Lectures Exam 2

trisomy 9 foreskin

Amniocentesis: Amniocentesis Stories Story #1 o A lab technician takes amniotic fluid from four different women so that it can be tested o In order to understand and inspect the fluid they must keep "feeding" it until it creates more fetal cells o Mrs. Ramirez a Honduran woman who is having her third child , but this is the first time she will give birth in a hospital o Her amniotic fluid is inspected by lab techs, and they find problems with the baby's chromosomes. Specifically on _______ __. o After further research they called Mrs.Ramirez and told her that according to reports the problems on trisomy 9 will most likely lead to visible and structurally significant physical anomalies and some degree of mental retardation. o Despite attempts to get Mrs. Ramirez to terminate the pregnancy she decided to have her child. o The genetic counselor furiously took notes and handled the newborn with care. o At the close of the examination the genetic counselor asked to have the baby's ________ when he is circumcised to do further research.

dominant education

Amniocentesis: Conclusions cont.: -In the case of amniocentesis, much of the issues that arise in the debate are subjective in nature, with different people arguing over definitions that may vary, ie. grave illness, life etc. -Power, and the topic of power, remain incredibly important and relevant in the 21st century. The details may change but the core of the issues remain. No culture is homogenous in nature which means that there will always be disagreements on certain choices and actions. -The ________ cultural group often has difficulties with adapting to other groups. In this matter, only increased _________ and awareness may deal with this. -Further conversation and discourse on the subject of amniocentesis and consent as well as increased education and scientific literacy is needed to further solve these issues.

objective power

Amniocentesis: Conclusions: -Science is merely a tool, one that can be dragooned for specific purposes. -We would like to be _________ when it comes to medicine to make decisions based purely on logic and reason, but that is impossible. Our choices and judgements are influenced by personal beliefs and bias. -So it is that those in positions of _______ and the relationship of power play a crucial factor in the science and medicine in the world

Sonograms In vitro

Amniocentesis: New technologies • __________/ultrasounds : x-rays of a child in the womb to analyze its' development. • ___ ____-fertilization: "test-tube babies," a sperm cell and egg cell are joined together in a lab, then later inserted into the woman to obtain a pregnancy

feminist stratification

Amniocentesis: Rayna Rapp - The Author • professor of anthropology at NYU • leader of _______ anthropology and medical anthropology study of biomedical technologies • "her research on the emerging technology of amniocentesis was inspired by feminist concerns • her field work emphasized the fact that the practice of amniocentesis is consistent with the ___________ of reproduction along social class lines - has led to work on genetics, disabilities, genetic counseling, and new reproductive technologies.

Down syndrome

Amniocentesis: Story #2 o Pat was 37 years old when she was accidentally got pregnant, although it was an accident she wanted another child but was unmarried. o Her Obstetrician recommended amniocentesis because she was over 35 years of age. o Her results came back positive for _____ ________ and her OB wanted to perform an abortion right away. o Pat stalled and visited a mental retardation center and went to temple (she is a Mormon) and was convinced to keep her baby. o This story shows the power of religion, community, class, personal reproductive history.

benefits/burdens SES male

Amniocentesis: The Problem of the Excluded Middle ● Amniocentesis as a practice is just as much influenced by cultural factors in our society as biological ones. ● Medical Anthropologists work on a triple-exclusion theory to evaluate amniocentesis in our culture. (Middle ground on which contests for meaning occur, other interpretations as not scientific enough, and work on being "outside" the objects of their study) ● Once the author was able to do this, she looked at five overlapping medical discourses about amniocentesis: 1) Genetics: ________/burdens of knowing the results of the tests 2) Health economists cost/benefit across different ____ groups 3) Social sciences investigate the psychological tolls of amniocentesis 4) Bioethicists discuss the legal/ethical/social implications of the practice 5) Feminists concerned about amniocentesis as a "_____ takeover" of motherhood ● None of these texts discussed the multi-layered processes underlying the field which relates to the production of technology, the work force, the creation of patient populations, and the new view of what it means to have a child.

Laboratory New York religion

Amniocentesis: The Problem of the Excluded Middle ● The author identifies seven processes at work overlooked by the medical world: 1) ________ Life: members of the lab (the new work force) are ethnically diverse, but gender specific--mostly women. Due to brain-drains, civil wars, labor migrations, etc. The laboratory also has job mobility is fast and continuous-- very little opportunity for long term connections. Lab job is also viewed as "distinctly and appropriately female". 2) Highly diverse,female, patients: nationally, amniocentesis is reserved for white, middle aged, high SES women. In ___ ____, the author claims this is not the case. "The Prenatal Diagnosis Laboratory of the Health Department" exclusively for non-white, low SES women. Economic outreach to the urban poor-- comes with a catch: their health vs. our cost-effectiveness 3) Science is constructed by both social and cultural processes: path connecting scientific information to medical policy, to counseling protocols to popular culture is rocky and not self contained in medicine. 4) Relationship between science and ________: diverse stances toward reproductive technologies for both patients and practitioners impacts results.

Culture Lag religious maternalist medical socially own

Amniocentesis: The Problem of the Excluded Middle ● These many stories should alert us to the fact that religions continue to proliferate and make claims on personal, ethnic, and communal identity throughout American cultural life. Far from representing a "_____ _______" that science will soon over take, _________ adherence might better be viewed as a continuous aspect of contemporary social life (Harding 1987). ● Fifth, there is no definitive "Catholic" or "Jewish" or "Protestant" position on reproductive technology, when viewed from the pregnant woman's point of view. -Both _________ and _________ discoveries require careful destruction. -The fact that the decision making involved in amniocentesis reveals the existing gender negotiations within which a specific pregnancy is undertaken. -Domination -Manipulation -Negotiation -Resistance ● Sixth, disabilities, like pregnancies, are _______ constructed. ● Seventh, Medical anthropologists must account for their ___ presence in the problems they study. ● These 7 proliferating processes make it difficult to ever completely frame our "unit" of analysis.

control abortions

Amniocentesis: These new technologies of biomedicine: •may prevent untold suffering due to infertility or prevent the birth of children with terrible medical problems •gives people more _______ over their reproductive lives •But can be considered symbols of biomedical dominance over women's lives and as technological intrusions into normal physiological processes. Potential Problem: •the use of amniocentesis for preferential ________ of females in some cultures. - this has been an issue with the US government, as abortion is a hot topic for debate during political campaigns.

Amniocentesis

Amniocentesis: __________ is a test given to women who are pregnant, that checks the amniotic fluid for chromosomal abnormalities of the unborn child, such as down syndrome and spina bifida. • This test can be done in the early pregnancy stages, giving the parents time to make decisions on courses of treatment or even termination.

individual understanding

Anthropology and the World of Physicians Biomedical Science & Medical Anthropology Biomedicine -Concerned with the ________ -Diagnosis/Objectivity above all -Affective Neutrality -Explanation of the diagnosis reduces stress and builds trust Medical Anthropology -Emphasis on ______ -Studies performed by individual reporting and understanding of the world in which the individual lives -Immersion into the culture -Johnson finds himself between these two. -A medical anthropologist in a biomedical world.

Time

Anthropology and the World of Physicians Concept of _____ Anthropological View -Controllable and at a determined pace Biomedicine View -Finite, unpredictable, rushed -Frustrating

Medicalese

Anthropology and the World of Physicians Ethnographic Tests -Tests that decide if one should be accepted as a practitioner in the cultural setting. Tests may include... -Removing an encrusted incisional drain without disgust -Experiencing insensitive remarks about patients and staying calm without being defensive -Learning "__________": the special terminology of the medical profession and then translating for the patients

Availability

Anthropology and the World of Physicians Expected _________ -Availability is very important in biomedicine. -The practice of carrying a beeper may symbolize that doctors or other medical professionals are always working and always available. -They work long hours and in addition are on call during nights, weekends, and holidays.

15 behavioral

Anthropology and the World of Physicians Express Care -Quicker and quicker visits -___ minute intervals -11 minutes in some cases -"One eye on the patient. One eye on the clock." - David Rothman of Columbia University -More medication and less emphasis on _________ change. -Losing weight/ Eating Correctly -"Permanent solutions to temporary problems..." -Primarily Primary Care (Family/ Pediatrics/ Emergency) -Pay-per-visit -As insurance companies pay less, time per visit decrease as well

doctor

Anthropology and the World of Physicians Johnson's Take on "Expected Availability" -In an effort to relate to those in biomedicine, Thomas Johnson carries a beeper as well. -His colleagues joke that he is trying to impersonate a _______. -Johnson feels that doctors' are sometimes perceived as arrogant but in actuality this is just a defense mechanism of the constant stress and pressure of their job and its "expected availability."

diseases

Anthropology and the World of Physicians Patient Management -Physicians unconsciously want to control patients themselves -A physician may want to control the patient in order to make him stop smoking or start exercising -Hard to predict patient behavior, which can be frustrating for physicians -Johnson states that they should attempt to control ________, not people -Could be called "disease management"

Practitioners

Anthropology and the World of Physicians Physicians' Assumptions and Divisions -Physicians tend to make assumptions about the world based on their core values -They attempt to guide people and force them into groups -They unconsciously divide people into two groups: _________ and public -If you take care of people, you are a practitioner. Everyone else is the public.

hospital psychology

Anthropology and the World of Physicians Thomas Johnson -Worked in medical setting for 25 years -Started off as a maintenance worker during his undergraduate years as a sociology major -As a graduate student, he found medical anthropology and encouraged him to conduct ethnographic studies of hospital wards, indigent clinics and migrant farm worker health care -Became one of very few non-physician medical anthropologists whose main teaching role has been in _______ wards and outpatient clinics -His love for working with patients directly prompted him to gain a second graduate degree in clinical ________ -Spent fifteen years working on clinical and teaching facilities at three different medical schools -During that time he also spent seven years teaching in a graduate medical anthropology program -His original goal was to change the way people learned about health care, but over the years his goal evolved to help physicians become more genuine and flexible in their care of patients.

war violent

Anthropology of Immunology: Central Images in Popular Scientific Literature on Immunology -Regulatory-communication network -Difference between self and nonself -The body is at ___ Central Images in Popular Scientific Literature on Immunology -Images of Police guarding its borders -Descriptive ________ words are used -Killing the non-self -This language is common in all texts -"Killing" "Attack" "Devour" "Charge"

typhus

Anthropology of Immunology: Example of an alternative Forms of imagery -Ludwik Fleck= A polish biologist who developed diagnostic and prophylactic measures for _______ fever in the 1930s and 1940s. -Published monograph and papers on methodology of scientific observation and principles of scientific knowledge.

complex

Anthropology of Immunology: Self-contained independent unit with fixed boundaries? Proposed idea of harmonious life unit 1. Man appears as a complex to whose harmonious well being many bacteria 2. Intestinal flora are needed for metabolism, also many kinds of bacteria living in mucous membranes are required for the normal functioning of these membranes -thinks it is better to associate immune system as a _______ life unit than invasion to better compare and relate its functions. -believed any invading organism had to have been living in our vicinity long enough to stay in our cells.

Communication native language educate

Anthropology of Immunology: The Body and the Nation -Images of entities within our bodies related to social forms pervasive in our time. -_________: In both the modern nation and the immune system communication was important -The invasion of foreign cells were compared to people from different nations -In the immune system it was difficult to understand foreign cells -Would be the same as having difficulty communicating with someone who did not speak the _____ _______. -Lack of mediating structures in the modern state between the individual and the state. -In the immune systems individual cells are launched into the body to protect its homogenous interior against attack. -Structures produce and "________" cells in the thymus and bone marrow -"Educational institutions" are crucial for maintaining a common language among cells. -The human immune system is not controlled by a central organ and has a biologic democracy where individual members achieve their ends through an information network.

Phagocytes T Cells Female Male

Anthropology of Immunology: The Body and the Nation Continued: -Nationalist ideologies and the immune system carries a kind of suppressed hierarchy. -________ are lower form of cell and _ ____ are more advanced with higher functions. -There is a hierarchical division of labor that overlaps with gender. -_________ associations with phagocytes.These cells are seen as "housekeepers" of the body. -_____ associations with T cells. These cells kill by penetrating or injecting. Going into battle.Heroic imagery is used to describe T cells.

closed

Anthropology of Immunology: Understanding forms of Imagery -recognized limitations of metaphors of welfare in immunology in the 1930s. -Prevailing Idea of organisms described as a ________ unit and hostile causative unit facing it. 1.The causative agent produces a bad effect (attack) and the organism responds with a reaction (defense) which results in conflict, the essence of disease.

internal Professors

Anthropology of Immunology: What do People do with the Imagery? -Other scientists also believed warfare/__________ purity model to be the most effective and can not be replaced by any other imagery -_________ tried avoiding using warfare/military references. -People suffering from immune system disorders also found warfare references to be the best way to describe the complexities of the immune system. -Didn't necessarily use warefare metaphors to describe own experiences

Immunology destructive Phagocytes

Anthropology of Immunology: What does the imagery do? -_________ came about around the 1970s. -We tend to use imagery when describing immunology and cells in the body because it makes it easier for us to understand. •The immune system is typically seen as _________ -When talking about the immune system is compared to war very frequently. -Cells are even sexualized. •Cells that attack the invaders in our bodies are seen as heroes and masculine. •Cells that clean up in the body are considered feminine. This is directly related to war and how in the past men were sent to war and women stayed home and were the housekeepers •Also another example is ________, these cells eat each other. So when using imagery these cells are seen as cannibals. They are also described as uncivilized.

