The 72 Diseases free listed for the Pile Sort
Alternative medicine is often embedded in a society’s social and cultural beliefs. Every society has its unique social and cultural belief system in health and diseases, and this can influence how people understand and classify diseases. Such classification system embedded in local social and cultural system is referred as folk taxonomy in anthropological terms as suggested by Emile Durkheim in 1912, and this classification is often based on people’s own cultural belief system rather than scientific knowledge. Folk taxonomy is noted as a form of ethnoscience, which “refers to system of classification that people construct to organize knowledge of their universe… Such systems are based on taxonomic hierarchies in which some entities are ordered hierarchically…and other entities are contrasted taxonomically” . Understanding the folk taxonomies of diseases will be another important approach in understanding people’s therapeutic approach(es), since their cultural understandings on diseases can be crucial in influencing their choices of remedy. As Kleinman (1980) stated,
Since beliefs about illness are always closely linked to specific therapeutic interventions and thus are systems of knowledge and action, they cannot be understood apart from their use.
Beliefs about illness, the central cognitive structure of every health care system, are closely tied to beliefs about treatment. Thus, ideas about the cause of illness (as well as its pathophysiology and course) are linked to ideas about practical treatment interventions. Part of medicine’s therapeutic mandate is that sickness beliefs organize health care seeking choices and treatment interventions .
The motivations for seeking alternative medicine for therapy are many, and they are never simple. As treatment decision is closely related to the cultural beliefs about illnesses and diseases, hence Kleinman (1980) argued that a structural analysis of the cultural understandings and classification of diseases, ie. folk taxonomy of diseases, can enable the understanding of people’s motivations in practicing alternative medicine. “Medical anthropologists have shown that the application of values to types of illness has an important influence upon the decisions people make in responding to particular episodes of sickness” .
Hong Kong is a medical pluralistic society. Alongside the mainstream medical system of biomedicine, other alternative medical systems such as traditional Chinese medicine,
Qigongand tai chiin Hong Kong
Little literature has provided a clear definition of
Two categories of
Four major traditions are noted within the category of soft
Contrary to popular perception,
As there are different traditions of
1.3. History of
qigongdevelopment as alternative medicine in Hong Kong
In Hong Kong, the practice of “active gong” –
it was only after 1949 that
In accordance with the four traditions,
The founder of
In Mainland China, the transition from martial arts tradition to health orientation of
The health orientation of
To understand how the cultural perceptions of
2.1. Free listing
The 57 participants were asked to free list all the diseases that they knew and/or have heard at the time of study. This was to ensure the selected seventy-two diseases could represent the range of diseases that the participants, and so the public to some extent, were familiar with. The seventy-two diseases mentioned by the participants and used in the pile sort were shown in Table 1.
|Allergic Rhinitis||ALR||過敏性鼻炎 (鼻敏感)||32||30||49|
|Colon and Rectal Cancer||CRC||大腸癌||57||57||57|
|Hand, Foot, and Mouth Disease||HFM||手足口病||57||11||1|
|Systemic Lupus Erythematosus||SLE||紅斑狼瘡||57||41||43|
2.2. Pile sort
After the free listing, the names of the mentioned seventy-two diseases were printed on a set of cards. The same set of 57 participants was asked to classify these seventy-two diseases into groups according to their own knowledge and classification criteria. They were asked to put those diseases which they thought to be similar together in the same pile. The therapeutic choices on these seventy-two diseases were also asked (Table 1). By doing this, it demonstrated not only the folk taxonomy of diseases of each participant, but also the relationship between the folk taxonomy of diseases and the therapeutic choices, as well as the practice of alternative medicine, among the participants in Hong Kong context. As the folk taxonomy of diseases reflects the underlying cultural perception of health and diseases, this experiment enabled the exploration of how close the relationship between the underlying cultural health and disease belief and the practice of
3.1. What was shown from the free listing?
The free listing of diseases from the participants showed that the concept of “disease” could be varied. Some of the items listed by the participants were “symptoms” rather than “diseases” from the biomedical point of view. The participants perceived uncomfortable and abnormal feelings, or “symptoms” in the biomedical sense, as diseases, and their descriptions could be different from the biomedical explanations. The fact that some of the participants perceived “symptoms” and “discomforts” as diseases introduced a conceptual distinction between “illness” and “disease”. Kleinman indicated that illness could include people’s responses to symptoms, and they could perceive “symptoms” as “diseases” in this sense,
illness…means to conjure up the innately human experience of symptoms and suffering. Illness refers to how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability…
Disease is the problem from the practitioner’s perspective. In the narrow biological terms of the biomedical model, this means that disease is reconfigured
In many cases, the participants had already classified the diseases into groups in their free listing. They would free list the diseases together if they perceived them as having similar elements and nature.
