The present book is the result of a process that can be traced back to the 80s. It started with a group of people of Quichua (Inca), in Ecuador, that created a healthcare initiative called Jambihuasi believing that traditional Quinchua healers could be effective partners to improve health status of the Quichua communities of the Andes. The project grew and Runajambi Institute, the first Quichua health research group, was created aiming to understand the nature and efficacy of traditional healers' work. In 2001 the Institute joined the Transcultural Psychiatric Section of the World Psychiatric Association (WPA-TPS) and in 2003 both have organized a conference held in Quito, Ecuador, titled 'Psychiatrists and Healers: Unwitting Partners -- A Challenge for Transcultural Psychiatry in Times of Globalization'. (p. xvii) Some of the presentations feature in the current book, others do not so the book is able to provide a wider view on the topic adding up to 20 chapters/ articles and covering all continents.
The book's editors have therefore realized that their aim (to understand the nature and efficacy of traditional healers' work) went further than Ecuador, and further than developing countries, being a topic that was relevant worldwide, both in developing and developed countries. One may think that it makes sense to reflect on the phenomena of traditional healing in developing countries but not in developed countries. And this is where the book's originality is: it approaches the topic of traditional healing worldwide showing that there is a sort of knowledge that also seeks to restore health but in different way than the one established as common western medicine.
This may well be because positive aspects of health (to undertake effectively clinical care, prevention and health promotion) have recently incorporated the emerging concepts of complementary and integrative medicine as attempts to harmonize conventional or scientific medicine and traditional medicine. (Juan E. Mezzich, President of the World Psychiatric Association, 2005-2008, p. xv) But what has led to this idea of complement and integrating traditional healing in western medicine? According to a general observation, expressed concisely by Raymond H. Prince, Emeritus Professor of Psychiatry, that their treatments, whatever they were, were as efficacious as his own. (Foreword, p. xi)
To start with, it is relevant to realize upfront that "the majority of the 450 million patients with mental disorders around the world are not receiving even the most basic mental health care. In developing countries, 76.3%-85.4% of serious cases receive no treatment". (ch 20, p. 251) And the number of people with psychiatric disorders is likely to rise in the coming decade becoming a pressing global issue.
Diagnosis similarity is a one of the topics addressed in the book. It is assumed that diagnosis and treatment are 'evidence-based' and that evidence is 'scientific'. So why are there so many people that turn to traditional alternative medicine? (ch 1) Don't people want science? There is a need to prove traditional healer's skills relying on their ability to provide a similar diagnosis (ch 5) and that is important in the sense that for centuries, Quichua people/ Inca Confederation (Bolivia, Ecuador, Peru and parts of Argentina, Chile and Columbia) lived under a regime of domination and exploitation which still persists today. Oppression, persecution and imprisonment. (ch 5, p. 54, 55; the same also happened in South Africa, ch 16) The diagnosis situation is a polemic one, even among psychiatrists, since there are several classification systems around the world ("DSM-IV", produced by the American Psychiatric Association; "International Classification of Diseases" (ICD) an international standard diagnostic classification for a wide variety of health conditions, including mental and behavioral disorders; Chinese Society of Psychiatry's Chinese Classification of Mental Disorders (currently CCMD-3), Latin American Guide for Psychiatric Diagnosis (GLDP). The Maori (New Zealand) have openly questioned the use of a diagnostic manual such as DSM IV because it seems to conflict with cultural understanding. (ch 19, p. 247) Treatment is in some cases not as effective as in Western Medicine (ch 14) but the fact that symptoms and diagnosis are correctly assessed, or it is assed as accurately as in Western Medicine, is important in the sense that it attests 1) seriousness in the observation of the patient by traditional healers; 2) affirming traditional healing knowledge itself as a different alternative/ possible method of classification.
