Monthly Archives: November 2014

Ethnopsychology: Creation of Culturally Specific Treatments

Ethnopsychology—The cultural framing of the self, emotions, and suffering.

In an earlier post I discussed methodology which can elicit local idioms of distress in regard to psychological issues. In this post I will examine how treatment models can also be created which are culturally specific. One such example comes from the work done by Kohrt et al. 2012 with Bhutanese refugees. These researchers state that there is an extremely high rate of suicide among Nepali Bhutanese in the United States and that a culturally specific treatment modality is necessary to alleviate the psychological distress among this population. They propose a framework designed to increase awareness among mental health professionals about Nepali Bhutanese experiences and interpretations of psychological distress; therefore reducing suicide risk.

The Nepali Bhutanese conceive of the self differently than the Cartesian mind-body split common in Western culture. The self is organized as the physical body (Nepali: jiu or saarir), the heart–mind (man), the brain–mind (dimaag), the spirit (saato), the soul (atma), and one’s social status (ijjat). Other aspects of the self are the family (pariwaar), which includes the extended family, and the spiritual world, especially relationships with ancestral deities (kul devta). The authors suggest that for mental health treatment, the heart–mind and brain–mind divisions are key. They suggest that the heart–mind aspect is the locus of memory and emotions. In contrast, the brain–mind is the organ of cognition, attention, and social regulation. Where heart–mind problems are considered commonplace, brain–mind problems carry more social stigma. A person with a prolonged heart–mind problem may eventually develop a brain–mind problem. In Nepal there is a traditional healing practice conducted by shamans (dhamijhankri) in which the heart–mind is “ritualistically bound (man baadne) to calm its desires and intense emotions, ranging from jealousy to sadness to love, so that the brain–mind is not overpowered and socially acceptable behavior can be maintained” (2012:94).

Shamans play an important role as treatment options for Nepali Bhutanese. As is common among populations in Latin America and elsewhere, a person’s spirit may be lost (saato jaane, spirit goes) when they become frightened or possibly cursed. Also, as is the case in other populations who recognize soul loss, healing by shamans is used in these instances to call the saato back to the body in order to restore health and vitality. “The physical body (jiu, saarir) is the site of physical suffering and pain. For physical problems, individuals may seek home remedies, the care of a dhami-jhankri shaman, or go to a health clinic” (2012:95). Health care professionals should recognize the important role shamans play in the treatment of these issues and include them in the treatment plan.

The authors also discuss how they adapted two therapy modalities to work specifically with Nepali Bhutanese. The first was Cognitive Behavioral Therapy (CBT), which is commonly used in Western psychiatric medicine to treat depression and other forms of psychological distress. In their specific case the treatment goal was framed as minimizing worries in the heart–mind by changing thoughts and behaviors related to the individual’s perceived powerlessness, which then reduced brain–mind distress. Their second treatment modality was Interpersonal Therapy (IPT). The authors suggest that the syndrome that was being treated by IPT can best be described as manosamajik samasya or a “heart-mind—society problem.” Their culturally specific treatment plan highlights goals for modifying the individual’s social relations and suggests changes in the person’s emotional appraisal of those relations.

It is my opinion that not only is it important to extract local conceptualizations of psychological distress, but it is even more important to create treatment modalities and ways of managing psychological distress which are culturally and context specific. Thinking back to the group of people I worked with who were diagnosed with bipolar disorder, it became clear that they had their own model for what they could do to manage their psychological distress. I thought it was unfortunate that this model was not shared by their doctors and other health practitioners. This illustrates the importance of the work of psychological anthropologists which can inform the dominant health care system in which most people seek treatment.

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Kohrt, Brandon A., Sujen M. Maharjan, Damber Timsina, and James L. Griffith
2012 Applying Nepali Ethnopsychology to Psychotherapy for the Treatment of Mental Illness and Prevention of Suicide among Bhutanese Refugees. Annals of Anthropological Practice 36(1):88.

