Transcript Ritual, Performance, Spectacle

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Medicine & Culture
15 week, 36 credit final year option in Anthropology
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Main Themes
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The cultural and social embeddedness of all disease
concepts and ‘medical’ practices
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‘Medicine’ no less than ‘culture,’ is a set of competing
discourses and practices, within situations characterised
by the unequal distribution of power (cf. Frank 1999)
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Medical anthropologists differ enormously in the kinds of
questions they ask and insights they achieve through
various approaches; this course draws attention to these
differences in order to learn from them
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Course Overview
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Week 1: Introduction
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Week 2: Biomedicine and the Birth of the Clinic
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Week 3: From Shamanism to Placebo
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Week 4: Phenomenology and Embodiment
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Week 5: Narrative Approaches 1
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Week 6: Narratives Approaches 2
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Week 7: Critical Medical Anthropology
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Week 8: Unequal Publics
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Week 9: Applied Anthropology and the Exigencies of the Clinic
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Week 10: Tutorials
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Format of the Course
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2-3 students will be responsible for ‘facilitating’ the first
hour of each seminar.
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Student facilitators are expected to (1) identify and discuss
the key themes of the week, and (2) plan and moderate the
in-class discussion of readings.
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Presentations, film clips, role-play, debates, case studies,
participatory techniques, small-group discussions, and largegroup discussions.
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Facilitators may find it helpful to meet with the Course Tutor
during office hours to discuss plans for the week’s session.
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Materials for the Course
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Course Document
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Study Direct: download and print key readings, download
PowerPoint presentations from lecture
 only those that are not available through online journals
will be posted on SyD
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Websites and blogs:
 http://openanthcoop.ning.com/
 http://neuroanthropology.net/
 http://www.medanthro.net/
 http://www.somatosphere.net/
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Course Instructor
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Dr Paul Boyce
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Arts C307
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Office Hours: Thursdays 1.30pm-3pm
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Email: [email protected]
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Sample dissertation titles
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Genetics, genetic diseases and personhood
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Channelling the universal energy: a study of Reiki*
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Shamans, traditional healers and Western biomedicine
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Understanding CFS in relation to structural violence
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‘You say he was shattered by his experience?’: PTSD and the politics of diagnosis
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‘It’s time to make our voices heard’: power and resistance in contemporary
psychiatry
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Organ transplantation and the brain-death criteria: reassessing social
conceptions of the mind-body relationship in light of ‘post-death’
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FGM is torture, not a culture: proposing a role for medical anthropology in the
female circumcision debate
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How has access to the internet affected the experiences of being a breast cancer
patient?
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Acculturation, appropriation, and antagonism: integrating acupuncture into a
Western medical system*
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A Potted History of Medical
Anthropology
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1950s:
 professionalisation of the discipline
 disenchantment with efficacy and equity of biomedicine
 new funding opportunities after WWII
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1960s:
 medical anthropology becomes distinct from studies of
ritual, symbolism, modes of thought
 development of an applied field/international aid
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A Potted History of Medical
Anthropology
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1970s:
 Arthur Kleinman (illness versus disease)
 interest in pragmatic and everyday aspects of health
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‘the body’ begins to emerge as a organising frame
1980s:
 studies of medicine in the West (biomedicine)
 critical medical anthropology
 political economies of health
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‘resistance’ (e.g., to capitalism) becomes a pervasive
theme
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A Potted History of Medical
Anthropology
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1990s:
 continuing interest in biomedicine, esp. HIV/AIDS
 science studies
 global political economy of health
 narratives, social suffering
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2000s:
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growing health crises (including migration, ‘social
exclusion’)
health activism and citizenship
new technologies (NRTs, vaccines, internet, hospital
infections, cyborgs, genetic screening)
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Byron Good: Four Orienting
Approaches
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Empiricist (belief and behaviour): medical knowledge is
normative, focus on individual actor and choice
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Cognitive (classification and structure): describing cultural
models of categorization, emotion, psychology, illness,
ethnomedicine
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Interpretive (meaning-centred): looks at relationship
between culture and illness, experience, embodiment,
narrative
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Critical (political economy and cultural critique): medical
language and practices are ideological, disguising unequal
relations of power
(Byron Good 1994)
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Key Concepts
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Disease: Abnormalities in the structure or function of
organs and organ systems (esp. as defined by
biomedicine)
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Illness: A person’s (patient’s) subjective experience
of malaise
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Sickness: A‘performance,’ which includes social
recognition (‘legitimation’) of the problem and
participation by more than just healers (e.g. kin,
workplace, etc).
(Scheper-Hughes & Lock 1987:10)
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Disease vs. Illness
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‘A key axiom in medical anthropology is the dichotomy
between two aspects of sickness: disease and illness.
Disease refers to a malfunctioning of biological and/or
psychological processes while the term illness refers to
the psychosocial experience and meaning of perceived
disease…’ (Kleinman 1980:72)
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Where does this distinction come from?
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What kinds of divisions of academic labour might result
from these distinctions?
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‘natural science’ approach to disease as prior and universal
‘social science’ approach to illness, involving questions of
meaning (cf. Comaroff 1982)
Disease:Illness::Nature:Culture
Disease
Illness
Object
Subject
Fact
Value
Physician
Patient
Biology
Psychology
Nature
Culture
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‘Outside the significance that man voluntarily attaches
to certain conditions, there are no illnesses or diseases
in nature’ (Sedgwick in Joraleman 1999: 2).
