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Lecture 2: Illness

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McMaster University
Andrew Wade

September 12, 2012 Illness MedicalAnthropology  Traditionally a subfield of cultural anthropology  One of the most rapidly growing areas of research in anthropology  Closely to linked to other subfields (especially biological anthropology)  The study of human health and disease, health care systems, and biocultural adaptation  Highly interdisciplinary, linking anthropology to: o Sociology o Geography o Economics o Medicine o Nursing o Public Health Ethnomedicine  Cross-cultural study of health & health care systems  Has been a focus of research since the early days of anthropology  Term first came into use in the 1960’s o Early use of the term was ethnocentric  Referred only to non-Western health systems  Was synonymous with ―primitive medicine‖ What is a Health System?  Ahealth system encompasses: o Perceptions & classifications of health problems o Prevention measures o Diagnosis o Healing (magical, religious, scientific, healing substances) o Healers  Acultures have a health system  Encompasses health systems everywhere Defining and Classifying Health Problems  Western labels often don’t correspond to the labels in other cultures Potential Base for Labelling/Classifying a Health Problem  Cause  Vector (means of transmission)  Affected body part  Symptoms  Any Combination American Indians of the Washington Oregon Region  Many popular stories refer to health  Stories convey messages about how to: o Prevent health problems o Avoid bodily harm o Relieve afflictions o Deal with old age Subanun People (1950s)  Horticulturists living in the highlands of Mindanao (Philippines)  Egalitarian people  Everyone (including children) had substantial knowledge about health problems Disease-Illness Dichotomy  Aset of concepts used by medical anthropologists to sort out the many cross-cultural labels and perceptions  We use them interchangeably in daily life, but in medical anthropology there is an important distinction between illness and disease Illness  Culturally specific perceptions & experiences of a health problem o ―I don’t feel well‖ o ―I’m tired all the time‖ o ―The pain is mostly in my back‖  Could be due to psychological/spiritual imbalance Disease  Biological health problem that is objective and universal o Bacterial/viral infection o Broken arm o Tooth decay  At the root of the experienced illness Explanatory Models  Why people get sick  Product of culture Hippocrates (460 BC Greece)  Most influential explanatory model  Western doctors still take the ―Hippocratic Oath‖ to do no harm  Believed that the body should be treated as a whole Four Humors – The Hippocratic Humoural Theory of Disease  In the ancient world they believe that the airs, waters, and places were the most important aspects of an individual’s health  Four waters in particular—the four humours—were most important  Imbalances in the humours could cause serious health problems o Counteracted through dietary & behavioural changes  Where you were and what you ate & drank could affect your health  Believed that everyone had dominant humours  Could tell a person’s humour by his/her complexion  Humoural healing has been practiced for thousands of years o Ancient Egyptians conceived of the body as filled with tubes through which the heart pumped a variety of substances (blood, air, feces, ect.) o Indigenous humoral systems exist today o Indian, Chinese, andArabic health systems all define health as the balance of opposing elements within the body.  Humours could even influence a person’s temperament: 1. Blood Organ: Heart Temperament: Passionate and sanguine Too much blood: hot and wet 2. Phlegm (Water) Organ: Brain, lungs Temperament: Sluggish and dull Too much phlegm: cold and wet 3. Yellow Bile (Choler) Organ: Liver Temperament: Choleric or quick to anger 4. Black Bile (Gall) Organ: Spleen Temperament: Melancholic and depressed  Hot injury or illness had to be treated w/ and cold remedy & vice versa  All diseases came from the same cause: being ―out of humour‖ Blood Letting  Most people were thought to have an excess of heat & moisture  Service that barber’s used to offer o Red and white barber pole symbolized blood and tourniquet th th  Popular in the 18 and 19 centuries  Still used in parts of the world today o India Miasma Model  View of the 1600’s Europe that disease came from harmful air, especially from the smell/fumes of tainted or decaying matter  Disease was locally based  Disease was a natural condition of the earth  Quarantine and sanitation were seen as ineffective Contagionist Model  View that disease was spread through contact with a germ—an animated particle invisible to the naked eye  Citizens could be protected by quarantine & sanitization Hot-Cold Theory of Disease  Latin-American folk medicine  An extension of the Hippocratic Humoural Theory th th  Carried to the West by the Spanish and Portuguese in the 16 and 17 centuries  Emphasis on the body in balance  Avoids imbalances of hot and cold in food, drink and environment Germ Theory of Disease  The most important model in Western modern medicine  Relied on innovations of the time o Microscope technology o Investigation of the microscopic world  Robert Koch th o 19 century o Introduced the idea of disease specificity  Each disease was caused by a specific/unique microorganism  Louis Pasteur o Founded of microbiology o Found the disease was caused by damage to the tissues, impairing the normal function of the body Western Biomedicine (WBM)  Ahealing approach based on modern Western science  Emphasizes technology in diagnosing & treating health problems  An ethnomedical system  Body as a functioning/malfunctioning machine  Heavily based on techno-chemical solutions  Focuses on ―repairing‖ the body  Concerned with the action of microorganisms  Treatment = kill the microorganism -> kill the disease  Divides the world into self and non-self Ethno-Etiologies  Across-culturally specific causal explanation for health problems & suffering  Biomedical etiologies tend to exclude structural issues and social inequality as causal factors of illness Natural Explanations  The effects of aging, heredity, personality, and gender Psychosocial Explanations  Emotions, such as anger & hostility, cause certain health problems Spiritual Explanations  Spirits & magic can cause health problems Structural Explanations  Lack of economic resources, proper sanitation, and health services Structural/Social Suffering  Aterm used by medical anthropologists  Refers to health problems caused by poverty, war, famine, and forced migration  Effects range from anxiety/depression to death Culture-Specific Syndrome  Ahealth problem with a set of symptoms associated with a particular culture  Social factors (stress, fear, shock) are often the underlying causes  Biophysical symptoms are involved  Can be fatal  Medical anthropologists first studied culture-specific syndromes in non-Western cultures, creating the bias that they only exist in ―other‖ cultures Sufriendo DelAgua – Suffering from Water  Immediate cause is lack of water for drinking, cooking and washing  Acommon health problem in Mexico—especially for women o Women—who are responsible for cooking/washing—feel anxious and constantly in state of tension because they cannot count on water coming from the taps on a regular basis  Lack of water puts people at a higher risk for cholera, skin/eye infections, and other biophysical problems  Structural cause: unequal development o Construction of piped water systems b
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