© 2012 S.Loue
2012 – № 2 (4)
Key words: shamanism, cultural and situational context of disease, exorcism, healing, ethical problems, vulnerable groups, ritual
Annotation: This presentation focuses on ethical issues arising in the use of shamanic journeys with clients presenting for mental and emotional issues to mental health providers. Ethical issues related to research of shamanism are also explored. One such question is whether shamans should be considered a vulnerable population in the context of research.
Background
Shamans have been described as “the progenitors alike of the physician and the sorcerer, the prophet, the teacher, and the priest” (Dixon, 1908, cited in Charles, p. 95). Indeed, the role of the shaman has frequently been likened to that of the physician, who is charged with the responsibility of diagnosing and treating illness (Peters, 1979), and the psychotherapist who, through a variety of techniques, breaks down the client’s resistance and facilitates the client’s healing (Dobkin de Rios, 2002). It may be more accurate, however, to liken the shaman’s role to that of the social worker who interacts at multiple levels, with the client as an individual and with the larger family, group, and/or community (Beck, 1967). This analogous function is reflected in the observation that shamanism “is primarily concerned with the bringing together in harmony and maximum mutual fulfillment of the person, the society, and the non-human environment” (Canda, 1982, p. 13). Frequently, the shaman—in a role analogous to both the psychotherapist and the social worker—must help his or her client pass through difficult and stressful life transitions, sometimes giving advice, sometimes attempting to modify the client’s behavior (Beck, 1967). In short, the shaman engages in crisis intervention (Canda, 1982).
The shaman must possess keen insight into the cultural and situational context of the illness in order to diagnose and treat it appropriately; just as with a physician, the prescribed treatment must be appropriate to the etiology of the problem (Beck, 1967; Peters, 1979). Depending upon the context, disorders or illnesses are often attributed to spirits, who may possess an individual or cause physical illness (Peters, 1979). Not infrequently, the onset of the illness is concurrent with a conflict between two or more individuals, suggesting that the true cause of the illness is socio-psychological (Beck, 1976; Dobkin de Rios, 2002). Peters (Peters, 1979, p. 32) explained how the shaman must address such situations:
“The shaman’s powers of curing are intimately connected to his knowledge of his client’s social situations. A social analysis always accompanied a major healing ritual. That is, when the shaman became possessed and gave a diagnosis, the more knowledgeable the “possessing spirit” was of the patient’s social relations and troubles, the more impressive he was. The shaman’s divination … was not to determine the future; rather it surveyed the patient’s current problems, often his interpersonal conflicts … So it is obvious that the more in touch with community affairs a shaman is, the more his powers are believed”.
Shamanic practices vary across cultures (Canda, 1982). However, in general, the shaman may provide curative treatment through physical means, such as blowing on parts of the client’s body (Beck, 1967; Canda, 1982; Peters, 1979) or exorcism (Charles, 1953); forms of immunization, such as calling on a particular spirit to protect the client, imposing a particular restriction on the patient, or prescribing a specified mantra for protection (Ackerman, 2001; Beck, 1967); pharmacopeia through the use of leaves, roots, and herbs (Beck, 1967); dream interpretation (Beck, 1967); and surgery (Beck, 1967). The shaman may utilize a drum or chant to facilitate his or her own entrance into a trance, as well as introducing the client to his or her own trance (Beck, 1967; Hyman, 2007; Krippner and Kremer, 2008). In some cultures, the shaman may also use psychoactive substances to facilitate his or her journey into and through other realms of existence. Just as with a mental health professional, the credibility or power of the shaman rests on his or her ability to discern the underlying conflict and to facilitate relief of the situation (Beck, 1967). It may also rest on the shaman’s ability to foster transference; as Lévi-Strauss (1967) noted, the shaman is in essence a symbol onto which the client transfers emotion.
Although some shamans may recognize their limitations and refer individuals with severe physical injuries or incapacitating disorders to modern physicians (Peters, 1979), some do not and may cause severe injury. As an example, Jochelson (Jochelson, 1926, cited in Merchant, 2006, p. 137) related an incident in which a woman died as the result of a ruptured perineum and punctured bladder, following a shaman’s efforts to force the premature delivery of an infant using iron tongs.
