CHAPTER-1

CHAPTER INDEX PAGE NO

1. INTRODUCTION 1-69
1.1. MEDICAL ANTHROPOLOGY 1-4
1.1.1 DEFINITIONS 1-3
1.1.2 HISTORY 3-4
1.2. STATEMENT OF PROBLEM 4-13
1.2.1 THE PRACTICE OF HERBAL MEDICINE AND 4-5
TRADITIONAL MEDICINE
1.2.2 THE PRACTICE OF HERBAL MEDICINE
7-8
AND CAM
1.2.3 THE PRACTICE OF HERBAL MEDICINE AND
FOLK MEDICINE 9
1.2.4 THE PRACTICE OF HERBAL MEDICINE AND 9-11
TRIBAL MEDICINE
1.2.4a AYURVEDA AND THE PRACTICE OF HERBAL 11
MEDICINE
1.2.5 THE PRACTICE OF HERBAL MEDICINE AND
ETHNOMEDICINE 12-13

1.3. RESEARCH PROBLEM 14-15

1.4. RATIONALE AND JUSTIFICATION BEHIND THE 15-17

STUDY
1.5. OBJECTIVES 17-18
1.6. HYPOTHESES 18-19
1.7 REVIEW OF LITERATURE 19-39
1.7.1 MEDICINE AND SOCIETY 19-20
1.7.2 HEALTH AND MEDICINE IN INDIA -A REVIEW 21-22
1.7.3 TRIBAL HEALTH AND MEDICINE 23-31
1.7.4 RURAL HEALTH AND MEDICINE 31-35
1.7.5 TRIBAL HEALTH STUDIES IN INDIA 36-39
1.8 THEORETICAL PERSPECTIVES ON MEDICINE AND 39-61
SOCIETY
1.8.1 THE SOCIOLOGY OF HEALTH AND ILLNESS 40-53
1.8.2 THEORETICAL UNDERPINNINGS OF MEDICAL 54-61
ANTHROPOLOGY
 CHAPTER: 1
INTRODUCTION

In contemporary society there is a resurgence of interest in herbal

medicine and other complementary and altemative medicine. As knowledge is
not fixed and constant rather dynamic and thus it is reinterpreted and
influenced by a particular historical, socio-cultural and political context;
Knpwledge of health, illness and medicine is also dynamic and complex
/(Geraldine Lee-Treweek [Link], 2005).
Medical Anthropology is one such body of knowledge which is
contributing to understand this dynamic and complex practice. A brief sketch
of medical anthropology is thus given as a part of introduction.

1.1 MEDICAL ANTHROPOLOGY:

During past several years many anthropologists have focused their attention
towards the problem of health and diseases woridwide cross culturally. It has
given rise to medical anthropology which is involved in carrying out
researches in the field of culture, illness and health, drug abuse, definition of
healths disease, ethno medicine, nutritional concepts, ethno physiology,
doctor-patient relationship, body symbolism,, preventive medicine, medical
ethics and so on (Tribhuwan, 1998). v ^

1.1.1 DEFINITIONS:
To begin with, the eariiest definition of medical anthropology was given by
Hasan and Prasad.

Hasan and Prasad (1959) defines "Medical Anthropology as that branch of

'Science of man', which studies biological & cultural (including historical)
aspects of man from the point of view of understanding the medical, medico-
historical, medico- legal, medico-social and public health problems of human
beings".(Hasan and Prasad,1959: 21-22).
^ b r e g a (1972) says, "A Medical Anthropology Is one that: (a) elucidates the
factors, mechanisms, and processes that play a role in or influence the way in
which individual and groups are affected by and respond to illness and
disease; and (b) examines their p r o b l ^ s with an emphasis on pattems of
behaviour" (Fabrega ,1972 :167\

C\' If ^-
Lieban ( 1 9 ^ defined medical anthropology as one which ".encompasses the
study of medical phenomena as they are influenced by social and cultural
features, and social and cultural phenomena as they are illuminated by theip^'
medical aspects" (Lieban, 1974:j[5^.

In other words, "Medical anthropology is not only a way of viewing the state
of health and disease in a society but a way of viewing society itself (Lieban,
ibid, 1974: 15).

Foster's (1978) twofold definition highlights the "bio cultural inter-relationship

between human behaviour" and "health and disease", as theoretical exercise
and the utility of this knowledge in health related planning "through changing
of health behaviourjn-direction believed to promote better health" (Foster,
1978:10). K^y^

"Medical anthropology is the holistic study of health, illness and related

misfortunes, as these are culturally perceived, labeled, classified, experienced
and communicated on the one hand, and socially constructed roles, statuses
and institutional networks which are believed to help in the health enhancing
process, on the other, with a view to identify cross-cultural similarities and
variations in the patteming of such behavior" (Joshi, 1990: 8).

Medical anthropology is the study of human health and disease, health cTare
systems, and Bio cultural adaptation (McElroy, 1996).

Medical anthropology can be shortly defined as that branch of anthropological

research that deals with the factors that cause, maintain or contribute to
disease or illness, and the strategies and practices that different human
communities have developed in order to respond to disease and illness (Baer
etal., 1Q97).

Medical anthropology is a sub-branch of anthropology that is concerned with

the application of anthropological and social science theories and methods to
questions about health, illness and healing (Bhasjn, 2007).

Medical anthropology is the study of ethno medicine; explanation of illness

and disease; what causes illness; the evaluation of health, illness and cure
from both an emic and etic point of view; naturalistic and personalistic
explanation, evil eye, magic and sorcery; bio cultural and political study of
health ecology; types of medical systems; development of systems of medical
knowledge and health care and patient-practitioner relationships; political
economic studies of health ideologies and integrating alternative medical
systems in culturally diverse environments (Bhasin, 2007). (^^^v r •>-1; r

Medicine, health and illness are all partly cultural categories and different
cultures have their own logic and altemative means to deal with these.
Medical anthropology looks at cultural conceptions of the body, health and
illness. It also focuses on health behaviour as a way to leam about social
values and social relations.

1.1.2. HISTORY:
Genesis and development of Medical Anthropology: .
• - / ' \ • ' '

George M. Foster and Barbaf^ Gallatin Anderson (1978) trace

the development of medical anthropology to four distinct sources: the
interest of early physical anthropologists in human evolution and
adaptation, ethnographic interest in primitive medicine, studies of
psychiatric phenomena in the culture and personality school, and
anthropological work in international health. William H. R. Rivers
(1924), a physician, is considered the first ethnologist of non-Western
medical practices.
 River's (1924) pioneering theoretical classic- "Medicine, Magic and
Religion" defined medicine as a cultural system. He perceived
medicine, magic and religion as "three sets of social processes so
closely interrelated that the disentanglement of each from the rest is
difficult or impossible" (Rivers, 1927: 1).Early theoretical work by
f o r r e s t E. Clements (1932) and Erwin H. Ackerknecht (1942, 1946)
also attempted to systematize primitive medical beliefs and practices.
Paralleling theory development were early applications of
anthropological principles to health problems. Since the 1940s
anthropologists have helped health care providers understand
cultural differences in health behaviors, as shown in Benjamin D.
Paul's edited volume "Health, Culture and Community: Case Studies
of Public Reactions to Health Programs" (1955), one of the first
medical anthropology [Link] Caudill (1953) was the first to
identify the field, followed by review articles by Steven Polgar (1962)
and by Norman Scotch (1963). Other active scholars were Hazel
•». — .. - ' .

Weidman, Arthur Rubel, Dorothea Leighton, Clifford Barnett, Marvin

Opier, Marion Pearsall, Donald Kennedy, Benjamin Paul, and Charles
Leslie (Hughes, 1968).

1.2 STATEMENT OF PROBLEM:

The research problem is Jo_understand the therapeutic practice of
Jierbal medicine in Munda tribal society. As health, disease and medicine are
dynamic in nature and cultural constructs, it is worth interesting and
fascinating to explore the ethno medical practices of tribal communities.
Health is a common theme in all cultures and every society has devised a
mechanism to cope up with the life threats in the form of ill health, disease,
and death, which is embedded in their bio-socio-cultural and ecological
diversity and level of technology (Park, 2007; Lieban, 1973).
Tribals, from time immemorial have sustained their life with various
ethno medical practices. Three major sources of their treatment and
therapeutics are primarily plants or flora, fauna and minerals. Plants have
been used for treatment of various ailments in different forms in their
livelihood strategy.
Munda are the third largest and one of the primary settler's tribe in
Chotanagpur region of Jharkhand. They belong to ProtOiAustralflid-_rjacial
stock and speak Mundari dialect of Austro-Asiatic language family. (The
detailed information of Munda tribe, is given in chapter III)

Figure 1.1:- Health care Systems: Herbal Medicine and others

1.2.1 The practice of Herbal medicine and tiie concept of

Traditional medicine:
The term Traditional Medicine (TM) has been variously conceptualized
largely because the range of items and structure which TM applies has been
described with different terminologies by different authors (Owumi, 1998).
According to the World Health Organization (WHO), the concept of TM eludes
precise and concise definition even at the global level (WHO, 2002).
 The therapies of the TM may include among others the use of herbs,
animal parts, minerals as well as non-medication therapies which includes the
acupuncture, manual therapies and spiritual therapies which may involve
Incantations to appease the spirits as in the case of the African traditional
medicine.
In 1978, a World Health Organization expert committee defined
traditional medicine as:"the sum of all knowledge and practices whether
explicable or not, used in diagnosis, prevention and elimination of physical,
mental or social imbalance and relying extensively on experience and
observation handed down from generation to generation, whether verbal or in
writing" (WHO, 1978, quoted in Erinosho, 1998). •
A more recent definition of TM sees it: "as including diverse health
practices, approaches, knowledge and benefits incorporating plant, animals
and/or mineral based medicines, spiritual therapies, manual techniques and
exercise applied singularly or in combination to maintain well being as well as
to treat, diagnose or prevent illness" (WHO, 2002).
Therefore, a traditional healer is any person who is endowed with the
knowledge and skills to maintain the health needs of the people of the
community using divination, medicinal herbs, symbolic rituals and
psychotherapy. The traditional healers prescribe medicines that are prepared
using animal parts, herbs, water, alcohol, roots, leaves and bark of trees
available in their community.
This signifies that TM consists of two major aspects: the physical
aspect (animal parts, leaves, barks etc) which is amenable to scientific test,
and spiritual aspect (incantations, incisions, sacrificial offerings, rituals etc)
which is not amenable to scientific tests. These healers have been found to
have greater influence and integrity in treating illness where change in
behaviour particularly of low status or less privileged or stigmatized patients,
is required (Erinosho, 1998). C -• - . ^•>''>- ^N>-^'^'',

Considering the definition of traditional medicine as given by WHO and

the dimensions entwined with the definition, we may presuppose that the
practice of herbal medicine found among Munda tribe is a kind of traditional
medicine and practitioners and healere are traditional healers; however the
difficulty with this definition and metaphor used is that it nuances towards a
static image of health, illness and medicine which is not true. The facts
indicate that the nature and scope of traditional medicine is always changing
across time and space. Secondly, as there is no precise definition of TM, its
fluidity may create confusion and lack of authentication.

1.2.2 The Practice of Herbal medicine and Complementary and

Alternative Medicine:
Complementary Medicine or Alternative Medicine as defined by
Stephen Fulder is. The aggregate of diagnostic and therapeutic practices
and systems which are separate from conventional scientific medicine.
They are usually less interventionist and technical and make more use
of self-healing capacities".
CAM Is neither a universally defined nor static term. CAM is a broad
domain of healing resources that encompasses all health systems, modalities,
and practices and their accompanying theories and beliefs, other than those
intrinsic to the politically dominant health system of a particular society or
culture in a given historical period. CAM includes all such practices and ideas
self-defined by their users as preventing or treating illness or promoting health
and well-being. Boundaries within CAM and between the CAM domain and
that of the dominant system are not always sharp or fixed.
(Zollman and Vickers, 1999, p.693; quoted In Geraldlne Lee-TreweekflzOOS)
\y
Comment:
First, this definition defines CAM in terms of what is not, rather than
what it is. This seems to make sense: after all, there is little to connect
iridology, chiropractic, the Alexander technique and Herbal medicine, other
than that they are not conventional or orthodox medicine as practiced in the
dominant health system.
Second, defining conventional medicine as that which is 'politically
dominant' in a 'particular society or culture in a given historical period' allow
CAM to vary with time and place because political systems are known to vary
between countries and over time.
Third, this definition implies that CAM is more difficult to delineate
where political systems are weaker.
 The distinguishing features of CAM through which we can differentiate
it with orthodox western or modem medicine* are:
• CAM as natural
• CAM as traditional and ancient
• CAM as energy
• CAM as holistic (Campbell, 2002)

The practice of herbal medicine like CAM is natural as the healing

techniques involved are nature based or derived from nature.
It is also mainly oral, age old practice, passed from generation to
generation in various form as a part of their culture. The practice of herbal
medicine identifies a patient as a whole entity rather than a mere biological
organism and so consider the socio-cultural and other dimensions of health.
Hence the therapeutic practice of herbal medicine can be considered
as a component of Complementary and Altemative Medicine.
However the problem with the concept of CAM is that its definition and
meaning varied from culture to culture. Complementary and alternative
medicine (CAM) is used in place of traditional medicine especially in countries
where the dominant health care system is based on the modem health care
system and the TM is seen as alien to the country's tradition and culture.
Therefore CAM is culture specific.
Secondly as the word indicates complementary medicine refers to a
kind of medicine which is complementary to dominant western allopath and
alternative medicine seems to be used in a sense of use of a medicine which
is different and can be used in lieu of allopath medicine. In contrast in tribal
society, neither the practice of herbal medicine is complementary or
altemative to westem modem medicine in same sense as used in westem
societies. Also any aspect of health, illness and medicine is considered
among tribal including Munda as an integral part of their bio-cultural
worldview.
1.2.3 The Practice of Herbal Medicine and Folk Medicine:
'FOLK MEDICINE' has been defined as, "The aggregate of practices,
remedies, and recipes which form a largely unwritten and unsystematic body
of knowledge among the lay population." (Fulder,j[9£6)^
Folk medicine can be conceptualized as health care and medicine practiced
by the folk communities who as Marriott has said are a part of little tradition
and emerged from their daily experience and local beliefs and lay man's
knowledge.
It is very difficult to differentiate in India the folk and the tribal
communities as a watertight compartment rather there is
intermingling/amalgamation of many practices, traditions, knowledge,
attitudes, beliefs as perceived about health, illness and medicine by the tribal
as well as other folk communities.
The folk system includes natural and supernatural, physical and
psychological, social and cultural and finally individual and societal aspects in
its conceptualization of health and its care. It is a complex but more
comprehensive approach to health care.
(Abraham, Leena,1991 : pp1-2).

