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Rev. Latino-Am. Enfermagem 2010 May-Jun; 18(3):459-66 www.eerp.usp.br/rlae

Corresponding Author:

Flavio Braune Wiik Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas. Departamento de Ciências Sociais Campus Universitário. Caixa-Postal 6001 CEP 86051-990 Londrina, PR, Brasil E-mail: [email protected]

Anthropology, Health and Illness: an Introduction to the Concept of

Culture Applied to the Health Sciences

Esther Jean Langdon1

Flávio Braune Wiik2

This article presents a reflection as to how notions and behavior related to the processes of

health and illness are an integral part of the culture of the social group in which they occur.

It is argued that medical and health care systems are cultural systems consonant with the

groups and social realities that produce them. Such a comprehension is fundamental for the

health care professional training.

Descriptors: Culture; Anthropology; Health Care; Health Sciences.

1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.

Email: [email protected]. 2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.

Email: [email protected].

Original Article

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Antropologia, saúde e doença: uma introdução ao conceito de cultura

aplicado às ciências da saúde

O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos

ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde

os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,

assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os

grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra

fundamental para a formação do profissional da saúde.

Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.

Antropología, salud y enfermedad: una introducción al concepto de

cultura aplicado a las ciencias de la salud

Este artículo presenta una reflexión acerca de como las nociones y comportamientos

asociados a los procesos de salud y enfermedad están integrados a la cultura de los

grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas

médicos de atención a la salud, así como las respuestas dadas a la enfermedad son

sistemas culturales que están en consonancia con los grupos y las realidades sociales

que los producen. Comprender esta relación es crucial para la formación de profesionales

en el área de la salud.

Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.

Introduction

Perhaps it seems out of place to address the theme

of culture in a journal dedicated to the Health Sciences

or to argue that the concept of culture can be useful

for professionals of this area. Everyone has a common

sense idea of what “culture” means. We say that a person

“has culture” when he or she has a higher education,

comes from a family of a good socio-economic level or

understands the arts and philosophy. It is normal to

consider that a “good patient” “has culture” sufficiently

to comprehend and follow correctly the instructions

and warnings given by the health professional. This

patient is contrasted with the one “without culture”, the

more “difficult” patient who acts incorrectly through

“ignorance” or who is guided by “superstitions”.

In this article, we will discuss another notion of

culture, the analytical concept that is fundamental to

anthropology. Culture, as conceived by anthropology,

also serves as an instrumental concept for health

professionals conducting research or health intervention

among rural or indigenous populations, as well as in urban

contexts characterized by patients belonging to different

social classes, religions, regions or ethnic groups. These

patients present unique behaviors and thoughts with

regard to the experience of illness, as well as particular

notions about health and therapeutic practices. These

particularities do not come from biological differences,

but from those that are social and cultural in nature.

In short, our point of departure is that everyone has

culture and that it is essentially culture that determines

these particularities. Moreover, questions related to the

processes of health and illness should be considered from

the perspective of the specific socio-cultural contexts in

which they occur.

This assumption about the role of culture is not

exclusive to anthropological knowledge, and theorists,

researchers and professionals in the health fields

- particularly those in medicine and nursing - have

embraced it since the second half of the 1960s(1-2).

They support the idea that biomedicine is a cultural

system and that the realities of clinical practice should

be analyzed from a transcultural perspective. Likewise,

they draw attention to the relevance of the use of

qualitative methods and techniques in health research, in

particular, the ethnographic method(3). Conjoined to these

reflections, are theoretical and philosophical premises

found at the intersection of health and culture, between

the imponderables observed in practical intervention

by health professionals in the face of cultural theory,

between cultural relativism and universal human rights,

and between the demands of a health profession and the

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more theoretical and reflexive space of anthropology(4).

