1 

DECOLONISING HEALTHCARE: 

BREATHWORK AS A TRADITIONAL AND COMPLEMENTARY MEDICINE 

 

 

By: Zuraida Jardine-Lindberg 

Student Number: 1240743 

 

 

This report is submitted in fulfilment of the requirements for the degree of 

MASTER OF ARTS 

 

in the department of 

CRITICAL DIVERSITY STUDIES 

 

at the 

UNIVERSITY OF THE WITWATERSRAND 

Supervised by: Prof Melissa Steyn & Dr. Haley McEwen  

 

 

Date of submission: 15 March 2023 



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Declaration 

 

I, the undersigned, declare that this research report is my original work. Any ideas in this 

report that are not my own are acknowledged through proper references and citations. This 

report is being submitted for a Master of Arts in the field of Critical Diversity Studies at the 

University of the Witwatersrand, Johannesburg, and no part of this report has been submitted 

in the past, or is being submitted, or will be submitted in the future for any degree or 

examination at any other university. 

 

 

 

______________________________ 

Zuraida Jardine-Lindberg 

 

 

15.03.2023 

Date  



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Table of Contents 

 

Acknowledgements          5 

Abstract            6 

Chapter 1: Introduction          7 

1.1 The Research Problem         11 

1.2 Purpose of the Study         12 

1.3 The Research Question         13 

Chapter 2: Theoretical Framework        15 

 2.1 Critical Diversity Literacy       16 

Chapter 3: Literature Review        22 

 3.1 Background         22 

 3.2 New Democracy in Healthcare       22 

 3.3 Indigenous Knowledge Systems (IKS)      25 

 3.4 Interdisciplinary Healthcare       26 

 3.5 Biomedicine vs Traditional, Complementary and Alternative Medicine  27 

 3.6 Breathwork: Ancient Art, New Science      30 

 3.7 Breathwork in Biomedicine       32 

 3.8 Breathwork Classifications       34 

  3.8.1 Mindfulness/Conscious Breathing     35 

  3.8.2 Deep Relaxing Breathing      36 

 3.9 Breathwork Findings        37 

 3.10 Decolonising Healthcare        38 

 3.11 The Curriculum         40 

Chapter 4: Methodology         41 

 4.1 Data Sources         42 

 4.2 Data Collection Techniques       43 

 4.3 Data Analysis         44 

  4.3.1 Thematic Analysis       44 

  4.3.2 Critical Discourse Analysis      45 

  4.3.3 Reflexivity        46 

  4.3.4 Ethical Considerations       47 

  4.3.5 Limitations        48 

 



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Chapter 5: Findings and Analysis        49 

 5.1 Breathwork as a Bridge        51 

 5.2 Epistemology of Ignorance       58 

  5.2.1 Epistemic Ignorance       59 

  5.2.2 Paradigm Shift        63 

 5.3 Social Transformation        67 

Chapter 6: Conclusions and Recommendations      74 

References           76 

Appendix A: Participant Information Sheet      87 

Appendix B: Consent Form         88 

Appendix C: Interview Schedule        89 

Appendix D: Ethical Clearance Certificate      90 

 

List of Abbreviations and Acronyms 

 

TCAM: Traditional Complementary and Alternative Medicine 

TM: Traditional Medicine 

THP: Traditional health practitioners  

CAM: Complementary and Alternative Medicine 

CDL: Critical Diversity Literacy 

IKS: Indigenous Knowledge Systems 

NCD: Noncommunicable Diseases 

WHO: World Health Organisation 

  



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Acknowledgements 

I am immensely grateful for the life-changing experience that pursuing a Masters Degree in 

Critical Diversity Studies has been. This program has challenged and inspired me to reflect 

on my own privilege while remaining aware of how power dynamics continue to perpetuate 

social inequalities. Through this journey, I have been able to learn, unlearn, and rewire my 

thinking, resulting in a positive and transformative change in myself. 

I would like to extend my sincere thanks to the Wits Centre of Critical Diversity Studies, 

particularly to my patient, optimistic, and compassionate supervisor, Haley McEwen, and our 

inspiring head of department, Mellissa Steyn. Your unwavering encouragement and support 

have been instrumental in helping me complete this thesis, especially during the personally 

challenging time of the Covid-19 pandemic. 

I am grateful to my wonderful classmates, who have become my confidants and friends, 

namely Sarah, Nyami, Jane and Amber. Your kindness and critical engagement have 

enriched my life over the last couple of years. 

Lastly, I want to express my heartfelt appreciation to my loved ones, my partner Josh and our 

children, Zaria and Shia. Your persistent support, encouragement, and dedication to my 

dream have been my source of inspiration during moments when I felt like giving up. The 

philosophy of ubuntu, which emphasizes the interconnectedness of all beings, has been most 

profoundly highlighted for me throughout the process of this degree. I am who I am because 

of others, and I am deeply grateful for all the love and support. 

Thank you all for igniting my passion for learning and nurturing my curiosity. 

 

  



 6 

Abstract 

 

This study investigates the potential for Breathwork as a traditional and complementary 

medicine to promote decolonisation in healthcare. The study utilised qualitative interviews 

with healthcare practitioners who integrate Breathwork into their practice, in order to explore 

their viewpoints on the potential therapeutic benefits of this modality. Colonisation has 

played a significant role in historically discriminating against indigenous knowledge systems 

when it comes to healthcare, leading to an epistemic ignorance around various healing 

modalities. To address this issue, a shift towards pluralistic healthcare systems that integrate 

traditional and complementary medicines is needed. This can provide patients with a wider 

range of medical options and a more holistic approach to healing, empowering the individual 

to take control of their own health. However, change needs to start at policy level, with a 

commitment to inclusivity and cultural sensitivity within healthcare systems. Academic 

institutions also have a critical role to play in transforming their healthcare curricula to be 

more inclusive of traditional, complementary, and alternative medicines. This involves 

recognising the extent to which Euro-western teachings still dominate healthcare education 

today and working towards greater diversity in curricular content. The observations made in 

this study suggest that socially constructed definitions of health require transformation, 

particularly in countries as diverse as South Africa. In conclusion, this study aimed to 

highlight the possible impact Breathwork as a traditional and complementary medicine may 

offer the healthcare sector. By acknowledging the historical discrimination against 

indigenous knowledge systems and embracing a more pluralistic approach to healthcare, 

South Africa can work towards building a more equitable and culturally sensitive healthcare 

system that not only meets diverse needs but offers empowerment for individuals to become 

active participants in their wellbeing. 

 

 

 

  



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Chapter 1: Introduction 

 

Breath is a powerful material and spiritual force, a point not only of harm but also 

recovery. It can show us how Black people experience multiple convergences of 

racial violence, health and environmental hazards, socioeconomic precarity, and 

disaster through time and space. (Jolaosho, 2021) 

 

Breathing is a vital function of the body’s need for air, while air is a critical constituent for 

life preservation. Remarkably, the act breathing is unique to the body in that it can be 

accomplished both consciously and unconsciously and is hardly considered until the body 

faces suffocation. Social scientists have started assessing the significance and urgency of the 

breath (Jolaosho, 2021) concerning systemic and structural oppressions (Ingold, 2020; Apata, 

2020; Huval, 2021). Using concepts of breath and suffocation, the following is an effort to 

uncover the impact that socio-political dimensions have had on suppressing indigenous ideas 

of knowledge in health and medicine. Unpacking power dynamics responsible for 

establishing whose lineage of knowledge is deemed un/breathable affords opportunities for 

transformative interventions towards an inclusive, pluralistic healthcare system. Medical 

pluralism, the co-existence of multiple medical methods, can benefit how practitioners and 

patients engage with healthcare and each other; this pluralism is crucial considering the 

multiplicity of worldviews that exist (Moshabela, Zuma & Gaede, 2016). 

 

Decolonising healthcare is the process of liberating healthcare practices and systems from the 

historical and ongoing influences of colonialism. Breathwork has roots in various cultural and 

spiritual practices, including indigenous healing traditions. Incorporating Breathwork into 

mainstream healthcare helps to not only preserve but revive important indigenous knowledge 

practices that were suppressed by colonialism, leading to losses of knowledge production and 

marginalisation. Integrating Breathwork into healthcare can aid in revitalising traditional and 

complementary medicines, promoting cultural diversity in healthcare, and expanding the 

range of effective treatment options available to patients. This study examines how politics of 

knowledge have contributed to structural inequalities in healthcare – whose world views of 

health and medicine are deemed in/valid and left out of the global narrative?  Further, the 



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paper explores the ancient traditional medicine1 (TM) of Breathwork2 by healthcare 

practitioners and how its use can aid a strained healthcare population. 

 

In 1948, The World Health Organization (WHO) defined health as "a state of complete 

physical, mental, and social wellbeing and not merely the absence of disease or infirmity" 

(WHO, 2020). Seventy-three years later, this health classification has shifted minimally 

(Nkemjika, Escobar, & Marin, 2020). The definition appears reassuring and comprehensive; 

however, it can be argued that the definition of health bears significant practical implications, 

extending beyond its theoretical underpinnings. The definition of health holds considerable 

implications across different domains including health policy, health services, and health 

promotion. It serves as a significant determinant in shaping the attitudes and behaviours of 

healthcare professionals, thereby influencing the social construction of health in 

contemporary societies (Leonardi, 2018). 

 

The social representations of health exert a profound influence on the expectations and 

requirements of healthcare services, policy makers, and other salient aspects of health. 

Furthermore, perceptions of health hold considerable sway over individual health behaviours 

and, consequently, the capacity to make informed decisions about health. For example, 

Indigenous Knowledge Systems (IKS) are structures embedded within communities specific 

to a geographical location, comprising a complex set of knowledge, rituals, and skills 

developed over time and central to a lifestyle (Centre for Indigenous Knowledge Systems, 

2005). IKS share comparable epistemological essentials grounded in interconnectedness, 

community, and culture concepts. The concept of spirituality alone is practised as an essential 

TM in numerous societies such as Aboriginal, African, African-American, Asian, Indian, 

Māori, Mexican and Native American cultures (Marks, 2006). In summary, the definition of 

health carries strategic significance across all domains of health-related activity. 

 

What constitutes medicine or health? The answer largely depends on perception, politics, 

culture, beliefs, location, time, socio-economic factors, and varying intersections. Due to the 

impact of these influential social contexts, the concept of health is inherently interconnected 

 
1 The term ‘traditional medicine’ (TM) will be used throughout this paper. TM is often used interchangeably 

with ‘complementary and alternative medicine’. Breathwork falls under ‘traditional, complementary and 

alternative medicine’ (TCAM). For this paper Breathwork is referred to as a traditional medicine (TM). 
2 Breathwork is an ancient medicine that uses conscious breathing practices for the purposes of physical, 

psychological, emotional, and spiritual healing. 



