Popular belief and religious therapies among Muslims in the Netherlands: an historical-sociological analysis of religious-medical practices.

Author: C.B.M. Hoffer

Summary

The arrival in the Netherlands in the last decades of migrants of Islamic origin has resulted in the gradual appearance in Dutch society of Islamic therapies. The present dissertation examines this process. To this end, I studied anthropolo-gical and socio-logical theories which provide insight into this pro-cess. In addition, my findings are based on empirical data I derived from socio-scientific research.

The book comprises three parts. In the first, I set out the methodological and theoretical foundation of my research. The second part gives an histori-cal-sociological description of the medical and religious backgrounds of popular belief in Islamic societies. It is this popular belief from which Islamic therapies spring forth. In the third and final part, I examine the practices and beliefs of Islamic healers and their patients in Dutch society.

1. Methodological and theoretical framework
The theoretical point of departure of my study is the hypothesis that all types of medical practices, whether `conventional' or `complementary', can be regarded as social and cultural constructs: beliefs and methods of treatment, developed by people, which differ from place to place and which change over time (Nijhof & Van der Geest 1989). In line with this point of departure, I used a symbolic interactional research framework so that a study could be carried out into the views and perceptions of those involved: Islamic healers, patients, Imams, physicians and other carers. The research was made up of a literature study and field work, comprising interviews and observations.

On the basis of this theoretical point of departure, a literature study enabled me to analyse the backgrounds and nature of the practices used by Islamic healers and their patients. I first examined the views expressed by Geertz (1973) on the concepts of culture and religion. Geertz sees culture as a system of symbols which carry meanings. People communicate these meanings to one another, but also modify them. The same applies to religion in its capacity as a specific part of culture. Geertz asserts that, through religion, people create for themselves an ethos and a view of the world.

According to Geertz, in order to study societal reality, an analytical distinction must be made between cultural (including religious) and social aspects of human society. Although cultural (religious) and social factors do indeed show a mutual coherence, they can also differ from one another. The distinction between culture (religion) and social system lies in the different types of integration which are possible in both domains. It is these different types of integration which result in culture and social systems not easily being linked to one another. There is an inherent incongruence and tension between them both, which also give rise to socio-cultural changes.

Tennekes (1990) develops further these views on the interdependent relationship between culture and society. He, too, regards religion as a specific part of culture, through which man learns about the order and purpose of his existence. Tennekes stresses that culture comes into being and develops under the influence of societal relationships and processes. Culture (and religion) is determined by power and interests.

On writing about Islam in the Netherlands, Tennekes (1991) calls for a combined symbolic-anthropological approach to religion, together with a political-anthropological approach to associated social practices. In the symbolic-anthropological approach, religion is taken to be a product of people's concrete practices. Tennekes examines both the structure and the internal dynamics of religious systems. The political-anthropological approach focuses on the internal dynamics of religious systems being linked to social factors. Here, interests and power play an important role.

Bax (1988) is another advocate of political analysis of religion. He believes that traditional research too often deals with politics and religion as separate domains. He calls for an approach in which both the religious components of meaning and power come to the fore, and introduces the concept `religious regime'. This concept allows for the study of internal relationships within religious systems, as well as the external social and political factors which influence them. Bax applies his model to the analysis of the relationship between `official doctrine' and `popular belief' in Catholicism. He asserts that the dividing line between official doctrine and popular belief changes according to time and place, and is the product of a combination of specific interpretations of the central Catholic sources, underlying internal religious balances of power and external political factors.

Archer (1988) develops even further the analytical distinction between culture and social practices. She, too, is of the opinion that culture and social practices logically and empirically constitute separate units which vary independently from one another. On the one hand, a society contains a cultural system which can be coherent or incoherent. In this regard, Archer refers to the degree of `logical coherence'. On the other hand, there is a social community in which there is, to a lesser or greater extent, consensus as to a cultural system. Archer describes this as the degree of `causal consensus'. She believes that cultural changes result from a combination of contradictions at cultural and social level. She points out that social groups, opposing the keepers of a dominant culture, adopt alternative and contradictory cultural elements.

In order to understand individual practices and beliefs of Islamic healers and their patients in the Netherlands, I turned, in addition to the above macro and mesoanalyses, to anthropological transactionalism (Bax 1993) and the sociological exchange theory (Blau 1972; Homans 1972). The point of departure of both approaches is that people have all sorts of material (money, gifts) and immaterial (affection, respect, power) needs, the fulfilment of which is experienced as a reward. People strive to satisfy their needs through exchanges with their fellow men. In doing so, they try to make as much `profit' at as little `cost' as possible. From this perspective, social reality can be regarded as a complex of transactions and exchange processes between individuals. The reciprocity principle plays an important part, in that relationships built on exchange result in mutual obligations for those involved.

