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Illness Stories, Medical Choices and Socio-Political Process

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Abstract

In this chapter the main question of the book is presented—why do actors perceive a certain medicine as effective? This question was born out of the observation that health problems—as well as the knowledge and experience of illness and the use of medicines—were often-discussed topics among members of the family, neighbours and colleagues. The theme of the book is presented through the story of 6-year-old Wanglen, who was treated in a context of medical pluralism, in her case biomedicine and Mapuche healing practices. Her case highlights a number of relevant themes and problems that are central to this book, first and foremost the complex reality of medical pluralism, of which both patients and practitioners form part. Moreover, the methodological and analytical framework is presented, more specifically the socio-somatic model and the theory of embodiment, which serve to link Wanglen’s case with a socio-political reality.

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Notes

  1. 1.

    http://www.censo2017.cl/wp-content/uploads/2018/05/presentacion_de_la_segunda_entrega_de_resultados_censo2017.pdf.

  2. 2.

    The names of the medical practitioners and the girl Wanglen have not been altered, but names given for other patients are pseudonyms.

  3. 3.

    According to Lawrence Kirmayer, the term “medically unexplained symptoms” names a social and clinical predicament, not a specific disorder. He furthers argues that many cultural traditions provide socio-somatic theories, which link social conditions with physical symptoms and illnesses (Kirmayer 2004: 663).

  4. 4.

    This figure is from the city of Puerto Savedraa (Diario Austral 5 July 2001).

  5. 5.

    Since my fieldwork, the Mapuche pharmacy has developed into a chain with a nation-wide presence.

  6. 6.

    The director explained that a Chilean anthropologist had recorded the work of machis (including Sebastian) and afterwards published extracts of conversations and prayers without having asked for permission. The board of directors considered suing her for cultural theft and violation of intellectual property rights. I also heard the story from the anthropologist in question, who insisted that all had consented, but had changed their minds after the book was published.

  7. 7.

    According to Freud, traumatic memories of the past can also return in peculiar and “uncanny” ways. As he writes, “the uncanny is in reality nothing new or alien, but something which is familiar and old-established in the mind and which has become alienated from it only through the process of repression” (Freud 1955: 240). One example is the superstition of the evil eye, the dread that whoever possesses something that is valuable and fragile is susceptible to the envy of others. Another example is the fear that even an intention can do harm, where certain signs are seen as proof that an intention has the potency to damage. The analysis of “the uncanny” is, in the Freudian universe, connected to an animistic concept of the world which involves, among other things, a view of it as inhabited by the spirits of human beings, by the belief in the omnipotence of thoughts and the attribution of “magical power” to outside persons and things, the so-called mana.

  8. 8.

    This ambivalence is symbolized by the hero of the Chilean nation-state, the liberator Bernardo O’Higgens. According to the historical sources, O’Higgens was the son of a Peruvian governor and a woman of unknown origin, although apparently indigenous. He is typical of the ambivalence of Chilean identity history: his origins are problematic as a result of being a racial mixture and an orphan, yet this did not prevent his becoming a national hero (Montecino 1996: 143).

  9. 9.

    This viewpoint is, in present-day Chile, especially promoted by the historian Sergio Villalobos, who was considered the country’s national historian during the military regime. Among the practices which he associates with the Mapuche culture are polygamy, homosexuality and sacrifice (“El Mercurio”, May 14, 2000).

  10. 10.

    Discussion of the subject, however, had recently started due to a report published in October 2003 entitled “Informe de la Comisión Verdad Histórica y Nuevo Trato”. Ministerio del Interior de Chile (2003).

  11. 11.

    The ontological turn has in recent years made a valuable contribution to the study of shamanism (de Castro 2004) and materiality (Henare et al. 2007; Petersen 2011). Viviero de Castro has proposed the term “perspectivism”, which inverts the Western distinction between nature (as a given) and culture (as a variable) and instead focuses on the distinctions between humans and non-humans. In the anthology Thinking Through Things (Henare et al. 2007), it is argued that we should take things seriously in and of themselves. It is proposed that objects and practices in different cultural and social settings should be explored not just as artefacts upon which people bestow meaning by virtue of use, but as ontologically important in their own right. The authors argue, furthermore, that we need to withdraw from the assumption that humans live in the same “world”, because different people and cultural and social groups represent and understand the world in various ways. Rather, we need to acknowledge that humans inhabit not a single but numerous “worlds” and “treat meaning and thing as an identity” (Henare et al. 2007: 4). I sympathize with the approach of treating a medical reality as an ontology; however, I regard it as emerging from the engagement with reality, and therefore sensitive to, and part of parcel of, social and political dynamics (see Kristensen 2015).

  12. 12.

    This approach characterized Kleinman’s writing in the 1980s; later he advocated an approach based on the concepts of embodiment and the socio-somatic (Kleinman 1994; Kleinman and Becker 1998).

  13. 13.

    In 1991 the National Institute of Mental Health (NIMH) recognized the special problem of diagnosis in a culturally diverse population and supported the formation of a group for culture and diagnosis, which included American anthropologists and psychiatrists. Its general goal was to suggest how to make culture more specific to DSM-IV (Lewis-Fernandéz 1996: 133). In the fourth edition of DSM, it is noted that culture-bound syndromes are “generally limited to specific societies or culture areas and are localized, folk, diagnostic categories”. The manual further contains two appendices relevant for the issue of culture: (1) a cultural formulation designed to assist the clinician in evaluating and reporting the impact of the individual’s cultural context; and (2) an appendix with 27 so-called culture-bound syndromes, among these some with exotic names (Lewis-Fernandéz 1996; Johansen 2006), such as ghost sickness, koro and amok. The commission felt that its serious and dedicated work towards integrating culture into the manual had been completely distorted. Kleinman dismissed the appendix as “little more than a sop thrown to cultural psychiatrists and psychiatric anthropologists” (Good 1997). These critiques led to changes in the fifth edition of DSM, which included a “Cultural Formulation Interview” (CFI) which was intended to elicit information about the socio-cultural context in which difficulties are experienced. In addition, the notion of culture-bound syndromes had been addressed by three concepts: (1) cultural syndromes: “clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts … that are recognized locally as coherent patterns of experience” (ibid.: 758); (2) cultural idioms of distress: “ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns” (ibid.: 758); and (3) cultural explanations of distress or perceived causes: “labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress” (ibid.: 758) (see Panter-Brick and Eggerman 2017).

  14. 14.

    The term “global mental health” (GMH) was coined in 2001. It is a movement that consists of stakeholders advocating for equity in mental health across the globe. The emergence of GMH has been linked to developments in the field of global health, which has been defined as “the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide”. GMH has been a target of criticism due to its biomedical domination (Patel 2012; Panter-Brick and Eggerman 2017).

  15. 15.

    The concept of “second-world reality” is inspired by Nicolas Argenti’s work on performance and violence in Cameroon’s Bamenda Grassfields, where he argues that children and adults use masquerades to negotiate power relations in a meta-reality, which is useful because it relates to everyday lived reality. Therefore, he argues that the performances are not unreal in the Freudian sense as a fantasy removed from reality, but are (sur)real engagements with a socio-political environment.

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Kristensen, D.B. (2019). Illness Stories, Medical Choices and Socio-Political Process. In: Patients, Doctors and Healers. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-97031-8_1

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