Clinical Medical Anthropology

I’ve picked this area of intersection because foremost, I find it generally interesting. I’m currently in the process of applying to different medical schools in order to fulfill my dream of becoming a physician and I find this area to be interesting because it could potentially involve me working with a clinical medical anthropologist one day. After watching Tribal Jazzman Scholar’s video on YouTube about medical anthropology I realized that there are many things to consider when “helping” individuals in a foreign culture. Taking an anthropological approach is necessary whenever dealing with any culture to which you do not belong or fully understand because otherwise it is likely that you will be applying your own logic, which is shaped by your cultural values, to the situation. For example, in the video, Jazzman talks about how he built a shower for an impoverished family near the Mexican border area. He said that he built it out of wood and came back later to discover that the family had dismantled the shower in order to use the wood for other purposes. He then has a brief diatribe about how he built this shower according to what his western perception of this family’s needs was and hadn’t considered that they would want the wood for other purposes. It is very important to prevent most situations like these from arising because with globalization, they are becoming increasingly more likely.

Especially within the United States’ Western culture, it is very important to take an anthropological approach to health care as a physician, nurse or other health care professional because this nation is so diverse. Americans are made of a diverse lot of unique cultures and individuals with many unique beliefs and because of this diversity, it is important to view patients anthropologically before suggesting a certain treatment.  For example, applied anthropologists are very important in this field because the same health programs implemented in a suburban, mostly white neighborhood are unlikely to be as effective in an urban, predominantly Hispanic neighborhood. Many barriers are beyond language and I think applied anthropologists are very important in that they can help medical professionals to bridge this cultural gap. In a way the world is getting smaller as we experience more and more globalization, but it seems like in many ways the cultural gap is growing as it is common for Westerner’s to enforce their beliefs and mentalities on other cultures.

 

Source:

http://www.youtube.com/watch?v=NjDPwF9uV58

http://www.medanthro.net/research/cama/index.html

FGM in Sudan

Female Genital Mutilation in Sudan has been going on for years, it is a process by which all or part of a females external sexual organs are removed during childhood. There are three main types of FGM practiced in Sudan including the less severe removal of the clitoral hood, the complete removal of the clitoris, all the way to the most invasive process known as infibulation in which all external organs are removed, leaving only a very small opening left for urine and menses (Simon-Levay, 2003).  The origins of this practice seem to be mostly cultural and social and it has been going on since the time of the ancient Egyptians. Although it is a practice initially performed on small children or infants, in the case of infibulation, after childbirth, many women opt to be re-infibulated, closing up the vaginal opening to the size of a pinhole again. Gruenbaum brings up a very important point in her article in that as outsiders we see this practice as barbaric and stagnant, but in fact, it has been evolving and changing over the years. There are many people trying to fight this practice, including human rights groups as well as individual female activists such as Nahid Toubia, who is a Sudanese surgeon and president of the RAINBO organization. RAINBO stands for Research, Action and Information Network for Bodily Integrity of Women. According to Gruenbaum, this is a very difficult and delicate practice to understand because it is very easy for outsiders to label the practice as male-dominated with the goal of removing female sexual satisfaction. Through her research and work, she discovered that this is not always the case and that many women actually support the practice as a female right of passage, a sort of restoration of virginity. Her research looked at the social and cultural dynamics of FGM in Sudan, with the goal of assessing how effective abolition movements are in this area. She found that resistance to change is very strong among many social leaders and it is likely because this practice has deep cultural roots and meaning which we do not understand as outsiders.

Sources:

Levay, S. (2009). Human Sexuality. Sunderland, MA: Sinauer Associates Inc.

