Oxford Development Studies,

Vol. 39, No. 4, December 2011

Illness and Healing in Urban Areas in Chile:

Between Tradition and Cultural Adaptation
MARIA COSTANZA TORRI

ABSTRACT The Mapuche communities living in the urban areas of Chile have undergone radical
cultural change as a result of modernization and urbanization. This article analyzes the influence of
these changes on the ideas and practices of traditional Mapuche healers (machi) and patients in
Temuco in Chile, and examines any changes or adaptations in perceptions of healing practices and
rituals. The paper shows how an encounter with another culture, such as the dominant Chilean one,
can under some conditions reinforce indigenous medicine by updating its practices and pushing it
towards increased specialization in psychotherapeutic treatments.

1. Introduction
Few experiences highlight cultural and cross-cultural dynamics as urban immigration
does. Cultural negotiation happens in every society and within every community where
forces of change meet forces of resistance (Kim, 2001; Doel & Segrott, 2003; Green et al.,
2006). However, it is in relation to urban immigration that these forces are most visible
and where cultural negotiation becomes most intense, as individuals and groups with
differing world views and socio-economic status meet and relate to one another.
Immigrants encounter forces of change that pose daily challenges to their cultural identity
in terms of values, beliefs and practices. When people move to urban areas, they often
bring along their medical traditions, despite the widespread availability of conventional
allopathic health care (Balick et al., 2000; Han, 2000; Balick & Lee, 2001; Corlett et al.,
2003; Pieroni & Vandebroek, 2007).
Much of the current work in ethnobotany and medical anthropology is concerned with
the loss of traditional knowledge and the preservation of biological diversity in remote
parts of the world where cultures and their ecosystems are being destroyed by
development (Torry, 2005; Waldstein, 2006; Vandebroek et al., 2008). However, by
recognizing the widespread use of plants as medicine by ethnic communities in urban
centers, interesting ethnobotanical studies can also be designed for this environment
(Corlett et al., 2003; Zuluaga, 2005; Cheung-Blunden & Juang, 2008).
This article aims to contribute to this novel approach by exploring potential changes in
traditional Mapuche medicine and by illustrating the process of cultural adaptation of

Maria Costanza Torri, PhD, Lecturer, Department of Social Sciences, University of Toronto Scarborough, 1265
Military Trail, ON M1C 1A4, Toronto, Canada. Email: mctorri@yahoo.it

ISSN 1360-0818 print/ISSN 1469-9966 online/11/040389-14

q 2011 Oxford Department of International Development
http://dx.doi.org/10.1080/13600818.2011.620084
390 M. C. Torri

Mapuche healers (machi) in the urban area of Temuco (IX Region), Chile. As religious and
healing practitioners, the machi have had a clear and indisputable role within traditional
Mapuche society, especially in the past. Indeed, they were the bearers of the beliefs,
morality and traditional practices that helped maintain the Mapuche sense of ethnic
identity. A central question then becomes, what happens when the role of the machi is
affected by the pressures of modernity and urbanization?
Will the processes of transformation in traditional medicine lead to a strengthening of
their role or, rather, to a decline in their popularity? What kinds of transformation have
been produced by the process of urbanization and modernization in traditional medicine
among the urban Mapuche communities in Temuco?
In the light of these considerations, the objectives of the paper are twofold. First, the
paper aims to analyze the role of traditional medicine among indigenous Mapuche people
living in the urban area of Temuco, Chile, a country where, despite the relevance of
traditional medicinal practices and intercultural policies, there is a paucity of studies on
this topic. Second, it aims to understand the processes of transformation and adaptation
indigenous medicine has undergone in the context of modernization and urbanization.

