Week 14 · Chapter

Chapter 14 — Health, Illness, and Healing

Cultural Anthropology Free sample edition

The module's primary reading · ~30–40 minutes · Objective 8 (interpret religion, ritual, and healing: apply the three phases of a rite of passage, liminality, and communitas, explain magic, witchcraft, and revitalization movements as anthropologists have analyzed them, and distinguish disease from illness using explanatory models and the idea of structural violence), Objective 2 (describe and practice ethnographic methods: participant observation, two-column field notes that keep observation apart from interpretation, interviews, the genealogical method, emic and etic perspectives, thick description, and reflexivity, following the discipline's ethics of doing no harm and obtaining informed consent) · Read it first this week; the lecture, the slides, the tutorial, and the quiz all build on it.

In plain language

Being sick is something that happens to a body, and it is also something a person lives through and tries to explain. This week you will learn to tell disease (what goes wrong in the body, as a doctor defines it) from illness (what being unwell is like and what it means to the person and the people around them). You will learn to ask about an explanatory model (a person's own account of what caused a problem and what should be done about it). You will see how people mix more than one way of healing, and how structural violence (harm built into the way a society is arranged) shapes who gets sick or hurt. Last, you will read one vendor's back strain at the running market through every one of these tools.

Why you already care about this

Picture an illustrative student on the night before a big exam. Around 9 p.m., a migraine starts: a pounding headache, bright lights that hurt, and a wave of nausea. A clinic note the next morning could sum it up in one line. But that one line leaves out almost everything the student lived through.

The student lost a study night and lay in a dark room with a cold cloth. A roommate said it was stress and too much coffee. A parent on the phone said it runs in the family. The student wondered whether to ask the instructor for more time, and whether anyone would believe how bad it was. None of that appears in the clinic note, yet all of it is part of being sick.

You have lived some version of this. Maybe it was a cold that kept you home, a sports injury that changed your season, or a relative's long illness that changed a whole household. Each time, the body was only part of the story. The rest was meaning, explanation, and the people and places that shaped what happened next.

By the end of this chapter you will be able to:

tell disease from illness, using Kleinman's distinction, and find each one in a real account;
ask the five explanatory-model questions as open questions and read an account with them;
explain ethnomedicine and medical pluralism, and read biomedicine as one healing system among many;
describe a cultural concept of distress in words, without offering any diagnosis;
explain structural violence, credit the term to Galtung, and describe the social distribution of illness in words;
read the running market's vendor and the vendor's back strain through every tool of the week.

Carry this sentence with you: the body has a disease; the person lives an illness.

Where we are

Already covered: Week 3 taught the open-ended interview, the emic and etic pair, and fieldwork ethics, and it met the vendor's interview excerpt. Week 4 heard the four emic terms in that excerpt. Week 13 read witchcraft as an explanation of misfortune and named the diviner, who seeks the cause of a misfortune.
This week: disease and illness; explanatory models; ethnomedicine, biomedicine, and medical pluralism; cultural concepts of distress; structural violence and the social distribution of illness; and the vendor's back strain read through all of them.
How they connect: Week 13 asked why misfortune strikes particular people at a particular moment, and this week asks the same kind of question about sickness. Week 3's interview tools are how an anthropologist hears a person's own account of being unwell.
Where we're going next: Week 15, Globalization, Colonialism, and Applied Anthropology, and the Course Synthesis, ties every site to a wider world and revisits the running market through every week's lens.

Three earlier ideas carry this week. From Week 3, an emic account uses the insider's own categories and meanings, and an etic account uses the outside analyst's categories. Also from Week 3, an open-ended interview lets a person answer in their own words rather than choosing from fixed options. From Week 13, Azande witchcraft, as Evans-Pritchard described it from the late 1920s, answered "why them, why now" alongside knowledge of natural causes. This week you will hear that same kind of "why" question in accounts of being unwell.

1. Tell disease from illness

Go back to the student with the migraine. A clinic note and the student's own story describe the same night, but they describe different things. The note describes what went wrong in the body. The story describes what it was like, what it cost, and what it meant.

