allen young- the anthropologies of illness and sickness

8/11/2019 Allen Young- The Anthropologies of Illness and Sickness

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Ann. Rev. AnthL :-Cpyrigh @ by Annual Rviws Inc A gh rvd

THE ANTHROPOLOGES

OF LNESS AND SCKNESS

An Yon

Depment Anthrplgy Cse Weste Reseve Uniersity

levland O 4106

INTRODUCTION

Micl hropolo s l of rserch wrii profssioctiit hs row rerkbl sice th Annual Review of Anthropolopublishe its lst icles o this subject. he Fbr (42) olsoSelb (21) reiew h 50 rs sic h publicio of irs' Medicine,Magic, and Region (13) i 192 h coul ci ol hful ofoorphs i olus houh he coul refr to hTranscultural Psychiatric Research Review (Motrel) Ethnomedizin(Hbur) hre ws o et jor jol eoe to this el

I h s ce, howr lr uber of pulicios h ppere: specilze collectios (71 76 96 99 103 105 146 150 167 170);coprhsi tholois (10 65 1 11 116 123 164) thoreticlworks (43 93) eicl horphies 9 38 69 83 88 108 111 128 135139 10 15 160 186) lr scle suis (2033 169) xbooks (3051

119 122 12 18 is rsolul bioicl spi is til hower); cross-culurl hoicl sur (125) Two oorph sries ruer w he "oprtie Suies of Hlh Sss n Meiclre uer the eitorship of hrles Leslie (77 93 105 113 163) h "ulur Mici li sries ei b rhur Kli ohrs 9 35 9). Thr jor opicl jouls r ow publisheCulure, Medicine and Psychiat, Medical Anthropolo, SocialScience and Medicine' quterl issues o eicl thropolo heMedical Anthpolo Newsletter qurerl publishe b the Meicl

hropolo ssociio hs xp o iclue oriil ricls isow h best sil source of book reiews i eicl thropolo iio to ths proicls thr is h Joual of Ethnopharmacolo two ew Europen jouls Ethnopsychiatrica (lix Frce)

5

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258 YOUNG

Curre (isb Fill h is lo lis of publicios which pucs c ccs sps i ic hp (1, 11, 39, 4, 63, 65, 76, 79, 80, 96 103, 05-107, 109, 16, 118, 17, 144,

165, 168, 10, 171, 178)Pubicios cofcs ol p of h so A c oos icl hopoloiss w ih coioll i hopoloiss who h bco is i icl issus o h wphsicis uss who h k s i hopolo Folucio i cl s ll ook plc ous h hopoloic cuiculu if i ok plc Bu h o h kblchs B 1980 0 uisis i h s w o upos i icl hopolo hus of hs h ocol

posool lls (8, 58).h hs icl hopolo ow so pil? o o sw his

usio i s css o kow sohi bou hopoloss ois hos

i ois h wo so sos fo hopoliissisi i i siss ii O is o wih hu c of sici hopoloicl iscous o sickss wih i coplli s of issus us Sic os of wh h o s i h followi ps cocs hs us shll sh si fo h o o sco so H i is hpp of w pofssiol oppoiis h li of ol osh h iuc hopoliss o wi o sch o iclsubcs So of h w oppouiis oii i h os of cliiciswho h ow issis wih h bioloicl uciois h coiuso b h coil wiso of hi pofssio (17, 34, 36 37, 44, 9,95, 154) hi s hopoliss h b icsil iiio liil sis pill i cocio wih pos i pi

c fil ici [Fo c suis b hopoliss wokii s cliicl ss s 15, 18251585962 0 89210110, 115, 118, 136, 141, 12, 152) o cos o hopoliss scliicis s (72, 147, 148)] h pofssiol ppouiis fo hopoloiss oii i h hih ll of cooic suppo h hs bilbl h i s ls uil cl fo socil sciiss who is i icl subcs This cobiio of pofssiol icis hlps o pli wh uch of h c icl hopolo liu is i il fo socil bhiol sciiss wih cliicl

