Final Flashcards
(43 cards)
Interpretive and experiential approaches
-Use interpretive approaches with critical approaches
Interpretive approach: medical anthropologists look at how sicknesses are “culturally constructed”; how understandings of and responses to disease are shaped by cultural assumptions. Interpretive approach addresses this question.
- Byron Good and Mary-Jo Delvecchio Good developed a “meaning-centered approach” to illness that captures the basic assumptions of the interpretive perspective. An illness or a symptom condenses a network of meanings for the sufferer. The meaning of illness for an individual is grounded in the network of meanings an illness has in a particular culture.
- An interpretive analysis of epidemics would document the thoughts and experiences of sufferers, their families, and others in their communities. Would explore the way people and healing specialists account for disease and how they treat it.
- Their critical-interpretive method, describe(s) the variety of metaphorical conceptions about the body and associated narratives and then show(s) the social, political, and individual uses to which these conceptions are applied in practice.
- Interpretive theory looks into material objects that are related to our health and the meanings of these material objects
Experiential approach:
- sick role
- looking at illness’ as an individual experience influenced by its cultural context
- illness narratives
- inter-subjectivity
Sick role
§ Acknowledge that your health is abnormal
§ Submit to the care of a professional
§ Be excused from regular responsibilities
§ Resume your normal activities
§Sick role can be beneficial or limiting (stigmatizing)
§Illnesses that are difficult to measure – mental health or pain
§Communicating one’s suffering is an essential part of the sick role if people don’t
believe that you are suffering, you cannot fully exercise the rights and responsibilities of
the sick role
Illness narratives
- Illness has cultural context which attributes to its meaning and its significance
- Interested in three aspects of illness: narrative of illness, experience, and meaning
They are important because:
- Narratives are not only individual endeavors but they can also be group endeavors
- Communicating your illness effectively is important because it will determine the outcome of your treatment.
Three patterns of illness narratives
o Restitution—person has a temporary state with the goal to restore health. Usually not applied to those with chronic illness’
o Chaos—this is more applicable to cases of chronic or degenerate illness, Illness is seen as a permanent state that’s only going to get worse. Often encompass their suffering in terms of silence. There’s usually a sense of non-acceptance because they don’t feel any sense of control. This type of narrative is usually only shared with close friends and family, not your physician. This narrative has no structure.
o Quest—illness is viewed as an onward journey. The patient is an active agent who is trying to recover. It is a journey for them to heal themselves and help others in the same situation become better too. The ways they often express these narratives is usually in three forms: memoires, manifestos, and complex renderings that are almost a form of ultum mythology.
Inter-subjectivity
- Involves the patient, physician, family. Also Includes distant actors such as pharmaceutical companies, lawyers etc.
- Kleinman tresses that physicians should focus more on the meaning then just attempting to establish a disorder or disease. Treatments should be different for everyone, not every understanding is the same.
- The way people relate to their body and how we understand our health is not limited to illness but more towards other aspects of health such as nutrition
- There is a routinization of clinical practices which is a lazy way of just checking the boxes, in a highly beuracratized medical system. They do this to limit time which doesn’t give much time to understand the meaning behind the illness
- Routinization tends to overlook beliefs and undermine outcomes
Hunt: Strategic suffering (Interpretive approach)
- deals with biological disruption
- illness narratives as social empowerment among Mexican cancer patients
- Cultural construction of illness and healing
- secondary gain
Hunt: Strategic suffering
(Cancer patients in mexico summary)
(Interpretive approach)
¬ For cancer patients in Mexico, “coping mechanisms” in additional to their psychological functions, are necessarily constrained by and responsive to the pressing problems of negotiating mutual rights and responsibilities between individuals in terms appropriate to the local moral and cultural world.
¬ Having cancer requires mobilizing resources for treatment, eliciting assistance for caring for the patient, and renegotiating the privileges and obligations of the patient within familial and other social hierarchies.
o Shifts in personal identity in having cancer therefore emerge in the context of a larger social framework, subsuming questions of domination and subordination.
¬ Disruptions in social identity because of cancer and the treatments present a challenge to existing social relations and in thrusting patients into a state of indeterminacy and ambiguity, provide an opportunity to negotiate new identities in the social space within which creativity can flourish.
¬ Chronic patienthood implies a level of role flexibility that may contain a moment of potential empowerment—can define one’s place in the social world while articulating and configuring the disaster of having cancer in innovative and strategic ways.
¬ Individuals in the process of producing illness narratives move between multiple ways that the sick role could be constructed, achieving altered identities not passively but through selective action
The orientation to the illness
Secondary gain (Hunt)
Clinical literature might construct the phenomenon, “secondary gain” which is the interpersonal advantages that result when one has the symptom of a physical disease, including such things as increased attention from family members, financial gain, and release from work or other social obligations.
Applied anthropology
-defined as research and
analysis done by anthropologists on a specific
problem for a specific client.
-Applied medical anthropology is the application of
anthropological theories and methods to health
interventions, for example, in international and
domestic health projects.
-Act as social activists, who scrutinize the
socioeconomic circumstances behind health
problems and design interventions with social
reforms in mind.
-¬ looking at world at the local level, now they are looking at it in terms
of globalization
-¬ Anthropologists look at macrolevel structures and relates these to micro level experiences
Uses interdisciplinary methods that make it possible to analyze ethno-medical systems and explanatory methods at the same time
-Chapter 8
-Mosquito Net
-Manderson
Globalization
The worldwide process of increasing economic, technological, political, cultural
interactions, integration and interdependence of populations across the globe.
