Medical anthropology

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Medical anthropology studies "human health and disease, health care systems, and biocultural adaptation". [1] It views humans from multidimensional and ecological perspectives. [2] It is one of the most highly developed areas of anthropology and applied anthropology, [3] and is a subfield of social and cultural anthropology that examines the ways in which culture and society are organized around or influenced by issues of health, health care and related issues.

Contents

The term "medical anthropology" has been used since 1963 as a label for empirical research and theoretical production by anthropologists into the social processes and cultural representations of health, illness and the nursing/care practices associated with these. [4]

Furthermore, in Europe the terms "anthropology of medicine", "anthropology of health" and "anthropology of illness" have also been used, and "medical anthropology", was also a translation of the 19th century Dutch term "medische anthropologie". This term was chosen by some authors during the 1940s to refer to philosophical studies on health and illness. [5]

Historical background

The relationship between anthropology, medicine and medical practice is well documented. [6] General anthropology occupied a notable position in the basic medical sciences (which correspond to those subjects commonly known as pre-clinical). However, medical education started to be restricted to the confines of the hospital as a consequence of the development of the clinical gaze and the confinement of patients in observational infirmaries. [7] [8] The hegemony of hospital clinical education and of experimental methodologies suggested by Claude Bernard relegate the value of the practitioners' everyday experience, which was previously seen as a source of knowledge represented by the reports called medical geographies and medical topographies both based on ethnographic, demographic, statistical and sometimes epidemiological data. After the development of hospital clinical training the basic source of knowledge in medicine was experimental medicine in the hospital and laboratory, and these factors together meant that over time mostly doctors abandoned ethnography as a tool of knowledge. Most, not all because ethnography remained during a large part of the 20th century as a tool of knowledge in primary health care, rural medicine, and in international public health. The abandonment of ethnography by medicine happened when social anthropology adopted ethnography as one of the markers of its professional identity and started to depart from the initial project of general anthropology. The divergence of professional anthropology from medicine was never a complete split. [9] The relationships between the two disciplines remained constant during the 20th century, until the development of modern medical anthropology in the 1960s and 1970s. A large number of contributors to 20th Century medical anthropology had their primary training in medicine, nursing, psychology or psychiatry, including W. H. R. Rivers, Abram Kardiner, Robert I. Levy, Jean Benoist, Gonzalo Aguirre Beltrán and Arthur Kleinman. Some of them share clinical and anthropological roles. Others came from anthropology or social sciences, like George Foster, William Caudill, Byron Good, Tullio Seppilli, Gilles Bibeau, Lluis Mallart, Andràs Zempleni, Gilbert Lewis, Ronald Frankenberg, and Eduardo Menéndez. A recent book by Saillant & Genest describes a large international panorama of the development of medical anthropology, and some of the main theoretical and intellectual actual debates. [10] [11]

Some popular topics that are covered by medical anthropology are mental health, sexual health, pregnancy and birth, aging, addiction, nutrition, disabilities, infectious disease, NCD's, global epidemics, Disaster management and more.

For much of the 20th century, the concept of popular medicine, or folk medicine , has been familiar to both doctors and anthropologists. Doctors, anthropologists, and medical anthropologists used these terms to describe the resources, other than the help of health professionals, which European or Latin American peasants used to resolve any health problems. The term was also used to describe the health practices of aborigines in different parts of the world, with particular emphasis on their ethnobotanical knowledge. This knowledge is fundamental for isolating alkaloids and active pharmacological principles. Furthermore, studying the rituals surrounding popular therapies served to challenge Western psychopathological categories, as well as the relationship in the West between science and religion. Doctors were not trying to turn popular medicine into an anthropological concept, rather they wanted to construct a scientifically based medical concept which they could use to establish the cultural limits of biomedicine. [12] [13] Biomedicine is the application of natural sciences and biology to the diagnosis of a disease. Often in the Western culture, this is ethnomedicine. Examples of this practice can be found in medical archives and oral history projects. [14]

