Medical Anthropology: The Development of the Field

and political-economic context, and links human behavior and biology. Medical The field of anthropology has anthropological theory can be divided into a changed, or perhaps more accurately, has number of distinct threads. These different expanded since its initial academic threads argue from very differing conception. Specific areas of study have epistemological foundations. To explore branched from the quintessential these different theoretical positions it is anthropology and have subsequently important to first gain an understanding of developed into new, more specialized how medical anthropology developed. subdisciplines. One must be cautious, however, when using the label "subdiscipline" THE mSTORY OF MEDICAL to describe these new fields in that it can ANTHROPOLOGY imply that they are somehow adjunctive, or even restricted to, the anthropological corpus. Prior to the 1950s, the study of Instead, these more focused branches must be medicine by anthropologists was done within recognized as highly specialized areas of the larger context of cultural and social study that take their ontological roots from studies (Baer et. at., 1997). Early interest in conventional anthropology, and have ethnomedicine was restricted to questions developed more eclectic epistemological regarding the ways other people dealt with traditions. Anthropologists in these new sickness and, generally, enhanced personal disciplines study specific aspects oflife based health. Currently, medical anthropologists on traditional anthropological theory, but will have expanded their interests from the way also consider other disciplines, like marketing other people conceptualize health to include or medicine, when conducting fieldwork, wider ranging issues, as will be explored proposing/considering theory, and writing below. Stewart and Strathem (1999:3) text. The following discussion will focus on observe that the field has undergone " ... a the field of medical anthropology. circular migration: from the jungle to the city, In general, medical anthropology is and back again." This circular migration is a interested in mind body interactions, thus result of researchers asking questions, not tracing the mediation of moral and only of other cultures and healing practices, psychological domains of experience - but also of their own. It is necessary to studying the bridge between the biological understand this circular movement in order to and the social. Johnson and Sargent (1996) understand the current state of research in coined the term biopsychosocial, which medical anthropology. At this point, describes a model that grounds the however, one must recognize that there exist anthropological study of disease in historical a number of distinct cleavages in medical anthropological theory. triumphalism, inherent in the Western It is possible to clearly identifY three biomedical institution, which the field has distinct theoretical positions. These positions exposed and attempts to transcend. Whatever are very different from each other as a result the case, over its brief history, medical of their different epistemologies. First, anthropology has become well established and ethnomedical anthropology, exemplified by continues to grow. the work of Nichter (1996), focuses on local Currently, the Society for Medical health models. These investigations are most Anthropologists constitutes the second largest closely related to the earliest form ofthe field. unit of the American Anthropological Second, Critical Medical Anthropology, like Association (AAA 2001). Medical Farmer's work (1992, 1999), is based on a Anthropologists frequently publish their political economy approach. Farmer has used research in several well-known academic this kind of analysis to write several journals such as Medical Anthropology interesting books on the subjects of Quarterly, Medical Anthropology, Social IDVIAIDS and infectious diseases such as Science and Medicine, and Culture, Medicine Tuberculosis. The final theoretical position in and Psychiatry. Before these specialized medical anthropology is known as the clinical journals, anthropologists published work that approach. It places primacy on the healing would today be considered in the realm of process itself Researchers such as Brodwin medical anthropology in more generic (1992), and the early works of Kleinman, look periodicals. W.H.R. Rivers was one of the at sickness as a social practice. These three first authors to publish work that dealt with main schools of thought will be further health related issues cross-culturally in explored below. Yet, despite dialogue Medicine, Magic, and Religion (1924). between these researchers it is important to According to Baer et. al. (1997), medical note that they are distinct from each other and anthropology did not become a distinct that researchers often clash due to their subdiscipline until the 1950s. They argue that differing ideological positions. the origins of the field can be traced back to As the above description illustrates, Rudolf Virchow, a renowned pathologist medical anthropology is by no means limited interested in social medicine who helped to questions directly related to the ways in establish the first anthropological society in which people deal with disease. Instead, the Berlin (1997: 15). It is interesting to note that subject matter includes the etiology of Virchow influenced Franz Boas while he was disease, preventative measures, gender roles, affiliated with the Berlin Ethnological medical pluralism, ethnopsychiatry, curative Museum between 1883-1886 (Baer et. aI., measures, bioethics, stress and social support, 1997:15). and disease eradication (Baer, et. aI., 1997; Since then, some major events in the Johnson & Sargent 1996; Stewart & Strathern field include an increase of anthropological 1999; Brodwin et. aI., 1992; Farmer 1999). writing regarding medicine after World War Indeed the term "medical anthropology" II (due to an increased interest in the effects seems restrictive and perhaps misleading. As of war), the publication of William Caudill's Baer et. al. (1997:vii) suggest, referring to the Applied Anthropology in Medicine (1953), field as the "anthropology of health and the increased involvement of anthropologists healing" is perhaps more appropriate. in international health work, and the However, the term "medical anthropology" is involvement of anthropologists in clinical largely preferred; it can be argued that this is settings. Thus, the circular migration the ad nauseam example of the medical becomes obvious as one can trace the anthropological work from field accounts of approach would argue that decisions are based "native" medicine to studying healthcare in primarily on cultural values. the West, and then back again to look at other Nichter and Nichter (1996) take an healthcare models and conceptions of health ethnomedical approach when investigating as compared to those in the West. The loop international health. They propose that the closes with research concerning, for example, best way to approach the subject is to examine the interaction between modem Western a number of individual case studies. They biomedicine and indigenous healthcare argue that each case study can shed light on systems, or the influx of "alternative" specific issues including reproductive