Clinically Applied Anthropology Anthropologists in Health Science Settings: Anthropologists in Health Science Settings
Abstract
like other collections of papers related to a single topic, this volume arose out of problem-sharing and problem-solving discussions among some of the authors. The two principal recurring issues were (1) the difficulties in translating anthropo logical knowledge so that our students could use it and (2) the difficulties of bringing existing medical anthropology literature to bear on this task. As we talked to other anthropologists teaching in other parts of the country and in various health-related schools, we recognized that our problems were similar. Similarities in our solutions led the Editors to believe that publication of our teaching experi ences and research relevant to teaching would help others and might begin the process of generating principles leading to a more coherent approach. Our colleagues supported this idea and agreed to contribute. What we agreed to write about was 'Clinically Applied Anthropology'. Much of what we were doing and certainly much of the relevant literature was applied anthropology. And our target group was composed-mostly of clinicians. The utility of the term became apparent after 1979 when another set of anthropologists began to discuss 'ainical Anthropology'. They too recognized the range of novel be haviors available to anthropologists in the health science arena and chose to focus on the clinical use of anthropology. We see this as an important endeavor, but very different from what we are proposing.
... ave been developed over time in both the field of psy-chological anthropology and the field of medical anthropology (Black, 2023;Chapin, 2008). For instance, medical anthropologists have recently paid more focus on the social determinants of health, which is the study of how social and economic factors affect health outcomes (Charlier et al., 2017;N. Chrisman & Maretzki, 2012). Researchers in the field of psychological anthropology have paid close attention to the ways in which cultural norms and expectations influence people's feelings. These anthropological specialisations have been, and will be, hotbeds of innovation for years to come. ...
... The area of anthropology that focuses on the investigation of the cultural, social, and historical aspects of health and illness is known as the anthropology of illness and sickness. Health-related anthropologists look at how other cultures view and react to sickness (Apud & Romaní, 2020;Chapin, 2008;N. Chrisman & Maretzki, 2012). In this essay, I'll talk about the anthropological features of illness and sickness using examples from many cultures and eras. Anthropologists who research illness and sickness first look into how different societies throughout the world see and interpret the occurrence. Illness, for instance, is seen as a consequence of sin or spirit ...
Psychological and medical anthropology converge in illuminating the symbiotic relationship between psychological well-being and physical health. Although numerous academic disciplines share an interest in these inquiries, but they approach them from distinct vantage points. The current study scrutinizes the historical evolution, methodologies employed, and fundamental theoretical frameworks underpinning of these two specialized branches of inquiry. The initial segment of this exposition serves to introduce the realm of psychological anthropology, furnishing a precise delineation of its scope, and critically assessing the field’s contributions toward augmenting the comprehension of human conduct vis-à-vis emotions, cognition, and psychological wellness. In the subsequent section, attention turns toward medical anthropology, delving into its purview, investigating the manifold facets of health disparities, cultural interpretations of maladies and convalescence, and the ramifications of healthcare systems upon individual well-being. Thereafter, arguments revolve around the probe between medical anthropology and psychological anthropology, penetrating their confluences and mutual enhancements. Cultural paradigms and rituals are also weighed in terms of their capacity to shape psychological equilibrium, and their potential repercussions upon health outcomes and healthcare dispensation. In the concluding segment the researcher contemplates the strides achieved by psychological and medical anthropology in advancing the cognizance of interplay amid cultures, society, and health, wherein these two spheres make headway in the direction of more culturally attuned healthcare methodologies and regulatory frameworks, notwithstanding the obstacles that lie ahead of them.
... Page 12 of 20 age motivation (N. Chrisman & Maretzki, 2012;Williams, 2011). The motivation to learn is a pivotal factor in academic success. ...
