Transcript Bad Blood, Spoiled Milk: Presented by Rockie Reiss

Bad Blood, Spoiled Milk:
Bodily Fluids as Moral Barometers in Rural Haiti
An Article by Paul Farmer
Presented by
Rockie Reiss
Overview
•Analysis of cultural illnesses Move san and Lèt gate
•Discussion of Farmer’s research and methods
•two case histories
•move san as an “interpreted disorder”
•many different personal interpretations of the
illness
•discussion of different causes of the illness
•a conclusion drawing all of the information
together
Move San
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Literal English Translation – “Bad Blood”
Some believe only women are afflicted
Not been systematically studied
Believed to be caused by malignant (very dangerous
or harmful) emotions
Symptoms: first an eruption of itchy bumps all over
body, then headache, fever, dry-mouth, very jumpy,
feel weak or stiff. “Blood turns to water”
Treatment: Herbal medicines.
Left untreated, or treated unsuccessfully, outcome is
said to be dismal, some individuals studied said they
have had friends or relatives die from the illness
Main, if not only, cause of Lèt gate
Lèt gate
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Literal English Translation – “Spoiled milk”
Seen in pregnant of lactating women
Milk described as thin or watery
Can pass itchy bumps and diarrhea to children
through milk
Frequently cited motive for early weaning which leads
to malnutrition and very poor health
Thought to be detrimental more to the mother than
the infant
If “spoiled milk” infiltrates brain you will go crazy
According to some, if it gets to the uterus you will
die.
The Republic of Haiti
 1982 population is around
5.1 million
 345 per square kilometer
 74% of the country’s
inhabitants are rural
 Life expectancy of 48 years
Do Kay
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Place studied in depth by Farmer
134 households
Total population of 772
Average number of individuals per household –
5.76
Most homes are two bedroom huts
No running water
No electricity
Prior to hydraulic pump being installed it was an
hike 800 vertical feet below the village to get
water, now there are three public fountains
along the road
Paul Farmer’s methods and survey
results
 36 of mothers (77%) who were interviewed
experienced one episode of move san
 Majority of cases were treated professionally, but
only after home medicine, and herbal remedies
were also used after the professional care
 In all cases that also involved Lèt gate it was shown
to be caused by move san
 During the preliminary interviews there was no
specific set of symptoms of move san that emerged
Ti Malou Joseph, the most upon
elaborated case study
 Case followed over a “long period of time” – 20
months
 She has had recurrent episodes of move san
 She believes it is due to a tumultuous relationship
with the father of her children
 Believed to be the poorest family in the village
 While pregnant, she was hit by the father of her
children
 Ti Malou says “If you’re having troubles (nan kont)
with someone, and they yell at you or strike you,
you can become ill…He struck me in the face. That’s
what makes the blood rise up to my head and spoil
the milk.”
Case study Continued
 Complained of severe lower-back pains, muscle cramps,
headaches, dizziness, light-headedness, diarrhea, crampy
stomach pain and was eventually unable to get out of bed
 Delayed herbal remedies therapy because she was pregnant
and the “medicine is too strong for the baby”
 Many complications during the birth of her child that
occurred during the move san episode
 Lèt gate occurred in the infant and he broke out into the
itchy bumps
 Took a long time for Ti Malou to gain the funds for the
herbal remedies and treatments, and others thought that
it was “scandalous” that she had not attended to “their”
illness properly
 Eventually both were cured
Farmer’s Methods of Explanations
 Adopts a “meaning-centered approach”
 Uses Explanatory models (EMs) of
individuals involved in Ti Malou’s case
 This model “attaches narrators to narratives”
 Allowing study to happen with periodic
interviews over 20 months it allows one
fundamental flaw in using EMs to study
move san in the idea that EMs change over
time
Ti Malou’s Explanatory Model
 Believes beyond a doubt that there are social
and psychological causes to her physical distress
and illness
 When discussing treatment the separation of
blood from mild was seen as a necessity by Ti
Malou
 Says that her Lèt gate was characterized by “weak
watery” milk and that she had been “invaded by
bad blood”
 According to Farmer, in reaction to this
interview, “Move san and Lèt gate, it is clear, are
embedded in social interactions
Ti Malou’s Mother’s Explanatory
Model
 There were many different incidences in this woman’s life
that led her to the conclusion that “Ti Malou’s illness
arose against a backdrop of unremitting struggle”
 Prior to her third trimester her mother said “I think it is a
difficult pregnancy, not move san”
 Shortly before the birth her mother then was confident
that move san was the cause of her daughter’s symptoms
 The change in opinion of the condition of her daughter
could have been brought on by a family friend and
confidante
 Mme. Joseph (Ti Malou’s mother) went from believing it
was a difficult pregnancy exacerbated by a fall to believing
it was move san, “and finally as the full diapason of move
san/lèt gate triggered by a malevolent lover.
