Cultural Models For Health Assessment
Cultural competence requires an overall understanding of culture because health problems disrupt personal, family, and social life, intimate behavior, and self-image and place additional demands on family and friends. Medical treatment can produce further disruptions and reduce a patient's motivation and ability to comply. Providers can reduce these difficulties by understanding the impacts of maladies and treatments on patients' lives and managing these disruptions as part of the total care of...
Infrastructure
Infrastructure is the interface of a culture with the physical environment it includes both a population's biological reproductive patterns that result in births and its material production system technoeconomic system that produces goods such as food and housing. Population relations with the environment provide energy and resources to sustain human life but that also create exposure to disease. Consequently, cultural-environmental relations affect many aspects of health. Basic aspects of the...
Special Featur
Areas of Medical Anthropology 12 Anthropological Approaches to AIDS Prevention 72 Eliciting an Explanatory Model 77 Cultural Defense as Advocacy in the Courtroom 104 Guidelines for Working in Clinical Settings 110 Integrating Folk Healers and Biomedicine 190 Culture in Human Development and Clinical Assessment 222 Using Indigenous Contagion Theory in Public Health Education 244 Changing the Micropolitics of Medicine 316 Developing Community Involvement and Practitioner Cultural Competence 328...
Animism Spirits as Self and Other
At the basis of shamanism is animism the spirit world. These systems of meaning have structures and functions that reflect human psychological, social, and biological needs for concepts of self and socially referenced others. Spirits reflect a personality model and a theory of the fundamental aspects of consciousness. Shamanism uses spirit constructs to represent personal, intrapsychic, and social dynamics. Spirit beliefs produce psychophys-iological manipulations through their meanings and...
Alternative and Complementary Therapies for HIV
The use of CAM among HIV-infected patients is extremely high. Furin 1997 found that 69 percent of a nonrepresentative sample of gay West Hollywood men infected with HIV used CAM 92 percent also relied on biomedicine, illustrating that these therapies are complementary rather than alternative. Reasons for the use of CAM include the lack of an effective biomedical treatment and the political, social, and psychological dynamics of AIDS and CAM therapies. Furin suggests that AIDS activism is an...
Nina Etkin
Nina Etkin, Ph.D., is professor of anthropology at the University of Hawaii, where she is also a member of the graduate faculties of the Department of Tropical Medicine and Division of Public Health Medical School , the Program on Population Studies, and the Social Science Research Institute. Her perspective on medical anthropology is biocultural linking culture, physiology, and the substance and sign of medicines through fieldwork and laboratory studies to understand the dialectic of culture...
Possession and Dissociative Disorders
Possession episodes are often characterized by symptoms taken as evidence of psychological disorders, such as glazed eyes, psychomotor activity, change in facial expression and voice quality, and constricted attention, . . . sleep disturbances, depressed mood, psychosomatic ailments, anxiety and panic attacks Ward, 1989, p. 29 . These associations have led to characterizations of possession as a dissociative disorder, where a split-off part of the personality temporarily controls the person....
Crosscultural Ethnomedical Syndromes
The efforts to understand the commonalities in the diverse ethnomedical systems of the world have produced systems that reflect the values and assumptions of Western thought. For instance, the separation of natural and supernatural theories is common, although many cultures do not make the natural-supernatural dichotomy characteristic of modern thought. Nonetheless, there are similarities across cultures that suggest the need to develop etic categories that represent the universal or...
Natural Selection and Adaptation in Disease and Health
Evolutionary perspectives of adaptation and natural selection underlie the field of evolutionary medicine see Eaton, Shostak, and Konner, 1988 Trevathan et al., 1999 , which examines disease in relation to genetic adaptations made over hundreds of millennia of evolution. Evolutionary medicine perspectives consider humans' ancient physiological adaptations to help explain contemporary health problems as acquired genetic diseases. Other diseases are the consequence of a lack of congruence between...
The Author
Michael Winkelman, Ph.D. University of California-Irvine , M.P.H. University of Arizona , is an associate professor in the School of Human Evolution and Social Change at Arizona State University and former head of Sociocultural Anthropology. For sixteen years, he directed the Ethnographic Field School in Ensenada, Baja California, Mexico. He taught for sixteen years in the California State University Statewide Nursing Program and currently teaches in the Arizona State University School of...
