 1, the need for isolating structural principles which allow fhi the exercise of power and choice was emphasized. It was also remarked that according primary emphasis to women's individual manipulative behaviour and competition for power poses serious limita— tions to the comparative study of power relations even within a single society, not to mention cross-cultural comparisons. By framing male/ female power relations in purely relativistic or individualistic terms, we have no basis for comparing one situation of power differential with another. In the above noted differentiation between power and authority, women are believed to wield informal power while males are presumed to exercise formal, legitimate authority. But if the exercise of this in- formal type of manipulation follows a regular pattern, it should be recognized as an element of social life and its power correlates should be explicitly defined. This is particularly important in view of the 421 fact that the exercise of such informal manipulations is not equally available to all women nor at all phases of their life cycle. If the informal power of women is subject to patterned variation, then it must be recognized as an aspect of the dynamics of power relations. But if the Variability is sporadic and inconsistent, then it has no place in a nomothetic statement about the character of social life. The critical aspect of the exercise of power by men or women, as viewed in this study, follows from Adams' formulation (Adams 1967, 1975). Accordingly, power (defined as the "control one party exercises over the environment of another" (Adams l967:32)) is available to both parties in any social relationship. Even in extreme cases of subordination, the sub- ordinate party holds some threat to the environment of the superordinate party. The crucial feature of the exercise of power is control over power bases which are accorded cultural recognition. According to Adams, authority is described, not in terms of legitimacy, but as "a quality ascribed to the exercise of power, the basis of which entails control over culturally defined parts of the meaningful environment of others" (Adams 1975:24). In FatiHa, the exercise of power by men or women, in the "private" or "public" sphere rests on such control. For the few persons in FatiHa who participate in public political contests or who are affiliated with the local chapter of the national political party, such engagements are extensions of their power base in the village. For the male villagers who are so involved, their power base is identified in the control over land. In the case of the female member of the ASU, her education is the significant resource on which her power in the com- munity rests. Finally, in the case of the descendants of the former 422 Turkish elite, their power in the village rests on their descent (aSl), which, when translated into concrete power indices, means access to com- munication channels through kinship ties and incurred obligations. Guided by Adams' above noted definition and conceptualization of power, an analysis of gender roles and power relations in the village of FatiHa was undertaken in Chapter 3. Generally, one may characterize the social life of the village of FatiHa as male dominated. Men have preferential control over culturally valued power bases. In attempting to explain this asymmetry, attention was devoted to an examination of the village economy and the social relations of production. In brief, it was pointed out that while gender role ascriptions related to the technical relations of production are subject to minimal differentiation, control over valued instruments of production and the products of agricul— tural labour is vested in males. It is such control which is deemed the basis of male-female power asymmetry in the village. Since the family in FatiHa constitutes the framework of production relations and gender role differentiation as well, the developmental cycle of the family is utilized as a framework for the descriptions of gender role differentia- tion, relations of production, and their consequences for power relations between and_amgng, men and women. This focus on the developmental cycle of the family illuminates the dynamics of male-female power relation. In this regard, the limitation of equating authority with legitimacy is brought to light. It is evident that the patterned, generalized authority of mothers-in-law in extended family households rests on performance, or the actual exercise of power, rather than legitimacy per se. The primacy of authority (the exercise of power through control 423 of culturally valued power bases) is also evident in cases of the breakup of the extended family upon the death of the senior male. While, accord- ing to custom, married sons are obligated to honour their mother, and while a mother may legitimately demand that her adult sons attend to her need and comfort until her death, a woman succeeds in keeping the extended family intact after her husband's death and continues to enjoy the prestigeous status of senior female if she owns property of her own. This may encourage her sons to remain as part of an extended pro- ductive unit. Alternatively, her sons may demand their share of their father's property. This brings about the fragmentation of the family property, and with it, the power base of the mother-in-law. In short, legitimacy does not substitute for a durable power base upon which an older female can rely to play an authoritative role. Further assessment of gender status in the village of FatiHa (in Chapter 3) included an examination of the differential valuation of male and female children, the differential degree of autonomy and decision making power, and identification of superstructural elements of village social life which reveal ideas and beliefs about males' and females' physical and mental attributes, which legitimize the power asymmetry related to gender identity. Beliefs regarding the human body, its forma- tion,structure, and