Revisiting Usog Pasma Kulam

N Revisiting
Usog, Pasma, Kulam

Revisiting
Usog, Pasma,
Kulam
N
Michael L. Tan
The University of the Philippines Press

Diliman, Quezon City
PUBLISHED BY THE UNIVERSITY OF THE PHILIPPINES PRESS
E. de los Santos St., UP Campus, Diliman, Quezon City 1101
Tel. Nos.: 9282558, 9253243
E-mail: press@up.edu.ph
© 2008 by Michael L. Tan

All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted, in any
form or by any means, electronic, mechanical, photocopying,
and/or otherwise, without the prior permission of the author
and the publisher.
First printing 2008

Second printing 2010
Third printing 2019
The National Library of the Philippines CIP Data
Recommended entry:
Tan, Michael L.
Revisiting usog, pasma, kulam/Michael L. Tan.—
Quezon City: The University of the Philippines Press, c2008.
(2010, 2019 printing)
p.; cm.
ISBN 978-971-542-570-4
1. Traditional medicine—Philippines 2. Healing—

Philippines—Folklore. 3. Philippines—Social life and
customs. I. Title.
GR880 306.461’09599 2010 P083000032
Book Design by Nicole Victoria

Illustrations set in Africain and Precassos
Printed in the Philippines by Econofast Press
Table of Contents
Preface vii
Acknowledgements xi
Chapter One
Introduction: Deconstructing Health and Illness 1
Chapter Two
Defining the Framework for Analysis:
Health, Illness, and Medicine 17
Chapter Three
Usog, Bangungot, and Other Mystical Theories
of Illness Causation 29
Chapter Four
The Engkanto, Mangkukulam, and Aswang:
Personalistic Theories of Illness Causation 55
Chapter Five
Pasma, Hangin, and Naturalistic Theories
of Illness Causation 76
Chapter Six
From Illness to Health 112
Abbreviations Used 143

References Cited 145
Preface
I HAVE STUDENTS at the University of the Philippines who

weren’t even born when this book was first published in 1987.
At that time, I thought there would be a small readership
for the book. Alay Kapwa Kilusang Pangkalusugan (AKAP), a
nongovernmental organization (NGO) involved in primary health
care, printed 1000 copies, thinking it would last a few years as it
made its way through our NGO networks. But maybe the title was
intriguing enough—Usug, Pasma, Kulam—to appeal to a wider
audience. I learned, over the years, that it’s been used by students
in anthropology, philosophy, psychology … and, most surprisingly,
by medical colleges. The book went out of print shortly after it was
published, but it has been photocopied over and over, which is fine
with me—we don’t have royalties in the NGO world.
Time and again, I’ve been asked if I intend to reprint or revise
the book. Several times, I got around to scribbling notes on the
margins of my copy of the book but that copy of the book went
missing as well.
Fortunately in 2005, thanks to the Ford Foundation and the
Social Medicine Unit of the UP College of Medicine, I was able to
get that final push to revise the book. It helped having a project,
together with the Social Medicine Unit, to compile a bibliography
of materials related to medical anthropology in Southeast Asia.
Scanning the entries for the Philippines confirmed my suspicions:
there hasn’t been that much of new anthropological materials
relating to health in the Philippines in the last twenty years or so.
What has seen publication are more of applied research, many of
the KAP (knowledge, attitudes, practices) survey type.
Despite the dearth of new published materials about the
Philippines, I have to say that much of what I saw in 1987 still
vii
Revisiting Usog, Pasma, Kulam
holds true today. Beliefs in usug, which purist Tagalogs have now
pointed out to me as being more properly spelled as usog, remain
widespread, as with pasma, kulam, and most of the other concepts
discussed in the 1987 book. Some businesses have even capitalized
on concepts such as pasma, peddling particular brands of alcohol
and gloves as preventive measures. Meanwhile, the vendors in front
of Quiapo church in Manila continue a brisk trade in medicinal
flora, fauna, minerals, an assortment of anting-anting (amulets),
and other religious and magical objects.
The three sections of this book that I’ve had to revise
substantially were those on bangungot, pasma, and the germ theory,
these expanded sections telling us something about the way our
health beliefs are evolving.
Let me explain.
There have been peaks in interest in bangungot and similar
syndromes, coinciding with “epidemics” such as among Thai
migrant workers in Singapore, and, in the Philippines, with the
death of popular actor Rico Yan. Bangungot therefore represents
the way traditions persist, even as the medical world continues to
propose new theories to explain these intriguing ailments.
This book was already going to press when I had to request
UP for additional time to revise the section on pasma, because of a
research report that had come out of the UP College of Medicine.
The research findings are intriguing, shedding new light on both
the biomedical and sociocultural aspects of pasma.
I also had to expand the section on the germ theory, given the
way Filipino “germ consciousness” has grown. This has been due in
part to the panic around HIV/AIDS, as well as SARS, avian flu, and
other outbreaks of infectious diseases. This germ consciousness
represents the way we do change our perceptions about health and
illness, but it doesn’t necessarily mean we’re “progressing”—in this
book I describe many continuing misconceptions around germs,
fuelled not just by street talk but by the medical establishment
itself, as well as the pharmaceutical industry.
viii
Preface
This book then is not just about “traditions” in a narrow

sense but about the culture of health in the Philippines, including
its many nuances and contradictions. I now write with a more
conscious effort to get to health professionals, hoping this book
can alert them to problems not just in “tradition” and “culture” but
also in the “modern” world of western biomedicine. I’ve edited the
book to reduce the social science jargon, but still hope that I have
not sacrificed the frameworks that the social sciences offer.
I readily agreed when Dr. Maria Luisa Camagay, director of the
UP Press, asked me if this book could be produced in a pocket-
sized format. This book is intended for informal use, something
that can be read on the LRT, but also used as a quick reference
in a clinic or a rural health unit. It will continue to be a work in
progress as popular medicine continues to evolve.
Michael L. Tan
August 2007
ix
Acknowledgements
THE RESEARCH PROJECT at AKAP which produced the first

edition of this book was partially supported by Filipinas Foundation
and Philippine Business for Social Progress, while the publication
of this book, and earlier reports, was made possible through a grant
from Christian Aid.
Work on the revised edition was made possible by a Ford
Foundation grant, through the Social Medicine Unit of the UP
College of Medicine.
I am also indebted to my master’s thesis adviser, Dr. Norman
Thomas of the Texas A&M University, who first introduced me
to medical anthropology, and to my dissertation mentor, Dr.
Sjaak van der Geest of the University of Amsterdam, who further
deepened my training in this exciting field. Finally, I would
like to acknowledge people, too many to name—from albularyo
to students, mangkukulam to fellow professors—who shared
their knowledge and insights into health and health care in the
Philippines.
xi
4
Chapter One
Introduction:
Deconstructing
Health and Illness
1.1 A Personal Note (1987)
THE ACCIDENT COULD not have been more timely. I was

preparing to leave for Bangkok’s airport when I slipped from the
pavement and twisted my ankle. There was no way I could postpone
the return flight, so it was a matter of bearing with the pain until
I got back to Manila. From Manila’s airport, I went straight to a
hospital, where the occupational therapists said they couldn’t do
anything because the doctor was out, but they said it looked like a
minor sprain and the best thing to do was to soak the foot in ice.
As I limped out of the clinic, a nurse whispered to me, “I think a
hot compress would be better.”
When I reached home, the foot was so swollen and painful
that I couldn’t do anything by way of a compress, hot or cold. All
I wanted was to rest the foot. My mother was horrified with the
suggestions given at the hospital. For her, anything wet was taboo
for a sprain, and between hot and cold, she would compromise
only for a hot compress. I ended up leaving the foot alone until I
could get an X-ray.
The X-ray didn’t show any fractures. Then came different
advice from my doctor friends. One suggested that I take Papase
to reduce the inflammation, although only the day before, the
Bureau of Food and Drugs had ordered the withdrawal of all
drugs containing proteolytic enzymes, Papase included, because
1
they had been found ineffective.1 I checked with friends who were
physicians and got different advice. Some said it was better to have
the foot immobilized with a cast. Others said it was better not to
use a cast and to just rest the foot. And of course, there was my
mother, who said that since it wasn’t a fracture, it would be better
to consult a traditional bone-setter. Fractures are handled better by
“western medicine,” she explained, while the traditional healers
are the experts for sprains and dislocations.
That meant another decision though—to go to Mang Cleto,
a Filipino bone-setter, or to a Chinese practitioner. With Mang
Cleto having a heavy patient load, I ended up with the Chinese
practitioner, who massaged the foot and applied a plaster with
an herbal paste. He said I needed three or four more sessions
of massage to make sure that the circulation would get going.
Otherwise, he warned that I’d have problems with the foot for the
rest of my life. I went back only twice, since each time he insisted
on a new plaster.
I ended up with self-treatment at home. I’d take clandestine
showers, since my mother wouldn’t hear of getting the foot wet. She
had her own medicines—a Chinese decoction that was probably
mostly ginger from the way it smelled, and Ben-Gay ointment. The
principle was to apply or to create heat. I didn’t have the foot cast,
but I used an elastic bandage to keep it fairly stable. That got my
mother’s imprimatur: the bandage would keep the foot warm and
would protect it from “winds,” but at times she had her doubts
because she was just as worried about the bandage restricting
circulation of the Qi or “inner energy,” which was needed for the
healing process.
More than a month after the accident, there was still a feeling of
soreness, bordering on anesthesia, one I’d described as “coldness.”
My mother says it’s either a sign that it’s healing (because the Qi
was now circulating) or that it wasn’t healing properly (because
complete healing would mean absence of any pain or soreness).
Personally, I still feel the foot would have healed on its own.
2
Introduction: Deconstructing Health and Illness
Besides, I realized so much attention had been put on the foot

“needing” the rest, rather than on the owner of the foot.
The whole point in this anecdote is that we find this clash of
paradigms as to how illness comes about, and how we handle it. We
see that it is not just a matter of the traditional versus the “western”
but that there are other divisions as well: a “Chinese” explanation
versus a “Filipino” explanation. There are disagreements as well
with “western” medical practitioners: to cast or not to cast, for
example. Yet, we all want explanations. Thoroughly secular
in outlook, none of my friends wondered about why I fell—if
it had happened in the barrio, there would have been a host of
theories about spirits or karma. Only my mother came closest to
using a magico-religious explanation—“Your father’s been having
problems with his back; your grandmother and your uncle fell
and you know, I did nearly slip while getting into the elevator
the morning you fell. It must be a bad time (minamalas) for our
family.” Later, she checked a Chinese almanac which confirmed her
suspicions that the day I had chosen to travel had been particularly
“inauspicious.” “We should have checked first before you made
your airline reservation.” All of this advice coming from someone
who had gone through Filipino Catholic schools her whole life.
Curiously, there were several friends who suggested the fall
was “subconscious,” a way of my body telling me to slow down. I
did get to excuse myself from facilitating one conference because
of the accident, but still had to attend another conference a week
later, over the objections of some friends and of course, my
mother, who was upset that there was no hot water available at the
conference site.
We all carry a fascinating repertoire, or a varied menu, of
theories about health, illness, and illness causation. The accident
made me even more conscious of the wide variety one would
find at the level of individuals. Even “western” medicine carries
so much of the undefined. Read, for instance, a discussion by
Fletcher (1978) on chronic obstructive lung diseases and find that
3
there are problems even in the definition of airflow obstruction

and pathological processes leading to such problems. Or, we could
turn to one survey of 274 physicians, psychiatrists, and nurses,
which showed that there was no agreement on the word “confused”
(Simpson 1984).
It is not so much confusion over the confused than the fact
that our ideas, concepts, and theories are clearly determined by
our social environment. Each disruption we have—an illness
episode, to use medical terminology—provides us with additional
insights that strengthen or modify our existing theories, which we
then pass on to others.
1.2 Rationale for the Study:

About Other People’s Concepts and Beliefs
I WROTE THIS book in response to health professionals who were

working with community-based health programs but it has since
been used by other professionals working in hospitals, as well as
those teaching in medical and nursing schools. Health professionals
go through a westernized educational system and although we (I
will use “we” since I work in public health as well) retain some
traditional beliefs, we remain alienated from the culture of the
majority, which we quickly dismiss as backward and superstitious.
This book works on deconstructing the traditional medical
system, offering a classification system to look into various
concepts of illness. The Philippines has an estimated 88 million
people, speaking some 171 languages according to the most
recent inventory of the Summer Institute of Linguistics (see www.
ethnologue.com). We are culturally diverse, with many different
lifestyles and religions, different degrees of exposure to other
cultures and to the world.
Much has been said in recent years about the need to help
health professionals to develop “cultural competence” or “cultural
4
sensitivity,” all the more important in a country where there is

so much ethnic diversity. The assumption here is that if health
professionals understand the “beliefs and practices” of different
ethnic groups, then they will be able to change people’s behavior,
in terms of disease prevention, compliance with prescriptions, and
health maintenance.
But Kleinman (2006) has criticized this “traits list approach”
where health professionals get a list of the “beliefs and practices”
and then presume they can now handle the different ethnic groups
that come to them. Kleinman suggests we go beyond this cultural
competence approach, the term itself implying it is some kind of
technical skill you can easily acquire, and learn to use ethnography,
an engagement with people that builds empathy in an “intensive
and imaginative” way.
I will be using the term “beliefs” quite often in this book,
but want to emphasize that the word is problematic. We often
think of other people’s “beliefs” and claim that what we have is
“knowledge,” the term “beliefs” tending to refer to the metaphysical,
sometimes even the illogical. Note how, in Filipino, “paniwala” has
even stronger connotations of the metaphysical, especially when
contrasted with “kaalaman” as knowledge.
The term “beliefs” is also problematic because of its association
with religion, especially world religions such as Christianity where
we speak of “faith” in beliefs-as-doctrines. It is dangerous to think
of traditional medical systems as carrying such doctrines; in fact, it
may be in western “modern” medicine where a faith in biomedical
“facts” is required. In popular medical cultures, “traditions” may
be powerful, but not imperative, with enough room for cynicism
and for people to adapt. This is why there is so much syncretism
in folk medicine.
In this book, I will present the results of different ethnographies
to show that medical culture is not just a random collection of exotic
beliefs and practices but are systems of knowledge. My review of
earlier ethnographic work, supplemented by my own research,
5
probes into the indigenous philosophies that lay the foundation of

culture. This includes ontological aspects (the nature of being and
of existence) as well as the epistemological (the nature, methods,
and limits of knowledge). One could even extend an analysis to
include the escatological (issues pertaining to death, judgment,
immortality, and an after-life), but again, I will warn here against
trying to think of simple dichotomies of “beliefs” determining
“practices,” or of morality being prescribed through religion alone.
Throughout the book, I try to show how traditional medicine is
embedded in other social structures, and therefore will sometimes
take on functions of what we think of as religion or politics.
Note this anecdote (Heiser 1936, 131-32) from the US colonial
period about a colonial public health official trying to convince the
people of Mountain Province about the existence of pathogenic
amoeba. He brought in a microscope and a slide with a “lusty
specimen” of amoeba mounted on it. Showing the slide to one of
the tribal chiefs, the official warned, “That’s what causes diseases
that kill you, but we can kill it.”
The chief retorted, “Well, it might kill a little white man like
you, but wouldn’t hurt a great big Apo like me.”
Many health professionals and workers undoubtedly have their
own stories to tell, reflecting the gap between the “professional” and
the “lay” perceptions of health and illness. But that anecdote from
Heiser shows us there is more to the differences than “culture.” We
find that culture relates as well to perceptions of status, rank, and
power. We see similar perceptions in many different situations.
Those of us working in HIV/AIDS programs have seen all too
many examples. There’s the young adolescent engaging in risky
sexual behavior, confident that he or she is invincible. We see it
too in the wife who believes she is not at risk from HIV/AIDS
because she is totally monogamous, even if her husband is not. We
see power relations at work, too, so that even if that wife suspects
she can get infected, she would not be able to ask her husband to
use condoms because that would mean she does not trust him.
6
This is when she might invoke religious beliefs, “Oh, the Catholic
church does not allow condoms.” Similarly, her husband might
also cite religious beliefs to justify his not using condoms, when
in reality, his real reason is the perception that the condoms reduce
pleasure.
In producing a book on traditional medicine in the Philippines,
I realize there are questions about what “Philippine” or “Filipino”
is, and what a “traditional medical system” might be. This is why a
cross-cultural survey becomes all the more important. In reviewing
the various ethnographies for descriptions of health and illness, I
did find many convergences, many cognitive clusters, for example,
the usog belief among Tagalogs so clearly related to those of buyag
in southern Philippines.
Yet I do agree that we have to be careful about using the word
“Filipino” here. I would be the last person to suggest that all
Filipinos share all the concepts described in this book. Kleinman
(2006) emphasizes that ethnography must capture ambivalence,
the way people move between worlds and, I would add, identities.
We can be “modern” or “traditional” depending on circumstance …
and convenience.
This study lays out the cultural “menu” that we have, much
like what I had to confront with the sprained foot. But I also try
to bring out the way popular medical knowledge is linked to
our natural environment, to our history, to our other cultural
repertoires, and that as individuals, we have our own contexts as
well. Culture is inscribed in our bodies and in our minds, but we
too are able, to some extent, to select from that menu.
1.3 Theoretical and Methodological Perspectives
MY STUDY DRAWS mainly from ethnographies, many from the

early twentieth century, many of which were produced by American
anthropologists who came in during the colonial period to study
7
“non-Christian tribes.” The studies are mainly descriptive accounts

of cultural phenomena, often with a focus on the exotic and the
“primitive.” This approach has come under challenge through
the years. Some of the challenges come from the “primitives”
themselves, who have since become anthropologists and who are
now in the position to critique the ethnocentric biases that appear
in many of the ethnographies—condescending descriptions which
were often ideological in nature, serving the purposes of racism
and justifying colonialism, i.e., the need to “civilize” the barbarians
that were being described.
These studies still have value, especially when they are revisited
with a more interpretative, cross-cultural approach. One has to
credit the colonial anthropologists with the thoroughness of their
accounts, even if filtered by ethnocentrism. I am amazed at how
the themes, even in accounts that are several decades old now, still
resonate and with unexpected connections. In the earlier edition
of this book, I had missed out on an article by Blust (1981) which
looked at linguistic evidence for Austronesian taboos, referring to
the region that includes Malaysia, Indonesia, the Philippines, and
parts of the west Pacific. Blust presented a particularly extensive
review of beliefs around “baliw,” which in the region referred
to storms that are set off by undesirable human behavior. I will
discuss this again in chapter 5, but it is interesting to speculate on
how baliw as storms probably relates to baliw as “crazy” or even
“insane,” if, for example, we were to play on the aphorism, those
that the gods are displeased with they make crazy.
I have drawn liberally from the works not only of an-
thropologists but also of sociologists, historians, psychologists,
philosophers, political scientists and of course, medical researchers.
Many of these studies focus on small communities. There is great
variance in the quality of these studies, but this can be an advantage
since the macro approach used here allows for some validation by
comparing different accounts for the same groups, as well as the
use of cross-cultural comparisons.
8
I have supplemented the ethnographic review with results from

another broad study of traditional medicine that was conducted
through AKAP in the early 1980s. AKAP was a nongovernment
organization doing primary health care, with an emphasis on
tuberculosis prevention and control. As research director, I was able
to visit many health programs in the Philippines and, through a
small grant, was able to collect information on traditional medicine
and traditional health practitioners.
This book is entitled Revisiting Usog, Pasma, Kulam because I
have revised, substantially, many parts of the book, and have added
new materials gathered in the last twenty years, not through formal
research but through more interactions with health programs as
well as with health professionals in clinical settings, and in the
classes I handle at the University of the Philippines and Ateneo de
Manila University.
Since 1997, I have also been writing a column, Pinoy Kasi,
twice a week for the Philippine Daily Inquirer. Doing the column,
which has included articles on the body, on pasma and usog, on
bangungot and kulam, has been a good exercise for updating readers
on the relationship between health and culture. I have incorporated
some of those columns into this book.
I have consciously avoided too much of anthropological jargon,
knowing that many of my readers will come from health professionals
with little exposure to the social sciences. At the same time, I did
want to sensitize our colleagues in the health field to some of the
lenses available from anthropology and the other social sciences.
Let me explain these theoretical lenses, and the methodologies
that come with those perspectives.
Phenomenological Perspectives
My emphasis is on producing an “ethnography of experience”

(cf. Marcus and Fischer 1986, 43-70): what does it mean to be ill or
to be healthy in a particular social context, at a particular historical
9
period? The work of the late Michelle Rosaldo (1980) was particu-
larly inspiring. Although her study was intended to draw out the
“emotional resonance” of how Ilongots define masculinity, her
book was a treasure trove for insights on indigenous ontology and
epistemology.
A phenomenological approach means heavy linguistic analysis.
Language is not just a medium through which ethnographers
obtain information; instead language is itself data, words providing
rich insights into how people look at the world around them.
The more orthodox secondary sources for medical anthropology
are ethnographies but I’ve found dictionaries to be fascinating as
well. A Manobo dictionary compiled by Elkins (1968) yields terms
such as ayew, “a supernatural being which causes sickness to a
person so that he will revive beliefs and practices of his ancestors”;
navey, “to inadvertently cause sickness to a human being who
accidentally comes in contact with his power”; sawan, “sickness
characterized by feeling one is falling from a high place.” The
Summer Institute of Linguistics has published some very useful
dictionaries with ethnographic notes (for example Newell 2005
on the Ifugao) and has a library with many unpublished linguistic
material waiting to be further analyzed by those interested in
culture and health.
Frake (1961) is credited as one of the pioneers in this area of
ethnolinguistics or the local terms used to describe and classify the
world around us. His study on Subanun disease categories is now
considered a classic, where he elicited from the Subanun their own
diagnostic criteria. Although Frake’s work is considered difficult to
read by many, the methodology, of evoking “native” categories (also
known as the emic, in anthropological jargon), has many possible
applications in health programs. His methodology was used as
part of this research. The value in using this approach is that one
dialogues with the community, unearthing the rich nuances and
connotations of the people’s concepts of health and illness, which
10
would otherwise be lost through individual interviews using only

structured questionnaires.
This evocative method, actually part of hermeneutical
phenomenology, has long been in use among local nongovernmental
community-based health programs as a result of the influence of
Paulo Freire’s (1970, 1972) writings on pedagogy. This technique
for education activates the human processes of interaction and
dialogue so that the community’s health problems are identified and
discussed collectively. Coming from that tradition in community
health, it was only appropriate to use this evocative method in the
research for this book.
Social Interactionist Perspectives
Social interactionism looks at the way people interact to shape

and reshape notions of health and illness. Here, we try to map out
the different social terrains in which we learn about health and
illness. These include the family, communities, traditional or folk
healers, as well as health professionals.
Discussions of meanings and experiences become esoteric unless
we relate them to the world in which these meanings are crafted.
Many of the ethnographies have wonderful accounts of how people
grapple with meanings, trying to make sense of their experiences.
I have tried to bring in some of those accounts to show how our
concepts of health and illness are in flux, reshaped and reinterpreted
in different settings: between a mother and her child, for example,
or between a physician and a patient … or even more importantly,
among patients, say, exchanging experiences in a ward.
Perceptions of “illness” vary—in a community where most
children are undernourished, it has been shown that mothers may
not recognize undernutrition in their children. Other potentially
serious illnesses, such as intestinal parasitism, may be considered
“natural lang” (only natural) since nearly all the children have
parasitic infestation.
11
Theories of illness causation embody a system of labels and

attributes through which Filipinos conceptualize and recognize not
only health and illness but also our social relationships. To cite just
one more example, the Mindoro isug refers to aggressive feelings
viewed as dangerous, which is to be expected in smaller societies;
but among Tagalogs, with its complex and more competitive social
dynamics, the same term refers to “bravery.”
The emphasis in social interactionist analysis is on
“discourse,” the exchanges people have in something as mundane
as a conversation, as well as in more formalized occasions. Social
interactionism looks at culture as being much like theater, with
people, as actors, performing scripts. The scripts can be formal and
rigid, acted out as in our Filipino diskarte with a hidden strategic
agenda, or done ad lib, sometimes almost subversively, as in
pasaway occasions. These diskarte and pasaway certainly exist in
our encounters around health and illness, for example, in the way
we might plead illness to exempt ourselves from work.
Discourse also includes what appears in print and, increasingly,
in broadcast media, even in advertisements. I would include literary
works as well. An example of that last category comes in the novel
Cave and Shadows by Nick Joaquin (1983, 2) about the month of
August, which conveys what I wanted to explain by “ethnography
of experience.” In many parts of the Philippines, August is part
of the rainy season, but it is also marked at times by intense heat.
Joaquin describes the month as “red with fire and red with blood,
the month of amok, when tempers cracked or crazed.” The reason
for this is the mixture of rains and the heat:
With the rains come a change of mood and a difference in

hotness. If you felt broiled in March, you felt boiled in August.
The seething month has nothing of the stillness, the candor, of
summer. Its heat waves are in constant stir, building up to a fit.
Danger looms if the air is unclear, like a smoke. This thickens and
darkens until, overheated, it explodes—into a thunderstorm, a
cloudburst, a typhoon. But the storm neither clears nor cools the
12
air. It only feels muggier afterwards; and from the ground steams
a miasma: the singaw ng lupa, or earthsmell, that’s mustiest after
an August flash flood.
That passage captures the discomfort and anxiety we have

about August’s strange weather, one which is seen as possibly
causing illness. Note how Filipinos in fact comment constantly on
this kind of weather and how it creates discomfort, malaise, and
illness, an example of how the discourse reinforces our notions of
health and illness.
Political Economy
Going a step further from meanings and social interactions,

I also take a macro perspective of political economy, looking
specifically at ideologies. Political economy looks at power
relationships and how these are linked to the economic system. In
the nineteenth century, the pathologist Rudolf Virchow wrote that
“Medicine is a social science and politics is nothing but medicine
writ large.”
A classical Marxist approach looks at dominant classes
wielding the power but there are also other perspectives, such as
the poststructuralist views of the French philosopher and historian
Michel Foucault, who emphasizes the need to go beyond the
structures and look instead at the way power is “exercised,” rather
than “possessed.” Foucault’s work often refers to the way bodies
are made docile through medicine and health care (see for example
Foucault 1991).
Geertz (1957, 422) defines ideology as a people’s “picture
of the way things in sheer actuality are, their concept of nature,
of self, of society. It contains their most comprehensive ideas of
order.” Geertz also emphasizes ethos as giving “tone, character
and quality” to life, going beyond cognition and moving on to
morality and aesthetics. It is impossible to understand ethics and
13
ethos divorced from its underlying world view, which can also be
defined as an ideology.
Many studies (e.g., Lieban 1960, 1962a; Paul 1963; Douglas
1966, 1970; Janzen 1978; Ehrenreich 1978) have demonstrated
how medicine carries a strong ideological component. Our medical
beliefs, symbolism, and rituals reflect a way of looking at the world
around us and help us explain or rationalize the existing order of
things, including our relationships in society. These beliefs are often
epicyclical, meaning they contain secondary elaborations to cover
every eventuality or even anomalies that have to be explained. This
ideological component guides our behavior, not only in terms of
the type of medical intervention that we seek but also in the ways
we behave as part of society.
An example is our belief in sorcery (kulam), which will be
discussed in another chapter, but which can be briefly described
here to demonstrate its ideological component. Beliefs that kulam
is a cause of illness remain widespread in the Philippines, even
in urban areas. It reflects, on the surface, our belief that certain
individuals have the power to cause illness, or even death through
various magical techniques, such as the casting of spells or the
use of poisons. When an illness is believed to be caused by
sorcery, the victim generally will not go to a physician. The more
“westernized” Filipino family may be divided—some will suggest
that the patient needs psychiatric care, but many relatives and
friends will suggest the use of a traditional healer, one who can
counteract the sorcery.
Beyond this relationship between “beliefs” and “practices,” we
have to recognize sorcery as a social phenomenon. Anthropologists
such as Kluckholn (1944), Whiting (1950), Lieban (1960, 1962a)
and Hallowell (1963) have proposed functionalist explanations to
suggest that sorcery and sorcerers “exist” as part of a system for
social control, for example, against philandering husbands and
their mistresses. Sorcery is recognized as a valid way of “punishing”
such individuals who have breached social norms. As for the
14
victims themselves, belief in sorcery strengthens the “efficacy”

of the spell that has supposedly been cast, particularly where the
victim feels guilt. Sorcery is therefore punitive in nature, and at the
same time may have “preventive” functions in that one may avoid
adulterous relationships out of a latent fear that this would bring
on the risk of future recrimination, through sorcery.
Functionalism emphasizes the need to look at how “belief
systems” have social functions. Political economy goes a step
further, looking at how these ideologies are created, often linked
to particular interests. Marxists would say these interests are those
of the ruling class. Other social scientists would suggest a more
diffused view, for example, of physicians as a stakeholder group,
releasing or withholding information and knowledge, as Foucault
does in the fields of criminology, medicine, and sexology.
Foster (1953, 217) once observed that “Spanish-American folk
medicine appears to be marked by a strongly eclectic nature which
has permitted it to pick and choose almost at random the concepts
and practices which it has incorporated.” I agree that traditional
medicine can be eclectic, but want to point out how very specific
social and historical forces have interacted to form our present
medical beliefs and practices, both traditional and “modern,” and
these forces continue to interact dynamically. Sorcery, for instance,
has now intruded into the business world, where a business partner
who feels he or she has been cheated may resort to the services of
one of the many available sorcerers in urban centers to punish the
absconding partner.
Cultural Ecology
It is impossible to discuss concepts of health and illness

without looking at the natural environment. A cultural ecological
perspective looks at how we use culture to respond to the challenges
posed by the natural environment. A cultural ecological perspective
also looks at the way we tap into the natural environment for
15
our materia medica, from medicinal plants to the explanations

themselves, what Ortner (1973) calls “root metaphors” or ways by
which we conceptualize, describe, and understand the world we
live in. Thus, in a society that is largely dependent on agriculture,
many explanations of health and illness draw on agrarian
metaphors. Given the close relationships between humans and
the natural environment in an agrarian society, it shouldn’t be
surprising we attribute health and illness to a balance of natural
forces, to winds (hangin), miasmas (singaw), to hot and cold, and
with ideas of equilibrium and harmony. In the twenty years since
I first wrote this book, I have noticed how urban Filipinos have
expanded their concept of hangin to include air pollution, blaming
this for respiratory illnesses, especially among their children.
A cultural ecological perspective will become all the more
important as societies come to terms with the changes in our
environment today, from global warming to the emergence of new
diseases such as avian flu. At the same time, understanding social
responses to these new health challenges will require us to go back
again and again to the basic stock of meanings and experiences, of
social interactions, and of political economy.
Endnote
1. This personal note about the accident was originally the foreword to
the earlier edition of this book. Papase was the brand name of a drug
that contained papain, an enzyme which was thought to be useful for
wound healing. The drug has since been withdrawn from the local
market because it was found ineffective.
16
N
Chapter Two
Defining the
Framework for
Analysis: Health,
Illness, and Medicine
BEFORE DISSECTING THEORIES of health and illness in the

Philippines, we should define the key terms that are being used.
In the jargon of linguistics, we are trying to focus on “frames,”
consisting of associated facts or ideas about a central concept.
The question arises, for instance, on why “illness” is used, instead
of “disease.” Are there exact equivalents in Philippine languages
for “health” and for “illness”? Such concepts tend to be taken for
granted, and yet they form the foundation for other beliefs and
practices in medical systems.
2.1 Medicine and Medical Systems
IN THE CONTEXT of this study, a distinction should be made

between “medicine” and “medical system.” Landy (1977, 131)
offers the following useful definitions:
A society’s medicine consists in those practices, methods,

techniques and substances, embedded in a matrix of values,
traditions, beliefs and patterns of ecological adaptation, that
provide the means for maintaining health and preventing or
ameliorating disease and injury to its members … A society’s
medical system is the total organization of its social structures,
17
technologies and personnel that enable it to practice and

maintain its medicine (as defined), and to change its medicine in
response to varying intracultural and extracultural challenges.
Landy’s definitions clearly distinguish medicine which as a

matrix of values, traditions and beliefs, is predominantly part of
culture, and medical systems, which involve social organization.
These definitions help us to go beyond purely medical solutions to
our health problems, recognizing how we need to deal as well with
culture and society.
Kazarian and Evans (2001, 51) adapted discussions from
Kleinman (1980) to define three systems of medicine: the folk,
the professional, and the popular. The folk system is described as
“loosely systematized health concepts held and practices carried
out by indigenous specialists.” The professional system refers to
“organized and officially sanctioned health concepts and practices”
and the popular system would consist of “lay or everyday theories
and practices of health.” In the Philippine context, the folk system’s
practitioners would include the hilot, the albularyo, the faith
healer, and healing priests such as Fr. Corsi Legaspi and the sisters
of the Religious of the Virgin Mary. The professional practitioners
are those who go through formal training and licensure, including
physicians, nurses, midwives, and a range of allied health
professionals. Finally, we have the popular system, which would
include mothers, grandmothers, and the wise neighbor.
In this book, I use terms like “traditional,” “folk,” and
“popular” interchangeably since out in the “real” world, the
concepts and the practices, as well as the practitioners, often
overlap. The “folk healer” might have trained, for example, as a
midwife. The physician may be praying silently as she performs
difficult surgery. And that wise neighbor might have actually been
a nurse, but stopped practicing after she married. It will still be
useful though to remember that the focus of the book is popular
culture, what’s out in the streets and in homes.
18
Defining the Framework for Analysis: Health, Illness, and Medicine
2.2 Illness and Disease
MEDICAL ANTHROPOLOGISTS DISTINGUISH the terms

“illness” and “disease.” Frake (1961, 113) defines illness as “a
single instance of ‘being sick’” and disease as “a diagnostic category,
a conceptual entity which classifies particular illnesses, symptoms
or pathological components of illnesses or stages of illness.”
Idler (1979, 723) points out that “disease is an abstract
biological-medical conception of pathological abnormalities in
people’s bodies” and, as such, “presents no data for sociological
analysis; it reveals no social facts.” On the other hand, Idler continues,
illness is “the human experiencing of disease … an explicitly social
phenomenon with both an objective and a subjective reality.”
For the purposes of this book, illness is, properly, the basic
unit for analysis since the term “offers an additional opportunity
to study how behavior is structured and organized by underlying
cultural rules” (Fabrega 1974, 3).
The distinction between “illness” and “disease” is not made in
day-to-day conversations. In most Philippine languages, only one
term, sakit, exists, coming closer to the above definitions of illness,
rather than disease. But it will still be useful to use “illness” as the
unit for analysis, helping us to move away from “disease” with its
biomedical emphasis. In many cases, these ailments are culture-
specific, and are therefore called “folk illnesses” or “culture-bound
syndromes.”
We should be careful with using such terms. There is, on one
hand, a tendency among health professionals, to think of these
folk illnesses as “psychosomatic,” “all in the mind,” or dismissed
outright as “superstition.” On the other extreme, applying terms like
“illnesses” and “syndromes” may reflect a tendency to medicalize or
pathologize many of these conditions. Kaye (1986, 11-12) argues
that physicians tend to be too quick to label, as medical problems,
what are essentially “philosophical” problems. When a person
begins to wonder about his or her role in society, that speculation
19
is automatically labelled as a “depressive disorder,” requiring a

dose of “antidepressants” which ironically, often lengthens and
aggravates what could have been a passing “in the pits” phase.
Beyond “folk illnesses” then, we see a trend toward
problematizing, through medicine, many of life’s passages.
Pharmaceutical companies have been especially enthusiastic
about capitalizing on the problems of what are normal, but
turbulent, passages through life. Women have been targets for
such manipulations. There are estrogens to pacify the menopausal
woman, analgesics for “premenstrual tension,” antimotion
sickness tablets for the housewife dizzy from household work and
tranquilizers for a wide variety of women’s depressive moods. All
these pharmaceutical “solutions” are premised on the perception
of the woman as being susceptible to particular “diseases,” which
in turn are “curable” through drugs. Few physicians would take
time out to probe the underlying causes of depression among
housewives, of menopausal “crankiness,” or of the rising tension
that accompanies anticipated menstrual pain (Querubin and Tan
1986).
Moynihan and Henry (2006) define disease mongering as
“the selling of sickness that widens the boundaries of illness and
grows the markets for those who sell and deliver treatments.” In
2006, there was even a conference on “disease mongering” held in
Australia, focusing on the way drug companies, public relations
companies, doctors’ groups, and even patient advocates had
sometimes collaborated to create a “disease” out of problems that
could actually be part of a health process of mental, emotional, and
social development on the part of the individual.
2.3 Sakit
THE PERCEPTION OF illness is itself a social, rather than a purely

biomedical phenomenon. Sakit literally translates into pain, and
20
is used in several Austronesian languages as synonymous with