One anthropologist gave those two sides names. Kleinman (1980), Patients and Healers in the Context of Culture, developed the distinction between disease and illness.

Disease is a biological malfunction of the body as a biomedical practitioner defines it, such as a strained muscle or an infection; Kleinman set it apart from illness.
Illness is the person's and community's experience and meaning of being unwell, including how it feels, what it disrupts, and what people say about it; Kleinman set it apart from disease.

The two usually travel together, but they can come apart. A person can have a disease that has not yet caused any illness, such as high blood pressure that no one has noticed. A person can also live through real illness while a doctor's tests find no disease. Neither side is the "real" one. They answer different questions.

Worked example — the migraine night, read twice (illustrative). The student is constructed for this chapter. Sort what was observed into the two sides.

What was observed. A headache that started around 9 p.m., light that hurt, nausea, a lost study night, a roommate's and a parent's explanations, and a worry about being believed.
The disease side. The pounding headache, the sensitivity to light, and the nausea are what a clinician would record and try to treat.
The illness side. The lost study night, the dark room, the roommate's "stress", the parent's "runs in the family", and the worry about being believed are what the night meant to the student and the people around the student.
What a comparison adds. Two students could have the same disease side and very different illness sides, depending on their exams, their families, and who believes them.

In words: the migraine is one disease, recorded in the body, and one illness, lived as a lost night and explained in more than one way by the people around the student.

Pause and think. Choose one option and answer it in two or three sentences:

(a) Think of a time you were sick or hurt. Name one thing that belonged to the disease side and one that belonged to the illness side.
(b) Why might a doctor and the person who is sick both be right, even when they describe the same problem in very different words?

Misconception check. Students often use disease and illness as synonyms, as if both words named the same thing. That is tempting, because everyday English swaps them freely. But in anthropology, disease is the body's malfunction as biomedicine defines it, while illness is the experience and meaning of being unwell. The cure: for any account of sickness, ask "is this about the body, or about what it is like and what it means?"

2. Ask the five questions: explanatory models

Think about how you explain your own aches. A stiff neck might be "sleeping wrong", "too much phone time", or "stress from finals". Each explanation names a cause, and each one suggests what to do next. You are carrying a small theory of your own body around with you.

Kleinman gave that theory a name in the same 1980 work.

An explanatory model is a person's account of an illness: what caused it, why it started when it did, what it does to the body, how serious it is, and what treatment it needs, drawn out by asking those questions openly rather than as a checklist with one right reply.

Here are the five questions, in plain words:

What caused it?
Why did it start when it did?
What does it do to your body?
How serious is it?
What treatment should it have?

The five questions are a classroom model. They organize listening; they do not settle a real case on their own, and a real conversation rarely follows them in order. They are asked as open questions. There is no single correct reply to mark.

This is where Week 3's method returns. An open-ended interview asks the five questions and lets a person answer in their own words. The person's words are an emic account, in the insider's own terms. "Explanatory model" is the analyst's etic term for what those words add up to. Neither is right and the other wrong; they are two ways of describing the same account.

Worked example — the vendor's back strain as two explanatory models (Dataset F, illustrative). The course's interview excerpt (Dataset F, illustrative, constructed for this course) comes from an unnamed vendor who has sold at the running market for years. In it, I is the interviewer and V is the vendor. Here are the last question and its reply:

I: Has the work changed for you over the years?
V: My back's not what it was. Twenty years of crates. My wife says it's the cold mornings, my doctor says it's the lifting.

Read it step by step.

The excerpt. The illustrative vendor has sold at the market for 20 years, and the interviewer asks 5 questions; the first 4 replies carry the 4 emic terms ("regulars", "seconds", "the swap", "the bell"), and the 5th reply carries the back strain, so 4 + 1 = 5 replies.
The back strain. The vendor says, "My back's not what it was. Twenty years of crates." That is the illness side: the vendor's own experience and meaning of being unwell.
Two explanatory models of 1 back strain. The vendor's wife says it is the cold mornings, and the vendor's doctor says it is the lifting, so there are 2 accounts of the cause of 1 condition.
The disease side. The doctor's account names a bodily cause, the lifting, which is how a biomedical practitioner frames the problem.
The five explanatory-model questions. Cause, timing, what it does to the body, how serious it is, and what treatment it needs make 5 questions; the excerpt touches only the cause question, so 5 − 1 = 4 questions stay open for a follow-up interview.

