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Invisible care and invisible women as health care-providers.

The author relates how the social and economical value of care provided by women changed completely with the confiscation of women's knowledge of the use of writing, held in men's hands. Furthermore, the rise of Christianity introduced despising and condemnation of the body, considered as the source of evil. While prosecuting as witches those women careproviders who were matrons and sages, the Church instituted consecrated women to provide what she expected from care-giving, and had them recognized as the socialized model of care-providers. The development of an ideology of care based upon dedication to the poor and salvation of the soul took the place of a fundamental knowledge of body care practices. This paved the way during the nineteenth century for the increased value of technical cure and consideration of care as menial work, worthless, requiring no ability, no knowledge, and therefore socially and economically unrecognized.

Attitude of Health Personnel↗

What's a woman doing in a place like this?

Medicine is not a science. It is an art that uses science to explore what William Harvey called "nature's closest secrets," that we may better minister to her children. We still need to remove some crackpot theories that have crept in, such as "holism." Even neurosurgery has a few. But we are beginning to humanize the traditional detached indifference and become the doctors we were meant to be. Our patients will be better for it. Society will be better for it. We will be better for it [1320]. In discussing the women's liberation movement in America, Reverend William Sloan Coffin once stated, "The woman who most needs liberating is the woman who lives inside of each man." This, I think, is the great awakening that the increasing influence of female physicians has brought about. Early twentieth century physicians, armed with a new science, became efficient fighters of disease. Disease was the enemy, the cure was the victory, and the patient was too often merely the environment in which the encounter was fought. This is what was taught in medical school and residency. It was necessary to learn the lesson well in order to be protected against the pain of others and to abort any insidious tendency to identify with their misery. Many teachers believed in preventing the enervating perils of "emotional involvement." This is not to say that physicians were unkind to their patients, merely that they kept their distance. Patients were treated with respect and even with a kind of formalized dignity. Physicians were as gentle as they knew how to be. But they were men apart. They towered over the sick as an adult towers over a child. Today something within men is being liberated. To a great extent, I believe that women physicians have been essential in bringing this change to medicine. We now know that physicians are not compromised by allowing themselves to feel some of what their patients feel. They are strengthened by it. A patient's life, the setting of his illness, the rending of his soul, the anguish of his family and the hope for his recovery have all become as much a part of good care as knowledge of the serum sodium and what to do about it. Men have become better nurturers, more empathetic. And the thing that is being liberated from inside men is something that society has always seen as a feminine quality. The peak of the healer's art is in bringing both science and empathy to bear on disease. This is what being a physician should mean.(ABSTRACT TRUNCATED AT 400 WORDS)

Europe↗

An Amerindian derivation for Latin American creole illnesses and their treatment.

We present an extended argument which we consider to be sufficient demonstration that a humoral tradition, notably a hot and cold classification, underlies medical etiologies and treatments used by certain groups of South American Indians, and that this is indigenous. We argue that several major, widespread categories of illness and treatments also have a mainly indigenous, Amerindian derivation: that they have not been derived, as often assumed, from unique importations from Spain or other Old World countries, so dating only from the Conquest and surviving in Latin American folk systems up to the present. Our ethnographic data derive from the Akawaio and northern Pemon (Arekuna, Taurepan and Kamarakoto), Carib-speaking Indians in the Guiana Highlands of the border areas of Venezuela, Brazil and Guyana. We stress the following points: The existence amongst these Amerindians, as amongst many Latin American creole and peasant groups, of certain specific and distinctive forms and interpretations of illness, their causations and cures. These include the binary oppositions of hot and cold and the notion of imbalance accompanying the concept of the mediate and harmonious state: sould loss through shock and fright: the capture of soul: whirlwind or cold air sickness: illness from contagious and powerful forces. Similarities between practitioners and remedies also exist. An interdependent relationship between indigenous concepts and language relating to the medical system Is demonstrated. Close associations between the medical system and the physical environment and the depiction of these in metaphors and symbols are detailed. Historical evidence in 17th century literature on Carib peoples is taken into account as well as evidence from remote, mostly unacculturated Amerindian societies of the recent past and of today. In the case of the Akawaio and Pemon, only the beginnings of syncretism in the medical system have been discovered. If our ethnographic data and the conclusions we draw are accepted, then question arises as to whether the hot/cold opposition and other medical concepts and practices relating to a humoral tradition in other Latin American groups, Amerindian and creole, are not wholley or in the main indigenous--as some scholars have already begun to suggest. If they are indigenous then they should be studied as such. We consider that there is a case for studying syncretism in medicine. We see this as a process whereby adoptions and adaptations are made selectively from incoming systems; where essential, indigenous elements may be reinforced and modified by the incoming, but where basic structures, objectives and characteristics of the indigenous remain identifiable and a continuity is achieved.