This research paper delves into the multifaceted realm where anthropology intersects with health, culture, and society. It unravels the profound contributions of various sub-disciplines within anthropology to our understanding of health disparities, cultural dimensions of education, the complexities of emotions, rituals of pregnancy and childbirth, the dynamics of public health emergencies, and the cultural underpinnings of illness and sickness. Our exploration begins with medical anthropology, illuminating the intricate interplay between health inequalities and societal constructs, with a specific focus on the influence of income disparity, racial prejudice, and cultural beliefs. This knowledge empowers medical anthropologists to devise more equitable public health interventions by recognizing the socio-cultural determinants of health disparities. The branch of psychological anthropology unveils cultural models of learning, intelligence, motivation, and assessment, shedding light on how cultural norms shape educational outcomes and learning approaches. Furthermore, the anthropology of emotions deciphers how different cultures uniquely perceive and respond to emotions, emphasizing the need for culturally sensitive interventions in diverse domains. Pre and perinatal anthropology explores the rituals, customs, and beliefs surrounding pregnancy, childbirth, and infancy in diverse cultures, highlighting the significant impact of tradition and modern medical practices on maternal and infant well-being. Amid public health emergencies, anthropological insights into social, cultural, and political dimensions offer valuable guidance for public health strategies, as exemplified by the Ebola and COVID-19 outbreaks. The anthropology of illness and sickness reveals how culture shapes illness perceptions, diagnostic frameworks, and health-seeking behaviours. This variety in cultural interpretations, from attributing illnesses to spiritual disharmony to understanding them as part of the human experience, underscores the importance of cultural sensitivity in healthcare delivery. Diverse contributions of anthropology enrich and complement conventional medical and public health paradigms, emphasizing the imperativeness of acknowledging cultural diversity, social context, and historical perspectives.
... This distinction of disease and illness, which has become a fundamental principle on which medical anthropology and cultural epidemiology are grounded, arose from disenchantment with the technological and increasingly industrial orientation of medical practice in the United States in the 1970s. Much of the work in the early development of medical anthropology, responding to practical needs and academic interests, was a product of clinical experience of anthropologists and clinician-anthropologists (Chrisman and Maretzki 1982). John Cassell, a practicing internist and public health researcher, initially developed and elaborated the distinction of illness from disease based on concerns about public dissatisfaction with medical care and the realization that the most significant improvements in the health of populations could not be explained as a simple product of technological advances enabling improved clinical treatment of disease. ...
Cultural epidemiology is an interdisciplinary field based on principles and
methods of medical anthropology and classical epidemiology. Its contribution
to health research results from a focus on illness, distinct from the
disease orientation of classical epidemiology. Though rooted in the
influential illness explanatory model framework, current developments in the
field of cultural epidemiology refer more explicitly to determinants of
health and illness beyond explanatory models based on frameworks of critical
medical anthropology. This rethinking of cultural epidemiology acknowledges
the need for research to consider domains of a revised Outline for Cultural
Formulation referring to cultural identity, key social relations, and the
impact of political economy and other structural features of society. In
addition to this current work in cultural psychiatry, two other areas of
research remain active: public health studies of professional and community
determinants of vaccine acceptance and research on assessment and study of
stigma as a clinically significant feature of illness experience, providing
a clinical complement to more mainstream community studies of stigma.
Artículo introductorio al Monográfico "Antropología y salud global" en la Revista de Antropología Social. El enlace al monográfico entero aquí: https://revistas.ucm.es/index.php/RASO/issue/view/4274
This article describes the integration of medical anthropologists as direct members of health care teams within a large, urban teaching hospital as a means to address the role of structural inequality in unequal health care delivery within the context of COVID-19. The pandemic starkly underlined the role structural forces such as food insecurity, housing instability, and unequal access to health insurance play among vulnerable populations that seek health care, particularly within the emergency department (ED). There is a critical need to recognize the reality that disease acquisition is a cultural process. This is a significant limitation of the biomedical model, which often considers disease as a separate entity from the social contexts in which disease is found. Further, a focus on patient-centered care can open the door for critical, clinically applied, medical anthropologists to team with physicians, merging ethnographic methods with health data and the socially constructed realities of patients’ lived experience to build new pathways of care. These pathways may better prepare physicians and health care systems to respond to novel threats like COVID-19, which are rooted in pathophysiological origins but have outcome distributions driven by cultural and structural determinants. To this end, we propose a reconfiguration of dominant biomedical ideologies around disease acquisition and spread by examining our work since 2018, which sees anthropologists embedded both locally and systematically in the creation of anthropologically informed treatment pathways for socially complex disease states like HIV, Hepatitis C, and Opioid Use Disorder (Henderson 2018). Understanding how these socially complex diseases concentrate and interact in populations is a potential opportunity to model solutions for other widespread and complex health care crises, including COVID-19.
