Anth 340 Midterm

Medical Anthropology

The cross-cultural study of the bioecological and sociocultural factors that influence the incidence and meaning of health and illness today and throughout history. Includes the analysis of medical systems cross-culturally.

History of Medical Anth

• Late 1950s-early 1960s - focus on the development of theory in medical anthropology 

  • Society for Medical Anthropology founded in 1967-1968

• 1970s - emphasis on critical medical anthropology and critical perspectives of biomedicine

• 1980 - present - reemergence of applied medical anthropology

Rudolf Virchow

German pathologist and anthropologist studied the typhus epidemic and famine in 1848, Upper Silesia (Prussia)

Father of Medical Anth

Four Sources

Physical (bio) anth, Ethnomedicine, Culture and personality studies, and International Public health

Constructivism

 the cultural and social construction of health and illness

• how they experience their body and illness

• how they treat illness

• what causes illness and health

Biomedicine (allopathic medicine)

• A medical system that links illness to scientifically demonstrated agents (germs, toxic chemicals, viruses, etc.)

• Allopathic – this medical system treats illness with certain sustains - drugs, surgeries, etc. that try to create the opposite of the symptoms you have 

Medical System - Medical Process

• Total organization of a society’s culture and social structure that’s aimed at ensuring health and also preventing, diagnosing, and curing illness

• Can involve health institutions, medicines, personal (healers, nurses)

Non-western medical system

Any kind of medical systems that are found in non-western countries or societies, based on indigenous beliefs and healing practices

Pluralistic medical systems

Two or more medical systems operating within a society

The body and illness as symbolic

A breakdown of social relations

ex. Measles and mumps within the Hmong in the US

Farming, beans=measles

ex. Ifugao, Philippines

Colic-y baby = infidelity within the parents

Medicalization

Refers to the process of taking something that is rooted in social and cultural processes, including illness or symptoms of the body, and transferring them into a medical problem which requires a biomedical response

Socio-somatic states

the body can become ill because of larger social processes

ex. Neurasthenia

Theories of illness causation

Mystical, Personalistic Naturalistic and Emotionalistic

Mystical

asserts that illness is the result of some act or experience of the patient with the involvement of a spiritual agent

Personalistic

Purposefully caused by another agent or being;

Spiritual or supernatural beings and powerful humans

It is targeted

Naturalistic

The idea that natural phenomena will cause illnesses

• It doesn’t involve religion or spiritual beliefs

It could be biomedical causes; wind/storms can cause illness

Emotionalistic

The idea that emotional experiences can cause an illness

Animism

The belief in a supernatural power that organizes and animates the material universe

Magic

an attempt by people to manipulate the forces of nature through things like words and act to create a supernatural pressure to create a result in the physical world

Examples of Religious and Magical Healing

• Voodoo

• Prayer

• Exorcism

Characteristics of religious healing

The idea that humans who believe in a religious system needs to request the assistance of a supernatural being to help heal the ill

• could be a god, ancestor or spirit

Characteristics of magical healing

An individual is not requesting help from a higher being, but instead, through magic of their own ability, attempting to heal the ill

• The repeating of bible phrases to attempt to help heal the ill (a cross-section with religious healing)

Characteristics of witchcraft

Generally, the belief that people possess an innate nonhuman power to effect changes in people’s lives, whether intentional or not (such as causing illness or curing illness)

Characteristics of sorcery

Involves the belief that illness or death is ritually sent from one person to another with the aid of a powerful supernatural being; sorcerers may also cure illness

Theories to explain illness and healing through witchcraft, sorcery and other religious beliefs

Intellectualist theories, Social control theories, Symbolic theories, Affective theories, Body/emotion theories

Intellectualist theories

Can offer a particular way of thinking about an illness

Based on rational thinking in light of larger worldviews and cultural ideas

Social control theories

Fear of becoming ill or having any misfortune leads others to engage with others in the environment in a harmonious/helpful way

Witchcraft/sorcery controls people’s behavior as a result of fear

People will act in a moral way to avoid being accused of witchcraft

Symbolic theories

Ritual practices use a lot of symbolic ideas

Helps people to reconceptualize their state of illness

Affective theories

Ideas about emotion

Argues that these kinds of ideas, help people to cope with the distress of being ill, it helps emotionally

