Clinical Medical Anthropology

 

I’ve chosen this area, clinical medical anthropology, since I overall find it quite interesting. My mother was a nurse and my sister is in the process of becoming a physician’s assistant, so I have always grown up with slight medical knowledge. I have a degree in Sociology and have also taken classes on Public Health, from which I have gained knowledge on our health care system and how Westernized medicine, especially with the American health care system vastly differs from other sorts. I feel as though have some sort of Anthropological background as a doctor, since there are people from several different countries and backgrounds. It is incredibly important to respect other individuals that have different values and mindsets than that of the Westernized American. While I don’t believe I’ll be doing anything regarding the medical profession, from the classes I have taken and the knowledge I have gained, I’ve come to learn how our health care system in America is a money game; while we have one of the most expensive systems in the country, we have one of the highest child mortality rates out of any developed nation. In my mind, this is a complete travesty, and all individuals should have access to health care, and be able to afford it. Medical anthropologists advocate for the community and push for greater equality for all and how politics and force of globalizations affect different social institutions. Medical anthropology helps to improve cultural sensitivity. In order to fully understand your patients, you should be sensitive to differences in religion, cultural background, local worlds, and country origin. 

 Cultural factors are incredibly important in order to diagnosis, treat, and care properly for a patient.  An example that was a case scenario listed was about a graduate student from China, in which she developed symptoms of palpitations, shortness of breath, dizziness, and fatigue.  When she went to receive treatment, tthey diagnosed her with depressive-anxiety disorder, and received antidepressants. While her symptoms got better, they never disappeared and then she dropped out of treatment. After an anthropologist discovered that Lin’s cousin is hospitalized with a  mental illness, she can’t even imagine being stigmatized with the disorder. By the anthropologist discussing with Lin abotu how this is considered a stress related condition, the individual decides to receive treatment once again.

 

http://www.univie.ac.at/ethnomedicine/PDF/Medical%20Anthropologie.pdf

http://socmedanthro.wordpress.comhttp://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030294

 

 

FGM in Sudan and Somalia

 

Female genital mutilation is prevalent in Somalia and Sudan; 90% of girls in these areas are subjected to infibulation, which is considered the most severe. Infibulation involves completely removing the clitoris and labia minora. The healed scar covers the urethra and a majority of the vagina, in order to act as a physical barrier from intercourse. There is a small opening created to allow urine and menstrual blood to come out.  Sexual intercourse can occur after the opening has been dilated, though reopening the cut sometimes must occur in order for it to happen.  When it comes to childbirth, defibulation always occurs, and re-infibulation will be performed after the woman gives birth, in order to give the appearance of virginity.

 

It is not sure when the origins of female genital mutilation came into occurrence, but it is possibly that it could go as far back as 5th century BC in Egypt.  The reasoning behind FGM were thought that it could maintain the cleanliness of the female sexual organs, by decreasing vaginal secretions that would contaminate the female body.  It was also thought to abolish sexual desire in women. Uncircumcised girls are considered to be sexually promiscuous by society, which is an undesirable/unattractive trait, especially for marriage.

 

In Sudan, genital mutilation has always been considered to be a long-standing tradition. FGM was deemed illegal in Sudan in 1941, but that has not stopped the practice.  In the 1970s anti-FGM activities were gathering strength. The Sudan Family Planning Association and Sudan Society of Obstetrics and Gynecology began recommending to families to abolish this practice.  Currently, several government organizations and voluntary organizations are attempting to work towards the elimination of FGM, though it is still widespread in Sudan. Though there has not been eradication, there has been a transition from infibulation to clitoridectomy, which is a less intensive procedure, and involves the clitoris being cut off.

 

Ellen Gruenbaum, a professor at Purdue University spent five years in Sudan, where she has witnessed the more severe forms of genital surgery.  Ellen released a book in 2001, “The Female Circumcision Controversy,” which emphasizes how Western efforts to stop this practice tend to provoke backlash from individuals in the countries, where this is common.  Change is occurring due to economic and social developments and it tends to be much better received when educated African women, Islamic activists, and Sudanese health educators give this information.

