Health and Society

Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is ob­ligated, at least for a spell, to identify ourselves as citizens of that other place.

After completing this section of the chapter, you should be able to meet the following objectives:

♦ Describe the concepts used to establish belief systems
within a community and the effects on its health care
practices

♦ Identify a disease believed to be generated by specific
emotions and the characteristics ascribed to it

♦ Explain how mythologizing disease can be detrimental to
individuals in a society

There is a long history that documents the concern of humans for their own health and well-being and that of their community. It is not always evident what particular beliefs were held by early humans concerning health and disease. Still, there is evidence that whenever humans have formed social groups, some individuals have taken the role of the healer, responsible for the health of the community by preventing disease and curing the sick.

In prehistoric times, people believed that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be pacified or the evil spirits driven from the body. In time, this task became the job of the healers, or tribal priests. They tried to pacify the gods or drive out the evil spirits using magic charms, spells, and incantations. There also is evidence of surgical treatment. Trephining involved the use of a stone instrument to cut a hole in the skull of the sick person. It is believed that this was done to release spirits responsible for illness. Pre­historic healers probably also discovered that many plants can be used as drugs.

The community as a whole also was involved in se­curing the health of its members. It was the community that often functioned to take care of those considered ill or disabled. The earliest evidence of this comes from an Old Stone Age cave site, Riparo del Romio, in southern Italy. There the remains of an adolescent dwarf were found. De­spite his severe condition, which must have greatly limited his ability to contribute to either hunting or gathering, the young man survived to the age of 17 years. He must have been supported throughout his life by the rest of the com­munity, which had incorporated compassion for its mem­bers into its belief system.² Communities such as this probably existed throughout prehistory; separated from each other and without any formal routes of communica­tion, they relied on herbal medicines and group activity to maintain health.

Throughout history, peoples and cultures have devel­oped their health practices based on their belief systems. Many traditions construed sickness and health primarily in the context of an understanding of the relations of human beings to the planets, stars, mountains, rivers, spirits, and ancestors, gods and demons, the heavens and underworld. Some traditions, such as those reflected in Chinese and In­dian cultures, although concerned with a cosmic scope, do not pay great attention to the supernatural.

Over time, modern Western thinking has shed its ad­herence to all such elements. Originating with the Greek tradition—which dismissed supernatural powers, although not environmental influences—and further shaped by the

Influences of zodiac signs on the human body. (Courtesy of the National Library of Medicine)

flourishing anatomic and physiologic programs of the Re­naissance, the Western tradition was created based on the belief that everything that needed to be known essentially could be discovered by probing more deeply and ever more minutely into the flesh, its systems, tissues, cells, and DNA.³ Through Western political and economic domina­tion, these health beliefs now have powerful influence worldwide.

Every society has its own ideas and beliefs about life, death, and disease. It is these perceptions that shape the concept of health in a society. Although some customs and beliefs tend to safeguard human communities from disease, others invite and provoke disease outbreaks.

The beliefs that people have concerning health and disease can change the destiny of nations. The conquering of the Aztec empire may be one example. Historians have speculated how Hernando Cortez, starting off with fewer than 600 men, could conquer the Aztec empire, whose subjects numbered millions. Historian William H. McNeill suggests a sequence of events that may explain how a tiny handful of men could subjugate a nation of millions.

Although the Aztecs first thought the mounted, gun-powered Spaniards were gods, experience soon showed

otherwise. Armed clashes revealed the limitations of horse­flesh and of primitive guns, and the Aztecs were able to drive Cortez and his men from their city. Unbeknownst to the Aztecs, the Spaniards had a more devastating weapon than any firearm: smallpox. An epidemic of smallpox broke out among the Aztecs after their skirmishes with the Spaniards. Because the population lacked inherited or ac­quired immunity, the results were catastrophic. It is pre­sumed that a quarter to a third of the population died from the initial onslaught.

Even more devastating were the psychological impli­cations of the disease: it killed only American Indians and left Spaniards unharmed. A way of life built around the old Indian gods could not survive such a demonstration of the superior power of the God the Spaniards worshipped. It is not hard to imagine then that the Indians accepted Chris­tianity and submitted meekly to Spanish control.⁴ Although we live in an age of science, science has not eliminated fantasies about health; the stigmas of sickness and the moral meanings that they carry continue. Whereas people in previous centuries wove stories around leprosy, plague, and tuberculosis to create fear and guilt, the modern age has created similar taboos and mythologies about cancer and acquired immunodeficiency syndrome (AIDS).

The myth of tuberculosis (TB) was that a person who suffered from it was of a melancholy, superior character— sensitive, creative, a being apart. Melancholy, or sadness, made one "interesting" or romantic. The general percep­tion of TB as "romantic" was not just a literary device. It was a way of thinking that insinuated itself into the sensi­bilities and made it possible to ignore the social conditions, such as overcrowding and poor sanitation and nutrition, that helped breed tuberculosis.

The infusion of beliefs into public awareness often is surreptitious. Just as tuberculosis often had been regarded sentimentally, as an enhancement of identity, cancer was regarded with irrational revulsion, as a diminution of the self.¹ Current accounts of the psychological aspects of can­cer often cite old authorities, starting with the Greek physi­cian Galen, who observed that "melancholy women" are more likely to get breast cancer than "sanguine women."

Grief and anxiety were cited as causes of cancer, as well as personal losses. Public figures such as Napoleon, Ulysses S. Grant, Robert A. Taft, and Hubert Humphrey have all had their cancers diagnosed as the reaction to political defeat and the end to their political ambitions. Although distress can affect immunologic responsiveness, there is no scien­tific evidence to support the view that specific emotions, or emotions in general, can produce specific diseases—or that cancer is the result of a "cancer personality," described as emotionally withdrawn, lacking self-confidence, and depressive.

These disease mythologies contribute to the stigma­tizing of certain illnesses and, by extension, of those who are ill. The beliefs about health and disease have the power to trap or empower people. They may inhibit people from seeking early treatment, diminish personal responsibility for practicing healthful behaviors, or encourage fear and social isolation. Conversely, they also can be the impetus for compassion to those who are ill, for commitment to

  

improving one's own health, and for support of efforts to improve the health status of others.

In summary, what constitutes health and disease changes over time. Prehistoric times were marked by beliefs that angry gods or evil spirits caused ill health and disease. To cure the sick, the gods had to be pacified or the evil spirits driven from the body. Tribal healers, or priests, emerged to accomplish this task. Prehistoric healers used a myriad of treatments, includ­ing magic charms, spells, and incantations; surgical treatment; and plant medicines.

Throughout history, the concept of health in a society has been shaped by its beliefs about life, death, and disease. Some beliefs and customs, such as exhibiting compassion for dis­abled community members, tend to safeguard human com­munities and increase the quality of life for all community members. Others invite and provoke disease outbreaks, such as myths about the causes of disease.

Even though science and technology have advanced the understanding and treatment of disease, misconceptions and fantasies about disease still arise. In previous centuries, dis­eases such as leprosy, plague, and tuberculosis were fodder for taboos and mythologies; today, it is cancer and AIDS. The psychological effects of disease mythologies can be positive or negative. At their worst, they can stigmatize and isolate those who are ill; at their best, they can educate the community and improve the health of its members.