Cultural Conceptions of Illness

I.  Nature of Illness                                                  

B.  Organic Perspective: Presence/Absence of physical indicators

1.  Evidence-based medicine: Treatment based on scientific studies.

2.  Weakness: Physical evidence doesn’t explain everything and some conditions cannot be verified (Ex: Chronic Fatigue, Depression).

3. Sick-Health is a continuum. There are varying levels of sickness and varying levels of health.

C.  Health as harmony: Health is a sense of well-being (biopsychosocial)

1. Navajo: Balance between physical health, social interaction, and spiritual beliefs.

2. Ojibway: Connected with nature/earth. Mother earth.

3. Chinese: Yin/Yang & Chi (life energy). Illness results from imbalance.

4. Native American:  Folk healers take personal interest.

5. Healing that includes “lifeworld” may be realistic and compassionate.

6. “Healing:” Restoration of wholeness (spiritual/moral).

7. “Curing:” Purely physical. May still leave patient in anguish about causes, effect, and does not address fears associated with illness.

8. Weakness of health as harmony approach: Difficult to measure; difficult to treat without evidence; some conditions require organic methods (e.g., cancer).

9. Harmony approach may work well as a way to resist disease and recover more quickly.

D.  Specific Religious Beliefs about Health: Fundamentals of Nursing

1.    Hinduism: Accepts modern science.

a.    Illness caused by past sins (karma).

b.    Prolonging life is discouraged.

2.    Buddhism: Accepts modern science.

a.    No euthanasia, may permit withdrawal of life support.

b.    Buddhist priest, nonhuman spirits invading the body causes illness.

3.    Islam: Fatalistic (i.e., nothing one can do to change fate), Five Pillars (e.g., 2^nd day person prays 5xs a day facing east).

a.    Family members are comfort; Group prayer; No euthanasia, may permit withdrawal of life support.

4.    Judaism: Sanctity of life; God & medicine must have a balance. Observe the Sabbath.

a.    Visiting sick is obligatory; Must seek health care; No euthanasia; Life support discouraged.

5.    Christianity: Accepts modern science.

a.    Prayer/faith; visits from clergy; some will use laying on of hands; holy communion commonly used.

6.    Appalachians: External locus of control; Life/death controlled by nature; folk healers; Servants (i.e., good, Christian members of the community) to minister.

a.    Dislike hospitals; noncompliant in medical care

II. Alternative/Complementary Care

A. Alternative medicine refers to therapies that have not been scientifically researched and “proved” by the medical profession. Examples are meditation, prayer, herbal teas, etc.

B.  Complementary medicine refers to care that occurs in addition to conventional medicine. The medical profession may approve of some complementary therapies.

C. “Traditional medicine” may be used instead of complementary or alternative medicine. Some prefer “holistic” and others prefer “CAM” an acronym for complementary and alternative medicine.

D. Types of Alternative/Complementary Medicine:

1. Alternative medicine: Not scientifically researched & not approved by the American Medical Association (AMA).
2. Complementary medicine: Some approval by medical community if used as a supplement.
3. Acupuncture: Stimulate and balance energy flow w/ tiny needles.
4. Aruveyda: Ancient Indian. Yoga, diet, meditation, chakras (energy centers on the body).
5. Biofeedback: Recognize and control bodies response. May work with the use of a biofeedback machine that pinpoints stress levels.
6. Herbal therapies: Examples are St. John’s Wort for depression or ginger for upset stomach.
7. Holistic care: Physical & emotional health.
8. Homeopathic: Small does to stimulate immune system (opposite of allopathic).
9. Integrative: Biomedical + naturopathic.
10. Naturopathic: Diet, herbs.
11. “Oriental:” Herbs, acupuncture, massage.
12. Osteopathic: Muscular, skeletal system, treating body as integrated unit (medical schools).
13. Reiki: Japanese, laying on of hands.

E. Popularity: $60 billion yearly.

F.  Advantages:

1. Low in cost, technology.
2. Simple, easy to understand principles, less frightening.
3. Directed to health maintenance, rather than curing.
4. Practitioners spend more time with patients.
5. Alternative to conventional methods which may not work.

G.  Drawbacks:

1. Herbs are not regulated by FDA. They may not be sufficiently researched.
2. Health risks (renal failure, hepatitis, bp, etc.) can be serious or deadly.
3. Swindling. The claims are often unverified and the products may be expense. For example, shark cartilage may sell for $115 a bottle.
4. Endangered species of plants may be wiped out. In some countries rain forests have been endangered by herbal farming.

III. Spiritual health   

A. Holistic view of heath: Look for factors that affect health and illness (nursing). Ex: physical, sociological, cultural, psychological, spiritual, etc.

B. Spirituality: Comes from the Latin word “Spiritus” meaning: breath, life wind.

C. Spiritual well being: A sense of harmonious interconnectedness between self, others/nature, and an ultimate other that exists beyond time and space.

1. Characteristics of spiritual well-being:

a. It is a unifying theme in people’s lives.

b. It is a state of being.

D. Atheist believes that God doesn’t exist. An agnostic believes that God is unknowable. Both may have “spiritual” sense.

E. Faith: Encompasses (1) Religion and (2) relationship with a divinity, higher power, authority, spirit that encompasses reasoning faith (belief) and trust faith (action).

F. Religion may offer rules, rituals, or a sense of connectedness to all life. Latter is most associated with spiritual well-being

G. Hope: Sense of anticipation may promote health

H. Spiritual distress: Disruption which exceeds one’s biological and psychosocial nature.

1.    May cause a person to feel abandoned, alone, loss of faith

2.    May result from a conflict with belief and practice

3.    Acute illness: People may look for ways to remain faithful. Ex: prayer, church attendance.

4.    Chronic illness: Spirituality may strengthen or cause dispiritness. Spirituality is a main factor in how one adapts.

5.    Terminal illness: Distress vs. peace. Will often question of the meaning of life.

I. Assessing Spirituality (nursing)

1. Spiritual well being occurs when:

Individual has sense of inner strength, hope and faith, believes in a higher power or unifying force, has a defined sense of purpose and meaning in life

2. JAREL (Spiritual well-being scale)

3. Do not impose values on clients

4. Knowing a client’s source of strength and faith can direct interaction Example: No blood transfusions for J. Witnesses.

5. Depending on clients views may influence types of support provided

6. Spirituality is associated with life satisfaction (acceptance)

7.  Questions for nurses:

a. To what or whom do you look as a source of strength and support?

b. What is personal source of strength?

c. How happy are you in your life?

d. With whom do you find the greatest source of support in times of difficulty?

J. Caring: Affects spiritual health.

1. Care involves providing: (1) Hope, (2) understanding of illness, and (3) social, emotional, spiritual resources

2. Nursing Care Behaviors:

a. Being honest

b. Clear expectations

c. Keeping family informed

d. Showing interest in questions

e. Making client comfortable

f. Necessary emergency care

g. Assurances care will be available

h. Answering family questions honestly, openly, willingly

i. Allowing clients to do some things for themselves

j. Teaching family how keep relative comfortable

This website is maintained by Marceline Thompson Hayes, mhayes@astate.edu

This page last updated August 21, 2007

Arkansas State University