ANTH-250 Medical Anthropology

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Medical Anthropology Brent Austin Dibble

Medical Anthropology Study

Guide Fall 2009

TERMS

Health Belief Syste! complex & coherent systems of thought, action, & content & knowledge& belief

• Depicts the nature of health, the nature of illness, & the role of healer

Ethnography: graphing of a people; study of a people; methodology to proide descriptions ofhuman societies, which as a methodology does not prescribe to any particular method, but prescribes the nature of the study;

• !ield "tudy• #elies on participant$obseration

Field"or# : going to the site of study for the collection of raw data

$ifferent Types of field sites! hospitals; healer%s home; forest as site of trance possession;clinics; medical offices

%articipant &'ser(ation: becoming an actie participant rather than simply an obserer in order

to reduce the cultural distance between oneself & the host society

• physically & emotionally participating in the social interaction of another society on adaily basis in order to learn about its culture

o usually reuires liing within the community as a member, learning the language,establishing close friendship ties, eating what they eat, & taking part in normalfamily actiities

• 'st person accounts

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o (ollaboration between the anthropologist & informant

Sei)structured inter(ie"s! open$ended uestions; not too strict

*ife histories+ life course! comprehensie biographic account

,llness narrati(es! work of narration; how you describe what happened to you; humans makesense of eents; organi)ed in particular ways

• rounds out cultural knowledge that is usually unspoken

• speaks to alues about life in general & what a good life means• used to acuire social identities & self understanding

Rapport! relation or connection; characteristic of unconscious human interaction; commonalityof perspectie

,nforant! someone who is not only knowledgeable about his*her own culture but who is able

& willing to communicate this knowledge in an understandable way to an anthropologist oroutsider

Applied Anthropology! branch of anthropology oriented towards using anthropologicalknowledge for practical purposes

• how do you use knowledge to improe life• social +ustice

Holistic+ conte-tual approach! ery detailed; encompasses the whole story-

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Rapid Ethnographic Assessent! learning about the culture of another society throughfieldwork & first hand obseration

• a way to uickly moe from community based research to interention shaped by thecultural knowledge obtained

• !ocus groups• /uick$intercept interiews• (oncentrated field obserations• "ocial mapping

Allopathic Medicine! conentional biomedicine; standard clinical medicine

• 011 yr old approach to a professional, secular, & scientific institution• Most alued & legitimate in 2estern tradition

&rthodo-! strict accordance to the rules; conentional

.northodo-! non$conentional

Standard/ &fficial/ ational! recogni)ed as the norm

.ncon(entional/ 1ernacular/ *ocal or Regional! not recogni)ed as the norm; what people

actually do

Bio)edical! obsered processes

linical! suggests an enironment

,nducti(e & Epirical! scientific; based on facts

$educti(e & Metaphysical! connection between factors like hot food & feer

oodification of therapeutic product: healing techniues*products can be bought & sold;used by people in other cultures

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• 4xample: sweat lodge in 5"

3Medicine3 is a process and product! commodification of the therapeutic product; no attentionis gien to the performance, only the results; from first set of power point notes

3Ethnography3 is a process and product!

Traditional E-pressi(e Fors/Fol#lore)Sta'le or $ynaic4!

%ro'le "ith 3ite centered3 or 3e-tracti(e3 approach!

E(olutionary approach! societies pass through a an orderly seuence of deelopmental phasesto go from the most 6primitie6 forms to the most 6ciili)ed6 forms; primitie are understood to be less socially, educationally , and technically sophisticated; cultural eolutionism as a theory of culture is not generally academically discredited on grounds of gross oersimplification and,worse, or parentalism and ethnocentric bias; the assumption is that the lower status is the more

primitie, local, ernacular forms 78ealing 9raditions (hapter .

Sur(i(al! eerything that stays with the folklore group today; 6trickle down theory6 7this is from8ealing 9raditions (hapter . and the ui) that was on it add to it<

Roantic Fol# ,deal!

5hy do fol# health practices sur(i(e4!

Therapeutic Actions!

Materia Medica! 9he 6pharmacology6 of a gien health belief system

E-perts! Training+ ertification+ E(aluation+ Reputation+ %ayent for Ser(ices!

Syste)onsistent responses to changing situations!

Syste *ogic!

E-aples of Health Belief Systes+ Types of ore oncepts a'out health and illness!

5hat does a patient)centered or counity)centered approach gi(e us that "e ight iss'y studying health care e-perts4! By studying health care experts alone, you lose a ma+or partof the narratie Medical experts freuently attend solely to the disease without caring for theindiidual experiencing it 9he expert is not so much focused on 6healing the entire person6 as heis on 6defeating*killing6 the disease 4x: =atient>s body is the +ust the battleground on which thewar between doctor and disease is played out

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3order of resort3))eaning and criti6ue! At what point do people turn to alternatie forms ofmedicine for treatment< (ontrary to popular belief, people will turn oftentimes employ bothalternatie and biomedical practices at the same time ?n our 2estern society, patients +ust knowto exclude mentioning the alternatie therapies they are seeking when talking to a biomedicalexpert

%&SS,B*E ESSA7 T&%,S

• 8ealth Belief "ystems• 8ealth #isk• "ocio$4conomic Access to 8ealth (are• Biomedical s @ernacular• =atient =erspectie: might not see clear cut distinctions between systems• ?llness and Disease: who defines them• (ulture Bound•

ender of a patient affecting access*type of health care• #eligion

HER *ET.RE %&5ER%&,TS

#obert A 8ahn

"ickness and 8ealing: An Anthropological =erspectie-

ale 5niersity =ress, 'CC

8is opening uotation is:

At its best anthropology has always been subersie By describing different social, cultural,and psychological arrangements, it challenges commonly accepted ways of perceiing,articulating, and understanding the world- (rapan)ano 'CC1

E Although we recogni)e that our medicine is imperfect in detail, we presume that itsunderlying principles are correct

E 8e looks for familiarity in the exotic and the exotic in the familiar

E Anthropologists must take seriously the new- forms of sickness they encounter inforeign settings




8ahn%s formulation of the problem of medical anthropology

A medical anthropologist raised in a culture that is saturated with the principles of biomedicinehas two aailable strategies for coping with different frameworks:

Arrange the unierse of sickness- into a hierarchical scheme:

9he basic iews of biomedicine are superior and other ideas are distorted or simplified

Fikewise

9he experts of biomedicine are masters and patients and practitioners of other types of medicine

hae simpler, less alid training

Gr

#esearchers aim to show local medical reality- on its own terms, assuming that local,indigenous explanations of the world of sickness and healing are alid

But

9his relatiism may minimi)e, ignore, or een implicitly deny uniersal biological and pathological realities 7as formulated in their own culture

E 9he first is ethnocentric- our way or the highway-

E 9he second could be called Henocentric- assuming that others hae the truth in their own setting

8ahn argues that both are false $$ +ust because a system of thought exists doesn%t mean it is right,an obserer always has a culture which may affect research

8ow can alid obserations be made at all<

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E ?f we agree that science constructs its own ob+ects, then how can we do research<

E Gur obserational framework must be explicit, rational, and consistent as possible and yetat the same time be receptie to the alternatie truths of other cultural frameworks

E ?f we come from a cultural setting with a biomedical framework, then we must first explainwhat the biomedical framework is

E 7although we may hae personal access to frameworks distinct from biomedicine, none ofus in the room is outside- of that framework

9he culture of a society has:

E (ultural systems 7science, religion, economics, medicine, etc

E 4ach of these has:

J A domain: what the system is about, what it includes, its goals, alues, techniues, knowledge

J "ociali)ation: how these are taught

J An arena: where the actiities are carried out, and designated roles

"ickness- or ?llness-

E An unwanted condition in one%s person or self $$ one%s mind, body, or connection to theworld

E ?n 2estern medicine, an indiidual has an illness $$ many other cultures hae a morecommunal, tribal, familial, etc concept of illness

E ?f a person is not working well in the world- 7howeer that is defined by self or society,whether this is noticed by the self or by others then they can be said to be sick

E 9his is not the biomedical framework, in which the physician determines illness,independently and sometimes contrary to the patient%s +udgment

8ealing

E 9he restoration of the prior healthy state

E 9he rehabilitation, compensation for loss of health

E =alliation $$ the mitigation of the suffering of the sick

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E ?t may inole healers, the patient, non$experts, and the physical enironment

?ntroduction to Medical Anthropology

Dr "ylia 2 Lnder

!all .11C

(lass 3

G%(onnor, Bonnie Blair (hapter ' Defining and 5nderstanding 8ealth Belief "ystems-

Definitions or ?@4": contain the eidence for their truth in the assertions themseles

9hey are not proable- but they can be used to support things deried from them

(an you think of examples<

Most 8ealth Belief "ystems recogni)e both physical and psychological*spiritual causes

=hysical: broken bones, rashes, upset stomachs, headaches, feers, aches, tumors, pustules,sei)ures, fainting

on$physical: stress, fear, depression, mania, anger, spiritual angst, possession, loneliness

But most systems recogni)e combinations:

(omparing 8ealth Belief "ystems

Difficult because the ery ?@4" may be different and the means to proe truths may be

different as well

Gne system may only accept reproducible laboratory test results as proof

Another system may prefer testimony from those healed as proof

7and one indiidual may like to hae both

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Daid 8ufford

2hat experience did this scholar hae that caused him to be interested in experience$centerednarraties<

(ommon assumption among members of the scientific and related academic traditions thatpatterns of thought that reach fundamentally different conclusions from those of modern sciencemust be, by definition, illogical, irrational, or een nonempirical- 7'CNN

But a system is by definition logical, if the axioms hae been deduced from the basic principles

Also, it is a problem to use the alternatie logic- model $$ they +ust think differently-

scientific- is not only a method of research, it is taken to be better, more reliable $$ and theflipside is that nonscientific- implies unreliability, inferiority

"cience is the main moral support of our way of life, and systems that include nonscientific-elements, like religions, are considered inferior or completely false

8ufford sees a tradition of disbelief- 7in the supernatural among the academic and scientific set

4olutionist and "urialist Assumptions

E 2ith education, they will learn to think like us

E Because of isolation, poerty, lack of mainstream skills in language, mental imbalance ordesperations $$ some people still- use old fashioned methods that surie in remote pockets ofhumanity

E 4en if poerty may reduce access to biomedical treatments, poor people often marshalimmense resources for treatments $$ it is possible that other factors than money may be at workin health care choices

E (hoice of a chiropractor for back pain or a folk healer for soul loss does not necessarilyimply a re+ection of mainstream medicine in its entirety

E All systems are concerned with timely treatment and may see insistence on the use of biomedicine for such problems as a waste of precious time

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E 5se of oer$the$counter medications is G9 +ust a strategy of those who cannot afford adoctor%s adice, it is heaily used by mainstream and affluent groups

E =atients with illnesses do G9 +ust go to alternatie medicine when other techniues fail $$they often start in ery early phases

E 8oweer, researchers may miss much of the data because of not asking the rightrange of uestions 7leaing out religion, for example and ? would argue that mainstream populations know how to please- medical researchers by leaing out certain facts

#omanucci$#oss

E hierarchy of resort- 'CIC, falls into +udgment of which is better and does not leae roomfor simultaneous usage

E G%(onnor likes order of resort- in a case$by$case basis to record what treatment is usedfirst, second, etc in any one particular case

2hy study Biomedicine<

E ?s it cultural<

E ?s it historical<

E ?s it a belief system<

E Does 8ealth (are matter in politics<

ood, Byron O (hapter 3 8ow medicine constructs its ob+ects- in his Medicine, rationality,and experience: An anthropological perspectie (ambridge 5niersity =ress, 'CC0*.113

E 2hat is the sub+ect of ood%s research< ?s his approach scientifically alid<

2hat is the empiricist paradigm<

empiricist paradigm

E 9hat the primary unit for analysis should be diseases or physiological processes that areexternal categories of more or less uniersal reference-

E 8is study: 8ow are medical specialists taught this paradigm< 8ow does this paradigmshape health care practices<

!oucault

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E !rench philosopher who examined how medical discourse has changed through history andhas shaped*formed the ob+ects of its study

E ood finds that !oucault is interested in the body only as the ob+ect of social and medical practices, not as a site of experience and understanding-

"cience*Medicine

E 8as taken the place of religion as the central organi)ing truth about the world

E 9his means that medicine and science hold the moral weight that religion does in manysocieties

E 9he indoctrination into medicine is only for a few, who must learn to inhabit a newworld- and then gain the prestige of the highest moral order 7in contrast, wealthy bond tradersand (4Gs get money and status but are rarely accorded moral authority

9he 8arard Medical "chool

E !irst two years spent on biomedical sciences $$ from the molecular to the organismic leel;pre$clinical-

E 4ntering the Body- $$ the interior of the human body as a new frontier, a whole new world,a world to be taken apart, examined in detail, cut, sliced, dissected

Biochemistry as a foreign language

E 8uge amount of ocabulary

E Fearning to see differently, to be able to distinguish things that look the same to theuntrained eye 7like knowing the names of trees makes you see differences between them, or the4skimo ocabulary for snow

E As science adances, we can see- with more detail, and we inest in better tools forseeing-

9he =latonic iew of the cosmos

9he small is a microcosm of a larger whole, the chain of being leads from the smallest to thelargest and most diine

9he Biomedical iew of the cosmos

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Medical classroom slides $$ start with the isible and increase the magnification, the chain of being leads down to the miniscule, more material $$ if we can%t go smaller now, we will find away in time 7and the deepest leels are not social or diine, +ust material

