Cambridge Studies in Medical Anthropology – serie

Daniel Moerman presents an innovative and enlightening discussion of human reaction to the meaning of medical treatment. Traditionally, the effectiveness of medical treatments is attributed to specific elements, such as drugs or surgical procedures, but many things happen in medicine which simply cannot be accounted for in this way. The same drug can work differently when presented in different colours; drugs with widely advertised names can work better than the same drug without the name; inert drugs (placebos, dummies) often have dramatic effects on people (the 'placebo effect'); and effects can vary hugely among different European countries where the 'same' medical condition is understood differently, or has different meanings. This is true for surgery as well as for internal medicine. This lively 2002 book reviews and analyses these matters in lucid, straightforward prose, guiding the reader through a very complex body of literature, leaving nothing unexplained but avoiding any over-simplification.

A guiding principle of international primary health care since the 1970s is contained in the slogan, 'community participation in health'. In practice, however, national and local political considerations are often decisive in the implementation of health policies. Dr Morgan shows how 'community participation' was sacrificed to competing political priorities even in Costa Rica, a country known for its dedication to health care. Focusing on a banana-growing community, she documents and analyses the process by which local health policy is politicized. Her sophisticated case study sets a detailed rural ethnography in both a national and international context. This book will be of great interest to medical anthropologists, planners, and anyone concerned with international health and development policy.

A guiding principle of international primary health care since the 1970s is contained in the slogan, 'community participation in health'. In practice, however, national and local political considerations are often decisive in the implementation of health policies. Dr Morgan shows how 'community participation' was sacrificed to competing political priorities even in Costa Rica, a country known for its dedication to health care. Focusing on a banana-growing community, she documents and analyses the process by which local health policy is politicized. Her sophisticated case study sets a detailed rural ethnography in both a national and international context. This book will be of great interest to medical anthropologists, planners, and anyone concerned with international health and development policy.

Students of culture have been increasingly concerned with the ways in which cultural values are 'inscribed' on the body. These essays go beyond this passive construal of the body to a position in which embodiment is understood as the existential condition of cultural life. From this standpoint embodiment is reducible neither to representations of the body, to the body as an objectification of power, to the body as a physical entity or biological organism, nor to the body as an inalienable centre of individual consciousness. This more sensate and dynamic view is applied by the contributors to a variety of topics, including the expression of emotion, the experience of pain, ritual healing, dietary customs, and political violence. Their purpose is to contribute to a phenomenological theory of culture and self - an anthropology that is not merely about the body, but from the body.

This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.

Andrea Wiley investigates the ecological, historical, and socio-cultural factors that contribute to the peculiar pattern of infant mortality in Ladakh, a high-altitude region in the western Himalayas of India. Ladakhi newborns are extremely small at birth, smaller than those in other high-altitude populations, smaller still than those in sea level regions. Factors such as hypoxia, dietary patterns, the burden of women's work, gender, infectious diseases, seasonality, and use of local health resources all affect a newborn's birth weight and raise the likelihood of infant mortality. An Ecology of High-Altitude Infancy is unique in that it makes use of the methods of human biology but strongly emphasizes the ethnographic context that gives human biological measures their meaning. It is an example of a new genre of anthropological work: 'ethnographic human biology'.

Morality and medicine are inextricably intertwined in rural Haiti, and both are shaped by the different local religious traditions, Christian and Vodoun, as well as by biomedical and folk medical practices. When people fall ill, they seek treatment not only from Western doctors but also from herbalists, religious healers and midwives. Dr Brodwin examines the situational logic, the pragmatic decisions, that guide people in making choices when they are faced with illness. He also explains the moral issues that arise in a society where suffering is associated with guilt, but where different, sometimes conflicting, ethical systems coexist. Moreover, he shows how in the crisis of illness people rework religious identities and are forced to address fundamental social and political problems.

