Community-Based Herbalism and Relational Approaches to Harm Reduction in Healthcare

Thesis (Ph.D.)--University of Washington, 2014Despite the ability of mainstream healthcare in the United States to provide essential care in emergency and life-threatening situations, it often falls short of a broader mission to ensure that effective, equitable, understandable, and respectful quality care is available to all. Instead, not everyone who needs or wants healthcare can access it; patients often do not experience their care as adequate and appropriate; and, far too often, it actually generates harm, which is referred to as iatrogenesis. This dissertation proposes that iatrogenesis can occur at a specific biomedical level with individuals, at a systemic social level with groups, and at a structural level with both society and the environment. Today, pharmaceutical drug medicine is central to mainstream healthcare delivery and is also a primary vehicle of iatrogenesis. Herbal medicine, which preceded pharmaceutical drug medicine, has in recent years been suggested as a partial solution to pharmaceutical iatrogenesis. While herbal medicine offers numerous benefits, the herbal industry, through which most individuals in the United States access herbal medicine, is limited in its potential to reduce pharmaceutical harm due to barriers from mainstream healthcare as well as the harms it can itself generate. Motivated by concerns over the shortcomings of mainstream healthcare, especially pharmaceutical drugs, as well as shortcomings of the herbal industry, this dissertation proposes that an approach to plant-based medicine, referred to as Community-Based Herbalism, has the capacity to reduce healthcare-related harm. Community-Based Herbalism expands the concept of medicine beyond the prevailing pharmaceutical drug model to incorporate food-like medicinal plants, kitchen-based medicine making, and access to living plants. In so doing, Community-Based Herbalism generates relationships with self, others, places, and plants. This dissertation further proposes that the types of relationships generated by Community-Based Herbalism are themselves key to reducing harm in healthcare. In order to understand the importance of relationship to harm reduction in healthcare, the dissertation offers an extended consideration of the nature of relationship. Ethnobiology, and within it ethnobotany, provides a focal point for this consideration. Ethnobotany uses an intersecting framework of anthropology and botany to make observations, draw conclusions, and create theories about cultural relationships between people and plants including medicinal plants. Thus, ethnobotany is relational in at least two respects: (1) it observes through the dual lenses of two disciplines in relationship to each other; and (2) it observes relationships between people and plants. However, as the broader cultural perspectives in which ethnobiology's academic perspectives are embedded have changed, so too have the interdisciplinary lenses of ethnobiology -- and therefore ethnobotany -- changed. Drawing from the analysis of ethnobiologist Eugene Hunn, ethnobiology has transitioned through historical eras characterized by modernism (utilitarian), postmodernism (classificatory), and ethnoecology (situating and legitimizing), each of which has influenced ethnobiologists' understandings of their observations and, each of which, I propose, are embedded within distinct paradigms. Further, the dissertation proposes that both the phases of ethnobiology and the identified levels of iatrogenesis can be correlated with each other on the basis of shared underlying paradigms, which I refer to as: Specificity, Systemic, and Structural Paradigms. Often, the differences between these paradigms present barriers to one another and operate in conflict. The dissertation introduces a Relational Paradigm, that models engaged relationship across paradigms, and proposes that engaged relationship - relationship in which each agent (person, idea or paradigm) changes beneficially as a result of open, respectful, and caring interaction -- is the form of relationship that has the capacity to reduce harm in healthcare. In order to understand the nature, potential, and means of establishing engaged relationship, the dissertation also examines relationship from the perspective of various academic disciplines, attachment theory, and ecopsychology. Successful engagement across paradigmatic differences is further modeled through the concept of ecotone, which -- borrowed from landscape ecology where it describes the influence that adjacent habitats have upon one another - is applied to ethnobiology and, within it, ethnobotany. Here, the concept of an ethnobotanical ecotone depicts the way in which the underlying disciplines of ethnobotany - anthropology and botany - do not simply exist in a patchwork of proximity but rather exhibit dynamic mutual influence or, stated otherwise, engaged relationship. A case involving diverging approaches to environmental management on the part of a Pacific Northwest Tribe and the U.S. Forest Service illustrates both the potential of the ethnobotanical ecotone to generate relationality across paradigms as well as the challenges faced by individuals in attempting to generate such ethnobotanical relationality. Finally, since engaged relationships are situated relationships, the dissertation situates the emergence of my understandings of both Community-Based Herbalism and means of fostering it through an autoethnographic accounting of my teaching and fieldwork over a period of two decades. This narrative incorporates ethnographic data that include student and community cases, and that (1) lead toward an informed analysis of the capacity of Community-Based Herbalism to integrate the Specificity, Systemic, and Structural paradigms; (2) model a Relational Paradigm; and (3) generate relational approaches that can reduce harm in healthcare. Potential pathways to foster Community-Based Healthcare complete the dissertation.