How the Body Gets Healthy: An Empirical Case of Animism and Naturalism Working Together in the Treatment of Disease Among the Nuosu People of Southwest China

Abstract

This paper examines perceptions of illness and related therapeutic practices observed among the Nuosu, an ethnic minority group of Southwest China. The paper will discuss the interplay between animism and naturalism in the treatment of Nuosu illness. Through a case study of a young Nuosu woman’s treatment of illness, the analysis reveals a relationship between animism and naturalism that is both antagonistic and synergistic. At the epistemological level, these two ontologies diverge; however, when confronted with differences in knowledge, the Nuosu worldview and view of illness exhibit a ‘relational’ model of intimate connection between human and non-human entities. The Nuosu did not reject naturalism, but rather ‘made connections’ in a way that led to greater intellectual convergence between animism and naturalism, thus providing a basis for cooperation between the two. On a practical level, modern medicine focuses on physical healing, while the Nuosu’s rituals emphasize the healing of the soul and body to achieve health. The integration of animism and naturalism in the healing process by the Nuosu allowed for cooperation and complementarity between the two in the realm of practice.

1. Introduction

In the early anthropological studies, animism was regarded as an indigenous belief system and cognitive framework. In his work Primitive Cultures, Edward Tylor (1871) was the first to introduce the concept of animism, positing that the notion of the ‘soul’ is central to animism. He argued that this concept was pervasive in early human societies, serving as a philosophical foundation and belief basis for various cultural practices. Today, it persists among some indigenous populations as a form of ‘survival’. Lévy-Bruhl (1923) elaborated that animism represented an early form of logical reasoning among ancient peoples, which diverged significantly from modern cognitive frameworks. For an extended period, the advancement of natural science and technology has led to an increase in natural disasters, resource depletion, extreme climate events, environmental pollution, species endangerment, and other issues. The proliferation of environmental crises has challenged the notion of ‘anthropocentrism’. Since the 1990s, scholars such as Nurit Bird-David (1999, 2006), Philippe Descola (1992, 1996, 2013), Tim Ingold (2000, 2006), and Eduardo Viveiros de Castro (1998, 2004, 2012) have moved away from Taylor’s evolutionary paradigm and the dichotomy between spirit and matter. They have embraced neo-animism as a foundational element for the ontological turn in anthropology, exploring the direct connections between humans and non-humans with renewed vigor.

New animism posits that animism is a belief system wherein natural entities are endowed with a soul principle (Descola 1992, p. 114). According to this perspective, these entities exhibit agency, vitality, a life force, and a sense of personhood (Ingold 2006, p. 10). The concept also explores the potential unity and interiority between humans and non-humans (Descola 2013, p. 120), as well as the proposition that all natural beings in the universe possess consciousness and agency. This forms a critical foundation for the belief in the presence of spirit in all things.

In contrast to animism, which posits the existence of spiritual entities, naturalistic ontology presents a dichotomous framework between humanity and nature. Central to ontological naturalism is the assertion that ‘all spatiotemporal entities must either be identical to or metaphysically constituted by physical entities’ (Papineau 2023). Naturalism maintains that only natural causal entities with natural causal powers exist, and well-established science serves as the benchmark for identifying these entities and their powers (Oppy 2018, p. 2). According to Descola (1996, p. 88), naturalism asserts that phenomena occur in a regular manner independent of human volition, while scientific inquiry aims to uncover the laws governing such regularities. Consequently, the epistemological claims of naturalism align closely with scientific understanding (Dawes 2023, p. 155).

The natural science movement is grounded in principles such as ‘objectivity,’ ‘universality,’ ‘rationality,’ ‘neutrality,’ ‘certainty,’ and ‘accuracy’. It tends to dichotomize and antagonize nature and human society. In contrast, animism advocates for the ‘relationality’ between humans and non-human entities, emphasizing the interconnectedness of society and nature. The assertion that ‘the modern scientific worldview is incompatible with animism’ (Van Eyghen 2023) was once widely accepted. Can animism and naturalism collaborate to enhance human health? Historically, animism and naturalism have diverged significantly in disease diagnosis, prevention, and treatment. This divergence reflects the conflict between two epistemological systems: the local knowledge of animist societies, which is often deemed less objective and efficient for medical solutions, and modern natural sciences, rooted in modernity, which offer precise and effective treatments. Consequently, local knowledge and practices are frequently marginalized or disregarded in the advancement of global modernity.

Focusing on the disease treatment practices of the Nuosu people in Southwest China, this paper examines the coexistence of animism and naturalism within their disease traditions. The research employs ethnographic methods, including participant observation, interviews, and analysis of ritual practices and medical treatments. In June 2023, I established initial contact with a Nuosu patient, S, who had been diagnosed with a mental illness, as well as with her family members. From December 2023 to August 2024, I conducted multiple field visits to W Village in Liangshan, where I performed in-depth face-to-face interviews with the research participants at their residences and observed both traditional ritual treatments and modern medical interventions administered to the patient. During this period, in addition to interviewing and observing the patient and her family, I also interacted with several of the patient’s neighbors and relatives, as well as five traditional healers and two physicians involved in the patient’s care. As a member of Nuosu, I further served as a liaison and translator between the patient’s family and medical professionals during two treatment-related trips to Chengdu.

This study addresses the epistemological debate between animism and naturalism by exploring how these two perspectives are integrated into the Nuosu’s healing processes. The case of the Nuosu’s utilization of both animism and naturalism in disease treatment offers valuable insights and inspiration for fostering mutually beneficial cooperation between cultural and natural systems.

2. Animism and Souls Causing Disease: Nuosu’s View of the World and Disease

Animism serves as both a belief system wherein the Nuosu conceptualize health, illness, life, and soul, and a cognitive framework that guides their understanding of the relationship between humans and non-humans. The prevalence of animistic concepts in Nuosu society suggests a significant connection between humans and non-humans within their worldview, particularly through the dimensions of blood and spirit.

Nuosu’s epic poem Hnewo Tepyy (ꅺꊈꄯꒉ) recounts the origin and evolution of the heavens, the earth, humanity, and other species. According to the poem, ‘From the sky descended a bubbling tree which landed on the earth, then ascended in three mists before rising into the sky once more, finally descending as three red snowfalls. Nine days merged into nights, nine nights merged into days; from this transformation emerged ancestors and humans. Nine black and white sacrifices were performed. Ice formed bones, snow formed flesh; wind formed breath, rain formed blood; stars formed eyes, thus creating the Snow Tribe. There were twelve lineages of Snow Clan descendants, categorized into two groups: six with blood ties and six without blood relations.’ (Feng 2006, pp. 15–20). In the primordial era, the world was in a state of chaos. From this disarray emerged water, mist, and other elements that gradually coalesced to form the Earth. All living organisms evolved from an ancient substance akin to red snow. This substance gave rise to two main categories of life forms: six kinds of bloodless organisms, including grass, broad-leafed trees, conifers, water-sinewed grasses, lampsbane grasses, and vines, and six kinds of blooded creatures, frogs, serpents, eagles, bears, monkeys, and human beings. Throughout this evolutionary process, various natural things including ice, snow, wind, rain, and celestial bodies played significant roles. The Nuosu creation epic portrays an intricate web of interconnectedness between humans and non-human entities. According to this narrative, all things in the world originated from red snow. The Nuosu people believe that six types of creatures with blood are directly related by blood. It is traditionally forbidden to kill or consume these animals, as doing so is believed to invoke various calamities. Animals not belonging to these six blood relations are considered kin through marriage ties. Consequently, within Nuosu culture, terms such as ‘Eldest Brother Frog’ and ‘Maternal Uncle Tiger’ have emerged (Swancutt 2021, pp. 25–26).

The existence of blood relations between humans and certain animals alone is insufficient to demonstrate that the Nuosu people believe in the existence of spirits. More crucially, the Nuosu people hold the belief that due to the universal presence of ‘souls,’ all entities in the world—whether material or immaterial—possess life, souls, and power. This includes humans, ghosts, deities, animals, plants, natural objects, ancestors, the sky, the earth, and other phenomena. These souls are immortal, can be attached to certain objects, and can also exist independently.

