W2: Diagnose a Person, Not a Body

Differing explanatory models of disease and sickness allow different cultures to view health in various ways.  As MD Namratha Kandula from The Health Care Blog explains, “What people believe and experience when they are ill is usually something far more complex, deeply interconnected with their daily lives”(Kandula, 2013).  She understands that disease and illness are not results from only the individual’s biology physiological mishaps.  How a person interacts with “symptoms” depends greatly on cultural factors and how their lifestyle within their community.

As Dr. Gabriel mentions in our online lecture, many doctors are diagnosing patients based off of the symptoms in our Western culture.  This clinical judgement, or also known as clinical gaze, is created when the patient is seen as a body instead of a real person with a unique interactions within his or her society that could influence their health in varying ways.  In the United States, an individual’s personal life is never questioned.  The doctor rarely ever asks about the different stresses the patient might be dealing with, or what makes them feel really good and uplifted.  The doctor patient interaction in this Western culture hardly every includes the patients current socioeconomic status or whether or not the patient believes in therapy versus prescriptions.  All of these differing factors play a huge role in how the doctor should “diagnose” the patient, if the medical system wants to benefit each patient to their individual needs most efficiently.  Two patients might have identical stages of breast cancer at the same time in their lives.  One patient might have horrible feelings/thoughts about the disease as the outcome of many lost family members to breast cancer.  The other patient also has family history of the cancer, but the family members are survivors.  These two patients should not be dealt with in the same manor.  The psychological differences could help or hinder specific treatment paths.

Dr. Metzl starts off by describes schizophrenia as a biological illness that causes symptoms such as delusions, hallucinations, etc, caused by “different brain anomalies”(Metzl, 2010).  His explanation is very biochemical explaining the illness as chemical imbalances of the brain which is very similar to how the United States’ perceive illnesses.  In Zanzibar contrastingly, a patient might experience the same “symptoms” but thinks totally different of them.  Instead of blaming these hallucinations on chemical imbalances in the brain, these patients in Zanzibar may be more accepting of these delusions.  In their culture, “spirits are active in the everyday experience of humans” (McGruder, pg. 257).  Because the Zanzibar patients have totally differing levels of acceptance of this idea of madness, treating them with the same treatment plan would be ridiculous.  If the Zanzibar patient was given the treatment plan and medication type that the Western model would prescribe, the patient would not show improvements.  They might not even participate in the prescription because they do not believe in what the Western model is diagnosing!

Sources:

Kandula, Namratha. “The Patient Explanatory Model.” The Health Care Blog. June 11, 2013. Accessed July 14, 2016. http://thehealthcareblog.com/blog/2013/06/11/the-patient-explanatory-model/.

McGruder, Juli H. “An Exploration of Lived Experience.” Madness in Zanzibar. Accessed July 14, 2016. http://anthropology.msu.edu/anp370-us16/files/2015/05/2.1-McGruder.pdf.

Metzl, Jonathan. “Book TV: Jonathan Metzl, “The Protest Psychosis”” YouTube. 2010. Accessed July 14, 2016. https://www.youtube.com/watch?v=pEpvqQcwmfE.

6 thoughts on “W2: Diagnose a Person, Not a Body

  1. Hello Sydney! I completely think you are spot on with Jonathan Metzl’s point of view. I too see it very formal and biochemical. I think that it directs how they see things when it comes to the patient, which clouds their perspective of how the patient is emotionally feeling as well as what the patient has socially been going through. I love how you compared the Zanzibar patient to Jonathan Metzl’s point of view. I think that the prescriptions would not work! They have their own views and beliefs as to what will works and it is what works for them. We need not force or westerly ways of prescription on them. I think that we should let them do what they think to be right. The fact that you were able to show both sides of the story from the people in Zanzibar to the way we sit it here in the Western hemisphere was great to me. Great job showing both sides and proving your point!

  2. I actually read in my outside source a similar idea of culture creating certain symptoms according to how the culture interprets the illness, and I found it fascinating. Doctors here really don’t see the whole picture as they do in other cultures, and that’s because illness here is viewed as a mechanical malfunction. Like Dr. Gabriel said in our lecture, not all clinicians are this way, but most are here in the States. Because of this some symptoms aren’t even recognized! Or they may be treated very differently than in other cultures. Plus, in the Zanzibarian example we see that they use religion to help with illness. This stems from the idea that they try and understand an illness as opposed to simply trying to fix it an move on. Not that western medicine doesn’t attempt to understand an illness, but the individuality in that understanding is lost here. The Zanzibarians seem to want to be able to explain where the illness is coming from or why it plagues them, whereas us westerners are more concerned with having a professional fix the problem. This cultural knowledge will actually contribute to how we view the illness and even what we choose to treat. Actually, the more I think of it I see that medicine is super biased to the culture it’s provided in. Either way, we can learn a lot from paying attention to other cultures’ approaches to healing. Great post!