Models, Incongruity, Consonance, and Stress: Implications for Managing Illness

I had a eureka moment when I learned that Toni Copeland had conducted research showing that knowledge of (competence) and behavior which approximates aspects of (consonance) a model of managing HIV among women in Nairobi, Kenya has been shown to be correlated to positive health outcomes, even going so far as affecting T-counts (Copeland 2012). I had obtained similar results in my Master’s research among a group of individuals diagnosed with bipolar disorder and who were attending a peer support group. Among this group there was a shared model of what a person could do to manage their disorder. I found that people whose behavior more closely approximated the model also reported less depressive episodes, mania, anxiety, and stress. In my opinion, this has enormous implications for treatment, especially in the area of my focus – psychological distress. This blog will focus on how the distribution and relationship to individual cultural models relates to health outcomes, the role of stress, and the implications for treatment of psychological distress.

Reflecting what I believe to be a general dissatisfaction with psychotropic medications, the people I worked with in the peer support group often complained of the efficacy and side effects of the drug cocktails they were taking to treat the issues which came with their diagnosis of bipolar disorder. If it can be shown repeatedly that knowledge of a model of managing psychological distress and behavior approximating that model correlate to better health outcomes, a more holistic approach to treatment can be employed.

The concept of cultural models has proven extremely useful to research in the social sciences (Strauss and Quinn 1994; D’Andrade 1984, 1995). If we start with a theory of culture derived from cognitive anthropology which states, culture is that which one needs to know in order to function adequately in any given social system, then the next task of the researcher studying culture would be to determine what exactly is it that the person needs to know. This knowledge is organized in models, consisting of interrelated elements which together represent something (D’Andrade 1984, 1995). Cultural models are not formulated as explicit declarative knowledge (as in theory), but as implicit knowledge, based on schemas embedded in words but not formulated as explicit propositions. Models are actively used, interpreted, and are socially transmitted. It has been shown that people cognitively model their illness experiences in culturally salient ways.

Incongruence, or status inconsistency, to dominant models has been shown to adversely affect health (Janes 1990; Dressler 1992, 2004; McDade 2001, 2002). One example of this is when an individual’s material lifestyle exceeds their social and economic status. This is the classic example of “keeping up with the Joneses”, where there exists a dominant cultural model of what a successful lifestyle consists of, and an individual is stretched beyond his means trying to achieve it. Incongruence or status inconsistency can also happen as a result of rapid cultural and economic change. This happens as a result of emerging markers of social status conflicting with traditional markers, creating discord or stress.

To examine the strength and distribution of a cultural model, or the level to which it is shared among individuals which make up the culture, cultural consensus analysis can be employed. This method was developed by Romney, Weller, and Batchelder (1986) and measures the degree of sharing of knowledge and individuals’ relative degree of shared knowledge. A measure of consensus is then found, weighted by the competence of the respondents. The idea of competence (which was originally raised by Keesing in 1972) is important in that an individual’s ability to meet the expectations of and function within a cultural model affects his or her psychological and physical well-being.

Cultural consonance, or the degree to which an individual approximates, in his or her own beliefs and behaviors, the prototypical cultural model, can also be calculated (Dressler 2000; Dressler et al. 2004, 2007, 2009). In theory, cultural consonance illustrates the relationship of individual experience and culture. Individuals may know a model in a cultural context, but for a variety of reasons they may not be able to act on or achieve accordance with it. If we assume, that for most people, there exists a desire and drive to achieve that which is seen as good or desirable in the model, then the relative ability to meet those ends will have an effect on the individual. Following methods illustrated by Dressler and colleagues (2000, 2007, 2011), individual levels of consonance are shown to be correlated with health outcomes, including levels of psychological distress. These researchers have also found that low levels of cultural consonance to be correlated with high blood pressure.

