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ANP 370: EXAM 1
Medical Anthropology Definition |
-A biocultural discipline concerned with both the biological and sociocultural aspects of human behavior and particularly with the ways in which the two have interacted throughout human history to influence health and disease.
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Medical Anthropology Goals |
-Medical anthropology is the study of how people in different cultures & social groups explain the causes of ill health, the types of treatment they believe in and to whom they turn to if they get ill
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Branches of Anthropology: Physical Anthropology |
-Human evolution
-Population Diversity
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Branches of Anthropology: Archeology |
-How human societies existed in the past
-Examines material culture to interpret the past
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Branches of Anthropology: Sociocultural |
-Compares societies and cultural systems
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Branches of Anthropology: Linguistic Anthropology |
-Evolution and Diversity
-Preservation of human language
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Social and Cultural Dimensions of Anthropology |
-Europe: more social (organization of humanity) is most important. Culture is a result of social organizations.
-America: culture is important. Our rituals/traditions/etc. dictate our social organizations.
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Culture Definition |
-cultures compromise systems of shared ideas, systems of concepts, rules, & meanings that underlie & are expressed in the way that human beings live
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Society Definition |
-society as comprising a total social system whose members share a common language & cultural tradition
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Different Levels of Culture: Tertiary Level |
-Explicit manifest culture
-Visible to the outsider
-Examples include: Social rituals, traditional dress, national cuisine, and festive occasions
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Different Levels of Culture: Secondary Level |
-underlying rules & assumptions are known to the members of the group but are rarely shared w/others
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Different Levels of Culture: Primary Level |
-Rules are known by all, obeyed by all, but seldom if ever stated
-Rules are implicit, taken for granted, almost impossible for the average person to state as a system and generally out of awarness
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Misuses of Culture |
-Generalizing Cultures
-Never generalize or homogenize culture
-Generalizing cultures can lead to discrimination, stereotypes, and prejudice
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Childhood and Old age (study of)
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Childhood: there are many different definitions to childhood, come cultures try to keep a child innocence while others expect children to grow up fast and perform adult duties (usually poorer societies)
Old age: Gerontology and is seen as a chronic illness that can not be cured only alleviated
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Health and Socioeconomic Status
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Study in UK found that there were higher rates of mortality and illness in poorer social classes
U.S. has found that members of minority groups suffer disproportionately from things such as heart disease, asthma, cancer, etc. yet minorities are the ones with less health care coverage.
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Health, Status, Affluent Socities
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The higher socioeconomic status a person has the more likely they are to live longer
However lower is not always detrimental- in China some groups became more affluent and started to eat more processed foods and became unhealthier while those who stayed in the same socioeconomic class seemed to maintain a healthier lifestyle.
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Transcultural Nursing |
-A formal study of practice focused on comparative holistic approach with respect to differences and similarities in their cultural values and to provide culturally congruent, sensitive care to people of different cultures
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Cultural Competence and Health Care |
-Goals: to improve health professionals sensitivity to different cultures and to eliminate “structural barriers” to improve health access.
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Status Syndrome |
-25 year study of Government employees
-Lower ranking officials had a greater rate of mortality; heart disease
-Higher ranking officials live longer
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Boiling Water in Peru: Reasons for Boiling |
-Chronic illness, or illness
-Already out of accepted culture (moved from another area) so can do it without social violation
-Person thought it showed higher status
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Boiling Water in Peru: Reasons for not Boiling |
-To not be rejected form acceptable society
-Didn't have the time/ or resources
-Didn't think it made a difference
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Body Image (Definition and Concepts) |
-Four main concepts:
-beliefs about the optimal shape and size of the body, including the clothing and decoration of its surface
-beliefs about the boundaries of the body
-beliefs about the body’s inner structure
-beliefs about how the body functions
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Body Weight (Culturally- Influenced Notions) |
-Western societies encourage “thinness” whereas other parts of the world ( West and Central Africa) affluent families send their daughters to ‘fatting houses’ which is called cultural obesity
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Anorexia |
