S&A 45B

Culture, Illness, and Health

Spring semester 2006

Friday 2:15-5:15, Kohlberg 228

 

 

  Everything humans do is culturally constructed.  Our experiences of health, illness, and healing are no exceptions to this.  This course examines the cultural construction of health, illness, and healing by looking at(mainly)anthropological treatments of these issues, which treatments contain in depth attention to natives in real life situations.  Our case materials will be drawn from a number of cultures, both non-Western and Western.  We’ll wind up with an anthropologically informed, social historical look at the biomedical model which dominates the modern American experience of health, illness, and healing; as well as the medical pluralism which characterizes modern America.

 

 And now, for those of you who don’t yet know me, an introduction.  I’m Steve Piker, an anthropologist.  Earlier in my career I did field work in a Thai rice village, where I lived for two years with my spouse and, for the second of the years, with our infant son, Josh.  The field work focused, inter alia, on popular religion, which in Thailand is Theravada Buddhism.  And, as I reconstruct it in my memory, that is when and where my anthropological interest in the issues of this course originated; because in Thailand, as in so many traditional cultures, the issues of illness and health and healing receive a largely religious phrasing.  More recently, I’ve worked with religious conversion in the United States.  I’ve been teaching anthropology at Swarthmore for longer than you folks have been alive, and for the past several years I’ve also worked as foreign study adviser.

 

  What you can expect of me:  You can expect me to be informal, friendly, always welcoming of your contributions(including suggestions about the course), responsive to your questions, and accessible.  I’ll be glad to see you in my office, either during office hours or by appointment, and will be glad to hear from you by e-mail as well.

 

Office:  Kohlberg 244

Office Hours:  TTH 9:30-11:30

Phone:  8111

e-mail:  spiker1@swarthmore.edu

 

  What I expect of you:  The specifics of what this course calls upon you to do are set forth in the syllabus, below.  Generally, I expect you to be unfailingly considerate of your fellow students in the work that we will be doing together this semester;  I expect you to produce your work for this course in the manner set forth in the syllabus;  I expect you to be punctual in the production of your work and to make sure you get to class on time; and I expect you not to hesitate to be in touch with me out of class whenever you are disposed to do so.  I expect you to be adults.

 

 

SYLLABUS TABLE OF CONTENTS

 

I)              Readings

II)            Course Procedures

III)          Organization of Subject Matter Outline

IV)          Schedule of Class Meetings

V)            Poster Session/Paper assignment

VI)          Final Exam Assignment

VII)        Terms and Concept

 

 

I)              READINGS

 

  The following books are available for purchase in the College bookstore.  Each will be read in its entirety, or almost so.  Copies of each will be available as well at the reserve desk in the library, and no member of the class is required to buy any books for this course.  In addition, a few articles or chapters will be assigned, which will be handed out in class.

 

Marina Roseman.  HEALING SOUNDS FROM THE MALAYSIAN RAINFOREST

Richard Katz.  BOILING ENERGY

Anne Fadiman.  THE SPIRIT CATCHES YOU AND YOU FALL DOWN

A.    Kleinman and B. Good(editors)  CULTURE AND DEPRESSION

A. Kleinman.  THE ILLNESS NARRATIVES

Melvin Konner..  BECOMING A DOCTOR

Hans Baer.  BIOMEDICINE AND ALTERNATIVE HEALAING SYSTEMS IN AMERICA

Theresa DeLeane O'Nell.  DISCIPLINED HEARTS.  HISTORY, IDENTITY, AND DEPRESSION IN AN AMERICAN INDIAN COMMUNITY

 

 

II)            COURSE PROCEDURES

 

  The class will meet FRIDAY AFTERNOON, 2:15 to 5:15, in Kohlberg 228.  Class meetings will be given over to a mixture of discussion, lecture, and presentation and discussion of student reports and projects.

 

  Required work for this course includes:

 

A)   Not graded:  submission at the first class meeting of a brief ‘episode of illness’ essay(assigned, below, under week 1, Schedule of Class Meetings)

B)   Not graded:  preparation and presentation in class of a group report, on a topic featured by the assigned reading for the week.  Report groups will consist of two or three students, and each group report topic will be assigned the previous week in class.

C)   Graded:  Poster session/paper(assigned in V, below)

D)   Graded:  Final exam(assigned in VI, below)

E)    Class attendance is required.  Unexcused absence(s) will result in a grade penalty.  The reason for this is that much of each class period will be devoted to us working with and helping each other, re the subject matter.  Participating in this is a requirement of the course.

F)    Your grade can be helped, but not harmed, by class participation.  Each of you is strongly encouraged to participate.  This is a main way in which we help each other, and enrich and enlarge our learning experiences.

G)   Grades.  Poster session/paper and final will weigh equally in computation of your grade.  Your grade can be improved by class participation.  There will be grade penalties for unexcused absence, late work, not doing a group report.  What grades mean:  B means good work, much relevant and important material well handled, well organized, no serious problems; C means acceptable work, some important material well handled, either some significant problem or not enough important material well handled, or both; D means poor work, no important material really well handled and/or a number of significant problems; F means failing work; A means everything for B plus you have shown unusual sophistication and/or intelligent creativity in your essay.

