Despite Hiedegger’s revolutionary claim that it is not possible to escape existence and find a view of the world from nowhere,we continue to divide anthropology into neat subfields— defined typically by institutional logics of modern societies — and act as if the subfields combine to make an entity that is culturally universal in its explanatory capacity. Existentialism may not be the most pragmatic philosophy after all. But having a strong temperament of wanting to recognise and purge forms of ethnocentricism from its analytic tool box, anthropology thus finds itself in a bind of false syntheses. This article explores this bind in the context of medical anthropology, a subfield that’s very name is made-up of two parts that, to a general audience, are likely to summon, on the one hand, images of doctors and nurses and, on the other, images of the social and cultural study of humanity.
The origins of medical anthropology are difficult to pin-down. The focus and concerns of the subfield have to a certain extent been part of anthropology since the beginning of the discipline (Tylor 1871, Rivers 1926), appearing in seminal functionalist, structuralist, and symbolic works (Evans-Pritchard 1937, Hallowell 1955, Levi-Strauss 1968, Turner 1967). Despite this early research on issues central to the subfield, medical anthropology did not gain wide recognition and a formal identity until the 1970s and early 80s with the emergence of a prolific series of anthologies, ethnographies, large scale studies, specialised and comparative surveys, and three major journals (Culture, Medicine and Psychiatry; Medical Anthropology; Social Science and Medicine Quarterly). Medical anthropology came of age during this period with research in different parts of the world focused on beliefs and practices related to medicine, illness, disease, and healing, and from which seminal theoretical and methodological trajectories were formed (see overview Young 1982). These ‘official’ beginnings of medical anthropology were inseparable to the broader academic renaissance of the period that was marked by interpretivist orientations, post-structuralism, postcolonialism, philosophical relativism, critical theory, feminism, and the rapid expansion of the university sector.
In the 1970s, the massive production of medical anthropological research stimulated and was accompanied by several texts that attempted to synthesis the disparate research from around the globe into grand or overarching concepts. One of the forefathers of this tradition, George Foster (1976), analysed literature on ‘non-Western medical systems’ to develop a comparative analysis of emic explanatory models of disease, illness, and misfortune. He called for the construction of cross-cultural taxonomies of notions of illness and misfortune and for the inauguration of a medical anthropology that was just as distinct in theoretical character as the anthropological classification of ‘kinship, political and economic systems, and witchcraft and sorcery beliefs’ (1976:774). His comparative approach included the premise that in most medical systems ‘diagnosis’ and ‘treatment’ are concerned less with ‘underlying pathological processes’ and more with the revelation of the causing factors or agents of pathology and misfortune (Foster 1976:775).
Foster argued that the world’s medical diversity is characterised by two dominant — though not exclusive — systems of disease/illness/misfortune explanation that he coined ‘naturalistic’ and ‘personalistic’. Naturalistic medical systems, Foster explained, refer to beliefs and practices that describe or involve ‘impersonal forces’ and ‘conditions’ that constellate around cosmological predicates of balance or equilibrium in the human body and environment, such as yin-yang principles in Chinese medicine, hot-cold principles in Ayurveda and Amerindian cosmologies, and humoralism in China, South East Asia, Ancient Rome, Ancient Greece and elsewhere. In contrast, the perception that pathology and misfortune are caused by witches, sorcerers, family members, enemies, nonhuman persons, spirits, and deities, marks the ‘personalistic’ and alternate pole of Foster’s global theory of disease etiology (1976:775). His notions have been criticized for producing an ahistorical and essentialist non-Western Other and for overlooking alternative practices of healing in Western societies (Worsley 1982:315). In addition, his taxonomical approach to etiology has been criticised for its inability to address societies in which multiple explanatory frameworks of disease and misfortune are present (Garro 2000:308). Later research has detailed that in many medical systems diagnosis is also a form of treatment (Csordas and Kleinman 1996:4) — in other words, in these contexts the two concepts are redundant and conflate to become different than their parts combined. The a priori distinguishing of ‘diagnosis’ and ‘treatment’ at the centre of Foster’s theory produces certain analytical and explanatory limitations given its ethnocentric impositions. Foster’s approach, along with similar early cross-cultural topologies of illness, disease, misfortune, curing and health (Young 1976, Murdock 1980), have contributed to the development of medical anthropology (in particular, interpretive medical anthropology) by bringing attention to the rich cultural diversity of meanings and practices that come into being in situations of illness, malaise, tragedy, misfortune, death, and health and wellbeing.
