Western v. Indigenous Practices and the Benefits of Both

 

What is normal? Some dictionary definitions are, “conforming to the standard or the common type,” “usual,” or “average.” But these definitions only apply in the context of what is around them. Thus, each culture has an understanding of “normal” based on their understanding of shared experiences, meanings and values. In the context of health, what a culture perceives as “normal” is at the basis of what health issues are recognized, diagnosed and treated. The definition of normal that best describes our culture’s interpretation of the term would probably be “average,” because of the scientific lens with which we tend to look at health issues. We recognize, diagnose and treat people using science and standards derived from data.

                This made me think of our class discussion about the increasing diagnosis of ADHD primarily in the U.S. and how western doctors are now prescribing medicine for those who have this behavioral, “abnormality.” However, behavior is hard to measure objectively and therefore the margin of error when diagnosing ADHD is quite large. And if so many children seem to have this “disorder,” is it really a disorder after all, or just a common behavioral trait that is difficult to live with in our society? Besides, it seems that only American doctors are recognizing the “disorder” on such a large scale. In an article from the British Journal of Psychiatry, titled ADHD is best understood as a cultural construct, the following perspective is offered:

By conceptualising problems as medically caused we end up offering interventions (drug and behavioural) that teach ADHD-type behaviour to the child. ADHD causes ‘tunnel vision’ in the system, making it more difficult to think about context, leading to interpersonal issues being marginalised. ADHD scripts a potentially life-long story of disability and deficit, resulting in an attitude of a ‘pill for life’s problems’. We create unnecessary dependence on doctors, discouraging children and their families from engaging their own abilities to solve problems.

While I am not intending to argue that ADHD does not exist or that it doesn’t negatively affect the lives of many people, I think it is interesting to consider how the diagnosis and treatment of it serves as an example of what happens when the explanatory model of western medicine must deal with a subjective health issue that cannot be accurately measured. This person raises a good point that there is no attempt through this approach for one to solve their own problems, but instead the issue is treated with medicine that affects one’s brain. Seeing how the western biomedical explanatory model struggles to deal with this more experience orientated, subjective issue, I began to think back to the other explanatory models we learned about in class, such as the native Indian practice of Ayurveda.

 

This diagram displays the basic elements of Ayurveda and how they are believed to relate to one another. In the practice of Ayurveda, it is believed that one cannot be healthy unless these natural elements and energies are in balance. I couldn’t help but wonder how an approach similar to this might lend itself better to dealing with what western doctors call “ADHD.” Practitioners of this model wouldn’t try to classify a patient’s perceived symptoms as abnormal or normal and diagnose them with a “disorder” and prescribe them medicine, but instead attempt to help the patient find balance for themselves. By considering all the aspects of an individual’s experience, this approach is more holistic. Given the subjective nature of the “disorder” ADHD, it seems to me that a practice like this could help someone by assisting them in centering themselves and potentially eliminating some of the symptoms of ADHD without chemical treatment. However, this approach requires more of the individual and could potentially require them to make lifestyle changes.  In general, this practice places responsibility on the individual for their own health, stressing the importance of a healthy diet and restraint from overindulgence. Therefore this practice demands that patients fully buy into the practice and commit themselves to following through with it. As we saw with the reporter in the Frontline video, he felt that if he continued to take care of himself in the way that he had been taught by the Indian practitioners, his arm would have continued to get better. In order for Americans, or others who believe in the western model, to benefit from a practice such as this, they must be willing to accept it and the responsibilities it entails.

As someone who has lived my whole life in western culture, I very much believe in biomedicine and often times I feel that it is more successful in curing patients than many other forms of medicine. Having said that, I think that there is much to gain from opening our minds to alternative approaches. We tend to think only of how to get people who believe in local indigenous practices to accept biomedicine, but perhaps we should think both ways. It is important to understand indigenous explanatory models not only to find ways to make western medicine more successful in foreign places, but also so that we can gain new perspectives from their practices. The following is a related quote from Susan Scrimshaw’s chapter, Culture, Behavior and Health:

A 16-country study of community perceptions of health, illness, and primary health care found that in all 42 communities studied, people used both the Western biomedical system and indigenous practices, including indigenous practitioners. Due to positive experiences with alternative healing systems, and shortcomings in the Western biomedical system, people relied on both. Experience has shown that health programs that fail to recognize and work with indigenous beliefs and practices also fail to reach their goals.

               As she states above, there is much to be gained from both approaches and most communities depend on both. However, often times the two belief systems contradict each other and people end up not receiving the care they need. That is a complicated issue, one that is very unlikely to be solved in entirety. However, I believe that the more people allow themselves to consider the value in alternative forms of medicine, the more likely they will be to find the care that best assists them with their problems.

