Medical Anthropology Final- long version

Emic vs. etic

Emic → Emic perspectives come from being deeply immersed in everyday life of a cultural group. Anthropologists spend extended, informal time with people and communities. Close participation often reveals the most powerful and meaningful insights. Participant-observation, interviews (key informants, focus groups); forms of collaboration An emic term reflects how people within a community understand and talk about their own lives and work. It is an “insider” perspective shaped by local language, values, and experience. Researchers often use emic definitions to communicate respectfully and effectively with the communities they study. However, assuming there is one fixed or universal emic definition can hide internal differences and the complexity of lived experience. Etic → An etic perspective is an “outsider” viewpoint used for analysis or comparison across cultures. It applies categories or frameworks that may not come from the community itself. For example, animal sacrifice in Voodoo might be described etically as similar to animal experimentation in biomedical research, even if practitioners understand it very differently.

Medicalization

Medicalization refers to the process by which medical authority defines what counts as normal bodies, abilities, and behaviors. Critics argue that it can be a colonizing force, turning natural human experiences—such as healing, aging, or dying—into medical problems. This can reduce individuals’ and communities’ ability to manage life’s challenges on their own. Biomedicalization expands this idea, describing how health becomes a commodity, a moral responsibility, and a marker of social status under modern biomedicine.

Social course of disease

Illness as both biological and shaped by social, political, and economic life.

Explanatory models of disease

Afford patients the opportunity to explain how they see their illness, as individuals and groups can have different explanations or notions of cause. Kleinman proposes that, instead of simply asking patients, "Where does it hurt?" physicians should do some work on eliciting patients' explanatory models.

The mindful body

Includes idea of illness vs disease DISEASE: The biomedical view of symptoms as rooted in biology or pathology. Focuses on biological cause and diagnosis. Emphasizes technical control of symptoms. Less attentive to lived and cultural meanings. ILLNESS The lived experience of symptoms, bodily processes. How affected persons/families perceive & respond to symptoms. Goes beyond the 'technical quest for symptom control.' Illness narratives capture cultural scripts and personal biographies.

Three-body concept

Includes the personal body, social-symbolic body, and political body Personal body – immediately grasped and intuitively true; at times hard to translate or communicate. Social – symbolic body - projected outwardly—through classifications, symbols, and labels (e.g., ‘but does she recognize you?’). We may or may not present our bodies in ways that follow cultural codes, whether to fit in, avoid conflict, challenge stereotypes, etc. Political – economic body - where social categories like class, race, and gender are inscribed (and some<mes resisted); where broader poli<cal and economic forces can shape health outcomes. Linked to Delirio Del Fome example The three-body concept views human experience through three interconnected spheres: the Personal body, which encompasses one's intimate and intuitive experience of the self,. The Social-symbolic body represents how one projects outwardly and is classified, labeled, and recognized within society,. Lastly, the Political-economic body is the sphere where macro-level forces like race, class, and economic systems are inscribed upon the body, shaping health outcomes and vulnerabilities,. This holistic framework is used by medical anthropologists to analyze complex problems by showing how these layers intersect

Panopticon - Panopticon has key attributes to achieve a ‘view from nowhere

Panopticon includes a coded racial bias Connect → Digital poor-housing (Virginia Eubanks): “we don’t even notice that we are being watched and analyzed” Induces a “state of conscious and permanent visibility that assures the automatic functioning of power” (201). • Induces a “real subjection [thatis born mechanically from a fictitious relation.” • A ”real subjection” that is self-motivated Connect to Covid and the plague The Panopticon is an architectural structure, conceived by Jeremy Bentham, originally designed for prisons, schools, or hospitals, that facilitates constant, unverified surveillance. Its circular design ensures that the inmates feel perpetually watched by an invisible central observer, creating a "state of conscious and permanent visibility",. This induces automatic self-monitoring or self-discipline, making the individual an "object of information, never a subject in communication". Michel Foucault traced the origins of this disciplinary mechanism back to public health containment strategies, such as those used during plague outbreaks, where authorities strictly monitored every household. The ultimate function of the Panopticon is to automate state projects of health and social control by linking individual morality to the reproduction of the social order

