Lectures on Medical Anthropology by Elisabeth Hsu

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Lectures on Medical Anthropology by Elisabeth
Hsu

• Michaelmas Term 2002
• Oxford

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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 Elisabeths class we will deal with the
  interpretation of med. ant.

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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

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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.

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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

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Disease - Illness - Sickness differentiation

• The classification is based on a sociology of
  knowledge approach applied to disease-illness-sick
  ness.
• 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
TREATMENT
LABEL
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Eisenberg 1997 Disease and Illness CMP 19-23.

• Patients suffer illness, doctors diagnose and
  treat disease.(p.9)
• Illness
• patient experience of discontinuity in states of
  being,
• perceived role performance, lay-persons
  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)

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Kleinmann 1980 and 2000Disease 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 indviduals 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.

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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.
• Illnessculture 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)

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Model by Kleinmann 1980
POPULAR SECTOR- BELIEFS -NONSPECIALISED PLACE
OF HEALING - FAMILY - HOMEBASED CONCEPTS
MDs
FOLK
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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.

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Young Frankenberg SICKNESS

• Class and culture specific recognition of the
  event, as economically and socially created and
  legitimised