A Westerner’s Pilgrimage – The Popular Sector

The Chinese medical philosophy is at once alien and similar to the system of Western medicine. Superficially, the systems seem to have very little in common with regard to history, diagnostic approach, evaluation of information and most glaringly, treatment regimen. In an effort to examine Chinese medical reasoning, I will document my journey through the system, hopefully inspiring instructive debate and input about the topic of Traditional Chinese Medicine.

I’ve decided to attempt to resolve a chronic but trivial problem with my eyes that has plagued me for 20 years. Specifically, the whites of my eyes constantly appear unclear, turbid and sometimes reddened. Though painless, this condition is rather annoying in that people often comment that I appear to be suffering from some sort of seasonal allergy. My journey will be divided into the distinct stages described by Arthur Kleinman in his study Patients and Healers in Context of Culture.

There are three divisions according to Kleinman, the “popular, professional and folk sectors”. The first division, the “popular sector” is an arena of non-specialists, non-professional, laymen. It is within this context that illness is first defined. According to Kleinman, “in the United States and Taiwan, roughly seventy to ninety percent of all illness episodes are managed within the popular sector.” (Kleinman, 50) I start my journey, rather started it twenty years in this sector, accepting advice from like-afflicted friends, well-intended relatives and even talkative physicians on the subway.

The effectiveness of this stage is difficult to discern because of the various components that contribute to its structure. The popular sector is influenced by cultural, social, community, family and individual factors. Determination of the efficacy of this sector could go a long way towards discerning its implications on the effectiveness of the overall health care system. For those who are afflicted with ailments that require professional medical attention, it is the popular sector that helps to identify the presence of an illness, thus convincing the would-be patient to advance to the next sector. In fact, if a person too long treats a condition as a mere illness instead of a disease, s/he might discover that medical practitioners may be unwilling or unable to help. So, while the recognition of illness ushers the individual into the first stage of TCM, it is disease that propels them to the next one. Let’s examine this illness-disease distinction more closely.

Kleinman distinguishes the two concepts by claiming disease refers to a malfunctioning of biological and/or psychological processes, while “illness” suggests the psychological experience and meaning of perceived disease. (Kleinman, 72) It is possible in cases such as acute trauma for disease to exist without illness, just as it is possible for the manifestations of illness to increase while those of the disease process decrease, e.g., cancer remission. A person’s acknowledgment of his/her own illness is greatly influenced by the popular sector. For example, an individual does not become what Kleinman terms a “sick family member” until someone acknowledges the presence of a physiological or psychological anomaly. Unfortunately, it is possible for one social arena to recognize a person’s illness while another denies it.

I was not classified as a sick family member for various reasons. First, the lack of any medical professionals in my family meant that no one was particularly aware of my eye condition or it relevance to illness. Also, since my family saw me on a daily basis, the gradual change in my eyes went unnoticed. My family delay in classifying me as sick delayed my own recognition of illness. Again, this is important because as Francesca Bray explains in her article “Chinese Medicine,” In the early… phases of a disorder, it is possible to treat the imbalance and disruption and restore the patient to health. Once it reaches the life-threatening… phases, the damage to the system may be irreversible, and a physician may refuse to take on the case. (Bray, 738) Next week, we discuss my voyage into the “professional sector.”

To learn more about Traditional Chinese Medicine visit that National Library of Medicine

Bibliography

Bray, Francesca. Chinese Medicine, pp. 728-753, Bynum and Porter 9eds), Companion Encyclopedia of the History of Medicine (New York: Routledge, 1993)

Kleinman, Arthur Patients and Healers in the Context of Culture (Los Angeles: University of California Press, 1981)