ch 2
Biomedicine and Complementary and Alternative Medicine (CAM)
Biomedicine Definition: Conventional system of health care in the United States and other Western nations based on the principles of natural sciences, including biology, physiology, and biochemistry.
Basis of Health Promotion: Founded on scientific research regarding diet, exercise, and lifestyle factors (e.g., smoking cessation and stress management); diseases are treated according to modern technologies.
Pluralistic Health Care: Health care in the United States is inherently pluralistic. Many individuals never consult a physician or allied health care provider upon experiencing physical or emotional symptoms, relying instead on home remedies and popular online therapies.
Complementary and Alternative Medicine (CAM) Usage: Data from the National Health Interview Survey published by the National Center for Complementary and Alternative Medicine estimated that in 2012:
Approximately of all adults and of all children used some form of CAM.
Lower rates of complementary therapy usage were reported among Hispanic adults () and non-Hispanic Black adults () compared to non-Hispanic White adults ().
Popular CAM therapies include natural products, deep breathing, yoga, tai chi, meditation, chiropractic and osteopathic interventions, special diets, guided imagery, and massage.
Consumer spending on CAM practices and products tripled over a decade, increasing from $11 billion annually to nearly $40 billion.
Integrative Medicine: The combination of conventional biomedicine and CAM treatments that have demonstrated scientific evidence of safety and effectiveness.
Categorization of Health Beliefs: Categorized by illness etiology (personal, natural, social, or supernatural causes) or employed cures (therapeutic substances, physical forces, or magico-religious interventions).
Worldview and Cultural Values
Worldview Definition: A unique outlook on life held by a cultural group, structured around a shared understanding and ranking of values that dictates expectations for conduct, social interaction, and perceptions of health and illness.
Value Differences Between Majority American Culture and Other Cultural Groups:
Mastery over nature versus Harmony with nature
Personal control over the environment versus Fate
Doing-activity versus Being/becoming
Time dominates versus Personal interaction dominates
Human equality versus Hierarchy/rank/status
Individualism/privacy versus Group welfare
Youth versus Elders
Self-help versus Birthright inheritance
Competition versus Cooperation
Future orientation versus Past or present orientation
Informality versus Formality
Directness/openness/honesty versus Indirectness/ritual/"face"
Practicality/efficiency versus Idealism
Materialism versus Spiritualism/detachment
Personal Accountability: Personal accountability and self-help are fundamental to majority American culture, with of American consumers believing they are directly responsible for their own health.
Fate and Preventive Care: Many global cultures attribute health and illness to fate, including God's will, supernatural agents, or birthright (astrological alignment or cosmic karma). In fate-dominated worldviews, the concept of preventive health care (such as annual biomedical checkups) is often absent.
Perceptions of Time:
Monochronistic / Future-Oriented: Focus on one sequential task at a time, adherence to schedules, promptness, and willingness to make present sacrifices for future gains. Planning ahead for appointments is standard.
Polychronistic / Present-Oriented: Comfortable managing multiple activities simultaneously, prioritizing immediate personal interactions and responsibilities over schedules and punctuality.
Activity and Relational Orientation:
Doing: Value placed on direct activity, task achievement, and active participation in care. Partners in health care expect to take action.
Being: Value placed on existence and personal relationships over accomplishments. For instance, in Buddhism, self-worth is derived from relationships, while suffering stems from attachment, desire, and craving. Provider-client partnerships may be unfamiliar to individuals who expect authoritative direction from practitioners.
Individual vs. Group Welfare: Autonomous individual decision-making and confidentiality are paramount in biomedicine, whereas cultures such as those in the Middle East prioritize family involvement in all health care decisions.
Communication Styles:
Direct Communication: Openly confronting issues, communicating concerns straightforwardly, engaging in necessary conflict, and expressing frank opinions (e.g., getting straight to the point).
Indirect Communication: Focusing on how something is said rather than just what is said, avoiding conflict or contentious issues, expressing concerns diplomatically, and expecting the listener to interpret meaning (e.g., saying "maybe" or "possibly" instead of "no").
