Wellness, illness and disease: prevention and intervention

Stigma, biomedical efficacy, and institutional control

This paper explores the role of biomedical efficacy in the rehabilitation of the disabled. Ethnographic data are presented from two studies, one concerned with the prevocationally blind, the other with the institutionalized chronically mentally ill. A comparison of rehabilitation for these two groups suggests that when disabilities do not respond well to biomedical interventions, inconsistent and contradictory interpretations and policies about etiology, therapy, and post-treatment prognosis are likely to flourish. These conflicts may, in turn, increase pressure on rehabilitation institutions to maintain control over their clients. This paper addresses these issues in order to stimulate discussion about the relationship of different kinds of disability to stigma and rehabilitation.

Expanding practice horizons: learning from American Indian patients

The integration of Western medicine with traditional folk medical systems remains a current challenge to individuals providing patient education in American Indian and Alaska Native communities. Cross-cultural patient education requires an understanding of contemporary Indian societies' cultural patterns, including theories of disease causality and therapy. Social organization and the relationship of the community to community-based health care delivery systems are important in making education relevant to prevailing values. This article reviews the history of patient education to Indian people, highlights some of the differences between traditional and allopathic approaches to patient care, and presents a case history of a recent community-based patient education program. The article includes suggestions for practice and identifies important questions to be addressed.