Essential of health, culture and diversity

subculture

cultural patterns that set apart some segment of a society's population subculture A culture within a larger culture. Ex: Amish in America, hippies in America, Indian community in US, bikers, Whovians in America, veterans in America

nocebo effect

harm resulting from the mere expectation of harm (e.g., voodoo doll phenomenon) harm resulting from the mere expectation of harm The nocebo effect occurs when belief in an ethnomedical system contributes to an individual's interpretation of some set of biophysical symptoms as a negative health condition...specifically, one that is named or categorized in that ethnomedical system. In other words, if there is a name for an illness, an individual could "organize" their symptoms to fit the named condition, thereby "becoming ill." Remember here the idea of biocultural phenomena. Examples of a nocebo effect? [Think - some drug company advertising...]

How does "health" or "healthy behavior" intersect with these images and what they represent?

health...> a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

There are five main aspects of personal

health: physical, emotional, social, spiritual, and intellectual.

WHAT CULTURE IS NOTT

here are often problems in the way the culture concept is used in public health, so here are a few examples of what culture is NOT: While culture includes language, language is not culture. Using a specific language is not a sufficient way to address culture (though language does have an important relationship to cultural cognition). Culture is not a static list of behavioral or attitudinal traits - e.g., "Hispanics are family oriented," or "Asians are private with respect to personal health issues." Culture of course includes traditions, but it is not traditions alone. Cultures continually change, and specific traditions may change as well, or take on different meanings. Some subgroups may also adhere to specific traditions more than others. People are not "cultural robots." Culture is like a world that people inhabit, but in different ways.We will talk more about this later in the course - when we get to

Moving from ethnomedical systems to healers...

illness(symptoms)....>cause....>approach healer who can address cause....>treatment

Nonmaterial culture

intangible things created and shared between the members of a culture over time are aspects of their nonmaterial culture. Social roles, rules, ethics, and beliefs are just some examples.

Blended or pluralistic system

most common. Most cultures/societies now include some blend of different ethnomedical systems, perhaps with one as the primary or central tendency. Will often see, for example, biomedical and elements of naturalistic systems occurring together. for example,Problem Fatigue and body ache Loss of soul Spirit healer to intervene and retrieve soul Seizures Retaliation by ancestors not properly honored Ritual (supervised by shaman) to placate and honor ancestors Stomach pain and vomiting cause ...> Imbalance of hot and cold foods and behaviors Treatment ...> Restorative herbal teas for balance, counseling to restore behavioral balance

cultural adaptation

new people adapt to the culture of the previously existing people The degree to which a person or community has adapted to the dominant culture and retained its traditional practices.

mores

norms that are widely observed and have great moral significance norms that dictate morally right or wrong behavior. Ex: Don't murder, no incest, in some societies (no homosexuality)

cultural relativism

not judging a culture but trying to understand it on its own terms Cultural relativism is the view that all beliefs, customs, and ethics are relative to the individual within his own social context. In other words, "right" and "wrong" are culture-specific; what is considered moral in one society may be considered immoral in another, and, since no universal standard of morality exists, no one has the right to judge another society's customs.

spiritist system -

some similarities to a personalistic system in that illness causation is often connected to a supernatural or spirit realm. The difference is that the primary causation path is not an intentional act of harm activated via the supernatural world, but simply the interaction of spiritual forces and powers as part of causation and healing.

Give some examples of diseases which were

stigmatised:HistoricallyClassicallyContemporarily HISTORICAL: Tuberculosis, Leprosy, EpilepsyCLASSIC: HIV/AIDS. Mental illnessCONTEMPORARY: Chronic Illness ('welfare to work'), 'Lifestyle' Diseases (obesity), Non organic diseases (eg Chronic fatigue Syndrome), Hep C,

cultural images:

sumo wrestlersfemale ideals of western culturesmoking as a "marker" of ideal prototypesguns, liquor, and ideal male images admired ...>tradition sumo wrestlers EMALE IDEALS/WESTERN CULTURE SMOKING AS A "MARKER" OF IDEAL PROTOTYPES GUNS, LIQOUR, AND IDEALIZED MALE IMAGES

material culture

the art, housing, clothing, sports, dances, foods, and other similar items constructed or created by a group of people Material culture includes all the physical things that people create and attach meaning to. Clothing, food, tools, and architecture are examples of material culture that most people would think of. Natural objects and materials (rock, dirt, trees, etc.) aren't considered to be part of material culture.

HIV/AIDS AND STIGMA

"AIDS has offered a new idiom for old gripes. We have used it to blame others: gay men, drug addicts, inner-city ethnics, Haitians, Africans. And we in the United States have, in turn, been accused of spreading and even creating the virus that causes AIDS." "The way in which a person, a family, or a community responds to AIDS may reveal a great deal about core cultural values First recognized signs of AIDS symptoms in the late 1970s among gay men. In 1981, the CDC began to report consistent symptoms among gay men, a number of whom died. In 1982, CDC linked the disease to blood, coined the term Acquired Immune Deficiency Syndrome or AIDS. Virus discovered: In 1983/1984, the HIV virus was discovered both in France (Pasteur Institute) and by U.S. scientist Robert Gallo. Already several thousand known deaths by this time. First HIV antibody test approved in 1985, beginning of blood product testing. In 1986, Surgeon General Everett Koop published report on AIDS and called for sex education. By this time more than 16,000 deaths had occurred, AIDS a national scare with wide publicity. People who were at risk or even infected were shunned. Borders shut to HIV infected immigrants and travelers. Problems with discrimination and insurance. Ryan White case in late 1980s - young boy infected through blood transfusion banned from school, etc. Becomes AIDS activist, died in 1990. Ryan White Care Act (Congress) named after him. Still a funding vehicle for a range of HIV/AIDS health and support services. First AIDS drug, known as AZT, developed in 1987. Reagan administration makes first major speech on AIDS, after silence on the subject for years. Discrimination against Federal employees with AIDS prohibited in 1988. Famous individuals in U.S. and elsewhere die or are infected by HIV (e.g., then-NBA star Magic Johnson). By early 1990s, more than 10 million infected worldwide. Other anti-retroviral drugs developed and tested in 1990s, funding increases for prevention programs in U.S. and globally. By 1995, annual known deaths in U.S. approached 50,000. With development of antiretrovirals and reverse transcriptase inhibitors, then multi-drug (cocktail) therapies (HAART), death rate begins to drop after 1996. But these treatments had very limited availability in poor countries. By late 1990s worldwide death toll approached 7 million, with 22 million+ infected. Sub-Saharan Africa, Thailand/Southeast Asia among hardest hit. In U.S., new AIDS cases began to shift from gay men to inner city populations - especially women - of color. With new millennium: New developments such as the Global Fund, changes in availability of drugs, etc., as well as catastrophic consequences of AIDS in Sub-Saharan Africa and emerging new areas, including India, Russia, E. Europe, etc. PEPFAR (President's Emergency Plan for AIDS Relief) in 2003. Selected countries - most in Africa, but also China, Russia, Haiti, and others. Since the beginning of the epidemic, 79.3 million people have been infected, and about 36.3 million have died (WHO, at https://www.who.int/data/gho/data/themes/hiv-aids). Roughly 37.7 million people around the world were living with HIV at the end of 2020. More recently, the development and testing of PrEP (pre-exposure prophylactic) approaches has been a focus. Then and now, HIV/AIDS associated with STIGMA, with behavior that "crashes into" moral aspects of cultures around the globe. WHY?

