Totem: The University of Western Ontario Journal ofAnthropology

Volume 9 | Issue 1 Article 8

6-24-2011

Medical Anthropology: The Development of theFieldOthon AlexandrakisThe University of Western Ontario

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Recommended CitationAlexandrakis, Othon (2001) "Medical Anthropology: The Development of the Field," Totem: The University of Western Ontario Journalof Anthropology: Vol. 9: Iss. 1, Article 8.Available at: http://ir.lib.uwo.ca/totem/vol9/iss1/8

Medical Anthropology: The Development of the Field

Keywordsspecialization, anthropology, medical, history

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Medical Anthropology:The Development of the Field

The field of anthropology haschanged, or perhaps more accurately, hasexpanded since its initial academicconception. Specific areas of study havebranched from the quintessentialanthropology and have subsequentlydeveloped into new, more specializedsubdisciplines. One must be cautious,however, when using the label "subdiscipline"to describe these new fields in that it canimply that they are somehow adjunctive, oreven restricted to, the anthropological corpus.Instead, these more focused branches must berecognized as highly specialized areas ofstudy that take their ontological roots fromconventional anthropology, and havedeveloped more eclectic epistemologicaltraditions. Anthropologists in these newdisciplines study specific aspects oflife basedon traditional anthropological theory, but willalso consider other disciplines, like marketingor medicine, when conducting fieldwork,proposing/considering theory, and writingtext. The following discussion will focus onthe field of medical anthropology.

In general, medical anthropology isinterested in mind body interactions, thustracing the mediation of moral andpsychological domains of experience -studying the bridge between the biologicaland the social. Johnson and Sargent (1996)coined the term biopsychosocial, whichdescribes a model that grounds theanthropological study of disease in historical

and political-economic context, and linkshuman behavior and biology. Medicalanthropological theory can be divided into anumber of distinct threads. These differentthreads argue from very differingepistemological foundations. To explorethese different theoretical positions it isimportant to first gain an understanding ofhow medical anthropology developed.

THE mSTORY OF MEDICALANTHROPOLOGY

Prior to the 1950s, the study ofmedicine by anthropologists was done withinthe larger context of cultural and socialstudies (Baer et. at., 1997). Early interest inethnomedicine was restricted to questionsregarding the ways other people dealt withsickness and, generally, enhanced personalhealth. Currently, medical anthropologistshave expanded their interests from the wayother people conceptualize health to includewider ranging issues, as will be exploredbelow. Stewart and Strathem (1999:3)observe that the field has undergone " ... acircular migration: from the jungle to the city,and back again." This circular migration is aresult of researchers asking questions, notonly of other cultures and healing practices,but also of their own. It is necessary tounderstand this circular movement in order tounderstand the current state of research inmedical anthropology. At this point,however, one must recognize that there exista number of distinct cleavages in medical

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anthropological theory.It is possible to clearly identifY three

distinct theoretical positions. These positionsare very different from each other as a resultof their different epistemologies. First,ethnomedical anthropology, exemplified bythe work of Nichter (1996), focuses on localhealth models. These investigations are mostclosely related to the earliest form ofthe field.Second, Critical Medical Anthropology, likeFarmer's work (1992, 1999), is based on apolitical economy approach. Farmer has usedthis kind of analysis to write severalinteresting books on the subjects ofIDVIAIDS and infectious diseases such asTuberculosis. The final theoretical position inmedical anthropology is known as the clinicalapproach. It places primacy on the healingprocess itself Researchers such as Brodwin(1992), and the early works of Kleinman, lookat sickness as a social practice. These threemain schools of thought will be furtherexplored below. Yet, despite dialoguebetween these researchers it is important tonote that they are distinct from each other andthat researchers often clash due to theirdiffering ideological positions.

As the above description illustrates,medical anthropology is by no means limitedto questions directly related to the ways inwhich people deal with disease. Instead, thesubject matter includes the etiology ofdisease, preventative measures, gender roles,medical pluralism, ethnopsychiatry, curativemeasures, bioethics, stress and social support,and disease eradication (Baer, et. aI., 1997;Johnson & Sargent 1996; Stewart & Strathern1999; Brodwin et. aI., 1992; Farmer 1999).Indeed the term "medical anthropology"seems restrictive and perhaps misleading. AsBaer et. al. (1997:vii) suggest, referring to thefield as the "anthropology of health andhealing" is perhaps more appropriate.However, the term "medical anthropology" islargely preferred; it can be argued that this isthe ad nauseam example of the medical

triumphalism, inherent in the Westernbiomedical institution, which the field hasexposed and attempts to transcend. Whateverthe case, over its brief history, medicalanthropology has become well established andcontinues to grow.

