Health Psychology

An Interdisciplinary Approach to Health, CourseSmart eTextbook

Deborah Fish Ragin, Elizabeth D. Whitaker

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780132568579
• eBook ISBN: 9781317347897
• Edition: 1
• Topic: Psychology
• Subtopic: Emotions in Psychology
• Index: Psychology

This reader looks at both the biological and cultural aspects of health and healing within a comparative framework.

Health and Healing in Comparative Perspective provides both fascinating comparative ethnographic detail and a theoretical framework for organizing and interpreting information about health. While there are many health-related fields represented in this book, its core discipline is medical anthropology and its main focus is the comparative approach. Cross-cultural comparison gives anthropological analysis breadth while the evolutionary time scale gives it depth. These two features have always been fundamental to anthropology and continue to distinguish it among the social sciences. A third feature is the in-depth knowledge of culture produced by anthropological methods such as participant-observation, involving long-term presence in and research among a study population. For medical anthropology, medical sociology, public health, nursing courses.

Part I

Healers and Healing Traditions

All societies have healing systems for dealing with illness and injury, but they do so in many different ways. The selections in this part of the book compare medical traditions and patient-healer relationships across cultures. The purpose is to develop a decentered perspective on world health and healing. To this end, the selections include analyses of not just non-Western medical systems but also the kind of medicine that is dominant in the United States and Europe, known as biomedicine or scientific medicine. Like other healing systems, biomedicine developed in a specific cultural and historical context. It is embedded in current social and politico-economic structures and varies across cultures (see Good 1995; Payer 1996).

In North America and Europe, there is a growing interest in alternative medicine and the medical systems of other cultures among students and professors, health professionals, and the public. There also has been increased scrutiny of biomedicine and structural factors that affect the fair delivery of health services (see Baer 2001; Inhorn and Brown 1997; Lindenbaum and Lock 1993; Nichter and Nichter 1996; Romanucci-Ross et al. 1997; Whiteford and Manderson 2000). Both intellectual curiosity and dissatisfaction with some aspects of biomedicine fuel these pursuits. Some patients and health professionals decry the depersonalized, hurried relationship between patient and healer that is often a feature of biomedical care. There are inequalities in access to both private and public health services. Meanwhile, the chronic diseases which have become the major public health problems of industrialized societies are complex, long-term conditions whose multiple causes are difficult to identify and separate using traditional reductionistic approaches. Unlike many acute infectious diseases, chronic diseases defy the “magic bullet” solutions that have brought spectacular successes in the struggle between humans and pathogens.

The worldwide vision and evolutionary time frame of medical anthropology provide both tools and substantive data for the study of disease patterns and cultural responses across time and space (on comparative methods, see Ember and Ember 2001). In selection 1, Charles Leslie reviews the history of medical anthropology and the kinds of research questions it has pursued. The second selection, by Margaret Lock, raises questions about the meaning of terms such as health, disease, illness, and specific disease entities and categories. This is important because it is humans who give meaning to illness and injury. In the United States, industrial metaphors about pumps, computers, and electrical systems and military metaphors such as “battalions” of “killer” (cytotoxic) T cells and other specialized components of the immune system are common in scientific and popular discussions of bodily processes (see Martin 1994). These metaphors grow out of particular sociohistorical contexts. There is no objective, culture-neutral way to think about health and disease.

Not all cultures agree about what constitutes disease, or how to classify diseases. Disease labels come and go, as the history of “diseases” such as homosexuality makes clear (see Terry 1999). Even the broad categories of infectious and chronic diseases are permeable. Infectious disease exposure and outcome depend on environmental and constitutional factors such as nutrition, hygienic conditions, immune function, and concurrent disease, whereas infectious agents play a role in a number of chronic diseases, such as cancer and coronary artery disease. Finally, as Lock shows through cross-cultural comparison of menopausal symptoms, seemingly “natural” or “normal” life stages and bodily processes are culturally constructed. What is considered pathological in one culture may be considered unremarkable in another. The image of typical menopause in the United States is based not on the general population but on a small sample of women who visit their physicians, indicating that standards of normality itself are cultural constructions.

To scientific medicine, disease is an observable physical phenomenon that expresses damage brought on by a pathogen or an internal functional abnormality. Particular disease agents are thought to bring predictable sequences of events, such that diseases may be categorized by their causes. This perspective is very useful for the control of many infectious diseases. It is less adapted to capturing the complex forces and multiple causes of disease in different individuals or groups of individuals (what Lock calls “local biologies”). In addition, the biomedical approach tends to individualize disease and obscure other relevant factors such as family context, socioeconomic status, or environmental quality. The shift toward an emphasis on individual pathology was part of an overall transformation of Western medicine in which treatment moved from the home to the clinic, and patients came to be seen as instances of a disease rather than persons embedded in a broader epidemiological picture (see selections 3, 11; Foucault 1973).

