This thesis examines the place of metaphor in biomedical knowledge about two major public health problems: cancer and coronary heart disease (CHD). Specifically, it considers why cancer is constituted by biomedicine in obviously metaphorical concepts that are also highly pejorative. Conversely, the metaphorical dimension of the biomedical knowledge concerning CHD is less obvious and less negative in its connotations. This thesis posits that the difference in linguistic styles associated with cancer and CHD can be accounted for by whether knowledge about them confirms or challenges the knowledge and value system of modernity. Cancer, as construed by biomedicine, appears to confound some important tenets of the epistemology and knowledge of modernity. In particular, it confounds the idea that the body is a machine and that nature is an inert order obeying objective laws. It thus suggests that the universe, including that of bodies, is not entirely subject to rational understanding and control. Women having irrational bodies and an affinity with unruly nature are primary sites for cancer. It is therefore hardly surprising that cancer's metaphors express a fear that order based on masculine rational agency is fragile. By contrast, biomedical knowledge about CHD appears to confirm key aspects of modernist knowledge. Specifically, it suggests that the (masculine) body can be understood as a machine that exists as part of a wider domain of nature that is inert and is fuelled by objective laws. Unlike cancer, which is depicted as mysterious and arcane, CHD is presented as an ailment with causes that are well understood and treatment that is effective, thus affirming the truth of rationality and technology. Coronary heart disease is construed overwhelmingly as a disease affecting men exercising their capacity for rational agency, free from the 'dictates' of an irrational body. Coronary heart disease is depicted as a disruption of supply and demand rather than as a threat to social order itself. In Durkheimian terms, sacred things can be pure and beneficent or they can take impure and threatening forms. Cancer expresses the impure, threatening dimension of sacredness in exposing threats to the knowledge and order of modernity. Conversely, coronary heart disease is profane, in those terms, since it offers apparent confirmation of the knowledge and order of modernity. Cancer makes us aware of deeply held values by making us conscious of threats to them but the knowledge of CHD is so congruent with the knowledge system of modernity, that it does not provoke us to examine that framework; it merely affirms our routine and mundane view of the world. These findings suggest that biomedicine can be regarded as a secular religion because it acts as a cosmology. Knowledge of the body and its ailments is set within a wider conceptual framework and value system recognizing and naming sources of order and danger. This further suggests that while biomedicine may be rightly regarded as a technical and instrumental body of knowledge, it is nevertheless fuelled by and intertwined with deeply held values and convictions that are beyond the domain of rationality. The unexamined, a-rational elements of biomedicine have been virtually ignored within public health and explain some of its limitations in defining and responding to familiar public health problems. / Thesis (Ph.D.)--Department of Public Health, 2003.

Orientador: Guita Grin Debert / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-08T09:47:02Z (GMT). No. of bitstreams: 1 Silva_AngeloAugustoda_M.pdf: 205227 bytes, checksum: a90ee24c9c1dc0f0ec0d1f921904787b (MD5) Previous issue date: 2007 / Resumo: A pesquisa teve como objetivo inicial apreender as re-configurações dos saberes e práticas médico-psiquiátricas, no contexto atual de expansão da procura e oferta desses serviços e de uma rebiologização nas explicações destes saberes. Paradoxalmente os "fenômenos não explicados organicamente" constituem um grande desafio ao campo e são descritos frequentemente pelo fenômeno de "somatização", nome dado a um programa de pesquisa e atendimento à  população e objeto dessa pesquisa. Se no referido contexto o trato a estes sofrimentos a partir de uma visão organicista e unidirecional mostra-se insuficiente, a incorporação de psicoterapias e da psicanálise no tratamento cotidiano da clientela também não se mostra isenta de dificuldades e dilemas. Buscou-se