Revisiting Usog, Pasma, Kulam

Tan, Michael: “Revisiting Usog, Pasma, Kulam”

I. Introduction: Deconstructing Health and Illness A. “Clash of Paradigms” (How illness comes about and how we can handle it) 1. Traditional vs. Western Traditional: experts for sprains and dislocations Western: handle fractures better 2. Chinese explanation vs Filipino explanation
Chinese: importance of the circulation ‘Qi’ or inner energy which is healing per se and herbal medicines prepared by his mom (Chinese decoction and Ben-Gay ointment) Filipino: Filipino bonesetters or manghihilot like Mang Cleto 3. Disagreements with “Western” medical practitioners To cast or not to cast the sprain 4. Mom’s magico-religious explanation “Minamalas” or bad time for the family Referred to a Chinese almanac and confirmed that the day was “inauspicious” 5. Friends’ suggestion:
The fall was ‘subconscious’, a way of the body telling him to slow down
The injury caused the author to excuse himself for one conference, but attended the other one—his mom upset for absence of hot water at the conference site. B. Rationale for the study
1. Response to health professionals who were working with community-based health programs, other professionals working in hospitals and teaching in medical and nursing schools
2. Deconstructing the traditional medical system, offering a classification system to look into various concepts of illness
3. Need to help health professionals to develop cultural competence’ or cultural sensitivity. Assumption: If health professional understand the ‘beliefs and practices’ of different ethnic groups, then they will be able to change people’s behaviour, in terms of disease prevention, compliance with prescriptions and health maintenance Criticism: Kleiman (2006) criticized ‘trait list approach’ where health professionals get a list of the “beliefs and practices” and then presume they can handle the different ethnic groups that come to them. **Suggested: Go beyond this cultural competence approach (term itself implying it is same kind of technical skill you can easily acquire) and learn to use ethnography, an engagement with people that builds empathy in an intensive and imaginative way.
4. Show how traditional medicine is embedded in other social structures and therefore will sometimes take on functions of what we think of as religions or politics C. Theoretical and Methodological Perspectives
-Draws mainly from ethnographies, many from the early 20th century, many of which were produced by American anthropologists who came in during the colonial period to study “non-Christian tribes” 1. Phenomenological perspectives
1.1 “Ethnography of experience”- What does it mean to be ill or to be healthy in a particular social context, at a particular historical period? Ex. The month of August described by Nick Joaquin in the novel Cave and Shadows as “red with fire and red with blood, he month of amok, when tempers cracked and crazed”. Reason for this is the mixture of rain and heat that causes discomfort and anziety we have about August’s strange weather, one which is seen as possibly causing illness
1.2 Heavy linguistic analysis- Language is not just a medium through which ethnographers obtain information; instead language itself is data, words providing insights into how people look at the world around them. Ex. Words from Manobo dictionary compiled by Elkins (1968) ‘ayew’- a supernatural being which causes sickness to a person so that he will revive beliefs and practices of his ancestors ‘navey’- to inadvertently cause sickness to a human being who accidentally comes in contact with his power 2. Social Interactionist perspective
2.1 Social interactionism- looks at the way people interact to shape and reshape notions of health and illness
2.2 Mapping out the different social terrains in which we learn about health and illness. These include the family, communities, traditional or folk healers, as well as health professionals.
2.3 Discourse- (emphasis in social interactionist analysis) the exchanges people have in something as mundane as a conversation, as well as in more formalized occasions
2.4 Looks at culture as being much like theatre, with people, as actors, performing scripts 3. Political economy
3.1 Political economy- looks at power relationships and how these are linked to the economic system
3.2 The author took a macro perspective of political economy, looking specifically at ideologies
3.3 Many studies have demonstrated how medicine carries a strong ideological component. 3.3.1 Our medical beliefs, symbolism and rituals reflect a way of looking at the world around us and help us explain or rationalize the existing order of things, including our relationships in society. *beliefs are often epicyclical, meaning they contain secondary elaborations to cover every eventuality or even anomalies that have to be explained
Example: Our belief in sorcery (kulam)
1. Certain individuals have the power to cause illness or even death through various magical techniques, such as the casting spells or the use of poison.
When an illness is believed to be caused by sorcery, the victim generally will not go to a physician
2. Sorcery as a social phenomenon
Anthropologists such as Kluckholn (1944), Whiting (1950), Lieban (1960, 1962a) and Hallowell (1963) – functionalist explanations to suggest that sorcery and sorcerers “exist” as part of a system for social control
Example: Against philandering husbands and their mistresses
Recognized as a valid way of punishing such individuals who have breached social norms
In an urban setting, sorcery has now intruded into the business world where a business partner who feels he or she has been cheated may resort to the services of one of the many available sorcerers in urban centers to punish the absconding partner.