What does ayurvedic mean?

"life knowledge" Where is the birthplace of Ayurvedic medicine? Inidia What are the basic principles of Ayurvedic medicine? 1. 5 elements control the body through 3 doshas (or forces)2. Doshas affect metabolism and in turn the mind and body What are the 5 elements and what do they represent? 1. earth: bones, structure2. water: urine, blood, saliva, etc.3. fire: metabolism4. air: movement5. ether: emotion, thought

Once someone is identified as being ill, and the cause is ascertained, what does a person do about it?

-Answering this question opens the door to a broad panorama of healers and healing practices across cultures. - And because healers perform an essential cultural role in all societies, we must also consider healers in terms of the social institutions of healing.

HIV/AIDS, BLAME AND MORAL FAILURE IT HAS BEEN EASY to blame HIV/AIDS on MORAL FAILURE OF INDIVIDUALS:

. Prostitution and its meanings (a complex and loaded term). IV drug use. Motherhood and transmission to children . YET, social circumstances and poverty in the developing world create conditions of RISK (e.g., poor women sacrificing for families, rural-urban movement, migratory workforces, trucking and transportation). QUESTION: Is there no moral failure here?

What law protects people from stigma

2010 equality acthas been brought in to ensure that not only is discrimination made unlawful but also its aim is to promote equality of opportunity and to foster good relations. The Equalities Act does not require Public Bodies to remove or ignore the differences between people. The differences between people make up a heterogeneous society.

Naturalistic ethnomedical system

: Disease is explained by the impersonal actions of systems - usually (according to Foster) based on old historical systems of great civilizations - so, yin and yang balance, hot/cold systems, etc. CURE? Restore balance, or system equilibrium.

AKAN-SPEAKING BONO HEALERS (GHANA)

A Minokua ceremony involves possession by a priest during which the deities accessed under possession inform the priest about the cause of the illness and which plants/herbs to use as a remedy. A second kind of ceremony is a "witch catching" performed by an obosombrafoo who identifies the individual(s) who have performed witchcraft, causing someone to become ill. Both are based on a concept of sunsun, the spiritual side of human nature, and on the co-existence of a liminal or spirit world which plays a role in daily affairs

antisocial personality disorder

A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist. Antisocial personality disorder is a chronic mental health condition, informally known as sociopathy, characterized by a disregard the feelings and rights of others. اضطراب الشخصية المعادية للمجتمع هو حالة صحية عقلية مزمنة ، تُعرف بشكل غير رسمي بالاعتلال الاجتماعي ، وتتميز بتجاهل مشاعر الآخرين وحقوقهم.

Healthy People 2023

A program that provides a prevention framework for the nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. It provides science-based, ten-year national objectives for improving the health of all Americans, managed by the U.S. Department of Health and Human Services. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:o Encourage collaborations across sectors,o Guide individuals toward making informed health decisions, and

Thomas: Witchcraft and HIV/AIDS

AIDS victims in Caprivi region of Namibia shift stigma off themselves through witchcraft accusations (often related to jealousies, rivalries). In turn, social systems and family relations disrupted.

culture-reactive syndrome

Abstract. Culture-bound syndrome is a broad rubric that encompasses certain behavioral, affective and cognitive manifestations seen in specific cultures. These manifestations are deviant from the usual behavior of the individuals of that culture and are a reason for distress/discomfort. Culture-bound symptoms have been documented in many different cultures within the US and around the world. They are commonly known as cultural manifestations of distress that tend to be more emic than etic. Two of the most-researched culture-bound syndromes include ataque de nervios and neurasthenia.

HEALERS AND RITUALS

Across cultures, healing is practiced in an organized, ritualized form - healing ceremonies, divination, appointments, and so on. All healing involves some ritual and theater (e.g., uniforms such as white coats, chanting, smells, the presence of other community members, the use of implements and healing tools). Think of healing as a collective act...true whether a Western biomedical orientation or not. [Ask yourself: If you step outside your "cultural box," is biomedical healing just pure technology and pure science?]

Farmer and Kleinman

Farmer & Kleinman: Stigma at multiple levels - the disease, the poverty that increases vulnerability. Cases of Robert and Anita.

What is felt or self stigma?

Felt or Self Stigma: describes feelings such as shame that interfere with a person asking for help. It describes the fear or shame that an individual or group may have that they, and their condition, will be negatively viewed. It occurs when people internalise enacted stigma ie when believe the enacted stigma focused on them. An example might be someone visiting a GUM clinic for the first time.

HEALING AND "TRUTH" How do you know when a form of healing works?

For biomedicine, relatively clear-cut - either the pathogen was eliminated or it wasn't. Either the bone was healed or it wasn't. In many cases, also clear-cut for non-biomedical healing. BUT what about, for example, "psychic surgery"? Is it "true"? Does it work? In the context of a collective belief system, however, it may in fact "work" in supporting or producing a psychological state in which a cure is anticipated.