Gruenbaum, E. (2005) Socio-Cultural Dynamics of Female Genital Cutting: Research Findings, Gaps, and Directions. Culture, Health & Sexuality , Vol. 7, No. 5, Themed Symposium: Female Genital Cutting (Sep. – Oct., 2005), pp. 429-441

 

Erectile Dysfunction

I think the condition of erectile dysfunction is biomedicalized in U.S. culture because it is a large source of dysphoria in many American men and women. According to Conrad’s article, it is common in our culture for many conditions which cause social problems or are perceived as deviations from the “norm” to be heavily biomedicalized such as baldness, obesity and menopause. Erectile dysfunction is not a condition which fits this category, it is not hazardous to ones biological health on its own, merely a deviation from the perceived norm. E.D. is unique in that although it is uncommon in women, it is a condition which may affect those in a relationship with an affected man and in this regard, its effects are two-fold. In the United States, this is a large issue due to sexual prowess being a strong drive of the male ego. Feelings of inadequacy in this area may extend to other aspects of the individuals life, making him feel hopeless and less likely to connect socially with people. I think that because of the more holistic view of medicine which is popular in today’s society, this condition has been framed as an “illness”. U.S. society largely views an illness as something which has a solution, and by framing erectile dysfunction in this way, it is more likely that people will seek treatment instead of living unhappily. In addition to cultural and social forces which re-frame this condition, economically, pharmaceutical companies are reframing this condition as a disease in order to sell their drug treatments. In this advertisement for Enzyte, natural male enhancement, one of the main advertising strategies used is humor in order to transmit a message which is not socially appropriate for general public television. By using puns such as “this santa will no longer be mistaken for an elf” the company is playing upon the value of humor in American culture. By using this device, the advertisement is able to create a solidarity with affected men who may be watching. This commercial provides an image of a socially strong male with women fawning over him. It purveys the message “take this pill and you’ll be an alpha too” showing Bob’s social role as dominant over women and even other men. There is little medical information presented other than that it is a “natural” option. This commercial presents the drug in a light which is almost free of the medical setting, which may be a play for the “natural enhancement” angle.

Enzyte advertisement: http://www.youtube.com/watch?v=t7vOPPXkqm4

Dichotomy between doctor/patient

The term “Culture of biomedicine” is very important because anthropologically speaking it reminds us that this is indeed a culture. Although biomedicine is the norm in western cultures and thus easily confused with “standard” or “correct” it is important to remember that it is not the most widely used form of medicine in all cultures of the world. Another reason why this is an important concept is because biomedicine really is its own entity which has grown and evolved over time alongside scientific advances. It has also been hard because all of the radical advances of biomedicine, society has had to grow in order to accommodate and regulate such newfound biological knowledge and power. When advances surpass what society is capable of regulating then unfortunate events such as the Tuskegee study result.

 

I chose the dichotomy between a doctor and his or her patient because in our western culture this is akin to the dichotomy between a mechanic and a car. We view the body as a machine to be fixed and improved and because of this, our doctors are seen as the “healers” that fix what is damaged or wrong with our body. Many westerners view the body as a completely physiological entity free of concepts such as a soul or spirit which are popular in other cultures. Increasingly popular, more than fixing what is perceived to be wrong, doctors improve what patients are not satisfied with. I think I view this dichotomy in this way because since I was little, I have never gone to the doctor for regular check-ups. I have always only visited the doctor when something is wrong so that he may fix it and send me on my way. I feel that this may also explain why this dichotomy is logical in western society. In this dichotomy, the patients have a lower social status than the doctors and may also feel at their physician’s mercy. I feel that in our society the reason that the profession of “doctor” is seen as so prestigious is due to our own western vanity. We want to live for as long as possible and we do this by being as healthy as possible, this is where the doctors come in. They are able to give us what we desire most, extended time upon this earth and it is for this reason that there is an inherent and unbalanced divide between doctor and patient.

