Disease, Illness, and Healing
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
A health system encompasses many areas…
Perceptions and classifications of health problems
Prevention measures
Diagnosis
Healing (magical, religious, and scientific healing substances)
Healers
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
Western Biomedicine (WBM)
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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
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
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
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
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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
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
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 cross-cultural variations in
causal explanations for health problems and suffering
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
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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!
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
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
Two Approaches to Healing
Healers
Informally, everyone is a healer!
Self-treatment is always the first consideration in dealing with a
perceived health problem
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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
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 people who know about botanical resources
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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
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
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
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
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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 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
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
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
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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
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
how healing systems provide meaning to people who are
experiencing seemingly meaningless forms of suffering
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
Critical medical anthropology
Focuses on how economic and political power structures
and inequality (“structural violence”) affect health
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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.
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
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
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.”
Critical medical anthropology
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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 individuals
Critical Medical Anthropology
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
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
Globalization and Change
Old infectious diseases are still a problem, too
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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
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=true&xmlFilePath=journals/ije/vol5n1/mortality.
xml
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
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
Medical Pluralism
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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
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
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.
The BIG Questions
Revisited
What is ethnomedicine?
What are three major theoretical approaches in medical
anthropology?
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How are disease, illness, and healing changing during
globalization?
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