Linda C. Garro

Narrative representations of chronic illness experience: cultural models of illness, mind, and body in stories concerning the Temporomandibular Joint (TMJ)

The narratives individuals told about their experiences with an illness they have come to understand as TMJ, a problem linked to the temporomandibular joints of the jaw, are complex. Each is embedded within a unique set of life circumstances and guided by individual schemas and explanatory models. Each recounts how persons have come to make sense of perplexing symptoms that are not easily categorized and treated within the North American health care system. Yet, in spite of their distinctiveness, the reconstructed narratives are not independent of shared cultural schemas, such as those relating to mind and body, and other shared models, such as the model for TMJ, which individuals come to adopt as a consequence of treatment and interaction with others. The consistent emergence of themes concerning the mind and body within and across narratives attest to their salience for understanding the narratives related here. While describing the effect of illness on individual lives, narratives also illuminate how shared understanding shape the interpretation and construction of individual experience.

Individual or societal responsibility? Explanations of diabetes in an Anishinaabe (Ojibway) community.

In recent years, many aboriginal communities in North America have experienced increasing rates of maturity onset diabetes. This paper is based on interviews held with individuals diagnosed with diabetes in an Anishinaabe community in Manitoba, Canada. The varying ways people account for their own case of diabetes and the increase in diabetes generally are described. Although people talk about diabetes as a result of individual dietary choices, much of the discourse links diabetes to environmental and societal changes.

Ethnographer's Toolkit:

The Ethnographer’s Toolkit (hereafter, the toolkit) consists of seven volumes, available separately or as a set. With the exception of volume 2, whose first author is Stephen Schensul, Jean J. Schensul and Margaret D. LeCompte alternate first authorship and are the sole authors of volumes 1 and 5. Those contributing to chapters in the remaining volumes are listed as authors of the volumes in which their work appears. The advance publication notice I received from the publisher proclaimed that the series covered “everything you need to know about doing ethnography in one package,” with the volumes designed to take the “novice fieldworker . . . through the multiple, complex steps of doing ethnographic research in simple, reader-friendly language.” These statements, the rest of the publisher’s write-up, and the title left me with the impression that this series would be useful, either as a resource or potentially as individual textbooks, when teaching introductory ethnographic research methods to either graduate or undergraduate students in anthropology. So, I was a bit surprised when the first line of each volume referred to “applied ethnographic research,” with the intended audience characterized as “educators; service professionals; professors of applied students in the fields of teaching, social and health services, communications, engineering, and business; and students working in applied field settings” (1:xiv). (More recent promotional material targets applied university-affiliated researchers.) In spite of the emphasis on using ethnography for identifying and solving human problems, the series touches only briefly on what the authors refer to as “compressed designs”—rapid ethnographic assessment or focused ethnography—and the value of long-term involvement at field sites is stressed repeatedly. At the same time, although the authors assert that the validity of one’s data depends on the cultural appropriateness of the collection process, the implications of these assertions for the conduct of ethnographic research are not explored in any depth, nor are references to relevant literature pro-

CULTURAL COMPETENCE AND PSYCHOTHERAPY: APPLYING ANTHROPOLOGICALLY INFORMED CONCEPTIONS OF CULTURE

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinmans (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlors (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Intracultural variation in causal accounts of diabetes: A comparison of three Canadian Anishinaabe (ojibway) communities

This paper presents a methodological approach for examining variation and consensus both within and between research settings and for addressing issues of generalizability and replicability. The comparison is based on how individuals diagnosed with diabetes and living in three Canadian Anishinaabe (Ojibway) communities explain diabetes and talk about their responses to the illness. Two kinds of interview format are used — an open-ended explanatory model type interview and a more structured, true-false, interview, amenable to analysis with cultural consensus theory. The responses given in both interviews converge on a set of explanations which can be found in all three communities, although differences occur in how these explanations are framed and emphasized. Implications of these differences and how these accounts relate to how individuals respond to diabetes are discussed. It is argued that the analysis of both interview formats leads to a deeper and more finely nuanced representation of understandings about causes of diabetes across the three communities than could be achieved by using one alone.

Culture: The missing link in health research

Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors. We first highlight the lack of progress made in the health sciences to explain differences between population groups, and then identify 10 key barriers in research impeding progress in more effectively and rapidly realizing equity in health outcomes. Second, we highlight the primarily mono-cultural lens through which health behavior is currently conceptualized, third, we present a consensus definition of culture as an integrating framework, and last, we provide guidelines to more effectively operationalize the concept of culture for health research. We hope this effort will be useful to researchers, reviewers, and funders alike.

