In an earlier paper (Dressler, 2001), I suggested that medical anthropology as a research enterprise could not ignore either meaning or structure in human social life in the production of health. Rather, drawing on the early work of Bourdieu, I argued that we need to take into account both how the world is configured by the collective meanings we impose upon it, as well as the social structural (and physical) constraints on our behaviour that exist outside those meanings. Human health can be understood, in part, as the intersection of meaning and structure. Here, my aim is to extend this perspective in three ways. Firstly, I present an expanded theoretical framework within which collectivei meaning and social structure can be conceptualised. A useful theoretical framework must take into account paradoxical features of culture, including the seeming contradiction that it is a property both of social aggregates and of individuals, and that, ultimately, social structural constraints external to individuals depend on shared meaning. Secondly, I review recent research employing this perspective conducted in Brazil, the southern United States and Puerto Rico. These studies have all employed a 'structural-constructivist' theoretical orientation, using especially the concept of 'cultural consonance', or the degree to which individuals incorporate shared meaning into their own beliefs and behaviour. Where individual efforts to attain a higher cultural consonance are frustrated by structural constraints, poor health results. Thirdly, I consider some of the policy implications of this perspective. While much work in traditional public health focuses on a highly individualised notion of meaning (as in 'health beliefs'), it seems unlikely that the health of populations can be altered substantially without taking into account the structures that constrain individual action.
The articles in this special issue tackle a problem at the heart of medical anthropology today—a problem that bedevils our methods, theoretical ambitions and public stance in the world. How should we rank the relative importance of local cultural meanings, on the one hand, and large-scale political and economic forces, on the other? That is, how should we train our sights on both culture and politics as we study the social contexts of suffering and apply our expertise to the worlds of policymaking and service delivery? How do we keep ‘culture’ and ‘politics’ in motion (and both are very broad analytical terms) without lapsing into one-sided analyses that champion the one term at the expense of the other? The following articles significantly advance the debate about such issues. They offer powerful theoretical models of the dialectic between culture-specific illness idioms and the operations of power that constrain people’s lives. They also re-think the very notion of culture in light of the complex networks—connecting individuals to nationstates, empires, NGOs, pharmaceutical firms and global capital—in which medical anthropologists increasingly work.
Sara Van Belle
In this article, I set out to capture the dynamics of two streams within the field of global health research: realist research and medical anthropology. I critically discuss the development of methodology and practice in realist health research in low- and middle-income countries against the background of anthropological practice in global health to make claims on why realist enquiry has taken a high flight. I argue that in order to provide a contribution to today’s complex global issues, we need to adopt a pragmatic stance and move past disciplinary silos: both methodologies have the potential to be well-suited to an analysis of deep layers of context and of key social mechanisms.
Moving as a Success or Failure?
Anne Sigfrid Grønseth
During a period of about 15 years, Tamil refugees have resided in the small fishing villages along the arctic coast of northern Norway. Employing an ethnographic approach that emphasizes agency and experience in everyday life, this study describes how Tamils face a lack of crucial social and religious relationships and arenas that provide recognition and meaning to their daily lives. Not being able to give voice to their social experiences, the Tamils suffer from bodily aches and pains. As part of the Tamils' search for recognition, community and quest for well-being, they have relocated to places that provide a more complete Tamil community. To assess whether the Tamils' choice of leaving the fishing villages is a success or failure is a complex matter. Exploring the intricacies of this decision, this article discusses the links between the 'narrative of suffering' and the Tamils' decision to move.
Medical Anthropology of the Middle East?
Soheila Shahshahani and Mohammad Shahbazi
In a region in which everyday life is under different kinds of threat, issues related to health are of prime importance. Preserving life, which is the least human right to be respected, is the last resort, yet it seems human life is an insignificant matter. For example, in everyday discourse in Tehran, we o en hear, “Human life doesn’t count.” Within this local world view the opposite can also be observed: an obsessive preoccupation with aesthetic aspects of the human body (see AME, vol. 1, no. 1). In between lies all that can be studied by medical anthropologists.
