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Filipino-Concept-of-Health-and-Illness2003

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					Filipino
Concept of
Health and
Illness
HEALTH
     Kalusugan = “able-bodied”

      LUSOG           Full development, progressiveness (in
                      terms of vigorous physical
                      development)
    Malusog vs.       -Panganiban
    Payat (not
    necessarily
    meaning ill)
 * HEALTH – a combination of maturative
 processes or development in correspondence to the
 ability to function properly, to be active.
 * Being either PAYAT or TABA are not
 considered as healthy, but not necessarily ill.
            Kamusta ka na?
    Mabuti naman.                 Eto, buhay pa.


             The tone of the response may insinuate
             that there may be underlying physical,
              psychological,or emotional problems


* Therefore, HEALTH cannot be translated as a mere
 absence of fever, pain or even generalized feelings of
    malaise. It is also loaded with notions of social
                      interactions.
Illness vs. Disease
 FRAKE
  Illness – a single instance of “being
  sick”
  Disease – a diagnostic category, a
  conceptual entity which classifies
  particular illnesses, symptoms or
  pathological components of illnesses
  or stages of illnesses
 IDLER
  Disease – an abstract biological-
  medical conception of pathological
  abnormalities in people’s bodies
  Illness – the human experiencing of
  disease
    sakit
       In Philippine society, only one word exists
        to describe such phenomena – SAKIT
       The term sakit is closer to the meaning of
        illness than to disease
       In many cases, ailments or illnesses are
        culture-specific.
         ◦ Ex. Usug, Bangungot (Western:
           nightmare death syndrome)

Although recent studies try to increase knowledge on these
illnesses, it cannot be denied that there is still a void due to the
inadequate attention given to such illnesses.
                    SAKIT = Pain
   Western medicine – pain as a symptom
   Filipino medicine – sakit = pain in
    several contexts (ex. sakit ng ulo, sakit ng
    tiyan)
    ◦ Sakit also has different degrees (ex. hapdi for
      a stinging type; kirot for a sharp, recurrent
      type; antak for internal, continuous stinging
      type)
   Sakit = illness
    ◦ Diagnosis involves the culmination of a process
      of observing signs and eliciting symptoms that
      are graded in terms of seriousness (often
      associated with level of physical activity one
      can still exert)
MAY SAKIT

 A normally strong person who suddenly
  feels weak is said to be have the beginnings
  of an illness. This weakness is close to the
  English term lethargic
 Persistence of lethargy, accompanied by
  other symptoms are monitored by family
  and friends but the term MAY SAKIT will
  only be used when the person is unable to
  perform physical tasks (common criterion:
  bed-ridden)
Filipinos on addressing illnesses

1.   No matter what ailment, it is considered as
     mild/slight at first notice. Patient is rarely
     given treatment during this stage.
2.   The gravity of the sickness will only be taken
     into notice when patient starts to suffer more
     and more.
3.   If one complains of pain or great itching, this
     is the first stage of malaise. If symptom
     continues over a considerable period of time
     accompanied by the intensifying of the
     symptom, the patient and the family sees the
     sickness as serious.
4. If patient starts to stay in bed than
  continuing with his daily routine, this is
  considered as another stage of severity.
5. Filipinos consider CRYING as the surest
  indicator of severity


•This framework exhibits a common problem in the Philippines
which is most exemplified by a mother who is shocked to find her
child dead barely after a day she has recognized that her child
was ill.

•This also shows the perception of Filipinos on illness. Illness, as
exemplified by SAKIT, has many social dimensions – mainly in
terms of using pre-defined “normal” social activity as a
reference for diagnosis of illnesses
Attribution of illnesses by the
Subanon

    1. Pathogenic
    2. Prodromal
    3. Etiological
    4. Symptomatic – the most effective and
       important
Medicalization by Western
countries