The concept of animism is prominently reflected in the Nuosu religious rituals concerning disease prevention and treatment. According to this belief, all entities and their souls occupy specific positions between heaven and earth. If a soul is misplaced or if this balance is disrupted, humans may fall ill. Bamo Ayi (2003a) outlines several scenarios where the soul can cause illness: (a) Soul loss can lead to illness. The soul can separate from the body; when it is united with the body, a person is healthy and vibrant. Conversely, once the soul leaves the body, the individual becomes unwell. (b) Ancestral spirits can cause illness. The souls of ancestors require veneration and worship by descendants. Ancestral spirits are considered pure and can bestow prosperity and health upon the family. However, if descendants violate taboos, have issues with spirit positions, or maintain disharmonious relationships with ancestors, ancestral spirits may inflict illnesses. Moreover, if an individual’s illness is not purified through ritual after death, the illness can be ‘passed on’ to future generations. (c) Diseases attributed to malevolent spirits: If a deceased spirit fails to transition into an ancestral spirit, it may transform into a malevolent entity that brings about disease, death, and conflict among people. For a deceased spirit to become an ancestral spirit, two conditions must be met: the individual must have had offspring during their lifetime, and their descendants must have conducted the appropriate rites to send the spirit to its proper place. (d) Jjylup yyrla (ꐰꇑꒌꆠ) and its influence on health: Jjylup yyrla is a spirit believed to oversee various aspects of a person’s life, such as fertility, luck, and protection. This spirit is typically associated with a specific object within a household. Illness can occur if the object it protects is mishandled, defiled, or becomes tempted by external influences. (e) Occupational deities and nature deities can cause illness: Occupational deities, specifically the Wasa (ꊂꌒ) deities, safeguard various professions. Nature deities encompass elements such as mountains, water bodies, celestial bodies like the sun and moon, atmospheric phenomena including wind, rain, thunder, and lightning, as well as flora. While these deities have the power to bestow blessings upon people, they are also believed to inflict illnesses as a form of punishment. (f) Witchcraft is predominantly practiced by Bimo and Sunyit, and curses may serve either as a means to forge alliances or as a method to inflict harm upon enemies. Curses can be invoked in two primary ways: through alliances or by targeting adversaries. Furthermore, the Nuosu people hold the belief that cursing others generates destructive spirits through spoken words, which can result in various misfortunes, including illness or even death. (g) Taboos and their perceived consequences: The Nuosu people observe numerous taboos in daily life and religious rituals. Violating these taboos is believed to lead to illness. For instance, the presence of snakes in one’s home is considered an omen of impending sickness. Additionally, it is forbidden to bring lightning-struck firewood into the home, consume crops struck by lightning, or reside in a house that has been hit by lightning. Such violations are thought to cause minor ailments like skin rashes, blisters, ringworm, and pimples, as well as more serious conditions such as leprosy, which can result in numbness in limbs or disability.

The belief in human and non-human spiritual entities influencing human health is deeply rooted in certain cultural practices. To maintain harmony and avoid disturbances, it is essential to adhere to specific behavioral norms in daily life. The Nuosu healer, known as Bimo, possesses the ‘Invitation of the Spirit of All Things Sutra,’ which aims to ensure the tranquility of all spirits. This ritual invokes the spirits of birds, beasts, crops, livestock, artifacts, and other elements, requesting them to remain in their rightful places and bestow blessings upon the family. Consequently, this practice seeks to promote the well-being of both humans and animals, a bountiful harvest, and overall prosperity (Huang and Ayi 2009, p. 248). In the event of a disaster or illness, the healers Bimo and Sunyit are summoned to perform religious rituals. Bimo, a hereditary role, primarily handles common illnesses through ritual activities such as reciting scriptures. Their main responsibilities include preventing and curing illnesses, praying for health, and ensuring the well-being of both the living and the spirits of ancestors. Sunyit, selected by the gods and equivalent to sorcerers or shamans, serves only the living. They address severe illnesses caused by malevolent spirits through various forms of divination, including singing, dancing, drumming, soul calling, exorcism, and ghost hunting. Both Bimo and Sunyit act as mediators between humans, spirits, deities, and ancestors, driving away impurities and restoring health by returning souls to their bodies or capturing malevolent entities.

Animism has significantly shaped the Nuosu people’s understanding of illness and healing practices. Consequently, the introduction of naturalism raises important questions regarding its impact on their perception of illness. How would the Nuosu people navigate between animism and naturalism in their health beliefs and practices?

3. Naturalistic Concepts of Medicine in Nuosu

Modern medicine has significantly advanced due to the development of modern science and technology, with its foundational principles rooted in naturalism. Naturalism posits that disease is a natural phenomenon resulting from dysfunction or abnormalities in human physiology. It advocates for understanding the nature of disease through the investigation of human physiological structure, function, and biochemical processes. The primary focus of modern medical treatment lies in restoring biological normalcy and elucidating physiological mechanisms, utilizing modern scientific and technological means to achieve precise diagnosis and treatment.

Naturalistic concepts of disease began to take root in the Nuosu region towards the end of the 19th century. The initial introduction of modern medical aid in this area was predominantly through the efforts of Western missionaries. Between 1888 and 1893, French Catholic missionaries, including Mgr. De Guébriant et al., provided medical treatment to the local population during their missionary activities in Mianning Lugu (Qin and Shen 2008, p. 539). During his missionary work, Earl identified cases of leprosy and funded the construction of a specialized treatment center outside the county (Xu 1995, p. 298). Subsequently, American Baptist missionary H.J. Openshaw established the first hospital in Liangshan Xichang (Zheng et al. 1992, p. 111). Following this, the Catholic Church opened hospitals in Xichang in 1919 and Huili in 1929, with a combined capacity of nearly 100 beds, two outpatient clinics, and approximately 10,000 annual patient visits (Qin and Shen 2008, p. 546). Despite these developments, missionary medical facilities remained limited in number and were primarily located in areas with mixed Nuosu and Han populations. Consequently, Nuosu communities residing in more remote regions continued to rely on traditional religious healing practices.

The large-scale promotion of naturalistic medical practices in the Nuosu region was initially spearheaded by the government. Beginning in the 1950s, China’s ethnic identification policy classified the Nuosu along with other closely related ethnic groups in Yunnan and Guizhou as one of the 56 officially recognized ethnic groups of the People’s Republic of China—the Yi ethnic group. Consequently, modern state nationalism and scientific discourse rapidly permeated Nuosu society through various channels. Between 1950 and 1957, the government established hospitals in each county of Liangshan Prefecture, alongside health and epidemic prevention stations, maternal and child health care centers, health clinics, and joint medical facilities, initiating treatment for endemic and infectious diseases such as schistosomiasis, hookworm disease, Keshan disease, goiter, Kashin–Beck disease, leprosy, tuberculosis, and venereal diseases. A particularly significant development was the extensive establishment of leprosy villages in the Nuosu region by the state. The government implemented isolation measures to accommodate all leprosy patients within the entire Nuosu region and treated them using modern medical methods. Diseases like leprosy, previously deemed incurable by the Nuosu people, were successfully treated with modern medicine, causing a profound impact on the local population. Some scholars argue that this represented the first direct and powerful confrontation between science and traditional beliefs in the Nuosu region (Guo 2007, p. 79). With governmental intervention, modern medical care was effectively implemented in the Nuosu region, leading to the successful treatment of numerous endemic diseases.

With the ongoing progression of globalization and modernization, the contemporary biomedical paradigm rooted in naturalism has increasingly shaped the Nuosu people’s comprehension and management of illnesses. The healthcare-seeking behavior is no longer confined to a singular governmental intervention model; instead, multiple paradigms have emerged, including self-medication and peer referrals for accessing modern medical treatments. Over several decades, the ontologies of naturalism and animism have continuously intersected within the social fabric of the Nuosu community. Presently, both ‘consulting spirits’ and ‘visiting doctors’ are integral components of the Nuosu people’s disease treatment beliefs and practices. While the utilization of Western medicine is prevalent and widely accepted among the Nuosu, traditional religious rituals remain an essential aspect of their daily health practices. The subsequent discussion will employ a specific case study to elucidate the intricate interplay between animist and naturalist ontologies in the Nuosu people’s approach to illness.

