12 September 2010

Somatosphere: Ian Whitmarsh on the ambiguities of asthma

In response to a blog on Somatosphere, of
Somatosphere: Ian Whitmarsh on the ambiguities of asthma

I found this work exceptionally useful since I am writing about traditional healing in the context of high levels of medical pluralism in South Africa. In a paper that will appear as "The market for healing and the elasticity of belief: Medical pluralism in Mpumalanga, South Africa" for a volume entitled Health and Healing in Africa; new arenas and emerging markets (African Studies Centre, E J Brill African Dynamics Series, edited by M. Dekker & R. van Dijk, 2010), for instance, I try to make the argument that what is called 'healing' is not a single-criterion category, but is like what Wittgenstein famously called 'family resemblance'. In other words, ‘ambiguous’. There is nothing that connects all forms of healing except this 'family resemblance' that consists of overlapping similarities and the fact that clients recognise it as 'healing'. Could this also be the case in asthma? It is a ‘familyh resemblance’ category? I found especially enlightening the description of mutually exclusive aetiologies. In my work, I am finding that this depends in part on the fact that people that I work with do not always think in terms of a ‘body’ as the ‘thing’ that is being healed. I argue "Whether of not healing has occurred and what has actually been healed—body, mind, social relations, spirit, or blood—[healing] often remains ambiguous, but … ambiguity is a necessary and unavoidable property of healing. Healing here takes many pathways but not all of them lead to health." One source of ambiguity, in other words, is cultural notions about what is being healed, and that this may be variable.

I was therefore particularly interested to read a similar argument about the value of ambiguity. In the case I am describing, ambiguity in results of medical/healing interventions (including biomedical treatment) that cause deep ambivalence in people's attitudes toward healing since no therapy/treatment is clearly better than the others. Biomedically-trained practitioners often do little better than traditional healers, partly because the primary diseases--HIV infection, AIDS, TB, diabetes, common viral infections--manifest in many ways, and over long periods. Most people (i.g South Africans of all colours) know a little bit about a vast range of healing options and use many at one time; thus it is not always clear which one might work or which don't. Ambiguity is a signal characteristic of the whole medically pluralistic context. Asthma is also increasing in this area (South Eastern Mpumalanga, South Africa), and I would confirm that it is also ambiguous, but is also confused with symptoms of TB, bronchitis, emphysema, and many other respiratory conditions. But I can agree very strongly with the notion of 'ambiguity' being fundamental, rather than epiphenomenal, to the medical system.

That 'tremendous market for and research into' asthma has increased rather than lessened this ambiguity seems to demonstrate that the ambiguity is intrinsic, rather than being simply an error in measurement of either cultural, social, or biological phenomena, a 'misdiagnosis', or other error of category assignment'

While Whitmarsh sees this as intrinsic to the illness itself, it seems to me that ambiguity of outcome, and the 'family resemblance' aspect of disease categories is also responsible for allowing--even requiring--medical pluralism in conditions where 'ambiguous diseases' (asthmas, but also the ones I have listed above, in addition to a lot of 'lifestyle' diseases) are prevalent.

I also find useful in this connection an article by Tina Moffat in Medical Anthropology Quarterly 24(1), 2010, on 'Childhood obesity' epidemics. There she cites another author, Natalie Boero, who calls this a 'postmodern epidemic' sicne it 'lacks a clear pathological basis', but is 'cast in the language and moral panic of 'traditional' epidemics' (2007). Against this Moffat usefully argues that not all ambiguous illness or diseases are entirely culturally constructed', and makes the case of the Childhood Obesity Epidemic" to be cast as both 'moral panic' and as real disease/pathology. In other words, again, we have a category, Childhood Obesity (and, 'epidemic') that is ambiguous and in which the ambiguity is intrinsic.

I would agree with Whitmarsh that it is, in part, the very ambiguity of asthma that 'sells' it on the market as research target, or target for pharmaceutical interventiuons, and that this market factors take advantage of this ambiguity. I would also argue that, notwithstanding biomedicine's tendency to reduce such complexity wherever possible, it is the ambiguity inherent in most experiences of disease that both give us hope, and that allow us to keep our options open, relying on many medical therapies, interventions, and philosophies all at the same time and without necessarily being concerned with incompatibilities, or even fundamentally mutual incommensurabilities.