Healers and Healing Professions Across Cultures

 Societies may have few or a number of overlapping healers and healing professionals. There are various TYPES of healing dynamics in societies:

• Everybody Can Heal:
• in small scale societies (like H/G bands) curing knowledge and therapeutic practices is known and practiced by most adults in the group.It is a common knowledge
• Part-Time Specialists:
• among village based horticulturalists, some individuals may be known for special healing skills, but they only carry out healing as a part time occupation (spare time after subsistence activities are met)
• Plural Medical Systems:
• societies that have many distinct healing roles
• more highly stratified societies with wider political integration
• full-time professionals
• healing roles compete and interrelate with each other in these plural medical systems

HEALING ROLES: Organizing the Diversity

• Authur Kleinman (1980) distinguishes between three kinds of healthcare sectors:
• Popular Healthcare Sector
• general body of knowledge available to the populace as a whole
• sickness is usually managed at the the level of the household
• usually under the supervene of females (mothers, and other adult females)
• not a privileged activity
• Professional Healthcare Sector
• healing is carried out by persons with specialized training and knowledge 
• standardized formal training based on an organized body of knowledge
• credentials or licenses required to practice
• structured relationship among those in the profession
• organizations which reinforce the standards of practice, share knowledge and protect the profession from competitors
• EXAMPLES: Ayuvedic medicine, Biomedicine, Accupuncture, Japanese Herbal Specialists
• Folk Sector
• nonprofessional, non-bureacratic specialists
• informal education often by apprenticeship 

The boundaries between these three sectors are highly contested:

• practices and knowledge may be borrowed and adapted across sectors
• folk healers initiate processes of professionalization
• competition within and between sectors
• professionals attempt to discredit the practices of their competitors by discrediting the quality of their training and knowledge on which their STATUS is based
• examples: Biomedicine versus: Homeopathy, Osteopathy, chiropractic

SOCIAL AND CULTURAL DIMENSIONS: General Concepts

• Sociologist Paul Starr (1982) Healing roles do not always come with high social status. healing professions gain POWER and PRESTIGE when they acquire social and cultural authority and convert that authority into economic and political control over the medical domain.
• DEFINITIONS
• AUTHORITY: the possession of some status, quality or claim that compels trust or obedience-may be grounded in the threat of physical coercion (violence or imprisonment), persuasion (indoctrination), or on willing consent
• when subordinates must depend on those that have authority over them (depend on the doctor for the treatment)
• the superior role must be culturally legitimated by shared values and interpretation of reality. (the body, the meaning of illness, etc.)
• SOCIAL AUTHORITY: the control of action through the giving of commands (resides in people)
• CULTURAL AUTHORITY:the construction of reality through definitions of fact and value, can reside in people, products (religious texts, standards, scientific works, folk wisdom)
• these two kinds of authority are not always combined. They may act without accompanying each other.

THERAPY OUTCOMES AND HEALER AUTHORITY

• The ability to CURE is the greatest source of authority of both kinds: anything that appears to his/her clients to be a cure
• But it is difficult to assess therapeutic results as a researcher because:
• many illness heal themselves, but curer may be credited with the healing
• patients do not necessarily apply the same criteria as healers or investogators when assassing the results of their therapy
• an individual case of sickness may have social significance that a successful cure would have to address in addition to the physical symptoms
• chronic conditions may have no clear point at which a therapy may be said to have ended and its results achieved. 

• when the results are ambiguous or negative, the healers authority can suffer.:

 When European colonists brought a plethora of new diseases to the new world, the resulting sickness and death was staggering. Shamans and other healers were useless in the face of these new diseases, and the quickly lost credibility in their communities. This represented a significant loss of social and cultural authority.This undermined the religious beliefs and entire social fabric on which their cultural authority rested.

AUTHORITY & FOLK HEALERS

• Folk healers operate in legal and social marginality=SOCIAL AUTHORITY
• strategies
• maintain a very low profile to avoid the notice of local officials
• some bank on the support of well-known clients who have power

• Cultural authority rests on:
• the capacity of the healing tradition to adapt to changing social circumstances
• generally have relatively HIGH CULTURAL AUTHORITY and low social authority in plural medical societies

AUTHORITY OF BIOMEDICINE

• what sets biomedicine apart, so that it has gained widespread authority, transcending cultural boundaries?
•  19th century=weak
• 20th century=solidified authority by:
• standardizing medical education
• improving the structure and function of hospitals
• lobbying for legislation against the healing practices of its competitors
• essentially creating a new SOCIAL AUTHORITY and a resulting ECONOMIC MONOPOLY for the profession

• developed a close relationship with COLONIAL ADMINISTRATIONS and therefore DEVELOPMENT and the GLOBAL SPREAD OF CAPITALISM.
• this has created a linkage between biomedicine and Western political-economic goals-domestically and internationally

• OUTCOMES OF BIOMEDICINE
• improved therapeutic outcomes resulting from scientific and technological developments, aimed at understanding disease and human physiology=RECIEVED THE CREDIT
•  notable: bacterial infection and the development of antibiotics
• improved surgical techniques
• "miracles of modern medicine", "medicine will find a cure"
• BUT how many of these statistics are linked to improvements in the standards of living, construction of a public health infrastructure?

• Cultural Authority & Biomedicine
• "PROGRESS" -biomedicine is bundles with international development and Western science and technology
• "MODERNIZATION"

CHALLENGES TO BIOMEDICAL AUTHORITY

• "crisis in American Medicine"
• COST prohibitive/access unequal
• have fought attemps at universal coverage at every turn since the 1920s
• seen as a challenge to the autonomy of the individual dr
• source of unequal or lack of access for many
• questionable ethics
• feminist critique: medical control of women and their reproduction
• lack of research for women and minorities
• impersonal treatment of patients
• increasingly devoted to technology & specialization of experts rather than patients
• unjustified claims
• IATROGENIC DISEASES:those caused by the process of treatment
• Longer lifespan due to changes in the standards of living, not Western medicine
• decline of crowd diseases occurred well before the development of vaccines and antibiotic treatments due to improved sanitary conditions and practices and better nutrition
• BAD DRUGS: Thalidimide, chemotherapy, interactive drugs, psychactive drugs overprescribed. antibiotics overused

IMPACT OF CRITIQUE

• Loss of Cultural Authority
• malpractice lawsuits
• resurgence of "Alternative healing"
• distrust of doctors