“illness.”
In western medicine, pain is considered only as a symptom.
In the traditional Philippine conceptual framework, sakit is used
in many ways. Besides meaning illness itself, it is used to refer
to pain, and in several contexts (e.g., sakit ng ulo for headache,
sakit ng tiyan for stomach ache). In addition, there are different
terms for the “quality” of pain as a symptom, such as hapdi for a
stinging type; kirot for a sharp, recurrent type; antak for internal,
continuous stinging type (Jocano 1973, 75).
When sakit is used to refer to illness, a different linguistic
framework is used, one which may be described as hierarchical.
The mere diagnosis that one is ill (may sakit) is the culmination of
a process of observing signs and eliciting symptoms that have been
graded in terms of seriousness, and which is often associated with
the level of physical activity that one can still exert.
Thus, in Tagalog, one may be “naturally” mahina (weak),
which does not necessarily progress into an actual sakit or illness.
But a person who is normally malakas (strong and active), and
then suddenly feels weak, would be concerned that this may be the
start of an illness. Even this weakness, however, will have qualifiers
such as matamlay, which comes closer to the English “lethargic.”
The persistence of the lethargy, accompanied by other symptoms,
are monitored by the individual and his or her family and friends,
but the term may sakit (is ill) will not be used until the person is
unable to perform physical tasks, a common criterion being the
stage when one is bed-ridden.
Pal and Polson (1973, 203-204) found in Dumaguete that the
Cebuano term kuyap is used to describe pulsations in the diaphragm,
accompanied by nausea. Kuyap in a pregnant woman does not mean
that she is sick, since this is a normal part of pregnancy. If it occurs
in a male, then it is considered to be abnormal, causing the male to
be nagkaluya (weak, but not bedridden). If these symptoms persist
in the male for one or two weeks, with prolonged vomiting and
21
difficulty in breathing, then the condition is now called kabuhi,

and kabuhi is considered to be sakit (illness).
The two examples above show a heavy reliance on prodromal
criteria, an assumption that a whole series of symptoms or even
“minor illnesses” must first appear before the outbreak of the “major
illness.” Recognition of acute illnesses may therefore be delayed,
as has been observed by many Filipino health professionals. Nurge
(1958, 1159) describes such a situation in a Leyte village:
No matter what the ailment, it will be considered slight

when it is first noticed. A mother rarely seeks aid or gives
treatment on the initial appearance of symptoms. The gravity of
the sickness will impress itself only as the patient suffers more
and more. If one mentions pain or great itching, that is one stage
of malaise. If the irritation continues over a considerable time,
the length of time is in itself unimportant, but if the duration is
coupled with increasing intensity, the sickness assumes greater
gravity in the minds of patient and family. If the patient takes
to his bed instead of continuing with his daily routine, this is
another distinct stage of severity. The surest indicator of severity
of suffering (and automatically more serious illness) comes
when the patient cries.
Nurge also writes about the shock and dismay of a mother

when her child dies barely a day after she had “realized” that the
child was ill, a problem that is common throughout the Philippines
and in other countries as well.
Diarrhea, for instance, may be considered “normal” in a child,
sometimes even attributed to teething, despite the potentially
fatal result of dehydration from prolonged diarrhea. There is
still a dearth of studies on the many nuances that characterize
perceptions of illness in the Philippines, but the point being made
here is that illness, as exemplified by sakit, has many social dimen-
sions, mainly in terms of using predefined “normal” social activity
as a reference for diagnosis and attribution of illness.
22
All languages have many terms to describe different physical

and psychological states, both objectively and subjectively. This
book focuses on intersubjectivity, on how a person feels in terms
of his or her capability to relate, socially, to other people. The term
sinusumpung, loosely translated as a “passing phase or mood,”
carries both subjective and objective aspects. For the person
who claims he or she is feeling sumpung, it could be an honest
self-evaluation, often a way of sending a social signal to be left
alone for awhile. On the other hand, it could be an individual’s
way of camouflaging more serious malaise, with the person using
the term to allay fears of relatives or friends. In another situation,
adults may attribute malaise, particularly in children, as sumpung.
Asthma, for instance, is frequently attributed to sumpung.
In all instances, social interaction is vital before an illness is
recognized. Frake (1961) found that out of 186 human disease
categories named by the Subanun, only seven involved magico-
religious methods of diagnosis. All the others were based on a
complex system of diagnostic criteria which he described as: (a)
pathogenic, (b) prodromal, (c) etiological, and (d) symptomatic.
As expected, symptomatic criteria proved to be the most important
although the other three criteria also created a complex system for
identifying diseases and the appropriate forms of therapy.
2.4 Health and Kalusugan
TO UNDERSTAND THE social and cultural dimensions of illness

(as well as the so-called sick role) in the Philippines, we would
have to relate to the ideas of health, commonly translated into
kalusugan. Again, the term, as with sakit, has other synonyms as
well as qualifiers.
A strict translation of kalusugan in Tagalog, Bikol, and
Kapampangan would be “able-bodied,” a logical correspondence
to the notion of illness as a physical debilitation. The root word
23
of kalusugan is lusog, defined by Panganiban (1972, 670) as “full

development, progressiveness.” Analysis of the colloquial usages
of the term suggests the need to qualify that progressiveness as a
vigorous development, particularly in physical terms. There is a
strong dynamic aspect here, a reference to maturative processes.
As Jocano (1973, 71) points out, malusog may be used in contrast
to payat (thin), rather than to sakit or illness itself. To be payat
is not to have attained the full potential of physical development.
The thin person is not malusog; but he or she is not considered
ill either. Not unexpectedly, in interviews with mothers, we find
them translating the English “The child is healthy” into “Mataba
ang bata” (The child is stout.) and yet the term mataba, used for
adults, refers more to obesity and is definitely not considered as
a sign of health. What we find is a combination of maturative
processes or development in correspondence to the ability to
function properly, to be active. For an adult to be payat (thin)
or taba (stout) is not considered healthy. At the same time,
such persons are not considered ill; in fact, one encounters
conversations where people will observe, “Di bale kahit payat,
basta hindi lang sakitin.” (Never mind if you’re thin, as long as
you are not sickly.” ) There is, again, a frame of reference, a kind
of baseline on which perceptions are based. A sudden or dramatic
loss of weight is considered as a sign of possible susceptibility to
illness, of existing illness, or of past illness from which the person
is still recovering.
The term malakas (strong) again figures prominently when
patients are asked how they are feeling in terms of “healthiness.”
Often, the term is used together with katawan, i.e., to have a
strong body, with the implicit assertion that one is able to work, to
function, because the body is fully developed in relation to one’s
need to work. A common complaint among patients, used as a
sign to suggest possible or impending illness, is madaling mapagod
(prone to fatigue).
24
Note that physical appearance is not the sole determinant for

evaluating one’s state of health. A thin person will use the term
malakas as well since subjectively, the individual feels “whole,”
and therefore healthy. One cannot help but refer to the Old English
root for health—“hal,” which meant “whole.” Thus the present
craze over “holistic” health is not new; in a sense, we face semantic
redundancy for health is wholeness.
Using colloquial examples again, a common reply to the
greeting “Kumusta ka?” (How are you?) is “Mabuti naman,”
literally translated as “Good.” The term mabuti is also frequently
used in medical consultations roughly to convey the message “I
feel good” or “I feel well.” Such observations would seem trite
were it not for the fact that an alternative reply to a greeting would
be “Eto, buhay pa” (Here, still alive), said in a rather tired tone.
To be alive is not a good enough indicator of being healthy and
the tone of the answer insinuates that there may be underlying
physical, psychological, or emotional problems, which might be
traced to a subjective assessment of anomie, that some element
vital for further development or progress is missing. In such cases,
health’s social dimensions are clear cut. They cannot be translated
as a mere absence of fever, pain, or even generalized feelings of
malaise. Health, in terms of lay perceptions, is loaded with notions
of social interactions. It should not be surprising then, that even
sakit is transformed into the root word for empathy, as in the term
magmamalasakit, literally to share the other’s pain.
There is a thin line between health and illness, precisely
because so much of intersubjectivity is involved—perceptions
of the self as well as others’ perceptions of oneself, all within a
complex socially defined and normative framework. The processes
of socialization and enculturation allow us to move within this
framework as we ascribe and label health and illness on ourselves
and on others.
25
2.5 Theories of Illness Causation
WITH AN UNDERSTANDING of the concepts of health, disease,

and illness, we can now move into a scheme for classifying theories
of illness causation.
Various schemes have been suggested for analyzing traditional
theories of illness causation. Rivers (1924, 7-8) proposed that
beliefs about illness causation are essentially based on one of three
“attitudes toward the world,” or what others would refer to as
world view. Rivers’ three categories are the magical, the religious,
and the naturalistic. Magical beliefs are those which attribute
illness to human manipulation of forces while religious beliefs
attribute illness to supernatural forces. Naturalistic theories view
illness as being caused by natural processes. Rivers concentrated
on magical and religious beliefs, declaring that “the third category
[naturalistic theories] can hardly be said to exist [in ‘primitive’
medicine].”
Despite the obvious deficiencies in Rivers’ scheme, his work
is still considered significant today. Foster (1976) proposed
another classification that still carries Rivers’ influence. Foster
divides medical systems into the personalistic and the naturalistic,
integrating Rivers’ magical and religious categories under a single
term: the personalistic. A similar scheme, using two main categories
of “supernatural” and “natural,” was proposed by Murdock (1980)
in his world survey of illness theories, which has both its strengths
and weaknesses (cf. Trotter 1983).
There is the need to recognize theories that are neither
personalistic nor naturalistic; thus, a third category of “mystical”
theories has been included. Such theories form an important basis
for the personalistic and naturalistic explanations of health and
illness. This is the framework that I will be using in this book.
I should emphasize that the purpose of classificatory schemes
is purely heuristic. The classification is an “outsider’s” formulation,
i.e., people do not go around thinking of usog as a “mystical illness.”
26
The classification scheme helps us to systematize the discussion of

these illnesses, and to identify the perceived sources of illness.
Glick (1967, 35) has stressed the need to recognize that
there are three possible levels of causation in traditional illness
theories. Using sorcery as an example, he distinguishes the levels
of causation this way: (a) the efficient (e.g., a sorcerer), (b) the
instrumental (objects used by the sorcerer) and (c) the ultimate
(motives, final explanations).
To elaborate, people may believe that the cause of their
illness is sorcery, implemented through objects sent into their
bodies. “Sorcery” and “object intrusion” represent different
levels of causes. Add to this the possible reasons why a spell was
cast—revenge, for instance—and we have still another level of
causation. In this study, I will concentrate on what Glick calls
efficient causes, agents whose actions we seek to explain in terms
of social interaction.
As with Glick, my concern is not to identify and catalogue the
names or types of illness-causing spirits, or the spells and charms
used in sorcery. These practices and beliefs are cited only insofar as
they provide us with information on social processes operating in
traditional medical systems. An identification of perceived efficient
causes of illness provides us with the springboard for an analysis of
the ultimate, social causes which should be our primary concern.
2.6 Explanatory Models
MEDICAL ANTHROPOLOGISTS OFTEN use the concept of

explanatory models or EM’s, proposed by Kleinman (1980) to look
at the way we handle illnesses. These are defined as “the notions
about an episode of sickness and its treatment that are employed
by all those engaged in the clinical process.” Kleinman emphasized
the need to look at these EM’s because these “offer explanations of
sickness and treatment to guide choices among available therapies
27
and therapists and to cast personal and social meaning on the

experience of sickness.” (1980, 205)
EM’s deal with five aspects of illness: (a) the etiology or cause
of the condition, (b) the timing and mode of onset of symptoms, (c)
the pathophysiological processes (changes in the body that occur
because of the illness), (d) the natural history and severity of the
illness, and (5) the appropriate treatments for the condition. Other
medical anthropologists have expanded EM’s to include concepts
about prevention, as well as health maintenance.
In this book, I will not go into specific examples of EM’s.
Instead, my emphasis is on the concepts that people have about
health and illness, which come together in the construction of
EM’s. Note that both the health care provider and the patient will
have EM’s, with some areas that converge as well as others that
conflict. They may also be in flux, changing as the person’s illness
unfolds, and in the context of social interactions.
Processing these EM’s is important, sometimes through the
“illness narratives” (Kleinman 1988) that patients have, some of
which may emerge during clinical consultations and others in day-
to-day discourses, with relatives and friends, with other health
providers. The illness narratives are themselves important, helping
the patient and his or her family to try to figure out what has
happened and why it has happened. Existential questions impinge
too, for example, “why me?,” “why now?” Kleinman (2006)
emphasizes the need to look at how the patient is processing
the stakes involved in terms of relationships, resources, and
commitments.
The illness narratives may themselves be therapeutic.
Simply talking about an illness, trying to make sense out of it, is
important and this “talking sense” will draw from a cultural stock
of knowledge around the self, society, and the environment.
28
w
Chapter Three
Usog, Bangungot,
and Other Mystical
Theories of Illness
Causation
MYSTICAL THEORIES OF illness causation are based on the premise

that impairment of health results as an automatic consequence of
some act or experience of the victim (Murdock 1980, 17). Note
how “impersonal” the attribution is. For example, although the
illness may occur through contact between two persons, as in usog,
there is an absence of actual intentional intervention by the person
that “causes” the illness. Instead, people believe there are intrinsic
qualities in the interacting parties that bring about the illness. This
will become clearer when we discuss the different illnesses.
I will discuss six mystical theories of illness causation here:
life forces, pollution, fate, mystical retribution, soul loss, and
bangungot.
3.1 Life Forces: From Bisa to Usog
MANY CULTURES HAVE concepts of a basic metaphysical life

force. An old anthropological term used to refer to such beliefs
is animatism (Marett 1909), examples of the life force being
the Polynesian mana, the Chinese Qi (or ch’i), and the Indian
(Sanskrit) prana. Such concepts are integral to medical systems, for
example, the Chinese believe that illness is due to obstructed Qi,
29
so therapies such as acupuncture are used to allow that Qi to flow

freely. Such concepts have been introduced into the Philippines
in recent years as part of New Age therapies (for example, pranic
healing) but many Filipinos are unaware that we have our own
indigenous terms for these life force and that they too are integral
to our popular concepts of health and illness.
Frake (1964, 117) says that the Subanun distinguish between
gimuud (soul) and gina (life stuff). Garvan (1964, 216), who did
his fieldwork among various Philippine Negrito groups in the early
part of this century, noted the following:
there is everywhere a very clear distinction between the soul as a

separable entity and the vital principal (sic), which is considered
to be in the pulse, heart, blood and brain so that when a soul
becomes separated from the body by death, it knows and feels
and performs the operations which it had in life.
Garvan (1964, 78) gives another interesting example of

animatist beliefs for the Bataan Negritos:
bananas and other plants should not be planted deeply, the

reason being that the soul of the plant dislikes absolute darkness.
While holding any plant it should not be pressed with the hand,
especially seed, because its productivity would be thereby
lessened, if not destroyed.
Among the Ilongots of northern Luzon, the term liget comes

closest to meaning “life stuff,” as opposed to rinawa or “heart,”
which is used in a context closer to lowland (Christian) notions of
the soul. Rosaldo (1980, 37, 44-53) says that liget suggests “energy,
anger and passion” present in nature, including the red color of
the sky at sunset, the wind, and the rain; in the supernatural; in
“potent and contagious plants,” and in human beings.
This vital principle is believed to be present not only in human
beings but also in anything that is animate, and occasionally, in the
30
Usog, Bangungot, and Other Mystical Theories of Illness Causation
inanimate as well. Furthermore, concepts of this “life stuff” always

carry connotations of potency.
Filipino Christians think of the soul as kaluluwa but will also
have concepts of a life force. The Tagalogs do have the concept of
bisa, which Jocano (1973, 51) describes as “psychic forces within
the body” but which can also mean “efficacy, effect, potency, result”
(Panganiban 1972, 169). The same word is used among the Malay
(Gimlette and Thomson 1939, 24) and by Muslim Filipino groups
(Saber 1979, 26) to mean “poison.”
Another way to grasp this concept is to differentiate the Cebuano
terms gahum and kusog (cf. Wolff 1972, 249-50, 526; McAndrew
1985, 61). Gahum comes closer to the Tagalog galing, acquired
power or skill as in the case of politics while kusog comes closer
to the Tagalog lakas, an almost innate power with connotations
of dynamism and energy. Kusog and lakas are also adjectives that
are used in other contexts as in voice projection, where it means
“loud” or “heavy.” Lakas or kusog are closer approximations of a
powerful mystical force which is an important attribute of health
itself, as reflected in malakas ang katawan, “the body is strong.”
Significantly, this mystical vital force, while perceived as an
attribute if not a source of health, is also seen as a potential cause
of illness. Among the Ilongots, illness can result from contact with
plants that have potent liget (Rosaldo 1980, 37). Similarly, Fox
(1952, 306) cites a number of plants considered by the Pinatubo
Negritos to have an inherent potency that would cause illness
through mere physical contact. The concept of potency extends
to many objects, which may even be perceived as being useful to
repel or cure illness: anting-anting, mutya, and other amulets or
charms are examples, as well as “magical stones” to “suck” poisons,
and of course, medicinal plants (cf. Arens 1956e; Campbell 1968;
Rahmann 1974; Baumgartner 1975).
As Fox (1982, 177) observes, the “power” of the mutya “is sui
generis and … it is only necessary for an individual to possess and
manipulate them.” The mutya in fact bestows certain powers on
31
individuals possessing them. Also significant is Fox’s (1982:179)

observation that among the Tagbanuwa of Palawan, charms used
in hunting (bangat) are perceived as being so powerful that the
hunting dogs which have been given bangat, as well as the hunters
using it, “are bathed in a temporarily dangerous power potential,
the sablaw.” Fox goes on to explain that:
this power is activated by social interaction, either of humans

or between animals and humans. It is perilous, therefore, to
touch a hunting dog which has been given bangat … Sexual
relationships may also be limited following the use of bangat …
The notion of gayuma is another way of understanding

animatism. The gayuma is a love potion or charm that is believed
to make a person’s amorous advances difficult to resist. In more
contemporary usage, it has a more secular meaning, referring to the
“appeal” a person carries, with or without an object. The original
meaning of gayuma does reflect animatism, the idea that an object
has power of its own, which can be transferred to someone in
possession of that object.
The anting-anting and the gayuma remain widely popular,
as can be seen among Quiapo vendors. The objects range from
religious medallions with corrupted Latin inscriptions, to a naked
Santo Niño and empty bullet shells.
If objects are seen as potentially powerful, it is easy to see
why humans are also believed to have some potent life force which
could cause illness, even without the individual’s wanting to cause
illness. This theory of illness causation is best exemplified by the
widespread beliefs, among Christian groups, in illnesses such as
usog, balis, gahoy, and uhiya. Such illnesses usually affect infants,
the afflicted child prone to crying fits, abdominal pains, and
vomiting. This illness is believed to be caused inadvertently by male
or female individuals with particularly strong “breath.” To prevent
this illness, a common practice is for a visitor to wet his finger with
his or her saliva and to apply this to an infant’s forehead, abdomen,
32
or soles of the feet, especially if this is their first “encounter.” (See

Jocano 1969:29; Concepcion 1976:49,108.)
Ponteras (1980, 86,143) describes usog from Iloilo, where he
says it is believed to be caused by someone with strong dungan or
will power. Among the Muslim Tausug, Bruno (1973, 85) reports a
belief in pasu simud (“hot breath”), an illness “induced by spoken
words or human breath.” In this case, the illness occurs as a result
of the child being complimented. Thus, when a child with “nice
features” is complimented by visitors, relatives quickly respond
with the expression “pasu simud hi babu/kaka” (“May the ‘hot
breath’ go to an aunt or elder cousin”).
Hart (1980, 64) mentions the Visayan practice of uttering
puera buyag (“away with buyag”) whenever one is complimented,
again based on the belief that such compliments may result in the
illness buyag, a rather diffused syndrome usually in the form of
stomach aches, affecting both adults and children.
Across the Mediterranean and Latin America, there are
widespread beliefs in the “evil eye” (mal de ojo in Spanish):
Through Spain and Spanish America it is thought that

certain individuals, sometimes voluntarily but more often
involuntarily, can injure others, especially children, by looking
at them. Admiring a child is particularly apt to subject him to
the ‘eye.’ Unintentional eyeing can be guarded against by the
cautious admirer adding “God bless you” or some such phrase,
and slapping or touching the child. (Foster 1953, 207)
In the literature on Filipino ethnic groups, the only reference

to a belief in the “evil eye” comes from Barton (1919, 70) on the
Ifugao: “Certain persons have an evil ‘cut’ of the eye, which, whether
they wish it or not, brings misfortune or sickness on whomsoever
or whatsoever they see. Injury by means of the ‘evil eye’ may be
effected intentionally or entirely unintentionally.” Picpican (1981)
says that among Benguet Igorots, there is the belief in mantala,
sickness caused by a person’s staring. The context is not clear as
33
to whether or not this is a belief in the “evil eye.” Ewing (1967,

16) says that “there was plenty of evil mouth in the southern
Philippines, but I have never found evidence for belief in the evil
eye.” Note, however, that the Tagalog uhiya is apparently derived
from the Spanish ojear, which Panganiban (1972, 1006) defines as
“witchery by the evil eye.”
While this “evil eye” belief is rare in the Philippines, it is
interesting that it does have similarities with beliefs in usog and
buyag.
In the Philippines, there is a closer association between
potency and “breath,” pneumatic medicine so to speak (from the
Greek pneuma). Many healing practices evoke this imagery, ranging
from Visayan tayhop (“to blow”) to the application of the healer’s
saliva (Tagalog buga and Visayan tutho), or herbs that he or she has
chewed, on the patient. The term bulong, which in Tagalog means
“to whisper” (and specifically with reference to healing rituals, to
recite incantations or prayers) translates as “herbs” or “plants”
in Visayan languages while a traditional “general practitioner” is
sometimes called a manugbulong.
Beliefs in illnesses such as mal de ojo, usog, pasu simud, and
buyag are based on this theory of a life force, with attributes of
“strong” and “weak.” Infants, whose life force is still weak, are
believed to be more susceptible to illnesses caused by someone
with a strong life force. Complimentary remarks likewise cause
illness because they are “strong” remarks; thus, even adults may be
perceived to be susceptible to illnesses as a result of receiving such
compliments. Managat (1984) refers to a particular type of buyag
called usikan, described as being caused by a person with a birthmark
on the tongue (lala og baba) who gives a verbal compliment.
In the beliefs that regard compliments and flattering remarks as
potential causes of illness, we begin to see the transition or extension
of illness causation theories into the social sphere. The beliefs in
buyag, for instance, reflect the value of modesty in Philippine society.
Notice how adverse many Filipinos are about flattery. You can praise
34
someone’s clothes as nice and automatically, the person will respond,

“Mura lang yan, galing ukay-ukay” (It came cheap, I got it from a
used clothing outlet.) Receiving a compliment, and deflecting it with
“Puera buyag” is simply an older expression of modesty.
The concepts of life forces should also be related to beliefs about
mystical bonds existing among people, particularly consanguinal
kin or blood relatives. We therefore find a variety of precautions
taken against upsetting a pregnant woman, lest the unborn child
be affected. As with other cultures, Filipinos feel compelled to
satisfy pregnancy cravings or idiosyncratic dietary preferences of
a pregnant woman, in the belief that if these are not satisfied, the
child will be born unhealthy (cf. Hart 1965, 34-52).
Hart describes lanti, an illness believed to be caused by fright,
with mystical bonds between parents and children implicated. The
illness is similar to the well-documented Latin American susto (cf.
Trotter 1982). The youngest child in a family is believed to be the
most susceptible to lanti, the illness being attributed to the child’s
“fright” from witnessing a fight between the parents (Hart 1975).
Nurge (1958, 162) reports a similar belief in a Leyte community,
with an illness called calas, wherein the child falls ill when the father
is away from home, or if the father has been maritally unfaithful.
Such beliefs clearly serve as forms of social control on parents.
Jocano (1969, 22-23, 47) reports beliefs in a Christian Panay
community about a pregnant woman’s “morning sickness” being
transferable to her husband. A similar belief is cited for the Ibanag
in Isabela (Gatan 1981, 80) where the symptoms are supposedly
transferred to the husband if the wife bends over him. Dozier (1966,
87) noted that among the Northern Kalinga, taboos on diets and travel
(to areas believed to be infested by spirits) were imposed not just on
the expectant mother but on the father as well because the health of
the unborn child depended on the behavior of both parents.
Finally, note that Jocano cites a belief in a Panay community
about a sickness not leaving a household until it has been “shared”
by all its members.
35
3.2 Pollution
POLLUTION RELATES TO contamination, defilement, and even

corruption. An example of pollution concepts would be beliefs
about menstruation, which are found not only among Filipino
groups but also in many other cultures throughout the world:
generally, a reflection of ideologies that label women, especially
those who are menstruating, as potentially dangerous. While such
beliefs are not as strong or harsh in the Philippines, we do find
reports of menstruating women being prohibited from working
with crops, lest they harm the harvest. Cabotaje (1976, 46) reports
that in her research area, a Christian community in Bukidnon,
menstruating women were not supposed to touch legumes, lest the
plants turn yellow. Jocano (1969, 60) mentions another Christian
community in Panay where menstruating women are believed to
cause flowers and leaves to wither. Muslim Filipino groups, which
emphasize precepts related to ritual purity (Kiefer 1972, 120-21)
also have prohibitions imposed on menstruating women.
A closer approximation of the concept of pollution may be
found in beliefs regarding the dead. There are reports, particularly
among nomadic tribal Filipino groups, of houses being abandoned
or destroyed after a person has died (cf. Ewing 1967, 58). Among
other groups, there are ritual observations after burying the dead,
often involving bathing or cleansing.
Note that there is the underlying notion of a metaphysical
life force in many beliefs about pollution from the dead. Death is
such a disruptive event that cultures attribute it with all kinds of
connotations of misfortune and danger. For example, Wulff (1964,
60) reports that among the Muslim Yakan, bamboo tubes containing
palay (rice) seeds must be taken out of the house of a dying person
because the person’s death might destroy the seeds’ viability.
There are interethnic variations in the concept of the
“contagious” quality of the dead. While certain Filipino groups
seem rather fearful of the dead, there are other groups, such as the
36
Bontoc of Sagada, who seek contact with the dead person. They
hope that contact with the deceased, now in a more potent state,
would result in a transference of the deceased’s “good luck, success,
ability and skill” (Pacyaya 1961, 132). Likewise, the Ifugao invoke
the lennawa, the souls, of the ancestral dead, to come and participate
in certain rituals, sometimes calling on “five hundred or more
ancestral souls, depending on the number of ritualists assembled
and the importance of the ceremony” (Newell 2005, 354).
The fear of “contagion” may be applied to undesirable social
behavior as well. Among the Sagada Bontoc, for example, “adultery
is contagious, such that if a man who has committed adultery eats
with another man from the same dish …, the other will get ‘infected’
and commit adultery himself” (Pacyaya 1961, 129). Fox (1982,
73) reports a similar belief, among the Tagbanuwa of Palawan,
about individuals who are sala (“who have sinned,” mainly incest)
as being forbidden from entering houses with patients under
treatment because “it is believed that the uba ubat or ‘medicines’ of
the medium will be destroyed if a patient comes in contact with a
‘sinful’ person.”
I referred to the “strong/weak” dichotomy operating in concepts
of contagion. A person can cause illness by contagion because he or
she carries a stronger life force. Conversely, a person is susceptible
to illness from contagion because of a weaker life force. In such
cases, the strong or weak qualities are perceived to be inherent;
however, we see that these concepts are extended into the social
sphere where strong kinship bonds tie its members in a potentially
“contagious” situation. We also find other cultural concepts
operating; for instance, the Latin American mal de ojo mentioned
earlier is described as a “strong person with vista fuerte (strong
vision) exert[ing] undue influence over weaker persons. Children
and women are particularly susceptible” (Harwood 1981, 33).
Paradoxically, a person also becomes “contagious” when
he sets himself apart by his behavior, as we saw in the Sagada
Bontoc perception of the adulterer. Note that “contagion” is
37
sometimes translated as nakakahawa in Tagalog but in Cebuano

and Hiligaynon, both Visayan languages, hawa translates as “to be
apart.” Sodusta (1983, 121) cites the use of the word “pahawa”
in a community in Surigao del Norte—the term is used to tell a
person to leave or go away when one feels that the person has en-
croached on one’s rights. In modern Tagalog colloquial usage of
hawa in Tagalog, a person who misbehaves is also berated as being
hawa (cf. Torres-Yu, Gonzales, and Tiamson-Rubin 1986, 42). To
summarize, deviation from social norms is to set oneself apart, and
yet become, in the process, “contagious.”
3.3 Mystical Retribution
THE LITERATURE IS full of references to taboos among Filipino

ethnic groups, with the authors generally assuming that Filipinos
believe that a violation of a taboo results in “punishment” by a
supernatural being in the form of illness or other misfortune.
Closer analysis of the context of beliefs in taboos and other
prohibitions will show that the relationship between the taboo
violation and illness or calamity is more mystical in its nature,
where a human act of transgression “logically” brings about negative
consequences without intervention of a supernatural being. This is
the concept of mystical retribution (cf. Murdock 1980, 18).
An example of such beliefs comes from the Tagalogs, where a
pregnant woman does not prepare new clothes for herself as this
would seem like she is preparing for her death. At the same time, it
is taboo for the pregnant woman’s kin to do any kind of work that
would involve digging, because this would be suggestive of their
preparing a grave for her (cf. Concepcion 1976, 8).
The beliefs in mystical retribution draw on principles of
contagious magic, where there is an assumption of continuity
among events, people, or things. There is a strong notion of tuluyan
or continuity. Even among urban adolescents, teasing a couple
38
about a possible relationship elicits a response, “Tigilan mo na,

baka magkatuluyan pa kami.” (Stop it, the relationship [presumed
to be nonexistent] might come about.)
Note the following observation by Garvan (1964, 107-108)
about the Pinatubo Negritos’ sanction against premarital sex:
This [premarital sex] would be makalili, causing some

indefinable bad influence. I could not … arrive at an intelligent
understanding of this term (makalili), which, incidentally, is
used with great frequency and applied to many actions, by these
Negritos. It seems to connote some future condition of evil that
would arise from a certain act but lays the infringer, from the
moment of infraction, under a malign influence that may be
noxious to others, thus differing from the term for taboo.
Apparently, it was difficult for Garvan to recognize a taboo that

did not involve supernatural retribution. Thus, it is not surprising
that Garvan did not seem to have seen the connection between the
Pinatubo Negritos’ makalili concept and that of “shame,” which
he himself had reported in the same ethnography, with reference
to sanctions against premarital sex among the Negritos of western
Pampanga: “Such cases cause ‘shame’ (makakasikau) and may entail
drought, smallpox, storms and so forth” (Garvan 1964, 102).
I cite these passages to underscore the need to reexamine
accounts about “primitive” concepts of taboo violations as a cause
of illness. The concept of supernatural retribution is probably
associated more closely with western Judaeo-Christian morality.
Writing on the Nabaloi, a Cordillera group, Moss (1920, 283)
observed that their “spirit belief” had “very little connection with
morality, although they could hardly be called an immoral people
even from the standpoint of civilization” and that the Inibaloi,
another Cordillera group, believed that “fate after death is not
determined by his acts while alive.”
This difference in “morality” explains quite clearly another
belief among the Pinatubo Negrito. Writing a quarter of a century
39
after Garvan’s fieldwork, Fox (1952, 319) noted that a Pinatubo

Negrito who damaged another person’s property felt obliged to
indemnify the owner because failure to do so would result in the
owner’s becoming ill.
In other instances, there are again expanded beliefs that
the undesirable social behavior brings illness not only upon the
transgressor but also on his family, community, or even descendants.
For instance, Kiefer (1968, 232) notes that among the Muslim
Tausug, the violation of an oath is considered to be so serious that
utuk sapa’, “a curse of unpredictable and terrible consequences,
such as sickness, a horrible death, or other misfortune” may afflict
not only the transgressor but the person’s spouse and “descendants
for 44 generations.” There is no reference here to a supernatural
being bringing about the curse; rather, the misfortune results from
the transgressor’s act.
Nurge (1958, 1165) observed in a Leyte community that “no
ailment was ever reported to be a visitation from God as a punishment
for sin or as a trial of one’s faith, ideas prominent in Christian circles.”
Likewise, Sechrest (1970, 8) suggests that the notion of sin “does
not seem especially salient in the Philippines and a disease theory
based on such a concept might not be a very powerful one.”
Mercado, a Catholic priest, says that the Filipino uses the concept
of “immanent justice” as retribution: “The sanction flows from
within himself” (Mercado 1976, 187). Mercado cites the Visayan
Christian concept of gaba as an example of the Filipino concept of
retribution. Gaba is frequently translated simply as a “curse from
God” or as “divine retribution” that could result in illness and other
misfortune but Garcia (1976) conducted interviews to reexamine
the context in which gaba is used and concludes that:
the gaba’ belief system supports the idea that certain actions of
a person will bring about, as a natural consequence, punishment
and suffering. Farmers, for example, believe that if food is not
shared during harvesting, gaba’ will be incurred” (Garcia 1976,
34-35, emphasis added).
40
Local concepts of mystical retribution deserve more attention,

perhaps providing a key to understanding our notions of right
and wrong and how they come together to provide an ethical
framework.
Earlier, I discussed local notions of contagion, how one’s
deviant behavior sets the transgressor apart from the rest of
society, and yet makes him or her “contagious.” Our concepts of
mystical retribution overlap to a large extent with the concepts of
contagion. The violation of social norms results in “shame,” which
can cause illness not just to the transgressor but to the family and
community, or even to the offended party.
The parallels to the Christian notion of “social sin” are striking.
Henriot (1973, 3) explains social sin as:
1) Structures that oppress human beings, violate human dignity,

stifle freedom, impose gross inequality; 2) Situations that
promote and facilitate individual acts of selfishness; 3) The com-
plicity of persons who do not take responsibility for the evil
being done.
Henriot explains that the concept of social sin has been

“underdeveloped” for a number of reasons including the influence
of existentialist philosophies which have “privatized” theology,
wherein morality is reduced to an individual affair, a relationship,
so to speak, between “myself” and “my God,” which is completely
different from many traditional societies’ concepts.
This takes us back to the notion of contagion as a consequence
of one’s deviation from social norms. Among the Ilongot,
Not to distribute or to share is ‘acting out and activating

emergent lines of social cleavage, signaling the collapse of a
presumed field of equal and cooperating kin.’ Excluded and
shamed, the person is torn with liget and wants a chance to beret.
(Rosaldo 1980, 77).
41
Liget is “energy, anger, and passion” and beret is “to divide, to

distribute, to contaminate, to revenge.”
Note how notions of contamination and vengeance overlap;
one could suggest that shame needs to be “redistributed,” through
vengeance. The factor of vengeance may not necessarily be present
in other societies but the idea that honor needs to be regained
is widespread. What is important to consider is that violations
of a social code result in social cleavage and that this separation
is perceived as carrying the potential for illness and misfortune,
much like the dead who are separated from the living.
The concept of mystical retribution is best captured by
karma as defined in Buddhism. Karma is not divine punishment
but a cause-and-effect relationship in one’s actions. The scholar
Humphreys (1951, 101) quotes from the Buddhist scriptural text
Dhammapada: ‘By oneself evil is done; by oneself one suffers. By
oneself evil is left undone; by oneself one is purified.’ We see
parallels here with Mercado’s description of immanent justice.
Karma is found in association with beliefs related to
reincarnation. The Boxer Codex of 1590 records the following
belief among the Tagalogs:
They say that the souls who inhabit these places [an
afterworld] die seven times, and some others are resuscitated
and undergo the same travail and miseries that they undergo in
their bodies in this world. (Quirino and Garcia 1958, 429)
Beliefs in reincarnation do not appear to be widespread.

