2009 Society for Medical Anthropology Conference: Reflections on the Future of Anthropology

In his plenary session entitled Five Questions on the Future, Harvard anthropologist Arthur Kleinman capitalized on the 2009 Society for Medical Anthropology Conference’s theme of Medical Anthropology at the Intersections to speculate on the future of the discipline.As he reflects on the field of anthropology, which had lacked theory, ethnography, and strong ties to public health and medicine, Harvard anthropologist Arthur Kleinman celebrates the accomplishments made by his contemporaries by saying, “My generation has made medical anthropology what it is today.” However, he is now looking to the future of the discipline, saying it must re-examine itself as a field.During the 2009 Society for Medical Anthropology Conference at Yale University, Kleinman capitalized on the theme of Medical Anthropology at the Intersections in his plenary session entitled Five Questions on the Future. Casting the conference itself as a kind of intersection, Kleinman not only lauded its size and diversity, but asserted that it marked a pivotal moment in which medical anthropology must re-evaluate its central questions.     

Rhythm in Chinese thinking: A short question for a long tradition

This paper tries to shed a fresh light on the use of several key terms in traditional Chinese medicine (and philosophy) related to the theory of so-called systematic correspondence. Drawing on some influential works in Chinese science and civilization (e.g., Marcel Granet, Joseph Needham, Nathan Sivin), the paper argues that the idea of rhythm, properly defined, should become an organizing idea in studying the traditions of Chinese thinking and practice in medicine as well as in general. Rhythmicity is not periodicity (though they are inseparable from one another) and the idea of rhythm is more useful (than for example the notion of correspondence) for medical anthropology. The paper is divided into three parts: 1) the idea of rhythm in some key terms of traditional Chinese medicine, 2) the Chinese theory of resonance versus the idea of rhythm, and 3) the relation of resonance, rhythm and ecstatic experiences with respect to medical anthropology. An acquaintance with the arguments of my previous article in these pages will be helpful but not necessary for the present paper.The article is a sequel to my Defining Rhythm: Aspects of an Anthropology of Rhythm inCulture, Medicine and Psychiatry (vol. 18 no. 3., 1994). I want to take the occasion to thank Professor Arthur Kleinman for his critical and careful reading of the present paper for which I am solely responsible. I also want to express appreciation for the criticisms and suggestions from two anonymous readers.     

Origin Myths in Bioethics: Constructing Sources,Motives and Reason in Bioethic(s)

Bioethics, the term now usually standing in for Biomedical Ethics, is a field of medical anthropological engagement. While many anthropologists and other social scientists work with bioethicists and physicians, this paper instead takes Bioethics as a topic of cultural research from the perspective of Cultural Bioethics and Interpretive Medical Anthropology. Application of useful findings of vintage anthropological research in cultural anthropology and the anthropology of religion and an interpretive lens reveal a field without a single origin or unified methodology. The paper suggests the appropriateness of a literal meaning of current conceptual commonality of the term Bioethics: that the term does in fact refer to a plurality of distinct enterprises with distinct origins and, hence, justifications.     

Suffering from Water: Social Origins of Bodily Distress in a Mexican Community

This article is an ethnographic analysis of what it means to "suffer from water." Using a critical medical anthropology approach, the study examines how residents living in a foothill community of the Valley of Mexico experience bodily distress associated with water scarcity. Data for the study come from participant-observation of domestic water use and community drinking water management as well as interviews with local civil and religious officials who monitor the water distribution system. While the community discourse on suffering from water does not correspond to biomedical categories of illness, it does speak to the physical and emotional hardships and the social conditions that limit residents' access to an adequate supply of domestic water. By taking a broad view of water-related suffering, the study reveals some of the efforts made by people to address what they consider to be the social origins of their bodily distress.     

Direct correlation between the circadian sleep-wakefulness rhythm and time estimation in humans under social and temporal isolation

Several bodily functions in humans vary on a 24 h pattern and most of these variations persist with a circadian period ofca 25 h when subjects are studied under conditions of social and temporal isolation. We report in this paper that the estimates of short time intervals (TE) of 2 h are strongly coupled to the circadian rhythm in sleepwakefulness. There is a linear correlation between the number of hours humans stay awake (α) and their estimation of 2 h intervals. The coupling of TE to α appears to obtain only under conditions of physical well-being.     

An Application of Dimensional Analysis in Cultural Anthropology

Lawlike generalizations can be developed only for variables exhibiting strict constancy in concept formulation. By considering anthropology a space and its basic concepts as dimensions and borrowing from ecology, cultural materialism, and social, political, and cultural anthropology, we develop a 14-dimensional space defined by 42 scaled variables. Dimensional analysis performed yields 14 equations and 28 dimensionless expressions that satisfy them. Additionally, we derive a set of 28 ethnological expressions. Entering scaled data from five societies, we solve for each. Twenty-one expressions yield significant order-ings. Examination of their performance confirms that they function holistically.     

