Ritual, Health, Healing

Question 1

Medical anthropology

Answer 1

Broadly defined as the study of health, illness and healing through time and across cultural settings

Question 2

What do medical anthropologists focus on?

Answer 2

• Illness as a social phenomenon, just as much as personal, individual
• How patients and healers are connected to social systems, which may inform diagnoses, treatment decisions, experiences of patients
• The meaning of people’s experiences of illness and what illness signifies and represents in a given context
• Examining both medicine and medical systems as cultural practices

Question 3

What do medical anthropologists study?

Answer 3

• The body and embodiment
• Different healing systems and healers (e.g. Western medicine and traditional healers such as shamans)
• Biosciences and biotechnologies (e.g. IVF, organ transplantations, ultrasounds)
• Patterning and spread of disease (e.g. epidemiology)
  Political economic impacts on health

Question 4

Biomedicine

Answer 4

Applications of natural sciences such as biology to clinical practices

Question 5

Ethnomedicine

Answer 5

A study or comparison of the traditional medicine practiced by various ethnic groups, and especially by indigenous peoples

Question 6

Disease

Answer 6

A biomedical condition characterized by a harmful biological irregularity in an organism

Question 7

Illness

Answer 7

A culturally defined state (or role) of general physical and/or mental discomfort and poor health

Question 8

Medicalization

Answer 8

The process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment.

Question 9

Medical pluralism

Answer 9

Defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness.

Question 10

Medical hegemony

Answer 10

Belief that there’s only one way of seeing health + disease

Question 11

Importance of context

Answer 11

• Illness is necessarily cultural – how we define and respond to illness
  Kleinman and the two interpretations of symptoms (1988):
  The meaning of the symptom itself
  The cultural significance of the symptom
  E.g. Cancer in North America, Neurasthenia in China
• All health practices must be understood within the local context in which they occur (whether ‘traditional’ or ‘biomedical’)

Question 12

Individuals’ explanatory model

Answer 12

Individuals’ own cognitive models related to their own illness
E.g. “water on the lungs”

Question 13

Doctor model

Answer 13

1. Etiology: Study of the causes of a disease/illness
2. Onset of symptoms
3. Pathophysiology: the disordered physiological processes associated with disease or injury.
4. Course of illness (type of sick role – acute, chronic, impaired) and severity of disorders
5. Treatment

Question 14

Three main theoretical approaches in medical anthropology

Answer 14

• Biocultural
• Cultural constructivist or interpretive
• Critical medical anthropology (CMA)
• In practice, many approaches bridge 1 or 2 or 3 theoretical perspectives. E.g. Holmes (2015)
• Research is often theoretical or applied or some combination of both

Question 15

Biocultural

Answer 15

Relationship between biology, health, and environment

Question 16

Cultural constructivist or interpretive

Answer 16

Cultural interpretations or meanings of illness

Question 17

Critical medical anthropology

Answer 17

Political economic impacts on health, arguing that social inequality and power differentials are primary determinants of health and health care

Question 18

Biocultural example

Answer 18

• Barrett’s (2005) research on the stigma of leprosy or Hansen’s disease in Banaras, India
• Stigma of disease is so powerful that it remains with a person even after cure
• Stigma combines with biology of disease to make disease worse
  Concealment
  Dissociation
  Disfigurement

Question 19

Interpretive example

Answer 19

Adelson’s (2000) work on miyupimaatissiun or “being alive well” amongst the James Bay Cree of Northern Quebec, Canada
For the Cree, health is inseparable from being Cree and being Cree is inseparable from the land, from eating Cree food, from being protected from the cold

Question 20

CMA example

Answer 20

• Farmer’s work (2004) on primary care, poverty, and human rights in Haiti
• Structural violence
• “Violence that results from the way that political and economic forces structure risk for various forms of suffering within a population” (Schultz, Lavenda, and Dods 2015, 120)
• Predisposes certain people to suffer (story of Acephie, pg. 121-122)
• Perpetuates inequalities and prevents certain people from accessing health

Question 21

Healing systems

Answer 21

• All healing systems deal with questions of:
  1) bafflement (why me?)
  2) action (what can be done?)
• Sectors of health care:
  Popular:
  Professional
  Folk

Question 22

Taxonomy of healing systems

Answer 22

• theory of etiology (disease causation or explanatory models)
• system of diagnosis
• techniques of appropriate therapy

Question 23

Theories of disease causation

Answer 23

• Naturalistic (e.g. TCM, Ayurvedic)

- Personalistic (e.g. Tumbuku healing)

Question 24

Naturalistic

Answer 24

• Single level of causality
• Natural environment
• Cures focus on individual body

