Topic 2

Ethnomedicine

• A society's ideas about what illnesses exist, how they develop, and how they should be treated.

• It includes cultural beliefs, healing practices, and explanations of sickness.

• Biomedical medicine is also shaped by cultural expectations, not just scientific knowledge.

The white coat as a symbol of medicine

• It symbolizes scientific authority, professionalism, and medical competence.

• Patients may feel reassured by it or anxious around it.

• White coat hypertension: when a patient's blood pressure rises around medical professionals wearing white coats.

Placebo phenomenon

• Positive expectations about a treatment can contribute to positive psychological and physiological responses.

• Even an inert substance may produce beneficial effects when a patient believes it will work.

• These effects can also occur alongside active medical treatments.

Daniel Moerman's meaning response

• The effectiveness of treatment depends partly on the meaning attached to it by the patient and healer.

• A physician's confidence, enthusiasm, and behaviour can influence patient responses.

• Outcomes depend on more than the substance itself; social and cultural context also matters.

Nocebo phenomenon

• Hahn.

• Negative expectations and associated emotions can contribute to sickness or worsening health.

• Effects may be subjective or objectively measurable, temporary or chronic, and sometimes fatal.

• Expectations are learned and shared culturally, which can influence physiological processes.

Specific vs. generic nocebo

• Involves expecting a particular harmful outcome that then occurs.

• Vs. involves general pessimism or negative expectations that contribute to symptoms.

• Both demonstrate that expectations can influence bodily experiences.

Voodoo death

• Walter Cannon.

• Intense fear and belief in a curse may contribute to severe physiological consequences.

• The overstimulation of the sympathetic nervous system.

• It illustrates the potential interaction between social identity, expectations, emotions, and bodily processes.

Sociogenic illness (mass hysteria)

• Symptoms spread through social interaction, observation, and shared expectations, without a clearly identified physical pathogen explaining the outbreak.

• This is often associated with uncertainty, anxiety, and social stress.

• The June Bug outbreak illustrates how symptoms can spread through workplace social networks.

Ethnomedicine and the nocebo effect

• Hahn.

• Cultural categories influence how people interpret symptoms and anticipate illness.

• Negative expectations may contribute to the symptoms people fear.

• Health professionals should consider how information about illness is communicated to avoid unnecessarily harmful expectations.

The placebo effect and energy healing

• Ostenfeld-Rosenthal.

• The beneficial effects of treatment are not simply the result of an inactive substance or conscious belief.

• Healing can result from the meaning attached to bodily experiences and symbols.

• Rituals may transform symptoms, identity, and well-being, including when symptoms lack a clear medical explanation.

Embodiment

• People experience and understand the world through their bodies.

• Cultural meanings, emotions, sensations, and physiological processes are interconnected.

• Healing rituals can create bodily experiences of recovery rather than merely communicating ideas about health.

Bodily-experienced symbols

• These are symbols whose meaning is experienced physically and emotionally rather than understood only through conscious thought.

• They connect bodily sensations with cultural values, metaphors, memories, and identity.

• Imagining roots growing from the feet, for example, may create an experience of stability and grounding.

Victor Turner's sensory and ideological poles

• One pole refers to bodily sensations, emotions, and desires associated with a symbol.

• The other refers to cultural values, beliefs, and ideas.

• Healing rituals connect these dimensions, allowing cultural meaning to become bodily experience.

Ostenfeld-Rosenthal's concept of rescripting

• Healing rituals can give bodily sensations new meanings and associations.

• Sensations become connected to memories, metaphors, and personal identity.

• Emma's energy and roots imagery helped her reinterpret bodily experiences and reconnect with her former cheerful self.

N/um tchai

• !Kung medicine dance.

• This communal ceremony involves singing, clapping, dancing, and the supernatural potency called n/um.

• Medicine men enter trance states and attempt to remove illness and protect community members.

• Healing involves the whole community, not just an individual practitioner and patient.

Social construction of reality

• Members of a culture share beliefs, values, and categories that shape their understanding of the world.

• Labels influence what people perceive and recognize as real.

• These shared understandings have real consequences for behaviour and social interactions.

Disease, illness, and sickness

• One refers to a pathological or physiological condition as understood within a medical framework.

• Another refers to the lived experience and interpretation of symptoms.