Stress levels in individuals have long been associated with health outcomes (Cassel and Jenkins 1960; Cassel 1976; Mason 1975). This fact combined with the relationship of incongruity, status inconsistency, cultural competence, and finally cultural consonance to a shared model and stress, illustrates the interrelatedness and importance of the stress process. To create a working definition of the stress process, it is helpful to consider four contributing aspects (Dressler 2004). First of all there are inputs; these can be acute or chronic stressors which an individual perceives as threatening or challenging. Secondly, there are mediating factors which can be psychological or emotional, physiological, metabolic, or morphological. Thirdly, it is helpful to consider resistance resources; these include social support, psychological resources of the individual, and biological resistance factors. Finally, there are outcomes including disease or other chronic conditions. I am suggesting here that by mediating this stress process through either re-evaluating unreachable models of lifestyle or increasing competence and consonance to a model of managing illness, the psychological and biological health of individuals may be improved. In the end, culture matters in both the conception of the meaning of illness and ideas concerning how to manage the illness experience.

Cassel, J.C., Patrick R., and Jenkins C.D. (1960).  Epidemiological analysis of the health implications of culture change.  Annals of the New York Academy of Sciences 84:938-949.

Cassel, J.C. (1976) The Contribution of the Social Environment to Host Resistance. American Journal of Epidemiology 104:107-123.

Copeland, T. J. (2011). Poverty, nutrition, and a cultural model of managing HIV/AIDS among women in Nairobi, Kenya. Annals of Anthropological Practice, 35: 81-97.

Dressler, William W. (1992). Culture, stress, and depressive symptoms: building and testing a model        in a specific setting, pp. 19-33 in Anthropological Research: Process and Application.  John J. Poggie, Billie R. DeWalt, and William W. Dressler Eds. Albany, NY: State University of New York Press.

Dressler, W.W. and Bindon, J.R. (2000). The health consequences of cultural consonance. American Anthropologist 102:244-260.

Dressler, William W. (2004). Social or status incongruence, pp. 764-767 in The Encyclopedia of Health and Behavior. Norman B. Anderson, Ed. Thousand Oaks, CA: Sage Publications.

Dressler, William W. (2004). Culture, stress and cardiovascular disease, pp. 328-334 in The Encyclopedia of Medical Anthropology. Carol R. Ember and Melvin Ember, Eds. New York: Kluwer Academic/Plenum Publishers.

Dressler, William W., Rosane P. Ribeiro, Mauro C. Balieiro, Kathryn S. Oths, and José Ernesto Dos Santos. (2004). Eating, drinking and being depressed: The social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community. Social Science and Medicine 59:709-720.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro, and José Ernesto Dos Santos. (2007). Cultural consonance and psychological distress: Examining the associations in multiple cultural domains. Culture, Medicine and Psychiatry 31:195-224.

Dressler, William W., Mauro C. Balieiro, Rosane P. Ribeiro and José Ernesto dos Santos. (2009). Cultural consonance, a 5HT2A receptor polymorphism, and depressive symptoms: A longitudinal study of gene x culture interaction in urban Brazil. American Journal of Human Biology 21:91-97.

Janes, Craig. (1990). Migration, changing gender roles, and stress: The Samoan case. Medical Anthropology 12: 217-248.

Mason, John. (1975). A historical view of the stress field. Journal of Human Stress 1:6-12; 22-36.

McDade, Thomas W. (2001). Lifestyle incongruity, social integration, and immune function among Samoan adolescents. Social Science and Medicine 53:1351-1362.

McDade, Thomas W. (2002). Status incongruity in Samoan youth: A biocultural analysis of culture change, stress and immune function. Medical Anthropology Quarterly 16:123-150.

Romney, A.K., S.A. Weller, and W.H. Batchelder. (1986). Culture as Consensus: A Theory of Culture and Informant Accuracy. American Anthropologist 88:313-338.

