Ya. V. Chesnov
HEALTH, ETHNO-CULTURAL TRADITIONS AND ECOLOGY
12th International Congress of Anthropological and Ethnological Sciences
Zagreb, Yugoslavia, July 24-31, 1988
The problems of health, i.e. its concepts and means for maintaining it has scarcely been studied by ethnography. Today the problems of health in traditional cultures can be worked out by ethnography in cooperation with ethno-medicine and ethno-psychology. All these sciences in general are related to human ecology. Ethno-medicine can provide essential initial orientations in differentiating health from disease. Ethno-psychology deals with value orientations of culture and the place of health among these values. Ecological sciences disclose the adaptation variety of human sciences. But ecology as a discipline investigates problems of health from the point of view of man’s vital functions. Ethnography has a conceptual and objective unity with all these sciences. Ethnology should also have its own subject and concepts which we shall discuss in this paper.
The history of medicine has tackled the problem of health as that of sanitary and hygienic rules practised both in the West and in the East. These rules exerted influence on the mode of life of vast masses. Such investigations are not numerous and are primarily concerned with peoples who have century-old traditions of written culture, e.g. Indian, Chinese, European and Arabic. These are peoples with established medical traditions who practise their own “culture of health”, or systems of rules, which provide for the attainment of all-round health, generally fixed in written form. How can we study societies which have no medical canons? Is there any similar culture of health in these societies?
The solution of this problem is important for defining the subject of the ethnography of health. We must find similarities typical of historically and typologically different traditions of health. This invariant is man’s attitude to his health, since it covers all ecological, historical and social demands. To consider oneself either to be sick or healthy person, to interpret one’s maladies, to see a healer in whom one places confidence, to be hopeful of being cured and a mere wish to be healthy, all these factors are not only bio-natural or socio-cultural but are also profoundly personal and psychological.
The history of medicine indicates that prevalent behaviour standards of health always emphasized emotional and personal position as well as search for individual mode of life.
In the 1930s-50s E. Ackerknecht, a prominent specialist in ethno-medicine, placed emphasis on cultural aspects of disease and medicine in “primitive” societies.1 Knowledge of the whole “cultural configurations” helped him to study particular medical practices.2 After Ackerknecht, many scholars emphasized dependence between popular medicine and culture.3 But this interpretation of popular medicine is too narrow, because it does not make it an open system, i.e. capable of experiments.4 These definitions should be understood as attention to the individual having certain autonomy within the framework of society which solves the problem of health and man’s mode of life.
Experiments undoubtedly are empirically valuable in popular medicine which was noted by many researchers. For this reason, it is interesting to note that both practical (empirical) medicine and “learned” (ritual) medicine based on magic and religion first appeared in ancient Babylon and Egypt. They coexisted for thousands of years but popular empirical medicine was gradually replaced by “learned” medicine.5
This happened because public health in class society was neglected and efforts were made to find cosmic sources of man’s health, which involved the creation of metaphysical systems and special cultures of health. These cultures initially served the upper classes of society.
European scientific medicine developed a concept of health as the absence of pathological disorders. This system of views has its history, its historical and cultural context which was formed by the ancient and Christian doctrine of the birth of man in a sin and liberation from it by outside interference of divine force or Messiah. These beliefs indicated that disease in European science was confined to a biological phenomenon, and medical treatment to removal of pathological factors. This system of views was very prominent and created a reliable social status of doctors in whom confidence was placed. The reason why this system of views is disputed now is a complicated problem and we shall not discuss it.
The newest medical paradigm is confirmed in view of the facts from the life of Afro-Asian and Latin American peoples. This is a system of views about health and disease as a complex phenomenon in which biological factors are combined with socio-cultural ones. This approach founds reflection in the position of the World Health Organization which defines health as the state of physical, psychological, social and cultural comfort. Here, the essence of the problem of health lies in the framework of psychological perception of man’s physical state and living conditions.
Personal attitudes to health linked with confidence in healers in case of illnesses are universally common to the entire history of human race. As far as health is concerned, in its individual specifics we single out the invariant which makes it possible to analyze various ethnographic realities.