-Carlie Anderson

Image; http://en.wikipedia.org/wiki/File:Ayurveda_humors.png

In class Reading: Chapter 2: Culture, Behavior and Health by Susan Scrimshaw (p.43)

Other source: http://bjp.rcpsych.org/content/184/1/8.full

 

DC HIV Efforts: Challenge to what we learned in class, or support for it?

DC HIV Efforts: Challenge to what we learned in class, or support for it?

My hometown, Washington DC, has an HIV infection rate of over 3%, exceeding the 1% required to define it as a generalized and severe epidemic (Vargas). It has one of the highest rates of any US city, and this has come as a shock to many who consider such high rates to be the worries of “developing” countries only. The District is no better than an average African country, and if it were somehow the 54^th African nation, it would have the 24^th highest rate (Schatz). So the current situation in DC with HIV and AIDS looks pretty bleak.. This is higher than West Africa and about the same as Uganda and Kenya (Vargas). This epidemic is not spread out evenly over the population either. In 2008, Black men bore the weight of the population with 7% infected (Vargas). In 2012, Black women had an alarming rate of 12.3% infected, a number that has doubled since a 2007 survey (Sun). With the infected population increasing, and with the widening difference between black and white, rich and poor, homosexual and heterosexual rates, DC is truly a mess. 

This graphic, though a little old (infected rate of black women is now 12.3%, for example) shows some facts that helped scare DC into making changes to their HIV policies.  http://www.globalpost.com/sites/default/files/imagecache/use-with-caution_original/rsz_africa-final.jpg

Many DC policy makers deny the epidemic because they continue to cling to the idea that the US is developed, or first world, and could therefore never have the same problems as a developing or third world country. This has been a policy burden over the past few years, especially because public health officials who left to work on HIV for developing countries in the early nineties on US government grants are coming back home. These returning veterans of the fight against HIV in Africa and all over the world have learned from their experiences some of the best ways to spread awareness and aid, but find many obstacles when they try to work here. Politicians and local leaders have resisted the use of this knowledge and experience because they are wary of “any comparison involving AIDS between Washington and an African country because it implies that largely African-American communities here are on par with the developing world” (Schatz). Oddly enough, much of the new knowledge proposed was gained from PEPFAR (President’s Emergency Plan for AIDS Relief) projects. PEPFAR provides relief for the foreign countries with the worst infection rates, but DC actually has a higher rate than five of them (Schatz). 

            Since the initial friction that came with proposals for African-inspired aid efforts subsided, many great and effective programs have emerged in DC based on programs that worked in Africa and other countries. Veterans reworked the way DC thought about the epidemic: “for years, the District had failed to do in-depth surveillance of the AIDS epidemic and had perceived it to a problem largely limited to the gay community and injectable drug users. But new data uncovered a new reality: AIDS was centered in the African-American community, infiltrating the general population of heterosexual couples” (Schatz). This has created programs that distribute condoms on the metro by areas with large black populations and also offer free testing on the streets. These new programs have been very effective so far and are starting to chip away at the high rate in these wards.            

In this case, policies used in foreign countries and supplied by NGOs helped revive the efforts against HIV in my city. In some ways, this contradicts many of our readings and class discussions that have addressed the pitfalls of a privatized global health paradigm. This is a sentiment summarized well by Pfeiffer and Nichter: “All too often, national health systems have been overcome by new NGO and donor pet projects, growing donor demands, and heightened expectations. As private health services and NGOs have multiplied, they have often contributed to the “brain drain” of health workers from public systems. Beyond the health sector, the push for privatization and free market reforms has in some cases stimulated economic growth but has also deepened social inequality and insecurity.” In addition, we have also learned that external aid is often detrimental in that it undermines community and local health systems and creates a system of dependence.

            I think that, while it seems that taking experience from African AIDS efforts into DC through NGOs is very privatized and external, this might not be true here. First of all, the aid is not very external considering that, while it does come from some African programs, these programs were headed by DC officials. They just returned to apply their experience to their own homeland. It seems likely, given the unconsidered consequences of foreign aid, the ideas of these DC officials will work better in DC anyway. As for the private nature of the help, only some of it was actually from NGOs. The DC Department of Health and Safety funded much of the research that lead to restructuring the overall HIV strategy, and NGOs just implemented the new projects. The NGOs involved were also mostly local, like CHAMPS and the Community Education Group. When I was reading about this hopeful new future for the dire HIV situation in DC based on programs developed for other countries and dependent on NGOs, I thought this went against what we have been learning in class. However, it seems that these new efforts are successful because they are designed by local people and mostly run through the DC government, which is in complete agreement with our lessons.

HIV and AIDS are a huge concern worldwide and control efforts are clearly unable to keep up with the transmission and mutation rates. I picked this issue because I’ve learned so far in class how local community based efforts are the most comprehensive and effective, and I want to look at an issue that plagues my country, and in particular, my city. As we learned in class, and as we can see in DC, public health organizations should be the driving force behind health change, and the change must come from within the community. 