2. INTEGRATION VS COLLABORATION
The WHO Strategy for Traditional Medicine 2002-2005 (World Health Organization, 2002) has encouraged countries to integrate traditional medicine within national health care systems, safely, and at affordable prices for the general population. But a main question remains: what aspects to keep from biomedicine and which one to eliminate? By whose standards? How can one consider legitimacy on this topic and why to address it, it is better to say collaboration instead of integration? (ch 2, p. 17, 18, 22)
Collaboration can be, for example, an experience of culture immersion where anthropology and cultural psychiatry meet (ch 6, p. 76), promoting a closer relation with the environment (ch 19), or engaging in the doctor as someone multi-dimensional, inserted in a community and not so much office based (ch 3, ch 8). The main idea is that a medical pluralism model that represents a health care environment should be a goal (ch 8, p. 105). Disregarding culture and cultural heritage when it comes to health may have serious consequences in disrupting individuals and social order. (ch 9)
The interaction between health, psychiatry and religion is also explored in the book. In Italy, religion plays a very important role in healing (ch 18); Islam, promotes self-help through religion but also encourages family, community, doctors and psychiatrists as additional resources (ch 15); Japan's view psychiatry is a complex one, precisely because it triggers a cultural ambiguity: should one aim at healing or salvation, should illness be battled or accepted? (ch 13)
3. ORAL TRADITION AND INTELECTUAL RIGHTS
Traditional healing relies heavily on oral religious healing traditions and secular codified medicines. (ch 12) It becomes there a problem to assure that countries who have been contributing with their knowledge on plants and medicines have received neither money or recognition for that. Considering that pharmaceuticals are an important part of Western medicine, for a fair collaboration, intellectual property laws should be addressed concerning this since traditional healers have contributed directly for development is science. (ch 4)
4. DUAL USE
There is a patients' dual, simultaneous, use of traditional healers and Western medicine. (ch 10, p. 124) And there are situations where collaboration is presented as being a successful one: in Ecuador (ch 7), South Africa (ch 16), UK (ch 17) and among North American Indians where a step by step model on how to promote collaboration is provided (ch 10).
5. DIFFERENCES AMONG TRADITIONAL HEALING METHODS
An interesting approach to the subject of the relationship between traditional medicine and Western medicine (and conventional modern psychiatry) is the one provided by chapter 11 and 17.
Chapter 11 focuses in China and it states that China has 56 ethnic nationalities of various populations, moreover that 80% of the population lives in rural areas having reduced access to medical schools and hospitals where psychiatrists are. (ch 11, p. 136, p. 137) Therefore, many complex issues are at stake: health care systems, law, culture, and economics. But the conflict is not only between traditional medicine and Western Medicine. There are several types of traditional approaches, concurring. What we therefore take as Traditional Chinese Medicine (TCM) can be assessed in multiple way, according to the region. So the discrimination takes place, not only concerning psychiatrists but also concerning different methods of healing, different than those practiced in a specific region.
Chapter 17 states that there is a growing popularity of Complementary and Alternative Medicine (CAM): "1 in 10 of the adult population consults a CAM practitioner every year, and 90% of these contacts happen outside the National Health Service (NHS)". (ch 17: p. 217) This can be due to the rise of immigration (since racial discrimination and language barriers in health care services do exist). Still, it is known that patients take traditional remedies while undergoing professional psychiatric treatments (ch 17: p 219). Moreover, what is labeled as CAM is the same as traditional medicine so the distinction between both is artificial and impractical. The question should therefore be: what is the patient trying to tell the NHS and how can the system be shaped in order to provide a better service to users? (ch 17)
Perhaps collaboration is boosted if countries around the world realize that there is a market for this traditional healing. Also, that any method or approach is a valid one if it is successful and more importantly, that "psychological and physical suffering of human beings can be seen and dealt with in many ways" (ch 11, p. 147)
The present book covers a wide range of different countries concerning the topic and there may be a feeling that there is a serious reflection on what they all mean (as a set). The final chapter aims at doing that and to a certain extent it succeeds but there are many features that remain unaddressed. Still, one book cannot stand for a multiplicity of future book on the topic and the fact that the book tries to start to address the topic, mapping it, is already a remarkable feat. The book may well be one of the first ones addressing a topic that will have to become widely discussed very soon in order to provide a satisfactory answer to the contemporary health world demands.
© 2010 Diana Soeiro
Diana Soeiro (b. 1978) works and lives and Lisbon. She is currently pursuing her Philosophy PhD thesis "Colour as shelter; Architecture as care" at the New University of Lisbon. www.linkedin.com/in/DianaSoeiro