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- Herausgeber: Books on Demand
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
This thesis focuses on empirical work conducted among beekeepers and their families in Lower Austria. It aims to answer the question if and how bee products are used to treat illnesses and maintain health. Furthermore, the findings are evaluated and interpreted according to the carefully selected theoretical framework. Arthur Kleinman's model of health care systems was a useful tool in order to understand the interplay of health practice and knowledge. My work makes no claim to be complete. Science is in constant motion and our knowledge increases all the time - just like our apiarists never stop exploring new ways of using honey, propolis, pollen, royal jelly, and Co.
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To my grandfather Johann Schmatz
Acknowledgements
I wish to thank the members of the Beekeepers’ Association Imkerverein Böheimkirchen and all interviewees for their kind and dedicated cooperation, Dr. Stefan Stangaciu, Dr. Roland Berger and IM Anton Reitinger of the Austrian Apitherapy Society (ÖGA) for their support. Furthermore I’d like to give special thanks to my supervisor Mag. Dr. Evelyne Puchegger-Ebner for her wise and ambitious mentoring, Andrea Bednarik MA and Andrew Couse MA for proofreading and finally yet importantly, I like to thank Philipp Kadlec, my family and friends for every time they lent me an ear, encouraged and supported me.
Table of Contents
FOREWORD BY DR. STEFAN STANGACIU
FOREWORD BY MAG. SILVIA EBERL-KADLEC
INTRODUCTION
RESEARCH QUESTIONS
DEFINITION OF KEY TERMS
3.1 Biomedicine, “western medicine” or allopathic medicine
3.1.1 Evidence based medicine (EBM)
3.2 Complementary and alternative medicine (CAM)
3.3 Sickness, illness and disease
WHAT IS APITHERAPY?
