ISP2017 Anthropological Approaches
Principles of
Anthropological
Approach
Retna Siwi Padmawati
2017
Content
Anthropology
Approaches of Anthropology
Medical Anthropology
Theore6cal founda6ons of Knowledge and
Theory
• Anthropology and Public Health
•
•
•
•
What is Anthropology
• Science that studying the diverse aspects of
human beings in terms of
– social life,
– its processes and causes,
– Interrela6ons of its elements
– Its rela6ons with phenomena being studied by
other disciplines
What is Anthropology
• Culture central concept in anthropology
• Culture: systems of beliefs, values, norms of
behavior found in all socie6es; they are more
or less coherent, systema6c and ra6onal
within their own context
Concept of culture
• Complex whole which include knowledge, belief, art, moral,
law, customs and any other capabili6es and habits acquired
by man as a member of society (Tylor 1871)
• The paMern of life within community, the regularly recurring
ac6vi6es and material and social arrangements characteris6cs
of a par6cular group (Goodenough)
• Mental equipment used by members of the society in the
orienta6on process, transac6on, mee6ngs, formula6ng ideas,
grouping, and interpreta6on of real social behavior in the
community (Goodenough)
Concept of culture
• Consis6ng of ideas and cri6cal assump6ons that owned by
a society that determines or affects communica6on,
jus6fica6on, and the behavior of its members (Sathe)
• A system of symbolic meanings that serves to communicate
the meaning of one's thoughts into the minds of others
(Geertz)
• Objects, ac6ons, or events in the world that can be seen,
felt, and understood and meaningful to the members of a
society (Keesing)
Culture Vs. Individual
• Culture is collec6ve behavior
• Related to any ac6on or behavior that is ideally
governed and shaped by knowledge, beliefs, values,
and norms, and conceived together by the members
of the community in its efforts to "survive" or
precisely controlled environment (physical and
social)
Anthropology
• studies:
– Human biology
– Ecology
– Economics
– Poli6cs
– Religion
– Social and cultural rela6ons
Stream of thought
• To study the cultural differences among
socie6es.
• Dealt with the struggle to explain the an6quity
of humans and the ar6facts le[ from these
ancient lives.
• The inves6ga6on of the biological origins of
humans and other species.
Approaches of Anthropology
• Cultural rela6vism: is the principle that an
individual person's beliefs and ac6vi6es
should be understood by others in terms of
that individual's own culture.
– No beMer culture
– Best understood as a whole systems
Cultural Rela6vism vs. Ethnocentrism
• Ethnocentrism: evalua6on of other cultures according to
preconcep6ons origina6ng in the standards and customs of
one's own culture.
• Chauvanism:
– Excessive patrio6sm, eagerness for na6onal superiority;
jingoism.
– (pejora6ve) Unwarranted bias, favori6sm, or devo6on to one's
own par6cular group, cause, or idea.
– Feminists say that male chauvinism is s-ll prevalent in cultures
worldwide.
Cultural rela6vism
• Holis6c studies of communi6es (ethnography)
– Interrela6onships of physical environment, principal
ac6vi6es, economics, religion, kinship and marriage. Etc.
• Western Civiliza6on is also a culture or combina6ons
of many cultures A as product of western world, A
has its own way to see the world (need to
communicate its concepts and methods into the
language of other disciplines)
Cultural rela6vism
• Local popula6ons, not the outsiders, are the
experts on their own sociocultural environment
A is students of others (emic perspec6ve)
• Moral obliga6on to take culture and foreign
culture seriously including their social
organiza6on and values (cross‐culture) deals
with interven6on (not seeing communi6es as
empty vessels”)
Cross culture
• Usually to develop local interven6on
– Respec6ng, aMending to and addressing local
percep6ons, interests, and way of life
– Listening and sympathe6c understanding
– Helping to serve local interest
– Moral grounds for rou6nely making local concerns as
a primary criterion in public health decision making
Anthropologists as students of others
• What knowledge is relevant in new cultural
sebngs (emic perspec6ve)
– Tools or instruments are developed on the basis of
their understandings on culture and society
– Needs to spend 6mes to understand other culture
– Par6cipatory to the culture/community they studied
is essen6als
– Immersive fieldwork
What is Medical Anthropology
• Focuses on the rela6onships of society,
culture, and biology; as well as on sickness
and healing
• It is included in the component of social and
cultural anthropology
– AAA sees medical anthropology as a new stream
in applied anthropology
What is medical anthropology?