End-of-Life Decision Making Across Cultures:
Southeast Asians: May disfavor life-prolonging measures for terminally ill relatives due to a belief in reincarnation.
African Americans: May harbor distrust toward do-not-resuscitate (DNR) recommendations partly because they clash with the central role of faith in healing.
Orthodox Jews: View physicians as obligated to preserve life, considering any withholding of life-sustaining care as equivalent to murder. Conversely, non-Orthodox Jews may prioritize avoiding uncontrollable pain over prolonging life.
Middle Easterners: Demand exhaustive efforts to prolong life, holding that death is solely in God's hands and hope must not be abandoned.
Mexican Americans: May view death as part of God's plan, opposing artificial quickening of death or deferring decisions entirely to the practitioner.
Cultural Humility: A practice requiring health care professionals to continuously self-reflect on their own cultural backgrounds and clinical interactions, questioning personal biases, assumptions, and stereotypes that could compromise patient care quality.
Biomedical Worldview Assumptions
Cultural Imposition: The tendency for health care providers to enforce their cultural beliefs, values, and practices onto clients, often due to an unawareness of cultural differences or an underlying belief in the superiority of biomedicine.
Mastery Over Nature:
Health is defined and evaluated numerically through standardized diagnostic tests (e.g., blood and urine analyses, X-rays, scans measuring blood sugar, cholesterol, or inflammatory markers).
Standardized parameters determine normal versus abnormal physical functioning regardless of individual cultural background or religious faith.
Symptoms lacking identified physiological causes are frequently designated as psychosomatic.
Personal Control and Scientific Rationality:
Rejects divine intervention or chance, asserting a specific biomedical cause for every condition.
Individual health preservation relies on personal choices (e.g., immunizations, vaccines, regular checkups), while risky behaviors (e.g., obesity, smoking, excessive alcohol intake, substance abuse, unmanaged stress) are viewed as personal failures in health maintenance.
Presumes complete client compliance with prescribed therapies and expects practitioners to deliver error-free care. Malpractice concerns drive extensive record-keeping and charting.
Youthfulness and Aging:
High societal value is placed on youth, driving technological life-prolongation and anti-aging treatments.
The global anti-aging market was valued at approximately $58.5 billion U.S. dollars in 2020, with a projected annual growth rate of between 2021 and 2026.
Demographic trends indicate that by 2050, the population of U.S. adults over 65 years will double, and the number of centenarians (individuals over 100 years old) will increase 10-fold.
Individualism and Privacy: Patients are treated as singular biological units rather than family/community members. Information privacy is enforced legally via HIPAA (Health Insurance Portability and Accountability Act).
Human Equality and Hierarchy:
Assumes equal access to health care for all individuals, though economic and geographical barriers persist.
Enforces a rigid internal professional hierarchy: physicians occupy the highest tier, followed by allied health professionals, non-clinical support staff, and folk healers. Clients traditionally occupy a subordinate rank, though online information access is altering this dynamic.
Mind-Body Dualism:
Biomedicine separates physical health from mental/emotional states.
Somatization: The expression of emotional distress through bodily physical complaints. While biomedicine often interprets somatic symptoms as maladaptive responses, somatization represents the most common presentation of psychological distress globally.
Cultural Definitions and Attributes of Health
World Health Organization (WHO) Definition: "A state of complete physical, mental, and social well-being, not merely an absence of disease or infirmity."
Cultural Variations in Defining Health:
Native Americans: Achieving harmony with nature, including family, community, and the environment.
Africans: Maintaining balance with natural forces; malevolent environmental, divine, or ancestor forces can disrupt energy.
African Americans, Latinx, Middle Easterners, Southern Europeans: Living in accordance with God's will.
Asians: Maintaining a balance between opposing cosmic forces, such as yin and yang.
Southeast Asians: Pleasing ancestor spirits to avoid sickness or accidents caused by their anger.
