ANTH 17: ANTHROPOLOGY OF HEALTH AND ILLNESS
SPRING 2008
Term: Spring 2007
Course Time: MWF 10 hour (10:00-11:05)
X-hours: Thursday 12:00-12:50
Office hrs: Mon 3-5; Thurs. 10-11:30
Prof. Sienna R. Craig
404 Silsby Hall
Tel: 646-9356
Course Overview
This course introduces students to medical anthropology. Broadly conceived, this discipline involves
the cross-cultural study and analysis of health and illness and medical systems, including conceptions
of the body, the nature of disease, and the values of medicine. Medical anthropology also speaks
directly to issues of global health equity, human rights, and social suffering. This class asks that
students explore their own assumptions about how medicine – including western biomedicine – is
embedded in culture. Through lectures, discussion, readings, films, and writing assignments students
will examine the role of the healer/physician in a variety of societies, explore the boundaries
between „religion‟ and „science‟ as they relate to healing, consider what is encompassed by the
concept „traditional medicine‟, and think about the effects of new technologies, clinical research,
international development, and the global pharmaceutical industry on medical practices in different
settings. In addition, we will investigate how individuals and communities make health care-related
decisions: what motivates or scares, encourages or hinders people to address the sources and causes
of their suffering? How are concepts such as diagnosis, causality, outcome, and efficacy understood,
or misunderstood, in different medical encounters? We will also discuss the concepts of „medical
pluralism‟ and „complementary and alternative medicine,‟ with a view toward what these ideas can
teach us about health and health care in the era of globalization.
Course Goals
By the end of this course, students should be able to:
1. Describe with confidence some of the key analytical and methodological approaches of
medical anthropology, and reflect on this sub-discipline‟s contributions within academic,
clinical, and other applied settings.
2. Clearly articulate what is meant by the „cultural construction‟ of health and illness, and
understand the distinctions between illness and disease.
3. Conceptualize western biomedicine as both a scientific and a cultural system, and constructively
critique some of the ways biomedicine has interacted with non-western or non-biomedical
systems over time.
4. Draw links between the biological, socio-cultural, political, economic, and environmental
dimensions of human suffering, and give examples of how these intersecting aspects play out
through health care policy, practices, and access.
Course Structure and Requirements
This course is designed not only for students who have some background in anthropology or the
social sciences, but also for those pursuing careers in health sciences, religion, or international
studies. Although this course will include lectures, I also expect and encourage a great deal of
discussion throughout the term. I anticipate a fair amount of discussion and debate – both
structured and unstructured. Given this, students are asked to be respectful of contrasting views and
to participate as much and as often as you are able.
Ground Rules
Please turn off cell phones/pagers during class.
If you would like to take notes on a laptop, that is ok, provided that you turn off the wireless
function. Using the Internet or checking Blitz messages during class is both disrespectful to
me and to your fellow students, and distracting.
I will do my best to answer emails you might send me related to the course in a timely
manner. However, this does not mean you will get an instant reply. I reserve the right to take
24 hours to return messages. Please bear this in mind if you contact me with questions and
requests.
Readings are due on the day they are listed in the week-by-week outline. It is your
responsibility to read the syllabus carefully and come to class prepared.
Exams, Assignments, and Grades
Your grade in this class will be based on the following:
- Critical Review
- Midterm Examination
- Research-based Essay
- In-class Participation
20%
30%
40%
10%
1. Critical Review of a Course Reading. During the first week of class, I will pass around a copy
of the syllabus on which I will ask you to sign up for one reading. This may be an article or a
chapter/chapters of a book. You will then be responsible for writing a 750-1000 word (3-4 pgs,
12 point, double spaced) critical review of this article. By „critical review‟ I expect you to address
the following:
o What is the author‟s main argument?
o What evidence (methods and materials) does the author use to support his/her case?
o How does this article relate to other readings in the course? Emphasize points of
affinity and contradiction.
o What do you see as the larger implications of this work? How is it useful? For
whom?
o Offer 1-2 discussion questions based on the reading.
