Does non-Western medicine work? If it succeeds, how does it work? As you will see, medical anthropologists insist that Western medicine in rich in symbolism in many ways similar to what we see in other medical systems. Sometimes biomedicine works for reasons other than what we believe.
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I. INTRODUCTION; THE LIMITATIONS OF BIOMEDICINE
At present, with the exception of the antimicrobial agents (such as penicillin, streptomycin, sulfonamides, antimalarial agents, and antiprotozoan agents), there are no therapeutic agents capable of removing the causes of most diseases.
There remain a large repertoire of impairments that lack a cure comparable to that for microbial disease. These include cardiovascular, kidney, and liver diseases, cancer, arthritis, and chronic pain. Digitalis for heart contractions, diuretics in the management of high blood pressure, AZT plus protease inhibitors for AIDS, insulin for type I diabetes, and aspirin for the relief of pain from arthritis all fail to eliminate the cause of the disease. The treatments only alter the course of the disease. Well used, the treatments extend and improve life.
Consider childhood onset diabetes. In its common form, it is the failure of certain cells in the pancreas (called the Islets of Langerhans) to produce insulin. Untreated, it results in excessive amounts of sugar in the blood and urine. Clinical signs include frequent urination, thirst, hunger, and loss of weight. Before modern laboratory techniques, it was diagnosed by tasting the urine. It thus had a name dating from ancient times: honey-sweet diabetes. Early in the century, Best and Banting won the Nobel Prize for the introduction of insulin therapy. It is one of the triumphs of modern medicine.
Childhood onset diabetes remains a systemic disease in spite of regular administration of insulin. Even well managed diabetics sometimes have trouble managing their blood sugar levels. After a number of years, the long term consequences appear of diabetes to appear. These include retinopathy (treatable nowadays with lasers), cardiovascular, and related circulation problems. Insulin has extended life--and the quality of life. The course is altered with insulin management. Yet, it is still there. Similar stories can be told for high blood pressure and high blood cholesterol levels.
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II. BIOMEDICAL TREATMENT TECHNIQUES AND PROCEDURES
Every therapeutic technique can be identified by its standard way of doing things. In orthodox medicine, you are used to the idea of laboratory tests followed by a consultation with the doctor. Now enters another element in the patient-healer encounter. You know it as the 'doctor-patient relationship.' The human side of it is often called bedside manner.
Everything the physician (or rainforest medicine man) does is a combination of technology and what we might call 'samaritanism.' The technology includes all those products of medical science that are useful in preventing or altering disease in a specific fashion. Samaritanism is the collection of behaviors that provide reassurance, or at least support, so someone troubled by disease or illness. These two functions are separable in theory but not in practice.
It can be argued that three-quarters of the nonsurgical physician's care today is not curative, but is supportive. In retrospect, fifty years ago, most medical practice was a form of samaritanism. Many of the treatments did nothing.
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III. PLACEBOS, "MAKE BELIEVE MEDICINE"
We think of them as inactive substances used in double blind studies of pharmaceuticals. To us, they are an intentional deception. In practice, the term can be extended to any type of therapy, including surgery and psychiatric care.
The term comes from the Bible. It arises from the 116th Psalm, a result of translating errors in the Latin Vulgate Bible. Literally, from this source it means 'I shall please.' In orthodox medicine it is considered 'make believe' medicine. Before you dismiss them, consider this, not only are there treatment successes with them, there are also reports of side effects from placebos. There are two components of the placebo effect, expectation of change and spontaneous change. Placebos are important in research studies to determine the validity of treatment procedures.
Read this carefully. What Western orthodox medicine calls the 'placebo effect' is called 'metaphor' or 'symbolic healing' by anthropologists. These terms are often used interchangeably. There are subtle differences, but in this article we will treat them as having similar meaning.
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The power of symbols in healing has been long recognized in anthropology. Taken in its strictest meaning, the placebo effect is any therapeutic intervention that alleviates the patient's symptoms without removing the underlying cause of the disease.
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There is a large body of literature on placebos and their effects. Briefly, the placebo effect is present in hope, transference, encouragement, and in the doctor-patient relationship itself. The placebo effect is often at work when a patient has full trust in his/her practitioner.
