Introduction to Medical Anthropology, Michaelmas 2001

Introduction to Medical Anthropology, Michaelmas 2002

Dr.E. Hsu

Recommended reading:

Good B. 1994: Medicine, Rationality, and Experience.Cambridge University Press (CUP).

Nichter M. & Lock M. (eds) 2002: New Horizons in Medical Anthropology. London: Routledge.

Textbooks:

Helman C. 1990: Culture, Health and Illness. 2nd ed. Oxford: Butterworth-Heinemann.

Janzen J. 2002: The Social Fabric of Health. Boston: McGraw Hill.

Handbooks:

Johnson T.M. & Sargent C.F. (eds) 1990: Medical Anthropology: a Handbook of Theory and Method. Greenwood: Westport, CT.

Albrecht G.L. & al. 2000: The Handbook in Social Sciences of Health and Medicine. London: Sage.

Edited Volumes:

Landy D. (ed) 1977: Culture, Disease, and Healing. New York: Macmillan.

Loudon J.B. (ed) 1976: Social Anthropology and Medicine. London: Academic Press.

Leslie C. (ed) 1976: Asian Medical Systems. Berkeley: University of California Press (UCP).

Leslie C. & Young A. (eds) 1992: Paths to Asian Medical Knowledge. UCP.

Feierman S. & Janzen J.M. 1992: The Social Basis of Health and Healing in Africa. UCP.

Lindenbaum S. & Lock M. (eds) 1993: Knowledge, Power, and Practice. UCP.

Csordas T.J. (ed) 1994: Embodiment and Experience. CUP.

Early Monographs predating the Field:

Rivers W.H.R. 1924: Medicine, Magic, and Religion. London: Kegan Paul.

Evans-Pritchard E.P.1937: Witchcraft, Oracles, and Magic among the Azande. OUP.

Field M. 1960: Search for Security. An Ethnopsychiatric Study of Rural Ghana. London

Early Monographs in the Field:

Kleinman A. 1980: Patients and Healers in the Context of Culture. UCP.

Lewis G. 1975: Knowledge of Illness in a Sepik Society. London: Athlone Press.

Favret-Saada (1977) 1980: Deadly Words. Witchcraft in the Bocage. CUP and Editions MSH.

Janzen J.M. 1978: The Quest for Therapy in Lower Zaire. UCP.

Important Journals:

Culture, Medicine, and Psychiatry (short: CMP) 1977-

Social Medicine and Society (short: SSM) 1976-

Medical Anthropology (short: MA)

Medical Anthropology Quarterly (short: MAQ) New Series 1987-

Medicine and Anthropology (short: Med & Anthro) 1994-

Standard Biomedical Reference Works:

Faure A. & al. 1998: Harrison's Principles of Internal Medicine. 14th ed. N. Y.: McGraw-Hill.

American Psychiatric Association 1980, 1987, 1994: Diagnostic and Statistical Manual of Mental Disorders. Washington D.C.: American Psychiatric Association. DSM-III, DSM-III-R, and DSM-IV.
1. Outline of Medical Anthropology (EH 15-10-02)

I. Background Reading:

Nichter M. 2002: The Social Relations of Therapy Management. In Nichter M. & Lock M. (eds) New Horizons in Medical Anthropology. London: Routledge, 81-110.

Question: what makes this a study in medical anthropology?

II. Early debates in medical anthropology:

Disease – illness – sickness

Eisenberg L. 1977: Disease and Illness. CMP 1: 9-23. (read abstract only).

Kleinman A. 1980: Patients and Healers in the Context of Culture. UCP, pp. 71-80. See also Kleinman A. & Seeman D. 2000: Personal Experience of Illness, in Albrecht G.L. & al. (eds), pp. 230-242.

Young A. 1982: The Anthropologies of Illness and Sickness. Annual Review of Anthropology11: 257-85.

Frankenberg R. 1980: Medical Anthropology and Development: a Theoretical Perspective. SSM 14B: 197-207. (in particular pp. 199-200)

Sectors of health care

Kleinman A. 1980: Patients and Healers in the Context of Culture. UCP, pp. 49-61.