Polenda (1989, 23) describes beliefs in reincarnation among
the Western Bukidnon Manobo. Fox (1982, 157-58) records
an interesting belief among the Tagbanuwa of Palawan which
bears striking resemblance to the Tagalog beliefs recorded in the
sixteenth century:
The spirits of the dead each die seven times. The first time
that the tiladmanin [spirit of the head] dies it is buried by the
42
other soul spirits. But the next six times that the soul-spirit
dies, the insects and small animals in the underworld bury it.
When the tiladmanin have died seven times, they return to earth
transmigrated as the ramu ramu, that is, as flies, dragon flies,
frogs, snakes …
Members of various spiritist sects (espiritista) believe that

illnesses may be the result of transgressions in the present and
previous lives. These sects were first established in the Philippines
only in the 1920s, using doctrines first formulated by the
nineteenth-century French spiritist Allan Kardec (cf. Schlegel
1965; Velez 1978; Licauco 1981, 11-12). There is also a revival of
beliefs in reincarnation among New Age groups.
Although Philippine languages contain a number of terms
borrowed from Sanskrit religious terminology, the word karma is
found only in Ilokano, with definitions of “soul, energy, strength,
power or ghost” (Mercado 1976, 186). The term is rarely used,
although nakarma-an has been reported by one of my Ilokano
students in medical anthropology as “the eventual fate of a person
subjected to sapata ti biyag or a curse similar to the Tagalog sumpa
following the violation of strict family values” (Alejandrino 1986).
Karma has come into vogue among younger Filipinos, who
use it half seriously, half in jest, to explain personal misfortunes.
The concept is distinct from malas (“bad luck”) in that one is
kinakarma, subject to karma for past deeds, while bad luck is fated.
The resurgence of the use of the term may have come through the
marginal influence of eastern mystical sects that have started to
appear in the country (e.g., Hare Krishna).
We can only speculate as to how current concepts about
karma came about. It is possible that the concept appeals because
of some collective cultural subconscious rooted back in history
or in a growing secular consciousness which places less emphasis
on divine intervention or retribution. Still another interpretation
would be the continuing social value of reciprocity or balance. The
43
concept of pagkukulang (a deficit) is still invoked in relation to the

fulfillment of obligations to friends and relatives. How this deficit
is to be corrected could be in the form of divine retribution or in a
more secular nontheistic form of karma.
3.4 Fate
MURDOCK (1980, 17) qualifies his inclusion of fate as a mystical

theory only insofar as illness is ascribed to “astrological influences,
individual predestination or personified ill luck.”
Notions of fate are expressed through terms such as suerte (an
expansion of the Spanish word to mean good luck in general, and
not just luck) as opposed to malas (bad luck). The term for fate in
several Philippine languages is palad, which also means the palm
of the hand. Lieban (1966, 174-75) mentions a Cebuano belief in
buayahan, individuals who are believed to be fated for illness and
death because of lines on the palm suggesting the shape of the
mouth of a crocodile or buaya. Palm readers are found in both
urban and rural areas and may be consulted on matters of health.
From the biography of Dinawat Ogil, a Bukidnon datu, we
find the following passage: “In marriage, I don’t look for beauty or
any special gift, but our palad—mine and my wife’s—must agree
with each other. That, to my mind, is most important, for without
that agreement of palm readings, it simply means we are not fit for
each other and our union would only mean disaster and trouble”
(Claver 1973, 77-78).
Kroeber (1928, 203) suggests that palmistry may have been
of relatively recent introduction in the Philippines, possibly
accompanying Islam. He bases this on the fact that ethnographic
references to palmistry seemed to be limited to tribal groups in
Mindanao.
Palmistry is not the only method for reading one’s fate. Among
the Ilokano, traditional healers examine a person’s sintas (linea
44
alba, the midline extending from the umbilicus to the xihpoid or

the chestbone) to predict one’s susceptibility to illness (Riguera
1968, 69-70).
Much has been said about Filipino “fatalism,” said to
be exemplified by the bahala na attitude. The conventional
interpretation is that the word bahala refers to Bathala, an archaic
name used by various Philippine groups for a supreme deity, with
its etymology traced back to the Sanskrit bhatara or “lord.”
Mercado (1976, 183) disputes this interpretation and argues
that bahala may have been derived from the Sanskrit bhara, which
means “load,” and that the expression bahala na comes closer to
meaning “be responsible for” or “assuming the load.”
All this speculation about Filipino theories of fate and
retribution may seem like a pedantic exercise, but its importance
emerges when one considers the many references in the literature
to the Filipino being passive or resistant to change because he is
fatalistic, leaving everything to the “will of God.” But, as Lieban
(1966) has pointed out in his study of fatalism and illness among
Cebuanos, “the will of God” may be used to rationalize or explain
“experienced incapacities”; in other words, such explanations are
coping mechanisms for what has already happened, and are not
necessarily part of the cognitive factors that discourage action.
(Also see Lagmay [1977] for a reexamination of this concept based
on a limited survey of its usage).
Concretely, it is easy to understand why a family resorts to
bahala na when a relative falls seriously ill, given the limited
options. Just observe any hospital and you will find relatives of the
patient madly rushing about trying to raise the money needed for
the hospitalization. Only when all options have been exhausted
will the family “resign” themselves to fate; in effect, bahala na
facilitates the acceptance of such a situation.
At several consultations with urban poor community
health workers, I brought up the concept of bahala na for them
to discuss. Inevitably, the expression was not taken as a sign of
45
passive fatalism but was, in fact, interpreted as an active way of

meeting a challenge, much like Mercado’s redefinition of the word
as “carrying one’s load.” One community health worker gave a
simple, down-to-earth explanation: when the demolition teams
come into their communities to destroy their shanties, they go
out to meet the teams fortified by bahala na, a kind of “do-or-die”
attitude.
Kiefer (1972, 127-28) notes that the Tausug distinguish
between two kinds of fate: the theological and the empirical.
Theological fate, or kadal, is “permanently attached” to the soul
and is divinely predetermined while empirical fate, sukud, comes
closer to “luck” and is predictable through divination. Kiefer notes
that the Tausug lifestyle derives meaning “from ultimate fatefulness
of the world: if it is predetermined that a man must die, then he
might as well fashion his death as part of an adventure.”
3.5 Soul Loss
MURDOCK (1980, 19) NOTES THAT many religions in “simpler”

societies believe in a soul that is capable of leaving the body
temporarily and that its prolonged absence may cause the owner
to fall ill, with death being the final or permanent separation of the
soul from the body.
Soul loss theories refer specifically to beliefs that the soul
may wander off on its own, as opposed to “soul capture” resulting
from “abductions” by supernatural beings or through sorcery.
This should also be differentiated from “possession” by spirits (cf.
Bulatao 1982).
Filipino beliefs in soul loss are clearly ancient. Referring to
documents written by a Spanish bishop in the early seventeenth
century, Best (1892, 124) says that among early Filipinos, “it was
also regarded as a great insult to step over a sleeping person, and
they objected to wakening one asleep. This seems to refer to the
46
widespread belief of the soul leaving a sleeping body. Their worst

curse was, ‘May thou die sleeping.’”
To understand Filipino beliefs about soul loss, we need to
examine corresponding beliefs about the soul itself. The distinction,
among some Philippine groups, between the soul and a life force
or life stuff has already been mentioned, the latter being a vital
principle that seems to stay in the body and is responsible for
corporeal existence in this world.
On the other hand, there is a more complex conceptualization
of the soul. There is, for instance, the notion of the soul as a
“companion.” The Tagalog word for soul is kaluluwa, while in
Cebuano, kaluha means “twin” (Panganiban 1972, 233). Dua,
itself means “two” in many Philippine languages. It should not be
surprising then, to note that various Filipino groups believe that
each individual has a “companion” animal. Jocano (1969, 21) writes
that in the Panay community he studied, each child is believed to
have a companion in the form of a gecko (butiki). If the gecko falls
into a crevice, the child may die of hupa or bad dreams. Similarly,
Ewing (1960, 132) observed that the Tiruray and Subanun, both
Mindanao tribal groups, believe that individuals have snake-siblings
with a corresponding life span to that of its human counterpart.
Note how the soul is seen as having a compulsion to wander
off. The word kalag, which means “soul” among the Bikolanos
and Visayan groups, translates as “loose, untied, free” in northern
Filipino languages including Kapampangan, Ilokano, Ivatan, and
Tagalog. The Tagalog lagalag refers to a wanderer. In addition, kalag
means “compulsion” in Ilokano (Panganiban 1972, 222). Thus, the
soul is regarded as not only carrying a degree of autonomy from
the body, but a compulsion to wander off. The Kapampangan lagyo
may help to shed light on this mystical concept, the term referring
to “essence,” “spirit” as well as “name” (cf. Panganiban 1972,
593). Zorc (1985, 196) lists the Malay lari and Javanese layu, both
meaning “to run,” to suggest a semantic development of the term
as “that which runs along with oneself.”
47
Several Filipino groups believe in multiple souls. Fox (1982,

156-57) says that the Tagbanuwa of Palawan believe in “one true
soul, the kiyarulwa, and five secondary souls, the pa yu.” The
Bagobo had the concept of a “good” right-handed soul and an “evil”
left-handed soul, the latter being the “wanderer” and a potential
cause of illness (Cole 1913, 105; Benedict 1916, 227-29; Kiefer
1972, 129-30). It is tempting to draw Freudian interpretations and
to look for examples of indigenous “conflict theories” within the
individual psyche. On the other hand, we could look at this “soul
wandering” concept as a way of warning against the dangers of
leaving the secure boundaries of a “social body,” a theme which
has been discussed earlier in relation to contagion. There is,
obviously, dialectical tension to be found in the terms, for the soul
is simultaneously part of the body, and yet carries the potential of
being “apart” or even “far,” a conjecture that can be drawn from the
fact that lagyo, mentioned earlier as “essence” in Kapampangan,
becomes “far apart” in Cebuano.
Note, too, that infants and children are considered more
susceptible to soul loss. An explanation may again be found among
the Ilongots, specifically in relation to their notion of beteng:
In certain contexts, heart [rinawa] is identified with beteng,

one’s ‘shade’ or ‘shadow,’ or the ‘person’ people see in vital eyes
when one is living, which turns into a spirit that stays to haunt
the living after the body dies. As beteng, hearts may leave their
bodies during sleep … (Rosaldo 1980, 37)
For the Ilongots, the danger of the beteng’s departure is that it

may become accustomed to the company of the dead (“the vanished
beteng”) and that this would cause “our living selves [to] withdraw
and start to die”; however, Rosaldo continues, “most hearts know
better; ‘startled’ (dikrat) by what is always a temptation, they will
jump back into their bodies—and so awakened, we survive.”
The saving grace, then, is “knowledge,” but this knowledge
is apparently deficient among infants: “Beya, or ‘knowledge,’ is
48
what gives form, sense—and consequence—to the motion of the

heart. … Thus, babies, lacking ‘knowledge,’ can lose their hearts
through fear because they do not ‘know’ that they have fallen”
(Rosaldo 1980, 38).
It is clear that Filipino conceptualizations of the soul go beyond
that of a double or a twin. Rosaldo (1980, 36) cites the following
linguistic information provided by another anthropologist, Howard
Conklin:
[The Ilongot] rinawa, or ‘heart,’ is cognate with the Proto-

Austronesian *nawah, ‘soul,’ and Proto-Philippine rehniwa,
‘breath.’ It is related to such words as Tagalog ginhawa, ‘comfort,’
‘ease,’ and ‘unhawa, ‘understanding’; Malay nyawa and Ifugao
linnawa, ‘soul,’ and Samar-Leyte ginhawa, ‘bowels.’ For Ilongots,
‘heart’ is at once a physical organ, a source of action and
awareness, and a locus of vitality and will.
Salazar (1977) provides a cogent and detailed analysis of the

concept of kaluluwa in relation to unawa (understanding), malay
(consciousness), and other important terms that shed light on
indigenous theories of ontology and concepts of morality.
If the life force allows one to exist, the soul emerges as a source
of “understanding” and “awareness” or even “goodness” as implied
in the Tagalog expression that an amoral person is one without
a soul, walang kaluluwa (cf. Torres-Yu, Gonzales, and Tiamson-
Rubin 1986, 155).
The concept of hawa inevitably recurs in the discussion. As
mentioned earlier, hawa means both “to contaminate” and “to be
apart.” In this particular context, ginhawa translates as “comfort,”
“ease,” and “freedom from want” (Panganiban 1972, 433); thus,
“to understand” and “to know” is to be free from want. The danger
of “soul loss” is one of “lacking knowledge” and consequently “to
want.” In the process, one becomes separated, excluded. Illness is
therefore self-inflicted, in an instance of mystical retribution.
Beliefs in soul loss continue to be widespread among Philippine
tribal groups. Among Christian groups, it has been recorded only
49
for the Ilokano and an acculturated Ibanag community (Gatan 1981,

16), although vestiges remain among other groups. In Cavite, for
instance, a sleeping child should not be moved, lest its wandering
soul returns and is unable to find the body.
3.6 Bangungot
WHILE SOUL LOSS beliefs are not significant among lowland

groups, there is, instead, the prevalent belief in bangungot, literally
translated as “nightmares,” from the root words bangon, “to rise”
and ungol, “to moan.” The belief is that a victim of bangungot may
die if he or she is not able to wake up during an attack.
Jenks (1905, 196) says that among the Bontoc Igorots, there
is the belief in li-mum’, described as a spiritual form of the human
body which causes “fiendish ‘nightmare’ [by] sitting heavily on
the breast and stomach” of the sleeping individual. Vanoverbergh
(1972, 22), in his Isneg dictionary, defines ab-ab as “a kind of
paralysis preventing people from moving and shouting, affecting
people who sleep alone.”
The belief in bangungot and similar illnesses can be explained in
relation to the notion of the “compulsive” soul. I have mentioned that
in southern Philippine languages, the term for soul is kalag, which
means “loose, untied, or free” in northern Philippine languages.
The term semangat, used by the Malay and some Philippine Muslim
groups to mean “soul,” has been suggested as being derived from
the Malay sangat, “excessive” or bangat, “sudden, quick” (Skeat
1900, 47). Beliefs about the soul therefore suggest a recognition
of dangerous “compulsive tendencies” in the individual to deviate
from the norm (expressed as soul wandering).
Bangungot was first reported in the medical literature in 1917
and has been the subject of medical investigations by Santa Cruz
(1951), Nolasco (1957), and Aponte (1960). The victims studied
were all males, middle-aged, and generally from lower economic
50
classes, including Filipinos in Guam and Hawaii. Because the

nightmares are sometimes attributed to a person going to bed after
an excessively heavy meal, the medical studies have tried to implicate
the Filipinos’ diet as a cause of the syndrome. However, the studies
have been far from conclusive, as the following report shows:
It is readily apparent that these peculiar, deadly dreams of the

Filipinos are not merely ordinary examples of food poisoning—if
they were, they would not so selectively affect male individuals
of a particular race in a rather limited age group. Also, the same
food which has caused the death of one man has consistently
failed to produce even the slightest adverse effect in many others
who have simultaneously participated in the culinary episode.
(Aponte 1960, 1262)
Interest in the bangungot syndrome has been revived with

the rash of reports about sudden deaths among southeast Asian
refugees in the United States, under circumstances similar to the
Filipino bangungot (see Centers for Disease Control 1981; Adler
1995).
In 1990 and 1991, a series of articles appeared in a British
medical journal, The Lancet, reporting on sudden deaths among Thai
construction workers in Singapore and among Cambodian and Lao
men in Thai refugee camps (Koh et al 1990; Munger and Booton
1990; Phua 1990; Nimmannit et al 1990; Yap 1990; Lonsdale 1990).
In 1992, Wong and his associates in Singapore reviewed the studies
around these deaths among Thai workers. A total of 226 deaths
had been reported from May 1982 to July 1990. Wong summarized
the studies: “Current hypotheses about the cause of SUDS [sudden
unexplained death syndrome] have included stress, genetic factors,
dietary deficiency (particularly thiamine), potassium deficiency,
melioidosis and sleep disorders.”
Adding to all those theories, we have cardiologists like Ramon
Abarquez (1999, 214) who proposes that bangungot may actually
be Brugada syndrome, a hereditary heart problem.
51
Surprisingly, despite the widespread distribution of this belief

in the Philippines, there has been practically no documentation of
bangungot by social scientists. I found only one reference, that of
Jocano (1973, 96) who mentions it in Bay, Laguna. He associates
this belief with that of soul loss.
Social scientists need to become more engaged in an
investigation of bangungot. I would start by noting how bangungot
and soul loss may have diametrically opposed “cures”—in
bangungot, the person should be awakened but in soul loss, the
person should be left to sleep—yet, I would suggest the two beliefs
are similar symbolic representations of the danger of an individual
losing control over one’s self or alter ego. The term for bangungot
in various Visayan languages is urom although a synonym is urong,
which in Tagalog would mean “to move” or “to be displaced” (Cf.
Wolff 1972, 1109). One research informant in Toril, Davao, warns
that one should never wake a person suffering from urong with
your bare hands or that person will wake up with a different voice
(Lorenzana 1984).
A Filipina psychiatrist has, in fact, observed that many of her
patients express their malaise as “Nawala ako sa sarili ko” (literally,
“I lost myself”) (Lapuz 1973, 28), actually a very common
expression to describe mental discomfort and sometimes even a
sense that a serious disorder has set in. While the phenomenon
of depersonalization is certainly not limited to Filipinos, it does
take on added significance in the context of beliefs in soul loss and
bangungot.
Bangungot deserves more study, particularly in terms of the
“triggering” factors. The most simplistic explanation would be
to suggest that the belief is a form of social control against over-
eating, or even against sleeping alone. But the reports of bangungot
“survivors” suggest there is much more involved than social
control. The fact that bangungot seems to affect more males,
for instance, could be related to pressures such as higher social
expectations and constraints on expressing one’s emotions, even
52
under stress. Note how so many of the medical journal reports of

sudden deaths occur among males who are away from their home
country: Filipino sailors out at sea, Thai construction workers in
Singapore, southeast Asian refugees in north America.
Note, too, how bangungot is often used to mean nightmares.
These nightmares are universal and because they are so terrifying,
many cultures have associated these with malignant spirits and
danger. The English word “nightmare” originally referred to a “mare,”
a female spirit that was believed to suffocate sleeping victims.
Bangungot may also be a way of describing some pathologies
that manifest themselves while a person is asleep. The feeling of
tightness around the heart, literally like a horse sitting on the
person’s chest, suggests cardiac problems but would be given
different interpretations in different cultures. In the Philippines,
we speak of bangungot while in the United States, descriptions of
“alien abductions” include references to heaviness in the chest, and
of hearts beating frantically. The “mares” of old have been replaced
by creatures from outer space.
3.6 Synthesis
THERE ARE DIVERSE mystical theories of illness causation among

Philippine groups, and these pertain to life forces, contagion and
pollution, fate, mystical retribution, and soul loss. These categories
overlap: karma for instance, has elements of mystical retribution
as well as fate; soul loss has connotations of mystical retribution
resulting from the individual’s soul wandering off. These theories
are not completely metaphysical; they have an inner logic based on
or reflective of material realities, particularly in the social sphere.
The notion of contagion, as expressed in hawa, is accompanied
by connotations of separation from the body politic or the social
fabric. Strong elements of social control appear in these theories,
advocating conformity to social norms.
53
“Sin” takes on social dimensions, with the focus on the “actor,”

as a member of society, rather than the act itself. As Rostagno
(1983, 64) points out, the Hebrew word for sin (hattah) actually
means “to miss out,” “to go astray,” with the criterion not being the
violation of a commandment than of a community relationship.
An understanding of the mystical basis for indigenous concepts
of existence, development, identity, and self-image is essential for
us to understand other traditional medical beliefs and practices.
The association of the “spirit” and “name” in the Kapampangan
lagyo, for instance, helps us to understand the practice of having
sickly children going through ritual changes of names, or ritual
adoptions to another couple (anak ti digos in Ilokano), with the
hope that this will improve the child’s health (cf. Hart 1977, 40-41;
Scheans 1966).
The notions of potency and power are also important,
especially as they apply to traditional therapeutic methods as well
as traditional healers.
In the next two chapters, we will see that even “personalistic”
and “naturalistic” theories of illness causation refer back to basic
mystical theories and concepts.
54
v
Chapter Four
The Engkanto,
Mangkukulam,
and Aswang:
Personalistic Theories
of Illness Causation
FOSTER (1976, 775) defines a personalistic medical system as “one

in which illness is believed to be caused by the active, purposeful
intervention of a sensate agent who may be a supernatural being (a
deity or a god), a nonhuman being (such as ghost, ancestor, or evil
spirit), or a human being (a witch or sorcerer).”
Personalistic theories of illness causation can be subdivided
into (1) the animist, where the causative agent is believed to be a
supernatural entity, and (2) the magical, where the causative agent
is believed to be human.
4.1 Animist Beliefs: Ghosts and Other Supernatural Entities
THE TERM ANIMATIST was previously defined, referring to beliefs

in a life stuff or life force found among animate and inanimate
objects. The term animist is narrower in its scope and is used here
to refer to ghosts and other supernatural entities.
A fear of ghosts or souls of the dead (multo, apparently derived
from the Spanish muerte), is found in many societies, together with
perceptions that such spirits can cause harm.
55
Among Philippine groups, ancestral spirits seem to be the most

frequently cited illness-causing ghosts. This is clearly a reflection
of the importance attached to kinship ties, a point that also has
been implicated in mystical theories of illness causation. In fact,
societies with elaborate or extended kinship structures generally
have correspondingly complex beliefs and rituals for the deceased.
Beliefs about ghosts date back to the pre-Hispanic period and
were apparently considered to be so important that early Spanish
chroniclers wrote that the indios were practicing “ancestor worship”
(Ortiz 1906[1731], 191; Quirino and Garcia 1958, 421-22).
Retribution from the departed may also be caused by the
violation of social norms. Hart (1979, 61) notes that among Visayans,
retribution from ancestors was believed to be precipitated by dis-
respect for elders, physical violence, and incestuous marriages.
In his study of traditional medicine in Iloilo, Ponteras (1980, 84,
239) cites tuyaw, which can be caused by human beings or spirits,
particularly deceased kin reminding their descendants of their
obligations through “dreams and slight discomfort.” Among the
Bagobo, Cole (1913, 116) cites cases of widows who claimed they
were being harassed by their husband’s spirit for not remarrying
early enough.
Ancestral spirits are not generally perceived as malevolent.
There are even instances where illness is believed to be caused by
close kinship ties of affection between the living and the dead. A
widespread belief is that a deceased grandparent’s longing for a
favorite grandchild can result in the child’s illness (Jocano 1969,
105; Hart 1979, 62). This is an obvious extension of the concept
of mystical consanguinal bonds (blood ties) being a source of
“contagion” for while the ancestral spirit may not have evil
intentions, it is now a transformed entity potentially capable of
causing illness.
Thus, among the Ilokano, Vanoverbergh (1938, 153) noted
beliefs in an illness called nakablawaan, which literally translates
to “being greeted,” i.e., to meet and be greeted by the soul of a
56
The Engkanto, Mangkukulam, and Aswang: Personalistic Theories of Illness Causation
dead relative may bring illness. Other variations on this belief have
been reported by my Ilokano students in medical anthropology.
Napadlaawan is similar to nakablawaan, and involves an
“unexplainable cold feeling” due to the presence of a spirit. It is
interesting that a distinction is made between kablaaw and padla-
aw, the former being a greeting following a long absence from
one’s ancestral home while padla-aw can happen at any time, and
is often associated with premonitions of a relative’s death, far away.
Nakalbit, on the other hand, is to be touched by a ghost, said to
result in a dark-bluish imprint on the skin (Alejandrino 1986).
Deceased traditional healers may also cause illness when they
call on a descendant to take up his or her vocation. This has been
recorded in some of my interviews with traditional healers, who
speak of an illness during which they experience apparitions from
deceased relatives, calling on them to continue the tradition.
Besides ancestral spirits, there also seems to be a fairly
widespread belief in the souls of unborn children as a cause of
illness. In Samar, a woman who dies after inducing an abortion
is said to have been claimed by the soul of the aborted fetus,
who then takes the mother to live with it in “a dark place” (Hart
1965, 9). A variation of this belief is related to the obligation of
parents to have infants baptized, following Catholic dogma that
only the baptized can enter heaven. Jocano (1969, 15) reports a
belief in Panay of unbaptized children’s souls wailing in “limbo.”
This wailing supposedly angers the angels, who then punish the
negligent parents with illness.
In Bauan, Batangas, one of my students also recorded beliefs in
mga bata ng limbo (the children of limbo) that may include aborted
fetuses. The belief here takes a different twist in that people who
hear the wailing of these infant souls (said to be buried in the
grounds of the elementary school) are afflicted with insomnia and
headaches, as a way of getting them to pray for the children. When
the insomnia and headaches disappear, then the souls are said to
have entered heaven (Gonzales 1986).
57
The beliefs in ghosts are obviously related again to social

control, reinforcing kinship ties as well as discouraging certain
practices such as abortion. The norms are relative, as we saw in the
case of Bagobo widows at the turn of the twentieth century being
“haunted” by their husbands for not remarrying early enough.
These beliefs about the dead relate back to mystical theories
discussed in the last chapter. The soul, as an unbound spirit, is
dangerous when it wanders. The souls of unbaptized children
may haunt the living, not only “to seek redress” but because as
unbaptized and unbound spirits, they are intrinsically dangerous.
Jocano (1969, 15) says that in Panay, the unbaptized children
(muritu) who die become dwellers of trees (tomawi) that disturb
the living. Ghosts are therefore similarly perceived, so that even a
“casual” encounter, as in being greeted (nabati in Tagalog), can be
a cause of illness. The same principle can be said to form the basis
for beliefs about contacts with other supernatural beings.
The potential malevolence of ghosts may even be determined
by the character of the individual at the time of death. We find an
interesting example from Buhid society, where isug or “aggression”
is considered to be very negative and that the correct response to
tense social relationships is withdrawal. Taken to the extreme,
however, this leads to depression and possible suicide. The ghosts
of these suicide victims are considered the most dangerous.
Even in urbanized areas, the notion of the discontented soul
being responsible for haunting is still strong, and may sometimes
carry political overtones as in the case of the beliefs surrounding
the “haunted” Film Center, whose construction was rushed by
the former First Lady, Imelda Romualdez-Marcos, resulting in an
accident that killed a still unknown number of workers who were
said to have remained entombed where they fell from scaffoldings
into the newly poured cement foundation of the building in order
that it could be completed on schedule.
Besides ghosts, there are many other supernatural entities
believed to be possible causes of illness. The perceptions of
58
supernatural beings as potential causes of illness are closely related

to notions of the degree of intervention such entities exert over
human affairs.
A supreme deity is generally conceptualized as remote and
detached from the human world, only occasionally inflicting
illness as punishment for “sins.” Among tribal groups, the concept
of a supreme deity may even be absent, or will be of relatively
recent introduction as a result of contact with Christian groups
(cf. Moss 1920, 280; Scott 1960). Significantly, I could find no
references to the concept of a supreme evil being (e.g., Satan) as
a cause of illness although the belief has been reinforced in recent
years by evangelical Christian groups that periodically advertise
prayer rallies to exorcise Satan and, in the same breath include
“exorcism” of communism, drug addiction, and homosexuality.
Among Christian groups, particularly Catholics, there
is an intermediate stratum of angels, saints, and the Virgin
Mary, perceived as being more involved with the human world.
Hagiolatry, or the worship of saints and in particular Mariolatry or
the worship of the Virgin Mary, is extremely strong in Filipino folk
Catholicism, as it is in Latin America (Foster 1953, 213). Saints are
believed to inflict illness as punishment for social transgressions,
including non-fulfillment of ritual obligations, as in the case of
a town not holding a commemorative fiesta for its patron saint.
While the Virgin Mary (and her many manifestations) and the
saints are seen as possible causes of illness, they are also invoked
in prayers for the sick.
Note again that as with mystical retribution, divine
“punishment” may be inflicted on a community, even if the
transgression is the act of an individual. Many anecdotes from
the Marcos era offer examples of such indigenous perceptions.
In 1983, an earthquake struck Ilocos Norte after an extravagant
wedding for the deposed dictator’s daughter, Irene. The fact that
the church used for the wedding collapsed was, in the mind of the
town’s residents, further proof of divine retribution. Similarly, the
59
people of Negros Occidental, after going through disastrous floods

that same year, attributed the calamity to the imprisonment, by the
Marcos government, of two priests on charges of subversion. Staff
from community-based health programs had difficulty explaining
that God would not punish the innocent for the “sins” of others;
as far as the people’s religious ideology was concerned, the entire
community had to share the burden of penance.
Sadly, during the 2004 floods in Quezon and Nueva Vizcaya,
some Catholic clergy preached that these were signs from a God
displeased with family planning. Officials in the two provinces are
known to be supportive of family planning and reproductive health
programs, which have been attacked by conservative Catholics as
“sinful.” A similar observation was made by a bishop in Bohol after
several children died of food poisoning in 2004; again, these were
interpreted as a “sign” of God’s displeasure with family planning
programs.
In general, the most important perceived sources of
supernaturally mediated illnesses seem to be the numerous spirits
inhabiting this world. Most of these spirits are associated with
natural habitats—rocks, trees, caves, and rivers. Although they are
known by a wide variety of names, certain generic terms are shared
among the different Philippine groups. One is anito, a term widely
used throughout the Malay region, and including some aboriginal
groups in Taiwan (cf. Lebar 1975). The term anito is apparently
derived from the Sanskrit hantu, which means “the dead” (Retana
1921, 33; Mohring 1973), suggesting a close connection between
beliefs in nature spirits and beliefs about ghosts.
Another widely used Filipino generic term for spirits is diwata,
which in Malay means spirit, a derivation from the Sanskrit devata,
which means godhead or divinity (Wolff 1976, 361).
Among lowland groups, a number of spirits are known by
Spanish-derived names such as engkanto (sometimes spelled
ingkanto), duwende (dwarfs), and sirena (mermaids). Among Muslim
groups, two terms of Arabic origin are often used: saitan and jin.
60
The lamang lupa (literally, those inhabiting the earth’s bowels)

or the Visayan taglugar (literally, “of the place”) are generic terms
for various environmental spirits. Many of these spirits are generally
perceived as benevolent, and may even become guardians for
shamans and other traditional healers. Other spirits inflict harm only
when provoked, particularly by intrusions into their “territory” as
in the case of the nuno sa punso or the matanda (old ones) inhabiting
anthills or secluded places. Such places are also often used as public
toilets; this practice has led to standard precautionary incantations
in different languages: “Tabi po” in Tagalog and “Bari bari, Apo” in
Ilokano, loosely translated as “Excuse me” or “Please move aside,”
fair warning, it seems, for the preternatural inhabitants.
Attitudes toward environmental spirits of the above type are
similar to those for ghosts. Terms such as nabati (to be greeted),
nakatuwaan (to be amused) and napaglaruan (to be played with)
are used to describe the relationship between the living and the
supernatural, which results in illness.
The intimate relationship between human communities and
their natural environment logically leads to the attribution of
power to physical objects. Reichel-Domatoff (1976) suggests that
beliefs about environmental spirits causing illness when there is
an intrusion into their territory actually function as a mechanism
for environmental conservation. Such theories may be criticized as
being based on ex post facto observation but there is no doubt that
simpler societies have a strong ecological sense and that beliefs in
environmental spirits reflect deeper social norms about reciprocity
in human relationships with or dependency on the environment.
Thus, ritual offerings to environmental spirits are part of the
agricultural cycle, an expression of beliefs that one must return
what is to be taken or has been taken from the land (cf. Arens
1956a, 1956b, 1956c, 1956d, 1956e, 1956f; Sodusta 1983; Polo
1986).
Gibson (1983, 280) observes that among the Buhid Mangyan,
the transformation of nature is a social process of exchange between
61
human beings and “owners” of the forest or the environment. Fox

