Mohan Dutta: Culture-Centered Approach

Until reading both Good (1995) and Hahn and Kleinman (1983), I hadn’t fully recognized the extensive power afforded to biomedicine by Western society. This power is pervasive and appears to encompass all aspects of our modern medical system, from healthcare delivery to medical research and technology, from the provision of health information to the public to medical training institutions. I found myself continually drawing examples from my own research and personal experience that matched the hegemonic influences of the biomedical system presented by these authors. For instance, Good spends a considerable amount of her piece discussing the biomedical model’s focus on cutting-edge technology as a medium of conveying hope. She notes, “American willingness to invest both public funds and private monies in experimental chemotherapies and clinical trials illustrates high commitment to biotechnology and the biotechnical fix” (p. 465). It is true that, in today’s society, competent oncologica...

One of the concepts that continually haunts the social scientist working on issues of social justice is the apparent disconnect between the issues he/she works on and the lived experiences of oppression and disempowerment that are often tied to these issues. So a question that naturally arises amidst this power imbalance is one of authenticity. How does one find the adequate language to talk about say poverty and hunger without having experienced poverty and hunger herself/himself? What credibility or meaningful place do I occupy as a scholar to speak about issues of poverty when my lived experiences have been situated amidst a privileged middle class upbringing? How can I talk about hunger in my work when I have not experieced hunger myself? I don't think there is a simple answer to this question. The academic response typically to questions such as this is one of defensiveness. Answers typically verge on responses such as "One does not really need to experience hunger to...

This is the sentence that I read again and again: “Identity refers to the ways in which we see ourselves, and is intrinsically connected to our understandings of health and illness, our relationship with others in healthcare settings, and the actions we engage in the context of health and illness(Bordo 1987; Shilling 1993).”

Boddy’s piece on spirit possession has prompted me to rethink some of my views about some cultural practices that I usually condemn without deeply reflecting about the underlying philosophy. For instance, growing up in an African setting, I had witnessed many people who were possessed, or who exhibited traits of being in ‘trance’. In those circumstances, my position was outright condemnation of the practice as uncivilized. But having read Boddy’s work, I have realized that passing judgment on the other is reductionism and parochial. For instance, I ask myself, how did I arrive at the negative assumption and condemnation about their practices? Is it right to pass judgment about their practices? Or better still, do I have the right to judge the practices of other people? Is it fair to judge their practices without listening to them? I have realized that condemning the practices of the other could be likened to claiming that one’s mother’s food tastes sweeter than every woman’s food wh...

If the act of developing a working knowledge of a theoretical framework using the culture-centered approach is like jumping off a diving board, then I’m certain I just left the board. While my own research has continually revolved around the area of culture, CCA is a lens that provides a wildly new view. I gladly embrace it for its valuable insight and ability to establish a dialogue with and among audiences that have typically been set out on the peripheries of the social environment. But, frankly, it is just plain hard… not because it is hard to accept, but because it is hard to practice. For the first time in my education and research, I have to deconstruct many of common understandings of audiences and social dynamics that I’ve been taught over the years and begin rebuilding them simply to be more purposeful in my research . Therefore, I’m thankful for the readings which challenge me with this new lens. For example, the Boddy article regarding spirit possession was, of course, a ...

In reading Dutta’s “Communicating Health” chapter on culture, identity, and health, I was prompted to critically evaluate a number of conflicts I’ve encountered in my study of rural health disparity. From the traditional perspective I’ve been exposed to in prior courses, it seems as though the primary focus of public health intervention is that of diagnosing the health status of a population, identifying contributors to negative health outcomes, and consequentially crafting programs that address these contributors. Just as in the biomedical model, this system propagates the view that the sick population is a site to be acted upon by an all-encompassing “medicalizing logic,” broadly applicable to any community in need of intervention. Such a viewpoint shifts the attention away from questions of resource inequities or structure. Ultimately, the health of the individual is the site by which change at the population level occurs, such that many interventions focus on encouraging a change i...

"The academic outsider always comes into our communities and takes." This is a sentiment that I have often heard articulated throughout my fieldwork, and beyond that, have also felt as a community member looking at many interventions that have been carried out by clueless academic experts. Later in life, as I grew into becoming a scholar within those very ranks of academe that seemed so impervious and out-of-touch, I used the term "academic tourism" to describe projects that went in and came out without really doing something meaningful for the community. This is why I hope that any project that steps out into the community begins with a clear delineation of its community-specific goals that demonstrate in tangible ways how it would first and foremost meet the needs of community members. More so, I am encouraged by examples in communities that have developed specific guidelines and measurement criteria for evaluating the meaningfulness of proposed projects. When c...

In this reflection, I argue that to achieve equitable health care, it is necessary to listen to all the agencies within a population. I use agency in this context to mean the different perspectives about a health issue within a population. Using Darby & Svoboda’s (2007) argument about the framing of male and female circumcision as a basis for my argument, I argue that presenting only a particular line of argument may inhibit equitable health care services in that it may lead to the formulation of policies that may not be representative. In addition, I argue that the presentation of a particular agency as seen in the Nigerian context with respect to circumcision symbolizes the role of structure in shaping policy decisions. By structure, I mean the social system that allocates resources within the society. I begin by looking at circumcision in the Nigerian context. Following this, I invoke the author’s findings to show how the framing of female circumcision symbolizes a hegemonic str...

As the Instructor of the “Sexuality and Health” class in our school, this paper by Robert Darby and J.steven Svoboda (2007) strongly triggered my attention. Following most of the other sex educators, I will definitely introduce the circumcision surgery to my students from both the culture and medical perspective. Very seldom, I talked about the female genital mutilation and explain it as very negative tradition in some isolated tribes. And as a medical person, my opinion used to be very straight forward that the circumcision already been taken as a normal medical procedure because it has obvious benefits: especially for the patients who have long foreskin and defect their sex behavior. This paper triggered some other thinking of me under culture: (1) Human rights under tradition: People claim that genital mutilation to the infants before they can make consent decision defects their right, so their parents should not have this right. But how about the baby shower and oth...

After reading the work of Darby and Svoboda (2007) on genital mutilation and Hahn and Kleinman (1983) on the connectedness between belief and body, as well as in evaluating the ways in which I’ ve been witness to the impact of culture on medical reality, it seems evermore evident to me now the ways in which one’s wider culture can come to profoundly affect what one knows and thinks about health. What does "sickness" mean? How are the mind and body connected in a way that can promote or deter healing? Consequentially, how might my answers to these questions fit into the larger order of power, agency, and resistance present within my cultural environment? It is in the negotiation of a space and appreciation for multiple answers to these questions that a critical-cultural approach to health values. My personal background as a white female from rural Indiana situates me within a realm of conservative Western medical perspectives. Here, the normality of medicine is often determ...

When we begin with the fundamental CCA question in our journeys of co-construction, we seek to understand the meanings of health among communities that have historically been erased from spaces of discourse. The dramatic difference that emerges throughout my CCA fieldwork is the gap between the meanings of health in the subaltern sectors of the globe and in the spaces of privilege inhabited by those of us who are counted among the haves. The politics of health as desire lies precisely in this gap, in this basic difference in our understanding about what health is, that is shaped by our material access to structures and the inequities that are written into the ways in which these structures are organized. The politics of desire then is precisely mapped into the politics of inequality, in the basic assumptions about what is "enough" or "sufficient" to have a healthy life. The challenge to the dominant structures in the mainstream that perpetuate these inequities can c...