The critical review is due on the day your chosen reading is listed in the syllabus. They can be
sent to me by email. An archive of these critical reviews will be posted on the Blackboard site,
and should be considered a resource for all the students in the class in preparing for
examinations. The critical review is worth 20% of your grade.
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2. In-Class Midterm. This will consist of definition, identification, short answer, and essay
questions covering materials from class lectures, discussions/debates, and reading; films are
considered equivalent to lecture material and are „fair game‟ for exam questions.
The midterm exam is worth 30% of your grade.
3. Research Project and Essay on a Drug/Medicine or a Disease/Illness. This project will
provide you with an opportunity to research either a particular drug/medicine or a particular
disease/illness, and to evaluate it from an anthropological perspective, with reference to the
literature and concepts we will discuss over the term. Once you have chosen the focus of
your project, you are expected to do some outside literature review. However, this paper is
not meant to be an exhaustive history of your chosen object of study. Rather, I ask that you
write a critical analysis of how this drug/medicine or disease/illness have been culturally
constructed and represented (in the medical and anthropological literature, in popular media,
in advertising, in policy, etc.). How have these therapies or afflictions been “marked”, in a
social sense, over time? (How) have these perceptions changed? Why? What marks this
particular drug/medicine as efficacious or dangerous? What makes a particular
disease/illness a social stigma, or a badge of strength or honor?
In general terms, critical analysis involves various ways of taking ownership of the
information you encounter by registering your active engagement with that information.
This can be done in a number of ways, including placing it into some broader context (e.g.,
historical, social, cultural, political, economic, regional, global, or theoretical), breaking it
down into underlying assumptions, assessing the perspective from which it is coming,
relating it to other information or experiences from outside the class, comparing and
contrasting the ideas or findings that were presented by different sources, synthesizing
different pieces of the puzzle into a new combination, offering new examples that illustrate a
point made, questioning the logic or evidential support of points that were made,
questioning the way in which an idea or culture or practice was represented, finding
contradictions between different statements made, tracing the broader significance or
implications, and/or raising additional related questions, etcetera. You probably can‟t do all
of these sorts of critical analysis in one paper, and you are not expected to. Doing a few is
fine.
We will meet with the Anthropology Librarian once during the term to help make you aware
of search mechanisms that you can use to access different kinds of relevant literature. You
will work with a partner on this assignment. You will exchange drafts of your essays and
then do a peer-review of your partner‟s work, in anticipation of handing in the final draft.
The Research Project and Essay is worth 40% of your grade (5% for proposal, 5% of which will be for the
peer review, 10% for first draft, and 20% for final draft).
4. General Participation. This includes attendance, participation in informal class discussion,
posting questions of general import to the Blackboard site and otherwise being an engaged
member of the class.
General participation will account for 10% of your grade.
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Books and Articles
Below are the required texts for this course. The books are for sale at the Dartmouth Bookstore.
1. Farmer, Paul, Aids and Accusation: Haiti and the Geography of Blame, Berkeley: University of
California Press, 1992.
2. Harper, Janice, Endangered Species: Health, Illness and Death Among Madagascar’s People of the Forest,
Durham, NC: Carolina Academic Press, 2002.
3. Baer, Hans, Merrill Singer, and Ida Susser, 2003. Medical Anthropology and the World System, 2nd
Edition. Westport, CT: Praeger.
4. Harrington, Anne. The Cure Within: A History of Mind-Body Medicine. New York: Norton.
**All other readings on the week-by-week outline are available as downloadable PDFs on the
course Blackboard site.
Films
We will screen several films this term. Some of them will be watched during regular class times,
others will either need to be screened during X-hours, or watched on your own time (provided Jones
Media gets them digitized and streamed in time). I will refer to films during lectures, and material
discussed in the film is „fair game‟ for examination questions. I will also place the films on reserve at
Jones Media Center.
Attendance
However, out of respect for your fellow students and me, I expect you will only be absent if you are
sick or have some other legitimate, unanticipated extenuating circumstance. If you know you will be
absent, please notify me ahead of time. More than three unexplained absences over the course of the
term will impact your grade.