This theme has been addressed in the Latin American

Journal of Nursing through publication of results of

studies and research conducted by health professionals

and academics(5-7). Using the ethnographic method and

interpretive analysis, these studies point out that the

patient’s construction of the meaning of illness is central

and which is superimposed upon that of biomedical

causality and rationality. For example, in a study

conducted with oncological patients, it was observed

that the symbolism of radiotherapy from the patients’

perspective and constructed throughout the treatment

process, proved to be a powerful organizer and arranger

of the patient’s experience against disruptions caused

by the disease and its therapy. Likewise, the influence

of religious belief has been observed to positively

affect the survival of total laryngectomy patients who

are surrounded by socio-affective religious networks

accompanying them and praying for their healing.

On the other hand, these studies call attention to the

challenges and paradoxes inherent in the ethnographic

method that require simultaneously the researcher’s

immersion in the quotidian socio-cultural universe of

the group (of patients) to be investigated and distancing

so that the investigator does not assume ethnocentric

postures. They also question the factibility between the

use of interpretivism, which tends toward hermeneutic

subjectivity, and the construction of knowledge according

to scientific objectivity.

An instrumental concept of culture

The universe that encompasses the conceptual

definition of culture is extremely complex and diverse,

the common divisor of anthropology’s various analytical-

theoretical currents and fomenter of their epistemological

and methodological approaches(8-9). Considering the

purpose of this article, we will limit ourselves to discussing

some essential and instrumental aspects linked to the

concept of culture, which, in turn, will be used in the

typological and analytical construction proposed.

Culture can be defined as a set of elements that

mediates and qualifies any physical or mental activity

that is not determined by biology and which is shared by

different members of a social group. They are elements

with which social actors construct meanings for concrete

and temporal social interaction, as well as sustain

existing social forms, institutions and their operating

models. Culture includes values, symbols, norms and

practices.

From this definition, three aspects should be

emphasized so that we can comprehend the meaning

of socio-cultural activity. Culture is learned, shared, and

patterned(10). In affirming that culture is learned, we are

stating that we cannot explain the differences in human

behavior through biology in an isolated way. Without

denying its important role, the cultural(ist) perspective

argues that culture shapes biological and bodily needs

and characteristics. Thus, biology provides a backdrop

for behavior, as well as for the potentialities of human

formation and development. However, it is the culture

shared by individuals of a society that transforms

these potentialities into specific, differentiated, and

symbolically intelligible and communicable activities.

Based on this assumption, being a man or woman, a

Brazilian or a Chinese does not depend on one’s respective

genetic composition, but on how that person, through and

because of culture, will behave or think. Ethnographic

studies on sexual behavior patterns according to gender

have indicated that there are wide variations in the

behavior of the sexes and that these variations are based

on what people have learned from their culture about

what it is to be a man or a woman(11-12).

Culture is shared and patterned, because it is

a human creation shared by specific social groups.

Material forms, as well as their symbolic content and

attributions, are patterned by concrete social interactions

of individuals. Culture is a result of their experiences in

determined contexts and specific spaces, which can be

transformed, shared and permeated by different social

segments. Although the content and forms inherent in

each culture can be understood and replicated individually

– conferring to the culture the character of internalized

and embodied personal experience – the concerns of

anthropology are i) to identify cultural patterns shared

by groups of individuals; ii) to deduce what is common in

the actions, allocation of meaning, and significance and

symbolism projected by the individuals on the material

and “natural” world; iii) to reflect on the experience

of living in society, including of that of becoming sick

and caring for one’s health, as a highly intersubjective

and relational experience, mediated by the cultural

phenomenon.

In order to illustrate our argument, we can observe

different cultural patterns regarding the types of food

and diet. In Brazil, the combination of rice and beans

is fundamental for a meal to be considered complete.

Without them, even with presence of meat, many say

their hunger is not satisfied. Others always need a meat

dish to feel well fed. They can even leave the table

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hungry, after eating a hearty dish of Chinese food filled

with mixed vegetables with little meat. But a Chinese

feels completely satisfied with a primarily vegetarian

meal.

