Recall Your Way to Health

Biographical Sketch

Dr. Cameron Hay is a premier cultural anthropologist in the study of health, medical systems, and medical knowledge, her major project being ethnography and comparison of the Sasak people of Lambok, Indonesia and their medical practice to American people. She cites her father as her strongest intellectual influence for his empathy and critical eye. Jon Andelson and Ron Kurtz sparked her interest in anthropology at Grinnell College. At Emory University, Dr. Hays earned her MA and  Ph.D. in anthropology with a biocultural focus. Earning a NSF Advanced Fellows award helped her continue her postdoctoral studies at UCLA, where she currently holds her secondary position as an associate research anthropologist.  She published her her first major paper in 1999 in the Medical Anthropology journal under the title “Dying Mothers: Maternal Mortality in Rural Indonesia.” Since then she has published 18 other papers and a book, Remembering to Live: Illness at the Intersection of Anxiety and Knowledge in Rural Indonesia.

Challenging Understanding of Medical Learning

Hay hopes to demonstrate three things about medical practice in particular and the effect of culture on the neurology of learning as a whole. The cultural context of medical learning affects how important different types of knowledge appear, in turn changing what and how we recall information. What information we tend to recall and how we recall it over time affects the tradition and practice of medicine.This process of ‘co-creation’ between medical knowledge and medical practice extends to “anytime learning takes place” (142). The process of learning then is generalized, not compartmentalized as academia would make it seem. Knowledge affects how we learn and is both culturally contextual and holistic.

Sasak Medical Tradition

Sasak tradition practiced in impoverished, rural community that continues to deal with the consequences of “domination, exploitation, and extraction.” Their history contributes to malnutrition, low wealth, low literacy, and life expectancy being around 50 years. Nevertheless, they have a self-sufficient medical practice, one not dependent on outside aid, in the form of jampi, “inherently potent sequences of words.” These words are memorized and used sparingly so as not to diminish their efficacy.

Although the Sasak medical tradition is vastly different from American medical practice and the communities American practice thrives in, Hay maintains that they can both be understood in terms of medical terminology, organization, and retrieval co-evolving to suit the needs of the community.

The Sasak regard biomedical care as speeding recovery but not healing like jampi. Jampi act as memorized responses to illness and are precious in part because they are not written down.  Giving and receiving jampi requires isolation. To limit degredation of memory, Sasak employ “multiple constraints:” consistent form, limited words around the limit of human memory capacity, the association of jampi with great importance leading to heightened arousal and thus encoding, self-concept of healers reinforcing already strong recall, and the intentional encoding based on future need. Because of the importance of memorization, Sasak tradition relies on the hippocampus, medial temporal lobes, and prefrontal cortex.

American Medical Tradition

American practice relies on several assumptions. Skilled practice is supposedly scientifically sound, with medical education valuing semantic knowledge over episodic. By being consistent, American practice hopes to avoid individual variation, especially through guidlines, even though American students are not good at memorization. American practice also assumes that it can be wrong, and thus can always be improved. Physicians tend to become more skeptical the more experience they have reading journals and practicing. Finally, American practice does not transfer knowledge of how medicine works in practice, but expects students to gain a holistic view over time.

Embodied cognition offers a way to understand why practical experience and episodic memory serve physicians better than semantic memory. Cognitive action can stimulate motor action, generating procedural memories. Procedural memory and episodic memory combine to make schemas, maps of one’s knowledge and appropriate response; the process of memory consolidation is closely tied to the hippocampus and neocortex, which takes over the cognitive burden. Over time and with enough reinforcement schemas become hippocampal independent and automatic, employing the basal ganglia and caudate.

Diagnosis and Motivation

Illness not recognized immediately push both Sasak and American healers toward more effortful recall. In Sasak communities, when few people gather, there are fewer jampi and low anxiety, but larger groups talk more often about illness, increasing anxiety and the stress response. Stress leads to release norepinephrine, activating the amygdala and thalamus, increasing attentiveness and potentially leading to activation of the hippocampus, facilitating recall. Since American healers tend not to rely on recall as much, stress pushes physicians to external resources, which might then be reintegrated by the stimulated hippocampus into their schema of treatment. Each of these strategies have a use: the Sasak reliance on memorization and connection to specific individuals helps when someone does not have personal experience treating an illness, whereas the American dependence on schemas and skepticism is suited to developing procedures for and diagnosis of new diseases.

