Cultural Models of Health and Illness

Ronald J. Angel Kristi Williams

Department of Sociology University of Texas at Austin Austin, Texas

A physician diagnoses disease on the basis of signs and symptoms, and society evaluates and responds to sickness with understanding or condemnation depending on the moral loadings of the behaviors involved. For the individual experiencing symptoms, though, illness remains intensely personal and subjective. No one besides the ill person can feel his or her pain. Ironically, that intensely personal experience reveals the meeting of private and social worlds. The meaning that illness has for the individual, and his or her response to it, are based both on individual psychological factors and the socially based cognitive models concerning pain and suffering, as well as their causes and consequences, that are part of one's cultural tradition. One experiences illness alone, but one does so using cognitive schemas and language that are part of the culture that one inherits from one's progenitors.

The anthropological literature is filled with examples of cultural differences in how individuals categorize and label diseases and symptoms (Gaines, 1992a; Kleinman, 1982; Yoder, 1995). People from different cultures think and talk

Handbook oj Multicultural Mental Health: Assessment and Treatment of Diverse Populations Copyright © 2000 by Academic Press. All rights of reproduction in any form reserved.

about their suffering using their own idioms of distress. For the scientific observer, the consequence is that he or she simply cannot assume that the illness terms used in standard research protocols that are based on the illness experiences of one culture remain conceptually equivalent in any other (Good, 1993; Marsella, 1987). Although basic pathological processes may be culturally invariant, the subjective experience of illness and its emotional consequences are certainly not.

For researchers, the message is that one cannot study disease in isolation of other aspects of personality, social organization, and culture. Most immediately, understanding the impact of culture on the subjective aspects of illness requires understanding the role of culture in defining the self and threats to the self. Like illness, the self is conceptualized in unique ways by individuals from different cultures (Lock & Scheper-Hughes, 1996). In the West we distinguish between mind and body, but this distinction and our separation of somatic and psychiatric medicine, is only one among many ways of conceiving the person (Kleinman & Kleinman, 1985). Many, if not most, cultures do not conceive of the mind as something independent of the body, and different cultures construe the self in very different ways. In some, individuals perceive themselves as having several selves, and in others, the individual self and the social self are synonymous (Lock & Scheper-Hughes, 1996). This diversity in conceptions of the self is paralleled by differences in how threats to the self are perceived and how these threats influence health.

In this chapter we do not attempt to review the massive literature related to culture and health, especially since there is a large body of work on the impact of culture on emotion and the self that is directly relevant to understanding the subjective aspects of physical and mental illness. There are too many fields and approaches involved in the study of the impact of culture on health and related issues, and one chapter is simply too limited to even superficially summarize what has been done in anthropology, sociology, and psychology with respect to culture, emotions, self-concept, and health. The literature cited in this chapter, as well as several surveys, serve as a good entry point for the general reader (D'Andrade, 1995; D'Andrade & Strauss, 1992; Holland & Quinn, 1987; Sargent & Johnson, 1996; Shweder & LeVine, 1984; Shweder & Sullivan, 1993).

This chapter focuses on the articulation of personal narratives and larger public discourses, including scientific discourses, that relate to health and illness. In it, we situate the study of culture, health, and illness within larger discussions of culture, self, and emotions, and develop a complex conception of culture that goes beyond simple notions of guiding principles, norms, or latent structures. We also develop an active conception of culture in which the narrative structures with which health and illness are perceived and acted upon are the result of purposive action by information-gathering actors who operate within changing, information-rich physical and social environments (Sewell, 1992).

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