Too much skepticism may blind the observer to genuine phenomena that cannot be verified by standard scientific methods.
– Frank and Frank (1991)
In comparing healing paradigms, Frank and Frank (1991) relies on the widely used binary of industrial and nonindustrial societies. About a century ago, Durkheim gave us the sociological distinction between organic and mechanical societies, correlating with industrial and nonindustrial societies respectively. His German contemporary, Tonnies, offered a similar distinction: Gemeinschaft and Gesellschaft respectively.
Their sociological perspectives may help illuminate not only “what works” but perhaps help us appreciate what “doesn’t work” among the Nacirema healing traditions. In contrast to a holistic approach to wellness—where “what works” involves much of one’s individual and communal life—the Nacirema’s industrialized approach to wellness emphasizes what Durkheim called the organic society’s “division of labor.”
Wellness elements divvied up
Like their predecessors the Naeporue, life is much more compartmentalized in Nacirema culture. So is their understanding of wellness. A biological need, such as relieving a persistent headache, is interpreted as somehow independent of one’s emotional needs. The body is an object to be probed rather than a vessel of life to be holistically understood. Instead of addressing underlying problems by seeing someone broadly knowledgeable about wellness, the Nacirema will go to a “medical doctor” to relieve their symptoms.
Specializing in the biological element of wellness, this “doctor” and “patient” typically enter into an unspoken pact. Despite admonitions about lifestyle patterns, they both know unless symptoms persist the patient will change little. The doctor is merely the first along an assembly line of wellness specialists. This wellness specialist may then refer the complainant to another wellness specialist, or many specialists, from a brain scanning technician to a counselor.
Instead of being served by these specialists in an emotionally supportive social gathering, the complainant must submit to more specialists along the assembly line. Such depersonalization is somehow not expected to further compromise the complainant’s wellness. If it does then the subject submits to the next stage of “managed healthcare.”
When symptoms persist and are theorized to have a mental component, there is an array of mental specialists in Nacirema culture from which to choose. Psychiatrists overlap the biological and mental wellness elements. With psychologists coming in a close second. Counselors focus on the individual’s mental element of wellness. Social workers consider the individual and social elements of wellness.
If the complainant identifies a sociocultural culprit to their compromised wellness, this almost never gets back to the other wellness specialists along the wellness assembly line. Divergence of beliefs is encouraged, working against a cohesive understanding of interpersonal or communal wellness. Nacirema culture if based on a widely held belief that everyone has equal access to necessary resources, so responsibility for wellness problems ultimately resides within each isolated individual.
In this division of labor, the spiritual element of wellness is commonly specialized by religious experts. The Nacirema appear to worship a compartmentalization of beliefs along with the atomization of community into isolated units. Irreconcilable beliefs are often encouraged for heady debate, with little if any accountability for outcomes. Morality is either parochial or political.
While this may seem as an oxymoron, religion is widely regarded as a mostly private matter. With few exceptions, the complainant’s hunger for meaning and for deeper connection is sought from a parochial religious leader. Of from one’s own personal search. In Nacirema culture, being spirituality connected often depends on being individually isolated and socially disconnected.
From this description of Nacirema and Naeporue cultures, a disorganized construct of wellness emerges. A well integrated holistic approach appears to be largely disregarded, as too imposing upon their materialistic cultural ways.
Comparable to Maslow’s hierarchy of needs, a nonindustrial and indigenous paradigm also appreciates a natural progression of needs. As the Sudanese proverb asserts, empty stomachs have no ears. Upon a foundation of resolved physiological needs, our psychosocial needs are felt and addressed. And these provide context for our need for meaning and connectedness.
In a highly fragmented culture as the Nacirema and Naeporue, this atomized approach to wellness appears to correlate with widely accepted unequal outcomes. Their political rhetoric betrays the relatively low level of full need resolution, hinting to a population acclimated to mounting levels of unresolved need strain.
In such a materialistic oriented culture, matters of importance beyond easy measurement are readily relegated beyond official Nacirema culture. In trying to understand novel problems, such as an individual’s obsessive attachments to one of their new technologies, they often turn to their venerated lacidem ledom. This allows them to categorize as “other” what is quite often right in front of their eyes, but disowned in their norms of being disconnected.
Vast attention is given to the many paths of faith toward meaning making and connectedness, and a dearth of ethnographic attention afforded to Nacirema and Naeporue actually experiencing meaningful connectedness and spiritual attunement. Their civic leaders are not held accountable for their level of wellness when making policy decisions ostensibly in the interest of the people. Honestly, their goal is less about individual and collective wellness and more about accumulating “exchangeable units of recorded or speculated productivity” they call money.
As noted by Frank and Frank (1991), “Healing rituals also bring out the parallel between inner disorganization and disturbed relations with one’s group, and illustrate the healing power of patterned interactions of patient, healer, and group within the framework of an internally consistent assumptive world” (p.87).
It may be disconcerting to give a rational explanation for a healing process to someone giving it a more spiritual explanation. Likewise, it may be disconcerting to give a holistic explanation for a healing process to someone accustomed to compartmentalizing wellness into discrete categories (i.e., biological, psychological, affective).
“Societies outside the industrialized world regard illness as a misfortune involving the entire person, including disturbed relations with the spirit realm and with other members of the community. Although these societies recognize different kinds of illnesses, their classifications often do not resemble those of Western medicine. In particular, non-Western societies may not distinguish sharply between mental and bodily illness, or between natural and supernatural causes of illness” (Frank and Frank, 1991, p. 89).
Preference for compartmentalized wellness appears contagious. In what appears as a rush to the materialistic bottom, the Nacirema’s venerated lacidem ledom has spread widely among the Nacifra and Naisa peoples, displacing much of their wellness traditions. As long as wellness is widely defined to mean increasing volume of complainants paying for the services of the wellness assembly line, industrialized wellness is an expanding success.
Frank, J.D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MA: John Hopkins Press.