Disease, Illness, and Healing (Miller – Chapter 5)

Copyright © Allyn & Bacon 2008

Disease, Illness, and Healing(Miller – Chapter 5)


The BIG Questions

What is medical anthropology? What is ethnomedicine? What are three major theoretical

approaches in medical anthropology? How are disease, illness, and healing

changing during globalization?


Medical Anthropology

Medical anthropology is the cross-cultural study of health, disease, and illness and the care practices associated with these


Ethnomedicine Ethnomedicine is the study of cross-

cultural health systems Includes the study of health systems

everywhere, including in the West


Ethnomedicine Key step in ethnomedical research is to

learn how people label, characterize, and classify health problems Categorizing differs depending on the

culture


Disease/Illness Dichotomy Disease refers to a biological health

problem that is objective and universal A bacterial or viral infection A broken arm


Disease/Illness Dichotomy Illness refers to culturally specific

perceptions and experiences of a health problem

Medical anthropologists study both disease and illness, and they show how both must be understood within their cultural context


Culture Specific Syndrome A culture-specific syndrome is a

health problem with a set of symptoms associated with a particular culture Social factors such as stress, fear, or

shock often are the underlying causes of culture-specific syndromes Somatization – refers to the process through

which the body absorbs social stress and manifests symptoms of suffering

Biophysical symptoms can be involved Can be fatal


Anorexia Nervosa: A Culture-Specific Syndrome

Associated with industrial, Western societies

Found mostly in Euro-American adolescent girls

Difficult to cure medically

Experts suggest it is due to excessive concern with looks and body weight caused by societal pressures


Anorexia


Culture Specific Syndrome Other examples? In the U.S. or anywhere else?


Culture Specific Syndrome In the U.S or in the West.…

Gulf War syndrome


Culture Specific Syndrome In the U.S or in the West.…

Alien abduction phenomenon


Culture Specific Syndrome Nearly 1/3 of the

population of Mexico “suffering from water”

Common health problem Severe anxiety – cannot

count on water coming from their taps on a regular basis

Biophysical problems because of lack of access to clean water – skin and eye infections, increased risk of cholera

In 20 years may have 600 million people on the planet without access to clean water


Ethno-etiology

Ethno-etiologies refers to cross-cultural variations in causal explanations for health problems and suffering Etiology = cause People in all cultures attempt to make

sense of health problems and try to understand their cause


Ethno-etiology

Causes of disease can be attributed to natural/environmental, socioeconomic, psychological, or supernatural factors


Healing Can be private healing or community

healing Private healing

Often occurs in Western contexts Addresses bodily ailments in social isolation


Healing Community healing

Encompasses the social context as crucial to healing

An example – Ju/’hoansi healing dances A community event In both ethnic and Western terms, community

healing works!


Healing Humoral healing systems

Approaches to healing based on a philosophy of balance among certain elements of the body and within the person’s environment


Two Approaches to Healing

Community healing

• example: the Ju/’hoansi foragers

• mobilization of community “energy” as key to cure

• all-night healing dances

• open, everyone has access

Humoral healing

• example: Malaysia

• based on balance among elements within the body

• different foods/drugs have “heating” or “cooling” effects


Healers Informally, everyone is a healer!

Self-treatment is always the first consideration in dealing with a perceived health problem

In all cultures, though, some people become recognized as having special abilities to diagnose and treat health problems

There are some common criteria of healers cross-culturally


Healers Some common types of healers include…

Midwife (someone who gives prenatal care and delivers baby)

Bonesetter (someone who resets broken bones) Shaman (a healer who mediates between humans

and the spirit world) Herbalist General practitioner Psychiatrist Nurse Acupuncturist Chiropractor Dentist Hospice care provider


Healers Some healing roles have higher status,

more power, and receive higher pay than others

Some traditional healing roles may become endangered due to globalization Costa Rica encouraging hospital births

Led to midwives abandoning their profession


Healing Substances Around the world, thousands of different

natural or manufactured substances are used as medicines for preventing or curing health problems

