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Perception of health : a phenomenological study of the meaning of health to Indo-Canadians Thompson, Robyn D. 1989

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PERCEPTION OF HEALTH: ft PHENOMENOLOGICAL STUDY OF THE, MEANING OF HEALTH TO INDO-CANADIANS BY ROBYN D. THOMPSON B.Sc.  (Biology),  University  B.S.N., U n i v e r s i t y  of V i c t o r i a , 1976  of B r i t i s h Columbia, 1982  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in FACULTY OF GRADUATE STUDIES The School  of Nursing  We accept t h i s t h e s i s as conforming to the r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA November 1989 (c) Robyn D. Thompson, 1989  In presenting  this thesis in partial fulfilment of the  degree at the  and  study. I further agree that permission for extensive  copying of this thesis for scholarly purposes may or  by  his or  her  representatives.  be  permission.  Department The University of British Columbia Vancouver, Canada  DE-6  (2/88)  granted by  It is understood  publication of this thesis for financial gain shall not be  Date  advanced  University of British Columbia, I agree that the Library shall make it  freely available for reference department  requirements for an  the head of  my  that  or  copying  allowed without my  written  ii ABSTRACT PERCEPTION OF HEALTH: THE  This to  was d e s i g n e d  Indo-Canadians.  Canadian of  study  MEANING OF HEALTH TO  society  Given  The 1984)  to investigate  the increasingly  of c r o s s - c u l t u r a l  i s both  explanatory  model  phenomenological  method  i s highly  study  conducted  formulation of suitable  description  group.  Semi-structured  participants  generation  Indo-Canadians  sample  study.  f o r enquiry  The  into the  of the study.  Most  collected  from  in-depth  individuals  of t h i s  sampling  Participants  participants  with  faith  were  techniques first  between t h e ages o f  i n Canada f o r 6 1/2 t o 21 y e a r s  i n Canada f o r about  assisted  an i n f o r m a l network o f  Theoretical  size.  research  i n t e r v i e w s were c o n d u c t e d  of the Hindu  and 56, who had r e s i d e d  Data  qualitative  to the actual  contacted through  the f i n a l  lived  this  o f t h e h e a l t h phenomenon from  determined  had  area of  (1978a,b, 1980,  questions to e l i c i t  and a c q u a i n t a n c e s .  time  recognition  t h e r e s e a r c h e r t o adopt t h e  suitable  prior  colleagues  28  this  nature of  and e x p l a n a t i o n o f t h e h e a l t h phenomenon.  A pilot  eight  knowledge,  guided  method t o c o n d u c t  cultural  multicultural  o f A r t h u r Kleinman  phenomenological  the  of health  t i m e l y and r e l e v a n t .  was t h e framework w h i c h  perception  t h e meaning  and t h e n u r s i n g p r o f e s s i o n ' s g r o w i n g  the importance  investigation  INDO-CANADIANS  were  in their  at the  mid-40's and  12 y e a r s .  a total  o f 15 i n t e r v i e w s w i t h  the 8  participants comparative the  data  were a n a l y z e d analysis.  formed  presentation meaning  to the  Common themes and  a final  technique  catagories  a n a l y t i c framework w h i c h  of r e s e a r c h  of h e a l t h  according  data,  f o r the  and  represented  I n d o - C a n a d i a n s who  of  constant  arising  organized  from the  the e s s e n t i a l  p a r t i c i p a t e d in  this  s t udy. Although the  the  researcher's  i n f l u e n c e which c u l t u r e e x e r t s  socio-economic circumstance important  f a c t o r s i n the  accounts.  Definition  structured  by  conceptualized  The the  findings  most  profession.  support  construct contexts.  defined This  study  study  that  advocate  social  is  milieu. holistic  Health  activities".  important  The  was mind  implications for practice,  the  of c r o s s - c u l t u r a l t h e o r y relevant  nursing  care  to to  become  health  within  socio-cu1tural  different  current  moves t o  of n u r s i n g  i n v e s t i g a t i o n of the  a  incorporate  graduate  research,  as  guide  nurses recognize  i n t o u n d e r g r a d u a t e and  on-going  which  factor influencing health.  have  supports  i n terms  were  a construct  inseparable.  normal  important  health,  a multidimensional,  mind a r e  culturally  research  Finally,  as  of  investigate  participant's health  emerged as  "doing  differently  theory  of  to  background  In t e r m s o f n u r s i n g  i t is crucial  cross-cultural curricula.  For  perception  educational  health  i n c r e a s i n g use  practice.  a reality,  this  the  i n t e n t was  i n t i m a t e l y r e l a t e d to  body and  f i n d i n g s of t h i s  nursing  nursing  of h e a l t h  p r i m a r i l y as as  on  construction  described  phenomenon where t h e  described  and  c u l t u r e , and  Participants  was  original  the  nursing findings  explanatory  of  iv models o f h e a l t h and  other  and  cultural  sickness  groups  held  making  by  the  Indo-Canadian  up t h e C a n a d i a n  mosaic.  community  Table  of Contents  Abstract Table List  i i  of Contents  .  v  of Figures  ix  Acknowledgements  x  CHAPTER  1  1: INTRODUCTION Background t o the Problem . Transcultural Studies The S i g n i f i c a n c e o f S t u d i e s on Indo-Canadians L i t e r a t u r e and R e s e a r c h on Indo-Canadians: a S c a r c i t y Lack o f L i t e r a t u r e on t h e H i n d u Community Conceptualization of the Problem Use o f K l e i n m a n ' s Framework w i t h i n The D i s c i p l i n e o f N u r s i n g Problem Statement S i g n i f i c a n c e of the Study Scientific Significance Practical Significance Purpose o f the Study Research Question T h e o r e t i c a l and M e t h o d o l o g i c a l Perspectives of t h e Study I n t r o d u c t i o n t o the Methodology D e f i n i t i o n o f Terms Theoretical Definition Operational Definition Assumptions .. Limitations Summary  1 3 5 6 7 7 11 12 12 12 13 14 14 15 15 18 18 18 18 19 19  CHAPTER 2: REVIEW OF SELECTED LITERATURE L i t e r a t u r e on H e a l t h and I l l n e s s Theoretical Perspectives on H e a l t h D e r i v a t i o n o f t h e Word " H e a l t h " Perspectives found i n S o c i o l o g y , P h i l o s o p h y and T h e o l o g y T r a d i t i o n a l Biomedical Perspectives Socio-Cultural Perspectives within the H e a l t h Care D i s c i p l i n e s  21 22 24 24 ...  25 27 28  vi C r o s s - c u l t u r a l n u r s i n g views H e a l t h and I l l n e s s : T r a d i t i o n a l B e l i e f s held i n India L i t e r a t u r e on I n d i v i d u a l s from I n d i a Indo-Canadians Summary  29  ^  CHAPTER 3: METHODOLOGY S e l e c t i o n of P a r t i c i p a n t s T h e o r e t i c a l Sampling Criteria for Selection Rationale f o r C r i t e r i a S e l e c t i o n Procedure The P i l o t S t u d y P i l o t Study: Results C h a r a c t e r i s t i c s o f t h e Sample Data C o l l e c t i o n D a t a C o l l e c t i o n : The P r o c e d u r e D e t a i l s o f t h e I n t e r v i e w s and C o n s t r u c t i o n of Accounts F i e l d Notes P r o t e c t i o n o f Human R i g h t s Informed C o n s e n t Confidentiality Data A n a l y s i s R e l i a b i l i t y and V a l i d i t y o f D a t a Summary  41  .  41 41 43 43 44 46 47 47 49 50 51 52 52 52 53 53 56 57  CHAPTER 4: PERCEPTION OF HEALTH: THE MEANING OF HEALTH TO INDO-CANADIANS H e a l t h : The Most I m p o r t a n t T h i n g i n L i f e D o i n g Normal A c t i v i t i e s What Normal A c t i v i t i e s a r e The T h r e e P h a s e s o f t h e H e a l t h E x p e r i e n c e : Complete H e a l t h - P a r t i a l H e a l t h - S i c k n e s s Complete H e a l t h Body and Mind T o g e t h e r : The T o t a l U n i t i n B a l a n c e and Harmony Doing H a p p i l y , Doing Well Doing h a p p i l y Doing w e l l E n e r g y and r e s i s t a n c e I n d e p e n d e n c e and c o n t r o l P a r t i a l Health Can do w i t h E f f o r t , But not W e l l . D e c r e a s e d e n e r g y and r e s i s t a n c e  33 35 36 38  58 62 63 64 68 71  ...  72 75 75 76 78 81 88 90 91  vii Decreased independence and c o n t r o l T e m p o r a r y and B o t h e r s o m e Sickness C a n n o t do, C a n n o t fulfill Responsibilities Low e n e r g y and r e s i s t a n c e D e p e n d e n c y and l a c k o f c o n t r o l .... P e r m a n e n t , S e r i o u s and W o r r i s o m e Return to H e a l t h , or C h r o n i c Disease and D e a t h I n f l u e n c e s on t h e S t a t e o f H e a l t h The M i n d : B o d y - M i n d I n t e r a c t i o n Worry P o s i t i v e Mental A t t i t u d e External Factors D i e t and E x e r c i s e Diet Exercise S l e e p and C l e a n l i n e s s Use o f M e d i c i n e s Maintaining Routine Summary  CHAPTER  5:  DISCUSSION  OF  THE  93 96 99 101 103 106 108 112 114 114 116 120 128 129 129 134 135 136 137 139  FINDINGS  The E x p l a n a t o r y M o d e l Framework D o i n g Normal A c t i v i t i e s : N o r m a l c y and H e a l t h The S o c i o - C u l t u r a l C o n s t r u c t i o n o f Normal A c t i v i t i e s F a m i l y , D u t i e s and Responsibilities in Indo-Canadian S o c i e t y The S o c i o - C u l t u r a l C o n s t r u c t i o n o f N o r m a l i t y and N o r m a l i z a t i o n i n H e a l t h Normalization C o n c e p t u a l i z a t i o n s of Health The H e a l t h - S i c k n e s s C o n t i n u u m I n d o - C a n a d i a n and O t h e r E t h n i c Canadian Perspectives Four Conceptions of Health H o l i s m : Body and M i n d T o g e t h e r Factors Influencing Health The M i n d and H e a l t h M i n d , t h e Immune S y s t e m a n d R e s i s t a n c e P o s i t i v e Mental A t t i t u d e Family: a moderator of life stress Other Factors A f f e c t i n g Health Maintenance of Routine D i e t and E x e r c i s e  142 143 144 144 145 148 153 156 156  ..  159 161 166 167 168 168 170 171 172 174 175  viii Use Summary  of Medicines  CHAPTER 6: SUMMARY, CONCLUSIONS AND OF THE STUDY  177 179  IMPLICATIONS 182  Summary and C o n c l u s i o n s o f t h e S t u d y Summary Conclusions I m p l i c a t i o n s o f t h e Study Implications f o r Nursing P r a c t i c e Implications f o r Nursing Education I m p l i c a t i o n s f o r Nursing Research Bibliography  182 182 188 189 189 191 192 ...  Appendices Appendix  195 210  A  -  Appendix B Appendix C Appendix D Appendix E Appendix F  -  I n f o r m a t i o n r e g a r d i n g t h e Study and C o n s e n t t o C o n t a c t Form C o n s e n t Form I n i t i a l Trigger Questions F i n a l Trigger Questions C e r t i f i c a t e o f A p p r o v a l f o r t h e Study ... H e a l t h Images i n c l u d e d i n t h e Health D e s c r i p t i o n s of P a r t i c i p a n t s i n t h i s S t u d y (Adapted a f t e r Woods and C o w o r k e r s , 1988) .......  211 213 214 215 216  217  ix List  Figure  1. The E x p l a n a t o r y  of Figures  Model.  conceptualization  Kleinman's  of the h e a l t h care  system  Figure  2. Components  Figure  3. S c h e m a t i c D e s c r i p t i o n o f t h e Framework from t h e P a r t i c i p a n t s ' P e r s p e c t i v e 4: The F o u r F a c t o r s i n each Phase o f t h e Health Experience  Figure  o f t h e Framework  8 60 61  78  X  Acknowledgements I am i n d e b t e d t o my t h e s i s c o m m i t t e e , Dr. Joan A n d e r s o n ( c h a i r p e r s o n ) and P r o f e s s o r D o n e l d a E l l i s , f o r t h e i r o n - g o i n g s u p p o r t and i n v a l u a b l e g u i d a n c e d u r i n g t h e c o n d u c t o f t h i s r e s e a r c h and p r e p a r a t i o n o f t h e t h e s i s . I t h a n k them both f o r so g e n e r o u s l y o f f e r i n g t h e i r e x p e r t i s e and knowledge, and i n i t i a t i n g me i n t o t h e j o y s and d e p t h s o f phenomenology. S p e c i a l acknowledgement goes t o Dr. J o a n A n d e r s o n f o r i n s p i r i n g me w i t h h e r u n d y i n g e n t h u s i a s m and commitment t o q u a l i t a t i v e research. I am d e e p l y g r a t e f u l t o my d e a r and l o v i n g p a r e n t s , f a m i l y and f r i e n d s f o r t h e i r f a i t h i n me, and t h e c o n s i s t e n t encouragement t h e y gave me d u r i n g t h e p r e p a r a t i o n o f t h i s work. A f f e c t i o n a t e m e n t i o n goes t o G. and G. - f o r a l l t h e s m i l e s and hugs when I needed them most, and f o r h e l p i n g me l e a r n about computers. The e i g h t s t u d y p a r t i c i p a n t s d e s e r v e p a r t i c u l a r t h a n k s . Welcoming me i n t o t h e i r homes, t h e y g e n e r o u s l y gave many h o u r s o f t h e i r t i m e . By s h a r i n g t h e i r u n i q u e p e r s p e c t i v e s on t h e h e a l t h e x p e r i e n c e t h e y made t h i s s t u d y p o s s i b l e . My t h a n k s a l s o e x t e n d t o a l l t h o s e who h e l p e d by e n l i s t i n g s t u d y p a r t i c i p a n t s . F i n a l l y , I am s i n c e r e l y g r a t e f u l t o H.H.S.C., t h e one w i t h o u t whom t h i s work would n o t have been s u c c e s s f u l l y c o m p l e t e d - f o r h i s b l e s s i n g s and l o v e which s u s t a i n e d me t h r o u g h o u t t h e months o f writing. T h i s work i s d e d i c a t e d t o him.  1  CHAPTER 1: Background Canada t o d a y cultural  groups  remaining 1975, the  p.  as  i s an  2).  Asian  country's  various  made up  of the  1985;  32%  Current  Asian  their  population  one  e t h n i c group  been  from  Since  Indian  flow.  1986,  born  year  1970,  (Palmer,  in  immigrants  have  (Canada Y e a r Book,  1976  and  1981,  Indo-Pakistani  1981,  been b o r n  16.1%  outside  heritage  (Canada Y e a r Book,  arrive  c o n t r i b u t e markedly  years  reported  cultural  of  1983).  continent  In  portion  more A s i a n s Asian  with  and  framework  population  Between t h e  i n Canada who  having  identities  social  Each  immigrant  the  mosaic"  of t h e  1985;  Current  the  languages Canadian  o f Canada and  stemming  to  from  7.6%  more  of  than  Demographic  1983). approximately  outside India,  general.  For  than  total  reported  come from  total  population.  countries.  reported  the  Analysis,  distinct  "cultural  constitute a significant  mother t o n g u e d o u b l e d .  population  In  immigrants  immigrant  number o f p e r s o n s as  diverse  Demographic A n a l y s i s ,  Individuals this  their  Problem  u n i t s w i t h i n the  growing  Canada from  to the  ethnically  maintaining  distinct  INTRODUCTION  Canadian  the  4 million  o f Canada. and  14%  population,  2.9  group,  having million  reported  of A s i a n  or M i d d l e  1988;  o f E t h n i c Groups,  Eastern  having  3.354 r e p o r t e d  having  come from A s i a i n persons,  having  634,000 p e r s o n s  mother t o n g u e Profile  this  reported  same y e a r ,  E n g l i s h or French;  Of  Canadians reported  11%  of  a mother t o n g u e  in t h i s origin  Statistics  or  group  the other  indicated  a  (Canada Y e a r Book,  Canada,  1988).  2 It  is predicted  immigration  rate  to  Book,  1985).  exert  significant  future. years  population meet t h e is  directly  La  in shaping  ongoing  and  (Splane,  for a l l . 1986)  can  to  as  the in  the  the  effectively care  system  care  system  by  the  unique  fruitful  on  Canadian  for  appreciate  and  social  society  scheme  the  fact  context  & New,  health  their  class  held  in  1987). by  the  is vital  f e d e r a l government's v i s i o n  only  Health  care  middle  the  documents,  f o r a l l as  of white  Torrance  perspectives  of the  government  propose a h e a l t h  cultural  up  p r o f e s s i o n a l s and  of h e a l t h  adequately  D'Arcy,  making  care  Epp's Framework  perspective  Mechanisms and be  well  Year  will  in  immigration  order  Recent  equity  however,  (Coburn,  realization  society  o f Canada's h e a l t h  (1974) and  the  i s determined  groups  (Canada  Canadian h e a l t h  to c l i e n t s .  They a l s o a p p e a r t o not  successful  In  1994  the  a f a c t o r which  s e r v i c e s as  p r a c t i c e of h e a l t h  documents,  cultural  be  increasing  the  philosophy  have p r o p o s e d  of the  year  in  a multicultural perspective.  care  i t i s embedded  increase  Canadian  1984).  population,  l a r g e l y from  Appreciation  are  thus appears to  Londe R e p o r t  (1986),  health  (Epp,  of  t o adopt  of h e a l t h  the  society.  health  the  composition  structured  various  by  a f f e c t s Canada's h e a l t h  These two  which  150,000 a n n u a l l y  influence  a f f e c t s the  Promotion  that  an  s t r u c t u r e and  provision  goal.  be  reality  challenged  such as  will  needs o f t h e  The  there  Immigration  The  ahead  that  for  of  strategies for health  promotion  when c r o s s - c u l t u r a l  viewpoints  acknowledged. In a m u l t i c u l t u r a l s o c i e t y  such as  Canada,  which has  formally  3 advocated impact  a policy  which  experience care  ethnocultural  of h e a l t h  1984).  from  and  The  needs  f a c t o r s have on t h e d e f i n i t i o n is essential.  largely  ignorant  d i f f e r e n c e s among c l i e n t s  Canadian h e a l t h  care  system  fit  of the mainstream  Transcultural and h e a l t h  socio-cultural  studies care  population explore  held  by  backgrounds.  (Dobson, itself  1983;  often  (Anderson,  the d i f f e r e n t  f o r increased  knowledge  culturally  determined perspectives Transcultural  t o meet  differs  1985b). perspectives  on  varying literature  i n the area  on h e a l t h  to,  Leininger,  fails  C r o s s - c u l t u r a l nursing  t h e need  health  of, or i n d i f f e r e n t  i n d i v i d u a l s of  emphasizes  and  present,  o f i n d i v i d u a l s whose e t h n o c u l t u r a l b a c k g r o u n d  that  health  p l u r a l i s m , r e c o g n i t i o n of the  illness  p r o f e s s i o n a l s remain  cross-cultural  the  of c u l t u r a l  and  of  illness.  Studies  As C a n a d i a n s o c i e t y becomes i n c r e a s i n g l y m u l t i c u l t u r a l i n nature,  i t becomes  imperative  a transcultural perspective. growing  reality  cross-cultural (Splane,  study  Transcultural health  a future necessity, as an  p r o f e s s i o n t o adopt  important  which  focus  care  clearly  f o r nursing  i s both a  signifies research  1984).  A sound essential  understanding  of the "concept of c u l t u r e " i s  f o r p r o v i s i o n of c u l t u r a l l y  (Dobson,  1983).  cultural  and  facilitate the  and  f o r the nursing  client.  N u r s e s who  ethnic  provide  g r o u p s need  o r impede t h e r a p e u t i c Traditionally  relevant  care  nursing  to c l i e n t s  t o be c o g n i z a n t interaction  educated w i t h i n  a  care  from  various  o f f a c t o r s which  between t h e n u r s e and unicultural,  4 biomedical  perspective,  perception  of h e a l t h  and  lifestyles,  unicultural associated as the  experience  of the  unique  be  social  and  at  part  unique  of the  cultural  experience  of h e a l t h  of the  client.  This  of the  nurse,  together  with  and  cultural  recognition  of  imposition,  care  s e r v i c e s which  milieu.  to  of  speak their  must  the  act  client's  "cultural  own  and  act  negate and  individual  acknowledge  rights'  and  expect  patterns.  i f i t i s to expectations demand.  The  prevent and  a  (1984,  p.  gain  unique  ethnocultural  perspective  to  backgrounds.  perception  a  42)  p r o f e s s i o n to  care  gap  nurses'  nursing  meaning w h i c h  This  demanding  states:  cultural  quickly  nursing  ethnic and  She  s e r v i c e s they  promotes t h e  u n i q u e human b e i n g .  values  ethnocultural perspective  and  of t r a n s c u l t u r a l n u r s i n g  Knowledge o f t h e  beliefs,  those  cultural  effective and  own  i n d i v i d u a l s in s o c i e t y are  behooves t h e  provide  subjective  their  underlying  between c o n s u m e r s '  to d e l i v e r  understanding  state  from  care  within  profession  thus c l e a r l y  component  and  that  1984).  health  developing  ability  various  client's  beginning  looked  nursing  to  the  to L e i n i n g e r ,  relevant  They a r e  order  markedly  (Leininger,  culturally  It  illness,  find  p r o v i s i o n of t h e r a p e u t i c n u r s i n g  According  from  differ  often  a t t i t u d e s of ethnocentrism  validity  to  and  o r i e n t a t i o n on  b a r r i e r s to  their  nurses  better in  i n d i v i d u a l s from Knowledge o f  of h e a l t h  individual  i s an e s s e n t i a l  practice. individuals assign  appreciation  of the  client  to as  the a  human-to-human r e l a t i o n s h i p , based u n i q u e n e s s and  worth,  upon  i s fundamental  to  5 the  p h i l o s o p h y of n u r s i n g Health  state,  and  in which  is a socio-cultural i s thus  transcultural  relevant  British population  Columbia  this  India remain ranking  one  after  other c u l t u r a l significantly Immigration  predominance pattern  not  on  so to  requires that  clients.  Indo-Canadians  largest  Indo-Canadian  to Ontario.  1986  nurse  provided  In 1981,  population figures  c o u n t r y of o r i g i n  reported  43,065,  resided  showed a  in B r i t i s h  (Summary  numerical decline,  o f t h e major  immigrant  from E u r o p e ,  Columbia; groups,  Canada,  predominately  given  or  in  small Columbia  Tabulations,  1986).  less  1988).  1984).  than a  practice  Indo-Canadian  s i x months o f 1988,  came t o B r i t i s h  be  The  w i t h 39,780 i n d i v i d u a l s  immigrants  Over the f i r s t  Canada,  (Johnson,  Canada,  Despite  1985b).  of Studies  only  rather  the e t h n o s o c i o c u l t u r a 1 context  c a r e can  second  I n d i a as t h e i r  Statistics  from  has t h e s e c o n d  i n Canada,  i n numbers,  reporting  a  nursing  Significance  Columbia  decrease  construct  (Anderson,  of the c o u n t r y ' s t o t a l  British  1971).  knowledge t o g u i d e n u r s i n g  The  37%  inseparable  i t i s grounded  culturally  (Travelbee,  The Sikh,  groups  i n the  1,890  individuals  numbers o f i m m i g r a n t s  (Employment  Appendum t o t h e D a i l y ,  Indo-Canadian  community  w i t h fewer Hindus  and  of Sikhs i n the province's within  from  India  were and  Statistics  in B r i t i s h  Pakistanis.  Indo-Canadian  the Canadian  China.  recorded f o ra l l  e x c e p t t h o s e from Hong Kong,  1988;  from  province,  t h e N e t h e r l a n d s and  o v e r t h e same p e r i o d  reflected  individuals  population  Columbia  is  This community i s as a whole  6 (Johnson,  1984;  Population  by E t h n i c O r i g i n , S t a t i s t i c s  Canada,  1986). In view  of the s i g n i f i c a n t  origin  currently arriving  nature  of the  given of  relevant  population,  perspective  and  community,  the Canadian h e a l t h care  cultural  the c u l t u r a l l y  studies focusing  in themselves.  system's  by  Indian distinct on  Moreover,  mandate t o meet t h e  investigation  of h e a l t h held  of  of the  needs  distinct  Indo-Canadians  i s timely  pertinent.  Literature Over  and  experience these  have  the  1980;  various  of i n d i v i d u a l s  focused  from  Indo-Canadian  such as Goa,  1980,  health care  available findings  Nursing  into  been  1913).  immigration  Many o f  (British  Columbia  Authors over issues,  of the  their  society.  i n t h e e a r l y 1900's Broad,  published  Canada and  i n Canadian  recent  statistics,  s o c i o — psycho 1 o g i c a l f a c t o r s a s s o c i a t e d community 1984;  Wood,  Neufeldt  traditions.  (Buchignani, 1980,  (1984)  Very  little  category,  1977,  1984).  have  concerns of Indo-Canadians.  in this are  life  1928;  1981,  Coward and  religious  India  p r i m a r i l y on  a c c o u n t s and  Naidoo,  group's  a c c o u n t s have  o f b u i l d i n g a new  Service Bulletin,  historical with  I n d o - C a n a d i a n s a P. S c a r c i t y  works were p u b l i s h e d  Public years  R e s e a r c h on  the years,  immigration  the  are c l e a r l y  the country's  and  i n Canada,  Indo-Canadian  Indo-Canadians  number o f i n d i v i d u a l s  1980;  Filteau,  Other  authors,  focused  theory  this  has a d d r e s s e d  Of t h e  studies presenting  on  literature  actual  research  scarce. has  begun t o s e r i o u s l y  examine h e a l t h c a r e  within  the  7 transcultural  context.  Indo-Canadian  and Greek women i m m i g r a n t s  recent  study  A n d e r s o n ' s work on t h e h e a l t h o f  conducted  by Majumdar and C a r p i o  nursing  research  carried  out by r e s e a r c h e r s  studies in this  case  studies of i l l n e s s e s  such  as m a l a r i a  trachoma Lack  (Ough,  The  concentrates experience  e t a l . (1966),  looked  exclusively  status  (Gibson,  evidence over  of a similar  1971)  and  (1985) r e s e a r c h e d t h e  p r e v i o u s l y noted Sikhs  in British  & Draper,  (Broad,  t h e Punjab. study  on t r a c h o m a ,  Columbia.  Recent  1986) and v i t a m i n D  1986) o f i m m i g r a n t s  from  literature  b i a s towards  t h e H i n d u community  Struser  S i k h women from  on samples drawn  and h i s t o r i c a l  (Smith,  p e r t a i n i n g t o Indo-Canadians  (Bindra & Gibson,  Nizan  community,  Community  amongst  status  chyluria  with  1966).  of l i t e r a t u r e  in their  Bindra,  India a l s o focused Sociological  & Dhir,  at Punjabi  on t h e i r o n  Most i n v e s t i g a t i o n s  filarial  on t h e S i k h community.  of c h i l d b i r t h  (1988) a r e e x e m p l a r y  i n the Indo-Canadian  on t h e H i n d u  Detels  studies  found  1976),  large majority  area.  1987) and t h e  i n other health professions deal  (Detels, Alexander  of Literature  (1985a,  the Sikh  community.  on t h e I n d o - C a n a d i a n s  study  from  of the Sikh  1913; B u c h i g n a n i ,  gives  community  1977; N a i d o o ,  1980).  Conceptualization The model  conceptual  of Arthur  framework  Kleinman  framework r e p r e s e n t s  o f t h e Problem  for this  (1978a,b,  study  i s the explanatory  1980, 1984).  the researcher's  mind  set,  The c o n c e p t u a l or the p e r s p e c t i v e  a from  which  question framework research guides  the t o t a l  research  is considered itself, process.  the a c t u a l  researcher's  and  process  i s viewed.  t o be g e n e r a t e d supported  As an  research  conceptual  by t h e framework d u r i n g  o r g a n i z i n g framework,  conduct  theoretical  from t h e  The  of f i e l d  work and  the  Kleinman's  model  the development  p e r s p e c t i v e as d a t a  are c o l l e c t e d  of the and  analyzed.  Sociocultural  Medical System(s) (PROFESSIONAL)  Figure  1:  POPULAR C u l t u r a l S y s t e m ( s ) of H e a l t h Care ( I n d i v i d u a l and F a m i l y Based)  The  Explanatory  Model.  the  health care  system  Kleinman's findings,  and  Systems  explanatory  model  views h e a l t h and  Kleinman's (Kleinman,  is  based  FOLK C a r e System(s)  c o n c e p t u a l i z a t i o n of 1978a,  upon  p.  422).  cross-cultural  hea 1th c a r e as c u l t u r a l  systems.  9 The  model c o n c e p t u a l i z e s  spheres, "health ...  of h e a l t h c a r e : and  interacting  popular,  folk  and  components w h i c h  overlapping".  s t r u c t u r e the  h e a l t h and  illness  structural  and  health c a r e - r e l a t e d aspects  distinctive  viewing  three  professional.  are  They  culturally  represent  individual's  (Kleinman  domains,  the  These  constituted essential  explanatory  & Chrisman,  or  model  1983,  p.  for  570-  571) . Kleinman's c u l t u r a l between  l a y and  illness  experience.  the  three  care  illness".  The  community.  and  the  Each  "a s o c i o c u l t u r a l i t s own  popular The  folk  system  domain  (Anderson,  Although models,  p r a c t i c e upon complex  1985b,  p.  concepts.  sickness" to disease  and  and  discomfort".  the  "malfunctioning  in  the  individual". being  the  reacted  i t s own  model  to  health  beliefs,  of h e a l t h  family,  health  within  and  social  network healers,  professionals  who  professional health cultures  are  as  illness  "culturally  the  Disease,  shaped  and  explanatory  distinguish  between  "human e x p e r i e n c e  i n t e r p e r s o n a l and  of b i o l o g i c  The  themselves  clearly  is defined  "personal,  as  culture,  illness  colleagues  Illness  or the  on  237).  disease  K l e i n m a n and  views,  includes non-professional  p r o f e s s i o n a l domain r e p r e s e n t s  base c l i n i c a l  discrepancy  domains o f  with  encompasses  the  and  of these  explanatory  domain  or  i s experienced  spheres.  norms and  and  two  Sickness  structural  and  model a d d r e s s e s  professional perspectives,  represents  values  system  cultural  in contrast,  is  i n the  of  reactions considered  psychophysiologic  experience  processes  is influenced  sense t h a t  how  the  we  by  10 perceive,  experience  explanations  of  positions  occupy  we  (Kleinman,  which the  individual  meaning he  holds  attaches  In t h i s  the  meaning c o n t e x t  referring reality,  to the  contexts"  (p. 569).  individual's  social  employ"  c o n s t r u c t i o n of  clinical  professional interactions  his  models.  and  The  patient's  illustrates  "illness,  (Kleinman  the  the  beliefs  personal  and  the  "meaning c o n t e x t s "  researcher  may  Kleinman  of  ...  et a l . , 1978).  illness  as  of  Chrisman  a cultural  or  symbolic behavior  in p a r t i c u l a r  cultural  perspectives construct explanatory  to  (1983),  cognition, motivation,  made m e a n i n g f u l  illness  appropriately refer  and  culturally-specific  Kleinman's  the  explanatory  experience  to c o n s i d e r a t i o n of  Kleinman,  to the  the  model  for  world.  Although viewing  our  251-252).  shaped  Such c u l t u r a l  personal  the  are  on  to h i s d i s o r d e r , h i s e x p l a n a t i o n s  "emotion,  interaction  specific  explanatory  about  the  experience  p.  care  of h e a l t h .  propose that  social  illness  study  i s based  o f meaning we  cultural  (1984) d e s c r i b e s  care.  suited  1978,  is culturally  and  for  of the  his therapeutic goals"  viewing  systems  & Good,  speaks  model  Kleinman  and  the  t r a n s a c t i o n s between  explanatory  and  and  disease  explanations  wherein c1ient—hea1th  represent  social  cope w i t h  sickness,  Eisenberg  Kleinman reality,  and  personal  illness,  individual  communication,  experience,  meaning t o h e a l t h  of  the  way  model has the  February  the  framework  experience  individuals  i s s t r u c t u r e d by  been used p r i m a r i l y  18,  is also  of h e a l t h  1989).  As  well  (A. in  perceive  h e a l t h and  e t h n i c and  cultural  the assign  factors  11 inherent that  i n each  of the three  the experience  culturally  domains.  of health,  determined  like  and based  The r e s e a r c h e r  the experience  upon  individual  proposes  of i l l n e s s , i s  explanations of  we 11-be i n g . Use  of Kleinman s 1  Kleinman's nursing as and  explanatory  research  a framework illness.  Framework w i t h i n t h e D i s c i p l i n e model has been employed  (Anderson,  1981a,  f o r viewing  1985b; A n d e r s o n  the s o c i o - c u l t u r a l  A n d e r s o n ' s work  Kleinman's theory  illustrates  p r o f e s s i o n , and a s s i s t i n g  concern  to nursing  enquiry  as s o c i o - c u l t u r a l  statement  regarding  framework  based  the c l i n i c a l  that  models o f c l i n i c a l  are  on  system  care  arises  phenomena o f  that  a r e grounded  i n the Canadian  f o r nursing care which  biomedical  the sociocu1tura1  experiences  which  health  focuses  shape t h e c l i e n t ' s  o f ' h e a l t h ' and ' i l l n e s s '  research  by a n u r s i n g  t o which  overlook  t o t h e needs o f c l i e n t s  i s t o be p r o v i d e d  makes t h e f o l l o w i n g  provided  i s the extent  .... A framework  distinct  within the  theory:  practice  make up t h e C a n a d i a n The  research  into  direction  the m u l t i p l e determinants  experience  of health  o f c o n s i d e r i n g h e a l t h and  i n which h e a l t h and i l l n e s s  responsive  care  context  c o n s t r u c t s , Anderson  upon K l e i n m a n ' s  question  context  & Chung, 1982)  practice.  In h e r d i s c u s s i o n on t h e r e l e v a n c e  The  in recent  the p o t e n t i a l of  f o r g u i d i n g and s u p p o r t i n g  nursing  illness  of Nursing  is critical  i f adequate  t o t h e many e t h n o c u l t u r a l g r o u p s  mosaic. problem  (1985b,  that  p. 234-235)  addressed  in this  study  evolved  12 from  the  foregoing  culturally that  health  validity the  and  social  socially  care  and  consideration grounded  professionals  uniqueness  context  of  of  the  that  perception  adequately  understood  professionals. perspective the  culturally  of  be  Previous health  There  When  relevant  a  means  to  Hindu  and  the  aware  health  recognition of  the  experience  and  by  a  of  care  used  appear  to  it is  Therapeutic  to  the  professionals  client's  unique  guide  have  is  not  care  between  exists  ensue.  the  health  discrepancy  health  and  Indo-Canadians  health  and  unlikely nursing  cultural  nursing  that  of  that care  perspective  practice.  e x c l u s i v e l y focused  on  what  Indo-Canadians. of  the  Study  Significance  Research  i s necessary  (Fawcett,  I960).  Canadians  contributes  theory  multidimensional,  Statement  Significance Scientific  a  become  individual  held  will  unless  not  to  discrepancy  care  do  phenomenon,  majority  be by  is appreciated studies  the  may  such  provided  health  by  as  experience.  health  entertained  client.  cannot  of  health  need  Problem The  of  and  This  furthers  for  study to  the  the  the  on  the  p r o f e s s i o n a l i z a t i o n of meaning  development  cultivation  of  a  of  of  health  to  nursing Indo-  transcultural nursing  unique  body  of  nursing  knowledge. Kleinman significant  in  (1984) the  cites  on-going  c r o s s - c u l t u r a l research work  to  build  a  theory  as  highly  on  the  13 universal al.  and  culture-specific  (1987) r e c o g n i z e  perspectives  of  the  need  aspects  of h e a l t h care.  for research  lay Canadians,  especially  on  Coburn  the  health  amongst  ethnic  et  populat ions. Leininger transcultural of  has  theory  knowledge.  The  transcultural theories  r e c e n t l y commented as  i s "one  of the  of n u r s i n g "  (1985a,  p.  strengthens  the  This focused  i n the  effectively area  "client's  that  as  of n u r s i n g  and  Echoing  study  future research  poses the  a topic  research  relevant  health  experience & Oiler,  an  1986;  unique  body  relevant  Leininger's  cross-cultural  research  base.  and  nursing  research  health care,  and  cross-cultural  i s supported  might  o f h e a l t h and question  Smith,  "what  study  Anderson's  focus  examine  the  illness". i s the  research  have c i t e d  important  by  effectively  for nursing  Other nurse r e s e a r c h e r s as  of  research.  240).  (Munhall  important  b u i l d s upon e a r l i e r  subjective experiences  specifically health"  most  of c u l t u r e , e t h n i c i t y  t i m e l i n e s s of t h i s  suggestion  that  to c o n s o l i d a t i o n of q u a l i t a t i v e  a major f o c u s The  of n u r s i n g ' s position  209).  theory  significance  the  (1983) s t a t e s t h a t  discipline's  study  contributes as  emphasizes  theory  deChesnay  the  a major component  author  sentiments,  on  She  meaning  (1985b,  investigation  for nursing  p. of  of  238the  enquiry  1986).  Practical Significance Theory care  generated  from c r o s s - c u l t u r a l  p r o f e s s i o n a l s i n the  research  p r o v i s i o n of q u a l i t y  guides  health  patient care.  By  14 guiding  practice,  profession beliefs about  and  the  regarding  care,  nursing  care  relevant  based 1983  on  to  personnel  the  becoming  health,  p.  satisfying  cross-cultural  as  nursing  society  be  care  profession  of  able  to  the  purpose  theory  i s to  meaning  of  this  health  the to  and  this  and  nursing  skill.  Conference  theory  must  Splane, of  be in  Schools  requirement values,  her  of  care. for  "health  beliefs  and  research  culturally-grounded provide Such  practice meet  increasingly  of the  to  better a  and  experience  more  consolidation is  the  of  imperative  if  the  challenges  of  the  m u l t i c u l t u r a l in  nature.  Study  phenomenological  study  was  to  investigate  Indo-Canadians.  Research In  relevant  transcultural  cultural  effectively  becomes  of  culturally  that  imperative  clients.  Purpose The  of  specific expectations  transcultural health  different  aware  will  nursing  associated  nursing  6).  more  nurses  for  i s an  understand  (1983,  the  culturally  s t a t i n g that  Canadian  need  there  proposes  knowledge  the  the  both  1983).  practice,  at  and  provision  nursing  that  who  practices"  future  to  benefits about  illness,  firmly  address  states  nursing  and  (1985a)  emphasized  By  Knowledge  t r a n s c u l t u r a l care  Nursing,  of  health  (deChesnay,  keynote  Splane  client.  contributes  Leininger is  c r o s s - c u l t u r a l study  the  Question  following  question  was  addressed:  "What  15 is  the  meaning  of h e a l t h to  Theoretical  and  Indo-Canadians"?  Methodological  Introduction Kleinman's suitable  framework  phenomenon health  (1978a,b,  w i t h i n the  Kleinman's  study  elicit  the  individual  perspective increased studying  is  well  in-depth  methods,  suited  1984).  1982;  Anderson  Munhall, Ray,  i t s relevance  1982,  1985;  of  model. a  perception  of t h e  from  supported method  of  explanatory  the  the  approaches are  practice.  phenomenological  approach  (Anderson, 1987;  phenomenological  Davis,  1986a,b; O i l e r , Smith,  experience.  1985a,  1982;  1987;  1978; Parse,  1986).  chosen of  gaining  effective  for  Among in  n u r s i n g r e s e a r c h where t h e  the  the  actor's personal  to n u r s i n g  p e r c e p t i o n and  1986;  by  for description  among n u r s i n g r e s e a r c h e r s as  & Lynam,  Reimen,  a  the  lay experience  of the  description  Qualitative  nursing researchers u t i l i z e  support  the  individual  research design  to c l i n i c a l  individual  provides  p e r c e p t i o n of  r e s e a r c h e r to design  investigated  phenomena o f c o n c e r n  understand of  the  health experience  (Knaack,  on  or s p h e r e ,  appropriate qualitative  acceptance  qualitative  individual  model  experience.  phenomenological i s the  explanatory  focused  domain,  which  models u n d e r l y i n g t h i s  framework  into  Study  Methodology  1984)  T h i s study  popular  in order to  The  1980,  framework d i r e c t e d  phenomenological health,  to the  f o r enquiry  of h e a l t h .  P e r s p e c t i v e s of the  particular aim  i s to  A growing  number  approach  Anderson  Lynch-Sauer,  and  & Chung, 1985;  Coyne & Smith,  1985;  16 Phenomenology viewing  the world  approach  is a philosophical  and c o n c e p t u a l i z i n g r e a l i t y ,  to enquiry  into  inductive,  descriptive  individual  (Omery,  structures" "inner both  phenomena  research  1983),  o f phenomena  experience  (Oiler,  method  phenomenology (Lynch-Sauer,  and o u t e r  behavior  f o r the study  social persons  i n everyday  the data  life"  (Anderson  t o "uncover  ground  1985).  It values  both t h e  experience. than  o f the study  (Parse,  Concentrating  of  a  everyday  attempts  Straus  experience  & Oiler,  stripping  o b j e c t i v e study  reality  conducted aiming  explore  from  t h e meaning o f nature of  experience,  on t h e s u b j e c t s o r on o b j e c t s " , i n the complexity  1986, p. 5 7 ) .  o f each  Thus,  from  focuses  person's the  o f human e x p e r i e n c e  of i t s primary,  1985).  of the fundamental  (1966) e x p l a i n s , phenomenology  situations.  responses  Coyne & Smith,  t o " s e e human e x p e r i e n c e  (Munhall  of world  perspective,  1982, p. 4 2 ) .  on t h e s u b j e c t ' s  moment, and r e c o g n i z e s t h e v a l i d i t y  1987),  "to formulate  the subject's  jointly  concentrating solely  i t s content" As  aiming  & Chung,  method,  r e s e a r c h e r and p a r t i c i p a n t  phenomenology  is  seeks  at the l e v e l  phenomena, c o n s t r u c t i n g a d e s c r i p t i o n  of  As an  o r g a n i z a t i o n ... ( f o c u s i n g ) on t h e s u b j e c t i v e e x p e r i e n c e o f  constitute  "rather  1982).  o f a s u b j e c t as viewed by  o f human b e h a v i o r  In t h e p h e n o m e n o l o g i c a l  the  as w e l l as an  f o c u s i n g on t h e whole  t h e r e s e a r c h e r and t h e p a r t i c i p a n t s " ,  model  The  p e r s p e c t i v e , o r way o f  fundamental  unique  phenomenological i s viewed as  aspects.  t h e emic p e r s p e c t i v e o f t h e s u b j e c t  t o see knowledge d i r e c t l y  on t h e l i v e d  through  Research (Morse,  immediate  human  17 experience  (Davis,  Knaack Keen  1978).  (1984),  (1975),  r e f e r r i n g to  o u t l i n e s the  basic  the  work o f G i o r g i  assumptions  of  (1975)  and  phenomenology  as  foilows: 1)  f a i t h f u l n e s s to  2)  the  3)  utilization  4)  d e s c r i p t i o n of the  importance  the of  phenomenon as  it exists;  experience within  of a d e s c r i p t i v e  the  world  as  we  live i t ;  approach;  s i t u a t i o n from  the  perspective  of  the  subj ect; 5)  consideration  of the  "lived  s i t u a t i o n " as  the  basic  research  unit ; 6)  "a  biographical  emphasis  temporal,  historical  7)  aim  be  8)  emphasis  These the  to  on  a  "search  context  of t h e i r  Grounded personal  experience,  communicates  insight  contrast  to the  enquiry,  which  objective  unique  i n the  (p.  support  by  that  phenomenological i n t o the  on  109).  gives  underlying  d e s c r i p t i o n of  individuals within  context  gives  description  method  ultimate the  of h e a l t h . of  to  effectively In  positivistic  reality  to  focuses  Shaped  individual's distinctive  the  the  meaning  phenomenology by  on  the  environment.  human e x p e r i e n c e  scientific  and  blocks  exhaustive  ethnosociocultural  recognition  focuses  and  essential building  i t is lived  traditional  world,  individual.  or  method, as  description";  f o r meaning"  b a s i c assumptions,  phenomenological  are  personal";  " p r e s u p p o s i t i o n 1ess  phenomenon o f h e a l t h  the  and  b e c a u s e a l l human phenomena  subjective  the world  of  cultural,  18 social for  and h i s t o r i c a l  each  background,  this  s u b j e c t i v e world  i s unique  person. Definition  o f Terms  Theoretical Definition 1) C u l t u r e : values, that  r e f e r s t o "the l e a r n e d ,  beliefs,  guides  (Leininger,  norms and l i f e w a y  thinking,  decisions  that  complex,  claims  often  ancestral,  and  transmitted  p r a c t i c e s of a p a r t i c u l a r group  and a c t i o n s  i n a patterned  way"  a cultural  social  1985, p. 2 0 9 ) .  2) E t h n i c : r e f e r s t o "a s o c i a l system  shared,  group w i t h i n  or i s accorded  variable traits  special status  on t h e b a s i s o f  including religious,  or p h y s i c a l c h a r a c t e r i s t i c s "  (Spector, of belonging  particular  (Spector,  Operational  ethnic  pride"  to a  1979, p. 7 6 ) .  Definition  1) I n d o - C a n a d i a n : residing  group;  linguistic,  1976, p. 7 6 ) .  3) E t h n i c i t y : r e f e r s t o " t h e c o n d i t i o n ethnic  and  for this  i n Canada, who  was  study born  t h e term  r e f e r s t o an i n d i v i d u a l  i n I n d i a and f o l l o w s  the Hindu  r e 1 i g i on. 2) H e a l t h :  r e f e r s t o what was d e f i n e d  by i n d i v i d u a l s i n t h i s  s t udy. ftssumpt i ons The taken  assumptions,  f o r true  1) That  study,  report  the verbal  of t h e i r report  were  a r e as f o l l o w s :  t h e members o f t h e s e l e c t e d  subjective 2) T h a t  in this  o r b a s i c c o n c e p t s and p r i n c i p l e s which  sample were a b l e  i n d i v i d u a l perception obtained  from t h e s t u d y  to provide  a  of h e a l t h ; p a r t i c i p a n t s was  19 true 3)  to their  That  perceptions  the perception  of health;  and e x p e r i e n c e  of health/meaning  of health  varies cross-culturally; 4)  That  health  i s a s t a t e which c a n be d e s c r i b e d  by v e r b a l  report.  Limitations The 1)  following  Sample: The sample had t o be E n g l i s h  researcher  t o be a b l e  Individuals excluded holds 2)  l i m i t a t i o n s f o r the study  who c o u l d  from  i n order  n o t communicate  i n E n g l i s h were  f o r the  herself. therefore  t h e meaning w h i c h  health  g r o u p was n o t i n v e s t i g a t e d .  D a t a : The p r e s e n c e  some o f t h e i n t e r v i e w s report.  speaking  identified:  a l l of the interviews  the study; consequently,  for this  verbal  t o conduct  were  of family may have  The m a j o r i t y  members a t c e r t a i n p o i n t s influenced  during  the p a r t i c i p a n t ' s  of interviews,  however,  were  und i s t u r b e d .  Summary In t h i s  introductory  was p r e s e n t e d . described this  current the  study  study  question The  The e x p l a n a t o r y  and i d e n t i f i e d  research.  chapter,  were s t a t e d  model  of Arthur  as t h e c o n c e p t u a l  The s c i e n t i f i c were n o t e d .  the background  and d i s c u s s e d ,  which d i r e c t e d t h e a c t u a l  research  t h e o r e t i c a l and m e t h o d o l o g i c a l  were a d v a n c e d ,  detailing  was  supporting  s i g n i f i c a n c e of the  statement  along  Kleinman  framework  and p r a c t i c a l  The p r o b l e m  t o t h e problem  with  and p u r p o s e o f the research  design.  perspectives  the phenomenological  of the study  a p p r o a c h and  20 providing terms. the  t h e o r e t i c a l and  The  study The  underlying  operational  assumptions  have been d e s c r i b e d researcher  subjective provision  emphasized  experience of  within  designed  explore  to  and  of  recognized  selected  l i m i t a t i o n s of  conclusion.  the  of h e a l t h  effective,  individuals  in  definition  need  and  culturally  for  illness relevant  understanding as  the  basis  health  care  Canada's m u l t i c u l t u r a l s o c i e t y . the  unique  perception  of h e a l t h  for to  This  study  held  by  was  Indo-  Canadians. The depth  methodology  in chapter  overview  of  current  origin  of the  illness research of  found on  India's  illness,  three.  selected  of the  used  This  "health"  within  the  the  also  be  research  will  following chapter germane t o t h e  literature and  belief included  be  examined  in  will  present  an  problem  review w i l l  various  different  Indo-Canadian  traditional  will  The  literature  study. word  in t h i s  community,  i n the  subsequent  on  the  health  Literature  together  systems r e g a r d i n g  purpose  discuss  perspectives  disciplines.  and  with  health  an  and  and  account  and  discussion.  CHAPTER 2:  The  following  viewing  the  divided  into three  existing health  literature  current  health  offered  perspective  study  literature by  various  language the  be  Cross-cultural  The  that  discussion  current  study,  explaining to  The illness  an  background The  overview  and  for  review  is  of  conceptualization examines how  of  each  understanding  the  as  vary  word  a fundamentally shows t h a t  according  literature  because  i t was  "health"  to  and  of t h e i r health  and  for health  a subjective  emphasizing why  word  between h e a l t h  literature  nursing  of t h i s  health  first, the  of the  link  from  recognized  characteristics  and  presents  origin  derived  phenomenon.  increasingly  In t h e  the  of h e a l t h .  t o d e s c r i p t i o n and  suggests that  may  meaning  disciplines,  i n s i g h t i n t o the and  the  provides  of  the  health.  Reference to the  holism,  on  SELECTED LITERATURE  review  sections.  