4. Mixed Treatment: The Healthcare Experience of a Nuosu Patient

The protagonist of this case, S1, is currently 16 years old. She was born and raised in what was formerly known as a leprosy village, now referred to as the rehabilitation village W.2 Established in 1968 in the northeastern part of Liangshan, W comprises a natural administrative village and a rehabilitation center. The village has 88 households, a population of 384, including 40 rehabilitated individuals. All residents are of Nuosu ethnicity, with agriculture and animal husbandry serving as their primary means of livelihood. The village encompasses a total of 390 acres of arable land. Due to its location at a higher altitude on mountainous terrain, the climate is relatively cold, and the land is characterized by steep slopes. Consequently, the villagers predominantly cultivate crops such as corn, potatoes, buckwheat, and round roots for sustenance. Most households also raise livestock, including cows, sheep, pigs, and chickens, which are utilized both for daily consumption and religious ceremonies. Additionally, villagers grow peppers, fruit trees, and vegetables near their homes primarily for personal use, with peppers being sold as agricultural produce.

As a former leprosy village, W Village has garnered significant attention and support from the outside world due to the challenges it faces in integrating into society as a result of the stigma and inequality associated with leprosy. In addition to government initiatives, several charitable organizations have become involved in W Village since the 21st century. Notable among these are Casa Ricci Social Services in Macau, Sisters of the Holy Family in Gansu, The Leprosy Project, XiChang Charity Social Service Center, and Zhongyuan Puji Charity Promotion. These organizations have provided sustained and impactful services in W Village over an extended period. Their volunteers, trained in modern medicine, offer dual services of healthcare and charitable relief. The medical assistance provided includes distributing medication for common illnesses, dressing wounds for elderly patients with ulcers, and organizing annual summer visits to villagers’ homes to provide hygiene guidance. Volunteers also educate children on recognizing and managing various health issues (such as skin diseases, eye conditions, gynecological disorders, diarrhea, fevers, headaches, AIDS, sexually transmitted infections, and drug-related concerns), promote the separation of humans from animals, organize household items, and clean living spaces. Both state and philanthropic efforts continue to pour into W Village, bringing with them extensive knowledge of disease from natural sciences that differs from traditional local practices, thereby enriching W Village with more modern medical discourse and resources than any other traditional Nuosu village. S’s pursuit of healing unfolds here.

4.1. Diagnosis, Etiology, and Management of Local Knowledge

In April 2023, S exhibited a noticeable reduction in speech. Initially, her family did not pay much attention to this change, attributing it to spiritual interference. Two months later, her father invited a local Bimo to perform an exorcism ritual, which had no significant effect on her condition. By August, S began experiencing symptoms such as diplopia, unsteady gait, self-talk, sudden smiling, and brief episodes of unconsciousness. The therapist diagnosed her condition as madness, referred to as ‘vu’ (ꃶ) in the Nuosu language. To address S’s condition, her family has pursued multiple treatment approaches, integrating both traditional rituals (

Table 1. The history of religious ceremonial treatment of mental illness.

No.	Date	Healer	Ritual Name	Duration	Sacrificial Animal	Effect
1st	16 June 2023	Bimo: Qubilazhe	bburhnat hlurhnat	1 night	goat:1 chicken:2	no
2nd	30 August 2023	Bimo/Sunyit: Keqiaju	nyitcy mgot syssut sissu nrepsur nreplyt xyyuo bur	2 days	sheep:1 pig:1 chicken:5	worse
3rd	12 September 2023	Chief Bimo: Leshimaji Assistant Bimo: Aduwule Assistant Bimo: Jikelagu	ku hxo zzy bi xyyuo bu	3 days	sheep:4 goat:3 pig:9 chicken:23	no
4th	23 October 2023	Bimo: Jikelaqu	nyitcy ssyp nrepsur nreplyt sybbut sibbut jyp xyyuo bur	3 days	sheep:1 pig:3 chicken:6	no
5th	6 November 2023	Sunyit: Qujierti	nyitcy mgot	1 day	goat:1 pig:1 chicken:1	no
6th	18 November 2023	Bimo: Jiemeiyobu	nyitcy ssyp	1 day	goat:1 pig:1 chicken:1	no
7th	13 December 2023	Sunyit: Qujierti	nyitcy mgot	1 day	pig:1 chicken:1	no
8th	15 January 2024	Bimo: Keqiaju	nyitcy ssyp nrepsur nreplyt xyyuo bur	3 days	sheep:2 goat:1 pig:1	no
9th	27 January 2024	Bimo: Hailaiwusa	nyitcy ssyp syssut sissut	2 days	sheep:1 goat:2 1 pig:1 chicken:4	no
10th	13 March 2024	Sunyit: Qujierti	nyitcy mgot	1 night	2 chickens	no
11th	19 April 2024	Chief Bimo: Jikeluoze Assistant Bimo: Jikelaqu	nyitcy ssyp syssut sissut syjuo dut nrepsur nreplyt nrepsur yyrcyt bi xyyuo bur	3 days	sheep:1 goat:1 pig:1 chicken:8	no
12th	1 May 2024	Sunyit: Weiegatie	nyitcy mgot	1 day	goat:1 chicken:1	no
13th	22 May 2024	Sunyit: Keqiaju	nyitcy mgot qyrho tup	1day	goat:1 dog:1	no
14th	31 May 2024	Bimo: Jikelagu	xyyuo bur	1 night	chicken:2	no

Data from S’s family members.

) and modern medical interventions.

S’s father informed me that from June 2023 to June 2024, he consulted Nuosu soothsayers and therapists over ten times through home visits, internet communication, and telephone calls to determine the cause of his daughter’s illness. The soothsayers and therapists concurred that S’s condition was primarily attributed to ‘ghosts’ as revealed through scripture divination, woodcarving divination, scapula divination, and egg divination. While both Sunyits and Bimos provided similar yet distinct explanations for the cause of the illness, Sunyits claimed to have identified three malevolent ghosts in S’s home, believed to be the restless souls of her deceased aunts and uncle, which were deemed responsible for S’s condition. In addition to the household spirits, Bimos, through divination, also attributed S’s illness to the spirits of ‘sylyp sysi’ (ꌦꇗꌦꌋ) as well as from debts incurred by humans. Relationships have consequently deteriorated, and religious healing ceremonies focus on repairing these relationships and restoring harmony. The causes and treatments can be summarized in the following three aspects.

4.1.1. Kinship Ghosts

S’s aunt and uncle are S’s father’s half-sister and brother, while Auntie is S’s mother’s sister. The aunt on the father’s side died of chicken pox at the age of seven, and the aunt on the mother’s side passed away at the age of three. According to Nuosu belief, young girls who die before undergoing rites of passage and marriage become ‘hniry’ (ꅪꏜ) ghosts when they die; furthermore, it is believed that ‘hniry’ ghosts can induce a range of psychological and physical symptoms in individuals, including mental confusion, self-harm, suicidal tendencies, aggression towards others, mood swings, manic behavior, psychiatric disorders, inappropriate conduct, pruritus, and back pain (Cai Fulian 2011). Her uncle, who fell gravely ill in his thirties, sought refuge with his father in W Village due to a lack of support. He remained unmarried throughout his life and passed away more than a year later. Unmarried men without children may become ‘ssep’ (ꌻ) ghosts, which are known for their fierce nature. The ‘ssep’ can occasionally bestow favors when treated with respect but may also inflict severe illnesses or sudden violent deaths if angered. The souls of men and women who die unmarried and without having children, and for whom no rites are performed, have no fixed abode, and are haunted by inner dissatisfaction and resentment. S’s disease is caused by the ‘hniry and ‘ssep’. ‘Ssep’ is more aggressive than ‘hniry’ and is the main reason for S’s prolonged illness, and behavioral abnormalities are mainly influenced by ‘hniry’. The approach to addressing ‘hniry’ and ‘ssep’ involves conducting rituals such as ‘nyitcy ssyp’ (ꑊꋌꍃ), ‘nyitcy mgot’ (ꑊꋌꈹ), ’bburhnat hlurhna’ (ꁱꅰꆰꅰ), ‘ku hxo zzy bi’ (ꈐꉘꋩꀘ); ghost-sending rituals involve the therapist communicating with spirits and ghosts through methods such as exhortation, appeasement, sacrifice, oath taking, cursing, seduction, and expulsion in order to make the spirits leave the patient. Both Bimo and Sunyit can drive out ‘hniry’ spirits; however, Bimo is generally ineffective against ‘ssep’ spirits.