4. Cultural Ecology -looks at how we use culture to respond to the challenges posed by the natural environment
4.1 How we tap into the natural environment for our material medica, from medicinal plants to the explanations themselves, what Ortner calls “root metephors” or ways by which we conceptualize, describe and understand the world we live in.
4.2 Attributing health and illness to a balance of natural forces, to winds, miasmas (singaw), to hot and cold and with ideas of equilibrium and harmony.
Chapter 2: Defining the framework for analysis: Health, Illness and Medicine 2.1 Medicine and Medical system 2.1.1 Landy’s definitions: * Medicine: a matrix of values, traditions and beliefs, predominantly part of culture * Medical systems: involves social organization 2.1.2 Kazarian and Evans’ (adapted from Kleiman) three systems of medicine:
* Folk system: described as “loosely systematized health concepts held and practices carried out by indigenous specialists Practitioners are: the hilot, the albularyo, the faith healer and healing priests
* Professional system: refers to “organized and officially sanctioned health concepts held and practices Practitioners are those who go through formal training and licensure, e.g doctors, nurses, midwives
* Popular system: consists of “lay or everyday theories and practices of health” Includes: mother, grandmothers and the wise neighbour

2.2 Illness and Disease 2.2.1 Definitions * Illness: “a single instance of being sick” (Frake, 1961)
“the human experiencing of disease…an explicitly social phenomenon with both an objective and a subjective reality” (Idler, 1979)
* Disease: “a diagnostic category, a conceptual entity which classifies particular illnesses, symptoms or pathological components of illnesses or stages of illness” (Frake, 1961)
“an abstract biological-medical conception of pathological abnormalities in people’s bodies, and as such, presents no data for sociological analysis; it reveal no social facts” (Idler, 1979)
*Illness and disease in Philippine languages In most Philippines languages, only one term, sakit, exists, coming closer to the above definitions of illness rather than disease.
* In many cases, these ailments are culture-specific and are therefore called “folk illnesses” or “culture-bound syndromes”
There is the tendency among health professionals, to think of these folk illnesses as “psychosomatic”, “all in the mind” or dismissed outright as “superstition”.
On the other extreme, physicians tend to be too quick to label, as medical problems, what are essentially “philosophical” problems. Example: When a person begins to wonder about his or her role in society, that speculation is automatically labelled as a “depressive disorder” requiring a dose of “antidepressants” which ironically, often lengthens and aggravates what could have been a passing “in the pits” phase.
* Beyond folk illnesses then, we see a trend toward problematizing, through medicine, many of life’s passages. Example:
Pharmaceutical companies have been especially enthusiastic about capitalizing on the problems of what are normal, but turbulent, passages through life.
Women have been targets for such manipulations e.g estrogens to pacify the menopausal woman, analgesics for “premenstrual tension”
* Disease mongering: “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments” (Moynihan and Henry, 2006) Create a disease out of problems that could actually be part of a health process of mental, emotional and social development on the part of the individual (Conference in Australia, 2006) 2.2.2 Sakit
* Literally translates into pain, and is used in several Austronesian languages as synonymous with “illness”
* In western medicine, pain is considered only as a symptom.
* In the traditional Philippine conceptual framework, sakit is used to: > refer to pain, and in several context (e.g. sakit sa ulo, sakit sa tiyan)
++different terms for the quality for pain as a symptom, such as hapdi for a stinging type, kirot for a sharp, recurrent type, antak for internal continuous stinging type
> refer to illness, a different linguistic framework is used, one which may be describe as hierarchical
Mahina (weak) does not necessarily progress into an actual sakit or illness. But a person who is normally malakas (strong and active) then suddenly feels weak, would be concerned that this may be the start of an illness.
Matamlay (which comes closer to the English “lethargic”) is considered a ‘qualifier’ or a symptom of having an illness.
The term may sakit will not be used until the person is unable to perform physical tasks, a common criterion being the stage when one is bed-ridden. *There is a heavy reliance on prodromal criteria, an assumption that a whole series of symptoms or even “minor illnesses” must first appear before the outbreak of the “major illness”. Example:
The shock and dismay of a mother when her child dies barely a day after she had realized that the child was ill.
Diarrhea may be considered “normal” in a child sometimes even attributed to teething, despite the potentially fatal result of dehydration from prolonged diarrhea.
* Illness, as exemplified by sakit, has many social dimensions, mainly in terms of using predefined “normal” social activity as a reference for diagnosis and attribution of illness. In all instances, social interaction is vital before an illness is recognized. 2.2.3 Health and Kalusugan
* “able-bodied”- A strict translation of kalusugan in tagalog, Bikol and Kapampangan, a logical correspondence to the notion of illness as a physical debilitation
* lusog- root word for kalusugan, defined as “full development, progressiveness” (Panganiban, 1972) Example: In translating from English, “The child is healthy” to Filipino, “Mataba ang bata” and yet the term mataba, used for adults, refers more to obesity and is definitely not considered as a sign of health. A common reply to the greeting “Kumusta ka?” (How are you?) is “Mabuti naman,” literally translated to good. The term is frequently used in medical consultations roughly to convey the message “I feel good” or “I feel well”. An alternative reply would be, “Eto buhay pa” (Here, still alive), said in a sad tone. To be alive is not a good indicator of being healthy and the tone of the answer insinuates that there may be underlying physical, psychological or emotional problem.

