4. Salutogenic Principals Found in Shamanic Practice
4.1 The View of Health and Illness in Shamanism and Salutogenesis
4.1 The View of Health and Illness in Shamanism and Salutogenesis
Before I compare the salutogenic and shamanic views of health – disease, I first want to point out and make aware the corner points of our common view – the view of Western medicine - where health is regarded as the normal state of the human being, while disease often is categorized by symptom catalogues and treated accordingly (Greve, 1982). Health and disease are dichotomic: one is healthy or ill. A crisis can cause serious illness which must be treated in order to regain health. In this view disease is an individual affliction. It shows a part of the body which does not function properly. That means the central subject of the illness is only referred to the specific organ or part of the body. It is caused by certain factors and only has the negative effects of suffering. Most factors causing the illness are external or genetic (in some cases certain behaviors). The person can and must learn to adapt to an illness and live accordingly. Psychological disorders can be caused by traumatic events or crisis.
Within the Salutogenetic Concept, health represents a state of balance on the health-dis-ease continuum, where stressors can be dealt with accordingly because of a high Sense of Coherence (SoC). Antonovsky himself describes “health as the state of that system we call human organism, which manifests a given level of order” (Antonovsky, 1996, p. 172). Illness is a naturally occurring process; the entropy (illness) always increases if not actively worked against (Schrödinger, 1968, cited in Antonovsky, 1985). According to Antonovsky, the human organism is a system in heterostasis. In order to reach homeostasis (health), the order within the human organism must be actively worked upon. Antonovsky’s continuum concept of ‘health-ease-dis-ease’ only regards the aspects of physical and mental health as aspects of order-disorder. Health and illness always occur in a person to a different degree, depending of its position on the continuum (Antonovsky, 1985). In Shamanism, good physical and mental health implies that not only the individual is free from suffering, but also it is in a larger state of equilibrium. Health is viewed as wholeness, a state of balance, and harmony in life (Singh, 1999). That means, the individual is in “a harmonious relationship with all things – with his biological, social, psychological, physical and cosmic environment” (Singh, 1999, p. 133). These things also include environment, spirits or supernatural forces, as well as the social group; the individual is integrated in a well functioning family unit or social group (Dow, 1986). Spirit and body are regarded as a unit, as one. That means spiritual health and body health can’t be separated. There are different levels of health, e.g. a Shaman – after having gone through his own cure – can reach higher levels of health and “yields not only of superior intelligence and refinement, but also of greater physical stamina and vitality of spirit than is normal to the members of the group” (Canda, 1982, p. 17, 18). In Shamanism, a higher level of order can be reached by certain successful undergone experiences or challenges (compare successful mastering of stressors by Antonovsky (1985)) which are esteemed, supported and assisted by the cultural context of the Shaman, resoluting the disorder (Canda, 1982; Larsen, 1976, cited in Canda, 1982).
The understanding of health in Shamanism explicitly includes the supernatural and all other aspects of balance (environmental, spiritual, physical, harmonic, etc.). In my opinion it goes beyond the salutogenic understanding, which seems to represent only two aspects (physical, mental) of the shamanic understanding.
Both concepts describe the healthy(ier) state as order and the disease as more disorder (position on the continuum). The image of the level of order in Shamanism exactly fits Antonovsky’s view of entropy: more entropy (Salutogenesis), meaning more disorder (Shamanism) in a stronger disease state and less entropy (Salutogenesis), meaning higher order (Shamanism) in a healthier state. In both Shamanism and Salutogenesis, the understanding of health-disease is a state of balance on a continuum and not a dichotomic view as in Western medicine. In Shamanism, health-disease cannot be separated from other aspects of life as in the Salutogenic Model, where these states stand more or less for themselves. The image of the health-dis-ease continuum in Shamanism (compared to a straight line in Antonovsky’s model) could be seen as a circle (see Lowery, 1998). While health and disease occur interchangeably and more or less irregularly - with other balance and imbalance aspects, within the Shamanic Concept, growth and higher levels of health can be achieved any time. A good example for this picture is the medicine wheel of many Native American Indian tribes.
The English language has several terms (disease, illness, sickness, disorder), of which I will use the two: disease and illness. 1) Disease: An impairment of the functioning of a system of the human body, or an organ or part thereof; a similar disorder in animals or plants; the breakdown of a material under special conditions. 2) Illness: The state or condition of being sick, whether in body or mind; an ailment or sickness (The Living Webster, 1977). Faltermaier describes the different meaning and use of these English terms (Faltermaier, 2005). For simplicity reasons, I will use both terms, disease and illness, interchangeably and do not differentiate between them.
In Antonovsky’s Salutogenesis, disease represents a state of disorder and imbalance in which stressors can not be dealt with accordingly by the individual person or group. E.g. stress can cause the move towards the dis-ease end of the health-dis-ease continuum. In Antonovsky’s view the human organism is a system in heterostasis. According to him this means that imbalance, pain and death belong to human existence, since all systems are exposed to the influences of entropy (Antonovsky, 1985). The movement towards illness is caused if the SoC is low and not appropriate (stress/crisis). Disease is regarded as an individual affliction. If seen as stressor, dis-ease can be a chance for growth, respectively a growing Sense of Coherence (SoC).
In Shamanism, illness is a disruption in the balance of life (Singh, 1999). Often disease is “the result of being literally dis-spirited” (Green, 1998, p. 211) or possessed by spirits. An imbalance or disharmony of specific spirits and forces, which cannot be dealt with accordingly, is the cause of suffering and pain, either of the body or the mind, or both (Singh, 1999). In this sense balance and harmony among physical and spiritual entities are considered especially important (Singh, 1999). The disruption in the communication with other beings – be it human beings and their social relations, supernatural beings, animal or plant beings, etc. – find different expressions. Examples are “the person’s spirit has left the body and not returned, or the individual has lost the aid of one of his or her helping spirits” (Green, 1998, p. 211). Greve writes of illness as punishment or examination from cosmic forces (within Nepalese people, Greve, 1982). Sacred forces also manifest their choice of a medium through illness. Illness always represents a symbolic aspect (Press, 1982, cited in Dow, 1986). Disease is not considered to be an individual affliction (Singh, 1999). Many shamanic cultures regard illness, especially psychic ailments, as a result of a disorder in social relations (Dow, 1986; Turner, 1967, cited in Dow, 1986). The sick individual mirrors the sick collective (family, society, social group), where the problem exists, since each individual is a part of the collective spirit of the culture (Kendall, 1977). In Turner’s view the sickness of the client is “mainly a sign that ‘something is rotten’ in the corporate body” (Turner, 1967, cited in Dow, 1986, p. 58). The person will only get better (in a healing), when all tensions and aggressions in the group’s interrelations are exposed and treated by rituals (Turner, 1967, cited in Dow, 1986), involving the whole family or an even wider network of people (Singh, 1999). Group rituals thus may bring everyone together in order to direct their collective life energies towards healing the individual (Singh, 1999). According to Greve, disease is a disturbance of the harmony between the world of humans and the world of supernatural beings (gods) (Greve, 1982). The microcosm ‘house’ or ‘village’ with quarrels in its social structure is reflected in the macrocosm of supernatural beings and gods. While certain diseases, if felt as examination or punishment, are seen as necessary part of nature’s order (forces of the middle world intervene and shoot a disease-arrow to a human being), there are also bad forces, which try to disturb the balance between good and bad powers within micro- and macrocosm (human witches, black magicians and bad ghosts attack the human being and try to damage him, Greve, 1982). In Shamanism and other traditional healing practices there is the “principle that if the spiritual aspect of the person is not well, the person’s body or mind or psychological development will not be well“ (Sinnott, 2001, p. 246). This stands in contradiction to our dominant materialistic culture which tends to overlook the emotional, intentional, and spiritual (Sinnott, 2001). In modern forms of Shamanism, which have been influenced, there are often two kinds of causative factors for illness: physical and supernatural which can be distinguished by the kind of illness (see table 3; Razali, 1999). A concept of mental illness does generally not exist in shamanic cultures (Stephen and Suryani, 2000), but the Shaman looks for the (symbolic) meaning of the symptoms in terms of supernatural powers speaking up whatever the specific value of that illness means to the person and his specific special abilities. The Shaman does the diagnosis and interprets the signs by speaking of those powers and translating them into human language.
The salutogenic understanding of the health-dis-ease continuum is congruent with the basic shamanic understanding. Both concepts assume a continuum of health-dis-ease, where the balance has to be actively worked upon. In Shamanism e.g. by keeping ubiquitous spirits peaceful by certain actions, not making them angry as well as keeping the communication with all other things and beings going and in Salutogenesis by coping strategies to handle the ubiquitous stressors. Both concepts also see a chance in illness either for suffering/death or for personal growth/transformation. In Salutogenesis, illness is seen as a stressor. Handled accordingly (high SoC), personal growth could happen and the move can be in direction of the health-ease-side of the continuum. Once the negative outcomes of unsuccessful management manifested as disease, the SoC is strongly negatively influenced and normally hard to change, according to Antonovsky (1985). In Shamanism, illness is seen e.g. as a selection by the spirits, as a chance to personally grow and become a Shaman or to suffer or die if the selection is not accepted by the individual.
There are also differences in the view of disease: In Salutogenesis, disease is regarded as an individual affliction, as it is in Western medicine, although influencing factors on the person, (e.g. GRRs) can be cultural, social and also on the family level, etc.. In Shamanism, disease is not regarded as an individual affliction (Singh, 1999). Salutogenesis regards the manifestation of health/disease/healing only on the physical and psychological level. Shamanism regards it on the spiritual level (communication with supernatural beings), on the social level (communication with tribe), on the environmental level, on the symbolic level as well as on the physical and psychological level. Shamanism works basically with psychological methods (psychotherapy, see below), as well as medicine (herbs, etc.) and spiritual methods. In Salutogenesis, spiritual and symbolic aspects of health/disease can come into play by the personal (cultural) belief system of the person. In providing a health-dis-ease continuum, and focusing on the origins of health, Antonovsky’s theory does consider the above aspects in the form of culture and beliefs as a significant way in which groups of people manage tension (Lowery, 1998).
The shamanic understanding of health-disease goes further than Antonovsky’s continuum concept. Whereas he only sees a line, Shamans see a whole complicated net: “the concepts of illness and health within Shamanism are not dichotomous, but are woven into the fabric of life and the environment and through generational time” (Garrett, 1990, cited in Lowery, 1998, p. 128), or respectively a circle, like the medicine wheel, which is “an ecological concept and organized knowledge that demonstrates the wholeness of life and the significance of illness and balance” (Lowery, 1998, p. 128). Deloria describes Antonovsky’s Salutogenic Theory (origins of health) as a coinciding perspective, as a “place where the circle and tangent lines meet, where tribal and nontribal orientations intersect” (Deloria, 1970, cited in Lowery, 1998, p. 129).
Table 3: Examples of shamanic views of certain diseases.
