Social Science & Medicine 70 (2010) 1756e1764

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Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

Maori healers' views on wellbeing: The importance of mind, body, spirit,

family and land
Glenis Tabetha Mark*, Antonia C. Lyons
School of Psychology, Massey University, North Shore Library Building, Albany Village, Auckland, New Zealand

a r t i c l e i n f o a b s t r a c t

Article history: From an indigenous and holistic perspective, the current dominant biomedical model of health and
Available online 16 February 2010 illness has a limited view of people and their wellbeing. The present study aimed to explore Ma ori
spiritual healers' views on healing and healing practices, and the implications of these for con-
Keywords: ceptualisations of holism, health and wellbeing. Six indigenous M aori in Aotearoa/New Zealand took part
Mind, body, spirit in in-depth, semi-structured interviews with a Ma ori researcher from March to September 2007. Tran-
Holistic
scribed interviews were analysed using interpretative phenomenological analysis techniques. We found
Maori healing
that Maori cultural perspectives influenced views of the mind, body, spirit and healers also identified two
Spirituality
Indigenous
additional aspects as significant and fundamental to a person's health, namely wh anau/whakapapa
Aotearoa/New Zealand [family and genealogy] and whenua [land]. We propose a model called Te Whetu [The Star], with 5
Wellbeing interconnected aspects; namely, mind, body spirit, family, and land. Results are discussed in terms of the
contribution of M aori knowledge to our understandings of health and wellbeing, and their implications
ori and other indigenous populations.
for conceptualising holism, as well as health policy and care for Ma
Ó 2010 Elsevier Ltd. All rights reserved.

Introduction
Many ancient non-Western cultures embrace a holistic
approach to health and illness which includes a focus on inter-
connections between the mind, body, and spirit (MBS). Cultures
around the world offer perspectives on the relationships between
spirituality, healing and illness (Young & Koopsen, 2005) that differ
from perspectives in mainstream Western culture (Struthers,
2003). However, although some literature has shown how
different understandings of health might be important for Western
medicine (Miller & Thoresen, 2003; Zimpfer, 1992), these ideas
have had relatively little impact. Below we review ideas about the
MBS and the nature and importance of holism in indigenous
worldviews on health and wellbeing. The present research aims to
explore M aori spiritual healers' views on healing and healing
practices in Aotearoa/New Zealand (NZ), and the implications for
understandings of MBS, health, illness and wellbeing.
Mind, body, spirit
Mind, body, and spirit are terms used in everyday lay language
and often associated with ‘new age’ views on health and healing.
According to academic definitions, ‘mind’ refers to ‘mental
* Corresponding author. Mobile: þ64 2102347047.
E-mail address: glennistabethamark@yahoo.co.nz (G.T. Mark).
processes’, while the body is said to include the physical, biological,
and chemical aspects of an individual (Fosarelli, 2002). Spirituality
is defined variously as existential reality, connectedness, and
energy (Chiu, Emblen, Van Hofwegen, Sawatzky, & Meyerhoff,
2004), or as a dimension of a person that is concerned with the
transcendent and life's meaning (Hiatt, 1986; Young & Koopsen,
2005). The interrelationship of the mind and body has gained
widespread acceptance in recent years (e.g. the rise in health
psychology, particularly the field of psychoneuroimmunology
(Lyons & Chamberlain, 2006)), with a large body of research
investigating how mind (thoughts, beliefs, cognitive processes etc.)
relate to physical health outcomes. Less attention has been paid to
spirituality, although some work has explored the relationships
between physiology, physical health and spirituality. Religiosity/
spirituality has been linked to health-related physiological
processes including cardiovascular, neuroendocrine, and immune
function (Seeman, Dubin, & Seeman, 2003), as well as mental and
physical health (Aukst-Margeti c & Margeti c, 2005). Religious and
spiritual beliefs and practices may provide physiological, affective,
behavioural, and cognitive mechanisms for coping with distress
and illness, mechanisms which may also act as protective resources
preventing the development of disease in healthy people (Fetzer
Institute and National Institute on Aging Working Group, 1999;
Mytko & Knight, 1999; Powell, Shahabi, & Thoresen, 2003).
Indeed, meditation and spirituality in the elderly has been related
to reduced anxiety, despair, and improved physical, emotional, and

0277-9536/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.socscimed.2010.02.001
 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
spiritual health (Lindberg, 2005). Further research is required to
determine factors linking spirituality with both physical and
mental health outcomes (Seeman et al., 2003).
Holism
The word ‘holism’ has been defined in various ways. For some
scholars, holism views a person's MBS as inseparable (Narayanasamy,
1999) making it artificial to try to separate these three dimensions
(Young & Koopsen, 2005). The MBS are said to be interconnected,
interacting in dynamic ways with one another (Young & Koopsen,
2005) and the environment (Burkhardt & Nagai-Jacobson, 2002).
‘Holistic health’ broadens the traditional medical focus on symptoms
and disease to include other health-related domains such as nutri-
tion, psychological and spiritual wellbeing, interpersonal relations,
and environmental influences (Lowenberg & Davis,1994). It adds the
concepts of balance, harmony, and mind-body integration to tradi-
tional ideas of physical, mental, spiritual, and social wellbeing,
complementing a multidimensional view of health (Saylor, 2004).