2hat is more central to health in the biomedical model:

E enetics or poerty<

E "ocial disruption in forced migration or epidemic<

E 2ar trauma or artificial limbs<

E Date rape or "exually transmitted disease<

E Anxiety or cancer<

E "elf$esteem or feer<

After seeing, write$ups and case presentations

E Fanguage learning, style

E Being in the lime$light-

E =erformance

J 9he most important performance is G9 to be +udged by the patient, but by the other medicalspecialists

Medical school as a total enironment, and embodied experience of sleep$depriation, being cutoff from the outside world, a hierarchy of power, learning to act without uestioning the big picture

soteriological

E Medicine is moral, not +ust physical, rational, technical

E Medical practitioners hae a passion- for helping other humans

E Medicine is an intense way of interacting, physically with the world, with other humans

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E Gur moral debates about life, from the fetus to grandma on ice- are couched in medicalterminology

2hat is 8ealth<-

Difference between experiential health- and functional health-

Disease: a natural entity that makes symptoms that can be diagnosed

?nternational (lassification of Disease ?(D $$ CCC distinct conditions 7is this a magical number<

?llness, in contrast, is a cultural construction that can be identified through narratie and treated

through culturally$appropriate methods

But, both disease and illness are cultural constructions $$ one is defined by healers 7powerful biomedical experts $$ who get to say what is real- and one is defined by patients and theirnetworks 7who are assumed to be culture$bound and lacking in real knowledge

And, they may disagree with each other

Biomedicine uses the placebo effect- as a catch$all phrase for what happens when heterodox orfolk medicine leads to cure

9hree human responses to in+ury or sickness:

J Autonomous response $$ all organisms work to regain health, immune system, etc

J "pecific response $$ of the body to treatment

J Meaning responses $$ psychological and physiological effects of meaning 7integrating theexperience so that it makes sense

8umoral systems

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E Ancient reek concept of organs and bodily fluids as an internal cosmology parallel to theexternal world

E =hlegm, yellow bile, black bile, blood

E Air, water, earth, fire

E !oods can be grouped as to their effects on the body and used as medicine if imbalanceoccurs

E =urging, blood$letting, fasting, etc to regain balance

9he body and family relations J are family members connected through blood< Mother%s milk<Gther ways<

"ufferer 4xperiences

"ufferer arratie

E ?%m a surior-

E ?%ll +ust hae to gie up-

E ? always had to swallow frogs-

E 8?@ was a wake$up call from od-

E Maternal responses to infant mortality in a Bra)ilian "lum 7ancy "cheper$8ughes, 'CC.

"ocial "uffering

E Finking indiidual suffering with broader social eents like war, political repression,terrorism, forced sterili)ation, etc

8ow can indiiduals, communities, and whole societies*nations*region recoer balance<

Disability

E "tigmati)ation

"mokers desere lung cancer-

2ar @eterans are dangerous*cra)y-

A?D" patients got what was coming to them because of their immorality-

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E onstigmati)ation

(ultural rewards for certain disabilities:

"tatus for blind, who can see the unseen-, parking spaces for handicapped*pregnant*elderly

"pecial Glympics

AAA and 8uman #ights

E Melille 8erskoits writing for the 5nited ations in 'C0K

E Anthropology cannot make a uniersal declaration because:

J 9he conception of rights and morality ary considerably cross$culturally

J As a science of culture, anthro doesn%t make normatie +udgments

J A uniersal declaration can be used to sanction a society that is acting within its own moralsystem

AAA in 'CCC

E Anthro as a profession is committed to the promotion and protection of the right of peopleand peoples eerywhere to the full reali)ation of their humanity, which is to say their capacity for culture

collectie and indiidual rights

cultural, social, and economic deelopment

clean and safe enironment

?llness arraties

9he work of narration

J 8umans make sense of eents

J #ounds out cultural knowledge that is usually unspoken

J "peak to alues about life in general, and what a good life means

J 5sed to acuire social identities and self$understandings 7AA meetings

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9he new field of arratie Medicine

Analy)ing arratie

9hree kinds of stories

#estitution arratie: stories of illness followed by recoery $$ proiding hope

(haos stories: filled with the uncertainty, confusion, fear, powerlessness in the face ofillness

/uest arraties: illness transforms a person and leads to new understandings

5sing narraties to gain insight to sufferer%s culture to proide better care

"torytelling

8ow does a medical student learn to tell stories<

Do patients hae to be story$tellers<

2ho has the power to tell the story of an illness<

4mbodied 4xperience

E 9he body itself is culturally constructed

E 8ow is the body ulnerable<

E Body image: ood and Bad

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Mindful Bodies

9he indiidual body

9he social body

9he Body politic- 7!oucault againP

E !asting during the Muslim month of #amadan

E 9he exhilaration of running long distances

E =ulling an all$nighter

E (ontrolling food intake through bulimic practices

Medicali)ation

E A condition that had no medical label gains one $$ in a culture that alues medicine, thiscan reduce the stigma of a problem: Attention Deficit Disorder, 8ysteria, (hronic !atigue"yndrome

E Medical terms change oer time: D"M$??? code 31.1 homosexuality- becomes D"M$???

4go distopic homosexuality- when unwanted and accompanied by heterosexual desires-

E Medicali)ation suggests that medical treatment is the best or only way to treat it

Miscommunications

E (ompliance is not a one$way street

E =hysicians do not behae in a uniform fashion, clinical decisions can be arbitrary

E ew research shows the power of patient self$assessment as a predictor

E 5sing the same word for a different concept

E Dis+unction between disease and illness $$ silent killers, psychosomatic problems

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E 8ow interactions with the medical sphere can be the source of misinformation 7oral testingfor 8?@ leading to the idea that the mouth is a common site for transmission

9rance

Altered "tates

Dissociatie state

4cstasy* 4nthusiasm

Mystic state

9rance$inducers

5nintentional

9emporary lobe sei)ures 7epilepsy

"udden fright

=rolonged fear

?ntense pain

?ntentional:

=sychoactie substances, meditation, rhythm

"ensory depriation, austerities, hypnosis, ritual inoling sensory oerload $$ drumming,dancing, crowds, hyperentilation, expectation of trance

Difference between @ision trance and =ossession trance

"haman controls own trance, often producing music or rhythm the entire time

5ses of 9rance 7!unctional approach:

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"ocial stress

?llness

4xpression of feelings in situation of oppression

Fimits of Faboratory studies

4xamples of how language and metaphor are used in health belief systems J what cultural aluesdo they express and how does this shape health care<

-the war on cancer,- -magic bullets,- siler bullets,- the therapeutic

armamentarium,- agents of disease,- the body%s defences,- and doctor%s

orders-

REA$,G &TES

8The .ni(erse of Sic#ness 78ahn

4ach eent of sickness is uniue to singular bodies, culture, historical position, circumstances

!orms of sickness that may hae labels in other societies but not in our own:

• "usto: loss of soul• Amok: iolent, homicidal outbursts• =ora$keri dohari: breech positioned baby

"ickness: condition unwanted by its bearer

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• osology: classification of the forms of sicknesso 4lement of a broader medical system & broader total culture$ a society%s system

of ideas, alues, & ways of doing things• ?f sickness is a matter of unwanted conditions of self, then the patient%s story retains a

central defining role because the story is an account of which conditions are wanted and

unwantedo "ickness is determined by the selfo !unctioning self is a prereuisite for self knowledge of sickness

• ?n non$2estern setting, sickness is connected to religious forces & social relationships orinterpersonal conflict

Maladies: dierse eils that hae in common that no one wants them

"ubanun: pagan population

• o designated healers• =atients use their own knowledge & that of neighbors• (onditions distinguished based upon symptoms, causal agents, symptoms before the

sickness, personal etiology• Botanical medicines• od effect cure

dembu: tribal people of Qambia

• Fogical on the basis of mystical premises• atural distinguished from supernatural on the basis of symptoms• "ickness R blackness; health R whiteness• Manipulation of substance representing the disease produces parallel effect on the

disease; #emedy works through mimicry

Biomedicine: western tradition

• Assumed to be rational, systematic, empirical, inductie or deductie logic

S8ow we think of sickness & the different kinds of sickness shapes our response, diagnosis, &treatment

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#ealist: phenomena labeled by words share essential properties, those that allow us to properlycall these things by the gien word & to distinguish these things from others

ominalists: words are arbitrary & conentional labels for collections of ob+ects that hae nocommon essence

(haracteristics chosen to distinguish among specific sicknesses are arbitrary & ary amongsocieties & historical periods

• (hoosing different characteristics might lead to different groupings of sickness eents

Accounts of sickness

• 4xplain the who, what, where, when, & why of sickness

• 4lements of larger cultural systems that assumes the world consists of certain kinds ofthings & forces & the sources & means of knowledge

• May play a role in the causation of eents of sicknesso =lacebo phenomenon

• Disease Accounts: focus on the body• ?llness Accounts: focus on person & social enironment•

Disorder Accounts: source & locus of sickness in the unierse at large

"ickness experience: flow of sensations, beliefs, attitudes, & emotions that contribute to people%sconsciousness that something is wrong & undesirable in themseles

(auses of "ickness:

• ecessary cause: must be present in order for the sickness to occur• "ufficient cause: makes the occurrence of sickness ineitable

(ultures may share many goals of medical practices but other goals may differ

• ood Buddhist seeks generali)ed hopelessness for which the 2esterner seeks treatment

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"tandards of truth may differ from one system to another, so that comparison is difficult

9he efficacy of an interention may be powerfully affected by cultural setting

All cultural systems of belief are at best approximations of the truth

Biomedical hierarchy of patient & healer is turned up$side down

• 2hile biological disease processes may play a role in the causation of sickness, it is theunwantedness of sickness by its patients that is primary & that dictates what is to becausally explained & therapeutically encountered

• 9he soul of sickness is closer to the self than to the cell• Moe in opposite direction so that pathology is marked not by smaller & smaller units of

obseration but by the mind, human relations & society, & the broader enironment

8ulture Bound Syndroes .n'ound 78ahn

?dea of culture bound syndromes is a conceptual mistake, confusing rather than clarifying ourunderstanding of the role of culture in sickness & fostering a false dichotomy of eents & thedisciplines in which they are studied

• !orm of reductionism: the explanation of a gien phenomenon by a single principle or body of knowledge

"yndrome: group of conditions, generally pathological that may be physical and*or mental, signsand*or symptoms, & that is thought to constitute a discrete entity

• 9he more culturally specific details a syndrome includes, the more likely it is to be aculture bound syndrome

(ulture: set of beliefs, rules of behaior, & customary behaiors maintained, practices, &transmitted in a gien society

(ulture Bound "yndromes

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• ?f particular cultural conditions are necessary for the occurrence of that syndrome• (onditions that don%t fit the nosological scheme of a 2estern obserer

o #ather than uestioning the completeness of alidity of the 2estern nosology, thenew syndrome is set apart as an oddity from another culture

• #esult from social factors not biological

• Association with illness behaior which is always culturally determined rather thandisease which is uniersal & biologically determined

• ?nclusionist perspectieso ature$culture continuum: all human eents hae cultural & biological &

cognitie & psychodynamic aspectso Multiple aspect: human conditions are eually biological & cultural & social,

cognitie, psychologic, & psychodynamic; all syndromes are eually culture bound

• 4xclusionist =erspectie: a condition that falls into one half of the diide as culture boundimplies that it does not fall in the other as culture free

Henocentric: positing that what other people beliee about their circumstances fully accounts forthese circumstances

• But many differing & inconsistent beliefs exist in eery society• ?f local phenomena & labels for them can be understood only in terms of other local

phenomena & their labels then research across localities becomes impossible

The 5oan in the Body ,ntro+ :+ ; < 7Martin

(oncepts of reproductie biology are permeated with cultural stereotypes

• "perm as irile & aggressie strongly thrusting into the deepest recesses of the femalereproductie tract

• Accolade for uantity & continuity of reproduction• !emale oulation is cyclic with period of infertility 7loses to males failure produced in

menstrual fluids

o 2hat about the concept of flexibly ad+usting, constantly changing body

?mportant to reeal the underlying cultural assumptions in scientific isions of the body, toclarify the complex ways scientific discoeries lead to new cultural understandings of life & personhood, & to document ways the bodies of women & men are ineitably entangled inoperations of power

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(oncerned with the social production of knowledge

• 4xplored current medical ideas by focusing on the texts that are the basis of teaching in

medical schools & handbooks that are guides to practice in hospitals• Does not hae the same kind of rich interiew material for doctors that she has for

ordinary women

=eople do not notice contradictions in their own society

• 9hat women%s responses were so obious to Martin is a way of saying that she felt asmuch at home hearing them as a fish is in water As an anthropologist her problem washow to find a antage point from which to see the water she had lied in all her life

• Medical culture has a powerful system of sociali)ation which exacts conformity as the price of participation ?t also has a cultural system whose ideas & practices perade popular culture & in which we all participate to some degree

2estern thought & medicine, body came to be regarded as a machine

• 5terus as a machine plus the use of actual mechanical deices 7forceps used by malehands

o 9echnology & machinery can be used to control those who labor• 2oman%s body is the machine & the doctor is the mechanic or technician who fixes it• =roduction metaphor: Doctor as superisor & woman as laborer whose machine 7uterus

produces the product 7babies• 5terus as an inoluntary muscle so it rather than the woman is seen as doing most of the

laboro 2oman as the passie host of a contracting 7working uteruso 2oman hardly has a role but she is the one ealuated as if she were the one

performing• 2oman%s labor like factory labor is subdiided into many stages & substages• 9wo pictures$ uterus as machine that produces the baby & woman as laborer who

produces the baby while the doctor manages the labor• ($section which reuires the most management by the doctor & the least labor by the

uterus & the woman is seen as proiding the best products• #ole of doctor to ally with baby against the potential destruction wreaked on it by the

mother%s body

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o Mother*fetus are seen in the medical model as a conflicting dyad rather than as anintegral unit

The 5oan in the Body = 7Martin

Do women as workers- in the birth process resist their condition<

• 2omen may try to reduce the amount of time they spend in the hospital by delayingadmitting themseles as long as possible

o 5terus is being gien less & less time to produce its product• Becoming you own boss & neer going to the hospital at all

o 2omen hae control oer the means of production in the form of their own bodies

• !ocus on producing perfect products-o 2omen are often gien no choice about sacrificing her rights to those of the fetus

• Doctor may becoming a new worker who 7with the help of machines produces the baby

#ace & (lass

• 9echnology is introduces on poorer patients where it is tested & where physicians learn touse the new methods, deices, or medications; if accepted it is then passed on to the

priate sector & becomes the preferred modern style of practice• Blacks got far more sections for the diagnosis of dystocia$ imposition of time limits onthe rate of production; control oer women%s labor

• 2hen there are clear clinical indications of fetal or maternal danger more white womenget a ($section but when labor is long or the rate of progression is slow more blackwomen get them

• #acism is explicitly used in medical school culture as a way of further entrenching thesuperior standing of doctors oer the rest of the population

8The Hands >no"! Bodily Engageent ; Medical ,passe in Highland MayaBonesetting 78ino+osa

Manual medicine: set of healing traditions prioriti)ing the use of the hands & manualmanipulation of the body to bring about healing

.




