Sociological Perspectives of Health and Illness [1 ed.] 9781443826068, 9781443825481

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Sociological Perspectives of Health and Illness

Sociological Perspectives of Health and Illness

Edited by

Constantinos N. Phellas

Sociological Perspectives of Health and Illness, Edited by Constantinos N. Phellas This book first published 2010 Cambridge Scholars Publishing 12 Back Chapman Street, Newcastle upon Tyne, NE6 2XX, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2010 by Constantinos N. Phellas and contributors All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-4438-2548-4, ISBN (13): 978-1-4438-2548-1

TABLE OF CONTENTS

Introduction ................................................................................................. 1 Constantinos N. Phellas Chapter One................................................................................................. 5 The Morals of Dying: Morality and Ideology of Death and the Issue of Euthanasia Alexandros Sakellariou Chapter Two .............................................................................................. 22 Sociological Approach of Health, Illness and Medicine in Greek Area during 16th and 17th Century based on a Historical Resource (No 218 manuscript of Monastery of Iviron of Mount Athos) Anastasia K. Kadda Chapter Three ............................................................................................ 41 Culture Conflict and Suicidal Behaviors among Ethiopian Youth in Israel Arnon Edelstein Chapter Four .............................................................................................. 59 The Reconfiguration of Trust Relations in Healthcare? The Case of the English NHS Michael Calnan and Patrick Brown Chapter Five .............................................................................................. 78 The Anthropology of Personhood and Health in Greek-Cypriot Community Costas S. Constantinou Chapter Six ................................................................................................ 97 Gendered Narratives of Sex, Health and Well-being Jo Woodiwiss

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Chapter Seven.......................................................................................... 115 Health, Human Rights, and Migrant Family in Greece Catherine Vassilikou Chapter Eight........................................................................................... 136 Conflicts between Health Care Professionals: Causes and Impact Martina M. Loos Chapter Nine............................................................................................ 157 Feminization of Health Care Mariam John Meynert Chapter Ten ............................................................................................. 176 My “Step-Leg”: Body Narratives of Lower Limb Amputees Michal Hoffman Chapter Eleven ........................................................................................ 193 Cultural Differences in Health: Considering Culture in Health Promotion in the Framework of the Multicultural Society Paltoglou Eleni and Tranta Elisavet Chapter Twelve ....................................................................................... 209 On Not Using the Term “Trauma” in the Case of Greek Cypriot IDPs Peter Loizos Chapter Thirteen ...................................................................................... 214 The Medicalisation in Special Education as a Factor of Educational and Social Exclusion Passas Dimitris, Petropoulos-Petalas Diamantis and Tsakona Stavroula Chapter Fourteen ..................................................................................... 237 Negotiating Cultural and Sexual Identity: A Qualitative Study of the Accounts of Cypriot Gay Men Constantinos N. Phellas Chapter Fifteen ........................................................................................ 256 Social Class and Health Inequalities in Portugal Ricardo Jorge Antunes

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Chapter Sixteen ....................................................................................... 276 Dignified Old Age for Vulnerable Seniors in Institutional Care in the Czech Republic KateĜina Ivanová, Radka Bužgová and Pavel Kurfürst Chapter Seventeen ................................................................................... 299 Temporal Acculturation and Acculturative Distress in Greek-Cypriots Marios N. Adonis, Maria Michailidis and Christiana Dipli Contributors............................................................................................. 318

INTRODUCTION CONSTANTINOS N. PHELLAS

Medical sociology has evolved from being considered as unimportant area of enquiry to being regarded as in the centre of the study of private troubles and public issues. At the present much of what is deemed in sociology as exciting is gaining or contributing to the field of health. The concepts of health and illness are neither clear-cut nor objective facts but subjective experiences which are historically and culturally bound, and therefore need to be understood in context. Several sociological perspectives (e.g. Biomedical approach, Holistic approach, Functionalism, The political economy perspective, Social constructionism, Feminism and Medicalisation) have been employed over the years in order to gain an understanding of health and illness as social phenomena. It is appropriate therefore that an edited text specifically examines some of the important themes currently in the medical sociology research and writing. This book focuses on the societal aspects of understandings of health (or wellness) and illness (or dysfunction) with specific consideration to how these understandings are informed by the intersections of issues of gender, race, class, sexuality and power/knowledge. It would also attempt to examine some of the most important themes currently in medical sociology research and writing by covering a wide range of topics ranging from the morality of death and euthanasia to the conflict that exists between different status health care providers. Specific references are made in this book to the different conceptualizations of health and illness by different groups or by people with different social and cultural background are presented (e.g. elite vs. popular culture, the lay perspectives). Additionally, the ideas that health and illness are not simply properties of individuals are examined and through the study of people’s responses to the challenges of poor health (or through their attempts to maintain good health) the influence of social structures can be examined. Sociological Perspectives of Health & Illness would be welcomed by students across a wide range of courses in sociology and the social sciences. Specifically, students undertaking undergraduate and postgraduate courses in health studies, and health promotion would benefit

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Introduction

by reading this textbook. However professional will also be attracted to the book due to the dissemination of current practises in health promotion issues and practices.

Structure of the book Chapter one deals with the morality of death and the issue of euthanasia. The writer presents the theoretical and historical analysis of death and the projectory of euthanasia through time. He summons up with a critical evaluation. The next chapter utilises historical archival research to examine health, illness and medicine in Greece during the 16th and 17th century. The social structure of medicine is examined through historical evaluation in the hope to discover and understand specific social factors which in turn will assist in a better understanding of health and illness. Further still the paper supports that better understanding of the social aspect of the history of medicine contributes in the better development of the field. Chapter three examines the different factors that either drive or discourage young Ethiopians immigrants in Israel from committing suicide. The principle which the research was based upon Sellin’s theory on culture conflict and crime. The article attempts to establish that cultural conflict can account for the problematic conduct of young immigrants from Ethiopians. Trust and its importance in connection to the provision of health care are explored in the next chapter. The need for interpersonal care is necessary due to the unequal relationship that exists between the vulnerable patient and the specialist staff. However changes at social and institutional contexts have affected this relationship. This chapter will investigate how these changes have affected the relationship and how they can dictate policy decisions in the future. The next chapter refers to the Greek community of Cyprus and the sensitivities that exist concerning personhood and how in turn they affect perceptions concerning health and illness. Chapter six focuses on the effect that literature reporting on recovery from sexual abuse has on women. Specifically it covers literature on sex and sexuality. Health, human rights and the immigrant families in Greece is the subject of the following chapter. The study is based on biographical reports domestic helpers from Easter Europe and Balkans. Access to the health care system is examined through the regularization program of the last decade with the focus on women immigrants. Also an overview of the

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actual health situation of migrants in Greece is presented as well as human rights framework related to the health issue of immigrants. In the chapter that follows the spotlight is placed on the conflicts between doctors and nurses in German hospitals. The paper is interested in discovering a connection between gender and professional identity. It will attempt to find whether the privileged position of doctors in comparison to nurses affects cooperation and in turn the quality of care to the patients. The researcher on the next chapter endeavours to define the term gender and the role sex and gender had in suppressing and oppressing women. Simultaneously feminist approaches and strategies in an effort to liberate women are scrutinised. Lastly in the paper the theoretical aspect of the feminization of health is analyzed. Chapter ten takes into account lower limb amputations and how the patients perceive the act. In turn how this perception affects the understanding of their loss as well the need for prosthetic. Cultural differences concerning health issues in addition to intercultural perceptions in connection with health and medical coverage is the subject of chapter eleven. Modern societies have evolved and have become more pluralistic in their composition. The question the paper wants to address is whether these societies can follow the rule “living together” by discarding old practises. The following chapter refers to people that have been forced to leave their homes. It examines the reason the term trauma is not used to describe their ordeal. The study focuses exclusively on Greek Cypriot persons. Chapter thirteen’s is the medicalisation of special education and how this acts to deter the full and successful inclusion of people with special needs in society. The possible relationship between the two is tested by exploring the attitude of educators towards special and general education. The next chapter examines some of the key cultural concepts and relevant historical factors that may shape the development of AngloCypriot gay identity. Accounts of sexual identity experiences provided by second generation Greek and Turkish Cypriot gay men living in London are examined in the light of this analysis as a way to explore how these men negotiate Anglo-Cypriot and gay identity. The findings of this research may help develop an understanding of the complexities surrounding the sexual and cultural identities of Anglo-Cypriot gay men, thereby reinforcing the notion that identity is malleable and ever-changing. Analyzing social structures and their influence in the unequal distribution morbidity and mortality in Portugal occupies chapter fifteen. It is argued that the unequal distribution of the diseases and causes of death is based on the access and in the use of health resources.

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Chapter sixteen examines the existing conditions in the area of institutional care for the elderly in the Czech Republic and whether the standard can provide dignified aging. It attempts to clarify if human rights of the elderly are respected and protected while being in care. The final chapter of the book deals with emotional stress that springs from acculturation that occurs to an individual or a group when two distinct cultural groups come into conflict.

CHAPTER ONE THE MORALS OF DYING: MORALITY AND IDEOLOGY OF DEATH AND THE ISSUE OF EUTHANASIA ALEXANDROS SAKELLARIOU

Historical and theoretical introductory remarks Can we speak of a “good” death and if so what would we mean by that? Is it possible for a human being to pursue imperatively its own death? Can a society preserve its cohesion by legalizing death? These are only a few questions which preoccupy those who study the issue of euthanasia, a social issue, which societies and powers–political and religious–regard mainly with repugnance. The issue of euthanasia has been–and still is–studied by historians, philosophers, doctors, anthropologists, theologians, jurists, priests and probably by some more scientific fields and constitutes a crucial social issue which caused many conflicts and disagreements in human societies in all places and in all ages. In this study we make an effort–not an innovative one of course–to examine this issue sociologically i.e. to examine the social relations which emerge and the social institutions which are interested in the issue of euthanasia and furthermore we focus our interest on the situation over euthanasia in Greek society by exposing the legal facts on the one hand and the ecclesiastical and religious opposition on the other. Our effort is to investigate and answer to a basic and substantial question: why euthanasia is a taboo-issue today in Greece? It is quite important to point out that euthanasia is not an exclusive scientific subject for one and only scientific field and that it is not acceptable to give precedence to the personal interest or the interest of one’s own group over the collective, that is, the social interest. Accordingly, on the issue of euthanasia, as in every scientific field and subject, we are obliged to expose our arguments with lucidity, having as a basis not our

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personal ideological convictions and dogmas but the free will of all human beings and their fundamental rights. Even though it is difficult for a scientist to be “objective” and “neutral” because he is raised and educated in a particular social milieu which has influenced his way of thinking, a scientist has the responsibility to put aside, as far as this is possible, all kind of preoccupations and ideological doctrines in order to study his subject of inquiry.

Euthanasia in past and present societies The issue of euthanasia is not a contemporary one even though in past and more precisely in ancient societies it did not have the exact same meaning as nowadays. In ancient Greece and particularly in the island of Kea in the Aegean Sea, when the elderly became of some age, before getting sick–not only physically but also mentally–and disabled to come up to everyday needs they committed suicide with poison after obtaining the approval of their fellow citizens, dying, in their opinion, in a good and beneficial, for the society, way. Plato refers to euthanasia, without stating the exact word, in the Republic (405c-408e), when he is mentioning Asklepios and his position, that a very sick man who can not live as everyone else should not receive any therapy because neither him, nor the city would have any profit from this therapy1. Furthermore the ancient Greek philosopher, Epicurus, in his Letter to Menoeceus suggested that death is not so important for human beings because, on the one hand, when death is there, they are not and, on the other hand, when they are alive, death is not there either. But when we study euthanasia in ancient Greece, we must bear in mind that in ancient societies, where diseases of today like cancer, HIV, Alzheimer etc. were not present, the issue of a good and decent death had to do mostly with heroism in the battle field, victory in athletic games, death while protecting family members or fighting against tyranny and many other cases. An honest and honored death in antiquity had to do at the most with matters that were important to ancient Greeks such as society, family, athletic games, protection of the holy land and the holy places of the city and this kind of death was indeed a good death for them. Later on, in Roman era Titus Lucretius Carus in his work “De Rerum Natura”, (chap. II 55-58, III 48-93 and III 830-1094) wrote about the issue of the fear before death and in agreement with Epicurus, stated that: 1 We are going to expose the issue of Hippocratic Oath in a next paragraph when referring to the medical dilemmas on euthanasia.

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“Death for us is nothing…we can be sure that nothing horrible exists in death” (chap. III 830-831).

