Culture and Health: Applying Medical Anthropology

514 Pages·2008·4.66 MB·English

by  Michael Winkelman

Praise for WINKELMAN
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CULTURE HEALTH
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“Winkelman amazes us once more with the quality and scope of his new book, Culture and Health: Applying
Medical Anthropology, as he hel ps us under stand the way that medical a nthropology’s biocultural approach U CULTURE
expands the biomedical perspective—he covers a vast array of topics, including cultural competence, cultural
systems models, cultural eĀ ect on biology, ethnomedicine and alternative medicine, and understanding health R
activities as cultural practices—a must have for the student, practitioner, or scholar!”—Marlene Dobkin de Rios,
PhD, associate clinical professor of psychiatry and human behavior, University of California, Irvine and professor emerita of E
anthropology, California State University, Fullerton

“Th is is the most comprehensive, holistic, and practical text on medical anthropology I have read in my eighteen A
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years of teaching and practice. It skillfully weaves together rich and clear explanations of all vital topics in medical D AND
anthropology with user-friendly, practical application models and assessment instruments for easy use with self, H
patients, health care providers, and community members. Th e book is a medical a nthropology gem.”—Mikel
Hogan, PhD, applied cultural anthropologist and professor and chair, Human Services Department, California State University,
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Fullerton
HEALTH
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“In this thorough and well-constructed introduction to medical anthropology, Winkelman has provided a key resource
for health sciences students, beginning researchers, and health professionals who are committed to a comprehensive
perspective on the means by which culture—systems, models, beliefs, and practices—aĀ ect sickness and healing. Th e L
book will be of use to students studying the applications of the social sciences to health and health care, public health T
scientists wanting a broad view of the means by which social and cultural systems aĀ ect the health of communities and
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populations, and clinicians who wish to develop greater cultural competence in their relationships with patients and their
families.”—Craig R. Janes, PhD, professor, associate dean, and director, Global Health Faculty of Health Science, Simon
Fraser University
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MICHAEL WINKELMAN, MPH, PHD, is an associate professor in the School of Human Evolution and p Applying Medical Anthropology
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Social Change at Arizona State University and former head of Sociocultural Anthropology. For 16 p
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years he directed the Ethnographic Field School in Ensenada, BC, Mexico. ty
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MEDICAL ANTHROPOLOGY/PUBLIC HEALTH oe
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Cover design: Michael Rutkowski
CULTURE AND
HEALTH
Applying Medical
Anthropology
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CULTURE AND
HEALTH
Applying Medical
Anthropology
M I C H A E L W I N K E L M A N
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Copyright © 2009 by John Wiley and Sons. All rights reserved.
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Library of Congress Cataloging-in-Publication Data has been applied for.
ISBN 13: 978-0-4702-8355-4
ISBN 10: 0-4702-8355-6
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C O N T E N T S
Figures, Tables, and Exhibits xi
Special Features xiii
Preface xvii
Medical Anthropology’s Perspectives xvii
Chapter Overviews xix
Special Features of the Text xxiii
Dedication xxvi
The Author xxvii
Acknowledgments xxix
ONE APPLIED MEDICAL ANTHROPOLOGY AND HEALTH CARE 1
Culture and Health 2
Culture, Ethnomedicines, and Biomedicine 5
Ethnomedicines as Subcultures
Cultural Competence in the Health Professions 8
Areas of Applied Medical Anthropology
Concepts of Health 13
What Is Health?
