Medical Anthropology: Explanations of Illness

In the Western World, people usually do not make a distinction between illness and disease. These two terms seem to mean essentially the same thing and are often used interchangeably. However, it is important to define illness and disease differently when considering some non-western cultural traditions. Disease is an objectively measurable pathological

condition of the body. Tooth decay, measles, or a broken bone are examples. In contrast, illness is a feeling of not being normal and healthy. Illness may, in fact, be due to a disease. However, it may also be due to a feeling of psychological or spiritual imbalance. By definition, perceptions of illness are highly culture related while disease usually is not. It is important for health professionals who treat people from other cultures to understand what their patients believe can cause them to be ill and what kind of curing methods they consider effective as well as acceptable. Understanding a culture's perception of illness is also useful in discovering major aspects of their world view.

How illness is explained often varies radically from culture to culture. Likewise, the methods considered acceptable for curing illness in one culture may be rejected by another. These differences can be broadly generalized in terms of two explanatory traditions--naturalistic and personalistic.

The Western World now mostly relies on a naturalistic explanation of illness. This medical tradition had its beginnings in ancient Greece, especially with the ideas of Hippocrates in the 4th and 5th centuries B.C. However, it did not begin to take its modern form until the 16th century A.D.

The naturalistic explanation assumes that illness is only due to impersonal, mechanistic causes in nature that can be potentially understood and cured by the application of the scientific method of discovery. Typical causes of illness accepted in naturalistic medical systems include:

1.	organic breakdown or deterioration (e.g., tooth decay, heart failure, senility)
2.	obstruction (e.g., kidney stones, arterial blockage due to plaque build-up)
3.	injury (e.g., broken bones, bullet wounds)
4.	imbalance (e.g., too much or too little of specific hormones and salts in the blood)
5.	malnutrition (e.g., too much or too little food, not enough proteins, vitamins, or minerals)
6.	parasites (e.g., bacteria, viruses, amoebas, worms)

Students learning to be doctors or nurses in medical schools throughout the modern world are taught this kind of naturalistic explanation. However, there are actually several different naturalistic medical systems in use today. In Latin America, many people still also rely on humoral pathology

to explain and cure their illnesses. This is especially true in rural areas among less educated people. To learn more about this alternative medical system, click the button below.

Naturalistic medical systems similar to European humoral pathology were developed independently in India (Ayurvedic system

) and China (acupuncture

and herbal medicine

Much of the non-western world traditionally accepted a personalistic explanation for illness. Today, it is mostly found among people in small-scale societies and some subcultures of larger nations. For them, illness is seen as being due to acts or wishes of other people or supernatural beings and forces. There is no room for accidents. Adherents of personalistic medical systems believe that the causes and cures of illness are not to be found only in the natural world. Curers usually must use supernatural means to understand what is wrong with their patients and to return them to health. Typical causes of illness in personalistic medical systems include:

1.	intrusion of foreign objects into the body by supernatural means
2.	spirit possession, loss, or damage
3.	bewitching

The intrusion of foreign objects was a common explanation among many Native American cultures for internal body pains such as headaches and stomachaches. The presumed foreign objects could be rocks, bones, insects, arrowheads, small snakes, or even supernatural objects. It was believed that they were intentionally put into an individual's body by witchcraft or some other supernatural means. The fact that there was no wound in the skin for the entry of the objects was consistent with the belief that supernatural actions were involved. The cure for this class of illness was the removal of the object by a shaman

. This usually involved a lengthy non-surgical procedure that was both medical and religious. Typically, the shaman would appeal to supernatural spirits for assistance, manipulate the patient's body, blow tobacco smoke over the site of the pain, and suck on the skin over the pain with a tube or by mouth to remove the object. However, there would be no incision made in the skin.

It is easy for people who only accept a naturalistic explanation for illness to reject the concept of the intrusion of foreign objects into the body by supernatural means. However, it is of value to keep in mind that this explanation is similar to the "germ theory" that is readily accepted by most people in the western world today. Both explanations require the belief in something that cannot be seen by most people. In both cases, there is an act of faith. During the late 19th and early 20th centuries, it was difficult for microbiologists and physicians such as Louis Pasteur, Joseph Lister, and Robert Koch to convince the medical profession that bacteria and other microorganisms can cause infection and disease. It took even longer for the general public in Europe and North America to be convinced that there are harmful microscopic "germs."