In words: the vendor's reply holds one illness and two explanatory models of its cause, and four of the five questions are still waiting to be asked.

Notice what the course does not do here. It does not decide whether the wife or the doctor is right. Both accounts are data about how people explain a back strain. A follow-up interview, with the vendor's consent, would ask the open questions the excerpt leaves untouched.

Pause and think. Choose one option and answer it in two or three sentences:

(a) Pick a minor ache or illness you have had. Answer two of the five questions about it in your own words, and notice which question was hardest to answer.
(b) Why might an interviewer learn more by asking "what do you think caused it?" than by asking "was it the lifting?"

Misconception check. Students often read an explanatory model as a quiz with one right reply, so they treat the doctor's model as the true one and the wife's as a mistake. That is tempting, because biomedicine carries a lot of authority. But the explanatory-model questions are asked openly, to learn how a person makes sense of an illness, not to grade them. The cure: record every account a person reports, and ask what each one leads people to do.

3. Map the healing systems: ethnomedicine and medical pluralism

Picture an illustrative family when the youngest child catches a cold. One parent makes a pot of soup with extra garlic. A grandparent insists on a scarf and an early bedtime. The other parent buys cold medicine at the pharmacy, and if the fever lasts more than a few days, the family will book a clinic visit. Nobody in the house sees a contradiction in any of this.

Anthropologists have names for what that household is doing.

Ethnomedicine is a culture's own system of health and healing, including its ideas about what makes people sick and the remedies and healers it relies on.
Medical pluralism is the use of more than one system of health and healing at once, such as a visit to a clinic alongside a family remedy.

There is one more system in that kitchen, and it is easy to overlook because it feels like the default.

Biomedicine is the system of medicine based on biology and laboratory science that is taught in medical schools and practiced in clinics and hospitals; anthropologists treat it as one healing system among many.

Calling biomedicine "one system among many" does not mean every remedy works equally well. That is a question for medical research, and this course makes no claim about whether any remedy cures anything. The anthropological question is different: what does each way of healing mean to the people who use it, and how do they combine them?

Worked example — the market's two kinds of care (Dataset A, illustrative). The running fieldwork site is an illustrative, unnamed weekly neighborhood farmers' market of 24 stalls (Dataset A, illustrative, constructed for this course).

What was observed. The market office keeps a first-aid kit, and one vendor brings ginger tea for anyone with a cold.
What it might mean to the people involved. The kit is there for cuts, scrapes, and emergencies; the tea is a vendor's way of looking after the people around the stall.
What the concept calls it. Medical pluralism: the market office keeps a first-aid kit, and one vendor brings ginger tea for anyone with a cold, so 1 market of 24 stalls holds 2 kinds of care at once.
What a comparison adds. The family's soup, scarf, pharmacy medicine, and clinic visit show the same pattern in a home.

In words: the first-aid kit and the ginger tea are medical pluralism, two kinds of care side by side in one place, used by the same people without any sense of conflict.

Pause and think. Choose one option and answer it in two or three sentences:

(a) List the ways your own family or friends deal with a cold. How many different kinds of care are on your list?
(b) Why might people keep a family remedy even when they also trust a clinic?

Misconception check. Students often read ethnomedicine as "superstition" set against biomedicine, as if other people had beliefs and clinics had facts. That is tempting, because biomedicine is familiar and its tools are powerful. But biomedicine is itself one healing system, with its own training, terms, and settings, and most people mix systems. The cure: describe each system in the terms of the people who use it before judging it, which is cultural relativism used as a method.