1.2.4 The Practice of Herbal Medicine and Tribal Medicine or

Indigenous Medicine:
This term tribal medicine has been used by scholars for designating the
health practices, knowledge, beliefs, behaviour and attitudes about the health,
illness, and medicine {prevalent among the tribal communities (Jain, 1998
;Kalla, Joshi, & et^^i!^04;kumar. Anil: 2007).

Following are the important features of the tribal knowledge systems:

• They are based entirely on the locally available resources.

• They are based on a keen observation of nature.
• They serve a functional purpose and are therefore continuously put to
use.
• They survive through oral traditions and through active utilization
 • They are time-tested.
• Presence of both natural and supernatural elements integrated in an
inseparable way in its understanding of nature, health and disease.

These features in combination with religious supernatural beliefs, social

and cultural values from the totality of the tribal knowledge system (Abraham,
Leena; 1991, pp 5).

The basic tenets of tribal medicine are-:

1. Disease is not entirely a natural phenomenon. Supernatural forces

have a role to play.
2. The life of the individual is determined by certain body constitution. A
way of life (which also includes moral aspects) and environment
compatible with the body constitution ensures health.
3. Body, by nature, has the capacity to resist diseases.
4. Remedies should be used sparingly in order to assist the body's
efforts.
5. Remedies are usually accompanied by rituals which may or may not be
religious in character.
6. (i)Medical knowledge survives through oral traditions. Oral history is a
living tradition and is closely connected with their mythologies, legends
and folklore and very useful in reconstructing the medical knowledge.
(ii)Medical knowledge is passed on from one generation to another
through a few specialists -the herbalists, medicine man, sorcerer etc
and medical knowledge is passed on to others very selectively.
(Abraham, 1991; p19)

Tribals in India have a distinct health culture different from the majority
of non-tribal population. Some important features of tribal culture as
influencing health are:
1. The presence of traditional health care practices
2. A collectlvist or group orientation

10
 3. Cultural diversity
4. The primacy of immigration and acculturation experiences
5. Bio diversity sustaining tlieir life needs(italics added){p 211 .[Link]
2007)

Indigenous medicine is another term which might be used for non-

westem, traditional medicine. Tribal communities are also being termed as
indigenous communities and their health practices and traditions may be
termed as indigenous medicine. Official term for medical systems other than
allopath as used by the Central Govemment and respective State
Govemments is indigenous systems of medicine which includes AYUSH i.e.
Ayurveda, Yoga, Unani, Siddha and Homeopathy. (A brief outline of AYUSH
has been given in the second chapter namely HEALTH AND MEDICINE:
CONCEPTUALIZATION AND OVERVIEW OF STUDIES)

1.2.4a Ayurveda and the practice of herbal medicine:

Ayurveda comprises of two words namely "ayur" means "life" and
"veda" means "knowledge", thus Ayurveda literally means "knowledge of life".
Ayurveda implies the "knowledge of life" or the knowledge by which life may
be prolonged. Its origin is traced far back to the Vedic times, about 5000 BC.
During this period, medical history was associated with mythological figures,
sages and seers. Dhanvantri is considered as the Hindu god of medicine.
According to some authorities, the medical knowledge in the Atharvaveda
gradually developed into the science of Ayurveda. In ancient India the
celebrated authorities in Ayurvedic medicine were Atreya, Charaka, Susruta
and Vagbhatt. Charaka mentions some 500 drugs in the "Charaka
Samhita".such as the Indian Snakeroot i.e. Rauwolfia - reserpine drug for
hypertension.
Another authority Susruta in his classic Susruta Samhita elaborated
mainly surgical knowledge, medicine, pathology, anatomy, midwifery,
ophthalmology, hygiene and bedside manners.
Of significance in Ayurveda is the "tridosha theory of disease". The
doshas or humors are: vata(wind), pitta(gall), and kapha(mucus). Disease
was explained as a disturbance in the equilibrium of the three humors; when

11
these were in perfect balance and harmony, a person is said to be healthy. It
is similar to the "theory of four humors" in Greek medicine. Hygiene was given
an important place in ancient Indian medicine. The golden age of Indian
medicine was between 800BC and 600 AD. During the Moghul period and
subsequent years, Ayurveda declined due to lack of State support.
Ayurveda was before the advent of British rule, the main system of
health care but gradually lost its glory in modem times.(Banerjee, M: 2009) '^
The practice of herbal medicine, found among Munda tribe like
Ayurveda use the plants for medical purposes but Munda people and healers
used those plants which were available in their ecological vicinity and many
plants are not mentioned in Ayurvedic treatises. The tribal pharmacopoeia
consist of more a wide range of plants, animals, minerals, faith healing etc
and thus broader than Ayurveda phannacopoeia. One important consideration
is that where Ayurveda was well written and centralized health care system,
the practice of herbal medicine is mainly oral, fragmented knowledge saved in
the form of myths, folklores etc.
Eariier days there was a symbiotic and harmonious relationship
between Ayurvedic practitioners and these ethno medical healers, which
gradually diminishes with the decay of Ayurveda and other reasons.

1.2.5 The Practice of Herbal Medicine and Etfino medicine:

Ethno medicine comprises of the words "ethno" means people and
"medicine". Literally it means medicine of the people. Ethno medicine is the
study of ethnography of health and healing behaviour in various societies.
Ethno medicine also refers to the study of traditional medical practice. It
encompasses methods of diagnosis and treatment.
Ethno medical studies are conducted to evaluate the efficacy of
traditional health care practices; the prevalence of illnesses and the
distribution of knowledge about illness attributes; the negotiations and
instantiation of illness identities; the power of discourse to produce as well as
cure affliction; discourse as moral commentary; linkages between medico-
religious institutions, models of self, power and the state (Bhasin, 2007). ,,^''

12
 Ethno medicine has been defined "ethno medicine as a culturally
ordered inten^elationship of medical symbols and meanings which are
associated with a community's notions of illness ideology, body image and the
entire set of preventive, promotive, curative and destructive health rituals
and/or therapeutic actions performed by the participant actors in various
healing contextSj^j^^a^a symbolic system there by representing the cultural
whole." (HughgsTl 968)
Thus it is evident that the practice of herbal medicine and its elements
found among Munda tribes can be embraced in the field of ethno medicine.
The use of plants for medicinal purposes is an age-old practice in tribal
communities. This practice of herbal medicine can broadly be seen in two
forms-
Firstly for many ailments and diseases/illnesses basically minor^ ones
the common layperson Munda uses many plants for healing and other
medicinal / health care purpose. Their knowledge is based on their close and
keen observation of nature and oral transmission of this heritage knowledge
from one generation to next one through riddles, folk songs, stories and myths
within family and neighbourhood.
This domain of knowledge is particularly but not exclusively found among
women of this community (Brenna H Mayer, 2004; Krishnaraj,1990; Renu
Khanna, 2002; Rosenfeld, 1997; Sheryl Burt Ruzek, 1997) ^ r,.^ ^^ ^: ':
The second form of the use of plants for medicinal purpose is its
institutionalized form in the therapeutic practice of -gthngumedicaL-^^eaters, ^
which requires a kind of expertise and also some kind of special knowledge
gained through experience or training or mystical power as given by god or
deity or spirits. This ethno medical practice uses special techniques of

^ Minor disease - it relates to sickness which can be temporary and does not
affect the entire body system. Cold, cough, fever, dian-hea etc are examples
of minor diseases

13
diagnosis, treatment of disease/illness. This practice is widely used for both
minor and major^ illness.
This research is focusing on both aspects but more focusing on the
second aspect of the practice of herbal medicine.
Klienman grouped healing practices in to three comprehensive sectors:
(!) professional sector, which includes both biomedicine and those alternative
such as osteopathy and chiropractic which are professionally organized in the
United States; (ii)[Link][[Link] sector that includes specialists who are
neither professionalized nor bureaucratized; and (iii) the popular sector
includes all the things which patient and his relatives do to cure sickness.
using their own-concepts
-com of what facilitates or delays healing (Kleinman, 1978
,1980 ; Ray,^005 ; Bhasin, 2007 ).Considering the model as spearheaded by
Klienman, the practice of herbal medicine comes under the category of the
folk health care sector and also to some extent the popular sector since this
practice is neither professionalized nor bureaucratized.

1.3 Research Problem

Q 1 What are the various health practices regarding causation,
diagnosis and treatment of diseases and healing practices,
nutrition and hygiene and preventive and curative medicine
among Munda tribe?
Q 2 What is the current status of the therapeutic practice of herbal
medicine? Why the practice of herbal medicine as therapeutic/
healing practice is declining among Munda tribe or why use of
allopath is increasing gradually day by day?
Q 3 What is the relation between socio-cultural variables such as
gender, age, locality, education, religion and others and the
practice of herbal medicine?

^ Major disease-any disease which is usually short and which effects the total
body system and can even lead to death, it could even be epidemic in nature.
(Das, D K, Project work, 1993, TISS, p 11)

14
Q 4 How does Munda tribe perceive health, disease, and various
therapeutic practices?
Q 5 Who uses the therapeutic practice of herbal medicine and why?
In other words what is the socio-demographic profile of Munda
users of herbal medicine?

1.4 Rationale and justification behind the study

The study of the medical systems of tribal societies needs urgent
attention, considering the influence of various agents which are inducing rapid
changes evident in tribal population. Most of the tribal societies are no longer
enjoying complete isolation from other communities and rapid social changes
can be noticed due to the contact with the people of other cultures. Man
induced changes like deforestation and monoculture afforestation altered their
habitat and resulted in the non-availability of games, tubers, honey, medicinal
herbs, fruits etc (Jose, 1998).
At another level, the displacement of tribals from their traditional forest
settlement and heavy deforestation in their traditional habitats had direct
consequences for their health. Their diet and food habits were ariDitrarily
altered, herbs and other plant and forest products which were essential in
their health care became unavailable and tribals had to face changing climatic
conditions and the disruption of their social and cultural supportive systems;
which led to:

i. Deterioration of health among the tribals

ii. Loss of medical knowledge which was closely related to the natural
environment and their socio-cultural milieu and
iii. The disappearance of certain plants eariier had been used for
medicinal purposes (Abraham, 1991).

The various welfare measures of the government to raise the standard

of life of the tribals accelerated the pace of these changes. Now a number of
tribes are following the life style of the non tribal societies and their traditional
norms, values, social institutions and subsistence pattem have undergone

15
vital transformation. Tribal indigenous knowledge is mainly oral in nature and
stored in their myths, folk stories, songs and daily experiences. Therefore
urgent steps must be taken to record all the plants used as medicines by them
befope they are lost and then validating and standardising that knowledge
-(^tose, 1998).
The acculturation process has great influence on their health. Due to
the close association with the members of other societies they are exposed to
new, unknown diseases. Now days many of the tribes are consuming food
items available from ration shops and hotels. This new diet is very poor in
quality when compared with the traditional food procured from the forest. So
these changes in food items and dietary patterns seem to be detrimental to
their nutrition and health (Jose, 1998).'
There is a need of more studies to be conducted to understand the
medical system of the tribal, the process of interaction between tribal
medicine and modem medicine and how both can cooperate to develop a
health care system desirable for the tribes. Special emphasis must be given in
these studies on sanitary facilities and the relevance of proper health
education. The information and data generated through such studies will be
very useful in modem health care planning which will be more equitable,
sustainable, efficient, comprehensive, and accessible and of better quality
(Jose, 1998)
In a welfare state like India, the administrative policies have direct
bearing on the people's economic aspects ultimately leading to several issues
in health related sector. In contrast to traditional health care system, the
official health care system is based on Western science and technology
separating it from broader social and cultural concems and influences. It is
evident that the state-supported western medical system does not generally
recognize the traditional medical systems. Several studies have proved that
traditional societies do not get the most needed psychological security in
westem medical system as it ignores the cultural petnponents of'disease and
treatment prevailing ip^a given soci^;/(Carstairs, 1955; Paul, 1955;Caudil,
J955;Marriott;^;Ld6^). John Bty&ht (1988) sees the involvement of the
individual and the local community in primary health care not as a social
nicety; rather as a medical necessity. But services that are delivered from the

16
outside have little effect unless absorbed by the individual and the community.
It has been revealed that the diverse and deep-rooted social and cultural
phenomenon of a society play important and many a time decisive role in
deciding acceptance or non-acceptance of particular health care option.
Thus, a study regarding nature and extent of acceptance of modern
health care facilities and the traditional health care practices among the
studied group was felt imperative so that a holistic approach covering the
social and political environment of the people can be fonvarded towards policy
planning (C.J. Sonowal and Purujit Praharaj, 2007, p 135-136) Mostly Munda
population of the Ranchi district is concentrated in villages in a cluster form;
particularly in Khunti and^undu sub division in many villages more than 80%
population is Sch§cttile Tribe population and predominantly Munda tribes
(Bhatt, 2003).
So it will be very interesting to explore the health beliefs and the ethno
medical practices of the Munda tribe and it will also help in formulation of
better health policy for them. Therefore a quantitative empirical study with the
help of interview schedule was conducted with a purpose of wider policy
implications.

With reference to the nature of research problem, review of literature

and considering broad aim of research following specific research
objectives have been formulated.

1.5 Objectives:
• To understand the concept of health, illness and medicine among the
Munda tribe of Ranchi.
• To explore the relationship between the practice of herbal
medicine and socio-economic variables such as gender, age,
education, income etc.
• To get aware of the practice of herbal medicine and its relation
with religious beliefs, superstition, magic, science, witchcraft
etc.

17
 • To understand the consequences of modern medicine and other
related factors in relation to the use of herbal medicine.
• To understand the ideological conflict among the youths
acquiring new modern practices and conserving natural
knowledge heritage of herbal medicines by the old ones.

A hypothesis is stated in the form of a declaration expressing a

relationship between two variables. With respect to the
objectives and operationalization of concepts and quantifying
variables of the research problem following hypothesis have
been formulated.
1.6 Hypothesis:
• Alternative hypothesis (Ha): The practice of herbal medicine is more
common in females as kitchen and home medicine than male
counterparts
• Null hypothesis (HO): There is no correlation between sex/gender and
the use and preference of the practice of herbal medicine.

• Altemative hypothesis (Ha): The practice of herbal medicine is more

prevalent in old generation than young ones.
• Null hypothesis (Ho): There is no correlation between age and the use
and preference of the practice of herbal medicine.

• Alternative hypothesis (Ha): The use of the practice of Herbal Medicine

will differ significantly with education level of Respondents.

• Null hypothesis (Ho): There is no congelation between education level

of respondents and the use and preference of the practice of herbal
medicine.

• Alternative hypothesis (Ha):The use of the practice of Herbal Medicine

will differ significantly with religion

18
 • Null hypothesis (Ho): There is no correlation between religion of the
respondents and the use and preference of the practice of herbal
medicine.