Such views of holistic health are essential foundations for comple-
mentary and alternative health therapies (Saylor, 2004). A holistic
practitioner focuses on the interrelationships of physical, mental,
emotional, and spiritual dimensions of the individual and how they
jointly affect health and wellbeing (Lowenberg & Davis, 1994).
It is difficult for ‘holistic’ perspectives to be assessed. Western
medicine tends to require that alternative forms of healing adhere
to the predominantly empiricist, bio-reductionist framework of
medicine (McKee, 1988). However, holistic health is usually defined
in subjective, experiential terms including feelings of wellbeing,
attitudes, a sense of purpose and spirituality. Such aspects are often
not able to be objectively and scientifically observed, measured or
tested (McKee, 1988). Nevertheless, views on holism deserve
further attention and scrutiny.
ori perspectives
Indigenous & Ma
Indigenous perspectives on holism and wellbeing are based on
cultural values, beliefs and traditions passed down the generations,
including beliefs in the unity of MBS. Indigenous cultures
frequently believe that all life is interrelated with one another, the
environment, and the cosmos (Lee & Armstrong, 1995), and that
holism is the most appropriate way to understand health and
wellbeing. For example, Matsigenka people of South America see
health and wellbeing as a holistic reflection of the biological,
cognitive, emotional, social, environmental, and psychological
aspects of their lives (Izquierdo, 2005) while Native Americans
recognise the four elements of the person as spiritual, emotional,
physical, and mental (Canales, 2004; Matthews, 2002). For African
Americans, good health is seen as derived from a holistic balance
among MBS (Russell, Swenson, & Skelton, 2003), while Chinese
traditionally see the physical, emotional, social, and spiritual
wellbeing of individuals as indivisible (Chan, Chan, & Lou, 2002). In
Canadian First Nation and Inuit communities health and wellbeing
are viewed as stemming from balance across the mental, physical,
emotional, and spiritual elements of a person (Richmond & Ross,
2009), while for the ‘Anishinabek’ First Nations peoples, land and
their relationship to it are also central (Wilson, 2003).
From a Ma ori perspective, health is invariably holistic (Cram,
Smith, & Johnstone, 2003), including wellbeing across spiritual,
mental, and physical dimensions. Although there are several Ma ori
models of health, two have been particularly influential in
Aotearoa/NZ in the previous two decades, namely Whare Tapa Wha
[the four-sided house] (Durie, 2001) and Te Wheke [the octopus]
(Pere, 1995). The Whare Tapa Wha model has four walls, which
represent the four dimensions of wha nau [family], hinengaro
1757
[mental], tinana [physical], and wairua [spirit], which are viewed as
interrelated and working in harmony to influence health. Te Wheke
employs an octopus metaphor to illustrate the interdependence of
all things: the head represents the child/family and each tentacle
represents an intertwined dimension that helps give sustenance to
the whole. The eight tentacles represent wairuatanga [spirituality],
hinengaro [mental], taha tinana [physical], whanaungatanga
[extended family], whatumanawa [emotional], mauri [life principle
in people and objects], mana ake [unique identity], h a a koro ma
a kui ma  [inherited strengths], and finally other M aori concepts.
These aspects of health are apparent in traditional M aori healing,
which involves the five cornerstones of: wairua [spirit], hinengaro
[mental], tinana [physical], wha nau [family], and matauranga
[education] (Jones, 2000).
Traditional Ma ori healing techniques include deep tissue
massage in Te Oomai Reia and mirimiri [massage], which is used
for healing injuries and releasing tension (O'Connor, 2007). Rongo a
[Ma ori herbal medicine] uses the medicinal properties of plants
(Jones, 2007), and other M aori healing techniques include karakia
[prayer] (Durie, 2001; Jones, 2007; O'Connor, 2007); ko rerorero
[discussion] (O'Connor, 2007); and water therapy, suffusions, and
heat applications (Durie, 2001). Traditional Ma ori healers were
called tohunga, or experts in a specific discipline (Durie, 2001), and
often had spiritual abilities, knowledge of the healing properties of
plants, and an inherent belief in the interrelated nature of wairua
[spirit], hinengaro [mind], and tinana [body].
Spiritual healers
Holistic healers are non-biomedical health practitioners who
use botanical, animal or mineral products to treat physical, mental,
and social diseases (McMillen, 2004). Spiritual healers also draw on
aspects of spirituality such as psychic abilities (Mark, 2008; Mcleod,
1999), spiritual communication (Mark, 2008; Mcleod, 1999), being
a channel or vessel for healing energy (Mark, 2008; Mcleod, 1999),
or using the gift of touch, energy work or rituals to heal people
spiritually, emotionally or physically (Hill, 2003). They have
a worldview on health, illness and healing that is grounded in
holism (Patterson, 1998); research with these healers has focused
on investigating phenomena such as the nature of energy (Warber,
Cornelio, Straughn, & Kile, 2004), spiritual diagnosis (Mzimkulu &
Simbayi, 2006), integration between traditional and Western
methods of health treatment (McMillen, 2004), and the use of
medicinal plants in healing (Vandebroek, Van Damme, Van
Puyvelde, Arrazola, & De Kimpe, 2004).
