DOCSLIB.ORG

Anthropology in the Clinic: the Problem of Cultural Competency and How to Fix It

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anthropology in the Clinic: the Problem of Cultural Competency and How to Fix It Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Kleinman, Arthur, and Peter Benson. 2006. “Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It.” PLoS Medicine 3 (10) (October 24): e294. doi:10.1371/ journal.pmed.0030294. Published Version 10.1371/journal.pmed.0030294 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34360747 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Essay Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It Arthur Kleinman*, Peter Benson patients of a certain ethnicity—such as, practical understanding of an episode the “Mexican patient”—are assumed (see Box 1). to have a core set of beliefs about Historically in the health-care illness owing to fi xed ethnic traits. domain, culture referred almost solely Cultural competency becomes a series to the domain of the patient and of “do’s and don’ts” that defi ne how family. As seen in the case scenario to treat a patient of a given ethnic in Box 1, we can also talk about the background [10]. The idea of isolated culture of the professional caregiver— societies with shared cultural meanings including both the cultural background ultural competency has become would be rejected by anthropologists, of the doctor, nurse, or social worker, a fashionable term for clinicians today, since it leads to dangerous and the culture of biomedicine Cand researchers. Yet no one can stereotyping—such as, “Chinese believe itself—especially as it is expressed in defi ne this term precisely enough to this,” “Japanese believe that,” and so institutions such as hospitals, clinics, operationalize it in clinical training and on—as if entire societies or ethnic and medical schools [14]. Indeed, the best practices. groups could be described by these culture of biomedicine is now seen It is clear that culture does matter in simple slogans [11 –13]. as key to the transmission of stigma, the clinic. Cultural factors are crucial Another problem is that cultural the incorporation and maintenance to diagnosis, treatment, and care. factors are not always central to a case, of racial bias in institutions, and the They shape health-related beliefs, and might actually hinder a more development of health disparities behaviors, and values [1,2]. But the across minority groups [15–18]. large claims about the value of cultural competence for the art of professional Culture Is Not Static care-giving around the world are simply Box 1. Case Scenario: Cultural In anthropology today, culture is not supported by robust evaluation Assumptions May Hinder not seen as homogenous or static. research showing that systematic Practical Understanding Anthropologists emphasize that culture attention to culture really improves A medical anthropologist is asked by clinical services. This lack of evidence a pediatrician in California to consult in is a failure of outcome research to take the care of a Mexican man who is HIV culture seriously enough to routinely Funding: Our work on cultural aspects of clinical care positive. The man’s wife had died of AIDS assess the cost-effectiveness of culturally has been supported by the Michael Crichton Fund, one year ago. He has a four-year-old son Harvard Medical School, and by a National Institute of informed therapeutic practices, not a Mental Health Training Grant on “Culture and Mental who is HIV positive, but he has not been lack of effort to introduce culturally Health Services” (5T32MH018006-21). bringing the child in regularly for care. informed strategies into clinical settings The explanation given by the clinicians Competing Interests: The authors declare that they [3]. have no competing interests. assumed that the problem turned on a radically different cultural understanding. Citation: Kleinman A, Benson P (2006) Anthropology Problems with the Idea of Cultural in the clinic: The problem of cultural competency and Competency What the anthropologist found, though, how to fi x it. PLoS Med 3(10): e294. DOI: 10.1371/ was to the contrary. This man had a near journal.pmed.0030294 One major problem with the idea of complete understanding of HIV/AIDS cultural competency is that it suggests DOI: 10.1371/journal.pmed.0030294 and its treatment—largely through the culture can be reduced to a technical support of a local nonprofi t organization Copyright: © 2006 Kleinman and Benson. This is skill for which clinicians can be trained aimed at supporting Mexican-American an open-access article distributed under the terms to develop expertise [4]. This problem of the Creative Commons Attribution License, patients with HIV. However, he was a which permits unrestricted use, distribution, and stems from how culture is defi ned in very-low-paid bus driver, often working reproduction in any medium, provided the