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Community-Based Herbalism and relational approaches to harm reduction in healthcare.

机译：基于社区的草药疗法和相关方法，以减少医疗保健中的伤害。

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摘要

Despite the ability of mainstream healthcare in the United States to provide essential care in emergency and life-threatening situations, it often falls short of a broader mission to ensure that effective, equitable, understandable, and respectful quality care is available to all. Instead, not everyone who needs or wants healthcare can access it; patients often do not experience their care as adequate and appropriate; and, far too often, it actually generates harm, which is referred to as iatrogenesis. This dissertation proposes that iatrogenesis can occur at a specific biomedical level with individuals, at a systemic social level with groups, and at a structural level with both society and the environment. Today, pharmaceutical drug medicine is central to mainstream healthcare delivery and is also a primary vehicle of iatrogenesis. Herbal medicine, which preceded pharmaceutical drug medicine, has in recent years been suggested as a partial solution to pharmaceutical iatrogenesis. While herbal medicine offers numerous benefits, the herbal industry, through which most individuals in the United States access herbal medicine, is limited in its potential to reduce pharmaceutical harm due to barriers from mainstream healthcare as well as the harms it can itself generate.;Motivated by concerns over the shortcomings of mainstream healthcare, especially pharmaceutical drugs, as well as shortcomings of the herbal industry, this dissertation proposes that an approach to plant-based medicine, referred to as Community-Based Herbalism, has the capacity to reduce healthcare-related harm. Community-Based Herbalism expands the concept of medicine beyond the prevailing pharmaceutical drug model to incorporate food-like medicinal plants, kitchen-based medicine making, and access to living plants. In so doing, Community-Based Herbalism generates relationships with self, others, places, and plants. This dissertation further proposes that the types of relationships generated by Community-Based Herbalism are themselves key to reducing harm in healthcare.;In order to understand the importance of relationship to harm reduction in healthcare, the dissertation offers an extended consideration of the nature of relationship. Ethnobiology, and within it ethnobotany, provides a focal point for this consideration. Ethnobotany uses an intersecting framework of anthropology and botany to make observations, draw conclusions, and create theories about cultural relationships between people and plants including medicinal plants. Thus, ethnobotany is relational in at least two respects: (1) it observes through the dual lenses of two disciplines in relationship to each other; and (2) it observes relationships between people and plants. However, as the broader cultural perspectives in which ethnobiology's academic perspectives are embedded have changed, so too have the interdisciplinary lenses of ethnobiology --- and therefore ethnobotany --- changed. Drawing from the analysis of ethnobiologist Eugene Hunn, ethnobiology has transitioned through historical eras characterized by modernism (utilitarian), postmodernism (classificatory), and ethnoecology (situating and legitimizing), each of which has influenced ethnobiologists' understandings of their observations and, each of which, I propose, are embedded within distinct paradigms.;Further, the dissertation proposes that both the phases of ethnobiology and the identified levels of iatrogenesis can be correlated with each other on the basis of shared underlying paradigms, which I refer to as: Specificity, Systemic, and Structural Paradigms. Often, the differences between these paradigms present barriers to one another and operate in conflict. The dissertation introduces a Relational Paradigm, that models engaged relationship across paradigms, and proposes that