Oceania Residents: Fulfilling social obligations to prevent disharmony with family or village members.
Asian Indians: Interconnecting mind, body, and soul, where spiritual health is equal in importance to physical diet and environmental balance.
Koreans: Maintaining health to avoid becoming a burden to one's children.
Mexican Men: Denying or ignoring physical pain to avoid appearing weak or unmanly.
Etymology: The word "health" originates from the Anglo-Saxon term hal, meaning "wholeness."
Physical Health Attributes:
Normal physical functions include regular bowel movements, routine menstruation, a steady pulse, and full use of limbs and senses.
In biomedicine, resting pulse is evaluated around a single rate of approximately . In Traditional Chinese Medicine, 15 separate body pulses are evaluated, each linked to specific internal organs.
Hair sheen preferences vary: while clean, flake-free hair is promoted in the U.S., oily hair is standard in many cultures and dandruff is often ignored.
Cultural Perspectives on Body Image:
In mainstream U.S. culture, thinness is valued and associated with self-control, whereas being overweight is heavily stigmatized.
Historically and in many traditional cultures (e.g., Africans, Caribbean Islanders, Filipinos, Mexicans, Middle Easterners, Native Americans, Oceania residents), a heavier body weight is viewed as a protective factor signifying health, wealth, and beauty.
Acculturation influences body image: higher acculturation to Western norms among Hispanic and Native American populations correlates with an increased desire for thinness and elevated body dissatisfaction among youth.
Health Maintenance Practices and Dietary Theories
General Health Maintenance Habits:
Universal agreement exists regarding the necessity of a proper diet, adequate rest, and personal cleanliness, though execution varies (e.g., daily showers in the U.S. vs. bathing multiple times daily among some Filipinos to balance hot-cold bodily states).
Dietary Guidelines for Americans (2020–2025): Recommends an average daily intake of for women and for men, depending on age.
Specific Folk Maintenance Practices:
Dressing Warmly / Outdoor Precautions: Eastern European, French, French Canadian, Iranian, Irish, Italian, Swedish traditions; avoiding wet hair outdoors (Eastern European, Italian).
Laxatives / Tonics: Daily doses of cod liver oil (British, French, French Canadian, German, Norwegian, Polish, Swedish) or molasses (African American, French, French Canadian, German, Irish, Swedish).
Amulets and Protections: Wearing camphor bags (Austrian, Canadian, Irish) or garlic cloves (Italian).
Religious Practices: Blessing of the throat (Irish, Swedish), wearing holy medals (Irish), and daily prayer (Canadian, Ethiopian).
Health-Promoting Food Habits:
Yin and Yang System (Chinese):
Yin Foods: Typically raw, soothing, cooked at low temperatures, or white/light green in color.
Yang Foods: High-calorie, cooked over high heat, spicy, or red-orange-yellow in color.
Neutral Foods: Staple foods, such as boiled rice, are considered perfectly balanced.
Humoral / Hot-Cold Food Systems:
Derived historically from ancient Greek humoral medicine based on four natural elements and corresponding body humors: blood (hot and moist), phlegm (cold and moist), yellow/green bile (hot and dry), and black bile (cold and dry).
Practiced in the Middle East, Latin America, the Philippines, and India. Focuses on balancing hot and cold food characteristics with personal constitution and environment (e.g., in Lebanon, allowing the body time to adjust to hot food before consuming cold food; in India, linking hot-cold balance to spiritual harmony).
Strengthening and Vitality Foods:
United States: Milk for strong bones, carrots for eyesight, chicken soup as a Jewish cure-all.
Navajo: Milk is considered weak, whereas meat and blue cornmeal are considered strong.
Asia: Pu or bo strengthening foods include pork liver or oxtail soup in China, and bone marrow soup in Korea.
Puerto Rico: Eggnog or malt beverages consumed to enhance vitality.
Sympathetic Qualities of Food: Properties resembling body parts impart benefits to those parts (e.g., drinking red wine to build blood among Italians; consuming gelatin for fingernail growth in the U.S.; consuming ginseng root—which resembles a human shape—for overall stamina).