 

http://www.landinfo.no/asset/764/1/764_1.pdf

http://www.circumstitions.com/FGM-defined.html

http://www.english.emory.edu/Bahri/FGM.html

http://www.imow.org/economica/projects/story?language=es&key=6105

http://www.stop-fgm-now.com/medical-anthropologist-speaks-abolishing-female-circumcision

 

Life/Death

In our culture, biomedicine plays a large part in western society. This is an important concept because it is considered the most legitimate form of medicine in our society and is of the greatest importance. The way that our society interprets illness plays large influence in the way that the sick are considered in western culture. For instance depression in our society is considered to be a negative and is something that needs to be taken care of right away, even though realistically there is no way for someone to get over depression like that. Western society presumes that when you put someone on medicine, it is going to instantly cure the problem and it will never be an issue again. In reality, that is not what the medicine does, though it does help some individuals, and there are large amounts of side effects that makes one think about whether or not being on an antidepressant is worth all the complications, for the mild relief from the depression. In other societies, depression may not even be considered to be bad thing, even normal, and seen as something that runs its course.

I consider dichotomy of medicine to be due to the advancements in medical knowledge. In times when there weren’t clinical trials and things weren’t for sure, people were taking medicine that they assumed worked, when in actuality they would not do anything for the individual, or could even have the potential to make them even more ill. It wasn’t until by chance advancements in medicine occurred and actual treatments were invented that could be backed with evidence and proof that it worked. Implications of this are they could just assume some sort of medicine or treatment works without testing it out as thoroughly as they should, resulting in side effects that could potentially play a large effect on an individual’s life.

The dichotomy I chose was looking at life/death, since I find it the most interesting and these things have very unclear, known boundaries and grey areas. At first glance, one assumes that there should just be life or death, but there are several in between areas. If an individual is being kept alive by machines, are they truly alive, or are they dead, with their body still living due to the help of machines? Or, another example of this, is when can we determine something a life; is it at the time of conception, after the first trimester, or at the point when a fetus has the ability to live on its own without any assistance from the mother? There is much debate and argument between individuals that are pro life and pro choice, though it is something that can’t be determined by politics, and it is something that no one can seem to agree on, though the medical community does have a definition for it. Society deems what is appropriate and what is the way it is, but when it comes to it affecting your life, your personal decisions and the closeness to the situation will determine the affect that will be there. Our views on dichotomies are formed from the environment we have grown up in and our dependent from our surroundings.

Depression

Depression is a condition that has been highly bio-medicalized in our society. While I feel as though depression is real, affects a lot of people, and if a person doesn’t receive proper treatment there could be hazardous consequences, I believe it is highly blown out of proportion and people are given too much medicine for it. Depression is a process that an individual goes through, it is a part of the ups and downs of life; it takes time to get through it, and if a person is just getting medicated, then they are not truly helping to fix what is going on in their life.

Depression has become highly mediatized in our society since everyone in the world goes through depression, companies know that there is a large market that they are able to advertise their medication to, thus resulting in them earning a lot of money. While the medicine can help certain individuals, it does not help everyone; it is a quick fix that does not get to the root of the problem; all of the side effects associated with depression medicine may not even make it worth it.

The effect that these medications give, is that once you take them, all your problems are solved.  Since it is the most socially accepted form of treatment, several individuals take these medications, which can harm them more than help them. If teenagers take antidepressants, they are more likely to become suicidal; in my opinion, that poses a much stronger risk, than just talking to a therapist or trying to find alternative methods to deal with your depression.

This Prozac commercial an individual made shows an individual at a beach, illustrating the effects he has received from using Prozac, a medication that is supposedly going to make a difference with your depression. The side effects that an individual can experience can include anything from drowsiness, wheeziness, insomnia, loss of taste, jaundice, loss of bladder control, death, narcolepsy, hernias, and seizures, just to list a few. The video ends with him jumping into the water and not emerging, thus giving the impression he feels hopeless, since this miracle drug that was supposed to help him has not done anything for him.

The second video I found was for Cymbalta, another medication for depression. It states that when you are depressed, you don’t want to do anything or see.  In order to relive your life, you should take this medicine to improve your outlook and to make things better overall. It states that depression hurts, and Cymbalta can take all your pain away.  In the advertisement, it stated multiple times that you should talk to your doctor about this medicine and getting on it, since it is something that you should speak to them about immediately.

http://www.youtube.com/watch?v=GWo571sERYM

http://www.youtube.com/watch?v=OTZvnAF7UsA

 

 

Bipolar Disorder

 

According to Public Medical Health, “bipolar condition is a condition in which people go back and forth between periods of a very good or irritable mood and depression.” There are several types of bipolar disorder. Bipolar disorder type one includes individuals that have had at least one manic episode and periods of major depression, which was previously referred to as manic depression. The second type is bipolar disorder type two that involve individuals who have never had full periods of mania. These individuals go through periods of impulsiveness and energy levels that are high, and alternate with episodes of depression. Culturally, our society does not view individual’s with bipolar disorder in the healthiest manner. It views these individuals as being mentally ill, and needing to receive treatment in order to be competent individuals in society. Biomedicine views bipolar as a illness that can be treated properly, if an individual is taking the proper medication, seeing a therapist, and willing to seek treatment, as well as acknowledge that they have a problem.