iss sposibliis fo cliicis icl ucos psi hos hopoloss h h o o lss isic

ws of wii bou sickss hli Fis so hopoloiss

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A SCKNESS 9

describe medical beliefs and practices by using conceptal systems whichwere originally intended for studying other phenomenological domains.This is clear if we look back at some classic ethnographies which predate

the growth of contemporary medical anthropology: ansPritchard'sWha Oale and Mag Aong he Aande Tuers Foe oSybols (1 and Dus ofAto (12 and Spiros Buese Supenaturasm 151 In spite of the fact that these monographs contain de-ailed descriptions of medical beliefs and practices (vansPritchard andTuer even include separate chapters on medical practices) anthropologists usually do not think of them as examples of medical anthropologyRather we talk about them as belonging to the anthropologies of religioncomparative modes of thinking witchcraft ritual and symbol culture and

psychology and so on That is we think of them as originatng in prob-lematics and analtical frameworks where sickness eents are onl ehiclesfor understanding other constellations of facts. The point at hand is thatmany of the books and articles cited in the rst paragraphs of this reieware examples of the ery same ethnographic traditions. This is not intendedto be a criticism since many of these publications are excellent and impor-tant in their own ight (e.g. 85 128 3. Indeed these kinds of analysesmay be the best ways to understand medical eents in structurally simplekinship based societies where the experience of sickness is so thoroughlyextealized that the body is reduced to an uninformatie black box" andpeoples attention is concentrated on the social and symbolic conditions ofsickness. [See for example Lewiss study of the Gnau of ew Guinea0.

Second other anthropologists write about sickness and healing by usingmethodologies and conceptualizations they hae borrowed from medicalsociology As a eld of research and writing medical sociology was estab-lished relatively early. It is now thoroughly conceptualized and its methods

and perspecties hae been tailored for conducting research in industriasocieties In each of these respects it contrasts with medical anthropologyand it is no surprise that anthropologists who have only recently begun tostudy sickness in industrial societies would be tempted to borrow fromsociology Unforunately the tendency has been to borrow from empiricist(cf empirical) sociology It is unforunate because social anthropologyand empiricist sociology are separated by dierent premises about theirfacts In a nutshell the empiricist works an epistemologyfree social sciencee supposes that his language and techniues once they hae en suitably

rened uncoer facts about the world rather than produce them. ow isthis dierent from social anthropology? Seen from one angle social an-thropology is a science in continuous pursuit of a satisfactory epistemologyWhat separates the anthropologist from empiricists is that he regards his

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own concepts and ideas as simultaneously privileged and a part of a culturalsystem That is to say he thinks of hs ideas as being suitable for iterpretingother peopls' beliefs about the world but at the same time knows that his

ideas like the beliefs the are intended to interpret are products of paticulr hstoical and social determinants The mere fact that he cn justify hisideas to the satisfaction of other anthropologists and sc scientists r thatthey seem reasonable to his educated countrmen des t reve themfrom his scruty (1) The anthrpologists wligess t scrtze hsown concepts as a cutural sstem to want to know and justify hs wctext of belief helps explain both the vitaity f anthrplgical discuseand its "failre to get beyond what Thomas Kuhn caled the preparadigstage of science

Given antropologs crosscultural eld can it be otherise? It canwhen medica anthropoligsts incorrecty suppose that epistemologicalquestions are limited to the task of nterpreting nonWeste belief systemsd the eld of "ethnomedcal inqury [an inquir whch ostensibly focuseson beliefs and practices "not expictly derived from the conceptual framework of mode (alopathic) meicine (, p. 99)] When ths happens anepistemologcal scrutiny is suspended for Weste social science nd Weste medicine empricstleanng anthropologsts are free to adopt as patof teir own conceptual apparatus the conventiona wisdom of the dominant medical culture of their society I am thinking of concepts such as"stressful life events "coping mechanisms "life styles and "socioeconomic status which having been raised out of the culture of the middleclasses into the halls of science by empiricist sociology and scial psychology desocialie sickness and the social scientists knowge of sickness Desociaiing concepts work by displacing the istorical political adecc deteiants f sicess I lace f scil deteiats wreuce to ghosty "situational variabs' an attributes, empiricists es-