Macrobiotic Diet:
Originating from concepts by Hippocrates and modernized in the 19th century by Japanese physician Dr. Sagen Ishizuka; popularized in Europe during the 1920s.
Consists primarily of brown rice, miso soup, and local seasonal vegetables. Severe nutritional deficits, including Vitamin B-12 and iron deficiencies, have been identified in infants and toddlers raised on this diet.
Etiology of Sickness and Cultural Explanatory Models
Key Distinctions:
Illness: A person's individual perception of and reaction to a physical or psychological condition, framed by their worldview.
Disease: Biomedical abnormalities or malfunctioning of internal body organs and systems.
Sickness: The overarching, complete disease-illness process.
The Sick Role: Social legitimization of sickness usually begins within the family (where mothers or grandmothers often serve as health experts). Once acknowledged, the individual adopts the sick person role, granting temporary exemption from daily work, family, social, and religious obligations.
Biomedical Etiology of Disease:
Immediate Causes: Bacterial or viral infections, toxins, tumors, or physical trauma.
Underlying Causes: Smoking, elevated cholesterol, glucose intolerance, or nutritional deficiencies.
Ultimate Causes: Genetic predispositions, environmental stressors, or obesity.
Four Cultural Client Theories on Sickness Etiology:
Sickness Due to the Patient: Attributed to individual physical/psychological constitution or lifestyle choices (e.g., poor diet, lack of exercise, failure to wear a seatbelt).
Sickness Due to the Natural World: Exposure to environmental hazards, weather changes, toxins, allergens, pollution, and biological pathogens. "Bad air" or wind entering body pores or orifices is a major concern among Arabs, Chinese, Italians, Filipinos, and Mexicans. Includes astrology and natural disasters.
Sickness Due to the Social World: Caused by interpersonal conflict or malice within the community.
The Evil Eye: Harm caused by an envious gaze (even if unintentional). Causes colic, crying, and seizures in children; causes headaches, complications during childbirth, male impotence, and insanity in adults. Protections include:
Red herb bags on cribs (Guatemala)
Black or red strings on wrists (India)
Leaving children unwashed (Iran)
Black hand charms (mano negro) (Puerto Rico)
Painting homes white and blue (Greece)
Red strings (Eastern European Jews) or blue strings (Sephardic Jews)
Carrying Bible passages (Scotland) or Qur'an verses (Muslim Southeast Asia)
Conjury: Invoking supernatural forces via practitioners (e.g., brujos/brujas, root doctors, voodoo/hoodoo doctors). Methods include scattering graveyard dust ("fading" in rural African American traditions), placing stick bundles in kitchens, using hair/fingernails for contagious magic, or projecting foreign objects into victims.
Sickness Due to the Supernatural World: Caused by divine action, fate, karma, or malevolent spirits/ancestor ghosts.
Spirit Interference: Cambodian nightmare spirits immobilizing a person's chest during sleep; spirit possession resulting in aberrant behavior; loss of internal caretaker spirits in Southeast Asian traditions.
Soul Loss: Detachment of the soul from the physical body due to emotional trauma or fright. Symptoms include listlessness, depression, malaise, suffocation sensations, and weight loss.
Folk Illnesses and Culture-Bound Syndromes
Definition: Specific disorders recognized within particular cultures, characterized by a standard set of symptoms, complaints, and behavioral changes.
Examples of Folk Illnesses:
Soul Loss: Known as susto or espanto among Latinx populations.
Muso: A form of mental illness affecting young Samoan women.
Sudden Unexpected Nocturnal Death Syndrome (SUNDS): Severe, spirit-induced nocturnal death recognized among Cambodians.
Emotional Fright/Anger Syndromes:
Bilis or colera: Stroke-like illness precipitated by rage among Guatemalans.
Ceeb: Cooling of the blood and internal organs due to fright among the Hmong.
Hwabyung: Abdominal and chest pain driven by unexpressed emotion among Koreans.