2. Processes of Change and Adaptation in Traditional Medicine

Indigenous and traditional societies continue to experience tremendous changes as their
economic and sociocultural life responds not only to the exigencies of modernization and
urbanization but also to the introduction of new production techniques and commercial
activities. One aspect of indigenous culture that has undergone considerable change is the
system of traditional medicine, i.e. the health knowledge, beliefs, values, skills and
practices of indigenous people, including all clinical and non-clinical activities and
institutions that relate to the health needs of the people (Belliard & Ramı́rez-Johnson,
2005; Colvard et al., 2006). In spite of a significant amount of research that has
been conducted on traditional medical practices in several Latin American
countries, changes occurring within urban areas have not been a focus of research
(Barnes et al., 2007).
Cultural diversity has affected health care in significant ways. How health care is
delivered, accessed and perceived is dependent on the “health world view” of an
individual or the collective health world view of a community (Turton, 1997). A world
view is the lens through which people see and make sense of the world; it helps locate an
individual’s “place and rank in the universe” (Samovar & Porter, 1994, p. 15). A health
world view is used in this article to refer to the way people understand and view health and
illness and where they see themselves in the greater scheme of health care systems.
Medical culture has been defined by Last as “all things medical that go on within a
particular geographical area” (Last, 1981, p. 388), “composed of competing systems
derived from distinct cultural groups” (Last, 1992, p. 406). The salient idea of a medical
culture is the lack of a consistent body of theory of medical ideas and practices (Last,
1981); a significant aspect of a medical system, on the other hand, is the coherence of its
theories (Leslie, 1976) and the organization and power of its practitioners (Last, 1992).
There has been a trend in public health studies and in the area of medical anthropology
to conceptualize the presence of parallel and complementary treatments following the
systemic approach of medical systems (Han, 2000; Nguyen, 2003; Kirmayer, 2004;
Mariman, 2004; Green et al., 2006).
 Illness and Healing in Urban Areas in Chile 391

State societies manifest the coexistence of a highly elaborate array of medical traditions
at both the conceptual and the practice levels, a pattern that medical anthropologists call
medical pluralism (Kaptchuk & Eisenberg, 2001; Hernández, 2003; Greenhalgh &
Wessely, 2004). In other words, the medical system of state-level societies tends to be
made up of various medical subsystems that coexist in a particular sociopolitical
environment. The environment ranges between extensive cooperation and open conflict.
Some studies assume that acculturation may result in conflictive relationships between
medical systems (Kaptchuk & Eisenberg, 2001, Quinlan et al., 2002; Sandhu & Heinrich,
2005). Although the contact between conventional medicinal practices and traditional
healers in urban areas may be actually or potentially conflictive, it may also provide an
opportunity for role adaptation. This could be the case if elements of the ideology and
behavior patterns of the impinging culture are adopted to enhance therapeutic efficacy, and
even to strengthen the traditional healer’s status in his or her own society (Nguyen, 2003;
Yoon et al., 2004; Zuluaga, 2005).
Some traditional healers’ roles may resemble those of marginal actors caught in an
insoluble dilemma involving the pull of the “culture of orientation” on the one hand, and
that of the “culture of reference” (here, scientific Western medicine) on the other; but
frequently the traditional healer maintains a strong position in his or her membership
group while borrowing liberally from Western medicine. The healer does this without
necessarily identifying with the reference group, to which he or she accepts realistically
that the doors to membership are closed, and without losing his or her psychological and
social stability through fruitless floundering between the two cultures (Greenhalgh &
Wessely, 2004; Kirmayer, 2004).
We define role adaptation as the process of attaining an operational sociopsychological
steady-state by the occupant of a status or status set through sequences of “role bargains”
or transactions among alternative role behaviors. In situations of rapid cultural change,
such as those produced by urban immigration, alternative behavioral possibilities,
expectations, rewards and obligations will originate both within and without the
indigenous social system. All individuals in any sociocultural system are confronted with
“overdemanding” total role obligations (Goode, 1960, p. 485) but must manage to balance
role relationships and role sets through continual bargaining and agreements with other
actors in the system. The example of the traditional healer’s role, under potential stress
from the demands and temptations of the competing medical system, represents an
extension of Goode’s theory of role strain (cf. also Banton, 1965).
In the medical culture of the Mapuche community living in the urban area of Temuco,
Chile, parts of different systems are incorporated and intertwined without being brought
together in any overarching theory. Mapuche practitioners apply similar conceptions of
body functioning and pathology recognized in conventional patient treatment; however,
Mapuche healers do not have associations, licensing or exams to provide consistency to
their work. Like many in the general population, the Mapuche have difficulty accepting
the logic of the theories that form the basis of conventional medicine (biomedicine),
although they seek care from biomedical practitioners. With the process of increasing
assimilation to the dominant Chilean culture following immigration into urban areas, the
Mapuche are exposed to new concepts when chronic illnesses, such as cancer, stroke and
diabetes, are diagnosed by biomedical practitioners.
A review of existing literature indicates that few studies have explicitly analyzed changes
occurring in the practice of traditional medicine in Latin America (McFarland et al., 2002;
392 M. C. Torri