Agnes G. Loeffler
This article offers an analysis of two medical case histories presented by an Iranian allopathic physician to illustrate the power of diet in the management of disease. Uncovering underlying cultural assumptions about health and health maintenance strategies leads to the following insights: (1) Galenic medical ideas have not been replaced by allopathic theories in the world view of Iranian physicians; (2) allopathic medical treatment options (pharmaceuticals) are applied to indigenous disease categories; (3) there is deep-seated scepticism about etiologic theories of allopathic medicine and its ability to treat certain conditions; (4) the authority of allopathic medicine is not unquestioned in Iran.
Learning Japanese Psychiatry
How is the knowledge embedded in a global institution such as psychiatry integrated into taken-for-granted understandings and everyday medical practice in a non-Western setting such as Japan? How can ethnographic research address this question without simplifying institutional complexity and cross-cultural variations? This paper argues that the ethnography of apprenticeship can resolve these tensions between global and local sources of cultural knowledge. Recent work in cognitive anthropology and practice theory has demonstrated the value of examining apprenticeship as a window onto dynamics of institutional production and reproduction. As an ethnographic strategy, the study of apprenticeship makes the processes through which knowledge crosses cultural boundaries accessible to research. Drawing on two years of ethnographic research on the training of Japanese psychiatrists, I describe the institutional structure in which psychiatric knowledge becomes embedded in newly trained psychiatrists. This system, known as the ikyoku system, reproduces many characteristics of Japanese organizational patterns. Examining the details of this system offers additional insight into the particular way in which psychiatric knowledge becomes situated in contemporary Japanese society. The theory of apprenticeship, however, has a much broader potential for informing ethnographic research strategies for studying contemporary global institutions.
What, if not Durkheim’s ‘collective representations’ acquired during exalted states of effervescence, gives rise to society, culture and science? Marcel Mauss provides another answer by pointing to the different rhythms of social relationships and the human effort to synchronise them. The seasonal cycle of the Eskimo [Inuit], Mauss argues, is in accord with their game; hence people disperse in summer to pursue economic activities in small bands, while they congregate in dense house-complexes in winter and engage in ritual. It would appear that Mauss draws heavily on Boas’s contrast between the Kwakiutl winter celebrations and their ‘uninitiated’ livelihood in summer. These insights have traction for medical anthropologists who are interested in finding an anthropological explanation for the efficaciousness of ‘traditional’ medicines or ‘indigenous’ healing techniques.
‘Cosmetic’ Investments in the Body
This article discusses the impact of skin colour inequality in the individual aspirations and prospects of social inclusion and success, social mobility aspirations, professional ambitions and career opportunities. Ethnographically, it studies specific forms of cosmetic investments and self-optimisation in Portugal and its effects on the micropolitics of bodies, correlating the agency of individuals (how they empower themselves maximising certain aspects and minimising others) with the ways in which a European white appearance circulates as a form of capital and commodity, creating body narratives that are very much racialised. By inquiring the actual European understanding of value in bodies, we can also understand the colonial legacy and how it is reproduced through the mutation of bodies.
On the Generosity of Ritual
The thought experiment ‘ritual in its own right’ implies a suspension of dominant interpretive paradigms in anthropological research. This essay begins by juxtaposing the foundational accounts of Weber and Geertz—both of whom associate ritual with the quest for meaning in suffering—with the phenomenological account of Emmanuel Levinas, who argues that suffering is inherently “useless” and therefore resistant to meaning’s claim. All three theorists are then juxtaposed with the Warsaw ghetto writings of a twentieth-century Jewish mystic, Kalonymos Shapira, whose work exemplifies the tension between meaningful and useless suffering in a real social setting. Shapira’s work bears comparison with Levinas’s, and lends support to the idea that our preoccupation with meaning may stem from a particular religious genealogy of social theory. Ritual can be analyzed as a ground of intersubjectivity or transcendence rather than meaning, which makes it more akin to medicine, in Levinas’s terms, than to theodicy.