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

2. 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?

3. Copyright © Allyn & Bacon 2008 Medical Anthropology  Medical anthropology is the cross- cultural study of health, disease, and illness and the care practices associated with these

4. Copyright © Allyn & Bacon 2008 Ethnomedicine  Ethnomedicine is the study of cross- cultural health systems  Includes the study of health systems everywhere, including in the West

5. Copyright © Allyn & Bacon 2008 Ethnomedicine  Key step in ethnomedical research is to learn how people label, characterize, and classify health problems  Categorizing differs depending on the culture

6. Copyright © Allyn & Bacon 2008 Disease/Illness Dichotomy  Disease refers to a biological health problem that is objective and universal  A bacterial or viral infection  A broken arm

7. Copyright © Allyn & Bacon 2008 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

8. Copyright © Allyn & Bacon 2008 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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10. 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

11. Copyright © Allyn & Bacon 2008 Anorexia

12. Copyright © Allyn & Bacon 2008 Culture Specific Syndrome  Other examples?  In the U.S. or anywhere else?

13. Copyright © Allyn & Bacon 2008 Culture Specific Syndrome  In the U.S or in the West.…  Gulf War syndrome

14. Copyright © Allyn & Bacon 2008 Culture Specific Syndrome  In the U.S or in the West.…  Alien abduction phenomenon

15. Copyright © Allyn & Bacon 2008 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

16. Copyright © Allyn & Bacon 2008 Ethno-etiology  Ethno-etiologies refers to cross- cultural 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

17. Copyright © Allyn & Bacon 2008 Ethno-etiology  Causes of disease can be attributed to natural/environmental, socioeconomic, psychological, or supernatural factors

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

20. Copyright © Allyn & Bacon 2008 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!

21. Copyright © Allyn & Bacon 2008 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

22. Copyright © Allyn & Bacon 2008 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

23. Copyright © Allyn & Bacon 2008 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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25. 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

26. Copyright © Allyn & Bacon 2008 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

27. Copyright © Allyn & Bacon 2008 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 http://www.bgci.org/files/Worldwide/Publications/PD Fs/medicinal.pdf

28. Copyright © Allyn & Bacon 2008 Healing Substances

29. Copyright © Allyn & Bacon 2008 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 http://www.saltworks.us/salt_info/si_DeadSeaSaltBathing. asp

30. Copyright © Allyn & Bacon 2008 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 http://www.radonmine.com/why.html

31. Copyright © Allyn & Bacon 2008 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

32. Copyright © Allyn & Bacon 2008 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 http://www.breastcancer.org/tre atment/comp_med/types/spiritu ality.jsp

33. Copyright © Allyn & Bacon 2008 Three Theoretical Approaches in Medical Anthropology  Ecological/epidemiological approach  Interpretivist approach  Critical medical anthropology

34. Copyright © Allyn & Bacon 2008 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

35. Copyright © Allyn & Bacon 2008 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

36. Copyright © Allyn & Bacon 2008 Colonialism, Death by Contact, and Displacement: The US before the Europeans

37. Copyright © Allyn & Bacon 2008 Native American designated reservations now

38. Copyright © Allyn & Bacon 2008 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

39. Copyright © Allyn & Bacon 2008 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

40. Copyright © Allyn & Bacon 2008 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

41. Copyright © Allyn & Bacon 2008 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

42. Copyright © Allyn & Bacon 2008 Critical medical anthropology

43. Copyright © Allyn & Bacon 2008 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

44. Copyright © Allyn & Bacon 2008 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

45. Copyright © Allyn & Bacon 2008 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

46. Copyright © Allyn & Bacon 2008 Critical medical anthropology  Critique of Western biomedical training  Too much emphasis on technology

47. Copyright © Allyn & Bacon 2008 Critical medical anthropology  Critique of Western biomedical training  Emphasis on “production” and “efficiency” rather than human experience

48. Copyright © Allyn & Bacon 2008 Critical medical anthropology  Critique of Western biomedical training  Why do students accept this model?  Enculturation  Physical hazing  Cognitive retrogression

49. Copyright © Allyn & Bacon 2008 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.

50. Copyright © Allyn & Bacon 2008 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

51. Copyright © Allyn & Bacon 2008 Globalization and Change  Globalization a two way street  Has vast effects on human health  Spread of western biomedicine  New infectious diseases

52. Copyright © Allyn & Bacon 2008 Globalization and Change  Old infectious diseases are still a problem, too  Malaria and tuberculosis are still leading killers in many 3 rd world countries  With globalization and migration these diseases are once again becoming a problem in the U.S.

53. Copyright © Allyn & Bacon 2008 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

54. Copyright © Allyn & Bacon 2008 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

55. Copyright © Allyn & Bacon 2008 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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57. 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

58. Copyright © Allyn & Bacon 2008 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

59. Copyright © Allyn & Bacon 2008 OCD ? http://www.minddisorders.com/Ob- Ps/Obsessive-compulsive-disorder.html http://www.minddisorders.com/Ob- Ps/Obsessive-compulsive-disorder.html

60. 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 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 http://recipes.howstuffworks.com/menus/sushi.htm/pri ntable

61. Copyright © Allyn & Bacon 2008 Other interesting websites  http://ethnomed.org/ 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/ http://www.ethnomedicine.org/

62. 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?

63. Copyright © Allyn & Bacon 2008 Question #1  A(n) __________is a biological health problem that is objective and universal. a)Culture-specific syndrome b)illness c)disease d)ethnomedicine e)ethno-etiology

64. Copyright © Allyn & Bacon 2008 Question #2  __________is the study of cross- cultural health systems. a)culture-specific syndrome b)illness c)disease d)ethnomedicine e)ethno-etiology

65. Copyright © Allyn & Bacon 2008 Question #3  Anorexia is an example of a(n) ____________. a)disease of development b)culture specific syndrome c)ethnoetiology d)ethnomedicine e)historical trauma

66. Copyright © Allyn & Bacon 2008 Question #4  Heart disease is an example of a(n) ____________. a)disease of development b)culture specific syndrome c)ethnoetiology d)ethnomedicine e)historical trauma

67. 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

68. 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

69. 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)personality b)redistribution c)enculturation d)reciprocity e)pronatalism

70. Copyright © Allyn & Bacon 2008 Question #8  Which mode of production is typically associated with low fertility rates? a)foraging b)pastoralism c)horticulture d)agriculture e)both A and D

71. Copyright © Allyn & Bacon 2008 Question #9  __________ is biological and something everybody is born with. a)gender b)sex c)dependent-dominant personality d)nurturant-responsible personality e)both A and B

72. Copyright © Allyn & Bacon 2008 Question #10  An exchange of birthday presents among peers is an example of ________. a)generalized reciprocity b)unbalanced exchange c)redistribution d)gambling e)expected reciprocity