June 27, 2024 <minato-nakazawa@people.kobe-u.ac.jp>

Medical Anthropology (12) "Psychobiological dynamics of health"based on Chapter 9 (pp.337-383), In: Winkelman M "Culture and Health: Applying Medical Anthropology", Jossey-Bass, 2009.
CULTURAL HEALING
Cultural approach emphasizes the efficacy of ethnomedical systems. Ritual healing: religion has the power to heal.
• Singer (1989) criticized such perspective (folk medicine is a compensatory practice to cope with the failure of societies toprovide adequate health care).
• Scheper-Hughes (1990) suggested alternative view: clinically applied / critical medical anthropology failed to address thechallenge to biomedicine's materialist premises posed by ethnomedical traditions that consider spiritual practices
fundamental to healing process. Understanding other ethnomedical healing practices as involving mechanisms distinct frombiomedical ones.
• Biomedicine discounted the effectiveness of ethnomedical traditions, at best they provide benefits through suggestibility:
Self-fulfilling expectations of improvement somehow trick people into feeling that they are better when they are not. Placebo
effects are real: Expectations, cultural symbols, personal meanings can have profound effects on biological processes andresponses.
• Religious healing involves aspects found in all healing Kleinman (1973) refers to as symbolic healing. One of the major
aspects of healing traditions includes the power of the interaction to elicit endogenous healing responses based on innate
processes such as relaxation. Religion has been a major mechanism through which symbolic effects are channeled toenhance human health. Higher mental level affects lower level physiological responses (fears produce physiological stress)• Ritual is not meaningless behavior but behaviors that affect humans at physical, emotional, social, and cognitive levels. The
universality of religious ritual healing reflects its powerful therapeutic effects (reflecting the impact of meaning and social
support on individual responses to stress by providing a sense of certainty regarding well-being).
• Excess reliance on drugs (for example, medicine to control hypertension even if it's not necessary) are culturally mediated.
RELIGION, RITUAL AND SYMBOLIC HEALING
Medicine's symbolic reality: Even when addressing disease with biomedicine, the experience of healing involves cultural meanings
and responses. (e.g. "Imagine how different you would feel if you thought you had the flu but your doctor told you that you had aserious infection of intestinal worms! Or how much better you might feel if your doctor told you that what you thought wasmononucleosis was just a nasty cold.") All healing practices are embedded in cultural systems that manage the experiences ofmaladies through the symbolic implications of conditions and therapeutic practices. "Receiving a diagnosis" has physiological,psychological, and social effects that structure the personal experience of illness.
Biosocialization: The mechanism of ritual healing are illustrated in perspectives of biosocialization. How ritual manipulates thelearned associations of symbols with physiological processes. Symbols and physiological processes are linked together throughentrainment (the habitual association of symbols with neutral structures and networks). If a person has suffered from DV always withhearing a specific music or with smelling a specific odor, only the music or the odor makes the one fearful or psychological stress.
Rituals and symbols can affect health because socialization associates them with physiological processes. Symbolic penetration (theeffects of a symbolically elicited neural system on other physical systems; e.g., imagine someone tells you "spider on your neck!" or"snake beside your foot!", you may be freezed) is also related with biosocialization.
Ritual as technical activity: Powerful ecstatic religious experiences may involve a direct experience of a sacred or spiritual dimensionof the universe that changes the nature of self and identity.
Religion's effects on health: Epidemiological analyses have established that there is a scientific basis for attributing positive effects ofreligion on health: Religious participation was significantly related with lower morbidity and mortality rates. Byrd (1988) has shown
the positive effects of prayer on recovery by double blind study (though it was dismissed in many biomedical journals). There may
be many possible pathways of religion linking with health.
Meaning as a mechanism of religious healing: Malinowski (1954) attributed the origin of religion to mechanisms for managing
emotional life and its stress, anxieties, and frustrations. Religion provides explanations, a worldview that makes maladies meaningful
in the context of cultural life and may heal the individual by relieving emotional conflicts and distress. It's a kind of stress coping.
