Madison Harmer and Dr. Jacob Hickman, Anthropology Department
Current social science literature outside of anthropology has attributed Hmong difficulties adapting to Western health care to their traditional healing practices, claiming that successful integration only occurs as the younger generation discards traditional beliefs (Franzen-Castle & Smith 2013). Ethnographic research conducted in France and Thailand refutes these claims; Hmong of younger and older generations utilize both the state medical system and traditional healing, integrating these systems instead of treating them as ontologically distinct (and thus in competition with each other). Many researchers and medical personnel studying or working with Hmong populations have ignored models of ontological holism because of the Western perspective that accepting both shamanism and Western health care is paradoxical (Mirzada 2016, Prentice 2014, Bassett 2011, Malina 2005). While some argue that Hmong immigrants in general have fundamental problems with biomedical practices (Fadiman 1994, Johnson 2002), research in French and Thai Hmong communities demonstrates that practicing shamanism does not preclude the regular use or ontological acceptance of biomedicine. To the Hmong individuals who use both shamanism and biomedicine interchangeably, these holistic medical beliefs are neither paradoxical nor incompatible.
By acknowledging ontological holism in medical practice, our research goes beyond theories of acculturation to look at cultural patterns of medical reasoning. One such pattern we discovered was the tendency to pass on traditional knowledge and ritual responsibility to individuals who had already married and had at least one child. We draw on ethnographically grounded life course theory to argue that generational differences in medical decision-making represent not intergenerational cultural loss, but rather a developmental transition in the transfer of health and ritual knowledge. According to Hmong life course, Hmong youth are not expected to gain cultural expertise or to have a deep understanding of shamanic rituals until later in life (Hickman 2011, 75). This cultural expectation manifests itself in the way Hmong youth exhibit ambivalence towards shamanism but rely on their parents for help in medical decision-making, and in the sophisticated ways older Hmong integrate traditional and biomedical treatment to deal with physical and emotional problems.
Another cultural pattern of medical reasoning we observed was ontological holism. Ontological holism describes the ideology undergirding the acceptance of medical aid from different sources as equally legitimate. It is similar to what is commonly termed “medical pluralism,” which is the practice of utilizing multiple medical systems simultaneously. However, it is useful to distinguish between the practice of medical pluralism and the ideology of ontological holism because the former describes an etic perspective on the confluence of disparate medical systems, while the latter identifies an emic viewpoint that is inclusive of systems of different origins and accepts any method that works is legitimate.
Ontological holism is especially useful in describing Hmong medical decision-making because it encapsulates the breadth of the sources of healing Hmong people use. Hmong in both France and Thailand commonly use not just “French” or “Thai” and “Hmong” medicine, but also “Chinese” medicine (acupuncture and cupping), massage therapy, magnetic therapy, and other alternative sources of healing. For the Hmong we interviewed and observed, there was no hierarchy of medical systems, no one method of healing that held a monopoly on efficacy. Navigating different medical systems is not about deciding between philosophical systems but simply about addressing the nature of the illness at hand.
We observed many examples of this approach in France and Thailand. A Hmong woman living in France suffered from a rash on her hands that had lasted for years. She tried using tshuaj, Hmong herbal medicine, then went to several French doctors and faithfully used the creams and medicines they prescribed. When none of this helped, she tried ua neeb (shamanism), then khawv koob, another form of traditional Hmong healing. Because none of this helped, she planned to try magnetic therapy. Among Hmong communities, conversion is a common means of managing an illness that nothing else will heal. A Hmong man in Thailand who had suffered heart problems since his youth saw many different doctors at different Thai hospitals. None of the doctors was able to help, so his family convinced him to convert to Christianity. After a few years, the man converted back to kev cai dab qhuas, the Hmong ancestral religion, and became a shaman. He felt that his health had improved since the time of his conversion. A Hmong woman in France who couldn’t conceive children converted to Christianity for just a year, and enlisted the help of a priest in scaring away a bad spirit that she believed was preventing her from having children. At the end of the year, she conceived and converted back to kev cai dab qhuas. This conversion was not viewed as unfaithful or duplicitous, but as a practical means of accessing the healing necessarily to remedy the woman’s particular malady.
Studying ontological holism in medical decision-making casts doubt on current psychological and sociological models of medical acculturation. These models place individuals on a false spectrum of assimilation into Western medical practices, ranging from complete rejection of biomedicine (in favor of traditional treatments) to complete acceptance of biomedicine (and subsequent rejection of traditional methods of healing). Instead of applying unilinear models of acculturation, which perpetuate a false dichotomy and essentialize both the mainstream society and the minority population, physicians treating minority and immigrant populations ought to use ethnographic models to better understand and care for their patients.