Despite the strong reflexive critiques of medical anthropology mentioned above, the subfield is inextricably bound to parameters of logic that, I argue, are inescapably ethnocentric. The assumption that medicine, disease, illness, and healing can be isolated as distinct concepts and practices of all cultural contexts becomes radically problematised in light of the various social roles that different “medical specialists” undertake in ritual and everyday contexts around the world.
Diviners, curers, oracles, shamans, and doctors the world over are consulted certainly about bodily ills, but also about mental illness, social problems, and calamities of supernatural provenance which express jealousy, hatred, and suspicions emanating from conflicts over land, money, and inheritance, over marital and sexual disputes, and from political ambitions and rivals. (Worsley 1982:315
Thus shamans, curers, oracles and similar practitioners have been increasingly described in anthropology in terms of notions of relatedness or relationalism. Practices of healing/sorcery among indigenous peoples of the Amazon, for instance, are typically centred upon rituals and activities in which social relations and moral questions are foregrounded. Amazonian shamans are typically endowed with ‘morally ambiguous’ (Whitehead & Wright 2004) powers to both heal and harm or kill. For example, Shipibo ayahuasca healers, as described by Brabec de Mori (2014:218), are structurally both healers and sorcerers ‘because healing consists of neutralizing an enemy’s action on the patient, and overthrowing this enemy by striking him with his own weapon’, and this morally ambiguous space of Amazonian shamanism becomes a complex site of micro-political tensions (Saez 2014).
Amazonian shamanism, including the shamanic practices of drinking the hallucinogen ayahuasca, include structural qualities that appear to lend themselves generally to relational and diplomatic acts. The skill and finesse that shamans require in order to contact and interact, negotiate, and develop relationships with spirits during ayahuasca trances (which is typically based upon practices of shapeshifting) place them in a good position to broker between local and foreign or ‘alien’ peoples more generally.A logic of alterity and practices of the negotiation of otherness characterise indigenous ayahuasca shamanism (Labate 2014). Thus it should come as no surprise that during a period of history in which many aspects of Yaminahua social and political organisation and practice were eroded by the modern world, Yaminahua practices of ayahuasca shamanism flourished (Townsley 1993). The transformative zone of forms of sociality is the stomping ground of ayahuasca shamanism. Ayahuasca drinking ‘materialises alliances’ (Virtanen 2014:60) between different social groups undergoing rapid cultural transformations.
In contrast to relational models of illness, disease, and misfortune,biomedical institutions are characterised by a kind of objective and clinical sterilisation that consistently banishes social, political, and moral concerns that may be embodied in the patient’s perceptions of health and pathology (Taussig 1982:7).This act of isolating dimensions of distress and suffering to impersonal dimensions involves a process in which pathology is characterised as a thing-in-itself that has certain relationships with environments or other impersonal things (including other impersonal human bodies). Given that these things-in-themselves are the prime objects of medical anthropology (from which social and cultural dynamisms are then considered or explained), I argue, medical anthropology is inextricably bound to a lineage of Western or allopathic medicine. The relational systems of types of ayahuasca shamanism are not confined to the emergence of issues that Western medicine would describe as pathological, but they include profound and everyday dimensions of sociality in which humans and nonhumans, the alive and the dead, and the visible and the invisible, are active agents and themes. Encompassing and before and after illness, disease, and misfortune, or any of these “objects”, relations appear to be the currency of Amazonian shamanism.