health, medicine in Western society. However, the disease control, health education, and methods of approaching these questions, as pharmaceutical use, etc. To illustrate their noted above, have strongly diverged. The point, they studied women's reproductive following will explore the three previously health by examining women's health practices mentioned theoretical positions in further during pregnancy, fertility related practices, detail. and interpretations of and demand for fertility control (1996: 1). By researching individual cases Nichter and Nichter were able to investigate many diverse factors, both social Ethnomedical anthropology is and biological, that contribute to each of these concerned with questions regarding local Issues. medical models. Stewart and Strathern (1999), for example, base their analyses on a theoretical opposition between personalistic and naturalistic medicine. Modem Western Critical Medical Anthropology (CMA) biomedicine, with its empirical, scientific takes a very different approach to looking at principles, is an example of naturalistic questions regarding health. CMA believes medicine. By contrast, the personalistic that there exists a hegemonic relationship (as system is usually attributed to any non- per Gramsci's use where a dominant practice scientific or non-empirical medical system. results in a predictable and controllable social These may include witchcraft, laying on of consciousness) between the ideology of the hands, and herbalism. Ethnomedical health care system and that of the dominant anthropologists will sometimes highlight the ideological and social patterns. More simply differences between these two systems when put, a political economy approach. CMA attempting to explore different kinds of views disease as a social as well as a healthcare models around the world. For biological construct (Baeret. al., 1997:35-36). example, Stewart and Strathern (1999) Critical Medical Anthropologists examines explain that Japanese holism is a result ofthe issues such as who have the power over pluralistic incorporation of traditional certain social institutions, how and in what Japanese medicine with modem biomedicine. form is this power delegated, and how this The ethnomedical approach attributes the power is expressed (Baer et. al. 1997:33-35). existence of this system to the cultural, or In effect, Critical Medical Anthropologists try perhaps, ideological tradition of the peoples to deconstruct the medical science and expose who use it. In the case of a clearly pluralistic the fact that all science is influenced by system, where people have to choose between cultural and historical conditions, much like biomedical treatment and traditional the social constructionist approach. indigenous treatment, the ethnomedical Therefore, if one wishes to study disease, it is necessary to start by identifYing political, different cultures. Thus, they examine the economic, social, and environmental experience of pain as " ... an intimate feature conditions within a particular society or of lived experience of individuals in the group. It is necessary for a researcher in the context of their local social world and CMA tradition to understand these and historical epoch"(Brodwin et. at., 1992:2). subsequently, understand the local group's Interestingly, with this perspective in mind, it etiology, before it is possible to attempt to is possible to detect differences between understand the medical system. groups of people depending on the type of A good example of the application of pain, or more generally, the suffering they CMA theory can be found in Paul Farmer's experience and how they express it. The book AIDS and Accusations: Haiti and the authors claim that"... chronic pain syndromes Geographv of Blame (1992). In this work, highlight the fault lines of society" (Brodwin Farmer explores political economic factors, a et. at. 1992:3). Suffering, in this case, can be wide range of historical events, and attributed to a number of acute social and epidemiology in his analysis of mvIAIDS in economic factors. Haiti. He looks at the increased susceptibility Where the clinical approach to mvIAIDS among the poor and common distinguishes itself from the other forms of social reactions to HIV/AIDS in Haiti. analysis is that clinical medical anthropology Farmer's focus is clearly political economic; is best suited to answer questions regarding he takes a very heavy neo-Marxist approach in suffering and other health issues faced by the his analysis. Farmer examines social class individual while CMA and ethnomedicine are and how mvIAIDS impacts the lives of focused on health issues regarding groups of residents of Do Kay, the village in which he people, or collectives. Moreover, clinical does his fieldwork. Farmer then ties in all the medical anthropologists are concerned with wide-ranging information in the concluding the way the bodily experience is influenced by chapters of his book, emphasising the role of meanings, relationships, and institutions world economic and political trends and their (Brodwin et. al., 1992:7). Another interesting affects on Haiti. aspect of Clinical Medical Anthropology is its study of healthcare systems and the study of conflicting ideologies. This ideological incompatibility is manifest in the differing of The focus of this approach is on the expectations of public healthcare held by the healing process itself. Moreover, it studies administrative "system" and the people it is sickness as a social practice. One of the most designed to treat. This is especially the case common areas of study when dealing with this when dualistic medical systems exist. kind of analysis is the exploration of different constructions of the concept of illness as a function of differing cultural ideologies. In their book Pain As Human Experience, This brief discussion ofthe history and Brodwin et. al. (1992) explore the concept of modem-day form of medical anthropology has pain and how it differs from culture to culture. touched on some of the major issues that From describing pain as "sound" in Japan, to concern the field today. The development of differentiating between headaches and the field from its early form as an adjunct to brainaches among North American Latinos, social or cultural anthropological study, to the these authors attempt to understand the large and ever-growing field it is today is but experience of pain and its treatment in one example of a trend in the discipline. The specialized use of anthropological principles Anthropology Today: An and theory in a more narrowly focused Encyclopedic Inventory. Kroeber, specified gaze, allows anthropologists to (ed.). pp. 771-806. Chicago: develop more eclectic, but still University of Chicago Press. anthropological, subdisciplines. Baer et. al. (1997:vii) argue that medical anthropology is Farmer, Paul. 1999. Infections and the most dynamic of the subdisciplines within Inequalities: The Modern Plagues. anthropology. It is easy to see how they could Berkeley: University of California come to such a conclusion considering the Press. range of theoretical positions medical anthropologists take and the breadth of Farmer, Paul. 1992. AIDS and Accusation: questions they aspire to answer. Haiti and the Geography of Blame. Berkeley: University of California Press.

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