Sexual Health in India

I chose to look at sexual health in India as my global health problem.  Specifically there is a big issue with the spread of HIV.  One of the issues leading to this problem is the taboo surrounding sexual activity-especially outside of marriage.  This taboo has led to conflict between volunteer agencies trying to promote sexual health and police who believe they are violating laws by educating the lower classes about safe sex and handing out free condoms.  According to Patralekha Chatterjee, “At the heart of the crisis are systems of law and enforcement that remain insensitive to the requirements of the unfolding epidemic and the dangers posed by cultural taboos that impede discussions about sexual health (more than 80% of HIV cases in India are attributed to sexual transmission)”.  Outreach groups who are working specifically with homosexual men are seen as acting unlawfully since homosexual sex is a criminal offence.  Local governments are working to mediate between the larger governments policies and aid groups to find ways to be more sensitive to cultural taboos and help these groups to not be harassed.  The Delhi State AIDS Control Society (DSACS), who is help these aid groups, is also working with police to educate them and “dispel myths about HIV/AIDS”. The origin of this problem goes back to the late nineteenth century when homosexual sex was criminalized.  The origin also lies in the cultural taboos surrounding sexual activity.  If people do not want to talk about it, it is difficult to promote healthy behavior.  The problem of high HIV rates is exacerbated by this cultural taboo and the disconnect between aid groups who are promoting safe sex and the police who are viewing their help as unlawful.  There is also a disconnect in understanding between what is needed to prevent the spread of this epidemic and what is ok to talk about.

One anthropologist working in this area is Dr. Paul Boyce out of University of Sussex.  His work is largely based around understanding the world of men who have sex with men in India and AIDS.  He has also written about why the HIV/AIDS epidemic is still growing despite the global efforts and programs aimed and reducing this epidemic.

http://search.proquest.com.proxy2.cl.msu.edu/docview/199050056/138784F85D633A7DD08/15?accountid=12598

http://www.sussex.ac.uk/anthropology/people/peoplelists/person/285569

Global Health and Medical Anthropology

I picked the intersection of global health and medical anthropology because it is of the most interest to me.  Last spring I took ANP 320 and my professor talked about her research about medical students treating patients in Malawi.  I thought it was interesting that rather than analyzing a different medical system in a different country, she analyzed and critiqued an American medical system working in a different country.  I majored in History, philosophy, and sociology of science so I find it very interesting to look at how different cultures understand health and the body and especially the incongruencies between western medical systems and others.  Although I find this area interesting, it has nothing to do with future career.  I decided to leave the world of healthcare two years ago and pursue a greater passion, literature.

If I was working as a health care provider such as a doctor, nurse, or in a NGO providing health care to people within a different cultural context, taking an anthropological approach would be helpful to create the most effective treatment plans for patients.  It is important to understand how people understand the body and how it works so that you can treat patients, or even just explain treatment plans, in a way that makes sense in their cultural context and does not violate their beliefs.  One example of this brings me back to a few weeks ago when we read about treating Hmong patients in California.  Because their ideas of illness are more focus on the spirit and not on the body, our biomedical explanation does not seem to correlate well.  Also, many of our treatment plans such as surgery violate body taboos and would not even make sense as a treatment for a spirit problem.  CITE.  A second way that taking an anthropological approach would be helpful is that it can help one learn which topics are all right to talk about and which ones are not.  For example, in the lecture a case was briefly mentioned of birth control and sexual health in India.  Because sexuality and sex outside of marriage are taboo topics, a sexual health discussion like those that are given here in many high schools or simply by doctors to patients of a certain age would not be appropriate and the information may be ignored.  In that case it would be much more beneficial to find a way to discuss safe sex within the context of marriage so as not to offend anyone or presume that one is condoning sex in an inappropriate context.

Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and Giroux, 1997. Print.