Examples of the placebo effect in a biomedical system?

The placebo effect has been measured in thousands of medical experiments. Placebos can affect a range of health conditions. The color of a pill or tablet can alter the strength of its effect, and larger pills produce a stronger effect than smaller pills. Various factors may be responsible - expectation and conditioning, neural responses triggered by expectations (e.g., dopamine receptor activity, other brain site activity), psychoneuroimmunology (effect of brain activity on immune system), evolved health system regulation.

ethnomedical system

alternative medical systems based on practices of local sociocultural groups It is generally accepted that the term "biomedicine" refers to the historically Western, scientific, hospital-based, technology-oriented system. Traditional healers who use indigenous drugs and/or ritual to treat patients are said to practice ethnomedicine.

biocultural

an approach that focuses on the interaction of biology and culture combining biological and cultural approaches to a given problem

HIV/AIDS AND STIGMA: Quoting Farmer and Kleinman...

All illnesses are metaphors. They absorb and radiate the personalities and social conditions of those who experience symptoms and treatments. Only a few illnesses, however, carry such cultural salience they become icons of the times. Like tuberculosis in fin de siecle Europe, like cancer in the first half of the American century, and like leprosy from Leviticus to the present, AIDS speaks of the menace and losses of the times. It marks the sick person, encasing the afflicted in an exoskeleton of peculiarly powerful meanings: the terror of a lingering and untimely death, the panic of contagion, the guilt of 'self-earned' illness.

LEPROSY: CLASSIC CASE OF STIGMA

BASIC FACTS about Leprosy (Hansen's disease)... Chronic, communicable disease affecting skin, eyes, internal organs, peripheral nerves, mucous membranes. Appears to be caused by a bacteria, Mycobacterium leprae, though the relationship still not clear. Is MILDLY communicable - long term contact necessary (10-15 years), and there is a long incubation period. Treated with sulfone drugs - typically multi-drug combinations - which can arrest the disease. It is now considered curable. There are also preventive drugs that reduce the likelihood of infection. At the end of 2018 there were just 184,212 cases globally, down from 5.2 million in the 1980s. India, Brazil, and Indonesia currently have the largest caseloads. Most individuals with the disease don't have the serious and disfiguring symptoms - they have much earlier stages of disease GIVEN THESE FACTS, ON ITS FACE IT IS LIKE MANY OTHER DISEASES. But over a long history it became a terribly stigmatized disease...so much so that the generic term "leper" now refers to people who are shunned for many reasons. Why an how did leprosy become more than just a disease, but a legendary, stigmatized condition? VARIATIONS IN LEPROSY STIGMA (1 of 4) While leprosy has been a classic case of stigma for a thousand years, leprosy is actually NOT UNIVERSALLY STIGMATIZED (see Waxler 1998/1981*) . This can be seen by examining the experience of leprosy across cultures - where the nature of the disease is a CONSTANT, but the social response is NOT. Waxler compares leprosy in India, Sri Lanka, and Nigeria, and the development of the stigma in Hawaii. INDIA: Lepers in the city who are from rural areas never return home due to stigma, become beggars. Cut out of inheritances, doctors refuse to treat them, cannot get insurance, sometimes forcibly divorced. This treatment even supported by law. SRI LANKA: So close to India, yet the experience is different. While leprosy feared, victims do not lose jobs and families. Yet STIGMA still exists - lepers often learn to withdraw from extensive social contact, etc. This portrayal supported by other data: In 1939, the Motor Vehicles Act in India forbade the granting of driver's licenses to leprosy victims, and until recently, the Indian Christian, Muslim, and Hindu marriage acts included leprosy as grounds for divorce (Bennett et al. 2008; Brown 2006). In Nepal, and elsewhere in South Asia, victims often are divorced by their spouses, lose connection to their families, lose their jobs, and may be denied access to education. The impact is worse for women, whose role in their family may suffer (Rafferty 2005) NIGERIA: Leprosy prevalent among the Northern Hausa (Muslim). Causes said to include "gluttony, swearing falsely by the Koran, or washing in the water a leprosy patient has used." Various treatments. BUT it is viewed as just ONE DISEASE AMONG OTHERS, NOT particularly stigmatized. HAWAII: Severe reaction/quarantining of people with leprosy coincided with rapid increase in Chinese immigration (to work on the plantations there). Racism, possible economic animosity against Chinese likely factors. Scapegoating using leprosy "LEPER COLONIES": Organizations that historically treated lepers perpetuated stigma by removing the lepers from "normal" society and treating them at removed facilities. The idea of "pollution." Shows up in HIV/AIDS stigma as well. EXAMPLES from film: "The Motorcycle Diaries," "Papillon." In Aceh, Indonesia, a survey showed the prevalence of beliefs that leprosy could be caused by the curse of an angry father, wrath of God for committed sins, breaking of food and other taboos, body fluids, and heredity. In Sierra Leone, research has indicated that the Limba people from the south and west believe that leprosy is caused by witchcraft, while the Limbas from the north believe that people infected with leprosy were witches (so - sympathy for victims in the first place, retribution in the other).

Culture

Beliefs, customs, and traditions of a specific group of people.

Culture

Beliefs, customs, and traditions of a specific group of people. the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups

STIGMA CASES: EXAMPLES FROM READINGS

Ebola in Northern Uganda 2000-2001 (Hewlett & Amola): Concentrated near Gulu town, Acholi people. Pluralistic ethnomedical system (including biomedicine). Also spiritist system in which jok are spirits that interact with human life. Illnesses can be caused by poisons from jok. Rapid, severe illnesses can be caused by gemo (malevolent jok, who come on wind, retribution for insufficient respect for gods). Quarantining of gemo victims, like biomed procedures. Some people avoid treatment in order not to be quarantined away from family. Blame on DRC military as well.