Not only is what to eat determined in a particular

way by culture, but also when to eat as well. Most

Brazilians eat the largest meal of the day at noon to

“digest the food well” and to be “well-fed for work” until

the late afternoon. It is common to claim that eating a

lot at night, especially eating “heavy food” is bad for the

stomach. In turn, North Americans, who do not miss

rice and beans, generally eat less at noon and a large

quantity of “heavy” food (in the eyes of the Brazilians)

in the evening before sleeping. For them, food in

abundance at noon is inappropriate and hinders the

afternoon’s work. From this perspective, culture defines

social standards regarding what and when to eat, as

well as the relationship between types of foods that

should or should not be combined, and, consequently,

the experience of satisfying hunger, or not, is both

socially and biologically determined. It is biology’s task

to indicate basic nutritional needs and to determine the

limitations of foods considered toxic.

In affirming that culture is tied to all physical or

mental activity, we are not alluding to a patchwork quilt

composed of pieces of superstitions or behavior lacking

in intrinsic coherence and logic. Fundamentally, culture

organizes the world of each social group according to its

own logic. It is an integrating experience, holistic and

totalizing, one of belonging and interacting. Consequently,

culture shapes and maintains social groups that share,

communicate and replicate their ways, institutions, and

their principles and cultural values.

Given its dynamic nature and intrinsic politico-

ideological characteristics, culture and the elements

that comprise it are mediating sources of social

transformation, highly politicized, appropriated, modified

and manipulated by social groups throughout their

history, guided by the intentions of the social actors

in the establishing of new socio-cultural patterns and

societal models.

Moreover, each group interacts with a specific

physical environment, and culture defines how to

survive in this environment. Due to the creative and

transformative character, inherent in human cultures, in

interaction with the natural world, we find the existence

of various different solutions for societies’ survival

within the similar environments. Human beings have

the capacity to participate in any culture, to learn any

language, and to perform any task. However, it is the

specific culture into which they are born and/or raised

that determines the language(s) they will speak, the

activities they will develop, and their position and

potential for social mobility in the social structure.

Language, social roles and positions are governed by

age, sex and other cultural variables that influence the

bodily techniques and aesthetic patterns adopted, as well

as the social roles performed according to ideal types

informed by the kinship system and other institutions

of the society to which a person belongs. Finally, in

this dialogue between the individual and society, culture

is both the subject and object. This happens, because

throughout a lifetime, individuals are gradually socialized

by/in the cultural patterns current in their society and

which are constructed through daily social interaction,

as well as through ritual processes and institutional

affiliations. They are responsible for the transformation

of individuals into social actors, into members of a

certain group that mutually recognize each other. As

social actors, they learn and replicate the principles

that guide ideal patterns of valued and qualified types

of action, those of behavior, dress, or eating habits, as

well as techniques for diagnosis and treatment of illness.

Moreover, the socialization of individuals is responsible

for the transmission of meanings about why to do it.

The why to do has special importance as it allows us

to understand the integration and the logic of a culture.

Culture, above all, offers us a view of the world, that is,

the perception of how the world is organized and how to

act accordingly in a world that receives its meaning and

value through culture. Thus, as previously discussed, it

is the culture of a group that provides social actors with a

classification and value system of those foods considered

edible or not, defines the techniques and environments

for obtaining food, and classifies, organizes and assigns

values to various types of food, such as “good”, “weak”,

“strong”, “light”(13).

To present another example: the concept of

cleanliness and hygiene are fundamental categories

present in all cultures. Every culture establishes its

categories of things, classifying them as “clean and

pure” or “dirty and impure”(14), as well as determines

which practices and knowledge are associated with

these categories that contribute to their maintenance,

classification and distinctions. However, the definitions

about what is considered “clean” or “dirty”, “pure” or

“impure” are as varied as the multiplicity of human

cultures found in the world. This variation reflects

a fundamental assertion in the construction of the

field of anthropological knowledge: the paradoxical

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confirmation of the diversity and unity encompassed by

cultural phenomenon that is, at the same time, one and

universal, diverse and specific.