contributes  phenomenon o f  valuable  REVIEW OF  concepts  found  different  health  is  phenomenon  of  i n each concept  of  being  with  s o c i o - c u l t u r a l context. research  form  a major  p a r t i c u l a r relevance  as  important  provides  to  focus the  a s o c i o - c u l t u r a l construct to  i n v e s t i g a t e the  meaning  of  Indo-Canadians. d e s c r i p t i o n of  presented  i n the  additional  background  the  phenomenon.  health  literature  on  India's second  traditional section  f o r viewing The  third  i n d i v i d u a l s from  the  beliefs  of t h i s  Indo-Canadian  Chapter  health  chapter,  s e c t i o n reviews  India.  on  one  and  provides  perspective  pertinent presented  the  on  2E  background studies  to  the  focusing  problem on  the  Indo-Canadians reviewed need  for research  on  in d e t a i l  and  Indo-Canadian in t h i s  the  health  discussed  community,  section  the the  relevance  of  literature  on  further substantiates  perspectives  of t h i s  the  cultural  group. Although in  health  remain  as  nursing a focus  relatively  information studies  on  few  the  Much has beliefs dealt  the  state.  Even  to  the  i n v e s t i g a t i n g the  virtually  disease  perceptions  extensively  meaning  and  review  shows,  and  of h e a l t h  to  of  i n the  Illness  and  illness.  illness  literature.  d i s c u s s i n g the  i n d i v i d u a l s perceive  experience  subsequent  non-existent.  on  with  increasing interest  Indo-Canadians.is limited,  less information  and  as  i n d i v i d u a l s from  a  cultural  have a l s o There  concept  is  been little  of h e a l t h  experience  exists dealing  of h e a l t h  The  the  specifically  health with  socio-cultural construct,  various  cultural  and  and  backgrounds  health.  Enquiry  i n t o the  consideration within  As  been w r i t t e n  meaning which  assign  of  a v a i l a b l e however,  individual the  i n number.  Health  ways i n w h i c h  showing  investigation, c r o s s - c u l t u r a l studies  on  quite  literature  are  Literature  associated  with  of  health  specifically  Indo-Canadians are  researchers  the  discussion,  of  nature  illness  as  of h e a l t h  a contrasting  h e a l t h - i l l n e s s context since  is facilitated  understanding  concept.  is therefore  what h e a l t h  by  Viewing  pertinent  " i s not"  to  assists  health this  23 description  o f what h e a l t h " i s " .  Health  and  i l l n e s s are t r a d i t i o n a l l y  context  o f t h e m e d i c a l model.  illness  and  health  health  described  absent  (Guttmacher,  contrast,  advocates health  (Blattner, Sarkis  1978).  1981;  Flynn,  & Skoner,  1987).  Each d i s c i p l i n e In  addition,  given of  discipline.  health  and  health  response  (Murray  Recent  198(3; Goldwag,  theoretical  is conceptualized & Zentner,  1976),  a diagnosis  responsibility  (Sider status  conceptualizations definition The  and  general health.  & Clements,  (Twaddle, of h e a l t h  discussion  on h e a l t h  account  1979),  vary  found  of c u r r e n t  the  section.  1979;  differently.  exist  within  on t h e  found  literature.  (Duhl,  1977),  a moral 1984),  a task  a state  in their  a  definition  1976),  obligation  1982).  presents  (Fuchs, (Illich,  or  (Terris,  1975),  These explicitness  i n the  some o f t h e  literature,  descriptions  of  theoretical  to provide  a  o f t h e phenomenon o f o f t h e word  For  a  of parameters.  Examination of the d e r i v a t i o n  introduces  Pelletier,  in the  in  wholeness  a wealth or resource  1974,  with  perspectives  & Grossman,  circumscription  following  perspectives  (Sebag,  decade  literature  slightly  as a g o a l  1975),  a process (Greifinger  of  perspectives  Various d i s t i n c t  last  where d i s e a s e i s  state  1979;  the  entities,  h o l i s t i c health  as a p o s i t i v e  1976),  a social  as a s t a t e  i l l n e s s are t h e r e f o r e  example,  and  terms  as o p p o s i t e  views t h e human b e i n g  differing  within  Consequently, over the  have been viewed  in negative  viewed  "health"  24 Theoretical P. b r i e f  account  health  with  social  environment  addition, word  the  this  the  may  from  or  'hole'  English  the  word  which H i n d i  of the  term  'hale'  of  "svastah",  may  one's n a t u r a l  be  "health" According  support to  this  each  and In  language's  as  Keller,  follows: and  of the  holistic holistic  (the  She  (1981,  p.  classical  Sanskrit  v a r i o u s l y as and  of  word  being  describes  'hall'  a d i f f e r e n t angle  The  provides  "'Whole' was from  from  the  is a positive state  English  provides  p.  been d e r i v e d  Investigating  "health",  in Sanskrit  translated  These a c c o u n t s  1981).  has  - whole - h e a l t h ) "  "health".  1976,  links  i n d i v i d u a l wholeness.  man's p e r s o n a l i t y .  state; contented;  (Monier-Wi11iams,  culture  suggests that  health  in Middle  i s derived) word  of  "health"  word  "health"  for health  of the  word  (Keller,  (hal - h o l e / h a l e  The  meaning  that  a l l aspects of the  identifies  "health"  a d i f f e r e n t fundamental  p o s i t i o n that  origination  word  "Health"  Word  development  encompassing  Health  phenomenon.  of wholeness  f o r the  and  account  on  of the  i n t e g r a l aspects  represent  i s proposed  historical  of h o l i s m ,  of the  o f the  concept  support  as  derivation  etymological  conceptualization  It  of the  concept  for health  Derivation  Perspectives  derived in  Old  44).  language on  for  the  the  from  literal  health,  " s e l f - a b i d i n g ; being  healthy  i n body and  in  mind"  1277). d e r i v a t i o n and health  meaning  perspectives  viewpoint,  psycho-physio-socio-cultural-spiritual  the  on  of the the  word  human  i n d i v i d u a l i s "a  being"  r e l a t e d to  being. whole  his/her  25 total  environment  Perspectives As  (1974;  found  noted,  theoretical  (Dorsey  & Jackson,  in Sociology.  the  concept  1982)  represent  The  two  p.  Philosophy  of h e a l t h  perspectives.  1976,  77).  and  Theology  i s constructed  work o f P a r s o n s  significant,  from  various  (1979) and  contrasting  Twaddle  sociological  v i ewpo i n t s. Parsons health  as  deviant health  (1979),  a social  notions  of  social  focus.  In  by  line  "grounding"  appreciation smaller ones"  (1982,  conceived context,  and  ethnicity client  and  context  understood  situational  to  Callahan  in the  but  a l s o an class  He  are  on  the  "meaning"  advocates  proposes  that  of l a r g e r  consequently  according  to  personal  circumstance,  According  t o Twaddle,  experiences  i n c r e a s i n g sense d i f f e r e n c e s as  health  context  socio-economic  system  from  biopsycho1ogical,  Twaddle  events.  illness  factors.  a  emphasis  statuses constructed  related  and  not  of  only  the problems  alienation  w e l l as  clinical  and  factors. (1982),  Beauchamp  (1982),  of  conformity.  social  e c o n o m i c and  organizational  life  relativity"  inseparable  r a t h e r than  experience,  of  in today's health care  to  c o n t r o l and  Health  of communication, related  them as  describes  socially  "cultural  347).  thus  of  champions a s o c i o l o g y of  individual  be  sociology,  a form  sociology's current  "need t o  o f as  social  1982)  with of  p.  perceives  a socio-cu1tura1,  of the  units  Parsons  role,  (1974;  characterized  s i c k n e s s as  While r e c o g n i z i n g the  sickness,  Twaddle  and  norm, and  behaviour. and  a f o r e f a t h e r of medical  Boorse  (1982) and  Capra  26 (1983) o f f e r some p h i l o s o p h i c a l characteristics competing  of health.  approaches  health  may  be  social  well-being"  Organization dimensions being  as  not  argues that  from  health  health  the organism's  health  (1983),  attempt  i s a "state  i s normality  the p h y s i c i s t turned  of health,  Capra  models o f l i v i n g  organisms  will  health".  i s viewed  as an  Health  approximate multiple Capra  models  "that  mirror  a s p e c t s o f t h e complex  summarizes h i s p e r s p e c t i v e Once t h e r e l a t i v i t y of h e a l t h experience  philosopher,  and  i s perceived, of health  and  health, which  (1982)  is deviation  speaks be  t h e need  proposes that  of  known to  "different  to d i f f e r e n t d e f i n i t i o n s of  a web  as  of  p. 4 4 ) .  (p.68).  i n t e g r a l part  and  well-  "natural  disease  Emphasizing  lead  Health  mental  1982,  Boorse  e x p e r i e n c e whose q u a l i t y can  but n e v e r q u a n t i f i e d .  definition  and  and  well-being"  (p. 5 3 ) .  species",  and  definition  of p h y s i c a l  functioning  mental  of " p h y s i c a l  of  that  of the World  (Beauchamp,  i n t h e sense  of the  natural  as a " s u b j e c t i v e  intuitively"  physical,  t h e WHO  and  suggests  the p h y s i c a l  impairment  "mental" w e l l - b e i n g  organization  Capra  only  prominent  He  i n the d e f i n i t i o n  (1982) a r g u e s a g a i n s t  encompass  functional  stated  of complete  significant  proposes that  need  "a s t a t e  i n d i v i d u a l ; o r as a s t a t e  w i t h o u t any  the  Beauchamp n o t e s t h r e e  (WHO); as e n c o m p a s s i n g  of the  on  to the v i s i o n of h e a l t h .  seen as  Callahan and  perspectives  of l i m i t e d ,  o f r e l a t i o n s h i p s among  fluid  phenomenon o f  life".  follows:  subjective i t also illness  nature of the concept  becomes c l e a r t h a t is strongly  the  inf1uenced by 4  27 the  cultural  sick,  normal  culture The  vision  of h e a l t h the  and  of h e a l t h  proposed  theologian,  of h e a l t h , life  concept.  Tillich  which a r e  Tillich  united  Concordant  states  the  that  health  of  psychological, historical exerts  What  insane,  i s healthy  varies  and  from  320-321)  Capra r e c o g n i z e s  r o l e of c u l t u r e  upon  health  and  (1961),  one  the  subjectivity  in d e f i n i t i o n  spiritual  and  of  in order  to  health  o f an  to  the  historical  understand  acknowledges the  meaning  the  perspectives,  93-99).  nature Tillich  result  mechanical,  (p.  is  a l l "dimensions  i n d i v i d u a l i s the  of h i s b e i n g :  following illness  section,  of  biological,  Tillich's  i n f l u e n c e which  found  some o f t h e  i n the  literature  T r a d i t i o n a l biomedical  of the  s o c i o - c u l t u r a l perspectives  by  health  These  specifically  health  culture  health.  reviewed.  the  view t h a t  must c o n s i d e r  holistic  health  each d i m e n s i o n  poses the  Referring  i n man"  with  overall  dimension  In t h e  are  p.  by  states that  of h e a l t h .  the  i t occurs.  sane and  (1983,  acknowledges the  multidimensional  of  abnormal,  to c u l t u r e .  and  i n which  concept. The  a  content  care  perspectives  disciplines, represent  the  are  on  explanatory of  m e d i c i n e and  perspectives, health  and  presented  models  and  a  illness  in t h i s  p r o f e s s i o n a l domain  of  nursing number  advanced  discussion. in Kleinman's  framework. Traditional  Biomedical  Medicine is  absent  Perspectives  traditionally  (Redlick,  1976;  views h e a l t h  Sebag,  1979).  as  a s t a t e where  From  the  disease  disease oriented  28 perspective  o f modern m e d i c i n e ,  as  one w i t h  no d e t e c t e d  no  irregularities  healthy". Redlich  This (1976).  is  i s completely  no p e r f e c t  i s viewed  (Sebag, society  investigators ethnicity  free  enduring  Health  rather  "when  t o be  b l u n t l y by  i s the absence of diseased  a c e r t a i n minimal  from d i s e a s e  o r , t o put i t  state  to the physician  of health,  ... fis no human  over a l i f e t i m e ,  of health  1979),  and t h u s  a concept  i n general.  In o r d e r  are focusing  on s o c i a l impact  there  even a t a m i n i m a l  as a s t a t e h a r d e r t o c o n c e p t u a l i z e not w e l l  to better  than  understood  understand  environment,  health,  c u l t u r e and  upon t h e d e f i n i t i o n and  Perspectives  (1973) and Blum  of the i n d i v i d u a l .  within  the Health  (1983) p r e s e n t Human b e i n g s  personality  level,  or subsystem,  Care D i s c i p l i n e s  us w i t h in this  possess a h i e r a r c h i c a l s t r u c t u r e within  each  (1979) s t a t e s  of health.  Socio-Cultural Brody  health  i s no l o n g e r  state  as v a r i a b l e s which  experience  concept  i s described  o f view,  has r e a c h e d  (p. 270)  within  to  point  level,  disease  on h e a l t h  i s o f no f u r t h e r c o n c e r n  being  Sebag  an i n d i v i d u a l i s presumed  Once a p a t i e n t  differently, he  individual is identified  He s t a t e s :  From a m e d i c a l disease.  abnormalities.  a r e found,  focus  a healthy  their  a systems context  a r e seen  personality,  with  contributing to individual  health. Health  i s seen a s an o n g o i n g  change and a c t i v i t y  process,  manifesting  continual  as t h e i n d i v i d u a l r e s p o n d s t o e n v i r o n m e n t a l  29 challenges.  Systems t h e o r y ,  the  psychic  somatic,  particularly  relevant  culturally-specific importance the  of the  experience The  illness Patrick, other  value  on  the  comparison  the  systems.  The  and  He  authors  and  nursing  field  1985a,b; need  has  for culturally  nursing  relevant  the  stress  importance  in  1980,  1984) and  factors.  Bergner  (1985)  importance Zola,  of  in h i s  symptoms,  are  found  1966 that  conditions differently  due  to c u l t u r a l l y background  and  specific  to c o n t r a s t i n g  experience.  principles  of  current  presented  next.  The  work  of  discussed.  views.  contributed  recognized the  and  values.  same  of t r a n s c u l t u r a l n u r s i n g 1988)  Carter  knowledge a r e is  the  environment  socio-cultural  differently  researchers  Cross-cultural the  by  ubiquitous  and  is  a  social  emphasizes the  to the  as  (1978a,b,  linked socio-cultural  response  areas,  of  knowledge p e r t a i n i n g t o h e a l t h  of h e a l t h  main p e r s p e c t i v e s  cross-cultural  and  i n t e r p l a y o f c u l t u r e and  same d i s e a s e  a composite  i t acknowledges  of Kleinman of  as  1983).  Somerville,  e t h n i c groups accept  definition  key  body  whose r e s e a r c h  cross-cultural  perceive  natural  (Blum,  research  of h e a l t h  in that  concepts constructed  authors  various  surrounding  and  person-level  study  construct,  Sittampalam,  research  to the  a significant  as  social  of h e a l t h  theory  represent  and  describing health  Leininger's (1967,  1970a,b,  significantly  nursing  care.  i n f l u e n c e o f c u l t u r e on of u n d e r s t a n d i n g  monumental work i n 1984,  to awareness of  the  O t h e r n u r s e s have  definition the  1977,  of h e a l t h  perception  of  also  and  clients  30 from  other  1983,  cultures  1985;  •rque,  Fong,  Bloch  Spector,  1981a, 1987;  1985;  1983;  Theiderman,  research  1985a,b,  & Paxton,  Hancock  & Monrroy,  1979;  of n u r s i n g  (Branch  1987;  Shubin,  1988;  Struser,  1985).  cross-cultural  presented  an  knowledge  understanding  in t h i s  Leininger and  nursing  a  (2)  "the  culture  (3)  "the  holistic  "the  background  o f an  in  and  often  of h e a l t h  his/her  unique  Hancock and beliefs  and  (Anderson,  Anderson  & Lynam,  Examination  of  discussion  of  the  earlier of  chapter,  the  and  nursing  a blending  made t o  nursing  comparative  of  anthropological  following contributions  theory: perspective  of  man";  cultural  context  approach  in  the  man"; that  health  and  illness  p r i m a r i l y determined  individual"  perspectives  meaning  volume  concept";  realization and  These  has  of  influenced  1985;  A growing  state  emphasizes the  " c r o s s - c u l t u r a l and  understanding  i n the  current  advocating  perspectives,  which a n t h r o p o l o g y  (4)  of the  expands on  1981;  area.  (1970a),  (1)  1977).  1982;  Dobson,  Mercer,  Sobralske,  & Chung,  authors  provides  1985;  1981;  c r o s s - c u l t u r a l focus  work o f a number o f t h e s e literature  Carpio,  1980;  White,  this  Anderson  Majumdar & C a r p i o ,  & Perkins,  1986;  supports  1976;  are from life  (p.  by  s t a t e s are the  strongly  cultural  21-22).  significant  t o an  i n v e s t i g a t i o n of  the  point  of the  vantage  the  individual  located  context.  Perkins  (1985) have n o t e d  attitudes heavily  that  i n f l u e n c e both the  cultural state  of  values, health  31 itself  and  individual  emphasizes as  the  identical  need  fact  with  that  the  assess  unique  perspective  Carpio adolescent  the  discussion  within  client  that  following  Health  and  specifically  for  i n h e a l t h and  need  to  client's  "find  the that  the  perception  (p. 7 5 ) .  needs  of  cultural In  her  illness,  a way  Bpector  of c a r i n g f o r  of the  Spector  can  health  the  problem  makes t h a t  be  i n t e r p r e t e d and  explained  i n terms  There are  many ways  experience  and  expectations.  in  w h i c h we  can  ...  health  or  s t a t e s mean ...  i n our  daily  define  what  these  from  our  own  c u l t u r e and  healthy,  how  to r e c o g n i z e  w h i c h we  recognize  society.  personal  illness  viewed  underscores  the  of  and  be  statement:  illness  Furthermore,  cannot  (1980) a d v o c a t e s  on  need  Canadian  diversity  problem"  significant  (1977)  client.  nurses  of that  and  Shubin  emphasizes the  matches t h a t  treatment  population,  multicultural  (1979) p r o p o s e s t h a t  White  f a c t o r s i n h e a l t h and  focusing  of c u l t u r a l  state.  of e t h n i c o r i g i n  sensitivity.  of the  immigrants,  sensitivity  peoples  cultural  (1981),  of the  mainstream  for cross-cultural  nurses  and  perception  the  illness  and  lives.  e t h n i c b a c k g r o u n d s how illness,  meanings a t t a c h e d  are  related  to the  define  a given  experience  and  how  to the  to  determine We  must  to  be  be  notions  ill. of  basic, culture-bound and  perception.  learn  health values  (1979,  75) Anderson's Anderson  extensive  & Chung,  1982;  qualitative  Anderson  research  & Lynam,  1987)  (1981a, on  1985a,b;  h e a l t h as  a  by p.  32 socio-cultural  construct,  cultural  groups h o l d  Studying  the  child's  long  defined  differently  and  white  children.  Chinese  parents  to  be  facet  illness  the  to  framework  f o r examining  which  provides  Indians  perspectives  on  health.  of h e a l t h  held  following  overview  to  this  by  how  Since  Chinese  & Chung, that  socio-cultural factors on  and  research.  held  by  shape  the  perception  is unavailable, findings  a  of h e a l t h  of h e a l t h  research  health  experience.  perceptions  of S o b r a l s k e ' s  1982).  (1985b) p r e s e n t s  s i m i l a r research  as  considered  p r a c t i c e and  India  i l l  happiness  for nursing  i n d i v i d u a l s from  they  the  is pertinent  discussion.  Sobralske's cross-cultural perception cultural  of the  illustrates  and  proposal  Anderson  were  chronically  s o c i o - c u l t u r a l context  guidance  account  i s the  their  goals  parents  (Anderson  noted.  of  contexts.  individual's subjective  the  been  i n t e r m s o f what  white  important  has  health  for their  while  work o f K l e i n m a n ,  Sobralske's Navajo  the  that  contentment  o f A n d e r s o n ' s work  Referring  illness  the  regarded  various  perceptions  cultural  state  goals,  illness,  found  to d i f f e r  most  incorporate  and  which  parents'  different  a desirable health  normalization  and  within  most d e s i r a b l e h e a l t h  A core  on  Anderson  f a m i l i e s were f o u n d as  perceptions  health  influences  illness,  envisioned  the  the  regarding  cultural term  and  (1985) s t u d y enquiry  of h e a l t h .  group r e f l e c t s  phenomena; a view w h i c h  of Navajo  specifically She  focusing  notes that  that  culture's  includes  Indians  the  i s an  of  on i n d i v i d u a l  language  unique  definition  example  employed  view of  of h e a l t h .  by  a  world Sobralske  33 mentions, better  f o r example,  understood  motion"  is  to d e f i n e health,  because  "they  the  definition  from  o f not  Navajo  being  (p.  vary  be  The  a l s o found  to  perception  of h e a l t h  in  mind"  " i f not  an  and  really  regard  health  inseparability essential  to  situations",  i n harmony w i t h  of  component  i s compared  to t h r e a t e n i n g  (1985) r e s e a r c h of h e a l t h ,  among c u l t u r e s .  individual  encouraging  about  as  underscores well  as  the  the  Consequently,  the  of  "a  and  surrounding  fact  that  t e r m s used effective  his/her perception  a d e s c r i p t i o n of the  phenomenon,  ways  of h e a l t h , may  to  differ  denote of  and from  to c u l t u r e .  Health Although  and  of  professionals  and  backgrounds, indigenous  Illness:  Western  practitioners  Sanskrit  be  being  have n e v e r  before"  surroundings.  vulnerable  conceptualizations  an  may  35-37).  Sobralesky's  culture  of h e a l t h  "a p e r f e c t body and  environment  asking  their  h e a l t h was  Navajo c u l t u r e .  health,  universe  difficult  and  includes  of the  i t very  inseparable  state  "concept  perceptions  found  about  religion  when t h e i r  individuals  impossible"  as  Navajo h e a l t h  recognized.  Navajo  thought  that  (allopathic)  indigenous  texts),  Yunani  from  are  systems are  o r Greek  in  consulted  groups. Ayurveda  medicine  held  i s common  a l l social  occupational  medical  Beliefs  medicine  medicine  laymen a l i k e  e t h n i c and  Indian  Traditional  India in India,  by  classes, The  traditional  (based  (based  religious  on  upon  Arabic  and  34 Persian  texts),  medicine). The "coded  In  Siddha  Homeopathy  Ayurvedic  into  popular  and  and  domestic  culture  addition  (a S o u t h  is also  Indian  practiced  o f h e a l t h and  culture,  cuisine,  religious  of p h y s i c i a n s t r a i n e d  laymen  astrologers  concerning  Pn  of the  essential  on  concepts  the  (Leslie,  concepts  physicians,  information  widely  o f humoral  Yunani  often c o n f e r with  ritual  (Western) and  Holy  h e a l t h problems  men,  the  medicine".  and p.  244).  provides  illness  are  indigenous  1978,  t e n e t s of Ayurveda o f h e a l t h and  and  priests  (Leslie,  1978).  illness  in cosmopolitan  to c o n s u l t i n g cosmopolitan  overview  system  useful  traditional  to  India. •beyesekere Ayurvedic (1)  "an  system  (1978) n o t e s of  indigenous  two  fundamental  f e a t u r e s of  the  medicine: conception  of the  body  (and  mind) and  its  funct ions"; (2) in  "indigenous  conceptions  t u r n d e r i v e d from  the  conceptions  of a great  even  cosmological  larger In  sees The  the  units  fire,  the  a i r and  space.  blood,  or,  and as  be  Ayurvedic  These  comprise the  flesh,  the  philosophical  view"  five  five  f a t , bone,  Indian  (wind,  components marrow, and  an  culture  with  elements:  elements are  3 humors  of  256).  relationship  of the  7 physical  (p.  tradition,  a fundamental made up  f u n c t i o n s are  in a l l t r a d i t i o n s ,  or s a c r e d w o r l d  to  "water") and  juice,  tradition,  having  and  p h y s i o l o g y and  metaphysical  i s seen  of a l l l i f e ,  phlegm  (food  with  individual  universe  water,  and  accordance  o f body  the bile  of the semen).  nature.  earth, basic "fire" body Health  35 is  seen  with  as  a  harmonious  believed  to  consequent the  state  5  functioning  disequilibrium  foods taken  Kakar,  at  Indian restoration  Vora,  mental  balance  the  consumption  right  form,  proportion,  body a r e theory  s o m a t i c and  American culture  of  environmental  of  natural  e l e m e n t s and  of  environmental and  i n a complex  health  as  elements,  an  care  Black,  Latino/Hispanic,  Indian  communities.  The  Kakar  India. United  literature  Japanese, majority  (p.  from  As  the  yet  in  right constituents  aesthetically of  231)  India of d i s c u s s i o n  a reflection  States, focuses  Chinese, of  at  thus  matter  equilibrium  i s e s s e n t i a l l y devoid  health  upon  s u b s t a n c e s and  Individuals  i n the  1984;  bodily  literature  found  (Helman,  equilibrium.  on  i n d i v i d u a l s from  certain  for different  Literature  populations  cross-cultural  physical  with  and  contain  or  combination  a l l integrated of  Foods a l s o  or c o l d ,  balance  the  plants,  3 humors,  l a r g e l y based  of  seasons,  Illness is  perspective:  on  ...  balance,  1986).  and  t h i s Ayurvedic  the  i s maintained  of  physical  systems.  y e a r and  approaches are  elegant  ethnic  1978;  hot  the  health  rests  the  as  of  health  time  the  that  of  in optimal  individual.  therapeutic  restoration  the  of  i n the  Dbeyesekere,  (1982) e x p l a i n s The  i s imbalance  classified  so  humors a r e  physiological  d i f f e r e n t times  conditions  1982;  of  are  three of  a r i s e when t h e r e  e l e m e n t s and  physical  where t h e  of  the  on  the  American primarily  V i e t n a m e s e and  textbooks  of  on  American  cross-cultural  36 health  care,  such as t h o s e by S p e c t o r  Orque,  Bloch  and  not  include  information  Canadian of  and  information  Dobson's looks  Monrroy  community literature  and  B r a n c h and  Paxton  i n d i v i d u a l s from  India.  1985)  care  almost  work w i t h  (Buchignani,  1987;  Struser,  1985).  focus  198©;  research  on  perspectives  on h e a l t h  India  on  groups  in B r i t a i n  the  the Sikh  Canadian  i n d i v i d u a l s of the et a l . , 1966;  Sikh  G i b s o n et a l . ,  i n the subsequent  Indo-Canadians' h e a l t h  are l i m i t e d  India.  discusses  noted  do  sources  encounter within  however,  Detels  Ps d e s c r i b e d  a c c o u n t s and  ethnic  Previously  a similar 1977,  from  Dobson,  exclusively.  faith  (1976),  o f i n d i v i d u a l s from  various  immigrants  system.  reflects  (1981),  p u b l i c a t i o n s c o n s t i t u t e t h e main  on t h e p e r s p e c t i v e s  (1983,  health  about  British  at t h e p r o b l e m s  Western  (1983)  (1979), Harwood  section,  c o n c e r n s and  i n number.  Indo-Canad i a n s In t h e d i s c u s s i o n o f t h e b a c k g r o u n d of the a v a i l a b l e l i t e r a t u r e literature  was  socio-cultural rather  characteristics  than h e a l t h  Columbia  history  of the Sikh  has  on h i s t o r i c a l  of the  Most  and community  community  f o r t h e most  i n the province part  (Pmes & I n g l i s ,  Tanaka  (1981)  research  on  on t h e 1973;  focuses  but a l s o r e f e r s t o I s m a i l i i s m and published  cited.  Indo-Canadian  Indo-Canadians  focused  s t u d y by D r a k u l i c and  Most  was  a portion  issues.  discussing  British  population  Indo-Canadians  seen t o c o n c e n t r a t e  Literature  The  on  t o t h e problem,  life  Bains,  on t h e  Sikh  Hinduism.  Indo-Canadians  of  i s disease  and 1974).  37 oriented.  That  o f Ough  (1966),  Gibson  already  been n o t e d  studies  issues,  as r e p r e s e n t a t i v e  examining  help-seeking  health  Indo-Canadian  concerns  (Struser,  1985),  are  (1985a) r e s e a r c h ' o n t h e h e a l t h  i s an  example  from  (1986)  has  are  e x p e r i e n c e of h e a l t h  e x p e r i e n c e s of Indo-Canadian  Indo-Canadians  D e t e l s et a l .  of t h i s r e s e a r c h .  Indo-Canadian  as c h i l d b i r t h  Anderson's  (1971),  Bindra & Gibson  addressing subjective  such  immigrants  Smith  et a l . (1987) and  Investigations and  (1976),  of i n v e s t i g a t i o n  and  scarce,  related  rare. concerns  and  Greek women  focusing  on  a feminist  perspective.  To  date  no  research dealing  specifical1y  with  men  has  been  found. The  recent quantitative  investigating  the concept  study  of h e a l t h  populations,  i s noteworthy  specifically  aims f o r s u b j e c t i v e  view in  on h e a l t h .  definition  health  perspectives account  of h e a l t h ,  The  study,  and  offers  however,  of the h e a l t h  and  phenomenon.  of the  Indo-Canadian  of Hindu,  S i k h or o t h e r  ethnicity.  Literature  on t h e h e a l t h  concerns  largely  not  grounded  in research.  of  which  of  culture  of the concept social,  mental  focus e x c l u s i v e l y  study  somewhat  also  sample  fails  of and  on  the  narrow to  specify  population in  Indo-Canadians  Thompson's  ethnic  Indo-Canadian  importance  p r e s e n t s an The  Canadian  of the  description  does not  (1988)  only research  description  r e c o g n i z e s the  of Indo-Canadians  characteristics  terms  as a p p a r e n t l y t h e  survey  Carpio  among s e l e c t e d  a c c o r d i n g t o f o u r components: p h y s i c a l ,  lifestyle.  the  This  by Majumdar and  is  (1987) a r t i c l e  on  health good  promotion  example  needs  of recent  of t h i s  nursing  s t r a t e g i e s f o r Indo-Canadian  group,  journal  literature  women i n Ottawa i s  focusing  but l a c k i n g t h e s u p p o r t  on t h e h e a l t h  of data  from  actual  research.  Summary To  provide  a background  various  perspectives  through  an o v e r v i e w  derivation  contrasting  views  perspectives  disciplines,  on h e a l t h  and i l l n e s s ,  were summarized  cross-culturally  concept  of t h i s  nursing  This with  research  focusing  context,  which  the health  of t h e i r  specifically  care  contribution to  d i s c u s s i o n shows t h a t  to social  context.  r e v i e w was c o n c e r n e d because  with  of i t s s i g n i f i c a n c e to  theory  as c u r r e n t  and i l l n e s s supports  health  vary  of L e i n i n g e r  to c r o s s - c u l t u r a l nursing  on h e a l t h  biomedical  as some o f t h e  parameters that  (1985b) was n o t e d  of the  for holistic  Traditional  as w e l l  i n v e s t i g a t i o n . The n u r s i n g  work o f A n d e r s o n  account  d i s c u s s i o n o f some  within  literature  as f u n d a m e n t a l  fin  presented  i n the s o c i o l o g i c a l ,  i n terms  and a c c o r d i n g  portion  cross-cultural  found  of health.  r e m a i n s an a b s t r a c t  emphasized  presented  study,  have been  o f f e r e d support  and i n t r o d u c e d  perspectives  conceptualization  P. major  of health  literature.  "health"  on h e a l t h  the current  and t h e o l o g i c a l l i t e r a t u r e .  socio-cultural  current  of s e l e c t e d  on h e a l t h ,  philosophical  the  on t h e c o n c e p t  o f t h e word  perspectives  f o r viewing  within  the focus  was  enquiry.  qualitative  The  nursing  the s o c i o - c u l t u r a l of the current  39 s t udy. The  key  concepts  perception  of h e a l t h  background  to the  studies  specific  Carpios'  recent  various  Canadian  investigation on  health.  components:  Sobralske's  were d i s c u s s e d  present to the  research,  (1988) r e s e a r c h ethnic  framed  on  details  of t h e  particularly  useful  the  of  health  perspectives  as  apparently  restricted  characteristics  and of  the  only  Indo-Canadian  however,  and  Navajo  similar  Majumdar  address  mental  lack  the  culture.  study,  d e s c r i p t i o n of h e a l t h social,  on  noted  specifically Carpios'  (1985) s t u d y  given  the  g r o u p s was  to  lifestyle,  as  Indo-Canadian  Majumdar and  quantitative  specify  from  provides  to the  a  four  p h y s i c a l , and  of the  views  fails  Indo-Canadian  to  sample  population. Examination surrounding background on  the  health  Indo-Canadian  health. The  on  The  this  need  supporting  concepts  cultural  in t h i s  this  study.  Current  health  was  found  group's  influenced  in order  to c o n t a i n  unique  in t h i s  chapter  by  to  The  and  virtually  is clearly  revealed  health  gain  on  a factors.  t o adopt  insight  into  Chapter  methodological  following chapter  no  evident.  as  socio-cultural researcher  system  literature  perspectives  area  of h e a l t h .  theoretical  research.  belief  valuable  s u b j e c t i v e experience  grounded  India's  further  framework d i r e c t e d t h e approach  of  provided  for this  community  i n t r o d u c t i o n to the  which  illness  concept  phenomenological individual  primary  for research  discussion  multidimensional  an  and  information  information  The  of the  the  the  one  provided  perspectives will  present  details  of the methodology  used  i n the  study.  4-1 CHAPTER 3: METHODOLOGY  This  chapter describes  qualitative procedures  research.  the p i l o t  research  carried  are detailed Issues  of r e l i a b i l i t y  phenomenological  methods used  theoretical  sampling  participants  Theoretical, that  " a l l actors  knowledge or  sought  culture  interviewed Morse the  than  methods,  employed  i n contrast  the researcher  and outcome of actual on p a r t i c i p a n t  i n phenomenological  theoretical, to the p r o b a b i l i t y  quantitative ultimately  in a setting  sampling  i s based  a r e not e q u a l l y  by t h e r e s e a r c h e r " .  research.  selects  t o t h e needs and d i r e c t i o n  others  (Morse,  of the research. upon t h e p r e m i s e  informed  Some i n d i v i d u a l s  underlying  Because t h e r e s e a r c h e r  1986, p.  the following  In  t h e study  about t h e i n a group  as more k n o w l e d g e a b l e and r e c e p t i v e  (1986) p r o v i d e s  assumptions  discussion  by t h e  sampling  research  or s e l e c t i v e ,  a r e viewed  The c o n d u c t  and v a l i d i t y  i n deductive,  according  as d i r e c t e d  of Participants  Theoretical  sampling  p a r t i c i p a n t s and  in conclusion.  Selection  nonprobabi1 i t y sampling  in this  out p r i o r t o commencement  i n the preliminary  are considered  This  o f study  method, a r e p r e s e n t e d .  study  selection. research  The s e l e c t i o n  used  f o r d a t a c o l l e c t i o n and a n a l y s i s ,  phenomenological of  t h e methodology  t o being  183). relevant  d e s c r i p t i o n of  non-probability  sampling:  i s interested  i n meaning,  42 understanding and  a concept,  the object  relevant,  t h e sample  size  and t h e t i m e  small  sample  data,  i t is essential  (p.  (Duffy,  to test  sampling  saturated  obtain r i c h  data  1980).  The method  process  when  descriptions",  of the  r e q u i r e d to c o l l e c t  describes  this  data  possible,  i n that  "repetition  completeness  (1986,  samples and advance  until  data c a t e g o r i e s are  Adequacy  o f t h e sample i s redundancy i n  of statements  regarding the  ( P a r s e et a l . , 1985, p. 17).  of sampling  Morse  as t h e p o i n t a t which  makes sense,  and has been  p. 184).  r e s e a r c h e r using n o n - p r o b a b i l i t y sampling  not  aim t o g e n e r a l i z e s t u d y  the  traditional  quantitative  findings sense.  In q u a l i t a t i v e  in "their  researchers  "generalizabi1ity  that  as no s i t u a t i o n  natural  can ever  techniques  does  t o the p o p u l a t i o n at large i n  phenomena a r e examined argue  of the  T h i s r e s e a r c h method does not  which c o n t i n u e s  occurs  the context  involves a continual  "does not have any gaps,  confirmed"  into  "the r e s e a r c h e r experiences  phenomenon u n d e r s t u d y "  illusion"  because  insightful  to enter  and no new themes emerge.  accomplished  The  Thus,  notes, i n  t h e r e s e a r c h e r maximize  i s used  1985; S t e r n ,  theory.  decision-making  theory  verbatim  and e f f o r t  t o o b t a i n t h e most  phenomenon under s t u d y ,  aim  comprehensive,  183)  Theoretical  theory  that  size.  of the s e t t i n g ,  are  the voluminous  limits  opportunities  sense  i s to obtain data that  and d e t a i l e d ,  bulk alone,  and making  settings", is itself  be e n t i r e l y  research, and something  context  free.  o f an  43 Qualitative can  be  research findings  found  i n the  Sandelowski should  be  particular"  states  viewed  are a p p l i c a b l e  that  (Sandelowski,  applicability  Referring  t o t h e work o f Guba and  describes  this  ft s t u d y  meets t h e  can  'fit'  its  audience  in  terms  of the The  into  contexts  views  findings and  ...  i t s findings own  'fit'  the  this  experience  the data  their  as  (1981),  Sandelowski  when i t s f i n d i n g s  situation  meaningful  and  In a d d i t i o n ,  from  which t h e y  i n the  typical  life  and  and  when  applicable the  findings  are d e r i v e d .  experiences  atypical  elements,  for Selection  were s e l e c t e d  phenomenon under s t u d y (Anderson,  criteria  the  time  of the  and  converse  interviews  had  and  in English  b a s i s of t h e i r  their  of study  ability  so t h a t without  the the  to  experience communicate  1984). participants  were  o f 25-60 y e a r s who  i n Canada f o r at  a l l participants  independently for  the  between t h e age  resided  study;  on  1985a; Knaack,  for selection  Indo-Canadians  i n I n d i a and  Rationale  research  32)  with  born  31).  fittingness.  study  experiences.  are well-grounded reflect  Participants  follows:  of  for fittingness  o u t s i d e the  Criteria  The  p.  "general  follows: criterion  of t h e i r  study  studied (p.  as  Lincoln  1986,  the  of q u a l i t a t i v e  i n terms of the c r i t e r i o n  "fit"  in that  least  were t o be  as were  5 y e a r s at  able to  read  r e s e a r c h e r c o u l d conduct a l l a i d of a  translator.  Criteria v.  Hindu r a t h e r than  Sikh  individuals  were s e l e c t e d  for this  44  study  because:  research command  has  generally with  the  they  English from  come from  urban  age to  access to  I n d o - C a n a d i a n s who the  time  participants' for  residence  men  (3)  increased  of  life  ability  sexes respond  speaking  status,  and  no  included  First  the  fact  detailed  likely  A  wide  of  five  well  as  opportunity  A maximum t i m e  i n the  the  order  insure  of  sample. study  in order  is involved  e r r o r of assuming that  the  generation  as  sex-difference  avoid  longer  with  provide  were s p e c i f i e d t o  i f any  The  is familiar  researcher.  s p e c i f i e d f o r the  Hindus q u i t e  formal  sample.  Sikh  immigrants  for p a r t i c i p a n t s in  society.  similarly.  English  set  of  community.  to  the  in Canadian  and  that  Hindu  familiarity  culture,  discover  to  group's  researcher  Hindu  in India's  not  this  i n Canada f o r a minimum  study  women were  of h e a l t h ,  since  the  phenomenon t o  resided  superior  less  p a r t i c i p a n t s because  greater  adequate  had  be  of the  study  imply  of the  and  researcher  perception  the  an  i n Canada was  Both the  as  and  grounding  experience  assumed t h a t  Punjab,  (between 25-60 y e a r s ) was  assure  y e a r s at  rural  settings;  d e s c r i p t i o n of that  range  i t was  lifeways  experience  phenomenon o f h e a l t h , verbal  the  were s e l e c t e d  life  (2)  a group t o w a r d s which  l a n g u a g e would  t r a d i t i o n s and  of  represent  focused;  coming  Adults years  been  of the  individuals  (1)  that  in  that the  both  p a r t i c i p a n t s were  determined  socio-economic c r i t e r i a  a certain  social  were s p e c i f i e d f o r  sample. Selection In t h i s  study  Procedure  p a r t i c i p a n t s were r e c r u i t e d t h r o u g h  an  informal  45 network  o f c o l l e a g u e s and  investigation potential informal  focus  contact  the  researcher.  Initial  participants  was  made t h r o u g h  a person  network  p u r p o s e and  person  with  conduct  of the  A).  participation  signed  communicated  researcher  who  the  contacted  contact  form  indication informant  at the  the  from  with  this  the  researcher;  this  study  adequate  After  study  sample  in d e t a i l  participate reassessed  i n the the  In t h e  occurred.  form  case  of  had  the  any  with  those their  consent  to  not  for  potential  form  to  the  i n c l u d e d i n the been  the by  obtained.  researcher phone, and  individuals  participant's  the  participant.  questions  Upon a c t u a l  to  signed  Dne  already  phoning  phone t o convey  to contact was  then  directly  d e s c r i b e d procedure  informants  answered  study.  the  for contact,  arranged  potential  either  form  study  They  to contact  with  however,  potential  and  i n t e r v i e w was  the  in  form.  r e s e a r c h e r by  size  consent  the  person.  consent  individual,  with  by  consent  for contact signed  receiving  communicated  to contact  meeting  study  to contact  interested  researcher obtained  d e v i a t i o n from  mailed  a consent  informants  the  potential  i n f o r m a t i o n d e s c r i b i n g the  for contact  initial  of consent  as an  and  network  f o r c o n t a c t , the  one  study,  or r e t u r n i n g t h e  consent  Only  of  consent  consent  through  participants  the  suitable  letter  Potential  their  researcher,  presented  a formal  (see A p p e n d i x  initial  of  by  participants  the  advised  network.  The  the  acquaintances  meeting,  described  at t h a t time. who  agreed  the  researcher  suitability  for  An  to  inclusion  46 in  t h e study,  study  and t h e f o r m a l  (see A p p e n d i x A total  network  o f 16 i n d i v i d u a l s  f o r study  although  they  a  list  their  consent  o f 11, 3 p e r s o n s  size  o f e i g h t was d e t e r m i n e d final  Following  f o r contact  person.  and 2  Prior  i n study  The r e s e a r c h e r t h u s  informal  At  with  according  time  (see A p p e n d i x  the  study  a s a sample  Pilot  Study  of the research,  informal  to the c r i t e r i a  to provide  questions  f o re l i c i t i n g  Indo-Canadians.  meetings  through the  and c o n t a c t  procedure  sample.  C ) . The two i n d i v i d u a l s  were a s k e d  requested  assisted  this  in detail.  the researcher tested the i n i t i a l  questions pilot  From  the c h a r a c t e r i s t i c s of  two I n d o - C a n a d i a n women c o n t a c t e d  f o r t h e study  this  study,  be p r e s e n t e d  t o a c t u a l conduct  network  described  i n t h e study  obtained  sufficient.  of the p i l o t  population w i l l  were a r r a n g e d  people  sample c o n s i s t e d o f s i x women and two men.  description  sample  contacted  to the researcher  interest  were n o t i n c l u d e d  The  from  16, 3 p e o p l e  o f 11 k n o w l e d g e a b l e and r e c e p t i v e p a r t i c i p a n t s .  The  i n the  by t h e i n f o r m a l  i n t h e study,  expressed  t o t h e network  list  the  Of t h e s e  i n t a k i n g part  had i n i t i a l l y  participation  f o rparticipation  were c o n t a c t e d  participation.  to indicate  form  B) was s i g n e d .  were n o t i n t e r e s t e d failed  consent  the i n i t i a l  feedback  participating in q u e s t i o n s and  on t h e a p p r o p r i a t e n e s s  a description  The i n f o r m a t i o n  i n the formulation  trigger  trigger  of these  o f t h e phenomenon obtained  of health  from t h e p i l o t  of appropriate trigger  questions  test t o be  47 used  i n the research Both  of the p i l o t  transcribed of  research the  Pilot  to receipt  feedback  and one  was  The c o n s i d e r a t i o n s f o r p r o t e c t i o n  i n t e r v i e w s were  of formal  approval  testing  were  observed  commenced  f o r conduct  of the  p r o c e d u r e was c o m p l e t e d  of the research  during  period.  Results  initial  trigger  questions  were r e v i s e d a c c o r d i n g  during  the p i l o t  test.  obtained  participants and  Pilot  The p i l o t  two weeks  Study: The  study.  study.  first  i n t e r v i e w s were t a p e - r e c o r d e d ,  o u t l i n e d f o r the a c t u a l research  the p i l o t  subsequent  (see A p p e n d i x D).  by t h e r e s e a r c h e r .  human r i g h t s  during  interviews  described  o f f e r e d two  the i n i t i a l  suggestions  The two  trigger  regarding  pilot  questions  alteration  to the  as "good",  of the t e s t  questions: (1)  that  between (2)  that  using  study food  the r e s e a r c h e r  the question  description  should  ask about  "What do you t h i n k  suggested of h e a l t h  that  this  i n terms  h e a l t h and a c t i v i t i e s  final  study  single  carried  in  28 t o 5&  their  years,  m i d d l e 40s.  t h e phenomenon health"?  question  of h e a l t h  The  pilot  elicit  a  feelings  healthy.  o f t h e Sample  sample c o n s i s t e d o f e i g h t  with  would  maintenance,  out when  whom s i x were f e m a l e and two were male. from  the r e l a t i o n s h i p  about  of h e a l t h  Characteristics The  about  and h e a l t h ;  participants  about  p a r t i c i p a n t s be a s k e d  the majority  Indo-Canadians,  P a r t i c i p a n t s ' ages of study  of  ranged  p a r t i c i p a n t s being  48 The status  sample was q u i t e  and l i f e s t y l e .  Of  t h e 8 study  in  attached  of  whom  study  area,  and one l i v e d Seven  parent,  participants' most  One f e m a l e years  i n a nearby  had l i v e d  with 6 p a r t i c i p a n t s  various  areas  Several  of northern participants  not given  researcher's familiarity described  India,  i n the United  interviews. with  this  subject  One p a r t i c i p a n t , cultural  background,  Canadian  without  were born i n  t h e Punjab.  of health  medicines,  matter d u r i n g describing  mentioned  her Indian  f o r three  p a r t i c i p a n t s had  The two male p a r t i c i p a n t s Indian  12 y e a r s .  to the researcher that  t o t h e meaning  traditional  6 1/2 t o 21  Kingdom  Participants  including  commented  much t h o u g h t  from  i n Canada f o r about  India.  having  o f t h e study, t h e  p r i o r t o coming t o Canada; t h e r e m a i n i n g from  Vancouver  and one was a s i n g l e  i n Canada r a n g e d  had l i v e d  come t o Canada d i r e c t l y  had  were m a r r i e d  of residence  participant  self-employed.  municipality.  had c h i l d r e n ,  participants  The r e m a i n i n g  i n the Greater  a t home. fit t h e t i m e  time  homes, and 2  in professional  g r o u p were  lived  means.  were homemakers,  t h e home.  employed  in this  participants  participants  living  i n free-standing  outside  were c u r r e n t l y  of the participants  fill  children  worked  two i n d i v i d u a l s  of the eight  6 lived  were o f c o m f o r t a b l e  T h r e e women i n t h e s t u d y  one o c c a s i o n a l l y  Seven  i n terms o f s o c i o - e c o n o m i c  participants  participants,  participants  years;  fill  dwellings.  occupations;  homogeneous  the fact  heritage".  indicated  of the  of pride  that  p r i o r to the  and s p o n t a n e o u s l y  the course  t h e sense  they  interviews.  she had i n h e r  she " c o u l d n ' t be  For this  participant,  49 being  Canadian  meant  being  Indo-Canadian.  Data The  phenomenological  experience  researcher by  "subjectivity"  constructed encounter  researcher  of  world"  that  interprets suspending,  it.  "clearer  focus"  "the n a t u r a l a t t i t u d e to  biography,  to i n t e r p r e t e d experience  a r e removed  words,  the researcher  i s not a " t a b l a r a s a " ,  i s the process  aside,  is controlled (Knaack,  During  the " l a y e r s  these  o f t h e phenomenon under  experience"  r e q u i r e s the  so t h a t  In o t h e r  Bracketing  the perspective  collection.  t o t h e way t h e i n d i v i d u a l  or s e t t i n g  from  approach  data  lays aside  personal  give r i s e  t h e mind  appears according  on  from  i s rather  and p a r t i c i p a n t .  human e x p e r i e n c e  the researcher  of data nor  phenomenon d u r i n g t h e  the phenomenological  resulting  "Meaning"  by t h e  t o be b i a s e d  i n the c o l l e c t i o n  of the p a r t i c i p a n t s .  