Siri Lohmann
St. Olaf College
April 2008
Unifying the Body: Anthropology, Sociology, and Medicine
“It is time to take health rights as seriously as other human rights…intellectual recognition is only a necessary first step toward pragmatic solidarity, that is, toward taking a stand by the side of those who suffer most.”
(Paul Farmer, Pathologies of Power, 246)
Michel Foucault, a twentieth century French philosopher once wrote: “The imperative of health: at once the duty of each and the objective of all” (Foucault 277). Although this statement was developed over half a century ago, it still resounds with power today. The basic right to health, and effective health care, in whatever sense of the word best fits the context, is not available to an appallingly large percentage of the population today. Fortunately, the response to the global health crisis has been met with a strong response to reverse the negative trend. Yet, even though current indicators reveal improvement in levels of global health, how are we to know if the systems created will take root and exist tenably? If the efforts and motives of those aiming to reshape the infrastructure of global health are not defined by the preexisting cultural conceptions of health, wellness, and the body, sustainable health care will be, devastatingly, unattainable. The latency period between the implementation of structural health care reform and its results is incredibly lengthy, yet if patience and time are not invested in the process of change, the original efforts will have been in vain. It is necessary to emphasize that anthropology and sociology must mandate the structural change required of healthcare practice and reform. The thoughts and actions of the anatomically defined body cannot be decoupled from the culture to which it belongs; thus, the ideological constructions (and accompanying anthropological/sociological methodologies of social analysis used to understand them) must be observed prior to any hopes of enacting effective, sustainable medical practices.
Simply put, anthropology is the study of humans and humanity, while sociology is the study of the social relationships and societies that are, logically, created by humans. Anthropology and sociology are, by virtue of their devotion to the exploration of humankind, inextricably tied to the human condition and all that entails. These disciplines of social science have deemed anything with which humans can have relationships (i.e. other humans, the environment, social constructions) worthy of study. In order for sociology and anthropology to broach the intricacies of human life, culture, and society, there are few boundaries that limit the subject or focus of study. Thus, there exist many protractions of sociology and anthropology into innumerable and diverse spheres of knowledge, both academic and non-academic, in an attempt to better understand the diversity of human nature. In this way, sociology and anthropology, at their roots, can be seen as, epistemologically based disciplines. In order to better understand any social group, sociologists and anthropologists must consider the nature of knowledge and to what extent it shapes cultures and social interactions; this necessitates an understanding of a multitude of human constructions. An attempt to understand the vastly complex nature of humans requires an equally complex analytic methodology. The field of medical study is no exception to this.
Although the human is an infinitely complicated subject of study, one homogenous characteristic that exists across the species is that of the body. The notion of body holds significance on two distinct levels: the individual body, the physical manifestation of the human and the social body, the organization of a group of individual people. These bodies are vastly different in composition, yet interaction with either requires delicacy, care, and respect; the exploitation of either type of body is generally characterized by depravity. Thus, it is crucial to take measures of extreme care when analyzing an individual or social body. Furthermore, an acknowledgement of the duality of the human body must presuppose any study of it. An inherent characteristic of the human being is the interconnected nature of the physical body and the social body; although many people attempt to understand the physical and social bodies as separate entities, neither can exist in total isolation from the other. Any attempt to produce a complete analysis of the whole physical body will be debased and incomplete if there is no indication of the innate social tendencies of humans.
As Michel Foucault discusses in his work, The Birth of the Clinic, there is an increasing propensity within the medical professional toward the medical gaze, as termed by Foucault. The notion of the medical gaze describes a physician’s tendency to separate the corporeal body from the other components of the person (the mental, emotional, and social realms) in order to attend to strictly anatomical ailments (Foucault 141-167). The human condition, the essence rendering the physical body more complex than an aggregate of matter, is often ignored or dissociated in medical practice. Frankly, this problem is not currently being combated; rather, recent analysis has shown that “the focus of attention within medical circles in recent years…has been confined with increasing intensity to changes in the physical body” (MacClancy 201). The act of making clear delineations between, and isolating the experiences of, the physical and social bodies ignores a crucial component of health. Health, no more than any other science devoted to the study of body, cannot be restricted to the confines of the individual, physical body. In order for the field of healthcare and medicine to provide thorough and effective practice, it must encompass a multitude of social factors.
