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CHAPTER 16

HOW IS ANTHROPOLOGY

APPLIED IN THE FIELD OF

MEDICINE?

Examine how medical anthropology

▪Is an applied approach relying on participant

observation

▪Shows that a cultural perspective uncovers

matters of illness and health often ignored by

traditional medicine

Discuss how different cultures understand

the causes of sickness and health

Learn how sickness and health are shaped

by the global economy

CHAPTER OBJECTIVES

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Medical anthropologists focus on human health and ways that humans perceive and react to disease and illness.

Health is a sense of physical, emotional, and mental well-being shaped by cultural, social, and political experiences and expectations.

Suf fering recognizes that physical, mental, or emotional distress associated with a disease extends beyond a traditional Western biomedical focused only on biological functioning.

WHAT IS MEDICAL ANTHROPOLOGY?

F I G U R E 1 6 . 1

M a n y p e o p l e

a r o u n d t h e w o r l d

s e e k h e l p f r o m

b i o m e d i c a l

p r a c t i t i o n e r s

w h e n t h e y f e e l

t h a t t h ey a r e n o t

h e a l t hy. A

K e n y a n

p e d i a t r i c i a n

e x a m i n e s a

y o u n g p a t i e n t .

[ASHRAF

SHAZLY/AFP/Getty

Images]

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Sickness can correspond to Western concepts of disease that are based in physical causes.

Medical anthropologists see sickness as how members of a cultural community recognize and classify physical, mental, and emotional distress.

Culture-bound syndromes are unique to a particular cultural group.

Illness is the suffering person’s own understanding of his or her distress.

WHAT IS SICKNESS AND ILLNESS?

Anthropologists emphasize that cultural practices mediate human biological adaptations to physical environments.

▪Biological evolution focuses on changes in gene frequencies over time.

▪Cultural evolution focuses on changes in cultural information obtained and spread through social learning.

Some medical anthropologists focus on the biological and cultural contexts of human sickness and health.

WHAT MAKES MEDICAL ANTHROPOLOGY

“BIOCULTURAL”?

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Patterns of sickness and health are examined through

▪Demography: the statistical study of populations

▪Epidemiology: the study of the distribution of disease and explanations for the distributions

Paleodemography uses archaeological and biological anthropological data to study demographic patterns of past human populations

HOW DO MEDICAL ANTHROPOLOGIST S

EXAMINE PATTERNS IN SICKNESS AND

HEALTH?

Epidemic diseases spread quickly through a

population over a short time period.

Endemic diseases are always present in a

population.

Syndemic approaches examine how

diseases in a population are affected by

stressful environmental factors such as

▪Poor nutrition

▪Social instability

▪Violence

DEMOGRAPHY AND MEDICAL

ANTHROPOLOGY

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Public health interventions directed at one component of a syndemic condition are always inadequate

SAVA is a common syndemic condition consisting of

▪Substance abuse

▪Violence

▪AIDS

A multipronged approach by medical anthropologists and other public health individuals is needed to address syndemic conditions

SYNDEMIC CONDITIONS

Adaptation refers to adjustments made

by organisms to environmental

challenges.

▪Biological adaptation focuses on

modifications of anatomical or physiological

attributes through natural selection.

▪Biocultural adaptation considers how human

cultural practices influence selection on

genes.

SICKNESS AND HEALTH IN

EVOLUTIONARY CONTEXT

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Sickle-cell anemia results from a genetic mutation that alters red blood cells into a sickle shape, reducing their ability to carry oxygen through the bloodstream

Most individuals with sickle -cell anemia do not survive adulthood

Sickle-cell anemia was selected for when populations shifted from being hunters and gatherers to farmers, opening areas to malarial mosquitoes

BIOCULTURAL ADAPTATIONS AND

MEDICAL ANTHROPOLOGY

Lactose intolerance is the inability to

digest fresh milk in adulthood.

Most populations outside of Europe and

parts of Africa are lactose intolerant.