Medical pluralism

Leslie C. 1976: The Ambiguities of Medical Revivalism in Modern India. Asian Medical Systems. UCP, pp. 356-67.

Amarasingham L. Rhodes 1980: Movement among Healers in Sri Lanka: A Case Study of a Sinhalese Patient. CMP 4: 71-92.

Nichter M. [1980] 1996: Popular Perceptions of Medicine, in Anthropology and International Health. Amsterdam: Gordon & Breach, ch 7

“Explanatory models”: their use and abuse

Kleinman A. 1980: Patients and Healers in the Context of Culture. UCP. Ch 3.

Young A. 1982: Rational Men and the EM Approach. CMP 6: 57-71.

Taussig M.T. 1980: Reification and the Consciousness of the Patient. SSM 14B: 3-13 (on the ‘clinical construction of reality’)

III. Journals on Medical Anthropology in Europe (available in Oxford)

Curare 1978 ff. (Germany),

Bulletin d’Ethnomedicine 1980 ff. (France)

Medische Anthropologie 1989 ff. (Netherlands)

Viennese Ethnomedicine Newsletter 1998 ff. (Austria)

2. The Recognition of Misfortune and Illness (EH 22-10-02)

General reading:

Lewis G. 1975: Knowledge of Illness in a Sepik Society. London: Athlone Press(ch 4 "disease" is here biomedically - rather than biologically - defined)

Young A. 1976: Internalizing and Externalizing Medical Belief Systems: an Ethiopian Example. Social Science and Medicine 10, 147-56.

Good B. 1977: The Heart of What's the Matter. CMP 1: 25-58 (on ‘semantic networks’)

Last M. 1981: The Importance of Knowing about Not Knowing, SSM 15B (3): 387-392 (essay on "traditional medical non-systems")

Examples:

-A serious disease from a biomedical viewpoint, culturally re-interpreted: e.g. S. Lindenbaum 1979: Kuru sorcery. Palo Alto: Mayfield (deaths due to a variant of Creutzfeld-Jakob disease attributed to sorcery)

-Misdiagnoses of the biomedical disease common, various cultural interpretations of the illness: e.g. M. Nichter [1989] 1996: Health and Social Science Research on the Study of Diarrheal Disease: a Focus on Dysentery, pp. 111-134, in M. Nichter & M. Nichter (eds) Anthropology and International Health: Asian Case Studies. Amsterdam: Gordon & Breach.

-Signs and symptoms of what could be a serious disease: e.g. Kim, Y. K. & al. 1982 ‘Naeng’: A Korean Folk Illness, pp. 129-149 in H.J. Diesfeld (ed) Medizin in Entwicklungsländern. Bern: Peter Lang (leucorrhoea is usually not indicative of cancer)

-Signs and symptoms which only in few cases are indicate disease, but the cultural significance (stigma) attributed to them, exacerbates them, e.g. Culture-bound Syndromes, e.g. Rubel A. 1964: The Epidemiology of a Folkillness. Ethnology: 268-283.

-Mental conditions reclassified in politically acceptable ways, e.g. PTSD, A. Young 1997: The Harmony of Illusions. Princeton: Princeton UP(chs 3-5, on political motivation for integrating PTSD into DSM-III and provides examples of diagnostic interviews)

-Erratic behaviour seen once as mental illness, once as deviant behaviour, e.g. Waxler N.E. 1977: Is Mental Illness Cured in Traditional Societies? CMP 1: 233-253 (illness is moulded by expectation)

-Chronic parasitic infestations which cannot be eradicated, e.g. worms: are they harmful, life companions or life promoters?, P.W. Geissler 1998: ‘Worms are our Life’, Anthropology and Medicine 5 (1):63-79 (the title says it, on Luo in Western Kenya)

-Recurrent and chronic pain, e.g. individually experienced chronic pain that cannot be communicated, J. Jackson 1992: "After a While No One Believes You", in DelVecchio Good & al. Pain as Human Experience. UCP (on alienation from the others due to pain)

-Misfortune that does not affect the person’s physical body, e.g. Favret-Saada J. 1980: Deadly Words. CUP (ch 9 on the accumulation of unlucky events)

3.a) Illness Narratives (EH 29-10-02)

Good B. 1994: Medicine, Rationality, and Experience CUP, ch. 6; Good, B.J. & Delvecchio Good M.-J. 1994: In the Subjunctive Mode: Epilepsy Narratives in Turkey. SSM 38: 835-42.