Until recently, little was known about ways in which placebos produce their result on a physiological level. It is well established that the placebo effect emerges under conditions of stress, anxiety, or pain. Placebos frequently achieve treatment success and patients have experienced side effects with them. In clinical trials, the better the tested drug, the more effective is the placebo! The form of the placebo is significant: injections give more results than tablets. Capsules do better than pills. Red ones do more than blue ones. Often, 1/3rd of patients taking a placebo get as much benefit as those taking the active ingredient. Up to 75% of patients with anxiety or depression get better on a placebo!
The placebo effect is NOT generated in psychotic patients (including schizophrenics) or in the absence of stress and anxiety. Pain associated with high anxiety, such as chronic pain, is also responsive to the placebo effect.
Medical researchers have usually dismissed the placebo effect as a nuisance. Research, however, has stimulated interest in placebos in their own right. Discoveries have demonstrated the role of endogenous opiates (endorphins) in the placebo effect. High doses of naloxone (an opiate antagonist) cancels the placebo effect. Thus, researchers speculate that endorphins are released in persons who respond to placebos. Administration of naloxone blocks the action of endorphins.
At present, this relationship between symbolic phenomena and their physiological basis (endorphins) leaves a number of unanswered question. Nevertheless, this line of research may furnish a concrete basis to symbolic healing phenomena. Symbols may operate on several physiological, neurological, and biochemical levels.
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IV. SYMBOLISM IN WESTERN MEDICINE
Medical anthropologists observe that the modern health care delivery establishment is rich in symbolism. In our culture, we demand it! Contemporary medical personnel are functionaries in a powerful symbolic system--for the patient, themselves, and ultimately society. We as patients are confronted by such symbols in the guise of complex and imposing machinery from the moment we enter a contemporary medical establishment.
We are a society that places emphasis on new, complex technology. This is also true of our computers, home entertainment, and automobiles. For us, new is better.
The technical accoutrements encountered in modern health care facilities are in themselves an imposing array of healing symbols. In a technology driven industrial society that demands the newest and latest regardless of cost, the symbolism is steadily increasing.
The physician's medicines or the surgeon's knife are symbols of the healer's power. Some people lament the disappearance of house calls, but it was inevitable in a society that demands medical technology. How effective is just the doctor's black bag when you consider all that hospitals offer? Yet, the doctor-patient relationship remains crucial in biomedical practice. It is especially true in psychiatry.
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V. THE DOCTOR-PATIENT RELATIONSHIP
Some scholars insist that the doctor-patient relationship is an essential ingredient in the healing process. This is especially true in psychotherapy. It is well established that the individual practitioner rather than a specific mode of treatment determines therapeutic effectiveness.
What specifically is curative in the patient-doctor relationship? This is open to debate. Some think that treatment is most successful when the physician has a strong belief in the effectiveness of the therapy. Others think treatment goes best when the patient understands the reason for the treatment. Even different are those who think the physician's role as an authority figure makes the treatment effective. What cures is NOT a settled issue.
The doctor-patient relationship is emphasized in industrial societies for two reasons. First, in modern industrial society, patients look to their physicians for affective support. Secondly, in our culture we focus on the individual. We expect to be the focus of attention in the doctor's office. This may contribute to our expectation of a cure.
At this point, we step off from these introductory remarks to look at spiritualist healers in Mexico. Are they effective? Can non-medical health care heal? If so, how?
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VI. MEXICAN SPIRITUALISM
Mexican spiritualist Temples provide health care to a large number of people in Mexico. It is a non-medical health care delivery system. The definitive studies of the Temples has been done by Finkler, cited at the end of this article.
The Temples have a dissident religious aspect which is vigorously anti-Catholic. The Temples are usually headed by women. The Temples are unified under a head Temple located in Mexico City. As a sectarian movement, Spiritualism possess separate rituals and doctrines which stand in opposition to the Catholic Church. The movement has grown in Mexico since 1920. There are some Temples in the country, mostly in border downs, the West and Southwest.
Spiritualist healers are strongly opposed to witchcraft. Spiritualism provides its followers with a clearly defined cosmology, ethics, and liturgical order. In this discussion, we examine the Temples as a non-medical health care delivery system.