Cold Temperature↗

Pain and the ethics of pain management.

In this article I clarify the concepts of 'pain', 'suffering', 'pains of body', 'pains of soul'. I explore the relevance of an ethic to the clinical setting which gives patients a strong prima facie right to freedom from unnecessary and unwanted pain and which places upon medical professionals two concomitant moral obligations to patients. First, there is the duty not to inflict pain and suffering beyond what is necessary for effective diagnosis, treatment and research. Next, there is the duty to do all that can be done to relieve all the pain and suffering which can be alleviated. I develop in some detail that individuality of pain sensitivity must be taken into account in fulfilling these obligations. I explore the issue of the relevance of informed consent and the right to refuse treatment to the matter of pain relief. And I raise the question of what conditions, if any, should override the right to refuse treatment where pain relief is of paramount concern.

Attitude of Health Personnel↗

Black magic and illness in a Malaysian Chinese community.

Ah Yuk Je is a successful Hakka Chinese spirit medium practicing in a small Chinese community in Malaysia. Her clientele consists largely of young children suffering from a culturally specific condition called haak geng or 'soul loss' and women concerned about infertility, prenatal problems and errant spouses. While in a trance state, assisted by her tutelary spirits, she diagnoses, prescribes and treats illnesses. Her treatment includes naturalistic and magico-religious elements such as 'cooling' herbal teas, tonics to strengthen the body, rituals and amulets. Because Ah Yuk Je is a wife and mother, women find her sympathetic and astute at solving family problems. When faced with an illness herself, which she suspects to be the result of kong tao (black magic) instigated by someone in her own village, she seeks assistance from a healer outside her own ethnic group as well as outside her community. Four important factors influence Ah Yuk Je's decision to seek out this healer. The first two, recommendation from a trusted friend and a positive previous experience, are obvious, and require no further discussion. The remaining factors are the special nature of the illness, which requires treatment from a specialist, and her practice as a spirit medium. Successful spirit mediums are perceived to have a certain immunity to and control over supernatural forces. Thus the need for secrecy when a spirit medium becomes the victim of evil forces. She is able to preserve her professional reputation by consulting someone outside her ethnic group of potential clients as well as outside her physical community.

Ethnicity↗

'New age' healing in the U.S.

This paper provides a conceptual overview of the 'New Age' phenomenon and of 'New age healing,' concepts which have gone virtually unaddressed in social science research, health-related or otherwise. First, drawing upon diverse sources, the authors attempt to define 'New age,' after which they discuss those medical, spiritual, and sociocultural developments which help account for the rise of new age healing in the U.S. Next, a comprehensive review of over a dozen schemata of healing, healers, and medical systems fails to provide a satisfactory classification of new age healing. Finally, by analyzing data derived from primary and secondary source materials on 81 healing systems or techniques identifying themselves with the new age, a typology of new age healing itself is inductively generated. Three general modes are found: mental or physical self-betterment, esoteric teachings, and contemplative practice. These types of new age healing place primary emphasis, respectively, on body, mind and soul.

Complementary Therapies↗

Behind shamanism: changing voices of Siberian Khanty cosmology and politics.

Siberian shamanism has roots in hunting traditions, kinship organization and soul beliefs which have changed under Soviet rule. Aspects of shamanic epistemology and curing survive, although native medical logic sometimes clashes with modern positivist medicine. Assumptions behind Siberian, particularly Khanty, shamanism are examined through analysis of training, seances and cosmology. The changing social context of shamanism is explored in a framework of Soviet pressure to reject shamanic 'superstitution' and 'exploration.' Shamans themselves have adapted their politics, diagnoses and symbolic actions to an increasingly cold social climate. Data results from ethno-historical and field research, including a summer 1975 trip to the Ob-Ugrian Khanty (Ostiak).