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with hegemonic views around health formations. This is evident in former colonies such as 

South Africa, where the practice of TM predates biomedicine3. Yet, despite this antecedent, 

the blueprint for health is biomedicine (Hassim et al., 2007). Biomedicine applies scientific 

principles of biochemistry and biology like pharmaceuticals and surgery to diagnose, treat 

and prevent illness (Hassim et al., 2007). TM, on the other hand, applies: 

diverse health practices, approaches, knowledge and beliefs incorporating plant, 

animal and/or mineral-based medicines, spiritual therapies, manual techniques and 

exercises applied singularly or in combination to maintain wellbeing, as well as to 

treat, diagnose or prevent illness. (WHO, 2008) 

 

The establishment of colonial powers was facilitated by their projection of knowledge as 

superior and legitimate, leading to a shift in the perception of health from a multidimensional 

approach to one that solely focused on biomedical perspectives. This shift, however, was 

fundamentally unjust, as it entailed the dismissal of IKS, particularly TM which was 

considered invalid owing to its lack of scientific validation (Marks, 2006). Additionally, 

Euro-western media referred to traditional healers, commonly known as sangomas, as 

"witchdoctors" (Parle, 2003). In South Africa, herbalists who practiced traditional healing 

were only permitted to do so until 1928 when the Medical, Dental and Pharmacy Act was 

enforced, prohibiting all herbalists from practicing, except for those in KwaZulu Natal (Flint, 

2008). This Act also imposed significant restrictions on traditional healers, including 

prohibiting the use of Western medical instruments, effectively reducing their profession to 

that of herbal merchants (Flint, 2008). 

 

Examining the relationship between biomedicine and TM exposes the dichotomy between 

science and sociocultural affiliations, revealing the underlying politics of inclusivity and 

exclusivity in healthcare. Establishing a connection between biomedicine and TM has the 

potential to transform the socially constructed norms of healthcare into an all-encompassing 

and multidimensional healthcare system. Such an integration would particularly benefit South 

Africa's diverse population, comprising individuals from different cultural, traditional, and 

spiritual backgrounds (Van Vugt & Cloete, 2000). Among the country's 59.3 million 

inhabitants, 92% belong to historically marginalized racial groups who rely on TM (World 

 

3 Biomedicine is also referred to as ‘western medicine’, ‘mainstream medicine’ ‘conventional medicine’ or 

‘modern medicine’. The term ‘biomedicine’ will be used throughout this paper. 



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Population Review, 2021; Pillay & Serooe, 2019). A study by Pillay & Serooe (2019) found 

that in South Africa, Christian, Hindu, Islamic, African and Asian cultures practice health-

seeking behaviours supervised by traditional healers. These include but are not limited to 

Christians accessing a pastor/priest, Hindus seeking help from a priest/guru, Muslims 

accessing a Moulana/Hakeem, Asians seeking out Ayurvedic Therapy/Acupuncture/Herbs, 

and Black Africans using Sangoma/Inyanga/Herbs. During apartheid, a pluralistic healthcare 

system was not a requisite as practicalities pertaining to healthcare favoured Western 

medicine as functional while traditional medicines were viewed as outdated (Mthembu, 

2020). 

 

The utilisation of TM in South Africa has gained prominence and recognition in recent times, 

particularly when the government enlisted the assistance of traditional healers to aid the 

healthcare sector in combating the COVID-19 pandemic. This call to action requested 

traditional health practitioners (THP) to refer patients exhibiting symptoms of the novel 

coronavirus to the appropriate level of care (Maphanga, 2020). Within the primary healthcare 

system, THPs play a crucial role in alleviating the burden of diseases in South Africa. The 

Department of Health has expressed appreciation for the contributions of THPs in the fight 

against COVID-19 (Maphanga, 2020). The request for traditional healers to aid the primary 

healthcare sector during COVID-19 also indicates the necessity of implementing a plural 

healthcare system that benefits practitioners and patients. Despite the hope that the 

democratic era has raised, the social reality is that the impact of colonialism persists and 

remains as exclusive as during the apartheid period, resulting in continuous marginalisation 

and segregation. A shift would require support from all structures contributing towards the 

practice and delivery of healthcare, inclusive of this, would be the role of higher education 

universities. Research and scholarship sit at the centre of producing new and alternative 

knowledge. Academic institutions, therefore, play a crucial part in disseminating knowledge 

and the monitoring this execution. Decolonising current biased biomedicine curriculums 

while expanding a medically pluralistic syllabi inclusive of IKS would benefit healthcare and 

further influence overall growth towards an inclusive, multi-knowledgeable healthcare sector. 

 

During the initial stages of the COVID-19 pandemic, which is arguably one of the most 

significant health crises of the past century, knowledge formation revolved around 

comprehending the disease, its treatment, and vaccine development. Meanwhile, traditional 

forms of medicine were being employed globally. For instance, Asia reported positive 



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outcomes in using Traditional Chinese Medicine (TCM) to manage COVID-19 (Chang et al., 

2020; Gao et al., 2020). According to Mirzaie et al. (2020), some Indian, Iranian, and 

Chinese herbs were effective in preventing, rehabilitating, and treating diseases, including 

COVID-19. Consequently, the World Health Organization (WHO, 2020) constituted a "25-

member Regional Expert Committee on Traditional Medicine for COVID-19" to aid 

countries in conducting clinical trials on traditional medicines according to international 

standards. The WHO's backing of this medicinal pluralistic realm endorses the benefits of 

TM and attempts to re-centre IKS. The urgent need to find a cure for COVID-19 has 

undoubtedly necessitated a rearrangement of healthcare structures to embrace, collaborate 

with, research, and teach pluralistic approaches. 

 

This research aims to examine how politics of knowledge as well as epistemic ignorance 

have overlooked vital contributions by marginalised sectors. A theoretical framework adapted 

from Critical Diversity Studies (Steyn, 2015) will form the lens of this research by attempting 

to answer questions such as: Whose knowledge is deemed valid? By who? Whose stories get 

represented in the global narrative? Why? How functional is the current status quo in 

healthcare? How can the use of a TM such as Breathwork aid healthcare? 

 

1.1 The Research Problem 

Even with a new constitution in place, remnants of apartheid remain active in the quotidian 

life of many marginalised South Africans. The prelude to the Constitution states, “We, the 

people of South Africa, believe that South Africa belongs to all who live in it, united in our 

diversity.” This statement, while idealistic, is fraught with political complexities in that 

belonging is an intrinsically subjective embodied experience, impacted by multiple 

dimensions and social relations. According to Yuval-Davis (2006), there are a variety of 

levels attached to the concept of belonging, including social locations such as identity, 

emotional attachment, ethical and political views. The political intricacies that accompany 

post-apartheid South Africa are indicative of a deficiency in transformation, thereby 

highlighting the substantial challenge of fostering a shared sense of purpose and belonging. 

This challenge is intricate, given that it encompasses rifts that stem from the interplay of 

diverse social differences and identities, encompassing variables including ethnicity, class, 

race, gender, sexuality, religion, language, geography, region, as well as other related forms 

of social differentiation. Such differentiation occurs within contexts of heightened social 

tension, as the nation continues to navigate the process of transitioning from its apartheid past 



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(Hino et al., 2019). Looking at healthcare for example, inadequate human resources pose a 

significant weakness in the health systems, according to Fonn et al., (2011). In Africa, the 

health worker-to-population ratio is below one per 1000 individuals, which stands in stark 

contrast to Europe's ratio of 10 per 1000. The disproportionate allocation of healthcare 

practitioners amongst private and public sections including the unequal distribution of public 

sector healthcare professionals across different provinces, exacerbates health challenges in 

South Africa, culminating in physical and mental fatigue (Barron & Padarath, 2017). 

Moreover, the deterioration of medical conditions further exacerbates the issue, leading to 

additional burnout and disillusionment of healthcare practitioners (Barron & Padarath, 2017). 

 

Post-apartheid, the South African government has officially regulated TM. The Traditional 

Health Practitioners Act No. 22 (2007) was a crucial milestone in acknowledging indigenous 

knowledge. More so, legitimising TM was imperative considering that the South African 

National Department of Health requires medical students to serve two years of training in 

rural areas where majority of their patients are likely to use TM in tandem with biomedicine. 

However, with medical students having limited exposure to TM, they pose a risk of service- 

inadequacy when dealing with diverse belief systems (Chitindingu et al., 2014). Pillay and 

Serooe (2019) have emphasized the issue that healthcare professionals in South Africa are 

bound to come across a complex interplay of diverse beliefs and practices related to race, 

spirituality, and religion. Hence, a functional healthcare system necessitates not only the 

regulation of TM but also the inclusion of pluralistic frameworks in higher education 

curriculums to equip healthcare practitioners with the necessary skills to support their 

patients. 

 

1.2 Purpose of the Study 

The primary aim of this study is to examine the transition of healthcare practitioners in South 

Africa towards embracing TM, particularly Breathwork, as a modality to decolonise 

healthcare. In doing so, the research investigates the power relations inherent within the 

healthcare sector that promote certain medicinal models while marginalising others, 

particularly those grounded in Indigenous Knowledge Systems (IKS) of health. Through this 

lens, the study further explores the meaning-making around healthcare delivery in South 

Africa and investigates the extent to which academic training in South Africa prepares 

practitioners to engage with TM practices to serve a diverse population. Breathwork was 

selected as the primary TM focal point due to the researcher's experience as a Breathwork 



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practitioner as well as the increased attention of the breath in the wake of the COVID-19 

pandemic. Breath has illuminated how respiration transcends race, gender, politics, and 

socio-economic status. 

 

The global impact of COVID-19 over the past two years has emphasized the importance of 

the breath, with the respiratory virus causing widespread devastation across the world. The 

researcher anticipates that Breathwork may hold significant value, as despite its association 

with contemporary science, it represents an ancestral traditional healing modality utilized by 

various indigenous communities. Its efficacy has been historically documented within global 

spiritual practices of antiquity (Gopal, Bhatnagar, Subramanian & Nishith, 1973; Conger, 

1988; Farhi, 1996; Hendricks, 1995; Victoria & Caldwell, 2013; Kuppusamy, Kamaldeen, 

Pitani, Amaldas, & Shanmugam, 2018). The medicinal benefits of Breathwork are also 

rooted in early African philosophy (Mutwa & Larsen, 2003; Edwards, Makunga, Thwala, & 

Nzima, 2007), making this indigenous knowledge relevant; as it is not imported or imposed – 

it is owned (Noyoo, 2007). 

