|Authors :||Elisha P. Renne, Holly Peters-Golden|
|Publication Info:||Ann Arbor, MI: MPublishing, University of Michigan Library
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Elisha P. Renne, Holly Peters-Golden
vol. 17, no. 1, 2008
Issue title: New Directions in Medical Anthropology
Department of Anthropology, University of Michigan
Medical anthropology has a history within anthropology that reflects changing concerns within the discipline and changing epistemologies regarding the health of individual bodies, society, and the political economy (Scheper-Hughes and Lock 1989). In the early 20th century, physician-anthropologists were engaged in creating systems of classification for medical beliefs and practices, charting the diffusion of traits across societies. As functionalist perspectives came to the fore, social institutions could be analogized to the workings of a healthy body (Joralemon 2006). International development and assistance programs after World War II highlighted the utility of medical anthropologists as ‘experts’ in understanding local medical beliefs that might compromise the implementation of health programs. William Caudill (1953) described this practice as “applied anthropology in medicine.” In the 1960s, medical anthropologists focused their attention on ecological issues, specifically on the ways in which health and disease were related to environmental conditions. The ‘symbolic turn’ of the 1970s was also reflected in medical anthropology; the interpretive perspective addresses issues of the cultural construction of illness and health. In recent years, critical medical anthropology has emerged out of Marxist theory, highlighting issues of political economy. Feminist scholarship, queer theory, and science and technology studies all inform the work of contemporary medical anthropologists, who have been influenced—directly and indirectly—by the work of Michel Foucault (1990, 1991) on the histories of sexuality and clinical practice in the West. Indeed, his insights on the ways that clinical sciences make the hidden visible underwrite several recent medical anthropological studies on genetic testing of a range of bodily circumstances (Downey and Dumit 1998).
Even within medical anthropology, individual practitioners have had different research foci, reflected in the work of those who sought to understand the meaning of illness within particular cultural and religious contexts (Turner 1969), those who worked with public health researchers to address specific health problems (Lindenbaum 2001), and those whose research examined the ways that concepts of health and the treatment of illness reflected culturally specific ideas about gender (Delaney 1988; Martin 1987), among others. Despite these historical and topical differences, medical anthropologists share a concern with the particularities of human experience of illness as they are expressed in specific social and cultural contexts. While some medical anthropologists have training in biology, public health, and medicine, they nonetheless stress the importance of the social and cultural as well as the political and economic contexts of medicinal thinking and practices (Farmer 1997; Kunitz 2006).
Thus, in recent work, medical anthropologists are examining the relationship between human bodies, social values, and the new medical technologies, such as PET scanning (Dumit 1998), neurological bases of disease (Martin 2000), organ transplantation in the US (Sharp 2006) as well as in Europe, India, Japan, and Mexico (Crowley-Matoka and Lock 2006), and various forms of assisted reproductive technologies including amniocentesis (Rapp 1999) and preemplantation genetic diagnosis (Franklin and Roberts 2007; Fullwiley 2004), in a range of sociocultural and political economic contexts. The impact of many of these new technologies are being studied not only in the US and Europe, where they originated, but also in many parts of the world where they are interpreted in culturally specific ways by men and women (Inhorn 2004; Roberts 2006).
However, while progress in medical and public health practices has improved human health universally, these improvements, nonetheless, come with their own set of problems. Indeed, these ‘health paradoxes’ are the subject of current medical anthropological research, of which the papers in this volume are a representative sampling. For example, in the United States, illnesses of old age such as Alzheimer’s disease would not have been a problem if the life expectancy of adults had not risen from a range of 47.55 to 62.67 years in the 1929-1931 to a range of 68.6 to 80.2 years in 2001.1 Precisely how this disease has come to be defined as a health problem, the various cultural interpretations of its physiological symptoms and the meanings attributed to them, and the social communities of care that have grown up around those suffering from this disease and their caregivers are subjects of medical anthropological research (Cohen 1998).