Lewis G. 1999: A Failure of Treatment. OUP (ch 1, on “Ethnography of an Illness”)

Background reading in sociology and psychology:

Goffman E. 1963: Stigma: Notes on the Management of Spoiled Idemtity. Englewood Cliffs, NJ: Prentice-Hall (in cases of “stigma”, there is no “natural” narrative)

Bruner J. 1991: The Narrative Construction of Reality. Critical Inquiry 18, 1-21 (on the psychology of narrative, outlines 10 features of narrative)

Illness narratives:

Murphy R.F. 1987: The Body Silent. London: Phoenix House (an anthro’s autobiography)

Mattingly C. 1998. Healing Dramas and Clinical Plots: The Narrative Structure of Experience. CUP (chs 1 and 5, gives insight into occupational therapy)

Skultans V. 1997. Theorizing Latvian Lives: The Quest for Identity. Journal of the Royal Anthropological Institute 3, 761-780 (narrative as testimony of personal and social memory)

Hunt L. 2000: Strategic Suffering: Illness Narratives as Social Empowerment among Mexican Cancer Patients. In Mattingley C. & Garro L. (eds) Narrative and the Construction of Illness and Healing. UCP, 212-236 (on illness and gender issues).

Goodman Y. 2001: Dynamics of Inclusion and Exclusion: comparing Mental Illness Narratives of Haredi Male Patients and their Rabbies. CMP 25: 169-194 (highlights how narrative shifts in accordance with social position)

Steffen V. 1997: Life Stories and Shared Experience. SSM 45 (1): 99-111 (reports on the use of life stories among alcoholics anomymous)

Lillrank A. 2002: The Tension between Overt Talk and covert Emotions in illness Narratives: Transition from Clinician to Researcher. CMP 26 (1): 111-127 (on the non-said).

Critiques of illness narrative approach:

Atkinson P. & D. Silverman 1997: Kunder’s Immorality: the Interview Society and the Invention of the Self. Qualitative Inquiry 3 (3): 304-344. See also: Atkinson P. 1997: Narrative turn or Blind Alley. Qualitative Health Research 7 (3): 325-344.

Wikan U. 2000: With Life in one’s Lap: the Story of an Eye/I. In Mattingley C. & Garro L. (eds) Narrative and the Construction of Illness and Healing. UCP, 212-236. See also:

Wikan U. 1992: Beyond Words: the Power of Resonance. American Ethnologist 19:460-82.

3.b) Case histories in biomedicine and scholarly medical traditions (EH 29-10-02)

Biomedical training and culture-specific biomedical attitudes:

Good B. & Good M.-J., Delvecchio 1993: “Learning Medicine”: the Constructing of Medical Knowledge at Harvard Medical School, in Lindenbaum S. & Lock M. (eds) 1993: Knowledge, Power, and Practice. UCP, ch 4 (typical case of an internalising medicine)

Adams V. 1998: Doctors for Democracy. Health Professionals in the Nepal Revolution. CUP, chs 5 and 6 (on motivations of medical professionals and on medicine and politics)

Giuseppe R. & al. 2002: HIV, Disease Plague, Demoralization, and “Burnout”: Resident Experience of the Medical Profession in Nairobi, Kenya. CMP 26 (1): 55-86.

Case history writing in biomedicine:

Sinclair S. 1997: Making Doctors. Oxford: Berg(ch 8 on ‘Experience: Patients and Ward Rounds’, on the practices related to case history writing)

Anspach R.R. 1988: Notes on the Sociology of Medical Discourse: the Language of Case Presentation. In: J. Colombotos (ed) Continuities in the Sociology of Medicine. Journal of Health and Behaviour 29: 357-375 (outlines features of the biomedical case history)

Good M.-J. Delvecchio & al. 1994: Oncology and Narrative Time. SSM 38 (6): 855-862.