Khmer CAMBODIAN/KHMER SYSTEMS

CAMBODIAN/KHMER SYSTEMS - ETIOLOGY Influence from Chinese medicine. Causes of disease include: Supernatural influences/spirits - in the sense of a personalistic system. Sorcery. Influence of "wind" or kchall in causing disease. Hot/cold imbalance - where hot and cold don't refer to temperatures, but to bodily states . Illness also attributed to general imbalance of natural forces within the body. CAMBODIAN/KHMER SYSTEMS - RESPONSE Treaters are called kruu Khmer, and treatments may include: Koo' kchall - for fever, URI, and other conditions, involves dipping a coin in a mentholated medicine and rubbing it away from the center of the body. Jup kchall - for headache and malaise, involves pinching/bruising the bridge of the nose, or placing a small candle on the forehead and "cupping" it to create a vacuum . Oyt pleung - for gastrointestinal disorders, involves a scarring procedure. There are spirit mediums and diviners to address sorcery. Massage, medicinal plants, spiritual healing also used.

COLLABORATIVE EFFORTS

COLLABORATIVE EFFORTS National Center for Complementary and Integrative Health at NIH - testing alternative therapies for biomedical impacts. Traditional healers and biomedical healers - collaborating to reduce HIV/AIDS in Africa. In Thailand, the state-sanctioned combination of nursing degree and Thai traditional medicine (TTM) . Use of Candomblé together with counseling in Brazil. Hmong shamans now in California hospitals where there are large Hmong populations. Accupuncture and drug treatment in U.S.

IS CULTURE A REFLECTION OF THE ENVIRONMENT ?

Can we say that a cultural pattern is a biological adaptation? Yes and no... A given cultural pattern is likely to have originated as a way of life in a particular environment - as a mechanism for group survival, communication, identity, and common reference points. Over time, the cultural pattern becomes a "thing in itself" that may or may not align with specific environmental characteristics, and may reflect elements of the social environment that developed over time (e.g., structural hierarchies, etc.) .In a globalized world, that culture-environment connection can become even more diffuse.

EXAMPLE: HEALERS IN BRAZIL

Candomblé is practiced in Brazil - especially the Bahia region. Heavily influenced by Yoruba traditions from Nigeria, in which people have personal spirits called orixas, who are intermediaries between them and the universe creator, Olorun (or Oldumare). There is also a spiritual force called axe. Candomblé believers increase their axe by daily devotional rites as well as possession ceremonies. In these ceremonies, drummers play rhythms linked to individual orixas, also linked with specific dance steps, and induce possession. Healing rituals are conducted by priests, priestesses, and other healers, and healing occurs as part of collective rituals that spiritually empower both the person who is ill and others in the Candomblé community to help find solutions, as well as through the use of sacred herbs and plants.

EXAMPLE: HEALERS IN MEXICO, CENTRAL, LATIN AMERICA

Common traditional healer called a curandero/a. Both spiritual healer and herbal healer, can have various specialties depending upon their don or gift from God. Examples: yerberos/as specializing in a deep knowledge of herbs, sobadoros/as who perform massage, espiritualistos/as serve as psychic mediums, and parteras who focus on midwifery. Shared belief that there are natural ailments for which various natural remedies are appropriate, and supernatural ailments that require intervention in the supernatural, or spirit realm. Cures: Prayers, amulets, and spiritual rituals, as well as herbs, counseling and lifestyle recommendations. Idea of restoring hotcold balance. Healing ceremonies often done in a family or collective setting. At the highest level of practice, some curanderos are said to use mental powers to harness energy towards the resolution of problems and illnesses

What is cultural stereotyping?

Cultural Stereotyping: Gender, Race, age and SE status also stigmatize patients in the health care system, in as much as prejudice exists resulting in health care disparity and poor health outcomes in the stigmatized group. It is the result of collective attitudes that groups hold towards a stigmatizing condition.

cultural relativist perspective

Cultural relativism is the idea that a person's beliefs and practices should be understood based on that person's own culture. Proponents of cultural relativism also tend to argue that the norms and values of one culture should not be evaluated using the norms and values of another.

Culture

Culture plays a key role in human behavior, emotion, and thought. Any ongoing human group has, to some extent, a "culture" - which is the reference point for individual self-understanding vis a vis the group, including how to act, how to interpret others' actions, and the meaning behind what happens as part of that group. Culture becomes "naturalized," tacit knowledge, underpinning much of behavior. CLASSIC DEFINITION (from E.B. Tylor back in 1871): "Culture...is that complex whole that includes knowledge, belief, art, morals, law, customs, and any other capabilities and habits acquired by man as a member of society." Definitions typically include the following elements: Culture refers to a kind of CONNECTED, or INTEGRATED PATTERN among a society or group, that integrates many aspects of life - including health . Culture encompasses the relationships among social CONTEXT, what people KNOW and BELIEVE, and what people DO . Cultural patterns are LEARNED - you are not born with cultural patterns, but learn them during the course of life in society. Cultural knowledge/patterns are (to one degree or another) SHARED and DISSEMINATED, over time, across generations. They are "public phenomena."

identify and define the components of an ethnomedical system

Ethnomedicine, in its wider definition, refers to the traditional medical approaches involved with the social and cultural impacts of health, illness, and disease that take into account the practice of healthcare and treatment techniques. Midwives, doulas, medicinal herbs, bonesetters, surgeon, and shamans are a few examples of ethnomedical physicians whose practices were practiced in cultural traditions all over the world until biomedicine. A cultural system grounded in Western science, biomedicine is an ethnomedical field that has been deeply affected by the histories of Europe and North America. It heavily cites biochemistry and biology. With scientifically supported treatments, biomedicine addresses illnesses and wounds. Biomedical healthcare professionals rely their evaluation of a treatment's validity on the findings of clinical trials that were carried out in accordance with the scientific method's guiding principles. Ethics-based systems a classification system based on a cultural understanding of what makes being healthy or not "an applied cultural knowledge system relating to health" - "an interconnected system of thought and action that spells out the kinds of health issues that may occur, their causes, and (according on their cause) effective treatments" The types of illnesses that can exist and their names are defined by a working knowledge of health and therapy that is shared by a certain cultural group. Define the causes of the sickness (biological infections, spirits, system imbalances, social injustices, etc.), and establish a link between the causes of the illness and the sorts of illnesses by classifying them according to a typology. Depending on the recognized causes, specify the recommended therapies for diseases. types of healers in relation to chinese medicine - tao, buddhism, yin/yang, qi -illness is the result of an imbalance in or blockage of the normal flow of the life force