The concept of folk medicine was taken up by professional anthropologists in the first half of the twentieth century to demarcate between magical practices, medicine and religion and to explore the role and the significance of popular healers and their self-medicating practices. For them, popular medicine was a specific cultural feature of some groups of humans which was distinct from the universal practices of biomedicine. If every culture had its own specific popular medicine based on its general cultural features, it would be possible to propose the existence of as many medical systems as there were cultures and, therefore, develop the comparative study of these systems. Those medical systems which showed none of the syncretic features of European popular medicine were called primitive or pretechnical medicine according to whether they referred to contemporary aboriginal cultures or to cultures predating Classical Greece. Those cultures with a documentary corpus, such as the Tibetan, traditional Chinese or Ayurvedic cultures, were sometimes called systematic medicines. The comparative study of medical systems is known as ethnomedicine, which is the way an illness or disease is treated in one's culture, or, if psychopathology is the object of study, ethnopsychiatry (Beneduce 2007, 2008), transcultural psychiatry (Bibeau, 1997) and anthropology of mental illness (Lézé, 2014). [15]

Under this concept, medical systems would be seen as the specific product of each ethnic group's cultural history. Scientific biomedicine would become another medical system and therefore a cultural form that could be studied as such. This position, which originated in the cultural relativism maintained by cultural anthropology, allowed the debate with medicine and psychiatry to revolve around some fundamental questions:

  1. The relative influence of genotypical and phenotypical factors in relation to personality and certain forms of pathology, especially psychiatric and psychosomatic pathologies.
  2. The influence of culture on what a society considers to be normal, pathological or abnormal.
  3. The verification in different cultures of the universality of the nosological categories of biomedicine and psychiatry.
  4. The identification and description of diseases belonging to specific cultures that have not been previously described by clinical medicine. These are known as ethnic disorders and, more recently, as culture-bound syndromes, and include the evil eye and tarantism among European peasants, being possessed or in a state of trance in many cultures, and nervous anorexia, nerves and premenstrual syndrome in Western societies.

Since the end of the 20th century, medical anthropologists have had a much more sophisticated understanding of the problem of cultural representations and social practices related to health, disease and medical care and attention. [16] These have been understood as being universal with very diverse local forms articulated in transactional processes. The link at the end of this page is included to offer a wide panorama of current positions in medical anthropology.

Applied medical anthropology

In the United States, Canada, Mexico, and Brazil, collaboration between anthropology and medicine was initially concerned with implementing community health programs among ethnic and cultural minorities and with the qualitative and ethnographic evaluation of health institutions (hospitals and mental hospitals) and primary care services. Regarding the community health programs, the intention was to resolve the problems of establishing these services for a complex mosaic of ethnic groups. The ethnographic evaluation involved analyzing the interclass conflicts within the institutions which had an undesirable effect on their administrative reorganization and their institutional objectives, particularly those conflicts among the doctors, nurses, auxiliary staff and administrative staff. The ethnographic reports show that interclass crises directly affected therapeutic criteria and care of the ill. They also contributed new methodological criteria for evaluating the new institutions resulting from the reforms as well as experimental care techniques such as therapeutic communities.

The ethnographic evidence supported the criticisms of the institutional custodialism and contributed decisively to policies of deinstitutionalizing psychiatric and social care in general and led to in some countries such as Italy, a rethink of the guidelines on education and promoting health.

The empirical answers to these questions led to the anthropologists being involved in many areas. These include: developing international and community health programs in developing countries; evaluating the influence of social and cultural variables in the epidemiology of certain forms of psychiatric pathology (transcultural psychiatry); studying cultural resistance to innovation in therapeutic and care practices; analysing healing practices toward immigrants; and studying traditional healers, folk healers and empirical midwives who may be reinvented as health workers (the so-called barefoot doctors).

Also, since the 1960s, biomedicine in developed countries has been faced by a series of problems which stipulate inspection of predisposing social or cultural factors, which have been reduced to variables in quantitative protocols and subordinated to causal biological or genetic interpretations. Among these the following are of particular note:

a) The transition between a dominant system designed for acute infectious pathology to a system designed for chronic degenerative pathology without any specific etiological therapy.

b) The emergence of the need to develop long term treatment mechanisms and strategies, as opposed to incisive therapeutic treatments.

c) The influence of concepts such as quality of life in relation to classic biomedical therapeutic criteria.

Added to these are the problems associated with implementing community health mechanisms. These problems are perceived initially as tools for fighting against unequal access to health services. However, once a comprehensive service is available to the public, new problems emerge from ethnic, cultural or religious differences, or from differences between age groups, genders or social classes.