Social support through ritual practice

Body/emotion theories

Tries to argue that we cant forget the body in these processes

That people often have a bodily sense of being cured

Types of healing practices

Empirical and Magico-religious

Empirical healing

Healing practices that we can observe and experience

May relate to naturalistic ideas

Biomedicine falls under this

Acupuncture, cupping

Use of herbal medicines

Magico-religious healing

Ideas of the supernatural

Related to different theories of illness causation

Witches

Born as a witch, can train power, if not trained powers may lie dormant

Sorcerers

occupational role, mastered diverse healing specialties

Priests

Religious healer with formal training

Holds position in power as a function relating to their role as a priest

Mediator, does not directly interact

Shamans

A repository of knowledge and a master of methods pertaining to the control of mysterious powers and forces that affect the affairs of humankind, it is the technique for dealing with the supernatural

Part-time work

Direct contact

Naturalistic healers

combines more than one healing system

five types: Herbalist, Chemist, Surgeon, Bodyworker, Midwife, Biomedical personnel

Medical syncretism

Combines more than one healing system as a cohesive unit

Three social locations and status of healers (Kleinman)

Professional, popular and folk sector

Professional sector

Long-term training, controlled substances and advanced technology, does healing for a living, organized

Popular sector

Laypeople, no special training, heal family and friends, gains knowledge from other healers/family members

Folk sector

Fall outside of popular and professional, have some training, no specialized technology, not full-time healers

Authority types of healers (Max Weber)

Traditional, rational-legal, charismatic

Traditional authority

When a healer claims they have the authority to heal people and we should trust them because they were trained by X amazing healer

Appealing to tradition

Rational-legal authority

Seen in biomedicine

Based on explicit rules, laws and systems

Charismatic authority

Gained through their charisma, personality, or extraordinary abilities to heal

Based on the belief that someone can have supernatural powers to heal

Clinically applied medical anthropology theoretical approach

Anthropologists research health maintenance and response to sickness in cultures globally and apply that anth knowledge to biomedical clinical settings

Reflections and criticisms of biomedicine

The biomedical explanation of disease takes away attention from social and cultural processes surrounding and influencing the body - biological reductionism

• Reduces all health problems to biology and biological causes

Splits the mind from the body

Social meanings are embedded in biomedical categories

Medical Pluralism

The coexistence of multiple medical systems or bodies of practice and thought within the same society

Resource models (Paul Unshuld)

an approach to analyzing the political and economic shaping of medicine

primary and secondary

Primary medical resources

The kinds of resources that can be drawn upon by medical healers to heal people

Secondary medial resources

The kinds of resources that come about when primary medical resources are controlled and organized in some way

• Organizing medicine in particular ways

• Organizing medical institutions

• Determining the salaries of medical healers

• Translating one healing power into political power

• Using medical institutions to make profits

Therapy management (John Janzen)

Trying to gain control over people and resources needed to treat people

Involved the understanding the illness, and diagnosing it, how they treat it, how they manage an illness

Therapy management group

The ill person doesn’t engage in therapy management alone

Not only children; adults involve other people (spouse, parents, friends, other healers)

Important to understand who is involved in this group

• Can involve differential power

• Parents get a lot of control in treating children

Factors influencing treatment choice (in pluralistic medical societies)

Deciding on the cause of illness, Perceived effectiveness of particular healing systems, Manners in which healers treat people, Costs of services, Patients self-treating within the home, Therapy management group, Legality of treatment, Health seeking process

Characteristics of Traditional Biocultural Medical Anthropology Theoretical approach

Bridging the cultural and biological elements of life into one theoretical approach, focusing on adaptation and ecology, viewing their research as objective science.

Criticisms of Traditional Biocultural Medical Anthropology Theoretical approach

Blames individuals for not adapting to achieve good health, does not deconstruct biomedical terms, doesn’t account for variability of people, leaves out ethical consideration for patients

Characteristics of Critical Biocultural Medical Anthropology Theoretical approach

A theoretical framework for connecting culture, history, political economy, local biology, and health: Thomas Leatherman, Alan Goodman

Also reads health disparities along axes of vulnerabilities structured by macrosocial and political economic processes and defined locally by

• Exposure to disease or other health insult

• Inadequate coping resources or constrained agency

• And diminished resilience to recover from these impacts

Critical Medical Anthropology Theoretical approach (CMA) (Four levels)

Views biomedicine as a cultural system

A special focus on analysis and criticism of biomedicine in capitalist and socialist societies and of biomedicine as it is practiced globally