In the shamanic sense, healing - which is the Shaman’s basic obligation - means, to restore the harmony, the balanced relations between good and bad, thus renewing the cosmic order with rituals, etc.. The other dimension of disease – the conflict situation – is thus cancelled (Greve, 1982). Symbolic curing or healing in the shamanic sense is “an action on the society - dealing with family and other social problems - rather than on the client” (Turner, 1967, cited in Dow, 1986; Dow, 1986). Kendall confirms that by citing other studies concerning spirit possession and healing cross-culturally (Kendall, 1977). In all of these studies, the nature of the possessing spirits and the symbolic content of the curing ceremony within the process from ‘initial possession’ to ‘cure’ is analyzed as projective symbols of stressful social relationships. Thus the chain of events, between possession and cure, e.g. as ritual play-acting, is taken as a “language of argument” (Leach, 1954, cited in Kendall, 1977, p. 278), in which stress and stressors are articulated and various compensations are made (Kendall, 1977). Therefore, healings carried out in group settings are thought to be more effective in the shamanic therapy among the Inuit (Murphy, 1964, cited in Dow, 1986).
Because of the Shaman’s understanding of the spirit world, healing in the Shaman’s view can mean undertaking a shamanic journey in order to attempt to find and bring back the missing spirit, extracting bad intrusions or the departure of evil spirits, which again can be done by good spirits or supernatural powers together with the Shaman (Green, 1998). Retrieving the soul or parts of it, then blowing them back into the client’s body and seal the parts by rattling around the person is a further way (Green, 1998). Another option could be reintegrating the client into the family unit (the goal of Tamang Shamanism, Peters, 1981, cited in Dow, 1986; Razali, 1999). In this sense, the Shaman works with the individual to appease the angry spirit, restore balance and harmony, and enable the individual to be healed (Singh, 1999). All these symbolic actions basically represent psychotherapeutic methods used by the Shaman (see chapter 4.5.2 below). If the Shaman is successful, the client’s symptom will improve until he is relieved and health is re-established (Green, 1998; Razali, 1999). For the Shaman, “healing requires much more than attention to the specific pain or suffering” (Singh, 1999, p. 134). Indian medicines (shamanic techniques) are not only used for treating illness, but also “for providing guidance and protection, betterment of environmental conditions, or improvement of life” (Garrett, 1990, cited in Lowery, 1998, p. 128).
In both – Salutogenesis and Shamanism - healing means balance can be restored by certain actions or techniques, using a high number of powerful GRRs (which are provided within the shamanic context, see chapter 4.3 below) that lead to appropriate coping strategies of the individual. In the shamanic sense, healing is nested in the context of the whole person, one who has a spirit, along with a body, mind, and heart. The whole person, in turn, is connected with the earth as a living system, with the community, and with the transcendent. The client is not psychologically alone. “Patients and clients live lives guided by meaning, intention, and spirituality” (Sinnott, 2001, p. 246). The Salutogenic Model regards specific factors (stressors, SoC, coping) as major components for healing and health but disregards e.g. spirituality and the interrelations to environment as specifically important. It only pays respect to these aspects by integrating the general influence of culture and belief system into the model. Shamanism delivers a living example for the influence and importance of those specific factors.
4.2 Crisis Intervention Coping: The Central Themes in Shamanism and Salutogenesis
In Antonovsky‘s opinion stressors are ubiquitous. All humans have to deal with them on a continuous basis (Antonovsky, 1985). The stress(or) concept and the process of coping with stressors (management), have a central meaning within the model of Salutogenesis (Faltermaier, 2005). A high Sense of Coherence, shaped by adequate experiences, personal characteristics (learned in childhood), genetic base and other resources like money, supports the likelihood of overcoming stressors and moving towards health (Antonovsky, 1985). Nevertheless, it is a lifelong process, which has to be actively worked upon. Thus, continuous intervention is needed in moments of tensions which can cause stress. In Antonovsky’s view it doesn’t matter whether the person him-/herself feels in control or feels that some legitimate authority is in control (Antonovsky, 1985). Canda writes that the shamanic treatment or practice focuses on the successful passage through critical transitions (Canda, 1982). The shamanic treatment – in Western therapeutic terms – is oriented towards crisis intervention (Canda, 1982). It is directed towards achieving material success which includes health (Canda, 1982). In Shamanism - either by the Shaman for himself or for his client - many different forms of crisis intervention and stressor management (coping) are offered. Shamanism basically represents a wide collection of methods and techniques to do crisis intervention (and coping), from a fund of resources, e.g. medicinal (herbs, etc.), psychological (therapy, mythologies, etc.), sociological (group support), ritualistic, divine/supernatural, explanations and solutions and symbolic healing, etc.. The main aspects are leading and guiding the client through his situations of stressors respectively stress/crisis. I regard stress and crisis as being on the same level, basically having the same meaning. Shamanism is the setting for crisis intervention, mostly called healing.
While the model of Salutogenesis is only a theoretical concept, Shamanism – as an ancient tradition - sets an example in how to practically apply the Salutogenic Model and more. In the case of crisis intervention, the Shaman himself first has to go through a crisis in order to learn. That means in order to be able to facilitate coping and crisis intervention for himself and others (as a kind of symbolic healing), like in many other systems of symbolic healing, the healer must first be healed (Dow, 1986). For this reason, the Shaman initiate himself has to go through the biggest crisis there is, often called the initiation disorder or transformation and often imaged as the death - rebirth experience (Canda, 1982). Doing so, he “plunges into experiences of death, suffering, and disorder with the support of master Shamans” (Canda, 1982, p. 18). Later on, he – in combination with the cultural and social supportive background – is able to practically apply shamanic methods corresponding to salutogenic patterns – to the clients in crisis situations. He also intentionally creates the latter for a client in order to - with his support – raise the client’s growth (GRRs, positive experiences, SoC) and level of health. Applicable examples and literature are described as follows:
Halifax writes: “The encounter with illness, suffering, and death not only opens the world of the gods to the Shaman, it also provides an experiental ground for the work of social, personal, and environmental healing that the Shaman will later be doing” (Halifax, 1990, p. 54). In this sense, Larsen points out that death and rebirth is the most fundamental symbolism of transformation, which can be empowering and life enhancing although it is an awesome and fearsome symbolism (Larsen, 1976, cited in Canda, 1982). The successful recruit then returns transformed, representing now a sacred healing instrument to and for the society (Canda, 1982). In this regard, Canda writes about the Korean shamanic initiation process as a culturally shaped form of a universal and psychosocial pattern (Canda, 1982). The Shaman is the master of anomaly and chaos, but not the slave of it (Lewis, 1971). As this, he embodies the ideal human being within the Salutogenic Concept – a master of anomaly and chaos, meaning of stressor and crisis situations - being high on the SoC score.
In the life of a Shaman recruit, a period of disorder (e.g. the shamanic crisis) is an integral part of the cure and transition to higher levels of health (Canda, 1982). The proper fostering of the shamanic crisis results not only in superior intelligence and refinement, but also in greater physical stamina and vitality of spirit than normal to the members of the group (Larsen, 1976, cited in Canda, 1982). The Shaman’s culture provides a context, where the resolution of the disorder into higher levels of order typically is esteemed, supported, and assisted (Canda, 1982). This is comparable to positive (coping) experiences made in stressor situations according to the Salutogenic Model, by changing the SoC as well as the social psychological assessment levels. In this case those experiences are made with the guidance and support of the (master) Shaman. This means, when situations of tension reoccur later on, the judging concerning their possible effect, might more often go into the direction of neutral or irrelevant, whereas the same in the past may have been threatening. Eliade and others view shamanic initiation disorder as a manifestation of a reconstructive therapeutic growth process, highlighting the spiritual aspect of the Shaman’s initiatory transformation (Canda, 1982). Canda describes initiatory transformation as a healing of the person through drastic experiences which encompass and engage the whole person (Canda, 1982). Illness (sickness, disorder) and health are integral facts of the complete transformation process (Canda, 1982). In this regard, Shamanism confirms Antonovsky’s opinion of the possible salutary effect of stressors by applying it (tension management) and goes even further by regarding not only stressors but even the experience of stress and crisis as the essential part of a transformation and growth process (raised SoC, health, balance). Such a crisis situation is seen as the necessary precondition for a drastic enhancement of the SoC (feeling of unity and interdependence) and health later on in Shamanism Thus Shamanism offers a practicable form of application for the theoretical model of Antonovsky. In the shamanic sense the bigger the crisis, the bigger of a change (raise of health, balance etc.) is possible and also the necessity for change. Antonovsky did not explicitly regard crisis or stress as chance for growth (raised SoC and health), possibly because he viewed (new/more) disease self-evidently as stressor with its corresponding management possibilities (successful/unsuccessful). He only saw the possibility of a successful management at the level of tension, caused by stressors. Experienced stress and crisis in his opinion only can have negative outcome (more disease). Brieskorn-Zinke writes that in crisis situations where the SoC is effected deeply, it is possible to restabilize it with corresponding interventions (Brieskorn-Zinke, 2002).
Apart from non-intended stressor- and crisis situations (in Shamanism), there are also consciously and intentionally chosen stressor- and crisis situations, as effective means to get into ASC, in order to raise someone’s capability to overcome stressors and crisis. These are for example hunger, thirst, sleep loss and sensory deprivation (e.g. Krippner, (2), 2000; Harner, 1980; Rogers, 1982; both cited in Krippner, (2), 2000; Winkelmann, 1997). These techniques are often used within certain rites, where tribe members – embedded in their shamanic cultural belief and supporting social system (high SoC in Antonovsky’s sense) - are purposely and consciously put in highly stressful and crisis situations. Examples for this in North American traditional life are:
Shamanism focuses basically on the overcoming of stressors and crisis, thus on rising one’s capability to live in active harmony and balance with the world by regular continuous efforts. This basically corresponds with Antonovsky’s opinion of the ubiquitous stressors, that have to be dealt with successfully on an ongoing basis in order to live in balance and on the health side of the continuum. Crisis (stress) is regarded essential for growth and more health in Shamanism while Antonovsky regards stress as a negative factor for health, and only the successful management of stressors possible and essential for a development towards health. The Shaman assists people in keeping that balance and in keeping successful outcomes. The option of changing a person’s view of something by offering new actions and the possibility of a positive outcome and experience helps growing to a higher Sense of Coherence and raising one’s position on the health-dis-ease continuum.
Shamanism offers a wide range of adaptive myths and mythologies, etc. in order to overcome crisis situations and it goes further than Salutogenesis, concretely stating the necessity to do so. At the same time, Shamanism offers different ways to achieve ‘growth’, in the salutogenic sense of raising one’s SoC. Larsen and Canda even state the basic human need for growth as a form of shamanic guidance/myths in order to be able to overcome basic human crisis situations (Canda, 1982; Larsen, 1976, cited in Canda, 1982). Compared to Antonovsky, whose model is very general and therefore not practicable, they specify this concrete basic need. As said before, Shamanism offers a practible form to turn the theoretical salutogenic aspect of SoC into an applicable method to raise one’s SoC and move towards health. Christine Lowery writes: “the Salutogenic Theory is compatible with the minimum requirements of an American Indian theory [shamanic theory], of addiction and recovery [= crisis and crisis intervention theory which originates from a shamanic belief system, note by author], which would encompass the perspective of two worlds, the world in which we live and the world of the spirit, including a balanced understanding of alcoholism [a form of crisis, note by author] and recovery that focuses on healing the spirit, and center on lifestyle and health ways, including the physical, mental, emotional, and spiritual. Antonovsky’s theory considers culture and beliefs as a significant way in which groups of people manage tension, provides a health ease-dis-ease continuum rather than a health-illness dichotomy, and focuses on the origins of health (Salutogenesis) rather than the origins of disease (Pathogenesis), the traditional perspective on [disease] alcohol addiction” (Lowery, 1998, p. 129).