By Molly Reid

 

Sources:

Vargas, Jose Antonio. "At Least 3 Percent of D.C. Residents Have HIV or AIDS, City Study Finds; Rate 

     Up 22% From 2006." Washington Post [Washington DC] 15 Mar. 2009: n. pag. Print. 

Sun, Lena H. "HIV infection rate skyrockets among some D.C. women." Washingtonpost.com. Washington

 Post, 20 June 2012. Web. 24 Oct. 2012. <http://www.washingtonpost.com/national/ 

health-science/in-dc-hiv-infection-rate-nearly-doubles-for-some-poor-black-women/2012/06/20/ 

 gJQAXIqKrV_story.html#>. 

Schatz, Juliana. "Groups fighting HIV/AIDS in DC find lessons in Africa." Global Post. Global Post, 

     11 June 2012. Web. 24 Oct. 2012. <http://www.globalpost.com/dispatch/news/health/120530/ 

     dc-aids-organizations-learn-africa>. 

 Pfeiffer, J, and M Nichter. "What Can Critical Medical Anthropology 
Contribute to Global Health?: a Health Systems Perspective." Medical Anthropology Quarterly. 22.4 

(2008): 410-415. Print. 

 

Perceptions of disability

I thought the topic of stigmatization or pathologization based off culture was interesting, particularly in terms of mental health. Across cultures, perceptions of health, healthcare, and treatment are so different, it is interesting to see how the dialogues on how to treat people are always changing. Mental ability in particular seems to vary in its perceptions and “treatments”.

Becker talks about Western views of what the autonomous, abled person embodies. There is also conversation about how cross culturally, these views are not static or single faceted. Even in the US, the cultures surrounding disability are entirely different. Conversations in the US seem to focus on disability justice and advocacy while globally there really is no focus, or the topic is of little importance in the first place. For example, in the US, diagnosing autism, ADHD and ADD often has an attached stigma but they are at least diagnosed and options exist for people to work with their conditions. So, there is stigma, but there is also help. In my experience with east-Asian cultures, mental ability is something that is ignored, lumped together as a single type of “crazy” or attributed to someone’s personality. An autistic person in Korea may not be seen as someone with a disability. Rather, they may be seen as awkward or crazy but not disabled. In which case, there is stigma but no help. In other cultures however, being perceived as neuro-nontypical may not have the negative connotations. If you take the autistic person in Korea and transplant them to the US or to another culture entirely, they may or may not be perceived as disabled at all. Which inherently asks the question, what defines mental disability? This is another cross cultural question.

“The normative, or transcendent, self is viewed as cohesive, bounded, autonomous, continuous, and stable ... This view of the self has been related to Western traditions and values of autonomy and independence … and has been weighted toward the effects of social structure and individual agency. In contrast, the contingent self is viewed as culturally determined and has been linked most often to cross-cultural work (Murray 1993). This view emphasizes contested and negotiated meanings, diversity, and inner experience… Ewing (1990) suggests that individuals continuously reconstitute their identities in response to internal and external stimuli as a "string of selves," ever changing, in which a person may overlook inconsistencies and experience wholeness and continuity. This perspective is supported by recent research on the narrative structures of life stories (Luborsky1 993)” (Becker, 387)

I chose this quote because I feel it succinctly sums up why people experience health and ability differently. It also touches on the idea that mental ability as part of identity politics.  As healthcare providers or even anthropologists, it is impossible to try and analyze a culture without looking at the factors that constitute it. The image I chose relates to the idea of different cultures creating different realities about identity dialogues. The image is a photo of a letter. The letter is from the Autism Speaks foundation , asking a Ms. Dana Commandatore to donate money to help cure autism and promote self-advocacy for those with autism. However, the language in the letter does not reflect promoting self-advocacy; rather it promotes the idea that those who are neurotypical should make decisions for those with autism and try to get rid of autism. Commandatore obviously takes issue with the language and the intent of the letter in general and annotates and returns it to the foundation.

I feel like this image is a good example of conflicting cultures regarding metal ability. Though this foundation is probably well meaning, their goal is to cure a condition that they have already stated is incurable. Instead of building support and advocacy networks that help people live with autism, their main goal seems to be curing autism. This ignores the main issue, which is that  people with mental disabilities are often silenced and oppressed and have little room to create those advocacy networks for themselves in a society that in inherently ableist.

- James

Becker, Gay. "Metaphors in Disrupted Lives: Infertility and Cultural Constructions of Continuity." Medical   Anthropology Quarterly 8.4 (1994): 383-410. Print.

