The potentiality and challenges of understanding illness through cultural interpretation

As medical anthropologists, we have an important stake in reforming and moralizing health care practices when the opportunity arises. What do we accomplish by aspiring to this lofty goal? We are privileged in a sense to do this work because our methodological approaches allow us to collect knowledge about the various healing practices that exist simultaneously (biomedicine and traditional healing), we can concern ourselves with documenting strengths and weaknesses of systems of “caring”, and we have access to analyzing the historical processes and myths that propagate culturally specific illness narratives. Lock’s definition of local biologies in “The turn of life – Unstable meanings” (1995) got me thinking about the ways in which people of various cultures understand their relationship to illness and the larger implications of socially stigmatize or legitimize that experience. To start off this discussion, I reflected on folk healing or folk medicine, which typically anchors illnesses through cultural interpretation.

https://www.youtube.com/watch?v=EoV3D49Qm94;http://www.ebay.com/itm/AGAINST-THE-EVIL-EYE-CANDLE-KIT-QUITAR-EL-MAL-DE-OJO-WITH-FREE-U-S-SHIPPING-/272275510629

Traditional healing takes on many forms. The first video shows a curandero conducting a limpiada or spiritual cleansing ceremony. The curandero/a proceeds to smack herbs deep onto the body. Not shown on the video, but afterwards, he will proceed to rub a raw unbroken egg, which is thought to absorb energy, up and down the skin to determine the potential ailment and provide a diagnosis. Most of the time, their explanation is that a person has mal de ojo (evil eye), which is caused when someone looks at you maliciously or with jealousy. This negative energy, physically manifests itself into stress, migraines, insomnia, etc.

From the comments, there are various questions about the authenticity of this activity. You can buy a kit and become trained in this form of activity in just a few weeks (see link to product if you are interested); but suspending disbelief for a minute, how would an anthropologist go about interpreting and analyzing this phenomenon? What assumptions are we making about the culture that engages in these practices? What implications (if any) exist for the individual body, for the social body, and political body when people have carved out a space to justify such an explanation? Is it useful to utilize our research as a means of disseminating knowledge about folk medicine (or other findings) where biomedicine (or an alternate form) already exists and works?

http://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?_r=0
This article introduces the story of Lia Lee, daughter of Hmong refugees suffering from “quag dab peg” or epilepsy. Observe the tension between Lia’s parents and the rest of the world as each party tries to make sure Lia is cared for adequately. Oths (1999) describes mythological concerns about the shortcomings of research investigating culturally specific illness. In particular, she does not see the individual as a good unit of analysis. What become the appropriate scale to look at a culture specific illness? Despite being an ethnography of one person, the “Spirit Catches You and You Fall” (1997) does a tremendous job at looking at the family’s interpretation of caring for their severely epileptic child, the Hmong and American assessments of Lia’s condition, the social implications that followed because of the collision of these two cultures. How is disease, illness, and healing changing in the wake of migration and globalization?

http://brainblogger.com/2014/09/03/is-anorexia-a-modern-culture-bound-disorder/
When thinking about culturally specific illnesses, I came across anorexia nervosa and bulimia as examples of modern culturally bound disorders specific to industrial nations. This had me reflect on my own understanding of what I look for when thinking about the universality of particular experiences. Maybe it is naïve to think that eating disorders and body issues are a shared experience across the world, but I realized I thought of it this way until I read Lock’s work on aging and menopause which illuminated me to think that phenomenon that is familiar to me, may be perceived, experienced, and spoken about differently for various reasons by someone else. If I am conducting fieldwork, I need to be especially conscientious of this and read between the lines, attempt to utilize cultural relativism as a framework, otherwise I will not be adequately acknowledging or describing the realities that I attempt to capture.

12 thoughts on “The potentiality and challenges of understanding illness through cultural interpretation”

  1. Hi Fabiola, thanks for the additional articles and links.

    I was particularly struck by the Fullwiley article on biosocial suffering, which I think strongly ties into what you have brought up. Navigating the cultural meanings of illness and medicine is a difficult task for anthropologists, public health researchers, and clinicians, alike.

    I think the Kariyama book, “The Expressiveness of the Body…” also brings up a lot of the same themes. How can anyone justifiably say one method is right or wrong if they both produce some level of results? And how can we help to unify classic bio-medicine with the cultural significance attached to health and illness around the globe?

