Why alternative medicine is so popular and what do we learn about the European medical system in a Chinese clinic? (HU)
Written by Diana Szántó
Text reference: “A komplementer és alternatív medicina felé orientálódó terápiaválasztást meghatározó tényezők” (Factors explaining the choice of complementary and alternative medicine) by Zörgő Szilvia, Purebl György, Zana Ágnes. Orvosi Hetilap, 2016 . 157. évfolyam, 15. szám . 584–592.
This paper treats a very broad question: why do people living in a 21st century European society turn away from biomedicine to seek remedy for their health problems in alternative curing systems? The authors search for an answer based on long term fieldwork starting from 2014, conducted in a Chinese clinic in Budapest. Their research sheds light on the fact that any given medical system – including biomedicine – is always a cultural system. The patients frequenting the Chinese clinic combine different cultural systems and navigate freely between these.
About CAM in a comparative perspective
The use of complementary and alternative medicine (CAM) is gaining in popularity everywhere in Western societies. In a study dated from 2002, 36-42% of the population of the USA was found to use such treatments. In Europe 56% of the population preferred such treatments, while in Hungary only 23.1% chose alternative medicine. It is true that the difference in time (the Hungarian statistics are from 1989) makes comparisons difficult. National statistics are seldom comparable but large differences usually point at different social contexts and cultural systems. For example, in Ghana 73.5% of cancer patients turn to traditional healing methods, understandable in a situation where most of the people cannot afford Western medicine. It is more surprising that 83% of European cancer patients use alternative medicine, too, according to another study. The adepts of CAM resemble each other in some of their socio-demographic traits: they tend to be well educated, middle-aged women, with long lasting sickness.
The popularity of CAM contributes to the proliferation of services. At the same time the availability of these services affect popular concepts of sickness, health and cure and make people more open to CAM. However, this circular relationship alone would not be enough to explain why individual users turn increasingly towards alternative medical treatments. In order to better understand these choices the authors examine further factors.
Factors influencing choice of CAM
These factors can be grouped in three large categories: market competition, information flow and cultural “creolization”. The three domains overlap.
Cultural creolization is a spontaneous process, but politics, regulations and the institutional system have a great influence on it. Policies influence what services are available, recognised and endowed with prestige. In Hungary, traditional Chinese medicine (TCM) enjoys high popularity and relatively high prestige, as shown by the project to create a TCM centre in Budapest. Market competition – aided or hindered by the State – affects the availability and choice of different services and also the availability of different world views. In the new global world order, individuals are in contact with a variety of worldviews and are not only free to choose, but also obliged to. They must compose their own hybrid cultural system out of different elements.
Information technology makes a great number of ideas, conceptions, and world views available. In principle, internet has made the access to information almost limitless, but in practice people tend to filter the information even before they access it according to their world view. Because cultural institutions tend to lose their credibility in late modernity, authenticity has to be found elsewhere: in personal experiences and in primary relations. When it comes to choices of therapies, people listen to their peers more than to the authorities. The combination of different world views lead to mosaic-like personalised, syncretic cultural systems. The self itself has become “divided, hybrid, often incoherent, inconsistent” (p. 586)
Complementary and alternative Medicine (CAM) is not only about alternative services, but also about alternative world views. Those believing and practicing CAM tend to support “ecological sustainability, cultural diversity, social optimism and spirituality”. An American author invented the term “cultural creatives” to describe the cultural system of this community. Zörgő et al. borrow the term and seem to suggest that it is applicable for CAM users in Hungary. Cultural creolisation in medicine affects two very important domains: the definition of health and aetiology (ideas dealing with the causes or origin of a disease).
CAM finds its place in the gaps that the biomedical model fails to address: pain and suffering, and the ability to give a meaning to these experiences.
The paper is based on information from 150 patients from the Chinese clinic, which constituted the field for this study. The results, beyond answering the original research question, also shed light on the patients’ expectations towards medicine and therapy in general. In other words, beyond the theoretical question “why people turn to Chinese medicine for cure”, the paper also answers a more practical question that might orient possible ways of adapting the biomedical medicine to the non-satisfied needs of the patients.
The most widespread of these needs relate to the doctor-patient relationship. Patients appreciate the time the doctor is willing to spend with them, the expression of attention they receive, and they are also aware of the non-verbal signs of care and sympathy of the medical staff. Medical communication is also experienced as violent in many circumstances, especially at the moment of revealing a diagnosis and offering a (negative) prognosis.
Another factor that makes CAM attractive is the fact that biomedicine does not have a therapy for all diseases at all stages, or the therapy it offers has too many negative side effects. It is not unusual in either case that CAM is used in a complementary manner beside a traditional biomedical treatment.
Another reason for the choice of CAM is related more generally to the identity of the person and to the world view he or she identifies with. Zörgő at al. call this factor “philosophical congruity”. People practicing some form of Oriental physical exercise or diet are more open to CAM. A holistic world view, attributing equal importance to the corporal and spiritual identity of the person can also be a good indicator of sensitivity to CAM.
CAM has got strength where biomedicine has its weakness: the individual has a deep need to construct order out of the chaos that constitutes his or her world. A recurrent complaint of patients encountering biomedical treatment is the lack of explanation of their illness or the refusal of the doctor to hear their own explanation. In case biomedicine does not offer an acceptable explanation or does not convincingly promise a cure, people might feel disempowered and impotent facing their disease. Turning to CAM might be interpreted in this case as an active move to take their curing “into their hands”. Losing confidence in biomedicine threatens with submerging into chaos unless one does not find a credible alternative. Such a loss in confidence might be caused because of late or bad diagnosis, unbearable side effects of a biomedical treatment, fatal prognosis or simply because the style of communication is experienced as alienating.
CAM helps to find a new order in the chaos by proposing a new cosmos in the somatic, moral and cognitive sense. It is important that the cure proposed should be consistent with the aetiology the person can identify with. The authors show the example of a patient who believes that cancer is not an independent sickness but a sign of a weak immune system. He would not concede to chemotherapy for fear of further weakening his immune defence. Traditional biomedical treatments, with a special importance given to drugs, are often associated with a way of life alien from nature and spirituality. CAM in this case helps to find a way back to a mythological closeness to nature and might be interpreted as a form of critique of the capitalist way of life where treatment is largely in the hands of the pharmacological industry.
One popular form of aetiology attributes all kinds of somatic diseases to psychological states. This explanatory mechanism is also a means to fight the feeling of impotence caused by the chaos, as it gives almost unlimited power to the patient to influence his disease through acting on his psychological state.
Finally, one potential cause of the popularity of CAM can be explained by what the authors call “the need to extend the cosmos”. Many people say they come to the clinic just out of curiosity or because they are open to any solutions that serve health. At the same time, the attraction CAM is able to exercise on the person depends greatly on his or her cultural values. As mentioned before, affinity with other health-centerd behaviour, Eastern philosophy and sport might facilitate openness towards CAM. It is interesting in this respect that a strong Hungarian ethnic identity, putting emphasis on “traditional roots” might also push somebody towards Chinese medicine.
The article puts the seemingly individual choice of turning to CAM in an interesting cultural context. Its main virtue is that by investigating a particular practice, that of CAM-users, it sheds light also on the fragmented nature of the late modern self, forced to assume an increased responsibility for individual choices between competing cosmologies and aetiologies. It also shows that any medical system (including biomedicine) is not only about finding the right treatment, but equally importantly about helping to find some sort of coherence in an otherwise incoherent world. By identifying patients’ motives for turning to alternative treatments, the paper also shows a mirror to biomedicine, helping to identify and capture needs that remain most commonly unsatisfied in a biomedical health system.