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MULTIPLE MEDICAL REALITIES

Patients and Healers in Biomedical, Alternative and Traditional Medicine

Edited by Helle Johannessen and Imre Lázár
With a Preface by Thomas Csordas

224 pages, index

ISBN  978-1-84545-026-7 $99.00/£60.00 Hb Published (December 2005)

ISBN  978-1-84545-104-2 $22.50/£13.50 Pb Published (December 2005)


Hb Pb
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“…an intriguing collection of articles exploring medical pluralism and bodily experiences from a largely European perspective.”   ·  American Anthropologist

Nowadays a plethora of treatment technologies is available to the consumer, each employing a variety of concepts of the body, self, sickness and healing. This volume explores the options, strategies and consequences that are both relevant and necessary for patients and practitioners who are manoeuvring this medical plurality. Although wideranging in scope and covering areas as diverse as India, Ecuador, Ghana and Norway, central to all contributions is the observation that technologies of healing are founded on socially learned and to some extent fluid experiences of body and self.

Helle Johannessen has a PhD in anthropology from University of Copenhagen and has done research and teaching in medical anthropology since the mid-1980s. She is currently associate professor at the Institute of Public Health, University of Southern Denmark, where she is head of a research unit and a PhD program for social studies in medicine. In her research she has studied medical pluralism in Denmark and Europe. She is currently involved with a comparative study of the use of complementary medicine among cancer patients in Denmark, Italy and India.

Imre Lazar graduated as a medical doctor from Semmelweis University of Medicine and in 1999 became an expert of occupational medicine. He has a Master's Degree in Medical Anthropology from the Brunel University and a Ph.D. in Behavioral Sciences from the Hungarian Academy of Sciences. Since the foundation of the Institute of Behavioural Sciences at Semmelweis University, Lazar has been teaching in the Medical Anthropology department and in 2004 he became its head. He is also associate professor at the Institute of Communication and Social Sciences, K.roli G.sp.r University of Reformed Church, Budapest.

Related Link: European Association of Social-Anthropologists (EASA)

Series: Volume 4, EASA Series


LC: R733 .M855 2005

BL: YK.2007.a.6021

BISAC: SOC002010 SOCIAL SCIENCE/Anthropology/Cultural; MED034000 MEDICAL/Healing

BIC: PSXM Medical anthropology; VXH Complementary therapies, healing & health


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Introduction

Body and Self in Medical Pluralism

Even at a glance, it is obvious that in all contemporary societies a variety of health care options exist and 'medical plurality' seems to be a common feature of today's world. The therapies available vary from one locality to another, and span from herbal medicines to biomedical treatments to psychological and spiritual forms of therapy. Different kinds of health care imply different techniques as well as different ideas of the body, health and healing. Research into these matters has been manifold, but two major theoretical trends stand out when considering approaches to the study of therapeutic options. One is based in the concept of medical pluralism; within this perspective pluralistic health care systems in Asia, Africa and recently also in Europe and the United States have been investigated, particularly with regard to the relevance of legal and socio-economic conditions for therapeutic practices as well as differences in explanatory models. Unrelated to the research in medical pluralism, there emerged in the 1990s in anthropology as well as in sociology and philosophy a growing interest in body and self, as well as the relation between body and self. This perspective emphasises the individual's creation of meaning in the midst of chaotic life events and acknowledges the importance of narratives linking health, body and sickness to the lifeworlds of everyday living, a theme that seems also to be important for an understanding of bodies and selves in medical pluralism.

