Health Social Sciences II

Alex J. B. Alip, Jr., MD, FPAFP

Past Chairman and Associate Professor
Department of Family and Community Medicine
University of the Philippines College of Medicine
 Explanatory Models
The central concept in health care pluralism
the notions about an episode of sickness and
its treatment that are employed by all those
engaged in the clinical process (Kleinman)
Explanations and interpretations are offered
to guide choices among available treatments
and possible healers
A personal and social meaning is attached to
the illness. Disparities thus may be seen
 Physiologic measurements, although an
essential aspect, give only a single view about
the complexity of human illness.
Attributes of a patient and his family quite
evidently color the meanings attached to ill-
health
Such cannot be understood with the aid of
diagnostic technology
 The EMs clarify five aspects of illness
The etiology or cause of the condition
The timing and onset of symptoms
The pathophysiologic process involved
The course and severity of the illness
The appropriate remedies for the condition
 Three major categories of illness
causation (Tan, 1987)
Mystical
Personalistic
Naturalistic

Mystical theories explain illness as being the

automatic result of the victims acts and behavior
They represent basic forces functioning in health
and illness: life-stuff and soul, which are
portrayed as contrasting elements of good and
evil, strong and weak
 Personalistic theory - disease is explained as
due to the active, direct intervention of an
agent, who may be human (a witch or
sorcerer), non-human (a ghost or an evil
spirit), or supernatural ( a deity or a powerful
being)
The sick person becomes an object of
aggression or punishment by virtue of some
perceived misbehavior
 Naturalistic systems health is regarded as an
equilibrium based on the hot cold dichotomy
The model explain illness in impersonal terms.
Disease does not come from the actions of an
angry being, but rather from nature or
environmental conditions like coldness or warmth
What is created is an imbalance of the body
elements. Any disturbance is to be treated by
herbal remedies or various food items that
restore the proper balance of heat and cold
 Mystical theory: usug, palad,
bangungot, or karma
Personalistic theory: kulam or sorcery, with
its agent, the sorcerer, who harms the
intended victim with the use of spells, chants,
and various objects.
Counter measures are the anting-anting or
agimat or consulting with a medicine man
 Disease vs. Illness
Disease is the physiologic data,
abnormalities in structure and function of
body organs and systems, which the physician
diagnoses and treats
Illness is what the patient experiences, a
subjective phenomenon with the meanings
given to it, including changes in states of
being and social functioning
 Disease and illness do not stand in a one-to-
one relationship
Similar degrees of organ pathology can
generate different reports of pain and
distress
Conversely, illness is possible in the absence of
detectable disease
One medical condition means different things
to different people