M07 MILL3290 05 SE C07 - DPHU · SURINAME FRENCH GUIANA PARAGUAY G U Y A N A URUGUAY Rondónia...

the BIG questions� What is ethnomedicine?

� What are three major theoreticalapproaches in medical anthropology?

� How are health, illness, and healingchanging during globalization?

HEALTH, ILLNESS,AND HEALING

O U T L I N E

Ethnomedicine

Eye on the Environment: LocalBotanical Knowledge andChild Health in the Amazon

Three Theoretical Approachesin Medical Anthropology

Globalization and Change

Culturama: The Sherpaof NepalLessons Applied: PromotingVaccination Programs inDeveloping Countries 163

77

Steven Benally Jr., an apprentice medicine man,

practices for a ceremony in his hogan on the Navajo

Reservation near Window Rock, Arizona. An

apprentice often studies for a decade or more.

164 PART I I CULTURAL FOUNDAT IONS

Western biomedicine (WBM) a healing approach basedon modern Western science that emphasizes technologyfor diagnosing and treating health problems related to thehuman body.

Primatologist Jane Goodall once witnessed the consequencesof a polio epidemic among the chimpanzees she was studyingin Tanzania (Foster and Anderson 1978:33–34). A group ofhealthy animals watched a stricken member try to reach thefeeding area but did not help him. Another badly paralyzedchimpanzee was simply left behind when the group movedon. Humans also sometimes resort to isolation and abandon-ment of those who are ill and dying. But compared to ournonhuman primate relatives, humans have created more com-plex ways of interpreting health problems and highly creativemethods of preventing and curing them.

Medical anthropology is one of the most rapidly grow-ing areas of research in anthropology. This chapter presentsa selection of findings from this subfield. It first describeshow people in different cultures think and behave regard-ing health, illness, and healing. The second section considersthree theoretical approaches in medical anthropology. Thechapter concludes by discussing how globalization is affect-ing health.

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EthnomedicineSince the early days of anthropology, the topic ofethnomedicine, or the study of cross-cultural health systems,has been a focus of study. A health system encompasses manyareas: perceptions and classifications of health problems,prevention measures, diagnosis, healing (magical, religious,scientific, healing substances), and healers. Ethnomedicinehas expanded its focus to include topics such as perceptionsof the body, culture and disability, and change in indigenousor “traditional” healing systems, especially as resultingfrom globalization.

In the 1960s, when the term ethnomedicine first cameinto use, it referred only to non-Western health systems andwas synonymous with the now abandoned term, primitivemedicine. The early use of the term was ethnocentric.Contemporary Western biomedicine (WBM), a healingapproach based on modern Western science that emphasizestechnology in diagnosing and treating health problemsrelated to the human body, is an ethnomedical system,too. Medical anthropologists now study WBM as a cultural

system intimately bound to Western values. Thus, the currentmeaning of the term ethnomedicine encompasses healthsystems everywhere.

PERCEPTIONS OF THE BODYIn Japan, the concept of gotai refers to the ideal of maintain-ing bodily intactness in life and death, to the extent ofnot piercing one’s ears (Ohnuki-Tierney 1994:235). WhenCrown Prince Naruhitao was considering whom to marry,one criterion for the bride was that she not have pierced ears.Underlying the value on intactness is the belief that an intactbody ensures rebirth. Historically, a warrior’s practice of be-heading a victim was the ultimate form of killing because itviolated the integrity of the body and prevented the enemy’srebirth. Gotai is an important reason for the low rates of sur-gery in Japan—compared to the United States—and thewidespread popular resistance to organ transplantation.

Ideals about the female body are implicated in thehigh rate of caesarian births in Brazil (McCallum 2005).

ethnomedicine the study of cross-cultural health systems.

South African healer Magdaline Ramaota speaks to clientsin Durban. In South Africa, few people have enough moneyto pay for AIDS drugs. The role of traditional healers inproviding psychological and social support for victims isextremely important.

� Do Internet research to learn about the current andprojected rates of HIV/AIDS in African countries.

disease in the disease/illness dichotomy, a biological healthproblem that is objective and universal.

illness in the disease/illness dichotomy, culturally shapedperceptions and experiences of a health problem.

CHAPTER 7 HEALTH, I L LNESS , AND HEAL ING 165

Piaul

Ceara

Roraima

Amazonas

Acre

Mato Grosso

Brasilia

Mato Grossodo Sul

Santa CatarinaRio Grande

do Sul

Rio Grande do Norte

NORTH ATLANTICOCEAN

SOUTHATLANTIC

OCEAN

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Pernambuco

Alagoas

SergipeBahia

Minas Gerais Espirito Santo

Rio de Janeiro

Peraiba

Tocantins

Amapa

Para

Parana

Golas´

Sao Paulo˜

ARGENTINA

BOLIVIA

PERU

COLOMBIA

VENEZUELASURINAME

FRENCH GUIANA

PARAGUAY

GU

YAN

A

URUGUAY

Rondónia

Maranhão

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250

MAP 7.1 Federative Republic of Brazil.Brazil, a federation of 26 states, is thelargest and most populous country in LatinAmerica and the fifth largest worldwide. Its totalpopulation is about 188 million, and São Paulo,its largest city has a population of 11 million.The economy is based on manufacturing,mining, agriculture, and technology. Ethnically,it comprises Europeans, Africans, Indians, andAsians. The official language is Portuguese.Roman Catholicism is the predominant religion,and Brazil has the largest Roman Catholicpopulation in the world. Brazil has the world’smost extreme economic and social inequalitywith many people, especially in the south andeast, living in wealth and comfort while othersinthe urban favelas (slums) and in the ruralnortheast experience extreme poverty,deprivation, and violence.

Ethnographic research in Salvador, a major city of the stateof Bahia (bah-EE-yuh) in northeastern Brazil (see Map 7.1),reveals that vaginal childbirth is considered more “primitive,”painful, and destructive of a woman’s sexuality than caesariandelivery. One doctor said that “more and more, the vulva andthe vagina are becoming the organs of sexuality and not par-turition” (2005:226). Doctors recommend a caesarian deliveryas safe, practical, and causing no “esthetic damage.”

Euro-American popular and scientific thinking empha-sizes a separation of the mind from the body. Thus, Westernmedicine has a special category called “mental illness,” whichtreats certain health problems as though they were locatedonly in the mind. In contrast, in the many cultures in which amind–body distinction does not exist, there is no category of“mental illness” and treatment is more holistic.

Cultures also vary in terms of whether people considerthe body to be a bounded physical unit, with healing focusedon the body alone, or connected to a wider social context, inwhich case healing addresses the body within the wider socialsphere. Variations in the definition of a living body versus adead body are also prominent worldwide. Different organsmay be seen as critical. In the United States, a person may bedeclared dead while the heart is still beating, so long as thebrain is judged to be “dead.” In many other cultures, people donot accept a brain-based definition of life and death (Ohnuki-Tierney 1994).

DEFINING AND CLASSIFYINGHEALTH PROBLEMS

Emic diversity in labeling health problems presents a chal-lenge for medical anthropologists and health-care specialists.

Western labels, which biomedically trained experts acceptas true, accurate, and universal, often do not correspond tothe labels in other cultures. One set of concepts that medicalanthropologists use to sort out the many cross-cultural labelsand perceptions is the disease/illness dichotomy. In this model,disease refers to a biological health problem that is objectiveand universal, such as a bacterial or viral infection or a brokenarm. Illness refers to culturally specific perceptions and expe-riences of a health problem. Medical anthropologists studyboth disease and illness, and they show how both must beunderstood within their cultural contexts.

A first step in ethnomedical research is to learn how peo-ple label, categorize, and classify health problems. Dependingon the culture, the following may be bases for labelingand classifying health problems: cause, vector (the means oftransmission, such as mosquitoes), affected body part, symp-toms, or combinations of these.

Often, knowledgeable elders are the keepers of ethno-medical knowledge, and they pass it down through oral tradi-tions. Among Native Americans of the Washington–Oregonregion, many popular stories refer to health (Thompson andSloat 2004). The stories convey messages about how to preventhealth problems, avoid bodily harm, relieve afflictions, and deal

THINKING

T H E B O XOUTSIDE

In your microculture, what aresome prevailing perceptions about the

body and how are they related tomedical treatment?

with old age. For example, here is the story of Boil, a story foryoung children:

Boil was getting bigger.

Her husband told her to bathe.

She got into the water.

She disappeared. (2004:5)

Other, longer stories about Boil add complexities about thelocation of the boil and how to deal with particular boils,revealing indigenous patterns of classification.

A classic study among the Subanun (soo-BAH-nan) peo-ple focused on their categories of health problems (Frake 1961).

The Subanun, in the 1950s, were horticulturalists living in thehighlands of Mindanao, in the Philippines (see Map 7.2). Anegalitarian people, all Subanun, even young children, had sub-stantial knowledge about health problems. Of their 186 labelsfor health problems, some are a single term, such as “itch,”which can be expanded on by using two words such as“splotchy itch.” Skin diseases have are common afflictionsamong the Subanun and several degrees of specificity (seeFigure 7.1).

In Western biomedicine, panels of medical experts haveto agree about how to label and classify health problemsaccording to scientific criteria. Classifications and descriptionsof thousands of afflictions are published in thick manualsthat physicians consult before they give a diagnosis. In coun-tries where medical care is privatized, the code selectedmay determine whether the patient’s costs are covered byinsurance or not. The International Classification of Diseases


The Brazilian girl, aged 9 years, is HIV positive. Her mother, inthe background, contracted HIV from her husband and trans-mitted it to her child at birth.

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Mindanao

Palawan

Luzon

THE PHILIPPINES

MALAYSIA

PhilippineSea

South ChinaSea

SuluSea

Manila

MAP 7.2 The Philippines.The Republic of the Philippines comprises over 7000 islands,of which around 700 are occupied. The population is 85 mil-lion, with two-thirds living on Luzon. The economy is basedon agriculture, light industry, and a growing business process-ing outsourcing (BPO) industry. Over 8 million Filipinos workoverseas and remit more than $12 billion a year, a large partof the GDP. Although Filipino and English are the officiallanguages, more than 170 languages are spoken. ThePhilippines has the world’s third largest Christian population,with Roman Catholicism predominant.

culture-specific syndrome a collection of signs andsymptoms that is restricted to a particular culture or a limitednumber of cultures.

somatization the process through which the body absorbssocial stress and manifests symptoms of suffering; also calledembodiment.