tablish the primacy of the ndividual ad his values motives dispositionsad perceptonshe danger in empiricist social science is that having fragented the

social relations of sicness particuar to Weste society social scientistswil help to reproduce these same social relatons 0 For example Fosterand Anderson in their book edical Anhropolo (1 dscribe theUnited States as a "complex societ with multiple life choices (1 p 19in the course of a discusson of careers in nursing) In this society theywrite disproportionatly few physicians come from "lower socioeconomic

levels because ower socioeconomic parents are unable to sustain the urgesad ambitions of those of their chldren who initially want to be doctors[(1 p 17 citing () Wrtg about regos of the world udergoingrapd change Foster and Anderson attribute "the diseases of civiliatio

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o h ndncy of pop o dop hh dsrciv prcics sch scssiv s of coho nd js pin nhhy prson if sys" 51p. 24) Mlipl lif coic? Lowr ocioconomic lvl? Di of

ivilizion? Of cor. B lif coic r no rndomly diribd in orcomplx ociy nor r h di of ivilizion rndomly diribdin lss dvlopd conis Throgh om mchnism popl lowr"v g miny wrcd choic c s choosing o work whr hy wi

b posd o oic sbsncs nd hoosing o b piodicy nmploydor chroniclly ndrmployd And hi m mchnism dirib o higr" lvl lrg nmbr of gnrlly mor hlfl coi. Th woss of choic do no mrly cooccr ch hlps o drmin h ohr(cf 5 pp 222). Th osr nd Andrson ignor ocil rlions of

sickns is consisn wih posiion Fosr ks in n rir ic whrh rfr o h mdil bhviorl in spilizion" of mdilnhropoogy nd mdc socoogy 50 Anhropoogiss h ris sdyiciy nd culrl liion blifs nd prci vl nd prmwil bjc sc s css nd conomic dirncs nd profsion ndprofssionizion blong o sociologiss.

Aow m o smmiz wh hv wn p o his poin I bgn bying nion o rpid growh of rrh wriing nd profsionlciviy in mdic nropoogy ovr h ls dcd. To ndrsnd hdvlopmns wro i i ncy o now vrio inniv nhropologiss hv d for ning his ld nd h h opions hy hvhd for rsponding o hs indcmns hy hv hd o rly on ihr nl m ol nndd r drbig nd lzinohr phnomnoogic domins (sch s ri bhvior) () modoo-gis nd onplizions borrowd from mpiici mdic socioogy or( c n volving concpl sysm cnrd on h socil nd pnipriclrii of sicknss nd ling. inlly dscribd limiions

of oions () nd (). Th rs of hi rviw is bo c

THE ANTHROPOLOGY OF ILLNESS

A good plc o bgin is wih rs ppr Th Dignosis of Dissmong h Sbnm of Mindno" (2). n his ppr rk s o vproposiions 1. Pop dpnd on cogniiv scrs o orgniz hirbhvior nd mk ir dcions. T cogniiv srcr of ickns isimplii in rncs whi cn b licid from informn by mn of

sndrdizd qsions (.g. Wh kind of inss is h?"). 2 In h cof h Sbm noldg of sin isss is srcrd by mns of onomy so h c rm is disingishd from ny ohr m by lon nshrd ib or by dirn dgr of spciciy (i.. by horzon

