Impact of Culture on Health

Catherine Anne Heywood
October 12, 2012
Impact of Culture on Health

STUDY GUIDE: EXAM 1

Chapter 2 – The Starting Point: Defining Culture, Defining Health

* What do we mean by culture? * Culture is one of those concepts that most people seem to intuitively grasp, yet cannot define clearly. * The process of categorizing groups of people as others (other than one’s own group) is a common feature of the way human beings think, and it forms a part of the whole phenomenon we think of as culture. * There other uses of the term culture that can confuse the situation – for example, saying someone is more cultured than the other, referring to some concept of high/elite culture, expressed through personal manners, education and knowledge, involvement in or familiarity with artistic activities such as opera, modern art, calligraphy, dance or theater – that is contrasted to pop culture. * Definitions they share the basic components, existing as a kind of whole and links many kinds of aspects of life and social structure within a group or society; it refers to the relationship between what people know and believe and what they do; it is acquired and shared, more or less, among members of the group or society and transmitted to members of the group/society over time. * The Classic Definition: Cultures is said to be that complex whole which includes knowledge, belief, art, morals, custom, and any other capabilities and habits acquired by man as a member of society (E.B Taylor, 1871) * The Symbolic Definition: Human culture is a kind of symbolic text, in which behavior, objects, and belief interact together in a kind of ongoing dramatic production that represents issues and concepts of meaning fr a particular society * Members act as characters in this grand drama and what goes on (plot) only makes sense in reference to an underlying interpretive framework. * Culture as an Ideology: Equate the concept of culture to a kind of dominant ideology or to beliefs, social institutions, practices, and media representation associated with particular configurations of power. * Discourse at any point is linked with a configuration of power and the rules for interpreting what is or is not a valid statement. * Culture Materialist Definitions. Viewing culture primarily as a system of belief, practice, and technology directly tied to economic activity or to the adaptation of a people to a particular physical environment. * Linguistic Definition: thinking of a culture as a type of language. Speakers of the language may use differently, to create slang, irony, humor, or even poetry OR they make break the rules to create a particular effect. BUT it is still the same language and underneath the language is some shared base of understanding about the nature of existence and day-to-day life. * Mental or Cognitive Definitions: Construct of culture as something primarily in the mind of people within a particular group, a kind of shared conceptual framework that organizes thought and behavior. From this perspective, culture is not so much about what people do, but about what they think and how that determines what they do. * Culture and Biocultural: Think of culture in relation to the human condition is to understand humans as biocultural. It is something that is imposed on the biological world by a society or group of people who have, over many years, developed a system of beliefs and practices. * How can we define the people who share a particular culture? * Is it a political definition? (most cases no) Is it a geographic boundary? A social boundary? Is it religion? * Culture is not fixed but evolves as people from one society or group come into contact with other people or as they change over time, their culture changes. * What do we mean by health? * Free of disease – absence of pathogens and healthy immune system * Body functions normally – organs, nervous and other systems function as they should * Free of injury and other problems * Eats healthy foods – food that provides essential nutrients and is free of substances that cause damage to bodily functions. * Engage in healthy, preventive behavior – basic hygiene, immunizations, sees a doctor * Avoids risky behavior * To be in reasonable physical shape. * To be in a stable mental state to be happy, satisfied with life, get along with people * General well being * In some parts of the world, criteria defined by other cultures can interfere with biomedical standards. * To obese can be a sign of wealth or in the case of females, fertility, maternal capability and warm personality. * Rites that often involve what we might call “health risks” yet they are understood to be good and absolutely necessary to proceed to the next life stage. * To understand diverse concepts of health and healthy behavior, it is necessary to think of health in a broader way, beyond biomedical. * Health is often very close to ideas within that culture about being well.

Chapter 3: Ethnomedicine I: Cultural Health Systems of Related Knowledge and Practice.

