ANTHROPOLOGY 5030.001
Medical Anthropology
Fall 2006
Thursdays 6:00pm
INSTRUCTOR:
OFFICE HOURS:
Doug Henry
Tues 1:00 – 3:00, Wed 10:30 – 11:30 Chilton 330M, or by appointment
Ph 565-3836 (office)
email: dhenry@pacs.unt.edu
COURSE DESCRIPTION AND OBJECTIVES:
This course offers an examination of health and disease in cross-cultural context. We’ll approach the
field of medical anthropology practically and in an applied manner, through looking at the specific
questions that medical anthropologists will ask during the course of researching a specific
anthropological topic. Specific topics include the cultural construction and organization of diverse
health systems, the “culture” of Western medicine, the relationship between social class and access to
care, health, disease, structural inequalities and health, gender and health issues, and medical ethics.
REQUIRED READINGS:
The bulk of readings for this course will be available on electronic reserve through the University
library.
COURSE REQUIREMENTS
There is not a textbook, but it should be understood that primary research and fieldwork (interview
design, data collection, analysis, and presentation) will represent a significant requirement for this
course. Over several weeks, you will need transportation around the Dallas area in order to visit and
interview patients. You will also need to be able to call them to set up meeting times.
Exams: There will be a midterm and class project with presentations. The midterm format will be
essay questions, with material coming from assigned readings and class discussion.
Abstracts: From each group of assigned readings, you will write a 1 page abstract on this article,
and summarize the article to the class as part of discussion. A model for abstracts will be handed out
during the first class.
Certification: NIH Human Participant Protections Education for Research Teams:
http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp
THE PROJECT: Student Self-regulation of Sleep
The Client
Our project will work with Dr. Daniel Taylor, a practicing behavioral therapist at the UNT Dept. of
Psychology, who specializes in cognitive behavioral therapy for insomnia patients. Dr. Taylor is in
the middle of conducting a study of sleep disorders among undergraduates. Because almost nothing
has been done to examine self-regulation and self-treatment of sleep problems among insomniacs, he
has asked for our involvement in the study, and will refer participants to us. Participants will be
reimbursed “extra credit” for current psychology classes.
Background
Between 50 to 70 million Americans in all age groups are affected by sleep problems and disorders 1.
Epidemiologically, sleep dysfunction has been associated with increased mortality, morbidity, errors
and accidents, absenteeism, a decrease in productivity, and the weakening of personal and
professional relationships2. Despite this, only 4% of adults with problems currently see a physician
regarding sleep problems3.
Sleep researchers have noted that “sleep hygiene” (the development of good sleep habits) can predict
or exacerbate sleep disturbance. The social patterns of this behavior, however, have remained as yet
unexplored, and may constitute a critical gap in our understanding of sleep disorders. Research has
long shown, for example, that patients of different ages or genders, or belonging to different racial,
ethnic, and social classes can vary tremendously in their decisions as to when and where to seek
medical advice. When advice is sought, symptoms of the same illnesses are often presented to
physicians very differently, again patterned by class, age, gender, or ethnicity. This kind of research,
however, has not yet expanded to include social and cultural components of sleep disorders.
Williams4 notes an increasing societal trend towards the commercialization of sleep disorders, and
the burgeoning industry of over-the-counter and complementary and alternative therapies available
for those who would self-diagnose and self-medicate. Little is known, however, about how members
of different ethnicities, genders, or social classes make decisions as to who or when to consult for
symptoms of sleep dysfunction, what patterns may exist in self-diagnosis and treatment (using overthe-counter and prescription sleeping pills, exercise, meditation, etc.), how different groups interpret
their symptoms, and how these symptoms become presented differently to a private practitioner or
sleep disorder clinic. This research aims to address this gap.
The Problem to be Investigated
The specific aims of the class investigation are threefold:
1. To gain a broader understanding of the social, environmental, and demographic factors
shared by undergraduates with self-described trouble sleeping.
2. To describe the prevailing social context that shapes individual interpretation of sleep
disorder symptoms, and patterns within self-diagnosis.
3. To illuminate the significance of peers in shaping how sleep disorders get diagnosed,
managed, and treated.
The result will be an examination of individual experiences of sleep played out against a social
context, in order to reveal the domain of activities which provide the basis of personalized sleep
1
Hunt, C. (2003) National Sleep Disorders Research Plan. Bethesda: National Institute of Health and the
National Center on Sleep Disorders Research.
2
Doi, Y; and M. Minowa (2003) Gender differences in excessive daytime sleepiness among Japanese workers.
Social Science & Medicine 56 (4): 883-895
3
National Sleep Foundation (1999). Sleep In America Poll. Washington, DC. Accessed through
www.sleepfoundation.org.
4
Williams, S. (2002). Sleep and health: sociological reflections on the dormant society. Health: An
Interdisciplinary Journal for the Social Study of Health, Illness & Medicine 6 (2): 73-201.
management. Questions will probe the social determinants of the following questions: At what point
does a “bad night’s sleep” becomes something worthy of a visit to a sleep disorder clinic, and when
is it considered simply one’s lot in life? How do men vs. women define quality of sleep differently?