STRESS RESPONSE
Anatomical basis of stress: Not all stress has negative effects on the body. Autonomic nervous system (ANS) relies on positive stress
to function properly. An organism's response to stress is maintained by the complementary functions and balance between the twodivisions of ANS (sympathetic and parasympathetic).
General Adaptation Syndrome: Selye (1956, 1976) found the general reaction to all stressors and labeled this generalized stressresponse the general adaptation syndrome. 3 stages of physiological response to stress by laboratory animals: (1) stress or alarm
reaction of the body, (2) resistance with a new adaptation at an increased level of pituitary-adrenal activity, (3) eventually exhaustion
leading to disease or death.
PLACEBOS AND PLACEBO EFFECTS
Placebos and nocebos: (cf. voodoo death [https://doi.org/10.2105%2Fajph.92.10.1564] – sudden unexplained death resulting fromvoodoo curse): Hahn (1995) suggested that most physicians misunderstood placebos, discounting them as not having real effects.
Even without pharmaceutical effects based on their biochemistry, subjective expectations have real effects on physiological responses
like "mind over matter".
History of the placebo effect / What placebos affect / Placebos and total drug effects / Total drug effects in the social dynamics ofpsychedelics / Cultural effects on drug dependence and addiction / Theories of placebo mechanisms: personal and social
characteristics, therapeutic relationships, endogenous opioids (functioning as pain reliever, e.g. "running high"), classic conditioning
Information and meaning as placebo mechanisms

PSYCHONEUROIMMUNOLOGY
Self / Body and embodiment
Mimesis (in Japanese, 擬態 or 模倣): Core of human symbolic systems, with the body and its ability to act the most fundamental
representational system and basis for metaphor. Generally used to refer to imitation or modeling, a body-based cognitive process inwhich movement establishes relationships of meaning between humans and other objects, based on correspondences of the body tosocial processes.
Social context / Emotional empathy and contagion / Elicitation of psychoneuroimmunological responses
METAPHORIC PROCESSES IN SYMBOLIC HEALING
Kirmayer's review (1993)• Dow's universal aspects of symbolic healing (1986): establishment of generalized mythic world, persuasion of the patient toparticularize his or her problems within that, attaching the patient's emotions to the mythic world symbols, manipulation of
those symbols for assisting emotional transactions.
• Metaphors provide healing by implicitly structuring conceptual domains through the logic of metaphoric implication,
evoking strong sensory-affective associations that transform abstract constructions, bridging the archetypal and mythic levelsof experience.
• Healing uses metaphors to evoke cultural myths and link them to bodily experiences.
<Debate of next week>• Some parents refuse the medical treatment for their children due to religious and/or cultural belief. For instance, surgicaloperations for the children whose parents believes Jehovah's witness are impossible because the parents refuse bloodtransfusion. It sometimes results in the death of children. Should the society allow the medical professionals to treat
children without parents' permission? Or, should the society accept the parents' decision?
• Prop side: The society should allow the medical professionals to treat children if necessary, even if they couldn't
get parents' agreement. By doing so, the medical professionals must not be blamed.
• Opp side: The society should approve the parents' decision based on religious and/or cultural beliefs to refuse
medical treatment for children, even if the child will be at severe risk of death without proper treatment.
• References• https://edition.cnn.com/2018/02/07/health/religion-medical-treatment/index.html• https://www.theguardian.com/us-news/2016/apr/13/followers-of-christ-idaho-religious-sect-child-mortalityrefusing-medical-help• https://www.healthline.com/health-news/parents-beliefs-about-medicine-child-abuse• https://www.pediatricnursing.org/article/S0882-5963(04)00077-6/pdf• https://www.transfusionguidelines.org/transfusion-handbook/12-management-of-patients-who-do-not-accepttransfusion/12-2-jehovah-s-witnesses-and-blood-transfusion