The Cultural Assumptions Behind Western Medicine

By Deborah Lupton

When most of us think about the medical approach that dominates in Western countries, we tend to view it as scientific and therefore as neutral, not influenced by social or cultural processes. Yet research undertaken by anthropologists and sociologists has revealed the influence that social and cultural assumptions play in the western biomedical tradition.

Linking the word "culture" with "medicine" is usually interpreted to mean one of two things. First, that people of non-western cultures may come to western medicine holding different beliefs about the causes and treatments of illness from those of scientific medicine, causing a "culture clash" between doctor and patient.

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Its attendant concept of "cultural competence" is now commonly used in the medical literature. It highlights the importance of doctors and other health professionals understanding that their patients from another culture that may hold different beliefs about illness and may experience poorer quality health care as a result of communication breakdowns.

The second common use of "culture" in medicine is the anthropological study of non-western medical systems. Medical anthropologists have identified several such cultural belief systems among non-western cultures. The "hot-cold" system found in many Asian and Hispanic countries, which holds that certain symptoms or illness are caused by imbalances of either "hot" or "cold" in the body is an example of this.

Medical anthropologists refer to "culture-bound syndromes" to describe clusters of symptoms that seem to be particular to a specific cultural context and are not recognised in other cultures or societies. Ataque de nervios ("attack of nerves") is one such condition involving behaviours such as uncontrollable shouting, crying, fainting or aggression. It is seen as an illness by Spanish speakers in the Caribbean and Latin America.

Another consideration

As important as these acknowledgements of culture are, it should be recognised that culture, more broadly, can also be understood as the meanings, technologies and practices that gather around medicine within western societies.

Despite the objectivity implied by the scientific principles underlying western medicine, it is still underpinned by a host of assumptions and beliefs developed through living in western culture. The white coat worn by doctors is a potent symbol of efficiency and hygiene, for instance, and the bleeping medical machines found in the hospital setting convey their own meanings of high technological prowess.

Certain stock metaphors and images tend to be used to describe specific illnesses and conditions ("the battle" against cancer, the "magic bullet" of drugs, the "war on drugs", the "innocent victim" of HIV infection).

In any cultural context, people with some medical conditions are assumed to "responsible" for their illness, while others are regarded as blameless. Thus, for example, in western countries where smoking has become viewed as a filthy and stigmatised habit, people with lung cancer are often assumed to have been smokers and therefore viewed as "bringing it on themselves". They tend to be subject to less compassion than are those people with diseases that are viewed as not their "fault" and may subsequently feel shamed and guilty. They may even delay seeking medical treatment because of the stigma that clings to the disease.

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Deborah Lupton is the author of Medicine as Culture: Illness, Disease and the Body (3rd revised edition, Sage, 2012). Commentary originally published on The Conversation.

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