If implementing community care mechanisms gives rise to one set of problems, then a whole new set of problems also arises when these same mechanisms are dismantled and the responsibilities which they once assumed are placed back on the shoulders of individual members of society.

In all these fields, local and qualitative ethnographic research is indispensable for understanding the way patients and their social networks incorporate knowledge on health and illness when their experience is nuanced by complex cultural influences. These influences result from the nature of social relations in advanced societies and from the influence of social communication media, especially audiovisual media and advertising.

Agenda

Currently, research in medical anthropology is one of the main growth areas in the field of anthropology as a whole and important processes of internal specialization are taking place. For this reason, any agenda is always debatable. In general, we[ who? ] may consider the following six basic fields:

Other subjects that have become central to the medical anthropology worldwide are violence and social suffering [17] as well as other issues that involve physical and psychological harm and suffering that are not a result of illness. On the other hand, there are fields that intersect with medical anthropology in terms of research methodology and theoretical production, such as cultural psychiatry and transcultural psychiatry or ethnopsychiatry.

Training

All medical anthropologists are trained in anthropology as their main discipline. Many come from the health professions such as medicine or nursing, whereas others come from the other backgrounds such as psychology, social work, social education or sociology. Cultural and transcultural psychiatrists are trained as anthropologists and, naturally, psychiatric clinicians. Training in medical anthropology is normally acquired at a master's (M.A. or M.Sc.) and doctoral level. In Latin countries there are specific masters' in medical anthropology, such as in México, [18] Brazil, [19] and Spain, [20] while in the United States universities such as Brown University, Washington University in St. Louis, University of South Florida, UC Berkeley, UC San Francisco, University of Connecticut, Johns Hopkins University, the University of Arizona, the University of Alabama, the University of Washington, [21] and Southern Methodist University offer PhD programs focused on this subject. In Asia, the University of the Philippines Manila offers both the Master of Science and master's degrees in Medical Anthropology. The University of South Florida, the University of Arizona, the University of Connecticut, the University of Washington [22] and others also offer a dual degree (MA/PhD) in applied anthropology with an MPH. In the UK, MSc and PhD programs are offered at University College, London, the University of Oxford, the University of Edinburgh and Durham University. In Africa, Master of Medical anthropology is offered at Gulu University in Uganda www.gu.ac.ug . A fairly comprehensive account of different postgraduate training courses in different countries can be found on the website of the Society of Medical Anthropology of the American Anthropological Association. [23]

See also

Related Research Articles

Anthropology Scientific study of humans, human behavior and societies

Anthropology is the scientific study of humans, human behavior and societies in the past and present. Social anthropology studies patterns of behaviour and cultural anthropology studies cultural meaning, including norms and values. Linguistic anthropology studies how language influences social life. Biological or physical anthropology studies the biological development of humans. Visual anthropology, which is usually considered to be a part of social anthropology, can mean both ethnographic film as well as the study of "visuals", including art, visual images, cinema etc. Oxford Bibliographies describes visual anthropology as "the anthropological study of the visual and the visual study of the anthropological".

Cultural anthropology Branch of anthropology focused on the study of cultural variation among humans

Cultural anthropology is a branch of anthropology focused on the study of cultural variation among humans. It is in contrast to social anthropology, which perceives cultural variation as a subset of a posited anthropological constant.

The following outline is provided as an overview of and topical guide to health sciences:

Medicalization or medicalisation is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.

Arthur Kleinman American psychiatrist

Arthur Michael Kleinman is an American psychiatrist, psychiatric anthropologist and a professor of medical anthropology and cross-cultural psychiatry at Harvard University. He is well known for his work on mental illness in Chinese culture.

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders which also includes a list of the most common culture-bound conditions. Counterpart within the framework of ICD-10 are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

Critical medical anthropology (CMA) is a branch of medical anthropology that blends critical theory and ground-level ethnographic approaches in the consideration of the political economy of health, and the effect of social inequality on people's health. It puts emphasis on the structure of social relationships, rather than purely biomedical factors in analyzing health and accounting for its determinants.

Madeleine Leininger was a nursing theorist, nursing professor and developer of the concept of transcultural nursing. First published in 1961, her contributions to nursing theory involve the discussion of what it is to care.