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Demographic Background and Health Status of Users of Alternative Medicine

A Hungarian Example

Societal processes are to some extent mirrored by transformation of the medical system of a given society. Among others, a symptom of the weakening of the predominant health care system with the underlying biomedical approach is exactly the appearance and spreading of different alternative forms of medicine spanning from traditional oriental medicine to distant energy healing, etc. In Hungary we are witnessing a significant increase of using alternative medicine (AM) both by visiting a practitioner and by buying, trying and applying herbal remedies and other alternative self-curing facilities. To understand the background and get a chance to discover reasons and patterns behind this phenomenon it is useful to obtain some empirical and quantitative data on the social reality related to it. Recently we have conducted a health-sociological research in Hungary, the aim of which was (1) to estimate the prevalence of, and likely, use of AM among the Hungarian population; (2) to identify demographic features of users of AM in order to refute the commonly held belief that AM in Hungary mainly serves as the last chance of desperate, credulous, naïve or poor people; (3) to investigate how AM use is associated with general health status; and (4) to obtain data about how AM is connected to the habits of turning to physicians and how we can describe as accurately as possible what actually is the role played by AM in the Hungarian health care system (Buda et al. 2002).

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Táltos Healers, Neoshamans and Multiple Medical Realities in Postsocialist Hungary

The conflict between Western biomedicine as the politically dominant health system based on bioreductionist assumptions and unconventional medicine with its wide eclectic syncretism reflects the cultural tension of the modern and postmodern. Hungary is itself undergoing a rite of passage from socialist modernism to globalised postmodernity. This liminality describes a situation of incomplete transition, a transformation in which elements of the old and the new coexist side by side without much integration (Schopflin 2002). This cultural transition has made people pay the high price of ill health, as selfdestructive cycles arose in the midst of cultural and socioeconomic transition, depressive symptomatology and health in a rapidly polarising society (Kopp 2000). As rituals always accompany transitions from one social world to another, in this 'postmodern turn' we may rediscover the rituals and their culturally transformative role in unconventional medicine, where — citing Turner (1982: 86) — 'dismembering may be a prelude to re-membering'. It is more pronounced in those who express their frustrations and helplessness in somatisation or illness. Illness itself is a heightened state of receptivity in which a patient calls for another style of knowing in the context of the ultimate values of that patient's community. The human body offers a cultic scene, as the body is traditionally the locus of revelation and hierophany, while ritual knowledge is, some think, gained by and through the body (Grimes 1990).

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'The Double Face of Subjectivity'

A Case Study in a Psychiatric Hospital (Ghana)

Sickness requires us to acknowledge the double face of subjectivity, for people are subjects in relation to affliction, in that they form ideas about it and act upon it, and they are also subject to it as it strikes them down and sometimes resists their attempts to manage it. They undergo and undertake (Whyte 2002: 172). The 'double face of subjectivity', aptly summarised by Susan Reynolds Whyte, as undergoing and undertaking, points to one of the major challenges of Medical Anthropology: How to bring together perspectives of sociopolitical structures and power relations with perspectives of suffering, recovering and acting subjects (Johannessen, this volume). On the one hand, one needs to shed light on the processes by which subjects and objects of medical practices are constituted and medical knowledge is authorised. On the other hand, it is necessary to develop analytical tools which are capable of grasping the sometimes inconsistent acts of the people involved.1 Concerning this challenge Michael Lambek states: 'Agency is a tricky concept. Leave it out and you have a determinist or abstract model, put it in and you risk instrumentalism, the bourgeois subject, the idealised idealistic individual etc. But we can see how agents are always partly constructed through their acts — constituted through acts of acknowledgement, witnessing, engagement, commitment, refusal and consent' (Lambek 2002: 37).

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German Medical Doctors' Motives for Practising Homoeopathy, Acupuncture or Ayurveda

Perhaps the most obvious questions that arise when surprising social developments occur are: 'Who are these people? And why are they doing it?' As regards the (re-) emergence of heterodox medicine in Europe and North America during the last two decades, numerous studies were conducted to answer these two questions. Most of these studies were concerned with the patients' perspectives: Patients often turn to heterodox medicine if they suffer from non-life-threatening chronic diseases for which biomedical treatment has produced unwanted side-effects rather than an effective cure. Therefore, the promise of gentle healing in heterodox medicine is appealing (Furnham and Smith 1988, Sharma 1990). Another type of heterodox patient has ideas on health that more closely correspond with heterodox treatment than with biomedicine (Stollberg 2002). It has been argued that heterodox patients were alienated from biomedical forms of the physician-patient relationship (Fairclough 1992). Empirical evidence of harmonious interactions in heterodox medicine is, however, ambiguous (Frank 2002a). Much less is known about the motives of those practising heterodox medicine (Cant and Sharma 1999). Sharma (1992) presented a wide range of motivational factors for non-medical practitioners, partly of a practical nature (e.g., possibility of flexible part-time work). Most of her interviewees practised another — not necessarily medical — profession before taking up heterodox medicine (Sharma 1992). We can assume that motives and career patterns are different for medical doctors practising heterodox medicine, as their professional biographies involve at least a decade of biomedical training.