• Alternative hypothesis (Ha):The use of the practice of Herbal Medicine

will differ significantly with occupation
• Null hypothesis (Ho): There is no correlation between religion of the
respondents and the use and preference of the practice of herbal
medicine.

• Alternative hypothesis (Ha): Quackery, beliefs in spirits is positively

related to the use of the practice of herbal medicine.
• Null hypothesis (Ho): There is no correlation between quackery,
witchcraft etc and the use and preference of the practice of herbal
medicine.

1.7 REVIEW OF LITERATURE

1.7.1 MEDICINE AND SOCIETY

Every human society in the world, irrespective of its degree of
cultural and material simplicity or complexity, has maintained an
effective medical system and possessed empirically tested knowledge
about aetiology and curing, to cope with the diseases which threaten
the well-being of its members. Very often, these traditional medical
beliefs and practices may not appear quite rational, when viewed
from the conceptual framework of modern scientific medicine (Lieban,
1973) The success of a medical system can be evaluated by
examining how the people utilizing this knowledge and its methods
are maintaining their health and living in harmony with their
environment. The evolutionary history of mankind reveals that the
notion of health, disease and healing practices constitute an
important part of the human culture itself. Diseases threatened man's
existence on earth and human societies were forced to invent a

19
pharmacopoeia and to develop therapeutic measures to win over the
challenges from his environment. The medical system in a society is
related to all other spheres of social life, and therefore medicine can
be considered as a sub-system, regulated and influenced by the
world view and material development of the wider social system.
Social anthropologists have been very keen in exploring the patterns
of interaction between the sub-system of medicine and the major
system of society, which ultimately paved the way to medical
anthropology. This science deals with the complex connections
between a folk therapeutic system and the culture within which it
operates. According to them neither concepts, and methods nor aims
are critical, but rather the content of the work that is performed. Thus,
medical anthropologist's major areas of concern are society's beliefs,
concepts and curative measures of illness and to explain how the
people cope up with a disease and what solution they offer to
overcome this situation in the general background of their culture.
One cannot examine the medical system of a society in isolation,
since the beliefs and practices related to disease, its causation and
cure, are very much incorporated with so many other activities of a
society. For understanding the medical beliefs and practices, one has
to deal with almost all facets of social life like the religious beliefs,
rituals, values, norms, world view, and interrelationship with other
societies, material progress and the ecosystem in which the society is
embedded. -* ,,'c

According to Lieban (1972? 1031) "An anthropological study of

health and the occurrence and means of coping with disease can
involve one deeply in the manner in which people perceive their
world, in the characteristics of human social systems, and in social
values. Thus medical anthropology is not only a way of viewing the
states of health and disease in society, but a way of viewing society
itself."One can attain better insight regarding the evolution of diseases
prevalent in the human society through the study of the diseases and medical
systems of the tribals. "Though contemporary tribal men cannot be equated
with prehistoric men, they resemble them more than do modernized men.

20
Therefore the study of tribal peoples not only widens the range of
circumstances in which human adaptability is observed. It throws some light
on the evolution of human diseases" (Polgar 1977:5)
Jose has mentioned that it is found that the tribals living in a harsh
environment could manage to maintain health and lead an active life with the
help of their own medical practices and cultural etiquette. Their religious
beliefs, cultural values and customs help them to regulate their activities and
to exploit the resources from their environment without disturbing ecological
balance. Their small group size and effected isolation from other human
societies reduced the chances of being afflicted by most of the contagious
diseases. However the good health of tribes is not a state characterized by
the absence of disease but one of steady control at bearable levels. (Jose, -
1998)
The ethnographic studies of primitive communities done by social
anthropologists have shown great concem in studying their social
organization, kinship, marriage, family, religion economy etc while their
medical beliefs and practices have been neglected. So the earlier
monographs of many of the primitive communities often contain little narration
in connection with disease and medicine. "It is true that all through the history
of mankind attempts have been made to explain different aspects of medicine
in terms of social variables. But it is only in the past fifty years or so that
serious attempts have been made to study systematically the relation
between the sub-culture of medjeine and the wider society of which it is a
part" (Ahluwalia 1974:401)

1.7.2. HEALTH AND MEDICINE IN INDIA- A REVIEW

A study of medical systems and health is very interesting in the
Indian context, because India possesses an immense heterogeneity
in medical beliefs and practices. Besides the well known and wide
spread medical systems such as Ayurveda, Allopath, Unani and
Homeopathy, there are various types of localized folk and tribal
medical beliefs and practices often based on magic and sorcery.
There are ample of medical anthropological research conducting from
many decades. These studies mainly focused their attention on both

21
tribal and less developed rural communities. Besides a description of
their beliefs and practices about illness and medicine, the interaction
between modern and traditional medical systems also forms an
important aspect of these studies.

Overview of the work already done on indigenous health and

medicinal practices among tribals:
The Purpose is to analyse very briefly the relevance and prospects of
such studies from the point of view of modem medicine and social sciences
and major trends on studies.
As Almas All (1994) has mentioned that there is comparatively little
published research specifically on this subject. Most of these studies are
exploratory and have touched on a variety of allied aspects of ethno medicine.
Basically three categories of studies are to be found:
• case studies dealing with problems
• Impressionistic or descriptive writings which is more common.
• Very few statistically oriented empirical surveys.

Again three important categories of persons/ researchers have evinced

a keen interest in the subject. They are
• sociologists
• anthropologists
• medical scientists

Some social anthropologists have underlined the importance of studies

on traditional systems per se as systems of values, beliefs, knowledge,
objects, tools and techniques on one hand and as organization of roles,
activities, and relationship on other.
They have studied these systems specifically with reference to
(I) Their distinctive notions regarding different aspects of disease, health,
food etc

22
(II) Their important differences in the institutionalization of norms,
expectations, in medical techniques and in procedures for making
diagnosis and prognosis,
(III) Their organisation of persons, roles and categories,
The studies on relationship between systems of medicine and other
§

spheres of social life such as religion, astrology, magic, etc.

According to Lewis (1958), "the advantage in leaning about the
indigenous beliefs and practices of the community is the insight it gives into
the world view of the people. Concepts of disease causation are part of a
society's total world view, which is also reflected in other spheres such as
agriculture, politics, and interpersonal relations."
Naik (1972) and Ahluwalia (1974) made useful surveys about the
medical anthropological literature available in India which deals with the
Indian tribal and rural communities.

1.7.3. TRIBAL HEALTH AND MEDICINE

Even the descriptive ethnographic literature complied by the British
administrators and missionaries did not fail to notice the primitive medical
beliefs and practices found among the tribals [the British administrators and
missionaries compiled the descriptive ethnographic literature and noticed the
primitive medical beliefs and practices found among the tribals.]. Since the
diseases often threatened the existence of eariy tribal communities the
concepts of aetiology and curing methods had an important place in their
culture tHoffman, 1830 ; Russell, 1916)Thurston (19077Bescribed the beliefs
in connection with charms magical spells, witchcraft and sorcery for curing
diseases and protecting people from evil spirits.

While discussing the religious belief of the Travancore tribes Krishna Iyer
(1941) mentioned briefly about their medicine man that cures all their ailments
and is a practitioner of magic. He says that propitiation of gods is intended to
restore man's confidence when shaken by crises like accidents and diseases.

Sengupta and Biswas (1956) conducted a dietary and nutritional survey

- — I

among the Malapantaram, the Muthuvan and Ullatan tribes of Travancore and

23
 made a comparison of the differences in the quality of their diet and its
influence on their health and physical growth.

With a description of the disease causing spirits taboos and the initiation and
functions of the medicine man of the Uralis, Gnanambal (1955) also noticed
that the Uralis make a fine distinction between the diseases of pathological
origin and those of spirit origin.

Majumdar (1961) puts forward the opinion that social and cultural factors do
play a major role in the spread of a disease.

'"Troisi(1979) made a fine analysis of the magic and witchcraft beliefs of the
Santhals of Bihar. He says that the Santhals look upon most of the diseases
as something unnatural, ascribing them to the agency of evil spirits and
malevolent forces, witches and the evil eye.

I." ' • -^

Hockings (1980) presented an elaborate account of the indigenous medical

system of the Badagas of South India. He showed that their understanding of
human physiology is rudimentary and misinformed.
I. *

Singh (1984) examined the drawbacks in the health policies of the

government and the shortcomings in their implementation among the tribal
communities. He points out that the government hospitals in the tribal areas
are handicapped due to lack of equipment, medicine, and well motivated staff.

In a monograph of the War Khasis, a tribal community of Meghalaya,

Dasgupta (1984) gives the impression that they are using both indigenous
herbal medicines and modern allopathic medicines for the treatment of
diseases. The influence of Christianity and education minimized the belief in
spirits as the causative agents of diseases.

Egnor (1984) discussed how some healers in Madras established a special

relationship with the deities and function as the vehicle of their power. It is
found that during the healing sessions the deity will speak through the servant

24
to each patient and the supernatural power acting through the healer will cure
the illnesses.
Vidyarthi and Rai (1977) explained the belief of different tribals like Ho,
Jaintia, Korwa, Maler and Oraon in malevolent spirits and powers which can
cause diseases, famine, infertility and even death. These tribals also believe
that there are some other spirits who protect the people from sickness and
other misfortunes.

Mathur(1982, 1987) examined the aetiology of illness, occurrence of

diseases, curing techniques and the efficacy of ethno medicine among the
different tribal communities of Wayanad. He pointed out that their contact with
the non-tribals had introduced new diseases and the spread of these diseases
adversely affected the growth of their population.

Besides giving a brief description of the ethno medical practices of the

Kanikkars of Kerala, Radhakrishnan (1986) also showed that they know a
large number of herbal medicaments for the treatment of various ailments.

In his study of the health and ethno medicine of some tribes of Kerala,
Viswanathan Nair (1985, 1987) gives much emphasis on how a tribal
community's health is affected by the disturbances in the habitat and alien
cultural contact. The study indicates that those tribal communities whose
natural habitat remains relatively undisturbed use more herbal medicine than
those whose habitats are disturbed.

Mahapatra (1986) found that the Santhals of Bihar believe that the ultimate
cause of disease and death is evil spirits and witches, and this belief
influences their attitude towards life and community. They are convinced that
the administration of medicine has to be supplemented by the practice of
exorcism and divination.

Sen (1986) presented the demography, prevalence of illness, vices and health
status of the Andamanese, which is one of the smallest tribal communities in
this country. He also suggested effective measures to increase their fertility.

25
After examining the impact of three diseases, namely leprosy, malaria and
tuberculosis which are more prevalent among the tribal communities in four
blocks of West Bengal, Chowdhuri et al. (1986) reached the conclusion that
the tribals are quite ignorant of many of the diseases. The tribals are little
aware of the importance of health and hygiene and the availability of modem
medical facilities.

Guha (1986) presents a descriptive account of the folk medicine of the Boro
tribe of Assam. After giving the details of the aetiology, diagnosis, treatment
and prophylactic measures of diseases, he makes an analysis of the impact of
modem medicine upon the traditional one.

Bhattacharya and Sen gupta (1986) observed that the general concept of
disease among the Birhor hints at intra-social hostility and a high degree of
insecurity owing to activities of the spirits. So they pay much importance to
community cohesion and propitiation of spirits in order to prevent illnesses.

According to Dash (1986ji^Jhe basic concept of illness among the Paraja of

Orissa, is explained by magico-religious beliefs. However, besides the
magico-religious treatment of the diseases, the herbal therapy is also very
much prevalent among them.

fzvi (1986) examined the health practices of the Jaunsari tribe of Uttar
Pradesh and described their concept of aetiology. As they believe that most of
the diseases originate due to supernatural causes, they do not know or think
that surroundings, hygiene and dietary habits may produce illnesses.

After conducting an empirical study among the KhenA^ar, the Chero, the Kol,
the Mar, the Oraon and the Munda tribes of Bihar, Chakraborty (1986) found
that these people prefer modern medicine because it brings speedy relief and^
is readily available. According to them ethno medicine takes longer period to
cure the patients and there is also scarcity of medicinal herbs.

26
Mukherjee (1986) carried out a research highlighting the gerentological
problems in the Ho, the Munda and the Santhal tribes of Bihar; he found that
the health status of the aging members is more pathetic in acculturated
hamlets than the traditional ones.

After concluding an empirical study among the Oraons of Orissa, Sahu (1987)
reached the conclusion that they are aware of the modern health services
available in various institutions and make special efforts to avail these
facilities when confronted with serious diseases.

In a case study of the Asur, the Birjia and the Kisan tribes of Bihar, Upadhyay
(1987) showed how changes in their natural habitat due to deforestation
brought adverse effect on their health. The tribal medicine men fail to cure the
new diseases which occurred due to causes like pollution, change of diet and
close association with the non-tribals.

Reddy (1987) analysed the problems involved in the implementation of

modem medicine among the tribal people. He suggested that a thorough
knowledge of the indigenous medical beliefs and practices and the different
cultural values attached to them has to be acquired and then the modem
medicine has to be introduced in a phased manner side by side with the
native medicines.

Xiwari (1987) studied the concepts of health and disease among the Raj and
the Shauka tribes of Uttar Pradesh. He found that most of their illnesses
derive from some of their age-old habits, poverty and the environment in
which they live.

Bhowmik and Bagchi (1987) examined the health and nutritional aspects
along with the frequency of diseases and treatment pattern of the Lodha and
the Mahali tribes of West Bengal. They found that these tribals suffer from
communicable disease due to improper sanitation, lack of pure drinking water,
open air defecation, etc.

27
In his study Ramesh Menon(.1988)-dxplained how the tribes of Arunachal
Pradesh attribute every disease or misfortune to a particular evil spirit. He
found that patients suffering from psychosomatic ailments respond favourably
to their Shaman's treatment.

After conducting an ethno zoological survey among the thirty five tribal
communities of Madhya Pradesh, Joseph (1989) brought out the role played
by reptiles in tribal medicine. He found that the traditional medical system is
economical and without any side effects.

Some other social anthropologists have given descriptions of some of these

aspects of traditional systems and have indicated the types of relationships
that may exist between these systems and other spheres of society. For
example FuqhsJiWB^yhas given a description of how two types of medicine
men, Janka, who works by calling to his aid a superhuman force practise their
respective arts.

In a study of Shamanism, Harper jJ96.6Xdescribes a Shamanistic session in

the Malnad region of Mysore. A Shaman in this South Indian setting is a man
who has a familiar spirit that he can ask to possess him whenever he desires.
Whenja^goes into trance, the spirits speak through him.

felwin (1955) has also described the role of male and female Shamans among
the hill Saoras of Orissa. "The Shamans emerges as one of the most
important figures amongst the Saoras"... to the sick and lonely the shaman is
the nurse, friend, the guide, the analyst, and the angel of strength and
consolation.

