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
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
The issue of the perception of medicine and medical plurality is particularly meaningful for those living in first world countries. The widespread use of Western biomedicine and the respect given toward scientific research in such countries often lead to the marginalization of traditional or alternative methods of medicine. I’d like to address one of the closing points of this blog post: “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” (Anderson). In addition to wholeheartedly agreeing with her statement, I think that Western biomedicine and traditional methods of medical treatment can complement rather than clash with each other. It’s natural for one’s culture to act like blinders, preventing one from exposure to peripheral methods of medicine, but I suggest that we take the blinders off and see the benefits of all practices.
ReplyDeleteThough traditional methods of medicine and biomedicine are often perceived to conflict with each other, as exemplified by the journalist’s early skepticism and sarcastic attitude while experiencing Ayurvedic treatment in the video, the coexistence and even hybridization of both approaches is possible. For this class’s ethnography assignment, I am reading a medical anthropologist’s account on how the globalization of Chinese medicine and its contact with biomedicine transforms and augments rather than stunts and diminishes it. In chapter three, she illustrates the daily life of a successful practitioner of traditional Chinese medicine, Dr. Fengyi Li, at his clinic in Shanghai—a city known for its relatively large hospitals and quality patient care. Although it seems as though he would have a difficult time competing with larger biomedical clinics for patients, Dr. Li has many loyal patients that advocate the efficacy of his practice (115-116). Furthermore, he attributes the competitive strength of his success to the hybridization of traditional Chinese medical and biomedical practice that he offers to his patients. For example, he implements the scientific information provided in MRI and CT scans alongside Chinese methods of tongue inspection and pulse taking in order to gain a greater understanding of his patient’s condition before prescribing herbal and formula medicines (113). I think that this example of how biomedicine and traditional forms of medicine can enhance each other illustrates a new possibility for the future growth of medicine. Understandably, there will be fiery criticisms from both sides of the issue; traditional practitioners will express disapproval at the “Westernization” of their cultural ways and biomedical doctors will question the legitimacy of methods that they perceive as obscure. However, such arguments fail to address the first priority of all forms of medical treatment: the patient. More than the individual levels that doctors respect cultural or scientific values, it’s the health and well-being of the patient that matters most. Cancer knows no culture. Chronic pain has existed before scientific technology became available. Both traditional and biomedical approaches to treatment can be utilized to improve the lives of those with such difficult diseases; it’s a matter of allowing ourselves to push away the arguments of culture and science that prevent us from accepting this potential avenue of medicine.
This comment has been removed by the author.
ReplyDeleteThis comment has been removed by the author.
DeleteRegarding AHDH, I won't say it's not real, but cannot be sure it is either. It seems quite normal to me that some people are more active than others. From my own experience, when my brother was young he was a famous trouble maker. He caused a lot of problems for several of his teachers as well as my parents, but he was never put on medication or anything else. When he was older and farther in school, it turned out to be that he just was really bored in school. And after he received more appropriate attention, his behavior improved; with more physical activity, like participating in sports, he had an easier time sitting still too. One reason children are diagnosed with this “disease” may be discipline problems --- Their parents may spoil them too much or didn’t set boundaries for them. Some of these children may also be somewhat neglected because both parents are required to work, leaving little time to give the proper care that their children need. Rather, they usually left with a babysitter, nanny, grandparent, etc., until the child is old enough for school. Children may become lonely, and lack parental warmth. As such, they release that loneliness by acting aggressively towards parents and peers. Because parents have less time to devote to their children, and if a child is hyperactive, parents may become easily frustrated with their “unruly” child. If they don’t have the time or skills to address this problem they may attempt to control their children’s behavior by asking for help from doctors. ADHD may be a culturally prevalent disorder, and it has been discussed by some scholars. Many researchers points out that it may relate to the parenting methods in the U.S compared to those such as in Asia. Compared to Americans, the majority of families in Asian countries follow strict patriarchal rules, where the mother is the major nurturer and the father is the breadwinner. Parenting styles there are also more lax regarding children who are hyperactive. Parents generally have more time with their children and thus there are fewer attempts to control their children’s behavior with medicine. This may be why the possibility of ADHD is overlooked in that culture, and there is not the same acceptance of this disorder in other countries. Other cultural factors also appear to influence its prevalence, such as illicit drugs and alcohol may play a role for older children. However, it’s important for western medical practitioners such as those in the US who focus almost completely on biomedicine to be aware that biomedicine does not have the power to cure everything; ADHD patients need more than just chemical medicine. It’s important to make the healing a process with personal and cultural connections; this is especially true of the whole range of psychological disorders where symptoms can be difficult to define. The combination of biomedicine and traditional medicine is required in diverse culture.
