CLINICALLY APPLIED ANTHROPOLOGY CULTURE, ILLNESS, AND HEALING
Studies in Comparative Cross-Cultural Research
Editor-in-Chief:
ARTHUR KLEINMAN
University o/Washington, Seattle, Washington, U.S.A.
Editorial Board:
LEON EISENBERG
Harvard Medical School, Boston, Massachusetts, U.S.A.
NUR YALMAN
Harvard University, Ozmbridge, Massachusetts, U.S.A.
MORRIS CARST AIRS Postgraduate Institute 0/Medical Education and Research, Chandigarh, India
VOLUME 5 CLINICALLY APPLIED ANTHROPOLOGY
Anthropologists in Health Science Settings
Edited by
NOEL J. CHRISMAN
University of Washington, Seattle
and
THOMAS W. MARETZKI
University ofHawaii, Honolulu
D. REIDEL PUBLISHING COMPANY
DORDRECHT: HOLLAND / BOSTON: U.S.A. LONDON:ENGLAND Library of Congress Cataloging in Publication Data Main entry under title:
Clinically applied anthropology.
(Culture, illness, and healing ; 5) Includes index. 1. Social medicine. 2. Medical anthropology. 3. Medicine and psychology. I. Chrisman, Noel J., 1940- II. Maretzki, Thomas. III. Series. [DNLM: 1. Anthropology. 2. Medicine. WI CU445 v. 5/ GN 296 C641] RA418.C64 1982 362.1'042 82-12301 ISBN-13: 978-90-277-1419-0 e-ISBN-13: 978-94-010-9180-0 DOl: 10.1007/978-94-010-9180-0
Published by D. Reidel Publishing Company, P.O. Box 17, 3300 AA Dordrecht, Holland.
Sold and distributed in the U.S.A. and Canada by Kluwer Boston Inc., 190 Old Derby Street, Hingham, MA 02043, U.S.A.
In all other countries, sold and distributed by Kluwer Academic Publishers Group, P.O. Box 322, 3300 AH Dordrecht, Holland.
D. Reidel Publishing Company is a member of the Kluwer Group.
All Rights Reserved Copyright © 1982 byD. Reidel Publishing Company, Dordrecht, Holland Softcover reprint of the hardcover 1st edition 1982 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any informational storage and retrieval system, without written permission from the copyright owner T ABLE OF CONTENTS
PREFACE W
NOEL J. CHRISMAN and THOMAS W. MARETZKI I Anthropology in Health Science Settings 1
SECTION I. CLINICALLY APPLIED ANTHROPOLOGY TEACHING
ROBERT C. NESS I Medical Anthropology in a Preclinical Curriculum 35 HOWARD F. STEIN I The Ethnographic Mode of Teaching Clinical Behavioral Science 61 ARTHUR KLEINMAN I Clinically Applied Anthropology on a PsychiatriC Consultation-liaison Service 83 NOEL J. CHRISMAN I Anthropology in Nursing: An Exploration of Adaptation 117 CHERYL RITENBAUGH I New Approaches to Old Problems: Inter- actions of Culture and Nutrition 141 IRWIN PRESS I Witch Doctor's Legacy: Some Anthropological Implica- tions for the Practice of Clinical Medicine 179
SECTION II: CLINICALLY APPLIED ANTHROPOLOGY RESEARCH
HAZEL HITSON WEIDMAN I Research Strategies, Structural Alterations, and Clinically Relevant Anthropology 201 ATWOOD D. GAINES I Knowledge and Practice: Anthropological Ideas and Psychiatric Practice 243 MARY-JO DEL VECCHIO GOOD and BYRON GOOD I Patient Requests in Primary Care Clinics 275 DAN BLUMHAGEN I The Meaning of Hypertension 297 BARBARA GALLATIN ANDERSON,I. RAFAEL TOLEDO,andNANCY HAZAM I An Approach to the Resolution of Mexican-American Resistance to Diagnostic and Remedial Pediatric Heart Care 325 vi T ABLE OF CONTENTS
LINDA ALEXANDER / Illness Maintenance and the New American Sick Role 351 SUE E. ESTROFF / Long Tenn Psychiatric Clients in an American Com- munity: Some Sociocultural Factors in Chronic Mental Illness 369 ELIZABETH L. BYERLY and CRAIG A. MOLGAARD / Social Institu- tions and Disease Transmission 395
AUTHOR INDEX 411
SUBJECT INDEX 417 PREFACE
like other collections of papers related to a single topic, this volume arose out of problem-sharing and problem-solving discussions among some of the authors. The two principal recurring issues were (1) the difficulties in translating anthropo logical knowledge so that our students could use it and (2) the difficulties of bringing existing medical anthropology literature to bear on this task. As we talked to other anthropologists teaching in other parts of the country and in various health-related schools, we recognized that our problems were similar. Similarities in our solutions led the Editors to believe that publication of our teaching experi ences and research relevant to teaching would help others and might begin the process of generating principles leading to a more coherent approach. Our colleagues supported this idea and agreed to contribute. What we agreed to write about was 'Clinically Applied Anthropology'. Much of what we were doing and certainly much of the relevant literature was applied anthropology. And our target group was composed-mostly of clinicians. The utility of the term became apparent after 1979 when another set of anthropologists began to discuss 'ainical Anthropology'. They too recognized the range of novel be haviors available to anthropologists in the health science arena and chose to focus on the clinical use of anthropology. We see this as an important endeavor, but very different from what we are proposing. Clinically applied anthropology is oriented toward clarification and expansion of perspective - a teaching, research, and consulting role. If the anthropologist is, or subsequently becomes, prepared to be a clinician, the clinical activities are genuinely nursing, medicine, alcohol and drug abuse counseling, or the like, but not anthropology. As anthropologists, we are not educated to intervene; nor is the legal, ethical, or supervisory structure set up to allow it. The nearly simultaneous development of similar new directions in medical anthropology highlights a decade of rapid change in this sub field that promises to continue. Significantly, medical anthropology's focus is shifting away from its roots in the anthropology of religion - health related beliefs and rituals - and traditional physical anthropology - describing biological variation. Research is directed toward understanding the cultural underpinnings of genetic diseases, popUlation dynamics, nutrition, healing practices, health care organization, and patient choices among health care alternatives in complex societies. The prolifera tion of journals related to anthropological study of health issues and the accelerated development of medical anthropology programs for graduate study are further evidence of growth. These changes in medical anthropology have increased its relevance for the health science professions of medicine, nursing, public health, pharmacy, dentistry, viii PREFACE and social work. Thus, we have the opportunity to contribute in health related academic, clinical, and research settings. What remains is to take advantage of that opportunity. We see this volume as one step in that direction. The Editors wish to acknowledge the important typing and editorial assistance provided by Donna Van Winkle. In addition, we benefitted from many helpful suggestions offered by colleagues at the Universities of Washington and Hawaii. The most Significant support came from Arthur Kleinman. As series editor and friend, he has helped with advice, ideas, and rewriting throughout the entire process. Our families, too, deserve recognition for relinquishing some family activities that would have occurred except for our work on this book.
THE EDITORS