med anth
Study notes + reading, lecture, 35 questions (most come from lecture)
Will be questions from every single reading
1/22/25 Week 2 - Medical Anthropology Introduction
Anthropology is the discipline that studies human sameness and difference across time and space with a particular focus on social and cultural situatedness
Anthropos - human being
Logos - language, reason, rational, discourse
Way of speaking through conceptual tool bag on a certain topic
Subfields of anthropology
Physical or biological anthropology
Archaeology: focus on material life of societies historically or prehistorically (fossilized species + poop = gold)
Linguistic
Social or cultural anthropology (socio-cultural)
Physical or biological: people that study evolution and non-human primates
Linguistic
Subfield of anthropology
Study of language
How its intertwined w/society + culture of life
Social or cultural:
Social : in England there is a focus on social structure, economic exchange, religion, and the function of kinship. In America there is more of a focus on culture, meaning, interpretation, what does it mean
Subdisciplines of socio-cultural:
Political anthropology: ex study bureaucracy
Economic anthropology: ex-gift exchange, corporation
Anthropology of kinship: family by choice
Anthropology of religion: practices, rituals
Anthropology of ethics
Medical anthropology
Key methods of socio-cultural
Putting body in unfamiliar environment and trying to get comfortable
Professional people watching
Sensibility to observing people around you
Ethnographic research or fieldwork: going and living someplace w/ppl (at least a year) (seeing how food production happens takes at least a year)
Participant observation
Do stuff that people do, but also pay attention, why do they do this stuff in this way?
Deeply hangout
Can get a pretty good sense of what it’s like to live in another world or another type of life
They have to have brackets around what they think is right and good (because this is going to be different for different people)
The difference between anthropology and other disciplines is oftentimes grounded in the critical questioning of normally assumed ontological, epistemological and ethical questions
What is reality?
What is a good life?
How does medical anthropology critically question medical knowledge?
A starting premise of medical anthropology is that health-related issues, including diseases/illness + treatment, are far more than narrow biological phenomena
Methods again:
Ethnographic research or fieldwork (the experimental dimension)
Holistic
Insider POV
In terms of addiction:
The government/scientists want to take all drugs away and create 0 access to drugs
Experiment: put rats in rat park with toys, fun things, morphine and they don’t always go to morphine (sometimes they do, and sometimes they don’t)
Put rats w/morphine in rat park and they are okay and don’t go to get more drugs, don’t go through withdrawal
Brain model of addiction: brain damaged for good → addict brain
This could be the case BUT brain also changes when in love, you drink too much soda, etc.
Creates discursive and creates impossibility that people might be okay if they use drugs, they have no hope
Anthropologists are interested in whole person
They don’t have think of humans as solitary individuals
They think of them as tied up with economic processes, history, kinship networks, communities
All this, helps w/insider POV
Medical anthropology describes, interprets, and critically appraises the relationship between culture, behavior, and disease, and places health and illness in the broader context of cultural, social, political, economic, and historical processes
What is biomedicine?
Modern western scientific medicine is often called “biomedical” because it explains health in terms of the natural sciences, and especially biology
It attaches importance to learning about body structure (anatomy) and systems (physiology) , thus, a focus on things like the heart, arteries, nerves, brain, and the systems to which they belong
Within biomedicine, health is understood as a state in which all the parts of the body function normally, like a newly repaired car
Materialist and mechanistic worldview of the 18th and 19th century
A biomedical account gives physical + biological explanation for health and offers physical/biological methods to “repair” the body when they are not correctly working
The biomedical model - an integral part of the modern worldview
Biomedicine is the primary way in which most people in the ‘west’ understand health and illness and their compliance with the system that supports biomedicine, this is likely true for most people in this room today
Medicalization - the extension of biomedicine into other areas of life that previously were considered social rather than medical (e..g birth and dying) and the expansion of the power and influence of medical experts, sometimes even to the extent that medicine takes on a deviance control function (e.g. addiction medicine/brain disease model of addiction)
Social things become medical
Ppl used to die at home now they die at hospital
Medical anthropologists go beyond seeing health and illness as primarily a biological condition
Social origins of disease
Cultural construction of symptoms and treatments
Interaction
Americans call it burnt out, Dutch call it “overworked”
In the Netherlands overworked is official medical diangosis you can go to doctors and get medical leave of 5 weeks
In america, no medical diagnosis, response is “suck it up”
Medical anthropologists tend not to accept any particular health system
Including “western biomedicine” as holding a monopoly on useful health knowledge, or effective treatment
Gender relations, culture, etc.