How do different genders and groups vary in their interpretation of symptoms, and in their healthseeking behavior? How is the utilization of personal sleep strategies shaped or constrained by social
and cultural factors?
Anticipated Products
A final report will be constructed and distributed that will describe the findings and implications,
including illustrative quotes and data documentation. These will include comparative analysis, detail
best practices and lessons learned, and make recommendations for future policy and programs in the
relevant areas.
Outcomes, Significance, and Implications for Programmatic Application
Results will provide insight into the social components of sleep disorders, including the social
patterns of sleep hygiene, patterns of health-seeking behavior, lay diagnoses, and lay treatment.
The project will also lead to recommendations on how sleep disorder research programs can be
strengthened.
Student Evaluation:
Class participation
Abstracts:
Midterm:
Project:
20%
25%
20%
35%
Statement on Plagiarism and Cheating. The department of anthropology considers graduate
students to be new members of the community of professional anthropologists, who are thus held to
the high ethical standards of practicing professionals. They are expected to follow the American
Anthropological Association’s code of ethics: “Anthropological researchers bear responsibility for
the integrity and reputation of their discipline, of scholarship, and of science. Thus, anthropological
researchers are subject to the general moral rules of scientific and scholarly conduct: they should
not deceive or knowingly misrepresent (i.e., fabricate evidence, falsify, plagiarize), or attempt to
prevent reporting of misconduct, or obstruct the scientific/scholarly research of others”
(http://www.aaanet.org/committees/ethics/ethcode.htm). Any work not meeting this standard will be
evaluated in a hearing before the student; infractions will merit dismissal from the master’s program.
For more information on paper writing, including how to avoid plagiarism, and how to use citations,
see http://www.unt.edu/anthropology/writing.htm. For information on the University’s policies
regarding academic integrity and dishonesty, see the UNT Center for Student Rights and
Responsibilities, http://www.unt.edu/csrr/.
Class Schedule and Readings (available on electronic reserve)
Note: Readings in bold require you to write an abstract to turn in to me. You will choose the other
reading, and will also have an abstract due on that, except that you will distribute that abstract to the
entire class (this way, everyone will have some record of all the readings).
September 1st: Class Introduction
Week 2 (September 8): Ethnomedicine, Explanatory Models, and Social Health
Williams, S. (2002). Sleep and health: sociological reflections on the dormant society. Health: An
Interdisciplinary Journal for the Social Study of Health, Illness & Medicine 6 (2): 73-201.
Interviews with “Oregon Patient 3” and “Patient 2.” (in this case, write a detailed paragraph response
to each)
Kleinman, Arthur, Leon Eisenberg, and Byron Good. 1978. Culture, Illness, and Care: Clinical Lessons
from Anthropological and Cross-Cultural Research. Annals of Internal Medicine 88:251-258.
Daley, T., and T. Weisner (2003). “I Speak a Different Dialect”: Teen Explanatory Models of
Difference and Disability. Medical Anthropology Quarterly 17 (1): 25-48.
Chavez, Leo R., F. Allan Hubbell, Juliet M. McMullin, Rebecca G. Martinez and Shiraz I. Mishra. 1995.
Structure and meaning in models of breast and cervical cancer risk factors: A comparison of perceptions
among Latinas, Anglo women, and physicians. Medical Anthropology Quarterly 9 (1): 40-74.
Week 3 (September 15) Medicalization and Culture-Bound Illnesses
Lyon-Callo, Vincent (2000). Medicalizing Homelessness: the Production of Self-Governing within
Homeless Shelters. Medical Anthropology Quarterly 14 (3): 328-345.
Henry, Doug (2006). Violence and the Body: Somatic Expressions of Trauma and Vulnerability During
War. Medical Anthropology Quarterly 20 (3): 379-398.
Banks, Caroline Giles (1992). “Culture” in Culture-Bound Syndromes: The Case of Anorexia Nervosa.
Social Science and Medicine 34(8):867-884.
Oregon Patient 6 (write a ¾ page response, comparing what you see going on here to the Lyon-Callo
article).
Week 4 (September 22): The Culture of Western Medicine
Worthman, C., and M. Melby (2002). Towards a Comparative Developmental Ecology of Human
Sleep. In Adolescent Sleep Patterns—Biological, Social, and Psychological Influences, M. Carskadon,
eds. Pp. 69-117. Cambridge: Cambridge University Press.
Konner, Melvin (1997). Basic Clinical Skills: The First Encounters. In The Social Medicine Reader.
Henderson et al., eds. Durham: Duke University Press, pp. 210-222
Payer, Lynn Borderline Cases: How Medical Practice Reflects National Culture. Sciences 30 (4): 38-42.
Sagan, Leonard- What Language Does Your Doctor Speak? New York Times July 10, 1988, and also
Ehrenreich, Barbara (1989). Sick Chic: Why Can’t You Ever Find a Good Disease When you Need
One? Ms. 17 (7/8): 28-29. (combine these short articles into 1 abstract).