This paradox, that longevity brings along with it both benefits and potential disease, may also be seen in the discovery of new drugs, some of which have had unintended consequences. Rather than reducing the complaints to which the human body is prone, new syndromes and disorders, such as post-traumatic stress disorder (Young 1995) and attention deficit/hyperactivity disorder, have been identified that are treated with pharmaceutical solutions, in the latter case, Ritalin®, a branded form of methlyphenidate (Singh 2004). In the United States, this growth of the pharmaceutical industry (Petryna et al. 2006) is paralleled by the legalization of drug advertisements and the increased direct marketing of new drugs to the public and to medical professionals (Potts 2004).
Another related ‘health paradox’ examined by medical anthropologists concerns the disparity between specialized medical treatments available for those in advantageous socioeconomic situations and inaccessible for those living in disadvantaged settings. The result of this “structural violence,” as it is referred to by Paul Farmer (2000), is that some privileged individuals receive anti-retroviral drugs to treat HIV/AIDS, while others, living in “zones of abandonment”(Biehl 2005), languish and die for want of access to treatment and care. Such inequalities may be seen in health care available for those suffering from tuberculosis, a disease complicated by inadequate HIV/AIDS treatment. This inequality may also been seen in the disparities of organ transplantation—where Indian organ ‘donors’ (the term donor implies a disinterested generosity) under financial duress sell their kidneys (Cohen 1999), which will be used to extend the lives of those who can afford to buy them.
Medical anthropologists have long been concerned with the meaning of health, human suffering, and health inequalities, as well as with the human ingenuity with which these problems, in different historical moments and in distinctive social, cultural, and political contexts are addressed. In an earlier volume of Michigan Discussions in Anthropology (1979), the authors focused on their “experiences with aspects of the US medical system,” with several papers examining various forms of doctor-patient relations. The papers in this volume—which focus on recent medical anthropological interest in Alzheimer’s disease, impotence, organ transplants and inequality, HIV/AIDS and gender, as well as government health programs— reflect health concerns and anxieties, from a particular perspective, at a particular moment in time.
The main themes of papers in this volume include health and citizenship; illness and imagination; inequality and health care access; health, gender, and ethnicity; and the political economy of health, which the authors examine in the contexts of the United States, Brazil, Ecuador, and Nigeria.
In her paper, “‘Older Americans’ and Alzheimer’s Disease: Citizenship and Subjectivities in Contested Time,” Jessica Robbins addresses the place of Alzheimer’s disease in the construction of aging in the United States. Using the final report of the 1995 White House Conference on Aging, she discusses the ways in which normative aging is imagined and explores the ways in which Alzheimer’s disease functions as an exception. Based on ethnographic examples in gerontological anthropology, she examines “the subjectification and subjectivity of old bodies” (Robbins 36, this volume) and calls for further fieldwork investigating both the constructions of normative old age, and those states of being which would then be excluded.
Emily Wentzell, in her paper, “Imagining Impotence in America: From Men’s Deeds to Men’s Minds to Viagra,” follows the shifting construction of male impotence in the US from the early 20th century to the present. While initially cast as a physiological problem caused by immoral or excessive sexual behavior, interest in psychoanalysis led to reconfiguring impotence as a symptom of psychological distress. This view held sway for the better part of the 20th century. In recent years, “impotence” has been redefined as “erectile dysfunction,” a biomedical pathology with a popular pharmaceutical treatment. Wentzell examines the consequences of this medicalization as it informs the discussion of masculinity.
Laura Heinemann examines structural inequality—Farmer’s “structural violence”—that exists throughout the process of organ and tissue transplantation in her paper, “Transplantation and Body Politics: Toward Assessing and Addressing Inequalities.” In her discussion of the ways that body parts and tissues have been commodified, she observes that how people think about and practice organ transplantation reflects the larger political economic contexts. This commodification has been exacerbated by the globalization of health care and increasing demand, which has contributed to the formation of “transplant communities,” peopled by a constellation of individuals—including, but not limited to patients, their relations, support groups, medical personnel, social workers, and drug sales representatives. She argues that if inequalities exist in the practice of organ and tissue transplant processes—that is, who gets organs and how quickly based upon economic factors—that these inequalities may be remedied by addressing social and economic inequality more generally.