How can we understand bio-medicine socio-culturally?
Materialist tendencies: signs much more visible under microscope
Social and historical context
Cultural metaphors of biomedicine
Body as machine metaphor: body break down → get it fixed (more likely to be seen as object not person at the doctors)
Diseases as combat metaphor
“Viruses invade body”
“Doctors combat disease”
“Body fights infection”
Life worlds of clinicians and biomedical practitioners
1/29/25 Week 3 - Medical Anthropology - Interpretive and Critical Approaches
Interpretive approach: coincided with the beginning of the interpretive turn in anthropology in the 1970s that is associated w/Clifford Geertz
Geertz argued that culture can be interpreted as a text using the interpretive methods of hermeneutics
Hermeneutics: theory of interpretation, theory of understanding and meaning (came from trying to understand religion)
Social persons are not autonomous actors or rule followers, but interpretive readers
Religion as a cultural system
Arthur Kleinmen - medical systems as cultural systems
Disease and illness:
Disease is a biological phenomenon
Cure
Illness is the patient’s subjective experience of physical or mental states (second illness)
Healing (subjective experience)
An explanatory model consists of the ideas and account of an episode of illness and its treatments that are employed by all those involved (doctors, patients, relatives, etc)
Not just medical people
Explanatory model emphasizes the subjective accounts of illness that provide the patient’s understanding and POV as opposed to a biomedical approach
Foundational claim of interpretive approach: disease itself is an explanatory model
Complex human phenomena that results from the interaction between the biological, social, and cultural aspects of human life are categorized as ‘disease’ and thus become objects of medical practice (e.g. brain disease model of mental health or addiction)
Disease is primarily found within the order of meaning and human understanding, and therefore is a social construct
Consequences of interpretive approach
Social constructivist approach that is interactivist and perspectile
Interpretive approach considers the interrelationship between biology, social practice, and cultural meaning
Embodiment as way to get past cognitive focus on mentalist approaches and look at the way social institutions, history and practice are manifest on the body
Critiques of interpretive approach
Focus on individuals as subjective experience
Ignores the power relations between groups and classes as factors in illness
Critical Medical Anthropology (CMA)
CMA considers how political and economic forces of both global and societal scope are present in local health conditions and medical institutions
“From a CMA perspective health issues are understood in light of larger political and economic forces that pattern interpersonal relationships, shape social behavior, generate social meaning,s and condition collective experience”
Ex: Peru in early 1990s cholera epidemic
Had to be understood in context of deteriorating public infrastructure
Merrill Singer (CMA) wants to determine how in late 20th century water systems would be bad enough for cholera
Analysis points to history of overpopulation, global oil crisis (cutting of funding for infrastructure)
CMA analyzes illness representations and medical knowledge as mystification or misrecognition of their underlying dependence on unequal social relations of power
Mystification and misrecognition
Hegemony as cultural forms and knowledge render existing social relations as part of the natural order
Genealogy of power questions the standard narrative of historical progress and considers the unintended or unnoticed consequences of social institutions
CMA poses the question of when illness representations are misrepresentations that serve the interests of those in power
“Access to and control over the basic material and nonmaterial resources that sustain and promote life at a high level of satisfaction”
CMA definition of health according to Merrill Singer
CMA has been main stand of medical anthropology that focuses on human rights in health contexts
A critique is that activist assumptions too often get in the way of scholarship
“Neither legal nor conventional human rights approaches have even begun to understand the nature of the problem”
Paul Farmer on the necessity of understanding structural violence as the root cause of TB epidemic in Russian prisons
He advocates for:
Pathologies of power: the structural violence caused by inequalities based on race, ethnicity, religion, and class
Structural violence: used to label the negative impact of power on health and refers to “large-scale forces — ranging from gender inequality and racism to poverty — which structure unequal access to goods and services “ (Farmer, Connors and Simmons 1996:369)
While experienced individually structural violence targets classes or groups of people and subjects them to common forms of lived oppression
Social suffering is the experience of structural violence
Ex: a consequence of this increase is drug use
Critiques of Critical Medical Anthropology
Interpretive and anthropologist would focus on critique of macro societal and historical structures rather than local ethnographic experience
Gives little credit to these real people for their ability to recognize the relations of inequality that they themselves are stuck in yet must find a way to live in
Teachers research on addition and the drug war:
A mix of interpretive and CMA approach (most ppl take this approach I think)
Embodied experience
Class, racial, historical dimensions
2/5/25 Week 4 - Biopower
Michel Foucault - Philosopher & historian (1926-1984)
Developed biopower term
Interested in sex and drug because he was interested in body in a way that isn’t just habit
Bipower: power to foster life or disallow it to the point of death
Thinking of biopower historically, 17th & 18th century, European history, moment where there is a shift in power, state becomes interventionist
Sovereign power: right to take life or let it live
Kings, queens, etc. most important decision that kings can make is this decision about life
There is a shift from torture (revenge based) to reformation
Biopower: form of power that seeks to administer, secure, develop & foster life
“[sovereign power] has tended to be no longer the major form of power but merely one element among others, working to incite, reinforce, control, monitor, optimize, and organize the forces under it: a power bent on generating forces, making them grow, and ordering them, rather than one dedicated to impeding them, making them submit or destroying them” - Foucault
Health = significant target of power of optimization
Knowledge-truth - the sciences! (ex: statistics, biology, economics, etc.)
