Comparative Studies of Health Systems and Medical Care – serie

From the Preface, by Arthur Kleinman:Patients and Healers in the Context of Culture presents a theoretical framework for studying the relationship between medicine, psychiatry, and culture. That framework is principally illustrated by materials gathered in field research in Taiwan and, to a lesser extent, from materials gathered in similar research in Boston. The reader will find this book contains a dialectical tension between two reciprocally related orientations: it is both a cross-cultural (largely anthropological) perspective on the essential components of clinical care and a clinical perspective on anthropological studies of medicine and psychiatry. That dialectic is embodied in my own academic training and professional life, so that this book is a personal statement. I am a psychiatrist trained in anthropology. I have worked in library, field, and clinic on problems concerning medicine and psychiatry in Chinese culture. I teach cross-cultural psychiatry and medical anthropology, but I also practice and teach consultation psychiatry and take a clinical approach to my major cross-cultural teaching and research involvements.The theoretical framework elaborated in this book has been applied to all of those areas; in turn, they are used to illustrate the theory. Both the theory and its application embody the same dialectic. The purpose of this book is to advance both poles of that dialectic: to demonstrate the critical role of social science (especially anthropology and cross-cultural studies) in clinical medicine and psychiatry and to encourage study of clinical problems by anthropologists and other investigators involved in cross-cultural research.

In this book, Dr. John M. Janzen describes patterns of healing among the BaKongo of Lower Zaire in Africa, who, like many people elsewhere, utilize cosmopolitan medicine alongside traditional healing practices. What criteria, he asks, determine the choice of the alternative therapies? And what is their institutional interrelationship? In seeking answers, he analyzes case histories and cultural contexts to explore what social transactions, decision making, illness and therapy classifications, and resource allocations are used in the choice of therapy by the ill, their kinfolk, friends, associates, and specialized practitioners. From the Preface: this book presents an 'on the ground' ethnographic account of how medical clients of one region of Lower Zaire diagnose illness, select therapies, and evaluate treatments, a process we call 'therapy management'. The book is intended to clarify a phenomenon of which central African clients have long been cognizant, namely, that medical systems are used in combination.Our study is aimed primarily at readers interested in the practical issues of medical decision-making in an African country, the cultural content of symptoms, and the dynamics of medical pluralism, that is, the existence in a single society of differently designed and conceived medical systems.

This book describes medieval Islamic medicine and to explore a specific medical text, On the Prevention of Bodily Ills in Egypt by 'Ali ibn Ridwan (A.D. 998 - 1068). It seeks to answer the following questions: What did it mean to be a doctor in medieval Islamic society? What was the nature of the medicine that physicians practiced? And what was the relationship between physician and patient?

"An excellent description and analysis of East Asian medicine ...Based on fieldwork conducted in Japan during 1973 and 1974, which involved the use of a variecy of participant-observer techniques, as well as extensive reading in primary and secondary sources in Japanese and English, Lock's study makes a significant contribution to our understanding of an important dimension of life in Japan...In well-written chapters dealing with the philosophical foundations and historical development of East Asian medicine, Japanese attitudes regarding health, illness, and the human body, detailed description of kanpo clinics, herbal pharmacies, acupuncture and moxibustion clinics, shiatsu and anma clinics, East Asian medical schools as well as the interactions between various providers and patients (customers), Lock develops the cultural thesis ...In the process, she provides information on things most visitors to Japan have seen, heard, felt, and smelled but rarely understood." (Journal of Asian Studies). "Breaks important new ground . Lock discusses concrete medical practice and its cultural significance in general...rich in comparisons, engrossing to read, and analytically penetrating ...an important and absorbing book.It is an engaging account of how at least some Japanese people respond to universal problems. Most readers will obtain from it their first clear impression of what East Asian medicine actually is and does." (Journal of Japanese Studies). "Of considerable significance for comparative cross-cultural studies of medicine, of which this is the best account for a Japanese setting that we now possess." (Monumenta Nipponica). "Both Japan specialists and medical anthropologists will be stimulated, challenged, and engaged by this book." (Medical Anthropology Newsletter).

