A Companion to Medical Anthropology. Группа авторов
within human minds (e.g., thought processes, beliefs, emotions, knowledge, etc.) and how those processes link to the observable behaviors that those same individuals exhibit (behaviors, actions, etc.); (3) theories about the social and cultural structures that humans create and the organization of human behavior beyond the individual level (e.g., kinship, social networks, voluntary associations, organization theory, institutions) and the impact of those entities on everyday life; (4) theories of human manipulations and human understanding of symbols (the domains of linguistic anthropology, symbolic anthropology, communication theories, etc.); and (5) theories that explore integrated cultural–ecological relationships (biology and behavior interactions at multiple levels), including relationships of humans to the biological and physical environments surrounding them, and vice versa.
To Theorize or Not to Theorize: When to Theorize without Putting the Cart before the Horse (Or Descartes before De Horst)
Anthropology is somewhat unique amongst the social sciences in having three different but defensible frameworks that determined the primary methodological and analytical foundation of the ethnographic research process. One justifiable research configuration in applied medical anthropology is to conduct “atheoretical” (exploratory, descriptive) research. In this form, no explicit explanatory or exploratory theory is adopted or expected to emerge. This approach is used predominantly in descriptive projects with the intent of presenting an “insider” view of a culture and adopting a culturally relativistic stance that avoids critique or cultural shaping from alternative viewpoints. If theory emerges from this approach, it does so because of the use of cross-cultural comparison and analogy, rather than systematic interpretation from a particular explanatory paradigm.
A second approach is to use the anthropological version of “Grounded Theory,” sometimes described as an emergent theory approach where theory is derived from the data themselves. In this process, the data shape the theory rather than the theory shaping the data collection. The result of the “emergent theory” approach is the development of new theory or the modification of existing theory; but the end result is still a theoretical framing for the research (from an inductive rather than deductive stance).
The third approach is to conduct theory-based or theory-framed research (the more classic inductive stance in research where correlation or causality is a key feature to be explored). All three approaches can be framed from a humanistic (hermeneutical, phenomenological) approach where theory allows for an interpretation of the anthropological data, or they can be framed from a positivist approach where data are analyzed (rather than interpreted) and theory is tested against that systematic analysis. The most common approach in applied medical anthropology, which normally has to be justified or even “sold” to both communities and sponsors, is to lean toward the positivist, empiricist, and even modernist end of the theoretical spectrum that is available, but to also take into account the humanistic aspects of people’s health.
The historic anthropological study of substance abuse, for example, has followed two general approaches: (a) “atheoretical” (descriptive-comparative) approaches, and (b) approaches that develop and/or apply mid-level anthropological theory. Midrange theory, in anthropology, is the testable portion of one or a combination of the grand theory themes described above. Both of these approaches have been incorporated in single disciplinary research (where only anthropology theory and methods are used to explore the nature of health and healing), and in multi-disciplinary approaches where both theory and research methods are drawn from multiple disciplines (such as psychology, epidemiology, sociology, geography, biology, public health, etc.). The latter approach is much more challenging, and is often much more productive of change in a health care system.
Most applied medical anthropology exists in a complex multidisciplinary space where each of the scientific specializations has a strong and defensible history of both theory development, and the development of associated methods that support those theories and allow them to be used to frame seminal applied research questions. Disciplinary specialization has commonly led to intensive elaborations of highly specific methods to extract information in minute detail from closely defined phenomena. In some ways, anthropology is in competition with these trends and has to accommodate the assumptions and the biases behind those paradigms. Much of the research conducted in medical schools, research institutes, and corporate research and development laboratories focuses on well-defined (mostly quantitative or probabilistic) boundaries within established disciplines. In the context of both multidisciplinary (multiple disciplines individually focused on a problem at the same time) and transdisciplinary (approaches that synthesize across disciplines) traditional disciplines can form synergistic relationships that unify results from the laboratory to the everyday human condition. In this context, the anthropological approach is often described as inductive research which attempts to build (or find, or identify) theory during the data gathering process. Atheoretical or emergent theory studies conducted by sociologists (cf. Corbin & Strauss 1990), or anthropologists (cf. Agar 1980; Spradley 1980) start out with very few assumptions about how the phenomena to be studied fit together to produce explanatory schema. This lack of assumptions (an attempt at neutrality, if not objectivity) allows the investigator to collect information and examples of the studied phenomena wherever and in whatever condition they may be found, without making a priori assumptions about what should be, or must be, or ought to be found. For example, in a study of needle use among injecting drug users (IDUs), it became clear through participant observation that needle “sharing” was inadequate as a descriptive term for use of contaminated injection paraphernalia (Page 1990) because the term sharing suggested an exchange or mutual use of the injection equipment. By not accepting the “sharing” gloss which had general acceptance among health researchers before going into the field, it was possible for the investigator to identify more accurately the kinds of risky behavior that took place among IDUs. These behaviors included use of “pooled” syringes (Page et al. 1990), transfer of drugs from syringe to syringe (Inciardi and Page 1991), use of common water containers (Page et al. 1990) and cookers, and cottons. In fact, sharing in the sense of passing a used needle from one person to another did not occur in any of the observational settings reported in these articles. Subsequent investigations by Koester (1994) and Jose et al. (1993) have supported the development of a theoretical concept of “indirect contamination” by these and other means. On a practical level, when drug users were told to “not share needles,” they could reply that they were not sharing, yet they were still becoming infected. The successful prevention campaigns that resulted from this applied approach were modified to fit the reality of the risks, so eventually people were cautioned to not share directly or indirectly, with considerably more success than the old messages that were not effectively changing behavior.
USING THEORY AND APPLYING METHODS: THE MARRIAGE OF MIDRANGE THEORY AND THEORETICALLY DRIVEN METHODS TO ACCOMPLISH CHANGE
There is a crucial relationship between theory and methods in all of the social sciences. In applied medical anthropology, the theory–methods connection is primarily associated with testable midrange theory, rather than with the broader grand anthropological theory discussed above. Applied ethnographic methods are the primary levers by which medical anthropologists justify moving the world a little closer to where it ought to be. The theory provides a framework for understanding and praxis, while the methods provide a transparent and defensible process for linking theory with reality. This linkage also helps address the question of “whose vision of” ‘ought to be’ is one that is finally implemented, ranging from top down research on public health issues to fully implemented community based participatory designs. With the possible exception of the “constant comparative method” most applied medical anthropology methods are direct decedents of focused ethnographic midrange theories with links back to grand theory.
THE IMPORTANCE OF BEING ABLE TO TELL PEOPLE HOW YOU ARE GOING TO DO SOMETHING: METHODS IN APPLIED MEDICAL ANTHROPOLOGY
Once a decision is made to conduct an applied medical anthropology project, it becomes necessary to clearly describe the basic “who, what, when, where why and how” of applied anthropological research. These elements are the core methodological components of applied medical anthropology. Theory