If a doctor walks in wearing a white lab coat, people are more likely to take the medicine. What you believe matters for how treatment goes — and that is true whether the system is biomedicine, shamanic healing, or your parents telling you to go to the hospital and also that they are praying for you. This lecture covers sections 15.3 and 15.4 of chapter 15, “Disease, Health, and Healing,” in The Human Story for Introduction to Anthropology, on healing systems, medical pluralism, biomedicine, and power. It sits in the Power Analysis hub, with the cultural-categories material connecting to Cross-Cultural Understanding. For the first half of the chapter, see Illness, Disease, and Sickness.
Key Concepts
- An ethnomedical system is the structures, practices, beliefs, and therapeutic techniques that together define a system for healing (449), including both lay and specialist knowledge. Every medical system has a theory of illness causation, a diagnostic system, and preferred healing techniques.
- Medical anthropologists distinguish personalistic from naturalistic healing systems. Personalistic systems attribute illness to disrupted relationships — with people, with the supernatural, through curses or witchcraft — and heal by restoring them (449–450).
- Belief is not decorative. The placebo effect means a sugar pill measurably improves outcomes for some people, and the white coat works the same way — as a marker of authority you either credit or you don’t.
- Shamanic healing among the Buryat of Siberia was suppressed under Soviet rule and resurged after the Soviet collapse, with healers now practicing openly as cultural revitalization (447).
- Healing is deep. A thousand-year-old ritual bundle from Cueva del Chileno in the Bolivian Andes held snuffing tablets, llama-bone spatulas, and multiple psychotropic plants; the iceman preserved 5,300 years ago carries 61 tattoos positioned on common arthritic points.
- Many modern medicines derive from ancient pharmaceutical knowledge shared by Indigenous peoples with researchers — quinine, used against malaria in South America, was elaborated by scientists into pill form (450).
- Medical pluralism, or syncretism, is engagement within and fusing of multiple healing systems in the quest for health (451). Cultural anthropologist Jessica Hardin’s work in urban Samoa shows people managing Type 2 diabetes across biomedical, church-based, and traditional approaches.
- Tuberculosis is still the world’s leading infectious killer, could be eliminated, and would not even be that costly — it simply is not prioritized, which is what health inequality looks like in practice.
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Health as Connection, Not Just Absence of Disease
Your textbook defines health as a relative absence of disease, illness, sickness, stigma, and suffering. That’s true — we don’t like these things, and it’s good when we don’t have them. But health also includes positive individual and social relationships. Research on what makes people happy keeps landing on talking to people, including strangers, and having conversations that open up new worlds.
If we think about health not just as absence of suffering but as restoring positive connections, healing becomes about more than eliminating pain. In many societies, treating an illness is not seen as treating an individual at all — it is the work of integrating that person back into the group.
Ethnomedical Systems: Personalistic and Naturalistic
An ethnomedical system is the set of structures, practices, beliefs, and therapeutic techniques that together define a system for healing (449). Ethnomedical systems include both lay knowledge — what your family does — and specialist knowledge, and they are organized culturally, with their own conventions, roles, and preferred modes of treatment.
Despite enormous variation in how they explain illness, all medical systems share three elements: a theory of what causes illness, a diagnostic system, and a set of appropriate healing techniques. Medical anthropologists draw a further distinction between personalistic and naturalistic systems (449–450). Personalistic systems attribute illness to disrupted relationships — with other people who may be trying to do you harm, or with the supernatural — and healing means restoring those relationships. Naturalistic systems look to imbalances, substances, and environments.
Why Belief Changes Outcomes
It is fair to ask what any of this has to do with whether someone is actually healthy or sick. The answer is that what you believe is very important for how the treatment goes, in whatever system you are in. If you believe the doctor knows what they are doing and that the pill will work, it usually works better.
