Education in Wellness

& Illness
Unit IV

Culture in Wellness & Illness

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 Medical Anthropology
• Medical anthropology is about how people
in different cultures and social groups
explain the causes of ill health, the type of
treatment they choose, the way they
behave in, and who they turn to if they got
ill.

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 "Anthropology“:
• Is the study of man in Greek.

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 What is culture?
The most famous definition   by Tylor (1871):
"that complex whole which includes the following:

Knowledge And
any other
Art Habits capability
that is
Belief acquired
by men as
Morals Customs
members
Law of society"
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 Thus Culture is a set of values
that guide people in a community

Implicit Explicit
It tells them how to:
• View the world
• Experience it emotionally
• View things in relation to other people
• Relate to the natural environment

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• Implicit: attitudes that are at the unconscious level, are
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involuntarily formed and are typically unknown to us.

• Example:
• You are out with your friends. You vaguely notice some of the
strangers around you but don't meet anyone. You talk with
your friends but feel extremely uncomfortable. Maybe your
friend even notices and asks what's wrong, but you have no
idea. In this scenario, it would be possible that one of the
strangers near you reminds you of someone from your past
that you greatly disliked. Your attitude towards this person is
what is making you feel uncomfortable. However, the attitude
is at the unconscious level, was involuntarily formed, and you
have no idea it's there, so you couldn't tell anyone about it.

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 Someone said

• Explicit: are attitudes that are at the

conscious level, are deliberately formed
and are easy to self-report.
• Example?

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 Culture helps man transmit the following to the next
generation
via

Culture Rituals
is:
"a
Use of
Transmitted Language
symbols Art

Lens across
generations Body language
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According to the American anthropologist,
Edward T. Hall:
There are 3 different levels of culture:
1. “Tertiary”: visible to the outsider/ “public
façade” e.g. traditional dress, national
cuisine.
2. 2o level culture i.e. underlying rules that
are rarely shared with others.
3. Primary level: the deepest level i.e. rules
to be obeyed by all but seldom or even
stated. It is hidden.
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A might have a
within it
There are stratifications:
• Men & women
• Children & adults
• Sick & wells
• Able & disable
• Young & old
• Kin or stranger.

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 Remember
The culture you are born to:
The culture you are born to
is not
your only culture

As you will have other distinct factors that will shape your
own culture. e.g.:

• Individual factors (personality & personal experiences)

• Educational factors (formal & informal)
• Socio-economic factors
• Environmental factors someone said
 So what about
GENERALIZATIONS ???

Generalization can be dangerous

.i.e.
one should differentiate between  the rules
of a culture
which governs how one should behave
and
how actually one behaves.
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 Stereo types
Remember stereo typing can lead
to:

• Cultural misunderstanding
• Prejudices
• Discrimination

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 Cultures are never

Cultures are never static

and they are
Influenced by human groups around them
and they are in a

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 In studying societies & cultural groups including
their health beliefs and practices
anthropologists have used two main approaches

• Ethnographic approach,
study of small groups
2nd stage:
i.e. looking at things comparative approach
from “actor’s i.e. “distills the key
perspective” features of each
society
& culture and
• Anthropologist live in a
community & use compares it with other
"participant observation" cultures to draw
technique. conclusions..
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New Research Method In Medical Anthropology
New research methods have developed recently to aid in data collection
in a relatively short time:

Rapid
assessment
Procedures
Open ended
RAP
questionnaires
Rank ordering

Focus groups Pile sorting

Free listing
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 More Research Methods:
More research methods in qualitative
Research…
 Semantic network analysis
 Family interviews
 Narrative analysis
 Collection of medical folklore
 Analysis of written visual material

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 More Methods in Qualitative
Research

o Videotapes, audiotapes, photocopy.

o Genealogies & genograms.
o Social network analysis
o Projective technique
o Structured vignettes.

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 “Disease” – the doctors perspective

Basic premises.
1. Scientific rationality
2. The emphasis is on objective and numerical
measurement.
3. The emphasis is on physiochemical data.
4. Mind-body dualism.
5. The view of disease is as entity.
6. “Reductionism”
7. The emphasis is on the individual patient
rather than the family.

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 According to Kleiman et al

Modern western doctor’s view of clinical

reality : “Assumes that Biologic concerns
are more basic i.e. “real”, clinically
significant, and are more interesting than
psychosocial & socio-cultural aspects.

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 Modern Medicine:
Modern medicine has come to rely on
diagnostic technology to collect & measure
clinical facts.