Zola, I. (1972). Medicine as an Institution of Social Control. Sociological Review 20 (4): 487-504.
Week 5 (September 29): The Physician-Patient Encounter/ The Sick Role
Helman, Cecil G. 1994. Chapter 5, Doctor-patient interactions. Pp. 101-145 in Culture, Health and
Illness, C.G. Helman, ed. Oxford: Butterworth-Heinemann Ltd.
Lazarus, Ellen (1988). Theoretical Considerations for the Study of the Doctor-Patient Relationship:
Implications of a Perinatal Study. Medical Anthropology Quarterly 2 (1): 34-58.
Waitzkin, H. (2000). Chapter Six: “The Micropolitics of the Doctor-Patient Relationship.” In The
Second Sickness: Contradictions of Capitalist Health Care. Pp. 119-162. New York: Rowman and
Littlefield Publishers.
Waxler, Nancy1982 Learning to be a Leper: a case study in the social construction of illness. In Elliot
Mishler et al., ed. Social Contexts of Health, Illness and Patient Care. Cambridge University Press.
Week 6 (October 6): Gender and Health
Inhorn, Marcia (2006). Defining Women’s Health: a Dozen Messages from More than 150
Ethnographies. Medical Anthropology Quarterly 20 (3): 345-378. (note: instead of an abstract, pick 3
of the 12 “messages” that sound the most interesting to you, and write an in-depth 2-3 page review.
Don’t just summarize, but include your own thoughts)
Hislop, Jenny, and Sara Arber (2003b). Sleepers Wake! The Gendered Nature of Sleep Disruption
Among Mid-life Women. Sociology 37 (4): 695-711.
Elderkin-Thompson, Virginia, and H. Waitzkin (1999). Differences in Clinical Communication by
Gender. Journal of General Internal Medicine 14 (2): 112-121.
Wynn, L.L., and James Trussell (2006). The Social Life of Emergency Contraception in the United
States: Disciplining Pharmaceutical Use, Disciplining Sexuality, and Constructing Zygotic bodies.
Medical Anthropology Quarterly 20 (3): 297-320.
Week 7 (October 13): Social Influences on Health
Farmer, Paul (1997). Social Inequalities and Emerging Infectious Diseases. In Understanding and
Applying Medical Anthropology. Peter J. Brown, ed. Mayfield Publishing Company: Mountain View,
CA pp. 98-107. and also Rothman, K. (1998). Should the Mission of Epidemiology Include Poverty?
The Lancet 352: 810-813 (you can combine these into 1 abstract).
Adler, Nancy, et al. (1997). The Relationship between Social Class, Race/ Ethnicity, and Health. In The
Social Medicine Reader. Henderson et al., eds. Durham: Duke University Press, pp. 108-120.
Parker, Sheila (1995). Body Image and Weight concerns among AA and White Adolescents. Human
Organization 54 (2): 103-114.
Lazarus, Ellen (1994). What Do Women Want? Issues of Choice, Control, and Class in Pregnancy and
Childbirth. Medical Anthropology Quarterly 8 (1): 25-46.
Week 8 (October 20): Research Methods in Medical Anthropology & Interviews!!
Pelto, Pertti and Gretel Pelto. 1997. Studying knowledge, culture, and behavior in applied medical
anthropology. Medical Anthropology Quarterly 11 (2):147-163.
Bernard, H. Russell (2000). Chapter 6: Unstructured and Semi-Structured Interviewing. In Social
Research Methods: Qualitative and Quantitative Approaches. Thousand Oaks, CA: Sage Publications.
Week 9 (October 27): no reading: interviews and transcription!!
Class activity: Discussion of interviews
Week 10 (November 3): Political Economy and Policy + interviews and transcription!
Farmer, Paul (2003). Introduction and Chapters 1 and 2 in Pathologies of Power: Health, Human
Rights, and the New War on the Poor. Berkeley: University of California Press.
Week 11 (November 10): interviews and transcriptions due!!
Bernard, H. Russell (2000). Chapter 12: Qualitative Data Analysis I: Text Analysis. In Social Research
Methods: Qualitative and Quantitative Approaches. Thousand Oaks, CA: Sage Publications.
Class activity: Atlas ti
Week 12 (November 17). Coding and Analyzing Data
Class activity: Intercoder reliability/ how to analyze
Week 13 (November 24): No class; Thanksgiving Holiday
Literature reviews, Work on data analysis!
Week 14 (December 1): No class: AAA’s!
Work on data analysis!
Week 15 (December 8): Wrap Up: Work on Presentation
Castro, A., and M. Singer, eds. (2004). Unhealthy Health Policy: a Critical Anthropological
Examination. Walnut Creek, CA: AltaMira Press. (Read introduction and do abstracts on two chapters
of your choice!)
Class activity: Final editing to presentations!
Week 16 (December 15): Client Presentation