Ethnomedicine: introduction and overview
by Peter Giovannini
Ethnomedicine is concerned with the study of medical systems from the native’s point of view. Native categories and explanatory models of illness , including aetiologies, symptoms, courses of sickness, and treatments are investigated (Kleinman, 1978; Kleinman, 1980). The ethnomedical approach proves particularly useful for the study of indigenous therapeutic agents because it allows the researcher to understand treatment patterns according to native explanatory models instead of only through the lens of biomedicine.
Important in ethnomedicine and generally in the medical anthropology literature is the distinction between the term “disease” and “illness”. Disease has been defined as “a biomedical condition” (Fabrega 1974:45) or “pathological states whether or not they are culturally recognized” (Young 1982:264), while Illness has been defined as a “sociocultural category” (Fabrega 1974:3) or a “person’s perceptions and experiences of certain socially disvalued states [..] including disease” (Young 1982:265). This distinction is based on the assumption that is possible to neatly separate the biological aspects of sickness from the social aspects.
Early studies on indigenous medical systems were mostly limited in focus on witchcraft and illness caused by super-natural forces, and on specialists such as folk healers, and shamans (Fortune, 1932; Evans-Pritchard, 1937; Turner, 1967; Fabrega and Silver, 1973). During this period the emphasis was put on the meaning of the illnesses and on the symbolism of the curing rituals performed by the folk healers with the result that scholars mostly overlooked empirical aspects of indigenous medical cultures (Waldstein and Adams, 2006).
In 1976 Foster proposed to classify illnesses as “personalistic” or “naturalistic”. The former category includes illnesses which are held to be caused by an external super-natural agent, and the latter includes illnesses that are supposed to be caused by nature (Foster, 1976). Naturalistic illnesses are likely to be first treated with the use of local pharmacopoeia, especially if the sickness is not perceived as a severe threat. This classification had the merit to acknowledge the coexistence of empirical and magical/supernatural aspects of indigenous medical cultures (Waldstein and Adams, 2006).
A criticism of this classification is that it forces a dichomitisation that does not faithfully represent the overlap between “magic” and “nature” that is present in many indigenous cultures (Weiss, 1998). Weiss suggests placing illness aetiologies within a continuum with illnesses with aetiologies that are clearly personalistic or naturalistic at either end (Weiss, 1998).
Later Kleinman (1980) distinguished three different sectors within healthcare systems: popular, folk and professional. The popular sector includes the self-medication of laypeople or the use of social networks to choose a treatment while the folk sector refers to shamans or traditional healers. The professional sector involves training in medical schools.
Both Kleinman’s and Foster’s classifications proved useful in permitting researchers to define more precisely which of these areas is studied (Waldstein and Adams, 2006). In the last decade the focus of research on indigenous medical culture has broadened, and some scholars have suggested that in many cases the naturalistic components of medical cultures had been underestimated and that strong evidence exists for empirical knowledge in many indigenous cultures (Brett, 1994; Berlin and Berlin, 1996; Waldstein and Adams, 2006).
Browner, Ortiz de Montellano and Rubel’s (1988) contribution was important in suggesting an empirical component in indigenous medical cultures. They suggested a model to evaluate ethnomedical data both independently and against the benchmark of biomedicine. They discussed examples that show how indigenous explanatory models of illness fit with the expected outcome provoked by the therapeutical agents used.
In order to “document the scientific bases of highland Maya ethnomedicine” (Berlin & Berlin, 1996:xxvii) Berlin and Berlin conducted long-term research on explanatory models of illnesses, knowledge of symptoms and herbal treatments, which was highly influential in ethnomedical inquiry . Their conclusion is that highland Maya medicine has an important empirical component resulting from observation and experimentation. The conclusions in Berlin and Berlin (1996) contrast with previous research carried out with the same ethnic group that had overemphasised witchcraft and shamanism (Villa Rojas, 1963; Vogt, 1969; Vogt, 1976). It also had the merit to broaden the focus, previously limited to experts, onto the medical knowledge of laypeople.
Interest in the medical knowledge of laypeople has been fostered by the cross-cultural observation that self–treatment is usually the first therapeutic choice in both urban and rural areas (Kleinman, 1980; Logan , 1983; Aboesede, 1984; Haak, 1988; Fryklof, 1990; Ngokwey, 1995; Waldstein, 2006; Giovannini 2009). These studies generally focus on urban communities often in economically wealthy countries. Kleinman (1980) estimates that in the U.S. and in Taiwan common people choose self-treatment in about 80% of illness episodes. An example from South America is Haak’s work (1988) looking at treatment choices in two villages in rural Bahia, Brazil. About 40% of his sample self-prescribed pharmaceuticals (see also Giovannini et al 2011 on the use of medicinal plants and pharmaceuticals). The WHO recognises the importance of self-treatment with its policy on primary healthcare (PHC), which emphasizes the significance of self-reliance in developing countries (WHO, 1978; Gish, 1979; Gish and Feller, 1979).
When within the same population we find theories and practices about illness that have different origins we can say that this population has a pluralistic medical system . (Fabrega, 1997). Fabrega argues that because there is no such a thing as a pristine and uncontaminated medical culture, medical pluralism is somewhat an artificial construction or an oversimplification of a more complex reality (Fabrega, 1997). The most basic and commonly found distinction of pluralistic medical systems is the dichotomisation/contraposition between traditional and modern medicine. While widespread in academic literature this classification has been challenged (Stoner, 1986). Stoner (1986) suggests that this classification creates artificial boundaries that do not reflect the syncretism observed in many medical systems. As a valid alternative, Stoner calls for a focus on therapeutic alternatives following Kleinmann’s (1980) view of a society’s healthcare system being composed of different sectors with different therapeutic options.
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