Abstract

The study of African American women's understandings of healing, health, and faith greatly informs the definition of black spirituality. Using ethnography and cultural studies, this essay focuses on this web of topics, with special attention to a sample of black women in the Detroit, Michigan metropolitan area. This investigation encompasses interrelationships between black women's gendered identities, mechanisms of interface with social structures, and ground-level tactics for building community and family health.

Key Words: African American culture, gender, spirituality, healing.

    1. Stephanie Y. Mitchem is Associate Professor, Department of Religious Studies, University of Detroit Mercy, P.O. Box 19900, Detroit, Michigan, 48219. Electronic mail may be sent via the Internet to: StephanieMitchem@sbcglobal.net.return to text

    Finding Balm

    There is a balm in Gilead, to heal the sin-sick soul..
    —Negro spiritual

    Mama Leslie is African American and a practicing traditional midwife—that is, one who use folk methods rather than nursing school training in her practice. She was 42 years of age, a single mother, and had been practicing for ten years during the time I interviewed her in 2001. I contacted Mama Leslie as part of a larger study about black women, healing, health, and spirituality. Her words serve as a rich introduction to this essay.

    Mama Leslie reported to me that she is the only black traditional midwife in the metropolitan area, possibly the state. She became a midwife during the time she herself was pregnant, as her dissatisfaction grew with medical doctors who insisted on hospitalization; she particularly disliked those who intimated that Caesarean birth was a high likelihood in their practices. She referred to the medical profession's tendency to force delivery or perform a Caesarean after so many hours of labor as "a technological birth, not a humanistic birth, not a holistic birth." Hospitals and birth are antithetical, as far as Mama Leslie is concerned. "Basically people die in hospitals." The midwife who worked with Mama Leslie during her pregnancy invited her to study.

    So far, Mama Leslie has caught 75 babies during the time of her own practice. She clarifies the language of catching babies, as a lifeguard not a deliverer: "I don't deliver babies. I can't do that. " Catching babies is more holistic, a sense of working with mother, and whoever her support persons are. Because she works with the families so closely, she usually senses when the delivery date nears, calling the family more often. If necessary, Mama Leslie induces labor with a mixture of orange juice and castor oil. She stated, "It's a trick of the trade, from other midwives," women with whom she meets annually. She is selective about the families with whom she will work, based on the mother's physical health, the possibility of a successful home birth, and the conditions surrounding the birth family. She showed photos of the birthing processes and of ongoing interaction with parents and children. Mama Leslie talked about the processes of birth as spiritual, with babies making choices whether or not they want to come in the world and mothers' having the ability to control aspects of their bodies' operations, such as the amount of blood loss, barring hemorrhage.

    Mama Leslie's objectives include healing families and breaking cycles. This sense of healing starts from her personal commitment to grow. "It's about conditionings and breaking those conditionings for me to be all I can be. Or to be in the world and not experience love, joy, and peace." The heart of her spirituality is simply stated: "There's only one truth, being one with God. Anything else is an illusion."

    This essay considers some of the dynamics of black women's healing concepts, often held in families, passed from mother to daughter. There is a recurring spirituality that surfaces when black women speak about healing. As with Mama Leslie, the movement against mainstream medical understandings can lead to some personal choices. The potential for this creative choice is a combination of culturally derived understandings of wholeness and illness. Through all of this, the consideration of how black women are understood in American society alternatively constructs gender, consequently empowering black women to make creative, Mama-Leslie-like choices.

    My explorations of the meanings of healing among black women began in Detroit as part of a larger analysis of black women's spirituality. Health concepts of black women were an important location to explore spirituality—bringing intense focus on cultural understandings of body and soul, of the family and its members, and of the person and the community. While I draw from cultural and historical studies, ethnography fills in some of the blanks about the real meanings of black women's lives. Yet, ethnography brings complications. As the sociologist Cheryl Townsend Gilkes stated, "Sometimes the simple act of writing the culture and its members into existence can be an act subversive of the inhuman consequences of marginalization and domination" (Gilkes, 2002, p. 176). This process of writing culture is fully present in a study of black women's understandings of healing and spirituality.