Spiritualist Biomedicine

Conclusion (Summary) -___________ alters the persons experience of his or her body. -Healers resolve contradictions for patients that physicians cannot because the biomedical script requires physicians to focus on discrete physical pains. -_________ often requires patients to alter customary behavior such as diet, work, or drinking habits. -Healers embody a spirit through trance and in so doing, experience their bodies in a new sacred way. -Spiritualist healing provides new interpersonal networks and also places the person in a new relationship with God. -Biomedicine, by treating individual bodies without transforming peoples lives, fails to contribute to new social forms for the collectivity. -Succeeds only in maintaining its hegemony as the major authorized provider of healthcare legitimized by the state.

protection

Doctors White Coat: Body And Sexual Taboos In American Culture -Physical body is not only threat to the individual but also to the one exposed to it. -Physicians began allowing gowns to be worn during physical examinations. -Gave a sense of ________ and lessened the embarrassment -People also began coming to the hospital to be treated versus house visits

agony

Doctors White Coat: Current Trends -Social symbols of authority are being rejected -Hospitals are accused of prolonging _____ rather than renewing life -Physicians are more focused on relationships that are more of a partnership than them being an authoritarian figure. -Many stray away from the white coat

green

Doctors White Coat: Developments From 1930 To 1960 -Adopted blue and _______ in operating rooms due to glare -Did not conflict like black and red -Some practices found it in their better interests to not use the white because it was overpowering.

stethoscope

Doctors White Coat: Symbols Of The Physician -Physicians are represented wearing white coats in media (television shows, comics, movies) -These sources represent stereotypes of the doctor -Principal objects used to depict the doctor: the white coat, __________, head mirror, and black bag

tan

Doctors White Coat: The Meaning Of Whiteness -White is a symbol of life. -White is a symbol of purity. Purity as two sectional meanings , concept of innocence and purity of unaroused sexuality. -Concept of innocence - meaning "no shadow of malice, of intention harm, can mar the white coat" - Perter Brown, Ron Barrett (pg.119) -Concept of purity - Superman power -The coats changed from ____ to white after medicine became involved. -Religiously the symbolism of white came from priest who exercised exorcisms (to bring back life) who wore white robes. -The meaning of white also comes from the word candor which comes from the Latin word candidus, which means white.

purity

Doctors White Coat: The White Coat In The Hospital -The hospitals had once been known as the place for outcast when this image changed from death to life. -The white coat was then introduced and showed this with its ______. -The Modern Hospital showed us that those who were in importance during the healing process of patients had to wear white including the patients. -Those who were not involved in the healing process had to wear different colors.

Panama Flexner

Doctors White Coat: The White Coat In The Laboratory -Healing cults such as homeopathy and eclecticism had threatened the existence of scientific medicine around the middle of the 19th century. -The public began to accept modern science as the foundation of modern healing, after seeing modern science being demonstrated such as the construction of the __________ Canal. -Medical education was built around laboratory science after the publication of ________ Report in 1910. -"The 'content' of medicine changed." -Towards the end of the transformation, physicians were viewed as "scientists wearing white coats." This perception gave physicians a tremendous amount of authority.

lab

Doctors White Coat: The White Coat In The Operating Room Origin: -started as a garb with the concept of aseptic surgery. -and then became a full-length gown to avoid the risk of cross contamination. -back opening for sterile technique -and made It patient care settings. 2 Purpose: (1) to protect the patient from being contaminated by physician (2) protect physician from contamination by patient during procedure being performed. The Term "____ coat" originally the primary term used for white coat. The Agnew Clinic by Thomas Eakins (1889)

Purity

Doctors White Coat: The White Coat: Symbolism Science _______ Modernity Authoritative knowledge Heroism "The physician's dress should convey to even his most anxious patient a sense of seriousness of purpose that helps to provide reassurance and confidence that his or her complaints will be dealt with competently" (117) The healer/patient relationship is serious and purposeful, not social, casual, or random

central

Doctors and Patients: -Doctors/ healers and their conviction of the positive outcome of the prescribed treatment is _________ to the human response to both active and placebo treatments. -These convictions are rooted in very different things across cultures/ professions and time. -Example: Abedi (A traditional African Psychiatrist) Another example of this is Sister Grace -This can't be said for the medicine and healing practices most of us are used to. -Since a doctor's convictions and the way they present those convictions happens to be very important on the effectiveness of medicine, there is a trend of old treatments becoming less effective when new treatments come along. Example: Ranitidine (Zantac) - What patients know and how information is presented to them is what accounts for the effectiveness of their treatment, the main source of their knowledge of prescribed treatments is their doctors.

70 30

Doctors and Patients: -Placebo drugs and angina pectoris -In the 1940s and 1950s, Benson & McCallie found that a number of pills used to treat angina pectoris were subject to placebo controlled trials -Enthusiastic doctors could heal __-90% while skeptical doctors could heal __-40% of patients while using the same drug Doctor-Patient Communication -Moira Stewart research -More than decision-making power: Respectful and empowering context -Patient choice: Mastectomy, Lumpectomy, choice of treatment -"Knowledge can mitigate the effects of illness."

Placebogenesis

Doctors and Patients: Doctor Effects and "______________" -"most important single factor shaping the meaningful quality of medicine springs from doctors"(135) -76 year old Veteran and his knee surgery He "seems" like a good surgeon -"the indirect interest of the physician in the patient" -Arthur K. Shapiro -The depressed woman given an elaborate dosages of placebos to convince her that the physical symptoms are psychological. -Shapiro, "the patients understanding of the physician's interest in her... seems to me to be as productive [in making her better]." (136) "therapeutic" attitude vs. "experimental" attitude

weed advance

Doctors and Patients: Patient psychology and the search for "placebo responders" -Patients who are designated "placebo reactors" have responded to a treatment of this sort. They have a variety of self-generating psychological conditions. -According to the article, "no one has ever been able to find a reliable way to predict who is going to respond to inert treatment and who is not." -They also made it important to note that people will react differently to the same medicines, and even people who are not identified as placebo responders can still say that the inert drug has had an effect on them. -In the 1950's they tried to give patients inert medications for weeks before the clinical trials to "______ out anyone who responded to the placebo", however despite their efforts people still reacted to the placebo drug. -In conclusion, there is no method today to identify placebo reaction in people in ________. In addition, "the characteristics and qualities of individual patients make no significant impact on the character and quality of meaning effects."

message physical/Physician?

Doctors and Patients: Placebogenesis (cont.) -Study examining dental patients and the placebo pill -4 variables: Status of communicator, attitude of the dentist, attitude of the dental technician, message of the drug -"Oversell message" vs. "undersell message" -The amount of pain varied depending on what they were told, and who told them. -The _________ was more significant than the attitude -Study examining the effect of a "positive" diagnosis compared with a more neutral approach on the part of the physician -64% of positive consultation patients said they were all better, while only 39% of negative consultations thought they were better -Treatment made no difference; the _________ attitude overrode any consideration of the pills patients might have received

placebo

Doctors and Patients: What The Doctor Knows Makes a Difference -A _______ is anything that seems to be "Real" medical treatment but isn't, they do not contain an active substance meant to affect health. -The placebo effect takes advantage of how a persons mind and body are strongly connected.

Susto Espanto depression

Epidemiology of Folk Illness -_____ is a syndrome that translates to "soul loss" or "magical fright." -_______ is the physical soul loss. The actual occurrence itself. -This is considered a folk illness in Hispanic America because it doesn't fit into the category system of biomedicine or psychiatry. -The symptoms of susto correlate to "____________" - victims who lost their souls, feel tired, have trouble sleeping, don't care about appearance, loss of strength, introversion, have little appetite, ect. -But the cultural meanings of susto are very different from what North Americans would call depression...

depressed

Epidemiology of Folk Illness Case Study Example -Anthropologist Gillin gives an example of a 63 year old, Pokomam Indian woman from Eastern Guatemala. -She told her neighbors of her discovery - that her husband was having an affair. -As a "consequence" of her confronting him, he retaliated with abuse. -When Gillin encountered the woman, she was experiencing the symptoms of susto. She was _________, neglected her daily activities and reduced her contract with outsiders. -She also had physical complaints of pain in her stomach, no appetite and pains in the back and legs. -At other times, she alternated between moods of timorous anxiety and tremors in her hands and jerky movements. -Overall, she was conscious of her day to day activities and was relatively normal. She was aware of time and place.

stressful cultural role

Epidemiology of Folk Illness Case Study Healing Stages -First, the native curer pronounces the clear diagnosis of espanto. -Later, she was required to confess the actual events that led up to the actual soul loss. -Next, a group of friends and family were assembled to attend the healing process. -Hen's eggs were passed over the patient to "absorb" the illness. These eggs were later buried at the site of her soul loss. -Lastly, a procession was formed to lead the soul back to the body. The Author's Final Hypothesis 1) The susto syndrome will appear in social situations which the victims perceive as ________. 2) The stresses are intra-________ and intra-societal. 3) In Hispanic-American societies, the susto syndrome is the consequence of an episode in which an individual doesn't meet the expectations of society for a certain social _____ he/she has been exposed to. 4) Even though all people may believe in the concept of soul loss, not all members of society will fall victim to it.

Indians shocked

Epidemiology of Folk Illness Curing Ritual -There is an initial diagnostic session between the healer and patient during which the cause of the episode is specified and agreed upon by the participants. -The soul is coaxed and entreated to rejoin the patient's body; in the case of _______ those spirits who hold the soul captive are begged to release it, and in both Indian and non-Indian groups, the officiant shows the soul the direction back to the host body. -During healing, a patient is undressed and "________" by cold liquor sprayed from the mouth of the curer, massaged and finally sweated, both to relax him and he is "swept" or rubbed with some object to remove the illness.

captured unexpected

Epidemiology of Folk Illness Indian vs. Non-Indian -Among Indians, the soul is believed to be _______ because the patient, wittingly or not, has disturbed the spirit guardians of the earth, rivers, ponds, forests, or animals, and the soul is being held captive until offense has been amended. -But when a non-Indian is diagnosed as suffering from soul loss, the locale in which it occurred, a river or forest, is of no significance. -In many cases, a fright occasioned by an _________ accident or encounter is thought to have caused the illness.

detached sleep

Epidemiology of Folk Illness Susto in Hispanic America -The belief is that an individual is composed of a corporeal being and one or more immaterial souls or spirits which may become _________ from the body and wander freely. -These souls are said to leave during ____, particularly when the individual is dreaming but among peasant and urban groups they may also become detached as a consequences of an unsettling experience.

cultural

Illness Narrative -"Through telling their story of illness and its perceived cause, patients can make new impression and understanding of order that mends their old [healthy] identity with a new identity that moves past victimhood"-Hunt -"Illness narratives can be used to restructure social role advantageously without challenging dominant model or losing legitimacy"- Hunt -Patient narrative performance is capable of enacting new empowered position -social change -reflect _______ norms -address contradiction -realign power relations

Indeterminate Secondary

Illness Narrative -________ gender roles were experienced by both Roberto and Isabella due to particular reproductive cancers and treatments -Their illness narratives allow them to express their frustration with gender roles and even create new gender roles -Isabella- finds power to resist husband's sexual demands in illness narrative -Roberto- produces "social accord on the limits to his ability to fulfil excessive familial obligations" -________ gain: patients may have ulterior motives that underlie failure to heal increased attention/ financial gain/ release from burden concern in identifying secondary gain to determine validity of pain and disability reports -Hunt calls this model judgemental & simplistic Patients are carving new niches for themselves in social structure in the context of gender roles and illness that is better for them than the roles they previously occupied

chronic biographical

Illness Narrative Changes in Social Identity •The core experience of ________ illness has often times been characterized as a loss, and a break in the normal rhythm of life. •Chronic illness is introduced as "________ disruption," or a time in which normal social structure and roles are disrupted.(Bury 1992) •In many ways, performance of roles is what defines a person, and when Chronic illness is suddenly inflicted on someone, this can seriously diminish one's ability to perform their regular roles.

metaphoric

Illness Narrative Changes in Social Identity and Illness Narratives -Cancer has a powerful _______ dimension -Coming to terms with having this illness presents many challenges to the everyday sense of self -Important to not only look at coping mechanisms on an intrapsychic dimension but also within a larger social and cultural context -There is a change in rights and responsibilities of cancer patients in society -Renegotiation of the privileges and obligations of the patients within their family and within society

flexibility

Illness Narrative Changes in Social Identity and Illness Narratives -Shifts in personal identity emerge in the context of a larger social framework subsuming questions of domination and subordination -This shift can be extremely frustrating due to the indeterminacy of the changing roles, but also extremely liberating for the same reason -The ambiguity opens the possibilities for these patients and creates a "social space within which creativity can flourish" (Rosaldo, 1993) -This implies a level of role ________ and moments of potential empowerment -Individuals in the process of creating illness narratives move between multiple ways the sick role could be constructed, thus achieving altered identities, not passively but by selective action -These illness narratives may just be be revised versions of their old roles, making it easier to cope

revised

Illness Narrative Changes in Social Identity and Illness Narratives -With all of the shifts in roles, there are now new questions of domination and subordination and how one fits into society. -This shift can be extremely frustrating due to the indeterminacy of the changing roles, but also extremely liberating for the same reason. -Forcing these patients into a state of such ambiguity where they have to re-learn their roles within society allows what Rosaldo has called "a social space within which creativity can flourish" -This Implies a level of role flexibility and potential empowerment because they are now able to do certain things they previously couldn't or didn't have the means to do so. -These illness narratives that are created by the patients may then result in a similar but ______ version of their old roles and old identity, making it easier to cope with this disease and create a new and enhanced place for this person in the social world.