 

Ayahuasca: Soldiers Seeking Healing

To repeat from my previous post: “This week in my Neuroanthropology class we are focused on tobacco use and the cultural context of addiction. This got me thinking about other mind altering substances, in particular marijuana and ayahuasca, which have both in the news recently. In the case of marijuana, the results of the midterm elections revealed that voters in three states have decided to join Colorado and Washington in legalizing various amounts of marijuana and its consumption on private property. In the case of ayahuasca, I recently watched an episode of “This is Life with Lisa Lee” in which war veterans were using ayahuasca in Peru as a method of relieving symptoms of PTSD. Being very interested in the topic of the therapeutic use of mind altering substances, I decided to catch up on my required reading and examined several articles on marijuana and ayahuasca.”

Amazonian shamans use a psychedelic compound called ayahuasca which is consumed as a ritual beverage. The word ayahuasca is believed to have originated in the Quechua language (Beyer 2009, Madera 2009). The word huasca is a Quechua term for various species of vines. The word aya refers to a soul or the spirit of a dead person. That is why ayahuasca is often referred to as the “vine of the soul” or the “vine of the dead.” Ayahuasca is made by combining the Banisteriopsis caapi vine with the leaves of dimethyltryptamine (DMT) containing species of shrubs from the genus Psychotria. The mestizo shamans have understood how these plants work together to create the psychedelic compound for thousands of years. Shamans are able to judge the strength of their ayahuasca brew and it has been found that the usual dose contains between 25 to 36 mg of DMT (Callaway 2005). DMT is listed as a Schedule 1 drug by the United Nations which bans not only the use, but also research on the drug. Brazil and Peru are the only United Nations members which allow the use of ayahuasca. In a rare study allowed within the United States, Rick Strassman of the University of New Mexico conducted research on the effects of DMT on human volunteers. Participants in this study reported that they were aware of and interacted with human and nonhuman entities including animals, elves, and aliens while under the influence of the DMT (Strassman 1994). DMT is found in many trees and shrubs throughout the world. Interestingly, it is also found endogenously in mice, rats, and humans (Strassman 1994). Strassman also suggests that DMT is naturally released in the pineal gland during traumatic experiences such as birth and death. The pineal gland is the organ René Descartes considered the seat of the soul and the place where all our thoughts are created.

There are certain features which typify an ayahuasca experience. It is reported that ayahuasca does not affect the lucidity or clarity of thought processes. While under the influence of ayahuasca, time becomes dilated and ceremony participants report that time seems to pass much slower than the clock would indicate. People also report a sensory convergence of vision, sound, and smell. Auditory and visual hallucinations are common. As well as the DMT effects mentioned above in the Strassman research, ayahuasca ceremony participants also often report the presence of beings including spirits, elves, and aliens. These presences are described as being solid, three-dimensional, and very real (Beyer 2009, Madera 2009, White 2001).

It is thought that through use of the ayahuasca shamans can enter the spirit world and communicate with various spirit beings, including those of nature. It is suggested that the ayahuasca is good for the shamans’ health, that through it they can control energy (Beyer 2009 White 2001). The shamans also receive visions through the use of ayahuasca, which can be used in various ways including healing as well as psychological warfare against their enemies, which in the Amazon basin presently include oil companies. In this respect, shamans use ayahuasca to see where the enemy is and how to defeat them. The use of ayahuasca for spiritual growth and healing has also entered the academic field. Bonnie Glass- Coffin, A professor at Utah State, has conducted research on shamanism involving the use of ayahuasca and has written openly about her relationship with the practice as well as her experiences while under the influence of ayahuasca (Glass- Coffin 2010).

Harris and Gurel (2012) surveyed individuals who had used ayahuasca at least once in North America. They found similar spiritual experiences amongst the ayahuasca users and a comparison group of worshipers who had attended a Catholic spiritual retreat. They also found that the ayahuasca users had made life changes after their experience with ayahuasca. The researchers found that they had reduced their alcohol intake, ate healthier diets, experienced greater self-acceptance and improve mood as well as reporting an increase in the experience of love and compassion related to their relationships. They also stated that they received ongoing guidance and support from the spirit of the ayahuasca.

