Understanding and Applying Medical Anthropology

461 Pages·2016·18.326 MB·English

by  Peter J. Brown, Svea Closser

UNDERSTANDING AND APPLYING
MEDICAL ANTHROPOLOGY
Third Edition
Page Intentionally Left Blank
UNDERSTANDING AND APPLYING
MEDICAL ANTHROPOLOGY
Biosocial and Cultural Approaches
Third Edition
Edited by
Peter J. Brown
Emory University
Svea Closser
Middlebury College
First published 2016 by Left Coast Press, Inc.
Published 2016 by Routledge
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Library of Congress Cataloging-in-Publication Data:
Understanding and applying medical anthropology : biosocial and cultural approaches / edited by Peter J. Brown and Svea
Closser. — Third edition.
   pages cm
 Includes index.
 ISBN 978-1-62958-291-7 (pbk. : alk. paper)
1.Medical anthropology—Methodology. 2. Medical anthropology—Philosophy. I. Brown, Peter J. II. Closser, Svea, 1978-
 GN296.U54 2016
 306.4'6101—dc23
2015026581
ISBN 978-1-62958-291-7 paperback
Contents
To the Instructor 7
To the Student 9
Part I
UNDERSTANDING MEDICAL ANTHROPOLOGY: BIOSOCIAL AND
CULTURAL APPROACHES 11
1 Peter J. Brown and Svea Closser, Medical CULTURAL APPROACHES
Anthropology: An Introduction 13 IN MEDICAL ANTHROPOLOGY
BIOSOCIAL APPROACHES IN MEDICAL Structural Violence
ANTHROPOLOGY
Conceptual Tools 116
Evolution and Human Biological Variation 11 Paul Farmer, Social Inequalities and
Emerging Infectious Diseases 118
Conceptual Tools 25
12 Nancy Scheper-Hughes, Culture, Scarcity, and
2 S. Boyd Eaton, Marjorie Shostak, and Maternal Thinking: Maternal Detachment and
Melvin Konner, Stone Agers in the Fast Lane: Infant Survival in a Brazilian Shantytown 127
Chronic Degenerative Diseases in 13 Seth M. Holmes, “Oaxacans Like to Work Bent
Evolutionary Perspective 27 Over”: The Naturalization of Social Suffering
3 Howard Chiou, Fundamentals of Evolutionary among Berry Farm Workers 140
Medicine 39 14 Merrill Singer, Does America Really Want to
4 Nina Jablonski and George Chaplin, Skin Deep 47 Solve Its Drug Problem? 155
5 Alan Goodman, Disease and Dying while Black: 15 Emily Mendenhall, Syndemic Suffering:
How Racism, Not Race, Gets under Rethinking Social and Health Problems
the Skin 52 among Mexican Immigrant Women 164
6 Sera Young, Pica: A Biocultural Approach
Ethnomedicine and Healers
to Curious and Compelling Cravings 58
7 Peter J. Brown, Adaptations to Endemic Conceptual Tools 177
Malaria in Sardinia 73
16 George M. Foster, Disease Etiologies in
History of Health Non-Western Medical Systems 180
17 Pamela I. Erickson, The Healing Lessons of
Conceptual Tools 85
Ethnomedicine 188
8 George J. Armelagos, Peter J. Brown, and 18 Claude Lévi-Strauss, The Sorcerer and His
Bethany Turner, Evolutionary, Historical, and Magic 197
Political Economic Perspectives on Health 19 Bisan Salhi, Beyond the Doctor’s White Coat:
and Disease 88 Science, Ritual, and Healing in American
9 Thomas McKeown, Determinants of Health 99 Biomedicine 204
10 Merrill Singer and Hans Baer, Applied 20 Daniel Moerman, Doctors and Patients: The Role
Medical Anthropology and the Adverse Health of Clinicians in the Placebo Effect 213
Effects of Climate Change 105
6  Contents
21 Robert A. Hahn, The Nocebo Phenomenon: 26 Marcia C. Inhorn, Religion and Reproductive
Concept, Evidence, and Implications Technologies 274
for Public Health 222 27 Monir Moniruzzaman, Spare Parts for Sale:
