compiled chapter 7 report mw 730.ppt

8/10/2019 compiled chapter 7 report mw 730.ppt

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CHAPTER 7:

A Look atIllness and

Healing



Ethnomedicine

• Medical anthropologists have long been

interseted in studying ethnomedicine, or

cross-cultural health systems: perceptions and

classifications of illness, prevention measures,diagnosis, healing (magical, religious,

scientific, healing substances), and healers.



• In the 1960s, “ethnomedicine” is only reffered

to non-Western health systems and was

synonymous with folk medicine, popular

medicine, and even the abandoned term

“Primitive medicine”.



Two major problems exist with using

the word “Ethnomedicine”

• Totalizing

- it is excessively generalizing.

•

Ethnocentric- it is ethnocentric.



The current use of the word “Ethnomedicine”

thus embraces all cultural health systems.

Within any of them, a range of variations may

exist--- from more local practices and beliefs

held by laypeople to more widespread

practices that require skills that must be

learned over many years of training availableonly to a few.



DEFINING HEALTH PROBLEMS



• Medical anthropologist often sounds like

philosophers, they are devoting much

attention to defining concepts and delineating

the object of study.

• MEDICAL ANTHROPOLOGIST – conducts the

study of health and health problems.



• DORE – term refers to a complex set of

symbols related to the verb “to order” or “to

send”. Sick as a result of an order or a

mandate sent through a supernatural agent.

• SUPERNATURAL AGENT – different definition

from any found in Western biomedicine.

• DICHOTOMY – is a parallel to etic and emic

understandings of health problems.



• DISEASE – refers to a biological pathology thatis objective and universal.

• ILLNESS – refers to culturally specific

understandings and experiences of a healthproblem or some more generalized form ofsuffering.

• STRUCTURAL SUFFERING – refers to a certaindevastating forces that cause suffering, such

as economic and political situations.



• NOSOLOGY - refers to the classification of

health problems.

• ETHNO-NOSOLOGY – refers to cross cultural

systems of classification of health problems.

• CULTURAL BOUND SYNDROMES – is a

collection of signs and symptoms that is

restricted to a particular culture or a limited

number of cultures.



Preventive Practices

Many different practices based in either religious

or secular beliefs exist cross-culturally for

preventing mis-fortune, suffering, and illness.

Ex.

• Among the Maya of Guatemala, one of the major

illnesses is called awas.

• Children born with awas show symptoms such aslumps under the skin, marks on the skin, or

albinism.



There are also common forms of ritual health

protection which include charms, spells, and

strings tied around parts of the body.

Ex.

• In Japan, after visiting a Buddhist temple, one

might purchase a small band to tie around

• the wrist to prevent future problems related

to health and fertility.

• Wrist ties are commonly placed on infants in

rural areas in India, especially by Hindus.



In a rural area in Northern Thailand, an

anthropologist learned that of display of

carved wooden phalluses throughout a village

as protection against a certain form of sudden

death among men.



• Diagnosis also includes magical- religious

techniques such as divination , in which a

specialist attempts to gain supernatural

insights , and secular techniques such asasking the ill person to supple detailed

descriptions of symptoms.



Examples:

• According to W. Morgan among Navajos, hand

trembling is an important diagnositic

technique.

• Among the urban poor of Bahia in Brazil, a

flexible approach exisits to ascertaining the

cause of disease (Ngokwey, 1988). In Feira de

Santana, the second largest city in the state of

Bahia, illness causation theories fit into thefollowing domains: natural, socioeconomic,

psycholoagical, and supernatural.



• Natural causes include exposure to the

environment. Contagion is another “Natural”

explanation, as are the effects of certain foods

and eating habits. Popular knowledgeconnects the lack of economic resources,

proper sanitation, and health services with

illnesses.



• In the Psychosocial domain, certain are

attributed to illnesses emotions: “Anger and

hostile feelings, anxiety and worry are

possible causes of various illnesses rangingfrom Nervoso, to heart problems and derrame

or cerebral hemorrage.



• In the supernatural domain, illness is caused

by spirits and magical acts.

Ex.

In the African-Brazilian religious systems of

the Bahia region encompass a range of spiritswho can inflict illness, including spirits of the

dead and devil-like spirits. Some spirits cause

specific illnesses: others bring generalmisfortune.



