by Zach Obaji
Chapter 5 in the Encultured Brain discusses Memory and Medicine, and memory plays a crucial role in medical decision making. Author Cameron Hay proposes a “neurological model of knowledge that compares how sociocultural traditions and neurological processes co-create distinctive possibilities for remembering (Hay, 142). After conducting fieldwork on coping and the medical traditions of the Sasak people in Indonesia, Hay conducted research in Southern California and to study the different neurological basis of memory in the American medical tradition compared to the Sasaks. The bicultural studies of medical traditions in America and Indonesia reveal significantly different practices in patient care, and both traditions have completely different neurological processes that work differently within the context of memory and healing. The chapter also discusses the four important memory systems along with their neural structures that correlate to the specific type of memory used in medical traditions.
The four memory systems that are important to medical traditions are episodic, semantic, procedural, and working memory. Episodic memories are memories of autobiographical events that can be explicitly stated or conjured. A physician who remembers examining his patient would be an example of episodic memory (Hay, 146). Secondly, semantic memory consists of general facts and knowledge such as the fact that acetaminophen is an analgesic. Episodic and semantic memories are both explicit and declarative, which enables content knowledge (Hay, 146). The third important memory system involves the memory of learned motor behaviors and skills that are unconscious—procedural memory. Imagine a surgeon who performs an appendectomy. The surgeon is likely using procedural memory, removing this vestigial organ is a smooth operation that the surgeon has likely performed hundreds of times. Lastly, working memory “involves allocating attention and linguistic resources for second or minutes to address problems at hand [that] may be relevant in both healers’ conscious efforts to address unfamiliar illnesses (Hay, 147).
The three critical neural structures that are important to these memories involve the hippocampus, basolateral amygdala, and the basal ganglia. The hippocampus is found in the medial temporal lobe, and it is essential for episodic memory. Also located within the medial temporal lobe, the basolateral amygdala is an important structure that makes up important nuclei. Stress responses stimulate these nuclei, and the amygdala plays an important role in “episodic and effortful semantic memory recall” (Hay, 147). The basal ganglia is important to procedural memory, which catalyzes memory processes independent of the hippocampus.
Hay compares and contrasts the American medical traditions to the those of the Sasak people in Indonesia. The Sasak medical tradition revolves around memory precision that is central to their medical practice; these potent “memorized formulate” are almost always retained from oral knowledge and are passed down from ritualized distribution. The knowledge retained by the Sasak are “primarily tightly constrained, episodic learning dependent on the hippocampus, medial temporal lobes, and the prefrontal cortex (Hay, 155). The knowledge within the American medical tradition differs greatly from that of the Sasak. American medical knowledge is obtained through not only through a scientific basis, but are also further refined from clinical experience. Hay describes the American medical knowledge as “encoded semantically, episodically, and procedurally and over time reconsolidated into schemas that can be accessed through the hippocampus as well as through the basal ganglia (155). As we can see, the Sasak medical tradition differs significantly from that of the American tradition. However, neither system is wrong, just extremely different.