Systems Approaches to Health 18
Biopsychosocial Model of Health (cid:129) Cultural Systems Models (cid:129) Sociocultural
Theories of Disease
Chapter Summary 25
TWO DISEASE, ILLNESS, SICKNESS, AND THE SICK ROLE 35
Experience of Maladies 36
Biomedical Assumptions About Disease 38
Biological and Cultural Aspects of Disease (cid:129) Deviation from Normal Biological
Functioning (cid:129) Assumption of Generic Disease (cid:129) Doctrine of Specifi c Etiology (cid:129)
Scientifi c Presumptions of Medicine
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vi
Culture and Health
Social Models of Maladies and Diagnoses 54
Social Construction of Disease (cid:129) Diagnoses as Construction
Illness and Sickness Accounts 60
Illness Narratives
The Sick Role and Sickness Career 65
Expansion of the Sick Role (cid:129) Sequences in Sickness Experiences (cid:129) Sickness Career
AIDS as Disease, Sickness, and Illness 70
AIDS as Disease (cid:129) AIDS as Sickness (cid:129) AIDS as Illness (cid:129) Political and
Economic Aspects of AIDS Treatment
Health Beliefs and Explanatory Models 74
Clinical Adaptations to Illness (cid:129) Health Beliefs Model (cid:129) Explanatory Model
Chapter Summary 79
THREE CULTURAL COMPETENCE IN HEALTH CARE 83
Cross-Cultural Adaptations in Health Care 84
Cultural Competence 86
Levels of Cross-Cultural Competence (cid:129) Organizational Cultural Competence
Anthropological Perspectives on Cross-Cultural Adaptation 92
Concepts of Culture 92
Effective Cross-Cultural Adaptations
Interpersonal Skills for Intercultural Relations 95
Language Barriers (cid:129) Listening and Attending (cid:129) Behavioral and Social Relations (cid:129)
Cultural Communication Style
Specialty Cross-Cultural Applications of Medical Anthropology 98
Cross-Cultural Training and Mediation (cid:129) Researcher (cid:129) Community Advocacy
and Empowerment (cid:129) Applications in Public Health Prevention Programs (cid:129)
Administrative and Organizational Change (cid:129) Clinically Applied Anthropology
Using Culture to Care for Patients and Providers 109
Patient-Provider Relationship Building (cid:129) Cultural Effects on Care (cid:129)
Using Culture to Care for Biomedical Practitioners
Chapter Summary 117
FOUR CULTURAL SYSTEMS MODELS 121
Cultural Models for Health Assessment 122
Cultural Systems Approaches to Health 124
Cultural Infrastructure, Structure, and Superstructure 126
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Contents
Infrastructure 127
Diet and Nutrition (cid:129) Sex, Conception, and Pregnancy
Family Infl uences on Health and Development 136
Gender and Health (cid:129) Family Roles in Care and Therapy
Understanding Worldview and Symbolic Resources 139
Religion as an Ideological Cultural Resource (cid:129) Curing, Healing, and Care (cid:129)
Culture Care (cid:129) Witch-Doctor’s Legacy
Community Health Assessment 147
Implementing Model Standards (cid:129) Evaluating Community Health (cid:129) Formative
Evaluation (cid:129) Process Evaluations (cid:129) Outcome Evaluations
Rapid Assessment, Response, and Evaluation (RARE) 153
RARE Sequences (cid:129) RARE Community Teams (cid:129) RARE Assessment
Modules
Chapter Summary 160
FIVE ETHNOMEDICAL SYSTEMS AND HEALTH CARE SECTORS 163
Popular, Folk, and Professional Health Care Sectors 164
Popular-Sector Health Resources 167
Culture and Symptoms (cid:129) Culture, Ethnicity, and Pain Responses (cid:129) Cultural
Conceptions of the Body
Folk Sectors and Ethnomedicines 176
Alternative Medicine Use in North America (cid:129) Unconventional Medicine in the
United States (cid:129) Appeal of Alternative Medicine (cid:129) Evaluating Biomedicine and
Alternative Medicine (cid:129) Complementary or Alternative Medicine? (cid:129) Cultural
Expropriation and Indigenous Property Rights
Professional Healers 193
Cultures of Biomedicine (cid:129) Nursing, Biomedicine, and Anthropology
Chapter Summary 199
SIX TRANSCULTURAL PSYCHIATRY AND INDIGENOUS PSYCHOLOGY 203
Culture and Personality 204
Cultural Concepts of Normalcy and Abnormalcy 206
Labeling Theory of Deviance (cid:129) Culture and Personality Disorders
Personality and Self in Indigenous Psychology 210
Personality and Indigenous Psychology (cid:129) Self: Status and Roles