Hahn & Inhorn, 2010). Although some relevant research findings exist, most are
fragmentary and unsystematic. Changes occurring in the practice of traditional medicine
need to be explored, especially if the World Health Organization’s recent proposal that
traditional medical practitioners should be involved in National Health Planning and Health
Care Delivery Systems is to be assessed realistically. Knowledge of the nature and direction
of the transformations occurring in Mapuche traditional medicine is also required to enable
health planners to decide how traditional health resources could be mobilized to reduce the
rates of morbidity among indigenous people in Chile as well as other Latin American
countries.
The various ways in which healers, for example, have altered or are adapting their
training, therapy and organization to meet current sociocultural, economic and political
changes need to be investigated. It is important to study the different processes of change
in the curative, preventive and sociopolitical roles of traditional medical practitioners.
This article examines the impact of social change on traditional medical practitioners in
Chile (machi). Using an example from the Mapuche community living in Temuco, the
main objective is to assess the hypothesis that an encounter with the dominant Chilean
culture in urban areas can, under some conditions, reinforce indigenous medicine by
updating its practices and pushing it towards increased specialization in psychotherapeutic
treatments.

3. Methodology
The field study took place in Chile, in the city of Temuco (IX Region), from March to May
2009. The city of Temuco is located in the Araucanı́a region (southern Chile), 670
kilometers south of Santiago. Temuco has some 300 000 inhabitants and is the city with
the highest population of Mapuche in Chile.
Individual interviews and observations were designed to collect data about the world
views and beliefs of practitioners and patients, as well as broader contextual material.
A sample of 12 traditional healers (machi) and 40 patients who visited the machi were
interviewed. The patients were selected on the basis of age, gender and ethnic background.
In order to take the gender component into account, half of the interviewees were women.
The age of the subjects interviewed ranged from 22 to 65 years. All the patients interviewed
belonged to the Mapuche community and lived in Temuco or in its periurban areas.
A common challenge in cross-cultural investigations of medicine and healing is to
understand diagnoses and treatments in medical systems that differ in their fundamental
assumptions and principles from those of conventional Western medicine. An important
aspect of this study has been the development of a methodology that both investigates
ethnomedical concepts of illness and utilizes conventional (biomedical) diagnostic
categories. The traditional practitioners who participated in this study were approached as
colleagues and recognized as experts in their healing tradition. For example, practitioners’
time was compensated, they contributed to the design of the interview methods and they
were frequently consulted as questions on ethnomedical concepts arose. The intention was
to ascertain the relevant diagnostic criteria as defined by the healers and to avoid imposing
biomedical perspectives.
Most people who are recognized in the community as traditional healers and who
prescribe herbal remedies do not hold official qualifications or licences; referrals are by
word of mouth and their “credentials” are a matter of community consensus. Practitioner
 Illness and Healing in Urban Areas in Chile 393

selection was, therefore, based on referrals from the community, together with an initial
in-depth interview with the practitioner. Selection criteria for practitioners included self-
professed knowledge about medicinal plants and treatment of a substantial number of
patients.
The neighborhoods of Pueblo Nuevo and Santa Rosa were selected for investigation
because of their high concentration of Mapuche communities. Practitioners were located
by establishing contact with community organizations and staff in health food stores and
selected botánicas in the neighborhoods. Botánicas are eclectic shops that sell fresh
and dried medicinal plants, tonics, books, and religious and spiritual items such as candles
and incense.
The study involved three stages of data collection: (1) open-ended, in-depth interviews
with practitioners to obtain information about their background, training and methods of
practice; (2) observations of patient – practitioner consultations; and (3) open-ended, in-
depth interviews with the patients. The interviews were conducted in Spanish, tape-
recorded and subsequently transcribed and translated into English. All patients, but only
one practitioner, agreed to be audiotaped; the information from the untaped interviews was
entered on to questionnaires and supplemented by extensive notes. In order to assure data
confidentiality, the names of the interviewees have been omitted or changed.

