One reason Amish people seek help from alternative providers is that such providers often replicate the high-touch, low-tech, informal ethos of the familial system. Medical professionals have noted that the Amish are often reluctant to talk about their reliance on alternative medicine, partly because of English disdain for folk remedies and partly because they are wary of providing too much information to outsiders. This makes it difficult to assess the scope of Amish use of alternative treatments. Thus, in the words of one study, health professionals must recognize that their “ethical mandate to provide health care that meets the beliefs of the individual may outweigh the mandate to provide the most advanced care for the body.”19
Many natural-remedy providers aggressively target Amish communities with services and products ranging from miracle supplements, body cleansing regimes, and cranial and body manipulation to home visits by unlicensed chiropractors. Both Amish and English vendors hawk their natural remedies via meetings, direct mail, and color advertisements and notices in Amish publications and newsletters. Typical of the health claims reinforced by religion are these by this Amish distributor: “Essential Nutrients have helped so many people with great results. The products are all natural and come from plants which God has provided! Ninety-five percent of all chronic and degenerative diseases can be prevented or reversed with Yongevity products. If you wish to live healthier, happier, with less pain …, call [retailer]. May God bless you with better health!”20 Filled with glowing testimonials, such promotions offer antidotes for stress, infertility, hormone imbalance, thyroid and adrenal issues, joint pain, arthritis, menstrual cramps, bulging veins, colon toxins, heart disease, sinus infection, fatigue, bedwetting, depression, cancer, and virtually any other imaginable malady.
Table 18.1. Health Care Practices in Two Amish Settlements
Standard Resources
The standard system of health care includes professionally trained doctors, midwives, dentists, optometrists, psychologists, and other professionals as well as prescription medicine and clinically tested procedures at major hospitals. As noted above, all Amish use some standard health care, but they typically use less than their English neighbors, with some Amish only calling on their local physicians or hospitals in emergencies.
Beyond routine illnesses and emergencies, Amish people use mainstream health care for these and other treatments and procedures: cochlear implants; chemotherapy, radiation, and surgery for cancer; skin grafting for burns; cleft lip and palate surgery; kidney and bone marrow transplants; heart, bone, and cataract surgery; and hip and knee replacements. As these examples show, despite their inclination for natural remedies, Amish people in more progressive affiliations willingly use state-of-the-art medical care; those in more traditional groups are hesitant.21
Immunization, birthing, and refusal of treatment are three aspects of standard care that are points of contention between the most traditional Amish and outside authorities as well as within the Amish world. (See Flashpoints, page 345.)
Church-Community Resources
Visiting is a frequent and valued antidote to illness in Amish society. The infirm receive many visits, as do the elderly and those who are grieving a death. Card showers, announced in Amish publications, are also widely used to show love for those suffering illness or accident, and the cards sometimes include small gifts of money to defray medical bills. One announcement invited readers to have a “thinking of you and cheer up shower” for a sixty-four-year-old woman who had recently broken her leg and been diagnosed with bone cancer. Another invitation asked readers to “fill the mailbox” of a ten-year-old with congenital cerebral palsy.
Circle letters are a common way of connecting with others who have experienced a similar illness such as heart disease or breast cancer, or those who have lost children through sudden deaths like drowning. The letters may circulate to eight or ten people who each add a page before mailing it on. Periodic regional or countrywide gatherings for people with certain disabilities or diseases are also an important source of support that stretches far beyond the family circle. All of these expressions of care—from church aid programs to voluntary offerings, from an aunt’s advice to a card shower—show the deep reserves of social capital available to support bodily health and emotional well-being.
A religious resource that some people turn to when facing a serious illness is anointing with oil, a ritual described in the Bible (James 5:14). Ordained ministers perform it in the individual’s home, not as a last rite but as a sign of the ill person’s complete and unconditional surrender and acceptance of God’s providential will.22
When it comes to dying, the Amish prefer to die at home surrounded by family. With a profound belief in a heavenly hereafter, they consider death a natural prelude to eternal life. They see little need for taking extraordinary measures to prolong life with expensive treatments that may do little to improve the person’s condition and may even obstruct God’s will. If an adult is unable to make decisions, the family takes over, secure in the knowledge that, by acting in accordance with the teachings of their church, they will make appropriate decisions. Some settlements make extensive use of hospice services, while others do not.23 When death is near, family and friends sit in vigil around the bed of their loved one. When a person dies, friends and neighbors prepare the body, build the coffin, dig the grave, and stay to mourn.
