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Chapter 4

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PSYC 3110
Kieran O' Doherty

Chapter Four (Pg 64-78): Culture and Health - Since we are cultural beings, an understanding of health beliefs and practices requires an understanding of the cultural, historical and social context within which we live - It is impossible to extract humans form the context that gives them meaning - Culture: a system of meanings and symbols which shapes every area of life, defines a world view that gives meaning to personal and collective experience and frames the way people locate themselves within the world, perceive the world, and believe in it - An understanding of people’s reaction to illness requires an understanding of these culturally specific health belief systems HEALTH BELIEF SYSTEMS - as societies evolve they have developed various health belief systems, knowledge of which is sometimes confined to those who undergo specialized training - this gives rise to the separation of expert or technical belief systems to the traditional folk or indigenous systems - these distinct beliefs interact and are in a process of constant evolution - most people organize their beliefs in traditional folk manner, which are connected in some form with the expert belief system - Kleinman (1980) distinguished between three overlapping sectors of any health case system: - (1) popular sector: refers to the lay cultural arena where illness is first defined and health care activities initiated - (2) professional sector: refers to the organized healing professions, their representations, and actions - (3) folk sector: refers to the non professional, non bureaucratic, specialist sector that shades into the other two sectors - these three health sectors both reflect and contribute to broader world views - other researchers have preferred a simpler two fold division into professional and popular realms - the broad classification avoids an accusation that certain specialized health belief systems are classified as folk when they have limited status in society although they may have an extensive codification of health complaints and treatments - these two broad systems do interact as the lay person can draw upon more specialized knowledge but also the specialist will make use of more popular knowledge - blumhagen (1980) says that these two belief systems should be considered distinct from the individual belief system that the individual uses to understand their personal experience of illness - an understanding of popular health beliefs requires an understanding of the dominant expert health belief systems Western Health Belief Systems Classical Views of Health - classical views of H and I in the West is derived from the Graeco-Arabic medical system are referred to as galenic medicine and it provided an expert system developed from the greeks, in particular Hippocrates and his colleagues - central concept is the balance of four bodily fluids or humors (bile, phlegm, blood and black bile) - balance implied health, and imbalance implied ill-health - the fluids are linked with the four seasons (an excess of phlegm was common in the winter leading to colds, etc) the four primary conditions (hot cold wet and dry)m and the four elements (air, fire, earth and water) - medieval scholars also added four temperaments (choleric, sanguine, melancholic and phlegmatic - this system placed responsibility on individuals to look after themselves, ill health was a consequence of natural processes and not a result of divine intervention Christian Ideas - during the middle ages in europe, galens work became confined more to a few individuals, and other ideas based upon religion became more commonplace - illness was seen as punishment for human kinds sinfulness - the church’s seven deadly sins even came to be associated with pathological conditions of the body - ex. pride was symbolized by tumors and inflammations while sloth led to dead flesh and palsy - christianity drew upon different traditions - the ascetic tradition scorned concern for the body and instead promoted acts such as fasting and physical suffering, which supposedly led to spirituality - with the protestant reformation this belief was replaced with the idea that the body had been given to humans by god.. it is the persons duty to look after and care for the body - illness was seen as a sign of weakness and neglect - honoring god= living a healthy life, and abstaining from excess, esp in terms of sex and diet - poor expected to take responsibility for their condition while at the same time the rich were wrong to indulge themselves while there was so much poverty and suffering - the religious interpretations began to decline with the growth of medical science Biomedicine - two streams of thought in knowing the world dominated during the enlightenment - the first was acceptance of the distinction between superstition and reason - the second was positivism that emphasized that science based upon direct observation, measurement and experimentation gave direct access to the real world - this approach concentrated attention on material reality and a conception of the body as distinct from the mind - Descartes (1596-1650) conceived of the human being as composed of mind and body - 18th century saw the rise of individualism in western society - professional understanding of health and illness became more closely entwined with knowledge of the individual physical body - Foucault (1976) described how between the mid eighteenth and mid nineteenth centuries the ‘medical gaze’ came to focus on the interior of the human body .. symptoms of illness now became signs of underlying pathophysiology - patient query goes from “how do you feel?” to “where does it hurt? - stethoscope became symbol of having insight into the bodily interior - this approach became known as the biomedicine: cosmopolitan or allopathic medicine - the focus on the body is in accord with the western emphasis on the individual - biomedicine separates the person from the body - the dominance was achieved, but it did have resistance as it required strong political action to organize the profession of medicine and to take legal action against other health practitioners The Biopsychosocial Model of Health - the dominance of this biomedical system has come in for substantial challenge both from the scientific establishment and the public - this was reflected in a call for more attention to the psychological and social aspects of health - this led to the development of the biopsychosocial model of health and illness - the various aspects of health and illness can be organized in a hierarchy from the biosphere and society down through the individuals level of experience and behavior to the cellular and subatomic level - in some respects this model has replaced the basic biomedical model - there is an emphasis
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