Reductionism-

Reductionism is a way of thinking that reduces complex phenomena, such as the human body or illness, to its fundamental component parts. Within biomedicine, this often involves treating the body as an objective, independent machine governed primarily by biology and focusing on technical control of symptoms. This process strips away emotional and cultural context, transforming a full person into an analyzable collection of symptoms or data points. Medical training encourages this perspective, calling it a "view from nowhere," where the aim is detached, neutral objectivity. Critics suggest that this narrow, linear model of scientific reasoning is insufficient for fully understanding health and healing.

Idioms of distress-

Idioms of distress are the common, popular expressions used within a social group or culture to communicate and articulate feelings of physical tension, chronic pain, weakness, or emotional turmoil. These linguistic tools can function as coping mechanisms for individuals navigating stress or conflict within their relationships and communities. They are sometimes referred to as 'culture-bound syndromes' because they represent socially recognized ways that groups give voice to internal struggles, often by expressing psychological pain through the body (somatization). Examples include phrases like "Thinking too much" in Zimbabwe or "My heart die in me" in Liberia

Somatization-

bodily susceptibility to societal pressures, linked to mindful body Somatization refers to the process by which emotional distress, psychological conflict, or social pressures are expressed through physical bodily symptoms,. It highlights the body's susceptibility, or "porosity," to social and political environments,. The concept suggests that the "social me" directly intersects with the "physical me". Historically, the physiological response mechanisms activated by intense emotional shock, such as fear, were studied to provide a biological basis for phenomena like voodoo death, suggesting that psychological states can precipitate bodily harm

Iatrogenesis-

Iatrogenesis refers to any adverse condition, injury, or illness caused, intentionally or unintentionally, by medical activity, treatment, or intervention,,. Sociologist Ivan Illich famously critiqued the medical establishment for producing "cultural iatrogenesis" by medicalizing natural processes like suffering, aging, and dying, thereby generating harm to health. A contemporary example is "prescribed harm" or "drug injury," encompassing the physical and psychological symptoms experienced during psychiatric medication withdrawal. This concept helps analyze how acts of care within biomedicine can sometimes unintentionally become acts of harm

Biopower-

Biopower, a term associated with Michel Foucault, refers to a form of power that is constructive and regulatory rather than overtly repressive. It is the process by which society and the state govern populations by administering and shaping human life, including the body, health, and population dynamics. Biopower operates through decentralized, pervasive social mechanisms (known as the "disciplines"), often stemming from concepts like the Panopticon, to instill behaviors deemed desirable or productive, such as self-monitoring of health and morality,. This discourse makes it difficult to think or act "outside of health

View from nowhere-

“Detached – separate from emotion, culture, or patient experience; imagines neutral, interchangeable roles—“the doctor,” “the patient” • “Reductionist” – breaks the body into parts, symptoms, or data points; context is secondary or doesn’t matter • Transparent – claims to simply “show what is there” without interpretation What is the value of a view from nowhere? -secures a kind of universal legitimacy; findings valid everywhere, for everyone -protects against charges of bias The "view from nowhere" is a concept describing an assumed position of objective, neutral observation in science and medicine. This perspective attempts to strip away emotional bias and patient experience, relying instead on data, specialized jargon, and a focus on breaking the body into quantifiable parts (reductionism),. The perceived value of this view is that it secures universal legitimacy for findings, making them seem valid everywhere and protecting them from charges of bias. However, obtaining this detached, neutral gaze is considered a difficult cultural achievement, particularly within the medical training process

View from somewhere

“Situated perspective” The "view from somewhere" is an alternative conceptualization of perspective, asserting that all knowledge and observation are rooted in a specific, situated context and history. It acts in opposition to the detached "view from nowhere" favored by traditional biomedicine,. This perspective encourages researchers and practitioners to acknowledge their own biases and social position, insisting that there is no universal objectivity. It centers accountability by forcing the observer to consider who is affected by how they see a situation, ultimately leading to a more just and effective practice