Unfortunately, recognition of the importance of the socio-physical dualism of bodies has increasingly waned in the field of medicine throughout the last several centuries. Historically, medicine was regarded as a profession that was equally comprised of science and art and which considered socio-political factors of influence in medicine (Porter 347-396); however, the last centuries have marked a distinct, definite, and discernable transition away from this definition of medicine. “The emergence in the nineteenth century of a systematic human biology in which nature is understood for the first time as constituted by a set of laws entirely independent of both society and culture” has contributed to the modern definition of medical practice and biomedicine (MacClancy 191). The evolution of medicine has given greater emphasis to the methodologies of the natural sciences, biology and chemistry, and consideration for the social dimension of patients has all but disappeared from the acts of medical diagnoses. Modern medical practices have continued this trend and the act of coupling social scientific and medically and laboratory based scientific methodologies to provide comprehensive patient analysis has become nearly extinct.
Any discourse revolving around the subject of health of must include a consideration for the inextricable dualism of the bodies, physical and social. The field of medicine must account for this dual nature in its study through the use of both socially- and medically-oriented scientific means of examination in healthcare. The intricacies of the life of a patient, and the culture to which they belong, cannot be discounted from doctor-patient interactions. Just as anthropological and sociological study must not ignore the fields of economics, history, religion, etc., so must medicine exist beyond the realm of biology. Since the academic disciplines of medicine and anthropology/sociology deal with the nature of human bodies, both fields of study must be prepared to accommodate an exploration of all aspects that accompany human existence. The omission of sociopolitical, historical, economic, and cultural factors in medicine yields a level of incompleteness of approach; as a field that has so strongly promoted precise and thorough study, it seems counter-intuitive that it disregard a multitude of factors of such vital influence to the state of health.
A thorough medical examination requires an incorporation of the aforementioned myriad of complex socially derived and dictated academic disciplines in its analytic methodologies. Here, the theoretical and methodological tools of sociology and anthropology are best applied in order to extract meaning from the intricate connections between the physical and the social body. Although there are many tools of social science that are essential to provide an analysis as complex as the culture or society studied, three pedagogical tools are particularly significant for the facilitation of proper social analysis within medical practice: self-reflexivity, ideology, and agency. Scrutiny and use of these forms of knowledge, which are crucial to the effectiveness of social science research, render the studies nearly epistemological in nature. A great deal of thought must be given to notions of the knowledge, thought processes, and actions that surround the study. Simply put, for these tools to be used most beneficially in the field of healthcare, the practitioner who employs these techniques must be cognizant of their own (as well as of those they are studying) thoughts and behaviors.
In order to belong to a medical profession, by standards of Western medicine, one must attain an extremely extensive level of specialized knowledge; it follows that possession of medical knowledge is rare. Also, since so few are qualified to practice medicine, the knowledge of maintaining health becomes a form of capital and, in many cases, translates to power. Further, because medical practice involves the physical body (and usually its ill-health) the patient is prone to vulnerability. If a physician assumes a disregard for patient susceptibility, the knowledge derived from medicine could be used over and against the patient, thus exploiting the imbalance of authority from the situation. The work of sociological theorist W.I. Thomas is directly applicable here. Thomas’ theory of the definition of the situation explains that if a situation is defined as real, it becomes real in its consequences; there is a strong significance in the relationship between “what people think and how this affects what they do” (Ritzer 56). If a doctor accepts that the acquisition of specialized medical knowledge creates a gap in power status between the physician and the patient, it will be actualized and the relationship between doctor and patient will be defined by hegemony and preponderance.
Medical professionals are rendered yet more powerful if their views are imposed upon their patients without first exploring the cultural implications that accompany health. To avoid the perpetuation of unjust power inequalities of the doctor-patient relationship, the doctor must apply principles of social analysis to him or her self. “Critical social analysis helps us to discern how we are constructed as persons through patterned and very ordinary relations of domination and subordination” (Hobgood 9). It is imperative that the medical professional acknowledge the potential he has, by virtue of his specialized knowledge, to exert power (whether or not the power is driven by conscious action), for not doing so compromises his ability to engage in a fruitful relationship with patients, thereby diminishing the quality of practiced medicine. Despite the fact that the power imbalance may never be entirely obliterated, the methodology of practicing critical consciousness can prevent power from becoming an obstacle for effective health care techniques.