Emphasizes the importance of culture and political and economic forces, including ways that power is exercised, in shaping health, disease, illness experience, and healthcare

View scientific research as political, including their own CMA research

Macro-Social, Intermediate, Micro-social, Individual

Macro-social Level (CMA)

Looking at the nation state

Large corporation influencing health

Larger scale elements

Differential power relations

Intermediate social level (CMA)

Focuses on instituitons

Social-relations within these healthcare institutions

Relations between admin-admin

Mirco-social level (CMA)

Relationships between healthcare providers and patients

Relationships between therapy management groups

Healthcare personnel determine who is sick and who is not

• Limiting access to healthcare

Individual level (CMA)

Look at patient responses to illness and healthcare

Looking at health and illness in relation to social-cultural ideas and socioeconomic ideas

- Has been less emphasized than the other three levels

Characteristics of Critical-Interpretive Medical Anthropology Theoretical approach (thee levels)

Response to CMA

View biomedicine as a cultural system

Emphasizes emotion

Looks at cultural interpretations and individual experiences of the body and illness and their relationship to historically specific social, political, and economic structures in a society

Ex. how cultural meanings we may attribute to particular bodies and lean forward and perpetuate social inequalities

The individual body, social body, and body politic

The individual body

The lived experience of the body-self, and the cultural shaping of this sense of the body-self

Personal experience

The social body

The representational uses of the body as a symbol with which to think about nature, society and culture

How do we conceive of our bodies, as our culture has defined them

The body politic

The regulation, surveillance, and control of bodies, individual, collective bodies, in reproduction, sexuality, work, leisure, and sickness

Power relations, Political-economical analysis

Ex. Drapetomania by Cartwright, a disease of the mind that would result in enslaved people attempting to escape slavery

Criticism of Critical Medical Anthropology Theoretical Approaches (both of them)

Emphasizes political economy greatly, doesn’t recognize biological processes or ecology

Biased because it has a political agenda

Too focused on the historical period of Western colonialism instead of going deeper

Mainly focuses on capitalism and socialist societies

Kali yuga (Book)

• Dark ages

• Third cycle - the end before the rebirth of the society

• From ancient Hindu texts

• Kali = demon and can influence this period

• Blame gods, but also other people - farmers, government, anyone whose actions led to feelings of abandonment and preputial poverty

• Critic of globalization 

• Needs individual and structural change

Cancer and cultural ideas of Dalit women (Book)

• Cancer linked to cultural moral ideals

• Sexual activities outside of married = cancer

• Bad habits = cancer

• Karmatic justice = cancer

• Cancer is contagious

• Dehumanizes women

Cancer, religion and spiritual ideas (Book)

• Karmatic justice = cancer

• Treatment depended on cultural religious framework

• Some chose Biomed over religion, others chose religion over Biomed

• Some doctors intergraded religion into their treatment

• Caste differences played a role in the religious acceptance of which gods are accepted

• Pledging of oneself to a god to hid balding from cancer

Public health and biomedical approaches to treating and preventing + criticisms (Book)

• Mobile clinics – information was one correct, and was politically charged

  • Healthy diets, yoga, etc

  • Use clean bathrooms – something they don't have

  • All things Dalit women cant do/don't have access to these things

  • Disconnect between healthcare workers and patients

  • Blames the individual rather than the social structure

• Had advanced treatment programs

• Had healthcare for impoverished women

  • Still cant afford screenings

  • Transportation expensive

• Needs a sociocultural, political-economic approach

Characteristics of medical pluralism + social power dynamics (Book)

• Combined Biomed and religious practices / spiritual healing

• Intersectionality of middle-class, acceptable Hindu practices combined with the government and Biomed

• Balance of hot and cold in terms of health 

Cultural and social constructs of gender in relation to women's class/caste (Book)

• Women are supposed to be taking care of their families, so their health is set aside for the benefit for family members

• Mastectomies - loss of value in society; husbands could leave cause they are not suitable for marriage 

• Often brought income for family members alongside or despite of a husband

• Impacts their worth as a women 

  • Not breastfeeding = bad mother, leads to cancer

• Public health messages often used to communicate moral ideas, or acceptable social behavior

What theoretical approach did Van Hollen use (Book)

• Critical feminist medical anthropology approach 

  • Gender inequalities are interwoven with caste/class system and cultural-social ideals