• 8ueseros: bonesetters• !ace opposition from physicians who argue that bonesetters are untrained in trauma

techniues• Body can constitute a source & starting point of knowledge• 9he hands know the unseen problems in the suffering body, apprehending the problems

directly

o "truggle for legitimacy among physicians

Bonesetter: someone who in addition to massage moes bones as a form of medical treatment

• "ets fractures• ?nduces motion in painful or impaired +oints•

=erform most treatment in the home• #euires aliente 7courage• Mostly men

o ?mmediate help by men in the hillso "trength of men

• H$rays not ital to their work

• 8ands sere as the primary ehicle for diagnosis & treatmento 8ands know the body & can directly determine what is wrong with ito Don%t know how their hands know this

5ntaught knowledge$ hands act without conscious effort

•

(o$experience the condition of their patiento ?nability to heal oneself is reuisite to an ability to heal otherso 8ealth problems experiences by bonesetters authenticate their bodies as sources

of knowledge & become a way through which healing knowledge is reealed• Bone$setting is empirically drien

o =lay down magico$religious aspects of curingo Bone setters low status because they do not work in the spiritual, supernatural

realmo Accrue more prestige by using magic

• Attributes state of knowledge to many years of curing experience rather than ant oneepisode of formal training

• =reconditions of hueseros which inite scrutiny from physicianso "ufferingo (onersant in spiritual etiology

• Accept cases only in which they hae proen experience• 8ueseros recogni)e some utility & alue in physician%s work while insisting on the

physician%s inability to deal with certain trauma cases

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o =hysicians are reluctant to recogni)e the talent among bone setters But don%t protest bone setters for physicians reali)e that they are under$

trained & under$ euipped esp in rural areas According to physicians, bonesetters% unstructured training & practice

makes bonesetters illegitimate

Eri#a Brady ,ntroduction

T 2hat is Medical Anthropology<

o 8ow medicine is practiced, what medical practitioners do

o Means to be sick & how it feels

o !olk illnesses in diff societies

o 8ow to apply cultural knowledge to #x of diseases

T 8ealth & illness are not +ust bio, but also cultural

o 4eryone inoled in U least ' health belief system

T "ome research terms:

o Ethnography: graphing of ppl*ethnos, study of ppl, product of study write$up

o Field"or# : going to setting of culture being studied

o $iff types of field sites: doesn%t hae to be outside

o %articipant o'ser(ation: researcher putting self in place of participant whileobsering

V ?nestigator acuires experiential understanding of social process byactually engaging in actiities of community while simultaneouslyobsering them w* eye to making sense of them in disciplinary terms

o Sei)structured inter(ie"s: open$ended, starting <s

o *ife h-/course: how an indi%s life has changed oer time

o ,llness narrati(es: how you describe what happened to you while you weresick

o Rapport: good chemistry w* ppl interiewing

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o ,nforant: ppl who gie you info

o Applied anthropology! how you use anthropological knowledge to improelife in setting

T 2hat makes it anthropological7*folkloric<

o =ressing health problems, applied

o !ield methods, immersion in daily lies

V Must understand culture of setting b*0 introducing solution

o /ualitatie 7some uantitatie methods

o Fearning insider%s =G@, alues, attitudes, connecting to obsered behaior

o Holistic, contextual approach, ery detailed

T Rapid Ethnographic Assessent

o "crimshaw & 8urtado 7late 'CN1s$early 'CC1s

o 2ay to uickly moe from community$based research to interention shaped by cultural knowledge obtained

o 8elpful, but not approed approach

o Focus groups, 6uic#)intercept inter(ie"s, conc field o'ser(ations, socialapping

o 9ension b*w immediate medical needs & solid research practices

T 4rika Brady, ?ntro to Healing Logics

o Author%s background< !ield<

V (haplain

V Gncologist

o 2hat is allopathic edicine<

V 9raditional medicine

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V 011 yr approach to professional, secular, & scientific institution 724urope intellectual traditionWfaors inductie, empirical process ofinuiry oer deductie & metaphysical models

V Glympian extracultural ineitability 7seems right b*c has history &

institutional power behind it

V "uperorganic mystiue

V "ecular religion, training of physicians an acculturatie conersionexperience

T (hristian theological diision of soul from organism

V "ystem in which training of physicians would take place w*in relatielyfew research$centered institutions emphasi)ing scientific method 'st &

foremost, w* clinical skills deeloped later & somewhat secondarily X nowcomprehensie & lengthy process which in practice now inoles nothingless than full transmission of would$be doctor%s way of knowingWa totalacculturatie conersion experience

T 9erminology

o Allopathic

o &rthodo- ? unorthodo-

o Standard ? uncon(entional

V un- defines opp as good

o &fficial ? (ernacular

o ational ? local/regional

o Bio)edical: focuses on particular attention to medical #x of bio processes

o linical: suggests enironment

o ,nducti(e ; epirical Y deductie & metaphysical

T (ultural & #eligious 8eritage of 2 4uropean ?ntellectual 9radition

o Ancient reek philosophy

o ?slamic thought

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o (hristian theological diision of soul from organism X can use dead bodies

o !ascination w* cause & effect

o 9esting in controlled setting

o 4laborate bureaucratic organi)ations

o oodification of therapeutic product

V Grgani)ational commodification of healing

o Medicine- is process & product

o o attention gien to performance, only results

o "pecific types of authority are legitimate & carefully guarded 7credentials

V ?nstitutional authority: from pt%s perspectie, credibility &accountability of practitioner of official medicine depend to significantdegree on alidity of credentials that guarantee that he*she is participant ingood standing in formal medical community

V 4xperiential authority: personal recall & application of what has workedin past

V #elational authority: credibility of indis & resources lies not w* remote

institutional affiliation, but exists w*in community

T Brady on !olklore

o !ocus on aspects of human behaior which, though informal & not protectedfrom change, nonetheless demonstrate certain consistency of form oer time &are particular to certain community*group w*in large society

o Traditional e-pressi(e fors+ 'oth sta'le ; dynaic

o roups 7poor*marginali)ed X debates about class w*in society of inestigator,

rather than far away

o 8,te)centered collection of folk$medicines

V (ontinues today in 8e-traction of substances from plant materials

V Foss of context of who*what item is

31




V #emoes ob+ect of study from rich matrix of social context, leaing behind much of what may be releant to an understanding of whole picture

o !olk belief systems

o =articipant$obseration, 'st$person accounts, collaboration

o 2hose culture is new age- culture<

V (ulture as dynamic*changing, taking in*re+ecting bits of diff traditions

V ?ndis seeking nonconentional #x are more affluent & better educated

V Foose term referring to uickening of interest dating from late 'CI1s inreligious & health belief systems characteri)ed by perceied integration of

body, mind, & spirit & attunement of cosmic*natural forces

V 4clectic appropriation of American ?ndian, 4, & self$constructedsystems of healing & spirituality

V Appreciation of therapeutic spiritual effects of altered state ofconsciousness

o 2hat does ' learn from experience that cannot be explained in '%s own systemof logic<

Good! 8Ho" Medicine onstructs ,ts &'@ects

T ood, Byron O (h 3 8ow medicine constructs its ob+ects-

o ?s it fun to see inside 8arard Medical "chool<

o 5hat is su'@ect of Goods research4

V .nd yr 8arard medical students

o ,s his approach scientifically (alid4

V =articipant$obserer

V Fong$term

V ?nteriews 71 ppl oer yrs

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V 8is main argument: medicine formulates the human body & disease inculturally distinctie fashion-

o 5hat is epiricist paradig4

V Znowing something is right b*c you%e obsered it

T Epiricist paradig

o .nderlying assuption! priary unit for analysis should 'ediseases/physiological processes that are 8e-ternal categories of ore/lessuni(ersal reference

V =t not important, but inisible processes occurring w*in pt

V Makes it easier not to think of body as person

o His study!

V Ho" are edical specialists taught this paradig4

V Ho" does this paradig shape health care practices4

V 8is argument: bio isn%t external to but ery much w*in culture

T Foucault

o French philosopher "ho e-ained ho" edical discourse has changedthrough H- ; has shaped/fored o'@ects of study

o Good finds that Foucault interested in 'ody only as o'@ect of social ;edical practices+ not as 8site of e-perience ; understanding

o (ares about birth of clinic & how what you do in clinic shapes your iew ofworld

o Makes remarkable idealist claim that social institutions are product of episteme7underlying epistemological structure of medical discourse

T 4mbodied 4xperience-

o !asting during Muslim month of #amadanWhas physiological effects

T Science/Medicine

o Has ta#en place of religion as central organiing T a'out "orld

3.




o C edicine ; science hold oral "eight that religion does in anysocieties

o ,ndoctrination into edicine is only for fe"+ "ho ust learn to inha'it8ne" "orld ; then gain prestige of highest oral authority

V ,n contrast+ "ealthy 'ond traders ; E&s get D ; status 'ut arerarely accorded oral authority

T Har(ard Medical School

o :st 2 yrs spend on 'ioedical sciencesfro olecular to organisic le(el8pre)clinical

o 8Entering Body! interior of huan 'ody as ne" frontier/"hole ne""orld/"orld to 'e ta#en apart/e-ained in detail/cut/sliced/dissected

V =ower of medical idea that disease is fundamentally*exclusiely bio

V Accomplished not only by learning language & knowledge base ofmedicine, but by learning uite fundamental practices through whichmedical practitioners engage & formulate reality in specifically medical-way 7speciali)ed ways of seeing,- writing,- & speaking-

T Bioche as foreign language

o Huge ats of (oca'

o *earning to see diff+ to 'e a'le to distinguish things that loo# sae tountrained eye li#e #no"ing diff trees

V Anatomy: ' significant contribution to reconstruction of personappropriate to medical ga)e, ?Ded as body*case*pt*cadaerWperson iscultural construct, complex & culturally shaped way of experiencing self& other X cultural work- reuired to reconstitute person who is ob+ect ofmedical attention 7essential to student becoming physician

o As science ad(ances+ "e can 8see "/ ore detail ; "e in(est in 'etter

tools for 8seeing

T %latonic (ie" of cosos

o Sall is icrocos of larger "hole

o hain of 'eing leads fro sallest largest ; ost di(ine

33




o 2orld of being represented as ontological hierarchy, from material world ofsubstance out to diine order

T Bioedical (ie" of cosos

o Start "/ (isi'le ; increase agnification

o hain of 'eing! *arge sall

V ,f "e cant go saller no"+ "e "ill find a "ay in tie

V $eepest le(els arent social/di(ine+ @ust aterial

T 5hat is ore central to health in 'ioedical odel

o Genetics/po(erty4

V enetics b*c we can study it using tools we hae & we know it hasimpact on health & alid in lab X moral weight in society

o Social disruption in forced igration/epideic4

V 4pidemic b*c we can do something about it & think of cureWscientific preention

o 5ar traua/artificial li's4

o $ate rape/ST$s4

V "9Ds b*c lab science can proe something

V Date rape too social of issue

o An-iety/ancer4

V (a: affects eeryone

V Anxiety as problematic category that marginal ppl hae

o Self)estee/fe(er4

T After seeing+ "rite)ups ; case presentations

o *anguage learning+ style

30




V Fearn to construct sick persons as pts, documents, & pro+ects, perceied, analy)ed, & presented as appropriate for medical #x

V 2riting authori)es medical student, +ustifies interaction w* pt, organi)esconersation w* pt

V 2ritten for audienceWother physicians will make decisions based ondocument & +udge student based on writing

o Being 8in lie)light

o %erforance

V Most iportant perforance isnt to 'e @udged 'y pt+ 'ut 'y otheredical specialists

V Medical school as total en(ironent+ e'odied e-perience of sleep)depri(ation+ 'eing cut off fro outside "orld+ hierarchy of po"er+learning to act "/o 4ing 'ig picture