Medical Anthropology: Toward a Third Moment in Social Science?

This article about medical anthropology was inspired by the work of Pierre Bourdieu, specifically, his efforts to reconcile the antinomy of a "social structuralist" and a "cultural constructivist" perspective. These perspectives are often opposed in the literature, but, in Bourdieu's view, human life cannot be studied without taking into account both how individuals are situated within and constrained by social structures and how those individuals construct an understanding of and impose meaning on the world around them. I argue that the special subject matter of medical anthropology--human health--demands that a synthetic approach be taken in our theory and research. I illustrate this argument with examples from my own research on social and cultural factors associated with blood pressure, and I point to other examples of this synthesis in medical anthropology. The results of this research hold promise for the continuing refinement of culture theory.     

Introduction à l’anthropologie clinique

This paper discusses the concept of clinical anthropology. It recounts how an anthropological school of thought emerged in psychiatry and clinical psychology. Nowadays, that school spans the fields of philosophical anthropology, medical anthropology, cultural psychiatry, anthropological psychology, and clinical anthropology. After providing a conceptual and historical definition, we briefly introduce the ideas of the psychiatrist and philosopher, Ludwig Binswanger. In 1930, he became the first to introduce anthropological research into psychiatry, emphasising the a priori difference between homo natura and existence. Finally, we outline the development of phenomenological anthropology in Europe, with reference to the major philosophers and psychiatrists of the second half of the twentieth century.     

Society's Metabolism

In this article, we inquire into the intellectual history ofthe application of the biological concept of metabolism to social systems-not as a metaphor; but as a material and energetic process within the economy and society vis-A-vis various natural systems. The paper reviews several scientific traditions that may contribute to such a view, including biology and ecology, social theory, cultural anthropology, and social geography It assembles widely scattered approaches dating from the 1860s onward and shows how they prepare the ground for the pioneers of "industrial metabolism" in the late 1960s. In connection to varying political perspedives, metabolism gradually takes shape as a powerful interdisciplinary concept It will take another 25 years before this approach becomes one of the most important paradigms for the empirical analysis of the society-nature-interaction across various disciplines. This later period will be the subject of part II of this literature review     

Biomedicine and naturopathic healing in West Germany a historical and ethnomedical view of a stormy relationship

We trace the history of medical pluralism in Germany from the perspective of a clinically oriented medical anthropology. The continuation of naturopathic medicine in both formal and informal health care illumines fundamental epistemological issues. Cultural and social forces in Germany shaped the scientific and technical development of medicine, which continues in a form distinctly different from that of medicine in North America. The construction of clinical reality in German practice is distinctive and edifying for a crosscultural understanding of medical systems of knowledge and praxis.A part of this article draws on Seidler 1983. Maretzki's research was carried out under a grant from the Fulbright Kommission, Germany, We acknowledge with appreciation the encouragement and support by colleagues at Albert-Ludwigs Universitaet, Freiburg, and in other German universities, by physicians in private practice who responded to our request for an interview, by physicians and others in different Kur institutions throughout West Germany, and, importantly, the help of patients in answering questions, We also appreciate the helpful comments on earlier drafts of this article by Atwood Gaines and Charles Leslie, Special appreciation goes to Arthur Kleinman for his stimulating encouragement and patient editorial assistance.     

Empowering Place: Multilocality and Multivocality

The concept of "voice" has received considerable attention in anthropology recently. This article suggests that the concept of "place" requires a concomitant rethinking. It explores ways in which place, like voice and time, is a politicized social and cultural construct. It applies insights from geography and sociology to the anthropological study of place, drawing on research in Melanesia, including the author's fieldwork in Vanuatu. The article concludes that attention to multilocality as well as multivocality can empower place conceptually and encourage understanding of the complex social construction of spatial meaning.     

