So What's So Cultural About Disease?

 Reading: Please Read This Short Article HERE

"We have to design a health delivery system by actually talking to people and asking, 'What would make this service better for you?' As soon as you start asking, you get a flood of answers." Paul Farmer

“Acting like a sponge, illness soaks up personal and social significance from the world of the sick person.” Arthur Kleinman

"The poorest parts of the world are by and large places in which one can best view the worst of medicine and not because the doctors in these countries have different ideas about what constitutes modern medicine. It's the system and its limitations that are to blame." Paul Farmer

"Anywhere you have extreme poverty and no national health insurance, no promise of healthcare regardless of social standing, that's where you see the sharp limitations of market-based health care." Paul Farmer

Medical Anthropology: The study of human disease in a cross-cultural, historical and evolutionary perspective. It marks the intersection between biology, culture and applied research.

Important tenets that will be covered over the course of this semester:

• Biology and culture matter equally in the human experience of disease
• every aspect of the illness experience from the individual's recognition of the symoptoms to assessments of treatment outcomes is shaped by the cultural frameworks of the sufferer and of those to who he/she turns for help. (A "bio-cultural perspective" avoids the REDUCTIONISM of models which neglect cultural factors)
• The political economy is the primary epidemiological factor
• People's health risks and the treatment resources which are available are directly related to the economic and political structures in a society
• Ethnography is an essential tool to understand human suffering due to disease
• allows for a holistic understanding of health and illness
• Medical anthropology can help alleviate human suffering
• Can lead to health interventions by providing cultural information on the community as well as the medical practitioners and healthcare institutions that undertake the interventions. Culture is relevant.

CULTURE IN MEDICINE

"Outside the significance that man voluntarily attaches to certain conditions, there are no illnesses or diseases in nature" (Peter Sedgwick, 1981)

• "natural events" do not prior to the human social meaning attached to them constitute illness, sickness or disease.
• disease is an imposition of human meanings on naturally occurring processes...this seems less controversial when we look at other cultures
• dano-Peruvian Shaman (illnesses result from injurious actions of sorcerers -HUMAN AGENCY), dano means "harm'. The Shaman's job is to reverse the effects of these poisons and in some cases punish them
• onanism-18th century Europe-masturbation=the cause of many illnesses
• draptomania-USA 1851 (Runaway Slave Syndrome)
• Ovarian diseases- Victorian Era USA-HRT today???
• Adam-today, USA

IMPACT OF CULTURE ON CONTEMPORARY BIO-MEDICINE

• The rise of the MECHANICAL METAPHOR for the functioning of the human anatomy (THE BODY AS MACHINE), can be traced to the shift from a rural, farm economy to an industrial economic base. This has been argued to have contributed to the DEHUMANIZING OF CLINICAL PRACTICE.
• DISEASE AS COMBAT (warfare metaphor) resonated with the priorities and concerns of the Cold War in which it arose. (Sontag, Martin, Jaret)
• expensive high tech approaches to curing disease find the same compelling justifications as Pentagon budgets- no cost is too high when it comes to conquering the enemy, surrender is unacceptable
• Doctors will not give up, patients are "forced" into extreme therapies
• influence the way that funds are allocated and limits the ways that we might deal with disease otherwise when we go at things full throttle
• mastectomy, chemotherapy and radiation
• "the medical enterprise is from its conception value-loaded, it is not simply an applied biology, but a biology applied in accordance with the dictates of social interest" (Sedgwick)
• These connections shape the knowledge and the practice of the surgeon and the shaman alike-CULTURAL ASSUMPTIONS and SOCIAL STRUCTURES have an impact on the way that both healers and patients think about and respond to disease.

DEVELOPMENT OF MEDICAL ANTHROPOLOGY

The history of the development of medical anthropology out of joint concerns of physical (biological) and cultural andthropology is recent in the discipline. 

• Physician and experimental psychologist William HR Rivers was interested in non-Western medicines as a member of the scientific expedition organized by AC Haddon to the Torres Straits of Australia. 
• Based on DIFFUSIONIST MODELS, he created a classification system for disease causation beliefs and an analysis of the geographic centers for each type.
• Diseases are believed to be caused by either human agency (magical beliefs), spiritual or supernatural agency (eg taboo), and/or natural agency (virus, bacteria, genetics).
• he concluded that Australian Aboriginal society must have been a wellspring for the idea that human agency is at the root cause of disease based on the intense clustering there of such belief. (through FIELDWORK)
  
• "the practice of medicine is a social process, subject to the same laws , and to be studied by the same methods as other social processes" and the the "practices of primitive people were logical and systematic and in some respects more rational [than Western medicine at that time]." (Western science did not have monopoly on rationality).
• Erwin Akerknecht: FUNCTIONALISM and Medical Anthropology
• Ideas about the causes of disease can reflect lines of social tension in a society
• The very threat of causing a disease can serve as a powerful social sanction supporting the status quo against those who are inclined to deviate from social norms 
• witchcraft
• homosexuality
• prostitutes
• argued for the interconnection of all aspects of society (functionalism) and the cultural construction of disease
• "What a disease is in the last instance is, not a biological fact, but a decision of society"
• 1950's Consulting :International Health Care Projects 
• final catalyst to the creation of a separate field of medical anthropology
• APPLIED ROOTS of Medical Anthropology
• The Marshall Plan, the development of agencies like WHO (world health organization), AID (agency for international development), and INCAP (institute of nutrition of central america and panama), sought to eradicate epidemic diseases and improve basic sanitation in poor countries.
• anthropologists were hired to identify and remove cultural impediments blocking the success of the project and overcoming these "cultural obstacles".
• research inside, and soon after arose the concept of applied anthropology in medicine
• Modern Medical Anthropology
• Founded in 1971