Some of the most innovative and provocative work on the emotions and illness is occurring in cross-cultural research on depression. Culture and Depression presents the work of anthropologists, psychiatrists, and psychologists who examine the controversies, agreements, and conceptual and methodological problems that arise in the course of such research. A book of enormous depth and breadth of discussion, Culture and Depression enriches the cross-cultural study of emotions and mental illness and leads it in new directions. It commences with a historical study followed by a series of anthropological accounts that examine the problems that arise when depression is assessed in other cultures. This is a work of impressive scholarship which demonstrates that anthropological approaches to affect and illness raise central questions for psychiatry and psychology, and that cross-cultural studies of depression raise equally provocative questions for anthropology.

In this widely-praised study, Carol Laderman provides a vivid picture of the daily life of rural Malays as she focuses on their dietary practices and the ritual and medical aspects of childbirth procedures. Apprenticed to a village midwife and a local shaman, she was able to observe a traditional culture adapting to modern practices.

Why does tuberculosis, a disease which is both curable and preventable, continue to produce over 50,000 new cases a year in South Africa, primarily among blacks? In answering this question Randall Packard traces the history of one of the most devastating diseases in twentieth-century Africa, against the background of the changing political and economic forces that have shaped South African society from the end of the nineteenth century to the present. These forces have generated a growing backlog of disease among black workers and their families and at the same time have prevented the development of effective public health measures for controlling it. Packard's rich and nuanced analysis is a significant contribution to the growing body of literature on South Africa's social history as well as to the history of medicine and the political economy of health.

Focusing on the history of one medical field--rehabilitation medicine--this book provides the first systematic analysis of the underlying forces that shape medical specialization, challenging traditional explanations of occupational specialization.

Until now our knowledge of African health and healing has been extensive but fragmented. Here in eighteen essays is the first comprehensive account of disease, health,and healing practices in the African continent. The contributors all emphasize the social conditions linked to ill health and the development of local healing traditions, from Morocco to South Africa and from the precolonial era to the present. Several chapters illustrate how the most basic facts of everyday life encourage the spread of disease and chape the possibilities of survival. Other discuss a variety of healing practices: drums of affliction in Bantu-speaking societies, Muslim humoral medicine, and biomedicine as practiced in hospitals and dispensaries. The editors provide introductory overviews explaining why and how health and disease are related to historical, economic, and political phenomena.

Judith Justice uses an interdisciplinary approach to show how anthropologists and planners can combine their expertise to make health care programs culturally compatible with the populations they serve.

Stephen Kunitz's work raises crucial issues for public policy in the medical field, and will be valuable for social scientists, physicians, and health professionals concerned with the social context of public health and other medical facilities.

As the median age of the population increases, the care and housing of the elderly in the U.S. are of increasing concern. Jeanie Kayser-Jones compares a typical private institution in the U.S. with a government-owned home in Scotland. Her analysis compels attention to the systematic abuse of the institutionalized elderly in the U.S.

Ngoma, in Bantu, means drum, song, performance, and healing cult or association. A widespread form of ritual healing in Central and Southern Africa, ngoma is fully investigated here for the first time and interpreted in a contemporary context. John Janzen's daring study incorporates drumming and spirit possession into a broader, institutional profile that emphasizes the varieties of knowledge and social forms and also the common elements of "doing ngoma." Drawing on his recent field research in Kinshasa, Dar-es-Salaam, Mbabane, and Capetown, Janzen reveals how ngoma transcends national and social boundaries. Spoken and sung discourses about affliction, extended counseling, reorientation of the self or household, and the creation of networks that link the afflicted, their kin, and their healers are all central to ngoma--and familiar to Western self-help institutions as well. Students of African healing and also those interested in the comparative and historical study of medicine, religion, and music will find Ngoma a valuable and thought-provoking book.

Like its classic predecessor, Asian Medical Systems, Paths to Asian Medical Knowledge significantly expands the study of Asian medicine. These essays ask how patients and practitioners know what they know--what evidence of disease or health they consider convincing and what cultural traditions and symbols guide their thinking. Whether discussing Japanese anatomy texts, Islamic humoralism, Ayurvedic clinical practice, or a variety of other subjects, the authors offer an exciting range of information and suggest new theoretical avenues for medical anthropology.

