A Companion to Medical Anthropology. Группа авторов
with cultural anthropology’s general anti-science tendency at the time, a “bias in favor of alternative, heterodox, or non-Western forms of medicine” was noted by Melvin Konner (1991, p. 80). In his opinion, “Criticism of medicine has become a major academic and publishing industry” (p. 81; and see Ortner (2016) regarding “dark anthropology”). Admitting that “there is a lot that is wrong with medicine,” still he argued that the negative tone taken by some medical anthropologists toward biomedicine was counterproductive: “Modern medicine is not a conspiracy against humanitarianism,” he wrote; “Least of all is it a capitalist plot” (p. 81). The “high-minded criticism with no evidence of sympathy for the doctor’s plight” (p. 81) that he observed did do some damage to medical anthropology’s reputation in biomedicine – but not much, because generally such critiques were not published in media perused by biomedically affiliated professionals.
Furthermore, many critically oriented scholars still prioritized careful research. Moreover, some made common cause with or were themselves biomedical insiders who offered constructive criticism, bridging the divide between an anthropology overfull with hyper-critical rhetoric and one that has been medicalized (regarding physician anthropologists, see (Wendland 2019). As Carole Browner explained in 1999, medicalized anthropology is that which has lost touch with anthropology’s principles; its practitioners “go native” when working within the health services (p. 135). Browner respected the anthropologist’s need to find a common language for communicating with health-care colleagues, and to adopt some of the medicine’s cultural practices to gain credibility. She understood the likelihood that many anthropologists have to some extent internalized biomedicine’s categories because of their reliance, at times, on the system for care. But, Browner warned, one of the grave dangers of being (bio)medicalized was sacrificing “critical distance” (p. 137).
Dissatisfaction with (bio)medicalized medical anthropology has increased since. Methodologically, many condemn the unthinking acceptance of biomedicine’s penchant for separating health-related situations or experiences into discrete, static, countable units or factors. “Research that sets out to generate data that fits within pre-existing categories embraced by the ‘factorial’ model” (Parker and Harper 2005, p. 2) pulls experience to bits, focusing attention on parts rather than the whole, and treating culture as just another variable in a researcher-imposed equation. Instead, “complex interpretive strategies” (p. 4) should be applied. This includes being free to redefine research questions and methods as research moves along, as well as to question initial research assumptions with the express goals of “reconfiguring the boundaries of the problem” (Lambert and McKevitt 2002, p. 212) and making sure that various stakeholders’ standpoints are represented. Happily, health-care experts, too, increasingly recognize the shortcomings of a factorial gaze; medical anthropology has contributed greatly to the nascent growth of a new methodological openness in these circles.
Biocultural Developments
Despite the scorn for science promulgated by some in the later twentieth century, biological medical anthropologists continued to attract students and quietly made substantial progress. They could afford to be quiet: Many journals outside of anthropology gladly accept their work. Importantly, in terms of tenure and promotion, many of the extra-anthropological journals that welcome biological anthropology have higher impact factors than those of the home discipline. Publications in such journals also can “count” more on grant applications, thereby helping assure a steadier stream of funding.
In the 1970s, the term “biomedical” had been applied to biologically oriented work with fairly immediate clinical applications or relevance for investigations of universal (albeit perhaps locally expressed) biological or disease processes. As time wore on, political ecology, which acknowledges that power relations affect the ways that human groups handle their natural environments (e.g., water, soil), and documents the health ramifications thereof, grew increasingly popular. While its treatment of culture was rudimentary, political ecology did offer an alternative to the narrower adaptationist perspective promoted by some environmentally oriented anthropologists.
By the 1990s, some biological anthropologists who had followed developments in critical theory acknowledged political ecology’s reductionist tendencies and called for deeper appreciation of the dialectical relationship between culture and biology (see Baer 1996; Singer 1996). A more sophisticated biocultural synthesis emerged – one highlighting the complexly interactive roles that social structures and the local and global political economies that support them play in biological outcomes (see Goodman and Leatherman 1998). Some areas of inquiry benefitting from this approach are global malnutrition, tourism’s impact on host population health, the situational emergence of syndemic clusters of disease or affliction, the consequences of declared and undeclared wars, or of structural racism, and even how pollution, deforestation, soil degradation, and climate change have affected human health. Such anthropogenic hazards can converge, each having a multiplier effect on the other, and thereby on human (and other species’) well-being; and effects can be transgenerational.
For example, a disenfranchised cultural group’s socioeconomic status can both set that group up for toxicant exposures and be the outcome of such exposures, experienced earlier. To wit: for years various factories discharged contaminants into the St. Lawrence River, upstream of Akwesasne Mohawk territory (which spans the US-Canada border). Fishing, hunting, and gathering became problematically dangerous: Developmental and reproductive abnormalities co-occurred with high pollutant levels, as did depressed thyroid activity, and obesity. Worse, one generation’s exposure-linked problems reduce life opportunities (e.g., educational achievement) for subsequent generations, compounding the toll as social distinctions become self-reinforcing (Schell 2012; Schell, Ravenscroft, Cole, Jacobs, Newman, and Akwesasne Task Force on the Environment 2005).
The demographic impact of COVID-19 follows a similar pattern: diseases more common in minoritized groups due largely to the legacy of their disenfranchisement (e.g., diabetes) increase the risk for infection and death from COVID-19. Concurrently, living and occupational conditions for such groups entail a higher risk for exposure. These inequitable arrangements simultaneously support an economy that benefits its investors and owners.
Biocultural explorations have advanced more than political ecology. For instance, investigations into culture’s role in creating and sustaining the placebo effect led to advances in theory regarding how healing works. Questions regarding the mechanisms whereby culture is embodied have enhanced our understanding of “stress.” Biologically oriented work has illuminated human–plant interaction, including regarding the microbiome and the antimicrobial value of certain herbs. Interest in trans-species or “human animal health” also has grown in recent years, as has our appreciation for multi-system interconnectivity.
THEORY TO THE CENTER
As the twentieth century drew to a close, and medical anthropology matured, the subfield’s theoretical and methodological advances began informing and inspiring the larger discipline. General debates concerning culture, power, representation, social justice, and other issues increasingly reflected advances stemming from medical anthropology. This was seen in work on narrative or storytelling; identity creation and maintenance, and subjectivity and temporality (especially in relation to stigmatized physical and mental conditions); the role and impact of audit and surveillance systems and authoritative knowledge; health-care consumerism, pluralism, and syncretism; local and global health inequities; postcolonial trauma, and so on. Much of this work, it must be said (and see later), was influenced by extra-anthropological ideas, such as: Johan Galtung’s “structural violence” (1969, but see also Virchow 1985 [1848]), Michel Foucault’s “governmentality” and “biopower” (e.g., 1976) and, more recently, Gilles Deleuze and Felix Guattari’s “rhizomatic” perspective (1987), with the latter leading to an amplification of agency, desire, and potentiality, and indeterminacy in explorations of biopower. Another arena from which medical anthropology has strongly drawn of late (and added to) is Science and Technology Studies.
The hope for generating generally relevant anthropological theories and concepts always has been there: As noted, some opposed medical anthropology’s instantiation as a subfield