Somatic Stress Reactions: Burning sensations on the soles of the feet or anxiety over semen loss among Asian Indian men.
Digestive / Diet Folk Syndromes:
Si zhi ma mu: Extremity numbness attributed to digestive imbalance among Chinese.
Empacho: Nausea and feelings of a ball of food stuck in the stomach among Mexicans.
Pasmo: Paralysis triggered by humoral/digestive imbalance among Puerto Ricans.
High and Low Blood Pressure: Cultural blood thickness/volume concepts among African Americans.
Western Culture-Bound Syndromes: Anorexia nervosa and bulimia nervosa, tied to intense cultural pressures surrounding thinness, body image, and control.
Modalities of Healing Therapies
Administration of Therapeutic Substances:
Pharmaceuticals & Supplements: Over-the-counter drugs, megavitamins, and mineral supplements. A 2019 Harris Poll indicated of Americans take vitamins or supplements, though only received test results confirming a nutrient deficiency.
Botanical Medicine: Uses whole plants or plant parts (roots, bark, sap, gum, oil, flowers, seeds, fruit). Over of the global population utilizes herbal remedies. Defined legally under the Dietary Supplement Health and Education Act (DSHEA) of 1994, exempting manufacturers from pre-market FDA safety proof.
American Herbal Products Association Safety Ratings: Class 1 (safe when consumed appropriately), Class 2 (restricted uses), Class 3 (use under expert supervision), Class 4 (insufficient data).
Herb-Drug Interactions: Ginkgo biloba reduces efficacy of antacids and antianxiety drugs while increasing effects of anticoagulants, antidepressants, and antipsychotics.
Homeopathy: Based on the principle that symptoms represent the body's natural healing effort; administering highly diluted remedies that mimic those symptoms accelerates recovery.
Naturopathy: Utilizes noninvasive natural therapies and whole-food nutritional medicine to assist self-healing mechanisms.
Application of Physical Forces or Devices:
Chiropractic: Corrects spinal subluxations to eliminate nervous system interference.
Osteopathic Medicine: Manipulates the musculoskeletal system to enhance blood, lymph, and nerve flow.
TCM Physical Therapies: Massage, acupressure, pinching, coining (rubbing coins/spoons across skin), acupuncture (inserting fine needles along 12 body meridians to reduce excess yang heat), moxibustion (touching smoldering herbs/wormwood to meridian points to counter excess yin cold), and cupping (placing heated vacuum cups over points).
Electrotherapy, Biofeedback, Hydrotherapy: Using electrical pulses, conscious involuntary regulation, or therapeutic water baths/saunas to relieve chronic conditions.
Magico-Religious Interventions:
Individual Practices: Meditation, yoga, guided imagery/visualization, hypnotherapy, and prayer.
Saints in Catholic Healing: Appeals made to specific saints, such as St. Teresa of Avila (headaches), St. Peregrine (cancer), St. John of God (heart disease), St. Joseph (terminal illness), and St. Bruno (possession).
Sacred and Faith Healers:
Traiteurs: Cajun faith healers in Louisiana using Catholic prayers and charms.
Powwowing (Brauche / Braucherei): Direct-instrument-of-God sympathy healing among Pennsylvania Dutch.
Curanderos / Curanderas: Traditional Mexican folk healers.
Neng: Sacred spirit healers among the Hmong.
Santeros / Espiritos: Spirit-communicating healers in Caribbean traditions.
Shamans: Indigenous sacred healers (medicine men/women, or two-spirit individuals) who undergo rigorous apprenticeships to address spiritual crises, retrieve lost souls, analyze dreams, perform séances, and administer botanical remedies.
Medical Pluralism and Transcultural Care
Medical Pluralism Definition: The consecutive or concurrent use of multiple health care systems (biomedical, folk, and alternative) by a single individual.
Demographic Patterns: Pluralism is widespread across all income and education levels in the United States; higher income and education levels are often correlated with increased utilization of unconventional healers.