4.3 Generalized Resistance Resources (GRRs) in Shamanism
To further enlighten the above I will list the Generalized Resistance Resources (GRRs) by Antonovsky (1985) and describe matching examples of them found in Shamanism. Antonovsky’s definition of the Generalized Resistance Resources (GRRs) as “any characteristic in persons, groups or environments that can facilitate effective tension management” (Antonovsky, 1985, p. 119), basically describes shamanic techniques which a Shaman is trained in and incorporates within his person. The Shaman learns those techniques and embodies them in order to help himself and others and also learns and practices the use of environmental and group characteristics for this purpose. He becomes the one who adopts these characteristics that can facilitate effective tension management after having gone through the experiences himself.
Resources are those forces which keep and support health. They play a central role within the Salutogenic Model. However, most research so far has investigated social and personal resources. As mentioned by Antonovsky in his model, there has been very little investigation into bodily resources (Faltermaier, 2002, p. 193). Faltermaier also suggests more investigation into the role of cultural resources, since health must be understood in future more and more in the context of a multicultural society (Faltermaier, 2002). Shamanism, in its traditional form, has a main cultural component, incorporates this aspect of Faltermaier fully and thus goes beyond Antonovsky’s thoughts of a salutogenic method.
The list of Antonovsky’s variables and their possible occurrence in Shamanism follows:
The three elements, which enter into every coping strategy and contribute to making it a GRR: rationality, flexibility and farsightedness (see chapter 2) are very important within Shamanism. The Shaman as an experienced healer acts as a filter for rationality by his judgment and adequate treatment. In this sense, rationality - being evaluated according to the corresponding culture - in shamanic treatment certainly is guaranteed by the Shaman, who has undergone an extensive training in judging different states of diseases as well as other states and situations. The Shaman knows and offers a wide range of coping styles (see chapter 4.2 crisis intervention/coping). In addition, a Shaman never ceases to learn new ways or “new overall plans of action for overcoming stressors” (Antonovsky’s, 1985, p. 112). Accessing and interpreting ASC in order to ‘go on a shamanic journey’ and gain insights in many different forms is one kind of coping strategy, from which further new and always adaptable, flexible coping strategies or directions for actions result, depending of the information gained within ASC (‘journeys’). The flexibility and adaptability of intervention plans (supernatural directions, etc.) for new challenges (stressors, crisis) is an essential part of the Shamans self-evidence, who – again – always accesses subconscious levels for answers.
The Shaman, with his clients, always incorporates farsightedness (as described in chapter 2, in the sense of Antonovsky). He anticipates responses from the inner and outer environment or, with other words, from different realities which he can access (underworld, upper world, etc. see chapter 3.5). This is the main part of his work in order to help restore balance with everything.
In shamanic cultures the individual is being embedded in networks of relatively stable social relationships, e.g. within tribes and in coherent, relatively integrated subcultures. If problems such as illness or similar occur, the social unit, like the whole family is involved and takes part in the healing process (guided by the Shaman), by reinforcing and stabilizing social ties, support and acceptance. In a functioning shamanic tribe or social group, this GRR exists. If not, the Shaman will restore it. In modern forms of Shamanism, social ties and support also exist, fortified through regular meetings and rituals like sweat lodges or others. Today there are networks and associations between modern Shamans (see e.g. on the internet). In healing, the traditional Shaman not only involves the client but also his/her social group, family, tribe and the client’s interaction with them. Thus they learn to accept the client and his/her problems. This puts him/her into a new respected and supported position within the social structure. In this regard Dow writes that a disorder in social relations can be the result of e.g. disarticulations in the social network between humans themselves as well as between humans and other beings or the result of a social impropriety (Dow, 1986). Meaning that this missing GRR can lead to disorders and also to illness, according to the shamanic interpretation. In the view of many cultures, a person’s illness mirrors problems of the society or social group. Therefore symbolic curing or healing is “an action on the society rather than on the patient” (Turner, 1967, cited in Dow, 1986, p. 58). One of the Shaman’s main tasks in order to assist people is to restore their social support system! That is why “symbolic healers often appear to deal with family and other social problems” (Dow, 1986, p. 58). Healing carried out in group settings are thought to be more effective in the shamanic therapy among the Inuit (Murphy, 1964, cited in Dow, 1986). In short, not functioning social relations (between humans, family, group members and spirits) often reflect the cause of psychological problems in the shamanic sense (Dow, 1986).
Through shamanic acting and rituals, like the Korean Kut (a communion feast in Korean Shamanism), relationships are healed (Park, 1991). Relationships between men and the spirits resume and among men themselves are revitalized, the solidarity between e.g. family members become reinforced (Park, 1991). Through the spontaneously letting out of emotions (e.g. crying, hugging) within the ritual, emotions become purified and change becomes readily acceptable. “Social harmony is secured by making cosmic interactions with natural forces” (Park, 1991, p. 82). “Suffering is resolved through reconciliation between men and spirits as well as among men themselves. Solidarity is thereby reinforced as harmony between men and spirits as well as among men themselves” (Park, 1991, p. 82). The ritual process (e.g. Kut) symbolizes all of these (Park, 1991). Social shamanic rituals often represent religious acts of the group (Park, 1991).
Different authors – including Antonovsky – agree that the evolvement of religion (religious beliefs and practices) basically developed on the base of human experiences with the unpredictabilities, uncertainties, anxiety provoking events of life (sickness, death, misfortunes and catastrophes, etc.), in order to help human beings deal and cope with it (Malinowski, 1931, cited in Antonovsky, 1985, Antonovsky, 1985; Pandian, 1997). Despite any knowledge and science, there will always be uncontrollable chance, unforeseen turns of natural events, catastrophes and unreliable human handiwork, not adequate to meet all practical requirements (Malinowski, 1931, cited in Antonovsky, 1985). In this sense, Pandian states that the formulation of the existence of sacred beings or powers does provide support for the maintenance and continuation of cultural traditions or social values that are constantly threatened and face possible extinction (Pandian, 1997). The same arguments are used by Antonovsky, stating that religion, as a GRR, grows out of every culture, “because knowledge, which gives foresight fails to overcome fate; because lifelong bonds of cooperation and mutual interest create sentiments, and sentiments rebel against death and dissolution” (Malinowski, 1931, cited in Antonovsky, 1985, p. 118, Antonovsky, 1985). Despite these findings, Antonovsky only regarded the aspect of religion as one possible GRR – which either can or cannot be present – but didn’t specifically incorporate that aspect of religion as a needed or essential element in his model. Malinowski regards the development of a special type of ritual activities, which anthropology labels collectively as magic, as a response to the unpredictable (Malinowski, 1931, cited in Antonovsky, 1985). “The richest domain of magic, however, is, in civilization as in savagery, that of health” (Malinowski, 1931, cited in Antonovsky, 1985, p. 118).
Pandian concludes that: religious phenomena are “projective systems”, which have personal and cultural functions, in which anthropomorphic, anthropopsychic, and anthroposocial characteristics are used for the construction of supernatural reality (Pandian, 1997, p. 507).
The reasons for religion being a GRR in Antonovsky’s sense are that religious belief and ritual make the critical acts and the social contracts of human life public and traditionally standardized, being “subject to supernatural sanctions, which strengthen the bonds of human cohesion” (Antonovsky, 1985, p. 118). “Religion in its ethics sanctifies human life” (Malinowski, 1931, cited in Antonovsky, 1985, p. 118).
All that Antonovsky talks about, from ready answers as the most powerful of all GRRs, to explanations for death and pain, ceremonies for crop failures, etc. (Antonovsky, 1985), is provided by the Shaman in a shamanic culture or society. He is the one who offers explanations by contacting the supernatural powers, he is the one who does rites and ceremonies, he is the one who represents the artistic expression of society, he provides myths and mythologies as well as drama and play, etc.. In order to achieve material success, which includes spiritual and physical health, for human benefit the magical manipulation of objects is used (Canda, 1982). The Shaman offers much more GRRs for himself and his social group than Antonovsky described (list of functions see chapter 3.4). Magic, religion and spirituality are embodied both as GRRs within the shamanic tradition.
Shamanism, as a traditional cultural setting offers and teaches a whole set of GRRs and possibilities in each category listed by Antonovsky. Psychological, social, and cultural GRRs are available to people and groups coping with stressors and crisis situations. These are basic for an ordered life (other than a chaotic), since “our behavior (in the broadest sense) [has to be] ordered, constrained, and guided by culture and society” (Dubos, 1973, cited in Antonovsky, 1985, p. 105). Shamanism offers not only explanations from an often different perspective (e.g. other realities) but also rituals, ceremonies and magic, which altogether support the client’s belief, that things can be understood (comprehensibility), events do make sense (meaningfulness) and he can take action (manageability). This often happens by sudden changes of the client’s perspective on things. In traditional cultures, the Shaman was the keeper of norms and corresponding behavior (see chapter 3.4, etc.) by setting out rules. In this way, he offered a role set in different areas, like social relations and behavior or hunting rules (environmental aspect). All of these rules were empowered by the supernatural powers, which only the Shaman was able to contact directly. His myths and mythologies, offered a world where people would fit in, and where unexplainable events could be explained and dealt with accordingly. Shamans open the way for a new view of problems and solutions – often in other worlds of understanding and different realities. They support clients in using their learning capacities to make new GRRs available and incorporate them into their lives. In this sense, the analysis of Strauss and Höfer indicates that not only different kinds of resources influence the outcome (on health) but also the number of influencing resources (Strauss and Höfer, 2002). They suppose that the lower number of resources in females is the reason for higher stress values compared to males. The Shaman - through the increasing number of GRRs and new experiences – induces the raising of the SoC and reduces the feeling of tension in many situations. By changing the view of a crisis/problem and offering solutions in different realms of reality, the Shaman ideally shifts the focus of the client to a successful coping strategy for that situation. Over thousands of years, they’ve offered proven methods for humans to raise existing and create new GRRs and raise their SoC. The outfit of a person with GRRs can be actively changed, respectively raised, in order to better cope with stressors and crisis situations with the corresponding expected outcomes (higher SoC, better health). The Shaman’s function, their acting, their meaning, including the cultural background, all aim at raising the number, availability and effectiveness of resources (social, psychological, medicinal, etc.).
4.4 The Feeling of Unity and Interindependence with Everything
The feeling of unity and interdependence with everything (Canda, 1982; Krippner, 1987), sometimes called state of balance and equilibrium in Shamanism, can be compared with the Sense of Coherence (SoC) as the central aspect of Antonovsky’s model. Shamanism, as a practical method fills Antonovsky’s theory with life and seems to involve more aspects than Salutogenesis. While the SoC, for example, describes a sense or feeling of connectedness from persons with their surrounding world, in Shamanism this feeling also exists (see above) as a mental image, called myth (chapter 3). The shamanic feeling of unity and interdependence involves every aspect of life, interconnectedness and unity, like a web or circle. Antonovsky regards the Sense of Coherence as a continuum, which can be applied for the feeling of interconnectedness and unity in Shamanism as well. Certain aspects of a person’s (group’s) feeling can be out of balance, to a different degree (continuum), while other aspects are in balance. The perfect feeling of unity and interdependency (SoC in Salutogenesis) as the highest possible positive end of the continuum can be reached closely by the Shaman, as the living example for it (Pandian, 1997). In Shamanism, this concept of unity means the divine connectedness with everything (meaningfulness). This feeling can be included in the Sense of Coherence (Salutogenesis) as well. In both, Shamanism and Salutogenesis, active work on interactions with inner and outer environments is necessary to keep balance and unity. “Living is a matter of constantly working out and reworking a modus vivendi with the relevant persons and environments” (Wertheim, 1975, 1978, cited in Antonovsky, 1985, p. 141).
