Social and Cultural Anthropology | Health, illness and healing

Hello IB Anthropology Students! Welcome to Health, Illness, and Healing

Welcome to one of the most relatable and important chapters in anthropology! We all experience health and illness, but how we understand, categorize, and treat them is deeply shaped by our culture and society.

In this chapter, we step away from purely biological definitions to explore how social relationships, power structures, and cultural beliefs determine who gets sick, why they get sick, and how they seek healing.

Don't worry if this seems tricky at first! By the end of these notes, you'll be able to differentiate between clinical sickness and the lived experience of illness—a core skill for passing the exam!

Section 1: The Core Anthropological Triad: Disease, Illness, and Sickness

In everyday life, we often use 'disease' and 'illness' interchangeably. However, medical anthropologists make a crucial distinction. Understanding this triad is fundamental to studying this topic.

1.1 Distinguishing the Terms

Anthropologists argue that treating only the biological problem misses the cultural and social pain experienced by the patient.

• Disease: This refers to the objective, clinical, or biological condition. It is measurable and diagnosable by a medical professional (e.g., a bacterial infection, a tumour, a broken bone). It is the physiological deviation from a biomedical norm.
• Illness: This is the subjective, lived experience of suffering. It is how the patient and their family perceive, describe, and cope with the disease or discomfort. Illness is rooted in identity and personal experience.
• Sickness: This term often refers to the public, social, and cultural recognition of the condition. It involves the social role or status a person takes on when they are deemed unwell (the 'sick role'). Sickness mediates between the person and the society through rules and expectations (e.g., being excused from work).

Analogy for Understanding the Triad

Imagine a car breaking down:

The blown head gasket (the measurable mechanical failure) is the Disease.
The owner's frustration, fear of missing work, and worry about the repair bill is the Illness.
The official diagnosis from the mechanic and the need to call a tow truck (the socially recognized event) is the Sickness.

Key Takeaway: Anthropology focuses primarily on Illness and Sickness because these are shaped by culture, belief and knowledge, and social structures, while biomedicine usually focuses only on Disease.

Section 2: Ethnomedicine and Cultural Beliefs about Causality

When someone gets sick, cultures provide the tools (knowledge and belief) to answer three crucial questions: Why me? Why now? What should I do about it?

2.1 Ethnomedical Systems

Every society has its own medical system, known as an Ethnomedical System. This is the cultural framework used to understand and treat health problems.

• Biomedicine (Western Medicine): This is the ethnomedical system most common in Western societies. It emphasizes scientific testing, rational causes (germs, genetics), and physical interventions. It often relies on a division between mind and body.
• Non-Western Systems: These include Traditional Chinese Medicine (TCM), Ayurveda, Shamanism, and local healing practices. They often view the body holistically, emphasizing balance (e.g., hot/cold, yin/yang) or spiritual connection.

Did you know? Biomedicine is an ethnomedicine, not the universal medicine. Anthropologists study it just like any other cultural system, noting its own rituals, symbolism, and power structures (e.g., the authority of the doctor).

2.2 Cultural Causes of Illness (Causality)

In many societies, the cause of sickness is not just biological—it is moral, social, or spiritual. Understanding causality reveals deep cultural values.

• Naturalistic Causality: Illness is caused by impersonal forces or conditions, such as temperature imbalance, weather, or natural toxins. (Often present in Ayurvedic or TCM systems).
• Personalistic Causality: Illness is caused by purposeful actions of an agent—a god, a spirit, a witch, or an ancestor. Healing often requires addressing the social or spiritual relationship that was broken. Example: Among the Azande (studied by E.E. Evans-Pritchard), illness is often attributed to witchcraft, which explains not just the disease itself, but the unfortunate timing of the disease.

2.3 Culture-Bound Syndromes

These are patterns of symptoms recognized as illnesses only within specific cultures. They highlight the link between culture, identity, and mental health.

• Example: Susto ("fright" or "soul loss") in Latin American cultures. Symptoms (insomnia, fatigue, anxiety) are attributed to a frightening event causing the soul to leave the body. Healing involves ritual retrieval of the soul.

Key Takeaway: All medical systems are embedded in belief and knowledge. The cultural definition of the cause (causality) dictates the method of healing and the meaning attached to the suffering.

Section 3: Healing Practices, Symbolism, and Power

Healing is not just about pharmacological treatment; it is a social, performative process involving symbolism and social relations.

3.1 The Process of Healing and Ritual

Anthropologists view healing as a process of restoring physical, social, and moral balance. Healing often involves rituals.

Ritual Effectiveness: Rituals work because they mobilize powerful cultural symbols and shared beliefs, often leading to physiological changes (like reduced stress or the famous placebo effect).

• Symbolic Healing: The healer (e.g., shaman, doctor, priest) uses powerful objects, language, and actions that have shared meaning within the society. Example: In Western biomedicine, the white coat, the stethoscope, and the complex jargon are all symbols of authority and specialized knowledge, which reassure the patient and enhance the effectiveness of treatment.
• Social Effectiveness: Rituals publicly reorganize the patient's place in society. By confirming the illness, the community validates the person's suffering and provides support, aiding recovery.

3.2 Critical Medical Anthropology (CMA) and Power

CMA focuses on how economic and political structures affect health outcomes. It connects health to issues of power, inequality, and social relations.

• Structural Violence: This concept, linked to anthropologist Paul Farmer, describes how large-scale political and economic systems cause harm to specific populations (e.g., poverty, racism, lack of infrastructure) and directly impact their health. These harms are often normalized or invisible.
• Medicalization: This is the process by which human conditions and problems (which were once seen as moral, social, or spiritual) come to be defined and treated as medical problems (e.g., shyness becoming "Social Anxiety Disorder"). This is a clear exercise of power by medical institutions to expand their control and definition of what is 'normal.'

Common Mistake to Avoid

When analyzing health, do not simply say "culture causes illness." Instead, analyze how structural factors (like limited access to clean water or systemic racism) or cultural concepts (like ritual purity or stigma) shape vulnerability and the distribution of disease (i.e., the exercise of power).

Section 4: Medical Pluralism and Change

Due to globalization and increased movement, most societies today do not rely on just one medical system. This leads to **Medical Pluralism**.

4.1 Medical Pluralism and Choice

Medical Pluralism is the presence and integration of multiple healing systems (biomedical, traditional, alternative) within a single society.

• Patients often become "health care shoppers," moving between different healers based on their condition, their financial situation, and their cultural beliefs about the cause of the illness.
• A patient might use antibiotics (biomedicine) for an infection while simultaneously seeking a traditional healer to remove the curse they believe caused the infection (personalistic causality). This illustrates how change is integrated into traditional practices.

4.2 Materiality and Health

The concept of materiality—the social significance of physical objects—is crucial in healing.

• Objects like pharmaceuticals, stethoscopes, herbs, and amulets are not just inert things; they are imbued with symbolic power and meaning that affect the healing outcome.
• Example: Access to certain expensive medications (a material object) is directly linked to socioeconomic status, highlighting issues of power and inequality.

Final Takeaway: Anthropology shows us that health is fundamentally a cultural and political concept, not just a biological one. Healing restores not only the body but also the individual's place within their social world.