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t or verical conra in a xonoic hierarch)3 Alhogh people adiagree abo wha name o give ome acal po or e of mpomdiagreemen occr wihin he hared axono 4 Diagreeen occr

becae axonomic caegoie are diconino b dieae and nare aeconino Diagreeen alo rel fro ocial role conngencie" (ega peaker' deire o aoid ping hi own mpom ino a igaizingpigeonhole) dialec variaion and he procliviie of axonomc hairpli-er 5. here are no eenial dierence beween he wa in which peopleorganize icne and oher phenomenological domain ch a boan

Frake' paper i a famo example of he formal anali of ehnographicdaa b i belong o he prehior of medical anhropologickne forFrake i a ehicle for pring oher inere I begin wih hi paper o

ha we can have a poin of reference from which o follow he raecorof a grop of anhropologi idenied wih he expnto mode ofness pproch, whoe work doe depart n a diincie wa from earliernderanding of ickne [In a omen we hall ee ha explanaorodel wrier beliee ha rake' ort of anali ha onl er limiedreevance for n cne o l eical anhroolo hare hiopinion howeer (eg 86 In addiion everal wrier hae recenlpropoed foal model for analzing how deciion are made drng ickne epiode (30 84 85]

A ke argen in he exlanaor odel approach r apeared in a1977 aricle b Bron Good iled he Hear of Wha he Maer" 61He laboraed hi in a econd paper (62 wrien ogeher wih MaroGood Like Frae Good ree h iporance of langage Hanilln he wre "s fundment semnt or mennu nd n prte s nherent nterprete 6 p 17) B here arefndamenal derence beween Frake and Good regarding how he lanae of icne oh o be inerreed Frae hilooh of lanae

i he foali radiion of anhropological emanic aociaed wihwrer ch a Ward Goodenogh God' orce on he oher hand arewrer on he anhropolog of ral and mbol noabl Vicor erand conemporar hermeneic philoopher among whom he cie anGeorg Gadaer and Pal Rcoer Good reec Frake poiion 2 and 3,and arge ha a ickne erm i no eqivalen o a e of dening mpom nor i i a neal bonded caegor' dened praril in diinciono oher caegorie According o Good each erm ha a dincie congraion of meaning b here are oerlapping aociaional pae among

erm (6 p 4. He alo reec Frake poiion 4 and 5 on he gondha ickne er be nderood in he conex of being ick wheren illne or pom condene a nework of eaning for he erer " (62 76 To are oherwie a Frae oe in propoiion 1di

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ANPL KNE 26

rects our attention away from the social and symbolic context which givesan ilness category its distinctive semantic conguration (61, p 38)

Good uses the term semnt ness network to label the networ of

words, situations, symptoms and feelings which are associated with anillness and give it meaning for the suerer (61, p 4 Good's case studiescome from a Turicspeaing region of Iran (6) and an outpatient clinic the United States (6), and they are mainy about chronic complaintsor each of his case studies, Good followed the same procedure ver apriod of months, he collctd information about symptoms, choice oftherapies, social situation, and the etiological circumstances his informantreported to him; special attention was given to how social and situationalchanges aected the illness's semantic conguration during this timeood

describes his methodology as a ind of socia free association whichenabled him to gain entry to the distinctive reality apprehended by informants (61, p 39, 6, p 168) In this way, he reconstructed his informant'ssemantic illnss networ [e ibeau's laboration of this schme (2)

n his anasis of ranian semantic illness networs, Good introduced thenotion that networs are organized through ore smbo eements TheIranian's heart and heat distress are described as core symbols in thispaper Good's idea of core symbos closey paralels Tuer's notion thatthere are dominant symbols which organize the meanings of rituals inpreindustria societies (161; 62, chap 6) Lie dominant ritual symbols,core symbols are poysemic in the sense of ining up with dierent symbolicdomains, and this explains why semantic ilness networs include suchheterogeneous elements Good descibes an Iranian case study in which thcore symo ins up cir, miscarrage, pregnancy, boo, poution,weaness, menstruation, oral contracepives, infertiity, loss of vitality, oldage, sorrow and sadness In another case stud, heart distress connects adierent, but overlapping, conguration old age, sorrow and sadness, ritual