 

  Now, some suggestions for how to produce your work for this course:

 

A)   Deadlines for required work(‘episode of illness’ piece, group report, poster session and paper, final exam)are in the syllabus.  For the ‘episode of illness’ piece, do it off the top of your head, an hour max, could well be less.  For your group report, prepare it with your groupies during the week before it is to be presented in class.  An hour should be more than enough for this(this will be discussed in detail in class).  The paper is due the last day of exam period, and the completed final exam will be due at the end of our scheduled three hour exam time during finals week.  But it will be A VERY GOOD IDEA for you to spread your work for these two assignments over several weeks.  For some of the exam questions, all of the relevant subject matter will be covered well before end of semester, and essays for these questions can and should be prepared in draft during the second half of the semester.  For the poster session/paper assignment, you should have a meeting with me before spring break, present the poster during the class meeting scheduled for this following the break, and prepare the final draft of the paper over the next several weeks.  You are encouraged to review drafts of the paper with me before you submit the final draft.

B)   For both the final exam and the poster/paper, the assignments call upon you to develop  lines of reasoning in .support of points or a conclusions that you will posit.  My assessment of your work will be based just about completely on how strong your lines of reasoning are.

C)   This is an anthropology course.  Cultural case material is largely where it’s at.  For all of your essays – paper and exam essays – a major part of your responsibility will be to identify relevant case material and use it effectively in the development of your line(s) of reasoning.

D)   For both paper and exam, I am glad to review your preparation with you.  About this, a couple of things:   First, I mean ‘preparation’ literally.  I am glad to review with you(only)work that you have already produced.  Bring or e-mail to me something in draft.  If you come to see me and, in effect, ask, ‘Is it alright if I do it this way or that way?’ you should expect that we will have a real brief conversation.  Second, there is the time consideration.  I have only so much of it.  If you get to me, say, a week or ten days before deadline with draft for review, there is an excellent chance that we can do our review.  If you get to me one or two or three days before deadline, the prospects for the review will be nowhere near as good.

E)    Please remember:  as far as the assigned readings are concerned, the sum total of your accountability for grading purposes is the final exam and its questions and the issues they pose.  It’s A VERY GOOD IDEA to read over the final exam questions no less than once a week, so that these issues will be in your mind as you are doing the reading, and you can be doing your reading – and your thinking about the reading – expressly with reference to these issues.

F)    And it’s a good idea to peruse the entire syllabus each week, because the syllabus tells the story of the course as I intend it and understand it.

G)   From time to time, I will be e-mailing messages to the entire class, perhaps commentary on subject matter or class discussion, perhaps schedule information, whatever.  Please attend to this; you are responsible for everything you receive from me. And, each of you will have the address list of the entire class.  As ideas,  questions, references to books or articles……of interest occur to you, you are strongly encouraged to share them with all of us.  It will truly be a service!

 

 

 

III)          ORGANIZATION OF SUBJECT MATTER OUTLINE

 

A)  Non-Western ethnomedical systems

 

1)    Illness and healing as social process

2)    Cultural phrasings of health, illness, and healing

3)    Illness and healing as personal and social transformation

4)    Depression viewed culturally and cross culturally

 

B)   Biomedicine, and medical pluralism in modern America

 

1)    The professionalization of healing

2)    Biomedicine and a medically plural American culture

3)    Can biomedicine be user friendly?  The proper role for the doctor.

4)    Healing as an arena for the clash of cultures

 

 

IV)          SCHEDULE OF CLASS MEETINGS

 

Please N.B.:  readings are correlated with the topic(s) of the week.  It is important that you do the assigned reading for the week before the class meeting.  Class discussions will be predicated upon this.  THE AMOUNT OF ASSIGNED READING VARIES CONSIDERABLY BY WEEK. Good idea to devote time in week one to looking at the in depth cultural case materials assigned for the next couple of weeks.  For just about all of you, the cultures – and, specifically, the healing usages – described will be esoteric, probably at the outset it will require some special effort to get your minds around what you are reading.

 

20 January.  Introduction; the concept of ethnomedicine; review of class procedures.

 

A)   Pleased bring to class a brief essay, one and a half or two pages, in which you describe an episode of illness of which you have first hand knowledge; or, if you prefer, e-mail it to me before our class meeting.  Don’t spend more than an hour on this, do it off of the top of your head.

B)   We will devote a good part of the class time to a buzz group exercise.  For this, the class will be divided into groups of 4-5 students, and each group will be asked to discuss for about fifteen minutes the ethnographic vignettes, right below, with reference to the questions and issues that follow them.  Then each group will report the gist of its discussion to the full class.

 

An ethnographic vignette

 

In the Thai rice village of Baan Oi(sugar cane village)in which I lived and did field work for a couple of years, an elderly woman came down with the following symptoms:  stomach pains, sometimes acute; vomiting; appetite loss; weight loss; lethargy; disorientation.  She was bed ridden and cared for by members of her household.  Her family asked a local healer – an herbalist and ‘ghost doctor’ – to see what he could do about the old lady’s affliction.  He determined that the source of the affliction was a particularly feared type of ghost, who gets into the victim’s abdominal cavity and eats away the victim’s insides.  By way of treatment, the healer performed at bedside a couple of rituals for the afflicted lady:  a ‘soul binding’ ritual, intended to insure that her soul would remain with her and not flee, and/or restore it to her if it had already fled; and a ghost exorcism.  Over a period of a few weeks, both rituals were performed a few times. The symptoms did not abate.  In fact, by the time we left the village a couple of months later, they appeared to have worsened.