In the same spirit, Seneca in his work “De Tranquillitate Animi” argued that a man should know how to live and how to die (chap. XI 4, 6) and in another of his works, “De Brevitate Vitae”, that if a man studies the teachings of the important philosophers of antiquity, he can take a lesson on how to die, not by committing suicide but in a peaceful and human way (chap. XI 2, XV 1). Some centuries later, Francis Bacon, following Lucretius, stated that: “Men fear Death as children fear to go in the dark; and as that natural fear in children is increased with tales, so is the other” (2002, p. 343)

And also that: “A man would die, though he were neither valiant nor miserable, only upon a weariness to do the same thing so oft over and over” (2002, p.343).

Finally, Thomas More in “Utopia”, his imaginary place of living, suggested a form of euthanasia for sick people, which reminds us of the death of the elderly in Kea that means without pressuring them and after the permission of their fellow citizens. As we conclude with these brief historical remarks, we argue that the issue of a good, politically and socially acceptable death had a central place in the thought of many thinkers and societies from ancient Greece to medieval times and, as we are going to see, in modern times as well, even though in our times the issue of euthanasia eventually became a medical and also a religious matter rather than a personal and political one that was in ancient and medieval times. Euthanasia in contemporary era acquired a negative shade after the Nazi regime in Germany (1933-1945) when people with disabilities, mentally and physically ill, became the experimental objects by the doctors of the regime and were guided to death, due to reasons of “philanthropy” as the regime claimed. It is easy to understand and argue that the Nazi regime practiced a form of so called euthanasia which had nothing to do with euthanasia in ancient times, as we mentioned above, where a person himself alone decided to die and then the society as a whole was providing him the permission to act so. In the case of Nazi Germany, manifest mass murder was named after euthanasia in order to ideologize the extermination of everyone “different” physically and mentally as well as nationally and socially. This reference to the Nazi

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regime in comparison with the antiquity is crucial in our opinion because the meaning of euthanasia is frequently misunderstood and very often the act of euthanasia is confused and equated with what was called euthanasia during the Nazi regime. After this historical period the issue of euthanasia was brought to public life again due to events which took place in Europe and in the U.S.A. some of which were highlighted in extent in Greek society too. The case of “doctor–death” Jack Kevorkian in the U.S.A. (1998-1999), of Ramon Sampedro in Spain (1998), of Piergiorgio Welby (2006) or more recently (2009) of Eluana Englaro in Italy, of Hugo Claus (2008) in Belgium as well as cinema movies, which met with international success, brought euthanasia in timeliness and caused conversations, wrangles and disagreements2. Euthanasia consequently consists one of the most important issues of modern bio-ethics and the avoidance of dialogue on it leads to the maintenance of all the negative perceptions and misconceptions. We can continue to expose paradigms of every day life from all over the world in order to confirm the argument that euthanasia is a very serious issue which causes important malfunctions to societies, but our purpose at the moment is to give an answer to a very important question referring to the scientific and theoretical way by which we study our object, and in succession, to focus on what is actually taking place over euthanasia in Greece. Before that we are going to expose in a brief way the situation over euthanasia in some Western societies and particularly the legal confrontation of euthanasia. Euthanasia is not legal in the majority of western societies. The Netherlands in 2002 and Belgium in the same year were the first European countries which legalized euthanasia, although in the Netherlands it had been widely tolerated since the early 1970’s, with Luxemburg following 2

These are some known international cases of euthanasia. J.Kevorkian was accused for multiple murders in the U.S.A. even though his argument was that he was helping people to die peacefully. R. Sanpedro was asking for euthanasia after an accident he had in the sea when he broke his neck and became paralyzed. P.Welby was ill from muscular dystrophy and could not move from his bed for many years and H.Claus, 78 years old, chose his own moment of death, i.e. he actually committed suicide, seeking for a decent death because he did not want to continue suffering from Alzheimer’s disease. He took advantage of Belgium’s liberal euthanasia law, which grants a doctor the right to help end a patient’s life. In England (November 2008) a thirteen year old girl, Hannah Jones, managed to be let to die due to his serious health situation overcoming the legal and judicial negations.

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recently (2008). In Sweden passive euthanasia is possible due to new medical guidelines which allow doctors to halt life-expanding treatment if a patient asks. In European domain quite interesting is the situation in Switzerland. Assisted suicide, not actually euthanasia, in not illegal and can have the involvement of non-physicians. Hundreds of Europeans have traveled to Zurich, to an organization after the name of “Dignitas”3, which was set up in 1998 to help people with terminal illness. Dignitas’ staff, which is working as volunteers, provides the patient a lethal dose of barbiturates which the patient has to take himself. According to Swiss law, a person can be prosecuted only if helping someone, commit suicide out of self-interested motivation. In the United States recently, and more particularly in Washington state, terminally ill patients with less than six months to live are going to be able to ask their doctors to prescribe them lethal medication. Washington is actually the second State, behind Oregon, to have a voter-approved measure allowing assisted suicide. The pole took place last November and carried a nearly 60 per cent “yes” vote. According to U.S. Supreme Court (2006) all States are free to decide on this issue and vote in favor or against it. Washington’s law, “Death with Dignity Act”, (Thursday 5th of March 2009), is based on Oregon’s measure, which took effect in late 1997. Since then more that 340 people–mostly ailing with cancer–have used that state’s measure to end their lives. Under that new law in Washington, any patient requesting fatal medication must be at least 18 years old, declared competent and a state resident. The patient who is interested in euthanasia should make two oral requests, fifteen days apart, and submit a written request witnessed by two people, one of which must not be a relative, heir, attending doctor, or connected with a health facility where the requester lives. Moreover it is necessary that the certification on his terminal condition is made by two doctors.

Death and life: a dialectical relation The thorough study and observation of human society leads us to the ascertainment that human life is at the same time interwoven with death, the death of one’s own and of the “others”, an observation which is grounded by every scientific aspect. This is a dialectical relation of life and death, death and life, a dynamic and quotidian relation, which has 3

During the summer of 2009 the famous conductor of BBC Philharmonic Orchestra sir Edward Thomas Downes along with his wife ended their lives together in “Dignitas” due to serious health problems.

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been set forth variously in human history, for example psychoanalytically by S. Freud (1995) with the life drive and the death drive or the drive in eros and thanatos4, philosophically by H. Marcuse (1955) with eros and thanatos end even literarily by J. Saramago (2008) in his novel “death with interruptions”5. Where is life, there is death and vice versa. Inside life exist death and through death emerges life. In everyday life, life and death coexist via the illness and the death of our friends, our family or our own, even though people try to avoid not only any conversation on death but even death itself. Life and death in the social field do not consist, only natural, biological facts but also cultural and moreover political facts as they can not be understood outside the field of political power. With these short points, we want to expose two main arguments. The first one is that life means nothing without death because its value derives from the existence of death and the second is that life and death are depended on the society in which they emerge, a fact which is easily proven from the historical study of life and death as social facts. Beside the importance of death in order to understand the value of life, we must emphasize on the attitudes towards death which have been differentiated, having as a consequence that death, instead of remaining a common social fact became something foreign and external for human beings. In past societies for example, to refer a paradigm on how the attitudes towards death are different, death constituted a collective fact which concerned the community as a whole. The dead body was staying in the house for days or at least for the night so the relatives could pay a visit and grieve with the family. Then the whole village was taking part in the ceremony and the burial was taking place in the center of the village or the city where the cemetery was. People used to live with death not only imaginary but every day when some friend or family member passed away. Gradually, in the 20th century, when human life was benefit from all the technical and medical discoveries and achievements, death and illness were put in special places, the hospitals, and became hospitalized. Today it is not acceptable for the children to visit cemeteries and attend burials and death is expelled from people’s lives even thought it is always there (Aries, 1975, 1977).

4

On the issue of death generally, from the psychoanalytic point of view, very famous is the book of I.Yalom Staring at the sun: overcoming the terror of death which follows the epicurean tradition. 5 In this novel Saramago outlines a character, death, who is falling in love and finally becomes life. In our opinion it is a direct dialectical meaning that first of all even death could fall in love and also that life means nothing without death.

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In contemporary narcissistic society where human body is idealized and appears healthy, trained, thin, spotless and without diseases or handicaps, where health and life as absolute values are not only raised but in essence are enforced to people, death is out of question. Nowadays, a certain body pattern has prevailed, which, as it is propagated, should be followed by every one, because otherwise a man is considered out of fashion and will not be accepted by others. Social sciences in general provide us with very interesting studies on the issue of every day life and the relative attitudes on several matters, from the way of eating and speaking to the way of growing up the children or even of clothing.

The sociological approach: bio-politics, bio-power, bio-ethics After a concrete observation, we can ascertain that on the issue of euthanasia is taking place a regulation, a bio-regulation, ruled by the state and of course by society, which is not taking under consideration or more precisely ignores the wills of the involved patients and enforces medical power-knowledge, which refuses to retire in its ‘battle’ with death and decay. In other words, bio-politics, political power, actually defines what is healthy, what has to be done not only in life but also in death and denies vigorously the legalization of euthanasia. On the other hand, doctors in their majority are interested in saving a life at any cost, but they should have in mind that life means nothing without death as we mentioned above. It is important to accept that life has some criteria of dignity and a human body which only breaths and perhaps talks is not actually a human being at least for a minority of people. By that it is not meant that societies and powers have the permission to exterminate everyone who is different, ill or handicapped and the issue of euthanasia has to be discussed only after the patient asks for it. As we already mentioned, we are going to study euthanasia sociologically, that is from a point of view which is interested on the one hand in social institutions, human relations and their dynamic interaction and on the other hand in human body and its utilization. Sociology is also interested in death of man (Sociology of Death), the way by which he is conducted to it and in the relation between man and death individually as well as collectively (Clark, 1993). A crucial and initial question is if Sociology is able to study euthanasia. Our position is that the answer is positive, from the moment Sociology as a science studies institutions and relations between institutions (Bourdieu, 2001) as well as between members of the society and social groups.

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Death and life are controlled by political society and consequently are politicized and ideologized, especially when “others” decide on the way of death of a human being and on how he will utilize his body, a fact which is not astonishing historically (see e.g. the right on life and death of the King on his subjects, the right of pater familias on his family members during Roman Empire, jus primae noctis in Middle Ages etc.). In a social framework of continuous search of what is defined as life6 and what is defined as death7, who defines them and who decides on them, emerge the morals of life and death and more precisely the morals of living and the morals of dying. The way of living of every human being and the way of his death form his personal morals, which should not be defined and enforced by others from the moment they do not afflict human society. As a consequence, we argue that it is false to meditate on life and death in any scientific way (legally, philosophically, sociologically) and do not bear in mind one of these two consisted elements, i.e. life and death, because the one is interwoven with the other not only philosophically but also socially. On the ground of this dialectical reasoning is grounded the right of death, a controversial right according to many thinkers, which means that if we accept the right of life then it is dialectically improper to refuse the right of death due to the reasons we exposed previously. Following M. Foucault (1979), one would have to speak of bio-power to designate what brought life and its mechanisms into the realm of explicit calculations and made knowledge-power an agent of transformation of human life bio-politics could therefore be defined as the escalating incorporation and subordination of “natural” life of man in the mechanisms, evaluations and plans of power. Having these theses as a starting-point and in addition the meditation of G. Agamben (2005) on the politicization of life and death, we argue–proposing a different and perhaps reversed decipherment of the issue8–that euthanasia constitutes an issue of biopolitics and bio-power, because political power desires and aspires to control the pace and the way of life and death of people, enforcing life in any form and expel death from public sight. On the other hand euthanasia can not be enforced on anyone because in this case it is becoming also a part of bio-politics and bio-power but in a very different and dangerous 6

For example in how many weeks of pregnancy life exists. We can mention the different types of coma (classic, carus, wakeful, depasse/ brain death). 8 For the majority of the thinkers euthanasia is a part of bio-politics, bio-power and is understood as a social and medical control on human body. Here we try to expose the opinion that the prohibition of euthanasia forms a bio-political and biopower act against human freedom and the free handling of human body. 7

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way as the effacement of a week body, which presence contradicts with the body pattern of contemporary society and surely not as the redemption or the relief from pain as it should be. In other words, euthanasia should be permitted only after judgment and control, because in any other case, a man who is subjected to euthanasia is becoming actually a form of “homo sacer”, a form of “bare life” according to G. Agamben and that is a state of enforcement of bio-politics/ bio-power on the body of unsuspected people. It is evident and totally acceptable that euthanasia is an issue of bioethics and is expected to be referred in the relative Declaration of UNESCO. In 2005 UNESCO published the Universal Declaration on Bioethics and Human Rights. In this document some very interesting opinions on human life and dignity are cited, but there is not a single direct phrase on the issue of euthanasia. In the preamble is cited that the following articles have been adopted “recognizing that health does not depend solely on scientific and technological research but also on psycosocial and cultural factors” and also “bearing in mind that a person’s identity includes biological, psychological, social, cultural and spiritual dimensions”. One of the basic aims of this declaration is “to respect human dignity, human rights and fundamental freedoms” (article 2, paragraph d and article 3, paragraph 1). Besides this “the interests and welfare of the individual should have priority over the sole interest of science or society” (article 3, paragraph 2) which means that in a case of euthanasia, a person’s will should be taken under serious consideration. But once more euthanasia is not mentioned and consequently could be included as much as excluded of the discussion and, from this point of view the declaration could be read under different interpretations. The more doubtful article is the sixth which mentions the patient’s consent where we read that: “Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be expressed and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice” (paragraph 1)

And that: “In appropriate cases of research carried out on a group of persons or a community, additional agreement of the legal representatives of the group or community concerned may be sought. In no case should a collective community agreement or the consent of a community leader or the authority, substitute for an individual’s informed consent” (paragraph 3).

