When Amish patients interact with Western medical systems, they enter clinics and hospitals where the doctors and nurses who care for them do not share their understandings of nature, illness, and personal hygiene. Some Amish people distrust modern medicine because it is such a foreign and inexplicable world, and they opt out of mainstream medical care and pharmaceutical treatments. Ironically, although they may not understand genetics, many Amish people, because of their involvement in animal husbandry, understand heritability much better than many other Americans.
The Amish inhabit a sacred world filled with the spirit of God, who intervenes to bring about certain outcomes, and Satan, who seeks to distort God’s plans. They see nature as God’s handiwork and think that the more one embraces nature, the closer one walks with God. Likewise, because the body is a natural organism, the more one treats its ills with natural remedies, the more one is in tune with the mysteries of God’s intents.
The Amish see modern attempts to explain and control nature, especially scientific techniques to control the body and prolong life—goals most non-Amish patients embrace—as sometimes obstructing the will of God. The Gelassenheit disposition to accept whatever comes means that Amish people are reluctant to hinder divine providence.
Such a stance may seem fatalistic to modern sensibilities. But if the Amish embraced a fatalistic worldview, they would never see a doctor or do anything to enhance their health. However, Amish people want to be healthy, and they want to avoid sickness and injury.1 They consult health care providers and use vitamins and homeopathic remedies. Many take prescription drugs and have high-tech surgical interventions because they believe these measures may heal them or prevent illness. Yet in general, Amish people are more willing to stop interventions earlier and resist invasive therapies than the general population because, while they long for healing, they also have a profound respect for God’s will. This means taking modest steps toward healing sick bodies, giving preference to natural remedies, setting common sense limits, and believing that in the end their bodies are in God’s hands.
Navigating Health Care
It is risky to generalize about Amish behavior, and health care is no exception. A diversity of perspectives and practices reigns across affiliations as well as within them. Some Amish people wear copper rings to ward off arthritis, go to unlicensed Amish “doctors” for care, and have their teeth pulled to avoid the need for future dental care, while members of other Amish groups dismiss such practices as foolhardy. Some households see a doctor only in emergencies; others go regularly to a family physician. Certain families would not consider open-heart surgery for a loved one, but others, sometimes even in the same Gmay, would welcome it.
Issues such as trust, friendship, and personal demeanor weigh heavily in the choice of health care providers. The rural family physician, who has a personal relationship with patients or even makes house calls, is the ideal doctor in Amish eyes because such an easygoing, high touch, low-tech style perfectly fits their values. For these reasons many Amish people will go to chiropractors before medical doctors and may even travel to Mexico for treatments in clinics whose chatty doctors and staff do not rush them through examinations. With limited schooling and English as a second language, Amish people can easily be intimidated by the often impersonal, jargon-filled, high-tech world of hospitals, with their frenetic pace and baffling bureaucracy.2
No official Amish pronouncements regulate health care. Choices are molded by tradition, extended family, ordained leaders, and informal conversations in the church-community. When his cardiologist advised seventy-nine-year-old Yonie Esh to have his heart valve replaced, his first thought was, “No way. At my age what’s the use?” But then his children “sort of talked me into it,” he said, and after reading the Bible, he decided to “give myself up to the surgery.”3 Unlike Esh, a seventy-five-year-old bishop with heart disease in a very traditional group refused any medicine or surgical interventions although doctors repeatedly told him he would die without them—and he did.
Extraordinary interventions for a premature baby or an elderly person rarely occur among the Amish, in part because of cost, but also because of a reluctance to interfere with God’s will. Few families want to keep a loved one on life support for more than a few days. Blood transfusions are acceptable, and some Amish people are regular blood donors. Elective abortions require no discussion because they are categorically considered wrong. Likewise, in vitro fertilization would rarely if ever be considered, although less expensive and less invasive fertility treatments are sometimes used. Decisions about how to treat heart disease, cancer, and other serious maladies are in the hands of family and friends, and like other people, Amish families do not always agree on how to proceed.
For religious reasons and because they are frugal, few Amish people have commercial health insurance, and most pay their health care bills with cash. Some Amish employees in English-owned industries do participate in company health plans. The Amish were exempted from the 2010 Patient Protection and Affordable Care Act, which mandates health insurance coverage, because of their religious objections to receiving government aid.4
Sometimes cost and convenience limit access to health care. Typically, Amish people have easier access to general practitioners who live nearby than to specialists in urban areas, which require hiring a driver. Although they may not understand the intricate economics of the health care system, Amish patients do know that a fifteen-minute visit with a doctor and a few tests might result in a bill of several hundred dollars or more. The accelerating costs of health care in the twenty-first century have levied a heavy burden on Amish communities, and some expensive procedures are simply rejected. Cautions about modern medicine and its cost lead some Amish people to use it as a last resort, which may at times create medical complications and actually increase the cost.