2.2.4 Theories of Illness Causation * Beliefs about illness causation are essentially based on one of three “attitudes toward the world” or what others would refer to as world view. (Rivers, 1924) **Three categories are:
1. The magical: those which attribute illness to human manipulation of forces
2. The religious: attribute illness to supernatural forces
3. The naturalistic: view illness as being caused by natural processes * Foster divides medical systems into personalistic and naturalistic—Rivers’ magical and religious categories under single term: personalistic. * Murdock: “supernatural” and “natural” * Glick: stressed to recognize the three possible levels of causation in traditional illness theories. Using sorcery as an example, he distinguishes the levels of causation this way:
1. The efficient (e.g. a sorcerer)
2. The instrumental (objects used by the sorcerer)
3. The ultimate (motives, final explanations)
** People may believe that the cause of their illness is sorcery, implemented through objects sent into their bodies. 2.2.5 Explanatory Models * Proposed by Kleinman (1980) to look at the way we handle illnesses * Defined as “the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process” * Offer explanations of sickness and treatment to guide choices among available therapies and therapists and to cast personal and social meaning on the experience of sickness
* Deals with five aspects of illness: 1. the etiology or cause of the condition 2. the timing and mode of onset of symptoms 3. the pathophysiological processes (changes in the body that occur because of illness 4. the natural history and severity of the illness 5. the appropriate treatments for the condition
* Processing these EM’s is important, sometimes through the “illness narratives” (Kleiman 1988) that patients have, some of which may emerge during clinical consultations and others in day-to-day discourses, with relatives and friends, with other health providers.
* The illness narratives are important in figuring out what has happened and why it has happened. It may themselves be therapeutic.

Chapter 3: Usog, Bangungot and Other Mystical Theories of Illness and Causation Mystical theories of causation are based on the premise that impairment of health results as an automatic consequence of some act or experience of the victim (Murdock, 1980)
3.1 Life forces: From Bisa to Usog
Animatism- an old anthropological ter used to refer to concepts of a basic metaphysical life force, e.g. the Polynesian mana, the Chinese Qi (or ch’i) and the Indian (Sanskrit) prana
-integral to medical systems, for example, the Chinese believe that illness is due to obstructed Qi, so therapies such as acupuncture are used to allow that Qi to flow freely
In the Philippines, we also have our own indigenous term for these life force and are integral to our popular concepts of health and illness. Example: Subanun- gimuud (soul) and gina (life stuff)
Bataan Negritos- bananas and other plants should not be planted deeply for the soul of the plant dislikes absolute darkness. Seed should not be pressed with hand for its productivity will be damaged or destroyed (Garvan, 1964)
Tagalog- The concept of bisa described as “psychic forces within the body” (Jocano, 1973), can also mean “efficacy, effect, potency, result” (Panganiban, 1972)
Malay and Muslim Filipino groups- bisa means “poison”
The concept of potency extends to many objects, which may even perceived as being useful to repel or cure illness: anting-anting, mutya and other amulets or charms
According to Fox, the power of mutya is sui generis and… it is only necessary for an individual to possess and manipulate them. The mutya in fact bestows certain powers on individuals possessing them. The notion of gayuma is another way of understanding animatism.
The gayuma is a love potion or charm that is believed to make a person’s amorous advances difficult to resist. Refers to “appeal” a person carries, with or without an object.
Humans are also believed to have some potent life force which could cause illness, even without the individual’s wanting to cause illness.
Examples: usog, balis, gahoy and uhiya
Such illnesses usually affect infants. Believed that it is caused by male or female with particularly strong “breath”. The popular solution/ prevention is to wet his finger with his/her saliva and apply this to an infant’s forehead, abdomen or soles of the feet, especially if this is their first encounter.
Other practices to counter usog:
Muslim Tausug: “pasu simud hi babu/kaka” (May the hot breath go to an aunt or elder cousin) (Bruno, 1973)
Visayan: “puera buyag” (away with buyag) (Hart, 1980)

