A Companion to Medical Anthropology. Группа авторов
a process-based theory of culture. It also questioned strongly “the tacit assumption… that medical systems are more or less homogenous, unchanging, and single” (p. 662).
More immediately, however, pointing to the importance of “microquestions” and adopting an anti-universalizing stance, the essay applauded the then-current growth of promising research using semantic network analysis methods. Referring particularly to the work of his Harvard colleague Byron Good, Kleinman lauded the study of sickness as “culturally constituted networks that link symbolic meanings to physiological and psychological processes and the personal experience of sickness, on the one side, and to social situations, relationships, and stressors on the other” and the circumvention of “biological language” that this allowed for (p. 663).
In short, rather than simply cataloging and classifying cultural practices, artifacts, and ideas (part of the archival tradition that did have its merits in anthropology’s early days), much work in this decade was devoted to identifying and understanding the various cultural forces within a given milieu that shape health and health-related experiences, ideas, and actions. And it wasn’t just semantic analyses that prospered. So did the meaning-centered approach to symbolic analysis, or what was to become known as the Geertzian tradition of interpretive anthropology. Also, a good deal of work (including Kleinman’s) took place through the study of illness narratives, using discourse analysis theories and methods and, later, phenomenology.
Anthropologists by this time had also come to understand, largely under the leadership of Charles Leslie, that highly elaborated medical traditions such as Ayurvedic, Unani, and Chinese medicine were dynamic, and porous, interacting with various local and global forces. The role of nationalism in keeping these “great traditions” of medicine vibrant also was theorized (see Leslie 1980). The general focus on how health-related experiences are shaped and expressed or given meaning locally was thus now complemented by efforts to examine how forces seen then as external to culture did the same.
Working in conditions of explicit change, first under the post-World War rubric of “development” and later as part of an acknowledged postcolonial transformation (see Marcus 2005), anthropologists increasingly studied, and created comparative frameworks for making sense of, health seeking, medical pluralism, and medical syncretism. Epistemological questions regarding evidentiary standards and modes of logic in medical decision-making were now raised more vociferously; theorists became concerned with the tendency to favor scientific or biomedical standards and the questions of legitimacy this can raise (Lock and Nichter 2002, pp. 4–5). New ideas about culture – and about neocolonial development and postcolonial existence – were given room to grow.
CRITICAL APPROACHES
As the 1980s ticked into place, anthropology – particularly cultural anthropology – began responding to changes in global and domestic power relations as well as to feel the heat of other disciplines’ critiques of traditional ethnographic methods: “The subjects of ethnography could no longer be constituted in as objective terms as previously” (Marcus 2005, p. 680). Definitions of culture, already in flux in the 1970s, grew increasingly “non-essentialist, fragmented, and [came to be] penetrated by complex world historical processes mediating the global and the local” (p. 681). The stage was set for the emergence of a critical form of medical anthropology – one that took the lessons of political economy to heart.
Even in the 1970s and earlier, some anthropologists had taken seriously the lessons of historical materialism encapsulated in the works of Karl Marx and Friedrich Engels. Eric Wolf’s contributions and subsequent changes in the political climate supported growth in this line of thinking, even in the USA, where earlier anti-communism had squelched it. In the UK and elsewhere, scholars such as Ronnie Frankenberg also drew on the work of Italian revolutionary Antonio Gramsci. The focus on conflict and reconciliation and the tensions extant between (individual) agency and (social) structure, promoted earlier by Max Gluckman’s Manchester School, gained new ground.
As a result, a newly “critical” perspective burgeoned. Proponents denounced past ignorance of political economic factors in medical anthropology. Systems thinking, most obviously in the form of world systems theory (as per Immanuel Wallerstein) and dependency theory (as per Andre Gunder Frank), was brought into play. Building on work done in the 1970s with regard to how “great traditions” (e.g., Ayurveda) do and do not respond to incursions from what some by now called “capitalist” or “cosmopolitan” medicine, medical anthropology in the 1980s confronted head-on the impact of hierarchical social relations on health knowledges, actions, and outcomes (see, for example, Baer et al. 1986; Singer 1986).
While interpretive medical anthropology focused on local symbolic significances and networks of meaning, taking ideas as key, critical medical anthropology (CMA) advocates prioritized the examination of power structures that underlay dominant cultural constructions, and questioned the ways in which power (including the power to frame “reality”) was deployed. In doing so, CMA sought (as it still does today) to expose local power dynamics and to reveal how outside interests – regional, national, global – affect local conditions. Furthermore, CMA showed (and shows) how health ideas and practices reinforce social inequality as well as expressing it.
A New Form of Activism
Medical anthropology grew dramatically in the last decades of the twentieth century, partly due to increased opportunities for applied medical anthropologists. But non-applied anthropologists interested in health saw that they, too, had something to gain by being identified as medical anthropologists. For one thing, those who affiliated with the subfield gained somewhat increased credibility in biomedicine and public health, and easier access to work within such organizations. This was and remains important to many medical anthropologists from the Global South, where anthropologists have generally had less interest in (and less support for) purely academic work (Laurie Krieger, personal communication, June 21, 2020; and see Mvetumbo et al. 2020). But also, the field’s relevance to theories regarding culture had grown more obvious. This trend intensified as the millennium drew near, due in part to richly ethnographic contributions in Dutch and Nordic medical anthropology (Ingstad and Talle 2009).
The cultural construction of biomedicine and public health itself came under increasing scrutiny, making manifest the important distinction between anthropology in medicine, which many early applied efforts represented, and anthropology of medicine (Foster 1974 [after Straus 1957], p. 2). Investigations into the medicalization of pregnancy and birth were central to increased appreciation of this distinction (see Browner and Sargent 2007).
Anthropology of medicine was buoyed by increased distrust of the “grand narratives” of modernity a la Lyotard (1979) as well as (in the USA particularly) the post-Vietnam War drive to “question authority” and academic anthropology’s related swing to the “intellectual Left” (D’Andrade 2000, p. 219). The situation was somewhat similar in Europe, as “anti-hegemonic social movements” were thriving (Hsu 2012, p. 51). Employment within the ivory tower supported medical anthropology’s close questioning of biomedicine’s and public health’s established agendas by providing a safe space for – and indeed, a cultural climate encouraging of – contemplations that would not have been safely brought into a practitioner workplace. Protected from the need to bring in contracts and grants, invigorated by increasingly popular “anti-establishment” sentiment, many university-employed US anthropologists proclaimed participation in government- or corporate-sponsored foreign- or domestic-aid work as retrogressive – as standing in the way of real social progress.
To some extent, the progressive climate fostered within numerous anthropology departments attracted newcomers to the field; some saw medical anthropology itself as a potential “social movement” (Stein 1980, p. 19). And while many went about their work systematically and with rigor, for others science was seen as “part of the military industrial complex” (D’Andrade 2000, p. 221) and therefore needed quashing: “Theoretically relevant description” gave way, in some circles, to “moral critique” (p. 222). Put off by this tendency where it arose, some scholars more committed to systematic and rigorous research inquiry than hortatory essay-writing switched their