Only a few studies have examined spiritual healers' perceptions
of the holistic nature of the actual healing process. For indigenous
women spiritual healers of the Ojibwa and Cree tribes in the USA,
healing involved cultural traditions, and mastery of the indigenous
culture was integrally involved in their work (Struthers, 2000).
Maori spiritual healers view ill health as resulting from factors such
as emotional blockages, unsettled ancestral grievances, curses
originating in the whakapapa [genealogy], and imbalances
between physical and spiritual dimensions (Mcleod, 1999). These
healers strongly believed that clients needed to learn about their
cultural connections and bloodlines, to re-establish their whaka-
papa, restore their identity and sense of belonging, as well as
learning about taha Ma ori [Maori culture and values] to enable
healing of the spirit (Mcleod, 1999). Thus cultural values and beliefs
are a strong part of the healing process among indigenous spiritual
healers.
In summary, holism is strongly related to indigenous and M aori
concepts of health and wellbeing. M aori worldviews, the cultural
perspectives of Ma ori healers, and healing techniques were seen as
an ideal way to explore Ma ori perspectives on the MBS, health, and
1758 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
healing. While other studies have described Ma ori views about
health and healing, this study extends current knowledge by
exploring the views of Ma ori spiritual healers who actively and
regularly undertake healing practices that include aspects such as
spiritual communication with ancestors.
Methods
Process
To establish a collaborative partnership between the researcher
and Ma ori participants, two kuia [elderly females] were consulted,
and both supported the nature of the research endorsing M aori
cultural sensitivity utilised with Maori participants and the use of
koha [gift], where a small gift and food was given to each partici-
pant to thank them for their time. The study was approved by the
Massey University Ethics Committee and conducted within the
ethical guidelines of the New Zealand Psychological Society. Full
informed consent was gained and all participants were given
a letter summarising the results following the study, while some
were provided with copies of their transcripts and audiotapes.
Recruitment
Snowballing techniques were employed to recruit Ma ori spiri-
tual healers. One participant was known to the researcher, while
five participants were identified by friends' and associates'
contacts. The researcher made the initial contact by email or tele-
phone and provided some information about the study. If partici-
pants identified as ‘Ma ori spiritual healers’ they were eligible to
take part. Information sheets were provided at the start of each
interview. Six non-Ma ori spiritual healers also participated in the
study, although this paper focuses on M aori healers and implica-
tions for Maori health and healing.
Historically, Maori tohunga [healers] were selected as chil-
dren or recognised as tribal leaders (Durie, 2001). Colonisation
and the influence of modern society (e.g. urbanisation, global-
isation, and the Internet) have changed this and modern Ma ori
healers can self-identify as healers. They also have greater
access to healing techniques from a range of other cultures. No
data is currently available on rates or selection of traditional
Ma ori healers.
Participants included five females and one male. Two lived in
Auckland, the largest city in New Zealand (population of over 1
million) and four lived in two different small rural towns. Partici-
pants practiced a wide variety of forms of spiritual healing; those
mentioned most frequently included hands-on healing, distance
healing, reiki, romiromi [deep tissue massage], pressure, and mir-
imiri [massage].
Interviews
Data collection took place from March to September 2007. Indi-
vidual, face-to-face, semi-structured interviews were employed,
allowing for multiple topics and concepts to be explored in detail
(Smith & Eatough, 2006). All participants were met at a time and
place convenient to them (two at their homes and four at their
healing clinics) and interviews lasted between 120 and 180 minutes.
Interviews were audio-recorded and conducted by GM (a M aori
woman in her mid 30s).
Data analysis
All interviews were transcribed verbatim and analysed using
interpretative phenomenological analytic techniques. This method
enables an exploration of the way participants make sense of their
personal world and is useful for complex or novel topics (Smith &
Osborn, 2003). It can capture the depth of an individual's experi-
ence (Willig, 2001). We began with a detailed thematic analysis of
each individual participant's transcript as follows: first, the tran-
script data was read and general notes made, then notes were
collated through commonalities into clusters which were then
organised into major themes, and labelled. These more generalised
themes were tabulated together with references to the data from all
transcripts (Smith & Osborn, 2004). The themes were identified and
analysed according to each theme's direct relevance to MBS
connections, frequency, importance to the participant, richness of
data, and Ma ori cultural understanding.
GM's cultural background was critical to the analysis, as her
own cultural insights and knowledge informed how the data were
read and interpreted. This shared background between participant
and researcher was considered beneficial for ease of communi-
cation and rapport but also for analytical insight. Regular discus-
sions about the ongoing analysis took place between both
researchers. AL is a Pa keha [European] woman, and the discus-
sions ensured that M aori cultural language and views were clear
and issues regarding sense-making around cultural concepts were
regularly considered.