 

Male Postpartum Depression

Male post partum depression is a problem that we do not often hear about.  According to postpartumprogress.com, “postpartum depression in dads tends to co-exist along side of, and follows, a mom’s postpartum depression”.  One of the largest problems with male postpartum depression is that the symptoms are different than those of female postpartum depression.  “Many men don’t relate to the classic descriptors of depression such as feeling sad or crying.  Cynicism, impulsiveness, indecisiveness, working constantly and losing interest in sex are just a few symptoms of male depression that may surprise you”.  Culture can have an adverse effect on the illness experiences of both men and women suffering from postpartum depression.  This is because there is such a great social stigma placed on people suffering from postpartum depression.  Although we now know that is a real problem, in the past it was believed to be the result of the mother simply being cold and not trying hard enough.  The symptoms are still those that we associate with weakness of character and it would be easy to pass judgment on someone suffering from postpartum depression and think that they simply do not love their child enough.  Thankfully the biomedical system has become much more accepting and understanding of postpartum depression as a real problem deserving of their attention.  This new acceptance is making the management and treatment of postpartum depression more widespread and access to treatment is easier to get.

I think that belief and healing are very closely linked.  Awe learned in the lecture that just having a positive attitude is beneficial and has lead to better treatment outcomes.  In “Placebo: Cracking the Code” we saw the efficacy of belief with the knee surgery clip.  One of the subjects has gone 7 years without any knee pain after having the placebo surgery.  The case of the depression trial also showed how one woman’s belief treated her depression.  After being told there was a 50% change that she would be on the placebo she immediately began to see results and was convinced that she was given the true drug when in fact she was given the placebo.  In terms of m own experiences, I would say that having a good attitude and expecting to get better has definitely helped me heal faster.  I used to get sick a lot and when I would dwell on my sickness and expect that I wouldn’t feel better, I would feel worse.

http://postpartumprogress.com/depression-in-men-a-dads-story-of-male-postpartum-depression

True Life: I Have Orthorexia

The episode I chose to analyze was “True Life: I have orthorexia”.  This followed three different people and their obsessions with food.

The first story is of Spring, a stay at home mom in her mid-twenties with one child.  She eats a very controlled diet of organic, raw foods. Her eating pattern started with organic food to produce the healthiest breast milk when she was nursing her child.  Over time she restricted food more and purges almost all cooked food.  She avoided going to social events because people would always make comments about her eating.  She knew something was wrong but was afraid to come clean to her family, her mother being a nutritional therapy practitioner. She did come clean to her family and began seeing a therapist.  She has begun to add specific animal proteins to her diet.  She still feels anxiety about some of her eating but it is getting easier for her.  She rarely purges cooked food anymore.  I would consider her story to be a cross between a restitution narrative and a quest narrative.  Her goal is to restore health, but the emphasis is on emotional restoration.  Her illness and treatment will be a journey, not a temporary state that will completely end. Her narrative emphasized on taking the first step to reach out to loved ones about her illness.  She felt this is what was hold her back from getting help.  Her narrative also expressed how support has helped her become healthier and happier.

 

Andrew has severely restricted his diet because he fears that unsafe food with give him cancer.  He has switched to eating only vegan food, wont use plastic for cooking food or holding it, and avoids processed chemicals. He fears getting diabetes, obesity, and basically death.  After going to a nutrition counselor he added animal proteins into his diet to avoid falling farther into a mental condition.  He sought out natural, organic, grass-fed meat and now feels that he has found what he is looking for and feels happier.  His illness narrative would be one of restitution.  His problem is that he knows his eating is wrong and is looking to fix it.  He went though how he found a solution (talking to a nutritionist and seeking out healthy meat) and is “better” now.