Among the Barasana Indians of the Colombian

Amazon jungle(15), apart from ants with cassava (manioc

bread), the diet consists of meat or fish obtained by the

men and eaten with cassava made by the women. When

a hunter is lucky, upon returning to the longhouse, he

delivers the largest portion of meat to the most senior

man of his extended family. His wife or wives cook the

meat in a large pot and put it on the floor in the center of

the house. Then, the senior man first calls the men to eat

according to hierarchical rules based on age groups and

prestige. Afterwards, he calls the women, though not

always all of them. Children are never called to eat when

the pot contains the meat of large animals or fish.

In addition to the social rules based on hierarchy and

distribution of power that regulate food consumption,

all foods and those who prepare or ingest them, are

regulated by cultural principles of cleanliness and purity,

known by the Barasana as witsioga. Witsioga consists of

a substance present in the food, especially meat, which

is dangerous for small children and people of certain

age groups or in liminal states, such as those entering

puberty or participating in shamanism initiation,

pregnant or women in post-partum, and those who are

ill. Since manioc bread is considered a “pure” food, that

which has been touched by the hand of a person eating

meat is contaminated it for those in liminal states.

The Barasana have a complex classification of

animals and fish that are witsioga. They classify them

according to size, behavior, etc. There are also principles

that regulate a series of practices and actions that can

and cannot be performed after eating meat, besides the

hygienic practices intended to cleanse this substance

from the people who eat meat that contains witsioga.

Witsioga also regulates the diagnosis, origin and etiology

of diseases, and, in turn, is linked to the cosmology of

the Indians. The world is controlled by beings (“spirits”)

and witsioga attracts evil spirits that attack people who

are classified as weak or vulnerable.

This example illustrates that when we are faced

with the customs present in other cultures, we should

try to understand their why. By doing this, we avoid

an ethnocentric comprehension of them, that is, judging

Barasana culture according to our own values and

classification of the world and not according to theirs.

The fact that they eat ants, eat from the same pot, eat

with their hands scooping up food with pieces of manioc

bread, and share a single gourd for drinking, might

cause a certain repulsion, since “ants are not food” and

“eating food from a pot on the floor is dirty”. Also, one

might consider the category witsioga to be “superstition”

since such behavior is opposed to what we comprehend

to be “healthy” and “clean” according to biomedical

rationality.

The anthropological perspective requires that, when

faced with different cultures, we do not make moral

judgments based on our own cultural system and that

we understand other cultures according to their own

values and knowledge - which express a particular view

of the world that orients their practices, knowledge and

attitudes. This procedure is called cultural relativism.

It is what allows us to comprehend the why of the

activities and the logic of meanings attributed to them,

without ranking or judging them, but only, and, above

all, recognizing them as different!

Many other examples could also be drawn from

ethnographic research conducted by the health

professionals cited in this article(4-7). All of them lead

us to reflect on issues related to health habits, rituals,

techniques of care and attention, and restrictions with

regard to the use of therapeutic practices (e.g. blood

transfusion, organ transplantation or even abortion);

all of these are mediated by cultural systems distant

from, or even opposed to, the cultural standards which

underlie the construction of the biomedical system and

with which health professionals are trained.

We have used examples taken from a society

whose culture is very distant, one characterized as a

simple society. However, in a complex society like Brazil,

which, in addition to being stratified by social classes,

is comprised of numerous ethnic groups and population

segments exhibiting diverse religious and regional

customs, we find internal cultural differences and inter-

group variations. Although these groups share aspects

of a general culture, identified as the so-called “Brazilian

culture”, but we must recognize that these collectivities

that make up the Brazilian population have different

views of the world and perceive reality in a diverse

ways, generating a complex and intertwined socio-

cultural mosaic. This complexity is the background of

the context that articulates health, culture and society,

and in which professionals and researchers in the field

of health are inserted.

Culture, society and health

If we accept that culture is a total phenomenon

and thus one which provides a world view for those

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who share it, guiding their knowledge, practices and

attitudes, it is necessary to recognize that the processes

of health and illness are contained within this world view

and social praxis.