original medicine, which contrasts strikingly author and source are credited. late-night shifts, and he had no time with its current use in anthropology— to take his son to the clinic to receive Arthur Kleinman is Chair and Esther and Sidney the fi eld in which the concept of care for him as regularly as his doctors Rabb Professor in the Department of Anthropology culture originated [5–9]. Culture is at Harvard University, and Professor of Psychiatry requested. His failure to attend was not often made synonymous with ethnicity, and Medical Anthropology at Harvard Medical because of cultural differences, but rather School, Boston, Massachusetts, United States of nationality, and language. For example, his practical, socioeconomic situation. America. Peter Benson is a PhD candidate in medical anthropology in the Department of Anthropology Talking with him and taking into account at Harvard University, Cambridge, Massachusetts, his “local world” were more useful than United States of America. The Essay section contains opinion pieces on topics positing radically different Mexican of broad interest to a general medical audience. * To whom correspondence should be addressed. health beliefs. E-mail: [email protected] PLoS Medicine | www.plosmedicine.org 1673 October 2006 | Volume 3 | Issue 10 | e294 is not a single variable but rather Box 2. The Explanatory Models of illness is recast into technical disease comprises multiple variables, affecting Approach categories something crucial to the all aspects of experience. Culture is experience is lost because it was not inseparable from economic, political, • What do you call this problem? validated as an appropriate clinical religious, psychological, and biological • What do you believe is the cause of concern [34]. conditions. Culture is a process this problem? Rather, explanatory models through which ordinary activities and • What course do you expect it to take? ought to open clinicians to human conditions take on an emotional tone How serious is it? communication and set their expert and a moral meaning for participants. knowledge alongside (not over and • What do you think this problem does Cultural processes include above) the patient’s own explanation inside your body? the embodiment of meaning in and viewpoint. Using this approach, psychophysiological reactions [19], • How does it affect your body and your clinicians can perform a “mini- the development of interpersonal mind? ethnography,” organized into a series attachments [20], the serious • What do you most fear about this of six steps. This is a revision of the performance of religious practices condition? Cultural Formulation included in the [21], common-sense interpretations • What do you most fear about the fourth edition of the Diagnostic and [22], and the cultivation of collective treatment? Statistical Manual of Mental Disorders and individual identity [23]. Cultural (DSM-IV) (see Appendix I in [35]) (Source: Chapter 15 in [38]) processes frequently differ within the [36,37]. same ethnic or social group because of differences in age cohort, gender, A Revised Cultural Formulation political association, class, religion, not eat pork; some Jews, including the Step 1: Ethnic identity. The fi rst step ethnicity, and even personality. corresponding author of this paper, is to ask about ethnic identity and love pork.) Ethnography emphasizes determine whether it matters for the The Importance of Ethnography engagement with others and with the patient—whether it is an important It is of course legitimate and highly practices that people undertake in their part of the patient’s sense of self. As desirable for clinicians to be sensitive local worlds. It also emphasizes the part of this inquiry, it is crucial to to cultural difference, and to attempt ambivalence that many people feel as acknowledge and affi rm a person’s to provide care that deals with cultural a result of being between worlds (for experience of ethnicity and illness. This issues from an anthropological example, persons who identify as both is basic to any therapeutic interaction, perspective. We believe that the optimal African-American and Irish, Jewish and and enables a respectful inquiry into way to do this is to train clinicians in Christian, American and French) in a the person’s identity. The clinician ethnography. “Ethnography” is the way that cultural competency does not. can communicate a recognition that technical term used in anthropology And ethnography eschews the technical people live their ethnicity differently, for its core methodology. It refers to mastery that the term “competency” that the experience of ethnicity is an anthropologist’s description of suggests. Anthropologists and clinicians complicated but important, and that what life is like in a “local world,” a share a common belief—i.e., the it bears signifi cance in the health-care specifi c setting in a society—usually primacy of experience [29–33].
