MEDICAL ANTHROPOLOGY TAKES SHAPE
Application or Theory?
When medical anthropology coalesced in the 1960s, it was as a “practice discipline” (Good 1994, p. 4) dedicated to the service of improving public health in economically poor nations. Indeed, initial effort at organizing a medical anthropology interest group in the USA – diligently fostered by Hazel Weidman – resulted in a 1968 invitation from the Society for Applied Anthropology (SfAA) to affiliate (Weidman 1986). The fledgling community, then called the Group for Medical Anthropology (GMA), accepted this invitation as a practical solution to the challenges of maintaining cohesion, but it was “something of an embarrassment” to many (Good 1994, p. 4). Even George Foster, a key founding figure, reported having to work through ambivalences: “We were trained to despise applied anthropology” (Foster 2000, quoted in Kemper 2006).
As Scotch reported, at the time many felt that because of its practical bent “the quality of literature in [medical anthropology] is not always impressive… It is superficial, impressionistic, and nontheoretical” (1963, p. 32): wholly infra dig. Some felt that its practitioners were “less rigorous than their more traditional-minded contemporaries” (p. 33) and denigrated them as mere “technicians” (p. 42). In the UK, this stigma was worse (Kaufert and Kaufert 1978): a British Medical Anthropology Society did form in 1976, but it served mostly medical doctors (Dingwall 1980).
Generalists or Specialists?
Anthropologists who did consider assembling worried whether formally organizing as medical anthropologists would reinforce an “artificial area of study”; in support of this claim some pointed to “the lack of systematic growth and the failure to produce a body of theory” (Scotch 1963). Some feared that formal organizing might “prove detrimental to the development of theory in anthropology” as it would force the fragmentation of the field (Browner 1997, p. 62), a growing concern at that time.
The American Anthropological Association (AAA) was itself then in “organizational disarray,” according to the Committee on Organization, which noted that while anthropologists in general desired to “retain an integrated professional identity” the profession also faced strong “fissiparous tendencies” (Anthropology Newsletter 9[7], as cited in Weidman 1986, p. 116). Some US medical anthropologists felt, accordingly, that simply maintaining a newsletter would be better than assembling as if a faction (Weidman 1986, p. 119). Alan Harwood was one who had, in the late 1960s, tried to put his “finger in the dike… of specialization” (Harwood 2019). Although Harwood eventually came round, taking over the editorship of the group’s renamed newsletter in 1985 when it finally became the journal Medical Anthropology Quarterly, others held out. Arthur Rubel, for instance, “would not be pigeonholed as a medical anthropologist [ever]… for he always saw health/medical phenomena as human behavior to be understood as anthropologists understood other forms of human behavior” (Cancian et al. 2001).
An Uneasy Resolution
Partially to better demonstrate ties to the parent discipline the GMA continued to push the AAA (which at that time did not have “sections”) to create a mechanism for its affiliation with AAA as a subgroup. Eventually, largely due to the GMA’s own organizing efforts, this came to pass (see Weidman 1986, pp. 121, 124): the group adopted a “constitution” in 1970, incorporated, and in 1972 became an official AAA “affiliate” (Society for Medical Anthropology 1975). This move firmly anchored the group – now the Society for Medical Anthropology (SMA) – within academic anthropology, although many members remained SfAA members also. Additionally, partly because anthropologists eschewing applied work tended not to join SMA née GMA (cf. Good 1994, p. 4), the influence of applied perspectives remained strong. Many SMA members were employed in schools of medicine, nursing, or public health or in the international and public health fields. The authority of biomedical clinical culture, where curative work and saving lives takes precedence, was manifest (Singer 1992a).
To counter accusations of over-specialization, a statement issued by the SMA in 1981 defining medical anthropology asserted unambiguously: “Medical anthropology is not a discipline separate from anthropology” (Society for Medical Anthropology 1981, p. 8). This did not offset objections related to the narrow technical definition of the term “medical,” noted, for instance, at the GMA’s 1968 organizational meeting. Not only did “medical” leave out nurses and members of the allied health professions; it suggested (and still does) a biomedical gold standard. Other concerns have been the implied focus on pathology and the implicit devaluation of interpretive ethnographic methods.
Nursing theorist Madeline Leininger suggested instead “health anthropology” – which an increasing number prefer today as well (e.g., Baer et al. 2016), perhaps most commonly in Europe, where the preference has deep roots (Hsu 2012). The appellation is perhaps least commonly heard in the Global South, where medical utility often is emphasized (Mishra 2007). At the 1968 meeting, however, although the proposal to rebrand instigated “lively discussion” it did not triumph (Weidman 1986, p. 119).
CULTURAL INTERESTS ASSUME THE LEAD
For better or worse, the subfield moved forward as “medical anthropology.” This was accompanied by a number of “What is Medical Anthropology?” essays. Howard Stein in 1980 recognized this “cri du coeur […as] a recurrent, quasi-ritualized annual event” (p. 18). While in its initial phase, generalist–specialist and applied–theoretical tensions had prominence, now the tension between cultural and biological priorities took precedence.
The global reach of British social anthropology notwithstanding – for instance, it was seen in Australian Shirley Lindenbaum’s important work on kuru disease in the early 1960s and the “epidemiology of social relations” she created to illuminate kuru (Anderson 2018) – medical anthropology’s official initial emergence as a named subdiscipline was largely fostered by culturally oriented scholars (see Paul 1963; Polgar 1962). This included those affiliated with the “culture and personality” school. Thus, early reviews of the field’s progress (e.g., Colson and Selby 1974; Fabrega 1971; Scotch 1963) highlighted medical anthropology’s relevance in psychiatry and related areas, their distinct focus on “nurture” over “nature” reflecting the strength of cultural determinism in mid-twentieth-century US anthropology.
The strong cultural bent among the subfield’s main organizers was reflected in the seven goals drafted by the initial steering committee of the emerging network of medical anthropologists: Biological factors received no mention. Furthermore, all of the goals stressed communication (Browner 1997). This was likely in part because, while physical (today’s “biological”) anthropologists had been working and publishing in and with medicine since anthropology’s inception, cultural anthropologists as a whole were still at that time rather new to cross-disciplinary communication and seemed uncomfortable in the medical milieu. In comparison to their physical/biological counterparts, they generally lacked easy access to it anyhow and could claim little authority within it. Cultural scholars’ desire for increased intellectual discourse, reflected in the goals list, also drove the creation of newsletters and forums that would become the subfield’s flagship journals, cementing its anthropological institutionalization, providing venues for specifically anthropological dissemination.
Whither Biology?
Biology’s recession within the subdiscipline irked SMA’s physically/biologically oriented members. Indeed, in his 1975 “What is Medical Anthropology?” commentary Khawaja Hasan – among the first to use the phrase “medical anthropology” in print – took