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 • A health system encompasses many areas… • Perceptions and classifications of health problems • Prevention measures • Diagnosis • Healing (magical, religious, and scientific healing substances) • Healers

5. 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

6. 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

7. 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

8. 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

9. 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

11. 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!

12. 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

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

14. 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

15. 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

16. 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

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

19. 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

20. 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

21. 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

22. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

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

33. 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

34. 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

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

36. Native American designated reservations now

37. 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

38. 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

39. 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.

40. 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

41. 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

42. 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 =

43. 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.”

44. 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 individuals

45. 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

46. 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

47. 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

48. 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.

49. 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

50. 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