198&, p. 7 2 - 7 3 ) .  recognizes  meaning  involvement  to appreciate  meaning" which  of a d e s c r i p t i o n of the  o f e x p l o r a t i o n shared  t o use " b r a c k e t i n g " d u r i n g  process,  (Oiler,  full  human  Data a r e not c o n s i d e r e d  between t h e r e s e a r c h e r  of the i n d i v i d u a l ,  the  i s a process  a s an " i n t e i — s u b j e c t i v e "  In o r d e r  this  Elicitation  and p a r t i c i p a n t .  the researcher's  the  method aims t o c o n s t r u c t  as i t i s l i v e d .  phenomenon under s t u d y  Collection  of d e l i b e r a t e l y  so t h a t  notions  "bias  and t h e e x p e r i e n c e  1984; O i l e r ,  the world  c o n s t r u c t s and  preconceived  study  and t h a t  about t h e  in reflection  i s brought  1982, p. 179).  into  50 Data C o l l e c t i o n ; D a t a were c o l l e c t e d interviews. with  most  Interviews  through  the researcher's  participants  extended  past  i n t e r v i e w s were c o n d u c t e d In t h e m a j o r i t y any  disturbance  where a f a m i l y course the  was  Interviews  proved  very  process.  helpful  This  sources.  fill  homes.  few  without  instances  t h e room d u r i n g t h e and  affected. on an a u d i o - r e c o r d e r  and  Ten i n t e r v i e w s were t r a n s c r i b e d by t h e L i s t e n i n g t o and t r a n s c r i b i n g  aspects  experience  of the data  the p a r t i c i p a n t s '  researcher's  entrance  phenomenon.  In t h e c a s e  the r e s e a r c h e r  collection  the interviews and a n a l y s i s  a f f o r d e d the r e s e a r c h e r a d d i t i o n a l  p o r t i o n s of the interviews,  All  study  t h e d i s c u s s i o n between t h e r e s e a r c h e r  certain  process  own  In t h o s e  pet e n t e r e d  into  the  the  i n t e r v i e w s were c o m p l e t e d  insight  typist,  In s e v e r a l  interviews.  i n the p a r t i c i p a n t s '  were t a p e - r e c o r d e d  herself.  in duration,  time with  of the formal  not a p p a r e n t l y  verbatim.  semi-structured  f o r a one h o u r p e r i o d .  member o r h o u s e h o l d  participant  researcher  that  external  of the interview,  transcribed  15 i n - d e p t h ,  actual contact  of cases,  from  Procedure  v a r i e d from 45 t o 90 m i n u t e s  interviews continuing  instances,  The  into  sentiments  and emphasis  placed  on  and so e n c o u r a g e d t h e  the p a r t i c i p a n t s '  d e s c r i p t i o n s of the  o f t h e 5 i n t e r v i e w s t r a n s c r i b e d by a  listened  to the interviews  o f c o r r e c t i n g and p r o o f i n g t h e  p a r t i c i p a n t s stated that tape-recorded.  they  interviews  being  During  interviews  p a r t i c i p a n t s were n o t a b l y  felt  in detail  during  script. comfortable  t h e second  with  set of  more r e l a x e d t h a n  during the  51 initial  interview,  and a p p e a r e d  the  audio-recorder.  all  p a r t i c i p a n t s during  participants perceptions Details  description  determined questions to  The v a s t  had e n j o y e d  with  majority of  describing  their  with  of Accounts  7 of the 8  questions  question  study  interview.  involved the r e s e a r c h e r  trigger  asking  (see A p p e n d i x  the d i r e c t i o n with  the health  the r e s e a r c h e r ' s being  initiate  had a s k e d an  of the interview  experience  The  one o r a l l  D) t o  Once t h e r e s e a r c h e r  by t h e p a r t i c i p a n t , concerning  meeting.  d e c l i n e d a second  o f t h e phenomenon.  trigger  the presence of  e s t a b l i s h e d good r a p p o r t  and C o n s t r u c t i o n  one p a r t i c i p a n t  the formulated  ignore  to the researcher.  set of interviews  initial  they  i n t e r v i e w s were c o n d u c t e d  participants;  of  the i n i t i a l  of the Interviews  Two  first  The r e s e a r c h e r  i n d i c a t e d that on h e a l t h  to t o t a l l y  was  subsequent  framed  according  t h e p a r t i c i p a n t ' s r e s p o n s e s and f r e e d e s c r i p t i o n o f t h e  phenomenon. Each complete  interview built account  accordance with interviews collected interview,  phenomenological  the i n i t i a l  under s t u d y  a  obtained.  t h e second  deeper  Upon c o n c l u s i o n  participants  stated that  discussion.  T h i s was a l s o t h e o p i n i o n  f u r t h e r on t h e  of perception  o f the second  had e x h a u s t e d  data  t h e second  t o expand levels  In  set of  t o v a l i d a t e and c l a r i f y  was a l s o a b l e  they  so t h a t  was  interviews. During  o f h e a l t h and d e s c r i b e  t h e phenomenon.  interviews  methodology,  the researcher  the p a r t i c i p a n t  description into  o f t h e phenomenon  permitted during  upon e a r l i e r  interview a l l  t h e theme o f  of the researcher.  The two  52 sets  of  interviews resulted  description Field  of the  in rich  phenomenon o f h e a l t h .  researcher maintained  complement  the data  obtained  field  i n the  keeping  field  notes  In  study  t h e r e s e a r c h e r kept  this  describing  the  i s unique  ambience and  the r e s e a r c h e r ' s personal study  notes  throughout  interviews.  t o each  the  study  method  to  of  (Spradley,  1979).  c o n t a i n i n g notes  o f each  experiences  The  researcher  a journal  conduct  i n t e r v i e w , as w e l l  of i n t e r a c t i o n  with  as  the  participants. Protection  Informed  research  study  participant  purpose  information. participant an  and  The  Rights  with  a  discussion  participant  was  participation signature  on  letter  Each  study  form  the  Participants  informed  v o l u n t a r y , and  remove t h e m s e l v e s  form  given the  from  that the  to  that  and  initial  B).  receipt  The  study,  might  study, A). each  for  participant's  o f a copy  the consent  participation  they  the  of the  o p p o r t u n i t y t o ask  signing  the  meeting,  form  the  printed  (see A p p e n d i x  a w r i t t e n consent  (see A p p e n d i x  research prior  were  of o r a l  i n f o r m a t i o n about  to contact  acknowledged was  e x p l a n a t i o n of  or r e s e a r c h e r p r o v i d e d  detailing  to sign  participant  concerning  form  t h e r e s e a r c h e r at t h e  asked  in the  i n the  person  consent  with  each  received a detailed  procedure  network  accompanying  entirely  o f Human  Consent  Each  After  providing a concrete  Notes The  and  data  i n the  questions  form. study  refuse participation  o r r e f u s e t o answer  form.  any  was and  53 questions  without  were a l s o  informed  portion  might  a t any t i m e  o f any k i n d .  participant  included  consequences  t h a t they  of a tape,  consequences each  negative  o f any k i n d .  request  during  Written  erasure  the study  permission  o f any t a p e ,  without  was  consent  form  described  or  negative  obtained  f o r i n t e r v i e w s t o be t a p e - r e c o r d e d ;  i n the formal  Participants  this  from was  above.  Confidentiality Confidentiality tapes  were t r a n s c r i b e d and c o d e d  participants only  of a l l c o l l e c t e d  d i d not a p p e a r  to the researcher.  course  d a t a was  assured.  The  audio  so t h a t t h e names o f t h e  on t h e t r a n s c r i p t s ,  Any names used  and were known  by p a r t i c i p a n t s  o f t h e i n t e r v i e w were removed from  during the  the t r a n s c r i p t  by t h e  researcher.  the  The  researcher,  her t h e s i s  only  individuals  with  participants revealed  were a s s u r e d  either  unpublished  an  and a t y p i s t  to recorded  that t h e i r  data.  identity  of the study  were  Study  would  not be  o r i n any  or published m a t e r i a l s . of B r i t i s h  Columbia  Committee f o r R e s e a r c h  ethical  research  access  during the course  . The U n i v e r s i t y Screening  committee,  review  was  of the study,  commenced  Behavioural  Science  I n v o l v i n g Human S u b j e c t s and g r a n t e d  approval  provided  before  (see A p p e n d i x E ) .  Data A n a l y s i s The  p r o c e s s of c o n s t a n t  phenomenological  study  comparative  directs  analysis  used  in  t h e r e s e a r c h e r t o b e g i n dat a  actual  54 analysis  as  collection separate In  soon as and  d a t a are  data a n a l y s i s  events  activities  overlapping  of  of  (occurring  analysis  then,  a period  ideas"  different  and  run  necessarily  researcher's concurrently and  1971,  Accord ing  to  these  three-fold  process  dwelling  with  the  analyzing  the  description  subject's  there  and i s temporal  The  ceased)  into  (1985) d e s c r i b e  the  of  "analytical  has  order  involves  process  as  final  stage  becomes,  previously  developed  118).  co-workers  data),  Data  described  a n a l y t i c a l work.  final  p.  1986).  (and)  a f t e r observation  for bringing  terms.  (Morse,  purposes.  the  observational  (Lofland,  Parse  are  for practical  r e a l i t y , , however,  observational  collected  of  description  the to  of  investigators, intuiting  and  (or  the  in  slightly  data  analysis  contemplative  describing.  findings, a  t h i s process  In  researcher  the  final  moves  s t r u c t u r a l d e f i n i t i o n of  from  the  phenomenon. In  t h i s study  methodology (1978) and  advanced Giorgi  were t r a n s c r i b e d analysis,  data a n a l y s i s  the  by  Knaack  (1975). verbatim.  researcher  an  overall  the  phenomenon o f  health.  the  pertaining extracted  next  step  d i r e c t l y to from  Following As  the  the  sense  of  data.  topic Meaning  according by  interview, step  through the  out  outlined  each  initial  of a n a l y s i s , the  carried  (1984) as  t r a n s c r i p t s were r e a d  the  In  was  subject's  the  Colaizzi audio-tapes  in formal  several  to  data  times to  description  give of  s i g n i f i c a n t statements  under units  investigation  were  (which r e m a i n e d  faithful  55 to  the o r i g i n a l  significant  were  statements.  contemplated  with  with  units  those  until  Formulated  meaning u n i t s into  from  the r e s e a r c h e r  in order to capture the  the informant's  own  words as much  f o r each t r a n s c r i p t .  t h e second  o f t h e phenomenon  clusters  sampling  transcript  transcript,  reached  In  (Morse,  1986),  were compared and so  forth,  where r e d u n d a n c y i n  occurred. e x t r a c t e d from  t h e d e s c r i p t i o n s were  o f themes r e g a r d i n g t h e e x p e r i e n c e  health.  The r e s e a r c h e r a t t h i s  original  transcripts  contradictory  unit  the f i r s t  o f s a t u r a t i o n was  organized  insight,  the t e n e t s of t h e o r e t i c a l  e x t r a c t e d from  descriptions  then  each  emerged  process.  e x t r a c t e d from  a point  as t h e y  creative  above s t e p s were r e p e a t e d  accordance meaning  Using  meaning, r e t a i n i n g  possible during this The  formulated  upon and r e f i n e d  most c o m p l e t e as  data)  to validate  point r e f e r r e d the c l u s t e r s  themes were r e c o g n i z e d  as r e a l  of  back t o t h e o f themes. Any  and v a l i d ,  and t h e  data retained. The  non-redundant  comprehensive analysis second their  was  description validated  experience  with  study  the study  integrated into  of h e a l t h .  participants  i f the a n a l y s i s  o f t h e phenomenon.  process,  description  o f themes were  of the experience  i n t e r v i e w s by a s k i n g  analytical  the  clusters  fis  the r e s e a r c h e r c o n s t r u c t e d a  of the e s s e n t i a l  participants.  This  during the  correctly  a result  a  described  of t h i s phenomenological  s t r u c t u r e o f h e a l t h as e x p e r i e n c e d  by  56 Reliability The research  i s s u e s of r e l i a b i l i t y center  around  confirmabi1 ity. faithfully "decision easily  In o r d e r  reflect trail"  the  must  f o l l o w the  personally. researcher  The to  "reduction  Obtained under t h e the  be  F e e d b a c k and assure  the  researcher the  subject's  the  process  report  i n the  itself  auditability. such  1984,  topic  and  i s of great  checking  and  data  ability use  the  of  discussed  how how  the  method  content  validity with  experiences". are  employed  research;  as  understands the  to  the meaning  of  112-113). strategies for achieving  Auditability  the the  importance  Creditabi1 ity  s t r a t e g i e s as  p.  data  or j u s t i f i c a t i o n  such as  collects  presuppositions.  of the  s/he  must  1986).  upon t h e  their  of c o l l e c t e d  and  can  p a r t i c i p a n t s "have e x p e r i e n c e  research.  explanation  data  researchers  f a c e and  communicate  (1986) has  description,  interested  of personal  the  auditability  the i n v e s t i g a t o r ' s  researcher  depends  reliability  (Knaack,  and  other  t o have both  can  and  in q u a l i t a t i v e  qualitative  requirements,  experiences"  " n e v e r assume t h a t  Sandelowski  research  of data  clarification  can  in  (Sandelowski,  s t u d i e s , the  that  and  validity  these  so t h a t  of r e a s o n i n g  i s accepted  phenomenon"  rigor  the  topic  Data  validity  fulfill  clear  validity  assumption  research  to  or b r a c k e t i n g "  data  and  of  human e x p e r i e n c e ,  line  "tap  Validity  truthfulness, credibility,  In p h e n o m e n o l o g i c a l  of  and  topic  i s viewed.  i n the by  by  o f a number o f  investigator first  i s managed f o r the  i s achieved  the  steps  research  of  researcher  representativeness  in  became  The  achievement  the  of  adopting data,  57  triangulation, The  and o b t a i n i n g v a l i d a t i o n  establishment  achieves  confirmabi1 ity.  determined are  of a u d i t a b i l i t y ,  by phenomena  of data  truth  The t r u t h  value  and e x p e r i e n c e s  p e r c e i v e d by t h e s u b j e c t s  value  from and  subjects.  applicability  of the research i s  being  (Sandelowski,  d i s c o v e r e d as  they  1986).  Summary The  phenomenological  employed  in this  participant in  this  p e r s p e c t i v e determined  study.  selection,  This chapter data  r e s e a r c h consequent  collection  has d e s c r i b e d t h e methods o f and d a t a  to interpretation  approach.  validity  r e s e a r c h were d i s c u s s e d  Theoretical participants research.  meeting  The  formulation  sampling  initial  pilot  study  trigger  description  questions  of  for inclusion  in this  direction for  to  o f t h e phenomenon  and  in brief.  selection  provided  utilized  implementation  of r e l i a b i l i t y  methods d i r e c t e d  the s t a t e d c r i t e r i a  of s p e c i f i c  participants'  Issues  analysis  and  of the phenomenological in qualitative  t h e methodology  initiate during  semi-structured  i n t e r v i ews. Shared,  in-depth  e x p l o r a t i o n and d i a l o g u e  r e s e a r c h e r and p a r t i c i p a n t s method, upon  resulted  informant  results  of t h i s  according to the  between t h e phenomenological  i n c o n s t r u c t i o n of a d e s c r i p t i o n  accounts. study.  The f o l l o w i n g c h a p t e r  of h e a l t h  presents the  based  58  THE This  chapter  participant health. by  inherent  presents  accounts  Although  virtue  the r e s u l t s  of t h e study,  t o d e s c r i b e how p a r t i c i p a n t s  the s u b j e c t i v e experience  of the d i s t i n c t  social,  in the individual  life  described During  CHAPTER 4 : PERCEPTION OF HEALTH: MEANING OF HEALTH TO INDO-CANADIANS  t h e h e a l t h phenomenon  data c o l l e c t i o n  cultural  context,  experienced  of health  i s unique,  and h i s t o r i c a l  study  in a strikingly  and a n a l y s i s ,  using  central  factors  participants similar  manner.  themes emerged  were common t o t h e d e s c r i p t i o n s o f h e a l t h p r o v i d e d  which  by a l l  participants. A final of  o r d e r i n g o f t h e common c e n t r a l  p r e v i o u s l y developed  definitive coherent  analytic  "general  description ideas" data  ideas,  framework  design",  of data,  f o rthe research  o r framework,  presented  final  period  analytic  in this  findings.  supporting  represents a "set of l o g i c a l l y  f o r an i n t e n s i v e  i s used  provides a vision  When s t u d y they  the data  in this  of h e a l t h true t o the accounts and i n c l u d e s t h e e s s e n t i a l  description  upon t h e  and r e p r e s e n t s t h e f u n d a m e n t a l  It  participant's  interrelated  to organize  h e a l t h f o r t h e I n d o - C a n a d i a n s who p a r t i c i p a t e d  participants,  analytical  contemplating  of  study  This  ( L o f l a n d , 1971, p. 124).  framework  chapter,  and r e f i n i n g  l e d to the formulation of a  d i s c e r n e d by t h e r e s e a r c h e r a f t e r  This  themes,  meaning study.  of i n d i v i d u a l  aspects  o f each  o f t h e phenomenon.  participants  described their  located i t within the o v e r a l l  context  experience  of doing  of h e a l t h ,  normal  59 activities. therefore  Participants'  make up  introductory ascribed  to  This central  the  or  the  The  of  normal  t h i s chapter,  i m p o r t a n c e which  health.  These two  holistic  view o f  sections  of  the  The  activities  along  with  an  participants  and  health,  the  final  of h e a l t h ,  to  second  h e r e as  "the  level other  of  A  and  sickness; phases  of  explains  influencing represent  second  and  s c h e m a t i c and  framework w i l l  from  explains  three  together the  two  focuses  description  factors  description  analytic  arising  body and health,  constitute  frames  of d e s c r i p t i o n  partial  t h i s chapter respectively. of  activities  physical  mind and  l e v e l s of  health,  level  the  referred  experience".  normal  description  of  complete  in r e l a t i o n to  doing  first  condition  phase c o n t i n u u m  description  of  l e v e l s of  accounts.  on  health  health  the  o v e r a l l context  i n terms of  a three  of  section  of doing  health.  participant  health  first  discussion  themes,  primarily  the  descriptions  now  be  a  third narrative presented.  60 Health:  The Most  Important  DOING NORMAL A)  The T h r e e P h a s e s Complete 1)  Health  Complete  Thing  in Life  ACTIVITIES:  of the Health - Partial  Experience  Health  -  Health:  -  2)  Sickness:  Body and mind t o g e t h e r : T o t a l u n i t Doing h a p p i l y , doing w e l l - Energetic resistance - I n d e p e n d e n c e and c o n t r o l Partial Health:  healthy  -  Can do w i t h e f f o r t , and n o t w e l l - D e c r e a s e d e n e r g y and r e s i s t a n c e - D e c r e a s e d i n d e p e n d e n c e and c o n t r o l — Temporary and bothersome 3)  Sickness: - Cannot do, c a n n o t f u l f i l l r e s p o n s i b i l i t i e s - Low e n e r g y and r e s i s t a n c e - Dependence, l a c k o f c o n t r o l - S e r i o u s , permanent, w o r r i s o m e - R e t u r n t o h e a l t h , o r c h r o n i c i l l n e s s and d e a t h  B)  Factors 1)  2)  i n f l u e n c i n g the Health  State:  The M i n d : -  Worry  -  P o s i t i v e mental  External -  (mental  stress) attitude  Factors  D i e t and e x e r c i s e S l e e p and c l e a n l i n e s s Use o f m e d i c i n e s Maintaining routine W o r k i n g o u t s i d e o f t h e home Home a t m o s p h e r e  Figure  2: Components  o f t h e Framework.  61 DOING NORMAL  Do i n g We 1 1  EXTERNAL FACTORS  ACTIVITIES  ^^^V  Do ing i  Happily  MIND  Med i c i n e s  Complete  Health  Sleep Worry Diet M a i n t a i n ing Rout i n e E x e r c i se  it Partial  Work i n g outside of t h e home  Health  CAN DO BUT NOT WELL  Positive Mental Att itude  Cleanliness Home At mosphere  Factors  Influencing Health  CANNOT DO NORMAL  1  Chronic  ROUTINE  Illness  De*ath  Figure  3: S c h e m a t i c D e s c r i p t i o n o f t h e Framework from t h e P a r t i c i p a n t s ' P e r s p e c t i v e  4  H e a l t h : The Participants importance to  Health people.  One  foremost far  seen as  participant  importance  a person  lives,  activities  as  a resource  resource  f o r being  great  "the  of  wealth  or  worth t o a l l first  and  a b l e t o do  something  possessions.  i n terms  o f f e r e d on  them  happiness.  o f how  f o l l o w i n g accounts  various perspectives participants  essential  a source  explained  The  of  spoke o f h e a l t h as  worldly  things.  Life  which a l l o w e d  of fundamental  others  either  in  something  d e s c r i b e d h e a l t h as  o f h e a l t h was  t o do  Thing  w e l l as  something  in l i f e " ;  more v a l u a b l e t h a n  allows  P = R =  in t h e i r  happiness  The  the  life was  Important  d e s c r i b e d h e a l t h as  t o them  c a r r y out  Most  illustrate  h e a l t h as  everything  in  it  an  life.  Participant Researcher P: W e l l , h e a l t h i s v e r y i m p o r t a n t , you know. I think one s h o u l d r e a l l y t a k e c a r e o f h e a l t h f i r s t b e f o r e a n y t h i n g else. R:  flh  huh.  P: Yeah. B e c a u s e i f y o u ' r e not h e a l t h y you j u s t c a n ' t do anything. So a l l y o u r dreams, o r w h a t e v e r you want t o do, a l l y o u r w i s h e s so h e a l t h i s I t h i n k t h e f i r s t t h i n g to l o o k a f t e r . R:  The  most  important  thing?  P:  The  most  important  thing,  yeah.  P: That ( h e a l t h ) means a l o t t o you. That means t h e w o r l d t you, you know, y o u ' r e b e i n g h e a l t h y and b e i n g f i t . Because i f you a r e n o t , d o e s n ' t m a t t e r what you have got, you have got a l l t h e w e a l t h i n t h e w o r l d , but i f you a r e not h e a l t h y what can you do w i t h i t ? P:  That's  ( h e a l t h i s ) the  most  important  thing  in l i f e .  If  you  a r e not healthy,  you a r e nowhere.  R: H e a l t h  i s t h e best  P:  i s t h e best  Health  R: The most P:  That's  important  thing  in life.  thing  in life,  you're  i t allows  Whatever  you t o do  everything?  I want t o do.  P: — H e a l t h i s i m p o r t a n t i n e v e r y c a s e , you want t o do, t h e h e a l t h comes f i r s t . The  importance  One  participant stated  from  of health  h i s childhood  explained contain  that  saying.  right.  R: B e c a u s e P:  thing?  that  and u p b r i n g i n g  school  or parable  i n terms  of happiness.  h i s a t t i t u d e s about  experiences  elementary  a lesson  was d e s c r i b e d  you Know. Whatever  text  about  books  health  stemmed  i n India.  i n India  t h e importance  He  commonly  of health i n  1 ife.  P: When we were c h i l d , t h e f i r s t l e s s o n t h a t we were t a u g h t i n s c h o o l , i f I were t o q u o t e t h a t l e s s o n , t h a t ' s a G u j a r a t i t i t l e , a p r o v i n c i a l language i n India, " P a h e l u sukh t e j a t e n a r y a " : t h e f i r s t and f o r e m o s t happiness i s the health. We a l w a y s t h o u g h t t h a t h e a l t h i s t h e most i m p o r t a n t t h i n g i n l i f e . These a c c o u n t s d e s c r i b i n g t h e i m p o r t a n c e  of health,  fitting  i n t r o d u c t i o n to the following d i s c u s s i o n  context  within  which  p a r t i c i p a n t s experienced  and p r o v i d e  of the o v e r a l l  h e a l t h : doing  normal  act i v i t i es.  D o i n g Normal Part i c i pants' d e s c r i p t i o n s  Activities  of the health  a  experience  were  64  located  within  the o v e r a l l context  When t h e r e s e a r c h e r o r what  their  primarily  experience  health",  contentment, to c a r r y  of health able  questioned  regarding  were h e a l t h y .  out t h e a c t i v i t i e s  that  These  o r " f e e l i n g good",  activities.  felt  about  was, d e s c r i p t i o n s  t o do n o r m a l  participants stated  happy when t h e y  normal  p a r t i c i p a n t s how t h e y  i n terms o f being  When d i r e c t l y with  asked  of doing  activities.  felt  associated  good,  or f e l t  f e e l i n g s of happiness,  however,  stemmed  when h e a l t h y .  examines how p a r t i c i p a n t s d e s c r i b e d  were  the " f e e l i n g s they  health,  from  being  The f o l l o w i n g  normal  able  section  activities.  What Normal A c t i v i t i e s A r e As  the researcher  became c l e a r t h a t life  process  normal life  intimately  activities  participant descriptions, i t  daily  was viewed  activities  linked to health.  as t h e d a i l y  duties  r o l e s and r e s p o n s i b i l i t i e s ,  personally  wanted  participants were,  in fact,  details,  their  a s each  social  in.  stated  duties  o f normal person's  factors.  participants daily  t o engage  generally  Descriptions  and  doing  explored  Upon  that  explained  individual  as t h o s e a c t i v i t i e s  the things  activities  they  varied  however,  "wanted t o do"  i n terms o f s p e c i f i c  distinct  accounts  normal a c t i v i t i e s  personal,  illustrate  P:  The d a i l y  life  normal  activities.  family  how  i n t e r m s o f d u t i e s and  routines. R: So " n o r m a l " means  they  activities.  included  The f o l l o w i n g  with  explained  further reflection,  and r o u t i n e  life  Participants  associated  as w e l l  as a n o r m a l  activities  means what?  65  R:  So,  how  do  " n o r m a l " and  P: T h e y ' r e t h e r e g u l a r work.  same.  You  "daily go  to  activities"  school.  Do  relate?  your,  you  R: When you were t a l k i n g about n o r m a l a c t i v i t i e s , you "normal" d u t i e s . Do you see d u t i e s and a c t i v i t i e s as same t h i n g , o r i s t h e r e any d i f f e r e n c e ? P:  No,  they  are  the  same  Um  Another "being  said the  things.  R: The same t h i n g s . Just same t h i n g ? what you P:  know,  a d i f f e r e n t word t o do?  describe  the  hum.  participant elaborated normal"  R: B e i n g dut i es? P:  Right.  R:  So  meant d o i n g normal  then  this  point,  explaining  that  action: i s being  able  to  do  than  do  your  daily  Yeah.  i t s more a b e i n g  P: I t h i n k it.  on  so.  The  able  to  f e e l i n g comes,  you  a  feeling?  see,  i f you  are  doing  R: Okay, so b e i n g " n o r m a l " means d o i n g t h e t h i n g s you'd n o r m a l l y do i n h e a l t h — i n a s t a t e of h e a l t h . Such as g e t t i n g up, and you t o l d me s h o w e r i n g , and g o i n g out, and w o r k i n g . P: This  was R:  Right. expanded So  "being  upon: normal"  i s i n terms of  P: Yeah. T h a t ' s r i g h t , a c t i o n , you see.  Other  R:  Action  P:  And  and  then  —  yeah,  same  thing  what?  duties  p a r t i c i p a n t s presented  perception  and  action?  that  daily  routine  s i m i l a r views, and  duties  illustrating  were viewed as  the synonyms.  66 The  f o l l o w i n g accounts describe  the nature  of these  R: Your " d u t i e s " . Okay, c o u l d you t e l l about what you mean by y o u r " d u t i e s " ?  duties:  me a l i t t l e  b i t more  P: W e l l , t h e s e a r e my d u t i e s . You know, I'm s u p p o s e d t o l o o k a f t e r my k i d s , l o o k a f t e r my husband, and my mothe>—in-law. Do what I c a n do f o r them. R: find you c a n o n l y  do t h o s e  things  when you a r e h e a l t h y ?  P: Yeah. P: W e l l , ah, r o u t i n e , you know, when you a r e d o i n g t h i n g s and l o o k i n g a f t e r y o u r f a m i l y and you know, s t a y i n g c o n t e n t . And you know, you t h i n k you have done a l l y o u r d u t i e s and a l l that s t u f f . R: Ah, huh. You m e n t i o n e d about t h a t . P: Yeah,  um  The  kind  things  before  when we t a l k e d a b i t  hum.  R: So t h a t ' s what P: Yeah,  duties  yeah.  you mean by a " r o u t i n e "  That's r i g h t ,  of a c t i v i t i e s  yeah.  considered  were f u r t h e r e x p l a i n e d  really?  t o be n o r m a l  daily  routine  by one p a r t i c i p a n t as f o l l o w s :  R: So " n o r m a l " t o you, n o r m a l exactly? C o u l d you e l a b o r a t e  t h i n g s means a g a i n a minute on t h a t ?  what  P: W e l l , a l l my t h i n g s w h a t e v e r I do, t h e housework, a f t e r t h e k i d s and go out s h o p p i n g . Normal  activities  activities affect  were d e s c r i b e d  a person  by one p a r t i c i p a n t as  u s u a l l y does t h a t  do not harm,  look  those  or adversely  t h e body.  R: How do you know what normal ?  i s normal  f o r you and what  isn't  P: Okay, t h e r e i s not a v a l i d c h a r t t h a t t h i s i s n o r m a l , t h i s i s abnormal, but t h e t h i n g s which you have been d o i n g and which has not a d v e r s e l y a f f e c t e d y o u r o t h e r w i s e d a i l y a c t i v i t i e s t h e next day o r s o m e t h i n g l i k e t h a t . I t s o n l y f o r t h e p e r s o n t o j u d g e from h i s own d a i l y look  67 in l i f e , t h a t f o r him. That R: Um  what i s normal f o r him, what p e r s o n o n l y has t o f i n d o u t .  hum.  P: S o m e t h i n g f o r you.  might  be normal  R: A l r i g h t , c o u l d you t e l l " n o r m a l " means? What t h a t  f o r me which would  same  usually  participant does,  professional  explained  i s normal work v e r s u s  be unaccustomed which at f i r s t  that  f o r him.  that  a r e not normal  you K e e p I mean,  t h e work which a p e r s o n  He d e s c r i b e d  suddenly taking  to, stating  not be normal  me a l i t t l e b i t more about what term means? How you a r e u s i n g i t ?  P: Normal i n t h e s e n s e I meant, s o m e t h i n g which d o i n g and which does not h u r t you. T h a t ' s what normal. The  i s abnormal  doing  h i s usual  on a j o b w h i c h he  a person can adapt  would  to a c t i v i t i e s  f o r him.  P: But say, normal i n t h e s e n s e t h a t I'm used t o d o i n g t h i s t y p e o f work ( h i s own p r o f e s s i o n a l w o r k ) . And tomorrow i f I were t o s t a r t w o r k i n g i n a s a w m i l l , i t s not normal f o r me. But i t s q u i t e r i g h t t h a t i n c o u r s e o f t i m e I would get used t o t h a t . R: Yes. P: But i n t h e i n i t i a l s t a g e s i t would d e f i n i t e l y h u r t me, i n the s e n s e t h a t e v e r y day e i g h t h o u r s work when I come home I f e e l so t i r e d , which d o i n g t h i s j o b 10 h o u r s a day I would not. T h a t ' s what I mean by n o r m a l . R: So I t h i n k y o u ' r e t e l l i n g me t h a t t h i n g s t h a t don't a f f e c t your h e a l t h  normal means adversely?  doing  P: Yeah. As I s a i d , but t h e n t h o s e w h i c h a r e normal f o r me, may not be normal f o r a n o t h e r p e r s o n , as I s a i d , b e c a u s e mine i s a d i f f e r e n t t y p e o f work. But i f I go and work i n a s a w m i l l and p u l l l o g s R: Yes. P: t h a t ' s abnormal f o r me i n t h e i n i t i a l stages. Q u i t e f i n e t h a t a f t e r a month t h e r e , I would become so used t o t h a t and I would not f e e l , and I would say t h a t t h a t ' s the n o r m a l work f o r me. But i t s a q u e s t i o n o f g e t t i n g  68 used  t o what  Participants wanted  to  R: to  i s normal  and  also described  abnormal.  normal  activities  as t h e t h i n g s  they  do:  So when you a r e h e a l t h y , do i n y o u r l i f e ?  what  kinds  of t h i n g s  a r e you  able  P: Whatever I want — any you know, l i k e i f I have t h e aim f o r music, o r f o r c o n c e r t , o r f o r d a n c i n g , o r f o r t e a c h i n g somebody, o r you know, h e l p i n g out, v o l u n t e e r b a s i s or anything. Whatever. R: Y o u ' r e a b l e t o do w h a t e v e r w h a t e v e r you want t o do? P:  Yeah.  Whatever  Participants partial three  completely  accounts  described  o f how  impinged phase  t o do  these  normal  three  or f a c i l i t a t e d making  totality,  the  u n i q u e p a r a m e t e r s o f each  to provide  Three  Complete  Participants' related  continuum  Phases  explained  or s i c k  how  being  a f f e c t e d , or Participant  of the h e a l t h  experience  experience  The  i s now  f o r subsequent  the  Health  Partial  three examined  -  o f h e a l t h were  Sickness  inextricably  "complete h e a l t h - p a r t i a l  (see f i g u r e  3).  fill  in  d e s c r i p t i o n of  Experience:  Health  in  phase  phase.  explanations phase  They  c a r r y i n g out a c t i o n .  of -  health,  r e f e r r e d t o h e r e as t h e  o r c o n d i t i o n s , o f each  the context  Health  to the three  sickness"  phases  doing,  of a complete  activities.  up t h e h e a l t h  its  The  i n terms  healthy  the c h a r a c t e r i s t i c s ,  continuum  yeah.  experience.  partially  ability  upon,  doing,  s i c k n e s s continuum,  healthy,  their  like  like  of h e a l t h  of the h e a l t h  altered,  terms  spoke  h e a l t h and  phases  I feel  you f e e l  health  p a r t i c i p a n t s without  -  69 exception health to  viewed  and  signify  varying  health  sickness,  although  the  p h a s e s and  three  degrees  of  Sickness  to complete rather  terms health  and  phase  Um  P:  —  R:  the  partial  different  three  The  of  in contrast,  a nebulous  phases  terms with  the  most  was  state  described  somewhere " i n  sickness.  describes  the  health  phases: complete  participant  partial  health  P: Maybe i f I t o o k b e i n g h e a l t h y h e a l t h being the second stage — R:  slightly  and  a s t a t e d i a m e t r i c a l l y opposed  health,  and  distinct  sickness.  "in-between"  health  were d e s c r i b e d  as  a c c o u n t s as  health  i t s three  used  described  explained  f o l l o w i n g account  of  they  sickness  Partial  i n most  between" c o m p l e t e The  and  was  health.  vaguely  of complete  specificity.  Complete h e a l t h clearly.  i n terms  experience  health,  here r e f e r s  to  in  partial the  "i11-hea1th".  as  i s the  first  stage, i l l -  hum. and  third  stage  being  sickness  or  i l l . Okay?  Yes.  P: In w h a t e v e r o r d e r you want t o t a k e i t . So, i f I had o n l y t h r e e stages, the t h i r d stage i s being s i c k , second stage i s b e i n g i l l - h e a l t h , and f i r s t s t a g e i s b e i n g p e r f e c t l y h e a l t h y . R:  Yeah.  P: Okay? find you degrees are t h e r e R:  c o u l d add any d e g r e e s t o i t . i n between. I mean, from one  Okay. T h a t ' s what  I'm  wondering  P: Yeah. W h i c h e v e r way you it. In t e r m s o f t h e body. Other  informants  subsequent  described  account  focused  parts on  the  want  to  of t h i s  right  now.  scale  i t or  continuum.  transition  Whatever to ten.  from  measure The  complete  health  70  to  partial  "health"  health.  The p a r t i c i p a n t r e f e r s t o c o m p l e t e  and p a r t i a l  health  as " l e s s h e a l t h y " ,  h e a l t h as  or " g e t t i n g  into a  pro b1e m " . P: I'm, I f e e l okay, you know, I'm h e a l t h y , and I want t o g i v e a best o f c a r e t o t h e p a t i e n t s . But s u p p o s i n g I h u r t my back, and t h e n I c a n ' t bend, c a n ' t do a n y t h i n g and t h e n I would s a y : Yes, I don't f e e l good. Whether you c a n c a l l i t less healthy, or g e t t i n g i n t o a problem. The in  movement other  clearly the as  from  partial  accounts.  health  " i n between" p a r t i a l  potentially  was  explained  In t h e f o l l o w i n g d e s c r i p t i o n , t h e p a r t i c i p a n t  distinguished health  "unhealth").  to sickness  from  health  The p a r t i a l  progressing  sickness,  stage  health  (which  but was vague  about  i s r e f e r r e d t o here  s t a g e was e x p l a i n e d  as  to sickness.  R: I'm j u s t w o n d e r i n g i f you s e e , you know, t h a t y o u ' r e h e a l t h y , and t h e n i f y o u ' r e n o t h e a l t h y , y o u ' r e c a l l i n g t h a t "being s i c k " ? Which I b e l i e v e you a r e . P: Yes. W e l l , h e a l t h y you a r e s i c k . so. R: Okay, so t h e word something e l s e ?  i s healthy.  unhealthy  Ond when you a r e s i c k  means b e i n g  s i c k , or i s that  P: No, s i c k i s s i c k . You've got some a i l m e n t I guess i t does mean t h e same t h i n g . R: U n h e a l t h y  means b e i n g  sick?  P: Yes, u n h e a l t h y means not i n f u l l h e a l t h .  would  R: You mean so you'd be u n h e a l t h y , on you c o u l d become s i c k ? P: Another sickness  You c o u l d  become s i c k ,  p a r t i c i p a n t viewed slightly  P: I mean,  or whatever  this  eventually then  mean you a r e  i f you l e t t h a t  go  yeah. progression  from  partial  health t  differently:  i t could  be, okay,  a higher  stage  or a lower  stag  71  — w h a t e v e r you want t o c a l l h e a l t h ) makes you s i c k . To  summarize,  reference  h e a l t h was e x p l a i n e d  to the three  participants  described  specificity,  complete  clearly  and p e r c e i v e d  Participants  were  i t , of unhealthiness  less  by p a r t i c i p a n t s w i t h  ph ase  h e a l t h continuum.  these  three  Although  phases with  varying  h e a l t h and s i c k n e s s were as o p p o s i t e precise  (partial  s t a t e s of  in their  degrees of  identified  most  experience.  d e s c r i p t i o n s of p a r t i a l  health. The  three  phases  (complete  health,  partial  health,  sickness)  were d i s t i n g u i s h e d p r i m a r i l y by t h e c o n d i t i o n o f t h e p h y s i c a l body,  although  inseparable the  three  p a r t i c i p a n t s recognized  aspects  phases of the h e a l t h  separately  i n the last  Participants  i n terms  individual  ability  to carry  these  health in  Existing  resistance  capacity  f o r normal  action  be d i s c u s s e d  phases  of the health They  activities  (to disease i n each  measures o f t h e s e  stage  inherent  explained  that  was a f f e c t e d by  and c h a n g e ) ,  phase o f t h e h e a l t h four c h a r a c t e r i s t i c s of  was c o m p l e t e l y  of p a r t i a l  o f t h e mind i n  chapter).  three  out n o r m a l  i n d i c a t e d whether a person  t h e " i n between"  will  for activity.  i n d e p e n d e n c e and c o n t r o l p r e s e n t experience.  (The r o l e  experience  of c a p a c i t y  amounts o f e n e r g y ,  person.  s e c t i o n of t h i s  described  experience  the  o f t h e human  t h e body and mind as two  health, i n each  healthy,  and s u p p o r t e d phase  sick, the  (see f i g u r e s 2 &  3) . Each The  phase o f t h e h e a l t h  parameters  of complete  experience  will  now be d i s c u s s e d .  health are presented  or  first.  72 Complete Being associated  able  feelings  characteristic health the  and  t o do  that  other  measure  distinctive  participants: action help  without  of o t h e r  "general okay",  participant  being  explained  embracing  health  being  t o do  healthy",  "being  fine"  complete  and  and  linked  to  in  the  by  able  to  and  do the  so  health",  "being the  on.  very  "being healthy".  main component  viewed  as  f a m i l y and  a  of  broader  personal  i n a d d i t i o n to complete h e a l t h ) .  s t a t e d p r e v i o u s l y , p a r t i c i p a n t s viewed unit.  present  v a r i o u s l y as:  h e a l t h as  activities,  as  life,  "total  itself,  section,  t h i n g s without  i n c o n t r o l o f one's complete h e a l t h  main  (energy,  health described  able  with  partial  in t h i s  They were  o f energy,  being  (Well-being,  life  later  the  from  experience  health.  full  percent  healthy",  concept  discussed  was  c o n t r o l ) were d e s c r i b e d  feeling  "100  well-being.  (effectively),  satisfaction,  of complete  described  overall  one  of the  features  people,  health",  relationships  be  getting tired,  "perfectly  As  will  i n complete  s u c h as  Participants  as  As  i n d e p e n d e n c e and  greatest  well  d i s t i n g u i s h e d complete h e a l t h  four c h a r a c t e r i s t i c s  the  activities  o f h a p p i n e s s and  sickness.  resistance,  One  normal  Health  Complete  health  meant t h a t  both  the  mind and  mind and  body  body were  healthy. Body and  Mind T o g e t h e r : The  Participants where t h e y  described  were both  participants  spoke o f  Total Unit complete  physically "health"  and  i n B a l a n c e and  h e a l t h as mentally  in general,  a totality,  healthy.  they  Harmony a state  When  r e f e r r e d to  the  73 state  of complete h e a l t h ,  accounts  illustrate  or g e n e r a l  complete  health.  h e a l t h as  The  a holistic  following phenomenon.  P: I n e v e r r e f e r t o h e a l t h as p a r t l y m e n t a l l y o r partly physically b e c a u s e whenever t h e q u e s t i o n o f h e a l t h , i f someone r e f e r s t o i t , I a l w a y s t h o u g h t i t r e f e r s t o t h e g e n e r a l h e a l t h , and i t c o v e r s t h e mental as w e l l as phys i c a l . R:  Okay.  P:  find  R:  Okay.  t h a t ' s a l l I always So  P: G e n e r a l t h a t ' s how R:  Health  you  say,  mean h e a l t h  "fine".  i s general  health?  h e a l t h , yeah. I t s p h y s i c a l as I take i t i n the e n t i r e t y . in general  means what  well  as  mental,  then?  P: L i k e , um, I'm not s u f f e r i n g from a n y t h i n g and I'm nicely r e s t e d , and I'm g o i n g a r o u n d d o i n g e v e r y t h i n g t h a t I have t o and m e n t a l l y I'm p r e p a r e d f o r e v e r y t h i n g , and my mental health is alright. L i k e I'm t h i n k i n g s t r a i g h t , and I'm not — l i k e I won't have t o "I'm not t o o t i r e d and I c a n ' t do anything" — that sort of t h i n g . R: So i t seems y o u ' r e t a l k i n g about y o u r mental and y o u r p h y s i c a l , when you say g e n e r a l h e a l t h ? r i ght ? P:  Yeah,  that's  R:  I t s the  P:  Is g e n e r a l  R:  How  P:  Yeah,  two  P: I am. okay, okay. R:  right. together  What does  that's  general  health?  health.  y o u r mind um  state Is t h a t  i s and  how  you're  physically  feeling?  hum.  like  I am  mentally  okay and  I'm  physically  "okay" mean?  P: Means l i k e body's p e r f e c t .  I have —  my  brain  i s p e r f e c t and  my  74 The  body  make  were  up t h e w h o l e  other. in  and mind  person,  The f o l l o w i n g  complete  described  as  and e x e r t  accounts  inseparable an m u t u a l  describe  entities influence  the unity  on  o f body  each and  mind  health.  R: Y o u ' r e c o n s i d e r i n g t h a t t h e m i n d i s i n v o l v e d w e l l , y o u s a i d t h a t t h e two c a n ' t be s e p a r a t e d . P: Y e s , t h a t ' s  right,  in health  as  yeah.  R: So y o u s e e m e n t a l h e a l t h a n d p h y s i c a l t h i n g s , o r as t o g e t h e r i n your health? P: is  which  T o g e t h e r a s one u n i t , p a r t o f body. Yeah.  because  body  P: T h e y a r e i n t e r r e l a t e d , t h e m i n d s e p a r a t e t h e two.  health  as  separate  i s one u n i t ,  and body,  and  mind  you cannot  P: T o s a y p e r f e c t l y h e a l t h y y o u h a v e t o be h e a l t h y both ways, p h y s i c a l and m e n t a l . Then you a r e p e r f e c t healthy. I f one t h i n g i s wrong, l i k e i f you a r e p h y s i c a l l y s i c k , you are not p e r f e c t healthy. I f you a r e mentally sick then you a r e n o t p e r f e c t l y h e a l t h y . So j u s t t h e way i t i s , you know. So you just can't d e f i n e y o u r s e l f that you a r e a healthy p e r s o n e i t h e r way ( i f only body or only mind i s healthy). Complete  health  the  and body,  mind  was  further  with  the  described "total  i n terms  unit"  o f harmony  being  in  a  between state  of  health: R: Y o u s a i d t h a t i n a s t a t e s a i d t h a t t h e mind a n d body P: R: P:  of h e a l t h , which a r e one —  I believe  you  In harmony. i n harmony, Yes, t h a t ' s  and can't  be  separated.  right.  R: S o when y o u s a y t h a t y o u ' r e h e a l t h y , body t o g e t h e r are healthy?  y o u mean  t h e mind  and  75 P: Yes, t h e whole u n i t The  way t h e body and mind  other  i s healthy.  i n f l u e n c e each  other  was d e s c r i b e d i n  accounts: P: I f you a r e m e n t a l l y happy and h e a l t h y , t h e n o n l y you would be n a t u r a l l y p h y s i c a l l y h e a l t h y as w e l l . I f you a r e m e n t a l l y u n w e l l , t h e n i t d e f i n i t e l y a f f e c t s y o u r p h y s i c a l as well.  P: H e a l t h , you know, mental and p h y s i c a l , a r e a g a i n two components o f h e a l t h , b e c a u s e t h e y a r e so c l o s e t o each other. R: Yes. P: T h a t ' s  what  I mean.  R: "So c l o s e t o each  other"  again  you mean?  P: In t e r m s o f how t h e y a f f e c t each o t h e r . Physical health a f f e c t s mental h e a l t h , mental h e a l t h a f f e c t s e m o t i o n a l w e l l b e i n g , and my j o b p e r f o r m a n c e , and how I d e a l w i t h t h e f a m i l y , and how I f e e l about m y s e l f , c o m p l e t e l y , you know. I t s so c l o s e you know, t h a t i t s h a r d t o say what i s r e a l l y what i n my mind. But c e r t a i n l y p h y s i c a l and mental h e a l t h a r e v e r y c l o s e , b e c a u s e t h e y a f f e c t each o t h e r . You know, i f you had s t r e s s a t work i t w i l l a f f e c t y o u r stomach; i f you eat t o o much i t w i l l a f f e c t y o u r mind, you know! As not  noted,  only  these  able  activities  complete Doing  being  participants  health  Happily.  they daily  were  t o do normal  i s discussed  that complete  activities,  w e l l and h a p p i l y .  This  health  but b e i n g  primary  meant,  a b l e t o do  f e a t u r e of  below.  Doing. W e l l  Participants or at t h e i r  explained  best  stated that level  they  c o u l d not perform  of e f f i c i e n c y  and e f f e c t i v e n e s s , u n l e s s  i n a s t a t e of complete h e a l t h .  activities  i n complete  action well,  Being  h e a l t h , and t h u s  a b l e t o c a r r y out  fulfill  life  76  responsibilities, happiness,  described  contentment  Doing happiness  was  happily.  with  t h e word  rise  to feelings of  satisfaction.  The f o l l o w i n g  associated  descriptions  and  as g i v i n g  doing  "health"  P: I t h i n k , y o u know, a l l your a c t i v i t i e s .  accounts  actions refers  illustrate  well.  the  In t h e s e  t o complete  health i s important T h a t makes y o u f e e l  health.  t o do, good.  y o u know  P: L i k e when I'm h e a l t h y I f e e l t h a t I c a n do t o o ( s o ) much, y o u know. I'm a c t i v e a l l t h e t i m e . L i k e I f e e l g o o d too, I'm h a p p y , I'm energetic.  P: Oh, of  you f e e l  performing  R: Um  hum.  good,  you see, you a r e  the duties  Y o u mean  and not being  that  capable sick.  satisfaction  —  P: S a t i s f a c t i o n . R: —  comes from  P: Y e s , t h a t ' s R: A n d t h e n P:  Yeah.  doing  right.  you f e e l  And t h a t  the  things?  Yeah. good.  That's  comes w i t h  what  you're  the health  telling  me?  you see.  P: M o s t o f t h e t i m e I'm on a r e a l h i g h . Because I f e e l r e a l l y g o o d when I wake up i n t h e m o r n i n g , a n d I'm r e a d y t o f a c e t h e d a y , a n d o f f I go. A n d y o u know, s i n g my h e a r t out i n t h e m o r n i n g . Y o u know, I e n j o y . Just everything comes from, i t stems from good h e a l t h . And i t s , o f c o u r s e , y o u know, r e l a t e d t o b e i n g b o t h m e n t a l l y and p h y s i c a l l y healthy. Doing the  second  health  well.  The e n s u i n g  aspect  of doing  state.  Being  able  accounts  normal  describe  activities  t o do a c t i o n  well  "doing  well"  as  i n the complete was  linked  to having  77 both  a healthy  body and  this  i n t e r m s o f p h y s i c a l and  explained  why  action  a high  at  both  the  level  a healthy  mind.  mental  body and  One  energy  participant  described  (or e f f o r t ) ,  mind need t o  be  healthy  and to  perform  of e f f e c t i v e n e s s .  