The participants also tended to free list those diseases that caught their attention most and that they were most familiar with in the first instance. They started with the more serious and life-threatening diseases, such as cancers and heart disease. They then proceeded to free list those diseases that occur commonly and which they often experienced, such as cold and flu.
The free listing also features common diseases in a society, those which have been present for a long time as well as those which have recently emerged. Hand, foot, and mouth disease, for example, was a new disease common in kindergartens and widely reported in the media at the time of the study, hence it was mentioned frequently by the participants.
In addition, the free listing of diseases could be time- and/or environment-bound. As the free listing was conducted in summer, therefore those diseases that mainly occur in summer, such as cholera, were often mentioned. Presumably the results of the free listing would vary depending on time and context. The free listing could thus reflect the social and cultural environment of a society.
The diseases free listed by the participants not only reflected a culture’s focus on disease, but also portrayed the institutional and social forces shaping the social beliefs and ideology on health and diseases of people. Female participants tended to free list more diseases than male participants. This could be related to their higher ratio in engaging domestic role in which they could have more time to learn about diseases from various media. The “women’s television programmes” in the afternoon, in particular, could be a popular medium for housewives to learn about diseases that were of current concern. On the other hand, male participants were more reluctant to free list sexually-transmitted diseases and those diseases that were suffered by females exclusively.
The free listing gives a general picture of how people of a culture view diseases, and how the social, environmental, and institutional forces influence people’s views on diseases. The free listing shows how people organize the knowledge of diseases, and the diseases in which a society is familiar with and concerns about. Therefore, free listing of diseases can reveal the difference between cultural belief system of “diseases” and biomedical point of view.
3.2. Folk taxonomies of diseases as mentioned by the participants
After the disease free listing, the participants were asked to do pile sort in which they were asked to classify the free listed diseases into groups. They were asked to put those diseases which they thought to be similar together in the same pile according to their own knowledge and understanding. The 57 pile sorts were analyzed by ANTHROPAC. A multidimensional scaling diagram of the 72 diseases was generated and constructed by ANTHROPAC according to the classification of the 57 participants (Figure 2). This showed how the participants classified diseases according to their own knowledge. Those diseases that were located closely together were perceived as similar by the participants.
Several clusters, ie. folk taxonomies, of diseases in Hong Kong context were illustrated from the multidimensional scaling diagram (Table 2). The folk taxonomies illustrated how the participants perceived and organized the knowledge of the free listed diseases. Those diseases in the same taxonomy were sharing similar nature and characteristics according to the participants.
Eight clusters were noted in participants’ folk taxonomy of diseases.
|1||Bone cancer, brain cancer, nasopharyngeal cancer, leukemia, colorectal cancer, gastric cancer, lung cancer, liver cancer, cirrhosis, renal disease, kidney stone, gallstone, hepatitis.|
|2||Cholera, malaria, Dengue Fever, Hand foot and mouth disease, German measles, measles, urticaria, psoriasis, eczema, chicken-pox, athlete’s foot, syphilis, herpes.|
|3||Fever, cold, asthma, tuberculosis, allergic rhinitis, cough, influenza, sore throat, pharyngitis, otitis media, bronchitis, sinusitis, tonsillitis.|
|4||Appendicitis, hemorrhoid, cystitis, urethritis, gastric ulcer, gastric bleeding, pneumonia, emphysema.|
|5||Osteoporosis, spurs, rheumatism, gout, stroke, arthritis.|
|7||Parkinson’s Disease, Alzheimer’s Disease, Down’s Syndrome, epilepsy, mental illness.|
|8||Systemic Lupus Erythematosus, meningitis, dizziness, headache.|
This cluster consisted those diseases that were serious and life-threatening from the participants’ point of view and those diseases that often required surgical treatment, such as cancers, kidney stones, and gallstones. On the other hand, the language of a culture also influenced the perceptions and cultural beliefs of people and the ways in which they classified diseases. Hepatitis was situated next to the gallstone in this cluster because, according to some participants, there was a Chinese slang expression which literally means “liver and gall bladder help and complement with each other” (肝膽相照). See the Sapir-Whorf Hypothesis, as recounted in Bonvillain (2000),
Some elements of language, for example, in vocabulary or grammatical systems, influence speakers’ perceptions and can affect their attitudes and behavior… In fact, both Sapir and Whorf wavered in their statements on the issue of causal or directional relationship between language and thought .
