Vracare: Village wise women, reproductive health, and Yugoslavia's early socialist modernisation project.

This historical article examines post-WWII Yugoslavia and the state's campaigns to modernise and unify the extensive Yugoslav peasantry, and draws comparisons with other countries from the Communist Bloc. It argues that even though Yugoslavia ostensibly set out to create a new 'Yugoslav way' that was dissimilar to Soviet socialism, its tactics and underlying motivations were very similar to those of the Soviet modernisation projects. The article analyses the evolving concept of the vracara (elder women folk healers) as a vehicle for the state's modernising mission. Just as Soviet babki represented a threat to the new 'social order' in Russia, vracare were the targets of the Yugoslav state's anti-folk-medicine propaganda. It also argues that reproductive health provided a moment in the lifecycle when the state attempted to bind women to its services. The first part of the article deals with the bureaucratic push to disempower village wise women using propaganda campaigns and the introduction of medical facilities in remote communities. Even though the medicalization process ultimately failed to fully establish science-based medical services in all areas of the Yugoslav Republic, the negative image of the old crone healer endured well beyond the first post-war decade. The second half of the article examines the gendered stereotype of the old crone and how she became a stand-in for everything backward and undesirable relative to modern medicine.

[On Conditioned Rats and Stressed Workmen : Rudolf Baumann and the Discourse About Stress and Environment in the GDR]. / Von konditionierten Ratten und gestressten Werktätigen : Rudolf Baumann und der Stress- und Umweltdiskurs in der DDR.

The emergence of cardiovascular diseases from stress, i.e. psychosocial pressure, was a constitutive element in the international medical discourse of the 1960s and 1970s. This article describes an East German variant of the stress discourse, developed by Rudolf Baumann and his associates at the Institute for cortico-visceral pathology and therapy in Berlin-Buch. The group sought to develop a genuinely materialist approach to the problem of psychosocially caused diseases, as well as ways of therapy and prevention suited to a socialist health system. At the same time, it was constantly drawing on Western concepts and practices. By examining this project in international context, congruences and differences between Eastern and Western perceptions of the stressful effects of industrial society are worked out. Furthermore, the article discusses that the concept of stress implied ambitious programs for social prevention and therapy, the realization of which in both political systems was constrained by the social reality.

Exploring Biomedicalization Through Complementary and Alternative Medicine in a Postsocialist Context.

Drawing on fieldwork in the postsocialist Czech Republic, we explore the transformative processes of biomedicalization, both within and in relation to complementary and alternative medicine (CAM). We argue that it would be simplistic to understand evidence of these processes in CAM as a sign that CAM has fallen prey to biomedicine. Instead, we show how particular CAM practices play a groundbreaking role in shaping developments in contemporary health care. In this respect, we question the utility of the concept of biomedicalization, arguing that it reduces the transformative processes to aspects of biomedicine.

[Is disease merely illness?: Biomedicine, "parallel" forms of care and power]. / Las enfermedades ¿son solo padecimientos?: biomedicina, formas de atención "paralelas" y proyectos de poder.

Following Giovanni Berlinguer's proposal that health/disease processes are one of the primary spies into the contradictions of a system, this article describes cases that occurred in central and peripheral capitalist contexts as well as in the so-called "real socialist" States that allow such a role to be seen. Secondly, we observe the processes and above all the interpretations developed in Latin America and especially Mexico regarding the role attributed to traditional medicine in the identity and sense of belonging of indigenous peoples, which emphasize the incompatibility of indigenous worldviews with biomedicine. To do so we analyze projects that were carried out under the notion of intercultural health, which in large part resulted in failure both in health and political terms. The almost entirely ideological content and perspective of these projects is highlighted, as is the scant relationship they hold with the reality of indigenous people. Lastly, the impact and role that the advance of these conceptualizations and health programs might have had in the disengagement experienced over the last nearly ten years in the ethnic movements of Latin America is considered.

Psychiatry in Former Socialist Countries: Implications for North Korean Psychiatry

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.

[Christa Kohler's "communicative psychotherapy" as an integrated psychotherapeutic concept and its biographical, scientific and historical context]. / Christa Kohlers "Kommunikative Psychotherapie"--ein integratives Psychotherapiekonzept im biografischen, wissenschaftlichen und historischen Kontext.