Ethnomedicine and Evolved Adaptations
Callahan 2006 notes that geophagy dirt-eating, which is considered a disease pica in biomedicine is considered a therapeutic practice in many cultures. The examination of geophagy cross-culturally and in an evolutionary perspective suggests that it is actually an adaptive behavior with significant health consequences. The biomedical characterization of an adaptive behavior as a disease illustrates the social construction of diseases. The DSM diagnoses the disorder of pica as engaging in eating...
CULTURE AND HEALTH Qkv
Native American Religious Health Beliefs Religion is important in the traditional indigenous health care systems of Native Americans and their conceptual frameworks of disease. Health issues are not merely biological but are spiritual and religious issues as well. Native American concepts of health as situated in a balance of forces are expressed through the four aspects of the medicine wheel, involving the physical body , mental mind , spiritual soul , and emotional heart . Illness is the...
Family Influences On Health And Development
A family's genetic contribution to health is mediated through socialization and environmental influences. Family mediates sanitation, housing, diet, physical activities, smoking and drinking, and risk exposures. Family is the context in which the sick role is learned and primary care is given. It is also the context for decision making about health care. Family values and norms influence basic health care behavior, including which resources to access see Chapter Five on health care sectors and...
Ethnic Identity
The relationships of culture to psychology produce differences among ethnic groups. Ethnicity individual identity as a member of a group derives from individuals' relationships to the multiple influences of their own culture and the broader society. Ethnicity derives from interactions among psychology, culture, and society, that is, from how individuals develop their biologically based potentials for personal and social identity through relationships with their own culture and other social...
Cultural Healing
The cultural or symbolic approach in medical anthropology emphasizes the efficacy of ethnomedical systems, pointing to a wide range of evidence that they relieve maladies. This presumed effectiveness of ritual healing implies that religion somehow has the power to heal. Indeed, anthropologists have often concluded that religious healing is effective in ameliorating suffering. Singer 1989a, 1989b criticized this anthropological support of folk medicine, considering its persistence a compensatory...
What Do The Metaphors Express About Internal Emotional Dynamics
Religious healing elicits top-down causation, where cultural, symbolic, and mental phenomena affect human physiology. The principal mechanisms through which they operate involve meaning, including the effects of cultural congruence and social connectedness on one's sense of well-being and, consequently, homeostatic balance in the nervous system. These symbolic effects on health are manifested in the important roles of social networks and support in maintaining health and enhancing recovery. The...
Functions of Shamanic ASCs
Human cognitive capacities evolved through specialized brain-processing modules Mithen, 1996 , leading to an increased fragmentation of consciousness. Shamanism engaged healing wholing by integrating consciousness through rituals that produce integrative brain states. As noted above, shamanic rituals produce such integration across functional levels of the brain Winkelman, 2000a, 2002b, 2002c . Healing is produced by eliciting paleomammalian brain processes to manipulate emotions, attachments,...
Diet and Nutrition
Diet is a primary context of human relationships to the environment and a fundamental determinant of health and disease. Culture shapes what is eaten, by whom, when, where, with whom, and how. Food can be a contributory factor in the development of disease, such as coronary artery disease, diabetes, and some cancers. Eating is a social event with many health implications. The use of food in social activities expresses relations between individuals and groups. Consequently, food sharing has a...
Ritual Healing in Suburban America
McGuire's 1988 study of alternative healing found the well-educated and economically comfortable middle and upper-middle class most often uses these practices. Alternative healing practices are part of a larger belief system that attracted adherents before their need for healing. Alternative healing practices provide meaning, describing what happens to the body, and imputing relationships with the wider society and issues of morality, community relations, and social status. Metaphors, symbols,...
BiologicalSocial Dynamics of Possession
The widespread manifestations of possession illustrate an underlying biological basis related to seizure phenomena. Possession has been associated with tremors and convulsions that indicate organic causes, which can be provoked by poor diet, trauma, stress, and disease Winkelman, 1986b, 1992a . The conditions associated with possession spontaneous illness and seizures, amnesia, tremors and convulsions, and compulsive motor behavior involving excessive, violent, and uncontrolled movements...
