Body balance

Concepts of the body and illness in Northeastern Thailand are a syncretism of Ayurveda, indigenous/classical Thai medicine and more recent biomedical contributions. The body is held to be made of four elements, water, air, earth and fire. The water body element embodies all fluids in or coming from the body. Such fluids can be blood, pus, perspiration, urine etc. The fire body element covers digestion and metabolism. The physiological and anatomical parts of the human body (non-liquid) constitute the earth body element. The air body element is defined as the air/breath/gas that circulates in and out of the human body. This element must not be confused with some kind of wind element (Ratarasarn 1989: 88).

The body elements must be kept in balance as an excess of any element will cause illness. Such an excess can occur because of poor nutrition, food which is inappropriate to an individual’s bodily configuration, heredity or possibly spirit intervention (Weisberg 1984). Keeping the body healthy, therefore, is a matter of adjusting the body with good nutrition, regular intake of medicines as needed and careful use of available healers during acute episodes of illness.

In general, health knowledge is generated within the family. All of the respondents listed their parents as their main source of information regarding sickness and health. Next on the list would be other relatives. Health centre or the media would come third in importance as a source of health knowledge. None of the villagers in Ban referred to the 4 body elements in their explanations although this was probably an underlying pattern in their concern with balance and health. They often stressed the above mentioned ways of keeping the body healthy.

Concepts of strength are linked to perceptions of the quality of the blood. While a number of people are aware that some characteristics can be inherited from the parents, in general non-hereditary factors are stressed. Strength is defined most often by a person’s ability to do hard physical work and by that person’s resistance to disease. Men are often perceived as stronger than women because of their ability to do hard physical work. Strength can be visually recognized by the redness of a person’s face (the redder, the better).

The quality of one’s blood influences a person’s strength. The blood has to be thick and red. If it is thin and black, it means that the person is weak and liable to get sick. Therefore it is important to eat well and exercise to maintain good quality blood. Vitamins are also stressed as being essential to maintaining good blood and health. The high consumption of multivitamins and vitamin B in Ban, indicates that the villagers eat vitamins as a regular part of their everyday diet. According to Weisberg, vitamins are assumed to be analogous to body elements just like blood pressure is perceived as a measurement of the “wind” element (Weisberg 1984a: 177). Some respondents also mentioned traditional herbs as contributing to good health.

According to the villagers, it is necessary to change one’s blood once in a while to get rid of the “bad blood”. One way of doing this is to donate blood at the periodic blood donation events in the village. That way a person’s body may generate new blood to replace the donated blood. Donating blood in Ban is not done out of any sense of civic duty but to strengthen one’s own health. It is the responsibility of the doctors to make sure that the bad blood is not given in blood transfusions to innocent patients.

The respondents in the different focus group discussions did not all agree about the advantages or disadvantages of menstruation as a type of blood change. Some people feel that menstruation, like childbirth, is detrimental to women’s health. Other people feel that these opportunities for generating new blood would make women extra strong.

Some medicines are perceived as being bad for the blood. Pain killers, such as Buadhai and Tamjai, will make a person’s blood bad. But other medicines, and especially injections and IV fluid, will make the blood good. The interviewed women explained that they always feel better after vitamin injections. And the observation that patients in hospitals always receive IV fluid is taken as proof that IV fluid is good for the blood (in some areas of Thailand the IV fluid is actually red like blood). Anita Hardon points to a similar trend in The Philippines where doctors’ prescriptions are perceived as recipes for future self-medication practices (Hardon 1991).

Diseases and inferior food can dilute a person’s blood. As a result of weak blood, one may feel vertigo, tiredness and loss of appetite. Such symptoms are taken very seriously in the popular health culture. They indicate problems with the blood which must be treated before things get any worse.

Causes of disease

According to Ratarasarn (1989: 90-110) Thai classical medicine describes the etiology of diseases as follows:

1. Imbalances and malfunctions of the 4 body elements and the corresponding organs cause diseases. For instance: diseases caused by the water/liquid element would result in abnormality of the urine. Such diseases would be considered renal diseases.

2. It is known that some diseases are caused by external “germs” but the origin of these germs is not clearly understood. Intestinal worms are an example of such a germ caused disease. In general, observing a patient’s discharges is an important diagnostic tool.

3. It is recognized that some diseases are caused by the individual’s exposure to the natural environment, particularly an unfamiliar environment. Examples of this are a new geographic location, a jungle, extreme hot or cold temperature, unfamiliar air etc, Being exposed to unfamiliar air or extreme temperatures can cause flu or pneumonia, according to Thai classical medicine.