(ICD), now in its tenth edition (1993), is a major source forcoding health problems according to Western biomedicalstandards. Even though it contains abundant details on manyhealth problems and is carefully arranged according to acomplex coding system, its categories often prove to be inad-equate. For example, following the attacks on the UnitedStates of September 11, 2001, medical personnel who had toclassify the cause of death of those who perished at the foursites and the health problems of survivors found the ICD-10codes of little help.

Further, the ICD-10 is biased toward diseases thatWestern biomedicine recognizes and ignores health problemsof many other cultures. Anthropologists have discoveredmany health problems around the world, often referred to asculture-specific syndromes. A culture-specific syndrome isa health problem with a set of symptoms associated with aparticular culture (see Figure 7.2). Social factors such as stress,fear, or shock often are the underlying causes of culture-specific syndromes. Biophysical symptoms may be involved,and culture-specific syndromes can be fatal. Somatization, orembodiment, refers to the process through which the bodyabsorbs social stress and manifests symptoms of suffering.


FIGURE 7.1 Subanun Categories of Nuka, Skin-RelatedHealth Problems

• Rash

• Eruption

• Inflammation— Eruption— Inflamed/Quasi-Bite— Ulcerated

• Sore— Distal Ulcer

ShallowDeep

— Proximal UlcerShallowDeep

— Simple Sore— Spreading Sore

• Ringworm— Exposed— Hidden— Spreading Itch

• Wound

Source: Adapted from Frake 1961:118, Figure 1.

FIGURE 7.2 Selected Culture-Specific Syndromes

Name of Syndrome Distribution Attributed Causes Description and Symptoms

Anorexia nervosa

Spain, Portugal, Centraland South America, Latinoimmigrants in the U.S. andCanada

Shock or fright Lethargy, poor appetite,problems sleeping, anxiety

Middle- and upper-classEuro-American girls;globalizing

Unknown Body wasting due to foodavoidance; feeling of beingtoo fat; in extreme cases,death

Susto

Japan, males fromadolescence throughadulthood

Social pressure to succeedin school and pursue aposition as a salaryman

Acute social withdrawal;refusal to attend school,or leave their room formonths, sometimes years

Hikikomori

China and Southeast Asia, men

Unknown Belief that the penis hasretracted into the body

Koro

Northeastern Brazil,especially women, perhapselsewhere among Latinopopulations

Excessive worry aboutothers

Enlarges the heart and“bursts” through it causing“openings in the heart”

Peito aberto (open chest)

Japan, older women whosehusbands are retired

Stress Ulcers, slurred speech,rashes around the eyes,throat polyps

Retired Husband Syndrome(RHS)

Valley of Mexico, low-income people, especiallywomen

Lack of access to secureand clean water

AnxietySoufriendo del agua(suffering from water)

Sources: Chowdhury 1996; Ennis-McMillan 2001; Faiola 2005; Gremillion 1992; Kawanishi 2004; Rehbun 1994; Rubel, O’Nell, and Collado-Ardón 1984.

For example, susto, or “fright/shock disease,” is found inSpain and Portugal and among Latino people wherever theylive. People afflicted with susto attribute it to events such aslosing a loved one or having a terrible accident (Rubel,O’Nell, and Collado-Ardón 1984). In Oaxaca, southernMexico (see Map 6.3, p. 144), a woman said her susto wasbrought on by an accident in which pottery she had made wasbroken on its way to market, whereas a man said that his cameon after he saw a dangerous snake. Susto symptoms includeappetite loss, lack of motivation, breathing problems, general-ized pain, and nightmares. The researchers analyzed manycases of susto in three villages. They found that the peoplemost likely to be afflicted were those who were socially mar-ginal or experiencing a sense of role failure. For example, thewoman with the broken pots had also suffered two sponta-neous abortions and was worried that she would never havechildren. In Oaxaca, people with susto have higher mortalityrates than other people. Thus, social marginality, or a deepsense of social failure, can place a person at a higher risk ofdying. It is important to look at the deeper causes of susto.

Medical anthropologists first studied culture-specificsyndromes in non-Western cultures. This focus created a biasin thinking that they exist only in “other” cultures. Now,anthropologists recognize that Western cultures also haveculture-specific syndromes. Anorexia nervosa and a relatedcondition, bulimia, are culture-bound syndromes foundmainly among White middle-class adolescent girls of theUnited States, although some cases have been documentedamong African American girls in the United States andamong young males (Fabrega and Miller 1995). Since the1990s, perhaps as a result of Western globalization, caseshave been documented in cities in Japan, Hong Kong, andIndia. Anorexia nervosa’s cluster of symptoms includes self-perception of fatness, aversion to food, hyperactivity, and, asthe condition progresses, continued wasting of the body andoften death. No one has found a clear biological cause foranorexia nervosa, although some researchers claim that it hasa genetic basis. Cultural anthropologists say that much evi-dence suggests a strong role of cultural construction. One log-ical result of the role of culture is that medical and psychiatrictreatments are notably unsuccessful in curing anorexianervosa (Gremillion 1992). Extreme food deprivation can


become addictive and entrapping, and the affliction becomesembodied, intertwined with the body’s biological functions.Extended fasting makes the body unable to deal with ingestedfood. Thus, medical treatment may involve intravenousfeeding to override the biological block. Sometimes nothingworks, and the affliction is fatal.

Pinpointing the cultural causes of anorexia nervosa, how-ever, is difficult. Some experts cite societal pressures on girlsthat lead to excessive concern with looks, especially bodyweight. Others feel that anorexia is related to girls’ unconsciousresistance to overcontrolling parents. For such girls, food intakemay be one thing over which they have power.

ETHNO-ETIOLOGIESPeople in all cultures, everywhere, attempt to make senseof health problems and try to understand their cause, oretiology. Following anthropological practice, the term ethno-etiologies refers to cross-cultural variations in causal explana-tions for health problems and suffering.

Among the urban poor of northeastern Brazil, peopleconsider several causal possibilities when they are sick(Ngokwey 1988). In Feira de Santana, the second largest cityin the state of Bahia (see Map 7.1, p. 165), ethno-etiologiescan be natural, socioeconomic, psychological, or supernatural.Natural causes include exposure to the environment—forexample, humidity and rain cause rheumatism, excessive heatcauses dehydration, and some types of winds are said to causemigraines. Yet other natural explanations for illness take intoaccount the effects of aging, heredity, personality, and gender.Contagion is another natural explanation, as are the effects ofcertain foods and eating habits. In the psychosocial domain,emotions such as anger and hostility cause certain healthproblems. In the supernatural domain, spirits and magic cancause health problems. The African-Brazilian religious sys-tems of the Bahia region encompass many spirits who caninflict illness. They include spirits of the unhappy dead anddevil-like spirits. Some spirits cause specific illnesses; othersbring general misfortune. In addition, envious people with theevil eye cast spells on people and cause much illness. Peoplealso recognize the lack of economic resources, proper sanita-tion, and health services as structural causes of health prob-lems. In the words of one person, “There are many illnessesbecause there are many poor” (1988:796).

The people of Feira de Santana also recognize several lev-els of causality. In the case of stomachache, they might blame aquarrel (underlying cause), which prompted the aggrieved partyto seek the intervention of a sorcerer (intermediate cause), whocast a spell (immediate cause), which led to the resulting illness.The multilayered causal understanding opens the way formany possible avenues of treatment.

The multiple understandings of etiology in Bahia con-trast with the scientific understandings of causality inWestern biomedicine. The most striking difference is the

ethno-etiologies culturally specific causal explanationsfor health problems and suffering.

structural suffering human health problems causedby such economic and political situations as war, famine,terrorism, forced migration, and poverty.

susto fright/shock disease, a culture-specific syndromefound in Spain and Portugal and among Latino peoplewherever they live; symptoms include back pain, fatigue,weakness, and lack of appetite.


tendency for biomedical etiologies to exclude as causal struc-tural issues and social inequality. Medical anthropologistsuse the term structural suffering, or social suffering, whichrefers to health problems that powerful forces such as poverty,war, famine, and forced migration cause (review the definitionof the related concept, structurism, in Chapter 1). Structuralconditions affect health in many ways, with effects rangingfrom anxiety and depression to death.

An example of a culture-specific syndrome that clearlyimplicates structural factors as causal is sufriendo del agua, or“suffering from water” (Ennis-McMillan 2001). Research in apoor community in the Valley of Mexico, located in the cen-tral part of the country (see Map 6.3, p. 144), reveals thatsufriendo del agua is a common health problem, especiallyamong women. The immediate cause is the lack of water fordrinking, cooking, and washing. Women, who are responsiblefor cooking and doing the washing, cannot count on watercoming from their taps on a regular basis. This insecuritymakes the women feel anxious and constantly in a state ofnervous tension. The lack of access to water also means thatthe people are at higher risk of cholera, skin and eye infec-tions, and other biophysical problems. A deeper structuralcause of sufriendo del agua is unequal development. Theconstruction of piped water systems in the Valley of Mexicobypassed low-income communities in favor of servicingwealthier urban neighborhoods and supplying water forirrigation projects and the industrial sector. In Mexico, as awhole, nearly one-third of the population has inadequateaccess to water, in terms of quantity or quality.

PREVENTIONMany practices, based in either religious or secular beliefs,exist cross-culturally for preventing misfortune, suffering, andillness. Among the Maya of Guatemala (see Map 7.3), awas isa common childhood illness (Wilson 1995). Children bornwith awas have lumps under the skin, marks on the skin, oralbinism. People say that events that happen to the motherduring her pregnancy cause awas: She may have been deniedfood she desired or have been pressured to eat food she did notwant, or she may have encountered a rude, drunk, or angryperson (usually a man). Therefore, to prevent awas in babies,the Maya are extremely considerate of pregnant women. Apregnant woman, like land before planting, is sacred. Peoplemake sure to give her the food she wants, and they behave withrespect in her presence. The ideal is that a pregnant womanshould be content.

