Leonardo Menegola
(University of Milano Bicocca)
Uršula Lipovec Čebron
(University of Ljubljana)
Clara Saraiva
(ICS, University of Lisbon)
Send message to Convenors
From medical pluralism to therapeutic plurality: medical anthropology and the politics of diversity, knowledge, and experience from multiple perspectives.
Panel W014 at conference EASA08: Experiencing diversity and mutuality.
This workshop will explore the tensions and complementarities between biomedicine and 'other' medicines, and the ways in which social representations and cultural constructions embedded in the encounters between "the West and the Rest" migrate, transform, or collide at the intersections of emergent scenarios of contemporaneity. We will outline dynamics of exclusion and inclusion between biomedical and alternative practitioners of healing. We will examine the interactions occurring between distinct discursive practices and systems of meaning relating to symptoms, illnesses, models of affliction and wider socio-moral notions of personhood and the Self. We will focus on the embodiments, feelings, and sensations through which people make sense of suffering, illness, and healing, and on the political and performative meaning of such experiences. We will explore the strategic references made to "experience" by non-hegemonic medicines that rely on the creation of experiences of intersubjectivity and mutuality between healers and patients.
Long Abstract:
This workshop will explore different aspects of the tensions and complementarities between biomedicine and 'other' medicines. Through ethnographic evidences, we will contribute to the study of diverse practices of suffering and healing by focusing on how social representations and cultural constructions embedded in the encounters between "the West and the Rest" migrate, transform, or collide at the intersections of emergent scenarios of contemporaneity. At the crossroad of medical pluralism and therapeutic plurality, human experiences, social representations, and culturally embedded practices linked to "suffering" will reveal a vast ethnographic territory, across which migrational processes will constitute one among the transversal concerns of this workshop.
We will outline dynamics of exclusion and inclusion between biomedical and alternative practitioners of healing in contexts of education and associations; and within processes of legalization in institutional practices and formal professionalization. We will examine the interactions occurring between distinct discursive practices and systems of meaning—as carried out and reproduced by different social actors—to investigate socially relevant ways in which diverging, pre-established schemes and representations interact with reference to symptoms, illnesses, models of affliction and wider socio-moral notions of personhood and the Self. By looking at the embodiments, feelings, and sensations through which people make sense of suffering, illness, and healing, we will focus on the political and performative meaning of such experiences as forms of resistance, opposition, defence from systems of hegemony, and on the politically authorized, socially recognized ways of performing both sufferance and healing. We will explore the strategic references made to "experience" (e.g. through the mundane world of sensing) by non-hegemonic medicines that rely on the creation of experiences of intersubjectivity and mutuality between healers and patients.
Section 1 (PAPERS No. 1 to 5): Cultural Diversity as Knowledge and Practice. Chair: Chiara Pussetti
This section deals with the biomedical discourse on diversity and cross-cultural communication and, at the same time, the absence of discussion on underestimated aspects of this relationship. By focusing on the building of knowledge and the articulation of criteria of efficacy (clinical trials, standardization and quality control of other "traditional" medicines,) we will explore the social use of diversity in public health policies, and we'll explore the boundaries between culture and affliction by analyzing the articulation of different therapeutic theories and practices among multiple social actors.
Section 2 (PAPERS No. 6 to 12): The Medical Anthropology of "Experience:" Illness, Suffering, Healing. Chair: Melissa Park
This section will explore the socio-political meanings of "experience" in different contexts of medical hegemony and pluralism. "Experience" identifies and differentiates both suffering and healing practices; it enters mechanisms of efficacy, apparatuses of techniques and the practical knowledge required to administer them. We will examine "who" experiences suffering, unease, processes of healing; "who or what" manages or interprets such experiences and administrates the dynamics of cure; and how social and medical systems locally structure (translate, legitimize, reshape, deny) particular facets of experience.
Section 3 (PAPERS No. 13 to 18): Politics and Challenges of Integration. Chair: Carlotta Bagaglia
This section introduces a critical medical anthropological discussion of various concepts of medical pluralism, and aims to draw ethnographic evidence on the ways in which biomedicine can coexist and/or interweave with other medicines. From both an applied and a theoretical perspective, the analysis will mainly focus on different strategic perspectives of actors and institutions involved, such as: users, complementary and traditional healers, medical professionals, health-care institutions, insurance companies, etc, as well as on the complexity of their mutual relationships in various ethnographic contexts, especially in Latin America.