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This article is supplementary of the previous (no 5) in which is referred that: “The autonomy of persons to make decisions, while taking responsibility for those decisions and respecting the autonomy of others, is to be respected. For persons who are not capable of exercising autonomy, special measures are to be taken to protect their rights and interests”.

At the end of the declaration is mentioned that “persons and professionals concerned and society as a whole should be engaged in dialogue on a regular basis” and that “opportunities for informed pluralistic public debate, seeking the expression of all relevant opinions, should be promoted” (article 18, paragraphs 2, 3). We exposed the basic points of the UNESCO declaration in order to point out two things. First of all that even in a progressive and humanitarian organization and its declaration, the issue of death and the decision on it has not a concrete place and that, secondly, even though societies are encouraged to come to dialogue for such issues, euthanasia in Greece is out of the agenda. Additionally the declaration on Human Rights of the UN (1948) declares in the first article that “all human beings are born free and equal in dignity and rights” and in article 3 that “everyone has the right to life, liberty and security of person”. But not an equal right for death is mentioned and by that we mean a personal choice of a dignified life and a dignified death and consequently we can ask how it is possible to establish a right for life without establishing a right for death with all the necessary prerequisites. Coming to an end with the theoretical arguments on euthanasia, we should add the following questions which are supplementary of the issue and concern the Greek case in particular which we are going to study in the following paragraphs. Is euthanasia a moral act according to the Orthodox Church? Is it reasonable to assert its legalization in Greek society? What prescribes the Greek legal system? Which is the role of the Greek Orthodox Church on the issue?

Euthanasia in contemporary Greece Firstly it is important to mention that facts as those which took place and caused conversations in other European countries and in the U.S.A. have not emerged in Greek society. Euthanasia is a taboo–issue and if it is performed, it is performed only under full secrecy. The legal system of Greece is in its totality inconsistent on this issue. Many argue that the

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issue of euthanasia is solved prohibitory by article 300 of the Penal Code, according to which: “Every person who decided and executed homicide after great and insistent demand of the victim and due to mercy for the person who was suffering from an incurable disease is punished with imprisonment”.

This article is obviously ideologically prejudiced from the moment it refers to homicide and not to euthanasia. It considers the act of euthanasia in a negative way regardless of the motive and it punishes it without exception. But if we are kept to the Penal Code and accept that the issue of euthanasia is solved by that article, we ignore two other laws of the Greek state, which lead us to the conclusion about the inconsistency of the legal system.

The legal system and the medical dilemmas According to article 47 of the law 2071/1992 “On the modernization and organization of the health system” which refers to the rights of the hospital patient, we read on the first hand that “the patient has the right to deny treatment” (paragraph 3) and also “the right of respect and recognition of his religious and ideological convictions” (paragraph 7). As a result, if a patient is ideologically convinced that an incurably ill man should end his life and he is in favor of euthanasia, we assume that, according to this law, his ideological conviction should be respected. Moreover, according to the Code of Medical Ethics (law 3418/28-112005) in chapter 9, “Special Issues”, and in article 29, “Medical decisions at the end of life”, the following are cited: “Doctor takes under consideration the wishes which had the patient even if, during the time of the surgery, the patient is not able to repeat them” (paragraph 2)

And that: “Any doctor is obliged to be informed that the wish of a patient to die, when he is in the last stage [of his illness] does not consist legal justification of any acts which target the acceleration of death” (paragraph 3).

The inconsistency is obvious. Either the doctor will respect his patient’s will, as law determines, but afterwards will suffer the legal consequences, or being in fear of the possible forthcoming punishment and his professional

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future he will not respect his patient’s will. As a result, the patient should seek assistance elsewhere with the existing danger of punishment as we already saw. Consequently, it is obvious that our legal system is clearly prohibitive but at the same time also inconsistent on the issue of euthanasia and needs to be clarified. A direct consequence of this legal ambivalent situation is the medical dilemma which emerges for doctors. Of course, beside the contradiction of the legal system we have to take under serious consideration the oath of Hippocrates which every doctor take. Many argue that this oath refers to euthanasia in the part in which it forbids every doctor to provide with poison the person who is asking for it. On this point, we should make two clarifications. First of all, some serious disagreements have been set forth on the issue of Hippocratic Oath, on its formation and history. Is it actually of Hippocrates? Is it expressing the mainstream of its era? This is a very important issue which can not be analyzed here but cast doubts on the issue of taking the oath verbatim. The second clarification has to do with the oath as a whole. Can this oath have any apply at all nowadays? The oath also refers to abortion and forbids it. Can we imagine a world without abortion and more accurately without the medical control and assistance on it? It also says that a doctor should not receive money when he passes through his knowledge to other doctors. Is this a fact in our era? Why no one protests on this issue? We think that the Hippocratic Oath is important but it should be taken as an ethical text which provides doctors with some basic values on human life. Some of its commandments or advises have no application for contemporary societies because were written for a different society and era. On the same issue, we can add that not many surveys have been made in Greece concerning the aspect of the doctors on euthanasia. The few which have been organized prove first of all that a large percentage of doctors are basically in favor of euthanasia and especially passive euthanasia, and, on the other hand, that it is not easy for them to admit publicly and namely the fact that they helped a person to die, due to the existing legal system and the fear of punishment, but as many admit, euthanasia is a common secret in Greece as elsewhere. Greek society in general is against euthanasia and this is also exposed in a few surveys on the issue. In one of these in 2006 only 6,5% answered “yes, I would do it” and 14,1% “perhaps, I would do it” on the question what would you do, if a close relative in hospital who suffers from an incurable disease asks you to buy for him a certain medicine in order to put an end to his life (Kiousis, 2006).

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The Orthodox Church’s opposition Where are this negative attitude on euthanasia and the consequent inconsistency of the law based? Which is the role of religion and more precisely of the Greek Orthodox Church? We argue that basic cause for this negative viewpoint and for the non acceptance of the legalization of euthanasia is the theological-ecclesiastical viewpoint on the issue. The Orthodox Church is declared clearly against euthanasia by putting forward two main arguments. Firstly, it argues that life is a gift from God and secondly that the seriously ill patient is not in a healthy mental state in order to take such serious decisions. Church’s viewpoint is aggressive and offensive against the supporters of euthanasia and is summarized in the following arguments about the causes of the issue: “The deeper reason that nowadays euthanasia concerns so much people and causes unprecedented movement is the fact, that prevailed a clearly materialistic, ephemeral and eudemonistic perception and practice, health has acquired an intense economic character and man is understood pure mechanically and transiently. (…) The demand on euthanasia derives mostly from human beings who are in a state of depression. This means that, first of all, the circumstances under which the will for euthanasia is expressed are such that do not guarantee the sobriety of the petitioner and secondly that with the proper support, solidarity and probably psychotherapeutic treatment, the same persons could be possible to express different choices in their future. The incurable and painful disease influences the mental equilibrium of the patient in such a way that we could argue that is almost impossible for the patient to express his will with clarity or soundness of judgment” (Committee of Bioethics of the Orthodox Church, 2002).

Furthermore the Church argues that “according to Christian teaching the duration of life and the time of our death are not defined from human rights in any way” and also that “a right for self-determination of life itself is not recognized” (Committee of Bioethics of the Orthodox Church, 2002). We are not going to examine these arguments in details. We are going, however, to pose some interrogations for wandering and reflection. If God provides life via the act of reproduction, as Church argues, it is obvious that the decision of a couple to have a child is not actually theirs but God’s. Why then the decision of a man to put an end to his life and the following act is not possible to accomplish God’s will and form a divine decision? The subsequent question has to do with the second argument of the Church. Why we suppose that every man who decides to put an end to

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his life is mentally ill but if in the same state decides to continue his life we think that is mentally healthy? The many Christians in the history of Christianity who were aiming death and more over a death of martyr were mentally ill? Finally, we must ask: is it acceptable for a social group, which considers itself a majority in a society, to enforce on a minority the way by which this minority should conduct its life and death, its body, as well as define what is dignified and what not? In other words, is it acceptable for this group to enforce its morals to other people and groups? We presume that these theological arguments can be powerful, nevertheless only morally and not legally, for the believers, that is for those who voluntarily are placed in the bosom of the Church and follow its rules and dogmas. Unfortunately in Greece, having in mind the regime of relations between the State and the Orthodox Church, we ascertain that the legal system is influenced by the ecclesiastical point of view on this issue. We can remind, in addition, how many years have passed until it was accepted in our country the right for abortion or even the decriminalization of adultery, and how many reactions by the Orthodox Church caused their legalization. Orthodox Church explicitly or implicitly influences very often state and judicial matters due to its close historical relation with Greek society. Paraphrasing J.Derrida (2001), who was talking about the death penalty, we could say that it is impossible to deal with the issue of euthanasia without referring to religion and to that element, which through the concept of sovereignty, connects law with religion and also without referring to the theological-political or theological-legal-political alliance, as he names it, the oration of which (theological-political) supports the negation to euthanasia and actually it founds it from the beginning. Of course, this historical bound does not justifies the social control on human bodies and its conduct even though it is known that all along Christian Churches consisted one of the main forms of bio-politics and bio-power on human body via the control of sanitation, nutrition, eroticism, clothing, reproduction and death. Church, as a consequence, consist a third form of power along with state and medical science which together pursue the control on human bodies and practice bio-power on them because, as the other two institutions, knows that the control on the human body is a very important prerequisite in order to control social groups and exercise its power on them.

Concluding remarks We tried in a few lines to study thoroughly a very important and multidimensional issue as much as vividly and succinctly as we could. We

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assume that we exposed the most important dimensions of the issue and that the suggested position is quite plain. Nevertheless, the legislation on euthanasia can not take place unconditionally and without any restrictions, because it may possibly lead to uncontrolled and inhuman conditions. The case of living wills9 is a possible solution but always with the potentiality of reconsideration of the initial decision. Human freedom is placed–and has to be placed–over any theological and ecclesiastical perceptions because human freedom is not just a private issue but it is nothing at all if it is not a private issue as well (Marcuse, 1955) and the right for life is not understood without the right for death, because if life is sacred then, dialectically, death is sacred as well. Of course, the issue of euthanasia, as all the bio-ethical issues have to be studied more and in accordance with the almost everyday new scientific findings, but the main problem remains the lack of communication and dialogue in the public domain in Greece as well as the denial of the state to face a crucial and important issue.

Bibliography Agamben, G. (1998). Homo Sacer: Sovereign power and bare life. (D.l Hellen–Roazen, Trans.). California: Stanford University Press. (Original work published 1995). Aries, Ph. (1983). The hour of our death. (H.Weaver, Trans.). Harmondsworth: Penguin. (Original work published 1977). Aries, P. (1975). Western attitudes toward death: From the middle ages to the present. (P.Ranum, Trans.). Baltimore: The Johns Hopkins University Press. (Original work published 1975). Beauchamp, T.L. (1995). Intending death: The ethics of assisted suicide and euthanasia. New Jersey: Prentice Hall. Biggs, H. (2001). Euthanasia: Death with dignity and the law. Oxford– Portland Oregon: Hart Publishing. Clark, D. (Ed.). (1993). Sociology of Death: Theory, culture, practice. Oxford: Blackwell. Committee of Bioethics of the Orthodox Church of Greece, (2002). Basic views on the issue of euthanasia. Retrieved June 3, 2009, from http://www.bioethics.org.gr/03_frame.html 9 In such a will it is stated namely that the person who signs it being of sound mind and voluntarily makes known his desires that his moment of death shall not be artificially postponed. In all cases the sign of one or two witnesses is obligatory in order to verify the will and execute it when the signatory is not able to express his written desire.