Picture: http://24.media.tumblr.com/tumblr_mb8wgwS6fv1r2i8g6o1_1280.jpg

Gay is not a medical condition

Homosexuality or commonly refer to as “gay” is a sexual orientation in which people experience sexual, affectionate, or romantic attractions primarily or exclusively to people of the same sex. People might wonder what exactly is the population of homosexual people out there. Many researchs have been done to investigate this matter. The 2000 US Census Bureau shows that homosexual couples make up less than 1% of American household. The data from the Family Research Report  shows that around 2-3% of men, and 2% of women, are homosexual or bisexual, while The National Gay and Lesbian Task Force reports that around 3 to 8 percents of the population is homosexual.  All those researchs were done produce different numbers, creating a doubt in the validity of those results. The reason behind this is because homosexuality is a sensitive topic, difficult to classify, and the methods of research. Most researches were done by asking people about their sexual orientation. In the past, gay was viewed as a bad thing so most gay people wouldn’t admit they are gay because they fear others will know about it. In August 2002, Gallup did telephone interviews  with 489 women and 518 men asking about their sexual orientation. Because interviews through the phone protect the identity of the interviewee, more participants were willing to answer the poll. The result was that 21% of men are gay and 22% of women are lesbians. It means that one out of five people of each sex in America is gay. The number tells us that a large proportion of the population is gay. It is not an uncommon thing anymore. We have to deal with how we perceive homosexuality.

Homosexuality has always been a conversial topic, and has been discussed over and over again in many debates. In the past, people try to medicalize it as a disease or a medical condition that need to be treated. People viewed it as a bad thing just because homosexual people were different from the norm. According to Scrimshaw 2006, disease is the outsider view, usually Western biomedical definition, refer to an undesirable deviation from a mesurable norm. This definition perfectly described people’s views of homosexuality. Gay people were viewed as having a disease just because they were different from the norm. Homosexual people were rejected from the society and attacked by many religious groups. They were even rejected by their friends and family members. That was why most gay people weren’t open about their sexual orientation. The fear of being viewed as a freak and discriminated by others drove them away from the society. That reason alone make it almost impossible to estimate the gay population in United States. And the United States is one of the developed countries that are very progressive about this issue. In many parts of the world, discrimination against homosexual people is even more harshly.

In recent years, there is a shift in the perception of people about homosexuality. In last week lecture, we learn that perception is a process of gathering information through any or all of our senses, followed by the acts of organizing this information and making sense of it. It is our view on matters or issues around us. Gay is one of them, and people start to change the way they perceive it. Many people stood up and for the rights and the acceptance of gay people.  The evidence of this is gay marriage was legalized in California in 2008 and laws legalizing gay marriage in Washington have been passed in 2012. There has been a decreasing trend in negative views toward gay people. Polls conducted in 2009 showthat 54% of the population opposed legalizing gay marriage and 35% supported it. Present polls show that the  percentage of the population opposing gay marriage has decreased to 46% while the percentage of those favor gay marriage has increased to 45%. And if we compare this data to the one in 1996, the percentage of people opposing gay marriage has dropped by 19 percents. Polls ,asking people about their views on the increasing number of gays and lesbians raising children, also show the same trend. Four years ago, 50 percents said it was a bad thing, 11 percents said it was a good thing, and 34% said it would make no difference. Compare to today, 35 percents said it was a bad thing, 14 percents said it was a good thing, and 48 percents said it would make no difference. The numbers clearly tell us there is a shift in people’s opinions about homosexuality. The number of people favoring it hasn’t increased by much throughout the years but the number of people accepting it as a normal “condition” has increased by a large percent.

People start to accept homosexuality as a normal thing in the society. This is partly due to an increasing in knowledge and education about homosexuality. Educated people are more open minded than uneducated ones. They no longer attempt to medicalize homosexuality, they stop trying to fix something that is not broken. The media also contributes to this trend. Homosexual characters featured in Holywood movies, become more and more common nowaday. 

Above is a scene of the two main characters in the movie Broke back mountain Ennis and Jack. The main plot of the movie is the complex romantic relationship between Ennis and Jack. It is a huge success and widely accepted by the community. Their relationship started when they were teenagers in Wyoming. As the two men grew up, they married and had children. But their relationship didn't fade away, instead it became sexually. However, during the course of the movie, their lives took different twists and turns, preventing them from being together. Movies such as broke back mountain and milk support the acceptance of homosexuality. Many celebrities “come out of the closet”, become an example for others. Together with activists who fight for the rights of gay people, these movements increase the acceptance of homosexuality in the society. My personal view of it is homosexual people do no harm to us. It is totally wrong to discriminate against others just because they’re different from you. I believe that as more and more people are educated about this matter, homosexuality will be more widely accepted, not only in the United States but also around the world.