Identifying Causes of Disease
When you think of the flu, do you think of the body aches and fever, or do you think of the virus that has caused it Most people think of the symptoms they experience, and diseases were traditionally classified in this way. However, as the underlying biological mechanisms were identified in specific microorganisms, etiological classifications based on underlying causes were developed. The identification of specific biological causes has not been possible for many major categories of disease,...
Case Study
The potentially tragic consequences of conflicts between biomedical culture and the culture of patients became more widely known to providers and the general public through the accounts provided by Anne Fadiman 1997 in The Spirit Catches You and You Fall Down. Numerous factors produced a disastrous outcome in infant Lia Lee's interaction with her doctors, factors that derived as much from the Hmong culture as from that of biomedicine and its efforts to control the Hmong and ignore their...
ASC Therapy for Drug Rehabilitation
McPeake, Kennedy, and Gordon 1991 point out that substance abuse rehabilitation programs need to incorporate the important benefits of ASCs to avoid relapse. They attribute the failure of treatment programs to the absence of practices for teaching addicts to address their basic needs by achieving ASCs through nondrug means. McPeake and coworkers 1991 point to the voluminous literature documenting the benefits of natural ASCs and the central role in Alcoholics Anonymous AA of a new state of...
Nightmare Deaths and Stress
The Hmong in America discovered that their dreams could kill them. During the early 1980s, the American public heard of nightmare deaths in which Hmong immigrants were dying in their sleep or shortly after awaking exhausted from gruesome nightmares. For a while, this sudden-death syndrome was the leading cause of mortality among young Hmong men in the United States. Although dreams were sometimes interpreted traditionally as communications from ancestors, the Hmong in America experienced...
Cultural Conceptions of the Body
Peoples' perceptions of the health of their body and its structures and functions reflect cultural, rather than biological, concepts of anatomy. The disjuncture of medical and popular conceptualizations of the body affects consultation, treatment, and compliance. Even when providers and clients share a common vocabulary, the meanings of words may differ considerably. For many, the stomach refers to the entire abdominal region between the rib cage and the pelvis, but to physicians, the stomach...
Drinking Problems from a Critical Medical Anthropology Perspective
Alcoholism and other alcohol-related problems are generally treated by biomedicine as individual problems of genetic susceptibility or poor self-control. The individual is seen as being at fault, and the broader social conditions that contribute to alcohol-related problems are neglected see Singer, 2008 . The perspective of critical medical anthropology on alcoholism is illustrated in an article, Why does Juan Garcia have a drinking problem Singer, Valentin, Baer, and Jia, 1992 . Rather than...
Social Influences on Health
Research on the positive health effects of social ties indicates that they operate through many mechanisms see Berkman, 1984, 1985 Heaney and Israel, 2002 Intimacy, companionship, social integration, and sense of belonging Opportunity for nurturant behavior and reassurance of social and personal worth Assistance with the provision of tangible resources Guidance and advice, particularly problem solving Access to new contacts and information Awareness of the availability of assistance Positive...
Cultural Systems Approaches To Health
Culture, the patterns of shared group behavior transmitted between generations through learning, provides the core conceptual framework for understanding all of human behavior, including health behavior. Culture is a metatheory for explaining human behavior, particularly differences among groups. All human behavior is shaped by it. Recognizing culture as the principal determinant of behavior is necessary for understanding how it affects health. The effects of culture are found throughout human...
Social Models Of Maladies And Diagnoses
The limitations of the biomedical perspective that disease is basically physiological and that mental and psychosocial issues are irrelevant led Engel 1977, 1980 to introduce the biopsychosocial model discussed in Chapter One. Understanding the nature of health and addressing maladies require this broader perspective concerned with the psychological, cultural, and social dimensions affecting well-being. Effective assessment requires an understanding of psychological and social aspects of...
Genetics and CVD
A reason for the increased incidence of CVD in African Americans is their higher incidence of hypertension, exacerbated by a greater tendency to retain salts. It has been hypothesized that this greater tendency was the result of genes that enhanced the retention of salt. These salt-conserving genetic tendencies made those who had them less likely to die from dehydration while chained in the holds of the slave ships transporting them across the Atlantic Ocean. This ability to retain salt also...
