Biological

In all honesty, I found it difficult to choose just one approach.  Although we haven’t actually studied them yet, they all have their own niches which make them important to the study of medical anthropology.  I wanted to choose several as the most important/useful/interesting. However as much as i liked the others, biological seemed the most obvious and/or simplistic choice, because it covers the body/genetics (most of ones health – diseases, etc. -stemming somehow from genetics), the environment (can have a profound effect on ones health & well being), as well as ones mind/life & the choices they make.

The distinction between disease & illness, although commonly interchanged or mixed up within society, is actually quite easy to determine, maybe even obvious.  Disease being the physical/biological dysfunction of the body; while Illness is ones perception of this, often the division or seperation from ‘normal’. As simple as this may seem, there is often a mix up, and sometimes even an actual overlap, causing confusion between the difference of the two.

I really enjoyed the article by Miner, I found it interesting and amusing to read such a description of our culture/society.  As far as when I knew what the culture was, I was suspicious earlier but was not positive until the sentence about Washington (or Notgnishaw) and the cherry tree.  It was a great way to display our culture, and our health care, using ethnography to show the absurdity of a society we concider normal. It was perfect. The “holy-mouth-men”, representing dentists, and the way society tends to feel about them as well as oral hygiene; the ‘latipso’ with its ceremonies, rituals, and gifts, representing hospitals and the healthcare system (great at showing classes/socioeconomic differences & treatment in system); the ‘listeners”, representing the therepists, psychologists, etc., and the stigma attached to them or being a patient of one; ‘medicine men’ obviously signifying doctors, and ‘herbalists’ as pharmacists; also the ‘shrine’ symbolizing the bathroom, ‘rites’ or ‘ceremonies’ preformed daily (or monthly in case of menstration), mixing of ‘holywater’ under the ‘charm-box’, and the privacy, even secrecy held with many ‘rituals’.

Ethnomedical

I find the ethnomedical approach to be the best way to study health especially when considering cultures that have existed for thousands and thousands of years. I like this approach because it takes into account all different types of traditional medicine used. In less developed countries than the United States, medicine men, shaman, and traditional healers are where most people go to receive care. In another class I’ve taken about public health we learned that in Africa bone setters are standard of care for broken bones and injuries. A large amount of the indigenous people do not want to go to hospitals and prefer the traditional methods. These methods are very popular in the Far East as well with use of different herbs, plants, and acupuncture.

I find it hard to distinguish the difference between illness and disease sometimes because the two are often interchanged or said that a diseased person will lead to having an illness. I believe the opposite that an ill person is at the beginning stages of disease. I had not read this article before and I did not realize it was about America until i saw the sentence talking about chopping the cherry tree. One of the rituals was the “holy-mouth men” i found this one as an interesting view on dentists and americans importance of a healthy mouth and nice smile. People with a nice smile make a wonderful first physical impression. I liked it also because my dad is a dentist. It also referred to our daily teeth brushing as a “private mouth rite”. The latipso ceremony is referring to our hospitals and there say it is a temple “where people go to die” and that those willing to undergo the purification ritual only receive it if they can afford it. The section about women’s appearance and their breast size was interesting, but easily recognizable in our culture. The article says, “a few women afflicted with almost inhuman hypermammary development are so idolized that they make a handsome living by simply going from village to village and permitting the natives to stare at them for a fee.”

This article shows that without knowledge of a people you can make assumptions and biases without realizing how similar you are. The article made our health system and culture seem so crazy with how it was worded, but we experience these “norms” everyday

Biological Approach.

In my opinion, all of the approaches mentioned have numerous
benefits to society and should be integrated into one “all-encompassing” approach.  Distinguishing one as being the most helpful in studying health
was difficult.  I believe the most direct and valid approach would be the Biological Approach. Environment can have a profound effect on health. Where you live can determine access to food, healthcare, and overall quality of life.Genetics brings into play predetermined susceptibility to certain diseases and essentially what you are made of and able to withstand. Not to mention that we are only scratching the surface in terms of our understanding of human genetics. Individual choice is also mentioned in the Biological Approach.  The daily choices we make directly affect our health.  Anything from eating a balanced diet and working out to choosing healthy relationships can harm or benefit how healthy we ultimately are. Because of these three cornerstones to the Biological Approach, I have decided that it is most relevant to the study of health.

Disease is considered a clinical diagnosis in which symptoms and irregularities are used to describe a patient’s condition. Illness is more centered around the patient’s experience with abnormal health issues. Illness also takes into account varying social and cultural factors.  Distinguishing the two, based off of these definitions is still complicated and rather difficultto me.

The culture Miner is talking about is American culture.  I picked up on the chopping down of the cherry tree reference and then that was followed with the highly developed market economy reference. I found it to be an interesting read.