• Medical anthropologists have long beeninterested studying ethnomedicine, or cross-cultural health systems

•

A health system encompasses many areas: – Perceptions and classifications of illness

– Prevention measures

– Diagnoses

– Healing• Magical / religious / scientific / healing substances

– Healers

Ethnomedicine



• Ethnomedicine has recently

expanded its focus to new topics: – Anthropology of the body

– Culture and disability

–

Change in indigenous/traditional healingsystems

– Change results from the effects ofglobalization

– Growth of multiple and mixed healingsystems



• The term ethnomedicine first came to

use in the 1960s and was referred toonly non-Western health systems

– It was also called folk medicine, popularmedicine, and even primitive medicine.

• Two major problems when using theterm ethomedicine:

– It is “totalizing” or excessively generalizing

– It was ethnocentric

• Current use of “ethnomedicine”embraces all cultural health systems



Perceptions of the Body

• Cultures have various ways of defining thebody and its parts in relation to illness andhealing

• Separation of the mind and body has longcharacterized popular and scientific thinkingand medicine has a special category called“mental illness”, which addresses certainhealth problems as though they were locatedin the mind



• Cross-cultural variation exists in the

perceptions of which bodily organs aremost critically involved in the definitionof life versus death.

• Another area of study related to thebody is whether the body is consideredto be a bonded physical unit, withdisease treatment thus focused on juston the body, or is considered to beconnected to a wider social context, in

which case treatment addresses thewider social sphere.



Ways of Healing



Community Healing Systems

It emphasizes the social contextas a key component and whichis carried out within the publicdomain.

Example:Ju Wasi (Ju /’ hoansi ) foragersof the Kalahari desert insouthern Africa.

• Ju Wasi healing emphasizes

the mobilization of community “energy” as a key element incure:



• The central event in

this tradition is the all-night healing dance.

•

Num– Spiritualenergy activated by

the healers

• Kia – enhancement oftheir consciousness



Humoral Healing Systems

• The term Humoral refers toelements in the blood or otherfluids that reside within the body.

• In medicine, the term humor refersto a fluid substance.

•

The aqueous humor is the fluidthat normally resides within thefront and rear chambers of the eye.



• The humors were part of an

ancient theory that believed thathealth came from balance

between the bodily liquids. These

liquids were termed humors. Ifthese fluids were not balanced, a

person was more likely to become

infected with diseases.



Example : Orang Asli Indigenous group

in Malaysia

• excessive heat is the primary causeof mortality

• heat emanates from the sun and isassociated

• with excrement, blood, misfortune,disease, and death

• Heat causes menstruation, violentemotions, aggression, anddrunkenness.

• Health is protected by staying in theforest to avoid the harmful effectsof the sun



HEALERS

• In an informal sense, everyone is a “healer”

because self-treatment is always the first

consideration in dealing with a perceived

health problem



Acupuncturist One who inserts needles into various

points on the body in order to relieve

pain or to relax certain areas of the body

Bonesetter A person who treats or sets fractures,broken or dislocated bones

Chiropractor Chiropractors treat problems with

the musculoskeletal system many times

by manipulating the spine. Some practice

methods such as water therapy, light,

massage, ultrasound, acupuncture and

heat.

Surgeon A vast array of surgeon jobs is seen from

plastic surgery to brain surgery

Dentist One whose business it is to clean, extract,

or repair natural teeth, and to make andinsert artificial ones

General Practitioner A medical practitioner who provides

primary care and specializes in family

medicine.



Herbalist A person who uses herbs (plants and

plant extracts) as their way of healing

and alleviating illness

Midwife A health care profession where providers

give prenatal care to expecting mothers,attend the birth of the infant, and provide

postpartum care to the mother and her

infant

Oneself Healing of ones self is usually used to heal

spiritually, mentally or emotionally rather

than physically

Psychiatrist A doctor who is certified in treating

mental illness

Shaman They are known for their ability to cure

illness and to pass between the

supernatural and natural worlds so as to

provide answers for humans.

Massage Therapist A doctor who uses body pressing

movements across another body to

relieve stress as well as reduce side

affects of cancer treatments;



Faith Healing Faith healing involves the placebo effect,

which is a form of medication with no

actual medicine in it

Physiotherapist A health care professional who issues

services and help to those in need ofrehabilitation as a result of old age, injury

or disease.