It appears that the transactionalistic approach can also be applied to the field of medicine. Wolffers (1990) speaks of the `health market'. In his opinion, all health care systems are based on an exchange of goods, services and power, with supply (healers) and demand (patients) being closely interwoven. A further theory with exchange and dependence as the principal factors in relationships between individuals in the medical field is developed by De Swaan (1989). His point of departure is, that in addition to a (bio)-medical vision on disease, there is also a sociological vision. The medical vision focuses on the loss of bodily functions, and the sociological vision on the loss of societal functions. In other words, the physician concentrates on biological processes, while the sociologist is concerned with developments in networks of dependency relationships in the field of disease.

Ter Borg (1998) says that the principles of supply and demand can also be applied to the field of religion. He observes that theologists traditionally limit their focus to the area of supply, despite the fact that in an age of rapidly changing religious needs, it is the area of demand which should be examined.

I used the theoretical insights described above as a basis for the subsequent sections of the book. First, an historical-sociological outline of the relationship between Islam and popular belief in Islamic societies will be given. I then describe the practice of Islamic healing and the social position of Islamic healers in Dutch society. I focus on Sunni Islam because it constitutes approximately ninety percent of Muslims, both globally and in the Netherlands (De Bruijn 1994:151).

2. Islam, popular belief and therapies in Islamic societies
Islamic therapies are linked to popular belief in Islamic societies. This popular belief is made up of a mixture of elements from Islam and various important developments in the field of medicine. Consequently, before presenting my study of Islam and popular belief, I first give an outline of the history of medicine in the Islamic world. This includes such medical traditions as Greek inspired Arabic-Islamic therapies; Prophetic medicine with its strong influence from orthodox Islam; and biomedical therapies. Moreover, I look at Sufism because the viewpoints of some leaders within this religious movement have also influenced the medical field.

The terms used to describe these traditions and movements illustrate that, in varying degrees, aspects of Islam have influenced medical viewpoints. Notably, religious discussions on such issues as the influence of Greek rationalism, predestination versus man's free will, the existence of natural and supernatural causes of disease, as well as the role and significance of magic have all left their mark on medical viewpoints.

Moreover, it is evident from debates between leaders of medical traditions that for the benefit of their own viewpoints and interests, they incorporated their own interpretations of the Koran and the Hadîth. The polyinterpretable character of the Koran and Hadîth, together with the way in which they are used to underpin viewpoints and interests, is also at the root of discussions on so-called popular belief in Islamic societies.

An important characteristic of this popular belief is that in addition to natural causes, supernatural causes are also regarded as possible links to disease and problems: magic, the evil eye and evil spirits (jinns). All sorts of therapies have developed as a result of this popular belief. Morocco and Turkey, for example, are home to a vast array of Islam-inspired therapies and healers, alongside biomedical health care. Such healers use blessings in the form of a spiritual power (baraka), either an inherited gift or through faith healing using Koran verses which contain this power. In addition to consulting Islamic healers, saint worship is also practised in Islamic societies. A saint's tomb is visited in the hope that diseases will be cured or problems solved.

For the purposes of analysis, the literature usually distinguishes between official Islam and popular belief in Islamic societies. The term `official Islam' refers to the Sunni religion, as practised by the orthodoxy: the religious scholars and Imams (religious officials) in mosques. In contrast, `popular belief' is taken to consist of pre-Islamic elements, local traditions and folklore. In practice, however, it is not easy to make a distinction between the two, as it also depends on the views held by those involved. I have described the distinction between Islam and popular belief from both an orthodox as well as an unorthodox angle. In doing so, and in line with the opinions of Geertz and Archer, I examined on the one hand the religious interpretations of the relevant parties (religious/cultural level), and on the other hand their social positions and associated interests (social level).

Throughout time, various theological arguments have been presented from within orthodox Sunnism calling for a definition of the dividing line between Islam and popular belief. Particular emphasis is laid on the fundamentally monotheistic character of Islam. Such practices as fortune-telling, magic rituals and saint worship are thus labelled new-fangled (bid`a), pre-Islamic or non-Islamic. In contrast, anthropological research shows that official Islam and popular belief go hand-in-hand in the everyday religious practices of many Muslims. For these people there is only one Islam: the one they have created for themselves.

