Jonathan de Rothewelle | ACADEMIA Letters: Cultural Awareness in Medicine: Health Insights from an Ethnographic Study of Ritual

Sen Trắng lược dẫn: Trên thực tế, ngày nay ngoài y học phương Tây, vẫn tồn tại một thế giới chữa bệnh bằng thảo mộc, “tiên” dược, và các nghi lễ mà những người chữa bệnh theo phong cách truyền thống đã sử dụng trong nhiều thiên niên kỷ.

Trong nhiều hệ thống tín ngưỡng, một tâm/linh hồn được chữa lành sẽ giúp một cơ thể được chữa lành; Nghĩa là, để cơ thể được chữa lành, tâm hồn phải được bình an.

Mặc dù y học dân tộc học và y tế phương Tây có thể ngày càng cạnh tranh với nhau, nhưng y học dân tộc học, trong đó nhiều phương pháp đóng vai trò là cơ sở để nghiên cứu và phát triển dược lý hiện đại.

Lời khuyên sống hài hòa với tha nhân, tiếp nhận không khí trong lành và ánh sáng mặt trời, hoạt động thể chất và dành thời gian cầu nguyện hoặc thiền định đều có thể có lợi cho sức khỏe. Một y sĩ ngoài kiến thức chuyên môn y học phương Tây, nếu hiểu biết và nhạy bén văn hóa y học dân tộc cũng như các truyền thống tâm linh có thể hỗ trợ nhiều điều bổ ích cho bệnh nhân trong quá trình trị liệu…

1. Introduction

Beyond Western medicine exists a world of healing botanicals, elixirs, and rituals that tradi tional healers have used for millennia[1]. In many belief systems, a healed soul begets a healed body; for the body to be healed, the soul must be at peace. Even though ethnomedicine and Western health may be increasingly pitted against each other, ethnopharmacology, which of ten serves as a basis for modern pharmacological investigation and development,[2] demon strates the important bond between Western medicine and its origins. Practitioners of West ern medicine should possess an openness to the contributions of other cultural paradigms of medicine and healing. Not only does a knowledge of cultural traditions prepare practitioners to treat a variety of patients more effectively, patients practicing such traditions may expe rience improved physical and psychological health. Spending time in gratitude and prayer, engaging in physical activity outdoors, and being part of a supportive community may all influence wellbeing.[3][4][5][6]

This research, with ethnography of communication as a methodological foundation, ex plores exactly how gratitude, prayer, and fellowship in an intentional community may be a means of healing. This study documents and describes the ways in which a ritual pro motes wellbeing through a mindbody approach.[7] In the midnorthern U.S., a contempo rary Maya shaman[8] leads a community of people seeking wellbeing, peace, and connected ness with their bodies, nature, and the universe.[9] The shaman that leads this community is from Guatemala and is guided through analysis of Maya constellations, visions and dreams of shamans past, and reading of ancient Maya texts. The ritual observed in this study is based on an ancient Maya calendar, the Tzolk in,[10] consisting of periods of thirteen days that are dominated by different spiritual energies. Participants are immigrants from Central America, specifically communities of Maya heritage, as well as EuroAmericans seeking to learn more about this belief system. English is spoken as the primary language, so as to accommodate more participants, with excerpts and key terms incorporated from various Mayan languages. The practices of this ritual may support wellness through what Western medicine might view as adjacent to mindfulness meditation, fresh air, exercise, and a community of support.[11] Along with these benefits, participants cite physical healings attributed to sacrifice and sup plication. Such spiritual activities may lend themselves to recent research on the treatment of pain and other conditions with meditation,[12][13] as well as studies of somatic symptom disorders. According to the DSM5,[14] somatic symptom disorders include illnesses that have physical affects that may or may not be associated with a diagnosed illness, which in some cases may be relieved through psychological approaches. The DSM5 states that “somatic presentations [of illness] can be viewed as expressions of personal suffering inserted in a cultural and social context.” 

2. Methodology

Ethnography of communication is a methodology of collaboration, active participation, and continuous dialogue within a community, so as to gain an understanding of communicative practices, such as prayer and supplication.[15][16][17][18] http://www.jstor.org/stable/2949351. Such a framework includes observation, participation, notetaking, conversation, and clarification. First, rituals were observed and notes were taken by the author of this paper followed by dialogue with participants. Soon after, the researcher was invited to participate in rituals and to take audio recordings for future reference. Once the researcher compiled notes from the rituals and conversations observed, central themes were gathered and analyzed. Finally, the researcher collaborated with the community to review the data collected, make necessary clarifications, and lend their voices to the experience.

