Med anthro wk5 ? lecture 10 ? April 27, 2001 Bring blue books and pens Know names of authors (posted on web) Hallowell?s challenge, Murdock?s subdivision, division between folk and modern medicine (ontological reality, behavioral environment and behavioral epistemology), systemic physiological v something This list of terms will be posted online! Will draw on things like main points from readings and main concepts from class Have general understanding about readings and main points ?People used to think of ethnomedicine as limited to exotic, non-western systems for healing? in the last couple of decades people have come to recognize that western practices are also the products of a particular culture?? Describing biomedicine as a cultural system > biomedicine is one ethnomedicine among others.. Some assumptions of the general biomedical model: Mind body dualism Stethoscope (1819), imaging methods, machine diagnosis, increase in paraclinical information (measured by diagnostic technology as guide to clinical work), notion you can peer inside patient?s body ?clinical gaze? (note this in Finkler?s article, note: takes different form in Spiritualism there are good clinical reasons to listen to the subjective reports of patients > Kleinman et. al Physical reductionism Notion that complex phenomena can be explained by reducing them to a more basic level (not saying biomedical practitioners don?t recognize the world is more complex, this is just the model they find helpful in a clinical setting; sometimes they may bracket out) Ex: Depression as chemical imbalance Can exclude the social and psychological in ways that could be clinically relevant, the ways social life and stresses may impinge on their heath Cassell ? lack of attention to treatment itself as a suffering > should be addressed Medicines inattention to social conditions that may contribute to illness or aid healing Specific etiology The focus on etiological agents that are independent of setting > focus on whats universal Doctrine of specific etiology ? idea that specific identifiable agent could be found Ex: TB, how there was a specific pathogen as the cause of TB, left out consideration of certain issues that lead to helpful broader generalizations The machine metaphor Most basic Enduring image for understanding the body Notion of the body as drawing a comparison with the function of a machine that can be broken down and repaired Debates about Biomedicine Culturally grounded debates What are some of the reflective assessments from clinicians? Many of these clinicians had specialties in areas where assumptions we?ve been discussing are more open for debate and reflection (social medicine, public health, psychiatry) Wanted to present reflections and debates as anthropological data > concerns and debates within ethnomedical tradition Approaching biomedicine as an ethnomedical position Does clinical responsibility extend to reducing the suffering associated with treatment? ?Cassell Is the doctors role to give instructions and the patients role to accept and comply? Or should they try and seek ways of lessening the power dynamic as a route to enhancing clinical care? Should clinical training include an emphasis on narrative medicine? > gain narrative competence Do clinicians really need to learn what really matters to patients (especially those that are critically ill?) Must consider variation in practices in biomedicine across different setting Considerable evidence that biomedicine is not practiced the same globally Ex: Battle and war metaphors ? more common here than in other cultures (cultural imposition on disease) Ex: Here in US we are more likely to offer psychotropic drugs Ex: places other than US use a lot more ?soft medicine? > more open to alternative drugs/treatments P 43: nature of ethnomedical inquiry Ethnographic descriptions of ehalers and/or ehaling practices Documenting nosologies of illness terms and categories Representing cultural understanding about illness and health; explanatory frameworks associated with health and sickness (?insider?s perspective?) The health seeking process > how they recognize and respond to sickness The comparison of and interaction between ehtnomedical systems Theories of sickness Comparative frameworks or typologies for health care alternatives Comparing and contrasting ethnomedical systems Patterns of cooperation, competition, borrowing? The efficacy of ethnomedical systems Main point: it is a really broad area of inquiry! ?All ehtnomedicines have their own nosologies and medical theories?? Documenting nosoliges of illness terms and categories Representing cultural understanding about illness and health; explanatory frameworks associated with health and sickness > insider?s perspective What is nosology? > classification system International classification of diseases as one ex Diagnostic and statistical manual of mental disorders You have to have names and you have to organize them Shirley Lindenbaum Kuru Individuals in community dying of disease characterized by tremors, slurred speech, and motor coordination failure Learned that Kuru was of recent origin, and a lot of people could provide vivid accounts with their first encounter with the disease (first appeared in 1920s, 30s, but at its worst in the 50s/60s when it was killing 10% of population, by 90s cases were extremely rare) Early hypothesis that it was genetic disease Largely women, children, and adolescents who came down with disease, but not adult men Taxonomy > fore illness nosology based on Kuru Sorcery by Shirley Lindenbaum Sorcery caused v. non-sorcery caused (most fell under sorcery) Described sorcery by term ?it was hidden? Tried to use existing explanatory frameworks for illness Saw this sorcery as an attack on their whole way of life, not just individuals > killing a lot of people in the prime of their life Depiction of main types of explanatory frameworks relied upon in this culture Think back to hallowell?s challenge article and the comparative frameworks presented there? How do we think about Kuru?s nosology in regards to what is presented there? External power explanations Personalistic causation framework (Foster) (Murdock) supernatural causation: animistic causation; magical causation; mystical causation (Young) externalizing systems causation
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