Medical Anthropology: A Comment on Recent Publication

Edward Wellin

George M. Foster and Barbara G. Anderson. Medical Anthropology. New York: John Wiley K Sons, 1978.302 pp. Bibliography and index. $14.95.

Eleanor E. Bauwens, ed. The Anthropology of Health. St. Louis: C. V. Mosby,
1978. 200 pp. Index. $10.50, paper.

Each of these books falls under the rubric of medical anthropology, and each appears on the heels of two good-quality readers in the field (Landy 1977, Logan and Hunt 1978). There the resemblances end. The Foster and Anderson work is a solid and timely contribution; although it invites some criticism, it must be taken seriously. The Bauwens volume includes a few worthwhile papers but, on the whole, is inconsequential.

Medical Anthropology is the first textbook in its subfield. The authors deny that the book is a comprehensive treatment of medical anthropology; rather, its purpose is to provide a "general overview" which concentrates on the topics the authors know best from their own research, consulting activities, and teaching. While they propose to pay some attention to biological dimensions of the field, they emphasize sociocultural aspects. What the authors promise, they deliver.

The Anthropology of Health is an edited reader. Its three purposes, according to the editor, are to help educate people to work in medical anthropology, to contribute to the literature in the field, and to introduce behavioral science to medical, nursing, and other health professions. In fact, the volume may be a contribution, but not a weighty one, to the third aim and virtual1v none at all to the first two.

Turning first to Medical Anthropology, the volume is divided into four parts. Part 1, "Origins and Scope," traces the roots of contemporary medical anthropology to four more or less distinct sources:certain concerns in physical anthropology, traditional interests in ethnomedicine, culture-and-personality studies, arid the international public health movement. Several chapters distinguish arid discuss three kinds of systems: ecological, sociocultural, arid medical. Part 2 deals with the "non-Western world" and covers ethnomedicine ethnopyschiatry curers and all assessment of (lie strengths and weaknesses of non-Western medical systems. Part 3, "The WesternWorld," discusses illness behavior, hospitals, doctors, arid nurses,drawing in good part on literature from medical sociology. Finally,part 4, "Roles for Medical Anthropologists," ranges over an array of topics: contributions of anthropology to the health sciences and viceversa; issues and anthropological perspectives in international

health; the complex relationships among and between modern,traditional, arid alternative systems of health care; nutrition and culture; arid bioethics in the areas of birth, old age, and death. In line with the authors' conceptualization of medical anthropology, the first three parts deal with the so-called anthropology of medicine'while the fourth addresses topics regarding anthropology in medicine

Foster and Anderson offer a formal definition of medical anthropology. In common with the core of recent definitions (Hochstrasser and Tapp 1970, Lieban 1973, Fabrega 1972, and Hasan 1975), they agree that the field is biocultural, comparative, and deals with variables that bear in some way on health and disease. However, they also depart from previous definitions in dividing the field into two parts-the theoretical arid the applied. Each part seeks to further knowledge of the interrelationships between biocultural phenomena and health. However, one part-the theoretical, or the anthropology of medicine-does so with little or no interest in the practical utilization of research findings, while the other part-the applied, or anthropology in medicine-involves professional participation programs aimed at improving health levels or changing health related behavior. Although the authors insist at one point distinction is "largely analytic," their view of the field appears to polarize it between the theoretic-scientist and the applied professional.

Among the book's solid contributions are its presentation of well organized ethnomedical data oil non-Western peoples, synopses of Euro-American, Black, arid Spanish -American folk medicine, arid surveys of humoral pathology, Ayurvedic medicine, and traditional Chinese medicine. A chapter is devoted to it balanced appraisal of the positive and negative features of non- Western medicine. The authors conclude that the strongest aspect is its psychological and social support therapies, that the case for the effectiveness of non-Western pharmacopoeias is at best equivocal, arid that the weakest element is [lie clinical treatment of organic illness. In comparing non- Western to contemporary American medicine, the authors characterize the strengths and weaknesses of (the latter in almost exactly reverse terms.