4. Results and Discussion

4.1 Mapuche Medicine: Some Distinctive Features
In the Mapuche vision, the causes of disease are divided into three categories: diseases
caused by nature (re kutran); diseases caused by supernatural/magical influences (weda
kutran); and supernatural diseases caused by spirits (wenu kutran). The traditional
Mapuche healers are known as the machi, and are mostly female. It is said that a machi is
chosen by “Chaw Ngenechen” (spirit guide) and called by dreams or visions when she is
relatively young. A new machi inherits the spirit of an ancestor through maternal lineage,
commonly from a grandmother that has passed away. After having experienced the dream
or vision, acknowledgement of the vocation occurs through an illness of the future healer,
which must be cured by a machi.
The machi interviewed generally use empirical and natural methods (herbs and very
occasionally natural pharmaceuticals), together with magical and spiritual methods that
are part of their rituals: prayers, singing and playing the kultrun, a traditional Mapuche
instrument. All machi interviewed highlighted how in all Mapuche healing rituals the
efficacy (therapeutic value) and the ritual execution by the machi are both important in
healing the patient. According to the traditional logic of the Mapuche, the first aspect is
inseparable from the second.
Commonly, the machi diagnoses illness by looking at a person’s urine. Clothes and
other objects frequently used by the patient can also be used. The machi use various types
of medicinal herb to make infusions and decoctions to cure or prevent diseases. From the
interviews with the traditional healers, it emerged that the plants used have numerous
medicinal properties as well as symbolic and spiritual values. It also emerged that there are
several ways in which the traditional healers acquire their knowledge of medicinal herbs.
The most important is through dreams where the spirit guide of the machi delivers him a
package of herbs that “work well”.
394 M. C. Torri

5. The Use of Medicinal Plants and their Cultural Context

According to the Mapuche, plants do not just belong to nature and to the universe, and
their therapeutic value, from an ontological point of view, is attributed to them by
supernatural forces. The interviews show how the machi and local communities believe
that each plant has a protective deity, called the Ngenenmapun. The machi has a duty to
pray to the divinity that “dwells” in the plant in order to seek authorization to collect and
use it to heal patients. The selection of which medicinal plants to use will depend on the
cause of the disease. This aspect determines whether the sickness can be treated at home or
by a machi.
In general, both the diagnostic process and the therapy carried out at home have an
empirical nature, but in some cases involve religious elements, such as prayers, which are
used while collecting and using the plants and while performing other ritual and symbolic
actions. For diseases perceived as “spiritual” (weda kutre), however, which are generally
considered to be more serious, stronger remedies than those for physical diseases are
required.
Plants also have a preventive action, according to the Mapuche, and can be used to chase
away evil forces. Plants with a protective function are typically spicy or have a pungent
smell. The plants most commonly identified with this function are the refu (Solanum
valdiviense Dun.) and the triwe (laurel, Laurelia sempervirens). The plants most
frequently cited by the machi interviewed are the foye or cinnamon (Drymis winteri), the
triwe or laurel (Laurelia aromatica) and the maqui (Aristotelia maqui), all of which have a
sacred value among the Mapuche.

5.1 Mapuche Medicine versus Western Medicine

The function of the machi has outlasted many other Mapuche traditional authorities. This
has been explained by the machi’s ability to adjust to new and shifting demands in society
(Bacigalupo, 1998) and to increased urbanization among the Mapuche. In this
development, the role and the services of the machi have progressively adjusted to meet
the demands deriving from cultural shifts and identity crises within the Mapuche
community, as well as new demands resulting from the modernization processes in
society. Part of that modernization process in Chile has been an increase in privatization,
which has also affected the health sector. This situation has created a growing need for
alternative services, which the machi have been able to supply. Moreover, the role of the
machi has developed an ability to complement medical systems. The adaptability of
the medical role of the machi can consist, as we shall see, of their ability to specialize in
the field of illnesses considered supernatural or spiritual, to which Western medicine
provides no answers. This flexibility is built into the Mapuche classification of illnesses,
in which Western medicine can be considered for treating physical symptoms and
non-spiritual illnesses.
The Mapuche patients interviewed seek biomedical care for a variety of health
problems, including local and systemic infection, traumatic injuries, acute illness, and
chronic illnesses, such as hypertension and diabetes. They also purchase various over-the-
counter medications such as aspirin or decongestants. These medicines are said by some
Mapuche to be more effective than traditional herbs. The interviews showed that the lack
 Illness and Healing in Urban Areas in Chile 395