Chronic pain challenges the central tenet of biomedicine: that objective knowledge of the human body and mind is possible apart from subjective experience and social context. Sufferers, finding that chronic pain alters every aspect of life, often become frustrated and distrust a profession seemingly unable to explain or effectively treat their illness. The authors of this innovative volume offer an entirely different, ethnographic approach, searching out more effective ways to describe and analyze the human context of pain. How can we analyze a mode of experience that appears to the pain sufferer as an unmediated fact of the body and is yet so resistant to language? With case studies drawn from anthropological investigations of chronic pain sufferers and pain clinics in the northeastern United States, the authors explore the great divide between the culturally shaped language of suffering and the traditional language of medical and psychological theorizing.They argue that the representation of experience in local social worlds is a central challenge to the human sciences and to ethnographic writing, and that meeting that challenge is also crucial to the refiguring of pain in medical discourse and health policy debates. Anthropologists, scholars from the medical social sciences and humanities, and many general readers will be interested in Pain as Human Experience. In addition, behavioral medicine and pain specialists, psychiatrists, and primary care practitioners will find much that is relevant to their work in this book.

Widespread throughout Latin America, susto is a folk illness associated with a broad array of symptoms. It is considered by susceptible populations to be a sickness caused by the separation of soul and body which is precipitated by a supernatural force. Most studies of culture-bound diseases have relied on descriptive approaches that focus on pathologies derived from medical textbooks. This study takes an interdisciplinary approach, looking for explanations of susto in the interaction of social, physiological, and psychological factors.

These original essays, which combine theoretical argument with empirical observation, constitute a state-of-the-art platform for future research in medical anthropology. Ranging in time and locale, the essays are based on research in historical and cultural settings. The contributors accept the notion that all knowledge is socially and culturally constructed and examine the contexts in which that knowledge is produced and practiced in medicine, psychiatry, epidemiology, and anthropology. Professionals in behavioral medicine, public health, and epidemiology as well as medical anthropologists will find their insights significant.

Here is the first translation into English of the complete Yin-Hai Jing-Wei, a classic fifteenth-century text on Chinese ophthalmology. As one of the few original manuscripts on traditional Chinese medicine translated into a Western language, this work offers an unprecedented view of the practice of medicine, and specifically eye care, in premodern China. Superbly rendered from the classical Chinese and extensively annotated by Paul U. Unschuld and Jurgen Kovacs, the text provides detailed descriptions of the etiology, symptomatology, and therapy of every eye disease known to fifteenth-century Chinese practitioners. The translators' introduction also provides the first in-depth analysis of the development of this specialty within Chinese medicine. As a source for comparative studies of Chinese and Western medicine and numerous other issues in the history of medicine and Chinese thought, the Yin-Hai Jing-Wei has no equal in the Western world.

Charged with restoring harmony and relieving pain, the Malay shaman places his patients in trance and encourages them to express their talents, drives, personality traits--the "Inner Winds" of Malay medical lore--in a kind of performance. These healing ceremonies, formerly viewed by Western anthropologists as exotic curiosities, actually reveal complex multicultural origins and a unique indigenous medical tradition whose psychological content is remarkably relevant to contemporary Western concerns. Accepted as apprentice to a Malay shaman, Carol Laderman learned and recorded every aspect of the healing seance and found it comparable in many ways to the traditional dramas of Southeast Asia and of other cultures such as ancient Greece, Japan, and India. The Malay seance is a total performance, complete with audience, stage, props, plot, music, and dance. The players include the patient along with the shaman and his troupe. At the center of the drama are pivotal relationships--among people, between humans and spirits, and within the self. The best of the Malay shamans are superb poets, dramatists, and performers as well as effective healers of body and soul.

Music and dance play a central role in the 'healing arts' of the Senoi Temiar, a group of hunters and horticulturalists dwelling in the rainforest of peninsular Malaysia. As musicologist and anthropologist, Marina Roseman recorded and transcribed Temiar rituals, while as a member of the community she became a participant and even a patient during the course of her two-year stay. She shows how the sounds and gestures of music and dance acquire a potency that can transform thoughts, emotions, and bodies.

