Considering the Alternatives

There are few things that the average person finds scarier than having to make a choice.

In modern Western society, people have a huge array of options to choose between when it comes to their health care. For many, the question may never really occur to them; when they get sick, they go to their doctor, and they're treated with Western-style medicine. We sometimes forget that there are other approaches to healing out there, and speaking on behalf of the medical system, many of my colleagues prefer that people forget that there are other approaches. Naturopathy, homeopathy, spiritual healing, and any number of other healing systems exist. Some, like naturopathy, can do a person a great deal of good in the hands of a well-trained and knowledgeable practitioner... although sadly, not everyone who has a sign in their window is either well-trained or knowledgeable. Some, like homeopathy, have volumes and volumes of evidence arguing against their utility, but remain popular with people who either don't know better or don't care to put their faith in evidence. Others, like some of the lore of Chinese traditional medicine, have shown to have some efficacy when tested in laboratory and clinical conditions, and have shown Western medicine some new directions to go. Still other forms of healing haven't yet been tested as thoroughly as one might like; Reiki is one that I personally don't believe in, but I'm prepared to say that it could, in theory, have some value, and I'll wait to see well-designed studies on the topic before I draw a conclusion one way or another. If you think you have a lot of choices today, characters in a medieval fantasy setting almost certainly find themselves in a similar position. There's the one, dominant, established paradigm -- clerical magic -- and for those who either can't afford it, don't trust it, or can't access it, there's "traditional medicine." As storytellers, it's important to have an understanding of why characters might pick one option over another, so it behoves us to consider some of the reasons why someone might choose to go visit the wise-woman, the herbalist, or the snake-oil salesman instead of the well-respected temple.

To help answer this question, I dug up a relatively recent article on the subject. In a clever sort of study, the authors looked at why people living in urban centers of developing countries -- which may or may not approximate the populations of a game setting, depending on one's point of view -- and tried to understand when and why they used traditional medicine instead of, or alongside, Western medicines. from their (regrettably small) sample of people, about two thirds had used traditional medicines in the prior year, and about one quarter had combined traditional medicine with Western medicine (which can be pretty risky... a lot of herbal medicines have as many or more side-effects than any pill you'd care to swallow). Interestingly, most had never learned about traditional medicines in any formal way, but rather learned about them from family members or other locals; I find this particularly interesting because it's a rather sharp contrast to in North America, where part of the problem we face is a plethora of poorly-written, poorly-researched books. Equally interesting, to me at least, is the fact that most of the people who used herbs medically grew them in their own gardens, which is, again, rather different from how they get disseminated in North America. People also reported obtaining plants just from their general surroundings, which gives a storyteller the ever useful plot hook of "boy, those two mushroom species look alike." Only a minority of people in the study preferred to use herbs over medicines because of cost or accessibility. So, given all of this, why would people choose herbs versus antibiotics, or to put it in the context of a fantasy world, why would someone pick willow bark over Remove Disease?

Here's a big one: people from this study often sought out traditional medicine for problems that Western medicine couldn't help with. If you go to see your doctor for the common cold, which is caused by a virus, you won't be given a prescription for antibiotics. Or rather, you *shouldn't* be, but I can't speak for what your doctor actually does. Herbals remedies were also used for problems like blood pressure, which regular medicine often has a hard time controlling, or for wounds, which can take a long time to heal.

Another major reason why some people preferred traditional medicines was that they felt that the traditional healers treated them with more respect. The study goes into some detail about why people may have had negative interactions with doctors and nurses, most of which center around the perception that doctors only help rich people (which there may be some truth to, arguably). People may feel that traditional healers take a more holistic approach to illness, or that they're kinder or more selfless people; it doesn't have to be true to be a motivator.

On finding in this study that I didn't expect was that while many people knew a traditional healer, very few actually went to see one. What this suggests is that a lot of people who use traditional medicine, at least in this population, draw upon their own knowledge rather than that of "professionals." This means that a lot of people are at the mercy of the accuracy of their bedtime stories.

About half of the people in this study used traditional herbs to prevent falling ill, as opposed to treat an illness. This is, perhaps, one of the few areas that traditional medicine does better than a Cure Light Wounds spell.

One finding from this study probably doesn't carry over to a fantasy world, which is that the poorer people in the study tended to have better insurance than the rich people. While this is a lovely example of socialized health care, I've personally never played a game of D&D where the NPCs had health insurance. The analogue might be if the local church has a "what you can afford" policy, charging the rich more than they do the poor. In my experience, few churches are this generous or this politically suicidal.

I won't go into it here, but if you scroll about halfway through the article, you'll find Table 3, which lists what plants the people were actually using, and for what problem. If you want to add a touch of authenticity to your game, you could have similar plants being used (or abused) in your game.

What's the bottom line to take from this? At least in this population, the people who used alternative medicines tended to be self-taught, tended to collect herbs themselves as opposed to buy them, and tended to combine traditional and mainstream healing. Neither poverty nor access to competent healers was a major predictor of use of alternative medicines. I think this gives some very interesting potential story directions for a storyteller to work with, but of course, it's the storyteller's prerogative to simply say that none of this applies to the city where their game takes place. 

Four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on July 14, 2013. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.