REVIEW ARTICLE

ANTHROPOLOGY'S HOODOO MUSEUM

Reviewed by Kenneth Fox, Walkin' Over Medicine: Traditional Health Practices in African-American Life. Loudell F. Snow. 311 pp. Boulder, Colorado: Westview Press. $55.

In these times, a great deal is at stake in representations of the health status and behaviors of African Americans. The dramatic and deteriorating politicoeconomic status of African Americans makes health research about them serious and risky business. Detailed demonstrations of the detrimental health effects of conservative, exclusionary fiscal and social policies may elevate the claims of advocates for social justice. However, poor health outcomes rendered as the consequences of freely chosen individual lifestyle behaviors may serve a mischievous inclination to blame the victim. Each of these possibilities has dramatic political implications for the subjects of the research. Thus, Loudell Snow's Walkin' Over Medicine may be useful for multiple audiences, lay and scholarly, across the political spectrum. Her work may invite a rush of memories for some, as it did for me. But such remembering costs. In this essay, I will explore the wonder of the exhibition she presents, as well as the price of the ticket.

Snow is a professor of anthropology and adjunct professor of pediatrics at Michigan State University who has devoted her professional life to the work of explaining the persistence of traditional "ethnomedicine" among African Americans in the post-Civil Rights context of improved access to modern biomedicine. How do the curious 'traditional' health beliefs and practices of some African Americans make sense? What needs do these beliefs and practices address that biomedicine does not address? Is the persistence of these beliefs an example of a salutary medical pluralism in the US context, or just another index of the ravages of institutional racism? Snow has had a long and distinguished career in teaching and research on 'folk medicine' in urban, African America. As an ethnographer, she has published in folklore, anthropology as well as mainstream medical journals. She has influenced the work of many graduate and undergraduate students in the social sciences. As "behavioral scientist consultant" and instructor in a public pediatric clinic, she has had impact on the careers of physicians and the lives of their patients. Snow's book is a synthesis

Culture, Medicine and Psychiatry 19; 409-421, 1995. �9 1995 KluwerAcademicPublishers. Printed in the Netherlands.

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of ethnographic materials collected over a 25 year career of conventional research on 'traditional health beliefs and practices' of African Ameri- cans.

For me, an African American pediatrician and medical anthropologist interested in issues of access to primary health care among urban African American children, Snow's work holds a special, ironic charm. I grew up in the vast and variegated Black metropolis of Chicago's South Side. I passed the storefront churches and religious paraphernalia shops of traditional African American folk healers on my way to school each morning. I am the son of a doctor. I laughed with my father when he shook his head in disdain as he lifted the advertisements of spiritual healers from the windshield of his Cadillac E1 Dorado. "My people", he sighed, his voice trailing away - one part mocking, one part weary of heavy burdens. I remember on WVON (station identification: "Fourteen-fifty am, Soul-in-the-City") ads for healers like Snow's Reverend Doctor Moses Hastings who appears in Walkin' Over Medicine: "Worriation? Nerve trouble? Looking for luck, love or money? Satisfaction Guaranteed!" I, too, bowed my head in prayers sent out for action from St. Paul's AME Church- appeals of a mixed middle and working-class African American congregation to an Almighty Father that He heal a "brother" or "sister" who lay dying in a bed at Cook County Hospital. The Chicago Defender's ads that offered the help of people like Snow's Mother Delphine, who showed a way out of trouble - for a small fee - were read regularly in my grandmother's house. That world Snow describes, though highly contested even within African American communities, is real and vital for many. What she describes is not mere ethnographic exotica. Accounts of divine exercise in the everyday lives of many African Americans are joumalistic rather than exotic, fantastical or fictional.

Snow's work also reminds me of long Sunday afternoons at Chicago's Field Museum of Natural History. I remember wandering as a child through the quiet, dark halls of the Museum. I was always struck by the odd scale of things, all the funny juxtapositions, the beauty and order of these vast collections: Spoons and hummingbirds; dung beetles and bridegowns; the diorama of an African village occupied by 'authentically' dressed natives the same height as the incisors of the stuffed polar bear; translucent pinned butterflies in lighted glass cases and raffia masks which seemed to float in mid-air; the mounted heads of beasts from every continent on earth; the bust of a Negro boy who looked just like my cousin. I walked among these artifacts and I wondered then, as I wonder now, "How did all this get here? .... Who brought these things together in this place and why?"