* An ethnomedical system can be defined as: an applied cultural knowledge system related to health that sets out the kinds of health problems that can exist, their causes and (based on their causes) appropriate treatments – as an interrelated system of belief and nature. * It is of key importance when thinking about the cultural aspect of ethnomedical system is that across cultures there are different answers to all of these questions, from the range of potential health problems, to causes, to treatments, as well as the closely related question of what kinds of individuals are qualified to provide treatment * Human beings are biocultural some theorists have found it useful to make a distinction between disease (abnormal biomedical state caused by pathogens or physical anomalies) and an illness (a culturally defined state of not being well, with many culturally defined causes including biomedical). * Disease and illness may or may not refer to the same phenomenon. * Functionally, both systems have the same kinds of elements and in both cases there is a linkage between the elements. The differences have to do with the specific content, and the means by which cause is determined (with respect to cause - in the biomedical case, that includes both research and clinical diagnosis.) * Where the biomedical system categorizes unwell states based on physical symptoms linked to biological causes, the nonbiomedical system may have its classification on combinations of emotional and physical manifestations links to the spiritual causes, disruption in harmony, imbalance in a person’s lifestyle or an improper mix of substances and forces. * Personalistic system – disease is due to the “active, purposeful intervention of an agent” where the ill person is the object of action by a sorcerer, spirit or supernatural force. * The general pattern of treatment is to block/counter the spiritual agent with spiritual forces in support of the patient. The center of action (in terms of cause or treatment) is not necessarily within the patient, but in the supernatural world. * Naturalistic system – disease is explained by the impersonal actions of systems based on old historical systems of great civilizations. Illness arise when people are out of balance physically, spiritually, or in some other way. * The pattern of treatment is to restore balance through various combinations of herbal medicinal, meditation, diet, lifestyle changes, or other actions. * A very important principle to remember is that a given social or cultural group will rarely operate in reference to a single ethnomedical system. The norm for most people is multiple and coexisting ethnomedical systems of some blending of elements from various types of systems. One system may be dominant, but aspects of other systems are also likely to be included. * The Placebo Effect and Role of Belief – placebo effect the tendency for treatments and pills to have no biochemical or biomedical effect to cause improvement in patient health symptoms. This occurs because of the belief that the treatment or pill has curative properties or because of the ritual process of going to a doctor itself. * Ethnomedical Systems: Non-Western Examples * Ayurvedic Medicine (India) * Originates with ancient Vedic culture in India and focues on prevention and a holistic concept of health accomplished through the maitenence of balance in many areas of life, including thought, diet, lifestyle and the use of herbs. * Body is comprised of 3 primary energy types called dosha each represents characteristics derived from the 5 elements of space, air, fire, water and earth. * Vata subtle energy associated with movement * Pittaconnected to the body’s metabolic system * Kapha associated with body structure * Cambodian/Khmer Health Belief Systems * The traditional system shares some aspects in common with Chinese and other Asian systems in the emphasis on balance. Illness may be attributed to imbalance in natural forces. This is often symbolized or expressed as the influence of wind or kchall on blood circulation illness * South African Health Belief Systems * Among the Shona and other peoples, one aspect of a naturalistic system is understood to be related to the presence of a nyoka or snake in the body. Movement of the nyoka is related to many diseases, including diarrhea, stomach ailments, sexually transmitted infections, epilepsy, mental retardation and others. * Health Belief Systems in Latin America and the Carribbean * Espiritismo common in Cuba and Puerto Rice, synthesis of Afro-Caribbean, French, and possibly U.S. spiritualist. The belief system is that there is both a supreme being and a world of spirits with influence on health that can be accessed through a medium, typically in a group séance-like setting. * Santeria also found in Cuba and Puerto Rico, blend of West African and Catholic traditions. It is based on the idea that there are many spirits called “orishas” who are connected to the supreme being and who can be appealed to help in various dimensions of life. * Curanderismo founded in many parts of central/latin America; a healer or curandero makes a diagnosis using tarot-type cards or by sweeping a broken egg or other object across the body of the patient. The idea is that there is a supremem/higher power that is the source of energy, and the curandero is the instrument of that higher power. * Western Example – the biomedical system is primarily based on a classification system tied to biological phenomena – the action of pathogens (viruses, bacteria), cellular or other biomechanical malfunctions, injuries/system damage, and others. Treatment is, of course, directly connected to generalists or specialists trained to address specific kinds of biomedical phenomena.