 

This research proposes a re-examination of the contemporary definition of healthcare. By 

utilising a critical approach, the intention is to clarify the epistemological implications of the 

entrenched biomedical model. Pascale (2010, p. 52) asserts that scientific research has 

contributed to the perpetuation of various forms of prejudice. By scrutinizing "taken for 

granted" perspectives, there is an opportunity to deconstruct the historical "givens" and 

evaluate which individuals or entities are benefited, legitimized or privileged, versus those 

who are harmed, oppressed or disqualified (Canella & Lincoln, 2012, p. 74). 

 

1.3 The Research Question 

What prompted healthcare practitioners to evolve their practices towards a pluralistic 

offering? 

Sub-questions 

o To what extent do practitioners view Breathwork as a tool for decolonising 

healthcare? 

o How do power relations within the healthcare sector impact the promotion or 

marginalisation of particular medical models, particularly those rooted in IKS? 

o What challenges are encountered by healthcare practitioners in providing pluralistic 

healthcare that integrates TM practices such as Breathwork? 



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o How are academic institutions in South Africa preparing healthcare practitioners for 

engaging with TM practices that aim at decolonising healthcare? 

o To what extent does the current academic curriculum support understanding and 

engagement with TM practices? 

o How does the practice of Breathwork reflect broader social transformation occurring 

within the South African healthcare sector? 

 

  



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Chapter 2: Theoretical Framework 

 

Many stories matter. Stories have been used to dispossess and to malign. But stories 

can also be used to empower, and to humanise. Stories can break the dignity of a 

people. But stories can also repair that broken dignity. (Ngozi Adichie, 2009) 

 

Stories emotionalise information, and they are laden with the power to protect, shape, 

destroy, elevate, enhance and marginalise people, places, events and ways of being in the 

world. In Chimamanda Ngozi Adichie’s Ted Talk (2009), she poignantly describes the 

danger of believing a single story. Explaining that if we only hear about a people, a place or 

an event from one viewpoint, we inevitably risk accepting that one story as the only one, 

never questioning that narrative's construction. She posits how power is intrinsically linked to 

a single story and how this single story is often responsible for producing stereotypes: “the 

problem with stereotypes is not that they are untrue, but that they are incomplete” (Ngozi 

Adichie, 2009). She encourages shaping the mind to be open and curious so as learn, unlearn 

and relearn facts from fiction. 

 

Over a prolonged period, the worldwide discourse on health has reinforced a one-dimensional 

portrayal of traditional healing systems as primitive, superstitious, and illegitimate, thereby 

perpetuating stereotypes (Marks, 2006). To redress this loss of dignity and revive the 

credibility of IKS, it is imperative for scholars to be attentive to the power dynamics 

embedded in everyday operations and to remain cognisant of the harmful consequences faced 

by marginalised groups (Smith, 1999). Fortuitously, the COVID-19 crisis has forced several 

mainstream operations, such as healthcare, to fall under scrutiny. With global consciousness 

centred on health, the pandemic emphasised inequities by bringing racial and social injustice 

to the forefront of public health. This period has not only highlighted the fragility of this 

weapon-less war but by what means operations of structural violence have impacted how 

health is perceived and accessed (Büyüm et al., 2020). Within this calamity exists an 

opportunity to shift the perception of health. Complexities underlying historically situated 

politics of knowledge require the implementation of diverse methodologies when researching 

in order to advance literature (Pascale, 2010). Gaining an understanding of the origins of 

healthcare services, including their geographical and socio-historical context, is crucial in 

comprehending the full narrative. According to Langdon (2013, p. 384), "Beginnings matter 

because they set the tone for what is to follow in explicit and implicit ways." By examining 



 16 

the past, it becomes possible to comprehend how biomedicine, touted as the pinnacle of 

healthcare, gained its status as the preferred standard of medicine. 

 

In order to unravel the intricate complexities of the landscape under investigation, this 

research will adopt a critical diversity literacy perspective. To achieve this, the analytical 

framework proposed by Melissa Steyn (2015), titled "Critical Diversity Literacy: Essentials 

for the twenty-first century," will be employed. This lens aims to elucidate how hegemonic 

orders surreptitiously infiltrate social channels to validate dominant ideologies, thereby 

shaping the discourses and practices in healthcare. Through this scrutiny, the study aims to 

illuminate the nuanced dynamics of power relations within the healthcare sector, the 

marginalisation of IKS and the potential role of TM practices like Breathwork in 

decolonising healthcare in South Africa. 

 

2.1 Critical Diversity Literacy 

In 2015, Professor Melissa Steyn, Head of the Centre of Critical Diversity Studies at the 

University of the Witwatersrand, developed the Critical Diversity Literacy (CDL) 

framework. This framework was conceptualised out of a necessity for advancement in higher 

education’s role post-apartheid towards improved “transformation, integration and greater 

equity” (Steyn, 2015, p. 381). The framework proposes that: 

Critical diversity literacy can be regarded as an informed analytical orientation that 

enables a person to ‘read’ prevailing social relations as one would a text, recognising 

the ways in which possibilities are being opened up or closed down for those 

differently positioned within the unfolding dynamics of specific social contexts. 

 

Further, the CDL framework highlights the complexities underlying globalisation. As the 

world condenses through crossing borders and transitioning of social relationships, a 

“multilayered and multiperspectival, shifting, ambivalent and open to yet unknown 

possibilities” is brought to the forefront (Steyn, 2015, p. 380). This shift necessitates new 

contextual ways of navigating critical and social literacy in a rapidly changing world. 

According to Anderson and Irvine (1993, p. 82), critical literacy is concerned with the 

practice of inequalities and social injustices: 

The importance of critical literacy being grounded pedagogically in a politics of 

difference offers learners, regardless of their particular class, race, or gendered  

subjectivities, opportunities to become 'border crossers.' Critical literacy, then, is 



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learning to read and write as part of the process of becoming conscious of one's 

experience as it is historically constructed within specific power relations. 

 

Social literacy is concerned with the ability to effectively engage with and participate in the 

world from dimensions related to; technology, media, science, emotional literacy to health 

literacy (Steyn, 2015). An alienation from any one or all of these scopes can be experienced 

as a dysfunction (Steyn, 2015). The foundation of CDL is a commitment to uncovering 

dominant powers at play while being conscious of one’s blind spots. The following ten 

criteria form the basis of the framework. 

 

1) An understanding of the role of power in constructing differences that make a difference. 

A fundamental awareness of the establishment of power in issues concerning diversity 

is the first tenet of CDL. It is imperative to be conscious of the behaviours in which we have 

come to think about differences, knowing that these differences have been socially 

constructed (Steyn, 2015). There is a “constant ideological” framing required to maintain a 

“natural hierarchy” (Steyn, 2015, p. 381). This results in polarisations of human variability 

and the binaries we have come to view as standard, such as black/white, 

heterosexual/homosexual, man/woman, masculine/feminine (Steyn, 2015). Binaries manifest 

in a currency that values one over the other in social, psychological and economic settings. 

These groupings produce a plethora of experiences rooted in the sense of belonging, 

exclusion or othering. On this axis, hegemonic order successfully establishes the privileged 

from the othered (Steyn, 2015). 

 

2) A recognition of the unequal symbolic and material value of different social locations. 

Much of our knowledge formation is founded on the hegemonic dispositions of 

identities related to “whiteness, heterosexuality, masculinity, cisgender, ablebodiedness, 

middleclassness etc.” (Steyn, 2015, p. 382). Here, Steyn highlights the positions of the 

privileged and how blind spots reinforce “denial and unwillingness to acknowledge how one 

benefits from the systems which continue to hoard advantage for those like oneself” (Steyn, 

2015, p. 383). However, it is essential to note that not all in a position of privilege benefit in 

the same way. For example, when looking at allowances afforded to maleness, 

heteronormativity and whiteness, privilege positions vary according to spaces and otherness 

(Steyn, 2015). A white heterosexual male in a heteronormative setting will encounter a 

different experience than a white homosexual male in the same space. So, although the order 



 18 

of position diminishes, the privilege continues through the proxy of being white and male 

(Steyn, 2015). While some social positions are centred, others lie on the margins where the 

powerful define who the othered is. This way, “they retain their own psychological and 

material comfort” (Steyn, 2015, p. 382). With this, for the othered, comes navigation of 

shaming, humiliation and challenges of psychological wellbeing, particularly if there is a 

challenge to the status quo of the ideologically hegemonic way of being (Steyn, 2015). 

 

3) Analytical skill at unpacking how these systems of oppression intersect, interlock, co-

construct and constitute each other, and how they are reproduced, resisted and reframed. 

Intersectionality plays a crucial role in understanding how systems of oppression and 

dominance get reproduced in quotidian life—being aware of the powerplays that normalise 

particular identities while alienating others is key to CDL. With intersectionality, individuals 

experience ambiguities such as “class and gender, gender and race, race and nation, 

masculinity and nation, sexuality and race, disability and race, gender and sexuality”, to name 

a few, all of which connect in the constructural matrix of identity (Steyn, 2015, p. 383). 

Acknowledgement of these multiple layered realities is crucial to social justice and, as such, 

requires voices of the marginalised to be legitimised to counter the functions of hegemonic 

forces. 

 

4) A definition of oppressive systems as current social problems and (not only) a historical 

legacy. 

The epistemology of knowledge interrogates the foundations of knowledge. What is 

knowledge? How is knowledge acquired? What knowledge is deemed popular? How have we 

come to know what we know and why? Dominate discourses have historically rewritten the 

past to assert their narrative, doing so with no “moral accountability” contributing to what is 

known as the epistemology of ignorance (Steyn, 2015, p. 384). An example of this has been 

the distortions of Africa, represented globally as deep dark Africa or traditional medicine 

being witchcraft. Many misrepresentations require a redressing to fully understand the “axes 

of difference that shape social orders” (Steyn, 2015, p. 384). 

 

5) An understanding that social identities are learned and are an outcome of social practices. 

The social self is positioned to the prevailing powers within a social context. Shared 

social identities benefit from belonging to the majority leaving the minority feeling unseen 

and often stereotyped.  This tenant of CDL seeks to recognise that “there are no immutable 



 19 

characteristics attributed to a group of people that would be evident regardless of the 

historical processes of location, socio-economic conditions and other such influences” 

(Steyn, 2015, p.385). The propensity to favour one group over another impacts distribution of 

resources, be they material or psychological, resulting in how the social self gets understood. 

In sum, an awareness that social identities are learned behaviours due to socially constructed 

practices (Steyn, 2015). 

