Transcript Lectures on Medical Anthropology by Elisabeth Hsu

Lectures on
Medical Anthropology
by Elisabeth Hsu
Michaelmas Term 2002
Oxford
Streams in Medical Anthropology
- Bio-cultural
- Marxist, political economy, macro social approach (often
called Critical medical Anthropology (see Baer)
- Critical medical anthropology ( Margaret Lock, developed
from critical cultural anthropology)
- ethnomedicine, early streams
in Elisabeth’s class we will deal with the interpretation of
med. ant.
Key topics
Illness and being ill is not only a biological event.
Religion and medicine are related.
Rituals are not only interesting because of cosmology but
because of their transformative effect on people (healing).
The secularistation process in our society brought up the
development of medical anthropology.
Early medical anthropologists distinguished themselves from
sociologists.
Disease course can be different because of illness behaviour.
(e.g. vaginal discharge in Korea ( D. Sich): a normal symptom
becomes an illness because of psychological poblems
Three insights that gave rise to medical
anthropology
1. GPs/psychiatrists/ and other health professionals saw that:
Sickness/Illness/disease is not only a biological event.
2. Anthropologists of Religion saw that:
Ritual informs not only on myth but actually has a transformative effect on
the individual practising it.
3. Sociologists of knowledge saw that:
Basic assumption of Western medicine are culturally constructed, and some
currents within medical anthropology question those.
Comments on authors on the field
Cecil Hellmann: writes for health care professionals, too
simplistic for deeper studies of MA
Arthur Kleinmann: psychiatrist and MA
Favre-Saada: psychologist an MA
important author in anthropology of religion: Gilbert Louis
B. Good was a student of U. Turner
E. Hsu: focuses on semantics, a sub-field of linguistics, and
cognition, A. of knowledge, Cognitive A.
Anderson and Foster: MA who were highly criticised for
being biomedically oriented
Disease - Illness - Sickness differentiation
The classification is based on a sociology of knowledge approach applied to diseaseillness-sickness.
Every biological event is mediated through social and cultural being.
Culture-bound syndroms ( term is out-dated), mentioned in cross-cultural psychiatry
studies, like SUSTO (Rubel 1964).
Explanatory models are powerful and useful in applied medical anthropology (for nonprofessionals), because people do have a model about illness in their minds.Professionally
we need to go beyond this model and account for social relations.
Biomedical EM (explanatory model, EMs are micro-social and also outdated)
SYMPTOMS
CAUSE
TREATMENT
LABEL
Eisenberg 1997: “Disease and Illness”
CMP 1:9-23.
“Patients suffer illness, doctors diagnose and treat disease”.(p.9)
Illness:
patient experience of discontinuity in states of being,
perceived role performance, lay-person’s understanding of the event
Disease:
abnormalities in the function of the body organs and systems, modern
biomedical paradigm, concepts used by MDs (This includes theoretical
understanding in different medical systems)
“When physicians dismiss illness because disease is absent they fail to meet
their socially assigned responsibility.” (p.9)
Kleinmann 1980 and 2000:
“Disease and Illness”
Disease:
“biological dysfunction”
biological event, biomedical professional understanding regardless of cultural
recognition.
Kleinmann did not make a distinction between biomedically identified event and
real medical event e.g. annorexia nervosa ( biomedically identified)
self-starvation, model view ( real event for the patient)
Illness:
An indvidual’s socio-psychological/ culture-bound understanding of the event.
Was criticised by Allan Young because his views were founded on micro-social
construction of the event, EM and Patient-doctor relationship.
Macro social aspects (pharmaceutical industries, economy, gender), also misfortune
were left out.
Gilbert Lewis 1975: “Disease and Illness”
Biomedical event = disease
Biomedical knowledge is socially constructed knowledge.
Hsu prefers Lewis def.:
Disease is the biomedical understanding of the entire event.
Illness:culture specific, social understanding
“defined by external modern medical criteria” as opposed to
“Illness as it happens to be recognised in the society [studied]”
( Lewis 1975)
Model by Kleinmann 1980
POPULAR SECTOR:
- BELIEFS
-NONSPECIALISED
PLACE
OF HEALING
- FAMILY
- HOMEBASED
CONCEPTS
MDs
FOLK
Culture-bound syndrom and EM
(Explanatory models)
Debate is en passe.
CBS implied that only “other “ cultures have such a
syndrom. But scizophrenia or PTSD are specific to our
culture.
EM are outdated because of limited ability to show all
aspects involved on all levels.
Young & Frankenberg: SICKNESS
Class and culture specific recognition of the event, as
economically and socially created and legitimised