In addition to religious differences in insight, social factors also play a part. From a social angle there is, at one end of the scale, a group of religious experts who, given their specific education and knowledge, determine the content of Islam with, at the other end, part of the religious masses which cannot exert any influence at all. Consequently, the traditional theological arguments favouring or opposing popular belief are somewhat ideological. The habit of orthodox scholars of labelling practices within popular belief as `pre-Islamic' can be seen as a form of marginalisation. They are protecting their own interests and positions. In contrast, it is possible that people who are unable to enter, or have restricted access to, the dominant religious system seek refuge in other religious interpretations and types of religious experience. In addition to reformist tendencies, this is also illustrated by popular belief. Popular belief can thus be an element in the conflict of interests between various religious and political groups.

We therefore see a dichotomy between Islam and popular belief which is arbitrary and fickle. It is religious (theological) interpretations in combination with social (political) factors which determine whether a distinction is made at all and, if so, where the dividing line is situated. In practice, this implies that Islam (the cultural level) will manifest itself differently according to social, political and economic factors (the social level) in a certain society or location. In association with constellations of power, throughout the history of Islamic societies, particular variations of Islam have taken precedence over others. To echo Bax, we can speak here of a conflict of religious (sub)regimes which alternate in taking positions of power.

3. Islamic therapies in the Netherlands
The examination of the relationship between Islam and popular belief in Islamic societies serves as background information for the recent appearance in Dutch society of Islamic therapies. This subject is the focus of the final part of the present book. I have described the practices of Islamic healers in the Netherlands as a complex of socio-structural and individual factors. On the one hand, Islamic healers operate from and within existing socio-cultural structures. They grow up in their own countries, emigrate to the Netherlands and are confronted with official Islam as institutionalized in that country, together with the Dutch system of conventional and complementary health care. On the other hand, the Islamic healers themselves give shape to those structures.

Islamic healers
The arrival in the Netherlands in the last decades of migrants of Islamic origin has resulted in the gradual appearance in Dutch society of Islamic healers. I define an Islamic healer as: a. a person who bases his or her work on an Islamic-inspired power (for example, hereditary healing powers said to have been passed down from the Prophet Mohammed); b. a person who retains an Islamic vision in regard to their healing work; c. a person who establishes him or herself as a healer, informally (through family and friends) or formally (through advertising).

Through interviews and observations, I collected information on 39 Islamic healers (34 men and 5 women) with diverse national backgrounds. Islamic healers (and their patients) generally hold views on certain diseases and problems which differ from those held by conventional carers. The Islamic healers distinguish between diseases with a natural (physical or psychological) cause and diseases with a supernatural cause. In their eyes, people consult a physician for natural diseases and go to an Islamic healer for supernatural ailments. An important element in the treatments used by Islamic healers is Koran verses, which are said to have a healing effect (baraka). Koran verses are used, among other things, for faith healing and in the preparation of amulets.

Most Islamic healers are of the opinion that they should not ask money for their work, nor that they should advertise. Most of their patients come to them on the advice of relatives and friends. There are, however, healers who find it acceptable to charge a fee, as well as those who communicate their services through advertisements or business cards.

The patients of Islamic healers
I collected information on patients of Islamic healers through interviews with 65 people, and a questionnaire distributed among 227 people. Those people have different nationalities and socio-economic backgrounds, and fall into all age categories. Eighty percent of the patients say they have consulted a physician or other conventional carer prior to visiting an Islamic healer. The respondents give a variety of reasons for visiting an Islamic healer. Some are simply looking for pain relief. Others visit an Islamic healer through disappointment with conventional treatment. Others are convinced that they are suffering from a supernatural disease which a physician can not treat. There is also a category of patients who consult an Islamic healer under the motto `It can't do any harm'.

People visit Islamic healers with a variety of symptoms. Biomedically, these are physical, psychosomatic and psychological. The symptoms of most patients are chronic and non-life threatening. One characteristic the symptoms all have in common is that they appear to be linked to situations and social problems (such as unemployment, relationships, social uncertainty) which the person can not cope with. Some of these are existential issues, or a need for personal guidance.

An important characteristic of the work carried out by Islamic healers is that they sometimes appear able to offer patients in a seemingly hopeless situation an entirely new perspective. This is done by the healer responding directly to the patient's particular situation and state of mind, through a combination of symbolic acts and practical advice. This may result in the disappearance of the symptoms or the patient adopting a different attitude towards their ailments.

Religious and medical aspects of Islamic therapies
The above shows clearly that, medically and socially, Islamic healers have a specific role in Dutch society. Because Islamic healers have an ambivalent relationship with both Islam and the health care system, this role is an informal one.