Violence, Exploitation, Suffering 277
The Meaning and Experience of Illness
28 Margaret Lock, Inventing a New Death
and Making It Believable 286
Conceptual Tools 228
22 Nancy E. Waxler, Learning to Be a Leper: Culture, Illness, and Mental Health
A Case Study in the Social Construction
Conceptual Tools 298
of Illness 230
23 Linda Hunt, Strategic Suffering in the Illness 29 Arthur Kleinman, Do Psychiatric Disorders
Narratives of Mexican Cancer Patients 241 Differ in Different Cultures? 300
24 Robert F. Murphy, The Damaged Self 249 30 Roy Richard Grinker, What in the World
Is Autism? A Cross-Cultural
Biomedicine, Technology, and the Body
Perspective 311
31 Erin P. Finley, “I Came Back for This?”
Conceptual Tools 261
Veterans Living with PTSD 320
25 Emily Martin, Medical Metaphors of Women’s
Bodies: Menstruation and Menopause 262
Part II
APPLYING MEDICAL ANTHROPOLOGY 331
Working with the Culture of Biomedicine Culture and Nutrition
Conceptual Tools 333 Conceptual Tools 382
32 Paul Farmer, Bruce Nizeye, Sara Stulac, and 39 Craig Hadley, Jed Stevenson, Yemserach Tadesse,
Salmaan Keshavjee, Structural Violence and and Tefara Belachew, What Happens When Food
Clinical Medicine 336 Prices Skyrocket? An Ethiopian Example 383
33 Arthur Kleinman and Peter Benson, 40 Richard A. O’Connor and Penny Van Esterik,
Anthropology in the Clinic: The Problem De-Medicalizing Anorexia: A New Cultural
of Cultural Competency and How to Brokering 394
Fix It 344 41 Alexandra Brewis, Expanding Bodies in a
34 Centers for Disease Control and Prevention Shrinking World: Anthropological Perspectives
Based on Work by Suzanne Heurtin-Roberts on the Global “Obesity Epidemic” 400
and Efrain Reisin, Health Beliefs and
Global Health Issues and Programs
Compliance with Prescribed Medication
for Hypertension among Black Women:
Conceptual Tools 408
New Orleans 1985–1986 350
35 Sarah Willen and Anne Kohler, Cultural 42 Matthew Steinglass, It Takes a Village Healer:
Competence and Its Discontents 353 Can Traditional Medicine Remedy Africa’s
AIDS Crisis? 409
Stigma and Coping with Chronic Illness 43 Ellen Gruenbaum, Sociocultural Dynamics
of Female Genital Cutting 418
Conceptual Tools 363
44 Svea Closser, The Polio Eradication Initiative in
36 Joan Ablon, The Nature of Stigma and Pakistan: Anthropological Perspectives on Why
Medical Conditions 364 the World’s Largest Global Health Program
37 Gaylene Becker, Coping with Stigma: May Fail 428
Lifelong Adaptation of Deaf People 372 45 Ippolytos Andreas Kalofonos, “All I Eat Is ARVs”:
38 Ron Barrett and Peter J. Brown, Stigma in the The Paradox of AIDS Treatment Interventions
Time of Influenza: Social and Institutional in Central Mozambique 436
Responses to Pandemic Emergencies 377
References 447
Index 451
To the Instructor
Teaching medical anthropology is both exciting and examples of such work. At times we have included
challenging. Undergraduates are able to relate to sick- two or more selections on a similar topic in order to
ness and healing because they have had some lim- enhance in-class discussions. Thus the organization of
ited experience with them. Of course, many of your this book suits a heterogeneous approach to a medical
students are thinking of careers in the health care anthropology course.
industry. Learning about the multiple causes of dis- As far as we can tell, there is no agreement about
ease and the cultural variation in healing practices how a basic course in medical anthropology should
makes students examine their own lives and culture be taught. Almost 35 years ago, the first special pub-
with a fresh perspective; one of the real satisfactions lication of the new Society for Medical Anthropology
of being a teacher comes from watching students get (SMA) concerned teaching medical anthropology; the
excited by such an intellectual journey. It is also sat- volume included nine different model courses (Todd
isfying when students become increasingly aware of and Ruffini 1979*). The diversity of those courses—
the health problems of others, especially the poor at ranging from ethnomedicine, to biomedical anthro-
home and around the world. At the same time, teach- pology, to family structure and health—was impres-
ing medical anthropology is challenging because of its sive. Today, the SMA website has a section on teaching
amorphous nature and the astounding growth of the resources that includes more than 50 syllabi.
body of theory and knowledge. How does a profes- Theoretical diversity has been a continuing hall-
sor organize such a course? How do you decide what mark of medical anthropology, and its importance is
examples to use? reflected in most of the edited textbooks of the field.