of health insurance or money to pay for preventive as well as curative biomedical care was
a barrier for many.
The machi attend many sick people, both Mapuche and non-Mapuche, who are
dissatisfied with the diagnoses and treatment available in Chilean hospitals. The patients
interviewed also emphasized that they went to see a machi when conventional doctors
were unable to diagnose an illness but they continued to feel ill (e.g. psychosomatic
diseases), or if the treatment in hospital and the use of pharmaceutical drugs failed to
relieve their ailments.
Often Mapuche patients with minor ailments are frustrated because Western physicians
“do not recognize” their disease immediately, as the machi does. They said that doctors
asked many questions and asked the sick person to undergo numerous expensive and
embarrassing examinations with various specialists before even diagnosing their illness.
Another aspect of the machi, often emphasized by the patients interviewed, was their
ability to give some indication of the future evolution of the disease through their capacity
for divination. This way of tackling the disease and its diagnosis is culturally significant
for many members of the Mapuche community. Indeed, knowing the evolution of the
disease straight away allowed the patients and their families to adjust more quickly to the
situation. This also gave them an opportunity to redirect or readjust their behavior within
the social and familial environment.
One of the most common criticisms that the machi interviewed made with respect to
doctors is that they are sometimes too rigid with their patients and do not allow them to
relax and be cured in a “positive” environment surrounded by friends and relatives. “Many
times hospitals make patients feel worse. Patients are in an ‘artificial’ environment and
physicians do not measure the side effects that the remedies prescribed for them can
cause” the machi, Jaime, stated. On the other hand, according to the majority of patients
interviewed (32 out of 40) the machi provided a personalized service and offered a holistic
treatment that is not commonly found in Western medicine.

5.2 An Increased Specialization

The machi in urban areas have become increasingly specialized in treating “spiritual”
diseases, which would be defined as psychosomatic diseases according to the modern
Western concept of illness and health. Although the machi coexist with practitioners of
alternative medicine, such as naturopaths or homeopaths, as well as modern Western
medicine, they claim that they are the only ones capable of curing spiritual diseases.
A machi explains: “The disease caused by evil is what is more common nowadays, this is
what I cure the most. It is produced by the envy that people have and by evil spirits.
I cure especially these problems.”
Practitioners all reported that they typically treat people with a wide range of physical
and psychological conditions. Women are reported to be frequent patients and one-third of
the women interviewed declared they saw a machi on a regular basis. The ailments most
commonly reported by the women interviewed were more psychological than physical,
associated with emotional problems (e.g. nerves, anxiety and depression) or family
troubles.
The women interviewed also said that they often consulted a machi for physical
complaints, in particular for reproductive health and gynecological problems. According
to the machi, this can be explained by the fact that women feel more comfortable
396 M. C. Torri

discussing such topics with a traditional healer than a doctor. As a machi explained:
“There are several women that told me they didn’t dare ask for advice from the doctor
when they have a gynecological problem as they feel intimidated by him . . . with me they
say that it is ok, they say they feel at ease . . . ”
Rosita, a young woman in her early 30s, described her experience with a machi:

I went to see a machi because I had a menstrual problem and I was not too
comfortable about seeing a doctor and talking to him about this issue . . . We spent
time discussing it . . . I feel depressed these days as I had a miscarriage six months
ago and I still feel emotionally overwhelmed . . . the machi listened to me and she
reassured me, saying that I will have another baby soon . . . She said that she will
pray to Jesus for that . . . I was feeling very relieved at the end . . . The machi
effectively cured my menstrual disorder too: she burned some leaves and she put
them on my abdomen while singing a song in Mapudungun and playing the kultrun,
our traditional instrument. Finally she gave me a decoction that I needed to drink for
several days . . . I feel much better now . . .