    Ethnography can be used as a tool for the outsider-within, as Patricia Hill Collins referred to the marginal, contradictory place designated for those who seem to fit by virtue of credentials, but do not by the constructions of race and gender (Collins, 1998, p. 5). Thinking about ethnography from my own location as outsider-within, I utilize it to point to African American social constructs that the dominant (whitened) society had rendered invisible. In doing so, I aim to celebrate the goodness, complexity, creativity, and ingenuity of the constructions of black people. These processes participate in the shifts away from colonial ethnography. Each of these notes utilizes ethnography on behalf of the black community. These ideas inform the following sections of this essay. Looking at black women's understandings of healing as connected with their spirituality participates in reconstructing knowledge. I find the difficulties in using ethnography as a primary method are more than rewarded with the rebellious, radical act of pointing to the rich, intellectually sophisticated lives of black women.

    This essay traces some of the streams of these concepts through an exploration of gender and its construction in black communities as a component of understandings of healing. One focused example of the interlocking, interactive understandings of healing and spirituality are explored through a Detroit-based group, the Detroit Metropolitan Black Women's Health Project. The final section weaves these together in the connections between medicine, healing, and faith among African American women.

    Being Black Women (& Health/Healing)

    Concepts of healing in the black community are complex and raise many critical issues. The dynamics inherent in these understandings are formative of gender roles which will weave throughout this article in a variety of ways. To begin, black women are triply impacted by race with class with gender. Such multifaceted experiences of oppression have multiple impacts on the lives of black women. As I have stated elsewhere:

    The belief that black women must conform to a certain standard of being women, being real "ladies" was and is enforced within communities in many ways. One place of enforcement can be black churches, where the way a woman is dressed is code for the way she is to be treated by the members of the church. . . . Too often, black women are given the message that they are just not good enough unless they earn respect, and prove their communal worth, often by emulating white women. Black women are told through many means, from families to churches to schools, that they must conform to standards, that their reputations as women are open for public discussion, and that their own communities may stand in judgment. African American women can adopt these attitudes and enter the trap. They are then caught in the need to prove themselves, feeling the need to do more, and to be best in any situation. (Mitchem, 2002, pp. 8-9)

    African American women's beliefs about religion and healing implicitly bring a focus on the social constructions of gender in black communities. What factors sustain the cultural health understandings of black women? What unique stresses do black women experience regarding health concerns? Most black women work will have lower income expectations throughout their lives, often working two jobs to make ends meet. Additionally, black women will have the reproductive work of childbirth, which becomes an additional job of childcare. Childcare, for poor women throughout the United States, is deplorable (Mullings, 1997). Each day, these facts stare black women in the face, even as marketing attempts to develop a commercial view of "woman" that will most often exclude women of color.

    Sociohistorical factors have created the climate in which black women's continued strength for the benefit of others becomes an expectation. Both black women's activism for community survival of the black people, and black women assistance in maintaining families are too often taken for granted. African American women will often tie their very sense of themselves to their continued strength, taking as a given that their social roles must include working on behalf of themselves and their communities with little regard of their own needs. The image of making a way out of no way, of doing what has to be done, is based on the very bodies of black women. Strength of body and will for the "good" of others, may turn and tear at the individual woman, not only her self esteem with a continual drive to succeed, but also destroy her physical and spiritual health. This type of living necessitates that black women constantly set their individual needs aside, to live for the community only. The empowerment of black women includes releasing and relinquishing the "strong women" role, which is accomplished with neither comfort nor ease, for black women who focus on self are often viewed as "selfish." Self-care becomes part of the need for black women in their health considerations.

    Each of these ideas becomes bound in black women's understandings of themselves as women. Gender construction in black communities is tied to the care of the community and the family. Black women, on a daily basis, attempt to take care of too much.

    Survival of the community is an integral value underlying black women's health understandings. African American women seldom had the luxury of being taken care of by others and seldom had the economic option of being stay at home mothers who hire "a girl" to help. Therefore, the ideas of what a woman ought-to-be is shaped differently in black communities. bell hooks, for example, wrote extensively of the impact of black women's devaluation on their self esteem (hooks, 1993). Some of these gender concepts are woven through black women's understandings of healing.

    Health Activism & The Detroit Metropolitan Black Women's Health Project

    "I didn't question why you took ginger tea. I just took the tea and shut up. Oh yeah. We did things with oil of peppermint. And turpentine. Turpentine, put a couple of drops on sugar and that was good for colds and stuffiness. And peppermint we put that in warm water, not hot, just warm, good for stuffiness, just inhale it. Now you know, peppermint costs almost five dollars."