This book examines the role of the Nepali physicians in the revolutionary changes in 1990. These doctors are trained in the Western tradition, and participate in international scientific debates, yet they have always been concerned to develop a form of medical practice that was relevant to Nepali conditions, and which could speak to local conceptions about health, and so their medical practice was always politicized. Vincanne Adams argues that the commitment of these professionals to the values of science, and to public health, was crucial in their political activity, and that ideas and practices associated with the notions of 'democracy' and of 'science' supported each other. Describing her book as 'a story that explores how very fine the line is between politics and scientific medical truth claims', it therefore encompasses both the modern political history of Nepal and the role of medicine in a poor, largely rural, Hindu kingdom.

This book examines the role of the Nepali physicians in the revolutionary changes in 1990. These doctors are trained in the Western tradition, and participate in international scientific debates, yet they have always been concerned to develop a form of medical practice that was relevant to Nepali conditions, and which could speak to local conceptions about health, and so their medical practice was always politicized. Vincanne Adams argues that the commitment of these professionals to the values of science, and to public health, was crucial in their political activity, and that ideas and practices associated with the notions of 'democracy' and of 'science' supported each other. Describing her book as 'a story that explores how very fine the line is between politics and scientific medical truth claims', it therefore encompasses both the modern political history of Nepal and the role of medicine in a poor, largely rural, Hindu kingdom.

Some of the most interesting ethnographies of experience are concerned to highlight the indeterminate nature of life. Questioning Misfortune is very much within this tradition. Based on a long-term study of adversity and its social causes in Bunyole, eastern Uganda, it considers the way in which people deal with uncertainties of life, such as sickness, suffering, marital problems, failure, and death. Divination may identify causes of misfortune, ranging from ancestors and spirits to sorcerers. Sufferers and their families will then try out a variety of remedial measures, including pharmaceuticals, sorcery antidotes, and sacrifices. But remedies often fail, and doubt and uncertainty persist. Even the commercialisation of biomedicine, and the peril of AIDS can be understood in terms of a pragmatics of uncertainty.

Some of the most interesting ethnographies of experience are concerned to highlight the indeterminate nature of life. Questioning Misfortune is very much within this tradition. Based on a long-term study of adversity and its social causes in Bunyole, eastern Uganda, it considers the way in which people deal with uncertainties of life, such as sickness, suffering, marital problems, failure, and death. Divination may identify causes of misfortune, ranging from ancestors and spirits to sorcerers. Sufferers and their families will then try out a variety of remedial measures, including pharmaceuticals, sorcery antidotes, and sacrifices. But remedies often fail, and doubt and uncertainty persist. Even the commercialisation of biomedicine, and the peril of AIDS can be understood in terms of a pragmatics of uncertainty.

This thought-provoking volume compares the responses of women in a variety of countries and cultural settings to modern medical technologies. The contributors describe how women in East Africa deal with infertility, how American women respond to pre-natal diagnostic screening, how women in China and Japan choose to make use of reproductive technologies. The essays also explore wider themes, such as the emergence of the breast cancer movement, and how women confront environmental hazards which threaten them and their families. It is often assumed that women are passive in the face of biomedical technology, but this book shows that they make pragmatic choices, with responses ranging from acceptance to rejection or indifference. The reception of biomedical technology is situated in its local cultural contexts, and vital issues of women's health are related to political and ethnic concerns.

This thought-provoking volume compares the responses of women in a variety of countries and cultural settings to modern medical technologies. The contributors describe how women in East Africa deal with infertility, how American women respond to pre-natal diagnostic screening, how women in China and Japan choose to make use of reproductive technologies. The essays also explore wider themes, such as the emergence of the breast cancer movement, and how women confront environmental hazards which threaten them and their families. It is often assumed that women are passive in the face of biomedical technology, but this book shows that they make pragmatic choices, with responses ranging from acceptance to rejection or indifference. The reception of biomedical technology is situated in its local cultural contexts, and vital issues of women's health are related to political and ethnic concerns.