Another chapter considers trends arid dilemmas in medicine, largely emphasizing issues in international health, with a thoughtful assessment of the current and future relationships of scientific to traditional and alternate medical systems. Given the expanding spread and increasing acceptance of many aspects of Western medicine, the authors suggest that traditional and alternate therapies (e.g., spiritualism) do not arid will not have much impact on national health services in developing societies. Under "bioethics," [lie authors call attention to the "enormous lag between scientific and cultural interpretations" of birth, aging, and death in the United States. They present a case for, but stop short of advocating, home delivery and midwifery as against the mechanization of hospital birth, and call for More communal supports for the aged and a more open approach to death.

Foster has a talent for formulating concepts, generated initially from his own field data, that attempt to synthesize and make cross cultural sense of various bodies of descriptive findings. Several of these generalizations-for example, the dyadic contract (1961) and image of the limited good (1965)-have stimulated widespread discussion and debate, given rise to efforts by others to test them against new data, and, ultimately, resulted in enriching comparative conceptualization in anthropology. He seems to have done it again. The authors of Medical Anthropology call attention to "the welter of (-liters, curing techniques . . . and all other medical elements described for the world's societies," and believe that this disparate collection of ethnomedical detail can and should be reduced to some semblance of order. To do this, and limiting themselves to non Western peoples, the authors dichotomize ideas and associated behavior having to do with disease causes into two major categories or systems- personalistic arid naturalistic This classification was first formulated several years ago (Foster 1976) and has already stimulated critical discussion (Forfeits 1978, Kleinman 1978). One can confidently predict that it will continue to provoke debate.

Despite the authors' claims as to the utility of the dichotomy its usefulness is not apparent. Although acknowledging that the two etiologic "systems" are not Mutually exclusive, they nonetheless insist-taking a position that appears to be empirically untenable that "most peoples seem committed to one or the other of these explanatory principles to account for Most illness" (p. 54). Among other objections, there are simply too many ethnographic instances of belief-behavior complexes-several, in fact, are cited by the authors-which are intrinsic blends of the personalistic and naturalistic. Putting aside the problematic nature of the categories themselves, the really pertinent question seems to be: under what conditions do what patients and what curers invoke personalistic ' naturalistic or combined explanations for what illnesses or symp- Such all approach seems more capable of generating significant research than does the Foster and Anderson effort to force the world's non-Western medical systems into a priori and static ideal types.

The authors toy with a number of classificatory devices but drop them in midstream. Thus, they suggest that the roles of doctor and patient call be compared in terms of four paired dimensions restricted-Universal, permanent-temporary, superordinate-subordinate, and voluntary-involuntary-with the first term in each pair characterizing the doctor's role, the second the patient's (pp. 103-4) Although the scheme's utility for comparative analysis of either role or their interrelationships is unclear, one gets no opportunity to learn flow it fares with empirical data; it enters in no way into subsequent discussion of the two roles. Again, the authors propose that each medical system may be divided, at least analytically, into a system of disease theory-essentially, beliefs about health, causes of disease, etc., and a health care system-how societies organize to care for the sick. This is all intriguing distinction, suggestive of interesting cross-cultural comparisons. Subsequently, however, major and explicit attention is given only to disease theory systems and their functions; health care systems and their structures and functions are dealt with lightly or only in passing. With respect to the latter point, the entire volume manifests a similar and quite consistent selectivity. That is, throughout, there is a relative richness of material on belief and accompanying ethnomedical practices and a paucity of attention to the social arrangements associated with them.

The volume is addressed both to anthropologists and to professional workers in health, especially but not exclusively in international health. The first three sections-those dealing with the anthropology of medicine-appear to be directed mainly to anthropologists, while the last-anthropology in medicine-seems to be addressed primarily to professional health workers. In fact, the latter section includes a primer on the "anthropological perspective," specifically on the holistic approach, cultural relativism, and the role of perception in change. The book is lucidly written, well organized, and includes a detailed index.

