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

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

2. 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?

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

4. Ethnomedicine • Ethnomedicine is the study of cross-cultural health systems • Includes the study of health systems everywhere, including in the West

5. Ethnomedicine • Key step in ethnomedical research is to learn how people label, characterize, and classify health problems • Categorizing differs depending on the culture

6. Disease/Illness Dichotomy • Disease refers to a biological health problem that is objective and universal • A bacterial or viral infection • A broken arm

7. 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

8. 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

10. 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 Nervosa: A Culture-Specific Syndrome

11. Anorexia

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

13. Culture Specific Syndrome • In the U.S or in the West.… • Gulf War syndrome

14. Culture Specific Syndrome • In the U.S or in the West.… • Alien abduction phenomenon

15. 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

16. 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

17. Ethno-etiology • Causes of disease can be attributed to natural/environmental, socioeconomic, psychological, or supernatural factors

19. Healing • Can be private healing or community healing • Private healing • Often occurs in Western contexts • Addresses bodily ailments in social isolation

20. 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!

21. 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

22. 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

23. 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

25. 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

26. 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

27. 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/PDFs/medicinal.pdf

28. Healing Substances

29. 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

30. 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

31. 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

32. 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

33. Three Theoretical Approaches in Medical Anthropology • Ecological/epidemiological approach • Interpretivist approach • Critical medical anthropology

34. 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

35. Ecological/epidemiological approach • 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

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

37. Native American designated reservations now

38. 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

39. 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

40. 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

41. 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

42. Critical medical anthropology

43. 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

44. 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

45. 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

46. Critical medical anthropology • Critique of Western biomedical training • Too much emphasis on technology

47. Critical medical anthropology • Critique of Western biomedical training • Emphasis on “production” and “efficiency” rather than human experience

48. Critical medical anthropology • Critique of Western biomedical training • Why do students accept this model? • Enculturation • Physical hazing • Cognitive retrogression

49. 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.

50. Critical Medical Anthropology Illness is more often a product of someone’s social position than “natural” Economic and political systems create health inequalities 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