Concerns with illness and health are universal

in human life and present in all societies. Each group

organizes itself collectively - through material means,

thought and cultural elements - to comprehend and

develop techniques in response to experiences or

episodes of illness and misfortune, whether individual

or collective. As a consequence, each and all societies

develop knowledge, practices and specific institutions

that may be called the health care system(1).

The health care system comprises all components

present in a society related to health, including knowledge

about the origins, causes and treatments of disease,

therapeutic techniques, its practitioners, and the roles,

standards and agents in interaction in this “scenario”.

Added to these are power relationships and institutions

dedicated to the maintenance or restoration of “the

state of health”. This system is supported by schemes

of symbols that are expressed through the practices,

interactions and institutions; all are consistent with the

general culture of the group, which in turn, serves to

define, classify and explain the phenomena perceived

and classified as “illness”.

Thus the health care system is not disconnected

from other general aspects of culture, just as a social

system is not dissociated from the social organization of

a group. Consequently, the manner by which a particular

social group thinks and organizes itself to maintain

health and face episodes of illness, is not dissociated

from the world view and general experience that it has

with respect to the other aspects and socio-culturally

informed dimensions of experience. Comprehension

of this totality makes it possible to apprehend the

knowledge and practices linked to the health of the

individuals that form a society’s cultural system and

intellectual and moral heritage. Thus, if we do not know

that the Barasana category of witsioga is linked to

their cosmology, to the classification of food and to the

state/status of the people, we do not comprehend the

importance given by them to the ways taken as correct

and “pure” for the preparation and consumption of food.

It would also be difficult to comprehend the importance

of this concept within their concerns for health or to

convince them that in an environment with few sources

of protein, prohibiting meat for young children and

breastfeeding women may affect their growth if they do

not have another adequate protein source.

A health care system is a conceptual and analytical

model, not a reality itself, for the understanding of

social groups with whom we live or study. The concept

helps to systematize and comprehend the complex set

of elements and factors experienced in daily life in a

fragmented and subjective manner, be this in our own

society and culture or in that of an unfamiliar one.

It is important to understand that in a complex

society such as the Brazilian one, there are several

health care systems operating concurrently, systems

that represent the diversity of the groups and cultures

that constitute the society. Although the state medical

system, which provides health services through the

National Health System (SUS), is based on biomedical

principles and values, the population, when sick, uses

many other systems. Many groups do not seek medical

doctors, but use folk medicine; others use medical-

religious systems, and others seek multiple alternative

health systems throughout the therapeutic process. To

think of the health care system as a cultural system

helps us to comprehend this multiplicity of therapeutic

itineraries.

The Cultural System of Health

The cultural system of health emphasizes the

symbolic dimension of the understanding of health and

includes the knowledge, perceptions and cognitions

used to define, classify, perceive and explain disease.

Each and all cultures possess concepts of what it is to be

sick or healthy. They also have disease classifications,

and these are organized according to criteria of

symptoms, severity, etc. Their classification, as well as

the concepts of health and illness, are not universal and

rarely reflect the biomedical definitions. For example, in

Brazil, and mau olhado (evil eye)(16) are folk illnesses

that deny biomedical diagnosis and treatment. These

diseases are classified according to their particular

symptoms and causes that guide their diagnosis and

therapeutic practices chosen. Only folk specialists have

the knowledge to diagnose and treat them.

In this way, culture provides etiological theories

based on the worldview of a group, and these theories

can frequently indicate multiple causes for an illness

episode, and they can be thought of as “mystical” and/

or “non-mystical”. Among the “non-mystical”, or natural

causes, we find theories and perceptions about the body

that attribute its poor functioning to the ingestion of

certain inadequate foods, climate, social relationships

or work conditions. These theories, in turn, provide

a basis for preventive medicine linked to behavior and

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Langdon EJ, Wiik FB.

hygiene, as well as to elements linked to a curative

medicine. The “mystical” causes frequently combine with

the “non-mystical” and may indicate the need for more

than one type of treatment, for example: one to heal the

physical body and another to heal the spiritual or social

body(17). Etiological theories that include “natural causes”

are accompanied by treatments based on knowledge

of herbs and techniques of body manipulation to treat

bodily symptoms. Ignorance or negation of their efficacy

demonstrates the bioscientific ethnocentrism often present

when evaluating other cultural systems of health care.