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7 thoughts on “Recall Your Way to Health”

  1. I wonder how exactly the jampi are supposed to work. I know that they are a series of memorized lines, but what do the healers actually do with the phrases? Do they just recite them to the patient, or are they filled with knowledge of the treatment so that the healer acts out the words of the jampi? I don’t know if it was just me, but I found that to be a little unclear.

  2. I like Hay’s approach on memory and medicine, it is much easier to find ways that the Sasak healers are different from biological medicine, especially from an “etic” point of view. By combining the two (bio medicine and Sasak healers) as traditions of knowledge, the “details” of their processes do not effect what their main goals are – to heal. I agree completely on how in order to understand all of this, we must first reframe our own thinking [bio. science + social science+ humanities] and that we should encourage this restructuring.

  3. Its clear that the way memories are encoded, prioritized and recalled is markedly different between the Sasak tradition and the american medical tradition. However, after I read the chapter I started thinking about all the pre-med students I know and how some have chosen very science based fields to prepare for medical school (chemistry, biology, physics) while others have chosen to mainly stick to the humanities during the undergraduate years. I wonder if this will have an impact on the way way they form neural connections for memory encoding and recall or perhaps develop different methods or ideas about what is important to memorize. Maybe their different paths will have more of an impact on their ideas on empathy and ethics or maybe not. I just can’t help thinking that four years in such distinct fields with different styles of learning and testing will have some type of impact on future learning.

  4. I understand that Jampi are used by the Sasak as medical treatment for sickness and I realize that a there may be a hesitance to use the word, but word this be considered magic? Also I found it interesting how the parts of the brain that were activated when learning occurs in the different culture was explored. I had never particualarly considered what was going on within the brain when it was responding, in the sense of the parts that were being activated and utilized depending on the type of response.

    1. I missed this class, so I don’t think I really understood what a Jampi was until i saw them used in class. And though to them it is a medical treatment I do believe that it is a magic phrase by definition. Additionally, we recently had a talk that explored the parts of the language centers associated with different languages and the visuals from that lecture really solitified my understanding of how the different parts of the brain may be activated when learning in different cultures.

  5. As a future doctor myself, I can appreciate the techniques of the Sasak healers and Western doctors. While the Sasak method seems unconventional and strange to someone like me, I can see how they are doing the best they can with the resources they have. I find it impressive that their oral medical tradition has survived the ages. However, it is exactly in that oral tradition that I see a potential downfall. In my understanding, the Sasak healers memorize the exact jampi that other healers have taught them. I wonder, with the emphasis on rote memorization, what the rate is of the formation of new jampi. Are the Sasak healers so focused on memorizing the exact wording of the jampi that they do not invent new treatments to fight different forms of sickness? Is their medical tradition stuck in the past or can it evolve?

    One upside to the emphasis of external knowledge of Western doctors is that the medical knowledge is always evolving. Instead of focusing on the techniques we personally know and guard, Western doctors use their combined knowledge to generate better treatments. One article that greatly interested me was explaining the use of spray on skin to treat burn patients. This greatly reduces time spent healing, risk of infection, and scarring, for the skin that is sprayed on the exposed flesh is taken from the patient. I just love medical research!!

  6. After I came back and read this I realized it was extremely relevant to another class I am in. In that class we have different medical specialists come in and talk to us about their various experiences in whatever specific field they practice. One woman came to talk to us about her experience as a psychiatrist but eventually digressed to her years in medical school and lamented that they were teaching students differently now. She clearly disapproved. Why? Apparently because in her time (not that long ago) the prevailing method was to have medical students learn each system, organs, how everything was connected, how it worked, related pathologies, etc. It was systematic. However, now the new technique includes presenting students with a case. Let’s say depression and asking for related systems and how the pathways of those systems operate. The students may be asked to dissect the case carefully, provide diagnosis, treatment, explain the treatment, and more. I found the entire lecture very interesting and had no idea these two methods of teaching existed. Our visiting lecturer said they have even existed in the same school but as separate programs a student could choose from which I find fascinating. It seems the first is much more rote memorization and the second is based more on episodic memory and building schemas. I wonder if you could compare students who choose differently while they were training and years later. Would their confidence be different? Would they rely on technology more often?

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