Right to health

“as with other rights, includes both freedoms (such as the right to control one’s health/body and to be free from interference - for example, free from torture and non-consensual medical treatment and experimentation), and entitlements, which include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health” and “right to health, offering essential, accessible services like prevention, education, and treatment. Beyond clinical care, it integrates public health measures such as sanitation, immunization, and maternal care, making health systems more equitable, costeffective, and resilient” - WHO The right to health is a fundamental human right recognized globally, mandating that every person is entitled to the highest attainable standard of well-being, encompassing physical, mental, and social aspects. It includes freedoms, such as the right to control one's own health and body and be free from non-consensual medical experimentation. It also includes entitlements, such as the right to a system of health protection that ensures universal and equal access to preventative services, education, and treatment,. The Alma-Ata Declaration in 1978 affirmed this ideal, aiming to extend full healthcare access to all people, beginning with the poorest on Earth

Compliance/non-compliance (labeling phenomenon)

Compliance, or the lack thereof, is a label used in clinical settings to describe whether a patient adheres to medical instructions, such as taking prescribed medications. The act of labeling a patient "non-compliant" often assumes an individual failing or cultural mistrust, shifting blame away from systemic failures. However, non-compliance is frequently the downstream consequence of structural violence, rooted in issues like poverty, lack of food access, or oppressive social constraints. This label can have severe repercussions, as it is used in life-and-death allocation decisions, such as organ transplant candidacy, demonstrating how medical language can reinforce systemic inequality.

Situated perspective

A situated perspective insists that knowledge and truth are produced from a specific context, position, and individual experience, making it the opposite of the detached "view from nowhere". This approach mandates that practitioners and researchers recognize the limits of their own objectivity and the impact of their personal and social location on their clinical or research judgments. By prioritizing the patient's lived reality and acknowledging inherent biases, the situated perspective enables better and more accountable care

Psychiatric medication withdrawal

Psychiatric medication withdrawal is defined by the emergence of physical and psychological symptoms when a person stops or reduces their dosage of psychiatric medication. These symptoms are medically acknowledged to be distinct from the original mental health condition and are often described by those affected as "drug injury" or "prescribed harm". Because the complexities of withdrawal are frequently difficult for the biomedical system to recognize, it can leave patients feeling subject to "biomedical abandonment",. This situation has led to the development of online communities where patients engage in "intimate experimentality" to safely taper their medication and seek support.

Colonialism and health impacts

Colonialism created pervasive, long-lasting structures of inequality that deeply influence health outcomes in formerly colonized territories. Its negative impacts are multiple, including the introduction and spread of non-native diseases like smallpox and tuberculosis, and the systemic extraction of wealth that prevents communities from overcoming poverty. Colonial powers frequently used Western medicine (imperial hygiene) as a tool for social control and to enforce racial hierarchies, blaming colonized people for disease outbreaks to justify political repression. Today, the legacy of colonialism is said to live inside bodies, contributing to chronic disease and patterned health disparities across populations.

Personhood (and loss of)

Personhood refers to the recognized status of having a defined role or membership within a society, embodying the relationship between an individual and their community. The loss of personhood occurs when an individual's identity or recognized status is eroded or removed by social or institutional forces. This phenomenon can result in "social death," such as when a person with progressive dementia is treated as if they are already gone, or when a patient's existence is reduced solely to a collection of symptoms. Critically, endowing cells like the fertilized egg with aspects of personhood can lead to increased technological and legal intervention in reproduction

Colonial roots/western medicine

Western medicine, or biomedicine, possesses deep colonial roots, as its development and practice were often interwoven with European imperial expansion. This history involved using medical science as a tool for social control, exemplified by practices like "imperial hygiene" which blamed disease on the "uncivilized" habits of nonwhite subjects to justify colonial rule. Colonial medical campaigns often focused on containment and enforcing hierarchy rather than equitable treatment or cure. This perpetuated racial ideologies by hardening observed disparities into claims of biological inferiority, which shaped the foundation of modern biomedicine.