Ethnicity↗

Destructive heat and cooling prayer: Malay humoralism in pregnancy, childbirth and the postpartum period.

Malaya, an ancient crossroads of trade, was the recipient of Chinese and Ayurvedic humoral ideas and, later, those of medieval Islam. These ideas were readily accepted by Malays, since they are highly congruent with pre-existing notions among aboriginal peoples of Malaya involving a hot-cold opposition in the material and spiritual universe and its effects upon human health. Islamic Malays have adapted these aboriginal beliefs to correspond to the Greek-Arabic humoral model in matters concerning foods, diseases, and medicines. Although Malay theories of disease causation include such concepts as soul loss and spirit attack, along with 'naturalistic' ideas such as dietary imbalance and systemic reactions to foods, all of these theories can either be reinterpreted in humoral terms, or, at least, are congruent with the basic tenets of Islamic humoral pathology. Behaviors and beliefs regarding human reproduction, however, while essentially following a humoral pattern, diverge from Islamic, as well as traditional Chinese and Indian Ayurvedic, humoral theories. Unlike any other major humoral doctrine, Malay reproductive theory (like that of non-Islamic aboriginal peoples of Malaya) equates coldness with health and fertility and heat with disease and sterility. These ideas, in turn, are related to beliefs regarding the nature of the spirit world: the destructiveness of spiritual heat and the efficacy of cooling prayer.

Cold Temperature↗

The pneumatic theory of female Warao herbalists.

Among the Warao Indians of eastern Venezuela herbalism is a nonritualized occupation practiced by women. As a medical practice herbalism complements the ritual occupation of shamanism practiced by men. But whereas Warao herbalism is governed by a theory of supernatural causation of illness mystically brought about by contagion, Warao shamanism is a theory of supernatural causation of illness attributed to spirit aggression and object intrusion. According to herbalist theory, pathogenesis results from odoriferous agents that invade the body regions (head, thorax, abdomen) of the victim. Here they expand in the form of fetid gas, producing clinical symptoms by affecting the organs and the soul of a particular region. Treatment of disease by herbal medicines is allopathic. Upon administration the remedy transforms into an aromatic gas which is denser, hence more powerful, than the noxious gas. This enables the therapeutic air to displace the pathogenic air. A cure is achieved after both gases have left the body, returning the patient to an inodorous state. This study presents physical, cultural and ideational data as they relate to health, disease and herbal medicine among the Warao. The status and role of the female herbalist are described. Warao herbal curers make use of more than 100 plant species from which they prepare 259 remedies. The collecting and processing of materia medica conform to a meticulous protocol which is transmitted from mother to daughter through informal methods of training. Treatment of 'symptom-oriented' diseases is effected through the administration of ablutants, ingestants and/or inhalants. While practicing medicine in a nonritual way Warao herbalists are nevertheless directly aligned with the Mother of the Forest.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Cultural Comparison↗

Differences between Kallawaya-Andean and Greek-European humoral theory.

Kallawaya Andeans and Classic Greeks have a humoral epistemology based on analogical thinking and systems of correspondence, but they are culturally different systems. This does not imply that the latter system derived from the earlier but rather than Andeans and Greeks emphasized the relationship of body and humors to climate and land. Ethnographic data indicates that Kallawaya Andeans have a topographical-hydraulic model for understanding the physiology of their bodies. This differs from Greek-European humoral theory, which scholars consider the basis of Latin American folk medicine, in that Greeks try to balance their body fluids, whereas Kallawayas understand their fluids in centripetal and centrifugal motion. Kallawayas conceive of the body in more holistic concepts than Greeks and Europeans who distinguish between thought and matter, body and soul, and inner and outer. The fact that Kallawayas employ hot/cold, and wet/dry categories suggest either that they adopted this from Greek European humoral theory from the Spaniards or that these categories were pre-Columbian. Epistemological similarities facilitate the adoption into Kallawaya ethnophysiology of foods, medicines, and illnesses classified as hot/cold, and wet/dry in Spanish herbal books, which were used in the Andes after the Conquest.

Body Fluids↗

The body: from an immateriality to another.