For the past 130 years, anthropologists have worked in diverse roles in medical schools including teaching, curriculum development, community engagement, research, planning, and administration with the goal of training practitioners and changing health outcomes. However, the history of anthropology in medical education and the training of physicians has not been published in one place and are often unknown to anthropologists entering the field of medical education, as well as physicians and medical school administrators. While a comprehensive history of anthropologists in medical education is beyond the scope of a single chapter, we identify the phases, trends, and continuous themes of how anthropologists have engaged in the training of physicians, medical school curriculum, and management. We touch upon major time periods in this history, including 1892 through the 1960s which saw a shift from physical to cultural anthropology. Foundations of theoretical models and community studies were developed in the 1970s. The 1980s focused on clinical anthropology, leading to diverse contemporary roles and engagements. We situate the contributions of anthropologists in the larger context of the political, economic, and technological developments of health care systems. Understanding historical changes in medical education provides a foundation for the book chapters which offer contemporary examples.
Family medicine began as a specialty dedicated to the holistic care of the whole patient in their family and community context. However, as health care in the United States has become increasingly technological and bureaucratic, family physicians and family medicine educators find it increasingly challenging to integrate the social dimensions of health into their practice and teaching. Professional organizations that evaluate graduate medical education increasingly recognize the need to expand the scope of medical training to address the social context of health. Family medicine residency programs are developing models for how to expand the curriculum in residency training to include social determinants of health, but few explicitly draw on anthropological frameworks. In this chapter, we present an example of how anthropology can collaborate with related fields, such as public health and social work, to contribute to innovative curricular development that supports active residency training in social determinants of health and health equity. We discuss the components of our curriculum, which was shaped by critical medical anthropological perspectives; challenges to implementation; and some lessons learned that might help other anthropologists engage with graduate medical education in the future.
This peer-reviewed book emphasizes the important role of anthropology in educating physicians throughout the world to improve patient care and population health. We reflect on how anthropologists have engaged in medical education to date and how to positively influence the careers of future anthropologists in medicine. Anthropologists working to prepare future physicians must not only be familiar with the culture of biomedicine, but also aware of the culture of medical education as well as the health systems in which medical students work. In this book, we describe the past and current experiences of anthropologists in medical schools, the modes and magnitude of this engagement, and reflect on these experiences from diverse settings in medical education globally. In this chapter, we introduce the scope of work of this book and its contributing chapters which is organized in four sections: (1) medical school culture, (2) beyond cultural competency, (3) ethics and humanities, and (4) addressing the socio-cultural determinants of health and health disparities.
Historically, medical humanities has buttressed medical education by asking students to consider themselves in relationship to their patients. As medical anthropologists, we have troubled this notion by encouraging students to consider the social determinants of health as well as reflect upon the economics and politics of medicine and their own motivation for becoming a doctor. This chapter analyzes the tensions between professional medical education and the disciplines of anthropology and humanities, noting their own internal logics and theoretical frictions. We use examples from interprofessional training and the integration of art in medical education to illustrate ways of incorporating the values of medical anthropology to shape medical students in their first 2 years of study. While we are proud of our medical anthropology training and work, we found that in order to effectively navigate the academic health sciences, we have had to cloak our anthropological identity and wear the hats more formally recognized in medical education.
Paternalism is no longer the best moral attitude to convey good care. This moral consensus between physicians and social scientists is becoming a motto in medical education. The aim of this chapter is to describe how a local version of this moral economy of care organizes medical education in France to humanize physicians. The first section is an auto-ethnography of my first lecture during freshman year, medical students being often seen as a wild horde. The second section specifies medical education in France and the introduction of Human science into this curriculum in the 1990s. The third section shows how humanities joined Medical Humanism as a moral education based on the same complaint to humanize a discipline too close to the natural sciences, inhuman by nature. Beyond this moralism, the fourth section highlights how in a paradigmatic case, psychiatrists can become anthropologists due to the gap between theory and practice and how difficult it is to judge good care.
This research aims to describe the complexity cultures consisting of kinship activities, economy, education, beauty and recreation, religion, politics, and physical needs in the novel Bumi Manusia written by Pramoedya Ananta Toer. The approach used in this research is the anthropology literature approach. Read notes, literature, and description of the analysis are methods used in collecting the data. Meanwhile, the data analysis technique used is descriptive qualitative analysis. The results obtained are (1) kinship activities: helping each other, visiting houses and caring among human, (2) economic activities: complementing the needs of human life, (3) educational activities: formal and non formal, (4) beauty and recreation activities: the art of motion and the art of sound done by human, (5) religious activities: marriage and mutual respect for every beliefs between people, (6) political activities: the fields of government and organization, and (7) physical needs activities: the fields of food, beverages, and clothing.