Load more

Recommended publications
  • Medical-Anthropology-2015.Pdf
    Princeton University Department of Anthropology Spring 2015 MEDICAL ANTHROPOLOGY ANT 335 M/W 11:00 am- 12:20 pm Lewis Library 120 Instructor: Professor João Biehl ([email protected]) Lecturer: Bridget Purcell ([email protected]) Graduate Student Assistants: Kessie Alexandre ([email protected] Thalia Gigerenzer ([email protected]) Course Description Medical Anthropology is a critical and people-centered investigation of affliction and therapeutics. It draws from approaches in anthropology and the medical humanities to understand the body- environment-medicine interface in a cross-cultural perspective. How do social processes determine disease and health in individuals and collectivities? How does culture surface in the seeking of treatment and the provision of medical care? What role do medical technologies and public interventions play in health outcomes? Which values inform medical theory and practice, and how might the humanities deepen our understanding of the realities of disease and care? In the first half of the course, we will discuss topics such as: the relation of illness, subjectivity, and social experience; the logic of witchcraft; the healing efficacy of symbols and rituals; the art of caregiving and moral sensibility. We will also probe the reach and relevance of concepts such as the normal and the pathological, body techniques, discipline and normalization, medicalization, the nocebo and placebo effects, the mindful body, and the body politic. In the second half of the course, we will explore how scientific
    [Show full text]
  • UC Berkeley UC Berkeley Electronic Theses and Dissertations
    UC Berkeley UC Berkeley Electronic Theses and Dissertations Title Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia Permalink https://escholarship.org/uc/item/5fv121wm Author Stroud, Martha Publication Date 2015 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia by Martha Stroud A dissertation submitted in partial satisfaction of the requirements for the degree Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Nancy Scheper-Hughes, Chair Professor Laura Nader Professor Sharon Kaufman Professor Jeffrey A. Hadler Spring 2015 “Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia” © 2015 Martha Stroud 1 Abstract Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia by Martha Stroud Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology University of California, Berkeley Professor Nancy Scheper-Hughes, Chair In Indonesia, during six months in 1965-1966, between half a million and a million people were killed during a purge of suspected Communist Party members after a purported failed coup d’état blamed on the Communist Party. Hundreds of thousands of Indonesians were imprisoned without trial, many for more than a decade. The regime that orchestrated the mass killings and detentions remained in power for over 30 years, suppressing public discussion of these events. It was not until 1998 that Indonesians were finally “free” to discuss this tragic chapter of Indonesian history. In this dissertation, I investigate how Indonesians perceive and describe the relationship between the past and the present when it comes to the events of 1965-1966 and their aftermath.
    [Show full text]
  • Bridget Hanna
    BRIDGET HANNA Social Science Environmental Health Research Institute Asia Center Department of Sociology and Anthropology Graduate School of Arts and Sciences Northeastern University Harvard University [email protected] [email protected] EDUCATION Ph.D Harvard Graduate School of Arts and Sciences, Cambridge, MA Social Anthropology, 2014 Dissertation Toxic Relief: Science, Uncertainty, and Medicine after Bhopal Committee: Arthur Kleinman, Ajantha Subramanian, Sheila Jasanoff Harvard School of Public Health, Boston, MA Courses Environmental Health, Epidemiology & Biostatistics, 2009-10 A.M. Harvard Graduate School of Arts and Sciences Social Anthropology, 2008 B.A. Bard College, Annandale, NY Cultural Anthropology, 2004 Thesis The School of the Future: The Social Construction of an Environmental Hazard in the Post-industrial Fringe POSTDOCTORAL AFFILIATIONS & OTHER RESEARCH POSITIONS Postdoctoral Research Associate, Social Science & Environmental Health Research Institute, Department of Sociology & Anthropology, Northeastern University, 2014-2015; 2016. Designed survey and research materials for environmental health data privacy project with Silent Spring Institute; developed socio-exposome research project; participated in SSEHRI research group, STS training program, and sociological research training. Visiting Scholar, Asia Center, Harvard University, 2014-2016. Visiting Scholar, Department of Anthropology, University of Colorado, 2012-2014 Research Assistant to Professor Arthur Kleinman, Harvard Department of Social Medicine 2008;
