An Aid of Meaning

Assumptions about the ailing are as common as doctors hypothesize on what’s wrong with their patients. In the work’s of John Aggergaard Larsen “Finding Meaning in First Episode Psychosis,” and Rachel R. Chapman “Endangering safe motherhood in Mozambique,” these assumptions are challenged by a broader understanding of the how and the why. Namely, by the context of the patient, and the meaning that they take in their experiences, will model how they are treated or diagnosed; the effectiveness of the treatment; and what other avenues they will take to understand their illness in order to get better.

As people go throughout their daily lives they attach meaning, symbols, and images to not only their communication, but also in their understanding of life and the world around them. In a very real aspect they are living a metaphor. These life metaphors find their voice in the narratives that often are passed over or missed entirely. When missed they present themselves in puzzles like, “why women are not going to a free maternity clinic until the end of their pregnancy, regardless of the high infant and child mortality rate?” (Chapman, 355) Or seen in the initiation of an early intervention program, OPUS, to study and understand why the mentally ill suffer as they do. (Larsen, 451) There are those that would be tempted to claim, like in the Gondola data, “high-risk women in developing countries as unmotivated and/or non-compliant victims.” (Chapman, 371) This in essence blames the women for the death of their children. Or that the mentally ill are just crazy and their ailment causes their suffering. (Larson, 451) But to accept these arguments would be to completely abandon conceptual clarity.

Conceptual clarity, or a system of explanation, emerges from many aspects. These are found in the biomedical aspect of an illness, the spiritual or religious, the financial, the cultural, and the individual narratives. In “Finding Meaning in First Episode Psychosis,” John Larson calls it Bricolage when, “they tried to connect and supplement various systems of explanation in innovative theory-building work.” (Larson, 461) That even the delusions themselves are a patients attempts, “to master a frightening and bewildering subjective state by imposing meaning or forcing an explanation upon experiences which would otherwise be meaningless or inexplicable.” (Larson, 460) In essence they are taking pieces of what makes sense and building an understanding of what they are experiencing. And for many, “they found resonance in a wider cultural repertoire, that is, the myths, traditions, and institutional bases of authority in the wider society.” (Larson, 462) It is through all the pieces or layers of understanding that the OPUS intervention program could find success.

Another parallel reference to a patients layering of treatments to find the cure is in Rachel Chapman’s “Endangering Safe Motherhood in Mozambique.” In Chapman’s chart on page 363 we see the veritable bricolage in the form of treatments the women pursue. Namely: Pharmaceutical, herbal, district health center, church, curandeiro, prophet, prayer, mission clinic, traveling “nurse”, and maternity clinic. For example, in Raquel’s story the layering of her treatment was related to finance, culture, religion, and biomedicine. After paying for first diagnosis, she was given a prescription that she could not afford. The pharmacy gave her half her treatment for the money which did not help her at all. The next month a curandeiro accepted the same amount of money for three months of an infusion of roots. This helped but did not cure the patient but gave her an understanding that it cleaned inside her for the baby. Then finally a traveling “nurse” charged three times the amount for the pills and infusion to inject Raquel and her husband over the next three weeks. She believes that the injections attacked the site where her illness was fixed. Although this overcame her symptoms, Raquel also went to her prophet who gave her a blessing and sacred water to drink and bathe in. This was to cleanse her body and to not have anymore bad luck. According to Raquel it was the multiple layers that was her cure under the umbrella of her belief that the three treatments were symbolic of the “Father, Son, and Holy Spirit.” (Chapman, 364)

With more of an Ethnographic research style that took into account attention to the Bricolage or fluidity of treatment, both authors’ uncovered important aspects in how to help and understand their patients better. This starts with understanding that the patients are very active in finding meaning in their ailment in order to help them. For example, Chapman noted that, “under conditions of frequent reproductive morbidity and loss, little access to cash, immense domestic and agricultural work burdens, and limited routes to female social and economic self-determination” the women still, “demonstrate significant initiative in mobilizing the resources they deem necessary to influence their own reproductive labor and decrease the odds of poor pregnancy outcomes.” (Chapman, 371) While Larsen argued that; “individuals take an active role when applying understandings and meanings to their situations and experiences,” that, “plural healing systems can exist within an overarching cultural tradition,” and that, “culture as a ‘tool kit’ of symbols, stories rituals, and world-views” will be used “in varying configurations to solve different kinds of problems.” (Larsen, 457) Due to these discoveries solutions could be addressed.

For the women in Mozambique, social conflict and economic tension are reproductive threats. Those, due to migration of women from large patrilocal and polygynous households into smaller nuclear residence, many women suffer under an economic vulnerability due to lack of wage paying jobs for women. (Chapman, 369) The women without cash capital cannot compete and must be directly or indirectly dependent on male cash resources. As these women compete for resources many keep their pregnancies secret as a protective measure. That once it is known they are preyed upon by mal espirito kin and midwives seeking assistant gifts. Basically, safe motherhood in Mozambique, “lies beyond the scope of medical or even public health solutions alone.” (Chapman, 372) However, some changes can be made. Merging the maternity clinic with the District Health Center will provide patient privacy and may draw more women in for early maternity care. Also, better service that lowers the wait time will draw the women who can’t be away from home or the farm long.

For those that are mentally ill, teaching them a psychoeducation, “provided highly influential concepts and theories.” Through this education many “found explanations by drawing on systems of explanation available from the cultural repertoire of the wider society.” (Larsen, 465) As meaning comes, many are relieved of their tormented feelings and to an extent their helplessness. Indeed, it is a goal as different explanations are, “rejected, accepted, appropriated, and reevaluated in a continuous process.” (Larsen, 465) By providing an institution or mental health community to provide education and various contexts, the patient can become part of the solution.

In both of these articles the Anthropologist’s looked for the narrative of those that were ailing. This required that they put aside assumptions or conclusions that they and others jumped to early on. By doing this a broader understanding of the how and why emerged in a format that could assist not only in effective treatment, but also in ways for the ailing to find meaning in their experiences. As noted above, understanding does not fix all problems. But it did offer incite into small changes that can make a difference. Perhaps, with more seeking meaning within a culture the larger socioeconomic changes can be made. In fact, I would submit that it is the only way those changes ever came to be.

Bibliography

Larsen JA. 2004. "Finding meaning in first episode psychosis: experience, agency, and the cultural repertoire". Medical Anthropology Quarterly. 18 (4): 447-71.

Chapman RR. 2003. "Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk". Social Science & Medicine (1982). 57 (2): 355-74.