Our field studies in the Caucasus (covering Abkhazians, Abazins, Adygheis, Circassians, Kabardians, Georgians) showed that the approach to the same natural factors (climate, food) was unambiguous at the level of individuals. Each individual creates his own mode of life.6 His attitude to environment and to problems of health and disease has emotional hues. The urge to be healthy or to be cured is prevalent in the attitude of individuals.
We want to suggest an important motivational factor which is the intention of health.7
This is a special emotional enthusiasm or will which occurs autogenously or due to a stimulating influence of the healer. The intention of health suggests direct relations between general natural resources of health (and life) and individuals. This intention involves prospects for the present and the future. The intention of health is a peculiar pre-adaptation of organism regulated by individuals.
Peoples differ vis-à-vis their concepts of the universe and place of man in it. But whether these concepts are mytho-poetical or scientific, the vector of the entire human activity will be the urge to be healthy, i.e. the intention of health. Correlations between man’s health and environment are often mediated by specialists such as healers, priests or fortune-tellers. Their role in society constitutes a typological feature in the ethnography of health of a given society.
When we turn to typologization, we want to emphasize that we understand it as an abstraction which comprises several features rather than one feature. Therefore, in giving typological assessments of societies, we are trying to outline a tendency or the relationship of features rather than individual feature. The problem may be considered as the relationship between the intention of health and nature. The correlation of other culturological features can be introduced at subsequent typological levels.
We shall deal in more detail with variants of individuals’ reactions to environment. There may be two types of adaptive reactions, passive and active. Various sufferings, indisposition or extreme forms of disease, are prominent in the passive reaction. Illness of man or even a group of people is regarded as disorder of normal vital functions. Causes and results of this disorder are not essentially social but the sick are temporarily excluded from the social system and get closer to nature.
In accordance with such views, the sick is isolated from society, he may even be placed outside his residence. Drugs that are not regular food are given to the sick. Their complicated formulations, which make pharmacologists amazed, indicate that the state of health of the sick becomes marginal or close to that of nature. The sick is allowed to behave in a manner the healthy person is not allowed to. Here, disease is the shift of the entire organism to nature, i.e. to the borderline between life and death. Any injury is dangerous for health, and man with such injuries is regarded as ritually dangerous for society.
Health of the sick appears to be exceptional. Illness is often regarded as his lot and his fate, as his own or one forced upon him from outside. In societies where the emphasis is on “passive health”, rational sanitary and hygienic measures do not make an integral system, although the presence of such measures cannot be ignored. In such societies, the culture of health does not act as an independent and formalized system and thus it cannot play an active role in individual’s mode of life. Examples are provided by the peoples living under extreme conditions in the north of Asia (Chukchi), in the Tropics, especially in natural isolation (many peoples living in South America, Sub-Saharan Africa, India and Indochina). Among Australian aborigines healthy persons cannot do anything if they are bewitched and may die. Here, the intention of health becomes generally weaker and the person often gives in to disease and death.
The actively adaptive type of reaction to environment stands in opposition to above type. In such a system of views disease is regarded not as a lot that falls upon man due to some unforeseen fate, but rather as a guilt or punishment for the fault or as the mark of behaviour. In this case, causes of disease are not related to nature and are dependent on the person. The sick is not isolated, he strives to be a full member of society and society pays attention of every kind to him. These situations are also typical of societies in which a specific culture of health exists.
In the actively adaptive type, the criterion of good and bad health is transferred from extra-personal sphere to person’s intellectual sphere. Here, the person is responsible for his health.
According to this concept the natural state ceases to be dangerous to society and man and becomes useful and essential. The approach to nature does not mean taking a step towards the borderline of life and death but making up for the resources of life. Incidentally, this is the essence of New Year festivals observed by different peoples of the world, such as Slavonic rites timed to June 24 and the like. This concept according to which health can be “accumulated” suggests that health is associated with satiety or even obesity. Yet these ideas are not typical of the active adaptive reaction in the ethnography of health.
In societies where active relations with environment arc practised, in addition to dietary measures various types of training, hardness, sanitation and hygiene have been worked out. These societies developed their independent doctrines of maintaining health, and most developed societies set up medical and hygienic schools. Ideas came to life according to which man represents a microcosm.