    [Show full text]
  • Erica Caple James
    Erica Caple James MIT Anthropology Program 77 Massachusetts Avenue Room E53-335G Cambridge, MA 02139-4307 (617) 253-7321 [email protected] EDUCATION Harvard University, Ph.D. in Social Anthropology 2003 Harvard University, A.M. in Social Anthropology 1998 Harvard Divinity School, Masters of Theological Studies (M.T.S.) 1995 Princeton University, A.B. in Anthropology 1992 DISSERTATION “The Violence of Misery: ‘Insecurity’ in Haiti in the ‘Democratic’ Era” Advisor: Dr. Arthur Kleinman FELLOWSHIPS AND HONORS Abdul Latif Jameel World Water and Food Security Lab Grant 2015-2017 Todman Family Fund, for launch of Global Health and Medical Humanities Initiative 2014 Alumni Class Funds 2014 Tenure, Massachusetts Institute of Technology 2013 Gordon K. and Sybille Lewis (Book) Award, Caribbean Studies Association 2013 School for Advanced Research on the Human Experience, Advanced Seminar 2013 James A. and Ruth Levitan Prize in the Humanities, MIT 2012 Gregory Bateson Book Prize, Society for Cultural Anthropology, Honorable Mention 2011 MIT Old Dominion Fellowship 2011 Class of 1947 Career Development Professorship 2010 Rita E. Hauser Fellow, Radcliffe Institute for Advanced Study 2010-2011 MIT School of the Humanities, Arts, and Social Sciences Research Fund 2009 NIH National Loan Repayment Program Funding for Health Disparities Research 2007-2009 Career Enhancement Fellowship, Woodrow Wilson National Fellowship Foundation, 2007 Honorable Mention Mellon Foundation Support for the Study of Science, Technology, and Medicine 2006 School of the Humanities,
    [Show full text]
  • Why Do Indigenous Practitioners Successfully Heal?
    WHY DO INDIGENOUS PRACTITIONERS SUCCESSFULLY HEAL? ARTHUR KLEINMAN University of Washington School of Medicine and LILIAS H. SUNG National Taiwan University [l] Abstract-The authors report findings from a follow-up study of patients treated by a shaman (t&q-ki) in Taiwan. and relate these to early findings from a much larger study of indigenous healing in that Chinese cultural setting. Ninety percent of patients treated by indigenous practitioners suRered from chronic. self-limited. and masked minor psychological disorders. The last group. involving “somatiza- tion” of personal and interpersonal problems. accounted for almost 50”,, of cases. In the follow-up study. IO of 12 consecutive cases treated by this indigenous healer rated themselves as. at least partially. cured. This occurred in spite of any significant symptom change in several cases. and in the face of considerably worsened symptoms in one case. In these cases. behavioral or social gains were respon- sible for the positive evaluation of therapeutic efficacy. INTRODUCTION Instead, I present the complex issues involved in how The study of indigenous healing may be important we evaluate therapeutic efficacy as the central prob- to the general anthropologist for the light it throws lem in the cross-cultural study of healing. The on a particular culture. It may be important to the explanations I propose for understanding how the in- medical anthropologist for the understanding it pro- digenous healing described in this paper works are vides of a given society’s system of health care. But anchored in a theoretical framework, which I outline the cross-cultural investigation of indigenous healing below.
    [Show full text]
  • Tradition, Christianity, and the State in Understandings of Sickness and Healing in South Nias, Indonesia
    TRADITION, CHRISTIANITY, AND THE STATE IN UNDERSTANDINGS OF SICKNESS AND HEALING IN SOUTH NIAS, INDONESIA by Edward Peake Thesis submitted for degree of PhD Department of Anthropology London School of Economics University of London September 2000 UMI Number: U126970 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U126970 Published by ProQuest LLC 2014. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 F 7202 7 3 8 3 9 % ABSTRACT TRADITION, CHRISTIANITY, AND THE STATE: UNDERSTANDINGS OF SICKNESS AND HEALING IN SOUTH NIAS, INDONESIA The thesis describes the range of south Nias villagers' understandings of sickness and healing, and investigates how and why they draw on various cultural spheres in the interpretation and management of sickness events. Traditional notions of sickness etiology are set in the context of both Christian beliefs and the state's efforts to promulgate modem, 'scientific' understandings, in order to show how sociologically distinguished individuals draw variously at different times and contexts on all three fields of sickness interpretation and management. The thesis begins with a history of Nias relations with the outside world, in order to delineate the genealogy of modem Indonesian attitudes to local culture.