From the literature surveyed it seems that the one most distinguishing
characteristic of traditional medicine is the notions regarding disease
causation. Herein one finds an extremely close relationship between medicine
and religion, morality and magic etc.

28
^^Ivvin (1955) has given an inventory of the gods, associated with various
diseases in the Saora Pantheon. For example, there are gods associated with
children's diseases, cough, colds, sore-throats, blindness, rheumatism etc.
most of these diseases can be cured by supplicating and propitiating these
gods^

/Opler(1963) lists the following as the most commonly believed causes of

various diseases:
Malfunctioning or imbalance of the three humours (Doshas)
Faulty diet
Lack of harmony with the supematural world
Activities of ghosts, especially unrequired and aggrieved ghosts
Displeasure of deities
Imbalance offerees which control health.
Immoderation or in appropriate behaviour in physical, social and
economic matters

This shows that the idea of hamriony and balance finds a central
position in their view of health and sickness.

Among^thers who give details of beliefs about health and diseases are Lewis
( ^ 4 ! Khare (1963) and IVIatjiur(1963).

Khare (1963) and Jaggi (1973) have discussed how the nature of treatment
varies with the type of cause identified. For example, religious rites occupy a
prominent place in the treatment of diseases which are associated with
supematural causes to the exclusion of other factors. Others who have given
brief descriptions of the traditional medical practices include Gould (1957,
1965), Mintum and Hitchcock (1963) and Hasan (1967).

Elwin had a great interest in tribal health and medicines. Actually he initiated
work among the tribes of Mandia (MP) by starting a small medical centre in
Patangarh and as he came to study tribal cultures in totality, he could see the

29
relation of culture to health and medicine (Elwin, 1941, 1942a, 1942b, 1943a,
1943b, 1950, 1953a, 1953b, 1953c). He also collected a great amount of
folklore on disease (1953c, 1953d, 1953e, 1953f). All these help us to
understand the place of culture in tribal health and medicine and these are
inextricable parts of tribal life, economy, society and culture. (ICSSR Vol.111,
pp-254)

In the ethnographic studies of tribal communities by [Link],

[Link] and others, some data on indigenous health practices of the
tribals are also available. Some work on tribal medicines, herbs and root has
been carried out by Naik (1954). Rev. and Jha et al (1954) have dealt with the
problem of health and disease in Ranital. The authors observe that folkways
centred on effect of image for cure of disease by shutting and preventing
recourse to modern medicine. They also point out that indigenous medicines
have the advantages in the context of folkways, the force of tradition, the
confirmation to mythology and legend, the prestige of strong personalities who
act as functionaries etc. they are interwoven with the common artefacts and
techniques of daily existence as readily available and inexpensive.
The importance of traditional (indigenous health practices) tribal
medicinal system and the like could draw the attention of Dunbar (1915),
Boding (1925), Radcliffe Brown (1948), Shukia (1959), Srivastava (1962),
Vidyarthi (1963), Saikia (1964), Mittal (1978), Sinha (1979), Pulu (1979),
Mathur (1982) and others.
Apart from these, there are a number of studies particularly on the
curative aspect of plants/herbs which are used by the tribals (Jain 1968). Jain
also points out the importance to document them and use them for adequate
experimentations. However in recent years a specialized branch of botany
namely ethno botany has been engaged in doing tremendous work in
documenting medicinal plants found in various ecosystem of Indian
subcontinent and used by different ethnic groups and also have tried to
standardise the aspect of health practices such as formation and application
of medicines for various diseases. On one hand it has helped in preserving
indigenous traditional knowledge from getting lost but also have produced
new challenges in front of us. Issues like overexploitation of medicinal plants

30
leading to extinction of rare medicinal plants and bio diversity and cultural
diversity erosion, intellectual property issues etc should be taken into
consideration.
It is clear though we have a number of studies on various allied
aspects of ethno medicine; unfortunately, specific study on indigenous health
practices among tribals in relationship with prevalent diseases is practically
absent or very few. There is also very few statistically oriented empirical
surveys of tribal communities regarding health research and almost lacking
among Munda tribe of Ranchi district.
There have been many commonalities in rural communities and tribal
communities regarding health practices as tribals in fact were had almost in all
cases been interacting with the non-tribal and other rural communities. A
glimpse of literature available on rural health and medicine is therefore
included in the review of literature.

1.7.4. RURAL HEALTH AND MEDICINE:

The study of the health problems of the village folk attracted the
attention of Anthropologists, social workers and public health administrators,
since very eariy times. The scarcity of pure drinking water, lack of sanitation
facilities and malnutrition are only a few among the large number of hazards
to the health of the villagers who form above 70% of the total population of
India. From very eariy times, anthropologists, social workers and public health
administrators have paid attention and studied the health problems of the
village folk. Villagers who forni 70% of the total population of India; are facing
many health hazards such as lack of safe drinking water, poor sanitation
facilities, malnutrition and increasing ecological and bio-cultural diversity
erosion.
Many of the health problems, concepts of aetiology and curative
techniques of the rural folk and tribals bear close resemblance. Therefore, a
review of the literature of rural health and medicine will be much illuminative to
understand the tribal health problems in a wider perspective.

Fuchs (1949) conducted a,study of the common diseases affecting the Nimar
Balahis, who are a group of scheduled caste people. He found that their

31
socio-economic bapkWardness and unhygienic sanitary conditions are the
major reason^-ft^the occurrence of epidemics every year.

Carstairs (1955) refers to the importance attached to "Confidence Prognosis"

"as^an attribute of the role of healer. Traditional medicine establishes "faith"
and assurance in the patient. Macriot C,1.955) has also emphasized the cultural
definition of medical roles. Trust, responsibility, charity, power, respect- these
are important aspects of interpersonal relations in the medical sphere. It is not
so much his technical skills which gives prestige to a healer (such as the
snake-bite curer) but his spiritual power gained through "piety". Marriot
compares different types of indigenous curers and methods employed by
them to establish good relations with their clients. Both Marriot and Carstairs
(1955) points out that the allopathic medicine does not fit into social system of
the villagers. Also villagers expect to pay only after they are cured and feel
that a doctor who immediately asks for fees is like a tradesmen or a
shopkeeper. They do not understand why modem doctor should ask so many
questions: Traditional practitioners tell them what is wrong without having to
ask.
Carstairs studied the occurrence of diseases and the healing methods
of the inhabitants of two villages in Rajasthan. From his own experiences with
the villagers, he advises that the western medicine must be presented to the
people in a way that will command conviction and acceptance. Again he
(1983) explained how the villagers believe that diseases are caused by the
activities of witches. He observed the changes taking place in a village
community from 1950 to 1981 and found that the people show a stubbom
resistance to change in the field of health care.

Marriot (1955) made an analysis of the various indigenous medical practices

in the Kishan Garhi village of Uttar Pradesh and re-examined the role of the
western doctor as it appears to the villagers in context of their social
organization and their own medical institutions. According to him, it would
appear that if westem medicine is to find a firm place in the village under
present conditions its role must be defined according to village

32
On the other hand Hasan (1967) says that there are two types of social and
cultural factors that affect the health of any community:
(a)Factors directly affecting the health of the community because of certain
customs, practices, beliefs, values and religious taboos etc, create an
environment that helps in the spread or control of certain diseases; and
(b) Factors that indirectly affect the health of the community as they are
related to the problem of medical care to the sick and invalid.
He presented an account of the beliefs, customs and practices of the village
folk in relation to health and disease. He pointed out the weakness of modem
medicine in the rural cultural context and suggested ways for the successful
implementation of public health programmes, concepts and practices.

Gould (1957) noticed that among the different studies of cultural change, very
little material has been obtained from the zone of interaction between the so-
called primitive and so-called scientific fonns of medical practice as an aspect
of the more general interaction between scientific and primitive technology. In
another study he (1965) clearly identified the reasons for the villagers not
wholeheartedly making use of the modern medical facilities available to them.

Khare (1959) argued that the failure of modem medicine in the folk
communities is due to ignorance of physicians about the beliefs and practices
of people regarding illness and its treatment. In another study, he (1981)
emphasized that the villager is adapting himself to the new system of
medicine by firmly locating himself in the ethics of his own system and its
cultural values.

Aiyappan (1965) made a few general observations on the health problems of

the villagers and showed how the caste factor influences the doctor-patient
relationship. He also explained how ecological factors like lack of sanitary
conveniences, poor quality of drinking water and air pollution have led to the
progressive deterioration of the health of the villagers.

According to Gorer (1967) the^fear of illness and the ceremonies against it

contributed, by far the largest impact of religion on the life of the Lepchas, a

33
village community of Sikkim. In their view, the cause of all illnesses and
misfortunes is the supernatural forces and, therefore, only supernatural
methods^re suitable for dealing with them.

/Madan (1969) examined certain influences like rural or urban upbringing, age,
education, occupation, income and religion of a person on his acceptance of
modem medicine for himself and for planned change.

With axlescription of the concepts of aetiology of some common diseases in a

vijl^e, Kama (1976) argued that the naturalistic interpretations of disease
have more prominent place in the villager's concepts of aetiology than the
supernatural explanations.

''Alandelbaum (1970, 1981) noticed that besides a number of purposes the

villagers of India and Sri Lanka use their religion to restore the sick of health.
He found that those ailments which could not be treated with drugs and
techniques that are within the power of man require the direct intervention of
Trans-human forces.

Djurfeldt and Lindberg (1976) made a detailed study of the health status and
disease panorama of a Tamilnadu village. They found that the most
fundamental reason for the apparent relative efficiency of indigenous
medicine in the village is the inefficiency of the allopathic one.

J<akar (1977)^ made an exploratory study of the cultural context of certain

diseases in a village in Punjab and offer helpful insight for further studies on
health and nutrition in other villages.
Besides briefly discussing some aspects of ethno medicine in Basanavahalli,
a Karnataka village, Bhat (1976) revealed details of the circumstances and
the forceis that play a role in the initiation of a medicine-man.

-Matthews (1979) studied the effect of poverty on health in a South Indian

village, she found that lack of proper understanding of the beliefs of the

34
people and gaps in communication between the doctor and the patient have
stood in the way of successful implementation of modem medicine.

Van DerVeen (1981) examined the various circumstances leading to the

failure of a government sponsored Primary Health Centre (PHC) in a village.
He found that the traditional village society could not wholly accommodate the
technical medical concepts as well as an organization mainly based on
western ideals and practices.

Mani (1981) studied the prevailing ethno medical beliefs and practices
regarding sterility, fertility, conception, gestation and abortion in rural
Tamilnadu. He cautioned that any attempt at improving the health care
system in rural India through the introduction of modem medical practices
should be sensitive to the already existing complex network of ethno medical
beliefs and practices.

Henry (1981j( studied the role and image of a North Indian magico-religious
medical practitioner and showed how he exploited the villagers' faith in his
powers for healing. His mode of healing in which natural remedies are
combined with exorcism, is an expression of a world view which comprehends
both natural and supernatural causes of illness.

Nichter (1981) puts forward the view that the villagers acceptance of modern
medicine did not mean that they lost faith in their traditional medical system.
Often, the use of allopathic medicine is constrained by cultural factors
including indigenous notions of body physiology, aetiology and diet.
Although it seems that modem medicine is accepted by a large number of
rural people, Bhardwaj (1985) 9autioned that the increasing utilization of
modern medicine does not mean that their attitude towards all aspects of
modern curative and preventive medicine and family planning measures has
undergone fundamental change.

35
 1.7.5. TRIBAL HEALTH STUDIES IN INDIA
It has been observed that among the tribal people the universal index
of a threat to health is expressed through withdrawal from work. Mahapatra
(1994), therefore, sees health among tribal groups as a functional and not
clinicatcdncept.

^achchidananda (1994) sees the field of tribal health aspects as a cultural

concept as well as a part of social structure and organisation which is
continuously changing and adapting itself to changes in the wider society. It is
a faith, prevailing among tribes that diseases are caused by supematural
agencies. Broadly, the tribal people believe in four types of super-natural
powers. These are (1) protective spirits who always protect them; (2)
benevolent spirits who are worshiped at the community and familial level
regularly, othenwise they may bring diseases or death; (3) malevolent spirits -
the evil spirits who control smallpox, fever, abortion, etc. and (4) Ancestral
spirits, the spirits of their ancestors and always protect them. The causes of ill
health perceived by the tribal communities can be divided into two categories,
namely, known and supematural.

958) believes that the study of tribal health

Choudhury (1994) and Lewis (1958)
should be with reference to their distinctive notions regarding different aspects
of diseases, health, food, human anatomy and faiths as well as in the process
of interaction with modern world.

>ingh (1994) indicates nine factors to examine and assess the tribal health
situation in India. He highlights the effect of changing physical environment on
tribal health, which is ultimately related to their economic pursuits, nutritional
availability, medicines etc. It has also been emphasized that ecology and
tribal health is intimately related.

> ^ f
Studies of Barth (1956) reveal how ecological niche influence people's health
status. In recent decades the tribal people have witnessed unprecedented
wave of non-traditional elements entering into their social and cultural life. The
concept of health and treatment is no exception. The inflow of western

36
concept of health care system and changing social and physical environment
has placed the traditional health care system of tribal group in a complex
situation. The tribal people are exposed to medical pluralism. Prevalence of
traditional health care practices and nature and extent of acceptance of
modem h e ^ h care practices among the tribal people in India has been
mentio^i*^ by various scholars in recent years.

Quite and Acharya (2006) have shown that the acceptance of a particular
health care system among the tribal people mostly depends on its availability
and accessibility. It is interesting to note that while the tribal groups following
traditional religion use traditional medicines putting religious or supernatural
value on it, the converted Christian tribes use the same medicine excluding its
religious tune. The study reveals that education has been able to heal the
traditional inhibition of tribal people to attend PHCs without ignoring the
importance of traditional healing practices.

Pramukh and Pglkumar's (2006) study shows that the tribal groups namely,
the Savaras, Bogatha, Konda Dora, Valmiki, Koya, Kond Reddi etc. believe in
the power of prayers and rituals that enables some herbs to act as medicines
to heal diseases among them. They attribute diseases to certain deviant acts
of self and others towards elders, nature, and divine rules. Thus, their first
priority iS/to get spiritual cure in a traditional way.

fain and Agrawal's (2005) study shows that the Bhills in Udaipur, Rajasthan,
attribute disease to the act of deities and spirits of various kind and by
appeasing them, they believe, disease may be healed. They depend on
Bhopa (traditional healers), herbalist and Dais for cure of disease. The same
study shows that people are, to a great extent, inclined towards modern
h e a l t h i 3 ^ system too, without ignoring the traditional system.

Jhasin's (2004) study among the Ladakhis shows a blend of health care
involvement. She finds that in case of serious illness people tend to attend
modern health care facilities. But in many cases accessibility of such facilities
do not confirm people's acceptance of modern health care system. People

37
 invariably believe in spirit and other supernatural beings as causes of disease
and priority of treatment inclined mostly towards traditional healers.

