Explanatory models of health and disease: surprises from within the former Soviet Union
Keywords:social anthropology, medical anthropology, social theory, public health, illness, explanatory models, media advocacy, health promotion, social epidemiology
The review of anthropological theories as applied to public health by Jennifer J. Carroll (Carroll, 2013) published in this issue of TCPHEE made me recollect my first and most surprising discoveries of how differently same things can be understood in different parts of the world. Probably less unexpectedly, these impressions concern substance abuse and addiction behaviors, similarly to many examples deployed by Jennifer J. Carroll.
The first of these events happened soon after the break-up of the Soviet Union when some of the most active people from the West rushed to discover what was going on behind the opening iron curtain. A director of an addiction clinic, who had just come into contact with a Dutch counterpart, invited me to join the collaboration and the innovation process he planned to launch. Being a participant of the exchange program started within this collaboration, I had an opportunity to discover how addictive behaviors were understood and explained in books (English, 1961; Kooyman, 1992; Viorst, 1986) recommended by the colleagues in the Netherlands and, as I could observe with my own eyes, addressed in everyday practice. This was a jaw-dropping contrast to what I learnt at the soviet medical university and some post-graduate courses, where all the diseases related to alcohol, tobacco, or drug abuse were considered predominantly a result of the substance intake. In the Soviet discourse, the intake itself was understood as 'willful and deliberate' or immoral behavior which, in some cases, was to be rectified in prison-like treatment facilities. In the West, quite oppositely, substance abuse was seen rather as a consequence of a constellation of life-course adversities thoroughly considered by developmental psychology. This approach was obviously deeply ingrained in how practitioners diagnosed and treated their patients.
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