 

Lauren is a college student who will only eat 10-15 “safe foods”.  She previously went through treatment for anorexia and now strictly controls her diet to be completely “nutritious”. She finds eating emotionally exhausting and it is causing problems with her friends and girlfriend.  She is trying to fix the problem by ignoring it.  She didn’t feel normal and didn’t want to have to worry about it.  She started to see a therapist with the goal of fixing the obsession while remaining health conscious.  After 2 months things have not gotten better for her.  She has restricted her diet more to eliminate all animal products and had to break up with her girlfriend because she couldn’t maintain her diet and relationship.  I would consider Lauren’s narrative to be a chaos narrative.  She displayed a high amount of social suffering and was very conflicted about her situation.  She often avoided telling people exactly how she was feeling or what she was doing because she didn’t think anyone would understand.  At this point there seems to be no end in sight for her problem.

 

 

In terms of culture and stigma, our culture reveres thin-ness, but does not value how one gets to a healthy state.  Our culture has conflicting ideas about eating and health.  In culture we see people who are extremely thin indulging in very unhealthy food.  None of the people in this episode went to medical doctors but rather nutritionists, nutritional therapy practitioners, and therapists, people with specialized knowledge in disordered eating.  In terms of the rights and responsibilities of this sick role, none of these people could take advantage of the rights and responsibilities that one usually sees accompanying the sick role.  Their kind of disordered eating did not take them out of work or gain them special privileges although many of them felt the need to avoid social situation.  Usually in the sick role this is done for the health of other, but in their cases it was to avoid embarrassment and shame.

 

Illness narratives can be very helpful to patients because it creates a community and awareness that show that individuals are not isolated in their suffering.  It also be informative for people who are trying to understand how they feel but have not yet received a diagnosis or are trying to learn about it.  A good example of this is the blog on male post partum.  It brought to light the fact that men can have it and that their symptoms differ from women.  Illness narratives can be helpful for families because they can create an understanding of what to expect or how others have reacted to someone’s illness.  The fibromyalgia blog would be very helpful to a family because she went into detail about all the things she feels and what can cause them.  Finally they can be helpful to health care providers because they can help create the best diagnosis.  This is especially true for mental health issues, which are almost solely diagnosed based off of the illness narrative.  Going to a doctor and saying “I’m sick, treat me” will not be productive where as explaining everything you have been feeling can lead to the best treatment.

Anorexia Nervosa in North America

The article I found is called “’Culture’ in Culture-Bound Syndromes: the Case of Anorexia Nervosa” by Caroline Giles Banks.  In this article, Banks explores a cultural cause of Anorexia in the United States that is often not considered.  Often, anorexia is expressed in more secular terms and associated with dieting to obtain the cultural ideal of thinness.  Banks looks at two case studies of religious women previously diagnosed with anorexia nervosa.  Through participant observation and interviews, Banks came to understand their anorexia as being related to their religious beliefs and practices.  Both women studied showed that “self-starvation can be expressed by contemporary anorectics in the West though religious symbols and idioms about food and the body” (881).  In the cases of Margaret and Jane (the two women studied), they “do not see themselves as ‘sick’ or ‘anorectic’.  Rather, they understand their starvation as a literal attempt to meet the normative ideals about controlling the body provided by their religious traditions” (881).

The biological components of anorexia can be seen clearly in the resulting physical complications of not eating such as hypotension, lanugo, and bradycardia.  Unfortunately, as what is considered a mental disorder, the biological causes of anorexia are unclear.  “Medical researchers who take a biological approach to anorexia generally seek to located the cause of anorexia in abnormalities in mechanisms regulating hormone output that have biochemical influences on eating behavior and weight control” (870).   The individual choice aspect of anorexia has to do with the individual’s choice of eating and exercise behaviors.  Additionally, each individual’s health seeking behavior and understanding of what a proper body should be like can affect the prevalence and characteristics of each case of anorexia.