This cluster consisted infectious and contagious diseases from the participants’ point of view. This mainly included dermatological diseases. All dermatological diseases were included in this cluster. Other infectious diseases that are not dermatological but with skin symptoms were also classified in this category. Some other infectious diseases such as cholera, malaria, and Dengue Fever were in this cluster as well. Such lay classification revealed the underlying perceptions of the participants on dermatological diseases as contagious (though not all of them were contagious), which were perceived as similar to those infectious diseases such as cholera, malaria, and Dengue Fever. On the other hand, the participants perceived some infectious diseases as dermatological, even though they are infectious in nature. For example, German measles, measles, and hand, foot and mouth disease are infectious in nature. However, because the symptoms of these diseases often appear on skin, this led the participants to have an impression that infectious diseases were similar to dermatological diseases.
The sexually-transmitted diseases, such as syphilis and herpes, were located closely to this cluster of infectious and dermatological diseases. Besides the contagious nature and the skin symptoms, the specialty classification in Hong Kong’s biomedicine also played a role in influencing participants’ perceptions, since both the sexually-transmitted diseases and dermatological diseases were under the same specialty – Dermatology and Venereology . The biomedical institution thus constructed the disease perceptions of the participants. From the participants’ viewpoints, the diseases in this cluster were infectious and contagious.
This cluster consisted the diseases and symptoms of the upper and lower respiratory system, which were perceived as common for anyone to suffer. Again, the specialty classification in Hong Kong’s biomedicine played a role in influencing participants’ perceptions in this group of diseases, as some participants indicated that most of the diseases in this cluster were under the specialty of otorhinolaryngology .
This cluster mainly contained the diseases in relation to gastrointestinal and urological system. However, two diseases in relation to breathing system were also grouped in this category. In participants’ terms, the diseases in this cluster were related to “internal organs”.
This cluster was made up of those diseases that were perceived as having a long-term impact on patients, or chronic diseases. This cluster mainly consisted bone and joint diseases. Some participants used age as a criterion in grouping these diseases together in the same category, having the impression that these diseases were mainly suffered by the elderly.
This cluster consisted of ophthalmological diseases in participants’ understanding. The diseases of glaucoma and cataract were usually straightforward to participants, since they often grouped these two diseases together in the same pile quickly.
This cluster contained those diseases that were related to mind, nerve, and brain function, and the participants often had the impression that these diseases were chronic and incurable. Another feature noted in this cluster was that the participants often did not have much knowledge on these diseases, since many of these names were new and “foreign” to them.
This cluster contained diseases in relation to head, though Systemic Lupus Erythematosus was located in this cluster as well. Some participants commented as Systemic Lupus Erythematosus has skin symptoms, especially in the area of face. Therefore, they grouped this disease under the category of “head”.
The folk taxonomies of the seventy-two diseases showed how the participants organized and understood diseases by using their own cultural beliefs. From the multidimensional scaling diagram as shown in Figure 2, there were at least two scales at work regarding the nature of the diseases. On the first scale, the diseases perceived as life-threatening were located at one end, while the diseases perceived as infectious and contagious, and as chronic and incurable, were located at the other. In the second scale, the diseases perceived as chronic and long term were located at one end, and the diseases perceived as acute and short term were located at the other. Such scaling demonstrated when the participants made classifications, whether the diseases are life-threatening or not and whether they are acute or chronic were the subconscious force at work in their perceptions.
3.3. The interrelationship between the folk taxonomy of diseases and the choices of remedy
Cultural belief system affects how people organize their knowledge on diseases. In addition, common sense, lay perceptions, and illness and treatment experiences also influence people’s decisions in choosing remedy. This section will examine the interrelationship between the folk taxonomy of diseases and the choice of therapies, and whether the same choice of therapies were to be used on the same clusters of diseases among the participants. The participants’ choices on the therapeutic approaches provide a framework of the underlying reasons for their
After the pile sorts, the participants were asked about their choice of therapies in dealing with those seventy-two diseases. They were asked to rank their choice of therapeutic approaches for suitability (Table 1). Their treatment decisions were to be compared with their folk taxonomy of diseases. Treatment choices are to be influenced by one’s cultural beliefs. As Kleinman (1988) stated:
local cultural orientations (the patterned ways that we have learned to think about and act in our life worlds and that replicate the social structure of those worlds) organize our conventional common sense about how to understand and treat illness; thus we can say of illness experience that it is always culturally shaped… Expectations about how to behave when ill also differ owing to our unique individual biographies .