    Quincy, quoted here, is a member of the Detroit Metropolitan Black Women's Health Project. As I gleaned information about culturally based health practices, I became aware of underlying themes that indicated a sense of body and health practices that were unique. During my research, I was specifically identifying healing concepts and related spirituality in their thinking. I have interviewed black women across the city of Detroit, with a variety of foci. Some of them, like Mama Leslie, stand out with individual perspectives that then have communal links. Others make deliberate attempts to improve the health of others through communal networking.

    The women quoted in this section are all members of the Detroit Metropolitan Black Women's Health Project (DMBWHP) and provide a look at African American women's conscious networking for health. Their words are also indicative of issues that will surface again in the next section of the essay where connections are made between healing and spirituality.

    The DMBWHP is a chapter of the National Black Women's Health Project (NBWHP). Begun in the 1980s, the Project defines itself as an organization:

    Committed to defining, promoting, and maintaining the physical, mental, spiritual, economic, and emotional well being of Black women. Therefore our mission is to facilitate the empowerment and wellness of women of African descent, their families, and future generations and communities globally. For us, health is not merely the absence of illness, but the active promotion of wellness. (Mission Statement, DMBWHP)

    ... Such wellness is impossible without individual and group empowerment. Such personal and collective empowerment is essential to the redefining and reinterpretation of who Black women are, were, and can become. (Vital Signs, 1995, p. 3)

    These statements underline the unique definitions of holistic health, for self and community, that are adopted by the members. Personal and collective power, global dynamics, and families are all intertwined with physical health of black people.

    From 1996-1998, I attended meetings of the Detroit chapter. The basic agenda of each meeting was usually the same. The meeting began with the "check in," moved to the chapter's business, continued with the guest speaker and then to some kind of evaluative process. Returning to the circle, members would evaluate the meeting: "Give me a word that describes how you feel now." The closing chant of every meeting "I love black women, deep down in my soul," maintained the focus on black women from beginning to end. Each agenda was a procession from individual reflection to community building among the members to a more global consideration of other black women. The meetings held great importance for the women.

    Frances is one of the founding members who explained that the meetings' importance is based on,

    "The key elements [of] safety, security, and opportunity. [The meetings] demonstrate that we can create community anywhere. Women often say ""This is the first time I've been able to talk about myself and have someone really listen." A woman gets to focus on herself, to experience acceptance by a number of folks and to increase her own self-esteem and power."

    I conducted interviews with several of the members. These individual interviews were not meant to indicate anything about all black women; therefore, essentialized conclusions cannot be drawn. However, generally the absence of self care was reported by members in interviews and within meetings as catalytic of a health environment that promoted life-threatening diseases, such as cancer and heart disease. The major stresses of being black and women drained energy and made additional demands on a daily basis that the women would attempt to meet. It is not surprising that the members' definitions of healing point toward spirituality.

    Lisa is a member and a poet who speaks of the need that black women have to experience healing for their own selves in the face of overwhelming daily responsibility. Lisa's words reflected these concepts when she spoke of healing as encompassing the physical, mental, and spiritual. "Healing means knowing myself enough to know when something's wrong. It means loving myself to give myself permission to do all the things I need to do to get well."

    Personal life experiences shaped the women's understandings of health. This was even more intense when illness is a factor. One member, Mattie, is a cancer survivor; the illness and her journey toward wellness glimmer behind her statements,

    "To me health is being able to pay attention to what s going on with you and your body. Learning your body and being able to identify when something is not functioning properly. It s like monitoring your body which a lot of us don t have time for because we have children, we have to work at various things."

    Azana's definition of health as physical, mental, and spiritual harmony reflect her own history as well. She sought to be healthy,

    "Because I was such an unhealthy person at a very young age. When I say unhealthy, you asked about the mental? Honey, I was laughing, saying as an African American in this country, I been crazy. I mean, didn't have nowhere to go but up. As a young woman, I was very much disrupted, my physical health was in bad shape, I was mentally distraught, and spiritually drained. So I had to make an effort to just work at that ... And so through that, I decided I was going to start thinking positive."

    These understandings of health had related meanings of what it is to live healthy lives. P'Jazz is a member who has a doctorate in nursing. She stated:

    "Being healthy doesn't mean to me that you don t get a headache. It just means, in general, your state of being in terms of how you take care of yourself, and what you do and your experiences. Without symptomology, it's pretty much your state of health, it's more or less your physical and your mental, emotional well-being, and your spiritual being. . . . If I'm tired, it doesn't mean I'm not healthy, unless it's continuous....But if I'm generally feeling like I'm in balance, then I'm O. K."