This influences the management and treatment of bipolar, since individuals do not want to be categorized by society as mentally ill; no one wants to view themselves in that way and doesn’t want to think of that at all. This can make it difficult for a person to want to seek treatment, let alone be willing to admit that there is something wrong with them.

In terms of this disorder, I do not believe that there is a connection between belief and healing, in terms of bipolar disorder. While being accepting and acknowledging the fact that you have, as a mental illness is a huge step and will help you with the recovery process. However, receiving proper therapy, as well as medication to even out a person’s brain chemistry is necessary for there to be proper treatment, and for an individual to lead a normal life. From what I recall from the placebo video, an individual’s mind has the potential to heal itself, or at least make the individual think t hat there is potential of actual recovery. While having a healthy mindset is extremely important and a big step towards there being an effective treatment, I feel as though it is highly important for individual’s to receive proper medical treatment that will play a truly affective role in helping to treat the problem. With my own personal experience, attitude is everything, but it will not improve your condition unless you are receiving the proper treatment for it; a positive attitude or way of thinking, or believing something is occurring will never truly alter the affects of say, cancer in a person’s body, fix a broken bone, or cure an illness.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

True Life: I have diabetes

This true-life episode revolves around three individuals whom have diabetes. These three people, with different lifestyles, behaviors, and have never met each other, are dealing with the effects of this disease. The first individual is Kristen, who had to move back in with her parents, due to the high costs of paying for her health care bills.  She must work long hours in order to pay off her bills and experiences conflicts with her mother, over how often she is working and how it is making her even more sick; though working is the only way that she is able to pay off her bills. The second person presented in this documentary is Matt and he is a college student that has had diabetes ever since he was a teenager. He had managed the disease well, up until he went to college and started participating in binge drinking, which affects his blood sugar.  He does not want to participate in missing out on the college experience, though every time he drinks, he is risking his life, since the drinking messes with his blood sugar so much. Jen is the final individual that is participating in this documentary and she never developed diabetes until she became pregnant. She is having a difficult time with the dietary restriction, and if she does not get it under control, she has the possibility of herself, or her baby being harmed. Jen ends up having an induced labor for her child. I feel as though this follows the chaos narrative, since Kristen, Matt, and Jen will have to deal with diabetes their whole life, and will have consequences to deal with if they choose not to take care of themselves.

Overall, I feel as though there isn’t much stigma associated with diabetes. It is a disease that ultimately will affect an individual over the course of their lifetime, and they need to be willing and able to handle the responsibility of controlling their diet and their activity level, as well as taking the appropriate medication, in order to remain healthy. I feel as though Matt deals with cultural stigmas, since people in his life are constantly worried that when he binge drinks, his blood sugar has the possibility of running so high that he could die or go into a coma. The biggest issue he faces results from the pressure from being in college to binge drink and party, which he struggles with, since it is what he wants to do, but it is not something that his body can allow him to do, since it can raise his blood sugar to the point where he could die. He is faced with the decision to decide whether or not societal pressures regarding the ability for college age students to drink, is worth him possibly loosing his life, or falling into a coma. Jen also faces the same thing, since all she has to do is watch her diet because she is pregnant and has developed diabetes while pregnant. While it is understandable that she is having a very difficult transition, she just has to watch what she eats, which she was given nutrition information to follow from her doctor. By not watching what she eats, not only is she endangering her life, but her unborn child’s life, creating potentially very dangerous situations.

Medically, these individuals are dealing with medical professionals quite a bit. Kristen, whom is working all the time in order to pay off her medical bills, is proof of how often she needs to see doctors in order to be healthy, and to order the equipment needed for her to take care of herself and to lead a healthy life, with diabetes. Matt has to see doctors because he has had diabetes since he was a teenager, and gets checkups. However, ever since he started drinking, he goes into diabetic seizures, which are not healthy for a person at all, and has led him to see more medical professionals for his disease, which warn him against binge drinking. Jen also sees lots of medical professionals, especially since she developed diabetes while pregnant. She continues to eat fast food and doesn’t eat the diet her doctors give her, which continues to make her disease worse to the point where she had to have labor induced, in order to not have any more harm come to her baby.