"Communicative psychotherapy" was developed in the 1960s by the East German psychotherapist and psychiatrist Christa Kohler (1928-2004) for the treatment of "neuroses". Similar to established present-day psychotherapeutic methods, such as cognitive behaviour therapy, it combined diverse therapeutic approaches into an integrated treatment programme. This included individual and group therapy, exercise, work and occupational therapy. In contrast to modern psychotherapeutic practice, communicative psychotherapy was based on a firm system of values, namely socialist ideals. According to this system, psychological breakdown was viewed and treated ideologically. In addition, any lack of conformity with the East German system was likewise regarded as a psychopathological deviation, which should be subjected to psychological treatment. The latter concept requires a critical analysis from a current-day perspective. For the first time, this paper concentrates on Kohler's work on neuroses and the theory and practice of her communicative psychotherapy, albeit without neglecting Kohler's other scientific works, her biographical information and her Stasi documents.

From non-aligned medicines to market-based herbals: China's relationship to the shifting politics of traditional medicine in Tanzania.

The institutionalization of traditional medicine in Tanzania reveals how strategies for socialist liberation are morphing into strategies for neoliberalization. In the 1960s and 1970s, traditional medicine promised the raw material for the scientific development of an indigenous pharmaceutical industry. At the turn of the millennium, however, traditional medicine has re-emerged in Tanzania as a new path into the fast-growing global herbals market. Tanzania's relationship with China has been central to these dynamics. Development programs rooted in socialist friendship trained Tanzanian doctors in China throughout the 1970s and into the 1980s. These practitioners forged Tanzanian efforts to develop and modernize traditional medicine. In this article, I look with particular detail at one woman who was chosen to start the Office of Traditional Medicine in the Ministry of Health in Tanzania, in order to elaborate the continuities and discontinuities central to the emerging field of market-based traditional medicines.

[Summary Tradition and innovation. Representatives of medical concepts in Uwe Tellkamp's novel The Tower]. / Tradition und Innovation. Medizinische Konzepte und ihre Vertreter in Uwe Tellkamps Roman Der Turm.

Uwe Tellkamp's novel Der Turm. Geschichte aus einem versunkenen Land (The Tower. A Story From a Lost Land) tells the story of a physician's family in Dresden during the last seven years of the GDR's existence. Crucial in this narration of this family, the Hoffmanns, are the medical aspects. I'm particularly interested in how various concepts of clinical diagnostics and therapies are introduced and linked to specific characters, respectively. While the physicians of the Hoffmann family follow a traditional and rather conservative notion of their profession and use orthodox medical methods, the novel presents a number of figures that are linked to alternative complementary healing methods. In the end, those characters searching for alternative ways of practicing medicine, in contrast to the traditional doctors, are also actively involved in the political uproar that led to the fall of the wall in 1989. Hence the text presents analogies that capture both the medical and the political spheres.

[The amazing career of a homeopath, philanthropist, Fourierist, Benoît-Jules Mure. (1809-1858)]. / L'étonnante carrière d'un homéopathe philantrope fouriériste, Benoît-Jules Mure. (1809-1858).

The authors evoke the difficulty of dealing with the life and work of Benoît-Jules Mure who was a homeopathic scientist and a keen specialist on propaganda. He was also an adept of Charles Fourier and he used almost his fortune to the spreading of homeopathy and at time, the improvement of social life. Thus he tried to settle humanitarian colonies in Brazil and later in Egypt, Nubian and Sudan in order to improve their fashion of life. He was hit by tuberculosis which led him discover homeopathy and by his strength of character lie led the idea of his mission in favour of his convictions. He was very angry with the official medical organisation and at last he never has been recognized as a médical doctor. The authors underline that his life and his work have probably left some definite marks in the South America let alone the birth of Socialism.

Informed consent in China: status quo and its future.

Informed consent is one of the fundamental rights of a patient. However it used to be ignored in mainland China and was neither academically discussed nor a matter of practical concern until recent years. Paternalism was dominant in the practice of traditional Chinese medicine which was intensely influenced by Confucianism. The historic medical paternalism was reinforced under communism and the planned economy due to the communist beliefs. But is has been frequently challenged in recent years with patients' awakening awareness of rights and the advent of rights-defending litigation culture in the course of the transformation to market economy. Nevertheless, the current Chinese laws lag behind this patients' awakening awareness and litigation culture. The resulting deficiency in Chinese laws governing medical relations has created dilemmas and chaos in the resolution of medical disputes. In conclusion, the author appeals for the amendment of Chinese law and tries to point out how it should be amended.