 

6) The possession of a diversity grammar and a vocabulary that facilitates a discussion of 

privilege and oppression. 

A crucial key in CDL is being fluent in the discourses surrounding power, privilege, 

oppression and dominance. When we understand the language around domination and 

oppression, we’re able to locate the people and events subjected to these positions, making it 

easier to “insist on the reality of the practices, strategies and effects of the operations of 

power on difference” (Steyn, 2015, p. 385). The aptitude needed in recognising these 

dynamics and practices will foster diverse, informed discussions in the field. 

 

7) The ability to ‘translate’ (see-through) and interpret coded hegemonic practices. 

“Power never names itself as such” (Steyn, 2015, p. 386). This statement is central to 

framing the work of CDL. Attaining the skill to detect and un-code hegemonic practices can 

reveal how hegemonic orders strategically “recast issues in ways that suit prevailing 

interests”, with this deflecting attention away from how power stays within the operations of 

social injustices. 

 

8) An analysis of the ways that diversity hierarchies and institutionalised oppressions are 

inflected through specific social contexts and material arrangements. 

Assumptions and constructions around gender, for example, are distinct globally. It is 

imperative that we understand the intricacies of this matrix and how location, space and time 

impact the material worlds of this distinction. The influence of varying historical processes 

and geographical areas has impacted how gender was/is expressed. It is dangerous to assume 

a generalised ideology as “misleading and imperialising in effect” (Steyn, 2015, p. 386). 

Instead, unpacking how hegemonic forces ‘translate’ between certain circumstances and their 

mutation over time will highlight how diversity hierarchies and institutionalised operations 

get inflected (Steyn, 2015, p. 386). The social and material worlds are intimately linked with 

symbolic and emotional substance retaining a significant position in determining how 



 20 

relationships are maintained or subverted (Steyn, 2015). Here, the unequal distribution of 

resources deepens social divisions resulting in the dependence-cycle of the oppressed having 

to hinge on the oppressor to survive. 

 

9) An understanding of the role of emotions, including our emotional investment, in all of the 

above. 

Our emotional patterns of behaviour result in who we connect with, distance 

ourselves from, and are protective over or repulsed by having all been socially constructed 

(Steyn, 2015). Our sense of self and how we “matter to all other mattering objects” is what 

Sara Ahmed (2004) calls an affective economy; this is how our emotions attach subjects into 

collectives that then take on an existence of its own. This affective state is induced by 

hegemonic forces reproducing power and oppression cycles. The CDL framework thus 

encourages a constant state of reflexivity to critically reflect on how our subjectivities are 

occupied in these collectives so that we may ask ourselves, “What do we learn about our 

participation in processes of social formations” (Steyn, 2015, p. 386). 

 

10) An engagement with issues of the transformation of these oppressive systems towards 

deepening social justice at all levels of social organisation. 

Here, the CDL criterion challenges the question of praxis and how we actively and 

intentionally begin to practice the above theory in our quotidian lives. A socially just world 

requires a constant examination of the intricate ‘messiness’ of our planet and the awareness 

of how power will never name itself as such. How then do we participate in centring the 

margins and becoming active agents of change to “those whose oppression would otherwise 

be further entrenched through conscious and unconscious assumptions of privilege” (Steyn, 

2015, p. 388). 

 

These ten criteria of the CDL framework serve as the analytical orientation for addressing the 

research questions and illuminating any obscured power dynamics present in the healthcare 

context. 

 

 

  



 21 

Chapter 3: Literature Review 

 

The vision of a truly global knowledge partnership will be realised only when the 

developing countries participate as both contributors to and users of knowledge. 

(World Bank, 1998) 

 

The core catalyst for social injustice in South Africa has been the impact of colonialism, 

characterised by its domination, exploitation, and belligerent occupation of indigenous 

people's land (Griffiths, Coleman, Lee, & Madden, 2016). A wide range of injustices, 

spanning personal and political domains and encompassing aspects such as culture, stigma, 

gender, unemployment, and socio-economic status, have contributed to the dysfunction in 

healthcare (Nkemjika, Escobar, & Marin, 2020). Economic, sociocultural, environmental, 

and other external influences have primarily determined how health is viewed, expressed and 

experienced by marginalised South Africans. Colonial hegemony centred itself as the 

superior, legitimate knowledge, restructuring conceptualisations of health from a 

multidimensional perspective to a siloed biomedical one. A fundamental injustice has been 

the dismissal of IKS around TM, which was deemed unfounded due to the absence of 

scientific validation (Marks, 2006). Scholars like Smith (1999) have critiqued these dominant 

discourses of superiority and highlighted how colonialism's version of truth and validity is 

situated within the very social systems that require urgent dismantling. In this system, TM 

was proclaimed as evil and considered uncivilised enforcing the 1957 Witchcraft Suppression 

Amendment Act, prohibiting TM practitioners from practising (Le Roux-Kemp, 2010). 

 

3.1 Background 

South Africa’s healthcare system is intertwined with its history. According to Van Rensburg 

and Harrison (1995), six phases of history impacted healthcare policy and legislation: 

o Phase 1 before 1919 was when the first health legislation was promulgated for the 

Union of South Africa. 

o Phase 2 was between 1919 and 1940, which saw the introduction of South Africa’s 

first health legislation incorporating national jurisdiction. 

o Phase 3 was between 1940 and 1950, a phase that was considered progressive within 

the health sector. 

o Phase 4 between 1950 and 1990, when apartheid had its most significant impact on 

the country. 



 22 

o Phase 5 between 1990 and 1994, a transitional time that saw the apartheid regime 

decline and democratic elections. 

o Phase 6 is the period after 1994. 

 

During the colonial era in South Africa, a series of laws were enacted to regulate the 

utilisation of TM. The laws introduced in 1862 prohibited sangomas (traditional healers who 

employed spiritualist powers to diagnose illnesses) from practicing (Parle, 2003). European 

newspapers often portrayed sangomas as uncivilized "witchdoctors" (Parle, 2003). Inyangas 

(traditional herbalists who did not use supernatural powers) were allowed to practice until 

1928 when the Medical, Dental, and Pharmacy Act was passed, which prohibited all 

herbalists from practicing, with the exception of those in KwaZulu Natal (Flint, 2008). 

Additionally, the Act restricted the use of Euro-western instruments such as stethoscopes by 

Inyangas. These measures effectively constrained traditional healers during this period, 

relegating them to the role of herb merchants (Flint, 2008). 

 

As with other colonised countries, South Africa encountered a conflict between the 

biomedical fraternity and the TM network. Biomedical doctors were not open to sharing the 

healthcare space with traditional healers and regulated the parameters traditional healers were 

allowed to practice in. The bifurcation of locations was a way of white doctors monopolising 

the field (Flint, 2001). TM's strict regulations and control remained in place during apartheid, 

which only shifted once South Africa gained its democracy (Flint, 2001). All phases under 

apartheid aided further racial segregation, failing to adequately consider South Africa’s 

diverse population and freedom of expression in practising religious/spiritual beliefs. As 

previously mentioned, these beliefs are intricately woven into many traditional healthcare 

practices. Today, the Freedom Charter, Bill of Rights acknowledges: 

Persons belonging to a cultural, religious or linguistic community may not be denied 

the right, with other members of that community to enjoy their culture, practise their 

religion and use their language; and to form, join and maintain cultural, religious and 

linguistic associations and other organs of civil society. (The South African Bill of 

Rights, 1996) 

 

3.2 New Democracy in Healthcare 

The new democratic government, aware of the significant role played by traditional healers 

within communities, integrated TM into the healthcare system (Flint, 2001). The recognition 



 23 

of TM was made formal with the 1996 National Drug Policy, followed by the Traditional 

Health Practitioners Act in 2004, which was reintroduced in 2007 to integrate and 

institutionalise TM. The Department of Health’s (2008) Traditional Health Practitioners Act 

22 of 2007 aims: 

o To establish the Interim Traditional Health Practitioners Council of South Africa. 

o To provide for a regulatory framework to ensure the efficacy, safety and quality of 

traditional health care services. 

o To provide for the management and control over the registration, training and conduct 

of practitioners, students and specified categories in the traditional health 

practitioner’s profession, and to provide for matters connected in addition to that. 

 

Towards the end of the 1990s, South Africa confronted a national medical crisis of significant 

proportions with the advent of the HIV/AIDS pandemic. In response, the South African 

government sparked controversy by declaring TM as a key approach in tackling the epidemic 

(Bishop, 2010). However, devising effective strategies to address the outbreak was fraught 

with difficulty, mainly due to persistent socio-political challenges that plagued the country at 

the time. The emergence of HIV/AIDS cases in 1982 was compounded by a state of 

emergency resulting from discriminatory healthcare policies (Van de Vliet, 2004). By the end 

of the apartheid era, approximately 4.3% of pregnant women were HIV positive, with the 

prevalence of the disease skyrocketing by 1997. 

 

In spite of appeals from various health organisations and activist groups, President-elect 

Thabo Mbeki publicly rejected the notion that HIV causes AIDS and discouraged the use of 

antiretroviral drugs (ARVs). He suggested that these drugs may be detrimental to the body 

(Van de Vliet, 2004; Butler, 2005). Reports have extensively documented the government's 

reluctance to acknowledge the effectiveness of antiretroviral drugs and their deliberate 

questioning of the relationship between HIV and AIDS (UNAIDS, 2006; WHO, 2003; 

Amon, 2008; Okome-Nkoumou, 2005). Instead, the health administration promoted the use 

of TM and nutritional remedies, such as garlic, beetroot, and lemons, as legitimate treatments 

for HIV/AIDS (Setswe & Zungu, 2017). The government's refusal to finance ARV treatments 

resulted in mothers passing the virus on to their babies during pregnancy (Bishop, 2010). 

According to Butler (2005), the South African government faced two options during this 

crucial period, one being “a 'mobilisation/biomedical' paradigm that emphasised societal 

mobilisation, political leadership and antiretroviral treatments” while the second was “a 



 24 

'nationalist/ameliorative' paradigm that concentrated on poverty, palliative care, traditional 

medicine, and appropriate nutrition” (p. 592). The Mbeki administration opted for the latter. 

