In this chapter, students will learn:

• how medical anthropologists approach the concepts of illness and healing
• how culture plays an important role in illness and healing
• the importance of an illness narrative
• about different approaches to healing
• about different concepts of body equilibrium
• how health inequity leads to different outcomes for patients
• an anthropological approach to disability

Introduction: Studying Concepts of Illness and Healing

Medical anthropology is a biocultural field of study that uses a holistic view to examine ideas about illness, health, healing, and the body.

Understanding Illness

Medical anthropologists seek to understand a person’s experience of their disease (the physical manifestation of a clinically identifiable entity) and the set of understandings that comprises their illness (the larger social and cultural context). Illness narratives are the stories that help people understand their own illness and the roles that people and events have played in it. Cultural models about health permeate a social group, such as the Western biomedical model of a “disease” that is separate from one’s “self.” People may ascribe natural or supernatural causation to illness.

Cultural Concepts of Healing

Ethnomedicine is a culture’s concepts, beliefs, and practices regarding health, the body, and healing. This includes the Western concept of biomedicine, which emphasizes the use of pharmaceutical drugs to cure symptoms, and also theories of body equilibrium, such as Traditional Chinese Medicine and Ayurveda. From an anthropological perspective, four processes—clinical therapeutic, symbolic therapeutic, social support, and persuasive—have been identified as helping sick patients heal.

Health Inequality

Health and illness around the world is linked to structural violence, or the ways the social, economic, and political structures of society oppress and harm certain members.

Disability

Although disability is unlike illness, it is also understood within a biocultural context. The reactions of others may be discriminatory or they may be positive, shaping a person’s experience of their disability.

1. What do medical anthropologists study?

2. What is the difference between disease and illness, using an anthropological approach?

3. What strategies do people use to understand and express their experience of illness?

4. What are the different cultural theories of illness?

5. What is the main focus of biomedicine?

6. What are the therapeutic processes used in ethnomedicine?

7. How are the ancient medical traditions of body equilibrium similar and different?

8. How does structural violence lead to different outcomes for people with illness?

9. What is the main factor that shapes a person’s experience with disability?

1. Have you personally undergone a medical treatment that relied on non-Western understandings of healing? If so, how was the experience different than biomedical treatments?

2. What are some examples of illness that you are familiar with that correspond to each of Murdock’s cultural theories of causation?

3. Have you ever injured yourself or been in a situation in which you were temporarily (or permanently) disabled? How did it change the way you thought about yourself or the way others responded to you?

Ayurveda (page 246): a system of healing used in India that focuses on the restoration of balance to the body’s systems

biomedicine (page 238): the field of medical care in which the scientific principles of biology, biochemistry, and physiology are applied to patient diagnosis and treatment

critical medical anthropology (page 249): a subfield of medical anthropology that examines health and its relation to power

ethnomedicine (page 241): traditional, non-Western medicine

explanatory model (page 247): a way of understanding the world; a description of how something functions

homeostasis (page 242): stability or equilibrium, especially among bodily processes

humoral theory (page 242): the ancient Greek idea that health was achieved by a balance of elements within the body

illness narrative (page 235): the explanation of how a person understands and experiences an illness

medical anthropology (page 232): a subfield of cultural anthropology that examines ideas about health, illness, and healing

medicalization (page 239): the process by which a normal human condition comes to be seen as a medical condition needing treatment

metaphor (page 235): an application of a word or phrase to something to which it is not generally applicable; a comparison to things without using the words “like” or “as”

moxibustion (page 246): a healing practice used in Traditional Chinese Medicine in which a burning stick of herbs is placed near acupuncture points on the body

naturopathy (page 239): a form of treatment for illness that relies on non-pharmaceutical and non-surgical methods such as nutrition, herbal medicine, body work, and self-care

Others (page 249): a view of a person or category of people as different from, and therefore less than, one’s self; also used as a verb, “to Other a group of people”

personification (page 235): the representation of an inanimate thing as having human qualities

placebo (page 242): an inactive medical treatment that may help a patient through psychological, not physiological, effects

qi (page 245): the body’s life force in Traditional Chinese Medicine; pronounced “chee”

structural violence (page 248): how the social, economic, and political structures of society oppress and harm certain members, especially the poor

Traditional Chinese Medicine (TCM) (page 244): a system of healing used in China that focuses on strengthening the body’s systems and improving the flow of qi

Society for Medical Anthropology (SMA)
www.medanthro.net

Partners in Health (PIH—international social and health justice organization)
www.pih.org

Online Medical Anthropology Tutorials (curated by Dennis O’Neill, Palomar College; no longer updated)
www2.palomar.net

World Health Organization (WHO)
www.who.int

Medicine Anthropology Theory Open Access Journal
www.medanthrotheory.org

Somatosphere—a Science, Medicine, and Anthropology Blog
www.somatosphere.net

Cultural Anthropology Open Access Journal—Issue on “Reproductive Politics in the Age of Trump and Brexit”
www.journal.culanth.org

Adelson, N. (2000). Being alive well: Health and the politics of Cree well being. Toronto: University of Toronto Press.