The Social System of Health

The system of health care is both a cultural system

and a social system of health. The social system of health

is composed of its institutions, organization of the health

specialists’ roles, rules of interaction, as well as power

relationships inherent to it. Commonly, this dimension

of the system of health care also includes specialists not

recognized by biomedicine, such as folk healers (massage

therapists, benzedeiras, curandeiros) or religious and

faith healers (pastors, priests, benzedeiras, shamans,

spiritists, and others), shaman, pajés, pais-de-santo).

In the world of each social group, experts have

a special role to perform concerning the treatment of

illness, and patients have certain expectations about how

this role will be developed, which illnesses the specialist

can cure, as well as a general idea about the therapeutic

methods he will employ.

In complex societies, besides the traditional

specialists mentioned above, we also find practitioners

of Chinese and Oriental medicine. In the last ten years

we have also seen a growing demand for practitioners

and therapists belonging to what has been called the

“new age”(18). Within the same city, there are specialists

practicing several alternative therapeutic methods

(reflecting different cultural systems of health care),

which are selected or rejected according to factors such

as religion, economic conditions, family experience and

social networks, as well as other political and/or legal

factors (such as the persecution by the State of a given

nonofficial therapeutic practice)(16).

Studies in Health, Culture and Society in Brazil

In Brazil, studies and research on health, culture

and society have multiplied significantly in the last

twenty years(19). In the last decade, Anthropology of

Health has been consolidated as a space for reflection

and for academic and professional training of doctors,

nurses and other professionals in the Area of the Health

of the country(19). There are interdisciplinary university

centers and research groups involving anthropologists

and researchers and intellectuals of collective and public

health, dedicated to the investigation of cultural, social

and politico-economic aspects linked to health issues(19).

Some publication collections have discussed the

experience of sickness and the sick body in light of issues

such as gender, religion, representations of healing and

illness narratives(20-21). Recent ethnographies describing

medical contexts, such as hospitals or clinics, have been

published(22-23). The Editor of the Foundation Oswaldo

Cruz (FIOCRUZ) has published the Anthropology and

Health Collection since the mid-1990s, whose volumes

have contributed to the dissemination of production

originating from research centers and national graduate

programs directed toward the area of health. Reports in

Public Health, also published by FIOCRUZ, has produced a

large number of articles focused on contemporary health

issues, such as STD/AIDS, structure and functioning

of health services, evaluation of health policies and

indigenous health.

Conclusions

Although subject to internal contradictions and,

consequently, potential sources of predicaments, the

values, knowledge and cultural behavior linked to

health form a socio-cultural system which is integrated,

holistic and logical. Therefore, issues relating to health

and sickness cannot be analyzed in isolation from

other dimensions of social life that are mediated and

permeated by cultural meaning. Health care systems

are cultural systems, compatible with human groups

and their social, political and economic realities that

produce and replicate them. Accordingly, for theoretical

and analytical purposes, the biomedical system of health

care should also be considered a cultural system, as any

other ethnomedical system. Therefore, interpretations

of and interventions in health and illness processes - be

they observed for individuals-patients or for biomedically

trained health professionals - must be analyzed and

evaluated using the concept of cultural relativism, thus

avoiding, ethnocentric attitudes and analysis by these

professionals and theorists.

In the end, we are all subjects of culture and

experience it in several ways, including when we become

sick and seek treatment. However, when we act as

professionals and researchers from the Area of Health,

we encounter cultural systems different from our own

(or in which we have been trained), without applying

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relativism to our own medical knowledge. This happens,

especially in the health field, because in the modern

and rational West, we naturalize the medical field,

attributing to it universal and absolute truth, distancing

it from culturalized forms of knowledge, where truth is

particular, relative and conditional.