Human populations with a history of

keeping dairy herds are more lactose

tolerant.

BIOCULTURAL ADAPTATIONS AND

MEDICAL ANTHROPOLOGY

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People from different cultures have their

own explanations for

▪Why people get sick

▪How (or whether) sicknesses may be cured

Cultural explanations for sickness

include

▪Biomedical causes

▪Witchcraft or sorcery

▪Punishment by ancestors for breaking taboos

HOW DO DIFFERENT CULTURES

UNDERSTAND CAUSES OF SICKNESS AND

HEALTH?

Biomedical accounts accept only

material causes for ill health.

Biomedical understandings define ill -

health as disease caused by material

entities located inside human bodies.

Medical anthropologists recognize that ill

health may be caused by cultural factors

located outside the body.

HOW DO DIFFERENT CULTURES

UNDERSTAND CAUSES OF SICKNESS AND

HEALTH?

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Some individuals have senses of self

that are not self-contained or closed off

Material entities like microbes and

nonmaterial entities like spirits can

enter individuals

Charismatic Christians

▪Are open to God’s Holy Spirit

▪Are vulnerable to evil spirits or demons

▪Can heal themselves through prayer

KINDS OF SELVES

F I G U R E 1 6 . 2

C h a r i s m a t i c

C h r i s t i a n s

c o n s i d e r

t h e m s e l v e s

v u l n e r a b l e t o

p e n e t r a t i o n b y

n o n m a t e r i a l

e n t i t i e s l i k e

s p i r i t s .

[Photo by Lannis

Waters/Palm Beach

Post/ZUMA Press. ©

Beach Post.]

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Cross-cultural concepts of spirit

possession resemble mental and

emotional disturbances studied by

Western psychologists and psychiatrists.

▪Medical anthropologies recognize that many

forms of suffering cannot be reduced to

simple material causes.

▪Prayer is a skilled practice that trains people

to ignore outside factors and focus on their

inner selves.

KINDS OF SELVES

Unified and integrated selves are bounded and centered

Decentered selves are open to the wider world, sometimes through spiritual discipline

Decentered selves include those involved in virtual reality and gaming ▪Avatars in Second Life are decentered selves

found on the Internet

▪Dividual selves have a divided sense of self which can manifest as multiple avatars

KINDS OF SELVES

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F I G U R E 1 6 . 3

A v a t a r s i n

S e c o n d L i f e c a n

b e c u s t o m i z e d t o

r e p r e s e n t t h e

s e l f . H e r e , a

s c r e e n c a p t u r e

f r o m S e c o n d L i f e

s h o w s a n a v a t a r

v i s i t i n g a v i r t u a l

m u s e u m i n

M a r c h 2 0 07.

[REUTERS/Suzanne

Miller]

Individuals may impose meaning on a world that bewilders them, developing an individual subjectivity

Interpretive medical anthropology is based on ▪ the view that culture mediates human experiences

▪ the recognition that cultural systems, including medical systems, are symbolic systems

Beliefs and practices about sickness and health are best understood in their own symbolic cultural contexts

SELF AND SUBJECTIVIT Y

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Explanations that people develop to explain the sources of their suffering are illness narratives

▪One way to explore the symbolic dimensions of human suffering and can be created by sufferers and caregivers

▪Provide information about illness experiences in particular cultural and political contexts

▪Women with cervical cancer in Brazil may incorporate a sexual stigma in their illness narrative

ILLNESS NARRATIVES

FIGURE 16 .4

P o o r w o m e n i n

B r a z i l w h o w e r e

d i a g n o s e d w i t h

c e r v i c a l c a n c e r

d e p e n d e d o n

p u b l i c h e a l t h

i n s u r a n c e o r

c h a r i t y f o r

t r e a t m e n t a n d

s o m e t i m e s

r e c e i v e d m o r e

i n t e n s i v e

t r e a t m e n t t h a n

w a s n e c e s s a r y.