(1982, 166, 172-73) also emphasizes this point in his fieldwork
among the Tagbanuwa, observing that the natural environment
is in fact “ritually defined” as “territories” of particular groups of
spirits.
Sodusta (1983), studying a community in Surigao del Norte,
distinguishes between two rituals: the ayo-ayo, which involves a
proposal for a contract with environmental spirits before clearing
the land and the orasyon, where the spirits are actually ordered to
leave. Not surprisingly, the orasyon is considered to be riskier.
Polo (1986, 86-96) elaborates on this theme in his description of
fishing rituals in Leyte, with the recognition of numerous spirits
each with their own niches—bura (bubbles or froth), kasulugan
(water current), kabatuhan (rocks), baras (sands). Ceremonies
such as the buhat (literally translated into “task”) contain both
“emotive” appeals as well as elements of urgency and command as
the fishermen explain their needs (kahanglan) to the spirits of the
sea. The first catch is always returned back to the waters as part of
an agreement of reciprocity, described by some fishermen as a loan
(utang). Ceremonies, in fact, have to be renewed as the south wind
(habagat) replaces the northeast wind (amihan) for the contracts
are not permanent.
There is also a striking parallel between illness, spirits, and
the unfamiliar. Territories of environmental spirits are often
characterized as being extraordinary by virtue of their size (e.g.,
huge boulders), shape (various Ficus trees such as the balete,
with its gnarled aboveground roots), or simply because the area
is dark and isolated. There probably is a relationship between
the Bikol hilang, which means sickness (Mintz 1971, 180) with
two Cebuano terms: hilan, which has been defined as “for an
uncultivated, unpopulated area to be disease-infected or infested
with supernatural beings;” and hilang, defined as “for things to be
in a row or woven further apart than they should be” (Wolff 1972,
322). The Malay hilang in fact means “lost, to disappear, to die”
62
(Gimlette and Thomson 1939, 81). Again, we have the recurring

theme of “what should be,” where illness is associated with a
violation of norms. Illness is un-natural, and therefore nature itself
provides a rich source of symbols for associations with health and
illness.
Recio et al (1978, 1-16) notes a Cebuano belief in the
gilangkatan ug spirito, where an individual’s soul leaves the body
temporarily, attracted to the supernatural. The individual then
“looks apathetic and suddenly loses interest in his work and in
people in general.”
This idea of dangerous contact with nonhumans is especially
strong in the engkanto belief.
The engkanto is generally described as having Caucasian (i.e.,
mestizo or mixed blood) features, sometimes compared to Spanish
friars or to Americans (Nydegger and Nydegger 1966, 771; Sodusta
1983, 56-60). They are said to be extremely wealthy and may even
send their children to Europe and America to study. Some of our
informants say that the engkanto world even has equivalents of
the guerrilla New People’s Army. In other words, the engkanto are
much like human beings, inhabiting a world parallel to our own,
but nevertheless different from the human domain (See Menez
1996 for more recent descriptions of engkanto courtship and
engkanto habitats.)
Contact with these beings results in being “enchanted”
(engkantado), with subsequent illness which can be cured by the
mananambal or local shaman. Lieban (1962b, 309) interprets this
belief as a form of social control:
This pattern of thought and behavior associated with beliefs

about ingkantos and their influence appear to support social
equilibrium in the community by dramatizing and reinforcing
the idea that it is dangerous to covet alluring, but basically
unattainable, wealth and power outside the barrios. In this way,
the value of accepting the limitations of barrio life and one’s part
in it is emphasized. Furthermore, if someone has a relationship
63
with a dazzling ingkanto and becomes ill, it is the mananambal,

a symbol of barrio service and self-sufficiency, who restores the
victim to health and reality.
Lieban’s analysis closely resembles Foster’s (1965) “image of

limited good,” a mechanism that is supposed to exist in peasant
societies, where excessive wealth in a situation of scarce resources
is depicted as dangerous. An alternative Marxist explanation is
that peasants perceive “good” as expanding, and that the objection
is to particular forms of how wealth is acquired (cf. Jayawardena
1968; Taussig 1980, 16-17). Whatever the interpretation may be,
we find that there is recognition of the metaphor of contact with
the supernatural being rooted in existing social realities.
It is interesting that even in urban areas, a belief similar to that
of the engkanto continues to exist. This involves young women
supposedly being courted by an unseen being. Stories of such
“affairs” appear frequently in women’s magazines, and has been
described as the “Prince Charming” syndrome, where women
enter a fantasy world, with the expected difficulties including
what some would label as psychopathology—depression, wasting,
even hysteria. Attitudes to such phenomena are mixed—such a
relationship is obviously not encouraged, but is considered to
be almost normal. In a way, Philippine culture, particularly the
cinema, creates and reinforces a larger fantasy world.
There are also spirits believed to be inherently malevolent.
These include underworld demons and the souls of “evil persons.”
It is interesting that for groups which believe in multiple souls,
there is the concept that the “evil soul” turns into a free roaming
evil spirit after the death of the individual (Cole 1913, 105).
We see then that the perceived power of ghosts and
supernatural entities is related to “social space,” to their distance
from the human sphere. A supreme deity, perceived to be quite
distant, only infrequently inflicts illness. Saints and the Virgin
Mary, who were once human, are believed to intervene more
64
frequently in human affairs. Finally, ghosts (particularly those of

recently deceased kin) and environmental spirits, are perceived as
still living in this world and therefore more prone to causing illness
as well as restoring health. In other words, the relationships with
the supernatural often parallel that of social relationships. Gibson
(1983, 25) observes that among the Buhid Mangyan of Mindoro,
some spirits are invited to communal meals or feasts, others only to
the house’s thresholds while still others are provided with separate
“spirit houses.”
Returning to the engkanto belief, one can recognize another
aspect of social relations structuring culture. More than just
representing “unattainable wealth and power outside the barrio,”
the engkanto is a projection of asymmetrical social relationships.
In the context of a long and harsh colonial occupation in the
Philippines, the description of the engkanto as a Caucasian is not
accidental. Note that in Central America, with a history of Spanish
colonization, there is also a widespread belief in a “sentient
being … characterized by its dwarflike stature, light-colored
skin, sometimes bearded and blond, and generally with Spanish-
American, Mexicanoid or Ladino [mestizo] appearance” (Adams
and Rubel 1967, 337). Contact with the colonizer, represented
by the engkanto, is understandably depicted as dangerous and a
potential cause of suffering and illness.
The Gaddang, a northern Luzon tribal group, offer a similar
case for analysis. Lambrecht (1959, 47,62) notes that a sacrificial
ritual has to be performed whenever a Gaddang has dreams
involving contact with the pina’ching (ghost deities), as well as
with “merchants and strangers.” Again, the belief can be better
understood if we consider the fact that tribal Filipino groups
such as the Gaddang are often exploited by lowland Christians
(strangers) and middlemen (merchants). Likewise, among the
Buhid Mangyan, certain spirits are called fangablang (“those who
are encountered”), described as “resembling ugly and ferocious
Christians,” again a reflection of the problematic relationships
65
between exploitative Christian lowlanders and the tribal group

(Gibson 1983, 243).
Concepts of the supernatural are structured by experiences
in the social sphere, including interethnic relationships. Several
lowland groups (cf. Recio et al 1978; Sodusta 1983, 51-53) have
beliefs in the agta, as dark and malevolent creatures. The same
term is applied to Negrito groups and reflects racist feelings that
many lowland Christian groups have for their Negrito neighbors.
Also worth examining is the curious confluence of Filipino
Christian and Muslim beliefs about “infidel spirits.” Kiefer (1972,
113) notes that the Tausug believe in jin Islam (Muslim spirits)
and jin kapil (“infidel” spirits), a division which has also been
reported among the Malay and the Javanese (Skeat 1900, 96).
Not surprisingly, the “Muslim” spirits are the good spirits and the
“infidel” or kapil spirits are the evil ones who bring illness.
On the other hand, the Filipino Christian spirits have a
malevolent supernatural being called the kapre, depicted as
dark giants. Panganiban (1972, 553) says that kapre is derived
from cafre, which the Spaniards used to refer to Muslim infidels,
although the Spaniards themselves borrowed the term from the
Arabs, who used the term Kafir to refer to the Christian infidels.
The antagonistic Christian-Muslim relationship therefore finds
common, yet contrasting, expressions in the use of the Arabic term
for infidel, and are now used to describe “evil spirits.”
The fear of strangers and “outsiders” may be based on a
very real concern over the threat of epidemic illnesses. It is not
surprising to find many simple forms of quarantine in use. For
instance, among northern Luzon groups, bamboo stakes are placed
in front of a house where a woman has just given birth. Similarly,
among Muslim groups, white banners are placed on top of the
houses of the sick. Ostensibly, these markers are meant to keep
away evil spirits, but in reality they probably do more good by
discouraging too many human visitors.
66
4.2 Magical Beliefs: Sorcerers and Witches
MURDOCK (1980, 20-21) defines magical theories as those

“which ascribe illness to the covert action of an envious, affronted
or malicious human being who employs magical means to injure
his victims.” The two subcategories of magical theories are sorcery
and witchcraft.
A distinction between sorcery and witchcraft was first
proposed by Evans-Pritchard (1937, 387): “the difference between
a sorcerer and a witch is that the former uses the technique of
magic and derives his power from medicines, while the latter acts
without rites and spells and uses hereditary psycho-psychical
powers to attain his ends.” Murdock (1980, 20-21) makes a similar
distinction between the two terms, sorcery being accomplished
with the aid of a specialized magician or shaman and witchcraft
being the “voluntary or involuntary aggressive action of a member
of a special class of human beings believed to be endowed with a
special power and propensity for evil.”
Of course, there are no hard and steadfast rules about
“identifying” a witch or a sorcerer. The distinctions in fact, are not
made in many of the earlier ethnographic literature, so inferences
have to be drawn from the context of the accounts.
Sorcery
Beliefs in sorcery are found throughout the Philippines, the

term kulam being the most popular. Among tribal groups, sorcery
is usually reported as the effort of a community to inflict illness
on a common enemy, using communal rituals (cf. Moss 1920,
Barton 1946, 140) although there seems to be no evidence of such
communal sorcery rituals at present (cf. Picpican and Guinaran
[1981] for sorcery among Benguet Igorots). Among Christians and
Muslims, sorcery is often an individual affair, usually spurred by
revenge motives for cases ranging from being jilted in courtship to
67
being deceived by a business party. The aggrieved party consults

known sorcerers and pays for such services. Such practitioners
continue to exist even in urban areas, as Lieban (1960, 1967) has
documented for the southern city of Cebu.
The early Spanish missionaries were aware of the existence of
sorcery beliefs among the indios. Plasencia (1903, 192-94) describes
the mancocolam (“emits fire from himself at night”), hocloban (“kills
without use of medicine”), manggagayoma (“prepares charms for
lovers from herbs, stones and wood”). These terms are still in use
among contemporary Filipinos. Similarly, a seventeenth-century
description of sorcery methods among Filipinos could apply as
well to contemporary practices:
My judgment from seeing these [sorcerers], so alike, is that

they are implicit compacts made with their ancestors. For it also
seems impossible that there are herbs with so powerful poison
that they can kill instantly … They also use figures which they
dedicate to him whom they wish to harm, and then accordingly
torment him … Others work by letters, and that is peculiar to
the Moro Kasis [caciques]. (Combes (1906[1667], 137)
There are different terms used for particular types of sorcery,

including kulam or gaway (Tagalog), tanem and tamay (Ilokano),
barang and hiwit (Visayan groups), and pantak (Muslim groups).
Despite the differences in terms, the methods are strikingly similar
among different ethnic groups. The sorcerers use incantations and
prayers, even incorporating ritual paraphernalia associated with
the Catholic church. In addition, imitative and contagious magical
principles are invoked, such as exuvial magic (using hair or nails
of the intended victim) and voodoo-like methods.
The similarities are found not just within the Philippines
but also throughout the southeast Asian region. Thus, although
a sorcerer from a Christian ethnic group may incorporate ritual
paraphernalia associated with Catholicism, he still uses figurine
representations of the victim as a Malay sorcerer would use the
68
polong or thumbsized manikins (Skeat 1900, 328-31; Provencher

1978, 255). This is the case with paraya, found in southern
Tagalog provinces down to Marinduque, where the sorcerer has
a doll (manika) used for voodoo-type sorcery. The Bikol luklob is
said to be based on similar principles.
Barang, a specific type of sorcery found among Filipino
Christian groups, uses “pet” insects and other animals to poison
the victim. Descriptions of barang by Lieban (1960, 129) and
Jocano (1973, 107) are similar to accounts of pelesit sorcery among
the Malay (Skeat 1900, 328-31) and ku sorcery among the Lu, an
ethnic group living around the Burma-Thailand border area (Lebar
1964, 213). Feng and Shyrock (1935) say that ku sorcery is an
old and widespread practice among the Miao and Tai of south and
southwest China. Significantly, the insects and animals are used not
only to harm the victim, but also to represent the sorcerer’s power.
Like the theory of “companion animals” (e.g., snake-siblings) for
“normal” human beings, the life-span of the sorcerer is said to
correspond to that of his or her “pets.”
Many beliefs surrounding sorcery involve “object intrusion”—
the sorcerer supposedly sends objects into the victim’s body,
ranging from fruits to insects and physical objects. Thus, persistent
abdominal pain may be attributed to sorcery, with a ritual needed
to remove the intrusive object.
Soul loss, which was discussed in the previous chapter, should
be distinguished from soul “abduction” or “stealing,” the latter being
a function of sorcery. Soul loss is the result of the soul’s “autonomy”
in wandering off. In soul abduction, the sorcerer uses his or her
powers to abduct the victim’s soul and cause illness. An example is
the Ifugao belief that the cause of a woman’s having difficulty during
childbirth is that her soul has been abducted through sorcery or, in
other instances, by spirits (Barton 1946, 169).
Correspondingly, sorcery may be used to “possess” a person,
although in such cases, it is a malevolent spirit that is “sent” to
take over the individual. As mentioned earlier, such beliefs remain
69
common, and are in fact reinforced by evangelical groups which

conduct exorcism.
The casting of spells through incantations and prayers is also
important to consider as it brings back mystical notions of the
power of the breath. Recio et al (1978, E-22) report that in Masbate
and Sorsogon, there are beliefs in the hiluanan and buayagan, who
cause illness by hanggab (inhaling) and buga (exhaling).
Some methods of sorcery may have empirical basis, par-
ticularly in the use of plant poisons. Galvez-Tan (1978), a physician
who worked in the eastern Visayas where beliefs in sorcery are
widespread, was able to get specimens of plants allegedly used by
the hilo-an (literally, poisoners). Chemical analysis showed that
the plants contained high levels of amygdalin, a substance which
produces cyanide on reaction with gastric acid.
Whatever the sorcery methods are, it is important to note that
sorcerers are usually known and accepted in their communities.
They are perceived as having legitimate roles and their practice is
socially sanctioned. In fact, in a survey of Filipino college students,
Ellwood (1977) found that students supported the use of sorcery
as a legitimate means of “punishing criminals when courts failed
or were slow to act.” In our research on traditional medical prac-
titioners, we found a number of healers who said they could lift a
sorcery spell and in some cases, after further probing, the healers
admitted that to be able to lift such spells, they also had to have the
power to perform sorcery.
Although socially sanctioned, sorcerers are of course feared and
are viewed as having acquired powers through demonic pacts. In
Marinduque, people we interviewed talked about sorcerers having to
pay a tax (buwis) of human lives each year to maintain their power.
Witchcraft
Beliefs in witchcraft seem to be limited to Christian and

Muslim groups. These beliefs center around the aswang and balbal
70
for Christians and the balbalan among Muslims. I will focus on the
aswang belief since there is little information on the balbalan except
for passing reference by Kiefer (1972, 113-14) on the Tausug.
The aswang belief is probably pan-Malayan. Ewing (1960,
130) says that Filipino beliefs about both the aswang and the
balbalan are similar to those related to the burong of the Achenese
and the penanggalan on the Malay peninsula, the latter term being
an obvious cognate of the Philippine manananggal, another type
of witch.
Linguistically, the term aswang is probably closely related
to the keswange belief complex widespread in the Moluccan
archipelago, the suangi being “a witch born with malevolent
powers” (Koentjaraningrat 1972, 114). The idea of the aswang
being a “vampire” is probably of more recent vintage, a borrowing
of western demonology.
Contemporary accounts of the aswang belief are similar for
various Philippine ethnic groups (see Lynch 1949; Arens 1956f,
Ewing 1960, 130; Ramos 1968). These accounts bear striking
similarity to the early Spanish descriptions of the osuang (Plasencia
1903, 194; Quirino and Garcia 1958, 405). Lynch’s (1949, 403)
description of the aswang is representative: “a man or woman
possessing preternatural powers of locomotion and metamorphosis
and an inhuman appetite for the voided phlegm sputum of the
deathly sick, as well as the flesh and blood of the newly dead.”
A person usually becomes an aswang by inheritance. There are
beliefs in both “walking” and “flying” witches and, in an amusing
instance of “acculturation,” the latter are sometimes referred to as
“night pilots” (Arens 1956f, 456).
Like sorcerers, certain individuals are publicly known (or
rather, publicly tagged) as aswang; however, they are greatly feared
and may on occasion be the target of physical violence. Mas (1843)
cites an extreme case involving a Filipino curate named Mallares,
who ordered fifty-seven assassinations to save his ailing mother,
who he believed was being bewitched. Mallares was hanged in
71
1840. Arens (1956f) says that the lives of suspected witches were
in constant jeopardy.
Descriptions of the aswang given by Arens (1956f, 462-465)
indicate that suspects are usually less sociable: “they cannot look
you straight in the eye,” “they are somewhat individualistic and
have self-reliance,” “they prefer not to seek advice from other
people.” Witches are perceived to “enjoy everything precious in
life”—Arens cites a case where a big landowner on Biliran island,
whose tenant had died from a dog bite on the landowner’s premises.
Eventually, this landowner had to build a high wall around his
house to protect himself because people started calling him an
aswang.
There is some overlapping of beliefs about the aswang and
the manananggal, the latter being creatures who are believed to
have the power of detaching the upper part of their body and to fly
around, the “night pilot” mentioned earlier.
Clearly, the aswang belief operates as a form of social control.
Lynch (1949, 420) says that the aswang belief discourages asocial
attitudes “such as secretiveness, solitariness, misanthropy and the
like.” Foster’s (1965) “image of limited good” may be operational,
the aswang belief working as a leveling mechanism because of
the risk of being accused of witchcraft once wealth or power is
accumulated.
Both witchcraft and sorcery beliefs should be related to forms
of social organization, including relationships between the sexes.
Ponteras (1980, 93) notes that in Iloilo, the aswang can be male
or female, but that the latter is considered to be more ferocious.
Hart (1965, 14-15) observes that in Samar, “witches” (osikan)
are usually women, but sorcerers (mambabarang) are always men
because sorcerers have to be courageous, a trait women allegedly
lack. Pertierra (1983) points out that the aswang belief is absent
in the Ilokano areas, and proposes that this is due to a difference
in the perceptions of “strong” women. Among the Ilokano, such
women are seen as assets but in other lowland cultures, a strong
72
woman is perceived as threatening: female sexuality is therefore

extended and projected into the dangerous “viscera sucker”—the
aswang or witch.
Taking off from Pertierra’s observation, I often ask my Ilokano
students if they “have” aswang back home. Almost always, they
say they don’t, and some will joke that this is because they grow so
much garlic, which wards off the aswang. One time though, one
Ilokano student did say there was an aswang in his town … and
that she was a “Bisaya” market vendor who had migrated to their
town. That account was amusing, and revealing, showing how
outsiders are labeled aswang.
Menez (1996) also looks into the politics of gender and the
aswang suggesting that the Spanish friars transformed native
women healers and religious practitioners into the aswang; just as
in the West witch-hunts and witch-burning were probably parts of
misogynist or antiwomen movements (cf. Ehrenreich and English
1973).
The distinction between sorcery and witchcraft is clear: the
former is a socially sanctioned practice while the latter is proscribed.
Both labels attribute special powers to certain individuals, but the
powers of the aswang are inherent, if not innate. The aswang has no
way of self-redemption and is permanently excommunicated, the
stigma even passed on to descendants. Obviously, the aswang does
not really exist in the sense of a ghoul cannibalizing the sick and
the dead. Rather, the label is a social construct, serving a particular
social purpose, that of stigmatizing and excommunicating asocial
or “different” individuals, often within one’s own community (cf.
Mayer 1982). In other cases, entire barrios may carry a stigma as
having more aswang than the others. In a sense, a social boundary
is created and reinforced.
The phenomenon of witch-hunts is well known, including
its modern secularized versions, as in the McCarthyite era in the
US during the 1950s and the continuing “red-scare” campaigns in
many Third World countries including the Philippines. Cardozo
73
(1982) points out that these movements are rooted in social,

political, or religious intolerance, occurring during periods of
social instability where scapegoats are needed. It feeds on fear and
ignorance, and is reinforced by officially sanctioned myths. For
instance, in the Philippines and in at least one Central American
country, government officials spread word around villages that
vaccines being administered by certain groups would turn their
children into communists (Tan 1986).
Synthesis
PERSONALISTIC THEORIES OF illness causation are different

from mystical theories in that illness is attributed to the intrusion or
intervention of a sensate agent, human or supernatural. Such agents
are, however, conceived in mystical terms: ghosts and supernatural
beings are disembodied souls while sorcerers and witches possess
special suprahuman powers. An overlapping of personalistic and
mystical theories is frequently encountered: terms such as balis and
uhiya, cited in the discussion on mystical theories, are sometimes
defined as being caused by people with “evil spirits,” a grafting
of notions of demonic possession with mystical theories. An old
term for witches or aswang is osikan, an obvious cognate for the
Cebuano usikan, which has been described earlier as a variety of
usog, caused by certain individuals with strong life force greeting
or complimenting a child.
Personalistic theories attribute evil or malicious qualities to
human beings who inflict illness and harm intentionally, and are
therefore perceived as being more dangerous.
The potency or “pathogenicity” of such agents is conceptualized
within a framework of social relations. A supreme deity is not
necessarily perceived as being more powerful or threatening than
a human sorcerer or witch. In fact, the more “earthly” an entity
or closer to human settlements and society, the greater the threat
74
that is felt. Labelling therefore becomes more rabid, as in the case

of the aswang.
At the same time, ascriptions of aswang and mangkukulam
clearly reflect social differentiation. Certain provinces in the Bikol
region and islands in the Visayas, particularly Samar and Siquijor,
are said to have more witches and sorcerers. But when you
interview people in these areas, they say that it is the more remote
barrios that have them. In a sense, the concept of the socially
remote is juxtaposed with concepts of powers to inflict harm.
As people become more secular in their beliefs, some of
these labels are in fact applied without necessarily believing
in supernatural forces. Terms such as demonyo and aswang are
frequently used in rural areas to describe the military or oppressive
landlords. In urban poor areas, the terms are also used to describe
the police and government officials. Correspondingly, there are
secularized witch-hunts that are often politically motivated, as in
the case of anticommunist movements.
75
{
Chapter Five
Pasma, Hangin,
and Naturalistic
Theories of
Illness Causation
MURDOCK (1980, 9) defines naturalistic theories of illness

causation as “any theory, scientific or popular, which accounts for
the impairment of health as a physiological consequence of some
experience of the victim in a manner that would seem reasonable
to modern medical science.”
That definition can be problematic given the last part, “seem
reasonable to modern medical science.” Considering the rigidity
of “modern medical science,” it is inevitable that many traditional
medical theories would be relegated by Murdock to his category of
“supernatural theories.” Murdock himself grapples with what he
calls a “category of theories of illness which occupy a sort of twilight
zone between those of natural and supernatural causation,” examples
of which are those related to acupuncture, chiropractic, osteopathy,
and faith healing. Such practices may have therapeutic effectiveness
but have not been accepted by mainstream medical groups.
In this light, I prefer a a definition of naturalistic theories
proposed by Foster (1976, 775):
Naturalistic systems explain illness in impersonal, systemic
terms. Disease is thought to stem, not from the machinations of
an angry being, but rather from such natural forces or conditions
as cold, heat, winds, dampness and, above all, from an upset in
the balance of the basic body elements. (emphasis in original)
76
Pasma, Hangin, and Naturalistic Theories of Illness Causation
Foster’s definition allows us to consider important traditional

theories which definitely are not “supernatural” but which simply
have not been evaluated or accepted by western medical science.
Using Foster’s definition and some of Murdock’s subcategories of
naturalistic theories, the following naturalistic theories of illness
causation can be identified among Philippine groups: natural
phenomena, diet, infections, humoral pathology, natural processes,
and stress.
5.1 Natural Phenomena
VARIOUS NATURAL PHENOMENA are cited as causes of illness

by Filipinos, from winds to thunder, but there is a tendency to
take these beliefs out of context, making them look exotic and
irrational.
An example comes with the beliefs around thunder and
lightning as a cause of illness. These beliefs are widespread among
Negrito groups not only in the Philippines but also in Malaysia
(Fox 1952, 338-39; Garvan 1964, 203-5; Maceda 1964, 115-19;
Endicott 1979; Blust 1981). Reports, however, vary as to the
perceived causal relationship. Many of the reports attribute the
illness not to natural phenomena itself but to a thunder god,
who punishes human beings for the violation of certain taboos.
On the other hand, Endicott (1979) suggests, from his analysis
of this belief among the Batek Negrito of Malaysia, that there are
actually two “systems of ideas” that are operational: naturalistic
and mythological. The mythological system attributes illness to a
thunder god, an anthropomorphic personification of the natural
phenomenon. At the same time, there is a naturalistic system
that operates, wherein “retribution” from thunder results from
the violation of taboos against the mixing of unlike categories
in nature, for instance, talking with or imitating animals. Thus,
Endicott suggests that:
77
[t]he naturalistic conception of thunder is that it is a normal

meteorological phenomenon which is an integral part of
the seasonal fruit cycle, but one which can get out of hand if
man disrupts the orderly processes of nature by confusing the
categories of the natural world. This system of explanation
is complete in itself, without any necessary reference to
anthropomorphic deities. (1979, 35)
We find that there are many taboos among different Filipino

ethnic groups on this “mixing” of “natural” categories. Maceda
(1964, 115-19) notes that in several Negrito groups, playing or
talking with animals is prohibited, apparently a way of defining
“human” and “animal” domains. Similar prohibitions are reported
for the Manobo (Elkins 1964) and the Tiruray (Moore 1975).
Other variations on this confounding of natural categories
are to be found, such as the taboo on mixing different fruits and
vegetables in one basket, reported among the Pinatubo Negritos
by Fox (1952, 338-40). In these cases, the principle invoked is the
danger of mixing things which do not “naturally” belong together.
Violations of these taboos result in a disruption in nature, e.g.,
thunderstorms.
The anthropologist Mary Douglas (1966) describes extensively
the way societies construct their notions of natural and unnatural,
pure and impure. The Old Testament book Leviticus is an example
of the extensive classifications people use, accompanied by
prohibitions. One sample passage: “You shall not let your cattle
breed with a different kind; you shall not sow your field with two
kinds of seed; nor shall there come upon you a garment of cloth
made of two kinds of stuff.”
Likewise, a pig is seen as “unnatural” and unfit to eat because
it is cloven-footed like cows and goats, yet it does not eat grass.
Likewise, creatures of the sea should have scales like fish; if they
don’t, as in the case of shellfish and crabs, they are “impure” and
therefore inedible. These dietary prohibitions exist to this day
among Muslims and Seventh Day Adventists.
78
We see then a “logic” that operates beneath many of these

beliefs. These are often lost in the accounts about “quaint” cultural
beliefs and practices. To underscore this point, I would cite another
variant of this “thunder belief,” this time among the Chinese in the
Philippines, who are often concerned about the effects of thunder
and lightning on children. Here, the fear is that the child may
have been “frightened” by the thunder and lightning, and it is the
“fright,” not some thunder deity, that is believed to be a potential
cause of illness.
Moving on to another natural phenomenon, there are
widespread beliefs in the Philippines about winds, hangin in most
Philippine languages, as a cause of illness. As with thunder and
lightning, illness-causing winds may be perceived as being sent by
supernatural or human entities. Hart (1979, 64) observed that in
Samar, hangin is itself a name for illnesses involving any type of
object intrusion caused by spirits or sorcerers.
On the other hand, the different Filipino ethnic groups also
believe in “self-activated” winds as a cause of illness, somewhat
similar to folk concepts in other cultures, of a draft causing
certain ailments, particularly respiratory ailments, muscular
pains, and skin diseases. The following observation by Adams and
Rubel (1967, 34) for Mesoamerica could very well apply for the
Philippines: “Aires, viento, and related forms are among the most
elusive of illness concepts … Sometimes it merely strikes the body.
In this sense the aire may be self-activated, or it may be a vector
used by a sprite, spirit or witch.”
Filipino theories of illness-causing winds probably belong to
a pan-Malayan complex since hangin (Malay angin, with an illness
described as masuk angin, the entry of wind or air) is always the
term used, rather than the Spanish aire or viento. Some of these
beliefs can be quite complex; for instance, Jocano (1973, 45-
48) describes a southern Tagalog community’s division of winds
according to direction, each causing particular illnesses.
79
In Jocano’s description of illness-causing winds, each month

is attributed with a predominant wind direction, causing specific
illnesses. This brings us to beliefs related to seasonal changes
and their effects on health. Again, some of these beliefs may have
magical and religious referents, certain days being perceived as
“sacred” and therefore particularly conducive to health or illness.
For instance, Demetrio (1970) cites the many prescriptions and
prohibitions related to days of the week, Friday being associated
with the most restrictions (e.g., bathing on Friday would cause
illness). Fridays are considered “sacred” because it is believed that
Christ died on that day.
Such beliefs are also strong among Filipino Muslims, to the
point that the prognosis for an illness may be based on the day
and month on which illness first appeared (cf. Gomez 1917). Wulff
(1964, 67) and Bruno (1973, 163) cite the belief that the second
month of the Islamic calendar (Safar) is unlucky. Thus, throughout
the Malay region, a ritual bath is taken on the last Wednesday of
this month to remove and keep away sickness and misfortune.
On a more empirical level, the seasons may be associated with
particular illnesses. Jocano (1973, 46) provides a brief description
of such beliefs among the southern Tagalogs:
When the temperature is relatively cool, sickness is not

widespread, except for those diseases which are deep in the body
and in an advanced stage, such as asthma, pilay lamig (muscular
pain), and pasma (rheumatism, joint pains). Generally, there is a
feeling of buoyancy and freshness. On the other hand, when the
temperature becomes warm and humid, there is a general feeling
of malaise and irritability even among healthy individuals.
Fox (1982, 153) wrote that the Tagbanuwa associate the intensity
of sicknesses with the period of the year in which the northeast
winds blow, roughly beginning in November and continuing into
January. This is the northeast monsoon, where the cold and wetness
is conducive to respiratory illnesses, not just because of the weather
80
itself, but because of demographic changes, the Tagbanuwa tending

to regroup in their permanent villages during this period, possibly
contributing to congestion and a more rapid spread of diseases.
In other areas of the country, “seasons of hunger” are common,
when food supplies have run out and the harvest has not been
brought in. These periods naturally correspond to “seasons of
disease.” In parts of Mindanao, the month of October is described as
ushering a season of “tigbali ug kaldero,” literally cooking utensils
being inverted, a reference to the lack of food because the eastern
monsoon reduces the fish that can be caught. Likewise, Dalisay
(2003) describes how in Batangas people talk about inaagosto, the
month of August being the peak of a lean season, and a time where
resources are scarce. Dalisay describes how women in particular
have to find ways to cope.
In examining theories which attribute illness to natural
phenomena, we find these theories relate to personalistic and
mystical theories. The awesome qualities of natural phenomena
such as thunder inevitably lead to their being vested with attributes
similar to those applied to the “life force” in human beings and the
supernatural.
At the same time, we cannot discount the empirical bases of
these concepts of natural phenomena as illness-causing agents. The
rapid spread of certain illnesses, in the absence of visible human
causative agents, could have led to speculation over the role that
nature would take, even if merely as an instrumental cause (e.g.,
the “air” or “wind” carrying illnesses). Subjective perceptions of
alterations in physical and mental states that accompany weather
changes, as well as perceived patterns of illness and death during
the year, may have contributed to the further development of these
theories. Other ailments believed to be caused by “winds,” such as
urticaria (pantal-pantal) also have empirical basis since these are
basically allergy reactions which may be triggered off by exposure
to substances in the environment that are then interpreted as hangin
in general.
81
We should not forget that until the nineteenth century, the

dominant medical theory in the west was of “miasmas” or vapors
causing illnesses. English terms for some illnesses retain the
original concepts of how the illnesses were caused: malaria due
to “bad air” (mal aire), or influenza from the Italian “influences”
(of the weather). Jose Rizal, the Philippine national hero who was
also a physician, wrote in the late nineteenth century, “El aire, el
calor, el frio, el vapor de tierra y la indigestion, son las unicas causas
patogenas que se admiten en el pais.” (“Winds, heat, cold, vapors
of the earth, and indigestion are the main causes of illness in
the country.”) (Cited in Bantug 1953, 12.) Today, we still speak
of hamog (literally, “dew”) as a cause of respiratory illnesses (cf.
Torres-Yu, Gonzales, and Tiamson-Rubin 1986, 160) and of singaw
ng lupa (vapors of the earth) causing a variety of illnesses.
The belief in singaw ng lupa is actually more complex. The
“vapors” are believed to be particularly harmful when it rains during
particularly hot weather, as is common in August. It is the contact
between the warm earth and the rain that results in the singaw,
which causes such conditions as the Tagalog na-alimuoman. Again,
there is an element here of the “unnatural,” rains occurring during
warm weather, resulting in discomfort and illness.
In some cases, other cause-and-effect relationships have
become so much a part of culture that they are no longer
questioned. The best example here is the Filipino fear of rain.
A German visitor once asked me, watching out students: “In
Germany, when it rains we find ways to protect our books. Why
is it that in the Philippines, when it rains, people use the books to
protect their heads?”
We do have a morbid fear of rain, thinking it causes respiratory
ailments. Medically speaking, there is no basis for this belief but
even physicians have been known to bring out their thick medical
books to cover their heads when it begins to shower. The rainy
season does result in more colds, not because of the rains but
because people tend to crowd together when they seek shelter from
82
the rain … sometimes still clutching the wet books and newspapers
they used to cover their heads.
5.2 Diet
THEORIES ABOUT DIETARY factors in health and illness are

important in all cultures. The aphorism “you are what you eat”
is universal and speculation on the relationship between diet and
health is a theme that continues to pervade both traditional and
western medical systems.
In the Philippines, the symbolism surrounding our psyche takes
on a visceral quality. Mention has been made of the term ginhawa,
referring to a sense of well-being, which Salazar (1983, 99-100) has
pointed out as believed to be situated “somewhere in the liver, or
atay.” Salazar goes on to explain that in an Old Visayan dictionary,
guinhaoa means “stomach, and the pit of the same stomach; to live,
to breathe, respiration, vital spirit; metaphorically, what is taken
upon eating for being that which, with nutrients, give life to all
living things; … sometimes and with relative frequency, the term
guinhaoa is understood to mean character, disposition, condition,
for the good or the bad.”
Interest in dietary beliefs and practices has given rise to the
subdiscipline of nutritional anthropology, with many studies on food
ideology, which consists of attitudes, beliefs, customs, and taboos
affecting diet and nutrition (cf. Farb and Armelagos 1980; Messer
1984). These studies show that diet involves more than physiological
processes, extending into the social and cultural spheres.
The literature on the Philippines is full of references to beliefs
about the effects of diet on health. A broad classification and
analysis is presented here.
First we find injunctions based on religion. The Islamic
prohibition on pork consumption is well known. Filipino Muslim
groups observe this prohibition, together with other Islamic dietary
83
injunctions. Bruno (1973, 173) lists “forbidden elements” (haram)

