Interest in the role of culture in defining health and illness and help-seeking behavior continues to grow because of the framing function that culture serves .in forming the backdrop against which all aspects of our lives are interpreted and from which our actions take meaning. Numerous general overviews and critiques of contemporary medical anthropology provide useful insights into the state of both theory and practice in the study of culture and physical and mental health (e.g., Good, 1993; Sargent & Johnson, 1996; Yoder, 1997). These overviews make the point that without an appreciation of the role of culture in human perception (including scientific observation), we run the risk of misinterpreting and misdiagnosing illnesses because of our own ethnocentric biases. Such biases are built into the very diagnostic instruments that we imagine are objective (Good, 1993,1994; Marsella, 1987).
Contemporary theories of psychopathology focus heavily on the biological or psychological correlates of emotional illness and ignore the contribution of the physical, social, and cultural environment to such disorders as depression (Marsella, 1987). As Anthony Marsella (1987) notes, however, mental and emotional well-being are embedded in a hierarchy of meaning-giving systems that include family and social networks at the interpersonal level, and culture and macro social structures at even higher levels (Marsella, 1987). To focus solely on biological or psychological processes is to ignore the context in which they operate and in which threats to one's sense of self and autonomy are interpreted and in which illness in defined, both by the individual and by society.
Yet, even a basic description of verbal illness categories, local explanatory models, and other cultural knowledge are not sufficient to predict behavior or to fully understand subjective experience (R. Rosaldo 1993; Rubel & Hass, 1996). In order to understand what makes individuals act in response to symptoms and malaise, it is necessary to understand the culturally based schemas that give rise to such explanatory models and illness labels. That meaning comes from multiple and changing sources, and it is negotiated between the individual and the healer (Hunt, Jordan, Irwin, & Browner, 1989). Ultimately, the meaning that symptoms and illness have for individuals is revealed narratively, because descriptions of structure provide only snapshots of dynamic processes.
Although we tend to think of culture as consisting of fundamental identities, typically those associated with one's tribal or national group, individuals can participate in several cultures at the same time, just as one can become fluent in more than one language. Professional groups, formal organizations, clubs, religious denominations, cults, and so on, have their own institutional cultures. Western biomedically based medicine itself represents a culture into which medical students are enculturated (Good, 1994; Pelto & Pelto, 1996). The cross-fertilization of these cultures is one of the most striking aspects of our modern world in which cultural isolation is almost impossible.
Education, including medical education and public health, is a form of en-culturation or acculturation (Angel & Thoits, 1987). The fundamental objec--tive of public health campaigns, whether aimed at getting people to practice breast self-examinations or to reduce the amount of fat in their diet in order to reduce their risk of heart disease, is to change people's understanding of how their bodies operate and convince them that they can and should take control of aspects of their own health. Whether changes in diet will, in fact, result in a longer life for any individual is as much an act of faith as the Hopi's belief that by dancing they can bring rain. Modern clinical medicine and epidemiology are as much belief systems as any other, even if a large body of that belief has empirical support. Much else in the canon does not.
To be useful, therefore, our understanding of culture must take into account many other institutions, including economic and political ones, that comprise part of the formal and informal system that gives meaning to the actions of any group, both to themselves and outside observers (Marsella, 1987). It must be understood as the context from which an individual draws social capital and resources and within which he or she interprets the world and acts.
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