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Pluralisms of Provision, Use and Ideology

Homoeopathy in South London

Homoeopathy represents an interesting case of pluralism of healthcare provision. It was one of the earlier of the currently popular alternative therapies to arrive in the United Kingdom in the early nineteenth century (Porter 1997). It became one of the earliest of the modern alternative therapies to be offered by orthodox physicians and integrated into the orthodox health care system. Homoeopathy was incorporated into the National Health Service (NHS) at its inception in 1947, becoming the first of the alternative therapies to be offered in tandem with orthodox healthcare services in the NHS (Nicholls 1992).

Homoeopathy arrived in Britain shortly after it had been established in the early 1800s by a German physician, Samuel Hahnemann. Hahnemann developed a new system of medicine based on the principle of treating like with like. He discovered this 'law of similars' when he ingested the bark of the Chinchona tree (Quinine) and experienced a fever similar to malarial symptoms. He went on to chart the action of a wide variety of substances through 'proving' (testing) them on healthy people. The classical homoeopathy that he developed involves trying to match the overall picture of a person's symptoms to the remedy that itself produces the most similar pattern of symptoms in the healthy.

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Re-examining the Medicalisation Process

My initial interest and preoccupation with the medicalisation legacy and process dates back to my PhD fieldwork1 in a rural Greek village with the pseudonym of Perachora. Whilst exploring local health-seeking activity I noted that people were unwilling to make their own illness subject of open discussion. Perachorans tended to often medicalise (or demedicalise) their activities claiming and disclaiming being sick according to who was present at the time. At first, I thought that they lacked an appreciation of modern medicine but later it became clear that this was done in hope of preserving their privacy and reputation, which is integral to their survival. In further exploring the people's unwillingness to talk about their health it became clear that they preferred to confine their knowledge to themselves out of fear that others may not hold the same 'medicalisation of ideas' as they did.

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Healing and the Mind-body Complex

Childbirth and Medical Pluralism in South Asia

This article attempts to put together two bodies of work I did at different times. The first was a kind of rethinking of anthropological theorising about mind, body and culture which was undertaken originally in the late 1980s in the context of a study of religion in Tibetan societies (Samuel 1990a, 1990b). The second area of research was in medical anthropology. In the late 1990s I undertook some research on medical pluralism in a Tibetan refugee community in North India (Samuel 1999, 2001a), and subsequently edited a book on childbirth in South and Southeast Asia along with my partner, Santi Rozario (Rozario and Samuel 2002a). I shall refer to some of the South and Southeast Asian childbirth research below.

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Self, Soul and Intravenous Infusion

Medical Pluralism and the Concept of samay among the Naporuna in Ecuador*

Medical practice among the Kichwa-speaking, native population of the lower Napo River in Ecuador, the Naporuna, appears to be a classical situation of contemporary medical pluralism with 'traditional medicine' (or 'ethnomedicine') and 'Western biomedicine' as its main elements. This article is about one specific aspect of the pluralistic medical practice of the Naporuna, which gained increasing importance for the medical anthropological fieldwork I conducted in this region from 1997 to 1999. The question I will focus on is how an indigenous concept, like the Kichwa-notion samay, shapes the perception of biomedical devices and services by Naporuna patients and their relatives.