4.1 Definitions
4.2 A brief history of bees and bee products in Central Europe
4.2.1 Role in mythology and religion in Central Europe
4.3 Apitherapy in homeopathy, TCM and Ayurveda
4.3.1 Homeopathy
4.3.2 Traditional Chinese medicine (TCM)
4.3.3 Ayurveda
4.4 The dilemma of classifying apitherapy
4.5 Legal status of apitherapy in Austria
THEORETICAL FRAME
5.1 Arthur Kleinman’s Model
5.1.1 Popular sector
5.1.2 Professional sector
5.1.3 Folk sector
5.2 An anthropology of
materia medica
5.3 Medical pluralism
5.4 Health knowledge
5.4.1 Interaction of health knowledge
5.4.2 Exchange of experience-based knowledge via internet
5.4.3 Development of medical knowledge
5.4.4 Globalization and medicine
5.5 Healing, meaning and placebo effect
5.5.1 Meaning response (placebo effect) in CAM
METHODS
6.1 Grounded Theory
6.2 Interviews and Qualitative Content Analysis (Mayring)
6.3 Participatory observation and research diary
THE SAMPLE
7.1 Beekeepers and/or family members
7.2 Medical practitioners
7.3 The Research Area
7.4 Self-perception and perception of others
RESULTS OF THE ETHNOGRAPHIC RESEARCH
8.1 Honey
8.1.1 Application of honey
8.2 Propolis
8.2.1 Application of propolis
8.2.2 The actual use of propolis among the sample
8.3 Pollen and bee bread
8.3.1 Application of pollen and bee bread
8.4 Bee venom
8.4.1 Application of and health knowledge about bee venom
8.5 Royal jelly
8.5.1 Application of royal jelly
8.6 Beeswax
8.6.1 Application of beeswax
8.7 Others
8.7.1 Entomophagy
8.7.2 Apilarnil
8.7.3 Bee air
8.8 Beekeeping, a wholesome activity?
8.9 Apitherapy and meaning response (placebo-effect)
RESULTS STRUCTURED ACCORDING TO KLEINMAN’S MODEL
9.1 Popular sector
9.1.1 Sharing information
9.1.2 Media and education
9.1.3 Passing on knowledge
9.1.4 Experience
9.2 Folk sector
9.3 Professional sector
9.3.1 Knowledge about apitherapy of the questioned general medical practitioners
9.3.2 Implementation of apitherapy
9.3.3 Use of terms: apitherapy – evidence based medicine
9.4 Overlap of folk sector and popular sector
9.5 The overlap of folk sector and professional sector
9.6 Overlap of professional sector and popular sector
9.6.1 Direct interaction of apiarists and medical professionals
9.6.2 Indirect interaction of apiarists and medical professionals
9.6.3 Use of bee products to treat diseases/illnesses by the questioned medical professionals
CONCLUSION
BIBLIOGRAPHY
LIST OF FIGURES
APPENDIX
13.1 Original Title of Thesis:
13.2 Semi structured interviews - field manual (apiarists and family members)
13.3 Semi structured interviews - field manual (general medical practitioner)
13.4 3rd Austrian Conference of Apitherapy
13.5 Curriculum vitae
13.6 Abstract (English)
13.7 Abstract (Deutsch)
Foreword by Dr. Stefan Stangaciu
I got to know Silvia Eberl-Kadlec in Surrey, British Columbia, Canada at an Apitherapy Conference in 2013. She wanted to show me her master thesis on the subject of apitherapy. I was immediately impressed by her hard work. In fact, I wholeheartedly congratulate Silvia on her excellent thesis.
Her medical anthropological methodology allows deep insights into how such different fields as apitherapy, medicine, beekeeping, science and lay knowledge are interwoven and interdependent. This kind of interdisciplinary approach contributes to a better understanding and interpretation of quantitative data. It also adds context to some highly specialized scientific fields. Describing a system that is interwoven and constantly developing is a complex matter. Nevertheless, Silvia’s writing style is easy to understand and therefore accessible to a broader audience.
The thesis is divided into three sections. The first part covers the theoretical background. The second describes knowledge about apitherapy and its practical use among the beekeepers and their family members within the research group, documenting the results of her qualitative research in the field. The third section deals with the interdependence and interconnection of healing knowledge.
In conclusion, I can recommend Silvia Eberl-Kadlec's thesis to anyone interested in apitherapy, medical systems and health knowledge.
Dr Stefan Stangaciu
Foreword by Mag. Silvia Eberl-Kadlec
Wo Bienen sind, sage ich, ist die Welt noch in Ordnung.
Where bees are, the world is still okay.
(Interview Herbert Anderle, 22.09.2011)
Apitherapy was, to be honest, a subject I had totally overlooked for a long time. Even though I was born into a family of beekeepers and I used bee products to treat illnesses myself, I had never really reflected on it. But as soon as I had started to do so, apitherapy literally captured my attention.
The use of bee products for treatment is not only one of the oldest medical practices in the whole world; it is also one of the widest spread ones. However, anthropological studies on this topic are extremely rare. Studies that put lay persons’ health knowledge into the center of attention are difficult to find too. These were two good reasons to focus on apitherapy, lay persons’ health knowledge and practice and its position in a certain health care system.
Generally speaking, health care systems consist of more than the predominant kind of medicine. Nonetheless, the predominant kind of medicine, which is biomedicine in the region of research, is certainly a very important part of the health care system. So I was interested to find out how popular and biomedical health knowledge interact. Furthermore, I wanted to stay open to any other kind of medicine (folk, alternative, complementary etc.) that might relate to apitherapy in the research area.
Biomedicine’s interest in the healing potential of apitherapeutical methods is quite young. Nevertheless the high number of studies in the last few years exemplifies increasing awareness and importance within biomedicine too. Those recent findings within biomedicines are certainly interesting, but would there be any research at all, if nobody used bee products as home remedies? On the other hand, the question arises if apiarists know more about the healing potential of bee products thanks to scientific research. Thus, how is lay medical knowledge connected to expert knowledge and vice versa? Is it interdependent? What role do traditional health knowledge and folk medicine play? What actually is health knowledge? And is a lay persons’ health knowledge as unknowing as assumed? I did my best to answer these “big” questions, using the example of apitherapy, with respect to medical anthropological theories, concepts and methods.
1 Introduction
The main objective of my work is to detect sociocultural mechanisms of interacting and interdepending health knowledge, by putting so called “lay” health knowledge in the center of attention. Apitherapy was chosen to exemplify how health knowledge and practice works among apiarists and their families (popular sector1) and how other medical systems (folk sector2 and professional sector3) are interconnected and/or interdependent.