morally

Illness Narrative Isabela Martinez •68 year old indigenous woman, the mother of 13 children. •"In Latin American culture, the ideal wife is often characterized as selfless, ______ pure, and dedicated to children and husband" •She viewed sexual submission to her husband as a marital duty, but one that had been abused by him. •Isabela and her husband were both from poor families, but they were able to form a successful business of buying and selling shoes. They lived a comfortable life with a nice bricked house in a large indigenous village. •Isabela felt symptoms related to the miscarriage of her 14th child and finally found out about her cervical cancer. Three years after her hysterectomy as her treatment, Dr. Hunt talked to her about her cancer. •Her reproductive history was the central in her story of the etiology of her illness. •She only talked about her pregnancies and how she had no control over them. •"On the 8th day after the birth, my husband would want to have relations with me." Every year, she would have a child because of her husband's demands. •She finally told her husband that since she is ill, she is unable to have these relations with him. •Now, she is able to refuse her husband's sexual demands and has managed to preserve her social identity as a dutiful wife. •She is now able to resist what she views as exploitive behavior on the part of her husband. -She turned suffering into a form of social empowerment

relationships revolutionary

Illness Narrative One's Illness Narrative •As patients move from the limiting factor of illness crisis back into a complex mindset, their illness narratives have a potential for affecting strategic changes in terms of the broad context of their lives. •The telling of one's illness narrative may be taken up as an opportunity to reorder contentious elements of the social field, creating new meanings and ___________. The Revised Identity -It will be argued that use of illness narratives is neither manipulative nor _________ but instead reflects the practical outcome of people creatively constructing a revised identity when confronted with the permanent disruptions presented by living with chronic illness.

negotiations

Illness Narrative Research Project Continued: • Method of Data Collection: In this study, data was collected from the participants and their families through extensive ________. ❖ This method of data collection involves qualitative data interpretation. ❖ In most cases, qualitative data research aims to deconstruct behavioral processes in humans and underlying causes/effects of that behavior. • Interpretation of the information offered by patients/families extend beyond context of interview. The information is interpreted with the presumption that it reflects the illness narrative as it exists between all members of the family. This presumption for interpreting information is based on 2 sets of observations: 1. Narratives cite _________ and resolutions that have taken place with others in the social lives of the patients. 2. Family members relayed the illness narrative of the patient as it relates to them.

testicular

Illness Narrative Roberto Juarez -At the age of 25, Juarez had no children and had never married. (_________ cancer) -Yet he was single-handedly supporting his parents, five younger siblings, an alcoholic brother-in-law, and various nephews/nieces. -In order to support his family, he grew corn and beans on his two plots of rocky, unproductive land. He also worked as a part-time bricklayer. -In short, he was constantly working yet the family remained desperately poor. -The obligation of taking responsibility for the well-being and support of one's family is a central aspect of what it means to be a "good man" in Latin America. -Roberto had found himself in a nearly impossible situation in trying to fulfill this role. -And then he was diagnosed with early-stage testicular cancer... -Due to the illness, Roberto wasn't able to work and needed three million pesos for the operation. -His family decided to put together for the treatment, hoping he'd be able to work more and harder after he recovered. -However, he never recovered fully and was no longer expected to solely provide for his entire family. -His illness allowed him to reconstruct his social identity without having to revise the central cultural norm.

social

Illness Narrative So in Mexico, as in much of the world, cancer has a very powerful metaphoric dimension. People often have images in their mind of cancer as being an invasion of a ruthless aggressor or a monster of some sort that slowly and inevitably destroys the person from within. Coming to terms with having this illness presents many challenges to the everyday sense of self Your role within society will change, for example, you may be unable to continue your career, or you may be the one relying on others when before you were always the caregiver. So, Along with the psychological and emotional process of accepting you have cancer, the shift in your position within society has a huge impact on successfully finding coping mechanisms Previous studies done on change in identity of cancer patients usually look at certain cognitive or psychological adjustments made internally within patients, but not many have looked at the changes that happen in a larger ______ and cultural context. However, it is important to understand these changes that happen on a macro level because a persons rights and responsibilities within society will change when someone becomes sick. Having cancer requires mobilizing resources for treatment, eliciting assistance for caring for the patient, and renegotiating the privileges and obligations of the patient within the family and other social hierarchies

reorganization

Illness Narrative The Effects of Disruption on Chronic Illness •The disruption brought on by chronic illness, usually appears in purely negative terms; something has been lost and the loss is something to be coped with and endured. •Examination of peoples long-term adaptations to chronic illness reveals that the initial phase of disruption is often followed by a period of _________.

roles

Illness Narrative The Reconstructing of Self and Social Identity •The reconstructing of self and social identity that occurs in response to chronic illness requires a long-lasting performance; a kind of pilgrimage into a sustainable construction of changed self and ______. •Some take this opportunity to redefine the self and social roles in ways that address broader personal and social conflicts and contradictions than those encountered in the illness itself.

Ethnography reconstruct

Illness Narrative The Research Project • Information and material presented by Dr. Hunt was drawn from an ethnographic study of hospital-based cancer care in Santo Domingo, Mexico. -__________ - the systematic study of people and cultures • Study Sample: 43 cancer patients and their families • Hypothesis of Study: It will be shown that, in generating a revised identity in the face of chronic illness, illness narratives guide ongoing negotiations over contentious elements in patients' social world such as struggles over legitimacy or victimization. • Purpose of Study: The results and implications of the study were presented to explore how illness narratives may be used to _________ the altered self in response to the serious daily challenges presented by cancer and its treatment.

intersubjective

Illness Narrative • Illness narratives are generated in an _____________ dialogue, articulating the illness and its effects with the broader context of life's issues and goals. • Patients of cancer in this study successfully turned suffering (their illness) into an empowering asset, resulting in both a socially and personally revised identity of themselves. As a direct result of the revision of their identities, patients redefined themselves, their perceptions of the world, and their place within the world. • This study conveys the embeddedness of the reorganization of identity during the course of chronic illness. This process of patients analyzing their identities is termed as constructing an "illness narrative" -Strategic use of these illness narratives can act to legitimize patient variation in prescribed roles while avoiding revision of moral principles underlying those roles.

oppressive

Illness Narrative Political Lens -Looking through a political lens, those that are disempowered use whatever resources are at hand to battle oppression -In this case resistance to both class and gender oppression 2 prerequisites: -Disempowered people need to see their situation as _________ -Act out of a motivation to resist oppressive structure -Neither of the two occur- cant use political lens reconstruction of gender roles does not challenge cultural concepts/ gender roles redefinition of roles attempts to resolve disjuncture b/w personal experience and expectations -New roles draw on conventional cultural roles as framework

nature

Illness Narrative The Research Project continued • During the course of the study, the variation of conflicts and tactics expressed/constructed in the illness narratives almost matched the number of patients. • Almost all of those who were interviewed had constructed the enduring aspects of "having" cancer in a way that had important implications for resolving contentious pieces of their lives. ❖ This notion of Hunt's study intended to argue that this reflects the interdependent nature of the illness and the illness narrative. • Main Theme of Study: The integration and growth of chronic illness narratives are built upon the ______ of the chronic illness itself, its treatment, the pressing issues encountered in everyday social interaction, and the conflicts/goals of those interactions. ❖ Therefore, illness narratives have great importance for addressing the most pressing and prominent problems for the person telling that story.

networks individuals

Internet Suicide in Japan -Loneliness can be seen as depending on two factors: the presence of social _______ and on _________'s subjective evaluations of their social networks. -A response to loneliness must therefore be multidimensional. -By addressing social factors, it is no longer left up to the individual to fix their own problems - rather, a social network is created which instead supports them in that process through education, opportunities for interaction, and so on.

Tibetan

Internet Suicide in Japan About the Author -Dr. Ozawa-de Silva -Associate Professor of Cultural Anthropology at Emory University. -She received her Ph. D in social and cultural anthropology from Oxford University in 2001. -Her academic vision is to contribute to cross-cultural understandings of health and illness, especially mental illness, and make a contribution to the field of medical anthropology by bringing Western and Asian (particularly Japanese and _______) perspectives on the mind-body, religion, medicine, therapy, and health and illness into fruitful dialogue. -In her work, Dr. Ozawa-de Silva stresses a critical awareness of cultural biases in medical anthropology, and facilitates collaborative research projects on cross-cultural understandings of mental health and well-being.

determinism individual pathology integration

Internet Suicide in Japan Approaches to Suicide -One could broadly categorize as falling into two extremes. -Social, economic, and cultural analyses that emphasize social _________. -Individual factors such as psychology and psychopathology. -US rationale is focused predominantly on ________ pathology. -Japan's discourse is focused on social _________, economic factors, a "culture of suicide", and cultural aesthetics. -The young Japanese seem to suffer from lack of _______, however seek others to die with. -Internet suicide pacts, exhibit an inseparability between agency (power of an individual to act independently of the determining constraints of social structure) and social forces.

stress

Internet Suicide in Japan Becoming an Adult in Japan and the "Worth of living" -"Worth of Living" - Ikigai -Japan has become a major capitalist power with tremendous success in terms of education, standard of living, and medical care. -Despite this, the social and cultural environment that individuals are born into is one within which they feel the absence of a clear ikigai, conjoined with a loss of traditional family values, changes in family structure, and a perceived failure to meet the aesthetic expectations of society. -Among the older and younger generations, there is a loss of a clear ikigai. -" For many Japanese, younger and older generations are perceived as having completely different core values, which leads to considerable ____ between those generations" (Traphagan).

30 27

Internet Suicide in Japan Death in a "Suicide Nation" -Japan has been known as a "suicide nation" due to the various forms of suicide that have gained prominence in public attention, as well as the fact that suicide has been seen as a moral action and as a last place to practice ones "free will" in a generally conformist society. -Suicide is the leading cause of death in Japan among people under the age of __. -Death in a "Suicide Nation" International Comparison In 2003 - 34,427 suicides or __ per 100,000 - highest in Japanese history Japan - 27 Men - 36 Women - 13 Russia - 34 France - 18 United States - 11 United Kingdom - 7

weak five

Internet Suicide in Japan Death in a "Suicide Nation" -While Japanese cultural attitudes toward suicide have been tolerant, the public and mass media have not been inclined to view Internet suicide pacts in this way. The underlying cause of these suicides is neither apparent nor clear, such suicides bring about little sympathy. Instead, they are seen as irresponsible, thoughtless acts, and those who engage in them are considered copycats or too _____-willed to die alone. -It has also been said that such individuals are incapable of understanding life and its depth and weight, seeing it instead as something light and virtual, and therefore they view death in the same virtual way; computer games, television, films and so on have been invoked and blamed for this. -Thus, such individuals are merely irresponsible for choosing to die when they have no good reason to do so, and when they are not undergoing any serious kind of suffering. -The number of suicides among middle-aged men between 40 and 54 was ____ times higher than that among women in the same age category, a figure some have pointed at as evidence of the link between suicide and the recent economic recession and rise in unemployment. -These findings suggest that internet suicides are characterized by severe existential suffering and loss or absence of the worth of living.

future anxiety meaning

Internet Suicide in Japan Is the Youth at Risk? -A younger person does not have a clearly defined role or position of responsibility within a family and has not assumed a position within a company or as a caregiver in his or her own family. -For them, ikigai comes from their anticipation of the _______ and future relational networks. -The traditional Japanese notions of adulthood often results in tension when it is combined with the ideals of the Western world. -"...The introduction of more Western institutions has also encouraged more individualistic views of self, family, and well-being". -The longer young Japanese stay home late into their twenties or even thirties, the more likely they develop anxiety because of the uncertainty and isolation caused by the absence of social relations. The main themes that are mentioned regularly in posts and recorded on suicide websites: -Existential ________ -Loneliness -Lack of satisfying social relations -Lack of a role or _______ for oneself

Shinyu Amae 40,000 3.14 million

Internet Suicide in Japan Japanese Suicide Pacts Suicide Pacts - "______" in Japanese. Why are they formed? -The origins of these pacts can be attributed to Hikikomori where the afflicted withdraw from society. What is the cause? -Societal forces such as Sekentei, a persons reputation in their community and the pressures that come with impressing others. -Another societal force, '____' - dependence- that characterizes family relationships in Japan. Who is affected? -Mostly teens and young adults. How Are These Pacts Formed? -Through the internet, those with hikikomori communicate with those like themselves in website chat rooms. -Most discussion about these pacts happens there, and meetings are arranged. -Japan recorded __,000 suicide websites and 150 "methods of suicide" websites as of October 2000. -By the end of 2006, a recorded __.14 million suicide sites and 22,000 "methods of suicide" websites.