Impact of globalization on health
o Facilitated the spread of infectious diseases (has to do with goods being transported worldwide)
o We can communicate ideas of healing across far distances but it draws our attention to health inequalities (people being denied treatments)
o Globalized has also exposed some controversial health practices
Manderson: Applying medical anthropology in the control of infectious disease
(Applied approach)
¬ Anthropological interest in infectious disease control comes from the expanding range of specializations within medical anthropology due to continuing anthropological curiosity about the natural, biological and cultural worlds and their intersections.
¬ Failure to contain various infections biologically or environmentally and the continued lack of comprehensive and enduring technical programmes leave us with health education and related behavioural interventions as the primary means to limit disease and reduce mortality.
¬ We need to better understand the roles of human behaviour and social structure in the transmission of infections, and to analyze the difficulties in introducing and sustaining interventions for prevention or treatment.
¬ Byron Good problematized the role of medical anthropology in public health. Argued scientific medical knowledge is positioned as superordinate to folk beliefs, constructing in the medical as in other domains a hierarchical relationship between cosmopolitan and indigenous knowledges, right and wrong, science and magic, myth and truth.
Case Study: Mosquito net use (Applied approach to medical anthropology)
Using a bed net has positive outcomes so they have been distributed across malaria prone countries
Used to protect humans, animals, plants, fishing nets
Why are they not using the product that is given for free
Anthropologists look at the issue of compliance and they come in and look at their beliefs of malaria and the context of the disease
There are other beliefs surrounding the nets itself, they think they are poisoned—they are insecticized pregnatic bed nets
In certain dry seasons people think that you don’t have to worry about malaria because there won’t be very many mosquitos. They think you need to be careful during wet seasons
There are different mosquitos during different times of the day and during different seasons
People often cut the nets up and use it over their windows and doors instead of on their beds. This isn’t as effective because sometimes their roofs are open and there is ventilation in the house where they could get in.
Your whole environment is a vector for disease
Mass distribution of bednets is not an effective way of fixing the structural inequalities such as poverty
Rapid anthropological assessments
Also known as ‘rapid ethnographic assessment’ and many other
variations including rapid rural appraisals, food ethnographic studies etc.
§First developed by Susan Scrimshaw and Elena Hurtado (1983)
§Many similarities with ‘traditional’ ethnography but conducted over much
shorter periods
§Developed into manuals used by many different types of practitioner not
just applied anthropologists
§Basic premise: health issues are socio-cultural issues and it is possible to
gain integrative/or holistic understandings of these issues even in short or
limited time studies
§Aim: collect and analyse data relating to disease-related belief,
behaviours, attitudes and practices
Big pharma ethnography
Identify unmet needs—this is where they start getting into a grey area in terms of ethics
Pharmaceutical companies are responsible for large amount of unequal distribution of products
Amsterdam Care collective
- Different form of medically applied anthropology—community engaged anthropology
- Looks at three different aspects of living with dementia—looks at good care (is the same for all, what are the tensions and what can we learn from them, etc.), the idea of dementia life worlds (the integration of different aspects of medical anthropology—macro and micro, looking at how dementia is embodied, how do we avoid medical labels of dementia?), what dementia means for carers in society (the social and cultural surrounds having to do with dementia, dying well, end of life care, etc.)
- Living with dementia is a relational disease—relies on others
- An aspect they raised is how can we get doctors to focus on how patients with dementia cope rather than just looking at the medical symptoms.
- How can relieve stress for those who have dementia, professional careers, and their family members
Social determinants of health
WHO defines the social determinants of health (SDH) as
“the conditions in which people are born, grow, work, live,
and age, and the wider set of forces and systems shaping
the conditions of daily life. These forces and systems
include economic policies and systems, development
agendas, social norms, social policies and political systems
Social determinants of health
¬ Primary factors that shape health in industrial countries in particular are not medical treatments or lifestyle choices but rather the living conditions they are living in.
¬ Health is shaped by how income and wealth is distributed and how health and education is received
¬ Life expectancy is determined by the resources available to you
¬ Continuous stress make people vulnerable to serious illness
¬ Stress, bodies, and illness affect Health Equity
¬ People do not create the social situations in which they find themselves, it is the social structures, social determinants, etc. that put them in that situation.
Social and cultural determinants of health
They look at social determinants of health at a downward motion as the circumstances affect them?
Housing broke up families social safety net which is part of a social determinant of health
Thrifty Gene Theory
¬ currently a captivating explanation for the high prevalence of non-insulin dependent diabetes mellitus among Indigenous peoples globally. Originally proposed by James V. Neel
o Based upon the evolutionary notion that hunter/gatherer populations survived feast and famine living conditions because they possessed a thrifty genetic predisposition to accumulate and store fat.
o Neel argued that under recent conditions of rapid “Westernization” and related lifestyle and dietary changes, this naturally selected genetic predisposition, which sustained populations during times of famine, has led to the onset of obesity and NIDDM among contemporary populations
-There is no evidence that the thrifty gene exists
Geneticization
¬ Geneticization: describes the condition under which cultures of individuals and groups become defined by scientific and genetic categories through a complex interplay between techniques of prenatal screening and contemporary discourses in genetic prediction.
Biosociality
¬ refers to a transformative condition under which both nature and scientific work in the life science become increasingly revealed as artificial and as cultural practice.
o In this new era of artificiality, the nature/culture divide will cease to exist and both culture and science will be increasingly understood through ethics.
Pre-menstrul syndrome
Premenstrual syndrome is commonly described as “the physical and emotional symptoms that occur in the one to two weeks before a woman's period”. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability, and mood changes. The menstrual cycle has historically been the focus of myth and misinformation, leading to ideas that constrain women's activities
Medicalization
understood as ‘giving a condition or behaviour a medical label, defining the problem in medical terms, and using a medical intervention to treat it’
- occurs at conceptual, institutional, and interactional levels
- Look at lecture slides for more info