Santo Daime was founded in the 1930s in Brazil by Raimundo Irineu. Santo Daime combines folk Catholicism, African animism, and South American shamanism with its use of ayahuasca in their ceremonies. The practice has become a worldwide movement and preaches the doctrine of harmony, love, truth, and justice (Langdon and Santana de Rose 2012). Ceremonies involve the consumption of ayahuasca while sitting in silent concentration, singing collectively, and or dancing in geometrical formations. Rituals usually last several hours, as long as ayahuasca is taking effect (Langdon and Santana de Rose 2012). The Santo Daime church maintains relationships with the Guarani, an indigenous Amazonian group, to ease the sense that this neo-shamanic group is simply involved with appropriating an indigenous healing complex. The church has recently been involved with and one several court battles in various countries concerning the legal use of ayahuasca in their ceremonies (Langdon and Santana de Rose 2012).

As with the case of marijuana, the cultural construction surrounding the use of ayahuasca seems to be changing in the United States. I was moved by the stories of war veterans who were dissatisfied with the psychological care and drugs they were receiving to treat their trauma. Perhaps with further research, those in the mental health professions will begin to treat the sufferers in a more holistic manner, providing a safe place for emotional catharsis and spiritual healing.

Beyer, Steven V. (2009) Singing to the Plants: a Guide to Mestizo Shamanism. University of New Mexico Press.

Glass-Coffin Bonnie (2010) Anthropology, Shamanism, and Alternate Ways of Knowing–Being in the World: One Anthropologist’s Journey of Discovery and Transformation. Anthropology and Humanism 35(2):204–217.

Harris, Rachel and Lee Gurel (2012) A Study of Ayahuasca Use in North America. Journal of Psychoactive Drugs 44(3):209-215.

Langdon, Esther Jean and Isabel Santana de Rose (2012) (Neo)shamanic Dialogues: Encounters Between the Guarani and Ayahuasca. Nova Religio 15(4):36-59.

Madera, Lisa Maria (2009) Visions of Christ in the Amazon: The Gospel According to Ayahuasca and Santo Daime. Journal for the Study of Religion, Nature and Culture 3(1):66-98.

Strassman, Rick J. and Clifford R. Qualls (1994) Dose-Response Study of N,N-Dimethyltryptamine in Humans. Neuroendocrine, Autonomic, and Cardiovascular Effects. Archives of General Psychiatry 51(2):85-97.

White, Steven F. (2001) Shamanic Ayahuasca Narratives and the Production of Neo-Indigenista Literature. Latin American Indian Literatures Journal 17(2):111-123.

Marijuana: Drug of Abuse?

This week in my Neuroanthropology class we are focused on tobacco use and the cultural context of addiction. This got me thinking about other mind altering substances, in particular marijuana and ayahuasca, which have both in the news recently. In the case of marijuana, the results of the midterm elections revealed that voters in three states have decided to join Colorado and Washington in legalizing various amounts of marijuana and its consumption on private property. In the case of ayahuasca, I recently watched an episode of “This is Life with Lisa Lee” in which war veterans were using ayahuasca in Peru as a method of relieving symptoms of PTSD. Being very interested in the topic of the therapeutic use of mind altering substances, I decided to catch up on my required reading and examined several articles on marijuana and ayahuasca.

Twenty-three states and the District of Columbia currently have laws legalizing marijuana in some form. Four states have legalized marijuana for recreational use. Alaska and Oregon will become the next states after Colorado and Washington where recreational marijuana is legal after voters approved cannabis ballot measures set to become effective in 2015. District of Columbia voters also recently approved a ballot initiative legalizing recreational use of marijuana that will be subject to Congressional review.

