Alternative Medicine and Medical Anthropology

Why is there alternative medicine?

antivaxxers and covid (here and here and here and finally here)

• The view that biomedicine should be the only legitimate practice of healing has been challenged.
• alternative healing is not a fashionable trend, it is a WELL-ESTABLISHED CULTURAL STRATEGY and a dynamic, heterogenous feature of most contemporary medical landscapes---a way that people seek to maximize their chances for wellbeing and adapt to the rapidly changing and unfavorable circumstances, by drawing on multiple sources and resources of knowledge and authority.
• WHAT IS IT?-hard to define
• there is such a variety of options which are quickly disseminated on the internet and an integration of various alternatives with biomedicine
• ORTHODOX (biomedicine) defended from "heroic medicine " of the colonial era, which endorsed aggressive measures such as sweating, purging, and toxic drugs. It was in contrast to heterodox medicine "sects" which upheld the gentler methods and the view that healing involved the strengthening of ones VITAL FORCE and required more than just mechanistic interventions
• homeopathy-
• the treatment of disease by minute doses of natural substances (distillations) that in a healthy person would symptoms of disease
• botanic medicine-
• use of healing through plants and other natural compounds
• osteopathy-
• healing through the manipulation of the bones of the body.
• hydropathy-
• the treatment of illness through the use of water, internally and externally (baths, steams & spas)
• chiropractic-
• like osteopathy, but focusing on spinal misalignments
• Christian Science-
• sin and illness are illusions that can be overcome by prayer. refuse any other intervention
• various folk medicines
• The practice of alternative therapies has always been deeply rooted in in class and ethnic distinctions and relations, and therefore a highly political process
• they have also become VENUES OF CULTURAL CRITICISM AND RESISTANCE and EMPOWERMENT in many parts of the world
• What constitutes the mainstream at any one particular time may be questionable or alternative a century later
• leeches
• blood letting
• electric shock
• hysterectomy
• zoo-therapies (Parasites ingested for Crohn's disease, e.g.)
• saltwater rinses and gargles
• neti pot or ear candeling
• Practices that originate elsewhere until they become familiar are always alternative
• Chinese medicine
• acupuncture
• DOUBLE-BLIND PLACEBO CONTROLLED MEDICAL TRIALS (gold standard for in Western medicine) are elaborate and expensive, so rarely available to prove the efficacy of alternative therapies
• SO..."different from the usual or conventional: existing or functioning outside the stablished cultural, social, or economic system" ALTERNATIVE
• subversive
• grassroots
• lack of standardization
• Sickness and suffering are not just natural processes. They are socially produced and shaped by local and global patterns of social inequality and power relations.

THE RISE OF INTEGRATIVE MEDICINE

• 1 in 3 people in the US use some sort of alternative therapy
• ethnographic studies have shown that traditional practices and beliefs involving health, illness and healing were NEVER fully extinguished. They live on, though they may be frowned upon
• are we in "a golden age of quackery"?
• governments are eager to assess and regulate these practices which can provide additional sources of income and novel cost containment solutions, as the cost of biomedicine rises.
• DANGERS OF MAINSTREAMING CAM?
• the loss of self-help and grass-roots ethos that have historically characterized alternative medicine-EXPENSIVE (as practitioners become bureaucratized, professionalized and commercialized they become luxuries for the wealthy)
• practitioners are understandably distrustful of biomedical specialists getting training and licenses in  hybrid, inauthentic fields like "oriental medicine" so that they can compete in the market

THE ANTHROPOLOGICAL APPROACH

•  explores the diversity of popular methods in cultural context
• seeks to clarify the VALUE and MEANING that these methods contribute to the lives of patients, practitioners, and communities
• seeks to understand how these meanings and values (etiologies) and therapeutic methods are constructed, imagined or contested in time and space.
• seeks to validate the experiences and testimonies of non-biomedical therapies rather than prove or disprove their objective validity in quantitative terms

THEMES TO BE EXPLORED

• diverse approaches to health and illness and healing engage mindful social , and political bodies which are shifting and permeable
• flow and circulation are central to biological and social life, wellness and healing.
• healing experiences are mediated through EMOTION, INTER-RELATIONS, MOVEMENT, SENSUAL EXPERIENCE, while they are rooted in local contexts
• the senses act and interact with the world in dynamic and complex ways. Their role in healing goes well beyond current Western conceptions and approaches