The “holy-mouth-men” are representing dentists in America,
which are widely considered, at least socially and medically, “less important”
than doctors. Miner is writing about America’s heightened importance placed on teeth and dental hygiene. Having presentable teeth is symbol of class and
garners admiration in American culture. The latipso cereomonies represent the affordability and accessibility of healthcare in the U.S. for varying economic classes of people.  Essentially, you are treated if you have adequate payment.  If not, often nothing is done for you. This is a fundamental flaw in our healthsystem.  The “listener” is representing
mental health professionals. Miner is referring to our general belief that a large amount of mental health issues stem from our childhood in correlation with our parents. The mental health field continues to evolve but many of it’s practices have acquired numerous skeptics.

The Biological Approach

I believe that the biological approach is the most useful for studying health for several reasons. The main reason is that I feel it covers the main areas that effect ones health, their individual choices, the environment and their genetics. These three aspects are simple and fairly straight forward in that just about anyone will acknowledge that any one of the three will have an enormous impact on whether a person is healthy or not. Another reason that I support the use of this approach is because it does not rely on a culture. Any individual in any culture (or for that matter any individual removed from their specific culture) can become sick, and this approach utilizes the environment (which I believe to be the single greatest contributor to health) as one of its aspects. The final reason that I like this approach is because it emphasizes individuality. A person can be more susceptible to certain illnesses than another person because their genes are different or they went through different situations that weakened their ability to fight off diseases.

To me the distinction between disease and illness is that disease is the physical problem that is effecting a person, and it is uniform across cultures, where illness is the persons perception of their disease or sickness, which changes depending on what culture they may be a part of, or what their attitudes towards sickness are. The distinction seems to be fairly easy to understand, but I can definitely see how the two can be confused or used synonymously.

The Nacerima culture that Miner is talking about is American culture, and I recognized this immediately when I saw the spelling. The rituals that stuck out in the article were the decorating of the shrine room, the use of the charm chest and the mouth-rite. The decorating of the shrine room has more to do with cultural tendencies than health concerns, but it does show a distinction between the classes of the society, and that the better quality of the shrine room, marks a overall better quality of living, and most likely health as well. The other two rituals (the medicine cabinet and brushing your teeth) both show rituals that are believed to increase or sustain good health and that are held in such high esteem that they are frequently used.

Experiential

In my quest to learn and understand topics in medical anthropology, I think the experiential approach would best suit me. Culture is based around people and their interpretations and perceptions, like a social reality that exists beyond biological and scientific facts. Therefore, I think to truly understand disease and illness within a cultural context, we must analyze the language and narratives surrounding it.

As I have learned in this class and in classes before, disease and illness are often used interchangeably in society but have different meanings. While disease is the actual clinical dysfunction of the body, illness is simply the perceived dysfunction of the body. Illness is a perception that is created by a social idea, and therefore is often different from culture to culture. Before taking any classes that discussed the differences between illness and disease, I would have assumed they were the same thing and the distinction would no have been nearly as obvious as it is now. Because these words are so often used in everyday life, I would not have assumed them to have such different meanings.

Unfortunately I have read the Nacerima article before in my high school sociology class and was able to remember and recognize the story a few lines in. However, remembering how much I enjoyed the trickery of the article, I continued to read and analyze how cleverly Miner put together the piece.  I think composing this article was an extremely clever way to put the “strange” behaviors of the American culture into perspective by letting us analyze our rituals and actions from an outsider’s point of view.

I found the daily rituals of the mouth to be quite humorous. I never really notice the great importance our culture places on dental hygiene, but when I read this part of the article, I was very amused to see the truth revealed by “an outsider”. The yearly trips to the dentist are very much an “unbelievable ritual torture to the client”, however, it is something we endure because of the great importance we place on our looks and dental hygiene.

I thought the part of the article talking about the latipso ceremonies also did a great job showing some of the values of the American culture. On the third page, the author states “the guardians of many temples will not admit a client if he cannot give a rich gift to the custodian”, this shows the very great importance on money and wealth. It displays how the American culture has comodified medicine and puts the value of money above saving a human life.

The author also mentions that upon entering the temple, one is stripped of all his or her clothes, which results in psychological shock. This demonstrates the very secretive and modest (somewhat) ideas that the American culture has about body exposure, especially to strangers.

Ethnomedical

I think that the ethnomedical approach would be best for studying health because it looks both at how the culture looks at health and illness, and how individuals seek out help for those diseases and illnesses, so it gives a broad and pretty comprehensive look at any kind of problem.

