164 chapter
Anthropologists who study chronic illness have occasionally refl ected on
the meaning of cure and the goals of therapy. Estroff (1981) in her ethnog-
raphy of people suff ering psychopathology while trying to cope with daily life
in non-institutional, community settings in the U.S. addressed the meaning of
“cure:” “I had expected that people in the treatment program would be cured
or would get better. I did not know that the process and progress would be
so slow, so painful, and so laden with failure and setbacks” (18). Th e situation
of the people Estroff describes is reminiscent of individuals in Kerala who
have chosen to live with intractable psychopathologies at a temple, mosque
or church having essentially given up on attempting to overcome their illness.
Additionally, Kleinman (1988a) proposed emphasizing care rather than cure
among people with chronic illnesses, asserting that “chronic illness by defi n-
ition cannot be cured, that indeed the quest for cure is a dangerous myth that
serves patient and practitioner poorly” (229). Estroff and Kleinman did not
elaborate on how the concept of cure is constructed, but their recognition of its
signifi cance to those seeking therapy foreshadows this chapter’s concern with
examining its cross-cultural implications.
Although he does not aim his critique at the ideology of cure specifi cally,
Alter’s (1999) work on the principle of health in ayurveda complements my
scrutiny of the goals of healing as he points to a “remedial bias” in medical
anthropology and contemporary medical practices (44). Alter claims that in
ayurveda health is seen as ongoing improvement rather than a concern for
restoring balance or removing illness. Analyses of healing in various cultural
contexts, Alter suggests, have overemphasized remedial, oppositional and cura-
tive approaches to health. Like the ideology of curing, the “remedial bias” tends
to isolate healing practices from approaches to health that engage in broader
projects of improvement and transformation.
Th e concept of cure is problematized in several ways by the experience of
patients in Kerala. First, patient experiences alert us to the importance of bal-
ancing caring and curing, of attending to the quality of the process of therapy
while “fi ghting” an illness. Second, living in an aesthetically- and spiritually-
engaging environment as a means of coping with a problem constitutes an
alternative to the goal of eradication of an illness that is implied in seeking a
cure. Finally, there are patients who felt they achieved a state that is better or
more exalted than the remission of symptoms or return to a pre-illness state that
is inherent in the concept of curing. Th at is, they claim they attained a state of
well-being that is more vibrant, more robust than what they experienced before
their illness. Recalling Alter’s claims about the goals of ayurvedic therapy, we
can say in this context that “health” is seen not simply as a lack of illness, or as
a default or baseline state of being. As implied by the Malayalam term sukham,