The ‘new cross-cultural psychiatry’ - Volume 158 Issue 4 - Roland Littlewood
The perspective for this review is that of a general psychiatrist who is convinced of the clinical relevance of sociocultural psychiatry for a full, multimodel understanding of mental illness, and is aware of the intellectual stimulus which occurs when the clinical and research vistas extend from one cultural unit to another (i.e. trans cultural psychiatry). My specific purpose therefore is to name some books which can help establish ‘good practice’ in multicultural Britain and are useful reference texts for teaching, as well as research. The choice of books inevitably reflects my own clinical and academic interests, and the volumes received from the review editor of this Journal over recent years. Any particularly disenfranchised reader will nevertheless find sufficient reference to other aspects of this fascinating field which has now become central to much present day clinical practice; transcultural psychiatry has been regarded as having ‘come of age’ and yet paradoxically also as beginning ‘at home’. Evidence in support of these developmental aphorisms can be culled from the publication of at least 20 books on cultural psychiatry in the last two decades, as well as from the final reports of the World Health Organization epidemiological studies which may have reassured the dubious that the major psychoses, such as schizophrenia and manic-depression, and even the neuroses are universally recognised, even if their presentation and ‘explanatory models' differ radically between some cultures, although are similar in others.
The development of medical anthropology in the 1970s and the coming of
anthropologists at the clinic led to the emergence of clinically applied anthropology.
The article is discussed the range of basic issues specific to the discipline. The ideas
of leading western scholars on objectives of anthropology in the clinical setting,
patient experience of illness, communication between doctors and patients about
treatment are analyzed.
The present study discusses access to scientific information on neglected diseases in the Oswaldo Cruz Foundation (Fundacao Oswaldo Cruz - Fiocruz) with respect to the Open Access Movement. Although neglected diseases are responsible for nearly half of the disease burden in developing countries, investments into the research on these diseases are limited and fall short of what is needed to produce necessary and urgent innovations in the field of public health. The free flow of scientific information is presented as imperative to sustaining research and innovation in the field. This discussion is guided by the central role of communication in science, its social commitment and recent changes in the sector of scientific publications that demonstrate, among other things, the low international visibility of scientific production in developing countries. The Budapest Meeting of 2002 represented a significant landmark for the movement of resistance to this scenario. The research presented was based on the concept of scientific communication, emphasizing interlinked pillars of communication: legitimacy or reliability, peer review, accessibility and publicity. From theory to empirical reality, the challenge posed to researchers was to identify the obstacles to and favorable aspects for the development of a policy of open access to scientific information on neglected diseases within Fiocruz. Indications that could support or even sustain the defining parameters of a public policy toward open access to scientific information in health were sought in the literature and in empirical reality to guide the present study. The results confirm the potential for open access to such information while suggesting the importance of a movement toward awareness and critical reflection on the topic to both guide and contribute to the proposition of a public policy of open access to scientific information about health, especially concerning neglected diseases.
In 2 Corinthians 12:7-10, Paul confesses to being beset by "a thorn in the flesh" connected in some way with a prior ecstatic experience (vv 2-4), which he summons "the Lord" on three occasions to remove (v 8). The intersecting topoi of this passage - illness, pain, healing, altered states of consciousness (Pilch 2004; Goodman 1990), strength and weakness, the role of non-human forces in human illness, explanations of/for illness, and the (non)efficacy of prayer for healing - raise a complex of questions that ought not be answered in isolation. In pursuit of answers to such questions regarding illness and healing in the "symbolic world" of Paul and the community he addressed, I employ here conceptual tools garnered from the field of ethnomedical anthropology. I offer fresh readings of the dynamics at work in Paul's "thorn" discourse - a key component of the rhetorical culmination of Paul's speech act designed to (re-)assert his credentials as God's apostle to the gathered people at Corinth (Neufeld 2000) - while making reference throughout to its immediate literary context, the so-called "letter of tears" (2 Cor. 10-13), as well as to its relationship to the structure of ideas on illness and healing in Paul's larger epistolary corpus (e.g. Galatians 4:13-15; 1 Corinthians 11:27-34; 12:8-10, 28, 29-30).