The theories of Brazilian theorist and activist Paulo Freire are directly applicable for the elimination of interactions that may obfuscate the doctor-patient relationship; specifically, the process of conscientization reveals the importance of social analysis in medicine. Conscientization will “explain the process of coming to understand how social structures cause injustice” (Farmer 143). In many cases the injustices between physician and patient may not even be realized if the doctor is not equipped with the appropriate tools to see instances and the effects of occurring violations. The physician cannot restrict the bounds of health care to those of the physical body; rather “it is most important…that in healing a patient the physician recognize the patient’s social environment” (Yale Guide 172). Detraction from social analysis in medicine can yield in incapability for reading social cues that may indicate the committing of unjust acts; beyond perceiving social cues, medical professionals must develop strategies for preventing human violations within the field of healthcare. Thus, critical consciousness must precede medical practice and can only be executed through the application of several anthropological/sociological theories and techniques.
To begin, conscientization implies questioning of the social structures that dictate relationships. The realities of the medical professional must be questioned in order to better understand the needs of each patient. To best accommodate for this, the anthropologically minded physician must put the theory of self-reflexivity into practice. Self-reflexivity implies an acknowledgement of one’s own position of influence or contrivance in a given situation. The doctor must recognize the potential she has to impose her own values and norms on a patient whose principles differ. In fact “the anthropologists’ primary concern,” as should be the doctor’s, “is to understand what is important to the locals they are studying, rather than to impose their own ideas and categories” (MacClancy 5). The physician must engage in measures to protect the vulnerable patient from incidents that may disrupt their levels of comfort; the aim of self-reflexivity is to raise in the doctor self-awareness of his capacity to cause such disruptions. An imposition of outside values may compromise the values of the patient, resulting in further vulnerability and discomfort. The act of critical self-awareness in which the physician must participate requires recognition and questioning of the fundamentals that shape individual realities, both of the doctor and of the patient, in order to comprehend the intricacies of culture which shape the doctor-patient dynamic.
Not only must the doctor recognize his or her own reality, he must acknowledge and seek that of his patients. Here, the theoretical use of ideology is essential to comprehend the ways in which reality is constructed, perpetuated, and understood. Ideology consists of culturally constructed beliefs or principles around which individuals or groups extract meaning; ideology serves as a means by which a group accesses the surrounding world (Nealon and Giroux 85). In order to make sense of the world, symbols are used to create a sense of shared reality; therefore, since each group of people comes from a different context, their ways of understanding of the world and their constructions of ideologies will vary greatly.
For a doctor practicing medicine in a context other than his own, an examination of the structures by which the group shapes their reality must precede any action. However, the ideologies that define meaning in culture cannot be found readily at the surface and the physician must adopt and enact Clifford Geertz’s concept of thick description. Thick description implies an analysis of cultural “structures of significance” and the means by which these symbols develop meaning; only through “determining their social ground and import” can the physician begin to uncover what lies at the heart of meaning in health (Geertz 9). The use of thick description implies precision and thoroughness of study of a culture. The meaning of a culture cannot be found at face value and must be sought beyond words or actions; to this end, thick description highlights the necessity of carefully considering the contextual aspects that influence and define human behavior.
Exploration of the structures of significance and ideologies that shape the standard of health of a given culture serves as an antecedent for gaining the trust of patients. Without that trust, the gap that divides the doctor and patient will prevail. A lack of thorough analysis of social systems prevents one from becoming accustomed to the conceptual understanding of health, as shaped by the idiosyncratic aspects of culture: language, rhetoric, socio-politics, and a myriad of additional factors. “Rhetoric is shaped by local biologies, historically informed knowledge and beliefs, government interests, and situated social exigencies” (MacClancy 206). Knowledge of the language that defines health and the body will provide the physician with more direct and accurate methods of communicating with patients. If the physician remains uninformed or makes presumptions about structures of significance regarding health and imposes his own “superior” knowledge on the patient, thereby subjecting the patients to governance, the relationship between physician and patient will perpetually be characterized, in a Foucaultian manner, by preponderance and misunderstanding (Ritzer 457). A practice of medicine infused with an ‘over-and-against’ mentality may lead the patient to feel invalidated, thereby diminishing any prospect of trust and effective healthcare reform (Foucault 212); here, the application of methodological principles of social analysis provide the potential to transform medical practice into effective, sustainable systems of health care.
