From: "Fellows, Jeffrey" <jmf9 at cdc.gov> To: Doug Henwood <dhenwood at panix.com> Subject: re: culture and illness Date: Fri, 18 Dec 1998 11:20:00 -0500 MIME-Version: 1.0
I have been reading this thread with interest and would like to make a couple of points.
1. In response to Doug's question, I don't know have a good sense of the effectiveness of drug and alcohol treatment. If I can use an analogy to explain my suspicions, I do suspect removing a seal from shark-infested waters to fix a broken bone in its flipper only to return to the same environment is bound to have limited effectiveness. If the life situations creating physical and emotional stress are not recognized and dealt with, interventions are unlikely to be effective.
2. I would like to see a more specific definition of what people refer to as 'culture'. It seems that "capitalist" culture or "industrial" culture are implied in many of the posts, which is fine but there still needs to be more specific sense of what is meant by that. Culture is regulalrly talked about as race or ethnicity, poverty, or (for violence problems) "southern culture." My work in and review of the lit in violence indicates race and southern culture explanations do not hold up when income inequality, racial income inequality, occupational status, and/or poverty rates are included in analyses. How we get from low socioeconomic status to incidences of violence (interpersonal and suicide) involve mediating and moderating factors that could be labelled part of a "culture of poverty", but I am suspicious of this type of label. If poverty is assumed to be a part of the natural laws of social life, the material connections to the culture of poverty may be discarded (which is regularly the case). The result is that once labeled poor, you' re also socially decrepit.
3. The biomedical model shares the medical philosophy foundations of neoclassical economic theory. It is thus not difficult to understand that the biomedical model is about as relevant to health as NC theory is to economics. Each take a narrow part of truth (or what they think is truth) and apply it to the whole, and neither understand the role of institutional structures, social conflicts, etc. in their respective sets of "tools." Public health does not work well within the biomedical model, and the history of medicine shows that public health activities and social changes have been much more effective at reducing adverse health than the advances made in the biomedical model. The latter has been effective in the area of trauma, that is keeping people alive through a critial period after a severe injury. Then again, the economic determinants of trauma center availabilty and willingness to take patients are important. I don't have the time to go into this more, but I suggest reading the work of Vicente Navarro, Henry Sigerist, and Nancy Tanenbaum (there are others of course).
Happy holidays. I hope to see some of you in NY next month.
n this way, the biomedical
---------- From: Doug Henwood To: lbo-talk at lists.panix.com Subject: re: culture and illness Date: Friday, December 18, 1998 10:21AM
Alec Ramsdell wrote:
>My criticism of addiction treatment is that it is too quick to accept
>the medical model of addiction, before other possible disabling
Most addiction treatments have pretty dismal records, don't they? The rabidly anti-drug Mitch Rosenthal of Phoenix House has refused to let anyone study their success rate, which leads one to assume it's very low. AA also has a high recidivism rate, no (not to mention all that "higher power" crap)? Does anything work?