In a discussion of culture and health schemas, Landrine and Klonoff (1992) provide a review of how culture influences health-related schemas. While much of Landrine and Klonoff's review is centered around the influence of culture on health, illness, and disease, the literature can be extended to disability and chronic illness.
In this review, Landrine and Klonoff analyze how culture influences health and illness schemas of ethnic and cultural groups in the United States and other countries and how the schemas of non-Whites differ from those of White Americans. A schema is an organized collection of beliefs or information about someone or something (Fisk & Taylor, 1991). An illness schema is an organized collection of beliefs about illness, whereas a disability schema would include organized beliefs and ways of thinking about disability or a particular type of disability. Schemas develop within and are a product of one's culture and socioenvironmen-tal context.
According to Landrine and Klonoff, White Americans espouse a Western cultural view of health and illness. This view tends to focus on illness as person centered, and as an interpersonal condition caused by microlevel, natural, and etiological agents such as genes, viruses, bacteria, and stress. Illness or disease is seen as discrete and/or episodic. The implication of this is that treatment will be time limited. Furthermore, illness is conceptualized and treated without reference to God, community, nature, or the family. Landrine and Klonoff note that this view results in medical care that is discrete, segmented, and episodic in nature. This view also assumes that only experts are trained in the diagnosis and treatment of the disease.
In contrast to the more person-centered approach of Western culture regarding illness and disability, Landrine and Klonoff note that many non-Western groups, including some ethnic minority groups in the United States, view illness as long-term, fluid, and continuous manifestation of long-term and dynamic relationships within the family, community, or nature. The schemas of these individuals include macro-level, interpersonal, and supernatural causes as explanations for illness or disease. One implication of the belief that an illness does not originate within the person is that the individual may not comply with Western treatment or recommendations.
According to Landrine and Klonoff, cultures that support the non-Western worldview of health and illness provide several alternative explanations for the causes of illness. These explanations assume that illnesses are caused by (a) violations of interpersonal norms; (b) deviations from social roles and norms; (c) certain emotions such as jealousy and envy that may provoke disease; (d) violations of religious and moral norms; and (e) certain agents found in nature such as weather conditions and hot or cold foods.
In a review of explanations for illness, Murdock (1989) (cited in Lan-drine & Klonoff, 1992) found that theories about the causes of illness can be categorized into two major types: theories of natural causation and theories of supernatural causation. Theories of natural causation include viruses, infection, aging, accidents, homicides, and stress as the causes of illness. Theories of supernatural causation include causes such as mystical retribution (punishment by the gods for violating rules), animistic causation (soul loss or spirit aggression for violating rules), and magical causation (witchcraft, ''evil eye''). In an examination of 189 different cultures, Murdock found that the beliefs of only four cultures included natural explanation for illness.
Some ethnic minority and cultural groups in the United States may also hold supernatural beliefs about the causes of illness. The beliefs that illness and disease are supernaturally caused have been documented among African Americans in the United States. The author is reminded of conversations with African Americans who held beliefs that certain persons have the power to put a hex or a spell causing illness on them or someone else. Such supernatural beliefs about the cause of illness and disease promote supernatural explanations for the treatment of illness and disease.
For example, within the African American community, there have been healers such as root doctors who were used to cure illness and disease. Root doctors used roots and herbs in treatments of physical, mental, and social conditions. Using the previous example, when a hex or spell was cast, it could only be broken by a root doctor. In some parts of the United States, the root doctors held positions of high status and prestige in the community. While root doctors are no longer prevalent within the African American community, there are some anecdotal accounts that they still exist, especially in certain areas of the South. It is interesting that many individuals from all ethnic groups are now using herbs and roots to maintain health and treat disease.
Other healers in the African American community provided nontrad-itional health care. Bailey (1990) provided an interesting history of the early evolution of folk health practitioners in one city in the United
States. Bailey studied patterns of health care use among Detroit African Americans from 1910 to 1939 and noted that a large percentage of African Americans consulted various folk health practitioners for several reasons. These included: (a) a need to cope with health problems within their own community and social environment; (b) a belief that folk health practitioners had some control over the forces that cause problems or abnormalities in the person's life; (c) less expensive cost of treatment; and (d) a need to be involved in the family's care, nurturing, and healing process. Bailey noted that folk health practitioners were adaptable and diverse in their abilities and specialized skills.
While faith healers are not unique to the African-American community, they have prospered here with their therapy of laying on of hands. These faith or spiritual healers, also known as spiritualists and Divine Healers, have played a prominent role within the treatment of African Americans with health and medical concerns. These healers, are believed to possess the power to cure disease. In an account of the prosperity of divine healers, Washington noted, ''One of these healers started in business only a month ago, charging 50 cents a treatment. He has built up such a following that he is now charging from $2.00 to $25.00, according to the amount he thinks a patient will be able to pay. His office is always full of sick Blacks who get up early in the morning to be the first in line when his place of business opens'' (Washington, cited in Bailey).
Within the African American community, the nonmedical healers fulfilled practical, as well as spiritual, functions. Given poor socioeconomic conditions and a history of racism, the health care system has not been accessible to all African Americans. The root doctor and other healers offered hope and faith that one would get better. These nontraditional healers lived within the community and were accessible and relatively inexpensive. Furthermore, the family was often acknowledged and/or involved in the treatment regimen. While faith healers and divine healers are not prevalent within the African American community today, there are still remnants of methods used by these individuals. This is evidenced by present-day testimonials, witnessing, and other expressions of spirituality and faith as a prerequisite to healing.
There is historical as well as theoretical support for the role of faith and spirituality in treatment. The power of faith and meditation has been documented since antiquity. If one has strong beliefs that one will recover and/or improve, this enhances the likelihood of improvement. This is akin to self-efficacy beliefs, which are discussed in chapter 8. The individual is more likely to have thoughts of and engage in behaviors to facilitate recovery and optimal functioning. The other beneficial aspect of faith is that it provides an adaptive coping strategy, so that a person is better able to deal with and accept the challenge and/or limitations of his/her health status, disability, or impairment.
Among African Americans, supernatural explanations may be given for the causes of disabling conditions. Toliver-Weddington (1990) writes that some African Americans show the same patterns of etiology of disabling conditions as can be found in Africa. For example, Nigerian mothers assumed that cleft palate was caused by evil spirits, that the spirits were angered by the mothers staying in the sun too long, or that the spirits for some were sent by others (Nwanze & Sowemino, 1987, cited in Toliver-Weddington, 1990). Nwanze & Sowemino noted that these beliefs are similar to those of some African Americans, who believed that a cleft lip can be caused when a pregnant woman is frightened by a rabbit, if she makes a mockery of someone with a similar problem, or is being punished for vanity.
In summary, the literature suggests that views of illness and disease are influenced by culture. Western conceptualizations of the etiology focus on disease and illness as person centered as opposed to non-Western cultures, in which views of illness and disease may be seen as caused by forces outside the individual. Some of the beliefs in more supernatural explanations for the cause of illness and disease are held among African Americans today, although to a lesser degree. These beliefs may be mediated by socioeconomic status and other demographic factors such as the region of the country where a person resides and age.
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