Academic Integrity
You are here at Dartmouth to expand your knowledge of yourself and the world around you, to
foster intellectual engagement with your instructors and your fellow students, and to push your
creative and analytic abilities through whichever disciplines in which you choose to concentrate. As
such, maintaining your academic integrity and protecting the intellectual property of both yourself
and others is paramount. You are here to collaborate and also to develop original ideas and
arguments, particularly in your written assignments. Plagiarism means the use of other people‟s
intellectual property – their ideas and words – without properly acknowledging such
sources, instead claiming the ideas as your own. I take the issue of academic integrity
seriously, and expect you to do the same, and to abide by the Dartmouth Honor Code. If
you have questions about how to reference sources, please see Sources, Their Use, and Acknowledgement,
available at: http://www.dartmouth.edu/~sources/.
Students with Disabilities
Students with learning, physical, or psychiatric disabilities enrolled in this course that may need
disability-related classroom accommodations are encouraged to make an office appointment to see
me before the end of the second week of term. All discussions will remain confidential, although the
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Student Accessibility Services office may be consulted to discuss appropriate implementation of any
accommodation requested.
Religious Observances
I realize that some students may wish to take part in religious observances that fall during this
academic term. Should you have a religious observance that conflicts with your participation in the
course, please come speak with me before the end of the second week of term to discuss
appropriate accommodations.
WEEK-BY-WEEK SCHEDULE
WEEK 1:
CONCEIVING OF HEALTH AND ILLNESS
26 March (W)
Readings
Course Introduction: Why Study Medical Anthropology?
NONE
28 March (F)
Readings
Theoretical Perspectives in Medical Anthropology
- Baer, Singer and Susser, Chapter 1-2.
WEEK 2:
PATIENTS, HEALERS, AND THE THERAPEUTIC PROCESS – PART I
31 March (M)
Readings
What is the „Therapeutic Process‟?
- Csordas, Thomas and Arthur Kleinman, 1997. “The Therapeutic Process,”
IN C. Sargent and T. Johnson, eds. Medical Anthropology: Contemporary Theory
and Method, revised edition. Westport, CT: Praeger, pp. 3-20.
2 April (W)
Readings
The Phenomenology of Suffering
- Sachs, Oliver, “Becoming a Patient.” IN A Leg to Stand On. New York:
Simon and Schuster/Touchstone, pp. 21-82.
- Good, Byron, 1992. “A Body in Pain: The Making of a World of Chronic
Pain.” IN Pain as Human Experience: An Anthropological Perspective, Berkeley:
University of California Press, pp. 29-48. [recommended; critical review]
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4 April (F)
Readings
Explanatory Models, Illness Narratives, and Therapeutic Alliance
Guest Lecture by Prof. Hoyt Alverson
- Good, Byron, 1994. “The Narrative Representation of Illness.” IN Medicine,
Rationality, and Experience. Cambridge: Cambridge University Press, pp. 135165.
- Alverson, Hoyt, Robert Drake, et al. 2007. “Ethnocultural Variation in
Mental Illness Discourse: Some Implications for Building Therapeutic
Alliances.” Psychiatric Services 58(12): 1-12.
Week 3:
PATIENTS, HEALERS, AND THE THERAPEUTIC PROCESS – PART II
7 April (M)
Biomedicine as a Cultural System
Guest Lecture by Ivy Wilkinson-Ryan, 4th Year Dartmouth Medical School Student
- Good, Byron and Mary-Jo DelVecchio-Good, 1993. “„Learning Medicine‟:
The Constructing of Medical Knowledge at Harvard University.” IN S.
Lindenbaum and M. Lock, eds. Knowledge, Power, and Practice: The Anthropology
of Medicine and Everyday Life. Berkeley: University of California Press, pp. 81106. [recommended; critical review]
- Bates, Don, 2006. “Why not call „modern‟ medicine „alternative‟?” IN
Whittaker, ed. Health and Healing in Comparative Perspective. Upper Saddle, NJ:
Prentice Hall, pp. 29-40.