Postpartum Depression

According to the CDC website, 11% to 18% of women in the United States have reported experiencing some postpartum depressive symptoms. The symptoms of postpartum depression include sadness, lack of motivation to do things you once enjoyed, difficulty concentrating, sleep pattern and eating pattern disruptions, negative feelings about ones self and life in general. This illness is interesting because the symptoms are that of normal depression, what separates this condition is that it is diagnosed only in mothers. During recent years in the United States, traditional medical doctors have shifted from a biomedical model of assessing health to a more holistic model of assessing something called wellness (Taylor, 2011) and it is because of this that American culture puts such a focus on mental illnesses such as depression. In the United States, we believe that our mental state can positively or negatively affect our overall health and therefore we are more privy to small symptoms and nuances. Once you’re expecting certain symptoms, you’ll notice them more. Another thing that we’re accustomed to in the United States, is being able to measure everything with an empirical test, we’ve become skeptics in the sense that “if you can’t prove it, then it isn’t real”. I believe that this is the problem with illnesses such as postpartum depression, there is no real way of proving that the condition exists, other than by patient account. As a result of our view towards these illnesses, I think mother’s are less likely to believe that it is even a real condition and therefore less likely to seek treatment options when experiencing postpartum depression. There is also a sort of stigma attached to the condition in that mothers who admit to having postpartum depression may be judged as weak or unfit to be a parent by some individuals. As far as a connection with the film “Placebo: Cracking the Code” I believe that with postpartum depression, there is a negative result in which mothers believe or accept that they have postpartum depression and that their symptoms may worsen due to their assumption of the sick role. Although, no type of depression is anything to scoff at, I feel that it is a paradox in which admitting and accepting that you have the illness may negatively affect your condition, merely because you expect it to.

Sources: http://www.cdc.gov/reproductivehealth/depression/

Taylor, S. (2012). Health Psychology. Boston: McGraw-Hill.

True Life: I have narcolepsy

In this episode of True Life, we meet Katy and Julie, two women affected by narcolepsy paired with cataplexy. According to the episode, narcolepsy is a sleeping disorder in which the individual will have a sudden, unprovoked urge to sleep or take a nap and will often have difficulty sleeping at night or staying awake during the day. Cataplexy is a sudden loss of all muscle control in which the individual may collapse. Cataplexy is often brought on by laughter in both Katy and Julie. The main difference between these two women, besides age, is that the twenty-something Katy relies heavily on her medications despite her boyfriend’s disapproval, while conversely Julie is rather reluctant to start these medications despite her mother’s urging. The drugs are a depressant, Xyrem, and a stimulant, Adderall, which may have adverse effects on the individual’s heart health. The types of narratives shared by these girls are mostly chaos narratives that we see in times of desperation, shared with members of their intimate inner circle, such as Julie’s mother and Katy’s boyfriend. The girls use this narrative to discuss frustrations when dealing with the illness, notably Katy uses the chaos narrative when discussing frustrations with her boyfriend about how she feels when off of her medications. The stigma associated with this illness is mainly that it keeps the girls from functioning normally and they are therefore treated differently by their peers. Katy finds it hard to keep down a normal job, as she is constantly in need of small naps each day. Julie finds it difficult to be a “normal” teenager, she isn’t allowed to drive by herself or swim alone. We see Julie’s experience with a medical professional in which he delivers her the news that her condition will not go away or get better on its own, she is very upset and he shows little empathy, possibly upsetting her even more. Throughout the episode, Katy has fully assumed the sick role, taking her medications and accepting her condition. Oppositely, Julie fights the sick role and just wants to go back to how she was before, by initially refusing the medications, she is showing denial of her condition. In this instance, the chaos narrative is actually quite useful to each of the girls as it allows them to, albeit incoherently, express their feelings about their condition with those closest to them. This allows their loved ones to feel less alienated and to relate to them, therefore allowing the loved ones to help them grow accustomed to life with their illness.