mentioned in the Koran: pork, dead meat (animals that died a natural
death), and blood. These precepts on diet are based on concepts of
the “pure” and the “impure,” haram itself having connotations of
“pollution.” Earlier in the chapter, I referred to the work of Mary
Douglas on natural symbols and on concepts of pure and impure.
Among indigenous groups, there has been little documentation
on religious beliefs related to food, other than references to the
fear of consuming food that has been “sorcerized” by enemies (e.g.,
Barton 1946, 142).
Gibson (1983, 264-69), however, presents a good discussion on
how food sources are categorized as “edible” or “inedible” among
the Buhid of Mindoro, including some of the magico-religious
underpinnings. He describes animal categories, such as the dog,
which is too close a companion to human beings and is therefore
inedible. Wild animals are considered edible, without need of rituals,
while animals that have been domesticated but may still live in the
wild are edible, if rituals are performed. Gibson also provides some
possible insights as to why two animals are popularly used as ritual
offerings: chickens and pigs. Chickens are said to mediate between
the household members and their aerial spirit companions—the
wing feathers are especially important for rituals. On the other
hand, pigs, which live below the house, mediate between human
beings and spirits of the earth.
Gibson suggests that animal sacrifices are not made for expiation
or to propitiate spirits; rather, they “appropriate the vitality of the
sacrificed.” Vestiges of such beliefs still exist even with lowland
rituals, for after all, there is human consumption of the sacrifices
after the rituals have been performed.
Among Christians, religious dietary prohibitions are found
among Catholics (abstinence from meat on Fridays during the
Lenten season) and the Seventh Day Adventists (total abstinence
from pork). We also find emphasis on the conservation of food
couched in religious terms. Cabotaje (1976, 94) cites the saying altar
84
ang lamesa (“The dining table is an altar.”). Food is considered grasya

or “grace from God,” and wasting food is deemed serious enough
to bring illness or misfortune. Such beliefs form the basis for folk
practices such as not leaving a house when others are eating because
this would be equivalent to “turning one’s back” on divine grace.
A second category of Filipino food beliefs deals with imitative
magical principles, defined by Frazer (1911, 52) as the belief that
“like produces like, or that an effect resembles its cause.” Examples
are the avoidance by pregnant women of slippery foods (e.g., okra)
in the belief that this would cause the uterus to slip (Nydegger
and Nydegger 1966, 814). Beliefs of this nature often date back
to the pre-Hispanic period, such as the still widespread belief that
a pregnant woman eating “twin bananas” (two bananas joined
together) would result in the development of twins. This belief
seems to date back, recorded in the Boxer Codex of 1590 (Quirino
and Garcia 1958, 442).
A third category of food beliefs are those based on theories of
humoral pathology, which will be discussed in greater detail in the
next section. Briefly, food items are classified as “hot” or “cold”
and these attributes are used as a guide for food consumption.
For instance, fruits are considered “cold” and therefore avoided
in the morning, the coldest part of the day, with the belief that
this intensification of the cold condition could result in ailments
like diarrhea and an aggravation of respiratory problems such
as pneumonia. Conversely, beans are considered “hot” and are
implicated in a number of “hot diseases” such as skin disorders and
boils including singaw (boils in the mouth, but also a synonym for
vapor rising from a hot-cold interaction). [See Jocano (1973, 49-
52, 59-62); Cabotaje (1976, 123-24) and Ramos (1977) for detailed
lists of these “hot” and “cold” foods.]
The hot/cold division of foods is extended to a belief that a
mother should not breastfeed her child if she has been working
hard or has been exposed to the sun because her milk would then
be too “hot,” turning salty and sour, and possibly causing illness
85
to the child (Jocano 1969, 35; Bruno 1973, 98; Guthrie et al, 1980,
41; Simpson-Hebert, Cresencio, and Makil 1986, 57). Lactating
mothers may even avoid sour foods in the belief that such foods
would curdle the milk and harm the infant.
A variation on breastfeeding beliefs, which incorporates a
mystical aspect, is that mothers should not breastfeed when sad,
upset, or angry because such emotions affect the quality of the milk.
There are many other aspects of beliefs about diet and health
that could be covered. Some of these are based on common sense,
such as recognition that overeating can upset the stomach. The
Ilonggos have the term nahubog, “to be intoxicated,” resulting from
overeating of particular foods (root crops, bulad, or dried fish and
nuts) resulting in the swelling of the face and itchiness (possibly
another allergy reaction). There are also many precautions about
giving young children foods which are perceived as being “hard to
digest” (mahirap matunawan), corn, for example. Such practices may
be detrimental since weaning foods tend to be confined to low-quality
nutritional items such as porridge, believed to be “easily digested.”
Food and diet have fascinated social scientists because although
on the surface they seem to be mainly biological, they also have so
many social aspects. We speak of attributes and labels attached to
food, including such notions as “prestige foods” to be served on
special occasions or to display one’s wealth. Food is also an ethnic
marker; for instance, a “Filipino” (or, for that matter, “Asian”) meal
would not be “complete” without rice.
One mistake often made in nutrition education programs is
to promote so-called “poor man’s protein” (e.g., legumes, fish)
by actually using those terms. In a highly stratified society such
as ours, the poorest families will go out of their way to purchase
expensive “status” foods for visitors, or will apologize for the food
they serve.
There are numerous “rules,” both restrictions and prescriptions,
particularly for infants; menstruating, pregnant, and lactating
women; the ill; and those who have just recovered from illness.
86
Hart (1965, 42-47) enumerates a long list of foods prohibited

during pregnancy and the postnatal period. These prohibitions
are intended to protect the mother and the child during what
is perceived as a crucial and life-threatening period. Similarly,
Cabotaje (1976, 123) lists foods which are classified as makabughat,
or “causing relapse.” Such foods are avoided by the sick and those
who have just recovered from illness. Many of these beliefs are
associated with concepts of hot and cold; but in other cases there is
a recognition of foods that are masustansiya (nutritious), needed by
people who are weakened or susceptible to illness.
The rules are also formulated in the context of social hierarchies.
The more nutritious foods (both biologically and socially defined)
are often saved for the men based on the misconception that they
have greater nutritional needs. In other instances, this practice is
implicitly sexist—women may actually have to wait for men to
finish their meals before they can eat.
Perceptions of edibility and palatability are results of
enculturation. There are even traditional classifications on the
nutritional value of certain foods. Cabotaje (1976, 128) writes that
in the Cebuano community she worked in, root crops are considered
sangga sa kagutum (guard against hunger) to be used when there is
a shortage of rice or corn, or as para isal-ang sa pagkaon (between-
meals food). These foods are not believed to furnish enough energy
or strength for the day’s work. A similar belief has been recorded
among the Tagalogs by Fujisaka (1986, 150) about root crops being
suited only for snacks (merienda). Interestingly, Fox (1982, 201)
has an anecdote about how the Tagbanuwa broke into laughter
when he asked them if they offered sweet potatoes and cassava as
offerings for the spirits of the dead. Apparently, what is inferior
food for the living also applies to the dead.
Such beliefs have implications for nutrition programs. Consider,
for instance, another observation by Cabotaje (1976, 128) about
vegetables not being perceived as sud-an (viand) but as utan, providing
flavor and a balance to hot and cold components of the meal.
87
The examples of perceptions about root crops and cereals again

show a relationship between biology and culture. The feeling of
“fullness” (busog in Tagalog) is not merely physiological; absence
of rice in the diet, as was pointed out earlier, leads to a feeling that
the meal is incomplete and that one is not “full.”
Gibson’s discussion of culturally defined “edible” foods could
be further elaborated. The Ifugaos, for instance, would not eat
monkeys because they believed the monkey descended from man
(Barton 1922, 393) while the Tagbanuwa avoid certain insects and
small animals (ramu ramu) believed to be transmigrated souls of
human beings (Fox 1982, 159).
Cross-cultural differences in the tolerance to spicy foods (e.g.,
pepper, salt) illustrate the importance of cultural conditioning in
dietary preferences. Cultural perceptions can be very powerful.
Rosaldo (1980, 112) cites the case of an Ilongot who vomited after
eating pork in a city restaurant because he found the “soft” quality
nauseating, in contrast to the meat of wild boars which he was
used to eating.
There are, certainly, important organoleptic criteria used
to determine a food’s edibility as well as palatability: taste and
smell in particular. It has been observed that we have many terms
to describe odors. In Tagalog alone, one researcher found 51
adjectives, three pertaining to the “pleasant,” 12 “neutral,” and 36
“unpleasant” (Narciso 1976).
These attributes are taken seriously; for instance, Guthrie et
al (1980, 40) report mothers tasting their own milk to determine
if it was “too salty” or “too thin” for the infant. In terms of odors,
unpalatability may be described by any number of terms including
malansa, panis, amoy amag, bulok, sira, amoy patay or even simply,
nangangamoy (“it smells”).
One other important concept should be discussed here:
hiyang, which means “compatible” or “suited.” Certain foods are
hiyang in the sense that they can be cooked together, or that they
“agree” with the individual. Among some communities, chicken
88
and squash (kalabasa) should not be cooked together as they are

believed to cause skin diseases. There are no particular attributes
given to the foods—they simply do not go together, hindi hiyang.
At the same time, there will be foods which create problems for
some individuals; again, there is the problem of hiyang.
Hiyang is applied to drugs as well. Simpson-Hebert, Cresencio,
and Makil (1986, 33) reported this belief in relation to the use of
contraceptives: “Certain elements in nature fit each other while
others don’t, causing disjunctions and possible illness.” In the
research of Hardon (1987) on self-medication patterns in an urban
poor community, and in my own work on the use of medicines
(Tan 1999), the concept of hiyang comes through repeatedly in
relation to the use of many medicines. Thus, while Tylenol and
Biogesic are both paracetamol, informants will insist that one
brand name works better because it is hiyang.
In the use of contraceptives, women will have a preferred
brand which they judge as hiyang because they put on weight
while using that particular brand. The irony here is that the weight
gain is actually a medical side effect of contraceptives, but for low-
income women, the weight gain may be seen as good, and therefore
labeled as hiyang.
Zorc (1982, 167) speculates that the term hiyang may have
been derived from an Indonesian language, where hiyang means
“stately, beautiful, splendid.” The term is, in fact, used to refer not
only to foods and drugs but also to cosmetics, i.e., a woman may be
complimented for her lipstick shade being hiyang to her.
To summarize, food items first have to be labeled with certain
qualities before their “effects” are inferred. “Hot” and “cold” labels
are examples. Certain items, as in other cultures, may also be
perceived as “sick foods,” i.e., used only for those who are ill, as in
the case of gruel. Still other attributes, such as “pure” and “impure”
may be used in both religious and secular contexts. An example of a
secular application is the widespread belief about colostrum being
harmful to the child (Jocano 1969, 31; Guthrie et al 1980, 40). This
89
belief probably developed because of colostrum’s dark yellow color

which may be interpreted as “dirty” or “impure.” Other qualities
attributed to food may relate to actual physical characteristics such
as texture, shape, or even sound (“crunchiness,” well exploited by
food companies in their advertisements).
We create categories that divide things into what is natural
and unnatural, what is hiyang and what is not hiyang. Once these
categories are adopted, they are difficult to defy. Thus we have
“sick” foods such as rice porridge (am), which could never make
it into restaurants. The lowly lugao (rice porridge) did make it, but
only after being rechristened “congee.”
Natural categories come into play even with medicines.
One example comes with the way medicines are given gender
attributes—at one time Midol and Alaxan had the same active
ingredient, yet it would have been unthinkable for a woman
suffering from menstruation to ask for Alaxan, as it would have
been inappropriate for a basketball player to ask for Midol to
relieve his muscle pains after a game.
5.3 Infections and Germs
BY INFECTIONS WE refer specifically to illnesses attributed to

microorganisms such as bacteria and viruses. The “germ theory”
of disease emerged in the West only in the last century and was
not introduced to the Philippines until the American occupation
in the past century.
Reference has been made to theories of “contagion” being
present even in simpler societies; however, this contagion is
perceived as a function of mystical and personalistic forces, and
natural phenomena such as winds. The whole concept of hawa goes
beyond that of “being infected” in the sense of the germ theory but
has deeper social implications relating to behavior, as we discussed
earlier.
90
Thus, it is important to reassess how much of the “germ

theory” itself is understood in the Philippines. The Tagalog term
kagaw is sometimes used to refer to pathogenic microorganisms.
Similar terms have been reported from other ethnic groups, e.g.,
kaga-o among the Maranao (Saber 1979, 26), kanam and kagao
among the Maguindanao (Gomez 1917, 264), and kamu among
the Subanun (Frake 1961, 125). Such terms actually refer to tiny
insects, such as the scabies mite, which cause skin diseases. Note,
too, the earlier references made to the Tagbanuwa kamu kamu,
insects and other small animals which are considered inedible not
only because they are believed to be transmigrated souls of human
beings but also because they are “ambiguous” because they are
“vaguely dangerous” in the sense that they do not eat rice or green
plants (Fox 1982, 159).
In the last thirty years or so, “mikrobyo” (microbes) has
come into wide usage accompanied by an increasing “germ
consciousness,” as in the use of germicidal soaps and washes and
hand disinfectants. Yet, the concept of germs actually remains
vague, as with the many modern-day rituals of disinfection.
The HIV/AIDS epidemic as well as the threats of SARS (Severe
Acute Respiratory Syndrome) and avian flu have raised public
awareness of germs, but again in a diffused way. Perhaps because
HIV receives so much publicity, the term bayrus (virus) has
become a substitute for microorganisms, with low awareness on
the difference between viruses and bacteria.
Concepts about microorganisms vary, sometimes with amusing
variations. The idea that food dropped on the floor isn’t necessarily
dirty if it hasn’t been on the floor for a certain time (varying
between 30 seconds and 5 minutes) is tied to childhood concepts
that the dropped food “scares” off germs. Until the germs regroup
and “attack” the food again, the food is seen as safe.
Germs are often given qualities of humans, if not the
supernatural. Women fear toilet seats, believing that the germs
lie waiting, ready to pounce on the vulnerable. Terms such as
91
kumakapit (sticking on) show that the germs’ mode of infection are
not often understood.
I have found villagers speaking of intestinal parasites (bulate) as
“adult germs” (mikrobyong naging laki). Likewise, after the launching
of information campaigns on HIV/AIDS and sexually transmitted
infections (STIs), many people took on the misconception that
the STIs directly lead into HIV/AIDS, almost as if the infectious
organisms all mutate into HIV. The source of this misconception
may have been ads showing a ladder of infections, where STIs
formed the lower rungs and HIV/AIDS was shown on top.
Heavy marketing campaigns have made germicidals—from
rubbing alcohol to soaps—popular. Self-medication with antibiotics
is also a problem, as people think that an infection like a cold can
be “cured” through these drugs.
5.4 Humoral Pathology
MANY CULTURES HAVE theories of humoral pathology. They are

important components of traditional medicine in Asia (including
the Philippines) and in Latin America. These theories are important,
shaping many other beliefs related to diet and health maintenance
and disease prevention. Its origins have been attributed to Greece
and Galenic medicine but elaborate discussions of such theories in
very early Indian and Chinese philosophical texts suggest that the
Greeks may have borrowed these ideas from Asia, rather than the
other way around (Goonatilake 1984, 44-45).
In humoral pathology, illness is believed to be caused by a
disturbance of the balance of forces within the body. In classical
Greek theory, these would be the four humors: black bile, yellow
bile, phlegm, and blood. Balance is determined by the distribution
of various attributes of living matter: hot and cold, wet and dry.
This distribution is, in turn, a function of the relative properties
of four natural elements: earth, water, fire, and air (cf. Foster and
92
Anderson 1978, 56-60). Personalities were attributed to these

humors, as we see in the terms “bilious,” “melancholic” (black
bile), “choleric” (yellow bile), sanguine (blood), and phlegmatic.
Arikha (2007) describes the history of humoral pathology,
including its persistence well into the seventeenth century, when
William Harvey’s description of blood circulation helped to raise
questions about the humors. In the nineteenth century, the rise
of the germ theory of disease relegated humoral pathology to the
sidelines, but Arikha reminds us that the humors remain important
as metaphors even in modern life, particularly those referring to
personalities.
In the Philippines, the theory of humoral pathology is
represented by beliefs about interactions between the hot and the
cold (init at lamig). Hart (1969) suggests that classical concepts of
humoral pathology were diffused by the Arabs to Spain, from where
it was brought into Latin America and the Philippines. Curiously,
Foster (1960, 15,20) notes that the hot/cold concept is absent in
Spanish folk medicine, and apparently did not exist either at a folk
level in the past so it is possible that the hot/cold concept was part
of elite and scholarly Hippocratic medicine and was transmitted to
Hispanic America (and presumably, the Philippines), on an elite
level, i.e., through Spanish physicians and the clergy.
The absence of the hot/cold syndrome as a theory of illness
causation among Filipino Muslim groups leads Hart to suggest
that this belief complex was introduced to the Philippines by the
Spaniards, rather than by the Arabs but we will see later, there is in
fact a hot/cold belief complex even among tribal groups that could
not have borrowed these concepts from the Spaniards.
The hot/cold syndrome forms the basis for the concept
of pasma or pasmo which is the same term used in Hispanic
America, which all seem to be derived from espasmo or spasm. In
local traditional medicine the term goes beyond this meaning of
spasm. Frake (1961, 125) loosely defines pasma as an “exposure
illness”; and in both the Philippines and Latin America, this illness
93
is believed to be caused by an attack of “cold” on someone who

is too “hot,” or vice versa (Adams and Rubel 1967, 343). Thus,
in the Philippines, someone who becomes “hot” from strenuous
physical activity would be advised against bathing in cold water,
lest he or she be affected by pasma. The same principle applies for
menstruating women who are advised not to bathe because their
condition is one of “heat.”
Both allopathic and homeopathic principles are invoked in
the application of the hot/cold theory of illness. Mixing hot and
cold is dangerous (allopathy), but so is aggravating “hot” with
more “hot” (homeopathy); thus, a woman who has just delivered
a child is believed to be in a dangerously “hot” condition
and should avoid “hot” foods that could only aggravate her
condition.
Pasma patients usually complain about hand tremors, sweaty
palms, numbness, and pains. Certain occupations are believed to
be more vulnerable than others, for example, farmers, secretaries,
pianists, students, factory workers, athletes, and laundrywomen
(labandera), in other words, anyone working with their hands.
Targeting athletes, the manufacturers of Green Cross alcohol
at one time had ads claiming that their product was a healthier
alternative to cold water baths, after a workout. The idea here was
that alcohol, although cold to the touch, was actually considered
“hot,” maybe because it warms the body when you apply it. “Hot”
alcohol on a hot body therefore prevented pasma.
Whenever I lecture on AIDS prevention, there are always
people, especially sex workers, who claim they get pasma from
bathing after sex. A rather amusing variation on this belief is
the idea that condoms cause pasma allegedly because the rubber
aggravates the body’s heat.
Theories of humoral pathology are clearly associated with
concepts of “balance” in nature. The need for balance of attributes
in nature—hot and cold, wet and dry—are projected to the human
body.
94
I have referred to the concept of singaw ng lupa (vapors of the

earth) as a cause of illness. Jocano (1969, 34) refers to a similar
concept, usbong ka lupa, in a Panay community, applied in a different
context. Productive agricultural fields are said to have a “cold” vapor
while those that are “hot” will be unproductive, no matter how much
fertilizer is added. The hot/cold differentiation of the land’s vapor is
used to describe “luck.” Cool vapor is auspicious while hot ones are
unfavorable; thus, there is a widespread practice of burying coins
and other brass items underneath the foundations of a house, these
“cool” items supposedly being useful to neutralize the unfavorable
effects of the “hot” vapor (cf. Cabotaje 1976, 79-80).
I find this striking because Bruno (1973, 12) reports that among
the Muslim Tausug, a mangingita (diviner) is consulted about a
good day for starting the construction of a new house, a lucky day
being called mahaggot (cool) while an unlucky one is mapasu (hot).
Reference has also been made to the Tausug term pasu simud (hot
breath) as an attribute of certain individuals who can inadvertently
inflict illness on an infant by mere contact (Bruno 1973, 85).
The Negritos apparently do not use theories of humoral
pathology in the sense of having concepts such as pasma, but we
find the following account from Garvan (1964, 28): “A man may
be sick and desire a change of place, thinks that such and such a
place is good, believes that the present site is ‘hot’ or ‘cold’ or ‘bad’
and so, off goes the group.” Garvan (1964, 76) later clarifies the
Negrito notion of a “hot” site as one in which people have stayed
too long, which Garvan cites as the reason for the Negritos being
“disinclined towards tilling the soil.”
It is therefore not surprising that the Tagalog term mainit is used
among political activists for a person or a place under surveillance
by the military, somewhat similar to the American usage of “hot
goods” (cf. Torres-Yu, Gonzales, and Tiamson-Rubin 1986, 173).
Likewise, Trosdal (1975, 32, 34) cites a Visayan belief that
in planting corn, a sower (mamumugas) is chosen for his “cool
palms” (bugnaw ug palad). The Tagalogs also have similar beliefs
95
about “warm hands” (mainit ang kamay) being unproductive in

planting as opposed to “cool hands” (malamig ang kamay) (Torres-
Yu, Gonzales, and Tiamson-Rubin 1986, 64, 66). In chapter 3, I
mentioned the taboos on menstruating women—apparently,
according to Trosdale, this is associated with the belief that such
women have “hot palms” which would cause plants to wither.
Fox (1982, 60) also records a belief among the Tagbanuwa of
Palawan about sumbang (incest) being dangerous because it leads to
the spirits causing “excessive heat and the failure of the rice crop.”
All this information suggests that the hot/cold dichotomy
may have first emerged as concepts pertaining to nature, which
were gradually extended into other fields not necessarily related
to theories about health and illness. Galdston (1981, 7) suggests
that “one can recognize an astute generalization derived from
long agrarian experience” in Greek humoral pathology. In a
predominantly agrarian country like the Philippines, it is easy to
understand why a theory of humoral pathology remains widespread.
The term pasma, for instance, is recorded for all Christian groups,
as well as for Muslim and indigenous communities. In fact, the
equation of “hot” attributes with potency may date back to hunting
groups. Referring back again to Fox (1982, 178) for the Tagbanuwa,
we find beliefs about a certain fruit being applied to the nose of the
lead hunting dog, with the belief that this fruit, being hot, causes
pigs to become overheated while running, making it easy for the
hunters to capture them.
5.5 Natural Processes
FOR WANT OF a better term, “natural processes” refers to emic

(i.e., native or “insider”) perceptions of human physiology and
metabolism which are implicated in health and illness. This “folk
physiology” or concepts of organic processes, is in turn based on a
“folk anatomy” or concepts of the different parts of the body.
96
Folk physiology includes popular perceptions of what is

“normal,” sometimes described by older Filipinos as naturaleza,
or by younger ones as “normal.” It is important to look into these
categories; for example, many Filipino parents will still consider
lice infestations and intestinal parasitism as “normal” or “natural”
and therefore leave these untreated.
Unfortunately, there is a dearth of materials dealing with folk
anatomy and folk physiology in the Philippines. There is some dis-
cussion on this topic by Jocano (1973, 54-57), who concentrates
on the hot/cold syndrome particularly as it relates to the folk image
of the human body and its functions.
As in many cultures in other parts of the world, concepts of
blood and the circulatory system seem to form a core concept in
folk physiology, perhaps because blood is known to be distributed
throughout the body and that its loss is correlated with weakness
and death.
Folk anatomy can also include symbolic uses of body parts. I
have mentioned that the heart is used in a number of Austronesian
languages to suggest a soul or “a locus of vitality and will” (Rosaldo
1980, 36). Correspondingly, blood is perceived as a carrier of this
vitality. In folk genetics, illnesses perceived to be hereditary are
said to be passed on through the blood (nasa dugo). Such illnesses
include mental disorders, some skin ailments, and tuberculosis
(Jocano 1973, 95).
Sexual reproduction is itself conceptualized as a function of
the blood. Thus, sterility may be attributed to “incompatibility” of
a couple’s blood. Jocano (1973, 57) mentions a southern Tagalog
belief that sterility results if both the husband and the wife have
“cold” blood.
Not surprisingly, blood is given attributes other than “hot” and
“cold.” Jocano (1973, 57) describes four classes of blood identified
by his informants: malapot (thick), malabnaw (thin), dilaw
(yellowish), and buhay (literally, “alive,” but translated by Jocano
as “normal”). Blood is believed to thicken when “overexposed to
97
heat or cold,” causing illnesses like high blood pressure and heart
illness because its viscosity results in sluggish circulation as well
as a sticking to the walls of the veins. This folk theory of blood
viscosity and cardiovascular diseases actually comes quite close to
the “modern” explanation.
Since blood circulation is considered to be so vital, it is
natural that pulse-taking forms an important part of traditional
diagnostics. The pulse is read not just for frequency, but also for
regularity and amplitude. Points used for reading include the wrist
and each of the fingers, each finger relating to particular parts of
the body. Moreover, the pulse is read and compared for both the
left and right hands (cf. Jocano 1973, 115-25).
People with insomnia, anemia, and generally weak body
resistance (sakitin, or sickly), are said to have “thin” blood.
Finally, yellowish blood is attributed to people with asthma, bile
troubles, tuberculosis, and malaria, perhaps because such diseases
may contribute to hepatic and biliary dysfunction, resulting in the
patient’s having a yellow pallor.
Jocano says that other parts of the body are also given labels,
mainly “hot” and “cold,” and that particular illnesses are believed
to be caused by an imbalance between external hot and cold
influences on the corresponding anatomical part. Thus, the back
(likod) is said to be especially sensitive to cold, rains and drafts,
while the abdominal region (tiyan), and its contents (sikmura) are
especially sensitive to “wind,” exposure to which results in gas
pains and flatulence (kabag).
Another aspect of folk anatomy which has received little
attention is the idea of “displaced organs” being a cause of illness.
Foster (1953, 210-11) says that this concept is found in both Spain
and Hispanic America, and he names a variety of folk illnesses
believed to be caused by such “displacements”: espinela, paletilla,
calleiro, caida de la paletilla, caida de mollera, estiramiento de las
venas, and descuajamiento. All these illness names refer to particular
anatomical parts described as “fallen” or “sunken.”
98
None of the above terms have been recorded for the

Philippines although similar concepts are present. In Isabela, for
instance, we recorded a folk illness known as matalinan, loosely
described as a knotting up of the intestines and resulting in colic.
Symptoms are the appearance of stiff veins in the abdominal
region. A hilot (“masseur” or bone-setter) is called in to massage
the abdomen as a cure. A concept of a “pinched nerve or vein”
(naipit ang ugat in Tagalog) is also present, with massage as the
required therapy.
Lieban (1976) devotes an entire paper to the Cebuano folk
illness called piang (pilay in Tagalog). Those unfamiliar with
traditional medical terminology translate piang simply as a sprain
or any dislocation in the skeleto-muscular system. In fact, the
treatment for this ailment is massage by a hilot. However, Lieban
found that most piang patients, all of whom were children,
actually had symptoms of respiratory disorders. Interviews with
the traditional bone-setters yielded the following information:
One manghihilot puts it, “It is piang when the bone is in

trouble—curved, dislocated, twisted or broken.” According to
the etiology, these [respiratory] symptoms develop when the
children fall, dislocating or bending the soft bones of the rib
cage, with adverse effects on the lungs. (Lieban 1976, 290)
Lieban notes that this concept of piang results in a reliance

on massage therapy to normalize the position of the allegedly
displaced bones. This delays treatment of the respiratory illness
itself. Similar concerns have been expressed by Central American
health workers over caida de mollera (“fallen fontanelle”), which
is a childhood illness and is treated by “sucking up” the fontanelle.
The problem is that the fontanelle sinks in as a result of dehydration
that accompanies severe diarrhea. Since the actual cause is not
identified, treatment (rehydration) is delayed, often resulting in
the child’s death (cf. Werner 1977, 9). Beliefs in pilay and piang
99
remain strong to this day, an example being a report from Bohol

(McNee et al 1995) on how a diagnosis of piang in a child with a
cough may delay a medical consultation.
Another example of the concept of “displaced organs” is that
of the postpartum uterus. Throughout the Philippines, and again
in many other parts of the world, traditional midwives regularly
massage the new mother’s abdominal region in order to “restore”
the uterus to its original position. Failure to do so is believed to
result in illness to the mother (Hart 1965, 65-66). It is interesting
that there are also midwives who claim to be able to massage
the uterus into a position which would delay or prevent another
pregnancy while others manipulate the uterus for women who
want to conceive but are unable to do so supposedly because their
uterus is not in the proper position.
“Roasting the mother” (agsidor in Ilokano, saklab or saklat in
Tagalog, palina in Cebuano) involves hot steam baths with herbs
and incense, which has symbolic qualities of purification but also
has the objective of “fixing” or “restoring” the uterus, while the
heat alleviates the pains following childbirth (Hart 1965, 67-71;
Mendez and Jocano 1974, 97-101). Frake and Frake (1957, 211)
note that among the Subanun,the birth pains are actually attributed
to what is called pengugapel, or postpartum uterus:
The Subanun conceive of the pengugapel not as an

anatomical organ related to the uterus or womb (telibeta-anen),
but as a vaguely defined, mobile entity appearing after delivery
and causing considerable pain (the afterpains). The application
of heat relieves the pain, reduces the size of the pengugapel, and
results in its eventual disappearance.
Folk perceptions of anatomy and physiology are important for

understanding a range of public health issues. Researchers from
the Guttmacher Institute (Juarez et al 2005) estimate that there are
close to 500,000 abortions a year in the Philippines. An article in
1980 by Flavier and Chen also reported widespread early induced
100
abortion. All this may relate to lay concepts of the development of

the fetus and human life.
More or less, the first trimester of a pregnancy is often
described as paglilihi, sometimes even translated into the English
“conception.” Rubel, Weller-Fahy, and Trosdal (1975) have
described the perceptions of Cebuano mananabang (midwives)
related to conception, gestation, and delivery. This includes
concepts about the uterus and the fetus itself, which is perceived
to be similar to a blood clot in its early development. “Dugo lang”
(It’s only blood) is the usual description of the uterus’ contents
during this period. It is not surprising the term pampabalik ng
regla (to restore menstruation) for abortifacients, whether herbal
or “modern” medicines.
Polenda (1989, 22) writes that for the Western Manobo
Bukidnon, “As long as the embryo is not yet formed but consists
only of blood, or if its movements are very feeble it may still be
aborted. But if its movements are vigorous because the pregnancy
has progressed as much as seven months, it will be very difficult to
bring about an abortion; the fetus must be allowed to come to full
term.” There are also descriptions in Polenda’s account of plants
used for abortion, and what has to be done after the woman has
taken the decoction. Moreover, there are descriptions of what to
do after the abortion: “When the fetus comes out, if it already has
the form of a child then it should be wrapped carefully in a cloth
and buried; if it is just blood then there is no need to bury it.”
Such concepts are found in many parts of the world. Whittaker
(2000, 164-65) mentions the Thai term gon lu’at (lump of blood)
used for the early stages of a pregnancy, and the use of yak hap lu’at
(medicine to bring blood down).
Another example of folk physiology that influences health-
maintenance practices comes with perceptions about the effects
of accumulating metabolic products of the body. Jaspan (1969,
25) notes that among the Malay, “perspiration, which accumulates
both whilst exerting oneself and in sleep, must be washed away to
101
maintain health and to avoid polluting or contaminating others.”