Case history writing in the scholarly medical traditions:

Farquhar J. 1991: Objects, Processes, and Female Infertility in Chinese Medicine. MAQ 5(4): 370-399 (an example of Chinese medical case histories in gynaecology)

Andrews B. 2001: From Case Records to Case Hsitories: the Modernisation of a Chinese Medical Genre, 1912-49, in Hsu E. (ed) Innovation in Chinese Medicine. CUP, ch 10 (on how a case history is transformed into a new format; ch 2 is on very early case histories)

Obeyesekere G. 1992: Science, Experimentation and Clinical Practice in Ayurveda, in Leslie C. & Young A. (eds) Paths to Asian Medical Knowledge UCP, ch 7 (a case of wind)

Trawick M. 1987: The Ayurvedic Physician as Scientist. SSM 24 (12): 1031-1050 (not about a case history but about a conversation during the process of diagnosis)

Examples of case histories in medical history

Duden B. [1987] 1991: The Woman beneath the Skin: a Doctor's Patients in eighteenth-century Germany HUP (chs 2 and 3, on the doctor's medical practice and his case histories)

Furth C. 1999: A Flourishing Yin: Gender in China's Medical History, 960-1665 UCP (ch 7, on narratives of the clinical encounter in late Ming China, 17th century)

4. Variation and Variability of Forms of Pain (EH 5-11-02)

Pain behaviour:

Helman C.G. 1990: Pain and Culture. In Culture, Health and Illness, ch 7 (provides good summary)

Zborowski M. 1952: Cultural Components in Responses to Pain. Journal of Social Issues 8 (4): 16-30 (early study, ethnically specific behaviour in responding to pain)

Bendelow G. 2000: Pain and Gender. Essex: Pearson Education (ch 6 on gendered beliefs about pain)

Hadolt B. 2000: The Making and Unmaking of the World: Considerations on Medicial Anthrpologists’ Recent Contributions to the Anthropology of Pain. Viennese Ethnomedicine Newsletter 11 (2): 18-24.

Acute pain in initiation rites, torture and other contexts:

Scarry E. 1985: The Body in Pain. OUP (on pain in torture and on the unmaking and making of the world)

Seremetakis N.C. 1998: Durations of Pain: a Genealogy of Pain. In Frykman J. & al. (eds) Identities in Pain. Lund: Nordic Academic Press, 151-168.

Connors M M. 1994: Stories of Pain and the Problem of AIDS Prevention: Injection Drug Withdrawal and its Effect on Risk Behavior. MAQ 8 (1): 47-68 (sharing in conditions of pain)

Johansen R. E. B. 2002: Pain as a Counterpoint to Culture: Toward an Analysis of Pain Associated with Infibulation among Somali Immigrants in Norway. MAQ 16 (3): 312-340.

Chronic pain:

Kleinman A. 1988: The Illness Narratives. Suffering, Healing, and the Human Condition. New York: Basic Books (chs 3, 4, 5).

DelVecchio Good M.-J. & al. 1992: Pain as Human Experience: An Introduction. In M.J. DelVecchio Good & al. (eds) Pain as Human Experience: An Anthropological Perspective. UCP (good summary)

Jackson J. 1994: Chronic Pain and the Tension between the Body as Subject and Object. In T.J. Csordas (ed) Embodiment and Experience: The Existential Ground of Culture and Self. CUP, ch 9.

Further Reading:

Szasz T.S. 1957: Pain and Pleasure: a Study of Bodily Feeling. New York: Basic.

Trigg R. 1970: Pain and Emotion. Oxford: Clarendon Press.

Morris D.B. 1991: The Culture of Pain. UCP.

Rey R. 1995: The History of Pain. Harvard UP.

Biomedical approaches to pain:

Wall P.D. & Melzack R (eds) 1984: Textbook of Pain. Edinburgh: Churchill Livingstone.