Public Policy and Coalition Development
Managing cultural differences and value-laden political issues is central in the development of public policy. Public policy is based on a multidisciplinary social science approach that addresses concerns of diverse constituencies, including government, the public, and health industries. Concepts of culture and social systems are used to analyze policy issues and alternatives on health issues, enabling anthropology to make substantial contributions to the development of culturally responsive...
Healing the Catholic Psyche of Unwanted Others
Catholic charismatic healing involves relationships with unwanted others, reflected in the movement's concern with demonology and its implications for the self. The characteristics of these evil beings reflect the negative attributes of the person. Demonic spirits are believed to attach to the patient, bonding undesirable behaviors and emotions that must be severed to heal the patient. These evil beings are conceptualized as persons and intelligent entities whose qualities, reflecting sins and...
Cultural Aspects of US Biomedicine
The norms of U.S. biomedicine are based on value orientations of middle-class European Americans. These are manifested in virtually all aspects of medical activities concepts of illness and sickness behavior, criteria of normal weight and height, diet and body form, psychological and social normalcy, and communication styles and patterns. The resolution of cross-cultural conflicts in medical consultation requires adaptation to these cultural influences. Biomedical culture is manifested in its...
Multiple Personality or Dissociative Identity Disorders
A diagnosis associated with possession is multiple personality disorder or its current term, dissociative identity disorder, where separate personalities develop dissociated from the ego. People in modern societies with dissociative identity disorder have symptoms similar to those of schizophrenia and are often misdiagnosed with schizophrenia Castillo, 1997a . In premodern societies, the disorder is integrated into other syndromes, particularly possession by spirits. Dissociative identity and...
Sex Conception and Pregnancy
Sexual behavior is biologically based, socially elicited, and culturally shaped it has many health implications, ranging from the spread of disease to the health of young mothers and their offspring. STDs are associated with promiscuity, extramarital sexual behavior, prostitution, and lower socioeconomic status. Norms affecting premarital sex, homosexuality, marriage, extramarital sex, and particular sex practices all have important health implications. So does the process of delivery of babies...
Macrolevel Social Effects On Clinical Health
The macrolevel approach of critical medical anthropology also assesses broader social influences on the microlevel physician-patient relationships Waitzkin, 1979, 1991, 2001 . These relationships are influenced by macrolevel political and economic contexts that structure the clinical encounter. Physicians are also agents of the ideology of the ruling classes. Key effects involve the control of access to treatments and the sick role limiting access and the medicalization of social distress, a...
Changing Health Through Public Policy And Community Involvement
Medical anthropologists have played a variety of roles in addressing the need for institutional responses of the health care sectors to cultural diversity, sociogenic illness, and the need for new policies and programs to address the relationships between health and social systems. Some of medical anthropology's principal involvements in this area include community coalition development, advocacy, and policy development. Some medical anthropologists have advocated on behalf of ethnic...
Selfassessment Interview Foreign Health Beliefs And Practices
Interview a person from an immigrant cultural group regarding their health beliefs and practices. Where were you born Your parents How long have you lived in the United States What are some of the illnesses that you would treat yourself or by members of your family or community rather than going to a doctor What are some of the causes of illness found in the beliefs of your culture What are some of the treatments provided by people other than physicians What were the treatments for What was...
Peyote Religion as Community Healing
The Native American Church NAC is not a traditional healing practice but a syncretic religion that combines Christian elements with the use of peyote Lophophora diffusa or Lophophora williamsii , hence its unofficial name as the peyote religion. The NAC has offered many benefits to Native Americans and their communities. Its moral code of devotion to family, abstention from alcohol, and obligations to the community help participants find the strength, motivation, and support to avoid alcohol...
Dreams and Shamanic Consciousness
Shamanic practices integrate the dreaming and waking modes of consciousness5 Winkelman, 2000a Peters, 1989 . Nighttime ritual activities deliberately blend dreaming and waking modes, with ritual activities before sleep, reducing barriers to the awareness of dream experiences. This practice reflects physiological effects of dreams that facilitate induction of the integrative mode of consciousness. Sleep induces parasympathetic dominance and other characteristics typical of ASCs, including vivid...