Of the various public services which are provided in sparsely settled areas, few have as great an impact on the well-being of the rural population as health care. Health services affect rural regions both directly and indirectly. The direct effects are most apparent. Health services are one determinant of health status; at the extreme, the presence or absence of health services may determine whether individuals survive specific disease episodes. In the case of cardiac arrest or major motor vehicle trauma, the absence of adequate health services may result in almost immediate mortality, while the presence of health services may prevent individuals from dying.
What can one do with a scholarly research project? Shall it sit in a library, to be read only by other scholars? Is it to profit only the investigators who get academic capital from the study? Coping and Health Among Older Urban Widows was a cross-cultural, longitudinal study of how Anglo and Mexican-American widows coped with bereavement and how their coping styles related to their health. The study was awarded to the Southwestern Institute for Research on Women (SIROW) at the University of Arizona and conducted by a team representing several disciplines: anthropology, gerontology, nursing, medicine, sociology, and social work. Here I want to discuss practical applications of our findings. I think that grant recipients must show how to convert into practice what they learned when they followed the careful scientific process that made the award possible. The National Institute of Aging awarded approximately a quarter of a million dollars to this study.
We present the first results of sunspot oscillations from observations by the
Interface Region Imaging Spectrograph. The strongly nonlinear oscillation is
identified in both the slit-jaw images and the spectra of several emission
lines formed in the transition region and chromosphere. We first apply a single
Gaussian fit to the profiles of the Mgii 2796.35 {\AA}, Cii 1335.71 {\AA}, and
Si iv 1393.76 {\AA} lines in the sunspot. The intensity change is about 30%.
The Doppler shift oscillation reveals a sawtooth pattern with an amplitude of
about 10 km/s in Si iv. The Si iv oscillation lags those of Cii and Mgii by
about 6 and 25 s, respectively. The line width suddenly increases as the
Doppler shift changes from redshift to blueshift. However, we demonstrate that
this increase is caused by the superposition of two emission components. We
then perform detailed analysis of the line profiles at a few selected locations
on the slit. The temporal evolution of the line core is dominated by the
following behavior: a rapid excursion to the blue side, accompanied by an
intensity increase, followed by a linear decrease of the velocity to the red
side. The maximum intensity slightly lags the maximum blueshift in Si iv,
whereas the intensity enhancement slightly precedes the maximum blueshift in
Mgii. We find a positive correlation between the maximum velocity and
deceleration, a result that is consistent with numerical simulations of upward
propagating magnetoacoustic shock waves.
Cultural pluralism that characterises many major urban centres, especially London,
underscores needs for research in cultural psychiatry to identify distinctive needs for mental
health services and clinical treatment. Such questions motivated development of this study of the
cultural experience and meaning of depression amongst white Britons in London, involving
development of a British EMIC interview for depression by adapting an earlier version of the
EMIC used in Bangalore, India. Steps in the process involved historical and ethnographic study
of depression, and extensive pilot testing. This report focuses on the experience of depression with
reference to patterns of distress and its meaning with reference to perceived causes. A wide range
of contradictory, overlapping and linked explanations, consistent with reports from previous
studies of Indian and other non-Western cultures, were notable among white Britons, whose
illness concepts are likely to appear as diverse and inconsistent to an outside observer as ndings
from research in South Asia may be for a Western medical anthropologist. Furthermore, somatic
idioms of depression, although not spontaneously reported, were frequently reported when
speci cally probed, raising questions about the distinctiveness of depressive and somatoform
disorders as discrete diagnostic headings. The range of perceived causes are reviewed, considering
the relationship between coded categories and narrative accounts that specify the interrelationship
of categories in a causal web. The discussion considers the utility of the EMIC for cultural
study and re ections on methodological issues arising in its adaptation and use that may help
other researchers wishing to apply the framework and use the tools of cultural epidemiology.
The claim that medical anthropology is failing medicine is wrong. Certain areas of medical anthropology contribute to theory, while others are intended to be of more clinical use. The problems that this latter category can encounter are rooted not within anthropology, but within medicine. For those practitioners that do choose to engage with anthropological ideas, it impacts in such a way that it cannot be readily proved within empirical data. This does not, however, mean it does not make significant and lasting contributions in the clinical setting.