This book focuses on empirical work conducted among beekeepers and their families in Lower Austria. It aims to answer if and how bee products are used to treat illnesses and maintain health. Furthermore the findings are evaluated and interpreted according to the carefully selected theoretical framework4. Arthur Kleinman’s model of health care systems was a useful tool in order to understand the interplay of health practice and knowledge.
My work makes NO claim to be complete. Science is in constant motion and our knowledge increases all the time - just like our apiarists don’t only stick to traditional medical use of honey, propolis, pollen and Co. but more on that mater later. Thus, I understand my work as only one further step towards a greater understanding of the complex, interwoven systems of medicines5, of more to come.
In order to do this step, my thesis is structured as follows:
First of all the research questions are defined. The second chapter clarifies the key terms used throughout my thesis. Then apitherapy is defined and analyzed from a historical point of view. Furthermore, its role in medical systems such as homeopathy, Traditional Chinese Medicine and Ayurveda is summarized.
The theoretical frame gives information about carefully chosen theories, that were used in order to understand apitherapeutical knowledge and practices from a social and cultural perspective. Thus, the phenomenon of apitherapy is viewed with reference to Arthur Kleinman’s model of health care systems, anthropology of materia medica and medical pluralism. Furthermore, it is essential to gain deeper insights into health knowledge, its exchange (orally, texts, books, new media, etc.) and development. Today’s zeitgeist also requires to take the impact of globalization on health knowledge into account. Meaning response, better known as placebo effect, is also a central concept to be dealt with, as there is no cure without it. No matter how effective a certain substance is, a certain percentage is always due to meaning response.
My thesis goes on describing the methods of research and the sample of interviewees. I used concepts of Grounded Theory, participatory observation, semi-structured interviews and data analysis with respect to Mayring’s Qualitative Content Analysis.
Then the results are presented in two different chapters. The first deals with the ethnographic data collected on the actual use of bees and bee products by apiarists and their family members. It is followed by a discussion about beekeeping being a potentially wholesome activity and the role of meaning and meaning response. The second chapter deals with health knowledge and practice among the sample, its interconnection and interdependence. Arthur Kleinman’s model of health care systems was used as a tool of analysis. At the same time, it was tested whether it was applicable to apitherapy in the chosen research area. While it was certainly a useful framework to get in-depth and structured insights, it was also found to be in need of improvement. The current zeitgeist requires a less stringent classification.
Finally, the conclusion sums up the answers to the research questions. Furthermore, a suggestion of improvement of Kleinman’s model was generated, in order to cope with the current spirit of time.
1 See chapter 5.1.1 “Popular sector” (p. →)
2 See chapter 5.1.3 “Folk sector” (p. →)
3 See chapter 5.1.2 “Professional sector” (p. →)
4 See chapter 5 “Theoretical frame” (p. →)
5 It is regarded more accurate to talk about medicines rather than medicine, please see 5.3 “Medical pluralism” (p. →) for further information.
2 Research Questions
Do beekeepers and their families use bees and bee products to treat illnesses and maintain health?
If yes: How are bees and bee products used to maintain and/or restore health?
Is health knowledge amongst bee keepers and their families, thus health knowledge of the popular sector, interconnect and/or interdependent with other health sectors (folk and professional sector)
What are the sources of health care knowledge of bee products and bees?
How is information about apitherapy shared?
Is health knowledge of beekeepers and their family members similar to apitherapeutical knowledge in biomedicine? Thus, is it possible to understand apitherapeutical practice amongst beekeepers and their families from a biomedical point of view?
Do findings of contemporary biomedical research on apitherapeutical methods and medical knowledge of Austrian beekeepers correlate?
What is the role of folk medicine in apitherapy?
Is Arthur Kleinman’s model still applicable?
Is Arthur Kleinman’s model generally applicable to apitherapy?
Does today’s spirit of time (new media, globalization,…) require a new model?
