The literature we have reviewed demonstrates that a growing number of researchers have come to the realization that individual behaviors are motivated by psychological factors that give meaning to actions within specific cultural and social contexts, yet those contexts are fluid and changing. Socialization is far more complex ihan Uauilioiial sociological theories held, and culture does not consist of a set of rigid norms that all members of a particular culture follow blindly. Cultural patterns and messages are, to differing degrees, ambiguous and tentative. They are incompletely internalized, and they compete with other social, cultural, and personal needs (Harkness, Super, & Keefer, 1992). In addition, the meaning of symptoms itself is ambiguous, and diagnoses must be negotiated within what are ill-defined and fluid situations (Kirmayer, 1994).
Much traditional work on culture unfortunately left the impression that cultural patterns are more structured and permanent than they are. A Zapotec Indian in Mexico may recognize various artifacts as part of his culture and he or she may even share in a common conception of the causes, and consequences of some particular illness. To speak of the typical Zapotec, though, or to try to predict how any individual will behave from knowing general cultural patterns related to any area of life is futile. Work by Young (1981) in Mexico shows that practical considerations, such as money and transportation, are as important as, if not more important than, strictly cultural factors in seeking health care. Even during the heyday of classical anthropology, the impact of European material and scientific culture was changing simple tribal life (R. Rosaldo, 1993). Today everyone has a complex set of explanatory systems and behavioral options to choose from when it comes to health and illness. Western biomedicine has extended over the planet since, although it is a discourse like any other, it has proved to be remarkably effective in dealing with disease (Pelto & Pelto, 1997).
The result is that, just as we begin to appreciate the situated and contextual-ized nature of all human behavior, including that related to health and illness, dealing with those situations and that context has become much more complex. Just as it is incorrect to posit that physical and mental health and illness are purely objective and the same from one cultural and social context to the next, so it would be wrong to adopt a cultural determinist perspective in which all aspects of health and illness are viewed as social or cultural constructions. Clearly, clinical entities exist, and basic human physiological processes are everywhere and always the same. What differs is the context in which those processes are experienced and the ways in which individuals and groups recognize and define physical and mental health and illness. To be useful, a culturally informed approach to illness brings the individual, in his or her full cultural, social, and physical context back into the picture. The utility of an understanding of culture as dynamic, and confounded with other organizational and social class processes, is that it offers a way of understanding how universal physiological and psychological processes are structured by one's physical and social environment and how these together give rise to one's sense of self and well-being.
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