far from trying to reduce ‘surrounding intentionality’ to zero in order to attain an absolute objective representation of the world, [Amazonian shamanism does the] opposite: true knowledge aims at the revelation of a maximum of intentionality, by way of a process of systematic and deliberate “abduction of agency”… a good shamanic interpretation succeeds in seeing each event as being in reality an action, an expression of internal states of intentional predicates of some agent. (Viveiros de Castro 2005:43)
Are shamans herbalist, relationship brokers, politicians, psychologists, and doctors? Do these concepts offer any real (and not simply convenient and romantic) analytic value in relation to understanding and explaining “shamans”? Roger Rouse demonstrated that the notions of “shamans” in Northwest Amazonia (pariekoku, kumu, ye’e,and paye) themselves appear to exist less as identities than as relational markets.He states,:
in a purely relational system of naming there are no absolute terms. Only from a particular point of view, that of the naming subject, does there appear to be an intrinsic identity between the name and the object so described. Kinship terminologies exemplify this. It seems useful, in the Tukanoan context, to regard statements such as ‘he is a shaman’ or ‘he is a jaguar’ as analogous to statements such as ‘he is a brother’ or ‘he is a ‘cross-cousin’… The Tukanoans themselves recognise that, in the last resort, terms such as ‘cross-cousin’ and ‘brother’ describe positions rather than people.(Rouse 1978: 121)
The revelation that “shamans” signify relational dynamics among affines and enemies (and humans and nonhumans), takes the practice and techniques of “shamans”well beyond the parameters of illness, disease, and malaise.Similarly, in cultural contexts where illness and disease summon the question of “why” or “why me” (Taussig 1982), and become the site of interpersonal dispute, sorcery accusations, and informal processes of social regulation, the notion of the “medical” appears to become overwhelmed and to fall short in terms of its analytic scope.
A Hmong shaman performing a soul-retrieval healing during a ceremony at the Mercy Medical Centre in California.
The linage or background situatedness of a global anthropology dedicated to medical issues maintains a particular cultural-historic positioning by being medical anthropology and not Qi anthropology, mana anthropology, or any other culture-specific concept that is central — but not necessarily limited — to notions of illness, disease, and healing. While this logic could be extended in different ways to various other subfields of anthropology, the unique reflexive marker of medical anthropology becomes apparent precisely in the ways in which the field has offered critiques of biomedicine and related institutions. These critiques also mark the movement away from medical anthropology being simply an applied science or instrument of Western medical institutions.
When taken to its extreme, this gesture away from the concepts or origins of the subfield of medical anthropology appears to signify a kind of analytical choking cannibalism insofar as the knowledge produced by medical anthropology problematises the subfield’s own existence through working to annihilate yet reproduce foundational ideas of health and the medical. This paradox is resultant of the need for the anthropologist to be candid about cultural diversity (and thus annihilate absolutist Western-derived analytic and explanatory categories) alongside the need to maintain the field of medical anthropology (and thus reproduce or relate to foundational ideas of “health” and the “medical”). The dialectic tension of this predicament is born precisely in the institutional logics of the university sector in relation to how it attempts to relate to and absorb other cultural institutions or contexts of knowledge production and practice around the globe. Idioms of spirit possession in Africa, perspectives on land and belonging in Aboriginal Australia, or the social morphology of humoralism under Mao in China, are explained and rendered meaningful anthropological knowledge through an integration of the different ethnographic encounters with anthropological discursive projects that cannot be fully purified of the logics of universities and the societies and histories of which they are constituted.
Yet the politics of knowledge and representation in anthropology are of course nothing new. We have a ‘general consensus in anthropology nowadays’ that ethnographers ‘create knowledge’ in their interaction with persons in the field (Knibbe and Versteeg 2008:52). That knowledge is not simply objective, nor purely subjective, but intersubjective.In this relational view of knowledge production,anthropologists begin to appear much more like “shamans”,”healers”, and “sorcerers”. The production or output of the researcher is characterised by relational objects (research papers) that are constituted intersubjectively in the field by multiple agents (or voices), and that have real consequences to social and cultural life. Finally, the nexus in which these agents converge is not neutral but dominated or enchanted by the politics of institutional logics,funding bodies, university departments, and cultural-historical forces that protect the limits and existence of anthropological subfields.Analytical cannibalism may be served and consumed as an entrée, but very rarely as a main course.
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