The procedures and contents of Bimo’s exorcism rituals (Table 2) are as follows:

Table 2. Procedure of the ghost-sending rituals.

Procedure	Content
Ritual Preparation	Determine the date and treatment plan through divinatory practices. Prepare the necessary sacrificial offerings, including sacred branches, straw effigies, wine, buckwheat cakes, and any other required supplies.
Call upon deities	‘Mugu cy’ (ꃅꇴꋊ): The ritual of releasing green smoke to notify the deities of heaven and earth. ‘Lyca sur’ (ꇓꊸꌣ): The scorched stone is immersed in water to generate steam, which purifies the external environment of the ritual space. A variety of deities are respectfully invited to provide their assistance.
Luring and attracting ghosts	Lure the ghosts to the ritual site through offerings of sacrifices, wine, and buckwheat cake, et al.
To persuade the ghost, curse the ghost, strike the ghost	The appropriate scriptures are selected and chanted with the intent to persuade the ghost to depart from the patient’s body. Should the ghost remain unresponsive, further measures including admonishing, restraining, and guiding the ghost are undertaken to encourage it to cease harmful actions and to move on to perform beneficial deeds elsewhere.
Sending the ghosts away	The ‘hniry’ and ‘ssep’ straw effigies, together with the ghost boards and sacred branches, are bundled and transported to the roadside or to a secluded tree off the main path (Figure 1).

Table 2. Procedure of the ghost-sending rituals.

Procedure	Content
Ritual Preparation	Determine the date and treatment plan through divinatory practices. Prepare the necessary sacrificial offerings, including sacred branches, straw effigies, wine, buckwheat cakes, and any other required supplies.
Call upon deities	‘Mugu cy’ (ꃅꇴꋊ): The ritual of releasing green smoke to notify the deities of heaven and earth. ‘Lyca sur’ (ꇓꊸꌣ): The scorched stone is immersed in water to generate steam, which purifies the external environment of the ritual space. A variety of deities are respectfully invited to provide their assistance.
Luring and attracting ghosts	Lure the ghosts to the ritual site through offerings of sacrifices, wine, and buckwheat cake, et al.
To persuade the ghost, curse the ghost, strike the ghost	The appropriate scriptures are selected and chanted with the intent to persuade the ghost to depart from the patient’s body. Should the ghost remain unresponsive, further measures including admonishing, restraining, and guiding the ghost are undertaken to encourage it to cease harmful actions and to move on to perform beneficial deeds elsewhere.
Sending the ghosts away	The ‘hniry’ and ‘ssep’ straw effigies, together with the ghost boards and sacred branches, are bundled and transported to the roadside or to a secluded tree off the main path (Figure 1).

Figure 1. The grass puppet sent to the tree by Bimo during the 31 May 2024 ritual symbolizes the sending and binding of ghosts to this place. Photograph by the author.

Figure 1. The grass puppet sent to the tree by Bimo during the 31 May 2024 ritual symbolizes the sending and binding of ghosts to this place. Photograph by the author.

The ritual of driving out ghosts is an integral component of various rituals, both large and small. It can stand alone as a healing ritual for curing diseases or serve as a ‘purification’ process in other types of rituals, removing all obstacles and interferences to ensure the smooth execution of subsequent rites. If only the ‘kinship ghosts’ are expelled, the ceremony concludes at this point. However, if additional rituals are required, the Bimo will incorporate supplementary procedures as necessary.

In S’s healing rituals, identifying and striking the cremation site is of paramount importance, a task that only Sunyit can perform. Sunyit prophesies that locating the cremation sites of S’s aunts and uncle will enable the sealing of the spirits. According to Sunyit, the most powerful spirit is that of S’s uncle, and thus all rituals conducted by Sunyit are primarily aimed at the uncle ghost known as ‘Ssep’. ‘Ssep’ is exceptionally fierce and can only be subdued through ritualistic means, as words of persuasion are ineffective. In May 2024, Sunyit Keqiaju located the cremation site through divination and on May 22nd, he presided over a sealing ritual named ‘qyrho tup’(ꐗꉻꄳ), attended by over twenty people, including S’s relatives, friends, and many neighbors who volunteered to participate in the ritual to subdue ‘Ssep’. The items required for the ritual included brooms, old shoes from the host family, bearskins, a black dog, several wooden pegs, a horseshoe, a magnet, a grinder, tung oil, iron pots, colorful threads, and other ceremonial objects. On the morning of the 22nd at approximately 5:00 or 6:00 a.m., guided by the Sunyit with rhythmic dancing and drumming, people arrived at the cremation site. There, the host family excavated the designated area, dripped tung oil onto it, and buried half of a horseshoe, which had been previously halved, at the center. An iron pot was then placed in the pit, followed by the remaining half of the horseshoe, additional tung oil, bearskin, and firewood. These items were subsequently ignited. The participants covered the fire with earth, compacted the mound while reciting incantations, and symbolically scolded ‘ssep’ using brooms and old shoes. Finally, they placed a millstone over the cremation ground, secured it with wooden pegs around its perimeter, and connected these pegs with colorful threads to form a “net.” A black dog that had been sacrificed was positioned in the middle of the cremation ground, tied around the millstone. This entire ritual symbolizes the burning, cursing, and suppression of ‘ssep,’ ensuring it can never emerge to harm people again.

According to S’s father, S’s condition has not shown any improvement following the ritual. However, the family remains confident in Sunyit’s abilities. His successful identification of the initial cremation site serves as compelling evidence of his expertise. The family is hopeful that Sunyit will be able to locate the cremation sites of the other two ghosts.

4.1.2. Natural Spirits

‘Sy’(ꌦ) is a kind of deity of heaven and earth, such as the god of mountain, water, earth, sky, etc. These deities are highly capricious, capable of associating with various natural elements and creatures such as wind, rain, thunder, sea, electricity, forests, rodents, insects, serpents, moths, and even the deceased, potentially causing illness at any moment. ‘Sy lyp (ꌦꇗ), ‘sysi’ (ꌦꌋ), and ‘sybbut sibbut’ (ꌦꁬꌋꁬ) are three of the diseases caused by ‘sy’. The ‘sybbut sibbut,’ which is believed to be carried by the mountain deity or various animals such as birds, monkeys, rats, snakes, frogs, etc., either on the mountaintop or through thunder and lightning, can induce a condition known as ‘sy lyp’. This condition manifests with symptoms including dizziness, headache, backache, blurred vision, vomiting, limb deformities, limb weakness, facial distortion, fainting, paralysis, and even death. ‘Sysi’ is believed to be caused by the water deity and manifests as abdominal pain, diarrhea, vomiting, and anorexia; ‘Sybbut sibbut’ is thought to result from various types of ‘Sysi’-related conditions. Symptoms include numbness in the limbs, mood instability, irritability, and cognitive confusion (Azi 1993, pp. 118–35). The ‘sy lyp’, ‘sysi’, and ‘sybbut sibbut’ are malevolent spirits of nature that can induce madness, rheumatism, skin diseases, and other ailments. According to Bimo belief, these spirits are one of the sources of insanity. The ‘syssut sissut’ (ꌦꌼꌋꌼ), ‘syjuo dut’ (ꌦꏪꄖ), and ‘sybbut sibbut jyp’ (ꁬꌋꁬꏹ) are rituals to drive out the spirits.

After divination, Bimo informs the master that ‘sy lyp,’ ‘sysi,’ and ‘sybbut sibbut’ are all attributed to the family’s kinship ghosts. In contrast to the more lenient attitude towards these kinship ghosts, Bimo adopts a much stricter approach towards the ‘foreign ghosts,’ with his words and demeanor being significantly more intense and severe. During these rituals, it is essential to perform the ‘nyitcy ssyp’ rite for exorcism. Unlike the exorcism ritual, Bimo must select appropriate incantations from scriptures such as ‘sy lyp,’ ’sysi,’ and ‘sybbut sibbut,’ and depending on the circumstances, may include additional procedures like medicinal baths. For instance, during the ‘syjuo dut’ (Figure 2) ceremony on the night of 19 April 2024, the Bimo meticulously prepared a decoction by boiling over ten different types of plants in a pot. Subsequently, he carefully administered the hot liquid to the patient by gently splashing it.