PRACTITIONER PROFILE Qmo
Noel J. Chrisman, Ph.D., M.P.H., is professor in the Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, with adjunct appointments in anthropology, health services School of Public Health , and family medicine. Since 1977 he has been teaching in family medicine. He teaches a course cross-listed between anthropology and nursing, Clinically Applied Anthropology, that explores data and concepts from medical anthropology and then determines ways to...
Folk Sectors And Ethnomedicines
The folk or ethnomedical sector involves a variety of forms of cultural healing. Folk medicine traditions in the United States include midwives, spiritual healers, diviners, faith healers, herbalists, root doctors, and many others labeled as involved in magical, stores, and pharmacies and from folk healers. The widespread use of herbal medications and their pharmacologically active substances means providers need to know about their patients' use of these remedies so clients can be advised...
Skin Coloration as Ecological Adaptation
The genetic basis of skin color needs to be understood to appreciate why it does not provide a scientific basis for racial distinctions. A microscopically thin pigment-bearing layer of skin determines skin color. The same substance a pigment called melanin determines all colors of skin, hair, and eyes. Differences in skin color among humans reflect the operation of this single genetic factor in interaction with the environment, along with minor variations in color and tone from near-surface...
Shamanism as a CrossCultural Phenomenon
The idea that shamanism is universal was accepted before being established by systematic research. Some, however, consider shamanism to be found only in Siberia Siikala, 1978 whereas others consider any practitioner who voluntarily enters an ASC to be a shaman Peters and Price-Williams, 1981 . Systematic cross-cultural studies illustrate empirical features of shamanism. A Cross-Cultural Study of Magicoreligious Practitioners A scientific cross-cultural study Winkelman, 1985, 1986b, 1990, 1992a,...
Imagery in Catholic Charismatic Healing
In Catholic charismatic healing, Internal Images play Important roles In diagnosis and healing. Images are considered important revelatory information, communication from the body that is embodied and reflected in a presentational immediacy in consciousness e.g., presentational symbolism . Images are evocative and allusive, linking the past and present, self and others, and mind and body in ways that allow for the reconstruction of memories. The repressed dynamics created by trauma are revealed...
CULTURE AND HEALTH Hbu
These wider concerns of health are reflected in ancient root meanings of heal, disease, sickness, and illness. Heal means To restore to health . . . to set right, amend. . . . To rid of sin, anxiety or the like. . . . To become whole and sound American Heritage Dictionary, Morris, 1981, p. 607 . Heal is derived from the Indo-European root kailo-, which means whole, holy, and good omen Old English derivative forms include holy, hallowed, and whole. Disease has its root meaning in ease and means...
Metaphoric Processes In Symbolic Healing
Kirmayer 2003 proposes that metaphor theory explains how learned behaviors, interpersonal relations, and communication dynamics are imposed on bodily experiences and physiological processes through socialization. These practices and experiences link associate the symbols of language with activities in the sensory and motor systems of the brain, thus making them capable of eliciting those same brain processes through the images evoked by metaphor. It is this power of metaphor that underlies the...
Culture and Symptoms
Zola 1966, 1973 pointed out that culture influences the recognition of symptoms as significant and requiring care, affecting health communication. Symptoms may be ignored in some populations because of their prevalence and relationship to the culture's value orientations. For example, the negative aspects of anorexia may be difficult for people to accept in a culture where you can't be too rich or too thin. Similarly, symptoms that are considered to be of little danger are not as likely to lead...
Meditation and Shamanism in Substance Abuse Rehabilitation
There has been a reinvention of shamanism in modern Western societies and its application in treatments for modern health problems one of the areas is in the rehabilitation of substance abuse McPeake et al., 1991 Jilek, 1994 Rioux, 1996 Winkelman, 2001b, 2003a, 2004c . These applications are in part inspired by the cross-cultural use of shamanistic practices for treating substance abuse Heggenhougen, 1997 Jilek, 1994 . These approaches typically include a number of common features The use of...
Mothers Against Drunk Driving as a Community Health Coalition
The roles of community coalitions in successful changes in health and mortality are illustrated by Mothers Against Drunk Driving MADD . MADD used coalitional building to combat the health problems caused by alcohol particularly the automobile fatalities that occurred among under-aged drinkers. MADD's coalitions had nationwide success in enacting laws that put tougher penalties on drunk drivers and in obtaining more stringent enforcement of laws against driving while intoxicated. The focus on...