Official Islam and Islamic therapies - The ambivalent relationship between `official' Islam and popular belief in Islamic societies is also evident among Muslims in the Netherlands. Given the absence in that country of Islamic religious scholars, it is generally Imams in mosques who imbue the official doctrine. At the same time, Islamic healers can be regarded as exponents of Islamic popular belief. I describe the viewpoints of both types of religious specialists in regard to the legitimacy of specific religious-medical acts (faith healing, amulets and rituals) as well as charging of fees.

Most of the 31 Imam respondents did not set limitations for acts of healing. Moreover, some Imams regarded it as a separate religious-medical specialism. The dividing line between what Imams regard as acceptable and unacceptable lies not so much in the area of healing activities but in the field of earning money for such practices. Virtually all Imams were opposed to the much-quoted practice of charging for services and advertising. Reflecting the indistinct dividing lines between Islam and popular belief, the research also shows that, on the basis of the descriptions given earlier of both types of religious officials, some Imams themselves practice Islamic healing.

Two elements constitute the basis of the legitimacy which Islamic healers attach to their work. First, the power which they use to perform their work, and second, their Islamic vision. With regard to the power, we can distinguish between three types of Islamic healers: those with hereditary healing powers, those with a teacher, and those who have studied alone. In describing their personal visions, all the healers refer to passages from the Koran and the Hadîth. With regard to fees, most healers believe that no money should be charged given the religious nature of their work. Although some do charge.

It may be concluded, therefore, that Islamic healers view their work as being in line with Islam. They do not make a distinction between what they do and Islamic doctrine. They and their patients are representatives of, and contribute to, the development of Islamic popular belief in the Netherlands.

The Dutch health care system and Islamic therapies - In addition to their special relationship with Islam, Islamic healers have a special role in the field of medicine. In the Netherlands, they are confronted with the national health care system and related services, an area which is dominated by biomedical therapies and where complementary medical practices play a secondary role. The arrival of Islamic healers has added a new dimension to the current debate on the position of complementary medicine.

Given that most people who consult Islamic healers also visit physicians and other carers, raises the question of whether, and how, these categories of care providers should cooperate with one another. This question is especially prompted by existing, informal contacts between physicians and Islamic healers. Both Islamic healers as well as physicians and other carers have given a variety of answers to this question. Islamic healers regard themselves as specialists in the area of the supernatural. Some Islamic healers strive in two ways to gain recognition within the Dutch health care system: either through establishing informal contacts with physicians and other carers or by seeking association with the network of complementary medicine.

Most of the physicians and other carers who were interviewed, say that they do not encourage their patients to consult Islamic healers but nor do they discourage it. This principle is underpinned by two viewpoints. First, given therapeutic considerations, belief in supernatural forces should be taken seriously, but Islamic therapies and cooperation with Islamic healers should be rejected. Second, elements from Islamic therapies should be given a place in conventional treatments.

Whenever conventional carers did mention cooperation with Islamic healers they attached various conditions, such as reliability and openness of Islamic healers, and the fact that treatments should not conflict. These conditions imply that the near future will not see any structural cooperation between conventional carers and Islamic healers. In addition to paradigmatic differences, this is due to the fact that Islamic healers do not constitute a homogenous group.

Despite these structural hindrances to formal cooperation, there are physicians who, for some Muslim patients, decide to informally call on the services of an Islamic healer. These are usually patients with psychological problems whose physicians have concluded that conventional treatments are ineffective, particularly when it involves understanding the perceptions of the patients. These physicians opt for conventional treatment in combination with the therapy offered by an Islamic healer.

Social practices of Islamic healers
To conclude, I describe how Islamic healers combine aspects of their own cultural and religious backgrounds with the opportunities offered to them by Dutch society. The point of departure here is the thesis that both the medical and religious fields can be regarded as a `market'.

Supply and demand - In this market, patients have a particular demand which can be met by Islamic healers. Islamic healers meet this demand in three ways. They provide: a. religious guidance in instances of disease and problems; b. mediation between the biomedical rationale and that of Islamic popular belief; and c. supervision in processes of change.

Islamic healers, too, have their motives for entering the religious-medical market. First, the goal of material reward. Although most healers do not charge a fee for their work (for religious reasons), they feel justified in receiving gifts. A gift constitutes a legitimate and implicit socially compulsory quid pro quo on the part of the patient in exchange for their services.

