ANTHROPOLOGY OF HEALTH, ILLNESS,
AND MEDICINE
Ethnocentrisms:
Disease-Illness distinction
• DISEASE — as a bio-scientific concept
– Abnormalities in the structure & function of body
organs & systems
• ILLNESS -- lay concepts
– Illnesses are “experiences” of disvalued changes in
states of being & in social function
• Cartesian Legacy
“health defined”?
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Disease – abnormalities
Illness – experience of
Suffering – sickness episodes
Health?
– Ability to function & Independence
– Both are crucial features of labor in capitalist society
• Medicine works to restore & remedy labor disruptions
• Emic Knowledge – ethno(s)
– Ability to function – culturally, social, historically
anchored definitions
– Flows and blockages
EXPLANATORY MODELS OF
ILLNESS/DISEASE
• offer explanations of sickness & treatment to
guide choices among available therapies &
therapists and to cast personal & social meaning
on the experience of sickness
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–
causes of the condition
timing & mode of onset
the physiology of the condition
the natural history of the condition-its course &
outcome (including severity)
– appropriate treatments
• practitioners & patients EMs
“It’s Not the Germs!”
• Etiology – disease causation
– Germs, nature, society, individual factors, super-nature
• Ethnoetiology – local knowledge & practices related
to theories of disease causation
– human - breaking taboo, social or moral transgressions,
behavioral control, pollution
– spiritual/supernatural - possession, magic, spells, God's
punishment, presence in spiritual power places/persons
– natural - humors, noxious miasmas, dry-wet, germs,
hygiene, environment
– Agents (personalistic): contextual (naturalistic)
– Internalizing (physiological/internal mechanisms):
externalizing (events outside the body/external
pathogenic agencies
Social labelling
• Order & disorder – normal & abnormal
• Social labeling & illness, disease, disability
– Who is to be called ill, diseased, disabled is
determined by the individual’s social position and
society’s norms rather than by universal and
objectively defined signs and symptoms
• A person is labeled in the course of social negotiations
• de-labeling difficult
• At each decision point it may be possible to return to
the normal label
STRUCTURE-FUNCTION & MEDICINE
• Practitioner-patient relationship
– Institutional integration
• Institutions defined as a society's recurrent patterns of
activity
– The “sick role” (T. Parsons)
• Illness as a form of “deviance”
– Physicians & return to equilibrium
– Alcoholism? Poverty related health issues?
– Compliance as solution?
– Local healthcare system
Abnormality/Deviance
& the Sick role (T. Parsons)
• Rights:
– The sick person is exempt from “normal” social roles.
• relative to the nature and severity of the illness
– The sick person is not responsible for his or her condition.
• An individual’s illness is usually thought to be beyond his or her
own control
• A morbid condition of the body needs to be changed and some
curative process apart from person will power or motivation is
needed to get well.
• Obligations:
– The sick person should try to get well. The first two aspects of the sick
role are conditional upon the third aspect
– The sick person should seek technically competent help and
cooperate with the physician.
medicalization
• the process by which health or behavior conditions
come to be defined and treated as medical issues
• the process by which certain events or characteristics
of everyday life become medical issues, and thus
come within the purview of doctors and other health
professionals to engage with, study, and treat
• The process of medicalization typically involves
changes in social attitudes and terminology, and
usually accompanies (or is driven by) the availability
of treatments
The social production of health
• Shift from disease focus of medicine
• Shift from focus on medicine
• Same emphasis on power, inequality, social
relationships/organization/structure
• Social characteristics play a predominant role
in determining sickness and health status
• Occupation related to health
• Social position: class, ethnicity, gender, age
• disease & feelings of sickness not determined
solely by underlying biology
Society and health
• Social relations of sickness which produce
forms and distributions of sickness in society
• Sickness is the process through which
worrisome behavioral and biological signs,
particularly ones originating with disease, are
given socially recognizable meanings resulting
in socially significant outcomes
• Sickness is a process for socializing disease
and illness
• The social order is embedded in medical
beliefs
“SOCIAL FORCES AND PROCESSES
EMBODIED AS BIOLOGICAL EVENTS”
THE CRITICAL PERSPECTIVE
• Paul Farmer:
• “Inequality itself constitutes our modern
plague – inequality is a pathogenic force”
• “Social inequalities often determine both the
distribution of modern plagues and clinical
outcomes among the afflicted”
Life Expectancy & Ethnicity in the US
Canada, Health, & Inequalities
Non-Medical Determinants of Health
• In First Nations communities only 56.9% of homes were
considered adequate in 1999--00.
• 33.6% of First Nations communities had at least 90% of
their homes connected to a community sewage disposal
system.
• In 1999, 65 First Nations and Inuit communities were
under a boil water advisory for varying lengths of time-an average of 183 days of boil water advisories per
affected community.
• Many communicable diseases such as giardiasis and
shigellosis (both acute infectious diseases characterized
by diarrhea, fever and nausea) can be traced to poor
water quality
Cultural Capital & Health
World-Wide Health Inequalities
WORLD SYSTEMS
World Systems (I. Wallerstein)
• A world-system is a social system
– one that has boundaries, structures, member groups, rules
of legitimation, and coherence.