I n t h e c i t y o f

R e c i f e , c e r v i c a l

c a n c e r w a s

n e g a t i v e l y

s t i g m a t i z e d .

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Individuals are agents of their own actions but are never absolutely free to act

Subject positions occupied by individuals are marked by social, political, and economic inequality

Events alter subject positions, including

▪Colonial conquests

▪Population displacements

▪Armed conflict and war

Traumatic events can have negative health consequences

SUBJECTIVIT Y, TRAUMA , AND

STRUCTURAL VIOLENCE

Korwa people of central India ▪ Former hunters, gatherers, and farmers

▪ Evicted from forest homeland in 1970s and resettled by government in current villages

▪ Today, some are wage laborers in stone quarries and on road construction

Experiential health describes the Korwa perceptions that they are tired, achy, and cannot be healthy

“Full healers” are not always available in the displaced communities to cure these experiential health issues

SUBJECTIVIT Y, TRAUMA , AND

STRUCTURAL VIOLENCE

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F I G U R E 16 . 5

A g r i c u l t u r e h a s

n o t p r o v e n t o b e

s u c c e s s f u l f o r

d i s p l a c e d

Ko r w a , a n d

m a n y f i n d

t h e m s e l v e s

f o r c e d t o w o r k

a s w a g e

l a b o r e r s o r, a s

h e r e , t o p r e p a r e

a n d s e l l

f i r e w o o d .

[Courtesy of Mokshika Gaur]

Structural violence results from the way political and economic forces structure risk for various forms of suffering

▪Infectious and parasitic diseases

▪Hunger

▪Torture

▪Rape

The poorest and least powerful members of society are subjected to highly intensified risk

SUBJECTIVIT Y, TRAUMA , AND

STRUCTURAL VIOLENCE

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F I G U R E 1 6 . 6

D r. P a u l Fa r m e r

w i t h A I D S

p a t i e n t s a t

C l i n i q u e B o n

S a u v e u r .

P o l i t i c a l a n d

e c o n o m i c f o r c e s

s t r u c t u r e

p e o p l e ’ s r i s k s

f o r v a r i o u s f o r m s

o f s u f f e r i n g i n

H a i t i a n d

e l s e w h e r e .

Photos

FIGURE 16 .7

T h e i n d i v i d u a l s u b j e c t i v i t i e s o f m a n y H a i t i a n s h a v e b e e n

s h a p e d b y t h e e x p e r i e n c e o f s t r u c t u r a l v i o l e n c e i n t h e f o r m o f

A I D S a n d p o l i t i c a l v i o l e n c e , t w o l e a d i n g c a u s e s o f d e a t h

a m o n g y o u n g p e o p l e i n H a i t i . T h e y l e a v e b e h i n d o t h e r f o r m s

o f s o c i a l s u f f e r i n g f o r t h e i r p a r e n t s a n d c h i l d r e n . H e r e , t h e

p a r e n t s o f J e a n - D av i d D r o i t d i e u , a n A I D S v i c t i m , h o l d i n g h i s

o r p h a n e d d a u g h t e r, s i t i n f r o n t o f t h e i r h o m e a n d t h e p l a c e o f

h i s b u r i a l , s u r r o u n d e d b y r e l a t i v e s a n d n e i g h b o r s . [© Mikce Stocke/Sun-

Sentinel/ZUMAPRESS.com]

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Medical anthropologists examine structural violence and syndemics to contextualize sickness and health across the world

Individual and local experiences and interpretations of suffering fit into broader historical and political contexts

Historical contexts include ▪ European colonial domination

▪ Institution of racial slavery

▪ Organization of indigenous groups into a hierarchy favoring colonizer over colonized

▪ Expansion of global capitalism

HOW ARE SICKNESS AND HEALTH

SHAPED BY THE GLOBAL CAPITALIST

ECONOMY?