Treatment must be individualized because each individual understands the body in a different way and has a different relationship with food and exercise as the others.  According to Banks, “Treatment can only be successful the extent to which medical practitioners begin to recognize alternative cultural explanations for symptoms as well as the role of culture in their own diagnostic and biomedical systems” (881).  Overall, treatment must be done on a per-case basis because all individuals have a different relationship with their own culture and cultural ideals and practices leading to their experience with anorexia.

http://za2uf4ps7f.search.serialssolutions.com.proxy1.cl.msu.edu/directLink?&atitle=%27Culture%27+in+Culture-Bound+Syndromes%3A+The+Case+of+Anorexia+Nervosa&author=Banks%2C+Caroline+Giles&issn=02779536&title=Social+Science+and+Medicine&volume=34&issue=8&date=1992-04-01&spage=867&id=doi:&sid=ProQ_ss&genre=article

Caroline Giles Banks, ‘Culture’ in culture-bound syndromes: The case of anorexia nervosa, Social Science & Medicine, Volume 34, Issue 8, April 1992, Pages 867-884, ISSN 0277-9536, 10.1016/0277-9536(92)90256-P.
(http://www.sciencedirect.com/science/article/pii/027795369290256P)

Hmong Shaman in Merced, CA

I chose to reflect on the article “A Doctor for Disease, a Shaman for the Soul”.  The healers described in this article are Hmong shaman working in Merced, California.  The Mercy Medical Center in Merced serves a large Hmong community, whose cultural understanding of disease and illness differs greatly from that of the United States.  While our cultural understanding of health and illness is based on the biomedical model, “many Hmong rely on their spiritual beliefs to get them through illness…”.  In the Hmong cultural system the soul is very important and can be a source of illness.  “The Hmong believe that souls, like errant children, are capable of wandering off or being captured by malevolent spirits, causing illness”.  In addition to different beliefs about the causes of illness, the Hmong have different ideas of what can and cannot be done to the body.  Some procedures that are not allowed include surgery, anesthesia, and blood transfusions.  The Hmong medical systems would be considered to be within the folk sector of the medical system.  This is characterized by healers who are not necessarily organized or legally sanctioned.  There is also a focus on cultural values and a more holistic approach.

Since the publishing of “The Spirit Catches You and You Fall Down” by Anne Fadiman, Hmong shaman have gained more respect and credibility within the Western medical system, especially at the Mercy Medical Center.  The medical center has worked to integrate the Hmong shaman practices into the biomedical system to best serve the Hmong community.  This program educates the shaman about the Western, biomedical system as well as teaching the American doctors about the Hmong system.  The hospital has worked to create policies that are friendly to the Hmong healing ceremonies to speed up the healing process since many people would wait to go to hospitals until after ceremonies were done at home.  Healing ceremonies typically take place at home, but most importantly in the presence of friends and family and often include animal sacrifice, music, and trance.  These shaman have been recognized as officials, given an official uniform, badge, and the same access to patients as clergy members.

Social anxiety disorder among White Americans

The health disparity I chose is social anxiety disorder.  I chose this because I have experience with it in my family. The bars on the far left represent social anxiety disorder.

According to the Mayo Clinic, social anxiety disorder is a chronic mental health condition in which everyday interactions cause irrational anxiety, fear, self-consciousness, and embarrassment.  This disorder has psychological symptoms like fear, avoiding situations, worry, etc., and physical symptoms like increased heart rate, nausea, muscle tension, etc.  While most people experience this from time to time like when giving a big presentation, for example, social anxiety disorder is chronic and the affected person knows that their feelings are irrational.  Like many other mental health cases, the cause of social anxiety disorder is not simple.  It is the result of both genetics and environmental experiences.  Treatment plans often include counseling, SSRIs, and learning techniques to control stress.  These are often done in combination, though not all are needed.

It has often been seen in the past that anxiety disorders are less common in minority groups.  According to Asnaani et al.  “Several studies have noted the differences between levels of anxiety in communities aligning themselves with more collectivistic values, where focus on maintaining harmony within the group is of the highest priority, as compared to those adhering the more individualistic cultural attitudes, where individual achievement are most highly valued and rewarded by the rest of the social group.” Breslau et al. suggests that ethnic identification and religious participation may be protective factors that could explain the lower risk of psychiatric disorders in general.  Like most psychiatric disorders, social anxiety disorder is very complex and it will take a lot of research to understand the differences in prevalence rates.