Filipinos have similar concepts, a survey by Lynch and Himes
(1967) showing that one commonly perceived cause of illness
was “perspiration drying on the skin.” These concepts have direct
bearing on health-maintenance practices such as frequent bathing.
“Mother roasting,” mentioned above, also has another objective
of having the mother perspire to remove impurities (Mendez and
Jocano 1974, 99). In some instances, these beliefs are the basis for
detrimental practices, such as that of wrapping feverish patients
to protect them from drafts and to have them perspire. While
diaphoresis (perspiring) does help to lower body temperature, the
tight bundling of the patient, especially children, may in the long
run be more harmful.
The time when one bathes is also determined by indigenous
physiological concepts. A widespread belief is that bathing in the
morning “adds blood” while bathing in the evening “drains blood”
(Demetrio 1970, 9). The line of reasoning goes on to conclude that
bathing in the evening results in “low blood pressure.”
There are undoubtedly other aspects of folk anatomy and
physiology which could be documented. Filipino psychologists
and psychiatrists have become more interested in the cultural
dimensions of mental health and might do well to look into local
constructions of emotions and feelings.
Santiago (1993) presents an exhaustive study of Filipino
emotions around mourning and depression, which could be
expanded to other languages and other domains. It might be useful
as well to link folk anatomy to mental health. It is interesting
that the liver actually constitutes a semantic reference point for
the description of emotions. Wolff (1976, 358) points out that a
number of Tagalog terms referring to emotions use the suffix -hati,
which in Malay means “the heart, the liver, seat of emotions, the
core” (Gimlette and Thomson 1939, 80). Examples of such words
are dalamhati (extreme sorrow), pighati (anguish) and luwalhati
(loosely translated, “feeling glorious, generous”).
102
Schlegel (1970, 32-33) says that among the Tiruray, fedew

(“gall bladder”) is used to refer to one’s state of mind or rational
feelings, as well as one’s condition of desiring or intending. A
person who is ill, lonely, or angry says that he has tete fedew, a “bad
gall bladder.”
As in many other languages, the blood is given attributes to
describe emotions and feelings. The Tagalog kumukulo ang dugo
ko carries the same connotations of anger as in the English “my
blood boils.” Tagalogs go a step further to describe one’s limits of
patience or tolerance with the expression, natutuyo ang dugo ko,
my blood is drying up or, more precisely, to be drained (Torres-Yu,
Gonzales, and Tiamson-Rubin 1986, 162).
We need to look at how the body itself becomes a symbol. Kin-
ship terms, for instance, relate to anatomical structures. Kapatid or
kaputol (utol in Tagalog slang) both mean siblings and refer to being
“cut from the same intestines,” and a married couple or lovers are
kabiyak ng puso (halves of a heart). Two people who are compatible
are described as kabagang, “of the same molar tooth” (Torres-Yu,
Gonzales, and Tiamson-Rubin 1986, 158). Rosaldo (1980, 242)
says that the Ilongot kibetrangan, which means any wide network
of relations such as kinfolk, is derived from bertrang or “body.”
In Tagalog, great-grandchildren and great-great-grandchildren
are distinguished respectively as apo sa tuhud (“grandchild on
the knee”) and apo sa talampakan (“grandchild on the sole of the
foot”). Kikuchi (1984, 36-38) describes an even more elaborate
symbolic representation of kinship, using human anatomy, among
the Hanunoo of Mindoro, with the breast representing Ego and
his/her spouse with the head and the neck representing parents
and grandparents (right side for the male lineage and the left side
for the female).
No wonder, then, that the Filipino concept of sakop, of
belonging to a group, takes on strong parallels to the notion of a
social body, a disengagement from which is potentially dangerous
and unhealthy. The body, clearly, is “both symbol source and
103
symbolized, a thing classified and a classifier of things, signifier

and signified” (Ellen 1977, 362).
Polunin (1977, 94) points out that even therapies using external
measures call attention to the existence of a morbid state, i.e., the
use of a poultice or a bandage is in a way an announcement that
one is ill. Although not specific to the Philippines, the following
anecdote from Jaspan (1969, 17) is worth quoting to emphasize the
point I have been trying to make:
In Cambodia, where herbal ingredients are not always easily

obtained in cities and towns and because other materials are more
readily at hand, I was interested, a little amused and on reflection
much impressed with the idea of a strip of surgical plaster or white
sellotape being placed diagonally across the forehead or temple.
Thus everyone knows—in the nicest and most effortless way—
that Sahachivin Kim Chon, for example, has a nasty headache,
cold, or hangover, and wants to be left in peace.
Folk concepts of anatomy and physiology are important

since they form the rationale for health maintenance and healing
activities. Note, too, how the concepts of the body and the attributes
and labels used, may extend to, or are extensions of other concepts
relating to emotions and feelings, natural and social phenomena, as
well as social structures and relationships.
5.6 Stress
MURDOCK (1980, 9) defines stress as “exposure of the victim to

either physical or psychic strain such as overexertion, prolonged
hunger or thirst, debilitating extremes of heat or cold, worry, fear,
or the emotional disturbances which constitute the province of
modern psychiatry.”
This rather broad category has generally been neglected in
the ethnographic literature, perhaps because it seems so obvious
104
that stress (particularly physical stress) would be easily recognized

as a cause, or at least a contributory factor, to illness. Another
reason for the neglect of this category may be the misconception
that underdeveloped societies go through an idyllic, “stress-
free” existence when compared with the rapid pace of life in the
industrialized countries.
In the last twenty years, there has been growing interest in an
anthropology of emotions, looking into the cross-cultural similarities
as well as differences, in the identification and classification of
emotions. As more work is done in this area, our understanding of
stress and culture will change as well.
Occasional references are made in the literature to physical
stress as a recognized cause of illness among Filipinos. This concept
is often couched in terms of humoral pathology, e.g., physical effort
increases the body’s “heat” and the resulting imbalance of “hot”
and “cold” is a potential cause of illness. The concept of pasma sa
kaon mentioned by Hart (1980, 62) attributes illness to prolonged
hunger. It is this same belief which forms the rationale for Filipino
mothers breastfeeding their children “on demand” (Guthrie et al
1980, 39).
There are few references to emotional stress as a perceived
cause of illness, except for the complex of “fright illnesses.” Lanti
has been mentioned earlier. In addition, we find references to a
startling or frightening experience as one of the possible causes
of the kabuhi syndrome among Visayan groups (Lieban 1967, 81;
Demetrio 1970, 441-42). Demetrio also mentions tu-ob, attributed
again to fright. Wolff (1972, 628) defines lubat as “illness caused by
a frightening experience, especially contact with the dead.” Tiston
(1978, 27) describes ugmad as an “emotional disturbance due to
the fear of a person, object, animal or situation.” All these illnesses
are reported mainly from the Visayas.
Although more work needs to be done in relation to indigenous
perceptions of stress, I would suggest that such concepts are again
closely related to concepts of balance. Even with the “fright illesses,”
105
we find that the illnesses are attributed not so much to fright itself
than to experiences of a “startling” or extraordinary nature. A new
and unfamiliar environment or experience disturbs the “natural”
balance of a person’s body and psyche; and it is this disturbance,
rather than an intrusive factor, that becomes a source of stress. It
should not be surprising then to find a logical continuum between
illnesses attributed to such startling experiences and those attributed
to sudden changes in the environment (e.g., thunder, strong winds,
heat, cold), or even to shifts in daily routines. Casino (1976, 116)
mentions new immigrants to a Muslim Samal community coming
down with an illness they called binaho (baha’o meaning “new”),
which they explained as their bodies “not agreeing with spirits of
the new place.”
With an estimated eight million Filipinos now part of a
global diaspora, malaise attached to homesickness will become
more important. Even when away from home for a short period,
many Filipinos talk about insomnia, weakness, inappetence, even
constipation, as symptoms of namamahay, the body looking for
home. The problems work on both ends, with children left behind
by parents also unable to sleep. The solution? Many Filipino
parents will leave behind clothes that they have worn, and have
not washed, which are then tucked into bed with a young child,
supposedly to reduce the separation anxiety.
Both deprivation and excess of material and emotional needs
enter into the configurations of stress. An example of the concept of
deprivation would be the belief that unfulfilled “pregnancy cravings”
for particular foods would result in illness to both the mother and
the child (Jocano 1969, 20). At the same time, an excess in emotions,
food, or even aspirations are perceived as sources of stress and illness.
Hart (1965, 31) cites a belief about anger affecting pregnant women
to the extent that the sex of the unborn child may be changed.
A lactating mother who feels stress—anger or unhappiness—is
advised not to breastfeed her infant or the baby sucks unsuitable
milk (Simpson-Hebert, Cresencio, and Makil 1986, 57).
106
More insights into the nature of stress may yet come from
indigenous communities, such as a Negrito belief of the soul
leaving the body, and therefore leading the illness, “when oppressed
with great emotion” (Garvan 1964, 215). Biernatzki (1973, 41)
discusses the ritual of pangimokod among the Bukidnon, which he
describes as a “feast of reconciliation” conducted even in minor
cases where conflict has occurred and feelings have been hurt, with
the objective being the restoration of “full union between his body
and soul (gimokod) which has been compromised by the agitation
of conflict.”
The Ilongots have the concept of ‘uget, or “bad feelings in the
heart that discourage eating,” as a cause of illness:
‘uget applies to the sense of resignation and withdrawal that

leads an angry or insulted person to ‘hold on’ to a disturbing
grievance and refuse to speak his thoughts. And just as illness
may affect our thoughts and leave us sullen and distracted, so
a severe disruption—occasioning fear, grief or anger—may
induce passivity and even illness because the heart cannot ‘think
through’ what it should do. (Rosaldo 1980, 41)
Lopez-Gonzaga (1983, 119, 123-24) describes the need,

among the Buhid Mangyan, to avoid rancor since this can cause
“knotted entrails,” derangement (kapaong), or suicide by hanging
(gugot). There is also the concept of kasamok among the Buhid
Mangyan, described as a deep or fervent longing or desire for
something which needs immediate satisfaction. Sharing of food or
goods is needed or else the one who refuses to give may become
ill. Central to these beliefs is the concept of kafiyaon, “just right;
what fits or fills a need,” as opposed to duwat, a term also used to
describe tangled, coarse, and unwashed hair.
Gibson (1983, 178, 190-91), also writing on the Buhid,
describes the belief that children with antisocial behavior are
possessed (“bitten” was the closer translation of the original term)
by such emotions as fangarisugan, “that which causes aggression”;
107
fanguyab, “that which causes crying,” or fansungun, “that which

causes depression.” In general, children are said to be more
susceptible to a range of emotions except fangasaya, “that which
causes desire,” probably a term referring to lust. Fox (1982, 162)
in fact describes a particular type of dreams among the Tagbanuwa
called uyaw, which afflicts men “who are always infatuated
with women and always courting.” Such persons will have “bad
headaches” and have to go to a traditional healer (babalyan) for
treatment.
5.7 Susceptibility as a Key Concept
AT THIS POINT, it would be appropriate to introduce the concept

of susceptibility, which Najman (1980, 235) defines as “some
combination of situations, experiences and behaviors [that] either
predispose or precipitate poor health and death in a number of
small proportion of persons so exposed.” Najman’s definition is
useful because it underscores susceptibility as a potential for illness
brought about by a combination of different factors, and which
draws different responses from those exposed to this multifactorial
situation.
I have already mentioned that particular individuals are
subjected to dietary precautions. Such individuals include
children; pregnant, postpartum, and lactating women; the sick,
and those who have just recovered from illness. These individuals
are perceived as being particularly vulnerable to illness or relapse
for a variety of reasons which should be examined if we are to
understand the Filipino notion of susceptibility.
Children, for instance, are perceived as being “weak,” not only
physically but also “spiritually” or “mystically” for any number
of reasons including “lack of knowledge,” expressed as the “loose
attachment of the soul” (cf. Fox 1982, 105). The child’s susceptibility
to soul loss has been described and in fact forms the basis for other
108
beliefs and practices. For instance, the idea of punishing a child by

withholding dinner is anathema among groups that believe in soul
loss, because the “hungry” soul might wander off while the child is
asleep, which would result in the child’s becoming ill.
One nurse I worked with at the nongovernment organization
AKAP once came down with stomach pains and general malaise
while working in Cagayan province. Not responding to “western”
therapy, her friends in the community advised her to seek a
traditional healer, who diagnosed her illness as “soul loss.” A ritual
was performed, and the nurse’s errant soul was finally located at
a school cafeteria. The healer’s advice to the nurse to prevent a
recurrence was to make sure not to go to bed hungry. (Our nurse
did recover after the ritual.)
My point here is that there are all kinds of concepts of
vulnerability in the folk sector. Reference has been made to the
mystical notion of unbaptized children being weak. This weakness
remains even after baptism in the sense that children are still
considered susceptible to certain ailments. Some of these ailments
are in fact perceived as “normal” parts of the developmental or
growth process. Jocano (1969, 36) says that “running nose and
coughing” in children were not considered serious in his research
community in Panay, and that hiccoughs were considered as a “sign
of growing up.” In other parts of the Philippines, we often hear the
term lagnat-laki, which literally translates as “fever of growing up,”
marking the time when a child’s growth is most rapid. A variation of
lagnat-laki would be the fever, crying fits and digestive disturbances
interpreted as a normal part of teething (nagngingipin). In all these
beliefs, there is an implicit recognition of certain ailments being
inevitable because of the rapid developmental changes in the
child.
Correspondingly, the pregnant and postpartum mother is
perceived as being susceptible to illness because of the changes in
her physical and metaphysical states. This notion of susceptibility
may be expressed as beliefs about pregnant women being prone
109
to attacks by supernatural beings or may again be described as a

disequilibrium in the hot/cold balance. Among Visayan groups,
childbirth results in a woman’s lifelong susceptibility to illness
because of the irreversible changes in her body. The term bughat
(relapse) is used to refer to this susceptibility (cf. Lieban 1979, 109
and Guthrie et al 1980, 39) with the assumption that a woman may
have a “relapse,” in the form of body aches and pains for instance,
many years after child delivery. Quite often, this means rheumatism
and arthritis being blamed on a child delivery many years earlier.
It may be worthwhile to conduct a study in the Philippines
similar to that of Fabrega and Hunter (1978), where peasants in
Chiapas (Mexico) were asked to relate caracteres (personality) and
sentidos (emotions) with disease susceptibility and severity. While
there was not always unanimous consensus on the correlations,
Fabrega and Hunter (1978, 8) conclude that “disease to
Tenejapencos is associated with physical and anatomic changes, yet
these changes are viewed as affected by and related ‘cybernetically’
to the individual’s psychological disposition and how he conducts
himself socially.” A few examples of the concepts of emotional
stress among Philippine groups have been given.
Jocano (1973, 93) in fact mentions a southern Tagalog folk
illness called sentido, the Spanish word for emotions, interpreted
as headache believed to be caused by worry, eye strain, or attacks
by supernatural spirits. Note that the Tagalog word karamdaman,
derived from the root word damdam (“emotions and feelings”), is
sometimes used as a substitute for sakit in referring to illness.
What needs to be further analyzed are not emotions per se, but
emotions as part of social responses and how these are perceived as
contributing to susceptibility.
In chapter 3, I discussed contagion in the sense of a person
becoming a potential source of illness from a lack of knowledge
expressed as uncontrolled wants or desires. Oppressed by such
wants, the soul takes leave of the body and brings about illness. On
the other hand, the individual who allows himself or herself to be
110
oppressed by these emotions behaves in a manner that is considered

socially undesirable. By cutting off (hiwa) oneself from the social
body, one becomes contagious (nakakahawa), a potential cause of
illness to that social body. This would explain why emotions and
feelings are considered “contagious.” Among the Kalinga, there is
the belief that excessive despondency following the death of a loved
one can bring on another death in the family (Dozier 1966, 114).
The intricate relationships are also clearly based on close social
ties; thus, Ilongot mothers have lullabies that plead crying infants
to take pity because the tears, suggesting frustration, can reflect
illness to other members of the household (Rosaldo 1980, 64).
Returning to Tagalog terms, we can use linguistic analysis to
uncover the cultural norms to maintain emotional balance. To be
excessively emotional is to increase one’s susceptibility to illness.
Maramdamin in fact means both “emotional and easily aroused, as
well as sickly” (Zorc 1982, 114).
An understanding of susceptibility, including its physiological
basis, is also useful in understanding illnesses believed to have
been induced by sorcery or environmental spirits. Belief is itself
a powerful variable in determining susceptibility, as has been
documented for “voodoo deaths” (Cannon 1942, Lester 1972, Lex
1974), where fear itself may initiate changes in the sympathetic
nervous system, particularly the production of adrenalin, resulting
in shock and, eventually, death. We should not forget, too, that
it is also now fairly well established that stress does contribute
to susceptibility to “western” diseases such as cardiovascular
disorders, peptic ulcers, and possibly even infectious diseases
through complex interactions that include a weakening of the
body’s immunological system (cf. Martin 1987).
We therefore come full circle by linking two key concepts of
contagion and stress, both of which imply disruptions that lead to
vulnerability and susceptibility to illness. These disruptions may be
physical or social, and may be expressed through a variety of symbolic
systems with mystical, personalistic, or naturalistic themes.
111
Q
Chapter six
From Illness
to Health
6.1 The Sources of Illness
IN CHAPTERS 3 to 5, I used three major categories—mystical,

personalistic, and naturalistic—to explain traditional concepts of
illness in the Philippines. This division is an “outsider’s” viewpoint
in the sense that people do not consciously think and classify illness
theories in these terms. The divisions were made for purposes of
discussing illness, with an emphasis on how people perceive and
explain illness, particularly its sources rather than the methods by
which those illnesses are inflicted.
Mystical theories attribute illness to the automatic
consequence of the victim’s acts and behavior. Personalist theories
attribute illnesses to the active intervention of sensate agents such
as supernatural entities or malevolent human beings. Finally,
naturalistic theories attribute illnesses to impersonal natural forces
or conditions such as cold, heat, winds, or an imbalance of the
body’s elements.
Mystical Theories: Life-Stuff and Souls
Mystical theories embody the concept of basic forces believed

to be operational in illness and health, if not life itself. These
forces are the “life-stuff” and the “soul,” which are perceived in
contrasting dichotomies of good and evil, strong and weak. “Good”
is associated with health while “evil” is associated with illness. A
“strong” person can make a “weak” person ill, even inadvertently.
112
From Illness to Health
Filipinos recognize a “you-reap-what-you-sow” relationship

in the concept of immanent justice, where health and illness are
natural consequences of “good” and “evil” behavior, rather than
as rewards or punishments from a supernatural entity. Moreover,
the concept of contagion expresses this causal relationship: deviant
behavior separates a person’s soul from his or her body, as well as
that person from the social body. It is this separation that makes
the person contagious (nakakahawa), a potential source of illness.
Personalistic Theories: Ghosts, Gods, Witches, and Sorcerers
In personalistic theories, supernatural entities and human

beings are again ascribed with attributes of “good” and “evil.”
However, the power to cause illness is perceived not only in terms
of such attributes but also in terms of these entities’ relationships
to the human world and to society. Environmental spirits existing
in “this world” and spirits of deceased kin are more likely to cause
illness than a remote supreme deity. At the same time, while these
entities are almost part of the human world, they are considered
“different” because of their transformed state (disembodied spirits)
and are therefore perceived as carrying potential powers to cause
illness as well as health. Thus, the Ilokano refer to malevolent
beings as haan a tao (di-katatawan) or “not-humans” and the
Visayans refer to environmental spirits as dili ingon nato, the “not
like us.” These concepts are extended to human beings such as
sorcerers and witches, who are ascribed with powers to cause
illness and misfortune because they behave differently.
Naturalistic Theories: Winds, Food, Hot, and Cold
Naturalistic theories divide natural phenomena and food items

into categories, such as “hot” and “cold.” Corresponding attributes
are supposed to be found in human beings and it is the interaction
of the attributes in nature (and diet), with those in human beings,
113
that determines health and illness. As in Mesoamerica (Adams

and Rubel 1967, 343), the hot and cold attributes are permanent
qualities of things, but are temporary or changing qualities of
human beings.
Health is closely associated with the notion of balance and
equilibrium, not only of hot and cold elements, but also in the
sense of anatomical organs being in the right position, or blood
being either too thick or too thin, or even in having “balanced”
emotions. The notion of hiyang or compatibility in relation to
foods and drugs was also discussed. Finally, we see how concepts
of stress and susceptibility interface with notions of balance, of
what is “natural” and “unnatural.”
Integrating the Theories: Inner and Outer Conditions
Adams’ (1953) differentiation of “inner” and “outer” conditions

in traditional theories of health and illness remains useful as a way
of integrating the discussions in this book. The “inner” condition
refers to situations that make an individual susceptible to illness
while the outer condition refers to “the thing” that takes advantage
of this susceptibility.
In Filipino theories of illness causation, we find that the
outer condition is the configuration of natural phenomena, diet,
supernatural entities, and “germs,” which may cause illness when
the individual is susceptible. There are local concepts that relate to
vulnerability, of people being sipunin (prone to sipon, or colds) or
of being sakitin (prone to sakit or illness). There is even a concept
of some women being buntisin (prone to becoming buntis, or
pregnant).
The usog case study shows how fatigue creates susceptibility,
aggravated by social demands. The notions of an inner condition
or susceptibility is sometimes linked to innate qualities that may be
described in a kind of folk genetics (nasa lahi) or in more mystical
but essentialist terms (mahina talaga siya). Susceptibilities are
114
perceived to apply to external changes as well, in conformity with

events in the individual’s life, actions, emotions, and ultimately,
social behavior.
Marshall (2001) reexamined bughat (binat in Tagalog) in
Negros Occidental and noted how this “relapse” was attributed to
a combination of different factors: physical and emotional stress,
the entry of hangin into the body, and the nonobservance of food
taboos, as well as rituals like the padungan.
Prescriptions and prohibitions come together to cause
illness but ultimately, people look at loob, which is sometimes
essentialized, represented as an innate quality that is described in
a kind of folk genetics (nasa lahi). On the other hand, there is still
a sense of agency, of people being able to do something, as when
patients are advised to muster loob: “Tibayan ang loob” (strengthen
the inner self).
6.2 Different Ways of Looking at Theories of Health and Illness
EARLIER ETHNOGRAPHIC OR anthropological accounts

sometimes encouraged exoticism by providing an enumeration of
quaint beliefs and practices. Sometimes, this exoticism reinforced
the biases we have about popular or folk cultures, e.g., that people
are resistant to change, clinging to irrational “superstitions.”
In this book I have tried to explain that traditional medical
beliefs are not limited to beliefs in the supernatural or to notions
of hot and cold. I have explained how profound some of these
concepts can be, often reflecting values and norms, ethics, and
morality.
If health care is to improve in the country, we need to continue
our dialogues with popular culture, trying to understand not just
what the beliefs and practices are out there, but also why they come
about. I will reiterate what I suggested in the first chapter, and this
is to think of local knowledge, rather than “beliefs,” which tend to
115
suggest the irrational. There are reasons why there are differences
in the way people look at health and illness and a good clinician,
like a good ethnographer, learns to understand why.
I mentioned several lenses from social sciences that we could
use to look at popular medicine, and will review them here.
Phenomenology and Meanings
One lens that can be used to look at health and medicine is

that of phenomenology, a study of meanings. This whole book has
in fact emphasized the way our concepts of health and illness are
so laden with meanings.
We experience the world and society through our bodies, so
perceptions about and meanings attached to the body itself are
important. I have discussed the importance of looking at folk
anatomy and physiology in an earlier chapter. Another example is
worth mentioning here: Nichter and Nichter (1994) observe that
accumulated phlegm is seen as dangerous by Filipinos, a belief
which helps to spur sales for mucolytic preparations, even if these
are inessential.
The body also generates many useful social metaphors, becoming
a source of symbols, a semantic reference point for the description
of emotional states, as well as social structures. Languages in the
Philippines have many of these social metaphors.
Words and meanings are important. In 2006, the Department
of Health launched a safe motherhood campaign called “Ligtas
Buntis,” to mean “safe pregnancy.” Catholic conservatives saw it
in a different light, as “safe from pregnancy” and asked if perhaps
pregnancy had been made a disease. The Department of Health did
have a project before called “Ligtas Tigdas,” safe from measles. The
controversy raged for several weeks and undoubtedly affected the
effectiveness of the campaign.
In my research on pharmaceuticals (Tan 1999), I described
the many nuances around words like “drug,” “medicine,” and
116
gamot. “Drugs,” for example, is associated with bawal na gamot

or forbidden medicines sold in the streets, while a tranquillizer
like diazepam (Valium), because it is available from drugstores,
is not seen as “bawal na gamot” and therefore not as potentially
addicting.
Social Interactionism
The focus of social interactionism is discourse, the social

exchanges in conversations as well as in mass media and
advertising. Social interactionism looks at how beliefs and practices
are validated, challenged, subverted.
Think, for example, of those ads around “haplos ng ina,” the
mother’s touch, applying something like Vicks Vaporub. Until
recently, it was almost impossible to think of a “haplos ni tatay”; yet,
given how many families now have a mother working overseas, the
drug companies have seen it fit as well to bring in male figures in
their advertisements, providing medicines that a child needs. We
haven’t quite arrived at a father giving a therapeutic touch through
“haplos,” but I suspect it is not a long way off.
Throughout the book I have described how people tend to
use labels for a process that’s called “othering,” describing people
different from ourselves, usually with connotations of deviation
from social norms. I mentioned Pertierra’s (1983) observation
about the aswang belief being absent in the Ilokano areas, where
strong women are appreciated rather than feared as aswang. For
years after Pertierra’s book came out, I would ask my university
students from the Ilokano provinces if they had aswang in their
towns and they always answered “no.” One common, and amusing,
explanation is that the Ilokanos grow abundant bawang (garlic),
which is believed to be an effective “witch-repellent.” Several years
ago, though, one of my students did say that in her town in Ilocos
Sur, there was someone who was “suspected” of being an aswang
but she was a woman merchant who migrated into their town from
117
the Visayas. This case shows how an outsider is more vulnerable

to being labeled as an aswang, particularly because she is a woman
and a merchant.
Traditional concepts have a way of lingering, of being recycled.
One of my physician students described, in 2003, a town in Samar,
one of the most impoverished provinces in the country, where
residents talked of a “hidden” or “mysterious” city. Residents
described the place as having people that look like us but, in
contrast to their own impoverished town, this mystery city was
said to be affluent with paved highways and hospitals and schools
and gas stations and shopping malls. In other words, the mystery
city has everything the impoverished town does not have. The
belief in the mystery city has spread to an adjoining town, which
says they too have such a parallel city, a kind of suburb, they say,
of the bigger and original mystery city. It too, has all the trappings
of modernization.
The residents know where this mystery city is, pointing to a
plot of vacant grassland. There is nothing there, on the surface
at least, but when residents pass through, they either fall silent,
or begin to engage in nervous banter and laughter. The residents
say there have been people, of our kind, who have gone off to the
mystery city, but have never returned. But those who disappear are
said to occasionally send letters which eventually find their way
into the real world.
The case of the mystery city reflects the way wealth is desired
and feared, much like the engkanto. The metaphors are clear: a
desire for wealth is dangerous, and if one is seduced, salvation
comes only by returning home, if one can.
Soul loss and bangungot (nightmare syndrome) are metaphors
for the loss of control over self while engkantado illness is, literally,
becoming “enchanted” either by unattainable wealth and power,
or by a colonizing power. Likewise, the more introverted villager is
tagged as an aswang in a society that emphasizes interdependence
and constant social interaction.
118
Even beliefs in soul loss should be understood in a wider

context of social relationships, particularly the close family ties
which extend into the realm of mystical “contagion.” Eggan and
Scott (1963, 45-46) describe the following for the Sagada Bontoc:
Its [the child’s] soul goes about with the parents, often even
if the infant remains in the house. When the new father goes for
wood, he carries a small piece home as a “load” for the baby to
be sure that the latter’s soul returns with him. The new mother
may not bathe in the river for fear that the baby’s soul might
wash away. When the child gets sick, it is believed that its soul
has been left out on the mountain; the father or mother takes the
baby blanket and calls the child to come home.
We have seen how illnesses are recognized as disruptions

or imbalance in the ecosystem as well as in societies. It is not
surprising the illnesses are seen as major social crises, often
requiring communal interventions, whether through religious
rituals or through concerted community action.
Social interactionist perspectives also look at how our concepts
of health and illness reflect the way a society attempts to keep itself
functioning. It is not surprising that illness, as a disruption, is
similar to notions of social sin. An example is the almost universal
incest taboo, the violation of which is perceived as a cause for social
as well as natural disasters, including illness. Thus, an exploitative
relationship is also seen as a potential cause of illness. The Pinatubo
Negrito belief about someone who damages a neighbor’s property
as being the cause of illness to that neighbor is a good example of
this indigenous concept of social sin and its pathogenicity.
As Douglas (1966, 50-51) points out, biblical terms translated
into “perverse” are actually inaccurate renditions of the rare
Hebrew word tebhel, which means mixing or confusion. Leviticus
has several passages on such “perversions”: bestiality (“And you
shall not lie with any beast and defile yourself with it …) as well
as a “mixing” of categories mentioned in chapter 5. Douglas
119
analyzes the concept of sin—whether in lying, cheating, hatred—

as “contradictions between what seems and what is.”
The concept of hiyang, which was introduced in the last
chapter, is also important in the way it provides a reference point of
what “fits.” A close analogy is the Javanese tjotjog, comprehensively
described by Geertz (1960, 31):
Tjotjog means ‘to fit’, as a key does in a lock, as an efficacious

medicine does a disease … If your opinion agrees with mine, it
is tjotjog, if the meaning of my name fits my character (and if
it brings me luck), it is said to be tjotjog. Tasty food, correct
theories, good manners, comfortable surroundings, gratifying
outcomes are all tjogjog. In the broadest and most abstract sense,
two items tjotjog when their coincidence forms an aesthetic
pattern.
Hiyang and tjotjog have social contexts. An urban poor

woman putting on weight because of a contraceptive is said to
be hiyang to that particular brand of pill. It does not matter that
the weight gain is actually a side effect, from the perspective of
a pharmacologist. To be complimented on the weight gain, via
hiyang, reinforces notions about the ideal body weight. This is what
social interactionism is all about, and what health professionals
need to consider when dealing with patients’ reinterpretation of
medicines and medicine.
Political Economy
Political economy refers to the way resources are allocated in

a society, and includes looking at the power relations that affect
those allocations. Power differentials—whether caused by class,
gender, ethnicity—affect health, including the cultural aspects.
Medicine is ideological in the way it contributes to “defining
(or obscuring) social categories, stabilizing (or upsetting) social
120
expectations, maintaining (or undermining) social norms,

strengthening (or exacerbating) social tensions” (Geertz 1964,
53).
Rodriguez (1985), researching on usog in Calawis, Antipolo,
documents how social relationships are perceived to shape
susceptibility to usog, noting, for example, that a Bikolana warned
her about the “Bisaya” having strong usog, while one “Bisaya”
pointed to non-Visayans as causing usog, even insinuating they
were aswang.
The gender dimension of medicine is also illustrated in a
report from Alejandrino (1986), who documented how a village
in Ilocos Sur responded to a “mystery disease” which was later
identified as capillariasis. All of the patients had been male, which
led the village to first attribute it to the village men’s cutting down
of bamboo along the river and offending a sirena (supernatural
spirits, similar to the mermaid in western mythology). Later, the
village residents said the men were being punished because they
were quarrelsome and were drinking too much, and not observing
many religious rituals. Others observed that many of the inmates
in their town prison were from this particular village.
It was the women who eventually had to make amends,
offering eggs and rice and performing religious rituals in the local
Catholic church, while resorting to traditional rituals of sacrificing
a chicken and sprinkling its blood along the bamboo grove where
the sirena were believed to live. A medical team eventually arrived
and treated residents, but the ailment is still referred to as Pudoc
disease, after the village where it had inflicted the men folk.
The dominant classes have always had their own cognitive
systems to explain what they perceive as the inferiority of the
dominated. In the eighteenth century, San Antonio (1977[1738],
139) attributed “differences in the features of the body among
nations as well as those in character, skills and customs” to
“variations in the temperaments of the regions where they live and
the variations of air, water and food.”
121
In more recent history, the amok and the juramentado labels

were used to suggest an intrinsic predisposition to violence among
Malays (for amok) and Muslims (for juramentado). Yap (1952,
518) attacks the “sterile belief in innate racial psychological traits,”
citing the works of a Dutch psychiatrist (Van Loon 1927) who
analyzed the Malayan latah syndrome as “a psychosis of the Malay
races, rooted in the oriental psyche” and so-called “protopathic-
instinctive phenomena” in Malay behavior.
The “disease” label of juramentado is a corruption of the
Spanish juramentar, “to take an oath.” Muslims who supposedly
run “amok” actually go through a ritual prior to attacking
Christian “infidels” (cf. Ewing 1955). The terms have been taken
out of their cultural contexts and are used today in the popular
press to refer to violent outbursts of anger, sometimes leading to
murder. With the rise of suicide terrorism (a term that is itself
ideologically loaded), it will be useful to look at juramentado.
Andriolo (2002) uses anthropology to analyze such cases,
including juramentado.
Often, diseases are used to draw social boundaries. A
contemporary example would be Acquired Immune Deficiency
Syndrome (AIDS), the fear of which has been used against blacks,
homosexuals, and prostitutes, labelled as “high-risk groups”
when in fact the problem is certain forms of high-risk behavior
not limited to sex. Sontag (1977, 6) points out that any disease
that is treated as a mystery inevitably takes on moral dimensions,
including qualities of contagion. Sontag wrote in particular about
cancer: “Cancer patients are lied to, not just because the disease
is (or is thought to be) a death sentence, but because it is felt
to be obscene—in the original meaning of that word: ill-omened,
abominable, repugnant to the senses.” When the AIDS epidemic
broke out, she again wrote on how illness can generate metaphors.
The two books were published together in one volume and the first
page, from her 1977 work on illnesses in general, still resonated
with an important message: “Illness is not a metaphor …” and that
122
the “healthiest way of being ill … is one most purified of, most
resistant to, metaphorical thinking.”
But metaphorical thinking is inevitable, amplified by the
mystification of illnesses, diseases. The inaccessibility to health
care for many Filipinos complicates the situation—for what cannot
be cured will be given ambiguous labels such as pilay and pasma,
or are vested with magical or religious explanations.
We tend to attribute misconceptions about health and illness
to traditional practitioners such as the albolaryo or hilot. But even
more powerful are “modern” institutions such as the drug industry,
or even health professionals themselves in the production of new
myths around miracle medicines (Hardon 1991, Tan 1999).
In recent years, the AIDS epidemic has also brought about
renewed interest in the structural issues around health. Examples
are the works of a physician-anthropologist, Paul Farmer (1993,
2001) writing on AIDS and tuberculosis in Haiti and Beyrer
(1998) on AIDS in southeast Asia. The title of Farmer’s latest
book, published in 2004, dramatically summarizes what a political
economy of health needs to look at: the pathologies of power.
Cultural Ecology
This view looks at culture—including our concepts and

practices around health and illness—as adaptations to the challenges
posed to us by the natural environment. For example, in a country
where respiratory ailments are so widespread, we develop many
classification systems and explanations around coughs, each with its
own suggested therapeutic course. This will range from cough syrups
(many of which are actually quite useless, but are heavily promoted
through advertising) to looking up a hilot to get rid of pilay.
Cultural ecology looks at beliefs and practices as being adaptive.
For health professionals, this means an open mind as to why the
practices emerged in the first place, and what empirical basis might
be present in culture. For example, the many prescriptions and
123
prohibitions around infancy suggest that people recognize the

precarious nature of the first year of life, and therefore this period
is surrounded by all kinds of fears and anxieties about illness,
accompanied by all kinds of suggestions on what can be done:
from bracelets to ward off usog to the use of the bigkis (abdominal
binder) to prevent hangin from entering the abdomen.
These concepts are well captured in a description from Jocano
(1973) of pulse-taking as a diagnostic method:
Life is conceived by the people as a theme in harmony and the

pulse is its outer manifestation. Informants compare the hands
to a guitar and the veins running through them to the cords or
strings. The wrist is compared to the fingerboard of the guitar,
and the pulse forms the frets which set the scale and tune of
harmony in life. Whether or not the individual is attuned to the
rhythm of life and to the regularity of the surrounding world is
known through the pulse. People believe that the pulse links the
inner self of man with the outer conditions of his life. Anything
which tends to interfere with this flow of harmony upsets the
pulsebeat. (Jocano 1973, 115)
In many ways, traditional concepts of health and illness are

folk versions of cultural ecology with recognition of their ecological
relationships and ecosystems. McElroy and Townsend (2003,
30) explains: “The immediate, clinically detectable stimulus for
disease may be a virus, vitamin deficiency, or intestinal parasite,
but disease itself is ultimately due to a chain of factors related to
ecosystemic imbalances.”
6.3 A Social Epidemiology
QUITE OFTEN, IT is necessary to use different perspectives to

analyze popular medical culture. For example, there is widespread
resistance to tuberculosis drugs in the Philippines, and this may be
124
rooted in a chaotic mixing of meanings. The term mahina na baga