In Shamanism, supernatural beings are an essential part of the environment. Coping experiences made within crisis and/or stressor situations with a certain set of GRRs have a direct influence on a person’s feeling of manageability, meaningfulness and comprehensibility (see chapter 2). According to Antonovsky, these are the three main factors influencing the Sense of Coherence (SoC). However, once established, the sense of meaningfulness is the hardest to influence, since it is imprinted by cultural and lifehistorical experiences (Brieskorn-Zinke, 2002). Shamans embody a connection to a supernatural source of wisdom, and provide answers to questions about the comprehension of life (comprehensibility). Similar to a religion, Shamanism represents a (culture’s) belief system (see chapter 3.4, etc.). This belief system, embodied by the Shaman, can explain natural disasters as well as personal destinies, crisis and problems in life. The Shaman makes the world explainable (supernatural forces, etc.), understandable and comprehensible, and gives or reminds the meaningfulness of their client’s life. They give advice how to change and how to deal with spirits, etc., which directly influences the sense of manageability, since new ways are shown to manage a stressor or crisis situation. The Shaman explains events/crisis/psychological problems through supernatural forces and shows healing paths or solutions, which foster the feeling of manageability. The stronger the client’s belief in the Shaman, the more powerful the Shaman and the more effective is the cure (manageability). He helps the client move from feeling like the ‘victim’ to become the ‘doer’. This corresponds with Antonovsky’s opinion that the higher the feeling of manageability, comprehensibility and meaningfulness (‘doer’) the higher the possibility of having a higher Sense of Coherence and being on the health side of the health-dis-ease continuum (Fäh, 2002). Shamans create (mirror) a personal myth for the client (as a metaphor for his (her) present situation), which then can be changed symbolically (chapter 4.5.2). In this way a feeling of meaningfulness of this event occurs as well as a feeling that there is a way to manage the situation.
Many authors agree, that Shamanism evolved because human beings - confronted with unpredictable, hostile, series of environmental challenges - needed explanatory stories (often enacted as mythic rituals), to be able to cope with these challenges on a daily basis (Ripinsky-Naxon, 1995). Shamans, with their intuition and imagination, met these societies’ needs (Krippner, (2) 2000). The society could relate causality to the Shaman’s worldview, and got a response offered through the mode of a visionary context (Ripinsky-Naxon, 1995), enhancing their feeling of unity and interdependence (SoC). This happened by the Shamans offering their versions of the visionary experiences and secular knowledge of the supernatural in order to assist humans to find their way through the challenging environment. The shamanic epistemology was based on: observations of the physico- and biotic environment, studies of the ‘ways of plants’, animals and of movements of celestial bodies as well as of properties of metals. It used perceptual, cognitive, affective and somatic ways of knowing, resulting in the understanding of healing potencies of divine plants and meanings of dreams and visionary experiences (Ripinsky-Naxon, 1995).
In congruence with Antonovsky, who basically states that meaningfulness and the other two components of the SoC must be present to a certain degree in order to develop a level of the SoC, which enables life, Paloutzian explains, there is a basic human need (of healthy people) for meaning or purpose in life (Paloutzian, 1981; Antonovsky, 1985). The latter can be fulfilled, for example by adopting an encompassing (religious or shamanic) worldview – created by the view of a human being on how it perceives itself in relation to life and the whole cosmos (SoC). This cognitive-need theory was confirmed by research results in which converts perceived greater meaning in life (one component of the SoC), compared to non-converts (Paloutzian, 1981). Different authors confirm that the shamanic worldview, including the feeling of unity and interdependence with its components (e.g. meaning), is the result of the human physiology, which creates this basic need of all humans, that can be fulfilled by shamanic acting (e.g. Krippner (2), 2000). Winkelmann points out the importance of neurognostic perspectives in understanding Shamanism, which are e.g. reflected in animal images (Winkelmann, 1992, cited in Krippner (2), 2000). The human nervous system - rather than intellectual speculation or detached observation of the environment - generates the ways in which the particular shamanic cosmos is conceived, (Clottes and Lewis-Williams, 1998, cited in Krippner, (2) 2000). Krippner means that neurognostic potentials and social construction operate in tandem, which result in those phenomena (Krippner (2), 2000).
4.4.1 The Potential for Change During a Life Time
Antonovsky believed that the Sense of Coherence is mainly built in early childhood (Antonovsky, 1985). According to him “the strength of a person’s SoC is more or less stabilized by the age of roughly 30, that is, when one has been in the ‘normal’ work and family situation of one’s culture and subculture for a number of years. Most people in the world do not, thereafter, go through radical and lasting changes in their life situations” (Antonovsky, 1996, p. 175). The stable location of the SoC on the continuum in adult life can only be shifted temporarily and minorily through “a particular experience, a specific situation, a detailed success or failure” (Antonovsky, 1985, p. 124). In his opinion psychotherapy could – if at all – only modify it a little: “A particular experience, a specific situation, or a detailed success or failure can effect a temporary and minor shift on one’s Sense of Coherence. [...] But such changes occur around a stable location on the continuum” (Antonovsky, 1985, p. 124). With these statement he obviously means, that adults normally don’t have life (SoC)-changing experiences anymore, which – in my opinion – seems to be in contradiction to some of his earlier statements cited below. Antonovsky writes that he is not “committed to understanding the Sense of Coherence as being determined forever [....] by genes or early childhood experience. It is shaped and tested, reinforced and modified not only in childhood but throughout one’s life” (Antonovsky, 1985, p. 125). Under certain circumstances, like “a radical change in one’s structural situation – in marital status, occupation, place of residence” the SoC can indeed be significantly modified (Antonovsky, 1985, p. 125). That means, if people are intentionally placed in those kinds of life-changing, drastic, dramatic experiences, like in Shamanism, it would also be possible to significantly change the SoC – according to Antonovsky. I believe that the consequences on the SoC depend on the strength and effect felt, if certain experiences are made.
The shamanic initiation process and other extreme stressor- or crisis experiences under shamanic treatment/guidance can lead to a new view of life and of the world, which means it represents a new adjustment respectively a reconstitution of the self. It seems that the SoC can be intentionally influenced through shamanic practice. Shamanic experiences generally lead to new adjustments concerning identity and visions, etc.. In this regard, Canda cites Eliade who writes about the “dialectic of hierophany”, referring to the religious person’s experience of manifestation of the holy (hierophany) as a revelation which disrupts and transforms from an ordinary and profane mode of being into an extraordinary, numinous, and sacred mode of being (Eliade, 1972, cited in Canda, 1982; Canda, 1982, p. 21). “When hierophanization occurs in a human medium, as in shamanic and mystical conversion, a drastic alteration and elevation of the total person results” (Canda, 1982, p. 21). Mystical consciousness, as a peak-experience, can provide a valuable reason for living or to continue living (Maslow, 1972, cited in Thalbourne, 1991). Maslow and others found that mystical experiences could reduce or eliminate suicidal ideation; the own lives seemed more meaningful after such experiences and death was less distressing (Maslow, 1972, cited in Thalbourne, 1991; Thalbourne, 1991). The different terms used to describe the experience reflect different cultural prejudices and influences which, in turn, have an important effect on the manifestation. In other words, while symptoms vary, what has been called by Fingarette the ‘drive towards meaning’ (meaningfulness as a human need, drive) appears in all unique cultural manifestations (Fingarette, 1963). “It is an endogenous process of personality change, ideally assimilating and accommodating itself to the norms, values, and meanings of the culture” (Peters and Price-Williams, 1983, p. 30).
Although the comparison between shamanic techniques and psychotherapy follows later (chapter 4.5.2), I want to mention already in this regard that there are authors, who disagree with Antonovsky’s opinion about the possible little effects of psychotherapy (see above) on the SoC and thus basically confirm shamanic effectiveness. For instance, Fäh found Antonovsky’s view of impossible or only minor change of the SoC to be different (Fäh, 2002). The Sense of Coherence is indeed improved through psychotherapeutical interventions (Sack and Lamprecht, 1994, cited in Fäh, 2002). A long term study from Sandell led to the conclusion that intense psychoanalytical long term treatments improve the Sense of Coherence persistently (Sandell, 1997, Sandell et al. 1999, cited in Fäh, 2002). Schröder states that nowadays it seems very likely that there is a certain range of change within the personal development over a life time (Schröder, 1999, cited in Brieskorn-Zinke, 2002). In this sense Brieskorn-Zinke writes that in crisis situations where the SoC is deeply affected, it is possible to restabilize it with corresponding interventions (Brieskorn-Zinke, 2002). All possibilities regarding this influence are intensively interactive between therapist and client (Brieskorn-Zinke, 2002). Fäh described a list of other studies which showed that psychotherapy, including the costly long term psychotherapy, saves health care expenses (medicine, hospital, etc.) in a lasting way by improving the SoC and health (Fäh, 2002). This confirms that the option of growth or development (changing, raising SoC) can also be made possible later in life, by corresponding techniques like those used in Shamanism.
The potential of a salutogenic orientation “can lead to working with the patient to engage in goal-oriented behavior that promises success, thereby strengthening the Sense of Coherence” (Antonovsky, 1985, p. 125). In the shamanic belief system, different to Antonovsky’s assumption of only minor possible changes in adult life, the feeling of unity and interconnectedness (SoC in the salutogenic sense) can be changed drastically any time in life: from the experience and feeling of illness, hopelessness and death to personal growth (see chapter 3 and 4.4). This is what Shamanism and its healing function is all about: to restore the sense of balance and the feeling of unity.
Antonovsky regards stressors including tension and its management as events which – depending on the SoC - can lead a person to an even higher SoC. Antonovsky’s question is, what can we practically and intentionally do to find an applicable salutogenic method to help people move towards the health end of the continuum (Antonovsky, 1985)? Apart from raising number and quality of GRRs, guided stressor and crisis (stress) intervention, directly raising the SOC and indirectly through its three components manageability, meaningfulness and comprehensibility, further possibilities are described in the next chapter.
4.5 Salutogenic Effects in Shamanism
Shamanism has its meaning and effects especially for the Shamans themselves, their clients, their tribes and the people who ask the Shaman for help and who take part in the rituals. In this chapter I describe some basic shamanic principles and techniques and how they are able to fortify or weaken certain salutogenic factors (e.g. SoC). In addition to medicinal treatments with herbs, etc., Shamanism offers different practical solutions for applying the – so far theoretical – salutogenic principles to increase a person’s SoC and state of health. There is, for example, ”the simple ‘hydraulic’ theory, that mental illness [or certain states of tension] is caused by the damming up of emotions and can be cured by letting them flow” (Dow, 1986, p. 58). Based on this theory an example for a solution could be intentionally placing a person e.g. by ritual and/or cultural force, into a situation with stressors (e.g. physical stressors in a sweat lodge). In this stressor loaded situation, tension arises, and unconscious problems automatically come to the surface, which were previously suppressed (“letting them flow”), and become conscious as do new ways of problem solving. Altered States of Consciousness (ASC) can bypass the conscious mind and work can be done directly on the subconscious mind to change e.g. the belief system and worldview. Changes in those states can be caused by suggestion (Winkelmann, 1997). Shamanic methods combined with preparation, support and guided interpretations, can create positive experiences (Dow, 1986), which match the term of ‘successful tension-management’ in Antonovsky’s model (figure 1). In Shamanism, guidance is offered from dismemberment (imbalance) to rebirth (equilibrium).
