Clinically Applied Anthropology: Anthropologists in Health Science Settings

434 Pages·1982·29.68 MB·English

by  Noel J. Chrisman

CLINICALLY APPLIED ANTHROPOLOGY
CULTURE, ILLNESS, AND HEALING
Studies in Comparative Cross-Cultural Research
Editor-in-Chief:
ARTHUR KLEINMAN
University o/Washington, Seattle, Washington, U.S.A.
Editorial Board:
LEON EISENBERG
Harvard Medical School, Boston, Massachusetts, U.S.A.
NUR YALMAN
Harvard University, Ozmbridge, Massachusetts, U.S.A.
MORRIS CARST AIRS
Postgraduate Institute 0/M edical Education and Research, Chandigarh, India
VOLUME 5
CLINICALLY
APPLIED
ANTHROPOLOGY
Anthropologists in Health Science Settings
Edited by
NOEL J. CHRISMAN
University of Washington, Seattle
and
THOMAS W. MARETZKI
University ofH awaii, Honolulu
D. REIDEL PUBLISHING COMPANY
DORDRECHT: HOLLAND / BOSTON: U.S.A.
LONDON:ENGLAND
Library of Congress Cataloging in Publication Data
Main entry under title:
Clinically applied anthropology.
(Culture, illness, and healing ; 5)
Includes index.
1. Social medicine. 2. Medical anthropology. 3. Medicine
and psychology. I. Chrisman, Noel J., 1940- II. Maretzki,
Thomas. III. Series. [DNLM: 1. Anthropology. 2. Medicine.
WI CU445 v. 5/ GN 296 C641]
RA418.C64 1982 362.1'042 82-12301
ISBN-13: 978-90-277-1419-0 e-ISBN-13: 978-94-010-9180-0
DOl: 10.1007/978-94-010-9180-0
Published by D. Reidel Publishing Company,
P.O. Box 17, 3300 AA Dordrecht, Holland.
Sold and distributed in the U.S.A. and Canada
by Kluwer Boston Inc.,
190 Old Derby Street, Hingham, MA 02043, U.S.A.
In all other countries, sold and distributed
by Kluwer Academic Publishers Group,
P.O. Box 322, 3300 AH Dordrecht, Holland.
D. Reidel Publishing Company is a member of the Kluwer Group.
All Rights Reserved
Copyright © 1982 byD. Reidel Publishing Company, Dordrecht, Holland
Softcover reprint of the hardcover 1st edition 1982
No part of the material protected by this copyright notice may be reproduced or
utilized in any form or by any means, electronic or mechanical,
including photocopying, recording or by any informational storage and
retrieval system, without written permission from the copyright owner
T ABLE OF CONTENTS
PREFACE W
NOEL J. CHRISMAN and THOMAS W. MARETZKI I Anthropology in
Health Science Settings 1
SECTION I. CLINICALLY APPLIED ANTHROPOLOGY TEACHING
ROBERT C. NESS I Medical Anthropology in a Preclinical Curriculum 35
HOWARD F. STEIN I The Ethnographic Mode of Teaching Clinical
Behavioral Science 61
ARTHUR KLEINMAN I Clinically Applied Anthropology on a PsychiatriC
Consultation-liaison Service 83
NOEL J. CHRISMAN I Anthropology in Nursing: An Exploration of
Adaptation 117
CHERYL RITENBAUGH I New Approaches to Old Problems: Inter-
actions of Culture and Nutrition 141
IRWIN PRESS I Witch Doctor's Legacy: Some Anthropological Implica-
tions for the Practice of Clinical Medicine 179
SECTION II: CLINICALLY APPLIED ANTHROPOLOGY
RESEARCH
HAZEL HITSON WEIDMAN I Research Strategies, Structural Alterations,
and Clinically Relevant Anthropology 201
ATWOOD D. GAINES I Knowledge and Practice: Anthropological Ideas
and Psychiatric Practice 243
MARY-JO DEL VECCHIO GOOD and BYRON GOOD I Patient Requests
in Primary Care Clinics 275
DAN BLUMHAGEN I The Meaning of Hypertension 297
BARBARA GALLATIN ANDERSON,I. RAFAEL TOLEDO,andNANCY
HAZAM I An Approach to the Resolution of Mexican-American
Resistance to Diagnostic and Remedial Pediatric Heart Care 325
vi T ABLE OF CONTENTS
LINDA ALEXANDER / Illness Maintenance and the New American Sick
Role 351
SUE E. ESTROFF / Long Tenn Psychiatric Clients in an American Com-
munity: Some Sociocultural Factors in Chronic Mental Illness 369
ELIZABETH L. BYERLY and CRAIG A. MOLGAARD / Social Institu-
tions and Disease Transmission 395
AUTHOR INDEX 411
SUBJECT INDEX 417
PREFACE
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. Clinically applied anthropology is oriented
toward clarification and expansion of perspective - a teaching, research, and
consulting role. If the anthropologist is, or subsequently becomes, prepared to be
a clinician, the clinical activities are genuinely nursing, medicine, alcohol and
drug abuse counseling, or the like, but not anthropology. As anthropologists,
we are not educated to intervene; nor is the legal, ethical, or supervisory structure
set up to allow it.
The nearly simultaneous development of similar new directions in medical
anthropology highlights a decade of rapid change in this sub field that promises
to continue. Significantly, medical anthropology's focus is shifting away from its
roots in the anthropology of religion - health related beliefs and rituals - and
traditional physical anthropology - describing biological variation. Research is
directed toward understanding the cultural underpinnings of genetic diseases,
popUlation dynamics, nutrition, healing practices, health care organization, and
patient choices among health care alternatives in complex societies. The prolifera
tion of journals related to anthropological study of health issues and the accelerated
development of medical anthropology programs for graduate study are further
evidence of growth.
These changes in medical anthropology have increased its relevance for the
health science professions of medicine, nursing, public health, pharmacy, dentistry,
viii PREFACE
and social work. Thus, we have the opportunity to contribute in health related
academic, clinical, and research settings. What remains is to take advantage of that
opportunity. We see this volume as one step in that direction.
The Editors wish to acknowledge the important typing and editorial assistance
provided by Donna Van Winkle. In addition, we benefitted from many helpful
suggestions offered by colleagues at the Universities of Washington and Hawaii.
The most Significant support came from Arthur Kleinman. As series editor and
friend, he has helped with advice, ideas, and rewriting throughout the entire process.
Our families, too, deserve recognition for relinquishing some family activities
that would have occurred except for our work on this book.
THE EDITORS
NOEL J. CHRISMAN AND THOMAS W. MARETZKI
ANTHROPOLOGY IN HEALTH SCIENCE SETTINGS
THE NEED FOR THIS BOOK
The explosive expansion of anthropology is startling when held against the short
span of time it has existed as a discipline. Numerically it appears to attract a dis