Transcultural Nursing Theory (Madeleine Leininger): Identifies three strategic modes to deliver culturally compatible care:
Cultural Care Preservation and/or Maintenance: Encouraging and preserving traditional health practices that are known to be beneficial.
Cultural Care Accommodation and/or Negotiation: Negotiating between provider and client/family to adapt care when client expectations fall outside conventional biomedical limits.
Cultural Care Repatterning or Restructuring: Cooperatively restructuring lifestyle and dietary habits when a traditional practice is mutually recognized as harmful.
Here are the explanations and answers for points 8 through 12 based on Chapter 2:
8. Key Definitions
Biomedicine: The conventional system of health care in the United States and other Western nations based on the principles of natural sciences, including biology, physiology, and biochemistry.
Cultural Imposition: The tendency for health care providers to enforce their cultural beliefs, values, and practices onto clients, often due to unawareness of cultural differences or an underlying belief in the superiority of biomedicine.
Medical Pluralism: The consecutive or concurrent use of multiple health care systems (biomedical, folk, and alternative) by a single individual.
Somatization: The expression of emotional or psychological distress through physical bodily complaints.
9. Comparison of Common Values (Table 2.1)
Majority American Culture | Other Cultural Groups |
|---|---|
Mastery over nature | Harmony with nature |
Personal control over environment | Fate |
Doing-activity | Being/becoming |
Time dominates | Personal interaction dominates |
Human equality | Hierarchy/rank/status |
Individualism/privacy | Group welfare |
Youth | Elders |
Self-help | Birthright inheritance |
Competition | Cooperation |
Future orientation | Past or present orientation |
Informality | Formality |
Directness/openness/honesty | Indirectness/ritual/"face" |
Practicality/efficiency | Idealism |
Materialism | Spiritualism/detachment |
10. Definition of Health by WHO
The World Health Organization (WHO) defines health as:
"A state of complete physical, mental, and social well-being, not merely an absence of disease or infirmity."
11. Health-Promoting Food Habits
Balance and Moderation:
General guidelines recommend balanced calorie and nutrient intake (e.g., U.S. Dietary Guidelines recommending an average daily intake of for women and for men).
Yin and Yang System (Chinese):
Achieves body balance by pairing Yin foods (raw, soothing, light/green, low-temperature) with Yang foods (spicy, high-calorie, red-orange-yellow, high-heat), while relying on neutral staples like boiled rice.
Humoral / Hot-Cold Systems:
Practiced in the Middle East, Latin America, the Philippines, and India to balance hot and cold food properties with weather and personal constitution.
Strengthening and Vitality Foods:
Specific foods consumed to enhance physical strength or stamina (e.g., milk in the U.S.; meat and blue cornmeal among Navajos; protein-rich soups like pork liver or oxtail (pu/bo) in China).
Sympathetic Qualities of Food:
The belief that foods resembling body parts impart specific benefits (e.g., red wine to build blood in Italian culture; gelatin for nails; human-shaped ginseng root for overall stamina).
12. Four Theories on the Etiology of Sickness (Figure 2.1)
Sickness Due to the Patient:
Attributed to the individual's physiological constitution, genetic vulnerabilities, or personal lifestyle choices (e.g., poor diet, smoking, lack of exercise, or failure to use safety devices).
Sickness Due to the Natural World:
Attributed to environmental forces (weather, pollution, toxins, allergens) and biological agents (viruses, bacteria). Includes concepts like "bad air" entering body pores, humoral imbalances, or astrological alignments.
Sickness Due to the Social World:
Caused by interpersonal conflicts or intentional/unintentional malice within a community. Examples include the evil eye (harm caused by an envious gaze) and conjury (invoking supernatural forces via witches, root doctors, or voodoo practitioners).
Sickness Due to the Supernatural World:
Attributed to divine action, cosmic fate, karma, or malevolent spirits and ancestor ghosts. Includes phenomena like spirit possession and soul loss (detachment of the soul from the body due to emotional trauma or fright).