Madame Anita Kado, a confidant’s EM
• According to Farmer, Kado was the first to
suggests that Ti Malou’s difficulties were due to
move san
• She also says that “it’s necessary to wean the
baby temporarily. If nothing is done about it,
even the next child will be affected” by lèt gate
• As an older member of the society Kado has
much authority and knowledge of the illnesses
• She says that babies never die from lèt gate, but
the mothers are in danger.
Madame Anita Kado, a confidant’s EM (Continued)
• When asked “how can one be sure that a baby’s [itchy
rash] and diarrhea are due to move san?”
– “Well, we knew the milk was no good: it was as clear as water.
But to make sure, express some of the milk into a large spoon;
if it’s thick and white, it’s probably not spoiled. Take the
spoon and hold it over a flame. As it begins to boil, put a
small twig in it. If the cream climbs up the stick, the milk is
good. If it doesn’t make cream, it’s no good. But it’s usually
not necessary to do this.”
• Kado believed that the emotion exclusively could have
caused the problem failed pregnancy, and “when the
illness is so bad that the baby dies, you begin to think that
the bad person did more than yell at the woman.”
Ti Malou’s Healer’s Explanatory Model
• Madame Victor’s idea of the causes of move san is somewhat different
than the previous individuals interviewed
• She believes it is not exclusively a woman’s disorder
• She gave the detailed description of symptoms shown at the beginning
of the presentation
• Mme. Victor linked the theme of weak or watery blood to poverty
• This healer also gives a very elaborate explanation of what the remedy
entails and there are variations on the main theme, but that the
“principal ingredients” always remain the same.
• She doesn’t believe that any modern medicine can cure the ails of move
san
• She also said nothing in the interviews with Farmer about the possibility
of the spoiled milk infiltrating the uterus and causing death
A Short Summary of a Doctor’s EM
• Although doctors have heard about these
problems, he was really not willing to address
them.
• When asked about move san the doctor
laughed
• Farmer: “Worth noting throughout these
exchanges are, first the degree to which the
EMs of the patient, the mother, the
confidante and the local healer converge, and
then how little these have in common with
the EM held by the doctor.”
Farmer’s Ideas, Post Interviews
• “The ‘illness’ might in fact be ‘illness behavior,’ a form of
chronic somatization that is related to strong social
pressures”
• According to Miriam-Webster’s dictionary somatic is “of,
relating to, or affecting the body especially as
distinguished from the germplasm or the psyche.” In
other words, a condition caused by neither psychological
nor biological origins.
• Farmer also points out that in the different case studies he
took and in the explanatory models he found that the
subjects always attributed social problems and their
psychological state as the cause of their problems, but
afterward only focused on the somatic symptoms.
Farmer’s Ideas, Post Interviews (Continued)
• Farmer then claims that move san is the physical signs of a distressing
home life and that using this illness to show the world what is
happening in the home is in sense a “moral barometer”. Using the
fear of peer judgment as an incentive not to harm the important
females in your life so they will not experience these very public
symptoms of this emotionally caused illness.
• Off of this idea, Farmer also makes the claim that lèt gate runs with
move san, but the “added factor of milk complicates the course of
the malady. It indicates, I suspect, the gravity of the initial offense,
the malignancy of the emotion. It recalibrates the barometer.”
• These ideas still allow room for the idea that these illnesses could
have a biological or organic basis, but Farmer concludes this section
of his essay with the idea that even if an organic basis is not found
there is much cultural meaning that this disease is based on, and that
therefore allows a broader based approach.