Examples of ritual health protection worldwide includecharms, spells, and sacred strings tied around parts of thebody. An anthropologist working in rural northern Thailand(see Map 6.7, p. 157) learned about a health protection prac-tice that involved the display of carved wooden phalluses

THINKING

T H E B O XOUTSIDE

Discuss some examples of culture-specific syndromes in your microculture,

or on your campus.


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Caribbean Sea

Lago deNicaragua

MEXICO

GUATEMALA

EL SALVADOR

NICARAGUA

COSTARICA

PANAMA

JAMAICA

COLOMBIA

HONDURAS

BELIZEBelmopan

Guatemala

SanSalvador

Tegucigalpa

Managua

SanJosé

Panama

MAP 7.3 Central America.The countries of Central Americashare a similar geography as partof a long isthmus with a moun-tainous spine, active volcanoes,and rich soil. A federation thatlinked much of the region intothe United Provinces of CentralAmerica existed from 1824 to1838. The population of theregion, around 40 million,includes indigenous peoples andpeople of mixed indigenous andEuropean ancestry. Europeancolonialism has left a strongmark on the region, which is now heavily influenced by theUnited States and its interests inhemispheric hegemony. Bananasare the leading export crop ofthe region.

throughout a village (Mills 1995). In 1990, fear of an attack bya widow ghost spread throughout the area. It was based on sev-eral radio reports of unexplained deaths of Thai migrant menworking in Singapore. People interpreted the sudden deaths ofmen as caused by widow ghosts. People believe that widowghosts roam about, searching for men whom they take as their“husbands” and with whom they have sexual intercourse. MaryBeth Mills was conducting research in Baan Naa Sakae villageat the time of the fear. After being away for a few days, shereturned to the village to find all 200 households decoratedwith wooden phalluses in all shapes and sizes:

Ranging from the crudest wooden shafts to carefully carvedimages complete with coconut shell testicles and fishnetpubic hair, they adorned virtually every house and residen-tial compound. The phalluses, I was told, were to protectresidents, especially boys and men, from the “nightmaredeaths” (lai tai) at the hands of malevolent “widow ghosts”(phii mae maai). (1995:249)

In the study area, spirits (phii) are a recognized source ofillness, death, and other misfortunes. One variety of phii, awidow ghost is the sexually voracious spirit of a womanwho had an untimely and perhaps violent death. When aseemingly healthy man dies in his sleep, the people blame awidow ghost who arrives in the night and has extreme sex


with a sleeping man to the extent that he dies. The woodenphalluses were protection against a possible widow ghostattack. The people said the giant penises are decoys: The sex-starved spirits take their pleasure with the wooden penisesand, satisfied, leave the men unharmed. As the radio reportsceased, villagers’ concerns about the widow ghosts faded andthey removed the phalluses.

HEALING WAYSThe following material describes two approaches to healing,one in southern Africa and the other in Malaysia, SoutheastAsia. It also discusses healers and healing substances.

COMMUNITY HEALING SYSTEMS A general distinc-tion can be drawn between private healing and communityhealing. The former addresses bodily ailments in social isola-tion, whereas the latter encompasses the social context as cru-cial to healing. Compared to Western biomedicine, manynon-Western systems use community healing. An example ofcommunity healing comes from the Ju/’hoansi foragers of theKalahari desert in southern Africa (review Culturama,Chapter 1, p. 23). Ju/’hoansi healing emphasizes the mobi-lization of community “energy” as a key element in the cure:

The central event in this tradition is the all-night healingdance. Four times a month on the average, night signals thestart of a healing dance. The women sit around the fire,singing and rhythmically clapping. The men, sometimesjoined by the women, dance around the singers. As the danceintensifies, num, or spiritual energy, is activated by the heal-ers, both men and women, but mostly among the dancingmen. As num is activated in them, they begin to kia, or

(LEFT) Throughout northern India, people believe that tyingon strings provides protection from malevolent spirits andforces. This Muslim baby has five protective strings.(RIGHT) A carved phallus displayed in a northern Thai village to protect men from widow ghost attacks.

community healing healing that emphasizes the socialcontext as a key component and which is carried out withinthe public domain.

humoral healing healing that emphasizes balance amongnatural elements within the body.


experience an enhancement of their consciousness. Whileexperiencing kia, they heal all those at the dance. (Katz1982:34)

The dance is a community event in which the entire campparticipates. The people’s belief in the healing power of numbrings meaning and efficacy to the dance through kia.

Does community healing “work”? In both ethnic andWestern terms, the answer is yes. It “works” on several levels.People’s solidarity and group sessions may support mental andphysical health, acting as a health protection system. Whenpeople fall ill, the drama and energy of the all-night dancesmay act to strengthen the afflicted in ways that Western sci-ence would have difficulty measuring. In a small, close-knitgroup, the dances support members who may be ill or grieving.

An important aspect of the Ju/’hoansi healing system isits openness. Everyone has access to it. The role of healer isalso open. There is no special class of healers with specialprivileges. More than half of all adult men and about 10 per-cent of adult women are healers.

A Ju/’hoansi healer in a trance, in the Kalahari desert,southern Africa. Most Ju/’hoansi healers are men, butsome are women.

� In your microculture, what are the patterns of gender,ethnicity, and class among various kinds of healers?

HUMORAL HEALING Humoral healing is based on aphilosophy of balance among certain elements within thebody and within the person’s environment (McElroy andTownsend 1996). In this system, food and drugs have differ-ent effects on the body and are classified as either “heating” or“cooling” (the quotation marks indicate that these propertiesare not the same as thermal measurements). Diseases are theresult of bodily imbalances—too much heat or coolness—thatmust be counteracted through dietary and behavioral changesor medicines that will restore balance.

Humoral healing systems have been practiced for thou-sands of years in the Middle East, the Mediterranean, andmuch of Asia. In the New World, indigenous humoral systemsexist and sometimes blend with those that Spanish colonialistsbrought with them. Humoralism has shown substantial re-silience in the face of Western biomedicine, often incorporatinginto it the Western framework—for example, in the classifica-tion of biomedical treatments as either heating or cooling.

In Malaysia (see Map 1.1, p. 10), several differenthumoral traditions coexist, reflecting the region’s history ofcontact with outside cultures. Malaysia has been influenced bytrade and contact between its indigenous culture and that ofIndia, China, and the Arab-Islamic world for around 2000years. Indian, Chinese, and Arabic health systems all definehealth as the balance of opposing elements within the body,although each has its own variations (Laderman 1988:272).Indigenous belief systems may have been compatible withthese imported models because they also were based onconcepts of heat and coolness.

Insights about these indigenous systems before outsidersarrived come from accounts about the Orang Asli, indigenouspeoples of the interior who are relatively less affected by con-tact. A conceptual system of hot–cold opposition dominatesOrang Asli cosmological, medical, and social theories. Theproperties and meanings of heat and coolness differ fromthose of Islamic, Indian, or Chinese humoralism in severalways. In the Islamic, Indian, and Chinese systems, for exam-ple, death is the result of too much coolness. Among theOrang Asli, excessive heat is the primary cause of mortality.In their view, heat emanates from the sun and is associatedwith excrement, blood, misfortune, disease, and death.Humanity’s hot blood makes people mortal, and their con-sumption of meat speeds the process. Heat causes menstrua-tion, violent emotions, aggression, and drunkenness.

Coolness, in contrast, is vital for health. Health is pro-tected by staying in the forest to avoid the harmful effects ofthe sun. This belief justifies the rejection of agriculture bysome groups because it exposes people to the sun. Treatmentof illness is designed to reduce or remove heat. If someonewere to fall ill in a clearing, the entire group would relocate tothe coolness of the forest. The forest is also a source of coolingleaves and herbs. Healers are cool and retain their coolness bybathing in cold water and sleeping far from the fire.

Extreme cold, however, can be harmful. Dangerouslevels of coolness are associated with the time right afterbirth, because the mother is believed to have lost substantialheat. The new mother should not drink cold water or bathein cold water. She increases her body heat by tying aroundher waist sashes that contain warmed leaves or ashes, and shelies near a fire.

HEALERS In an informal sense, everyone is a “healer”because self-treatment is always the first consideration indealing with a perceived health problem. Yet, in all cultures,some people become recognized as having special abilitiesto diagnose and treat health problems. Cross-culturalevidence indicates some common criteria of healers (seeFigure 7.3).

Specialists include midwives, bonesetters (people whoreset broken bones), shamans or shamankas (male or femalehealers who mediate between humans and the spirit world),herbalists, general practitioners, psychiatrists, nurses, acupunc-turists, chiropractors, dentists, and hospice care providers.Some healing roles may have higher status, more power, and re-ceive higher pay than others.

Midwifery is an important example of a healing role thatis endangered in many parts of the world as birth has becomeincreasingly medicalized and brought into the institutionalworld of the hospital rather than the home. In Costa Rica (seeMap 7.3, p. 169), a recent government campaign to promotehospital births with a biomedical doctor in attendance has


achieved a rate of 98 percent of all births taking place inhospitals ( Jenkins 2003). This achievement means thatmidwives, especially in rural areas, can no longer supportthemselves, and they are abandoning their profession.Promotion of hospital births has destroyed the positiveelements of community-based midwifery and its provisionof social support and techniques such as massage for themother-to-be.

HEALING SUBSTANCES Around the world, thousandsof different natural or manufactured substances are used asmedicines for preventing or curing health problems.Anthropologists have spent more time studying the use ofmedicines in non-Western cultures than in the West,although a more fully cross-cultural approach is emerging

FIGURE 7.3 Criteria for Becoming a Healer

Umbanda is a popular religion in Brazil and increasinglyworldwide. Its ceremonies are often devoted to healingthrough spiritual means. In this session, tourists at the backof the room watch as Umbanda followers perform a dancerelated to a particular deity.

� What is your opinion on the role of spirituality in healthand healing, and on what do you base your view?

shaman/shamanka male or female healers who havea direct relationship with the supernaturals.