mouing, worries about poverty, anxiety, interpersonal problems withparticular relatives, nerves, madness, and blood problems Lie dominantritual symbols, core symbols lin ideologica elements (specially valueslind to normative behavior) to emotionalphysical ones in such a way thatth semantic illness networ develops a degree of unity in spite of itscomplexity and heterogeneity ithin the seantic illness networ, coresymbols form a symbolic pathway which lins the values and aspirationsof purposive interaction, the stresses, shmes and disappointments of socialcontingencies, and the aective and ultimately physiological elements of the

persona (61, p 39 9, p 2) [or other analyses of core symbols insicness, see (13, 133)]Semantic ilness netwos are also descibed in the wor of lumhagen

and leinman lumhagen's artice (3) is about how hypertension is per



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ceved by a oulaton o Amercan who uer rom th deae It woulde nteretng o comare te decrton gven y Blumhagen' normantwt te account o Good Iranan nce te ycal locaon o ter

core ymol mlar e the cculatory ytem, whle ther emantcconuraon are vey deren o coure Unotunately, t dcult omake the comaron becaue Blumhaen aroach o emantc llnenetwork deart rom ood n moran way Frt Blumaen collected data om a elatvey age nume o eole, 05 clent oa Veteran Admntraton hotal Each emantc llne network wacontucted on he ba o a nle ntervew un an oenendedquetonnare Second, Blumaen oraned h normant' reonento what e call node and arrow Node cont o reor o

ymtom (eg dy el), nteracton (eg amly argument), yologcal uncton (eg alloonn ven) ody tate (eg overwegt)athoenc agence (eg acute te) and actvte (e mokn eatnalt) Arrow denty u re eween node (e hh reurecaue balloonn ven whch caue rutured blood veel) Blumhaen 13 vl n 59 t wh arrow to ndcate the relatve requency wth whch h normantreorted caue and eec

But th very derent rom wat Good rooed to do What earate

ood' work rom earler more tradtonal anthroolocal vew o ckne the dea that an normant' tatement need to e nterreted nte contet o llne eeence and cloe attenton need to e vento the way h tatement cane ove tme n reone to crcumtance In re ood ay ta emantc llne network are nearale rom the dea tat llne an ndvdualed roce Another derence wt Blumhagen hat Good take the more challengng otontt lo me te elmnt ne n emnc lne ntwokare lnked by caue and eect other may be aocated n noncaualway

Now or Arhur Klenman Klenman robably the mot nuentaland rolc wrter n medcal antroology today In work emantclne network ave een made ar o a comrehenve ramework Beore takn Klenman ue o emantc network, owever, I want to aya ew word aut ramework

Lke Good and Blumhagen, Klenman reject te hycaltc reductonm o the bomedcal model and relace t wth the ollown cheme:

DISEASE reer to abnormale n he tructure and/or uncton ooran and oran ytem; atholocal tate whether or not they areculturally recogned the arena o te omedcal model

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AROOOGY O KN 265

ILLESS refers to person's percptions nd experiences of crtinsocilly disvlued sttes including, but not limited to, disese.

SCKNESS is a blanket term to label events involvn disease and/or

llness ccord to Kleman, medical atroolosts need to remember tat teir domain is sickness, even tou teir secial contrutionwill be minly wit rerds to illness [For similr positions, see (34,42 43) n te antropological study of illness nd disese, see (4 481)

Kleinmans interest n medicl eliefs nd ractices is essentiall clinicalor im, tis meas concentratin on wat e calls te core clnicalfunctions," ie ow systems of medicl knowledge and ractice enablepeople to () construct illness as psycosocial exerience (b) estblis

general crtera suitable for guiding te ealt cre seekng process andassessin te otential ecac of dierent tretment aroaces; () manging illness epsodes rog communctie opertons suc s lbelingad exlanin (d) rovidin ealin activities (tereuc tevention,suorive care) and (e) manan teraeutic outcomes (includincronic illnss nd det) (93 pp 7172)

e clinical process is, ten, w for nddus to dpt to certanworrisome circumstances (see lso 32, 4) [Kleinman does not believe tateve medical ractice is necessarl dative in te lon n, owever 93

