Ethnomedical Approach to Schizophrenia
The ethnomedical approach to medical anthropology studies systems of treating illnesses. Medical anthropologists who focus on the ethnomedical approach study how different cultures heal people by looking at their models of health and sickness, methods of healing, and health systems. In some cultures, such as western culture, the main source of medicine may be biomedicine, while in another culture when one becomes sick, he or she may consult a shaman or medicine man (Karim 2014). It's important to study ethnomedical systems because although most cultures have a primary form of medicine, there are usually a combination of medicines working together. In this page, I will investigate how Schizophrenia is looked at in different ethnomedical systems and how medical anthropologists look at Schizophrenia in order to best treat it in different cultures.
Before understanding how other cultures look at this illness, we must first understand the concept of "culture." From this class, I feel that I have a much better understanding of culture than I did before. Culture is the attitudes, beliefs, customs, and traits that is shared by a religious, racial or social group. These can either be passed down by kin or by geography. It's important to contextualize illness in a given culture, because what one culture might consider abnormal, another culture might consider normal. Schizophrenia is a very good example of a good example as to why illness needs to be contextualized in a given culture. In the western culture, hearing voices is considered psychotic and a sign of Schizophrenia, while in another culture, it may be considered communicating with spirits or a god. It is the job of medical anthropologists evaluate health care systems and the overlapping or co-existence of health care systems in certain cultures. Medical anthropologists compare using the legitimacy, popularity, cultural identity, prestige, familiarity, and cost of the health care system (Karim 2014). All of these are important in where a certain person would go for their health care needs. For example if a person was very poor, they may not have access to biomedicine, and a medicine man may be their main form a treatment in their area.
Before understanding how other cultures look at this illness, we must first understand the concept of "culture." From this class, I feel that I have a much better understanding of culture than I did before. Culture is the attitudes, beliefs, customs, and traits that is shared by a religious, racial or social group. These can either be passed down by kin or by geography. It's important to contextualize illness in a given culture, because what one culture might consider abnormal, another culture might consider normal. Schizophrenia is a very good example of a good example as to why illness needs to be contextualized in a given culture. In the western culture, hearing voices is considered psychotic and a sign of Schizophrenia, while in another culture, it may be considered communicating with spirits or a god. It is the job of medical anthropologists evaluate health care systems and the overlapping or co-existence of health care systems in certain cultures. Medical anthropologists compare using the legitimacy, popularity, cultural identity, prestige, familiarity, and cost of the health care system (Karim 2014). All of these are important in where a certain person would go for their health care needs. For example if a person was very poor, they may not have access to biomedicine, and a medicine man may be their main form a treatment in their area.
Kleinman's Explanatory Models of Health
When someone is faced with an illness, they also face a choice on how to respond to that illness. For example, if a person has a headache, he or she can take an aspirin. If that doesn't work, they can change their diet or consult a doctor. The treatment options that people use to respond to illness is known as the hierarchy of resort. According to Kleinman's Explanatory Models of Health, there are three overlapping and interconnected and overlapping sectors of health that people will use to treat their illness: the popular sector, the folk sector, and the professional sector. The popular sector is where the illness is first recognized. People take advice from family and friends on what step to take next in your illness experience. This is where the illness is treated outside of other medical systems. Examples of treatment outside of other medical systems would be a self-help group, a website, a support group, behavior modification, or meditation. Although many treatments in the popular sector may not be as helpful for someone suffering with schizophrenia, many people suffering with schizophrenia also have drug and alcohol abuse problems that worsen their psychosis. Behavior modification may be helpful by cutting out drugs and alcohol. The next sector of health is between the popular and professional sector: the folk sector. The folk sector is more popular is non-industrialized societies where healers, either sacred or secular, are the main form of treatment. In the folk sector, examples of