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Archived Comments for: Investigation of the cerebral blood flow of an Omani man with supposed ‘spirit possession’ associated with an altered mental state : a case report

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  1. Biomedicine and culture-bound health: is it a double-deaf conversation?

    Nasser Al-Azri, Medical Department, Petroleum Development Oman

    11 February 2010

    Dear sir,

    I've read with great interest the article of Guenedi, et al,[1] on investigating biomedically a supposed "spirit possession" case. The idea is interesting but it seems we are missing the point in here. Biomedicine is a wholly different paradigm that has its' own epistemological foundations and assumptions on which it bases its' interpretation and management of events. A particular culture, on the other hand, has its' own. With such significant differences in the input (epistemology) and output (interpretation and management), the description of the process (event) is a mere de facto. Therefore, “linking possession to brain abnormality' empirically is like building a bridge on the earth to reach the moon. It takes us no further than our eyesight does within our own world.

    The pathologic process, which is the focus in western biomedicine, should not be confused with the cause as the latter entails aspects of beliefs and theoretical foundations of the healing system. The positivist approach in the biomedical model acknowledges only observable and measurable phenomena and thus limits the ontological world of health and healing within such constraints. Etiology is not so central to biomedical practice as management usually targets, more or less, the pathologic process rather than its’ underlying cause.

    On the other hand, etiology of illness is a central aspect of ethnomedical systems while the (pathologic) process is of much less concern. Moreover, it is very important when dealing with ethnomedical systems to comprehend the presence of multi-level etiology. Glick has defined at least two levels in such systems: the efficient cause and the instrumental cause[2]. He asserts that “[c]auses may turn out to be as invisible as viruses, but never as impersonal”. This is quite in contrast with the approach adopted in biomedicine where the cause is, at best, of less practical importance while the process dominates the practice.

    Confining socio-cultural issues of health and illness within the boundaries of the medical paradigm will do no benefit to understand the hidden doctrines underlying cultural perception of health and illness. It might be interesting to indulge further in such cases to examine whether a treatment outcome considered successful on biomedical bases is so for the patient and his/ her family. Also, whether such a perceived success alters initial assumptions of the illness or not.

    The current study is valuable in trying to investigate the case from a psychopathological perspective. Nevertheless, a comprehensive approach including social, religious, cultural and anthropological perspectives is indispensable[3]. Without this, such an investigation might just augment the imbalance in favour of biomedical view which may increase further the gap between biomedical practitioners and patients with socio-cultural perceptions of illness. Possession and brain abnormalities are words of two different ontological languages, and a true conversation between the two requires more than one speaking and the other hearing. It requires active listening.

    1. Guenedi AA, Al Hussaini A, Obeid YA, Hussain S, Al-Azri F, Al-Adawi S: Investigation of the cerebral blood flow of an Omani with supposed ‘spirit possession’ associated with an altered mental state: a case report. Journal of Medical Case Reports 2009, 3:9325. Available: Accessed February 7th 2010.
    2. Glick LB: Medicine as an Ethnographic Category: The Gimi of the New Guinea Highlands. Ethnology 1967, 6(1):31-56
    3. Khalifa N, Hardie T: Possession and jinn. J R Soc Med 2005, 98:351-353

    Competing interests