Chinese or Indian traditions are good examples of this typological group. We can also find typical features of passive adaptive reaction in the concepts and behaviour of the entire population of these countries. The same is true of Georgian traditions where elaborate sanitary and hygienic rules were specified in the ancient collection Karabadini and complemented with passive magical rituals.8
In any tradition health can be attained by a combination of active and passive adaptive reactions. Our division is conventional, and we only want to emphasize the attitude of societies to factors that are not directly affected by man. And here special attention should be given to passive adaptive reaction. This reaction is linked with a search that entails error, thus creating a factor of regulative stress.
If scientific medicine suggests that in order to be healthy a person should be slightly ill, members of traditional society united by the intention of health and by the concept of common health should create a hostile world with unpredictable aggressive acts. This world is structurally remote from harmonized nature and is correlated with such natural components that disturb normal biorhythms, e.g. natural calamities. Adaptation to unknown and unpredictable natural effects can only be passive. Society protects its members living under non-standard conditions. In our view, this is the cause of predominance of passive adaptive reactions typical of the peoples living under extreme conditions or in isolation.
The ability of persons to behave adequately in a chaotic reality and readiness for future changes determine health, i.e. their psychosomatic stability, a unique combination of bodily and spiritual patterns. It is difficult, therefore, to single out the leading natural factor of health. However, most important are relations between man and nature in which their common laws appear to be prevalent. The absence of hierarchy of leading natural factors of health makes it possible to combine acts of vital functions depending on the intention of health.
This conclusion is in agreement with facts of the history of medicine: “History suggests a futile attempt to catch ‘a blue bird’, a universal theory based on the idea of the ‘main link’ with respect to a multi-factor phenomenon such as social health and individual’s health.”9
Only rhythms combining nature and the organism, i.e. unity of bodily substrate and the environment can be “a blue bird” which is difficult to catch and yet so alluring, i.e. the nature of time sequence of organism’s functions and external conditions. In traditional society man maintains direct relations with nature; it is easier for him than for the urbanized person to be oriented to bio-natural rhythms. Traditional culture is not only built in opposition to nature, it also includes nature. It involves economic, social, ritual and biological rhythms. Ideologically, this relationship gives rise to various kinds of allegories, metonymies and metaphors in which natural phenomena provide foundations for a language that expresses human life. This language objectifies the person and makes him an integral part of nature.
Position of the person of urbanized society is more difficult, He is also part of nature but he is subordinated to laws of nature. These changes are not always predictable; this requires that the person who has both types of reactions respond to the environment. Typological variants of these reactions and the intention of health based on person’s adaptive abilities make it possible to investigate the ethnography of health.
1 E. H. Ackerknecht. Medicine and Ethnology. Baltimore, 1971.
2 Ackerknecht. “On the Collecting of Data concerning Primitive-Medicine.” In: American Anthropologist. 1945, vol. 47, pp. 427-428.
3 R. W. Lieban. Medical Anthropology, Handbook of Social and Cultural Anthropology. Chicago, 1973, pp. 1031-1072.
4 For more detail see Yu. V. Bromley. Sovremenniye problemy etnografii (Problems of Contemporary Ethnography). Moscow, 1981, p. 211
5 A. L. Oppenheim. Drevnyaya Mesopotamiya. Portret pogibshey tsivilizatsii (Ancient Mesopotamia. The Portrait of Perished Civilization). Moscow, 1980, pp. 29-307.
6 Ya. V. Chesnov. “Ethnographic Studies of Human Activity (Based on Materials of Traditional Abkbazian Culture).” In: Sovetskaya etnografiya (Soviet Flhnography). 1987, No. 3, pp. 25-26.
7 Ibid., pp. 27-28.
8 I. I. Nokobadze, I. Ya. Tatishvili, I. B. Kurchishvili. Basic Stages of Development of Medicine in Georgia. Part 1. Tbilisi, 1964; N. R. Mindadze. Georgian Popular Medicine. Tbilisi, 1981 (In Georgian); I. Sh. Gagulashvili. Gruzinskaya magicheskaya poeziya (Georgian Magical Poetry). Tbilisi, 1983.
9 Yu. A. Shilinis. “Basic Trends of Formation and Development of Theoretical Fundamentals in Medicine”. In: The 3rd All-Union Congress of the Historians of Medicine. Kobuleti, 1986; Development of Theoretical Fundamentals in Medicine. Abstracts of Reports. Moscow, 1986, pp. 17-18.