Structural competency

Structural competency is a framework for medical education aimed at training health professionals to understand how health outcomes are shaped by upstream economic, political, and infrastructural structures, rather than solely individual factors or cultural misunderstandings. It moves beyond traditional cultural competency by rearticulating problems like medication non-compliance or depression as downstream implications of forces such as housing policy, food deserts, or racialized economic inequality. The goal is for clinicians to recognize the systems that shape the clinical encounter and participate in advocating for structural change, guided by a sense of humility about the limits of individual medical expertise

Deficit- and damage-centered thinking

These are critical frameworks describing approaches that explain the hardships and inequities of marginalized groups by pointing to their inherent failures or dysfunctions, rather than analyzing systemic oppression. Deficit-centered thinking blames an individual or community’s challenges on their perceived lack. Damage-centered thinking establishes harm and brokenness to account for contemporary problems, often with the benevolent goal of securing resources or reparations. However, this approach risks reducing oppressed communities to a single narrative defined solely by their injuries, pathologizing them and obscuring their complexity and resilience

Social medicine

Social medicine is a concept championed by Rudolf Virchow, viewing medicine not merely as a biological science but as a fundamental social and political practice. Virchow argued that disease incidence is directly linked to societal conditions, stating that "politics is nothing else but medicine on a large scale". The goal is to address diseases rooted in social inequality, poverty, and structural issues through large-scale political and social reconstruction, rather than focusing exclusively on individual treatment. Physicians advocating for this model are characterized as the "natural attorneys of the poor

Rudolf Virchow

Rudolf Virchow (1821–1902) was a German doctor, pathologist, and politician considered the pioneer of social medicine. He is famous for identifying leukemia cells, but his enduring legacy stems from his assertion that social inequality is the cause of mass disease. Virchow argued that morbidity and mortality rose in direct proportion to impoverishment, which led him to propose societal reconstruction—including better wages and universal education—as the necessary cure for epidemic disease. He famously proclaimed that medicine has an obligation to enter political life, as "politics is nothing else but medicine on a large scale"

Structural violence

Structural violence describes the systemic ways in which social and institutional structures create widespread, patterned harm and oppression, making it appear routine or invisible. Paul Farmer argued that this violence is not caused by individual malice but by "historically given (and often economically driven) processes and forces" that deny basic human rights and constrain the agency of marginalized individuals. For example, chronic epidemics like HIV and tuberculosis in resource-poor settings are seen as manifestations of structural violence. Structural violence is often internalized, making social or economic misfortune appear to be the result of a victim's poor personal choices

Paul Farmer

Paul Farmer was a physician, anthropologist, and global health activist who co-founded Partners In Health (PIH) to advocate for the right to health for the poor worldwide. He emphasized treating disease through the lens of structural violence, arguing that poverty and inequality are the root causes of major epidemics like tuberculosis and HIV. His work in Haiti led to the development of the successful accompaniment system of community health workers, proving that highly effective medical treatments could be delivered even in resource-poor settings. Farmer was known for challenging the economic justifications used by global health authorities to withhold life-saving care from the poor

Accompaniment system & accompagnateurs

The accompaniment system is a community-based care model, championed by Paul Farmer’s Partners In Health, that focuses on providing comprehensive support to patients with complex diseases like tuberculosis and HIV/AIDS. The local health workers who carry out this work are called accompagnateurs (Haitian Creole for "companions"),. Their role goes beyond clinical care to address the non-medical needs—such as poverty, lack of food, and emotional despair—that act as barriers to treatment success. By putting responsibility on the system rather than blaming patients for "non-compliance," this model achieved cure rates near 100% for TB in Haiti

Tuskegee syphilis study

The Tuskegee Syphilis Study was an infamous, unethical U.S. Public Health Service experiment conducted in Macon County, Alabama, from 1932 to 1972. The goal was to observe the "natural course" of untreated syphilis in 399 Black men, who were deceived into believing they were receiving free medical care for "bad blood",. Life-saving treatment with penicillin, which became widely available in the 1940s, was intentionally withheld from the subjects for decades. This violation resulted in hundreds of participants suffering severe health consequences, including death, blindness, and neurological damage. The study is a landmark example of racism in medicine and directly contributed to the development of modern ethical principles in human research