• Cultural construc6on of illness and suffering,
illness experience, medical knowledge and
healing prac6ces
• Study of the body and lifecycle from childhood
to old age
• Cri6que of produc6on of biomedical
knowledge and power rela6ons
Cultural aspects
• Beliefs, percep6ons, and knowledge about illness
(onset, e6ology, transmission, treatment, etc)
• Concepts of health and illness
• Concepts of hot and cold food in rela6on to
illness and sickness
• Norms, rules, moral, etc. which have func6on to
solve human problems
Cultural Aspects in Health‐care
Seeking
• When there is illness there is cure
• Moral efforts to regain health (including back
and forth to many medical prac66oners and
facili6es as well as to alterna6ve medicines)
• People would try every sugges6on
• Failing to follow the sugges6on would cause the
blaming of the neighbors to the family and
rela6ves of the sick person (social pressures)
Percep6on of Health and Disease
• Based on medical system
• Based on e6ology of the disease (causes)
– Natural: illness caused by imbalance nature
– Personality: illness as reflec6on of punishment/sin; a
sign of weakness
– Social/Agent: illness as an effect of social rupture;
illness as sent by enemy/agent
Explanatory model
sector and sub‐sector in health care system
popular
professional
folk
Percep6on on:
• E6ology
• Onset
• Pathophysiology
• Severity
• Sick role
• Treatment
availability
Social and cultural influence
• S6gma: TB is God‐given and incurable – delay and
non compliance for treatment
– Sin commiMed by the people and ancestors
– Karma
• Less socializing and used separate ea6ng utensil
• Marriage arrangement could be canceled
because of TB infec6on
Social and cultural aspects
• Culture determines
– who is vulnerable to illness
– Who agrees to become pa6ents – (actually seek professional
treatment)
– What and who causes illness
• Culture affect decisions about a pa6ent’s treatment and
who makes decisions
• Cultural differences create problems in communica6on,
rapport, physical examina6ons, treatment, compliance,
follow up, etc.
Anthropological methods
• Par6cipant observa6on/ethnography
• Focus groups/semi‐structured interviews:
‘qualita6ve methods’
• Rapid par6cipatory methods
• Newer methods: use of camera, videos
• Importance of stories: link between anthropology
and medicine
• By the nature of their work, GPs already have many
anthropological skills
Founda6on of Knowledge and Prac6ce:
induc6ve (shaped by field experience)
• Ecological/evolu6onary theory: physical
environment and human adapta6ons to it are the
principals determinant of sickness and healing
unilinear and mul6linear evolu6on
• Cultural theory: cultural systems of beliefs, values
and norms are basic determinants of sickness and
healings (func6onalism, structuralism, symbolic
interac6onism, etc.)
Founda6on (cont’d): Poli6cal economy theory
• The economic organiza6on and rela6onships of
power are the principal forces determining
human sickness and health cri6cal medical
anthropology
• Structural/conflict theory, materialism, socialism,
capitalism, communism, etc. economic factors
may constrain health‐promo6ng human ac6on
Central themes of medical anthropology
• Illness versus disease (Eisenberg 1977)
• ‘Lay’ explanatory models (Kleinman):
‘idiosyncra/c and changeable, and heavily
influences by both personality and cultural
factors. They are partly conscious and partly
outside of awareness and are characterised by
vagueness, mul/plicity of meanings, frequent
changes, and lack of sharp boundaries between
ideas and experience’
Embodiment
• A way around the mind‐body split central to Western and
biomedical culture
• A way of understanding lived experience
• Seminal paper by Scheper‐Hughes & Lock (1987): individual,
social and poli6cal bodies as interconnected
• Work with GPs around embodiment (Jaye 2003): some
respondents saw the task of re‐embodying pa6ents as a central
concern in general prac6ce.
