Multiple Medical Realities

My original motivation for creating this site was to have a link I could send to people who messaged me after attending one of my history lectures at herbal conferences. Those of you who have been to them will recognize this as the content I cover on my first slide.

Like most anthropology students interested in medical anthropology, I was assigned to read Arthur Kleinman’s Patients and Healers in the Context of Culture.  Classifying things helps my brain, so I was drawn to the way he breaks down the various components of healthcare in societies and I keep that up in my own work with minor language modifications.

Domestic Medicine (Popular Healthcare Culture)

The term domestic medicine is used to refer to self-care, or familial, practices informed by popular knowledge. Domestic medicine is grounded in autonomous self-care and the common production of locally available remedies. It is an empiric practice grounded in experiential knowledge and not bogged down with a lot of theory.

Knowledge of this nature is passed down through the generations or via community skill-sharing networks. In some populations, this transmission is through word-of-mouth, but medicinal formulas have also been recorded in the form of manuscript recipe books, commonplace books, and journals. We have a rich paper trail of the kinds of household remedies used by people throughout written history and there is archeological evidence that gives us a glimpse at older practices.

At one point most preparations were produced in the home, but people of means began to buy over-the-counter herbal preparations from apothecaries and traveling merchants.  These days pharmaceutical and nutraceutical companies have co-opted self-medication, but it is still the primary form of healthcare in the US.  Every time someone takes ibuprofen for a headache or sprays Biofreeze on a pulled muscle, they practice domestic medicine.

Ritual Healing Specialist
In most cultures, we find specialists, such as the cailleach luibh working from a framework influenced by Indigenous beliefs. One belief across many cultures is that illnesses are thought to be attributable to supernatural causes such as demons, ghosts or maleficent magic workers. Anthropologists sometimes call these personalistic illnesses. 

To cure these illnesses, benevolent magic workers use supernatural means to discover the cause and cure the illness. I call them ritual healing specialists. Ronald Hutton calls them “service magicians” which I also enjoy a great deal. Julian Goodare who put the database of the Scottish witch trials online calls them “traditional magical healers.” These healers are distinct from those magic users in the community who are thought to do harm by uncanny means or maleficence.

The ritual healing specialists channel magical healing power and are sometimes responsible for undoing the harm done by another. They might speak pisreóga, charms, incantations, or prayers while leading their patients through elaborate healing rituals.  They might work these rituals with sacred herbs, but they also work with other natural items like magical water, stones, or amulets. They do not have to be pagan practices. A priest who performs an exorcism is a ritual healing specialist. The point of distinction here is that unlike our domestic caregivers, these healers have far more in their repertoire than the therapeutic delivery of plant medicine.

There has been a lot written by anthropologists about the ritual practices of Indigenous cultures all over the world. The problem with reading those works is that we cannot always trust that the observations made by those researchers were accurate. Prejudices often distorted their observations, and they frequently took practices out of context because they did not understand the Indigenous framework they were observing. Sometimes they were purposefully misleading in order to justify land grabs and ethnocide.

US government ethnographers sent to gather information about various Indigenous groups were the worst. Many of them were missionaries who used terminology about witchcraft to describe Indigenous practices without bothering to distinguish between service magicians and those considered a threat to their community.

For example, a “witch doctor” was a service magician who used benevolent magic to heal someone who had been harmed by maleficence, but the term was thrown around indiscriminately to refer to anyone who used magic and even some people who were just using plant medicine to heal an illness.

I won’t be spending a lot of time talking about ritual healing specialists on this site, although there is definitely some overlap at times. There are enough blogs out there trying to cash in on the “witchy” trend and I prefer to spend my time lifting the voices of people whose contributions have been less sensationalized.

Professional Practitioners
The professional healthcare sector is comprised of trained providers such as medical physicians, nurse practitioners, naturopathic physicians, herbal clinicians, chiropractors, and so on. They engage in their practice as a means of supporting themselves financially — either by charging clients or through patronage.

Achieving professional status typically involves academic training, apprenticing oneself to an established practitioner, or both. This is still how the AMA works modernly. You first go to medical school and your residency is your apprenticeship.

Professional practitioners tend to believe that illnesses have mechanistic causes that are to be diagnosed and treated by the application of whatever theory of medicine they practice.  In the early modern era, humoral medicine was just as mechanistic in nature as germ theory is today.

Midwifery
Midwives hold in a confusing place in all of this, so I am giving them their own space. Technically, the term translates simply to “with the woman” and was used to refer to the professional in the community who helped deliver babies and provide care for women. There were trained midwives who were clearly part of the professional sector. Two of my favorite 15th-century resources on women’s health were written by professional midwives.

Older women who had raised many children to adulthood often became valuable community resources, particularly in rural areas. Some researchers consider these “old women” to be empirics who operated within the broader professional sector. Their success is suggested by the way physicians of the time often disparaged the knowledge and practices of both old women and midwives.

These distinctions become less clear when we look at healthcare among the very poor or people who live remotely. In some communities, midwives practiced, out of necessity, through the early 20th century. My great-grandmother attended births and shared her knowledge of home remedies in her community through the Great Depression. My best friend’s mother was a midwife who apprenticed to her lineage in the 1980s. I consider these women to be a part of the popular healthcare culture of their community, but they were sometimes paid in kind, so some people might debate that with me.