Download Miller - Chapter 5

Disease, Illness, and Healing
(Miller – Chapter 5)
Copyright © Allyn & Bacon 2008
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?
Copyright © Allyn & Bacon 2008
Medical Anthropology
 Medical anthropology is the crosscultural study of health, disease, and
illness and the care practices
associated with these
Copyright © Allyn & Bacon 2008
Ethnomedicine
 Ethnomedicine is the study of cross-cultural
health systems
 Includes the study of health systems
everywhere, including in the West
 A health system encompasses many areas…




Perceptions and classifications of health problems
Prevention measures
Diagnosis
Healing (magical, religious, and scientific healing
substances)
 Healers
Copyright © Allyn & Bacon 2008
Ethnomedicine
 Key step in ethnomedical research is to
learn how people label, characterize,
and classify health problems
 Categorizing differs depending on the
culture
 May label and classify health problems
by…
 Cause
 Means of transmission (vector)
 Affected body part
 Symptoms
 Combination of these
 Knowledge often passed along through
oral traditions
Copyright © Allyn & Bacon 2008
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
 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
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
Disease/Illness Dichotomy
 Disease refers to a biological health
problem that is objective and universal
 A bacterial or viral infection
 A broken arm
 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
Copyright © Allyn & Bacon 2008
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 culturespecific 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
Copyright © Allyn & Bacon 2008
Copyright © Allyn & Bacon 2008
Koro (genital retraction
syndrome)