Nagia' (2004) shows that among the tribal people of Rajasthan, illness and
consequent treatment is not always an individual or familial affair. At times the
whole village or the community may be perceived as affected by such
diseases and healing must be done at community level. Such perception
shows the integrity and responsibility of entire community towards an
individual or family and vis-a-vis which is defined by existing culture. In such
cases modem system has nothing to do in treatment.

t
Sunita Devi's (2003) study among the Meitis of Manipur reveals that though
the people are educated enough, the concept of deities and their effect on
human health are widely prevalent among them. The author, in details,
describes the ill effect of the deity Hingchabi and the treatment offered by
traditional healer Maiba. She shows how effective is the use of medicinal
herbs^along with beliefs to heal an ill person influenced by the deity.

'^Bhasin's (2004) another study deals with the causes of underutilization of

Biomedicines among the tribal women of Rajasthan in treating sexually
transmitted infection (STI) diseases, locally called Sujak. They attribute Sujak
to the evil effect of matron, a spirit that evolves when a pregnant woman dies.
The author finds that when the women see a modern health care provider in
case of other diseases, STI diseases are closely guarded and treated with the
traditional healers. This certainly shows their cultural attributes attached to the
concept'of health and diseases.

K^agga and others (1996) have found that belief in spirits and deities are
prevalent among the most of the tribal population in West Godavari district of
Andhra Pradesh. This leads for seeking curative measures from traditional
healers. The authors also show that the people are in transition and realize
the changing situation in their environment, culture and food habit etc, for
which, they believe, the traditional treatment system is loosing its credentials.

38
Currently there are few interesting studies in the field of tribal health with
qualitative methodology and based on grounded theory or phenomenological
theory. Sujata Rao while using Schultz concept of stock of knowledge has
explained the folk medicine.

Thus it is clear that though there is a plethora of ethnographical studies

on tribal health, but we may infer that there is dearth of statistically oriented
empirical survey on tribal ethno medical practices. Therefore a study in the
form of PhD research has been taken to explore the practice of herbal
medicine as an ethno medical therapeutic practice to fill this gap.

1.8. THEORETICAL PERSPECTIVES ON MEDICINE AND SOCIETY:

The late 1980s and early 1990s have been characterized by an
increasing propensity for the boundaries between disciplines to blur,
particulariy among the humanities and social sciences such as increasing
interaction between literary studies, psycho-analytic theory, social psychology,
cultural studies, linguistics, history, sociology and anthropology. The
emergence of the 'linguistic turn' or the increasing attention paid to language
and discursive processes in the production and maintenance of social life and
subjectivity is of particular importance. (Pieris, 1999)
In line with these developments, the scholariy activities which may
loosely be gathered under the mbric of the sociology of health and illness
have altered focus. This change can be reflected in following impetuses:
One is the emergence of a growing disillusionment with scientific
medicine on the part of both intellectuals and some consumers in the late
twentieth century.
As the effectiveness and benevolence of medicine began to be
challenged, its claim to inaccessible and arcane knowledge based on
objectivity and political neutrality also get challenged.
The other is the impact of the post structuralist movement including the
release of the translated works of the French Philosopher-historian Foucault,
and the growing concern of feminist scholarship with gender and the body.

39
 In response of these impetuses, anthropologists and sociologists of
health and illness have begun to call into question the claims to 'truth' and
political neutrality of biomedical knowledge.
With the growing use of qualitative methodologies in health research,
particular attention is paid to the emergence of social constructionism as a
dominant perspective appropriate for engaging in inquiries into the socio-
cultural dimensions of medicine, health and disease while examining the
social role of medicine in western and other societies and reviewing the
theoretical developments which have occurred over the past four decades
(Prakash, Padma: 1986, 1994)

Following are the major theoretical perspectives on medicine and society:

1.8.1. THE SOCIOLOGY OF HEALTH AND ILLNESS:

Medical sociology or the sociology of health and illness has primarily
been concerned with systematic empiricism using the measurement of
objective variables deemed quantifiable. Early in its development, in order to
be accepted as a quasi-scientific discipline applied to a scientific discipline of
medicine, medical sociology adopted largely positivist values. As a result,
often medical sociology could best have been described as a derivative of
social medicine rather than as a sub-discipline of critical sociology
(Jordanova, 1983; Scambler, 1987; Mechanic, 1993). Accordingly, in line with
the assumptions of the model of scientific medicine itself, for much of the
history and development of medical sociology and the sociology of health and
illness the biological, human anatomy conception of the body has remained
unchallenged (Armstrong, 1978a: 651). In the early 1980s the impact of social
constructionism along with post structuralism and the ascendancy of
Foucault-dian critiques of medicine, began to reassert itself as an influential
approach.
There have been three dominant theoretical perspectives in the history
of medical sociology/ sociology of health and illness; functionalism, the
political economy approach and social constructionism.
Since the 1970s functionalism has been on the wane, as has been
appearing.

40
FUNCTIONAUSM:
The functionalist approach to medical sociology views social relations
in the health care setting as products of a consensualist society, in which
social order and harmony are preserved by individuals acting in certain
defined roles and performing certain functions. It is interested in the
processes by which doctors and other health care professionals carry out their
everyday work, and how individuals cope with illness and disease. The classic
functionalist position is to view illness as a potential state of social 'deviance';
that is failure to conform to societal expectations and nomrjs in some way.
Illness is considered as an unnatural state of the human body, causing both
physical and social dysfunction, and therefore a state which must be
alleviated as soon as possible. Functionalists argue that the feelings of
stigma, shame and vulnerability accompany many illnesses. (Pieris, 1999)

Therefore the role of the medical profession is to act as a necessary

institution of social control, or a moral guardian of society, using its power to
distinguish between normality and 'deviance'. The maintenance of social
order is thus the basis of the functionalist theorizing on the nature of illness
and the medical encounter, with medicine being viewed as an important
mechanism to control the potentially disruptive nature of illness.
The leading scholar in the application of functionalist theory to
medicine was the American sociologist Talcott Parsons, whose explanations
of the demands and function of the 'sick role' and its implications for the
doctor-patient relationship and discussion of the social aspects of the
institution of medicine as a profession were influential in medical sociology in
the 1950s and 1960s. According to Parsons and his followers, a person
afflicted with serious illness is physically disabled, and is forced to rely upon
others, and hence is deviating from the expectations of social roles. Parsons
argued that confinning to the nonns of the sick role legitimates such deviance.
He described four major components of the sick role: ill persons are exempted
from the performance of social obligations which they are nomnally expected
to fulfil; they are not blamed for their condition, and need not feel guilty when
they do not fulfil their normal obligations; however, ill people must want to try
and get well- if they do not, they can be accused of malingering, and being
sick is defined as being in need of medical help to return to 'normality'-the sick

41
must put themselves into the hands of medical practitioners to help them get
well again (Parsons, 1987/1951: 151-2). The patient is therefore placed in the
role of the socially vulnerable supplicant, seeking official verification from the
doctor that she or he is not 'malingering'. The role of doctor is seen as socially
beneficent, and the doctor-patient relationship as inherently hamionious and
consensual even though it is characterized by an unequal power relationship.
While Parsons' work was ground-breaking in elucidating the social
dimension of the medical encounter, the functionalist perspective has been
subject to criticism based on the neglect of the potential for conflict inherent in
the medical encounter. Critics argue that the functionalist position typifies
patients as complaint, passive and grateful, while doctors are represented as
universally beneficent, competent and altruistic (Turner, 1988: 46-7). On the
contrary, critics assert, the conflict of interest between patient and doctor is
expressed over a struggle for power, which may be explicit or implicit, and
involves negotiation and manoeuvre at every step in the encounter (Gerson,
1976; Strong, 1979:7). It should be taken into account that the doctors and
patients have different, and often conflicting, interests: doctors to perform their
duties of the professional in the medical workplace, seeking to earn a living
and progress in their career; patients, to alleviate the physical pain or
discomfort which is disrupting their lives. Furthermore, it is argued, there are
organizational constraints in the medical setting and extemal factors
influencing the behaviour of doctors and patients when they meet in the
medical encounter which go beyond the dynamics of the sick role model. Both
the doctor and the patient have the relationships outside the medical
encounter which affect their approach to the encounter.

THE POLITICAL ECONOMY PERSPECTIVE:

The political economy approach, informed by Marxist critiques of the
nature of the capitalist economic system, was a dominant intellectual
movement in the 1970s and early 1980s, and is still influential in the 1990s in
the sociology of health and illness. Under this perspective, good health is
defined in political terms not only as a state of physical or emotional well
being but as 'access to and control over the basic material and non-material
resources that sustain and promote life at a high level of satisfaction',

42
meaning that 'a key component of health is struggle' (Baer et al 1986:95). For
political economists, ill, ageing or physically disabled people are marginalized
by society because they do not contribute to the production and consumption
of commodities. Other marginalized groups, such as tribals, women, blacks,
the unemployed and members of working class, live disadvantaged lives
compared with those from privileged groups, have restricted access to health
care services and suffer poorer health as a result.
From this perspective the institution of medicine exists to attempt to
ensure that the population remains healthy enough to contribute to the
economic system, as workers and consumers, but is unwilling to devote
resources for those who do not respond to the treatment and are unable to
return to the labour market. Medicine thus serves to perpetuate social
inequalities, the divide between the privileged and the underprivileged, rather
than ameliorate them. (Pieris, 1999)
Political economy writers comment on the 'cultural crisis of modem
medicine', in which health care under capitalism is perceived as largely
ineffective, overly expensive, under-regulated and vastly inequitable. For
writers such as Freidson (1970), the high status of the medical profession and
the faith that is invested in its members' abilities to perform miracles has
resulted in other social problems being inappropriately redefined as illness.
He contended that as a result of the widening of medical jurisdiction, more
social resources have become directed towards illness, and as a
consequence, the medical profession's power and influence have increased
markedly in the twentieth century, with little scope to question its activities or
uses of resources. This 'medicalization' thesis was adopted by other political
economic critics, including Zola (1981) who saw medicine as becoming a
major institution of social control, superseding the influence of religion and law
as a' repository of truth', and lllich (1976) who argued that modem medicine
was both physically and socially harmful due to the impact of professional
control over medicine, leading to dependence upon medicine as a panacea,
obscuring the political conditions which cause ill health and removing
autonomy from individuals to control their own health: such medicine is but a
device to convince those who are sick and tired of society that they who are
ill, impotent, and in need of technical repair'(lllich, 1976:9).

43
 Like the functionalists, political economists see medicine as a moral
exercise, used to define normality, punish deviance and maintain social order,
but the latter school of thought believes that this power is harmful rather than
benevolent and is abused by the medical profession. The political economic
critique questions the values of biomedicine and focuses on the identification
of the political, economic and historical factors that shape health, disease and
treatment issues. Scholars argue that the capitalist economic system has
promoted a view of health care as a commodity, in which profit seeking is a
major influencing factor, and therefore the relationship between doctor and
patient is characterized by conflict and the clash of differing interests and
priorities. They argue that biomedicine attempts to narrow the cause of ill
health to a single physical factor, upon which treatment is then focused. As a
result, medical care tends to be oriented towards the treatment of acute
symptoms using drugs and medical technology rather than prevention or the
maintenance of good health. Political economists suggest, however, that the
cause of ill health are more diffuse and are related to socio-economic factors
which are themselves the result of capitalist production (Mckee, 1988: 776).

Political economy commentators have written extensively about the

state's failure to acknowledge the role of environmental toxins caused by
industry in causing illness, to regulate the activities of multinational
corporations to create healthier environments, or to take steps to regulate the
production, marketing and advertising of unhealthy commodities such as
alcohol and tobacco (for example, Epstein, 1978, 1990; Breslow, 1982; Syme
and Alcalay, 1982; Doyal, 1983; Russell and Schofield, 1986). They see a
symbiotic relationship existing between capitalism and health care: capitalism
produces health needs which are treated in such a way to obscure their
origins and demands the consumption of commodities to secure the healing
process, which in turn supports the capitalists system of production (Navarro,
1976; Renaud, 1978). The proposed alternative is a socialized system of
health care, in which the state provides care for all free of charge and
alternative; non-bio medical methods of health care delivery are accepted as
valuable.
There are two major facets to the critical political approach. The first
largely accepts that biomedicine is a politically neutral 'good' and seeks to

44
provide more and better medical services to the underprivileged, while the
second, more radical critique, has questioned the value of biomedicine itself,
and highlighted its role as an institution of social control, reinforcing racism
and patriarchy (Ehrenreich, 1978). However both approaches conform to the
'use/abuse' model of medical knowledge, which tends to accept the neutrality
and objective validity of medical knowledge itself, but questions the use to
which it is put in the interests of doctors and the wider capitalist system, often
retreating into 'doctor-bashing' (Jordaiiova^ 1983: 91). Their critique
sometimes seems contradictory: for example, medicine is typically criticized
for being both overly expansionist and exclusionist of the underprivileged; and
illness is seen as being caused by both deprivation and medical domination
(Gerhardt, 1989: 318-22).
The political economy perspective has been criticized for ignoring the
micro social aspects of doctor-patient relationship (Ehrenreich, 1978: 16-18).
According to this perspective, the doctor-patient relationship is represented as
the equivalent of the capitalist-worker relationship, in which the former exploits
the latter. In this conceptualization, an individual who is ill may be reduced to
'a specimen of societal processes', his or her suffering not acknowledged as
the focus of the doctor's wish to help, and emphasis upon structural societal
change may detract from the plight of cun-ent cases needing immediate
attention (Gerhardt 1989: 350-1). Furthennore, the political economy
perspective calls for a mass social movement to change dependency upon
medical technology, de-commodify medicine, challenge the vested interests of
drug companies, insurance companies and the medical profession, and
redirect resources towards ameliorating the social and environmental causes
of ill health (Ehrenreich, 1978: 25-6; Gerhardt, 1989: 323). For critiques such
a call may seem idealistic and unrealistic, particularly given the symbiotic
relationship between capitalism and medicine:
The political economy approach has been also criticized for its
unrelenting nihilism; its tendency to fail to recognize that advances in health
status and increased life expectancy which have occurred over the past
century, associated with improvements in the human diet, reforms in
sanitation and the supply of clean water, a rise in standards of housing, better
contraceptive technologies and progress in medical treatment and drug

45
therapies, are intrinsically linl<ed to the requirements and demands of the
capitalist economic system (Hart, 1982). It has been argued that political
economists tend to be highly critical of patterns of health status and inequality
in capitalist societies, but yet fail to fully recognize that socialist states are no
more successful in reducing inequalities, and indeed that the overall health
status and access to health care of the populations of such societies have
historically been worse than that of populations of capitalist societies (Turner,
1988:221-2).