existential fake

Internet Suicide in Japan Loneliness and Existential Suffering -The three essential characteristics of loneliness are: It involves perceived deficiencies in one's social world It is a subjective state experienced by the individual rather than an objective feature of the individual's social world. It is experienced as unpleasant and distressing -When different aspects of this definition are emphasized, different treatments are called for. -Change in social situations in Japan -Individual therapy in the U.S. -A common trend on Internet suicide sites is a type of loneliness that Yalom calls _________ isolation. -"A separation from the world where the person is confronted with an anxiety in the face of nothingness but also his own freedom". -The connections that users on these sites make seem to allow them to make their loneliness less painful and instead it becomes an opportunity for constructive introspection and growth. -Another common trend among comments on Internet suicide sites is the expression of feeling "____" or being unable to relate to other people. -Social psychologists have noted three things related to reports of lower subjective well-being and suffering. -An inability to maintain a certain consistency of self-understanding across multiple social roles. -A sense of being therefore inauthentic or fake to one's true self. -An inability to see actions of social duty as autonomous engagement. -The inability to reconcile one's social relations and one's own autonomy can severely damage one's sense of life's purpose.

cross-cultural depression

Internet Suicide in Japan Mental Health -Many medical anthropologists focus research on mental health and illness as seen from a ____-cultural perspective. -Mental illness can cause much disability and suffering both in economically disadvantaged societies as well as wealthy, technologically advanced societies. -Suicide is most often understood as an extreme outcome of _________.

withdrawal six

Internet Suicide in Japan Suicide or Social Murder? -The definition of suicide in the West is "deliberate self-harm" -Overall, Japanese cultural perceptions of suicide are more tolerant than those in the United States -In Japan certain suicides are viewed as culturally aestheticized and more tolerated. -Among middle aged, primarily male adults, suicide has been attributed to the economic downturn in Japan. -Hikikomori (_________ syndrome) refers to the more than one million citizens who have stopped going to school or work for more than ____ months and subsequently stay at home. Internet causes hikikomori to raise. -Neither Internet suicide pacts nor hikikomori can be explained by citing the economic recession as a primary reason for suicides -It is important to examine broader social and cultural factors that have been undergoing recent change.

humanistic nation recession

Internet Suicide in Japan This Chapter -Discusses the changing patterns of suicide in Japan. -Takes a ________ approach that emphasizes cultural history, patterns of cultural change, and the lived experiences of individuals committing suicide. -Lately (since 1998) there has been evidence of increased group suicide among young people in Japan. Japan -Typically, Japan is known for the longevity of its citizens. -Also has a less favorable reputation as a "suicide ________". -Beginning in 1998 suicide rates shot up dramatically. Many scholars have attributed this to Japan's long-term economic _________. -A notable trend is the increased number of suicides among young Japanese citizens, and the new forms of suicide, such as internet packs.

Decline

Internet Suicide in Japan Worth of Living, Then and Now -Following World War II, Japan's social and cultural situation has been affected. -______ of traditional extended family structures -Changes in traditional values such as placing the family above the individual's needs -Suspicion of the idea of religion -Changes in company structures such as the loss of lifelong job security -Traditionally ikigai was closely associated with social roles. -One's job for men -Caring for the family and one's in-laws for women -Now, it has many Japanese struggling to find a meaning for their existence.

Shiniyu stigmatized

Internet Suicide in Japan _______ -In Japanese society, dying alone is ________, and it is a cultural imperative for family members to be present when a person dies -In individual suicide, one might not actively wish for others to die alongside oneself -In cases of group suicide, there is a wish to avoid a "lonely death" -For the collective, it is socially prescribed

1909 church nonindustrial

Learning to be a Leper -19__ Leprosy declared incurable -1920 moderately successful treatment -1920 private ______ organizations became the main providers of treatment to leprosy patients. -Leprosy strongly stigmatized in _________ countries -Leprosy is not a terrible or life threatening disease nor a real threat to westerners.

accidents cultural

Learning to be a Leper -Depending on specific historical/cultural/medical "________" leprosy and by implication perhaps all disease, are transformed into illness having _______-specific social and moral definitions.

social

Learning to be a Leper -People who discover that they have leprosy respond to the _____ definition that their culture has set out for them. -Lepers learn how to be lepers from the beliefs and expectation their society has for them. -In everyday society the sick person is socialized to take a role the society expects.

leprae scapegoat

Learning to be a Leper Chinese Stigma: -1856: Hawaii quarantined Lepers: implies leprosy is contagious and not inherited. This belief was further supported by the discovery of Mycobacterium ______ in 1874 by Hansen -Chinese became a __________: potential of economic threat that native western workers may have felt from chinese workers. -Inherent inferiority of non white people.

hereditary Chinese

Learning to be a Leper Hawaii: -In 1840s leprosy was a ________ disease and was not stigmatized. -However by mid century Hawaii's economic and social situation started to change. -Europeans were moving out of colonies, americans traveled more for trading purposes and the _____ moved to Hawaii to work on the plantations.

10 million five historical

Learning to be a Leper How common is Leprosy? -According to WHO, the worldwide prevalence is ___ million -94% of cases are in tropical africa and asia -One in ___- are being treated -With early diagnosis and regular treatment symptoms will disappear and the disease will be arrested. -In Africa and Asia a "protocol" of drugs is available. Moral Definition Develop -Very complex, no single answer -Can be related to specific ____ and economic circumstances

west community

Learning to be a Leper How is the moral def of leprosy perpetuated? -Many churches and missionaries set up hospitals for lepers. --Had took an aura of saintliness --Collected funds from industrial ____ and funneled it to poor tropical countries. -Shift went from needs of lepers to needs of _________. --community wanted lepers removed --donating money did not help reduce the stigma for people with leprosy.

nerve 15

Learning to be a Leper Leprosy: characterized by a progressive degeneration of _____ limbs. -Assumed to be mildly communicable -Long term skin and respiratory contact of 10-__ years duration is required for transmission.

India Sri Lanka Nigeria 20%

Learning to be a Leper Social Stigma -In ______ Lepers experience profound life changes -Lose Occupation -Wives and Children -Identities -Physically and socially rejected in Indian society -Pre 1950's all Lepers segregated regardless of level. In ____ _______ -Life experience would be similar to Indians including rejection and mobility In ______ -Avg frequency of ___% -Estimated prevalence in southern nigeria at time 2-30% -Not regarded with any special apprehension -Continue to live a normal life until advanced stages of disease

1823 DECADE

Learning to be a Leper Social Stigma: -Chinese believed to have brought leprosy to Hawaii -However--according to the Hawaii board of health records chinese did not actually bring leprosy -Leprosy was recognized by missionaries in ____ -Recognized by a physician in 1840 -A _________ BEFORE THE GREAT INFLUX OF CHINESE.

anesthetic cure three

Learning to be a Leper Symptoms: Most common are ________ skin and raised patches resembling eczema, skin ulcers that do not heal. -Symptoms may contribute to late treatment -Many years without treatment can cause severe malformation and dysfunction. -Currently no _______ -Drugs: known to stop the growth of bacteria. May lower bacterial count. After _____ months the patients disease no longer communicable

Tuberculoid contagious Lepromatous

Learning to be a Leper Types of Leprosy: _______: mild less severe form -One or few patches of flat pale colored skin -least ________ _________: more severe -widespread skin bumps and rashes, numbness, and muscle weakness. Borderline: Symptoms include both tuberculoid and Lepromatous

breast-feeding

Malnutrition in Mali About the Author -Katherine A Dettwyler -Nutritional Anthropologist -Primary interest area is _____-_______ -Author of Dancing Skeletons: Life and Death in West Africa. Awarded the Margaret Mead Award for communication to the public by the American Anthropological Association and the Society for Applied Anthropology.

3

Malnutrition in Mali Case Study 1 -Jeneba left her husband and moved in with her first husbands family -Although the father of the twins had a steady salaried job the mother had little access to this income, which caused the children to starve and be malnourished while growing up -The boy Al-Hussane passed away at age __ -The girl Assanatu is still underdeveloped due to malnutrition and had to drop out of school because she couldn't keep up. She will never be able to live a normal life, this happens to many children who survive severe cases of malnutrition

3 malaria

Malnutrition in Mali Case Study 2 -Fatoumata and Oumou are a set of identical twins. -The mother, Aminata, was 16 when she had them. -They were both severely malnourished. -The twins caught measles -Fatoumata had a more serious case of measles because she was more malnourished. -Their mother refused to take them to the hospital 19 months of age Both children were 5 SD below the median -Anything more than __ SD below the median of the NCHS standards is considered "severely malnourished" -They both could not walk or talk -They were still nursing and only eating food like rice or millet breakfast porridge -Around two years the children were still nursing and just beginning to walk. They both had put on some weight but were still almost 4 SD below the median -The mother asked Dettwyler stop providing formula because she did not have the time to administer it. -They could not run, but they could both walk -Talking was limited to only the words "mother" and "water" -Fatoumata was still shorter than Oumou and both children only went up the to chest of a healthy child their same age -She thought of the kids as being a burden to her and that they were getting in the way of her life. After looking more into her life, it was easier to understand why she felt this way. She was a foster child of low status. -At 15 years old, she became pregnant from one of her friends. At home, where she lived, the adult men were not happy and did not approve and would not let her marry the boy. -On a relative scale of SES where she lived was above average. The other children of the compound were only mildly malnourished because they had some money available to them. Aminata had no money available to her. No one at the house would even watch her kids for her, she always had to turn to a friend. -In 1989 Aminata was no longer living in the compound but was living in a close by community. Fatoumata, who was always the smaller child passed away in 1984 from ________. After that Oumou was sent to live with Aminata's parents. Once her kids were out of the picture, Aminata's foster parents set up an arranged marriage. -Since her marriage she had three children, only two survived. Both children are considered to be "mildly malnourished"

pregnant

Malnutrition in Mali Case Study 3 -A boy named Umaru, a success story in Farimabougou -Parents' 14th child, developed polio at 10 months old and entered study at 18 months old -Because of his weight of 8.3 kilos, was placed in "moderately malnourished" category, he was weaned at 24 months because Mother was _________ again -Gained weight steadily over course of study, weighed 11.3 kilos at 32 months placed him in "mildly malnourished" category typical of children in the community -Because of Umaru's polio, his Mother regularly took him to Chinese hospital at Kati and spent many hours with him to teach Umaru to walk -She was upset by the stillbirth of her 15th child who died during a painful labor -Her doctor warned that she shouldn't have anymore children which also made her sad -While she was recovering, her husband took over cooking, cleaning and other chores, he was devoted to his children and confident that Umaru would recover -Because of his devoted parents, Umaru survived -Despite suffering from both polio and the measles, Umaru survived although his family's income was only "average" and there were many other children to feed -Umaru had devoted, traditional and caring parents

periurban 136 interviews

Malnutrition in Mali Demographic and Ethnographic Background -In 1982 to 1983, Dettwyler conducted research in ________ communities in Mali focusing on the relationship between infant/child feeding beliefs and practices and the growth and development of children -10 periurban communities among 117 compounds -Randomly selected study samples consisting of ____ children -Children and families were visited every 4 to 8 weeks -Growth data was collected at each visit -Semi-structured ________ of mothers and caretakers -Participant-observation of child feeding activities -Anthropometric measurements of physical, motor and language development -Follow-up studies conducted in 1989

Socioeconomic negatively

Malnutrition in Mali Malnutrition in Mali -Socio-cultural malnutrition- growth failure in children due to factors other than poverty and the lack of availability in food -Research showed that relative income is not closely related to diet in Mali Factors in Malnutrition -__________ status -National rates of malnutrition __________ correlate with per capita income -Environment- social and physical Ex. In Sierra Leone, "fosters" aren't given as much care as "born" children Culture -Ex. If a mother feels a child is beyond saving, she may neglect them until they die -Ex. Infants who cry more (seen as "fighters") will be given more attention than quiet babies

Biological Cultural

Malnutrition in Mali Malnutrition: The Biocultural Approach -Biocultural- relationships between biological and cultural factors -Both factor into malnutrition -________- hunger, how much can be eaten -_________- what there is to eat, how much there is to eat, cultural factors in preparation of food, what food is acceptable to eat

bad mother

Malnutrition in Mali Mori -Umaru's nephews were Mori and Bakari, Mori is one of the tragic failures out of the case studies -Mori weighed 3.9 kilos at birth and was weaned at 13 months old because his Mother was pregnant again -He entered the study at 15 months and weighed 7.9 kilos, putting him in "moderately malnourished" category -In the next month, Mori got the measles and spent 18 days in hospital, being fed through a subclavicular IV -At 16 months old, mother reported that since coming home from hospital, he "refused to eat" but she made little effort in encouraging him to eat or drink -Mother not interested in suggestions, preferred to talk about current pregnancy -At 16 months, his weight dropped to 6.7 kilos, at 17 months dropped again to 6.4 kilos Mori died before he reached 18 months -Grandmother blamed his death on his mother (her daughter) saying she was a "___ _______" and "did not care about her children" -The mother blamed his death on the measles and refusal to eat and felt no responsibility -The fact that she weaned Mori very early because of her pregnancy indicates that they were not observing the tradition of waiting to wean the baby until he can walk -Shortly after Mori died, his mother and father moved due to "arguments" with the grandmother and were lost in the study for more than a year -Mori's mother was "below average" since she was inexperienced and rejected traditional values -Her focus was on her husband and the modern lifestyle, if this had been different Mori may have survived -The combination of amateurish parents, premature weaning and poor outlook turned out to be fatal

warfare one single

Malnutrition in Mali Overall Conclusion -After the conduction of research in this study, we see that there are many contributing factors to the cause of malnutrition. -There are effects such as weather, which caused many child deaths in the drought of 1985-1985. -Other factors such as ________ and refugee camps represent causes for worldwide malnutrition -The mothers from this study had to face constraints such as poverty, social institutions, traditional practices, inadequate health care, contaminated environment and lack of running water and electricity. -This causes many of the children of these communities to be malnourished -However, there are other factors from within the home that contribute. It is apparent that the families who had access to medical attention for their sick children were the families whose children recovered from illness. Mothers who did not seek out the attention and treatments, or have access to funds for their severely malnourished kids did not have the same outcome -While not every situation for malnourished children and their fate has the same causes, many cases can have similarities in underlying factors, such as poverty and lack of medical relief. And that is what we need to focus on in future research in order to hopefully change the outcomes. -The three case studies may have differed in detail, but in every case a variety of biological, social, and cultural factors contributed to the child's poor growth and malnutrition -It is misleading to think that there is ____ _______ factor that causes, or cures malnutrition. There are a variety of factors that contribute to both the cause and the cure. -"To save a child from death by diarrhea today using oral rehydration solution, so that he can die tomorrow from malaria, is not a significant improvement."

