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The subject of medical anthropology recognizes a significant value in the interaction between health care provider and the patient. Therapy cannot be considered as an impersonal process, following some universal patterns of treatment. Ember and Ember (2004) consider the following:
All health care systems are based upon a dyadic core consisting of a healer and a patient in interaction. The healer role may be occupied by a generalist, such as the shaman in preindustrial societies or the proverbial family physician in modern societies. (p. 29)
Following this experts’ opinion, the term “healer” will be used for the purposes of this paper to identify any health care specialist involved in a patients treatment throughout diverse cultures and communities.
Complex cultural and social circumstances determine the relationships between the healer and the patient as they “enter into focused social interactions organized around their own explanations for why a particular health problem occurred when it did, its pathophysiology, the course it is likely to run, and the steps necessary to resolve the problem” (Suls & Davidson, 2011, p. 285). The quality of these interactions is essential for the treatment success, on top of the main therapy. Thorough researches in medical anthropology by Singer and Baer (2007) indicate that “illness and disease involve complex biosocial process and that resolving them requires attention to a range of factors beyond biology, including systems of belief, structures of social relationship, and environmental conditions” (p. 10). There are numerous components contributing to the healer/patient relationships. Far from being fully understood, the concept of belief seems to play a major role in the treatment process.
According to Benedetti (2010), “when the patient meets the doctor, and more in general, the healer, this interaction triggers some complex brain processes that have to do with trust and hope” (p. 47). There is no telling as to how exactly these brain processes influence the success, or failure of the treatment; however, the existence of a firm connection between the patient’s beliefs, healer’s aptitude to use or modify such beliefs, and the sickness’s outcome has never been questioned. It is a mechanism that works regardless of a scientific understanding: “Call it placebo if you like, but the human touch has a real and measurable effect” (Edberg & Edberg, 2012, p. 78). The placebo context seems to be the closest to the explanation of a mechanism involved in the effective healer/patient interaction. Benedetti (2010) points out that “The clinical improvement of [ ] patients who receive a placebo is very complex and is attributable to plenty of factors, all of them embedded in the patient-healer relationship” (p. 45).
Medical anthropologists attribute exceptional value to the concept of belief, involved in a course of therapy. However, the use of the belief term is often ambiguous, as the meaning behind it can be diverse. According to Good, Fischer, Willen and Good (2010), “The term belief, though present throughout anthropological writing, appears with quite varied frequency and analytic meaning” (p. 73). Therefore, this paper will address different shades of the belief in the healer/patient interactions. The semantics behind the term will be related to spiritual and cultural beliefs, social beliefs of individual communities and trust issues between patient and health care system in general, and healer in particular.
Gochman (1997) argues that the healer/patient relationships are based on the “cultural context  in terms of their respective patterns of belief, values, roles, and relationship prescriptions” (p. 196). Over centuries, different cultures have developed firm health beliefs and traditions that ultimately dictate the respective course of treatment in every particular case. The healer is expected to comply with patients expectations, sharing (or appearing to share) his cultural notions and beliefs. It is an essential part of controversial “native” medication methods, still used in many societies. Exotic treatment techniques “derived legitimacy not from scientific evidence but from the cultural values of a particular class of citizens at a particular period in history. Much of its success depended upon the consensus of belief between doctor and patient” (Frank & Frank, 1993, p. 277).
Consequently, therapists face a major challenge when treating patients who belong to the different culture. According to Rush (1996), “With respect to cross-cultural counselling/therapy, [ ] the anthropologist [ ]can diagnose both the social and the physical manifestation of illness, which, then, can be correlated to indigenous belief systems regarding cause and effect” (p. 204). Despite the wide propagation of modern clinical methods, cultural traditions in connection with health belief system often limit the treatment’s success.
According to Moore and McClean (2010), community represents the authority which requires and sanctions the cure, while the healer’s success is determined by the “beliefs and practices traditionally understood in these communities, and because people want and expect healers to cure them” (p. 125). Christian communities approve the methods in which a “Holy Spirit” plays a major role (Johannessen, 2006, p. 58). The success of shamanic healers “depends, in part, on the degree to which the healing practices are supported by community belief and, in many cases, participation” (Edberg & Edberg, 2012, p. 74). Consequently, the anthropologist works at the “intersection of knowledge and belief regarding health and illness in different segments of [ ] society” (Suls & Davidson, 2011, p. 285). Therefore, the treatment is limited by diverse belief systems that frame the process of the healer/patient interaction within boundaries of social constraints and cultural acceptance (Johannessen, 2006, p. 39).
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Benedetti (2010) attributes a key role in the treatment’s success to the patient’s personal expectations. Whenever sick approaches a healer, “be he a shaman or a modern doctor, this is because of his personal beliefs about the healer’s therapeutic capabilities” (p. 258). Correspondingly, anthropologists encourage the recognition of patients beliefs by “the development of appropriate communication skills, social relationships, and negotiation approaches to engage patients in their treatment” (Winkelman, 2008). The healer is expected to comply with the patient’s belief system, intervening in a cognitive and behavioural manner that would not appear alien to the patient (Koenig, 1998, p. 328).
Religious beliefs can be a powerful tool and an obstacle through the course of therapy. The reasons behind the religious behaviour are extremely diverse:
Whether individuals enjoy greater well-being because of their belief in the efficacy of prayer, the comfort of ritual, the opportunity to socialize with friends, the strength of a philosophical system of beliefs, or the sense of being a part of something greater than oneself, religious belief and practice doubtless provide vast levels of comfort to millions throughout the world. (Koenig, 1998, p. 147)
The religious beliefs, including the associated curing practices, comprise both the myth and action in accordance with that myth. As Littlewood and Dein (2000) describe the methodology of shamanistic cure, “the healer supplies the myth and the patient performs the action” (p. 174).
