Patients’ health beliefs can have a profound impact on clinical care. They can impede preventive efforts, delay or complicate medical care and result in the use of folk remedies that can be beneficial or toxic. Culturally-based attitudes about seeking treatment and trusting traditional medicines and folk remedies are rooted in core belief systems about illness causation, i.e., naturalistic, Ayurvedic, biomedical, etc. The range of understandings people have around what causes of illness is considerable – from witchcraft and soul loss to germs and weak immunity. In the Western world, the body is often thought of as an intricate machine which must be kept “tuned-up,” and illness is viewed as a breakdown of the machine. This contrasts with eastern philosophies in which health is seen as a state of balance between the physical, social, and super-natural environment.

Let’s take a closer look at a few dominant theories of illness causation that inform people’s attitudes toward seeking treatment in cultures around the world. These fundamental theories are likely to have a strong influence on the health behaviors of many patients/families served by CCHAP practices.

Personalistic

In a personalistic system of belief, illness is believed to be caused by the intervention of a supernatural being or a human being with special powers. A supernatural being might be a deity or a dead ancestor. A human being with special powers might be a witch or a sorcerer. Evil forces cause illness in retaliation for moral and spiritual failings. If someone has violated a social norm or breached a religious taboo, he or she may invoke the wrath of a deity and their sickness is explained as a form of divine punishment. Similarly, illness is seen in many cultures as punishment for failing to carry out the proper rituals of respect for a dead ancestor. Evil spirits possess the living to revenge the dead. Finally, illness in many cultures is accepted as simply bad karma or bad luck. Recovery from an illness arising from personalistic causes usually involves the use of ritual and symbolism, most often by practitioners who are specially trained in these arts. Many people in Asian and Latin American countries adhere to a personalistic beliefs system, as do many Native Americans.

Naturalistic

In the naturalistic system of belief, a person’s health is closely tied with the natural environment. A proper balance must be maintained and harmony protected. When balance is disturbed, illness results. Three of the widely-practiced naturalistic approaches to health are humoral, Ayurvedic, and vitalistic.

Humoral is a naturalistic approach with roots over two thousand years old. The humoral approach is widespread in Asia and Latin America, though it takes somewhat different forms on different continents. Maintaining humoral balance involves attention to appropriate diet and activity, including regulating one’s diet according to the seasons. Illnesses may be categorized into those due to hot and cold imbalances in the body. If a patient suffers from too much hot, the treatment would involve measures such as giving cooling foods and liquids and applying cool compresses.

Ayurveda is an ancient naturalistic approach to health in India. Therapy in Ayurveda includes a vast array of preparations made from herbs and minerals, and dietary advice also forms part of every prescription. It is believed that building a healthy metabolic system, attaining good digestion and proper excretion leads to vitality. Ayurveda also focuses on exercise, yoga, meditation, and massage. Ayurveda is actively practiced in India today and has shaped the way Indians think about their bodies in health and in illness. The practice is closely connected to religion and mythology. Ayurveda has gained recognition in the Western world and medical scholars have researched and outlined its various postulates. In the United States, the National Institute of Health expends some of its $123 million budget on Ayurvedic medicine research.

Vitalism is based on a core belief that disease is the result of some imbalance in the vital energies which distinguish living from non-living matter. In the formative days of the Western medical tradition founded by Hippocrates, these vital forces were associated with the four temperaments and humours. In Eastern traditions, related terms are qi and prana. Today, vitalistic approaches to health are widespread in Asia. The ancient art of acupuncture in China is an example of this system which focuses on the flow of vital forces or energy within the body. If energy within a person’s body is flowing harmoniously, their health is deemed good. Illness results when this smooth flow of energy is disrupted and therapeutic measures are aimed at restoring a normal flow of energy in the body. In India, yoga (particularly hatha yoga, the physical form of yoga) is used therapeutically to restore a balanced energy flow through body and mind.

Biomedicine

Biomedicine is based on the “body-as-machine” metaphor. This metaphor has been a powerful way of conceptualizing the body in western medical practice. A core assumption of the value system of biomedicine is that diagnosis and treatment should be based on scientific data. One of the core theories of contemporary biomedicine, the germ theory of disease, is of relatively recent origin. Biomedicine is usually not concerned with the practice of medicine as much as it is with the theory, knowledge and research of it; its results lead to possible new drugs and a deeper, molecular understanding of the mechanisms underlying disease, and thus lays the foundation of all medical application, diagnosis and treatment.

The health beliefs of cultures worldwide are informed by some combination of the above theories, and these theories underlie the use of many traditional medicines and therapeutic practices. All theories of health and illness help patients make meaning of their bodily experience, allowing a sense of self-control in what can be frightening situations. In ideal circumstances, American medical professionals and their patients from different cultures negotiate an understanding of what causes illness. Through open communication they can agree on treatments that combine the advantages of several theories. While western medical professionals clearly need to be vested in the value of modern medicine and their training in it, an open and nonjudgmental mindset towards the ideas other people use to explain illness and treatment will ultimately achieve better health outcomes for their patients.

‘Culturally-based Beliefs about Illness Causation’ by Marcia Carteret. Copyright © 2011. All rights reserved.