The increased participation by medical anthropologists in medical research and public health in the recent past has seen medical anthropology become an important area of study among anthropologists. It is therefore not surprising that the increasing number of medical research projects and public health interventions that involve medical anthropologists or that are closely related to social science disciplines.
This has also given rise to a powerful cooperation that now exists between anthropologists and health professionals. Despite their different ideologies, these two groups of people have been working hand in hand to lessen the effects of poverty (Pool & Geissler, 2005).
As a social science, medical anthropology addresses specific health issues and also seeks to build a broad, theoretical based understanding of what health is, how it interacts with culture, the role of social relations in shaping disease, the importance of the health environment interface, and a range of other issues (Singer & Baer, 2011).
In spite of this, true relationship between the social sciences and medicine remains a challenge for a number of reasons. First, anthropology and biomedicine are based on different assumptions about fundamental issues such as the nature of social reality and how it should be studied.
Second, medical research and public health are dominated by biomedicine and biomedical professionals often have a poor understanding of what anthropology is and what it has to offer.
Third, anthropologists have always failed to communicate effectively with medical professionals and as a result, they have been unable to make a convincing case for what anthropology has to offer. Consequently, there is often a need to mediate between these two groups of people with different disciplinary perspectives working towards the same goal.
This paper provides a discussion on the different theoretical perspectives in medical anthropology, namely, ecological, interpretive, and critical perspectives. It also looks at how biomedicine relates to culture as well as medicalization of life in Brazil and its consequences.
Theoretical Perspectives in Medical Anthropology
As is typical in science generally, medical anthropologists understand the world in certain ways. One of the influences on how a medical anthropologist approaches issues of health or illness is the particular theoretical framework or school of understanding employed. Although there are several such frameworks in medical anthropology, many individuals do not see themselves as supporters of any single perspective.
Instead, they take a more varied approach and allow the problems at hand to shape the perspectives that they use. Other medical anthropologists consider themselves advocates or even activists of particular points of view. Indisputably, however, the perspectives they bring to their research strongly influence the way a problem is approached, how questions are asked, and the kind of answers that are deemed sufficient and adequate.
Among the primary perspectives found in medical anthropology are medical ecology, interpretive or meaning-centered anthropology, and critical medical anthropology. These are explained as follows:
Entrenched in both cultural ecology and evolutionary theory, this approach began with an emphasis on adaptation, defined as behavioral or biological changes at either the individual or group level that support survival in a given environment as the core concept in the field. From this perspective, health was seen as a measure of environmental adaptation.
Initially, the central principle of medical ecology was that the type of relationships that existed within different social groups was closely associated with the health status of the members in the groups. While better health meant good relations, poor health meant the opposite. In general, beliefs and behaviors that improve health or protect societal members from disease or injury are adaptive.
From the medical ecological perspective, behavioral complexes such as medical systems, including everything from soul loss healing to biomedicine treatment of heart disease can be viewed as social-cultural adaptive strategies. As observed by Singer and Baer (2011), there is no single cause of death.
Whilst the immediate cause may be a virus, vitamin deficiency, or psychological trauma, disease ultimately is the product of a chain of interacting factors related to ecosystem imbalances, including physical and social vulnerability and resilience. Health and disease are deemed to develop within a context of interaction among physical, biological, and cultural systems.
The environment that people inhabit includes not just the physical habitat where they live but also the culturally constructed or built environment such as a city or a village, an acknowledgement that, in health, people impact their environment as much as the environment impacts them.
Interpretive or Meaning-centered Medical Anthropology
According to Baer et al. (2003), the cultural interpretive approach, resulted from the fact that the ecological perspective about health-related issues was increasingly becoming popular. By and large, the fundamental claim of cultural interpretive model is that disease is not an entity but an explanatory model.
From the interpretive perspective, illness tends to have a strong connection to the culture of medicine that is deeply rooted within societies. And culture is not only a means of representing disease but is essential to its very constitution as a human reality (Baer et al., 2003). From a cultural point of view, it is only through interpretive undertakings that both therapists, as well as their patients, get to know the diseases.
