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Introduction: The Contributions of Medical Anthropology to Anthropology and beyond Author(s): Peter J. Guarnaccia Source: Medical Anthropology Quarterly, Vol. 15, No. 4, Special Issue: The Contributions of Medical Anthropology to Anthropology and Beyond (Dec., 2001), pp. 423-427 Published by: Wiley on behalf of the American Anthropological Association Stable URL: http://www.jstor.org/stable/649666 Accessed: 14-01-2018 17:52 UTC

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Institute for Health, Health Care Policy, and Aging Research

Rutgers University

Introduction: The Contributions of Medical Anthropology to Anthropology and Beyond

T he articles in this issue, first presented as papers in the plenary session of the 2000 Society for Medical Anthropology Meeting, powerfully exemplify

“The Contributions of Medical Anthropology to Anthropology and Beyond.” In planning this plenary, a committee of Carole Browner, William Dressler, Peter Guarnaccia, Lucille Newman, and Arthur Rubel envisaged a session that would bring

together some of the leading scholars in our field to address the following questions:

1.What have been the major accomplishments of medical anthropology on which to build a medical anthropology for the 21st century?

2. How has medical anthropology contributed to the theoretical, substantive,

and applied development of anthropology as a whole?

3. How do we further re-emplace medical anthropology in the core of anthro-

pology? What is the relationship of medical anthropology to the four subdisciplines of anthropology?

4. What have been the contributions of medical anthropology to social policy? 5. What are the promising and urgent directions, both theoretical and substan-

tive, for medical anthropology to pursue in the next century?

William Dressler, Arthur Kleinman, Charles Leslie, Margaret Lock, Rayna Rapp, and Arthur Rubel presented papers at the plenary session. As my introduc-

tory comments below indicate, the speakers addressed the issues just outlined and much more. In choosing the speakers, we sought a diversity of perspectives on the field. What impressed me about the papers was the extent to which, collectively,

they pointed to a synthesis of these different perspectives to set a course for our field in the 21st century. As many who attended the plenary session commented,

the richness of the papers argued for their publication, both so that those present to hear them could think about them more deeply and those not present could share their insights.

Medical anthropology provides a rich field for integrating divergent perspectives

in our subdiscipline, more generally in the field of anthropology, and beyond. For ex- ample, cultural constructivism-the ways that meanings shape our understanding and experience of the world-can be linked with a social structural perspective- the ways that social realities shape health and illness. Following Margaret Lock’s

MedicalAnthropology Quarterly 15(4):423-427. Copyright 0 2001. American Anthropological Association.


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suggestion, this synthesis can be characterized as “biopolitics,” which involves un-

derstanding the “body” as both a biological system and the product of social and

cultural processes, that is, accepting that the body is, at the same time, totally bio-

logical and totally cultural. Medical anthropology can integrate a humanistic, inter-

pretive approach to the study of health and illness with a natural science tradition

of fieldwork conducted with a species-wide and long-term perspective. As a cross-

cultural project, medical anthropology can use diseases as biological constants to

study the importance of cultural variation in understanding illness and coping with

it. Medical anthropology has become a rich site for communication across subdis-

ciplinary boundaries within anthropology and with other theoretical streams such

as feminist studies and science studies.

The articles collected in this issue of Medical Anthropology Quarterly make

these points and more. The past two decades have been a time of rich theoretical

ferment in medical anthropology, as in the discipline as a whole. These articles

make clear that medical anthropology has an important role to play in leading our

discipline into the next millennium and out of some of the conceptual morass that

has characterized it over the last decade. By juxtaposing the contributions of a cul-

tural constructivist approach, particularly as applied to science in the form of bio-

medicine, with serious attention to the social structural constraints of local and

global politics and economics, medical anthropology can bridge what often have

been seen as incommensurate approaches in both our subdiscipline and anthropol-

ogy more broadly.

Of particular note has been the centrality of the “body” in these analyses.