proportionately large number of interested individuals to its medically focused
sub-discipline. Less than two decades old as a recognized distinct area within
anthropology, medical anthropology has taken an independent and vigorous course
of its own. Its roots in anthropology and its continuing ties with the theoretical
formulations and important general data base of biological, linguistic, and social
anthropology are not in question. New areas of investigation are generated and
tested with theories central to anthropology, and with reliance on interdisciplinary
thinking. The core activities within medical anthropology are social science brought
to bear on issues that relate to the universal human challenge of health maintenance
and response to sickness.
Clinically applied anthropology is one special emergent direction within medical
anthropology, found within the context of health science schools. The move to
that setting happened long ago, but only recently have the implications for the
field and for our professional behavior emerged as interesting enough to stimulate
sharing information. The recent interest stems from the existence of larger numbers
(though still not very large) of anthropologists in health science settings and the
likelihood that these numbers will grow as the anthropological job market changes.
Working alone for the most part, anthropologists in health science settings have
developed their own approaches for doing anthropology in novel environments.
They endured the problems and celebrated the successes by themselves, but some
times shared them in conversation at the meetings of the American Anthropological
Association, the Society for Applied Anthropology, or the Association for the
Behavioral Sciences and Medical Education.
The need to more formally communicate what we have learned - to ourselves
and to anthropologists who hope to work in the health sciences - is what stimulated
this volume. Although clinically applied anthropology is no exception to the notion
that new interest areas arise through coffee and cocktail table talks, a time comes
for putting pen to paper. Steps in this direction began in 1980 with the preliminary
discussions of clinical anthropology and the debate on that subject in the Medical
Anthropology Newsletter (MAN 1980). More will appear through this decade.
Rather than debate the format of an interest area, we have chosen to exchange
information - about teaching strategies, about research relevant to our clinical
audiences, about the nature of where we work. These issues deserve communication
if only to create a sense of community among those of us who buck anthropological
1
N. J. Chrisman and T. W. Maretzki (eds.), Clinically Applied Anthropology, 1-31.
Copyright © 1982 by D. Reidel Publishing Company.
2 NOEL J. CHRISMAN AND THOMAS W. MARETZKI
tradition by working outside anthropology departments. There is, however, a
broader need. It appears unlikely, even with the funding crises apparent for the
80's, that all anthropologists will leave health science schools. In addition, we
believe that anthropology can benefit from the expansion of some of its members
into a new niche. Growth, analogous to that in medical anthropology and urban
anthropology, is possible. This expansion will depend on two qualities: close
adherence to the established norms of anthropology and clear translation and
communication of these norms to members of other disciplines who work with
us.
We see clinically applied anthropology as a specialized focus within the discipline
that clusters the data, theory, and methods of anthropology in ways that serve to
clarify specific clinical issues in health maintenance and response to sickness. To
some extent, this view contrasts with the notion that what happens in health
science schools is the medical anthropology of anthropology departments. It is true
that clinically applied anthropology like medical anthropology is concerned with
the anthropological issues surrounding health and sickness. Yet the professional
thrust differs and the difference is most strikingly seen in the nature of the intended
audience. The readers of literature in medical anthropology are predominantly
anthropologists who hope to expand knowledge of their field. The audience for
clinically applied anthropologists is primarily constituted by clinicians of various
sorts. Thus the presumed recipients of our social science skills do not automatically
share the professional assumptions that sustain discourse within a discipline.
We believe that this lack of congruence in professional assumptions is the funda
mental challenge and source of excitement in the field. It permeates the daily life
of an anthropologist in a health science setting. An experienced anthropologist,
working for a year in a health science school, said that the most bothersome aspect
of his new position was the constant need to justify his existence. Academic an
thropologists are accustomed to teaching graduates and undergraduates taking
courses with established content and to debating disciplinary perspectives on
various subjects with colleagues from their own and other departments. But the
persistent need to legitimize a claim to be there in the first place is beyond the
experience of most of us.
This book was explicitly designed to aid anthropologists in health science
settings as we attempt to justify our existence in a novel territory. And the most
important topographical feature of this territory is the service mandate of clinicians.
This mandate is an essential element in the professional assumptions of health
scientists. It also contrasts strongly with the thrust toward 'understanding' common
within anthropology. In this volume, we hope to present some examples of how
anthropologists have attempted to translate the understandings of anthropology
for health professionals so that their services to patients can be more humanistic,
holistic, or culture-sensitive. This is a difficult task: the basic perspectives of the two
fields differ; educational expenences are dissimilar; the personality types and per
sonal interests of people drawn into anthropology are probably different from those
drawn into the health sciences. Yet both fields stand to gain. And, more importantly