SOCIAL CONSTRUCTIONISM:
With the growing influence of post structuralism, second wave
feminism and Foucauit-dian scholarship, the perspective of socfal
constructionism has begun to receive increased expression in the sociology of
health and illness and the history of medicine. Post structuralism is essentially
an approach which questions claims to the existence of essential truths. What
is asserted to be 'truth' should be considered the product of power relation,
and as such, is never neutral, but always acting in the interests of someone.
They argue that all knowledge are inevitably the products of social relations,
and are subject to change rather than fixed. Knowledge is seen not as a
universal, independent reality but as a participation in the construction of
reality.
Human subjects are viewed as being constituted in and through
discourses and social practices which have complex histories. Thus the
examination of the ways in which the 'common-sense knowledge' which
sustains and constitutes a society or culture is generated and reproduced is a
central interest. (Pieris, 1999)
The application of this perspective in sociology and history is generally
termed 'social constmctionism'. For social constructionists examining the
social aspects of biomedicine, the development of medico-scientific and lay
medical knowledge and question the reality of disease or illness states or
bodily experiences, it merely emphasizes that these states and experiences
are known and interpreted via social activity and therefore should be
examined using cultural and social analysis.

46
 According to this perspective, medical knowledge is regarded not as an
incremental progression towards a more refined and better knowledge, but as
a series of relative constructions which are dependent upon the socio-
historical settings in which they occur and are constantly renegotiated. The
approach allows alternative ways of thinking about the truth claims of
biomedicine, considering them as much as social products as lay knowledge
of medicine. Such a project has brought together sociologists,
anthropologists, philosophers and social historians interested in the cultural
assumptions in which biomedicine is grounded and the practices that sustain
it (see for example, Foucault, 1972, 1975, 1979; Wright and Treacher, 1982;-
Amistrong, 1983; Lock, 1988; Tumer, 1988; Brandt, 1991). The feminist
movement has led the way in which medical and scientific knowledge's are
used to privilege the position of powerful groups over others, and has
developed a trenchant critique of the 'biology as destiny' ideology which has
frequently been adopted in the medical context to deny women full
participation in the public sphere (Prakash, Padma: 1984,1986,1990,1994,
2005 ).

There is a range of political positions taken by scholars adopting the

social constructionist approach (Bury, 1986). Some view medical knowledge
as neutral, while others emphasize the social control function of discourses,
arguing that such knowledge and its attendant practices reinforce the position
of powerful interests to the exclusion of others. However, social
constructionist scholars generally avoid viewing power as being wielded from
above and shaped entirely by the forces of capitalism, recognizing instead a
multiplicity of interests and sites of power. The notion that medicine acts as an
important institution of social control has remained, but the emphasis has
moved from examining medical power as an oppressive, highly visible,
sovereign-based power, to a conceptualization of medicine as producing
knowledge which change in time and space. They argue that medical power
not only resides in institutions or elite individuals, but is deployed by every
individual by way of socialization to accept certain values and norms of
behaviour.
Constructionist analyses have been criticized for concentrating upon
medical discourse at the macro-level, for making broad generalizations and

47
avoiding a detailed examination of the micro-context in which discursive
processes tal<e place, such as the everyday experiences of people, for their
insistence that discourses have general social effects, regardless of social
class, gender or ethnicity and for not recognizing human agency and the
opportunity for resistance (Turner, 1984; Outram, 1989; Shilling, 1991 ).
Critics of the social constructionist approach have argued that the approach,
like all others influenced by the post structuralist movement, can descend into
relativism and nihilism if taken to its logical conclusion, that all knowledge are
social products, and that therefore the insights of social constructionist
analyses are themselves to be questioned. How are the claims of social
constructionist analyses to be justified, if they themselves are contributing to
discourses which provide certain ways of seeing the world which are not
necessarily any more valid or reasonable than other ways? (Bury, 1986:151).
However in response as Nicolson and Mclaughlin (1987:117) argue : 'Far
from relativism being an "abyss" to be avoided, proper standards of
sociological scholarship imply and demand that sociologists of knowledge be
methodologist relativists. Anything less unnecessarily detracts from the scope
and power of sociological inquiry'. Indeed many scholars now emphasize that
experiences such as pain and death exist as biological realities, but that such
experiences must always be understood through social processes.
Furthermore, social constructionism is not nihilistic if it is recognized that
exposing the social bases of medicine, health care and illness states renders
these phenomena amenable to change, negotiation and resistance.

MEDICAL ANTHROPOLOGY:
Over the past decade the projects of medical anthropology and medical
sociology/ sociology of health and illness have come close together to the
extent that it is difficult to identify the boundaries separating them.
Anthropological research aids a cross-cultural understanding of orientations to
health care which may differ from the traditional bio medical model, including
the lay health beliefs of ethnic minorities living in a western culture (Klienman
et al., 1978; Littlewood, 1991), and provides a comparative perspective
against which the western medical system may be examined. Due to its
tradition of participant observation ethnographic research in small scale

48
societies, anthropology has developed sophisticated analytic tools to
document and understand the meanings of communicative processes in the
medical settings (leazaD)R,.19R8:5C0.
They have traditionally been concemed with the interpretation and lived
experience of illness. They recognize that the culture within which a patient is
operating influences the illness experience, although 'culture' when used in
this context often refers to ethnicity or race. This approach view disease and
illness as 'a form of communication-the language of the organs-through which
nature, society, and culture speak simultaneously' (Scheper-Hughes and
Lock^ 1987:31). Although the major focus of westem anthropologists has been
upon studying small scale, rural, underdeveloped. cultures rather than the
large, urban, (ate-capitafist cultures in which they themselves have been
encultured, recent scholarship in medical anthropology has begun to examine
the health beliefs of westem society. DiGiacomo (1992:132) has termed this
process 'Anthropologizing the west'.
In their avoidance of the social criticism perspective for fear of losing
access to the health arena, medical anthropologists have often supported
hegemonic ideologies supporting medical assumptions and have neglected
the macro, socio-economic perspective for a more politically neutral micro-
level of analysis. They suffered because of their close links with biomedical
practice and their need to appear institutionally 'useful'. Clinical
anthropologists have sometimes been expected to act as cultural translators
or public relations personnel in health care settings rather than as analysts
and critics of the social and the social and political structures in which
biomedicine is embedded. While going well beyond the biomedical model of
understanding illness, and questioning notions of medical epistemology in
relying upon empirical evidence in which symptoms are regarded as the
objective expressions of bodily disorders, medical anthropologists' project of
exploring the cultural construction of illness has often been positioned as a
tool of doctors for better diagnosis of patients' ills and enhanced
understanding of their experiences of illness. (Pieris, 1999) ^-"""'^
As a result, patient is portrayed as a constellation of 'unknown'
meanings, which it was up to the doctor to 'decode', using the elicitation of
patients' narratives as the method of inquiry as opposed to the use of tests.

49
Biology was considered essentially universal, while culture was considered as
external to disease and biology (Gordon, 1988a:28X. While placing emphasis
upon the socio-cultural nature of illness, such an approach tended to imply
that 'folk illness' was an inferior version of 'real' biomedical illness as
diagnosed and treated by doctors and described in medical textbooks and
journals: Stoeckle and. Barsky (1981:233) commented that folk and primitive
beliefs persist today, even in the attributions offered by the modem "well-
educated" patient, not only in those of the less educated, ethnic minorities'.
Recently, however, the political economy and social constructionism
have influence the medical anthropology research and scholarship. An
emergent perspective in medical anthropology, entitled 'critical medical
anthropology", has begun to be met with favour in some quarters (Baer et al.,
1986}^ SingeM[199p)^has identified several areas of research interest for
critical medical anthropologists which; are also relevant to medical
sociologists and historians. These include the following:
The social production of medical knowledge; the functions of medicine
and public health in social control; the importance of consciousness and
agency in health-related behaviours and beliefs; the relation of health and
medical language to power; the identification and labelling of disease; the
contestable nature of medicine and disease as biomedical realities; and the
meaning of illness experience. Recent critical approaches are
interdisciplinary, incorporating political economy concerns with the stnjctural
economic features of society and how they impinge upon health status, with a
social constructionist interest in epistemology and language use, as well as an
interest in the phenomenological aspects of medical encounter.

THE HISTORICAL DIMENSION:

In Eariier decades the history of medicine was tended more towards
the hagiography of medicine in viewing scientific medicine as enlightened,
ever progressing and triumphant (Wright and Treacher, 1982; Brandt, 1991).
However, recent social histories of the ways in which society has responded
to disease and illness have taken a more critical constructionist approach.
The history of medicine has therefore moved towards medical sociology and
anthropology, and vice versa, for one of the most important features of social

50
constructionism as adopted in medical sociology and anthropology is its
recognition of the historical nature of medical knowledge. (Pieris, 1999)
History provides a perspective which is able to show, as does the
cross-cultural perspective that the conventions of western medicine are no
more 'scientific' or 'objective' than medical systems in other cultures or in
other times. The historical perspective provides a chronological approach, a
sense of continuity as well as change, and an ability to intenveave different
levels of interpretation in its analysis of medical and public health issues and
events (Benidge and Strong, 1991:137). It also allows an insight into social
issues which, by highlighting their historicity, demonstrates that the taken for
granted features of the present should be challenged: "we use the past to
shaken confidence in the "obvious" appearance of medicine today; not in
order to sanctify it as has so often happened in histories of medicine' (Wright
and Treacher, 1982:2).
Without the historical perspective, the beliefs and behaviours of people
in response to health issues often appear inexplicable, irrational and self-
defeating. Such accounts are valuable in providing an important perspective
upon contemporary westem society's responses to health threats and
diseases and explaining reasons why certain responses occur; why, for
example, some diseases are stigmatized and provoke widespread fear and
moralistic judgements; why certain kinds of imagery and rhetorical devices
continue to enjoy resonance in the mass media's coverage of medical
matters; why current health policies succeed or fail. As Brandt, in a recent
review of the history of medicine, concluded:
History offers us an avenue to better understand critical aspects of
human motivation, organization and relationships. In the crucible of sickness,
these relationships are thrown into sometimes stark and dramatic relief,
enhancing our ability to see and perhaps understand them. Ultimately then in
studying the history of medicine we learn about the constraints and prospects
of the human conditions across time and cultures (1991:211).

CULTURAL STUDIES:
Human body became a focal point of sociological investigation
gradually, led by the work of Bryan Turner (1984,1988, 1992).such studies

6624 51
bring together the concerns of the sociology of knowledge and the sociology
of culture in ways which provide fascinating explanations of how seemingly
individual characteristics such as a person's physical appearance, style, taste,
manners and bodily deportment are not merely personal idiosyncrasies but
are highly influenced by socio-cultural nonns linked to social class, gender
and ethnicity.
The theoretical base and empirical research produced by the field of
cultural studies offers insight into the socio-cultural aspects of medicine
.cultural studies is an interdisciplinary area which originally developed from
the sociology of culture^(Williams, 1976) and has incorporated literary theory,
film studies, Marxist, linguistic and psychoanalytic theory to examine not only
the products of the elite cultural endeavours, such as opera, fine art, theatre
and literature, but mass produced commodities and the products of the
popular mass media (Tumer,1990jnd Fiske, 1992). R.^*^' ]
Because most social scientists have tended not to view medicine as a
product or part of culture, but as an objective body of scientific knowledge
external to culture where 'science' is seen as the antithesis of 'culture', the
cultural studies approach has rarely been adopted to analyse biomedicine or
public health institutions and practices. Yet people construct their
understandings of the worid, including their beliefs about medicine and
disease, from their interaction with cultural products as well as personal
experience and discussions with others. The mass media are important in
portraying medicine, health care, disease, illness and health risk in certain
ways, from the soap opera's kindly doctor to the news bulletin's account of
medical miracles, contributing to people's understanding of these phenomena,
especially when they have little or no direct experience of them. Medicine,
health care, illness and the doctor-patient relationship are cultural activities
and experiences and as such, are appropriate areas of study for sociologists
of culture and scholars in the field of cultural studies. Furthermore, the study
of the ways in which medical practices and institutions are represented in the
mass media and the reception of such representations by audiences are
integral to interpretive scholarship attempting to understand the socio-cultural
aspects of medicine and health related knowledge and practices (Lupton,
1992).

52
DISCOURSE AND THE 'LINGUISTIC TURN':
The examination of texts is central to discourse analysis and other
forms of interpretive research. Indeed it is becoming recognized in all areas of
social research that texts are important items of analysis as sensitive
barometers of social process and change (Potter and Wetherell, 1987;
Jensen, 1991; Fairclough, 1992). For scholars interested in medical
fiscourses, texts to examine may include medical textbooks, hospital records
and admission forms, popular self-help manuals, novels, television
programmes about health issues, articles in medical and public health
journals and popular news papers or magazine articles, as well as the
transcripts of conservations between doctors and patients or interviews
between researcher and subject. When applied to socio-cultural analyses of
medicine, the analysis of discourse has the potential to demonstrate 'the
process by which biology and culture interact' in social construction of
disease, and the ways in which western culture uses disease to define social
boundaries (Brandt, 1988: 417; Lugtop^^UaOZX, f^-^- * t ^ ."• ^ -^ I

CONCLUSION: A MERGING OF PERSPECTIVES

While, there are important differences in the manner in which different
disciplines, sub-disciplines and interdisciplinary fields approach the analysis of
medicine as culture, what is common amongst all the perspectives is the
acceptance that in modern westem societies the institution of medicine has an
important part to play in social control, in shaping the regulation of human
action, the deportment of human bodies and the construction of subjectivity.
There is much more to be gained from an eclectic perspective which
approaches the same research problem from different theoretical and
methodological angles which at the same time maintaining an awareness of
the disciplinary traditions and rationale of the different approaches. (Pieris,
1999)
For the research problem selected, a further elaboration of theoretical
orientations of medical anthropology has been delineated:

53
1.8.2. THEORETICAL UNDERPINNINGS OF MEDICAL ANTHROPOLOGY:
The theoretical approaches to study the tribal traditional medicine had
adopted two dimensions:

• Tribal traditional medicine as a cultural complex, of material objects,

tools and techniques, ideas and values, and

• A part of social structure and organization i.e. network of relations

between groups, classes and categories.