Section 4: Round Table: Healing as Plurality, Politics, and Experience
The discussants, Chairs, and convenors of the workshop will partake in a final Round table. The discussion will address "diversity" in its medical anthropological declination, both as migration of particular individuals and groups, and as encounter (hybridization, borrowing, translation, struggle) between different practices of suffering and healing. We will gaze at cultural diversity and medical pluralism through a multiple perspective and threefold socio-cultural lens: as a cultural construction, as a social strategy, and as a political performance. We will adopt multiple perspectives (e.g. focusing on institutions, cultural heterogeneity, and the particularities of experiences of falling sick, being ill, returning to a 'sense of ordinary life'). We will thus contribute to the social and political analysis of the epistemological heterogeneity of socially co-habiting healing systems, issues of therapeutic (or scientific) efficacy, and dynamics of social inclusion and exclusion. Finally, we will reflect on the epistemological challenges of an increasingly "pluralist" Medical Anthropology, where plural scenarios and objects give way to plural-synthetic conceptual frameworks and methods.
We focus on use of ayahuasca among persons who live in the streets of the city of São Paulo. Such experience is related to considerable changes in their lives; also, it helps getting them out of streets. The ritual use of Santo Daime is against the abusive use of alcohol and crack.
Paper long abstract:
The spread of the ayahuasca consumption around the world, regarding spiritual practices from Amazonian region, is strongly linked to processes of self knowledge and therapeutic purposes. We focus on experiences of persons who live in the streets of the city of São Paulo, which promoted both behavioral changes and reevaluations of negative experiences along their lives. Analyzing some cases and information about other similar situations, we saw the cure of the addiction to alcohol and drugs and their reinsertion in productive activities, as already reported in other social categories. The analysis of elements in ritual use of Santo Daime is against the abusive use of alcohol and crack by homeless individuals, commonly treated under psychiatric point of view. Considering homelessness as an experience of social liminality, the use of ayahuasca in the ritual context operates as an important transitional element.
Acknowledging anthropological approaches to emotions as a helpful theoretical tool for analyzing migrants’ mental health, this paper – based upon a fieldwork in the Bijagó Archipelago (Guinea Bissau) and in a Portuguese mental health service for migrants - underlines how biomedicine is responsible for pathologizing the moral experience of suffering.
Paper long abstract:
Acknowledging anthropological approaches to 'emotions' as a helpful theoretical tool for analyzing migrants' mental health, this paper - based upon a long-term fieldwork in the Bijagó Archipelago (Guinea Bissau) and in a Portuguese mental health service for migrants - underlines how the culture of biomedicine is responsible for pathologizing the moral experience of suffering. Among the Bijagós, hopelessness and depressive affect are emotional experiences not only accepted, but also considered morally and aesthetically appropriate. The "burnt heart" (local expression) is an existential condition due to the awareness of the misery of human life: a sign of intelligence and refinement and not at all as a deviant behaviour, an emotional trouble or a medical problem. In the diasporic context, what is seen by my Bijagós informants as a sophisticated emotional attitude, in the psychiatrists' interpretation, driven by the political economy of the pharmaceutical industry, counts as a depressive disorder. The "burnt heart", a culturally constructed emotional attitude, is considered pathological and an obstacle to the goal of assimilation: the pharmaceutical make-up is regarded as necessary. This ethnographic case presents a reflection about old questions: is the category of depression a universal condition? And are its treatments applicable everywhere? What should we consider normal and abnormal states of unhappiness? Who has the power to propose emotional models to aspire to in order to define ourselves and the wished quality of our life and our emotions? Which are the economic and political interests of these new models of persons and emotions?
HIV counselling in initiation rites is based on a dialogue between nurses and godmothers. Contradictions must be managed between the nurses who must overcome their "splitting" and the godmothers who are torn between the biological contamination and the local paradigms of impurity and prevention.