Phytotherapy is healing through the use of plants 70,000 plant species around the world are

believed to be medicinal http://www.bgci.org/files/Worldwide/Publications/PD

Fs/medicinal.pdf


Healing Substances


Healing Substances Minerals

Japan – bathing in mineral waters Bathing in the Dead Sea (between Israel and

Jordan) to treat skin diseases such as psoriasis

http://www.saltworks.us/salt_info/si_DeadSeaSaltBathing.asp


Healing Substances Gases

Radon According to the US Environmental Protection

Agency (EPA), radon is dangerous! But some people swear by its ability to heal such

chronic afflictions as arthritis Visit “radon spas” in mines in the mountains of

Montana http://www.radonmine.com/why.html


Healing Substances Western medicines

Increasingly popular worldwide Have many benefits but also some drawbacks

Over-use Over-prescription Ability to obtain these drugs without a prescription Emergence of drug-resistant strains High prices and lack of access to helpful drugs in

many areas of the world


Healing Substances Spirituality and Prayer??

“83% of the studies done on spirituality found a positive effect on physical health.”

“An analysis of 43 studies on people with advanced cancer said that people who reported spiritual well-being were able to cope better with their illnesses and find meaning in their experience.”

http://www.breastcancer.org/treatment/comp_med/types/spirituality.jsp


Three Theoretical Approaches in Medical Anthropology

Ecological/epidemiological approach

Interpretivist approach

Critical medical anthropology



Examines how environment interacts with culture to influence the cause and spread of health problems May study…

how urbanization affects the spread of various infectious diseases

how migration affects the spread of various infectious diseases

geographic distribution of disease distribution of disease among various microcultures

Research methods tend to be etic and quantitative



May incorporate the concept of historical trauma The intergenerational transfer of the emotional

and psychological effects of colonialism/slavery from parents to children

Expands the scope of traditional epidemiological studies by drawing on factors from the past to explain the social and spatial distribution of contemporary health problems


Colonialism, Death by Contact, and Displacement: The US before the Europeans


Native American designated reservations now


Interpretivist approach Examines health systems as systems of

meaning Interpretivists study…

how people in different cultures label, describe, and experience illness and how healing systems offer meaningful responses to individual and communal distress


Interpretivist approach Placebo effect, or meaning effect…

A positive result from a healing method due to a symbolic or otherwise nonmaterial factor

In the U.S., depending on the health problem, between 10 and 90 percent of the efficacy of medical prescriptions lies in the placebo effect


Critical medical anthropology Focuses on how economic and political

power structures and inequality (“structural violence”) affect health

Substantial evidence indicates that poverty is the primary cause of morbidity (sickness) and mortality (death) in both industrialized and developing countries



Rates of childhood malnutrition are inversely related to income Therefore, increasing income levels of the

poor is the most direct way to improve child nutrition and health


Critical medical anthropology But many health and nutrition programs

around the world focus on treating the outcomes of poverty rather than its causes Medicalization – Labeling a particular issue

or problem as medical and requiring medical treatment when, in fact, its cause is structural Treating symptoms rather than root cause


Western Biomedicine (WBM) Western biomedicine (WBM) is a

healing approach based on modern Western science that emphasizes technology in diagnosing and treating health problems related to the human body

Is an ethnomedical system Is a cultural system intimately bound to

Western values


Western Biomedicine (WBM) Classifications are often highly

formalized International Classification of Diseases

(ICD) Limited by the cultural context

Before September 11 terrorist attacks, there was no classification for deaths or injuries by terrorism

Ignores health problems of many other cultures


Critical medical anthropology Critique of Western biomedical training

Too much emphasis on technology



Emphasis on “production” and “efficiency” rather than human experience



Why do students accept this model? Enculturation Physical hazing Cognitive retrogression


Western Biomedicine (WBM) Critiques of Western Biomedicine

Tends to focus too narrowly on treating disease while neglecting illness

Tends to focus too narrowly on microbes rather than larger structural forces

Private versus community based

vs.


Critical Medical Anthropology

Economic and political systems create health inequalities

Illness is more often a product of someone’s social position than “natural”

Western doctor-patient relationships as a form of social control

Poverty is a major cause of suffering death

Western medicine emphasizes technology and is dehumanizing


Globalization and Change Globalization a two way street Has vast effects on human health

Spread of western biomedicine New infectious diseases


Globalization and Change Old infectious diseases are still a

problem, too Malaria and tuberculosis are still leading

killers in many 3rd world countries With globalization and migration these

diseases are once again becoming a problem in the U.S.