HISTORY OF ANTHROPOLOGY & MEDICINE

• Western medical training prioritizes the workings of the MACROSCOPIC PHYSICAL & BIOLOGICAL SCIENCES, and the notion of the NEUTRAL OBSERVER.
• This makes Western medical students and doctors uneasy with models that do not employ these notions. (non-Western systems) 
• if you cant measure and compare it, it aint real!
• medical anthropology developed out of the attempt to understand the health-related beliefs and practices in their local cultural context.
• medical anthropologists explore culturally situated ideas, norms and practics related to health and illness, natural and supernatural. 
• health and healing are approached as CULTURAL CONSTRUCTS (not scientific facts), expressed symbolically through language, informed by particular historical, socioeconomic, and political circumstances. 

HEALING AND THE POWER OF AGENCY

• the ability to heal confers high status in all societies (social and cultural)
• traditional healers are often born into families or lineages of healers and apprentice through family members who are also healers 
• may be "odd" people or have an ecstatic experience early in life, suffer from unusual conditions (epilepsy) or show signs of special healing powers from birth
• Western medicine believes in a SINGLE CURE for every illness, so it is difficult for us to understand the traditional healers may suggest a number of different herbal cures, for instance.
• Herbal medicine (traditionally)
• different parts of the same plant prepared in different ways and used in different combinations with other aspects of curing are used for different purposes 

• In Western hierarchtical medical systems, the distance between patient and biomedical doctors is vast and communication is impeded by terminology and social awkwardness, such as hesitancy of patients to ask questions. 

THE DOCTOR PATIENT RELATIONSHIP AND THE ROLE OF THE PATIENT

• Models:
• ENGINEERING MODEL
•  patient directs his/her own care; doctor assists
• this model has the highest agency of the patient and is now beginning to be encouraged , has led to the rise of CAM
• PRIESTLY MODEL
•  patient is passive, trusting and obedient; doctor has full authority
• paternalistic
• describes traditional western medicine
• CONTRACTUAL MODEL
•  legal agreement between to parties who share the same goal
• COLLEGIAL MODEL 
•  trust between patient and doctor with equal effort

• THE SICK ROLE (in sociology-Parsons)

• Parsons was a functionalist sociologist, who argued that being sick means that the sufferer enters a role of 'sanctioned deviance'. This is because, from a functionalist perspective, a sick individual is not a productive member of society. Therefore this deviance needs to be policed, which is the role of the medical profession. 
  
  • The general idea is that the individual who has fallen ill is not only physically sick, but now adheres to the specifically patterned social role of being sick. 
  • ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it contains within itself customary rights and obligations based on the social norms that surround it. 
  • The doctor patient role is inherently hierarchical 
  • The theory outlined two rights of a sick person and two obligations:
• Rights:
  • The sick person is exempt from normal social roles
  • The sick person is not responsible for their condition

• Obligations:
  • The sick person should try to get well
  • The sick person should seek technically competent help and cooperate with the medical professional

AGENCY: CAM versus BIOMEDICINE

• CAM practitioners spend more time with patients perceptions and experience of illness.
• individualized attention, and a greater willingness to listen to patents concerns have contributed to the popularity of many alternative therapies (Mediation) >Agency

• BIOMEDICINE: spend little time with patients
• seek to elicit specific complaints  (symptoms)dominate conversations and expect unswerving obedience from patients (Coercion) <Agency

CULTURAL CONSTRUCTIONS AND WHY THEY MATTER TO HEALTHCARE 

• drapetomania, hysteria, onanism...and...
• speaking against a repressive state=mentally ill
• alcoholism ? PTSD? PMS? "pre-diabetes"? 
• These are created, deleted and legitimated through overt and covert channels of power...as are policies, programs and drugs to treat them.
• resources and blame are also redirected, everyone is encouraged to take stock and seek treatment
• deeply embedded in modern capitalist society

CORE CONCEPTS IN ANTHROPOLOGY

• BIOMEDICAL PERSPECTIVE: health : the absence of disease -NEGATIVE
• disease: the malfunction or disturbance, usually physical or biochemical in nature
• may have a disease (arthritis) but feel "healthy...never hurt and visa versa
• HOLISTIC PERSPECTIVE: health is a state of harmony and balance and wellbeing (includes physical as well as emotional, mental, social and spiritual aspects of a person) -POSITIVE
• from the holistic perspective if someone is feeling ill, something is out of balance-there is disharmony
• roots of suffering are social, emotional or supernatural, depending on your cultural beliefs
• healing traditions have a way of addressing the discomfort and re-balancing a person to restore health. HEALTH IS A NATURAL STATE
• analogy of beauty: if beauty is defined in positive terms as harmonius and balanced or pleasant appearance, those blemishes may matter less.