 

In 2003, after being sued by the Treatment Action Campaign, an AIDS activist group, the 

government was forced to make ARVs available (Chigwedere et al., 2008). The initial and 

detrimental decision to not make ARVs available to the public resulted in 330,000 people 

losing their lives to HIV/AIDS (Chigwedere et al., 2008). Currently, antiretroviral drugs 

(ARVs) have become easily accessible in South Africa. Out of the 7.5 million individuals 

living with HIV in the country, approximately 71% are utilizing ARVs as a part of their 

treatment regimen (UNAIDS, 2020). Despite the increased use and availability of ARVs, 

many South Africans still use TM in isolation or with ARVs to treat HIV/AIDS (Mncengeli, 

Manimbulu, & Panjasaram, 2016). Pluralistic healthcare options allow for multiple 

approaches to healthcare and healing, including both conventional biomedicine and 

traditional complementary and alternative forms of medicine. An inclusive health system 

such as this offers patients a wider range of choices hereby allowing them to choose the 

treatment that best suits their individual needs. 

 

South Africa's healthcare practitioners and research associations have earned global 

recognition for their expertise. Recently, Professor Marietjie Venter of the University of 

Pretoria (UP) was appointed as the chair of the WHO's Scientific Advisory Group for the 

Origins (SAGO) of Novel Pathogens, where she leads investigations into the origins of 

COVID-19 (WHO, 2021). Additionally, Professor Salim Karim, an esteemed clinical 

infectious diseases epidemiologist, has been acknowledged for his research contributions in 

HIV and his proficiency in COVID-19 research. He was appointed by the WHO Science 

Council as one of nine international experts tasked with investigating a range of disciplines, 

from scientific research to public health implementation (WHO, 2021). Finally, Professor 

Motlalepula Matsabisa, of the Department of Pharmacology at the University of the Free 

State (UFS) leads Africa's response to the COVID-19 pandemic as the chairperson of the 

WHO Regional Expert Advisory Committee on Traditional Medicines for COVID-19 (WHO, 

2021). This 25-member team supports countries in conducting clinical trials on TM in 

compliance with international standards. The WHO's recognition of Africa's indigenous 

knowledge, health proficiency, and the significance of a medically pluralistic realm in 

research and practice highlights the need to re-spatialise healthcare delivery and experience. 

 



 25 

3.3 Indigenous Knowledge Systems (IKS) 

IKS pertains to the comprehension, competencies, and beliefs that have been cultivated by 

communities with extensive experience in engaging with their natural environments 

(Ebijuwa, 2015). For indigenous populations, this knowledge system serves as a basis for 

making informed choices regarding essential facets of their daily existence (Moshabela et.al, 

2016). Globally, communities are renowned for their indigenous approaches to health, food, 

functionality, shelter and overall ecosystem (Ebijuwa, 2015). These skills, developed through 

communal societies, have long histories encompassing language systems and social and 

spiritual interfaces that have informed day-to-day living long before colonialism (UNESCO). 

These unique ways of being are fundamental to understanding cultural diversity so that 

service deliveries are locally appropriated towards sustainable advancement (UNESCO).  

In the global knowledge economy, which is a country's ability to go beyond finance, goods, 

and production, and to foster innovative markets of knowledge capital is crucial for 

ecological expansion (World Bank, 2002). IKS are intimately interwoven into cultural value 

systems that have and continue to be developed and passed down through generations adding 

significant value to the knowledge economy. 

 

Literature on IKS doesn’t deliver a singular definition; however, according to South Africa’s 

Department of Science and Innovation (2023), IKS may be comprehensively characterised as 

the knowledge and customs accumulated by a local, native community through generations of 

dwelling in specific locations. This embodies varieties of knowledge, practical abilities, 

practices, and beliefs that equip a community with the capacity to attain a sustainable 

subsistence within their ecological setting. Similarly, the World Bank (2002) describes it as: 

o Local knowledge. 

o Unique to every culture or society. 

o The basis for local-level decision-making in agriculture, healthcare, food preparation, 

education, natural resource management and a host of other community activities. 

o Providing problem-solving strategies for communities. 

o Commonly held by communities rather than individuals. 

o Tacit and therefore challenging to codify, it is embedded in community practices, 

institutions, relationships and rituals. 

 

TM is an example of IKS that is inherited generationally through apprenticeship and practice, 

and its preservation is detained through story-telling and proverbs. However, there is a dearth 



 26 

of literature on IKS compared to biomedicine, and it is in danger of dilution (Ebijuwa, 2015).  

It is therefore essential to document and preserve this knowledge and incorporate it into 

mainstream university curriculums, particularly within the faculties of medicine, health and 

wellness. Euro-western epistemology has historically marginalized IKS in efforts to find 

sustainable solutions for developmental issues, such as addressing health equity and public 

health challenges (Nlooto & Hassan, 2017). In order to attain health equity, it is crucial to 

acknowledge and appreciate the variety of knowledge systems and incorporate them into 

health policies and practices. The integration of IKS into mainstream healthcare can assist in 

building a more comprehensive and integrated approach to healthcare. By working 

collaboratively with traditional healers, biomedically trained healthcare practitioners can 

provide culturally appropriate healthcare that is more responsive to the needs and preferences 

of indigenous communities. This can help address current inequities in healthcare delivery 

and promote the unique Africanisation of healthcare delivery (Nlooto & Hassan, 2017). 

 

TM practitioners use an integrated, holistic approach in diagnosing disease, where 

consideration of the psychosocial, psychological, physiological, spiritual and environmental 

determinants plays a crucial role in treating disease (Nlooto & Hassan, 2017). This treatment 

approach is echoed by the recent addition to WHO’s definition of health which initially stated 

that “health is a state of complete physical, mental and social wellbeing and not merely the 

absence of disease or infirmity”, and now further includes “the ability to lead a socially and 

economic daily productive life” (WHO, 2014). For these political goals to be achieved, 

organisations and leaders are required to “embrace the virtues of inter-disciplinarily in a poly-

epistemic world, where knowledge systems are complementary rather than competitive” 

(Nlooto & Hassan, 2017, p. 2). 

 

3.4 Interdisciplinary Healthcare 

Globalisation affords immediate access to vast knowledge economies and ever-connected 

societies. With this, the pattern of approach to disease is evolving. In the past, communicable 

diseases were most prevalent, though today the health burden resides mainly in 

noncommunicable diseases (NCD), also known as chronic disease (WHO, 2021). 

Noncommunicable diseases kill over 41 million people annually, which is equivalent to 71 

percent of all deaths globally (WHO, 2021). NCDs are typically characterized by their 

extended duration and their emergence from a complex interplay of physiological, genetic, 

environmental, and behavioural factors. Examples of such diseases include but are not 



 27 

limited to diabetes, hypertension, addiction, depression, and anxiety (WHO, 2021). Key 

noncommunicable disease factors, according to WHO (2021), are: 

o Annually more than 15 million people die from NCD between 30 and 69 years; 85% 

of these "premature" deaths occur in low- and middle-income countries. 

o Cardiovascular diseases account for most NCD deaths, or 17.9 million people 

annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and 

diabetes (1.5 million). 

o These four groups of diseases account for over 80% of all premature NCD deaths. 

o Tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets increase 

the risk of dying from NCD. 

o Detection, screening and treatment of NCDs, and palliative care, are vital components 

of the response to NCDs. 

 

Traditional, complementary and alternative approaches can play an increasingly important 

role in advancing healthcare delivery. Lifestyle, nutrition, physical inactivity, addiction, and 

stress are contributing factors in the causation of noncommunicable diseases. With this, the 

probability of individuals subscribing to numerous belief systems about health and wellbeing 

are likely. Likely too is the possibility of using multiple methods of medicine that may be 

traditional, complementary, alternative medicine (TCAM) to the one potentially prescribed 

by a biomedical practitioner. Biomedical practitioners often view these diverse approaches in 

a dualistic manner, as mutually exclusive and in competition with each other (Kiesser et al., 

2006). Patients, however, are opting for more pluralistic healthcare “moving freely between 

TCAM and biomedicine, based on what they can access, what they can relate to, and what 

they believe works” (Kiesser et al., 2006, p. 223). 

 

3.5 Biomedicine versus Traditional, Complementary and Alternative Medicine 

In biomedicine, illnesses are understood to be caused by various reasons, from predisposed 

(inherited) genetic ailments to diseases that occur by an outer organism causing infection or 

other diseases attributed to lifestyle factors. Martin (1994) perceives biomedical concepts of 

health to be war-like, a “fight” against the disease, the battle armoured using science-based 

drugs and/or surgery. On the other hand, integrative practitioners who have backgrounds 

ranging in traditional, complementary, alternative and biomedical spaces focus on identifying 

the root cause of disease, not symptoms. These practitioners practice a broader scope of 



 28 

medicine cognisant of the biopsychosocial elements, using various therapeutic methods 

(Koithan, 2009). 

 

Integrative practitioners believe that diseases occur due to several causes, such as depression 

for example, which can result from several factors, including inflammation in the body. The 

aetiology of the disease encompasses intersecting domains of physical, emotional, spiritual, 

psychosocial and environmental factors (Tabish, 2008). Treatments that address the precise 

causes of disease are the ones that have “lasting benefits beyond symptom suppression” 

(Institute of Functional Medicine, 2022). Interventions are essentially low risk, often 

including lifestyle adjustments aimed at reversing drivers of disease (Institute of Functional 

Medicine, 2022). This integrative matrix prioritises personal, family, social and medical 

history in treating disease. Treatments are patient-focused, utilising therapies that are both 

evidence-based and experience-based. Notably, the role of the practitioner-patient partnership 

is crucial to eradicating the disease. Studies have shown that the variety of traditional and 

complementary options individuals desire is limited to the ones their biomedical practitioners 

offer (Mothibe & Sibanda, 2019; Chitindingu et al., 2014). Also, the available offerings are 

often considered costly, inaccessible, universal and depersonalised (Mothibe & Sibanda, 

2019; Chitindingu et al., 2014). 

 

For more than half a century, biomedical physicians and clinical researchers believed that 

evidence-based information obtained in randomised controlled trials (RCTs) delivered 

definitive diagnoses to disease (Jones & Podolsky 2015). This diagnosis is referred to as the 

“gold standard” in biomedical research and health. As a result, evidence-based research has 

long been hailed as the superior standard of knowledge production in the sciences and 

academia where constructs such as validity, replicability and controlled experiments are 

preferred over subjective experience-based knowledge (Cannella & Miller, 2008). 

 

The emergence of medical “big data”, which are technologies used to amass healthcare 

information, generated at an exceptional speed has resulted in “increasing methodological 

self-reflection” (Jones & Podolsky, 2015, p. 1502; Costa, 2014). Jones & Podolsky (2015) 

have critiqued areas such as pharmaceutics, psychiatry and psychology for failing to 

recognise cultural bias. For example, neuropsychological assessments, which are evaluations 

that focus on mental status, motor and sensory functions, vital signs, and cognition to identify 

any abnormalities that impact quotidian living have been found to be biased to western norms 



 29 

(Rank, 2010). These types of assessments are critiqued for their omittance of socio-cultural 

consideration (Fernández & Abe, 2017; Ardila, 2007; Nell, 2000; Manly, 2008). This 

includes challenges related to sociocultural contexts globally. For example, researchers have 

raised questions of what constitutes appropriate norms, and whether standard test assessments 

are suitable for individuals with varying education levels, literacy and social beliefs. 

