Health Psychology. Michael Murray
her pa-tzu is paired with the timing of nature. Over time these pairings change and create the individual’s luck or yun.
Buddhist beliefs are also reflected in Chinese medical belief systems. Good deeds and charitable donations, for example, are promoted. Heavenly retribution is expected for those who commit wrongs. This retribution may not be immediate, but it will be inevitable. An important concept in this respect is pao, which has two types: (1) reciprocity and (2) retribution (Cheng, 1997). In mutual relationships reciprocity is expected. When this does not occur some form of retribution will take place.
These influences are not only codified within Chinese medicine, but also influence everyday lay beliefs about health and illness in Chinese communities around the world. For example, Rochelle and Marks (2010) explored the extent of medical pluralism among Chinese people in London. The thematic analysis suggests that Chinese medicine and Western medicine were perceived as two systems of health provision and that these two systems could be used concurrently. Generally, the National Health Service was perceived to be difficult to use and concerns were expressed around communication and trust with health care providers due to language barriers. Similarly, qualitative research by Jin and Acharya (2016) suggests that yin–yang balance and ‘qi’ still influence practices related to medication adherence among people of Chinese descent in the USA. Narratives also suggest that Western and Chinese medicine have strengths and limitations that can counteract each other. Participants also discussed the importance of social support and how they coped with acculturation stress, especially when health care providers failed to understand their cultural practices and beliefs.
Like orthodox medicine, TCM raises ecological and ethical concerns. TCM is a private industry worth billions of dollars and the efficacy of the treatments is largely unknown. Many rare and endangered species currently face extinction owing to the harvesting of animal parts such as tiger bone, rhinoceros horn, turtle shell and seahorses, and the cruel conditions in which the animals used as a source of medicines are kept causes suffering, e.g., the harvesting of bile from thousands of captive Asiatic black bears, which are held in small cages. The bile is the main source of ursodeoxycholic acid, which is used to treat kidney problems and stomach and digestive disorders (Lindor et al., 1994). Cruelty to animals to generate medicines within TCM is paralleled by the use of animals in the testing of new medicines in orthodox medicine.
Islamic views on medicine
Islam is derived from the Arabic words istaslama, which means surrender, and salam, which means peace. As such, Islam, in its religious sense, means submission and obedience to the will of God. During sickness, Muslims are expected to seek Allah’s mercy and help through prayer. They also believe that death is an inevitable part of life and that the whole creation belongs to Allah and to him is the final return.
There are specific health-related practices which Muslims follow. Health care providers need to have an understanding of general Islamic beliefs and practices to enable them to provide quality care for Muslim patients. For example, health care professionals need to be aware of the need for modesty, privacy, the appropriate use of touch and clothing, dietary requirements (e.g., Halal and fasting during Ramadan), the availability of prayer rooms, interactions with opposite-sex patients, the use of medications, shared decision-making and its impact on the family (Rassool, 2000; Mataoui and Sheldon, 2016).
Awareness and respect for spiritual and cultural values are important in clinical practice since these have implications on patients’ choices and engagement in health care. For example, it is Islamic practice to visit the sick. Culturally sensitive health care establishments find ways that enable such visits from families, friends and other well-wishers. Health care professionals need to be aware that there is Islamic guidance on end-of-life care and funeral arrangements. When treating migrant Muslims from non-English speaking countries, health care providers need to consider health literacy and linguistic barriers, which may interfere with the patient’s comprehension and ability to implement health advice when given in their non-native language (see Chapter 14).
Ayurvedic medicine
The Ayurvedic system of medicine is based upon the Sanskrit words ayus (life) and veda (science). This system is practised extensively in India. It is estimated that 70% of the population of India and hundreds of millions of people throughout the world use Ayurvedic medicine, which is based on Hindu philosophy (Schober, 1997). Both the cosmos and each human being consist of a female component, Prakrti, which forms the body, and a male component, Purusa, which forms the soul. While the Purusa is constant, the Prakrti is subject to change. The body is defined in terms of the flow of substances through channels. Each substance has its own channel. Sickness occurs when a channel is blocked and the flow is diverted into another channel. When all channels are blocked, the flow of substances is not possible and death occurs. At this stage, the soul is liberated from its bodily prison. The task of Ayurvedic medicine is to identify the blockages and to get the various essences moving again. The different forms of imbalance can be corrected through both preventive and therapeutic interventions based on diet, yoga, breathwork, bodywork, meditation and/or herbs (Schober, 1997). The use of herbs plays a major role in the treatment and prevention of illnesses (see Table 6.1 below).
As in TCM, the Ayurvedic system informs beliefs about health and illness through the Indian sub-continent and among Indian communities everywhere. However, Ayurvedic medicine has not dominated Western biomedicine, even within India. There is a variety of other competing health belief systems in a pluralistic health culture. In an interview study of a community in northern India, Morinis and Brilliant (1981) found evidence not only of Ayurvedic beliefs, but also beliefs on ‘unami’ (another indigenous health system), allopathic, homeopathic, massage, herbalist, folk, astrologic and religious systems. They note that while these systems may formally seem to conflict, participants can draw on some or all of them to help explain different health problems. Further, the strength of these beliefs is related to the immediate social situation and the roles and expectations of the community. For example, for women in some parts of Pakistan, the health belief system is a mixture of biomedicine and unami medicine, which is a version of Galenic medicine.
African health beliefs
A wide range of traditional medical systems continues to flourish in Africa. These include a mixture of herbal and physical remedies intertwined with various religious belief systems.
Two dimensions are paramount in understanding African health beliefs: spiritual influences and a communal orientation. It is common to attribute illness to the work of ancestors or to supernatural forces. Inadequate respect for ancestors can supposedly lead to illness. In addition, magical influences can be both negative and positive, contemporary and historical. Thus, illness can be attributed to the work of some malign living person. The role of the spiritual healer is to identify the source of the malign influence. African culture has a communal orientation. Thus, the malign influence of certain supernatural forces can be felt not just by an individual, but also by other members of his/her family or community. Thus intervention may be aimed not only at the sense of balance of the individual, but also at the family and community.
Nemutandani et al. (2015) explored HIV- and tuberculosis-related beliefs among traditional practitioners in South Africa. Findings suggest that the belief that HIV/AIDS and tuberculosis patients were bewitched was still prevalent. In particular, it is believed that HIV is caused by sexual promiscuity and that transmission of this disease is a punishment from God. Similarly, in a study exploring beliefs on family planning in Kenya, Nigeria and Senegal, it was suggested that the most prevalent beliefs were that modern contraceptives are dangerous and can harm women’s wombs (Gueye et al., 2015).
Using the 2010 Malawi Demographic and Health Survey, Sano et al. (2016) found that knowledge about prevention was associated with a lower likelihood of endorsing misconceptions around HIV transmission. Socio-demographic factors such as marital status, ethnicity, income, religion and urban or rural residence also showed significant associations with misconceptions around HIV transmission. Thus, it is important that cultural