4.5.1 The Role of Altered States of Consciousness (ASC)
Satisfying basic human needs
Winkelmann found in his cross-cultural studies that ASC-based healing is a universal phenomenon (Winkelmann, 1986, 1992, cited in Winkelmann, 1997). Bourguinon confirms that humans in all cultures know about ASC (Bourguinon, 1973, cited in Rätsch, 1995). Noll writes that mental imagery, as a result of non-ordinary or Altered States of Consciousness, is ubiquitous and “has probably been experienced by individuals in all cultures and in all eras of human history” (Noll, 1985, p. 443). It is suggested that ASC is psycho biologically based, derived from its characteristics and its universal presence, associated with magical and religious healing practices and functional relationships of ASC with the abilities of healing and divination (Winkelmann, 1997). Besides Winkelmann, different authors point to evidence that the “desire to alter consciousness periodically is an innate normal drive analogous to hunger or the sexual drive”, as Weil expresses it (Weil, 1972, cited in Noll, 1985, p. 447; Siegel, 1989, cited in Winkelmann, 1997; Weil, 1986; cited in Rätsch, 1995; Rätsch 1995). Winkelmann has the opinion that religions basically have been the institutionalized forms for meeting the need for ASC (Winkelmann, 1997). The drive towards meaning finds its expression as an attempt of the ego to “reconstitute itself due to a critical experience” (Freud), in the experiences made during Altered States of Consciousness or trance states (Freud, 1911, cited in Peters and Price-Williams, 1983, p. 30; Peters and Price-Williams, 1983). This process of personality change is endogenous, where norms, values, and meanings of the culture are ideally assimilated and accommodated within the person (Peters and Price-Williams, 1983).
As a precondition for using his Salutogenic Model in a practical way, Antonovsky stated that basic human needs, like eating and drinking have to be fulfilled, (Antonovsky, 1985) but I can’t recall him mentioning other needs or drives like sexuality. I am also sure that he did not talk about the necessity of meeting the human need for ASC. In some cultures ASC (with their often mystical experiences) are supported, whereas in others they are suppressed (Rätsch, 1995).
Winkelmann describes the consequences for a society that views ASC (behavior) as aberrant, atavistic, and pathological: “Since these ASC behaviors represent fundamental human drives, the failure of legitimated religious organizations to address these needs means that other institutionalized forms of behavior will be developed to address the needs. In the context of U.S. society, several alternate behavioral patterns appear to address this biologically based need for ASC. One is the “bar scene” and alcohol consumptions, combining the physiological induction of ASC with the provision of community relations found in traditional shamanic practices. A second related ASC feature of modern societies is the illegal drug use considered to be a rampant problem in our country. Such drug-induced ASC can be seen as an alternate to transcendence. And finally, the increase of Eastern religions and associated meditative practices constitute another set of practices for inducing ASC. These phenomena suggest that societal failure to create legitimate modes for the alteration of consciousness will result in the emergence of other traditions that may be at odds with other aspects of society. The use of these ASC procedures in other societies is explicitly in the context of healing, which means “to make whole”. The physiological properties of ASC are a “wholing” of the individual, an interaction of different aspects of brain function. The common roots of heal, whole, and holy suggest that these conjunctions of healing and religious experience represent a fundamental adaptation of human societies to the manipulation of consciousness for health” (Winkelmann, 1997, p. 421). I would like to add other alternate behavior patterns e.g. TV-watching puts the brain into a relaxed alpha-state of mind within minutes. In North America, where a large amount of people have their TV running day and night, daily time spent watching TV increases rapidly. Even children watch several hours a day. In addition teenagers listen to techno music. High frequency drumming in combination with dancing, and often with drugs (e.g. Ecstasy), is used to enter ASC (Rätsch, 1998). Since no instruction, no underlying belief system or guidance is given in these cases, this is not useful for ones health, but rather leaves a great emptiness after those states have been reached. The meaning is missed. “Debilitating results” (e.g. “the real terror – and even suicidal urges”) might occur, if no senior Shamans are there “to help ensure that our dismemberment is followed by rebirth” (Canda, 1982, p. 18). In this sense Winkelmann writes that set and setting factors effect and thus are crucial for the outcome of the experience (Winkelmann, 1997). This means that positive set and setting influence physiological properties of ASC that tend to promote therapeutic processes (Winkelmann, 1997). Larsen and Canda see a great danger in Western societies where the same behavior and experiences occur, but the normative, conceptual and practical guidance by senior Shamans as well as the supporting cultural environment for the experiencers do not exist (Canda, 1982; Larsen, 1976, cited in Canda, 1982). The experiencers don’t know the mythological pattern and “that experience of deep despair is always prelude to an invitation to rebirth” (Larsen, 1976, cited in Canda, 1982, p. 18). If ASC is used appropriately, with guidance, meaning, purpose and underlying belief systems, valuable insights and positive health effects can be reached.
Rätsch discusses extensively the effects of different drugs and the absurdity of laws, allowing some (alcohol, nicotine) and forbidding others, without any proven scientific background concerning their differences and negative effects as potential of addictives (Rätsch, 1995).
I suggest adding ASC to the Model of Salutogenesis. Entering ASC (Altered State of Consciousness), plays a role in itself as a basic human need (like food and water) – being essential on the way to health. At the same time the regular practice of ASC, combined with a purpose (belief system) and guidance, for “the manipulation of consciousness for health” (Winkelmann, 1997, p. 421), can contribute to a higher Sense of Coherence, as a valuable regular life experience. As such, ASC (in some form) should be lived as the necessary life experience it represents.
Information and knowledge about all levels of human beings and their surroundings
Shamans, as humankind’s first healers, developed and use(d) ASC mostly by way of mental imagery in order to get information (Achterberg and Lawlis, 1984, mentioned in Krippner, comments in Noll, 1985). This information can occur as different sensory experiences, like hearing, smell, taste, and touch, while visualization is the basic and minimum sensory experience of the shamanic journey. Imagery is essential and “it is virtually impossible to experience the shamanic journey and most of the shamanic practice without the ability to visualize” (Harner, comments to Noll, 1985, p. 452). Apart from apprenticeship and learning from another Shaman, ASC seem to be the Shaman’s main sources of information. This information can be received directly or indirectly, seen as stories, myths or symbols, and be about diagnosis, treatment of disease (e.g. Noll, 1985), medicinal characteristics of plants, weather conditions, location of game and myths, etc.. It can become incorporated in one’s personal myths as client or Shaman. Although the mechanisms involved are still unknown, there are research results that imagery predicts with greater accuracy than physiological indices e.g. in remission from cancer (the standardized Imagery of Disease test, Krippner, referring to Achterberg and Lawlis, 1984, comments in Noll, 1985). Achterberg concludes that imagery must be regarded “as the essence of many shamanic practices and as a cross-cultural resource for diagnostic and therapeutic information” (Achterberg, comments in Noll, 1985, p. 451). In her opinion “in order to reinstate imagery as a legitimate, even indispensable, aspect of medicine and psychology, additional research must answer two difficult questions: What are the psychobiological mechanisms involved in the phenomenon? Does it work for any of the purposes its tenacious history suggests?” (Achterberg, comments in Noll, 1985, p. 451).
Health and therapeutic effects of ASC respectively imagery
ASC facilitates the typical shamanic tasks of healing and divination (Winkelmann, 1997). It has direct and indirect outcomes on health (Winkelmann, 1997). Numerous reasons for this functional relationship of ASC to healing and divination abilities are suggested by research (Winkelmann, 1997; Dow, 1986; Neher, 1962). Some authors described correlations between imagery analyses and matching immunological responses (standardized Imagery of Disease test, e.g. Schneider, Smith, and Whitcher, 1983, mentioned in Krippner; comments in Noll, 1985). Winkelmann calls visualization (imagery) as “a successful strategy for effecting physical systems through psi (psycho kinesis), suggesting, [...], that visual imagery has an adaptive role in facilitating healing” (Winkelmann, comments in Noll, 1985, p. 457). ASC causes physiological changes which improve psychological- and physiological well-being in a number of ways (Winkelmann, 1997). This includes physiological relaxation, facilitating self-regulation of physiological processes, reducing tension, anxiety, and phobic reactions, inducing and eliminating psychosomatic affects, facilitating extrasensory perception and psycho kinesis, bypassing normal cognitive processes in accessing unconscious information, interhemispheric fusion and synchronized coherence, cognitive-emotional integration, and social bonding and affiliation (Winkelmann, 1997). Direct health outcomes were for instance lowering of blood pressure, controlling of hypertension, relaxation with therapeutic effectiveness against a range of stress-induced-maladies (Winkelmann, 1997). Neher describes a ‘pain-killer’ function (Neher, 1962). Altered States of Consciousness have already been successfully used as therapeutic tools resulting in the psychedelic paradigm “recast the psychiatrist as a modern day Shaman” (Bravo and Grob, 1989, cited in Winkelmann, 1997, p. 408).
Based on the example of ASC caused by drumming, Harner and Tryon described positive health effects (Harner and Tryon, 1996). They showed in a quantitative study that journeying with drumming had significant positive psychological and physical effects on well-being, lowering states of anxiety, fatigue, confusion, tension, stress, depression and anger, and mood disturbance. Thus ASC seems to be an effective means in order to reduce tension and stress in the sense of Antonovsky, apart from direct positive effects on health. In this study the baseline group was resting, listening to birdsongs. People with one to seven years journeying/drumming experience were studied. The included physiological parameters, acting as physical and biochemical GRR in Antonovsky’s sense, were influenced actively and consciously: “Positive-constructive imagery style as a trait characteristic is positively correlated with concentration of S-IgA [Immunglobulin]. Distinct patterns of trait features appear to be associated with levels of immune response as measured by S-IgA concentration” (Harner and Tryon, 1996, p. 95). In this sense rhythmic sensory stimulation, as well as light stimulation (e.g. fire) as in drum ceremonies or in the laboratory result in similar physiological and psychological characteristics (Neher, 1962). The most effective frequency range for obtaining responses to rhythmic light or sound stimulation is between slightly lower than eight to thirteen cycles per second (Neher, 1962). Ceremonial drumming frequencies lie between 7 to 9 cycles per second (Neher, 1962).
As Winkelmann describes, widely divergent stimulation respectively ASC induction techniques and conditions (rhythmic auditory stimulation, extensive motor behavior, fasting and nutritional deficits, sensory deprivation and stimulation, sleep and dream states, meditation, sexual restrictions, endogenous opiates, hallucinogens, alcohol, community rituals, etc.) evoke the same common response of the human brain (Winkelmann, 1997; Neher, 1962). This evoked brain response is characterized by limbic system slow wave discharges that synchronize and dominate the frontal cortex. This common response from widely divergent stimulation indicates that this is a biologically based mode of human consciousness. The physiology of ASC and its consequences have been researched and described by different authors (Winkelmann, 1997). A wide range of ASC induction conditions and procedures are associated with the following psycho physiological changes, physiological integration and coordination (Winkelmann, 1997, p. 405):
The parasympathetic-dominant state goes along with a basic relaxation response. This has preventive and therapeutic value in many diseases and represents the basic body response to counteract the over activity of the sympathetic nervous system (Winkelmann, 1997). Further biochemical explanations for shamanic experiences are based on neurotransmitter substances in the brain which govern the rate and nature of communication across brain synapses (Carpenter and Buchanan, 1995; Wyatt, Kirch and Egan, 1995; both cited in Stephen and Suryani, 2000). According to Winkelmann basically all described physiological effects do have inherent benefits for the functioning of the human system (Winkelmann, 1997). The comparatively greater predominance of brain activity from the right hemisphere and non-frontal parts of the brain can be seen as “having therapeutic effects sui generis” (Winkelmann, 1997, p. 405). In contrast to ASC dominated by the right hemisphere, ordinary states of awareness are dominated by the left hemisphere, characterized by rational, linear, verbal modes of experience and the activation of the sympathetic nervous system (Winkelmann, 1997).