In technical psychological jargon, koro is known as genital retraction syndrome. In layperson's terms, it's a
pathological fear that the genitals are shrinking into the body. Many victims of koro believe that their genitals
will be completely sucked into the body, causing death. While this condition occasionally occurs in women,
it is much more common in men1.
Koro is a considered a culture-bound syndrome, meaning that it only occurs in certain cultures, and does
not directly correspond with diseases or conditions recognized by Western medicine. It is most common in
China, Southeast Asia, and Malaysia, although outbreaks have occurred in Africa as well. The condition
tends to have a different name in every region, but these names often translate as 'shrinking penis'2.
Causes and Cures
Commonly cited causes of koro include witchcraft, sexual relations with prostitutes, masturbation, and food
poisoning.
In some parts of Africa, lynch mobs have attacked so-called penis snatchers based on accusations of men
who claimed that the evildoers have somehow caused their genitalia to retract into the abdomen. Later
medical examinations, however, showed the accusing men to be completely intact.
In China, men may believe that the yin/yang balance of sexual relations is fatally disrupted when 'male
essence' is released in any situation other than spousal intercourse.
Mass hysteria has often caused widespread epidemics of koro, such as the one in 1967 purportedly caused
by eating contaminated pork in Singapore. Public reassurance from doctors and the government was
enough to quell the epidemic.
Ethnographic psychologists3 consider koro to be closely related to panic attacks precipitated by sexual
anxiety. Attacks of koro are often set off when men are in situations that would normally cause the male
genitals to shrink slightly, such as emotional distress or cold temperatures.
While there are no substantiated reports of the condition itself resulting in any physical damage to the
individual, many sufferers have unfortunately inflicted harm upon themselves in frantic attempts to stretch
the penis to prevent further shrinkage. It is not unusual for those with koro to resort to using mechanical
devices such as clamps or weights4.
1 While the fears of men with koro center around the penis and testicles, in women the fears may be
focused on the v***a and/or nipples.
2 For example, the Chinese term of 'suo yang' translates as 'shrinking penis'
3 Ethnographic psychologists are shrinks who analyze other cultures.
4 Ouch!
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
Culture Specific Syndrome
 Other examples?
 In the U.S. or anywhere else?
Copyright © Allyn & Bacon 2008
Culture Specific Syndrome
 In the U.S or in the West.…
 Gulf War syndrome
 Alien abduction phenomenon
 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
 Piped water bypasses low-income communities and instead
goes to supplying water for wealthier communities, irrigation
projects, and industrial sectors
 In 20 years may have 600 million people on the
planet without access to clean water
Copyright © Allyn & Bacon 2008
Ethno-etiology
 Etiology = cause
 People in all cultures attempt to make
sense of health problems and try to
understand their cause
 Ethno-etiologies refers to crosscultural variations in causal
explanations for health problems and
suffering
Copyright © Allyn & Bacon 2008
Ethno-etiology
 Can be natural, socioeconomic, psychological,
or supernatural
 Natural
 Heat causing dehydration
 Old age or heredity causing disease or illness
 Socioeconomic
 Lack of economic resources/money, proper sanitation, and
health services
 Structural suffering, or social suffering, refers to health
problems that powerful forces such as poverty, war, famine,
and forced migration cause
 Psychological
 Anger, anxiety, depression can cause certain health
problems
 Supernatural
 Spirits, magic, God causing health problems
 May be multiple layers of causality
Copyright © Allyn & Bacon 2008
Copyright © Allyn & Bacon 2008
Healing
 Can be private healing or community
healing
 Private healing
 Often occurs in Western contexts
 Addresses bodily ailments in social isolation
Copyright © Allyn & Bacon 2008
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!
 It works on several levels…
 Group solidarity supports mental and physical health
 The drama and energy of the all-night dances may act
to strengthen the afflicted in ways that Western
science would have difficulty measuring
 When one member falls ill and/or dies the dances
serve to support those who are grieving
 Everyone has access to the healing process
Copyright © Allyn & Bacon 2008
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
 Foods and drugs have different effects on the body
and are classified as either “heating” or “cooling”
 Disease are the result of bodily imbalances – too
much heat or coolness – which must be
counteracted through dietary changes or medicines
that will restore balance
 Practiced for thousands of years in the Middle East, the
Mediterranean, and much of Asia
 Differ depending on whether too much heat or
coolness causes death
 In Malaysia – heat; China – cold
Copyright © Allyn & Bacon 2008
Two Approaches to Healing
Community healing
Humoral healing
• example: the Ju/’hoansi
foragers
• example: Malaysia
• mobilization of
community “energy” as
key to cure
• all-night healing dances
• open, everyone has
access
• based on balance
among elements within
the body
• different foods/drugs
have “heating” or
“cooling” effects
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
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
 Cross-culturally, people know about and use many
different plants for a wide range of health problems,
including gastrointestinal disorders, skin problems,
wounds and sores, pain relief, infertility, fatigue,
altitude sickness, and more
 Increasing awareness of the range of potentially useful
plants worldwide provides a strong incentive for
protecting the world’s cultural diversity, because it is
Copyright © Allyn & Bacon 2008
people who know about botanical resources
Healing Substances
 Coca plant
 Common among the people of the Andes
mountains (e.g. Bolivia)
 Important in rituals
 Acts as a mild stimulant
 Suppresses hunger, thirst, pain, and fatigue
 Treats gastrointestinal problems, sprains, swellings,
and colds
Copyright © Allyn & Bacon 2008
Healing Substances
 Minerals
 Japan – bathing in mineral waters
 Bathing in the Dead Sea (between Israel and
Jordan) to treat skin diseases such as
psoriasis
 In true commercialized fashion, us Westerners can
bath in Dead Sea salt without leaving home! Order
salt extracted from the Dead Sea online and have it
delivered to your home so that you can bath with it
in your very own bathtub!!
 http://www.saltworks.us/salt_info/si_DeadSeaSaltBathing.
asp
Copyright © Allyn & Bacon 2008
Healing Substances
 Gases
 Radon
 According to the US Environmental Protection
Agency (EPA) “Radon is a cancer-causing natural
radioactive gas that you can’t see, smell or taste.
Its presence in your home can pose a danger to
your family's health. Radon is the leading cause of
lung cancer among non-smokers. Radon is the
second leading cause of lung cancer in America
and claims about 20,000 lives annually.”
 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 Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
Healing Substances
 Spirituality and Prayer??
 “Studies have found that spirituality, religion, and
prayer are very important to quality of life for some
people who have been diagnosed with cancer.
Research has not shown that spirituality and prayer
can cure cancer or any other disease, but they may be
a helpful addition to conventional medical care.”
 “The benefits of praying may include:
• reducing stress and anxiety
• promoting a more positive outlook and a stronger will to live”
 “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 wellbeing were able to cope better with their illnesses and
find meaning in their experience.”
 http://www.breastcancer.org/treatment/comp_med/typ
es/spirituality.jsp
Copyright © Allyn & Bacon 2008
Three Theoretical Approaches
in Medical Anthropology
 Ecological/epidemiological approach
 Interpretivist approach
 Critical medical anthropology
Copyright © Allyn & Bacon 2008
Ecological/epidemiological
approach
 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
Copyright © Allyn & Bacon 2008
Ecological/epidemiological
approach
 May incorporate the concept of historical
trauma
 The intergenerational transfer of the emotional and
psychological effects of colonialism from parents to
children
 An example – high rates of depression and suicide,
low self-esteem, high rates of child and adolescent
drug use, and high rates of alcoholism, obesity, and
hypertension among indigenous peoples worldwide –
enduring effects of European/Western colonialism
 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
Copyright © Allyn & Bacon 2008
Colonialism, Death by Contact,
and Displacement: The US before
the Europeans
Copyright © Allyn & Bacon 2008
Native American designated
reservations now
Copyright © Allyn & Bacon 2008
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
 how healing systems provide meaning to
people who are experiencing seemingly
meaningless forms of suffering
Copyright © Allyn & Bacon 2008
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
 Why?
 The confidence and power of the person
prescribing a treatment
 The act of prescription itself
 Concrete details about the about the medicine,
such as its color, name, and place of origin
Copyright © Allyn & Bacon 2008
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
 Manifest in different ways – in some areas it is
child malnutrition, in other areas it is violence,
etc.
Copyright © Allyn & Bacon 2008
Critical medical anthropology
 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
Copyright © Allyn & Bacon 2008
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
 Give anti-depressants rather than eliminate
unemployment
 Give food or pills rather than seeking to increase
incomes
 Medicalization serves the interests of
pharmaceutical companies and helps to keep
inequitable social systems in place
Copyright © Allyn & Bacon 2008
Critical medical anthropology