Question 25

Personalistic

Answer 25

• Disease due to an agent (human or nonhuman)
• Sick person intended victim
• Cure deals with underlying causes and social rifts (social body)

Question 26

Tumbuku healing (Malawi)

Answer 26

• Illness caused by Gods, spirits and witches. In this sense, illness caused by witchcraft is always intimate – by someone related to you or someone you know. Not impersonal or ‘objective’
• Mizimu (ancestors) can send illness by withdrawing their protection
• Nyanga (bad medicines, considered living things) are responsible not only for diseases but also financial disasters, love problems, poor harvests, things biomedicine would not count as its areas of specialty
• Yet, even now, we acknowledge that social problems (poverty, stress, heartbreak) do cause us to feel ill. We look for the physical manifestation in the body, whereas Tumbuku do not need to see it to know something is wrong

Question 27

Tumbuku healing (nchimi)

Answer 27

• Witches living in parallel world to nchimi but world of evil
• Body is seen as permeable (if sweat comes out, then things go in), connected to environment and social relations
• Both patient and healer will dance until very hot, trying to release excess heat caused by bad spirits entering your body

Question 28

Ritual

Answer 28

Repetitive social practice set off from everyday routine and composed of a sequence of symbolic activities that adhere to a culturally defined ritual schema and are closely connected to a specific set of ideas significant to the culture

Question 29

Rite of passage

Answer 29

A special type of ritual that serves to transition a person from one type of social identity to another
E.g. graduation, marriage, baptism, funerals

Question 30

3 stages of rite of passage

Answer 30

• Separation: leaving behind symbols and practices of previous position (e.g. hair, activities)
• Transition or Limen (threshold): the in between phase where you’re really nothing
• Re-aggregation: reintroduced into society in new position

Question 31

Liminality

Answer 31

• The period of “anti-structure” where a person is “betwixt and between” two stages in life
• Victor Turner (1967) proposed that this stage is highly important and used it to examine puberty rituals of Ndembu boys becoming men in Zambia
• One feature of liminality is the formation of communitas
• Ritual “experts” often guide initiates (neophytes) through the process

Question 32

Communitas

Answer 32

An unstructured or minimally structured community of equal individuals frequently found in rites of passage

Question 33

Patients with advanced cancer

Answer 33

• Straddle the worlds between cancer survivorship and oncology and palliative care and death and dying
• They undergo treatment very similar to patients with locally advanced disease but their outcomes are often different
• Hospital is itself a liminal space serving to transition people from being sick -> well
• One ritualistic aspect of their treatment that can be examined is the ringing of the chemo bell

Question 34

Rite of passage of advanced cancer

Answer 34

• Diagnosis as separation
• Treatment as transition
• But no potential re-aggregation except for status of person still living with incurable cancer. Identity of ‘cancer survivor’ is not available to them

Question 35

Ritualistic aspects of chemo

Answer 35

• Chemo itself puts patients in transition – they often look physically different, and it is a time where they develop communitas with other cancer patients
• At the end of their last treatment cycle in one “round” of chemotherapy, patients ring the bravery bell
• This event is symbolic of their transition from the world of treatment to the world of survivorship

Question 36

Ritual of ringing the chemo bell

Answer 36

• Repetitive social practice (= repeated symbolic activities)
  Sequence of events is often the same (ringing, clapping, congratulations, thank yous)
• Set off from social routines of everyday life (=separate from day to day life)
  You only ring it at the end of chemo, not halfway through
• Adhere to a characteristic, culturally defined ritual schema (=obvious that it is a ritual)
  Patients quickly learn what it means; reminiscent of having “happy birthday” sung to you at a restaurant
• Closely connected to specific ideas that are significant to a culture (=socialization)
  Transmitting values of ‘doing something is better than doing nothing’, fighting cancer until the end, faith in medical technology to cure or at least to prolong life

Question 37

Challenges of re-aggregation for patients with cancer

Answer 37

• The new identity of “cancer survivor” is not often available to patients with advanced disease who emerge from treatment with cancer still in their bodies and lives
• People do not recognize advanced cancer patients for where they are – somewhere between living with disease and dying from it
• Ringing the bell multiple times
• Being structurally invisible

Question 38

Liminality and advanced cancer

Answer 38

• The ritual of ringing the bell actually serves to hide patients’ liminality
• This means that patients’ realities are somewhat invisible to the people around them
• Liminality framework helps to draw attention to the fact that approaching death and living with incurable illness is not just an individual process but a social process as well
• Demonstrates how we may be unintentionally abandoning people at the end-of-life, right at the time when they most need support from their communities

Question 39

Sick role

Answer 39

• Temporarily excused from social responsibilities
• You have to want to get better, you have to get competent help, you have to cooperate with healer
• But context might interfere with following these principles
• Blaming individual takes blame off government