Tài liệu MULTIPLE MEDICAL REALITIES Patients and Healers in Biomedical, Alternative and Traditional Medicine

MULTIPLE MEDICAL REALITIES
Patients and Healers in Biomedical, Alternative and Traditional Medicine
Edited by
Helle Johannessen
and Imre Lazar
224 pages

Nowadays, a plethora of treatment technologies is available to the consumer, each employing a variety of concepts of the body, self, sickness and healing. This volume explores the options, strategies and consequences that are both relevant and necessary for patients and practitioners who are manoeuvring this medical plurality. Although wideranging in scope and covering areas as diverse as India, Ecuador, Ghana and Norway, central to all contributions is the observation that technologies of healing are founded on socially learned and to some extent fluid experiences of body and self.



Contents
List of Tables vu
List of Figures VUI
I
Preface by Thomas Csordas IX
List of Contributors xu
Chapter 1 Introduction: Body and Self in Medical Pluralism 1
Helle Johannessen
Part! Body, Self and Sociality
Chapter 2 Demographic Background and Health Status of Users 21
of Alternative Medicine: A Hungarian Example
Laszl6 Buda, Kinga Lampek and Tamas Tahin
Chapter 3 T;iltos Healers, Neoshamans and Multiple Medical 35
Realities in Postsocialist Hungary
Imre Lazar
Chapter 4 'The Double Face of Subjectivity': A Case Study in a 54
Psychiatric Hospital (Ghana)
Kristine Krause
Chapter 5 German Medical Doctors' Motives for Practising 72
Homoeopathy, Acupuncture or Ayurveda
Robert Frank and Gunnar Stollberg
Chapter 6 Pluralisms of Provision, Use and Ideology: 89
Homoeopathy in South London
Christine A. Barry
Chapter 7 Re-examining the Medicalisation Process 105
Efrossyni Delmouzou
Part II Body, Self and the Experience of Healing
Chapter 8 Healing and the Mind-body Complex: Childbirth and 121
Medical Pluralism in South Asia
Geoffrey Samuel
Chapter 9 Self, Soul and Intravenous Infusion: Medical Pluralism 136
and the Concept of samay among the N aporuna in
Ecuador
Michael Knipper
Chapter 10 Experiences of Illness and Self: Tamil Refugees in 148
Norway Seeking Medical Advice
Anne Sigfrid Grenseth
Chapter 11 The War of the Spiders: Constructing Mental Illnesses 163
in the Multicultural Communities of the Highlands of
Chiapas
Witold Jacorzynski
Chapter 12 Epilogue: Multiple Medical Realities: Reflections from 183
Medical Anthropology
Imre Lazar and Helle Johannessen
Index 199

Preface
Thomas Csordas
When good science makes an advance it pauses and turns to reacquaint itself
with the modes of thought that immediately preceded it. Science orients itself
with respect to these modes of thought, examines its connections, debts and
disputes with them, decides whether it is operating at a different level of
analysis and with respect to different interests, conceptualisations and subject
matter. The present volume is a case in point of good science in this sense. It
addresses medical pluralism, a founding concept of the field of medical
anthropology. To the consideration of pluralism is added medical
anthropology's more recent concern with body, self and experience. These
articles demonstrate, with exceptional consistency, an assiduous attention to
ramifying the interconnections between these two modes of reflection in
medical anthropology, situating them as dialogical partners within the
theoretical and empirical discourse of the field. In the process, both become
refined and the field advances.
This observation can be elaborated as follows . Within any complex
contemporary society, there exist a range of therapeutic alternatives ranging
from biomedical treatment to religious healing, from highly technological
therapies to casual folk remedies, and from professional treatment to informal
treatment by family members. Such therapeutic alternatives are often based
on very different cultural presuppositions, but in practice may be related to
one another in the following four ways. First, they may be regarded as
contradictory and incompatible, and hence in conflict or competition with
respect to cultural legitimacy. Second, they may be regarded as
complementary in the sense of addressing different aspects of the same health
problem or category of problem, addressing a problem in a different but
compatible idiom, or having an additive effect in alleviating a problem. Third,
they may occupy coordinating positions within a total societal repertoire of
health care resources, regarded as suitable for quite different kinds of
problem. Fourth, they may be coexistent with contact or direct interaction,
serving the differently defined needs of different segments of a population.
However, these relations do not necessarily define a structure. As practice
theory has taught us, they may be understood as strategic options for defining
the relative deployment of treatments throughout the course of any illness
episode or healing trajectory. In other words, what a methodological
standpoint grounded in bodily existence adds to an understanding of medical
pluralism is experiential immediacy. In that immediacy the conceptual
distinctions among medical systems and treatment modalities, distinctions
that we may indeed find useful in mapping out situations of medical
pluralism, can break down entirely. Here the descriptive language of
pluralism is necessarily replaced by the existential language of self,
intersubjectivity and the present moment. The intellectual polarity that is
synthesised in these contributions thus reminds us that the core topic of
medical anthropology is neither politics, economics nor political economy;
neither biology, chemistry nor biochemistry, but the misery of those who are
ill, the pity of those who become healers for those who are in misery, and the
unwillingness by either to tolerate such pitiful misery.
Furthermore, as these studies conducted in all corners of the globe
admirably show, pluralism may exist insofar as there are distinct practitioners
who can be consulted for different kinds of healing, but also may exist within
the practice of individual healers who possess expertise in a variety of
therapeutic modalities of different cultural provenance - and both kinds of
pluralism are to be distinguished from syncretism, in which different
modalities or elements of therapy are combined in practice. Individual patients
and healers may be highly eclectic in their choice of treatments or may be
devotedly committed to one or more forms. The immediate experience of
pluralism can be radically different for members of immigrant communities
and those who are fluent with the cultural valuations placed on the alternatives
available to them. Prior to all of this is the series of questions that has perhaps
the most existential salience of all: what is the nature of the problem, how is it
best defined, what are the criteria of diagnosis? Intuition and sensibility abouJ
these issues may determine initial choices among pluralistic options, or a
disposition to consult one form of healing may predetermine how the inchoate
distress of raw existence become shaped by the rhetoric of healing.
For Lizar and Johannessen, a principal motivation in having brought these
contributions together is to argue that the proliferation of medical ideas,
interpretations, nosologies and therapies across the globe is not evidence of a
deep confusion in humanity's confrontation with affliction, a hit and miss
effort to systematise an approach to affliction that' gets it right once and for
all'. The plethora of healing forms linked loosely by various degrees of
elective affinity has a more radical implication in that it points to 'complexity
in the body per se'. This articulates the truly intriguing promise of the
synthesis between the study of medical pluralism and that of body, self and
experience. The promise is that of elaborating the insight that the body is not
only an organic entity, but the seat of a nuanced and multifaceted existence, a
being-in-the-world.
In this sense the multiple realities of the volume's title are not fragments of
reality that must be pieced together in order to construct a comprehensive
understanding of illness and healing. Neither are they necessarily dimensions
of reality that coexist in a manner analogous to the way string theory in
physics posits multiple dimensions of the structure of the universe. For, in
appealing to Alfred Schutz, they emphasise that 'It is the meaning of our
experiences and not the ontological structure of the objects which constitutes
reality'. In these essays, that in effect bring an always-relevant question in
medical anthropology into a new age, medical pluralism clearly shows its
transnational face, its postmodern modality and its experiential immediacy.