spirit and healing in africa - University of the Free State

English language, that encapsulated the same meaning in a single concept: ‘healthworld’. A
healthworld is “the complex and increasingly mixed set of ideas, signs, linguistic conventions,
and cultural traditions and practices within which people live and by which they orient
themselves” (Cochrane 2006a:69). This means that a person’s healthworld is always the guiding
factor in everything that has to do with his or her comprehensive well-being. The distinction
between health and ill-health, the decision to seek help in overcoming dysfunctional health,
determining the cause of illness, one’s behavior, values, choices and actions – all these aspects
are determined by one’s healthworld. The notion of a healthworld thus shows that the only way
to determine what ‘health’ is, is to pay attention to the beliefs, concepts and worldview(s) of the
one defining ‘health’. In other words, a definition of health is always constructed in a particular
context based on specific, individual and collective experiences, ideas and beliefs.
The ARHAP perspective on healthworlds has been recognized by other scholars as well. The
medical anthropologist John Janzen, for example, emphasizes the need to consider what he calls
‘health utopias’ when studying and describing health situations (Janzen 1981:185). He argues
that, in order to gain a full understanding of African therapeutics, one has to include the health
point of view, the subjective constructions of health, from which sickness is a departure and
treatment an attempt to return. In every society and at every level of cultural development certain
specific health concepts and practices are present. These concepts can be seen as ‘health
utopias’: they should not be regarded as mere fantasies, but rather as culturally specific concepts
of what (ultimate) health is or should be. According to Janzen, these health utopias are real
concepts and they function in the same way that concepts of disease do. The advantage of a
utopian perspective is that it reveals the way in which health is classified in a specific culture,
and can help in the understanding of health causality within a given society.
Whether naming them as social structures (cultural theory), as a healthworld (interdisciplinary
health science), or as a health utopia (medical anthropology), these concepts refer to the context
of health. So the meaning of contextuality is not only to acknowledge that a discussion about
health or illness must consider its social context (fortunately this insight is gaining influence
within the biomedical model as well), but is much more about the idea that concepts of health,
illness and healing are generated and sustained by that very social context. Thus, the
contextuality of health ideas and practices preserves the meaning of health (what health ought to
be, how health can be understood), and as such this element of health as a social construct cannot
be neglected.
30