Several criteria were employed to evaluate rigour of the
research, namely balanced integration, openness, reflexivity, plau-
sibility and trustworthiness (Horsburgh, 2003; de Witt & Ploeg,
2006). These ensured that participants' voices were kept true to
their meaning by continually referring to raw transcripts and
ensuring that MBS interconnections were interpreted from partic-
ipants' meanings rather than constructions of the researcher's
making. Each major decision and stage of the study was discussed
in detail by the authors and justified using previous literature.
An audit process was used to document each step as well as
personal considerations and impacts. Findings were assessed in
terms of relevance to current and future theory and practice.
Results
Five superordinate themes emerged from the analysis of Ma ori
spiritual healers' talk about spiritual healing, understandings of the
MBS, health and wellbeing, namely: impact of colonisation; wair-
uatanga: spirituality for Maori; whanau and whakapapa [genealogy];
whenua [land]; and Ma ori healing techniques. Within three of these
superordinate themes, a number of subordinate themes were
identified. All themes are displayed in Table 1 and described in
greater detail below. A Ma ori word glossary is included in Table 2.
Impact of colonisation
Several of the M
aori healers focused on the effects of the coming
of the Pakeha [European settlers] that initiated the process of
colonisation, and ‘impact of colonisation’ was identified as
a superordinate theme (with no subordinate themes). Healers
viewed the mind, body, soul or spirit concept as something Pa keha
brought to Aotearoa/NZ, as the following quotes demonstrate:
. going back to the concept of the mind, body, and soul . that's
more of a colonisational concept (Participant 5, female).
. do you know, in our time, there was never a mental. We never
had a mental problem, Ma ori. We were physical and spiritual all
the way. There was no need for mental, until the white man came
. That mental, that never existed. Came when the Pa keha came
aye. I call that mental part, just a bridge. The physical's lost contact
with your wairua. But I call it the bridge, so I have to walk that
mental bridge with people . And god, there's a lot of rubbish along
 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764 1759

Table 1
ori spiritual healers' interviews.
Superordinate and subordinate themes from Ma

Superordinate Impact of Wairuatanga Wha nau & Whakapapa Whenua [land] M

aori healing techniques
Themes: colonisation [spirituality] [family and genealogy]
Superordinate None Spiritual guides None Healing and the land M
aori rongo ori herbal medicine]
a [Ma
Themes: and sources
Spiritual tohu [signs] Narrative connection between Romiromi [deep tissue massage]
land and Maori
Mirimiri [massage]

that bridge. But I eventually get to the wairua . And my job is to ori
Wairuatanga: spirituality for Ma
bring the wairua and the physical back together again . very
simply . Once you get there, well, you just bring them back . The second superordinate theme identified was ‘wairuatanga’
(Participant 4, female). [spirituality], and this contained two subordinate themes, namely
‘family spiritual guides’ and ‘spiritual tohu’. Spirituality is a central
Traditionally, Maori regarded the body as connected with the
feature of the Ma ori worldview, and is held with an almost tangible
mind, but the mind was viewed as consisting essentially of spiri-
sense of reverence within the healing session and in daily life.
tual essence (Goldie, 1999). Nowadays mind is seen in more
Western terms as thoughts, beliefs or cognitive processes. In the
Family spiritual guides
quote above, participant 4 considers the ‘mental’ or mind as
Five Ma ori healers referred to specific spiritual connections with
a bridge that symbolically represents the connection between the
family members who had passed away and who now acted as
physical and the spiritual aspects of a person. Notably, this
spiritual guides for individuals:
participant points out there is a lot of rubbish on the bridge,
perhaps denoting the problematic difference in definition of terms Cause Ma ori belief is that we go through God, through our tu  puna
between traditionally held M aori views and modern views of the [ancestors]. So. the closest human connection is our parents and
mind (which the participant sees as a Pa keha construction). grandparents. And so. we always believe that they hang around
Perhaps she views thoughts, beliefs and cognitive processes as the us, they look after us and watch us. Ah, but also that they come to
“rubbish”; in other words, as the factors that complicate the deliver messages for those matakite [psychic] who are around us
traditional Ma ori understanding of mind as spiritual essence. can communicate with them and tell them that they're angry with
However, all Ma ori healers talked about the use of the mind in us, or they're happy with us, or keep going the way we're going,
their current practice, despite it also being described as introduced encouraging us. So that, they, um, they give us information from
by European colonisation. The impact of European colonisation on another source. But you need to be able to discern what that
the health of indigenous M aori is significant and involved the information, interpret that information from where you are. And
introduction of new infectious diseases (Jones, 2000) that seri- also where, understanding that in some ways when your grand-
ously affected M aori health. Major adaptation was also required parents crossed over, they had beliefs of another time. So. you
due to a loss of resources (Durie, 2001) and changes to Ma ori have to sort of really look at, what are they trying to say to me. If it
culture. is to put into action or just sit back and take that on for your, for
your self development. and they could growl you and you can
growl them back. You know, so {laughter} so, they're not just here,
just so, oh just leave me alone, this is my life, not yours. You know,
Table 2
ori terms.
