American Anthropologist March 1980, Vol. 82 No. 1, p145-147

Medical Anthropology George M. Foster and Barbara G. Anderson. New York: John Wiley & Son.

Bonnie Jean McCay

Rutgers University

This comprehensive, up-to-date overview is destined to become a standard text and will further legitimize the field of medical anthropology. it brings together the extensive experience of its authors and exhaustive coverage of much of the best work in medical anthropology and related disciplines within the frameworks of cross-cultural analysis and applied anthropology.

The book is divided into four parts. Part one, "Origins and Scope," delineates the field, gives definitions, and includes a chapter on biocultural adaptation and medical ecology, otherwise outside the scope of the book. Part two, "The Non-Western World," encompasses ethnomedicine, ethnopsychiatry, "traditional" practitioners, and reflections on the strengths and weaknesses of non-biomedical scientific, medicine. Part three, "The Western World," introduces the anthropologist to studies of sickrooms and illness behavior, hospitals, and processes of professionalism. Part four, "Roles of Medical Anthropologists," ranges from how to survive in a medical institution and the past and present status of applied medical anthropology to nutritional anthropology and the anthropologist as "a constructive critic who asks questions about the appropriateness of medical assumptions [about birth, old age, and death] in our own society that have long been taken for granted" (p. 281).

Among the best attributes of the book are the generous use of ethnographic material to support or illustrate general propositions and the sheer volume of bibliographic references. Definitions, discussions, and arguments are presented with clarity and logic-although not all readers would agree with them. Moreover, the reader is introduced to many major findings and important issues. For example, the treatment of medical ecology and biocultural adaptation is brief but includes excellent summaries of key works; it also incorporates the adverse effects of development projects on human health and nutrition. The more extensive treatment of ethnopsychiatry includes not only cross-cultural findings on mental-illness etiologies and modes of treatment, but also the issue of "labeling" as a self-fulfilling prophecy.

Cross-cultural analysis applied to disease theory results, in the authors' views, in a dichotomy between personalistic and naturalistic explanations of illness-really a trichotomy, for "scientific," or Western biomedical etiology, is treated apart-which in turn generates much more in a medical system and is a pervasive theme of the book. Applied to "therapeutic interviews," cross-cultural analysis yields a set of curing role universals and a distinction between public and private social contexts of curing. This theoretical strategy, enriched by numerous qualifications in response to ethnographic complexity, is a useful organizational device. It is also oversimplified, however, likely to lend itself to abuse, and reminiscent of the mind/body dichotomy of the Western mind from which Foster and Anderson [82, 1980] try to dissociate themselves. Another flaw in thecross-cultural strategy is the neglect of specific historical, economic, and sociopolitical forces. that may- irrespective of a "primary disease etiology" -shape a medical system and the social interrelations within it. Moreover, cultural analysis is reserved for non-Western' medical systems, reflecting partly the relative paucity of anthropological studies of "the Western world" and partly the likelihood that anthropologists who do find themselves working within Western medical contexts are not welcome to the study of basic premises, symbols, and social structure. As the authors note, " 'The anthropologist, to work in a hospital or medical school, must be accepted by the establishment." (p. 207). The book is pragmatic but falls short of its goal of promoting constructive, and reflective criticism.

The book gains much of its strength and source book from its chapters focusing on concerns often outside or on the fringes of me medical anthropology. A major contribution is lengthy discussion of the therapeutic efficacy of Western and non-Western medical practice This question is one that calls for a more scientific approach to research than anthropologists are usually prepared to offer. Another valuable aspect is the discussion of cultural and minority group variations on themes of sick-role behavior and stages of topic too much neglected by anthropologists. Largely abandoning cross-cultural analysis, chapters on hospitals and on educational and other processes of professionalism introduction provide extremely useful in to introductions to important fields of study. Included are suggestions about why anthropologists seem to prefer to study mental hospitals, plus information about alternative and changing forms of hospitalization that is seldom available in me sociology books. Foster and Anderson a update received wisdom about medical education and medical students and about changes the field of nursing, again offering more than many other books dealing with the topics. Yet their chapter on contributions of anthropology to the health sciences (and vice versa) seems oddly old-fashioned, resting heavily on holism an cultural relativism. Moreover, two of the three

anthropological contributions described bed holistic, or approach" and a "model to explain the processes of social and cultural change" (p. 208)-are not well substantiated largely because the cross-cultural strategy use elsewhere in the volume extracts traits from their contexts and ignores external processes.

Other "fringe" topics explored include nutritional anthoropology and the "bioethics" of birth, old age, and death. As does most of the text, these chapters pull together literature that is scattered among the journals of many disciplines, reflect the authors' long experience in the field, and may help stimulate anthropological involvement in growing areas such as gerontology and coping with death and dying. Even more valuable is the authors' treatment of a central concern in medical anthropology: the application of medical anthropology to the improvement of health status. Chapters 13 and 14 review the tenets of anthropological participation in international health programs and elaborate upon "a disquieting thought: at least as many of the resistances encountered in the promotion of sicentific medicine are rooted in the medical profession and in health bureaucracies as in the target peoples" (p. 233). Moreover, the "adversary model" of applied anthropology is seen as inadequate to the task of explaining medical modernization. A new perspective is one that emphasizes the pragmatism of the consumer, the adaptability of the traditional practitioner, and a certain flexibility whereby health beliefs, interwoven with other dimensions of life are retained while health behaviors are change radically. Other current notions, such as the value of incorporating traditional practitioners into government health programs, are discussed with informed pessimism.

This is a fine book from which to learn and with which to argue. The time was ripe for a text in medical anthropology; the authors were among the best qualified to write that text, and they did.

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