   Some illnesses are more than just physical
    ◦ More health professionals are starting to recognize
      the important role of social relationships in
      determining health and disease
   “Syndrome” – slowly becoming a popular
    term in medical literature but still reflects
    the need to delimit the qualifiers used by the
    western-oriented medical system
    ◦ Some illnesses/ailments cannot and should not be
      immediately appropriated into biomedical or
      psychiatric pathology
   Some physicians quickly label some
    problems as medical, when some are
    actually more philosophical in nature.
    ◦ Ex. A person pondering on the meaning of
      his/her life = depressive order = need for anti-
      depressants
 Few health professionals have the ability
  to see that some “problems” may actually
  be part of a healthy process of an
  individual’s mental, emotional, and social
  development
 Therefore, immediately attaching medical
  labels and treatment on such conditions
  may be detrimental as it medicalizes life’s
  processes
Theories of illness causation
I.     Mystical Theories
      a.    Contagion/Pollution
      b.    Mystical Retribution        III. Naturalistic
      c.    Fate                            theories
      d.    Soul Loss
II.    Personalistic                       a. Natural Phenomena
       Theories                            b. Humoral Pathology
      a. Animate                           c. Diet
           1.   Ghosts
           2.   Supernatural Entities      d. Infections
      b. Magical                           e. Natural Processes
           1.   Sorcerers
           2.   Witches                    f. Stress
MYSTICAL THEORIES
Attribute illness to the automatic
consequence of the victim’s acts and
behavior
Mystical theories: Life-Stuff
and Souls

    Embodies the concept of basic forces as being
     operational in illness and health, if not life
     itself
    Health and illness as natural consequences of
     good and evil behavior
1. Contagion

 “Contact with some purportedly polluting
  object, substance, or person” (Murdock)
 Animatism – belief in a metaphysical life
  force
    ◦ Some Phil. ethnic groups distinguish between a
      “life force” and the “soul.”
    - This “life force” is considered an attribute of
      health and also a potential cause of illness
    - A human being with a strong or potent life force
      would be perceived as a potential cause of
      illness, regardless of he/she has intentions of
      causing illness. Those with weak life forces are
      more susceptible to illnesses
2. Mystical retribution
 Filipinos believe that a violation of a taboo
  results in “punishment” by a supernatural
  being in the form of illness or other
  misfortune.
 Research has shown that most acts that
  violate a taboo and result to misfortunes
  may not necessarily have been caused by a
  “supernatural being.” Some believe that it
  is a natural consequence and is more
  closely related to social propriety than
  mystical retribution
    ◦ Best captured by karma
3. Fate

 Illness as ascribed to astrological
  influences, individual predestination, or
  personified ill luck
 Filipino = PALAD (palm of the hand)
    ◦ Palmistry (mostly in Mindanao) -> predicts
      one’s fate in life
    ◦ Sintas (the midline extending from the
      umbilicus to the chestbone) -> predicts one’s
      susceptibility to illnesses
    ◦ “Bahala na” attitude – manifestation of
      Filipinos’ passivity and resistance to change by
      leaving everything to the “will of God”
4. Soul loss

 Belief that a soul is capable of leaving the body
  temporarily and its prolonged absence may cause
  illness to the owner with death, as the permanent
  separation from the body.
 Different from “possessions” by spirits
 Ex. Ilongots – beteng (heart) may leave the body
  during sleep and may get used to the company of the
  dead – this leads to death
    ◦ Saving grace is knowledge, thus making infants more
      susceptible to this illness because they lack this
      knowledge
    ◦ Some believe that souls are companions (ex. belief that
      children have companion animals in Panay)
    ◦ Some believe that some souls feel compelled to free itself
      from the body (compulsive soul) – ex. bangungot
PERSONALISTIC
THEORIES

 Attribute illnesses to the active
 intervention of sensate agents such as
 supernatural entities or malevolent
 human beings
Animate: Ghosts and other
supernatural entities

