PHANTOMS AND PHYSICIANS: SOCIAL CHANGE THROUGH MEDICAL PLURALISM
Vicente Callisaya, an elderly rural Bolivian Aymara man, was obviously sick in 1977, but everyone in town had a different opinion about what he had. He himself considered all possibilities, and finally determined he had a fatal disease that, according to local belief, affects only Indians. Another opinion was anemia that, consensus had it, cosmopolitan medicine could cure; but he rejected it. Why he made such a choice had little to do with his frame of mind, his access to medicine, or with Aymara beliefs as such. Nor was it due to race, although Doña Teresa, the self-appointed town aristocrat, held that it was. Rather, Vicente's choice was related to the use of the concept of ethnicity and race in Bolivian society and history, and to the use of medicine to create social change.
Doña Teresa's convictions about the "Indian race" are hardly peculiar. In the Bolivian popular mind, as throughout much of the Western world, ethnically defined indigenous populations are considered racially distinct. 1 On those grounds, Indian labor has been exploited since the conquest. Those segments of Bolivian society that have regarded the nation as backward have blamed the lack of national progress on the Indian -- along with U.S. imperialism when the Indian vote was desirable. Although there is much to support the latter assertion, its periodic appearance contrasts with the consistency of the former explanation. 2
This chapter is an expanded version of "Medical Dialogue and the Political Economy of Medical Pluralism: A Case from Rural Highland Bolivia". Reproduced by permission of the American Anthropological Association from American Ethnologist 13( 3) ( August 1986). It includes text from my From the Fat of Our Souls ( Berkeley: University of California Press, 1991). Clotilde in this chapter is Doña Antonia de Villazon in From the Fat; Vicente Callisaya and Doña Teresa are Edegon and Doña Ana in " Medical Dialogue."