poverty

Malnutrition in Mali Results -Relative __________ is not an accurate predictor of observed variations in nutritional status and growth -Other cultural factors that are responsible -Malnutrition is a result of a complex set of factors acting in combination

males

Obesity: -In conclusion, obesity considers both its evolutionary background and cross-cultural variation. It explains three basic facts about obesity: Gender dimorphism (woman > men), an increase with modernization, and positive association with socioeconomic status. -Obesity is so prevalent in society it has created a very profitable weight loss industry and obesity leads to a higher risk of cardiovascular disease, stroke, and certain types of cancer. Fear of obesity, has also led to eating disorders such as anorexia, and bulimia. -Majority of the world's cultures had a have ideals of feminine beauty that includes plumpness which is consistent with the hypothesis of developed/underdeveloped countries with and socioeconomic status correlating western populations. -Working/lower class are more likely to be/become obese due to it's lack of proper nutritional diet/resources. -It's more acceptable for ______ to be overweight, whereas women have to control their weight due to the stigma and norms of society of slim being sexy.

social class less genetics and cultural fatness

Obesity: -____ ______ and obesity are inversely related in heterogenous and affluent societies such as the US -especially for women -This correlation doesn't always stay consistent during the duration of a woman's life. In childhood, middle and upper class women are fatter than poorer women to be from the lower class while the middle and upper class women become _____ obese. -Obesity is thought to be the product of two main etiologies: ____ and _____ predispositions are the two main culprits. -Obesity genetic traits and the cultural selectivity of these traits may be linked by their evolutionary causes. -First, the traits code for "_______" were selected for improved survivability during food shortages, especially for nursing or pregnant women and also fatness was selected for genetically because it is a cultural symbol of prestige and index for general health.

protein double food shortages

Obesity: Adequacy of Pre-Industrial Diets -Studies of paleolithic diets showed food foragers were high in _____, fiber, and vegetable carbohydrates and low in sugar and saturated fats -This diet was more strict and stringent than that recommended by the FDA today. This study also stated that the increase in population sizes showed a tendency for people to switch to less healthy alternatives. -In ethnographic studies of the diets of todays non-industrialized countries foraging societies, the diets that were observed were also within the recommended US standards for mean percent of calories from fats and carbohydrates while protein intake was _____ the recommended values. There main inadequacy is the susceptibility to _____ ______.

95 mortality neolithic socioeconomic

Obesity: Cultural Evolution: -__-99% of human history has consisted of humans as hunter/gatherers -Food foragers lived in small, socially flexible, semi-nomadic bands, experiencing slow population growth because of longer nursing and development times and also higher infant ______. -They were however, healthier as a result of high quality diets and a tiny proportion of time allowed for food acquisition. -Around 12,000 years ago, humans evolve into food producing economies this included the domestication of plants and animals including the selection of certain phenotypes in plants and animals = ______ revolution. -This allowed for the growth in population and also for more complex societies and civilizations. -Larger societies led to food _____ and osteological evidence of nutritional stress, poor health, and diminished stature. -The stratification of social elites and pawns led to food scarcity for some while insulating the stocks of the rich. -Obesity didn't become common until Europe's elites around 200 years ago and symbolized ones ___________ status.

agriculture food foraging supplements emergencies

Obesity: Food Shortages and Adaptations to Scarcity Food shortages have been common in human history -Mild shortages -Medium shortages -Severe Shortages Relationship between weather and food foraging/agricultural societies -More rainfall= _________ -Less rainfall= food _______ Food shortages and their effect on birth weights and childbirth -Third Harvard Growth study Cultural adaptations to allow for successful pregnancies and childbirth 1. usage of ______ 2. storage of foods 3. valuables exchanged for food in ________ 4. Holding strong relations with people of other regions.

Dimorphism adipose and subcataneous

Obesity: Sexual ________: phenotypic difference or obvious differences between male and female of the same species Men -Larger stature Total body mass greater Women -Larger skinfold test measures -more ______ and ______ fat -Western population more likely to be/become obese -!Kung San Both -Distribution: trunk, arms, legs -Reproductive maturation -Peripheral fat -Certain Types unrelated to chronic illness -In poor populations in underdeveloped world more of equivalent ratio in being/becoming fat.

self-worth stigmatized five women and not for men

Obesity: The social meaning of Obesity: Cross-Cultural Comparisons -In many societies, fatness is psychologically linked to self-_____ and sexuality. In our mainstream culture in the US, obesity is socially _______. -Weight loss is a major industry in the US ranking in over ___ billion dollars in expenditures. -Between 1943 and 1980, ideal weights have decreased and continue to fall for ______ and not for ______. However, more recently these weights have slightly risen in light of achieving healthy weights compared to cosmetic weights. -Though obesity is mainly seen as a negative aspect of the body in the US culture, this is not the case cross culturally -In many other cultures, fatness is seen as a sign of health and prosperity and thinness conveys starvation. -It may be large body size rather than obesity in agricultural societies that is an admired symbol of health, prestige, and prosperity and maternity.

81 Arab smarter economic

Obesity: The social meaning of obesity: Cross Cultural Comparisons -So far we have no systematic cross-cultural survey of feminine beauty or ideal body type. -For data we do have, plumpness or desire of being filled occurs in ___ percent of societies. -Fatness can also be a symbol of maternity and nurturance in other cultures. -Larger women are seen as well taken care of and take good care of their children. -In ____ societies a fat woman has more room to bear children. -American Ideals of thinness occur in a setting where it is easy to become fat, and preference for plumpness occurs in settings where it easy to remain lean due to food shortages. -American society most people aim to be thin. This is seen as healthy and lean people may be viewed as sexier and even _______. -In other societies thinness is seen as a sign of starvation and thin people are pitied for this. People seek to be larger. -Ethnographic records concerning body preference for males are weak. -Thinness for women in US is seen as a symbol of ________ status mostly for middle and upper class people, and show leisure time.

Anthropometric fiber Polynesian first

Obesity: Three Social Epidemiological Facts- Obesity and Modernization- Culture change/modernization -Obesity Prevalence __________ studies -Traditional hunter, gatherer populations -did not report obesity Change in Diets -Decrease in ____ intake -Increase of fats and sugars _________ Islanders study -compare diet and health -different stages of acculturation -Islands of rapid modernization had a _____ percentage than traditional. Trowell and Burkitt -15 case studies increase obesity with western disease during modernization -___ of diseases to appear

Material Idealistic prehistoric

Obesity: Variables of Obesity: __________: -Economic Status -Diet _________: -Cultural Perspective -Aesthetic Standards of Ideal Body Type -Symbolic meaning of "fatness" Cross-cultural approach looking at ______ periods relationship between economic production and diet

25% cardiovascular

Obesity: __% of 2-5 year olds and 33% of school aged children are considered obese in the US -Obesity is so prevalent in society it has created a very profitable weight loss industry -Obesity leads to higher risk of ________ disease, stroke, and certain types of cancer. -Fear of obesity, has led to eating disorders such as anorexia, and bulimia.

Kendall Foote

Oral Rehydration Therapy Authors -Karl ______ - well known anthropologist and professor of global and community health who works primarily in Latin America -Dennis _____ - works for the Academy for Educational Development and vice president of the Global Learning Group -Renyaldo Martorell -Professor of global health and nutrition at Emory University and expert in child health and nutrition

purgatives

Oral Rehydration Therapy Discussion -Program overall successful about informing families of ORT -Diarrhea attributed to empacho was treated with _______ instead of ORT (8/9) Reasons of Rejection -Rejection of public discussion of Empacho by Honduran cosmopolitan medical community and refusing to promote ORT as purgative -Few mothers identifying empacho as diarrheal disease -Primary symptoms before diarrhea, stomach ache and skin quality change -Reasons initial studies were not utilized -"What if" survey formats can be greatly challenged

empacho purgative 56% 11 empacho

Oral Rehydration Therapy Ethnomedical Results -Original study found resistance to use ORT as treatment of Empacho -normal treatment is purgatives -Used a survey "Can healer x cure y" -Many believed diarrhea could be cured not _________ or ojo -No one surveyed knew about dehydration -Medical community did not use these results in planning -Outcome of these findings market ORT as __________ Results -Surveyed diarrhea occurrence, food intake,demographic changes and Campaign exposure -On average __% to 45% of children had diarrhea -Every women except one breastfed -All families claimed awareness of ORT -Of 20 cases reported ___ used ORT (Doesn't mean they followed protocol) -9 cases did not use ORT of these 8 were attributed to _______.

750 ethnomedical

Oral Rehydration Therapy Honduras Case Study -Jointly administered by Academy for Educational Development and Division of Education of the Honduras Ministry of Health -Study of ___ families in 20 sites in Honduras -Conducted concurrently with ethnographic investigate -Portrays need for/difficulties with _________ perspectives -Active in Honduras for three years

diarrhea

Oral Rehydration Therapy Introduction -Dehydration due to _______ has been a major cause of childhood mortality in developing world -The World Health Organization has designated diarrheal disease control as a primary objective -This case study presents a program that refuses to incorporate an ethnomedical perspective to promote acceptance and use of Oral Rehydration Therapy -Need for cross-cultural communication between biomedical and ethnomedical systems.

one Shopkeepers

Oral Rehydration Therapy Medical Services: Biomedicine Biomedicine: -Ministry of Health facility is staffed by a graduate medical student and two nurses -The Ministry of Health facility is a ___ and a half hour walk from Los Dolores -Two local representatives in Los Dolores: village health worker and a health promoter in sanitation projects -_________ and clerks carry medicines and prescribe to the locals (no pharmacies) -Nearest hospital is located in the capital of Honduras, a one and a half hour bus ride away

injectoadores purteras sobadores

Oral Rehydration Therapy Medical Services: Local -There are no injectadores or purteras in Los Dolores. -___________: people that dispense medication by injections -________: traditional or trained midwives -Instead, nearby communities provide healers -_________: massages the body and prescribes medicines for a number of diseases (men or women) -Herbal remedies are used by older men and women -Younger villagers do not know these remedies and prefer commercially packaged medicines

sodium potassium glucose

Oral Rehydration Therapy Oral Rehydration Therapy -Orally distributed hydration packet containing: 3.5g _______ chloride 2.5g ________ chloride 2.5g sodium bicarbonate 20g _______ Added to 1 liter of clean water at home What is ORT? -A safe and effective therapy for dehydration -For use in rural households -Widely known in the village, but treatment was not always used -Designed to help combat diarrhea

Interviews

Oral Rehydration Therapy Research and Site Evaluation Research -Los Dolores, one of the main sites of research and share Ladino culture -Spring of 1980-________ were conducted with four key informants and Ministry Health staff -June 1980-all households were conducted to collect baseline data on household size, maternal histories,mortality, hygiene and sanitation Investigation centered around diarrheal disease treatment, literacy, radio listening habits and household characteristics Evaluation -There was a peak of diarrhea incidence during June just after the rainy season had started. -All households in Los Dolores posses land which were quite small -Rainfall extends from May to October, which is the cause of high streams -Valley floors consist of mainly farms throughout the lands

Municipio Aldea three

Oral Rehydration Therapy Social Context -________: the local political-administrative unit that contains a headquarters and a number of villages and hamlets -______: a typical rural community is a locale with a number of town centers all connected by paths. -Over 20 of these communities were studied, and six of the sites became inaccessible in the rainy season. -All villages have primary schools for grades 1-6 and secondary schools are located in the headquarters of the municipio -Only ________ aldeas have completed water systems and none have electricity

Honduras

Oral Rehydration Therapy The Program -Integrated Program of radio, print material, and health worker training to teach and reinforce changes in a variety of practices and beliefs surrounding infant diarrhea and ways to promote ORT. -Involves samples from 750-800 families from over roughly around 20 communities in ________ (each family is visited over two years by a field worker to take surveys questions, make observations and measure the children) -Methods used for Program: heavy use of research for planning, pretesting and evaluation, use of integrated campaign format through various channels and concentration on a set of objectives.