V ot merely way of depicting reality, but constructing it

V #epresent disease as ob+ect of medical practice

V =owerful ways of acting that X further actions, medical procedures,technical interentions, use of pharmacological agents X literally shape &reshape body

V (onentional & arbitrary

T Soteriological! referring to suffering & salation

o Medicine is oral+ not @ust physical+ rational+ technical

V Medical practice can neer fully contain moral & soteriological

o Medical practitioners ha(e 8passion for helping other huans

o Medicine is intense "ay of interacting physically "/ "orld/other huans

o Moral de'ates a'out life couched in edical terinology

*oudel Sno"! ,ntroduction to Walkin' over Medicine

9he introduction to "now>s book is a uote from an interiew "now conducted in Detroit,Michigan 9he speaker says that before there was 6real6 medicine, by which she means

3




biomedicine, people got along with weeds, grass, and dandelions as remedies "o, all the time people are 6walkin> oer medicine6 9he speaker says that she still owns copper bracelets to helpher arthritis, een though modern biomedicine has no use for them 9his uote exemplifies thestaying power of folk belief systems, because the speaker states that copper bracelets must proide some good, een though she can>t explain why

*oudell Sno"! hI : 3, Sa" a Shado" *ea(e Me3

o "tory of Oacie burns, an African$American woman who lies in "outh (arolina "he has astrong belief in sorcery, which she calls by the regional name roots- or rootwork- Gne canwork roots through: handwriting, photos, possessions, food, and drink

o 4eryone in her family- beliees in roots, and that there are people with supernaturalabilities ood people use their abilities to help others, root doctors- use their abilities to enrichthemseles

o Oacie beliees she was born with an unusual gift of ision- and that she foresaw the deathsof her baby sister and father

o According to Oacie%s belief system, when someone is ill because of a hex from roots,Doctors [meaning medical doctors\ can%t do nothin% for it-

o Oacie%s marries Big Ooe, and they hae four sons together "oon after, Big Ooe begins actingout of rage, and beats her on a regular basis 8e becomes unbearable to lie with Oacie does notresist or run away at first because she beliees it is her duty to stay with her husband 9hen,

o "oon, Oacie reali)es that he is using roots against her, and makes no attempt to leae because

she fears the power of sorcery "he knows that he is working roots because she failed to kill himseeral times, een when she was standing oer his sleeping body with a gun

o Big Ooe also fears sorcery, like one time he was afraid to touch a Bible they receied in themail because he thought it was hexed

o 2hen Oacie learns of the death of her husband%s root doctor, she decides it is her time toescape with her four children to Michigan Gnce they are far away from the home, she watchedthe personification of the hex leae her after so many years- 9his is where the title ? "aw a"hadow Feae Me- comes from 9he shadow personifies her husband%s control oer her 9hiscan also connect back to the theme of women and trance

o Oacie reasons that her husband%s anger and control issues come from when he was youngerand his mother would beat him 9his shows that she has an understanding of psychologicalfactors, and is not irrationally- attributing eerything to magic

o 9he article argues that Oacie%s analysis of the situation is completely rational ?nstead ofinternalizing the cause of her suffering 7as is common in American society by blaming herself

3I




for her misfortunes, she externalizes her misfortunes as the cause of her husband using powerstronger than any human%s

*oudell Sno"! hI =+ 8Soe Slip .p+ Soe %lan+ ; Soe Ha(e JE to Ha(e JE

T African$American young mothers & pregnancy

T =regnancy #isks

o "tressful life situations hae increased likelihood of complications in absenceof strong system of social support

o (onentional biomedical risks: unfaorable combos of age & parity, birthinteral ] . yrs, hx of miscarriage*neonatal death, other medical conditions

o ew risk factors: A?D", syphilis, gonorrhea, cocaine, heroin, methadone,

iolence, increasing rates of homelessness

o ?nfant mortality rates closely ties to prematurityWrecent dramatic increase in prematurity

o Marriage as unrealistic optionWsuggested often to aoid marriage, see noadantage to marriage b*c cannot count on economic*emotional support from menX hae to rely on public assistance anyway

V X increasing ^ of African$American families headed by womenWI1_ poor

o Birth of 'st child as symbol of attaining manhood*womanhood when usualaenues for mainstream success absent*truncated

V 2omen make conceptual distinctions b*w realms of male*femalerelations, pregnancy, & child Jrearing X expressed in dissociation ofmarriage & childbearing & isolated importance accorded to pregnancy asseparate from motherhood

V Dissociation of marriage & parenthood X issues of legitimacy lesscompelling X rare descriptions of illegitimate children as unnatural &

unwanted

T @ery fact of child%s existence seems to legitimi)e child in eyesof community

T Fegitimacy applies to parents not children

T Babies innocent of actions of parents

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V randparenthood alued

o Deep diision b*w men & women

V #elatie importance of blood kin demonstrated by fact that 3K_ of

women liing in household w* male partner didn%t mention him as familymember

V "eparation of roles of loer & proider

V !undamental distrust of nature of opp sex

V ?mportant aspect of haing male partner was being able to tap intoadditional help of his network of female kin

V Fow expectations present U early age

o Middle class dream as +oke to youth gang members

o !act that pregnancies are unplanned R*R unwanted

V ew mother U less of disadantage if she can count on help from ownmother

V 4en woman liing by self isn%t socially isolated if she is member offemale network

V (ontinuous households

V ?n some instances, pattern of informal adoption w*in network ofcooperating kin 7giing away- X ensures that babies & children lookedafter

o Abortion:

V "trongly euated abortion w* murder of innocent X conseuentdisapproal of practice on moral grounds

V "ome may allow for health reasons

V 9eenagers most ocal in opposition to abortion

V 9raditional methods of ridding body of unwanted fetus:

T 9rauma

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T ?ntroduction of ob+ects into uterus

T "itting in tub of hot water

T "oaking feet in tub of water containing some substance

T Douching w* arious products

T ?nhaling fumes of*suatting oer pot of some boilingsubstance

T #ubbing area around nael w* some substance

T ?ngestion of substances

V "ome of these methods based on ideas about how body works:

T 8eat opens pores & eins ` will perhaps open uterus

T "ome products hae penetrating*cutting effect

T /uinine, nutmeg, herbs swallowed b*c known to promoteuterine contractions

T "ome hae symbolic appeal: red pepper, gunpowder, buckshotwill expel unwanted fetus

T ^ magic

o ?deas about health birth

V 9raditional iew: natural part of women%s life

V Biomedical iew: medical eent reuiring constant monitoring & high$technology interentions

T Many women do not receie biomedical prenatal care R*RYwomen don%t know importance of prenatal care

V ?llicit drug use correlated w* inadeuate*no prenatal care

V "ome hae unpleasant clinical settings

V "ome unable to take adantage of prenatal care

V =roblems w* access:

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T eed for child care

T Fack of transportation

T Fong waits in crowded clinics

T =regnancy & 9raditional Belief

o =resence of extended family network of cooperating relaties important

o Menstruation puts woman U risk while simultaneously allowing her to radiate power that can 7$ly affect immediate enironment

V =regnancy tooWwhen this power moes from woman to outside world,usually 7

T "igns of =regnancy

o (essation of menstruation

o 2eight gain

o Breast tenderness

o =hysical changes

o =remonitory dreams

V Message deliered by dreamWcan be of self*friend*family member

V !ish as common theme

o Behaioral shifts in interpersonal relationships

V Men can detect

V oung person may fade away from older person when preiously wereclose

V =recocious behaior in infant*small child may alert others that mother is pregnant again

o May be known to others b*0 known to mother$to$be

o Double heartbeat-

01




o "election of ender

V Mother & father can deliberately create boy*girl by actions 7turningmarital bed, leather string in pocket

V !emale as F, male as #Weach gender produced by diff oary X turn on' side*other after sex

o =renatal Determination of ender

V =rettier if carrying boy

V Foses looks if carrying girl b*c donates them to daughter

V 8air growth, perfume smells

V (hild%s 'st

words

o Doctrine of Maternal ?mpressions

o ?mprudent =hysical Actiity

V 2orking too hard

o ?mprudent Diet: !ood (raings

V Birth marks for diff foods

o ?mprudent Diet: =ica

V =ica: craing for unnatural food, as seen in hysteria & pregnancy

V Argo "tarch

o ?mprudent Behaior: "trong 4motional "tates

o =renatal Marking as "ocial (ontrol: "upernatural*5nnatural "anctions

V Bad behaior during pregnancy can cause deformity

V 8oodoo marking babies

o Fabor

V 9ides as prediction of labor

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V 8ome setting preferred

o ?ncorporation of Modern =roblems into Gld 4xplanations

The oparati(e Study of Greco),slaic Medicine!The ,ntegration of Medical >no"ledge into *ocal Sy'olic onte-tsood, Byron O and Mary$Oo Del@ecchio ood 'CC.

• 9his articles tries to answer: 6how can a medical cosmology gien classic formulation in ancient reeceseem uniuely suited to map the life world of extraordinary dierse Muslim societies6R ho" can onesyste 'e applied to so any uni6uely different Musli cultures4

• uniue symptoms and problems arising from local cultural influences are defined and experienced throughthe language to its reek origins 7eg hot*cold; wet*dryR Medical traditions originating in ancientGreece ha(e 'ecoe uni6uely suited to descri'ing di(erse Musli cultures

• cultural analysis perspectie • !ie aspects of the symbolic organi)ation of ?slamic Medicine, which are important for examining how

reco$?slamic Medicine is integrated into local cultures and comparing forms of medicine in different?slamic societies

o cosmology ?slamic cosmology built from the =tolemaic conception of concentric spheres,

Aristotelian understanding of the elements fire water, earth, and air nature is a hierarchy that can be analy)ed as a series of oppositions and correspondences humans are microcosms of the unierseRby understanding human nature, we can

understand the unierse o symbolic oppositions and correspondences

hot*cold wet*dry differences between cultures in the extent and depth of cultural intensity of these

relationships ?ran for example has extensie but lacks cultural intensity but in (airothese oppositions and correspondences are extensie and intense linked to social life

o semantic networks o clinical knowledge and practice o illness narrati(es

ne" research on the perforance diension pro(ide 'iographical conte-t and e-periential reference edical discourse lin#s personal 'iography to local cultural (alues 3,slaic edicine is e'edded in stories+ and these stories pro(ide a ediu for

interpreting sy'olic fors originating in ancient Greece3 and those fors incurrent cultures

• Ho" did Greco),slaic edicine gain cultural authority4 o history of goernmental legitimation o association with intellectual and political centers o kind of secular$ deals with social issues and procreation issues

0.




honor*shame complex monogenesis theory $$$Y accepted in reco$?slamic physiology

Morsey 8%olitical Econoy in Medical Anthropology

o =olitical economy J A way of looking at oerall systems which is widely applicable Doesn%tallowing systems to be natural in themseles,- all systems are always influenced by othersystems Medical anthro is a subdiscipline of political economy

o =4MA R =olitical 4conomy of Medical Anthropology

o =48 R =olitical 4conomy of 8ealth

o Medical anthropology problem of socio$culturalism J trying to get biomedicine moreincorporated into exotic% settings, an ideologically shaped pro+ect

o ?s =4MA more concerned with micro or macro analysis< J medical anthro used to be erygood at being micro but lacked macro, for example field work resulting in specificethnographies =4MA tries to put the macro- back into the discipline without completelyreplacing the micro- aspect

o Author poses that anthropologists should balance thinking locally and globally, as well as balancing being purely academic- and purely applied-

o (olonialism J Anthropology is deeply rooted in colonialism, when the sophisticated-anthropologist would isit an unciili)ed- group of people to obsere and report

o ender issues J"ocial production of illness in relation to class$based power differences can parallel issues of power relations surround women%s reproductie health defined biomedically

o "outh s =ostmodernist J ?n the "outh 7meaning the southern 5" science is tool for political resistance, biomedicine is useful Discourse is important, but also main tool forinteracting across lines of power

o lobal illage describes when sophisticated- foreigners go into an exotic, primitie- placein hopes of moderni)ing- the place to be able to connect with the rest of the world 9he global pillage- is that in reality a lot of such missions end up exploiting the natie people

*oc# and Scheper)Hughes+ 8A ritical),nterpreti(e Approach in MedicalAnthropology! Rituals and Routines of $iscipline and $issentFro! arolyn FI Sargent and Thoas MI Kohnson+ edsI Medical Anthropology!onteporary Theory and Method+ re(ised edI 5estport+ T! %raeger+ :99LI

8ow is the body naturali)ed- in the social order<

03




o As the body is treated and studied, it becomes a medium on which to describe the socialorder o 9he body naturali)ed the social order by making society and all of its parts real and certaino "omething tangible to apply abstract ideas too aturali)ation: something is happening to the body rather than +ust being natural