Paper long abstract:
HIV/AIDS prevention in Mozambique has a low efficacy rate. The national strategic plan to control HIV/AIDS criticizes that prevention messages are not culturally adequate and cannot lead to a safer behaviour. Anthropologists` question how can the positive aspects of tradition be used for HIV/AIDS prevention? Initiation rituals of girls are practiced in 7 from 11 provinces; they teach sexuality (without mutilation) and how to be a responsible human being. Initiation rites represent culturally the best recognised context to speak about sexuality and moral (prevention) behaviour. To introduce bio security HIV/AIDS prevention counselling in initiation rites implies a dialogical communication between biomedical nurses and initiation godmothers, women healers, on verbal and on mostly non-verbal forms. Dances and songs are the main communication forms together with the verbal traditional counselling. It is a process that teaches through diverse stages the girls since they reach 7-9 years old, through transition ritual, marriage and until the first baby. The complementary introduction of biosecurity counselling in the initiation imply the management of diverse contradictions; biomedical trainer nurses (with "splitting" problematic between modernity and tradition) should learn to be open and able to bridge between the traditional and the biosecurity paradigms. The initiation godmothers/healer women have to deal with contradictions between the biological contamination concept and the local paradigm of impurity, danger and prevention -, with their own neglecting of the promotion of the use of condoms.
This approach provoke an empowerment-process of women in their communities.
The study about health politics for early detection of breast cancer, prostitutes and HIV pointed out how women handle in the Brazilian Amazon Region health risks and illnesses which often without the support of conventional health systems, but by the use of traditional knowledge and medicine.
Paper long abstract:
Two researchers of different sex, language, cultural background and education are working on aspects of woman´s health in Belém do Pará, Brazilian Amazon Region. In our projects with prostitutes, HIV and health politics for early detection of breast cancer, we are confronted with a reality were women suffer from diseases, lack of health services and other dangers.
The living reality in the Amazon Region is especially hard for women. On the one hand, there is a lack of doctors, health services and hospitals; and on the other, there is the tradition of the use of plants for healing passed down through the ages from the people's indigenous ancestors.
During conversations with women of different ages and life situations, we made observations, held discussions and asked for their perceptions of health and health services. We received from this information about health and illness beliefs, recipes and explications of how and why they make use of plants and traditional healers.
In a minority of public health services in Brazil, they are starting to use the traditional knowledge and medicines to cure people, often motivated both by lower costs and by people's belief and trust in this form of medicine.
This paper aims at developing a critical perspective on the common medical and social discourses on complementary and alternative medicine (CAM) in Turkey, based on an ethnographic research on Turkish cancer patients' illness experiences and narratives. It describes the broad range of complementary and alternative medical methods, and explores how those methods are related to the medical conceptions of good and bad patients. This paper also investigates the ways in which those methods are informed by Islamic views and practices, and how this connection is evaluated in the Turkish medical realm, which is traditionally associated with modernity and secularism.
Paper long abstract:
This paper investigates complementary and alternative medicine (CAM) in Turkey, based on the illness narratives of Turkish cancer patients, which I collected and studied for my Ph.D. dissertation. It describes the broad range of complementary alternative medical methods that those patients benefit from, as well as providing a general categorization of those methods in Turkish society. Accordingly, these methods are categorized as the ones, which are informed by the global, new age trends, such as yoga, reiki and positive energy, and the "traditional" ones, which are based on popular Islamic and folk conceptions of health and illness. These categorizations also reflect the health behaviors of people with different socio-economic backgrounds, since the former is generally associated with people with higher education level and urban, middle and upper class background and the latter with less educated people with rural and disadvantaged background. This categorization also informs medical discourse on patients and influences the health care providers' differentiation of good and bad patients, as well as their attitudes towards those patients. This paper also analyzes how those dynamics and processes are influenced by the historical and current interaction between Turkish medicine and modernity and how the patients and health care providers evaluate the possibility for the discoursive and practical integration of CAM to the dominant biomedical system. This paper also questions the concept of "Islamic medicine" and how it is used in the Turkish medical realm, and relates that concept to the recent debates on the rise of political Islam in Turkey.
This paper explores how Thai clients interpret their symptoms and why they choose Thai massage. It reveals that they view Thai massage as a ‘natural’ therapy efficacious in treating root causes, and that they acquire a sense of trust and ease through tactile interaction and communication with practitioners.
