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October 3: When is a Disease a Disease?

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ANTH 3330
Christianne Stephens

THE EMERGENCE OF A NEW DISCIPLINE (CONT'D) ▯ Medical Anthropology Methods: • Mixed methods: live with people, study their world views, look at people in their everyday lives, is there a correspondence with what they say and what they do? ◦ interviews: they can be formal (including surveys) but typically anthropologists like more open-ended interviews, and they actually allow for a dialogic process and the consultant and inform the direction of the interview ◦ different sampling methods: more lines of evidence, more robust data • life history interview: a patient goes in to see a physician, interested in a specific health issue, you want to see the entire life history of their health: genealogy of the disease, community health and history, treatment methods, are there local or folk methods, how do they view causality, and try to understand the larger community health profile • focus groups: usually are very good when dealing with a group of like- minded individuals, that engage in similar behaviour, and that share similar world views • considering "consensus": try and look at the degree of cultural agreement within a group or between subgroups, narratives that come from these groups ◦ a lot of people from the hard sciences considers anthropology a soft science and can't define the reliability of their data ◦ qualitative data is significant when it reaches a level of theoretical saturation ◦ if you constantly hear the same stories over and over again, that is something used to gauge the accuracy and validity of what people are talking about, even thought it's "qualitative" and not technically objective • Doing diaries: to get the participant to actually write their own diaries, helpful when they need to communicate psychological trauma, abuse, and is a form of empowerment (i.e. Righteous Dopefiend) • Quantitative methods: tend to use these methods in concert with qualitative research methods ◦ adding numbers adds to the breadth and analytical nature of the study ▯ WHEN IS A DISEASE A DISEASE? ▯ Disease and Illness In the Western World: • Usually no distinction between illness and disease • terms used interchangeably • important to define and understand difference between these terms, especially when studying non-Western health beliefs and practices Illness • subjective experience of feeling unwell • can include the manifestation of physical symptoms in addition to experiences of changes involving feelings, ideas, values, language and nonverbal communication, symbolic behaviour • the way that illness is understood and manifested and enacted really depends upon one's cultural context • anthropologists shed light on the fact that the information that patients give shouldn't be seen as irrelevant, and provides important clues to medical personal regarding health world views and beliefs, which inform health behaviour and affect the efficacy or success of intervention strategies Disease • Arthur Kleinman's Definitions • In the biomedical paradigm, disease indicates abnormalities in or malfunctioning of the body, organs, or systems, a biophysical reality • it's a label, a reality, and can be materially detected • they're measurable, pathological conditions of the body: fever, blood tests, etc • it is the MD's perspective, but formalized ethnomedical systems that often use certain criteria and techniques to identify disease (Chinese, Ayurvedic, humeral system, etc) • conception of disease is not exclusive to Western medicine • Disease is what the practitioner, medical doctor, or folk healer creates in recasting one's illness in terms of theories of the disorder ◦ the biomedical has been trained through years of medical school in his area of expertise to see through the theoretical lenses of their form of practice ◦ refigures disease as an alteration of biological structure or functioning ◦ If it were another system (shamanism), they would look at disease intrusion by a foreign object, breaking of taboos, supernatural illness from supernatural forms • to understand the biomedical perspective further, what Kleinman would argue is that diseases aren't only socially constructed but the disease process is a biological construct • in this process we start to lose the patient's experience of suffering; in that process of collecting their history, the doctor is editing their narrative and transforming what you're saying so that it fits with the biomedical paradigm • power deferential, seen as biased, subjective accounts, difference in terms of knowledge, doctor is seen as being the "expert", the interaction doesn't necessarily take place on a level playing field ◦ Chinese medicine, more of a negatiational process • suffering is marginalized when identifying diseases • categorize things into clean and defined units and boundaries: classification of diseases; bounded entities, that they exist in isolation, that they're easily classified, and that there's no interaction between different conditions ◦ very limited: dynamism between diseases, cultural variables, and environmental contexts • doctor replaces subjective suffering with medical data and tests ◦ take verified and verifiable measurements ◦ certain doubt of the illness narrative, the doctor has to decode this experience, turned into "evidence" because it is now scientific, collected in a sterile and controlled environment, and turns personal illness narrative into a disease that adheres to the standards or parameters of a given, and recognized by biological pathology The Anthropology of Sickness • dualism of disease and illness was too dualistic, saw the individual as an object despite of significant events • what was missing was that social context; it was still seen as a one-to- one relationship to the exclusion of all the other variables that determine one's health ◦ power relations • anthropologists felt this dichotomy didn't account for how social relationships shape and distribute illness in society ◦ poverty and inequality contribute to a differential existence of risk • find a paradigm or conceptual framework that reintroduced the social aspect • this is where articulation and clarification of sickness came from ◦ moving from the exclusion of doctor and patient to a broader framework of understanding • moving from the dyad to the social context of disease and illness • Sickness has multiple dimensions ◦ they talk about understanding a disorder across a population, in relation to macro-social events: economic and political forces ◦ how sickness in a population is produced ◦ elements of how epidemiologists look at a condition whether it is an epidemic or endemic at the population level ◦ how a disorder become socialized ◦ each culture group has certain rules for translating signs of illness into symptoms, and for linking those symptoms to aetiologies (origins of the condition) and interventions ◦ rules for within a given culture group for using the evidence provided by interventions to confirm translations and legitimize outcomes • distinguish between the three ◦ Disease: referring to the organic pathology ◦ Illness: individual consciousness of the disease ◦ Sickness: the process or path by which disease or illness are socialized ▪ i.e. Alcoholism: how does it go to individual disorder to a social problem ▪ transforming from badness to sickness or disease • Sickness is also the social role adopted by an individual: it doesn't exist in a vacuum but is negotiated within a given society ◦ all knowledge of society and hence sickness is socially determined ◦ what anthropologists' job is to examine the social conditions of this knowledge production ▪ how do they originate, how are they enacted, reinforced, perpetuated by the formal or informal medical system, who is that transmitted from generation to generation, and how is that mediated between different players in that network Case Study: Nevra/Nerves • Pamela Wakewich Dunk, wanted to study a condition among Greek immigrants in Montreal, "nerves" • group of women who lived in Montreal, worked in the garment industry as peace workers but worked at home, limited to home environment, what was different among this specific culture group in this city • nervous disorder, but different from what the biomedical world would define as anxiety or a p
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