Medical anthropology

Overview
Medical anthropology is a subfield of social and cultural anthropology. It is a term which 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 nineteenth century Dutch term "medische anthropologie". This term was chosen by some authors during the 1940s to refer to philosophical studies on health and illness. A basic bibliography for this field is quoted in this page.

Historical background
The relationship between anthropology, medicine and medical practice goes back a long way and 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 and medicine in general adopted a reticent attitude towards the empiricism gained by doctors working in their daily practices among the people. Furthermore, its basic source of knowledge was experimental medicine in the hospital and laboratory, and these factors together meant that over time doctors abandoned ethnography. This abandonment 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 twentieth century, until the development of medical anthropology in the 1960s and 1970s. A large number of contributors to twentieth-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 (see General references), describes a large international panorama of the international development of medical anthropology.

Popular medicine and medical systems
For much of the twentieth 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.

The concept of folkmedicine 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.

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:

1) The relative influence of genotypical and phenotypical factors in relation to personality and certain forms of pathology, especially psychiatric and psychosomatic pathologies.

2) The influence of culture on what a society considers to be normal, pathological or abnormal.

3) The verification in different cultures of the universality of the nosological categories of biomedicine and psychiatry.

4) 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 twentieth 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 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 criticisms of 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 anthropologists being involved in many areas. These included: 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; 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 chromic 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 out of 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.

The agenda of medical anthropology
Currently, research in medical anthropology is one of the main growth areas in the field of anthropology as a whole and we are even seeing important processes of internal specialization. For this reason, any agenda is always debatable. In general, we may consider the following five basic fields:


 * the development of systems of medical knowledge and medical care
 * the doctor and patient 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 impact of biomedicine and biomedical technologies in non-Western settings

Important fields have been excluded, such as cultural psychiatry and transcultural psychiatry or ethnopsychiatry. These are clinical fields which have connections with medical anthropology in terms of research methodology and theoretical production.

The training of medical anthropologists
All medical anthropologists are trained in anthropology as their main discipline. Many come from health professions such as medicine or nursing, whereas others come from backgrounds such as psychology, social work, social education or sociology. Cultural and transcultural psychiatrists are trained as anthropologist and, naturally, psychiatric clinicians. Training in medical anthropology is normally acquired at master’s (M.A. or M.Sc.) and doctoral level. In Latin countries there are specific masters’ in medical anthropology, such as México, Brasil, Portugal and Spain. A fairly comprehensive account of different postgraduate training courses in different countries can be found on the web site of the Society of Medical Anthropology of the American Anthropological Association.

The literature on medical anthropology
Despite the high prevalence of English literature on medical anthropology there is an enormous quantity of medical anthropological research available in other languages.