A Companion to Medical Anthropology. Группа авторов
pan-anthropological concerns. Yet, despite the persistent argument for medical anthropology’s relevance to “issues of interest to the discipline [as a whole, such as] culture contact, the acceptance of innovations, the organization of professional subcultures, and aspects of role theory among many others” (Colson and Selby 1974, p. 254) and despite exceptions to the rule, it was not really until the late 1980s and 1990s that such relevance was strongly seen. This marked medical anthropology’s emergence from the margin into the mainstream of the field (Johnson and Sargent 1990; see also Singer 1992a). More recent evidence of this has been the prevalence of health-related anthropology occurring outside of the subfield altogether, and of individuals not belonging to the SMA self-identifying as “medical” anthropologists.
Reinventing Wheels?
The named subdiscipline of medical anthropology has existed now for over 60 years. Its degree programs and textbooks have proliferated. However, and perhaps partly as a result, much present scholarship is in some ways redundant. For one thing, concepts and new bits of jargon delineated in popular publications are applied or repeated ad nauseam as others seeking to advance follow fashion. Take, for instance, “biological citizenship,” key to Adriana Petryna’s theorization of Chernobyl-injured Ukranians’ struggles with the state over access to health care and related resources (2002). Petryna’s work was part of a wave of innovative writing on biosociality (Rabinow’s term) that also spawned various other forms of corporeally anchored “citizenships.” By the end of the decade, however, the biocitizenship construct had, some said, lost its analytic power (Cooter 2008; and see Whyte 2009).
A second source of redundant scholarship in medical anthropology today is its magnitude. The literature is vastly more extensive now than a generation ago, making total command a real challenge. Concurrently, journal submission length limits have shrunk as publishers have had to economize (and to accommodate readers’ new habits), limiting the thoroughness of literature reviews. Sometimes areas of study, despite certain scholars’ insistence that they are brand new, have actually been scrutinized by many scholars previously.
Take, for example, hospital ethnography, which saw increased interest in the early 2000s. While those involved claimed that anthropologists were only just discovering the benefits of active research in hospital settings, Foster and Anderson devoted an entire chapter to hospitals in their 1978 textbook and included also a separate chapter on doctors and another on nurses. “Some of the most important studies of hospitals have been done by anthropologists,” they said (p. 164), such as one of the earliest behavioral science studies of nursing (this, in 1936). An early 1970s review of medical anthropology (Colson and Selby 1974) also provided a number of examples of this genre.
This is not to say that aims and approaches remain unchanged. Neither is it to deny that subtle differences can mean the world in terms of what publications contribute to the field, nor to ignore the heavy institutional pressures on scholars to stake claims of novel research (see Sobo et al. 2008). Yet a better grasp of the history of scholarship in a given topical area can support more efficient and effective theoretical advancement. Even this is not a new observation: It was in fact the point of many who, in the 1960s, took medical anthropology to task because “it has not been cumulative” (Scotch 1963, p. 39). Adding to the challenge today is medical anthropology’s success: It is a massive, noisy subdiscipline, whose various networks are not always or easily aware of each other, particularly when language barriers must be crossed (see Sailant and Genest 2007). Again, this problem is not new – but its significance has no doubt broadened as the field has grown.
The Periphery’s Significance?
Nonetheless, medical anthropology remains positioned well to contribute to general anthropology: Its focus – health (and things related) – intrinsically lends itself to intradisciplinary collaboration. It has inherent interdisciplinary ramifications, too, as seen in work undertaken toward such goals as: improving life for people with chronic diseases, bettering palliative care and our handling of death, increasing our understanding of (and ability to address) health inequities related to structural racism, and helping us deal ethically with biotechnology.
George Marcus has highlighted medical anthropology’s interdisciplinary appeal as well. Calling it “one of the most energetic and successful of the established subfields” (2005, p. 681), he argues that, today in anthropology, “newer topical arenas and theoretical concerns are developed through interdisciplinary discussions… not through studied debates and discussions around products of anthropological research among the community of anthropologists itself” (p. 675). Marcus further contends that medical anthropology enjoys “derived prestige in anthropology by dint of this [interdisciplinary] participation” (p. 681).
Some of this prestige relates to the push from within the academy to secure more grants and contracts. Financial awards from biomedical research and public health funders are generally heftier than humanities awards. In addition, the former have more cachet outside of anthropology. This can be important to scholars seeking career advancement: There does exist a political economy of research (see Singer 1992b; Sobo 2009).
But Marcus’s argument is not directly concerned with that. Rather, he worries that most “career making research projects” today rely on “social and cultural theory produced elsewhere than in anthropology” (p. 676). He also argues that, with no prevailing “disciplinary metadiscourse” or unique central tendencies – even the old claim of culture as anthropology’s special purview has been challenged, for instance, by “cultural studies” – prestige in anthropology may influence but cannot come from the core: “Anthropologists in general tend to be most impressed with their own research initiatives that most impress others” (p. 681) – by work that garners recognition in extramural “authoritative knowledge creating spheres” (p. 687).
This emphasis on work undertaken at the periphery or even extra-disciplinarily and then returned to the anthropological fold also was seen in the SMA’s 2009 conference theme, “Medical Anthropology at the Intersections,” which highlighted work in twelve areas: global public health, mental health, medical history, feminism and technoscience, science and technology studies, genetics/genomics, bioethics, public policy, occupational science, disability studies, gender/sexuality studies, international and area studies. Convener Marcia Inhorn, reminiscent of Marcus, identified these disciplines as housing “the cutting edges of our field” (2007, p. 249).
AN OUTWARD REACH
The emphasis on interdisciplinarity has been accompanied by a new appreciation for applied research: practicing anthropologists who have not contributed to anthropology through publications became eligible for SMA awards in 2004, when the George Foster Practicing Anthropology Award was instituted. Concurrently, the subfield began to address constructively its low profile by engaging more thoughtfully in discussion regarding dissemination. Although public and clinical health professionals have increasingly appreciated the anthropological perspective, work for hire has commonly been appropriated without attribution; and many in the subfield continue to find writing for non-anthropologists quite a challenge (see Sobo 2009).
An important recent trend in dissemination has been toward “public anthropology,” which seeks to break free of academic “intellectual isolation,” engaging straightforwardly with issues and audiences beyond the discipline’s self-imposed boundaries (Borofsky 2000). One aim of public anthropology is to spread knowledge and understanding, and rising scholars are increasingly groomed for public dissemination via -op-eds and podcasts. But public anthropology also seeks to compete directly with journalists and scholars from other disciplines who have succeeded at repackaging and selling – often at quite a profit – our anthropological insights. Marcus (2005) specifically sees the call for public anthropology as a quest for recognition from the media, which has become, for many, “the most prestigious realm” of authoritative knowledge. Marcus attributes this need to the fact, as he sees it, that anthropology is currently paradigm-poor and therefore authority-weak. In this light, public anthropology serves as “a place-holder, an attractive surrogate” and “a source of solidarity” much needed (p. 687).
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