functions were also found to allude to the relative powers of males and females in village social life. From villagers' accounts of the human body detailed in Chapter 4 it is noted that asym— metrical power relations between males and females are given symbolic expression in people's belief in the more determinate role of male semen in influencing the character of the unborn child and the faster development 424 of the male foetus. The greater significance attributed to male semen in the process of conception reflects informants' belief in male super- iority and their conception of the social differentiation between males and females as natural. Their assertion that male-female differences exist at the pre-natal stage indicates their justification of existing social differentiation related to gender. iMen's right to almost un- interrupted access to their wives' sexual services, including the period of pregnancy, indicates (and is recognized by villagers themselves) men's power over women. Further exploration of villagers beliefs about the human body in Chapter 4 indicates the great obsession of women with fertility and their almost complete rejection of modern birth control methods. These facts indicate the tremendous valuation of children and point to parenthood as a culturally valued power base. Additionally, the assignment of blame for the birth of females, or for childlessness, to women, in contradic- tion to villagers' assigned importance to male semen in the process of conception, is exemplary of "blaming the victim" rationalizations typical of asymmetrical power relations. Differential valuation of male and female infants, translated into asymmetrical power relations between males and females at a later stage of the life cycle, is indicated in villagers' beliefs regarding the relatively deleterious effect of the female foetus on the mother's health. Mbreover, the belief that post-partum discomfort and bleeding are greater after the birth of a girl, like the solemn reaction of the occasion of such birth, is also indicative of the differential valuations of male and female children - the basis of power asymmetry in adult 425 life. Other indices of power differentials described in Chapter 4 include villagers' emphasis on superior physical strength of males. This belief is cited as a rationalization for male domination of women. Indications of power differentials are also found in the discriminating allocation of food which is regarded as necessary for the maintenance of good health. Preferential treatment of sons in food distribution indicates mothers' banking strategies which maximize their chances of better treatment at the hands of sons in their old age. The different rationalizations for the practice of circumcision on males and females reflect villagers' ideology of female impulsiveness in sexual behaviour. Additionally, the cultural practice of using stimulants for the maintenance of a healthy disposition by males, and its relative restriction for females, also reflects the belief in males' greater ability of self control. Finally, even in death, which is regarded as the "ripening" of the body and the termination of its viability by Divine Will, a person's misfortune of not having a son (a culturally valued power base) is lamented by mourners. In terminating our discussion of gender as a dependent variable, we may conclude, on the basis of data presented in Chapters 3 and 4 that although male-female power relations are subject to patterned variation related to the developmental cycle of the family, in general, the village of FatiHa may be described as male dominated. Rather than regarding the various indices of male dominance described in the above noted chap- ters as supportive of the alleged universality of male dominance, the contention is made in Chapter 3 that the pattern of male-female power relations described for the study community is representative of a 426 specific structural type, namely peasant society. The distinguishing elements of the relations of production of village society and the social formation of which it partakes is contrasted with nonexploitative social formations where the differences between males and females are not socially converted into inequalities. In the treatment of gender identity as an independent variable in Part III of the study, the main focus is on the village medical system. The analysis of the consequences of gender identity for the experience and response to illness is guided by a theoretical perspective developed in Chapter 2. Briefly, Chapter 2 provides a review of the general anthro- pological and Middle Eastern literature on the topic of gender roles and illness. It indicates the present study's reliance on a stress model of illness butpoints to the limitations of studies based on that model, which define stressfulness as an attribute of women's roles and describe ill- ness as a form of culturally sanctioned deviant behaviour which is func- tional. In pointing to the limitations of this explanatory mode, it is noted that it suffers from drawbacks typical of the structural-functional framework by focusing on female roles and defining the illness role as functional for the maintenance of the social system, without attempting to explain why some roles are more stressful than others in the first place. This mode of explanation does not extend serious considerations to the structural constraints, to the objective social conditions, the structural bases, the asymmetrical power relations which underly conditions of stressfulness and which are attributes of female roles. Consequently, the model, by taking femalg_rglg_as its central explanatory element, cannot adequately account for variations among women, all of whom.clearly 427 share the "female role". Not only does this perspective obscure struc- tural elements which affect some women and not others, and which some women also share with men in subservient positions of relative powerless- ness, but it also ignores the dynamics of female role within