We might emphasize how healing employs the extended metaphors of secular and
religious ritual to create and restore harmony within the individual and therefore to fill the
sufferer’s experience with meaning and to increase morale (Bloom, 2002; MacPhee,
2003).
Healing involves a basic logic of transformation from sickness to wellness that is
enacted through culturally salient metaphorical actions, such as the use of plants and of
musical instruments and enchantments. Levi-Strauss argued that the transformations of
healing involve a symbolic mapping of bodily experience on to a metaphoric space
represented in the ritual (Albretch et al., 2000; Brown, 2008). At the heart of any healing
practice are metaphorical transformations of the quality of experience (from feeling ill to
wellness) and the identity of the person (from afflicted to healed).

5.3 The “Alienation” of the Mapuche Community and the Healing Role of the Machi
The Mapuche’s current difficult economic situation is undermining the traditional rural
lifestyle of the communities, thus forcing them increasingly to interact with the modern,
urban Chilean world (Mariman, 2004). The impoverishment of the Mapuche community,
most of whom possess a limited amount of land, often of poor quality, frequently causes
conflicts among neighbors concerning the appropriation of the land and increases bad
feelings towards those who are believed to possess more than what is considered to be
“a fair share of land”. According to some of the members of the Mapuche community
interviewed, this situation is contributing to increased tension among the families and is
eroding the social solidarity and reciprocity that were supposed to exist in the past in these
communities. In the last few years, land shortages and economic problems have forced a
growing number of Mapuche to seek work in the city or to become laborers in the farms
owned by white Chileans (Ray, 2007). As José, a Mapuche man in his early 50s affirms:
“The problem is that we have no land to work. When we were born, we were many
brothers and had no place for all of us to work the land. Because I couldn’t find work in the
village where I was living, my older brother says to me ‘Why don’t you try it out in
Temuco or Santiago?’”
 Illness and Healing in Urban Areas in Chile 397

Currently, 80% of the Mapuche population lives in the city, but the Mapuche notion of
identity in Auracania is still centered on a fundamental idea of a rural community that has
remained quite traditional and static over time (Hernández, 2003). The image of Mapuche
people as it is portrayed among white Chileans often ignores the complexities of Mapuche
ethnicity (Mariman, 2004). Many Mapuche feel uprooted and alienated in the city.
Twenty-eight out of 40 Mapuche people interviewed, especially those in their late 40s and
50s, emphasized how after they moved to Temuco they had progressively lost touch with
their families, with their plots of land, and their sense of belonging to a community.
This sense of alienation is evident in the words of a man in his early 50s who affirms:

Before coming here in Temuco I lived in a village about 100 km from here. It was
better living in the village, I knew everybody and everybody knew me. I used to
meet people after work, I had a social life . . . Here it is very difficult to meet people,
to have friends . . . many Chileans don’t like Mapuche people and I feel
discriminated against.

Moreover, the fundamental differences between Chilean and Mapuche culture and the
discrimination against indigenous people in the city limit their opportunities for well-paid
work. In this respect a young man in his late 20s affirms:

I have a diploma as a technician . . . I came to Temuco as they told me that there

were more job opportunities but this was not the case . . . I have sent my résumé to
many different places but I have never been considered. I think that the winka (the
white Chileans) don’t like the Mapuche, they think we are stupid or lazy . . . that is
why it is so difficult to find a job . . .

After moving from rural to urban areas, the Mapuche also feel under stress, as they have to
meet the new demands of the city. While some of the Mapuche try to adapt to new
circumstances without losing their cultural identity, the transfer from an ideal of social
solidarity and reciprocity, present in the rural milieu of the Mapuche, to a capitalist and
competitive environment produces confusion and insecurity among those who immigrated
into the cities. A Mapuche man in his late 20s explains:

When I was living in my community before coming to Temuco life was much easier
and I was happy. I used to know everybody and if I had a problem I could ask for the
advice and the support of my family and friends. I had time for myself and my
family. Now I work all the time, I barely know anybody in the city and I often feel
lonely.