and so. it's ah, just another dialogue on another level, in another
Glossary of Ma
dimension. And um, and you can tell them to stop interfering. and
e kare Exclamation P
akeha European they listen. You know, because they know. at the heart, if you're
 a koro ma
ha  Inherited strengths patu Weapon
 a kui m
really sincere. What I'm, what I'm trying to achieve (Participant 1,
ha a Inherited strengths romiromi Rigorous massage
hapu Sub-tribe 
rongoa Maori herbal male).
medicine
hara Offence kau
ra Trees
Healers referred to spiritual communication with ancestors
ka haere mai That comes to you ori
taha Ma Maori culture and through giving and receiving messages both inside and outside the
ki a koe values healing process, communication which is said to be used not just by
karakia Prayer taha tinana Physical side ori population (Eames, 2009).
healers but also by the general Ma
koha Gift taha wairua Spiritual side
rero
ko Stories tapu Sacred
rerorero
ko Discussion te wheke The octopus Spiritual tohu [signs]
korowai Cloak tinana Physical/body When receiving communication from spiritual sources, one
kuia Elderly female tohu Signs Maori healer mentioned unique modes of receiving messages, such
mahi Work tohunga Expert in a specific as via animals, dreams, and smells:
discipline
mamae Illness  puna/tıpuna
tu Ancestors ori was about . tohus [signs]. And
Cause a lot of it . for the old Ma
mana ake Unique identity wairua spirit/spiritual
tohu is . things that you might see. It could be the way, you know,
matauranga Education wairua mirimiri Spiritual massage
matakite Psychic wairuatanga Spirituality
a bird, he manu, ka haere mai ki a koe [that comes to you] or it
mate Maori Cultural illness related whakapapa Genealogy could be um, colour (...) . for my uncle who just passed away. For
to spiritual causes me, it came in a smell . it's normally the first thing that comes to
maunga Mountain whanaungatanga Extended family your mind . and it came loud and fast in . a death smell
mauri Life principle in people whare tapa wha Four-sided house
(Participant 5, female).
and objects
mere Short flat weapon whatumanawa Emotional People and nature are interconnected and the personification of
mirimiri Massage
natural elements is part of Ma ori understanding of the world
1760 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
(New Zealand Conservation Authority, 1997). This bonds Ma ori with
elements of nature such as birds, so that receiving messages in this
form seems natural. Spiritual tohu further highlighted the impor-
tance of the spiritual dimension for Ma ori healers, who repeatedly
referred to the use of spiritual guides, ancestors, and tohu.
nau/Whakapapa
Wha
Wha nau/whakapapa [family and genealogy] was identified as
a superordinate theme across the interviews, with no subthemes.
nau/whakapapa is very important for Ma ori and healers drew
Wha
on these concepts in describing healing sessions, discussing cases
nau trans-
where the cause of an illness comes from past wha
gressions which have been passed down the bloodlines to the
nau
client, or where individuals commit an offence and it is the wha
or the extended hapu  [sub-tribe] who pay for the misdeeds of that
family member:
ori, because we're a communal people . it's also about
. for Ma
nau. It's also about . their whakapapa. There might be
the wha
a mamae [illness] that's come through the line . might . been
a hara [offence] . way back . (Participant 5, female).
. I had . families come, real bad stuff . it's passed down through
ori [cultural
the families like that . I'm talking about mate Ma
illness related to spiritual causes] now (Participant 4, female).
One healer described a group intervention where the whole
nau gathered to address a sexual abuse offence, and shares
wha
 was potentially liable for the offender's actions.
how the hapu
. they just abused. I didn't realise . they actually doing that
because they gonna lose things. Material things . the hapu [sub-
tribe] had lost . korowais [cloaks], patus [weapon], meres [short,
flat weapon]. For that. whatever you commit, the whole hapu  wherever they come from to the land that they've tramped as they
suffers (Participant 3, female).
Here both the wha nau and client receive the consequences of
offences, and yet neither the whanau nor the client may be aware of
the offence that is causing the illness or the suffering. Therefore,
clients seek help from a healer who may involve the client's
wha nau in the healing session. Sometimes wh anau organise heal-
ing for the client:
naus come and they drag that one by the
The clients come, the wha
noose to come (.) It helps to know their background . I ask the
whanaus . where's this been . why is this one, why do you think
he's like that. You tell me why, and then I get a story from that one
. You need the whole information . (Participant 4, female).
Without information from the wha nau, it is believed that the
client may not receive the required healing. The wha nau may take
responsibility for the client's healing if they think the client is
unable to do so themselves. For M aori, whananaungatanga is
a family connection maintained through ancestral, historical,
ori whanau
traditional and spiritual ties (Pere, 1995). During Ma
intervention there is an effort to establish responsibility and once
nau
the offender has confessed, the members of the offender's wha
share blame and responsibility for the wrongdoing (Metge, 1995).
nau intervention becomes an extension of the individual
Wha
healing session which is consistent with Ma ori healers' beliefs
about the role of whanau in a person's life.