2hy did Medical Anthropology miss the boat-<o Didn%t initially incorporate the significance of the body into their studieso 2estern biomedical traditions were already the normo Missed the boat in using the body as the center of analysis2hat happens when nature and culture are taken to be separate categories<o 2hen medicine is exempt from cultural analysis: assumption follows that nature and cultureare dichotomous 7diidedo 9his would mean that the following assumption is also true: that it would be impossible tounderstand the natural world logically and rationally with scienceo Means you can rationally understand eerything natural meaning we can hae technologicalmastery of the body these are false assumptions because the body and its culture is not so

easily separated2hy are Medical Anthropology and Biomedicine irreconcilable<o Anthropology is concerned with esoteric knowledge 7otherness, difference; anarchic- bodies*sub+ect matter o Biomedicine is concerned with uniersal knowledge and ob+ectiism; uniersal and historicalsub+ecto Biomedicine has its own truth alue, and medical anthropology is trying to interrogate thetruths of systemso Medical anthropology came up in a context where biomedicine is assumed to be absolutetruth8ow can Medical Anthropology be radical and good for adancing thought about humanity<o Medical anthropology: the way in which all knowledge relating to the body, health, andillness is culturally constructed, negotiated, and renegotiated in a dynamic process through timeand spaceo ?ts radical because its challenging biomedicineo ?t makes us think about out bodies and whether our ideas about them are constructed fromoutsideo Gne of the easiest ways we hae to challenge biomedicine is to look at past errors andincorrect assumptions of biomedicine 7eg hysteria as a woman%s disordero 8ow to think about humanity in different ways: challenges our way of think about biomedicine as absolute truth8ow does the topic of pain impact the field of med Anthro<o Before medical anthropology, pain was either completely biological or completely psychosocial, and neer could be a synthesis of the two medical anthropology suggests asynthesis of the two as a source of paino 2hat other problems do people hae< Biopolar disorder, AD8D$ both make it hard tofunction in society, but not like a pain that you can uantifyo Also +ust not feeling rightWnot the same as paino =ain is sub+ectie and difficult to measure, but ery central to healthcare2hat are the tricky roles for a Medical Anthropologist<

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o 9he medical anthropologist must acknowledge the efficacy of biomedicine while alsoretaining a critical stance on biomedicineo !irst: cultural interpreter$ must describe the culturally constructed ariety of metaphoricalconceptions about the body and associated narratieso "econd: cultural critic$ must show the social, political, and indiidual uses to which these

conceptions are applied in practiceo (ultural interpreter explains how the system works and makes senseo (ultural critiue can look at issues of power, access etc in a system$ critiuing it as a system;either be a defender of tradition and broker for changeWbut do you hae the right*responsibilityto adocate for people within< (an traditions be good*bad<2hat are the three bodies-<o 9he indiidual body:o 9he social body: how the body relates to your social context; taking societal alues andmaking them work on your body 7eg eating disorders, hair remoalo 9he body politic: iewing the body as something that is functional in the society 7egciti)enship duties, reproductie duties

o 8ow can politics play on the body<E 4xample: handi fasting: using his indiidual body within the context of his society andreligious beliefs, to influence change in the political arenaE 4xample: solitary confinement$ is it torture< =olitics is making this happen to youE 4xample: using prisoners as medical sub+ects2hat is the (artesian Fegacy<o 9he separation of the mind and the bodyo (artesian legacy to biomedicine and natural*social sciences: a mechanistic conception of the body and its functions and a failure to conceptuali)e a mindful- causation of somatic states2hat other dualities relate to the mind$body split<o 9he split between disease and illnesso ature*cultureo =assion*reason: a doctor is supposed to be compassionate not +ust completely rational thesystem in play urges doctors to remain distant, only spend a certain amt of time with each patientetco ?ndiidual*society2hat is epistemology<o A branch of philosophy that inestigates the origin, nature, methods, and limits of humanknowledgeo 2e learn by looking closer, by getting a better tool to get better magnificationo ?n besetting 7different system, emphasis is on touch, not lookingo "tory$telling is also a way of knowledgeWcommunity shared understanding, building what isknows together to understand better 2hat examples of different epistemologies do the authors proide<o Durkheim: 9he 4lementary forms of the #eligious Fife wrote man is double- in referenceto the biological*social dichotomyo Mauss: wrote of the dominion of the conscious [will\ oer emotion and unconsciousness-o Marx and !reud: unresolable contradictions such as natural*uniersalo !reud: said the indiidual is at war with himself biological dries s domesticatingreuirements of the social order

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o Marx: natural world was an external ob+ectie reality that was transformed by human labor o ing$yang cosmology is another epistemology?s the connection between the indiidual body and the indiidual self natural and uniersal<o Grnstein: claims that mind*body dualism is a result of human brain laterali)ation2hat can Medical Anthropology show about body imagery<

o ?t can present information on both social and cultural meanings of being humano Medical anthropology can specifically present a new perspectie about body boundaryconceptions, distortions in body perception etc8ow is the body good to think with-<o ?n the case that the mind is afflicted and incapable of rationality, one can think with the body;"ack%s suggests that there is a soul force- or mind$self- that makes humans human, eenwithout rationality because of disease etco Douglas says the body is a natural symbol that gies us our best sources of metaphor iacomparison to body secretions*excretions 7blood, milk, tears, semen, excremento (ultural constructions about the body are useful in sustaining particular iews of society andsocial relations

2hat examples of symbolic uses of the human body are gien in the article<o #eproductie systems: emphasis on importance of women in matrilineal societies, andimportance of men in patrilineal societies, and eual importance of men and women in modern2estern societies talk about the body and sexuality tends to be talk about the nature of societyo 8ealthybody*healthy society s diseased body* malfunctioning society eg, ital balanceand harmony idea found in ancient medieal systems of (hina, reece, =ersiao ?llness and death attributed to social tensions and hostilities as seen in Mexican folk belief 8ow does new technology influence our symbol of body as machine-< p I1o 2ith the rise of industrialism and increased technological adances, the body is compared toa machine that is a commodity, +ust as products of industry*technology are a commodityo man sees himself in terms of the external world, a reflection of himself-2hat is healthist- culture<o 9he politically correct body in a healthist culture such as ours is lean, strong, androgenous,and physically fit; this body reflects the social expectations and cultural alues of autonomy,toughness, competitieness, youth and self$controlo ?llness in the healthist culture is attributed to the indiidual%s failure to eat right, excerci)e,etc2hat is the !oucauldian body-<o "ubordination of the indiidual body to the body politico 9he body is more often afflicted, alienated, and sufferingm than it is ecstatic, decorated andaffirmingo 8is image still presents problem of a body lacking sub+ectiity and the experience of powerand powerlessness it is a negatie notion of the body(an illness hae political significance<o 4", political actiity is physically dangerous sometimeso =eople who are powerless drag their feet, slander, refuse to comply etco Accusations of witchcraft, sorceryo 5se of trance or illness as safest way to portray political opposition: can communicate fear,anxiety and anger without being held fully accountable for actions2hat is Bodily praxis-<

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o 9he notion of someone liing out and reacting to his assigned place in the social order o 4xamples: Oapanese students refusing to go to school in opposition to the pressure their parents place upon them , experience of women in menstruation, childbirth, and menopause andhow they accept or re+ect ideologies concerning these eents

"A#A8 #A>" G94":

HEA*,G *&G,S 4rika Brady

,ntroduction:o Brady$ part time chaplain in a hospital in Missourio 2as he saed- rather than did he suffer<-o ?ncorporated the patients% arious religious*spiritual healing rituals into

their treatmentso Allopathic treatmento "tudies show that in 'CC3, out of pocket money spent on alternatietreatment euals that of out of pocket money spent on hospitali)ations umber ofisits to unconentional medicine exceeded conentional by '1_ More commonlyaffluent, educated peopleo (redibility, institutional and relational authority$ K,No "tereotype of folk medicine$ isolatedo ew Age Moement-$ '1

.nderstanding Fol# Medicine o

!olk medicine$ represents a body of belief and practice isolated in ariousways from the social and cultural mainstream and intriguingly unaffected by modernknowledgeo 8ierarchical model of medicine$ below official, scientific and oer primitieo Medicine presumed to hae deeloped upwardly 4ffectie methodsretained, obsolete discarded to lower layers of cultureo =assed on through apprenticeshipo =eople are pragmatic in approaching and ealuating treatments orremedieso (G#4 (G(4=9":

9ransmission through oral means, unofficial status 8armony or balance ?nterrelation of body, mind, spirit @italism Magical or supernatural elements 9houghts and emotions as etiologic factors (oncern with underlying causes

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=ositie*negatie energies; transference Moral tone, meaning

o !olk illness*culture bound syndromes$ implies that it is not a real illness"ome tied to particular cultures, some go across the board 7ie soul loss, Gld 8ag8ealth officials cannot dismiss it but must rather understand it and its causes

o (GMMG 984#A=549?( =#A(9?(4": #eligious, spiritual and magical actions and sacramental ob+ects atural substances =hysical therapies

o ?nteractions with other systems$ usually use multiple health systemsdepending on aailability of resources

,n(isi'le Hospitals! Botanicas in Ethnic Health are o (ooperatie model of fieldwork, raised uestions of the role of practitioner as both healer and entrepreneur in impoerished, biomedically resistant%communitieso Botanicas sell herbal products, ritual implements, and sacramental goodsas well as proide medical and spiritual consultation 4lements of religiono Demand has increased dramaticallyo !undamental beliefs:

9he belief in supernatural beings who interact with humans Disease can by the result of natural causes, diine retribution orsocery 8ealers must be able to treat all causes 5se of ceremonial and herbal therapies

o Biomedicine separates body from mind and spirit !ocuses on biologicalelements of disease 4xcludes cultural, social and psychological construction of

illness 4xplains how but not whyo 8ot*(old properties of body parts, illnesses, foodso Desperation of the clients at the hands of health care proiders

The %oor Mans Medicine Bag! Epirical Fol# Reedies of Tillan 5aggoner o (ooperatie model of fieldwork, raised uestions of the role of practitioner as both healer and entrepreneur in impoerished, biomedically resistant%communitieso #epresents the confluence of dierse streatms of medical tradition, oldand new, local and exotic, distilled from popular literature as well as oral traditiono 9?M 2AG4#o Doesn%t rely solely on faith healing aturalistic and empirical medical

beliefs and practiceso =oor Man%s Medicine Bag$ remedies, recipes, adice, philosophy (omesfrom a ariety of sources$ oral and written Fargely naturalistic, does call for professional care if needed (ritical of unnecessary folk practices

,ntegrating %ersonal Health Belief Systes! %atient)%ractitioner ounication o (AM$ complementary and alternatie medicine !olk medicine is subseto Breast cancer$ rapid study

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o 9he indiidual%s own health beliefs must be studies as the locus forintegration

opeting *ogics and onstruction of Ris# o 4xamines the subtle cultural contextuali)ation of ob+ectie% informationconduits concerning risk factors in A?D" #aises uestions about the conseuences

of policy based on such datao "hift from risk groups to risk actiitieso #isk is culturally assessed and defined #isk categories must beanaly)ed, not +ust adoptedo Misreading data (an be stereotyped and abstracted from context ieAfrica 4erything they do is risky behaior-o Medical eidence concerning A?D" in Africa has been constructed to fit preexisting notions about African sexuality and disease, and to fit preexisting notionsof the exoticism of traditional cultures

The e" Age S"eat *odge o 9raditional ?ndian sweat lodge has been adopted by ew Agers in the K1so (hanged some of the traditions to conform to modern wants*needso 4clectic and olatile moement Marks the shift from 4astern healingrituals to atie Americano (riticisms

atie Americans don%t like non$atie Americans using theirreligious practices without belieing and improperly =eople are selling% ?ndian ceremonies Feaders don%t hae the proper training 2esterners change it for their own purposes$ make it too indiidualand not enough about community 9ake only what they want and leae the

rest =laying ?ndian- (ompared it to ?ndian Medicine shows$ +ust one way to gain profit =art of 2esterners attraction to what%s primitie 9rying to find aspiritual answer to 2estern problems

o 4asily blendable into Oudeo$(hristian enironments Does not need ahuge commitment$ psychologically, religiously or physically

E(ergreen! The Enduring 1oice of a ine)Hundred)7ear)&ld Healer o Mass appeal !ollowers include scholars and new age adherentso 8ealth through faith More than +ust the absence of disease 5nderstandshealth in a broad, holistic senseo Alternatie to conentional medicineo 2hy has she attracted new age adherents<

8er gender 8olistic health @ariety 4cological consciousness

o Authentication through association with 8ildegard

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Reflections on the E-perience of Healing! 5hose *ogic4 5hose E-perience4 o Discussion of the uestions raised by the challenge she faces in teachingethnographic courses based both on the 2estern critical tools of inuiry and on herown experience of shamanistic practiceo ?nterpretie drift-$ process by which people come to iew magic as an

efficacious and rational explanation of eentso =roides rational explanation for seemingly irrational belief and practices 5sed by researchers to reoke eracity of magic or potential harm ofsorceryo !unctional, structural and symbolic iews of sorceryo 4xperiential fieldwork allows us to explore the possibility that peoplecome to beliee in the reality of magic after experiencing effectie results rather thanthe other way aroundo #esearchers should +ust try to beliee their informants$ they might berightPo Are we able to talk about experiences if we lack the ocabulary<o Direct experience is the best enhancement in shift perception

The Hoho Factor! The *ogic of a(a@o Healing o 4xplores the meaning of a personal experience in which his surialreuired sacrifices followed by tragic conseuences 4xample on page 'NI$Ko 4xperienced based essay by a white person in a aa+o setting ot pneumonia in eada and credits aa+o healing to his health 49?( perspectieo 2ant to examine the system of thinking that frames the eents$ thehealing logico 2ant to look at their assumptions on health and sicknesso "pecialty doctors in the aa+oo =reformed their healing rituals on him when he was sick$ describesarious rituals and healing processorso 8ealing is about bringing back balance, harmony and stabilityo 8ealing songso Many aa+os hae been hesitant to adopt 2estern medicine becausesome biomedical practices 7biopsies, taking blood are seen as actions eil people doto bring health to themseles Anglo medicine is frighteningo 9alks about how important phrasing is in medicine$ affects people%sresponses ?nstead of saying: if you don%t take your medicine, you will die,- say ifyou do take your medicine, you%re going to lie and be with your grandchildren-