Medical anthropology’s attention to the body in the late 1980s opened a decade of

exciting work on “bodies” from individual, social, and political perspectives that

continues into the present. The “rediscovery” of the body as a rich site for analysis

and praxis in medical anthropology has linked our field to some of the most excit-

ing developments in related disciplines, such as philosophy, history, women’s

studies, literary studies, and science studies. At the same time, attention to the

body, particularly bodies ravaged by disease and suffering, has reawakened us to

the pragmatic imperatives of our work.

The articles included in this special issue also make clear that this synthesis

will not be fully effective unless we apply our analyses to what is at stake for peo-

ple in the communities we study. Contemporary health issues that have been the

focus of our analyses-infectious diseases such as AIDS and tuberculosis, chronic

diseases like hypertension, and the impact of new reproductive technologies on

women’s health-have an immediacy that pulls us to think not only about how we

can better understand the world, but also about how we can effectively act in the

world to reduce suffering and promote health. Whether working on intervention in

the AIDS pandemic, supporting asylum for women resisting the practice of female

circumcision, advocating for the inclusion of those with multi-drug resistant tuber-

culosis in global health intervention programs, defending women of color who use

drugs during pregnancy against unlawful testing and arrest, or exposing the global

market in human organs, medical anthropologists have made clear that the richness

of our analyses can also be powerful tools for acting in the world. Although Arthur

Kleinman did not contribute an article to this issue, he would have argued that

medical anthropology should engage the issues that matter most to people in the

communities and countries where we study; that we should engage in what is at

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stake in the local moral worlds of the communities where we work. This concern

with engagement and praxis is central to several of the articles presented here.

The first article in this issue, by Charles Leslie, is entitled “Backing into the

Future”-its title alone lent itself to opening the issue! Charles Leslie is emeritus

professor of anthropology and the humanities at the Center for Science and Culture

at the University of Delaware and is currently at Indiana University. Charles is en-

tering his fifth decade of contributions to medical anthropology, having received

his doctorate from the University of Chicago in 1959. After initial fieldwork in

Oaxaca, Mexico, to the benefit of our field he turned to the study of modern Ayur-

vedic and Unani medical institutions in South Asia, particularly India. His collec-

tions Asian Medical Systems. A Comparative Study (1976) and Pathways to Asian

Medical Knowledge (1992, with Allan Young) serve as invaluable resources to our

field. His careful editing of the medical anthropology section of Social Science and

Medicine for many years was another of his important contributions. Charles re-

views the development of our field as a participant and actor in that development.

He calls for the integration of humanistic, interpretive approaches to the study of

illness and health seeking with a natural science tradition of fieldwork conducted

with a species-wide and long-term perspective. We recognize these as strong tradi-

tions not only in medical anthropology, but in our parent discipline as well. In his

review, Charles provides examples of books in our field that exemplify the integra-

tion of these traditions and serve as examples of why medical anthropology is at

the core of the best of contemporary anthropological scholarship.

The second contribution to this issue is by Art Rubel and Carmella Moore.

Sadly, in the interim between completing the article and its appearance here, Art

passed away. Publication of this article is a fitting tribute to Art, as he was inti-

mately involved in organizing and presenting at the 2000 SMA plenary session.

Arthur Rubel was professor emeritus in the Department of Family Medicine and

the School of Social Sciences at the University of California at Irvine. He was be-

ginning his fifth decade of major contributions to medical anthropology. The cur-

rent article reflects the themes that characterized all of his work: a focus on the

health of Latinos, careful attention to methodological issues, and great concern that

his research make a difference in people’ s health. It also reflects the value he

placed on collaboration with colleagues both in the United States and Mexico. Art

received his Ph.D. in anthropology from the University of North Carolina, Chapel

Hill, where he also studied epidemiology. His fieldwork took him to communities

on the Texas-Mexico border and to indigenous communities in Oaxaca and Chia-

pas. Art Rubel and Carmella Moore’s article on “The Contribution of Medical An-

thropology to a Comparative Study of Culture: Susto and Tuberculosis” links

medical anthropological research to the larger comparative project of anthropol-

ogy as a whole. A continuing theme in Art’s work was to search for ways in which

the study of health and illness illuminates both normative and day-to-day social re-

lationships. This theme is beautifully illustrated in his book Susto, A Folk Jlltiess