   Ancestral spirits – most frequently cited
    illness-causing ghosts
    ◦ Illness is perceived as retribution from
      ancestral spirits for non-fulfillment of ritual
      obligations or violation of social norms
 Deceased traditional healers – may cause
  illness when calling on a descendant to
  take up his/her vocation
 Souls of unborn children – aborted
  children, unbaptized children
    ◦ Parents are punished with illnesses due to
      negligence
*Even “casual” encounters with ghosts, as in
  being greeted (nabati) can be a cause of illness
 Discontented souls- potential malevolence of
  ghosts may be determined by the character of
  the individual at the time of death
      - ghosts of suicide victims are believed to
  be the most dangerous.
 Supreme deity- is generally conceptualized as
  remote and detached from the human world,
  only occasionally inflicting illness as
  punishment for “sins”.
  -Among Catholics, saints are believed to inflict
  illness as punishment for social
  transgressions, including non-fulfillment of
  ritual obligations.
 Environmental Spirits- They are generally
  perceived as benevolent and/or guardians for
  shamans and other traditional healers.
       -generally perceived as benevolent but
  others inflict harm only when provoked
  particularly by intrusions into their
  “territory.”
“nabati, napaglaruan, nakatuwaan ng laman
  lupa ”– used to describe relationship bet
  humans and supernaturals, which results in
  illness
- Once “enchanted”, illness can only be cured by
  the mananambal or the local shaman.


    *Perceived power of ghosts and
    supernatural entities is related to “social
    space”, to their distance from the human
    sphere.
MAGICAL BELIEFS: SORCERERS and
WITCHES

Magical theories are those “which ascribe
 illness to the covert action of an envious,
 affronted or malicious human being who
 employs magical means to injure his
 victims”. (Murdock)
SORCERER- uses the technique of magic and
 derives his power from medicine
WITCH- acts without rites and spells and
 uses hereditary psycho-psychical powers
     Sorcery
 Kulam- most popular term
 Among tribal groups, sorcery is usually
  reported as the effort of the community to
  inflict illness on a common enemy
 Among Christians and Muslims, sorcery is
  often an individual affair usually spurred by
  revenge motives
         Methods
  Sorcerers use incantations and prayers, even
  incorporating ritual paraphernalia associated
  with the Catholic church. Imitative and
  contagious magical principles are used, such
  as hair of the intended victim and voodoo-like
  methods
 Barang- uses “pet” insects and other animals
  to poison the victim
      --the insects and animals are used not
  only to harm the victim but also to represent
  the sorcerer’s power
 Object Intrusion- sends objects into the
  victim’s body, ranging from fruits to insects
  and physical objects.
- Persistent abdominal pain may be attributed
  to sorcery, with a ritual needed to remove the
  intrusive object
 Soul abduction- the sorcerers abducts the
  victim’s soul and cause illness
 “Possession”- a person may be possessed by
  the sorcerer or a malevolent spirit is sent to
  take over the victim
   Some methods of sorcery may have empirical
    basis, particularly in the use of plant poisons.




     •Sorcerers are usually known and accepted in
     their communities. They are perceived as
     having legitimate roles and their practices is
     socially sanctioned.
Witchcraft
   Seemed to be limited to Christian and Muslim
    groups: Aswang and balbal for Christainas
    and the balbalan for Muslims

