Anthropology
Medical Anthropology: Critical, Interpretive and Biocultural Approaches
The study of biomedicine and the study of anthropology have some obvious similarities but they also have some interesting and not so obvious differences. According to Wiley and Allen (2009) the similarities include one very basic reality; each human being, wherever they live and whoever they look to for help during ill health are very much the same.
Anthropology is a discipline that investigates the nature and causes of human variation and those aspects of life that are common to all of humanity. Anthropologists seek to understand similarities and differences in behavior and biology across cultures and populations, and how these dimensions change over time (both historic and prehistoric) . . . Medical Anthropology is a subfield of anthropology that draws upon social, cultural biological, and linguistic and anthropology to better understand those factors which influence health and well-being. (Wiley & Allen, 2009, p. 2)
The differences between biomedical and anthropological areas of study are based on assumptions which reach back to the beginning of their development. Each of them has a different perception of the how society works and how it should be studied. Another difference is the way medical doctors and public health policy makers view the how experiments should be conducted. They are familiar with quantitative data that can be obtained in controlled laboratory settings. Whereas for anthropologists the whole world is there laboratory; they deal mostly with qualitative data. There is also a problem of communication because anthropologists are not always able to explain to the medical community the value of anthropological research. Now multidisciplinary research is becoming more accepted so the chance for medical anthropologists to gain the respect they rightly deserve is very likely.
Health is linked to our prehistory and our history. Health is also related to each person’s cultural experiences, their traditions and their environment. These five factors, (a) prehistory, (b) history, (c) culture, (d) traditions and (e) environment are linked to different groups as well as each individual. The group can be as big as the entire world and there is a timely example of how health is related to each of us on earth; that is global warming and climate change have affects on everyone single person. The multitudes of layers of groups under the global umbrella include manmade divisions such as nations, states, cities and other manmade boundaries. Other layers are called societies, cultures, religions and families. Each of these has an impact, perhaps negative or perhaps positive, and that is why the medical anthropology field of study was initiated. Medical anthropology is a new study area of area and it very popular. This paper attempts to answer the question "What is medical anthropology, and what distinguishes the critical, interpretive and biocultural approaches?" The hypothesis is that the critical, interpretive and biocultural aspects of ancient human history are still impacting the contemporary world in valuable ways.
Critical, Interpretive and Biocultural approaches
Critical Approach
Tambiah (1990) has written about the ways a critical approach may not be self-evident to others outside of the realm of anthropological studies. For example he has pointed out the importance of anthropology by discussing the way anthropology is able to rationally take into account the areas of magic and religion in way that brings balance to their historical impacts along with science. Instead of ignoring the realms of magic and religion that are the basis of modern science he demonstrates how reasonable it is to include them in the history of science. Tambiah offers three important critiques; firstly, “language activities and social practices actively contribute to the construction of scientific knowledge” (Tambiah, 1990, p. 22). Secondly, “claims that biomedicine provides straight forward, objective depictions for natural order an empirical order of the biological universal, external to culture, no longer seem tenable and must be submitted to critical analysis. . . .The empirical theory of medical language with its focus representation must give way to alternatives” (Tambiah, 1990, p. 22). Thirdly he points out that biomedicine has made incredible discoveries but it is not the only path to understanding nature and how health works. Littlewood (2002) argues that the pathology of mental illness needs to include input from alternative sources not only from the psychiatric model. Janes and Corbett (2009) discuss critical medical anthropology from a global perspective by discussing how global health governance can optimize the political economy of health. Biological embedding takes into account “the process by which human experience alters biological processes in stable and long-term ways that influence health over the life course” (Hertzman & Boyce, 2010, p. 329). This new approach offered by medical anthropologists observes childhood development through a lens which includes genetics and social environment in order to understand it more realistically.
Interpretive Approach
Medical anthropology can be studied with an interpretive approach that discerns the causes of illness by interpretation and by translating different cultural representations. This approach has been criticized because the observations are too subjective to be valuable as experiential data. On the other the social sciences have been developing ways to limit and control subjective viewpoints that cause bias. Also there is a great degree of common sense and reason that must be used in order to understand interpretive and representational data. Academic journals use peer review to ensure the professional quality of medical anthropological research. Kleinman (1975) offers an essential discussion on the symbolic reality of medicine and the disconnect between the emotional and imaginative feelings of illness which contrasts with the concept of medicine as a rigid system. He sees this as the main problem with the philosophy of medicine. The people being healed are not rigid systems after all, they are biological systems. Dow (1986) synthesized the universal aspects of “symbolic healing” in order to evaluate what is missing (or what is wrong) with modern psychotherapy by comparing the shamanic symbols of health to contemporary uses.
