Chapter 15
Medical Anthropology
What Do We Mean by Health and Illness? 1
• Medical anthropology is the subfield of anthropology that tries to understand how social, cultural, biological, and linguistic factors shape the health of human beings. Doctors and other allopathic practitioners tend to focus on treating sickness and disease.
•
•
•
Public health officials focus on preventing outbreaks of disease.
Medical anthropologists differ in their emphasis on illness and disease as culturally influenced subjective states.
The mindful body: A prolegomenon to future work in medical anthropology
• A ground-breaking paper by Nancy Scheper-Hughes and Margaret Lock (1987).
• States there are 3 bodies to be considered when looking at health and disease:
1.
The individual body has become the sole source of discourse in Western medicine
• This is the result of the dichotomy-based thinking of Rene Descartes.
• The focus is on those identified by the members of the cultural group themselves and away from
•
• external labels. Gone from etic to emic categories.
Often looked at as pairs of opposites (dichotomies); the dichotomy is common as a theme of
Western cultures.
•
This idea of dichotomy is often called ‘dualism’ and is associated with both Plato and René
•
Descartes (body-mind dichotomy).
In anthropology it is strongly linked with Claude Lévi-Strauss (binary opposition).
Try it, think of body and mind, humans and animals, and so forth.
What Do We Mean by Health and Illness? 2
• The mindful body (continued)
2.
The social body is where the physical body of an individual and the social world of the individual connect.
3.
•
•
They remind us that societal ills, such as inequality or stress, can harm individual health.
There is the counter-balance that an egalitarian, well-integrated society should promote good health.
The body politic talks to the social and political forces that can limit good health. Think “Obama Care” as an obvious example of this discussion.
•
• Consider health in relation to all three “bodies” makes it clear the ways that individual health is connected to larger social conditions.
The individual subjectivity of illness
• Anthropologists often create distinctions between the terms health, disease, illness and sickness. But, these terms
• are the focus of much debate.
Defining health can be quite tricky. According to the WHO (World Health Organization), health is “a state of complete social, psychological, and physical well-being.”
• According to your text, health is “freedom from disease.”
• What does this state look like and is it something that is universally recognizable?
• For instance what is obesity in our society (BMI >30) is considered as desirable in others. Watch this
•
• video from Mauritania and this video from Nigeria .
In one culture depression causes hospitalization, in others sign of the power of witchcraft.
Polycythemia (>17 mg/dl of hemoglobin) can be an adaptation at high altitudes to combat hypoxia.
What Do We Mean by Health and Illness? 3
•
The individual subjectivity of illness
•
Disease refers to a physiological alternation that impairs function in some way. This can manifest as one of several disease states: Injury, infectious disease, nutritional disease, genetic disease, chronic disease, and psychological/behavioral disease
•
Illness is:
• The presence of sickness or disease.
•
•
Illness is a subjective experience of symptoms and suffering, which motivates changes in behavior to alleviate this discomfort. The subjective component of illness is informed by cultural contexts that provide ways of thinking and understanding what we feel.
Arthur Kleinman (well-known medical anthropologist) stated that “illness complaints are what patients and their families bring to the practitioner (1988, p. 5).

• Environment and cultural expectations affect the perception of illness.
• For example, in parts of Mali, infection rates of schistosomiasis, a liver and bladder infection caused by a parasitic worm that lives in water, are so high that it is not locally recognized as “illness.”
•
•
•
•
Blood in the urine is a symptom experienced so frequently by adolescent males that they associate it with the transition to adulthood, not parasites.
Most Americans would run, not walk, to a doctor if they saw blood in their urine. The key point here is that people rarely worry about symptoms that are common in their community.
• In the village where I was, one could become sick if another person broke a taboo.
I am trained as a medical anthropologist, but from the biological side of the subfield. Another example of how illness is best studied from the biocultural perspective.
What Do We Mean by Health and Illness? 4
The sick role
Sickness is sometimes equated, as a term, with disease or illness or both.
4.
One respondent wanted a very specific definition of “sick.” She described sometimes feeling so bad that she
5.
could “curl up and die” but was not “sick” because her family lacked money to visit a doctor and the kids needed care, concluding “most of us can’t be sick—even when we need to be.”
Others might have sufficient wealth to be “sick” often, seeking medical treatment for even the most minor ailments.
•
• It helps to employ the relativistic concept of sick role: the culturally defined agreement between patients and family members to acknowledge that the patient is legitimately sick.
•
•
A socially recognized set of different expectations for individuals with a socially recognized disease or illness.
•
There is some relief from one’s obligations, but at the same time the sick role imposes other obligations.
• The role may include staying home if you are contagious, eating certain foods, and so forth.
The sick role also creates a stigma.
•
•
In Western societies, often, without an official diagnosis of disease the sick role is not legitimate. In other societies, other healers may be expected to take on this same process.
Further, while one may not have a complete sense of ‘well-being’ may not self-label as sick.
•
•
Perhaps health is the ability to perform one’s normal functions
Social ‘well-being’ is a part of the WHO definition of health and the statistics show those who are more integrated are more likely to stay health.
What Do We Mean by Health and Illness? 5
The sick role (continued)
In a successful therapeutic encounter there is a close match between the articulation of the illness and the diagnosis of disease. This can be a problem in that:
•
•
•
There may not be objective evidence for the disease or the diagnosis may not be a complete resolution.
The person may feel well, but be given a diagnosis of disease.
206_Lectures Chapter 15 Page 2