A first level of immateriality of the human body is very classic for anthropologists: it concerns the different conceptions of soul, of a supernatural component of the human being. It refers also to different kinds of continuity and exchange between the human body and society. The other immateriality appears as an answer to the biological reductionism of the body. As we can see in biomedical conception of the body, as well as in different totalitarian utopias, biological reductionism tends to reduce the whole person to its biological body. Consciously or unconsciously, people cannot accept it. Contemporary ways of healing reflect this contradiction: people accept biological knowledge but they do not accept a purely biological conception of their own body. They conceive that there is an immaterial part in the human body; however it is not supernatural but a part of nature. In this way this 'not divine immateriality' can be conciliated with some kind of scientific approach. The refusal to enclose the person in the biological body appears as a constant through human societies. At the medical level, this refusal is always present in the ill person's image of his body and of his illness. At a more general level, this refusal is probably necessary in order to keep human freedom as well as human specificity.

Complementary Therapies↗

Hot and cold in transformation: is Iban medicine humoral?

Iban categories of hot and cold are examined in the context of humoral medical systems in southeast Asia. These categories are more than binary and oppositional: they are also contradictory and can only be understood in terms of their capacity for transformation in 'depth'. Analysis of the Iban epistemology of temperature sensation reveals the limitations of reductionist empirical approaches to hot and cold. Illness is apprehended, at one level, in terms of unusual conjunctions of opposite temperatures which signify a deeper disturbance in the relationship between body and soul, humans and spirits. Iban therapy redefines and relocates these categories in their proper place and at their appropriate level. It progresses from hot lay treatments to cool ritual treatments, yet cannot be accounted for within a limited framework of homeostatic balance. This paper develops an ethnographically grounded definition of humoralism which emphasizes non-reductive logic, cultural practice and transformation. The key element, transformation, is defined as a transition between categories and a shift in the level of interpretation which fundamentally alter the Iban experience of body and illness.

Borneo↗

Gall's psychophysiological concept of function: the rise and decline of "internal essence".

Gall did not employ the term "function" to refer to adaptive mental processes or to observable behavior. To the contrary, he and the phrenologists took a traditional concept of function regarding the contribution or duties of a part within the overall "animal economy" and argued that the "faculties" of the soul are among the functions of the nervous system. In particular, he brought this psychophysiological use of the term into his Enlightenment perspective when he aligned it with internal essence, juxtaposed it to its external sign, and argued that the cerebral organs are the material instruments through which the internal faculties manifest themselves in behavior and in the shape of the skull. Gall did not believe that the faculties are a product of the organs but that the organs, being material incarnations of the internal functions, contain the power to express the faculties externally. Purely psychological uses of function are infrequent among the works of Gall and his followers. It was not until the functionalists at the turn of the century that the word was applied to the adaptive utility of mental processes in relation to the environment and not until the advent of behaviorism that it was employed to refer to the end or adaptive utility of a particular behavior.

Europe↗

The medical philosophy of Francis Bacon (1561-1626).

Francis Bacon's view of man is dualistic but, although he takes note of mental faculties, he makes the relation between mind and body, rather than the substance of mind, the basis for enquiry into mental processes and, more particularly, for the medically relevant study of mind. (He uses "mind" and "soul" as equivalent terms.) The healing of the body requires study of the body, and the ineffectiveness of physicians is due to their failure in this respect rather than to the body's complexity. To learn about the body requires clinical observation and recording, together with the comparison of bodies, experiments on living animals and attention to pathological changes. The aims of medicine should include not only the restoration of health but also the relief of suffering and they are not to be limited by putting aside a disease as incurable. To learn from treatment it must be fixed in its ordering with controlled and limited variation. Bacon has no separation of medicine from natural science; his philosophy of medicine is his general philosophy of the advancement of knowledge, but limited to a particular field of application. If medicine is separated from natural philosophy it is changed wholly or greatly into empiricism.

England↗

Systematic and medicinal reasoning in Mitla folk botany.

This paper reviews cognitive, symbolic, systematic botanical, and biochemical bases of plant classification, and analyzes their interrelationships in the medicinal folk botany of Mitla, Oaxaca, Mexico. It evaluates the "pharmacological wisdom" of the local population, along with their symbolic use of the environment, to show how they construct medicinal plant classifications which follow a folk logic, but often conform as well to modern botanical classifications based on the principles of systematic botany or chemistry. Working from both the chemical data and the folk categories, the analysis suggests the local Zapotec population systematically selected plants which foam for symbolic reasons to treat illnesses of the "soul" and identifies their underlying chemical constituents and medicinal qualities. Other correspondences between chemical, medicinal and reputed folk qualities are also suggested.

