Conceptualizing Sickness and Healing Holistically
The idea of medical memes (i.e., healmemes and sickmemes) constitutes a way of providing content to the SH adaptation discussed in chapter 2. To recall, the adaptation was held to consist of psychological mechanisms sculpted during human evolution that endow disease and injury with conceptual and behavioral meaning. The adaptation was held to have a biological machinery that promoted culturally meaningful behaviors geared to adaptively coping with disease and injury in the environment of evolutionary adaptedness. It thus furnished the "trait" that enables individuals of a society to learn and enact the behaviors associated with sickness and healing.
The concept of a medical meme was introduced because it will prove analytically useful in the discussions of the social and cultural evolution of medicine in the next chapter. In a sense, medical memes constitute a conceptual bridge for crossing from the biological evolution of medicine to its cultural and social evolution. As units of cultural meaning, the products of medical memes realize or make up the SH adaptation in a particular social and cultural context.
The idea of a medical meme thus serves as an analytic tool with which to begin to develop a comparative and evolutionary account of sickness and heal-
ing. The basic adaptive problem that such an account of the medical seeks to comprehend is how different types of societies cope with disease and injury. A step in the direction of explaining medical phenomena using a scientifically satisfactory theory is to describe how different types of societies have configured sickness and healing. Descriptive material was reviewed in the earlier two chapters. The patterns of sickness and healing in the different societies discussed in previous chapters are summarized below.
It is useful at this juncture to state in summary and extended form the seeming rationale of medical memes. In any given social formation this rationale is contextualized in culturally meaningful behaviors of sickness and healing. The following declarative sentences summarize basic directives and imperatives of medical memes associated with sickness and healing. Detect and define the manifestations of disease and injury (registered as a state of illness). Identify and name the condition as a sickness. Ascertain possible causes of the sickness. Estimate prognosis of sickness. Seek to undo the causes, manifestations, and consequences of sickness through healing. Prepare for the process of termination in the event healing is of no avail.
The biological components of disease/injury that undergird and support the sickness/healing response (i.e., the SH adaptation) can usefully be recalled. These organic, physiological, and bodily components of disease and injury are expressed behaviorally in units of cultural information (i.e., medical memes) that constitute an interpretation of the disease/injury as sickness. When properly understood, the set of medical memes pertaining to an eventuation of sickness and healing allow the self and others to draw inferences about diagnosis, cause, prognosis, course, and healing regimen. The set of medical memes serves to delineate a relevant domain and set of parameters that stipulate what the effects of disease/injury mean and how they should be dealt with.
Bodily aspects of sickness and healing may be based on physiology, but (as discussed in chapter 2) they are expressive and social in nature. To give free play to communicative and interpretive idioms, the underlying rationale of medical memes is stated in the form of imperatives that accompany, monitor, and activate in a reflexive manner the SH response. Some examples of the rationales of medical memes follow (see also chapter 2): (1) relieve pain wherever it is located on the body (i.e., relieve pain regardless of its nature and location, whether it is associated with a physiologic function, whether it is in the body cavities, in the musculoskeletal apparatus, or on the skin and body surface); (2) stop bleeding wherever it occurs on or inside the body; (3) warm the body in the event that it is cold; (4) cool the body in the event that it is warm; (5) relieve and undo abdominal cramps and diarrhea; (6) provide fresh air and ventilation and support upright posture in the event of shortness of breath; (7) relieve and eliminate feelings of nausea and associated vomiting; (8) counteract feelings of weakness and lassitude; (9) replace loss of fluids and nutrients;
(10) stabilize, neutralize, counterpoise, repair, or eliminate changes in the outline, appearance, and structure of the body (e.g., swellings, eruptions, protuberances, dislocations, fractures).
The cognitive and behaviorally expressive components of disease and injury that serve to elaborate the sickness/healing response (i.e., the SH adaptation) need to also be taken into consideration. These, essentially, are medical memes that communicate psychological needs and social imperatives triggered by disease and injury. These medical memes serve to configure in symbolic terms the sickness and healing adaptation or suite of behaviors. As in the previous instance, the medical memes are held to be communicated in symbolic form and interpreted socially. For purposes of illustration, the rationales of these medical memes will also be stated in general declarative form: (1) provide knowledge/information that is helpful and encouraging; (2) offer emotional/affective communications that promote hope; (3) notify and seek out friends and family; (4) undertake tasks and responsibilities that are negated by the condition of illness and that are vital for continued subsistence; (5) perform rituals of appeal and supplication that elicit moral and spiritual support; (6) seek and consult with specialist healer(s) and diviner(s); (7) select from among alternative remedies proposed; (8) participate in and help carry out the chosen regimen; (9) prepare the sick and family for, and help them cope with, the implications of terminality in the event the sickness is serious and protracted and fails to improve.
As reviewed in earlier chapters, sickness and healing also provide the context for the expression of existential questions. The latter can be viewed as a reflexively central part of the sickness and healing ensemble. The questions draw on and essentially constitute general properties of sickness and healing that when provided with cultural content or meaning articulate its existential importance in the society. In summary, because of its biological significance in signaling vulnerability and impermanence, an event of disease and injury has the potential of expressing existential questions and these also are judged as coded in medical memes. Properly interpreted, they stipulate and elaborate the medical memes reviewed earlier. The following are some examples of elements of sickness and healing that provide the context for the elaboration of basic existential issues that are seen as coded in medical memes: (1) identity and nature of the agents or agencies responsible for cause of sickness; (2) nature of evidence integral to disease and injury that points to a diagnosis of sickness; (3) social and moral implications of sickness and healing; (4) exemptive value of manifestations of sickness; (5) spiritual interpretation of sickness and of healing regimen; (6) social composition and character of healing party; (7) social and psychological implications of the nature and types of actions, medicines, and procedures of healing; and (8) variability of course and susceptibility to healing influences.
The material discussed in this section summarizes basic aspects of sickness
and healing that are culturally and behaviorally elaborated in any society. It provides a good focus for the comparison of sickness and healing across social types and formations. In a conceptual sense, this material can be thought to provide the conditions for and also stipulate elemental medical memes comprising the SH adaptation, for when examined from a symbolic standpoint and diachronically, they register the transformation in the SH ensemble that take place during biological and social evolution.