Health is man's natural condition and is his
birthright. Since time immemorial man has strived to understand the determinants
of health and tried to device methods and practices to remain healthy, diagnose
and cure illness. However, still today our ignorance about health continues to
be profound. The definition of health is still elusive, determinants of health
are not yet clear and there is still no single yardstick to measure health.
Modern medical science is largely preoccupied
with the study of disease and devising methods of diagnosis
and treatment of particular disease conditions. It has encouraged reliance
on drugs and tonics for remaining disease‑free which is considered to be
equivalent to being healthy. The spread of modern medical system has created
vast institutional structure of hospitals, doctors and related infrastructure.
All this vast modern medical institutional structure caters to various types of
sick people yet it is sad that there is very little effort to study and cater
to the need of healthy people and teach them the ways and means by which to
remain healthy. This anomalous situation has its roots in the formulation of
the modern concepts of health and health‑care.
In recent times, there has been much
disillusionment with the modern scientific medicine, particularly amongst
general public throughout the world. This has resulted in re‑emergence of much
interest in various alternative traditional/folk medical systems, medical
practices and health‑care methodologies like Ayurved, Homeopathy, Unani, Yoga,
Acupuncture etc. Various medicines and practices of these traditional systems
are being tried alongwith modern scientific medicines and practices in a
variety of permutations and combinations on a hit‑and‑trial basis. This
situation is primarily due to the fact that all the alternative medical systems
and methodologies are presently viewed from the perspective of modern
scientific medicine whereas the perspectives and concepts of health, health‑care,
illness, diagnosis, treatment etc. of traditional/folk systems are fundamently
different from those of modern medicine. Therefore, to evolve a comprehensive
alternative system of human health, it is necessary that the concepts of health
and related concepts of the modern scientific medicine and alternative
traditional medical systems should be thoroughly reinvestigated, analysed,
compared and integrated. Since concepts related to body, diet and nutrition and
health‑care are central to conceptual framework of human health in every
culture, these three aspects have been
discussed below.
BODY
Medical anthropology studies the biocultural disciplines concerned with both
biological and sociological aspects of human behaviour, particularly the ways in which the two interact and have
interacted throughout human history to influence mankind's concepts of health
and disease.
Studies of the sociocultural end of this
spectrum (Foster & Anderson, 1978) have pointed out that in every human
society beliefs and practices relating to ill-health are central feature of its
culture.
To the members of all societies the human body
is more than just a physical organism fluctuating between health and
illness. In addition, human body is also
the focus of a set of beliefs about its social and psychological significance,
structures and functions. The term body
image is used to describe all the ways that an individual conceptualizes
and expresses his or her body whether consciously or unconsciously.
The culture of the group in which a person
grows up teaches him or her how to perceive or interpret the changes that can
occur over time in the personal body or in the bodies of other individuals. For example, a person
learns from the culture of his or her upbringing the characteristics by which
to differentiate a sick body from a healthy body, the ways to identify the fever or pain in the body or to identify
the feeling of anxiety etc.
Thus it can be said that the body image is something which is acquired by
an individual as part of growing up in a particular culture imprinted through
the family and the society. Though there are individual variations also, the
overriding influence of family and society at large can not be overemphasized in the development of body
image. Not going into details worked out quite exhaustively by workers of the
concerned fields, it would suffice to point out that, in general, concepts and
beliefs related to body image can be divided into two main groups:
1. Beliefs about the optimal size and shape
of the healthy body,
2. Beliefs about the inner structure and
functioning mechanisms of the body.
A third group, though
studied implicitly yet not emphasized clearly so far, can be added to the above
two:
3. Beliefs about the body as an instrument
of interpersonal interactions,
psycho-social interactions and spiritual
experience.
All the above three aspects of body image are,
to a large extent, a function of social and cultural background and have
profound effect on the individual health. Since every system of medicine, modern or traditional, has its own particular
socio-cultural perspective, it is imperative to integrate the conceptual and
perceptual frameworks of modern and traditional/folk systems relevant to above
three aspects of body image. This is necessary for evolving a really meaningful
concept of health and effective alternative system of medicine.