In the shadow of "death with dignity": medicine and cultural quandaries of the vegetative state

In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "'culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self-regulating, yet who are sustained by modern medical practices, destabilize the existing social order in ways that are different from other hybrid forms, [medical anthropology, anthropology of the body, bioethics, personhood, culture/nature dichotomy]     

From Types to Populations: A Century of Race, Physical Anthropology, and the American Anthropological Association

In the 1960s, U.S. physical anthropology underwent a period of introspection that marked a change from the old physical anthropology that was largely race based to the new physical anthropology, espoused by Washburn and others for over a decade, which incorporated the evolutionary biology of the modern synthesis. What actually changed? What elements of the race concept have been rejected, and what elements have persisted, influencing physical anthropology today? In this article, I examine both the scientific and social influences on physical anthropology that caused changes in the race concept, in particular the influence of the American Anthropological Association. The race concept is complicated but entails three attributes: essentialism, cladistic thinking, and biological determinism. These attributes have not all been discarded; while biological determinism and its social implications have been questioned since the inception of the field, essentialism and the concomitant rendering of populations as clades persists as a legacy of the race concept. [Keywords: race, essentialism, physical anthropology]     

2009 Society for Medical Anthropology Conference: The Intersection of Anthropology and Medicine as Portrayed in Paul Farmer’s Photo Album

Paul Farmer, physician, anthropologist, and author, spoke at the 2009 Society for Medical Anthropology Conference at Yale University in September.Medical anthropology is a very young field, only approximately 50 years old. The underpinnings of medical anthropology have been around for some time, but as a discipline, the burden to ensure that it continues to flourish and grow belongs to future generations of students and scholars. However, future generations of medical anthropologists cannot carry the field forward unless they examine the teachings of previous teachers and scholars. By narrating his own story, just as he so frequently narrates the intricacies of Haiti [1], Paul Farmer, physician, anthropologist, and author of Pathologies of Power: Health, Human Rights, and the New War on the Poor [2], displayed a parallel between the stories of his own past with that of medical anthropology.At the 2009 Society for Medical Anthropology Conference at Yale University in September, Farmer began his aptly titled presentation, Photo Album, with a discussion of his introduction to medical anthropology while an undergraduate at Duke. He stumbled upon medical anthropology quite by chance as an ambitious pre-med who was interested in taking every course that had the word “medical” in its title. He credited many people, including Patricia Pessar, Arthur Kleinman, and Linda Garro with aiding the development of his ideas and perception of the world and teaching him to use medical anthropology not only in passive observation, but in the active practice of medicine. You “don’t have to be a faculty member to teach,” stressed Farmer. Some of the most important lessons to learn come from the poor, to whom few listen.Farmer believes that listening can form the work we do. He honed his listening skills, which are used in anthropology in an ethnographic context, after his first night in an emergency room, when he saw that many minor cases were brought in solely because individuals had no other outlet for treatment. Being a good listener allowed Farmer to understand the full impact of a 1981 slavery case involving migrant workers in Florida. It was this skill of listening that enabled Farmer to understand and tell Haiti’s story, as well as understand the intricate web that exists between privilege and privation. Just as the line between medical anthropology and primary care is often blurred, the “bracing connection between privilege and privation” becomes even more apparent the longer one spends studying both extremes.This is a vantage point Farmer was particularly susceptible to, given his trips from Haiti to Harvard and back again. Listening to his patients in Haiti and the United States would allow Farmer to draw parallels of inequality and injustice that exist for the impoverished in both places. The only difference between the United States and Haiti is that eventually many impoverished individuals in the United States will wind up in somewhat adequate medical facilities. In the story of global economics, Farmer said, “Good things get stuck in customs and bad things get traded freely.” A practicing physician may easily note that inequalities between the rich and poor are not unique to the United States or to Haiti, but what, Farmer asks, can anthropologists say about this division?The cursory glance through Farmer’s photo album ended with a picture of friends whom he fondly termed “the structural violence mafia” and anthropological ideas regarding unequal access to health care. While at first, the portion of anthropology that dissects the structures of violence seems isolated from medical anthropology, those structures of violence institute the vast inequalities that cause medicine to seem inaccessible. Farmer also stressed that “how we think about social theory influences global health.” Work in Haiti taught Farmer firsthand about the phenomenon of blaming the victim [3]. To understand this entrenched system of structural violence fully, an intensive bio-social analysis must be undertaken. Structural violence results in a system in which the victims are blamed, empowering those who suppress the victim while inhibiting the victim’s access to health care. Pointing fingers at the vulnerable is illustrated by the fact that Haiti is often blamed for the introduction of AIDS into North America [4,5]. Farmer stressed not only the inherent trauma of structural violence, but Carolyn Nordstrom’s ideas on violence having a distinct tomorrow [6]. The perpetual cycle of structural violence enables this concept of violence having a clear future with the inherent cultural systems that allow for violence remaining stagnant while the individuals entrapped within the system change.Beyond this concept of structural violence is that of structural healing [3]. Though structural healing is a new phenomenon being examined by anthropologists, it provides a balance to structural violence with the idea being that there are certain societal standards that are either in place or can be introduced that allow for an alleviation of the suffering caused by structural violence. While Farmer’s discussion of the path that led him to his current position was inspirational in itself, the sharing of his story is of even more importance because he has been a teacher to so many. His story reinforces the idea that even though structural violence has a definite past and future, so do medical anthropology and the idea of structural healing. Thankfully, medical anthropology may be used as a relatively new force to combat structural violence. Farmer’s speech may have been unexpected in its autobiographical content, but perhaps the main point is that the intersection between medicine and anthropology can be seen not as a single point but a line that runs the full length of each of these disciplines. We all have a distinct responsibility to not only hear but to listen and learn, not to just passively observe, but actively understand. It is with this listening and acting, that future medical anthropologists can bridge the gap between social sciences and practical medicine.     