In Kichwa-language dictionaries and related ethnographic writings, samay is usually translated as 'breath', 'respiration' or 'rest' (Orr and Wrisley 1965, Mugica 1979, Cordero 1992). Other, more extensive interpretations and my own observations suggest that the notion samay refers, at the same time, to a very broad and complex understanding of such diverse issues (from a 'Western' point of view) like 'soul' or 'soul substance', 'life force', 'personhood', the 'inner will' and something akin to the physical 'resistance' of a person (cf. Palacio 1992, Guzmán 1997, Macdonald 1999, Uzendoski 2000).

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Experiences of Illness and Self

Tamil Refugees in Norway Seeking Medical Advice

This paper focuses on links between medical pluralism, refugee health issues and forms of healing that together are seen through a lens of self and wellbeing as part of a process of embodiment. The study is concerned with individual Tamil persons that experience and embody a dramatic social and cultural change that challenge questions of illness and healing as these are interconnected to constitutions of identity and personhood. The investigation was conducted among Tamil refugees in Norway who make use of and negotiate between various medical approaches to health and well-being. I see Tamils' quest for well-being as broadly defined and embedded in social and religious relations. From this perspective, health and healthcare are not limited to the arena of interaction between doctor and patient, but involve a variety of coping strategies among the 'normal' Tamil population. Also, the perspective of well-being acknowledges the traditional perspectives of medical pluralism (Loudon 1976, Kleinman 1980, Jacobson-Widding and Westerlund 1989, Samson 1999, and others), and opens for less recognized aspects such as social or communitarian practices. Additionally, I seek to avoid the difficulties related to the often-used concepts of disease, illness and disorder (Kleinman 1980, Hahn 1984, and others).

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The War of the Spiders

Constructing Mental Illnesses in the Multicultural Communities of the Highlands of Chiapas

How do contemporary Maya Indians from Chiapas satisfy their medical needs in new, multicultural, heterogeneous, highly stratified and conflicting communities? How do they negotiate between national, and 'modern' medical systems, and local, traditional systems? This chapter proposes to answer these questions using as a case study the experience of Trifena, a Tzotzil woman suffering from schizophrenia and epilepsy. Our case study is multifaceted and emerges as a result of interference of three dimensions: the medical systems in a globalised and pluricultural world, the ethnic and social situation of the living Maya Indian groups in the Highlands of Chiapas and, so-called mental illnesses as they appear and as they are interpreted and treated in the region. The anthropological literature emphasised one or two of the aforementioned aspects, but rarely the three of them at the same time. Some authors try to describe the core of the pluriethnic and globalised medicines (Janzen 1978, Kleinmann 1980, Lupton 1994, Nichter and Nichter 1996), others have written on the specific topics related to indigenous medicine in the Highlands of Chiapas envisaged as a dynamic, syncretic system (Holland 1963, Köhler 1974, 1995, Beltran 1986). Very few tried to analyse the pluricultural indian medicines situating the healing process in the postmodern, pluricultural and globalised context of the Chiapas region (Ayora Díaz 1998, Freyermuth 2000). I will follow those authors while at the same time avoiding their highly macro/etic-oriented inclination.

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Multiple Medical Realities

Reflections from Medical Anthropology

The papers in this volume all convey plurality in medicine. The perspectives differ from one study to another and plurality is exposed and explored at different levels and in different contexts. And yet some patterns seem to cut across all the differences. From the health-seeking behaviour of Tamil refugees in the north of Norway to treatment of mental illness in Ghana and Mexico, and from psychologists in Hungary to homoeopaths in London, a very broad concept of health and healing seems to be of importance. All papers show that sick persons, families and healers interpret symptoms as signs of social and spiritual disturbance. In fact, social and spiritual aspects of sickness and healing seem to be generally acknowledged and acted upon, a feature which questions the hegemonic concept of sickness as a physical problem primarily calling for physical interventions. A pattern connecting people in all the localities studied is that whatever sickness they suffer, the problem is not only understood as a problem of the physical body, but also as one of the self. And strategies to get well likewise concern not only well-being of the body, but also restoration of the self and of relations with others, be they neighbours, spirits, saints, or God.

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