Another important interpretive perspective had been trying to unravel the ways that a terrible trauma affects a person and their lives after experiencing the trauma. Young (1995) discusses the reason the topic became interesting was because of the devastating effects to soldiers after World War I. Young (1995) explains how Abaram Kardiner, a psychiatrist in the Veteran’s Department from the years 1922 to 1925. “In Kardiner’s account, traumatic events create levels of excitation that the organism is incapable of mastering, and a severe blow is dealt to the total ego organization. The individual experiences this as a sudden loss of effective control over his environment.” (Young, 1995, p. 90)
Wilkinson and Pickett (2009) describe the material and psychosocial determinants of health that demonstrate evidence that the modern culture is different from ancient times in a very important way; the modern world may be making us ill. (p. 73) During most of history, infectious diseases were the greatest health danger fortunately strategies were discovered to lessen mortality from infectious diseases. Then the industrial revolution entered the scene with new types of chronic diseases. A change in the medical establishments view of medical anthropology started changing when a results of a study on stress demonstrated that top executives are not experiencing the most stress in the workplace instead employees low on the companies ladder have more stress and are more negatively impacted by stress. In fact Wilkenson and Allen (2009) explain that “a strong inverse association between position in the civil service hierarchy and death rates. Men in the lowest grade (messengers, doorkeeper, etc.) had a death rate three times higher than that of men in the highest grade (administrators)” (p. 75). Since that time more research studies have corroborated those results and more data has been added to the original conclusion of the groundbreaking study in the study. The lack of control in a person’s employment is the main culprit that causes the chronic stress related illnesses that can (and do) lead to premature death.
Biocultural Approach
A good working definition of biocultural anthropology is “a critical and productive dialogue between biological and cultural theories and methods in answering key questions in anthropology” (Hruschka et al. 2005:4). Levi-Strauss’ (1963) work “Structural Anthropology” suggests that in the future the mythical connection between therapist and patient may return as a construct of changes in how we use language. Although we cannot ‘go back’ in history but must take the best of what history has to offer and include it in our contemporary culture. Foss and Rothenberg (1987) may have been ahead of their time by several years when they started the discussion on how the transition from biomedicine to infomedicine could transform our communications and understanding of wellbeing. In 1995 Good offered an approach that stretches even the boundaries of medical anthropology. He considered the linking between culture and psychotherapy as a way to set forward a fruitful discussion on the future of psychiatric anthropology. Greene (1998) looks at the Shaman’s role in the health and well being of Peruvian indigenous tribes and how the disruption by colonial powers impacted primitive medicinal and concepts of healing. Petchkovsky and Roque (2002) look at one of the terrible crimes of the modern world, the forced removal of aborigine children from their families and Australian communities. This is an good example of how ‘delinking’ a person from the cultural leads to mental illnesses such as “complex PTSD, depressive type” (Petchkovsky & Roque, 2002, p. 345). Hunter (2006) discusses the plight of Australian aboriginal people from the complexities of doctor-patient dynamics, his purpose being to consider the impact colonialism still has in the paternalistic attitudes of doctors towards aboriginal patients. Farmer (2009) is a good example of how medical anthropology can embrace studies of power that may not be socially acceptable but are crucial to the continuance of a culture of humanity. He observes power through the lens of human rights and the disruptions to the lives of the poor.
Das and Das (2007) studied the power dynamics between doctors and patients in order to better understand how power impacts disease. The population they studied was a poor community in Delhi. Their study led them to contemplate a very serious question “What is normal” (Das & Das, 2007, p. 74). They were able to observe that not only do doctors have an influence on a person’s health but so do the people in the environment around them. Lyon (2003) approaches cultural issues from the perspective of conditioning and how it “involves the establishment, in social-relational contexts, of patterns of response. . . The expectation that is formed emotionally can lead to “bodily impact of such social-emotional states” (p. 90). Edmonds (2007) has offered a very interesting new discussion into how culture may potentially change the socially accepted view of the differences between life and death when she discusses the phenomenon of human organ transplants on the receiving person. An intriguing view of plastic surgery for the poor in neo liberal Brazil deconstructs the phenomena to point out that when education is unavailable perhaps the road to hope is only open to the beautiful. (p.378)
Conclusions
This brief essay could only offer a glimpse of the complex issues medical anthropology is uniquely suited to research. Hopefully the way that the complex issues are linked has become clearer. For example two very different research studies discussed help bring an understanding to the negative effects of having no control over one’s own environment. The impact on colonialism and contemporary indigenous may lead to solutions to help improve their well being. This type of lack of control has an impact on mortality statistics as well as the way businesses are organized. That is a good example of the type of conclusions that are typical for medical anthropology. No other area of the social sciences or the medical sciences is able to research with such a broad stroke. Without medical anthropology much important information about health and illness would pass by unrecognized. Therefore the hypothesis is judged to be true: that the critical, interpretive and biocultural aspects of ancient human history are still impacting the contemporary world in valuable ways.
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