Due to marijuana being classified as a Schedule 1 substance in the U.S., most research is being conducted in other countries, however, this seems to be changing as I was able to find a couple studies conducted in the U.S. One interesting study, (Chapkis 2007), interviewed medical marijuana (MMJ) patients in California. Chapkis found many of her respondents reported that they valued the consciousness altering properties of marijuana significantly more so than its other various reported therapeutic benefits (2007). These patients reported that the effects on mood and cognition were difficult to separate from its medical benefits. I theorize the consciousness altering properties allow patients to relax, dissociate, and ease the stress response from worrying over their pain or other conditions.

In research conducted by Vadhan et al. (2007) the complex cognitive functioning during marijuana intoxication under controlled laboratory conditions was examined on regular marijuana users. The subjects were given a controlled dosage of marijuana and were presented with various cognitive tasks and The Iowa Gambling Task, which is said to model real-life decision-making, forcing the participant to balance potential gains and losses. The researchers found that the participants required greater amounts of time to complete the tasks, but their primary performance on tasks of deductive reasoning, cognitive flexibility, and working memory were not altered during intoxication. In regards to the gambling task, the researchers found that marijuana did not disrupt advantageous card selection or money earned.

In Australia, Jones, Blagrove, and Parrott (2009) examined creative responses and self-perception of creativity in marijuana and ecstasy users while they were not under the influence of either drug. They found that marijuana users scored higher on “rare-creative” responses than a control group, but rated themselves as not more creative. Ecstasy users rated themselves as more creative, but rated lower on the creative responses test (Jones et al. 2009). This research begs the question, does marijuana actually lead to more creativity as many musicians and authors have suggested over the years? Perhaps it is the dissociative state which enables a person to remove himself from the immediate physical sensory stimulation and imagine novel ways of looking at things.

In research conducted by Ringen et al. (2009) effects of marijuana use on neurocognitive functioning was assessed in patients with Bipolar Disorder (BPD) and patients with schizophrenia. The researchers found that in the patients with BPD, marijuana use was associated with better cognitive functioning, while the opposite was the case for the patients with schizophrenia. This suggests two things; first, that there may be different neurocognitive mechanisms in play in BPD as opposed to schizophrenia, and second, that something about marijuana’s effect on neurochemistry benefits people with BPD.

Often marijuana is described as a “substance of abuse” and medicinal marijuana patients as “drug abusers.” What effect does the use of this language have on the self-perceptions of patients? Would it not be healthier for these patients to be thought of as people who are undergoing treatment for their various ailments? Does feeling like a patient and not an abuser lead to better health outcomes?

In the words of an acquaintance who has a prescription for medical marijuana in Colorado, “With marijuana you know what you get, you can track it back to the warehouse which is 20 miles away and you know exactly what’s in it. It has to be grown in state; it’s actually a local crop too. Everything a doctor prescribes you; they get a kickback from the prescription or insurance companies. With all the commercials and stuff it makes all these prescription painkillers socially acceptable when it’s just the exact same thing as taking heroin or something.”

I conclude that the cultural construction of meaning regarding the use of marijuana may finally be changing. This reflects the current issues in the U.S. concerning the rising abuse of prescription painkillers and increased recognition of the dangers of alcohol abuse. Hopefully this will open the doors to more scientific studies on the effects of marijuana use, allowing people to form opinions based on facts rather than propaganda.

Chapkis, Wendy (2007) Cannabis, Consciousness, and Healing. Contemporary Justice Review, 10(4):443-460.

Jones, Katy A., Blagrove, M., and A.C. Parrott (2009) Cannabis and Ecstasy/MDMA: Empirical measures of Creativity in Recreational Users. Journal of Psychoactive Drugs, 41(4):323-329.

Ringen, P.A., Vaskinn, A., Sundet, K., Engh, J.A., Jonsdottir, H., Simonsen, C., Friis, S., Opjordsmoen, S., Melle, I., and O.A.Andreassen. (2009)   Opposite Relationships between Cannabis Use and Neurocognitive Functioning in Bipolar Disorder and Schizophrenia. Psychological Medicine, 40:1337-1347.

