In the opening sentences of the preface to her book “I Choose Life”: Contemporary Medical and Religious Practices in the Navajo World, Maureen Trudelle Schwarz writes: “My first and foremost goals as a scholar are to foreground Native voices whenever possible and to present native views with respect” (ix). These goals are readily apparent, at the level of both content and structure, throughout this book exploring the relationship between Navajo notions of health and illness and what the author terms the contemporary moral and political landscape of Navajo people. Beginning each chapter with excerpts from her interviews, Schwarz foregrounds her consultants’ perspectives as the starting point for her well-researched and well-written exploration of the topics covered in the following pages. Indeed, she dedicates much space in the book to the illness narratives and interpretations her Navajo consultants shared with her during her field research, highlighting both their individuality as well as the commonalities that tie them together.
In chapter 1, appropriately entitled “Groundings,” Schwarz introduces the various conceptual strands she seeks to tie together throughout the book, including Navajo oral history, Navajo ideas of relatedness and collective identity, cultural trauma, individual heath care choices, and medical and religious pluralism. This introductory chapter makes clear to the reader the complex nature of Schwarz’s project, and in the following chapters she weaves these strands together impressively into an analysis that demonstrates “how by negotiating among competing medical discourses and practices, Navajo people creatively respond simultaneously to an immediate crisis of illness or accident, specific contradictions within their family and community, and the ongoing fragmentation of traditional society” (28).
In chapter 2, “Christianity, Biomedicine, and the Native American Church,” Schwarz historically contextualizes her analysis. The history she offers includes the Navajo’s introduction to allopathic medicine during their forced internment at Fort Sumner and the role Christian missions – as providers of education, spiritual guidance, and healthcare – played in the development of the medical and religious pluralism she explores in the book. Schwarz pays particular attention to the development of the Native American Church (NAC), “a pan-Indian, semi-Christian, nativistic, redemptive religion focused on the ritual ingestion of peyote” (58). Situating native Christian beliefs within frameworks of incorporation and syncretism, she lays a solid groundwork for examining the flexibility and innovation in traditional health belief systems.
Schwarz begins chapter 3, “The Politics of Language and Well-Being,” by identifying a pattern in her interviews with Navajo individuals, specifically the idea that “at different levels of understanding, what are perceived to be recently introduced diseases such as diabetes, cancer, and heart ailments actually stand for social change, loss of tradition, and conflict with their colonizers” (89). She then situates these ideas about health and illness within a broader framework of historical trauma experienced by the Navajo since colonization. After introducing the “us-them” binaries constructed in individual accounts of illness, Schwarz turns attention to the power and performativity of language in traditional Navajo beliefs, whereby talking about illness risks calling it into being. Through this discussion, she highlights the differences in perspective between some Native patients and some allopathic providers, citing specific examples of unintentional conflicts arising from explicit language choices made by health care providers. She concludes the chapter by identifying key health idioms emerging from her interview data with her Navajo consultants, including loss, balance, redemptive suffering, and predetermination, to illustrate how ideas about health are internalized at the local level.
In chapter 4, “Sources of Pathosis,” the author looks at the role that contamination plays in the illness narratives she collected, turning to oral histories and Navajo origin stories to explore in greater depth Navajo perceptions of illness as manifestations of conflict with colonizers. In the following three chapters, she examines how beliefs about contamination are negotiated by individuals as they engage with different biomedical technologies, including blood donations, transfusions, and CPR (chapter 5, “The Exchange of Life Substances”); surgeries and amputations (chapter 6, “Surgery and the Disposal of Body Parts”); and transplants (chapter 7, “Transplants”). In these chapters, she uses the words of her consultants to demonstrate the variety of ways in which people draw upon different religious belief systems, ranging from Christian beliefs in redemptive suffering to participation in traditional healing ceremonies, highlighting the “inherent flexibility in Navajo traditional religion enabling it to accommodate the unexpected” (282).
In chapter 8, “Closing Thoughts,” Schwarz rearticulates her major arguments, tying her insights back to the key ideas she introduced in chapter 1. Understanding the personal testimonies of illness she collected during her research in light of cultural trauma and exploring how global forces are mediated at the local level, she ultimately argues that “the coexistence of [biomedical technologies, Navajo traditional belief systems, the Navajo Native American Church, and native Christianity] is dependent on the biomedical system being integrated into the world within a set of traditional philosophical tenets governing notions of the body and identity” (330).
While her argument is quite complex, she ends chapters 3–7 with a concise summary of each chapter’s main ideas, thereby providing the reader with useful “touchstones” for tying the information in the chapter to the broader arguments of the book. The topic of this ethnographic study is extremely timely, and it offers insights that will be of great interest to a range of readers, from those interested in Navajo health issues specifically to those interested in the dynamics of religious belief systems more broadly. I could see her book working particularly well in graduate classes to open up conversations about religious and medical pluralism, for example, or about how the body can function as a space for asserting and contesting notions of identity. On the final page in the concluding chapter, the author explains that in writing this book, she seeks to offer insight both for scholars studying religious and medical pluralism and allopathic providers working with indigenous populations (332). Based on my reading, she has successfully reached these goals.
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[Review length: 986 words • Review posted on November 23, 2011]