3 Definition of key terms
In order to clarify the key terms used in this thesis it is essential to define them first. Yet the definitions of apitherapy and health knowledge are to be found and discussed in chapter 4 “What is apitherapy?” (p. →), and in chapter 5.4 “Health knowledge” (p. →).
3.1 Biomedicine, “western medicine” or allopathic medicine
Kirch’s (2008a:1458) defines “western medicine” as following:
“Western medicine refers to medicine practices that developed in western world since the early Renaissance period (around 1450) and that are still practiced by majority health care systems throughout the world. Western medicine is also called biomedicine, allopathic medicine or the Hippocratic tradition. It is opposed to various medical practices that have also developed in the Western world, primarily in terms of scientific basis.”
However, Hörbst and Wolf argue that the terms “western”, “modern”, “scientific”, “school” or “cosmopolitan” medicine are based on an ethnocentric perspective. As a consequence the term “biomedicine” was introduced to the medical anthropological debate.
According to them biomedicine bases its knowledge and actions on biology, physiology and pathology.
They therefore defined biomedicine as:
Eine Medizin, deren Wissens- und Handlungsspektrum auf der Grundlage der Biologie, Physiologie sowie Pathologie beruht. Der Begriff Biomedizin wurde in Abgrenzung zu ethnolzentrischen Begriffen wie westliche, moderne, wissenschaftliche, Schul- oder kosmopolitische Medizin in die medizinethnologische Debatte eingeführt. (Hörbst and Wolf 2011:240)
In this thesis the terms “biomedicine” and “allopathic medicine” are used interchangeably according to Hörbst’s and Wolf’s definition. The term “western medicine” makes little sense geographically and arises from an ethnocentric perspective. Nevertheless, it is widely used and understood. Therefore it is used, but solely put in quotation marks.
The expressions “school”, “scientific” and “cosmopolitan medicine” are deliberately left out, as they are not as commonly used as “western medicine” and intolerably misleading. Biomedicine is one out of many that needs schooling to be practiced. Scientific medicine is misleading because it carries a connotation of being the “real” medicine out of scientific proof. Yet scientific proof can also be found in non-western medicines. Furthermore, biomedicine is only based on some sciences, mainly biology, physiology and pathology. It is NOT based on science as a total. Sciences is more than natural sciences, it includes social sciences, arts and humanities, economics, engineering and more. Thus the term “scientific medicine” is misleading. “Cosmopolitan medicine” assumes biomedicine being the only medicine used internationally, which is of course not the case. Popular examples of internationally used medical systems are TCM or Ayurveda.
3.1.1 Evidence based medicine (EBM)
EBM is a way of dealing with biomedicine. Decisions are made according to the best scientific proof available, preferably double blind studies.
It has actually existed for centuries, but in the 1970 Archie Cochrane was the first who stressed the importance of randomized clinical trials. In 1992 the term “evidence based medicine” appeared in medical literature for the first time (Kirch 2008a:415).
One of the most commonly used definitions is:
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. (Sackett et al. 1996:71)
However, this systematic decision making has its weaknesses too. Critics state milder medicines are seen as less good as more potent ones, even though those ones often also have more and stronger side effects. They doubt that statistical proof is a suitable measure because it is designed for an “average person”. Furthermore statistics can easily be manipulated and even if a correlation is found it is still no proof of causation. (Ivanovas 2004:141–147)
3.2 Complementary and alternative medicine (CAM)
The World Health Organization’s (WHO) definition of complementary and alternative medicine (CAM) is as following:
The terms “complementary medicine” and “alternative medicine” are used interchangeably with “traditional medicine” in some countries. Complementary/alternative medicine often refers to traditional medicine that is practised in a country but is not part of the country’s own traditions. As the term “complementary” and “alternative” suggest, they are sometimes used to refer to health care that is considered supplementary to allopathic medicine. However, this can be misleading. In some countries, the legal standing of complementary/alternative medicine is equivalent to that of allopathic medicine, many medical practitioners are certified in both complementary/alternative medicine and allopathic medicine, and the primary care provider for many patients is a complementary/alternative medical practitioner. (World Health Organization 2001:1)
Cant and Sharma (1999:5) state that using plural - so alternative “medicines” – makes more sense as there are various forms. Therefore, alternative medicines should not be treated as a single category. They use the term…
“... to refer to forms of healing that depend on knowledge based distinct from that of biomedicine and which, as such, do not share the special legitimation that the state has conferred upon biomedicine.” (Cant and Sharma 1999:5)
Most alternative medicines can be assigned to one of the following five categories6according to their origin:
Those forms of healing that came into being before or simultaneously with modern biomedicine. Examples are European herbalism, phytotherapy, homeopathy and non-professionalized “folk” healing.