Duong Ly

                                                    Work Cite
 "Most Say Homosexuality Should Be Accepted By Society." PewResearchCenter Publications . N.p., 13 2011. Web. 24 Oct 2012. <pewresearch.org/pubs/1994/poll-support-for-acceptance-of-homosexuality-gay-parenting-marriage>.
Robison, Jennifer. "What Percentage of the Population Is Gay?." Gallup. N.p., 08 2002. Web. 24 Oct 2012. <http://www.gallup.com/poll/6961/what-percentage-population-gay.asp&xgt;.
Image:
 http://static.guim.co.uk/sys-images/Film/Pix/pictures/2008/06/06/brokebackmountain460.jpg

Exploration of “different perceptions”

Qin Qin Williams

Through the readings and Dr. Alejandro’s lecture, it’s clear that the theory and practice of dealing the disease is essentially cultural. An individual’s perceptions are based on the environment that he or she lives in or is surrounded by.  It’s not difficult to understand why different cultural backgrounds have different etiological interpretations (disease etiologic) and disease awareness.

Many of the examples Nichter gave in his article won’t seem strange to a Chinese person. The diagnosis and treatment of disease based on the bodies’ internal equilibrium, the balance between hot and cold, are common concepts in India, Thailand, China and many other Asia countries. Even though there are many differences between Indian and Chinese culture, if we compare them, they also have a lot of the same ideas regarding medicine. Both use the pulse for diagnosis, value the use of herbs as drugs, and share beliefs in the heat and coolness of foods in the daily diet.  Both countries share Buddhist beliefs, and their knowledge of medicine is inherited from their culture. This may explain why there are so many similarities in their medical behaviors. In contrast, in the Western biomedical cultural system, the diagnosis of disease is highly dependent on medical instruments, and often appears as bacterial infection, inflammation, or tumor, etc. People have no doubt that the treatment of the above should accordingly be anti-bactericidal, anti-inflammatory or surgical methods. To an Indian or Chinese doctor, all of these techniques are effective to treat symptom of problems, but fail to look for the underlying cause of the problem. Therefore, this different kind of disease awareness will lead to different treatments.

Susan Scrimshaw mentioned in her article “Culture, Behavior, and Health” that because an individual’s perceptions are shaped by the culture, disease in one culture might not be seen as a disease in another culture.  Obesity is an example of this.  Fat is not often seen as a manifestation of beauty and health, and we see it as pathologically ugly. But fat is a mark of beauty in some Africa countries. “In a rite of passage, some Nigerian girls spend months gaining weight and learning customs in a special room. ‘To be

called a ‘slim princess’ is an abuse’¹. Fat is a symbol of fertility and wealth. One’s behavior may be seen as normal in one cultural background, but may be regarded as very unusual behavior in another. This is often found in the study of cross-cultural psychiatry. I have been told that the Indians often claim to hear the calls from deceased loved ones. This seems to a common thing for certain tribal people. But for many people in the world, this illusion obviously belongs as a sign of mental illness. Auditory hallucinations may be diagnosed as schizophrenia by Western doctors.

Because an individual’s perceptions are shaped by the culture, “what is healthy for one man may not be healthy for another”²; a culturally devout medical tradition may be regarded as preposterous in another culture. A typical example is the Chinese ailment “weak kidneys”.  It is closely linked with Chinese traditional culture. For thousands of years, Chinese people have often been told how important this is, especially sexually.  Because of this, you can see stores everywhere in China selling a variety of "warming" tonics to treat this issue.  To a westerner, he or she may have never heard of such a disease. Similarity, in many Western countries, the ancient Chinese practices of “cupping” and “acupuncture” are regarded as nonsense. In the movie "Scraping", it’s misinterpretation as an example of abuse is a great reflection of this; one man’s consecrated therapy is another’s physical torture. How great the difference is. For generations, Haitian dependence on voodoo rituals for popular treatment also cannot be understood by the West. The example Nichter sited in his article is how Thai women have different way to treat their bodies after giving birth. Chinese nursing is also totally different. They think giving birth can have serious consequences for their bodies, and therefore typically confine themselves to bed for a month afterward.  Even nowadays this tradition is still popular.  In the West this is completely different. Most women soon begin to return to work after giving birth without a long convalescing period.

Because individual’s perceptions are shaped by culture, we can see that effective treatment practices in one culture may be meaningless in another culture. Witch doctor treatments are an example of a practice that is only valuable in a particular culture and will be significantly impaired in a region which doesn’t have the same culture. Because “perception can be shaped by information, practices in daily life, economic concerns…”², the “debate” about HPV vaccine in the class is a great example of the diversity of people’s perceptions, and how it is shaped differently by individual surrounding.

http://www.mandmx.com/tag/chinese-medicine/

Is disease just an abnormal physiological function? Will biomedicine be able to solve every problem? “You cannot just treat diseases, you have to treat bodies, and you cannot just treat bodies unless you understand the lives bodies have become accustomed to living”3. In all the examples we have seen our knowledge of disease and disease treatment is actually a mirror of culture. Different cultures have different concepts of disease, and therefore different healthcare behaviors. Social status, level of education, gender, age ... even small habits can affect the scope of a spreading epidemic. Recognizing this difference is not only good for improving the relationship between doctors and patients in the clinical environment, but also has a positive impact on promoting healthy decision-making practices. It is therefore a benefit to global health.