• Selection: Certain individuals may show moreability for entry into healing roles. In Westernmedical schools, selection for entry rests on ap-parently objective standards, such as pre-entryexams and college grades. Among the indige-nous Ainu of northern Japan, healers were menwho had a special ability to go into a sort ofseizure called imu (Ohnuki-Tierney 1980).

• Training: The period of training may involve yearsof observation and practice and may be arduousand even dangerous. In some non-Western tradi-tions, a shaman must make dangerous journeys,through trance or use of drugs, to the spirit world.In Western biomedicine, medical school involvesimmense amounts of memorization, separationfrom family and normal social life, and sleep dep-rivation.

• Certification: Healers earn some form of ritual orlegal certification, such as a shaman goingthrough a formal initiation ritual that attests to hisor her competence.

• Professional image: The healer role is demarcatedfrom that of ordinary people through behavior,dress, and other markers, such as the white coatin the West and the Siberian shaman’s tambourinefor calling the spirits.

• Expectation of payment: Compensation in someform, whether in kind or in cash, is expected forformal healers. Payment level may vary, depend-ing on the status of the healer and other factors.In northern India, strong preference for sons is re-flected in payments to the midwife that are twiceas high for the birth of a son as for a daughter. Inthe United States, medical professionals in differ-ent specializations receive markedlydifferent salaries.

phytotherapy healing through the use of plants.


that also examines the use and meaning of Western pharma-ceuticals (Petryna, Lakoff, and Kleinman 2007).

Phytotherapy is healing through the use of plants.Cross-culturally, people know about and use many differentplants for a wide range of health problems, including gas-trointestinal disorders, skin problems, wounds and sores, pain

THINKING

T H E B O XOUTSIDE

What steps do you take to treat yourselfwhen you have a cold or headache? Ifyou take medicine, do you know what

materials are in the medicine?

The Tsimané are a foraging-horticultur-al society of Bolivia’s northeasternAmazon region, numbering about8000 people (McDade et al. 2007).Although most people make a livingfrom horticulture, complemented bysome gathering and hunting, newopportunities for wage work are in-creasingly available in logging camps oron cattle ranches, or by selling productsfrom the rainforest. At the time of thestudy described here, in 2002–2003,the Tsimané were not much affected byoutside forces and still relied heavily onlocal resources for their livelihood.

The study focused on mothers’botanical knowledge and the healthof their children. The word botanyrefers to knowledge about plants.Household visits and interviews withmothers provided data on mothers’

knowledge of plants. Children’s healthwas assessed with three measures:concentrations of C-reactive protein(or CRP, a measure of both immunityand “infectious burden”); skinfoldthickness (which measures bodyfat); and stature, or height (whichindicates overall progress in growthand development).

The results showed a strong rela-tionship between mothers’ knowledgeof plants and the health of their chil-dren. Botanical knowledge promoteshealthier children through nutritionalinputs, that is, knowledgeable motherstend to provide healthier plant foodsto their children. It also improveschildren’s health by providing herbalways of treating their illnesses. Theoverall conclusion is that a mother’sknowledge of local plant resources

contributes directly to the benefitof her children. In contrast, levels offormal schooling of mothers andhousehold wealth had little, if any-thing, to do with child health.

Given the positive effects of moth-ers’ botanical knowledge and use oflocal plants to promote their children’shealth, it is critical that access to plantresources by indigenous people beprotected and sustained and that localbotanical knowledge be respectedand preserved.

� FOOD FOR THOUGHT

• What do you know about the effectson your health of particular plantsthat you eat? When you eat herbssuch as oregano or parsley, forexample, do you think about theirhealth effects?

eye on the ENVIRONMENTLocal Botanical Knowledge and Child Health in the Bolivian Amazon

PACIFICOCEAN

LakeTiticaca

PERU

BOLIVIA

ARGENTINA

PARAGUAYCHILE

BRAZIL

La Paz

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MAP 7.4 The Republic of Bolivia.Situated in the Andes Mountains, Bolivia is the poorestcountry in South America, although it is rich in naturalresources, including the second largest oil field in SouthAmerica after Venezuela. The population of 10 millionincludes a majority of indigenous people of nearly 40different groups. The largest are the Aymara (2 million)and the Quechua-speaking groups (1.5 million). Thirtypercent of the population is mestizo and 15 percentare of European descent. Two-thirds of the people arelow-income farmers. The official religion is RomanCatholicism, but Protestantism is growing. Religioussyncretism is prominent. Most people speak Spanishas their first language, although Aymara and Quechuaare also common. Bolivia’s popular fiesta known as Elcarnival de Oruro is on UNESCO’s list of IntangibleCultural Heritage.

relief, infertility, fatigue, altitude sickness, and more (see Eyeon the Environment). Increasing awareness of the range ofpotentially useful plants worldwide provides a strong incen-tive for protecting the world’s cultural diversity, because it ispeople who know about botanical resources (Posey 1990).

Leaves of the coca plant have for centuries been a keypart of the health system of the Andean region of SouthAmerica (Allen 2002). Coca is important in rituals, in mask-ing hunger pains, and in combating the cold. In terms ofhealth, Andean people use coca to treat gastrointestinal prob-lems, sprains, swellings, and colds (Carter, Morales, andMamani 1981). About 85 percent of 3500 people surveyed inBolivia reported that they use coca medicinally. The leafmay be chewed or combined with herbs or roots and waterto make a maté, a medicinal beverage. Trained herbalistshave specialized knowledge about preparing matés. Onematé, for example, is for treating asthma. Made of a certainroot and coca leaves, the patient takes it three or four times aday until cured.

Minerals are also widely used for prevention and healing.For example, many people worldwide believe that bathing inwater that contains high levels of sulfur or other mineralspromotes health and cures ailments such as arthritis andrheumatism. Thousands of people every year go to the DeadSea, which lies beneath sea level between Israel and Jordan,for treating skin diseases. The mud from the shore and thenearby sulfur springs relieves skin ailments such as psoriasis.In Japan, bathing in mineral waters is popular as a health-promotion practice.

In a more unusual practice, thousands of people in theUnited States and Canada visit “radon spas” every year,

seeking the therapeutic effects of low doses of radon gas toalleviate the symptoms of chronic afflictions such as arthritis(Erickson 2007). In the United States, many radon spas arelocated in mines in the mountains of Montana. At one suchspa, the Free Enterprise Mine, the recommended treatment isto go into the mine for 1-hour sessions, two or three timesdaily, for up to a total of about 30 sessions. The mine containsbenches and chairs, and clients read, play cards, chat, or take a


These boys are selling hyssop, a medicinal herb, in Syria.In Unani (Islamic) traditional medicine, hyssop is used toalleviate problems such as asthma.

� Do research to learn more about hyssop and its medicinal uses.

Guests are undergoing radontreatment at the Kyongsong SandSpa in Haonpho-ri, North Korea.The spa, and its hot spring, hasa 500-year history as a healingcenter. The treatment shownhere is a “sand bath” used forchronic diseases such as arthritis,postoperative problems, andsome female problems.


nap. Some “regulars” come back every year and plan to meetup with friends from previous visits.

Pharmaceutical medicines are increasingly popularworldwide. Although these medicines have many benefits,some negative effects include frequent use without prescrip-tion and overprescription. Sale of patent medicines is oftenunregulated, and self-treating individuals can buy them in alocal pharmacy. The popularity and overuse of capsules andinjections has led to a growing health crisis related to theemergence of drug-resistant disease strains.

��

Three Theoretical Approachesin Medical Anthropology

The first major theoretical approach to understanding healthsystems emphasizes the importance of the environment inshaping health problems and how they spread. The secondhighlights symbols and meaning in people’s expression ofsuffering and healing practices. The third points to the needto look at structural factors (political, economic, media) as theunderlying causes of health problems and examines Westernbiomedicine as a cultural institution.

THE ECOLOGICAL/EPIDEMIOLOGICALAPPROACH

The ecological/epidemiological approach examines how as-pects of the natural environment interact with culture to causehealth problems and to influence their spread throughout thepopulation. According to this approach, research should focuson gathering information about the environmental contextand social patterns that affect health, such as food distributionwithin the family, sexual practices, hygiene, and populationcontact. Research methods and data tend to be quantitativeand etic, although a growing tendency is to include qualitativeand emic data in order to provide context for understandingthe quantitative data (review Chapter 3).

The ecological/epidemiological approach seeks to yieldfindings relevant to public health programs. It can provideinformation about groups that are at risk of specific problems.For example, although hookworm is common throughout ruralChina, epidemiological researchers learned that rice cultivatorshave the highest rates.The reason is that hookworm can spreadthrough the night soil (human excrement used as fertilizer)applied to the fields in which the cultivators work.

Another significant environmental factor that hasimportant effects on health is urbanization. As archaeologistshave documented about the past, settled populations living indense clusters are more likely than mobile populations toexperience a range of health problems, including infectiousdiseases and malnutrition (Cohen 1989). Such problems areapparent among many recently settled pastoralist groups in

East and West Africa. One study compared the health statusof two groups of Turkana men in northwest Kenya (seeMap 6.5, p. 153): those who were still mobile pastoralists andthose who lived in a town (Barkey, Campbell, and Leslie2001). The two groups differ strikingly in diet, physical activ-ities, and health. Pastoralist Turkana eat mainly animal foods(milk, meat, and blood), spend much time in rigorous physicalactivity, and live in large family groups. Settled Turkana meneat mainly maize and beans. Their sedentary (settled) lifemeans less physical activity and exercise. In terms of health,the settled men had more eye infections, chest infections,backache, and cough/colds. Pastoralist Turkana men were not,however, free of health problems. One-fourth of the pastoral-ist men had eye infections, but among the settled men, one-half had eye infections. In terms of nutrition, the settledTurkana were shorter and had greater body mass than thetaller and slimmer pastoralists.