 

Another ethnographic vignette

 

In an Appalachian Pentacostal congregation, some members at services from time to time handle poisonous snakes.  This is understood by congregants as a test of the strength and purity of one’s faith, and congregants find scriptural justification for this belief and the corresponding practice(“…and they shall take up serpents…”).  On one such occasion, a snake handler was bitten by the poisonous snake that he had draped around his neck and shoulders.  Non-Pentacostal visitors to the religious meeting at which this occurred urged the snake bite victim(who immediately began to exhibit the symptoms of poisonous snake bite)to go right away to the nearest hospital.  But the snake bite victim refused to do so(and in so doing was supported by his fellow congregants), insisting that this was not a matter for a hospital.  Rather, he avowed, the snake bite was the will of God; and in fact God, through this event, was testing his faith.  It was, therefore, his religious duty to leave his affliction and its outcome in the hands of God, and not to treat it as a medical problem.

 

Members of the class are asked to address the following:

 

1)    Are these afflictions diseases?

 

2)    With these two cases in mind, please attempt to propose a general definition of disease.

 

 

 

27 January.  Illness and healing as social process.

 

Reading:  Richard Katz.  BOILING ENERGY

 

Group report:  Collective ritual as healing agent

 

 

3 February.  Cultural phrasings of health, illness, and healing

 

Reading:  Marina Roseman.  HEALING SOUNDS FROM THE MALAYSIAN RAIN FOREST

________  “Engaging the spirits of modernity:  the Temiars.”  In:  Linda Connor and Geoffrey Samuel(Editors).  HEALING POWERS AND MODERNITY:  TRADITIONAL MEDICINE, SHAMNISM, AND SCIENCE IN ASIAN SOCIETIES.  Handout.

 

Group report:  Ethnomedicine and ethnomusicology – the aesthetics of sound and the practice of healing

 

 

 

10 February.  Illness and healing as personal and social transformation.

 

Reading:

Gananath Obeyesekere.  “Buddhism, depression, and the work of culture in Sri Lanka.”  In:  Kleinman and Good.  CULTURE AND DEPRESSION

________  “A psychocultural analysis of a case of spirit possession in Sri Lanka.”Handout.

 

Group report:  re Obeyesekere, exorcism, and healing:  the work of culture

 

 

17 February.  Depression viewed culturally and cross culturally.

 

Readings:  Kleinman and Good.  CULTURE AND DEPRESSION.  Intro to part 1, chs 2,3,4,6,8,9,10,12,13, epilogue.  These readings are for both this week and week of 26 March.  The group report for this week focuses on chs. 2 and 4.

 

Group report:  the cultural translation of depression

 

 

24 February.  Depression viewed culturally and cross culturally(continued).

 

Readings the same as for week of 17 February.

 

Group report:  the cultural translation of depression.

 

 

3 March.  No class meeting.  Individual appointments with SP to discuss poster/paper.  It is expected that you will have looked at your poster/paper book prior to your appointment.

 

 

10 March.  SPRING BREAK

 

 

17 March.  Depression viewed culturally and cross cultural(continued)

 

Reading:  Theresa DeLeane O'Nell.  DISCIPLINED HEARTS

 

Group report:  Emic and Etic perspectives on Flathead Indian depression

 

 

24 March.

 

  Mari Clemens, Nutrimtion Clinical Specialist at Worth health Center will join the class to discuss Asian healing systems, presence of same in modern America. and juxtaposition of same in modern America with biomedicine.  Readings to be handed out in advance of the class meeting.

 

 

31 March.  The Professionalization of Healing

 

Reading:

Eliot  Friedson.  PROFESSION OF MEDICINE, Editor’s Intro, Preface, Intro, chs. 1 and 4.  Handout.

Melvin Konner.  BECOMING A DOCTOR

 

Group report:  medicine as a profession, and medical training

 

 

 

7 April.  Biomedicine and medical pluralism in modern America

 

Reading:  Hans Baer.  BIOMEDICINE AND ALTERNATIVE HEALING SYSTEMS IN AMERICA.  ISSUES OF CLASS, RACE, ETHNICITY, & GENDER

 

Group report:  medical pluralism and its correlates

 

 

14 April.  Alternative perspectives on the role of the doctor

 

Reading:  Arthur Kleinman.  THE ILLNESS NARRATIVES.  SUFFERING, HEALING, & THE HUMAN CONDITION

 

Group report:  illness as a career; possible and/or desirable permutations on the role of physician.

 

 

21 April.  Poster sessions

 

 

28 April.  The clash of cultures; and, can biomedicine be user friendly?  Wrap up.

 

Readings:

Anne Fadiman.  THE SPIRIT CATCHES YOU AND YOU FALL DOWN. A HMONG CHILD, HER AMERICAN DOCTORS, AND THE COLLISION OF TWO CULTURES

Arthur Kleinman.  THE ILLNESS NARRATIVES. SUFFERING, HEALING, & THE HUMAN CONDITION.