Fernández & Abe (2017) argue concepts of test scores when assessing culturally diverse 

populations. No one-size-fits-all measurement can be applied universally, reflecting an 

inherent test bias towards the cultural norms of western produced assessments (Fernández & 

Abe, 2017). Culture pervades all facets of these psychological evaluations, from belief 

systems to identifications and definitions of relevant concepts (Ardila, 2007). While distinct 

cognitive processes are common to all humans, what differs is how these functions evolve in 

culturally-distinct populations. 

 

Considering the social determinants that underwrite social injustices birthed through 

colonialism is fundamental to understanding healthcare holistically. Furthermore, there exists 

a deficiency in acknowledging individuals as holistic entities whose attributes are essentially 

moulded by personal, societal, familial, and historical factors (Pillay & Serooe, 2019). An 

important question to consider is how we begin to recognise these key roles that influence 

and intersect with cultural diversity to better address varied health issues in diverse 

populations (Henrich et al., 2010). According to Koithan (2009), Integrative medicine 

represents a positive stride towards optimising health outcomes. This approach considers the 

entirety of an individual's life history, as well as the interconnected elements of their lives. As 

such, it plays a pivotal role in promoting overall wellbeing. Nurses have historically operated 

within the holistic framework, providing patients with therapeutics that facilitate 

biopsychosocial healing. To this end, they have incorporated a range of traditional, 

complementary, and alternative healing modalities into their practices. These modalities 

include but are not limited to guided imagery, therapeutic touch, prayer, body-based 

massage/manipulation, and Breathwork therapy (Hanley, Coppa & Shields, 2017; Koithan, 

2009). 



 30 

 

Figure 1: Biomedical Paradigm vs Integrative Healing Paradigm 

 

3.6 Breathwork: Ancient Art, New Science 

Breathwork has become a relatively new science but is historically, an ancient practice. 

Referenced as a foundation to the spiritual self across ancient civilisations, Breathwork holds 

to this day a simple yet effective method to heal and invigorate one’s biochemistry. The 

health functioning role of the breath has been documented in several spiritual practices 

globally (Gopal, Bhatnagar, Subramanian & Nishith, 1973; Conger, 1988; Farhi, 1996; 

Hendricks, 1995; Victoria & Caldwell, 2013; Kuppusamy, Kamaldeen, Pitani, Amaldas, & 

Shanmugam, 2018). The phenomenon has been referred to by Hindus as the prana, Chinese 

as the chi, Japanese the ki, Africans umoyo, and by Christians as the Holy Spirit (Gopal et al., 

1973; Young, Cashwell & Giordano, 2010; Edwards, Makunga, Thwala & Nzima, 2007). 

The term spirit stems from the Latin word spiritus translating to "breath" or "breath of life " 

(Young et al., 2010, p. 113). Breathwork has been an ancient healing practice, its function in 

health preservation rooted in earliest African philosophy and belief systems (Mutwa & 

Larsen, 2003; Edwards, Makunga, Thwala, & Nzima, 2007). In his book, Zulu Shaman 

(2003, p. 13), traditional healer, philosopher, artist and author Vusamuzulu Credo Mutwa 

noted his experience and introduction to Breathwork as a young child: 

My grandfather also taught me how to control my powers of seeing and how to 

sharpen them and make them more accurate and efficient. He taught me the art of 

breathing properly. He taught me the secret art of joining my mind to that of the great 



 31 

gods in the unseen world. He taught me how to sit still - very, very still - and 

eliminate all thoughts from my mind and call upon the hidden powers of my soul. In 

short, my grandfather taught me the Zulu version of what is called in English, 

"meditation". How to breathe softly and gently like a whisper until you feel 

something like a hot coiled snake bursting through the top of your head - a fearsome 

thing that is known as the umbilini. This umbilini, my grandfather told me, is the 

source, the primal source of the sangoma's powers. A sangoma must be able to 

summon this umbilini at will through the beating of the drum and through meditation, 

very, very deep meditation. 

 

This release of the umbilini through breath that Mutwa speaks of is similarly found in the 

East’s yogic practice of Kundalini and the “breath of fire”. Kundalini means “to coil or 

spiral” (Khalsa, 1975). Umbilini and Kundalini are both aroused through the practice of 

conscious Breathwork to elicit deep states of healing. Healing is multifaceted, fundamental to 

any medicine method, with the primary objective being the transition from illness to wellness 

(Kirmayer, 2004). Healing practices globally include: 

The use of medicines that are drunk, smoked, injected or otherwise taken into the 

body; methods of getting things out of the body by emetics, cathartics, purgatives, 

bloodletting or surgery; manipulations of the body through touch and gestures or with 

specific materials; diagnostic or divinatory practices that establish the nature of the 

affliction in terms of its causes, consequences or some other classificatory scheme; 

and the use of rituals and ceremonies incorporating words, music, costumes and other 

theatrical devices that may involve the afflicted individual or the healer alone, the 

interaction between patient and healer, or the participation of a whole group or 

community. (Kirmayer, 2004, p. 34) 

 

Breathwork's potential therapeutic advantages have captured the attention of academic 

scholars, social media influencers, and celebrities alike, including figures such as Justin 

Bieber and Ellen DeGeneres (Collinge & Yarnold, 2001; Young, Cashwell, & Giordano, 

2010; Lalande et al., 2011; Cronshaw, 2019; Turner, Wooten, & Chou, 2019). Harper's 

Bazaar (2021) published an extensive article on Breathwork, entitled "Breathwork has gone 

mainstream during the Covid-19 era," which explores the method's surge in popularity 

during the pandemic, the various Breathwork techniques and their applications, its 

contribution to stress reduction, and its potential to address generational trauma in 



 32 

marginalised communities. Breathwork has also garnered attention from the entertainment 

industry, as evidenced by actress and entrepreneur Gwyneth Paltrow's Netflix series, The 

Goop Lab. In this program, Breathwork is demonstrated through a method developed by 

Dutch speaker and athlete Wim Hof, which utilises breath and cold exposure to enhance 

athletic performance, boost immunity, alleviate chronic disease symptoms, and address 

mental health concerns (Netflix, 2020). The Wim Hof method arguably resembles ancient 

Indian yogic practices of pranayama dating back to 1500 BCE and documented in the Vedas, 

the oldest Sanskrit scriptures of Hinduism. (Gopal et al., 1973; Zainuddin, 2020). Prana is 

defined as the flow of life force, or breath that sustains the body and yama is controlled 

together pranayama is breath control (Kuppusamy et al., 2018). 

 

The globally-trending documentary, The Goop Lab, missed a crucial opportunity to engage 

with the genuine heritage of Breathwork, instead popularising and attributing credit to white, 

Western "experts" in the field while ignoring the originators of this IKS and traditional 

healing method. According to Zainuddin (2020, p. 3), The Goop Lab's "whitewashing of 

these alternative therapies represents a form of colonisation and commodification of non-

Western practices that have existed for centuries," motivated by profits for marketing 

purposes rather than medicine. Despite being based on IKS, the creative content of shows 

such as The Goop Lab, will continue to flourish financially, reflecting how knowledge is 

political, and who disseminates the knowledge determines how and what becomes 

mainstream. The West's politicisation of IKS calls for accountability to prevent consumers 

from being exploited at the expense of marginalised communities. In this context, questions 

arise about who gets to breathe and who suffocates. 

 

3.7 Breathwork in Biomedicine 

Excluding Crockett et al.'s work (2016), the existing corpus of literature corroborating the 

effectiveness of Breathwork is circumscribed to antiquated investigations, anecdotal 

testimonials, and conjectures derived from other healthcare domains. The lack of extensive 

research on this practice may be due, in part, to the ambiguity in the conceptualisation of 

Breathwork. Breathwork encompasses a diverse range of techniques, characterised by 

significant complexity in terms of type, application, and outcomes (Young et al., 2010, Grof, 

2014, Zope & Zope, 2013, Aideyan et al., 2020).  There is a pressing need for greater 

specificity regarding the types of Breathwork interventions being utilised, the populations for 



 33 

whom they are intended, and the conditions under which they are administered and its 

subsequent efficacy. 

 

From a biomedical perspective, it was doctor and psychoanalyst Wilhelm Reich who, in 

1942, documented the correlation between breath and health, suggesting how people 

unconsciously restrict breathing to control feelings of discomfort. This dysfunctional 

breathing pattern results in individuals holding their breath as a defence mechanism, usually 

against physical or emotional threats (Victoria, H. K., & Caldwell, 2013; Sharaf, 1994; 

Totton, 2002). Integrative practitioners and biomedical clinicians agree that 

functional/dysfunctional breathing is impacted by both conscious and unconscious efforts to 

suppress intense emotional states, with each state producing a corresponding breathing 

pattern (Aideyan et al., 2020; Brulé, 2018; Crockett et al., 2016; Victoria & Caldwell, 2013; 

Young et al., 2010). By learning to harness effective use of the breath, four levels of healing 

become possible: these being cognitive, physical, emotional and spiritual restoration (Young 

et al., 2010; Brulé, 2018; Crockett et al., 2016; Grof, 1988; Taylor, 1994; Collinge & 

Yarnold, 2001; Sointu, 2006; Orr & Ray, 1977). 

 

With growing evidence that health and wellbeing involve biological considerations, a need to 

develop methods that address psychological, physiological and sociological functioning is 

required. Breathwork can influence clinical practice, holistic practice, research and, 

importantly, empower self-regulation. With Breathwork being a self-regulated activity, it 

allows individuals to process physiological resistance and emotional challenges, which 

typically are not accessible in conventional therapeutic settings (Young et al., 2010). 

Empirical studies related to the efficacy of Breathwork in therapeutic spaces have previously 

and primarily been anecdotal. This dearth is perhaps due to the unclear classification of 

Breathwork (Aideyan et al., 2020). With Breathwork being based on ancient healing 

traditions, there are numerous techniques, complex or simple in method, application and 

outcome (Aideyan et al., 2020). Hence, there is a requirement for more interventions that 

investigate specific circumstances, using straightforward methods, be it conscious breathing, 

mindfulness breathing, breath-awareness, yogic breathing, holotropic breathing or one of the 

many existing methods (Young et al., 2010; Aideyan et al., 2020; Grof, 1988; Brulé, 2018). 