• The third refers to the socially recognized condition and status associated with being unwell.

Illness as a social construct

• People interpret bodily experiences through shared knowledge, beliefs, and cultural categories.

• Recognized categories organize symptoms into coherent explanations.

• A legitimate claim to being sick often requires social recognition of the condition.

The meaning of illness

• A condition can have both physical and moral or symbolic dimensions.

• Societies may associate particular conditions with blame, stigma, or assumptions about behaviour.

• Historical labels such as French disease, Italian disease or “gay” disease attributed sexually transmitted infections to other populations.

Medical systems as sociocultural systems

• They operate within social, economic, political, and moral contexts.

• These contexts influence who receives care, which treatments are available, and how sickness is understood.

• Practitioners and clients occupy social roles within particular settings and institutional arrangements.

Illness behaviour

• This is the process through which people respond to symptoms and seek recognition or treatment.

• It often begins with symptoms, discussion with family or friends, and seeking assistance.

• Diagnosis and consultation help formalize and socially negotiate experiences of sickness.

Hierarchy of resort

• This describes the sequence through which people seek help for health problems.

• They may first interpret symptoms themselves, then consult family or friends, and eventually approach a practitioner.

• These patterns reflect social relationships, cultural expectations, accessibility, and beliefs about treatment.

The sick role

• Parsons.

• This is a socially recognized position occupied when a health condition legitimizes a change in normal responsibilities.

• It includes specific rights and obligations that distinguish it from ordinary social positions.

• Long-term conditions complicate this model because a person may not return to their previous position.

Rights and obligations of the sick role

• Parsons.

• One right is exemption from normal social responsibilities, generally requiring appropriate medical sanction.

• Another is that the patient is not held personally responsible for having the condition.

• The obligations are to try to recover and seek assistance from competent healthcare providers.

Social production of health

• Health emerges partly from social relationships, everyday interactions, and material conditions.

• Family care, household labour, economic circumstances, and cultural expectations influence health outcomes.

• Informal caregiving and social networks contribute alongside professional medicine.

Gulf War Syndrome

• Cohn, Dyson, and Wessely: Early accounts of Gulf War Illness

• This is a contested collection of symptoms reported by some Gulf War veterans, including fatigue, muscle pain, headaches, memory problems, and insomnia.

• Proposed causes included vaccines, pesticides, chemical agents, and environmental exposures.

• The authors examine how uncertainty, rumours, and social interactions helped shape a collective account of illness.

Illness narratives and rumours

• These are accounts through which people explain and communicate experiences of sickness.

• In early accounts of Gulf War illness, rumours helped create shared explanations rather than simply describing an established condition.

• Shared narratives can organize uncertainty and create solidarity and collective understandings.

The body as vulnerable and invaded

• Gulf War illness.

• Veterans described their bodies through metaphors of machines, contamination, defence, and invasion.

• Invisible threats created uncertainty about possible harmful exposures.

• These metaphors reflected military culture, concerns about bodily control, and mistrust of official explanations.

Body-oriented healers

• Focuses more directly on bodily conditions and interventions, as with physicians, herbalists, and chiropractors.

Mind-oriented healers

• Focuses primarily on mental, emotional, spiritual, or symbolic suffering, as with shamans, rabbis, and psychotherapists.

Clinical logical sequence of biomedicine

• The diagnostic process works backward from symptoms to lesions and then to causes.

• Physicians use anatomical knowledge, examinations, investigations, and differential diagnosis.

• This framework organizes clinical evidence into a causal explanation of a condition.

Shamanism and Its Discontents

• Brown.

• Brown examines Yankush, a shaman from northeastern Peru, challenging romanticized views of shamans as universally trusted practitioners.

• They may be respected for healing but feared for their ability to harm.

• Ceremonies involve therapeutic practices as well as social conflict, authority, and suspicion.

Shamanism and spirit darts

• In Brown's account, sickness may be attributed to harmful spiritual darts placed inside the body.

• Practitioners attempt to locate and remove them through ceremonies involving altered states, singing, and bodily manipulation.

• Because the same powers are believed to enable healing and harm, the boundary between shaman and sorcerer is unstable.

Rhetoric and counter-rhetoric in healing

• Rhetoric: how a practitioner presents their knowledge, authority, and ability to cure.