groups of women. In short, the concern with women's social roles is believed to have led to a neglect of societal constraints and power relations which are stressful for women and_men. The theoretical perspective which guides the analysis of the relation between gender identity and illness in the present study, rather than focusing on social roles as such, extends primary consideration to the larger system in which the elements of social role operate, notably the elements of power relations. Accordingly, stress itself is defined in terms of asymmetrical power relations, in terms of the inability to influence one's environment to one's own benefit (Ryan 1976), i.e., in terms of relativepowerlessness. Since relative powerlessness is not an attribute which is exclusive to female status, stress among women, and_ among men is defined, not in terms of gender role, but in terms of the elements of powerlessness which operate and affect men and women in dif- ferent social contexts. Additionally, the theoretical perspective which guides this study regards the sick role as a mechanism which ensures the maintenance of prescribed social roles, their attendant asymmetrical power relations, and stressfulness. The sick role is regarded as an instrument of social control which is selectively assigned to symptomatic persons to mediate inherent contradictions in social life. It regards definitions of illness, which are cultural prescriptions for controlled deviance (Parsons, op. cit.) as superstructural elements bearing a dialectical 428 relation to infrastructural contradictions and attendant power differen- tials. In the context of the present study, it is not gender role per se which is assumed to be stressful and to precipitate illness. The ems phasis is on stressful situations (defined in terms of power differen- tials), which are related to gender roles. Since stressful situations are not unique to women, one may expect stressfulness to precipitate ill- ness in men. Moreover, subgroups of women may be expected to vary in the experiencing of stressful situations. Indeed, some stages of the life cycle and the developmental cycle of the family expose individuals to variable types and degrees of stress. Furthermore, one may expect some women to approximate the expected role behaviour (which is a source of power) more than others, with deviants representing the most extreme cases of role conflict and powerlessness. The same is expected to hold true for men. Hence, we may expect variation in the frequency of illness amgng_women (and among men) as well as between women and men. Validation of the assumption that higher frequency of illness among women results from stress should involve, not only a demonstration of higher frequency of illness (or perceived stress) among females than males (this would be a restatement of the proposition), but more fundamentally, it should show that a higher frequency of illness should occur among women (and men) who are identified as being under greater stress than their co- horts. Finally, it should be noted that just as concentration on gender roles obscures the bases of male-female power relations, it also obscures the bases of stress associated with those roles. To explain gender roles or stress associated with them, one must move, conceptually, outside the 429 analytic boundaries of roles themselves to consider the structural ele- ments which maintain these roles. In applying the theoretical perspective noted above to the study of illness in the village of FatiHa, it was deemed necessary to obtain an understanding of the village medical system as a whole in order to under— stand villagers' conceptualizations of illness and their response to it. In Chapter 4 this task was initiated through an examination of local ideas and beliefs about the human body, which form the basis of villagers' views about illness. The people of FatiHa, while regarding their body as a complex system of differentiated parts, attribute general functions to only a few named body structures. The body is generally regarded as a complex structure of which villagers have only limited knowledge. As in the case of other Middle Eastern societies (Shiloh 1962), the working of the internal body is the least elaborated area of the medical system. Among the villagers of FatiHa, the body is regarded primarily as the seat for crystallization of external social events which affect the individual. Bodily changes associated with illness are not described simply as disruptions in the functioning of specific body parts, but in terms of meaningful social events. The body is not only regarded as a physical structure, but more importantly, as an individual centered depository which mirrors social events that transcend the individual's physical being. Physical symptoms of illness are significant only to the extent that they are associated with psychological and social symp- toms which indicate departure from culturally defined normal states of health. According to this logic, illness diagnosis and treatment are applied to the socially significant elements of the afflicted person's 430 identity rather than aiming to deal with the functioning of specific body parts. In sum, an illness occurrence is the concrete expression of a socially significant episode which is experienced by a person and re- flected on his/her body. In our discussion of body-environment interaction in Chapter 4, it is remarked that just as the body is believed to be affected by the natural environment and social interactions, it is also believed that bodily substances have a reciprocal effect on the natural and social environment. In our description of villagers' beliefs about the effect of body secretions on culturally significant events in Chapter 4, atten- tion is devoted to the topic of female ritual pollution. Post-partum rituals, which have often been regarded by male anthropologists as indica— tive of females' devalued status, are considered as cultural elaborations designed to help restore a