Although this reviewer had intended to compare The Anthropology of Health with Medical Anthropology, there is little basis for comparison. The Anthropology of Health consists of nineteen papers, most of them previously unpublished, divided into four sections: Clinical Anthropology, Strategies for Health Care, Nutritional Anthropology, and Anthropological Perspectives on Aging and Dying. The primary disciplines represented among the authors are nursing, anthropology, and pediatrics.

There are two good papers and seventeen that range between inoffensive to dreadful. Of the good papers, one by Christine Wilson deals with ethnographic methods for dietary study and is a useful survey of a range of ethnographic approaches to gathering data on an array of variables from food habits to nutritional status. The other, by Clarissa Scott, is on health and healing among five ethnic groups in Miami; essentially descriptive, it is clear, vivid, and informative.

Clinical anthropology is defined in the lead paper as "anthropology applied to patient care." No effort is made to compare the concept as applied here to its uses by several other anthropologists. Many of the papers are limited surveys of literature dealing with particular topics-human foodways, pica, aging and the aged, middle-aged women, an unsystematic sampling of medical anthropology literature, and others. One describes a course taught by the author; another is a didactic outline for a health study of one's community. Of the papers that report actual studies, most present little data; rather, illustrative or anecdotal materials are offered to buttress the author's viewpoint. Among papers with analyzable data, there is a general disinclination on the part of authors to analyze the data they have; instead, they talk about analyzing them and quote respected authorities.

One paper purports to be about home care, but virtually all its anecdotes are about hospitalized patients. Another, billed as a Study of coronary heart disease risk factors in a school population, devotes perhaps two of its thirteen pages to vague description of the study and the remainder to a review of literature oil various background topics. A paper on Chagas disease in the Southwest concludes that neither the author nor. anyone else knows much about it.

This reviewer finds little of value in The Anthropology of Health?. There is one thing, however. It is sometimes difficult to locate material that can serve as examples of how not to conceive, or how not to do, or how not to write up research in medical anthropology. In these respects, this volume is a useful reference.

Edward Wellin is a Professor of Anthropology at the University of Wisconsin-Milwaukee.

References

Fabrega, Horatio

1972 Medical Anthropology. In Biennial Review of Anthropology 1971. 13. J. Siegel, ed. Stanford, California: Stanford University Press, pp. 167-229.

Foster, George M.

1961 The Dyadic Contract: a Model for the Social Structure of a Mexican Peasant Village. American Anthropologist 63: 1173-1192. 1965 Peasant Society and the Image of the Limited Good. Amen. call Anthropologist 67: 293-315.

1976 Disease Etiologies in Non-Western Medical Systems. American Anthropologist 78 773-783.

Foulks, Edward F.

1978 Comment on Foster's "Disease Etiologies in Non-Western Medical Systems." American Anthropologist 80: 660-661.

Hasan, Khwaja A.

What is Medical Anthropology? Medical Anthropology

Newsletter 6(3): 7-10.

Hochstrasser, Donald and Jesse Tapp

1970 Social Medicine and Public Health. In Anthropology and the

Behavioral and Health Sciences. Otto Von Mering and L. Kasden,

eds. Pittsburgh: University of Pittsburgh Press, pp. 242-271.

Kleinman, Arthur

1978 What Kind of Model for the Anthropology of Medical Systems? American Anthropologist 80: 661-665.

Landy, David, ed.

Culture, Disease and Healing. New York: Macmillan.

Lieban, Richard

Medical Anthropology. III Handbook of Social and Cultural

Anthropology John Honigmarm, ed. Chicago: Rand McNally, pp.

Logan Michael and Edward Hunt Ms.

1978 Health and (tie Human Condition. North Scituate, Mass.:

Duxbury Press.

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