(weak lungs) is used widely in the Philippines as a euphemism
for tuberculosis. This came about because the disease is heavily
stigmatized, so doctors had to find a way to tell mothers about
their child’s infection. “Weak lungs” seemed a logical choice, but
using the term reinforces misconceptions about tuberculosis as a
passing childhood illness, which can be cured with bitamina para
sa baga or vitamins for the lungs. It is not surprising mothers end
up giving their children antituberculosis drugs like isoniazid for
several years.
A recently published book by Charles MacDonald (2007)
shows the value of using different theoretical perspectives and
methodologies from the social sciences to look at health and
illness. In MacDonald’s book, the focus of the research is the high
suicide rate in one community.
MacDonald uses the term “Kulbi people” to refer to his study
community, which is a subgroup of the indigenous Palawano.
Using a careful study of cohorts, MacDonald calculates the suicide
rate for the Kulbi to be 136 per 100,000 between 1990 and 2000,
and 173 between 1990 and 2001, which are staggering compared
to the national rate of only 1.8 per 100,000 people.
MacDonald collected information on the reported causes of 87
suicides and grouped them into “melancholy suicides” (common
among older people), “gender relations suicides,” “passionate and
angry suicides,” “multiple suicides out of grief” (a chain of suicides
or cluster suicides) and “impulsive suicides of teenagers.”
MacDonald tested different explanations for suicide by
probing deeply into Kulbi society and culture. He leaves no stone
unturned, looking into everything from the natural environment
to kinship and politics, from concepts of “personhood, emotions
and moral values” to religion.
Each chapter in MacDonald’s book seemed to provide the
answers to the suicide riddle, only to be challenged by MacDonald
himself. For example, as MacDonald describes the Kulbi’s great
125
sense of autonomy, and the lack of hierarchial structures, one

is tempted to think that maybe they’re similar to many western
societies where individuals are left on their own to decide. Yet,
MacDonald links this autonomy to the Kulbi’s overwhelming fear
of society, an unwillingness to confront critics or judges. A 13-
year-old boy, for example, had caught his grandmother’s chicken
in a snare. His siblings said his grandmother would hang him for
the misdeed. The boy ended up hanging himself.
At the end of his suicide “profiles,” MacDonald noted that a
common denominator to the suicides was pain or stress, whether,
physical, mental, or emotional. “The suicide,” MacDonald
proposes, “wants to stop hurting.” But MacDonald went on to
exhaust all possibilities, including looking into the angle that the
Kulbis might have a “melancholic” cultural personality. He also
looked to other studies conducted among small groups, looking
for possible correlations with the predisposition to suicide, from
the presence of organized violence to a belief in vengeful souls.
In the end, after excluding different theories, he suggests a
wave theory, meaning at some point in the past, some catastrophic
event such as an epidemic may have spurred a surge of suicides
and that with time, suicide then became somewhat acceptable.
MacDonald admits it is difficult to prove that wave theory,
but it does give food for thought, maybe even a warning. In more
urbanized and industrial areas throughout the world, including
Metro Manila, we do occasionally find cluster suicides—one
suicide setting off another. Japan has been facing the problem of
group suicides involving younger people who meet and eventually
reach a suicide “pact” through the Internet.
MacDonald’s work is an example of how the social sciences
can contribute to public health, in this case, to suicide prevention.
So many characteristics of Kulbi society—individualism amid
continuing fear of authority—are in fact found throughout
the Philippines. MacDonald’s study raises questions about the
vulnerability of small communities like the Kulbi. Is it possible that
126
they might reach a critical “tipping point” more easily? Or could a

small community act faster to prevent suicides from becoming an
acceptable norm? Given, too, that we now live in a world where
isolation is almost impossible, does the outside world (in the Kulbi
case, the Philippine mainstream) have any impact on the Kulbi,
reversing or reinforcing the current suicide trend?
Beyond suicide, however, MacDonald’s study also challenges
our ideas about culture. We tend to presume culture is shared
and that people happily adhere to the norms. MacDonald’s study
shows that culture is much more complex, that even with a kind of
national norm like what we have for suicide, the Catholic concept
of suicide as a mortal sin, there can be significant exceptions. In
the Kulbi case, what passes as deviance from a national norm
is in fact the small-group norm. As MacDonald’s book shows,
understanding the “uncultural” provides the key to unlocking the
many mysteries of “culture.”
6.4 Integrating the “Traditional” and the “Modern”
TALK ABOUT INTEGRATING traditional and modern medicine

has become almost a cliché. “Integration” is not easy to achieve,
and must start with using the different lenses I mentioned earlier
to reexamine popular beliefs and practices.
In 1998, the Institute for Science and Mathematics Education
Development at the University of the Philippines published a book
called “Philippine Folk Science,” providing a second look at many
folk beliefs and looking at the “scientific” rationale behind many
of these beliefs. The book included a section on folk medicine,
and provides a model for future practical research to guide health
professionals as they deal with popular medical beliefs.
Palaganas (2001) provides another model with the book
Mainstreaming Indigenous Health Knowledge and Practices,
cataloguing various aspects of health culture in the Cordillera and
127
offering concrete suggestions on how traditional medicine might

be tapped by government and nongovernment groups.
We do need to be careful about avoiding the trap of over-
simplifying traditional medicine. Bangungot provides us with
a particularly difficult challenge of exhausting all possible
explanations. The syndrome continues to confound us with
medical researchers suggesting that it may be pancreatitis, or
nutritional deficiencies, or congenital defects in the heart. It
could of course be all these different causes, converging into this
culturally constructed concept of bangungot.
We have to guard against relegating the unexplainable to the
realm of psychiatry or “psychosomatic” medicine, an unfortunate
legacy of dichotomizing mind and body. Ominous feelings
and premonitions of illness and death, for instance, cannot be
discounted simply as psychological events; rather, they reflect the
intimate relationships that exist among human beings in their social
and natural environment. Tales of premonitions during funeral
wakes may be dismissed as after-the-fact, but they do reinforce the
close kinship ties that characterize our society. In the same way,
feelings of “coldness” and “dampness” are clearly drawn from our
experiences with nature and would of course be more vivid among
people in rural areas.
Even rituals should not be seen as mechanical repetitions of
old traditions. Rituals are in fact techniques embedded in society.
In chapters two and four, I discussed the mutya or charms. These
have different uses in different social contexts—they may be used
beneficially as in hunting or they may be used in sorcery, although
this is socially proscribed. Even the “potency” of the mutya is also
socially determined—Fox (1982, 183) describes the correlation
between social status and ritual power among the Tagbanuwa,
where the “high bloods” (ginu u) are perceived as having more
powerful mutya than the “low bloods” (timawa).
Beliefs do not exist in isolation; rather, we deal with a cognitive
complexes, different elements which need to be analyzed in the
128
way they come together. To use an example, we can examine the

belief among the Tagbanuwa that a house should be abandoned if
wild pigs run under it because these animals, being “wild,” should
not normally come to where people live (Fox 1982, 206). The
ideological aspect has been mentioned earlier—that of keeping
things as it ought to be. At the same time, note that there is an
extended interpretation among the Tagbanuwa, that the wild pigs
are sent as a “sign” (pamanya) by ancestral spirits of impending
illness, or even death, within the family. Several components can
be identified in this illness theory, including beliefs about “what
fits” as well as that of omens and the protective role of ancestral
spirits. As Fox (1982, 160) observes, Tagbanuwa society has a
well-developed kinship structure which is manifested in many of
their beliefs and practices.
Using a more recent example, Espino et al (1997) report
that people’s perceptions about the causes of malaria are mixed,
including the idea that one ingests the larvae of malaria-causing
mosquitoes through dirty water. Diet and hunger are also named
as causes of malaria. Perceived causes of illness often reflect other
pressing concerns people have, such as the lack of access to safe
water, sanitation, food.
Consider, too, the multiple levels of causation that operate in
illness theories. Hart (1979, 76) described epilepsy (buntag) in a
Samar barrio as being attributed to poor blood circulation, heredity,
environmental spirits, or sorcery. Insanity is attributed to failure
to care for oneself during menstruation, environmental spirits,
St. Anthony, or inheritance. Tuberculosis is described as a typical
ailment of a tabardillo, a person who misses meals, eats irregularly,
or neglects a cold. Tuberculosis may also be inherited. Finally, a
person is believed to be predisposed to asthma if, as a newborn child,
phlegm is not removed from the lungs. Such infants will always
have colds and cough, which eventually develop into asthma.
It is clear, too, that illness is perceived as a condition which
results from a conjunction of many factors in time and in space.
129
Himes’ (1971, 28) study of Tagalog concepts of illness causation

leads him to conclude that:
“Low resistance” in the West is caused by lack of sleep,

improper or irregular eating habits, excessive use of alcoholic
beverages, and the like. The Westerner, it appears to me, is as
much predisposed to illness under these conditions as is the
Filipino to those singled out as disease causes: hunger plus getting
rained on, fatigue plus exposure to dew, just having awakened
plus getting wet, and so on. The difference between the two is
one of emphasis and not one of kind … The Filipino emphasizes
not the germs plus low resistance but rather the correct timing
(tiyempo-tiyempo) of the two most important elements in the
development of low resistance—internal predisposition and
external mitigating circumstances.
Heggenhougen (1980, 239) puts it more succinctly when he

observes that “most Malaysians are quite cognizant of the germ
theory of disease, but understanding ‘how’ an illness occurs still
does not explain ‘why’ this illness should happen to this particular
person at this particular time.”
It is not enough to recognize that there are differences
between “traditional” and “western” medical systems. We have to
understand and present a critique of the social formation in which
such paradigms are shaped without presuming that one group is
more “primitive” than the other.
6.5 Biomedical Validation?
INEVITABLY, AS WE discuss the possibilities of integrating

traditional and “modern” medicine, people will ask about the
possibilities of biomedical validation. Bangungot is an example
where numerous biomedical studies have been conducted, with
explanations ranging from pancreatitis to nutritional deficiencies
to congenital anatomical defects.
130
Another more recent example comes with pasma. Physicians

will sometimes focus on the tremors and try to explain it as a
neurological condition while others will use endocrinology, saying
it might be a thyroid problem.
In 2007, the department of physiology at the University of the
Philippines’ (UP) College of Medicine supervised a group of medical
students to compare laundrywomen with and without pasma
complaints. The women went through a battery of tests including
blood pressure, body mass index, blood chemistry (fasting blood
sugar), and various neurological tests. The choice of the tests
was based on the most common complaints that people associate
with pasma. Since the complaints are often neurological, such as
the hand tremors, the students looked for possible problems with
different parts of the nervous system, testing the women for their
sensitivity to light touch, pain, temperature, vibration, and position
sense. They also tested the women’s reflexes, nerve conduction, and
muscular strength, as well as the autonomous nervous system (i.e.,
blood pressure, respiration).
Because pasma’s symptoms are also found in people with diabetes
mellitus and thyroid dysfunction, the researchers tested the women
for fasting blood sugar and thyroid function. Recognizing that
perhaps pasma might be an occupational problem, they probed into
the women’s total years of work and hours spent ironing in a week
and reviewed some of the women’s medical history and activities
that might put them at risk for illness, for example, smoking.
For nearly all the tests they conducted, including body mass
index, menopause, and smoking history, the researchers could
not find significant differences between women with and without
pasma. The researchers even looked for possible signs of carpal
tunnel syndrome, which is common in people whose work involves
constant pressure on the median nerve on the wrist but found no
difference between the two groups.
The team did find that women without pasma, when subjected
to tests like hand grips and cold pressor tests, were able to return to
131
their regular blood pressure levels more quickly than women who
complained about pasma. This small detail alerted researchers to
the possibility that women with pasma may be more vulnerable to
the “cumulative effect of stressors” than those without. That finding
seemed to complement one aspect of the women’s histories: on
average, women complaining of pasma had more jobs and longer
hours of work, not in terms of laundry but of ironing. Perhaps then,
women with pasma do go through more stress, and may take longer
to recover from those stressors, as shown by the findings around
high blood pressure.
After I read the UP report (Evangelista, Vios, and Buenaluz
2007), I looked up a term paper submitted by another one of my
students in a medical anthropology class many years ago. The
student was Rogelio de la Cruz, a physician, and what he did was
to hold a group discussion involving four of his family’s household
help: a laundrywoman, a cook, a plantsadora (an ironing woman),
and someone who handled the cleaning. He asked them to define
pasma and discuss its causes, signs and symptoms, treatment,
prevention, and complications. The answers were quite diverse for
each of the discussions except for complications: all four helpers
agreed pasma led to varicose veins, indicating how pasma is seen as
an affliction of “ugat,” the veins.
The helpers also agreed about the mixing of hot and cold as the
cause of pasma, about symptoms like sweaty palms (and soles) and
tremors. Treatment was more varied: coconut oil, alcohol, and that
notorious remedy, urine. Prevention methods also had a pattern:
resting the body before getting it wet, especially if with cold water.
Even a small group of four people, in a focus group discussion,
can be useful. De la Cruz, who had a philosophy degree before
entering medicine, offered many reflections coming from the focus
group discussion. He was intrigued, for example, by how the illness
always involves a hot body’s exposure to cold rather than the other
way around, to which the laundrywoman replied: going from cold
to hot is natural, as in a person that has slept and rested, now in a
132
cold condition, then going to work and getting “hot.” That would
be a “natural” process and does not cause illness. The other way
around though, moving abruptly from “hot” to “cold” isn’t right,
and therefore produces illness.
But de la Cruz eventually zeroed in on the attributed causes,
noting how it is not washing or ironing per se, but sobrang
paggawa and sobrang pagod, too much work or fatigue, that is seen
as leading to pasma. Again, there is some kind of baseline of what
might be normal in terms of work or tiredness, which could vary
with individuals. Some might be able to take more than others, but
their referent would be their own capacities, and a perceived excess
will be blamed for illness.
The UP researchers noted that women with pasma, when taking
particular tests, would have higher blood pressure than the women
without pasma. Not only that, it took longer for their blood pressure
to return to normal. We see two possible explanations here. One is
that the women with pasma may already have been under greater
stress or what the researchers call “cumulative effects of stressors.”
They had, after all, found that the women with pasma had longer
work hours. There is an objective reality here of overworking.
But a second possibility is that women with pasma might
generally react more strongly to stressors, setting off other
physiological changes that lead to the tremors and the sweating.
That will have to be established through future research.
Meantime though, we see the importance of a phenomenological
approach, of looking into people’s experiences and their
constructions of what is “natural” and “unnatural,” and how much
of the “unnatural” one can take. People then express what they
think is “unnatural” in terms of sobrang pagod and sobrang trabaho.
There is an interface between biology and culture, of patients feeling
malaise, which they then express as pasma, the hot/cold interactions
becoming more symbolic to dramatize the “unnatural.”
Health professionals might dismiss all this as somatization,
but it is quite a dramatic somatization when you think of how the
133
autonomic nervous system is affected, with changes in blood pressure,

and the tremors. The challenge then, with biomedical validation, is
to bring together the measurable conditions and changes with the
world of symbols and meanings that people have, and to understand
the social context in which all this is created and recreated.
I would even propose that an openness to traditional and folk
medicine might even help to change concepts in “modern” medicine.
Several years ago the Dalai Lama began to work with neurologists
to look into Buddhist meditation, using the technologies of modern
medicine. Many of the findings have helped medical scientists to
debunk older ideas about the nervous system being rigid, and of
damage being irreversible. The findings around meditation support
the idea of neuroplasticity, of a nervous system that can be “exercised”
and can be “repaired.” These findings have implications for many
areas of medicine, from rehabilitation of patients with damaged
nervous systems, to the prevention of senility, maybe even Alzheimer’s
disease. Reading the reports around the research on meditation
(Begley 2007) has led me to wonder, too, if our research on pasma
might eventually yield new knowledge around the area of neurology,
of muscular function, and of immunity itself. In the same way that
we deconstruct traditional medicine, we might want to do something
similar with western medicine, challenging existing concepts around
resistance and vulnerability, susceptibility, and immunity.
6.6 Beliefs as Practices
LIKE MANY ILLNESSES, pasma can function as an idiom of distress,

a way for people to say they are overworked, that they need to be
excused from work. Even children learn, early enough, to play this
“sick role,” using a stomach ache as an excuse to stay home.
While we encounter the sick role all too often—with the
medical professions even adopting terms like “malingering” and
Munchausen’s syndrome—we often fail to recognize the importance
134
of the underlying idioms of distress. Whittaker (2000), who

looked into women’s health in Thailand, uses the term “hidden
transcripts” (borrowed in turn from Scott 1987, 1992) to explain
that these idioms often reflect a social relationship between a
dominant class and the dominated, or even exploited. Unable to
tell their employers that they are overworked, a laundrywoman
will invoke pasma with its hidden transcript. Even a child may
use these hidden transcripts because they feel they are unable to
bargain with their parents.
I would, however, warn against too quick a dismissal of
pasma and other illnesses invoked in a sick role as imaginary and
fabricated. Culture is laden with symbolism, but symbolism is
not all in the abstract. Metaphors fall back on realities, a way of
representation, as well as explanation.
As medical anthropology develops in the Philippines, we will
find that the distinction between “beliefs” and “practices” is often
artificial. In popular medical culture, the metaphors allow people
to express their concerns about the human condition, even as their
symbolism is acted out. A good example comes from among the
Western Bukidnon Manobo who say that adultery can lead to meliit,
an epidemic. To prevent this epidemic, certain rituals are needed,
involving blood of animals. As explained by Polenda (1989, 35):
“Figuratively speaking, the village has had trash thrown in it and
become filthy through the sin of adultery, and so it is necessary to
provide blood to “sweep away the trash” and like water, wash away
the filthy of the wicked happening so that it might not happen
again, because the sacrifice makes an end of the matter.
It is not enough to prevent an epidemic. Recognizing that people
have been hurt in the process, there are prescribed reparations
in the form of gifts called layag, bagkes, and pekurab that must
be given to the offended husband. The terms are metaphorical,
yet they involve actual objects. Layag means “to sail,” needed to
restore him to a “happy state” after the grief done to him. Sailing
is also a figurative representation of a person’s journey through
135
life, without having to die prematurely. Another gift is bagkes, to

tie up in a bundle, to represent the need to bind his life after it has
been shattered by his wife’s misbehavior. Finally a pekurab gift is
needed, the action of a ritual performed to call the soul of a sick or
grieving person to return to the body, based on the belief that the
evil done to him has hurt his soul so badly it has departed.
In the last two decades, research on pharmaceuticals and
culture have shown, too, how artificial the distinction is between
“beliefs” and “practice.” Van der Geest and Hardon (1996, 154)
explain:
Medicines are tangible, usable in a concrete way. They can

be swallowed, smeared on the skin, or inserted into orifices—
substances that hold the promise of a physical effect. By
applying a “thing,” we can transform the state of dysphoria into
something concrete, into some thing to which the patient and
others can address their efforts …
Medicines, as “beliefs” and as “practices” are central in

popular medicine, and can overlap with other aspects of people’s
lives. Fox (1982, 203-4) observes that the Tagbanuwa do not dis-
tinguish between “magical” and “natural” usages of “medicines”
(uba-ubat). Plants which are used to heal, as well as plants used as
natural pesticides are referred to by the same term, uba-ubat (also
see Sodusta 1983, 146-50 for traditional pest control methods
which incorporate magical rituals). This helps us to understand
why synthetic pesticides have also gone through “semantic
transformation” in Philippine society—in the 1960s, these were
referred to as lason (poison) but today, they are called gamot
(medicine) in many areas, reflecting an alarming change in the
perceptions of these chemicals following its massive promotion
as part of the Green Revolution. Today, health groups tackling
problems of pesticides need to be conscious about insisting on
using the word lason or poison to describe the pesticides. Words
are keys, bridging “beliefs” and “practices.”
136
6.7 Cultural Politics of Medicine
PUBLIC HEALTH PROBLEMS are often attributed to “ignorance”

and a “lack of knowledge” among people (read: the poor) and
the solutions are couched in the language of “behavior change.”
Corollary to this is the talk about the need for “values change”
in society, often a way to camouflage more conservative thinking
that attributes problems to “lack of values” among the masses. Too
little is said about how we might want to look at the values that do
exist, and to question the conservative interpretations that have
been proposed. Questions about the bahala na attitude have been
raised earlier, and how this is used for further victim-blaming.
In this section, I would like to tackle the broader issue of an
assumed passivity in our culture. If that passivity does exist (and
certainly it can be found even in the grammatical structure of our
language), can its roots be found in our history?
A tentative hypothesis that could be offered here is that
in the context of precolonial society, the strong emphasis on
communalism encouraged not passivity itself but accommodation,
as was cited in the case of the Buhid Mangyan, where the “correct”
response to aggression was withdrawal. In a sense, it is similar to
what Koyama (1974, 115) has described as “vicarious suffering,”
which in Japanese is tsurasa, to experience a painful inner dilemma
caused by one’s concern for others, where pain is kept within
oneself for the sake of the happiness of the other.
Such a perspective could have been transformed, during the
colonial era, to the advantage of the dominant classes, where
this norm becomes submissiveness and resignation in the faces
of forces that are perceived to be superior. Feudal relationships
were therefore reinforced through such “norms,” and continue to
be powerful forces that obstruct change in contemporary society.
Fox (1982, 184) describes the fear of Tagbanuwa “commoners”
over speaking harshly or quarreling with village leaders because
these leaders are “naturally” vested with sablaw, an aura that
137
can automatically cause illness when transgressed. A more

contemporary example was given by one of my students, Rosario
Cruz-Lucero (1985), in her work with sugar workers in Negros.
Interviewing an old sugar worker suffering from a number of ill-
nesses, she found him explaining his miserable state as gaba, a
result of his having been rebellious against the landowner in his
younger days.
We still have much to learn from so-called pagan traditions
and their conceptualizations of social sin. For instance, there
is so much more rationality in beliefs that one causes illness to
another by damaging a neighbor’s property. The symbolism could
be drawn further for it is not so much the infringement of private
property than the violation of a neighbor’s integrity or dignity that
brings illness to that person, for the notions of “ownership” are
not always as we view them in a market society.
We could learn, as well, from the tribal groups that stress the
consequences of our actions in this world, rather than the next,
that one does good because it is for the welfare of the community,
not because of individual aspirations for a reward in the next
life. We need to rediscover the wisdom of indigenous concepts.
In the previous chapter, the use of the suffix “-hati” (Malay for
“liver, heart”) was mentioned; we could go another step toward
understanding dalamhati as extreme sorrow that is kept within
(Malay dalam, “within”) while lualhati is generosity, with a sense
of reaching out (Malay luar, “outside of”).
The notion of “balance” should not be interpreted in a narrow
functionalist framework that emphasizes maintenance of social
equilibrium or the status quo. What is more important are the ways
accumulation and excess are questioned, perceived as dangerous.
The term lubha or “serious,” often used to refer to disease, is in
fact derived from the Sanskrit lobha or greed (Zorc 1985, 220).
We tend to think of traditional beliefs as deflecting
responsibility away from the individual, and that illness is more
often attributed to external factors such as spirits, preventing
138
individuals from taking responsibility for maintaining health.

But closer analysis will show traditional beliefs do not “deflect”
individual responsibility; rather, they situate the individual within
a broader social framework where collective social responsibility
is paramount in the prevention and treatment of illness, as can be
seen in the communal nature of many rituals. Communal welfare
is paramount and is again reflected even in so-called supernatural
beliefs. Fox (1982, 171) points out that the Tagbanuwa “evil
spirits,” significantly called damdam (feelings and emotions in
other languages), cannot in themselves inflict illness since they are
controlled by benevolent spirits, the panya an, who will unleash
the damdam only when there has been an infringement of social
norms. If there is indeed a deflection of responsibility, one must
ask who is doing that deflecting, and for what purpose.
Ileto (1979) has proposed that Philippine popular movements
for change drew heavily from traditions to articulate their
aspirations for freedom and justice. In some instances, a stubborn
clinging to traditions may in fact be a form of resistance against
those who dominate. An example from the Spanish colonial period
illustrates this:
In disregard of the monks, the Indians [indios] secretly

circumcise their children. The banyan tree is held sacred. They
burn incense under it, which they obtain from the friars under
various pretences. (Bowring 1859, 135)
The friar Juan Francisco de San Antonio (1977[1738]) wrote

in exasperation:
it is necessary to use the force of the whip to get them to hear mass
on holidays of obligation and to confess and receive communion
as ordered by the Church. They are very reverent to the Father
Ministers because of the superiority they recognize in them, but
at the same time, they make fun of them, they murmur against
them, and they even sell them out.
139
The retention of certain traditions may also reflect the

inadequacies of “western” explanations of disease and suffering.
Reality, after all, is experiential and indigenous concepts and
theories may in fact exhibit closer explanatory fit with that reality.
Health professionals working in community-based health programs
are often amazed by the villagers’ own perceptions about causes of
illnesses as “hunger,” “usury,” and “landlessness.”
The rapid processes of social change, including greater contact
among different cultures, create constant crises in meaning which
require new paradigms and explanations. Berger (1973) describes
“the homeless mind”: “modern” society’s members detached from
traditional institutions. It is not just the “uneducated” who are
easy prey to scientism and quackery; the middle class is in fact
much more gullible and “conversion-prone,” having access to
more options and expensive frauds. The totalitarian temptation is
stronger for such sectors who seek facile solutions from “experts,”
a pill for every ill—medical or social—as long as the solutions do
not involve too much disruption of personal lives. Mass society
has allowed large-scale dissemination of escapism, fantasies, and
panaceas by those who control the media and other information
outlets.
Stewart (1954, 39-58) gives a fascinating account of “group
therapy” among the Negritos of northern Luzon, where the
shaman induces a trance in the patient and instructs him to
fight and overcome the “demon” that is causing the illness. The
patient not only overcomes the “demon” but demands a dance
and a song from this “demon.” After coming out of the trance, the
patient performs this dance-drama for the community, validating
his having overcome the “demon.” Healing in this context takes
place “in a whole cultural area; it is not divided between clinic
and ‘outside’ ” (Fox 1967, 256). Furthermore, the rationale can
easily be extended into the notion of social change, where one
overcomes the “demon,” and can share the fruits of this victory
with the community.
140
Watson and Caldwell (2005, 2) talk about how research into the
culture of food can actually yield insights into social structures:
[C]ontinued attention to the most mundane and intimate

aspects of people’s ordinary lives—in this case, how they relate
to food—can help us understand the big issues of twenty-first
century politics: State formation, and collapse, global flows and
anti-global reactions, and new notions of identity and the rebirth
of nationalism (among other topics.)
In this book, I have presented many examples of Kleinman’s

(1980) Explanatory Models (EM’s), dealing with the way people
describe and explain health and illness. The concept of an EM
is not meant to suggest a static, homogenous medical culture,
where people pull out one EM per illness. People instead shop
for explanations, hopeful but often cynical. The more serious the
ailment, the more alternative EM’s that might be explored, often
with syncretism or a mixing of different beliefs and practices.
EM’s carry their own idioms, and a good health provider must
be able to read through these idioms, such as when a laundrywoman
expresses her fear of getting pasma, which may be another way of
saying, “Please do not overwork me with laundry and ironing.”
If the conceptualizations of health and illness, and the practices
resulting from such concepts, are indeed “social metaphors,” we
have much to learn from an Ilongot description of the transition
from illness to health (Rosaldo 1980, 44): “A nu me’ugu, ‘i’aa nima
rinawam ‘ipawa, ‘iruyuk” (“When the rain stops, your heart grows
open, it lengthens”). In Tagalog, when we speak of someone who
is recovering from illness, we say, gumagaling siya, galing used here
to describe a process, a struggle toward a goal of wellness. In many
ways, we are all like the child who still needs to acquire humanity
(pagkatao) through increased knowledge and consciousness.
141
Abbreviations Used
AA—American Anthropologist
AQ—Anthropological Quarterly
AS—Asian Studies
CEUGFS—Centro Escolar University Graduate Faculty Studies
JEAS—Journal of East Asian Studies
PJS—Philippine Journal of Science
PS—Philippine Studies
PQCS—Philippine Quarterly of Culture and Society
PSR—Philippine Sociological Review
SLURJ—St. Louis University Research Journal
SSM—Social Science and Medicine
TPI—The Philippine Islands (edited by Emma Helen Blair and James
Alexander Robertson, Cleveland: Arthur Clark Co., 1903)
UCPAAE—University of California Publications in American Archeology
and Ethnology
143
References Cited
Abarquez, Ramon F. 1999. The relevance of the hibernating myocardium:
An ischemic but viable myocardial burden. Phil. J. Int. Med. 37:211-27.
Adams, Richard N. 1953. An analysis of medical beliefs and practices in a
Guatemalan Indian town. Washington, D.C.: Pan American Sanitary
Union.
Adams, Richard N., and Arthur J. Rubel. 1967. Sickness and social
relations. In Handbook of Middle American Indians, ed. Manning Nash,
6: 333-56. Austin: University of Texas Press.
Adler, S. 1995. Refugee stress and folk belief: Hmong sudden deaths. SSM
40(12):1623-29.
Alejandrino, Evangeline C. 1986. Ilocano traditional concepts of illness and
illness causation. Term paper submitted for Medical Anthropology,
University of the Philippines.
———. 1987. Ilocano supernatural archetypes in relation to health and
cures. Term paper submitted for Medical Anthropology, University of
the Philippines.
Andriolo, Karin. 2002. Murder by suicide: Episodes from Muslim history.
AA 104 (3):736-42.
Aponte, Gonzalo E. 1960. The enigma of “bangungot.” Archives of Internal
Medicine 52:1258-63.
Arens, Richard. 1956a. Animism in the rice ritual of Leyte and Samar. PSR
4(1):2-6.
———. 1956b. Animistic fishing ritual in Leyte and Samar. PSR 4(4):24-
28.
———. 1956c. The corn ritual in Leyte and Samar. PSR 4(2/3):29-31.
———. 1956d. Notes on camote ritual in Leyte and Samar Islands,
Philippines. PJS 85:343-47.
———. 1956e. The use of amulets and talismans in Leyte and Samar. JEAS
7(2):115-26.
———. 1956f. Witches and witchcraft in Leyte and Samar Islands,
Philippines. PJS 85:451-65.
Arikha, Noga. 2007. Passions and tempers: A history of the humours. New
York: Ecco Press.
145
Arriola, Fe Maria C. 1993. The body book. Quezon City: GCF Books.
Bantug, Jose P. 1953. A short history of medicine in the Philippines. Manila:
Colegio Medico-Pharmaceutico de Filipinas.
Barton, Roy F. 1919. Ifugao law. UCPAAE 15:1-186
———. 1922. Ifugao economics. UCPAAE 15:385-446.
———. 1946. The religion of the Ifugaos. American Anthropological
Association Memoirs 65:1-219.
Baumgartner, Joseph. 1975. Some notes on the so-called snake stone.
PQCS 3(1):51.
Begley, Sharon. 2007. Train your mind, change your brain. New York:
Ballantine Books.
Benedict, Laura W. 1916. A study of Bagobo ceremonial, magic and myth.
New York Academy of Sciences 25:1-308.
Best, Eldson. 1892. Pre-historic civilization in the Philippines. Polynesian
Society Journal 1:118-25, 195-201.
Berger, Peter. 1973. The homeless mind. New York: Vintage.
Beyrer, Chris. 1998. War in the blood: Sex, politics and AIDS in Southeast
Asia. London: Zed Books.
Biernatzki, William E. 1973. Bukidnon datuship in the upper Pulangi
River Valley. In Bukidnon politics and religion, ed. Alfonso de Guzman
II and Esther M. Pacheco. (IPC papers no. 11), 15-50. Quezon City:
Institute of Philippine Culture, Ateneo de Manila University.
Blust, Robert. 1981. Linguistic evidence for some early Austronesian
taboos. AA 83:285-319.
Boulet, M.J., B.J. Oddens, et al. 1994. Climacteric and menopause in seven
South-east Asian countries. Maturitas 19(3):157-76.
Bourdieu, Pierre. 1977. Outline of a theory of practice. Cambridge:
Cambridge University Press.
Bowring, John. 1859. A visit to the Philippine Islands. London: Smith Elder
and Co.
Bruno, Juanito. 1973. The social world of the Tausug. Manila: Centro
Escolar University Research and Development Center.
Bulatao, Jaime. 1982. Local cases of possession and their cure. PS 30:415-
26.
Cabotaje, Esther M. 1976. Food and Philippine culture. Manila: Centro
Cannon, Walter B. 1942. “Voodoo” death. AA 44:169-81.
146
References Cited
Cardozo, A. Rebecca. 1982. A modern American witch-craze. In Witchcraft

and sorcery, ed Max Marwick, 2nd ed., 469-76. Harmondsworth,
Middlesex: Penguin.
Casino, Eric. 1976. The Jama Mapun. Quezon City: Ateneo de Manila
University.
Centers for Disease Control (U.S. Department of Health and Human
Services). 1981. Sudden, unexpected, nocturnal deaths among
Southeast Asian refugees. Morbidity and Mortality Weekly Report
30(47):581-84, 589.
Claver, Francisco F. 1973. Dinawal Ogil: High datu of Namman. In
Bukidnon politics and religion, ed. Alfonso de Guzman II and Esther
M. Pacheco. (IPC Papers No. 11), 51-114. Quezon City: Institute of
Philippine Culture, Ateneo de Manila University.
Cole, Fay Cooper. 1913. The wild tribes of Davao district, Mindanao. Field
Museum of Natural History, Anthropological Series 12:49-203.
Combes, Francisco. 1906 (1667). The natives of the Southern Islands. TPI
40:99-182.
Concepcion, Mercedes B., ed. 1976. Children of the lakeshore. Quezon
City: University of the Philippines Population Institute.
Constantino, Ernesto. 1971. Tagalog and other major languages of the
Philippines. In Current trends in linguistics, ed. Thomas A. Sebeok,
112-54. The Hague: Mouton.
Covar, Prospero. 1975. General characteristics of contemporary religious
movements in the Philippines. AS 13(2):79-92.
Cruz-Luzero, Ma. Rosario. 1985. Social diabetes in sugarland, Negros
Island. Term paper submitted for Medical Anthropology, University
of the Philippines.
Dalisay, Soledad. 2003. Surviving inaagosto: Household strategies to cope
with the lean season in a community in Batangas province. PhD
dissertation submitted to the University of the Philippines.
Demetrio, Francisco R. 1970. Dictionary of the Philippine folk beliefs and
customs. 4 vols. Cagayan de Oro: Xavier University.
Demetrio, Francisco, Gilda Cordero Fernando, and Fernando N. Zialcita.
1991. The soul book. Quezon City: GCF Books.
Douglas, Mary T. 1966. Purity and danger. London: Routledge.
———. 1970. Natural symbols. London: Routledge.
Dozier, Edward P. 1966. Mountain arbiters. Tucson: University of Arizona
Press.
147
Eder, James. 1987. On the road to tribal extinction: Depopulation, deculturation

and adaptive well-being among the Batak of the Philippines. Berkeley:
University of California Press.
———. 1997. Batak resource management: Belief, knowledge and practice.
Gland, Switzerland: World Conservation Union and World Wildlife
Fund.
Eggan, Fred, and William H. Scott. 1963. Ritual life of the Igorots of
Sagada: From birth to adolescence. Ethnology 2:40-45.
Ehrenreich, Barbara, and Deirdre English. 1973. Witches, midwives and
nurses: A history of women healers. 2nd ed. Old Westbury, New York:
The Feminist Press.
Ehrenreich, John. 1978. The cultural crisis of modern medicine. New York:
Monthly Review Press.
Elkins, Richard E. 1964. The anit taboo: A Manobo cultural unit. Practical
Anthropology 11:185-88.
———. 1968. Manobo-English dictionary. Honolulu: University of Hawaii
Press.
Ellen, Roy F. 1977. Anatomical classification and semiotics of the body. In
The anthropology of the body, ed. John Blocking, 343-73. New York:
Academic Press.
Ellwood, Bettie C. 1977. Folk tradition in Filipino student culture: A study
of Cebuano preternatural beliefs. Silliman Journal 24:154-75.
Endicott, Kirk. 1979. The Batek Negrito thunder god: The personification
of a natural force. In The imagination of reality, ed. A. L. Becker and A.
A. Yengoyan, 29-42. Norwood, New Jersey: Ablex Publishing Corp.
Engelhardt, H. Tristam, and Edmund L. Erde. 1980. Philosophy of
medicine. In A guide to the culture of science, technology and medicine,
ed. Paul T. Durbin, 361-461. New York: The Free Press.
Espino, F, L. Manderson, C. Acuin, F. Domingo, and E. Ventura. 1997.
Perceptions of malaria in a low endemic area in the Philippines:
Transmission and prevention of disease. Acta Trop. 63(4):221-39.
Evangelista, Teresita Joy, Salome Vios, and Myrna Buenaluz. (Faculty
advisers) 2007. Clinical and neurophysiological profile of
laundrywomen with and without self-perceived pasma: A cross-
sectional survey. Unpublished report, University of the Philippines
College of Medicine.
Evans, Dylan. 2004. Placebo. London: HarperCollins.
148
References Cited
Evans-Pritchard, E. E. 1937. Witchcraft, oracles and magic among the

Azande. New York: Oxford University Press.
Ewing, J. Franklin. 1955. Juramentado: Institutional suicide among the
Moros of the Philippines. AQ 28:148-55.
———. 1960. Birth customs of the Tawsug, compared with those of other
Philippine groups. AQ 33:129-33.
———. 1967. Illness, death and burial in the Southern Philippines with
special reference to the Tawsug. AQ 40:13-25, 45-64.
Fabrega, Horacio Jr. 1974. Disease and social behaviour. Cambridge: MIT
Press.
Fabrega, Horacio Jr., and John E. Hunter. 1978. Judgements about disease:
A case study involving ladinos of Chiapas. SSM 12B:1-10.
Farb, Peter, and George Armelagos. 1980. Consuming passions: The
anthropology of eating. New York: Washington Square Press.
Farmer, Paul. 1993. AIDS and accusation: Haiti and the geography of blame.
Berkeley and Los Angeles: University of California Press.
———. 2001. Infections and inequalities: The modern plagues. Berkeley and
Los Angeles: University of California Press.
———. 2004. Pathologies of power: Health, human rights and the new war on
the poor. Berkeley and Los Angeles: University of California Press.
Feingold, David A. 1976. On knowing who you are: Intraethnic distinctions
among the Akha of Northern Thailand. In Changing identities in modern
Southeast Asia, ed. David J. Banks, 71-82. The Hague: Mouton.
Feng, Han-yi, and J. K. Shyrock. 1935. The black magic in China known
as ku. Journal of the American Oriental Society 55:1-30.
Flavier, J. M., and C. H. Chen. 1980. Induced abortion in rural villages of
Cavite, the Philippines: Knowledge, attitudes and practice. Studies in
Family Planning 11(2):65-71.
Fletcher, C. M. 1978. Terminology in chronic obstructive lung diseases.
Journal of Epidemiology and Community Health 32:282-88.
Foster, George M. 1953. Relationships between Spanish and Spanish-
American folk medicine. Journal of American Folklore 6:201-19.
———. 1960. Culture and conquest: America’s Spanish heritage. Viking Fund
Publications in Anthropology No. 27. Chicago: Quadrangle Books.
———. 1965. Peasant society and the image of limited good. AA 67:293-
315.
———. 1976. Disease etiologies in nonwestern medical systems. AA
78:773-82.
149
Foster, George M., and Barbara G. Anderson. 1978. Medical anthropology.