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Similarly, I am enraptured by the epic sweep of Snow's collection. And yet sometimes, the wonder disappears, and I am done with reverie. The moral bite of rapture sinks in. The critical questions of how and why this 'curator' makes the choices she does require answers. What political and cultural contexts made the acquistion of these materials possible at all? How does it happen that the artifacts, ideas and behaviors of some people are always marked as 'exotic' or 'collectible' and so worthy of exhibition? What is the intellectual heritage that makes this collection of "findings" a complete set in the eye of the curator? Of the reader? What are the politics and ethics of these ethnographic encounters? And I note: How quiet the halls of Anthropology's Hoodoo Museuem!

'Hoodoo' represents a system of institutions, practitioners, ideas, activ- ities and materials in the domain of African American ethnomedicine. Hoodoo, according to the traditional, essentialist, and objectivist ethno- graphic genre of which Snow's work is a part, is the authentic folk medical system Blacks draw upon to prevent, make sense of, and treat illness experiences. Faith in the possibility that the world of health, wealth and power can be transformed by use of 'roots' or 'footwork' is the evidence of things not seen. The mark of a folk healer is that he is born with 'the veil' (or 'caul') over his eyes which, ironically, signifies the gift of"vision." People with the gift have power to do good or harm to others because they can see the root causes of inharmonious imbalances of mind, body and spirit, and they know what remedies to use to correct or sustain them. Hoodoo doctors are God's chosen brokers of fortune or misfortune in people's lives.

In Snow's earlier work like "Sorcerers, Saints and Charlatans: Black Folk Healers in Urban America" which appeared in this journal (Snow 1978), Hoodoo was central to the medical belief system of "American Blacks," and "low income Blacks" in particular. In accord with the prevail- ing social science theory of that earlier era, members of this subculture of poverty would be transformed by the processes of assimilation and upward social mobility. Many predicted that the folk theories would be attenuated or simply disappear over time. Snow's view is that these 'traditional beliefs' have persisted over time in spite of better access to biomedicine, and so must represent some essential, core truth of 'the African American'.

Like pentimento, apparitions of Snow's earlier work appear in the current effort. She paints over ancient assumptions about the nature and meaning of ethnic identity, but the outlines of the older pictures show through: 1) Ethnic groups are homogeneous. Thus, Snow writes of "the African American community", rather than 'communities' which may differ dramatically by region, SES, or local social history. One way to define "the community" is to identify continuities of belief among popu-

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lations of individuals. Thus, in the Hoodoo Museum, African Americans in Lansing, Michigan and in Tuscon, Arizona (where her fieldwork was conducted) share traditional beliefs about health and illness (e.g., "Sick- ness is a form of weakness that is nearly the same as sin" [p. 29]). "Shared beliefs" are the attributes that fill an ethnic category. 2) Ethnic attributes, like genes, are inherited and conserved rather than reinvented by each generation. One's 'African Americanness' is defined by the possession of an "integrated balance of body, mind and spirit" (p. 35). This 'cultural sur- vival' may be more or less elaborated in any individual Black. However, this ethnic kernal of truth always exists in any 'real' African American ("It will not soon disappear", she writes [p. 35]). What "works" for the Black sharecropper sick in a shack in South Carolina, will also work for a Black "in a storefront church in Harlem" or in Watts or Newark (p. 36). The ties that bind" the African American" in these diverse places are the 'cultural survivals' of a common African past. 3) Ethnic attributes are adaptive and functional. These features of 'culture' allow people to "cope in traditional ways within their own social networks and institutional structures" and "allow them a sense of mastery and control [and a feeling of] well-being" (p. 32). Snow's curatorship in the Hoodoo Museum fixes her informants in a happy-go-lucky ethnographic present. What the 'curator' finds among African Americans today can be found in every preceding generation and in every one to come. People act the way they do because it allows them a sense of well-being or power over the social context in which they exist.