Readings
9 April (W)
Readings
Efficacy, Placebos, and „Belief‟
- Moerman, Daniel, 2000. “Cultural Variations in the Placebo Effect: Ulcers,
Anxiety, and Blood Pressure. Medical Anthropology Quarterly 14(1): 51-72.
10 April (x-hour)
Film Screening “Doctors of Nigeria”
11 April (F)
Readings
Medical Pluralism and “Ethnomedicine”
- Waldram, James, 2000. “The Efficacy of Traditional Medicine: Current
Theoretical and Methodological Issues.” Medical Anthropology Quarterly, 14(4):
603-625
- Baer, Singer and Susser, Chapter 11.
WEEK 4:
TRACING A PANDEMIC: THE MEANINGS AND USES OF HIV/AIDS
14 April (M)
Readings
Myths, Histories, and Realities of HIV/AIDS
- Farmer, Introduction and Part I, pp. 1-58
- Baer, Singer and Susser, Chapter 8.
15 April (Tues)
Public Talk by Dr. Phuoc V. Le, M.D. Harvard University
Sponsored by the Dickey Center, Physicians for Human Rights, and
Dartmouth Coalition for Global Health
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16 April (W)
Readings
HIV/AIDS, Development, and Social Inequality
Farmer, Part II, pp. 59-120
- César E. Abadía-Barrero, 2004. “Happy children with AIDS: The paradox
of a healthy national program in an unequal and exclusionary Brazil,” IN A.
Castro and M. Singer, eds. Unhealthy Health Policy, Walnut Creek, CA: Alta
Mira Press, pp. 163-176. [recommended; critical review]
17 April (x-hour)
RESEARCH SESSION
Presentation by Amy Witzel, Anthropology/Social Science Librarian
18 April (F)
Readings
Film screening
Global Pharma and HIV
- Farmer, Part III, pp. 121-150
“Patients and Patents”
WEEK 5:
APPROACHES TO HIV/AIDS TREATMENT, ACTIVISM, AND ADVOCACY
21 April (M)
Readings
Social Suffering, Structural Violence and Global Health Challenges
- Farmer, Part IV, pp. 151-190
- Paul Farmer, 1997. “On Suffering and Structural Violence: A View from
Below,” IN A. Kleinman, V. Das and M. Lock, eds. Social Suffering, pp. 261284. [recommended; critical review]
- UNAIDS, 2006. “Report on the Global AIDS Epidemic: Executive
Summary. New York: United Nations, a UNAIDS 10th Anniversary Special
Edition, pp. 5-26. **SKIM
500 word proposal for drug/medicine or disease/illness paper due in class
Assignment
23 April (W)
Readings
Traditional Healers, Culture, and HIV/AIDS
- Farmer, Part V, pp. 191-264
- Edward Green, “Engaging Indigenous African Healers in the Prevention of
AIDS and STDs.” IN R. Hahn, ed. Anthropology in Public Health: Bridging
Differences in Culture and Society, Oxford: Oxford University Press, pp. 63-83
24 April (x-hour)
Review Session (optional)
25 April (F)
Readings
MIDTERM EXAM
NONE
WEEK 6:
POLITICAL ECOLOGIES OF HEALTH
28 April (M)
Readings
What is “political ecology” and how does it relate to health?
- Harper, Chapters 1-3
- Baer, Singer and Susser, Chapter 3.
30 April (W)
Readings
Culture, Biodiversity, and the Values of Medicine
- Harper, Chs. 4-5
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- Michael Dorsey, “Future Markets in Biology: Life After Bioprospecting.”
IN Report: The Bio Politic, NACLA Report on the Americas, March-April
2006, pp. 31-34. [recommended; critical review]
2 May (F)
Readings
Negotiating Health between Humans and non-Humans
- Harper, Ch. 6
WEEK 7:
DEVELOPMENT AND HEALTH
5 May (M)
Readings
Strategies of Health Development in View and Review
- Harper, Ch. 7
- Joan E. Paluzzi, 2004. “Primary Health Care since Alma Ata: Lost in the
Bretton Woods?” IN A. Castro and M. Singer, eds. Unhealthy Health Policy,
Walnut Creek, CA: Alta Mira Press, pp. 63-78.