 

Group report:  illness as a career; possible and/or desirable permutations on the role of physician.

 

 

 

V)            POSTER SESSION/PAPER ASSIGNMENT

 

  The paper(10-12 pages)is due at the end of final exam period, and the poster sessions which are preparatory for the final draft of the paper are scheduled for 19 March.   For the poster/paper, each student will read one book beyond the assigned reading on the syllabus.  Here’s how we want it to work:

 

1)    Each poster/paper will focus upon an issue germane to the course.  Six general issues are set forth, below, and for each issue a number of relevant books are suggested.

2)    Each student will select, from this list, an issue and a relevant book.  More than one student can write on the same book.  If and when this occurs, the students will be expected to share the book, and will be encouraged to consult with each other at the preparation stages.

3)    The specific procedures for the poster session will be discussed in class.  Here I just note that the poster which each of you will present on 21 April should encompass graphically(e.g., pictures, diagrams, charts….you name it)the gist of what you provisionally intend, by way of line of reasoning and conclusion, to include in your paper.  THERE SHOULD BE VERY LITTLE BY WAY OF PROSE ON THE POSTER.  The point of this is to enable other members of the class, including yours truly, to spend a couple of minutes looking at your poster, maybe ask a question or two, and then be able to talk sensibly with you about it.  For each and all, this will pay two dividends:  each will get an introduction to the paper project and its subject matter of every other member of the class, and each will get feedback and suggestions from other members of the class, including yours truly, which can and should be taken into account in preparing the final draft of the paper.

4)    Prior to the poster sessions, each member of the class will  have a scheduled meeting with yours truly to discuss the topic.  Following the poster session, you are encouraged to review preparation of your final draft with me.

5)    You don’t have to stay with this list of topics and books.  You may, if you wish, define your own topic and select an appropriate book for the topic.  If you do so, it’s a real good idea to review your selections with me, to make sure they are ok.  For you and I to conduct such a review, it will be necessary for you to tell me your topic and issue, and why the book you have selected is relevant to it.  It won’t be of use for you simply to name a book and ask me, in effect, is this book ok?

6)    It is your responsibility to be sure that the book you are using will be available to you when you need to use it.  If this condition doesn’t obtain, change books.  Unavailability of a book will not be an acceptable excuse for late work.

7)    AND, please N.B. the time line for the poster session/paper project:  a)  class meeting of 17 February is deadline for selection of book/issue.  We will also schedule individual appointments with yours truly at this time. b)  Weeks of 24 Feb,  3 March, make a start on the book.  c)  Week of 3 March, have your scheduled appointment with yours truly to discuss the directions you will be taking with your poster/paper. d)  Class meeting of 21 April present your poster.  e)  Final draft of paper due at end of exam period.

 

 BELOW, PLEASE FIND ISSUES OR TOPICS, WITH SUGGESTED READINGS FOLLOWING

 

(In parentheses, following each book, you will find an availability code.  S:  at Swarthmore,  H: at Haverford;  B: at Bryn Mawr; SP:  yours truly has a personal copy)

 

  Disease vector refers to an identifiable contributor to the occurance of illness.  Thus, biomedicine especially emphasizes, e.g., heredity and microbes and trauma as often important disease vectors.  It is also possible that historically conditioned, culturally elaborated lifeways may be disease vectors.  The volumes, below, provide illustrative case material..  The point of the paper is to show, using one study, how this works; and to explore the implications – for health, illness, and healing – of accepting lifeways, along with more orthodox biomedical categories, as disease vectors.

 

Konner, Shostak, and Eaton.  THE PALEOLITHIC PRESCRIPTION(H, SP)

 

Colin Turnbull.  THE MOUNTAIN PEOPLE(S,B,H,SP)

 

Nancy Scheper-Hughes.  SAINTS, SCHOLARS, AND SCHIZOPHRENICS:  MENTAL ILLNESS IN RURAL IRELAND(B)

 

________  DEATH WITHOUT WEEPING:  THE VIOLENCE OF EVERYDAY LIFE IN BRAZIL(S,H)

 

Anastasia Shkilnyk.  A POISON STRONGER THAN LOVE.  THE DESTRUCTION OF AN OJIBWA COMMUNITY(S,B,SP)

 

A Kleinman.  SOCIAL ORIGINS OF DISTRESS AND DISEASE:  DEPRESSION, NEURASTHENIA, AND PAIN IN MODERN CHINA(S,H)

 

Elaine Showalter.  HYSTORIES.  HYSTERICAL EPIDEMICS AND MODERN MEDIAS,B.H,SP)

 

Anthony F. C.. Wallace.  THE DEATH AND REBIRTH OF THE SENECA.(S,B,H,SP)

 

 

When someone becomes seriously or chronically ill, or old, an important social transformation occurs: the sick or elderly person understands and experiences himself or herself in new and different and distinctive ways, and is thought off and responded to be significant others in new and different and distinctive ways.  The roles of sick  and elderly person are like all other social roles(e.g., mother, student, mechanic, priest)in the important sense that they are culturally constructed and specific.  But they are unlike most other roles in that they are almost always unwelcome.  The studies, below, illustrate this social transformation.  The point of the paper is to detail, using one study, such a transformation, showing circumstantially why the outcome is unwelcome; and to explore the implications of this circumstance for the development of humane responses to serious or chronic illness, or growing old.