Despite their contributions through the effectuation of individual healing and the restoration of harmony and resolution of conflict within families and communities, shamans have not infrequently be subjected to persecution and social sanction. As an example, Glass-Coffin (1999) found in her research in Peru that female shamans are frequently subject to oppression. Shamans in Siberia suffered persecution under the Soviet regime (Bulgakova, 2003; Hangartner, 2010; Leete, 2005), with politicians referring to them as “the restrainers of socialist construction work” and opining that the fight against shamanism represented “one of the spheres of class struggle in the North (Bulgakova, 2003: 132, quoting Suslov, 1932, p. 172). Shamans in Mongolia similarly faced persecution and oppression (Buyandelgeriyn, 2007). Too often, researchers without an understanding of the social and cultural context in which shamans practice have characterized them as suffering from a psychiatric or epileptic disorder (Jiler, 2005. See Beck, 1967, as on example.). In essence, whether intentionally or not, such pronouncements have exploited the shamans participating in these studies through their portrayal as somehow exotic or deviant.
The responsibilities entrusted to shamans and the potential for both benefit and harm to their clients necessarily raise questions relating to their ethical responsibilities in the provision of such services, just as ethical issues would be raised in the context of care provision by a social worker, psychologist, psychiatrist, or physician. One must also address the ethical issues that arise in the conduct of investigations into shamanic practice and the nature of being a shaman. Because shamans have historically been subject to persecution and oppression across diverse societies and era, it is critical to examine whether shamans as a group constitute a vulnerable population in the context of research involving human participants and. If they do, what special protections should be put in place in the conduct of such research. The remainder of this paper addresses these two critical areas.
Ethical Issues Associated with the Provision of Care
Unlike physicians and mental health care providers such as social workers, psychologists, and psychiatrists, there is no licensing or credentialing examination for shamans. How one becomes a shaman appears to vary across cultures, so that some individuals inherit the skill and status from a parent, while others must undergo exhaustive training. Notwithstanding the lack of licensing or credentialing that would be required of a practitioner of Western medicine, there have been increasing and significant efforts by groups of shamans to develop ethical codes to guide their practice. In part, this derives from the need of legitimate shamans to distinguish themselves from charlatans who wish to exploit their familiarity with shamanic practices for their personal aggrandizement and enrichment (Boyle, 2001).
In general, these various codes require that shamanic practitioners demonstrate compassion and respect for themselves and for others and work for good (Foundation for Shamanic Studies, 2008; International Society of Shamanic Practitioners, n.d.; Mokelke, 2008; Union of Yagé Healers of the Colombian Amazon, 2000). Some of these codes and writings also enunciate the need to:
- obtain informed consent of the client(s) prior to performing shamanic healing or divination (Mokelke, 2008);
- maintain client confidentiality and privacy (International Society of Shamanic Practitioners, n.d.; Mokelke, 2008);
- confine one’s services to shamanic healing if that is what has been requested, rather than utilizing multiple modalities for healing (Mokelke, 2008);
- avoid exploiting clients (International Society of Shamanic Practitioners, n.d.);
- be honest with clients and other practitioners (International Society of Shamanic Practitioners, n.d.);
- offer fair fees for services (International Society of Shamanic Practitioners, n.d.; Union of Yagé Healers of the Colombian Amazon, 2000);
- refrain from seeking publicity (International Society of Shamanic Practitioners, n.d.; Union of Yagé Healers of the Colombian Amazon, 2000);
- refrain from the use of alcohol during healing rituals (Union of Yagé Healers of the Colombian Amazon, 2000); and
- recognize the value of and need for modern medicine and the ability of Western doctors to treat diseases that shamans are unable to cure (Union of Yagé Healers of the Colombian Amazon, 2000).