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Derrida, J. & Roudinesco E. (2001). De quoi demain…dialogues [Dialogues for tomorrow]. Paris: Fayard. Eser, A. (1985). ǿĮIJȡȚțȩ țĮșȒțȠȞ įȚĮIJȘȡȒıİȦȢ IJȘȢ ȗȦȒȢ țĮȚ įȚĮțȠʌȒ șİȡĮʌİȓĮȢ [The medical duty of preserving life and the cease of treatment]. (P.M. Vassilakopoulou & A.Zioga–Sakta, Trans). Athens– Komotini: Ant.N.Sakkoulas. (Original work published 1976). Euthanasia: a continent divided (n.d.). Retrieved July 15, 2009, from http://www.news.bbc.co.uk/go/pr/fr/-/2/hi/europe/7322520.stm Foucault, M. (1979). The history of sexuality: volume 1: an introduction. (R. Hurley, Trans.). London: Penguin Books. (Original work published 1978) —. (2003). Society must be defended: lectures at the College de France 1975-1976. (D. Macey, Trans.) New York: Picador. (Original work published 1997). Freud, S. (1995). Oeuvres completes. [The comlete works]. Paris: Press Universitaires de France. Kiousis, G. (2006, March 13). ȆȠȚȠȢ İȓȞĮȚ Ș ȘșȚțȩȢ țȫįȚțĮȢ IJȦȞ ǼȜȜȒȞȦȞ. [Which is the ethical code of the Greeks] Eleftherotupia, pp.18-19. Kuczewski, M.G. & Polansky, R. (eds.). (2000). Bioethics: Ancient themes in contemporary issues. Cambridge: The M.I.T. Press. Lucretius, T.C. (1995). De Rerum Natura. (A.M. Esolen, Trans.). Baltimore: Johns Hopkins University Press. Makrinioti, D. (Ed.). (2008). Ȇİȡȓ șĮȞȐIJȠȣ: Ǿ ʌȠȜȚIJȚțȒ įȚĮȤİȓȡȘıȘ IJȘȢ șȞȘIJȩIJȘIJĮȢ. [On Death: The political handling of mortality]. Athens: Nissos. Marcuse, H. (1955). Eros and civilization. Boston: Beacon Press. More, T. (2003). Utopia. (P.Turner, Trans.). London: Penguin. (Original work published 1516). National Hellenic Research Foundation, (2000). ǼȣșĮȞĮıȓĮ: Ș ıȘȝĮȞIJȚțȒ IJȠȣ «țĮȜȠȪ» șĮȞȐIJȠȣ. [Euthanasia: semantics of “good” death]. Athens: National Hellenic Research Foundation. Paddock, C. (2009). Washington State Legalizes Assisted Suicide. Retrieved July 15, 2009, from http://www.medicalnewstoday.com/articles/141318.php Peck, M. S. (1997). Denial of the soul: Spiritual and medical perspectives on euthanasia and mortality. Maryland: Random House Inc. Plethon, Free School of Philosophy (1977). ȂİȜȑIJȘ șĮȞȐIJȠȣ [Reflexion on Death]. Athens: Hestia.

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Protopapadakis, E.D. (2003). Ǿ İȣșĮȞĮıȓĮ ĮʌȑȞĮȞIJȚ ıIJȘ ıȪȖȤȡȠȞȘ ȕȚȠȘșȚțȒ [Euthanasia facing contemporary bio-ethics]. Athens– Komotini: Ant.N.Sakkoulas. Raanan, G. (1994). Philosophical medical ethics. New Jersey: Willey editions. Rigou, M. (1993). ȅ șȐȞĮIJȠȢ ıIJȘ ȞİȦIJİȡȚțȩIJȘIJĮ [Death in modernity]. Athens: Plethron. Saramago, J. (2008). Death with interruptions. (M.J. Costa, Trans.). Boston: Houghton Mifflin Co. Seneca, L.A. (2005). De Brevitate Vitae. [On the shortness of life]. (G.D.N. Costa, Trans.) London: Penguin Books. —. (1946). Dialogorum Libri IX-X: De Tranquillitate Animi, De Brevitate Vitae. [On the tranquility of the mind, On the shortness of life]. (L.Castiglioni, Trans.). Aug. Taurinorum: In aedibus I.B. Paraviae. Vickers, B. (Ed.). (2002). Francis Bacon: The major works. Oxford: Oxford University Press. Washington State to allow “dignity” deaths (n.d.) retrieved July 15, 2009, from http://www.msnbc.com/id/29454171/ Yalom, I. (2008). Staring at the sun: Overcoming the terror of death. San Francisco: Jassey-Bass.

CHAPTER TWO SOCIOLOGICAL APPROACH OF HEALTH, ILLNESS AND MEDICINE IN GREEK AREA TH TH DURING 16 AND 17 CENTURY BASED ON A HISTORICAL RESOURCE (NO 218 MANUSCRIPT OF MONASTERY OF IVIRON OF MOUNT ATHOS) ANASTASIA K. KADDA

Abstract The present study’s aim is the sociological research of health, illness and medicine in Greek area during 16th and 17th century based on a historical resource. For this purpose a research was made using the No 218 manuscript of Monastery of Iviron of Mount Athos under the principles of sociology of health, with the following results: a) health, illness and medicine are indirectly defined in association with the wide social environment, b) social designating factors affect health and illness, c) health is accentuated as the biggest social value, d) diseases with a social character are mentioned, e) a correlation between wide social environment and disease’s manifestation is noticed, f) the therapeutic ways used have a social character, g) the cultural formation of the society at the under study time period is orientated towards practical even supernatural or religious therapeutic means and that affects the modulation of practice of medicine and therapeutic h) many therapeutic preparations are proven to have social functions, i) the alphabetical classification of herbs in the manuscript has social functionality and utility, k) the magical-supernatural elements and practice that mainly ruled medicine during Turkish occupancy had a social function, l) diagnosis and prognosis are considered to be social useful, m) the anatomy is considered socially important, n) society seems to look

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after for public health issues, o) doctor’s profile is socially defined, p) the practical doctors or priest-doctors are proved to play a social role during the whole time of the Turkish occupancy, q) medicine and medical knowledge are products of the society, r) the population’s health status and medicine are affected by social, financial, political and cultural structure, s) diseases seem to be diachronic, t) the utility and the role of the manuscript are characterised as social. Keywords: sociology, health, illness, medicine, society, social, manuscript

Introduction The meaning of health, illness and medicine throughout their historical course are affiliated with wide social environment, introducing social phenomena. In a similar way, the theories and concepts developed around health-illness and medicine in a time are affiliated with social, financial and cultural conditions of a certain place and time. They interact dynamically due to a variety of social, financial, political, cultural, environmental and other factors which affect health and illness. The systemization of medical knowledge in a society is also related with social relationship’s standards, institutions and social structures and the organization of the social life. The past years, among many approaches developed concerning the social dimension of health, illness and medicine, the sociological approach is very enlightening about the understanding of the relations between health, illness, medicine and society. Historically, studying history of medicine in every step of its evolution from a sociological point of view contributes to fully comprehension of medicine as a science, of health’s phenomena and of illness’s phenomena observed in a certain society as well as of the society itself, in a relationship of mutual and dynamic interaction. According to Lidaki (2001, pp. 84-87) the approach of history of medicine through sociology is necessary due to the existent relation between history and sociology. More specifically, as mentioned: “…Sociology, like psychology as well, can study the present recording actions, behaviors, structures aiming to interfere and predict personal and general situations but the study of the present cannot be achieved without the knowledge of the past because nothing is bourn from zero and everything is the succession of something else and the knowledge of a living organization, like man, demands the quest of the previous, the initial..”

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Chapter Two “…History is the baseline of social science, and a sociologist cannot sufficiently express the issues towards which his studies are orientated unless he uses history and unless he can sense historically the psychological problems because biography, history and society are the coordinates of correct human’s study…”

Furthermore, the examination of the social frame of medicine from history’s side contributes to knowledge of certain social factors without which the problems of health and illness cannot be sufficiently understood. For instance, every social group is characterized by a reality which consists of a typical system of beliefs and actions concerning health and illness, tested in time, which supports or blocks the acceptance of new ideas and technological achievements and which must be considered (Smith, 1989). In addition, the historian of medicine and everyone wanting to study and understand history of medicine must always keep in mind the wide social, financial, cultural and political level of development of medicine in different cultures and times because it’s now proven that the knowledge of medicine in a certain place and time is more important even from technical knowledge of medicine (ȉemkin, 2002). On the other side, studying the social dimension of history of medicine contributes to further development to the science of medicine. More specifically, during 19th century, people starts to understand that knowledge and comprehension of social procedures positively affected the development of medicine as a social science and that history under the prism of interscientific approach of health and illness is affiliated with history of society comprehending the importance of the relations between medicine and today’s society (ȅcana-Rodrigueze, Lewis, 1998). Based on the above findings, a research was made aiming to sociologically investigate health, illness and medicine in Greek area during 16th-17th century through an historical resource, the No 218 manuscript of Monastery of Iviron of Mount Athos, which is an unpublished resource of medical knowledge and practice of the time, given the necessity for full comprehension of health, illness and medicine as well as of the under study society.

Researchs material and method The material for this research was No 218 manuscript of Monastery of Iviron of Mount Athos and more specifically its seven texts-nostrums (Kadda, 2007). Methodologically the research was based on the review of the relevant literature and on the elaboration of the above mentioned

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manuscript-transcribed from its original form-following the principles of sociology of health.

Results The social dimension of health-illness and medicine in Greek society of 16th and 17th century is indirectly confirmed in many ways by the content of under study No 218 manuscript of Monastery of Iviron of Mount Athos. First of all, the definitions of health-illness and medicine during the under study time which seem to be socially defined, given that healthillness and medicine are designated in relation with wide social environment. More specifically, health and illness are mainly defined according to the wide ancient Greek philosophical conceptions of the basic elements of which the world consists and their basic properties which characterize the world view of the under study period of time according to which good mixture, good juices’ analogy, ensure the body is in good health status while bad mixture or luck of a juice cause the disease. Searchingly, it is evident in many parts of the manuscript that the defining role in the examination of the elements of the world and of human juices which affect positively health or induce diseases, play not only personal factors (physique of the patients) but environmental-social factors as well concerning outer environment (the relationship between man’s receptors and nature’s elements, the relationship of vertebra, teeth and nails with the juices, the alteration of four elements during the seasons of the year, the focus on the necessity of taking in mind the solstices and the physique of the patient for treating the diseases, the adjustment of therapeutic means-mostly phlebotomy and purgation-based on the elements and the season of the year, the prediction of diseases according to constellation, time and weather, the exact period of time during which the four juices increase and the accordingly therapeutic means which must be followed by everybody in order to ensure health and avoid physical or psychic pain, the exact definition of the age of a man based on certain changes to its body). In addition, medicine is accordingly defined bibliographically and through some reports in the manuscript as an art or a science which studies diseases from a causative, diagnostic, therapeutic and preventive point of view, reinforcing historically the theories of the existence of a form of medicine during middle ages which was handed on-like art-from generation to generation (Mavromatis, 1989, Pentogalos, 1983). More

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specifically, in the manuscript the causes of the diseases are firstly described and the symptoms and treatment follow, while the concept of prevention for the society of that period of time is interspersed in the texts of the manuscript and especially the affect of the way of life and outer environment to health’s ensuring and diseases’ avoidance. Concerning the social designating factors which affect health and illness, many of them are pointed out at the under study manuscript such as gender, age and social status, factors that are also taken in mind during therapeutic procedures and practice. For instance, we often find in manuscripts’ texts reports about the manifestation of certain diseases according to the gender or the age of the person. In the same time, in some of the recipes presented in the manuscript we spot the needed adjustment of the therapeutic preparations suggested according to gender and age. Similarly, during the therapeutic procedure and practice, and more specifically the procedure of phlebotomy, it seems that the gender, the age and social status of the patient are taken into consideration. As characteristically mentioned in the text: “Concerning phlebotomy: of which and of how many vanes we take of the blood…We make phlebotomy taking in mind needs, requirements or demands…Because we have to extract blood according to norms, that is differently for men or women,…you have to extract blood, as much as 2 or 3 liters, taking in mind the age of the young or old man. At the old we find less blood, at the young, especially men, we find more…”

At the same time, in some of the recipes we find mentioned adjustments of the proposed therapeutic preparations concerning the gender and the age of the patient. (“About herpes: For the herpes found in children, you should rub constantly human saliva…”, “About colic: at the children we should apply soaking, cataplasms and warmness…”, “About rage: concerning women,… it holds every month…”). Worth mentioning is also the fact that health in Greek society of 16thth 17 century and at previous times is considered to be of great value in human’s life. Indeed, from the whole manuscript we spot the importance given by the society of the time, and all societies as time passed by as well, to man’s health through the suggestion of therapeutic means and ways of treatment for many diseases as well as through specific reports of meaning of health in many parts of the manuscript. Afterwards, the social dimension of health is accentuated by the report of certain diseases of the time having a social character, such as alcoholism, obesity, anorexia, bulimia as well as by the report of the existence of pestilent-epidemic diseases (mainly of epidemic plague and

