Mapping the Relations of Meaning Between Illness and Disability

Within medical anthropology the study of impairment-disability is peripheral to the core concerns of the subdiscipline (Kasnitz & Shuttleworth, 1999; Shuttleworth, 2000b). Unless there is a strong connection to a phenomenology of illness, therapeutic treatment, and/or a culture's ethnomedical system, many medical anthropologists choose not to study disability/difference. While some medical anthropologists have expanded their focus beyond ethnomedical and therapeutic systems per se to models of social suffering and affliction (see, e.g., Kleinman, Das, & Lock, 1997), the study of impairment-disability can yet still sit uneasily within these kinds of frameworks. The fact that impairment-disability is so variously constructed cross-culturally in relation to sickness, illness, pain, and suffering often requires an initial exploratory phase of research before knowing exactly what one will be studying. One cannot simply say, "I am going to X society to study their illness meanings and patterns of therapy seeking!" or "I am going to X society to study their experience of impairment and disability!" An emically driven study must first discover which physical/behavioral differences are considered significant for a particular society.

A requisite for future ethnographic research on impairment-disability is a mapping of local meanings of anomalous physical/behavioral differences in relation to etic distinctions between illness meanings, therapeutic treatments, and pain associations across a societies' contexts. Different societies' models of bodily and behavioral difference would variously range across a continuum of meanings and complexes involving impairment-disability that at one end are almost completely mapped onto illness meanings and at the other end almost exclusively involve meanings of sociocultural stigma, adversity, and contention. Discerning where particular kinds of physical/behavioral differences fall on this continuum in terms of local meanings in different societies and the multiple contexts within these societies should constitute a major task of the disability ethnographer.

For example, Helander (1995) states, that "the Hubeer do not discriminate firmly between disability and disease. The practices and ideas surrounding disabled people can be described within the framework of health seeking and health management through which all health problems are processed." This is probably the case in many non-Western societies. Devlieger (1995), for instance, also notes that among the Songyem, disability is initially perceived and responded to as illness. However, Helander also shows how Hubeer health-seeking behavior for what we would perceive as a functional-limitation-defined impairment eventually falls off when funds run out and the gamut of therapies is exhausted. At this point, family members give up the cure and the affected individual is increasingly left to him or herself. These kinds of trajectories need to be presented in much more detail to provide us with the above kind of mapping, which would thus provide a strong basis for cross-cultural comparison. Yet, a further question is also relevant: Can this partial withdrawing of support, albeit framed within a health-seeking model, in the critical conceptual model briefly sketched above, be considered disabling?

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