FIVE MODELS OF HEALTH (Owen)

1. PATHOGENIC MODEL: looks at an external cause (aetiology)
2. BIOLOGICAL MODEL: focuses on symptoms, recognizing that a single cause may produce different effects in different systems
3. HOLISTIC MODEL: many aspects of the patient and the environment are involved and connected through a mutual feedback, and that illness may be necessary to affect a change in that environment or person
4. HOLOGRAPHIC MODEL: symptoms reflect the "whole picture" and the "essence of the person" no matter where they occur in the body
5. RELATIONAL MODEL: highlights the role of the "context" of symptoms and the patients relationships, including the relationship with the healer

disease (biological) versus illness (subjective experience)?????? regardless of whether there is confirmation of the illness or not, to the sufferer it represents the personal and social experience of malfunction or discomfort in particular cultural contexts

the EXPERIENCE of illness is based on the cultural context of illness and suffering.

CURING OR HEALING:

• HEALING

• Healing is the therapeutic process or action that addresses the whole suffering person and the illness rather than just the specific body part or a particular problem-includes emotional, mental, social and spiritual needs and concerns in the treatment plan. 
• Healing aims at bringing about improvement 
• no enemy, nothing to be destroyed, making whole- may not return to original state

• CURING

• Curing has the goal of removing a particular problem completely and permanently, whether that may be a disease, social or spiritual disorder mental or emotional dysfunction, etc.
• curing aims to eliminate condition, healing aims to restore balance
• in traditional settings, FAMILY and COMMUNITY are usually involved in healing and curing.
• biomedicine: kill the enemy, elimination or destruction of external illness-return to original state

Harikari: suicide as social healing in japan-since the ki resides in the abdomen ( and it redresses social imbalance and disruption through dishonor)

BIOMEDICINE VERSUS TRADITIONAL MEDICINE (summary)

• Biomedicine
• employs mechanical model of the human body
• treats each organ and each person in isolation
• emphasizes causation and responsibility (blame)
• sees TARGET MEASURES for health (height, weight, red blood cell count, blood pressure
• focus is on "magic bullet" (drug)
• Ethnomedicine
• illness results from a complex combination of natural and supernatural causes
• requires a combination of therapies to achieve a cure
• aim is to restore harmony (which may not be original state)
• no magic bullet, community and family are important considerations (social world)

NORMALITY:

• normality is shaped by cultural forces
• MEDICALIZATION -what used to be normal can come under the domain of biomedicine and medical surveillance
• pregnancy and child birth
• aging
• menstruation (the curse)
• constitutional states
• alcoholism
• ADHD
• PMS
• altered states of consciousness
• infertility
• defiant disorders
• "micromastia" small breasts
• menopause (hormone deficiency)

• "TYRANNY OF NORMAL" overemphasis on "normality" that leads to excessive interference with the minds and bodies of people who do not meet these measures, or social stigma
• abort abnormal fetuses (Dwarfism)
• Southern Europe and Middles East: light eyes: give the evil eye, red hair=witchcraft
• Africa: albinos: may be kidnapped and killed for their body parts (magical)
• CORRECT ABNORMALITIES MEDICALLY IF WE CAN
• south africa: schizophrenia=healer
• PLACEBO: the "nothing" given of the placebo is far from nothing at all...it is the impact of the anticipation, meaning, and cultural context of healing-GENUINE AND POWERFUL HEALING FORCE IN ITS OWN RIGHT
• The nocebo effect is the adverse reaction experienced by a patient who receives a nocebo. Conversely, a placebo effect is an inert substance that creates either a beneficial response or no response in a patient. The phenomenon by which a placebo creates a beneficial response is called the placebo effect. In contrast to the placebo effect, the nocebo effect is relatively obscure. 
• Both nocebo and placebo effects are psychogenic. Rather than being caused by a biologically active component of the placebo, these reactions result from a patient's expectations and perceptions of how the substance will affect him or her. Though they originate from psychological sources, nocebo effects can be either psychological or physiological. 

