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Chapter 4

Anthropology - Chapter 4 - Illness and Death.docx

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Karen Slonim

CHAPTER FOUR – ILLNESS AND DEATH Ethnomedicine  Ethnomedicine: study of cross-cultural health systems  Health system: perceptions and classifications of health problems, prevention measures, diagnosis, healing and healers  Western biomedicine (WBM): healing approach that emphasizes technology in diagnosing/treating health problems related to human body Defining and Classifying Health Problems  Disease: a biological health problem that is objective and universal (ex. Bacterial/viral infection or a broken arm)  Illness: a culturally specific perceptions/experiences of a health problem  Labeling/classify health problems by cause, vector (how it gets to humans), affected body part, symptoms  Elders pass down knowledge about ethnomedicine  Western biomedicine: medical experts have to agree how to label/classify health problems according to scientific criteria  One culture will not necessarily recognize a health problem from another  Culture-specific syndrome: health problem with a set of symptoms associated with a particular culture  Somatization: process through which body absorbs social stress and manifests symptoms of suffering  Ex. Susto (Latino people): “fright/shock disease” from losing a loved one or having a terrible accident  Ex. Anorexia nervosa (Western cultures): not eating Ethno-Etiologies  Ethno-etiology: cross-culturally specific causal explanation for health problems/suffering  Bahia people have multiple understandings of etiology: o Natural causes: head causes dehydration, some winds cause migraines o Psychosocial causes: emotions like anger and hostility cause health problems o Supernatural causes: spirits and magic can cause health problems o Structural causes: economic resources, proper sanitation and health services  Western biomedicine has scientific understanding: o Exclude structural issues and social inequality as causes of illness o Structural suffering: health problems caused by poverty, war, famine, forced migration Healing Ways Community Healing  Private healing addresses bodily ailments in social isolation  Community healing encompasses social context as crucial to healing  Usually non-Western systems use community healing  Ex. Ju/’hoansi healing: emphasizes mobilization of community “energy” as key part in cure (healing dance) Humoral Healing  Balancing certain elements within the body and person’s environment  Food and dugs have different effects on body  Classified as “heating” or “cooling” (does not meant temps)  Diseases happen because of too much heat or coolness  Fixed by diet and behavioral changes that restore balance  India, china and Arabic health systems o Define health as balance of opposing elements within body o Say death is a result of too much coolness  Indigenous people say o Heat is cause of death, menstruation, violent emotion, aggression and drunkenness o Coolness is vital for health o Treatment of illnesses involve removing heat o Healer keep cool by bathing in cold water and sleeping far from fire Healers  Midwives, nurses, general practitioners, hospital care providers  Bonesetters: reset broken bones  Shamans/shamankas: male/female healers who mediate between humans and spirit world  Herbalists, psychiatrists, dentists, chiropractors, acupuncturists Healing Substances  Phytotherapy: o Healing through the use of plants o Used for gastrointestinal disorders, skin problems, wounds, sores, pain relieve, infertility, fatigue, altitude sickness o Ex. Andean people use coca leaf to treat gastrointestinal problems, sprains, swellings, colds  Minerals can also be used for healing: o Ex. Bathing in water with sulfur cures arthritis and rheumatism o Bathing in the Dead Sea and using mud from shore cures psoriasis  Use “radon spas” to relieve symptoms of arthritis  Pharmaceutical medicines are popular worldwide (also have negative side effects of overdose and stuff) Three Theoretical Approaches The Ecological/Epidemiological Approach  Examines how natural environment interacts with culture to cause health problems/influence spread throughout population  Research should focus on food distribution within family, sexual practices, hygiene, contact with outsiders  Want to find things relevant to public health programs  Can find out who is at highest risk for certain problems  Dense populations more likely to experience more health problems  Settled pastoralists have more health problems, are shorter and fatter because eat less healthily and do not exercise as much  Cities provide stressors to human health but also greater access to healthcare  New World brought smallpox, measles and malaria to Indigenous people who were not resistant to them  Historical trauma: transfer of emotional/psychological effects of colonialism from parent to child  Can help explain distribution of contemporary health problems The Interpretivist Approach  Study how people in different cultures label, describe and experience illness  Examine different healing processes  Healing systems provide meaning to people experiencing meaningless form of suffering  Offers psychological support to suffering  Can be related to the “placebo effect”  In US: between 10-90% of effectiveness of prescription is from placebo effect  Could be enhanced by confidence of doctor, getting a prescription at all, colour/shape of the pill Critical Medical Anthropology  Analyze how structural factors affect health system (types of illness, health status, access to health care)  Study global political economy, global media, social inequality  Medicalization: treating problems caused by poverty with pills/medicine  Need to be better nourished, not treated with pills  Social Inequality and Poverty o Poverty is primary cause of sickness and death o Rich people die from cancer, HIV/AIDS, alcohol, smoking o Poor people die from TB, malaria, HIV/AIDS o Child malnutrition increases as income decreases  Cultural Critique of Western Biomedical Training o Improved by: relying less on technology, broadening understanding of health problems, diversifying healing o View medicine as steps to follow, not focusing on patients experience o Medical students taught to be interested in machines not humans o Taught dehumanization (to be inhuman) Globalization and Change New Infectious Diseases  Scientific advances (antibiotics, vaccines) improved sanitation and reduced threat of infectious diseases  