See in particular articles on:

Acute versus Chronic Pain by R.A. Sternbach (pp. 173-7)

Emotional Aspects of Pain by K.D. Craig (pp. 153-61)

Cognitive Aspects of Pain by M. Weisenberg (pp. 162-72)

5. Anthropological approaches to treatment evaluation (EH 12-12-02)

On treatment evaluation in general:

Lewis G. 1993: Double Standards of Treatment Evaluation. In Lindenbaum S. & Lock M. (eds) Knowledge, Power & Practice, ch 9 (on whom to believe what, and why or why not)

De Boek F. 1991: Therapeutic Efficacy and Consensus among the Aluund of South-Western Zaire. Africa 61 (2): 159-185 (lack of consensus need not mean that treatment is inefficient)

On drug treatment evaluation:

Moerman D. 2002: Meaning, Medicine and the ‘Placebo Effect’. CUP (ch 5, on drug colour, shape, number etc., heart coronary surgery, and other, and the meaning response)

Van der Geest S. & Whyte S. Reynolds 1989: The Charm of Medicines: Metaphors and Metonyms. MAQ 3: 345-367 (on meaning aspects of medicines)

Etkin N.L. 1992: ‘Side Effects’: Cultural Constructions and Reinterpretations of Western Pharmaceuticals. MAQ 6(2), 99-113 (on the positive use of “side-effects”)

On the problem of the notion “placebo”:

Kaptchuk T. 1998: Intentional Ignorance: a History of Blind Assessment and Placebo Controls in Medicine, Bulletin of the History of Medicine 72, 389-433.

Sullivan M.D. 1993: Placebo Controls and Epistemic control in Orthodoc Medicine. Journal of Medicine and Philosophy 18: 213-31.

On the evaluation of “traditional” and “alternative” medicines:

Waldram J.B. 2000: The Efficacy of Traditional Medicine: Current Theoretical and Methodological Issues. MAQ 14 (4): 603-625.

Ortiz de Montellano B. 1975: Empirical Aztec Medicine. Science 188 (4185): 215-220 (the subtitle is: Aztec medicinal plants seem to be effective if they are judged by Aztec standards)

Hsu E. 1996: The Polyglot Practitioner: towards Acceptance of Different Approaches to Treatment Evaluation, 37-53. In S. Gosvig Olesen & E. Hoeg (eds) Studies in Alternative Therapy III. Odense: Odense UP (on therapeutic efficacy and therapeutic success, written for non-anthros)

On the human edge of biomedical practice:

Gaines A.D. & Hahn R.A. (eds) 1985: Physicians of Western Medicine (chs by Katz P. on how surgeons make decisions and by Delvecchio Good M.-J. on physician competence)

Gordon D.R. 1988: Tenacious Assumptions in Western Medicine. In Lock M. & Gordon D. R. (eds) Biomedicine Examined, pp. 19-56. Dordrecht: Kluwer.

6. On colonialism and medicine (EH 19-11-02)

Fanon F. (1965) 1978: Medicine and Colonialism. In Ehrenreich J. (ed) The Cultural Crisis of Modern Medicine. New York: Monthly Review Press (plain and biting on the view of the colonised Algerian towards French (medical) authorities).

Vaughan M. 1991: Curing Their Ills: Colonial Power and African Illness. Stanford UP (ch 5 on psychiatry)

Comaroff J. & J. 1992: Medicine, Colonialism, and the Black Body. In Ethnography and the Historical Imagination. Boulder: Westview Press. (ch 8, good summary of main issues)

Turshen M. 1984: The Political Ecology of Disease in Tanzania. New Brunswick: Rutgers UP (accounts for the human agency in creating socio-political “contexts” and ecological “environments”)

Taussig, M. 1987: On the Indian’s Back: the Moral Topography of the Andes and its Moral Conquest. In Shamanism, Colonialism, and the Wild Man: a Study in Terror and Healing. Chicago: Chicago UP (ch 18, the colonisers and the colonised were human beings who interacted with each other)

Further reading:

Vaughan M. 1994: Healing and Curing: Issues in the Social History and Anthropology in Africa. Social History of Medicine 7 (2): 283-95 (contains references to the seminal articles and books on colonial Africa)

Examples of dealing with specific sicknesses:

Ranger T.O. 1992: Godly Medicine: the Ambiguities of Medical Mission in Southeastern Tanzania, 1900-1945. In S. Feierman & J.M. Janzen (eds) The Social Basis of Health and Healing, ch 10 (abbreviated from SSM 15B [1981] (3): 261-277; on yaws)

Iliffe J. 1987: Leprosy. In The African Poor: a History. CUP, ch 12.

Arnold D. 1988: Small-pox and colonial Medicine in Nineteenth-century India. In D. Arnold (ed) Imperial Medicine and Indigenous Societies. Manchester UP, ch 3

Vaughan M. 1991: Curing Their Ills: Colonial Power and African Illness. Stanford UP (ch 6 on syphilis)

7. On the political economy of medicine and disease (EH 26-11-02)

Waitzkin H. 1983: The Second Sickness: Contradictions of Capitalist Health Care. New York: Free Press (ch 1 raises central issues of the Marxist approach to health care)

Navarro V. 1989: Radicalism, Marxism, and Medicine. MA 2: 195-219.

Morsy S. 1979: The Missing Link in Medical Anthropology: the Political Economy of Health. Reviews in Anthropology 6: 349-363.

Baer H.A. 1996: Bringing Political Ecology into Critical Medical Anthropology. MA 17: 129-141.

Fassin D. 2000: Entre politiques du vivant et politiques de la vie: pour une anthrpologiew de la sante. Anthropologie et Societes 24 (1): 95-116.

The example of alcoholism:

Singer M. 1986: Toward a Political-Economy of Alcoholism: the Missing Link in the Anthropology of Drinking. SSM 23 (2): 113-130 (begins with F. Engels on drinking as an identity marker among the working class)

Waitzkin H. 1991: The Politics of Medical Encounters : how Patients and Doctors deal with Social Problems. New Haven, Yale UP. (ch. 8, pp. 177-190, drinking problem as dealt with in a biomedical encounter)

Alasuutari P. 1992: Desire and Craving : a Cultural Theory of Alcoholism. Albany : State University of New York Press (ch 2 on the cult of self-control; not on political economy but on alcoholism in Finland)

McKnight D. 2002: From Drinking to Hunting: the Devastating Effects of Alcohol on an Australian Aboriginal Community. London: Routledge (comprehensive ethnography).

The example of public health:

Manderson L. 1990: Race, Colonial Mentality and Public Health in Early Twentieth Century Malaya. In Rimmer J. P. & Allen L. M. (eds) The Underside of Malaysian History. Singapore: Singapore UP, ch 9 (asks the question : Whyhookworm campaigns?)

Brown E.R. 1976: Public Health in Imperialism: Early Rockefeller Programs at Home and Abroad. American Journal of Public Health 66 (9): 897-903 (rather programmatic style, contains an answer to the above question)

Onoge O 1975: Capitalism and Public Health: a Neglected Theme in the Medical Anthropology of Africa, in S. R. Ingram & A. E. Thomas (eds) Topias and Utopias in Health. The Hague: Mouton (attacks the socioculturalist approach as one which blames the victim)

Bibeau G. 1997: At work in the fields of public health: the abuse of rationality. MAQ 11 (2): 246-52 (points to the normative features of public health, and calls them into question)

8. On nationalism and the revival of “traditional” medicines (EH 3-12-02)

Hobsbawm E. 1983: The Invention of Tradition. CUP, ch 1

- Leslie C. (ed) 1977: Asian Medical Systems. UCP (chs by Otsuka on Japan, Croizier on China, Unschuld on Taiwan, and especially Leslie on India)

- Leslie C. & Young A. (eds) 1992: Paths to Asian Medical Systems. UCP (on pluralism, see ch 6 by Trawick and ch 10 by Nichter, see esp. ch by Unschuld on Chin med and Obeyesekere on Ayurveda)