Whenua
Whenua [land] was viewed as centrally relevant to health and
ori spiritual healers, and identified as a superordinate
illness by the Ma
theme that contained two subordinate themes, namely ‘healing and
the land’ and ‘narrative connection between land and Ma ori’. Healers
viewed the land as having a unique and distinctive existence, and
viewed people as suffering consequences that originate over land
issues.
Healing and the land
One healer provided the following example of trespassing
against the land which affected the health and wellbeing of one
client:
And apparently the land that they were living on, the boy was
growing dope on. And . this specific area that he was growing
dope on was an old urupa [cemetery] and the people that had come
up were . these ugly looking people . with . teeth like that. You
know, razor sharp teeth and they were wearing grass so it was
really, really, really, really old stuff . (Participant 6, female).
In this case, the young man became very sick, ranting and raving
incoherently and trying to do damage to himself. This was viewed
as a consequence of committing an offence to the land and showing
a lack of respect for the land. One of the capacities of the wh
anau is
guardianship for wh anau heritage but also for wise management of
wha nau land (Durie, 2001).
Healers discussed land as a reason clients required healing, but
commented that the land itself also sometimes needed healing (not
necessarily separately from the client's healing), as shown:
Land is the biggest reason that people come to see me. Land, people
fighting over land, take land that's not theirs. They sign a piece of
paper, sign their land away and end up getting sick. They come to
me to channel healing to them. No, land is a very important one
(Participant 2, female).
. healing to me is . a holistic thing because you're working on
everything . you're working on the land that they were on, where,
went through (Participant 6, female).
Thus, the holistic view of the client extends to include land; it is
seen as a fundamental part of the client's existence and an inclusive
part of Ma ori identity. Ma ori people and tribal groups are
frequently referred to by a geographical feature such as a mountain
that recognises the local tribe's intimate connection with the land.
Maori identity is linked to the earth by a sense of belonging to the
land, being part of the land and being bonded together with the
land (Durie, 2001).
Narrative connection between land and Maori
Maori also have a strong attachment to the land through
mythology and traditions (Walker, 2004). This narrative connection
to the land was apparent in the interviews with healers, with one
relating a story which was passed down the generations about how
the mountains of the area moved across the land:
And they go, you know, your people were geologists cause look.
They did and they passed these stories so well because when they
look at the satellite, they could actually see the tracks under the
whenua. And how the maungas [mountains] did go. You know and
they were all passed down. All these ko rero [stories] always been
passed down (Participant 3, female).
From this participant's perspective, the legend that was passed
down the generations about how the mountains had moved over
the centuries was later verified by geologists who used satellite
images showing tracks indicating land movement over hundreds of
years. Stories are an intrinsic part of M ori have
aori culture and Ma
multiple ways of showing a mythological, historical, and kinship
connection with nature (O'Connor & Macfarlane, 2002). Stories
keep ties with the land alive and commemorate both history and
local geology.
 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
ori healing techniques
Ma
The superordinate theme of ‘Ma ori healing techniques’ con-
tained three subthemes concerning traditional healing techniques
ori, namely ‘M
considered to be unique to Ma aori rongoa’, ‘romir-
omi’; and ‘mirimiri’.
Maori rongoa 
This is a form of M aori healing that uses the medicinal proper-
ties of plants as well as other objects. One of the healers told a story
about how she was treated with rongoa  after she was dragged by
a bus over a gravel road when she was a young girl:
. everybody run and get some . plants . and this big bathtub.
And they filled it up with . water, and then they put me into this
water. And it was all these plants . ra kau [trees], all floating
around in it . And it was really stinging and all my body was raw.
E kare [exclamation], too, and no scars from it (Participant 3,
female).
However, rongoa  does not necessarily have to be plants, as one
healer also discusses the use of spit for healing and can also involve
physical therapies and spiritual healing (Jones, 2007). Traditionally
Maori rongoa  involves the gathering, preparation, and formulation
of plants (including leaves, roots, bark) (Riley, 1994). However,
ori also regard water as having significant ritual cleansing power
Ma
that is derived from the application of water such as washing hands
when exiting a cemetery or after visiting a tupa paku [deceased's
body] to cleanse after being in a tapu [sacred] area (Parsons, 1985b).
Romiromi
This Maori healing technique involves deep tissue massage and
pressure being applied to the body:
the healing art called romiromi which is . body alignment .
which . applies pressure on pressure points in the body . the
effect of that is it opens up different parts of the body and brings
new information in where there's some blockages in that body. And
that ancient art is called Te Oomai Reia (.) when they have
emotional issues . when you press . it's like there's a flame that
goes through your body and up through your . mind and . all
your worries are burnt away. Ah, because you're screaming
(Participant 1, male).
The healer applies pressure to the client's body which can
involve working with deep tissue alignment, pressure points, nerve
centres, and muscle tissue to aid the body release and remove toxic
buildup and waste, which helps relieve tension, stress, and pain
(O'Connor, 2007). The healers conceptualized deep physical
massage as able to effect change in the body and also lead to
positive change in mind and spirit.