Medical anthropologists contrast “disease” as a process involving the interaction between a host organism and an environmental insult, such as a pathogen, toxin, or metabolic abnormality, against “illness” as the overall experience of disease (see Hahn 1995). The purpose is to draw attention to social and psychological dimensions of being ill. However, the categories of disease and illness do not always go hand in hand; there can be disease without illness and illness without disease. In addition, separating the two may play into the biomedical distinction between objective signs and subjective symptoms that may contribute to a devaluing of the patient’s point of view. That is, disease is considered real but illness is not. Sickness is a term that is sometimes used to express both of the others simultaneously.

If cultural definitions of disease vary, we can expect that cultural beliefs about health also vary. The World Health Organization defines health as not a simple absence of disease, but a state of complete physical and psychosocial well-being. The General Assembly of the United Nations takes this a step further, arguing for the universal right to a quality of life sufficient to ensure the health and well-being of not just individuals but also their families. Although these definitions may be difficult to implement, the selections in this book show that they are in keeping with nonbiomedical healing traditions in which health is a dynamic process involving the entire environmental and social situation of individuals, rather than a static state of nondisease.

Various systems of classification have been proposed for comparing diverse healing traditions (see Fábrega 1997; selection 26). All healing systems have a set of components on which such contrasts may be based. These components include theories of disease causation, models for diagnosing disease, relevant treatment procedures, behavioral standards for regulating patient-healer interactions, and social systems for passing on medical knowledge to new healers.

For example, all healing systems use symbolic healing processes, from praying to saints or gods to wearing white coats and adorning oneself with medical equipment. Healing systems are sometimes classified according to the degree to which they emphasize spiritual or religious causes and treatments of disease and other forms of misfortune (see Foster 1976). Some healing systems such as shamanism openly emphasize spiritual forces, whereas others such as biomedicine or humoral medicine downplay them in favor of naturalistic factors (although there is recognition within biomedicine that religious adherence is related to preventive health-care utilization and health outcomes; see Benjamins and Brown 2004). Nevertheless, naturalistic and spiritualistic systems overlap. Selection 9 describes a Peruvian shamanic healer who also prescribes antibiotics, while selection 8 describes the role of spiritual healing practices in amplifying the effectiveness of biomedical treatment in a New York hospital.

Healing systems may also be classified in terms of social organization. In small foraging and agricultural societies, healing roles tend to be diffuse, and healers, including those who distinguish themselves as especially capable, work at other economic tasks contemporaneously. In contrast, in larger-scale, more complex societies, healing roles may be full-time professions, and medical care tends to be more institutionalized. Another way to compare healing activities is to divide them into those that occur at the popular or household level, where most illness episodes are managed (see Kitson 2003; Wayland 2001); those that are managed by folk healers operating without a formal organization to oversee training and maintain standards; and those that fall within the purview of professional medical systems, such as biomedicine or Ayurveda. As the selections in Part I show, these sectors may coexist and merge in particular cultural settings.

The authority of healers depends in part on treatment outcome, but how this is defined varies widely. For example, in healing systems that emphasize spiritual or social forces, treatment is not limited to the individual patient but may require the reconciliation of social groups or the performance of collective rituals to rectify a religious transgression. Some treatments or remedies may be evaluated in the short term, others over the span of many years.

The authority of healers and healing professions has two components. Social authority refers to one’s ability to bring about desired behavior in another person, or to achieve compliance in the other person. Cultural authority refers to the domain of knowledge and values and resides not just in people but also in objects such as medical treatises. The two forms do not necessary appear together or to the same degree (see selections 5, 6, 8–11). Where social and cultural authority are both strong, a healing profession may be able to organize and institutionalize to the point of eliminating competing medical systems. This was the case for scientific medicine in Europe and the United States during the last century, in contrast to previous times when medical professionals enjoyed relatively little public esteem or governmental support (see selection 3; Foucault 1973; Starr 1982). The past few decades have seen a questioning of bio-medicine’s social and cultural authority as a result of growing awareness of health disparities, treatment failures and medical errors, allocation of resources away from primary health care, and unsatisfactory relationships with health professionals.

Part I contains a group of four selections that focuses on the characteristics of diverse healing traditions, from localized ethnomedical systems to the “great traditions” of classical Hippocratic medicine, Ayurveda and Unani, traditional Chinese medicine, and biomedicine (see Foster 1994; Hsu 1999; Leslie 1997; Lloyd and Silvin 2002). Selection 3, by Don G. Bates, begins the set with an analysis of biomedicine as an anomalous system compared to those that preceded it and those that are now considered “alternative” to it. This is followed by Judy F. Pugh’s selection on the Indian medical traditions Ayurveda and Unani, which provides substantive detail to fill in the framework developed by Bates concerning classical medicine. Homeopathic medicine is the focus of Michael B. Whiteford’s selection on medical pluralism or the coexistence of many thriving medical traditions in Mexico. Selection 6, by Russel Barsh, discusses medicinal plant use in indigenous medical systems, raising issues about how cultures assess the efficacy of medical treatments and how healing knowledge is transmitted across generations.

The following five selections are ded...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Part One: Healers and Healing Traditions
• Part Two: Biocultural Approaches
• Part Three: Culture-Oriented Approaches
• Part Four: Special Topics and Case Studies
• References