It is realized now that knowledge of these two aspects of medicine, in

itself and in relation to other aspects of social life such as economy, religion,
magic and law is becoming increasingly necessary for a comprehensive
understanding of any society. This approach also allows us to understand the
social dynamics as to why certain elements of the modem medicine are
accepted and why the others are rejected.
The social dynamics, vapproach studies the medicinal practices
epistemologically. Khare(1963) studies the medical practices in North India in
the framework of 'Parochialization' and 'Sanskritization' showing how the
upper castes try to place their aetiology in temis of the ideas of great tradition
and the lower castes define them in terms of the lesser gods and deities. This
perception has later been supported by Ahluwalia and Leslie (1967) through
their studies.
Political-economic dimension has been emphasized by Melt in the
study of medical systems. Helt (1981) says, "Political economic forces play a
dominant role in shaping of the health services of a community, for instance,
through decisions on resource allocation, manpower policy, choice of
technology, and the degree to which the health services are to be available
and accessible to the population". It has also been used as a political weapon
to increase dependence for exploitation of one class by another to promote
certain vested market interests. This view has been supported by Banerjee
(1981) and KleinrnenXlgTBHas well. Similarly Djurfeldt, Lindberg, Zurbrigg
and Mathew emphasized Trom this perspective that it is necessary to link the

54
struggle for health as a part of broader struggle for social and economic
justice and the important effect of poverty on health and culture. P. Mandal
(1996) stressing upon the political dimension of health has traced the
evolution of using medicine as an instrument of consolidation of political
power by the upper caste/ classes in India from the ancient times to the
present day.
One of the radical theoretical formulations In medical sociology in the
west has been the "Theory of Gaze" fonnulated by Foucault (1973) in which
I
\
he traces historically how the medical system in the west has operated in the
feudal capitalist environment and led the medical profession into an industry-
by dehumanising it. The patient has been reduced to an object of laboratory
experiment for the physicians. This view has also been supported by Aird
(1968); Kothari and Mehta (1988). f ' '-
Opposite to Foucault's approach majority of anthropologists have tried
to focus the humanistic dimension of the system of tribal medicine. However,
some of them have certainly tried to trivialise it by stressing on their 'irrational'
outlook towards modernization due to their 'rigidity and faith in religion and
superstitions'. Majority of anthropological work has overemphasized the
supernatural aspects and ignores the socio-political aspects of traditional
medicines.
Emphasizing the role of ethnicity in health research; Lipton and
J^arbach state, 'Ethnicity has been shown to be a relevant determinant of
health beliefs and illness behaviour. Ethnic group membership influences how
one perceives, labels, responds to and communicates various symptoms, as
well as from whom when one selects to obtain care, when it is sought, and the
type of treatment received. Similarities and differences between and within
ethnic groups have been related to major functions. The first, culture
influences the meanings of symptoms and the ways in which health problems
are related and treated. The second, social involves how families, kin or local
groups affect people's behaviour relate to health and illness and how ethnic
expectations influence practitioner-patient relationships. Rathwell (1984)
states, "in Great Britain ethnic minorities not only have markedly different
health care needs, but also different ways of making the needs manifest

55
....cultural differences predetermined to a large extent the type of care or
service people seek".
Some scholars have stressed on the class approach in terms of
political economy. Cokerham (1988) states that studies done in the 1950s and
1960s suggested that poverty produced beliefs and values which inhibit the
use of physician's services. The poor generally held beliefs that were not
congruent with scientific medical care and were sceptical about the intentions
of symptoms. They suffered from the cultural lag.
Many of these studies reveal an ethnocentric bias of westem scholars
as they hold only western medical system to be rational and scientific.
Banerjee (1986) strongly criticizes Marriot's views on the North Indian mral
people's in-ational attitude towards medicine.
Contrary to the westernization or modernization model, some scholars
have again stressed on the counter hegemonic dimension of medicinal
practices as an aspect of political economy. Nichter and Vuckovic hold the
view that, "shifts in affiliation to a particular type of medicine are it modem or
traditional may emerge as a fomri of resistance to hegemony when prevailing
medical systems is perceived to be affiliates with an established power
apparatus. Support of traditional medicine through public discourse has been
widely employed as a means of resisting colonial rule and as a 'grass roots'
strategy to foster cultural identity at a time of social transformation (Kamath
n.d).
The political economic approach to the study of medicinal practices in
the recent year has been stressing the role of the political forces in promoting
different systems of medicinal practices. Perdersen and_Baruffati (1989) have
observed "there are many examples in the history of Latin American countries
where those in power have tried to eradicate the indigenous medical
ideologies, practices and materia medica. Where as in some countries the
ruling class remained tolerant or indifferent to the presence of traditional
medicinal practices, in others a more radical posture was adopted in which
traditional medicine and its 'mentality' was considered retrograde and
undesirable to be replaced entirely by modern 'scientific' knowledge and
practices".

56
 In the recent years the political-economic dimension of health has also
been linked with the issues of human rights and intellectual property rights
(IPR), medical ethics and ethics in research particularly in connection with the
developments in the 3'^'' world countries.

Following are the major theoretical perspectives or orientations in

Medical Anthropology:

Theoretical orientation I: Medical Ecology

Anthropologists using an ecological perspective to understand disease
patterns view human populations as biological as well as cultural entities.
Taking a systems approach in research, culture is seen as one resource for
responding to environmental problems, but genetic and physiological
processes carry equal weight. The evolution, demography, and epidemiology
of humans are subject to ecological forces, as are other species.
A key concept in medical ecology is "adaptation," the changes,
modifications, and variations that increase the chances of survival,
reproductive success, and general wellbeing in an environment. Alexander
Alland, Jr. (1970) was one of the first to apply the concept of adaptation to
medical anthropology. Humans adapt through genetic change, physiological
responses (short-term or developmental), cultural knowledge and practices,
and individual coping mechanisms. A basic premise is that health is a
measure of environmental adaptation, and disease indicates disequilibrium. A
second premise is that the evolution of disease parallels human biological and
cultural evolution. The risks faced by foraging peoples differ from those of
agricultural groups and industrial societies, and the epidemiological profile of
each subsistence type is a function of human relations with the environment
and with other species in the ecosystem, especially food sources,
domesticated animals, and pathogens.
Medical ecology, unlike other orientations, assumes that biomedical
disease categories are universal. Disease rates can be measured, compared
through time and across geographic space, and correlated with changes in
settlement patterns and subsistence. The frequencies of haemoglobin types
can be measured and mapped geographically in relation to the incidence of

57
infectious diseases such as malaria. The impact of diseases of contact, such
as malaria, smallpox, and tuberculosis, on the native populations of the New
Worid can be studied historically.
In the field, medical ecologists study subsistence patterns and nutrition;
children's growth and development; pregnancy and birth rates; population
size, density, and mobility; chronic and infectious disease; hazards and injury
patterns; and demographic change over time. Research on prehistoric
populations analyses skeletal remains, house sites, settlement patterns, and
ecology. Medical ecology has usually studied isolated populations living in
rigorous environments, such as high-altitude regions, the arctic, and tropical
forests, such as the classic woric of Napoleon A. Chagnon (1992) and James
V. Neel (1977) on the Yanomamo, the wori< of A. T. Steegmann, Jr. (1983),
on cold adaptation, and the long-term research in high-altitude regions of
South America by Paul T. Baker and Michael A. Little (1976) and by R.
Brooke Thomas (1973) and their respective colleagues and students.
Increased attention has been given since the 1980s by human
biologists and medical ecologists to seasonality and health in agricultural
populations, environmental and cultural regulation of fertility, migration and
change in health status, and to work productivity in chronically
undernourished and infected populations. The urban ecology of health is a
new focus as well, and there is increasing dialogue with political economy
theorists with respect to developing a "political ecology of health."

Theoretical orientation II: Ethno medicine

The ethno medical perspective focuses on health beliefs and practices,
cultural values, and social roles. Originally limited to study of primitive or folk
medicine, ethno medicine has come to mean the health maintenance system
of any society. Health ethnographies encompass beliefs, knowledge, and
values of specialists and lay people; the roles of healers, patients or clients,
and family members; the implements, techniques, and phamnacopoeias of
specialists; legal and economic aspects of health practices; and symbolic and
interpersonal components of the experience of illness.
Pluralistic societies often encompass several ethno medical systems.
Among these are cosmopolitan medicines, a dominant system in North

58
America and in urban centres elsewhere, which emphasizes empirical
research, naturalistic explanations, technology and surgery, use of
extraordinary intervention to preserve life, and hierarchical roles. Humoral
medicine, derived from ancient Greek medicine, emphasizes that health
reflects balance among bodily humours and their intrinsic qualities.
Disequilibrium derives from ingestion of inappropriate food and other
substances, from change of climate, and from exposure to natural elements
like air and water. Therapy involves restoring equilibrium through applying or
ingesting remedies opposite to the state of the body. Humoral medicine
coexists with other systems in Latin America, the Middle East, Malaysia,
Indonesia, and the Philippines. Ayurvedic medicine in India and Chinese
traditional medicine meld humoral elements with elements of other systems.
A key concept in ethno medicine is "explanatory model," introduced by
Arthur Kleinman (1980). Explanatory models (EMs) are notions about the
causes of illness, diagnostic criteria, and treatment options. In a clinical
encounter, the EMs held by practitioners, patients, and family often differ. The
ensuing communication and negotiation of decisions for managing illness lead
to the cultural "construction' of illness. To the extent that disparity among EMs
continues because of cultural, ethnic, or class differences, communication
remains problematic.
The disease-illness distinction is important conceptually in the study of
ethno medicine. Disease, defined clinically as deviation from medical norms,
is considered to be a Western biomedical category and not universal.
Biomedical terms such as "hypertension' or "diabetes" may not con-espond to
diagnostic categories of a given ethno medical system. Illness, in contrast, is
the experience of impairment or distress, as culturally defined and
constructed. Cause of the illness may also be located in social and spiritual
realms, so that ethno medical aetiology may include sorcery, soul loss, and
spirit intrusion (see also Bhasin, 2007).
In addition to negotiation of the meaning of illness, management of
illness and disability also occur in a social and cognitive matrix. Healing is
often mediated by symbols and practices that induce conditioned Neuro-
physiological and immune system responses. The placebo effect of the
healer's behaviour and symbols to induce healing or to reduce stress is of

59
central interest in ethno medical studies. Cultural psychiatry is closely allied
with ethno medicine. Many folk illnesses or "culture bound syndromes" (such
as susto, arctic hysteria, or amok) appear to be psychogenic, although
environmental stressors play a role in their onset. These folk illnesses do not
fit easily Into Western diagnostic categories.
Ethnographic methods are primary in this orientation, and researchers
usually do participant-observation, sometimes becoming apprentices of
healers and midwives. Some elicit ethno semantic data on disease
categories, causes, and decision models in order to study underlying
cognition. Interviews and life histories allow in-depth analysis of the lives of
healers and patients, and medical discourse analysis is a specialized linguistic
technique that studies the negotiation of meaning and power. Some
specialists collect and analyse phamriacologic items; others study the history
of medical practices. Although traditionally researchers have worked in folk
societies, increasing numbers are studying pluralistic societies, such as
Margaret Lock (1980). Attention has been given since the mid-1980s to
integrating ethno medicine and ethno ecology, as in studies of indigenous
people's knowledge of medicinal plants. There is also strong interest in clinical
applications of ethno medical treatments.

Theoretical orientation III: Applied Medical Anthropolopv

Theories of the cultural patterning of health behaviour can be applied in
any arena. Following the pioneering examples set by Margaret Clark, George
Foster, and Pertti Pelto, anthropologists work, for example, in clinics serving
multicultural populations, in maternal and child health programs, on surveys of
community responses to environmental hazards, on program planning and
evaluation in psychiatric hospitals, on AIDS prevention projects, and on the
reintegration of people with traumatic brain injury to community life. The
populations served are often people on the margins of mainstream society-
refugees, native peoples, rural elderly, drug addicts, and people with
disabilities, ethnic minorities and tribals. The difference between basic and
applied research is that applied medical anthropologists deliberately become
advocates for the community and attempt to do research that is useful and
ethical.

60
 While some applied research is a theoretical, others employ explicit
theoretical frameworks. One notable framework is the political economy of
health, also called critical medical anthropology. Influenced by Marxist theory
and dependency theory, this approach analyses the impact of global
economic systems, particularly capitalism, on local and national health.
Political economists such as Soheir Morsy, Hans Baer, Lynn Morgan, and
Merrill Singer argue that change programs should not be attempted unless
one also studies the social production of illness and poverty within the larger
dynamics of class interactions, colonialism, or world economic systems.
Critical clinical medical anthropology is an adjunct of political economy.
This approach analyses biomedical practice and the differentials in
power and authoritative knowledge of practitioner and patient. Clinical
anthropology has been influenced by Michel Foucault's writings on the
historical production of medical knowledge and the notion that the body can
become an arena in which social control issues are played out. Usually
focused on medical communication, the approach has been used particulariy
in relation to women's reproductive health and has developed a controversial
literature on the lexicalisation of women's bodies through the work of Brigitte
Jordan, Emily Martin, Rayna Rapp, and others.
Applied anthropology methods are eclectic, ranging from qualitative to
highly quantitative. Ethnographers have developed rapid assessment
techniques to document community health needs during brief field trips.
Others trained in public health, epidemiology, nursing, or medicine may do
clinical or laboratory procedures or work with vital statistics. In quantitative
approaches, rigorous attention is paid to sampling issues and sophisticated
statistical analysis, and infonned consent procedures are followed. As Carole
E. HiilJ1991) points out, many medical anthropologists are now working
outside academia and combining standard anthropological skills with technical
planning evaluation skills.
Considering the merits and limitations of each theoretical models of
medical anthropology, the researcher has 02tfid._ettiao_jTiedicine_and
applied medical anthropology to understand the health beliefs ancjj
practices of Munda tribe and appropriate quantitative methodology witl^
interview schedule and observation method has been used for dat^
collection (The detailed information of tools of data collection is given in
Chapter 4 Research Methodology).

61
 REFERENCES

Abraham, L. (1991). Sources of Indigenous Knowledge Tribal and Folk

Medicine in India: A case for ethno-nnedical exploration. Mumbai: TISS.
Abraham, Leena and Anil Kumar K (1993) "Kerala -An Unhealthy
Population?" Economic and Political Weekly, [Link], Nos 11
PP478-493. ^

\X'
Ackerknecht, E. H. (1942). Problems of Primitive Medicine. Bulletin of
History of Medicine; [Link], 503-21.
Ackerknecht, E.H. 1943. "Psychopathology, primitive medicine and
primitive culture." Bulletin of the History of Medicine, 14: 30-67.
Ackerknecht, E.H. 1944. "Primitive Surgery." American Anthropologist,
49: 25-45.
Ackerknecht, E. H. 1946. "Natural diseases and rational treatment in
fmitive medicine." Bulletin of the History of Medicine, 19(5): 467-497
Ahluwalia, A. (1974). Sociology of Medicine. In M. N. Srinivas [Link]., A
Survey of Research in Sociology and Social Anthropology, Vol.11.
Bombay: Popular Prakashan.
All, A. (1987). Tribal Health Research: Issues and Challenges.
Ali, A. (2003). Health Status of Tribals in India : An Overview. In B.
Bhattacharya., Dipak Kumar Adak,(eds) Demography & Health Profile
otthe Tribals. pp. 1-23. New Delhi: Anmol Publications Pvt. Ltd.
Baer H.A., M. Singer and I. Susser. 1977. Medical anthropology and
the World System. A Critical Perspective. Westport, London: Bergin
and Garvey.
Banerji, D. (1992). Health Policies and Programmes in India in the
Eighties. Economic and Political Weekly;[Link](12), , 599-605.
Banerji, D. (1976). Health Services and population Policies. EPW,
[Link](31,32,33) , 1247-52.
Banerji, D. (1974). Social and Cultural Foundations of Health Services
Systems. Economic and Political Weekly; [Link] (32,33,34) , pp 1333-
1343.