-constitutes an extreme pathological form of dissatisfaction with body image in societies that value and rewards slimness
-can only be understood in the context of certain cultural values that are spread through the media, in magazines, tv and movies
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Ideal Body Size and the Media (Barbie Doll) |
-Widening gap between ideas of the ideal female body size and reality of the population weight
-Ex. Barbie doll was a lot thinner than the average woman
-Between 1950 & 1978 average weight of most women was increasing, whereas the size of models kept decreasing
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Gestures and Profession |
-A person's gestures & posture differ from culture to culture or even within individuals of a particular culture
ex: the body language of doctors, police officers, sales people, bartenders
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Clothing and Authority |
-Clothing can signal status, as well as wealth & authority
ex: a doctor's white coat & a nurses cap are symbols of cleanliness & prevention of infection, it also signals their membership to a prestigious group
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Thinness and the Media |
EATING DISORDERS & WESTERNIZATION
exposure to super slim females in the media & encounters w/foreign tourists result in females dissatisfaction w/their body image
global incidence of eating disorders has risen steadily over the past 50 years & is affecting poorer countries (esp. in Africa, Middle East, Latin America, & Eastern Europe)
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Culturally Induced Body Modifications: Circumcision |
-The most widespread form of bodily mutilation is MALE CIRCUMCISION -- practiced by 1/6th of the world’s population
-Has been around in some communities for over 5,000 years to the present
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Culturally Induced Body Modifications: Female Circumcision |
-FGM is the most controversial artificial changes of the body
-FGM involves the removal of all or part of the external genitaliza & is carried out on girls ranging in age from 1 month to puberty
-80 million girls today have undergone FGM esp. in Sub-Saharan Africa
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Culturally Induced Body Modifications: Tattoos (Western Society) |
-Tattoos have become common--a phenomenon that represents a craving for a permanent, fixed identity in an age of unpredictability & constant flux
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Eating Disorders Around the World |
-Cultural obesity in West & Central Africa
affluent members of society send daughters to fattening-houses
girls are fed fatty foods, with minimal exercise, so as to gain weight, which is a sign of fertility & wealth
obesity/plumpness is a sign of wealth and status
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Eating Disorders Around the World cont. |
-Global incidence of eating disorders has risen over the 50 past years & is now affecting many poorer countries, especially those in Africa, the Middle East, Latin America, & Eastern Europe
-Nasser & Di Nicola: eating disorders “are not just an imitation of the western body image; on a much deeper level they are embodied metaphors for “cultural chaos” and “social crisis” -- a quest for ‘self redefinition’ in relation to others in a rapidly changing world
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Notions of the Body: Individual Body |
-Individual body-self
-Both physical and psychological
-Acquired at birth
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Notions of the Body: Social Body |
-Social body is one that is needed in order to live within a particular society & cultural group
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Notions of the Body: Body Politic |
-Body politic exerts a powerful control over all aspects of the individual body--its shape, size, clothing, diet, & postures
-Its behavior in sickness & health and its reproductive, work & leisure activities
-Individuals EMBODY the culture they live in
Their sensations & perceptions, feelings, bodily experiences are culturally patterned
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Different Models of the Body: Machine Model |
-The conceptualization of the body as an internal combustion engine or as a battery driven machine has become more common in western society
-Central to the body as a machine concept is the idea of a renewable fuel/battery power needed to provide the energy for the smooth working of the body
-Includes the idea that individual parts of the body, like parts of a car, may fail/stop working, & may need to be replaced
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Different Models of the Body: Plumbing Model |
-Cavities are connected to each other by pipes such as the intestines, the windpipe and blood vessels
-From book - “the body is conceived as a series of hollow cavities/chambers, connected w/one another & w/the body’s orifices by a series of pipes/tubes”
- Belief that health is maintained by the uninterrupted flow of various substances: ex blood, air, food, feces, urine, & menstrual blood between cavities
disease is seen as the result of blockage of an internal tube/pipe
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Different Models of the Body: Computer Model |
-New metaphors for the mind as mainly a processor/storehouse of information & personality are all seen as forms of ‘software’ or programs hidden inside the hardware of the brain & skull
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Disease vs. Illness |
-Illness” represents what the patient feels when he(she) goes to the doctor
-“Disease” is what he or she has on his or her way home from the doctor (Cassell 1976)
-Disease is something an organ has; illness is something a person has
-Book defines disease as “a deviation from normal values, accompanied by abnormalities in the structure/function of body organs/systems “
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World Health Organization Defining Health |
-In 1946, the W.H.O. defined “health” as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (126-127).