woman's normal state of health. In fact, the implementation of the ideal of female menstrual/post-partum confinement is found associated with relatively high socioeconomic status. The enforce- ment of confinement rituals is considered a status symbol, an index of women's culturally specific valuation rather than their inferiority. Continued exploration of the village medical system is pursued in Chapter 5 which provides an account of village medical theory and an in depth analysis of the culture bound illness of 1323 (a local variant of spirit possession), linking its occurrence to power relations and gender identity. Our examination of village medical theory shows that the people of FatiHa have various explanations of illness. It is evident that causation is accorded primary significance in the process of ill- ness diagnosis. Symptoms of illness and its severity are important 431 as manifestations of the operation of causal factors. Of minimum sig- nificance as diagnostic indices are the physical/anatomical processes associated with illness, i.e., the pathology of illness. The concept of levels of causation is deemed useful for ordering multi-causal expla- nations implicated in an illness episode. In dealing with illness causation in the village at the most general level, illness is described in terms of supernatural power. However, more immediate causes are shown to be recognized by the people of FatiHa. Generally, the ultimate determinant of health and illness in villagers' wordly environment is defined in terms of social interpersonal rela- tions. As the people of FatiHa regard their individual lives and physi- cal well being as inextricable from their social context, they also define illness, which is manifested in individual behaviour, as an out- come of social relations. This is not to say that illness is explained solely in terms of social interactions, but explanations of illness ulti- mately lead to the social environment of the sick person. In dealing with natural causation, villagers clearly follow a prospective path to diag- nosis. In cases of supernatural causation, on the other hand, diagnosis is always retrospective. When illness symptoms manifest themselves, the are traced to significant episodes of emotional distress and/or impair- ment of social relations which may have occurred at an earlier time period. In our discussion of the specificity of illness explanations in Chapter 5, it is noted that while information obtained from survey data informs us of the underlying logic of villagers' medical taxonomy, it does not adequately reflect the actual use to which that taxonomy is put in specific illness cases. During survey interviews informants 432 generally cited one cause for their illness. Extended case studies, on the other hand, demonstrated the variability of illness explanations and illuminated multiple levels of illness causation. Through our discussion of the specific illness episodes in Chapter 5, the specificity of ill- ness explanations is revealed. Moreover, it is noted that the granting of legitimacy of the sick role to symptomatic persons is subject to nego- tiations which are influenced by the symptomatic person's social identity and power relations vis-a-vis significant others. In dealing with illness explanations in Chapter 5, a description of some culture-bound illnesses is undertaken and their critical diagnostic indices are noted. Special attention is devoted to the culture-bound illness of :32; and extended case studies of this illness are analyzed. These analyses link illness causation to the dialectics of social life, particularly in terms of power relations and gender roles. In noting the multiple levels of causation associated with reported and observed cases of :uzr, interpersonal relations, including those associated with powerlessness, and those involving deviation from.oulturally valued be- haviour, are identified as ultimate causes of the affliction. In presenting cases of :uzr_in Chapter 5, the telescoping of explana- tions of illness is noted and the legitimization of deviance through the social granting of the illness label is shown. Therapeutic strategies associated with the illness are regarded as a means of controlling it, not eliminating it altogether. Indeed, from an etic perspective, the persistence of the illness is consistent with the relative stability of the structural power relations with which it is associated. Case studies of ‘uzr (excuse) detailed in Chapter 5 show that, as 433 its very name suggests, the illness of 1223 is a legitimated form of deviance. The compensatory value of the illness role is evident. It is clear that the legitimized illness role mediates asymmetrical power relations and allows dispensation from expected role behaviour. However, discussion of the compensatory value of the sick role concludes that the social sanction which allows temporary transgression of socially defined role behaviour and/or positions of relative powerlessness, is itself subject to structural constraints related to the social identity of the symptomatic person. Additionally, it is noted thattthe sick role, like other manipulative strategies adopted by the powerless, when attain- able, brings about only a temporary enhancement of social position. It is not a stable, culturally valued power base which can induce per- manent modification. Finally, on the basis of extended case studies presented in Chapter 5, it is hypothesized that touch by supernatural beings (_l_at_n_s§_ M), resulting in the illness of 13.23, is a significant etiological category among both males and females who occupy a subor- dinate social role, which may change in a lifetime. According to this postulate, the frequency of’:££3_among women, as among men, may be expected to vary in relation to different stages of the life cycle and the develop- mental cycle of the family. Thus, :223_would be less likely to affect women in the dominant role of mother-in-law, for example, nor men who occupy the dominant status of older brother