 Source

11. Ann M. Simmons, Los Angeles Times, September 30, 1998.

22. Nichter, Global Health, 2008

33. Susan Scrimshaw, “Culture, Behavior, and Health”

44. http://www.mandmx.com/tag/chinese-medicine/

How Culture can affect Psychosis

What is culture and does one define it? In what ways are we as human beings able to understand the various cultures that exist today? In class we are able to understand culture in using the “social fabric” as a metaphor to explain health in terms of social, economic, health care, cultural, and moral fabric. It can be considered as a “safety net” or some sort of support network that if it is broken it can resemble similar characteristics in identifying the social fabric of health such that maintenance or repairs can be made. According to the article read in class the fabric can be used by medical anthropologists as a medium to explain, “health, illness, and healing that can be represented in social and cultural images, society, and institutions, and ideas” (Janzen 1).  I find it rather interesting that all things medicine such as health, illness, and healing can be understood culturally and socially.  And according to the article by Janzen, culture cannot be inherited, but rather it is learned or taught via language. So in essence the social fabric, aside from being a metaphor, means that in order to fully understand the healing process or medicine, one must not only understand the science aspect, but also the cultural aspect. Anthropologists see culture as part of the human genome and in some respects it is part of the evolutionary process such that culture needs to be adept to survive in ways animals do to survive whether it be in the change of climate, food sources, to find shelter, distance, and to utilize technology. “The unique way that a community of individuals organizes itself and marshals its skills, knowledge, and energies to combat disease is thus a very central part of culture” (Janzen 3). And thus to fully understand the healing process of to seek an efficient approach to such process requires knowledge of other cultures in their values and character.

In the article, “living Through a Staggering World: The Play of Signifiers in Early Psychosis in South India” discusses the role of culture in psychosis. Interesting how we, in the western world, do not correlate culture and mental health together. We often medicalize the issue of mental and behavior health, but do not see the cultural and social aspect of it. In the case of schizophrenia, some may see patients with this disorder as delusional or crazy. In other cultures, some may see it as a spiritual deity using the patient as a medium to speak through. Thus in interpreting such psychiatric disorders may vary from culture to culture. Culture bound syndrome is defined as, “a combination of psychiatric and somatic symptoms, believed to be only recognizable within a particular culture or society” (Lecture). Interestingly enough, it is not the disorder itself that is different from culture to culture, but rather it is the symptoms. But for schizophrenia it is not particularly applicable because it is absent from any biochemical or neurobiological abnormalities. Nonetheless it is interesting to see how important culture is in the understanding of psychiatric issues.

Back on the issue of the article one must consider that the cultural contexts of schizophrenia without objectifying the disease since it affects people differently. Strauss and Estroff states that schizophrenia is an “I” disorder such that the, “heterogeneity of course is the rule at a cross-cultural level” (Corin, Thara, Padmavati).  The article goes on to explaining the research project at hand in trying to understand how culture may shape the evolution of schizophrenia. The project was conducted in Chennai, South India where 11 test subjects that were recently diagnosed with schizophrenia and their family members were to be interviewed. Each of the patients and their family members were interviewed in the language of their choice to provide insight on their experience with schizophrenia in a narrative. The interview would then be translated into English. Five of the patients were Hindu, one Muslim, and one Christian. The researchers found that Hinduism was a powerful signifier and so it was more focused on than the other religions. Questions were more focused on “reconstructed perceived signs, behaviors and feelings, meanings and reactions, coping strategies and help-seeking, as well as modifications of interpersonal relationships and social activities” (Corin, Thara, Padmavati) by the patients and their family members. In several interviews the patients were subjected to fear. Many subjected themselves to fear life and death in some paradoxical manner in which they questioned their very existence. Other patients were afraid of their thoughts being heard by others that their minds were being invaded. Interestingly enough, some resorted to religion for comfort. But their experiences and how it is narrated, one cannot merely understand what is is like to be schizophrenic such that the experience can only be subjective to the patients and though the interviews were translated to English, the cultural context in Hindi or the chosen language by the patient, cannot properly convey their experience. 

I found a video via youtube about a woman in India that suffers from schizophrenia and is also mute. Her name is Lalita Uike. In the video, I'm assuming to be Lalita's mom and Leah (news correspondent) is attempting  to understand why Lalita is not taking her anti-psychotic medication. During the attempt,  one can see that Lalita's mom is frustrated and impatient with her daughter and see it as an obligation to help her daughter. It is rather painful to watch the mom slap and hit Lalita for refusing to take the anti-psychotic medication.         Eventually Lalita agrees to take a shot that would only require a dose once a month rather than taking a pill every day. The video ends rather tragically. Apparently Lalita was missing for some time and a body was found that looked just like her. Men, who most likely raped and killed her, were trying to make Lalita leave her home. Not only was she ostracized, but she was taking advantage of because the men who did this to her knew that she would not be missed. 

