LAY CONCEPTS OF HEALTH AND ILLNESS

Lay concepts (or folk concepts) of health and illness are conceptual models used by individuals, communities, or cultures in attempting to explain how to maintain health and to provide an explanation for illness. Lay concepts of health and illness often have theoretical underpinnings that arise from the wider theories of illness (e.g., humoral, Ayurvedic, biomedical), but also include locally developed concepts about the body in health and illness that may not directly relate to the major theories of illness.

Lay concepts of health and illness include particular ideas about the way the body functions, and they also highlight particular symptoms as being of special significance. For example, in the Western world, the body is often thought of as an intricate machine which must be kept "tuned-up," and illness is viewed as a breakdown of the machine. This contrasts with the Ayurvedic concept of the body, a concept prevalent in India and South Asia, in which health is seen as a state of balance between the physical, social, and super-natural environment and illness can result from disturbances in many different spheres. In the Western world, a symptom such as chest pain has a particular cultural significance and tends to be regarded with alarm. In Ayurvedic medicine, chest pain is also regarded with concern but as a symptom of emotional upset and not as the organic breakdown of bodily function. In South Asia, the symptom of "semen loss," a symptom generally regarded as innocuous in the Western world, is regarded with alarm. Cultural differences in the meaning of symptoms can lead at times to a delayed diagnosis of potentially serious conditions. For example, abdominal pain associated with appendicitis may not be interpreted to be serious, or a lump in the breast may be attributed to injury rather than to a potentially malignant process.

Lay concepts of illness usually include more than just ideas about the immediate cause of an illness. They also incorporate ideas about gauging the severity of illness, concepts about appropriate treatment for an illness, and ideas about the meaning of illness. Lay concepts of illness differ widely among cultural groups, and also between groups of people from differing socioeconomic strata. A research study done in the United States among members of lower socioeconomic classes revealed that lay concepts of illness in this group tended to have a functional basis—only if a person was ill enough to not be able to work would medical attention be sought. Lay concepts about appropriate treatments for illness may differ from a doctor's concepts; an example from contemporary North America is the commonly held belief that antibiotics are helpful in curing colds and the flu, a notion that most doctors try hard to refute. Lay conceptualization about the meaning of illness is also important. When people fall ill, they need to find an answer to the "why" of the illness as well as to the "how" of the illness. Making sense of serious illness becomes an urgent task that involves the patient at the deepest level.

Lay concepts of illness have been classified as being derived from within the individual, from the natural world, from the social world, or from the supernatural world. For example, lay concepts about illness in rural India often locate the origin of illness within the social world (failure to observe social norms or perform essential rituals) and within the supernatural world (a spirit attack or the "evil eye"). Other lay concepts about illness from India relate to the individual (improper diet) and to the natural world (exposure to extremes of hot or cold). Lay concepts about illness causation in the Western world often locate the origin of ill health within the individual—perhaps the person has behaved inappropriately (wrong diet, lack of exercise); or perhaps the person is vulnerable to illness in some way (hereditary or psychological factors). Lay concepts about illness that locate the cause of illness external to the individual include ideas about infection, exposure to heat or cold, and, increasingly, exposure to environmental contaminants.

Where many people in a culture agree about a pattern of symptoms or signs, and have a conceptual model about the origin and significance of these symptoms and signs, the illness can be termed a folk illness. Folk illnesses have a range of symbolic meanings that have moral, social, and psychological dimensions. A person suffering from a folk illness often expresses emotional distress through the physical body. This emotional distress may arise from conflicts within the family, or from the larger social world that the individual inhabits. Symptoms associated with folk illnesses often have a particular cultural significance, and they are often shaped by the way people in a cultural group think about the body in health and in illness. Traditional healers within a particular culture recognize, interpret, and treat the illness using therapies that are congruent with the particular lay concepts of illness that underpin the condition.

Examples of folk illness include susto in Central and South America, amok in Malaysia, and nervios among Latino populations. Sometimes folk illnesses overlap with serious biomedical disease. For example, a person who complains of weakness, dizziness, and palpitations may be diagnosed by a traditional healer to be suffering from nervios, when he or she may be experiencing a serious cardiac or neurological crisis. More often, though, the symptoms do not have a serious organic cause, and are related to the social or emotional stresses the person is experiencing. Biomedical practitioners who are not familiar with nervios as a folk illness may misinterpret the condition, and inappropriately overmedicate the patient. Clearly, it is important for biomedical practitioners to learn about local concepts of health and illness and to be alert for symptoms that may reflect emotional and social distress rather than a breakdown in the biomedical functions of the body.

Karen Trollope-Kumar

John Last

(see also: Anthropology in Public Health; Cultural Factors; Ethnicity and Health; Folk Medicine; Theories of Health and Illness )

Bibliography

Helman, C. (1990). Culture, Health and Illness. Oxford, UK: Butterworth-Heineman.

Kinsley, D. (1996). Health, Healing and Religion: A Cross-Cultural Perspective. Englewood Cliffs, NJ: Prentice Hall.

Kleinman, A. (1988). The Illness Narratives: Suffering, Healing and the Human Condition. New York: Basic Books.