Cities present many stressors to human health as well asopportunities for improved health through greater access tohealth care. Typically, cities comprise diverse social categories,varying by class and ethnicity. These groups have different ex-periences of health risk. In the United States, the incidence oftuberculosis (TB) has increased in recent years, mainly inurban areas (DeFerdinando 1999). Tuberculosis is spread byinfected humans, and its rate of spread is increased by crowd-ing, poverty, poor housing, and lack of access to health care. Inthe United States, rates of tuberculosis are generally higherin southern than in northern states, with the exceptions ofNew York and Illinois, given their large urban populations.

ecological/epidemiological approach an approach withinmedical anthropology that considers how aspects of the naturalenvironment and social environment interact to cause illness.

Women working in padi fields in southern China. Agriculturalwork done in standing water increases the risk of hookworminfection.

� Is hookworm a threat where you live? What is the majorinfectious disease in your home region?


Beginning in the 1990s, outbreaks of multidrug-resistant tuber-culosis (MDRTB), a new strain of TB that is resistant to con-ventional drugs, led to its being recognized by public healthauthorities as a major “new” infectious disease. Even more re-cently, the new threat of extra- multidrug-resistant tuberculosis(XMDRTB) has emerged. New forms of the disease mutatemore rapidly than scientists are able to develop drugs to com-bat them.

Anthropologists have applied the ecological/epidemio-logical approach to the study of the impaired health and sur-vival of indigenous peoples resulting from colonial contact.Findings about the effects of colonial contact are negative,ranging from the quick and outright extermination of indige-nous peoples to resilient adjustment, among other groups,to drastically changed conditions.

In the Western hemisphere, European colonialismbrought a dramatic decline in the indigenous populations,although disagreement exists about the numbers involved( Joralemon 1982). Research indicates that the precontactNew World was largely free of the major European infectiousdiseases such as smallpox, measles, and typhus, and perhapsalso of syphilis, leprosy, and malaria. Therefore, the exposure

of indigenous peoples to these infectious diseases likely had amassive impact, given the indigenous people’s complete lackof resistance. One analyst compared colonial contact to a“biological war”:

Smallpox was the captain of the men of death in that war,typhus fever the first lieutenant, and measles the secondlieutenant. More terrible than the conquistadores on horse-back, more deadly than sword and gunpowder, they madethe conquest by the whites a walkover as compared to whatit would have been without their aid. (Ashburn 1947:98,quoted in Joralemon 1982:112)

This quotation emphasizes the importance of the threemajor diseases in New World colonial history: smallpox,measles, and malaria. A later arrival, cholera, also had severeeffects because its transmission through contaminated waterand food thrives in areas of poor sanitation.

Besides infectious diseases, indigenous populations weredecimated by outright killing, enslavement and harsh laborpractices, and the psychological ravages of losing one’s liveli-hood, social ties and support, and access to ancestral burialgrounds (see Map 7.5 and Map 7.6).

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ShoshonePaiute

Ute

Navajo

Apache

Pawnee

Sioux

Shawnee

Cherokee

Choctaw

Cheyenne

Apache

Seminole

Crow

NisquallyQuinault

Kalispell

Spokane

ChinookCowlitz

Chenalis

Tillamook

KalapuyaTakelma

Wallawalla

Siletz

Yakima

Umatilla

KlamathKarok

Pomo

Yuki

YurokCoos

Shasta

Maidu

Wintuk

Miwok

NorthernPaiute

NezPercé

Coeurd'Alene Blackfoot

Flathead

KootenayPiegan

Atsina

Cree

Bannock

Lemhi

Wind RiverShoshone

Teton

WesternShoshone

SouthernPaiute

Gosiute

ChumashSalinan

EsselenCostanoan

Yokuts

Mono

Cahuilla

GabrielinoLuiseño

SerranoMojave

Chemehuevi

Panamint

HopiHavasupai

YavapaiWalapai

Pima

Aravaipa

Zuñi

Pueblo

Acoma

ApacheMescalero

SantoDomingo

JicarillaApache

Comanche

Wichita

LipanApache

Tonkawa

Tawakoni

KichaiComanche

Caddo

Illinois

Kaskaskia

Peoria

Iowa

Missouri

CahokiaArapaho

PoncaOmaha

Kansa

Chippewa

Chippewa

MenominiSauk-fox

Kickapoo

Winnebago Potawatomi

Ottawa

Chickasaw

Chakchiuma

Chickamauga

CreekTaposa

Natchez

ChitimachaWasha

Chawasha

BiloxiMobile

Tunica

Quapaw

Calusa

Yamasee

Apalachicola

Yuchi

Guale

Cusabo

Sewee

TimucuaApalachee

TuscaroraPamilco

MonacanWeapemeoc

NottowaySaponi

Tutelo

Catawba

Erie

Munsee

Piankashaw

Wea

Miami

Huron

Susquehannock

IroquoisPequot

Mahican

Wappinger

Delaware

Unalachtigo

Minisink

NarragansetNauset

Massachuset

Nipmuc

Pennacook

Penobscot

Cayuga

Onondaga

Seneca

Mandan Santec

Wahpeton

Hidatsa

ArikaraSans Arc

Hunkpapa

Ogala

Yanktonai

Osage

Kiowa

Yuma

Maricopa

Papago

MAP 7.5 Precolonial Distribution of Indian Tribes in the 48 United States.Before the arrival of European colonialists, Indians were the sole occupants of the area.The first English settlers were impressed by their height and robust physical health.


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150Federal Indian Reservation

State Indian Reservation

MAP 7.6 Designated Reservations in the 48 United States.Indian reservations today comprise a small percentage of the U.S. land mass. Reservationsare allocated to “recognized tribes.” Several states recognize no tribes. Many Indians liveoff the reservations, often as poorly employed or unemployed urban residents.

historical trauma the intergenerational transfer of thenegative effects of colonialism from parents to children.

Enduring effects of European colonialism among in-digenous peoples worldwide include high rates of depressionand suicide, low self-esteem, high rates of child and adoles-cent drug use, and high rates of alcoholism, obesity, and hy-pertension. Historical trauma refers to the intergenerationaltransfer of the emotional and psychological effects of colo-nialism from parents to children (Brave Heart 2004). It isclosely associated with substance abuse as a vehicle forattempting to cover the continued pain of historical trauma.Troubled parents create a difficult family situation for chil-dren, who tend to replicate their parents’ negative copingmechanisms. The concept of historical trauma helps toexpand the scope of traditional epidemiological studies bydrawing on factors from the past to explain the social andspatial distribution of contemporary health problems. Such anapproach may prove more effective in devising culturallyappropriate ways to alleviate health problems.

THE INTERPRETIVIST APPROACHSome medical anthropologists examine health systems as sys-tems of meaning. They study how people in different cultures

label, describe, and experience illness and how healing sys-tems offer meaningful responses to individual and communaldistress. Interpretivist anthropologists have examined aspectsof healing, such as ritual trance, as symbolic performances.French anthropologist Claude Lévi-Strauss established thisapproach in a classic essay called “The Effectiveness ofSymbols” (1967). He examined how a song sung by a shamanduring childbirth among the Kuna Indians of Panama (seeMap 9.4, p. 228) helps women through a difficult delivery.The main point is that healing systems provide meaning topeople who are experiencing seemingly meaningless forms ofsuffering. The provision of meaning offers psychological sup-port to the afflicted and may enhance healing through whatWestern science calls the placebo effect, or meaning effect, a

placebo effect or meaning effect a positive result from a healing method due to a symbolic or otherwisenonmaterial factor.

positive result from a healing method due to a symbolic orotherwise nonmaterial factor (Moerman 2002). In the UnitedStates, depending on the health problem, between 10 and90 percent of the efficacy of medical prescriptions lies in theplacebo effect. Several explanatory factors may be involved inthe meaning effect: the confidence of the specialist pres-cribing a treatment, the act of prescription itself, and concretedetails about the prescription (see Everyday Anthropology).

CRITICAL MEDICAL ANTHROPOLOGYCritical medical anthropology focuses on the analysis ofhow structural factors such as the global political economy,global media, and social inequality affect the prevailing healthsystem, including types of afflictions, people’s health status,and their access to health care. Critical medical anthropolo-gists show how Western biomedicine itself often serves tobolster the institution of medicine to the detriment of helpingthe poor and powerless. They point to the process ofmedicalization, or labeling a particular issue or problem asmedical and requiring medical treatment when, in fact, itscause is structural. In this way, people are prescribed pills andinjections for poverty, pills and injections for forced displace-ment from one’s home, and pills and injections for being un-able to provide for one’s family.

SOCIAL INEQUALITY AND POVERTY An importanttopic to launch this discussion is social inequality and poverty.No matter how you measure these factors, they always havesomething to say about health. Substantial evidence indicatesthat poverty is the primary cause of morbidity (sickness) andmortality (death) in both industrialized and developing coun-tries (Farmer 2005). It may be manifested in different ways—for example, in child malnutrition in Chad or Nepal or throughstreet violence among the urban poor of wealthy countries.

At the broadest level, comparing richer countries to poorercountries, distinctions exist between the most common healthproblems of rich, industrial countries and those of poor, lessindustrial countries. In the former, major causes of death arecirculatory diseases, malignant cancers, HIV/AIDS, excessalcohol consumption, and smoking tobacco. In poor countries,tuberculosis, malaria, and HIV/AIDS are the three leadingcauses of death. One disease they share is HIV/AIDS.

Within the developing world, rates of childhood malnu-trition are inversely related to income. In other words, as

income increases, so does calorie intake as a percent of recom-mended daily allowances (Zaidi 1988). Thus, increasing theincome levels of the poor is the most direct way to improvechild nutrition and health. Yet, in contrast to this seeminglylogical approach, most health and nutrition programs aroundthe world focus on treating the health results of poverty ratherthan its causes.

Critical medical anthropologists describe the widespreadpractice of medicalization in developing countries, or treatinghealth problems caused by poverty with pills or other medicaloptions. An example is Nancy Scheper-Hughes’s research(1992) in Bom Jesus in Pernambuco, northeastern Brazil(mentioned in Chapter 6; see Map 7.1 p. 165). The people ofBom Jesus, poor and often unemployed, frequently experiencedsymptoms of weakness, insomnia, and anxiety. Doctors at thelocal clinic gave them pills to take. The people were, however,hungry and malnourished. They needed food, not pills. In thiscase, as in many others, the medicalization of poverty serves theinterests of pharmaceutical companies, not the poor.