(Cure 2011)

This picture reminds me of the interviews conducted in the article we had to read in class. Some of the patients narrated their experience about others trying to attack them or invade their mind. Others said that they felt as though others can read their mind. I cannot even fathom what their experience is like. 

Resources: 

Trialx. 2011. http://trialx.com/curetalk/2011/03/understanding-schizoaffective-disorder-vs-schizophrenia/

Corin et.al. 2004. Corin Etal2004-Living through a staggering world-the play of signifiers in early psychosis in South India.pdf

Cultural Determinism and Mental Illness

Cultural determinism is an outdated theory that claimed that individuals were solely a product of the culture that they were raised in and/or surrounded by. The problem with this assertion is that it operates on the premise that cultures are static and insular, which has been proven to not be true. Ideas travel like trade winds around the globe to and from every continent, even more so now in a world that puts increasing value in globalization. The three pieces that I will be comparing in this blog are a quote from Corin et. al., a black and white picture of a strait jacket, and a quote from Spiro. These three fragments connect in a way that explains the flaws of cultural determinism yet explain the objective and subjective functions of culture in mental illness.

 “In our study, traditional cultural etiologies did not play a central role in shaping the experience of patients and their families…when they do appear in narratives cultural etiologies usually emerge as personal or familial formulations, which enable people to name feelings of strangeness and alienation the experience.” (Corin et.al. 137) 

“According to one meaning [of cultural determinism], it is conceptions of mental illness that are culturally determined, by which it is meant that these conceptions are culturally constructed. According to a second meaning, the psychological conditions that are believed to constitute mental illness are themselves culturally determined, by which it is meant that these conditions are culturally caused… regarding this there is much disagreement.” (Spiro 224)

In the first quote Corin et. al states that in the fieldwork they participated in, cultural etiologies were not the dominant force in the experiences of mentally ill patients in southern India. To me this is statement provides direct support in the case of debunking the previous notion of cultural determinism. But it does provide information into how the patients think of the perceptions of their families and society. This statement is explaining how there are two components to being conflicted with a disease: the etiology, or cause, of the disease, and how you think the people around you perceive the disease which in the case of mental illness often feeds into the feeling of alienation.

The picture that I chose is of a strait jacket. The significance in this picture lies in the very nature and use of strait jackets as a way to bind and confine individuals. Similar to a strait jacket, cultural determinism is a theory that claimed culture is a binding force for individual’s thoughts, actions, and beliefs. If this were to be true, like a strait jacket, culture would be something that confines, and limits the growth of those that participate in said culture.

In the second quote Spiro is explaining two applications of the phrase cultural determinism. Here he is stating what we have discussed and know to be true; anthropologists are in disagreement with the theory of cultural determinism.

These two quotes and picture all relay a common message: cultural determinism was a starting point of thought from anthropologists but was eventually seen to be a restricting and limited concept with limited applications. First I will look at the limited applications. Similar to how a strait jacket serves a purpose of confining people, which can be used in a protective and positive manner; cultural determinism has its uses in explaining how those in different societies and cultures may view mental illness and diseases, but not provide them with explanations of the cause. Now we can discuss the detriments of applying the theory of cultural determinism. Through the fieldwork done in the two articles which the quotes are taken, it was clear that the individuals afflicted with mental diseases in South India didn’t have explanations of the cause of their diseases based on their culture. Mental disease and their causes are as confusing to those in India as they are to persons of the United States, United Kingdom, etc. These three pieces come together to share the same message; culture is the beliefs, actions, thoughts, knowledge, etc that shape the environment around individuals but is NOT the sole variable in their determinations about health problems.

The theory of cultural determinism although outdated in the study of anthropology, can be a mindset of some individuals outside of field. Because of this way of thinking racism and other inequalities are created and then applied. In this blog I focused also on how culture DOES affect the subjective environment of mental illnesses; which includes but is not limited to, familial/societal expectations, and experiences of alienation. This makes a clear claim against cultural determinism in a way that states: culture shapes the environment that a patient is in at the time NOT how they think their disease came to be. As a product of the 21^st century, I am fully aware that we live in a dynamic ever changing world. It is more than foolish to think that rural communities’ thoughts and experiences are affected any less. All people function in the same way and our beliefs, actions, thoughts, experiences are shaped by similar forms of information flow. It is important for everyone to recognize this and eliminate the primitive and restrictive claim of cultural determinism.  