‘In general prac-ce…you have an ongoing rela-onship with the self. You really
have to live with people in the way that you don’t in other special-es. So I
think from the general prac-ce point of view, embodiment is very
important. I mean it is what you’re there for in many ways, is to help
people become embodied, to own themselves again.’
Public health/medical discourse
• Highly cultural and reality‐shaping
• Medical jargon and effect on pa6ents; how pa6ent
experience is ‘re‐packaged’ in clinical leMers
• Example: debate around organ dona6on and ethnic
minori6es (Cierans & Cooper 2011)
Cri6cal medical anthropology
• ‘Social suffering’ (Kleinman et al 1997) and the
impact of inequali6es/poverty and racism on
bodies and lives
• Health as a human right
• Cultural and economic poli6cs of communi6es
& how these affect individuals
Psychiatry and medical anthropology
• How are ‘normality’ and ‘abnormality’ defined in
different cultural sebngs?
• How does mental disorder present differently?
• Are diagnos6c criteria applicable globally?
• How is psychiatric knowledge/prac6ce culturally
constructed?
• Why is mental illness diagnosed more among Afro‐
Caribbeans in the U.K.?
• ‘Culture‐bound’ syndromes?
Anthropology’s engagement with public/
interna6onal health
• Arose from repeated failures of health
programmes & wish to engage on par6cular
issues (e.g. safe motherhood, condom
promo6on, diarrhoeal disease, vaccine uptake)
• Anthropologist as ‘cultural consultant’/cri6c of
cultural naivete in design and pilo6ng of health
promo6on campaigns
THANK YOU
Anthropological
Approach
Retna Siwi Padmawati
2017
Content
Anthropology
Approaches of Anthropology
Medical Anthropology
Theore6cal founda6ons of Knowledge and
Theory
• Anthropology and Public Health
•
•
•
•
What is Anthropology
• Science that studying the diverse aspects of
human beings in terms of
– social life,
– its processes and causes,
– Interrela6ons of its elements
– Its rela6ons with phenomena being studied by
other disciplines
What is Anthropology
• Culture central concept in anthropology
• Culture: systems of beliefs, values, norms of
behavior found in all socie6es; they are more
or less coherent, systema6c and ra6onal
within their own context
Concept of culture
• Complex whole which include knowledge, belief, art, moral,
law, customs and any other capabili6es and habits acquired
by man as a member of society (Tylor 1871)
• The paMern of life within community, the regularly recurring
ac6vi6es and material and social arrangements characteris6cs
of a par6cular group (Goodenough)
• Mental equipment used by members of the society in the
orienta6on process, transac6on, mee6ngs, formula6ng ideas,
grouping, and interpreta6on of real social behavior in the
community (Goodenough)
Concept of culture
• Consis6ng of ideas and cri6cal assump6ons that owned by
a society that determines or affects communica6on,
jus6fica6on, and the behavior of its members (Sathe)
• A system of symbolic meanings that serves to communicate
the meaning of one's thoughts into the minds of others
(Geertz)
• Objects, ac6ons, or events in the world that can be seen,
felt, and understood and meaningful to the members of a
society (Keesing)
Culture Vs. Individual
• Culture is collec6ve behavior
• Related to any ac6on or behavior that is ideally
governed and shaped by knowledge, beliefs, values,
and norms, and conceived together by the members
of the community in its efforts to "survive" or
precisely controlled environment (physical and
social)
Anthropology
• studies:
– Human biology
– Ecology
– Economics
– Poli6cs
– Religion
– Social and cultural rela6ons
Stream of thought
• To study the cultural differences among
socie6es.