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Biomedicine |
-Biomedicine can be regarded as the ethnomedicine of the western industrialized world
-Western biomedicine is now the dominant form of health found worldwide, & in most countries forms the basis of the professional sector
-It is important to realize that for all its power & prestige, western biomedicine provides only a small proportion of health care in most parts of the world
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Biomedicine and Power/ Authority |
-The only practitioners of scientific medicine form the only group of healers whose positions are upheld by law
-Practitioners of scientific medicine enjoy higher social status & greater income, more clearly defined rights, & obligations than other types of healers
-In hospitals, practitioners can tightly control patients’ diets, behavior, sleeping patterns & medication, & can initiate a variety of tests (biopsies, X-rays, or venesection)
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Biomedicine and Power/ Authority Cont. |
-Western practitioners have the power to question & examine patients, prescribe powerful & sometimes dangerous treatments/medication, & deprive certain people of their freedom & confine them to hospitals if they are diagnosed as psychotic/infectious
-They can also label their patients (sometimes permanently) as ill, incurable, malingering, hypocondriacal, or as fully recovered
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Medical Facts |
-Constructed from the “consensus” of the observers who carry out these measurements according to specific rules or guidelines
-The assumptions behind these guidelines, which determine search and measurement of a given phenomena, provide what is called a “conceptual model” (122)
-According to kleinman et al., the modern western doctor’s view of clinical reality’ assumes that biologic concerns are more basic, “real”, clinically significant, and interesting than psychological and sociocultural issues (122)
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Medical Facts Cont. |
-Modern medicine relies on DIAGNOSTIC TECHNOLOGY to collect/measure clinical facts
this implies a shift from the subjective towards notionally objective forms of diagnosis
-Increasing use of NUMERICAL definitions of health & disease
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Medical Facts Cont. |
-Medicines main focus is on the consequences of illness, accident/misfortune, rather than on their CAUSE
-Medicines predominant approach in clinical practice remains the search for PHYSICAL EVIDENCE of disease of dysfunction & the use of physical treatments in correcting underlying abnormalities
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Medical Students and illness |
-Medical students develop some type of hypochondria while learning about various diseases, and may even develop the symptoms
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Culture Counter Transference |
-Whatever speciality they chose to work in, physicians themselves are also part of the ‘fol’ world for most of their lives- both before & after graduating medical school
-Cultural transference is when physicians unconsciously impose their own cultural values, assumptions & expectations on their patients by using psychoanalytic imagery **
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Biomedicine and Diagnosis |
-The physician has to ‘decode’ a patient’s discourse by relating symptoms to their biological referents in order to diagnose a disease entity (p.122)
-The traditional method of biomedicine/diagnosis
It implies a shift from the subjective (patients’ subjective symptoms, the physicians subjective interpretation of the physical signs) toward the notionally objective forms of diagnosis”
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Biomedicine Health/ Illness Definition |
-For the most part, a person is defined as being ‘ill’ when there is agreement between his/her perception of impaired wellbeing and the perceptions of those around him.
-In other words, becoming ill is always a social process that involves other people in addition to the patient (128)
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Psychiatry and Models |
-Psychiatry uses multiple & manifestly contradictory models that are used by different psychiatrists in explaining psychosis
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Psychiatry and Models: Organic Model |
-Emphasizes physical & biochemical changes in the brain
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Psychiatry and Models: Psychodynamic Model |
-Concentrates on a developmental & experiential factors
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Psychiatry and Models: Behavioral Model |
-Psychosis is maintained by environmental contingencies
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Psychiatry and Models: Social Model |
-Emphasis on disorders & role performance
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Different Health Care Sectors: Popular Sector
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Non-specialist and non-professional Sector; ill health is first recognized
Self medication and treatment and advice from friends and family
Main providers are women
70-90% of all health care takes place in this sector; both western and non western societies
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Different Health Care Sectors: Folk Sector
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Prominent in large unindustrialized societies
Individual specialized in secular (non-religious), sacred (religious), or mixture of the two
Healers are not part of the medical system
Intermediate sector between popular and professional
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Different Health Care Sectors: Professional Sector
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Organized, legally sanctioned, health professionals (physicians, nurses, etc.)