The relationship between race, genetics, and health is complex and often misunderstood.  In the past it was believed that different races were actually different species.  This is not a popular theory today but it is often assumed that there are distinct genetic differences between races.  This is leading to the racialization of medicine.  One example of this is the heart drug Bidil, which was advertized as being specifically for African Americans.  The research on this is questionable as to how they proved its increased efficacy in African Americans compared to other races.  There are several other non-genetic factors that can cause health disparities, which have trends along socially constructed racial lines.  These include socio-economic status, education, income, wealth, and neighborhood.  These socially constructed racial lines are often confused with “genetic racial lines”.

http://www.mayoclinic.com/health/social-anxiety-disorder/DS00595

JOSHUA BRESLAU, SERGIO AGUILAR-GAXIOLA, KENNETH S. KENDLER, MAXWELL SU, DAVID WILLIAMS and RONALD C. KESSLER (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36 , pp 57-68 doi:10.1017/S0033291705006161

ANU ASNAANI, J. ANTHONY RICHEY, RUTA DIMAITE, DEVON E. HINTON, and STEFAN G. HOFMANN (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. Journal of Nervous and Mental Disease, 198, pp 551-555 doi: 10.1097/NMD.0b013e3181ea169f

When the Bough Breaks

I have taken a lot of classes in the past concerning health and health care so I expected to do decently well.  I got 6 out of 10 correct.  Most of the questions I got wrong were concerning statistics and my answers were close.  The question that I was most surprised about was the one about health care spending in the U.S. I was not aware that we were spending so much more on health care.  One of the questions I got right but was still surprised about was the fact that recent Latino immigrants have better health than the average American.  In another class I learned that each generation of a family has worse health outcomes the longer they have been in the U.S.  To me that really says something about the American lifestyle.

One of the videos I watched was “When the Bough Breaks”, which concerned the drastic disparities in infant mortality rates between black and white women.  Researchers originally have attributed this to differences in socio-economic factors such as wealth and education levels.  When these were factored out the gap in infant mortality rate widened, rather than shrunk.  It was determined that college educated black women had higher infant mortality rates than white women who did not complete high school.  Researchers are now working under the assumption that the everyday stress of racism felt by black women is leading to poor health outcomes in infants, putting them at risk of death before age one.  This everyday stress affects the baby in utero through decreased blood flow and can lead to premature birth, which was the case for Kim Anderson.  The conclusion is that nine months of pre-natal care is not enough.  Things need to start changing so that black women do not feel this stress and this cycle can end.

The development, spread, and treatment of illness is affected by several different areas, as we learned this week in lecture.

Politics: Politics can be influential in regards to health care policy.  This includes how a government reacts to an epidemic to how health care is made available to the people

Economics: One example of how economics can affect the spread of illness is the case of shistosomiasis along the Nile River.  It was because of economic development and the building of the dams that interrupted the homeostatic balance between humans and parasitic disease, bring the parasite closer to local villages.

Environment: The environment can become either a breeding ground for disease or prevent it by being an unlivable environment for things like bacteria and parasites.

Culture: Culture effect come from how people understand disease and their behaviors, which can increase or decrease the likelihood of infection.  In the case of shistosomiasis, cultural norms surrounding water affect who gets infected.  Fishermen and young boys have high risk of contracting it because they spend a great deal of time in the water.  Muslim women, on the other hand rarely contract it because they do not enter the water.

Biology: Biology can affect disease in terms of peoples susceptibility.  One example of this is the case of malaria and sickle cell anemia, where being a carrier of the sickle cell gene prevents malaria .

Individual Choice: One example of the effect of individual choice is the decision to participate in risky behaviors such as drinking, smoking, and engaging is unsafe sex practices.

Old Age

My definition of health that I came up with was “the absence of physical or mental maladies.  I thought of this because when I hear the question “are you healthy?” I think of whether or not I need to go to the doctor or be on medicine.  My definition of illness was “the human experience of a physical or mental malady.  How a disease is experienced by the individual and understood in the culture”.  I considered illness to be more social because I have taken many classes that talk about illness being social.