Perhaps as a result of the high cost, the Amish have become shrewd consumers of particular kinds of health care, especially for emergencies. For example, one family in upstate New York telephoned neighbors to find someone who could drive an injured boy with a “cut finger” to the emergency room. The family wanted the boy to go to a hospital in Ontario rather than to the closest one in New York because the Canadian hospital was much cheaper. Furthermore, the boy’s father explained, if the Ontario hospital didn’t have a surgeon, patients could transfer to “a teaching hospital with doctors on call for different kinds of emergencies.” He also advised not calling ahead, because if you do, he said, “they might tell you that they can’t help you and send you elsewhere. If you just show up, then they have to take you.”5 Despite his limited knowledge of modern medicine, this man had learned how to navigate the health care system for his advantage.
Amish people routinely meet with health care providers to work out payment plans and to negotiate lower rates for cash payment. Some Amish communities have forged agreements with hospitals for significant health care discounts. In some locations hospitals compete for Amish patients because they pay cash, bypass insurance regulations, and almost never file malpractice lawsuits.
Many hospitals no longer try to accommodate self-pay patients, however, because hospitals negotiate reduced rates with the government and insurance companies. As a result, Amish patients are sometimes charged higher rates for the same treatment than the hospital receives from insurance companies. Hospitals in areas with large Amish populations are generally better than hospitals in areas with smaller Amish populations at recognizing this problem, but it varies regionally and even among patients in the same hospital.
Many liberal communities have Amish-style “health insurance” plans with premiums and high deductibles; after these are paid, the plan pays some but not all of the expenses. These informal church-aid plans are run entirely by volunteers. Other Amish groups help needy families through voluntary contributions. Typically, it is the job of the deacon to collect or supervise the collection of contributions and, in some settlements, to make financial arrangements with med
ical care providers. In northern Indiana, one deacon volunteer works full time advising Amish people about where they can obtain the best value for professional health care and reviewing their medical bills. Although the Amish emphasize personal responsibility, each individual also knows that, upon joining the church, he or she has accepted responsibility for sharing the burdens of the other community members.6
Resources for Health Care
Amish people tap resources in four systems of care when they seek treatment for physical and mental ailments: folk, alternative, standard, and church-community. Often they use a combination of resources from these four systems. The use of each type of care varies widely by family, affiliation, and settlement. An Amish person may, for example, seek mental health care from a self-trained Amish counselor (folk system), travel to Mexico for cancer treatment (alternative system), go to a state-of-the-art hospital for a knee replacement (standard system), and receive visits and financial support while recuperating (church-community system). The lower groups rely primarily on the folk and alternative systems, using standard care only for emergencies. At the other end of the spectrum, some families in higher groups rarely if ever visit folk practitioners and routinely use the resources of modern medicine alongside homeopathy. All Amish people, however, tap the resources of their church-community.
Extended families are large and provide rich health care resources as well as advice and recommendations. A typical thirty-five-year-old married person is embedded in an extended family system of more than two hundred people. In addition to this dense family network, friends in the Gmay and larger church-community also stand ready to help. Thus, Amish people are rarely alone when they face illness, accident, suffering, or grief. The family system may at times offer erroneous advice or worthless treatment, but its empathic, loving intent meets emotional needs that the modern health care system may be ill-equipped to address.
Folk Resources
Amish people, in general, have a high respect for traditional remedies.7 The kinship system preserves the wisdom of past generations—knowledge for delivering a baby, tips on toilet-training a child, advice for coping with stress or caring for an injury, and so on. They will often try a traditional herbal concoction for burns before going to a doctor. Although they do turn to doctors and hospitals for emergencies such as broken legs and clogged arteries, Amish people rarely see a physician for a cold or simple illness, believing that patience, hot tea, and a homemade remedy are the best cure. Die Botschaft includes a weekly column about home remedies that have been passed along for generations. For example, one treatment for poison ivy suggests rubbing the inflamed skin with water into which a blacksmith has dipped horseshoes, and another suggests using a warm vinegar-water soak. Coltsfoot tea is suggested for chest congestion, and hot lemonade for a head cold.
Beliefs about “drawing pain” off of others may involve family members as well as others. “Mothers can’t draw pain off their own children,” one woman asserted, in explaining an old practice of an ultraconservative group. In other words, those with ailing offspring must seek help from others. Attempting to relieve one dying elderly woman’s pain, several men joined hands in a line. The first laid his hand on the woman, while the last held a wire that went into a tub of water. The pain passed through the men and into the tub. In another case that required six men to draw pain off a suffering child, a woman noted that the water in the bucket “became thick with the pain.” One woman implicitly linked medical help to more general social support by noting that, because she is good at drawing pain, other women give her the fussy babies to hold so that she can calm them.8 This ritual of care, which brings great comfort to the sick and a sense of solidarity to those trying to mitigate the suffering, is only practiced in the most traditional groups. Members of some higher groups consider it witchcraft.