Economic Forces as Causation
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In the argument for what this disease is
actually caused by there are many unclear
definitions and far too many possible causes
to name them all, but one major idea is
that the poor economy of rural Haiti could
be an influence.
Do Kay individuals attribute what they are
calling an epidemic of these illnesses to “the
gradually deteriorating economy of the
village in which they work.”
Poverty could be seen as a contributing
factor. Poverty leads to disputes in the
home which could lead to abuse (verbal or
physical) due to frustration and an inability
to care for one’s family. This abuse is
believed to be the main cause of the move
san/lèt gate syndrome.
Economic Forces as Causation (Continued)
• The workforce of Haiti has an exceptionally large number of women.
This is because the wages women make are necessary for family survival.
• Women in the workforce, and traveling to Port-au-Prince for much of
the year to work could also be an attributing factor, according to
Farmer.
• Farmer also believes that the course of the illness, rather than its
incidence, could be attributed to the mother’s occupation although
there was no discernable evidence for the individuals in Do Kay that he
studied.
• After looking at all of these possible economic causes for move san/lèt
gate Farmer comes to the conclusion: “I do not believe that move
san/lèt gate is a direct product of economic forces. But I do believe that
the weight of material deprivation may change the incidence and course
of the illness, and even serve as a causal factor in some instances.”
Using the DSM-III to Diagnose Move San/Lèt Gate
• The first disorder Farmer attempts to have move san fit into is Major
Depressive Disorder. (For specifics on Major Depression go to:
http://www.psychnet-uk.com/dsm_iv/major_depression.htm)
• This idea was thrown out because there seemed to be much more
anxiety involved than depression. After some more consideration
Farmer comes up with a “modified ‘somatized’ MDD category” that
would include some of the physical symptoms, but this really isn’t on
par with the APA guidelines.
• Another suggested diagnosis would be Generalized Anxiety Disorder,
but the diagnosis requires persistent anxiety for at least one months’
duration which may not describe some women’s intermittent phases
of move san.
• Though GAD could explain more of the somatic symptoms, it really
doesn’t paint the entire picture of these women’s suffering and
illness.
Using the DSM-III to Diagnose Move San/Lèt Gate
(Continued)
• The most useful diagnosis when viewing move san from the DSM
perspective would be Somatization Disorder which isn’t discussed directly
by Farmer (it may have been added in more recent DSM editions). His
idea is that move san is “not only physical symptoms that occur in the
absence of organic findings, but also the amplification of complaints
caused by established pathology, such as a chronic illness.”
• The conclusion of this discussion is also somewhat vague in that Farmer
believes that “The disorder, and their [the psychologists] view of it, calls
into question the tenaciously dissecting gaze not only of psychiatry, but
of much medical anthropology as well.”
• My personal opinion on the matter has me leaning toward a
Somatization Disorder (for more information visit:
http://www.psychnet-uk.com/dsm_iv/somatization_disorder.htm) and
there likely being very few physical symptoms behind the illness, but
that leaves me questioning how move san and lèt gate could be related.
Farmer’s Conclusions
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Very simply Farmer states, in the first paragraph of his conclusion, that the
illness is culturally constructed.
He also makes a clear and intriguing point in the overall meaning of the
disorders: “Viewed as a cultural artifact, the most striking thing about move san
is the lurid extremity of its symbolism: two of the body’s most vital
constituents, blood and milk, are turned to poisons.”
He also brings back the idea that “As somatic indices, ‘bad blood’ and ‘spoiled
milk’ submit private problems to public scrutiny…and lethal body fluids serve as
a moral barometer”
Farmer closes the article with a perplexing inquiry of his audience. When
discussing the herbal remedy with the healer a moral dilemma was subtly posed
of Farmer. The healer said “Surely you are collecting these leaves in order to
better understand their power and improve their efficacy?” “Had she added, ‘If
you think we’ll be satisfied with a symbolic analysis of move san/ lèt gate you’re
quite mistaken,’ I would not have been more surprised.”
There the article ends with the audience left to wonder if this in depth analysis of
this illness really helps anyone more than the curious anthropologist.
THE END!