An obvious interrelationship between the folk taxonomy and treatment choices was noted for cluster 1 diseases, which were perceived as life threatening and serious. As most of the diseases in this cluster were cancers that were life-threatening, all 57 participants had no hesitation in asserting that they would try all forms of remedies, including biomedicine, traditional Chinese medicine,
Although the participants would use all the remedies they knew for life-threatening diseases, the acceptability of alternative medicine was much higher for cancers than for renal disease, kidney stones, and gallstones. Some participants even would try all sorts of alternative medicine for the treatment of cancers, no matter how “strange” the remedies were. However, participants tended not to search alternative remedies for renal disease, though a few would search for
Another cluster of disease which showed clear corelation between folk taxonomy and treatment choices was dermatological, sexually-transmitted, and infectious diseases. Most participants would first seek biomedicine for therapy for this cluster of diseases, and then some of them, especially those older ones, would use traditional Chinese medicine afterwards. The underlying Chinese cultural belief in health motivated these participants considering traditional Chinese medicine for remedy. In that case they would perceive their body suffered from “wet toxin” (濕毒). As this concept is embedded in traditional Chinese medicinal belief, therefore adopting the remedy with the same cultural medicinal belief would be perceived as a “sensible” solution for the participants. On the other hand, the participants believed biomedicine was the best remedy for contagious diseases. As contagious diseases were more “polluting” in both physical and cultural sense, participants would prefer the remedy that they were most confident. Also, biomedicine often gave an impression “quick” to the participants, therefore biomedicine was often attempted in order to get rid of such social labeling as soon as possible.
Social and cultural environment and gaze on certain groups of diseases also influenced participants’ decision in remedies. As shown from the folk taxonomies in the multidimensional scaling diagram, dermatological diseases located closely to sexually-transmitted diseases. Sexually-transmitted diseases receive much stigmatization in Chinese culture. As dermatological diseases located closely to the cluster of sexually-transmitted diseases, which indicated these two types of diseases were similar from participants’ viewpoint, presumably the participants would want to get rid of dermatological diseases in order to avoid being stigmatized. As biomedicine was perceived as giving a quick treatment, the participants were thus motivated to choose biomedicine in the first instance.
Age was another influential element in predicting how participants choose treatment approach. Same disease could be perceived differently by different age groups. Take inflammatory disease as an example, the treatment choices can be varied for different age groups. Younger participants were more under western cultural exposure so they were more motivated and ready in choosing biomedicine. Antibiotics were widely known by these young participants. In contrast, middle-aged and the elderly participants would prefer traditional Chinese medicine more as they were under more influence of Chinese culture. They believed many inflammatory diseases, and dermatological diseases, were induced by the “wet hot” (濕熱) and the toxins of the body, and the best way to deal with these bad forces was the use of traditional Chinese medicine in order to “clear the root”.
Whether the disease itself has a cultural medicinal explanation would be remarkable in participants’ choice of alternative medicine. If the disease had a cultural medicinal explanation, participants would be more motivated in using alternative medicine. As alternative medicine is embedded in a community’s cultural belief, therefore using the same cultural medicinal approach is to be perceived as the most optimal approach. Just like “wet hot” and toxins is a Chinese cultural medicinal concept, hence these problems are believed to be best overcome by the Chinese approaches.
Another cluster which demonstrated a clear relationship between folk taxonomy and treatment choices were ophthalmological diseases. There was a strong preference in biomedical treatment among the participants in this category of diseases. As the biomedical treatment of ophthalmological diseases has long been established, hence the participants believed that only biomedicine and surgery could treat these diseases. Only a few older participants would attempt traditional Chinese medicine and
Language influences how people think and perceive things. As demonstrated by the participants, the names of diseases could serve as an influential factor for determining suitable remedy. The participants tended to seek biomedical remedies for the cluster of brain, mind, and nerve diseases. As the names of the diseases, ie. Parkinson’s Disease, Alzheimer’s Disease, Down’s Syndrome, in this cluster are “western” and “foreign” to them, they believed biomedicine was better in treating these “western” diseases. Another example was German Measles. All the participants would choose biomedicine as treatment for German Measles, though more participants would choose traditional Chinese medicine for ordinary measles instead.