P: B e c a u s e t o do s o m e t h i n g good, you have t o c o n c e n t r a t e on i t m e n t a l l y and p h y s i c a l l y b o t h . P h y s i c a l l y you a r e d o i n g s o m e t h i n g , m e n t a l l y you a r e p u t t i n g y o u r c o n c e n t r a t i o n i n t o it. So s u p p o s e i f I'm s t u d y i n g , i f I put my both e n e r g y t o g e t h e r i n t o t h e s t u d y , t h e n I can a c h i e v e t h e t o p , you know b e s t out o f i t .  She  R:  Um  hum.  P:  Otherwise  explained  I can't.  "doing  So  t h a t ' s the  way.  something  good" more  explicitly:  R: In y o u r mind f o r you t o be c o m p l e t e l y h e a l t h y , t h e two have t o be t h e r e t h e p h y s i c a l and mental h e a l t h t o g e t h e r ? P: Yeah, Yeah. Um hum. T h a t ' s t h e o n l y way you you want. Participants only  the  account  stated that  mind,  or only  illustrates  body was  not  be  perfectly  healthy.  The  executed  if  following  point:  P: I f you a r e n o t , i f not h e a l t h y , i s s t i l l a r e l i k e m e n t a l l y good you c a n n o t p e r f o r m t h e  you a r e m e n t a l l y h e a l t h y and p h y s i c a l l y you c a n n o t p e r f o r m w e l l . find i f you and p h y s i c a l l y not good, t h e n still way you want t o p e r f o r m t h i n g s .  fts m e n t i o n e d  participants described  resistance,  normal  earlier,  i n d e p e n d e n c e and  characteristics out  action could  the  this  I f you want t o do s o m e t h i n g good. can p e r f o r m s o m e t h i n g t h a t w h a t e v e r  directly  activities  In c o m p l e t e  are  activities,  t o do  and  underlying  i n each  health,  characteristics  c o n t r o l as  phase  four  amounts o f t h e s e  greatest, these  health  a person's of the  allowing  activities  the  energy,  ability  health four  to c a r r y  experience.  health  individual  effectively  and  t o do  more  easily.  fts  78 one  enters  the  partial  health  characteristic  decreases.  totally  altogether.  absent  amounts o f t h e s e  ; •)> ^ ^  %.  . .  4:  complete  health;  Energy described without  and  and  effort. and  of  each  measures a r e  recovers  from  PARTIAL HEALTH less less less  presents  later  sections  %  very  resistance. able  t o do  They a l s o not  described  of these  in t h i s  chapter health  without  spoke o f h a v i n g  experiencing  "any  low  each within  two  control.  two  The  themes i n  will  and  In c o m p l e t e h e a l t h , activities  or  SICKNESS very low very low very low  i n d e p e n d e n c e and  accounts  low  again.  ^  c h a r a c t e r i s t i c s are and  very  sickness,  ^ ;> •)>  less  c h a r a c t e r i s t i c s in p a r t i a l  being  enthusiasm,  one  resistance,  discussion  four health  As  amount  The F o u r H e a l t h C h a r a c t e r i s t i c s i n Phase o f t h e H e a l t h E x p e r i e n c e  four health  themes: e n e r g y following  sickness,  %  Figure These  In  the  four c h a r a c t e r i s t i c s increase  COMPLETE HEALTH Energy "' Resistance Independence Control  stage,  discuss  the  sickness. participants  getting tired  strength  b u r d e n " when  and  and doing  a c t i v i t i es. The described energy  ensuing the  descriptions  energy  promoted d o i n g  illustrate  present  i n complete  normal  activities.  how  participants  health,  and  how  this  P: So b a s i c a l l y h e a l t h means, you know, e n e r g y and, you know, w i t h me, t h e d e s i r e t o do t h i n g s and t h e a b i l i t y t o do them — t o be a c t i v e i n many t h i n g s , and l i k e t o do a l o t o f r u n n i n g a r o u n d , and end up t a k i n g on t h i n g s t h a t I r e a l l y d o n ' t have t o , b e c a u s e t h e r e i s t h a t e n e r g y . And i f I d i d n ' t have good h e a l t h t h e n c e r t a i n l y , I w o u l d n ' t be a b l e t o do  79  that. This  energy  when d o i n g  was f u r t h e r  explained  i n terms  o f "not f e e l i n g  tired"  activities:  R: C o u l d you d e s c r i b e — how a h e a l t h y s t a t e you p e r s o n a l l y , o r what i t means t o you?  feels f o r  P: I'm q u i t e j o y f u l a l l t h r o u g h o u t t h e day. I f I keep d o i n g t h i n g s , t h e r e a l s o , so l o n g as I don't f e e l t i r e d , I f e e l t h a t r e a l l y I'm h e a l t h y . Feelings  o f enjoyment  associated  and e n t h u s i a s m  w i t h t h e energy  f o r work and l i f e  i n complete  were  also  health:  P: I mean i f good h e a l t h i s not t h e r e t h e n , you know, you r e a l l y don't enjoy a n y t h i n g . There i s always that lack of you know, enjoyment, lack of enthusiasm f o r l i v i n g , lack of e n t h u s i a s m f o r t a k i n g on new p r o j e c t s and l i f e becomes a r e a l drag. You d o n ' t have because h e a l t h g i v e s you e n e r g y , and you t a k e on t h i n g s , because o t h e r w i s e you'd j u s t s a y : " w e l l , f o r g e t i t , you know, i f I t o o k on any more I wouldn't be a b l e t o h a n d l e i t , so j u s t l e t ' s n o t b o t h e r with i t " . That would p r e v e n t me from making f r i e n d s , o r l i k e m e e t i n g f r i e n d s as o f t e n and i t would have a b e a r i n g on e v e r y t h i n g I do. I f I wasn't h e a l t h y . Abundant health,  energy  and a p r e r e q u i s i t e  following health or  was d e s c r i b e d  accounts  as a c o r e f e a t u r e  f o r d o i n g normal  illustrate,  feeling  any  activity.  t h e abundance  a l l o w s a p e r s o n t o do d a i l y  of complete  activities  o f energy without  As t h e i n complete being  tired  "burden":  P: As l o n g as y o u ' r e n o t s u f f e r i n g from any d i s e a s e , o r you are say, i f you c a n c a r r y out a l l y o u r normal d u t i e s , t h e s a i d a c t i v i t i e s o f l i f e w i t h o u t f e e l i n g any f a t i g u e o r things like that. Then I t h i n k you a r e a h e a l t h y p e r s o n . P: H e a l t h t o me means no h e a d a c h e s , no t i r e d n e s s a t t h e end of t h e day, e n e r g y t o do t h i n g s . You know, not j u s t go t o work and come home and c o l l a p s e on t h e bed. H e a l t h means t h a t I s h o u l d have t h e e n e r g y when I come home t o be a b l e t o do o t h e r t h i n g s , go f o r w a l k s and b a s i c a l l y f e e l i n g good about m y s e l f .  80 P: L i s t e n , i f you a r e h e a l t h y you don't f e e l t i r e d . You d o n ' t f e e l i l l at a l l , and when you e n j o y t h e work you don't f e e l i t . I t ' s more t h a t you don't f e e l t i r e d , b e c a u s e you a r e e n j o y i n g t h e work at t h e same t i m e . R: So you mean you are t e l l i n g me?  have a  l o t of  energy?  Is t h a t  what  you  P: You have e n e r g y . I f you a r e s i c k , t h e r e i s no e n e r g y t o f i g h t with those t h i n g s — w i t h y o u r r o u t i n e work even. But i f you a r e h e a l t h y you d o n ' t f e e l i t i s t i r i n g or burden, or a n y t h i n g you have done e x t r a o r d i n a r y .  This  R:  You  don't  feel  "a  P:  I'm  moving a r o u n d ,  energy a l s o a l l o w e d  unanticipated participant  work.  burden"  when?  everything  the  i s great  for  i n d i v i d u a l to take  Speaking  o f what he  could  me.  on do  extra in health,  one  said:  P: Not o n l y t h a t ( d o i n g t h e a c t i v i t i e s you want t o d o ) , you c o u l d do what you h a v e n ' t s c h e d u l e d a l s o when i t comes on. Go ahead and do them anyways and not f e e l (anything). R:  You  P:  That's r i g h t .  R:  find  not  feel  P:  find  not  feel  Another vitality  mean t a k e  extra  as  the  the the  energy,  environmental  things.  physically tired energy  expression  person,  or  being  the  v i t a l i t y , was  c h a n g e s and  of  about i t . i n terms  inner  able  he  would  t o do  equated  be  vitality. levels.  activities. would have,  capable  with  changes w i t h i n  of  energy  more v i t a l i t y he  more a c t i v i t y  or  extra  anything.  into action,  "healthier" therefore,  outer  things?  Take on  p a r t i c i p a n t explained  translated  This  on  of  saw  Vitality Thus,  the  and  doing.  r e s i s t a n c e to  the  He  both  body.  P: Yeah. V i t a l i t y , I mean, t h e v i t a l i t y s h o u l d be l i k e t h i s , t h a t a l i t t l e change i n w e a t h e r , a l i t t l e change i n eating habits I mean, out o f r o u t i n e does not make  81 you you R:  sick. sick.  I f you're  g o i n g out  of r o u t i n e  i t does  not  make  I see.  P: Sometimes I have seen p e o p l e b e i n g s i c k j u s t b e c a u s e t h e y d i d n ' t get enough s l e e p . Or j u s t b e c a u s e t h e y had t o go out and p i c k up s o m e t h i n g and f o r g o t t o put t h e i r j a c k e t on o r s o m e t h i n g l i k e t h a t , and got a c o l d and got s i c k . Healthy p e r s o n s do n o t , I mean t h e i r own h e a l t h i s such a way t h a t t h e y c o u l d w e a t h e r t h a t out and not have t h e e f f e c t o f t h e w e a t h e r a l l t h e way a r o u n d . R:  I see.  P: Body r e s i s t a n c e i s more, as a m a t t e r o f f a c t . keeps body r e s i s t a n c e b e t t e r . He  expanded  complete  on t h e r e l a t i o n s h i p between  energy  and  P: You can c a l l i t e n e r g y , against these things. Explaining stated  even  in  health:  R: find y o u ' r e s a y i n g t h i s energy, or a s p e c i a l k i n d  health  health  resistance  P: Yeah, and you don't f e e l t h e e f f e c t o f t h a t t h i n g ( i n complete h e a l t h ) .  he  Good  that that  was  though  t h e body's the energy,  t h e r e a s o n why t h e y might  be  non-routine  i s b e c a u s e you have t h a t of energy? o r t h e body d e v e l o p s  resistance  was  or r e s i s t a n c e  a sign  extra  resistance  o f good  health,  present i n complete  healthy  p e o p l e do not  exposed  to the v i r u s .  get c o l d s  P: and t h a t ' s y o u r own body r e s i s t a n c e which you d e v e l o p e d , and t h a t , t o me i s a s i g n o f good h e a l t h . t h a t comes from r i g h t , h e a l t h y l i v i n g h a b i t s . Explaining  this  same p o i n t  from a m e d i c a l p e r s p e c t i v e ,  he  or f l u ,  have And said:  P: — Now w e ' l l go t o i n m e d i c a l t e r m s . You say y o u r own b l o o d c e l l s f i g h t i t out a g a i n s t t h o s e v i r u s e s , o r whatever, and t h e y win out and so you do not get s i c k . This  resistance  another  to disease  p a r t i c i p a n t as  and  the environment  "not a l w a y s  ailing  from  was  described  something".  by  82  P: I would see h e a l t h as n o t — a l w a y s a i l i n g w i t h s o m e t h i n g , and not a l w a y s t a k i n g m e d i c a t i o n f o r s o m e t h i n g o r the other. Independence  and  i n d e p e n d e n c e and c o n t r o l intimately  people  being  independent  accounts  characteristic One using  normal  t o c a r r y out p e r s o n a l  characteristics  activities.  d e p e n d e n t on  aspects  and b e i n g g e n e r a l l y  or l i f e s t y l e .  The  o f the independence  o f complete h e a l t h .  participant  vitamins  on a c t i v i t y  illustrate  Independence  work and r e s p o n s i b i l i t i e s ,  o f v i t a m i n s and m e d i c a t i o n s ,  of other r e s t r i c t i o n s  following  doing  described  h e a l t h had v a r i o u s m e a n i n g s : not b e i n g  other  free  as two a d d i t i o n a l  a s s o c i a t e d with  in complete  Participants  control.  spoke  of t h i s  or t a k i n g medicines.  independence She  i n terms o f not  said:  P: C o m p l e t e l y h e a l t h y i s e v e r y t h i n g i s w o r k i n g i n y o u r as i t s h o u l d be, w i t h o u t t h e a i d o f a r t i f i c i a l means.  system  R: I s e e . P: That's completely healthy. Whereas you know, you c a n have, you know, 60 d i f f e r e n t m e d i c i n e s a day and f e e l r e a l l y g r e a t , but I don't c a l l t h a t h e a l t h . R: What would  you c a l l  that  state?  P: I would c a l l t h a t , you know, t h e s t a t e o f a r t i f i c i a l health. How c a n you f e e l good about y o u r s e l f i f y o u ' r e h a v i n g so many v i t a m i n s and so many m e d i c i n e s t o r e l i e v e t h i s o r r e l i e v e t h a t from t h e s y s t e m ? T h a t ' s what I mean. C o m p l e t e l y h e a l t h y i s h e a l t h on y o u r own w i t h o u t t h e a i d o f s u p e r f i c i a l t h i n g s , w h i c h a r e v i t a m i n s which c a n be a c q u i r e d by good d i e t s . And w i t h o u t t h e a i d o f p a i n - k i l l e r s and whathave-you. The  same i n f o r m a n t  restrictions account  later  concerning  spoke o f b e i n g diet,  she d e s c r i b e d c o m p l e t e  activity  independent  of  and l i f e s t y l e .  h e a l t h as b e i n g  In t h i s  100 p e r c e n t  83  healthy. R: You c o n s i d e r P: Um  y o u r s e l f 100 p e r c e n t  healthy  now.  hum.  R: So do you f e e l you have any r e s t r i c t i o n s y o u r l i f e a t t h e moment?  on any p a r t o f  P: Not f o r now. I c a n do w h a t e v e r I want t o do. I can run as much a s I want. I c a n e a t w h a t e v e r I want, and I c a n do j u s t about l i k e nobody has t o l d me "you have t o t a k e m e d i c a t i o n f o r so and s o " , so I have no r e s t r i c t i o n s about anything l i k e that. She  explained  healthy,  how a v e r y  because  obese p e r s o n  would n o t be  o f t h e numerous r e s t r i c t i o n s  completely  placed  on him.  P: W e l l , ( i f I were obese) my system would be w o r k i n g a l l r i g h t , but I w o u l d n ' t c o n s i d e r m y s e l f v e r y h e a l t h y b e c a u s e you know, I c a n n o t do e v e r y I cannot r u n , I cannot p l a y a l o t o f games, I c a n n o t do a l o t o f t h i n g s . I may even put a r e s t r i c t i o n on m y s e l f f o r e a t i n g t h i n g s , b e c a u s e I want t o get back t o my n o r m a l . I might c a t c h a c e r t a i n s o m e t h i n g c o u l d happen t o me. I don't know. My h e a r t b e i n g heavy i s one o f t h e r e a s o n s t h e y say s h o u l d n ' t do t h a t b e c a u s e i t does c a u s e a l o t o f h e a r t p r o b l e m s . Being h e a l t h y i s I t h i n k , r e a l l y b e i n g a b l e t o do e v e r y t h i n g w i t h o u t any r e s t r i c t i o n s . Notions of  o f i n d e p e n d e n c e were v e r y  being  "being  i n c o n t r o l o f one's  able  to plan  ahead"  being  able  daily  a c t i v i t i e s could  control  t o do s o m e t h i n g  t o cope".  what  aspects  aspects with  life.  other  aspects  participants  was d e s c r i b e d as  to resolve health concerns  go on i n a n o r m a l way.  o f h e a l t h they  as " b e i n g  could  i n charge"  very  similar  and  "being  of c o n t r o l i n terms o f  t o be i n t h e c o n t r o l o f n a t u r e ,  provided  so t h a t  In a d d i t i o n ,  personally control,  of the accounts,  the idea  f o r t h e f u t u r e " , and a l s o as  Some p a r t i c i p a n t s spoke  were viewed  a s s o c i a t e d with  Control  or "plan  i n h e a l t h was e x p l a i n e d  able  closely  and what  o r God. fls  t h e male and f e m a l e  study  d e s c r i p t i o n s of independence  84 and  control The  is  in health.  subsequent  related  to  narrative  illustrates  how c o n t r o l ,  or coping,  independence.  R: I t seems y o u ' r e in c o n t r o l .  telling  me t h a t  when y o u ' r e  healthy  you're  P: W e l l , you know, you need t o t h e k i n d o f l i f e you l i v e h e r e , ah, y o u ' r e on y o u r own, you have t o do e v e r y t h i n g . You d o n ' t depend on anybody, o r t r y n o t t o depend on t h e c h i l d r e n , or whatever. You have t o be a b l e t o work, you have t o be a b l e t o move a r o u n d , and you have t o be a b l e t o cope w i t h y o u r day t o day l i f e . find how c o u l d you do a l l t h o s e t h i n g s o f you d i d n o t e n j o y good h e a l t h ? R: So b e i n g a b l e  t o cope  i s part  of being healthy?  P: Oh, d e f i n i t e l y ! Definitely! I t s t o cope w i t h y o u r r e s p o n s i b i l i t i e s , with your o b l i g a t i o n s , with your commitments, you know. Your whole l i f e depends on y o u r health basically. E v e r y t h i n g you do depends on w h e t h e r you c a n d e a l w i t h , f u l f i l l t h o s e a l l those d e c i s i o n s depend on w h e t h e r you c a n f u l f i l l them. Your j o b , y o u r work, your c h i l d r e n I mean r e a l l y , w i t h o u t good h e a l t h , you j u s t , you don't have a hope! (LftUGHS) You know? With a l l the, you know, a l l y o u r I don't know t h e r e might be some t h i n g s one c a n do even t h o u g h i t s n o t p e r f e c t l y h e a l t h y , t h e r e may be t h i n g s you c a n do, but i t does l i m i t you. Being  in control  activities, of  health  i n t h e sense  of being able  to plan  one's  and not h a v i n g t o put o f f s c h e d u l e d programs  problems,  was d e s c r i b e d  life because  as f o l l o w s :  P: Any s c h e d u l e d r o u t i n e , I mean g e n e r a l l y p e o p l e have s e t t h e i r r o u t i n e , from g e t t i n g up i n t h e morning t i l l g o i n g t o s l e e p , t o bed. T h e r e i s a s e t r o u t i n e , and t h e n i n t h a t t i m e frame t h e y s e t t h e i r own s c h e d u l e s f o r what t h e y want t o do. find i f t h e y a r e h e a l t h y , t h e y do n o t have t o worry about c h a n g i n g t h a t s c h e d u l e o r m i s s i n g t h i n g s because o f i11-health.  P: T h a t ' s r i g h t . That ( h e a l t h ) g i v e s you y o u r own t i m e t o y o u r p r a y e r s and t h i n g s , and keeps e v e r y t h i n g on a c e r t a i n t i m e and c e r t a i n p l a c e . That i s j u s t g r e a t . R: When y o u ' r e schedule?  h e a l t h y you're  able  t o keep a c e r t a i n  85 P: T h a t ' s  right.  R: Whereas when y o u ' r e  feeling  sick  P: F e e l i n g s i c k , you might not get up i n t i m e t o do t h e thing. You might not be a b l e t o h a n d l e t h e few t h i n g s w h i c h you want t o do, but you c a n ' t b e c a u s e you a r e s i c k . Another  participant  spoke  of t h i s  control  more  eloquently:  P: I f y o u r h e a l t h i s good, t h e n y o u r whole p e r c e p t i o n i s d i f f e r e n t about l i f e . About work, about f a m i l y , about what you do, how you view t h i n g s , p l a n n i n g h o l i d a y , p l a n n i n g what e v e r . R: And f o r you p e r s o n a l l y ,  what  i s that  perspective  like?  P: I d o n ' t know, j u s t a s e n s e o f , you know, a s e n s e o f optimism, a sense of being i n c o n t r o l . And you know, t h e r e i s t h e f e e l i n g t h a t , you know, I c a n do t h i n g s , I c a n do what I want t o do, b a s i c a l l y . R: A s e n s e  of "being i n c o n t r o l " ?  P: Yeah. Yeah, b e i n g i n c o n t r o l o f y o u r h e a l t h , b e i n g i n c o n t r o l o f your l i f e , you're sort of being i n charge of t h i n g s r a t h e r than d r a g g i n g your f e e t . She  further  described  this  perspective:  P: W e l l , b e i n g h e a l t h y , you know, i s b e i n g i n c o n t r o l o f your l i f e , t h a t ' s what I f e e l . In t h e s e n s e t h a t i f y o u ' r e n o t h e a l t h y you c a n ' t make p l a n s , you don't know what y o u r c o n d i t i o n w i l l be. You c a n ' t t a k e on any j o b s . You c a n ' t t a k e on a n y t h i n g which r e q u i r e s , you know, d e p e n d i n g on t h e k i n d o f p h y s i c a l and mental c o n d i t i o n y o u ' r e i n , you c a n ' t commit y o u r s e l f t o a n y t h i n g . I f you do, you d o n ' t have t h e e n e r g y t o do i t . So you g r a d u a l l y , you know, have t o c u t down on t h i n g s , so you r e a l l y don't have you're going t o be so you c a n ' t t a k e on a n y t h i n g . But i f you a r e h e a l t h y and, you know, you don't t h i n k a b o u t : " w e l l , o f c o u r s e , you know, I c a n do t h i s " . You j u s t get up and do i t . Or you say: " f i n e , I ' l l do i t " . And I j u s t f i n d t h a t t h a t ' s what c o n t r o l means i n terms o f h e a l t h , i s t h e a b i l i t y t o do t h i n g s and t o d e c i d e t o do t h i n g s , and make p l a n s and go ahead w i t h them - w i t h o u t which, you know, ( w i t h o u t ) w h i c h h e a l t h you c o u l d n ' t do i t . What would you do i f you were s i c k a l l the time? R: So i t seems t h a t you're s a y i n g ?  there's  a certainty,  i s that  what  86 P: Yeah. R: B e c a u s e i f y o u ' r e you're not sure P: You d o n ' t R: —  sick,  know what  what's g o i n g  you say you c a n ' t  plan  because  you  t o happen.  P: Yeah, yeah. I t h i n k so. T h a t ' s what i t means. You're c e r t a i n about y o u r a b i l i t y t o do t h i n g s , t h a t g i v e s you t h a t c o n t r o l o v e r y o u r p l a n s and f u t u r e and commitments and everything. Two  p a r t i c i p a n t s spoke o f t h e i n d e p e n d e n c e  health  as p a r t i c u l a r l y  explained  that  independent.  Canadian  dai1y  society  In c o n t r a s t ,  i n d e p e n d e n c e was a l e s s were s i c k ,  important  members  for life required  when t h e y  important  of the extended  i n complete  i n Canada.  They  a p e r s o n t o be  were  facet  inherent  living  i n India  of health,  family  because  or servants  i f they  could  do t h e  chores. R: Do you f e e l t h a t b e i n g h e a l t h y i n Canada e n t a i l s a n y t h i n g d i f f e r e n t t h a n b e i n g h e a l t h y when you were i n I n d i a ? P: You know, i f you a r e h e a l t h y h e r e means e v e r y t h i n g has t o be done by you. T h e r e ' s nobody e l s e . fls you t h i n k e v e r y b o d y mind t h e i r own b u s i n e s s . I f you a r e s i c k , means somebody comes f o r r e s t , you might need a g l a s s o f water, you might need s o m e t h i n g . But a t home t h e r e a r e a l l j o i n t f a m i l i e s , and t h e y h e l p w i t h s i c k n e s s and w i t h h e a l t h i n e s s . You know, t h a t makes a d i f f e r e n c e . B e c a u s e you a r e i n a j o i n t f a m i l y , and t h e y look a f t e r you, and you d o n ' t w o r r y t h a t much. You might t h i n k t h a t y o u r c h i l d i s s i c k , and you have t o get up h e r e , but n o t t h e r e ( i n I n d i a ) . — R: So a r e you t e l l i n g i n d e p e n d e n t and b e i n g  me t h a t b e i n g h e a l t h y h e r e , means a b l e t o do t h i n g s f o r y o u r s e l f ?  being  P: F o r y o u r s e l f and f o r t h e f a m i l y and w i t h h a p p i n e s s , means you a r e c o n t e n t , and you don't mind and e v e r y t h i n g i s going j u s t great. Here you have t o be h e a l t h y t o cope with the world. ft few  participants  a l s o spoke  of c o n t r o l  i n t e r m s o f what  they  87 personally totally  could  do t o keep h e a l t h y .  i n the c o n t r o l  Health  o f t h e i n d i v i d u a l , but r a t h e r  of nature,  o r i n God's hands t o some e x t e n t .  like  exercise,  diet,  mental  keeping  a t t i t u d e , and s t a y i n g  regarded  was seen a s n o t  active,  as h e a l t h f u l a c t i v i t i e s  Preventive  maintaining  contented under  i n t h e domain actions  a calm,  o r happy w i t h  clear  life,  were  individual control.  P: H e a l t h i s s o m e t h i n g t h a t c a n ' t be p r e d i c t e d r i g h t ? I would say i t s n o t i n y o u r hands. I mean i t ' s n o t even i n t h e hands o f d o c t o r s , o r s c i e n c e o r anybody. Because i f i t was, nobody would e v e r get s i c k , r i g h t ? We'd be a l l healthy f o r a l l of t h e i r l i f e , r i g h t ? I t ' s , I mean, i t ' s — you d o n ' t c o n t r o l t h e s e t h i n g s , somebody e l s e does, find, but you s t i l l , you know, a l l we c a n do i s j u s t , you know, do w h a t e v e r we c a n t o s t a y h e a l t h y . R: So i f y o u ' r e s a y i n g t h a t C o u l d you d e s c r i b e t o me P: Yeah, The stay  that's,  participant  later  "someone e l s e " does i t .  you know,  someone e l s e  clarified  what  —  she c o u l d  I mean God! personally  do t o  healthy: P: W e l l , I guess I've a l r e a d y t o l d you. You s a i d , yeah, c o n t r o l y o u r d i e t a l i t t l e , and t h e n do your, you know, t r y t o do a b i t o f e x e r c i s e and be c o n t e n t , and t r y t o be happy a l i t t l e . Do a l l t h o s e t h i n g s , and t h e n l e a v e t h e r e s t i n HIS hands, I g u e s s .  Another  p a r t i c i p a n t presented  a similar  perspective:  P: N a t u r e i s n o t i n y o u r c o n t r o l . You c a n o n l y c o n t r o l y o u r f e e l i n g s , o r your, you know, body - l i k e d i s e a s e . But n a t u r e you c a n ' t c o n t r o l , you know. B e c a u s e maybe i t s i n y o u r d e s t i n y t h a t you have t o go i n accident and l o s e y o u r l e g o r l o s e y o u r hand o r s o m e t h i n g . That, Hindu philosophy s a y s i s t h e karmas ( p a s t a c t i o n s ) , you know. You have t o s u f f e r w h a t e v e r you have done, maybe i n y o u r past l i f e or t h i s l i f e . R: Okay. So you s a i d t h i n g s l i k e d i e t and e x e r c i s e , a l l t h o s e t h i n g s t h a t you have c o n t r o l o v e r . P: Yeah! You c a n do i t , yeah. f a s t , you c a n change y o u r b r a i n  You c a n m e d i t a t e , you c a n ( d i s c i p l i n e your t h i n k i n g ) ,  aa you can r e d i r e c t y o u r t h i n k i n g , you can okay, you a r e not good i n s t u d y , you can a l w a y s go t o music. I f you a r e not good i n music, you can a l w a y s p i c k up s p o r t s , you know. So t h e s e t h i n g I'm t a l k i n g about which you can do. To  conclude,  the  health  are  healthy  explained  complete  experience. and  that  activities  the  presented  of  and  happily.  control  section describes  Abundant  the  partial  between c o m p l e t e health  accounts as:  "a  healthy,  with  but  ill-health.  health  that  health  energy,  as  phase  of  body and  mind  Participants  t o do  normal  resistance,  capacity  for action.  the  second  and  bit sick",  in t h i s  feature  In t h i s  of are  state,  was  days o r weeks.  headache  sickness variously  "not  "more o r  The  phase  the  other  as  partial short  health  the  of  (see  in participant well",  "being  100%  less healthy" experience of  of  i s that  stage  f i g u r e 3).  l e s s than  type  least  "in-between"  feeling  "in-between" s t a t e  partial the  healthy  and  of a c o l d  short  still  term  ache  health.  symptoms,  or or An  or  term.  participants' ability  interrupted Most  or  described  a definite  described  f o r example),  problems,  activities  were a b l e  phase was  Participants described  being  important  both t h e  harmony.  health  a b i t of a problem",  f l u , a temporary as  was  little  (80-95% h e a l t h y ,  pain,  first  Health  health  p a r t i c i p a n t s agreed  Partial  the  the  experience.  Although  existed  this  partial  Partial  clearly,  and  they  supported  as  health,  balance  in complete h e a l t h  well  health  was  In c o m p l e t e  in a state  i n d e p e n d e n c e and following  health  f o r a temporary  t o do  normal  period  p a r t i c i p a n t s spoke o f t h e  daily  of time,  pain,  usually  discomfort  89 and  other  complaints  headache,  associated  f o r example,  experience  i n terms  was d e s c r i b e d  hindrance,  i n t h e sense t h a t  activities  was i n t e r r u p t e d  partial (Being  health, worried  discussed  healthy,  frequently described  during  partial  period  "bothered  associated of t h i s  about  with  sickness,  health  could  problems d i d n ' t  completely  experience.  f l u or headache  Partial  health  health.  deteriorate  as w i l l be  chapter).  a cold,  back t o t o t a l  being i n  o r a n n o y e d " them.  was n o t an uncommon  having  or a  of time.  were not w o r r i e d  i t just  t h e year.  as l e a d i n g  This  t o do normal  p a r t i c i p a n t s saw t h e m s e l v e s as  reported  f l u and  a nuisance  individual ability  section  health  colds,  o f a few d a y s d u r a t i o n .  f o r a short  was s o m e t h i n g  most  like  t o mean a n n o y i n g ,  they  but t h a t  partial  Participants  health  that  i n the f i n a l  Although  that  stated  ailments  a s "bothersome".  B o t h e r s o m e was e x p l a i n e d  Participants  with  was  reasonably  generally  Participants  into sickness  go away s p o n t a n e o u s l y ,  explained  i f the small  o r were  left  untreated. Partial for  doing  health  normal  i s discussed  activities,  described  effort,  but n o t w e l l " ,  partial  health,  present  i n l e s s e r amounts t h a n  characteristics describing  i n t e r m s o f (1) c a p a c i t y here  and (2) as t e m p o r a r y  the four health  are discussed  normal  below  activity  as "can do  with  and bothersome.  In  c h a r a c t e r i s t i c s were d e s c r i b e d i n complete h e a l t h .  within  in partial  t h e next health.  as  These  portion  of the text  90  Can  do  with E f f o r t .  The partial  following  "not  feeling  not  little  doing  things, saw  flu,  headache) was  would  go  themselves  normal  effectiveness  than  in a  participants described  is slightly  Consequently,  in less  "off",  the t o t a l  healthy.  either  "unit"  This condition  effective  described this  t h e d a y ' s work. as  not  They  phase,  do  activity  or  person  of being  "  and  activity.  themselves  although  less  p e r c e p t i o n s of  anything".  results  through  could s t i l l  with  In t h i s  as c o m p l e t e l y  Some p a r t i c i p a n t s  perceived  and  h e a l t h , something  when d o i n g  themselves"  where t h e y  health.  bit sick"  tiredness  describe participants'  effort  or m e n t a l l y .  regarded  Well  accounts  with  like  partial  physically  a  but  of complete  In  is  not  h e a l t h as a s t a t e  activities, state  But  still  as w e l l as  still  less  fit  this  as  time,  h e a l t h y because they o r as h a p p i l y as  "dragging participants could s t i l l  i n complete  h e a l t h y because the c o n d i t i o n  temporary  away more o r  experience  and on  considered  i t s own,  with  "no  big deal",  little  or  do  health. (cold, as i t  no  i n t e r v e n t i on. The partial  following h e a l t h , and  accounts their  illustrate  ability  t o do  how  participants described  normal a c t i v i t i e s  in t h i s  phase. P: Sometimes y o u ' r e when i t s a c e r t a i n responsibilities. a r e w e l l o r no.  P:  I f say,  a l i t t l e s i c k , you can s t i l l d r a g a r o u n d t i m e o f age. Means t h e p e r s o n has some You've got t o do a few t h i n g s w h e t h e r you  you've got  up w i t h a headache,  you'd  still  be  91 h e a l t h y , you know. a bit off.  It doesn't  One p a r t i c i p a n t d e s c r i b e d didn't not  consider  do d a i l y  the fact  t a k e away from that  as w e l l  It's just  when she was s a d , she  h e r s e l f p e r f e c t l y healthy.  activities  it.  as when  fit  that  in a state  time  she c o u l d  o f complete  health: P: L i k e I c a n ' t say t h a t t i m e ( i n p a r t i a l h e a l t h ) t h a t I'm, you know, p e r f e c t l y h e a l t h y . Because I cannot perform t h i n g s good, and my speed i s slow t h a t t i m e , l i k e t h e way I do things. Describing and  the miserable  running  participant  experience  nose a s s o c i a t e d explained  o f t h e body.  with  developing  how p a r t i a l  Here p a r t i a l  he had w i t h  health  health  the watering  allergies,  eyes  one  r e f e r s to the condition  i s denoted  by t h e term  i 11-health. R: So a r e you t e l l i n g o f t h e body?  me t h a t  ill-health  f o r you, i s i n t e r m s  P: Yes. B e c a u s e w i t h t h e mind I c o u l d s t i l l r a t i o n a l i z e and try to r a t i o n a l i z e things. Okay. find have no p r o b l e m b e c a u s e I s t i l l m a i n t a i n e d a l l my, a l l t h e r o u t i n e s o f work, and so a r e a s o n a b l e t h o u g h t p r o c e s s . But body r e m a i n s m i s e r a b l e b e c a u s e o f w h a t e v e r c h e m i c a l c h a n g e s happen i n t h e body. The  four  health  health  are described  Decreased characterized The  low e n e r g y  tired,  c h a r a c t e r i s t i c s underlying  in partial  below.  e n e r g y and r e s i s t a n c e . by d e c r e a s e d in partial  or fatigued.  activity  Partial  amounts o f energy health  account  P: (finy change) i n n o r m a l h e a l t h y c h e m i c a l food intake, or p h y s i c a l make me i l l , i l l - h e a l t h , o r t i r e d of i l l - h e a l t h .  was  and r e s i s t a n c e .  was d e s c r i b e d  The f o l l o w i n g  health  i n terms o f being  illustrates  this:  h a b i t , whether i t s i n change, I mean i t w i l l tiredness i s a sign  even  92 Partial  health  resistance participant chemical from  was f u r t h e r d e s c r i b e d  to diseases viewed  and e x t e r n a l  this  lowered  changes o c c u r r i n g  mental  worry.  stress,  o r worry,  this  a person  becomes a l l e r g i c t o t h i n g s  how  partial  complete partial  health  health.  state  o f lowered mode".  as t h e p r i m a r y c a u s e  resistance.  h i s resistance  of  i s low.  such  In t h i s  can d e t e r i o r a t e account  into  resistance Mental  in partial  as d u s t account,  health  and f o o d s , he a l s o  sickness,  t h e term  arising  o f lowered  I t was h i s e x p e r i e n c e t h a t  In t h i s  One  i n t h e body, due t o t h e s t r e s s  physical  because  changes.  as t h e r e s u l t  i s i n a "low v i t a l i t y  was seen  of lowered  environmental  resistance  He d e s c r i b e d  as a t i m e when t h e body  i n terms  explained  o r move back t o  " i l l - h e a l t h " denotes  health.  R: So i n t h i s s t a t e its resistance?  o f i l l - h e a l t h , t h e body's  lost  P: Yes. Body has l o s t i t s r e s i s t a n c e t o f i g h t any k i n d o f change h a p p e n i n g , and c h e m i c a l change i t g e t s  exposed  to. R: So t h i s  state  o f i l l - h e a l t h c a n become  sickness?  P: I t c o u l d ! R: I f i t g e t s worse? P: I t c o u l d . R: find would t h i s P: Yes, i t would R: I t w i l l  resistance go lower.  t h e n change a s w e l l It w i l l  in sickness?  decay.  decay?  P: Yes. R: And so when a p e r s o n , i n t h i s s t a t e o f i l l - h e a l t h t h e n , i f a p e r s o n ' s r e s i s t a n c e improves, t h e n h e ' l l become h e a l t h i e r ?  9 3  P: T h a t ' s  right.  Decreased  i n d e p e n d e n c e and c o n t r o l .  was d e s c r i b e d activity in  and l i f e s t y l e .  to take  cartilage. it  i n t e r m s o f imposed  terms o f being  having  medicine  with  she d e s c r i b e d  account,  she e x p e r i e n c e d  although  percent  feeling  she r e f e r r e d  normal  to a torn  t o do a c t i o n .  by t h e s e  health  and  knee  a limitation,  She s t i l l  as  saw  h e a l t h y . Her  restrictions  "a b i t h a n d i c a p p e d " .  to partial  partial  activities,  was i t s e l f  not c o m p l e t e l y  independence  o r l i m i t a t i o n s on  described  f o r the pain r e l a t e d  i n d e p e n d e n c e was r e d u c e d and  i n doing  her a b i l i t y  as h e a l t h y ,  Decreased  restrictions,  One p a r t i c i p a n t  restricted  The p a i n  interfered  herself  Yes.  on h e r d a i l y  life,  In t h e f o l l o w i n g  h e a l t h as "not b e i n g  a 100  healthy".  R: You gave me t h e f e e l i n g t h a t you d i d n ' t c o m p l e t e l y h e a l t h y a t t h e moment.  see y o u r s e l f as  P: I'm n o t c o m p l e t e l y a h u n d r e d p e r c e n t h e a l t h y , b e c a u s e I r e a l l y c a n n o t use my knees a h u n d r e d p e r c e n t . find i f I s t r e s s i t t o o much, i f I go r u n n i n g down t h e s t a i r s o r , l i k e I used t o do a l l k i n d s o f t h i n g s . I can't. I cannot s i t on t h e f l o o r , I c a n n o t s q u a t , I c a n n o t bend my knees. find I f e e l a b i t h a n d i c a p p e d , you know, i n t h e s e n s e t h a t I c a n ' t use, I c a n n o t do t h i n g s t h a t I c o u l d , as e a s i l y . So o t h e r t h a n t h a t I'm n o t , I'm not u n h e a l t h y , I don't f e e l t h a t my h e a l t h i s a p r o b l e m r i g h t now. But t h a t ' s a s m a l l — you know, i t i s a n a g g i n g p a i n , b e c a u s e I'm not used t o not b e i n g a b l e t o go up and down t h e s t a i r s as I f e e l . R: So t o do w i t h y o u r knee a g a i n , i s i t t h e l i m i t a t i o n i n a c t i o n t h a t you a r e l o o k i n g a t ? Or i s i t y o u r you s a i d you f e e l " h a n d i c a p p e d " or i s i t both o f t h e s e t h i n g s ? P: I t ' s b o t h o f t h e s e t h i n g s . Because t h e r e i s t h a t f e e l i n g o f not b e i n g a h u n d r e d p e r c e n t . And a l s o t h e a c t u a l p a i n , i f I'm s i t t i n g on t h e f l o o r , o r you know, I l i k e to, the m u s i c I p l a y o r s i n g , I have t o use, s i t on t h e f l o o r and bend my knee t o be a b l e t o p l a y t h e harmonium, w h a t e v e r , t h e tamboora.  94 R: Yes. P: Ond i t s a p r o b l e m . B e c a u s e you know i t p a i n s . I have t o s i t on a c u s h i o n . find a y e a r ago I would have n o t t h o u g h t t w i c e about t h e s e t h i n g s and t h e s m a l l d i s c o m f o r t s . But now I have t o t h i n k about i t . I have t o f i n d a c u s h i o n , and I have t o f i n d s o m e t h i n g t o r e s t t h i s knee on. Then I c a n s i t in the proper p o s i t i o n . But a l s o t h e r e i s t h e f e a r , o r — t h a t I may n e v e r have f u l l use o f my knee as I had b e f o r e . And i t ' s , you know, when I go i n and out o f t h e c a r s , i n t h e car i t s a b i t o f a s t r a i n t o get i n and o u t . I c a n ' t do t h i n g s as f r e e l y . Movements have become a b i t r e s t r i c t e d . The  same i n f o r m a n t  after  h e r knee was much  reflected had  explained  improved.  on why she f e l t  restricted  this  she was  from  a different  In t h e e n s u i n g in partial  movement and she was on p a i n  perspective account,  she  h e a l t h when h e r knee medication.  P: I j u s t d o n ' t have a n y t h i n g (no p a i n m e d i c a t i o n ) now. And sometimes i t j u s t h u r t s a l i t t l e b i t . So I am much h e a l t h i e r I f e e l t h a n I was when I saw you l a s t . B e c a u s e now I am n o t having Entrophen (medication). And my knee i s much b e t t e r , i t ' s n o t h u r t i n g , so t h a t ' s what I'm t r y i n g t o s a y . I was o n l y p a r t i a l l y h e a l t h y , a l t h o u g h t h e r e was r e a l l y n o t h i n g drast ical1y wrong w i t h me. But I d i d n ' t f e e l h e a l t h y b e c a u s e I was h a v i n g f o u r o f t h e s e t a b l e t s a day. R: Yes. Y e s . P: And now I t h i n k i t s o v e r a month I h a v e n ' t had any, and I j u s t won't have i t u n l e s s I'm d y i n g o r s o m e t h i n g ! (LAUGHS) You know, u n l e s s i t s r e a l l y n e c e s s a r y . So I mean, i n my mind h e a l t h i s r e l a t e d t o I mean, i f y o u ' r e h a v i n g m e d i c a t i o n t o c u r b some s o r t o f p a i n i n y o u r system, t h e n how c a n you c a l l y o u r s e l f c o m p l e t e l y h e a l t h y ? Another p a r t i c i p a n t activity heart  described this  restriction  on l i f e s t y l e and  i n t e r m s o f t h e c o n d i t i o n o f h e r husband  who had open  surgery. R: You s a i d y o u r husband i s r e s t r i c t e d i n h i s a c t i v i t i e s , t h e r e f o r e y o u ' r e c o n s i d e r i n g him 80 p e r c e n t h e a l t h y ?  and  P: Um hum. Even 90 p e r c e n t , b e c a u s e he r e a l l y t a k e s c a r e o f h i m s e l f v e r y w e l l , but he has c e r t a i n r e s t r i c t i o n s . He c a n n o t e a t t o o much f r i e d f o o d . He c a n n o t e a t t o o much sweet food. L i k e and he c a n n o t l i f t t o o much w e i g h t . He's n o t  95 a l l o w e d t o do t h a t . Normally he's very h e a l t h y . I wouldn't say a n y t h i n g about him n o t b e i n g h e a l t h y , but inward I know, I'm a l w a y s s c a r e d , l e t me say t h a t , t h a t I don't know what c o u l d happen t o him. T h a t ' s i t . She  s t a t e d at another  time:  P: W e l l , he i s v e r y h e a l t h y , l i k e i f he c h a n g e s h i s way o f e a t i n g and does not c a r e about h i m s e l f , and e a t s j u s t about e v e r y t h i n g , and he e a t s a l o t o f s a l t , he e a t s a l o t o f sweets, and he i s not g o i n g t o be h e a l t h y , he is_ a l w a y s g o i n g t o be a i l i n g w i t h s o m e t h i n g o r t h e o t h e r . He might be b e d r i d d e n f o r a l l I know, but r i g h t now he i s h e a l t h y . But i f you a s k f o r a d o c t o r ' s o p i n i o n , he i s h e a l t h y , but he's not he c a n n o t say t h a t he i s a 100 p e r c e n t h e a l t h y . R: So you c o n s i d e r him h e a l t h y now, but n o t a 100 p e r c e n t healthy. C o u l d you t e l l me t h e d i f f e r e n c e between t h o s e two t h i n g s i n y o u r mind? P: W e l l , i f he d i d n ' t have t h i s h e a l t h p r o b l e m about h i s h e a r t , he would be d o i n g j u s t e v e r y t h i n g t h a t I do. I do a l o t of running. I e a t j u s t about e v e r y t h i n g I f e e l l i k e . I don't r e s t r i c t m y s e l f about n o t e a t i n g a n y t h i n g o r n o t d o i n g i t . I e a t a l o t o f sweets, I e a t a l o t o f f r i e d f o o d . He does n o t e a t t h a t . So t h a t ' s why he e a t s l e s s s a l t . He's on m e d i c a t i o n . R: Yes. Yes. P: So t h e s e k i n d o f t h i n g s t h e y do r e f l e c t being a t o t a l l y h e a l t h y person. Another account temperature time  described the experience  and how t h i s  the p a r t i c i p a n t  b e c a u s e he d i d not f e e l  of having  condition restricted  felt  t h a t he c o u l d  like  doing  on you as not an e l e v a t e d  activity.  not do t h e work  anything  but l y i n g  Pt  this  well,  down.  P: I f I'm r u n n i n g a t e m p e r a t u r e and s t i l l I have t o work i n t h e house, I might do i t b e c a u s e I have got t o do i t . But I might n o t be a b l e t o do i t w i t h s i n c e r i t y , o r I won't be a b l e t o do i t t h a t good. That put r e s t r i c t i o n on my a c t i v i t y out put. R: Why  won't  P: Okay. R: Okay,  you be a b l e  Because your  t o do i t w e l l ?  my mind  "mind  i s not  i s not a t t u n e d attuned"?  to that.  96 P: Mind i s n o t a t t u n e d t o t h a t , o r s e c o n d l y when I am n o t w e l l I n a t u r a l l y f e e l l a z y , I f e e l l i k e l y i n g down, r a t h e r t h a n do some l a b o r i o u s work. In  a later  meant  i n t e r v i e w he e x p l a i n e d t h a t  not f e e l i n g  like  doing  "mind n o t b e i n g  activity.  He s t a t e d :  P: You don't f e e l l i k e d o i n g a n y t h i n g l i e down o r s o m e t h i n g l i k e t h a t . R: So "mind n o t a t t u n e d " P: Mind  not a t t u n e d  R: B e c a u s e y o u r P: T h a t ' s One p a r t i c i p a n t his  attuned"  a l t o g e t h e r , and j u s t  means  means you don't  feel  like  doing  i t . Yeah.  body want's t o l i e down and r e s t ?  right. described the limited  condition in partial  control  a person  has o v e r  health.  P: W e l l , l i k e i f you a r e a l i t t l e b i t s i c k , l i k e I s a i d you a r e a l i t t l e b i t s i c k w i t h t h e f l u and c o l d s and a l l that. Of c o u r s e you c a n have m e d i c a t i o n f o r t h a t , r i g h t ? find s t a y i n bed and r e s t . find t h a t ' s a l l , t h a t ' s what you can do t o c o n t r o l i t . Temporary  and B o t h e r s o m e  fis d e s c r i b e d  i n the i n t r o d u c t i o n  participants  viewed  bothersome.  The f o l l o w i n g a c c o u n t s  bothersome normal  because  activities  partial  h e a l t h as both  in this  t e m p o r a r y and  a person  phase o f t h e h e a l t h  you, t h a t ' s r i g h t .  section,  described partial  of the lessened a b i l i t y  R: You s a i d t h a t , I b e l i e v e , d o e s n ' t w o r r y you? P: B o t h e r s  to t h i s  a cold  h e a l t h as  has t o do  experience.  "bothers"  you, but i t  Urn hum.  R: find I'm s t i l l not c o m p l e t e l y c l e a r between " b o t h e r i n g " and " w o r r y i n g " .  on t h e d i f f e r e n c e  P: B o t h e r i n g means i t s a n n o y i n g . You know, i t s a n n o y i n g you, you s a y , I mean "what i s i t " you know. I c a n ' t do what I'm s u p p o s e d t o do, I c a n ' t do what I, you know, l i k e t o do. But  97 w o r r y i n g i s s o m e t h i n g when you s i t t h e r e and you say "what i s g o i n g t o happen now"? R i g h t ? That k i n d o f s t u f f . R: So you mean worry i s , w o r r y i n g about b e i n g about w h e t h e r i t s g o i n g t o be more s e r i o u s ? P: Oh, yeah.  That's  sick?  Worrying  right.  R: So I t h i n k t h a t you were s a y i n g t h a t c a n c e r , s a y , t h e y would be w o r r i e d ?  someone who has  P: Yeah. The  temporary  health  nature  o f "not b e i n g  is illustrated  i n the f o l l o w i n g accounts  experience  o f t h e f l u , headache,  ailments.  These a i l m e n t s  would  a b l e t o do t h i n g s " i n p a r t i a l d e s c r i b i n g the  f e v e r , b a c k a c h e and s i m i l a r  were d e s c r i b e d as minor s i c k n e s s e s t h a t  go away. R: find when l i t t l e t h i n g s come, l i k e a l i t t l e b i t o f p a i n w i t h a headache, f o r i n s t a n c e , t h e n y o u ' r e h e a l t h y but you have t h a t t e m p o r a r y  P: Temporary you c a n s t i l l alright.  phase o f b e i n g u n a b l e t o do t h i n g s maybe, but be f i n e . A f t e r a w h i l e i t goes away and y o u ' r e  P: You a r e a b i t s i c k , R: T e m p o r a r i l y  temporarily,  yeah.  sick.  P: Yeah, but y o u ' r e not r e a l l y , you c a n ' t r e a l l y c a l l yourself (sick) i t j u s t b o t h e r s you i n s i d e . F o r you know, — you know, i t s o n l y t e m p o r a r y . But s t i l l i t b o t h e r s you f o r a l i t t l e b i t . You know, you c a n ' t do get up and do t h i n g s f o r o t h e r s and f o r y o u r s e l f . Or you know, you become somebody e l s e has t o you know, cook f o r you o r do t h i n g s f o r you.  P: I f i t s a c o n s t a n t o n - g o i n g p r o b l e m t h e n I would c a l l myself unhealthy ( s i c k ) . I f i t i s j u s t f l u or a l i t t l e b i t of p a i n , o r a l i t t l e b i t o f d i a r r h e a , t h a t ' s n o t I'm s t i l l healthy.  98 R: You're  still  healthy.  P: T h a t ' s j u s t a t e m p o r a r y p a i n , you know. And I don't about i t . I t h i n k I'm g o i n g t o get o v e r i t .  worry  P: T h a t ' s a t e m p o r a r y i l l n e s s , l i k e i t s n o t an i l l n e s s — i t ' s not you're not h e a l t h y . It's just — I don't know what c a u s e s a headache, but t h a t ' s a v e r y t e m p o r a r y t h i n g t h a t y o u ' r e t a k i n g ( m e d i c a t i o n ) , and i f you t a k e t h a t and y o u r headache i s a l r i g h t , you're f i n e . That's a very temporary t h i n g a c c o r d i n g t o me.  P: A g a i n , i t ' s t e m p o r a r y , r i g h t ? You know i t i s g o i n g t o go away. You have f e v e r , you have f l u , but a g a i n y o u ' r e w o r r i e d t h a t y o u ' r e g o i n g t o pass i t on t o t h e k i d s and o t h e r members of t h e f a m i l y . But s t i l l you know t h a t i t ' s n o t a b i g d e a l , i t w i l l go away. I t ' s j u s t s o m e t h i n g you g e t i n e v e r y season. Partial of  health  normal  meant a t e m p o r a r y  activities.  One p a r t i c i p a n t  d a u g h t e r was v e r y t i r e d her a  normal short  activities  term  deviation  usual  explained  f o r a few days,  i n a usual  from  that  she c o u l d  fashion.  This  performance when h e r  n o t carry  was  out  i n d i c a t i v e of  illness.  