(1984, with Carl O’Nell and Rolando Collado-Ard6n). In their contribution, Art

and Carmella return to the work on susto and add new work on tuberculosis to

show the power of analyses that compare highly charged disease and illness expe-

riences across cultural groups to examine the cultural construction of varying re-

sponses to these core human problems, shaped as they are by underlying biological

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processes. This article stands as a testament to Art’s contributions to medical an-

thropology and makes us realize how much he will be missed by our field.

William Dressler explicitly tackles the synthesis of cultural constructivism

and a social structural approach in medical anthropology via Bourdiets in his arti-

cle, “Medical Anthropology: Toward a Third Moment in Social Science?” Bill re-

ceived his Ph.D. in 1978 from the University of Connecticut. He is currently Presi-

dent of the Society for Medical Anthropology. He has done fieldwork in the West

Indies, the southern United States, Brazil, Mexico, and the United Kingdom on

how the social contexts of culture shape cardiovascular physiology. His book

Stress and Adaptation in the Context of Culture. Depression in a Southern Black

Community (1991) is a compelling examination of the social sources of psycho-

logical distress. Bill argues that cultural consensus analysis provides a method for

systematically assessing cultural construction of lifestyle and then links this per-

spective to the social constraints on achieving a culturally desired lifestyle. He has

found across cultural settings and diseases that those whose culturally constructed

aspirations are blocked by social constraint are most susceptible to developing

chronic disease.

Rayna Rapp examines the productive interchange between medical anthro-

pology and feminist theory and activism in the study of reproduction in her article,

“Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduc-

tion to the Center of Social Theory.” Rayna taught anthropology and gender stud-

ies at the Graduate Faculty of the New School for Social Research until she re-

cently moved to the Department of Anthropology at New York University. Her

edited volumes Toward an Anthropology of Women (1975) and Conceiving the

New World Order. The Global Politics of Reproduction (1995, with Faye

Ginsburg) have helped to build a feminist agenda within medical anthropology and

the study of reproduction more broadly. Rayna’s book Testing Women, Testing the

Fetus. The Social Impact of Amniocentesis in America (1999) was named co-win-

ner of the Eileen Basker Prize in gender and health research. Her work has em-

ployed the analysis of biomedicine as a key site for interrogating the social and cul-

tural underpinnings of science. Her work has made visible the centrality of

“reproduction” to social life and demonstrates the centrality of active engagement

between activists and scholars to make the study of reproduction in its broadest

sense a vibrant domain of research.

Margaret Lock’s article, “The Tempering of Medical Anthropology: Trou-

bling Natural Categories,” provides several agendas for medical anthropology re-

search and makes clear many things that need to be done in the next decades. Mar-

garet is professor of social studies of medicine and anthropology at McGill

University. Her book Encounters with Aging. Mythologies of Menopause in Japan

and North America (1993) won, among other prizes, the Wellcome Medal in

Medical Anthropology and the Eileen Basker Prize in gender and health research

from the Society for Medical Anthropology. Margaret’s article, with Nancy

Scheper-Hughes, “The Mindful Body: A Prolegomenon to Future Work in Medi-

cal Anthropology,” which appeared in the inaugural issue of Medical Anthropol-

ogy Quarterly, was a major force in turning our field’s attention to the “body” in a

rich and productive way. Her book Twice Dead: Organ Transplants attd the Rein-

vention of Death (2002) promises to continue and reshape this important area of in-

vestigation within our field. As do the other authors here, Margaret argues that

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medical anthropology is a key site of communication across disciplinary bounda-

ries both within and outside anthropology. She proposes the term “biopolitics” to

link studies of the meanings of illness and challenges to the “natural” categories of

biomedicine with examination of the social relations that produce the forms and

distribution of sickness in society. She argues convincingly for linking studies of

local cultures to local biologies to elucidate the dialectical relationship that shapes

these two core areas of our discipline. She ends by echoing others’ calls to link our

analyses to action. As she puts it, “Medical anthropologists have much to keep

them occupied.”