When historical change is acknowledged in the Hoodoo Museum, a tiny placard represents it as the outcome of "an ongoing exchange of ideas among different groups ["African", "European" and "Native American"]" (p. 32). The myth of the ethnic melting pot is dusted off and polished to a high shine. In one rhetorical stroke Snow "whites-out" a narrative that would represent the four hundred year history of African Americans in the US with images of the brutal enactment of structures of domination and appropriation upon them and the constant subversion of traditions of resistance.

The odd scales of things in the Hoodoo Museum remind me of museum visits of my childhood. The microscopic details of 'traditional beliefs' are gathered and sifted through in search of explanations for why these curious people make the choices they do. However, the ways in which those choices are constrained by macro-order issues of political economy are rarely men- tioned in the three hundred page catalogue of Snow's exhibition. Poverty rates for African American children in places like Lansing and Detroit are higher today than at any time since the early 1960s. The decline in manu- facturing jobs, the erosion of real wages for the working poor and of the real

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value of AFDC benefits (adjusted for inflation), slashes in supplemental nutrition programs like WIC, and welfare "reforms" like those underway in Michigan, dramatically alter the frame in which African American families' health beliefs, behaviors and experiences make and acquire meaning. We learn little of these contexts in Walkin' Over Medicine. The omission of suffering, incoherence, terror and pain in these narratives of the lives of people makes Snow's exhibition incomplete. The price of the ticket to the Hoodoo Museum is that we shield our eyes from a vision of how structures of privilege are buttressed by Others' suffering. It is as if we dare not ask what interests are served by relations of power that determine structures of health, wealth, knowledge and opportunity in places like the ones where Snow works.

Walkin' Over Medicine begins with a breathtaking, death-defying escape. Snow tells a story of Jacie Burnes, a poor, African American woman who flees with her six children under the cover of a hot, moonless South Carolina night in 1982. She runs through the fields to escape the vicious beatings and curses of her husband, Big Joe, who had held her there by the power of his rootwork for 15 years. Burnes kept running for a thousand miles until she reached the safety of Lansing, Michigan where her story was then collected by the ethnographer. Snow hears the story of how Burnes came to realize that she, too, had special powers. The stories of other tragic lives are woven into the narrative of Burnes' life. Bumes first "vision" was of the imminent death of her infant sister. In the mid 1950s, Burnes' newborn sister acquired "contact pneumonia" and cried inconsolably after head trauma suffered while in the care of a brother and sister. The family took her to the hospital, but after one day, the doctors just sent the baby home. Jacie speaks of her first "vision":

The doctors didn' t tell [the mother] that the baby was gonna die; they just told her to take her home .... I saw a halo over her head and I knew God wanted her, you know ... and I knew she was gonna die. (p. 4)

In the Hoodoo Museum, the curator presents this tale as demonstration of an essential fact of the cultural heritage of Blacks - that "rootwork" exists. This early formative experience of little girl Burnes 'explains' how she comes to be an adult who believes "that things can happen that are beyond natural explanation" (p. 4). But Burnes' story can and should be read in many different keys. These other perspectives on Burnes' narrative - like angry, torch-bearing villagers at the gates of the Hoodoo Museum - raise insolent questions that demand answers.

What political and economic order was bolstered by the circumstance in which poor, school-aged, African American children were responsible for the care of a sick newborn - especially in the wake of dramatic social

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and political events of the time like Brown v. Board of Education? Who gained most from the labor of the parents who were driven by social and historical forces in the world - but beyond their control - to leave their children unattended? For whom and in what type of moral world does exploitation and indifference to other's suffering make sense? How and why did the Burnes family finally decide to take this neonate to the hospital at all if their faith in prayer and rootwork was functional, essential, or gave them a "sense of mastery" over their social situation? How did physicians involved in this child's care reconcile the withholding of current therapies of the time with professional standards of behavior? Exactly how did these professionals articulate their final decision to send this child home without therapy? And why did the family submit to the immoral decision that nothing more would be done? Would the ethnographer have us believe that watching the baby suffer and die somehow gave this "traditional" family a redemptive sense of empowerment, mastery or control? Who paid for this medical encounter? Who authored and authorized the structures of inequity in access to adequate medical care that framed this tragic episode? And on another level: What interests are served by representing Jacie Bumes as a poor Black woman fully persuaded by the view that her sister's death was "beyond natural explanation"? Jacie Burnes's story is, at least, as much about these issues as about any "exchange" of ideas that resulted in an African American belief in rootwork. The historical record is replete with examples of how African Americans have been condemned to lives of exploitation, loss, anguish and suffering by people with power to make choices about their lives. The locus of these choices has often been fully within the realm of the 'natural' world of human agency (in contrast to the 'supernatural' world of the gods), as the horrific images of the "strange fruit of Southern [and Northern] trees ''1 would attest. My point is that the ethnographer's choice of analytic focus reveals particular features o f experience as it obscures others. And these games of hide-and-seek in analyses of meaning in ethnographic work have moral consequences that reach far beyond the local settings in which they are generated.