My ideas about health originally came from my family experiences.  I got sick a lot in grade school-a lot of respiratory infections and pneumonia-and to me being healthy was not being on medicine.  I also did not go to the doctor just for check ups because I was there so often so health to me meant I did not see the doctor.  It was not until college that I developed and understand of mental illness but after several experience I now consider mental status a big part of determining health.  I understand illness to be more that the disease from learning about it in different classes. I can also see how I have applied this to my life.  I have read about how different “conditions” are experienced as normal and abnormal in different cultures and I have also seen how people experience disease different.  When someone has a disease or condition they experience it differently from the next person who has it.  The people who are with that sick person also experience the disease from a different perspective and each person finds their own way to understand and conceptualize it.

I would consider menstruation to be an illness, but not a disease.  Although many women experience symptoms that are often associated with disease-pain, nausea, etc.- menstruation is a normal part of the female life cycle.  Therefore, within the context of a woman’s life cycle it is a normal event.

I would not consider old age to be either a disease or an illness.  Again, aging is a normal part of the life cycle for all people so it is not socially, culturally, or environmentally out of the ordinary.  Old age is often characterized by other “problems” that I would consider disease and illness such as osteoporosis, blood pressure problems, and thyroid issues.

I would consider HIV both a disease and an illness.  The fact that it is a virus characterizes it as a disease.  HIV can also be categorized as a very complex illness.  It is considered both an individual problem as well as a social and global issue.

Experiential Approach

I think that the experiential approach will be most useful to me in studying health.  I picked this approach because I think that it is very important to look at how people experience and understand their illness in addition to the actual “disease” itself.  Looking at illness is this way creates a more holistic understanding of the disease and illness experience, which can be beneficial in creating the most effective treatment plan.  As we learned, illness can only be understood within the broader social and cultural context that each individual is living in, therefore treatment for illness must stand up to those social and cultural contexts as well, if the condition is even seen as needing treatment.

Disease, as defined in the lecture, is the outward clinical manifestation of altered physical function or infection.  In my own words I would call this the actual physical or mental malady.  On the other hand, illness is the experience and understanding of this malady.  This ranges from how the sick person experiences, feels, understands, and deals with the malady to how it is perceived and experienced by the larger society and culture. I have taken other classes that have discussed the distinctions between disease and illness before so the distinction is quite clear to me. Disease is physical (and/or mental) and illness is social.

In his article, Miner is talking about the American culture.  I knew this going in to reading the article because I had heard of it before but I had never read it.  I had received a brief description of the article in ANP 422 (Religion and Culture) and I knew that Miner wrote an article about the Nacirema people (American backwards) about cleaning rituals.  Had I not heard of it before, I imagine I would have gotten it around when he starts talking about the “holy-mouth-men”.  I used to work for a dentist and would have understood that it was modern dental practice.

The act of going to the latipso shows how the Nacerima people have an extreme faith in their healers and put high value on their skills.  This can be seen in how they give rich gifts for entry into the latipso and again after being subject to various act that seem somewhat torturous and humiliating according the cultural norm of bodily secrecy-such as being stripped of clothing and forced to bathe and perform excretory acts in the presence of others.

The rituals of the mouth show how the Nacerima believe that physical health influences social standing.  According to Miner, “were it not for the rituals of the mouth, they believe that their teeth would fall out, their gums bleed, their jaws shrink, their friends desert them, and their lovers reject them” (2).  To them, the physical ritual of cleaning the mouth keeps social relationships intact.

The fact that the all family has at least one shrine but the rituals done there are private and secret and only shared with children for a short amount time shows that health and medicine are very important but are not considered things that should be shared with others.  All families having these shrines and their status and a status symbol shows how important health and medicine are because health ritual and performed there and medicine is kept there.  These rituals are performed in private and people do not share medicines.  This shows how health status and need for medicine or the types of medicine used are secret.