Filipino Concept of Health and Illness

HEALTH Kalusugan = “able-bodied” LUSOG Full development, progressiveness (in terms of vigorous physical development) -Panganiban Malusog vs. Payat (not necessarily meaning ill) * HEALTH – a combination of maturative processes or development in correspondence to the ability to function properly, to be active. * Being either PAYAT or TABA are not considered as healthy, but not necessarily ill.

Kamusta ka na? Mabuti naman. Eto, buhay pa. The tone of the response may insinuate that there may be underlying physical, psychological,or emotional problems * Therefore, HEALTH cannot be translated as a mere absence of fever, pain or even generalized feelings of malaise. It is also loaded with notions of social interactions.

Illness vs. Disease FRAKE Illness – a single instance of “being sick” Disease – a diagnostic category, a conceptual entity which classifies particular illnesses, symptoms or pathological components of illnesses or stages of illnesses IDLER Disease – an abstract biological- medical conception of pathological abnormalities in people’s bodies Illness – the human experiencing of disease

sakit In Philippine society, only one word exists to describe such phenomena – SAKIT The term sakit is closer to the meaning of illness than to disease In many cases, ailments or illnesses are culture-specific. ◦ Ex. Usug, Bangungot (Western: nightmare death syndrome) Although recent studies try to increase knowledge on these illnesses, it cannot be denied that there is still a void due to the inadequate attention given to such illnesses.

SAKIT = Pain Western medicine – pain as a symptom Filipino medicine – sakit = pain in several contexts (ex. sakit ng ulo, sakit ng tiyan) ◦ Sakit also has different degrees (ex. hapdi for a stinging type; kirot for a sharp, recurrent type; antak for internal, continuous stinging type) Sakit = illness ◦ Diagnosis involves the culmination of a process of observing signs and eliciting symptoms that are graded in terms of seriousness (often associated with level of physical activity one can still exert)

MAY SAKIT A normally strong person who suddenly feels weak is said to be have the beginnings of an illness. This weakness is close to the English term lethargic Persistence of lethargy, accompanied by other symptoms are monitored by family and friends but the term MAY SAKIT will only be used when the person is unable to perform physical tasks (common criterion: bed-ridden)

Filipinos on addressing illnesses 1. No matter what ailment, it is considered as mild/slight at first notice. Patient is rarely given treatment during this stage. 2. The gravity of the sickness will only be taken into notice when patient starts to suffer more and more. 3. If one complains of pain or great itching, this is the first stage of malaise. If symptom continues over a considerable period of time accompanied by the intensifying of the symptom, the patient and the family sees the sickness as serious.

4. If patient starts to stay in bed than continuing with his daily routine, this is considered as another stage of severity. 5. Filipinos consider CRYING as the surest indicator of severity This framework exhibits a common problem in the Philippines which is most exemplified by a mother who is shocked to find her child dead barely after a day she has recognized that her child was ill. This also shows the perception of Filipinos on illness. Illness, as exemplified by SAKIT, has many social dimensions – mainly in terms of using pre-defined “normal” social activity as a reference for diagnosis of illnesses

Attribution of illnesses by the Subanon 1. Pathogenic 2. Prodromal 3. Etiological 4. Symptomatic – the most effective and important

Medicalization by Western countries Some illnesses are more than just physical ◦ More health professionals are starting to recognize the important role of social relationships in determining health and disease “Syndrome” – slowly becoming a popular term in medical literature but still reflects the need to delimit the qualifiers used by the western-oriented medical system ◦ Some illnesses/ailments cannot and should not be immediately appropriated into biomedical or psychiatric pathology

Some physicians quickly label some problems as medical, when some are actually more philosophical in nature. ◦ Ex. A person pondering on the meaning of his/her life = depressive order = need for anti- depressants Few health professionals have the ability to see that some “problems” may actually be part of a healthy process of an individual’s mental, emotional, and social development Therefore, immediately attaching medical labels and treatment on such conditions may be detrimental as it medicalizes life’s processes

Theories of illness causation I. Mystical Theories a.Contagion/Pollution b.Mystical Retribution c.Fate d.Soul Loss II. Personalistic Theories a.Animate 1.Ghosts 2.Supernatural Entities b.Magical 1.Sorcerers 2.Witches III. Naturalistic theories a. Natural Phenomena b. Humoral Pathology c. Diet d. Infections e. Natural Processes f. Stress

MYSTICAL THEORIES Attribute illness to the automatic consequence of the victim’s acts and behavior

Mystical theories: Life-Stuff and Souls Embodies the concept of basic forces as being operational in illness and health, if not life itself Health and illness as natural consequences of good and evil behavior