healers would be shaman, herbalists, or midwives. A major difference between folk and professional medicine is that healers in the folk sector are members of the culture they serve, and they share the same beliefs and ideologies as the culture they are serving, including beliefs about the illness they are treating. It is usually comforting for a patient to be treated by a healer from their own culture. Schizophrenia is very interesting from the folk sector because mental illnesses are interpreted differently in other cultures. Some religions believe that schizophrenics are hearing the voice of the devil so they may treat them with an exorcism. In other societies, these people are considered to be hearing spirits. In other cultures, some may not think that schizophrenia is even an illness. Cultures change our interpretations of everything. In western culture, if someone is hearing voices, we automatically assume the person is psychotic. In another culture, if a person is hearing voices, they may think the person is communicating with spirits and this person may become a shaman in their society. In one culture, someone is shunned for hearing voices, while in another their position is raised (Wilkins). Shamans have also been known to communicate with spirits through schizophrenics. In the YouTube video above, a shaman does not communicate with spirits through a schizophrenic, he heals the person suffering with schizophrenia. The healer in the YouTube video is similar to the movie The Horse Boy: in both scenarios, the illness is attributed to negative energy on the mother's side. The next sector of health is the professional sector, which is made up of professionals and paraprofessionals who have been given legal authority to practice medicine. In western culture, biomedicine is the main form of ethnomedicine, being so important that it has become a part of western culture. In biomedicine, schizophrenia is treated with antipsychotic medications, such as Seroquel, Risperdal, Zyprexa, and Clozaril to normalize biochemical imbalances (Grohol 2013).
The Three Bodies
Schizophrenia can be studied by medical anthropologists using the "Three Bodies" approach introduced by Nancy Sheper-Hughes and Margaret Lock. This approach allows anthropologists to examine the body and also it's relationship with the broader culture. The Three Bodies approach is helpful to prevent ethnocentrism, which is common in western culture. Ethnocentrism is using your own cultural beliefs as a standard for another person's beliefs and practices. An example of this is Cartesian Dualism in the west, where people separate the mind and the body, the mind suffering from illness and the body suffering from disease. In the Three Bodies approach, the body is divided into the Individual Body, the Social Body, and the Body Politic. The individual body is what we think of when we hear "body," but it does not just incorporate the physical body. The individual body refers to how all parts of the body relate to each other, including body, mind, soul, psych, and more. Looking at the body this way prevents a Cartesian Dualism way of thinking. When thinking about schizophrenia, it is important to think of the individual body that Hughes and Lock refer to. Schizophrenia is a mental disorder, but it also affects the body as a whole. Since schizophrenia is triggered by an imbalance in the brain and can be controlled by antipsychotic medications, the body and the mind cannot be separated since the body is affecting the mind. The mind also affects the body since high stress situations can trigger psychotic episodes. The social body is how the body becomes representative of something in nature. In western medicine, we see the body as a machine. Other cultures may see the body as a temple. The difference between treating the body as a machine or treating the body is a temple is very important when treating schizophrenia. In western culture, schizophrenia is seen as being something abnormal that needs to be fixed. In another culture where the body is treated as a temple and a more spiritual being, a schizophrenic's illness may be interpreted as communicating with spirits. The next dimension is the body politic, which is the regulation of bodies seeking health as a population-wide goal. An example of this would be removing homeless from the general population or the one child rule in China. An example of the body politic for schizophrenia would be putting people with schizophrenia in a mental health facility, taking them away from the general population.
Bibliography
Figure 1: “Core Concepts in Social and Medical Anthropology.” Reach. Accessed July 21, 2014. http://reach.gopfp.gov.vn/English/Publication%206.htm.
"Dr. and Master Sha: Soul Healing for Schizophrenia." YouTube video, 2:11. Posted by "Master Sha," February 23, 2010. https://www.youtube.com/watch?v=U7K0-DjnZ9s
Grohol, John M, “Schizophrenia Treatment.” Psych Central. Last modified October 9,2013. http://psychcentral.com/disorders/sx31t.htm.
Wilkins, Anthony, “Shamans Equal Schizophrenics.” Undergraduate Research Community. Accessed July 21, 2014. http://www.kon.org/urc/v8/wilkins.html.