Navajo Ghost Sickness

This article pays close attention to certain superstitious beliefs and actions of the Navajo tribe of Native Americans. According to Navajo folklore, the Anasazi are a group of prehistoric people who existed before the Navajo did. This tribe of individuals was killed off by the wind spirits due to trespasses committed against nature, what specifically defines a blasphemy against nature is not clearly defined. Some groups of the Navajo believe that the Anasazi ruins are still inhabited by their malevolent spirits and others view these spirits as their ancestors. The common shared theme is that these grounds are inhabited by long perished souls and the grounds are sacred. The Navajo believe that disturbance of the Anasazi grounds will antagonize the resting spirits here resulting in dire consequences. As a fundamental belief in Navajo culture, one should not disturb the dead, meaning treading on burial grounds or even viewing exposed prehistoric bones. Disturbance of the dead or exposure to them may leave an individual vulnerable to a condition termed “Ghost Sickness”. Ghost sickness is a Navajo sickness that is characterized biologically by unexplained nonspecific physical illnesses as well as sudden misfortunes after unearthing any artifacts related to the dead or disturbing grounds which may be inhabited by spirits. The Navajo people believe that Ghost Sickness is caused by a malevolent spirit inflicting retribution as penance for the disturbance of its grounds or artifacts. A Navajo concern which relates to modern-day archaeologists excavating these Anasazi lands is that if the perpetrator somehow escapes the spirits punishments then the bad luck will stick around with the inhabiting Navajo people, causing Ghost sickness in them. Navajo individuals take this sickness very seriously and completely avoid disturbing the dead, however some archaeologists insist upon proceeding with their excavations, often hiring Navajo religious figures to perform rituals protective against Ghost Sickness.

The only treatment of this illness discussed pertains to the folk sector, rituals performed by Navajo religious figures. The main strategy discussed for this illness was prevention by avoiding disturbing the dead. In the professional sector, it is debatable whether or not this is a real illness or if it is a psychological phenomenon.

Shaman’s in Mongolia

In the film Horse Boy we meet a young boy with autism named Rowan. He has rather severe autism to the point in which he has awful fits and is rendered incontinent. His mother is a professor of psychology from California and his father is a journalist from England, both are desperate for some improvement in his condition. His father discovered that one of the only things able to calm down a fitful Rowan is Betsy, a neighbor’s horse. His father discovered that Rowan was so calmed by the horse that he wondered if maybe they should venture to where horseback riding originated: Mongolia. Rowan’s parents are seasoned travellers and therefore more open to other cultures, which is why they decided to embark on a shaman seeking adventure. On this adventure they are a part of several rituals, each with the hopes of bettering Rowan’s autism, not curing it.

In this nomadic society it seems that the shamans are of a relatively high status and are revered or at least respected by surrounding peoples. The techniques employed by these shamans are not all the same, some rituals included whipping the parents in order to cleanse them and therefore Rowan as well as having Rowan’s mother, Kristen, wash her genital area with cleansing water in order to decontaminate the bad spirits which had inhabited her womb. The shaman’s interacted with Rowan and his family via a translator but spoke to them and welcomed them just as they would a member of their own culture.

These shaman’s represent the Folk sector which I believe is more popular in a nomadic society which does not always have access to hospitals and more professional sector style health amenities. In the film we see that the family has to travel sometimes for ten hours in order to reach the next shaman, effectively the phrase “in the middle of no where” comes to mind. In larger cities such as Ulaanbaatar it is likely that more traditionally westernized healthcare is available in the form of hospitals, pharmacies and doctors offices, however across the rest of the country it is probable that shaman’s remain the dominant healthcare givers. The shaman’s treated the body and symptoms and mind as one with the proverbial spirit. This holistic view was shown by the physical rituals which they performed on the body with the goal of them having affects on the spirit, in this case in order to remove Kristen’s grandmother’s angry spirit from Rowan.

Becoming an American

I was surprised to find that I did awful on the Health Equity quiz, I think my final score was something like 8 out of 22 correct. I was most surprised to see the United States rank 29th among countries when looking at life expectancy when they spend almost more than any other country on health expenses. I chose to analyze the episode “Becoming an American” because the latino paradox is something very interesting to me and was the underlying theme of the entire episode. Just as the title implies, this episode chronicles an immigrant family’s day-to-day life highlighting their hardships and tight-knit relationships despite long work hours and stressful living conditions.

