When most of us think about the medical approach that dominates in Western countries, we tend to view it as scientific and therefore as neutral, not influenced by social or cultural processes. Yet research undertaken by anthropologists and sociologists has revealed the influence that social and cultural assumptions play in the western biomedical tradition.
Linking the word “culture” with “medicine” is usually interpreted to mean one of two things. First, that people of non-western cultures may come to western medicine holding different beliefs about the causes and treatments of illness from those of scientific medicine, causing a “culture clash” between doctor and patient.
Its attendant concept of “cultural competence” is now commonly used in the medical literature. It highlights the importance of doctors and other health professionals understanding that their patients from another culture that may hold different beliefs about illness and may experience poorer quality health care as a result of communication breakdowns.
The second common use of “culture” in medicine is the anthropological study of non-western medical systems. Medical anthropologists have identified several such cultural belief systems among non-western cultures. The “hot-cold” system found in many Asian and Hispanic countries, which holds that certain symptoms or illness are caused by imbalances of either “hot” or “cold” in the body is an example of this.
Medical anthropologists refer to “culture-bound syndromes” to describe clusters of symptoms that seem to be particular to a specific cultural context and are not recognised in other cultures or societies. Ataque de nervios (“attack of nerves”) is one such condition involving behaviours such as uncontrollable shouting, crying, fainting or aggression. It is seen as an illness by Spanish speakers in the Caribbean and Latin America.
As important as these acknowledgements of culture are, it should be recognised that culture, more broadly, can also be understood as the meanings, technologies and practices that gather around medicine within western societies.
Despite the objectivity implied by the scientific principles underlying western medicine, it is still underpinned by a host of assumptions and beliefs developed through living in western culture. The white coat worn by doctors is a potent symbol of efficiency and hygiene, for instance, and the bleeping medical machines found in the hospital setting convey their own meanings of high technological prowess.
Certain stock metaphors and images tend to be used to describe specific illnesses and conditions (“the battle” against cancer, the “magic bullet” of drugs, the “war on drugs”, the “innocent victim” of HIV infection).
In any cultural context, people with some medical conditions are assumed to “responsible” for their illness, while others are regarded as blameless. Thus, for example, in western countries where smoking has become viewed as a filthy and stigmatised habit, people with lung cancer are often assumed to have been smokers and therefore viewed as “bringing it on themselves”. They tend to be subject to less compassion than are those people with diseases that are viewed as not their “fault” and may subsequently feel shamed and guilty. They may even delay seeking medical treatment because of the stigma that clings to the disease.
In all these aspects, and many others, scientific medicine and understandings and experiences of ill health and disease in western societies are inevitably and always underpinned by sociocultural meanings in ways that we don’t always recognise.
Anthropologists and sociologists use the concept of the “lifeworld” to describe the everyday sociocultural context in which meaning is generated. In the case of lay people, this term refers to the understandings, concepts and beliefs they bring to the medical encounter. These are shaped not only by their encounters with doctors and other health-care professionals but also by such factors as personal experiences, interactions with others, information derived from the mass media and the internet, and membership of social class, gender or generational groups as well as racial or ethnic groups.
Same, same but different
Even within the western world, there are significant national differences in how scientific medicine is understood and practised. These differences can be particularly evident in controversies over medical innovation, such as human embryonic stem cell research.
Major differences between western countries are also apparent in health-care spending and statistics of drug prescriptions and medical techniques. A comparative study showed that the French tend to be less obsessed with germs and hygiene but are more focused on the health of their livers – and their doctors treat them accordingly.
Americans, on the other hand, are generally germ-aversive and favour “fighting” disease aggressively. Their doctors have a highly-technical “no-holds-barred” approach to testing for and treating disease. And US health-care costs are the highest in the world partly as a result of this.
Germans are influenced by a lingering Romanticism that considers “heart insufficiency” as a cause of illness, and are therefore high consumers of heart drugs.
For their part the British are stoic supporters of their nationalised medical system, the National Health Service (NHS). It may not offer many luxuries but at least provides care for all. Britons tend to be concerned about their bowel habits and the importance of “soldiering on” in the face of illness.
And Australians? A detailed study has yet to be undertaken of our health beliefs and practices. It would be fascinating to do such research taking into account the increasing cultural diversity within the Australian population.
As these comparisons show, culture-bound syndromes are not confined to non-western cultures. And we shouldn’t assume that just because a medical system has science as its knowledge base that it is morally neutral or somehow immune to the influences of culture.
Just as the lifeworlds of patients need to be acknowledged, it’s equally important to recognise that doctors and other health-care professionals bring their own cultural beliefs to the medical encounter. This is generated not only by their scientific training but also by other aspects of their own lifeworlds.
Deborah Lupton is the author of Medicine as Culture: Illness, Disease and the Body (3rd revised edition, Sage, 2012)