With institutional oversight for working with human subjects, participants were recruited and informed consent was attained; presented findings were stricken of participant identi fiers. Research methods, including ritual participation, notetaking, recording, ethnographic interviewing, and collaboration with the community, were IRB approved.[19] The author of this paper conducted research on site within this community over the course of one year. Research took place around a stone pyramid and a fire where prayers were facilitated through incense, musical instruments, and movement. Descriptions of ritual, artifacts, prayers, and actions performed by this community are that of the community and only observed by the researcher. As research was conducted and observations were complied, participants were continuously interviewed to gain further understanding of this ritual’s effect.

3. The Ritual

Through prayer and movement, participants show gratitude and welcome to the spirits of the universe and nature, and to sacrifice and supplicate for better health and protection. To prepare for the beginning of the ritual, logs are split with a hatchet, a wooden dome is built in a stone pit, and a fire is started. Next, candles and incense are used as offerings. Six candles are lit and placed atop the pyramid representing the six directions: right, left, front, back, up, and down. Charcoal is used to maintain a steady stream of incense for the duration of the ceremony. It is then placed in a shell from Central America, and filled with small coarse chunks of copal.

Once the offerings have been made, the incense facilitates ritualistic healing, by which the participants are purified from any bad intentions or maladies. The leader then faces the participant and censes them with the shell, while circling them, from head to toe. While the purification seeks to heal maladies in general, sacrifices may be targeted to specific illness; flowers, fruits, and vegetables are often sacrificed. To do so, the participant holds the item on an area of illness, asking the ailment to leave the body and enter the sacrifice, which is placed into the fire. For example, one might say, “I plead to you, please take away my abdominal pain. I ask this pain to leave my body and to go into this sacrifice.”

After sacrifices are made, supplications are spoken in six directions. Participants stand around the fire and pyramid, uniformly rotating to face the different directions while the mara cas are played: “Thank you, god of the universe, for such beautiful days and nights. Humbly we ask forgiveness for our misdeeds and implore for your guidance to make of this world what was intended. May the universal force protect us.” After the prayer is made in each direction, a salutation to the six directions is performed. The leader of the ritual blows the conch horn for approximately ten seconds in each direction while participants stand, rotating to face different directions, squat to the earth below, stretch to the sky above, and finish with a 360degree spin.

Lastly, the group acknowledges the ways in which they have been blessed since the last ritual of this type, and the spirits or forces of the upcoming days are received and greeted with gratitude: “We give thanks for all the blessings we had. We give thanks to the god of the universe for all the blessings we will receive. We welcome the new and hope to be guided in a good path and to do the missions that the universe wants us to do on this planet. Thank you for all the blessings that we are about to receive in the next 13 days” After the meditation, participants may disperse.

The stone pyramid and storage area at the ritual site; a closeup of instruments
used sitting atop the pyramid. Photographed by the author with permission of the community.

4. Findings & Discussion

Congregating with others, getting fresh air and sunlight, physical activity, and spending time in prayer or meditation may all have health benefits. A culturally sensitive practitioner may support a patient’s participation in such activities due to the general health benefits that could complement biomedical treatment.

Cultural Awareness

In addition to general health benefits, a practitioner, without a sensitivity to cultural diversities, may attempt to treat a patient in a way that might prove to be ineffective.[20] In one example, in this community there are certain time periods that are taboo for conception, such as one called Wayeb—which loosely translates as death.[21] A child conceived or born in this period would be destined to a life of untold anguish. In the example of fertility treatment, the practitioner may find such treatment ineffective during this time, only to realize the patient is not and cannot adhere to their treatment, due to cultural beliefs. Not only can a practitioner better serve patients through cultural awareness, they can further respect the autonomy of the patient. In this example of fertility treatment, the patient may not know how to explain the cultural belief that they cannot adhere to treatment at this time; a practitioner guided by cultural awareness, on the other hand, might be encouraged to ask more questions, rather than make assumptions about the reasons for a patient’s apparent refusal to comply with prescribed medical treatment.