50)] e adation remise is reected in Kleimans coice o wordsguidin, mnging, copin, explainin, negotiating llinces [For similarperspectives see (48 49 131 132)] e premise is also mplicit in teimorance e ve to ealin in is teoretical ad emircl studiesAltoug leinmn does not discuss e erm eln" in deil, e usesit in a wa tat allows me to loss it as a roces wic () disease adcertain oter worrisome circumstances re mde into illness ( culturalconstuction and terefore meninul), and (b) te suerer ins a dereeof stisfaction troug te reduction, or even eliminaon, of te psycologicl, sensor, and exerientil oressiveness enendered b is mediclcircumstnces Kleinmn's concetion distinuises elin from curin ina wa wic arallels te dierence between illness and disease (see Fire1) But it is imornt to reconize tt e is distinuisin between cultureand nture, not between mind nd ody n Kleinmn's wor, eling isnot mentlstic ctivity, ltoug it is ound to te feelings, percepions,and exerences of te indivdual So, for examle, armacodnamic intervention ad its eects on te od are art of te ealin rocess even wen

tey re lso prt of te unpoess ie te process ectin toloicalorgnic states n te oer nd, tere re occsionl instnces in wicte constrction (or reorderng) of cultural meng may be all tat

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(

no disease

cunterpart

SIC K N S S

LL N E S S

S E A S E

- nena

Fire The disease-illness approac.

Healg

Crg

therap (and ecac) conit o (93 p 235) ee alo a detailed treatmentof thi ie in (98)] B aertg the complimentarit of mind and bodealg and cng, Kleinman and i aociate reject te crde arteian-im of the biomedical model of icne ther anthropologt notablMoerman (21), hae moed far beond thi point to arge that ecaneed to be ndertood in term of te mind organicall mediated eecton bod procee or, pt into oter word te eectiene of ealingpon crin (ee alo 89) Moeran radical antiarteianim ha beenforcef ctced b rod n a wa tat ee cnten wt e-man own premie abot ice (6)

Altog Kleinman refer to emantic llne network in hi workanother noton lom large Thi i the idea that emantic network arerelated to tem of medical nowedge throgh people expn mdes f ness a concept whic Kleinman abbreiate a EM A EM ia et f belief wc contain a or all of e ie: etilg; onet ofmptom; pathphioog; coe of ickne (eert and tpe of ickrole); and treatment (91 pp 888) At t ight EM eem to be merel

a lael for the idea that ee cltre ha it paticlar explanation foricne Kleinman i aing more than thi howeer Firt hi EM con-cept reemble eertz idea that cltre proide people wit wa ofthining that are imltaneo model of and model for realit (5) EM

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simultaneously create order and meanng, gve plans for purposive action,and help to roduce the conditions required for their own peretuation orrevision. Second Kleinman attributes EMs to individuals, not cultures.

According to him, EMs are unliely to be homogeneous even within thesame community Moreover, a erson's EM is liely to alter over time, inreonse to his paticlar meical expeiences an to the clinical encontersin hich he becomes acquainte ith practitioners' EMs n order to keeptrack of these vaios EMs, Kleinman stingishes them along one dimen-sion in tems of ierences beteen practitioner EMs an lay EMs alonga second dimension in terms of ho a Weste practitioners Theoreticalor Scientic EM hich he shares ith other practitioners formalize inprinte tets) leads to his Clinical EM articularized by his clinical eperi

ences), an how a layman's Polar M shared by a community of lay-men) leas to his Family EM paticulaize ithin a family) an ens pas hs Indual EM and alon a third imenson in hich a Clinical EMor niial EM passes trough its various eitions (93, pp. 111). naition to Kleinmans work on this suject, see Helman's paers 7, 74)on how Clinical and Individual EMs of colds," fevers," and psychotropicrugs are use an sometimes transforme urn clinical transactions; alsosee Gainess aer 56) on the ierences he foun among the Clinical EMsof a grou of resents n psycatrc meicne