ASC have the function to make the inner world conscious (the unconscious accessible), connect with it and let suppressed feelings and emotions come out, break up the habitual views of the world and show other perspectives and ways of solutions. This is what I experienced and observed myself in the sweat lodge purifying ritual (see chapter 1) where we were put under extreme physical stressors (heat, smoke, complete darkness, loud drumming (ASC), singing, crowdedness). Suppressed emotions came out and people cried, etc.. Similar mechanisms have been described cross-culturally in literature basically saying that through ASC (healing rituals), repressed unconscious aspects of self (bodily processes, memories, complexes) are expressed by the activation of their brain/mind interface, reducing critical screening, causing emotional events, and presenting new messages (e.g. Budzynski, 1986; Winkelmann, 1997). By this conscious-unconscious integration and ‘abreaction’, (personality) conflicts - often results of failure of the conscious mind to understand and know about the unconscious mind - are resolved (Budzynski, 1986). The influence of ASC on cortical arousal is able to reduce critical screening by the left hemisphere, thus limiting the repression of the unconsciousness. In this way, the normally repressed side of the brain is permitted expression and reprogramming at these unconscious nonverbal levels (Budzynski, 1986). In normal states, dominant frontal hemispheres often repress the unconscious mind, although - nonetheless - the right hemisphere persists and effects behavior, emotions, and physiology. Within the ASC those unconscious aspects can be controlled and regulated consciously (Budzynski, 1986). ASC stimulate memories, bringing them to consciousness, where they can be worked on.
The processes within the ASC are also the basis for a more objective perception of the external world (reality), rather than being bound up in subjectivity (Winkelmann, 1997). The typical sense of self is altered or dissoluted (e.g. release from egocentric fixations etc.), which means the worldview changes dramatically by breaking up the habitual experiences of the world. The client becomes more open to multiple interpretations and integrates new awareness (Langner, 1967, cited in Winkelmann, 1997). The ASC can be viewed as a means of recognizing the illusions and constructed nature of ordinary perception (Winkelmann, 1997). Sargent confirms the effects of ‘changed beliefs’ and erased memories (Sargent, 1974, cited in Winkelmann, 1997).
Susceptibility to reprogramming as well as suggestibility is increased (Sargent, 1974; Langner, 1967, both cited in Winkelmann, 1997). The Shaman uses the increased suggestibility for psycho emotional reprogramming with chants, songs, myths, psychodrama, and direct suggestion (Winkelmann, 1997). Increased suggestibility is made responsible for physiological improvement for the client, possibly by increased placebo or other psychosomatic effects (Winkelmann, 1997). Sargent describes my observed effects (tension and emotional excitement, chapter 1) confirming the Sweat Lodge experiences, and explains “the induction of a total parasympathetic collapse from stress and emotional excitement has a variety of effects upon previous learning” (Sargent, 1974, cited in Winkelmann, 1997, p. 406). These include complete abolition of conditioned reflexes and the ultra paradoxical phase in which the conditioned behavior and responses are reversed” (Sargent, 1974, cited in Winkelmann, 1997, p. 406).
All the described therapeutic- and health effects are also valid for numerous hallucinogens or psychedelic substances as another form to enter ASC. This is “in spite of predominant Western perspectives that hallucinogens are dangerous drugs” (Winkelmann, 1997, p. 406). These effects derive from the general aspects of Altered States of Consciousness induction and the associated psycho physiological effects of the hallucinogens itself (Winkelmann, 1991, cited in Winkelmann, 1997). They play the role of a medicinal aid in the total context of psychotherapy. Examples are psychedelic therapy, which names the model of LSD therapy (Schultes and Hofmann, 1979, cited in Winkelmann, 1997; Winkelmann, 1997; Grof, 2002). Because of the ability of directly accessing embedded traumas, emotions, and conflicts relevant to problems within the therapeutic use of LSD, patients had less need for the therapist (Langner, 1967, cited in Winkelmann, 1997). The psychedelic approach employed a single large dose of LSD, using it to facilitate peak and mystical experiences that would bring about major personality changes (see above). These personality changes indicated that the beneficial therapeutic outcomes derived from these LSD-induced ‘peak experiences’ (mystical insights), which provide a profound sense of interconnectedness, unity, and meaningfulness (Kurland, 1985, cited in Winkelmann, 1997). The reason for the dramatic effect of LSD in psychotherapy is that it promoted a resolution of psychosocial conflicts and provided access to a sense of higher self. These experiences gave the client a greater sense of self-control and the opportunity to make use of his insights for life changes. LSD and similar agents, as forms of ASC, activate repressed memories, producing catharsis and abreaction, leading to an awareness and sense of freedom (Kurland, 1985, cited in Winkelmann, 1997). Winkelmann writes about a wide range of research, which showed that psychotherapy could largely benefit from the use of e.g. LSD (Winkelmann, 1997). Reasons for inherent therapeutic effects like psycho integrative effects of these substances have a neurophysiological basis (Winkelmann, 1997), causing e.g. interhemispheric integration of thought and feeling (Mandell, 1985, cited in Winkelmann, 1997).
Possible health effects of meditative practices as one form of ASC
Exampling meditation (meditative practices) as one form of ASC, health and therapeutic effects are widely reported (Shapiro, 1980, 1990; Walsh, 1983; all cited in Winkelmann, 1997). They are congruent with the above general findings on ASC. Meditative practices
4.5.2 An Effictive Tool in the Salutogenic sence: the Shamanic work with Myth
ASC as described above, is able to break down old behavior patterns and to open a person for suggestion. Then, in order to heal, the Shaman’s suggestive techniques come into play, myth being one main component. Myth is the vehicle for symbolic healing, it works with symbols. As a basic condition, the manipulation within the shamanic cure - be it manipulation of ideas or organs – must be carried out through symbols, which means meaningful equivalents of things which belong to another order of reality (Lévi-Strauss, 1979).
Krippner’s functions of myths listed below basically describe their salutogenic meaning, by naming their effect on the SoC, namely influencing (raising) the personal feelings of comprehensibility, manageability and meaningfulness. He just uses different words to express the same components as Antonovsky did. “These cultural myths were narratives that: (1) explained the workings of the world [comprehensibility]; (2) reaffirmed the social order; (3) assisted people’s developmental birth-to-death process [manageability]; and (4) connected them with a spiritual link to the cosmos” [meaningfulness] (Krippner, 1987, p. 23).
Cultural myths moved societies along – or held them back by setting the parameters for what was permitted and what was possible” (Krippner, 1987, p. 23). Krippner describes myths as concepts that people use to make sense of reality, which basically means meaningfulness in Antonovsky’s sense (Krippner, 1987). Myths explain the workings of the world (Krippner, 1987) which causes higher comprehensibility in Antonovsky’s sense. Assisting in people’s developmental birth-to-death process can contribute to higher manageability. A high sense of meaningfulness can be reached by the connection from human beings with a spiritual link to the cosmos. The reaffirming of the social order (Krippner, 1987) even shows parallel aspects to Antonovsky’s concept of lawfulness, the feeling of security and in a sense also to manageability (Antonovsky, 1985).
Krippner describes in his words basically the salutogenic impliances (elements of the Salutogenic Model, which are listed in brackets) of (shamanic) work with personal myths, helping people (Krippner, 1987):
Myth is the base for the working of both, shamanic and modern therapeutic techniques. Krippner stresses its meaning even in today’s technological world, where myth has the ability to promote well-being of individuals and groups, “if its messages are honored, respected, and understood” (Krippner, 1987, p. 27). Myth and its therapeutic value are based on symbols and metaphors which are universally valid as “artistic and literary devices that have been able to move people profoundly over the millennia” (Krippner, 1987, p. 27). The techniques in Shamanism, religious healing and Western psychotherapy all represent different forms of symbolic healing and share a universal structure (Dow, 1986). This universal structure of symbolic healing is a result of human social communication, having evolved from the structure of emotional communication and being biologically organized by evolution (Dow, 1986). The basic assumption for symbolic healing is that there are psychological processes in which symbols effect the ‘mind’, which in turn effects the body (Dow, 1986). Symbols, as verbal metaphors, are thought to be the only access to the unconsciousness and (psychopathological) disturbances (Lévi-Strauss, 1979). Precondition for symbolic healing to work is that a general (cultural) model of the mythic world is established, maintained and believed in by healers and potential clients (Dow, 1986). This particularized mythic world must exist for both the therapist and the client and the client must accept the power of the therapist (Shaman) to define the relationship to it (Dow, 1986). In this context it doesn’t matter that the mythology of the Shaman does not correspond to an objective reality. The clients (and the society) just need to believe in it.
The “spirits, the supernatural monsters and magical animals, are all part of a coherent system on which the native conception of the universe is founded” (Lévi-Strauss, 1979, p. 323). While the function of mythic worlds can be the same, their forms and their locations (e.g. in a supernatural realm, as part of everyday reality or as scientific knowledge) can be different (Dow, 1986). The shamanic processes used are making the old myth conscious and within this condition of higher suggestibility (see chapter ASC above) change the myth through symbolic / metaphoric work for clients (see below, Dow’s structure of the shamanic curing process). The Shaman or therapist attaches the client’s emotions to transactional symbols and manipulates these symbols (Dow, 1986). That means Shamans create respectively mirror the myth for the client which then can be symbolically changed.
The following citation by Lévi-Strauss compares well this mechanism of a shamanic cure by the use of myth with a possible Western medicinal approach: “Once the sick woman understands, however, she does more than resign herself; she gets well. But no such thing happens to our sick when the causes of their diseases have been explained to them in terms of secretions, germs, or viruses. We shall perhaps be accused of paradox if we answer that the reason lies in the fact that microbes exist and monsters do not. And yet, the relationship between germ and disease is external to the mind of the client, for it is a cause-and-effect relationship; whereas the relationship between monster and disease is internal to his mind, whether conscious or unconscious: It is a relationship between symbol and thing symbolized, or, to use the terminology of linguists, between sign and meaning. The Shaman provides the sick woman with a language, by means of which unexpressed, and otherwise inexpressible, psychic states can be immediately expressed. And it is the transition to this verbal expression [...] which induces the release of the physiological process [...]” (Lévi-Strauss, 1979, p. 323).
Nails being pulled out of the body for the manipulation of transactional symbols may seem ridiculous, but this form of symbolic healing can be a significant experience for the client if the healer does the job well (Dow, 1986). Based on how a Shaman has described the cause of an illness, he uses different combinations of propitiation, magic and exorcism (Spiro, 1967, cited in Dow, 1986). This means, the myth aims at recreating a real experience in which the myth merely shifts the protagonists (e.g. within the technique of the narrative) (Lévi-Strauss, 1979). In this case, the curing is based on restructuring a disorder modeled in a mythic world (Munn, 1973, cited in Dow, 1986). There is a parallel between events in a mythic world and the somatic condition of a client (Dow, 1986). Through the media emotions, the self and the somatic systems are linked. The client’s belief in the therapist’s power to help enables change and the ability to find new opportunities for adaptation (Dow, 1986).
