Ethnomedical Transmission and Cause

The concept of contagion is a common characteristic of ethnomedical systems and diarrheal events are explained as contagious especially when there is an abnormal outbreak of diarrheas with shared symptoms. Virtually every study that describes folk attribution of cause includes foods (spoiled, bad, prohibited, etc.) as a source. However, air and wind may enter the body to cause any number of illnesses, including diarrhea. Ethnomedical causative explanations for diarrheal disease can be characterized as contagious, disruptive, fatalistic, and person-alistic (in which the victim of the disease is specifically targeted).

Contagious. Foods and beverages are probably the most commonly recognized contagious source of diarrhea. Foods may be considered spoiled, unclean, contaminated, or inappropriate for the person, circumstance, or event. Empirically, the foods consumed prior to a diar-rheal event are sometimes visible or scentable in the stool. Nausea, vomiting, and a Garcia effect (avoidance of foods and beverages that are associated with prior illness events) may be triggered. Wind and air that are perceived to carry contaminants can enter the body and cause disease, including diarrhea.

Disruptive. From ancient humoral systems comes the most prominent disruptive theory of causation—humoral imbalance. Eating or drinking too many hot or cold foods can cause humoral imbalances that produce diarrhea (as well as many other kinds of health problems). However, disharmony in social and spiritual relations is also a widespread disruptive concept of causation.

Fatalistic. Conditions that occur as commonly as diarrhea in contexts characterized by poor sanitation and public health infrastructure are quite often viewed as inevitable events of life. Most anthropologists and their subjects have developed a tolerance for occasional bouts of mild diarrhea. In most cases no treatment is necessary or sought. Folk explanatory models are heavy with "stuff happens" kinds of explanations. Anthropologists do not talk much about these fatalistic explanations because they are not subject to very interesting analysis. However, they are ubiquitous.

Personalistic. "Why me?" is the cry of the severely threatened. When a familiar condition such as diarrhea turns fatal or life-threatening and/or is resistant to treatment, exceptional explanations must be sought. The high mortality associated with untreated or inadequately treated diarrhea certainly makes it a candidate for this classification. The need to answer why this disease event is extraordinary leads to the search for explanations for why this person at this time is suffering this life-threat. It is now generally uncontestable that any condition, including diarrhea, can be attributed to personalistic causes. It is also clear from the literature, however, that most cases of diarrhea begin with a more mundane diagnosis and move into the personalistic etiology only when treatment fails or signs and symptoms are extraordinary.

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