 

The distinction between disease and illness is that disease is a physical result of some kind of infection or other pathogenic cause, where as illness in something that separates an individual from normal, whether it’s a mental illness because their mind does not work the way a “normal” mind might and etc. The distinction is pretty easy for me to make, having a little bit of a background in the medical world and a pretty solid understanding of diseases and their effects on the body. Illnesses are a bit harder for me to distinguish, mostly because there are so many more factors that define an illness, even socially and culturally, so it’s more of a spectrum of things instead of a specific effect.

 

The culture that Miner is talking about is the American culture. It definitely took me two reads through the article to figure this out though. The first read I thought that all of the rituals sounded really bizarre and the second time I read it I noticed all of the things that were spelled backwards and really felt a little silly when I started recognizing all of the rituals.

 

One of the first rituals that Miner mentions is the sacred box within the shrine. I think this says a lot about how we treat health and medicine. We focus so much on using drugs and prescriptions to treat all of our problems with disease and illness. Another ritual I thought was interesting was his look into hospitals and how we have to pay so much to go to hospitals and have procedures done and then get charged for release. Finally I really enjoyed how he looked into how we treat going to the bathroom and just personal cleanliness in general. Its such a taboo thing to talk about going to the bathroom or to be unclean.

Applied Approach

I chose the applied approach as the most important approach because it seems to be the most versatile and culturally sensitive approach. Most medicine is done in such a way that the practitioner will only take into account their own culture’s value and practice of medicine, which can be detrimental when treating someone of another culture. Different cultures view treatments very differently from others, and knowing the correct way to approach this is key. The applied approach also looks at the bigger picture, which is an important quality.

I believe that the distinction between disease and illness is mental. Disease is a physical affliction, typically received through things like germs or viruses. These diseases can also be passed on and will affect you in obvious, physical ways, such as gastrointestinal problems, or something else that can be tangibly observed. However, illness is much more mental. It’s not something that can be quantified or measured – many people will say that someone who acts strangely is ill. However, that doesn’t mean that they are actually sick. It could simply be a different personality or even someone from another culture with different beliefs and values.

The culture discussed in the Nacerima article is American culture, quite possibly western in general. I realized this because the point of view was very focused on western medicine and view the Nacerima rituals often as “sorcery”. The first ritual I found strange was the value placed on “mouth-healers”. We have dentists, so I can relate to some degree, however, it shows a high amount of faith in that they let these people essentially determine their social life, especially when the ritual comes with a great amount of pain. However, oral-health can certainly determine social value, as someone with rotting teeth and bad breath will find it harder to find a partner, and thus have lower social rank. The second ritual that came to mind is the charm box that all Nacerima homes have. I find this interesting because it shows that, even if we may know or believe that these remedies don’t work, the Nacerima not only hold mass amounts of them in these boxes, but they save them after they’re used. To me, this shows that they want something physical to attribute to afflictions they may be feeling. These scapegoats may help someone feel better about a condition after they’ve been “treated” for it because they can actually believe that something went towards the cure. Finally, the rituals performed in the latipso temples struck me as fascinating, because people go into them to get cured, but as a result have to essentially be humiliated and possibly end up no better off anyway, and still have to pay the medicine man in valuables or goods. It shows that their culture is rooted in the market, and also shows that they believe that whatever they’re afflicted with can only go away through massive amounts of pain and suffering from the sounds of it. And through all of this, they hold these healers to great esteem and trust them as much as we may trust our own doctors.

Ethnomedical Approach

I think the ethnomedical approach is most useful in studying health, since it addresses health and illness within indigenous constructs and local disease taxonomies. Hence, anthropologists can explore cultural explanatory models of etiology, pathophysiology, treatments, and prognosis of an illness entity. The ethnomedical approach is also valuable in its incorporation of linguistic categories used in the relaying of an illness narrative, and can be a lens to interpret an individual’s “language of distress” (a term used by Cecil Helman) and whether they will be compliant with physician instructions. It evaluates the effectiveness of traditional remedies of popular, folk, and professional sectors of a society, and can provide insight into an individual’s “strategy of resort to healing”, a phenomenon described by John Janzen.

Disease represents the visible, clinical, and physiological manifestations of abnormalities in bodily function or structure, or infection with a pathogen. In contrast, illness is an individual’s experience of distress or disorder with regard to health within a particular sociocultural context. The distinction is apparent because the former invokes biomedicine, while the latter is of subjective nature, in that illnesses are not uniformly identified by Western physicians and are based on patient perception.