These individuals in the documentary have a difficult time accepting the sick role that always has played in their lives since they were diagnosed with diabetes, which is an illness that will never go away, and will progressively get worse without time. Kristen, while she tries to take the best care of herself, financially can’t afford the bills, and has to work excessive hours on no sleep, thus making her more unhealthy to fight her diabetes. Matt, while he has had diabetes for a long time, he almost feels invincible, as though he is able to handle the situation and nothing bad will happen to him, as long as he is able to give himself insulin while he is binge drinking, he will be fine. Jen, as well, continues to eat fast food, and bad food in general, which negatively affects her blood sugar, harming herself and her baby. Since they aren’t accepting or dealing with the situation properly, they are not taking care of themselves in the way that they should be, thus making themselves more sick.

Anorexia nervosa is an eating disorder, prevalent in Westernized societies, characterized by individuals who have a fear of weight gain. Dieting and over exercising are common with this disorder. While the causes of this disorder are not known, genes and hormones are thought to increase an individual’s risk in having this. According to PubMed Health, “risk factors for anorexia include: being more worried about, or paying more attention to, weight and shape, having an anxiety disorder as a child, having a negative self-image, having eating problems during infancy or early childhood, having certain social or cultural ideas about health and beauty, and trying to be perfect or overly focused on rules.” It usually begins during teen years, common in females, and is primarily seen in white women that are high achievers.

There are biological dimensions of anorexia nervosa that have to be present in order for it to be diagnosed properly. There needs to be an overall loss in bone strength, muscle, and body fat, sensitive to cold, dry mouth, depression, blotchy skin, skin covered with hair, and confused or slow thinking. Since you are not consuming enough nutrition, your body is feeding on itself, thus eating away at your fat, muscle, bones, and ultimately, your internal organs. Anorexia is a disease that slowly kills you, and mentally, most individuals have very difficult times coming back from it.

Culturally, thinness is preferred in Western societies and is considered ideal and beautiful. Dieting and exercising are the norm in our society and it is idealized that in order to have the perfect body, you must be thin. Advertisements, actors, actresses, singers, and models all prove this point in society, that if you are not thin, you are not good enough, and are unattractive by societies’ standards. This pushes individuals to go the extra step, to do whatever it takes, so that they can feel beautiful, which ultimately can lead to anorexia, and their death.

There are different tests that are available to be done to an individual, if others suspect them of having anorexia; some of these include albumin, bone density test, CBC, electrocardiogram, electrolytes, kidney functions tests, liver function tests, total protein, thyroid function tests, and urinalaysis.

Treatment for anorexia itself is a whole other process, since the person with the disorder needs to recognize that they actually have an illness. If the person does not think they have anorexia, they will deny they have an eating disorder, and will only enter treatment when their condition becomes serious. The ultimate goal of treatment is to have an individual return to a normal body weight and have regular eating habits. Different therapies that are available are cognitive behavior therapy, which is a form of talk therapy. These are available in groups, with the person’s family, or individually. Medications are available as well, such as antidepressants, antipsychotics, and mood stabilizers. These can help treat depression and anxiety that goes with having anorexia, though there is no proof that it actually decreases an individual’s desire to loose weight.

 

PubMed Health. (2012, 02 13). Anorexia nervosa. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001401/

Clown Doctors: Shaman Healers of Western Medicine

I article I am choosing to reflect on the clown doctor article, which I found really interesting. The clown doctors work in various hospitals throughout New York City and spend their days lifting patients and families spirits. While it isn’t necessarily considered medicine, these individuals are able to get these people’s minds off of their difficult situations. The clown doctors began in 1986 and currently work in several different medical facilities throughout New York City. According to the article, the flows will usually distract families, calm down parents, and keep children from becoming afraid during painful, or scary procedures that need to be completed. The clowns in these hospitals are compared to traditional healers of non-Western communities, which help deal with a individual’s social conditions and how their experience with their illness is going, compared to how Westernized medicine deals with primarily the clinical symptoms.

In this particular situation, the healers are the clowns. Their social status is almost one of a joking manner; their job is one that is very silly, one that brings joy and happiness, and gets people’s minds off of severe issues that are going on in their life, or that they are currently dealing with. Their social status, while they do play a important role in helping children and families feel better, they have a low status position in society. This is because they aren’t actual doctors, and in a Westernized society, techniques like this, though they do help, are looked down upon and tend to not receive serious praise for the work put in. These healers fully interact with their patients, by entertaining them, joking around with them, seeing how they are doing, and getting them to not think about difficult and scary things that are also going on in their life. It keeps them from concentrating on purely negative things. Compared to most Westernized doctors, the Clowns actually know all these patients and spend about three days a week in hospitals, creating a close bond with these individuals.

