Health and the Kiche

The development of the field of medical anthropology has been a testament to the recognition of the cultural diversity that exists among contemporary societies. Initially developed as a tool to understand cultural variations in kinship, religion, subsistence patterns and enculturation, more recent work has been targeted to humanize the increasingly bureaucratic and impersonal aspects of biomedical care (Baer, Singer, & Susser, 2003:19). The emergence of fields like critical medical anthropology have prompted researchers to re-analyze the very framework of western cultural thought, turning critical analysis back towards deconstructing biomedicine’s ideological roots. Decades of participant observation work has led us to realize that at the core of every cultural system lies particular conceptions of the �body’ and �mind’, which in fact dictate the underpinnings of its healthcare system. Recent pioneer studies and ethnographies have not only allowed us to unravel some of these complex cultural perceptions but have also questioned existing western ideologies, such as the stark distinction between the �psychological’ and the �biological’, exposing their inherent bio-cultural fallacies and assumptions. In an attempt to elucidate how alternative socio-cultural conceptions of the �self’ can influence perceptions of health and well being, this paper draws on ethnographies from the K’iche’ culture of Guatemala to question some of the concepts of �body’ and �mind’ considered highly fundamental to biomedicine.

Paradigmatic to biomedicine is the cultural notion referred to as Cartesian dualism – the separation of the mind from the body, spirit from matter and real from the unreal (Hughes and Lock, 1987: 6-7). Its reductionist view of the human body as comprising of discrete organs, each one with its own function signifies the materialism and absolute dichotomies western medicine is based on. The consequences of this materialism are evident in the wholesome dependency of biomedicine on quantitative markers to determine illness causalities and in their failure to conceptualize a �mindful’ causation of somatic states. This radical materialist view of biomedicine evident in the classification of illness as being either somatic or psychological, physical or mental is a product a broader epistemological history, going as far back as Aristotle and Hippocrates’s starkly biological view of the body. The rather artificial separation of the body from the mind was reinforced by philosopher Decartes who argued the existence of dualisms in the body and nature, reflections of which are seen in the origins of western medicine three hundred years ago (Hughes and Lock, 1987: 9). Even with the recent inclusion of psychiatry and psychosomatic medicine as a part of clinical theory and practice, the notion of the disease residing in either the mind or the body still overshadows any clinical diagnosis.

In contrast, the K’iche’ culture represents an alternative to the reductionist standpoint taken by biomedicine, one that is far more universal to cultures across the world. The K’iche’ share a more cosmological view of nature, considering themselves to be an integral but dynamic part of nature. This holistic epistemological concept is referred to as balanced complementarity, where the relationship of parts to the whole is emphasized. (Hughes and Lock, 1987: 12). The K’iche’ understanding of complementarity is also translated into their perception of health, which requires a balance be maintained in nature and between the different facets of life such as hot and cold. Unlike the biomedical notion of illness representing the body’s response to a pathogen, the K’iche’ culture views illness as a consequence of imbalances in nature. Such naturalistic etiologies, termed as yab’ilal, manifest symbolically, echoing the natural cause of disturbance such as hot or cold, wet or moist. As a consequence, treating the illness focuses on balance restoration through complementary natural sources rather than adopting an antagonistic approach to �ward off’ or �fight’ against the infectious agent (Adams and Hawkins, 2007: 70-71).

The K’iche’ concept of balanced complementary is not solely limited to natural or physical entities but also extends into the social fabric of society. The K’iche’ view the body as a unitary but integrated aspect of the self and social relations, and in many ways a reflection of the social body. In fact, the western notion of the 'self' as being a bounded, unique individual, autonomous in emotion, judgment and action, is a remarkably rare concept in world cultures (Hughes and Lock, 1987: 14). Just as balance in nature can influence