Flashpoints
Immunization
In the Amish world, the question of vaccination drives a complicated conversation about human volition, responsibility, providence, and the role of government. Although immunizations against such diseases as polio, measles, mumps, and rubella are required for children entering school, parents can be exempted on religious grounds.24 This decision is generally a family decision and not a church matter. A diversity of opinion persists on whether to vaccinate or not.25 In 1991 correspondents for the Budget estimated the number of people in their communities who had vaccinated their children, and the responses demonstrated the diversity of opinion on this subject. For example, one correspondent reported that 90 percent of parents in his community had had their children vaccinated. Then he noted, “We would not want to deny that there may have been cases where shots have caused adverse effects or even possibly death, but our feeling is that there would probably be much more sicknesses, paralysis, and deaths if no one took them.”26
In contrast, a correspondent from another community reported that no families had gotten vaccinations. “I feel we should put our trust in God rather than the technology of the world,” he said. “I think God put these diseases here for a purpose to chasten us sometimes.”27 One person said that her family opposed vaccinations because they viewed them “as a form of insurance,” and, she asked, “Why vaccinate for a disease that isn’t even present in a child’s body?”28 Most Amish who refuse immunization see it as putting their faith in science rather than trusting in God.
Even within a single church district or family, members may have different understandings. One mother of four said that she had had her first child vaccinated because her own mother had insisted. Her mother-in-law had objected to vaccinating the second child, however, so that child had only received some of the inoculations. In contrast, a Kentucky letter writer to Family Life noted, “We can think that our children will not get these diseases unless God wills, but are we doing our part if we purposefully neglect a preventive measure?”29 A 2007 study of progressive Amish parents in Holmes County found that only 14 percent had not vaccinated their children. Reflecting the views of non-Amish critics of vaccination, most of them had refused because of concern about adverse effects rather than for religious reasons.30
Some outbreaks of poliomyelitis, whooping cough, measles, and rubella have been disproportionately high in Amish communities.31 For example, in 2005 four cases of polio among the Amish in Minnesota were the first known cases of the polio virus in the United States in twenty-six years.32 Such outbreaks often stir anger and resentment among English neighbo
rs who think that their children are threatened by what they consider Amish negligence. For their part, Amish people are sometimes willing to vaccinate their children when they realize that noncompliance may endanger the health of others. Although many Amish people have shown greater openness to immunizations in the twenty-first century, pockets of resistance still persist.
Birthing
Many Amish people are ambivalent about government attempts to regulate who may assist families with childbirth and where it should occur. This contentious issue has left a trail of prosecutions of unlicensed midwives serving the Amish in several states for violating regulations regarding childbirth.33 In a few cases Amish people have even protested by taking their objections and placards to public rallies in support of English birth attendants.
To certain Amish people, some state laws appear to infringe on the choice to have home births. One man lamented, “The State of Ohio is making it very unhandy for midwives who help people do home birthing. These midwives can no longer verify pregnancies or live births. They say that only licensed nurses and doctors can do verification. … It is an attempt by the state to shut down home birthing.”34
Some Amish communities have developed birth centers that commingle professional care and an Amish ethos—a negotiated compromise between home-based and hospital births. One Amish midwife in Ohio transformed her practice into the Mount Eaton Care Center, operated by certified physicians and nurses who are sensitive to Amish ways and who deliver babies in a comfortable, low-tech setting.35 Various settlements have birth centers that serve Amish families—the Middlefield Care Center in Geauga County, Ohio, and the New Eden Care Center near Shipshewana, Indiana, are two examples. The location of these centers makes it easy for friends and relatives to visit by buggy and bring meals and gifts to the new mothers. “Grandparents sometimes have more than one grandchild at the birthing center at the same time!” noted one doctor. “There is an obvious feeling of pride and community at the center.”36
With birth centers such as these, expectant mothers are offered the possibility of quality medical care in a setting that is sympathetic to their cultural and religious values.37 The staff and midwives at such centers know that the women have been running their households up to the time of labor and will return to their work within a day or two after birth. They also know that they may have used raspberry tea to relieve nausea and labor pain or black cohosh root to reduce pain during delivery.38 These culturally sensitive centers relax some of the routines followed in hospitals and welcome the entire family (including older siblings) immediately after the birth, offering Amish women a hybrid between a hospital and a home birth that grants families greater control over this significant life event. Birth centers are not an Amish invention, however—nearly three hundred of them offer similar services in mainstream society.39 Nevertheless, those serving Amish families are especially sensitive to Amish cultural issues and preferences.
