READER pp 70-76 (The syllabus is in error; these are the correct page numbers.)
DETERMINANTS OF HEALTH
Check out the dates in the bibliography and those show at the bottom of the various graphs. This article is old, yet it illustrates a question that interests sociologists and annoys doctors: Does health care matter, and does biomedicine deserve all the credit?
-Read the article. I'll ask about it on the final. Its central theme is a bit like Moerman's interpretation of surgical results: Yes, there is improvement, but not for the reasons thought to be by the practitioner.
-The author argues that health in America has improved because of better nutrition, a healthier environment, and having fewer children. Check out his chart on p 71. It suggests that, we as a population have a greater longevity because more infants survive now. (My note: demographers say that longevity increase as we stay alive longer. In other words, our chances of reaching 80 are better if we reach 70, than when we only achieve 20. Why? It is some statistical thing-as we get older, the early deaths drop out of the group.)
-Check out each of the charts. Note the long 'secular' decline for tuberculosis long before chemotherapy hit the scene in the late 40s.
-At the end of the article, he says that 'routine checkups are quite useless.' Do you agree? Does that statement tick you off?
READER pp 118-128 SACRED HEALING AND BIOMEDICINE COMPARED
-This article by Kaja Finkler is a classic. She is a fine writer, and this article fits well with our unit on placebos and symbolic healing.
-The core question she has asked is this: can a non-medical health care delivery system give results?
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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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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 study 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 possesses 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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HEALTH CARE IN MEXICO
In Mexico, health care is a fundamental right written into article four of the Constitution. The health expenditure is about 1.1 percent of the total GNP. In the U.S. system, care seems more of a privilege and the U.S. expenditure is now about 14% of GNP.
Approximately 43% of Mexican citizens receive care through the IMSS (social security). This is available to all private sector employees, retirees, and dependents. The premium cost is 12.5% of income. Another 10% are covered by ISSSTE, a system for government employees. The rest of the population is covered by the Ministry of Health
Public health services are not well funded and their physician staffing is based on a required year of duty in return for the right to practice medicine. They consider it hardship duty.
Private health insurance is available, but difficult to obtain over age 65. Some plans cover care in the United States as well as Mexico.
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In the United States, the three principal forms of coverage are employer-financed insurance, Medicare, Medicaid, and a patchwork of other programs ranging from charity, the Veterans Administration, Indian Health Service to cash paid out-of-pocket. The U.S. is the only major industrialized country without a comprehensive health system to cover all of its citizens.
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In Mexico, the spiritualist temple healers are a form of alternative medicine, albeit a 'non-medical' system of healing.
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Resources for this mini-unit are the two Finkler articles and a wonderful new book
Loustaunau, M., Sanchez-Bane, M. eds Life, Death, and In-Between on the U.S. Mexico Border. Westport: Bergin & Garvey, 1999. specifically articles 1 and 10.
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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 especially true of patients who have 'shopped around' and have become mistrustful of physicians 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 is 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 recapitulates 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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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.
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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 patient 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 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.
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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.
READER pp 129-137 The Sorcerer and His Magic
-Claude Levi-Strauss is one of the major theoreticians in sociology and social anthropology. You may find reading difficult, but I encourage you to do it. Appended below is my own summary of shamans and shamanism.
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Shamans and Shamanism
Shamanism is a religious phenomenon centered on the shaman, an ecstatic figure believed to have power to heal the sick, and to communicate with the world beyond. The term 'shaman' means literally, 'to know'.
It is likely that shamanism evolved before the development of class society in the Neolithic Period and the Bronze Age. It was practiced amongst peoples living in the hunting-and-gathering stage, and that it continued to exist amongst peoples who achieved domestication of plants and animals is well established.
We use the term freely in anthropology. There is, however, no single definition of shamanism that applies to the elements of shamanistic activity found in the Americas, in southeast India, in Australia, and in small areas all over the world as well as to the phenomenon amongst the north Asian, Ural-Altaic and Paleo-Asian peoples.
Shamanism achieved its most articulated and specialized form in northern Asia, from where the term is derived. Shamanism there is distinguished by its special clothing, accessories, rites, and a specific world view. Among these people, the person was often epileptic or had other physical abnormality with an intuitive, sensitive and mercurial personality.
Phenomena similar to the traits of shamanism may be found among primitive peoples everywhere in the world. Such detached traits, however, are not necessarily shamanistic. The central personalities in such systems--sorcerers, medicine men, and the like--may communicate with the 'other world' through ecstacy. Unlike the shaman, they have attained their position through deliberate study and application of rational knowledge. Part of the knowledge is some cultures is a knowledge of healing plants, a topic we cover elsewhere in a forthcoming unit on ethnobotany and pharmacognosy.
True shamans acquire their position through inheritance, learning, or by inner call (which we would call 'self proclaimed'). Shamans vary in quality and degree. It is the obligation of the shaman to know all matters that humans need to know in everyday life but are unable to learn through their own capacities. Shamans may be men or women, or in some societies, transvestites (My note: berdache amongst Native American Indians is a third gender, a transvestite.) In a course such as this, we are primarily interested in their healing capacities. Their healing talents (apart from applications of ethnobotany) are aided by the force of their unique personalities.
Cross-culturally, most shamans appear able to hallucinate or enter trance. Sometimes it is with the use of drugs, at other times by their inborn ability to do so entirely on their own. At such times they are believed to be possessed by spirits whom they have invited into their bodies. Usually, a shaman must undergo 'uncontrolled' invasions of such beings, and able to recover. This is like being 'born again.'
An essential element of their healing in many societies is to perform the 'sucking cure' in which they claim to suck the 'evil' from the body of the afflicted. (My note: whenever I have blood drawn for medical tests I am intrigued by the anthropological symbolism of what medical persons do to people.) Successful shamanism involves the shrewd manipulation of both information and props.
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How do shamans cure? There is no simple answer. In many societies, the dance is as important as the materials in achieving a cure. Certainly there are metaphor and symbolism. Ethnobotany can explain some of it scientifically. Some speculate that endorphins contribute to the cure. Psychosomatic healing must be considered. What shamans do is easier to explain than how they do it.
..... CJ '99
Resources
This article is loosely adapted from Encyclopedia Britannica and by leafing through every relevant book I had at hand.
READER pp 170-173 Dark Side of the Shaman
-The term nocebo is not in the dictionary. In READER p 139 the nocebo effect is the causation of sickness or death by expectations of sickness or death and by associated emotional states.
-This article is quick reading.
Transcendental Meditation pp 173-176
-Read for interest
"Psychic Surgery" pp 177-182
-As you read this, you should recall the video that we saw early on in this course. Be able to describe it.