Categorize
Order
To come to know that which has been categorized as an order of the world
Control + administer
categorization , objectification, and utility become the way to know and understand everything — how to evaluate and value
Scientism - the idea that only science offers truth, and that truth takes the form of the law of cause and effect
Fully engrained in 19th century
“Science is meaningless because it has no answer to the only questions that matter to us: what should we do? How should we live?” - Max Weber quoting Leo Tolstoy
Disenchantment and nihilism ? ??
Knowledge - Techniques
For the first time life emerged as that which could be controlled, monitored, and optimized, one result of which is that it could be used systematically
Political arithmetic → now known as statistics
17th & 18th century techniques for agriculture arrived
Dutch figured out how to stop famines → don’t plan everything in same place same year
17th & 18th century — policing, stop throwing waste in streets
In administering and regulating life processes, biopower affects what counts as life processes
Two basic forms of biopower
Disciplinary
Techniques for supervising, controlling, and shaping the individual body
Seeks to create useful & compliant bodies - Docile bodies (malleable)
Fit a role, knowledgeable and accountable to a role
Individuals who control themselves rather than being controlled through repression
Regulatory - population
Not population as the sum total of individuals, but rather as an independent phenomenon
Rise of knowledge disciplines such as sociology, demographics, and statistics
Birth rates, death rates, life rates, crime rates
Security of the whole from internal danger
Practices of Biopower
Seek to know or govern populations (individually or collectively) by means of exclusion, correction, normalization, disciplining, therapeutics and optimization
Panopticon
From ancient Green-pan-all / optikos - seeing
Jeremy Bentham - designed this prison
“Morals reformed - health preserved industry invigorated - instruction diffused - public burthens lightened- Economy seated, as it were, upon a rock-the gordian knot of the poor-laws not cut, but untied all by a simple idea in architecture!” - Bentham
The Panoptican is not merely a design for prison but a design for society
Person in guard tower can see into all cells, prisoners don’t know whether they are watching
Prisoner learns to watch themself
Classrooms, harm reduction/safe consumption sites, hospital, work (all places where you can be watched)
Subjectivation
The manner in which subjects are brought to work on themselves, guided by scientific, medical, moral, religious, and other authorities on the basis of socially accepted arrangements of bodies and sexes
Affects individual and collective actors and gives rise to new forms of identity (ex: higher education students)
Normalizing Society
Norm - double meaning of normal
Expectation of value, ethics, statistical norms
Sovereign will to decide is replaced by a relative logic of calculating, comparing, and measuring
“It is no longer a matter of bringing death into play in the field of sovereignty, but of distributing the living in the domain of value and utility. Such a power has to quality, measure, appraise, and hierarchize, rather than display itself in its murderous splendor.. It affects distribution around the norm” - Michel Fouult on the normalizing society
Individual - through discipline, normalized in terms of moral and political values
Population - through regulation and control is balanced at the statistical norm (e.g. birth and death rate, life expectancy, crime rate, economic productivity
That individual or segment of the population that cannot become normalized
Excluded or marginalized
Their life is no longer fostered
Left to die
Biopower - the right to make live and to let die
“To say that power took possession of life in the nineteenth century, or to say that power at least takes life under its care in the 19th century, is to say that it has, thanks to the play of technologies of regulation on the other, succeeded in covering the whole surface that lies between the organic and the biological, between body and populations. We are then, in a power that has taken control of both the body and life or that has, if you like, taken control of life in general - with the body as one pole and the population as the other.” - M. Foucault
2/12/25 Week 5 - Phenomenology - World and Body
We are relational beings
Takeaway is that phenomenology is all about relationality, relationships, relational being
Ontology: theoretical and philosophical word for studying being or existence or fundamental reality
Most likely have heard things at the level of epistemology (study of knowledge) and empiricism and not ontology
World is dominated by sciences which is an empirical study, probably know things by empirical ways of knowing things
Going to be talking about assumptions of what really is and exists, what being really is
Assumptions are foundations of knowledge, sciences, and our common understanding
Phenomenology: a philosophical approach concerned with articulating the essential conditions or structures that make lived experience possible and meaningful
People have experiences and phenomenology asks how is it possible to have experience?