My goal in fostering the publication of this dynamic set of articles is to en-

courage us to occupy our minds absorbing, discussing, and debating the challeng-

ing ideas put forth to move medical anthropology forward. This set of articles

should occupy all of us in assessing the accomplishments of our field. At the same

time, it should energize us to communicate our insights beyond anthropology into

the public sphere. My hope is that these articles spur us forward to new investiga-

tions that synthesize rather than fractionate our field and that move us toward ac-

tions that alleviate the heavy burden of suffering caused by sickness in our world.


Acknowledgments. I want to acknowledge Mac Marshall, editor of Medical Anthro- pology Quarterly, for his efforts to publish this special issue and to thank the presenters for

their additional work in turning their presentations into a set of articles that enriches the field

in so many ways.


Dressler, William W.

1991 Stress and Adaptation in the Context of Culture: Depression in a Southern Black

Community. Albany: State University of New York Press. Leslie, Charles, ed.

1997 Asian Medical Systems: A Comparative Study. Berkeley: University of Califor- nia Press.

Leslie, Charles, and Allan Young, eds.

1992 Pathways to Asian Medical Knowledge. Berkeley: University of California Press. Lock, Margaret

1993 Encounters with Aging: Mythologies of Menopause in Japan and North America.

Berkeley: University of California Press. 2002 Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: Univer-

sity of California Press.

Rapp, Rayna

1999 Testing Women, Testing the Fetus: The Social Impact of Amniocentesis in Amer-

ica. New York: Routledge.

Rapp, Rayna, and Faye D. Ginsburg, eds.

1995 Conceiving the New World Order: The Global Politics of Reproduction.

Berkeley: University of California Press.

Reiter, Rayna R., ed.

1975 Toward an Anthropology of Women. New York: Monthly Review Press.

Rubel, Arthur J., Carl W. ONell, and Rolando Collado-Ard6n

1984 Susto, a Folk Illness. Berkeley: University of California Press.

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Issue Table of Contents
Medical Anthropology Quarterly, Vol. 15, No. 4, Special Issue: The Contributions of Medical Anthropology to Anthropology and Beyond (Dec., 2001), pp. 421-567
Volume Information [pp. 563-567]
Front Matter [pp. 421-422]
Introduction: The Contributions of Medical Anthropology to Anthropology and beyond [pp. 423-427]
Backing into the Future [pp. 428-439]
The Contribution of Medical Anthropology to a Comparative Study of Culture: Susto and Tuberculosis [pp. 440-454]
Medical Anthropology: Toward a Third Moment in Social Science? [pp. 455-465]
Gender, Body, Biomedicine: How Some Feminist Concerns Dragged Reproduction to the Center of Social Theory [pp. 466-477]
The Tempering of Medical Anthropology: Troubling Natural Categories [pp. 478-492]
In Search of Community: A Quest for Well-Being among Tamil Refugees in Northern Norway [pp. 493-514]
Negotiating the New Health Care System in Cape Town, South Africa: Five Case Studies of the Acutely Chronically Ill [pp. 515-532]
Virginity Testing: Managing Sexuality in a Maturing HIV/AIDS Epidemic [pp. 533-552]
Book Reviews
Review: untitled [pp. 553-554]
Review: untitled [pp. 554-556]
Review: untitled [pp. 556-558]
Review: untitled [pp. 558-559]
Review: untitled [pp. 560-561]
Review: untitled [pp. 561-562]
Back Matter