F I G U R E 1 6 . 8

C o l o n i a l p o w e r s

b r o u g h t

b i o m e d i c i n e

w i t h t h e m a n d

e s t a b l i s h e d

h o s p i t a l s l i k e

t h i s o n e i n

M o z a m b i q u e i n

c o l o n i a l

t e r r i t o r i e s , b u t

a c c e s s t o t h o s e

h o s p i t a l s w a s

n o t e q u a l f o r

e v e r y o n e .

[ERIC LAFFORGUE /

Alamy Stock Photo]

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Cosmopolitan medicines are Western

biomedical systems adopted by non -

Western peoples

Ethnomedical systems are based on

practices of local sociocultural groups

Medical pluralism results in hierarchies of

resort

▪Local practitioners are often sought out initially

▪If not satisfied, other practitioners of

ethnomedical systems are sought out

HOW ARE SICKNESS AND HEALTH

SHAPED BY THE GLOBAL CAPITALIST

ECONOMY?

F I G U R E 1 6 . 9

M e d i c a l

p l u r a l i s m i n

G u i d e r, 1 976 .

Ve n d o r o f

t r a d i t i o n a l

m e d i c i n e s i n t h e

m a r k e t .

[Courtesy Robert H.

Lavenda]

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Medical anthropologists are concerned with factors affecting women’s health related to childbearing

Formal studies of fertility by government agencies or biomedical authorities emphasize controlling population in poorer societies

Medical anthropologists focus on the challenges of infertility in societies with particular gender and family structures

Males are preferred as children in many societies

HEALTH, HUMAN REPRODUCTION, AND

GLOBAL CAPITALISM

F I G U R E 1 6 . 1 0

R e s o u r c e

i n e q u a l i t y

s o m e t i m e s

m e a n s i n e q u a l i t y

i n h e a l t h c a r e .

E x p e c t a n t

m o t h e r s w a i t t o

d e l i v e r t h e i r

b a b i e s a t t h e

Te m e k e h o s p i t a l

i n D a r - e s - S a l a a m ,

Ta n z a n i a .

[ROBERTO

SCHMIDT/AFP/Getty Images]

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Adherence to antiretroviral (ARV) therapy for HIV/AIDS are lower and infectious rates are higher in poorer communities

ARV therapies can only succeed ▪ If ARV drugs are free

▪ If a solid government-run health care infrastructure exists

▪ If there are more trained health care providers

▪ If programs designed to relieve poverty exist

Medical anthropologists examine the challenges of the poor trying to survive with AIDS

MEDICAL ANTHROPOLOGY AND HIV/AIDS

F I G U R E 1 6 . 1 1

A s o c i a l w o r k e r

c a r r y i n g a c r a c k

a d d i c t t o r e c e i v e

t r e a t m e n t i n

N o v e m b e r 2 01 2 .

A s i s t h e c a s e f o r

p o o r p e o p l e

l i v i n g w i t h

H I V / A I D S , p o o r

p e o p l e s t r u g g l i n g

t o r e c o v e r f r o m

d r u g a d d i c t i o n

n e e d f o o d a n d

s o c i a l

c o n n e c t i o n s t o

s u r v i v e a f t e r

t r e a t m e n t . I f

t h e s e s u p p o r t s

a r e n o t a v a i l a b l e ,

t h e i r c h a n c e s f o r

r e c o v e r y a r e

s l i m .

TEIXEIRA/dpa/Corbis

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Biomedical breakthroughs mediated by technology are welcomed by medical anthropologists as a form of cosmopolitan medicine

More than pharmaceuticals are required if positive health outcomes are to be achieved

Ethically, medical anthropologists must emphasize the problems of structural violence creating worse health and early death for some people

THE FUTURE OF MEDICAL

ANTHROPOLOGY

F I G U R E 1 6 . 1 2

I n 2 01 2 , A I D S

a c t i v i s t s i n

B r a z i l

d e m o n s t r a t e

a g a i n s t

g o v e r n m e n t

m e a s u r e s

a g a i n s t

H I V / A I D S

p r e v e n t i o n .

LESSA/dpa/Corbis