P: E i t h e r s h e ' s got a f e v e r , o f she had s o m e t h i n g t o e a t something t h a t i s not that i s bothering her, that i s a s h o r t - t e r m i l l n e s s , but n o t a l o n g - t i m e , a l o n g - t e r m , something. But i t i s , a g a i n i t ' s d e v i a t i n g from h e r normal day a c t i v i t i e s normal l i f e , so i t i s d i f f e r e n t , I s h o u l d s a y . And once s h e ' s t a k e n h e r m e d i c a t i o n f o r i t s h e ' l l be a l l r i g h t . So t h a t i s h e a l t h t o me, t o be a b l e t o resume y o u r e v e r y d a y a c t i v i t i e s i n a normal s o r t o f way. To  summarize,  phase  partial  "in-between"  denoted  this  considered  state  partial  health  complete  was d e s c r i b e d health  by d i f f e r e n t health  related  to lessened  health,  participants  could  and s i c k n e s s .  terms.  a temporary  ability  carry  Participants  A l lparticipants,  however,  and bothersome e x p e r i e n c e  t o do n o r m a l still  as a somewhat u n c l e a r  activities.  out normal  In p a r t i a l  a c t i v i t y , but  99 less  well  energy,  and  with  more e f f o r t  resistance,  characteristics experience. participant health  in complete h e a l t h .  i n d e p e n d e n c e and  underlying  The  than  action  following  descriptions  in t h i s  portion  of  c o n t r o l were t h e  health  phase o f t h e  of t h i s  sickness  Decreased  section  - the  third  health  presents  phase o f  the  experience. Sickness  Sickness totally  was  clearly  unable to c a r r y  independent  action.  with  little  having  that.they  d i d not  anything  described  out  This o r no  normal  physical  to  do  and  action  energy.  anything  because the  a s t a t e where a p e r s o n  activities,  inability  want t o do  in sickness,  as  incapable  was  in fact,  body needed  to  of  associated  Participants  and,  is  stated  could  rest  not  do  and  r e c u p e r a t e. Participants Some d e s c r i b e d childhood. family  an  members o r  sickness  he  was  was  sick.  episode  of  he  he  taken  not  Sickness was  wrong  to  disease,  friends.  really  He  retrospect  external  relatively  little  sickness  O t h e r s were aware o f t h e  of  had  had  was  not the  chemical  agents  (like  sickness  informant  having  consider illness  viewed  i n s i d e the  in t h e i r  t h e o r e t i c a l since  described  did  One  experience  as  typhoid  that  life,  had  as  sickness.  usually  experiences  s a i d that he  with  his  never  a child,  a sickness,  in  of  discussion  "felt" but  b e c a u s e as  that  in a  child  seriously. a  serious  body. T h i s  " s o m e t h i n g wrong" was  changes w i t h i n viruses).  s i t u a t i o n where  In  the  body,  sickness  "something" attributed  or a c t i o n the  body  from was  100 described  as i n a s t a t e  resistance In like  o f very  t o change and  sickness,  socializing  participants described because  carry  i s very  person fulfill person  family having  dependent  a sick  on o t h e r s  little  long  control  to p a r t i a l  term,  person  t o meet  health,  o r permanent.  uncertainty persisting Being although  person  other  explained  so l o n g  because  i t was  or i n c u r a b l e . about t h e  why symptoms were  associated  better. with  being  bed-ridden,  d i d n o t mean one was s i c k . sick",  was i n bed he c o u l d  n o t do h i s d a i l y  activities.  anyth ing,  and t h i s  bed-ridden  process.  unanimously  i n bed as " b e i n g  being  the sick  went "on  being  words,  described  a s w e l l as  that  C a n c e r was  and he was n o t g e t t i n g  i n bed i t s e l f  a sick  was viewed as  a s i c k p e r s o n would worry  s i c k was f r e q u e n t l y  being  that  described  Any c o n d i t i o n  and about  unable t o  needs,  and e i t h e r permanent  that  because  and t h e d i s e a s e  as a s i c k n e s s ,  of h i s condition,  Participants a  serious,  on o t h e r s ,  sickness  emphatically  identified  d i d not f e e l  is literally  over a c t i o n  and  Participants  low  They had t o f o r c e  Accounts also  on and on" was viewed as a s i c k n e s s .  as v e r y  they  personal  and  perceived  very  P a r t i c i p a n t s explained  responsibilities.  In c o n t r a s t something  Being  activities.  i s dependent  that  o f a c h e s and p a i n s .  restricted,  out n o r m a l  with  disease.  t h e m s e l v e s t o do t h i n g s . action  low energy,  denoted  not being  i n a b i 1 i t y t o do a c t i o n  sickness.  P a r t i c i p a n t s explained  generally,  although  that  not n e c e s s a r i l y ,  able  was what  a sick  b e c a u s e when In  t o do  signified  person  was  i n bed b e c a u s e he had no  101 energy  or  partial  inclination  health,  exclusively  on  In t h i s in  terms of  being  able  serious, brief  t o do  anything.  d e s c r i p t i o n s of the  physical  to  not  being  fulfill  permanent  presentation  sickness  sickness  able  t o do  worrisome.  The  Participants normal d a i l y  (2)  as  described  therefore  not  something with  of p a r t i c i p a n t a c c o u n t s d e s c r i b i n g the  death. Cannot  and  and  be  s e c t i o n concludes  illness  Do,  will  activities,  sickness: return to health,  Cannot  and  almost  experience  outcomes o f and  complete  focused  responsibilities,  and  with  body.  d i s c u s s i o n , the (1)  As  or d e c l i n e t o  a  possible  chronic  f u l f i l l Responsibilities viewed  activities  a sick and  person  as  someone u n a b l e t o  independently  fulfill  do  life  responsibilities. R: So i t seems y o u ' r e t e l l i n g y o u ' r e not a b l e t o do t h i n g s .  me  that  when y o u ' r e  sick,  P: Not o n l y (not) a b l e t o do t h i n g s , you see. There i s something the pain i s there, constant pain. Let alone t h e work, you see. Your body's not a b l e t o do a n y t h i n g . Loss  of  one's a b i l i t y  t o do  normal  activities  meaning d e p e n d i n g  upon one's d u t i e s and  more a p e r s o n  prevented  the  s i c k e r h e / s h e was  participant meant "being  "being  described a  little  that  many c u r r e n t  from  perceived that  the  breaking  f o r her a  be.  For  as  l e g now  responsibilities  a wife meant to  one  (breaking  a  was  a child,  but  and  mother.  She  sickness,  family  and  The  responsibilities,  example,  same c o n d i t i o n when she  different  responsibilities.  meeting h i s / h e r to  bit sick"  seriously sick"  explained so  was  had  because  others;  leg) meant  she  whereas  had  10E when she to  was  a child  she  had  no  responsibilities  other  than  going  school. R: What I'm w o n d e r i n g about h e r e i s , you know, say when were seven and you had t h i s b r o k e n l e g , and you f e l t i t wasn't r e a l l y s i c k n e s s , b e c a u s e i t wasn't d i s r u p t i n g y o u r s c h o o l work, e t c e t e r a . But now f o r you, say you b r o k e y o u r l e g now, and you had t o be i n bed? P:  That's  right,  R: Why t h a t and now?  I would c a l l  difference  myself r e a l l y  between when you  sick  were  you  then.  seven  P: B e c a u s e I had no r e s p o n s i b i l i t i e s t h e n . find I have l o t s now. find i f I were t o be i n bed w i t h a b r o k e n l e g , say f o r a few months, even f o r a month, t h a t would be a l o t . Participant  accounts also  more s e r i o u s linked  to  than  being  personal  was  less  depression, complete (and  the  because daily  family  that  being  in India.  This  associated  duties  P a r t i c i p a n t s explained  "serious",  therefore  extended  sick  r o l e s and  responsibilities. sick  explained  and  family  did  frequently  regarded not  in India,  again  being  were t h e r e being  more s e r i o u s  a v a i l a b l e to  was  and  i n Canada,  as  was  f e e l i n g s o f worry  servants  In c o n t r a s t ,  d e p e n d e n t ) was  to  i n Canada  perception  that  lead  members o r  chores.  are  not  sick  assist  or  to sick  because with  work.  P: fit home, i f you a r e s i c k s t i l l you a r e not worried. You a r e s t i l l okay, b e c a u s e you know e v e r y t h i n g i s l o o k e d after. T h e r e you depend on e l d e r s and s e r v a n t s . That makes l i f e e a s i e r . Even i f you a r e s i c k , you d o n ' t f e e l t h a t burden. Here, i f y o u r husband i s not home, and you need t h e g r o c e r y i n t h e house and you a r e s i c k , you have t o f e e d t h e kids you have t o get out w h e t h e r you l i k e i t or no. It  i s apparent able  from  o f not  being  t o do  linked  i n t i m a t e l y with  participant descriptions daily  the  activities  need t o  during  fulfill  that  the  sickness  personal  life  meaning was  103 responsibilities. experience  The f o u r  underlying  c h a r a c t e r i s t i c s of the health  activity  in sickness  Low e n e r g y and r e s i s t a n c e . able  and  normal  changes  routine  described  This  were a s s o c i a t e d  Participants associated  abnormal  feature  two p h a s e s o f t h e h e a l t h  low r e s i s t a n c e  action. and  P a r t i c i p a n t s viewed  t o do a c t i o n " as t h e p r i m a r y  from t h e o t h e r  with  this  sickness  ways o f f e e l i n g and d o i n g present  R: So you mean  in sickness  P: Yes, i t i s .  Lower t h a n  low e n e r g y  manifested  that  the t i r e d n e s s  something  that  needed  R: So i f y o u ' r e  following  sickness  Low  energy  tiredness,  weakness  led to deviations things.  from  Accounts  in sickness: then,  t h e energy  t h e normal  in sickness  level  i s less?  person. One p a r t i c i p a n t  i n d i c a t e d that  there  was  t o be t r e a t e d . sick,  then,  this  tiredness  P: Yeah. T i r e d n e s s comes. Or some have stomach u p s e t , you might go t o c o n s t i p a t i o n , or things l i k e that. t h a t : okay, t h e r e i s s o m e t h i n g t h a t The  "not b e i n g  incapacity f o r  with  as t i r e d n e s s .  explained  below.  distinguishing  experience.  i n t h e body, w h i c h  t h e low e n e r g y  are discussed  accounts  elaborated  comes?  o t h e r , I s a i d you might t h e loose motion or I t g i v e s me t h e i d e a needs t o be r e c t i f i e d .  on b e i n g  tired  and not d o i n g  a c t i v i t i es. P: — (when s i c k ) j u s t I t a k e l i t t l e b i t , you know. I slow down my l i f e and r e l a x and s i t down. Don't do t o o much, you know, a c t i v i t y . P: You f e e l no s t r e n g t h  l e t h a r g i c and t h e n i n you.  R: You've t o l d  me you f e e l  you t h i n k ,  you s e e , t h e r e ' s  l e t h a r g i c and weak  (when  sick).  104 P: Um hum. The  I don't  feel  like  doing  r e l a t i o n s h i p between t h e low e n e r g y  bedridden  was e x p l a i n e d  in sickness,  and  being  as f o l l o w s :  R: Y o u ' r e b e d r i d d e n recuperat e ?  b e c a u s e t h e body's — -  P: Yeah, you use up t h a t better, to recuperate. R: So a l l y o u r t h e body?  anything.  energy  energy  you have t o  t o make t h a t  when y o u ' r e  sick  body  i s going  feel  to  recuperate  P: Yeah. R: Whereas when y o u ' r e h e a l t h y , t h i n g s other than ( r e c u p e r a t i o n P: T h a t ' s  is right.  be  He e x p l a i n e d  a l t e r e d i n order  energy f o r  Yes.  One p a r t i c i p a n t d e s c r i b e d sickness.  you c a n use t h a t o f ) t h e body?  that  t h e need  the diet  to increase  f o r extra  of a sick  the store  R: So you say t h a t when y o u ' r e h a n d l e t h a t e x t r a work?  sick,  energy  during  p e r s o n needed t o  o f a v a i l a b l e energy. y o u r body  isn't  able to  P: Pny work! R: Pny work. P: Yeah, b e c a u s e i t p u t s a l l i t s e n e r g y t o r e c u p e r a t e itself, t h a n p u t t i n g e n e r g y t o do o t h e r work. Yeah. I think w h a t e v e r e n e r g y i s t h e r e and t r y i n g t o h e a l you from i n s i d e t o make you f e e l b e t t e r . find t h a t , I mean i s where n u t r i t i o n comes i n . I mean you r e q u i r e e x t r a n u t r i t i o n t o f e e d yourse1f. R: When you a r e s i c k ? P: When you a r e s i c k . You do r e q u i r e e x t r a n u t r i t i o n t o s u p p l e m e n t t h e same e n e r g y as t o make you f e e l w e l l . I mean t o make you f e e l b e t t e r t h e n , t h e o p p o s i t e o f b e i n g i l l , okay? find t h e n t o do some a c t i v i t i e s . Sickness  was p e r c e i v e d  were n e g l e c t e d .  as a s t a t e a r i s i n g  One p a r t i c i p a n t a d v a n c e d  i f symptoms that  such as p a i n  view t h a t  symptoms  105 of  " s o m e t h i n g wrong"  i n t h e body warned  R: So s o m e t h i n g wrong w i t h Is t h a t r i g h t ?  of developing  y o u r body means  sickness.  sickness?  P: Wouldn't say s i c k n e s s . But t h a t ' s a s i g n o f coming sickness. Yeah. B e c a u s e i f you n e g l e c t i t t h e r e a f t e r , t h e n q u i t e p o s s i b l y you might be s i c k a t a l a t e r d a t e . Or you might be a g g r a v a t i n g t h e s i c k n e s s , you c a n put i t t h a t way. Older  p e o p l e were p e r c e i v e d  because t h e i r  resistance  as more prone t o becoming  i s lower than  that  sick,  of a younger  person.  P: But my m o t h e i — i n - l a w , she c a t c h e s i t (a c o l d ) e v e r y t i m e t h e k i d s get i t . So s h e ' s s i c k w i t h them a n y t i m e t h e y are s i c k . So I guess when you a r e o l d e r you c a t c h them (colds) you've got l e s s r e s i s t a n c e i n y o u r body and t a k e m e d i c i n e more. R: So, when a p e r s o n g e t s would get s i c k more? P: Un hun. The  older  meaning  on t o e x p l a i n  she would  still  cold  would  have  less resistance,  younger  mean  that  they  that  a c o l d would  have  f o r h e r s e l f as a young w i f e  m o t h e r - i n - l a w . ft c o l d  because  you t h i n k  I t h i n k so.  p a r t i c i p a n t went  different  older,  sickness  would  be a b l e  and mother,  mean p a r t i a l  health  t o do some a c t i v i t i e s .  t o her mother-in-law  and be c a p a b l e  because  of less a c t i v i t y  and h e r  to her However, a she would than a  person.  R: You'd s t i l l say y o u r s e l f t h a t you were h e a l t h y w i t h a c o l d ( p a r t i a l h e a l t h ) a t a y o u n g e r age, but t h e same c o l d when you were o l d e r P: You'd c a l l  yourself  sick,  yeah.  R: You'd c a l l y o u r s e l f s i c k , b e c a u s e a b l e t o do t h i n g s ? Is t h a t r i g h t ? P: Um Partial  hum.  health  you w o u l d n ' t  be  That's r i g h t . was d e s c r i b e d  as a s t a t e c h a r a c t e r i z e d  by d e c r e a s e d  106 i n d e p e n d e n c e and c o n t r o l . a  Sickness,  s t a t e c h a r a c t e r i z e d by dependency  in contrast, and l a c k  Dependency and l a c k o f c o n t r o l . both  limited  Participants activities  activity felt  that  they  were s e v e r e l y  accounts describe  were s i c k  impeded  as  of c o n t r o l .  Dependency  and a c t u a l dependency  was e x p l a i n e d  in sickness  meant  on o t h e r s .  when t h e i r  normal  or r e s t r i c t e d .  life  The f o l l o w i n g  the 1 i m i t e d . a c t i v i t y i n d i c a t i v e  of sickness.  P: I f you a r e s i c k , you won't be a b l e t o p e r f o r m a l l y o u r everyday c h o r e s or your w h a t e v e r you have t o do. You a r e sick  then,  yeah.  One p a r t i c i p a n t d e s c r i b e d had  no p e r s o n a l  this  experience  with  further, stating sickness,  that  although  he  other  people  he had seen  who were s i c k . P: I f c a n c e r i s t h e r e i t w i l l l i m i t b e c a u s e o f t h e p a i n . Or p a i n , o r s t r e s s . I h a v e n ' t e x p e r i e n c e d t h a t , okay. So I d o n ' t know what happens w i t h car\cer. I honestly don't know. I mean I have seen o t h e r p e o p l e b e i n g i n p a i n and v e r y sick. I mean i n v e r y much p a i n and n o t a b l e t o do t h i n g s which t h e y want t o , and be i n bed. Another  participant elaborated  on t h e meaning  of being  sick:  P: I t h o u g h t b e i n g s i c k means you a r e i n bed i n t h e h o s p i t a l . b e i n g s i c k means once you a r e b e d r i d d e n and i n t h e h o s p i t a l and you a r e n o t a b l e t o a t t e n d t o y o u r day t o day d u t i e s , o r y o u r day t o day r o u t i n e , n o t d u t i e s . R: — being  Okay, you say s i c k n e s s a b l e t o do y o u r normal  P: That  i s say, b e i n g routine.  bedridden  and n o t  i s r i g h t , yes.  R: So y o u ' r e s a y i n g t h a t when y o u ' r e h e a l t h ) y o u ' r e s t i l l a b l e t o do y o u r  in ill-health things?  (partial  P: Yes, yeah. R: Whatever r o u t i n e i s t h e r e . d e t e r m i n e d by p h y s i c a l l y b e i n g P: P h y s i c a l l y —  to physical  Okay. So s i c k n e s s i s l i m i t e d i n terms —  limitations  o f t h e body,  that  107  I'm so much i n p a i n , o r my body t e m p e r a t u r e i s so much t h a t I have t o r e s t i t ( t h e body) some more. Okay? R: Yeah,  okay.  P: T h a t ' s ' P  sick  and  person  being  sick.  was d e s c r i b e d as i n c a p a b l e  t h e r e f o r e i n need P: S i c k n e s s , attention.  of independent  o f a t t e n t i o n and c a r e  I mean  a sick  person  from  activity,  others.  needs a l o t  of  P: W e l l , by dependence, I mean you r e l y on o t h e r s i f y o u ' r e u n a b l e t o do t h i n g s . You know, i f you a r e s i c k f o r a l e n g t h y p e r i o d o f t i m e , somebody would have t o t a k e c a r e o f you. Or you won't be a b l e t o do s o m e t h i n g , so y o u ' r e a l w a y s r e l y i n g on o t h e r s . The  relationship  between d e p e n d e n c y and c o n t r o l  was d e s c r i b e d as  foilows: P: I t a l l , you know, r e l a t e s t o what I f e e l about b e i n g i n control. When you a r e d e p e n d i n g on somebody e l s e , o r even a s i m p l e t h i n g , l i k e you know, i f s o m e t h i n g , I c a n bend my knee and go u n d e r n e a t h t h i n g s t o get them o u t . I c o u l d n ' t do t h a t f o u r months ago. I was a l w a y s would have t o get somebody i n t h e f a m i l y t o say, you know: " I ' v e d r o p p e d t h i s t h i n g t h e r e , c a n you r e a c h out and get i t f o r me". So d e p e n d e n c y and l i m i t a t i o n , t h e y a r e both, you know c o n t r a r y to being i n c o n t r o l . Feelings  of helplessness,  of the l o s s  of c o n t r o l  loneliness  and f e a r were o t h e r  a s s o c i a t e d with  aspects  sickness.  P: S i c k n e s s would mean, h e l p l e s s , a f e e l i n g o f b e i n g helpless. P f e e l i n g o f b e i n g d e p e n d e n t on o t h e r s , a f e e l i n g of f e a r , l o n e l i n e s s . Scary. I l l n e s s means something I d o n ' t want t o t h i n k about i t . Pnd I'm t a l k i n g about s e r i o u s illness. I'm n o t t a l k i n g about a headache o r a c o l d . I'm t h i n k i n g i n t e r m s o f p r o l o n g e d i l l n e s s , even l i k e b r e a k i n g an arm, o r s o m e t h i n g which makes me an i n v a l i d , o r makes me h a n d i c a p p e d , o r i n some way, you know, t h a t I'm d e p e n d e n t on others. R: and  so y o u ' r e t a l k i n g about b e i n g h e l p l e s s , you s a y .  P: Yeah.  Pnd a g a i n ,  losing  dependency.  control.  Being  Because  dependent  I've been a  108 s i n g l e p a r e n t f o r 11, 12 y e a r s , and make a l l t h e d e c i s i o n s , and down goes t h i n g s , and s o r t o f , you know,always l o o k e d a f t e r m y s e l f most o f t h e t i m e . So i t ' s t h a t , you know, f e e l i n g t h a t : w e l l , what i f t h i s happened, what would I do? Another p a r t i c i p a n t R: What  expressed  i s i t like  when you a r e s i c k ?  P: Oh, you a r e d e p r e s s e d are h e l p l e s s . The  loss  of c o n t r o l  terms o f not being not  being  accounts  and you c a n ' t  a s s o c i a t e d with  out s c h e d u l e d  these  two  do a n y t h i n g ,  s i c k n e s s was a l s o  a b l e t o do a n y t h i n g  a b l e t o carry illustrate  a similar perspective:  about  and you  explained in  t h e s i t u a t i o n , and  activities.  The f o l l o w i n g  views:  P: And l i k e c a n c e r , o r h e a r t d i s e a s e , you see and t h e n , y o u ' r e s u f f e r i n g w i t h i t , and a t t h a t same t i m e , you know, you c a n ' t do a n y t h i n g about i t .  R: When y o u ' r e h e a l t h y you know f o r s u r e you c a n do a l l those t h i n g s you're p l a n n i n g . Whereas when a p e r s o n ' s s i c k t h e y ' r e n o t a b l e t o c a r r y out t h e i r r o u t i n e s . P: Yeah, anybody, — their what you  t h a t ' s t r u e , yes. I t h i n k i t s d i f f i c u l t f o r b e c a u s e now you have one more t h i n g t o t a k e c a r e o f own body and t h e i r own h e a l t h . And i f i t s n o t up t o had s c h e d u l e d —  R: What's  "not up"?  You mean y o u r  body?  P: Yeah. Your body. I f you're not f e e l i n g w e l l , or you're i l l , t h e n you c a n n o t do many t h i n g s which you wanted t o do, h o p i n g t h a t t h e body w i l l c o o p e r a t e w i t h you, w i t h y o u r schedule. Permanent. S e r i o u s and Worrisome As  noted  earlier,  something continuous, something  serious.  generally  being  participants long-term  explained  o r permanent.  Participants  i n bed, not b e i n g  s i c k n e s s as Sickness  described feeling  meant  uncomfortable,  a b l e t o do a n y t h i n g ,  and b e i n g  109 worried. The term  ensuing  condition.  incurable. health  and  accounts  illustrate  In s i c k n e s s  "something  Participants described sickness,  sickness  emphasizing  the  the  as  a serious,  i s wrong",  and  often  d i f f e r e n c e between  serious,  long term  long  partial  nature  of  sickness. P:  I'm  sick,  something's r e a l l y  wrong w i t h  me.  P: P s h o r t term i l l n e s s i s l i k e i f somebody's got t h e f l u . I wouldn't c a l l t h a t a s e r i o u s s i c k n e s s . You go t h e r e ( t o t h e d o c t o r ) and you t a k e m e d i c a t i o n . You go t o t h e d o c t o r , t h e d o c t o r g i v e s you t h e m e d i c a t i o n , and you t a k e c a r e o f t h a t l i t t l e f l u or w h a t e v e r — i t might j u s t be a bug. Pnd i f you're a l r i g h t you're normal a g a i n i t ' s a l r i g h t . But i f you p r o l o n g b e i n g s i c k f o r a l o n g t i m e , you a r e s i c k . Pnd you've got a h i g h t e m p e r a t u r e , t h a t i s b e i n g s i c k , b e c a u s e t h a t i s not y o u r n o r m a l day t o day a c t i v i t y . You have a h i g h t e m p e r a t u r e , you a r e t a k i n g m e d i c a t i o n f o r i t , and you a r e l y i n g down i n bed, and so you a r e a s i c k p e r s o n at t h a t t i m e u n t i l you resume y o u r n o r m a l e v e r y d a y a c t i v i t y. P: You know, s i c k n e s s i s much more s e r i o u s t h a n t h e k i n d o f l i m i t a t i o n I have now ( t o r n knee c a r t i l a g e ) . I think i n my mind s i c k n e s s i s , you know, 104 d e g r e e t e m p e r a t u r e , a v e r y s e r i o u s cough, or you know, p r o l o n g e d s t a t e o f affairs.  or  P: L i k e I had a c e s a r e a n s e c t i o n and t h a t was j u s t t e m p o r a r y , b e c a u s e t h e weakness was o n l y t e m p o r a r y . I got o v e r i t , and I f o r g o t about i t . But s u p p o s i n g , you see, now somebody l i k e , have a c h e s t p a i n c o n t i n u o u s , you know, and t h e n say t h r e e or f o u r t i m e s , you know, and p e r s p i r i n g and h a v i n g c h e s t p a i n , and t h e r e i s s o m e t h i n g wrong. Pnd t h e n you d o n ' t c a l l y o u r s e l f h e a l t h y . There i s something wrong and you have t o have t h e i n v e s t i g a t i o n s , and go t o the d o c t o r . P: I mean s i c k n e s s i s a more s e r i o u s term f o r me t h a n p a r t i a l health. Yeah. S i c k n e s s means t h a t I am not a b l e t o do on a r e g u l a r b a s i s , o r I am i n g r e a t p a i n . S i c k n e s s i s more s e r i o u s , has a more s e r i o u s c o n n o t a t i o n t h a n p a r t i a l h e a l t h  1 10 does you know. R: So when would  you go from  being  healthy  to being  sick?  P: S i c k ? Oh, s u p p o s i n g you see, s o m e t h i n g wrong, l i k e I've got a g a l l b l a d d e r t h i n g , o r I c a n ' t d i g e s t my f o o d , o r I have some k i n d o f u l c e r , o r a p a i n i n my c h e s t . So you a r e not , you s e e . R: Then  you a r e not  what?  P: Then  you a r e not  healthy,  R: Then  you a r e not  healthy  you s e e .  P: No. R: Why  not?  P: B e c a u s e you see, t h e r e i s a r e a s o n t h a t why you a r e h a v i n g t h e s e p a i n s , t h e r e ' s s o m e t h i n g wrong i n y o u r system. P: B e i n g s i c k i s i f y o u r time, or permanently. The  f o l l o w i n g accounts  worry to  a s s o c i a t e d with  illness  doesn't  go away f o r a l o n g  of the sickness experience constant  described the  p a i n and not knowing what  i s going  happen. P: C o n s t a n t a l s o comes.  p a i n g o i n g on. So a t t h a t t i m e That r e l a t e s w i t h t h e p h y s i c a l  R: How  i t relate?  does  t h e mental sickness.  worry  P: B e c a u s e you s e e , you don't know what's g o i n g t o happen. Y o u r mind i s w a n d e r i n g , you know, w h e t h e r y o u ' r e g o i n g t o have s u r g e r y , w h e t h e r i t ' s g o i n g t o be s u c c e s s f u l , w h e t h e r y o u ' r e g o i n g t o get t h r o u g h . So many t h i n g s , you see, go t h r o u g h y o u r mind. Rs  At t h e t i m e  you a r e s i c k ?  P: At t h e t i m e  you a r e s i c k .  P: I f  i t s constant  p a i n week a f t e r  week, week a f t e r  week,  111  you d o n ' t f e e l good. find you a r e w o r r i e d . find you're f e e l i n g some a c h e s : "what's g o i n g t o happen, t h e p a i n i s s t i l l t h e r e , w h e t h e r I am g o i n g t o have s u r g e r y , what's g o i n t o be done. D o c t o r t a k e s X - r a y s and he c a n ' t f i n d a n y t h i n g , but t h e p a i n i s s t i l l t h e r e . So t h a t ' s when I say t h a t , you see, you c a l l y o u r s e l f t h a t y o u ' r e not h e a l t h y . R:  Y o u ' r e not  P:  find  R:  When would  healthy.  there's  something  you  there.  really  be  sick  then?  P: When someone's got c a n c e r , as I a l r e a d y t o l d you. heart d i s e a s e or something l i k e t h a t . Yeah, you get about t h a t and t h a t r e a l l y w o r r i e s you. C a n c e r was in  participant  pox,  however,  and  of  on-going  Sickness labelled The  being  as  was  chest  with pain  and  of the  described health  i t meant  frequently  as  something  as  from  heart  the  In  fact,  Tuberculosis, disease,  meaning  sickness.  stomach  " t o worry  a  "major t h i n g " ,  as  about",  as  while  "minor  d e s c r i p t i o n s of cancer  something  i n c u r a b l e and  R: I j u s t wanted t o u n d e r s t a n d s a i d s o m e t h i n g l i k e c a n c e r was  because  conditions things". as  a  I t s major b e c a u s e  you  said  a bit better a major t h i n g .  "they're  not  major  permanent. why  you  P: Yeah. You know, somebody i s , yeah, t h a t s i c k , you t h e y ' r e not g o i n g t o e v e r get b e t t e r , r i g h t ? So t h a t minor. I t s major. R:  On  symptom.  were d e s c r i b e d  provide  sick.  sickness. and  perceived  "regular" bleeding  nature  partial  because  cancer  conditions  f o l l o w i n g accounts  thing  only  sick,  most  meaning a p e r s o n was  more commonly  mentioned  indicative of the  equated  were o t h e r  informant  condition described  a c c o u n t s as  some i n f o r m a n t s small  the  Or worried  going  to  know i s not  get  112  better"? P: Yeah,  that's  right.  R: I'd l i k e t o u n d e r s t a n d a l i t t l e b i t b e t t e r how you a r e s e e i n g t h e two t h i n g s : t h e d i f f e r e n c e between s o m e t h i n g minor and s o m e t h i n g m a j o r ? P: W e l l , t h a t ' s major b e c a u s e you know t h a t what i t i s l e a d ( i n g ) you t o . find i f i t s minor, you know i t s s o m e t h i n g t h a t i s g o i n g t o go away i n a few days, a few weeks, s a y .  P: S i c k n e s s I a l w a y s t h o u g h t t h a t i t ' s r e a l l y s o m e t h i n g v e r y serious. I f f o r example t h e t h i n g s which, o f c o u r s e I have never p e r s o n a l l y experienced, but s o m e t h i n g l i k e say cancer o r TB, o r some s u c h t h i n g . R: You m e n t i o n e d P: Yeah, you w i l l Participants death,  well call  c a n c e r and a l l t h o s e  described  accounts  return  The  vast  or Chronic  majority  sickness.  that  a s i c k person could  place.  possibility following return to  Illness  of sickness  d i e i f (s)he  accounts  illustrate  and d e a t h .  portion  on t h e s e  two outcomes.  recovery  to health  d i d speak  of the fact  was u n a b l e t o get t r e a t m e n t , low and h e a l i n g  indicated, albeit  progressing  d i s e a s e and  and D e a t h  A few p a r t i c i p a n t s , however,  Participants also  to health  The next  perspectives  i f t h e body's r e s i s t a n c e was v e r y  take  or chronic  of accounts described  from  or  to health,  illustrating  Return t o Health,  of i l l n e s s e s .  yeah, when somebody has t h a t , I guess t h a t them s i c k , yeah. N o t h i n g c a n be done f o r i t .  as t h e two outcomes o f s i c k n e s s .  provides  kinds  to chronic  i m p l i c i t l y , the  illness.  t h e two main a f t e r m a t h s The f i r s t  account  c o u l d not  The  of sickness:  explained  recovery  health. P: In t h e s i t u a t i o n s l i k e , l i k e s u p p o s i n g — I won't say f o r e v e r , but when I'm s u f f e r i n g from s o m e t h i n g , l i k e I'm sick. I'm r u n n i n g a f e v e r o r s o m e t h i n g , i f I have t o go t o  113 t h e d o c t o r t h e n I'm not Once I'm r e c o v e r e d I am  a healthy a healthy  Another account  described  linked  body's d e c r e a s e d  with  externally  the  caused  the  p e r s o n at person.  d e c l i n e towards ability  that  time.  possible  to r e s i s t  death,  internally  or  sickness.  P: It (the c a u s e o f t h e s i c k n e s s ) c o u l d be an e x t e r n a l s o u r c e a l s o (as w e l l as an i n t e r n a l s o u r c e ) . A bug which I h a v e n ' t seen, made me s i c k w i t h t h e f l u , okay? Which got d e t e r i o r a t e d i n t o worse and worse and I d i e d b e c a u s e o f t h a t . T h a t must be s i c k n e s s . Okay? My body not a b l e t o t a k e i t . To as  conclude,  s i c k n e s s was  a s t a t e c h a r a c t e r i z e d by  activities,  and  d e p e n d e n c e and characteristics In c o n t r a s t  lack  sickness c l a r i f i e s vision  of the  energy  the  understood  Two  fulfill  limited  as  permanent  experience partial  as  with  the in sickness.  of p a r t i a l  and  health,  worrisome.  of p a r t i a l  of c o m p l e t e  normal  personal  activity  bothersome n a t u r e  health  health,  a three  and  and  provides  phase  h e a l t h and  sickness  were  p a r t i c i p a n t s i n terms  of being  able  p o s s i b l e consequences or c h r o n i c  had  personal  little  of t h i s  by  to  out  to  activities.  to health,  of the  very  parameters health  by p a r t i c i p a n t s  to c a r r y  were e x p l a i n e d  the  defined  normal  able  characteristics  Complete h e a l t h ,  do  able  the  total  clearly  r e s i s t a n c e , along  serious,  continuum. and  and  temporary, as  being  being  of c o n t r o l ,  perceived  Understanding  a  Low  underlying  to the  s i c k n e s s was  not  t h e r e f o r e not  responsibilities.  described  sickness chapter  illness  experience  experiences presents  of and  s i c k n e s s were d e s c r i b e d : death.  with  Participants  sickness,  of other  persons.  participant  accounts  but The  were  return  generally cognizant  final  describing  section the  114 influence  which t h e  the  health  total  mind and  the  activities", description sickness health  health  data a n a l y s i s of h e a l t h :  experience  described  of the  "being  figures  factors 2 & 3).  by  and  factors  section to  of  exert  be  on  a  Health  able  the  health  lesser  do  normal  categories  the  of  - partial-health -  influencing The  the  previous  three the  total  section  phases factors  of  the  which  health. i n most d e t a i l ,  factor exerting  diet,  routine,  to  distinct  presented  Exercise,  maintaining  of  discusses  influence  p a r t i c i p a n t s as  exerting  two  complete  the  mind w i l l  over h e a l t h .  medicines  external  the  (2)  This  considered  role  influence of  (see  State  participant descriptions  participants  was  the  revealed  (1)  and  experience.  The  on  o v e r a l l frame o f  continuum,  presented  factors  experience.  Influences Within  other  sleep  will  and  be  influence  the  it  greatest  cleanliness,  briefly on  as  the  use  described  total  as  health  e x p e r i ence. The Although experience  participants  based  nonetheless  upon t h e  singled  attitude)  as  therefore  important  explained  the  the  role  M i n d : Body-Mind  the  factor  role  of the  out  explained  health  i n s e p a r a b i l i t y of  the  condition  as  a  integrated  body and  of the  mind  (or  mind,  of the a  mind  the  ways t h a t  in health,  and  s e p a r a t e theme f o r  they  mental  most a f f e c t i n g a p e r s o n ' s h e a l t h .  to d i s c u s s  mind as  Interaction  It  is  participants r a t i o n a l to discussion.  focus  on  115 Participants terms both  provided  of a balance body and  experience. three  mind Ps  on  how  involved  the  f o r doing  however,  also  partial  health  and  earlier,  to  greatest  how  influence  responsibilities  on  the  participant  the  physical impacts  Participant influences  with health  health  and  role  health  focusin  upon a  person'  health,  described  body, w i t h  visa  a  mental  versa.  of the that  body,  complete  the  the  accounts,  unanimously  mind and  in  mind  the  in  mind  health.  exerted  the  experience, a f f e c t i n g  normal a c t i v i t i e s  and  fulfill  life. t o have b o t h a p o s i t i v e ( b e n e f i c i a l )  (destructive)  m a i n t e n a n c e and on  t o do  explained  accounts,  phases of the  body  Accounts  total  in d a i l y  mind was  a negative  effect  mind  the  f i g u r e 3),  participants described  participants felt  individual's ability  The  the  sickness.  of  (see  three  normal a c t i v i t i e s .  acknowledged  majority  mind  of the  affect physical  Participants  d e s c r i p t i o n of h e a l t h  i n terms of the  i n t e r a c t i o n between t h e  seen  vast  i n the  condition  described  health  reciprocal  and  body and  discussed  capacity  the  between  phases p r e d o m i n a n t l y  primarily  The  a holistic  influence  mind can  improvement  on  health.  either assist  of h e a l t h ,  or  exert  According in  a  to  the  detrimental  health.  Worry,  described  considered  capable  ultimately  sick.  of  in r e l a t i o n  stress  making a h e a l t h y  In c o n t r a s t ,  characterized  p r i m a r i l y by  beneficial  health.  to  to  i n some a c c o u n t s ,  person  less healthy,  and  a p o s i t i v e mental a t t i t u d e ,  freedom  from  worry,  Participants stated  that  was  viewed  this  was  as  positive  116 mental  attitude  assist  a partially-healthy  even  heal  worry  could  the s i c k  h e l p a person remain  body.  completely healthy,  person to r e g a i n Participant  complete  health,  and  accounts of the e f f e c t s  of  a r e p r e s e n t e d below.  Horry Although accounts, opposite  i t was  was  following  section). and  situations,  drains  by,  (described or r e a c t i n g  healthy.  individual  resistance  Some p a r t i c i p a n t s sickness.  Several  or e f f e c t ,  o f worry.  equated  participants One  a  as t h e  Worry was  viewed  and  mental  to  illness.  worry  i n the to,  external  referred  participant  fundamental  as a f a c t o r and  which  therefore  u n h e a l t h , or  to stress  described  and  as c a p a b l e o f  energy,  w i t h mental  state  individual  lamenting over the past  were d e s c r i b e d  away a p e r s o n ' s p h y s i c a l  decreases  agitation;  W o r r i e d t h o u g h t s were viewed  less  in participant  f o u n d when t h e  attitude"  Being a f f e c t e d  life  f o r worry.  making t h e body  ruin  mental  ways  w i t h mental  condition  anxious over the f u t u r e  causes  in various  equated  mental  a "positive  circumstances  explained  basically  t o t h e calm  cultivated  being  worry  as t h e  t h e way  result,  stress  can  health: P: Yeah, b e c a u s e i f y o u ' r e under p r e s s u r e a l l t h e t i m e , i t ' s ( s t r e s s i s ) a mental c o n d i t i o n , i t becomes l i k e a and i t j u s t has a c h a i n r e a c t i o n o v e r e v e r y t h i n g . And you know, you get f r u s t r a t e d , and you c a n ' t d e a l w i t h i t ( s t r e s s ) so you get d e p r e s s e d , o r you get a n g r y . And t h e n t h a t ' s how my u l c e r c o n d i t i o n s t a r t e d , i s b e c a u s e I d i d n ' t know how t o d e a l w i t h i t . And I j u s t t h o u g h t about i t and t h o u g h t about i t and n e v e r r e a l l y a c t e d . So I t h i n k i t d i d a l m o s t r u i n my, you know, h e a l t h .  As n o t e d , worry  was  equated  w i t h mental  sickness  i n some a c c o u n t s .  117  P: T h a t ' s when you'd say t h a t y o u r mind i s s i c k , B e c a u s e you have l o t s o f w o r r i e s i n t h e r e . This  negative  mental  of  mental  balance".  in  terms of "being  a t t i t u d e was a l s o  described  One p a r t i c i p a n t viewed c o n t r o l l e d " by f e e l i n g s  P: When mental b a l a n c e i s n o t t h e r e , t h e y ( p e o p l e ) become s i c k .  right?  i n terms  l o s s o f mental  of "loss balance  (emotions): that's  t h e way  R: So f o r you, i f you had t h e p h y s i c a l h e a l t h , but you l o s t y o u r mental b a l a n c e , t h e n you would say t h a t you were mentally sick? P: Yeah. Yeah. T h a t ' s t h e t i m e you become s i c k , you know. S o m e t h i n g overcome, you know, y o u r t h i n k i n g power, you know. Maybe i s t h e d e p r e s s i o n , maybe i s g r e e d , maybe i s t h e j e a l o u s y , maybe anger, o r maybe r e v e n g e f e e l i n g , you know. This  negative  mental  temporary  w o r r y about  explained  how mental  generally  affects  state life  involved  on-going  situations.  worry,  not j u s t  The f o l l o w i n g  accounts  worry d e c r e a s e s t h e body's r e s i s t a n c e and  health.  P: Mind i s t h e t h o u g h t p r o c e s s which, i n t h i s i l l h e a l t h , ( p a r t i a l h e a l t h ) b r i n g s out c h e m i c a l c h a n g e s i n t h e body, which makes body n o n - r e s i s t i v e t o a l l o u t s i d e e f f e c t s , l i k e allergies. P: W e l l , i f you d o n ' t keep y o u r s e l f happy, o f c o u r s e you c a n get w o r r i e d . Pnd w o r r i e s a r e not good f o r y o u r h e a l t h . You know, t h e y g i v e you u l c e r s sometimes. Ps I t o l d you l a s t t i m e , you c a n get u l c e r s i f you worry t o o much. R: Would worries?  you f e e l  you were h e a l t h y  i f you had any k i n d o f  P: No. I w o u l d n ' t r e a l l y b e c a u s e i t i s not a — normal s t a t e o f mind a t t h a t t i m e . So I have t h e s e w o r r i e s and i t c o u l d a f f e c t my h e a l t h as w e l l , i n t h e s e n s e t h a t i f my mind i s w o r r i e d I might not e a t p r o p e r l y , I might n o t do my c h o r e s p r o p e r l y . Pnd t h a t c o u l d a f f e c t my body. The  participant clarified  this  point:  118 P: i f y o u ' r e m e n t a l l y not h e a l t h y , i f y o u ' r e w o r r i e d about s o m e t h i n g a l l t h e t i m e , i t does a f f e c t y o u r ( p h y s i c a l ) h e a l t h as we 11. A c l e a r d e s c r i p t i o n o f worry health  was  provided  traditional worry  with  keeping  Indian  by  as  another  saying  s t r e s s , and  a factor adversely participant.  about  mentioned  the  effects  of  a  o f worry,  he  related  opposite  mental a t t i t u d e :  equivalent  word  i n , say,  Hindi  "Chinta"  R:  Oh,  P:  Yeah,  so  thinking! "chinta".  R: Okay, so I was w o n d e r i n g i f I c o u l d understanding o f what you were s a y i n g , e n g 1 i sh word. P: Yeah. worry? R:  Speaking  happy.  R: I am w o n d e r i n g what t h e would be f o r s t r e s s ? P:  the  affecting  You  know what  " c h i n t a " means?  get a b e t t e r by not u s i n g Worry.  the  You  know,  Okay.  P: find somebody might have t o l d you " c h i n t a " and "chita" a r e two t h i n g s . " C h i t a " d e s t r o y s or f i n i s h e s t h e dead body. You know what i s " c h i t a " ? R:  I'd  r a t h e r have you  P: " C h i t a " i s t h e withthelogs. R: P: the  translate i t .  cremation  thing.  Where you  put  the  body  Yes. and put dead body.  f i r e to i t . That's " c h i t a " . " C h i n t a " d e s t r o y s the l i f e .  That d e s t r o y s Okay?  R: So t h a t r e a l l y shows t h e i m p o r t a n c e t h a t ' s s t r e s s t h e n i n t e r m s o f h e a l t h and illness. P:  Yeah.  That  R:  And  that's  so  is right.  placed  on  Yes.  something that  you  learned  as  you  were  this  119 growing  up, o r h e a r d  P: Um hum. be happy"! The  then?  The song i s , I mean, a p p r o p r i a t e It i s very appropriate.  same p a r t i c i p a n t  explained  how worry  leads  "don't  worry,  t o mental  stress.  P: S t r e s s i s a g a i n t h e a t t i t u d e t o w a r d s i t , t o w a r d s t h a t t h i n g , how you want t o r e a c t o r c o u n t e r a c t . I mean, okay F i r s t t h i n g i s y o u r t h o u g h t p r o c e s s , okay? I could be w o r r i e d about my mother's l e g . R: Yes. P: find i f I am so much w o r r i e d t h a t my r a t i o n a l t h i n k i n g goes o f f , and I s t a r t s h o u t i n g a t my c h i l d r e n and a t my w i f e and t h i n g s l i k e t h a t , i s s t r e s s . — - W o r r y i n g about s o m e t h i n g ( t h a t ) might happen, o r has a l r e a d y happened beyond o u r control. I mean "what i f " s c e n a r i o . R: — I'm s t i l l not s u r e about how y o u ' r e d e f i n i n g s t r e s s . Are you s a y i n g s t r e s s i s a l o t o f w o r r y ? Or i r r a t i o n a l worry? P: No. No. T h a t worry c a u s e s , i n y o u r t h i n k i n g , s t r e s s . Worry i s c r e a t i n g s t r e s s . How would I meet my tomorrow's payment? Okay. R: — So t h e worry, t h a t ' s t h e r e t h i s s t r e s s or t e n s i o n , which  i n the thoughts,  can cause  P: Yeah. Which w i l l change y o u r c h e m i c a l , body's — body c h e m i c a l s t o r e a c t d i f f e r e n t l y . Chemical changes i n your body i t b r i n g s . I mean t h a t ' s what c a u s e s a l l e r g i e s . The  role  o f mental  another account. to  cause  attitude  Reacting  in health  negatively  was f u r t h e r to external  explained e v e n t s was  in viewed  stress.  R: So t h i s a t t i t u d e  you have p l a y s  a role  i n your  health?  P: That i s r i g h t . Attitude to the external things. I mean t o me you a r e an e x t e r n a l p e r s o n . And what you s a i d , I r e a c t — how I r e a c t , o r c o u n t e r r e a c t my a t t i t u d e t o w a r d s — I mean you might be d r i n k i n g t e a , and I d o n ' t ' l i k e you d r i n k i n g t e a w h i l e I am s i t t i n g h e r e . Or you might be s c r a t c h i n g y o u r head, and t o me i t s , i t might b o t h e r me. I r e a c t d i f f e r e n t l y . So r e a c t i o n t o t h a t a l s o c a u s e s e i t h e r s t r e s s or happiness r e a c t i o n , or counter a c t i o n to other p e o p l e ' s a c t i o n o r words o r w h a t e v e r .  120 The  following  influence Positive  accounts  t h e mind Mental  Participants opposite mental the  basic  from  on t h e t o t a l  health  experience.  described  positive  o f worry  was d e s c r i b e d  mental  just  described.  variously  c h a r a c t e r i s t i c emerging  attitude  from  as e s s e n t i a l l y  Although  in participant  this  accounts,  t h e d a t a was b e i n g  free  worry.  "nothing  further  bothering  optimistic,  seeing  the p o s i t i v e  or emotions,  e v e n t s and s m a l l  aspects  of t h i s  •ne  small  feelings  health  healthy, health  or  things  side  happy.  physical  of "being  helped  being  in control  being  content  with  o f one's  to (or worrying  p r o b l e m s were d e s c r i b e d  about) as o t h e r  attitude. how  positive  healthy  He f e l t  as h a v i n g  seriously,  of l i f e ,  Being  mental  described  problems.  and a l s o  this attitude  and not r e a c t i n g  positive  participant  involved  described  you", not t a k i n g  one has, and k e e p i n g  feelings, life  the b e n e f i c i a l , or p o s i t i v e ,  Attitude  Participants  what  exerts  to the state  attitude  illustrate  that  him r e g a i n  mental  at a l l times", this attitude health  attitude despite  having  kept him  when he was  in partial  sickness.  P: Even i f t h e r e i s some ( h e a l t h ) problem, okay, that i t w i l l take care o f i t s e l f i n course of time, so i t s f i n e . T h a t ' s what I f e e l . And t h a t i s why I say t h a t mental a t t i t u d e g i v e s you h e l p s you b e i n g h e a l t h y . He e x p l a i n e d thinking sick,  further  how t h i n k i n g  you a r e h e a l t h y ,  can a f f e c t  makes you h e a l t h y ,  health,  stating  and t h i n k i n g  you a r e  makes you s i c k . P: I d e f i n i t e l y f e e l  that  t h e mental  attitude  that  which you  121  d e v e l o p , i t d e f i n i t e l y h e l p s y o u r p h y s i c a l body as w e l l . B e c a u s e o v e r a p e r i o d o f t i m e I have a l w a y s t h o u g h t : yes, i f you t h i n k t h a t you a r e h e a l t h y , you r e a l l y a r e . He  elaborated R:  I was  P:  Yes.  on  this  as  wondering  follows: i f the  mind can  e i t h e r harm t h e  body  —  R: — o r i t can work i n a p o s i t i v e way and h e l p t h e body h e a l o r keep h e a l t h y ? P: P o s i t i v e way, yeah. That's r i g h t . T h a t ' s what I f e e l . B e c a u s e s e v e r a l t i m e s I see t h a t , okay, i f I r e a l l y want t o be sad i n my l i f e a l l I need t o do i s s i t l i k e t h i s f o r a c o u p l e o f h o u r s , and you w i l l see t h a t two h o u r s l a t e r you w i l l f e e l t h a t you r e a l l y a r e , t h e r e i s s o m e t h i n g wrong somewhere. R:  You  mean j u s t  P: It  Yes, s i t t i n g two h o u r s t h i n k i n g t h a t d e f i n i t e l y a f f e c t s your h e a l t h .  R:  Because  P:  Yeah, t h a t ' s  R:  So,  you  keeping  P: Yeah, positive  staying  start  to  sitting  really  f o r two  believe  hours? you  are  unhappy.  that  you  are  could  say  unhappy?  right. p o s i t i v e thoughts,  you  k e e p i n g p o s i t i v e t h o u g h t s does h e l p , thinking.  power  of  R: Power o f p o s i t i v e t h i n k i n g . So do you f e e l t h a t t h e mind a c t u a l l y can h e a l t h e body? I f we use t h e word h e a l , or cure t h i n g s ? P:  Ph,  not  e i t h e r heal  contributes This  a t t i t u d e was  participant's  to  both  or not  processes  a t t r i b u t e d , at  upbringing  in India  cure  but  I would  it definitely  say.  least  in part,  and  associated  to  the  family  influences. He e x p l a i n s how he a c q u i r e d t h i s mental a t t i t u d e . P: T h i s i s not a v e r y c o n s c i o u s e f f o r t t o t r a i n i t (the mind) as s u c h . But I b e l i e v e i n i t , and t h a t i s how i t has happened. R: Okay. Pnd you — y o u ' d say you b e l i e v e i n t h i s b e c a u s e your past? You were s a y i n g l i k e w i t h y o u r grandfather  of  122  talking  about  (ayurvedic  medicine)  P: B e c a u s e o f t h e yes, p a r t l y because o f t h e i n f l u e n c e , p a r t l y b e c a u s e o f w h a t e v e r we s t u d i e d i n t h e s c h o o l s . R: So t h e whole e d u c a t i o n a l  system?  