• Counter-rhetoric: how patients, relatives, or other participants question or challenge those claims.

• Yankush's participants pressure him to produce results, showing that healing authority must be negotiated.

Healing as a political exercise

• Brown.

• Ceremonies involve power relationships between the practitioner, patient, family, and community.

• Relatives can influence treatment, demand results, and hold the practitioner accountable.

• A healer's reputation depends on social relationships and interpretations of outcomes, not only claimed abilities.

Healers and distrust

• Brown and Yankush.

• Practitioners may be valued for protecting people while simultaneously being suspected of causing harm.

• A shaman may be accused of sending the same darts they claim to remove.

• Their authority is culturally meaningful but socially and politically precarious.

Healing rituals and bodily complaints

• Rituals use symbolic actions to make bodily suffering understandable and potentially manageable.

• In Yankush's ceremonies, singing, sucking, and spitting out substances symbolize removing illness.

• These practices may transform interpretations of suffering while involving bodily sensations, emotions, and social support.

Biomedical and occult explanations of causality

• One approach moves from symptoms → a lesion → an underlying cause.

• The other may begin with illness or misfortune and use divination to infer hidden supernatural causes.

• Both organize events into causal explanations but rely on different assumptions about sickness.

Biomedical temporality

• Healing is understood as a process that unfolds over time, with interventions and outcomes occurring in a particular sequence.

• Recovery is often viewed as a gradual process involving diagnosis, treatment, and monitoring.

• This reflects a biomedical understanding of illness as something that can be treated through interventions that produce changes over time.

Evangelical temporality

• Healing emphasizes a rupture or transformation, in which recovery may be understood as already accomplished through faith.

• Rather than focusing on gradual improvement, this perspective can frame healing as a decisive spiritual change.

• This reflects a religious understanding in which faith can transform a person's condition and relationship with illness.

Christian healing and social transformation

• Hardin - Healing is a Done Deal

• Recovery may involve transforming relationships, moral life, and society rather than only treating an individual's body.

• In the Samoan examples, sickness is connected to broader social and religious concerns.

• Religious practices can critique existing social conditions and offer a vision of collective transformation.

Folk illness

• Rubel: The Epidemiology of Folk Illness

• This is a syndrome that a cultural group recognizes as an illness and for which it provides explanations of cause, diagnosis, prevention, and treatment.

• Rubel asks whether such conditions can be studied epidemiologically, including who develops them and under what circumstances.

Susto

• Rubel: The Epidemiology of Folk Illness

• This condition is found in parts of Hispanic America and is commonly associated with a frightening or disturbing event.

• It is often understood as separation of a person's soul or spirit from the body.

• Symptoms may include restless sleep, weakness, loss of appetite, weight loss, depression, and social withdrawal.

Susto and epidemiology

• Rubel investigates whether a culturally recognized syndrome can be studied systematically across populations.

• It displays a relatively consistent set of symptoms and triggering experiences despite local variation in beliefs and rituals.

• Studying its distribution can reveal who becomes ill, under what circumstances, and how social factors relate to illness.

Culture-bound syndromes

• Lilienfeld/ Thames - Culture Bound Syndromes

• These are conditions or patterns of distress traditionally understood as especially associated with particular cultural settings.

• Examples include amok, koro, susto, latah, piblokto, and windigo psychosis.

• The concept raises questions about whether disorders are culturally specific or whether shared conditions are expressed differently across societies.

Cultural concepts of distress — DSM-5

• The DSM-5 moved away from treating culturally specific conditions as an exclusive separate category and introduced a broader framework.

• It includes cultural syndromes, cultural idioms of distress, and cultural explanations of distress.

• Clinicians are encouraged to consider patients' cultural backgrounds and interpretations when diagnosing.

Could Western disorders be culture-bound?

• Keel and Klump argue that bulimia nervosa may be strongly associated with Western cultural settings.

• Its emergence in Japan has been associated with the spread of Western ideals of thinness.

• This challenges the assumption that cultural specificity applies only to non-Western disorders.

Universal vs. culturally specific mental disorders

• Universal mental disorders: that psychological disorders are broadly universal but expressed differently across cultures.

• Culturally specific mental disorders: some conditions are culturally specific and may not have direct equivalents elsewhere.