Daisy Deomampo is also concerned with the ways that inequalities affect health care, specifically inequalities based on race, class, and gender which affect access to HIV prevention and treatments in Brazil. In her paper, “Gender, Sexuality and AIDS in Brazil: Transformative Approaches to HIV Prevention,” she documents how HIV/AIDS interventions, including those which focus on condom use, may reinforce gender stereotypes which undermine program objectives. Rather, she advocates an activist approach, which is “both culturally specific and transformative” (Deomampo 109, this volume). Like Heinemann, she argues that in order to bring about changes in the health practices, underlying social inequalities must be addressed and gives examples of approaches which incorporate both men and women in prevention programs which draw upon liberation theology to examine the relationship between moral citizenship and sexual agency.
This approach to improving health care through social reform may be seen in Sara Cooley’s paper, “Bringing Body to Bear in the Andes: Ethnicity, Gender, and Health in Highland Ecuador.” In light of the Ecuadorian government’s recent emphasis on multiculturalism and multi-ethnicity, reflected in the 1998 constitution that promotes “indigenousness,” Cooley critically examines how distinctive concepts of the body and health held by women and men in Highland Ecuador differ and intersect with the thinking of government and NGO workers. Specifically, Cooley is interested in how seriously these “indigenous” concepts of the body and health care are taken by government health officials and NGO workers. Based on her field research among rural Kichwa-speaking community members in highlands Ecuador, she is also concerned with examining whether and how highland Ecuadorian women and men have come to rethink their own bodies in these terms.
The final paper in this volume, “Perspectives on Polio Immunization Campaigns in Ibadan, Nigeria,” also examines a health intervention from a political economic perspective, albeit from a somewhat different methodological stance. Viola Allo analyzes both in the findings of her research on polio eradication in Southwestern Nigeria and the processes by which these findings were obtained. While conducting fieldwork on the polio immunization campaign in Ibadan, she noted the importance of medical anthropological research that presents the perspectives of individuals receiving vaccines such as oral polio vaccine. The specificity of this approach allowed her to consider how Hausa-speaking communities in different parts of Nigeria responded to the campaign as well as to document people’s explanations for differences in their responses. She then juxtaposes these local perspectives with some of the problems in conducting field research on controversial health issues where distrust of government (and associated health providers) undermines immunization efforts.
Robert Louis Stevenson, in his parable about human ambition and the contradictory benefits and disadvantages of medical practice, observes that Dr. Jekyll’s new “drug had no discriminating action; it was neither diabolical nor divine.” Yet the biological basis of this drug and others, along with the physiological and psychological conditions which they have been developed to treat, are interpreted in culturally specific ways, which may not be understood without taking the social, political, and economic contexts into account. The authors of the papers in this volume of Michigan Discussions in Anthropology examine the ways that medical techniques and treatments are situated in specific sociocultural concepts of health, illness, and cure.
1. These life expectancy figures are extrapolated from census data and are broken down by sex and race. The specific life expectancy figures (at birth) for the period, 1929-1931, in the continental US are as follows: “White males—59.12 years, White females—62.67 years; Negro males—47.55 years; and Negro females—49.51 years” (Hill 1936). In 2001 these figures are listed as “White males—75.0 years; White females—80.2 years; Black males—68.6 years; and Black females—75.5 years” (Arias 2004:3).
2004 United States Life Tables, 2001. National Vital Statistics Reports 52(14):3. Electronic document, http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_14.pdf, accessed on 10 June 2007.