-Brittany Peters-

Works Cited

Ber, Albert. "Micro Fiction Challenge: The Straight Jacket." Albert Berg's Unsanity Files. Word Press.com, 11 June 2011. Web. 17 Oct. 2012. <http://unsanityfiles.wordpress.com/2011/06/23/micro-fiction-challenge-the-straight-jacket/>.

Corin, Ellen, Rangaswami Thara, and Ramachandran Padmavati. "Living Through a Staggering World: The Play of Signifiers in Early Pyschosis in South India." N.p.: n.p., n.d. 110-45. Online.

Spiro, Melford E. "Cultural Determinism, Cultural Relativism, and the Comparative Study of Psychopathology." Ethos 29.2 (2008): 218-34. Wiley Online Library. 3 Jan. 2008. Web. 17 Oct. 2012. <http://onlinelibrary.wiley.com/doi/10.1525/eth.2001.29.2.218/pdf>.

Pressure to be Fertile

Women, especially those living in poverty feel pressure to have many children. According to Rachel Chapman, “In this environment of economic insecurity exacerbated by congested living conditions, women report competing for scarce resources, including male support and income”(1). In third world countries, women are most likely uneducated and unemployed. These women really have no option and are forced into the roles of being wives, mothers, and caregivers. In comparison to women in the western world, the women in third world countries are not given many options or an option at all to go to school and pursue a real career. For this reason, the pressure to be fertile and be able to have as many children as these women and their spouses desire, is very high. Many women living in poverty must rely on their fertility to have a spouse and live a better life. Infertile women are belittled and seen as worthless to men because they are not able to so freely have children. I believe that the pressure for women to have children is unfair and unnecessary.  Women should not be defined and categorized just by their ability or even desire to want to have children. In poorer communities couples rely on having many children in order to have more family support when they are older and to also have a greater the chance of passing on the family name. I think that some families in these poor communities may have the mentality of “the more the merrier”versus carefully planning ahead and knowing that they can fully support their families.

I feel a lot of sympathy for the women living in poverty because they must rely so heavily on their body to determine the outcome of their future. You really have no control over whether or not you can have a baby or not. It’s not like it is a personal choice women make to be fertile or infertile. Women are capable of doing more than just having children and taking care of them. I think in many countries around the world women are still seen as incapable of doing harder and more strenuous work that men do. I think many traditional men still have a feminist mentality and think that they must take up the role of the provider of the family. 

This first picture represents the pressure women feel to have children. In the women’s thought the idea of having children almost seems like a factory because the strollers are lined up with numbers on them. It’s as if as after she’s had one child it’s on to the next one. Having children should be something women really want not feel like it's just a job they are required to do. 

Some people strongly criticize couples in third world countries that decide to have a lot of children. I am currently taking a Global Inequality class and we recently learned about the Malthusian Theory. According to Malthus, “poor people grew their numbers irresponsibly and were kept in check by their own bad habits and addictions”(Whitty 6). The Malthusian Theory blames those living in poverty for the current state of overpopulation in the world because they are sexually irresponsible. Malthus believed that there should be a limit on how many children couples should be able to have, or else the world’s resources would run out and would not be able to support mankind any longer. The Malthusian Theory did eventually lead to the creation of contraception’s in attempt to decrease the amount of childbirths in the word. This theory is really just pointing the finger at people living in poverty and blaming them for the problems that the world faces. The western society always believed that they were more dominant and knew better than the south and therefore could not be the cause of the lack of resources in the nation.
I don’t agree with the Malthusian theory because there should not be a limit to how many children a couple can have. At the same time I think that people should have children responsibly and know that they have enough money and resources to take care of all their children. The women in poverty who depend on their ability to have children do live in very different circumstances than the rest of the world.

I chose to use this second picture because it represents the Malthusian Theory and the idea that the world is becoming overpopulated and we are slowly running out of resources. The bird appears to be struggling to be able to fly because it is being weighed down by the weight of all the babies he is carrying. This picture is portraying the idea that there are more humans on the earth and not enough resources to provide for all of us.
I think the Malthusian Theory really ties together with Rachel Chapman's ideas because it is true that couples in impoverish countries tend to have more children then those in western societies. But contradictory to the Malthusian theory, these couples in poorer communities are not necessarily being "sexually irresponsible", but rather just doing what they feel is necessary for their families. I feel like women are viewed as the problem and cause of all the conflicts concerning having children but it is not true. Women should not be viewed as any less just because they are infertile or don't want to have children. Men should not blame women if they are unable to provide children because that is really something women can't control over their bodies. A women's ability to have children should not define who she is as an individual. 

Sources
Chapman, Rachel. "Endangering Safe Motherhood in Mozambique : Prenatal Care as Pregnancy Risk." Anthropology : People : Faculty : Rachel R. Chapman. N.p., n.d. Web. 24 Oct. 2012. 
Whitty, Julia. "The Last Taboo." Mother Jones. N.p., n.d. Web. 24 Oct. 2012.