ANTH210 midterm readings

Brown and Closer

Disease (clinical) vs. illness (broader social, cultural dimensions)
Well-being differs among societies, normal is not the same everywhere
In west, lean body is a sign of health but in Sub-Saharan Africa this may indicate sickness and malnutrition
Any idea of health is dependent on how so-called normal states of being are constructed within particular social, cultural, and environmental contexts

Lock

Trend of data collected from west being “the norm”
Biology and culture coexist and are deeply intertwined
Biology does not solely dictate health
Menopausal experiences in Japan are very different from US experiences; culturally infused values, due to local environments, life styles, behavioral patterns
Brain death not recognized as end of life in Japan for several decades
What constitutes human life is not the same everywhere

Barsh

Traditional medicine is not “primitive” it is simply a different system of ethnomedicine
Sometimes healers may be hesitant to share full knowledge about their medicine, can lead to inaccurate recreations in labs
Healers individualize remedies and thus have a greater knowledge of the patient than biomedical doctors

Foster

Personalistic and naturalistic disease etiologies (causes of disease)
Focused in non-western systems

Payer

Doctors from different countries, countries that are all “western” (US, England, West Germany, and France) diagnosed different causes of death even when shown identical information from the same death certificates
Similar symptoms will be given completely different diagnoses
Different meanings of words in different languages, sometimes not a direct translation
Different meanings of sayings, French often refer to migraines as “liver crises” and the German language has no word for chest pain
How can medicine be so different in four countries where the people are quite similar? → culture

Bates

Need to see biomedicine (modern medicine) as one of many
There were earlier medicines, biomedicine was originally an alternative to other forms of traditional medicine

Kleinman

·      Normal ways of being ill: ways that our society regards as appropriate

o   There is an expectation to get better

o   We behave based on how we were raised, what we learned from our culture

o   Fits in cultural context – who’s around, who cares for you

·      Illness experience is culturally shaped; disease is problem from healer’s perspective

·      Some definitions

o   Illness: subjective experience of poor health

§  How sick person and friends/family deal with these symptoms and disability

·      Is social, you don’t do it yourself, it fits within a larger community context

§  Can become part of a person’s identity (chronic illness); can take over your life

o   Disease: biological process or disorder, usually diagnosed by a doctor

o   Sickness: understanding a disorder across a population in relation to economic, political, and institutional forces

·      We learn how to take on a sick role

·      Type of medical care that one seeks will vary based on sociocultural contexts

·      Emotions are heavily tied in with illness

Gawande

Learning through experience
Skill comes from practice, is not innate
Surgeons are always learning
Must appear confident for patient

Byron Good

Learning to see and communicate in new ways as a biomedical doctor
Reconstruction of person appropriate to medical gaze, as an object (cadavers)
Illness is given meaning in a cultural context
Families behave differently when someone is sick
The anatomy lab as a sacred, ritual space
One student commented on how it felt like an intrusion to have someone else watching in on
Learning to become a doctor is a process of enculturation; the biomedical system is a culture
Learning how to tell patients’ stories, don’t want to hear the patient’s illness story, learning to talk about people as medically constructed objects

Pashigian

Plural medical environment in Vietnam
“Our” vs “their” medicine
Suitability·      : measure used to evaluate how compatible a treatment and its delivery are with a woman’s own perceptions of her medical condition and her social circumstances

Criteria:

Reputation of practitioner

Perceptions of the speed with which the medicine works

Socioeconomic factors

·      Age, marital instability, fear of divorce, expense

·      Age can be a huge factor and cause women to abandon a treatment if it does not seem to be acting quickly enough

o   Believed Western medicine would work faster than traditional medicine

·      Pressure to have children right after marriage

·      Some kept infertility secret

·      Uneven access to medical care

Tiger’s Apprentice

Medical knowledge is passed down in family on paternal side
To sons or daughters-in-law
Medicine is herbs, minerals
Treating people even if they can’t pay
Healing took place in kitchen
Informal
Western medical practitioners don’t like folk medicinal practices (taking money away)

Hunt and Arar

Patient’s perspective ignored sometimes
Doctors disregard social aspect of disease
Lots of racism
Doctors and patients have different viewpoints
Noncompliance in type 2 diabetes in Mexican Americans
Not because they don’t want to get better, doctors and patients have same goals
Noncompliance places blame on patient
Providers create an idea of “an other”
Socioeconomic factors make it difficult for patients to strictly follow regimen – money, jobs, family

Kleinman and Benson

Problem of cultural competency
General and stereotyping
Assumes there are fixed ethnic traits
Old idea that societies are isolated and contained
Biomedicine is a culture too
Patients should be treated as individuals with their own life worlds
o   Example: father who was ethnically Mexican but that wasn’t why he couldn’t take his son to the doctor, it was because he had a job where he couldn’t

o   People don’t act a certain way because of their culture, culture doesn’t make someone behave a certain way

·      Culture is not homogenous, all people within a culture do not behave in the same way

Taylor

Fadiman’s narrative is meant to elicit an emotional response
Presents a clash of cultures
Uses culture as a static thing
Culture is not a cause of disease, not a reason someone acts a certain way
Leads to generalization
The Lees’ decisions are rooted in context, not culture
Interacting in new contexts
Would have been less stress with a cultural broker? Possibly but also may not have changed outcome