Psychological anthropology is an interdisciplinary subfield of anthropology that studies the interaction of cultural and mental processes. This subfield tends to focus on ways in which humans' development and enculturation within a particular cultural group—with its own history, language, practices, and conceptual categories—shape processes of human cognition, emotion, perception, motivation, and mental health. It also examines how the understanding of cognition, emotion, motivation, and similar psychological processes inform or constrain our models of cultural and social processes. Each school within psychological anthropology has its own approach.

Cross-cultural psychiatry is a branch of psychiatry concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services. It emerged as a coherent field from several strands of work, including surveys of the prevalence and form of disorders in different cultures or countries; the study of migrant populations and ethnic diversity within countries; and analysis of psychiatry itself as a cultural product.

Clinical ethnography is a term first used by Gilbert Herdt and Robert Stoller in a series of papers in the 1980s. As Herdt defines it, clinical ethnography

is the intensive study of subjectivity in cultural context...clinical ethnography is focused on the microscopic understanding of sexual subjectivity and individual differences within cross-cultural communities. What distinguishes clinical ethnography from anthropological ethnography in general is (a) the application of disciplined clinical training to ethnographic problems and (b) developmental concern with desires and meanings as they are distributed culturally within groups and across the course of life.

Nancy Scheper-Hughes is a professor of Anthropology and director of the program in Medical Anthropology at the University of California at Berkeley. She is known for her writing on the anthropology of the body, hunger, illness, medicine, psychiatry, mental illness, social suffering, violence and genocide. In 2009 her investigation of an international ring of organ sellers based in New York, New Jersey and Israel led to a number of arrests by the FBI.

Transcultural nursing is how professional nursing interacts with the concept of culture. Based in anthropology and nursing, it is supported by nursing theory, research, and practice. It is a specific cognitive specialty in nursing that focuses on global cultures and comparative cultural caring, health, and nursing phenomena. It was established in 1955 as a formal area of inquiry and practice. It is a body of knowledge that assists in providing culturally appropriate nursing care.

Charles Miller Leslie anthropologist

Charles Miller Leslie was an American medical anthropologist, who was an avid contributor of published works in his branch of anthropology. Leslie’s career was influential to the shaping of medical anthropology, as his works have inspired other medical anthropologists to further research and popularize anthropological concepts which includes medical pluralism, social relations of therapy management, the relationship between state and medical systems, and health discourse. Leslie’s main focus within medical anthropology has been the study of Asian medical systems, specifically Ayurvedic, Unani, and Chinese medicine.

Robert Lemelson is an American cultural anthropologist, ethnographic filmmaker and philanthropist. Lemelson received his M.A. from the University of Chicago and Ph.D. from the Department of Anthropology at the University of California, Los Angeles. Lemelson's area of specialty is transcultural psychiatry; Southeast Asian Studies, particularly Indonesia; and psychological and medical anthropology. He currently is a research anthropologist in the Semel Institute of Neuroscience UCLA, and an adjunct professor of Anthropology at UCLA. His scholarly work has appeared in numerous journals and books. Lemelson founded Elemental Productions in 2008, a documentary production company, and has directed and produced numerous ethnographic films. His blog Psychocultural Cinema contains numerous blog-posts and edited film works.

William Abel Caudill was an applied medical anthropologist. His work centered on psychiatry, and the influence of culture on personality. Caudill was especially interested in diagnosis and treatment of mental issues in Japan. Caudill was the first to identify the field of medical anthropology, and was active in organizing it during its formative years.

Margaret Lock Canadian anthropologist

Margaret Lock is a distinguished Canadian medical anthropologist, known for her publications in connection with an anthropology of the body and embodiment, comparative epistemologies of medical knowledge and practice, and the global impact of emerging biomedical technologies.

Carolyn Sargent is a medical anthropologist.

Byron Joseph Good is an American medical anthropologist primarily studying mental illness. He is currently on the faculty of Harvard University, where he is Professor of Medical Anthropology at Harvard Medical School and Professor of Cultural Anthropology in the Department of Anthropology.

