Undergraduates: Two midterms (worth 21% each) and a final exam (worth 33%) will be given for a total of 75% of the grade. Exams will consist primarily of brief and long essay questions. Class discussion will constitute 20% of the grade. A two-page review paper on a student's choice of ethnography will be due at the end of the semester and will count as 5% of the grade.

Graduate Students: A twenty-page research paper on a subject approved by the instructor will be due at the end of the semester and will be worth 50% of the grade. The other 50% of the grade will be based on the quantity and quality of participation in class discussion.

Class participation is expected from all students, especially during seminar sessions. Students should endeavor to limit their contributions to discussion to a maximum of three to four comments per class in order to allow all students the chance to participate. If students are not preparing for and participating in seminar discussions, in-class essays may be given upon a one-week advance notice. These will be graded Pass/Fail.

1. Ohnuki-Tierney, 1984, Illness and Culture in Contemporary Japan.
2. Farmer, 1999, Infections and Inequalities: The Modern Plagues.
3. Joralemon and Sharon, 1993, Sorcery and Shamanism.
4. Joralemon, 1999, Exploring Medical Anthropology.
5. Payer, 1996, Medicine and Culture.

All required articles are to be found on reserve at Gorgas Library. Reserve articles are on end-of-day reserve at Gorgas library, but please try to limit your use to no more than 2 hours at a time. The professor reserves the right to change, delete or add articles to the reading list as necessary.

1: Jan. 11   Introduction

• Joralemon text Chapter 1, 2

2: Jan. 16, 18  History and Overview of the Field

• Landy, D. Medical anthropology: A critical appraisal
• Glick, L.. Medicine as an ethnographic category (New Guinea)
• Dressler and Oths Cultural determinants of health behavior

3: Jan. 23, 25 Disease through the Ages

• Armelagos, G. Human evolution and the evolution of disease
• Ackerknecht, E. Paleopathology
• Dubos, R. Determinants of health and disease
• Comaroff, J. The diseased heart of Africa: Medicine, colonialism, and the Black body

4: Jan. 30, Feb 1 Fundamental Approaches to the Study of Medical Anthropology

• Joralemon text Chapters 3, 4, 5

5: Feb. 6, 8 Fundamental Approaches, cont.

• Joralemon text Chapters 6, 7, 8

6: Feb. 15 Etiology: Cultural Classifications of Disease and Illness

• Farmer ethnography

7: Feb. 20, 22 Etiology: cont.

• Farmer finish ethnography
• Burkett, G. Culture, illness and the biopsychosocial model
• Dressler, W. Health in the African-American community: Accounting for health inequalities
• Palinkas, L. Social, Cultural, and Psychological Impacts of the Exxon Valdez Oil Spill

8: Feb. 27 Etiology: cont.

• Ohnuki-Tierney ethnography

9. Mar. 6 Etiology: cont.

• Logan, M. Humoral medicine in Guatemala and peasant acceptance of modern medicine
• Engel, G. Sudden and rapid death during psychological stress film Evil Wind, Evil Air (Andes)

• Crandon-Malamud Changing times and changing symptoms: Case of two Mestizo sisters (Bolivia)

10: Mar. 13 Signs and Symptoms: cont.

• Kliger Somatization: Social control and illness production in a religious cult (U.S.)
• Gaines/Farmer Visible saints (France)
• Rubel, A. The epidemiology of a folk illness: susto in Hispanic America

Mar. 15 Help Seeking: Lay consultation, Local Health Care Systems, and Treatment Choice

• Jansen, J. Strife in the family as cause of child’s illness (Zaire)
• Oths, K. Health care decisions of households in economic stress (Peru)

11: Mar. 20, 22 Help Seeking: cont.

Grads Only: Witchcraft Oracles and Magic Among the Azande (ethnography) (Sudan)

film Witchcraft Among the Azande

12: Apr. 3 Help Seeking

• film To Taste 100 Herbs (China)

13: April 10, 12 Diagnosis and Treatment: Healers and Healing, Provider Patient Interaction, and Treatment Efficacy

• Levi-Strauss A sorcerer and his magic (Native American)
• Lambo Psychotherapy in Africa
• Adler Ethnomedical pathogenesis  and Hmong immigrants sudden nocturnal deaths
• Miles, A. Science nature, and tradition: The mass-marketing of natural medicine in urban Ecuador
• Film Hmong shamans

14: April 17, 19 Diagnosis and Treatment, cont.

• Joralemon/Sharon ethnography
• film Eduardo the Healer (Peru)

15: April 24, 26 Diagnosis and Treatment, cont.

• Kleinman, A. et al. Culture, illness and care (U.S.)
• Good, BJ et al. "Learning medicine": The constructing of medical knowledge at Harvard Medical School
• Lewis, G. Double standards of treatment evaluation
• Finkler Diffusion reconsidered: Variation and transformation in Biomedical Practice (Mexico)

16: May 1, 3 Diagnosis and Treatment, Conclusion

Payer ethnography

1. anthropology = the study of all aspects of human living

2. culture = a blueprint for living (Paul, 1955)

                  = the acquired knowledge that people use to interpret their world and generate social behavior (Spradley, 1989)

3. health      = (50’s) a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity    

                      = (60s) complete è optimal

                      = (80s) optimal è the highest possible level

4. healing = the alleviation of illness, where disease vs illness / curing vs healing

5. medical anthropology = the formal anthropological activities concerned with health and disease, with a focus on beliefs, behaviors and practices

(theoretical):

                = inquiry that (a) elucidates the factors, mechanisms, and processes that play a role in or influence the way in which individuals and groups are affected by and respond to illness and disease, and (b) examines these problems with an emphasis on patterns of behavior (Fabrega, 1972)

(theoretical and applied):

                = 1. research whose goal is the comprehensive description and interpretation OF the biocultural interrelationships between human behavior, past and present, and health and disease levels, without primary regard to the practical utilization of this knowledge, or,

                 = 2. the professional participation IN programs whose goal is the improvement of health levels through increased understanding of the relationships between bio-socio-cultural phenomena and health, and through the changing of health behavior in directions believed to promote better health (Foster, 1978)

1849 Rudolph Virchow

--"medicine is a social science, and politics is nothing but medicine on a grand scale"

1924 WHR Rivers, Medicine, Magic and Religion

--first to see medicine as part of a culture system, as a social institution

1932 Forrest Clements, Primitive Concepts of Disease

--medicine an area worthy of study in it's own right

1937 EE Evans-Pritchard, Witchcraft, Oracles and Magic among the Azande

--a people's medical practices follow logically from underlying beliefs

1942 Erwin Ackerknecht, Primitive Medicine and Cultural Patterns

-- medical historian, paleopathologist. M.D.

-- there are many primitive (sic) medicines

-- first to argue for cultural construction of disease concepts

1951 Henry Sigerist, A History of Medicine

--medical historian

--first to bring together cross-cultural materials on medicine

1955 Benjamin Paul, Health, Culture & Community

--first applied work: attention to international aid programs;

1963 Steven Polgar, Health Action in Cross Cultural Perspective (article)

Four fallacies about other people's medical knowledge:

1. the empty vessel

2. the separate capsule

3. the single pyramid

4. the interchangeable faces