    The ideas and words of the members of the DMBWHP in their communal efforts link with the ideas of Mama Leslie, having cultural and historic roots that mix with professional Western medicine. This mixture yields results that present continuing challenges for health care and communities.

    Medicine & Healing & Faith

    The history of exclusion from western medicine blended with the cultural beliefs of black people combine to create a fertile ground for belief in faith and healing. A rich body of folk cures and home remedies are part of the culturally accumulated knowledge of black people throughout the Diaspora. These concepts continue to be transmitted, with differences in regions, familial structures, and so on:

    • How not to stunt the growth of a boy child;
    • Cures for acne or morning sickness or headaches or nosebleeds;
    • Predicting the sex of the child of a pregnant woman;
    • Birth control.

    Each of these becomes part of the knowledge base on which black women and men—consciously or not—draw in daily living. The relationships between body and soul, individuals and communities, and human life with the greater universe are sketched out and given meaning in these understandings. For instance, in this African American meaning-framework, both the individual human body and the body of the community are considered locations requiring healing. The power to bring about healing resided in the members of the community. Wisdom from elders and unnamed sources became a foundation for this thinking. "Alternative medicine" is not a new idea in the black community.

    Historically, within African American cultures, a healer could be female or male. The power to heal was seen as a charism, a spiritual gift, and gender was not a determinant of who received the gift. From granny midwives to root women to spiritual healers, women have been an expected part of black communities' experiences of healing. Black women in their own homes or through kinship networks were and often still are the first dispensers of extant folk cures. Historically, with good reason, the white medical establishment was often perceived as the last line of defense against illness especially when contrasted with healers who were known to be trusted parts of the communities of black people. Today, advertisements for spiritual healers or root workers—Madame C or Sister Rosa —are still found in black newspapers throughout the United States.

    These understandings of healing reflect culturally specific cognitive orientations. That these remnants continue to have some life in black American communities, often without a specific one-to-one correspondence in any African culture, gives credence to the theories of Sidney Mintz and Richard Price, who conceptualize how African American cultures developed (Mintz & Price, 1976). They posit the idea that African "cognitive orientations" were part of the mentalities of those who were enslaved, as one way to discuss connections between African thought throughout the Diaspora. Perhaps, as remnants of African orientations, the interconnections between physical, mental, spiritual, and emotional life are deeply felt. Resistance against the definitions of Western medicine is tied with faith and culture in intricate weavings that most health care workers miss or dismiss as superstition.

    In a study of black, rural women in North Carolina, concepts of disease and healing became barriers to diagnosis and treatment of breast cancer. Attitudes of the women in the study toward testing saw cancer as a disease that, once activated, needed care "'not to stir it up.,'" Cancer testing is viewed as "'looking for trouble."' Many of the women were reported as viewing cancer as a disease in need of a spiritual remedy. As one woman stated, "The only one powerful enough to overcome it is the Lord. You just have to trust in Jesus to do battle for you and save you from the horrible affliction." Another woman told of her response to the diagnosis of cancer: "So I just decided then and there that I wouldn't worry any more. That I would give it to God, and that I would never speak of it again, I trusted God to heal me and I believe he has. That's all I need to know" (Davis-Penn, 1996, pp. 150-151). This study would seem to indicate mere ignorance on the part of the women. Instead, an epistemological framework is glimpsed in their pronouncements. Rich strands of meaning are woven together through historical experiences that shaped their current thinking.

    At the heart of this discussion is a chasm between the understandings of black folk methods and the world of professional medicine that cannot be simply addressed as allopathic vs. holistic or scientific vs. superstitious. It must be stressed here that resistance to Western medicine and retention of faith and folkways indicate complexities that Karen McCarthy Brown has also encountered. Karen McCarthy Brown contrasted Haitian Voudun with Western medicine and referred to this gulf as a clash of root metaphors. Western medicine locates disease primarily in the physical. In this view, healing is a commodity, to be controlled by the powerful, appropriately trained person. "Seeing healing power as property, subject to all the dynamics of a capitalist system, is one of the most significant root metaphors of Western medicine and one of the most damaging to women" (Brown, 1987, pp. 123-124).