 

Currently, there exists a notable trend in the advancement of research within the biomedical 

arena, specifically in the area of neuroscience. Researches have uncovered that the limbic 



 34 

system, which serves as the brain's crucial emotional centre, is intricately involved in 

regulating respiratory patterns (Kamath et al., 2017; Victoria & Caldwell, 2013; Aideyan et 

al., 2020). This respiratory phenomenon occurs throughout the limbic system, connecting 

breathing patterns to emotions, perceptions and speech where unpleasant feelings derived 

from mental stressors alter breathing patterns (Masaoka & Homma, 1997; Fried & Grimaldi, 

1993). Masaoka & Homma (2001, p. 171) found that “respiratory patterns are influenced by 

cortical and limbic factors and generated by a complex interaction between metabolic 

requirements and their behavioural effects”. This implies that there may not be a direct 

correlation between brain arousal and the body's metabolic demands, which can affect 

breathing patterns and physiological arousal. In this case, the individual under stress does not 

consciously select their breath pattern at a given moment, but “the mode of breathing seems 

to be selected automatically depending on what is anticipated in the next few seconds” 

(Gilbert, 2002, p. 119). An emotional stimulus impacts breath regulation and breath-holding; 

for example, “a positive emotion such as laughter, will decrease inspiratory time and tidal 

volume, and negative emotions, particularly disgust, induce both breath-holding and 

prolonged inspiratory pauses” (Victoria, & Caldwell, 2013, p. 217). 

 

Gilbert (2002, p. 111) believes that “regardless the presence or absence of disease, transience 

or permanence, functional or organic, there is a person experiencing it all, and a person in 

distress can disrupt his breathing so much that other interventions are thwarted”. Further, 

Victoria and Caldwell (2013) assert that the relationship between breath, emotion and 

perception is paramount to emotional fluency. Dysfunctional breathing patterns impact the 

capability to sense emotional states arising from trauma, disease, chronic illness and distress. 

In sum, the role of the breath plays an integral role in regulating optimal function or 

dysfunction in the mind-body system. 

 

3.8 Breathwork Classifications 

Breathwork therapy is classed as a mind-body tool used for healing (Collinge & Yarnold, 

2001; Sointu, 2006). Breathwork can generate biochemical responses that result in the 

surfacing of emotional and physical tensions linked to unresolved psychological and physical 

traumas (Collinge & Yarnold, 2001). It can promote wellbeing on various levels of 

functioning such as cognition, emotion, physical and spiritual (Taylor, 1994). Globally, there 

are several Breathwork techniques that fall into two distinct categories. One type promotes 

conscious breathing that stimulates and triggers psychological breakthroughs, while the other 



 35 

type focuses on restoration and relaxation (Victoria, & Caldwell, 2013; Kamath et al., 2017; 

Aideyan et al., 2020). 

 

3.8.1 Mindfulness/Conscious Breathing 

The health impact of mindfulness is widely researched and recognised as a beneficial 

treatment in depression, anxiety, post-traumatic stress disorder, addiction, heart rate 

variability and trauma (Creswell, 2017; Chung et al., 2010; Tsai et al., 2015; Brulé, 2018; 

Dowling, 2000; Taylor, 1994; Lalande et al., 2011). Mindfulness or conscious breathing 

incorporates various techniques used to promote an awareness of one’s breath and physical 

sensations, which ultimately result in an alerted state of consciousness. These techniques 

require direction from a qualified practitioner and are typically administered as a stand-alone 

treatment or within a group setting (Aideyan et al., 2020). Breathwork therapies include 

conscious-connected breathing, circular breathing, holotropic breathing, integrative 

breathing, Wim Hoff breathing, and guided respiration (Lalande et al., 2016; Young et al., 

2010; Aideyan et al., 2020; Grof, 1988; Brulé, 2018; Manne, 2004; Orr & Ray, 1977; Taylor, 

1994). What differentiates a conscious connected breathing style from a relaxed breathing 

style used in meditation, yoga or clinical settings, for example, is that the conscious 

connected breath is an uninterrupted breath rhythm, free of pauses between the inhale and 

exhale (Lalande et al., 2011). Although there are subtle variances in conscious breathing 

techniques, all fundamentally encourage deeper quicker breaths in a sustained manner that 

ultimately results in an altered state of consciousness (Young et al., 2010; Brulé, 2018; Grof, 

1988). Young et al. (2010, p. 116) describes the altered state as follows: 

An altered state of consciousness is a mental state other than normal waking 

consciousness in which one loses the sense of identity with one's body or with one's 

perceptions. Such non-ordinary states of awareness include dream states, 

meditative/prayer states, hypnosis, sensory deprivation, some psychoactive drug 

states, and social activities such as frenzied dancing or chanting. These experiences 

are thought to allow access to experiences of the self not possible in ordinary 

consciousness. Breathwork is a self-regulated controlled process that allows access to 

an altered state of consciousness. 

 

These Breathwork sessions are usually one or more hours and involve the individual lying 

comfortably on their back while mindfully applying one of the above-mentioned Breathwork 

techniques (Lalande et al., 2011). In this setting, the Breathwork practitioner aims to guide 



 36 

the individual into a relaxed state by aiding in maintaining the breath cycle (Dowling, 2000). 

The practitioner supports the individual in integrating any inner emotional breakthroughs that 

may surface during the session. Practitioner verbal guidance may include statements such as, 

‘‘Focus on the dominate sensation in your body—whatever stands out—study that and 

whatever is happening right now, just allow it to be there’’ (Lalande et al., 201, p. 114). 

During this phase, individuals may experience psychological and/or physiological 

breakthroughs manifesting in muscular tightening up. This results from defensive responses 

to somatic experiences. If this state occurs, individuals are encouraged to cultivate an 

awareness of their reactions and endeavour to address them through controlled breathing 

techniques (Dowling, 2000). After a conscious Breathwork session, mental clarity and 

relaxation are commonly reported (Brulé, 2018; Dowling, 2000; Taylor, 1994; Lalande et al., 

2011). According to existing literature, the utilisation of Breathwork to induce emotional 

arousal has been purported to facilitate the acquisition of improved coping strategies, 

heightened self-regard, and enhanced capacity to express one's emotions to healthcare 

providers and the wider social milieu (Collinge & Yarnold, 2001, Dowling, 2000; Taylor, 

1994; Lalande et al., 2011). 

 

3.8.2 Deep Relaxation Breathing 

Nurses and numerous other health disciplines commonly prescribe this particular technique; 

also referred to as deep breathing, abdominal breathing, belly breaths, relaxation breathing 

and diaphragmatic breathing (Aideyan et al., 2020; Consolo, Fusner, & Staib, 2008; Rickard, 

Dunn, & Brouch, 2015). Deep relaxed breaths involve slow, deep inhalations through the 

nostrils and even slower exhalations through the nose or mouth. Deep relaxation breathing 

can incorporate counting and pausing such as: 

o The box breath, also known as square breath, requires inhaling for a count of four 

seconds, pausing for four seconds, exhaling for four seconds and pausing again for 

four seconds (Ahmed et al., 2021). 

o The 4-7-8 breath requires an inhale of four seconds, pausing of seven seconds and a 

slow exhale of eight seconds (Weil, 1998). 

 

The practice of deep relaxation breathing has an impact on the autonomic nervous system 

(ANS), which is comprised of two divisions: the sympathetic nervous system (SNS) and the 

parasympathetic nervous system (PNS). These two systems operate unconsciously and have 

opposing functions in regulating bodily processes. The SNS governs the fight or flight 



 37 

response, while the PNS regulates the rest and digest response (Liza, 2011; Pal & Velkumary, 

2004). Evidence shows that regular practice of deep relaxation breathing increases PNS while 

decreasing SNS: this, in turn, lowers blood pressure, reduces heart rate, lowers anxiety and 

increases overall feelings of wellbeing (Kaushik et al., 2006; Mourya et al., 2009). Notably 

studies have also indicated that deep relaxation breathing is advantageous for students in 

managing chronic stress (Perciavalle et al., 2017). Moreover, research in nursing has 

demonstrated a significant correlation between deep relaxation breathing and a reduction in 

symptoms of depression (Chung et al., 2010; Tsai et al., 2015). 

 

3.9 Breathwork Findings 

Researchers are increasingly reporting favourable findings supporting Breathwork as a 

traditional, complementary and alternative healing method. Sudres, Ato, Fouraste and 

Rajaona (1994) investigated the benefits of a ten-session Breathwork intervention on 12 

depressed and anxious patients and found that 10 of the 12 participants achieved significantly 

improved clinical results. Findings by Holmes, Morris, Clance, and Putney (1996) revealed 

that people who practised regular Breathwork therapy instead of psychotherapy achieved 

significantly higher gains in self-esteem and reduced anxiety. Another study carried out on 

married partners who served as sitters for each other during a Breathwork session reported 

increased affection, more in-depth communication, increased physical connection and an all-

round acceptance for one another (Chou, 2004). Scholarly literature indicates that individuals 

who engage in Breathwork frequently report experiencing a profound sense of relaxation and 

a heightened state of mental and physical wellness following a session (Holmes et al., 1996; 

Lalande et al., 2011; Brulé, 2018; Grof, 1988; Manne, 2004; Orr & Ray, 1977; Taylor, 1994; 

Young et al., 2010; Chou, 2004). Conversely, prolonged patterns of constrained breathing can 

manifest as a response to environmental factors that elicit heightened levels of arousal 

leading to a reduction in serotonin synthesis, resulting in anxiety and depressive 

symptomology (Lalande et al., 2011). Thus, acquiring the skill of regulating one's breath 

effectively may lead to favourable health consequences. In contrast to biomedicine's 

emphasis on the body's biochemistry, traditional modalities such as Breathwork centre on the 

individual's human experience (Ventegodt, Morad, Andersen, & Merrick, 2004). 

 

The demand for easily accessible therapeutic interventions to mitigate or build resistance 

against diseases is escalating worldwide. Breathwork has emerged as a prominent technique 

owing to its prospective therapeutic advantages. Nevertheless, there is a possibility that the 



 38 

enthusiasm surrounding Breathwork may not always be substantiated by strong empirical 

evidence. A meta-analysis by Fincham et al., (2023) revealed that Breathwork produced a 

significant small-medium effect in reducing self-reported/subjective stress, anxiety, and 

depression when compared to non-Breathwork control conditions. Despite preliminary 

evidence of Breathwork’s effectiveness, efficacy around deeper mental illnesses in particular 

requires more research (Aideyan et al., 2020). Despite the dearth, therapeutic benefits of 

Breathwork began emerging in counselling literature decades ago with a distinct emphasis on 

informative, educational contexts where participants showed positive results in their ability to 

distinguish between states of relaxation and tension and how through Breathwork, stress 

reactions declined (Rossman & Kahnweiler, 1977; Wilkinson, Buboltz, & Seemann, 2001; 

Taylor, 1994; Zaichkowsky, & Yeager, 1986). 