Chapter 4: Ethnomedicine II: Cultural Systems of Psychology and Mental/Emotional Health

The Cultural Construction of Mental/Emotional Illness * Anything defined as an abnormal mental/emotional state is also likely to involve a cultural judgement and therefore may say a lot about cultural values and beliefs as a whole at particular moments in history * Ex. drapetomania – the disease causing negros to run away. It was thought to be a curable disease of the mind, involving sulkiness and dissatisfaction prior to running away, that could be brought on when white slave owners trated slaves too much like human beings, or on the other hand when they were overly cruel and brutal. * Ex. dysaethesia aethiopica – characterized by a state of half-sleep and a physical or nervous insensibility that caused them to behave like “rascals” * DSM – reference book for mental conditions that are viewed in Western/biomedicine as abnormal, with detailed descriptions of the etiology, symptoms and treatment for each condition. While it is based on scientific/clinical research, the symptoms and descriptions for many conditions offer a fascinating glimpse of the way in which such conditions can be shaped by cultural expectations and changes in such expectations. * Ex. Antisocial Personality Disorder the symptoms seem to outline a kind of personality that could be viewed as troublesome if not criminal but the picture changes when context and culture are added. * Ex. ADHD according to the DSM IV, this disorder is characterized by two sets of symptoms – inattention and hyperactivity impulsivity. This is a condition that can cause difficulties and impairs appropriate functioning. But there is room for interpretation. Some elements of hyperactivity and are subjective and depend on culturally related standards for appropriate behavior. The Question of Universal vs. Culture-Specific * Do all humans beings experience the same mental health phenomena or emotional phenomena? * The universalist position would argue that human beings have essentially the same psychological makeup – a position often referred to as “psychic unity” * The cultural relativist perspective cultures entail unique patterns of thought and behavior. * Combination of both perspectives cultures shape how emotions and mental experiences are constructed, named, and given meaning, and the living patters of specific cultures tend to accentuate particular stressors that may result in mental health issues. * There do appear to be some mental health conditions that occur in some form across cultures, and so could be seen as universal conditions (ex. depression). * Mental conditions that appear unique to one or a few cultural groups can be thought of in 2 ways * culture bound syndromes defined as any form of disturbed behavior that is specific to a certain cultural system and does not conform to western classification of diseases * Many of these patterns are considered to be “illnesses” and have local names. * Problems with culture-bound syndromes: no suggested steps for how a provider should incorporate cultural factors into the diagnosis or learn what those factors are; overlap between some conditions across cultures; the process of selecting the culture bound system is unclear * Conditions that are prompted by specific patterns of social stress and/or ecological contexts * Ex. In the Saora tribe in India there is a peculiar condition among young men and women who cry and laugh at inappropriate times, experience memory loss and feel like they are being bitten by ants. These young people are considered misfits and are not interested inpursuing the traditional subsistence of farming life. For this, they are under considerable stress due to social pressure from relatives and friends. To solve this problem, a marriage ceremony is carried out in which the disturbed person is married to the spirit. Young person becomes a shaman. * Anorexia/Bulimia in the United States * Fear of weight gain and distorted view of one’s body. This causes people to restrict their eating or binge eat/purge. One of the key contributing factors is the combination of weigh gain during puberty set against perceived social pressure to conform to culturally specific ideals of beauty * Historical Trauma * American Indian/Alaska Native populations have long experienced a range of disparities in health. These peoples suffer from a collective, psychological scar resulting from the experience of violence, culture loss, land loss, discrimination and eventual marginalization that resulted from European colonialism and conquest in the Americas. * Immigrant/Refugee Mental Health Syndromes * Many immigrants and refugee populations coming to the United States and other host countries from civil disasters and other traumatic situations experiences psychological consequences in addition to the stress of acculturation itself. * Emotions and Culture * Lutz and the Ifaluk found that emotions are culturally constructed. Emotions are a daily working phenomenon.