Intense debates across the human sciences have emerged in recent years over the ethical dilemmas that arise as writers represent Others' social realities. The possibilities, limitations, merits and dangers of a critical and activist Anthropology are hotly contested (e.g., Asad 1973; Marcus and Fischer 1986; Fox 1991; Farmer 1994). In this context, the moral dimen- sions of Snow's work are worthy of careful scrutiny. Snow tells a channing story of how Jacie makes use of two belief systems simultaneously. Jacie acts as if she has faith in the power of biomedicine to alter health - that is, she chooses to bring her children to a Lansing clinic for regular preventive

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care as well as when they are sick. She participates in family counselling with a psychologist. Yet when her oldest child persists in a pattern of delinquency and violence she blames her estranged husband's "rootwork." Here, the ethics of a detached, objectivist, 'apolitical' and 'amoral' genre of ethnographic writing come alive. Writes Snow: "There would have been no point in trying to dissuade her of her belief and I did not try" (p. 15). The divergence of native "beliefs" (cast as negative and immutable) and the social scientist's 'knowledge' (cast as benevolent, open and value-free) is rendered in sharp contrast. The meanings of what happens in ethnographic encounters like this one extend far beyond Snow's Lansing clinic con- ference room. That the ethnographer does not "speak truth to power" is neither her fault nor any surprise given the texts to which she was likely socialized in her graduate student days. Snow's lack of attention to the local effects of macrosocial issues like Black-White disparities in poverty rates (U.S. Department of Health and Human Services 1990), national data on the inequitable distribution of mental health services across ethnic/racial groups independent of SES (Manderscheid and Barrett 1987), and data that suggest that among juvenile offenders, 'race' predicts placement in the criminal justice rather than the mental health system while personality and psychopathology variables apparently do not (Westendorp 1986), 2 is an important limitation of this text. However, Snow's dismissal of any attempt to persuade the people she studies (or the audiences she writes for) about the existence of structures of oppression around them as futile, is a bit too facile. How academics may become unwitting accomplices in the reproduction of unequal relations of social capital and political power is a morally complex issue worthy of careful and critical attention.

When Jacie's boy ends up in a distant juvenile detention center, she decides that coming North was a mistake. Jacie's son's moral and mental health crisis eventually drives her back to South Carolina and to Big Joe. However, Jacie's ultimate fate is relegated to a footnote in the text. After two more pregnancies, Jacie is Big Joe's victim in attempted murder. He shoots her. Jacie survives the shotgun blast, but it leaves her paralyzed. While no one could fairly blame Snow for this tragic series of events, the ethical dilemmas of whether and how to advocate on behalf of one's informants are more than intellectual curios. What concerns me is how an ethnographer's epistemological paralysis, generated by an ideology of scientific objectivism and an ethic of detached concern, and exacerbated by a resistance to use one's work as a mode of cultural critique, may end in tragedy. I can't help but wonder, "What if Snow had tried to change Jacie's mind"? But even if the anthropologist's audience is strictly limited to other academics, what if Snow had tried to have them consider the ways in which

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their work contributes to buttressing structures of domination under which their subjects suffer? For example, 'amoral' scholarly discourses about victims of "dependency," "learned helplessness," and labelling of some kinds of people as "hard to reach" because of their 'traditional beliefs' have all served well as justifications for subordination or exclusion. A more reflexive and critical ethnography would exhume the bodies of knowledge and ideology buried deep in the crawlspaces of the Hoodoo Museum. In this narrative of a lifetime of work, ethnographer Snow seems never to wrestle with the skeletons in her own discipline's closet.