4. Overlapping with the concept of germ-induced diseases are the concepts of infectious diseases. Examples of these are cholera, smallpox, and chicken pox.

5. Endogenous diseases include congenital abnormalities, diseases and germs which have developed in an individual’s body “automatically” and finally diseases of obscure origin; cancer and epilepsy are examples of this category of diseases,

6. Allergic reactions are responses to “disagreeable and external” substances. Whether or not an individual has allergic reactions depends on his or her immune system.

7. Emotional disturbances can be the results of disorders of the bile, varieties of fever and “poisonous or deadly” blood.

8. Psychosomatic diseases are recognized in Thai orthodox medicine as diseases caused by the unhappy condition of an individual’s mind or psychic strain. Such strains can induce and increase the susceptibility to disease and illness. According to Thai medicine the victims of psychosomatic diseases are frequently prominent political leaders who are deprived of the power and territory. An example of this is given in the Ratanakosin historical chronicles; King Anu of Vientiane who lost to king Rama III’s Bangkok army in the first part of the 19th century “suffered from the fatal disease of bloody vomit...and died within 7 days” (Ratarasarn 1989:108).

While the above classification of the causes (and symptoms) of diseases represents the scholarly version of Thai medicine, the villagers concepts of disease causation are simpler. According to them an imbalance in body elements or a dilution of a person’s blood will make a person prone to disease. A change of seasons also influences the body balance which makes people liable to get sick. Person to person transmission is not often mentioned as a cause of disease. And bacteria are believed to be a problem only in water. Acid food or upsetting the digestion (body functioning) by not keeping to proper meal times, can also cause sickness.

All of our respondents agree that there are more diseases today than in the old days. Some people point out that children are less sick (probably due to vaccinations). The reason why adults are suffering more today is indicated to be chemical pollution. Many respondents complain that food today contains chemicals. It is also quite common to see dead fishes in the canals or to get rashes from using this water. Given the high use of fertilizers in Thai agriculture, such observations are not surprising. Insecticide poisoning was also mentioned by a former public health official as a growing problem (Dr Chin, personal communication).

When the respondents were asked to group or categorize a number of common local diseases, the results were not very consistent from one group of respondents to another. It is an accepted fact in Thai culture that “....one never quite knows the cause of an illness....” (Weisberg 1984a: 173). The observations confirm that people in Ban actually care less about what caused their sickness and more about what to do about it. It was much easier getting people to talk about various medicines than about diseases. One should caution here that the research methodologies employed in the two questions were slightly different. In the case of the medicines, actual samples were shown to people while in the case of diseases, local disease terms were written on cards.

A list of local illness categories is given below:

Table 8
Local illness categories (as listed by the research assistant in Ban)

As is generally the case, the popular categories are based on symptoms rather than causes. Attention is given to getting treatment and alleviation of the symptoms rather than seeking the underlying cause of the symptoms. This list of local illness terms refers to a different medical orientation than the one which informs the bio-medical categories.

Tolerance level of discomfort

The consumption of pain-killers in Thailand is very high and on the rise. Part of the reason for this is the easy availability of medicines today. Before, when people fell sick, they had to use herbs for recovering. These herbs were time consuming to prepare and slow to take effect in the body. People had to cope with a good deal of pain and discomfort because there were no alternatives. Now, however, nearly every grocery shop sells pain-killers and in the slum area it is common to keep some packages of pain-killers at home. In the rural area, many women reported their first experiences with injections during childbirth. It is unknown what the pharmaceutical contents of these injections were but reportedly they helped alleviate the pain.

This easy availability of effective pain-killers, both from the formal and the informal health care system, may have changed people’s tolerance level for discomfort. Pain mat before was accepted as an unavoidable part of life, is not so acceptable now because people have effective remedies for it. In the words of one of the respondents: “(Before) There was no medicine to take or nowhere to buy like nowadays. But these days, when people get even a little sick or painful, they often go to see a doctor”.

Some researchers have even talked about a psychological dependency on pain-killers in Thailand (Srigernyuang et al. 1991). Many pain-killers used to contain caffeine which is addictive. But the Ministry of Public Health was quite adamant about implementing a ban on this ingredient and it has been removed as an ingredient in these products¹⁵. However, this does not seem to have slowed down the consumption of pain-killers. As the physical reason for addiction disappeared with caffeine, the continued high consumption of pain-killers would seem to support a psychological dependency theory. In this theory the demand for pain-killers is seen as a result of the increasing levels of social disintegration and stress in Thai society.

¹⁵ However, since the very popular tonics are not controlled by the FDA, the ban on caffeine does not apply to tonics.