References

  1. McElroy, A (1996), "Medical Anthropology" (PDF), in D. Levinson; M. Ember (eds.), Encyclopedia of Cultural Anthropology, archived from the original (PDF) on 2012-10-01
  2. Ann McElroy; Patricia K. Townsend (1989), Medical Anthropology in Ecological Perspective (2nd ed.), Boulder, Colorado: Westview Press, ISBN   0-8133-0742-2
  3. Charlotte Seymour-Smith (1990), Macmillan Dictionary of Anthropology, London: Macmillan Press, pp. 187–188, ISBN   0-333-39334-1
  4. Scotch, Norman A (1963), "Medical Anthropology", in Bernard J. Siegel (ed.), Biennial Review of Anthropology, 3, Stanford, California: Stanford University Press, pp. 30–68 Book review citing details
  5. Pedro Lain Entralgo (1968), El estado de enfermedad. Esbozo de un capítulo de una posible antropología médica (State of Disease: Outline of a chapter of a Possible Medical Anthropology) (in Spanish), Madrid: Editorial Moneda y Crédito
  6. Comelles, J.M.; Martínez-Hernáez, A (1993), Enfermedad, sociedad y cultura (Illness, Society and Culture) (in Spanish), Madrid: Eudema
  7. Foucault, Michel (1963), Naissance de la clinique (The Birth of the Clinic) (in French), Presses universitaires de France
  8. Isabelle von Bueltzingsloewen (1997), Machines à instruire, machines à guérir. Les hôpitaux universitaires et la médicalisation de la société allemande 1730-1850 (Machines instruct machines to heal. University hospitals and the medicalization of German society 1730-1850) (in French), Lyon: Presses Universitaires de Lyon
  9. Comelles, Josep M (March 2000), "The Role of Local Knowledge in Medical Practice: A Trans-Historical Perspective", Culture, Medicine and Psychiatry , 24 (1): 41–75, doi:10.1023/a:1005560608783, PMID   10757209
  10. Francine Saillant; Serge Genest (2005), Anthropologie médicale. Ancrages locaux, défis globaux (Medical anthropology. Local roots, global challenges) (in French), Quebec: Les presses de l'Université Laval, Ma, ISBN   978-2-233-00490-1
  11. Francine Saillant; Serge Genest (2007), Medical anthropology: regional perspectives and shared concerns, Malden, Ma: Blackwell, ISBN   978-1-4051-5249-5
  12. Comelles, J. M (1996), "Da superstizioni a medicina popolare: La transizione da un concetto religioso a un concetto médico (From superstition to folk medicine: The transition from a religious concept to a medical concepts)", AM. Rivista Italiana di Antropologia Medica (Journal of the Italian Society for Medical Anthropology) (in Italian), 1–2: 57–8
  13. Charuty, G (1997), "L'invention de la médecine populaire (The invention of folk medicine)", Gradhiva, 22: 45–57
  14. Monoclonal Antibodies to Migraine: Witnesses to Modern Biomedicine, an A-Z : Ed E M Jones and E M Tansey Queen Mary University, University of London 2014
    • Lézé, Samuel (2014) "Anthropology of mental illness", in : Andrew Scull (ed.), Cultural Sociology of Mental Illness : an A-to-Z Guide, Sage, pp. 31-32
  15. Ialenti, Vincent F., A Review of Humanistic Scholarship on Health Insurance, Policy, and Reform in the United States (April 2011). 2011 Tobin Workshop on Behavioral/Institutional Research and Regulation of the New Health Insurance Market, Cornell Law School, April 28–29, 2011 http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1995046
  16. Farmer, Paul (1999) Infections and Inequalities: The Modern Plagues. Berkeley, University of California Press. Farmer, Paul (2003) Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley, University of California Press.
  17. "CIESAS - Centro de Investigaciones y Estudios Superiores en Antropología Social". www.ciesas.edu.mx.
  18. pt:Antropologia da Saúde
  19. Virgili, Universitat Rovira i. "University Master's Degree in Medical Anthropology and International Health - Universitat Rovira i Virgili". Universitat Rovira i Virgili.
  20. "Archived copy". Archived from the original on 2009-08-09. Retrieved 2009-07-20.CS1 maint: archived copy as title (link)
  21. "Archived copy". Archived from the original on 2009-08-10. Retrieved 2009-07-20.CS1 maint: archived copy as title (link)
  22. "graduate programs in medical anthropology". Archived from the original on 2003-04-22.

Further reading

The following books present a global panorama on international medical anthropology, and can be useful as handbooks for beginners, students interested or for people who need a general text on this topic.