Eli, K., & Warren, M. (2018). Anthropological perspectives on eating disorders: Deciphering cultural logics. Transcult Psychiatry, 55(4), 443–53.

Ember, C.R., & Ember, M. (2004). Encyclopedia of medical anthropology‬: ‪Health and illness in the world’s cultures‬. New York: Springer Science and Business Media.‬

Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Strauss and Giroux. (Although not written by an anthropologist, this account is well worth reading.)

Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305–25.

Farmer, P. (2004). Pathologies of power: Health, human rights, and the new war on the poor. California Series on Public Anthropology. Berkeley: UC Press.

Hamdy, S., & Nye, C. (2017). Lissa: A story about medical promise, friendship, and revolution. Art by Sarula Bao and Caroline Brewer; lettering by Marc Parenteau. Toronto: University of Toronto Press.

Jain, S.L. (2013). Malignant: How cancer becomes us. Berkeley: UC Press.

Katz, P. (1999). The scalpel’s edge: The culture of surgeons. Boston: Allyn and Bacon.

Luhrmann, T.M., & Marrow, J. (2016). Our most troubling madness: Case studies in schizophrenia across cultures. Berkeley: UC Press.

Rebhun, L.A. (1994). Swallowing frogs: Anger and illness in northeast Brazil. Medical Anthropology Quarterly, 8(4), 360–82.

Scheper-Hughes, N. (1993). Death without weeping: The violence of everyday life in Brazil. Berkeley: UC Press.

Singer, M. and Baer, H. (2012). Introducing medical anthropology (2nd ed.). Lanham: AltaMira Press.

1. How do medical anthropologists contextualize people’s understanding of illness? What are the kinds of questions they might ask in order to have a full picture of the experience of illness in a community?

Your answer should include the following items:

• people’s ideas about health, disease, illness, rehabilitation, and recovery
• how patients’ bodies feel when they are ill
• how others treat them when they are ill
• the status and roles of practitioners in their community
• how patients understand the ways medicines or other cures work
• how being ill changes a person’s sense of self
• how communities support or create barriers to healing
• •whether people feel they have access to the resources they need when ill

See page 233 of your text.

2. How do patients use an illness narrative to understand their illness? In particular, how do Brazilian women describe an illness that manifests itself after experiencing emotional abuse?

Your answer should identify the ways that people explain how they got their disease from their own perspective. These might be biomedical or non-scientific explanations that help a patient understand and cope with their illness.

• Define illness narrative.
• Identify the three types of illness narrative presented in the text: metaphor, cultural models, and personification.
• Brazilian women who suffer symptoms after experiencing emotional abuse will say they are “swallowing frogs” (engolir sapos), a metaphor for suppressing emotion and not letting it out. Eventually it will erupt in illness such as nerves, shock, or evil eye sicknesses.

See page 249-250 of your text.

3. Consider a scenario in which a person has an accident and falls from a ladder. Use the theories of natural and supernatural causation to provide reasons for the accident.

Your answer should focus on Murdock’s cultural theories of illness, both natural and supernatural causation. You should provide a reason using all three of the supernatural categories (mystic, animistic, and magical), but you may choose any specific cause within each of these categories.

• Describe the scenario to set the scene.
• Apply natural causation to the accident, such as mechanical or physical reasons for the fall.
• Then, choose one of each type from the supernatural causation categories, such as mystical retribution (the ancestors were angry); spirit aggression (a demon took over the ladder and shook me off); and sorcery (my brother visited a shaman, who put a curse on me).

See page 237-238 of your text.

4. The person in the example above broke several bones due to their accident and is now seeking treatment. Use the four therapeutic processes identified by Csordas and Kleinman to illustrate different ways that the patient could seek treatment.

Your answer should identify how each of the four therapeutic processes might approach the healing of broken bones.

• Define each type of therapeutic process: clinical, symbolic, social support, and persuasive.
• A clinical therapeutic process might provide a painkiller, set the patient’s bones, enclose the area in a plaster cast to immobilize it, and remove the cast after several months, once the bone has healed itself.
• A symbolic therapeutic process would differ, based on the type of practitioner and cultural tradition within which they are operating. One example would be to pray daily to a god with significance to the patient, so that they feel empowered and active in their own healing process. Physical symbols, icons, or images can support this process.
• A social support therapeutic process might involve regular visits from friends and family who provide support, gifts, laughter, and a sense of community for the patient.
• A persuasive therapeutic process might include a prescription of herbal teas for the patient, who believes they help in bone healing, but for which there is no scientific evidence.

See page 241-242 of your text.

5. Discuss the idea that, for a person with disability, the “disabling force” is the reaction of others and not the impairment itself.

Your answer should emphasize the cultural differences in the way that disabilities are accepted (or not) in societies.

• Disability may be attributed to many causes, such as biomedical causes, supernatural causes, karma, sin, or other.
• Based on the community’s understanding of the disability, the person with the impairment may be fully accepted or rejected and excluded from social life.
• The experience of disability in social life is therefore shaped by others’ responses. It may be embedded into social and economic life as a result of structural inequality.

See page 249-250 of your text.