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Culture and Health
Possession in Clinical and Cross-Cultural Perspectives 216
Possession and Dissociative Disorders (cid:129) Multiple Personality or Dissociative
Identity Disorders (cid:129) Possession as Normal Behavior
Biocultural Approaches to Indigenous Psychology 220
Culture’s Developmental Effects on Brain Plasticity (cid:129) Psychocultural Adaptations
to Universal Biological Features (cid:129) Ethnic Identity (cid:129) Psychocultural Model of
Human Development
Ethnomedical Theories of Illness 228
Culture-Bound Syndromes (cid:129) Biobehavioral Perspective on Ethnomedical Syndromes
Cross-Cultural Ethnomedical Syndromes 236
Natural Disease Causation (cid:129) Personalistic Theories of Supernatural Causation
Chapter Summary 244
SEVEN MEDICAL- ECOLOGICAL APPROACHES TO HEALTH 249
Medical Ecology and Disease 250
Evolutionary Adaptations and Health 253
Environment in Adaptation and Natural Selection
Genetic, Individual, and Cultural Adaptations to the Environment 255
Natural Selection and Adaptation in Disease and Health (cid:129) Nutrition in an
Evolutionary and Cultural Perspective (cid:129) Individual Physiological Adaptations (cid:129)
Cultural Adaptations and Health (cid:129) Disease in Ecological Context
Epidemiology of Disease 267
Measuring Disease (cid:129) Identifying Causes of Disease (cid:129) Cultural Systems
Approaches in Epidemiology
Racial and Ethnic Categories and Health 273
Racial Categories as Cultural Concepts (cid:129) Skin Coloration as Ecological
Adaptation (cid:129) Rejecting the Race Concept
Triune Brain Structures and Functions 279
Ancient Brains and Health
Evolution of the Sickness-and-Healing Responses 282
Shamanism as an Evolved Healing Response (cid:129) Foundations for Innate
Healing Capacities
Emotions in Biocultural Perspective 285
Human Emotions: Universal or Culturally Specifi c? (cid:129) Evolutionary and
Physiological Perspectives (cid:129) Constructionist Perspectives and Biocultural
Correctives (cid:129) Cultural Production of Emotions
Chapter Summary 292
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Contents
EIGHT POLITICAL ECONOMY AND CRITICAL
MEDICAL ANTHROPOLOGY 295
Political Economy Approaches to Health 296
Critical Medical Anthropology 299
Biomedicine as Capitalist Medicine (cid:129) The Pharmaceutical Industry and
Disease Production (cid:129) Biomedical Science as Cultural and Political Activity
Social Conditions as Causes of Disease and Health 306
Economic Status as a Cause of Poor Health (cid:129) Individual Versus Social
Interventions to Promote Health
Social Networks and Support 312
Social Networks, Social Support, and Mortality (cid:129) Social Infl uences on Health
Macrolevel Social Effects on Clinical Health 315
Drinking Problems from a Critical Medical Anthropology Perspective (cid:129)
The “War on Drugs” Versus the Medical Marijuana Movement
Changing Health Through Public Policy and Community Involvement 324
Community Health Development (cid:129) Advocacy for Health Improvement (cid:129)
Public Policy and Coalition Development (cid:129) Coalition-Building Processes
Chapter Summary 333
NINE PSYCHOBIOLOGICAL DYNAMICS OF HEALTH 337
Cultural Healing 338
Religion, Ritual, and Symbolic Healing 342
Medicine’s Symbolic Reality (cid:129) Biosocialization (cid:129) Ritual as Technical Activity (cid:129)
Religion’s Effects on Health (cid:129) Meaning as a Mechanism of Religious Healing
Stress Response 352
Anatomical Basis of Stress (cid:129) General Adaptation Syndrome
Placebos and Placebo Effects 356
Placebos Versus Nocebos (cid:129) History of the Placebo Effect (cid:129) What Placebos
Affect (cid:129) Placebos and Total Drug Effects (cid:129) Total Drug Effects in the Social
Dynamics of Psychedelics (cid:129) Cultural Effects on Drug Dependence and
Addiction (cid:129) Theories of Placebo Mechanisms (cid:129) Information and Meaning
as Placebo Mechanisms
Psychoneuroimmunology 372
Self (cid:129) Body and Embodiment (cid:129) Mimesis (cid:129) Social Context (cid:129) Emotional
Empathy and Contagion (cid:129) Elicitation of Psychoneuroimmunological Responses
Metaphoric Processes in Symbolic Healing 377
Chapter Summary 381
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