    [Show full text]
  • How to Use the PIH Engage Curriculum Led By: Community Building Lead
    How to use the PIH Engage Curriculum Led by: Community Building Lead Each of the lessons revolves around a specific theme pulled from research, writing, and experience that is integral to the PIH mission and model of global health care delivery. There is a suggested order; however, each lesson can stand-alone and spark unique discussion pertinent to the movement for the right to health. Choose lessons to curate specific meetings, and play into the interests of your team members. There are two different ways to use these lessons, either through the discussion guide or lesson plan; however, every lesson has an overarching goal. By the end of the lesson, whether you use the discussion guide or the lesson plan, you should accomplish this goal. Goals can be shared with your team, or simply used to guide how your time is spent. It is imperative that the Community Building Lead deeply engages with and has a strong understanding of the readings to properly facilitate these discussions. Reviewing the discussion guide and lesson plan prior to the meeting is also necessary. The Community Building Lead should also make sure team members have copies of the reading, either digital or physical, prior to and during the meeting. Additionally, the Community Building Lead should feel free to use additional resources (e.g. videos, handouts, slides, etc.). It is also helpful to be interactive while conducting lessons –use blackboards/whiteboards, projectors, and any other resources available to you. Discussion Guide Use the discussion guide if your team members will fully engage with the readings and come with a solid understanding of the literature.
    [Show full text]
  • Princeton University Fall 2019 CRITICAL PERSPECTIVES in GLOBAL HEALTH GHP 350 / ANT 380 / WWS 380 Lewis Library 120 M-W 11:00
    Princeton University Fall 2019 CRITICAL PERSPECTIVES IN GLOBAL HEALTH GHP 350 / ANT 380 / WWS 380 Lewis Library 120 M-W 11:00 am – 12:20 pm Instructor: João Biehl | [email protected] Teaching Fellows: Arbel Griner [email protected] Heidi Morefield [email protected] Sebastián Ramírez [email protected] Course Description Global health brings together a vast and diverse array of actors working to address urgent health issues worldwide with unprecedented, if unequally distributed, financial and technological resources. This course is a critical analysis of the cultural, social, political, and economic processes related to this expanding medical and humanitarian field. Taking an interdisciplinary approach, the course identifies the main actors, institutions, practices, and forms of knowledge production at work in the ‘global health systems today and explores the multiple factors that shape patterns and variations in disease and health across societies. As we scrutinize the evidence-making practices, agendas, and values that underpin specific paradigms in global health, we will place current interventions in historical perspective, gauging their benefits as well as their sometimes- unintended consequences. Throughout the course, students will be encouraged to think critically and creatively about health problems and policies and to envision innovative and effective forms of collaborative research and interventions. We will emphasize the ways in which the field of global health challenges both the social and natural sciences to keep up with changing socio- medical realities and to better understand local worlds and the needs, experiences, and capacities of people—from the subjects of interventions to the health workers and scientists who seek to assist them.
    [Show full text]
  • Explanatory Models in Psychiatry
    Explanatory models in psychiatry The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Weiss, Mitchell G and Daryl Somma. 2007. Explanatory Models in Psychiatry. In Textbook of Cultural Psychiatry, eds. Dinesh Bhugra and Kamaldeep Bhui, pp. Cambridge; Cambridge University Press. Published Version doi:10.1017/cbo9780511543609.012 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:23593201 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Explanatory models in psychiatry Mitchell G. Weiss and Daryl Somma EDITORS' INTRODUCTION the biopsychosocial model. They are also aware of possible critique of the model. This critique includes the perceived Similar experiences of illness or distress are seen as being fixed and static nature of the model and that clinical inter- caused by different elements across different cultures. ests do not take into account the injuence of social context. Feeling gutted and sinking heart are idioms of distress Perhaps the most significant criterion is based on the ques- which are remarkably different across cultures, but their tion of whether too much emphasis on the model in explan- implications at an individual level are very similar. atory model exists. Models are important for developing Furthermore, the causation of the distress will be seen as theory and for research. The approach remains a useful remarkably different. It is evident that, in traditional cul- one for bridging the interests and experiences of clinicians tures, the locus of control may be seen as external which may and their patients.