There is a major risk, associated with mistaking the belief for delusion when treating the overly religious patients (Littlewood & Dein, 2000, p. 273). Kleinman (1981) reports two cases of religious patients who definitely have not suffered from schizophrenia, but have developed extremely strange symptoms. Kleinman stated the following:
In both these cases belief and perception so intermingled that the patients reported distorted (delusional) perceptions: in one instance, pain in a specific location in the brain associated with a conception that brain nerves were dying in that spot; in the other, a sensation that the right half of the brain was unable to function and that cognitive operations, therefore, had to be carried out in the left half of the brain. From a neurological standpoint, these perceptions were absurd [ ] but firmly believed in by the patients even in the face of evidence to the contrary. (, 1981, p. 162)
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Patient’s beliefs and practices determine the way and the level in which anthropologists should filter the information, distorted by sometimes highly exotic health belief systems (Geest & Rienks, 1998, p. 141). The opposite is also true: patients are generally selective about their healers. According to Frank and Frank (1993), given the choice of therapists, patient will prefer the healer who shares his views: “belief about the cause of a particular problem [ ] determines who will conduct the treatment” (Frank & Frank, 1993, p. 17). However, even the most firm personal beliefs of the patient do not pose difficulties to the experienced anthropologist. According to Littlewood (2007), “People generally hold not well-systematized belief systems but bits of information that may often be conflicting” (p. 44). The therapist can use this confusion to his advantage, adjusting the patient’s attitude toward the particular therapy needs.
Trust in the healer/patient relationship
In order for the therapy to succeed, a bond of trust must be created between the patient and the healer. According to Budd and Sharma (1994) “The healing bond rests on the assumption that the healer has something to offer which can make a difference” (p. 17). Sometimes, this assumption can be completely wrong, as Benedetti (2010) puts it:
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What the sick does first is to rely on the healer who, he believes, is capable of suppressing the pathological process. It is important to realize that [ ] the ability, competence, and skills of the healer do not matter. (p. 102)
However, in majority of cases the competence is assured, which helps creating an atmosphere of trust between the powerful healer and the child-like patient (Budd & Sharma, 1994, p.223). Complex psychological mechanisms facilitate the process of curing by applying the trust to the patient/healer relationship, as Edberg and Edberg (2012) cite: “The behavioural and psychological features of this relationship – such elements as authority, trust, shared beliefs, teaching, nurturance, and kindness – significantly, and sometimes dramatically, affect the course of illness, promoting healing, and preventing recurrence” (p. 78).
Patient’s trust vs. healthcare system
Budd and Sharma (1994) acknowledge the value of healthcare system from the patient’s standpoint: “The difference between healing services which are bought and sold in the market-place and those which are supplied through a state bureaucracy [ ] has a powerfully determining effect on the patient-healer relationship” (p. 4). The individual patient perspective in this regard can vary depending on the previous experience or prejudice. Privately funded healthcare sometimes encourage patients to think that “they are back in the realm of traditional ethics, where exchange is negotiated as part of mutual trust within a network of obligations” (Good et. al, 2010, p. 316). Contrastingly, many patients still put their faith in a state-owned healthcare system. The choice is generally influenced by the number of considerations, such as “privatization and growing costs, greater patient responsibility and activism, and the erosion of public and community health services” (Inhorn & Wentzell, 2012, p. 87). The last does not stimulate patients’ trust, limiting their chances for the professional healthcare. As Baer (2003) cite, “the problem of alienated patient cannot be overcome until medical knowledge becomes social property in practice” (p. 361).
Hierarchy in patient/healer relationships
Despite the mutually accepted health beliefs, the therapist must not appear to be equal to the patient in dealing with the disease: “The relationship between a health care provider and a patient [ ] is necessarily hierarchical [ ] patients rely on the knowledge of their providers to heal them” (Singer & Erickson, 2011, p. 452). Similar point of view is presented by James and Mills (2006):
Medical authority is primarily constructed within the embodied disciplines of the patient-healer relationship, in which a particular medical practitioner not only asserts the truth of a particular medical ideology , but asserts the reality of that truth within the particular case at hand” (p.350).
Traditionally present social hierarchy helps formatting the doctor-patient intercommunion, as they “frequently reinforce hierarchical structures in the larger society by stressing the need for the patient to comply with a social superior’s or expert’s judgment” (Baer, Singer, & Susser, 2003, p. 15).
It is apparent from the discussion above that the concept of belief is crucial in the healer/patient interactions. Patients as individual agents are free in choosing “the system they favour based on their own explanations of illness” (Pool & Geissler, 2005, p. 90). Once the healer is chosen, the healer/patient relationships determine the treatment’s success. As Winkelman (2008) puts it very neatly, “the healing occurs through meaning derived from internal logic of the relationships in a total”. Apart from the drugs, personal values are very important during the course of treatment. Hahn and Gaines (1984) conclude that “the key conception of person [ ] lies behind and organizes patients’, and healers’ thinking about sickness” (p. 230). Finally, doctor’s role is crucial according to Geest and Rienks (1998), “partly because they are expected to play it when the patient demands it, and partly because the physician’s faith in science is still on shaky grounds. It has only been 150 years since he came out of his shamanistic roots” (p. 384).
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