Various Amish folk practitioners provide services designed to promote healing. Perhaps the most curious of these to modern minds is sympathy healing, also known as brauche, or powwowing. These “arts” were typical of German immigrants to southeastern Pennsylvania in the eighteenth century.9 Folk practitioners use incantations and charms that have special powers to detect and purge illness in the body. A woman braucher explained that after she “finds the sore” with her hands, “I let it [the pain] out, shake a little, blink my eyes.” One of her male patients described her reaction to finding his pain spot: “She threw her head around, her eyes rolled in her head, and she emitted a series of staccato popping sounds.”10
The secret skills are learned or transferred from older brauchers—often of the opposite sex. Many Amish people view brauche as a form of witchcraft and shy away from it. An Amish cousin of a female “healer” believes that her cousin’s art comes from the devil, and an Amish man in the same settlement declared that “the church forbids it [powwowing].”11
Members of more liberal groups rarely use brauchers, but in the mid-1980s in northern Indiana, Amish people identified fifteen self-taught Amish folk healers. Patients said they sought out healers to treat small children, keep costs down, and avoid using drugs, and also because they were convenient.12 In some cases healers have a dispensary of herbs, supplements, and other homespun remedies. Their services, typically based at their home, are advertised only by word of mouth.
In addition to the traditional brauchers, a handful of Amish “doctors” practice other healing arts. These healers, who do not have professional training or state certification, include dentists, physical therapists, chiropractors, and midwives. Many sidestep state regulations by accepting donations from patients rather than charging for services. Some of these mavericks have run afoul of state regulations governing medical practice. Solomon J. Wickey, originally from Berne, Indiana, was known as an iridologist who could diagnose patients’ ills by looking in the irises of their eyes. In the 1980s, he was charged with practicing medicine without a license. Wickey eventually agreed to refrain from offering patients formal diagnoses, but he was allowed to recommend remedies and nutritional supplements.13
In a 1989 legal case that terminated his career, Amish “chiropractor” Joseph W. Helmuth of Elkhart County, Indiana, faced not only the sanction of the state but the ire of professional chiropractors and the censure of the church. Helmuth had provided chiropractic treatments and physical therapy to an estimated six thousand people over sixteen years. He eventually pleaded guilty to practicing chiropractic treatment without a license, but he was permitted to provide some treatments with, in his words, “certain restrictions which I will try to accept.” The church censured him, not for his practice but for hiring a lawyer to defend him in court.14
Perhaps the most well-known Amish health expert in the twenty-first century is John Keim, who is widely sought after for his knowledge of treating burns, among other ailments. The author of Burn Aid, Keim provides step-by-step instructions for applying his B & W salve, a mixture of honey, lanolin, olive oil, wheat germ oil, aloe vera gel, beeswax, comfrey root, myrrh, and other ingredients, to burn wounds with a dressing of burdock leaves. Anecdotal Amish sources praise the effectiveness of this treatment, and some hospitals endorse it; however, it has not been tested in clinical trials.15
Outside observers might wonder how Amish people can believe in folk remedies. For Amish and English alike, the answer is quite simple: when you suffer, you turn to someone like yourself who has experienced the same pain and found an antidote. From an Amish perspective, it is far easier to believe what one’s aunt heard from her friend’s sister than in what a doctor one does not know says about a drug made by a nameless researcher in a large, profit-driven pharmaceutical corporation.
Alternative Resources
Amish people also rely on many services in the alternative health systems that are provided by non-Amish vendors and practitioners. These resources, available to the larger American public as well, include homeopathic treatments, unlicensed midwives, acupuncture, patent medicines, natural supplements, and many other remedies sold and promoted on th
e public market. Reflexology, the application of pressure to different areas of the foot to bring about relief from various ailments, is common in some communities. Some Amish people have come to rely on the “healing” properties of essential oils as well as periodic cleansing routines and formulas to detoxify their bodies. It is also fairly common for Amish people to travel by train, bus, or hired van to Mexican clinics, which operate outside of U.S. medical regulations, for dentistry, face surgery, and treatment of cancer, leukemia, hernias, ulcers, and chronic infections. One family, for example, made three separate three-month-long trips.16
A study that compared the use of alternative medicine between Amish people and their rural neighbors in Ohio found that 90 percent or more in both groups had used some forms of alternative treatments. The use of chiropractic therapy and reflexology was higher, however, among the Amish. Non-Amish people were more likely to name a medical doctor as the health care professional that they see most often.17
Amish health practices from samples of two progressive settlements (Holmes County, Ohio, and Lancaster County, Pennsylvania) are summarized in table 18.1.18 Among the participants in both areas, about 90 percent report using chiropractic therapy and also seeing a medical doctor, 40 percent or more have used reflexology, and over 80 percent use dietary supplements. In Lancaster County, 38 percent have used tinctures, oils, or dilutions; 50 percent have used cleansing and detox regimes; and 8 percent have traveled to Mexico for medical treatment. Only two people in the combined settlements have used powwowing as a treatment. About one-third of the subjects in both studies report that the health professional they see most often is a chiropractor.
The Amish Page 42