Ojo red

Oral Rehydration Therapy ____ (evil eye) =Result of malicious penetrant visual rays Produces fever and lack of symmetry in eyes Two types: Mal de ojo- ____, sore eyes Ojo- penetrant rays Treatment -Bundling, spraying of skin with liquids -No purgatives used

Caida Lombrices gut empacho

Oral Rehydration Therapy ____ de Mollera (fallen fontanelles) -Believed to be caused by improper maternal handling of an infant -Infant's palate is incompletely developed -Tissues underlying the fontanelles can fall Treatment -Pushing on the roof of the mouth -Tapping on the heels of inverted child -Sucking on the fontanelles _________ (worms) -Known as normal symbiote of the ____. -When mistreated it is able to leave the sack and wander the body and cause illness(mistreatment by purgative results in fatal illness such as worm fever) Treatment -Administration of mild local purgatives -Worm fever is treated like __________

Empacho

Oral Rehydration Therapy _______ =A painful condition of the gut. Symptoms: -Explosive evacuations -flatulence -skin quality indicator Causes: -heavy foods (pesado) -improper balance of foods on hot-cold spectrum Treatment: -masseur or masseuse (sabador or sabadora) massages and applies purgatives -Purgatives- substance that promotes evacuation (oil, salts or absorbents) -Cleans (limpiar) gut of improperly digested, or dirty (sucio) contents

Identity stake illness Narrative Psychosocial Culture Culture Competency

Problem of Cultural Competency A Revised Cultural Formulation --Step 1: Ethnic ________: Determine the importance to the patient Ethnicity is a vital aspect of how life is lived However, it's importance varies from case to case with the individual --Step 2: What is at ______?: evaluate how this illness will affect the patient and loved ones --Step 3: The ______ _______: acquiring an understanding of the meaning of illness from the patient using a series of questions to evaluate the patient's explanatory model using this explanatory model to determine cultural meanings and their implications for care --Step 4: _________ Stress: Considering the ongoing stress and social supports that characterize people's lives. Having interventions could help improve patients difficulties such as professional therapy, self-treatment, family assistance. --Step 5: Influence of ________ on Clinical Relationship: examining culture in terms of its influence on clinical relationship. --Step 6: The Problems of a ______ _______: Taking into account the question of efficacy, "Does this intervention actually work in particular cases?"

certain static identity cultural formulation

Problem of Cultural Competency Conclusion --Under cultural competency, physicians and professionals can assume certain things that makes it easy to overlook the basic factors like economic and overall health of the patient because they might contribute the causes of a problem to cultural factors instead. •--Cultural competency leads people to assume what each culture contains and makes physicians and health professionals treat patients a _______ way. •--CMA seeks to show that one of the main problems with cultural competence is that it assumes that culture is _____, or in other words a variable or something that medical professionals can acquire and easily change. •--CMA argues that culture on the other hand is composed of many factors (such as religion, political, economic, and affecting many different aspects of one's life and the way one experiences their life. •--Cultural competency causes cultures to be put in a certain box thus making it easy for the patient to lose their _________, as seen with the explanatory models approach. •--The revised ______ ________ model is important to help the clinician what is most important for the patient and helps focus on the patient as an individual with different influences rather than a person of a different culture.

Static Culture ethnic

Problem of Cultural Competency Culture Is Not ______ --In anthropology today, culture is not viewed as static. -"Anthropologists emphasize that culture is not a single variable but rather comprises multiple variables affecting all aspects of experience." --_______ cannot be separated from economic, political, religious, psychological, and biological conditions. --Cultural processes represented by psychophysiological reactions, interpersonal attachments, religious practices, and cultivating collective and individual identity. --Even within the same _______ group, it is common for cultural processes to differ among groups of individuals based off their age, gender, political affiliation, class, religion, and personality.

broken individual

Problem of Cultural Competency Determining What is at Stake for the Patient -Using culturally appropriate terms to explain people's life stories helps in the restoration of "_______" relationships between the patient and the health professional. -Health care professionals must not stereotype or stigmatize patients. -Culture is not just what patients have, but clinicians also participate in cultural worlds themselves. -As French philosopher Emmanuel Levinas stated: "In the face of a person's suffering, the first ethical task is acknowledgement...Face-to-face moral issues take precedent over epistemological and cultural ones." -The point is, health care practitioners must speak to the patient as an _________, not in the context of the individuals assumed cultural background.

skill do's & don'ts racial

Problem of Cultural Competency Problems with the Idea of Cultural Competency --The major problem with the idea of cultural competency is that it minimizes culture to a ____ or practice that clinicians may become trained upon. --The origin of this problem is due to how culture is defined within medicine. Yet, it's definition in medicine is strongly different within anthropology. --Cultural competency gives rise to the "___ and ____" of how to treat an individual based off their ethnic background. This only leads to further stereotyping within a culture and can hinder a gaining true understanding of an individual and their background. -Example: A Mexican Father & Son with HIV -Sometimes solely looking at culture causes an individual to ignore other factors such a social, political, or economic status. --It is important to take culture seriously while avoiding dangerous stereotyping. --Unfortunately, biomedicine has created a stigma that incorporates ______ bias when it comes to patient treatment which has further led to large health disparities across minorities.

Ethnography split experience

Problem of Cultural Competency The Importance of Ethnography --__________ -Definition: refers to an anthropologist's description of what life is like in a "local world", a specific setting in a society that is usually different from that of the anthropologist's world. --How is Ethnography Studied? -Visit a foreign country and learn the local language and social patterns of the village, neighborhood, town, etc. -Involves significant engagement with the natives to acquire an appreciation for their religion, moral value, and everyday practices -Significant importance placed on understanding the native point of view (sets it apart from other social research methods) --Ethnography versus Cultural Competency -Ethnography disregards the "trait list approach" that is associated with cultural competency -Creates hindering stereotypes -Example: "Chinese eat pork, Jews don't" -Addresses the "____" feeling that some people may feel that are between two cultures (Jewish and Christian, American and French) while cultural competency does not -Clinicians and Anthropologists share a belief in the importance of __________ -With more experience, clinicians can act as a anthropologist and empathize with the lived experience of the patient's illness -Better understand how he or she feels and their point of view in suffering form the illness

Explanatory measurement conversation

Problem of Cultural Competency The _________ Models Approach -The Model -an interview technique used to understand how a patient's world affects and is affected by an illness -often misused by clinicians as a measurement tool (blood pressure, hemoglobin, MRI, X-Rays) --Current Problem -Clinicians use model as a __________ tool similar to blood pressure, MRI, hemoglobin, etc. -end conversation rather than to start a conversation -the model as a tool does not validate the human experience (patient's perspective) as an essential clinical concern --Solution -The model should be used as a ________ opener -Set the patient's explanation alongside the clinician's expert knowledge -Allows for a "mini ethnography" to be done by health care provider -Can be done with a revision of the Cultural Formulation

Kleinman symptomology

Psychiatric Diseases in Different Cultures -Arthur _________ is an eminent physician, medical anthropologist, and professor of psychiatry and anthropology at Harvard University. -He's written many books and articles focusing on cross cultural psychiatry, social stigma, and chronic pain. -In this article, he challenges us to consider the degree to which psychiatric or medical categories are really universal or objective and how different cultures influence basic concepts such as epidemiology and __________ of psychiatry.

Unemployment stress witchcraft

Psychiatric Diseases in Different Cultures Contrasting causes of Schizophrenia Occurrence and course of Schizophrenia depends on: -Differing Political Economies -__________ rates -Economic depression -Capitalist modes of wage labor (non-western society) -Differing cross cultural _____ levels and lifestyles -Differing definitions of schizophrenia -Ex. Non-western societies believe that possession and __________ is a symptom of schizophrenia whereas western societies do not.

Waxler's normalization industrialized

Psychiatric Diseases in Different Cultures Course and Outcome -_______ Theory (1977) Schizophrenia= an acute problem and patients suffering from it are expected to recover just as quickly as those who suffer from other acute disorders -Reinforced by familial and community responses to the patient that encourage _________ -Long term outcomes are measured by the result of social messages and interpersonal reactions to the patient and prevent his/her sense of control and undermine his/her optimism Factors to better outcome from schizophrenia -Economics of disability -Investment of certain mental health programs in maintaining patients in long-term patient roles -Very high demand that __________ societies make on former patients in the absence of effective supports

1/3 40% Psychomotor reproach

Psychiatric Diseases in Different Cultures Cross cultural study of depression in Montreal, Teheran, Basel, Nagasaki, and Tokyo -¾ of the depressed patients studied in these countries had symptoms of sadness, joylessness, anxiety, tension, lack of energy, decreased interest and concentration, and feelings of inadequacy and worthlessness. -_/_ had symptoms of hypochondriacally ideas (anxious about their health) -___% had somatic complaints, obsessions, and phobias -More personality disorders were found in the Western centers included in the study -__________ agitation was more frequent in Teheran -Symptoms of self-________ were higher in European centers

1981

Psychiatric Diseases in Different Cultures Depression in China and Other Non-Western Societies -Prior to 19__, clinical depression was simply not recorded -After 1981, depression rates shot up from 1% to 20% in China due to: -Use of newer Western-influenced diagnostic criteria and assessment tools -Different ways of expressing distress -It's much more common to express depression now that it's more culturally accepted -Difference in help-seeking patterns ex. Some cultures go to psychiatrists or doctors, others go to a shaman or other indigenous healers

Depression 3.2% in Males 4-9.3% in Females Uganda

Psychiatric Diseases in Different Cultures Epidemiology (___________) -Much greater range of variation from culture to culture -Western Societies: Much more common -_.2% in males -4%-_.3% in women Non-Western Societies: -Little to no studies -Range in prevalence in these societies are much greater Ex. ________ has the highest rates of depression in Africa due to: -pressures and problems of modernization -political chaos -murderous oppression 14.3% in men 22.6% in women

Scandinavian 17 12.6

Psychiatric Diseases in Different Cultures Epidemiology Studies -Studies have shown small scale, preliterate societies with hardly any cases and small communities (isolated _________ ones) with very high rates. -Book et a. 1978 reported a rate of __ cases per thousand in northern Sweden. -Torrey et al 1984 report a rate of __._ per one thousand in western Ireland

procreation witchcraft

Psychiatric Diseases in Different Cultures Generalized anxiety disorders among Yoruba and west africa Three clusters of primary symptoms: -Worries (________ of large family) -Dreams of _______ -Bodily complaints

help seeking

Psychiatric Diseases in Different Cultures Illness Behavior -Few researchers have actually compared the illness behavior (meaningful experience of symptoms and patterns of coming and help seeking-of appropriately matched samples of depressed or anxious patients in different societies.) -There are differences in pattern of ____ ________ Ex. North American Indian, Asian and Caucasian ethnic patients follow distinctive pathways to the mental health center, arrive there at very different points in the course of illness, and experience greatly divergent types of involvement of their family members -Differences in response to psychiatric treatment Among east Asian and Caucasian groups, disclosing different physiological responses to treatment in their ethnic groups

polluted

Psychiatric Diseases in Different Cultures Illness behavior: Anorexia -The symbolic meaning in modern Portuguese peasant society and medieval Italy is to bring what society deems "_______" women closer to God -The symbolic meaning in North America is subjecting young girls to starving themselves as a way to fit the body image that society has created -Anorexia is more of a Western society illness because of how it is depicted by society whereas in modern Portuguese peasant societies it's not really viewed negatively

little

Psychiatric Diseases in Different Cultures North American and Western European Society -Trained to treat schizophrenic patients with expectations that _____ can be done to help them recover -Research shows that the course of many schizophrenic patients is more hopeful in the West than the professional stereotype

international

Psychiatric Diseases in Different Cultures Society/Geographical Differences (Schizophrenia) -Different societies have different ways of classifying and defining certain physiological diseases such as schizophrenia -There is no ___________ standardized definition of each disease Western Societies: -A lot of cases, more common -Chronic mode of onset is more common which is the only kind of onset that is considered schizophrenia in the DSM III. Non-industrial/Developing societies: -Far fewer cases of schizophrenia -Acute onset (quicker duration) is more common, which isn't considered schizophrenia in the DSM III

selective

Psychiatric Diseases in Different Cultures Symptoms from Chinese and Taiwan societies Similarities -Headaches -Dizziness -Lack of energy -Chinese, however, appear to be more ________ with diagnosing and perceive, label, and communicate these symptoms differently.

Epidemiology ten

Psychiatric Diseases in Different Cultures __________ is the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health. -Data suggests a band of prevalence rates ranging from roughly two to ___ cases of schizophrenia per thousand population across a range of populations. -However, research on diseases such as schizophrenia is limited, and a specific cause is unknown, leading to different diagnostic criteria. -The DSM III only considers a disease as schizophrenia if there is at least 6 months of symptoms. -The world health ICD-9 doesn't have the same diagnostic requirements which leads to inconsistent diagnosis and skewed cross cultural rates.