 

Robert Murphy.  THE BODY SILENT(S,SP)

 

Myra Bluebond-Langner.  THE PRIVATE WORLDS OF DYING CHILDREN(B)

 

Barbara Myerhoff.  NUMBER OUR DAY(S,B)

 

Charlotte Ikels.  AGING AND ADAPTATION.  CHINESE IN HONG KONG AND THE US(S,B)

 

Jennie Keith.  AGING:  DIVERSITY AND COMMONALITY ACROSS CULTURES(S)

 

Kathy Charmaz.  GOOD DAYS, BAD DAYS.  THE SELF IN CHRONIC ILLNESS(B)

 

E.Zevarubel.  PATTERNS OF TIME IN HOSPITAL LIFE(H)

 

Erving Goffman.  ASSYLUMS(H)

 

 

Biomedicine purports to be applied science.  It is also a profession.  The volumes, below, detail important aspects of the professionalization of medicine, and/or treat issues surrounding this circumstance.  The point of the paper is to show the ways in which and the extent to which professionalization structures and imparts distinctive content to healing, and enables or constrains, or both, developments in this domain.

 

Paul Starr.  THE SOCIAL TRANSFORMATION OF AMERICAN MEDICINE.(S, H, BM, SP)

 

Eliot Friedson.  THE PROFESSION OF MEDICINE(S,B,SP)

 

John Ehrenreich.  THE CULTURAL CRISIS OF MODERN MEDICINE(S,B)

 

Byron Good.  MEDICINE, RATIONALITY,AND EXPERIENCE:  AN ANTHROPOLOGICAL PERSPECTIVE(S,H)

 

 

Many ethnomedical systems posit that illness often occurs as the result of the malign intentions of one’s neighbors.  In such situations, the cultural construction of illness and healing is likely to be inseparable from how natives understand their relationships with each other.  Using one of the volumes, below, the point of this paper is to show how the latter influences the former, and to explore the implications of this for native understandings of and responses to issues of health and illness.

 

Clyde Kluckhohn.  NAVAHO WITCHCRAFT(S,B)

 

Reo Fortune.  SORCERERS OF DOBU(S,B)

 

Lucy Mair.  WITCHCRAFT(H,SP)

 

Ron Querry.  THE DEATH OF BERNADETTE LEFTHAND(H,SP)

 

E.E. Evans-Pritchard.  WITCHCRAFT, ORACLES, AND MAGIC AMONG THE AZANDE.(S,B,H)

 

Jeanne Favret-Saada.  DEADLY WORDS.  WITCHCRAFT IN THE BOCAGE(B)

 

 

When an ethnomedical system posits that illness sometimes is caused by some of the suprahuman beings that populate the culture’s pantheon, natives often will attempt to interact in specific ways with these same beings in pursuit of healing.  The point of the paper is, first, to characterize this interaction and, second, to assess possible healing outcomes from both an emic and etic point of view.

 

Bruce Kapferer.  A CELEBRATION OF DEMONS(S,B,SP)

 

Nancy Ammerman.  BIBLE BELIEVERS.  FUNDAMENTALISTS IN THE MODERN WORLD(S,H)

 

Horacio Fabrega and D. Silver.  ILLNESS AND SHAMANISTIC HEALING IN ZINACANTAN(H)

 

Gananath Obeyesekere.  MEDUSA’S HAIR(S,H,SP)

 

Calvin Martin.  KEEPERS OF THE GAME.  INDIAN-ANIMAL RELATIONS AND THE FUR TRADE(S,B,SP)

 

Henry Michael(edit)   STUDIES IN SIBERIAN SHAMANISM(B)

 

Emiko Ohnuki-Tierney.  ILLNESS AND HEALING AMONG THE SAKHALIN AINU:  A SYMBOLIC INTERPRETATION(B)

 

Ruth Landes.  OJIBWA RELIGION AND THE MIDEWIWIN(S,B)

 

Frank Speck.  PENOBSCOT SHAMANISM(S)

 

Gladys Reichard.  NAVAJO RELIGION(S,B,SP)

 

Thomas Csordas.  BODY/MEANING/HEALING(B,H,SP)

 

 

The mythos of biomedicine posits, inter alia,  that modern medicine is applied science and, derivatively, that determination of diagnostic categories, of what qualifies as an illness,  results from objective application of unambiguous scientific criteria and methods.  However, inspection of the history of biomedicine shows that delineation of illnesses often involves negotiation, and that non-medical and non-scientific cultural factors often figure prominently in such negotiations.  This has been especially evident in the mental health field and the branch of medicine known as psychiatry.  The point of the paper is, first, to identify an instance of such negotiation and, second, to elucidate how the interplay of science and other cultural forces shapes the definition of illness.