62
\ ^ / ^ a n e r j e e , Madhulika (2009) Ayurvedic Pharmaceuticals at Home and
inthe World. Hyderabad. OrientBlackswan Pvt. Ltd.
• /Bhasin, Veena. (2004). "Sexual Illness and Underutilization of
Biomedicirie Among Tribal Women of Rajasthan." Anthropologist, 6(1):

*^Bhasin, Veena. (2005) "Ecology and Health: A Study Among Tribes of

^ k h . " Studies of Tribes and Tribals, 3(1 ):1-13.
Bhasin^V<(2007)."Medical Anthropology: A Review". Ethno-Med ,New
Kamla-Raj; pp1-20.
^hatt, S. (2003). The District Gazetteer Of Jharkhand. New Delhi:
Gyan Publishing House. pp251-288
Bhowmick, P. K. (1955). Treatment of Diseases among the Lodhas of
West Bengal. Man in India , Vol.35(4); pp. 287-298.
Bhowmik, K. L. (1971). Tribal India: A Profile in Indian Ethnology.
CaletJtta: The World Press.
Jryant, J. (1988). "Health for all: The dream and the reality." World
Health-Forum, 9(3): 291-302.
•^^^Campbell, A. (2002): Complementary and alternative medicine: some
basic assumptions. In Alternative Medicine, Should we Swallow it? (pp.
l-l/lJ^TLondon: Hodder& Stoughton.
^arstairs.G. M.(1955)."Medicine and Faith in Rural Rajasthan". In B. D.
Paul(ed), Health Culture and Community. New York: Russel Sage
FoLmdation; pp107-134
rj^C5audill W (1953). "Applied anthropology in medicine", in A. L. Kroeber
(ed), Anthropology Today. Chicago: University of Chicago Press.
• Chand, S.K, Minz, D [Link] (1988) "The Traditional Herbal Medicine
System of Chotanagpur: A Study of its Present Status and Future
Prospects" Ranchi: Xavier Institute of Social Service.
• Chaudhary, B. (1986). Medical Anthropology in India with special
reference to Tribal Population. In [Link](ed.), Tribal Health :
Socio-Cultural Dimensions. New Delhi: Inter India Publications.

63
 A.^
\j<^Chaudhuri, B.1994. "Social and environmental dimensions of tribal
health," in S. Basu (ed.) Tribal Health in India. Delhi: Manak
Publications Pvt. Ltd. pp.70-83
• Clements F.E. 1932. "Primitive concepts of disease." University of
California Publications in American Archaeology and Ethnology, 32(2):
185-252.
• Cockerham, W. C. (1978). Medical Sociology. Congeewood Cliffs:
Prentice Hall.
• Devi, L. Sunita. 2003. "Ethnomedical Practices in Manipur: A Case of
Evil Eye." Anthropologist, 5(1): 25-40.
• Eliade, M. (1987) The Encyclopedia of Religion Vol.13. New York:
Macmillan and Free Press.
• Elwin, V. (1955). The Religion of an Indian Tribe. London : Oxford
University Press.
• /Fabrega, H. (1972). Medical Anthropology. In B. J. Seigel(ed.), Biennial
Review of Anthropology. Stanford: Stanford University Press .(pp. 167-
229).
• Foster, G. (1976) "Disease etiologies in non-western medical systems"
American Anthropologist, Vol.78, pp. 773-781.
v,_^«Xhoster, G. M., SAnderson, B. (1978). Medical Anthropology. New
York: Johnwilly & Sons.

y' Geraldine Lee Treweek et. al. (2005). Perspectives on Complemetary

and Alternative Medicine. Routledge Press.
• Ghosh, Abhik "Oraon Woridviews and Concepts of Health and
Medicine" Man in India, 76(1); pp 67-80.

• Ghosh, Abhik (2005) "Mythologies of the Everyday: Tribal' Health and

Medicine in Jharkhand" Mani in India, 85(3&4): pp209-219

• Greenough, Paul. (2003) The Social and Cultural Framework of Health

and Disease in India, in Veena Das(ed.)The Oxford India Companion
to Sociology and Social Anthropology pp 303-316

64
vX' Gould, H. A. (1957)."The Implications of technological change for folk
and scientific medicine". American Anthropologist, Vol.59(3) pp. 507-

x f ^ ' ^ u i t e , N. and S. Acharya. 2006, "Indigenous Medicinal Substances and

Health Care: A Study Among Paite Tribe of Manipur, India", Studies of
Tribes and Tribals, 4(2): 99-104.

• Hasan, K. A. (1959). A Note on the contributions of Anthropology to

Mas
tedical Science. Journal of Indian Medical Association , 182-190.
Hasan,
x X Haj K. A. (1967). The Cultural Frontier of Health in Village India.
Bombay: Manaktalas.
^» Hughes, C^(1968)^thno medicine. International Encyclopedia of the
Social Sciences, Vol. 10. pp. 87-93. New York: Free Press/Macmillan.
Imam, Bulu.(1993) "The Story of Kamli: A Birhor Medicine-Woman"
Man in India; 73(4); pp 377-385.
ICSSR. (1974). Survey of Research in Sociology and Social
mhropology; Vol.11. New Delhi: Popular Prakashan.
Jagga Rajama, K., D. Vijaya and B. Raw. 1996 "Health Seeking
Behaviour, Acceptability of Available Health facilities and Knowledge
about Tuberculosis in a Tribal Area." Indian Journal of Tuberculosisi,
43: 195-199.

Jain S. and S. Agrawal, 2005, "Perception of Illness and Healthcare

Among Bhills: A Study of Udaipur District in Rajasthan" Studies of
Tribes and Tribals, 3(1): 15-19.

• Jaggi, O. P. (1973). Folk Medicine. Delhi: AtmaRam & Sons.

• Jaggi, O. P. (1973). Indian System Of Medicine. Delhi: AtmaRam &

Sons.
• Jaggi, O. P. (1980). History of Science, Technology and Medicine in
IndiaJ/dTxV. Delhi: AtmaRam & Sons.
ose, B. K. (1998). Tribal Ethno Medicine: Continuity and Change. New
D^^hl^A.P.H. Publishing Corporation.
Joshi, P. C. (1990). Medical Anthropology: An Overview. In P.C. Joshi
and [Link], Tribal Health, New Delhi: APH Publishing House, pp 1-
20

65
(1^ •^ Kakar, D.^N. (1988). Primary Health Care and Traditional Medical
Praatitioners.
Pmjsti New Delhi: Sterling Publishers Pvt. Ltd.
^• / ^Kalla,
l l a . A.K and [Link] (2004). Tribal Health and Medicines. New
DpJhi: Concept Publishing Co.
V * * ^ a m a , M. N. (1976). Etiology of disease: A sociological study in the
a rural context. Man in India; Vol.56(1) , 50-64.
^•\ Khare, R. S. (1996) "Dava, Daktar and Dua: Anthropology of Practiced
medicine in India". Social Science and Medicine , Vol.43 (5) pp. 837-
848.
• Khare, R. S. (1981). "Folk Medicine in a north Indian Village". In GiriRaj
Gupta (ed.), 777e Social and Cultural Context of Medicine in India. New
Delhi: Vikas Publications. pp266-285.
,^_5XKIeinman, A. (1978). Concepts and a model for the comparison of
medical systems as cultural systems. Social Science and Medicine ,
Vol. 12.85-93.
\»^ Kleinman, A. (1980). Patients and Healers in the Context of Culture.
Berkeley: University of California Press.
Lewis, Oscar. IdS^Village Life in Northern India. New York: Random
House.
(L^^Lieban. (1973). Medical Anthropology. In J. J. Honigman, Handbook of
Social and'uultural Anthropology. Chicago: RandMcnally & Co. pp
1p3<1073.
>.„><^Madan, T. N. (1969). "Who Chooses Modern Medicine and why?"
Economic and Political Weekly .Vol.4(37) pp1475-84.
^ \» Mahapatra, L.K. 1994. "Concept of Health Among the Tribal Population
^ " Groups of India and its Socioeconomic and Socio-cultural Correlates"
in S. Basu (ed.). Tribal Health in India. Delhi: Manak Publications Pvt.
Ltd. pp1-12
• Maiti.S (1993) "Cognition of Disease and Curing Behaviour in Rural
Bengal" Man in India; 73(4). Pp 387-393.
• Majumdar, D. N. (1933)." Disease, death and divinating in certain
primitive societies in India. Man in India .Vol.13

66
 Mandelbaum, D. (1981). Transnatural curing. In [Link]. (ed),
Social and Cultural Context of Medicine in India. New Delhi: Vikas
Publications. pp237-265.
^ •i^ MaiTiott,M.(1955)."Little Communities in an indigenous civilisation".In
M. Marriott, Studies in the little [Link] Delhi: Asia Publishing
[Link] 175-227
v » / Marriott, M. (1955a). Western Medicine in a village of North India. In B.
D. PaulyHealth, Culture and Community. New York: Russel Sage
Fpufidation.
'^« Mathews, C. (1979). Health and Culture In a South Indian Village. New
Delhi:''Steriing Publishers Private Limited,
w-,*^ Mcelroy. (1996). "Medical Anthropology" Retrieved 2007, ,\N)-OA<^IC -
• Naidu,T.S.(2007). Tribal Health in India: Problems and Future
Perspectives. Puducherry: Pinnacle Computer Offset.
• Nichter, M. (1980). "The Lay Person's perception of Medicine as
perspective into the utilisation of multiple therapy systems in the Indian
context". Social Science and Medicine , Vol.14B; pp. 225-233.
• Nayak, A N and 8 V Babu (2003) "Tribal Health Problems: An
Anthropological Appraisal" Man in India, 83(3&4): pp 301-313
• NFHS;2 India 2000. National Family Health Survey (NFHS-2). Mumbai,
International Institute of Population Studies.
v^«'^Opler, M. (1963). "The Cultural definition of illness in village India".
Human Organisation , Vol.22 (1) pp. 32-35.
• Pal, D C and S K Jain (1998). Tribal Mediicne. Calcutta: Naya Prokash.
• Pandey, G. D. 1996. Highlights of Tribal Health Research under Indian
Council of Medical Research, ICMR Bulletin, 26: 3&4: pp 21-2.
Y•' Park,K.(2007). Preventive and Social Medicine. Jabalpur: M/S
Banarasidas Bhanot Publishers
• Parsons, T. (1951). The Social System. New York: Free Press.
^ ^ ^ ^ ^ a u l , B. D. (1955). Health, Culture and Community. London: Russel
Sage Publications.
>ieris, I. (1999). Disease, Treatment & Health Behaviour in Sri Lanka.
New Delhi: Oxford University Press.

67
 /• Polgar, S.(1964). Evolutimfand the Ills of Mankind in Horizons of
Anthropology. Sol Tax. Ed. Chicago: Aldine.
• Polgar,S.(1968). Health. International Encyclopaedia of Social
Sciences.
• Raj Pramul<h,and P.D.S. Palkumar. 2006, "Indigenous Knowledge:
Impiica^ofiin Tribal Health and Disease" Studies in Tribes and Tribals,
4j[>jf1-6.
^^•*nRay, A. (2005). Social Dimensions of Health and Well Being: An
Overview of Research Trends. In A. K. Ray, Social Dimensions Of
Health. New Delhi: Rawat Publications. pp1-26.
• Raza, M and Ahmad, A (1990). An Atlas of Tribal India. New Delhi:
Conpe0t publishing Company.
ivers, W. H. (1924). Medicine, Magic and Religion. London: Kegan,
Paul, Trench, Turner and Co.
Rizvi, N.'H. (1991). Folk Concept of Health and Disease: A Case Study
o^/<Jaunsari. Eastern Anthropologist, 1-7.
^Rizvi, N. H. (1986) "Health Practices of the Jaunsaris-A Socio-cultural
Analysis" in B. Chaudhari (ed.) Tribal Health: Socio-Cultural
Dimensions.
Roy, Kanchan & Abha Prasad (1993)"Towards Inheritance of
Nonlepromatous Leprosy: A Segregational Analysis of Family Data
fronT,Santal of Santal Parganas, Bihar, India" Man in India; 73(4), pp
3-362.
Sachchidananda. (1994). "Socio-cultural Dimension of Tribal Health", in
S. Basu (ed.). Tribal Health in India. Delhi: Manak Publications Pvt. Ltd.
pp 57-69.
Sahu, S K (1991) Health Culture in Transition. New Delhi: Khama
v«in\" Publishers
Sarkar, R M (1993) "Dimensions of Folk Mediicne Traditions in Human
Society With Special Reference to Rural Bengal" Man in India,
73(4).pp. 327-341.
Singh, B., and Mahanti, Neeti (ed). (1995). Tribal Health in India. New
Delhi: Inter India Publications.

68
 jMTSingh, K. S. (1994). People of India-The Scheduled Tribes (National
Series) Vol. Ill. New Delhi: Archaeological Survey of India and Oxford
University Press.
• Singh, M., & Singhal, P. K. (1990). Health for Mothers and children: A
need for national commitment. Think India , Vol.22 (1); pp.77-87.
• Singh, S. P. (1987). Tribals and Forests. Ranchi.
• Shivaramakrishnan, G(1987) "Sociology of Medicine in the Indian
Context" Vidya Bharathi. Vol.8(1); pp 31-50.
• Turner, V.W. 1967. The Forest of Symbols: Aspects of Ndembu
Rituals. Ithaca: Cornell University Press.
• Turner, V.W. 1968. The Drums of Afflictions: A Study of Religious
Processes among the Ndembu of Zambia. Oxford Claredon.
• Treweek,G. L. (2005). Perspectives on Complementary and Alternative
Medicine. London: Routledge.
\Jflxo\^\, J. (1978). Santhal Religion. New Delhi.
>* Tribhuwan, R. D. (1998). Medical World of The Tribals. New Delhi:
Discovery Publishing House.
• Tyagi, D. (2006). Medical Anthropology. New Delhi: Anmol Publication
Priv3t^imited.
\ ^ ^ / ^ y a r t h i , L P and B. K. Rai (1977). The Tribal culture of India, Delhi:
Concept Publishing Company.
• Weaver. (1968). Medical Anthropology: Trends in Research & Medical
Education.
• [Link] retreived on
24/1/2008.

69