    I feel that that is the next major stride to be made in the fields of public health and medical anthropology.

    1. Fabiola — thanks for the wonderful post about illness and cultural interpretation. I especially liked that you drew connections to anorexia and bulimia nervosa as being two potentially culture-bound illnesses in industrial nations. I too often think of body image issues as a universal experience, but I will echo you and say that this week’s readings have prompted me to reconsider any preconceived notions that I have about the “sameness” of cross-cultural experiences.

      One of medical anthropology’s greatest strengths as a discipline, which you touched on in your post, is that there exists the methodology to truly explore seemingly conflicting ideas and do so with a historical, social, or cultural lens. I think several of the readings this week, but especially the Lock and the Fullwiley pieces, demonstrate the possible richness of the material that can be extracted when those tools are used.

      In public health, there has recently been more talk about the idea of the “social determinants of health,” namely things like SES, education level, and living conditions. The inclusion of these social determinants has been an important step in medicine, as it has ultimately enabled clinicians and other health professionals to have the language to inquire about and describe the larger societal factors that affect an individual’s well-being. Drawing on your comments, and reiterating what Shannon said, I think that the next big movement will be towards a more culturally (and spiritually) informed group of providers. As expressed in “The Spirit Catches You and You Fall Down,” there are many potential negative consequences from the blind application of biomedical therapies. In the future, I hope that there are deeper discussions about the ways that religion, culture, and spirituality affects a patient’s health and treatment plan.

    2. Good points, Shannon. One interesting question is should we unify classic biomedicine and “alternative” medicine, or should we focus on patient-centered, individualized care?

  2. Thanks Fabiola! I really enjoy your question about how disease, illness, and healing are changing in the wake of migration and globalization. In particular, this made me reflect upon the imposition of biomedical models on populations that may not ascribe to the biomedical paradigm. For example, Western physicians often diagnose refugees with PTSD or other trauma-related disorders. However, just because Western criteria for PTSD (as outlined in documents like the DSM) can be identified in non-Westen settings, do these symptoms mean the same thing as they do in the Western world? If something has become normalized, is it still considered a syndrome? In a 2008 article entitled “How scientifically valid is the knowledge base of global mental health?” Derek Summerfield notes that a study of refugees found that “the mental phenomena being identified as satisfying criteria for a mental disorder (typically depression or post-traumatic stress disorder) were mostly incidental and a normal reaction to their circumstances” (2008:993). In other words, although the refugees display symptoms indicative of what the Western biomedical world would call depression or PTSD, in the refugees’ context these symptoms are simply part of everyday life. So, is imposing diagnoses harmful? Is humanitarianism creating victims?

    1. Hi Erin, I just wanted to suggest a book that you might enjoy based on your comment. If you haven’t read it, Sharon Abramowitz’s recent book Searching for Normal in the Wake of the Liberian War is a really interesting look at the ways that international NGOs attempted to reconstruct mental health and trauma in Liberia, based on Western definitions of “normalcy,” and how people negotiated local definitions of illness to be included and treated as legitimate illness as well.

  3. Thanks for the post Fabiola! I think it’s very important in considering local biologies to interrogate our ideas about culturally specific illnesses, especially the tendency to consider “traditional” forms of healing to be somehow more archaic or less rational and scientifically valid than biomedicines. Different forms of healing are often constructed in a hierarchy in Western society, with biomedicine on the top and spiritual or folk healing at the bottom, particularly when describing healing practices outside the West, perpetuating the us versus them divide of healing practices. So how can we challenge this hierarchy of treatments?