Medicines that where invented during the period of medical individualism. In the late nineteenth and early twentieth century chiropractic, osteopathy or radionics developed in America, when licensing laws were not as strict as they are today.
Healing traditions that developed in central Europe in the context of health spas. Probably the best known form is naturopathy.
Medicines (mainly eastern and oriental) imported to “the west” by “westerners”. Acupuncture is a well-known example.
Medicines imported to “the west” by immigrants. Examples are Ayurveda, Chinese herbal medicine and numerous spiritual or ritual healing traditions. While some are little known outside its ethnical group, others became rather popular.
Furthermore, Cant and Shaman (1999:3) propose to include ‘lay” people’s health care services to the range of alternative medicines. I agree to that. Using home remedies and prescription-free medicines as treatments is without doubt an alternative to seeing a doctor, when successful. According to Kleinman (1980:50) roughly 70 to 90 percent of all illness episodes are managed solemnly in the popular sector. Thus an overwhelming percentage of all illnesses are successfully treated by “lay” people.
If home remedies are used in addition to biomedicine I see it as a complementary treatment. The therapeutic options within the public sector7 don’t only include home remedies, but also readymade products such as cough sweets, vitamins or bath essences and drugs sold prescription-free in pharmacies. Furthermore, certain diets, foods, sports or exercises (Yoga, Qi Gong...) can help to restore or maintain health. Information about those self-treatment options is shared with family members, friends and further acquaintances. Moreover, media like television, radio and especially internet are new forms of social and informational interaction.
In this thesis complementary and alternative medicines (CAM) are used according to the WHO’s definition. However, they are understood as diverse, numerous and include “lay” health knowledge and treatments.
6 I am aware of the fact that the categorization of Sarah Cant and Ursula Sharma derives from a “western” perspective. Their regional interest mainly addressed the UK. Nevertheless I found their categorization useful as my research takes place in Europe too. The persons questioned (apiarists and family members of them and regional medical professionals) ultimately share a comparable perspective.
7 See chapter 5.1 „Arthur Kleinman’s Model” (p. →)
3.3 Sickness, illness and disease
The terms “sickness”, “illness” and “disease” might be used interchangeably during everyday conversations, but used within medical anthropological discourses, they all have different meanings.
Kleinman (1980:72) drew the difference between illness and diseases as following:
Disease refers to a malfunctioning of biological and/or psychological processes, while the term illness refers to the psychosocial experience and meaning of perceived disease. Illness includes secondary personal and social responses to a primary malfunctioning (disease) in the individual’s physiological or psychological status (or both). Illness involves processes of attention, perception, affective response, cognition, and valuation directed at the disease and its manifestations (i.e., symptoms, role, impairment, etc). But also included in the idea of illness are communication and interpersonal interaction, particularly within the context of the family and social network. Viewed from this perspective, illness is the shaping of disease into behavior and experience.
According to Kleinman “sickness” is a collective term for both, “disease” and “illness”.
However Allan Young (1982:270) criticized that, and redefined the term together with Frankenberg as following:
Sickness is redefined as the process through which worrisome behavioral and biological signs, particularly ones originating in disease, are given socially recognizable meanings, i.e. they are made into symptoms and socially significant outcomes. […] Sickness is, then, a process for socializing disease and illness.
I use the terms “disease” and “illness” as suggested by Arthur Kleinman and “sickness” according to Allan Young. For further clarification see the following definitions according to my comprehension:
Disease addresses the physiological or psychological pathology of abnormalities. It is what biomedicine usually tries to cure to reach the goal of a fully functioning human body and mind.