In personalistic medical systems, spirit possession, loss, or damage are seen as the result of actions by supernatural beings or people. They may also be due to certain kinds of unpleasant or shocking social situations. An example of this kind of illness is found among some Hispanics in the United States and Latin America. It is called susto

, which literally means fright or sudden fear in Spanish. The fear is of losing one's soul. Susto is also referred to as perdida de la sombra

(literally, loss of the shadow). This latter name is likely a reference to the fact that people who do not have souls do not have shadows or reflections in mirrors, like Hollywood movie vampires. Susto results from incidents that have a destabilizing effect on an individual, causing the soul (espiritu

) to leave the body. Typical incidents that can cause susto include:

1.	the sudden, unexpected barking of a dog
2.	being thrown from a horse
3.	tripping over an unnoticed object
4.	sharing a hospital ward with a patient who has died during the night
5.	having a nighttime encounter with a ghost who keeps your spirit from finding its way back into your body before you wake
6.	being socially impinged upon by society (e.g., being forced to do something that you do not want to do)
7.	being in a social situation that causes you to have fear or anger

Common symptoms of susto are restlessness during sleep as well as being listless and weak when awake. In addition, individuals who have susto are likely to lack an appetite and to not be interested in their personal appearance. These symptoms are characteristic of what western trained medical professionals would likely attribute to excessive emotional stress or even clinical depression. Traditionally, susto is cured with a ritual carried out by a curandero

(i.e., a folk curer). Among the Maya Indians of Southern Mexico and Guatemala, this ceremony typically involves a lengthy series of ritual actions in the presence of the patient's friends and relatives. It usually begins with prayers to the Catholic saint of the village. Next, a chicken egg and special herbs are passed over the patient's body to absorb some of the illness. Later, the egg may be left where the soul loss occurred, along with gifts to propitiate the supernatural being who has the patient's soul. The patient is then partly stripped and "shocked" by liquor being sprayed from the curandero's mouth. The patient may then be massaged and finally "sweated" on a bed placed over or near a hot stove. Alternatively, the patient may be covered with many blankets to induce profuse sweating.

In traditional Hispanic communities of the Southwestern United States, susto is likely to be treated in a similar manner by a curandero. The curing ceremony is called a barrida or "sweeping", which is a reference to a bundle of fresh herbs being swept over the patient's body. However, the cure for mild cases of susto is likely to be medicine taken orally. Teas made from an infusion of marijuana, orange blossoms, and brazil wood are commonly used for this purpose.

Another common type of soul loss in Latin America and around the Mediterranean Basin is the "evil eye" or mal de ojo

in Spanish. This illness results from the perception that some people are "stronger" than others and that their strength can harm "weak" people. In traditional Mexican and Central American culture, women, babies, and young children are thought of as being weak, while men as well as rich and politically powerful people of either gender are strong. When a strong person stares at a weak individual, the eyes of the strong person can drain the power and/or soul from the weak one. Proof that this may have occurred to someone is that he or she cries inconsolably without a cause, has fitful sleep, diarrhea, vomiting, and/or a fever. It is thought that powerful people can cause this draining of the soul intentionally or unintentionally. As a result, parents must guard their children and women must be careful when interacting with government officials, rich city people, foreign tourists, and machos in general. The traditional cure for mal de ojo in rural Mexico often involves a curandero sweeping a raw chicken egg over the body of a victim to absorb the power of the person with the evil eye. The egg is later broken into a glass and examined. The shape of the yolk is thought to indicate whether the aggressor was a man or a woman. It is widely believed in Mexico that at the time that the evil eye drains the soul from a victim, the perpetrator can easily return it by passing his or her hand over the forehead of the victim.

In the traditional Hispanic culture of the Southwestern United States and some parts of Mexico, the cure for mal de ojo may be slightly different. An egg is passed over the patient and then broken into a bowl of water. This is then covered with a straw or palm cross and placed under the patient's head while he or she sleeps. The shape of the egg in the bowl is examined in the morning by a curandero to determine whether or not the cure has been successful.

In personalistic medical systems, bewitching is often thought to be a cause of changed behavior or illness. Bewitching involves the use of magical acts and supernatural powers either by humans or supernatural beings. This may involve sympathetic magic, contagious magic, or simply the casting of a spell. An example of bewitching occurs among the indigenous Nahua Indians of Central Mexico. They believe that a particular kind of supernatural being can cause an illness called aire (literally "air" in Spanish). These beings are "rain dwarfs." They are about 1½ feet tall and are thought to be made almost entirely of water. As a result they are essentially invisible. They cause aire by breathing on people. The typical symptoms of this illness may include paralysis, a twisted mouth, palsy, pimples, and aching joints. The first two symptoms are consistent with a stroke. Aire is cured traditionally by a curandero cleansing the victim by rubbing the body with herbs and an unbroken chicken egg.

In traditional Hispanic communities of the Southwestern United States, aire is usually not thought to be caused by bewitching. Rather, it attributed to a rapid change from a hot to a very cold environment. Ear aches in children are believed to be a consequence. Similarly, paralysis of one side of the face or muscle spasms in adults are thought to be caused by aire. To treat an ear ache, warm smoke is blown into it. Muscle spasms are treated by "cupping". This involves heating the air in a cup with a flame to cause it to expand and drive out excess air. The cup is then placed over the site of the pain. As the air within the cup cools it creates a vacuum which pulls on the skin.


		Guatemalan Maya woman