Mirimiri
Mirimiri is described as massage of soft tissues of the body that
provide therapeutic treatment for malfunctioning body systems
(Fontaine, 2000). Two of the healers described mirimiri as a healing
technique that also incorporates treating the client's taha wairua
[spiritual side], and thus providing wairua mirimiri [spiritual
massage]:
a physical massage, body massage but we also mirimiri of the taha
wairua so there's those other different mirimiri as well . that's not
just of the basic muscle massage (Participant 5, female).
our wairua mirimiri [spiritual massage] . it's on a deeper level
than just mirimiri. It's incorporating . everything that our tıpuna
[ancestors] are telling us . and everything that we've learnt
(Participant 6, female).
1761
ori model of health and wellbeing
Te Whetu: Ma
These findings highlight the uniqueness of various aspects of the
healers' conceptualisations of health, illness, wellbeing, and MBS.
In addition to MBS, the healers all consistently emphasised the
fundamental importance of wha nau/whakapapa and whenua.
Including both wha nau/whakapapa and whenua alongside the MBS
concept creates an expanded holistic model of Ma ori health and
wellbeing that has 5 interconnected aspects: hinengaro, tinana,
wairua, wha nau/whakapapa, and whenua. We developed a graphic
representation of this model using a star symbol, and named it Te
Whetu [the star]. This symbol reinforces the connectedness of the
five elements as one whole system, consistent with the findings of
this study. Te Whetu model, displayed in Fig. 1, differs from
previous M aori models of health (e.g. Whare Tapa Wha, Te Wheke)
because it includes land as one of the five major integrated aspects
of health and wellbeing, yet it is similar in other respects. The
uniqueness of this model comes from being developed from prac-
tising spiritual healers views, and, therefore, may be applicable and
worthy of considering across different kinds of healing situations.
Discussion
This study provided insights into Ma ori spiritual healers' views
on health, illness, and wellbeing, adding to the research in this
area. It demonstrated the importance of whanau/whakapapa
[family and genealogy] for M aori health, that included spiritual
communication with ancestors and considerations of family
transgressions from past generations, and importance of connec-
tions to ancestral land. Healers' viewed the term ‘MBS’, and
particularly understandings of ‘mind’, as brought into M aori
culture through colonisation, suggesting the concept of MBS did
not fit easily into their conceptualisations which was unexpected.
This is surprising as holism is often linked to indigenous world
beliefs (Lowe & Struthers, 2001; Mark, 2008), rather than intro-
duced by European settlers.
In discussing holism, the healers included the mind, body, and
spiritual realms, but additionally emphasised the fundamental
importance of wh anau/whakapapa for the individual's health
and wellbeing. This is consistent with previous research with
M aori (e.g. Cram et al., 2003; Mcleod, 1999) which shows that
MBS and family are interrelated and work together to create
harmony (Durie, 2001). Indeed, family is seen as a major
component of Ma ori life (Metge, 1995) and thus is included in
other models of M aori health (e.g. Whare Tapa Wha; Durie, 2001;
ori health and illness: Te Whetu (The Star).
Fig. 1. A conceptual model of Ma
1762 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
Te Wheke; Pere, 1995). Previous research with other indigenous
cultures demonstrates similar beliefs in the connectedness of the
mind, body, spirit, as well as family and nature (e.g. Struthers,
2000). For example, the Matsigenka of the Peruvian Amazon
view family as a crucial component of health, such that
supportive relationships, responsibility and respect for family,
are all central for achieving health (Izquierdo, 2005).
In addition to MBS, family and genealogy, this study also found
that land was centrally important in Ma ori spiritual healers'
conceptualisations and practices. Land is included in the Te Wheke
model of Ma ori health, but not as a major feature. The current
healers emphasised the significance of land for health and well-
being, and considered land as a potential cause of illness. Research
with other indigenous groups has not identified land as a major
component of health in research, except for Anishinabek First
Nations peoples, for whom land provides food and medicine but
also spiritual connections, as the land is seen as alive with spirits
that promote positive mental and emotional health (Wilson, 2003).
Spirituality was a major component of the healing session for
every healer, and for some so was communication with spiritual
sources. Previous research has demonstrated the use of commu-
nication with spiritual sources in a wide variety of indigenous
cultures as a natural part of life (Struthers & Peden-McAlpine, 2005)
and during healing processes in Pacific Island cultures (Parsons,
1985a). Ma ori healers have previously been found to use high
sensory perception during healing sessions (Mcleod, 1999). In the
current study spiritual communication involved communication
with deceased close family members and also with aspects of
nature or the environment. Few studies have explored spiritual
communication and healing. A traditional African worldview
includes the notion that after death ancestors remain intimately
involved in virtually all aspects of family life, and traditional healers
are in constant communication with spirits of ancestors to aid in
diagnosis and treatment of illnesses (Bojuwoye, 2005). Hmong
American shamans, Rarotongan and Native American healers
discuss receiving messages from nature, such as a bird indicating
a specific message (Helsel, Mochel, & Bauer, 2004), dreams
containing spirits who come to communicate (Baddeley, 1985) or
provide spiritual guidance (Portman & Garrett, 2006). In Pacific
Island cultures, ancestral spirits are influential and seen as potential
causes of illness (Parsons, 1985a).
