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Update: Cultural Assumptions on Health April 19, 2015

Posted by Bettina Hansel in Uncategorized.
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This update is based on Issue 7, January 18, 2008 of this blog, which I searched for today after reading APRIL 17, 2015 in the New York Times — a gently self-mocking essay about entering a German pharmacy to purchase a product for foot fungus, carrying her cultural baggage of sensibilities formed in the USA. Since I had also written on this topic, in a post that is no longer online, I wanted to bring it back to share again, with a few revisions. 

Cultural Assumptions on Health

Featured imageThinking about the video clips of Jacques Tati and Rowan Atkinson from Issue 6 of this blog reminded me of how much of an intercultural experience involves physical reactions. The research we have done with Mitch Hammer using the Intercultural Development Inventory has brought home the fact that we often tend to minimize cultural differences by focusing largely on how, deep down, all human beings are the same. Yes, we are all physically similar, but how differently do we care for our bodies? I was struck recently at how, in spite of globalization, a pharmacy in another culture, for instance, feels foreign and familiar at the same time. Shelves of products to heal and soothe, to care for our bodies, a pharmacist who knows the drugs and will listen as you describe your symptoms, and yet the packaging is different from place to place. A minor difference or one with more importance?

I seem to always find myself in a pharmacy when traveling, though I don’t always find what I am looking for. A hair brush, in Groningen, for instance. Or nail clippers, in Andalucia. Or perhaps it was deodorant, someplace else. Essential components of U.S. personal hygiene are not always found in pharmacies, though my first instinct is to start there. And should I have a cough or a sore throat or an allergic rash, I will always go the pharmacy and ask to speak with the pharmacist, and typically I come away with an unfamiliar-looking medicine. In January 2014, in Cologne, Germany, my husband and I both came down with colds, and we didn’t want this to spoil our time with friends we were visiting. Instead of the usual pills or capsules we always purchased from New York pharmacies, after talking with the pharmacists here, we came away with a powerful and perhaps dangerous nasal spray. It seemed like a miracle cure. We strictly followed the instructions against using it for more than a week.

Cultural differences in how we care for our bodies and deal with illness are often larger than we might assume, and our attachments to our particular cultural patterns are frequently very strong. My experiences of illness as a child were not extreme, but the special tray by my bedside and the Jell-O, toast, tea, cola or ginger ale I was served when my stomach was upset have become equated with a quiet, comfortable convalescence. Once while in Brazil I became very ill and unable to keep any food in my system. The friends I was staying with lovingly cared for me, but with a very different set of ingredients, all quite unexpected and some, like the boldo tea, were quite horrible, I thought. What I craved so much was a cola or a ginger ale, and only this, it seemed, would cure me. I had to explain my strange medical beliefs to my friends, who chided themselves for not having thought of my customs, and quickly provided the needed beverage. Within a day, I was again able to eat, to take a walk, to go to the beach.

I have been lucky with my health generally, but I have seen enough illness to realize that no culture is entirely successful in its remedies. I have my own faith, somewhat shaky at times, in “western” medicine, but this doesn’t explain the documented power of the placebo against which all new medicine is tested, or my belief that I needed a cola to relieve my stomach distress.

I was recently talking with a colleague from Hong Kong who has lived in the United States for several years. She was fighting a cold and we were discussing the Chinese medicine she uses. She told me that it typically works for her, but never works for her American friends. But this time, the Chinese medicine wasn’t working for her, either. We wondered if there was a relation to the diet and the effectiveness of the medicine. Maybe Chinese medicine needs to work with a Chinese diet. But maybe it’s also the cultural assumptions we carry about what is effective and what we believe will work.

In the meantime, my colleague gave me some of her Chinese cough drops to deal with my cold and sore throat. They worked very well for me.

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Issue 90. Culturally Conditioned Response January 13, 2010

Posted by Bettina Hansel in Uncategorized.
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The University of Rochester Medical Center recently released a report of research headed by Dr. Robert Ader that tested the use of placebos as part of the treatment for psoriasis patients. Though many studies have found placebos to be surprisingly effective in the double-blind studies that are standard for medicines, this study looked at characteristics of the administration of the placebo as elements that lead to a conditioned response, like the salivation of Pavlov’s dogs when they heard the dinner bell, and considered how placebos could be used effectively as part of the treatment, with a focus on immune system diseases. Is a conditioned response less than a belief? Can we knowingly take placebos and still expect improvement because we believe in our conditioned response? Or would we start distrusting our medicine because it’s probably mostly placebo and therefore unlikely to be effective?

A few years ago I read an article in the New Yorker  about a color consultant named Leslie Harrington who studied 27 possible pill colors with populations in 12 countries. The consulting was related to selected the color that could be most effectively marketed in different countries, but perhaps if Ader’s research team is correct, Harrington’s marketing research is also likely to show which color pill will be more effectively medically as well.

Of course, other aspects of dispensing medicine are involved as well. Which would you trust more: a placebo that tastes bitter or one that tastes sweet? Would pills, capsules, liquids, or powders prove most effective as placebos? Can a placebo be too tiny to be effective? Certainly not in cultures where tiny grains of homeopathic medicine would commonly be used for many types of illness. All of these questions about perception and beliefs involve culturally-based assumptions about health.

This brings me to the fascinating article in the New York Times Sunday magazine by Ethan Watters earlier this week. In “The Americanization of Mental Illness,” Watters looks at the export of not just American medical treatments for mental illness, but also the symptoms as US and European psychologists, medical professionals and pharmaceutical industries make their science and products available around the world.  According to Watters’ article, research has long shown that “people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.” An anthropologist named Juli McGruder from the University of Puget Sound looked into this question in her study of families of schizophrenics in Zanzabar who frequently believed their family member was possessed by spirits. This belief prompted them to do certain things to appease the spirits, so that the patients were “coaxed with food, feted with song and dance” all of which, it seemed, led to a better result in the long term for these patients than for their American counterparts, who are believed to have a chemical imbalance and whose families try to help them take full responsibility for themselves. Find time to read the whole article.   

Tuesday I took a yoga class as I often do. It provides a stretch of the body and a stretch of the imagination, and plays with the relationship between them. Mostly, it just feels good. But yoga itself is a complicated belief system about the relationship of health, energy, the heart, the blood flow, the mind, and much that is spiritual. I don’t pay a lot of attention to the explanations about how some posture massages my inner organs, or the explanations about how a posture with your feet up in the air helps the blood flow back to your heart. I keep thinking that the blood still has to get up to those feet when you’re upside down, and the inverted position of the feet and heart can’t be that important in the equation. But if I suspend these beliefs for the 60 or 90 minute lesson and try to follow the instructions of the teacher, I feel stronger, stand taller, and feel calmer. Maybe yoga is my placebo, or one of them.

I can’t help thinking that intercultural experiences also require this suspension of your own belief system and openness to another one. And it may also be true that in a similar way you can benefit from an action that is at odds somehow with your own beliefs, as long as you’re willing to loosen them a bit.