Indispensability of Medical Anthropology

26 Apr 2011, Sao Felix, Brazil --- A Kayapo man, receives attention after a surgery, at his house on the sixth day of a medical expedition of the Expedicionarios da Saude (Brazilian Health Expeditions) in Kikretum community in Sao Felix, northern Brazil April 26, 2011. The organization is currently on a medical expedition to the area with volunteer doctors that twice a year build a mobile hospital to provide clinical and surgical treatment for indigenous tribes and residents from different parts of the Amazonian Rainforest. REUTERS/Ricardo Moraes (BRAZIL - Tags: HEALTH SOCIETY) --- Image by © RICARDO MORAES/Reuters/Corbis

Indispensability of Medical Anthropology

Medical anthropology, although considered a subcategory in anthropology, has been making contributions to medicine and public health since the development of anthropology itself. The fact that anthropology, as a multi-disciplinary, intrinsic, discipline has contributed valuable information and techniques to several other disciplines justifies its essential importance. Although its early history is diverse, there exist three empirical foundations that are considered “universals.” They are: 1) disease is a fact of life; occurring in all times, places and societies; 2) all groups of humans develop some sort of beliefs and perceptions for defining it; and 3) all groups of humans have methods for coping and responding to it. Writers like Rivers, Clements  Ackerknecht, Paul, Livingstone,Wiesenfeld and others formulated these generalizations in a variety of ways yet they all maintain the legitimacy of these observations.

Starting with the work of William Hallam Rivers Rivers (1864-1922), better known for his work in ethnography and social organization, we find an emphasis on native medicine as a social institution and the relationship of native medical practice and belief serving as an integral part of culture. Rivers concerned himself more with cognition’s about the causes of illness rather than the impact of Western medicine on non-Western societies . The two principal theoretical themes of Rivers, exemplified in such works as Medicine, Magic, and Religion (1924) and Psychology and Ethnology (1926), states that primitive medical beliefs follow from an understanding of underlying medical beliefs, and second, that primitive medical practices are not frivolous folklore but constitute a cultural meaning and value. Hence, during the second decade of the 20th  Century, Rivers provides an insight into primitive medicine as a social institution by establishing the relationship between medical practice and cultural belief.

The work of Forrest Clements, who uses a classificatory approach, worked within the framework of historical particularism. In Primitive Concepts of Disease (1932), Clements classifies disease causation into five categories: sorcery, breach of taboo, intrusion by a disease object, intrusion by malevolent spirit, and soul loss. He extends this view by developing a chart of worldwide distributions of these characteristics inferring that diffusion or historic-geographic events, along with sequences and routes, determine the distribution of disease concepts. This approach is a shift to a more empirical orientation. Further, he lists about three hundred groups that summarize the distribution of these traits. Despite the limits of his model, that is, the assumption that without diffusion distribution would have been random and that there are no functional societal relationships between these traits, still, he proves that societies throughout the world develop some set of perceptions about disease.

Although Edwin Ackerknecht did little in the way of field research, he made a considerable contribution in shaping the framework of modern medical anthropology. The basis of Ackerknecht’s theories came from influence by British functionalists, the Boasian tradition and particularly Ruth Benedict, which he publicly acknowledged. Over the course of three decades, beginning in the 1940s, Ackerknecht presented his orientation based on five generalizations: 1) the significance of a medical system in a society lies not in the single trait but the “total cultural configuration”of that society and the place that medical system occupies; 2) there is not one native medicine but several native medicines – as many as there are native cultures; 3) that the parts of a medical system, like the components of a culture itself, are functional and interrelated although they may vary from culture to culture; 4) that native medicine is best understood as cultural belief and definition; and 5) that varied manifestations of native medicine receive influence from magic medicine. Ackerknecht attempts to describe the importance of how the medical pattern can only be adequately understood within the context of the overall cultural configuration and it’s functioning relationship to the total culture. It should be apparent that this orientation presents a historical and cultural representation, an adapting analysis similar to Ruth Benedict’s approach and functionalism of the British school.

By contrast, the principle contribution of Benjamin D. Paul in his work Health, Culture and Community (1955), departs from the theoretical orientation of his predecessors in one important way – he addresses the dynamic nature of an applied strategy. His work during the 1950s was not concerned with the nature of research or theory inasmuch as his concern was with the point at which medicine meets the community, which later became the stimulus for the public health movement. In short, Paul’s concern with systems and system changes makes two fundamental propositions: 1) an entity has identifiable parts that are mutually interdependent in a way that each influences the other; and 2) the introduction of new elements can affect the host medical system and in turn causes the entire system to be reinterpreted. Paul’s “system-model” is important because it addresses the modern medical system, accounts for the complexity of community structures, and is dynamic in that it addresses the consequences of change.

We should also note that a later orientation known as the “ecological” model benefited from the work of Paul’s system model. Studies by Livingstone (1958), Wiesenfeld (1967), McElroy and Townsend’s (1966 – Medical Anthropology in Ecological Perspective) and Peter Brown’s Understanding and Applying Medical Anthropology (1998) emphasize the relationship of environmental factors on medical anthropology.

Thus, medical anthropology developed from an interest in medical belief systems of non-Western societies and later became the stimulus for public health systems. But moreover, early theorists recognized that it was important to understand these beliefs and practices in terms of their unique cultural perceptions.

Sources: Ackerknecht, E. H. (1948). Anticontagionism Between 1821 and 1867. Hist Med 532.567, 589-592; Brown, P. (1998). Understanding and Applying Medical Anthropology: Mayfield Publishing Company; Clements, F. E. (1932). Primitive Concepts of Disease. University of California Publications in American Archaeology and Ethnology, 32, 185-252; McElroy, A. P. K. T. (2008). Medical Anthropology in Ecological Perspective (Fifth ed.): Westview Press; Paul, B. D. (1955). Health, Culture, and Community: Russell Sage Foundation; Rivers, W. H. R. (1924). Medicine, Magic, and Religion. New York: Routledge.