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variola) as a reflection of hard social conditions in many places of Greek area. More specifically, the places of Greece which suffered from plague were Epirus, Corfu, Zante, Peloponnesus, Candia, Nafplio, Salonica, Chios and Athens. Regions which suffered from variola were Zante, Cyprus and Candia (Kostis, 1995). Besides, we observe a correlation between wide social and ecological environment (geographical, climatologic and environmental conditions) and disease’s manifestation according to Hippocrates’s and Galenos’s beliefs as well as between personal behavior (dietetic habits, way of life, exercise, physique) and health-illness. Concerning the last one, information is given in a relevant text of the manuscript about some type of food, the exact way and time of their allowance, their dosage and preparation, their combination with other food or other activities (walk), the benefits or the harm they can cause to man’s health, facts that state the existence of an organized system of dietetic instructions from the society at the time and the importance of dietetics in health’s prevention and diseases’ treatment since many types of food were used as remedies for the treatment of certain diseases. In addition, the correlation of dietetics and exercise is accentuated. For instance, in the text of the manuscript called: “About good juice”, food with good juice and taste, the kind of food and its preparation and allowance are presented as well as their benefits or damage to human’s health when combined with other kind of food. (“Milk has the best juice compared to anything and the best milk is the one of healthy animals when we drink it right afterwards the milking…”, “Fish from the ocean and from the sea nearby rocks…”). From the other side, all food causing bad digestion is also presented (“Old cheese, sea shells, lamb stacks, crabs, crawfish, shrimps”), food that is warm (“palm fruits which are sour, quinces, apples…”) and food causing stomach ache (“Celery, blite, cabbage…”). In the same time, bad juice is mentioned as well as its kind (“Bad juice doesn’t have only one kind”) and abstention is suggested from all bad juicy alimentation, which are considered to be bad for digestion. It is also mentioned that bad juice concentrated in vanes can be the cause of many diseases (“You should not eat bad juicy food, although it might have good taste, because during the years bad juice is concentrated in the vanes… and might cause heavy fevers”). Afterwards, all bad juicy food is presented as well as the warm, cold, refreshing of blond choler etc (“The meat of sheep and goats, of male goats and the bread made out of it,

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sweets palm fruits…”, “Barley baked in any way”, “they are much refreshing of blond choler…”). Furthermore, the relevant therapeutic practice, as pointed out from the under study manuscript, has also a social character, given that the methods used for preventing and curing disease in Greek society during 16th-17th century, popular medicine’s methods, connect with social or religious functions and points of view as well as with the level of technologic development of the society at the time and of previous in time societies (ancient Greek and roman medicine, medicine of ancient nations and Byzantine medicine) from which it is affected. The cultural formation of the society at the under study time period and more specifically the customs and morals, the predominant values and beliefs of Greek people during the under study time period is also orientated towards practical even supernatural or religious therapeutic means and that affects the modulation of practice of medicine and therapeutic which are presented in the manuscript because a sustenance of means of popular medicine is noticed even in places of Greek area were a high level of medicine’s development is observed like Eptanisa, Chios, Candia, Cyclades fact that is verified from the frequent reports of the therapeutic means named after these areas in the texts-nostrum of the under study manuscript. Indeed, in certain parts of the manuscript the Byzantine point of view of treating diseases with God’s help is predominate and we find texts that imply the elements of belief and prayer and their contribution to the cure of the diseases. In that way the tight relationship between religion-church and society is indirectly expressed, a relationship that characterized the under study period of time, that of Turkish occupancy in Greece, as well as the theurgical character of medicine from ancient years till the under study period of time. For instance, some therapeutic means, like antidotes, are used as means of precaution for evil eye and demonic attacks. From their name we conclude that these medicaments have a divine origin, that is they are given by God, and their use should be accompanied by faith to God (‘’Antidote which is called earth: the one who has this antidote comes without fear, because he can repel any evil eye or demonic attacks…this antidote is given by God and you should have faith in Lord”). In the same time, some of the drugs accentuated in the manuscript’s texts are characterized as God-given having an intense religious role since their application and effectiveness were combined with the belief in God expressing in this way the theocratic conceptions of medicine-therapeutic which, starting from prehistoric years, are conserved in medicine of many

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ancient people, mostly Hebrew people, are climaxed at middle ages’ and Byzantine’s society and continue until Turkish occupancy when medicine and therapeutic are characterized by an extremely tight relationship with religion. In addition, the role of many therapeutic preparations we find in nostrums presented in the under study manuscript is also social given that they successfully dealt with a wide range of diseases. We truly observe that remedies presented in the manuscript are not only used for the treatment of certain diseases but are also applied for many diseases which makes them the right ones for a wide use. In this way the needs of doctors were covered as well as medical and therapeutic needs due to various social incidents of the time (luck of doctors-scientists, instability of commerce etc). Moreover, the alphabetical classification of herbs, also presented in the manuscript but in a different text, has social functionality and utility given the fact that the doctor had an easy to handle and use instrument of medical knowledge, a medication that could also be called dictionary, suitable for an easy selection of the appropriate herb for curing every disease. The alphabetic classification which, bibliographically, is also mentioned in the projects of Dioskourides and Galenos and later on of Orivasios allows the immediate finding of the prescription of the remedy as well as the verification of the appropriateness of the product giving the doctor the chance to known the properties and the way each remedy acts as well as to define easily the necessary remedy and to fully known all parameters (Ciancarpro, Cavallo, Touwaide, nd). Besides, the magical-supernatural elements and practice that mainly ruled medicine during Turkish occupancy which are presented in some parts of the manuscript and denote the mythic and non rational spirit of therapeutic of the time through centuries also had a social function because they positively affected the psychology of week patients in dealing with pain confronting the unknown and incontrollable sometimes factors of the diseases of the time. The place that these elements have among medical instructions may today seem stupid or ridiculous but in older times and areas far away from medical centers, was neither irrational nor unnecessary. Given the fact that health was not defined only by man but by many other factors which could not be controlled, the recourse to exorcisms was as important to the society as to the appliance of a medical recipe consisted of strange and hard to find herbs, of bugs and of substances having strange names and of homemade preparations (Tselikas, 1999).

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In addition, the function of the diagnosis using the relevant means (examination of pulse and urine, the color of the skin), as mentioned in many parts of the manuscript, is based in Hippocrates’ diagnostics, in ancients’ people’s diagnostics and in Byzantine’s diagnostics, was also social because it offered useful tools to health professionals on the one hand and provided medical and therapeutic treatment to a wide range of people on the other, in a time period that medical technology did not exist. In a similar way, prognosis for a disease is socially popular, useful and important for the medicine of the time and is made, as mentioned in the manuscript, according to the principles of holistic treatment of the disease and of the patient, including the psychosomatic and social status of the patient as well as environmental and widely social factors such as the nature of the patient, the time of year, the age and the physique of the patient, the air condition and the periods of exacerbescence (in correspondence with Hippocrates and Galenos) of the disease and of the suffering of the patient, since it takes in consideration the implication of the outer environment at the manifestation of the disease. We can also state that it is a dynamically changing and non static situation considering the fact that in prognosis non stable factors are taken into consideration such as the periods of exacerbescence. As mentioned in the text: “Prognosis of a disease caused by a crisis: You should look at the crisis that caused the disease, look for its nature…, the time of the year and the age of the person who had the crisis as well as his physique and the status of the air…, the periods of paroxysm…”

Socially important is also considered the anatomy. Besides, 16th century is called “Century of Anatomy” because the scientific importance of body’s anatomy for medical purpose is recognized, in a period of time when medicine regained its Hippocratic spirit and got away of the absolute hug of divine influence (Anatomy of gender, 2007). In particular, during this century, the field of human’s anatomy progressed explosively: a) concerning the first anatomy ever made in a human body by Andrew Vesalio (1514-1564) and his anatomic observations on a human body, b) concerning the perfect anatomic designs of Leonardo Da Vinci (14521519) painter and scientist from Florence, excellent anatomist, as well as of other important personalities such as Gabrielle Fallopio (1523-1562), who studied the ears and discovered the hydra main (Bouillet, 1884), Rampele (1490-1553), doctor and great writer of the 16th century, Realdo Colombo (1516-1559), professor at University of Padova, writer of the project “De Re Anatomica” (Louros, 1967, Papaspirou, 1944,

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Papagianopoulos, 1992) and Bartholomew Efstahios (1510-1576) who described the hearing system and discovered the efstahian tube (Maniatis, 2000, Glaser, nd). In the under study manuscript, we find anatomical figures of the front and the back of the human body as well as reports revealing the Hippocratic mainly way of thinking and acting of the certain historical society as well as the scientific importance and progress of the anatomy which was manifested in Europe mostly during 16th century and a concept of the human body as utensils, as a group of interdependent organs and functions (Alexias, 2006). In addition, we often observe that society is interested in topics concerning health and illness and it provides of prevention and protection of public health given the frequent reports in the manuscript of therapeutic preparations aiming prevention which imply the dominant conceptions of ancient Greek medicine. For instance, we often find reports in the under study manuscript of ways of prevention of certain diseases or morbid situations: “Concerning the movement of entera”, “Concerning good speaking”, “Preventing breasts”, “Concerning good teeth cleaning”, “Concerning the face”, “Concerning flees at home”, “Prevention of tooth ache”, etc. Social care for protecting maternity is also pointed out as important by the reports in the texts of the manuscript of preparations aiming the wellbeing of the pregnant woman, characteristic element of social providence in Byzantine years (“Concerning arthritis and pregnant women…”). Furthermore, the social providence for restoring animal’s health is obvious in reports of veterinary diseases, given that some animals, like horses for instance, offered many services to people helping in transportation or fulfilling other professional needs (“About heart ache due to non medical reason: Honey and salt and wine and oil and garlic pounded, mixed together and given by the anus and it will be cured”). In addition, as we understand from some parts of the manuscript referring to therapeutic preparations for the teeth or the hair, the society of the time paid a lot of attention to outside looks and appearance of the person since recipes were presented for hair dying and teeth whitening: “Concerning diseases of the mouth and infection of the teeth causing pain”, “Concerning the teeth”, “Whitening therapeutic preparations”, “For blackened and weathered teeth”, “Black hair dying”, “Blond hair dying”. What is more, the profile of the doctor that Greek society wants during the under study time period consists of certain elements and skills that constitute of his personality such as education, diligence, accuracy,

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wisdom, experience, justice, elements that a doctor should have in order to detect the symptoms of every disease and to suggest the appropriate therapeutic treatment for restoring patient’s health. In general, these elements are considered necessary in order to successfully fulfill his medical task. According to Pentogalos 1983, the characteristics mentioned above and which a doctor should have feature mainly at renaissance years as well as the study and the knowledge on behalf of the doctor of ancient medical texts and consecutively the observation as a basic characteristic of Hippocratic education at the school of Ko as well as empiricism which was handed on for many years from generation to generation. In the same time, the practical doctors or priest-doctors as mediums of medical practice or practical medicine are proved to play a social role because they use nostrums during the whole time of the Turkish occupancy, fulfilling an important need for provision of immediate medical-therapeutic treatment of the week patient considering that scientists doctors was rare to be found in Greek area as well as the entire ottoman empire. The reputation of certain practical doctors was so great that even powerful ottoman rulers or even the Sultan himself asked their services. More specifically, during the age of slavery of Greek nation, when total luck of culture is observed and the educational and cultural status of people had to remain lows, the development of medical science and the production of doctor scientists as well as the health of Greek people were based in popular medicine. Popular medicine was applied not only by professional empirical or practical doctors but by common people as well who were inclined for popular medicine and had the necessary experience to perform small surgeries or had the empirical medical knowledge that was carried on from generation to generation (Antonogiannakis, 2003). Most of practical doctors were usually self-taught, fact which did not however eliminate the good results of the cure they applied. Communities hired a doctor for the needs of its members and his fees were analogue to the financial status of his employers. When the disease was much more serious and hospitalization was demanded, communities were responsible for the transportation and acceptance of the patient-member to a hospital, even in Constantinople (Efthimidis, Kirkini, Nikolopoulos, Penna, 2001). Practical doctors also offered valuable and patriotic medical services to the community, given the fact that they were fighters, before and after the Greek Revolution (Gatopoulou, 1995). As far as the under study manuscript is concerned, the copiers (doctors or monks) offered important medical services to the society by providing