The Mapuche have different reactions to this challenging situation, which ranges from a
process of “Chilenization” in the city to a return to their communities to work the land. The
most common reaction is to change the way they appear and act according to the new
context; but whatever the answer, feelings of unease, tension and anxiety remain.
This situation has produced a series of psychosomatic illnesses that the Mapuche often
attribute to the “evil” sent by a third person. The anxiety felt by the individuals who are the
target of this “evil” continues to increase because, according to many Mapuche,
wrongdoers are rarely identified and evil spirits can be chased away but never really
398 M. C. Torri

eliminated. Here, in the Mapuche vision, as in the vision of several other traditional health
approaches, afflictions are understood to involve a wider social network and healing
practices should therefore address that larger system (Summerfield, 2002; Conrad, 2007).
The interviews emphasized how this sentiment of anxiety is particularly present among
the younger generations of Mapuche. One of the machi interviewed was surprised by the
number of children and young people who come to visit her. Most of them suffer from
“depression”; at least that is how they have been diagnosed by psychologists. The machi
views these cases more as cases of spiritual disorientation: “They live in a reality which is
too competitive. They cannot find the adequate resources with which to face it”, she
affirms.
Some psychiatrists have established a link between migration and social mobility, and
certain types of psychological conflict and mental disturbance (Bhui et al., 2003; Cantor-
Graae et al., 2003; Cooper, 2005). Some studies have found a clear relationship between
certain forms of psychosis and the anxiety experienced by the Mapuche in urban areas
(Vicente et al., 2005; Alegria et al., 2008). Whereas modern Western culture classifies
such mental diseases in terms of “madness” or “abnormality”, Mapuche medicine makes
distinctions within these types of illness. Some psychological illnesses are classified by
machi as Mapuche spiritual diseases, whereas others are seen as symptoms of insanity.
According to the more traditional vision of the Mapuche, individuals prone to fantasizing,
having visions or hallucinations and daydreaming are not abnormal. A person only
becomes pirulonko (mad) if wesalonko (bad headaches) are not properly exorcised and the
person becomes aggressive and constantly behaves in an unusual or dangerous way.
Several Mapuche who have recovered from “psychotic illness” attribute their illness to
divine punishment for turning away from traditional Mapuche rules (Kastrikutran). Other
causes cited by the interviewees to explain these spiritual diseases are thinking, feeling and
imagining too much, or topetun (also known as magical fright), which is produced by an
encounter with a Wekufe (evil spirit).
As the machi are still people of prestige within the Mapuche society, the advice they
give to patients helps them solve their problems in a way that is culturally acceptable and
at the same time is adequate for the new demands of modern Chilean society. The machi
therefore seem to be able to bridge the gap between the individual and his or her universe,
and in doing so they relieve the feeling of alienation that many members of the Mapuche
community experience in urban areas.
In this respect, a Mapuche patient affirms:

The machi knows the Mapuche culture thoroughly . . . When I visit a machi I feel at
ease as I know that he can understand my cultural background, the values which I
have been brought up with . . .

From the perspective of biomedicine, authors have contrasted the physiological effects of
physical healing and the psychological effects of rituals, ceremonies and other symbolic
action. On closer inspection, however, this distinction is hard to sustain. Research on the
many types of placebo effect makes it clear that symbolic stimuli and psychological
attitudes and expectations can exert myriad effects on physiology, facilitating healing or
aggravating disease (Roof, 1998; Van der Veer, 2001; McMahan, 2002). Of course, this
symbolic efficacy is not limited to psychosocial interventions: any intervention will have
psychological and social effects based on its meaning for the patient and others with whom
 Illness and Healing in Urban Areas in Chile 399

they interact (Scheff, 1979; Kirmayer, 2003). Consequently, the material and symbolic
effects of healing must be considered part of one interacting system.