This book is divided into two main parts. Part However, the relatively few regular textbooks in the
I illustrates the variety of theoretical and analytical field have had, by necessity, a more narrow theoreti-
approaches used by medical anthropologists. Part II cal focus, such as the ecological approach (McElroy
provides examples of those approaches as they relate and Townsend 1996) and the cultural aspects of heal-
to a variety of health issues and problems; hence the ing and medicine (Foster and Anderson 1978; Helman
title of the reader—Understanding and Applying Medical 1994; Strathern and Stewart 2010). Recently some new
Anthropology. The first part of the book makes apparent books have provided a synthesis of medical anthro-
that we hold a very broad view of the scope of medical pology, even as the discipline has expanded and the
anthropology and that we are committed to the tradi- theoretical basis of research has become more sophis-
tional four-field approach of general anthropology. We ticated (Anderson 1996; Hahn 1995; Janzen 2001;
believe that the application of anthropological knowl- Joralemon 1999; Nichter 2009; Singer and Baer 2012:
edge—the job of making our research useful—is part Wiley and Allen 2008; Winkelman 2008).
of the responsibility of all anthropologists. Aspects of The first and second editions of this book were
nearly all anthropological work are relevant to under- well received. There is a need for a reader in medical
standing and solving human problems. That is why anthropology that includes original research articles
we use the term applying medical anthropology rather that can accompany the texts, ethnographies, and
than the narrower and more specific applied anthropol- case studies that we use in such courses. As we have
ogy (in both this and other edited readers). The latter collected course syllabi from other medical anthro-
term refers to anthropological work done by an applied pologists over the years, we have been struck by
anthropologist for a client on a problem identified by the diversity and richness of the teaching resources
the client. We think students want to read about anthro- available. For the first edition, we thought it would
pological research and analysis on relevant topics, and be easy to assemble such a reader, but it turned out
the second part of the collection provides some good to be quite a difficult task—partially because of the
*The reference listings for all citations in To the Instructor, To the Student, and all chapter introductions and Conceptual
Tools sections are in the References section at the end of the book.
8  To the Instructor
expanding breadth of the field and partially because anthropology are not represented here, including eth-
there are so many fascinating articles available. Our nopharmacology, health policy, childbirth, gerontol-
first list included more than 220 articles, and when we ogy, embodiment, phenomenology, and specific clini-
asked colleagues to help cut them down, they simply cal cases. We hope that instructors using this book feel
suggested more titles. The list got much longer for the free to contact us with their opinions about selections
second and third editions. It was a long and painful that work (or do not work) and with suggestions for
process to make the selections. future editions.
In the end, we selected the readings with five cri-
teria in mind:
NEW TO THE THIRD EDITION
n Readability: reading levels appropriate for upper-
division undergraduates who have already taken
a basic anthropology course One of the main challenges in revising this reader has
n Diversity: a mix of classic articles and more recent been to update it without completely changing a text
contributions that has been warmly received. The combination of
n Different theories: a range of orientations newer articles and “classics” was designed for maxi-
n Level of difficulty: a range of theoretical difficulty mum pedagogical benefit. We believe that the new
selections are great vehicles for teaching and encour-
or sophistication
n Ethnographic variation aging class discussion. Many new articles are original
to this reader, written with an undergraduate audi-
Many selections are from the standard professional ence in mind. We think that these new chapters—writ-
journals in the field, including Medical Anthropology ten by many of the field’s leaders, including a number
Quarterly; Medical Anthropology; Social Science and Med- of Margaret Mead Award winners—convey clearly to
icine; Human Organization; Anthropology and Medicine; undergraduates the current vitality and relevance of
and Culture, Medicine, and Psychiatry. medical anthropology.