P: Or my f a t h e r ' s i n f l u e n c e might have worked t o a g r e a t e x t e n t on me. My f a t h e r i s one o f my t y p e , who would n e v e r say even i f he i s s u f f e r i n g from a n y t h i n g . Nobody would know i n t h e f a m i l y a l t o g e t h e r . One  participant  philosophy. attitude the  linked this  To h e r t h e most  was " b e i n g  feelings control  participant, training  a t t i t u d e to the tenets important  in control you".  she l i n k e d t h i s  o f t h e mind, which  aspect  o f Hindu  of t h i s  mental  o f t h e f e e l i n g s , and n o t l e t t i n g  In c o n t r a s t control  t o t h e view o f t h e e a r l i e r  of emotions with  she d e s c r i b e d  conscious  as " t r a i n i n g t h e b r a i n " .  P: A c t u a l l y t h i s t h i n g which I'm d i s c u s s i n g w i t h you, i t s t h e I n d i a n p h i l o s o p h y — t h a t m e d i t a t i o n s t a r t , yogas you must have h e a r d , yoga and m e d i t a t i o n ? They a r e a l l f o r t r a i n i n g the brain. She  elaborated P: train  as f o l l o w s :  t h a t ' s t h e way ( t h r o u g h yoga and m e d i t a t i o n ) you y o u r b r a i n (mind), so l i k e n o t h i n g b o t h e r s you.  R: Okay. P: H a p p i n e s s o r sorrow, t h e y come and go. L i k e  you t a k e that.  everything,  R: Okay, so y o u ' r e t e l l i n g me t h a t t o " t r a i n then t h i s meditation p r a c t i c e i s important? P: R i g h t . — so y o u r b r a i n h e r e and t h e r e , you know. Explaining  this  doesn't  "training" further  wander  you know, as your  like  brain"  f o r nothing  she s t a t e d :  P: — You have t o p r a c t i c e i t . L i k e p r a c t i c e i t , n o t t o — l i k e you s h o u l d overcome, y o u r b r a i n (mind) s h o u l d overcome a l l t h o s e f e e l i n g s , n o t t h o s e f e e l i n g s s h o u l d command y o u r b r a i n , you know.  123 This  mental  affected  balance, or a t t i t u d e ,  was r e l a t e d  by s u r r o u n d i n g s i t u a t i o n s ,  you.  Positive  mental  state  characterized R: So mental P: H a v i n g  attitude  by i n n e r  health  control  t o not b e i n g  and not l e t t i n g  was f u r t h e r  described  b a l a n c e and c l e a r  means h a v i n g c o n t r o l  o v e r y o u r mind,  things  overly bother  as a mental  rationality. over your  mind?  yeah.  R: And n o t , as you say, g e t t i n g P: D i s t u r b e d o v e r , say g e t t i n g e m o t i o n a l l y upset over s o m e t h i n g f o r any r e a s o n s , e i t h e r e m o t i o n a l l y o r o t h e r w i s e . P: Yeah, i f t h e b a l a n c e i s n o t t h e r e , w i l l a f f e c t me more o r l o n g e r t i m e .  this  thing  (bad news)  P: N o t h i n g b o t h e r s me t o o much. And even i f s o m e t h i n g , you know, sometimes somebody does bad t o me, o r s a y s s o m e t h i n g bad t o me, i t d o e s n ' t h u r t . I don't t a k e t h a t t h i n g t o o d e e p l y , you know. A few p a r t i c i p a n t s contributing  viewed  to t h i s  working  positive  mental  not  mentioned  in relation  and  volunteer  work were d e s c r i b e d  participant "mental  explained  that  outside  to t h i s  o f t h e home a s a  attitude.  work. Both in this  a change  salaried  context.  d o i n g work o u t s i d e  t h e r a p y " , as i t p r o v i d e d  Economic  factor  gain  was  employment  One  o f t h e home was  o f atmosphere.  R: I wondered i f you c o u l d j u s t e l a b o r a t e on t h a t f o r a few m i n u t e s , about what you mean by "mental t h e r a p y " ? P: L i k e you see Yeah, I'11 t e l l you. Some o f my f r i e n d s , you know, when I t a l k t o them, "Oh, we a r e b o t h s t a y i n g a t home, you know". And t h e n t h e y c o m p l a i n , you know, j u s t "I have t o go t o t h e d o c t o r b e c a u s e I have t h i s ache, and I g o t , you know, b a c k a c h e o r headache". I say, l i s t e n you have t o change y o u r a t m o s p h e r e . You have t o go out and meet o t h e r p e o p l e . Or even w o r k i n g f o r a few h o u r s , part time, I s a i d . That w i l l change y o u r mental a t t i t u d e . So t h a t , you s e e , y o u ' r e n o t t h i n k i n g a l l t h e t i m e about yourself.  1E4 She  went  active,  on t o say t h a t and t h a t  this  this  mental  work h e l p e d h e r t o s t a y m e n t a l l y attitude  P: So t h i s i s what I s a i d , t h a t see. Work i s a mental t h e r a p y . R: And t h a t P:  f o r you i s i m p o r t a n t  as worry  or u n h e a l t h , t h i s  the  i t s a mental  t h e r a p y , you  i n being healthy?  Right.  Even  mental  was i m p o r t a n t t o h e r h e a l t h :  health  positive  mental  i n some a c c o u n t s .  beneficial  participant  was sometimes r e f e r r e d  effect  called  attitude  sickness,  was r e f e r r e d  t o as  The f o l l o w i n g  o f an a c c e p t i n g ,  this  t o as mental  attitude  calm  account  mental  described  attitude.  One  being "mentally f i n e " .  P: I f you a r e m e n t a l l y f i n e , I t h i n k i t r e d u c e s y o u r s u f f e r i n g s t o a g r e a t e x t e n t t h a t ' s what i t i s . As I s a i d , t h e way I a p p r o a c h t h e l i f e , okay, i t had t o happen and i t d i d happen, okay. Then now I have t o f a c e it. And t h e n , see i t r e d u c e s my s u f f e r i n g s , i t e a s e s t h e burden on my head. R: So t h i s  attitude  of acceptance?  P: A t t i t u d e o f a c c e p t a n c e and u l t i m a t e l y t r y t o s o l v e t h e (problem) — form a r e s o l u t i o n t o s o l v e t h e p r o b l e m . R: So t h a t  would  be t h e r e  when y o u ' r e  mentally healthy?  P: Yes. That would be t h e r e when y o u ' r e m e n t a l l y h e a l t h y . And i f y o u ' r e m e n t a l l y h e a l t h y , p h y s i c a l l y you m i qht be s i c k , but s t i l l t h a t (mental a t t i t u d e ) a l s o h e l p s r e c o v e r y o u r body. Or i f n o t r e c o v e r t h e body, a t l e a s t i t d e f i n i t e l y h e l p s reduce your s u f f e r i n g s . He e l a b o r a t e d  on t h i s  perspective:  R: You t a l k e d a l o t about how worry c a n d i s t u r b y o u r h e a l t h . F o r i n s t a n c e you s a i d w o r r i e s o v e r a s m a l l p h y s i c a l problem, t h a t mental a t t i t u d e can cause p h y s i c a l problems. P: Yeah.  T h a t ' s r i g h t . Yes.  R: Is t h a t P: Yeah,  t h e same t h i n g  that's  exactly  you're t a l k i n g  what  I'm  saying.  about That  now? y e s , i f you  125 are — i f you have some s m a l l p h y s i c a l p r o b l e m s a l s o , perhaps you c a n say, i g n o r e t h e s e p r o b l e m s . I g n o r e i n t h e sense n o t t h a t you don't go t o a d o c t o r , o r don't t r y t o get i t h e a l e d . But what I mean i s t h a t you know what t o do w i t h i t , r a t h e r t h a n say, i f you a r e , i f you don't have c o n t r o l o v e r y o u r mind: "Oh, my god! what have I t o do t h i s there". Whereas i f you have a c o n t r o l , a l l t h a t you would do i s okay, go t o t h e d o c t o r you t r y t o c o n t r o l t h e p a i n s o r something. Or even i f you have t h e p a i n s , you know t h a t "okay, t h i s i s t h e problem, i t has happened". But you have t o f a c e i t and you have t o b r i n g — solve i t subsequently, r a t h e r than j u s t c r y i n g over i t a l l the time. R: " R a t h e r t h a n j u s t c r y i n g o v e r i t a l l t h e t i m e " . t h a t means w o r r y i n g about i t ? Or b e i n g a n x i o u s ? P: Yeah. This life.  mental  That's  attitude  The f o l l o w i n g  right,  yeah.  was a l s o accounts  So  d e s c r i b e d as a p o s i t i v e illustrate  view on  this:  P: T h i n g s happen i n s i d e , and t h a t makes you happy o r sad a t times. But s t i l l you know, you t r y t o something t h a t b o t h e r s you, y o u r mind, and you s t i l l , you know, t r y t o be happy. Say, l o o k f o r t h e good s i d e o f i t , and t h e r e ' s nothing there. Look a t y o u r k i d s and be happy w i t h them. Right? I j u s t f e e l happy w i t h what I've g o t . I l o o k a t my k i d s , and my mother, and so I, you know, f e e l happy w i t h them. R: You s a i d t h a t i n h e a l t h t h i s t h i n k i n g p o s i t i v e was v e r y i m p o r t a n t . find I was w o n d e r i n g e x a c t l y what you meant by "thinking positively"? P: To me t h i n k i n g p o s i t i v e l y means t o t r y and s e e i f t h i n g s a r e n o t , you know, a l w a y s t r y and see what i s g o i n g f o r you. What i s okay, I'11 g i v e you an s i m p l e example okay? Say i f you had p l a n s t o go t o a movie w i t h somebody, fit q u a r t e r t o s e v e n somebody c a l l s and s a y s " s o r r y . I c a n ' t go". find you r e a l l y were l o o k i n g f o r w a r d t o i t . R a t h e r t h a n s a y i n g , you know, " t h a t ' s i t , my whole e v e n i n g i s r u i n e d , you t a k e t h e o p p o r t u n i t y t o t h i n k , o r s i t down and r e a d a book, o r , you know. T h a t ' s what I t h i n k i s p o s i t i v e t h i n k i n g , i s t o make t h e most o f what i s t h e r e , r a t h e r t h a n be d e p r e s s e d o r d i s a p p o i n t e d w i t h l i f e b e c a u s e o f what we don't have. Participants affected  explained that  by t h i n g s ,  keeping  was a n o t h e r  a happy a t t i t u d e  facet  of t h i s  and n o t b e i n g  beneficial  mental  126 a t t i t ude. P: S t a y i n g happy means t h a t you a r e n o t w o r r y i n g about t h i n g s and you j u s t have a happy a t t i t u d e t o w a r d s l i f e , and you know. That would — yeah, keep you h e a l t h y , i n t h a t s t a t e of h e a l t h . Yeah. You know, you a r e n o t w o r r y i n g about t h i n g s and, l e t t h i n g s happen and not l e t them a f f e c t you, that's the idea.  P: W e l l , k e e p i n g y o u r s e l f happy, you know, d o i n g your a g a i n t h e same s o r t o f t h i n g comes, you know, d o i n g y o u r r o u t i n e c h o r e s and d o i n g y o u r d u t i e s , and k e e p i n g y o u r s e l f c o n t e n t and you know. Not l e t a n y t h i n g worry you, t h e t h i n g s do come t h a t you know, nag a t you. But j u s t t r y t o keep y o u r s e l f away from i t , and know t h a t t h e y a r e g o i n g t o pass away, o r w h a t e v e r . Several  participants related this  happy home and f a m i l y the  b e n e f i c i a l mental  environment.  home was c o n s i d e r e d  very  Keeping  important  a t t i t u d e to a  a good a t m o s p h e r e i n  in health.  P: Home a t m o s p h e r e i s v e r y i m p o r t a n t t o o . P good r e l a t i o n w i t h a l l t h e f a m i l y members i s a l s o v e r y i m p o r t a n t - t o have good h e a l t h m e n t a l l y , as w e l l as p h y s i c a l l y . If there's peace and harmony and e v e r y b o d y i s g o i n g t o be v e r y happy, and, you know, t h e n o r m a l way. But i f t h e r e i s any k i n d o f f r i c t i o n i n t h e house, t h a t would b r i n g mental w o r r i e s and mental — and t h e n i t might — i t could lead to other kind of p r o b l e m s as w e l l . So a l l t h i s does c o n t r i b u t e t o b e i n g healthy.  P: I f you a r e happy  in a life  your c h i l d r e n ,  affects  that  One p a r t i c i p a n t e x p l a i n e d Canada from having the  worries  being  associated  with  was d e t r i m e n t a l helps  with  difficult  the extended  personal  to health,  family  a l o t too.  i t was o f t e n  keeping  t o keep a p e r s o n  your  (health)  away from  no one t o t a l k t o about  worry  inside  India,  that  with  f a m i l y , and  problems.  personal he a g r e e d  Describing  concerns that  coming t o  that  b o t t l e d up  a mind  free of  healthy.  R: So t h e n t h i s not b e i n g a b l e give r i s e to t h i s worrying?  to t e l l  your problems  could  127  P: Yes. It c o u l d give r i s e to the worrying. It c o u l d give rise and t h o s e w o r r y i n g a l s o i t — it definitely affects y o u r body as w e l l u l t i m a t e l y . R: R i g h t . So about t h i n g s , P: Pbsence one  k e e p i n g y o u r mind f r e e o f w o r r i e s , w i l l h e l p your p h y s i c a l h e a l t h ?  Yeah. T h a t ' s of worry  account  described  as  the  right.  ( o r mental  s t r e s s ) was  important  role  of the  R: as  So y o u ' r e t e l l i n g me t h a t t h e mind d o e s n ' t have any  P:  Yes.  Ps  R:  "Ps  f a r as  P:  Yeah.  P:  specifically  something c o n t r i b u t i n g to h e a l t h .  R: So t h a t health?  worrying  f a r as the  the  health  health  means t h e  mind  mind  in the  described  The  in  participant  health  experience.  t h e body s t a y s h e a l t h y s t r e s s in i t ?  as  long  i s concerned.  i s concerned"?  is really  i n c o n t r o l of the  body's  It i s .  R: So f o r you, t h e mind d e t e r m i n e s w h e t h e r t h e body i s h e a l t h y or not? Is t h a t what y o u ' r e t e l l i n g me? P: Mind does not d e t e r m i n e i f t h e body i s h e a l t h y or Mind i s t h e c a u s e which c r e a t e s i t s a f f e c t o f h e a l t h t h e body. R:  Creates  (complete) h e a l t h  P:  Both  ways.  R:  Both  ways?  P: Mind i s t h e c a u s e , i s t h e , I mean — and s t r e s s i n i t . Okay. the body('s) h e a l t h . In summary, influence (often  on  three  manifesting  as  ill-health  (partial-health)?  the thought process, thought process t h e s t r e s s i n i t , o r not h a v i n g t h e Having i t w i l l a f f e c t changes i n  p a r t i c i p a n t s explained the  or  not. on  that  phases of the s t r e s s ) was  the  health  described  mind  exerts  experience. as  a  two-fold Worry  detrimental  to  128 health, by  while  freedom  influence that  from  mental  fts  exerts  noted  t h e most  other  influencing  as h a v i n g  previously, powerful  factors  a c c o u n t s a r e now d i s c u s s e d section.  In c o n t r a s t  influencing  factor,  influence  described  t o t h e mind, which  these  are referred  Diet,  other  factors  t o as e x t e r n a l  exercise,  as m a i n t a i n i n g  sleep,  perceived  working  and use o f m e d i c i n e s , as outside  health,  partial  and s i c k n e s s .  referred  t o as " l e s s e r  o f t h e mind),  influences  influencing  they  Accounts d e s c r i b i n g a t m o s p h e r e were a l r e a d y relation  to positive  be p r e s e n t e d of the other  participant reveal  the importance  work o u t s i d e presented  Although (in contrast  explained  they a r e to the  as s i g n i f i c a n t  o f t h e home and home  i n the previous  attitude;  i n the current  lesser  accounts.  factors"  influencing  state.  mental  again  o f t h e home and  factors  were n e v e r t h e l e s s  on t h e h e a l t h  influence  Factors  complete  health  to  factors.  cleanliness  a routine,  of t h i s  i s viewed as an i n t e r n a l  as o t h e r  each  on t h e t o t a l  portion  were p e r c e i v e d  not  explained  in participant  home a t m o s p h e r e ,  role  primarily  a beneficial  participants  i n the concluding  External  well  (characterized  experience.  The  health  attitude  w o r r y ) was d e s c r i b e d  on h e a l t h .  t h e mind  health  a positive  influences  Participants' of preventive  these  two f a c t o r s  discussion.  will  section in will  The n a t u r e o f  now be d e s c r i b e d  descriptions health  thus  of these  behaviors.  through factors  129 Diet  and E x e r c i s e After  the  t h e mind,  participants described  diet  most  significant  factors influencing health.  exercise  were viewed  t o be v e r y  being  almost  always d e s c r i b e d  closely  together  and e x e r c i s e as D i e t and  r e l a t e d t o each r a t h e r t h a n as  other,  isolated  entities. P: I t h i n k d i e t and e x e r c i s e both s h o u l d be v e r y c l o s e l y m o n i t o r e d , t o ... you know, have good h e a l t h . So j u s t not one o r t h e o t h e r , t h e y b o t h s h o u l d be done. R: The two t o g e t h e r ,  diet  and e x e r c i s e ?  P: T h a t ' s r i g h t . B e c a u s e you c a n e a t , you know, r e a l l y h e a l t h y f o o d , and y e t f e e l s l u g g i s h i f you don't e x e r c i s e . So you have t o complement y o u r d i e t w i t h e x e r c i s e . Diet. health.  P a r t i c i p a n t s saw d i e t  Improper d i e t  Proper diet, involved sickness,  was d e s c r i b e d  on t h e o t h e r  i n keeping  as s o m e t h i n g  hand,  important f o r  a s a major c a u s e  was viewed,  a person healthy  very  not only  and p r e v e n t i n g  but a l s o as a i d i n g a p e r s o n ' s r e c o v e r y  of sickness. as a f a c t o r  d i s e a s e and  from  sickness to  health. The  f o l l o w i n g account  contribute  eating  habits  t h a t most o f t h e d i s t u r b e d , say, p h y s i c a l o r w h a t e v e r i t i s , a r e due t o y o u r i l l d i e t . y o u r d i e t i s n o t p r o p e r , o r you d i g e s t i o n i s not o n l y most o f t h e i l l n e s s e s you g e t .  He f u r t h e r e x p l a i n e d in India  foods to avoid terms  how wrong  to sickness.  P: We l e a r n e d disturbances Okay? So i f proper, then  doctors  describes  that,  strictly  i n order  of "disturbances" P: T h a t ' s why  when he was s i c k advised  to heal  what  as a c h i l d ,  foods t o take  t h e body.  ayurvedic  and what  He spoke o f s i c k n e s s i n  i n t h e body:  I said  that  your d i e t  also  i s responsible f o r  130 most o f t h e d i s t u r b a n c e s i n y o u r body. find t h a t ' s how i f you a v o i d t h o s e d i e t s (wrong f o o d s ) , i t h e l p s by i t s e l f (to h e a l t h e b o d y ) . Although the  the nature  accounts,  of a "proper"  participants  diet  agreed  on b a s i c  participants  explained that  a proper  of p r o t e i n s ,  carbohydrates,  fats,  were n o t c o n c e r n e d each  food  group,  necessary Indian  about  meals were seen used  participants  had a d e q u a t e  f o r such  illustrates  fruits  scientifically  diet.  Both  Western  foods  principles.  Most  was made up o f a and v e g e t a b l e s .  established  v e g e t a r i a n and balanced.  balance They  amounts o f  t h e amounts o f each  as n u t r i t i o n a l l y  participants  required  diet  but r a t h e r e s t i m a t e d  f o r a balanced  was d e s c r i b e d v a r i o u s l y i n  food  non-vegetarian Many  extensively in their  diets.  All  economic r e s o u r c e s t o p r o v i d e the foods  a balanced  diet.  The f o l l o w i n g  a common p e r s p e c t i v e on p r o p e r  account  diet.  P: A p r o p e r h e a l t h y d i e t f o r me would be — excess of a n y t h i n g i s not a h e a l t h y d i e t . And m o d e r a t i o n o f a n y t h i n g is — you K n o w , — I l i k e t o e a t a l o t o f sweets, o r w h a t e v e r you c a n c a l l i t , — but a n o r m a l amount i s j u s t a l l r i g h t . But i f I s t a r t e a t i n g j u s t sweets and c a n d i e s e v e r y d a y , i t s not — i t s g o i n g t o t e l l on my h e a l t h and my t e e t h and everything i n l a t e r years. And t h a t i s n o t a v e r y h e a l t h y d i e t b e c a u s e i t does n o t , i t does n o t g i v e you e v e r y t h i n g t h a t you r e q u i r e f o r a h e a l t h y body. You must have some meat, you s h o u l d have some c e r e a l , you s h o u l d have some m i l k , you s h o u l d have f r u i t and f r e s h v e g e t a b l e s — t h a t ' s a proper balanced p o r t i o n of these i s a healthy d i e t . The  benefits  salt,  of f a s t i n g ,  as w e l l  was d e s c r i b e d by a n o t h e r  as l i m i t i n g  i n t a k e o f s u g a r and  participant:  P: I keep f a s t t w i c e a week (on l i q u i d s and f r u i t s ) j u s t t o - c l e a n , you know, t h e system. And t h e n I t r y t o c o n t r o l s u g a r and s a l t . I don't t a k e s u g a r i n my t e a . I look a f t e r my h e a l t h . Advocating  a n a t u r o p a t h i c p e r s p e c t i v e on d i e t ,  one p a r t i c i p a n t  131 explained meant  "proper"  eating  person needs  has  diet  f o o d s which  a natural  for health,  as  rather different1y. "the  body c r a v e d  inclination well  as  to  eat  a natural  To  him  after".  the  a proper  He  felt  that  foods which the  instinct  t o not  diet a  body  overeat.  P: When you f e e l an urge t o eat s o m e t h i n g , i t o n l y shows t h a t y o u r body needs t h o s e p a r t i c u l a r t h i n g s . Pnd t h e n o n l y you f e e l an urge f o r i t ... But t i m e comes when you f e e l t h a t "oh, hey, t h a t ' s enough, I d o n ' t t h i n k I need t o eat more". But b e c a u s e you l i k e i t s t a s t e , i f you keep e a t i n g i t , t h a t d o e s n ' t h e l p you at t h a t t i m e . Pnd t h e n i t a d v e r s e l y a f f e c t s y o u r body. Diet Ps  noted  altered  was  previously, during  recommended of quick energy  energy  f o r doing  of  very  wholesome  energy  to  special  sick  P  liquid  person,  or  to  promote h e a l i n g ,  activities. importance  food,  and  the  food  body.  The  that  of  diet  the  energy. needed  and  Milk  of c h o i c e  during  provides  f o l l o w i n g accounts  was  a  be  source  provide  accounts described  diet.  to  was  body w i t h  recuperation  Several  to the  store  semi-liquid diet  provide  i t i s r a p i d l y a s s i m i l a t e d and to the  body's  p a r t i c i p a n t s explained  sickness.  f o r the  food  because  l i n k e d i n t i m a t e l y to the  extra  milk  described  as  as a  sickness  a quick  illustrate  source  of  this  p e r s p e c t i ve: P: I d e f i n i t e l y b e l i e v e t h a t i t s ( m i l k ) a v e r y h e a l t h y d i e t , p a r t l y because I don't know why, we have been b r o u g h t up l i k e t h a t . Pnd we were a l w a y s t o l d — I think even i n t h e s c h o o l i t was t a u g h t t h a t you must have a good amount o f m i l k e v e r y d a y . R:  Would  you  change  your d i e t ,  would  you,  i f you  were  sick?  P: Yes, I d i e t or s u p p l e m e n t w i t h v i t a m i n s , and I might d r i n k more m i l k . I might eat d i f f e r e n t d i e t . It c o u l d be semi-liquid diet. And l i q u i d d o e s n ' t mean l i q u o r ! More m i l k , and d i f f e r e n t , I mean, so e v e r y t h i n g you c o u l d d i g e s t it better. L i k e I won't eat meat, as i t s h a r d t o d i g e s t .  a  132 R: So y o u ' r e s a y i n g t h e s e t h i n g s , m i l k and l i q u i d s , t h e y ' d be easy t o d i g e s t when y o u ' r e s i c k ? Is t h a t what you mean? P: Yes.  find  g i v e you more energy,  "What" f o o d s were e a t e n a point foods  emphasized  should  and "when" t h e y  i n many a c c o u n t s .  be e a t e n  and f a s t e r were e a t e n  Participants  a t s e t meal t i m e s ,  energy. was  also  explained that  and i n moderate  amounts.  P: E a t i n g p r o p e r f o o d , yeah, and d o i n g t h i n g s i n t i m e t o o . L i k e l u n c h t i m e you have t o e a t i n t i m e , and you know, no m a t t e r i f you e a t l i t t l e o r more — and j u s t t a k e w h a t e v e r you, and do t h i n g s i n t i m e , you know. R: What do you mean  "do t h i n g s i n t i m e " ?  P: T r y t o do, okay, some p e o p l e have h a b i t t h e y w i l l g e t up 11 o ' c l o c k , t h e n t h e y w i l l s p o i l t h e i r whole r o u t i n e . So l u n c h t i m e , t h e y w i l l have b r e a k f a s t , and d i n n e r o r snack time they w i l l eat lunch! P: E a t a p r o p e r d i e t a t p r o p e r t i m e s , and not j u s t e a t any t i m e you f e e l l i k e i t — j u s t open t h e f r i d g e and e a t something.  P: I f you keep e a t i n g i t (a f o o d you f e e l l i k e e a t i n g ) , t h a t d o e s n ' t h e l p you a t t h a t t i m e . find t h e n i t a d v e r s e l y a f f e c t s y o u r body. It  was f e l t  that  lighter  o f t h e day, and t h a t person's  vitality.  this  foods  should  be t a k e n  p a t t e r n of e a t i n g  One p a r t i c i p a n t  in the early  contributed  described this  part  to a  as f o l l o w s :  R: fire t h e r e o t h e r t h i n g s t h a t you t h i n k a r e i m p o r t a n t f o r you, t o m a i n t a i n c o n t r i b u t e to t h i s v i t a l i t y t h a t ' s part of h e a l t h ? P: I t a g a i n comes t o e a t i n g h a b i t s . What you e a t and when you e a t . I mean, I would not e a t any meat i t e m s b e f o r e l u n c h . Okay. On my b r e a k f a s t , I'11 have a v e r y l i g h t breakfast. Very l i g h t means a c u p o f t e a , o r a c u p o f m i l k , or a cup o f j u i c e and maybe a p i e c e o f f r u i t . find l u n c h w i l l be a l s o v e r y l i g h t — i t s n o t a b i g l u n c h , I mean. R: So a l l t h e s e t h i n g s y o u ' r e d o i n g , h a v i n g a l i g h t b r e a k f a s t and a m o d e r a t e l y l i g h t l u n c h a r e c o n t r i b u t i n g t o h a v i n g you  133  have t h a t P: One  That  feeling  R:  spoke  stemmed So  energetic?  is right.  participant  practice  of being  you  of t a k i n g foods  from  upbringing  grew up  which were  in season;  in India.  t a k i n g the  foods  t h a t were  P: Yeah. F r u i t s and f o o d what i s i n s e a s o n , most a t t h e farm, t h a t ' s t h e main. R:  So,  here  P:  Okay, h e r e  Temperature important that  habit  freshness  aspects  to take  is s t i l l  He  healthy.  food,  that are  participant  instilled  described that  Fresh  and  what  grows  i n season?  were d e s c r i b e d as  One  were  i n season?  same.  eaten  diet.  diet  foods  that  of foods  proper  in India.  i s not  tend  of a h e a l t h y  a t t i t u d e s about  upbringing food,  and  a l s o you  this  very  explained  i n him  cold  during  food,  i n c o n t r a s t , was  other  or  his  stale  described  as  healthful. P: R i g h t s t u f f to  from our c h i l d h o o d , eat a l t o g e t h e r .  R:  you  Could  d e s c r i b e what  we  you  were n e v e r mean by  given  any  cold  "cold"?  P: E i t h e r t h a t i s a c t u a l l y r e f r i g e r a t e d o r — one i s refrigerated — that i s anything that i s extremely c o l d i s n e v e r consumed. Secondly, anything that i s s t a l e i s never consumed. R:  Stale.  How  would  you  determine  "stale"?  P: S o m e t h i n g t h a t i s , s o m e t h i n g which you s t o r e up i n t h e f r i d g e o r somewhere f o r d a y s t o g e t h e r . Or i n a f r e e z e r and put i t f o r d a y s t o g e t h e r . Or canned f o o d s and t h i n g s l i k e t h a t , we n e v e r knew. Everything is fresh. He  explained  how  he  still  observed  these  p r a c t i c e s i n Canada.  P: I u s u a l l y d o n ' t d r i n k v e r y c o l d w a t e r , sometimes I do t a k e t h e s e pops and o t h e r t h i n g s , but s t i l l i f I have t o d r i n k w a t e r a l s o , I do t a k e c o l d w a t e r but not t h a t v e r y c o l d one.  134  The  following  E x e r c i se. essential terms well  accounts  t o maintenance  of health.  of exercise  as t r a d i t i o n a l  were d e s c r i b e d  below  perspectives  P a r t i c i p a n t s unanimously  of the type  exercise  illustrate  hatha  perceived Pccounts  advocated.  yoga e x e r c i s e s  as b e n e f i c i a l t o h e a l t h .  as a way o f c o p i n g  illustrate  with  some o f t h e s e  stress.  on e x e r c i s e . exercise varied,  Walking  as however, i n  and j o g g i n g ,  and b r e a t h i n g  as  techniques,  One p a r t i c i p a n t saw The a c c o u n t s  presented  perspectives.  P: I've a l w a y s been a c t i v e , and a l w a y s ... n o t , n o t you know, r i g o r o u s e x e r c i s e , j u s t a r e g u l a r b a l a n c e d ... i n m o d e r a t i o n , you know.Go f o r l o n g w a l k s o r s o m e t h i n g , swimming, o r whatever. Do s o m e t h i n g on a r e g u l a r b a s i s . Exercise resistance; life  style.  physical  was p e r c e i v e d  with  exercise  as e n h a n c i n g  itself  The i m p o r t a n c e  and b r e a t h i n g  v i t a l i t y and  viewed as one a s p e c t  of increasing  exercises  t h e body's  cardiac  was d e s c r i b e d  of a  output  healthy  through  by one p a r t i c i p a n t :  R: You j u s t s a i d t h a t t h i s r e s i s t a n c e comes from s e v e r a l t h i n g s , o r l i v i n g a c e r t a i n way.  doing  P: Yeah. L i v i n g a c e r t a i n s t y l e of l i f e s t y l e . Generally we have been t a u g h t i n o u r s o c i e t y t h a t g e t t i n g up b e f o r e s u n r i s e and h a v i n g a b a t h and c l e a n i n g up, and a l l c l e a n i n g , and t h e n d o i n g a l i t t l e b i t o f e x e r c i s e — you c a n c a l l i t yoga o r w h a t e v e r you c a n , e x e r c i s e which r e l a t e s t o t h e body. Okay? Like breathing exercise. R: So when you say " r e l a t e s t o t h e body", t h e body? P: Yes, u s i n g  you mean  using  t h e body.  R: You mean p h y s i c a l  exercise?  P: Yes. T h a t ' s r i g h t . Your p h y s i c a l e x e r c i s e , t h a t p h y s i c a l exercise also includes breathing. find l i k e , a g a i n , i f you want t o b r i n g , i n c l u d e t h e m e d i c a l t e r m s h e r e , I mean t h e — I ' l l be s a y i n g you have t o pump up y o u r c a r d i o v a s c u l a r system.  135  R: Okay. Yes, y e s . P: But i t s t h e b r e a t h i n g e x e r c i s e s , i n a way, which a l s o does t h a t s i m i l a r l y . find some o t h e r e x e r c i s e s , and t h e same e x e r c i s e s which g i v e you — w i t h o u t t h a t much s t r a i n on y o u r body — s t i l l t h e same v i t a l i t y . But one e s s e n t i a l p a r t i s , I mean, h a v i n g , g e t t i n g up b e f o r e s u n r i s e and h a v i n g b a t h b e f o r e s u n r i s e , g i v e s you e x t e r n a l e n e r g y . It  was a l s o  type  explained that  o f f o o d and e x e r c i s e  people they  vary  require  i n terms  o f t h e amount and  t o be h e a l t h y .  P: Some p e o p l e c o u l d become h e a l t h y w i t h l e s s e x e r c i s e t h a n some p e o p l e , who c o u l d , t o some i t might t a k e more e x e r c i s e and f o o d , o r c h e m i c a l i n t a k e ( f o o d s ) . As compared — t h a t ' s t o t a l l y (dependent) upon y o u r own p h y s i c a l r e q u i r e m e n t s , body requirements. R: And what about  these  requirements?  P: As I s a i d , d i f f e r e n t f o o d s , and more e x e r c i s e , a d i f f e r e n t type of e x e r c i s e . That's again a p h y s i c a l r e q u i r e m e n t , I mean. R: I know. But I mean why, o r how, do you see t h i s b e i n g d i f f e r e n t from p e r s o n t o p e r s o n ? What would t h e r e a s o n be? P: B e c a u s e e v e r y b o d y ' s body s t r u c t u r e i s d i f f e r e n t . And c h e m i c a l body, i n t e r n a l l y c h e m i c a l r e a c t i o n t o d i f f e r e n t chemicals i s d i f f e r e n t . R: I s e e . e x e r c i se. P: T h a t ' s  So some p e o p l e  will  need  more d i e t  and some more  r i g h t , yes.  S l e e p and C l e a n l i n e s s Although briefly to  these  physical  participants  in their  accounts,  two i n f l u e n c e s and mental  mentioned they  nonetheless a t t r i b u t e d  on h e a l t h .  health  s l e e p and c l e a n l i n e s s  The i m p o r t a n c e  only  importance  of sleep f o r  was d e s c r i b e d i n one a c c o u n t  as  foilows: R: So i t seems t h a t s l e e p has an e f f e c t h e a l t h a s w e l l a s y o u r mental h e a l t h ?  on y o u r  physical  136  P: I t does, y e s . I t r e s t s my mental — b e c a u s e I'm n o t t h i n k i n g , maybe u n c o n s c i o u s l y I am_ d r e a m i n g o r w h a t e v e r , I don't know. I c a n ' t say about t h a t , I have no i d e a what goes on — but I f e e l t h a t my b r a i n i s g e t t i n g a l i t t l e b i t o f r e s t a s w e l l as my body's g e t t i n g r e s t . So next morning when I wake up, t h e v i t a l i t y i s a g a i n back and I c a n s t a r t work a g a i n . Another  participant described  his/her  duties:  how s l e e p  helps  a person  c a r r y out  P: I f you don't have a good s l e e p , n a t u r a l l y , you know, you a r e not c a p a b l e o f p e r f o r m i n g y o u r d u t i e s d u r i n g t h e day. So ... i f y o u ' r e not s l e e p i n g e v e r y n i g h t , i n c a s e o f i n s o m n i a or something, you're not going t o stay h e a l t h y . ... Y o u r d u t i e s t h a t you have t o p e r f o r m t h e next day ... s u p p o s i n g you have had a good s l e e p , you know, y o u ' r e capable of doing (the d u t i e s ) b e t t e r . I f you h a v e n ' t had i t ( s l e e p ) , you a r e j u s t d o i n g i t , but n o t i n a p r o p e r way. T h a t ' s what I t h i n k . C l e a n l i n e s s o f one's p e r s o n , as w e l l as t h e s u r r o u n d i n g environment, The  was d e s c r i b e d  following  accounts  as a n o t h e r  explain  factor  the importance  influencing  health.  of c l e a n l i n e s s :  P: C l e a n l i n e s s . You s h o u l d keep y o u r s e l f c l e a n , o t h e r w i s e i t does b r i n g a c e r t a i n k i n d o f maybe i t c o u l d b r i n g s k i n disease. L i k e d e n t a l h e a l t h i s very important, t o o . I f you don't wash y o u r h a i r t h e n t h e r e c a n be — c e r t a i n p r o b l e m s c o u l d come. So, c l e a n l i n e s s i s v e r y i m p o r t a n t t o o , on y o u r p e r s o n as w e l l as i n t h e house. P: When you get up, you b r u s h y o u r t e e t h , you t a k e a b a t h , and you change y o u r c l o t h e s e v e r y d a y . L i k e my c h i l d r e n n e v e r wear t h e same c l o t h e s t h e n e x t day. I t has t o be washed b e f o r e t h e y c a n wear t h e same c l o t h e s ... So I t h i n k t h a t i t i s a n e c e s s i t y t o be h e a l t h y , b e c a u s e i f you d o n ' t b r u s h y o u r t e e t h , n a t u r a l l y germs go i n , and t h a t s o r t o f t h i n g I believe in. To be f r e s h . Pnd t h a t ' s t h e way I s t a r t a day f o r myself. Pnd I keep t h e house c l e a n so t h a t , you know, my k i d s l i k e t o p l a y on t h e f l o o r so I would l i k e t o have t h e floor clean. So t h a t , I mean, t h a t ' s t h e way I t a k e h e a l t h as. Use  of Medicines Pccounts described  medicines.  use o f b o t h W e s t e r n and t r a d i t i o n a l  Some p a r t i c i p a n t s used W e s t e r n  medicines  Indian  exclusively,  137 others  used  explained health,  both  that  W e s t e r n and I n d i a n m e d i c i n e s .  herbal medicines  particularly  promoting  were  in relation  proper d i g e s t i o n  One  important  in maintaining h i s  t o p r e v e n t i n g c o n s t i p a t i o n and  of food.  R: So y o u ' r e t e l l i n g me t h a t you f e e l t h a t works much b e t t e r ( t h a n W e s t e r n a l l o p a t h i c P: Oh, d e f i n i t e l y much b e t t e r . these medicines only. He e l a b o r a t e d on t h e t y p e R: You don't l i k e Western m e d i c i n e s  participant  h e r b a l medicine medicines)?  I have a l w a y s  of herbal medicines  t o t a k e any o f t h e s e (like aspirin)?  trusted  he used  and why:  traditional  P: Any o f t h o s e p i l l s . Not o n l y Western, I don't t a k e — and t h a t ' s where t h e c o n c e p t o f n a t u r o p a t h y comes — I don't t a k e even a y u r v e d i c m e d i c i n e s a l s o so o f t e n . I have a few m e d i c i n e s b r o u g h t o v e r from I n d i a . And i t r e a l l y works extremely w e l l . O n l y a c o u p l e o f them. One i s known as "harde". Now, t h a t ' s a s o r t o f l a x a t i v e , okay? but n o r a r e a l l a x a t i v e , but i t l o o s e n s up y o u r m o t i o n s , and motion i s r e a l l y good. And t h a t h e l p s you v e r y much. Now t h i s i s one t h i n g which I t a k e o c c a s i o n a l l y . And t h e r e i s a n o t h e r one, i t i s known a s " s u d a r s h a n " . T h a t ' s an e x t r e m e l y b i t t e r powder. And t h a t powder, i f you a r e h a v i n g t e m p e r a t u r e o r s o m e t h i n g , i t h e l p s you a l o t . In c a s e s o f f l u o r something, i t h e l p s a l o t . Accounts  describing  exclusively temporary  use o f W e s t e r n  t o t h e use o f a s p i r i n  complaints  such  medicines,  referred  almost  a s a common way o f t r e a t i n g  as headaches,  b a c k a c h e and f e v e r .  P: L i k e i f I had a h e a d a c h e I j u s t took an a s p i r i n and t h a t would go away. I w o u l d n ' t need t o go t o a d o c t o r f o r t h a t . Or a s l i g h t f e v e r , I c o u l d j u s t t a k e an a s p i r i n , and t h a t would be a l r i g h t . Maintaining  Routine  Maintaining additional describes  factor  one's u s u a l d a i l y influencing  the importance  routine  health.  of keeping  was d e s c r i b e d as an  The f o l l o w i n g  a routine,  account  or doing things  138  regularly. regular  The p a r t i c i p a n t e x p l a i n e d  maintaining  a routine of  exercise.  P: Then, l i k e you do t h i n g s r e g u l a r l y , and e v e r y t h i n g . Like i f you e x e r c i s e r e g u l a r l y t h e n i t a f f e c t s ; i t d o e s n ' t a f f e c t i f you do once a week, o r , you know, do maybe, you know, sometime i n t h e e v e n i n g and, o r , sometime i n t h e morning. K e e p i n g a r o u t i n e i s good t h i n g t o become healthy person. Doing to  "something d i f f e r e n t than the r o u t i n e "  sickness.  The e n s u i n g  account  described  was viewed  your r o u t i n e s  R: find w h a t e v e r t h a t  i s very  routine  leading  this:  R: So a c t u a l l y t h i s seems t o be i m p o r t a n t , t h a t h e a l t h you need t o m a i n t a i n y o u r r o u t i n e s ? P: M a i n t a i n  as  t o keep  your  important.  i s you c a n change  i t slowly?  P: You c a n change i t s l o w l y , but you c a n n o t make a sudden change and n o t f e e l t h e e f f e c t o f i t on y o u r body. R: So, i n o r d e r t o keep h e a l t h y you need t o m a i n t a i n t h e t i m e you get up, and what you e a t , and t h e r o u t i n e o f how much e x e r c i s e you have? P: T h a t ' s r i g h t . R: find when you don't keep t h a t r o u t i n e into i l l - h e a l t h (partial health)?  going,  you c a n get  P: Yeah. Then body has t o r e a c t t o t h a t change, and t h e n t h e v i t a l i t y goes down b e c a u s e i t s t r y i n g t o cope w i t h t h a t change, e n e r g i e s a r e d i v e r t e d t o w a r d s c o p i n g ( w i t h ) t h a t change and a d j u s t i n g t o w a r d s t h a t change. B e c a u s e now t h e body w i l l a c c e p t s i m i l a r c h a n g e s t h a t next t i m e h a p p e n i n g . So t h e e n e r g i e s a r e g o i n g t h e r e , so e n e r g i e s a r e not t h e r e f o r o t h e r t h i n g s which a r e h a p p e n i n g a r o u n d t h e body, i n t h e environment. In  summary, p a r t i c i p a n t s d e s c r i b e d  cleanliness,  use o f m e d i c i n e s ,  working  outside  factors  i n f l u e n c i n g the three  Diet,  exercise,  diet,  maintaining  exercise,  a regular  o f t h e home and home a t m o s p h e r e ,  sleep,  sleep, routine,  as a d d i t i o n a l  phases o f the h e a l t h  experience.  c l e a n l i n e s s , use o f m e d i c i n e s , and  139  maintaining  a regular  routine  participant  accounts  presented  presented included outside minor  i n the previous participants'  have been d e s c r i b e d in this  section  section.  on p o s i t i v e  descriptions  greatest  factors,  importance  diet  The a c c o u n t s  mental  of the influence  o f t h e home and home a t m o s p h e r e  influencing  through the  exert  and e x e r c i s e  in participants'  attitude which  on h e a l t h .  working Of t h e s e  were g i v e n t h e  accounts.  Summary This form  of p a r t i c i p a n t s '  Analysis context and  c h a p t e r has p r e s e n t e d  of data revealed within  which  Within  this  description  according health,  overall  to the three  normal  health  context,  unit  the  three  phases  the  physical  and s i c k n e s s ) .  influencing  linked  up t h e t o t a l  health  In c o n t r a s t , focused  health  health  to influence  together person.  which  two l e v e l s  experience  phenomenon  experience  (complete was health.  involving  both  as an i n s e p a r a b l e Participants  primarily  descriptions  largely  offered  Secondly,  perceived  as a h o l i s t i c  experience,  framework  described  phases o f t h e h e a l t h  of the health  body.  they  as t h e o v e r a l l  chapter.  participants  Firstly,  t h e two b e i n g  and making  in this  in the  of health.  the health  o f an a n a l y t i c  of data  was p e r c e i v e d  body and mind,  activities"  explained  i n terms o f t h e f a c t o r s  Health  whole  structuring  of health.  partial  described  "doing  the presentation  o f t h e study  of t h e i r experience  participants  l e d to the f i n a l  organized  of  accounts  the r e s u l t s  on t h e r o l e  described  i n terms o f  of the f a c t o r s o f t h e mind,  140 although  other  minor  factors  (such  as d i e t  and  exercise)  were  also  d e s c r i bed. Complete  health  person  (both  body  normal  activities  participants less  well  normal and  and well  with  and  Partial was  worrisome.  four  as  normal Health  described  out d a i l y  i n complete  that  they  could  not  as s e r i o u s ,  activities  permanent  independence  i n each phase  perceived  in relation  and  and  activities, health.  but  In  not c a r r y  out  personal  duties  and  (or long and  phased  Descriptions  sickness  clarified  while  term)  and  c o n t r o l were experience.  of the h e a l t h  f o r normal  to the three  bothersome,  These  individual capacity for  experienced  of c a p a c i t y  experience.  health  out  health,  fulfill  as t e m p o r a r y  c h a r a c t e r i s t i c s supported  was  to c a r r y  could  four c h a r a c t e r i s t i c s of the h e a l t h  described  partial  viewed  resistance,  i n terms  health  therefore  able  In p a r t i a l  to carry than  and  total  independently.  primarily  total  happily.  able  was  Energy,  health  doing  health  as a s t a t e where t h e  healthy  p a r t i c i p a n t s explained  responsibilities  described  and  more e f f o r t  activities,  sickness  explained  mind) was  were s t i l l  and  sickness,  was  experience.  by p a r t i c i p a n t s action.  Health  continuum  making  was up t h e  of the c h a r a c t e r i s t i c s of the nature  of complete  health. The essential this  r e s u l t s of t h i s meaning  of h e a l t h  investigation.  domain  study  of Kleinman's  This  c o n s t i t u t e a d e s c r i p t i o n of the  f o r the  Indo-Canadians  d e s c r i p t i o n represents  explanatory  model.  The  involved in  the  following  popular chapter  141 discusses  the  1i t e r a t ure.  r e s u l t s of the  research  in l i g h t  of  relevant  142 CHAPTER 5  The  framework  fundamental  explanatory  presented  meaning  participated  i n d i c a t e that  those held  by  Health  was  health  construct  related  by  plays  who  illustrates  within  the  figure  health  1).  The  between  care  is a  significant  f i n d i n g of the  data, an  however,  important  ethnocultural  intent  in the  and  study.  The  of  c u l t u r e exert  i n d i c a t e that  role  way  and  study.  i n both  e t h n i c i t y and  of  the  professionals  constructed  the  sphere  the  study  as  with  some o f  popular  p a r t i c i p a n t s in t h i s  study  the  on  social people  health. chapter,  of t h i s  (3)  (1)  presented  activities,  The  the  findings will  0 brief model  and  framework  health,  to the  three  in the  preceding  discussed  examination  (2)  influencing health.  three  be  following discussion  normalcy  factors  themes c o r r e s p o n d  framework  study's  explanatory  chapter.  main themes: and  the  literature.  of Kleinman's  of h e a l t h ,  normal  held  current  The  represents  Indo-Canadians  (see  i n f l u e n c e which  to relevant  light  content  the  the  also  In t h i s  three  This  definition.  environment  three  revealed  four  i s some agreement  of h e a l t h  s t a r t e d the  investigating  model  there  FINDINGS  framework  located  Indo-Canadian  contexts.  researcher  in  the  f o r the The  models o f h e a l t h  conceptualizations  social  study.  system  THE  in chapter  of h e a l t h  in t h i s  Kleinman's c u l t u r a l findings  : DISCUSSION OF  data  introduces focuses  the  on  conceptualizations These  fundamental chapter:  phases of the  of the  and  health  components namely experience  of doing and  143 factors the  influencing  literature  discussion  cited  emphasized  context  Kleinman  viewing each  health  own p e r s p e c t i v e s Effective and  illness.  participants  and i l l n e s s  and h e a l t h share  associated  Participants' health,  and r e l a t e d  similar  to those held  These rather  similarities than  health  care  presented sphere based  by o t h e r  groups  a p p e a r t o be based  culture.  Therefore,  has  its  when  clients  o f h e a l t h and  in clinical are l i k e l y  t o e x i s t when  from  each  other.  i n the accounts of o f t h e model, and beliefs,  r o l e s and  of health  t h e f a c t o r s which  promoting  model,  2 & 3).  i s encouraged  the experiences  b e l i e f s regarding  i n Kleinman's  remain d i s t a n t  the popular  model f o r  p o p u l a r and f o l k )  difficulties  of health  with  s o c i a l and  (see f i g u r e s  care  encompass t h e i n d i v i d u a l and f a m i l y behaviours  that  s i m i l a r views  perspectives  represent  Framework  As i l l u s t r a t e d  and i n e f f e c t i v e h e a l t h  descriptions  of health  the i n d i v i d u a l ' s explanatory  On t h e o t h e r hand,  and p r o f e s s i o n a l The  Model  (professional,  on h e a l t h  professionals  communication lay  domains  communication  health  of notions  1980, 1984) s t a t e s  and i l l n e s s .  of the three  in this  discussion.  Explanatory  structure  again  Some o f  The s i g n i f i c a n c e o f  in construction  (1978a,b,  context  (see f i g u r e s 2 & 3 ) .  findings.  in t h i s chapter's  The  cultural  state  i n c h a p t e r two i s r e v i e w e d  of the study's  socio-cultural is  the health  lifestyles, i n North  and  illness.  influence appear  Pmerican  quite society.  on s o c i o - e c o n o m i c s i t u a t i o n  we c a n n o t  say t h a t  people's  144 notions  of h e a l t h  ethnocultural  and  illness  are  constructed  of h e a l t h .  employed  the  distinct  ways: t h e y  term  The  concept  Socio-Cultural  Construction  described  "doing  carried  out  i n both t h e  health  healthy  Participant  in;  (3)  the  course  harm t h e without  participants  of n o r m a l c y ,  in  two  activities,  being.  The  and  also  following  i n terms of  duties (2)  adverse four  normal  normal  i n both  and  of these  routines, to  and  day  two  and  which a p e r s o n  health  "normal  one  partial  to  i s accustomed  to  phases  viewed  in  four  society  wished  activities  be  states.  family,  usually  the  health  activity"  personally  (4)  as  could  participants  or a c t i v i t i e s ,  life;  activities"  and  responsibilities which  Activities  Normal a c t i v i t i e s  Consequently,  activities  o f day  body,  o f Normal  accounts described  everyday  These  showed t h a t  normal  complete h e a l t h  continuum.  t h e m s e l v e s as  occupation;  of  "normal"  c h a r a c t e r i s t i c of h e a l t h .  (1)  doing  state  primary  ways: as  data  their  health.  Participants  of the  term  concepts  (1)  a normal  the  the  of the  and  spoke o f  as  discusses in  Analysis  "normal",  viewed h e a l t h  activities  in  Health  p a r t i c i p a n t s emphasized  accounts  section  "normal"  Activities!  