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medical and therapeutic knowledge in the bounds of the hospice operating at this Monastery which was an important medium of medical care and treatment during the tough years of Turkish occupancy, having also intense social activities. In the same time, the long-lasting and alive presence of Byzantine’s medicine was maintained through meta-Byzantine years and the existence of hospices-hospitals in monasteries proves it. Furthermore, the form of medicine dominating in Greek area during 16th and 17th century as well as medical knowledge based on hand script nostrums of the time like the under study manuscript of Monastery of Iviron of Mount Athos, are products of the society of this certain period of time and of societies previous in time (ancient, roman and Byzantine) considering their general characteristics. They reflect and state the effects to Greek people during Turkish occupancy at customs and social life in general from ancient Greek and roman medicine, medicine of ancient nations and from Byzantine medicine. They also state the continuity of Greek tradition and heritage concerning medical-therapeutic concepts and practice in Greek area. Searchingly, empirical-practical and sometimes more scientific character and orientation that medicine of the period of time studied presents follows the transformation of societies from one form to another, from prehistoric period until the one studied. More specifically, there are many reports in the manuscript’s texts that belong to medicine of previous periods of time, mainly to ancient Greekroman medicine as well as Byzantine medicine. For instance, the first text-nostrum is really a task similar to the one performed by Theophanis Chrisovalantis or else called Nonnos when he was writing a medical encyclopedia under the orders of King Constantine Porfirogennitos where we find the Byzantine medicine of 10th century based on the projects of great ancient doctors. In this text important role has the clustered presentation of diseases manifested at different parts of human body starting from the brain. This kind of presentation is also found at ancient Greek doctors mostly in the projects of Hippocrates and Dioskouridis and it reflects an ancient system of recording the therapeutic means from head to toe and it reveals the affect of ancient Greek and roman medicine (Dioskouridis, Galenos) as well as of byzantine medicine to meta-Byzantine medicine. In a similar way, the causative analysis of the diseases reveals the Hippocratic and Galenic concept of the role of external and wide social environment to the manifestation of the diseases because of the overbalance of juices due to environmental factors or unhealthy behaviors.

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Likewise, in some parts of the manuscript we find reports of the ways of preventing certain diseases or unhealthy situations through the appropriate therapeutic preparations which characterizes ancient, Hippocratic, roman, Byzantine and meta-Byzantine medicine. We also find many reports in the manuscript of therapeutic means of medicine of ancient people and posterior to Byzantine and meta-Byzantine medicine. Besides, the characterization of man as a logic animal, mortal in flesh and with many virtues, the description of his basic anatomy and the referral to many diseases that affects him as well as to his health reflect the ancient philosophical beliefs (Plato, Aristotle) which as known affected medicine and its evolution (Maniatis, 2002). In addition, the health status of the people during 16th and 17th century considering the law quality health care system of prevention and treatment of epidemics which spread in most places of the country, as well as the medicine which is generally characterized poor in scientific standards and ignorant concerning people’s treatment, are directly affected from social, financial, political and cultural structure and level of development of Greek society (factors that basically designate health, illness and medicine) and from the evolution of the science of medicine during Turkish occupancy . More specifically, ottoman occupancy, the hard social and financial conditions, the luck of scientific medicine and probably the high mortality are the main characteristics of the under study period of time. The ottoman occupancy of Greek areas caused deep and painful alternations in the life of people and to its historical course deteriorating notably the social conditions of living for the Greeks who had also greatly suffered during the previous centuries. The language, the morals, the law, religious and social habits, festivals and celebrations were altered since the fall of Constantinople until the Greek revolution (Hassiotis, 1974, Vourazelli, 1939). Greek words were now useless and new Turkish ones were added to every day language of Greeks which had embodied the Turkish language, fact that is also induced from the texts of the under study manuscript since there are reports of therapeutic preparations named in ottoman and designated for the ottomans. Even the outer look of occupied Greeks was according to Sultan’s orders. For instance, luxurious and open-colored clothing was forbidden by the sentence of licking and a certain type of uniform and haircut were obligatory. Sorcery, so popular among uneducated Greek people, as well as clairvoyance, astrological prophesies, use of medicaments or stones is mainly due to Turkish influence (Vourazeli, 1939).

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In addition, in classic Greece and later on in Hellenistic and roman times until the end of 17th century factors such as wars, refugees movements, the abandonment of the task of draining the swamps, the overpopulation in the cities, the law quality of housing, watering and sanitation, were the cause for the manifestation of epidemic diseases such as Hansen’s disease, malaria, tuberculosis, gastroenteritis, eye’s infections, dermatitis and so many others. All these factors were considered to be the main causes of mortality with differences in fluctuation of the frequency of their manifestation (Tountas, 2000). Similarly, in Europe during the under study period of time, people suffered greatly from pestilent diseases while the level of institutional care for public health was characterized very poor. On the other hand, the public’s health status, the diseases that negatively affect the social web and the popular medicine that characterizes the under study period of time, influence Greek society and contribute in its maintenance and development providing its members of personal and collective practices and of means of preserving good health and coping with illness through the operation of the hospices-hospitals and the application of the resources of popular medicine, practical doctors and nostrums, proving the interaction relations between health, illness and society. Consecutively, illness and medicine during 16th and 17th century are defined and designated as a reflection of the according historic-social frame of Turkish occupied society as well as the second one which strongly connects health, illness and medicine with the society in a relationship of dynamic interactions. In the under study manuscript, the situation mentioned above concerning the public health in Greek area in the under study period of time is confirmed by the report of pestilent-epidemic diseases (mainly of epidemics of plague and variola) as well as by the existence of contagious diseases such as Hansen’s disease, crabs and syphilis which indicated the poor level of development of public hygiene of the time in many areas of Greece, affecting mostly young people and inducing the death of thousands of people. In the same time, the existence of the same diseases mentioned in the text-nostrum in modern society, except maybe pestilent diseases, proves they are diachronic. More specifically, we find in the text reports of disease such as cancer, diabetes, mental disorders, alcoholism, obesity, which are now characterized as modern civilization’s diseases and present an increase in their manifestation. These diseases have socials implications

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and are attached to the modern way of life of a person and the consuming social model. In addition we should point out the fact that many texts in the under study manuscript state the utility of therapeutic preparations (preventiveprecautionary and therapeutic as well) for the mass in the under study period of time such as antidotes, plasters, oils, salves. In the same time the transcriber of the manuscript refers to kings and we find parts of the texts inducing the use by kings and patriarchs of therapeutic preparations described in the manuscript which proves that the manuscript it was written incidentally but it was a project addressed to and used by people belonging in the higher rank. Concluding, the role and the utility of the present manuscript as well as of other similar resources of the time which were preserved and constantly multiplied by doctors or monks who added or altered things writing all over again in a new project are considered to be social given that they preserved the natural therapeutic means and the traditions of ancient, Byzantine and meta-Byzantine medicine and that they served the medical needs of the under study period of time in times when scientific medicine in Monasteries is almost inexistent, while later on doctors or monks were adjoined to the Monasteries, fact confirmed not only theoretically but practically as well by the existence of great many written resources of that kind in many places in Greek area. As characteristically mentioned: “With these nostra, medicine helped occupied nation and these 400 years of slavery to cure itself and to face diseases, trauma, even death, because most practical doctors stood by the patient and his family and operated as psychotherapists without even knowing it” (Haviara-Karahaliou, 2006, pp. 4-5).

In addition, from many parts of the texts of the manuscript, like for instance the sixth text where herbs we find in medical books are alphabetically presented or the first text, information is induced concerning a variety of therapeutic herbs useful and applicable in medicine and pharmaceutics until even today and also concerning the origin of some herbs based on which we known about commercial relationships and communication between certain regions (between the place of production and the place where it was used) that characterized this period of time confirming the bibliographical reports of intense commercial activities at the time in our country and in the whole world affecting positively the under Turkish occupancy Greek people in one hand, and the social utility

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and necessity of studying these historical resources in the other as well as their diachronic feature (Kouzis, 1930, Amantos, 1931). The fact that even today we find among the people elements related to nostra or concepts same or similar to the concepts of ancient years concerning the cause of the diseases, the doctors and the therapeutic means, is not irrelevant. For instance, primitive nations base their therapeutic in herbs and their pharmacology tries to extract substances from herbs in order to prepare synthetics for therapeutic use (Oikonomidis, 1951, Rigatos, 1996, Kiriakidis, 1925). In addition, the research concerning popular medicaments can lead to the discovery and production of new and useful medicaments, given the facts that many of today’s medicaments, which save lives, were in the past medicaments of popular use. In our country, as well as in other European countries and in America, there is a large body of traditional medicine coming from Ancient Greece, Rome, Middle Ages and Renaissance, easily recognized, which describes a great variety of plants and other substances not yet systematically researched. In the same time, there are efforts to discover them, examine them and apply them (Holland, 1994). Finally, the social dimension of these sources of popular medicine is even more supported by the modern, European scientific point of view for popular medicine according to which: “Popular medicine is not only a simple collection of popular therapeutic methods and concepts, neither an effort to confront the scientific medicine, nor a detection of therapeutic methods and dees inherited by ancient years today in a variety of forms, nor a non scientific medicine which is alive only in so called popular people. Popular medicine is a scientific object which includes all the above, is placed beyond the segments and it is a system consisted of popular therapeutic concepts, sociological and cultural beliefs and dees which operates under its own rules within a narrow or wild human society” (Imellos, 1994, p. 38).

Conclusion Based on the above elements it is obvious that health and illness and the science of medicine are social products which are defined by the social status of the under study time and are constantly in interaction and interdependence with society given the fact that the are of the most important issues occupying people’s mind and affecting greatly social activities being the catalysts and protagonists as centuries are passing by. Through the detailed study of No 218 manuscript of Monastery of Iviron of Mount Athos, lots of social elements come out, very enlightening

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concerning health-illness and medicine in Greek society during the first centuries after the capture of Constantinople period of time during which health and medicine were the reflection of the Hellenism during the centuries after the Capture, a period of time characterized by extremely bad conditions of living and luck of scientific medical knowledge and practice sufficient to cover the needs of the whole country. In the under study manuscript we find valuable information concerning the society at that time, the science of medicine-therapeutic and its development1, the concept of the people for the healer, the concepts about the cause of the disease, the way of therapeutic confrontation of the disease (prevention, rehabilitation), the therapeutic means used and their evolution, the different diseases, the connection of medicine with the other sciences etc (Mpimpi-Papaspiropoulou, 1989, Karas, 1994). In general, the study of an historical resource of practical medicine like the 218 manuscript of Monastery of Iviron of Mount Athos is a useful mean of practice of medicine in Greek society of 16th-17th century through which ancient Greek medical therapeutic revives as well as medicine of many other ancient people and Byzantine medicine and therapeutic from which it is greatly affected. It’s about an historical resource of great value which has also a diachronic value given the fact that, on the one hand, many diseases, the ways of their treatment and therapeutic means are still applied and are of benefit for medicine even today, and on the other hand a great number of material-substances used then for the preparation of remedies became the foundation of modern therapeutic. In the same time these features verify the continuity of the life of Greeks as a nation being an integral element of their society from Homer’s time until today.

Bibliography Antonogiannakis, M., 2003. Popular Medicine in the area of Vrissina, International Scientific Congress of Popular Medicine, Rethimno: Historical-folkloric Company of Rethimno, p. 31 Alexias, G., 2006. Sociology of the body, Class notes, Panteion University of Social and Political Sciences, Department of Psychology

1

According to Tselika (2004, p. 337): “The evolution of science, and especially of medicine, in society as the years passed by was based in popular medicine’s tradition, given the fact that medicine, in order to reach the point where it stand today, was based in long-term experience and the observations of the doctors and the simple people who struggled to ease the human pain using any means nature and divine inspiration offered them."