1. Contagion “Contact with some purportedly polluting object, substance, or person” (Murdock) Animatism – belief in a metaphysical life force ◦ Some Phil. ethnic groups distinguish between a “life force” and the “soul.” - This “life force” is considered an attribute of health and also a potential cause of illness - A human being with a strong or potent life force would be perceived as a potential cause of illness, regardless of he/she has intentions of causing illness. Those with weak life forces are more susceptible to illnesses

2. Mystical retribution Filipinos believe that a violation of a taboo results in “punishment” by a supernatural being in the form of illness or other misfortune. Research has shown that most acts that violate a taboo and result to misfortunes may not necessarily have been caused by a “supernatural being.” Some believe that it is a natural consequence and is more closely related to social propriety than mystical retribution ◦ Best captured by karma

3. Fate Illness as ascribed to astrological influences, individual predestination, or personified ill luck Filipino = PALAD (palm of the hand) ◦ Palmistry (mostly in Mindanao) -> predicts one’s fate in life ◦ Sintas (the midline extending from the umbilicus to the chestbone) -> predicts one’s susceptibility to illnesses ◦ “Bahala na” attitude – manifestation of Filipinos’ passivity and resistance to change by leaving everything to the “will of God”

4. Soul loss Belief that a soul is capable of leaving the body temporarily and its prolonged absence may cause illness to the owner with death, as the permanent separation from the body. Different from “possessions” by spirits Ex. Ilongots – beteng (heart) may leave the body during sleep and may get used to the company of the dead – this leads to death ◦ Saving grace is knowledge, thus making infants more susceptible to this illness because they lack this knowledge ◦ Some believe that souls are companions (ex. belief that children have companion animals in Panay) ◦ Some believe that some souls feel compelled to free itself from the body (compulsive soul) – ex. bangungot

PERSONALISTIC THEORIES Attribute illnesses to the active intervention of sensate agents such as supernatural entities or malevolent human beings

Animate: Ghosts and other supernatural entities Ancestral spirits – most frequently cited illness-causing ghosts ◦ Illness is perceived as retribution from ancestral spirits for non-fulfillment of ritual obligations or violation of social norms Deceased traditional healers – may cause illness when calling on a descendant to take up his/her vocation Souls of unborn children – aborted children, unbaptized children ◦ Parents are punished with illnesses due to negligence

* Even “casual” encounters with ghosts, as in being greeted (nabati) can be a cause of illness Discontented souls- potential malevolence of ghosts may be determined by the character of the individual at the time of death - ghosts of suicide victims are believed to be the most dangerous. Supreme deity- is generally conceptualized as remote and detached from the human world, only occasionally inflicting illness as punishment for “sins”.

-Among Catholics, saints are believed to inflict illness as punishment for social transgressions, including non-fulfillment of ritual obligations. Environmental Spirits- They are generally perceived as benevolent and/or guardians for shamans and other traditional healers. -generally perceived as benevolent but others inflict harm only when provoked particularly by intrusions into their “territory.”

“ nabati, napaglaruan, nakatuwaan ng laman lupa ”– used to describe relationship bet humans and supernaturals, which results in illness - Once “enchanted”, illness can only be cured by the mananambal or the local shaman. * Perceived power of ghosts and supernatural entities is related to “social space”, to their distance from the human sphere.

MAGICAL BELIEFS: SORCERERS and WITCHES Magical theories are those “which ascribe illness to the covert action of an envious, affronted or malicious human being who employs magical means to injure his victims”. (Murdock) SORCERER- uses the technique of magic and derives his power from medicine WITCH- acts without rites and spells and uses hereditary psycho-psychical powers

Sorcery Kulam- most popular term Among tribal groups, sorcery is usually reported as the effort of the community to inflict illness on a common enemy Among Christians and Muslims, sorcery is often an individual affair usually spurred by revenge motives

Sorcerers use incantations and prayers, even incorporating ritual paraphernalia associated with the Catholic church. Imitative and contagious magical principles are used, such as hair of the intended victim and voodoo-like methods Barang- uses “pet” insects and other animals to poison the victim --the insects and animals are used not only to harm the victim but also to represent the sorcerer’s power Methods

Object Intrusion- sends objects into the victim’s body, ranging from fruits to insects and physical objects. - Persistent abdominal pain may be attributed to sorcery, with a ritual needed to remove the intrusive object Soul abduction- the sorcerers abducts the victim’s soul and cause illness “Possession”- a person may be possessed by the sorcerer or a malevolent spirit is sent to take over the victim

Some methods of sorcery may have empirical basis, particularly in the use of plant poisons. Sorcerers are usually known and accepted in their communities. They are perceived as having legitimate roles and their practices is socially sanctioned.

Witchcraft Seemed to be limited to Christian and Muslim groups: Aswang and balbal for Christainas and the balbalan for Muslims ASWANG- a man or woman possesing preternatural powers of locomotion and metamorphosis and an inhuman appetite for the voided phlegm sputum of the deathly sick, as well as the flesh and blood of the newly dead.