Now that we now hat an EM is we can retu to the issue of semanticillness networs. In his work, Kleinman refers to both EMs and semanticillness networs, and he even inclues them within a single iagram (93, p.18). The relation beteen them is not mae clear, hoever, an there aeons a wc ey sound ver smar: e Vaueness mutcy ofmeaning, frequent changes, and lac of shar boundaries between ideas andeperiences are characteristc of lay EMs" (93, p. 107 In site of this, thereis a fundamental dierence in the ways in which the concepts are used Mostof the time, Kleinman employs the idea of eplanatory models to show howhs informants roduce their statements about sicness. EMs emerge in hisriting as sets of propositions or generalizations Sometimes they are eplicit, but oen they are tacit hien aay in bits and pieces in nonmeicaldiscorses Also it seems EMs are usually about causes and eects andit is this quality that maes them useful as moels for trying to control andpredict hat is going to happen or to give moral signicance to hat hasalreay hapened If! am correctsem ess etwor e the produsof EMs That is to say, an ifomant's semantic illness network refers to

a set of statements he actually maes over a given eriod of time, using EMsto respon to particlar contingencies, e.g. an episoe of sicness, an anthropologist's estions. When, for instace, oo refers to core symbols"and describes the Iranian heart as an idiom for epressing emotion in the

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cure f ille he i referrig t freuetly ued elemet i Iri EMAd whe lumhge ue 10 emtic etwrk t ctruct iglerrgmet f de d rrw d rfrm the idetermicy f my

lik it cue d eect he eem t be mvig frm emtic illeetwrk cgurti f ttemet) bck twrd the Ppulr EM thtprduced them

he exct relti betwee EM d emtic ille etwrk icmplicted by the fct tht ifrmt EM my be chgig durigthe perid i which hi ttemet re beig mde But the EM ide reti degree f mbiguity eve ter it cmplex d dymic chrcter hbee tke it ccut Oe re fr mbiguity i ht it i t lwycle hw EM writer ited t ue the ti O dieret cci

writer hve dvcted the EM pprch i term f it () nt imprtce itrumet fr tudyig the helig prce d cliicltrcti betwee ptiet d prctitier (b) pedagogic imprtce frmewrk fr techig prcttier the meig f lle dthe tti f the bimedicl mdel fr cliicl prctice d () clinicalimprtce itrumet fr determiig the prritie d ccef ptiet explrig prblem cmplice egtitig therpeuticllice with ptiet epecilly whe they re ethiclly ditict) dchig d evlutig tretmet d methd fr mgg therpeutic

utcme 1 p. 181; 9 chp ; 9)he iue f EM mbiguity ide it i imprtt t recgize tht thi

prticulr cmbiti f climlytic pedggc cliicli itrict the EM pprch EM dvcte jutify their ert t develp thifrmewrk by pitig t it uiue prcticl dvtge pedggic dcliicl). At the me time they lk t the Wete cliic plce frtfi they Le a ple it hich the ccept d methd ce itrduced tted d reed e 4 110. Put it ther wrd thelyic pedggic d cliicl clim f EM dvcte re fued thugh pxi itti

THE SOCIAL RELATIONS O SICKNESS

While Kleim d hi cite hve bee etblihig the EM pprch ther thplgit hve develped piti which giveprmcy t the cil rlti which prduce the frm d ditrbutif icke i ciety. It wuld be gg t far t y tht thee writigpreet uied view f icke prllelig the wrk f EM writerHwever it i pible t ee i hei wrk the trt f rivl pprchrted i divere urce but epecilly idebted t EvPritchad lyi f Zde mice , Gluckm tudy f the cil rgizti