 

Elaine Showalter.  HYSTORIES.  HYSTERICAL EPIDEMICS AND MODERN MEDIA(S,B,H)

 

__________  THE FEMALE MALADY:  WOMEN, MADNESS, AND ENGLISH CULTURE, 1830-1980(S,B,H)

 

Allan Young.   THE HARMONY OF ILLUSIONS:  INVENTING POST-TRAUMATIC STRESS DISORDER(S,B)

 

Herb Kutchins.  THE SELLING OF DSM:  THE RHETORIC OF SCIENCE IN PSYCHIATRY(S,B)

 

_______ and Stuart S. Kirk.  MAKING US CRAZY.  DSM: THE PSYCHIATRIC BIBLE AND THE CREATION OF MENTAL DISORDERS.  (S, SP)

 

Dennis Healy.  THE ANTI DEPRESSANT ERA( S, SP)

 

Debbie Nathan and Michael Snedeker.  SATAN’S SILENCE.  RITUAL ABUSE AND THE MAKINGS OF A MODERN AMERICAN WITCH HUNT(S,H,SP).

 

Robert Whitaker.  MAD IN AMERICA.  BAD SCIENCE, BAD MEDICINE, AND THE ENDURING MISTREATMENT OF THE MENTALLY ILL(H,B,SP)

 

 

  For its hundred(plus or minus)year history, biomedicine has always been high tech.  Its ‘applied science’ aura has been essential to the extraordinary legitimacy it has attained, especially in modern America.  Advances of the past two or three decades, however, in biotechnology have fostered ‘newly ramifying cultural effects…’(Brodwin, just below), which change the ways in which we think about and experience such fundamental issues as identity and social obligation and even life itself.  ‘These technologies have emerged from years of specialized laboratory and clinical research.  They come with the aura of objective science and the prestige of a highly trained and credentialed  class of experts.  The meanings of these technologies, however, quickly escape professional control and infiltrate the diverse domains of everyday life’(Brodwin). The point of the paper is to show how modern biotechnology has been implicated in fundamental cultural reformulations,and how this affects our conceptions of illness and healing and human potentiality.

 

Paul Brodwin(edit)   BIOTECHNOLOGY AND CULTURE.  BODIES, ANXIETIES, ETHICS

 

Renee Fox and Judith Swazey..  THE COURAGE TO FAIL:  A SOCIAL VIEW OF ORGAN TRANSPLANTS AND DIALYSIS. (H,B)

 

Charles Bosk.  ALL GOD’S MISTAKES:  GENETIC COUNSELING IN A PEDIATRIC HOSPITAL.  (S, Cornell)

 

Gena Corea et al.  MAN-MADE WOMAN:  HOW NEW MAN MADE REPRODUCTIVE TECHNOLOGIES AFFECT WOMEN(S,B,H)

 

Carl Cranor(edit)  ARE GENES US?  THE SOCIAL CONSEQUENCES OF THE NEW GENETICS(H)

 

Sarah Franklin and Helena Ragone(edit)  REPRODUCING REPRODUCTION:  KINSHIP, POWER, AND TECHNOLOGICAL INNOVATION(S,H)

 

Albert R. Jonsen.  THE BIRTH OF BIOETHICS(H)

 

Andrew Kimbrell.  THE HUMAN BODY SHOP:  THE CLONING, ENGINEERING, AND MARKETING OF LIFE. (S)

 

Nancy Lublion.  PANDORA’S BOX:  FEMINNISM CONFRONTS REPRODUCTIVE TECHNOLOGY(H)

 

Robyn Rowland.  LIVING LABORATORIES:  WOMEN AND REPRODUCTIVE TECHNOLOGIES(H)

 

 

 

VI)          FINAL EXAM

 

  At the start of our scheduled three hours exam period during finals week at the end of the semester, three from the list of questions, below, will be specified for you to answer.  Completed exams will be due three hours later.  Each essay should be about 700-800 words.  Further:

 

A)   You are encouraged to prepare your essays in advance and review your preparation with yours truly before the scheduled exam period.

B)   Members of the class are encouraged to work together in small groups(3-4 students)in preparing the exam.  Groups that do so may, with my permission, submit a single exam for the group.

C)   Extra credit option:  if you submit more essays than the required three, and if some or all of the essays are at least as good as the three that you are required to write, you will receive extra credit in the form of a boosted grade(unless you already have a grade of A, in which case it doesn’t get any better than that).

 

 

EXAM QUESTIONS

 

 

1)    “It is at the level of emotion that humans are most unalterably uniform.”  Please discuss and evaluate, with reference to the papers by Lutz and Obeyesekere in the CULTURE AND DEPRESSION volume, and any other one study of your selection from the same volume.

 

2)    “A therapeutic outcome often involves both the personal and social transformation of the patient.”  Please illustrate this, and attempt to show how it works, with two or three well selected examples from our course materials.

 

3)    In his book, ILLNESS NARRATIVES, Kleinman tries his hand at reconfiguring the role of physician.  You are asked to describe the changes that Kleinman calls for, identify his grounds for making the call, and evaluate his proposals.

 

4)    This course has suggested that central features of biomedicine as a healing system result from the professionalization of healing that it embodies.  Each of us as lay people has first hand experience with biomedicine in some of its several concrete expressions, e.g., a doctor’s office, a pharmacy, the College health service, a hospital, drug advertisements in the media.  You are asked to identify one such example with which you have first hand experience and, from your observations, to show ways in which the professionalization of healing expresses itself in your chosen example, and how these expressions impart distinctive content to what goes on there.