compreender também como a própria classificação e elaboração do diagnóstico e prognóstico são realizadas segundo as representações e visão de mundo dos profissionais do programa, estreitamente coadunada com a visão psicologizante de Pessoa, configurando universos de valor diversos que são fundamentais de serem apreendidos para melhor compreensão e reflexão das questões e dificuldades em jogo no atendimento / Abstract: The aim of this research is to capture the re-configurations of the several kinds of medical and psychiatric knowledge and practices in the current context of demand and offer enlargement of those services and also of a re-biologization of the explanations related to this kind of knowledge. In a paradoxical way, the phenomena which are not explained in an organic way constitutes themselves a great challenge and are often described by the "somatization" phenomenon, name attributed to a research and support program to the population, and also the purpose of this study. If in the context mentioned, the treatment of these sufferings from an organicist and unidirectional point of view proves to be insufficient, an incorporation of psychotherapies and psychoanalysis in the daily treatment of clients also presents difficulties and dilemmas. We tried to understand how the very classification and elaboration of diagnosis and prognosis are made according to the representations and perspectives of the professionals of the program, strictly linked to their psychological view of the world, setting up universes with different values which have to be captured in order to find a better understanding about the issues and difficulties in the treatment / Mestrado / Mestre em Antropologia Social

Orientador: Vanessa Rosemary Lea / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciencias Humanas / Made available in DSpace on 2018-08-15T10:32:37Z (GMT). No. of bitstreams: 1 FrancoNeto_JoaoVeridiano_M.pdf: 8359968 bytes, checksum: 5445033d8280dd10ba03fc66c179c7e8 (MD5) Previous issue date: 2010 / Resumo: Esta dissertação é resultado de doze meses intercalados de pesquisa de campo realizada entre os índios Kalapalo do Alto Xingu, Terra Indígena do Xingu, Mato Grosso. Busca empreender uma descrição e análise do modo pelo qual ocorre uma interação entre o xamanismo dos Kalapalo e o saber biomédico tal como esta se dá no âmbito das práticas da política nacional de atenção à saúde dos povos alto-xinguanos. O xamanismo kalapalo não difere do xamanismo praticado no Alto Xingu como um todo: consiste, basicamente, em um sistema terapêutico que aborda o fenômeno da doença como um acontecimento em que uma determinada pessoa tem a sua 'alma-sombra' (akua) capturada por um 'espírito' (itseke). O conceito de itseke se relaciona com as formas 'animais' definidas no interior da cosmologia kalapalo, e seus modos de existência são mais bem compreendidos sob a luz do conceito de ponto de vista, articulado com a lógica predatória e com o regime alimentar alto-xinguano. O xamã é acionado para que, por meio do transe induzido pela fumaça do tabaco, entre em comunicação com o itseke causador da doença e possa trazer de volta a akua do doente. A possibilidade de cura é então concebida nos termos do resgate da 'almasombra', realizado pelo xamã. As relações construídas a partir da situação de contato entre os alto-xinguanos e a sociedade envolvente engendraram a elaboração de duas categorias cruciais: doenças-de-índio e doenças-de-branco, onde as primeiras figuram como enfermidades causadas por itseke e as segundas aparecem na forma das doenças infectocontagiosas, como gripe, sarampo, caxumba, catapora, etc. A problemática que delineia nosso trabalho se fundamenta no caráter ambíguo que é assumido pela oposição entre doenças-de-índio e doenças-de-branco: da perspectiva dos Kalapalo essa dicotomia não define uma separação de natureza entre as duas categorias, servindo apenas como modo de comunicação instrumental com as equipes de assistência médica. Por outro lado, as equipes de assistência médica estabelecem um corte entre doenças-de-índio e doenças-de-branco de maneira que as primeiras configurariam uma manifestação singular da cultura indígena. Essa singularidade é pensada a partir da ideia de uma psicossomatização dos aspectos culturais, entendendo-se 'cultura' enquanto conjunto de crenças. Assim, a separação entre doenças-de-índio e doenças-de-branco, do modo como é concebida pelas equipes de assistência médica, atribui