Decision-Making Models of Treatment Choice

When people perceive themselves as ill, they may do a number of things. They may do nothing. They may try to treat the illness by themselves or within the family. They may consult with friends and relatives about what they should do. They may seek care from a number of different sources, including but not limited to physicians. Indeed, studies carried out in North America and Great Britain indicate that roughly 70 to 90 percent of all illness episodes are never seen by a physician (Hulka, Kupper, and Cassel, 1972; White, Williams, and Greenberg, 1961; Zola 1972, 1973). Many of these illness episodes are treated within the family, yet little attention has been given to this dimension of health care by researchers (Dean, 1981; Kleinman, 1980). Another alternative to the physician is traditional or folk healers. Anthropologists working in a variety of cultural settings have detailed how folk healers relate, interact and contrast with people seeking help and other providers of health care (e.g. Garro, in press; Janzen, 1978; Kleinman, 1980; Lock, 1980; J. Young, 1981a). Additional alternatives that vary across cultural settings include pharmacists, osteopaths, chiropractors, faith healers, health food and vitamin vendors, and quacks.

Continuity and change: the interpretation of illness in an Anishinaabe (Ojibway) community.

Rich descriptions of Anishinaabe medical knowledge and the cultural meanings associated with illness are available in the anthropological literature, especially in the writings of A.I. Hallowell. Most of this work is based on fieldwork carried out prior to 1940 and was often motivated by a desire to reconstruct the pre-contact situation. Since that time, there have been numerous changes affecting health status and health care. This paper examines lay medical knowledge in a contemporary Canadian Anishinaabeg community, with particular attention to change and continuity in the way people explain and respond to the occurrence of illness.

Chronic illness of the temporomandibular joints as experienced by support-group members

Purpose: For temporomandibular disorders, the clinical situation is one of considerable etiologic, diagnostic, and therapeutic uncertainty. Using interview data, this report describes this condition and the search for care from the perspective of sufferers who are support-group members.Participants and methods: Thirty-two individuals participated; all were members of a support group for individuals with long-term problems attributed to the temporomandibular joints and/or the surrounding masticatory muscles. Using a structured, open-ended interview format, this study investigated how individuals understand and give meaning to their symptoms, their patterns of care seeking, and the consequences of the illness on their lives. The participants also completed several structured questionnaires.Results: For these support-group members, symptoms extended beyond the jaw and surrounding area, with extensive musculoskeletal involvement and resulting dysfunctions that have far-reaching consequences for the sufferers’ lives. Primary care physicians are often consulted, especially early in the illness history. They also provide ongoing care and are asked for guidance when patients seek specialized treatment. A striking aspect of the findings from the interviews is the complex and costly pattern of health care seeking. This extended search for effective treatment is examined with reference to culturally based understandings, shared by patients and clinicians, about the nature of illness.

“A Massive Long Way”: Interconnecting Histories, a “Special Child,” ADHD, and Everyday Family Life

Focusing on one family from a study of dual-earner middle-class families carried out in Los Angeles, California, this article draws on interview and video-recorded data of everyday interactions to explore illness and healing as embedded in the microcultural context of the Morris family. For this family, an important aspect of what is at stake for them in their daily lives is best understood by focusing on 9-year-old Mark, who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). In this article, we grapple with the complexity of conveying some sense of how Mark’s condition is experienced and relationally enacted in everyday contexts. Through illuminating connections between lives as lived and lives as told, we explore the narrative structuring of healing in relation to Mark’s local moral world with the family at its center. We examine how his parents understand the moral consequences of the child’s past for his present and future, and work to encourage others to give due weight to his troubled beginnings before this child joined the Morris family. At the same time, we see how the Morris parents act to structure Mark’s moral experience and orient to a desired future in which Mark’s “success” includes an appreciation of how he is accountable to others for his actions. Through our analyses, we also seek to contribute to discussions on what is at stake in everyday life contexts for children with ADHD and their families, through illuminating aspects of the cultural, moral and relational terrain that U.S. families navigate in contending with a child’s diagnosis of ADHD. Further, given that ADHD is often construed as a “disorder of volition,” we seek to advance anthropological theorizing about the will in situations where volitional control over behavior is seen to be disordered.