Symptomology

Psychiatric Diseases in Different Cultures __________ of mental illness -How people's ways of reacting to their symptoms and seeking help differs cross culturally -This section in the article mainly focuses on depression, anxiety, and suicide and how they differ in different societies.

somatization Hunan catholic family

Psychiatric Diseases in Different Cultures: Suicide rates -Less common among third world countries along with better course and outcomes -Due to the many suicide cases that have gone unrecorded in third world countries -Treated as _________ (as a long term illness) rather than as acute -More suicides among Western societies -Less suicide among Chinese in _____ -Due to Somatization (misdiagnosing of depression) -Lower among Peruvians than North Americans -Due to teachings of _________ church against suicide -Lower rates in India -Due to emphasis on ________ obligations over individual rights and beliefs in karma. -Attempted and completed suicide rates are higher among women than men in all cultures -Due to powerlessness, difficulty communicating problems, and despair

couples

Religion and Reproductive Technologies: -Infertility used to be the problem of just women but now it has become the problem of ________ -Reproductive technologies such as surrogacy, sperm donation, egg donation and egg implantation are all issues that are acceptable in the U.S. but raise ethically issue in other countries -One of the most popular differences in opinions on the in vitro fertilization (IVF) compared to the U.S. is the views of the Islamic nations -In Islamic nations the moral acceptability of reproductive technologies is left in the hands of scholars/clerics -In this chapter we will be looking at the views of the two branches of Islam the Sunni and the Shi'ite branches and their opinions on IVF compared to the United States

20

Religion and Reproductive Technologies: Conclusion -Reproductive technologies have brought hope to infertile couples over the last ___ years since its introduction to the Muslim world -It has also fundamentally altered the ways in which families can be made and the ways in which marriages can be saved through the use of donor technology.

adoption marriage surrogacy

Religion and Reproductive Technologies: Iran -The religious leader Ayatollah Khamanei issued the fatwa for the Shi'ite allowing donors -In 2003 Iranian parliament made sperm donation illegal in Iran reversing Ayatollah's proclamation to the Shi'ite in Iran -But in Iran embryo donation from one married couple to another is allowed because everyone involved is married and the transfer of the embryo to another couple is considered a form of _________. -Egg donation is allowed as long as the husband conducts a temporary muta _________, making all three parties married. -In recent years the Shi'ite in Iran have been one of the only Muslim countries to adopt __________.

childlessness Louise Brown Fatwa

Religion and Reproductive Technologies: Main Issues -Reproductive health -achieving a much desired pregnancy overcoming the stigmatization __________. -Since the birth of _____ Brown, the worlds first test tube baby, in 1978 new technologies have been adopted to help couples facing infertility -In the Middle East private the IVF industry is expanding with larger places like Egypt having 50 IVF clinics and smaller places like Lebanon having 15. What anthropologist are looking at in this study -How local morals come into play when Muslims attempt to use the new reproductive technologies -Muslims seek out the opinion of fatwa's before implementing any new reproductive technologies -______-nonbinding but authoritative religious proclamation made by an esteemed religious scholar

Sunni

Religion and Reproductive Technologies: Marriage Saviors -The Shi'ite practices of allowing egg and embryo and sometimes sperm donation have been considered by those infertile couples are marriage saviors -They have been said to have helped avoid martial and psychological disputes amongst couples -It has been found the some _______ are going against religious leaders fatwa's secretly and seeking donors to help conceive.

Sunni forbidden

Religion and Reproductive Technologies: ______ Muslim world -First fatwa was issued on March 23,1980 speaking for the Sunni Muslim world -Al Azhar was the religious leader that issued the official fatwa about IVF for the Sunni -Sunni Islam is the dominant form of Islam in the Muslim world ( 90% of the worlds 1.3 billion Muslims are Sunni) -According to the Sunni vitro fertilization is allowed as long as it entails the union of the ova from the wife with the sperm from the husband and the transfer of the embryo back into the uterus of the same wife -Surrogacy and the use of any 3rd parties for sperm egg of embryo donation is _________.

Shi'ite adoptive polygamy

Religion and Reproductive Technologies: _______ Muslim world -The minority branch of Islam found in parts of Iraq, Lebanon and Saudi Arabia is the Shi'ite (popular for its war with the U.S. ) -Allows donor technologies to be used with regard to sperm and eggs and infertile parents are considered ________ parents -But the Shi'ite also practice ijtihad- individual religious reasoning. -Some religious leaders amongst the Shi'ite still denounce donors forbidding their followers to use it. -Others Shit'ite accept egg donation and consider it ________ which is allowed but reject sperm donation because it is considered polyandry ( a marriage with multiple husbands).

women catharsis

Sacred Healing and Biomedicine -Mexican spiritualist healers are primarily _______ -Spiritualist tame the spirits of the dead that roam the Universe and harness them for the good of mankind to heal the sick -Do not provide definite diagnosis -Possesses a gift that requires future development -Possessed by an obscure spirit that require removal -Once a person can train their gift, they can become a healer, or another type of temple functionary Techniques include -Ritual cleansing -Purgatives -Massages -Spiritual surgeries -Pharmaceuticals -Passive _______ - when the patient experiences a sense of relief without having said anything

Susto

Sacred Healing and Biomedicine Etiological Beliefs and Diagnoses -Environmental Assaults -Interactions -Inappropriate diet -Emotion (anger) -_____

witchcraft

Sacred Healing and Biomedicine Etiological Beliefs and Diagnoses -If biomedicine fails, ___________ is believed to be the etiology and treatment is sought from a spiritualist. -Spiritualists typically deny witchcraft as a cause. -This denial removes the fault from neighbors, relatives, etc. -Culpability is placed on impersonal spirits. This restores order and avoids future anger resulting in illness -Spiritualists are not focused on etiology. If they are, it is fixed and usually attributed to acts of evil spirits. -Mexican physicians use a combination of traditional folk understandings and biomedicine to explain illness -Physician's justifications relating to the body were based on biomedical understandings of the body, pathogens, stress, and obesity in addition to folk understanding such as anger, nerves, and fright. -Illness is never attributed to spirits or witchcraft.

consistent stereotypic Biomedicine

Sacred Healing and Biomedicine Etiological Beliefs and Diagnoses -Spiritualist diagnoses are limited, and they tend to be ___________. -Patients don't expect diagnosis from Spiritualist, but expect them from physicians. -Physician base diagnosis on symptoms, medical history, and a physical exam -Found that physicians' judgements were based on ________ epidemiological understandings of the population, training, experience, and moral values. -Physicians are required to test hypotheses and revise diagnoses based on observations and the patients response to treatment. -This can be upsetting to the patient. Changing the diagnosis showed uncertainty in the physicians knowledge to cure an illness -Patients who received various diagnoses from the same or different doctors became worried about the nature of their illness and sought confirmation from spiritualists. -_________ alters the way patient's view their bodies. -Frequency of sexual intercourse, menstruation, contraception, number of births and abortions -Became especially prevalent in the age of AIDS -Women changed the concept of shape of their bodies when physicians diagnosed patients as obese and prescribed special diets.

men

Sacred Healing and Biomedicine Mexican Biomedicine Practice -Physicians are mostly ____ -All employ similar technological advances (scales, stethoscopes, and x-ray machines) and international vocabulary of diseases

autonomy

Sacred Healing and Biomedicine Physical Setting -Respective societies influence healing environments -The settings where healers practice reflect Mexican cultures concern with family, community, and lacks privacy -Biomedicine respects patient ________ -Mexico adopted, from Europe and the United States, spatial structure of the physician and patient encounter

limited 21 Palpation Auscultation

Sacred Healing and Biomedicine Physicians Interactions with Patients -Physician and patients sit facing one another -Physical contact is ________ -Limited to the physician's physical explorations by palpation1 and auscultation2 -Physicians' expression vary some smile some maintain serious demeanor -Consultation time usually average __ minutes with patients, Spiritualist healers spend about half this time on average. 1. _________: the process of using ones hands to examine the body ___________ (based on the Latin verb auscultare "to listen") is the term for listening to the internal sounds of the body, usually using a stethoscope.

lack

Sacred Healing and Biomedicine Practitioner-Patient Encounter -The doctor-patient encounter has become a central concern in the study of biomedical activities -There is a widespread notion that the doctor-patient relationship provides the key to good medical practice -Alternative healers (as well as Spiritualists) are often held up as examples to show what physician-patient relationships _____ -Mainly because they have a holistic view if the patient -Contrary to belief, it has been discovered that Spiritualist healer lack many positive traits for successful interaction with patient that physicians have: eye contact with patients fail to recognize the individual

healthy affliction

Sacred Healing and Biomedicine Recruitment into the Healing Role -Those recruited into the medical profession are usually ______ individual -Those recruited into Spiritualist healing usually experience an ________ themselves before becoming healers. -Formerly sick, who have become health providers -Are examples of potential recovery -Convey to the patient that they understand the patients anguish (from personal experience) -Doctors cannot provide the patient with evidence as Spiritualist healers proudly do -Doctors must have adequate schooling

Spiritualist Physical

Sacred Healing and Biomedicine Similarities between Spiritualists and Biomedical practices -Focuses on the body -Symptom alleviation in much of the same way -Dualistic view of the body and inner disturbances -________ cleanse the body of its impurities whereas physicians describe antibiotics -Both physicians and healers attempt to peer inside the body (technology vs. spirits) Differences between Spiritualists and Biomedical practices -________ setting -Etiological beliefs and Diagnoses -Practitioner-patient Encounter -Recruitment into the healing role practice -Treatment Repertoires

closed

Sacred Healing and Biomedicine Spiritualist Healers Interactions with Patients -Sit in a trance with expressionless faces -Eyes _______ -Holding and/or stroking the patient -Patient briefly murmurs a description of the disorder -This trance state precludes the healers' displaying any kind of affect for their patient

treatments complex Spiritualist

Sacred Healing and Biomedicine Treatment Repertoires -Spiritualist healers' diagnoses are relatively simple, but ___________ are complex -Physicians' diagnoses are _________, but the cure repertoire is limited -Physicians' treatments are chiefly medication or surgery -Spiritualist healers' treatment kit contains a large array of treatment option -Patient involvement in treatment activities -Use of pharmaceuticals or herbs or other botanicals -Taking baths that require preparation -Participation in Spiritual rituals -Physicians take full responsibility for the patient's successful cure -If not, for their failure to heal -Spiritualist healers assign responsibility to patients for their cure -By constantly reminding them that they must have unrelenting faith in the Spiritualist God and His benevolence

lower

Sacred Healing and Biomedicine: Methods -Two separate research periods -Spent two years in a Spiritualist temple in a rural region of Mexico -Observed 1,212 healer-patient interactions -Studied healing practice of 10 healers -Spent two years in a large urban hospital in Mexico City -Sat in on 800 medical consultations -Studied healing practice of 17 physicians -Followed up on patients in both studies to evaluate their responses to the treatment -Patients at both places were ________ class and had similar non-life threatening complaints

Spiritualism romanticized

Sacred Healing and Biomedicine: •________ in Mexico originated in 19th century - Anti-Catholic stance - Hundreds of first time patients seeking healing for self-assessed, nongrave ailmets •French model of scientific medicine introduced in 19th century, but after WWII, US model replaced it and is still followed today. •Many differences between spiritualism and biomedicine - Sacred world vs. secular science - Folk practitioners vs. professionals with formal training •People judge treatments they are given by their effects. •Two perspectives on alternative healing: - Folk healers _________ - Folk healers dismissed as crazy •Patients who go to Spiritualist healers usually go after unsuccessful treatment by physicians.

Asexual

The Damaged Self -Common view of disabled: ______ -But most of disabled still have same sexual urges as able bodied and are just as capable at expressing them. -A large part of the disabled population are able to lead normal and healthy sex lives.

Murphy Brazil Body Silent

The Damaged Self -Robert F. _______ (1924-1990) -Anthropology professor at Columbia University -Original fieldwork dealt with social structure of the Mundurucu, who live in the Amazon forest of ______ -Diagnosed with a slow-growing spinal tumor in 1974 -Wheelchair bound two years later -Began research on the anthropology of disability -"The Damaged Self" is a passage from his book, The ___ ______ (1987) -Uses personal experience and anthropological observations on the experiences of the disabled

castration Mental C-section

The Damaged Self Males -Creates "________ anxiety"—removal of testes. -Can no longer engage in genital sex from the numbness of genitals. Murphy says males have become "effectively emasculated" -"_______ orgasm"—since no longer can physically have sex or orgasm, males develop an ability to use their brain to achieve sexual climax. Females -Also have lost the ability to orgasm, but still engage in genital intercourse because they don't need to be aroused to have sex. -Most can even bear children through _______ -Derive psychological gratification and stimulation of other parts of body through knowing they can still provide pleasure to others. -Women are still able to be active participants of sexual relationships because of these reasons.

entire

The Damaged Self Medical Aspect -In regards to a damaged body, biomedicine has an inability to deal with the ________ self. -Medical people have little curiosity about what the patient thinks about their condition, but instead just know the symptoms. -Doctors provide a generous daily dosage of medication, such as muscle relaxants, for the patient -Nurses that interact with the patient add to the emotional detachment from the body by saying things like "hold the arms, grab the legs"

