Asram: A superdiverse illness concept
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In this article, we move beyond pluralism and syncretism and address the dynamic and multi-faceted nature of illness by offering a detailed ethnography of an illness concept and the ways in which it is negotiated, transformed and reconstructed as it is passed between different people, practitioners, medical traditions, and geographical settings. In Ashante, asram condenses worries, self-care norms, practices, and social sanctions relating to pregnant women and their children. It is used to think about and act during pregnancy and the first months of motherhood. In the local performance of asram, local healers, pregnant women, relatives, neighbours, and biomedical practitioners interact trying to explain and improve the health status of fragile women and their babies. Asram is a superdiverse concept, with a clear enough core of meaning to enable people to communicate about it meaningfully and use it practically, but has an ambiguous wider meaning. It varies within settings and moves, enabling a variety of interpretations within local population, among local healers, between different geographical areas, between people with different levels of education, and between different biomedical practitioners. It is a naturalistic illness category, but witchcraft and the supernatural are ever-present. Women adjust it to their practical experiences of physical symptoms, interpreting the specificities of their experiences and responding to new questions that their experiences pose. Asram is also a mobile category: migrants embody asram and carry it with them, and Asante healers repackage, reconfigure and market it in other regions. However, these fluxes involve transformations and simplifications of the disease category, and in contexts where biomedicine remains relatively uniform while traditional practices vary and where the social networks that guide their use are absent, trust in biomedicine and, therefore its hegemony, is reinforced.
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