Music & Dance

Within this ritual, participants may find relief through music and movement. As the psycho logical benefits of music have previously been established, the use of musical instruments like maracas and conchhorns, in conjunction with rhythmic prayers or chants, may alleviate anxiety and stress.[22] In addition, under the umbrella of dancemovement therapy, ritual movements combined with such music and chant may also be beneficial to wellbeing.[23] In a specific instance of a practitioner encouraging a geriatric patient to get more exercise, the practitioner may see beneficial results in a patient that participates in community ritual that incorporates physical activity.[24]

Spirituality

Spirituality has been positively correlated with psychological and physical health,[25] and sup ported by a medical practitioner’s cultural awareness, may improve treatment and therapeu tic relationships. The benefits of spiritual practice, as already well established in previous research, are worth noting in this ethnographic example.[26][27] Spirituality through ritual in general, as well as through prayer and expressions of gratitude, could have an impact on well being.

Mindfulness Meditation

Ongoing research on mindfulnessbased interventions has substantiated the approach’s strong clinical potential.[28] Activities like meditation and mindfulness have been shown to produce a number of health benefits. In this community’s ritual practice, moments where participants were still and attempting to be fully present with their bodies and the universe could serve as what could be viewed as mindfulness meditation, which in conjunction with spirituality, expressions of gratitude, and prayer, could likewise be beneficial for participants.[29]

Somatic Symptoms

In this community, participants cite healings and remission of illness. While there may be no empirical evidence for the remission of malady through sacrifice, existing psychosomatic symptoms may be ostensibly interpreted as relieved through such practice.[30] In addition to the healing of the body through relief of psychosomatic symptoms in ritual practice, some evidence may point to a capacity of a healed mind to promote a healed body.[31][32] In the extreme perspective, some may believe that the body has potential to be regulated through meditative states similar to those observed in this ritual. In one study, Tibetan monks were able to raise the temperature of their fingers and toes 8° C through meditation alone;[33] following this line of reasoning, forms of sacrifice in this community could therefore be viewed by some as encompassing a similar potential for physical relief.

5. Conclusions

This miniethnography of communication suggests that healthcare practitioners should adapt a certain clinical cultural awareness.[34] In this specific instance, a community ritual led by an ethnically Maya shaman who was trained in Guatemala leading a community of immi grants as well as EuroAmericans, demonstrated potential health benefits. Such benefits may be attained through aspects considered adjacent to Western practices including dance move ment therapy, mindfulness meditation, and spirituality. However, this research does not claim that all traditional ethnic practices could be beneficial to wellbeing, as some traditional prac tices may be harmful.[35] This author argues, moreover, that medical practitioners should not participate or assume leadership in rituals for communities of which they are not members, as doing so would be out of scope of practice and could constitute cultural appropriation or medicalization. Instead, physicians may strive for a certain clinical culturalawareness and be cognizant of longstanding community practices that may promote health, and acknowledge that different people experience life and health in different ways.[36]