This is one of the first studies of traditional medical education in an Asian country. Conducting extensive fieldwork in Kunming, the capital of Yunnan Province in the People's Republic of China, Elisabeth Hsu became the disciple of, a Qigong master a scholarly private practitioner, who almost wordlessly conveys esoteric knowledge and techniques; attended seminars given by a senior Chinese doctor, an acupuncturist and masseur, who plunges his followers into the study of arcane medical classics, and studied with students at the Yunnan College of Traditional Chinese Medicine, where the standardised knowledge of official Chinese medicine is inculcated. Dr Hsu compares the theories and practices of these different Chinese medical traditions and shows how the same technical terms may take on different meanings in different contexts. This is a fascinating, insider's account of traditional medical practices, which brings out the way in which the context of instruction shapes knowledge.

This stimulating collection of essays is the product of face-to-face dialogues among anthropologists, sociologists, and philosopher-historians, all of whom focus their attention on the newly created biomedical technologies and their application in practice. Drawing on ethnographic and historical case studies, the authors show how biomedical technologies are produced through the agencies of tools and techniques, scientists and doctors, funding bodies, patients, clients, and the public. Despite shared concerns, these essays reveal that the authors have achieved no consensus about the objectives of their research, and the deep epistemological divides clearly remain - making for provocative reading.

This book shows how practitioners in the emerging field of 'cultural epidemiology' describe human health, communicate with diverse audiences, and intervene to improve health and prevent disease. It uses textual and statistical portraits of disease to describe past and present collaborations between anthropology and epidemiology. Interpreting epidemiology as a cultural practice helps to reveal the ways in which measurement, causal thinking, and intervention design are all influenced by belief, habit, and theories of power. By unpacking many common disease risks and epidemiologic categories, this book reveals unexamined assumptions and shows how sociocultural context influences measurement of disease. Examples include studies of epilepsy, cholera, mortality on the Titanic, breastfeeding, and adolescent smoking. The book describes methods as varied as observing individuals, measuring social networks, and compiling data from death certificates. It argues that effective public health interventions must work more often and better at the level of entire communities.

This book shows how practitioners in the emerging field of 'cultural epidemiology' describe human health, communicate with diverse audiences, and intervene to improve health and prevent disease. It uses textual and statistical portraits of disease to describe past and present collaborations between anthropology and epidemiology. Interpreting epidemiology as a cultural practice helps to reveal the ways in which measurement, causal thinking, and intervention design are all influenced by belief, habit, and theories of power. By unpacking many common disease risks and epidemiologic categories, this book reveals unexamined assumptions and shows how sociocultural context influences measurement of disease. Examples include studies of epilepsy, cholera, mortality on the Titanic, breastfeeding, and adolescent smoking. The book describes methods as varied as observing individuals, measuring social networks, and compiling data from death certificates. It argues that effective public health interventions must work more often and better at the level of entire communities.

Medicines are the core of treatment in biomedicine, as in many other medical traditions. As material things, they have social as well as pharmacological lives, with people and between people. They are tokens of healing and hope, as well as valuable commodities. Each chapter of this book shows drugs in the hands of particular actors: mothers in Manila, villagers in Burkina Faso, women in the Netherlands, consumers in London, market traders in Cameroon, pharmacists in Mexico, injectionists in Uganda, doctors in Sri Lanka, industrialists in India, and policymakers in Geneva. Each example is used to explore a different problem in the study of medicines, such as social efficacy, experiences of control, skepticism and cultural politics, commodification of health, the attraction of technology and the marketing of images and values. The book shows how anthropologists deal with the sociality of medicines, through their ethnography, their theorizing, and their uses of knowledge.

Daniel Moerman presents an innovative and enlightening discussion of human reaction to the meaning of medical treatment. Traditionally, the effectiveness of medical treatments is attributed to specific elements, such as drugs or surgical procedures, but many things happen in medicine which simply cannot be accounted for in this way. The same drug can work differently when presented in different colours; drugs with widely advertised names can work better than the same drug without the name; inert drugs (placebos, dummies) often have dramatic effects on people (the 'placebo effect'); and effects can vary hugely among different European countries where the 'same' medical condition is understood differently, or has different meanings. This is true for surgery as well as for internal medicine. This lively 2002 book reviews and analyses these matters in lucid, straightforward prose, guiding the reader through a very complex body of literature, leaving nothing unexplained but avoiding any over-simplification.

This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.