Likeliness of exposure/contamination is increased through o Travel/migration: spread of HIV/AIDS and SARS o Deforestation: malaria because of change of habitat of mosquitos o Development projects: constructing dams and clearing forests cause health problems for local people Diseases of Development  Disease of development: health problem caused/increased by economic development projects  Construction of dams lead to diseases called schistosomiasis caused by presence of parasitic worm in blood system  Caused by dams slowing rate of water flow  Larvae can develop in slower waters Medical Pluralism  Medical pluralism: presence of multiple health systems within a society  Usually: Provides clients with many choices for healing  Enhances quality of health  Or: confronted by conflicting models of healing/illness  Misunderstandings between healers and clients  Selective Pluralism: The Case of the Sherpa o Three varieties of healthcare exist in Upper Khumbu region in northeastern Nepal o (1) Orthodox Buddhist practitioners: consult for prevention and cure through blessings – a humoral healing system o (2) Unorthodox religious practitioners: perform divination ceremonies for diagnosis o (3) Biomedical practitioners: work in clinic first established for tourists but now Sherpa use o Western biomedicine incorporated but did not take over traditional  Conflicting Explanatory Models o Miscommunication occurs between biomedical doctors and patients o A prescription taken with every meal means three times a day but some people do not eat three times a day Applied Medical Anthropology  Applied medical anthropology: application of anthropological knowledge to further goals of health-care providers  Improving doctor-patient communication in multicultural settings  Culturally appropriate health intervention programs  Providing insights about factors related to disease that doctors do not usually take into account  Reducing Lead Poisoning among Mexican American Children o Robert Trotter o Mexican Americans use traditional healing remedy that contains lead to treat culture-specific syndrome (empacho) o Empacho: indigestion and constipation o Made US government place restrictions on using this healing o Made recommendations for a substitute treatment  Public Health Communication o Anthropologists help health educators develop meaningful messages by: o Addressing local health believes/concerns o Taking local illness terms seriously o Identifying subgroups who are responsive to different messages/incentives o Monitor response of communities to health messages o Making corrections in communities when needed o Exposing/removing “blame the victim” health messages o Cultural broker: anthropologists who are familiar with two cultures and can promote communication/understanding between them  Promoting Vaccination Programs in Developing Countries o People often suspicious or scared about vaccination programs o Cause them to reject them o Medical anthropologists conduct surveys to understand why o Results: parents do not know what vaccines protect against, people do not understand importance Culture and Death  Levels of deaths causes considered are: o Proximate – closer to actual outcome (ex. Infant died of dehydration, will be written on death certificate) o Intermediate – closer look into why the baby was dehydrated (could have been malnourished causing diarrhea and therefore dehydration) o Ultimate – analysis of deeper economic, political and social factors that put baby at risk of dying (why the baby was malnourished? maybe was not breastfed and bottle feed was diluted with dirty water or baby was unwanted so was fed less) Infanticide  Direct infanticide: death of infant/child because of beating, smothering, poisoning, drowning  Indirect infanticide: subtle process like food deprivation, failure to take care of sick child, failure to provide warm clothing in winter  Infant mortality rate: deaths of children under the age of one year per 1000 births  Maternal mortality rate: deaths of women related to pregnancy/birth per 1000 live births)  Main motive for direct infanticide is if child is deformed or very ill  Others are sex of infant, adulterous conception, unwed mother, twins, too many children already, poverty  Family Resource Constraints and Child “Fitness” o If child does not meet parents expectations may be neglected or killed o Indigenous people in Mexico culturally accept infanticide if unable to work hard like everyone else in society (ex. Child who lost foot killed) o In Brazil indirect infanticide because of harsh conditions and poverty o Infant mortality rate declined in richer areas o Poor mothers neglect sick/weak babies, send to heaven “angel babies” o China, Korea, India, Pakistan kill female babies cause prefer males Suicide  Catholicism considers suicide a sin so lower in those societies  Buddhism does not consider it a crime, sometimes used to make a statement  Suicide terrorism: suicide of one or more people with intention of killing other people as well (ex. suicide bomber)  Martyrdom: person facing death for a scared cause (many religions support)  Islamic people think that if they die for a heroic reason will not go to hell  Suicide can be considered honourable in Asia and South Pacific  Sati: suicide of wife after husband dies (in India)  Wives sometimes blamed for husbands death, lose status, feel shame  Suicide rates have risen  Most prevalent in industrialized/urbanized societies  Suicide in US and Canada is highest for First Nations because of stress of identity/self-definition, stress of isolation, stress of changing intergenerational relations Epidemics  Diseases that spread rapidly and widely through populations  Challenge people social and psychological coping mechanisms  Major epidemic: HIV/AIDS  Many children in Africa left parentless because of HIV  10 million children under 15 lost children to AIDS Violence  Direct: someone kills someone with a weapon  Indirect: government does not provide food after disaster  Private Violence: Wife Killing o Middle East: husband kills wife or daughter to protect family honour o Canada (1997): 1 in 8 women living with a man abused at some time o Femicide: murder of female because they are female o In India is related to low value of women, want to take their wealth o Set on fire  Public Violence o Warfare: leading cause of death in males in horticultural societies o Require large territories so groups fight with each other for land o Gen
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