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[1] 1Pan SY, Litscher G, Gao SH,  et  al.  Historical  perspective  of  traditional  indigenous  medical  practices: the current renaissance and conservation of herbal resources. Evid Based Complement Alternat Med. 2014;2014:525340. doi:10.1155/2014/525340
[2] Phillipson JD, Anderson LA. Ethnopharmacology and Western medicine. J Ethnopharmacol. 1989 Feb;25(1):61-72.
|[3] Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology.
Annu Rev Clin Psychol. 2019;15:285-316. doi:10.1146/annurev-clinpsy-021815-093423
[4] Hilton L, Hempel S, Ewing BA, et al. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med. 2017;51(2):199-213. doi:10.1007/s12160-016-9844-2
[5] Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci. 2016;1373(1):114-127. doi:10.1111/nyas.13153
[6] Gu Q, Hou JC, Fang XM. Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis. Chin Med J (Engl). 2018;131(7):829-838. doi:10.4103/0366-6999.228242
[7] This research was funded by Northeastern Illinois University and was approved by institutional review board oversight for research with human participants. All participants received informed consent and participant identifying data has been concealed.
[8] Shaman is a term used by the principal informant in this community used to describe herself, along with the term Daykeeper or Calendar Keeper. She is ethnically Maya.
[9] Precise locations, names, and other identifiers have been redacted to protect the identity of this community.
[10] Rice, PM. Maya Calendar Origins. University of Texas Press. 2007.
[11] Ruegsegger   GN, Booth   FW. Health   Benefits  of  Exercise. Cold Spring Harb Perspect Med. 2018;8(7):a029694. Published 2018 Jul 2. doi:10.1101/cshperspect.a029694
[12] Gu Q, Hou JC, Fang XM. Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis. Chin Med J (Engl). 2018;131(7):829-838. doi:10.4103/0366-6999.228242
[13] Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci. 2016;1373(1):114-127. doi:10.1111/nyas.13153
[14] The Diagnostic and Statistical Manual of Mental Disorders
[15] Kaplan-Weinger, J, Ullman, C. Methods for the Ethnography of Communication: Language in Use in Schools and Communities (1st ed.). Routledge. 2014.
[16] Spradley,https://doi.org/10.4324/9780203123768
[17] JP. The ethno- graphic interview. New York: Holt, Rinehart and Winston. 1979.
[18] Bauman, R, Sherzer, J. The Ethnography of Speaking. Annual Review of Anthropology 4 (1975): 95-119.
[19] At Northeastern Illinois University
[20] Fadiman, A. The Spirit Catches You and You Fall Down. Farrar, Straus and Giroux. 1997. 978-0-374-52564-4
[21] Foster, LV.  Handbook to Life in the Ancient Maya World.  New York:  Facts on File.  2002.  ISBN  0-8160-4148-2. OCLC 50676955
[22] Martina de Witte, Anouk Spruit, Susan van Hooren, Xavier Moonen & Geert-Jan Stams. Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses, Health Psychology Review, 2020; 14:2, 294-324, DOI: 10.1080/17437199.2019.1627897
[23] Conceição LS, Neto MG, do Amaral MA, Martins-Filho PR, Oliveira Carvalho V. Effect of dance therapy on blood pressure and exercise capacity of individuals with hypertension: A systematic review and meta-analysis. Int J Cardiol. 2016 Oct 1;220:553-7. doi: 10.1016/j.ijcard.2016.06.182. Epub 2016 Jun 26.
[24] Joung HJ, Lee Y. Effect of Creative Dance on Fitness, Functional Balance, and Mobility Control in the Elderly. Gerontology. 2019;65(5):537-546. doi: 10.1159/000499402.
[25] Anandarajah G, Hight E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001 Jan 1;63(1):81-9. PMID: 11195773.
[26] Turner N, Hastings JF, Neighbors HW. Mental health care treatment seeking among African Americans and Caribbean Blacks: what is the role of religiosity/spirituality? Aging Ment Health. 2019;23(7):905-911. doi:10.1080/13607863.2018.1453484
[27] Dein S. Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care. BJPsych Bull. 2018;42(3):127-129. doi:10.1192/bjb.2017.13
[28] Shapero BG, Greenberg J, Pedrelli P, et al.. Mindfulness-based interventions in psychiatry. Focus 2018; 16(1): 32–39.
[29] Wielgosz J, Goldberg SB, Kral TRA, Dunne JD, Davidson RJ. Mindfulness Meditation and Psychopathology.
Annu Rev Clin Psychol. 2019;15:285-316. doi:10.1146/annurev-clinpsy-021815-093423
[30] Simkin DR, Black NB. Meditation and mindfulness in clinical practice. Child Adolesc Psychiatr Clin N Am. 2014 Jul;23(3):487-534. doi: 10.1016/j.chc.2014.03.002. PMID: 24975623.
[31] Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, Urbanowski F, Harrington A, Bonus K, Sheridan JF. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003 Jul-Aug;65(4):564-70.
[32] Pace TW, Negi LT, Adame DD, et al. Effect of compassion meditation on neuroendocrine, innateimmune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009;34(1):87-98. doi:10.1016/j.psyneuen.2008.08.011
[33] Benson, H., Lehmann, J., Malhotra, M. et al. Body temperature changes during the practice of g Tum-moyoga. Nature 295, 234–236 (1982).
[34] Moreira-Almeida A, Koenig HG, Lucchetti G. Clinical implications of spirituality to mental health: review of evidence and practical guidelines. Revista Brasileira de Psiquiatria. 2014;36(2):176-182. doi:10.1590/1516- 4446-2013-1255.
[35] United Nations and The Rule of Law. Harmful Traditional Practices Affecting the Health of Women and Children (Fact Sheet No. 23)
[36] Toye F. ’Not everything that can be counted counts and not everything that counts can be counted’ (attributed to Albert Einstein). Br J Pain. 2015;9(1):7. doi:10.1177/2049463714565569

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