References

1. Kleinman A. Patients and healers in the context of culture.

Berkeley (CA): University of California Press; 1980.

2. Leininger MM, organizadora. Qualitative research methods in

nursing. Orlando (FL): Grune & Stratton; 1984.

3. Clammer J. Approaches to ethnographic research. In: Ellen

RF, organizadora. Ethnographic research. Londres: Academic

Press; 1984. p. 57-72.

4. Leininger MM, organizadora. Culture care, diversity and

universality: A theory of nursing. New York (NY): National

League for Nursing Press; 1991.

5. Muniz R, Zago M. A experiência da radioterapia oncológica

para os pacientes: um remédio-veneno. Rev. Latino-Am.

Enfermagem. 2008 novembro-dezembro; 16(6):998-1004.

6. Aquino V, Zago M. O significado das crenças religiosas para

um grupo de pacientes oncológicos em reabilitação. Rev. Latino-

Am. Enfermagem. 2007 janeiro-fevereiro; 15(1):42-7.

7. Vieira N, Vieira L, Frota M. Reflexão sobre a abordagem

etnográfica em três pesquisas. Rev Latino-am Enfermagem.

2003 setembro-outubro; 11(5):658-63.

8. Ortner S. Theory in anthropology since the Sixties. Comparative

Stud Soc History. 1984; 26(1):126-66.

9. Geertz C. A interpretação das culturas. Rio de Janeiro (RJ):

Guanabara Koogan SA; 1989.

10. Laraia R. Cultura: um conceito antropológico. Rio de

Janeiro(RJ): Zahar; 1986.

11. Mead M. Sex and temperament in three primitive societies.

New York (NY): Morrow; 1935.

12. Butler J. Gender trouble: Feminism and the subversion of

identity. New York (NY): Routledge, Champman & Hall; 1990.

13. Campos MS. Poder, saúde e gosto. São Paulo (SP): Cortez;

1982.

14. Douglas M. Pureza e perigo. São Paulo (SP): Ed.

Perspectiva; 1978.

15. Langdon EJ. Dados de pesquisa-de-campo entre os índios

Barasana (1970). Mimeo; s/d.

16. Loyola A. Médicos e Curandeiros. São Paulo (SP): DIFEL;

1984.

17. Langdon EJ. Representações de doença e itinerário

terapêutico entre os Siona da Amazônia colombiana. In: Santos

RV, Carlos C, organizadores. Saúde e povos indígenas. Rio de

Janeiro (RJ): Editora Fiocruz; 1994. p. 115-42.

18. Groisman A. Saúde, religião e corpo – seção temática. Ilha

Rev Antropol. 2005 janeiro-dezembro; 7(1-2):111-62.

19. Garnelo L, Langdon EJ. A Antropologia e a reformulação das

práticas sanitárias na atenção básica à saúde. In: Minayo MCS,

Coimbra C, organizadores. Críticas e atuantes: ciências sociais

e humanas em saúde na América Latina. Rio de Janeiro (RJ):

Editora Fiocruz; 2005. p. 136-56.

20. Alves PC, Rabelo MC, organizadores. Antropologia da saúde:

traçando identidades e explorando fronteiras. Rio de Janeiro

(RJ): Relume Dumará/Editora Fiocruz; 1998.

21. Canesqui AM, organizadora. Ciências sociais e saúde para o

ensino médico. São Paulo (SP): Hucitec/Fapesp; 2000.

22. Bonet O. Saber e sentir: uma etnografia da aprendizagem da

biomedicina. Rio de Janeiro (RJ): Editora Fiocruz; 2004.

23. Tornquist CS. Paradoxos da humanização em uma

maternidade no Brasil. Cad Saúde Pública 2003; 19(Suplemento

2):419-27.

Received: Ap. 22th 2009

Accepted: Nov. 16th 2009

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