    [Show full text]
  • An Sfaa Oral History Interview with Paul Farmer
    An SfAA Oral History Interview with Paul Farmer On the Evolution of an Applied Anthropologist and Healer By Barbara Rylko-Bauer Michigan State University [email protected] Paul Farmer is a medical anthropologist and physician who has dedicated his life to improving health care for the world’s poorest people. He is a co-founder and chief strategist of Partners in Health (PIH), an international non-profit organization whose mission is to provide a preferential option for the poor in health care, to bring the benefits of modern medical science to those living in great poverty, and to undertake research and advocacy activities on behalf of the destitute sick. PIH has operations in twelve sites in Haiti, as well as major programs in nine other countries, including Rwanda and Sierra Leone. Paul Farmer and his colleagues have pioneered community-based treatment strategies for AIDS, TB, and other infectious and chronic diseases, thus demonstrating the delivery of sustainable, high-quality health care in resource-poor settings. Paul Farmer holds an M.D. and Ph.D. from Harvard University, where he is Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School. He also serves as Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston, and as U.N. Special Adviser to the Secretary-General on Community-based Medicine and Lessons from Haiti. He has written extensively on health, human rights, and the consequences of social inequality and his books have garnered major awards in anthropology, including the Wellcome Medal, the Eileen Basker Prize, the Margaret Mead Award, and the J.
    [Show full text]
  • Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? a Quandary for "The New Bioethics" Author(S): Arthur Kleinman Source: Daedalus, Vol
    Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for "The New Bioethics" Author(s): Arthur Kleinman Source: Daedalus, Vol. 128, No. 4, Bioethics and Beyond (Fall, 1999), pp. 69-97 Published by: The MIT Press on behalf of American Academy of Arts & Sciences Stable URL: http://www.jstor.org/stable/20027589 . Accessed: 23/04/2014 17:01 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp . JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. The MIT Press and American Academy of Arts & Sciences are collaborating with JSTOR to digitize, preserve and extend access to Daedalus. http://www.jstor.org This content downloaded from 128.103.149.52 on Wed, 23 Apr 2014 17:01:18 PM All use subject to JSTOR Terms and Conditions Arthur Kleinman Moral Experience and Ethical Reflection: Can Ethnography Reconcile Them? A Quandary for "The New Bioethics" REMAKING THE CASE FOR BIOETHICS ITH hastening pace, bioethics in America is moving in manifold ways to deal with serious problems in its modus operandi. These problems have become so w well known they are by now clich?s. In previous studies I have attempted to characterize them by means of three "isms": ethnocentrism, medicocentrism, psychocentrism.1 By this awk ward-sounding trio I meant to encompass past criticism of on bioethics account of its Eurocentric orientation and grudg ingly limited engagement with non-Western and ethnic value orientations.
    [Show full text]
  • 1965 and Now in Indonesia by Martha Stroud a Dissertation Submitted In
    Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia by Martha Stroud A dissertation submitted in partial satisfaction of the requirements for the degree Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Nancy Scheper-Hughes, Chair Professor Laura Nader Professor Sharon Kaufman Professor Jeffrey A. Hadler Spring 2015 “Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia” © 2015 Martha Stroud 1 Abstract Ripples, Echoes, and Reverberations: 1965 and Now in Indonesia by Martha Stroud Joint Doctor of Philosophy with University of California, San Francisco in Medical Anthropology University of California, Berkeley Professor Nancy Scheper-Hughes, Chair In Indonesia, during six months in 1965-1966, between half a million and a million people were killed during a purge of suspected Communist Party members after a purported failed coup d’état blamed on the Communist Party. Hundreds of thousands of Indonesians were imprisoned without trial, many for more than a decade. The regime that orchestrated the mass killings and detentions remained in power for over 30 years, suppressing public discussion of these events. It was not until 1998 that Indonesians were finally “free” to discuss this tragic chapter of Indonesian history. In this dissertation, I investigate how Indonesians perceive and describe the relationship between the past and the present when it comes to the events of 1965-1966 and their aftermath. Do the killings and detentions still emerge in and influence daily life today? If so, how? The experiences, interactions, and conversations I had and the interviews I conducted during two years of fieldwork, primarily in Yogyakarta on the island of Java, shape the form and focus of this dissertation.
    [Show full text]