New York: Wiley and Sons.
Fox, Robert B. 1952. The Pinatubo Negritos: Their useful plants and
material culture. PJS 81:173-395.
———. 1982. Tagbanuwa religion and society. Manila: National Museum
Monograph No. 9.
Fox, J. Robin. 1967. Witchcraft and clanship in Cochiti therapy. In Magic,
witchcraft and curing, ed. John Middleton, 255-84. Austin: University
of Texas Press.
Foucault, Michel. 1991. Discipline and punish: The birth of the prison.
Trans. Alan Sheridan. London: Penguin Books.
Frake, Charles O. 1961. The diagnosis of disease among the Subanun
Mindanao. AA 63:113-32.
———. 1964. A structural description of Subanun religious behavior. In
Explorations in cultural anthropology, ed.Ward H. Goodenough, 111-
29. New York: McGraw-Hill.
Frake, Charles O., and Carolyn M. Frake. 1957. Postnatal care among the
Eastern Subanun. Silliman Journal 4:207-15.
Frazer, James G. 1911. The golden bough: A study in magic and religion. 3rd
ed. vol. 1. London: Macmillan.
Friere, Paulo. 1970. Cultural action for freedom. Cambridge, Massachusetts:
Center for the Study of Development and Social Change.
———. 1972. Pedagogy of the opressed. Trans. Myra Bergman Ramos.
Middlesex: Penguin Books.
Fujisaka, Sam. 1986. Pioneer shifting cultivation, farmer knowledge,
and an upland ecosytem: Co-evolution and systems sustainability in
Calminoe, Philippines. PQCS 14:137-64.
Galdston, Iago. 1981. Medicine and culture. In Social and historical
foundations of modern medicine, 3-11. New York: Brunner/Mazel.
Galvez-Tan, Jaime. 1978. Religious elements in Samar-Leyte medicine. In
Filipino religious psychology, ed. Leonardo Mercado, 3-21. Tacloban,
Leyte: Divine Word University.
Garcia, Lillian C. 1976. Some observations on the gaba’ phenomenon.
PQCS 4:31-36.
Garvan John M. 1964. The Negritos of the Philippines. Wiener Beitrage
zur Kulturgeschichte und Linguistik, ed.H. Hochegger. Band 14. Horn-
Wein (Austria): Verlag Ferdinand Berger.
150
References Cited
Gatan, Marino. 1981. Ibanag indigenous religious beliefs. Manila: Centro

Geertz, Clifford. 1957. Ethos, world view and analysis of sacred symbols.
Antioch Review 17(4):421-37.
———. 1960. The religion of Java. New York: The Free Press of Glencoe.
———. 1964. Ideology as a cultural system. In Ideology and discontent, ed.
David Apter, 47-76. New York: The Free Press of Glencoe.
Gibson, Thomas Paul. 1983. Religion, kinship and society among the Buid
of Mindoro. PhD thesis, London School of Economics.
Gimlette, J. D., and Thomson, T. W. 1939. A dictionary of Malayan medicine.
London: Oxford University Press.
Glick, Leonard B. 1967. Medicine as an ethnographic category: The Gimi
of the New Guinea highlands. Ethnology 6:31-56.
Gomez, Liborio. 1917. Mohammedan medical practices in Cotabato
province. PJS 12B:261-79.
Gonzales, Rosario Brenda. 1986. Some theories of illness causation in
Bauan, Batangas. Term paper submitted for Medical Anthropology,
Goonatilake, Susantha. 1984. Aborted discovery: Science and creativity in
the Third World. London: Zed Press.
Greenhalgh, Trisha, and Brian Hurwitz. 1998. Why study narrative? In
Narrative based medicine, ed.Trisha Greenhalgh and Brian Hurwitz,
3-16. London: BMJ Books.
Guthrie, George M., et al. 1980. Maintenance and termination of breast
feeding in rural and urban Philippine communities. Ecology of Food
and Nutrition 10:35-43.
Habermas, Jurgen. 1971. Knowledge and human interests. Boston: Beacon.
Hallowell, A. Irving. 1963. Ojibwa world view and disease. In Man’s image
in medicine and anthropology, ed. Iago Galdstone, 258-315. New York:
International University Press.
Hardon, Anita. 1987. Hiyang is beautiful. Essential Drugs Monitor. no. 4.
Geneva: World Health Organization.
———. 1991. Confronting ill health. Quezon City: Health Action
Information Network.
Hart, Donn V. 1965. From pregnancy through birth in a Bisayan Filipino
village. In Southeast Asian birth customs: Three studies in human
reproduction, ed. Donn V. Hart, 1-113. New Haven: Human Relations
Area Files Press.
151
———. 1969. Bisayan Filipino and Malayan humoral pathologies: Folk

medicine and ethnohistory in Southeast Asia. Southeast Asia Program
Data Paper no. 76. Ithaca, New York: Cornell University.
———. 1975. Lanti: Sickness by fright: A Bisayan Filipino peasant
syndrome. PQCS. 3:1-19.
———. 1977. Compadrinazgo: Ritual kinship in the Philippines. Dekalb:
Northern Illinois University Press.
———. 1979. Disease etiologies of Samaran Filipino peasants. In Culture
and curing, eds. P. Morley and R. Wallis, 57-98. Pittsburg: University
of Pittsburg Press.
———. 1980. Ethnomedicine and social control in the Bisayas, Philippines.
PQCS. 8:60-72.
Harwood, Alan. 1981. Introduction. In Ethnicity and medical care, ed. A.
Harwood, 1-36. Cambridge: Harvard University Press.
Heggenhougen, H. K. 1980. Bomohs, doctors and sinsehs: Medical
pluralism in Malaysia. SSM 14B:235-44.
Heiser, Victor G. 1936. An American doctor’s odyssey. New York: W. W.
Norton and Company.
Henriot, Peter J. 1973. The concept of social sin. In Sourcebook on poverty,
development and justice. Washington, D. C.: United States Catholic
Conference Campaign for Human Development.
Himes, Ronald S. 1971. Tagalog concepts of causality: Disease. In
Modernization: Its impact in the Philippines, ed. Frank Lynch and
Alfonso De Guzman. Vol. 5. Institute of Philippine Culture Paper no.
10, 29-47. Quezon City: Ateneo de Manila University.
Humphreys, Christmas. 1951. Buddhism. Middlesex: Penguin Books.
Idler, Ellen L. 1979. Definitions of health and illness and medical sociology.
SSM 13A;723-31.
Ileto, Reynaldo C. 1979. Pasyon at rebolusyon. Quezon City: Ateneo de
Manila University Press.
———. 1988. Cholera and the origins of the American sanitary order
in the Philippines. In Imperial medicine and indigenous societies, ed.
Arnold D, 125-48. Manchester: Manchester University Press.
Janzen, John M. 1978. The comparative study of medical systems as
changing social systems. SSM 12:121-29.
Jaspan, M. A. 1969. Traditional medical theory in South-east Asia. Hull,
Yorkshire: University of Hull.
152
References Cited
Jayawardena, Chandra. 1968. Ideology and conflict in lower class

communities. Comparative Studies in Society and History 10:413-46.
Jenks, Albert E. 1905. The Bontoc Igorot. Department of Interior
Ethnological Survey Publications no. 1. Manila: Bureau of Printing.
Joaquin, Nick. 1983. Caves and shadows. Manila: National Bookstore.
Jocano, F. Landa. 1969. Growing up in a Philippine barrio. New York: Holt,
Rinehart and Winston.
———. 1973. Folk medicine in a Philippine municipality. Manila: National
Museum. (Reprinted in 2003, Metro Manila: Punlad Research House,
Inc.)
Juarez, Fatima, Josefina Cabigon, Susheela Singh, and Rubina Hussain.
2005. The incidence of induced abortion in the Philippines: Current
level and current trends. International Family Planning Perspectives
31(3):140-49.
Karim WJ. 1990. Introduction: Emotions in perspective. In Emotions of
Culture, ed. WJ Karim. Singapore: Oxford University Press.
Kaye, Richard. 1986. On referring to a Philosopher. New Doctor 39:11-
12.
Kazarian, S. Shahe, and David Richards Evans. 2001. Handbook of cultural
health psychology. London: Academic Press.
Kiefer, Thomas M. 1968. Institutionalized friendship and warfare among
the Tausug of Jolo. Ethnology 7:225-44.
———. 1972. The Tausug. New York: Holt, Rinehart and Winston.
Kikuchi, Yasushi. 1984. Mindoro highlanders. Quezon City: New Day
Publishers.
Kleinman, Arthur. 1980. Patients and healers in the context of culture. Los
Angeles and San Francisco: University of California Press.
———. 1988. The illness narratives: Suffering, healing and the human
condition. New York: Basic Books.
———. 2006. What really matters: Living a moral life amidst uncertainty
and danger. Oxford: Oxford University Press.
Kleinman, Arthur, and Peter Benson. 2006. Anthropology in the clinic:
The problem of cultural competency and how to fix it. PLoS Medicine
3(10):e294.
Kluckholn, Clyde. 1944. Navaho witchcraft. Papers of the Peabody
Museum of American Archeology and Ethnology no. 22. Cambridge,
Mass.: Harvard University.
153
Koentjaraningrat. 1972. Tanimbar. In Ethnic groups of insular Southeast

Asia, ed. Frank Lebar. Volume 1: Indonesia, Andaman Islands and
Madagascar, 112-14. New Haven: Human Relations Area Files Press.
Koh, KT et al. 1990. Sudden nocturnal deaths among Thai construction
workers in Singapore. The Lancet 335:1154.
Koyama, Kosuke. 1974. Waterbuffalo theology. New York: Orbis Books.
Kroeber, Alfred L. 1928. Peoples of the Philippines. 2nd ed. American
Museum of Natural History Handbook Series no. 8. New York:
Museum of Natural History.
Laderman, Carol. 1992. A welcoming soil: Islamic humoralism on the
Malay Peninsula. In Paths to Asian medical knowledge, ed. Charles
Leslie and Allan Young, 272-88. Berkeley and Los Angeles: University
of California Press.
Lagmay, Alfredo V. 1977. Bahala na. In Ulat ng ikalawang pambansang
kumperensiya sa sikolohiyang Pilipino: Ang kahalagahan ng sikolohiyang
Pilipino sa pambansang kamulatan, ed. Lilia F. Antonio et al., 120-30.
Lunsod Quezon: Pambansang Samahan sa Sikolohiyang Pilipino.
Lambrecht, Godfrey. 1959. The Gaddang of Isabela and Nueva Ecija:
Survivals of a Primitive animistic religion. PS 7:194-218.
Landy, David. 1977. Medical systems in transcultural perspective. In
Culture, disease and healing, ed. David Landy, 129-31. New York:
Macmillan Publishing.
Lapuz, Lourdes V. 1973. A study of psychopathology. Quezon City:
University of the Philippine Press.
Lebar, Frank. 1964. Lu. In ethnic groups of mainland Southeast Asia, ed.
Fank Lebar, 206-13. New Haven: Human Relations Area Files.
———. 1975. Bunun. In Ethnic groups of insular Southeast Asia, ed. Frank
Lebar. Volume 2: Philippines and Formosa, 134-37. New Haven:
Human Relations Area Files.
Lester, David. 1972. Voodoo death: Some new thoughts on an old
explanation. AA 74:386-90.
Lex, Barbara. 1974. Voodoo Death: New thoughts on an old explanation.
AA 76:818-23.
Licauco, Jaime T. 1981. The truth behind faith healing in the Philippines.
Manila: National Bookstore.
Lieban, Richard W. 1960. Sorcery, illness and social control in a Philippine
municipality. Southwestern Journal of Anthropology 16:127-43.
154
References Cited
———. 1962a. Qualification for folk medical practice in Sibulan, Negros

Oriental, Philippines. PJS, 91:511-21.
———. 1962b. The dangerous ingkantos: Illness and social control in a
Philippine community. AA 64:306-12.
———. 1966. Fatalism and medicine in Cebuano areas of the Philippines.
AQ 39:171-79.
———. 1967. Cebuano sorcery. Berkeley: University of California Press.
———. 1976. Traditional medical beliefs and the choice of practitioners
in a Philippine city. SSM 10:289-96.
———. 1979. Sex differences and cultural dimensions of medical
phenomena in a Philippine setting. In Culture and curing, ed. P. Morley
and R. Wallis, 99-114. Pittsburg: University of Pittsburg Press.
Lonsdale D. 1990. Thiamine deficiency and sudden deaths. The Lancet
336:376.
Lopez-Gonzaga, Violeta. 1983. Peasants in the hills. Quezon City:
Lorenzana, Cyril. 1984. Field notes (AKAP research project on traditional
medicine).
Lynch, Frank. 1949. Ang mga asuwang: A Bikol belief. Philippine Social
Sciences and Humanities Review 14:401-27.
Lynch, Frank, and Ronald S. Himes. 1967. Cognitive mapping in the
Tagalog areas. In Modernization: Its impact in the Philippines, ed.
Walden Bello and Maria Roldan, Institute of Philippine Culture,
Paper no. 4, 9-52. Quezon City: Ateneo de Manila University Press.
MacDonald, Charles J-H. 2007. Uncultural behavior: An anthropological
investigation of suicide in the southern Philippines. Honolulu, Hawaii:
University of Hawaii Press.
McAndrew, John P. 1985. The peasant world view of healing and religion.
Aghamtao, (5/6:54-62).
McElroy, Ann, and Patricia Townsend. 2003. Medical anthropology in
ecological perspective. 4th ed. Boulder, Colorado: Westview Press.
McNee, A., N. Kahn, S. Dawson, J. Gunsalam, VL Tallo, L. Manderson, and
I. Riley. 1995. Responding to cough: Boholano illness classification
and resort to care in response to childhood ARI. SSM. 40(9):1279-
89.
Maceda, Marcelino P. 1964. The culture of the Mamanua (Northeast
Mindanao). University of San Carlos Monograph no. 1. Manila:
Catholic Trade School.
155
Managat, Isabelo Jr. 1984. Field notes. (AKAP research project on

traditional medicine).
Marcus, George E., and Michael M. J. Fischer. 1986. Anthropology as
cultural critique. Chicago: University of Chicago Press.
Marett, Robert R. 1909. The threshold of religion. London: Methuen.
Marshall, Harold Alfred. 2001. Perspectives of bughat in a farming
community in Negros Occidental. MA Health Social Science thesis
submitted to the De La Salle University.
Martin, Paul. 1987. Psychology and the immune system. New Scientist,
April 9, 1987, 46-50.
Mas, Sinibaldo de. 1843. Informe sobre el estado de las Islas Filipinas en
1842. 2 vols. Madrid: I. Sancha.
Mayer, Philip. 1982. Witches. In Witchcraft and sorcery, ed. Max Marwick,
2nd ed. 54-70.
Mendez, Paz P., and F. Landa Jocano. 1974. The Filipino family in its rural
and urban orientation. Manila: Centro Escolar University Research
and Development Center.
Menez, Herminia. 1996. Explorations in Philippine folklore. Quezon City:
Ateneo de Manila University.
Mercado, Leonardo N. 1976. Elements of Filipino philosophy. 2nd ed.
Tacloban, Leyte: Divine Word University.
Messer, Ellen. 1981. Hot-cold classification: Theoretical and practical
implications of a Mexican study. SSM. 15B:133-45.
———. 1984. Anthropological perspectives on diet. Annual Review of
Miguel, Cynthia A., Lenore Manderson, and Mary Ann Lansang. 1998.
Patterns of treatment for malaria in Tayabas, The Philippines:
Implications for control. Tropical Medicine and International Health
3(5):413.
Ministry of Health. (Republic of the Philippines) 1981. National health
survey 1981. Manila: Ministry of Health (now Department of
Health).
Mintz, Malcolm W. 1971. Bikol dictionary. Honolulu: Pacific and Asian
Linguistics Institute, University of Hawaii.
Mohring, H. 1973. The word anito and its association: A remark about
etymological research. In Parangal kay Cecilio Lopez: Essays in honor
of Cecilio Lopez, ed. Andrew B. Gonzales, 15-37. Philippine Journal
156
References Cited
of Linguistics Special Monograph Issue no. 4. Quezon City: Linguistic

Society of the Philippines.
Moore, Grace W. 1975. Tiruray. In Ethnic groups of insular Southeast Asia,
ed. Frank Lebar. Volume 2: Philippines and Formosa, 41-45. New
Haven: Human Relations Area Files Press.
Moss, Claude R. 1920. Nabaloi law and ritual. University of California
Publication in Archeology and Ethnology 15:207-342.
Moynihan, Ray, and Henry David. 2006. The fight against disease
mongering: Generating knowledge for action. Public Library of
Science (PLoS) Medicine 3(4):e191.
Munger, R. G., and E. A. Booton. 1990. Thiamine and sudden death in
sleep of South-East Asian refugees. The Lancet 335:1154.
Murdock, George P. 1980. Theories of illness: A world survey. Pittsburg:
University of Pittsburg Press.
Najman, Jacob M. 1980. Theories of disease causation and the concept of
a general susceptibility. SSM 14A:231-37.
Narciso, Victoria V. 1976. Katangian ng mga amoy: Isang panimulang pag-
aaral. In Sikolinggwistikang Pilipino, ed. Virgilio G. Enriquez. Vol. 2,
337-55. Quezon City: University of the Philippines.
Newell, Leonard E. 2005. Batad Ifugao dictionary with ethnographic notes.
Manila: Linguistic Society of the Philippines.
Nichter, Mark. 1994. Illness semantics and international health: The weak
lungs/TB complex in the Philippines. SSM 38(5):649-63.
Nichter, Mark and Nichter, Mimi. 1994. Acute respiratory illness: Popular
health culture and mothers’ knowledge in the Philippines. Medical
Nimmannit, S. et al. 1990. Potassium and sudden unexplained nocturnal
death. The Lancet 336:116-17.
Nolasco, J. B. 1957. An inquiry into “bangungot.” Archives of Internal
Medicine 99:905-12.
Nurge, Ethel. 1958. Etiology of illness in Guinhangdan. AA. 60-1158-72.
Nydegger, William, and Corinne Nydegger. 1966. Tarong: An Ilocos barrio
in the Philippines. Six Cultures Series 6. New York: Wiley.
Ortiz, Tomas. 1906 (1731). Superstitions and beliefs of the Filipinos. In TPI
43, 103-12.
Ortner, Sherry B. 1973. On key symbols. AA 75:1338-46.
Packe, G. E., and Jon G Ayres. 1985. Asthma outbreak during a
thunderstorm. The Lancet, July 27, 1985, 199-203.
157
Pacyaya, Alfredo G. 1961. Changing customs of marriage, death and burial

among the Sagada. Practical Anthropology 8:125-33.
Pal, Agaton, and Robert A. Polson. 1973. Rural people’s response to change.
Quezon City: New Day Publishers.
Palaganas, Erlinda. 2001. Mainstreaming indigenous health knowledge
and practices. Quezon City: University of the Philippines Center for
Integrative and Development Studies.
Panganiban, Jose V. 1972. Diksyunaryo tesauro Pilipino-Ingles. Quezon
City: Manlapaz Publishing Co.
Paul, Benjamin D. 1963. Anthropological perspectives on medicine and
public health. Annals of the American Academy of Political and Social
Science 346:34-43.
Pertierra, Raul. 1983. Viscera suckers and female sexuality. PS 31(3):319-
37.
Phua, K. H. et al. 1990. Thiamine deficiency and sudden deaths: Lessons
from the Past. The Lancet 335:1471-72.
Picpican, Isikias T., and Ermelinda C. Guinaran. 1981. Folk medicine
among Benguet Igorots. SLURJ, 12(1):93-123.
Plasencia, Juan de. 1903 (1589). Customs of the Tagalogs. In TPI 7, 171-96.
Polenda, Francisco Col-om. 2002 (1989). A voice from the hills: Essays
on the culture and world view of the western Bukidnon Manobo people.
Trans. Richard E. Elkins. Manila: Linguistic Society of the Philippines
and Summer Institute of Linguistics.
Pollanen, M.S. et al. 1996. Sudden unexplained death in Asian immigrants:
Recognition of a syndrome in Metropolitan Toronto. Canadian Medical
Association Journal 155:537-40.
Polunin, Ivan. 1977. The body as an indicator of health and disease. In
The anthropology of the body, ed. John Blacking, 85-98. New York:
Academic Press.
Polo, Jaime B. 1986. Ingon man gintutuuhan: Fish tales fishers tell in a Leyte
Community. Research Notes Series number 1. Quezon City: n.p.
Ponteras, Moises. 1980. Folk healing in Iloilo. Unpublished PhD
dissertation (Philippine Studies), University of the Philippines,
Diliman, Quezon City.
Provencher, Ronald. 1978. Malays. In Muslim peoples: A world ethnographic
survey, ed. R. Weekes, 253-59. London: Greenwood Press.
Querubin, Milagros P., and Michael L. Tan. 1986. Old roles, new roles:
Women, primary health care and pharmaceuticals. In Adverse effects:
158
References Cited
Women and the pharmaceutical industry, ed. Kathleen Mcdonnell, 175-

86. Penang and The Hague: International Organization of Consumer
Unions.
Quirino, Carlos. 1958. The manners, customs and beliefs of the Philippine
inhabitants of long ago: Being chapters of ‘A late 16th century Manila
MS’ transcribed, translated and annotated by Mauro Garcia. PJS
87:325-449.
Rahmann, Rudolf. 1974. Magico-religious and medicinal stones: A case
study in ethnomedicine. PQCS 2:81-84.
Ramos, Alicia C. 1977. Food aAttitudes and beliefs among selected
families in Barrio Ususan, Taguig,Rizal. Philippine Journal of Nutrition
30(1):29-36.
Ramos, Maximo. 1968. Beliefs in ghouls in contemporary Philippine
society. Western Folklore 27:184-90.
Recio, Dolores M. et al. 1978. Perceptions of health and illness and
patterns of health care intervention in relation to improving the
quality of life of the Filipino. (1976-1978) NSDB-UO Project 7606SO.
Mimeographed. n.p.
Reichel-Domatoff, Gerardo. 1976. Cosmology as ecological analysis. Man.
11:307-18.
Retana, Wenceslao E. 1921. Diccionario de Filipinismos. Paris: Bailly-
Bailiere.
Riguera, Florencio. 1968. “Sumang”: A folk ritual in Ilocos. PSR. 16(1-
2):66-73.
Rivers, W. H. R. 1924. Medicine, magic and religion. New York: Harcourt
Brace.
Rodriguez, Suzanna F. 1985. The concepts of usog in a Philippine barrio.
Term paper submitted for Medical Anthropology, University of the
Philippines.
Rosaldo, Michelle Z. 1980. Knowledge and passion: Ilongot notions of self
and social life. Cambridge: Cambridge University Press.
Rostagno, Sergio. 1983. The bible: Is an interclass reading legitimate? In
The bible and liberation, ed. Norman K. Gottwald, 61-73. New York:
Orbis Books.
Rubel, Arthur J., Karen Weller-Fahy, and Mimi Trosdal. 1975. Conception,
gestation, and delivery according to Some Mananabang of Cebu.
PQCS 3(2/3):131-45.
159
Saber, Mamitua. 1979. Magic and folk medicine among the Maranao.
In Papers in Mindanao ethnography. Data Paper no. 3, Ethnography
series, 22-31. Marawi: University Research Center, Mindanao State
University.
Salazar, Zeus. 1977. Ang kamalayan at kaluluwa: Isang paglilinaw ng ilang
konsepto ng kinagisnang sikolohiya. In Ulat ng ikalawang pambansang
kumperensya sa sikolohiyang Pilipino: Ang kahalagahan ng sikolohiyang
Pilipino sa pambansang kamulatan, ed. Lilia F. Antonio et al., 131-44.
Lunsod Quezon: Pambansang Samahan sa Sikolohiyang Pilipino.
———. 1983. Ethnic psychology and history: The study of faith healing in
the Philippines. In The ethnic dimension: Papers on Philippine culture,
history and psychology, ed. Z. Salazar, 89-106. Cologne: Counseling
Center for Filipinos, Caritas Association for the City of Cologne.
San Antonio, Juan Francisco de. 1977 (1738). The Philippine chronicles
of Fray San Antonio (Cronicas de la Provincia de San Gregorio
Magno). Transl. Pedro Picornell. Manila: Casalinda and Historical
Conservation Society.
Santa Cruz, Florencio Z. 1951. The pathology of bangungot. Journal of the
Philippine Islands Medical Association 27(7):476-81.
Santiago, Luciano P. 1993. The language of mourning and depression in
Filipino and its Indonesian and Malayan cognates: Transcultural,
sociological, historical, artistic and therapeutic significance. PQCS
21(3):269-311.
Scheans, Daniel J. 1966. Anak ti digos: Ilokano name changing and ritual
kinship. PSR. 14:82-85.
Schlegel, Stuart A. 1965. The upi espiritistas: A case study in cultural
adjustment. Journal for the Scientific Study of Religion. 4:198-212.
———. 1970. Tiruray justice. Berkeley: University of California Press.
Scott, James C. 1987. Weapons of the weak: Everyday forms of peasant
resistance. New Haven, CT: Yale University Press.
———. 1992. Domination and the arts of resistance. New Haven, CT; Yale
University Press.
Scott, William H. 1960. The Apo Dios concept in Northern Luzon. PS
8:772-88.
Sechrest Lee. 1970. Conceptions and management of mental disorder in
some Negros Occidental barrios. PSR 18:8-15.
Simpson, C. J. 1984. Doctors’ and nurses’ use of the word confused. British
Journal of Psychiatry 145:441-43.
160
References Cited
Simpson-Hebert, Mayling, Elias N. Cresencio, and Lorna P. Makil. 1986.

Infant feeding in Metro Manila: Infant feeding decisions, infant health
and family planning among Low-income families. Manila: Ramon
Magsaysay Awards Foundation.
Skeat, Walter William. 1900. Malay magic. New York: Barnes and Noble.
Sodusta, Jesusita L. 1983. Jamoyawon ritual: A territorial concept. Quezon
City: University of the Philippines Press.
Sontag, Susan. 1977. Illness as metaphor. New York: Farrar, Strauss and
Giroux.
———. 1989. Illness as metaphor and AIDS and its metaphors. New York:
Picador USA.
Stewart, Kilton. 1954. Pygmies and dream giants. New York: Harper and
Row.
Tan, Michael. 1980. Philippine medicinal plants in common use: Their
phytochemistry and pharmacology. Revised edition. Quezon City:
AKAP.
———. 1982. Social structure and the traditional medical system in the
Philippines. Unpublished M.A. thesis. Texas A & M.
———. 1985. Current status of research on traditional medicine in the
Philippines. Quezon City: AKAP.
———. 1986. The chronic crisis in the health care system. In Caring
enough to cure, 15-50. Manila: Council for Primary Health Care.
———. 1989. Traditional or transitional medical systems? Pharmacotherapy
as a Case for Analysis. SSM 29(3):301-307.
———. 1994. The meaning of medicines: Examples from the Philippines.
In Medicines: Meanings and contexts, ed. Michael L. Tan, and Nina L.
Etkin, 69-82. Quezon City: Health Action Information Network.
———. 1999. Good medicine: Pharmaceuticals and the construction of power
and knowledge in the Philippines. Amsterdam: Het Spinhuis.
Tan, Michael L., Milagros P. Querubin, and Tita Rillorta. 1984. Traditional
medicine and community-based health programs in the Philippines.
Quezon City: AKAP.
Taussig, Michael T. 1980. The devil and the commodity fetishism in South
America. Chapel Hill: The University of Carolina Press.
Tiston, Rebecca C. 1978. The psychology of the tambalan in Leyte. In
161
Torres-Yu, Rosario, Lydia Fer Gonzales, and Ligaya Tiamson-Rubin. 1986.

Talinghagang bukambibig. Manila: National Bookstore.
Trosdal, Mimi. 1975. Cebuano folk beliefs and customs connected with
planting. PQCS 3(1):31-35.
Trotter, Robert T. 1982. Susto: The context of community morbidity
patterns. Ethnology 21:215-26.
Van der Geest, Sjaak, and Anita P. Hardon. 1996. The anthropology of
pharmaceuticals: A biography. Annual Review of Anthropology 25:153-
78.
Van Loon, F. H. G. 1927. Amok and Lattah. Journal of Abnormal and Social
Psychology 21:343-444.
Vanoverbergh, Morice. 1938. Negritos of Eastern Luzon (Part 2). Anthropos
33:119-64.
———. 1972. Isneg-English dictionary. Honolulu: University of Hawaii
Press.
Velez, Amosa L. 1978. Faith-healing among the Cebuano espiritistas. In
Watson, James L., and Melissa L. Caldwell. 2005. Introduction. In The
cultural politics of food and eating, eds. James L. Watson and Melissa
L. Caldwell, 1-10. Oxford: Blackwell Publishing.
Werner, David. 1977. Where there is no doctor. Palo Alto, Calif.: Hesperian
Foundation.
Whiting, Beatrice B. 1950. Pauite sorcery. Viking Fund Foundation in
Anthropology no. 15. Tucson: University of Arizona Press.
Whittaker, Andrea. 2000. Intimate knowledge. London: Allen and Unwin.
Wolff, John. 1972. A dictionary of Cebuano Visayan. 2 vols. Southeast Asia
Program Data Paper no. 87. Ithaca, New York: Cornell University and
Manila: Linguistic Society of the Philippines.
———. 1976. Malay borrowings in Tagalog. In Southeast Asian history and
historiography, eds. C.D. Cowan and O. W. Woters, 345-67. Ithaca,
New York: Cornell University Press.
Wong, ML et al. 1992. Sudden unexplained death syndrome: A review and
update. Trop. Geogr. Med. 44(4):S1-9.
World Health Organization. 1987. Prevention and control of intestinal
parasitic infections. Technical Report Series no. 749. Geneva: World
Health Organization.
162
References Cited
Wulff, Inger. 1964. Features of Yakan culture. Folk 6:53-72.

Wuthnow, Robert et al. 1984. Cultural analysis. London: Routledge and
Kegan Paul.
Yap, Pow Meng. 1952. The latah reaction: Its pathodynamics and
nosological position. Journal of Mental Science 98:515-64.
Yap, EH et al. 1990. Pseudomonas pseudomallei and sudden unexplained
death in Thai construction workers. The Lancet 336:376-77.
Zorc, R. David Paul. 1979. Core etymological dictionary of Filipino.
Fascicle 1. Manila: PNC-La Salle-Ateneo Consortium.
———. 1981. Core etymological dictionary of Filipino. Fascicle 2. Manila:
PNC-La Salle-Ateneo Consortium.
163
The Author
MICHAEL L. TAN is a medical anthropologist. He is currently
professor and chairperson of the Department of Anthropology,
University of the Philippines Diliman, and head of the Medical
Anthropology Section, Social Medicine Unit, UP College of
Medicine. He writes a column, Pinoy Kasi, twice a week in the
Philippine Daily Inquirer covering issues of popular culture.

Revisiting Usog Pasma Kulam

Uploaded by

Copyright:

Available Formats

Revisiting Usog Pasma Kulam

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Revisiting Usog Pasma Kulam

Uploaded by

Copyright:

Available Formats

N Revisiting

Usog, Pasma, Kulam

The University of the Philippines Press

© 2008 by Michael L. Tan

First printing 2008

The National Library of the Philippines CIP Data

1. Traditional medicine—Philippines 2. Healing—

GR880 306.461’09599 2010 P083000032

Book Design by Nicole Victoria

Abbreviations Used 143

I HAVE STUDENTS at the University of the Philippines who

This book then is not just about “traditions” in a narrow

THE RESEARCH PROJECT at AKAP which produced the first

1.1 A Personal Note (1987)

THE ACCIDENT COULD not have been more timely. I was

Besides, I realized so much attention had been put on the foot

there are problems even in the definition of airflow obstruction

1.2 Rationale for the Study:

I WROTE THIS book in response to health professionals who were

sensitivity,” all the more important in a country where there is

probes into the indigenous philosophies that lay the foundation of

1.3 Theoretical and Methodological Perspectives

MY STUDY DRAWS mainly from ethnographies, many from the

“non-Christian tribes.” The studies are mainly descriptive accounts

I have supplemented the ethnographic review with results from

My emphasis is on producing an “ethnography of experience”

would otherwise be lost through individual interviews using only

Social Interactionist Perspectives

Social interactionism looks at the way people interact to shape

Theories of illness causation embody a system of labels and

With the rains come a change of mood and a difference in

That passage captures the discomfort and anxiety we have

Going a step further from meanings and social interactions,

victims themselves, belief in sorcery strengthens the “efficacy”

It is impossible to discuss concepts of health and illness

our materia medica, from medicinal plants to the explanations

BEFORE DISSECTING THEORIES of health and illness in the

2.1 Medicine and Medical Systems

IN THE CONTEXT of this study, a distinction should be made

A society’s medicine consists in those practices, methods,

technologies and personnel that enable it to practice and

Landy’s definitions clearly distinguish medicine which as a

2.2 Illness and Disease

MEDICAL ANTHROPOLOGISTS DISTINGUISH the terms

is automatically labelled as a “depressive disorder,” requiring a

THE PERCEPTION OF illness is itself a social, rather than a purely

is used in several Austronesian languages as synonymous with

difficulty in breathing, then the condition is now called kabuhi,

No matter what the ailment, it will be considered slight

Nurge also writes about the shock and dismay of a mother

All languages have many terms to describe different physical

2.4 Health and Kalusugan

TO UNDERSTAND THE social and cultural dimensions of illness

of kalusugan is lusog, defined by Panganiban (1972, 670) as “full

Note that physical appearance is not the sole determinant for

2.5 Theories of Illness Causation

WITH AN UNDERSTANDING of the concepts of health, disease,

The classification scheme helps us to systematize the discussion of

2.6 Explanatory Models

MEDICAL ANTHROPOLOGISTS OFTEN use the concept of