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 disease- illness-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 non- professionals), 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 LABEL TREATMENT

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 MDs FOLK POPULAR SECTOR: - BELIEFS -NONSPECIALISED PLACE OF HEALING - FAMILY - HOMEBASED CONCEPTS

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