The nature and experience of affliction and the causes and consequences thereof vary from culture to culture and, over time, within a culture. Cultures have developed more or less organized approaches to understand and treat afflictions, and identify the agents, forces, or conditions believed responsible for them. Ethnomedicine is that branch of medical anthropology concerned with the cross-cultural study of these systems. While medical systems or elements thereof were foci of research early in the 20th century in the work of W. H. Rivers, the study of popular systems of health and illness did not coalesce into a field of study in anthropology until the 1980s. Foundational formulations of the field of medical anthropology appeared in the 1950s and 1960s, in the works of such writers as William Caudill and Steven Polgar.
Indigenous medical beliefs and practices appeared earlier in works focused thereon, as well in ethnographies of religion and culture and personality. Ethnomedicines were conceptualized in terms of an idealized Western medicine, biomedicine. Anthropologists considered it to be of an entirely different order than medicines of other cultures, and the term ethnomedicine reflected this radical dichotomy.
Ethnomedical beliefs and practices were the products of indigenous cultural developments outside of “modern medicine.” Writers unabashedly referred to such systems as “primitive,” and “irrational.” Because these systems were assumed to be based upon custom, they were, by definition, inefficacious “beliefs” in contrast to the putatively certain “knowledge” of biomedicine. Whether they were the ultimately biological theories of misfortune (witchcraft, as among the Azande) or the diagnosis of skin maladies among the Subanun, any reported ethnomedical efficacy derived “coincidentally” when their beliefs paralleled those of “scientific” medicine.
Early researchers, from Rivers forward, recognized the intimate interconnections of medical with other cultural ideas; no separation existed between medicine and other cultural domains such as religion, gender, or social structure. Researchers assumed this separation held for biomedicine.
Ethnomedical studies’ central foci of concern were systems of classification of illness and etiological theories. Researchers developed broad generalizations that often served to bolster the dichotomy between “primitive” or folk medical systems and “scientific medicine.” These etiological theories were dichotomized and classified as concepts as “naturalistic” (caused by outside forces and events such as ecological changes) or “personalistic” (caused by specific agents such as witches or sorcerers) or “externalizing and internalizing” medical systems. Such notions dichotomized ethnomedical systems in terms of their logic.
Diagnosis and therapeutic approaches to illness, including rituals, pharmacopoeias, and body manip-ulation, attracted attention as did the healers themselves. Shamans as well as sorcerers and diviners received considerable interest, including research on recruitment. A research staple was the plethora of folk, or culturebound, disorders (for example, susto, amok, latah, koro). Ethnomedical nosologies are not universal, as biomedicine asserts with respect to its own classifications. Rather, such systems are local, as are many of the illness entities they classify. An example is the well-studied system of humoral pathology in the Americas. As well, what is regarded as a symptom of illness or health varies from culture to culture. Signs of sickness in one culture are signs of health in another. This is the case with depressive ideation, which is seen as troubling in the United States but suggests growing enlightenment in Buddhist cultures.
Ethnomedicines have a wide variety of healing strategies. They include magical/religious means as well as mechanical (body manipulation) and biochemical agents and compounds (for example, purgatives, poultices, drugs). Biomedical compounds also may be employed within a folk medical system, where criteria of usage diverge from that of biomedicine. Therapies may integrate biomedical ideas into traditional practices or reconceptualize such ideas in light of local realities, as with folk systems in the U.S. South. Of concern, too, are indigenous preventive measures. These measures take specific, local forms, depending on indigenous etiological theories. Encounters and transactions in the context of healing were central and have renewed interest due to the increasingly sophisticated semantic, narrative, and linguistic analyses in all medical contexts.
The anthropology of biomedicine in the late 1970s and early 1980s permanently altered the perception of biomedicine. The view of it as acultural, rational, and scientific rapidly became unsustainable. The theory and practice of biomedicine is thoroughly cultural and local, with distinct local biologies underlying biomedical research and practice in the West and beyond, as with the notions of “race,” that shape scientific/ medical research and practice. Biomedical theory and practice is also gendered and generally ignores differential social status and its attendant differences in mortality and morbidity and the geography of affliction.
The term ethnomedicine originally included the professional medicines of other cultures, suggesting that these were merely more formalized folk medicines, with rare exception. These professional medicines include Ayurvedic (India), Unani (Middle East), traditional Chinese medicine (TCM), and Kanpo in Japan.
Such medicines evidence all of the features that earlier writers suggested distinguished biomedicine from them: dedicated educational institutions, formal curricula, licensing, pharmacopoeia, divisions of labor and specialization, experimentation, change over time, and written texts.
Biomedicine now is seen as one of a number of professional ethnomedicines. Instead of asserting that “we” have (bio)medicine and “they” have ethnomedicine, we now recognize that all medical systems are medicines. Now, issues of difference and power are foci of research in studies of practice as well as the new biomedical technologies and procedures (for example, definitions of death, organ transplantation).
The new ethnomedicine allows us to examine health and illness experientially, phenomenologically, and in terms of social causes of illness and distress and to dispense with the biased implicit suppositions that framed the early medical anthropological gaze on non-Western medicines.
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