Chapter 5: The Moral Dimension: The Relationship of Etiology to Morality in Cultural Beliefs and Practices Related to Health

* Cross Cultural etiologies of illness can range from those that seem neutral, like pathogens or genetics, to those that don’t like sorcery or family disharmony * In other words, there appear to be some causes for which no judgment can be made or blame assigned, and some that can be blamed on somebody or something, whether the person who is ill, or another person, or another social institution or group. Culture, as reflected in ethnomedical systems, involves socially produced definitions of what is normal vs. not normal. * When a person experiences some abnormal phenomenon (illness) it could be thought of as: * Abnormal but morally ok not your fault * Abnormal but not morally ok your fault or somebody’s fault. Can result from stigma. * The moral connection to illness is very much related to several kinds of factors: * Cultural conceptions of the individual and the degree to which individuals are viewed as responsible for their condition and their behavior * Most western societies are typically viewed as individual-centric * The degree to which external forces are viewed as responsible for their condition and their behavior * In many cultures, what you do and what happens to you may not originate with you but with other forces. These forces could be attributed to one or more gods, to broader natural forces, to specific spirits, or to sorcery ad witchcraft. The moral source, so to speak, may in part be related to individuals but indirectly. * The kinds of social divisions that exist in a particular society and what those social divisions are held to mean – social class/social stratification, gender, race/ethnicity, religion and other divisions. * Refers to a moral source that is society itself the way in which society creates conditions that make some peole more vulnerable to disease than others or that forces some people into choices (with health consequences) that others do not have to make. * Physical Symbolism of the Disease * If the appearance of the disease looks like the embodiment of a culturally defined malevolence of some kind, people may react to it regardless of whether or not the victim is initially held to be at fault. Alternatively, the appearance of the disease may be seem like evidence that the person must be at fault or is some way selected for punshement, triggereing a kind of after-the-fact blame. * All of these can lead to the stigmatization of people with a particular illness or disease. * Stigma: the discrediting, social rejection or staining of types of people who are viewed as blameworthy in one way or another. It is the social construction of spoiled identity for classes of people viewed as undesirable by some social standard. The exclusion and abuse caused by stigma may even be sanctioned by law. * Illness Behavior * Two kinds of sick roles: * A set of roles for people who are ill * A set of roles for the other people who interact with the sick person, whether as a healer or family member or even a classmate. * Illness behavior is produced or socially constructed within the framework of a culture. It involves an entire production, in which many players act out their roles and in doing so, work together to produce a result that comes out as the way of a particular illness takes form, and the consequences of that, in a given society. An important result of this and other culturally shaped interactions is to reproduce the culture. * LOOK AT THE SLIDES FOR LEPROSY AND HIV/AIDS

* The othering function of culture and stigma

* The issue of stigma and the intersection of culture, morals, and illness brings us another social function of culture othering function * The tendency for culture to provide a general coherence associated with a society or group mens that the features of the coherent life pattern becomes integrated in, and valued as, the identity of people with that group. The opposite of that is when a group of people assert an identity, a sense of who they are, they are also creating a sense of difference – who they are not. People outside of the group, who do not assert the same identity but other identities, which may entail other thoughts, beliefs and actions, are then by definition the other. * And if there is a value attached to identity in a group, then there may be a negative value judgement made about those who are viewed by the other. * Ex. our tribe/not our tribe * With us/against us * Citizen/alien * Pure/polluted