Snow also tells the story of Janine Jackson, an elderly widow, who was part of the great 20th century migration of African Americans from the South to the North. Snow writes, "this [woman] certainly does not lack access to [biomedical] care. A doctor has his office right across the street from her home and there is a hospital only blocks away" (p. 29). And yet we learn that Mrs. Jackson had her very first doctor visit at age 64 only after an injury on the job. Snow reports of Jackson:

She saw sickness as a form of weakness that is nearly the same as sin, and as such, as something that is not allowed in her house! Pain and other symptoms were, in her view, simply a trick of Satan and she simply ordered him off the premises.

Further, Snow reports that Jackson was less concerned about her pain (after the accident) than about why the accident happened. "She attributed [the accident] to her own carelessness and believed [she] had allowed Satan to step into the picture" (p. 30). Snow views these as 'traditional African American medical beliefs' and as adequate to explain a pattern of non-use of services.

What Snow doesn't consider is revealing. Snow tries to argue that traditional African American ethnomedicine persists despite access to [biomedical] care because it is a form of community empowerment. How- ever, Snow gives us very little data to support the claim that her informants do indeed have adequate access to relevant biomedical services. Snow

g i v e s us very little objective data on her informants' income or occu- pations (though we can guess from her descriptions that most of them come from the ranks of the working poor). She seems not to consider that their preexisting conditions, insurance status, ability to pay for prescrip- tion drugs, and past experiences of pain and humiliation in dealing with medical institutions might also be important determinants of their use of services. Health services researchers have shown that even once African Americans make it through the clinic door to the doctor, for similar rates of hospitalization, numbers of visits and severity of illness, they are less likely than whites to receive the local standard of care (AMA Council on Ethical and Judicial Affairs 1990; Ayanian 1994; Kahn, et al. 1994)

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- whatever that might be. Perhaps some level of awareness of such dis- parities informs the mistrust of medical institutions so prevalent among Snow's informants. Further, in this context, a turn to an explanatory model in which one's own carelessness results in pain and illness seems decidedly disempowering. Focusing solely on how one's own personal lapses lead to one's own pain and poverty does not encourage a sense of well-being. Rather, such an explanatory model invites conservative ideologues to heap even more scorn and suffering upon the wretched oppressed.

In study after study over the past several decades, Blacks are nearly three times as likely to live below the poverty line than whites. Snow fails to explore the health consequences of this inequity. It has been widely reported that if Black mortality rates were the same as white mortality rates, over 80,000 excess black deaths/year would not occur (Cooper and David 1986; Krieger and Bassett 1986). And in another analytic key, for the most important causes of mortality, class disparities are larger than 'racial' disparities (Navarro 1990). These issues are never voiced in the quiet halls of the Hoodoo Museum.

Many writers note that despite the $350 billion increase in total national health care expenditures between 1980 and 1990, access to care for groups like the working poor and the uninsured actually deteriorated (Ginzberg 1994; Johnson, Sum and Weill 1992). The dramatic declines in employer- financed health insurance coverage during the 1980s - especially for less educated, low-skilled workers - would seem to be salient for analyses of utilization of medical care among people like Snow's informants. Yet, too often, the kinds of health questions that fascinate the curator concern which traditional medicines these politically marginalized African Americans 'choose' to use and what are the 'real' (i.e., Latin) names of remedies like "poke greens" (p. 77) and catnip tea.

Racial discrimination in employment continues to drive Blacks' dispro- portionate representation in the rapid expansion of a low-paid, part time, unskilled working class (Kirschenman and Neckerman 1991). The least desirable jobs in the poorest areas have the highest rates of work related death. People with the lowest incomes live and work in the most toxic and hazardous settings where risk exposures are great (Baker et al. 1992). We never learn exactly what kind of work Janine Jackson actually does or in what setting. Nevertheless, the critical questions remain: Are Snow's audi- ences or her informants like Janine Jackson aware of this bigger picture of the systematic and unequal distribution of access and risk? If Snow had presented such information in a dialogue with her subject, would she have found it a compelling answer to the question of why this accident happened to her? Would Snow's "traditional" African Americans still believe that

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their higher rates of occupational injury compared to the lower rates for Whites were the wages of sin, the tricks of Satan? Or is there "no point" to critical education? Is there no moral cost for not even trying to change people ideas, behaviors or social circumstances?