 

The aforementioned findings propose that Breathwork may represent a viable solution for 

addressing the demand for accessible therapeutic interventions. Nevertheless, to ensure that 

any suggestions made be grounded on research data, it is imperative to conduct additional 

studies employing low risk-of-bias designs. By engaging in robust research, a more 

comprehensive comprehension of Breathwork's therapeutic potential can be attained, thereby 

potentially facilitating its integration into public healthcare in an effective manner. 

 

3.10 Decolonising Healthcare 

What does it mean to be human? For decades, this has been the ethical and epistemological 

question in the social sciences and an essential factor in addressing dynamics of knowledge, 

positionality, prejudice and power (Carolissen and Duckett, 2018; Fanon, 1963). As 

mentioned, cultural imperialism and biomedicine, influenced by modernity and the 

enlightenment age, ushered in a vastly different medicinal culture to that known by 

indigenous Africans (Matheson, 2009). Disparities included the “supremacy of reason, 

scientific objectivity, the compartmentalisation of life into facts versus values and belief in 

the autonomous individual” (Matheson, 2009, p. 1192). In Africa, relationships to land and 

country carry vital significance for indigenous people experienced through spiritual 

connections (Dudgeon, Bray, D'costa, & Walker, 2017). A country can be considered “a 

living entity said to give and receive life while providing nourishment for body, mind, and 

spirit” (Rose, 1996). This divine connection to land, living and wellbeing was uprooted with 

the emergence of colonialism and apartheid. Evidence of this oppression is found in 

pervasive epistemologies that reveal disparaging narratives of IKS in healthcare, such as 



 39 

traditional practices being barbaric, bewitched, superstitious, primitive, obsolete and savage 

(Harvey, 2003; Smith, 1999). Yet, despite the dominance of the biomedical healthcare model 

and systematic efforts to suppress IKS, indigenous healing traditions have stood the tests of 

time globally (Marks, 2006; Ndubani & Hojer, 1999). 

 

Currently, a pervasive theme encompassing the world demands the immediate reassessment 

of human rights. The Black Lives Matter movement, for instance, meticulously emphasizes 

that issues of race and discrimination extend far beyond the asphyxiation of black individuals 

and the continued systemic injustices resulting from power and privilege imbalances. 

Externally, support for the Black Lives Matter movement has mobilised educational 

institutions, corporations, academics, and laypeople alike to demonstrate solidarity while 

consciously striving to become antiracist. Crucially, this collective movement seeks to 

eradicate the deeply entrenched injustices that have persisted in silence (Sobo, Lambert, & 

Heath, 2020). 

 

This literature review has highlighted the historical discriminations of indigenous knowledge 

in healthcare and raised valuable questions around a pluralistic healthcare. In Marks' (2006) 

study: Global Health Crisis: Can indigenous healing practices offer a valuable resource, she 

argues for decolonisation in healthcare: 

Indigenous healing practices can no longer be ignored by conventional medicine. 

These practices are potentially invaluable in addressing the ongoing global health 

crisis. However, to ethically address the role of indigenous healing practices within a 

Westernized worldview, certain policy, methodological, and conceptual changes will 

be necessary. (Marks, 2006, p. 471) 

 

Marks (2006) posits that the relentless global health crisis, due to socio-economic challenges, 

HIV and AIDS, overpopulation, substance abuse, inadequate resources and infrastructures, 

breaks down important cultural structures, such as indigenous knowledge, while increasing 

overall anxiety. Attending to this predicament would require addressing the healthcare 

framework holistically: this will include academic institutions where medical healthcare 

services are born. Healthcare delivery should consider the biopsychosocial, which essentially 

recognises the integrative role biological, psychological, and social influences play in 

promoting health and wellbeing (Engel, 1977). It is imperative for healthcare practitioners 



 40 

from all backgrounds and training to be cognisant of the unequal distribution of political and 

social agency and to work together towards an efficient healthcare for all. 

 

3.11 The Curriculum 

Healthcare is one of the many areas in which decolonisation requires attention. Post-

apartheid, the South African government has made significant progress in acknowledging the 

roles of traditional healers and TM. However, minimal evidence illustrates the carryover and 

inclusion of IKS in medical training and learning institutions. The healthcare system 

continues to be plagued by stark inequalities, with biomedicine being the exclusive model of 

healthcare. 

 

A study conducted by Chitindingu, George & Gow (2014) titled, A review of the integration 

of traditional, complementary and alternative medicine into the curriculum of South African 

medical schools, investigated the extent to which medical schools in South Africa were 

incorporating traditional, complementary and alternative medicines into their curricula. Out 

of the eight medical universities approached to participate in the study, seven consented. All 

were asked to provide evidence of the courses assigned to alternative medicines and identify 

the graduate level at which these courses were taught.  The study found a profound lack of 

commitment to teaching alternative medicines other than biomedicine by all schools except 

for the University in KwaZulu Natal. If schools were covering any form of alternative 

medicine, this was introduced in a “tokenistic” manner (Chitindingu et al., 2014). 

In sum, this crucial study revealed that South African medical schools were failing to 

adequately recognise the ongoing interplay between biomedicine and alternative medicines in 

patient care. The inclusion of additional medicinal options in medical education has the 

potential to enhance healthcare outcomes and promote a stronger practitioner-patient 

relationship. Medical pluralism, which encompasses the coexistence of diverse medical 

practices, can have a favourable impact on how healthcare professionals and patients interact, 

particularly in light of the multiple worldviews that exist (Moshabela, Zuma & Gaede, 2016). 

  



 41 

Chapter 4: Methodology 

 

It appals us that the West can desire, extract and claim ownership of our ways of 

knowing, our imagery, the things we create and produce, and then simultaneously 

reject the people who created and developed those ideas and seek to deny them 

further opportunities to be creators of their own culture and own nations. (Smith, 

1999) 

 

Smith (1999) critiques the persistent coloniality residing in academia and research 

methodologies. She invites reflection on the historical links between the Euro-western 

development of scientific inquiry that centred on the dehumanisation and appropriation from 

indigenous people and calls for a decolonised and decontextualised framing of normality. 

Decolonisation refers to the dismantling of hegemonic rule, questioning all positions of 

power. In academic research, decolonisation recognises assumptions around rationality by 

identifying that historically, literature was developed in specific locations at particular times 

for certain populations (Griffiths, 2017; Radcliffe, 2017). Therefore, decolonising research 

seeks to highlight how "truths" presented as universal are laden with invisible power, 

constructed to preserve, protect and maintain distorted notions of histories (Maldonado-

Torres, 2007). 

 

When attempting to impact policy frameworks, delving into discrepancies between 

governmental policies and academic institutions, the use of critical qualitative research can 

bring awareness of unknowns about the social world (Fielding, 2019). Healthcare 

practitioners' experiences of navigating power relations within the healthcare system suggest 

that a critical qualitative approach would be most suitable for this study. Critical qualitative 

inquiry examines the significance behind testimonies which aid in decolonising research, 

particularly those that perpetuate ongoing marginalisation (Atallah, Shapiro, Al-Azraq, Qaisi, 

& Suyemoto, 2018). A critical qualitative approach also explores the richness of human 

experience, permitting flexibility that delves into individual experiences where themes about 

the personal and professional can emerge (Padgett, 2004). Further, this approach can amplify 

social change by challenging western hegemonic understandings of IKS around TM which 

have been misrepresented in the social sciences (Fielding, 2019). 

 



 42 

In undertaking research that adopts a critical approach, it is essential to go beyond a 

superficial acceptance of findings and engage in a process of self-reflection that can facilitate 

transformation (Fossey et al., 2002). In so doing, the researcher recognises the subjective 

nature of their perspectives, including their personal worldviews and the potential influence 

of these views on their understanding of the participants' realities and the larger context 

(Spinelli, 2005). Such a reflective approach is fundamental to ensuring a rigorous and 

unbiased inquiry that addresses the complexities inherent in the research study. This chapter 

comprises a discussion of the research methodology as mentioned above, data sources, data 

collection techniques, the data analyses used for the study, reflexivity, and finally, ethical 

considerations. 

 

4.1 Data Sources 

A qualitative method was chosen to explore the complexities around this research. 

Qualitative research is suitable when concerns warrant further investigation or if issues are 

complex and cannot be clearly measured (Creswell, 2013). Qualitative research typically 

involves smaller sample sizes compared to quantitative research which relies on larger 

samples. Creswell (2005) recommends that a qualitative sample range be between one and 25 

participants, while Polkinghorne (2005) recommends between five and 25. Patton (2002) 

believes there should be no specific sample size rule, suggesting instead that the researcher 

decide what works best for the study as “sample size depends on what you want to know, the 

purpose of the inquiry, what’s at stake, what will be useful, what will have credibility, and 

what can be done with the available time and resources” (Patton, 2002, p. 244). 

 

For this study, a sample consisting of five healthcare practitioners who incorporate diverse 

traditional and alternative modalities into their practice was utilised. The inclusion criteria 

included (a) practitioners who integrated Breathwork into their practice, (b) practitioners who 

studied and graduated at South African universities, and (c) practitioners who had at least 10 

years of working experience in the South African healthcare sector. Exclusion criterion were 

healthcare practitioners who were not favourable towards practicing TM. 

 

A snowball sampling method was used to recruit eligible participants. Snowball sampling 

uses a network where each individual is connected to another through either direct or indirect 

association (Neuman, 2003). For this study, participants were recruited through their 

affiliation to a globally recognised Breathwork organisation. This organisation trains 



 43 

Breathwork practitioners and works closely with other healthcare professionals, NGOs, 

educators, athletes, students promoting improved healthcare (Breathwork Africa, 2021). 

 

From the five participants interviewed for this study, Mila is a General Practitioner (GP) who 

transitioned into Integrative Medicine (IM) and now exclusively practices as a Breathwork 

practitioner. Lebo is a Cardiologist practicing as Functional Medicine (FM) practitioner. 

Kajal holds a PhD in Social work and lectures at a university, she is also a Breathwork 

practitioner. Zak is a Physiotherapist and Breathwork practitioner. Unathi has a background 

in Psychology but practices as Breathwork practitioner exclusively. 

 

4.2 Data Collection Techniques 

All participants were based in South Africa. All were contacted thro