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Paper short abstract

Drawing on ethnographic research on water cures in Portugal and Brazil we examine therapeutic itineraries framed water as “medicine” or “energy”. We compare medical and therapeutic pluralism, exploring their ethical, political and epistemological implications for knowledge legitimacy.

Paper long abstract

In Portugal and Brazil, thermal practices are classified and institutionalised in different ways according to their respective national health systems. In Portugal, thermalism is subsidised by the National Health Service and framed within the biomedical apparatus. In Brazil, thermal practices have been incorporated since 2006 into the Unified Health System (SUS) as Integrative and Complementary Health Practices. These arrangements stem from distinct historical and social processes (Quintela 2004, 2008, 2011) and allow thermalism to be understood both as a regulatory framework and as a site where therapeutic practices adapt to changing health configurations, increasingly shaped by notions of wellbeing, prevention and health promotion (Nairandas & Bastos, 2011).

Drawing on ethnographic research on “water cures” in Portuguese and Brazilian thermal spas, this paper analyses spa users’ practices and narratives that frame water as “natural medicine” and/or “energy”, as well as their therapeutic itineraries across different medical systems. Based on these materials, we propose a critical discussion of medical pluralism in dialogue with the concepts of therapeutic pluralism and therapeutic syncretism, highlighting processes of articulation, tension and negotiation between diverse forms of knowledge and care.

The contrasting medical frameworks within which thermal practices are embedded—biomedicine in Portugal and CAM in Brazil—raise questions about the analytical usefulness of medical pluralism (Leslie 1980; Hsu 2008; Khalinova, 2023), particularly in relation to its overlap with therapeutic pluralism and syncretism. To address the fragility of these conceptual boundaries, the paper engages with recent debates in medical anthropology, including Papalini’s (2024) contributions.