Globalization and Change Diseases of Development

Are health problems (both diseases and illnesses) caused or increased by economic development activities Diseases often associated with poor diets (high

in saturated fat, sugar, salt, low in fiber and fruits, vegetables, and healthy fats) and/or lack of exercise and inactivity


Globalization and Change Diseases of Development

Diseases brought about by “development projects” changing the environment The construction of dams and irrigations

systems Diseases increased by standing water or slowing

rate of water flow, such as malaria

Globalization and “development” brings these diseases to many new areas of the world


Medical Pluralism Refers to the presence of multiple health

systems within a society May provide clients with a range of choices

and enhance the quality of health Since 1978 the World Health Organization

has endorsed the incorporation of local healing practices in national health systems


Medical Pluralism People may be confronted by conflicting

models of illness and healing, a situation that can result in misunderstandings between healers and clients and in unhappy outcomes Take a pill with every meal…what does that

mean? Cultural miscommunications can lead to death


Applied/Clinical Medical Anthropology

Is the application of anthropological knowledge to further the goals of heath-care providers

Applied/clinical medical anthropologists help… multicultural doctor-patient understanding in making recommendations about culturally

appropriate health programs develop more effective health communication providing insights related to disease that medical

practitioners do not usually take into account


OCD

http://www.minddisorders.com/Ob-Ps/Obsessive-compulsive-disorder.html


Tapeworm & Other Foodborne Illnesses (such as Salmonella and E. coli) Proper preparation of foods Avoidance of cross-contamination “FDA requires that fish to be served raw remain

frozen for seven days at a temperature of minus four degrees Fahrenheit (or for 15 hours at a temperature of minus 31 degrees Fahrenheit in a blast freezer). Freezing kills any parasitic worms and their larvae that may infect some species of fish.” http://www.drweil.com/drw/u/id/QAA400212

“Saltwater fish are less prone to bacteria and parasites than freshwater fish” http://recipes.howstuffworks.com/menus/sushi.htm/printable


Other interesting websites

http://ethnomed.org/ The EthnoMed site contains information about

cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world.

http://www.ethnomedicine.org/


The BIG Questions

What is medical anthropology? What is ethnomedicine? What are three major theoretical

approaches in medical anthropology? How are disease, illness, and healing

changing during globalization?


Question #1 A(n) __________is a biological health

problem that is objective and universal.

a) Culture-specific syndrome

b) illness

c) disease

d) ethnomedicine

e) ethno-etiology


Question #2 __________is the study of cross-

cultural health systems.

a) culture-specific syndrome

b) illness

c) disease

d) ethnomedicine

e) ethno-etiology


Question #3 Anorexia is an example of a(n)

____________.

a) disease of development

b) culture specific syndrome

c) ethnoetiology

d) ethnomedicine

e) historical trauma


Question #4 Heart disease is an example of a(n)

____________.

a) disease of development

b) culture specific syndrome

c) ethnoetiology

d) ethnomedicine

e) historical trauma


Question #5 Medical anthropologists who study the

placebo effect most likely take a(n) ____________.

a) critical medical anthropology approach

b) medical pluralism approach

c) applied/clinical medical anthropology approach

d) interpretivist approach

e) ecological/epidemiological approach


Question #6 Medical anthropologists who study the

phenomena of medicalizaion most likely take a(n) ____________.

a) critical medical anthropology approach

b) medical pluralism approach

c) applied/clinical medical anthropology approach

d) interpretivist approach

e) ecological/epidemiological approach


Question #7 The process by which culture is

passed from one generation to the next and through which individuals become members of their society is ____________.

a) personalityb) redistributionc) enculturationd) reciprocitye) pronatalism


Question #8 Which mode of production is typically

associated with low fertility rates?

a) foraging

b) pastoralism

c) horticulture

d) agriculture

e) both A and D


Question #9 __________ is biological and

something everybody is born with.

a) gender

b) sex

c) dependent-dominant personality

d) nurturant-responsible personality

e) both A and B


Question #10 An exchange of birthday presents

among peers is an example of ________.

a) generalized reciprocity

b) unbalanced exchange

c) redistribution

d) gambling

e) expected reciprocity

Disease, Illness, and Healing (Miller – Chapter 5)

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