uma causa psicológica para as primeiras e uma causa fisiológica para as segundas. Essa redução das doenças-de-índio ao âmbito da crença é explorada como a configuração de uma estrutura hierárquica na qual a cosmologia indígena é englobada pela cosmologia ocidental. Tal englobamento encontra sustentação a partir do relativismo cultural, que supõe a coexistência de uma diversidade de culturas com a existência de uma única natureza. Os dados de nossa pesquisa etnográfica apontam para um arranjo distinto quando o foco de análise toma em consideração o modo como os índios kalapalo recorrem ao tratamento médico ocidental: a terapêutica xamanística não é descartada pelos índios mesmo quando o que está em jogo é aquilo que a assistência médica entende por doençasde- branco, o que sugere uma origem comum entre doenças-de-índio e doenças-de-branco: os itsekeko ('espíritos') ou os kugihé-ótomo (feiticeiros) / Abstract: This dissertation is the result of an interpolated twelve-month fieldwork among the Kalapalo of Upper Xingu (Xingu Indigenous Land, Mato Grosso, Brazil). It seeks to undertake a description and analysis about the way in which an interaction takes place between the Kalapalo shamanism and biomedical knowledge the way it happens within the practices of the national health care policies to the Indian people of Upper Xingu. Kalapalo shamanism is not different from Upper Xingu shamanism as a whole. Upper Xinguano shamanism is basically a therapeutic system that addresses the phenomenon of illness as an event in which a person has his/her 'soul-shadow' (akua) captured by a 'spirit' (itseke). The itseke concept is related to the 'animal' forms as defined within the Kalapalo cosmology, and their ways of existence are better understood when it is associated with the concept of point of view, along with the predatory logic and the Upper Xinguano diet. The shaman is called in order to, through the trance led by tobacco smoke, communicate with the itseke that is the illness cause, so that he might bring the 'soul-shadow' back into the ill. The possibility of cure is so understood in terms of the 'soul-shadow' rescue, performed by the shaman. The relations created from the contact situation between the Upper Xinguano and the surrounding society engendered the development of two-key categories, named Indian Illnesses and White Illnesses. The first category indicates illnesses caused by itsekeko and the second appears as infectious illnesses such as influenza, measles, mumps, chicken pox, etc. The issue that outlines our work is based on the ambiguous character that is taken upon the opposition between Indian Illnesses and White Illnesses. From the Kalapalo perspective this dichotomy does not determine a separation of nature between the two categories, but it defines an instrumental mode of communication with the health care teams. On the other hand, the medical teams conceive a division between Indian Illnesses and White Illnesses and consider the first one as a particular manifestation of indigenous culture. This uniqueness is perceived from the idea of a psychosomatization of cultural aspects, it is understood that 'culture' is a set of beliefs. Thus, the dichotomy between the Indian Illnesses and White Illnesses, from the way it is conceived by the health care teams, impute a psichological cause for the first and physiological cause for the second. This reduction of Indian Illnesses regarding Indian beliefs is explored as a hierarchical structure configuration, in which, the Indigenous cosmology is embodied by the Western cosmology. Such embodiment finds its basis in cultural relativism, which pressuposes the coexistence of a cultural diversity along with the existence of a universal nature. Data from our ethnographic research suggests a different arrangement when the focus of analysis shows the way by which the Kalapalo indians search for the Western medical treatment. The shamanistic therapy is not ruled out by the indians, even when what the health care understands as White Illnesses is what is at stake. This suggests that there is a common origin of Indian Illnesses and White Illnesses: itsekeko ('spirits') or kugihé-ótomo (sorcerers) / Mestrado / Etnologia Indigena / Mestre em Antropologia Social