5.4 The Machi in Urban Areas: Renegotiating Identity

Almost all the machi are traditional in some respects and have adapted in others. This
allows them to interact with today’s modern world while at the same time remaining
faithful to a traditional way of life and world view. Some of these traditional notions are
that machi should always be married, must pray to their spirit and ask permission of the
rewe1 when they want to leave the house. It is believed that they become sick if they
violate the rules that are considered appropriate for the machi, or when they are absent
from their homes for long periods of time.
This process of adaptation and renegotiation of identity with modernity and the
dominant political and cultural system is not always simple: five out of 12 machi
interviewed affirmed how, in some cases, they have been accused of being “awinkados”
(too close to mainstream Chilean society) and of being unable to portray and preserve
Mapuche traditions sufficiently. They have also been accused of becoming “businessmen”
and too money-oriented, trying to charge high fees when consulted and preferring to attend
foreign patients who are able to pay more money. This category of machi was deprecated
by the Mapuche patients interviewed and they were considered to have limited knowledge
of Mapuche traditions and to be more oriented towards capitalist values than the values of
reciprocity, solidarity and community well-being. An example of this category of machi,
trying to increase visibility and social recognition through modernity, was provided by the
machi Sergio, who during his interview declared that he would have liked to be filmed and
appear on television. According to him, this would increase the number of his patients and
enhance his prestige. This machi also emphasized with pride how some photos of him
were sold at the Central Market in Temuco.
When the machi acts only in strict accordance with traditional ways, however, without
any adaptation to ‘modern’ society, their popularity as healers may on some occasions be
undermined. From the data, it appears that some machi were losing their clients because
they were following a very traditional way of healing, which was not fully understood and
accepted, especially by the younger generations. A woman patient in her 30s explains
this point:

Machi Isabel is a very traditional machi . . . She does not speak Spanish, she has
nothing to do with winka, the white Chileans, and she does not understand anything
of their world. She can only “see” the disease when she is possessed by her guide
spirit, not in urine samples as other machi do. Now she sees very few people. People
come to see her only when they have a very serious disease produced by evil forces
because she knows how to do these treatments such as “machitun” that are very
expensive and very exhausting. She does not treat people with herbs. That’s why the
people are going to see other machi. She is too old, she works as in the old times.

6. Conclusion
In urban centers, migrants from indigenous backgrounds make active use of the wide
variety of healing traditions available. Complementary and traditional systems of healing
400 M. C. Torri

are widely used among people who have migrated to the urban areas, although specific
forms may be more or less popular among particular ethnocultural groups (Kirmayer,
2003; Trevathan et al., 2007).
In economically developed countries such as Chile, where biomedicine has achieved
enormous structural power and professional sovereignty, non-biomedical healing systems
continue to attract substantial numbers of patients. Why this is the case is a complex
question. This study has shown that this phenomenon can mainly be explained by two
factors. First, the traditional medical systems of Mapuche are able to frame diagnosis and
treatment in terms compatible with locally salient belief systems that hold clear benefits
for patients attempting to cope with illness, including but not restricted to simple
therapeutic efficacy. Second, indigenous medical resources are perceived to be part of a
larger, “metamedical” framework within which ethnicity and rapid social change both
resonate with and are expressed through patterns of illness behavior (Fauconnier &
Turner, 2002). In multicultural urban settings, tradition and healing practices often
undergo creative change and hybridization (Scheff, 1979; Kirmayer, 2003).
The field data in this paper highlight how the use of traditional medicine is not just
restricted to rural areas in Auracania but is present in the urban area in Temuco. The article
shows that the role of the machi has gone through important changes from an ideological
point of view, as well as in its empirical practice in the city of Temuco.
While Mapuche traditional medicine continues to maintain its beliefs about the
explanation of diseases and their possible cures, the contact the Mapuche have with Chilean
society has produced important transformations. The article shows that in the urban context
Mapuche traditional medicine still plays a relevant role because it is capable of addressing
people’s physical as well as psychological complaints. The machi have chosen to locate
themselves in areas close to urban centers because they have adapted their traditional roles
to the current situation of the Mapuche and created a new cultural synthesis of what it means
to be a machi, the role they play and the expectations that patients can have from them.
The paper shows that under some circumstances, Mapuche medicine can benefit from
contact with another culture, extending its sphere of influence by updating its practices.

Note
1
The rewe is the sacred altar used by the Mapuche of Chile in many of their ceremonies.

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