Cultural beliefs, actions, and interactions are defined by context. Thus, it is of utmost importance for the physician to account for variation among views of health, wellness, and the body that exist cross-culturally. These contextually defined differences may appear to be subtle or insignificant, but to make assumptions regarding individual or cultural concepts that surround health may result in violation. Further, the ideological convictions regarding adequacy in health care practice of one individual or social group may not align with standards of medicine elsewhere. These discrepancies must be carefully analyzed and considered prior to acting medically among an unfamiliar society. As stated in the Yale Guide to Medicine (Donaldson 173), “an understanding of the particular circumstances of a stranger’s life may help the physician anticipate and prevent distortions in the doctor-patient relationship that differences in cultural background frequently create.” Hasty action that presupposes the needs of the culture may produce a barrier between the physician and the patient that does not allow for the practice of effective medicine. Thus, observations in social analysis should precede medical practice so that the methodology of medicine applied aligns with that which is most conducive to the circumstance.
The theoretical structure of Liberation theology provides a sound rubric for gaining awareness of the ideological constructions of culture that dictate the concepts of health and wellness. Knowledge must precede any form of action; instances that require the intervention of an outsider, such as third world healthcare reform, mandate the principles of Liberation theology: observe, judge, act (Farmer 140). The aforementioned formula is simple and, although it requires patience and careful study, the production of sustainable results can be actualized if observation precedes both judgment and action. The fundamental nature of reality and ideology must be analyzed through observation and scrutiny of all aspects of culture must be acknowledged, when dealing with systems of health. Further, it is not sufficient to simply look at the reigning structures of culture, for minority structures also define the dynamics of social interaction and culture. As an outsider, the physician must learn to question every action; even the actions he may not be compelled to scrutinize must be considered, for how is he to know whether or not those actions influence the understanding of health?
The information that the physician derives from cultural analysis and observation are, perhaps, the most importance sources of information that can impact the practice of medicine by an outside physician. The act of coupling culturally specific knowledge with the knowledge and experiences of the doctor may stimulate an important discourse to unraveling social inequalities and restructuring a system of health care so that it becomes more sustainable. And although imbalance in power may not be entirely eliminated from the relationship between the physician and patient, an acknowledgement of the imbalance is ultimately beneficial to the relationship. “Moreover, recognition of these unequal power relations enable us to problematize not only the conditions in the communities in which we work but also our own conditions as researchers and our roles in these relations of inequality” (Sanford and Angel-Ajani 6). If the physician enters, equipped with methodological tools for social analysis, their perspectives as an outsider may put them in a position to be an agent for positive and lasting change.
If the goal of the physician is to aid in the implementation of sustainable systems of healthcare, he or she must understand the dynamic relationship of structures and agency that pervade the society. Structural change cannot occur without a thorough knowledge of those existing structures and their symbolic meanings, as well as the ways in which agency dictates those structures. The work of Simmel, Bordieu, Parsons, Berger, and several other structuralist-oriented sociologists helps to unpack the relationship between agency and structure. The physician must find a delicate balance, in practicing medicine and implementing health care reform, of communication with individual agents of change and the structures that dictate society in order to deduce the course of action most appropriate and conducive to the situation. “It is not our role to speak to the people about our own view of the world, nor to attempt to impose that view on them, but rather to dialogue with the people about their views and ours. We must realize that their view of the world, manifested variously in their action, reflects their situation in the world” (Paulo Freire qtd. Sanford and Angel-Ajani 228). By better understanding their situation in the world, we can begin to see how to improve the structure of health care in a way that is conducive to their ideological constructions of culture.