Snow's exhibition touches on the most important health issues for contemporary African American communities. For example, native constructions of and responses to infectious diseases including AIDS, cardiovascular disease, violence, reproductive health, nutrition and child development all make appearances in Walkin' Over Medicine. Snow also expounds on her longstanding interest in the intricacies of 'traditional' beliefs about blood - its composition, consistency, kinetics, and classifica- tory states. She seems to write within a conventional biomedical paradigm ever vexed by 'compliance issues' with regard to management of prob- lems like hypertension and anemia. Her message seems to be, if health care providers could just understand what 'the African American' really believes about health and disease, they could devise the right strategies to convince these 'difficult to reach' patients to comply with prescribed treatments. In Snow's world, conflict in the clinic is merely the out- come of miscommunication. The possibility that miscommunication is accomplished 3 in order to protect privilege and to preserve the current and unequal order within our body politic is never considered in the halls of the Hoodoo Museum.

Snow convincingly argues the case for some important concepts in medical anthropology: 1) That conventional approaches to health education are doomed to failure. These approaches wrongly presume that educators with valid, 'correct' and morally neutral scientific information can simply pour their knowledge into students cast as 'empty vessels' .4 2) That among some cultural groups the responsibilities for health decision making rest not with individual actors but in wider social networks. However, her critique of traditionalism within the culture of biomedicine is not sharp enough. For example, Snow, who is a former medical lab technician, reproduces a conventional semantic field in which "non-White race" (p. 172), the "epidemics" of teenage pregnancy, crack, and female-headed households are understood as preeminent risk factors that explain disparities in infant mortality rates across the population. She misses some key references. As the noted health services researcher on infant mortality Paul Wise points out, "The bulk of disparate infant mortality occurs in the mainstream of women who are not teenagers ... and who do not use illicit drugs" (Wise 1993). The bottom line is that there is nothing intrinsic to African American culture that causes poor birth outcomes. Rather, a racist, sexist, and classist political context that devalues non-White, female and poor

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people's lives generates unequal risk. Health disparities will persist and increase unless our work challenges and subverts institutional structures that require unequal access to health care, education, employment, income and opportunity for the poor, women and ethnic minorities.

Until the call for equity is acted upon, some are doomed to continue to amaze us by what "[they] can do with what they have" (p. 34). In the eerie light and heat of slash and burn conservative health and social reform, the words of one of Snow's informants Latishia Simmons haunt me as I wander the halls of the Hoodoo Museum:

Why there's a lot of weeds out there now; why, you're walkin' over medicine! ... Dandelions is a wonderful food. There's so many vitamins out there right now that we're walkin over. We walk over medicine, that's fight (p. 34).

And I think: Health and social justice for African Americans will require that critical medical anthropologists do much more than walk over medicine. The task will be to walk all over it, turn it over, shake it out, wipe it off, wear it as a poultice, and perhaps, leap over it in no less than a single bound.

Department o f Social Medicine Harvard Medical School 641 Huntington Ave

Boston, M A 02115

NOTES

1. This is a play on Billie Holiday's haunting lyric about lynching, Strange Fruit. "Southern trees bear stra~age fruit; blood on the leaves and blood at the root...".

2. In addition, Evan Stark points out in the New York Times (7/18/90: p. A21), that the National Youth Survey (which collected confidential interview data on youths law- violating behavior) showed "no significant race differences in any of the violent or serious offense scales". Yet, over the same time period, though blacks represented about 12% of the population, more than half of juvenile arrests for violent crimes were among black teens. Notably, the black-white ratio of imprisonment rates during this time was 44 to 1.

3. The concept of miscommunication as an "accomplishment" rather than accident or misfortune first came to my attention in work in educational anthropology; in particular in an essay by R.P. McDermott and K. Gospodinoff, "Social Contexts for Ethnic Borders and School Failure", in Trueba et al., Culture and the Bilingual Classroom: Studies in Classroom Ethnography. London and Tokyo: Rowley (1981).

4. I borrow this perspective from the seminal work of Byron and Mary-Jo Good, Arthur Kleinman and Leon Eisenberg, Department of Social Medicine, Harvard Medical School.

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