We know this as the placebo effect: give people a sugar pill, tell them it will help, and some improve. Not everyone, and this is not to say medicine has no effect — but belief has a large one. The same logic runs the other way. If you believe your relationship with God has been disrupted and needs rebalancing, that can matter enormously to your emotional state.
And this is not something only other people do. There are studies showing that when doctors wear a white lab coat, patients are more likely to take the medicine. If the doctor walks in dressed like me, the reaction is more along the lines of: must not even be a doctor, not taking this. The white coat and stethoscope are globally recognized markers of authority — which also creates social distance, and distance is one source of miscommunication in the clinic.
Shamanic Healing and the Buryat Revival
The Buryat people in Siberia practice shamanic healing, found in many parts of the world (447). A shaman or religious practitioner connects the spiritual and physical worlds and works to rebalance a person’s relationships with other people and with the cosmos. Someone performing what might look like weird rituals to outsiders may actually be helping people reconnect the different parts of their lives — and if they believe in it, it might work.
Shamans have gotten a bad rap, and modern states have often tried to suppress them. Buryat practice was heavily suppressed under Soviet rule, much as ancestor worship was suppressed in China, and it resurged after the Soviet collapse. Buryat healers now practice openly, and that practice connects people to their roots — cultural revitalization rather than a survival from an untouched past.
Ötzi’s Tattoos and the Bolivian Healer’s Bundle
Personalistic healing has real archaeological depth. At Cueva del Chileno in the Bolivian Andes, excavators recovered a healer’s thousand-year-old ritual bundle: a leather bag holding carved wooden snuffing tablets, a snuffing tube with two human hair braids attached, a pouch stitched from three fox snouts, llama-bone spatulas, plant material on wool strings, and a woven headband. Chemical analysis identified multiple psychotropic plants. Connection to other worlds, sometimes through ingested substances, has been a route to repairing relationships in many societies across many ages — and we are poorly placed to lecture anyone else about drug use, having taken it to extremes ourselves.
Ötzi, the man recovered from an Alpine glacier and preserved with his belongings from about 5,300 years ago, carries 61 tattoos. What makes them interesting is their placement: on common arthritic points, the places where people actually develop arthritis. Puncturing the body, acupuncture, pressure points — tattooing often carries a ritual or medical dimension. That is a partial answer to a question raised in Illness, Disease, and Sickness about whether contemporary tattooing belongs alongside rituals of pain.
Ancient Pharmaceutical Knowledge
Many of the drugs used in modern medicine are synthesized from the traditional knowledge of people who worked with the plants in their environments (450). Quinine, used against malaria by people in South America, was elaborated by scientists and turned into pill form. That is a great deal of local knowledge, developed over hundreds or thousands of years, now embedded in pharmacies.
Naturalistic healing systems get a bad rap, and sometimes an overly good one — people wanting to herb it out and skip the vaccine is its own problem. But when we look around the world, we can learn from other people.
Medical Pluralism: What Everyone Actually Does
In today’s world, most people practice what the textbook calls medical pluralism or syncretism (451): engagement within, and fusing of, multiple systems of healing in the quest for health. Almost everywhere, people know about aspirin and Tylenol and also combine them with ethnomedicine, prayer, acupuncture, or natural remedies.
In my family, you go to the hospital and take all the medicine, and people are also praying for you. Lighting candles. Doing different kinds of things. It is not that anyone says don’t go to the doctor — it is that God is understood to be the ultimate arbiter of whether someone is sick or healthy. You might combine ethnomedical beliefs with acupuncture. Throw some astrology in there.
It runs both directions. In societies with strong traditional systems, people add biomedicine on top — often the shamans themselves are the ones dispensing aspirin. Your family lights candles and prays while someone’s in the hospital? That’s medical pluralism. Acupuncture alongside physical therapy? Medical pluralism. The line between “scientific” and “traditional” medicine blurs once we recognize that healing means treating the whole person.