• Dealt with the struggle to explain the an6quity
of humans and the ar6facts le[ from these
ancient lives.
• The inves6ga6on of the biological origins of
humans and other species.
Approaches of Anthropology
• Cultural rela6vism: is the principle that an
individual person's beliefs and ac6vi6es
should be understood by others in terms of
that individual's own culture.
– No beMer culture
– Best understood as a whole systems
Cultural Rela6vism vs. Ethnocentrism
• Ethnocentrism: evalua6on of other cultures according to
preconcep6ons origina6ng in the standards and customs of
one's own culture.
• Chauvanism:
– Excessive patrio6sm, eagerness for na6onal superiority;
jingoism.
– (pejora6ve) Unwarranted bias, favori6sm, or devo6on to one's
own par6cular group, cause, or idea.
– Feminists say that male chauvinism is s-ll prevalent in cultures
worldwide.
Cultural rela6vism
• Holis6c studies of communi6es (ethnography)
– Interrela6onships of physical environment, principal
ac6vi6es, economics, religion, kinship and marriage. Etc.
• Western Civiliza6on is also a culture or combina6ons
of many cultures A as product of western world, A
has its own way to see the world (need to
communicate its concepts and methods into the
language of other disciplines)
Cultural rela6vism
• Local popula6ons, not the outsiders, are the
experts on their own sociocultural environment
A is students of others (emic perspec6ve)
• Moral obliga6on to take culture and foreign
culture seriously including their social
organiza6on and values (cross‐culture) deals
with interven6on (not seeing communi6es as
empty vessels”)
Cross culture
• Usually to develop local interven6on
– Respec6ng, aMending to and addressing local
percep6ons, interests, and way of life
– Listening and sympathe6c understanding
– Helping to serve local interest
– Moral grounds for rou6nely making local concerns as
a primary criterion in public health decision making
Anthropologists as students of others
• What knowledge is relevant in new cultural
sebngs (emic perspec6ve)
– Tools or instruments are developed on the basis of
their understandings on culture and society
– Needs to spend 6mes to understand other culture
– Par6cipatory to the culture/community they studied
is essen6als
– Immersive fieldwork
What is Medical Anthropology
• Focuses on the rela6onships of society,
culture, and biology; as well as on sickness
and healing
• It is included in the component of social and
cultural anthropology
– AAA sees medical anthropology as a new stream
in applied anthropology
What is medical anthropology?
• Cultural construc6on of illness and suffering,
illness experience, medical knowledge and
healing prac6ces
• Study of the body and lifecycle from childhood
to old age
• Cri6que of produc6on of biomedical
knowledge and power rela6ons
Cultural aspects
• Beliefs, percep6ons, and knowledge about illness
(onset, e6ology, transmission, treatment, etc)
• Concepts of health and illness
• Concepts of hot and cold food in rela6on to
illness and sickness
• Norms, rules, moral, etc. which have func6on to
solve human problems
Cultural Aspects in Health‐care
Seeking
• When there is illness there is cure
• Moral efforts to regain health (including back
and forth to many medical prac66oners and
facili6es as well as to alterna6ve medicines)
• People would try every sugges6on
• Failing to follow the sugges6on would cause the
blaming of the neighbors to the family and
rela6ves of the sick person (social pressures)
Percep6on of Health and Disease
• Based on medical system
• Based on e6ology of the disease (causes)
– Natural: illness caused by imbalance nature
– Personality: illness as reflec6on of punishment/sin; a
sign of weakness
– Social/Agent: illness as an effect of social rupture;
illness as sent by enemy/agent
Explanatory model
sector and sub‐sector in health care system
popular
professional
folk
Percep6on on:
• E6ology
• Onset
• Pathophysiology
• Severity
• Sick role
• Treatment
availability
Social and cultural influence
• S6gma: TB is God‐given and incurable – delay and
non compliance for treatment
– Sin commiMed by the people and ancestors
– Karma
• Less socializing and used separate ea6ng utensil
• Marriage arrangement could be canceled
because of TB infec6on
Social and cultural aspects
• Culture determines
– who is vulnerable to illness
– Who agrees to become pa6ents – (actually seek professional
treatment)
– What and who causes illness
• Culture affect decisions about a pa6ent’s treatment and
who makes decisions
• Cultural differences create problems in communica6on,
rapport, physical examina6ons, treatment, compliance,
follow up, etc.