Paper long abstract:
Today, Thai massage is popular not only as a means of relaxation for foreign tourists but also as a therapy for the Thai urban middle class. In fact, the Thai government, which has been standardising Thai traditional medicine since the 1990s, has been promoting Thai massage as one of its traditional therapies. Based on fieldwork at a traditional therapies clinic in Chiang Mai, this paper explores how Thai clients interpret their symptoms and why they choose Thai massage to solve their health problems. The majority of Thai clients have 'pain' or 'stiffness' in the body and find their symptoms are caused by a disorder of the 'sen', lines which run through the body in folk anatomy. They feel massage is more efficacious in treating the root cause, the 'sen', than biomedical treatment. Notably there are many clients who say that they choose Thai massage because they prefer 'natural therapy' to taking painkillers which have side-effects. At the same time, they say that they prefer Thai massage which has been standardised and thus controlled by biomedicine to massage done by 'unqualified' healers. Massage practitioners at the clinic, however, acquire massage skills not only through the standardised curriculum but also through intersubjective experience in the process of tactile interaction and communication with colleagues and clients. A practitioner's experiential knowledge, which includes knowledge of an individual client's body and symptoms, creates a sense of trust and ease for the client, and is therefore also important in keeping regular clients.
With few exceptions pain has been described in the literature as the epitome of the subjective, the inarticulate, the a-social. Here I draw on ethnographic fieldwork with chronic pain sufferers to reflect on pain as a dynamic field of relationships rather than as private experience.
Paper long abstract:
With few exceptions, chronic pain has been discussed in the relevant literature as the epitome of the subjective, the inarticulate, the a-social. Pain is discussed as a sensation and feeling which can be neither communicated in language nor perceived by the observer's senses. In this sense, pain constitutes an experience strictly private to the subject in pain. Pain is also private in the sense that it appears to engulf the subject and disrupt her social world.
Yet, despite the above, pain is a socially and culturally constituted experience. Pain's very designation as chronic derives through long, and as a rule, painful trajectories of the subject among a multitude of fields and relationships of mutual determination. From self-healing to folk healing practices and from biomedicine to alternative healers the subject in pain becomes a chronic pain sufferer. Life trajectories might be private but are not solitary; their pain constitutes a field of encounter and negotiation among people in pain, their close ones, doctors and carers, insurance organizations and work place. Through these encounters with self and others, the subject makes meaning of her experience and re-organizes her social world. In this presentation:
• I draw on ethnographic fieldwork with chronic pain sufferers
• I use a life history to reflect on trajectories in pain
• I attempt to see pain as a dynamic field of relationships rather than as private experience.
This paper explores a widely overlooked dimension of illness, namely the acoustic aspect. Heart disease patients, in particular, may become aware of unusual, often frightening sounds originating from inside them. For some patients these disturbing sounds become woven into the illness experience.
Paper long abstract:
Following my research into patient experiences and interpretations of hospital soundscapes (Rice 2003), this paper explores the soundscape within patients themselves. The internal soundscape has been an important resource for doctors since Hippocratic times. Through auscultation, the act of listening to the body (in more recent years using a stethoscope) sounds have been used to provide indications as to the health of the organs by which they are generated. But while useful to the doctor, the internal soundscape is generally quiet for a patient, and is only rarely or distantly perceived, staying on the very edge of consciousness. In some cases, however, patients can become acutely aware of strange and frequently irritating sounds originating from inside them. These patients are often suffering from heart problems, usually involving quite severe abnormalities of the heart valves. The bizarre sounds, which are repetitive and sometimes loud, inspire fear and anxiety, in some cases becoming integral to patients' sense of themselves as 'sick' or 'diseased'. The paper draws on ethnographic encounters with what is known as 'auto-auscultation' to bring sound into an anthropological consideration of the body, and initiate an acoustic exploration of ideas of health and sickness.
This paper will investigate how the socio-political disability experience is incorporated within the democratic transformation process in South Africa. With ethnography from two settings (rural and urban) subjective disability experience will be emphasized in conjunction with poverty.