Jessica Hardin: Diabetes and Medical Pluralism in Samoa
The chapter’s extended case is cultural anthropologist Jessica Hardin‘s fieldwork in urban Samoa on how people manage Type 2 diabetes. Samoans there blend naturalistic and personalistic approaches: they recognize sugar as a cause, and they also incorporate church-based and traditional healing. Prayer happens in the clinic waiting room, not instead of the clinic.
What Hardin’s work shows is that medical pluralism is not indecision or a failure to understand biomedicine. Samoa’s pluralism lets patients shift between systems, and that mobility is what makes a chronic condition like diabetes — which biomedicine can manage but not cure, and which demands lifelong change — livable rather than simply a permanent verdict.
Biomedicine Is Also an Ethnomedical System
Biomedicine is the system most of us are familiar with: diagnose an illness, treat it with a drug or a biomedical intervention. It is usually secular and scientifically based, and it has done enormous good — the vaccines that ended the childhood killers being the clearest case. It also carries its own cultural meanings and assumptions, which is why it is best understood as one ethnomedical system among others rather than the neutral default.
Medical anthropologist Elisa Sobo‘s research suggests that adopting particular health beliefs can function as social capital, building connections that supply information and support. That helps explain vaccine hesitancy, which medical anthropologists were documenting well before COVID-19 — after a 2017 measles outbreak in Italy prompted new vaccination requirements, public protests followed. Hesitancy tracks community identity, which is why anthropologists argue for trust-building rather than information alone. Medical anthropologist Arthur Kleinman proposed a set of questions for doctors to close the gap in understanding with patients, on the principle that effective healing depends on trust running both directions.
Biomedicalization and the Commodification of Health
Biomedicine is global, and it is tied to contemporary structures of health inequality. Certain people in certain parts of the world and certain segments of society have access to the good stuff, and others don’t.
Tuberculosis is the sharpest illustration. It is still the number one infectious killer worldwide. It could be eliminated. It would not even be that costly — global funding reached only $5.9 billion in 2024 against a $22 billion annual target. It simply is not prioritized, because health has been commodified and a premium placed on other treatments, which directs where resources flow.
Biomedicalization is what happens when a condition is redefined as needing biomedical treatment. In wealthier nations it has turned childbirth and aging into medicalized events managed with injections and surgeries. The chapter describes biomedicine as hegemonic: it limits other healing options and commodifies health itself. South Korea has become the world’s largest center for cosmetic surgery, producing a standardization of beauty that women are pressed to conform to — though the pressure is not exclusively applied to women. In southern India, a traditional self-care system coexists with a middle- and upper-class preference for commercially produced medicines.
Commodification produces harm at both ends. Organ tourism sends buyers to places where organs can be purchased, and donors in countries like Bangladesh face loss of dignity and long-term complications. At the other end, unaffordability simply excludes people — and not only elsewhere. Dental and vision are excluded from many insurance plans in the United States, so people stand in line and wait, if they can get care at all. Severe dental decay in rural Appalachia is the chapter’s illustration, where lack of access produces decay, pain, and stigma together. Where people are denied access or distrust mainstream services, informal communities of care emerge, which local healthcare professionals sometimes join.
Biopower and Bodies
Biopower refers to the capacity of institutions — governments, public health agencies, media, corporations — to regulate people’s health and bodies, producing differential treatment for different populations. Japan’s “Metabo Law” and the broader “war on obesity” are the chapter’s examples of concern about body size becoming institutional regulation.
The distributional edge is the point. Certain neighborhoods and areas are simply not considered worthy of investment: no clean water, no sanitation services, and cholera follows. The chapter’s case is the racialization of cholera risk among Warao communities in Venezuela’s Orinoco Delta, where inadequate sanitation puts residents at risk and the risk then gets explained as a property of the people rather than of the infrastructure. Waterborne disease is neither difficult nor expensive to prevent. People get left off the radar.