N o r m a l c y and  (2)  by  context.  D o i n g Normal  Study  solely  to  and  engage  c a r r i e d out which do doing  in  not  everyday  effect. meanings of n o r m a l  are  very  closely related, i f  145 not  e s s e n t i a l l y t h e same, s i n c e  activities duties  c a r r i e d out d a i l y  related to l i f e  participants personally described  described  wished normal  p a r t i c i p a n t s explained  were synonymous w i t h  roles.  Furthermore,  these d a i l y  t o engage  in.  activities  duties  personal  t h e vast  majority of  as a c t i v i t i e s  P a r t i c i p a n t s most  as d u t i e s ,  that  they  frequently  responsibilities,  o r "what  I u s u a l l y do". Although and  tasks  and  participants in this  the importance  of health  responsibilities.  responsibilities the  study  the  life  Duties  A survey  structure  of the l i t e r a t u r e which  study  and t r a d i t i o n a l  to  influenced  responsibilities daily  for a l l  area  duties  o f d u t i e s and germane t o  i s confined to  with  they  values.  family  S o c i a l context  and e d u c a t i o n a l  considered  as "normal  Indo-Canadian  participants' definition  that  Society  t h e d u t i e s and  participants described  cultural  status  level) also  (most appears  o f t h e r o l e s and  important  to f u l f i l l in  lives.  Many o f t h e r e p o r t s community  family  i s therefore  shows t h a t  are largely associated  socio-economic  their  personal  in this  roles  p a r t i c u l a r emphasis  discussion  society  literature  life  o f I n d o - C a n a d i a n women.  notably have  The f o l l o w i n g  Most  placed  and R e s p o n s i b i l i t i e s i n I n d o - C a n a d i a n  responsibilities activities"  study  in daily  outcome o f h e a l t h  f o rf u l f i l l i n g  i n Indo-Canadian  results. context  Family.  engaging  i s a common, i f n o t u n i v e r s a l ,  individuals, on  i t c a n be assumed t h a t  have  focused  and s t u d i e s  on t h e I n d o - C a n a d i a n  p r i m a r i l y on women  (Anderson,1985a, 1987;  146 Anderson Naidoo, their  & Lynam,  1981; Majumdar & C a r p i o , 1988;  1980, 1984) and a t t i t u d e s o f I n d o - C a n a d i a n  children  perspectives Khosla describes to  1987; K h o s l a ,  (Yoshida  & Davies,  of Indo-Canadian (1981),  t h e H i n d u woman.  towards  L i t e r a t u r e on t h e  men i s l a c k i n g .  in a report  t h e importance  1985).  parents  of South-Asian  of family  Describing  and f a m i l y  cultural  women i n Canada, duties,  role  o r dharma,  e x p e c t a t i o n s , she  states: Based is  upon t h e c o n c e p t  socialized  society  t o b e l i e v e that  married  goal  as a w i f e  good d a u g h t e r - i n - l a w . (1980),  o f a happy  i n a study  family family  women i n N a i d o o ' s accomplishment and  outside  Concurring  life  stemming  For the  o b l i g a t i o n s d i c t a t e that her of a  (p. 178-179) of r o l e  perceptions,  high  value  from This  found  and emphasize  view would  the importance  The I n d o - C a n a d i a n  also reported  a balance  similarly  on f u l f i l l i n g  and home a t m o s p h e r e .  (1980) s t u d y ,  r o l e s and a s e n s e o f  between r o l e s both  inside  likely  by many  be e n d o r s e d  women as w e l l . with  the majority  subscribed  responsibilities  i n a t t a i n i n g the status  r o l e s and d u t i e s ,  t h e home.  Anglo-Canadian  (1980),  h e r main c o n t r i b u t i o n i n  role  lies  I n d o - C a n a d i a n women p l a c e  traditional  t h e H i n d u woman  o f home-making and c h i l d - r e a r i n g .  woman, a p p r o p r i a t e  ultimate  that  or duty,  i s t o her f a m i l y ; her primary  consisting  Naidoo  o f Dharma,  t h e f i n d i n g s o f Naidoo of female  to the t r a d i t i o n a l  (1980) and K h o s l a  participants in this perspective  that  life  study  147 responsibilities "duty"  c e n t e r around  was employed  health. normal  by many o f t h e s e  The m a j o r i t y activities,  activities, duties.  almost  as w e l l  emphasize  this  as t h e a c t u a l  theme  after their in their  activities  as a c t i v i t i e s  t h e home.  A few f e m a l e  having  a fulfilling  In a l a t e r professional  Hindu  approximately roles this  study,  Naidoo's  possessed  (1981) s t u d y  Canada r e q u i r e d have engaged It  health  an i n t e r a c t i o n between normal  as w e l l  as i n s i d e  the importance  of  o f t h e home. that  well-educated,  i n Canada f o r  r o l e s as c o n t i n u o u s  (p. 8 5 ) .  Although  s i m i l a r background sample,  d i d not  of health.  (1981) r e p o r t e d  "saw t h e i r  they  they  with  similar  the p a r t i c i p a n t s i n  c h a r a c t e r i s t i c s to  frequently  said that  out d i f f e r e n t r o l e s t h a n  life in they  would  i n i n India.  lives  participants  outside  them t o c a r r y  i s c l e a r from  people's  accounts  or  spoke o f t h e  men and women who had r e s i d e d  10 y e a r s  out o f t h e s e  r o l e s , and e x p l a i n e d  Naidoo  perceived  centered a c t i v i t i e s ,  participants described  i n t h e home c o u n t r y " study  carrying  c a r r i e d out o u t s i d e  career  accounts of  f a m i l i e s , although  reported  and t r a d i t i o n a l  The word  study  participants also  Some p a r t i c i p a n t s a l s o contemporary  in this  e x c l u s i v e l y as f a m i l y  of looking  and home.  women i n t h e i r  of p a r t i c i p a n t s  The two male s t u d y  importance  the family  the data that  influence  in this  to the fact  how t h e y  study  that  view h e a l t h .  frequently  they  Many p a r t i c i p a n t s d e s c r i b e d  the s o c i a l  live  circumstances of As n o t e d ,  related their  i n Canada,  rather  i n d e p e n d e n c e as a v e r y  views on than  i n India.  important  part  148 of h e a l t h ,  explaining  that  independent  because they  the  of extended  support  participants coming the  be s o c i a l l y  experience.  activities" concept  Although  discussion  The  In o t h e r  line  research within  with  reveal  differs  from  of  state  "normal  also  used t h e itself.  The  in health i s  Construction i n Health  t h e m s e l v e s as " n o r m a l " ,  words,  were a b l e  t o carry  i t appears that  or i n a  out normal  participants  viewed  of normalcy.  t h e work o f A n d e r s o n  (1981a),  " n o r m a l " and n o r m a l i t y and s o c i a l  t h e view t h a t  "culture-bound"  as a " n o r m a l "  experience  and N o r m a l i z a t i o n  when t h e y  an e t h n o c u l t u r a l  outside  unnecessary.  and n o r m a l i z a t i o n  Socio-Cultural  i m p l i c i t l y as a s t a t e  In  they  the health  study  findings.  described  "normal c o n d i t i o n " ,  health  employment  and/or  of health,  of normalcy  of Normality  activities.  in India  inappropriate  accounts  from  n e v e r had a j o b b e f o r e  p a r t i c i p a n t s emphasized  to the study's  Participants  they  removed  some f e m a l e  sometimes r e f e r r e d t o h e a l t h  in their  significant  that  them t o be  i f not t o t a l l y ,  F o r example,  that  "normal" t o d e s c r i b e  following  19&6,  family.  t o Canada; e x p l a i n i n g  home would  i n Canada r e q u i r e s  are largely,  spoke o f t h e f a c t  Participants of  life  notions  (Ahmed, K o l k e n  the data  as c o n c e p t s  context.  This  of normality  & Coelho,  from  this  constructed perspective  are  1979; O f f e r  & Sabshin,  1984). Offer  normality.  and S a b s h i n They  (1984) a d v a n c e  propose that  four  normality  perspectives  may be e x p l a i n e d  of a s : (1)  149 health  (reasonable  (optimal  functioning  ideal); and  (3)  both  system  an  of these  discussion,  The  by  (conceiving  o f change  Two  and as  health  partial  normal a c t i v i t i e s clear  contrast  normality, as  health  (the  people, The  (4)  occurring  appear  state  health,  highest than  an  Sabshins'  of h e a l t h . of h e a l t h )  unattainable  a transactional  system.  One  study  two  normalcy average.  The  conceptions  data noted  means u n a t t a i n a b l e  from by  to  interest the  and  study  views  Sabshin  resembles describe  able  completely  to  partial  also  felt  and  that  as  do  healthy.  In  on complete  complete  attainable  of n o r m a l i t y perspective  which  by a l l  this Offer  that  "become n o r m a l " w i t h study and  do  not  Sabshin  health,  or a  bear  of n o r m a l i t y  p a r t i c i p a n t explained  could  optimal  of  ideal.  descriptions  "abnormal a c t i v i t i e s "  (normality  study.  is a state  Sabshins'  of time.  similar  both  They  and  other  system) a r e  changing  (1984) p e r s p e c t i v e s  to O f f e r  passage  a complex,  in t h i s  were not  normal,  a transactional  normality  somewhat  some s i m i l a r i t y  so-called  on  which O f f e r  they  data also contain  unattainable  m i d d l e r a n g e as  within  p a r t i c i p a n t s viewed  state  - an  utopia  p a r t i c i p a n t s were s t i l l  and  states  (2)  normality  state described  to O f f e r  normal  rather  and  a transactional  although  however,  health  of the  perspectives  they  "reasonable" health In  health);  some p a r t i c i p a n t s i n t h i s  partial  normal.  optimal  deviant);  reasonable health  articulated  not  self-actualization  average  (or p r o c e s s  to t h i s  the  or  e x t r e m e s as  environment). as  health,  support (1984)  the the  that  statistical  as  150 Every as  "normal" h e a l t h .  values in  s o c i e t y has " a c c e p t a b l e  i s considered  this  "doing  study d e f i n e d normal  partial  described  Sebag,  or s o c i a l  as " n o r m a l "  (Miles,  The p a r t i c i p a n t s  health  perspectives  i n terms They  as " n o r m a l "  This  similar  t o Twaddle's e x i s t s which  health  and p a r t i a l  of t h e h e a l t h  in contrast,  and h e a l t h  was  s i m i l a r to  (Redlick,  still  may  be d e f i n e d  health  continuum,  Furthermore, period  engage  they  were  "not  normal"  that  time. The  "back  health  1976;  perspectives  certain  to Miles ubiquitous  as n o r m a l .  Although  perfect  complete  as two d i s t i n c t  activities  phases  or sickness,  they could  not c a r r y  was r e g a i n e d  sickness  (1978) and Z o l a conditions  a c t i v i t i e s at  generally  views  "symptom-free".  (1966), each  as p a r t  that  s t u d y a r e not u n l i k e  society  i s not t o t a l l y  after a  was seen as  out normal  of p a r t i c i p a n t s i n t h i s that  states.  participants stated  In c o n t r a s t ,  them  the i n d i v i d u a l  i n both  of complete h e a l t h  as an e x p e r i e n c e which  According  of l e s s than  i n t h e sense t h a t  presented i n the l i t e r a t u r e  health  of h e a l t h are  p a r t i c i p a n t s nonetheless perceived  t o normal".  because  a range  were r e c o g n i z e d  i n normal  when a s t a t e  of p a r t i a l  on " n o r m a l " s t a t e s  (1974) view t h a t  be t h e same, o r " n o r m a l " ,  views  sickness,  on n o r m a l c y  capacity f o r  c o m p l e t e h e a l t h and  view a p p e a r s q u i t e  perspectives  health  could  of a valued  viewed  states;  1978).  group  1979).  Participants'  to  what a c u l t u r a l  as "abnormal".  biomedical  i s regarded  Frequently,  activities".  health  s t a n d a r d s " o f what  o f normal  society  considers  health.  In some  Western c u l t u r e s , decay  may  a particular  socio-cultural contexts,  contexts  from  these  p.  (and) p a r t  in this  with  themselves  t o be h e a l t h y  suffering  from  partial  a cold  because they  activities.  These  of North  Indo-Canadians, participants as  The another  do  Within  overall  be seen  of normally  study  some  health  status.  "as c o m p a t i b l e  accepted  'health'"  viewed  t h e minor  complaints  h e a l t h as "normal", in this  or fever,  state.  with (Miles,  with  participants  extent  health. as p a r t  study,  life  t o which  suddenly  were they  were  g o i n g on  with t h e i r  normal  t o t h e views h e l d  Consequently, backgrounds  i t seems similar  that  to the  t h e same  way  groups. normal  compatibility  (1978) s t a t e s  o f normal  that  still  similar  symptoms d i s r u p t  of t h e i r  Miles  was  felt  p e r c e i v e h e a l t h i n much  Pmerican  definition",  not a r i s e  society.  socio-cultural  in this  and c o n s i d e r e d  Even when t h e y  were a b l e t o c o n t i n u e  Pmerican  determinant  symptoms "social  may  In o t h e r  not be c o n s i d e r e d as  p e r s p e c t i v e s appear  many o t h e r N o r t h  normal  may  and t o o t h  o f normal h e a l t h ,  be o t h e r w i s e .  h e a l t h y " , and e x p l a i n e d t h a t  much  of h a i r  10-11).  associated  normally  loss  norm o f h e a l t h .  h e a l t h " o r as a f f e c t i n g  Participants  by  i t might  common c o m p l a i n t s  good h e a l t h ...  "still  socio-cultural  minor a c h e s and p a i n s  "deviations  1978,  backache,  be c o n s i d e r e d w i t h i n t h e p a r a m e t e r s  reflecting  Rather,  f o r example,  that  activities is  with conceptions of  people  "tend  h e a l t h " as l o n g as t h e y  to accept  fall  within  and " t h e more so i f t h e symptoms a r e minor, and do not d i s r u p t  everyday  activities"  (p.  15E 37).  This  is a significant  meaning w h i c h to  life  the  one  life  responsibilities life  p a r t i c i p a n t explained  She  a wife  that  changes a c c o r d i n g  explained and  that  breaking  mother t h a n  from  school  more s e r i o u s people  are  i n bed.  viewed  as  "sickness"  be  viewed  as  sickness"  explains  that  states.  She  identified  reference (1981b),  cannot  at  be  and  b e c a u s e any  to concepts of  life  also  she  stated  small  one  as  an  the  two  cannot  be  discussion  to She  life  not  "had  was older  lot sick"  may  (1981b)  f a c t s or be  makes to  "not  cycle.  given  objectively  distinguished  According  further describes  "a  Anderson  given  of n o r m a l i t y  evaluate,  she  because  cycle,  life  "abnormal" are  adjudge,  as  p a r t i c i p a n t , what  absolute.  clearly  now  responsibilities  concepts cannot  of a b n o r m a l i t y .  us  f o r her  makes them  in the  "abnormal" are  " n o r m a l " and  events.  point  situation.  a common c o l d  study  with  and  life  for herself,  i n the  the  b e c a u s e now  that  this  point  and  no  that  example,  "health"  had  sickness to  upon  For  more s e r i o u s  a child,  a child  viewed  proposes that  notions  was  another  " n o r m a l " and  schemes" which a l l o w everyday  any  at  or d e f i n e d ,  another  l e g was  related  associated  status.  is called  the  explained  duties  a p e r s o n ' s age  According  is  Normality  the  mothei—in-law than  " f e e b l e " and  p u t s them  a  as  work. She  f o r her  to  study  often  depending  family  what  when she  many r e s p o n s i b i l i t i e s " ;  apart  and  r o l e s and  i n d i c a t e that  symptoms was  Some p a r t i c i p a n t s i n t h i s  age-related  "sickness"  one  to  data  same symptoms have d i f f e r e n t meaning,  his/her  and  The  p a r t i c i p a n t s assigned  context.  individual's  so  point.  from  implicit  Anderson  "interpretive  and this  give  meaning  perspective  to as  153 foilows: We  know from  define  our  what n o r m a l i t y  interpretive 'abnormal' daily  everyday  lives.  embedded  be  read  (Anderson, The  data  as  evidence  1981b,  p.  show t h a t  research  on  Notions  an  'normal'  and  i n the n a t u r a l  attitude  of  we  can  and  display  o f our c u l t u r a l  Anderson  & Chung,  of  in t h i s  " u s u a l " or  p e r c e p t i o n s of c h r o n i c i l l n e s s  1981b) has  cannot  of  participants  i n t h e common s e n s e  1982)  we  i n our  conduct  ways  which  competence.  235)  "normal"  (Anderson,  although  i n our ways o f s e e i n g t h e w o r l d ,  o f managing o u r s e l v e s so t h a t can  that  i s , i t i s c o n s t a n t l y o p e r a t i n g as  schema i n our  are deeply  life,  experience  and  normal  and  reported similar  study  used  the  "everyday". (Anderson,  term  Recent 1981a;  d i s t u r b e d f a m i l y dynamics usage  of the  term.  N o r m a l i z a t i on Normalization normalcy. relevant  A brief to the  participants in  and  because they  discussion  study  "normal partial  two  states.  never  saw  themselves  activities". h e a l t h as  as  which t h e y  Secondly,  "normal", out  of  their  Firstly,  is study  could carry  they  defined  out  both  or h e a l t h y , c o n d i t i o n s normal a c t i v i t i e s  some p a r t i c i p a n t s  sick  to notions  n o r m a l i z a t i o n process  activities  Finally,  closely  f o r three reasons.  were a b l e t o c a r r y  these  linked  of the  results  d e s c r i b e d the  h e a l t h , as  complete  i s a concept  even t h o u g h t h e y  explained that experienced  in they  physical  sympt oms. According  to Anderson  (1981a),  normalization is a  process  154 which  emphasizes  disease  label  by  normality  normalization  usual,  and  described child  as  of the  and  part  Wo 1 f e n s b e r g e r normalization. to  He  attitudes  and  coming t o  of normal d a i l y  (1972),  seen as  "normal".  conditions  Wo 1 f e n s b e r g e r  equates the  conventional"  (p. 28),  term  and  as  on  with  speaks of n o r m a l i z i n g  in i n s t i t u t i o n s  of  illness  view  primarily  by  and  s o c i e t y as  normative with  speaks  i l l  life.  and  towards persons c o n s i d e r e d  or  (1981a)  view c h r o n i c  normalization  context,  the  "normal",  Anderson  advances a c o n t r a s t i n g  discusses  living  or c o n d i t i o n  are  scenario.  o r removes,  i n terms of t r e a t i n g a c h r o n i c a l l y  institutional  humanizing) the  conditions  everyday  "normal c h i l d " ,  non-deviant  reference  process,  normalization a  "deconstructs",  making a p a r t i c u l a r event  In t h e  part  and  societal  deviant.  "typical  sickness  as  (or  or  a deviance  from  normalcy. The  f i n d i n g s of t h i s  normalized example,  their  explanations  nothing  though they  experienced  Although  complaint in  the  (such  partial  "essentially sick.  This  therefore  to  that  partial the  over or  be  some d e v i a t i o n  as  a cold,  health  view t h a t  the  state, or  "still  partial  normal.  health  from  the  having  healthy"  is explained  was by  at  about,  complete a small  this  or  time,  health,  fact  that  For "still  even health  physical headache)  themselves  still the  sickness. s t a t e as  backache  considered  health  and  concerned  f l u , fever,  they  participants  health  partial  participants described  healthy"  still  worry  suggest  of  participants described  n o r m a l " and  state.  study  as rather  than  and participants  155 could  still  state, than  although  out normal not as w e l l  i n complete •ne  or  carry  " i f you t h i n k  said  he was  This  account  symptoms.  and f e l t  provides  following  that  despite  He  researcher  informed  the  he had n e v e r r e a l l y o f how  study  address  conceptualizations  the second  of health.  since  as a two d i m e n s i o n a l  the  of  on " d o i n g "  health  offered  of health  dimensions described  and s i c k n e s s )  how  study  as w e l l  s i m i l a r t o and  lies  and (2)  The  different uniqueness  i n t h e emphasis  as t h e i r  phenomenon.  they  conceptualizations Participants'  a unique arrangement  i n the  phase  p a r t i c i p a n t s ' v i e w s on  i n the l i t e r a t u r e .  include  (1) a t h r e e  factors.  descriptions  in health,  c o n t i n u u m and  conceptualized  involving  a r e both  as a m u l t i d i m e n s i o n a l  descriptions health  partial  continuum  participants' health  of h e a l t h  participants  experience  illustrates  the perspectives  placed  study  o f t h e mind and o t h e r  health-sickness  from  health,  discussion  been s i c k .  The d i s c u s s i o n  of health,  This  always  major theme o f  dimensions  influence  He  participants  d e s c r i b i n g the health-sickness  the  i l l  of normal.  section will  (complete  as  he was h e a l t h y "  literature  continuum  effort  saw h i m s e l f  emphasizes  health  health  more  you a r e h e a l t h y " .  one i l l u s t r a t i o n  the notion  chapter:  and w i t h  "he n e v e r  that  you a r e h e a l t h y ,  "fine",  constructed  that  "always f e l t  minor p h y s i c a l  that  this  o r as h a p p i l y ,  p a r t i c i p a n t emphasized  experiencing  i n the p a r t i a l  health.  s i c k " , but r a t h e r  The  activities  literature.  o f many o f t h e  156 Conceptualizations The ft r e v i e w as  of  a continuum  further  Matsal, 1986;  The  work o f  opposite this  this  of h e a l t h  discussion,  i n the  literature  Rogers,  authors  illness, - the  two  as  manner i n which  Tripp-Reimer,  r e f e r s to  1970;  it  participants  been  (ftntonovsky, Roy,  1976;  rather  than  terms are  1980).  here.  (The  sickness,  as  used  1987;  Fisk  Seedhouse,  1984c; W i n s t e a d - f r y ,  i s discussed  health  provides  study  has  of  The  literature the  polar  interchangeably  in  discussion). Conceptions  health  and  various Smith  of t h e  illness  interfacing,  are  viewed  i s an  between any  point.  The  smooth.  dichotomous  along  whether  variables,  linked together the  by  or  a range  of  continuum.  c h a r a c t e r i s t i c s o f the h e a l t h - i l l n e s s  (p.  unbroken two  points  sequence of t h i n g s there  There are term,  no  discrete points.  rather  than  arranged  i s a l w a y s an  v a r i a t i o n s between h e a l t h  a comparative term.  the  i n terms o f  follows:  ft c o n t i n u u m that  as  differ  of h e a l t h / i 1 l n e s s  (1981) d e s c r i b e s as  continuum  continuous concepts  combinations  continuum  Roy  to  1973;  some o f t h e s e  generally  Continuum  h e a l t h - i l l n e s s continuum  Lerner, 1981;  Health  examining c o n c e p t u a l i z a t i o n s  unique  variously  1980;  Smith,  literature  i n t o the  viewed h e a l t h . conceptualized  Health-Sickness  is pertinent  insight  of  and  intermediate  illness  Health  so  are  then  a classificatory  becomes  (either/or)  44)  (1976) o f f e r s a d i f f e r e n t view.  Explaining  the h e a l t h - i l l n e s s  157 continuum  i n terms of a d a p t a t i o n  continuum  made up  high  level  health,  (6)  (3)  extreme may  time,  either  seven d i s t i n c t  wellness,  individual given  of  be  and  located  that  this  rather  then  the  seven  Participants sickness. return  participants' chronic  phases,  described  and  (2)  of a r e t u r n  figure  Tripp-Reimer's  and  variable  reflects  participants. Although ranging  as  a state  only  and  whether they  views h e l d  She  states: continuum to  may  one  consist  they  the  one  illness  pole  sickness,  could  continuum  regainable  death.  of  illness  (see as  a  illness,  study  of  (or sometimes d e a t h )  and  to  the  illness  consequence  (1)  Os  reference  perceived  by  from  sickness:  o f a sequence  a bipolar construction.  disease,  However,  after chronic  aspects  symptoms c o n s t i t u t e  this  (1984c) d e s c r i p t i o n o f h e a l t h  of the  an  any  they  implicit  other  from h e a l t h  with  outcomes o f  as  the  at  that  within  illness  health  poor  i n d i v i d u a l moves i n  line  mentions death  essentially  termed  to  (2)  Roy.  possible  i t is unclear  possibility  continuum  by  chronic  the  (5)  a  holds that  continuum  continuum.  health  two  the  Roy  explained  stages,  accounts contained  illness,  3).  or  peak w e l l n e s s ,  death.  In  study  (1)  conceptualizes  normal h e a l t h ,  o c c u r s as  the  outlined  They d e s c r i b e d  to h e a l t h  (7)  continuum.  move i n both d i r e c t i o n s a l o n g three  (4)  anywhere a l o n g  adaptation  she  stages:  and  p a r t i c i p a n t s in t h i s  conceptualized  holism,  good h e a l t h ,  poor h e a l t h ,  d i r e c t i o n along  perspective,  and  Absence  abnormality  of  states i t is  pathological  (variously  or n o n - h e a l t h )  constitutes  158 the  other,  (p.  Participants rather  defined  phased  continuum.  varying relation  to  sickness.  These  health/i1lness Seedhouse,  position  the  that  envisioning  possible  to  "speak  at  healthier  than another"  health  located  particular time.  t i m e t h a n at  along  the  or  various  participants' normal  health  accounts  i n terms of  continuum  with  1981,  continuum  or t r a i t s  are on  and  the  this  1974).  (1984c)  continuum  concept, of an  of  one  44).  in  i t becomes  individual  being  individual  being  The  structured  gradations by  of  the  under e v a l u a t i o n  at  a  given  the h e a l t h - i l l n e s s  continuum are  1976;  102).  models o f h e a l t h the  of  1984c; Twaddle,  (p.  p.  found  Roy,  Tripp-Reimer's  or  are  1981;  and  opposite,  of a range  range along  another,  its  perspectives  (Kass,  less health,  of h e a l t h  activities,  as  i n terms  ways o f c o n c e i v i n g  gradations,  were c o n c e p t u a l i z e d  a comparative  (Smith,  p a r t i c u l a r gradations  doing  as  human c o n d i t i o n s  These  continua, The  one  in  Tripp-Reimer,  more or  healthier  health)  h e a l t h - i l l n e s s continuum,  consistent  health  partial  the  of h e a l t h / i 1 l n e s s "  of  and  described  sickness  i n d i v i d u a l "may  combinations  participants  They  three  and  the  1981;  entity.  i n terms of a  s i m i l a r to current  along  views a r e  isolated  health  describing health  Smith,  an  continuum,  described  views a r e  states  1986;  on  as  experience  (complete  Health  Participants'  By  this  of h e a l t h  generally  health  health  Within  literature  various  see  polar concepts  participants  the  total  sickness.  continuous,  in  d i d not  the  degrees  102)  described  i n terms  underlying  (Smith,  1981). in  of c a p a c i t y  for  health c h a r a c t e r i s t i c s  159 (energy,  resistance,  constitute, complete  o r form,  health,  Lerner's on  i n d e p e n d e n c e and c o n t r o l ) . the three  partial  different  continuum. concepts  of normality  values.  Lerner  ...  Lerner  or weights,  point  human b e i n g s  the subjective valuing  points along  that  continuum; that  different  'meanings' t o p e o p l e ,  values  or weights.  varies  according  therefore  accounts other  Further,  to cultural  socially  two.  that  here t o provide  meaning,  (Lerner,  different  value,  of t h e i r  study  o r weight  s y s t e m s and  1973, p. 9)  <19Q8) was  discussed  q u a n t i t a t i v e study a r e  additional insight  of p a r t i c i p a n t s i n t h i s  a p p e a r s t o have  f a c t o r s and v a l u e  defined.  Aspects  stages  weights to  i s , l i f e at  and t h e r e f o r e  work o f Majumdar and C a r p i o in chapter  presented  that  of the health  subjectively attribute different  ages o r a t i t s v a r i o u s  earlier  points within the  i n terms o f s o c i o - c u l t u r a l  different  The  proposes that i n d i v i d u a l s  i n view o f t h e f a c t  are constructed  light  as f o l l o w s :  various  is  experience:  sheds a d d i t i o n a l  qn v a r i o u s  is significant  describes  gradations  and s i c k n e s s .  study.  values,  This  experience  health  of the health  (1973) d e s c r i p t i o n o f h e a l t h  the f i n d i n g s of t h i s  place  phases  These  i n t o how t h e h e a l t h  resemble  those  d e s c r i b e d by  Indo-Canadians.  I n d o - C a n a d i a n and O t h e r E t h n i c C a n a d i a n Majumdar and C a r p i o perspectives health  on h e a l t h  perspectives  (1988) found  were both  that  similar  of (Euro-)Canadian,  Perspectives Indo-Canadian  t o and d i f f e r e n t and P h i l i p i n o  women's from t h e  and L a t i n  160 women l i v i n g provided is  i n Canada. ft b r i e f  since  although  the p a r t i c i p a n t s i n t h i s  much b r o a d e r ,  Majumdar and C a r p i o health  primarily  dimensions  found  health  of health.  t h e most  maintenance.  Lifestyle  importance  less  Conceptualizations  of health  physical),  with  emphasized  t h e most  support  findings  defined  as l e s s  important  as a d i m e n s i o n however, was  and mental  causation  health  included  (lifestyle,  a l l the four  social,  women's d e s c r i p t i o n s  (23.8%)  not a t a l l .  mental and  (50%) and p h y s i c a l a s p e c t s  i n these  health  i n d e s c r i p t i o n s of health  area,  definition  study  reveal  f a c t o r s as components  however,  role  experience.  Physical  Lifestyle,  o f Majumdar and C a r p i o s '  of t h i s  experience.  their  expressed  (14.3%) and p h y s i c a l h e a l t h  in this  lifestyle  (55%).  study  (33.3%)  being  (Majumdar &  1988).  In  social  of health.  of disease  categories  Carpio,  images  I n d o - C a n a d i a n women  was n o t i n c l u d e d  (61.9%)  Social health  were e m p h a s i z e d  that  (16.7%) were viewed  o f t h e s e women's p e r c e p t i o n s  study  views on t h e h e a l t h  i n t e r m s o f mental h e a l t h  (27.8%) and s o c i a l  given  of the health  by t h e I n d o - C a n a d i a n women i n Majumdar and C a r p i o s '  of interest,  similar,  account  In c o n t r a s t  The  as w e l l  plays  of the Indo-Canadian  study  included  and a l s o  health (1988) f i n d i n g s ,  lifestyle  emphasized  h e a l t h , and  factors in  the important  i n both t h e m a i n t e n a n c e and r e g a i n i n g o f  as c a u s a t i o n  r e s u l t s of t h i s  mental  t o Majumdar and C a r p i o s '  of health,  which t h e mind  health,  physical health,  participants in this  perceptions  (1988) r e s e a r c h , t h e  of sickness.  study  concur with  Majumdar and C a r p i o s '  161 (1988) f i n d i n g t h a t  social  family  of Indo-Canadian c o n c e p t u a l i z a t i o n s  orientation)  health  m a i n t e n a n c e and e x p l a n a t i o n s in  this  family other  study life  described  they  home e n v i r o n m e n t contributes  the importance  considered  to p a r t i a l  childbearing that  Indo-Canadian  with  with  perceptions  energetic this  study,  The  energy,  and a s s i s t s  The d a t a  & Davies,  provide  (1981),  c h i l d r e n as these  as unhappy and from  this  study  concur  1985).  Participants in  four c h a r a c t e r i s t i c s of the health i n d e p e n d e n c e and c o n t r o l .  of these  four conceptions,  four  described  models  o r models,  illustrates  aspects  by t h e p a r t i c i p a n t s i n t h i s  in appreciating  the uniqueness of  images.  Four Conceptions Smith  which  Canadian f a m i l i e s ,  In c o n t r a s t ,  examines  the reader  participants' health  l i f e and  as s o m e t h i n g  healthy  a sick child  resistance,  experience  family  On t h e  a s a s t a t e where t h e i n d i v i d u a l i s  described  Presentation  of the h e a l t h study,  described  section  harmonious  i n v e s t i g a t i o n of  described  nourished.  (Yoshida  however,  following  of h e a l t h .  as w e l l  in their  parents  of health  Participants  and s i c k n e s s .  loss of appetite.  and happy  experience:  the  parents  of health  of health.  stressful  and c h i l d r e a r i n g among immigrant  happy and w e l l  irritable,  f o r maintenance  (1985),  Indo-Canadian  energetic,  o f a happy,  to health,  health  ( d e s c r i b e d as  causation.  an unhappy,  detrimental  Y o s h i d a and D a v i e s  found  of disease  and home a t m o s p h e r e  hand,  i s a component  Laffrey  conceptualizations  of Health  (1986) and Woods and c o w o r k e r s of health  based  upon  four  (1988)  fundamental  162 models o f h e a l t h : Role-performance  (1) and  Eudaimonistic, (4)  Clinical.  (2) A d a p t i v e , Each  of t h e s e  represents  one  way  of c o n c e p t u a l i z i n g the  continuum,  and  has  a distinct  "health  (3) four  models  health-illness  e x t r e m e " and  "illness  extreme". According are  conceived  Arranged  to Smith to  of the  characteristics The  and  overlay  o f each  Health  fullest  inner p o t e n t i a l .  The  using  and  adaptive  functioning. inability  of t h e  t o cope w i t h  in adaptation.  (1979),  the  of  expected  and the  the  The  roles  health  ideas  of t h e  and  basic  of g e n e r a l  view o f t h e  and  illness  the  (Smith,  the  effective illness  extreme  well-being,  of the  1981,  ability  from  emphasizes of the  maximum e x p e c t e d  the  (1959).  social continuum  work o f  is  and  is  subsequent  performance  output",  The  to f u n c t i o n  and  continuum  is  p.45).  of the  environment,  his/her  extreme  p h y s i c a l and  extreme  human  health-illness  work o f Dubos  i s seen as  model  work o f Maslow  extreme  Drawn p r i m a r i l y  health with  on  changing  role-performance  various  a person's r e a l i z i n g  health  continuum  Conversely,  roles.  as  i s based  the  a holistic  well-being",  mechanisms,  of  continuum.  overview  from  notions  presents  The  model  failure  social  An  languishing d e b i l i t y "  adaptive  extreme  derived  is conceptualized  i s "exuberant  dimensions  i s warranted.  model,  being.  "enervation  phenomenon.  model  and  various  encompass a l l t h e  i s a s s o c i a t e d with  self-realization,  continuum  these  basic health-illness  they  health  eudaimonistic  1970),  health  the  hierarchically,  conceptions  (1968,  (1981),  Parsons of  "performance nothing  163 impeding end  effective  of the  p.  as  clinical  model  mental  continuum  as  being  focuses  normality  as  "conspicuous  p.  46).  Smith  alternate,  on  of  by  Pt  the  extreme  other  is  one's r o l e "  (Smith,  not  model  mutually  i n the  in t h i s  of h e a l t h  eudaimonistic  the  advanced  and  the  Building  most  models  (Smith,  each  as  The  p.  the  47).  models,  of  health  Normal  role-performance.  however, adaptive  also  embraced  and  work o f Smith which  (1981), more c l o s e l y  study.  d e s c r i p t i o n s of h e a l t h of the  that  embracing  of h e a l t h  d e s c r i p t i o n s of h e a l t h  (1986) r e p o r t e d from  clinical,  current  images  model.  1981,  provide  1981,  explanations  the  extreme  (Smith,  models  health  the  or  illness  inclusive,  of h e a l t h  on  physical  broader contexts".  role-performance  by  The  four  the  extreme of  symptoms"  exclusive,  presented  f i n d i n g s of the  dimensions  these  d e s c r i p t i o n s of h e a l t h ,  models.  approximate the  or  (1981) h i e r a r c h y  study  (1986) p r o v i d e s  Laffrey  signs  three  approximate concepts rich  health  science".  b r o a d e r and  other  views o f  symptoms o f d i s e a s e  of t h e s e  is holistic  p r i m a r i l y on  Participants'  or  in i t s perspective,  The  (1981) p r o p o s e s t h a t  found  activities  health  of  biomedical  medical  i n d i v i d u a l "within  participants  Laffrey  familiar  signs  In t e r m s o f S m i t h ' s  ideas  illness  most narrow  or a b n o r m a l i t y .  presence  although  eudaimonistic  focusing  the  i n performance  the  identified  is  concepts  "failure  i s "absence  disability  view t h e  individual roles.  46).  Criticized  and  of  h e a l t h - i l l n e s s continuum,  conceptualized 1981,  performance  four health  incorporating  models,  or  164 conceptions. Laffrey health  Utilizing  (1986) d e v e l o p e d conception,  adaptive  that  description  study.  "not  having  health.  capacity, although  require  items  pills  clinical  medicines"  noted  in Laffrey's  for illness"  (p. 111). cited  also  of t h i s  "able  daily  to carry  responsibilities", out d a i l y  responsibilities") Participants Laffrey  calls  (p.  wrong"  i n t h e body  with  by t h e d a t a i n  sick"  as a s p e c t s o f  some o f t h e  ( f o r example,  "do not  Some o f t h e f u n c t i o n a l  in Laffrey's study:  role  r e s e a r c h were  ( f o r example,  " a b l e t o do what  I have t o do",  and " f u l f i l l  role  35). study  the c l i n i c a l  means " n o t h i n g  also  a s s o c i a t e d with the  responsibilities",  in this  health  accounts  study d e s c r i b e d  with  research  and "not s i c k "  by t h e f i n d i n g s  focused  (associated  in this  and "not b e i n g  performance h e a l t h c o n c e p t i o n s  "fulfill  items  are consistent  health conception)  supported  their  They  i n the  dimensions.  participants  These d e s c r i p t i o n s  structural  study.  of health) are supported  F o r example, t o take  T h i s was t h e c a s e  in this  (1986) s t r u c t u r a l  four conceptions  (3)  o f h e a l t h can "stand  of h e a l t h .  of other health  Many o f L a f f r e y ' s  this  o f h e a l t h : (1) c l i n i c a l  one d i m e n s i o n  of p a r t i c i p a n t s  on h e a l t h as f u n c t i o n a l  these  1981),  and (4) e u d a i m o n i s t i c h e a l t h  descriptions  descriptions  included  (Smith,  (2) f u n c t i o n a l / r o 1 e p e r f o r m a n c e c o n c e p t i o n ,  She f o u n d  i n peoples'  health  four conceptions  health conception,  conception. out"  t h e f o u r models o f h e a l t h  d e s c r i b e d h e a l t h i n terms  o f what  h e a l t h p e r c e p t i o n when e x p l a i n i n g  that  i s wrong", and s i c k n e s s means " s o m e t h i n g i s  o r mind.  Study  participants  also  explained  165 health  i n terms  similar  performance c o n c e p t i o n normal  activities.  descriptions the to  health  to Laffrey's  when e m p h a s i z i n g  experience, reflect  or coping,  adaptive  health conception.  contentment,  harmony and e n t h u s i a s m  Smith  participants'  i n terms o f f e e l i n g s  of  for life,  view o f h e a l t h d e s c r i b e d  views on h e a l t h Participants'  happiness,  resemble the  by both  Laffrey  (1986) and  (1981). Woods and c o w o r k e r s  proposed Laffrey Black,  by S m i t h (1986),  (1988) combined  (1981) w i t h  to describe  North American  N o r t h West. of  as a f u r t h e r c h a r a c t e r i s t i c o f  that  of health  t o do  (1986)  suggests  descriptions  eudaimonistic  h e a l t h as a b i l i t y  A c o n s i d e r a t i o n of L a f f r e y ' s  of control,  some e x t e n t  (1986) f u n c t i o n / r o l e  the conceptions  t h e meaning  Indian  a  of the health  list  participants health  similar  by p a r t i c i p a n t s i n t h i s  in this  images d e s c r i b e d study  included  o f f e r e d by  ftsian,  white,  women i n t h e P a c i f i c  images d i s c u s s e d  Woods and c o w o r k e r s a p p e a r q u i t e presented  of h e a l t h  of health to  and H i s p a n i c  Many o f t h e h e a l t h  health  t h e f o u r models o f h e a l t h  i n the research  t o the d e s c r i p t i o n s of  study  (see A p p e n d i x  Ffor  by Woods and c o w o r k e r s  which  in their  accounts  of the  experience).  When  speaking  activities,  and b e i n g  incorporated described  happy,  the "negating",  "doing"  of disease,  "doing"  and " b e i n g "  (1988) s t u d y .  and " b e i n g " ) r e p r e s e n t  of the c l i n i c a l ,  the doing  participants in this  i n Woods and c o w o r k e r s '  ("negating", dimensions  of the absence  role  o f normal  study dimensions These  terms  t h e dominant  p e r f o r m a n c e and  eudiamonistic  166 health  images r e s p e c t i v e l y .  images d e s c r i b e d presented that  in the research  differences.  coworkers' Ps it  (1988)  and  of health This  mind.  This  the  their  described  this  f i n d i n g of the study.  (such  offered  experience state  perceptions  traditional  where t h e d i f f e r e n t  o f harmony and b a l a n c e  Current nature  holistic  health  sickness  ( Flynn,  Study  and s i c k n e s s .  sleep)  discusses  health  o f body and  i s an  o f t h e human b e i n g  (Obeyeskere,  participants clearly  in health  as a u n i t y  expresses  1981; S a r k i s identified  t h e meaning  are in a  1977, 1978; Vora,  and t h e e x p e r i e n c e s  mind and body, and d e s c r i b e d unit  aspects  1980; K r e i g e r ,  and  Together  views t h a t  literature  of the i n d i v i d u a l ,  exercise  by t h e s t u d y p a r t i c i p a n t s .  of health,  Indian  t h e body and mind i n  section briefly  H o l i s m : Body and Mind  reflect  unitary relationship  as d i e t ,  The e n s u i n g  view o f h e a l t h  Participants'  i n v o l v i n g both t h e body  and a l s o d e s c r i b e d  factors  of health,  group o f Indo-Canadians  the fundamental,  influence health.  mind,  suggests  both c u l t u r a l and  perceptions  experience  i s an i m p o r t a n t  to external  holistic  (1988),  research.  between t h e body and mind,  which  and t h o s e  f i n d i n g was a l s o an outcome o f Woods and  as an i n t e g r a t e d  Participants  relation  may t r a n s c e n d  i n c r e a s i n g l y c l e a r that  view h e a l t h  study  o f Woods and c o w o r k e r s  participants narrated  became  between t h e h e a l t h  by t h e p a r t i c i p a n t s i n t h i s  some d i m e n s i o n s  social  The s i m i l a r i t y  1986).  s i m i l a r views o f t h e o f h e a l t h and & Skoner,  1987).  the i n s e p a r a b i l i t y of  of t h i s  Harmony and b a l a n c e  total  (body-mind)  o f t h e whole  167  person,  within  him/herself  theme a r i s i n g from emphasized  health  participants' as a p o s i t i v e  two d i m e n s i o n s and framed activities. facet  which  In viewed  t h e next  dimension 2 & 3). health,  by t h e o v e r a l l  the t o t a l section,  This  described  and f u r t h e r  participants'  These  discussion  exercise to  some d e g r e e .  they In  could  disease  under D i v i n e Although  control  was  only  Study  normal  one  minor  participants  and p e r s o n a l  factors  which  are presented  constitute  in participant  in light  the second  accounts  on t h e r o l e  the h o l i s t i c  participants  (see f i g u r e s  o f t h e mind i n  nature  of the study  explained  Health that  factors  such as d i e t ,  were under t h e i r p e r s o n a l  about",  factors  or t h i n g s  control  were seen as t h i n g s "they c o u l d  control".  and s i c k n e s s were sometimes d e s c r i b e d  as  control.  limited  in health,  of doing  in  multifaceted  experience  influencing  "do s o m e t h i n g  contrast,  being  attitude  These  structured  health.  participants  and mental  Participants  experience.  Factors Influencing Some s t u d y  with  social  factors  focuses  reveals  views on  context  some o f t h e f a c t o r s  the health  literature.  of health  health  or s t a t e ,  of health.  of health,  was a major  of health.  of disease  descriptions  vision  as i n f l u e n c i n g  relevant  quality,  of the environmental,  influence  the environment,  accounts  as t h e a b s e n c e  a holistic  description  of  Health  of p a r t i c i p a n t s '  presented  and w i t h  d a t a were g a t h e r e d  the r e s u l t s  of t h i s  on p a r t i c i p a n t s '  study  views o f  are s i m i l a r to  168 Majumdar and C a r p i o ' s expressed area  greatest  of health  health  over  were viewed  four,  factor  in this  vast  attitude,  healthy"), health,  majority  Physical  t h e i n d i v i d u a l had  described  little  t h e mind as t h e most  Ps d i s c u s s e d  in chapter  both a p o s i t i v e and  by a b s e n c e  over t h e emotions,  negative  viewed a mental  as r e c o v e r y  attitude characterized  following  interaction  section  The  discusses  findings  mind  health  and  calmness  one i s  and improvement o f On t h e o t h e r  hand,  they  s t r e s s and  a detrimental  various  e f f e c t on  aspects  of the  L i t e r a t u r e on t h e  s t r e s s and immune r e s p o n s e i s since  this  i n some p a r t i c i p a n t s ' a c c o u n t s  t h e Immune System  mental  to sickness.  between t h e mind,  t o the study  importance  "thinking  by worry,  between t h e body and mind.  relationship relevant  illness.  one was s i c k " , a s e x e r t i n g  a positive  o f worry and s t r e s s ,  and a c t u a l l y  from  and a c t u a l l y l e a d i n g  The  Health  as b e n e f i c i a l t o t h e m a i n t e n a n c e  as w e l l  "thinking  Mind and  of p a r t i c i p a n t s described  (characterized  control  either  health.  i n the  on h e a l t h .  The  Mind,  health  1988).  influencing health.  The  health  over t h e i r  as something  study  I n d o - C a n a d i a n women  and s o c i a l  t h e mind was viewed a s h a v i n g  effect  and  mental  (Majumdar & C a r p i o ,  Participants important  f e e l i n g s of control  maintenance,  deficits  control  (1988) f i n d i n g s t h a t  theme was  given  of health.  Resistance  i s seen as b o t h a " h e a l e r "  and a " s l a y e r " ,  or sickness  Ps d i s c u s s e d  (Wolf,  1986).  creating  above,  study  169 participants accounts  described  this  twofold  influences  t h e body's r e s i s t a n c e  stress to increased  Participants effect Their  explained  on immune  body and immune  function,  on t h e f i e l d  psychiatry  stress,  that  They  t h e mind  specifically  to sickness.  o r worry, has a damaging to disease. exerts  appear s i m i l a r to current & Sobel,  on t h e  v i e w s on  1987; S e l y e ,  & Reich,  thus  1979a,b;  states  well  as such  (Najman,  health  stress  exerts  with  of c o n t r o l  decreased over  one's  experience  (Rogers,  (Risenberg,  Some  Dubey &  1986).  ( e s p e c i a l l y s t r e s s ) , as  been  sleeplessness,  race,  linked to a l t e r a t i o n s  and bereavement, immune competence. life,  1986; R o g e r s ,  the i n d i v i d u a l i s able to  system t o some d e g r e e  and c i r c a d i a n r h y t h m s , have  of  an i m m u n o s u p p r e s s i v e e f f e c t  v a r i a b l e s as age, sex, p r o l o n g e d  been a s s o c i a t e d  (a s y n t h e s i s  S h a v e r , 1985).  1979a,b), and t h a t  Depression  literature  1980; R i s e n b e r g ,  1979a,b;  and p s y c h o l o g i c a l  immune f u n c t i o n .  feelings  i n recent  v u l n e r a b i l i t y to disease  t h e immune  Mood  and s u s c e p t i b i l i t y t o  o f psychoneuroimmuno1ogy  propose that  1979; S e l y e ,  pregnancy,  documented  1979; S e l y e ,  increases  influence  in resistance  and immunology)  researchers  in  to sickness.  susceptibility  (Ornstein  has been w e l l  focusing  Reich,  in their  1985).  illness  and  perception  and r e s i s t a n c e  The r o l e o f t h e mind  Dubey,  their  o f t h e e f f e c t w h i c h mental s t a t e  and s i c k n e s s  Shaver,  that  function  descriptions  health  o f t h e mind  of health.  Many p a r t i c i p a n t s d e s c r i b e d  related  capacity  and happy  f o r example, Conversely,  a f f e c t , are  have  170 perceived of  the  been  to  p o s i t i v e l y influence  individual's  emphasized  sense  i n the  A number o f  study  participants  to  effects  psychological  is  of  interest  advanced  that  i n the  (Risenburg, Positive  Mental  Selye  stress  of  (1979b) c o n t e n d s  "perceived,  individual  (p.  his/her  of  of  remove  stress,  in  recovery  as  " t r a i n i n g the health  feelings  the  stress  of  to  or  with the  physical  stress.  s i m i l a r to  those  other  It  authors  from  control  Shaver  immune f u n c t i o n .  reacts, of  to  (1979b) comments  thus  brain",  study  on  "a  The  an  way  that  situations  described  mental  maintain  They r e f e r r e d  Their  is  stress.  in t h i s  worrying"  "thinking  Risenburg  environment  external  promote and  "not  the  (1985) and  and  any  stressor  by  stress or  with  way  external  illness.  you".  