Biomedicine
Constitutes the dominant form of healing worldwide, and is ethnomedicine
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Food and Culture |
-Food: not just nutrition, in all human societies it plays an important role and it is “deeply embedded in the social, religious, and economic aspects of everyday life” (52)
- Food carries a lot of symbolic meaning. It expresses and creates the relationships between human, between humans and their deities and between humans and their natural environment. (52)
- Food also plays a role in how a society organizes itself and the way people view the world they inhabit. “you are what you eat- or what you refuse to eat.” (52)
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Food and Cooking; Levi- Strauss |
-all cultures in some way prepare/cook food. It sets mankind apart
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Food Preparation and Gender |
-STAT: in Africa, women prepare 70% of food
-Women are mainly the ones responsible for food preparation in many parts of the world & societies
-Women are also the ones more closely involved in FOOD PRODUCTION(milking animals, caring for livestock, planting/harvesting crops)(many African countries)
-In many rural parts of the the 3rd world women play a leading role in the RETAIL MARKETING of the food
such as the famous ‘market women’ of West Africa, the Carribbean, & parts of Latin America
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Different Systems of Food: Profane vs. Sacred |
-Sacred is validated by religious beliefs while profane is forbidden In some cultures all food is profane at certain time (e.g. fasting for yom kippur)
Cultural Taboos for Islam: Meat is only allowed from cloven hooved animals that chew the cud; no pork. Fish have to have scales and fins. Animals have to be ritually slaughtered
Cultural Taboos for Judaism: Same rules apply as Islamic cultures. Meat and milk dishes can never be mixed in the same meal.
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Culture and Malnutrition |
-May exclude nutrients that are needed from their diets to classify them as “non-foods”, as profane as poison, lower class food, or food on the wrong side of the hot/cold dichotomy
- Other hand may encourage consumption of certain types of foods and drinks by defining them as whole foods, sacred, religious, or ethnic identity when can be detrimental to a person’s health
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Health Care or Medical Pluralism |
-In most societies people suffering from a physical or emotional distress employ several strategies to alleviate it:
Rest, home remedy, seek advice from a friend or relative, consult with a priest, consult with a healer, or see a doctor.
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Social and Cultural Dimensions of Pluralism |
-Healthcare systems should not be studied in isolation; embedded in social, economic, religious and political systems
-Has cultural aspects: basic concepts, theories, and and shared modes of perception
-Has social aspects: organization of roles (doctors and patients), and rules of governing relationships (patient has to see a doctor at a clinic)
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Dominant Health Care Systems |
-In the western hemisphere, the dominant healthcare system is biomedicine
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Sacred and Secular Healers |
-Secular: Bonesetters, midwives, herbalists, etc. and give injections
Shai of Yemen (health worker)
-Sacred: Spiritual healers, clairvoyants, and shamen. Use holistic approach (look at all parts of the patient, including relationships with others, with the environment, and with supernatural forces)
The shamen; Mastering of spirits, enters his or her body, uses hallucinogenic drugs, and help diagnose and prescribe treatment
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Premises of the Bio Medical Profession
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Physician Centered: Physician, not the patient defines the nature of the patients problem
Specialist Oriented: Specialists are given higher prestige and awards
Credentials Oriented: Higher credentials= higher in medical hierarchy
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Premises of Bio Medical Profession Cont.
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Memory Based: Memory is rewarded and gains respect from peers
Single Case Centered: Decisions on a case are made from a cumulative description of previous cases
Process Oriented: Evaluations of the doctor are made on the doctors clinical skills made by measuring the impact on quantifiable biological processes (fall in blood pressure, decrease in cholesterol levels)
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Different Systems of Food: Food vs. Non-Food
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Different cultures have different beliefs of what is edible and what is not; however this can change under times of deprivation, famine, etc.
All cultures agree that human flesh is not food.
even under conditions of extreme starvation, utilizes all available nutritional substances as food
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Different Systems of Food: Parallel Food Systems
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-Parallel food classifications are the divisions of all foodstuffs into 2 main groups: HOT and COLD
-The theory of physiology on which this is based, equates health w/ balance between these two categories
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Different Systems of Food: Food and Status |
-Protein meals are often associated with powerful dominant groups, caviar in Europe, and pig in New Guinean societies
-In cases status is shown by throwing huge feasts in which a lot of the food is consumed and wasted. (e.g. Native American Groups: the Potlach)
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Different Systems of Food: Food and Identity
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Identities can include regional ones, familial ones, ethnic, or religious.
Each country has their own traditional dish and regions within that country have their own traditional cuisine.
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