Anthropological methods
• Par6cipant observa6on/ethnography
• Focus groups/semi‐structured interviews:
‘qualita6ve methods’
• Rapid par6cipatory methods
• Newer methods: use of camera, videos
• Importance of stories: link between anthropology
and medicine
• By the nature of their work, GPs already have many
anthropological skills
Founda6on of Knowledge and Prac6ce:
induc6ve (shaped by field experience)
• Ecological/evolu6onary theory: physical
environment and human adapta6ons to it are the
principals determinant of sickness and healing
unilinear and mul6linear evolu6on
• Cultural theory: cultural systems of beliefs, values
and norms are basic determinants of sickness and
healings (func6onalism, structuralism, symbolic
interac6onism, etc.)
Founda6on (cont’d): Poli6cal economy theory
• The economic organiza6on and rela6onships of
power are the principal forces determining
human sickness and health cri6cal medical
anthropology
• Structural/conflict theory, materialism, socialism,
capitalism, communism, etc. economic factors
may constrain health‐promo6ng human ac6on
Central themes of medical anthropology
• Illness versus disease (Eisenberg 1977)
• ‘Lay’ explanatory models (Kleinman):
‘idiosyncra/c and changeable, and heavily
influences by both personality and cultural
factors. They are partly conscious and partly
outside of awareness and are characterised by
vagueness, mul/plicity of meanings, frequent
changes, and lack of sharp boundaries between
ideas and experience’
Embodiment
• A way around the mind‐body split central to Western and
biomedical culture
• A way of understanding lived experience
• Seminal paper by Scheper‐Hughes & Lock (1987): individual,
social and poli6cal bodies as interconnected
• Work with GPs around embodiment (Jaye 2003): some
respondents saw the task of re‐embodying pa6ents as a central
concern in general prac6ce.
‘In general prac-ce…you have an ongoing rela-onship with the self. You really
have to live with people in the way that you don’t in other special-es. So I
think from the general prac-ce point of view, embodiment is very
important. I mean it is what you’re there for in many ways, is to help
people become embodied, to own themselves again.’
Public health/medical discourse
• Highly cultural and reality‐shaping
• Medical jargon and effect on pa6ents; how pa6ent
experience is ‘re‐packaged’ in clinical leMers
• Example: debate around organ dona6on and ethnic
minori6es (Cierans & Cooper 2011)
Cri6cal medical anthropology
• ‘Social suffering’ (Kleinman et al 1997) and the
impact of inequali6es/poverty and racism on
bodies and lives
• Health as a human right
• Cultural and economic poli6cs of communi6es
& how these affect individuals
Psychiatry and medical anthropology
• How are ‘normality’ and ‘abnormality’ defined in
different cultural sebngs?
• How does mental disorder present differently?
• Are diagnos6c criteria applicable globally?
• How is psychiatric knowledge/prac6ce culturally
constructed?
• Why is mental illness diagnosed more among Afro‐
Caribbeans in the U.K.?
• ‘Culture‐bound’ syndromes?
Anthropology’s engagement with public/
interna6onal health
• Arose from repeated failures of health
programmes & wish to engage on par6cular
issues (e.g. safe motherhood, condom
promo6on, diarrhoeal disease, vaccine uptake)
• Anthropologist as ‘cultural consultant’/cri6c of
cultural naivete in design and pilo6ng of health
promo6on campaigns
THANK YOU