the  the  participants  concerns,  by  to  experience  and  associated  appraised"  c u l t i v a t i n g a non-reacting  or  small  that  According  i n d i v i d u a l responds,  importance  are  attitude  describing  (1979a,b) and  interpreted,  response  modulator  A number  mental  than  has  a l . , 1979).  health,  rather  Selye  et  i s l a r g e l y determined  60).  cognitive  influences  stressful situations  linked of  importance  Attitude  agents are  the  promotion  The  Shaver,1985).  situation  important  over  t h e i r perspectives  particular  (1986),  and  writings  1986;  control  function.  l i t e r a t u r e (Rogers  resistance of  disease  of  immune  to  this  about  perceptions  mind-ovei—body  are  attitude health  in  combat assist  variously  situations  "not line  approach" to  to  and  process  life  p o s i t i v e l y " and  the  and  letting with  dealing  Selye's with  171 stress.  He  states  Stress that by  i s a matter of p e r c e p t i o n  t h e body can  t h e human body  being In t h i s  o f a p o s i t i v e mental  and  promotion  described  and  family  and  evident  capable of  (1979b,  p.  76)  support with  attitude.  stress.  (Cobb,  p a r t i c i p a n t s emphasized  atmosphere  changeable,  conditioning.  or b u f f e r ,  the e f f e c t s of s t r e s s  study,  increasingly  level  A brief  discussion  of s t r e s s  of  (or  i s p r e s e n t e d next.  of l i f e  as a moderator,  being the case,  at a p r o p e r  support in prevention  of h e a l t h  F a m i l y : a moderator  from  is pliable,  of f a m i l y  that  I t i s becoming  study, p a r t i c i p a n t s r e l a t e d  importance  and,  i n s t r u c t e d to react  a l t e r e d t h r o u g h mental  development  worry)  be  e d u c a t i n g t h e mind.  that  the  :  Social  which  1976;  the  protects  Hammer,  importance  the support of extended  s u p p o r t has  family  been  the i n d i v i d u a l  1983).  In  o f a happy i n the  this  family  health  e x p e r i ence. The  views  supported support  by  e x p r e s s e d by t h e p a r t i c i p a n t s i n t h i s  literature  networks  i n promoting  Canadian  society  has  emphasized  been  Indo-Canadian 1981). found  that  family support  (Lynam, as an  culture  In t h e i r  describing  systems  and  As n o t e d  and  1981;  noted  earlier,  Khosla,  other ethnic  with  1981;  the  Canadian  social groups i n  family  network  i n Hindu Naidoo,  s t u d y , Y o s h i d a and  described  (associated  of  o f immigrant  i m p o r t a n t s u p p o r t system  previously  support h i g h l y  importance  the h e a l t h  1985).  (Ahmad,  Indo-Canadian  the  study are  1980,  Davies  (1985)  f a m i l i e s valued  l o s s of t r a d i t i o n a l  i m m i g r a t i o n ) as a s o u r c e o f  family  172 stress.  Imbalances  spiritual  life  disorders  i n Hindu c u l t u r e  Singh,  have  in personal,  been d e s c r i b e d  accounts  provided  relationships  i n the health  extended  the l o s s of support  worry,  or s t r e s s ,  his/her  sick.  family,  and  t o mental  and Canada  (Ananth,  experience.  from  because  the c a r r y i n g  extended  1984;  their  health,  out o f d a i l y  P  and h e a l t h  few p a r t i c i p a n t s  growing  up i n C a n a d i a n  those  s u c h a need family  Participants family  growing  members.  described  means  by s t u d y  Indo-Canadians),  society  Indo-Canadians  might  their  that  and t h e r e f o r e  means  Indo-Canadians  might  not f i n d  exclusively to close  of family  (who were f i r s t so i m p o r t a n t  family  sickness  be s o c i a l i z e d d i f f e r e n t l y  the importance  i f traditional  negatively  activity.  felt  concerns  not p r o v e  (2) l a c k s  s i c k " more o f a p r o b l e m .  view t h a t  study  participants  might  explained  i f he/she were t o become  "being  independent  up i n I n d i a ) ,  Hence,  of these  leads to  and  s i t u a t i o n s as  to t h e i r  in this  for confiding  often  members,  tasks  these  and making  situations contributed  dependency,  described  (1) t h e i n d i v i d u a l i s u n a b l e t o e x p r e s s  Participants described  affecting  participants  and t h e i m p o r t a n c e  c o n c e r n s and f e e l i n g s t o f a m i l y  with  (than  India  by many s t u d y  with  These  life,  as c o n t r i b u t i n g  i n both  relationships  help  and s o c i a l  1985).  The  that  family  support  generation  t o second  structures  in health  generation  a r e not  maintained. Other Factors As  noted,  Affecting  one o f t h e main f i n d i n g s  Health of t h i s  study  i s that the  173 way  the p a r t i c i p a n t s  other The  people  speak about  following It  context  discussion  has been play  mentioned  i n t h i s study were  living  i n t h i s study.  of f a c t o r s  t o t h e mind,  influencing  of these  Nutrition,  stress  factors  t h i s study  study  t o Western  may v e r y  of this,  the health  upper-middle  likely  who a r e  hold  views  by t h e  the current  o f study  described perceived  briefly  examines  participants  of " l i f e s t y l e  to influence  the health  literature discussing  have  been  i n Indo-Canadian d e s c r i p t i o n s  these  1988).  findings  factors",  to diet  a  or f a c t o r s  of routine,  as w e l l  home and home a t m o s p h e r e as a d d i t i o n a l  expand  which  of  sleep,  on t h i s  influence  participants  cleanliness,  described  The r e s u l t s  and a l s o  and e x e r c i s e ,  mental a t t i t u d e ,  and m a i n t e n a n c e  factors, in  factors.  (Majumdar & C a r p i o ,  In a d d i t i o n  several  management and e x e r c i s e  concur with  described  medicines the  section  t h e most common themes  health.  e d u c a t e d , and  those described  In l i g h t  which they  few  description  from  i n t h i s study  This  of  jobs,  influencing  experience.  lifestyle  well  meaningful.  Participants  as  according  i n menial  which a r e d i f f e r e n t  becomes more  were g e n e r a l l y  I n d o - C a n a d i a n s who do not speak E n g l i s h ,  and w o r k i n g  discussion  finding.  of health.  majority  participants  to t h i s  professionals.  i n the construction  standards.  addition  relates  health  a significant role  vast  health  - including  i n many ways t o how  educational  the  on  health  is similar  s o c i o - e c o n o m i c and  participants  uneducated  health  that  The  class  explain  in this  use o f  as work o u t s i d e  factors  of  influencing  174 health.  Ps d i s c u s s e d  described  mental  w o r r y ; hence, health  may  attitude  "stress  P discussion  medicines cultural  groups w i l l  They This  established  daily  participant  outside  without  a  rest  do".  or  attitude in Carpio  study  participants  t h e scope  of t h i s  of t h i s  chapter  and t h e use o f other  examined.  was  disruption  factors,  and c o g n i t i o n .  this  practice  one f a c t o r  they  (see f i g u r e s  described  daily  schedule of  as  of d a i l y  influencing  2 & 3).  schedules  t o keep h e a l t h y  a person  he c a u g h t  and o m i t t e d  work - t h e s e  in this  i tis  as " m a i n t e n a n c e  that  a jacket  i s linked to  that  fixed  explained  that  of usual  Participants  perspective  t o keep a s u i t a b l e ,  explained  after  that  o r mental  similar  described  experience  Participants  short  of s t r e s s ,  o f I n d o - C a n a d i a n s and  the f a c t  affect  the r a t h e r  f o r a person  routine(5)".  One  sections  experience  by e n v i r o n m e n t a l  expressed  health  which  and e x e r c i s e ,  (1985) d e s c r i b e d  activities.  the  on m e n t a l  i s beyond  be b r i e f l y  i n behaviour,  important  to control  of Routine  body r h y t h m s  study  health  diet  i n the health  Shaver  changes  of a l l the f a c t o r s  of routine,  Maintenance  views  accounts  management".  In t h e c o n c l u d i n g  maintenance  some h e a l t h  s i m i l a r t o what Majumdar and  as i n f l u e n c i n g  discussion.  four,  as i t r e l a t e s  the p a r t i c i p a n t s '  be somewhat  (1988) c a l l  described  in chapter  should  and a v o i d  a cold  h i s usual  were t h i n g s  s t i c k to illness.  b e c a u s e he had r u n practice  he " d i d n ' t  of  taking  usually  175 Diet  and  Exercise  Food  and p r o p e r n u t r i t i o n were o t h e r a s p e c t s  participants' striking  health  similarity  professionals 1).  participants'  within  Kleinman's  n o t be c o n c l u d e d , descriptions  - they  participants  however,  of d i e t  i n the accounts  Some s t u d y  of t r e a t i n g d i s e a s e just  a source The  1978; and  within  (Dunn,  views on d i e t  (Shaver,  saw d i e t  and p r o m o t i n g  traditional Indian  1978).  and p r e v e n t  which  Chinese  very  much as a way  health,  Diet  disease  Chinese c u l t u r e  culture  rather  than  (Fishman,  Evans & J e n k s ,  Transcultural  and e x e r c i s e  has been  (Anderson  (Obeyesekere,  nursing  1977),  Vietnamese  literature  and h e a l t h  status  & Anderson,  1988) and M a l a y s i a n  have been d e s c r i b e d  influencing the health/wellness  has a l s o  (Leininger, as  lifestyle  of i n d i v i d u a l s  1985).  Leininger and  four,  A y u r v e d i c and  on t h e r e l a t i o n s h i p between d i e t  1970b; 1988). factors  Western  in chapter  and c l a s s i c a l  participants  to treat  Cambodian c u l t u r e  focused  a l l o f the study  of n u t r i t i o n .  Koo, 1984),  cultures  of India,  and i l l n e s s  use o f f o o d  described  (see f i g u r e  established  presented  sometimes e x p r e s s e d  perspectives  perspectives.  that  bear  care  framework  mirrored  more c l o s e l y a p p r o x i m a t e t h e t r a d i t i o n a l naturopathic  extent,  d i d not.  Pis i l l u s t r a t e d study  to a large  t o t h e views o f W e s t e r n h e a l t h  described  It should  perspectives  a c c o u n t s which,  of the  culture.  (1988) e x p l a i n s She p r o p o s e s t h a t  the close promotion  r e l a t i o n s h i p between of healing,  food  treatment of  176 disease,  maintenance  culturally  of h e a l t h  determined  food  universal  p r a c t i c e across  foods are  used d u r i n g  health  (Koo,  energy  i m b a l a n c e and  greater are  cultures  of  1970b).  in f a s t e r  concomitant  resistance,  lowered  and  health  Convalescing  promote r e c o v e r y ;  others  as  to  i s r e l a t e d to leading  Chinese  to h e a l t h  to  patients  c e r t a i n foods  detrimental  is a  Special  recovery  ill  to d i s e a s e .  through  d i e t a r y regimens,  (Leininger,  to a s s i s t  illness  In C h i n e s e c u l t u r e ,  c e r t a i n foods to  beneficial  prevention  p r a c t i c e s and  illness  susceptibility  given  seen as  1984).  and  are  (Koo,  1984). The  data  from t h i s  regarded  food  as  prevention dietary  and  very  increased  e n e r g y and  recovery.  "Faster  when f o o d s a r e  avoidance  explanations dietary exert  during "faster  mentioned and  the  salt  Although  of  energy"  maintenance  sickness  and  to  the  as  the  energy  r a p i d l y absorbed  were themes e m p h a s i z e d  of d i e t  a factor influencing health.  health,  as  prevent  need  Fasting,  behaviours sickness  and  study  importance  of a v o i d i n g  excess q u a n t i t i e s of  beliefs  the  in p a r t i c i p a n t s '  R number o f  keep  and  and  sickness.  to  for  resulting  into  of a n u t r i t i o u s d i e t  were a l s o d e s c r i b e d  disease  of h e a l i n g  overeating as  and  provide  f o r promotion  explained  Consumption  a p o s i t i v e i n f l u e n c e on from  in health  times  digested  supplementation  recovery  fat  easily  that p a r t i c i p a n t s  P a r t i c i p a n t s explained  e n e r g y " was  system.  of  illustrate  important  treatment.  modifications  circulatory  study  and  which aid  in  participants also sugar,  healthy. i n the  intrinsic  hot  and  cold properties  of  177 foods,  treatments  (Parker  et  support  of h e a l t h  & Davies, this  experience. physical  Study  common  have been documented from  the  p a r t i c i p a n t s in t h i s in t h e i r  temperature  medicine  Vietnamese c u l t u r e  of  foods,  i n the  accounts  r a t h e r than  in  India  previous  (Obeyesekere,  1977)  or  (Ahern,  Fishman,  study  of the  community  did  not  health  to the  "hot"  sense t r a d i t i o n a l l y  1974;  in  Indo-Canadian  p a r t i c i p a n t s r e f e r r e d only  Ayurvedic  and  actual "cold"  described  Indo-Chinese  as  in  and  Evans & J e n k s ,  1988;  1984). Participants'  Western  described  breathing  mentioned  walking,  of Western  Use  Medicines  The  views  jogging  presented  in health  context.  Their health as  extent.  Although  in hatha  yoga  the  majority  and  other  of  resemble a  few  (physical  study  exercises  participants  recreational activities  middle c l a s s s o c i e t y .  medicines  perspectives  engaging  techniques),  typical of  d e s c r i p t i o n s of e x e r c i s e a l s o  views t o a c o n s i d e r a b l e  participants  care  c o n d i t i o n s are  elicited  perspective  qualities  and  and  1985),  intrinsic  Koo,  health  a l . , 1978),  descriptions (Yoshida  and  well  and  by  study  sickness accounts  as  p a r t i c i p a n t s on also reflect  illustrate  perspectives  the  of  socio-cultural  traditional  endorsed  use  by  Indian  Western  health  professionals. One  p a r t i c i p a n t emphasized  check-up with  her  family  importance  the  results  on  the  physician, of the  necessity and  medical  placed  of a r e g u l a r  yearly  considerable  t e s t s conducted  at  that  178 time. "go  The m a j o r i t y  to the doctor"  o f study  to a doctor  or i f they  Participants  d i d not f e e l  i f they  were j u s t  minor h e a l t h c o m p l a i n t s state).  study  of medicines  practices two  remedies  r a t h e r than  practices  i n Indian  Nichter  needed t o or other health  a different  system,  and t r e a t m e n t  c u l t u r e i s mentioned of s e l f  use o f s p e c i a l  (laxatives,  Plexander  such  fortreating  similarly  pregnancy  their  practices in rural  families  i n other  by r u r a l  self  stomach. studies of diets,  populations i n  t h e use o f h e r b and  partum  Participants  d e s c r i b e d a number o f t h e s e  special  to r e l i e v e  and t h e p o s t  children.  and home and  and t o n i c s ) f o r  (1985) r e p o r t e d  by I n d o - C a n a d i a n  care  care  that  Yoshida  Indian  in conclusion.  (1979),  India.  The  discussing self  as c o l d s and upset  and d i e t a r y s u p p l e m e n t s were used and D a v i e s  treatment.  here  vitamins  and Neumann  care  o f s i c k n e s s and  diets  fasting  during  self  use o f t r a d i t i o n a l  p r a c t i c e s i n I n d i a , a l s o found  discomforts  supporting  s t r o n g l y advocated  o f common a i l m e n t s  remedies  view on t h e  medical  the frequent  Shah,  care  presented  (1978) i n h i s s t u d y  noted  treatment  as  a cold  they  never d e s c r i b e d  Some o f t h e l i t e r a t u r e  ready-made m e d i c i n e s  folk  they  t h e use o f W e s t e r n  f o r the prevention of health.  self  that  would  that  i n the p a r t i a l  participants  and t h e h e a l t h c a r e  promotion  Parker,  that  suspected  from  as d e s c r i b e d  participants  male p a r t i c i p a n t s  India,  suffering  they  the s e r v i c e s of nursing p r o f e s s i o n a l s .  Other use  (such  It i s of interest  seeking  stated that  f o r treatment,  were g e t t i n g s i c k . go  participants  common  p e r i o d , as w e l l  in this  care  study  practices in their  179  accounts  of the  health  experience.  Summary In t h i s relation  to  chapter  the  relevant  study's  literature.  main themes: n o r m a l c y  and  influencing health.  derived  from  presented As  three  i n the  dimensional  doing  normal  activities.  as  goal,  normal  chapter  or  four,  Health  Being  outcome,  activities  as  able of  by  was  t o do  themes o f d i s c u s s i o n  are  organizing  framework  f i g u r e s 2 & 3).  the  overall  described normal  healthy.  duties,  three and  p a r t i c i p a n t s explained  being  everyday  on  in  of h e a l t h  of the  (see  phenomenon framed  activities.  the  conceptualization  main components  preceding  normal  d i s c u s s i o n centered  These t h r e e  d e t a i l e d in chapter  a two  The  health,  factors  the  f i n d i n g s have been d i s c u s s e d  as  health  concept  of  a means t o  activities  was  Participants  responsibilities  doing  viewed  described or  rout ines. The rested  uniqueness  in t h e i r  hallmark  emphasis  of h e a l t h ,  characteristics  activity The  participants' health  on  in  "doing  their health  control).  descriptions  normal a c t i v i t i e s "  as  the  d e s c r i p t i o n s of the  four  experience  resistance,  Previous  d e s c r i p t i o n of these  (energy,  studies  have not  reported  four c h a r a c t e r i s t i c s underlying  health.  f i n d i n g s of t h i s  constructed finding  and  of t h e  i n d e p e n d e n c e and similar  of the  i n both  of t h e  study  study  illustrate  ethnocultural i s the  fact  and that  that  social the  health  is  contexts.  A  health  as  major  perspectives  180 participants  are  s i m i l a r i n many r e s p e c t s  Western  middle c l a s s s o c i e t y .  evident  i n p a r t i c i p a n t s ' d e s c r i p t i o n s of d i e t  their The  perspective  that  health  This  to the  similarity  i s not  totally  is and  finding  involving a unity  of t h i s  in t h i s  of  "usual",  "common",  as  "being  the  way  explained  "as  doing  described  s i m i l a r use  illness  & Chung, In  support  dimensions  continuous  Health functional  Smith  free".  holistic  body and  mind  i s another  study  used  term  normal  the  "everyday".  usually  what  one  family  of  previous  Being  i s " , and  healthy  doing  u s u a l l y does".  of the  and  overlaying as  term  "normal"  normal  important  i n the was  sense  regarded  activities  Previous  research  was has  in situations involving  i n t e r a c t i o n (Pinderson,  phases.  with was  health the  Within  equated  1981a;  Anderson  Complete h e a l t h  was  comprised  this  conceptualization,  various  continuum.  of t h r e e  continuum,  health Participants  distinct,  yet  complete h e a l t h  (the h e a l t h  and  and  illness  characteristics. p r i m a r i l y with  health  Laffrey  health  i n t e r m s of  polar concepts,  opposing  of a l l f o u r  on  health-sickness  role capacity,  (1981),  research  a continuum  were seen as  extremes),  aspects  one  or  described  health  sickness  a  and  1982).  participants  viewed  exercise,  research.  Participants  chronic  of  as  by  particularly  "symptom  p a r t i c i p a n t s ' c l e a r d e s c r i p t i o n s of h e a l t h  experience  views h e l d  although  described  as  health  and  p a r t i c i p a n t s ' accounts  conceptions  (1986) and  social  described  Woods and the  included  previously  coworkers  acme of h e a l t h ,  by  (1988). and  unlike  181 previous  conceptions  complete  health  Participants  of optimal  health  was seen as a f u l l y r e a l i z a b l e  described  partial  health  located  between t h e two c o n t i n u u m  earlier  research  phases along Twaddle, rather  Partial  t h a n as p a r t  The reflect  health  health  Participants  emphasized  The the  will  also  of normal  Indian  be  1984c;  as p a r t  of health,  f o r nursing presented.  participants in this society  health  and s o c i e t y ,  i n general,  study  as w e l l as  perspectives.  of personal viewing  d u t i e s and  these  activities  activities. of the t h e s i s w i l l  and s t a t e c o n c l u s i o n s  Implications  from  the importance  to family  c l o s i n g chapter  study,  support  of h e a l t h / i 1 l n e s s  was c o n s i d e r e d  of Indo-Canadian  of t r a d i t i o n a l  the essence  These views  phase  of sickness.  some a s p e c t s  as  health  (Roy, 1976; T r i p p - R e i m e r ,  images e l i c i t e d  the values  responsibilities  extremes.  utopia,  state.  as a d i s t i n c t  f i n d i n g s d e s c r i b i n g a range  the continuum  1974).  as an u n a t t a i n a b l e  t o be drawn  p r a c t i c e , education  provide from and  a summary o f  the data. research  182 CHAPTER 6: SUMMPRY, CONCLUSIONS PND  Summary  IMPLICPTIONS OF THE STUDY  and C o n c l u s i o n s  o f t h e Study  Summary This  study  has i n v e s t i g a t e d t h e meaning  Indo-Canadians. are  focusing  various  cultural  focus  for this  by t h i s  advocating formal the  of h e a l t h .  perception because  cultural  group.  perceptions  on t h e meaning  i s t o be e f f e c t i v e  when h e a l t h  to the h i s t o r i c a l ,  The  life  health  care  on h e a l t h  policies  investigation of  by Canada's  various  increasingly multicultural in of h e a l t h  is critical  and c u l t u r a l l y  programs a r e r e a l i z a b l e  individual  that  i s imperative.  research  only  in this  as t h e  perspectives  continued  on h e a l t h h e l d  nature,  linked  o f h e a l t h was c h o s e n  of mu1ticu1tura1ism,  s o c i e t y becomes  society  Q u a l i t a t i v e research  F o r f e d e r a l government  Canadian  promotion  i s a v a i l a b l e on  f o r a l l C a n a d i a n s t o be s u c c e s s f u l and t r u e t o  populations  care  information  the unique  Ps  health  and r e s e a r c h  p e r s p e c t i v e s h e l d by  i t i s important  b e t t e r understand  policies  cultural  little  literature  lacking.  research  health  distinct  very  perceptions  Indo-Canadian  professionals held  groups,  is particularly The  cross-cultural  i n c r e a s i n g l y on t h e h e a l t h  Indo-Canadian area  Plthough  of health to  relevant.  Health  f o r a l l segments o f C a n a d i a n  i s appreciated social  i f Canadian  as a c o n c e p t  and c u l t u r a l  inextricably  f a c t o r s inthe  context.  background  t o t h e problem  presented  i n chapter  one  183  emphasized future,  the  and  focused  group w i t h i n in  this  reality  the  study  health  validity  arose  background  mosaic.  grounded  p r o f e s s i o n a l s need  was  of the  reviewed  f o r viewing  the  on  illness offered  and  branches  of  illness,  and  the  lack  of  and  perceptions  research  literature  learning,  literature information on  reviewed  defined  described  contexts.  between the  perspective  backgrounds.  perspective  health  health  studies  and  particularly  held  was  Chapter three  major  the  on  different  health  significant as  by  a  from  As  literature  on  and  background  social  current  and discrepancy  care  various the  Indo-Canadian  unavailable,  other  concerns  construct  most h e a l t h  clients  cultural  a number groups  the  methodology  o f the  of  view  discussed.  presented  and  illustrated  literature  health  by  essentially  areas  perspectives  review  different  held  i n v e s t i g a t i n g how  i l l n e s s were  The  i n d i c a t e the  health  socio-cultural  research  that  beliefs  socio-cultural  studies  and  Three  the  Indo-Canadian h e a l t h  illustrating  on  provide  authorities within  traditional  the  experience.  review: t h e o r e t i c a l  by  The  professionals,  on  research.  variously within  These  to  addressed  recognition  become aware o f  two  the  a  phenomenon, and  to  a v a i l a b l e on  study,  as  in  cultural  problem  of h e a l t h  Indo-Canadians.  constituted  f o r the  cultural  on  health.  information and  India's  a significant  Indo-Canadian h e a l t h  current  i n the  i n t o Canada  research  in chapter  were examined health  The  from c o n s i d e r a t i o n  uniqueness  Literature  immigration  I n d o - C a n a d i a n s as  culturally  care  and  on  Canadian  multidimensional, that  of c o n t i n u e d  study.  184 Kleinman's the  explanatory  b a s i c framework  explanatory  model  model  (1978a,b,  supporting  this  proposes that  1980,  research.  the  when t h e r e  perspectives  of these  directed  the  r e s e a r c h e r to  approach  to  i n v e s t i g a t e the  Phenomenology was  an  three  methodology  for this  explain  individual  the  Participants colleagues pilot  and  study  elicit  conducted  in a f i n a l  (6 women and  open-ended,  semi-structured  participants'  56,  who  had  arise  the  framework research  Indo-Canadians.  research to d e s c r i b e  and  of h e a l t h . through  i n f o r m a l network  of  formal  a  informants  to  study  an  to the  be  used  research,  to determine  i n the  to  sampling of eight  D a t a were c o l l e c t e d  i n t e r v i e w s conducted  the  interviews  Theoretical  sample c o m p r i s e d  were  Indo-Canadian  through  15  i n the  a d u l t s between t h e  r e s i d e d i n Canada f o r 6  participants  were  approximately  12  were of a s i m i l a r possessed  was  popular  homes.  Participants and  aim  of h e a l t h .  2 men).  between  phenomenological  appropriate  two  questions  and  p r o b l e m s can  of h e a l t h to  Prior  with  description  methods r e s u l t e d informants  experience  were r e c r u i t e d  of t r i g g e r  in-depth  and  that  folk  Kleinman's  where t h e  acquaintances.  was  suitability  study,  and  the  meaning  effective  Kleinman's  is conflict  domains. utilize  was  professional,  domains e x p l a i n phenomena d i f f e r e n t l y , in c l i n i c a l communication  1984)  in t h e i r years  at  mid-40's, the  time  socio-economic  professional levels  1/2  and  of the  had  t o 21  of e d u c a t i o n .  years.  28  Most  r e s i d e d i n Canada f o r  study.  s t a t u s , and  ages o f  the  Participants majority  Participants  were a l l  185 of comfortable environment majority  means, and f o r t h e most  approximated  of p a r t i c i p a n t s  Interviews  that  (1978),  by t h e r e s e a r c h e r  phenomenological  data.  overlapping  (1984),  were r e a d  guided  fill  with  and r e - r e a d  during  analytic  framework o r g a n i z e d and r e p r e s e n t e d  Indo-Canadians.  data  analysis,  themes and  from t h e d a t a .  explanatory  This of  model.  s t r u c t u r e of h e a l t h f o r  d e s c r i b e d w i t h i n the o v e r a l l  normal  No d i f f e r e n c e s were e v i d e n t  of h e a l t h .  a  meaning o f h e a l t h t o  I n d o - C a n a d i a n s was  descriptions  of the  of h e a l t h c o n s t i t u t e d the  four, the e s s e n t i a l  activities.  vision  steps of  the p r e s e n t a t i o n of the r e s u l t s  This description  domain o f K l e i n m a n ' s  In c h a p t e r  the i n i t i a l  a general  the e s s e n t i a l  data  method.  c a t e g o r i e s and themes were r e f i n e d ,  framework e v o l v e d  and  of constant  to the phenomenological  of data  Ps t h e s e  the a n a l y s i s of  the process  the r e s e a r c h e r with  explanations  Colaizzi  D a t a a n a l y s i s began as soon as  meaning u n i t s formed c l u s t e r s  study,  India.  and a n a l y s i s were s i m u l t a n e o u s  During  definitive  vast  and  (1975) and  of h e a l t h .  categories.  popular  i n accordance  to provide  participants'  the  by Knaack  a n a l y s i s inherent  Transcripts  analytic  method o f G i o r g i  ( L o f l a n d , 1971).  comparative  natural  from  in English.  on an a u d i o - r e c o r d e r ,  Data c o l l e c t i o n  were c o l l e c t e d ,  analysis  The  verbatim.  as d e s c r i b e d  research  living  of m i d d l e - c l a s s Canadians.  i n t e r v i e w s were t a p e - r e c o r d e d  The  their  had come t o Canada d i r e c t l y  were c o n d u c t e d  transcribed  part  Male and f e m a l e  context i n men  participants  of doing  and womens' provided  186 similar varied  accounts  o f t h e phenomenon, a l t h o u g h  according  to individual l i f e  Participants body and mind in  viewed  inseparably  two d i m e n s i o n s .  phase c o n t i n u u m sickness,  control  comprised  (to disease  (over  one's  as a h o l i s t i c  health  and e n v i r o n m e n t a l  life  In c o m p l e t e carry able  out n o r m a l to f u l f i l l  Secondly,  was  with  described  i n terms o f a partial  experience. change),  h e a l t h and Energy,  i n d e p e n d e n c e and were d e s c r i b e d  underlying  health  three  as  action in  was p e r c e i v e d  in  influencing health. health,  participants described  activities  well  and h a p p i l y ,  the r e s p o n s i b i l i t i e s  roles.  Health  abundant  energy,  resistance,  complete  health,  participants described  o p t i m i s t i c about and f e e l i n g  in this  able to  and t h e r e f o r e associated  they  being with  phase was c h a r a c t e r i z e d  i n d e p e n d e n c e and c o n t r o l .  life,  like  being  and d u t i e s  life  anything,  seen  experience  personal  energy,  Health  and p h y s i c a l c o n d i t i o n )  phase o f t h e c o n t i n u u m .  terms of f a c t o r s  phenomenon,  health,  health  four c h a r a c t e r i s t i c s of the h e a l t h each  was  of complete  the t o t a l  details  contexts.  linked together.  Firstly,  representing  resistance  health  specific  feeling  happy,  c h e e r f u l , not w o r r i e d could  do a n y t h i n g  by  In full  of  about  they  wanted t o  do. In p a r t i a l still of  carry  out normal  p a r t i c i p a n t s explained activities,  e f f i c i e n c y ) and w i t h  partial and  health,  health  experience  but l e s s w e l l  more e f f o r t covered  t h e f l u , and was d e s c r i b e d  that  than  they  (at a lower  i n complete  minor c o m p l a i n t s  as t e m p o r a r y  could  health.  level The  such as c o l d s  and bothersome.  187 Partial  health  problem  lasts  minimal  intervention.  because  p a r t i c i p a n t s found  normal this  f o r only  activities  phase,  associated  with  enthusiasm feeling  was  decreased  independence  daily  was viewed  a few days, Partial  capacity  their  or hindered  of motivation anything,  and h a v i n g  as bothersome t o do  temporarily.  normal  f o r doing  or with  ability  action  was  lack of  action;  to drag  In  and d e c r e a s e d  Participants described  viewed  sickness  unable t o c a r r y  fulfill  ones r e s p o n s i b i l i t i e s  serious,  frequently  of  that  e n e r g y and r e s i s t a n c e ,  totally  The  away by i t s e l f ,  was d e s c r i b e d  f o r doing  health  b a s i c a l l y not  themselves  through  activities. Participants  as  health  i t annoying  and c o n t r o l .  doing  b e c a u s e t h e minor  going  interrupted,  decreased  and l a c k  like  as t e m p o r a r y  very  sickness  limited action  Participants  described  explained  Worry was p e r c e i v e d mental  exercise,  sleep  Sickness term).  was  and l a c k  Participants i n t h e body.  with  low l e v e l s  of c o n t r o l .  t h e y d i d not want t o do  of health  They  felt  that  the s i c k  d e s c r i p t i o n , t h e mind  factor  as d e t r i m e n t a l  influencing  to health,  while  use o f m e d i c i n e s ,  was  health. a positive  as b e n e f i c i a l t o h e a l t h .  and c l e a n l i n e s s ,  viewed  and h e a l .  significant  a t t i t u d e was p e r c e i v e d  and c o u l d not  was a s s o c i a t e d  not do a n y t h i n g . to rest  one would be  " s o m e t h i n g wrong"  dependency  dimension  as t h e most  with  f e e l i n g that  t o l i e down,  On t h e s e c o n d  (or long  in sickness  and a l s o c o u l d  body needed  independently.  w o r r i s o m e and permanent associated  i n which  out normal a c t i v i t i e s ,  e n e r g y and r e s i s t a n c e ,  anything,  as a s t a t e  Diet,  maintaining  laa regular  routines,  working  outside  atmosphere,  were a l s o d e s c r i b e d  influencing  health.  Research literature that  social this  five.  and s i c k n e s s  contexts.  study  by p a r t i c i p a n t s as f a c t o r s  f i n d i n g s were d i s c u s s e d  i n chapter  health  o f t h e home, and home  This  middle c l a s s s o c i e t y .  discussion  are constructed  The h e a l t h  were found  in light  h i g h l i g h t e d the fact  i n both  perspectives  t o be q u i t e  of r e l e v a n t  e t h n o c u l t u r a l and  of the Indo-Canadians i n  s i m i l a r t o those held  The l i t e r a t u r e  reviewed  by W e s t e r n  supported  this  finding. For  t h e p a r t i c i p a n t s , normal  "everyday" r o u t i n e s life  and work a s s o c i a t e d  r o l e s and r e s p o n s i b i l i t i e s .  emphasized included  "doing  normal  activities".  i n recent  meant t h e " u s u a l " o r  with  culturally  defined  P a r t i c i p a n t s ' views o f h e a l t h Their health  images o f t h e h e a l t h - s i c k n e s s  dimensions discussed 1981;  activities  continuum  literature  descriptions  and h e a l t h  ( L a f f r e y , 1986; S m i t h ,  Woods et a l . , 1988). Cone1 us i ons Three  Firstly, the  main c o n c l u s i o n s  t h e p a r t i c i p a n t s emphasized  primary  holistic together, Thirdly, within  c a n be drawn from  feature  experience  of health.  social  Secondly,  normal  they  study. a c t i v i t i e s " as  viewed h e a l t h  where body and mind a r e i n s e p a r a b l y  and i n f l u e n c e d their  "doing  this  by p e r s o n a l  conceptualizations and c u l t u r a l  and e n v i r o n m e n t a l  of health  contexts.  were  as a  linked factors.  constructed  189  This held  by  study  Study  i n v e s t i g a t e d the  unique  perspectives  health.  areas are  The  described  and  the on  health  of  of  have  important  and  research.  this  These  the  unique,  as  promotion  for  p r i n c i p l e s of  e s s e n t i a l to  nursing  care.  perception skills,  sickness,  programs  provision  of  The  findings  study  client's need t o  social  be  given  n u r s e s need  socio-culturally and  implications  supports c r o s s - c u l t u r a l  specific  models o f h e a l t h  health  study  i n f l u e n c e which t h e  In t e r m s o f  and  study  relevant  recognition.  care  purpose  understanding  have s p e c i f i c  illness  exerts  explanatory  study  this  culturally  clients'  the  health  Practice  circumstances  understand  professionals'  In a c c o r d a n c e w i t h  theory,  i n d i c a t e that  with  on  below.  knowledge o f h e a l t h therapeutic,  faith,  p r a c t i c e , education  f i n d i n g s of t h i s practice.  Hindu  f i n d i n g s of t h i s  f o r Nursina  cross-cultural  also  care  for nursing  Implications The  of the  to health  implications  nursing  of the  Indo-Canadians  contributing view on  Implications  equal  to  determined  and  structure  in accordance with  nursing  these  perspectives. The health,  nurse r e q u i r e s as  knowledge  well  the  skills  i n t o everyday  of t h i s  study,  fulfill  the  study  as  health  knowledge o f  effectively  practice.  means b e i n g  responsibilities  findings direct  to  the  Indo-Canadian  According able  t o do  associated  nurse to  be  with  perspectives  incorporate to the daily life  on  this  participants activities  roles.  s e n s i t i v e to the  and  The  distinct  190 Indo-Canadian implementing cannot on  v i e w s on nursing  illness.  Indo-Canadians higher  levels  similar  with  health  background  Health  imply  the  fulfilling  responsibilities,  Health  an  was  important  experience  and  participants medicines  and  factors  placed  plans  According  The  on  diet,  and  be  and  possessing  h e a l t h which  are  however,  may  a common  f o r the and  relevant i f  incorporated  three  programs f o r  i f health is  f o r doing  daily  activities,  happy.  study  as  a two  phases of the health.  The  importance  r o u t i n e s , suggests factors i n the  into  dimensional  health  exercise, cleanliness  health  into a l l  participants' descriptions  enhanced  being  incorporate these  to Tripp-Reimer  views  show t h a t  share  programs  i n the  daily  f o r promoting  study  of h e a l t h promotion  resource  the  they  study  influencing  maintaining  effectively  program  both  that  environments,  h e a l t h are  conceptualized  phenomenon e m b r a c i n g  same  more e f f e c t i v e  may  as  hold  nurse  society in general.  success  recognized  The  Indo-Canadians.  be  I n d o - C a n a d i a n community  and  clients.  v i e w s on  prevention  planning.  that  hold  other  may  planning  circumstances,  social  p e r s p e c t i v e s on  o f program  of h e a l t h  may  class  and  community  socio-cultural  of t h i s  images a l t h o u g h  with  promotion  Indo-Canadian  aspects  middle  clients  social  from d i f f e r e n t  dissimilar  might  Indo-Canadian  results  of e d u c a t i o n ,  to Western  cultural  The  of c o m f o r t a b l e  Indo-Canadians  the  care  assume t h a t a l l I n d o - C a n a d i a n  h e a l t h and  hold  h e a l t h when a s s e s s i n g ,  and that  the  longer  nurses  content  Indo-Canadian  (1984b) " i t i s no  sleep,  of  community.  sufficient  for  191 investigators culture  to s t a t e  of the  client",  cross-cultural the  nursing research  nursing's  human b e i n g personal  following study  and  crucial  implications are  of c r o s s - c u l t u r a l Implications  this  taught be  how  to care  educated  cultural  intervention"  and  with  (p.  as a  254). unique  his/her growing  arising  i s an  The from  foster  the  development  nursing profession.  Education for nursing  students  from  clients'  education  need t o be  principles.  for clients  concerning  client  background,  need t o  the  be a r t i c u l a t e d  models o f h e a l t h  the  to  how  of f u t u r e n u r s i n g care.  i n the  implication  theory  (can)  i n s e p a r a b l e from  a s s o c i a t e d with  i s that nursing  cross-cultural  sensitive  made c l e a r  f o r nursing education  knowledge  be  v a l u i n g of the  explanatory  aspect  f o r Nursing  primary  study  and  of the c l i e n t ' s  findings,  The  social  be  d i a g n o s i s and  o f u n c o n d i t i o n a l worth,  recognition  should  findings  fundamental  historical,  inevitable  nurse  r a t h e r " i t must  f u n c t i o n s of assessment, Given  to  t h a t the  arising  exposed  Pis n u r s i n g  to  students  v a r i o u s backgrounds, unique  from  p e r c e p t i o n s on  are  they  need  world  phenomena. Nurse recognize  educators the  explanatory  I n d o - C a n a d i a n s and Nursing safe, to  both  this  and  other c u l t u r a l  culturally  and  programs  graduate  which  illness  held  groups w i t h i n Canadian  designed  by  society.  t o p r o v i d e c a r e which i s  r e l e v a n t to the  goal, c r o s s - c u l t u r a l  undergraduate  nursing  models on h e a l t h and  programs need t o be  effective  meet  need t o d e s i g n  content  client.  needs t o be  nursing c u r r i c u l a .  In  order  included in  This  192 perspective (Branch  has been  & Paxton,  Muri11o-Rodhe, also  presented  as w e l l  Implications  research  in the f i n a l  f o r Nursing  study  has c o n t r i b u t e d  o f t h e meaning  of health  i s necessary.  this  study,  future  of t h i s  to nursing  social  on h e a l t h .  this  The  study a r e  chapter.  knowledge about  how  further research  context  in this  to further  i n t e r a c t s with  In l i g h t  culture  of the f i n d i n g s of  the a d d i t i o n a l f o l l o w i n g areas are suggested f o r  research:  R e p l i c a t i o n of the current  the  meaning  example,  of health  study  to gain  f o r Indo-Canadians  focus  on s p e c i f i c  deeper  insight  into  of t h e Hindu f a i t h .  t h e r e l a t i o n s h i p between c h r o n i c  particular  illness  outcomes o f c h r o n i c  and h e a l t h illness)  For (with  i s an  which w a r r a n t s a d d i t i o n a l i n v e s t i g a t i o n .  (2)  Further  the  participants in this  research  Indo-Canadian (3)  from  a l s o needs t o be g i v e n  (1)  area  p r a c t i c e and e d u c a t i o n .  Plthough c r o s s - c u l t u r a l i n v e s t i g a t i o n  Pttention  perspectives  constructed  context.  i s increasing,  o f t h e ways t h a t  to c o n s t r u c t  programs  as phenomena  arising  section  1986;  Research  view h e a l t h .  exploration  and i l l n e s s  guides nursing  Indo-Canadians  area  literature  1978; Morse & E n g l i s h ,  as c u l t u r a l ,  f o r nursing  below  This  on h e a l t h  research  implications  nursing  1978; Drque et a l . , 1983). E d u c a t i o n a l  social,  Nursing  i n recent  1976; L e i n i n g e r ,  need t o f o c u s  within  supported  on t h e two d i m e n s i o n s  explanatory  study, model  I n v e s t i g a t i o n o f t h e meaning  as c o r e  of h e a l t h  aspects  described  by  of the  f o r health. of health  to Indo-Canadians  using  193 all  male and  a l l female  perceptions (4)  of h e a l t h  are  I n v e s t i g a t i o n of the  Indo-Canadians, multicultural (5)  Further  the  meaning  on  to the  (such  of  as  turning  and  point  more, we  the  method  has  g r o u p s making  wellness,  of  by  non-Hindu  nursing  new  that  "native  (p.  24).  body  Leininger's  f o r nurses  Phenomenology ought  will  know t h e  methods  for  human b e i n g s .  More  will  become  health,  care  and  Nurse r e s e a r c h e r s  must  awaken  in order  substantive  continue  appropriate  to c l a i m  on  especially  to develop  knowledge  to r e v e a l  a primary  research  to a  in  reality. the  r e l a t i o n s h i p between c u l t u r e  i s one  the terms.  view  and  d i r e c t i o n s and  p r e d i c t i o n s become a  q u a l i t a t i v e research fundamental  language"  q u a l i t a t i v e research  of  disease),  profession:  understand  fully  health  between  a futurist's  o f q u a l i t a t i v e methods  nursing,  and  with  people.  relevant  and  us  the  illness,  groups p e r c e i v e  equivalent  to  and  i s hoped t h a t  sickness,  been r e a c h e d  see  of c h o i c e  lifeways  enquiry,  held  terms used t o d e s c r i b e  know and  distinct  health.  of h e a l t h  cultural  to chart  shall  importance  inseparable  if  gender d i f f e r e n c e s .  meaning which d i f f e r e n t  the  ways t o  and  Ongoing  further clarify  Canada's  (1985) p r o v i d e s  alternative  such  the  health,  research  general  to  up  various  nurse r e s e a r c h e r s  the  cultural  e n g l i s h t e r m s and  qualitative  by  perceptions  d i f f e r e n c e s which c u l t u r a l  Leininger  The  influenced  other  research  experience and  and  populations,  society.  groups a s c r i b e  It  sample  and  methodology  p o s i t i o n in  future  for  nursing  research.  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L. , M i t c h e l l , E. S., T a y l o r , D. and Cowan, K. A. (1988). B e i n g h e a l t h y Womens' images. Advances i n N u r s i n g S c i e n c e . 1_1_(1), 36-46. Y o s h i d a , M. & D a v i e s , M. (1985). C o n t e m p o r a r y Canadian i n v e s t i g a t i o n 1 an i n n o v a t i v e p r o j e c t - C h i l d b e a r i n g and c h i l d r e a r i n g : Recent immigrant f a m i l i e s i n t h e urban T o r o n t o s e t t i n g . In M. S t e w a r t ( E d . ) , Community H e a l t h N u r s i n g i n Canada (pp. 663-678). Z o l a , I. K. (1966). C u l t u r e and symptoms: An a n a l y s i s o f p a t i e n t s ' p r e s e n t i n g c o m p l a i n t s . American S o c i o l o g i c a l Review. 31. 615-630.  210  Appendices:  211  Appendix Information My name towards  Columbia.  I am  Indo-Canadians, understand  interested so t h a t  Indo-Canadian  better health The  regarding  i s Robyn Thompson.  my M a s t e r ' s d e g r e e  I am a r e g i s t e r e d  in nursing  health  about  beliefs  may  and p r a c t i c e s  working of B r i t i s h  what h e a l t h  care professionals  health  nurse  at the U n i v e r s i t y  in learning  o f my s t u d y  i s to learn  how you e x p e r i e n c e b e i n g h e a l t h y .  like  t h e Study  means t o  better and p r o v i d e  care.  purpose  participate  A  in this  to interview  study.  I am  how you view h e a l t h and inviting  you t o  I f you a g r e e t o p a r t i c i p a t e ,  you i n y o u r home  so t h a t  I can l e a r n  I would  about  your  v i ews. Each attention for  interview t o what  so t h a t  you a r e t e l l i n g  me.  I would  b o t h o f us c a n d i s c u s s  Interviews w i l l  Each like  I c a n pay  interview  to interview  y o u r views  be a r r a n g e d a t t i m e s which  will  full last  you 2-3  in detail.  are mutually convenient  b o t h o f us. The  teachers not  be t a p e - r e c o r d e d so t h a t  a p p r o x i m a t e l y one hour.  times  to  will  interviews  I hold  at the U n i v e r s i t y  be i d e n t i f i e d Your d e c i s i o n  w i t h you w i l l of B r i t i s h  i n any c o n v e r s a t i o n to participate  be d i s c u s s e d  Columbia.  Your name  or w r i t t e n  material.  o r not i n t h i s  AFFECT ANY MEDICAL OR NURSING CARE THAT YOU MAY decide  to p a r t i c i p a t e  in this  only  s t u d y , YOU MAY  w i t h my will  s t u d y , WILL NOT RECEIVE.  I f you  WITHDRAW FROM THE  STUDY AT ANY TIME WITHOUT ANY CONSEQUENCES TO CARE PROVIDED TO YOU  214 Appendix Initial  These  initial  pilot  study.  1) What for  trigger  Trigger  questions  C Questions  were r e v i s e d s u b s e q u e n t  does h e a l t h mean t o you? ... What  to the  i s the experience  like  you?  2)  What do you do t o g a i n a s e n s e  3)  When do you c o n s i d e r  4)  What  5)  When you a r e h e a l t h y ,  o f ease and w h o l e n e s s ?  y o u r s e l f t o be  t h i n g s are important  healthy?  t o you i n l i f e ?  what t h i n g s a r e you a b l e t o do and  a c c o m p l i sh?  fe) What  i s your experience  or s u f f e r i n g  from  any  i n everyday  illness?  life  when you a r e not s i c k  215  1) What do you t h i n k  2) for  What does h e a l t h  Appendix  D  Final  Trigger  Questions  about  health?  mean t o you? ... What  i s the experience  like  you?  3)  When do you c o n s i d e r  4)  What  5)  When you a r e h e a l t h y ,  things  y o u r s e l f t o be  are important  healthy?  t o you i n l i f e ?  what t h i n g s a r e you a b l e  t o do and  a c c o m p l i sh?  6)  What  i s your e x p e r i e n c e  or  suffering  from any  i n everyday  illness?  life  when you a r e not s i c k  217 Appendix F Health  Images i n c l u d e d i n t h e H e a l t h D e s c r i p t i o n s of P a r t i c i p a n t s i n t h i s Study  (Adapted  after  Wood and C o w o r k e r s .  1988)  CIinical  Adapt i v e  Role  -No t i r e d n e s s  -Don't l e t t h i n g s get you down -ACCEPTANCE OF L I F E ' S SITUATION(S) - A b i l i t y t o cope -ABLE TO TAKE ANYTHING MENTALLY -IN CONTROL  -ABLE TO DO WORK, DO USUAL FUNCTIONS -ABLE TO PERFORM  -Not i l l o r s i c k , disease free -No p a i n -NORMAL -Not  bedridden  -NOT SUSCEPTIBLE TO DISEASE  -CONTROL OVER  LIFE  Performance  -ABLE TO DO THINGS -Able t o f u n c t i o n without f a t i g u e - P r e d i c t a b l y being a b l e t o do t h i n g s - A b l e t o be a s a c t i v e as you want  -CONTROL OVER MIND, AND BODY -Se1f-d i s c i p l i n e  Actualizing -Able goals  Practicing  Self  Healthy  Life  Ways  -EXERCISING  to achieve  -EAT BALANCED DIET -good n u t r i t i o n Positive -Feel  Self-Concept  good  Positive  about  self  Affect  -POSITIVE MENTAL ATTITUDE -Sense o f w e l l - b e i n g -HAPPY -Cheerful - F e e l good  Cognitive  Function  Body  Image  -Think -Clear  rationally headed  -Look  Social  Involvement  Fitness  -Involved i n commun i t y -Able t o enjoy fam i 1 y  good  -Strength - A b l e t o be act ive -ENERGETIC  218  Harmony -Cal m - I n harmony - L i f e i n balance -NO WORRIES -Peace o f mind -BODY/MIND IN HARMONY -Cont ent  NOTE:  The h e a l t h emphasized  images which p a r t i c i p a n t s in this t h e most a r e shown i n c a p i t a l i z e d  study terms.  

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