HEA*,G TRA$,T,&S Bonnie Blair G%(onnor

hapter :) $efining and .nderstanding Health Belief Systes o All health belief systems are products of (5F95#4o 9erms: primitie, ethnic, marginal, unorthodox, deiant$ BAD 94#M"?mplies that systems are outmoded, simple and that the people who use them showthe same traits

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o 9alks about 94#M?GFG and its implicationso 8igh regard for science does not go across the boardo "tereotypes: isolated, recent immigration or minimal acculturation, ethnicminority membership, poerty, low formal education, mental or emotional imbalance,desperation

o Difference b*w conentional and ernacular$ not commitment to health of patient but rather what treatments are necessary and propero (onentional only addresses the symptoms or proximate causes@ernacular deals with ultimate causeso 8ealth belief model$ how and why people make the health care choicesthey do

hapter 2) ritical Approaches to *iterature and Theories o Belief and behaior are strongly culturally shapedo Definitions of health illness are cultural productso 4thnocentric bias$ our traditions are normatie and don%t needexplanation while those of others% are stranger and need explanationo !unctionalist, psychological theorieso !olklore*belief, medical anthropology, medical sociologyo =atients assess their own situations and make important decisions basedon their priorities and experienceo (onentional health professionals should be aware of parallel healingtraditions and deelop ways to interact with them

hapter ) Hong ultural 1alues+ Bioedicine+ and hronic *i(er $isease o (onflict between indiidual choice and community choiceo 8mong culture$ family and community are the locus of identity, action,care and decision making G9 indiidualisto

Misunderstandings add to the fear*suspicion and narraties that 8monghae about American medical practiceso Fiero "oul Foss$ remoal of body partso Death might +ust be due-$ can%t do anything about ito !amily wanted a second medical opinion More respectful of culturalneedso Didn%t follow prescribed treatments, ended up in hospital again eededlier transplant ot considered a good candidate for new lier because of pastfailure to comply with treatments

hapter <) 1ernacular Health are Responses to H,1 and A,$S o =2A$ =eople 2ith Aids Mainstream- patient group$ middle$class, welleducated, and familiar with conentional medicineo 5se alternatie medicine as a complement to biomedicine when it doesn%tsucceedo Gld stereotype$ alternatie medicine was only used by poor peopleo ow$ types of alternatie medicine is typically only used by people whocan afford ito (are is "G(?G$4(GGM?(AFF "9#A9?!?4D

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o ?n general more people combine forms of healthcare to produce the mosteffectie treatmento (hinese traditional medicine$ a ery popular alternatie treatmento =roliferation of information by =2As to other =2As$ informal andformal

o 9reatment options are used for as long as they%re fruitfulhapter N) ,plications for the Health %rofessions

o !A(9": onbiomedical health belief systems are alie and well ?n common use by all kinds of people 8ealth professionals should ask patients about them =atients are authoritatie agents of their own health care eeds to be taken seriously by health care professionals

o =atients seek ernacular medicine because they want different cognitieframework, different leel of skill, different interaction patterns and specifictherapeutic interentionso Ma+ority use both conentional and unconentional medicineo rowing criticism of biomedicine$ too for$profit, too little attentiono American diersity and multi$culturalism$ present many challengeso (ompliance*noncompliance$ 'K3$0o 8ealth professionals need to understand why patients comply*don%tcomply and what they need to doo 8ealth professionals need to be more educated about the patientsthemseleso ADD "G(?G(5F95#AF (G94H9 9G 984 84AF984(G594#

o (annot +ust attach marginality, ignorance and desperation tononconentional medicine

Brady/Malpei ) 8E(ergreen! The Enduring 1oice of a 900 7ear &ld Healer $ 8ildegard of Bingen was an unofficial (atholic saint from the '. th century$ "he is still releant today and inspires (D%s, 9$shirts, websites, and books in her honor$ 8er teachings appeal to ew$Age mystics and Benedictine scholars alike

$ As the tenth child of her parents, 8ildegard was committed by religious custom to aspiritual life at a young age$ "he was a prophet, isionary, abbess, musical composer, scientist, herbalist, and dramatist

$ =racticed holistic, hands$on healing$ =ublished a book documenting medicinal uses for herbs, stones, animals, metals, plants, andminerals, as well as origins and home treatments of diseases$ ?n (hristian tradition, she saw sickness as a result of the !all and, in the same way, sawhealth as more than +ust physical$ "ince (reation is related to the (reator, she saw medicinal uses for eerything in the naturalworld, though she was also schooled in and respectful of conentional science$ Zey concept of viriditas which means green, life, growth, fertility, a life$force from od

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$ 8ealth is this growing, blossoming, energetic life force, while sickness is its drying out$ 9he imagery of sickness and sin as aridity is reflected in Oudeo$(hristian thought$ 8ildegard%s teachings are popular as medical*religious alternaties because of:

$ender "he accomplished a lot in a ery misogynist enironment$8olistic 8ealth (onnection of mind, body, spirit, cosmos

$@ariety 4ncompasses a lot of techniues: diet, fasting, herbalism, stones, prayer, lightenergy, sound and art therapy, aromatherapy, hydrotherapy, incantations$4cological (onsciousness #espects nature and recogni)es its power

$ 5sed mandalas as healing tools to restore psychic and cosmological balance

Rhodes O 8Studying Bioedicine as a ultural Syste ) Fooks at the paradoxes in the relationship between biomedicine and medical anthro

$ (linically applied- med anthro R clarifying specific issues in health maintenance andresponse to illness$ (ritical- med anthro R concerned with macro political and economic forces, analy)ing therole of power in social life and how biomedicine is culturally constructed

$ Biomedicine, like religion, operates under an aura of factuality that makes eerything aboutit seem ineitable, natural, and separate from other more cultural domains$ 8oweer, biomedicine is embedded in a specific historical context$ Biomedicine%s cultural side can also be reealed by obsering clinicians% daily practices$ Biomedical theory deeloped out of the (artesian mind$body dichotomy 9his is a particular cultural assumption about the body$ Descriptions of bodily processes are often metaphors of economic systems there-productie- system, systems of communication in neres, parts breaking down$ !oucault says that modern medicine was born in 'N11 when medicine became clinical$ 9he ability to see- into the body with new technologies shape how we treat it$ 9his turned the body into a perfect domain for social control and minute obseration

$ "ome sole the problem of medicine%s domain of the factual- by separating biomedicinefrom social science, as in most clinically applied anthropology$ 8ence the diision between disease 7biomedical and illness 7socio$cultural$ 5nfortunately, this diision does not problemati)e disease- and sees it as a biomedical factto be taken as truth and a gien 2e need to inestigate the cultural construction of medicineitself, not +ust try to separate it from culture-$ Disease*illness dichotomy is related to mind*body and nature*culture dichotomies$ Anthropologists often explain the alternaties- to biomedicine, taking biomedicine asnormal and the gien, without inestigating its construction$ Medicine is such a big part of society that it cannot be described without describing its role

of power in society and the ways in which this obscures its problems, which mirror problemsin society$ 9wo aspects to the relationship between medicine and society: health problems may besocially caused, and medicine may function to conceal the social origin of sickness$ Medical conditions are seen as separate from their social causes*meanings ie =M" isdiagnosed as a medical disorder separate from women%s social suffering*stigmati)ation

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$ Medical definitions of physical*mental disabilities are used to weed out unproductie- oruseless- people from society 8ence the asylum Also used against fragile and emotional-women to keep the home as the woman%s separate domain$ =eople are now resisting biomedicine%s oppressie control by deeloping their own systemsand bodily metaphors

&onnor hI :! $efining and .nderstanding Health Belief Systes

Gi(ens 7axiomatic principles$ things we +ust assume to be true, but are not necessary to proe we build health belief systems off of giens 7ary across different systemsE 4xamples: belief that hospital is the place to go when sick o Belief that a diine being exists, which influences human eentsE Belieers seek cure or response to illness through the assumption of the gien$ it makeslogical sense to that person, in the context of their belief systemE Gne%s explanation of an illness emerges from the gien

=hysical and =sychological causes:E #ecogni)ed by most health systemsE 5sually they are combined in analysis and explanationo 4xamples: eil eye, depression running in family, an illness attributed to od%s will(omparing "ystems:E 9his is difficult to do because the giens- are ariedE "h proposes the terminology of$ 'ioedicine (sI (ernacular health 7combines allnonconentional- medicineE 2e get proof- in scientific data and testimonies of success storiesE "ystems maintain their own ocabulary$ potential for miscommunication when we refer tosomething as primitie,- unorthodox,- ethnic,- marginal-

o (ould dealue the alidity of another%s health belief system, or imply that they +ust need todeelop more

8ealth Belief systems hae their own internal logic:E Belief and knowledge are culturally constructed and context$dependentE Associations of ocabulary$ scientific- proof is immediately acceptedE 8Tradition of dis'elief - for nonscientific elements 7like religiono 9endency to beliee that a particular healing belief system is inferior if it is not in lie withones own systemE "cience is its own paradigm of belief and knowledge"tereotypes (reated by 4olutionist and "urialist Assumptions:

E 2ith education, the other health systems will learn to be right, like us- ethnocentric iewo Assumption that folk medicine will decline eentuallyE 4xplanations of another systems wrongness$ they are poor, old fashioned, not$mainstreamE Belief in science that we can reach perfection in medicine$ beyond +ust surialE 8ierarchy of #esort- 7as called by #omanucci$#oss$ in what order do you do things inresponse to a health issue< 2here do you turn to find a cure<o G%(onnor proposs we call it 8order of resort- to not place certain treatments ashierarchically better than others

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E Medicine and science are eoling and self$correcting

igh) Bioprospecting!

oing into a community obsering healing practices borrowing for deelopment of

pharmecuticalsE "een as iolent against the Mayan culture$ takes practice out of contextE =atroni)ing position of =ower$ stealing culture-Mayan (ulture:E (ommunal system of landownership$ based on mutual trust and commitment E "pirited landscape$ reward good communal practicesE #elation with nature$ humans embedded in karmis forcesE Mai)e$ holding communal power Disturbance of bioprospecting:E ?ntroduces force of capitali)ationE Material success$ causing +ealously

E (hanging moral of the younger generationE (reates natural subordination between biomedical and mayan shamans forming hybridmodel of a unified systemE (onfirmed alidity- of Mayan remedies$ biomedicine recogni)es their effectieness7proes- local knowledgeE 9akes Mayan medicine out of context=ro+ect:E =roblems$ no legal framework, leads to complicationsE #A!? 7#ural Adancement !oundation ?nternationalE /uestion of intellectual property$ biological piracy<E Mayans are not necessarily resistant to 2estern medical systems

E (riticism$ research did not take spirituality into account

HA%TER N! &P&&R ,plications for Health %rofessionals

• =atients are authoritatie agents of their own healthcare 9hey chose their own

therapeutic goals regardless of the iews of clinicians• at least one third of Americans has used or is using alternatie healing sources• =atients prefer someone fully trained in traditional (hinese medicine to a physician$

acupuncturist because the latter has less training in alternatie practices and stillapproaches healing from a biomedical perspectie

• =atients looking for alternatie practices are looking for more than +ust differenttechniues 9hey are also looking for a different mindset and way of thinking comparedto biomedicine




• #easons why patients use alternatie practices 7p 'I:o chronic problems that biomedicine has little help foro conentional medicine practices are offensieo alternatie health practices are part of a person>s culture and backgroundo times when conentional medicine is thought to be inadeuate

• (hanges in healthcare hae transformed conentional medicine from medicine$as$sericeto medicine$as$business 9his also transforms patients, who become 6consumers6 9heycan shop around for the clinician that best suits their needs 7example on top of page 'IC

• (ultural diersity is not a problem to be soled but a set of relationships to be negotiated$ p 'K.