This implies a shift from the subjective

(patient’s Sx-the physicians interpretation
of physical signs
to
the major use of objective form of diagnosis
(blood test, MRI, etc …)
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 The medical perspective…
The medical perspective rarely/ does not
include the:

 Psychological
 Social cultural

 The dimensions of ill health

&
 the context which can give the meaning of the
disease for the individual.

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 Illness – The patient perspective

Cassel uses

 to represent what the patient feels when he goes to

the doctor
and

 for what he has on the way from doctor’s office.

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 Illness is the subjective…
Illness is the subjective response of an individual
and those around him to his being unwell …
Particularly
How he & they interpret the origin & significance
of this event.
 It only includes his experience of ill-health,
but also
the MEANING to it.
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 Health
WHO … Definition (1946)

“AState of complete physical,

mental & social wellbeing and not
merely the absence of disease or
“infirmity”.

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 Health among western
communities:

Tends to be less embracing but still includes

physical, psychological & behavioral
aspects. Yet they may vary between social
classes e.g. a common definition among
poorer people is probably based on
economic need to keep working,
however they feel as well as on having low
expectations of medical care.
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On the individual level: if one experiences
some abnormal physical/psychological
symptoms
(according to Apple’s study on middle-
class Americans):
They only considered themselves ill if
their symptoms interfered with their
usual daily activities.
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 Cultural Factors
Cultural factors determine which sx or
signs are perceived of as normal or
abnormal.
They also help shape these factors diffuse
emotional and physical changes into a
pattern that is recognizable to both the
sufferer and those around him, e.g.
Schistosomiasis and its connotations for
boys undergoing puberty in Egypt!!!

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 Children’s perspective of illness
COMAC study and Vander Gest noted 4 themes common to
all European studies:
1. Children’s experiences of illness are expressed by how
they describe the medicines they were prescribed i.e. they
remember a sweet taste if they were pampered and
spoilt & vice versa if they were bored & lonely.
2. Other aspects of care e.g. rest & attention etc were more
important to them than medications … i.e. they
welcome their need for dependence.
3. In illness, MEDICATION, communicates to children
powers that adults have over them… It is forbidden for
children to play with meds e.g. the thermometer as a ritual
symbol object plays an important part in marking
boundary believe health & illness.
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 Appendix of terms with Cultural
Connotations.
 Monochromic time: Time which is linear i.e. clock
time. Monochromic time is a form of external social
organization impressed on people, and is essential
for the smooth functioning of industrial society.
Polychromic time: in contrast, is much
more human time, where the personal relationships
and interactions take precedence over the rigid
schedules & the calendar and the clock. Time is not
experienced as a line, but as a point at which
relationships or events happen.
Polychromic people are more
oriented towards people.
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 More Terms:
Prejudice/ Discriminations/ Stigma.
o The degree of stigma can depend on a
number of factors:
Type of impairment/disability ( e.g.hard of
hearing, blind, has paralysis etc)
The socio-economic position of the person.
Family vis -a -vis the wider society.
Level of technology and social organization of
the society itself.

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 “Cyborg”
“Cyborg”: advanced fusions of human
beings & machines:
e.g.
Kidney dialysis
 Respirator/”iron lung” for those who can’t
breath in their own
Pace maker: to keep heart electricity
balanced & keep the heart pacing.
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 The medical body
The medical body: the essential
reductionism of modern medicine coupled
with advances in diagnostic technology
has led doctors and scientists to a focus
on progressively smaller areas of the
body.. i.e. shift from gross anatomy to
micro-anatomy … interest in cells & genes
etc.

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 “The External Womb”
In Vitro Fertilization (IVF) Or Surrogating
Motherhood, have influenced the view
many women have their own babies &
reproductive functions e.g. Now ovulation
can be placed in one womb and
fertilization & pregnancy can happen in
another.

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 “Symbolic Skins”
Symbolic skins: In every human group the boundaries of
individual’s sense of self are not necessarily the same
as the boundaries of their physical bodies, and their
sense of personal identity extends beyond the borders
of their skin. This is understood as:
1. Intimate Distance (0-18 inches)
2. Personal distance (18-4 feet): maintains a small
protective bubbly around one self.
3. Social distance (4 feet-12 feet): maintained for
impersonal business.
4. Public distance (12 feet -25 feet): no interaction takes
Place.

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 Social Labeling
Social labeling: society decides what
symptoms or behavior patterns are to be
defined as deviant or as that special type
of deviance “mental illness”.
Mental illness does not appear until it is
so labeled, and has no prior existence.

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