I show how a set of questioning techniques developed for ethnographic research (Spradley, 1979) may be applied to the counseling interview. The analysis of the appropriateness of ethnograhic questioning in therapeutic conversations is grounded in the understanding that research concepts can be integrated with counseling skills (Gale & Newfield, 1992; Sells et al., 1994). The conditions for initiating therapeutic change are established when clients become aware of some of the cultural rules and maps by which they live. The counselor can elicit this awareness through an examination of the client's vocabulary. In this article, I outline the concepts of cluture and ethnogrphic semantics, describe the major categories of ethnogrphic questions, and illustrate how ethnogrphic question can be applied to the healing interview.
The Koach Project was conceived by the Department of Mental Health of the Israel Defense Forces to find a means to improve treatment for chronic battle related PTSD. Having described the rationale and method for the project (Solomon et al., 1991) the ethnography of the residential stage is introduced and analyzed from an anthropological perspective.
This research is in the form of a quantitative study aimed at discovering‘What registered nurses and midwives feel and know about research'. Data were gathered on a fixed response questionnaire, with open spaces for comments to support the results with written factual qualitative evidence. The questionnaire was directed towards obtaining results associated with‘Attitudes’ towards research;‘Understandings’ about research, and‘Obstacles’ to implementing research. A sampling technique was used in which a total population of 765 registered nurses and midwives working in this district general hospital were involved in the study. The results demonstrate(inferential statistics chi-square and correlation tests) that registered nurses and midwives are largely in agreement with research based practices, although understanding about research in minimal and dependent on grade, length qualified, shifts and numbers of hours worked.
In this article we delineate a systematic approachfor incorporating qualitative methods in research on primary prevention. Using examples from our studies of both smoking and cessation processes, we describe our procedure in four consecutive stages: (]) interviews and fieldnotes, (2) case studies or life histories, (3) discourse and content analyses to identify emergent issues and themes which are subsequently standardized as codes, and (4) the interpretation of sociocultural patterns and idioms of bodily experience. The relevance of qualitative methods in primary preventive medicine is discussed with examples from our own research on smoking. We argue that this form of basic research is an essential precursor to culturally effective interventions in clinical as well as community settings.
Contemporary information programmes for health staff fail to give thorough consideration to the influence of situational factors on information transfer within health institutions. To study information transfer in Swedish primary care health centres, we have therefore used the participant observation method, to explore the influences of practice on knowledge and attitude formation, in turn giving rise to new practice. Management of hyperlipidaemia was used as an example. Our study suggests that the practice generates new information, which is added to or counteracts the acquisition and use of already existing information and is subsequently used in practice. Ongoing discussions between staff members give an opportunity to share practice experiences. Profession, professional hierarchy and gender are some of the factors influencing the use of information in this context. To improve the effectiveness of information programmes these factors and the professional roles of the health staff should be taken into consideration.
Recent attempts to understand the emergence of a growing population of homeless mentally ill individuals have almost exclusively relied on epidemiological and clinical approaches, the result being an incomplete and even distorted perception of these people and their behavior. This paper describes gaps that currently exist in our understanding of the homeless mentally ill, focusing on the dearth of rich qualitative descriptions of lives in process, the overwhelming preoccupation with pathology and disaffiliation, the failure to view homeless mentally ill individuals in the broader socio-economic and situational contexts of their daily lives, the absence of a longitudinal perspective, and an over-reliance on self-report as a source of data. Data are offered from an ethnographic examination of the ongoing adaptation of 50 chronically mentally ill homeless adults in the downtown area of Los Angeles to suggest how research utilizing an anthropological perspective can fill some of these gaps. This discussion indicates by extension that anthropological research can provide policy-relevant insights in this critical area and that the study of homelessness and mental illness presents opportunities for anthropologists to pursue a variety of issues relevant to the field.
The notion of 'pathology' presumes an experiential and socially embedded frame of reference which is at variance with some recent attempts to understand the procedures and subject matter of psychiatry. Psychiatric theories remain bound by individual and historical contingencies whose compelling urgency obfuscates the inter-relationship of phenomenon, social context, response, and explanatory model.
Over the last ten years a new approach to psychiatric knowledge has developed under the influence of social anthropology. Its origins, assumptions, methods, achievements, and limitations are reviewed.
This paper initiates a discussion of some viable approaches to a critically applied as opposed to a clinically applied medical anthropology. The old question of the role of the intellectual man or woman is at the heart of this enquiry. Analogies are drawn between the current relations of anthropology to medicine and the history of anthropology's relations to European colonialism. The dilemmas of the clinically applied anthropologists 'double agent' role is discussed and alternatives offered in the form of three separate and to some extent contradictory projects, each of which, however, demands that the anthropologists cut loose his or her moorings from conventional biomedical premises and epistemologies. Ours must be an anthropology of affliction and not simply an anthropology of medicine. Praxis must not be left in the hands of those who would only represent the best interests of biomedical hegemony.