    I think the point about anorexia as a culturally specific illness is a great example to show how “the West” also has specific local biologies. As another example, one of my favorite German illnesses is kreislaufzusammenbruch, which translates to “circulatory collapse.” This illness is specifically German and is not the serious and life threatening event it sounds like it should be. Instead kreislaufzusammenbruch is an illness where you feel a little bit bad today, maybe you have a headache, and don’t really feel like going to work, but instead want to stay home and lie down. http://www.spiegel.de/international/you-have-what-mysterious-illness-in-germany-a-416475.html (There are also a variety of other illnesses that you can only get in Germany, that don’t exist anywhere else. http://mentalfloss.com/article/61140/15-unique-illnesses-you-can-only-come-down-german )

    The German example illustrates the culturally specific understandings of illness that exist throughout Western societies. Where we would maybe not see this as a “real” illness in the U.S., this is considered a completely legitimate illness in Germany, and a valid excuse for missing work. I think this highlights just how non-universal understandings of symptoms and classifications of illness are, as if I tried to claim that I needed to lie down and didn’t feel like going to work in the U.S. without needing to go and see a doctor, I probably wouldn’t get paid, and if I said I was having a circulatory collapse, I would be rushed to the emergency room.

    Additionally, the use of homeopathic medication, such as herbal supplements, all the things sold at GNC stores, and other non-biomedical remedies is a widely accepted practice in the U.S., for conditions that we would consider to be minor illnesses, and not worth a trip to the doctor. How can we think about these alternatives to biomedicine for what we deem more minor illnesses in the U.S., such as taking herbal treatments for a cold or the flu, in relation to taking artemisinin for malaria in other parts of the world?

  4. Hi Fabi, thanks for your post and thoughts. It really got me thinking, not the specific mechanisms for biomedicine and traditional healing, but first and foremost, why is there such a dichotomy between these two categories? Biomedicine is usually imagined as the “Western medicine,” which when one thinks about it is more of a fantasy than reality. Rather than biomedicine, one may as well say biomedicines, for there exist striking differences between, say, American biomedicine, French biomedicine, German biomedicine, English biomedicine, etc. In some sense, “biomedicines” are also culturally specific medical beliefs and practices. Is this dichotomy helpful? Or should we simply give up on this division for a more helpful understanding about healing?

    Whenever I read writings about “traditional healing/medicine,” I find myself constantly thinking “are these real or are they making that up?” (I was very skeptical when I read the examples given by Csordas in religious healing). Somehow when I read biomedical journals, I never ask questions like these. What is revealed here is a strong, perhaps unexamined, belief in the so-called biomedicine. Just as Canghuilhem (and in that regard Foucault) point out, one should always ask how biomedicine establishes itself as the ultimate “truth,” as objective and scientific.

    I also find your question “If biomedicine already exists and works for a certain disease, should we still disseminate knowledge about folk medicine” an interesting and challenging one. I do not have an answer for that. But I think one needs to make serious the question of in what ways should we consider a medicine works. In a lot of mental illness, I would say there are tons of medicines available, but I would be cynical and say they don’t work. Just as Catarina’s case exemplifies, most of these medicines simply put patients to sleep or inactivity, they are not cured in any way. Generally speaking, however, I argue that it is necessary to research on and disseminate knowledge on “folk medicine,” for the simple reason that in far too many cases the reliance of biomedicines on technology and science seem to render the sickness experience impersonal. In traditional healing, on the other hand, retains a certain level of humanity where “care” seems to play a more important role than biology (of course, I’m contradicting myself here in evoking the dichotomy between biomedicines and traditional medicines).

  5. Dear Fabiola, thank you for sharing the videos and your thoughts! I’m particularly interested in the issue concerning the “authenticity” of “traditional” medicines. It makes me wonder: What do we mean when we evaluate certain medical traditions as “authentic?”

    As you know, “authenticity” is an extremely loaded theoretical concept in anthropology. For example, we could argue that the search for “authenticity” tells us more about the social history of Europe and the U.S., where generations of intellectuals and cultural elites attempted to pursue something that is primitive and original, something that has not been effected by the modernization processes. In the case of medicine, perhaps “authenticity” is something that has not been molded into a set of homogenous practices, or standardized methods. Or, we could unpack “authenticity” in a different way and argue that it reveals the hegemonic power of biomedicine and the structural inequalities inherent in global infrastructures, where traditional healers are unjustifiably marginalized as “quacks” or “charlatans.”