Vadhan, Nehal P., C.L. Hart, W.G. Van Gorp, E.W. Gunderson, M. Haney, and R.W. Foltin. (2007) Acute Effects of Smoked Marijuana on Decision Making, as Assessed by a Modified Gambling Task, in Experienced Marijuana Users. Journal of Clinical & Experimental Neuropsychology 29(4):357-364.

 

Biomarkers

In previous posts I have discussed the use of self-report questionnaires to measure aspects of health, for example stress and depression. In this post, I will describe two methods for measuring “biomarkers” which are characteristics that are objectively measured and evaluated as an indicator of biological processes. As part of my research in the Bribri village of Yorkin, Costa Rica, I would like to measure health in the village in order to show that because of their initiation of an ecotourism project, which has allowed them to work in the village rather than in plantain and banana plantations, their overall health has improved. In order to accomplish this, I have chosen two biomarkers to examine health which are relatively easy to conduct in the field in minimally invasive. The first biomarker is blood pressure, which is one of the principal vital signs used in many healthcare settings. Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels. High blood pressure can be a warning sign for hypertension which can lead to strokes and various heart conditions. The second biomarker I intend to use is the level of the stress hormone cortisol (CORT), which provides a measure of hypothalamic-pituitary-adrenal axis (HPA) system activity or more simply, physiological stress. Prolonged periods of physiological stress have been found to have negative health effects including impaired cognitive performance, suppress thyroid function, blood sugar imbalances, higher blood pressure, immunity impairment, and increased abdominal fat.

To measure blood pressure in the field I will use an automatic blood pressure monitor, the OMRON HEM-711, one of which we have in the Human Behavioral Ecology Research Group HBERG lab run by Dr. Chris Lynn at the University of Alabama. Similar OMRON models have proved adequate for measuring blood pressure (Wan et al. 2010). To use this instrument, the cuff is placed on the left arm above the elbow at approximately heart level. It is suggested that the participant has remained seated for 10 minutes before taking the measurement and the person should not have consumed tobacco or caffeine for at least 30 minutes before the measurement is taken. Researchers suggest taking multiple measurements, for example three, and then calculating the mean of these measurements (Wan et al. 2010). Below is a video describing the use of the automatic blood pressure monitor.

To measure the stress hormone cortisol I intend to use the hair extraction method. Cortisol is slowly incorporated into the hair of humans and other mammals and allows for the measurement of physiological stress over several months. The process involves first obtaining a sample of hair from a participant. A portion of hair up to the width of a pencil is first secured with a clip or rubber band and then cut as close to the scalp as possible with sterilized scissors. The sample is taken from the posterior vertex portion of the skull. To examine the distribution of cortisol over time, the hair sample can be cut into 1 cm segments, the segments furthest from the scalp being the oldest. The samples can then be placed into a paper envelope and then secured in a container. Upon returning from the field, the samples can then be taken into the lab, I plan to use Dr. Jason DeCaro’s lab here at the University of Alabama, to be analyzed. The samples are washed in an alcohol solution, dried, ground, and then the cortisol is extracted and analyzed. The above procedures were described in an article by Meyer et al. (2014). Below is a video provided by the same authors describing the methodology.

http://www.jove.com/video/50882/extraction-and-analysis-of-cortisol-from-human-and-monkey-hair

I have chosen these two measurements of health because they will be logistically easy to perform in the field, require no more special instruments, and do not require refrigeration. By combining these two biomarkers with self-report measurement scales, I believe I will be provided with a robust survey of health in the village.

Meyer, J., Novak, M., K. Rosenberg, and A. Hamel 2014 Extraction and Analysis of Cortisol from Human and Monkey Hair. Journal of Visualized Experiments (83).

Wan, Y., C. Heneghan, R. Stevens, R. J. McManus, A. Ward, R. Perera, M. Thompson, L. Tarassenko, and D. Mant 2010 Determining which Automatic Digital Blood Pressure Device Performs Adequately: A Systematic Review. Journal of Human Hypertension 24(7):431-438.