The concept of ill-health, which some scholars and the public refer to as sickness, indicates a state of disease and/or illness. In generally spoken English there is little differentiation between the concepts of disease and illness. However, in the anthropological study of healthcare systems, these concepts are used to indicate slightly different conditions (Herselman 2007:62; McElroy & Townsend 2009:47; Seymour-Smith 1986:187).
Medical anthropologists13 describe “disease” as a physiological and/or psychological condition that indicates a malfunctioning of the human body, which is characterised by universal identifiable symptoms (Sobo 2011:15). The perception of disease as a biological phenomenon is fundamental to biomedicine,14 which characteristically confines medical explanations to scientific knowledge (Barfield 2001:122). International scholars of biomedicine have over time and by means of comprehensive scientific research compiled an inventory of all known diseases categorised by causative factors. These are the International classification of
diseases (9th edition) and the Diagnostic and statistical manual of mental disorders
(4th edition). Tuberculosis, for example, can be regarded as a categorised disease because its symptoms are universally recognised by biomedical practitioners and its treatment is prescribed in a standardised way as determined by scientific research (Herselman 2007:62; see also Barfield 2001:122–123; Thomas 1999:95, 98).
Illness refers to the patient’s perception and experience of ill-health and includes an individual and sociocultural dimension (Sobo 2011:15). Hence, illness usually comprises disease, but is not limited to it. A person experiences ill-health in a particular sociocultural setting that encompasses certain ideas about this condition. The meaning of ill-health is, next to individual experiences, to a large extent determined by the sociocultural circumstances in which it occurs. For that reason a condition of ill-health classified as illness may vary between societies with differing
13
Medical anthropologists study healthcare systems in their sociocultural contexts. This means that they cover the entire system of sociocultural factors such as religion, kinship, education, political systems and economy, which are all interrelated and therefore affect health and healing each in their own particular way (Barfield 2001:316; Herselman 2007:62; McElroy & Townsend 2009:7).
14
The term “biomedicine” is used by medical anthropologists “to refer to the tradition of scientific, biologically oriented methods of diagnosis and cure”. Biomedicine is in the generally spoken English language also known as allopathic medicine (Barfield 2001:318; Brown 1998:108–109).
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sociocultural settings (Barfield 2001:256; Herselman 2007:62; McElroy & Townsend 2009:47; Steyn 1996:5).
Health constitutes the opposite of ill-health, which means that it is important to know what the concerned patients perceive as healthy. Hammond-Tooke (1989:35) explained that from a biomedical perceptive an individual is perceived as being healthy when nothing is wrong with the structure and function of bodily organs and systems. This strictly confined medical explanation excludes other possible aspects of a person’s life, for example, those associated with a person’s emotional and/or religious life. Hammond-Tooke regarded this shortcoming as one of the main reasons for the increasing criticism of the biomedical system. Being healthy in many societies implies a state of general well-being and not just the absence of a bodily disorder.
Barfield (2001:256) explained that “according to the charter of the World Health Organization, health is not simply the absence of disease but a state of physical, social, and psychological well-being”. Similarly the medical anthropologist Sobo (2011:15) defined health as “a broad construct, consisting of physical, psychological, and social wellbeing, including role functionality”. Attaining health therefore implies more than the process of fixing the imbalances of the physical body, it implies restoring certain relationships as well, for example, with other people, nature and the supernatural (see MacCormack 1986:151). Being defined as healthy depends on what people within certain sociocultural circumstances perceive as normal. Illness, consequently, cannot really be understood without knowledge of the particular sociocultural setting in which it is embedded and what its corollary condition of health entails (Herselman 2000:2–3, 14).
Different meanings are also attached to the concepts of healing and curing in an anthropological context (Herselman 2007:62). Generally, practitioners of biomedicine, more commonly known as medical doctors, “cure” disease by means of clinically removing a patient’s symptoms, in other words they restore the patient’s biological functions to normal. In contrast, healthcare practitioners “heal” illness, which in non-biomedical healthcare systems usually includes all kinds of misfortunate happenings (see Steyn 1996:5). In this regard Thomas referred to
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Foster (1976:776, as quoted in Thomas 1999:108) who emphasised that the perception of physical ill-health (disease) in non-biomedical healthcare systems “is but a special case in the explanation of all misfortune”. Healing, therefore, implies a more holistic approach than curing because it includes the restoration or healing of the equilibrium of a patient’s sociocultural relationships. It is important to note that these kinds of relationships could include any kind of undesirable situation, such as unemployment, jealousy or fights among family members or community members and problems in a person’s love life (Oosthuizen 1992:17). The health practitioner therefore has to use acceptable ideas and techniques that are embedded in the patient’s sociocultural setting. In particular this means that identification of the causes of illness and the kinds of illness and the treatment thereof have to be socioculturally acceptable to the patient. Consequently, ideas and techniques concerning healing tend to differ from those used concerning curing. Although curing is generally associated with the more clinical biomedical treatment and healing with non-biomedical indigenous or alternative15 healthcare systems, they are not necessarily always mutually exclusive (Herselman 2000:1–2).
According to Thomas (1999:95) people are inclined to make use of different healthcare systems depending upon their personal preferences. Their preferences will depend upon different kind of circumstances, such as emotional, economic and political situations. Underprivileged people, for example, might rather use their traditional healthcare system because it is more accessible and sometimes more affordable than biomedical treatment. It also happens that the biomedical practitioner is not able to satisfactorily identify and treat the socioculturally acceptable cause of an illness. Whenever a state of health is not obtained people might opt for biomedical treatment and vice-versa (see Herselman 2007:64). In this regard Hammond-Tooke (1989:8, 34) mentioned that whenever people are not satisfied with their progress in attaining health they tend to pursue different kinds of treatments irrelevant of its sociocultural setting, which could include combinations of biomedical, alternative or indigenous therapies.
15
The concept of alternative health-care systems is used to refer to healing systems such as acupuncture, homeopathy, naturopathy, etc. (Hammond-Tooke 1989:34).
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According to Barfield (2001:319), regardless of the healthcare system a patient uses, the patient and her/his family have to believe and trust in the efficacy of its healthcare practitioners and the prescribed treatment procedures to enable absolute healing. This belief, the suggestibility or therapeutic effect that is also sometimes labelled as the placebo effect, is induced by the symbolic healing processes present in all healthcare systems (Brown 1998:109; Craffert 1999:128–129; Helman 1994:200; McElroy & Townsend 2009:284).