Copyright © Allyn & Bacon 2008 Disease, Illness, and Healing (Miller – Chapter 5)

Copyright © Allyn & Bacon 2008

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


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) 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



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!


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


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



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

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


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



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


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


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



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



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


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

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 "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 =


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 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

Economic and political systems create health inequalities

Illness is more often a product of someone’s social position than “natural”

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


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 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=tru

e&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 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? How are disease, illness, and healing

changing during globalization?

Documents

Copyright © Allyn & Bacon 2008 Disease, Illness, and Healing (Miller – Chapter 5)