Delete
ReplyDeleteThe author of this blog pointed out the importance of being open to alternative therapies and not just solely believing in the biomedicine that we consider “normal”. Although we are part of culture that predominantly believes exclusively in the use of biomedicine to treat disease, other approaches to treating disease exist in other cultures. Many westerners don’t believe in these practices because they are not usually supported by science and westerners are used to the science heavy practice of biomedicine. This reasoning for not using and at times completely disregarding alternative forms of medicine as viable treatment for disease is somewhat contradictory though. As the author pointed out, ADHD has no scientific proof of its existence. The only testing that can be performed to diagnosis ADHD is all based on behavior, is rather subjective, and has no scientific or biological proof. Yet ADHD is still treated by doctors that practice biomedicine, despite the lack of scientific proof of the disorder. Even though scientific evidence of a disease or a healing practice may not yet have been discovered, this does not necessarily mean that the disease does not exist or that the healing practice will not work. Because of our culture’s clear preference to biomedicine, we have come to expect scientific evidence in order to believe something to be true.
The author’s main point that we should be more open to alternative forms of medicine when treating disease reminded me of the video we watched recently in class. The Frontline video, “The Alternate Fix”, explored the increasing popularity of alternative medicine in the United States. Over the past few decades more and more patients have begun to seek alternative medicine beyond just treatment from biomedicine practices. Although alternative medicines have been growing in popularity, many patients still do not report to their doctors that they had received alternative therapies in addition to their treatment from their doctors. In our culture, it is believed that most doctors look down upon alternative therapies such as acupuncture because it has not been proven scientifically to work. Overall, I agree with the author’s main idea, it is important to be open to other cultures, even if they might not be “normal” to us. Expanding beyond just the use of biomedicine in the treatment of disease could have potential benefits for the patient. Other alternative treatments are less evasive could be used to treat a disease, such as in the case of the Frontline reporter with the hurt shoulder. The author mentioned how he had an injured shoulder that required serious surgery according to his western doctors. After trying alternative therapy in India, he began to experience healing of his shoulder and he believed that the constant pain could have totally been eradicated if he continued treatment. A combination of both biomedicine and alternative therapies should be used to treat disease because all therapies have shortcomings in one way or another. Also, if we expect other cultures to try our biomedicine, such as the distribution of polio vaccines in another country, we too should also be willing to try the health systems of other cultures.
In this blog post Carlie Anderson compares and contrasts the benefits and short comings of biomedicine and an alternative medical practice known as Ayurveda. She highlights these differences by using the ADHD case study that was discussed in lecture. Aside from this case study the overall message that I feel was being made was presented in a specific statement that states “…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.” (Anderson)
ReplyDeleteI agree with her assertion that the mutual exclusivity of biomedicine and alternative medicine in industrialized nations needs to be rethought. It has been presented in research time and time again that when there is a psychological component to the healing process, patients either have a shortened illness or increased survival rates of terminal diseases. While I am not an authority on either of these topics and this might be a case of correlation not causation, the data that has been found is something to be curious and critical of.