THE "SICK ROLE"

Expectations people who are ill have about what they should do and how others should treat them. BUT if there is STIGMA or ambiguity in the CULTURAL VALUES attached to that illness, treatment from others will be affected. So, sick roles also include expectations of other (NOT SICK) people about how the "ill" person should behave and what they (the not sick) should do. Anthropologists often view these roles and sociocultural domains as SCRIPTED

HIV/AIDS INTERSECTS WITH VERY BASIC CULTURAL

HIV/AIDS INTERSECTS WITH VERY BASIC CULTURAL TERRITORY: Gender relations (power). Gender roles (male vs female, number of partners expected, etc.). Sexuality and gender, and definitions of appropriate/inappropriate sexuality and gender . Social stratification - hierarchies of wealth, power and resources. Family honor, shame.

SOCIAL INSTITUTIONS OF HEALING

Healers are selected individuals...special category of individuals. People turn to one or more types of healers who are recognized as such and who operate within the ethnomedical system or systems prevalent in that society. Healers are therefore embedded in a cultural process and at least some institutionalized practice or system so that individuals who are ill can make a decision about their treatment.

LEGITIMIZING HEALERS How do you know the healer you go to is legitimate, and knows what he/she should know?

If you go to a general practitioner (MD), what can you expect him/her to have done in terms of training? If you go to a shaman, what can you expect him/her to have done in terms of training? For either: What evidence would you expect to see/hear about their qualifications?

Indigenous contagion theory

Illness is caused by impersonal exposure3 beliefs:Naturalistic infection ("folk germ theory")invasion of victim's body by microorganismsreference to germ theoryagents of infection often described as worms or tiny insectsMystical contagionpollutionAfricans in unclean/impure state kept apart from othersChildren's diarrhea and dehydration caused through exposure to polluting substanceEnvironmental dangers

HOPI INDIAN HEALERS

Important healer among the Hopi Indian people of the Southwestern U.S. is the Tuuhikya. Usually an elder. These healers work within the partially naturalistic system of the Hopi Way, in which emotional as well as physical balance and harmony produces health. Distinction made between natural and unnatural causes for illness. Unnatural may include negative emotions/social actions, or even witchcraft (when the problem doesn't respond to other treatment). Diagnosis is an extended ritual activity. Healing may involve prayer, herbal preparations, rituals involving feathers, smoke, crystals, etc., as well as practical tools such as splints and bandages and specific behaviors required of the patient. There are also kachinas - spirits of the deceased who return to intervene on behalf of humans, and who are bearers of the lifeforce

Session 4: The Moral Dimension - Culture and the Meaning of Illness (Culture-Health Lens #2) Ethnomedical system

In addition to setting out a framework for illness categories, causality, and treatment, culture is also involved in the assignment of VALUES to the disease/illness categories. The ETHNOMEDICAL SYSTEM intersects with other key cultural domains - the MORAL domain, cultural constructs of the individual, assigning responsibility for personal health. Ethnomedical system also intersects with the various SOCIAL DIVISIONS that exist, including gender, social class/systems of social stratification and race, etc. These may have a moral dimension CULTURE can be said to help define NORMAL vs. ABNORMAL, GOOD vs. BAD, etc. Those divisions typically accepted as NATURAL - they exist below the conscious level. WHEN a phenomena is classed as ABNORMAL, it may also be classified as ABNORMAL BUT MORALLY OK ("not your fault") or ABNORMAL BUT NOT MORALLY OK ("your fault or somebody's fault") For the LATTER category, STIGMA is the result.

Ayurvedic system

India's ancient and traditional natural system of medicine that provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies NATURALISTIC EXAMPLE Originates from India - multiple traditions including the Vedic texts (i.e., the Vedas, dating from the 2nd millennium BCE). Holistic (integrated) system. Each person has a particular combination of physical, mental and emotional characteristics, which together form a person's constitution or energy pattern. Diagnosis within Ayurvedic medicine involves finding out the imbalance(s) leading to disease. In the Ayurvedic system, the body is comprised of three forces, called doshas: Vita, Pitta, and Kapha are the doshas - these represent characteristics of the five elements of space, air, fire, water, earth. Each dosha is connected to particular bodily activities and processes. An imbalance in the dosha causes disease. Once an imbalance is located, treatment aims to restore balance. Medicinal plants are an important part of treatment - some 1,400 plants are used in Ayurvedic medicine.

cognitive dissonance

Inner tension that a consumer experiences after recognizing an inconsistency between behavior and values or opinions the condition of being inconsistent in one's thoughts, views, or attitudes, particularly as they relate to actions taken and attitudes changed.

HIV/AIDS AND STIGMA: WHY? (

It is UNSEEN and at times DORMANT...so it cannot always be identified. May resonate with ethnomedical systems that include other-worldly forces as causal. IT TOUCHES ON POLITICAL ISSUES: Discovered and first gained prominence in developed countries (the "West"), yet origins tied to Africa, so it was associated with the "OTHER. AIDS treatments also discovered in the West, were/are expensive, and under the control of Western corporations. Though most serious HIV/AIDS consequences have occurred in Africa, treatments controlled by the West, so issues of POST-COLONIAL POLITICS came into play (EXAMPLE: previous resistance by President Thabo Mbeki in South Africa, in late 1990s/mid 2000s to conclusion that HIV causes AIDS) - and related issues of morality. HIV/AIDS STRUCK many disempowered communities, some of whom have viewed it as a general part of the conspiracy of dominance

Is stigma variable?

