An Ethnography of the Concept of Illness by the Elderly

Cho, Myoung Ok

Abstract

This ethnography was based on Kleinman's explanatory model of a health care system. It is conducted to make thick discription of illness conception of the elderly in a sociocultural context. The basic assumptions were as follows. 1) A health care system is a cultural system, and as with any other cultural system, it is a system of symbolic meanings anchored in a particular arrangement of social institutions and patterns of interpersonal relationships; 2) In all societies health care activities are more or less interrelated. Therefore, they need to be in a holistic manner as socially organized responses to disease that constitute a special cultural system; health care system; 3) Health and illness experiences are the natural process of disease. Individuals who recognized a for state of health, their family, neighbors, and communities define the state, search for causes of the health problems, and response to it. According by, they proceed to search for healing stratagies. So, understanding of the illness experience is the starting point for health care. The study participants were 12 elders aged 60 or more. The fieldwork was conducted in an agricultural clan village of Namwon city. The data collection and analysis were cyclic, from descriptive observation, domain analysis, focused observation, taxanomic analysis, selected observation, componential nalysis, and finally cultural themes were all analysed. Proxemic and text analysis techniques were used according to the characteristics of the data. The data of sociocultural context and descriptive data were collected from 1990 to 1992. Informations on illness concepts were collected during 1994 using focused observation. Data confirming and contrast observations were conducted from 1997 and 1999. Illness concepts of the elderly were taxonomized supernatural cause, non-supernatural cause, immediate cause, and ultimate cause. The supernatural ones were ancestors, god of home, god of village, and ghost such as 'sal(evil force of dead man)' and 'gagqui(ghost of begger)'. The non-supernatural ones were Ki, natural phenomenones, natural objects, foods, human and human behaviors. Immediate ones were insufficiency and overflows, discretion and consolidation, disorder and out of order, cloudness and contamination, and fluctuation and stagnation of supernatural cause and non-supernatural ones. Ultimate causes were intrusion and loss of supernatural and non- supernatural ones. The cultural themes of illness concepts of the elderly are: 1) illness concepts are not based on causality principle, but on reciprocal principle; 2) illness concepts are affected by social level and charicteristics of the patients; 3) the causes of disease are recognized as imposed both positive and negative effects on health based on interpretation of the indiviuals; 4) illness concepts reflects on principles of everyday life of the society members such as hierachial structure and group cohesiveness; 5) illness concepts are ruled on principle of reciprocity and spread; 6) illness concepts are interrelated with physical environment of the participants. It can be concluded that the illness concepts of the elderly in a traditional clan village are a component of health care system as a cultural system based on these results. The these results can be a useful basis for gerontological nursing practice and education.