Although gastrointestinal, urological, and lung diseases were in the same cluster according to the participants, treatment choices varied for these three groups of diseases. Participants preferred adopting biomedicine as the first line of treatment for the gastrointestinal and lung diseases, whereas they preferred traditional Chinese medicine in urological diseases such as cystitis and urethritis, and hemorrhoid, though younger participants would prefer biomedicine for urological diseases. For lung diseases, the acceptability of alternative medicine such as traditional Chinese medicine and
Alternative medicine was shown to be popular in dealing chronic and long-term diseases, and the findings from the participants demonstrated the same picture. Traditional Chinese medicine and
Bone and joint diseases was another cluster which showed the strongest correlation between the folk taxonomy and alternative medicine practice as suggested by the participants. Most participants would choose
For the cluster of diseases that were more common and less serious, such as those in relation to upper respiratory tract infections, the acceptability of traditional Chinese medicine as a remedy was high among the participants. However, the interrelationship between the diseases in this cluster and the choice of remedy was rather weak. Some participants would choose biomedicine as first line for remedy on account of its fast relief and efficacy, while others would choose traditional Chinese medicine as first line treatment. But in general older participants tended to choose traditional Chinese medicine as the first option for these diseases. Only when they failed to experience the efficacy that they would then turn to biomedicine for treatment.
The above findings illustrate that the folk taxonomies of diseases are closely related to people’s organization of disease knowledge and perceptions, which is often based on their cultural belief system. This influence their treatment choices and decisions to a certain extent. From the participants’ choices of therapies and their explanations on their treatment decisions, they usually had their own interpretations on the best treatment for those diseases. These revealed how they perceived the strengths and weaknesses of biomedicine, traditional Chinese medicine, and
From the participants, the folk taxonomy consisting the relatively more serious diseases such as the life threatening diseases, the contagious and dermatological diseases, and ophthalmological diseases, a remarkable correlation with biomedicine was observed. In contrast, for the folk taxonomy that consisted of the less serious diseases such as the non-life threatening chronic diseases and the bone and joint problems, a strong correlation with alternative medicine practice such as traditional Chinese medicine and
Qigongpractice and the Chinese philosophical teaching
As alternative medicine practice is embedded in a community’s cultural belief system, therefore, the cultural values and ideal will be transmitted and reinforced through people’s practice. Alternative medicine practice also conveys other symbolic meanings as discussed by Lupton (2000), particularly the aspects of virtue and goodness within the Chinese culture.
Other than traditional Chinese medicine,
In the lectures of a
The importance of reaching a highly tranquil state recalls the importance of the ancient Chinese teaching about controlling the “seven emotions” (七情) properly, linking this with health. The ancient Chinese teachings, particularly the Confucian ideas, emphasize that one should not expose one’s emotions in a vigorous manner. The “seven emotions” include: happiness (喜), anger (怒), worry (憂), puzzle (思), sadness (愁), fright (驚), and fear (恐). If one expresses these emotions in a vigorous manner, one will fall short of the model of an ideal human. In the practice of
In the past, I often felt unhappy and got angry easily. I was often annoyed with the staff. As I could not scold them, so I lost my temper to my family instead… Perhaps I expected too much on the job, so it exerted a lot of pressure on myself… I think these negative emotions accumulated to cause the disease. If I had known how to control my emotions and express them properly in the past, I would not need to suffer [from cancer]. The practice [of
Hence, not only does
Morality in contemporary society is a result of the control of laws, which aim at controlling one’s behavior. It is very similar to
Some traditions of
The practice of
As demonstrated in this chapter, a community’s social and cultural belief system is remarkable in influencing people’s understandings on diseases. This affects how they perceive and classify diseases, which can be reflected from the folk taxonomy of diseases. As folk taxonomy is a classification system embedded in a community’s social and cultural beliefs, therefore each society has its own folk taxonomy of diseases. People’s cultural perceptions on diseases can also influence how they choose remedy, whether biomedicine and/or alternative medicine should be adopted. Alternative medicine is mostly embedded in the cultural beliefs of a community, hence it is mostly used on those diseases which can fit with their cultural understandings. Also, biomedicine has its own weaknesses and limitations, therefore, alternative medicine is often used on those diseases which cannot be handled by biomedicine. This chapter demonstrates how people’s cultural understandings on diseases can influence treatment approaches, and thus the practice of alternative medicine in Hong Kong.
Although cultural belief system can influence how people perceive and classify diseases and thus the disease folk taxonomy as well as their treatment choices, the interrelationship between folk taxonomy of diseases and treatment choices is not always absolute. As demonstrated by the participants, only some taxonomies of diseases, such as those that are life-threatening, serious, ophthalmological, and chronic bone and joint diseases show apparent relationship in the treatment choices. Treatment choices, however, are still more embedded in people’s cultural perceptions on individual diseases.
The use of alternative medicine was widely welcome by the participants, since they would attempt alternative medicine (traditional Chinese medicine and/or