2005 Vita: Life in a Zone of Social Abandonment. Berkeley: University of California Press
1953 Applied Anthropology in Medicine. In Anthropology Today. A. L. Kroeber, ed. Chicago: University of Chicago Press.
1998 No Aging in India: Alzheimer’s, the Bad Family, and Other Modern Things. Berkeley: University of California Press.
1999 Where It Hurts: Indian Material for an Ethics of Organ Transplantation. Daedalus 128(4):135–165.
Crowley-Matoka, Megan, and Margaret Lock
2006 Organ Transplantation in a Globalised World. Mortality 11(2):166–181.
1988 Mortal Flow: Menstruation in Turkish Village Life. In Blood Magic: The Anthropology of Menstruation. A. Gottlieb, ed. Pp. 75–93. Berkeley: University of California Press.
Downey, Gary, and Joseph Dumit, eds.
1998 Cyborgs and Citadels: Anthropological Interventions in Emerging Sciences. Santa Fe: School of American Research Press.
1998 A Digital Image of the Category of the Person: PET Scanning and Objective Self–Fashioning. In Cyborgs and Citadels: Anthropological Interventions in Emerging Sciences. G. Downey and J Dumit, eds. Santa Fe: School of American Research Press.
1997 Social Scientists and the New Tuberculosis. Social Science & Medicine 44(3):347–58.
2000 An Anthropology of Social Violence. Current Anthropology 45(3):305–325.
1990 The History of Sexuality, vol. 1. New York: Vintage Books.
1991  The Birth of the Clinic: An Archaeology
of Medical Perception. London: Routledge. Franklin, Sarah, and Celia Roberts
2006 Born and Made: An Ethnography of Preimplantation Genetic Diagnosis. Princeton: Princeton University Press.
2004 Discriminate Biopower and Everyday Biopolitics: Views on Sickle Cell Testing in Dakar. Medical Anthropology 23:157–194.
Hill, Joseph A.
1936 United States Life Tables, 1929 to 1931. Washington: United States Government Printing Office. Electronic document, http://www.cdc.gov/nchs/data/lifetables/life30.pdf, accessed 10 June 2007.
2004 Middle Eastern Masculinities in the Age of New Reproductive Technologies: Male Infertility and Stigma in Egypt and Lebanon. Medical Anthropology Quarterly 18(2):162–182.
2006 Exploring Medical Anthropology. Boston: Pearson Press
2006 The Health of Populations: General Theories and Particular Realities. New York: Oxford University Press.
2001 Kuru, Prions, and Human Affairs: Thinking about Epidemics. Annual Review of Anthropology 30:363–85.
1987 The Woman in the Body. Boston: Beacon Press.
2000 Mind–Body Problems. American Ethnologist 27(3):569–590.
Petryna, Adriana, Andrew Lakoff, and Arthur Kleinman, eds.
2006 Global Pharmaceuticals: Ethics, Markets, Practices. Durham: Duke University Press.
Potts, A., V. Grace, N. Gavey, and T. Vares
2004 Viagra Stories: Challenging ‘Erectile Dysfunction’. Social Science and Medicine 59:489–499.
1999 Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in America. New York: Routledge.
2007 Ethics, Cryopreservation and IVF in Ecuador and Elsewhere. American Ethnologist 34(1):181–199.
2006 Strange Harvest: Organ Transplants, Denatured Bodies, and the Transformed Self. Berkeley: University of California Press.
Scheper–Hughes, Nancy, and Margaret Lock
1987 The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology. Medical Anthropology Quarterly 1(1):6–41.
2004 Doing Their Jobs: Mothering with Ritalin in a Culture of Mother–blame. Social Science and Medicine 59:1193–1205.
Stevenson, Robert Louis
1979  The Strange Case of Dr. Jekyll and Mr.
Hyde. New York: Penguin Books.
1969 The Ritual Process: Structure and Anti–Structure. Chicago: Aldine.
1995 The Harmony of Illusions: Inventing Post–Traumatic Stress Disorder. Princeton: Princeton University Press.