• Biological and psychological similarities can coexist with culturally shaped symptoms, meanings, and interpretations.

Technology and material culture

• Technology refers to human tools and means used to meet needs and wants.

• It has both a functional dimension and a meaningful social dimension.

• Medical technologies can change professional roles, social relationships, and understandings of health.

Three dimensions of technology

1. The practical or functional aspects of technology.

2. The social relationships and organization associated with it.

3. Its symbolic, ideological, or belief-related aspects.

Duality of structure: technology and social practice

• Social structure is both the medium and the outcome of human action.

• People act within existing structures, but their actions can also reproduce or transform them.

• Medical technologies shape clinical practices, while their use helps establish new specializations and professional norms.

Biomedical technology

• Medicine draws on healing traditions while emphasizing scientific progress and advanced technology.

• New technologies can change how conditions are diagnosed, treated, and understood.

• They can also create new specializations, forms of expertise, and financial incentives within healthcare.

Medicalization

• This is the process through which human experiences, characteristics, or social problems become defined as medical problems requiring intervention.

• Examples include treating age, height, weight, or sex as properties to be medically altered or managed.

• Technology can extend medical intervention into everyday life.

Obstetrical forceps and the professionalization of childbirth

• These instruments were developed to help facilitate a child's passage through the birth canal.

• The Chamberlen family controlled the technology for generations, illustrating how medical knowledge and instruments could generate wealth.

• Instruments and obstetrical schools contributed to the replacement of traditional midwives by male medical practitioners.

Inventing a New Death and Making It Believable

• Lock argues that a new definition of death emerged alongside advances in intensive care and organ transplantation.

• Life-support technology allows bodies with irreversible brain damage to maintain circulation and other biological functions.

• Definitions of death are shaped by technology, legal standards, moral concerns, and social institutions.

The living cadaver

• Margaret Lock - Inventing a New Death and Making it Believable.

• This refers to a body with irreversible brain damage that maintains certain biological functions through technological support.

• Such bodies occupy an ambiguous position because they may appear biologically active while being classified as dead.

• The concept shows how intensive-care technology challenged existing definitions of life and death.

Brain death and organ transplantation

• Margaret Lock: Inventing a New Death and Making it Believeable

• Organ transplantation created legal and practical questions about removing organs from patients whose hearts were still beating.

• Standardized criteria helped establish when such patients could be classified as dead.

• Lock argues that the need for transplant organs was an important force behind this definition.

The 1968 Harvard Ad Hoc Committee

• The committee helped establish the concept of irreversible coma, closely associated with modern definitions of brain death.

• It cited advances in life-support technology and problems with existing definitions of death.

  • The rise of mechanical ventilators and intensive care units meant patients with permanently damaged, non-functioning brains could still have a beating heart and circulating blood.

• Its work illustrates how technological developments can require new medical, legal, and ethical categories.

The biological clock

• Friese, Becker, and Nachtigall: Rethinking the Biological Clock

• The authors examine how cultural ideas about women's age and fertility intersect with medical assessments of reproductive capacity.

• This metaphor links physiological changes with social expectations about when women should have children.

• Medical technologies and ideas about 'old eggs' shape interpretations of aging and infertility.

Diminished ovarian reserve

• Frise, Becker, Nachtigall - Rethinking the Biological Clock.

• This clinical designation refers to qualitative and quantitative changes in the ovaries associated with aging and fertility treatment outcomes.

• Patients may interpret it as evidence that their eggs are old and reproductive potential is declining.

Eleventh-hour moms and miracle moms

• Friese, Becker, and Nachtigall.

• One group initially tried to conceive using their own eggs before turning to donated eggs.

• The other generally used donated eggs, including women who knew from the outset that conception using their own eggs would not be possible.

• These narratives reveal different ways women understand infertility, aging, reproductive technologies, and motherhood.

Biomedicalization

• Medicalization: The process through which experiences or conditions that were not previously considered medical problems become defined and treated as medical issues.

• Biomedicalization: Developed Clarke and colleagues, it builds on medicalization by emphasizing how technologies, medical institutions, practitioners, and consumers interact to reshape health and the body.

• Both show how medicine reshapes experiences and expectations, while the latter particularly emphasizes technological development and use.