CULTURAL CRITIQUE OF WESTERN BIOMEDICALTRAINING Since the 1980s, critical medical anthro-pologists have studied Western biomedicine as a cultural sys-tem. Though recognizing many of its benefits, they point toareas where WBM could be improved, for example, by reduc-ing the reliance on technology, broadening an understandingof health problems as they relate to structural conditions andnot just biological conditions, and diversifying healingthrough alternative methods such as massage, acupuncture,and chiropracty.

Some critical medical anthropologists have conductedresearch on Western medical school training. One study ofobstetric training in the United States involved interviewswith 12 obstetricians, 10 male and 2 female (Davis-Floyd1987). As students, they absorbed the technological model ofbirth as a core value of Western obstetrics. This model treatsthe body as a machine. The physician uses the assembly-lineapproach to birth in order to promote efficient productionand quality control. One of the residents in the study ex-plained, “We shave ’em, we prep ’em, we hook ’em up to theIV and administer sedation. We deliver the baby, it goes to thenursery and the mother goes to her room. There’s no room forniceties around here. We just move ’em right on through. It’snot hard to see it like an assembly line” (1987:292). The goalis the “production” of a healthy baby. The doctor is a technicalexpert in charge of achieving this goal, and the mothertakes second place. One obstetrician said, “It is what we allwere trained to always go after—the perfect baby. That’s whatwe were trained to produce. The quality of the mother’sexperience—we rarely thought about that. Everything we didwas to get that perfect baby” (1987:292).

This goal involves the use of sophisticated monitoringmachines. One obstetrician said, “I’m totally dependent


critical medical anthropology approach within medicalanthropology involving the analysis of how economic andpolitical structures shape people’s health status, their accessto health care, and the prevailing medical systems that existin relation to them.

medicalization labeling a particular issue or problem asmedical and requiring medical treatment when, in fact, thatissue or problem is economic or political.

on fetal monitors, ’cause they’re great! They free you to doa lot of other things. . . . I couldn’t sit over there with awoman in labor with my hand on her belly, and be in hereseeing 20 to 30 patients a day” (1987:291). Use of technologyalso conveys status to the physician. One commented,“Anybody in obstetrics who shows a human interest inpatients is not respected. What is respected is interest inmachines” (1987:291).

How do medical students learn to accept the technologi-cal model? Davis-Floyd’s research points to three key processes.One way is through physical hazing, a harsh rite of passage in-volving, in this case, stress caused by sleep deprivation. Hazingextends throughout medical school and the residency period.

Second, medical school training in the United Statesinvolves a process of cognitive retrogression in which studentsrelinquish critical thinking and thoughtful ways of learning.During the first two years of medical school, most courses arebasic sciences, and students must memorize vast quantities ofmaterial. The sheer bulk of memorization forces students toadopt an uncritical approach. This mental overload socializesstudents into a uniform pattern, giving them tunnel vision inwhich the knowledge of medicine assumes supreme impor-tance. As one obstetrician said,

Medical school is not difficult in terms of what you have tolearn—there’s just so much of it. You go through, in a six-week course, a thousand-page book. The sheer bulk ofinformation is phenomenal. You have pop quizzes in two orthree courses every day the first year. We’d get up around 6,attend classes till 5, go home and eat, then head back toschool and be in anatomy lab working with a cadaver, orsomething, until 1 or 2 in the morning, and then go home

and get a couple of hours of sleep and then go out again.And you did that virtually day in and day out for four years,except for vacations. (1987:298–299)

Third, in a process termed dehumanization, medicalschool training works to erase humanitarian ideals through anemphasis on technology and objectification of the patient. Oneobstetrical student explained, “Most of us went into medicalschool with pretty humanitarian ideals. I know I did. But thewhole process of medical education makes you inhuman . . . bythe time you get to residency, you end up not caring aboutanything beyond the latest techniques you can master and howsophisticated the tests are that you can perform” (1987:299).The last two years of medical school and the four years ofresidency are devoted primarily to hands-on experience.

��

Globalization and ChangeWith globalization, health problems move around the worldand into remote locations and cultures more rapidly than everbefore. The HIV/AIDS epidemic is one tragic example. Othernew epidemics include SARS (Severe Acute RespiratorySyndrome) and avian (bird) flu. At the same time, Westernculture, including biomedicine, is on the move. Perhaps noother aspect of Western culture, except for the capitalist mar-ket system and the English language, has so permeated the restof the world as Western biomedicine. But the cultural flow isnot one-way. Many people in North America and Europe areturning to forms of non-Western and nonbiomedical healing,such as acupuncture and massage therapy. This section consid-ers new and emerging health challenges, changes in healing,


Medical students in training ina Western biomedical setting.These students are observingbrain surgery.

� What does this scene conveyabout values and beliefs ofWestern medicine?


and examples of how applied medical anthropology has in-creasing relevance.

NEW INFECTIOUS DISEASESIn the mid-twentieth century, scientific advances such as an-tibiotic drugs, vaccines against childhood diseases, and im-proved technology for sanitation dramatically reduced thethreat from infectious disease. The 1980s, however, were thebeginning of an era of shaken confidence with the onset andrapid spread of the HIV/AIDS epidemic.

New contexts for exposure and contagion are createdthrough increased international travel and migration, defor-estation, and development projects, among others. Increasedtravel and migration have contributed to the spread ofHIV/AIDS and SARS. Deforestation is related to higherrates of malaria, which is spread by mosquitoes; mosquitoesthrive in pools of water in open, sunlit areas as opposed toforest. Development projects such as dam construction andclearing forests often have negative health effects.

DISEASES OF DEVELOPMENTDiseases of development are health problems (both diseasesand illnesses) caused or increased by economic developmentactivities. For example, the construction of dams and irriga-tion systems throughout the tropical world has broughtdramatically increased rates of schistosomiasis (shish-to-suh-MY-a-sis), a disease caused by the presence of a parasiticworm in the blood system. Over 200 million people sufferfrom this debilitating disease, with prevalence rates the high-

est in sub-Saharan countries in Africa (Michaud, Gordon,and Reich 2004). The larvae hatch from eggs and mature inslow-moving water such as lakes and rivers). When mature,they can penetrate human (or other animal) skin with whichthey come into contact. Once inside the human body, theadult schistosomes breed in the veins around the human blad-der and bowel. They send fertilized eggs through urine andfeces into the environment. These eggs then contaminatewater in which they hatch into larvae.

Anthropologists’ research has documented steep in-creases in the rates of schistosomiasis at large dam sites indeveloping countries (Scudder 1973). The increased risk iscaused by the dams slowing the rate of water flow. Stagnantwater systems offer an ideal environment for development ofthe larvae. Opponents of the construction of large dams haveused this information in support of their position.

New diseases of development continue to appear. One ofthese is Kyasanur Forest Disease, or KFD (Nichter 1992). Thisviral disease was first identified in 1957 in southern India:

Resembling influenza, at onset KFD is marked by suddenchills, fever, frontal headaches, stiffness of the neck, andbody pain. Diarrhea and vomiting often follow on the thirdday. High fever is continuous for five to fifteen days, duringwhich time a variety of additional symptoms may manifestthemselves, including gastrointestinal bleeding, persistentcough with blood-tinged sputum, and bleeding gums.In more serious cases, the infection progresses to bron-chial pneumonia, meningitis, paralysis, encephalitis, andhemorrhage. (1992:224)

In the early 1980s, an epidemic of KFD swept throughover 30 villages near the Kyasanur forest in Karnataka state,southern India (see Map 8.5, p. 202). Mortality rates in hospi-tals ranged between 12 and 18 percent of those admitted.

(LEFT) A woman takes her 8-year-old grandson, who has HIV/AIDS, to a clinic in Dar es Salaam, Tanzania. Throughout the world,increasing numbers of children are infected and, at the same time, are orphans because their parents have died of the disease.(RIGHT) Social stigma often adds to the suffering of HIV/AIDS victims. The billboards, near Soweto in South Africa, promotecondom use and seek to reduce social rejection and stigma.

disease of development a health problem caused orincreased by economic development activities that affect theenvironment and people’s relationship with it.

The name Sherpa means “person.”About 35,000 Sherpa live in Nepal,mainly in the northeastern region.Another 10,000 reside in Bhutan andSikkim (Fisher 1990), and another 5000live in cities of Europe and NorthAmerica.

In Nepal, the Sherpa are mostclosely associated with the Khumburegion. Khumbu is a valley set high inthe Himalayas, completely encircledby mountains and with a clear view ofMount Everest (Karan and Mather1985). The Sherpa have a mixedeconomy involving animal herding,trade between Tibet and India, smallbusinesses, and farming, with the maincrop being potatoes. Since the 1920sand the coming of Western moun-taineers, Sherpa men have becomeincreasingly employed as guides andporters for trekkers and climbers.Many Sherpa men and women nowrun guest houses or work in guest

houses as cooks, food servers, andcleaners.

The Sherpa are organized into 18separate lineages, or ru (“bones”), withmarriage taking place outside one’sbirth lineage. Recently, they havebegun marrying into other ethnicgroups, thus expanding the definitionand meaning of what it is to be Sherpa.Because of increased intermarriage,the number of people who can be con-sidered Sherpa to some degree is130,000. Status distinctions include“big people,” “middle people,” and“small people,” with the middle groupbeing the largest by far (Ortner1999:65). The main privilege of thosein the top level is not to carry loads.Those in the poorest level are landlessand work for others.

The Sherpa practice a localized ver-sion of Tibetan Buddhism, which con-tains non-Buddhist elements having todo with nature spiritualism that con-

nects all beings. The place nameKhumbu, for example, refers to theguardian deity of the region.

Tourism has been and still is a majorchange factor for the Sherpa. InKhumbu, the number of internationaltourists per year exceeds the Sherpapopulation.