Illness is the conscious experience of disease and/or sickness. The existence of an objectively measurable abnormality is not necessary. It is a feeling that grounds in the social or moral system of a certain community or society. It can affect a group not just a single person e.g. one family member has a disease, but the whole family feels ill.
Sickness is how cultures deal with illness and disease. It is where something is labeled as abnormal and then symptomized. The sociocultural system decides what is perceived as a disease and how it has to be treated. It is also where beliefs concerning the causes and the right treatments of diseases and illnesses ground. Knowledge of healthcare or treatments is therefore ALWAYS based on its sociocultural system.
4 What is apitherapy?
Apitherapy consists of the words “api” and “therapy”. Api derives from the Latin word apis meaning “bee” (American Apitherapy Society INC. n.d.; Stangaciu and Hartenstein 2000:13). “Therapy” dates back to 1846 and stems from the Latin word therapia and the Greek therapeia meaning “curing”, “healing”. It is related to therapon which means “servant” or “attendant” (Harper 2001).
4.1 Definitions
The American Apitherapy Society (AAS) defines Apitherapy as follows:
“APITHERAPY, or “bee therapy” (from the Latin apis which means bee) is the medicinal use of products made by honeybees.” (American Apitherapy Society INC. n.d.)
According to the AAS bee products are: bee venom, honey, pollen, royal jelly, propolis and beeswax.
The Standing Commission of Apitherapy (Apimondia) definition of Apitherapy is the following:
“Apitherapy is a medical concept, based on a scientific approach reinforcing traditional knowledges, including:
Clinical protocols integrating the use of api-pharmacopoeia and/or bees (Api-medicine).”
(The Standing Commission of Apitherapy of Apimondia n.d.)
Stangaciu and Hartenstein describe apitherapy in the following way:
“Apitherapie nennt man die Heilmethode, bei der Bienenprodukte zur Prävention, Heilung und Genesung von einer oder auch mehreren Krankheiten eingesetzt werden. (...) So umfassend dies bereits klingt – der Begriff Apitherapie meint noch mehr: Er bezeichnet eine wissenschaftliche Heilmethode auf ganzheitlicher Basis, die durch unzählige Behandlungserfolge längst international etabliert ist.” (2000:13)
This translates into English as follows:
“Apitherapy is a cure, where bee products are used for prevention, healing and recovering from one or several sicknesses. As comprehensive as this may already sound, the term apitherapy covers even more: It is a scientific medicine on a holistic basis, which has been established internationally for a long time, due to uncountable therapeutic successes.”
As mentioned before, according to the AAS bee products are honey, propolis, bee venom, royal jelly, pollen and wax. I basically agree with this definition but I would like to add “bee bread” and “bee air”. All products named are produced by honey bees. Afterwards the products are harvested and often processed according to the needs of consumers. Yet it is not only bee products that are used for the purpose of nutrition and/or healing.
Bees and insects in general are used as nutrition and medicine in many parts of the world. They played and partly still play an important role in Asian, African and Latin American dieting. The medical use of insects (“medico-entomological drugs”) is also a very common practice, globally speaking (Chakravorty, Ghosh, and Meyer-Rochow 2007).
It is certainly not as common in Europe or North America to consume insects. Therefore, the omission of “entomophagy”8 and “medico-entomological drugs” indicates an ethnocentric perspective on the topic of apitherapy. For that reason, I am strongly in favor of including the usage of bees and bee larvae to the definition of apitherapy.
Hence my definition is the following:
Apitherapy is the use of bee products (processed or raw products) and bees (in all development stages) for the purpose of restoring and maintaining health.
Another reason why the inclusion of the usage of the insect itself is long overdue, is that apilarnil9 became part of apitherapeutical practice, even in industrialized countries (Stangaciu and Hartenstein 2000:55–57).
4.2 A brief history of bees and bee products in Central Europe
The earliest way of gathering honey was collecting it from wild bees. As land was gradually cleared and cultivated occupiers marked trees with wild bee nests, as a sign of ownership of the honey they produced. The next step towards beekeeping was to hollow out trees in order to create spots which wild bee swarms favor to occupy. This method was soon modified to hollowed tree-trunks placed on the ground, what is more convenient than up in a living tree. The German word “Bienenstock”