Biomedicine is the dominant force in the industrialized world, and we have relied on it to be the end all be all of authorities when it comes to health related issues. The largest problem within the scientific and biomedicine field is the need to objectify and harness only experimentally derived data. More often than not scientists search for methods to objectify subjective data specifically in healing methods. The problem that arises from this is that healing is defined differently for every person; therefore this is a variable that cannot be identified to be the same for the Earth’s populace. When presenting biomedicine to 3rd world countries, definitions that are commonplace in the global north are superimposed on the community being offered a biomedical therapy with little or no acknowledgment of a difference in healing belief systems. On the other hand if an Ayurveda health professional were to come to America with the same agenda, to present Ayurveda as a reliable therapy for any ailment, this professional would be greeted with disbelief, claims of naivety, and possible complete disregard. This unfortunate static state of mind in regard to healthcare isn’t shared by all individuals but as a majority I would say that alternative methods are treated with little reverence.
This almost hypocritical outlook about biomedicine vs. alternative medicine is saddening to me. I am a firm believer in the fact that an inclusive attitude towards medicinal practices is the most beneficial view that someone can have. If the phrase “you’re only as strong as your weakest link” has any application at all I encourage it to be applied here. If the weakest link lies within the only medicinal practice that you seek then your therapy will be just as weak; therefore alternative methods must be sought out to offer a more holistic and stronger treatment.
This blog post talks about the importance of the benefit of Western medicine, which is also referred to as biomedicine, and indigenous medicine. The author of this blog post believes that understanding and considering other approaches to health and medicine might assist people with alleviating their health problems. One approach of health mentioned in this post was the practice of Ayuveda, where health is defined as a balance of energies and natural elements. In this concept of health, disease is treated and viewed differently. There are many different approaches to health, and not one approach to health definite or correct. Depending on how health is defined, different cultures treat, and define diseases differently. As the author states, “there’s much to be gained from both approaches and most communities depend on both”.
ReplyDeleteLike the author of this blog post, my belief in medicine is strongly influenced by biomedicine since I grew up in an environment where biomedicine was valued the most. Currently, biomedicine seems to be the most popular and trusted approach to health throughout the most of the world. However, there still exist many other types of medicine regardless of how advanced biomedicine is. Throughout the history, biomedicine has developed exponentially, and has cured, prevented, and discovered the causes of many diseases compared to other types of medicine. This success of biomedicine has convinced many different countries to rely on biomedicine to cure their diseases. In the other hand, this shift to biomedicine has decreased the popularity of other kinds of medicines in some cultures. Connecting this idea to a cultural history of Korea, I’ve learned that there was a decrease in popularity of traditional Korean medicine in Korea since the arrival of Western medicine. Traditional Korean medicine is still big part of the medicinal culture in Korea, and many people seek for it, however, it’s not the dominating medical system as it used to be before Korea became Westernized, which was roughly around hundred years ago. From what I observed in Korea, it seems most of the patients find biomedicine first. Although biomedicine seems invincible, it cannot find the solution to every disease. If the doctors do not bring them satisfying results they look for alternatives, which is mostly traditional Korean medicine. Biomedicine became the main approach to medicine for people in Korea, and Korean traditional medicine as an alternative for many. It’s interesting to see how multiple medical systems exist in one society, and how one system overpowers others, but people still seek alternative medicine to improve their health. Those who believe in biomedicine strongly may view other practices of medicine unsafe, and illogical, because it’s not easy to change the view of health, and accept the other system of health. I also think other systems of medicine needs to be reviewed, and chosen thoughtfully because of the possibility that it might do more harm than good.
At the same time, I also agree with the author that understanding other types of medicine biomedicine is important in health because biomedicine is not the only answer to health.
I agree with what you’re saying here. Conceptions of “normal” and “average” are always interesting to deal with in scale. For example, the average person in the world may be 5’6” but that doesn’t mean that being shorter or taller than that it not normal. Like you said, conceptions of normal can vary hugely across cultures. It seems obvious then that notions of health and treatment would also vary immensely and yet ethnocentrism has a funny way of tunneling our perspective to one ideal of medicine. I think it’s interesting to approach cultural variations on medicine via data. Biomedicine puts the emphasis on quantitative data, whereas many other medical cultures put the emphasis on qualitative data. Who is to say that data is less valuable or correct based on what type it is? There is definitely value in biomedicine, but as reality has proven, there is also huge weight in medical cultures that utilize placebo and less tangible methods of treatment.