Currently, the Society for MedicalAnthropologists constitutes the second largestunit of the American AnthropologicalAssociation (AAA 2001). MedicalAnthropologists frequently publish theirresearch in several well-known academicjournals such as Medical AnthropologyQuarterly, Medical Anthropology, SocialScience and Medicine, and Culture, Medicineand Psychiatry. Before these specializedjournals, anthropologists published work thatwould today be considered in the realm ofmedical anthropology in more genericperiodicals. W.H.R. Rivers was one of thefirst authors to publish work that dealt withhealth related issues cross-culturally inMedicine, Magic, and Religion (1924).According to Baer et. al. (1997), medicalanthropology did not become a distinctsubdiscipline until the 1950s. They argue thatthe origins of the field can be traced back toRudolf Virchow, a renowned pathologistinterested in social medicine who helpedestablish the first anthropological society inBerlin (1997: 15). It is interesting to note thatVirchow influenced Franz Boas while he wasaffiliated with the Berlin EthnologicalMuseum between 1883-1886 (Baer et. aI.,1997:15).

Since then, some major events in thefield include an increase of anthropologicalwriting regarding medicine after World WarII (due to an increased interest in the effectsof war), the publication of William Caudill'sApplied Anthropology in Medicine (1953),the increased involvement of anthropologistsin international health work, and theinvolvement of anthropologists in clinicalsettings. Thus, the circular migrationbecomes obvious as one can trace the

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anthropological work from field accounts of"native" medicine to studying healthcare inthe West, and then back again to look at otherhealthcare models and conceptions of healthas compared to those in the West. The loopcloses with research concerning, for example,the interaction between modem Westernbiomedicine and indigenous healthcaresystems, or the influx of "alternative"medicine in Western society. However, themethods of approaching these questions, asnoted above, have strongly diverged. Thefollowing will explore the three previouslymentioned theoretical positions in furtherdetail.

Ethnomedical anthropology isconcerned with questions regarding localmedical models. Stewart and Strathern(1999), for example, base their analyses on atheoretical opposition between personalisticand naturalistic medicine. Modem Westernbiomedicine, with its empirical, scientificprinciples, is an example of naturalisticmedicine. By contrast, the personalisticsystem is usually attributed to any non-scientific or non-empirical medical system.These may include witchcraft, laying on ofhands, and herbalism. Ethnomedicalanthropologists will sometimes highlight thedifferences between these two systems whenattempting to explore different kinds ofhealthcare models around the world. Forexample, Stewart and Strathern (1999)explain that Japanese holism is a result ofthepluralistic incorporation of traditionalJapanese medicine with modem biomedicine.The ethnomedical approach attributes theexistence of this system to the cultural, orperhaps, ideological tradition of the peopleswho use it. In the case of a clearly pluralisticsystem, where people have to choose betweenbiomedical treatment and traditionalindigenous treatment, the ethnomedical

approach would argue that decisions are basedprimarily on cultural values.

Nichter and Nichter (1996) take anethnomedical approach when investigatinginternational health. They propose that thebest way to approach the subject is to examinea number of individual case studies. Theyargue that each case study can shed light onspecific issues including reproductive health,disease control, health education, andpharmaceutical use, etc. To illustrate theirpoint, they studied women's reproductivehealth by examining women's health practicesduring pregnancy, fertility related practices,and interpretations of and demand for fertilitycontrol (1996: 1). By researching individualcases Nichter and Nichter were able toinvestigate many diverse factors, both socialand biological, that contribute to each of theseIssues.

Critical Medical Anthropology (CMA)takes a very different approach to looking atquestions regarding health. CMA believesthat there exists a hegemonic relationship (asper Gramsci's use where a dominant practiceresults in a predictable and controllable socialconsciousness) between the ideology of thehealth care system and that of the dominantideological and social patterns. More simplyput, a political economy approach. CMAviews disease as a social as well as abiological construct (Baeret. al., 1997:35-36).Critical Medical Anthropologists examinesissues such as who have the power overcertain social institutions, how and in whatform is this power delegated, and how thispower is expressed (Baer et. al. 1997:33-35).In effect, Critical Medical Anthropologists tryto deconstruct the medical science and exposethe fact that all science is influenced bycultural and historical conditions, much likethe social constructionist approach.Therefore, if one wishes to study disease, it is

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necessary to start by identifYing political,economic, social, and environmentalconditions within a particular society orgroup. It is necessary for a researcher in theCMA tradition to understand these andsubsequently, understand the local group'setiology, before it is possible to attempt tounderstand the medical system.