Generally, the actions or undertakings include a complex interaction of medicine and social behaviors. That different sub-specialties of biomedicine sometimes reach quite different conclusions about the same clinical episode affirms to the interpretive medical anthropologists’ fundamental role of cultural construction in the making of a disease.
Historically, the primary shortcoming of the interpretive approach from the critical perspective has been its lack of attention to the role of asymmetrical power relations in the construction of the clinical reality and the social utility of such construction for maintaining social dominance (Baer et al., 20003).
Critical Medical Anthropology
In the study by Baer et al. (2003), critical medical anthropology (CMA) seeks to understand who ultimately controls biomedicine and what the implications are of such control.
An analysis of the power relations affecting biomedicine addresses questions such as who has the power over agencies of biomedicine, how and in what forms power is to be delegated, how the power is to be expressed in the social relations of the various groups and actors comprising the health care system, and the principle contradictions of biomedicine and associated arenas of struggling and resistance that affect the character and functioning of the medical system and people’s experience of it.
Ideally, any discussion of the impact of power relations in the delivery of health services needs to recognize the existence of several levels in the health care systems of developed capitalist, underdeveloped capitalist, and socialist-oriented societies.
At the macro-social level, critical medical anthropology recognizes that the development and expansion of a global economic system represents the most significant, transcending social process in the contemporary historic period. To a large extent, capitalism has progressively shaped and reshaped social life.
As a discipline, anthropology has lagged behind in its attention to the nature and transforming influence of capitalism. As part of the larger effort of critical medical anthropology in general to correct this shortcoming, it attempts to root its study of health-related issues within the context of the class and relations inherent in the capitalist world system.
At the international level, the World Bank has become a key player in establishing health policies and making financial loans to health care undertakings. As a result of its practice of co-financing resources from international and bilateral agencies, the bank has a strong influence on health policies.
The bank also conducts country-specific health sector investigations and makes proposals for health care reforms that are compatible with market-driven economies. Despite the fact that almost all Third World nations are supposed to be politically independent, their colonial inheritance and their neocolonial situations impose health care systems modeled after those found in the advanced capitalist nations (Baer et al., 2003).
As a result of the clash and exchange between medical ecology theory, cultural perspective or meaning-centered theory, and critical medical theory, there have been developments in all three of the primary theoretical models within medical anthropology.
While medical ecologists have begun to adopt a more political-ecological orientation, interpretive medical anthropologists acknowledge and are attempting, and in some cases, succeeding in producing work that is highly sensitive to political-economic issues.
Critical medical anthropologists, on the other hand, have also developed a significant level of interest in political ecology and the role of political economy in the production of meaning.
Biomedicine and Culture
While recognizing the fundamental importance of biology in health and illness, medical anthropologists generally go beyond seeing health as primarily a biological condition by seeking to understand the social origins of disease, the cultural construction of symptoms and treatments, and the nature of interactions between biology, society, and culture.
Similarly, they tend not to accept any particular health care system, including Western biomedicine, as holding a monopoly on useful health knowledge or effective treatment. Instead, they see all health care systems from advanced nuclear medicine or laser surgery to dream based healing or acupuncture as cultural products, whatever their level of healing value and however efficiency is defined within particular healing traditions.
Medical anthropologists seek to understand and help others recognize that health is rooted in three key notions. First, there are cultural perceptions, such as culturally constituted ways of experiencing pain or exhibiting disease symptoms. Second, there are social connections, such as the type of relations that exist within the family or within society and the encompassing political and economic systems generally.
Third, there is human biology, such as the threat of microscopic pathogens to bodily systems and the body’s immune responses to such threats. In pursuing these lines of inquiry, medical anthropologists are especially concerned with linking patterns of disease, configurations of health-related beliefs and behaviors, and healing systems with cultural foundations, social hierarchies, and bio-social relationships.
Consequently, medical anthropologists have tended to look at health as bio-cultural and bio-social phenomena, based on an understanding that as both physical and socio-cultural environments interact, they determine the health of populations under investigation (Singer & Baer, 2011).
