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October 9: Anthropology and Global Health

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ANTH 2200
Victor Barac

ANTHROPOLOGY AND GLOBAL HEALTH ▯ Paul Farmer • structural violence: violence exerted systematically (indirectly) by everyone who belongs to a certain social order: hence the discomfort these ideas provoke in a moral economy still geared to pinning praise or blame on individual actors • intended to inform the study of the social machinery of oppression • an anthropology of structural violence draws on history and biology, just as it draws on political economy ◦ look at how the erasure of history – of temporality itself – and of biology comes to hobble an honest assessment of social life • Erasure of distortion of history is part of the process of desocialization necessary for the emergence of hegemonic accounts of what happened and why • "world-systems theory", an approach that is committed to ethnographically embedding evidence within the historically given social and economic structures that shape life so dramatically on the edge of life and death • these structures are transnational, and therefore not even their modern vestiges are really ethnographically visible • Neoliberal thought is central to modern development efforts, the goal of which is less to repair poverty sand social inequalities than to manage them • scientific rationalism, the rationalism of the mathematical models which inspire the policy of the IMF or the World Bank, that of the great law firms, great juridical multinationals which impose the traditions of American law on the whole planet, that of rational-action theories, etc. – is both the expression and the justification of a Western arrogance, which leads some people to act as if they had the monopoly of reason and could set themselves up as world policemen, in other words as self-appointed holders of the monopoly of legitimate violence, capable of applying the force of arms in the service universal justice ▯ ▯ Medical Anthropology • Study of disease, health problems, health care systems, and theories about illness in different cultures and ethnic groups ◦ Disease: a scientifically identified health threat ◦ Illness: a condition of poor health perceived or felt by an individual or community ◦ Health-care systems: beliefs, customs, specialists, techniques, institutions • Theories about the causes of illness: ◦ Personalistic disease theories: illness caused by agents such as sorcerers, witches, ghosts, or ancestral spirits ◦ Naturalistic disease theories – impersonal explanations of illness (i.e. Western biomedicine attributes illness to organisms, accidents, or toxic materials) ◦ Emotionalistic disease theories: illness caused by emotional experiences (i.e. susto in Latin America) • Have progress and development improved global health? ◦ What is a pathogen? ◦ How successful has the biomedical model been in treating disease? ▪ the invention of anaesthetics, painkillers, antibiotics, development of surgery, cosmetic surgery ▪ these successes are dependent upon development, a specific kind of economy, industrial capitalist economy, technology behind all these things, is capital intensity ◦ What illness in Canada are currently diagnosed and treated according to the biomedical model? ▪ old age, mental illness, cancers/tumours, infections, viruses ◦ What are traditional medical techniques? ▪ humoral medicines: theory of medicine that in Western cultures traces back to at least Aristotle, who believed that health and illness was function of the balance of the "humors," which were the basic elements of life ▪ consisted of dry and wet, hot and cold ▪ health had to balance these four elements, and disease was the result of the imbalance between these factors ▪ shamanism, Ayurvedic Contemporary Biomedicine • health care is the largest component of the economies of affluent nations • medical establishment is an institution ◦ deeply imbedded, with its own rituals, roles, and epistemologies • anthropologists study complex processes ▪ good way to establish links to the bigger picture by studying specific areas ◦ doctor training ◦ doctor/patient relationship ◦ medicine and big business ▪ pharmaceuticals, capitalist-based society, all major work can only be undertaken with paid labour ◦ "There's gold in them there pills" ▪ play on the old gold rush, "there's gold in them there hills" ▪ the pharmaceutical industry is one of the most profitable, one of the biggest markups in terms of their pricing in terms what it costs them to produce these pills ▪ links between medicine as a business and as an institution ◦ ethics of medical research and publication of that research ▪ plagiarism cases, lying about their data, falsifying information Biomedical Model • Scientific epistemology ◦ Natural basis of illness; natural science • The human body and its functions ◦ Claude Bernard (1813-1878) ▪ father of medicine, established the various workings of various organs ▪ he establishes the medical idea of homeostasis (equilibrium) ◦ An Introduction to the Study of Experimental Medicine (1865) ▪ Considered to be one of the founding scientific treatises of modern medicine ◦ Homeostatis = health ▪ idea of balance preceded Bernard, but it's placed on a scientific, experimental footing during this time period ▪ influence on Emile Durkheim, social theory of functionalism, was modelled on a scientific, medical metaphor ▪ how do you study a society/culture? functionalism says you have to study it based on its function, and its function contributed to the overall social structure ◦ Epidemiology ▪ illness in terms of its distribution in populations ▪ medicine, plus demography Cultural – Interpretive Model • Limits of biomedical model ◦ biomedicine roots things in the model, nonexistent analysis of the socio-cultural context of health • The cultural basis of illness and health ◦ historical context ◦ gender in terms of access to medicine in terms of diagnosis and how individuals approach self-health ◦ contradictions within medical models: why do we do what we're not supposed to do? Why do people smoke cigarettes? • Phenomenology ◦ language of human experience and subjectivity ◦ important concern of medical anthropology; what is the natives' perspectives? Critical Medical Anthropology Model • Health and social inequality • health and capitalism ◦ health care biggest expenditure, very big subject that gets a lot of attention • medicalization ◦ medical hegemony: refers to those theories that upon which the dominance of the biomedical approach is based Shamanism • Universal mode of healing ◦ it was the dominant mode of healing until you started getting the separation of medical from religious practices ◦ term comes from a Siberian tribe, ethnography of the Tumbas, what they called their healer; this specific term is now used as a generic term used to apply to a particular type of healer in small-scale societies • doctor, priest, social worker, mystic ◦ small-scale subsistence economy, everyone is involved in subsistence, including the shaman, but the shaman embodies all these specialized functions ◦ strong, forceful personalities, as often revered as they are feared, possessive of power ◦ one of their functions is the contacting the spiritual world or the supernatural on the behalf of someone else ◦ not always for money, they could be doing it also for gifts • contact with spirit world • same curing odds as MDs ◦ they heal imbalances of the spirit ◦ soul-loss, you lose your soul, or one of them (depression, listlessness, self-loathing as well as illness/disease) ▪ believed to be one of the principal causes of disease (evil- eye, potion, cursed, touched me with a negatively charged item, bad magic, come into contact with something bad) ◦ shaman can travel to the spirit world and retrieve/heal your soul ◦ they undergo a serious alteration of consciousness, often "possessed" because they are travelling in the spirit world, looking to restore the balance ◦ when they come back from their journey, they're physically tired, drained ◦ they are very powerful; people will take whatever western medicine is giving them, but they want it with their shaman's help because of the belief system ◦ shamans also often magicians, they engage in a lot of slight-of- hand, performance magic ◦ there's a large degree of legerdemain ◦ performance, suggestion, thought-control, getting people to focus on certain things while something else is being done outside of the field of consciousness ◦ Michael Homer, became a shaman after studying as a anthropo
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