What is the kind of being that can have experience?
Experience
Much of phenomenological work done in medical anthropology has focused on the experience of illness, medical encounters between patient and doctor or nurses and doctors, or experience of healing or experiences of care
This would be first person conception of experience
More specifically often focused on narrative first person the way that person speaks about experience, “I experienced that and…” this is often called lived experience
Lived experience: the aspectual, partial, perspectival, situated, affective, embodied, and horizon-defined and horizon-defining modes that constitute the embodied subject - the person for whom, from whom, and toward whom, existence emanates
Aspectual: lived experience has an aspect to it, my perspective on something is only seeing certain aspect of something else
Ex: When you look at computer screen, you are only seeing one aspect of computer screen, but there are other parts of screen that you don’t see, but you fill in other parts of screen that you don’t see
Ex: experience of being ill, there are certain aspects of being ill like a cough, but you won’t be experiencing the underlying causes of the cough
Perspectival: my lived experience is my perspective on things (coming from my life history)
Affective: experience comes at (to) us and affects us
We embody our experiences over time
Horizon-defining: horizon of meaning, frames perception, there is horizon that frames the way we understand and put meaning to experiences and we are confined by it
Lived experience is the singular, irreplaceable, and unique vantage point of experience (but NOT individual, always relational)
Individual is not divisible
Relational is singular because there is unique singularity to relational history that has accumulated over lifetime, but this unique history is a result of all the relationships you have been tied up in over life, so it comes from outside (affective) not inside (which would be individual)
The arc of any given particular life
Each one of us has unique life trajectory
Lived experience highlights our fragility, precarity, vulnerability. This has made it very appealing to some versions of medical anthropology.
Experience can be taken in a much more expansive way than simply lived
What allows us to be the kind of being that has experience in the first place?
Condition of experience?
Experience as being-with
The existential betweenness that arises between subjects (person), and between those subjects and the world itself
Cartesian dualism:
The philosophical foundation of modern science and biomedicine
Substance ontology
All beings must be understood in terms of substance of some sort, where ‘substance’ refers to the enduring properties or essence that remains the same throughout all change
Ex: human nature, they are articulating substance ontology there is something essential to humans that can never be changed
Substance ontology would argue that this is true for all things, rocks, trees, etc.