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VII. HEALTH CARE IN MEXICO
Biomedical physicians and spiritualist healers are the providers that predominate in the Mexican health care market. Additionally there are various kinds of non-biomedical folk healers. The Mexican government provides subsidized biomedical health care to government employees and to permanently employed factory workers. The majority of the rural population must seek medical care from private physicians or government run health centers. Spiritualists are an alternative medical choice. One incentive is that the government health centers are staffed by newly graduated young physicians who consider required duty in government clinics as hardship duty.
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VIII. TEMPLE PATIENTS AND SPIRITUALIST HEALING
Regulars at the temples have adopted Spiritualism as their religion. (My note: did you know that The Salvation Army functions as a distinct religious denomination? I mention this as an analogy.) First timers often come to the Temples as a last resort after conventional biomedical treatment has failed. This is expecially true of patients who have 'shopped around' and have become mistrustful of physicans when they walked out of each office with a fistful of prescriptions.
The patient's confidence in the healer is very important. Treatment begins with a 'cleansing' which is a light body message. This is observed to have a tranquilizing effect on the patient. Then, the curer asks about the purpose of the visit. After this the curer may faint away in a sort of trance. The curer has transferred the illness from the patient unto herself. (My note: this is a frequent theme in aboriginal healers who employ 'sucking cures' to treat their patients. These have been observed world wide, including here in North America.)
The curers are dressed in white robes and a smell of incense permeates the air. Usually there is a sea of people of all ages sitting patiently waiting to be served by one of the healers. Religious ceremonies are part of the curers' weekly routine.
Then, a series of remedies are prescribed in an authoritative fashion. These prescriptions may include messages, baths, teas, and possibly some pharmacological remedies. Some healers include antibiotics in their pharmacopeia. Herbal remedies are frequently prescribed. Curers are usually dogmatic with patients and will not permit any kind of challenge to what they prescribe. The curers simply say, "do as I say!"
During the final phase of the healer-patient interaction, the healer recapitualtes the prescription and instructions given to the patient. This followed by a blessing with the healer's hands over the patient's body. Upon leaving, the patients leave a voluntary contribution.
Patients do not question the reasons for their illness. There is no witchcraft. Spiritualist healers do not explain the etiology of their illness. A diagnosis is only given infrequently.
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IX. SPIRITUALIST THERAPEUTIC OUTCOME
Does it work? If you are reading with any interest at all, you are asking for the results. The crucial test of illness management is how it deals with chronic diseases. or those for which radical cures are presently unavailable. In the study of the Temples, a full blown Western style biomedical appraisal was simply not feasible.
In these studies, patient perception was used as the criterion for success. Thus, the patient was asked to make a judgement call on the effectiveness of treatment based simply on whether or not improvement was perceived by the patient.
The figures are based on follow-up interviews.
Failure.........35.3%
Success.........25.9%
Inconclusive...19.4%
Other...........19.4%
Patients who perceived themselves as recovered through Spiritualist healing attributed the recovery to the cleansing they had received. Whereas patients may have disagreed with the treatment course proposed by orthodox physicians, patients always agreed with the Spiritualist treatment, especially when it involved ritual cleansing coupled with herbal remedies. With these cleansing, the healers symbolically removed evil eye that may have befallen the pateint and thereby resolved the disorder in the patient's life.
Aside from health care, the Spiritualist beliefs have contributed to religious pluralism in Mexico. Biomedicine treats treats individual bodies without transforming people's lives. Spiritualism is much different. It transforms people's lives. Intended or otherwise, the Spiritualist Temples have created a movement comprising thousands of people united by their experience.
..... CJ '98
Resources
Finkler, K. Spiritualist Healers in Mexico. Salem: Sheffield Publishing Company, 1985.
Finkler, K. "Sacred Healing and Biomedicine Compared" Medical Anthropology Quarterly 8(2):178-1994.
Moerman, D. "Anthropology of Symbolic Healing" Current Anthropology March, 1979
pp 59-64.
Sherman, M. "The Placebo Effect" American Druggist. January, 1992 pp 39-41.