The latino paradox is a phenomenon in which young latino immigrants exhibit the best overall mental and physical health but by five years of living within the United States, they exhibit some of the worst health, being prone to hypertension and other obesity related complications. A theory is that the young immigrants have such good health because they were able to make the journey, leaving their less healthy counterparts behind in their native countries. Upon assimilating to American culture and the American way of life, their health seems to rapidly decline, including mental health. Latinos, Mexicans specifically have very low rates of mental illness such as depression and anxiety but comparatively, Americans have very high rates of these illnesses. One theory proposed is that the American way of life is detrimental to mental and physical health, we work more hours than any other nation which results in less time spent with family and less time to foster other important social relationships human beings thrive on. Latino familial culture is characterized by very close-knit family units in which the needs of the family are emphasized over the individual, we see an example of this in the episode when the two eldest sons mention working long hours and neglecting homework just to provide income for their families. Conversely American culture emphasizes the individual over the family unit. The long hours that migrant parents work at minimum wage jobs means less time spent fostering close family ties, effectively breaking down those stress-reducing relationships and resulting in weakness to mental and physical illnesses.

For these immigrant families, the development, spread and treatment of illness is affected adversely by politics, economic and environment. These families are most often very low income which normally limits the environment that they live in, mostly to poorer neighborhoods and schools. As a result of the economic hardships these families face and lack of political protection via job benefits, it is not likely for them to have access to adequate health care therefore adversely affecting the treatment of illness. The father figure in the episode had not been to the doctor once since visiting the U.S.A. and because  the family lives on such a tight budget it is likely that it is because of the cost. Also stemming from economic problems, individuals choose to purchase more affordable food options which in the U.S.A. means less healthy options such as fresh produce, effectively bringing them closer to obesity and resulting complications. The remnants of their culture serve to protect them from the adverse health effects of American culture but as they assimilate to the American way of life, their health declines.

 

Cervical Cancer among Hispanic Women

I personally have the privilege of identifying with many races: Hispanic, black, white and even American Indian, but for simplicity’s sake I will focus on the Hispanic race. As is shown by the graph I’ve selected, incidence rates of cervical cancer in the United States are notably higher among marginalized minority groups such as black and Hispanic women. Cervical cancer is one that is rather easy to manage when caught in its early stages, I believe that mainly social factors explain why its rates are highest among Hispanic women. Also from the CDC website, I was able to find that the incidence rates of HPV are much higher among Hispanic and black women than any other group. Certain strains of HPV are precursors to cervical cancer so I do not believe that this correlation is a coincidence. Similar to the Pima Indians discussed in lecture, I do not believe that these statistics can be attributed to genetics alone. On the whole, Hispanics are considered a socially marginalized minority group and as such rates of unprotected sex are higher among them which is more likely to lead to HPV contraction and therefore increased risk of cervical cancer. Aside from this, I also believe that treatment seeking behaviors are such that Hispanic women are less likely to have regularly scheduled doctor visits than white women in the United States due to economic factors such as lack of health insurance or even social factors such personal shame or embarrassment.

Based upon what we learned this week, Race is a completely social construct and therefore can have no significant bearing upon genetic-related treatments and diseases. For example, within the Hispanic group alone, there are individuals of many skin colors ranging from what would be considered “white” to what would be considered “black”. Therefore, I feel that the relationship between race and health illustrates the way in which social determinants can negatively or positively affect ones health. Since there is no way to genetically determine “race” I believe that most genetic predispositions to certain health conditions are free from association with racial classification.

 

Cervical cancer Incidence rates by Race and Ethnicity, U.S., 1999-2008

graph source: http://www.cdc.gov/cancer/cervical/statistics/race.htm

HPV info source: http://www.cdc.gov/cancer/hpv/statistics/race.htm