Dow outlines this structure of the shamanic curing process (by myth) in different stages (Dow, 1986, p. 66):
Catharsis, described as being at the base of all religious healing, expresses what may be several different types of emotional transactions (Girard, 1977; Feshbach, 1984, both cited in Dow, 1986). Confession is seen as cathartic therapy among American Indian groups (La Barre, 1964, cited in Dow, 1986). A transculturally most fruitful model of symbolic transaction in this sense is Scheff’s emotional distancing, which explains the therapeutic functions of religious ritual (Scheff, 1977, 1979, cited in Dow, 1986). It means changing the perspective for the client in order to become the observer. With this essential element in all suggestive techniques, the healer is able to develop new patterns of thought and behavior in a client, which would not be possible in a normal environment (Dow, 1986).
Apart from the outlined structure for mythical healing by Dow (above), there are other patterns and explanations, for the healing effect through work with myths. An example of modern research about creating and changing personal myths and health promoting behavior is described by Krippner: Subliminal psychodynamic activation with a 4-millisecond exposure of stimuli intended to activate unconscious symbiotic-life fantasies (e.g. the words ‘Mommy and I Are One’), have been employed (Krippner, 1987, p. 25). “The beneficial effects of this stimulation were often dramatic and long-lasting” (Krippner, 1987, p. 25). Positive results occurred with e.g. smokers, that stopped smoking, but also with alcoholics, people phobic to insects, people engaged in group therapy, persons with assertiveness disorders and adolescents with personality disorders, who were all involved in some kind of training or therapy (Krippner, 1987). The conclusion was that “if a fantasy can connote a situation where one is constantly fed and nurtured” (feeling protected and comforted, fantasies of oneness with the mother), “one can reduce the necessity to seek dependency gratification (dependency-related needs) in maladaptive behavior such as alcoholism, drug abuse, and overeating” (Krippner, 1987, p. 26). Anxiety was allayed, positive effort for behavior change mobilized, receptiveness to psychotherapists and promoting adaptive behaviors increased (Krippner, 1987; O’Dowd, 1986, cited in Krippner, 1987).
The Shaman was always the specialist in procedures that utilize one’s capacity for identifying and changing one’s myth about health (Krippner, 1987).
Shamanism and Western psychotherapy
That Shamanism, religious healing and Western psychotherapy, invoke similar psychological processes is widely accepted (Opler, 1936; Lederer, 1959; Frank, 1961; Tseng and McDermott, 1981, all cited in Dow, 1986; Pandian, 1997, etc., see chapter 4.5.1). Furthermore, many researchers describe shamanic healing techniques as completely comparable therapeutic methods to such as psychotherapy and psychoanalysis, where parallels in methodologies are exactly analyzed and proven (e.g. Lévi-Strauss, 1979; Jilek, 1994; Green, 1998), although shamanic techniques are more often applied to groups than to individuals (Jilek, 1994). Lévi-Strauss even calls psychoanalysis “the modern version of shamanic technique”, which “derives its specific characteristics from the fact that in industrial civilization there is no longer any room for mythical time, except within man himself” (Lévi-Strauss, 1979, p. 327). In this regard, Andritzky advised recognizing the unforeseen value of the magic-religious elements (e.g. traditional medicine (in Peru)) as a kind of psychosomatic medicine (Andritzky, 1999, p. 44). For Pandian, Shamanism represents both, a kind of psycho cultural-therapeutic system and a kind of religious communication, having consequences for the maintenance of the integrity of the symbolic self and culture (Pandian, 1997). When disintegration of the symbolic self and “cultural distortion” occur – as nowadays – “shamanic communication with the sacred-other takes on an added significance in society” (Pandian, 1997, p. 511).
Compared to psychoanalysis “the shamanic cure seems to be the exact counterpart to the psychoanalytic cure, but with an inversion of all elements” (Lévi-Strauss, 1979, p. 324, table 4). There are strong similarities between both, shamanic initiation and a certain kind of deep psychological experience (Halifax, 1990). Psychoanalysis and Shamanism are forms of symbolic healing with a universal structure (Dow, 1986; see above). Both kinds of cure provoke the experience and recreate a myth, which the client has to live or relive (Lévi-Strauss, 1979, see above). In psychoanalysis, as well as Shamanism, these mythic worlds (representing models of experiential realities) are the basis for every system of symbolic healing (Dow, 1986). As the experience becomes structured, regulatory mechanisms (beyond the subject’s control) are spontaneously set in motion and lead to an orderly functioning (Lévi-Strauss, 1979). The Shaman plays the same dual role as the psychoanalyst. In both cases healing is a matter of stimulating an organic transformation (structural reorganization) by intensively inducing the client to live out a myth – either received or created by him – “whose structure would be, at the unconscious level, analogous to the structure whose genesis is sought on the organic level” (Lévi-Strauss, 1979, p. 325). Both methods work through the accessibility of symbols, effectively guarantying the harmonious parallel development of myth and action which always form a pair associated with the duality of client and healer. According to Lévi-Strauss, in Shamanism as well as in psychoanalysis, the purpose is to bring conflicts and resistances, which have remained unconscious, to a conscious level (Lévi-Strauss, 1979). They have either been repressed or other psychological forces worked on them. Conflicts and resistances cannot be resolved because of knowledge alone, but because of applied knowledge that makes a specific experience possible, in which conflicts materialize, permitting their free development and leading to their resolution (‘abreaction in psychoanalysis’) (Lévi-Strauss, 1979, p. 324). The comparison between the Shaman’s method and certain recent therapeutic techniques of psychoanalysis show even more the striking resemblance between them (Lévi-Strauss, 1979). The differences between both methods only show inversions of the roles between Shaman / therapist and their clients (table 4).
Table 4: Some differences showing the inversion between psychoanalytic and shamanic cures, described by Lévi-Strauss (1979).
Lévi-Strauss concludes that working with the remembrance of past events is only one expression of a more fundamental method (Lévi-Strauss, 1979).
Compared to Western scientific form of psychotherapy, there are potential advantages of shamanic (psycho)therapy, which include the whole range of shamanic treatments. The interaction between Shaman and client has a ‘therapeutic value’ in itself (Kim, 1975). Likely reasons are that the Shaman meets the expectations of the client in addressing psychological, physical, social, and economical problems in the process of providing care for a culturally defined illness (Yoon, 1976, cited in Kendall, 1977). Contrary to the stigma of mentally ill persons within a psychiatric treatment, the therapeutic alliance between client and (shamanic) therapist who are sharing their ethnic background, language and social class, strengthens the positive therapeutical outcome. Acceptance of the clients’ interpretations of their illness and understanding of their cultural background represent further advantages (Razali, 1999). This supports Antonovsky’s salutogenic approach, where the clients have to be seen ideally with their complete (social) situation and history, in order to be able to raise their health level (Antonovsky, 1985). This is easier when there is a certain kind of trust and relationship, as described for shamanic treatments (Razali, 1999).
If trust in a healer and therapist exists, the sense of manageability is strongly influenced, as is the feeling of unity (SoC). It is the availability of knowledge and trust in a person who shows the way (Shaman) as a strong GRR. This is expressed in the following example: “Dona Maria’s feeling’s of unity with nature and with the spirit world is revealed by” her chants. “She, and other Shamans, learn from the ‘spirits’, ‘the waters’, and ‘the divine sea’. Tradition and holy writ might provide source material for the Shaman, but it is his or her ‘heart’ and ‘soul’ that are final arbiters of knowledge” (Krippner (2), 2000, p. 95).
The importance of this kind of therapeutic interaction is confirmed by Ellison and Levin, who have shown that the cognitive expectations of clients and their therapists (physicians) can influence prognosis, therapeutic efficacy, course of treatment, and even the clinical endpoint like recovery or mortality (Ellison and Levin, 1998). Behind that stands the conception that ‘people make their own reality’, at least when it comes to health (Ellison and Levin, 1998).
Further salutogenic effects by the use of myth and its therapeutic value
In one example Fäh describes the change of the Sense of Coherence through intrapsychic processes (Fäh, 2002). He states the discovering and realization of one’s own self-images and self-needs as a key element of the psychotherapeutical effect (Fäh, 2002). Bollas describes this as the learning of “self-management”, recognizing one’s own needs and consequently creating an environment (relationships, etc.), which corresponds to these needs (Bollas, 1992, cited in Fäh, 2002, p. 152). Fäh writes that psychoanalytical therapy can help to learn to deal with the ‘human condition’, that means with the inner world, the own urges and states of excitement in a creative and life artistic way and to give up rigid defense- and control-mechanisms (Fäh, 2002).
Mythical advices for practical actions by the Shaman can make life (stressors/events/crisis) more manageable. The Shaman supports those, who seek his help by giving advice and by involving the family or clan in the healing process and ritual. Thus often reuniting social ties and bringing back social support to the clients by their family/clan.
The effectiveness of many (but not all) healing rituals can be explained by neurobiology. Rituals can cause emotions and the production of stimuli (neurochemicals), by causing stressful situations with consequent euphoria, which produce psychological states, responsible for ritual cures (Dow, 1986). Stressful situations can be expressed as stressor loaded situations causing tension, in Antonovsky’s terms, and their successful management as leading to more health on the continuum. In this regard, the release of endorphins causes certain psychological states and functions also as pain reducer and thus also leads to [more] well-being (Dow, 1986). Psychotherapeutic methods working with myth are able to contact the deep levels of one’s psyche and soma, facilitating positive unconscious motivation and raising the function of the immune system (Krippner, 1987).
It can be concluded that the shamanic work with myth, as a form of symbolic healing which originated from the human structure, (re)creates experiences (on the mythic level) and successful coping with stressors. This aspect can be regarded as a coping strategy, and an addition to Antonovsky’s concept of Salutogenesis. Even after the unsuccessful attempt to cope with stressors (in Antonovsky’s model, figure 1), this form of shamanic work can intervene and lead to successful coping respectively managing of stressors (tension) and stress.
4.5.3 The Role of Ritual and Magic in the Salutogenic sence
Different authors agree that ritual can have an important social function and symbolically presents the meaning in life (Munn, 1973; Krippner (2), 2000). Therefore in Antonovsky’s salutogenic sense it can serve as a GRR (social function) and can fortify the sense of meaningfulness. Munn describes ritual “as a societal control system, a generalized medium of social interaction”, where the individual is linked to a community of significant others through the symbolic mobilization of shared life meanings, while Krippner regards it as “an opportunity to express the community’s conceptions of reality in a social setting” (Munn, 1973, p. 605; Krippner (2), 2000, p. 94). Krippner sees it as a stepwise social performance, which is the key to the structure of a group’s mythology, or worldview (Krippner (2), 2000). In shamanic societies, ritual with its symbols and metaphors is a stylized technology which can trigger healing, relieve suffering, and provide a link between the ordinary world and non-ordinary realms (Krippner (2), 2000, citing several authors: Krippner, 1993; Turner, 1992; Turner, 1968). Ritual and the ritual use of culturally validated symbols, acts, and objects are associated with implicit and explicit suggestion, as the main features held in common by traditional (shamanic) approaches (Jilek, 1994). These suggestions, embedded in shamanic rituals (magic, shamanic/hypnotic), were shown by a wide range of research (anthropology, folklore, hypnosis, medical history, psychoneuroimmunology, and religion) to have different therapeutic effects, like reducing pain, enhancing healing, controlling blood loss, facilitating childbirth and alleviating psychological disorders (McClenon, 1997). Further direct health outcomes of shamanic rituals using suggestive hypnotic processes lead to psychological mechanisms, causing the increase of survival and fertility (McClenon, 1997). The explanation suggests emotional states which can alter mortality and fertility because psychosocial factors influence diseases (McClenon, 1997). Diseases are effected not only in their susceptibility, but also in their progression (McClenon, 1997).