Two cartesian substances
Res cogitans- immaterial mind (thinking things)
Reason, thoughts, beliefs, subject of experience
Res extensa - material bodies (extended things)
Governed by causal laws of nature
Human beings are a combination of these 2 things, mind and body, whereas everything else cats, trees, asteroids, water, is just simply res extensa
The mind body problem, mind body dualism of the human
Two dualisms:
Human is divided between cogitan and extensa (mind and body)
Whereas everything else is divided from the human by the fact that it is only res extensa
There is fundamental distinction between the human and everything else
This is foundation of science and medicine in philosophical terms ^^
Cartesian world - the container or extended space within which all these subjects and objects are located
Ex: fish bowl, and inside is fish, rocks, and little plastic guy, everything inside the world is located somewhere so you can GPS it and the differences between the location of the rock and submarine can be measured and quantified
World today is mathematized and the kind of world that is measurable and mathematized in modern science and biomedicine
Cartesian human - primarily defined by mind (res cogitans) and exists at a reflective distance to the world and its constituent beings such that the human’s relation to world is always one of objective reflection (science)
To be human is simply to be a scientist in a lab, reflecting on questions and problems and responding to questions and problems through measurements and experiments
Cartesian world is a scientific laboratory dominated by cartesian human which is defined by reflection and mind
“I think therefore I am” - decart
This is the ontological assumption behind the modern world
Back to phenomenology → all things are relational
Reject the ontological assumption behind the modern world
Relational being to exist is to be relational
I do not exist as an isolated point, but rather as a vector or arrow that gestures beyond itself in everything I think and do
Ecstatic relationality: always outside oneself, intertwined with other humans and non-humans alike, we are this intertwining
Relationally connected
Cartesian worldview: 2 dots that are not connecting
Phenomenological worldview - continuous outpoor of relationality
Like fireworks, lines that are continuing
Relational knotting, a previous knot that has been made will effect knots made in the future
Each a singular being overtime that is affected by unique relational connections that alway affect the next one
Decart - says to be human is to think
Location means you could gps something
Martin heidegger - being-in-the-world
Heideggar in his book “being and time” argues against Cartesian philosophy and trying to create new understanding of being, sociality, and ultimately science
Dasein: there-ness as always already being situated in a relational context or world (this word just means in german, existence)
Da - “there”
Sein - “being”
“Being there” or “thereness”
To be human, is to be there, situated in relational context or world
This contrasts Decart who says to be human is to think
Location in world of meaning and context, Dasein is always located somewhere, here as in located there and there of overthere
Dasein is to be stretched out such that an openness or clearing emerges within which meaningful experience happens
Ex: a path in the forest and there comes a clearing in the path where there are less trees and sun shines into it and its much brighter than the darker path, dasein, the human, is this place where the sun shines in and meaning and experience happens in the world
“Being-in-the world” - intertwining of human and world
World: a dynamic web of relations that together manifest a sense or “meaning” for the totality as well as each of its interconnected “parts”
World is always unfolding, world is always in the process of becoming something else because of more things coming into relationships or somethings coming out
Image of world is like a network and this is contrasting to a cartesian world to a container that is defined by modernity and science and biomedicine, fishbowl that has different subjects and objects that are separated from each other
We do sometimes step back and reflect, but that is not our fundamental way of existing that is instead a derivative way of existing
The Hammer example (imagine yourself hammering)
Zuhanden: ready to hand
The everyday, relational intertwinement between “things” and dasein
Normal way of doing things, when we do things we do them almost habitually (like hammering a nail or typing)
Vorhanden: present at hand
The derivative, objective, thing-being
Something goes wrong and the hammer becomes present to us, it is what happens in the breakdown of normal life
Still, even in this derivative modality, the being-there of being human (dasein) is always to be in a world as essentially intertwined and relationally constituted
Maurice Merleau-Ponty’s Body Schema
The body schema is a way of trying to understand the relationality as emanating from the body and trying to think the body as constitutive of our very existence and historical contingent and open to reconfiguration
The body schema is not just an image in my mind of what my body looks like; it is a dynamic organizational matrix or template, both for my sense of embodiment and for embodied action
The embodied sense of having a body and much of our action is done in an embodied way like typing
When you are first learning an instrument you are in this cartesian, reflective thinking being, how do i play this chord? But then overtime you just learn to play guitar w/out really thinking
Intercorporeality: the relationally intertwined body with others and the world
Flesh: the overlapping or intertwined relation — the connection — between “me” and the other/world
The body schema: an embodied historical record of experience, social context, emotion, taboos, and desires
Embodiment: helps us understand how illness can be experienced differently by specific person, within different cultural contexts (e.g. overworked/burnout), and among different social groups (e.g. higher obesity or shorter life expectancy among american poor; higher rates of diabetes among black americans)
The way in which the world comes into our bodies
Whereas these difference are often times articulated as genetic differences by biomedicine, phenomenologists understand them, at least in part, as consequences of the body schema, or embodiment as a habituated and embodied life trajectory
Body schema is a Feedback or attunement: each of us are an archive of our particular life trajectories or experiences in particular worlds
Embodiment helps explain how particular worlds oftentimes marked, for example, by inequalities of various kinds of immense pressure to be financially secure, become manifest on and through our bodies as illness — both physically (e.g., child mortality, heart disease) and mentally (e.g. anxiety)
Body schema or embodiment: allows for various forms of experience, and in our case, various forms of illness experience
Cartesian perspective: economic and social inequalities these hardly play a role in scientific understanding
The phenomenological perspective: tied up in the world and a version of the world just like its a version of you
Scared and alone rat will be different than rat living in world with play things and friends
The heidegger perspective??