Global warming is also having signif-icant effects. Glaciers are melting,lakes are rising, and massive flooding isfrequent. Some of the swollen lakesare in danger of breaking their banks(United Nations EnvironmentProgramme 2002). Many communitydevelopment projects are aimed at re-forestation, planting fruit orchards, andprotecting and expanding local knowl-edge of medicinal herbs.

Thanks to Vincanne Adams, Universityof California at San Francisco, forreviewing this material.

C U L T U R A M AThe Sherpa of Nepal


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INDIA

NEPALCHINA

Pokhara

Kathmandu

Qomolangma(Mt. Everest)

MAP 7.7 Nepal. The Kingdomof Nepal has a population of almost30 million inhabitants. Most of its territory is in the Himalayas, and Nepal has 8 of the world’s 10 highest mountains.

(LEFT) A Sherpa porter carries a load up a steep mountain path in the Himalayas. Portersearn relatively good wages, especially when they work for international tourists.(CENTER) Nepali children learn writing in a school supported by the Himalayan Trust,an organization founded by Sir Edmund Hillary in 1961, after he climbed MountEverest and asked the local people he met how he could help them.

181


Apia

Savaiì

Ùpolu

SAMOA

American Samoa(United States)

TutuilaManuàIslands

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FEDERATEDSTATES OF

MICRONESIA

NewCaledonia

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Niue

Hawaii

NAURU

KIRIBATI

FRENCHPOLYNESIA

Tokelau

Tahiti

Wallis &Futuna

MARSHALLISLANDS

VANUATU

SOLOMONISLANDS

FIJI

TUVALU

TONGA

SAMOA

AmericanSamoa

MAP 7.8 Samoa and American Samoa.Samoa, or the Independent State of Samoa, was known asGerman Samoa (1900–1919) and Western Samoa (1914–1997)until recognized by the United Nations as a sovereign country.Its population is around 177,000. American Samoa, or AmerikaSamoa in Samoan English, is a territory of the United Stateswith a population of about 57,000. During World War II, U.S.Marines in American Samoa outnumbered the local popula-tion and had a strong cultural influence. Unemployment ratesare now high and the U.S. military is the largest employer.

Investigation revealed that KFD especially affected agricul-tural workers and cattle tenders who were most exposed tonewly cleared areas near the forest. In the cleared areas, inter-national companies established plantations and initiated cattleraising. Ticks were the vector transmitting the disease fromthe cattle to the people. Ticks had long existed in the localecosystem, but their numbers greatly increased in the clearedarea, finding many inviting hosts in the cattle and in theworkers. Thus, human modification of the ecosystem throughdeforestation and introduction of large-scale cattle raisingcaused the epidemic and shaped its social distribution.

MEDICAL PLURALISMContact between cultures may lead to a situation in whichaspects of both cultures coexist: two (or more) differentlanguages, religions, systems of law, or health systems, forexample. The term medical pluralism refers to the presenceof multiple health systems within a society. The coexistence ofmany forms of healing provides clients a range of choices andenhances the quality of health. In other cases, people areconfronted by conflicting models of illness and healing, asituation that can result in misunderstandings betweenhealers and clients and in unhappy outcomes.

SELECTIVE PLURALISM: THE CASE OF THE SHERPA The Sherpa of Nepal (see Culturama) are an unusual exampleof a culture in which preference for traditional healing systemsremains strong along with the selective use of Western bio-medicine (Adams 1988). Healing therapies available in theUpper Khumbu region in northeastern Nepal fit into threecategories:

• Orthodox Buddhist practitioners, which include lamas,who Khumbu people consult for prevention and curethrough their blessings, and amchis, who practiceTibetan medicine, a humoral healing system.

• Unorthodox religious or shamanic practitioners whoperform divination ceremonies for diagnosis.

• Biomedical practitioners who work in a clinic that wasfirst established to serve tourists. The clinic was estab-lished as a permanent medical facility in 1967, andmany Sherpa selectively use it.

Thus, three varieties of health care exist in the region.Traditional healers are thriving, unthreatened by changesbrought by the tourist trade, the influx of new wealth, andnotions of modernity. The question of why Western biomedi-cine has not completely taken over other healing practicesrequires a complicated answer. One part of the answer is thathigh-mountain tourism does not deeply affect local produc-tion and social relations. Although it brings in new wealth,it does not require large-scale capital investment from out-side as, for example, mega-hotel tourist developments have

elsewhere. So far, the Sherpa maintain control of their pro-ductive resources, including trekking knowledge and skills.

CONFLICTING EXPLANATORY MODELS In manyother contexts, however, anthropologists have documentedconflicts and misunderstandings between Western biomedi-cine and local health systems. Miscommunication oftenoccurs between biomedical doctors and patients in matters asseemingly simple as a prescription that should be taken withevery meal. The Western biomedically trained doctor assumesthat this means three times a day. But some people do noteat three meals a day and thus unwittingly fail to follow thedoctor’s instructions.

One anthropological study of a case in which deathresulted from cross-cultural differences shows how complexthe issue of communication across medical cultures is. The “Ffamily” are immigrants from American Samoa (see Map 7.8)living in Honolulu, Hawai’i (Krantzler 1987). Neither parentspeaks English. Their children are “moderately literate” inEnglish but speak a mixture of English and Samoan at home.


Mr. F was trained as a traditional Samoan healer. Mary, adaughter, was first stricken with diabetes at age 16. She wastaken to the hospital by ambulance after collapsing, half-con-scious, on the sidewalk near her home in a Honolulu housingproject. After several months of irregular contact with medicalstaff, she was again brought to the hospital in an ambulance,unconscious, and she died there. Her father was charged withcausing Mary’s death through medical neglect.

In the biomedical view, her parents failed to give Maryadequate care even though the hospital staff took pains toinstruct her family about how to give insulin injections, andMary was shown how to test her urine for glucose and acetoneand counseled about her diet. She was to be followed up withvisits to the outpatient clinic and, following the clinic’s un-official policy of linking patients with physicians from theirown ethnic group, she was assigned to see the sole Samoanpediatric resident. Over the next few months, Mary was seenonce in the clinic by a different resident, she missed her nextthree appointments, came in once without an appointment,and was readmitted to the hospital on the basis of testresults from that visit. At that time, she, her parents, and herolder sister were once again advised about the importance ofcompliance with the medical advice they were receiving. Fourmonths later, she returned to the clinic with blindness in oneeye and diminished vision in the other. She was diagnosedwith cataracts, and the Samoan physician again advised Maryabout the seriousness of her illness and the need for compli-ance. The medical experts increasingly judged that “culturaldifferences” were the basic problem and that in spite of alltheir attempts to communicate with the F family, they werebasically incapable of caring for Mary.

The family’s perspective, in contrast, was grounded infa’a Samoa, the Samoan way. Their experiences in the hospitalwere not positive from the start. When Mr. F arrived at thehospital with Mary the first time, he spoke with several differ-ent hospital staff, through a daughter as translator. It wasa teaching hospital, and so various residents and attendingphysicians had examined Mary. Mr. F was concerned thatthere was no single physician caring for Mary, and he wasconcerned that her care was inconsistent. The family observeda child die while Mary was in the intensive care unit, reinforc-ing the perception of inadequate care and instilling fear overMary’s chance of surviving in this hospital.

Language differences between Mary’s family and thehospital staff added to the problem:

When they asked what was wrong with her, their percep-tion was that “everyone said ‘sugar.’ ” What this meant wasnot clear to the family; they were confused about whethershe was getting too much sugar or too little. Mary’s motherinterpreted the explanations to mean she was not gettingenough sugar, so she tried to give her more when she wasreturned home. Over time, confusion gave way to anger,

and a basic lack of trust of the hospital and the physiciansthere developed. The family began to draw on their ownresources for explaining and caring for Mary’s illness, rely-ing heavily on the father’s skills as a healer. (1987:330)

From the Samoan perspective, the F family behaved logi-cally and appropriately. The father, as household head andhealer in his own right, felt he had authority. Dr. A, althoughSamoan, had been resocialized by the Western medical systemand alienated from his Samoan background. He did not offerthe personal touch that the F family expected. Samoansbelieve that children above the age of 12 are no longer childrenand can be expected to behave responsibly. Assigning Mary’s12-year-old sister to assist her with her insulin injections andrecording results made sense to them. Also, the hospital inAmerican Samoa does not require appointments. Culturalmisunderstanding was the ultimate cause of Mary’s death.

APPLIED MEDICAL ANTHROPOLOGYApplied medical anthropology is the application of anthro-pological knowledge to further the goals of health-careproviders. It may involve improving doctor–patient commu-nication in multicultural settings, making recommendationsabout culturally appropriate health intervention programs, orproviding insights about factors related to disease that med-ical practitioners do not usually take into account. Appliedmedical anthropologists draw on ethnomedical knowledgeand on any of the three theoretical approaches or a combina-tion of them.

REDUCING LEAD POISONING AMONG MEXICANAMERICAN CHILDREN An example of the positive im-pact of applied medical anthropology is in the work of RobertTrotter on lead poisoning among Mexican American children(1987). The three most common sources of lead poisoning ofchildren in the United States are these:

• Eating lead-based paint chips

• Living near a smelter where the dust has high lead content

• Eating or drinking from pottery made with an improp-erly treated lead glaze

The discovery of an unusual case of lead poisoning byhealth professionals in Los Angeles in the 1980s prompted in-vestigations that produced understanding of a fourth cause: theuse by many Mexican Americans of a traditional healing rem-edy, azarcon, which contains lead to treat a culture-specific

applied medical anthropology the application ofanthropological knowledge to furthering the goals of health care providers.

medical pluralism the existence of more than one healthsystem in a culture, or a government policy to promote theintegration of local healing systems into biomedical practice.


Vaccination programs in developingcountries, especially as promoted byUNICEF, are introduced with muchfanfare. But they are sometimes metwith little enthusiasm by the targetpopulation. In India, many peopleare suspicious that vaccination pro-grams are clandestine familyplanning programs (Nichter 1996).In other instances, fear of foreignvaccines prompts people to reject inoculations. Overall, acceptance rates of vaccination are lower than Western public health planners expected.