 

5)    “In most cultures – ‘primitive’ as well as ‘civilized’ – where the ethnomedical system leaves off and the religious system begins is impossible to say.”  Accepting that this is so, and our course provides several cultural cases which illustrate this state of affairs, you are asked, why should this be so?

 

6)    No matter how successful healing may be, illness and death  are inescapable for each and all of us. The !Kung(as a community of healers, albeit with specialists)and Arthur Kleinman(a medical anthropologist and – sometimes – practicing physician)accept that this must be so.  Each, in his(their)own fashion, believe that the therapeutic process should and can accommodate this circumstance.  You are asked to compare and/or contrast the accommodations offered by each.  In working on this, you may wish to consider the following question:  when there is no prospect of recovery(, e.g., chronic or terminal illness), what good(s) may still be available to the patient,  and how may they become available?

 

7)    Please, now, revisit and rewrite your ‘episode of illness’ piece, submitted at the first class meeting.  In doing so, please illuminate the episode, and edify your reader, by bringing to bear on it knowledge and perspectives that you have gleaned from this course.

 

8)    Please make up a question which frames an issue important to the subject matter of this course, and answer it.

 

 

VII)        TERMS AND CONCEPTS

 

  The following terms and concepts will be important to us during the semester.

 

1)    Ethnomedicine(or ethnomedical  system).  For any culture, the ethnomedical system is the culturally specific way of understanding and responding to the nexus of issues, health/illness/healing/dying.  As such, the ethnomedical system is coordinate with, e.g., the religious system, the kinship system,  the educational system, subsistence practices………  Of course, we can name and define each of these cultural systems independently.  However, the extent to which such cultural systems are mutually segregated domains in the lives and experiences of natives is properly an empirical question.  We see a high level of such segregation in middle class America.  In most traditional cultures, there is much less segregation, sometimes bordering on none.

 

2)    Culture.  Anthropologists use the term ‘culture’ in(at least)the following two ways:

 

A)   General and evolutionarily.  Culture is the mode of adaptation of the human species.  All human groups, now and in the past, are fully cultural.   A cultural mode of adaptation features, e.g., language, technology and material culture, learned and diversifiable social relationships, and belief systems.  Necessary for all of this is capacity for symbolization.  In cross species perspective, it is evident that culture, in this sense, is not an all or none thing.  Many species – extant and extinct – other than the human species are cultural in different ways and to significant extents.

B)   Specific and contemporary.  A specific culture – e.g., !Kung, Sinhalese, Semang, Navajo – is the lifeway of a particular human group.  Human cultures are highly diverse.  Please N.B., this does not imply that a specific culture must be a neatly bounded self contained entity.  i.  Distinct cultures share traits.  ii.  Cultural boundaries are permeable: both people and culture traits cross them.  iii.  Many ‘named’ cultures – e.g., American, Creek Indian – are actually historically recent amalgams of several disparate cultures.  iv.  All cultures, by virtue of the ubiquity of diffusion, adopt and adapt and incorporate exogenous culture traits.  v.  An individual may have a multicultural identity.

 

3)    Cultural relativism.  This expression has many uses.  Here we note two of them.

 

A)   World views – how people think about and experience the world, especially life as we inescapably live it – are to a significant extent specific to cultures.  This is an empirical proposition.  It is indisputably true(although the limits to the proposition implied by, ‘…to a significant extent…’ are debated).

 

B)   Because, inevitably, we think about things in terms of the symbols and meanings embodied by our cultures(A, just above), universal, cross culturally valid, timeless truth is not possible.  This is a philosophical issue.  The truth of (A) does not, on logical grounds, address this issue.

 

C)   Taken in conjunction, (A) and (B) can often, for anthropologists(and others), be vexing.  Thus, accepting (A), as most anthropologists do, we are disposed to intend to respect cultural practices and the natives who enact them, even if the practices are alien or even obnoxious to us.  But sometimes we find the practices – e.g., what the Nazis did, female genital mutilation – to be so repugnant that we feel obligated morally to condemn them..  When this occurs, we often find ourselves seeking a universally valid ethic to justify our moral condemnation.  Impressionistically, these efforts often have recourse to the device of ‘self evident truth’ – either negatively, through the use, e.g., of the term ‘evil’, or positively, e.g., by positing inalienable human rights.

 

4)    Ethnography(field work, participant observation).  Ethnography is the main empirical method for learning about local life, that is, natives in naturalistic everyday situations, how natives behave, what the situations mean to natives, and especially how natives experience their lives – in other words, culture, in the sense of (2,B), above.  The ethnographer usually lives with the people he or she is learning about, accommodates to their customs, tries to speak their language, and merges his or her life in socially significant ways with the lives of the people being studied.  Participation is a main means for learning.  Ethnography is not a single technique.  It can, and typically does, involve, e.g., observing, listening, conversing, questioning or interviewing, recording, and filming; and it may involve administration of tests.  An ethnographic study takes a long time.  The ethnographer may well be there pretty much non stop for a year, sometimes longer.  And often the ethnographer will return, sometimes more than once, for more field work.  Ethnography is done mainly, but by no means exclusively, by anthropologists, and has been going on in a sustained way around the world for more than a century.  Any and all aspects of local life – e.g., social relations subsistence practices, religiousness, family and kinship, violence, recreation, art, education, politics, material culture, substance abuse, healing practices, crime – can be studied ethnographically.  Ethnography helps mightily in uncovering the connections – especially as experienced – among different parts of natives’ lives, thereby enabling wholistic perspectives on local life.  Many thousands of ethnographic reports – e.g., books, articles, monographs, films – have been produced.  These reports, in the aggregate, comprise the ethnographic record.  The ethnographic record contains the most detailed and extensive documentation of the diversity of human lifeways available.  But, of course, it only treats a tiny fraction of human history and the human experience..

