Anthropologists have demonstrated that all human cultures embrace a system of beliefs relating to the maintenance of health and illness causation, and concomitant therapeutic and preventive practices relating to these beliefs. In fact, most cultures have numerous and diverse therapeutic options. In this medical plurality, which option or options are chosen are determined by a complex “hierarchy of resort,” depending on such factors as cost, self-diagnosis, time, physical as well as cultural accessibility, and the like. Clearly, the preceding is a brief summary of an extraordinarily complex and dynamic process.
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Yet maintaining awareness of these factors while interacting with individuals, families, and populations leads to a more complete understanding of people than simply characterization as a member of a particular culture illness and disease may be universal, the definition of health, and the interpretation of symptoms, and remedies and treatments to promote and restore health are very much culturally defined. Sensitizing healthcare professionals to these cultural differences is the main goal of this book. Cultural competence is the ability to “perform and obtain positive clinical outcomes in cross-cultural encounters”. Within this broad definition, there are two related sets of competencies (Kleinman, 1982)
‘Culture’ is often used to refer to the high art that is enjoyed by a happy few. As expressed by Adam Kuper, high culture can be represented as an instrument of domination” (2000: 4), and furthermore culture is always defined in opposition to something else” (2000: 14). I agree with Kuper when he states that, “modern theories about culture recycle earlier ones” (Kuper 2000: 245). Accordingly, I view ‘culture’ as a form of collectively shared and socially acquired consciousnesses that are transferred and preserved through communication. This way to conceptualize culture is often observed in anthropological studies of different medical systems, where relations between medicines and cultures are in focus.
In his study of Chinese patients, for example, he found that patients talked about experiences of illness by relating these to classical symbolic associations from the popular culture. In the classical Chinese medical system the term ‘sourness’, which was used by patients when talking about pain in the body, was also related to one phase of the hepatic functional system of the body. The symbolic meaning of illness was particularly in focus among the medical anthropologists of the 1970s who participated in the creation of what has been referred to as interpretive anthropology (Leslie 2001: 430). This perspective (which I will discuss in the next chapter) places the relation of culture and illness at the center of analytic interest and understands cultures as systems of meanings. But first, let me make a brief presentation of medical anthropology.
Medical anthropology is unavoidably concerned with, or perhaps even trapped within, the paradigm of modern Western medicine whether explicitly or implicitly. However, it is not derived from medicine, as one might assume, but from social anthropology in the USA and Great Britain where it emerged as a special field of research and training following World War II. Its roots are to be found in the long-standing interest in shamanism and other forms of ritual acting as well as in the psychological anthropology of the 1940s and 1950s with its interest in culture-bound syndromes, personality variation, and mental illness (Leslie 2001: 430). Another stimulus for the development of medical anthropology came from applied anthropology and health projects among indigenous people in Latin America, Asia, Africa, and the United States
Medical anthropologists are especially interested in the relations between illness, medicine, and human culture. Many of these anthropologists have shown that illness theories cannot be understood without an understanding of particular cultures and social structures. Lisbeth Sachs, writing about medical anthropology, points to an interconnection between the person and the society (1987). She suggests that illnesses can be seen as signals of conflicts in the individual’s interpersonal relations, or as signals of contradictions in the cultures.
Medical anthropology can be shortly defined as that branch of anthropological research that deals with the factors that cause maintain or contribute to disease or illness, and the strategies and practices that different human communities have developed in order to respond to disease and illness. Medical anthropology is a sub-branch of anthropology that is concerned with the application of anthropological and social science theories and methods to questions about health, illness, and healing. Some medical anthropologists are trained primarily in anthropology as their main discipline, while others have studied anthropology after training and working in health or related professions such as medicine, nursing, or psychology.