    The history of the development of Western medicine provides an important context for understanding black women and faith healing. I am grateful to Dr. Sharon Oliver, a medical doctor, for pointing to these dimensions. She contends that most medical doctors are unaware of the history of Western medicine; it is not part of their training. As a black woman, Dr. Oliver's liberation from the confines of Western medicine came during her residency, as she witnessed how black and poor people were treated in hospital systems. Her experiences are reflected in the ways black women participate as professionals in health care, which becomes another gulf between black cultural perspectives and Western medical practice, and its history provides a wider view.

    Jean Achterberg demonstrated in Woman as Healer that women were systematically excluded from healing professions as they developed in the 18th through the 20th centuries (Achterberg, 1991). Women's folk-based healing activities were eliminated with the establishment of professional medicine, consequently embedding sexism as normative. Wise women and witches alike were marginalized, excluded, or burned as dangers by the real (male) professionals. Achterberg is quite thorough in her development of this history. However her scope only includes white women. Black women's medical history, while reflecting some of these gendered biases, is different. The unique experiences of African American women, particularly in the contexts of American society and black communities, created very different ways of interacting with the medical profession.

    Because enslaved Africans were not viewed as humans, they were not expected to receive the same health care (Savitt, 1978; Smith, 1995). Health care became a site of struggle for black people to maintain positive views of their own bodies in the face of negative views of the European American society. Of course, Europeans also compared black women with white women unfavorably, viewing them with disdain. In general, black women were rendered socially invisible except for their productive and reproductive labors for the benefit of white American society. This marginalization of black women, however, has created locations where the women have been able to recreate themselves, to employ moral agency, and to affect their communities—even in health care. This practice is reflected in the continuation of black folk medicine and furthered by the state of health care today. The health care industry has become a brutal business, with less self-awareness as a helping profession. Systems of HMOs, PPOs, DRGs, not to mention legal snarls, ethics boards, and professional standards, hamstring good intentions of the practitioners.

    Black women who work in the health care industry, most often as service workers, add to the sophisticated ways that health and healing are culturally appropriated. The African American women I interviewed who earn their livings in this field quietly incorporate their culturally grounded beliefs into their medical schools' training. Dr. Sharon Oliver is an example. I interviewed Stella who stated the case bluntly, "Look, black women have always taken care of the community's health. Our grandmothers dosed us with the change of the seasons and told us how to avoid illness by being good people. Why should things change because I became a nurse?" Stella's words indicate retention of her cultural beliefs.

    Conclusion

    Studying healing among African American women is not merely recounting anecdotes that are then placed in a Western epistemological framework. Instead, this study, as brief as it is, entered into the complexity of social dynamics by investigating facets that yield a glimpse into African American religiosity, black women's gendered identities, mechanisms of interface with social agencies, and tactics for building community and safeguarding family. These concepts have consequences for considerations of health care today.

    The interconnections between body and soul continue to inform African Americans' cognitive frameworks. The spiritual realm is not distant, but near, having the capacity to affect all aspects of human life. To consider oneself a healer, to wear an amulet or to look for the healing of faith, all have groundings in African American experiences of embodied spirituality. Black women and men hold complex, culturally-based, survival-oriented views of life which inform conceptualizations of body and spirit, of options for health, of expectations for healing. I contend that such deeply held beliefs, with suspicion of conventional medicine, influence African American perceptions about health care, as evidenced in low incidents of organ or blood donations from black adults.

    There are ethical implications of this kind of information. How can health care providers work with instead of against these underlying culturally derived concepts? A wider application of this question can be raised when any health care provider works with a different personal cultural reference. The most practical applications of this information have been from African American doctors who work within black communities. One long-time general practitioner tells of prescribing medicine for a condition while straightening the amulet the person is wearing: "In order for the prescribed medicine to work, these leaves will have to be kept straight." Some might question the validity of such an approach, yet how can medical professionals establish their legitimacy with a given community if there is no respect for the local practices and the people's intelligence? Are health care professionals meant to be like the missionaries of the nineteenth century, carrying a single culture as part of colonization?

    In this time when there are narrower health care options, higher health care costs,, and patients are sent home quicker and sicker, the lure of the folk healer along with alternative medicines have new meaning in all communities of the United States. There are opportunities to study African Americans' health care needs in new ways, such as the longitudinal Black Women's Health Study undertaken by Howard University and Boston University. (For information on this study, see their website: http://www.bu.edu/bwhs). Such considerations are only partial steps toward a greater understanding that would enrich dialogues in health care. The potential for greater understanding will have particular meanings for better health care service delivery for black families. The study of dynamics of health among African Americans is intertwined with the spiritual meanings of healing.

    And there is so much more to be done.

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