4. Describe shared ways of suffering: cultural concepts of distress

Picture an illustrative dorm floor during exam weeks. Students say they feel "fried". The whole floor knows what the word means: too little sleep, too much screen time, a short temper, and a head that will not hold one more fact. They know what brings it on and what helps: a walk, a meal with friends, a night off. A newcomer from another campus might use a different word, or none at all.

That shared word is a small example of something anthropologists study across many communities.

Cultural concepts of distress are ways of experiencing and talking about suffering that are shared within a cultural group; anthropologists describe them in words and do not use them to diagnose anyone.

Anthropologists have documented many such shared ways of naming suffering in communities around the world. This course names none of them here, describes the idea in words, and offers no diagnosis. A concept of distress belongs to the people who use it, and the respectful first move is to learn what it means to them.

Worked example — reading "fried" in four moves (illustrative). The dorm floor is constructed for this chapter.

What was observed. Students on one floor use the word "fried" during exam weeks, and they agree on what it feels like, what causes it, and what helps.
What it might mean to the people involved. Saying "I'm fried" asks for understanding and a break without making a fuss; it tells others how to respond.
What the concept calls it. A cultural concept of distress: a way of experiencing and talking about suffering that the group shares.
What a comparison adds. Week 13's Azande account showed people asking "why them, why now" about misfortune. "Fried" also carries an explanation, exam weeks, and a plan for what to do.

In words: "fried" is a cultural concept of distress for the illustrative dorm floor, a shared way of naming and explaining suffering, and the anthropologist describes it without diagnosing anyone.

Pause and think. Choose one option and answer it in two or three sentences:

(a) Describe a word or phrase a group you belong to uses for feeling worn down or unwell. What does the group expect people to do when someone says it?
(b) Why might it matter that an anthropologist describes a concept of distress without turning it into a diagnosis?

Misconception check. Students often treat a group's shared way of talking about suffering as a diagnosis, or as a sign that the group does not understand "real" medicine. That is tempting, because clinics sort suffering into named conditions. But a cultural concept of distress is a shared way of experiencing and explaining suffering, and the course describes it in words and diagnoses no one. The cure: ask what the words mean and do for the people who use them.

5. Trace harm to arrangements: structural violence

Picture two illustrative warehouse workers who hurt their backs the same way on the same shift. One has a full-time job with paid sick leave and a health plan, so she sees a doctor and rests for two weeks. The other has a temporary contract with neither, so he skips the doctor and is back lifting boxes in two days. Their injuries started the same. Their outcomes did not, and no one punched anybody.

The difference comes from how the work is arranged. Anthropologists have a term for harm of that kind.

Structural violence is harm done by social arrangements, rather than by a person's blow, that put some people in the way of illness and injury; Galtung coined the term in 1969, and Farmer brought it into anthropology.

The term has a history worth getting right. Galtung (1969), "Violence, Peace, and Peace Research", Journal of Peace Research, coined it. Farmer (2004), "An Anthropology of Structural Violence", Current Anthropology, brought it into anthropology as a way to explain why illness and suffering fall unevenly. Galtung coined structural violence in 1969, and Farmer brought it into anthropology in 2004, so 2004 − 1969 = 35 years passed between the coinage and Farmer's article.

Structural violence opens onto a wider pattern.

The social distribution of illness is the uneven way illness and injury fall across a society, following people's place in its social arrangements rather than chance alone.

The course teaches the social distribution of illness in words and keys no figure for it. Any real figure about the health of a living people would need a year and an issuing body, and this week uses none.

Worked example — the two warehouse workers (illustrative). The workers are constructed for this chapter.

What was observed. Two workers, one kind of back injury, and two different paths afterward: rest and care for one, a quick return to lifting for the other.
The disease side. The injury is the same kind of strain in both bodies.
The arrangements. One job came with sick leave and a health plan, and the other came with neither. Nobody chose to hurt the second worker; the arrangement did the work.
What the concept calls it. Structural violence: harm done by social arrangements that put one worker more in the way of a longer, worse injury.

In words: the two workers share one kind of disease, but the way their jobs are arranged shapes their illness and their recovery, which is what structural violence names.