This is also where structural violence becomes visible: violence that does not arrive at the point of a gun, but as differential rates of cancer from environmental toxins, or diabetes, or the absence of good food and adequate care.
The concept of biopower comes from the French philosopher Michel Foucault, who used it for the way modern states took the health and vitality of populations as objects of government. The history supplies reasons for suspicion: the contemporary practice of gynecology was substantially developed through experimentation on enslaved women in the United States, and there are other experiments that went terribly wrong for particular groups. Mistrust of the medical system is a reasonable inference from that record, not a failure of health literacy.
Structural Competency and Its Limits
Biomedical practitioners often treat patients outside their own communities, which creates distance and makes local realities hard to see. One response is teaching structural competency — recognizing that some groups don’t have the same access, that people express distress in idioms that are difficult to parse, and that structural barriers shape every clinical encounter.
The concrete version: when someone says their head hurts or their heart hurts, they may not need Tylenol. They may be telling you about their social relationships, or their anxiety about their economic conditions. If a person is anxious about getting food and providing for their family, an analgesic is not what they need — food security is. What they are actually asking for might be access to food, education, or physical safety. If you are going into healthcare, or nursing, or policing, or any profession, the skill is listening to what people are telling you.
The chapter is blunt that awareness is not sufficient: meaningful intervention requires dismantling the institutional structures that produce health inequalities. It makes a related point about short-term international medical volunteering, or “voluntourism,” where untrained volunteers can cause harm and funds may be diverted from local systems.
Paul Farmer and Health as a Human Right
Paul Farmer was a physician and an anthropologist, and he is probably the person most responsible for bringing structural violence into the conversation in medical anthropology — the ways in which particular populations suffer from diseases that are, in many cases, quite preventable. The term itself was coined by the Norwegian sociologist Johan Galtung in “Violence, Peace, and Peace Research” (1969); Farmer’s contribution was to develop it, evidence it clinically, and make it central to the field.
He worked in Haiti, in Rwanda, and elsewhere, and he died in his sleep in 2022 at 62, in Rwanda, while doing healthcare work there. His argument is the one the chapter ends on, and it is worth stating plainly: healthcare is a human right. The question that follows is whether we will actually dismantle the structures, or only become competent at describing them.
Frequently Asked Questions
What is medical pluralism?
Medical pluralism, also called syncretism, is engagement within and fusing of multiple systems of healing in the quest for health (451). It is the norm rather than the exception: going to the hospital while family members pray, using acupuncture alongside physical therapy, or consulting a shaman who also dispenses aspirin.
What is the difference between personalistic and naturalistic healing systems?
Personalistic systems attribute illness to disrupted relationships — with other people, with spiritual beings, sometimes via curses or witchcraft — and heal by restoring them. Naturalistic systems explain illness through imbalance, substances, and environment. Shamanic healing is the standard personalistic example (449–450).
Does belief actually affect medical outcomes?
Yes. The placebo effect is the clearest case: a sugar pill improves outcomes for some people. The white coat operates similarly, as a marker of authority that makes patients more likely to take the medicine. This is why belief is not a soft variable in any healing system, biomedicine included.
Is biomedicine a culture-free system?
No. Biomedicine is itself an ethnomedical system, with its own symbols, assumptions, and authority relations. Recognizing this is what lets anthropologists analyze vaccine hesitancy in terms of trust and belonging rather than ignorance.
What is biopower?
The capacity of institutions — governments, media, corporations — to regulate bodies and health, producing differential treatment. Japan’s “Metabo Law” is one example; another is neighborhoods left without clean water and sanitation, where cholera then spreads.
Who coined the term structural violence?
Johan Galtung, in “Violence, Peace, and Peace Research” (1969). Paul Farmer brought the concept into medical anthropology and is the figure most associated with it there, but he did not originate the term.
Course Navigation
- This chapter, part one: Illness, Disease, and Sickness — disease co-evolution and the epidemiological transitions (15.1–15.2)
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