Cette thèse en anthropologie fait suite à des travaux réalisés dans le cadre d’un programme de santé publique mis en œuvre au Burkina Faso. Celui-ci concernait la prise en charge de la tuberculose dans la région sanitaire du plateau central. Le travail dont je me suis occupé, porte sur les aspects anthropologiques de la tuberculose en se focalisant sur les représentations de la maladie, ainsi que la nature des relations et processus thérapeutiques. Il rend compte d’une mise en perspective de la dynamique de prise en charge des malades soufrant de la tuberculose dans les familles et les centres de soins. L’analyse est principalement orientée vers une approche critique sur la place qu’occupent les sciences sociales dans la mise en œuvre de projets de santé et de développement dans une perspective interdisciplinaire. L’anthropologue convié dans un programme de santé publique s'invertie dans le but d’identifier et analyser les perceptions locales, ainsi que les attitudes et pratiques des populations, en indiquant les modalités de leur prise en compte pour faire face aux besoins de santé. Ceci permet de définir des orientations dans la réalisation des programmes de santé qui prennent en compte les réalités locales et les caractéristiques des acteurs. Par ailleurs, l’appropriation et la mise en application des connaissances produites par une démarche anthropologique suscitent bien des interrogations. Par une approche réflexive qui prend racine dans de multiples contributions d’anthropologues impliqués dans des programmes de santé et de développement, je me suis interrogé de savoir dans quelle mesure l’implication de l’anthropologue dans des actions de développement tient lieu d’un corpus qui soulève des questionnements d’ordre méthodologique et théorique. Ces questions ont ouvert des perspectives pour l’élaboration de nouvelles connaissances au travers d’une anthropologie du changement social. A partir de mes propres expériences, j’ai donc essayé d’examiner la pratique de l’anthropologie et les modalités de ses apports au fonctionnement des services de santé et la réalisation des projets de santé publique au Burkina Faso. / Doctorat en Sciences politiques et sociales / info:eu-repo/semantics/nonPublished

Cette étude s’appuie sur une recherche ethnographique commencée en octobre 2006, dans le cadre d’un doctorat en anthropologie. C’est une étude qui vise à comprendre la façon dont les relations sociales, qui articulent le continuum accueil-soins des malades, contribuent ou non à l’accès aux soins à l’hôpital Sendwe.<p><p>La plupart des études qui ont abordé la problématique de l’accès aux soins, et de l’utilisation des services de soins dans les hôpitaux publics des pays en développement, ont envisagé cette problématique davantage en termes de carence en matériel ;et réduit souvent l’essentiel des problèmes à une question financière.<p><p>Et pourtant, comme le témoignent des études récentes conduites dans les hôpitaux africains au cours de la dernière décennie, soutenues notamment par une méthodologie qualitative, alliant observations intensives et entretiens approfondis (cf. Jawkes & al. 1998 ;Gobbers, 2002 ;Jaffré & Olivier de Sardan, 2003 ;Vidal & al. 2005 ;Jaffré & al. 2009), l’accès ou non aux soins et l’utilisation des services hospitaliers recouvrent des champs plus vastes et plus complexes qui englobent à la fois des questions, bien sûr, économiques que des problèmes comportementaux d’exclusion, des violences, des humiliations… bref, des questions liées à la relation inégalitaire des pouvoirs due à la distance sociale qui s’observe entre soignant et soigné. Dans le cadre de l’hôpital Sendwe, cette inégalité de la relation soignant-soigné est particulièrement exacerbée par un contexte de misère sociale à laquelle se conjugue une bureaucratisation des tâches dont l’exécution vient ici redoubler au statut du fonctionnaire un pouvoir de soigner. C’est face à cette tension permanente entre partie en interaction favorisée par le décalage entre l’offre médicale et la demande des soins que je me suis interrogé comment les soins hospitaliers sont-ils négociés à l’hôpital Sendwe. Avec quelles ressources les parties s’engagent dans le processus d’accès aux soins ?Quelles sont les pratiques effectives qui s’observent dans les interactions avec le patient et ses proches ?Comment les patients catégorisent-ils le personnel médical, et vice-versa ?Quelles sont les règles, pratiques et morales, qui régissent leurs interactions ?C’est donc à toutes ces questions que cette étude tente de répondre. / Doctorat en Sciences politiques et sociales / info:eu-repo/semantics/nonPublished