Naturopath A health care provider who follows a

natural approach to healing of the body

using natural remedies and the body's

vital ability to heal and maintain itself



Healing Substances

• Cultures use a variety of different substances

for healing. Some cultures rely on drugs to

induce a state of healing, while others put

their lives in the hands of healers such asshamans to regain health.



Phytotherapy is healing through the use of plants.

Example

• Coca plant use to treat gastrointestinal problems, sprains,swellings, and colds

•

Medicinal Marijuana - It is primarily used as a painreliever of muscle relaxant but it has also been claimedto help with insomnia, glaucoma, and alcoholism. Cancer

patients receiving radiation are alsogiven the option to take the plant inorder to settle the stomach andpromote eating.



Examples:

•

Guest are undergoingradon treatment at theKyongsong Sand Spa inHaonpho-ri, North Korea.The spa, and its hotspring, has a 500-yearhistory as a healingcenter. The treatmentshown here is a “sand bath” used for chronicdiseases such as

arthritis, postoperativeproblems, and somefemale problems.



• Minerals – Bathing in water that contain high levels ofsulfur or other minerals to cure arthritis, rheumatism and

skin ailments. (Dead Sea)

• Pharmaceutical medicines are increasingly popularworldwide. (capsules and injections)



Theoritical Approaches in

Medical Anthropology



The different approaches to Medical

Anthropology

• The ecological epidiomological approach

• Colonialism and Disease

• The interpretivist approach

• Critical medical anthropology

• The role of poverty

•Western medical training examined



Ecological Epidiomological

• Consider how natural environment and social/culturalenvironment interact to cause/spread illness.

• Focuses on gathering information about theenvironmental context and social patterns that affect

health,• Anthropologist pays attention to food distribution

within a family.

• Sexual practices

•

Hygiene and population contact• Research tends to be quantitative & etic or quantitative

emic.



Colonialism and Disease

• Foreign invaders tend to bring with them their

local diseases which cause:

• Resilient adjustment of the locals to the new

viruses

• Depopulation

• Quick and outright extermination of locals



Colonialism and disease

• Disease together with other factors like warfare, harshlabor practices, and general cultural disruption cancause massive depopulation or extinction.

• Example

– Precontact New world was free of many European diseaseslike small pox, measles, typhus

– Syphilis, leprosy, malaria could have been absent fromduring Precontact New world thou this is still speculated,

– Cholera was also a cause of major depopulation due to factthat its method of transmission is through water and foodthrives of poor sanitation



Interpretivist approach

• Studies how people of different cultures label,describe, and experience illness.

• How healing modalities offer meaningful responses toindividual and communal distress.

• Examines aspects such as ritual trance, symbolicperformances.

• Healing systems provide meaning to people who sufferthrough meaningless pain. –Claude Levi-Strauss (1967)

• Western science calls this the Placebo effect ( a healingobtain through the positive power believing that aparticular method is effective)



Critical Medical Anthropology

• Focuses on how economic and political powersstructures shape people’s health status. Their access tohealth care and prevailing healing systems.

• Shows how economic and political systems, create and

perpetuate social inequality in one’s health status.

• “illness is more often a a product of one’s status thansomething natural.”

• Medical anthropologist exposed the power ofmedicalization (the power to label a particular issue assomething that needs medical treatment). Whereinthat issue could be political or of economical



Critical Medical Anthropology

• Looks first of how larger structural forces

determine the distribution of illness and

people’s response to it.



The Role of Poverty

• Poverty is a major cause of illness morbidity (sickness)and mortality (death) in developing countries.

• In the developing world childhood malnutrition areinversely related to income, as income increases so

does calorie in take and the percentage of calorieintake recommended per day also increases.

• Increasing the income of the poor can greatly effecttheir nutrition.

• Surprisingly most of the nutrition programs around theworld focuses on treating the outcome of povertyrather than its causes.



Western Medical training

• Since the 1980’s medical anthropologist havepursued the study of western biomedicine as apowerful cultural system.

• They critic western medical school training since

they focus on technology.• An example is the training of doctors who

specializes in obstetrics.

• This model treats the body as a machine.

• The physician uses the assembly line approach inrelation to birth. In order to promote efficientproduction and quality control.



Western Medicine training examined

• Their goal is the production of a healthy baby.

the doctor is in charge of achieving this goal.

The mother takes second place.

• The quality of the mother’s experience is not

given any attention. Their goal is to be able to

get the power baby.



Globalization and Change



Objectives

• How globalization trends changed the world

of medicine.