4.1.3. Debt Ghosts

The Nuosu people hold the belief that any disruption in the balance among humans, ancestors, nature, animals, spirits, other individuals, and deities can lead to the unconscious accumulation of ‘debts’. These debts are believed to influence emotions and behaviors, resulting in abnormal conduct and contributing significantly to mental illness (Quibi Aguo 2022). Bimo attributes S’s illness to these ‘debts’ as well as the wandering of the soul. Consequently, rituals such as ‘nrepsur nreplyt’ (ꎞꌣꎞꇔ) and ‘nrepsur yyrcyt bi’ (ꎞꌣꒌꋊꀘ) are conducted to alleviate debts, repay obligations, and redeem the soul, thereby clearing debts, retrieving the soul, and preventing further illness. During the debt-repayment ceremony, the Bimo employs sacrifices such as those of pigs to attract the illness spirit to the ritual site, where it is subsequently confined and cursed. Following this, the Bimo meticulously clarifies the debts owed by S and other family members, recites scriptures to invoke deities for assistance in eliminating these debts, and symbolically transfers the debts onto snake skins and rat nests. This signifies that the snakes and rats carry away the illness spirit, thereby protecting the people from its influence. In addition to the aforementioned ‘nyitcy ssyp’ ritual, the debt-repayment ritual must be conducted in conjunction with the ’xyyuo bur’ (ꑭꑼꀱ) ritual. The sequence of the three ceremonies is as follows: ’nyitcy ssyp’ (exorcism)—‘nrepsur’ (pay debts and redeem soul)—‘xyyuo bur’ (blessing for health). Typically, it takes two or more Bimos a period of three days to complete the entire process.

The concepts of ‘kinship ghosts’, ‘natural ghosts’, and ‘debt ghosts’ are identified as the primary causes of S’s disease. People’s attitudes towards ‘relative ghosts’ are complex and multifaceted. On one hand, these entities are often held responsible for inflicting illness upon their descendants, which can evoke feelings of resentment. On the other hand, they were once family members who turned malevolent due to circumstances beyond their control, eliciting sympathy from people. The interconnectedness of souls establishes a relationship among ‘kinship ghosts’, ‘natural ghosts’, and ‘debt ghosts.’ Ghosts frequently collaborate with others of their kind to torment humans. They are perceived as ‘relatives’ with whom negotiation is required. Consequently, all rituals addressing ghostly phenomena begin with courteous words and offerings of fine food and wine to appease them. Severe cases may involve the confinement and suppression of ghosts, yet there is no practice of exterminating them.

If you successfully negotiate with a ‘ghost’, the ‘ghost’ is believed to depart from this location and relocate elsewhere, thereby resulting in the patient’s illness being alleviated. S’s family unanimously maintained that the ritual did not improve S’s condition; however, they did not question the authority or efficacy of the ritual. They expressed: “Illness stems from misfortune. When one’s fortune is unfavorable, various adverse events may occur, including contracting any disease. Treating illness similarly relies on fortune. If one’s fortune is favorable, the illness might be swiftly resolved. Both superstition and medical treatment share this uncertainty; their effectiveness depends on fortune. When one is out of luck, the “ghost” is not at home and thus cannot be driven away.”3

4.2. Contemporary Medical Knowledge Pertaining to Diagnostics and Therapeutics

The Nuosu people attribute diseases and misfortunes to ‘luck,’ and this belief motivates them to attempt various forms of medical treatment as a way of taking chances. In September 2023, after discussions with charity volunteers, S’s family began to seek assistance from modern medicine (

Table 3. S’s treatment with modern medical methods.

Time	Motivation	Location	Diagnosis	Medications	Effects
17 September 2023	Volunteer persuasion	Liangshan	No diagnosis of disease, the notification of critical illness	Olanzapine, Alprazolam	Effective, self-talk symptoms disappear, gain dozens of pounds
1 February 2024	Volunteer persuasion	Chengdu	Major depression is accompanied by psychiatric symptoms	Agomelatine Tablets, Contin, Benzhexol Hydrochloride	No obvious effect, self-talk symptoms appeared again after more than ten days of taking the medication
19 March 2024	Go by themselves	Chengdu	Inpatient treatment, schizophrenia	Electrotherapy, Contin, Benzhexol Hydrochloride, Olanzapine	Symptoms disappeared after hospitalization and recurred a week after returning home
8 June 2024	Go by themselves	Liangshan	Schizophrenia	/	/

Data from S’s family members.

).

The hospital employs a comprehensive diagnostic protocol encompassing physical examinations, EEGs, ECGs, brain function imaging, eye movement tracking, echocardiography, gynecological ultrasounds, abdominal ultrasounds, transcranial Doppler ultrasounds, psychological evaluations, and inquiries into family genetic history. Based on the examination results and an understanding of S’s background, the medical team suspects that she has developed mental health issues and depression as a result of prolonged verbal and physical abuse from teachers and classmates at school, stemming from her status as a descendant of someone with leprosy.4 Due to the prohibitive cost of psychological counseling, S’s family has opted not to pursue this form of treatment. The primary treatment plan therefore focuses on pharmacotherapy and instrumental interventions.

Following the administration of olanzapine and alprazolam, patient S exhibited a significant improvement in clinical symptoms with a reduction in abnormal behaviors. However, S became increasingly withdrawn. According to the medication guidelines for olanzapine, common side effects include drowsiness, weight gain, and increased appetite, all of which were prominently observed in S. Specifically, S experienced heightened appetite, persistent drowsiness, diminished energy levels, and a 50% increase in body weight. Consequently, S gradually developed reluctance to continue hospital visits for treatment. This led to a recurrence and exacerbation of initial symptoms such as self-talk, mood instability, and aggressive behavior towards family members. The family ultimately decided on hospitalization for further observation. During this period, S received both pharmacological therapy and ECT. Upon discharge, S demonstrated heightened resistance to any form of medication, leading to a relapse of the condition. No additional therapeutic interventions have been pursued since then.

According to S’s family, the significant weight gain and hospitalization were primary factors contributing to S’s aversion to modern medical treatments and her refusal of further care. ‘As a young woman who values her appearance, she has difficult to accept gaining approximately 50 pounds. During her hospital stay, she frequently contacted us, expressing her desire to leave the hospital and return home’.5

The patient has exhibited a prolonged aversion to medication and treatment. In an effort to address this issue, the parents have attempted various strategies, including misleading the patient about the purpose of hospital visits and disguising medication in food. However, these methods were often detected by the patient, leading to refusal of both food and treatment. During the most recent consultation, the father was advised to consider long-term inpatient care at a specialized mental health facility. While he acknowledged the need for continued medical intervention, the patient’s strong resistance to modern medicine poses a significant challenge.

From June 2023 to June 2024, during S’s disease treatment process, ritual therapy served as the predominant and spontaneous method of treatment, occurring with greater frequency than conventional medical interventions. Ritual and medical treatments were alternated but were not entirely independent; they exhibited certain interdependencies. For example, a ritual would be conducted several days prior to deciding on hospitalization, and the timing and mode of transportation for medical visits were determined by the therapist through divination during the ritual. Regarding the efficacy of the treatments, S’s family perceived modern medical treatment as more effective. However, from S’s perspective, there was a higher acceptance of ritual therapy and a lower acceptance of medical treatment. These treatment preferences and phenomena reflect the conflict and cooperation between animism and naturalism, two distinct ontological frameworks. The subsequent section will analyze their differences and interactions from a theoretical standpoint.