"Disease mongering exploits the deepest atavistic fears of suffering and
death. It is in the interests of pharmaceutical companies to extend the range
of the abnormal so that the market for treatments is proportionately
enlarged." Iona Heath, General Practitioner at the Caversham Practice in
London
“Prevention is conspicuously absent from today's public health scene.
The use of nutrition and other natural means of preventing and curing illness
is actively, if covertly, discouraged by most health authorities across the
world. It is strictly forbidden to inform the public about preventive and
curative properties of any product not registered as a pharmaceutical drug,
creating the illusion that foods and nutrition are ineffective in prevention and
healing. But more importantly even - normal, everyday behavior is
increasingly medicalized, actually creating new diseases that 'must be
treated'.”

Disease Mongering: Corporations Create New 'Illnesses'
 “Monger” = promote/sell
 Atavastic =
Copyright © Allyn & Bacon 2008
Critical medical anthropology
 Critique of Western biomedical training
 Too much emphasis on technology
 Dehumanizing – emphasis on machines and
objectification of body parts and the patient
 Knowledge of technology and being able to perform
sophisticated surgical techniques leads to prestige
in the profession rather than care or compassion
 Emphasis on “production” and “efficiency”
 Delivering babies much like building a Ford Model
T on an assembly line!
 “The quality of the mother’s experience – we rarely
thought about that.”
Copyright © Allyn & Bacon 2008
Critical medical anthropology
 Critique of Western biomedical training
 How do students accept this model?
 Enculturation
 Being constantly exposed to a model of Western
biomedical training that emphasizes technology and
efficiency over valuing cultural understanding and the
patients’ individual experiences
 Physical hazing
 A harsh rite of passage involving stress caused by sleep
deprivation throughout medical school and the residency
period
 Cognitive retrogression
 Memorizing vast amounts of material
 Turning students into human memorizing machines rather
than compassionate, thoughtful, critical thinking
Copyright © Allyn & Bacon 2008
individuals
Critical Medical Anthropology
Illness is more often a
product of someone’s social
position than “natural”
Western doctorpatient relationships
as a form of social
control
Western medicine
emphasizes technology
and is dehumanizing
Economic
and political
systems
create health
inequalities
Poverty is a
major cause of
suffering death
Copyright © Allyn & Bacon 2008
Globalization and Change
 With globalization, health problems
move around the world and into remote
locations and cultures more rapidly than
ever before
 Also get the spread of Western
biomedicine with globalization
 Globalization is not one way – we also
get the spread of non-Western forms of
healing into new areas
Copyright © Allyn & Bacon 2008
Globalization and Change
 Starting in the 1950’s with the
development of many new antibiotics
and vaccines there was the hope that
Western medicine would eradicate
infectious disease throughout the world
 But unfortunately that hasn’t happened!
 New Infectious Diseases
 HIV/AIDS in humans likely started in
Cameroon from eating a chimpanzee or
getting cut by a chimpanzee
 HIV/AIDS has now become a global
epidemic
Copyright © Allyn & Bacon 2008
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.
Copyright © Allyn & Bacon 2008
Globalization and Change
 Diseases of Development
 Are health problems (both diseases and
illnesses) caused or increased by
economic development activities
 Include…
 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






Cancer
Hypertension
Diabetes mellitus
Heart disease
Respiratory disease
http://www.ispub.com/ostia/index.php?xmlPrinter=tru
e&xmlFilePath=journals/ije/vol5n1/mortality.xml
Copyright © Allyn & Bacon 2008
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 disease to many new areas of the
world
Copyright © Allyn & Bacon 2008
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
 Yanomamo utilizing Western clinics to treat the symptoms of
their illness
 Utilizing shamans to combat the ultimate cause of the illness
 Since 1978 the World Health Organization had
indorsed the incorporation of local healing practices in
national health systems
 Increasing appreciation of the value of many non-Western
healing traditions
 Growing awareness of the deficiencies of Western
biomedicine in addressing a person’s psychosocial context
(lack of attention to mind, soul, and social setting)
 High cost and lack of access to Western biomedicine
Copyright © Allyn & Bacon 2008
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
 Example of Samoan girl living in Honolulu when she died
from diabetes
 Father confused that there was no single physician
caring for his daughter
 Seeing someone else die in the ICU
 Different staff members have different interpretations
of the illness and test results
 Was she getting too much or too little sugar?
 Distrust and confusion with overall medical system
Copyright © Allyn & Bacon 2008
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
 Traditional healing remedy for indigestion and constipation
among some Mexican Americans which contained lead
 Anthropologist studied this and made
recommendations for a culturally appropriate
substitute remedy
Copyright © Allyn & Bacon 2008
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.
Copyright © Allyn & Bacon 2008
The BIG Questions
Revisited
 What is ethnomedicine?
 What are three major theoretical
approaches in medical anthropology?
 How are disease, illness, and healing
changing during globalization?
Copyright © Allyn & Bacon 2008