It is important to understand that stigma is socially and historically variable and what is discouraged or perceived negatively may be affected by when or where you live. For example having a large body size is celebrated in some countries because it implies wealth; rather than greed and laziness as it has come to be perceived in UK and North America. Smoking used to be accepted and encouraged. At different times, different attributes and behaviours may be discrediting

personalistic systems

It is thought that a supernatural person, such as a god or goddess, as well as nonhuman entities like ghosts, ancestors, or malevolent spirits, as well as human beings like witches and sorcerers, are responsible for the illness. A personalistic medical system is one in which illness is attributed to the direct, purposeful action of an agent, who could be human (a witch or sorcerer), nonhuman (a ghost, an ancestor, an evil spirit), or Extraterrestrial (a deity or other very powerful being)

LATIN AMERICAN-CARIBBEAN SYSTEMS - ETIOLOGY

LATIN AMERICAN-CARIBBEAN SYSTEMS - ETIOLOGY Espiritismo (Cuba, Puerto Rico): Health effects related to belief in a supreme being and a world of spirits that can intervene in human life. Spirits can accessed by a healer, who gains participation of spirits in healing. Syncretic blend of Catholicism, American spiritualism (19th century), African systems. Santería (Cuba, Puerto Rico): Syncretic blend of Catholic and Yoruba (Nigerian) traditions. Belief in a world of orishas or spirits - divination/trance accesses appropriate orisha who then prescribes cure. Also belief in a basic energy force called ache. Related to candomble in Brazil (in terms of origins). Curanderismo (Central and Latin America): A multiplex system of causation that includes spiritual, mental, physical, emotional dimensions. Curanderos/as are trained to be instruments of a higher power/energy, used for healing. Herbs also prescribed, to restore balance.

SHAMANS/SHAMANIC HEALING a shaman.

Major cross-cultural category of non-biomedical healer is known as a shaman. Has become almost a generic term for a broad range of spirit/herb healers, both men and women, and the term has arguably been misused in recent years in connection with a range of Western contemporary practices (e.g., "new age"). A shaman is seen as a mediator between the human world and the world of spirits, between the living and the dead, and between animals and human society. Shamans fill many societal and religious roles - soothsayer, therapist, and interpreter of dreams. Also play "offensive" and "defensive" role in protecting against aggressive actions of other shamans or spirits. KEY: Shamans are "crossers of boundaries" within the category systems of cultures. Shamans often engage in altered states of consciousness (ASC) and collective healing rituals that draw from and stimulate bio-psychological (neurological, emotional, consciousness-related) processes that can promote healing. In recent years, research has investigated what actually happens during shamanic healing activities (neurologically and otherwise). Some of this research has focused on stimulation of serotonin (a neurotransmitter) and internally produced opioids in the brain, as well as on stimulation of the autonomic nervous system (ANS) and other kinds of activity. AT THE SAME TIME...Success for shamanic healers depends in part on the degree to which the healing practices are supported by community belief and, in many cases, participation. Music that involves chants and repeated rhythms, drumming. [Q: What does this do?] Manipulation/use of symbolic objects - e.g., crosses, figurines, staffs, feathers, and altars with symbols . Shaman (and possibly participants) go into a trance (ASC) state, where shaman is understood to be free of daily, earthbound experience, and can travel in the world of the supernatural. Hallucinogenic substances (e.g., peyote, the San Pedro cactus in Latin America, iboga in Gabon and Zaire) may be involved Ritual sequence, invoking spiritual power, closing off with solutions/conclusions about the illness, its causes, and how to proceed. May be followed by the prescription of a curative regimen and herbs. Michael Brown (1989), in "Dark Side of the Shaman" illustrates the precarious role of Yankush, a shaman among the Aguarana of Peru. In the Aguarana personalistic system, both shamans and sorcerers get their power from the same supernatural realm - one for good, one for "evil." If a healing done by Yankush (against a sorcery-related illness) does not work, he may be accused of aiding the sorcery. To help "insure" success, Yankush sometimes prescribed antibiotics, etc. NOTE: Yankush was murdered ten years after the article, in a village vendetta

ethnomedical systems

Medical systems based on the cultural beliefs and practices of particular ethic groups. The nature of the ethnomedical system is connected to the social system of treatment providers, because it provides a key underlying rationale for who those treatment providers are An ethnomedical system has a number of ramifications for other dimensions of the culture-health interaction (we will explore these later in the course). One typology of non-Western systems, from anthropologist George Foster (1976): Personalistic ethnomedical system: Disease is due to the "active, purposeful intervention of an agent," as in a sorcerer, spirit, etc. So, sick person is an object of action. The CURE? Countervailing action. Naturalistic ethnomedical system: Disease is explained by the impersonal actions of systems - usually (according to Foster) based on old historical systems of great civilizations - so, yin and yang balance, hot/cold systems, etc. CURE? Restore balance, or system equilibrium. These include: The way in which illnesses are categorized (in terms of cause) may intersect with moral issues and lead to stigma for certain illnesses. That, in turn, may affect behavioral norms/scripts for people who have those illnesses and those around them.

What is the difference between using the terms illness vs disease?

One important tool for linking culture and health is by mapping out ETHNOMEDICAL SYSTEMS - cultural systems of health knowledge and practice that: Define the kinds of illnesses that can exist, and what these illnesses are called. Define the factors that cause the illnesses (biological pathogens, spirits, system imbalances, social violations, etc.), and links causal factors to the types of illnesses - categorizing them in a typology. Define the treatments that are appropriate for illnesses, based on the identified causes. Link types of healers to the treatments.

WHAT IS CULTURE

Other definitions of culture draw from particular perspectives within anthropology. For example: Culture as a "web" of symbol and meaning, almost like a text (symbolic definition) . Culture as a (dominant) ideology, supported by political-economic structures and associated rules, discourse (ideological or power-based definition) . Culture as a shared system of knowledge, belief, and practice that evolves in relation to a particular economic pattern and/or adaptation to a physical environment (cultural materialist definition). Culture as a shared interpretive or information processing system (cognitive definition). Linguistic aspects of culture/the organizing of thought via language fall in this category. [Just saw a reference to a book on culture as a "system of distributed cognition"? (D. Kronenfeld). This perspective was also integral to the movie "Arrival."] All these perspectives will appear in our survey of different tools for looking at the culture-health interaction. LL PEOPLE, AND ALL PEOPLES, ARE CULTURAL