Whistleblower/muckraker

A whistleblower is an individual, usually an employee or former employee, who internally or publicly exposes wrongdoing or unethical activity within their organization, often facing retaliation as a result,. For instance, Peter Buxtun acted as a whistleblower by repeatedly protesting the Tuskegee Syphilis Study before bringing the case to the press. A muckraker is generally defined as an investigative journalist who uncovers and reports on social injustice, corruption, or corporate misconduct from an external position

Ethical principlism

Ethical principlism is a framework that asserts universal moral standards for research and practice, such as Autonomy, Beneficence, Nonmaleficence, and Justice,. It is formalized in guiding documents like the Belmont Report, serving as a global standard intended to apply everywhere in the same way, thereby promoting a "view from nowhere",. The creation of this framework was a direct response to historical violations of human rights and dignity in research, including the Tuskegee Syphilis Study

Ethical variability

Ethical variability is the concept that ethical standards and judgment can shift and adapt according to the specific local circumstances or context of a situation. It contrasts sharply with the fixed standards of ethical principlism. Critics argue that this flexibility has historically been exploited to justify otherwise questionable research, particularly in settings of global inequality or extreme vulnerability, such as the use of placebo-controlled drug trials in developing nations or the use of incarcerated persons as research subjects

Clinical trials (phases)

Clinical trials are structured research studies involving human subjects that are designed to test the safety and effectiveness of new drugs or interventions. They proceed in sequential phases: Phase 1 involves 20 to 80 participants and focuses on safety and how the body processes the drug. Phase 2 includes hundreds of participants to determine proper dosage and initial efficacy,. Phase 3 involves thousands of participants to confirm effectiveness in large populations before submitting for FDA approval. Phase 4 occurs after approval, monitoring long-term effects, rare side effects, and cost-effectiveness

Frances Kelsey

Frances Kelsey (1914–2015) was a Canadian-American pharmacologist and physician employed by the U.S. Food and Drug Administration (FDA). She is historically significant for her refusal to approve the drug thalidomide for market in the early 1960s due to her concerns about its safety. Her cautious stance prevented the widespread use of the drug in the U.S., sparing the country from the severe birth defects seen globally. Her integrity led to the passage of stronger FDA drug oversight laws

Nonmaleficence

Nonmaleficence is one of the four foundational principles of ethical principlism, often summarized as the duty to "do no harm",. It requires researchers and clinicians to actively protect participants and patients from injury or negative consequences related to medical interaction

Autonomy

Autonomy is a core ethical principle asserting the right of individuals to self-determination and the capacity to make informed, voluntary decisions about their bodies and participation in research,,. This is the basis of informed consent, which demands that potential research subjects be fully aware of a study’s risks, benefits, and purpose before agreeing to participate,. Historical abuses, such as the deception used in the Tuskegee and Holmesburg experiments, were severe violations of patient autonomy

Justice

Justice is a foundational ethical principle that requires fairness in the selection of research subjects and the equitable distribution of research burdens and benefits. It dictates that no population group should bear the disproportionate risks of research from which others benefit

Beneficence

Beneficence is a core principle in biomedical ethics that mandates that medical actions should actively seek to produce a benefit for the patient or research participant. This principle requires balancing the potential benefits of an intervention against the risks of harm to maximize a good outcome. However, the concept can be misused, as seen when researchers argued for the "beneficence" of intentionally infecting children in the Willowbrook study, claiming it offered a perceived benefit (being housed in a special unit) despite the clear ethical violation

Partners In Health (P Farmer)

Partners In Health (PIH) is a global non-profit health organization founded by Paul Farmer, Jim Yong Kim, and Ophelia Dahl,. Starting in Haiti, their mission was to fight for the right to health for the poor, demonstrating that high-quality medical care could be delivered effectively in resource-poor settings using community health workers,. PIH actively challenged global health policies that limited treatment for diseases like MDR TB and HIV/AIDS based on cost or sustainability,. The organization advocates for revitalizing public health infrastructure through aid money and currently employs over 18,000 people, most of whom are from the communities they serve