Critical consciousness is, once again, of utmost importance if sustainable structural reform is ever possible. Observation must come before any form of action; it must serve as a precedent for thoughts about action. “What appear to be the exotic anomalies associated with other parts of the world are made intelligible through anthropological research. At the same time the contribution of social inequalities, politics, and violence to the incidence of so much disease and distress is brought into focus. Furthermore, the way in which biology, society, and cultural values are co-produced – how they are inseparable from one another and mutually malleable is made abundantly clear” through the application of anthropological/sociological methodologies to medical practice and healthcare reform (MacClancy 207). Once again, it is important to highlight the fact that the human body cannot be separated from its inherent social nature. The social body and the physical body cannot be decoupled with regard to health care reform. If structural change is ever to take place, it must be adhere to the ideological principles that dictate the contextual existence of the individual body and the social body, and their interconnection as a comprehensive whole.
Human rights are dictated by health. Although this statement serves as an oversimplification of many factors involving human rights, it is necessary to reveal the absolute and profound need for health care reform in the world. It logically follows that if any group is comprised of corporeal bodies that are sick or unhealthy, the social body must also exist in a state of ill health. If the body is not healthy, there is no chance for sustainable development of the culture or society. Simply (and perhaps rather blatantly) put, health care reform must coincide with governmental, economic, and social reform. The words of both Michel Foucault and Paul Farmer ring especially true in this context: “The surest and perhaps the sole guarantee of the maintenance of health and good habits and order is the law of rigorously executed mechanical work.” (Foucault 149) and “Efficiency cannot trump equity in the field of health and human rights” (Farmer 241). These messages reveal the fact that, although the process of human rights restoration in the field of health care may not produce immediately lucrative, sustainable, or even effective results immediately, patience, perseverance, and precision will provide the potential for successful reform.
Observe. Judge. Act. If the anthropologically-minded physician follows these simple commandments he will be equipped with the tools to dissect and glean meaning from the web of ideological constructions and structures of significance that define culture. After all, culture is inscribed in the body and the body is inscribed in culture; these two entities cannot exist without the other. In order to best understand the body, the physician must understand its culture.
Addendum: A Personal Note
The act of crafting this essay was an incredible challenge for me. My impetus for writing was to reveal the ways in which the disciplines of anthropology and sociology have strongly dictated the course of my future life, as I see it laid out before me. I intended to couple my twin passions of medicine/health care with anthropology/sociology; I believe that my anthropologically and sociologically based studies will serve as a steadfast foundation for the life I hope to pursue in medicine and international health care. I understand that working under the guise of human rights reform requires the correct tools if the efforts made will yield any residual, positive effects upon the individual lives and cultures in need of intervention. My education in anthropology and sociology has best equipped me (with the tools of theory, methodology, cultural sensitivity, and the capacity for epistemologically driven thoughts and actions) to interact with and best understand the intricacies and meanings that define unfamiliar cultures.
Although I am aware that the analysis I provided can be characterized as an obtuse, amorphous, and vastly incomplete analysis of issues that are immensely complicated, I aimed to use this piece to mark the commencement of a life-long exploration of healthcare and human rights. As these fields of study define the shape of my life in an increasingly inextricable and powerful way, I will begin to write my own voice into the content of the essay. For now, however, I can only dream about what is to come in the future of my life and that of the field of international medical practice and health care reform; I am indebted to my education in anthropology and sociology for the preparation with which it has provided me to lead the life I have imagined for myself.
Works Cited:
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Farmer, Paul. Pathologies of Power: Health, Human Rights, and the New War on the Poor. University of California Press: Berkeley and Los Angeles, CA. 2005
Geertz, Clifford. “Thick Description: Toward and Interpretive Theory of Culture.” The Interpretation of Cultures. Basic Books: New York. 1973.
Hobgood, Mary Elizabeth. Dismantling Privilege: An Ethics of Accountability. The Pilgrim Press: Cleveland, Ohio. 2000.
MacClancy, Jeremy, ed. Exotic No More: Anthropology on the Front Lines. The University of Chicago Press: Chicago. 2002.
Nealon, Jeffrey and Susan Searls Geroux. The Theory Toolbox. Rowan and Littlefield: New York. 2003.
Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. W.W. Norton & Company: New York. 1997.
Rabinow, Paul, ed. The Foucault Reader. Pantheon: New York. 1984.
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Sanford, Victoria and Asale Angel-Ajani, eds. Engaged Observer: Anthropology, Advocacy, and Activism. Rutgers University Press: New Jersey. 2006.