In the preceding discussion, I have elaborated on healing practices of a Nuosu youth who integrates both religious rituals and biomedicine in disease treatment. This form of combined medical practice is commonly referred to as ‘medical pluralism’ (Leslie 1973, 1976). Indeed, the phenomenon of utilizing multiple medical systems for treatment is prevalent globally. For example, in China, ethnic groups such as the Dong (Yu 2019), Dai (Duan and Li 2014), Naxi (He 2011), Tibetan (Liu 2008), and others often employ diverse medical systems, including herbal medicine, rituals, and biomedicine, for therapeutic purposes. Similarly, in the southern Mexican city of San Cristobal, both the Maya Indian ethnic and Ladinos utilize a variety of treatment approaches to address health issues (Fabrega and Manning 1979). In Navajo society, the interplay between conventional biomedicine, traditional Navajo healing practices, Native American Church healing, and Navajo Christian faith healing significantly influences the treatment decisions and healing processes of the Navajo people (Csordas 1999, 2000).

Given the widespread existence of pluralistic healthcare systems, academic research grounded in this framework has been expanding significantly. A common approach in academia involves categorizing healthcare systems into two ends: scientific, modern, and Western medicine on one side, and traditional, alternative, and complementary medicine on the other (Ember and Ember 2004, pp. 109–15). Alternatively, Kleinman proposed dividing healthcare into the popular section, professional section, and folk section (Kleinman 1980), while Zhang categorized healthcare into secular, sacred, and Western systems (Zhang 2000). These frameworks effectively elucidate how beliefs, knowledge, practices, personnel, facilities, and resources influence and shape the manner in which social and cultural groups access disease care and treatment (Fabrega and Manning 1979, p. 41). They also demonstrate how different healthcare systems establish distinctions, collaborations, and complementarities (Lock and Nguyen 2010), as well as explain how individuals utilize the interactive relationships among these systems to collectively contribute to health services.

However, under the ontological turn in anthropology, simplistic dichotomies such as traditional versus modern or sacred versus secular are insufficient to fully capture people’s everyday lives. Moreover, existing research frameworks on pluralistic healthcare practices inadequately address the interaction logic among various healthcare systems. In light of this, I propose integrating an ontological perspective into the analysis of disease treatment concepts and phenomena, aiming to perceive the realities of Nuosu people’s disease treatment practices through a more comprehensive ontological lens.

5. Divergence and Collaboration

Different social environments and historical contexts have engendered distinct knowledge traditions. In ancient times, when social productivity was relatively underdeveloped, the Nuosu people’s understanding of diseases was limited. Given that diseases posed a significant threat to human life and safety, the Nuosu people developed a body of knowledge concerning disease cognition and treatment grounded in their animistic beliefs and practical experiences in production and daily life. Over time, this knowledge system has been perpetuated and transmitted within their social structures through rituals, language, writing, myths, and stories, thereby becoming entrenched and institutionalized. Consequently, the current disease-related knowledge held by the Nuosu people is based on positive, concrete, and a priori experiences or reasoning derived from their ancestors. Due to the ‘path dependence’ (Mahoney 2000) inherent in local knowledge, they rely on traditional practices and directly extract necessary knowledge from their established knowledge base to inform their actions. The logic of disease treatment within the Nuosu people’s local knowledge framework adheres to a knowledge–practice model.

Modern science, by contrast, represents a relatively recent new knowledge system. As exemplified by the introduction of modern medicine, governmental bodies, healthcare institutions, and charitable organizations have bypassed the phase of knowledge assimilation and directly implemented robust practices among the Nuosu people. Consequently, the Nuosu people, through practical experience and embodied encounters, gradually develop an understanding of natural science, thereby establishing a cyclical process of practice–knowledge–practice. However, these two paradigms do not evolve independently; rather, they intersect in certain areas. For instance, in cases of traffic accidents, stab wounds, and other unforeseen incidents, the Nuosu people attribute the underlying cause to ‘bad luck,’ ‘demons,’ and ‘evil spirits,’ with external injuries being manifestations of these malevolent forces. In such situations, the injured person initially receives modern medical treatment, followed by religious rituals post-recovery to cleanse ‘impurities’ and exorcise ‘ghosts,’ thus preventing recurrence. Furthermore, for conditions such as paralysis, cerebral infarction, rheumatism, facial distortion, and mental illness, the Nuosu people believe that immediate ritualistic intervention is necessary. Seeking hospital care might exacerbate the condition, although medication can provide some relief from physical pain. Therefore, these ailments are primarily addressed through rituals, supplemented by pharmacological treatments. Additionally, for diseases outside the local knowledge framework (such as AIDS) or when divination suggests hospitalization, traditional healers recommend seeking modern medical assistance.

Overall, the Nuosu people select treatment methods according to their specific needs, following several pathways: traditional knowledge informing traditional practices; modern medical knowledge guiding modern medical practices; traditional knowledge informing modern medical practices; modern medical knowledge informing traditional practices; and traditional practices incorporating modern medical knowledge. According to modern medicine, the Nuosu people’s understanding of diseases is considered a misassociation, and their rituals for disease prevention and treatment are deemed unscientific (Ayi 2003b, p. 64). Consequently, there is currently no pathway where modern scientific knowledge informs traditional practices, and medical professionals generally discourage patients from undergoing ritual treatments. Ritual therapy and modern medical treatment may function independently or in conjunction with one another, coexisting within the disease treatment practices of the Nuosu people. This raises the question of how these approaches diverge and collaborate? The answer to this question lies in exploring the fields of cognition and practice.

5.1. Cognitive Discrepancies

David Ludwig (2016) introduced the concept of ‘Overlapping Ontologies’ to characterize the intricate phenomenon of integrating indigenous local knowledge with Western scientific knowledge. The notion of ’Overlapping Ontologies’ allows for both successful and unsuccessful integration scenarios. Ludwig’s research offers a framework: overlapping areas foster collaboration, while non-overlapping areas highlight challenges in reaching consensus.

The conflict between animism and naturalism primarily centers on the understanding of diseases. There are substantial disparities between local knowledge and scientific knowledge regarding diagnostic methods, etiologies, and treatments of diseases (

Table 4. Comparison of local knowledge and modern scientific knowledge in disease cognition and treatment.

	Local Knowledge	Modern Medical Knowledge
Diagnostic	Divination	Comprehensive diagnostic procedures including instrumental examinations, clinical observations, and assessments
Causes	Souls causing disease	Genetic, environmental, psychological, and social factors
Treatment	Religion ritual	Pharmacological treatments, medical device-based therapies
Participants	Relatives, ancestral spirits, family members, patients, neighbors, traditional healers, animals, plants, deities	Medical professionals, patients, family members
Objectives	Restoration of physical health, social harmony, and soul well-being	Normalization of individual physiological indicators

). Traditional beliefs and modern medicine often adhere to distinct perspectives, making it challenging to achieve consensus. While these knowledge gaps appear insurmountable, there are instances where they intersect. In light of the differences in scientific knowledge, the Nuosu people’s worldview, which emphasizes the ‘relationality’ and ‘kinship’ of all things, enables them to not outright reject modern medical knowledge. Instead, they may actively seek to establish connections between the two systems:

In terms of diagnostic methodologies, the Nuosu people perceive that divination and machine-based physical examinations are not mutually exclusive. Both approaches employ specific techniques to assess the internal conditions of the human body. To enhance the credibility of divination, practitioners incorporate modern elements into rituals by metaphorically referring to traditional practices such as egg divination and sheep scapula divination as ‘CT scans’ or ‘X-rays.’ Consequently, when individuals undergo instrument-based physical examinations at hospitals, they tend to associate these methods with similar functionalities as divination.

In the context of explaining disease causation, the Nuosu people tend to rely on local traditional knowledge at specific times. For example, they firmly believe that conditions such as rheumatism, skin diseases, and loss of consciousness are caused by evil spirits. The S family similarly adheres more readily to local traditional beliefs regarding S’s illness. They lack clarity about and do not concur with modern medical explanations of diseases. When the doctor suggested that S’s condition might be linked to school violence and volunteers advised S’s father to hold relevant school personnel accountable, S’s father immediately dismissed this notion: “For us Nuosu, illness is attributed to ‘ghosts’; it is our internal issue, not others’ responsibility. It is already highly embarrassing, so how could I blame others?”6 Nevertheless, this does not imply that the Nuosu people view the theory of ‘soul-induced illness’ and the theory of ‘nature-induced illness’ as entirely contradictory. As highlighted by Hallowell (1964) and Viveiros de Castro (2013), in the cosmology of indigenous peoples, no separation is drawn between the natural and supernatural domains. The existence of the soul is regarded as an intrinsic and essential element of reality. Consequently, within the conceptual framework of the Nuosu people, the soul is considered the primary causative factor of illness, while natural elements, such as environmental conditions, function as the mechanisms through which the soul manifests disease. The symptoms of the illness serve as its tangible expressions. Therefore, ‘soul-induced illness’ and ‘nature-induced illness’ are interrelated and overlapping phenomena that cannot be easily disentangled. In the context of disease treatment methods, modern medicine generally advises against patients relying on ritualistic treatments. However, religious rituals do not necessarily exclude modern medical approaches. For example, practitioners occasionally integrate recommendations for modern medical consultation into divination outcomes. Some patients seeking medical care may consult a diviner to determine an auspicious day for travel and medical treatment prior to engaging with modern medicine, with the aim of optimizing therapeutic efficacy.