A second motive for healers is aspiration towards social prestige. A distinction can be made here between internal social hierarchies and external social hierarchies. If healers enjoy a certain prestige in their own circles to which they, on religious grounds for example, attach a great deal of importance, they will not strive towards that goal outside those circles. Examples of this are Surinamese-Hindustan and Turkish Islamic healers who work primarily for patients of their own nationality. Those healers enjoy a position of standing within the internal hierarchies of their groups. The situation is different, however, for Moroccan healers who often have diverse patient groups, where there is no question of hierarchical relationships. In the absence of their own social networks in which they are appreciated, they try to gain respect externally. In addition to maintaining informal contacts with regular carers, they also regard membership of complementary medicine organizations as a means to that end. Finally, there may be a spiritual motive for Islamic healers to do their work. Some of them regard their treatment of patients as good deeds for which they hope to be rewarded in the hereafter.

Social interests and religious interpretations - The motives of Islamic healers, described above, conceal social interests which they have in Dutch society. I have related those interests to the described marginal position held by these healers, both religiously and medically. In the area of religion, the interests of Islamic healers differ from those of Imams. In combination with theological differences in insight, both groups consequently have different approaches to healing activities. As representatives of `official' Islam, such as is institutionalised in the Netherlands, Imams cannot afford to be openly and formally involved with healing activities associated with popular belief. In practice, however, they are confronted with popular belief among Muslims in the form of requests for amulets and faith healing. They sometimes comply informally with these requests or they refer them to Islamic healers.

In contrast to the formal views held by Imams, Islamic healers see no dividing line between Islam and popular belief. They see their activities as part of Islam and are completely open about their work. Aside from their relationship with official Islam, Islamic healers are also confronted with the dominant biomedical approach present in Dutch society. They respond by presenting themselves as specialists in the field of supernatural diseases, of which biomedical practitioners have no understanding.

Thus, the practices of Islamic healers reflect certain interests. In this context, I have described a number of trends. Firstly, it appears that most healers carry out this work along side formal employment or claiming social security benefit. In that respect, their healing activities are of secondary importance to them. Although, the fact that some healers live on social security benefit does not imply that they have no material interests in their work.

Secondly, the healers' interests are associated with the way they are organised which, among other things, appears to be linked to their national backgrounds. Surinamese-Hindustan Islamic healers are usually associated with international mystic movements, which represent their interests. West African healers probably also work within international contexts, albeit on a more commercial basis. Turkish healers work independently and treat only a limited number of people in their own circles. Thus, they appear to have predominantly religious motives. Moroccan healers also work independently but they manifest themselves and operate among a wider circle of patients with a variety of national backgrounds. The biographical data on the Moroccans show that most of them turned to healing after they had left the labour market. These healers probably have social and material interests in carrying out their work, in addition to religious ones. Such healers make use of their status as sharîf (plural: shurafâ'), meaning that they are descendants of the Prophet Mohammed or a saint, and claim to possess healing powers.

Thirdly, the interests of healers are further spotlighted in the many stories from patients claiming malpractice and fraudulent behaviour. It is difficult to determine the accuracy of these stories due to the subjective criteria pertaining to the reliability of healers. Some healers are regarded as reliable by some patients, while others praise them.

Fourthly, accounts given by some respondents illustrate that the decision to become a healer is the sum of personal choices and social factors. There are, for example, shurafâ' whose status would entitle them to work as healers but who refrain from doing so because of social circumstances.

Changes surrounding Islamic therapies - Migration does not only influence the interests of Islamic healers but also the methods they use. Their techniques appear to change because: a. some healers gear their techniques towards the cultural backgrounds of patients; b. some healers who are associated with Dutch organisations for complementary therapists follow training courses. An additional change linked to this last category of healers is that under the influence of such organisations, they sometimes start charging fees. Such changes also affect patient groups: as a result of their therapeutic adaptations, a number of Moroccan healers now have primarily Dutch patients and only a few Moroccan ones.

Medical integration as a dilemma - It thus appears that Islamic healers are being confronted with a dilemma. Either they can opt to gain a degree of social recognition within the Dutch complementary and conventional health care system, but will lose credibility in the eyes of their Islamic community. Or they can choose to remain faithful to the authentic principles of their treatments thus retaining clientele within their own circles. But the latter implies they will continue working in an informal and hidden network structure.

4. Conclusion
The research shows that the practices adopted by Islamic healers in the Netherlands are determined by a combination of social requirements, individual motives, social interests, as well as religious interpretations. Islamic healers fulfil certain needs of their patients. Those needs involve providing guidance when a patient has no further recourse, either medically or socially. The motives of healers are material (remuneration, gifts) and immaterial (from social esteem to religious rewards).

Whereas Imams embody official Islam, Islamic healers hold religious views which are connected to popular belief in Islamic societies. These focus on interpretations of the Islamic sources, based partly on personal convictions and partly on the social position of Islamic healers in Dutch society. In this regard, it can be said that in addition to official Islam, Islamic popular belief is gradually taking shape in the Netherlands.