ReplyDeleteThe quote you pulled from the British Journal of Psychiatry said a lot to me about the possibilities of the nocebo effect and defining illness. This quote is really interesting because it addresses what we talked about in lecture on Monday, how medicalization affects the social realities of illness. The quote seems to say two things about diagnosing deficits in societal expectations. One is that by medicalizing ADHD, we give it power as a social illness and we support the nocebo effect. People may have this disorder, but we reinforce behavior and perceptions of life that only further the effects of ADHD. The second point is, medicalizing what is essentially a personality trait teaches the public that if you do not fit into society’s expectations, you can just go to a doctor to be fixed. According to the quote, this is dangerous because it teaches people that they don’t have to deal with their problems, they can just medicate them. I’m inclined to agree. This brings up the question of whether it is OK to medicate an inconvenience. That is not to say that some people don’t hugely benefit from an ADHD diagnosis and treatment; obviously it really is helping people function in what we deem acceptable society.
What I’m really asking is: In terms of stigma associated with illness, does ADHD even warrant any, when it is a trait that is only perceived in large scale in US society to begin with? This dips into defining illness in different societies. If the illness is a result of society’s changing expectations, does it really mean that a person is ill? There are so many ways to define illness across cultures, it seems obvious that biomedicine alone is certainly not the answer. Even Western biomedicine can be considered holistic, though maybe not to the extent of many indigenous medical cultures. I agree with you in that there are huge benefits to Western and indigenous cultures, and that there is much to be gained in treating patients with aspects of both.
- James
This blog is about ADHD, a psychiatric and neurobehavioral disorder that is commonly diagnosed in children. ADHD children are very hyper and have difficulties in focusing. Lacks of attentiveness and hyperactivity have been used to characterize the disorder. These traits, however, are very difficult to be measured accurately, result in many kids are diagnosed with ADHD when they don’t actually have this disorder. It is a strange thing because the disorder is very popular in our society today, but there is no clear symptom of it. Carlie raises a good point that if so many people are diagnosed with ADHD, is it still a disorder or just a common trait that is difficult to live with. I agree with this point because it seems like ADHD doesn’t affect those who have it negatively. Most of the kids who have it eventually grow out of it. Treatment provided by western medicine for ADHD is taking pills to control the disorder. This practice is questionable because there is a high marginal error in the diagnosis of ADHD and taking pills generally have some other side effect on the patient’s health. It is a character of western medicine. It usually uses pills to treat diseases. Although it may not be a bad thing, it makes many people become dependent on medicine pills to function. I think this is a serious problem because it is impossible for us to know all the side effects, both short term and long term, of the drugs. The long term side effects are especially difficult to predict, and it is often too late when they are diagnosed.
ReplyDeleteBecause the western medicine approach was an effective way to deal with this disorder, Carlie suggested another approach. It was the indigenous approach involving the patients using their own abilities to solve their problems or disorders. An example was given in this blog is the native Indian practice of Ayurveda. Ayurveda has five basic elements and if these five elements are balanced, the body will be healthy. Carlie argued that instead of giving pills to the ADHD diagnosed patients, the doctors should help them finding balance in their body, curing ADHD without using chemical treatment. I completely agree with it because biomedicine is not always the answer for every disorder or disease. Sometimes, in order to cure a disorder, one just has to change their lifestyle or finding their balance. Often time, this treatment is difficult to carry out because they require a lot of commitment from the patients to make these changes. But if they are willing to commit to make these changes, they can cure the disorder without taking medication.
The traditional western medicine has made us believed that everything has be treated with medicine. This is not true. I think Ayurveda or other indigenous practices are a good alternative treatment for many disorders .This blog is not only about ADHD, it is also about the treatment we should use to treat disorders. We can also combine the two approaches to create an effective way to treat ADHD.