A caveat for your own reading: the warehouse is an illustrative case. It shows the shape of the idea, but a real claim about structural violence in a real place needs fieldwork and sources, not a story built for a chapter.

Pause and think. Choose one option and answer it in two or three sentences:

(a) Think of a job, school, or neighborhood you know. Name one arrangement there that could put some people more in the way of illness or injury than others.
(b) Why might "nobody meant any harm" be a weak defense when harm comes from an arrangement rather than a person?

Misconception check. Students often read structural violence as physical violence by a person, such as a fight or an assault. That is tempting, because "violence" usually means someone hurting someone. But structural violence is harm done by social arrangements, with no single person throwing a blow. A second wrong turn credits the term to Farmer as its coiner. The cure: Galtung coined it in 1969, and Farmer brought it into anthropology in 2004.

6. Read the running site: one back strain through every tool

Walk back into the running fieldwork site, the illustrative, unnamed weekly neighborhood farmers' market of 24 stalls (Dataset A, illustrative). You heard the vendor's interview in Week 3 and its emic terms in Week 4. This week you have four new tools to bring to its last reply.

Worked example — the vendor's back strain, read with every tool of the week (Datasets F and A, illustrative). You bring all four tools to the same reply, one at a time.

The excerpt. The illustrative vendor has sold at the market for 20 years, and the interviewer asks 5 questions; the first 4 replies carry the 4 emic terms ("regulars", "seconds", "the swap", "the bell"), and the 5th reply carries the back strain, so 4 + 1 = 5 replies.
Disease and illness. The doctor's account names a bodily cause, the lifting, which is the disease side. "My back's not what it was" is the illness side, the vendor's own experience.
Explanatory models. There are 2 accounts of the cause of 1 condition: the cold mornings and the lifting. The excerpt touches only the cause question, so 5 − 1 = 4 questions stay open for a follow-up interview.
Medical pluralism. The market office keeps a first-aid kit, and one vendor brings ginger tea for anyone with a cold, so 1 market of 24 stalls holds 2 kinds of care at once.
A structural-violence question. What social arrangements put a vendor in the way of 20 years of lifting crates? The excerpt does not say, so the question stays open for fieldwork, and no cause is keyed.

Here is the reading in plain words: the vendor's back strain is one condition read through 2 explanatory models, and the market's first-aid kit and ginger tea are medical pluralism, so an anthropologist asks the open questions before calling any one account the right one.

The method matters as much as the reading. Any follow-up would begin with the course's consent script, record no name or identifying detail, and stay on a non-sensitive everyday practice. A back strain from lifting crates is the vendor's to describe; the interviewer asks and listens, and never offers a diagnosis.

An honesty note on this reading: the excerpt is one short, illustrative interview with one person. The interviewer's 5 questions and the vendor's 5 replies make 5 + 5 = 10 lines, all from 1 illustrative person's interview. It shows how one vendor talks about one back strain. It cannot tell you how vendors in general explain pain, and a fieldworker would need many conversations, over many market days, before writing anything broader.

Pause and think. Choose one option and answer it in two or three sentences:

(a) Write two open follow-up questions you would ask the vendor, with consent, about the four explanatory-model questions the excerpt leaves open.
(b) Make the strongest case that the vendor's back strain is mostly a matter of the body, and then the strongest case that it is mostly a matter of social arrangements.

Misconception check. Students often treat one person's account as the story of a whole group, writing "vendors believe cold mornings cause back pain" from a single reply. That is tempting, because one vivid quotation feels like evidence. But the excerpt is one illustrative interview, and in it even one household holds two models. The cure: write "one vendor reported that a spouse and a doctor explain it differently", and say what more fieldwork would be needed.