A good example of the application ofCMA theory can be found in Paul Farmer'sbook AIDS and Accusations: Haiti and theGeographv of Blame (1992). In this work,Farmer explores political economic factors, awide range of historical events, andepidemiology in his analysis of mvIAIDS inHaiti. He looks at the increased susceptibilityto mv IAIDS among the poor and commonsocial reactions to HIV/AIDS in Haiti.Farmer's focus is clearly political economic;he takes a very heavy neo-Marxist approach inhis analysis. Farmer examines social classand how mvIAIDS impacts the lives ofresidents of Do Kay, the village in which hedoes his fieldwork. Farmer then ties in all thewide-ranging information in the concludingchapters of his book, emphasising the role ofworld economic and political trends and theiraffects on Haiti.

The focus of this approach is on thehealing process itself. Moreover, it studiessickness as a social practice. One of the mostcommon areas of study when dealing with thiskind of analysis is the exploration of differentconstructions of the concept of illness as afunction of differing cultural ideologies. Intheir book Pain As Human Experience,Brodwin et. al. (1992) explore the concept ofpain and how it differs from culture to culture.From describing pain as "sound" in Japan, todifferentiating between headaches andbrainaches among North American Latinos,these authors attempt to understand theexperience of pain and its treatment in

different cultures. Thus, they examine theexperience of pain as " ... an intimate featureof lived experience of individuals in thecontext of their local social world andhistorical epoch" (Brodwin et. at., 1992:2).Interestingly, with this perspective in mind, itis possible to detect differences betweengroups of people depending on the type ofpain, or more generally, the suffering theyexperience and how they express it. Theauthors claim that" ... chronic pain syndromeshighlight the fault lines of society" (Brodwinet. at. 1992:3). Suffering, in this case, can beattributed to a number of acute social andeconomic factors.

Where the clinical approachdistinguishes itself from the other forms ofanalysis is that clinical medical anthropologyis best suited to answer questions regardingsuffering and other health issues faced by theindividual while CMA and ethnomedicine arefocused on health issues regarding groups ofpeople, or collectives. Moreover, clinicalmedical anthropologists are concerned withthe way the bodily experience is influenced bymeanings, relationships, and institutions(Brodwin et. al., 1992:7). Another interestingaspect of Clinical Medical Anthropology is itsstudy of healthcare systems and the study ofconflicting ideologies. This ideologicalincompatibility is manifest in the differing ofexpectations of public healthcare held by theadministrative "system" and the people it isdesigned to treat. This is especially the casewhen dualistic medical systems exist.

This brief discussion ofthe history andmodem-day form of medical anthropology hastouched on some of the major issues thatconcern the field today. The development ofthe field from its early form as an adjunct tosocial or cultural anthropological study, to thelarge and ever-growing field it is today is butone example of a trend in the discipline. The

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specialized use of anthropological principlesand theory in a more narrowly focusedspecified gaze, allows anthropologists todevelop more eclectic, but stillanthropological, subdisciplines. Baer et. al.(1997:vii) argue that medical anthropology isthe most dynamic of the subdisciplines withinanthropology. It is easy to see how they couldcome to such a conclusion considering therange of theoretical positions medicalanthropologists take and the breadth ofquestions they aspire to answer.

American Anthropological Association.Consulted March 19th, 2001.American AnthropologicalAssociation, Internet, ur!:}

Baer, Hans, Singer, Merrill, & Susser, Ida.1997. Medical Anthropology andthe World System: A criticalPerspective. London: Bergin andGarvey.

Brodwin, Paul, Good, Byron, Good, Mary-Jo, & Kleinman, Arthur. 1992. Painas Human Experience: AnAnthropological Perspective.Berkeley: University ofCalifornia Press.

Cawdill, William 1953. "AppliedAnthropology in Medicine." In

Anthropology Today: AnEncyclopedic Inventory. Kroeber,(ed.). pp. 771-806. Chicago:University of Chicago Press.

Farmer, Paul. 1999. Infections andInequalities: The Modern Plagues.Berkeley: University of CaliforniaPress.

Farmer, Paul. 1992. AIDS and Accusation:Haiti and the Geography of Blame.Berkeley: University of CaliforniaPress.

Johnson, Thomas & Sargent, Carolyn.1996. Handbook of MedicalAnthropology: ContemporaryTheory and Method. London:Greenwood Press.

Nichter, Mark and Nichter, Mimi. 1996.Anthropology and InternationalHealth: Asian Case Studies.Australia: Gordon and BreachPublishers.

Rivers, W. H. R. 1924. Medicine, Magicand Religion. London: Trubner &Co., Ltd.

Stewart, Pamela and Strathern, Andrew.1999. Curing and Healing: MedicalAnthropology In Global Perspective.North Carolina: Carolina AcademicPress.

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