The chronically mentally ill tend to receive inadequate medical care for nonpsychiatric illnesses and to have poor health care status. Their medical problems lead to excessive morbidity and mortality and adversely affect their adjustment to psychiatric illness. The authors argue that many of the barriers to medical care for these patients can be overcome by using case managers as "culture brokers"-persons who provide bridges between the worlds of the chronically mentally ill and medical providers. This paper presents the culture broker model and its roots in anthropology, and illustrates its application to the medical care of the chronically mentally ill with case examples.
Teaching ethics in medical school has become an increasing concern for medical educators over the past two decades. The definition and subject matter of medical ethics has changed with the changing nature of health care needs and delivery. Finding ways to introduce concepts of ethical decision-making on an individual as well as social scale into already overcrowded curricula poses a challenge for medical schools. This paper describes some of the approaches which have evolved and identifies medical ethics as a force for integration of the biomedical and psychosocial aspects of medicine.
There is currently strong pressure for nursing to base its education and practice upon rigorous research. A strong research foundation is perceived as integral both to the formation of a distinct discipline, and also to the establishment of the profession. The broader implications of this initiative have, however, received little attention in the literature. This paper discusses the current status and organization of nursing research in the United Kingdom in the light of the history of its development alongside other research endeavours. The differing agendas of policy makers, practitioners and researchers are examined to ask the question 'Does research inform either policy or practice?' This issue is explored through a consideration of the constraints which may impinge upon the successful initiation and conduct of research in nursing, and its utilization to improve health care.
In recent years a dialogue has occurred between critical medical anthropologists and clinical anthropologists about the possibility of developing a critical clinical anthropology. Although critical medical anthropology aims to merge theory and praxis, I argue that achieving this goal in a biomedical clinical setting will be extremely difficult if not impossible. In pursuing their commitment to social action, critical medical anthropologists need to establish connections with other groups including: labor unions, ethnic minorities, women's organizations, environmentalists, and self-help groups, in the struggle to create a healthy society.
The aim of this paper is to consider how nurses from the 'developed world', in this instance Great Britain, may assist women from the 'developing world', specifically from Pakistan, to meet their and others' health needs. To explore nurses' understanding of women from Pakistan and its translation into delivery of nursing care, a number of topics require exploration. These include culture, health, origins of Pakistani women who have settled in Britain, clarification of the geographical area under discussion and a brief introduction to two studies that have investigated the health beliefs of communities in Pakistan, in particular the health beliefs of women. Appreciation of studies that illustrate women's beliefs about health can provide a basis upon which further examination can take place. Ideas can then be assimilated into a framework for nursing care centred around anthropological and holistic approaches to women from Pakistan. The outcome of this should be an examination of women's beliefs within a cultural context in relation to nursing care and management.
The field of bioethics has been dominated by the tenets and assumptions of Western philosophical rationalistic thought. A principles and rights-based approach to discussions of moral dilemmas has sustained and reinforced a pervasive reductionism, utilitarianism, and ethnocentrism in the field. Recent explorations of casuistry and hermeneutics suggest a movement toward an expanded theoretical and conceptual framing of medical ethical problems. Increased attention to moral phenomenology and a recognition of the importance of social, cultural, and historical determinants that shape moral questioning should facilitate collaborative work between anthropologists and ethicists. In this article, I examine the philosophical orientation of U.S. bioethics and the relationship of the social sciences to the field of medical ethics. Deterrents to collaboration between anthropologists and bioethicists are explored. Finally, I review past and possible future contributions of anthropology to the field of bioethics and, more generally, to medical ethics.
The term 'transcultural psychiatry' has encompassed changing notions of race, culture and psychiatry and, as a result, it is a difficult concept to define. For a long time psychiatrists and social scientists have been commenting on how the psyches and psychiatric illnesses differ in non-White populations. However, transcultural psychiatry was not created as a distinct discipline until after World War II. This article will attempt to tell the story of transcultural psychiatry, charting its genesis in the aftermath of World War II, and then go on to describe how it has taken different forms in response to developments within psychiatry and wider sociocultural changes.
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