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
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Ethnomedicine
 Ethnomedicine is the study of crosscultural health systems
 Includes the study of health systems
everywhere, including in the West
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Ethnomedicine
 Key step in ethnomedical research is to
learn how people label, characterize,
and classify health problems
 Categorizing differs depending on the
culture
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Disease/Illness Dichotomy
 Disease refers to a biological health
problem that is objective and universal
 A bacterial or viral infection
 A broken arm
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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
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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
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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
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Anorexia
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Culture Specific Syndrome
 Other examples?
 In the U.S. or anywhere else?
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Culture Specific Syndrome
 In the U.S or in the West.…
 Gulf War syndrome
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Culture Specific Syndrome
 In the U.S or in the West.…
 Alien abduction phenomenon
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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
Copyright © Allyn & Bacon 2008
Ethno-etiology
 Ethno-etiologies refers to crosscultural 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
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Ethno-etiology
 Causes of disease can be attributed to
natural/environmental, socioeconomic,
psychological, or supernatural factors
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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
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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!
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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
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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
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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
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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
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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
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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
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Healing Substances
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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
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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
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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??
 “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/tre
atment/comp_med/types/spiritu
ality.jsp
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Three Theoretical Approaches
in Medical Anthropology
 Ecological/epidemiological approach
 Interpretivist approach
 Critical medical anthropology
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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
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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
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Colonialism, Death by Contact,
and Displacement: The US before
the Europeans
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Native American designated
reservations now
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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
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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
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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
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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
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Critical medical anthropology
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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
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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
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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
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Critical medical anthropology
 Critique of Western biomedical training
 Too much emphasis on technology
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Critical medical anthropology
 Critique of Western biomedical training
 Emphasis on “production” and “efficiency”
rather than human experience
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Critical medical anthropology
 Critique of Western biomedical training
 Why do students accept this model?
 Enculturation
 Physical hazing
 Cognitive retrogression
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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.
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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
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Globalization and Change
 Globalization a two way street
 Has vast effects on human health
 Spread of western biomedicine
 New infectious diseases
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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.
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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
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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
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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
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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
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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
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OCD

http://www.minddisorders.com/ObPs/Obsessive-compulsive-disorder.html
Copyright © Allyn & Bacon 2008
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/pri
ntable
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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/
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
Question #1

A(n) __________is a biological health
problem that is objective and
universal.
a)
b)
c)
d)
e)
Culture-specific syndrome
illness
disease
ethnomedicine
ethno-etiology
Copyright © Allyn & Bacon 2008
Question #2

__________is the study of crosscultural health systems.
a)
b)
c)
d)
e)
culture-specific syndrome
illness
disease
ethnomedicine
ethno-etiology
Copyright © Allyn & Bacon 2008
Question #3

Anorexia is an example of a(n)
____________.
a)
b)
c)
d)
e)
disease of development
culture specific syndrome
ethnoetiology
ethnomedicine
historical trauma
Copyright © Allyn & Bacon 2008
Question #4

Heart disease is an example of a(n)
____________.
a)
b)
c)
d)
e)
disease of development
culture specific syndrome
ethnoetiology
ethnomedicine
historical trauma
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
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
Copyright © Allyn & Bacon 2008
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)
b)
c)
d)
e)
personality
redistribution
enculturation
reciprocity
pronatalism
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Question #8

Which mode of production is typically
associated with low fertility rates?
a)
b)
c)
d)
e)
foraging
pastoralism
horticulture
agriculture
both A and D
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Question #9

__________ is biological and
something everybody is born with.
a)
b)
c)
d)
e)
gender
sex
dependent-dominant personality
nurturant-responsible personality
both A and B
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Question #10

An exchange of birthday presents
among peers is an example of
________.
a)
b)
c)
d)
e)
generalized reciprocity
unbalanced exchange
redistribution
gambling
expected reciprocity
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