engaged relationship -- relationship in which each agent (person, idea or paradigm) changes beneficially as a result of open, respectful, and caring interaction --- is the form of relationship that has the capacity to reduce harm in healthcare.;In order to understand the nature, potential, and means of establishing engaged relationship, the dissertation also examines relationship from the perspective of various academic disciplines, attachment theory, and ecopsychology. Successful engagement across paradigmatic differences is further modeled through the concept of ecotone, which --- borrowed from landscape ecology where it describes the influence that adjacent habitats have upon one another - is applied to ethnobiology and, within it, ethnobotany. Here, the concept of an ethnobotanical ecotone depicts the way in which the underlying disciplines of ethnobotany - anthropology and botany - do not simply exist in a patchwork of proximity but rather exhibit dynamic mutual influence or, stated otherwise, engaged relationship. A case involving diverging approaches to environmental management on the part of a Pacific Northwest Tribe and the U.S. Forest Service illustrates both the potential of the ethnobotanical ecotone to generate relationality across paradigms as well as the challenges faced by individuals in attempting to generate such ethnobotanical relationality.;Finally, since engaged relationships are situated relationships, the dissertation situates the emergence of my understandings of both Community-Based Herbalism and means of fostering it through an autoethnographic accounting of my teaching and fieldwork over a period of two decades. This narrative incorporates ethnographic data that include student and community cases, and that (1) lead toward an informed analysis of the capacity of Community-Based Herbalism to integrate the Specificity, Systemic, and Structural paradigms; (2) model a Relational Paradigm; and (3) generate relational approaches that can reduce harm in healthcare. Potential pathways to foster Community-Based Healthcare complete the dissertation.
机译：尽管美国主流医疗保健机构有能力在紧急情况和危及生命的情况下提供基本医疗保健服务，但通常它没有实现确保所有人都能获得有效，公平，可理解和尊重的优质医疗保健服务的使命。取而代之的是，并非每个需要或想要医疗保健的人都可以使用它。患者常常没有得到足够和适当的护理；而且它常常产生伤害，这被称为医源性疾病。本文提出，医源性发生可以发生在特定的个人生物医学水平上，可以发生在具有群体的系统性社会水平上，也可以发生在社会和环境的结构性水平上。如今，药物是主流医疗保健的核心，也是医源性的主要载体。近年来，草药被认为是药物医源性治疗的部分解决方案。尽管草药提供了许多好处，但美国大多数人通过草药行业获得草药的机会有限，由于主流医疗保健的障碍及其自身产生的危害，减少草药危害的潜力有限。出于对主流医疗保健（尤其是药物）的缺点以及草药行业的缺点的担忧，本文提出一种称为“基于社区的草药”的植物性医学方法具有减少与医疗保健相关的能力。危害。基于社区的草药主义将医学的概念扩展到了流行的药物模型之外，从而融合了类似食物的药用植物，基于厨房的药物制造以及对活动植物的获取。这样，基于社区的草药主义就可以与自我，他人，地方和植物建立联系。本论文进一步提出，基于社区的草药学所产生的关系类型本身就是减少医疗保健危害的关键。；为了理解关系对于减少医疗保健危害的重要性，本文对关系的性质进行了广泛的考虑。 。民族生物学以及其中的民族植物学为这一考虑提供了一个重点。民族植物学使用人类学和植物学的交叉框架来进行观察，得出结论并创建有关人与植物（包括药用植物）之间的文化关系的理论。因此，民族植物学至少在两个方面具有关系：（1）它通过两个学科的双重视角观察彼此之间的关系； （2）观察人与植物之间的关系。但是，随着民族生物学的学术观点所嵌入的更广泛的文化视角发生了变化，民族生物学的跨学科视角（因此也就是民族植物学）也发生了变化。根据对民族生物学家Eugene Hunn的分析，民族生物学已经过渡到了以现代主义（功利主义），后现代主义（分类论）和民族生态学（处境和合法化）为特征的历史时代，这两种历史都影响了民族生物学家对其观点的理解，并且每一个都影响了民族生物学家的理解。我建议将它们嵌入不同的范式中。此外，论文提出，在共享的基本范式的基础上，民族生物学的各个阶段与确定的医源性水平可以相互关联，我称之为：特异性，系统和结构范例。通常，这些范式之间的差异构成了彼此的障碍，并在冲突中发挥作用。论文介绍了一种关系范式，该模型对跨范式的订婚关系进行建模，并提出了订婚关系，即每个主体（人，思想或范式）由于开放，尊重和关怀的互动而有益地变化的关系。为了理解健康关系的本质，潜力和建立方式，本文还从各个学科，依恋理论和生态心理学的角度对关系进行了考察。成功的跨范式差异的参与还通过生态过渡的概念进行了建模，生态过渡是从景观生态学中借用的，它描述了相邻生境彼此之间的相互影响，并应用于民族生物学以及其中的民族植物学。在这里，民族植物生态调的概念描述了民族植物学的基础学科（人类学和植物学）不仅仅存在于邻近的拼凑物中，还表现出动态的相互影响，或者相反，订婚关系。太平洋西北部部落和美国森林服务局在环境管理方法上存在分歧的案例既说明了民族植物生态交错带在跨范式上产生关系的潜力，也说明了个体在试图建立这种民族植物关系方面所面临的挑战。最后，由于订婚的关系是关系型的关系，因此本文提出了我对基于社区的草药学的理解的出现，以及通过对二十年来我的教学和田野调查进行自动人种志研究来促进这种理解的方法。该叙述结合了包括学生和社区案例在内的人种学数据，并且（1）对基于社区的草药学整合特殊性，系统性和结构性范式的能力进行了有根据的分析； （2）建立关系范式的模型； （3）产生可以减少医疗保健危害的相关方法。促进基于社区的医疗保健的潜在途径完成了本文。

著录项

  • 作者

    Eloheimo, Marja.;

  • 作者单位

    University of Washington.;

  • 授予单位 University of Washington.;
  • 学科 Health Sciences Alternative Medicine.;Health Sciences Public Health.;Sustainability.
  • 学位 Ph.D.
  • 年度 2014
  • 页码 403 p.
  • 总页数 403
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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