Medical anthropology studies "human health
and disease, health care systems, and biocultural
adaptation". It views humans from multidimensional
and ecological perspectives. It is one of
the most highly developed areas of anthropology
and applied anthropology, 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.
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.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.
== Historical background ==
The relationship between anthropology, medicine
and medical practice is well documented. 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. The hegemony of hospital clinical
education and of experimental methodologies
suggested by Claude Bernard relegate the value
of the practitioners' everyday experience
who 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. 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.
== Popular medicine and medical systems ==
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. Examples of this practice
can be found in medical archives and oral
history projects.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
or, if psychopathology is the object of study,
ethnopsychiatry (Beneduce 2007, 2008), transcultural
psychiatry (Bibeau, 1997) and anthropology
of mental illness (Lézé, 2014).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 which 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:
The relative influence of genotypical and
phenotypical factors in relation to personality
and certain forms of pathology, especially
psychiatric and psychosomatic pathologies.
The influence of culture on what a society
considers to be normal, pathological or abnormal.
The verification in different cultures of
the universality of the nosological categories
of biomedicine and psychiatry.
The identification and description of diseases
belonging to specific cultures which 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. 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 demand that we inspect the (unfortunately-named)
predisposing social or cultural factors, which
have been reduced to mere 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 may consider the following
six basic fields:
the development of systems of medical knowledge
and medical care
the patient-physician relationship
the integration of alternative medical systems
in culturally diverse environments
the interaction of social, environmental and
biological factors which influence health
and illness both in the individual and the
community as a whole
the critical analysis of interaction between
psychiatric services and migrant populations
("critical ethnopsychiatry": Beneduce 2004,
2007)
the impact of biomedicine and biomedical technologies
in non-Western settingsOther subjects that
have become central to the medical anthropology
worldwide are violence and social suffering
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, Brazil, and Spain, 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, 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
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.
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.
== See also