DIET AND NUTRITION
Food is fundamentally the source of nutrition
to the body. However, in all human societies, food plays many other additional
roles which are deeply embedded in social, religious and economic aspects of
everyday life. Fooding is an essential part of the way in which any society organises itself and of the way in which it
views the world it inhabits. Just as there is no human society without a spoken
language, there is no human society or group which does not have certain
particular beliefs and ways of processing full or part of its food supply
through cooking or other manipulative practices. Transformation of its raw food
supply into processed food is one of the defining features of all the human
societies and is a key criterion of 'culture' as opposed to 'nature'. Cultural
groups differ markedly from one another in many of their beliefs and practices
related to food, diet and nutrition. These beliefs are particularly related to:
1. Food, diet and nutrition in relation to
various aspects of body image
2. Natural properties of food items and
dietary and nutritional regimes
3. Supernatural properties and religious
sanctions related to food, diet and nutrition
4. Preventive, curative and other medical
properties of food items and dietary
methods.
Because
of the central role of food, diet and nutrition in daily life of an individual,
especially in social relationships, dietary beliefs and practices are extremely
difficult to change even if they interfere with health.
Therefore, in
considering various aspects of health in relation to diet and nutrition, it is
essential to sort out, analyse and integrate the beliefs and concepts related
to food in modern and traditional/folk
medical systems keeping in view the socio-cultural perspectives in which
these concepts and beliefs have evolved and of which they are an integral part.
In absence of such an attempt at integration at conceptual level, mere
prescription and practice of varied dietary practices belonging to different
medical systems evolved in different socio-cultural milieu shall remain a
sterile exercise as far as the problem of human health, ill-health, treatment
and cure is concerned.
HEALTH-CARE
In every society, people suffering from some physical or other
discomfort have a number of ways in which they help themselves and seek the
help of other people to alleviate their suffering. All such ways constitute the
Health-care system of that society.
Societies differ in organisations of the Health-care systems. Kleinman
(1978, 1980) has suggested that in any complex society, three overlapping sectors of Health-care can be
identified. These three sectors of Health-care may be called the popular sector, traditional/folk sector and professional sector. Each of these
sectors in every society has its own conceptual and perceptual framework of health, ill-health, diagnosis, treatment
and cure and accordingly has its own particular ways of defining who is healthy
and who is patient, explaining ill-health, devising ways of treatment and
specifying how healer and patient should interact in their therapeutic
encounter. The organisation and concepts of each of these sectors depend
thoroughly on the culture of the particular society.
Popular sector consists of the lay, non-professional and non-specialised
domain of the society where health condition of an individual (whether proper
healthy or ill-health) is first recognized and defined. In every society,
health-care activities are always started first in the popular sector.
Health-care activities of this sector include all those therapeutic options
which people utilized without any payments and without consultation with any
traditional/folk healer or professional medical practitioner. The options
available in this sector generally are self-medication, advice and treatment
given by family members, relatives, neighbours, workmates etc. or consultation
with another lay person who has special experience of the particular health
disorder. The family is the main arena of health-care in the popular sector
where ill-health is first recognised, diagnosed and treated. In every society,
family is the real site of primary health-care.
Therefore, the
concepts, beliefs and perceptions of the family regarding body image, diet and
nutrition, health, ill-health, diagnosis and treatment have significant influence
on the health condition, health-care given, diagnosis and treatments
followed in case of every individual
member of the family.
Traditional/folk
sector consists of a mixture of sacred and secular
traditional/folk healers in the society. There is wide variation in types of
such healers found in any society from purely secular and technical experts
like acupuncturists, vaids, hakims, bone-setters, herbalists etc. to spiritual
healers like Shamans, Sadhus, Siddhs etc. Most important characteristics of the
folk healers is that most of the folk healers in a society share the cultural
values, perspective and world-view (including beliefs about the origin,
significance and treatment of ill-health condition) of the community in which
they live and work. In a small society, such a
healer also has first-hand knowledge of the family conditions, cultures
and beliefs of the family alongwith the psychological profile and history of
the patient. This knowledge is usually very useful in diagnosis and treatment.