ASWANG- a man or woman possesing
 preternatural powers of locomotion and
 metamorphosis and an inhuman appetite for
 the voided phlegm sputum of the deathly sick,
 as well as the flesh and blood of the newly
 dead.
 A person usually becomes an aswang by
  inheritance.
 Suspected aswangs are less sociable: they
  cannot look you in the eye, somewhat
  individualistic and have self reliance. They
  prefer not to seek advice for other people
 Witches are perceived to “enjoy everything
  precious in life”
  Manananggal- believed to have a power of
   detaching the upper part of their body and to
   fly around
  The idea of the aswang being a “vampire” is
   probably of more recent vintage, a borrowing
   of western demonology
•The aswang belief operates as a form of
social control. It discourages asocial attitudes
such as secretiveness, solitariness,
misanthropy and the like (Lynch)
NATURALISTIC THEORIES
    Attribute illnesses to impersonal
    natural forces or conditions such as
    cold, heat, winds, or an imbalance
    of the body’s elements
   Naturalistic systems explain illness in
    impersonal, systemic terms. Disease is thought
    to stem… from such natural forces or
    conditions as cold, heat, winds, dampness, and
    above all, from an upset in the balance of the
    basic body elements. (Foster)
1. Natural phenomena
   Thunder and lightning – believed to be a cause of
    illness among Negrito groups
    ◦ Illness is not attributed to the phenomena itself but to
      a thunder god, who punishes humans for violations of
      taboos (mythological)
   Naturalistic – mixing two things that do not
    naturally belong together
    ◦ Ex. Mixing different fruits and vegetables in one
      basket (Negritos)
   Hangin – perceived as being sent by supernatural
    or human entities
    ◦ Different ethnic groups believe in “self-activated
      winds” (may cause respiratory problems, muscular
      pains, skin diseases)
    ◦ Each month has a predominant wind direction which
      causes illnesses
   Singaw ng Lupa – vapors are harmful when it
    rains during particularly hot weather
    ◦ Contact between warm earth and rain = singaw =
      unnatural = discomfort and illness
   Seasons are associated with particular illnesses
    ◦ When it is relatively cool, sickness is not widespread
      except those that are deep in the body and in the
      advanced stage. When it is warm and humid, there
      is a general feeling of malaise and irritability
    ◦ Seasons of hunger (food supplies are out) = seasons
      of disease
2. Diet
                  “You are what you eat.”
  a. Injunctions based on religion
    Ex. Islamic prohibition on pork consumption
  b. Deals with imitative magical principles – “like
    produces like or that an effect resembles its cause”
    (Frazer)
    Ex. Avoidance of slippery foods by pregnant women in
    the belief that this would cause the uterus to slip
  c. Those   based on theories of humoral pathology
    Ex. Food items are classified into HOT and COLD
    Fruits (cold) are avoided in the morning, the coldest
        part of the day because it may intensify the cold
        condition which could result to diarrhea and
        respiratory problems
d. Other aspects
  - overeating
  - intoxicated (overeating of particular food)
  which could cause allergies or itchiness
  - indigestion (eating food that is hard to
  digest) – usually occur in young children
  - foods that are hiyang or compatible
3. Infections
 Refer to illnesses attributed to microorganisms
  such as bacteria and viruses
 KAGAW – pathogenic microorganisms
  (Tagalog)
 Mikrobyo – Filipinos are starting to become
  more germ-conscious due to the influence of
  media




    * The Germ theory may be recognized, not by overemphasizing it,
    but by incorporating it into more substantial health-maintenance
    practices.
4. Humoral pathology
 Illness is believed to be caused by a disturbance of the
  balance of forces within the body
 This theory is found mainly among Christian groups
  and is represented by the belief in the interactions
  between the hot and the cold.
 Hot/cold syndrome – known as pasma; believed to
  be an attack of “cold” on someone who is too “hot” or
  vice-versa
   ◦ Ex. A person who has just finished exercising will be
     advised against bathing in cold water to avoid
     pasma
   ◦ Hot/cold theory is said to be both allopathic (mixing
     hot and cold), and homeopathic (adding hot with
     more hot)
5. Natural processes
   Blood is given much importance because it is
    distributed throughout the body and its loss is
    associated to weakness and death
    ◦ People with insomnia, anemia, and sickly = “thin” blood
    ◦ People with asthma, bile troubles, tuberculosis, and
      malaria = yellowish blood
    ◦ Bathing in the morning adds blood and in the evening
      lessens blood (low blood pressure)
   Other parts of the body are given labels as to “hot”
    or “cold”
    ◦ Illnesses are said to be caused by an imbalance
      between external hot and cold influences on the
      anatomical part
    ◦ Ex. The back (likod) is especially sensitive to cold and
      rains; while the abdominal region (tiyan) is sensitive to
      wind exposure = kabag
   Displaced organs = illness
    ◦ Ex. Isabela – knotting up of intestines and resulting
      in colic (hilot as the cure)
    ◦ Midwives massage the mother’s abdominal region
      (post-partum) in order to restore the uterus in its
      original position; failure to do so can lead to illness
6. stress
    Exposure of the victim to either physical or psychic
     strain such as overexertion, prolonged hunger or
     thirst, debilitating extremes of heat or cold, worry,
     fear, or the emotional disturbances which constitute
     the province of modern psychiatry. (Murdock)
     EX.
     Lubat – illness caused by a frightening experience
     especially being in contact with the dead
     Ugma – emotional disturbance due to fear of a
     person, object, animal, or situation
    Is related to the concepts of balance
    For example, when one has the “fright illness”, it is
     not attributed so much to fright itself. A new and
     unfamiliar environment disturbs the natural balance
     of a person’s body and psyche, and this disturbance
     becomes a source of stress.

				
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