The Right to Refuse Care
Amish confidence in God’s will, their preference for natural forms of healing, and their reservations about scientific interventions have led a few families to refuse treatment—pitting them against state regulations and, when it involves children, raising complicated legal issues regarding child rights and parental rights. Those instances of boycotting treatment are usually guided not by official church regulations but by family preference, with or without the counsel of church leaders. Many, but not all, of the cases of refusing care have involved foregoing chemotherapy or radiation for various types of cancer.40
One non-cancer example occurred in 2008, when a New York judge ruled that Swartzentruber parents had neglected their infant son by failing to agree to a surgical procedure to implant a shunt in his heart. The father and the boy’s bishop testified that their religious beliefs precluded open-heart surgery because “it stops the heart.” The court ordered the surgery against the parents’ wishes, finding that their son’s physical condition “has been impaired or is in imminent danger of being impaired as a result of the failure of his parent … to exercise a minimum degree of care,” in supplying the child with “adequate … medical, dental, optometric or surgical care.”41 When a child’s death is preventable, it can challenge medical and legal protocols as well as the Amish community itself. Some Amish people worry that, by privileging the standards of modern western medicine, the state may impose on their religious beliefs and curtail the ability of parents to make health care decisions—including end-of-life decisions—for their offspring.
Mental Health Care
Even some liberal Amish who embrace standard medical care are slow to see mental health as a medical issue and view psychotherapy as a questionable exercise in abstracting thoughts and feelings from soul and spirit. Likewise, Amish culture, with its bias against subjective, personal reflection, typically resists talk therapy with professionals because one-on-one counseling introduces an outside, non-church authority (the therapist) into the mix and focuses on the desires of the individual client apart from the wisdom of the church-community. One Amish person said, “Some counselors just blame religion for your problem.” Families and leaders may be wary of mental health professionals who have, in some cases, encouraged defection by suggesting that leaving a confining religious community is the path to self-fulfillment. Members of lower affiliations may believe that confession before the Gmay is the only “therapy” necessary.42
Nonetheless, a growing number of Amish people now accept mental illness as a medical issue and view depression and anxiety as physical ailments, treatable at least in part with drugs. “Our brains work by using chemicals, like a battery,” one Amish publication explained in 2000. “How do we know this? When you take anti-histamines for hay fever you become drowsy because it is the same chemical used by the brain that regulates alertness.”43 Since 1990 more than a dozen essays in Family Life, as well as growing contact between Amish people and health care providers, have spurred a major redefinition of mental illnesses as medical rather than spiritual ailments.44
One result of the mushrooming interest in mental illness was the formation of an informal lay counselor network known as People Helpers in 1995. Regional People Helpers meetings sometimes feature educational presentations by non-Amish psychologists; however, most of the speakers are Amish ministers who offer practical advice on topics such as disciplining children and recognizing depression. In 1997 a new network known as Family Helpers launched an annual marriage meeting in Ohio to promote healthy marriages and reduce marital conflict and abuse. The meeting draws several hundred participants each year.45
Since 1999 a handful of communities have opened Amish-operated mental health treatment centers in Michigan, Ohio, and Pennsylvania. These provide services for men, women, and couples in a religious atmosphere. Participants engage in Bible study, group sessions, and physical work. Lay Amish counselors administer medications and arrange for visits to off-site therapists and psychiatrists.46
Like the hybrid care modeled by Amish birth centers, some psychiatric centers combine a professional standard of care and Amish sensibilities. In 2002, Rest Haven, an Amish-constructed facility, opened on the campus of Oaklawn, a community-based mental health center in Indiana. Rest Haven houses up to sixteen patients—eight men and eight women—at a time. The medical and counseling staff from Oak-lawn conducts group and individual therapy at Rest Haven. An Amish board sets the center’s cultural boundaries, which permit electricity but not televisions, computers, or telephones in patient rooms. Volunteer house parents from Amish settlements across the country oversee the kitchen and laundry and lead residents in morning and evening devotions. In 2005 a similar facility, known as Green Pastures, opened in conjunction with Philhaven, a behavioral health care center in Mount Gretna, Pennsylvania. In its first five years this facility served nearly one thousand patients from twenty-seven states and provinces. Fifty-nine percent were Amish, with the remainder coming from other Plain groups.47
The emergence of Amish-related and Am
ish-operated organizations from birth centers to homespun mental health treatment centers illustrates a structural negotiation with modernity—new organizational forms that reflect aspects of formal organizations with a distinctive Amish imprint.
Genetics and Medical Research
The Amish are ideal subjects for genetic research because their exceptional genealogical records, small number of founders, and large families make it possible to trace hereditary traits across centuries and continents. These characteristics of Amish populations and their unique lifestyle have stimulated an unusual amount of scientific research on health and illness in their communities. Although some Amish question or resist mainstream medical treatments, many gladly help to advance scientific research. Households in many settlements willingly cooperate with health professionals who combine clinical services with gathering DNA samples and other data for scientific studies.
Amish populations have a limited gene pool due to their small number of founders and the fact that few converts have joined their communities. These characteristics mean that Amish people have a higher incidence of certain types of genetic disorders than that found in the general population. The types of disorders vary in different settlements. At the same time, a restricted gene pool also provides a protective buffer, so some hereditary diseases in the larger society appear much less frequently or not at all in Amish families.
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