In general, the basic premises of the perspectives of various traditional/folk medical systems may be
summarised as following:
1. Intuitive rationality
2. Emphasis on subjective observations and
interpretations
3. Emphasis on psychological, social and
subjective data
4. Mind-body-nature unitarism
5. The view of diseases as effects or
states
6. The consideration of supernatural
forces in all aspects of human life
7. Greater emphasis on social, natural and
supernatural conditions in all aspects of health, ill-health and health-care.
Most important
advantages of the traditional/folk sector are that it has extremely well
developed skills of understanding and creating rapport with the socio-cultural
concepts and beliefs of the patient as well as skills of involving the family
in diagnosis and treatment.
Professional sector comprises of the organised, legally
sanctioned healing profession including recognised medical practitioners of
various types, specialists and para-medical professionals in a society. In the last
century, the modern scientific medicine (i.e. Allopathy) has become the basis
of professional sector in most of the countries. Only recently some traditional medical systems have also
become professionalised in some countries, for example, Ayurved and Unani in
India.
Most interesting observation about the modern
scientific medical professional sector is that persons who practice modern
scientific medicine in any society have come to form a group apart with their
own sets of beliefs about body, body image, food, diet, nutrition, health,
ill-health, diagnosis, treatment, health-care etc. The modern scientific
medical profession can be seen as a healing sub-culture with its own particular
world-view. In the process of medical education, the students of modern
scientific medicine undergo a form of enculteration thereby acquiring the
particular perspective which may be termed the 'scientific medical
perspective'. This perspective that lasts throughout their professional life is
quite hard to change. Basic premises of this perspective may be described as
following:
1. Scientific rationality
2. Emphasis on objective numerical
measurements
3. Emphasis on psycho-physico-physiological
data
4. Mind-body dualism
5. View of diseases as entities
6. Complete denial of supernatural forces
7. Much greater emphasis on the individual
rather than on family, community and society.
Therefore, in
understanding various aspects of health, ill-health, disease, diagnosis,
treatment, health-care etc. the predominant approach of modern scientific
sector is the search for physical, measurable, empirical evidence of the
disease condition and use of physical administrations such as drugs or surgery
to treat the underlying abnormality thought to be the cause of disease
condition.
MODERN SCIENTIFIC VERSUS TRADITIONAL/FOLK
SYSTEMS
In every society throughout the world, medical
anthropological studies and medical sociological studies have revealed that
individual health is to a very large extent associated with various
socio-cultural aspects of the community in which the concerned individual
lives. The definitions of health, ill-health and diseases depend on the
concepts about body-image, diet and nutrition prevalent in a particular family,
community and society. Similarly, the diagnosis, treatment and health-care
given also depends on the prevalent concepts, notions and beliefs about proper
health-care in a society. It is also observed that in every society, people
move from popular to folk to professional sectors quite freely in relation to their health conditions. The
ill people mostly start with popular sector and if find no relief there, move
either to traditional/folk or to professional
sector depending on their socio-cultural domain. If desired relief is
not obtained, the person may move from traditional/folk to professional sector
or vice-versa.
In most of the societies, traditional/folk and
modern scientific medical systems are perceived as alternatives of each other.
The relationship between the two usually tends to be marked by mutual distrust,
suspicion and rejection or at best by a resigned tolerance and grudging
acceptance. This situation is because of the fact that the concepts,
perspective and world-views of traditional/folk medical systems prevalent in
all societies are almost opposite to those of modern scientific medicine. On
the other hand the conceptual frameworks, perspectives and world-views of
different traditional/folk systems are mutually comprehensible and translable
to quite a large extent despite having some or the other differences.