    However, I’m not certain if the current anthropological discussions and debates about authenticity fully capture the complexities involved in the production of fakeries. For instance, how could we use “authenticity” as a theoretical framework to address the following cases (see links below), where a “traditional” medical remedy is considered fake because it has the potential to cause real and serious health problems, if not a public health crisis?

    http://www.nytimes.com/2016/01/29/world/asia/china-tcm-donkey-skin-gelatin.html
    OR
    https://www.washingtonpost.com/world/asia_pacific/himalayan-viagra-tibets-gold-rush-may-be-coming-to-an-end/2016/07/01/2e710d3a-2d8b-11e6-b9d5-3c3063f8332c_story.html

  6. Thanks Fabiola,

    I have been thinking about what you presented in this post and also what we have read, especially the Locke piece, and I am constantly thinking back to the ontological turn in anthropology and how anthropology has allowed for the possibility of multiple realities in various ways. With the ontological turn, rather than assume various ‘mythologies’ are expressions of cultural beliefs as existing in a separate order from reality, people in different cultural contexts are experiencing different ‘ontologies.’

    When put into conversation with the medical anthropology literature, the various medical and physiological experiences that are covered by the texts and in your post can be thought of as being part of a wider category of various ontologies. Considering this, how do we understand biomedical science and its various cultural manifestations since it seems to transcend or is at least immanent to most cultural contexts? Can it still be thought of as a cohesive whole or is it more of a fractured object with discrete pieces covering the globe?

  7. Thanks Fabi.

    Like Troy, I want to comment more about this dichotomy between biomedicine and traditional medicine. By posing these two types of medicine as opposites, I wonder if we are not foreclosing the intimate linkages between the two. In many ways, it mirrors the separation of the categories of religion and science, as if they do not always coexist and inform one another. For instance, before I embarked on my fieldwork last summer, in my mind I had held this thing called “Islamic healing” and “biomedical healing” as these two separate entities. However, what I soon realized upon embarking on my fieldwork is that these two things were highly intertwined. Religious and biomedical healing did not constitute these two separate and reified domains. Rather, traditional forms of healing incorporated aspects of biomedical healing, as well as the other way around. And I argue that neither were being “destabilized” in this process. Ritual wailing was followed by clinical detoxification; and clinical detoxification centers often engaged in ritual wailing exercises. They were part of a co-constitutive process. I think it is important to think through the porous nature of medicine and healing by attending to the lived reality of these processes. By doing this, we can depart from their textbook descriptions.

  8. Thanks Fabiola!

    While I agree with Katelyn that there should be a shift in medical settings to promote intercultural understanding, many people living in the US seek out physicians that share similar beliefs. Patient reports of quality confirm that many individuals of certain faiths seek out physicians that share those views, and while that certainly isn’t an option for many individuals due to access constraints, it is still common. For example, many religious communities will prefer going to a physician that shares the same religion, even if the members of that community go to the physician for very traditional western medical interventions.

    In the Kuriyama reading, we looked at varying approaches and understandings of the same concept, taking the pulse, and while Kuriyama focused on the immense differences between cultural interpretations of this concept, I saw a surprising amount of similarity. A good friend of mine practices Acupuncture and Eastern Medicine, and she was actually trained through a program that works with Tufts Medical School; whenever we discuss her work she has a language to translate Eastern practices into Western ideas. Is this the same practice that we would see in China or Japan? Is it OK to Westernize concepts to those unfamiliar with them in order to promote greater understanding, and possibly faith? This idea brings in the ideas from the Kaptchuk article: should we promote greater understanding of “alternative” practices and potentially encourage a placebo effect of some sort? If a person feels better and their burden of illness is reduced, isn’t that healing?

  9. I really enjoyed reading this thread, and looking through all the materials Fabiola posted (as an aside, having ‘grown up’ academically with ‘The Spirit Catches you’, I was surprised and saddened to hear of Lia Lee’s demise…). Some of the questions all of you have raised have been central to what I have found so compelling about medical anthropology over the years. As Samee noted here and in class, the idea of multiple realities and multiple ontologies coexisting even on the level of an individual body has been, in my view, one of the critical contributions that anthropology, and med anthro in particular, has made. If we can pull ourselves away from either the purely constructionist/post-structuralist view (everything is constructed, there is no reality) and from the purely scientific view (there is a single true reality out there waiting to be found and if we can only use the right tools and technologies we will eventually find it) I think there is something rather profound that can emerge. We are all experiencing multiple realities, all the time, and all simultaneously, both figuratively and literally. The potential of that point of view to help relieve suffering is I think immense.

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