NON-BIOMEDICAL HEALERS IN THE WEST

Pennsylvania Dutch Pow-Wowers - among Pennsylvania Dutch groups in the U.S., a folk-healing tradition. Origins in pagan practices of the Druids in Europe, with the use of magic, mysticism, and spiritualism from ancient Wicca (white magic) practices of tribal Germany (e.g., Saxons, Visigoths). Herbal remedies and potions part of the rural German tradition as well, and some practices came from interaction with American Indian peoples. These Pennsylvania Dutch healers have a cooperative attitude with respect to biomedical practitioners Pow-wowers are formally trained - before training begins, they choose whether to practice as Christian faith-healers or pagan/Wicca practitioners. However, the power to be a healer runs in families, and is "handed down" in a ceremony called the "passing of power." Chiropractors - chiropractic is a manipulative therapy, recognized and licensed in the U.S., but with a different history than biomedicine. Chiropractic shares roots with other similar techniques practiced in Indonesia, Hawaii, Japan, China, India, Central Asia, Mexico, Nepal, Russia, and Norway. In the U.S., origins of modern chiropractic linked to a magnetic healer named D.D. Palmer in the late 19th century, who said that most diseases were caused by displaced vertebrae, or by "luxations" (dislocations, misalignments) of other joints. Central idea: Bodily functions controlled by flow of nerve vibrations from the brain to the spinal cord and then through openings in the vertebrae. When one or more vertebrae move out of position they are said to create pressure on, irritate, or disrupt the function of spinal nerves ("subluxation"), which then malfunction and create health problems. Chiropractors view themselves as holistic health practitioners. Trained in and use a range of spinal manipulation techniques, and sometimes use a hand-held, spring-loaded metal device called an Activator - the latter is intended to tap vertebrae into alignment. Also use x-ray diagnostics.

"PSYCHIC SURGERY"

Practiced in the Philippines, Brazil, parts of the Caribbean, and elsewhere. Psychic surgery involves an apparent cut or incision made to a patient, the insertion of the psychic surgeon's hands inside the ill person, and the "removal" of diseased or polluting tissue, sometimes accompanied by what appears to be blood. Like other types of healing, psychic surgery involves a ritualized performance in a collective setting

Protocols for training healers

Protocols for training healers - anything from apprenticeships to formal training. A system of compensation through which the production of health is rewarded - whether this is in "cosmic credits," barter, private payment, or managed care. In some societies, a social hierarchy of healers, where some types of healers have more status, prestige, or power than others. In some societies, organized groups of healers - for example, medical associations or healer's guilds. [Examples: U.S., Ghana, Thailand]

SELECTED SOUTH AFRICAN SYSTEMS - ETIOLOGY

SELECTED SOUTH AFRICAN SYSTEMS - ETIOLOGY Among the Shona (Zimbabwe, southern Mozambique), a key part of the body system is a nyoka or snake, acting as a kind of bodily guardian. The nyoka reacts badly to impurities or pollution of the body (e.g., a nyoka may "contract" and cause cramps if bad food or medicine enters the body). Movement of the nyoka related to many diseases: diarrhea, stomach ailments, STIs, epilepsy, mental retardation, and others. The nyoka may serve as a symbol or metaphor representing the need for balance. [If so, what kind of system is it?

STATEMENT: THE BIOMEDICAL SYSTEM

STATEMENT: THE BIOMEDICAL SYSTEM (WESTERN MEDICINE) IS ALSO AN ETHNOMEDICAL SYSTEM. What do you think? Hint: Do we have a system of causation? What is it? Hint: The role of "pills" (placebo effect). Hint: The social role of doctors, and the "uniform" (white coats). Hint: Many health conditions that could be viewed as having a social component are framed as biomedical conditions - DSM V example (e.g., "AntiSocial Personality Disorder example, Problem ...> Flu Cause...>Virus Treatment...>Medication to control fever, anti-viral treatments, rest" Problem ..> Meningitis Cause...>Bacteria Treatment...> Anti-bacterial medication (antibiotic) to attack invading pathogens Problem ...>Sickle-cell anemia cause...> Genetic Genetic Treatment...> testing to assess risk, medication to control disease side effects

Elements of every culture

Symbols (Ex: American flag)language (Spoken language such as French, but also body language, slang, and common phrases that are unique to certain groups of people) values (defined standards for what is good or desirable) (Ex: Competition is good in US culture) Norms (defined expectations of behavior) (Ex: we know that we should stand in line to use the restroom and no cutting, boys wearing pants instead of skirts)

TAKING CULTURE FOR GRANTED EXAMPLES EXAMPLE: CLASSROOM AS CULTURAL CONCEPT.

TAKING CULTURE FOR GRANTED: EXAMPLES EXAMPLE: CLASSROOM AS CULTURAL CONCEPT. We are now in what we call a classroom. If I talk to you about "being in the classroom," you know what I mean. YET, there is nothing that objectively, outside of our social or cultural knowledge of it, that says this physical space, and this social activity, are necessarily a "classroom." As a shared cultural concept - you learn what classrooms look like, what kinds of people are usually in them, what appropriate behavior is in a classroom, what the purpose is relative to the general set of life-paths that are part of your culture, what values are associated with being in a classroom, and so on. You don't think about it. You just "know." [OTHER EXAMPLES OF CONVERSATIONAL TRANSCRIPTS, EDIBLE/NON-EDIBLE FOODS (the idea of biocultural phenomena)]

THE PLACEBO PHENOMENON - CULTURAL BELIEF AS CURATIVE

THE PLACEBO PHENOMENON - CULTURAL BELIEF AS CURATIVE There are two phenomena that are related to the effects of shared ethnomedical systems - the placebo and nocebo effects. The placebo effect occurs when belief in an ethnomedical system contributes to the curative effect of treatment. In other words, if individuals believe that their ethnomedical system - causal diagnosis and prescribed treatment - is valid or "true," that belief in itself may contribute to biological healing.

Two case examples of ethnomedical systems

The Garhwali ethnomedical system - People of Northern India, agricultural, syncretic mix of Hinduism and indigenous animism. Pluralistic ethnomedical system. African-American rootwork system - African-based pluralistic ethnomedical system from the American South.

social determinants of health

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels

Remember the different ways to think about culture - symbolic, ideological, materialist, cognitive/linguistic?