The adaptive nature of culture

Some have argued that the major contribution of anthropology to science is the concept of culture. Until very recently, however, evolutionary anthropologists have largely ignored culture as a topic of study. This is perhaps because of the strange bedfellows they would have to maintain. Historically, anthropologists who claimed the focus of cultural anthropology tended to be anti‐science, anti‐biology, or both. Paradoxically, a segment of current mainstream cultural anthropology has more or less abandoned culture as a topic. It is particularly ironic that in spite of a growing awareness among evolutionary anthropologists that culture is critical for understanding the human condition, the topic of culture has fallen out of favor among many “cultural” anthropologists. ^1,2     

Forensic social anthropology: an Australian perspective

If forensic physical anthropology is the science of biological processes and related medico-legal investigations, then forensic social anthropology is the science of cultural processes and related socio-legal investigations. This article lays out the terms, definitions, and application of forensic specialization in social anthropology as it is practised in Australia. The objective of this exercise is to equip both physical and social anthropologists with a consilient model for the joint engagement of their parent discipline in legal proceedings where cultural processes are deemed relevant by a court or other legally empowered body. As demonstrated in Australia, the potential applications of forensic social anthropology range across a variety of matters involving both civil and criminal investigation. Such matters include systematic land expropriation, child removal, forced population movement, modern-day slavery, unlawful detention, and other important social phenomena. The questionable legality of these kinds of phenomena is not isolated to Australia but is, rather, of international significance.     

Emotion (or Life,the Universe,Everything)

Emotions are fundamental to human life; they define its quality and motivate action. In the past, social scientists who have studied emotions have treated them as biological, cultural or social phenomena. These approaches have tended to fall on either side of the culturally recognised division between nature and culture, and so have failed to recognise that emotions bridge this division, that they are thought of as both biological and cultural, as consisting of both physical feeling and cultural meaning. In this article, an alternative approach is presented in which emotions are treated as ecological mechanisms that operate in the relationship between an individual human being and their environment. In this approach, which draws on models of emotion proposed by William James and Antonio Damasio, emotions connect individual human beings to their surroundings and play an important role in learning. A focus on the individual as the centre of analytical attention—often referred to as ‘methodological individualism’—is a logical consequence of the ecological approach to emotion, which also has significant implications for the relationships between ecological anthropology and other branches of the discipline, and between anthropology and other disciplines. In the face of an ecological understanding of emotion, all relations, including social relations, become ecological and social anthropology melts into and is subsumed by ecological anthropology. At the same time, anthropology tends to lose its distinctiveness from biology, psychology and other disciplines by focusing on a phenomenon that is of common interest to all the human sciences.     

Prehistoric Transpacific Contact and the Theory of Culture Change

Employing genetic theory as an analog, the paper argues that when the concept of culture is separated from the concept of society, anthropology can be shown to have depended for culture-change theory on a genetic model, which predicts pre-Columbian contact between the Old and New World, a prediction which is supported by a growing list of cultural parallels . [prehistoric transpacific contact, culture, society, culture change, scientific explanation]     

Beyond Malinowski and After Writing Culture: On the Future of Cultural Anthropology and the Predicament of Ethnography

Following out certain implications of the 1980s Writing Culture critique, this paper envisions a future for anthropology that remains focused on innovations in the ethnographic research process. A sense of change in the world, conceived in the 1980s as postmodernity and now widely discussed as globalisation, suggests the need for an alternative paradigm of ethnographic practice, different in significant ways from that which shaped social‐cultural anthropology over the previous eighty years. Based on working through the implications for the norms and forms of both fieldwork and ethnographic writing of the multi‐sited design of many current research projects, this paper outlines such an alternative paradigm. Further, the paper argues that the explicit disciplinary dynamic driving such innovation in ethnography is, in contrast to the so‐called crisis of representation of the 1980s, a more urgent crisis of reception for anthropology.