From the Fat of Our Souls offers a revealing new perspective on medicine, and the reasons for choosing or combining indigenous and cosmopolitan medical systems, in the Andean highlands. Closely observing the dialogue that surrounds medicine and medical care among Indians and Mestizos, Catholics and Protestants, peasants and professionals in the rural town of Kachitu, Libbet Crandon-Malamud finds that medical choice is based not on medical efficacy but on political concerns. Through the primary resource of medicine, people have access to secondary resources, the principal one being social mobility. This investigation of medical pluralism is also a history of class formation and the fluidity of both medical theory and social identity in highland Bolivia, and it is told through the often heartrending, often hilarious stories of the people who live there.

The work of inner-city emergency psychiatric units might best be described as 'medicine under siege'. "Emptying Beds" is the result of the author's two-year immersion in one such unit and its work. It is an account of the strategies developed by a staff of psychiatrists, social workers, nurses, and other mental health workers to deal with the dilemmas they face every day.

This finely drawn portrait of a complex, polycultural urban community in Madagascar emphasizes the role of spirit medium healers, a group heretofore seen as having little power. These women, Leslie Sharp argues, are far from powerless among the peasants and migrant laborers who work the land in this plantation economy. In fact, Sharp's wide-ranging analysis shows that tromba, or spirit possession, is central to understanding the complex identities of insiders and outsiders in this community, which draws people from all over the island and abroad. Sharp's study also reveals the contradictions between indigenous healing and Western-derived Protestant healing and psychiatry. Particular attention to the significance of migrant women's and children's experiences in a context of seeking relief from personal and social ills gives Sharp's investigation importance for gender studies as well as for studies in medical anthropology, Africa and Madagascar, the politics of culture, and religion and ritual.

In the first comprehensive and analytical study of therapeutic concepts and practices in China, Paul Unschuld traced the history of documented health care from its earliest extant records to present developments. This edition is updated with a new preface which details the immense ideological intersections between Chinese and European medicines in the past 25 years.

Why do certain easily preventable diseases persist in the modern world? Renate Lellep Fernandez sheds light on this paradox by investigating the high incidence of iodine deficiency disease (IDD) among mountain villagers in northern Spain. Just as the mystery of non-prevention leads the author far beyond the confines of a single place, so are the experiences of these villagers rich in lessons for biocultural anthropology and public health in many contexts. The symptoms of iodine deficiency include not only the disfiguring goiters associated with the disease but also a catalog of more serious and even fatal complications. The burden of caring for victims of IDD has taxed the resources of this Spanish village beyond reason. Yet even though its people were—and are—eager for good health and quick to take advantage of modern medical treatment, which has long been available, until very recently they failed to learn that iodized salt prevents the disease. A Simple Matter of Salt unveils the social and political obstacles that have impeded the successful dissemination of preventive knowledge. Here are valuable implications for the prevention of other endemic diseases on a global scale.This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1990.

Lives at Risk describes the introduction of Western medicine into Egypt. The two major innovations undertaken by Muhammad Ali in the mid-nineteenth century were a Western-style school of medicine and an international Quarantine Board. The ways in which these institutions succeeded and failed will greatly interest historians of medicine and of modern Egypt. And because the author relates her narrative to twentieth-century health issues in developing countries, Lives at Risk will also interest medical and social anthropologists. The presence of the quarantine establishment and the medical school in Egypt resulted in a rudimentary public health service. Paramedical personnel were trained to provide primary health care for the peasant population. A vaccination program effectively freed the nation from smallpox. But the disease-oriented, individual-care practice of medicine derived from the urban hospital model of industrializing Europe was totally incompatible with the health care requirements of a largely rural, agrarian population. This title is part of UC Press's Voices Revived program, which commemorates University of California Press's mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1990.