The first cultural lens we will use comes largely from a cognitive perspective, the idea of culture as an interpretive system, a "map" for thinking about, understanding, interpreting and acting in a social world. Begins with our labeling of health problems as "states of not being well (however 'well' is defined)." Relates to the difference between thinking of such problems as diseases or illnesses

SOCIAL INSTITUTIONS OF HEALING INCLUDE... (

The typology of healers in society (e.g., curanderos, shamans, midwives, doctors, physical therapists, diviners, or psychologists). The division of labor for these healers - e.g., if some are "generalists" and others "specialists." The physical sites of healing, whether hospitals, doctor's offices, sweatlodges, or sacred spaces. Rules/practices for regulating healers - who can be a healer, what are the boundaries of their practice.

Ecological Model Explained

There are five stages to this model - Individual, Interpersonal, Organizational, Community, and Public Policy.

culture and stigma

This exists in every society. Roots of stigmatization are complex and embedded in individual cultures. A major barrier that discourages people from getting help. Imperative to tackle stigma first in order to reduce public-health burden of mental illness. "OTHERING" also impacts on SOCIAL STRUCTURE (creating approved vs marginalized groups and associated life patterns/conditions). THIS IN TURN creates conditions that impact on the trajectory of a disease - the path it takes in a particular society or cultural group. Fear of the alien: Existential fear that the alien somehow poses a danger to the equilibrium of society (whether the alien is a communist, an HIV-infected person whose alleged "behavior" is the threat, an infidel, or other). Examples from popular media? STIGMA is thus in part a reaction to suppress or deny the OTHER, the people who symbolize a threat or challenge to the social whole. : One way in which cultural processes operate is to construct definitions of THE OTHER - the flip side of asserting a cultural or group identity. Binary oppositions of the "other" - our TRIBE/not in our TRIBE, our NATION/not in our NATION, from our NEIGHBORHOOD/not from our neighborhood, WITH US or AGAINST US, DECENT FOLK/not DECENT FOLK, FRIENDS and ENEMIES, and of course CITIZENS and ALIENS.

naturalistic systems

Views sickness as the result of external natural forces such as cold, heat, winds, or an imbalance in the fundamental constituents of the body. Personalistic ethno-etiology: Thinks that illness is caused by the deeds of humans or other supernatural creatures When the humors, the yin and yang, or the Ayurvedic dosha are in the balance appropriate to the individual's age and condition, in his natural and social surroundings, health results. This is how naturalistic systems view health.

Ebola stigma (Obilade):

Virulence, rapidity, and lack of cures fueled West African Ebola stigma, undermined trust in government. Victims, health workers shunned. Blamed European colonial influence. High uncertainty.

WAS JIMI HENDRIX A SHAMAN?

WAS JIMI HENDRIX A SHAMAN? Jimi Hendrix - iconic and gifted guitar player who revolutionized the role of the electric guitar. Died tragically in 1970. Unusual, theatrical performer, seemed to be in touch with deep, supernatural powers. Music, and performances, often transfixing, and mesmerizing - his entire body and soul seemed to be carried away to another plane. Gave a startling performance at Monterey Pop Festival in 1967, treating his guitar as a sacrificial object, burning it on stage, calling forth the flames as if calling forth its spirit. At the Woodstock festival in 1969, he played an ethereal and emotional Star Spangled Banner, pulling and bending his guitar, scraping it across the microphone, piercing the melody with sounds of exploding bombs and anguished cries, as if channeling souls of those killed in the ongoing Vietnam warfare

illness behavior

Ways in which people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system. Involves how people monitor their bodies and define and interpret their symptoms Illness behavior is what people in a particular society DO when they believe that they are ILL - a "cultural script." CODED or SYMBOLIC behavior, because what people do has a lot to do with how the illness they believe they have is LABELED. EXAMPLE: In a culture with a male gender role where "males don't call for help when the situation is not really serious," illness behavior will be guided, and judged, by this "rule.

CULTURE AND HEALTH

a center where cultures developed and from which ideas and traditions spread outward Culture, as an element of human behavior, intersects with health in many ways, including: Defining "health" and "healthy." Defining illnesses, or CONDITIONS OF "NOT BEING WELL." These may or may not coincide with biologically driven diseases. Linking illnesses and diseases to causes, to types of healing, to types of healers, to appropriate patterns of behavior for those who are ill and others around them ("sick roles"). Linking illnesses to moral and normative beliefs (e.g., regarding HIV/AIDS). Creating vulnerability to disease with respect to external disease environments or internal socioeconomic structures. Culture helps to shape social roles that people take on (e.g., gender roles, family roles, etc.) . The motivation to carry out specific roles may override health concerns or risks associated with doing so - gender roles are a good example. Culture may also shape people's understandings about risk, because culture contributes to socially valued goals - for example, life goals, or guidelines for how to be a good or admired person. Such goals may involve certain (health) risks, or de-emphasize the risks relative to the goal. KEY POINT: Culture refers to the human function of MAKING MEANING, sharing it, passing it down, living it, and interweaving it with what we DO, how we THINK, how we FEEL, and how all of that interacts with the SOCIAL AND PHYSICAL WORLD around us. BECAUSE WE HAVE SYMBOLIC THOUGHT, AND AN INTERPRETIVE BRAIN, we organize our cultural worlds around SHARED PUBLIC CONCEPTS - good/bad, funny/not funny, young/old...and of course, for our purposes, HEALTHY/NOT HEALTHY.

What is stigma?

a mark of disgrace associated with a particular circumstance, quality, or person. A label or stereotype that links a person to unfavourable characteristics"a negatively defined attribute, trait, condition or behaviour conferring 'deviant' status, which is socially, culturally and historically variable"

Culture of Biomedicine

a practice, often associated with Western medicine, that seeks to apply the principles of biology and the natural sciences to the practice of diagnosing disease and promoting healing

Biomedicine

a practice, often associated with Western medicine, that seeks to apply the principles of biology and the natural sciences to the practice of diagnosing disease and promoting healing uses scientific materialism (evidence) to guide techniques, is ethnomedical, focuses on the physical body of the individual patient and the physical cause of his/her disease.(ex. United States healing system)`