Paper long abstract:
The historical and social transformation process after apartheid has extended the disabled person into political subjects who resist the one-dimensional picture of the disabled body as part of domination, normalization and dependency; culture produces the person "all the way down" in Geertz's sense (2007). The political movement of struggle against apartheid has created new relations among people and new social identities. The root of apartheid, the sign classification, and labelling disability have a common ground with general discrimination mechanisms in South Africa. Further, the fact that many people became disabled due to the struggle against apartheid makes the connection to the national project of reconciliation and rehabilitation. The movement have made a culture of disability which flow between people and creates support and possibilities ("I can" Merleau Ponty 2002). Establishment of such cultures has manifested the self within intersubjective encounters were the person is woven into close relationships to manage the every day life situations. This paper investigates how disability activists rewrite poverty knowledge by giving the poor disabled persons new images closely linked to the local concept of ubuntu. Using multi sited ethnography the material is collected over a period of 11 month fieldwork in two settings rural areas in Eastern Cape and the political urban centre. The project has financial support from Norwegian Research Council (2005-2008).
This paper explores gendered attitudes towards madness, mental disability and their treatment among highland Moroccan Berbers. It focuses on the differences between men and women’s experiences of being labelled as ‘mad’ and the plurality of possible responses to such ascriptions, from social exclusion to pilgrimage or psychiatric medication.
Paper long abstract:
Madness and mental disability are highly gendered forms of illness/suffering among highland Berbers. Not only are women far more likely to be defined as mad, but the social treatment meted out to them also differs radically from that accorded men. Where madmen are normally married off and kept under the tutelage of brothers or uncles, women are often 'exiled' to high mountain pastures and/or 'denied' marriage opportunities. These differences are also reflected at the level of medical approaches. Women are more likely to respond to their illness by performing (collective) pilgrimage and trance - their illness isolates them and they respond publicly and/or collectively. Men, in contrast, often seek a Western bio-medical response to their suffering and endeavour to keep it within the private domain. This paper explores these divergences and analyses local people's own interpretations of the differing regimes of treatment available to them. It also looks at how they relate to the different sorts of practitioners to whom they have recourse, from religious specialists (fqihs) to city doctors and French NGO nurses, exploring the ways in which these encounters shape their understandings of the issues.
This paper will discuss patients' perspectives on the effects of acupuncture as compared to the results of a medical evaluation carried out in a public hospital in Norway in order to measure these effects.
Paper long abstract:
This paper will discuss patients' perspectives on the effects of acupuncture as compared to the results of a medical evaluation carried out in a public hospital in Norway in order to measure these effects. In the discussion I will draw on data from a project focussing on experiences (bodily feelings and verbal articulation) from participation in Chinese health practices (traditional Chinese acupuncture and qigong/taijiquan) in Norway. Fieldwork has been carried out in different social settings, both inside and outside public health care. In the autumn of 2006 a hospital in Norway conducted a pilot project to evaluate the effects of receiving a series of acupuncture treatment sessions. As part of my fieldwork,
I have observed treatment sessions and interviewed some of the persons who participated in the pilot.
I will apply the concept of the power of constructing reality, as elaborated by Bourdieu (1991), in order to analyse the finding that there are effects that both patients and the medical evaluators seem to see as 'natural', but that there also are examples of great discrepancy between the viewpoints of patients and medical observers. In conclusion I will discuss the question of acupuncture evaluation in the context in which it takes place, namely in the tension between evidence-based medicine and an attempt to integrate acupuncture in a public hospital ward.
This paper examines a Brazilian spirit medium's multiple treatment-seeking strategies that have culminated in an orientation to both biomedical and spiritual understandings, which in turn, shape embodied experiences and notions of selfhood. Implications about the relationship between medical pluralism and subjectivity are discussed.
Paper long abstract:
In medically plural environments clinical and religious ideologies and interventions have the power to differentially shape experiences of illness and selfhood. How do social actors select from and make sense of multiple meanings, practices and frames of reference that are available to them? I address this question by drawing on a case study of Paulinho, a young research informant from my ethnographic fieldwork in the Brazilian Amazon. Paulinho is a practicing spirit medium in the Kardecist tradition who has suffered from epilepsy and episodic psychosis. In this paper I trace his life history and highlight important aspects of his psychosocial experience and help seeking strategies that led him to simultaneously utilize clinical and spiritist therapeutic modalities. I discuss how Paulinho has internalized cultural messages from both domains and how they jointly inform his understanding of illness, spirituality, and moral identity. Additionally, Paulinho makes distinctions between, peculiar sensations and imagined voices and visions that are psychotic symptoms on the one hand, and those that are manifestations of spirits on the other. I illustrate this by examining his use of different metaphors of embodiment that register subtle distinctions in perceptual attunement. Paulinho's 'experiential dualism' is a compelling example of how 'flexible selves' are cultivated in medically plural social ecologies. Implications for the role of person-centered ethnography in the study of medical pluralism are also discussed.