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Amantos, Ȁ., 1931. Nostrum Code, Reprint from volume 43 of «Athinas», Athens: Estia Anatomy of gender, Retrieved March 3 2007 from http:/www.anatomyofgender.northwestern.edu/about.htm1 Bouillet, J., 1884. History of Medicine, (N. Parissis Trans). Athens: Press of Korinni Gatopoulou, A., 1995. Doctors of Peloponnese, Patra : Achaian Publications Ciancarpro, M., Cavallo, G., Touwaide, A., nd. Dioskourides about the subject of medicine, scientific attention and transcription: ǹ. Tselikas, Athens: Militos Glaser H., nd. The man with the eyes of the great doctors, Athens: Minotaur Publications Efthimiadis, S., Kirkini, A., Nikooudis, N., Penna, V., 2001. Public and personal life in Greece from ancient years until meta-byzantine years, Patras Greek Open University, Human Studies Department Hassiotis, ǿ., 1974. Hellenism during the first two centuries after the Capture, History of Greek Nation:ǿǯ, Athens: Ekdotiki Athinon Haviara-Karahaliou, S., 2006. Folklore and medicine, reprint from issue No 39 of Newsletter of Institution of Korinthian Studies, pp. 3-5 Holland, B., 1994. Prospecting for drugs in ancient texts, Nature: 369, p. 702 Imellos, S., 1994. Folkloric issues, Athens Kadda, ǹ., 2007. Social and historical approach of health, illness and medicine in Greek area during 16th and 17th century: the case of No 218 manuscript of Monastery of Iviron of Mount Athos , Doctoral Dissertation, Panteion University of Athens Karas, G., 1994. Sciences during Turkish Occupation period, Athens: Estia Kiriakidis, S., 1925. Popular medicine, Clinic: 1, p. 36 Kostis, Ȁ., 1995. The time of plague. Iraklio: University Publications of Crete Kouzis, ǹ., 1930. The project of Neophitos Prodrominos about the misfortunes, Athens: Estia Lidaki, ǹ., 2001. Qualitative methods of social research, Athens: Kastaniotis Louros, N., 1967. Retrospections, Athens: Parizianos Maniatis, P., 2002. History of medicine from prehistoric years since today, Athens: Entos

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Mavromatis, L., 1989. Views of philanthropy at Byzantine, Transactions of ǹǯ International Symposium, Athens: Center of Byzantine Studies, p. 148 Mpimpi-Papaspiropoulou, A., 1989. Byzantine medicine and metabyzantine Nostrum Codes. The contribution of Byzantium to the occupied Greek nation, Greek Medical Tradition: Bǯ, ǹthens, p. 27 Oikonomidis, D., 1951. Popular medicine in Thrace, Reprint from archives of Thracian folkloric and Linguist Thesaurus: ǿȈȉǯ, ǹșȒȞĮ, pp. 196-211 Papagianopoulos, I., 1992. Elements of History of Medicine, Ioannina Papaspirou, N., 1944. Short History of Medicine, Athens: Pyrsos Publications Pentogalos, G., 1983. Introduction to the history of Medicine, Paratiritis: Salonica Rigatos, G., 1996. Medicine in “The Murderess” of Papadiamantis, Athens: Domos Smith, E., 1989. Learning from the past, improving upon the present: traditional and western medical systems at the juncture, Journal of Health Social Policy: 1(2), pp. 109-130 ȉemkin, ȅ., 2002. ȅn second thought and other essays in the history of medicine and science, The John Hopkins University Press Tountas, G., 2000. Society and health, Odisseas: Athens Tselikas, A., 1999. Charms and exorcisms in two meta-byzantine manuscripts, Archaeology and Arts: 71, p. 31 Tselikas, A., 2004. Issues of Greek paleography, Athens: Institute “Arethas” ȅcana-Rodriguez, E., Lewis, J., 1998. The History and Philosophy of Medicine and Health: Past, Present, Future, Sheffield: European Association for the History of Medicine and Health Publications Vourazelli, Ǽ., 1939. The life of Greek people during Turkish occupancy based on foreign travelers: ǹǯ, Athens

CHAPTER THREE CULTURE CONFLICT AND SUICIDAL BEHAVIORS AMONG ETHIOPIAN YOUTH IN ISRAEL ARNON EDELSTEIN

Abstract Despite sixty years having passed since Sellin wrote his famous book on immigration and crime, his theory is still relevant in explaining antisocial behaviors among second generation immigrants. Ethiopian youth, brought to Israel since 1984, experienced a major cultural and social conflict within Israeli society. As a result, parental authority and control over a child’s behavior had vanished. Some Ethiopian youth experienced social difficulties integrating into Israeli society, having higher school dropout rates and differential association to veteran vagrant Israelis as well as to other Ethiopians in their situation. Consequently, there is an over-representation of Ethiopian youth with antisocial behaviors, including: juvenile delinquency, substance use and suicidal behaviors. The pilot study presented here introduces independent variables that explain risk and immune factors for suicidal behaviors among Ethiopian youth. While some of the variables mentioned are known from former studies across the world, other variables are linked directly to the culture conflict experienced by Ethiopian youth in their encounter with Israeli society. Key words: Ethiopian, culture conflict, risk and immune factors for suicidal behaviors.

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Introduction While the connections between immigration and anti-social behaviors are not new, they continue to capture academic as well as public attention, especially as the globalization process continues. Sellin (1938) was the pioneer in studying these connections and until today, his theory on culture conflict and crime, was ratified by many academic researchers in various countries (Freilich, et al., 2002; Edelstein, 2000, 2006; Waters, 1999; Tonry, 1997). One of the important assumptions in Sellin's theory is that second generation immigrants have more antisocial behaviors (including crime) in relation to veteran youth in the absorption society. Israel, like other immigration countries, acts as a natural laboratory when studying immigration as well as the relationship between immigration and anti-social behaviors. Since the 1950s until today, 40% of Israel’s population was born abroad (Israel National Bureau of Statistics, 2008). This article suggests a theoretical explanation to the higher levels of anti-social behaviors, in general, and the higher levels of suicidal behaviors among Ethiopian youth, in particular. This explanation is unique because it shows how the concept and variables of culture conflict play an important role in explaining such behaviors among immigrant youth.

The Concept of "Culture Conflict" According to Sellin (1938), in immigration situations, members of one culture who immigrate to another bring with them values and norms that permit or forbid certain behaviors in specific "life situations" (circumstances). These values might conflict with the norms and the laws of the host culture (Wolfgang, 1968). Culture conflict includes two concepts. First, it is a values and culture conflict that occurs between the culture of the immigrant society and the values and norms of the majority culture of the absorbing society. Second, a structural and social conflict manifests in discrimination against immigrants through the socioeconomic stratification system of the absorbing society; this is caused by the intentional or unintentional differential allocation of resources between the immigrants and the native population. As a result, certain immigrant groups find themselves at the bottom of the social stratification ladder of the absorbing society. One result of culture conflict may be the weakening of the social and cultural structure of the immigrant group, followed by an acculturation processes to the absorbing society. In addition, while the parent generation

Culture Conflict and Suicidal Behaviors among Ethiopian Youth in Israel 43

attempts to conserve the “culture of the old world,” their children (the second generation) undergo processes of “acculturation” and “socialization” to the culture of the absorbing society. If there is a culture conflict between these parents and the absorbing society, an inter-generation culture conflict will follow, resulting in possible alienation, abandonment, delinquency and other forms of social deviance with regards to the second generation.

Anti-social Behaviors and Crime in Second Generation Immigrants In his work, Sellin (1938) also linked immigrant youth to culture conflict and crime. These youngsters experience culture conflict as they undergo a process of socialization into the norms of the absorbing society, norms that often clash with those of their immigrant parents. While the relationship between culture conflict and anti-social behaviors among the second generation is not direct, it is mediated through the culture conflict experienced by first generation immigrants. Rahat (1985) and Hassin (1985, 1992) discerned the dual acculturation process undergone by the children of immigrants. In formal institutions of the absorbing society, such as school, children undergo acculturation; however, when at home, parents generally attempt to socialize their children into the norms of the culture of origin ("the Old World"). Assuming that the two cultures differ, a culture conflict is created in these children- one that is more complex than the conflict faced by their parents. Furthermore, at the individual level, the child experiences an emotional conflict with his parents, as he is torn between loyalty and love for his parents and a wish to belong (through the acculturation process) to groups in the absorbing culture (Shoham et al., 1987). This conflict is fed by the fact that it is clear to the child that loyalty to the norms and the groups representing the culture of origin equals little or no social mobility for him in the host society. Foblets (1998) discusses the results of dual socialization. He notes that this situation creates a normative conflict which increases the rate of antisocial behaviors. In his opinion, many young immigrants drift and tend to waver in and out of their native culture towards the norms of the absorbing society. One disturbing result occurs when these youngsters break their ties with tradition before they have absorbed the behavioral models and norms of the host society. At this point, another problem linked to the characteristics of adolescence can appear. According to Foblets (Ibid., 191-2), “Culture

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conflicts that derive from second generation immigrant delinquency contain at least three contradicting cultures: 1) the culture of the absorbing society, 2) the culture of origin, 3) the youth culture that includes a code of honor or solidarity between the age group.” At the age of adolescence, and earlier, young immigrants experience an additional responsibility as they assimilate the language, customs, and culture of the absorbing society more rapidly than their parents. Accordingly, these youngsters assume - or their parents impose upon them - the role of mediators between their parents and the institutions of the absorbing society. A great deal of responsibility is thus placed on the shoulders of youngsters who are not mature enough to assume such responsibility. As a result, parents lose their authority over their children, becoming dependent on their children. Children feel the reversal of these roles: they function as adult children, precisely at a critical stage in their lives when they are in need of support and of maximum guidance from their parents. Sellin (1938) noted that the rapid passage from one culture to another may lead to the loss of social control by primary groups, principally by the family. The main difficulty in supervising immigrant youngsters stems from their departure from the "ethnic ghettos" and their coming into contact with the norms of other cultural groups. These youths either undergo a process of acculturation to the norms of the absorbing society or are introduced to models and patterns of anti-social behaviors (Yeager, 1997). This situation of social disorder can, in Sellin's opinion, explain the higher rates of delinquency in second generation immigrants. Other scholars, such as Gluck & Gluck (1959), also saw culture conflict as a significant factor in the development of delinquent behavior among the children of immigrants. Eisenstadt (1965) observed a situation in the formal education process whereby the identity and loyalty of the youngsters are transferred from the primary structure (family) to the general structure (society). He considers that the lack of support by the family and the community of origin during this socialization process occurring in school can lead to disintegration and social deviance; this results from growing inter-generational tension.

Culture Conflict among Ethiopian Immigrants in Israel In Ethiopia, Jews lived in rural communities that encompassed several households. The community was based on patriarchal and hierarchical relations. At the head of the social-religious ladder were “Kessim” who constituted the supreme spiritual leadership. They were knowledgeable,

Culture Conflict and Suicidal Behaviors among Ethiopian Youth in Israel 45

could read and write, and transmitted the laws to the community, principally according to the "Orit" (the Bible) (Baharani, 1990; Salomon, 1987). At a lower level were the elders of the community ("shimglautz") who had authority in interpersonal matters, giving consultations in family and social decisions. The hierarchical structure found in the community was replicated in the family and therefore, in both settings, the emphasis is on showing respect for the adults, in general, and for parents, in particular (Weill, 1991). Ethiopian Jewish culture includes a normative system that emphasizes customs related to purity and impurity. This system was designed to preserve and protect the faith of the community when in non-Jewish surroundings. Ethiopian Jews strictly observed the customs of purity in order to prevent assimilation and impurity. These behaviors included separate quarters for women ("hut of ritual impurity") after childbirth and at the time of the monthly period, ritual washing of the hands and ritual immersion after contact with any non-Jew, and examining the genealogy of seven generations before marriage, etc. The “Code of Honor" is another key cultural component which refers to the obligation of honoring the person of authority. This code is a normative system linked to relations of authority within community and family, between the members of the community, and towards external agents of authority. Ben-Ezer (1989) interprets the main concepts of this code: every person is bound to respect his hierarchical superior; a person's rank is determined by gender, age, familial authority and function inside and outside the community; it is forbidden to refuse to answer this person or to ask the authority figure too many questions (since this constitutes disrespect); characteristics such as restraint, courtesy, and obedience are a result of the code of honor, and are therefore considered fitting. The use of language, also derived from the code of honor, causes language to be metaphoric rather than direct. Other behavioral norms emphasized are: personal responsibility, mutual responsibility, trusting one's interlocutor, confidence in the word/promise of a person of authority, and confidentiality. This hierarchy is a traditional system that resembles that of North African Jewish communities that immigrated to Israel in the 1950s. However, Ethiopian immigrants are, first and foremost, characterized by their skin color and their unique religious customs, setting them apart in an unprecedented way from the previous waves of immigration to Israel. Ben-Ezer (1992) outlines the following differences between Ethiopian Jewish culture and Israeli culture in an attempt to explain situations of

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culture shock and culture conflict that have appeared among Ethiopian immigrants since the mid-1980s: Religion – While Jews in Ethiopia were defined as religious, they encounter a secular majority in Israel ("Zion"). Skin color – In Ethiopia, the majority has dark-colored skin; in Israel, the majority is white. Community – In Ethiopia, they lived in rural communities; in Israel, they live in cities. Employment – Most of the employment in Ethiopia is in agriculture, in self-employed work; in Israel, most employees earn a salary and work as part of services and modern industry. Education – In the country of origin, the majority of the population was illiterate; in Israel, most of the population has at least, completed elementary school. Concept of time – In Ethiopia, time was flexible, following daylight hours and seasons of the year; in Israel, one has to follow a tight schedule, as everything is scheduled Leadership – In Ethiopia, people followed the traditional religious leadership of the elders and the Kessim; in Israel, the leadership is young, secular and educated. Culture code – In the country of origin, there was a code of honor involving courtesy and restraint, whereas in Israel the code calls for directness in social contact ("bluntness"). Family – In Ethiopia, the model was that of an extended, authoritative and patriarchal family, in which the child constituted an auxiliary force with marginal status; in Israel, the family is egalitarian and democratic and the child fills an important position. As seen above, the differences between the two cultures are tremendous. In addition to the fact that Ethiopian immigrants lack the relevant professional and educational skills in order to integrate into modern Israeli society, their skin color and religious customs create another obstacle to their integration and adaptation to the absorbing society in Israel (Kaplan & Salamon, 1998).