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‘What, are there no diseases in nature? Are there no
infections and contagious bacilli? Are there not definite
and objective lesions in the cellular structures of the
human body? Are there not fractures of bones, the fatal
ruptures of tissues, the malignant multiplications of
tumorous growths? Are not these, surely, events of
nature?’ (Sedgwick in Joraleman 1999:3)
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‘Yet these, as natural events, do not – prior to the human
social meanings we attach to them – constitute illnesses,
sicknesses, or diseases. The fracture of a septugenarian’s
femur has, within the world of nature, no more
significance than the snapping of an autumn leaf from its
twig: and the invasion of a human organism by choleragerms has no more the stamp of “illness” than does the
souring of milk by other forms of bacteria.’
(Sedgwick in Joraleman 1999: 3)
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Key Concepts
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Aetiology: an explanation of the cause or origin of a disease
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Affliction: the cause or state of mental or bodily pain,
distress, grief, or misery
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Epistemology: a branch of philosophy concerned with the
nature of knowledge
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Explanatory model (EM): attributed to Arthur Kleinman, an
EM is comprised of ideas about a particular episode of
sickness and treatment (e.g., a patient’s explanatory model
may diverge considerably from that of a physician)
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Key Concepts
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Health belief model (HBM): a model of health behaviour
that assumes that people’s actions are rationally determined
by (and follow directly from) their pre-existing ‘beliefs’
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Medical pluralism: the existence of different (oftentimes
competing) medical traditions within a single society
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Popularisation: (1) when aspects of biomedicine ‘filter
down’ to the popular sector, (2) the increasing use of aspects
of foreign medical traditions (e.g. Tibetan medicine in
Mexico)
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Week 2: Biomedicine and the Birth
of the Clinic
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Ferzacca, Steve. (2000). ‘“Actually I Don’t Feel that Bad”:
Managing Diabetes and the Clinical Encounter’
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Foucault, Michel. (1989). ‘Introduction,’ ‘Space and
Classes,’ and ‘Open Up a Few Corpses’ from The Birth of the
Clinic
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Good, Byron. (1994). ‘Chapter 3: How Medicine Constructs
its Objects’ from Medicine, Rationality, and Experience
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Lock, Margaret and Nancy Scheper-Hughes. (1996). ‘A
Critical-Interpretive Approach in Medical Anthropology:
Rituals and Routines of Discipline and Dissent.’
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Pinto, Sarah.(2004). ‘Development without Institutions: Ersatz
Medicine and the Politics of Everyday Life in Rural North
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The Birth of the Clinic
(Foucault,1973)
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Foucault questions the accepted truth that
modern medicine was born in Ancient
Greece, lost, and reclaimed in early 19th
century…
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…when Enlightenment triumphs of autopsy made the
body ‘known’
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Foucault shows instead that:
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empirical medicine was established in the 17th century
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that clinical practice declined after the French revolution
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that autopsies had in fact been carried out throughout 1700s
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The ‘Official’ History of
Medicine?
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The history of medical knowledge is that of progress over
time…
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…in which nature becomes gradually discovered and
known effectively and scientifically…
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…and disease itself is ‘universal’ in the sense of being
prior to society or culture…
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…meaning that social factors are separate from (and
ancillary to) medicine or science
(Wright and Treacher 1982)
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Bentham’s Panopticon (1785), and
the Medical Gaze
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The Birth of the Clinic
(Foucault,1973)
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Interested in power/knowledge in the
‘disciplinary society’
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panopticism
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the medical gaze
Looks at clinical practice c1800 in Paris
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the importance of clinical practice for…
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…the construction of man as an object and subject of knowledge
New concepts of disease emerge in association with the
creation of a new ‘individual’ after the French revolution
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related to new forms of regulating and organising the poor
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Lessons from Foucault
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The ‘clinic’ is a place of categorization,
diagnosis, enumeration, and knowledge
production
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Through which the patient becomes ‘known’ in particular
ways to both him/herself and to the clinician
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Clinical ways of ‘seeing’ are not pure and direct but rather are
shaped by discourses of disease, the body, and the individual
that came to the fore in the late 18th century
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The clinic itself is the product of diverse historical currents, to
which it was ‘born’ at a particular moment in time
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The Hidden Curriculum
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‘Students were encouraged to learn new narrative
forms, to create medically meaningful arguments and
plots with therapeutic consequences for patients. In
this process, they sharpened their biomedical “gaze”
and developed their clinical reasoning. Throughout
these exercises [patients’] social histories and
emotional states, and their lives outside of the
hospitals…was largely irrelevant; these data from daily
life were regarded as “inadmissable evidence”.’
(Hafferty 1998)
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Social Constructionism
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Is concerned with how knowledge, social phenomena,
and perceptions of reality develop in particular
historical, social, and political contexts
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e.g., Foucault’s example of the development of the
modern body as an object (and subject) of medicine and
science
Pushes us to ask:
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Are claims to knowledge supported by reality?
Or are they social constructs?
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Social Constructionism
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Uses of social constructionism (Hacking, 1999):
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Unmasking, refuting ‘ideology’ and official histories
Shows the contingent and historical nature of social
reality
Misuses of social constructionism (Hacking, 1999):
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Histories sometimes anachronistic, decontextualised
Is the natural world adequately addressed?
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Questions to Consider for Week 2
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How, according to Byron Good (1994), does biomedicine
‘construct’ its objects?
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Where does the authority and legitimacy of doctors come
from? (see especially Pinto 2004)
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When does ‘self-care’ become ‘non-compliance’? (see
Ferzacca 2000)
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What are the ‘three bodies’ (Lock and Scheper-Hughes
1996), and how do they relate to the development and
practice of biomedicine?