In the modern medical system, disease treatment primarily involves two key stakeholders: doctors and patients. By contrast, ritual healing is considerably more intricate, encompassing interactions among humans, spirits, deities, and healers. Within religious rituals, ritual healers often assume a dual role, functioning both as spiritual guides and medical practitioners. They may recommend specific medications to patients in addition to conducting rituals. Thus, these healers serve not only as intermediaries between humans and non-human entities but also as facilitators in the dissemination of modern medical knowledge.

At the epistemological level, animism and naturalism exhibit divergent ontologies. Nevertheless, in addressing differences in knowledge systems, the Nuosu’s worldview and disease perception reflect a ‘relational’ model that intricately links human and non-human entities. The Nuosu people do not reject naturalism; instead, they foster greater intersections of knowledge between animism and naturalism through the approach of ‘establishing connections’, thereby laying a foundation for their cooperation.

5.2. The Effectiveness of Practice

Stevan Harrell (1974) emphasized in a study based on Taiwanese folk beliefs that Chinese folk beliefs demonstrate significant flexibility and individualism. Unlike the consistency typically found in religious logic, individuals may prioritize practical efficacy. In other words, ‘practicality’ is a defining feature of Chinese folk beliefs, with therapeutic efficacy being a primary factor shaping people’s choices of medical systems. Likewise, the religious beliefs of the Nuosu are primarily focused on providing practical services, and ‘effectiveness’ plays a crucial role in influencing their selection among various medical approaches.

As Jiarimuji and Yang (2022, p. 105) Dachuan note, in Nuosu culture, “all rituals aim to repair and rebuild broken relationships of the patients at both the action and symbolic levels”. The core logic of the S disease treatment ritual lies in restoring relationship breakdowns caused by relatives, nature, and the interaction between humans and nature. The overarching objective of the treatment is to foster harmonious interactions and communication among all living and non-living entities, ensuring that each exists in its rightful place and coexists in harmony, thereby enabling the human body to naturally recuperate. The therapeutic goal of modern medicine lies in eliminating pathogens and restoring physiological functions. Enhancing human health serves as the common aim of both modern medicine and traditional ritual practices, making ‘effectiveness’ a pivotal factor in their acceptance by the Nuosu. Subsequently, we will shift the discourse from epistemology to an emphasis on ‘existence’, exploring how these two systems coexist within the Nuosu’s disease treatment practices through their understanding of treatment ‘effectiveness.’

Modern biomedicine is celebrated for its ‘efficiency’ and ‘accuracy,’ focusing primarily on the study and treatment of human physiological structures, pathological changes, and biological processes. This focus has significantly advanced medical science and disease treatment technologies. For example, S’s case demonstrates that the modern medical model effectively inhibits her condition. From being persuaded to seek medical help to actively consulting and seeking treatment through various means, as well as the evaluation of the medical treatment effect by S’s family, it is evident that natural science has a clear improvement effect on individual physiological symptoms. However, the modern medical model often overlooks factors such as the patient’s psychology, society, culture, and personal experience, separating dimensions like emotions, intuition, and values from human ontology. Side effects such as obesity caused by drugs and feelings of fear, inferiority, and loneliness during the treatment process are part of S’s narrative of the pain of the disease and the fundamental reason for her refusal of modern medical treatment. Additionally, once medication is discontinued, the condition recurs, leading S’s family to question whether modern medicine can only provide temporary relief for physical discomfort without addressing ‘soul diseases’.

The Nuosu people’s perception of the ‘effectiveness’ of treatment diverges from that defined by modern natural science. Scientificism posits that the efficacy of curing a disease is determined by the complete disappearance of symptoms and signs, as well as significant improvement in the patient’s condition, which essentially refers to the restoration of physiological indicators. In contrast, the Nuosu people have a more holistic understanding of treatment effectiveness. For them, the criteria for cure encompass not only physical health but also the return of the soul, the restoration of order, and the removal of impurities.

I conducted inquiries with multiple individuals from the Nuosu community to determine which approach—modern medicine or traditional treatment—possesses a definitive advantage in different contexts. The responses were largely consistent: modern medicine is more effective for treating external injuries, while ritual-based traditional treatments are generally preferred for managing chronic conditions. The Nuosu people hold the belief that certain rituals have pronounced effects, particularly those aimed at alleviating physical ailments such as rheumatism, skin conditions, and joint disorders. These ailments are often attributed to possession by malevolent spirits and constitute a significant portion of the traditional Nuosu disease classification system. Within the Nuosu belief framework, rheumatic conditions characterized by limb pain and swelling are termed ‘sysi na,’ (ꌦꌋꆅ) believed to be caused by ‘sysi’ spirits from the underworld. Skin conditions manifesting as itching, sores, and rashes are referred to as ‘dipmu na,’ (ꄃꃅꆅ) thought to be caused by ‘dipmu’ (ꄃꃅ) spirits derived from buried humans or primates (Li et al. 2021, pp. 70–71). Nuosu believe that hospitalization might exacerbate the condition and poses a risk of complications such as cerebral palsy. According to traditional beliefs, only the immediate performance of specific rituals such as ‘sysi bi’, ‘syssut sissut’, and ‘syjuo dut’ is considered essential for their resolution.7

The universality of modern science hinges on three essential conditions: (a) the establishment of controlled environments where counterfactual scenarios can be tested while maintaining all other variables constant (such as in laboratory or celestial settings); (b) the formulation of mathematical models to describe and predict phenomena; and (c) the process of laboratory simulation, which involves recreating these controlled conditions in a laboratory setting to ensure reproducibility (Wu 2014, p. 52). Conversely, local knowledge is often deemed non-universal due to its lack of adherence to these conditions. However, if local knowledge is subjected to rigorous testing within a laboratory environment, it may yield universally applicable results, thereby establishing its objective validity from a natural science perspective. For example, traditional rituals for treating rheumatism, skin diseases, and joint disorders involve fumigation and medicinal baths. In these practices, Bimo practitioners prepare decoctions using various plants such as coriaria, rhododendron, birch, and litsea, which are applied to patients. Many of these plants possess properties that help clear heat and detoxify. The efficacy of these traditional treatments has been validated by several studies (Li et al. 2021; Tang et al. 2022; Li and Luo 2023).

For certain rituals whose efficacy cannot be scientifically validated, the Nuosu people have established their own criteria to evaluate the success or failure of these practices. The effectiveness of a ritual is primarily determined by whether the patient’s condition has shown improvement. Successful outcomes are indicated by the recovery of some patients following the ritual, while unsuccessful attempts do not necessarily undermine the overall status of ritual treatment. To prevent errors during the ritual, therapists exercise stringent and meticulous control over offerings, procedural steps, and observance of taboos. In cases where a ritual fails, the Nuosu people provide various flexible explanations for the failure, including factors such as the quantity and color of offerings, timing and sequence of the ritual, violations of taboos, or even the unavailability of the ‘ghost’ at home. Subsequently, adjustments are made in subsequent rituals to mitigate the risk of failure and enhance the prospects of achieving healing.