The concept of the ‘evil eye’
Mediterrean and Latin America (mal de ojo in Spanish) -Certain individuals can injure others, esp. children, by looking at them.
Ifugao- Certain persons have an evil ‘cut’ of the eye which, whether they wish it or not, bring misfortune or sickness on whomsoever or whatsoever they see. (Barton, 1919)
Tagalog- ‘uhiya’ apparently derived from the Spanish ojear, defines as ‘witchery by the evil eye’ (Panganiban, 1972)

** Beliefs in illnesses such as mal de ojo, usog, pasu umid and buyag are based on this theory of a life force, with attributes of ‘strong’ and ‘weak’.
3.2 Pollution Relates to contamination, defilement and even corruption.
Example:
Beliefs about menstruation
There is a reflection of ideologies, not only among Filipino groups but also in many other cultures throughout the world that label women, especially those who are menstruating, as potentially dangerous. Examples: Bukidnon: menstruating women were not supposed to touch legumes, lest the plant turns yellow (Cabotaje, 1976) Panay: menstruating women are believed to cause flowers and leaves to wither (Jocano, 1969)
Beliefs regarding the dead Death is such a disruptive event that cultures attribute it with all kinds of connotations of misfortune and danger. Examples: Nomadic tribal Filipino groups: houses being abandoned or destroyed after a person has died Ritual observations after burying the dead, often involving bathing or cleansing Muslim Yakan: bamboo tubes containing palay (rice) seeds must be taken out of the house of a dying person because the person’s death might destroy the seeds’ viability Bontoc of Sagada: seek contact with the dead person. Contact with the deceased would result in a transference of “good luck, success, ability and skill”.
3.3 Mystical retribution Full references to taboos among Filipino ethnic groups. A violation of a taboo results in punishment by supernatural beings in form of illness or misfortune. Example: Tagalogs: Pregnant women does not prepare new clothes for herself as this would seem she is preparing for her death.
Relatives of a pregnant woman should not involve in digging because this would be suggestive of preparing a grave for her. **The concept of mystical retribution is best captured by karma as defined in Buddhism. Karma is not a divine punishment but a cause-and-effect relationship to one’s action.

3.4 Fate A mystical theory only insofar as illness is ascribed to “astrological influences, individual predestination or personified ill luck Example:
Cebuano belief: buayahan- individuals who are believed to be fated for illness and death because of lines on the palm suggesting the shape of the mouth of a crocodile or buaya
Dinawat Ogil, a Bukidnon datu- “In marriage, I don’t look for beauty or any special gift, but our palad—mine and my wife’s—must agree with each other Palmistry may have been of relatively recent introduction in the Philippines, possibly accompanying Islam. Ilokano: traditional healers examine aperson’s sintas (linea alba, the midline extending from the umbilicus to the xiphoid or the chestbone) to predict one’s susceptibility to illness (Riguera, 1968)
3.5 Soul loss Many religions in ‘smaller’ societies believe in a soul that is capable of leaving the body temporarily and that its prolonged absence may cause the bod to fall ill, with death being the final or permanent separation of the soul from the body. (Murdock, 1980) Example: Early Filipinos- It is regarded as a great insult to step over a sleeping person and they object to wakening one asleep. Panay- Each child is believed to have a companion in the form of a gecko (butiki). If the gecko falls into a crevice, the child may die of hupa or bad dreams. (Jocano, 1969) Tagbanuwa of Palawan- belief in “one true soul, the kiyarulwa, and five secondary souls, the paʔyu
Bagobo- concept of a “good” right-handed soul and an “evil” left-handed soul, the latter being the “wanderer” and a potential cause of illness
Cavite- A sleeping child should not be moved, lest its wandering soul returns and is unable to find the body
3.6 Bangungot Literally translated as “nightmares” originally referred to mare, a female spirit that was believed to suffocate sleeping victims; from root word bangon, “to rise” and ungol “to moan” A victim of bangungot may die if he/she is not able to wake up during an attack. First reported in medical literature in 1917. Victims studied were all males, middle-aged and generally from lower economic classes. Nightmares are sometimes attributed to a person going to bed after an excessively heavy meal. Cases: Isneg dictionary: ab-ab as a kind of paralysis preventing people from moving and shouting, affecting people who sleep alone Sudden deaths among Southeast Asian refugees in North America, under similar circumstances to the Filipino bangungot. Sudden deaths among Thai construction workers in Singapore and among Cambodian and Lao men in Thai refugees camps Current hypotheses about SUDS (sudden unexplained death syndrome) Caused by: stress, genetic factors, dietary deficiency (particularly thiamine), potassium deficiency, meliodosis and sleep disorders Brugada syndrome, a hereditary heart problem (Abarquez, 1999) Cure: Generally, the person should be awakened. Toril, Davao: One should never wake a person suffering fom urong with your bare hands or that person will wake up with a different voice. (Lorenzana 1984)

** The belief on bangungot is also a form of social control against overeating or even against sleeping alone.