Key terms

Disease — A biological malfunction of the body as a biomedical practitioner defines it, such as a strained muscle or an infection; Kleinman set it apart from illness. (first used: 1. Tell disease from illness)
Illness — The person's and community's experience and meaning of being unwell, including how it feels, what it disrupts, and what people say about it; Kleinman set it apart from disease. (first used: 1. Tell disease from illness)
Explanatory model — A person's account of an illness: what caused it, why it started when it did, what it does to the body, how serious it is, and what treatment it needs, drawn out by asking those questions openly rather than as a checklist with one right reply. (first used: 2. Ask the five questions: explanatory models)
Ethnomedicine — A culture's own system of health and healing, including its ideas about what makes people sick and the remedies and healers it relies on. (first used: 3. Map the healing systems: ethnomedicine and medical pluralism)
Medical pluralism — The use of more than one system of health and healing at once, such as a visit to a clinic alongside a family remedy. (first used: 3. Map the healing systems: ethnomedicine and medical pluralism)
Biomedicine — The system of medicine based on biology and laboratory science that is taught in medical schools and practiced in clinics and hospitals; anthropologists treat it as one healing system among many. (first used: 3. Map the healing systems: ethnomedicine and medical pluralism)
Cultural concepts of distress — Ways of experiencing and talking about suffering that are shared within a cultural group; anthropologists describe them in words and do not use them to diagnose anyone. (first used: 4. Describe shared ways of suffering: cultural concepts of distress)
Structural violence — Harm done by social arrangements, rather than by a person's blow, that put some people in the way of illness and injury; Galtung coined the term in 1969, and Farmer brought it into anthropology. (first used: 5. Trace harm to arrangements: structural violence)
Social distribution of illness — The uneven way illness and injury fall across a society, following people's place in its social arrangements rather than chance alone. (first used: 5. Trace harm to arrangements: structural violence)

Summary

Disease is the body's malfunction; illness is the lived experience and meaning.
Kleinman (1980) developed the distinction and the explanatory model.
An explanatory model answers five open questions, with no single right reply.
Ethnomedicine is a culture's own healing system; biomedicine is one of many.
Medical pluralism is using more than one healing system at once.
Cultural concepts of distress are described in words, never used to diagnose.
Structural violence is harm done by arrangements; Galtung coined it in 1969.
The vendor's back strain is one condition read through two explanatory models.

Check your understanding

Work these before looking at the answers — they are ungraded, and the answers (with reasoning) are at the bottom of the page.

An illustrative walk-in clinic's intake form asks how long a problem has lasted, how bad it feels, and what the person has tried for it. How many of the five explanatory-model questions does the form cover, and which ones does it leave out?
An illustrative choir member with a sore throat sees a doctor, gargles warm salt water the way her grandmother taught her, and rests her voice because the choir director says to. What concept does this show, and how many kinds of care is she using?
A classmate writes, "Farmer coined the term structural violence in 2004." Name the wrong turn and rewrite the sentence so it is accurate.
An illustrative hiker sprains an ankle two days before a long-planned trip. The doctor writes "ligament sprain". The hiker says, "I lost the trip, and I can't work my shifts at the coffee shop." Which statement belongs to the disease side, and which to the illness side?

Answers (worked reasoning — read after attempting)

The form covers 3 of the 5 questions: how long it has lasted is a timing question, how bad it feels is a seriousness question, and what the person has tried is a treatment question. So 5 − 3 = 2 questions are left out: what caused it, and what it does to the body. An interviewer would ask those two openly.
It shows medical pluralism, the use of more than one system of health and healing at once. She uses 3 kinds of care: the doctor's visit, her grandmother's salt-water gargle, and the choir director's advice to rest her voice.
The sentence credits the term to Farmer as its coiner. An accurate version: "Galtung coined the term structural violence in 1969, and Farmer brought it into anthropology in 2004."
"Ligament sprain" is the disease side: the body's malfunction as a biomedical practitioner records it. "I lost the trip, and I can't work my shifts" is the illness side: what the sprain means and disrupts in the hiker's life.

Next up in this module: the Readings & Resources page, the lecture tutorial, the practice set, and the quiz — and next week, Globalization, Colonialism, and Applied Anthropology, and the Course Synthesis, reads every week's model at the running market one last time.

Built with The Course Maker · samples.thecoursemaker.com