The current healers employed a mixture of healing modalities in
an unproblematic manner, seeing these as tools that easily
combined with their inherently M aori cultural views. The ease of
intermingling techniques may be a result of colonisation, and living
in the two worlds of both M aori and Pa keha [European settlers].
Ma ori may have become accustomed to integrating, or hiding,
Ma ori cultural views because of the colonial history of Aotearoa/
New Zealand (NZ). In 1840, the Treaty of Waitangi was signed
between Ma ori and Pa keha, with a broad principle of equal part-
nership and two people sharing one land. This partnership has not
been realised, however, with governments ignoring the Treaty and
Ma ori rights to self-governance (Tuffin, 2008), and presuming that
“M aori would be assimilated into the dominant (P akeha) society”
(Nairn, Pega, McCreanor, & Barnes, 2006, p. 185). Shameful racist
practices have disenfranchised M aori (e.g. forbidding the use of
Ma ori language in schools early in the 20th century) and created
what some would call a hostile society to M aori (Nairn et al., 2006).
Colonisation is presented as a major reason for Ma ori having the
poorest health of all in Aotearoa/NZ (Ministry of Health, 2006).
New Zealand health policy currently aims to reduce health
inequalities for all New Zealanders, especially M aori (Ministry of
Health, 2006). We urgently need to find ways to respond to
Ma ori health needs, and the current findings provide fuller
understanding of the cultural views of Ma ori spiritual healers
which may be relevant for Ma ori health more generally. Gaining
insights regarding Ma ori healing methods, and the reasons for
them, may provide further understandings as to why many people
are increasingly dissatisfied with the Western medical system
(Furnham, 2005) and why they turn to alternative, cultural
methods of treatment (Struthers & Eschiti, 2005). Jones (2000)
argued that traditional healing should be incorporated and
accepted into the Western medical system because collaboration
between traditional M aori healers and mainstream health treat-
ment would benefit M aori and result in a more comprehensive
health delivery mechanism.
These results could also provide greater understanding for
health practitioners who are the first point of call for Ma ori clients
and who may benefit from gaining knowledge about cultural
factors involved in Ma ori illness and disease. Cultural examples
given in the literature include mate Ma ori [cultural illness related to
spiritual causes] (Durie, 2001), a culture bound syndrome where
afflictions are related to spiritual causes. M aori families will often
be reluctant to discuss mate Ma ori with health professionals for
fear of ridicule (Durie, 2001). If there were greater acceptance of
culturally based explanations for disease or illness, M aori may feel
able to talk more openly about their real concerns for family
members and participate more fully in their own health care.
Health practitioners need to have greater knowledge regarding
cultural explanations for illness and consider the importance of
involving family members in consultations.
While models are developed in the first instance to explain and
describe a paradigm (Eder & Pú, 2003), in this case, to explore Ma ori
healers' views on holism and healing, they also have the potential
to explain how the components of the model could function in
practical ways (Eder & Pú, 2003). Te Whetu, as a model of health has
the potential to support the inclusion of Ma ori cultural values in
health policy in a detailed way. For example, the model could be the
foundation of educational programs designed to inform health
practitioners and validate culturally held beliefs about the holistic
nature of Ma ori health, spiritual causes of illness, and possible
avenues of spiritual healing that may benefit Ma ori. The five
aspects of this model could also be the basis of health intervention
programmes that aim to provide holistic health information and
prevention strategies for Ma ori in a range of illnesses and diseases
before treatment is needed.
The study included only one male spiritual healer, although his
conceptualisations did not differ greatly from the female partici-
pants. The focus of the study was to elicit in-depth meaning and
understanding from Ma ori spiritual healers rather than to gener-
alise to the greater population of healers. This study may not
necessarily show how the majority of Ma ori (or even Ma ori healers)
view health, and we would expect a range of views across both
healers and lay people. It would be beneficial for future research to
investigate lay M aori beliefs as well as a more diverse population of
healers, and indeed other Ma ori health practitioners. Future
research could beneficially explore the process of becoming Ma ori
healers, as well as Ma ori concepts of MBS, spirituality, and
communicating with ancestors/spiritual sources. We also know
little about the healing processes of Ma ori rongo a, romiromi,
mirimiri or incidences of family transgressions being passed down
through the generations, and such topics are worthy of further
investigation.
In summary, this study revealed principles of Ma ori healing that
originate from ancient cultural knowledge and traditions which see
the mind, body, spirit, family, and land as essential aspects of health
and wellbeing. The connectedness of mind, body, and spirit was
highlighted, but the external relationships people have with their
family/genealogy and with the land are viewed as just as important
for maintaining good health. Treatment and healing practices that
 G.T. Mark, A.C. Lyons / Social Science & Medicine 70 (2010) 1756e1764
address these relationships are seen as culturally appropriate for
ori customs, values and ways of life. Further research into the
Ma
holistic nature of health, different conceptualisations of MBS, and
understanding indigenous peoples' worldview regarding health,
illness and wellbeing will provide essential and timely knowledge
for academics and practitioners alike.
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