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CHAPTER 3 Applied Medical Anthropology: Praxis, Pragmatics, Politics, and Promises
Robert T. Trotter, II
INTRODUCTION
Applied medical anthropology is a natural extension of basic anthropology theory and systematic qualitative methods focused on a practical exploration of the relationships between culture, society, health, healing, and the culturally created definitions of distress and disease, with the general pragmatic goal of deliberately improving health, healing, medicine, and the overall wellbeing of individuals, communities, cultures, and societies.
Applied medical anthropology has roots in the exploration of cultural differences in the common everyday experiences that shape peoples’ lives (c.f. Rylko-Bauer et al. 2006). While some areas of anthropological inquiry draw heavily on a relatively narrow range of theory and methods, applied medical anthropology tends to draw from all of the primary and secondary sources of anthropological theory. This empirical, and often eclectic or synergistic, approach commonly produces crucial links between different theoretical perspectives, methodological advances, and practical viewpoints within anthropology. It also challenges, supports, expands, and occasionally defeats theoretical paradigms from psychology, economics, political science, public health, epidemiology, and other parts of the biomedical and health research spectrum.
One of the consistently synergistic conditions that applies to medical anthropology in general, and applied medical anthropology in particular, is the impetus in many US universities to support the ideal of a synthesis of the theory and methods embodied in a four-field approach to anthropology (socio-cultural anthropology, linguistic anthropology, biological anthropology, and archeology or prehistoric anthropology). Some US anthropology programs have stubbornly clung to the opportunity to maintain all four fields in their undergraduate and graduate programs, in the face of both intellectual challenges and the tendency to fragment into competing or more narrowly focused departments or programs. Medical anthropology has benefited from this stubbornness by producing individuals who are both comfortable and competent in multi-disciplinary, multi-theory, multi-sectoral, multi-focal projects and programs. This acknowledgement of the viability of a four-field approach has also enhanced participation by anthropologists in the emerging areas of “team science.”
Applied medical anthropology has been strongly impacted by external theoretical and methodological pressures, as well as discipline specific values, theories, and dialogs from the biomedical sciences, as well as from the other social sciences. That impact has clearly moved and modified anthropological theory in innovative directions. There are numerous instances where other disciplines, theoretical approaches, and values have been strongly influenced by medical anthropology. And the reverse is equally true, creating general improvement in the impact of applied medical anthropology over time.
This flexibility of paradigm is one of the reasons for the successful expansion of applied medical anthropology, including a consistent expansion of the amount of federal and foundation resources that are devoted to medicine and the health care industries in the United States, and the success that medical anthropologists have had in competing for those resources through consistent changes in the biomedical paradigm as well as expertise in culture theory and qualitative (exploratory, formative, comparative) methods.
Applied medical anthropology is full of interesting dualities, theoretical competitions, and correspondences. Two of the most commonly addressed paradigms are the “biomedical paradigm” which embodies a strong orientation toward positivism and modernism (linearity, logic, evolutionary change, and progress through scientific research), and American individualism, which embodies the ideals of self-determinism and free will (resulting in a focus on psychosocial dynamics such as self-efficacy, individual responsibility, and competence). A good deal of applied medical anthropology is a dynamic balance between universalism (from the search for biomedical certainties to international classifications of diseases, syndromes, and conditions) and particularism or cultural (and individual) relativism in which everyone participates in a unique life experience and constantly constructs and reconstructs their perception of reality through a post-modern or neo-liberal lens.
This chapter explores the eclectic nature of applied medical anthropology theory, methods, applications, and opportunities. The following sections address or exemplify several important contributions and challenges that applied medical anthropology has contributed to medical anthropology in general and anthropology as a whole. These include the importance of theory in applied medical anthropology as it is challenged by other theoretical viewpoints from other disciplines; the numerous contributions that medical anthropology has made in the development of highly useful research methods while also expanding the methodological tool kits of the other social and biomedical sciences and humanities; examples of the relationship between midrange theory and applied medical anthropology methods; and the important central place of ethics in applied medical anthropology.
THEORY IN APPLIED MEDICAL ANTHROPOLOGY
There Is Nothing so Practical as a Good Theory
Historical or “Grand” Theory in Anthropology There are a number of very solid contemporary books on anthropological theory, mostly presented as a historical progression of both positivist and humanistic dialogs and developments (Murphy and Erickson 2017). That approach provides students with an interesting view of the anthropological theoretical debate as a dialectic process of point, counterpoint, and synthesis, leading to new (often labeled “neo”) iterations of the basic theories and counter theories. These theoretical paradigms are sometimes labeled “grand theory” and, for some anthropologists, function more as foundational philosophies for understanding culture and human behavior than as “testable theory.” In contrast, the other social sciences predominantly consider testable theory as the gold standard. The distinction between adherence to “grand theory,” as opposed to a pragmatic focus on testable midrange theory is one of the common distinctions between applied and non-applied medical anthropology.
The primary theoretical threads in anthropology can be cataloged as one of five cultural themes, with associated sub-themes that accommodate competing definitions and explications of the basic theories. The five themes include (1) evolutionary theories that focus on creating an understanding of individual, social and cultural “change through time”; (2) cognitive or cultural domain theories that explore the relationships between what and how people think, and what and how they behave