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
successfully applied to make sense of and improve upon the management of health systems and the implementation of health policies. Due to its practitioners’ engagement with meaning, applied medical anthropology has a critical role to play in enabling community
Navigating Research on the Fertility Quests of Mozambican Women and Men
This article addresses the challenges and reflections of a junior anthropologist while developing research on the delicate topic of reproductive health and infertility in Maputo, Mozambique. Based on participant observation notes, entries in fieldwork diaries, and interviews, and assuming the character of a reflexive ethnographic account, the article concerns personal and research challenges and opportunities experienced during the preparation and development of a research project and a PhD thesis. While reflecting more broadly on processes of knowledge production, history and colonial relations, and on the writing of a scientific account, it provides insights into the pragmatics of research in medical anthropology by detailing the everyday life of doing ethnography, including networking, bureaucratic processes, boredom, the exploration of new fieldwork landscapes, and positionality dilemmas.
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.
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.
This paper explores the problem of knowledge and knowledge making among Polish primary care doctors. Following Kirsten Hastrup and Tim Ingold, I argue that doctors are skilful social-weavers capable of exploring and reconciling various orders of knowledge. Thus, through a diverse set of knowledgeable yarns – originating from professional and state regimes, and embedded in today’s social relationships and economies – doctors are involved in the art of weaving a fabric composed of many, it would seem, contradictory orders of knowledge. The fabric in question is one in a constant state of reworking – although it is one that establishes a meaningful and knowledgeable environment in which the doctors can perform.
‘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.
Clinicians on the Frontlines of the COVID-19 Pandemic
COVID-19 has overwhelmed health-care providers. The virus is novel in its prevalence, severity and the risk of asymptomatic infection. In order to reduce the risk of infection and stop the spread of COVID-19, clinicians in hospitals across the United States are taking measures to limit exposure to infected patients by reducing the frequency of visits to patients’ rooms, touching patients less, and adopting new protocols around the use of personal protective equipment (PPE). While these newly adopted practices are helping to reduce transmission risk of COVID-19, they are producing a habitus of infection; an acute shift among clinicians that is deeply embodied and likely to have a permanent impact on the health and wellbeing of both providers and already isolated patients.
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.