7 May (W)
Readings
Legacies of Colonialism and Social Inequality in Medicine
- Harper, Ch. 8
- Apffel Marglin, Frederique, 1990. “Smallpox in Two Systems of
Knowledge.” IN F. Apffel Marglin and S. Marglin, eds. Dominating Knowledge:
Development, Culture, and Resistance. Oxford: Oxford University Press.
- Peter Brown, 1987. “Microparasites and Macroparasites”, Cultural
Anthropology, 2(1): 155-171. [recommended; critical review]
9 May (F)
Readings
Traditional Medical Practitioners and “Integrative” Medicine
- Harper, Ch. 9
- Stacey Leigh Pigg, 1997. “Found in Most Traditional Societies: Traditional
Medical Practitioners Between Culture and Development,” IN F. Cooper
and R. Packard, eds. International Development and the Social Sciences: Essays on the
History and Politics of Knowledge, Berkeley: University of California Press, pp.
259-290.
- WHO website on Traditional Medicine:
(http://www.who.int/mediacentre/factsheets/fs134/en/) **SKIM
WEEK 8:
INDIVIDUAL BODIES, SOCIAL BODIES, AND THE BODY POLITIC
12 May (M)
Readings
Considering the „Mindful Body‟
- Nancy Scheper-Hughes and Margaret Lock, 1987. “The Mindful Body: A
Prolegomenon to Future Works in Medical Anthropology,” Medical
Anthropology Quarterly, 1(1): 6-41.
First draft of medicine/illness essay due to your peer review partner and me
Assignment
14 May (W)
Readings
Individuals, Science, and the State
- Emily Martin, 1990. “Toward An Anthropology of Immunology: The Body
as Nation State,” Medical Anthropology Quarterly, 4(4): 410-426.
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- Foucault, Michel. 1984 (1972). “The Politics of Health in the 18th Century.”
IN P. Rabinow, ed. The Foucault Reader. New York: Pantheon Books, pp. 273289
15 May (x-hour)
Readings
Depression in China: Between the Personal, Social, and Political
Guest Lecture by Prof. Justin Rudelson
- Rudelson reading TBN
- Arthur and Joan Kleinman, 1999. “The Transformation of Everyday Social
Experiences: What a Mental and Social Health Perspective Reveals about
Chinese Communities Under Global and Local Change.” Culture, Medicine,
and Psychiatry, 23(1): 7-24. [recommended; critical review]
16 May (F)
Readings
NO CLASS – GREEN KEY
- Harrington, Introduction
WEEK 9:
MIND-BODY MEDICINE IN ANTHROPOLOGICAL PERSPECTIVE
19 May (M)
Readings
Assignment
Revisiting the Therapeutic Process
- Harrington, Ch. 1-2
Peer reviews of medicine/illness paper due back to your partners
21 May (W)
Readings
Modernity‟s Ills
- Harrington, Ch. 3-4
23 May (F)
Considering Evidence and Efficacy in Chinese Medicine
Guest Lecture by Prof. Jeanne Shea, University of Vermont
- Harrington, Ch. 5-6
- Shea, Jeanne, “Applying Evidence-Based Medicine to Traditional Chinese
Medicine: Debate and Strategy.” Journal of Alternative and Complimentary
Medicine 12(3): 255-263).
Readings
WEEK 10:
MIND-BODY MEDICINE, CONT.
26 May (M)
NO CLASS - MEMORIAL DAY
28 May (W)
Readings
Wrap-up, Catch-up and Course Evaluations
- Harrington, Conclusion
2 June (M)
Final Portfolios of Medicine/Illness paper DUE 4PM
Feature Film possibilities – we‟ll do at least 1 movie night over the course of the term:
The Devil Came on Horseback
Dirty Pretty Things
Before Night Falls
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Four Months, Three Weeks and Two Days
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