Some medical anthropologists, particularly critical medical anthropologists stress what they call a critical bio-cultural model, one that is especially concerned with investigating the role of social inequality in shaping health, health-related experience, behavior, and healing. Whatever their theoretical perspective, however, medical anthropologists tend to lean more towards a particular orientation.
They are concerned with putting their work to good use in addressing real and pressing health-related problems in diverse human communities and contexts. As noted by Singer and Baer (2011), illness is ordinarily perpetrated by the way a patient perceives his or her experienced symptoms.
Nevertheless, these interpretations are not solely personal but rather are witnessed by wider cultural understandings of illness and the comments and actions of the sufferer’s social network.
Apparently, illness behavior is impacted by various factors that include both gender and socioeconomic status. In addition, illness behavior in a society is dynamic and not static. As a society changes, illness behaviors change as well, including patterns of use of health services.
As noted by Hahn and Gaines (1984), earlier research studies demonstrated that biomedicine is a cultural system comprised of numerous variations.
The studies also stressed on the importance of observation and reporting on actual practices and beliefs, rather than employing negative or positive idealized versions of medical practice, so that it is possible to understand that the healing encounter is a social and cultural event involving communication across cultural or sub-cultural boundaries (Hahn & Gaines, 1984).
Unlike its characterization by proponents and opponents, biomedicine may be seen to be a part of the wider culture.
Theories of Supernatural Causation
The most prevalent and important theories of illness found cross-culturally in pre-modern societies involved theories of supernatural illness causation associated with personal assumption, meaning that some personal agent acted aggressively to cause the malady (Winkelman, 2008). Apparently, these notions are based on assumptions not recognized by modern medical science as being valid.
Although framed in supernatural terms regarding the powers of unusual humans or evil spirits, these theories may nonetheless represent important social and physical processes relevant to health. The most prevalent and important supernatural theories of illness are related to concepts of animism where attacks or punishment from the spirit entities are reflected in a universal theory of illness.
Animistic causes of illness involve the actions of a supernatural entity such as a spirit or ghost. These universal beliefs include the attribution that some unseen entity is the cause of our problems. According to Winkelman (2008), there are two types of animistic causation. These are spirit aggression and soul loss.
Spirit aggression is a universal belief that illness is caused by the aggressive action of the spirits, an attack that comprises the spirits putting something into a person or doing something to one’s body. On the other hand, soul loss involves a person having an aspect of his or her self, the soul or spirit, leave during a dream, or as a result of the soul being frightened or captured by a spirit or act of sorcery.
Theories of magical causation involve the linking of illness to malicious actions of other people. Seemingly, the wicked human, sorcerer or witch, has negative effects on other people’s health from overt actions or inadvertent emotions, particularly envy or jealousy. A distinction between sorcery and witchcraft reflect important differences involving intentional and unintentional effects, respectively.
Sorcery includes the impairment of health caused by the intentional aggressive use of magic, affected either by an individual’s power or through assistance provided by a specialized sorcerer or spirits. According to Winkelman (2008), sorcery as a cause of illness is found in most societies of the world.
The other societies generally have beliefs in witchcraft, impairment of the health of persons, animals, or crops caused by involuntary actions by special types of persons with inherent powers to cause harm to others.
A similar belief is associated with the evil eye. In this belief, someone can inadvertently cause harm by among other things, looking at another’s property. Evil eye power is frequently thought to emanate from the eyes or mouth of persons as a result of their envy.
According to Burri and Dumit (2007), analyzing medicine as culture opens up a fresh perspective on knowledge practices and epistemic features in biomedicine, namely, the construction and fashioning of knowledge objects within science or on the arrangements and mechanisms in biomedicine that shape what is known and how it is known.
Biomedicine takes on responsibility for the release of its strange entities and facts into culturally diverse environments. Biomedical experts are, however, able to do so only in close collaboration with social science and the humanities.