To understand why peoplereject inoculations, medicalanthropologists conducted surveysin several countries. The resultsrevealed that many parents have apartial or inaccurate understandingof what the vaccines protectagainst. Some people did notunderstand the importance ofmultiple vaccinations. Public healthpromoters incorporated findingsfrom the survey in two ways:

LESSONS appliedPromoting Vaccination Programs in Developing Countries

A young girl in Bangladesh,photographed in 1975, has the raised bumps of smallpox. In 1977,the World Health Organizationannounced that smallpox had beeneradicated in Bangladesh.

� Has smallpox been eradicatedworldwide?

syndrome called empacho. Empacho is a combination ofindigestion and constipation believed to be caused by foodsticking to the abdominal wall.

The U.S. Public Health Service asked Trotter to investi-gate the availability and use of azarcon. He went to Mexicoand surveyed the contents of herbal shops. He talked withcuranderos (traditional healers). His findings convinced theU.S. government to place restrictions on azarcon, and a relatedremedy called greta. Trotter also made recommendations aboutthe need to provide a substitute remedy for the treatment ofempacho that would not have harmful side effects. He offeredideas about how to advertise the substitute in a culturally effec-tive way. Throughout his involvement, Trotter played severalroles—researcher, consultant, and program developer—all ofwhich brought anthropological knowledge to the solution ofa public health problem.

PUBLIC HEALTH COMMUNICATION Much work inapplied medical anthropology involves health communication

(Nichter 1996). Anthropologists can help health educatorsin the development of more meaningful messages throughthese methods:

• Addressing local health beliefs and health concerns

• Taking seriously all local illness terms and conventions

• Adopting local styles of communication

• Identifying subgroups within the population that may beresponsive to different types of messages and incentives

• Monitoring the response of communities to healthmessages over time and facilitating corrections incommunication when needed

• Exposing and removing possible victim blaming inhealth messages

These principles helped health-care officials understand localresponse to public vaccination programs in several countriesof Asia and Africa (see Lessons Applied).

• Educational campaigns for thepublic that addressed their concerns

• Education for the public healthspecialists about the importance ofunderstanding and paying attentionto local cultural practices and beliefs

� FOOD FOR THOUGHT

• If your job were to promote wideracceptance of vaccinations in yourhome country, what would youwant to know before you began aneducation campaign?


WORKING TOGETHER: WESTERN BIOMEDICINE ANDNONBIOMEDICAL SYSTEMS Since 1978, the WorldHealth Organization has endorsed the incorporation of localhealing practices in national health systems. This policyemerged in response to several factors. First is the increasingappreciation of the value of many non-Western healing tradi-tions. Another is the shortage of trained biomedical personnel.Third is the growing awareness of the deficiencies of Westernbiomedicine in addressing a person’s psychosocial context.

Debates continue about the efficacy of many traditionalmedical practices as compared to biomedicine. For instance,

opponents of the promotion of traditional medicine claimthat it has no effect on such infectious diseases as cholera,malaria, tuberculosis, schistosomiasis, leprosy, and others.They insist that it makes no sense to allow for or encourageritual practices against cholera, for example, when a child hasnot been inoculated against it. Supporters of traditional med-icine as one component of a pluralistic health system pointout that biomedicine neglects a person’s mind, soul, and socialsetting. Traditional healing practices fill that gap.


7the BIG questions REVISITED

� What is ethnomedicine?

Ethnomedicine is the study of health systems of specific cul-tures. Health systems include categories and perceptions ofillness and approaches to prevention and healing. Research inethnomedicine shows how perceptions of the body differcross-culturally and reveals both differences and similaritiesacross health systems in perceptions of illness and symptoms.Culture-specific syndromes are found in all cultures, not justnon-Western societies, and many are now globalizing.

Ethnomedical studies of healing, healing substances, andhealers reveal a wide range of approaches. Community heal-ing is more characteristic of small-scale nonindustrial soci-eties. They emphasize group interaction and treating theindividual within the social context. Humoral healing seeks tomaintain balance in bodily fluids and substances through diet,activity, and behavior. In industrial/ informatics societies, bio-medicine emphasizes the body as a discrete unit, and treat-ment addresses the individual body or mind and frames outthe wider social context. Biomedicine is increasingly relianton technology and is increasingly specialized.

� What are three majortheoretical approaches inmedical anthropology?

Ecological/epidemiological medical anthropology emphasizeslinks between the environment and health. It reveals how cer-tain categories of people are at risk of contracting particular dis-eases within various contexts in historical times and the present.

The interpretivist approach focuses on studying illnessand healing as a set of symbols and meanings. Cross-culturally,definitions of health problems and healing systems for theseproblems are embedded in meanings.

Critical medical anthropologists focus on health prob-lems and healing within a structurist framework. They askwhat power relations are involved and who benefits from par-ticular forms of healing. They analyze the role of inequalityand poverty in health problems. Some critical medical anthro-pologists have critiqued Western biomedicine as a systemof social control.

� How are health, illness, andhealing changing duringglobalization?

Health systems everywhere are facing accelerated change inthe face of globalization, which includes the spread ofWestern capitalism as well as new diseases and new medicaltechnologies. The “new infectious diseases” are a challenge tohealth-care systems in terms of prevention and treatment.Diseases of development are health problems caused by devel-opment projects that change the physical and social environ-ments, such as dams and mines.

The spread of Western biomedicine to many non-Western contexts is a major direction of change. As a conse-quence, medical pluralism exists in all countries. Theavailability of Western patent medicines has had substantialpositive effects, but widespread overuse and self-medicationcan result in negative health consequences for individuals andthe emergence of drug-resistant disease strains.

Applied, or clinical, medical anthropologists play severalroles in improving health systems. They may inform medicalcare providers of more appropriate forms of treatment, guidelocal people about their increasingly complex medical choices,help prevent health problems through changing detrimentalpractices, or improve public health communication by makingit more culturally informed and effective.


K E Y C O N C E P T S

applied medical anthropology, p. 183community healing, p. 170critical medical anthropology, p. 178culture-specific syndrome, p. 167disease, p. 165disease of development, p. 180ecological/epidemiological

approach, p. 175

ethno-etiologies, p. 168ethnomedicine, p. 164historical trauma, p. 177humoral healing, p. 171illness, p. 165medicalization, p. 178medical pluralism, p. 182phytotherapy, p. 173

placebo effect, or meaningeffect, p. 177

shaman/shamanka, p. 172somatization, p. 167structural suffering, p. 169susto, p. 168Western biomedicine (WBM)

p. 164

help the Ju/’hoansi cope with recent and contemporary socialupheaval. Their healing dances help them maintain a sense ofcommunity and are important for their cultural survival.

Carol Shepherd McClain, ed. Women as Healers: A Cross-CulturalPerspective. New Brunswick, NJ: Rutgers University Press, 1989.Case studies discuss women healers in Ecuador, Sri Lanka,Mexico, Jamaica, the United States, Serbia, Korea, SouthernAfrica, and Benin.

David McKnight. From Hunting to Drinking: The Devastating Effectsof Alcohol on an Australian Aboriginal Community. New York:Routledge, 2002. McKnight documents the history of drinkingin Australia, causes of excessive alcohol consumption, and vestedinterests of authorities in the sale of alcohol to Aboriginal people.

Ethan Nebelkopf and Mary Phillips, eds. Healing and Mental Healthfor Native Americans: Speaking in Red. New York: AltaMira Press,2004. Chapters address mental health and substance abuseamong Native North Americans and provide cases of healing thatinvolve Native American culture.

Merrill Singer. Something Dangerous: Emergent and Changing IllicitDrug Use and Community Health. Long Grove, IL: WavelandPress, 2005. This ethnography combines theory with researchand applied anthropology about drug use and public healthresponses in the United States.

Paul Stoller. Stranger in the Village of the Sick: A Memoir of Cancer,Sorcery, and Healing. Boston: Beacon Press, 2004. After beingdiagnosed with lymphoma, the author enters the “village of thesick” as he goes through diagnostic testing, chemotherapy, andeventual remission. He describes being a cancer patient in theUnited States and how he found strength through his earlierassociation with a West African healer.

Johan Wedel. Santería Healing. Gainesville: University of FloridaPress, 2004. This book discusses Santería healing in Cuba.The author conducted interviews with priests and othersknowledgeable about Santería and observed many Santeríaconsultations.

Eric J. Bailey. Medical Anthropology and African American Health.New York: Greenwood Publishing Group, 2000. This bookexplores the relationship between cultural anthropology andAfrican American health-care issues. One chapter discusses howto do applied research in medical anthropology.

Ron Barrett. Aghor Medicine: Pollution, Death, and Healing inNorthern India. Berkeley: University of California Press, 2008.This study of the Aghori, Hindu ascetics of India, shows howthey have recently become involved in healing victims of stigma-tized diseases.

Bernhard M. Bierlich. The Problem of Money: African Agency andWestern Biomedicine in Northern Ghana. New York: BergahnBooks, 2008. Fieldwork among the Dagomba people providesthe basis for this description of ambivalent attitudes towardWestern biomedicine and other aspects of modernity.

Nancy N. Chen. Breathing Spaces: Qigong, Psychiatry, and Healingin China. New York: Columbia University Press, 2003. Thisethnography explores qigong (chee-gung), a charismatic formof healing popular in China that involves meditative breathingexercises.

Paul Farmer. Pathologies of Power: Health, Human Rights, and the NewWar on the Poor. Berkeley: University of California Press, 2005.Farmer blends interpretive medical anthropology with criticalmedical anthropology in his study of how poverty kills throughdiseases such as tuberculosis and HIV/AIDS.

Bonnie Glass-Coffin. The Gift of Life: Female Spirituality andHealing in Northern Peru. Albuquerque: University of NewMexico Press, 1998. The author examines women traditionalhealers in northern Peru. She provides a descriptive account oftheir practices and an account of how two healers worked to cureher of a spiritual illness.

Richard Katz, Megan Biesele, and Verna St. Davis. Healing MakesOur Hearts Happy: Spirituality and Cultural Transformation amongthe Kalahari Ju/ ’hoansi. Rochester, VT: Inner Traditions, 1997.This book presents the story of how traditional healing dances

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