Sunday, September 20, 2009

Shamanism in Hospitals

There is an interesting piece in today's NYT about hospitals in the US that tolerate shamanistic traditions in order to accommodate cultural beliefs of some of their patients. This is in reference to Hmong community living in California. On the one hand this seems like a reasonable flexibility - it allows patients skeptical of medical doctors to at least come to the hospital when they need help. On the other hand, some may take this as a statement in support of the effectiveness of shamanism. We might then as well add astrology and other New Age therapies to the list. Oh wait...some of the New Age therapies, such as Reiki, are also accommodated in some hospitals.

But here is the issue:
Designed to defuse the Hmong fear of Western medicine, the program has “built trust both ways,” said Dr. John Paik-Tesch, director of the Merced Family Medicine Residency Program, which trains resident physicians at Mercy Medical Center.

Since the refugees began arriving 30 years ago, health professionals like Marilyn Mochel, a registered nurse who helped create the hospital’s policy on shamans, have wrestled with how best to resolve immigrants’ health needs given the Hmong belief system, in which surgery, anesthesia, blood transfusions and other common procedures are taboo.

The result has been a high incidence of ruptured appendixes, complications from diabetes, and end-stage cancers, with fears of medical intervention and delays in treatment exacerbated by “our inability to explain to patients how physicians make decisions and recommendations,” Ms. Mochel said.

The consequences of miscommunication between a Hmong family and the hospital in Merced was the subject of the book “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and The Collision of Two Cultures” by Anne Fadiman (Farrar, Straus and Giroux, 1997). The book follows a young girl’s treatment for epilepsy and the hospital’s failure to recognize the family’s deep-seated cultural beliefs. The fallout from the case and the book prompted much soul-searching at the hospital and helped lead to its shaman policy.

The Hmong believe that souls, like errant children, are capable of wandering off or being captured by malevolent spirits, causing illness. Mr. Lee’s ceremony for the diabetic man was a spiritual inoculation, meant to protect his soul from being kidnapped by his late wife and thus extending his “life visa.”
Oookay...

But then, it is about patients getting better - even with placebo:

A turning point in the skepticism of staff members occurred a decade ago, when a major Hmong clan leader was hospitalized here with a gangrenous bowel. Dr. Jim McDiarmid, a clinical psychologist and director of the residency program, said that in deference hundreds of well-wishers, a shaman was allowed to perform rituals, including placing a long sword at the door to ward off evil spirits. The man miraculously recovered. “That made a big impression, especially on the residents,” Dr. McDiarmid said.

Social support and beliefs affect a patient’s ability to rebound from illness, Dr. McDiarmid added, pointing out that over half of the people who respond to antidepressants do so because of the placebo effect.

One of the goals of the new policy, Ms. Mochel said, is to speed up medical intervention by having a healing ceremony coincide with a hospital stay, rather than waiting days for a patient to confer with family and clan leaders after a ceremony at home.
...
At the hospital in Merced, Dr. Lesley Xiong, 26, a resident physician, grew up as the granddaughter of two distinguished shamans. Though she chose to become a doctor, she said there was ample room for both approaches. “If I were sick, I would want a shaman to be there,” Dr. Xiong said. “But I’d go to the hospital.”
This again shows the complexity of how people incorporate/manifest beliefs. But these kind of exceptions by hospitals can open the door to all sorts of medical quackery to get a foothold in hospitals.

Read the full article here.

6 comments:

Matthew said...

I think it depends upon the level of care that the religious figure provides and whether it interferes with or replaces standard care. Is this different than (say) a priest easing someone's level of stress and anxiety by providing Extreme Unction in an ICU?

I would not have a live chicken walking across a patient in ICU. I would also not want my insurance plan to cover chickens, but likewise I would not want it to cover priest visits either (though they are almost certainly free). But now insurance does cover acupuncture and chiropractic (I haven't checked lately to see if Reiki is covered), which worries me more.

We already have this (sort of) in western medicine with prayer and everything else -- I see this as the same. It just isn't Western.


(By the way, hi. Acadia was awesome.)

sigob said...

I think we have a long way to go to fully leverage placebo effects. From my limited experience, attempting to do so still seems taboo.

Salman Hameed said...

Matt,

"We already have this (sort of) in western medicine with prayer and everything else -- I see this as the same. It just isn't Western."

On the first approximation I agree with you. But in general, the system of prayers is not directly competing with modern medicine (though for some people it does) - i.e. it is by its essence a supplement. But, Shamanism or Reiki or many of the New Agey treatments do make claims that compete with medicine - i.e. they are better, hence no need to go to the hospital. Of course, the NYT story is specifically talking about shamanism as a supplement in the hospital. But others may take this as an endorsement of its treatment effectiveness.

Most likely we are saying the same thing - but I thought I'll just argue with you :)

Sigob:
Yup - Placebo needs to be better understood...

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Matthew said...

But others may take this as an endorsement of its treatment effectiveness.

Sure. Actually, one of the things that came to mind reading that was the death of Peter Sellers and psychic surgery. But like sigob said the placebo effect may be very important. I can see how prayer and ritual can be a huge help with stress relief, and stress has important (and poorly understood) effects.

Sally Joyce said...

By reading the comments of your readers it is clear that many do not understand what Shamanism is and have many incorrect preconceived notions about what it is. I hope that many will do their research to broaden their understanding of this way. As a Shamanic practitioner initiated into this work through illness I agree with Dr. Lesley Xiong's comment “If I were sick, I would want a shaman to be there, but I’d go to the hospital.”