• made up of the conflicting forces which hold it
together by tension and tear it apart as each group
seeks eternally to remold it to its advantage.
• a life-span over which its characteristics change in
some respects and remain stable in others.
• its structures -- at different times strong or weak in
terms of the internal logic of its functioning.
Medicine as a Cultural System
• all human groups develop some set of beliefs,
patterns of thought, perceptions consistent
with their cultural systems for defining &
conceptualizing disease
• all societies have medical practices and beliefs
based on theories of diseases & disease
causation with an internal logic of their own,
and should not be dismissed as bizarre,
esoteric, illogical, & irrational bits and pieces
of belief & practice in exotic cultures
Medicine as a Social System
• all human groups develop methods & allocate roles congruent with
their resources & structures for coping with or responding to
disease
• norms governing choices and evaluations of treatment - the types
of treatment they believe in, and to whom they turn if they do
become ill
• social statuses, roles, power relationships
– patients & healers - basic components of health care system
– embedded in specific configurations of cultural meaning and other
social relationships
• interaction settings - clinic, hospital, with healer, family, society-atlarge
• institutions related to health and healing
Medicine as Social Construct
• Medicine is a set of categories that filters and
constructs experience
• Medicine produces its own objects and
subjects (subjectivity & subject positions)
– i.e. body mind dualism – nature is separate from
society
Materia Medica:
Therapies & Medicines
• Transformative power put to different purposes
– From therapeutic to toxic
– Simultaneous noxious & beneficial
• Material things used intentionally to achieve and
effect in some body
• change minds, situations and modes of
understanding
• Material things that have social lives and cultural
biographies
• Material things that have the power to transform
bodies/minds – the significations of efficacy
Hierarchies of Resort & Medical Pluralism
• agency - "patients... are reflective actors who
review information about health and illness
and make decisions based on what makes
sense given their experience of bodily
changes, the framework of their prior
knowledge, and the everyday life situation in
which illness is lived and treatment is used."
Medical Pluralism and the Cultural
• Richard Fox - culture is in a constant state of becoming/inthe-making
• unitary set of rules & meanings continually are in-themaking through oppositions & struggles among groups,
where groups themselves & the rules that regulate their
interactions only develop in the process of ongoing social
relations
• culture often is taken as a constant & long - lived cultural
pattern, a coherent set of cultural meanings is only a
momentary & localized product of human action &
contest, culture always "is," but it has always just become
so
Medical Pluralism and the Cultural
• "culture as... the fabric of meaning in terms of
which humans interpret their experience and
guide their actions... "man is an animal
suspended in webs of significance he himself
has spun, I take culture to be those webs, and
the analysis of it to be therefore not an
experimental science in search of law but an
interpretive one in search of meaning."
Medicine as a Cultural System
• all human groups develop methods & allocate roles
congruent with their resources & structures for coping
with or responding to disease
• all human groups develop some set of beliefs, patterns
of thought, perceptions consistent with their cultural
systems for defining & conceptualizing disease
• all societies have medical practices and beliefs based
on theories of diseases & disease causation with an
internal logic of their own, and should not be dismissed
as bizarre, esoteric, illogical, & irrational bits and pieces
of belief & practice in exotic cultures
Medicine as a Social System
• norms governing choices and evaluations of treatment
- the types of treatment they believe in, and to whom
they turn if they do become ill
• social statuses, roles, power relationships
– patients & healers - basic components of health care
system
– embedded in specific configurations of cultural meaning
and other social relationships
• interaction settings - clinic, hospital, with healer, family,
society-at-large
• institutions related to health and healing
Local Health Care Systems & Medical
Pluralism
• The health care system is a concept, not an
entity – a conceptual model held by the
researcher
• The model of a health care systems derived by
the researcher by examining how people think
about health care, the ways people act in it
and use its components
Local Health Care Systems
• health care as a system that is social and cultural
in origin, structure, function, and meaning
• Health care systems are forms of social reality
• Clinical practice occurs in and creates particular
social worlds – clinical reality
– the health related aspects of social reality – attitudes
and norms concerning sickness, clinical relationships,
and healing activities
Indonesia: From an Ethnographic Point of
View
• Pembangunan – development, lit. “to wake
up,” “to structure/form,” “to rise, “to model”
• Suharto’s New Order – pembangunan
government
• 1990s – epi/health transition
– Cultural critique
Medical Pluralism, Modernity, & Health
Transitions
Healing the Modern in Indonesia
• a theory, a livelihood, or a health condition conjoined
in expected and unexpected ways that sometimes
are not easily contained by a globalizing “regime of
modernity”
• process of global integration, a process coined as
modernity, producing a “unified history of the world”
that shapes “meanings and values as they are
actively lived and felt” into now transnationally,
globally shared “structures of feeling”
– All over progress?
Local & Global: The Irony of Progress