  3. Hi Sydney, I totally agree with your thoughts about medicine in the Western Culture. Everything is focused around the patient’s described symptoms. Taking in account of all the other factors that are a part of the patient’s life could lead to a totally different approach to the treatment options. Unfortunately, our culture is more focused on fixing illnesses with things that cost money. It could be a whole different approach to medicine if we started focusing on other options that other cultures partake in. Doctors need to be more personal with their patients to better understand why they are sick and what would be the best treatment for them.
    The range of acceptance of a mental illness is fascinating. You would think that families would be more accepting of an illness, but as it was described with one of the families in Zanzibar, that is not always the case. I agree with you when you say the patients in Zanzibar may be more accepting of their delusions since their culture thinks of schizophrenia as more of a spiritual influence rather than biological. The way a person thinks about an illness can cause a huge difference in the treatment. Our own culture is always focused on the symptoms rather than the patients.

  4. Hi Sydney! I completely agree with the statement you made saying that doctors who practice Western medicine always tend to use “clinical gaze,” by only focusing on the patient as a body that needs to be fixed, rather than as a person. If doctors were to focus on the patient as a person, they would do things like ask about their lifestyle, societal interactions, life stressors, etc. If they were to do this, then the doctors would see that these factors can affect a patient’s health just as much as known, common health impediments. I think it is necessary to incorporate these details when it comes to diagnosing a patient. It could also be integrated into treatment of patients. Medical care that includes these aspects is the type of care that we see more often in Eastern countries, like Zanzibar off the coast of East Africa. This is the type of care that was written about by McGruder. In this care, psychological, social, and socioeconomical issues are considered when it comes to diagnosing medical problems, like you said. I think that this is something that should be integrated into the Western medicine health care system. If we focused on these issues along with the symptoms, then medical professionals may find out more to help them with a diagnosis, and the patient would then be better taken care of.

  5. Hey Sydney! Great post, I agree with everything you wrote and had a lot of similar thoughts in my own post. I think all too often, especially in our western society, doctors and physicians only look at the scientific aspect of a diagnosis, and not the entire person. The problem with this method, is that not every person is the same. As mentioned in lecture, some sort of diagnosis that works for someone may not work for another, and this can be based on a number of things: their background, family history, socio-economic status, etc. I think all too often doctors are using drugs as a simple fix. For the most part, yes, they do get rid of the problem you are having, short term. But the long term affects that the drugs can have on our bodies, especially if we are taking multiple medications, can be detrimental. If a person can afford some type of alternative therapy to drugs first, I almost think that is better. I know personally growing up, my parents never wanted to give me drugs unless I was in pain, sick or it was absolutely necessary, but they always tried other alternatives first. I also like the part how you said we need to focus more on the issues in our medical system, it is so true, we need to look at the whole person and not just their physical body.
    I look forward to reading more of your posts!

  6. In my opinion, Western medicine focuses more on healing everyone with treatments rather than understanding the symptoms of one as individual rather than as a whole group. In other cultures, symptoms such as hallucinations, visions, or voices may be some sort of religious interactions with one of a higher being. Whereas, here in the Western area of the world, those symptoms are recognized as factors or being mentally ill or crazy doctors and society. If one visited a doctor with those symptoms in the United States, they would be institutionalized in some sort of psychiatric hospital and sedated probably almost immediately. Understanding other cultural backgrounds and beliefs other than our own opens or minds to different, yet effective treatments to many people without treating everyone the same assuming everyone has different circumstances, beliefs, traditions, and ideas. The belief of similar treatments means similar treatment is an understatement and a close-minded theory the well-known fact people are different. And if we are different, with different beliefs, different cultures, ideas, and etc, shouldn’t we consider other treatments for people who are not like us. Understand people who aren’t like us culturally, spiritually. What is normal to them may not be normal to us. That’s doesn’t make one mentally ill. Do not define what people are based on similar symptoms because not everyone believes in the same things we do.

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