Bureaucratic Absorption of Ethiopian Immigrants The bureaucratic absorption to which Ethiopian Jews were subjected was characterized by paternalism and cultural ethnocentricity (Herzog, 1998; Halper, 1985). As an example of bureaucratic paternalism, Hebrew

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names were given to the immigrants, regardless of the meaning of the name in relation to the individual’s identity (Shabtai, 1999). These immigrants were concentrated in absorption centers, which constitute a kind of "totalitarian institution," where civil servants controlled the immigrants’ lifestyle. In the case of the Ethiopians, the centers worked precisely in favor of separation, alienation, and bureaucratization; center employees acted as supervisors, controllers, and mediators in the immigrants’ relations with other institutions. All of the interactions between the immigrants and the outside world passed through these civil servants, and not through the immigrants themselves, thereby preventing the development of relations between the two parties. Immigrants were treated as part of a "needy" and "primitive" category; as a result, these civil servants were entitled to interfere in the immigrants’ daily lives, to channel their connections and to adopt determining functions, as the civil servants saw fit. This situation led to disregard for the culture of origin of the immigrants, a delay in their integration into the absorbing society, and enhanced their dependence on the absorbers (Herzog, 1992, 1998). The stay in the absorption center created ghetto-ization, secularization, and a continued lack of relevant education and employment skills for their advancement and integration into Israeli society. These issues developed alongside manifestations of "culture shock" (Minuchin-Itzikson, 1983). Decisions concerning the geographical distribution of the immigrants and of the extended family, in regards to the type and the location of the educational institution to which the immigrant children are to be sent and in regards to the placement of the immigrants in temporary residences, are prejudicial, making it difficult for the immigrants to integrate into the absorbing society. In fact, there is a high concentration of immigrants in economically and socially weak towns, thereby creating "pockets" of immigrants in weak neighborhoods (Posner, 1996); some of these weak neighborhoods have become "black" ghettoes (Ben Ezer, 1992). It can be said that the objective intercultural differences, which are strengthened at the time of absorption, together with the ethnocentric treatment of the immigrants by the absorbers, have led to a situation of culture conflict and difficulty when immigrants are in the process of adaptation and acculturation to Israeli society.

The Difficulties of Ethiopian Youth Immigrants In Shabtai's view (1999), Ethiopian immigrants had to deal with their group identity as their Jewishness came into question. The Israeli Orthodox Rabbinate cast doubt on whether or not this community was, in

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fact, Jewish and therefore, demanded that the immigrants undergo a symbolic conversion. These doubts stemmed from the controversy over the immigrants’ origin - and the threat to their self esteem mainly because of their different skin color. These obstacles raised uncertainties and inequalities with respect to the legitimate belonging of Ethiopian immigrants to Israeli society. This situation, in turn, led some immigrants towards a life characterized by marginality, alienation, social isolation, stigmatization, and ostracism. While some immigrants attempted to prove that they were similar and equal to their Israeli counterparts, others, principally the adults, clung together in the “culture of origin" in order to protect their sense of identity. Bodowski (et al.) (1994) classifies the acculturation process of the immigrants as: "mainly there” – the elders; "mainly here” – the children; "here and there” – the youths; and "neither here nor there" – a group of youngsters who have cut themselves off from Ethiopian culture, have not integrated into legitimate Israeli culture, have dropped out of the education system, and have adopted the Afro-American identity. As a result of the culture conflict, a situation of social disorder appears. This situation manifests itself at various levels: the community, the extended family and the nuclear family. Dolev and Gendelman (1989) indicate that at the community level, immigration to Israel has led to the dismantlement of social networks and eliminated community life as it originally existed. In Israel, there is an artificial change whereby members of the ethnic community who come from different families form one large community. This change undermines the familiar community structure (Barahani, 1990). The family structure that was known in Ethiopia disappears in Israel, since members of one family can be placed in different absorption centers, and the family can be split along its nuclear structure precisely at a time when its members require a broad support structure (Kaplan & Salamon, 1998). Regarding the nuclear family, the conditions and norms in Israel no longer enable the family members to follow the women’s laws of purity as they did in Ethiopia. In addition, according to Israeli law, the woman is the one who receives the National Insurance benefits. Therefore, in Israel, the balance of power between the sexes is changed; the woman has both higher status and greater independence than she did in the country of origin (Cohen, 1994). The status of the Ethiopian male is substantially weakened in Israel. He changes from being self-employed to being a salaried worker, from being a professional to being someone without a profession; and now in Israel, he comes into contact with women as figures of authority (Bodowski,

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1990). This situation poses a threat to the male who feels frustrated and helpless as he is stripped of his traditional status; it leads to tensions within couples and in certain cases to serious consequences such as divorce, murder, and suicide (Weill, 1995). Another important factor with regards to family in the context of culture conflict and the bureaucratic absorption is the relationship between subsystems of parents and children, particularly as the children grow up. Immigration to Israel, followed by the breaking of the social systems linked to Ethiopian culture, led to a weakening of the "code of honor" whose role was to maintain and implement these structural systems. Taking children from their homes, sending them to "Youth Aliyah" residential frameworks and to educational frameworks such as boardingschools, creates a situation whereby the father loses his authority as being a source of knowledge for the child; in addition, there is a role-reversal, whereby the child knows more than his father, particularly regarding mastering the Hebrew language and regarding the activities operated by the absorption authorities. This role-reversal leads to parental dependence on the children and in certain cases, results in disobedience of the youngsters (Dolev-Gendelman, 1989; Edelstein, 2000, 2006). The children want to be Israelis; school socializes them into different and even conflicting behavioral norms in relation to those of their parents. This situation leads to an inter-generational conflict with serious consequences: parents try to demand obedience and loyalty to the old culture, but are unable to provide their children with tools to deal with the new culture and with the norms it sets before them. Hence, the cultural norms of the parents are liable to be perceived by the children as an obstacle to social mobility in Israeli society (Minuchin-Itzikson, 1983). Furthermore, parents themselves are too busy to care for the emotional and material needs of their children. Most parents are disoriented and have difficulty mediating between their children and Israeli society. This problem occurs precisely when the children encounter new norms and unknown situations that call for parental guidance and mediation (Bodowski, et al., 1990). Many scholars have analyzed the problematic nature of the absorption of Ethiopian immigrants in the education system (Zahavi, 1989; Szold Institute, 1986; Weill, 1988; Golan-Cook et al., 1987; Gwili, 1997; Edelstein, 2000). In the late 1990s, some 90% of Ethiopian youngsters were sent to residential frameworks or youth villages (Association for Ethiopian Jewry, 1995), while today only approximately 54% remain in these frameworks since many return to the community. In these youth villages they meet, among others, veteran youths at risk; thus, they associate with groups characterized by anti-social behavior ("differential

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association," Sutherland, 1939). School students of Ethiopian origin also suffer socially from stigmatization and sometimes from rejection due to their skin color. Some are advised to study tracks that do not lead to a matriculation certificate (approximately one-third). Only approximately 20% of Ethiopian youth immigrants obtain their matriculation certificate as opposed to some 50% among veteran Israeli youths (Lifshitz, et al., 1998; Zahavi, 1989; Golan-Cook, et al., 1987). Lifshitz et al. (1998), in their report, characterize the population of school children of Ethiopian origin, ages 12-18, who were enrolled in the education system that year: approximately 20% come from one-parent families, one-quarter are in families with six children or more, half have a parent over age 55 and in 66% of the families, there is no breadwinning parent. In other words, beyond the difficulties these youths encounter in the education system, they come from socio-economically disadvantaged families and towns, located in the periphery, with parents who are unable to function as guides and support, not to mention as supervisors of their children's behavior. Naftali (1994) points out the open and latent dropout rates of about 6.2% of youth of Ethiopian origin (compared to 3.5% among veteran Israelis). In addition, he mentions that there are hundreds of Ethiopian youngsters in situations at-risk. School becomes a frustrating medium for youngsters who experience reoccurring failure, and who feel that the legitimate means towards social mobility are unavailable to them. Shemesh (1998), Lahav (1997), and Lifshitz et al. (1998) characterized Ethiopian youths-at-risk, as follows: (1) Family-related difficulties with respect to structure and the parents are low functioning: When the code of honor is not maintained, parents are unaware of their children's whereabouts. There is no parental supervision or obedience. (2) Difficulties relating to the learning process: Adjustment difficulties affect learning and generate serious gaps. The youngsters lack learning tools and skills and their parents cannot help them, so they drop out of school. (3) Environmental and family-related difficulties: An ever-growing intergenerational gap leads to the abolishment of the "code of honor" and to a lack of parental control. The studies mentioned above clearly show the link between dropping out and types of risk behavior, including delinquency. The salient picture of youths-at-risk is one of failure in the education system, together with inter-generational conflict and intensified due to immigration. This results in a lack of parental supervisory ability and differential association of Ethiopian youths with the members of their community or with veteran

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Israelis in disadvantaged neighborhoods, who are also in situations of vagrancy and alienation. A social learning process mat result in overrepresentation of Ethiopian youth in anti-social behaviors (Edelstein, 2000, 2003, 2006).

Suicidal Behaviors among Veteran and Immigrant Youth Suicidal behavior is an example of anti-social behavior. In traditional Judaism, suicide appears to be a major sin because it is believed that only God gives and takes life. Accordingly, suicidal behaviors among Ethiopian youth can be seen as a process of secularization that the youth are going through because of their assimilation in Israeli society, or it can be seen as an indication of the major distress that these youth are living in. The theoretical and empirical literature on suicidal behavior among youth suggest a variety of risk factors: former suicidal attempts, mental disorders and substance use, among the youth and/or his parents, history of sexual or physical abuse, stress factors, acculturation stress among immigrants, contagion and accessibility to means like weapons or drugs (King, 2004; Hawton, 1986; Pelkomen & Mattunen, 2003; Galas, 1994; Maris, 1992). Studies on suicidal behaviors of youth in Israel did not find a significant difference between veteran Israelis and immigrants, and between youth from different socio-economic classes. These findings contradict studies made in other nations (Mei-Ami, 2004; Gilat & Shif, 1995). One of the more up-to-date explanations regarding suicidal behaviors among immigrants states that, in fact, there is a connection between immigration and suicidal behaviors. According to this explanation, immigrants are at risk because they experience mental and linguistic difficulties and they suffer from lacking a social network. In addition to these problems, immigrant youth find themselves stuck between two cultures. As a result, they suffer from identity problems and find it difficult to solve conflicts because no proper social model exists for them. Accordingly, in stressful situations they may adopt self-destructing behaviors, including suicidal behaviors (After & Froidenstein, 2001).

Suicidal Behaviors among Ethiopian Youth Suicidal behavior among Ethiopian youth did not gain an empirical scientific analysis, despite the fact that the ratio of suicidal youth among

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Ethiopians is seven times the ratio of suicidal youth in the general population ages 12-18 (Israel Ministry of Health, 2003-2006). The assumption is that there are risk factors as well as protective factors that can be universally and/or culturally influenced. The pilot study: the sample includes sixty-two youths from the two main towns in Israel where Ethiopian youth have committed suicide. These towns are not different in respect to other towns that have absorbed Ethiopian immigrants. Closed and open questionnaires included demographic, familial, social and school data as well as information on suicidal behaviors, such as thoughts and attempts (Willburn & Smith, 2005; Roberts & Roberts, 1997). Some of the questions in the closed questionnaire defined two main measurements or indices: One is "the despair index"- This index was based on questions that examine the responders’ confrontation with daily problems and their perception of their future (alpha=0.77). A high score in this index means that the youth confront a majority of the problems they face without a solution, and see their future in a pessimistic light. The results show significant (X2