• How biomedicine is adopted in countries with

different cultures.

• How diseases have evolved through

development of society.

• How different diseases is viewed differently

among countries.



Medical Anthropologist

• Studies how and why changes in medicine and

diseases occur and what its effects are on the

people involved.



New Infectious Diseases

• New infectious diseases arise from social and

cultural practices.

• Diseases become widespread due to

international travel, overcrowding in cities andexpansion of populations.

• Viruses and bacteria have mutated and become

more resistant to known drugs and medicines.• Examples are: Malaria, Tuberculosis, Drug-

resistant strains of H7N9 bird flu (previously

H1N1), HIV drug resistant strains, superbugs



Diseases of Development

• Diseases of Development are diseases that arecaused or increased by economic developmentactivities.

•

These are due mostly to environmental changes,increased population densities, and pollution.

• In third world countries where overpopulationhas occurred, cities often become far too large

for the capabilities of their sewage processingsystems thus the spread of feces born diseasessuch as cholera and dysentery.



Diseases of Development

• The common practice of burning garbage on thestreets and unofficial dumps also results in theaccumulation of dioxins and other dangeroussubstances on the ground, water and air.

• Increased air pollution has resulted into higherrisks of lung cancer and asthma.

• Autoimmune diseases and allergies also arisefrom pollution and man-made chemicals.

• Diets that include too many calories andespecially high amounts of animal fats have beenconnected with obesity, diabetes, andhypertension.



Medical Pluralism

• Different cultures sometimes lead to a situation inwhich aspects of both cultures coexist such aslanguage, religion or health systems.

• Pluralism expresses the presence of multiple cultural

options within a society.• Medical pluralism is, therefore, a term used to refer to

a situation in which more than one medical or healthsystem exists in a given culture.

• It is the adoption of more than one medical system, or

the simultaneous integration of both Orthodoxmedicine with alternative medicine.

• It is a wide range of therapeutic options available forthe alleviation and prevention of physical discomfort or

emotional distress.



Three Sectors of Health Care

• Popular Sector

• Folk Sector

• Professional Sector



Popular Sector

• The lay and non-professional domain

• All therapeutic options that people utilize

without any payment or consultation.

• Both patient and healer share similar

assumptions on health and illness

• Includes a set of beliefs on health

maintenance (Don’t sleep with wet hair, brush 2x a day,

drink 8 glasses of water)



Sources of Health Advice

• Those with long experience on a particular

illness

• Doctor’s spouses

• Those with extensive experience

• Organizers of self-help groups

• Family members (usually women)



Folk Sector

• Healers specialize in forms of healing that are

either spiritual or secular or a mixture of both.

• Examples are spirit healers, shamans,

midwives, herbalists, etc.

• Usually focuses on the balance between the

person and his social, natural and spiritual

environment.



Professional Sector

• The organized and legally sanctioned

professionals

• Uses modern, Western medicine

• High specialized in their fields such as

cardiologists, paediatricians, gynaecologists,

etc.



Medical Pluralism

• Medical pluralism provides both options and complications.Something may be classified as a health problem in somecultures and not in others.

• Spirit possession is welcomed in some cultures but wouldbe considered a mental illness in Western medicine. It may

also be viewed as something supernatural or caused byvirus which translates into different treatments.

• In rural areas, going to witch doctors may be more practicaland become than visiting real doctors

• Traditional Chinese therapies (acupuncture, massage,cupping) may be viewed as inferior or based onspeculations only and not real science.

• Some cultures prefer herbal medicine than drugs.



Clinical Medical Anthropology

• Clinically applied anthropology is broadly theapplication of medical anthropology to clinicalissues in health, mental health and socialservices.

• Clinical Medical Anthropology or Applied MedicalAnthropology is the application ofanthropological knowledge to further the goals ofhealth care providers – improving doctor-patient

communications in multicultural settings andmaking recommendations about culturallyappropriate health intervention programs.



Clinical Medical Anthropology

• Helps modern medicine practitioners have amore holistic approach, including mental andrelational factors in their treatment.

• Example: Obesity

• Medical Anthropologists will study the societyand how they obtain their food, what they eatand their lifestyle. To help solve the problem,they analyze the data and try to create a

healthcare program addressing their lifestyle andeating patterns. Modern medicine, on the otherhand, would simply treat the diseases that arisefrom obesity.

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