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Medical anthropologists conduct research in settings as diverse as rural villages and urban hospitals and clinics. Medicine, health, and illness are all partly cultural categories and different cultures have their own logic and alternative means to deal with these. Medical anthropology looks at cultural conceptions of the body, health, and illness. It also focuses on health behavior as a way to learn about social values and social relations. Medical anthropology is the study of ethnomedicine; explanation of illness and disease; what causes illness; the evaluation of health, illness, and cure from both an emic and ethic point of view; naturalistic and personalistic explanation, evil eye, magic, and sorcery; biocultural and political study of health ecology; types of medical systems; development of systems of medical knowledge and health care and patient-practitioner relationships; political-economic studies of health ideologies and integrating alternative medical systems in culturally diverse environments.
Ethnomedicine is the study of ethnography of health and healing behavior in various societies. Ethno medicine also refers to the study of traditional medical practice. It encompasses methods of diagnosis and treatment. Ethno medical studies are conducted to evaluate the efficacy of traditional health care practices; the prevalence of illnesses and the distribution of knowledge about illness attributes; the negotiations and instantiation of illness identities; the power of discourse to produce as well as cure affliction; discourse as moral commentary; linkages between medico-religious institutions, models of self, power and the state. Pioneering theoretical classic-Medicine, Magic and Religion defined medicine as a cultural system.
Others maintain that it is a distinct area of its own lying somewhere between the disciplines of medicine and anthropology. There have been multiple ways to approach the concept of illness, as for example through medical ecology or social epidemiology, but for my purpose, the ethnomedical model is the most useful as it is based on individuals’ own ideas about illness and treatment. In what follows, I will introduce the term ‘medical pluralism’ and show how it has been used in ethnomedical contexts. I will also reflect on the problems of incorporating alternative medicine into a dominant medical system. I am aware of the problematic notion of the ‘medical system’ especially when it is understood as a product of categorization and ordering integral to modernization and globalization (this has also been pointed out by Lisbeth). Using the term in this sense runs the risk of assuming that all other medicines in their original form will shortly die out. The goal in many countries is hence to incorporate some aspects of local medicines and create a standardized medical system that can relieve all human suffering and distress. However nowhere has such a vision been realized and in reality, pluralism and complementarity are the norms
Anthropological approaches broaden and deepen our understanding of the finding that high levels of socioeconomic inequality correlate with worsened health outcomes across an entire society. Social scientists have debated whether such societies are unhealthy because of diminished social cohesion, psychobiological pathways, or the material environment. Anthropologists have questioned these mechanisms, emphasizing that fine-grained ethnographic studies reveal that social cohesion is locally and historically produced; psychobiological pathways involve complex, longitudinal biosocial dynamics suggesting causation cannot be viewed in purely biological terms; and material factors in health care need to be firmly situated within a broad geopolitical analysis(Kleinman, 1982)
As a result, anthropological scholarship argues that this finding should be understood within a theoretical framework that avoids the pitfalls of methodological individualism, assumed universalism, and unidirectional causation. Rather, affliction must be understood as the embodiment of social hierarchy, a form of violence that for modern bodies is increasingly sublimated into differential disease rates and can be measured in terms of variances in morbidity and mortality between social groups. Ethnographies on the terrain of this neoliberal global health economy suggest that the violence of this inequality will continue to spiral as the exclusion of poorer societies from the global economy worsens their health—and illness poverty trap that, with few exceptions, has been greeted by a culture of indifference that is the hallmark of situations of extreme violence and terror. Studies of commodities and biomarkers index the processes by which those who are less well off-trade in their long-term health for short-term gain, to the benefit of the long-term health of better-off individuals. Paradoxically, new biomedical technologies have served to heighten the commodification of the body, driving this trade in biological futures as well as organs and body parts(Kleinman, 1982)
Adam Kuper 2004 (Eds.). Medical Anthropology. The Hague: Mouton.
Kleinman, A. and T. Lin, T. (Eds.) 1982. Culture and medicine. Dordecht,Holland: Reidel.
Lisbeth sach 1984. “Medical Anthropology: A critical appraisal” New York: Gordon and Breach.