In our Western world today, developmental rituals (such as puberty rites and vision quests) have disappeared with the exception of baptisms, marriages, funerals, and a few other rites of passage that have become increasingly insipid and secular (Krippner, 1987). Instead, science now explains that “mechanisms of the environment, laws and custom-regulated social interactions, and institutionalized religions claim to provide a route to salvation or enlightenment” (Krippner, 1987, p. 23). New forms of Shamanism could help to fill this gap.
Magic is defined by Malinowski as a “special type of ritual activities”, which develops in cultures because of unexplainable and unpredictable events, such as inability “to control chance, to eliminate accidents, to foresee unexpected turns of natural events, or to make human handiwork reliable and adequate to meet all practical requirements” (Malinowski, 1931, cited in Antonovsky, 1985, p. 118). He describes health as the richest domain of magic (Malinowski, 1931, cited in Antonovsky, 1985). The power of magic is attributed to its suggestive power and to the performer’s adherence to standard formulas (Malinowski, 1948, cited in Dow, 1986; Dow, 1986). Magic has the character of a science or technology, with its primary suggestion that faith and hope will succeed when people are overwhelmed by doubt and fear. Thus magic aids culture by supplying “a number of ready-made ritual acts and beliefs, with a definite mental and practical technique which serves to bridge over the dangerous gaps in every important pursuit or critical situation” (Malinowski, 1948, cited in Dow, 1986, p. 58). It strongly supports the sense of manageability in Antonovsky’s sense. Antonovsky also cites Malinowski to distinguish religion from magic: Religion “creates values and attains ends clearly, whereas magic consists of acts which [...] are effective only as a means to an end” (Malinowski, 1931, cited in Antonovsky, 1985, p. 118).
4.5.4 Further Shamanic aspects and their role in the Salutogenic sence
In Canda’s view, Shamanism basically represents the therapeutic commitment of the social work profession as well as of other helping and healing professions, especially under the rubric of ‘holistic health’ (Canda, 1982). Primary concern is “the bringing together in harmony and maximum fulfillment of the person, the society, and the non-human environment” (Canda, 1982, p. 13). This includes the salutogenic health definition (chapter 2, chapter 4.1). “Shamanic holism is probably the oldest and most prevalent surviving style of therapy in the world” and therefore the “new holistic approaches in medicine and mental health are really returns to primal insights” (Canda, 1982, p. 13). This is confirmed by Krippner, saying that shamanic studies teach us a great deal about the healing process of the individual and the cultural enrichment of the tribe (Krippner, in comments to Noll, 1985).
Concerning substance use problems, shamanic therapeutic management commonly includes features like the client’s public admission of harmful behavior combined with a solemn pledge of correction and specific procedures intended to eliminate the addicting substance by various methods of internal and external ‘purification’ (Jilek, 1994, p. 245). Thus social acceptance and support as GRRs in the sense of Antonovsky can be reestablished.
Shamanic rhetorical practices are described to provide benefits, particularly for mild psychiatric and psychosomatic disorders (Csordas and Kleinman, 1990, cited in McClenon, 1997). Besides hypnosis, also herbal and placebo effects may be responsible for the shamanic efficacy on direct health outcomes (Schumaker, 1990, cited in McClenon, 1997).
The self (middle, perceivable world) and the sacred (supernatural world) are connected by the Shaman. In this linkage, the shamanic self, as a type of symbolic sacred coherence, represents a living example, a vivid proof for both the corresponding belief system (symbolic sacred coherence) and one’s own position in this world. This vivid proof can raise the sense of meaningfulness in the salutogenic view. The linking shamanic self manifests in cultural settings in which a resolution of stress/crisis (respectively tension, stressor and stress in Antonovsky’s terms) occurs. In such situations of crisis, the role of the Shaman being associated with rituals of divination, witchcraft, and healing becomes important (Pandian, 1997).
4.5.5 The Salutogenic role of Spritual and Religious aspects in Shamanism
Spirituality, as the opposite of the pure scientific world-image, can be regarded as a belief system containing supernatural beings, gods, etc., being a basic element of traditional Shamanism.
Canda calls the Shaman a religious specialist of healing (Canda, 1982). Pandian distinguishes between the shamanic self, which occurs in Shamanism through contact or union with the sacred other being linked with biological/psychological health and ritual, and the priestly self, which is aligned with social/political order (Pandian, 1997). “The Shaman is the prototype for the representation of the biopsychological dimension or processes; the priest is the prototype for the representation of the sociopolitical dimension or processes” (Pandian, 1997, p. 509). He describes Shamanism as “a non-religious orientation because the basic premises of Shamanism are not related to conventional morality or social processes but to the restoration of psychological and/or biological equilibrium” (Pandian, 1997, p. 511). In contrast, other authors regard Shamanism as a form of religiosity (see chapter 3.2). As I have already described, Shamanism certainly contains religious elements but is not a religion, although it was originally even more than that. Religions probably evolved from certain aspects of Shamanism. According to Ellison and Levin there should be distinction between “behavioral and functional aspects of religious involvement” (Ellison and Levin, 1998, p. 710). Behavioral indicators of religion would be, for example, frequency of religious attendance, prayer and media consumption (Ellison and Levin, 1998). The effects of religious behavior can – to a certain extent – be seen in Shamanism as well and therefore are described here.
Researchers interested in coping overlooked the role of religion for years and others even suggested much more research is needed “to better understand what role religion and spirituality can and do play in the prevention, onset, status, care and resolution of illness” (Weaver et al., 1998, p. 189). There is a widely observed salutary effect of religious involvement and subjective religious identity to health - like religious attendance, devotion and personal piety, frequency of prayer and feelings of closeness to God (Ellison and Levin, 1998). These positive effects are valid for physical and mental health (psychological well-being, life satisfaction, happiness, etc.). They effect health-related behaviors, beliefs, attitudes and thus patterns of health care use (Ellison and Levin, 1998). Examples of results, indicating such effects through religiosity are:
1) Religion represents one mechanism of social control: regulating health-related resources (e.g. dietary constraints, prohibition of smoking and alcohol and fertility resources) (Jarvis and Northcott, 1984, cited in Anson et al., 1990), also addressed by Ellison and Levin (1998) in their ‘Prevention Model’.
Health related resources are promoted by healthy beliefs and regulation of individual lifestyles and health behaviors. Examples are: discouraging certain behaviors that increase the risk of disease and violate internalized religious norms with feelings of guilt, shame and fear of divine punishment like hellfire and encouraging positive, low-stress lifestyle choices, inverse relation between religious involvement and alcohol, tobacco, substance use and abuse, less risky sexual behaviors, distinctive dietary practice, encouraging moderation, moral and ethical teachings, moral guidance, practical advice about family life (Ellison and Levin, 1998). Religious involvement may enhance health by lowering the risk of stress [stressors] and problems within the domain of marital and family life (Ellison and Levin, 1998).
2) Religion as a social institution provides social support and social integration (Jarvis and Northcott, 1984, cited in Anson et al., 1990)
Social resources and support is provided by social ties, formal and informal support, tangible or instrumental aid (e.g. goods and services), socioemotional assistance (companionship and increasing access to supportive intimate relations with spouses and other family members) (Ellison and Levin, 1998). Religious groups (churches) can enhance perceptions of support by fostering a sense of community that leads individual members to feel loved, cared for, valued, and integrated. Supportive relationships are most beneficial when involved persons have similar status characteristics, experiences, and values (Ellison and Levin, 1998). Salutary effects of various types of social resources on mental and physical health outcomes are widely documented (Ellison and Levin, 1998). Social integration factors like network size, frequency of interaction, objective and subjective support (satisfaction with and anticipated support) are distinguished. The more regular involved person has stronger social support and resources, like larger and denser social networks, as well as more frequent and varied exchanges of goods, services, and information than the less regular involved person (Ellison and Levin, 1998).
3. Religiosity provides a comprehensive world view and meaning for human existence (Jarvis and Northcott, 1984, cited in Anson et al., 1990).
Religion plays a role in terms of personal and cultural integration and meaning (Pandian, 1997). Religious symbols “synthesize conceptions of order and experiences of disorder, functioning as paradigms for comprehending the world of human existence and human experience in a coherent and integrated manner” (Geertz, 1973, cited in Pandian, 1997, p. 515). Religiosity could be particularly important as a response in the context of personal crisis and major life transitions, because it offers “meaning for suffering and comfort for the distress caused by the deterioration of physical and psychological well-being” (Anson et al., 1990, p. 94). Religion provides an interpretation scheme and a supreme power for consolation (Anson et al., 1990). This is the explanation why the decline in physical and psychological well-being is associated with an increase in religiosity (Anson et al., 1990). Religiosity and likewise Shamanism support the sense of meaningfulness.
4) Religious involvement offers a special support in difficult situations such as suffering, bereavement and role loss (Jarvis and Northcott, 1984, cited in Anson et al., 1990).
This also addressed by Ellison and Levin in their ‘Stressor Response Model’ (Ellison and Levin, 1998). Religion provides specific coping resources, coping styles, like the collaboration with a divine other, and attaining positive results in cognitive or behavioral responses to stress [stressors] (Pargament, 1988, cited in Ellison and Levin, 1998). “Religious cognitions and practices may aid in coping with stressors in several ways. Prayer and other intrapsychic religious coping efforts may alter primary appraisals, leading religious persons to reassess the meaning of potentially problematic conditions as opportunities for spiritual growth or learning, or as a part of a broader divine plan” (Ellison and Levin, 1998, p. 708). In (pastoral) counseling and through church programs, individuals receive help in managing emotions and solving problems (Ellison and Levin, 1998). Religious coping is not only popular but also effective for certain social groups, like elders and women (Ellison and Levin, 1998). In particular those religious cognitions and behaviors that center on prayer, meditation (compare chapter 4.5.1, ASC) and other devotional pursuits, seem to be especially valuable in dealing with bereavement and serious health problems (Ellison and Levin, 1998). Those events often lack common worldly explanations (meaningfulness) and constitute ‘boundary experiences’ by challenging fundamental premises of existence or threatening existence (manageability). They can also undermine common sense beliefs that the world is just and that people “get what they deserve” by premature or violent deaths and unexpected accidents (Ellison and Levin, 1998, p. 707, 708) (comprehensibility). These events may require emotion management or pragmatic problem-solving efforts as well (Ellison and Levin, 1998). Further possible consequences of religious activities, described by other authors may be:
Concerning mental health, it seems that the aspect of religious meaning has a greater potential for negative associations, while the practical religious activities like attending services and ceremonies, social support, prayer, and relationship with God have more positive associations.
In general, I conclude, that religion can have direct health outcomes (better health, higher well-being, lower mortality etc.) as well as indirect outcomes in the salutogenic sense (social support, meaningfulness etc.). On the other hand, certain religious aspects do have negative effects on health as well (lower self-esteem and lower feeling of personal manageability).