Comparison of the premises of traditional/folk medicine with those of modern
scientific medicine described above shows the almost unbridgeable chasm between
the two.
It is now gradually being recognised that
subjective, social and cultural factors have much greater influence on the life
of an individual than purely objective and intellectual knowledge. As discussed
above, body image, diet and nutrition and health-care, the three basic aspects
of human health, are particularly influenced by
the socio-cultural milieu. A major shortcoming of modern scientific
medical system is that it tries to disregard the socio-cultural aspects of the
body image, diet and nutrition and health-care and tries to enforce a purely
objective, physical, data-based view about the three. On the other hand,
despite various other shortcomings, the traditional/folk systems have the
advantage that they being rooted in their particular cultures take into full
account the socio-cultural aspects of body image, diet and nutrition and
health-care while dealing with the problems of human health.
In recognition of the obvious advantages of
traditional/folk systems, WHO in 1978 recommended that traditional or folk
healing be integrated wherever possible with the modern scientific
medicine and stressed the necessity to
ensure rapport, recognition and collaboration among practitioners of various
systems. In the last two decades there has been much fruitful effort in
generating meaningful interaction between modern scientific and alternative,
traditional/folk medicine. However, presently the situation is that various
practices of modern and traditional/folk systems are being mixed together on a
hit-and-trial basis and not much serious efforts has been made to synthesise
the concepts of modern and alternative systems into a meaningful whole.
CONCLUSION
In view of the above discussion, following
conclusions may be drawn:
1. Individual health is intricately
associated with various aspects of family, society and culture in which a
person lives. Body image, diet and nutrition and health-care are three most
important aspects of health which are overwhelmingly influenced by
socio-cultural factors.
2. Basic premises and, therefore, the
concepts, perspectives and world-views of modern scientific and
traditional/folk medicine are almost diametrically opposite to each other. Most
important differences between the two are with respect to:
(a) Nature of rationality
(b) Relative importance of objectivity versus subjectivity
(c) Relationship between mind, body, nature
and supernatural
(d) Relative emphasis on individual person,
family, community and society
(e) Level of understanding, rapport and
empathy with the socio-cultural aspects of patient's life.
3. There has been growing awareness of the
shortcomings of both modern and traditional/folk medical systems and growing
attempts at integration of the two. However,
such attempts till now have concentrated more on trying out various
permutations and combinations of medicines and methodologies of modern and
traditional systems without much effort
at integrating their concepts, perspectives and world-views. Without such
integration at conceptual and perceptual level it would be difficult to develop
a comprehensive, consistent and useful system of medicine incorporating
benefits of all the modern scientific and traditional/folk medical knowledge
accumulated throughout human history.
4. The most important aspects of the
perspectives of modern scientific and traditional/folk systems which need to be
thoroughly understood and integrated may
be summarized as:
(a) Nature of human existence, relationship
between body, mind, nature (and may be supernatural also) and socio-cultural
aspects of human health particularly body image, diet and nutrition and
health-care.
(b) Nature
of objectivity and
subjectivity, nature of scientific and intuitive
rationality and relative importance of
scientific-reductionist versus traditional-holistic approaches in dealing with
problems of human health, ill-health, disease, diagnosis, treatment and
health-care.
(c)
Nature of
disease, diagnosis and treatment and role of family, community and society in
various aspects of human health.
REFERENCES
1. Foster, G.M. & Anderson, B.G.
(1970) Medical Anthropology-NewYork:Wiley, pp 2-3.
2. Kleinman, A., Eisenberg, L. & Good,
B. (1978) Clinical Lessons from Anthropological & Cross Cultural research.
Ann. Int. Med. 88, 251-258.
3. Kleinman, A. (1980) Patients &
Healers in the context of Culture. Berkeley: University of California Press, pp
49-70.
4. World Health Organisation (1978)
The promotion & development
of Traditional Medicine. WHO Tech. Rep.
Ser. 622.
No comments:
Post a Comment