The paper explores the characteristics of traditional Istrian medicine as it is understood and practiced by traditional healers on one hand, and the theory and practices of complementary therapists on the other. The analysis of their understanding of the body, categorization of illnesses, etiological concepts and treatment methods enables a further examination of relations between these two medical systems and helps establishing whether there is continuity between them or not.
Paper long abstract:
The paper is based on a two-year ethnographic research conducted among traditional healers and complementary therapists in Istrian Peninsula, their patients and users, inhabitants of different Istrian localities, both rural and urban.
The paper explores the theory and practices of traditional healers and complementary therapists through their understanding of the body, categorization of illnesses, etiological concepts and treatment methods. This enables a further examination of relations between these two medical systems and helps establishing whether there is continuity, a close encounter between the two, or whether no closer link exists but they rather operate in parallel.
The analysis will be focused on the conceptualization of the body which seems of essential importance for both medical systems in the determination of the rest of their aspects: i.e. the understanding of the causes of illnesses, their categorization and treatment. The understanding of the body by traditional healers is tagged as the "collective-metaphysical" conception of body, and by complementary therapists as the "individual-metaphysical".
Special attention is given to questions of etiology, which lead to the conclusion that in the context of Istrian traditional medicine mostly the so called external causes of illness are applicable, and commonly represented by "ideology" of the curse and the related concepts of collective and individual štriga (a type of witch). The analysis of the etiological concepts of complementary therapists shows the recurrent involvement of the idea of internal causes of illness, whereby illness is perceived mostly as a consequence of different kinds of imbalances, for which the persons themselves are responsible. It is also noted that recently complementary therapists often tend to interpret illness through the "ideology" of the curse, and by doing so draw closer to traditional medicines and their external conception of causes of illness. In relation to this, the reasons for the occurrence of this significant "epistemological shift" of complementary medicines are also analyzed.
This paper is based on my PhD research (2005-2007) which dealt with interrelatedness and co-existence of biomedical and non-biomedical systems in the city of Zagreb, Croatia. The process of rapid adoption and introduction of complementary and alternative medicine (CAM) to Zagreb was evident after the fall of communism and was shaped by the context of transitional postsocialism.
Paper long abstract:
This paper is based on my PhD research (2005-2007) which dealt with interrelatedness and co-existence of biomedical and non-biomedical systems in the city of Zagreb, Croatia. The process of rapid adoption and introduction of complementary and alternative medicine (CAM) to Zagreb was evident after the fall of communism and was shaped by the context of transitional postsocialism.
The staring points of this research were the patients and their attitudes towards illness, health, wellbeing and suffering which determined their choice of therapies and healers. I looked at which factors (cultural, social, generational, educational, religious, political-ideological, financial, and emotional) determined their choice of therapies. Secondly, I also looked at the feelings of social exclusion the CAM users (and practitioners) reported. Thirdly, I examined the current political discourses surrounding the legislation of CAM in Croatia, now presented as liberal, democratic and a pro-EU type of legislation, versus more conservative, Catholic views sceptical towards plurality and multiple realities.
As an ethnographer, I was faced with moving stories of loss and trauma, patients with Post Traumatic Stress Syndrome, patients suffering from Alzheimer's disease, cancer patients, as well as stories of miraculous healings and becoming well again which made me re-examine my position of observer, interpreter and analyst. Through the process of understanding and interpreting sensitive cultural practices, I explore whether anthropologists are uniquely placed to actively protect the rights of people to whom they owe their science.
This paper examine the consequences of cultural sensitivity training courses for clinical care-givers in ethnically diverse settings. The paper outlines some dangers of under-training clinicians, and asks whether such courses do more harm than good.
Paper long abstract:
This paper examine the consequences of empathic cultural sensitivity training courses for clinical care-givers in ethnically diverse settings. The paper outlines some dangers of under-training clinicians, and asks whether such courses do more harm than good. Using data collected from several years of work with medical and pre-medical students, and with medical associations attempting to introduce cultural sensitivity training for clinicians, the paper argues that the kinds of generalizations about culture that clinicians are drawn to on short courses actually introduce new problems to clinical encounters that perpetuate stereotypical behaviors. In many cases the very assumptions about culture and ethnicity that we strive to overcome are reintroduced and misused in clinical situations where training course in cultural sensitivity lead clinicians to make generalizations about how culture influences illness behavior. Examples from research conducted in the United States is compared to problems of clinical practice in multi-cultural settings in the UK. Alternative methods for training physicians that do not involve such generalizations are recommended, though there is little evidence that such changes in educational practice will be implemented in the near future.