• (omplianceo alue laden term idea that the physician has control oer the patient and the

patient is submissieo 9his is contradictory to the idea that patients are actie and authoritatie agents in

their healthcare•

health professionals need to see that they are members of a alue system and not thealue system

Research Report! Susto and %esticide %oisoning Aong Florida Far"or#ers

• ?nestigated migrant farmworker interpretation of a serious incident of pesticide poisoning

o "usto$ Mexican folk illness ersus biomedical• ''. migrant farmworkers became ill to a arious degree after working in a field sprayed

with insecticide phosdrin and were rushed to a biomedical center where they were treatedo Decontamination, intraenous, therapy, cardiac monitoring, assistance to 4M"

• #ecoery period may take up to '.1 days• 4en after patients seemed stabili)ed they continued to complain of di))iness, headaches,

weakness, blurry ision$ this warranted further inestigation in relation to folk illnesses• =atients may hae self$diagnosed themseles with susto 7untreatable by biomedicine• Gther illnesses in the Mexican folk medical tradition: empacho, caida de mollera, mal de

o+o 7eil eyeP• "ustoo (aused by a frightened experience: departure of soul from bodyo Foss of appetite, listlessness, lack of motiation

• ?f diagnosing self with susto, higher expectation of mortality and morbidity

• .3_ of the population interiewed belieed they had susto or might hae it as a result ofthe pesticide poisoning

o =rior experience with susto did not seem to predispose a self diagnosis of poisoning$induced susto

o !elt themseles to be sicker than the others, complained of more residualsymptoms

o "elf diagnosis of susto linked to a greater self perception of degree of illnesso "elf diagnosis psychological trauma somati)ation

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• ?mplication for medical proiders: folk illnesses should not be considered old fashionedsuperstitions that are fading, more research needed on pesticide poisonings in relation tosymptoms reported; self diagnosis of a folk illness may indicate a patient is indeed sicker thanother indicators suggest

Brady h :0! The HQhQ Factor

E @iew of a(a@o healing systems by a non$aa+o whose life they saed 7pneumonia

E 8e went from being a stranger*guest to a familiar, coughing, feer$ridden resident-

E 9hey performed the #ed Antway ceremony, and he healed

E 8e says they things they gae him to eat, drink, smoke, etc must hae had actual healing properties-

E Hataalii - a singer or chanter for healing, medicine man-

E Most are men, but they can be female too 2omen hae the power 7children, home,liestock, so they seldom sacrifice it to become a hataalii $ Besides, men need somethingimportant to do-

E Gther healers: diagnosticians 7employ hand trembling or crystal ga)ing, herbalists, and faith

healers, which are something like shamans

E "hamans are rare except yenaaldlooshi 7skin walker- who in+ure or kill others

E 4xperience$centered discussion attempts to account for:

E An occurrence one might not witness except for haing been a patient

E 5tili)ing the perspecties of the experience itself

E in a way that is true to the logic of those who understand it

E and articulated in a way that makes it part of something worth learning

E aa+o rituals restore HH 7beauty*stability*balance*harmony

E "and paintings proide isual icons of the natural forces one must heed to heal

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E "ongs and prayers are repetitie and reestablish reciprocatie balances in the mind of the pt

E aa+o beliee that language creates the reality in "hich "e li(e

E Gld naa+o pt thought biomed physician was trying to kill him because he said if youdon%t take your medicine, you will die- and for the man, saying it makes it so

E ?ndian 8ealth "erice hospital in AQ allows chanters to isit pst N1_ success 8ow<

E aa+o logic for this is based on their concept of the spirit*soul, nílch'i 7literally wind,air, bree)e

E aa+o concept of witchcraft: operates in opposition to healing, separates, alienates,destabili)es, de$harmoni)es, kills, in+ures

E Gther- culture%s logic of health can generate insights as reliable as our own:

E aa+o hold that when rodents 7esp mice becomes numerous, all clothes and beddingshould be immediately burned 9his was bc of a past disease 7pulmonary affliction

E aa+o used to use colored glass beads and +uniper seeds for balance in one%s life ow wesee less and less of these, which may signal a departure from the logical assumptions whichgae them intense meaning for many preious generations- aa+o young people are going todoctors instead of to their singers what a shame

Good! Medicine, Rationality, and Experience+ h : 8Medical anthropology and the pro'leof 'elief

E ood starts off talking about Fewis 8enry Morgan, a lawyer who rallied support for the?ndians and carried the cause to congress

E Morgan tried to rethink the human family and #inship 7not simply as part of nature, butas a social and cultural domain-

E 9he confrontation btwn the natural sciences and historicism $ the iew that all knowledgeis unaoidably relatie to historical context $ has been the central issue of philosophy, thesociology of knowledge, and historical studies of science for much of this century 2ithinanthropology today, ? would argue that medical anthro is the primary site in which these issuesare being addressed and inestigated-

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E ?n the 'CI1s it was somewhat of an embarrassment to be identified as a medicalanthropologist

E ?llness as a syndrome of experience-, a set of words, experiences, and feelings whichtypically run together% for members of a society-

E ood argues that belief is a key analytic term within in empiricist paradigm, and that thisconcept is linked to a set of philosophic assumptions in a way that is far from obious Beliefas a central analytic category

E ?ssues with little prominence in an anthro framed in terms of belief:

E Anthro of experience and what we can learn from studies of human suffering

E "tudies of interpretation and its constituting role in social process

E (ritical analyses of medical discourse and their institutional and societal relations

E 9here is a close relationship btwn science, including medicine, & religious fundamentalism

E (onception of language in which representation and designation are exceedingly importantattributes

E A central issue in the rationality debate has been discussion of the problem of apparentlyirrational beliefs- $$ rationalists argue that seemingly irrational statements must be understoodsymbolically rather than literally Many wonder, when confronted with irrational- beliefs,what should be my attitude toward them<-

E 9he problem of belief

E the idea that belieing is religiously important turns out to be a modern idea-

E 4nglish words to beliee- and belief- hae changed dramatically in the past 3centuries

E Beliee came from to hold dear- or to beloe-

E ow: belief defined as an opinion of coniction- $ the belief that the earth is flat-, as

in, the belief that the earth is round isn%t a belief, but is knowledge-

E Belief seems to connote error of falsehood

E Beliee tends to be associated with ascribe- regard- and attribute-

E Znowledge tends to be associated with recogni)e- reali)e- acknowledge- andawareness-

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E 8ypotheses:

E 9he +uxtaposition of belief and knowledge and the use of belief to denote or at leastconnote counterfactual assertions has a long history in anthro and philosophy

E Belief as an analytic category in anthro appears to be most closely associated withreligion and with discussions of the so$called folk sciences

E 9he term belief appears with uite aried freuency and analytic meaning in differenttheoretical paradigms

E 9he representation of others% culture and beliefs- authori)es the position and knowledgeof the anthropological obserer

E Despite post$modern hypochondria in some regions of the contemporary social sciences,the term belief and its counterparts continue to be important odd +ob words not only in the

cog scis, where culture is closely linked with states of the mind, but in fields such as themedical social sciences, where the conflict btwn historicist interpretations and the claims of the natural scis is most intense

E Aspects of the empiricist paradigm that hae become problematic:

E =ositiist approaches to epistemology and the empiricist theory of language hae comeunder sustained criticism in philosophy and anthro

E 9he normatie dimensions of the empiricist paradigm seem increasingly unacceptable

E 9he place of the ethnography as ob+ectie, scientific obserer $ both in research and inethnographic texts $ seems less and less aailable to us today

E A ariety of more technical analyses of belief suggests problems with the empiricist program, challenging the utility of belief as an analytic category, een uestioning theexistence in other societies of beliefs- in our sense of the word

E "orry that these notes are so dry the reading itself was painful

ora eale Hurston 8Hoodoo fro Mules and Men :9N

(hapter ': 8urston first uses Biblical figures 7like Moses to introduce hoodoo, and describeshow od bestowed special powers to them 9hen, she describes a conersation she had with twoAfrican$American women in !lorida about 8oodoo, where they first test her to make sure she%sworthy of their hoodoo secrets, and then tell her stories about hoodoo that happened to them and people they know

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(hapter .: ?n ew Grleans, 8urston meets with Fuke 9urner, who claims to hae gotten hishoodoo powers from Marie Feeau, a great hoodoo practitioner 8e tells her some stories aboutFeeau, and after a while she gains his trust 9hen she begins being initiated into hoodoo so thatshe can become the heir to his powers "he describes all the rituals she has to go through to prepare for this ceremony, including lying naked on a bed for three days without moing or

eating anything, being dressed and painted and crowned with a snake skin, eating a special meal,sacrificing animals and doing encantations, until finally she has gotten his powers

"hortly afterward she leaes, which is controersial because she is not only stealing his secrethoodoo religious traditions to put in her book, but also potentially all the hoodoo powers he gaeher

QUIZ QUESTIONS

' 2hen Qora eale 8urston says 9he way we tell it- what is she identifying as hergroup<

African$Americans who know about*beliee in 8oodoo

. 8ow do the stories told by 8urston connect religious figures such as Moses and "olomonto 8oodoo<

"he talks about how od gae them some of his power and taught them how to use it, like shewas taught

3 ?s there a conflict in collecting stories and information from a secret religion<

=eople don%t trust researchers enough to tell them anythingWthey aren%t willing to admit they beliee in hoodoo, because they want to keep it secret

0 !inish 8urston%s sentence: 9he crown without the preparation means no more than acollege diploma without the four years work -

Fist some critiues that were made of 8urston%s work

"he got too absorbed in the culture she studiedWshe was a part of it, which biased her as anobserer Also, she basically tricked Fuke 9urner the hoodoo doctor into giing her all of hissecrets and powers, and then she left and put them in her book

Glo'al Health Recoendations for a e" Adinistration and ongress 2009

9he authors are upset that deelopmental assistance has done ery little to improe the health of people in poerty 9he Millennium Deelopment oals were set by the 5 in .111 to improe

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health, education and the status of women and children, and there has been little progresstowards reaching these goals since then

9he main mistake the authors think has been made is that too much money has been allocatedtoward the priate sector, which has no responsibility to protect ulnerable people and no one to

answer to 9hey want funding to go to the public sector and to goernments, who can be heldaccountable and who can build systems to fight the root causes of disease on a larger scale

QUIZ QUESTIONS

' 2hat is the main example used in this report to show the failings of deelopmentalassistance< 2hat is the main example of success in the efforts of goernmental and non$goernmental cooperation in global health care<

•€€€€€€€ !ailure: #ate of mothers dying in childbirth hasn%t changed afterdecades of deelopmental aid Midwies were taught proper sterili)ation

techniues and when to send patients to hospitals, but the problem was the care proided in the hospitals was inadeuate

•€€€€€€€ "uccess: A?D" rates leeled off

. 2hat are some of the authors% suggestions for addressing the Millennium Deelopmentaloals set by the 5 in the year .111<

•€€€€€€€ (ommit to a comprehensie approach to health

•€€€€€€€ Address ?nefficiency in Aid

•€€€€€€€ Build Focal*ational (apacity

•€€€€€€€ #educe child mortality

•€€€€€€€ ?mproe women%s health

•€€€€€€€ !ight 8?@*A?D"

•€€€€€€€ !ight 9uberculosis

•€€€€€€€ !ight Malaria

•€€€€€€€ Decrease 4xtreme =oerty and hunger

•€€€€€€€ #edefine foreign aid policy and goals

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•€€€€€€€ #ecogni)e the full scope of human rights

3 Are the authors more in faor of non$goernmental organi)ation efforts or goernmental

effortsWand why<

9hey are more in faor of goernmental efforts, because there is no accountability for non$goernment aid G%s don%t answer to anyone Also, goernments can better prioriti)e on alarger scale, and can build up infrastructure

0 ?f the global "outh embraced the Alma Ata Declaration of 'CK3, why were its goals notmet<

9here was a lack of necessary funds and collaboration in order for the goals to be completed

Under!tandin" #olk Medicine $ %onnie %& O'onnor and (avid ) H*++ord

?ntroduction

$ (ultural 4olution $ medicine has deeloped 6upward6 to modern practices

$ eerything else has drifted downward, is 6primitie

$ assumed that traditional practices are outdated will be replaced by biomedicine

$ other extreme: folk medicine is old knowledge, truth

Defining

$ relatiely oral transmission

$ unofficial with respect to dominant cultural forms

$ identified by ethnicity, cultural heritage, regional influence

=ragmatic ature

$ wouldn%t be used if it didn%t work

$ complex systems that coer broad content

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$ no formal licensure, but still methods of legitimi)ing practitioners

$ like language $ operate within scope of system

(ore (oncepts

$ health as harmony $ hot*cold, yin*yang etc

$ interrelation of body, mind, spirit $ unlike (artesian dichotomy, each can cause troublein others

$ @ital force$ disturbance of leads to illness

$ magical and supernatural $ often in sources of disease

$ thoughts and emotions as etiologic factors $ emotions contribute to disease

$ concern with underlying causes $ treat underlying as well as immediate disease causes

$ 4nergies and transference $ positie and negatie healing

$ Moral tone $ inherent goodness of nature, responsibility for good behaior

Disease (lassification

$ natural and unnatural

!olk ?llness

$ largely a construct of academia, used to downplay reality of way folk system describesillness

$ soul loss

=ractitioners

$ general and specific

$ often attributed with innate ability

$ dreams and isions contribute to ability

=ractices

$ #eligious, spiritual, magical ob+ects

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$ atural substances

$ physical therapies $ bonesetting

?nteraction with other systems

$ most people use ariety of systems

Hon" -rticle $ %onnie %& O'onnor

4mergency '

$ Mr F determined to hae lier problem, recommend immediate transplant

$ complicated by cultural difference

$ illness has to be debilitating, notion of underlying condition unheard of

$ can>t see issue as life threatening

!amily and (ommunity

$ 8mong make decisions with all releant family members

$ doesn>t want to show his own opinion, might sway family

$ family doubts American physicians

=roper treatment of body

$ primary nutritie food is rice

$ insulted when doctors wouldn>t let him eat

$ fear*mistrust of American physicians, hear bad rumors about their practices

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$ sickness has natural cause, supernatural reasons for ictim selection

$ risk of dying during surgery would lead to a spirit R bad luck

(onsiderations of the Fier

$ locus of character and motiations

$ description of F>s condition defied cross$cultural consensus, can>t hae physical illnesswith no physical manifestation

"oul Foss

$ inhibits passage to underworld

=redestination

$ don>t agree with western notions of risk*benefit

$ see implanting a 6dead6 lier as trading down

$ death is determined, shaman can bargain for extension, but if not granted then it>s timeto die

Feaing and 8ealing strategies

$ underwent seeral therapeutic methods administered by family

$ aided by shaman, scarce in 5"

.nd Gpinion

$ Dr G more considerate, F more trusting of him

.nd 4mergency

$ with no more physical signs, no reason to adhere to treatment regimen, second criticalepisode

$ labeled as 6uncooperatie6

$ feared following adice of this hospital because he would be 6switching allegiances6

$ Dr G called back, carefully explains disease, coninces them of F>s condition

$ transplant out, can>t risk lier on a non$compliant patient

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$ F becoming more accustomed to American health care, but still sees problem with lackof understanding for 8mong