Medicalization of Life
The concept of medicalization rests on the assumption that some occurrences belong in the domain of medicine while some do not. Typically, everything that we do or everything that happens to us affects or depends on the use of our bodies.
In principle, we can treat what people do or what happens to them as belonging in the domain of medicine. We can also claim that nothing that we do or nothing that happens to us belongs in the domain of medicine because everything is ordained by God and belongs in the domain of religion.
In some instances, medicalization has been used to reassure patients and relieve them of guilt, but at other times, medicalization has been held responsible of oppresses them, as when the complaints of poor and minority patients are dismissed due to bad or immoral behavior.
Equally wicked are the understated ways in which bias is built into the very diagnostic categories used by biomedical practitioners that force them to make marked distinctions between normal and abnormal and to use assigned categories of ethnicity or race to mark out those people assumed to be at differential risk for various conditions.
Generally, to understand medicalization primarily as enforced surveillance, as certain social scientists have done, is totally misleading and must be avoided. Individual citizens and even families frequently cooperate willingly with medical monitoring and management of bodily distress in the belief that they will also benefit.
In Brazil, local doctors were able to transform despair, misery, and suffering into the language of sickness. The decisions of local doctors to treat social illnesses as bodily ills and to see hunger, widely experienced by poverty-stricken shanty dwellers, as a nervous complaint rather than a symptom of politics of economic distribution were seen to represent an extreme case of what is commonly referred to as bad faith.
Through medicalization of the ailments of their patients, local Brazilian doctors consciously deflected attention from the more fundamental incubators of affliction that lie in social, political, and economic oppression.
Medicalization is regarded to be bad faith in that doctors and other health workers pretend to themselves and to others that they are not really involved in or responsible for what they are doing or the consequences of their actions.
According to Scheper-Hughes (1988), medicine can play a very critical role in reorganizing people’s needs. Although it has been argued that medicalization leads to the isolation of the experience of misery and domesticates people’s anger about the reality in which they are forced to live, it has a serious consequence of creating an over-dependence on medicines.
As an example of this negative repercussion of medicalization, consider a terrible illustration of the effect of drugs to isolated populations in Brazil. In September 1987, Goiania, a small town in central Brazil suffered a tough blow when several individuals were exposed to dangerous radioactive contamination. Due to ignorance and over-reliance on medicine, more than 200 people were seriously affected.
While some people applied the radioactive material on their bodies or faces with a hope of becoming more beautiful, others went on to swallow the poisonous substance in order to get healed from ailments (Scheper-Hughes, 1988). Clearly, this example demonstrates how these Brazilians had very high expectations of regaining their health status by depending on medicine regardless of the repercussions.
Apparently, the local physicians could not be accused of such incidences and nor could they be held liable of the free circulation of restricted drugs across the Brazil.
Nonetheless, they had to be blamed for not putting in place strict control measures to check against the importation of harmful pharmaceutical products into their country from places such as the United States, Germany, and Switzerland. Local physicians were also blamed for letting the citizens suffer due to their own selfishness and poor moral standings in the society (Scheper-Hughes, 1988).
The so-called bad faith thus operates among doctors and pharmacists, who let their knowledge and skills to be misused by the greedy in the society, and self-centered politicians who care less about the masses.
As has been discussed in this paper, turning to the use of medicine has completely changed the way the society views illness. In the past, people simply lived based on their cultural settings and never depended so much on advice from local medical practitioners. When people got sick, traditional approaches would be followed while explaining the cause of the illness.
Today, however, there is so much reliance on modern medicine and often times, people end up being treated by professional doctors. There is thus a medical explanation for any illness that a person may suffer from. Due to medicalization of life, most people have lost touched with their cultures and are now simply relying on doctors to guide them whenever they fall sick and are in need of treatment.
However, it is imperative for people to know that there are negative effects that are linked to the idea of medicalization. As explained earlier, heavy dependency on medicine can lead to undesirable consequences. Unfortunately, undisciplined doctors may indulge in illegal practices to satisfy their own selfish interests at the expense of the masses.
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