 GENDER AND MEDICINE

• women
• more likely to be accused of witchcraft when they are successful in ways that are not available for women
• Reproduction: regulated
• women's bodies :regulated more than men's

TWO TYPES OF ILLNESSES RECOGNIZED IN ANTHROPOLOGY

• NATURALISTIC
• emphasize the physical body and the environment as causative and therapeutic agents 
• unintentional harm
• PERSONALISTIC
• prioritize the role of social and supernatural factors
• tend to point to intentional harm

FACTS and TRUTHS: understanding others

• EMIC vs ETIC perspectives
• post-rationalism: holds that there is no one truth, but many truths, so there is an interest insharing perspectives and experiences in CAM and alternative medical camps (KLASS)
• growing mindset in American culture which allows people to believe in and make use of alternative practices while also using biomedicine

HYGIENE HYPOTHESIS:

• biomedicine has waged a war on viruses, bacteruia and parasites, but can some of these be beneficial? Can soone be "healthy" with these present?
• MODERN LIFE is seen as the cause of many diseases instead (asthma, fibromyalgia, allergiescrohn's disease. HYGEIENE itself is to blame
• the birth canal: what is lost in a C-section?
• what is killed with antibacterial soaps?
• what is good about kids getting pin-worms?
• what is lost in genetic engineering of food plants and commodification of seeds by bio corporations?

CRITIQUE OF WESTERN SPIRITUALITY/WELL-BEING (Richard King)

• "spirituality" in the West are a"silent takeover of religion and Asian wisdom traditions by the forces of market capitolism which promote INDIVIDUALISM and CONSUMERIST SPIRITUALITIES"
• Yoga & Toaism originally sought to extinguish self-centeredness and the attachment to material things while fostering RENUNCIATION COMPASSION and SIMPLICITY-
• have been adopted and rebranded for Western tastes and agendas; becoming primary tools for HEALTH, LONGEVITY, and PROFESSIONAL ACHIEVEMENT.

• The World's Traditional Religions and practices provide a vital source for RESISTANCE to the way that these forces are operating in biomedicine (unrestrained commercialism & commodification of life itself)
• ALTERNATIVE MEDICINES arise from these traditions, creating hybrid therapies

Hallucinogens and Alternative Narratives: Variety of Hallucinogens are used indigenously

• Mecaline
• mushrooms
• Psilocybin 
• LSD

Active Ingredients:

• similar to neurotransmitters in the human body. 
• therapist or shaman acts as a GUIDE to help the patient integrate the experiences within the larger life context
• uses ritual, mythic, and symbolic elements to change the patient's awareness of self and break up habitual experiences of the world (become more suggestible)

WINKELMAN: Therapeutic uses for hallucinogens:

• effecting neural, sensory, emotional, and cognitive processes
• can be effective in treating ADDICTIONS due to their ability to induce the RELAXATION RESPONSE, enhance THETA WAVE PRODUCTION, and stimulate endogenous opted and sterotogenic mechanisms and their MOOD ELEVATING effects.
• shamanic drumming approach to treating addictions 

FAITH HEALING

• ritual healing and religious pilgrimage
• COMMUNITAS: collective consciousness which emerges during religious ritual, infusing the community with power and solidarity
• health and longevity benefits of social involvement
• ECSTACY/ENSTACY: (Eliade) Ritual offers humans the opportunity to renew themselves and the world around them by uniting with the divine through ritual action
• example: girls puberty rituals as healing among the Apache
• PILGRIMAGE (Turner): pilgrimage is a breach of time and space
• when social order is temporarily suspended or challenged-possibility for great change-personal and communal.
• LIMINALITY: socially ambiguous states often incorporating hardships or chjallenges into transitions
• exorcism
• pilgrimage (extended period of liminality)-Vietnam War to the Wall, Hajj to Mecca (path of Mohammed), Kumbh Mela (Allabbad), Lourdes---
• identity differennces suspended, communitas, modifications of perceptions & consciousness, possibility of transformation & healing
• sickness=sin: cure is to be "touched" by sacred-object, person, place
• healing restored or enhanced social status
• suffering is remade into a meaningful and powerful narrative in culture
• miracles
• vision quest
• sweat lodge
• drum circle
• ritual has the potential to rejuvenate self and society