Secondly, concerning psychological and mental therapy, both individual and group therapies have demonstrated high acceptance of rituals, which indeed play a significant role. Collective ritual therapy fosters unity among participants, thereby reducing societal stigma towards patients while enhancing understanding and empathy. This enables patients to gain a sense of security and strength within the group, empowering them to confront disease-related fears and facilitating the healing of psychological wounds. Furthermore, the efficacy of rituals extends beyond individuals to encompass entire communities. The Nuosu people’s belief that diseases are caused by malevolent spirits implies that these entities can affect any individual through social interactions. Consequently, an individual’s illness is perceived as potentially impacting the health and well-being of family members and village neighbors. S’s father expressed concern to the author about the potential harm these spirits might inflict on other family members. Through ritual treatment, the recovery of an individual’s illness signifies the mitigation of potential threats to the family, clan, and neighboring village.

The collective emotions of helplessness, fear, and unease towards illness, death, and malevolent spirits foster communal solidarity during rituals. Religious healing rituals are typically grounded in the family unit but can extend to involve multiple families, clans, or even entire villages. Participation can range from a few individuals to hundreds or even thousands. During these rituals, participants engage in social interactions such as exchanging toasts, conversing, laughing, joking, and expressing concern for the patient. As Smith observed in Semitic religious practices, when people confront misfortune, their habitual response is one of despondency; however, they strive to generate a religious stimulus to uplift their spirits, much like modern individuals might resort to alcohol to drown their sorrows. Worship activities often commence with sorrow and anguish but soon undergo an emotional transformation. Following the initial somber atmosphere, there is a rapid shift to exuberant celebration (Durkheim 2008, pp. 392–93). Individuals participate in collective rituals to express and release their emotions. For example, in the ‘qyrho tup’ striking the cremation site ritual, participants channel their frustration and anger towards the perceived cause of illness, thereby restoring their confidence in the departure of malevolent forces and the return of well-being. This ritual has a profoundly positive psychological and spiritual healing impact on both the patients and their communities.

The Nuosu people’s perception of treatment efficacy is marked by a dualistic approach: modern biomedicine alleviates physical symptoms through pharmaceutical interventions and medical technologies, while religious rituals foster holistic healing by reestablishing harmony among humans, spirits, ancestral deities, and natural divinities. This dual perspective on corporeal and spiritual treatment encapsulates the multifaceted conception of health in Nuosu culture, where health is not solely defined by the proper functioning of physiological processes but also signifies a state of balance in social interactions and order. In the sacred and unified framework of ritual, interactions between humans and non-human entities are facilitated. Rituals continuously reinforce the bonds among clans, families, individuals, and ancestors. Through these rituals, social order is reaffirmed, social structures are stabilized, social emotions are harmonized, social group ties are strengthened, and social equilibrium is restored. The healing ritual manifests its effects in three dimensions: physical restoration, psychological well-being, and spiritual rejuvenation. These three dimensions possess an inherent and cohesive logical relationship and confer an open-ended significance to the ritual process as a therapeutic practice.

As S’s father previously noted, curing diseases involves an element of uncertainty, often described as ‘taking a chance,’ due to inherent unpredictable factors. Consequently, the Nuosu people have ample room to interpret treatment effectiveness: sometimes it is clear which method is efficacious, while in cases where modern medical practices and ritual treatments are combined or intertwined, it may be unclear which approach has been effective, or they may attribute success to a synergistic effect. These two therapeutic approaches are not inherently contradictory and can even complement and collaborate with each other to enhance human health. Thus, the seemingly irreconcilable contradiction between the two ontologies at the knowledge level manifests as cooperation in practical application.

Whether animism or naturalism, both emerge from specific social practices (Dawes 2023, p. 164). Ingold (2016) argues that the ontology of animism represents a theoretical interpretation of ‘animic’ practices, just as naturalism serves as a theoretical interpretation of the practice of science. Individuals may engage in animic practices while interpreting them in a manner consistent with the practice of science; conversely, they may also engage in scientific practices while interpreting them in ways that do not necessarily align with naturalism. Thus, despite the ontological contradiction between animism and naturalism, animic practices and the practice of science need not be mutually exclusive (Dawes 2023, p. 156). This practical compatibility suggests that although animism and naturalism exhibit tensions at the epistemological level, they can form cooperative and complementary relationships in concrete operational contexts. Animic practices also possess objective validity under certain circumstances. They address the issue of meaning construction through symbolic systems, while the practice of science resolves technical challenges using empirical methodologies. As Latour (1993) has noted, the ‘hybrid’ of practices often transcends theoretical dichotomies, creating a realistic space for the coexistence of multiple knowledge systems.

6. Conclusions

In this study, I investigate the practices of the Nuosu people in addressing mental illness within an ontological framework and examine how local animistic beliefs integrate with modern scientific knowledge to shape the Nuosu people’s understanding of diseases and their approaches to treatment.

The case analysis highlights the distinctive wisdom of the Nuosu people in managing health challenges. In the Anthropocene era, Haraway (2016, pp. 99–103) advocates ‘making kin’ in order to seek kinship and identity between species in the sense of symchthonically and sympoetically surviving together; she argues that all Earth’s creatures are interconnected at a fundamental level, sharing a common ‘flesh’ across lateral, semiotic, and genealogical dimensions. She further posits that ancestors can be intriguingly unfamiliar; kinship transcends conventional familial or clan boundaries, embodying qualities that are both mysterious and dynamic. The worldview of the Nuosu people offers a compelling paradigm. They hold that all entities are interconnected, and their approach to non-human entities is characterized by ‘coexistence’ rather than ‘confrontation’. Instead of resorting to extreme measures in addressing diseases, they strive for harmonious coexistence. While the onset and healing processes of diseases are inherently uncertain, the relationships involved remain manageable. Consequently, the diagnostic and therapeutic strategies of the Nuosu people focus on establishing and restoring these relationships. They perceive the disruption of relationships between humans, ghosts, spirits, ancestors, other humans, deities, animals, plants, and substances as the root cause of diseases. Therefore, religious ceremonies are conducted in various settings such as homes, fields, forests, and roads. During these ceremonies, therapists mobilize all relevant relationships, invoke deities and sacred objects to restore order between the human and non-human worlds, and facilitate interaction and communication among different entities through a series of symbolic activities. In this manner, chaos is pacified, relationships are restored, and therapeutic outcomes are achieved. The Nuosu concepts of ‘sharing,’ ‘kinship,’ and ‘relationship’ provide valuable insights for reflecting on the relationship between humans and non-human entities.

The dichotomous frameworks of culture versus nature, tradition versus modernity, religion versus science, and the sacred versus the secular—frameworks that presuppose rigid boundaries between medical systems—have become increasingly entrenched in contemporary discourse. Integrating medical and anthropological epistemologies constitutes a pivotal methodological framework in interdisciplinary research (Hahn and Kleinman 1983, p. 323). The case of the Nuosu people serves as an illuminating example for examining the effective integration of medical knowledge with indigenous local knowledge systems. Latour’s analogy of knowledge as a railroad track elucidates our understanding of two distinct types of knowledge: When people say that knowledge is ‘universally true’, we must understand that it is like railroads, which are found everywhere in the world but only to a limited extent. To shift to claiming that locomotives can move beyond their narrow and expensive rails is another matter. Yet magicians try to dazzle us with ‘universal’ laws which they claim to be valid even in the gaps between the networks (Sismondo 2010, p. 167). In reality, both knowledge systems are inherently local, and natural sciences have been labeled as ‘universal’ due to their broad applicability. Historically, when integrating local and natural science knowledge, local knowledge was often dismissed as ‘non-scientific,’ only acknowledged if beneficial to Western scientists, or criticized solely for its shortcomings. Reconciling these knowledge differences poses significant challenges, and emphasizing either successes or failures will inevitably exacerbate conflicts and polarization. The Nuosu’s approach to harmonizing the two ontologies provides valuable insights: First, individuals who embrace an animistic worldview may tend to address differences by seeking and establishing connections, thereby promoting the convergence of various theories and knowledge systems while mitigating contradictions and conflicts stemming from worldview disparities. Second, recognizing knowledge as an ongoing developmental process, a more effective method of mitigating tensions lies in the ‘bringing our knowledges together’ (Kochan 2024) or the ‘two-eyed seeing’ (Bartlett et al. 2012) approach, where diverse knowledge is integrated to form a comprehensive ontology. By synthesizing extensive knowledge, actors navigate between multiple knowledge domains, selecting pertinent knowledge to guide practice and reflecting on its validity within that context.