Miner is referring to American culture, which I inferred from his description of cultural hero “Notgnishaw” chopping down a cherry tree, who I recognized as George Washington.
One cultural value of the Nacerima is purification and cleanliness as an indicator of health, as revealed through “shrine” or bathroom rituals and “mouth-rites” or teeth-brushing.
Another Naceriman cultural value is esteem for medical practitioners, as exemplified by their fee-for-service paradigm (they are “rewarded with substantial gifts”).  Additionally, prestige for practitioners appears through their portrayal as the guardians of a privileged and sacred knowledge; for example, they write ingredients for medicines in “an ancient and secret language,” which represents the medical terminology with which laymen are not familiar. Furthermore, the Nacerima value specialization and compartmentalization of medical practice typical of the reductionism of Western biomedicine. This trait is highlighted by the use of medicine men, herbalists, dentists (“holy mouth men”) and psychoanalysts (“listeners”) and their hierarchy in terms of reputation and power. A final cultural health value of the Nacerima is privacy and modesty with respect to bodily matters such as excretion and parturition, due to a “pervasive aversion to the natural body and its functions” which alludes to shame surrounding bodily taboos.

Ecological Approach

In my opinion this is the most dynamic of all the approaches.  The way in which power, political economy, Industry, environment, and poverty all seem to interact with one another to produce suffering throughout the world is an important field of study.  It all seems to boil down to greed.  Whether it’s The World Bank holding developing nations natural resources as collateral, or the polluting of waterways by industry, people seem to always suffer through poverty, hunger, and disease.   I find this approach interesting because it studies issues that are horrific but changeable.

The distinction between disease and illness I found interesting.  I have never thought about these distinctions before this week.  My understanding of these distinctions is; a disease is the medical definition assigned to distinct signs and symptoms of a physical or mental abnormality and an illness is the perceptions and experience by people caused by the abnormality.  Disease is a clinical definition where illness is a psychological and cultural definition.

The culture Miner is describing in his article is America.  I realized this as soon as I saw the article because I read it in ANP 201.  One important ritual in the article was visiting the charm chest.  The charm chest is a medicine cabinet.  It is filled with magical charms (medicine) that people believe they would die without.  It shows the importance Americans have placed in the biomedical industry.  People believe without having pharmaceuticals for every potential abnormality that they will surely die.

Below the charm chest is the Water Temple (sink) where people bow and sprinkle holy water on themselves.  Here also is another interesting ritual called the “mouth rite” (brushing teeth).  This rite was given to them by the “holy-mouth-men” (dentists).  This rite shows the lengths people will go through to keep themselves healthy and the trust they have in the medical industry by believing the dentist that spending time by brushing ones teeth will prevent disease.

Another rite in which the “holy-mouth-men” are involved is the “exorcism of the evils of the mouth” (dental cleaning).  Here people go through “unbelievable ritual torture.”  Not only are the Narcirema people willing to spend their time and money on their oral fixations of health but they are also willing to undergo torture as well.  This shows the commitment of the people to following the recommendations of the medical industry even if such recommendations are known to be painful.

Biological Approach

I picked the biological approach as the most useful in studying medical anthropology and health. It is difficult to pick a single approach to this field, because all of the approaches discussed in the video lecture (biological, ecological, ethnomedical, critical, and applied) seem to have their own merit and own benefits. I chose the biological approach because it encompasses a person’s genetic makeup, environment, and personal health choices as contributing factors to health.  All of these factors greatly impact health. A person’s genetics is important as related to what they have inherited, as well as the relation of certain diseases to a gene or set of genes. Environment complements a person’s genetic makeup and can impact health either positively or negatively. Lastly, a person’s own choices regarding their health are a huge factor, especially when considering “risky” health behaviors such as drug use.

The distinction between disease and illness is not obvious to me. As working definitions for this class, disease is the outward clinical sign of altered physical function, while illness is a person’s experience and perception of their health. I feel that both disease and illness are seen through a cultural context; their uses and definitions depend on the practices of the surrounding culture.

In his article about the Nacirema culture, Miner is discussing the American culture. I really didn’t realize this until I read the article a second time, and now it seems perfectly clear! It’s interesting to re-read his article and pick up the references I didn’t before.

One ritual in the Nacirema article is the use of the box or chest built into the wall of the family’s shrine. I think here Miner is referring to a medicine cupboard or bathroom cabinet, in which the family places “charms” from “medicine men”, or in other words pharmaceuticals and other supplements from physicians.  This could tell us that the culture is obsessed with avoiding illness and feels the need for special potions to do so. Another ritual Miner discusses is that medicine men decide what the ingredients in the curative potions should be, but do not provide them directly to clients. Similarly, patient doesn’t receive medication directly from a physician, but generally gets it from a pharmacist. This shows that the culture allows only a few individuals to hold the “secret” medical knowledge, and that a person must visit many to remain healthy. Lastly, Miner discusses the refusal of the person to dispose of the charm after its use. This shows the somewhat paranoid attitude of the culture, in which the person assumes they will be ill again at some point, but isn’t always comfortable using the particular charm again.