Mammalian Skin, a complex and multifunctional system, serves as a vital interface between the organism and its environment. Its structure reflects an intricate balance between protection, sensory perception, and adaptability. The skin, composed of the epidermis, dermis, and subcutaneous fat, is equipped with specialized structures such as hair, glands, and modifications like claws and hooves, which are tailored to the diverse ecological niches mammals occupy. This dynamic system ensures thermal regulation through features like blood vessel networks and sudoriferous glands, while providing mechanical protection, water retention, and a barrier against microorganisms. Its sensory capabilities, coupled with glandular functions like milk production and pheromone secretion, underscore its evolutionary significance in survival and communication.This comprehensive exploration of mammalian skin reveals how its adaptive traits are shaped by environmental challenges. From aquatic mammals' water-resistant layers to the insulating properties of desert species, the skin showcases nature's ingenuity. By examining its morphology, physiology, and biochemical processes, this study not only highlights its pivotal role in ecological adaptation but also opens avenues for applied sciences. Understanding these structures has practical implications, from advancing fur animal breeding to exploring mammalian glandular secretions for behavioral control. This work integrates decades of research, offering a systematic analysis that bridges pure science and practical application, while emphasizing the need for continued study in this fascinating field.This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1982.

Therapy, Ideology, and Social Change: Mental Healing in Urban Ghana by Leith Mullings examines how therapeutic systems both reflect and reproduce the social relations and ideologies of their settings. Focusing on Ghana, Mullings situates indigenous psychotherapies within broader debates on the authority of Western biomedicine and the reassertion of traditional practices. She notes that all medical systems—whether biomedical or indigenous—are cultural processes that structure the meaning of illness and health. Psychotherapy is especially revealing because it directly addresses deviant behavior and is therefore grounded in specific moral and ideological assumptions. The book places Ghana within the context of World Health Organization initiatives to integrate traditional and biomedical systems, critiques of colonial legacies in health care, and the persistent inequalities that shape access to medical resources in postcolonial societies.Mullings advances the argument that therapeutic systems cannot be understood apart from infrastructural conditions and class relations, both domestic and international. She critiques approaches in medical anthropology that treat medicine primarily as cultural expression, emphasizing instead how therapies serve social formations and reproduce ideological systems. The study contrasts two main forms of indigenous psychotherapy in Ghana—traditional religious healing and spiritualist Christianity—demonstrating both their shared symbolic processes, such as dramatic healing rituals, and their divergent goals, especially in relation to Western psychiatry’s emphasis on “ego strengthening.” By grounding analysis in urban Accra, particularly the community of Labadi, Mullings shows how local practices intersect with national health planning, postcolonial state policies, and international debates. Ultimately, the book links healing to broader processes of social change, arguing that therapies both respond to and shape Ghana’s evolving political economy.This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1984.

The End of an Illusion: The Future of Health Policy in Western Industrialized Nations critically examines the evolving challenges in health policy, focusing on the unsustainable nature of current systems in the face of rising medical costs and limited resources. The book argues that while health has long been regarded as a fundamental right, the growing burden of healthcare expenditures in Western countries challenges the idea that the welfare state can continue to provide unlimited access to services for all. As healthcare costs outpace economic growth, the illusion of abundant resources fades, forcing difficult decisions about the allocation of medical services. Central themes include the growing role of the state in healthcare, the implications of new medical technologies, the ethical dilemmas of healthcare rationing, and the shift from idealism to realism in health policy. The book aims to frame the debate on the future of health care, identifying key issues that will shape policy discussions in the 1980s and beyond.The book is structured in four parts. Part 1 reflects on the historical context of state involvement in health systems and its impact on the current state of affairs. It critiques the notion that healthcare can remain a purely private matter, highlighting how economic retrenchment will push for alternative conceptions of medicine. Part 2 explores various perspectives on the role of the state in health policy, analyzing historical debates on disease prevention, the evolution of medical technology, and the ethics of healthcare rationing. Part 3 provides case studies from France, Britain, the United States, and Québec to offer insights into the practical realities and potential solutions in these nations' health systems. Finally, Part 4 synthesizes the findings from the case studies, speculating on the future direction of health policy. The book aims to contribute to a more informed, realistic discourse on health policy by addressing the complex interplay between economics, technology, ethics, and social values.This title is part of UC Press's Voices Revived program, which commemorates University of California Press’s mission to seek out and cultivate the brightest minds and give them voice, reach, and impact. Drawing on a backlist dating to 1893, Voices Revived makes high-quality, peer-reviewed scholarship accessible once again using print-on-demand technology. This title was originally published in 1984.