Green politics in Germany: what is Green health care policy?

For the first time ever, a Green party has governed in Germany. From September 1998 to January 2001 the German Green party, Bündnis 90/Die Grünen, held the Federal Ministry of Health. Little has been said so far about Bündnis 90/Die Grünen and its relation to health policy. This article is intended to fill that void. An analysis of the health policy program of the Greens reveals that it centers around moving the health sector toward more comprehensiveness and decentralization, strengthened patients' rights, increased use of preventive and alternative medicine, and a critique of the German cost-containment debate and policy. The current health policy program of the Greens is closest to that of the Party of Democratic Socialism, and to a lesser extent it has affinities to the program of the Social Democratic Party. The health policy program of Bündnis 90/Die Grünen is furthest from those of the Christian Democratic Union and the Free Democratic Party. The health care reforms passed in 1998 and 1999 were not a shift toward a "Green paradigm" of health care policy, because they included no fundamental changes. In addition, cost-containment is still a major political goal in German health care policy.

Deciphering "integrated Chinese and Western medicine" in the rural Lijiang basin: state policy and local practice(s) in socialist China.

Based on ethnographic research during an eighteen-month period in 1989-90, this article explores the rural practice of "integrated Chinese and Western medicine" (integrated medicine) in southwest China's Lijiang basin. Integrated medicine is a consciously formulated hybrid medical practice that was introduced by Chairman Mao during the Cultural Revolution as the cornerstone of national health policy. It was originally envisioned as the epistemological handmaiden of the "cooperative health care" system (of "barefoot doctor" fame). The relationship between the respective People's Republic of China (PRC) practices of "Chinese medicine" and "Western medicine" embedded in integrated medicine is explored here on two levels. Integrated medicine is analyzed both as a state policy and as an everyday practice engaged in by village practitioners and lay villagers alike. During the Maoist period, integrated medicine in the rural Lijiang basin was particularly receptive to local interpretation and experimentation by "the masses." This local license in interpreting state policy represented a point of contrast between integrated medicine and other state-sanctioned medical practices. During the ensuing first decade of the post-Mao period, a popular cultural influence on integrated medicine persisted. Integrated medicine is thus examined here both in terms of how state/urban/elite agencies have enacted processes of "syncretism from above" as well as how local/rural/peasant agencies have enacted processes of "syncretism from below" in shaping it as a therapeutic practice. Rural Lijiang basin explanatory models reveal a pattern whereby afflictions are classified according to either "medicine of systematic correspondence" criteria or "stigmatized affliction" criteria. Both types of criteria reflect distinctive interpretations and appropriations of theories rooted in Chinese therapeutic practices and "Western medicine," respectively. The rural basin practice of integrated medicine thus reflects a local appropriation and mediation of state policy, and provides some insight into the nature of a "circularity" that operates between local (or popular) knowledge and state policy in the PRC.

Necessary conditions for a socialist health service.

A socialist health service in a non-socialist society may be forced to stress care and rescue rather than prevention, health maintenance or the promotion of better health and more equal health status. A socialist health service ought to be 'integrated'. A socialist health service ought to provide universal and comprehensive care.

[A new political contribution to medicine: homeopathy in 19th century Spain]. / Una nueva aportacion de la politica a la medicina: la homeopatia en la España del siglo XIX.

The author has sumarized the role of well known 19th century doctors, Thackray, Villermé, Chadwick and especially Virchow (whose socio-medical works are related in detail), in the influence of political ideas on Medicine. As a new contribution to this subject the author informs us of the participation or a Spanish homeopathic doctor in this task. Anastasio García López (1821-1897), was influenced by the works of Charles Fourier, whose doctrine was spreading throughout Spain at that time. García López aplied the sociological concepts of the French utopian philosopher to his idea of homeopaty. A review is made of how Fourierism penetrated and became implanted in Spain and the mark it left on Hahnemann is analized using the "passionate attraction" concept and the ideas of social constriction and violence. García López believed that Hahnemann was attempting to free therapeutics from the yoke of attacking symptoms, emphasizing the affinities of the illness with the cure. Finally, this influence is demostrated in all the activitires of this Spanish doctor, politican, spiritualist, mason and hydrologist of renown.