Starting from the concept of `empowerment`, this paper aims to explore the ongoing tension between emic and etic analysis in social psychological as well as in more recent political economy approaches to HIV prevention. In this paper we will discuss possibilities to overcome those frictions. Inspired by the work of the Latin American Collective Health Movement (f.i Almeida & Silva, 1999; Breilh, 2003).
Paper long abstract:
Traditionally, HIV prevention programmes reproduce a discourse that emphasises individual behavioural change. This discourse is based on health promotion and health education models grounded in social psychological theories (Green & Kreuter, 2005). Recent studies in medical anthropology and AIDS focus on the interaction between local culture and local institutions (social representations of body, health, illness, risk, gender, kinship, local economic structure and organization) and national-global political and economic processes (f.i Parker et al., 2000; Schoepf, 2001).
Starting from the concept of 'empowerment', this paper aims to explore the ongoing tension between emic and etic analysis in social psychological as well as in more recent political economy approaches. It will explore questions such as "What value to attach to the "local" problem definitions, including emic analyses of the problem´s context?" and "How does or should the emic analysis interact with the etic problem analysis of health professionals and other experts?"
In this paper we will discuss possibilities to overcome those frictions. Inspired by the work of the Latin American Collective Health Movement (f.i Almeida & Silva, 1999; Breilh, 2003) we initiated a study in which we explored the relationship between expert and the local knowledge in the analysis of HIV/AIDS phenomenon in Cartagena-Colombia. Our study started with a "dialogical ethnography" among men and women living in Cartagena.
In this paper we will present the first results of the fieldwork and discuss the question whether our approach sheds light on the interaction between expert and local knowledge and institutions.
This paper examines medical pluralism in Post-Soviet Kazakhstan, with the focus on its dynamic political and socio-economic context, the process of professionalisation of complementary practitioners and the attempts at integration of some branches of complementary medicine with biomedicine.
Paper long abstract:
The focus of my paper is on the complex field of medical pluralism in post-Soviet Kazakhstan, examined as the arena of encounters, competition and cooperation between biomedicine and complementary medicines of diverse origins. I will stress the dynamics of these processes connected with radical political changes and economic difficulties during the period of transition and the following relative stabilisation. After the first period of strong ideological - nationalistic bias, which resulted in predominant official support for the Kazakh folk medicine, more weight was given to such "great medical traditions" as Chinese or Korean medicines, to homeopathy, manual therapies and other branches of the so-called "traditional medicine". I will explore official strategies of legalisation and professionalisation of complementary practitioners and their responses to such efforts, as well as modest effects of the attempts at integration, especially in medical education. The analysis is based on my many years' fieldwork in Kazakhstan and my main aim is to stress the importance of careful examination of manifold factors that influence the relations between biomedicine and other medicines in a given socio-cultural context, and the need to take into account perspectives of multiple social actors involved.
On the piece of ethnography I would like to show how members of the community, in which personal experience is a very important factor in constructing the knowledge, connect non-specialist local healing knowledge and practices with the official medicine.
Paper long abstract:
Pojana Mikuli is a village in Carpathian mountains inhabited by Polish minority. Local knowledge on medicinal plants is well established there. Almost every family in the village collects and uses medicinal plants. I would like to present the attitude towards official and local healing practices - how they are interconnected in the discourse of Polish minority living there. The knowledge on medicinal plants among my interlocutors is very individual (for example neighbours, members of the same family often use different names for the same plant), and personal experience is very important in this context. Sentences like: "this or that medicine/plant are said to be good for such or such illness, but I don't know if they are because I didn't try them yet" can be heard very often there. In local medicinal knowledge, pieces of knowledge and therapeutic practice from various sources are bound and mixed. In this paper I would like to answer the questions: which of them are the most important in the context of this place and time, what kind of power and authority official doctors have, how this knowledge is constructed (the role of authority and personal experience).
has 1 download
1