To add to the pedagogical value of this collection, We have reorganized the section and subsection
we have included section and reading introductions. headings to fit current themes in medical anthro-
In section introductions, we emphasize the “concep- pology. In addition to section and article introduc-
tual tools” that are put to work in each kind of medi- tions—with thought questions for your students—a
cal anthropology. Students should be reminded of the context box appears at the end of the introduction
central concepts before they start reading the details to each selection; these short pieces are intended
of a particular case. In selection introductions, we for more advanced students interested in knowing
describe the context for the problem at hand by rais- where the articles fit within the intellectual history
ing related issues and by listing some questions for of medical anthropology—and they often describe
discussion. Most introductions and conceptual tools the author’s larger research agenda and discuss why
sections include bibliographic suggestions for further this particular article was written. This background
reading, which are listed at the back of the book. These information can help students to appreciate the read-
references may be useful for undergraduates who are ing more fully. (The article’s original source citation,
writing term papers or for graduate students who are when applicable, appears on the bottom of the chap-
developing a stronger grasp of the field. There are, ter-opening page, along with the book’s copyright
of course, a great many other resources in medical statement.)
anthropology, many of which are available through Over the years we have heard positive feedback
the Society for Medical Anthropology. about the conceptual tools introduction, especially from
We are painfully aware that, owing to space students. Therefore, we have updated and expanded
constraints, many important topics in medical these bullet points where appropriate.
To the Student
What initially sparked your interest in medi- will also see this book as a resource for independently
cal anthropology? The prospect of studying other exploring other approaches.
medical systems, such as shamanism? The thought We have selected the readings with you, the stu-
of discovering what made disease rates increase in dent, in mind. Primarily, we picked selections that
ancient societies? Your concern about the serious contain interesting case studies or that are controver-
health problems in the United States and through- sial and might help to spark class discussions. But
out the world? An interest in how people are affected we also wanted the selections to reflect diversity—in
by chronic disease, or in the culture of Biomedicine? terms of both sophistication and the areas of the world
All these topics—exotic and mundane—are related represented. Some readings are classics in the field
to medical anthropology. Or maybe your interest is written by famous anthropologists. Although these
related to your career ambitions or current work in articles may be older, they usually make for wonder-
the health care field. Whatever the case, you will find ful reading. Most of the articles are from professional
the study of medical anthropology to be intriguing scholarly publications (for example, Medical Anthro-
and intellectually rewarding. pology Quarterly; Medical Anthropology;
We also hope that you find the study of medi- Social Science and Medicine; Culture, Medicine, and
cal anthropology to be relevant to your life—if only Psychiatry; and Anthropology and Medicine), and they
because disease, illness, healing, and death are uni- will, on occasion, require concentrated reading on
versal in the human experience. All cultures have your part. You may want to skim the article first to
medical systems. Whether you participate in a medi- familiarize yourself with the overall structure of the
cal system as a patient or a healer, there is real value argument. “Prereading” for the main ideas is not a
in understanding the big picture of how and why that substitute for the real reading, but it can prepare you
system works. But, as the title of this book suggests, to understand the article when you do read it.
you first need to understand medical anthropology In the introductions we have provided orientations
before you use it to make a difference in the world. to the general context and framework of the material.
As you skim through this book, notice the Section introductions provide important “conceptual
extremely wide variety of topics included within tools”; put these concepts and vocabulary tools into
medical anthropology. This diversity is based on the your own personal intellectual toolbox and “own”
broad, holistic approach that anthropology takes to them. Each selection introduction also includes ques-
the study of human biology and cultures. In the United tions to ponder. These questions will help you to place
States, anthropology traditionally includes four fields; a particular selection into the larger scheme of things,
biological or physical anthropology, archaeology, cul- to get you to think about the broader (and sometimes
tural anthropology, and anthropological linguistics. unanswerable) questions involved. At the end of each
Medical anthropology is not one of the four fields; introduction, you will find a “context box” that will
rather, it involves the use of anthropological concepts tell you something about the selection’s author and
and methods from all four fields in the study of health, why the article was written.
disease, and healing. One of the hallmarks of medical Because medical anthropology is such a diverse
anthropology, therefore, is the theoretical and practi- field, we have divided this book into two main parts.
cal diversity within the field. Part I introduces you to the multiple approaches used
Most medical anthropologists, like most anthro- by medical anthropologists in their research and other
pologists in general, concentrate on the cultural end work. Part II is about applying medical anthropology.
of the field. Many courses in medical anthropology This part covers a variety of different problem areas—
do not deal with evolutionary or biological questions. from doctor-patient communication to global health
Your course instructor will likely pick and choose programs—and presents selections that illustrate how
selections according to his or her orientation to the anthropological analysis can be relevant to under-
field. That is as it should be, but we hope that you standing and solving those real problems.