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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by Centers for Disease Control and Prevention, Global Forum for Health Research, National Institute for Child Health and Human Development, National Institute for Mental Health, National Institute for Neurological Disorders and Stroke, and the Fogarty International Center of the National Institutes of Health. The views presented in this report are those of the Institute of Medicine Committee on Nervous System Disorders in Developing Countries and are not necessarily those of the funding agencies.

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Cover: Mbangu mask, Central Pende, Bandundu, Zaire, registered in 1959. One of the great masterworks of Pende art in Western collections, this Mbangu mask represents the bewitched him. It dances to the song, “We look on (unable to help), the sorcerers have bewitched him.” The masker wears a humpback from which an arrow extends. The arrow refers to the popular image of sorcerers “shooting” their prey with invisible arrows when they cast their spell. The metaphor communicates the perception of sudden onslaught in illness or misfortune, just as we might say, “It came out of the blue.”

Mbangu is “bewitched”; however, since the Pende worldview attributes almost all illness and personal misfortune to the malice of others, what is really at issue is chronic illness or disability and our response to it. If he does not carry a bow and arrows, the dancer usually avails himself of a cane to indicate his physical weakness. The black-and-white division of his face refers to the scars of someone who fell into the fire due to epilepsy or some other medical condition. This sculptor has also depicted traces of smallpox on the black eyelid, and the face is pulled down on one side due to a paralysis of the facial nerve. Sculptor and performer collaborate to make Mbangu a composite sign of illness and disability, of all the misfortunes that can befall someone.

What then is to be our response to Mbangu? Some sculptors render the mask comedic, but this work conveys an extraordinary delicacy and sympathy by contrasting the gentle perfection of the features on one side with the systematic distortion on the other. This sculptor responds to the widespread version of Mbangu's song: “Do not mock your neighbor, do not laugh at your brother, the sorcerers have bewitched him.” In other words, anyone can fall prey to misfortune; it could happen to you. Our brother, our neighbor, deserves our support.

Permission to use this image was kindly granted by the Royal Museum of Central Africa. ©AFRICA-MUSEUM TERVUREN(BELGIUM)

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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