The system and culture they operate in is New York City hospitals, which are also involved in Westernized culture. The healthcare system of Westernized societies is one of purely biological medicine, in which they tend to not concentrate or see how the patient is doing, they just treat the physical ailments of what is going on with a person. The emotional aspects tend to never be dealt with. The doctors dissociate what is going wrong with a person physically, and never think to include or figure out if it is something that mentally it could be affecting them as well.

 

Tay Sachs & Ashkenazim [European] Jews

Google Image Result for http://www.textmed.com/heatmaps/disease/tay-sachs-disease-us-heatmap.gif

I chose to do this post on Tay Sachs and about how it is so prevalent in the Ashkenazim Jewish population, which means European Jewish individuals. The reason I chose this was because my ancestors were Jewish and from Europe, so there is a chance that I could be carrying this gene without realizing it, though chances are slim, since no one in my extended, nor immediate family has this disease.

Tay-Sachs is a disease that is the result of a genetic mutation; it is fatal and affects the central nervous system. It is the result of the HEXA gene, located on chromosome 15; what occurs is that children have the deficiency of the enzyme, Hex X. When this occurs, a fatty substance accumulates in in nerve cells of the brain.

There are two different kinds of this; infantile tay-sachs disease and late onset of tay-sachs disease. Infantile Tay-Sachs starts to show signs when the infant is around six months old; by age two, most children with this condition have seizures and decreasing mental state. This is fatal and death happens between the ages of five and eight years.

Late onset of Tay-Sachs disease, otherwise known as Chronic GM2-Gangliosidosis. Onset of this second form usually during adolescence, but has the ability to occur during prepubescence as well. Symptoms associated with this are tremors, slurred speech, and poor coordination.

Currently, there is no treatment for Tay-Sachs, health care professions are only able to help the patient with their reoccurring symptoms.Blood tests are the only way to test to see if a fetus has the disorder.

The only reason race plays a role, with regards to Tay-Sachs and Jewish individuals, is due to the fact that this specific disease only affects the European Jewish population, which is primarily composed of individuals who are Caucasian. An example of race playing a role with disease, is this one, or when you look at the prevalence of African Americans that have Sickle Cell Disease. Individually, your health doesn’t play a role in a person getting Tay-Sachs, since you can only get it from your genetics, not from the lifestyle that you lead. An example of this could include heart disease, which you can obtain from having poor diet and no exercise. Lastly, genetics plays a prominent role in this disease, because you can only get it if you inherit it from your parents. Another example of genetics playing a role in disease, could be considered color blindness, or certain forms of cancers such as breast cancer.

 

Sources

http://www.haaretz.com/print-edition/news/tay-sachs-the-jewish-disease-almost-eradicated-1.147493

http://www.mazornet.com/genetics/tay-sachs.htm

 

In Sickness and in Wealth

I did alright on the health quiz for the most part; I received a 8 our of ten, which I wasn’t unhappy with. The question that really threw me off was the one concerning what group of individuals had the greatest health. Due to stereotypes and false thoughts, I assumed that recently immigrated Hispanics would not have the best health. However, it makes sense when you truly think about it. Children’s parents are around more, the food they are consuming is much better for them, and there is a strong family bond. This, however, changes once individuals enter the United States, and the longer they are there, the more American they become, which is when their health decreases substantially. For the most part however, I wasn’t surprised with what was on that quiz; being a Sociology major, I have taken several classes, in which I have learned things, for instance, even though health care in America is so expensive, we still have the highest infant mortality rates, compared to any other industrial nation.

A prime example of how development, urbanization, and globalization affects health among local populations, is when you look at the ever growing income gap in America. The middle class is shrinking, and the working class is growing, thus meaning that individuals are becoming more poor, and do not have the means to afford health care. This concerns the following topics I stated above, since even though we are in a technology driven society, where there are advances and treatments for almost anything, most individuals do not have the access to it, unless they are able to financially afford it. In our society, we should not be able to tell how long an individual is going to live, nor what they could die from, depending on what neighborhood they live in, or their yearly salary. Everyone should have access to good health care, not on the basis of whether or not they can afford it.

Politics, economics, environment, culture, biology, and individual choice all influence the development, spread, and treatment of illness. Biology accomplishes this by being the thing that thing that hopes to find out how illnesses spread and how to treat them. Politics and government play an important part in how illness is spread and treated since they decide whom and how individuals should receive medication. The culture determines how the public will treat individuals that have this illness, whether they will be stigmatized against, treated as normal, or pity will be brought onto them. Environment and individual choice almost go hand and hand; your environment determines what you are exposed to, though individual choice is when you do or do not choose to partake in certain decisions, which have the possibility of causing illness in your body.