The code of ethics promulgated by the Union of Yagé Healers of the Colombian Amazon (2000) is, as indicated above, particularly comprehensive in its enunciation of the principles that are to guide its practitioners. Importantly, it recognizes the limitations of shamanic practice and the value of biomedicine, thereby strengthening the edict that practitioners should do no harm and work for the good of the client. At the same time, this code seeks to preserve the integrity of the healing process and the healer through its prohibition of alcohol use during healing rituals and its admonition against publicity. The code situates these principles in the context of the history of these shamans, a history that reflects both exploitation and oppression. This brings us to the second issue to be addressed in this paper: whether shamans constitute a vulnerable population in the context of research involving humans and, if so, what special protections can be established for their protection.
Shamans as a Vulnerable Population and Implications for Research
The ethical principles of respect for persons and beneficence, derived from the Nuremberg Code (1949), demand that we as researchers assess the risks and benefits to prospective participants prior to the initiation of an investigation, in order to determine whether the investigation should even be pursued. In general, special justification is need for the conduct of research with vulnerable participants (Council for International Organizations of Medical Sciences, 2002, Guideline 13). Accordingly, one must first ask whether shamans as a group constitute a vulnerable population within the context of research involving human participants.
Vulnerability refers to those persons who are relatively or absolutely unable to protect their own interests because “they have insufficient power, prowess, intelligence, resources, strength, or other needed attributes to protect their own interests through negotiation for informed consent” (Levine, 1988, p. 72). Vulnerabilities may be cumulative, resulting in what is essentially compounded powerlessness. A review of the treatment of shamans in many cultures argues in favor of a determination of vulnerability in at least some contexts, such as Peru, Mongolia, Siberia, and other locales in which shamans have historically faced persecution and oppression. As a politically marginalized group, individuals may not perceive their participation in research as voluntary (Barsdorf and Wassenaar, 2005).
Although the principles of respect for persons and beneficence would suggest that these circumstances disallow the participation of shamans in research, the inquiry cannot stop there. The exclusion of shamans from participation based on such factors alone may, first, constitute a paternalistic overemphasis on the principles of nonmaleficence and beneficence, which provide that researchers minimize harm and maximize good, respectively. Second, it reflects a concomitant failure to acknowledge the principles of respect for persons, which requires individual decision making, and justice, which dictates that the benefits and burdens of research be accessible across populations (Beauchamp et al., 2002; Erlen et al., 1999; cf. Roberts et al., 2004; Stanley et al., 1981). Depending upon the nature of the study to be undertaken, participation in research may represent for a means by which shamans can obtain needed health information and care that they may need for themselves or their clients. This may be particularly true for shamans and their clients who reside in non-urban areas where access to Western medicine is limited. Too, research relating to shamans’ abilities and practices may provide information critical to our understanding of emotional states and the connections that exist between emotions, thinking, and physiology, thereby contributing to our greater scientific knowledge.
Accordingly, shamans should be provided with the opportunity to participate in research protocols for which the risks and benefits of participation have been carefully assessed and special protections implemented (Council for International Organizations of Medical Sciences, 2002, Guideline 13). Such protections may include heightened provisions for confidentiality and privacy, provisions to ensure the anonymity of participants, and inclusion of a shaman on the ethics review committee charged with responsibility to review the research protocol and monitor the approved study.
Conclusion
This paper has only touched the surface of the ethical issues that are associated with shamanic practice and the conduct of research relating to shamanic practices. Additional ethical issues require examination and discussion. These include, for example, the nature of the shaman’s obligations, if any, to the client if adverse consequences should occur as a result of the attempted healing, e.g., physical or psychic injury; whether the shaman has an obligation to inform the client of the potential risks and benefits associated with a particular healing practice as part of the consent process; and how to determine who has the authority to speak for a community of shamans in the context of reviewing proposed research.
This paper has also underscored the wisdom reflected in the development of codes of ethics by various shaman communities. The enunciation of these principles and practitioner adherence to them serves to protect the clients, the shamans, and the healing rituals involved. It is suggested here that other groups or communities of shamans might wish to also examine the need for a clear recitation of guiding ethical principles that are relevant to their historical, social, and political context.
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