in a fraternal joint family household. Data recorded in Chapter 5 of this study lend support to this hypothesis. Further exploration of the village medical system is pursued in Chapter 6 which provides an account of villagers' methods of coping with 434 illness. In reference to the variety of preventive measures employed by the villagers of FatiHa, it is remarked that these reveal.the differential valuation of persons to whom they are administered and the significance of the events with which they are associated. Beyond pre- vention of illness, the villagers of FatiHa avail themselves of a variety of forms of treatment of both the indigenous and cosmopolitan variety. In noting these different forms of treatment, attention is extended to the social characteristics of indigenous medical practitioners and the type of medical knowledge on which the performance of their curative roles rests. Structured interviews designed to compare shared knowledge about illness among indigenous practitioners of spiritual medicine (rawHaniya) and lay persons indicate that the rawHaniya do not deal with illness through the reliance on specialized, exclusive knowledge. Their power is derived primarily from their culturally valued control over elements of the supernatural environment. This lends authority to their diagnosis of illness. The exercise of their diagnostic role is contingent upon their familiarity with local culture. Finally, the administration of Shweder's cognitive capacity test shows the rawHaniya's greater capacity to impose order on ill-defined situations. This characteristic is consistent with their expected role of imposing explanations when confronted with the confusion of illness and its associated deviant behaviour. Extended case studies indicate that selection of medical treatment is situationally determined and is not predictable from information about village medical taxonomy. Differential utilization of indigenous forms of treatment are utilized when access to physicians' services is blocked for financial reasons, or when treatment by physicians fails to 435 bring about a noticeable improvement. Generally, choice of treatment rests on the immediate requirements of cure rather than on the conceptual compatibility of logical categories underlying different forms of treat- ment. In fact, the physicians' services are the first choice of villagers, in spite of the obvious fact that the peasants have not internalized the theoretical assumptions underlying cosmopolitan medical treatment. The examination of bases of choice of medical treatment in FatiHa reveals the operations of various factors which include the progression of illness and its response to certain forms of treatment, the nature of interpersonal relations between the sick person and the medical practitioner, the economic requirements of different therapeutic practices, and of particular relevance to the theoretical premises of this study, the social identity of the symptomatic person. It is evident that the rela- tivepower of symptomatic persons influences their access to resources which more powerful persons may or may not choose to expend for medical treatment. Within the family context, a person's identity is significant, not only in determining the form of medical treatment which is extended to him/her, but also for the more fundamental process of extension of social legitimation of the sick role, upon which initiation of treatment is contingent. In terms of the micro-unit of village society, it is evident that villagers of higher SES utilize the services of private physicians more readily than do their less affluent cohorts. Within the family it is evident that the status of the symptomatic person is an important de- terminant of the urgency and form of treatment extended to him/her. The highly valued and expensive services of private physicians are 436 preferentially provided to members of the household whose health receives culturally defined high valuation, notably male household heads. Gener- ally, valued resources are allocated more frequently for the treatment of males than females. However, gender identity is mediated by the dynamics of the developmental cycle of the family. Thus, a woman who enjoys the culturally valued status of mother of adult sons, for ex— ample, is provided more prompt and expensive medical treatment than a young, powerless son's bride, or a male infant occupying the same house- hold. In considering the peasants of FatiHa within the larger context of the encompassing social structure, the significance of their social identity in relation to national priorities for health care is par- ticularly pronounced. Indeed, medical care for the peasants of FatiHa, like their gender roles, cannot be divorced from the sociopolitical superordinate power relations which direct every facet of their lives. The peasants of FatiHa do not live an isolated, independent existence; they are part of a stratified sociopolitical entity, the Egyptian state. Their subservient power status within the nation state precludes inde- pendent planning of their lives in their own best interest and leaves them subject to the imposed planning of health care, and other require- ments of their livelihood, by the ruling power elite. To conclude, a major purpose of this study has been to contribute to the recent trend towards more balanced accounts of gender roles, and, simultaneously, to question some of its theoretical assumptions. Just as recent theoretical insights and substantive treatments of gender roles have underscored the limitations of earlier theoretical traditions, 437 so will these analyses eventually be challenged in light of new data. Nevertheless, anomalies which undermine existing theoretical categories should not detract from their long term contributions to theoretical development. The refinement of theoretical formulations should not be expected to follow a smooth path through the elaboration of prior as— sumptions. 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