(i"e!tion in I!laic Medicine $ %yron )& .ood

9hroughout history idea of opposing ideas has been popular

$ warming and cooling, important in food

$ hot and cold a constant theme in ?slamic medicine

$ hot and cold attributes applied to foods, used to craft therapeutic diets

Body systems

$ progression of food through body heats it

$ @ital Breath $ blood heated*cooked in body, combines with breath

$ bile is a byproduct of blood cooking

$ poorly digested food R false heat, stagnation or rotting R opposite of cooking

$ creates morbid humors

$ medicine is determining good humors from morbid

8ot*2arm and (old

$ also used to describe social relationships

$ example of polarity and analogy present in many forms of science

$ pure ersus impure in religion

$ opposites are symbolic as well as practical

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$ relate to gender differences

$a(id Hufford! ,nclusionis (I Reductionis in the study of ulture)Bound Syndroes

• #esponse*reiew to "imon & 8ughes% 9he (ulture$Bound "yndromeso (ross$cultural utility of the D"M$???$ integrate the culture$bound syndromeso 9axon$ from biology, grouping based on similarity without specifying the leel of

abstraction of that similarity, and a less than final grouping #efers to sets of similar behaioral clusters without the metaphorical

excess of using local terms for cross$cultural reference• 9heoretical orientation raising issues and uestions of theory and method within the

disciplines of anthropology and psychiatryo inclusionist- orientation$ 7#obert 8ahn, includes enironmental, cultural,

psychological, biological factors as interacting shapers and determiners of human experience and behaior

o Biological biological plus psycho$social psycho$social forms of analysis• ?nclusionist perspectieo Between exclusionist- approaches: biological G# psychosocialo "ame type of eent can occur, different meaning amongst cultures

• 4xclusionist$ positiist, uniersalisto #eflects disciplinary ideologies interdisciplinary• (arr%s definition of a culture$bound syndrome: distinct repertoire of behaiors that hae

eoled as the result of a social learning process and are locally defined as illnesses• !ew admit culture is a superficial facade- but consistently gie primacy to underlying

material causes

• (ultural materialism$ priority to the study of infrastructural ariables as determinatieand assumes the real infrastructure to be material rather than intrapsychic or social

• ature nurture• Discussion of the old hag attacko 8ae you eer awakened feeling like you couldn%t moe<- 8ae you eer

had the old hag<-o 4xample of the underestimation by scholars of the difficulty of accurately

deriing the distribution and nature of eents from the distribution and nature of reports aboutthose eents$ central flaw of the culture$bound syndrome literature

Sno"+ hapter N O 8To Be Healthy 7ou Must Ha(e Good Blood

Background

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$ Dr frustrated when Mrs 9hompson, a patient, did not disclose that family hadhistory of high blood pressure "he responds, ? didn%t know high blood pressure was adisease.-

$ #aises important uestion for social scientist obsering a clinical setting: whether

or not to interene-

o "now wonders if she should say something to mother using folk medicineinstead of biomedical treatments

(onceptions of Blood

$ (ontrasting ideas about the blood and its functions contribute importantly tomisunderstandings between physicians and African American patients in clinicalsettings-

$ Blood is a health cultural focus- for groups of African descent J including8aitians, Bahamians and African Americans of the southern 5"

$ ?n the traditional system blood is a substance in constant flux, responding to aariety of external and internal stimuli in a ariety of ways-

o 4xternal factors include J season, temperature, emotional triggers, lack of bodily cleanliness, positions of heaenly bodies

o ?nternal factors include J food, lack of internal cleanliness, disruption ofnormality due to illness

$ Blood may be too high,- too low,- too thick- or too thin-

9hin*9hick

$ Blood expected to get thinner or thicker due to changes in climate, season Jabnormal when it is too thick or too thin

$ (old climate causes blood to thicken, warm causes it to thin

$ Gther factors: age, special life stages 7ie puberty, foods, remedies

$ 4xample J older people hae thin blood, therefore become cold more easily

$ 9hin blood J associated with enhanced ulnerability to illness

$ "ome informants donated blood to keep it from becoming too thick-

$ "alt makes blood thicker

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$ Must maintain balance J too thick or too thin is bad

$ connection between blood thickness, cold, and low blood olume-

=urity*?mpurity

$ Aboe all, the blood must be kept clean-

$ 2hereas blood can moe from a thinner to thicker state and back without being perceied as abnormal, it can neer change from a pure to an impure state without beingseen as unhealthy-

$ Bodily processes important for release of impure substances J regular sexualactiity preents buildup of sexual secretions, while too much sex is also bad; impuritieseliminated ia feces, urine, sweating, menstruation for women

$ Manifestations of impurities: increase in body heat and*or skin eruptions

$ #emedies to purify blood 7also used to thin blood J catnip tea, sassafras tea, pokegreens, sulfur and molasses, cream of tartar, castor oil, and 4psom salts

$ bad blood- J contamination of blood J used to describe syphilis, 8?@*A?D" Jshows the way that new pathologies 7like A?D" become incorporated into traditionalsystem

"now, (hapter I J "o Many Different 9ypes of 9hings 2ill #un our Blood 5p-

8igh Blood

$ Most commonly identified health problem in "outhern African Americancommunities according to surey results

$ Gften conflated with high blood pressure and hypertension

$ =ossible definitions for high blood,- often used interchangeably with high blood pressure- and hyper tension-

o 8aing too much blood, haing blood located high in the body,- haing blood that is too sweet

$ 9emperature, diet, and emotional upheaal can cause high blood

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$ "ymptoms associated with high blood: feers, colds, nausea, headaches, di))iness,short memory, nosebleeds 8eadache is a key symptom-

$ Difference between traditional high blood- and orthodox high blood pressure-

o

?f symptoms are not present, blood is not high, therefore medicine is notnecessary

o 9his isa ma+or problem from the iew of the health professional,- as patients with high blood pressure but no symptoms may not see themseles asneeding medication

$ 9raditional treatments for high blood

o =reentatie $ Aoidance of food and drink associated with high blood Jincludes salty, greasy, foods, red meat 7especially pork, and sweets

o #ubbing of substances, like inegar or plant remedies, consuming certainfoods, like garlic, teas made from herbs to bitter- sweet blood

o 4psom salts, inegar, lemon +uice, honey

Fow Blood

$ Fess freuently mentioned than high blood by patients

$ ?ncorporates two biomedical categories J low blood pressure and anemia

$ 9raditional iew J not enough blood, blood that is too thin, blood located low in the body, blood that is too bitter

$ (auses J consumption of alcohol, improperly balanced diet

$ "ymptoms J lack of energy, constipation

$ 9reatment J foods and beerages that build blood- J sassafras, sugar, salt, sweets,red meat

o Many of these treatments are high in iron, this blurs differences that exist- between traditional and orthodox systems, as low blood and anemia areconflated ?ron pills become a treatment for low blood, een if it is not actuallyanemia

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Most important thing about traditional iew of blood is that balanced must be maintained 9hiscan be between hot*cold, high*low

Glass)offin O 8Reflections on the E-perience of Healing! 5hose *ogic4 5hoseE-perience

9he Account-

$ 2hile liing in =eru, the author%s friend%s grandmother had died because ofsorcery

$ "he had become sick because a neighbor had gien her hueso de muerto 7powdered

human bone in a roast pork, a acuired from a sorcerer

$ 9he neighbor had thus purposefully harmed the grandmother, using sorceryDoctors were unable to identify a water or food borne illness

9he #eaction-

$ "tudents ask if the author actually beliees in sorcery

'st

response $ 9he Fogic of "orcery

$ (oncept of interpretie drift- J process by which people come to iew magic as aefficacious and rational explanation of eents-

o ' acceptance of illness label and etiology

o . emotional engagement or catharsis

o 3 experiential change in consciousness due to insight- or reelation-about the illness as offered by the healer

o 0 @ictim now has sense of insight and confidence about the healer, whohas lead the ictim to a sense of master oer the illness-

o 9hus, interpretie drift proides a ery rational explanation for aseemingly irrational belief and practice-

.nd response $ 9he Fogistics of "orcery

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$ !unctionalist explanation for sorcery J examines utility of cultural beliefs insoling problems

o 9hese explanations focus on the way that sorcery is a pro+ectiemechanism- for hostilities stemming from limited resource aailability and

competition

$ "tructuralist iew, symbolic iew

$ All three of these are assertions of cultural relatiism that smacks ofethnocentrism-

o 2hat may be true for others is not true for ourseles-

o 9hus, these analyses dismiss sorcery from serious- consideration withinour own intellectual tradition

3rd response $ ?ntersub+ectiity in Fogic and 4xperience

$ ?n order to understand, one must lie and do as the informants J experientialfieldwork-

$ otion that reality is shaped somewhere in the interstices between external eentand perception or meaning gien it-

$ ?nterpretation and understanding then go hand in hand with experience

$ 9hus, instead of dismissing that which is difficult to measure or obsere as patently unscientific,% we should seek new ways to measure, replicate and alidateempirical experiences that go beyond those aailable to a detached, ob+ectie% obserer-

(onclusion: 4xperience #econsidered $

$ Author has seen, experienced things that she cannot explain or replicate

$ Model for explaining sorcery that makes sense to eeryone is difficult to create

$ Ambiguities of empiricism-

$ ?mportance of the role of experience in Anthropology

Helan+ 85hy Medical Anthropology Matters

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$ Distinct discipline for the past 31 years

$ Draws from anthropology, epidemiology, genetics, medical history, literarycriticism, semiotics, clinical medicine and psychiatry

$ Medical anthro has become more important in a global- world, with itsincreasingly complex medical pluralism-

$ Also, world now faces daunting health problems-

o 01 million liing with 8?@*A?D"

o 31$011 million cases of malaria each year

o =roblems of oerpopulation, urbani)ation, especially in deelopingcountries

$ Medical anthropologists must apply their work to help sole these pressing real$world issues

o global solutions- to global problems-

$ Another reason J issues created by new areas of medical research J genome pro+ect,stem cells, biotechnology, genetici)ation- of medicine and psychiatry

o 4thical implications

o "ocial effects

o 2ho will these changes benefit<

o Medical Anthro can help answer thes uestions

$ Author recommends that different types of professional experience een if they originate beyond the borders of anthropology,- be welcomed into the discipline "uch an eclecticapproach can only benefit, and enrich, anthropology-

Brady) Adler+ ,ntegrating %ersonal Health Belief Systes

$ 9his article discusses the misconception that nobody really uses alternatiemedicine anymore and the new combination of both systems

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$ (omplementary and alternatie medicine 7(AM is a broad domain of healingresources that encompasses all health systems, modalities, and practices and theiraccompanying theories and beliefs, other than those intrinsic to the politically dominanthealth system of a particular society or culture in a gien historical period- 7Fogics, ''I

$ Gerwhelming ma+ority of users of (AM also use biomedicine

$ "tereotypes that come with the eolutionist and surialist theories: these are practices that most of the modern world do not use and hae to do with location andsocial status

$ Case study on Women’s reast Cancer treatment choices

o Gn going year ualitatie study of treatment decision making on the partof women with breast cancer

o Disclosure was a ma+or issue with patients$ if a physician does not generallyseem interested in the patient%s use of (AM, the patient simply would not mentionit at all

4asier to discuss their alternatie treatments when they thought that the physician expected them to be using (AM

o populist- orientation$ an approach that links well with the patientconsumerism that is so influential in the phenomenon of (AM 7it is a strength offolklorists

o 8olistic nature of many (AM healing systems

Bourguignon) Suffering and Healing+ Su'ordination and %o"er! 5oen and %ossessionTrance

!ntroduction

$ =rimarily women with possessions with spirits$ either for worship or foraccommodation and healing

$ 2omen usually are often both leaders and participants; Men are generally exorcists,while the women are the ictims

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$ Acting out the identity of spirits in ritual possession trance offers womenacceptable, and consciously deniable, way to express unconscious, forbidden thoughtsand feelings, particularly in situations of social subordination- 7N

What is possession trance"

$ 5sed to be thought of as hysteria, which used to be a female disorder J (harcot

$ Dissociation$ a psychological mechanism, producing an alteration of consciousness,so that there appears to be a discontinuity of identity, accompanied by alternations in self presentation and appearance, in sensations such as analgesia, in memory and more Jessential to possession trance

#xplanations

$ 9rance is in response powerlessness of women

$ "aar 7or sar or )ar cult spirits used in different cultures, including the study on"omalia and "udan J need an exorcism to get the spirit out, need husband%s materialgoods to sae the wife

#mic #xplanations

$ @ariety of explanations of trance

$ "uffering and the capacity for suffering become preconditions for the acuisition of power, including the ability to heal

$ Men don%t usually participate because being submissie to spirits who chose to possess them make men appear to be passie

$ymolic %imensions o& #mic #xplanations

$ "pirit possession linked to femaleness-

$ Marriage, explicit or implied is a freuent formulation between the human and thehost 7spirit

o

?noles sex and procreation, power and control

$ Gne example of reproduction and birth$ women are possessed by the spirits ofyoung men who died during initiation$ birth of special power by ritual birth of the menwho did not complete the process

$ "exual symbolism of spirit possession$ loe and sex; horse and mount

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$ Middle class households and working class households J women are ideally seen asguardians of the home, which is regarded as an autonomous place different form theworkplace

$ Medical culture has a powerful system of sociali)ation which exacts conformity as

a the price of participation

$ (onseuences of medical lexicon$ women%s bodies are shown as statistics Jinfluences how women iew their own bodies

Documents

ANTH-250 Medical Anthropology