A person usually becomes an aswang by inheritance. Suspected aswangs are less sociable: they cannot look you in the eye, somewhat individualistic and have self reliance. They prefer not to seek advice for other people Witches are perceived to “enjoy everything precious in life”

Manananggal- believed to have a power of detaching the upper part of their body and to fly around The idea of the aswang being a “vampire” is probably of more recent vintage, a borrowing of western demonology The aswang belief operates as a form of social control. It discourages asocial attitudes such as secretiveness, solitariness, misanthropy and the like (Lynch)

NATURALISTIC THEORIES Attribute illnesses to impersonal natural forces or conditions such as cold, heat, winds, or an imbalance of the body’s elements

Naturalistic systems explain illness in impersonal, systemic terms. Disease is thought to stem… from such natural forces or conditions as cold, heat, winds, dampness, and above all, from an upset in the balance of the basic body elements. (Foster)

1. Natural phenomena Thunder and lightning – believed to be a cause of illness among Negrito groups ◦ Illness is not attributed to the phenomena itself but to a thunder god, who punishes humans for violations of taboos (mythological) Naturalistic – mixing two things that do not naturally belong together ◦ Ex. Mixing different fruits and vegetables in one basket (Negritos) Hangin – perceived as being sent by supernatural or human entities ◦ Different ethnic groups believe in “self-activated winds” (may cause respiratory problems, muscular pains, skin diseases) ◦ Each month has a predominant wind direction which causes illnesses

Singaw ng Lupa – vapors are harmful when it rains during particularly hot weather ◦ Contact between warm earth and rain = singaw = unnatural = discomfort and illness Seasons are associated with particular illnesses ◦ When it is relatively cool, sickness is not widespread except those that are deep in the body and in the advanced stage. When it is warm and humid, there is a general feeling of malaise and irritability ◦ Seasons of hunger (food supplies are out) = seasons of disease

2. Diet “You are what you eat.” a. Injunctions based on religion Ex. Islamic prohibition on pork consumption b. Deals with imitative magical principles – “like produces like or that an effect resembles its cause” (Frazer) Ex. Avoidance of slippery foods by pregnant women in the belief that this would cause the uterus to slip c. Those based on theories of humoral pathology Ex. Food items are classified into HOT and COLD Fruits (cold) are avoided in the morning, the coldest part of the day because it may intensify the cold condition which could result to diarrhea and respiratory problems

d. Other aspects - overeating - intoxicated (overeating of particular food) which could cause allergies or itchiness - indigestion (eating food that is hard to digest) – usually occur in young children - foods that are hiyang or compatible

3. Infections Refer to illnesses attributed to microorganisms such as bacteria and viruses KAGAW – pathogenic microorganisms (Tagalog) Mikrobyo – Filipinos are starting to become more germ-conscious due to the influence of media * The Germ theory may be recognized, not by overemphasizing it, but by incorporating it into more substantial health-maintenance practices.

4. Humoral pathology Illness is believed to be caused by a disturbance of the balance of forces within the body This theory is found mainly among Christian groups and is represented by the belief in the interactions between the hot and the cold. Hot/cold syndrome – known as pasma ; believed to be an attack of “cold” on someone who is too “hot” or vice-versa ◦ Ex. A person who has just finished exercising will be advised against bathing in cold water to avoid pasma ◦ Hot/cold theory is said to be both allopathic (mixing hot and cold), and homeopathic (adding hot with more hot)

5. Natural processes Blood is given much importance because it is distributed throughout the body and its loss is associated to weakness and death ◦ People with insomnia, anemia, and sickly = “thin” blood ◦ People with asthma, bile troubles, tuberculosis, and malaria = yellowish blood ◦ Bathing in the morning adds blood and in the evening lessens blood (low blood pressure) Other parts of the body are given labels as to “hot” or “cold” ◦ Illnesses are said to be caused by an imbalance between external hot and cold influences on the anatomical part ◦ Ex. The back (likod) is especially sensitive to cold and rains; while the abdominal region (tiyan) is sensitive to wind exposure = kabag

Displaced organs = illness ◦ Ex. Isabela – knotting up of intestines and resulting in colic ( hilot as the cure) ◦ Midwives massage the mother’s abdominal region (post-partum) in order to restore the uterus in its original position; failure to do so can lead to illness

6. stress Exposure of the victim to either physical or psychic strain such as overexertion, prolonged hunger or thirst, debilitating extremes of heat or cold, worry, fear, or the emotional disturbances which constitute the province of modern psychiatry. (Murdock) EX. Lubat – illness caused by a frightening experience especially being in contact with the dead Ugma – emotional disturbance due to fear of a person, object, animal, or situation Is related to the concepts of balance For example, when one has the “fright illness”, it is not attributed so much to fright itself. A new and unfamiliar environment disturbs the natural balance of a person’s body and psyche, and this disturbance becomes a source of stress.