 

5)    Religion.  A definition of religion widely adopted by anthropologists goes like this:  Religion is ‘…an institution consisting of culturally patterned interaction with culturally postulated(and anthropomorphized) suprahuman beings.’  Accepting this definition, we can sensibly think of a particular religion, e.g., Judaism, Buddhism, Islam, Native American Shamanism, without knowing anything at all about anyone who embraces the religion.  We would do so by learning about, e.g., the beliefs and symbols and icons and rites of the religion.  Alternately, we can think about religiousness, which refers to religion as lived by individuals and groups.  Anthropologists interested in studying religion focus mainly on religiousness, the lived experience of and interaction with anthropomorphized suprahuman beings.  Since the anthropomorphized suprahuman beings who populate the pantheons of the religions of the world are so variable in their characteristics, and since the needs and hopes that natives bring to their interaction with these suprahuman beings are also variable(both within and across cultures), religiousness is enormously variable from time to time and place to place.

 

6)    Emic and Etic.  These funny sounding paired terms refer to two different perspectives on the same thing, the perspective  of the insider(native)and of the outsider(researcher, e.g., anthropologist).  They come from descriptive linguistics, where the ‘same thing’ is a speech sound.  For any speech sound, phonetics describes the sound in physical terms.  Only a trained linguist can do phonetics.  A native speaker can’t begin to do phonetics with his or her own speech, and the linguist’s phonetic representation of speech would be incomprehensible to a native speaker(unless the native speaker were also a trained linguist).  Phonemics, on the other hand, treats what makes the sound(s) uniquely meaningful to native speakers.  Whereas phonetics has nothing whatsoever to do with the speaker’s understanding of his or her speech, phonemics is grounded expressly in the speaker’s understanding of what his or her speech means, it embodies the speaker’s perspective on his or her own speech.

 

Analogously, recall the sick lady in the first ethnographic vignette, week 1.  The emic, the native, perspective on her situation says she is afflicted by ghost possession, and should be treated accordingly.  An etic perspective on the same thing, which would be sensible to us and is grounded in biomedicine, would say she is afflicted by a serious gastro-intestinal disorder, would name the disorder, interpret its etiology, and recommend a very different kind of treatment.  Or(week of 27 Sept.),  Gananath Obeyesekere presents for us the case of Somavati, a young married Sinhalese woman, who is also afflicted.  Obeyesekere gives us both the emic perspective on Somavati’s affliction(demon possession)and a psychologically flavored etic perspective grounded in the field of anthropology(culture and personality, or psychological anthropology), in which he is a leading scholar.

 

Further:  a)  For our two cases of affliction, the respective emic and etic perspectives certainly disagree.  Which is correct?  Almost always, for the anthropologist, this is not a useful question, we shouldn’t waste time on it.  Thus, I expect that most anthropologists don’t believe in the existence of ghosts and demons.  But it’s not part of our anthropological calling to treat native beliefs(and practices rationalized by them)as empirical propositions to be tested according to the procedures and criteria of Western science.  Rather, it’s our job, first, fully and accurately and contextually to describe the usages which are important in the lives of the natives we are learning about; and, second, to try to figure out why, in the context of these lives, these usages are compellingly sensible to the natives.    b)  It is increasingly commonplace, as literacy overtakes even remote parts of the third world, for natives to read studies of them produced by outsiders.  Often, these studies contain etic perspectives on native life and culture.  Sometimes native readers criticize these etic perspectives on the grounds that, as natives, they know the significance of the usages of their own culture; and if their native knowledge  disagrees with the outsiders knowledge, the outsider is ipso facto wrong.  What about this?  The point to remember is this:  emic and etic are disjunctive frames of reference.  The validity of an etic perspective is properly judged in terms of the frame of reference which generates it.  Of course, if we don’t think a frame of reference is worthwhile, then we won’t be interested in any of the perspectives it generates.  Thus, modern chemists don’t have much time for anything that comes from alchemy.  c)  Much of anthropology addresses the meaningfulness to natives of local life.  If we wish to interpret this, etically, as does Obeyesekere, it is imperative that we first learn and describe the emic perspective, as does Obeyesekere.  The emic perspective – e.g.,

Somavati’s experience of her possession episode and its sequalae – is Obeyesekere’s empirical object of analysis.  If he doesn’t have this in proper focus, he can’t get anywhere, no matter how worthwhile his etic interpretive frame of reference may be.

 

7)    Native.  We are all natives.  We differ from each other according to what culture(s) we are natives of.

 

 

 

"It rains on both the just and the unjust fella

 

But it rains mainly on the just, because  the unjust has stolen his umbrella"