Metamorphosis self-esteem anger identity

The Damaged Self Mental Changes -___________--not only have the bodies transformed but so has the external world. They think of themselves and objects differently due to the obstacles they now face. -Disembodiment -Detachment from body emotionally -Withdrawal from the outside world Murphy concludes that there are 4 prominent changes the consciousness undergoes: -lowered ____-______ -the invasion and occupation of thought by physical deficits -a strong undercurrent of _____ -the acquisition of a new, total, and undesirable _____

tiredness

The Damaged Self Physical Changes -Wheelchair bound after a slow-growing cancer began pinching his spinal cord, leaving his legs paralyzed. -Physical Symptoms/Changes: A constant tingling in hands, forearms, and feet. Pain, tingling, aches, and immobility in legs. Curling of fingers inward toward palms. -His physical disabilities made everyday tasks difficult and left him with a "deepening sense of ________" (Brown and Barrett, 2010, p. 173). Difficulty in communicating with others example. -"I lost much more than full use of my legs. I had also lost a part of my self" (Brown and Barrett, 2010, p. 173). Sense of Shame and Guilt. Mind and Body Connection. -"Disability is not simply a physical affair for us; it is our ontology, a condition of our being in the world" (Brown and Barrett, 2010, p. 175). Re-embodiment and new identity centered on physical impairment.

nerves

The Damaged Self Sexual Relations -Varies from person to person with variety of disabilities/injuries -Men and women take on changed roles due to physical complications -Spinal cord afflictions tend to create some level of impotency no matter the case. -Impotence--sexual malfunction -Due to numbed _______ the brain receives no messages of sexual excitement

uncomfortable emotion

The Damaged Self Social Changes -There is a lack of social interaction between those with 'damaged bodies' and those without -This is mainly due to the fear of making one another feel ___________. -'Nobody asked me what is was like to be a quadriplegic- for this would violate all the rules of middle-class etiquette.' -There are limited social interactions because of physical impairment -Murphys example: stand up vs. sit down gatherings -Lack of ability to show _______, difficult to use body language

decreased

The Sorcerer and His Magic Brief Shaman History -Shamanism has existed for centuries -Has _________ significantly but still being practiced in many areas of the world -They gain knowledge and power to heal by entering into the spirit world -Act as mediators in their cultures and communicate with spirits on their behalf

chief

The Sorcerer and His Magic Nambicuara Indians example in Brazil -Tribes consist of both a secular ____ and a sorcerer -The sorcerer disappeared for a time and based on his story of what happened, and in his return, suspicions arose. -Even though the skeptics had analyzed the sorcerers motives, they would've been shocked if someone would've suggested the incident was a hoax. -The sorcerer still had a certain amount of good faith and competence.

crazy and cured

The Sorcerer and His Magic Zuni Tribe Shamanism -A young girl becomes stricken with nervous seizures -Young boy holding her hand is accused of sorcery -The boy denies being a sorcery to the court but eventually changes his tactic and admits to sorcery. -Says he had two substances one that made girls go _____ and another that ______ them -Boy runs away at night but is eventually captured and put back on trial -Comes up with an even more elaborate story about his ancestors being able to change shape -Produce plumes from wall of his house to convince townspeople -The boy is eventually let off of the crime -He admitted to everyone what they wanted to hear and presented enough evidence to be believable

ars magna

The Sorcerer and His Magic Suspicion of Shamanism -Quesalid is a Shaman of Kwakiutl tribe from the Vancouver region of Canada. -Quesalid did not believe the powers of the Shamans, he became curious about their tricks and desired to expose them. So he became a spy. -___ _____: "shaman hides a little tuft of down in a corner of his mouth, and he throws it up, covered with blood, at the proper moment- after having bitten his tongue or made his gums bleed-and solemnly presents it to his patient and the onlookers as the pathological foreign body extracted as a result of his sucking and manipulations" -Quesalid believed he "healed" people because of their strong belief in him -When visiting other Koskimo Indians he saw they have less believable techniques which resulted in less positive results.

three

The Sorcerer and His Magic Suspicion of Shamanism -Queslid returned to the village -He learns a shaman of a neighboring clan , then he decides to challenge his colleague to compete with him in curing several patients -When he arrives to the contest he observed the competition -The shaman did not show the illness, he used an invisualable object "what he called the sickness" into his head ring made of bark or bird shaped ritual rattle -The objects would hang in the air and own the illness -He failed the contest and sent his daughter to interview his colleague -In the letter read ,"I beg you to have mercy and tell me the way you did so I can imitate you ." -His colleague showed him a nail hidden in the head ring where you can press at right angles and the way he tucked his head on a rattle between his finger , created an illusion and the bird was hanging by its beak from his hand -Queslid was mad and left the village, when he returned he died ______ years later.

Yogi inward twice

Transcendental Medication TM stands for Transcendental Meditation ● Developed by Maharishi Mahesh ____ ● Focused on allowing your mind to settle ______, reaching pure consciousness ● Natural technique practiced for 20 minutes, ______ a day ● TM is not a religion, philosophy, or lifestyle

healer and victim

Transcendental Medication Folk Healing Systems & Biomedicine ● Healing systems and modern medicine is based on the relationships between the _____ and ______ of illness ○ Can dramatically affect the outcome of an illness

600 Blood pressure

Transcendental Medication Health Benefits -"SInce 1970, more than ____ research studies on transcendental meditation have been done at over 250 universities and research institutions in 30 countries" ● After a session of TM , meditators feel less stressed and more calm in tense situations ● Better sleep and clearer thinking ● ______ _______ reduced -Improved functional capacity and quality of life in patients with chronic heart failure -TM more effective than psychotherapy in decreasing multiple features of PTSD

touch

Transcendental Medication Konner's Experience and Hypothesis ● Participant Observation with the !Kung. ● Believed and trusted in one of the tribesmen, whom was his mentor. Committed himself entirely to his friend. ● Felt strange effects from the dance reverberation through his body, staring into the fire, and possible smoke inhalation. Broke trance during the night. ● Human ______ has a real and measurable effect. ● Western medicine still does not fully understand psychotherapeutic practices.

global country of world peace

Transcendental Medication Maharishi Mahesh Yogi -12 January 1918 - 5 February 2008 -In 1955, the Maharishi began introducing TM to India, and around the world. -In 2000, he created the _____ ______ of ______ ______, a non-profit organization that promotes TM.

Konner

Transcendental Medication Melvin ________ ○ medical and biological anthropologist who conducted ethnographic research among the !Kung

one-on-one

Transcendental Medication Skeptical? -Effectiveness is the same whether you believe it will work or are completely skeptical ● Requires personalized interactive guidance by a trained TM teacher ● Taught only through ____-on-____ instruction

N/um Tchai stomachs animism Half Death

Transcendental Medication ___ ______ "Medicine Dance" ● Ritual connection between healer and patient (San people) ● N/um: Is stored in the ________ of the owners of medicine. Is heated through dance. ● _______: Belief in souls. These souls can be seen through death, dreams and trances. ● The Kwi "___ ____": A trance is started in the healer which allows him to transfer his "sweat and energy" to the victim of illness. Pulling out the sickness within. ● The trance and its power is in large part due to the community ● Men and women both take part. Women can be healers, but typically discontinue after pregnancy. ● Older men have more experience to control the N/um, but have less energy and vis versa with younger men of the tribe.

!Kung

Transcendental Medication _____ ● Lived in the Kalahari Desert in Namibia, Botswana and Angola ● Lifestyle (foragers) ● Roles of men and women ● Religion

Heart Attacks 50 ADHD 50

Transcendental Medication Health Benefits ____ ______ ● Nine year randomized controlled trial followed 201 men and women (average age 59) ● Randomly chosen to be in one of two groups: Practice transcendental meditation or participate in a control group that received health education class in traditional risk factors ● Patients with coronary heart disease who practised transcendental mediation had nearly __ percent lower rates of heart attack, stroke, and death than non meditating controls. ADHD ● Study followed middle schoolers with ADHD and had them meditate twice a day in school ● After doing this in school for three months, Researchers found a __ percent decrease in stress and anxiety as well as improvements in ADHD symptoms ● The children also showed improvements in attention, working memory, organization, and behavior regulation

two

Transcendental Medication Health Benefits- PTSD Patients with PTSD were asked to practice TM techniques two times a day for ___ months Case 1 ● Backstory: Explosive device blew up under the vehicle he was riding, directly underneath his seat area. His head hit the top of the vehicle ● Afterwards, he was highly anxious and had fears for his safety. Was using alcohol to cope with feelings. Nightmares occurred almost every night. ● After TM ● Soldier felt calmer and more positive; less stressed and less irritable, calmer. Able to get more tasks done than before. ● He liked it so much, asked to return to for follow ups with next group of trainees. Case 2 ● Backstory: Sustained two blast-related concussions. Initially the ordinance specialist who arrived at scene thought he was dead ● Afterwards he was highly anxious with ongoing flashbacks and nightmares ● After TM ○ Felt more energetic and alert. Irritability decreased. More cheerful and smiles all around. Case 3 ● Backstory: Sustained a blast-related concussion ● Afterwards: Highly anxious and flashbacks and nightmares. Fear for his safety, using alcohol to cope with feelings ● After TM ○ Used it as a calming strategy, felt less anxious and less stressed. ○ More energized during the day and restful at night.

Communication asymmetrical

Turn Taking Candace West was a professor who studied language and social interactions. She talks about the different aspects of doctor-patient dialogue ● _________ plays a key role in the doctor and patient relationship today ● West says the social relationship between doctors and patients is _________. Social asymmetry is the key to establishing medical authority o Doctors wear white coats, patients wear open-backed gowns ● She says the problems of turn-taking conversation have been overlooked because of the overemphasized importance of the Doctors contributions.

roles real life

Turn Taking Conversational Dominance ● Males use of interruptions might display dominance or control to females. ● Medical sociologists place a heavy emphasis on social ______ as determinants of behavior and actual behaviors of people in everyday life. ● Main Point: Instead of the conversation being "rehearsed" and "script-like", the doctor and patient should have more of a ___ _____ interaction. ● Result: That could possibly increase the doctor's control and dominance during patient and physician interaction.

advance

Turn Taking Conversational Dominance Example ● A disagreement between a white male physician and white female patient was resolved by the doctor's interruption of the patient's opinion (regarding sleeping pills) with his own opinion by saying "that won't help". ● In that example interruption was used to _________ the physician's perspective while cutting off the patient's point of view. ● Result: the physician gained control/dominance of the conversation by interrupting the patient's opinion because he knew what the problem was.

67% 33% 32% 68% 1:8 2:6

Turn Taking Interruptions in Medical Dialogues ● Doctor's interrupt patients far more often than vice versa. ● Interruptions display further patterned unevenness according to patients race and gender. ● Male physicians contribute __% of all interruptions relative to their patients ___%. ● Female physicians only initiate ___% of interruptions relative to their patients ___%. ● Patients in exchanges with female physicians interrupt as much or more than their physicians. ● The ratios of physicians interruptions to patient interruptions are: for White male patients interruptions are 1:1 (or nearly equal), 1:__ for White female patients; __:__ for Black male patients and 4:4 for Black female patients.

systematically reversed

Turn Taking Interruptions in Medical Dialogues ● There's a chart in the article with two column's characterized by more patient-initiated than physician-initiated interruptions, the patient is hard of hearing on one hand, and mentally impaired on the other. With the exception of these exchanges, doctors interrupted patients more in every dialogue. ● Interruptions constitute violations of a persons rights to be engaged in speaking, there is more than enough evidence in the transcripts that patients rights to speak are _________ and disproportionately violated by their male doctors. however, when physicians are women, the asymmetrical relationship between doctor and patient is exactly __________.

Male communication Gender

Turn Taking Summary/Conclusions ● _______ doctors interrupt their patients far more often than their patients interrupt them. -They use interruptions as devices for exercising control in their -These interruptions appear to hinder the physicians effort at healing ● Patients interrupt their female doctors as much or more often. ● These findings do not attribute to the physician's __________ skills ● ________ may have primacy over professional status

male

Turn Taking The Case of Female Physicians: According to this article, female physicians are interrupted by male and female patients, but on average _______ patients are known to interrupt female physicians more.

92% symmetrical

Turn Taking The Case of Female Physicians: ● Exchanges between female physicians and male patients show the male patients interrupting the female physicians the most (___% of interruptions in one exchange and 72% in another) according to an analysis done. ● Exchanges between female physicians and female patients show the distributions of interruptions to be ________. ● The excerpts in the article prove that neither technical qualifications nor personal assurances are sufficient for the female physician to have her authority respected by the patient. ● The article spoke of how most doctors, engineers, lawyers, professors, managers, and supervisors in industrial plants are men, although no law requires that they be so. That is why most male physicians are respected and their authority is not questioned but female physicians have a harder time gaining their respect.

upcoming overlaps and interruptions independent knowledge

Turn Taking The Model ● It was observed that speech exchange systems are arranged to ensure that one party talks at a time and the speaker change recurs. ● Turns in talking are built out of "unit types" which are described as projective devices that allow enough information prior to their completion to allow the hearer to anticipate an ________ transition place. ● Two general categories of simultaneous speech are ________ and ___________. ● Another form of simultaneous speech is a display of ______ _________. One example is saying the same thing at the same time as the other person- this indicates the listener is paying attention to them and also that they are listening careful enough to predict what they're going to say. ● An interrupting speaker is engaged in a violation of the current speaker's right to be engaged in speaking. This can happen in arguments between the patient and the physician.

friendliness disrespectful Doctors authority woman

Turn Taking ● The social implications of two people talking at the same time in the medical field vary in different cultures - NorthEast U.S.- overlapping conversations are considered a sign of ________ - South U.S. - people consider overlapping conversations rude and ____________ ● The study shows that ________ interrupts patients more than patients interrupt doctors ○ interrupting almost is a sign of ________ ● Doctors interrupt more except when the doctor is a _______