Animals↗

Does stage-of-change predict dropout in a culturally diverse sample of adolescents admitted to inpatient substance-abuse treatment? A test of the Transtheoretical Model.

The Transtheoretical Model (TTM) () proposes that the stages-of-change construct can serve as useful tool for identifying those most at-risk of treatment dropout [Prochaska, J. O. (1999). How do people change, and how can we change to help many more people? In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change (pp. 227-255). Washington: American Psychological Association]. While researchers have found mixed support for this claim in adult samples, studies have not yet tested this issue in adolescent substance-abuse treatment settings. This paper reports findings from a Canadian study of adolescents (n = 130: 80 Caucasians, 50 Aboriginals) admitted to a hospital-based, residential substance-abuse treatment program. Two approaches were used to test the TTM's claim: (1) a hierarchical logistic regression model of dropout was developed using the subscales of the University of Rhode Island Change Assessment instrument (URICA), demographic variables, and subscales of the Addiction Severity Index (ASI); and (2) a chi-square analysis was employed to test the hypothesized relation between stage-of-change and dropout status. The findings demonstrated that the best predictive model of dropout included only the Precontemplation subscale of the URICA (OR: 4.3; 95% CI: 2.0-9.0). In addition, adolescents assigned to the Precontemplation stage manifested significantly higher rates of treatment attrition than individuals in the Contemplation or Preparation/Action stages. This study provides important empirical support for the predictive utility of the stage-of-change construct among a culturally diverse sample of adolescents admitted to an inpatient substance-abuse treatment program.

Adolescent↗

[The therapeutic function of the aesthetic surgery].

By its definition and its etymology, aesthetic surgery is as much a surgery for the soul as for the body. Aesthetic surgery is a true "armed" therapy that essentially targets the psychology of the patient. This therapeutic "arsenal" preserves and/or restores the health of the patient according to its different aspects as defined by the World Health Organization. The plastic surgeon is always concerned about his patient as a whole, and as a human being, of whom he takes charge. Indeed there lies his specificity: He is as well a surgeon and a physician. We identify and analyze, in this chapter, the particular quality of patient-surgeon relationship on a surgical, psychological and juridical level. It is interesting to note that this collaboration results from a spontaneous convergence. The surgeon, the main interested figure, asserts himself mainly as a physician that is totally involved in a dialogue with his patient. He multiplies the interviews and he sharpens his clinical approach, and his own reactions, with regard to the demand for plastic surgery. The psychiatrist establishes the theoretical and practical aspects of the patient demand. The jurist, far from the barren dissertation of the law, reconsiders the environment of the demand and legitimates the generating wish: he insists on the necessary information but also on assuming responsibility. The therapeutic function of the plastic surgery appears essentially related to the success of a psychic repair solicited by the patient but that is scarcely specified by him as such, and of which he is, most probably, rarely fully aware. The process is to listen and to gather the information that guarantees mutual understanding. Plastic surgery is considered irreplaceable by many of our patients, and indisputable by us. It brings incomparable social and human fertility. It is, however, an ambitious and difficult project that is highly demanding. It is far from the impression of facility reflected by the media. Every actor of this scene, where the patient takes the center stage, must be aware of it.

Humanism↗

Exotic animal corporate practice.

I have attempted to give insight into many of the aspects of a corporate veterinary job in the retail pet industry. Understand that these are my experiences, and corporate jobs are as diverse as the number of corporations in this field. My experiences have been positive because I have been fortunate enough to become an integral part of a company with an outstanding company ethic regarding animal care and business as a whole. This is a dream position for a veterinarian who wishes to make a far-reaching difference for animals. At PETCO I am the Animal Advocate and I do have the responsibility to look at every situation through the eyes of the animals. I take this responsibility very seriously and understand that every decision I make has a lasting impact on not only the animals we sell but also the associates who daily give their heart and soul as they care for the animals in our stores. This is the way I have chosen to make a difference in the world: by using my veterinary education as well as my life experiences in ways that are very different from the James Herriot of old-different from the advanced veterinary practices in this new millennium but steadfastly following the same principles we promised to uphold when we took the veterinary oath... Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering,the conservation of livestock resources, the promotion of public health, and the advancement of medical knowledge. I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.

Animals↗