Placebo/nocebo effect

The placebo and nocebo effects describe how the body’s expectations of a medical intervention can directly influence physiological outcomes, collectively illustrating a "physiology of expectation". The placebo response is a positive, therapeutic effect resulting from hopeful beliefs about a treatment. Conversely, the nocebo effect is a negative, pathological reaction resulting from fearful or anxious expectations. This phenomenon reveals a complex bodily ingenuity that connects psychological states to the physical body

Racism and medicine

Racism in medicine refers to the persistent systemic and institutional practices that create, distribute, and reinforce health inequality along racial lines. This often occurs when structural factors—such as poverty, environment, or unequal access to care—are incorrectly medicalized and attributed to false biological differences, or "racialized medicine",. Historical examples include the Tuskegee Syphilis Study, founded on the premise of innate racial differences in disease progression, and the targeted marketing of harmful products like menthol cigarettes to Black communities. Contemporary efforts advocate for "abolition medicine," which challenges race-based diagnostic tools and addresses the structural causes of disparity

Thalidomide tragedy

The Thalidomide tragedy was a major pharmaceutical disaster in the late 1950s and early 1960s involving a sedative drug approved for use in Europe and Canada. It was prescribed to pregnant women for morning sickness but resulted in severe birth defects, including infants being born with missing or malformed limbs. The U.S. was largely spared this disaster due to the actions of FDA physician Frances Kelsey, who refused to approve the drug based on insufficient safety data. This event underscored the need for rigorous drug testing and led to stronger regulatory oversight laws for pharmaceuticals

Restorative justice

Restorative justice is an approach focused on repairing the harm caused by injustice through active efforts toward accountability, reconciliation, and reparations for victims and their families. In the context of the Holmesburg Prison experiments, demands for restorative justice include formal apologies from involved institutions, financial compensation to survivors, and full disclosure of the profits gained from the unethical research. Survivors argue that since the drug patent profited companies and universities immensely, they deserve to "share the wealth" derived from the exploitation of their bodies.

AI in healthcare (A. Reddy lecture)

AI in healthcare refers to the use of computational systems and deep learning models for medical tasks such as imaging analysis, diagnosis, and supporting clinical decision-making,. The technology offers revolutionary potential, especially in settings lacking specialists, like using algorithms for fast tuberculosis screening where radiologists are scarce,. However, these systems face challenges because they are often "black boxed" (meaning their decision processes are opaque), undermining scientific transparency and trust. Furthermore, AI models are inherently limited by the finite data they are trained on, raising questions about the generalizability of their results and the possibility of unseen bias

Holmesburg prison experiments

The Holmesburg prison experiments were decades of unethical medical research (1951–1974) conducted on incarcerated individuals, predominantly Black men, at Holmesburg Prison in Philadelphia,. Led by Dr. Albert Kligman, inmates were bribed with small sums of money to participate in testing commercial cosmetics (like Retin-A), pharmaceutical drugs, and chemical warfare agents for the U.S. Army,,. Informed consent was routinely violated, as the subjects were rarely told the true nature or risks of the tests, leading many to suffer long-term physical scarring and psychological problems,. The experiments are a landmark example of how economic desperation and racism facilitated egregious research abuse

Chronic critical illness & recovery from ICUs (D. Lamas, R. Perfetti)

Chronic Critical Illness (CCI) is a condition afflicting patients who survive a catastrophic illness but require long-term organ support, often defined as needing mechanical ventilation for over 21 days. Patients with CCI experience persistent health issues, including profound weakness, recurrent infections, and cognitive deficits, with a poor prognosis for independent recovery or survival past one year. Physician Daniela Lamas notes that this high burden of disease is often invisible to acute care staff because patients are routinely transferred to specialized long-term acute care hospitals (LTACs),. This lack of continuity means physicians often fail to adequately discuss the expected prolonged debility with families, leading to significant misconceptions about the patient’s recovery prospects.