Chapter 6: Culture, Healers, and the Institutions of Health

* Once someone is identified as being ill, and the cause is ascertained, what does no do about it? * The Social Institutions of Healing * People turn to one or more types of healers who are recognized as such and who operate within the ethnomedical systems and health provider structures prevelant in that society. * Healers are embedded in a cultural process and at least some institutionalized practice so that individuals who are ill can make a decision about their treatment. * Types of Healers and Rituals of Healing * Across cultures, healing is practiced in an organized, ritualized form – healing ceremonies, divination, appointments and so on. healing can therefore be thought of as a collective act. * Shamans and Shamanic Healing Practice: An Example of Healers and their social role * Definition: a shaman is a mediator between the human world and the world of spirits, between the living and the dead, and between animals and human society. Shaman fills many societal and religios roles. He/She plays an offensive and defensive role in the protection of his/her group against the aggressive actions of other shamans or displeased spirits. * In other words, shamans are crossers of boundaries within the catgory systems of cultures. * Like all healers, success for shamanic healers depends in part on the degree to which the healing practices are supported by community belief and in many cases, participation.

Chapter 7: Sociocultural Ecologies of Disease and Illness

* Overtime the ecology helps shape characteristics of the culture, and in turn, those characteristic of the culture, and in turn those characteristics create constraints and boundaries for people within a culture. * Withing specific ecologies, people and cultures adapt to the environments they are face with. * Vulnerability * A key concept in trying to understand how health affected through interaction with different ecologies is the idea of vulnerability. * There are layers of vulnerability created by specific sociocultural and political ecology. It doesn’t have to be that way, but the combined layers of cultural and political relationship, interaction with a physical environment, have produced a situation. * Vulnerability is to some degree arbitrary, based on social, cultural and political-economic configuration. * Generally: societies and communites are all exposed to pathogens and environmental risks. The degree to which these exposures have an impact on the society has to do with the society’s resources, capacities and other characteristics. * At the individual level, individuals within societies are all exposed to pathogens and many individuals experience other kinds of physical challenges and problems. Exposure to pathogens alone is not sufficient for an individual to become ill. It depends on how physically vulnerable that individual is. When a group of individuals within a society share a pattern of health vulnerability, we can think of it as a trajectory. * Some patterns of vulnerability to disease are driven by the interaction between a society/cultural group and a physical environment the beliefs, social organization, and living pattern of a particular culture are causing that culture to adapt well to a disease environment, not to adapt well, or even to exacerbate a disease or health threat. * Vulnerability: culture, physical environment and disease * Cultural patterns within societies and vulnerabilities to disease ex. dietary practices; gender roles and smoking tobacco. * Culture, the political economic environment and disease all political and economic systems are infused with cultural ideologies that shape those systems and provide explanation and legitimacy for them. Political economic systems shape vulnerability includes the way that resources and social benefits are distributed in society and the nature and logic of the economic activity that produces those resources and goods. Vulnerability is higher among thosewho have the least access and resources.

Chapter 8: Culture, Subculture, and Constructions of Health Risk

* Certain kinds of behaviors, social practices, or beliefs are easily called “risky” or “at risk” if they present risks for infection, injury, physical functioning, or other biomedical health conditions. * Rites of Passage and Health Risk * All cultures include rites of passage as part of the process of moving from one stage in life to another, whether initiation into adulthood, marriage, funerals, or other stages. These rites involve ceremonies, but also in some cases trials that the initiate must undergo to demonstrate readiness to move to the next phase. * When a risky situation is part of the ritual process, it will be interpreted with a very different lens than just thinking about the risk alone. * When public approach aims to prevent or avoid risk, some rites of passage assume that pain or potential danger are necessary elements of the transition. * Ex. female circumcision, drinking as an adolescent rite of passage in the US