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ANHROPOLOG OF ICKNE 26

of ritual behavior (eg 60) various Marist writers and Michel Foucaultn the net pages am going to describe this social relations of sicknessview b comparing it with the EM approach The latter sets ot in a clearfashion man of the fundamental issues in which a distinctive medicalanthropolog wll be built the distinction between disease illness sicknessthe connecton between sickess and peoples statements about sickessand the practcal (eg clinical) role of medical anthropolog For thisreason comparisons ith the EM approach are an epedient wa to showwhat these other writers have in common Moreover some of these writersare arguing eplicitl against the premises of the EM approach

Sickness and Heang

We begin wth the jutapositon of dsease and illness the EM approachIt will be recalled that EM wrters adopted this diseaseillness scheme asan ateate to wat tey aw a te Cartean uam o te bomea

vew e n reaction to the vew in whch dsease = sckess and theconsciousness of the patient s bracketed out The usefulness of the schemehas been challenged b Frankenberg 53) and mself (176 181) n ourseparate arcles we argue that while the bomedical and diseaseillnessviews clash in one respect ie over the isue of phsicalistic reductionismthe resemble each other in another euall important wa pecicall

both vews take the individual as ther object and the arena of sgncantevents The oint is that the diseasellnes vew does not requre wrters togive an account of the was in whch social relatons shape and distributesickness n this respect it is not so dierent from the biomedical model ast avate eem to beeve

From a dstance this appears to be an unfair criticism since Kleinmanmakes several references to socal determnants of medical behavior in hismonograph on Chnese medicine ( pp 24 202 2888) and ood toomentions the imporance of relations of power in medical practice But thefact is that neither leinman nor ood actuall undertakes such an analsisin his own work What is more to the point their scheme gives them nocompellng reason to make this analss ook at it from their pont of view:(a) their theoretical interests focus on clinical events and the healing (illness) process (b) looking outward from the clinical setting social relationscan be seen to radiate dadicall e between patient and practitionerpatient and individual famil members and so on and () while there aresocial factors that lie outside this circle the can be deferred indenitel

wthout serousl aectng our ablt to stud the healng processccording to its critics there are two roblems with the EM view Firstit overlooks the fact that power orgnates and resdes in arrangementsbetween socal groups and between classes Power is merel manfested in

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27 OUG

insonal laions, and fo his ason a focus on dyadic aionsfamns and dsocializs h nau of pow (18) Scond h pahfolowd by M ws sms asonabl ony bcaus h is a m

missin fom h disasillnss schm on which hi wok is basd oundsand hs ciicism, i is ncssary o s how h dsasillnssschm is wn by Fanknb and myslf

DSS ains is oiinal manin (oanic paholois and abnomaliis)

LLSS is ssnially h sam, fn o how disas and sicknssa bough ino h indiidual consciousnss

SCKSS is no lon a blank m fin o disas and/o illnssSicknss is dd as h pocss houh which wosom bhaoa

and biooical sins, paticuay ons oiinain in diss, a insociay cognizab manings, i hy a mad ino sympoms and socially sinican oucoms y culu has uls fo ansain sins inosympoms, fo linkin sympomaoois o ioois and innions,and fo usin h idnc poidd by innions o com anslaionsand liimiz oucoms (24 117 30) h pah a pson follows fomanslaion o socialy sinican oucom consius his sicknss

Sness s then proessfor sozn dsese nness Fo mpl1 n pualisic" mdica sysms, a sing s of signs can dsina

mo han on sicknss (137 138) and social focs hl o dminwhich po which sicknsss his happns, fo insanc, whn aarticula s of sins can b fd o din kinds of dianosicianhapiss, bu h sicknss domains of h din paciions do noola (hy ach own a disinci s of iolois and poofs), and hsics of h din paciions a no qualy accssib o al scosof h pain popuaion n his cas, disas and illnss a socializdhouh h aanmns which dmin who s wha aciions andinnions (55 68 1 1 4)

2 In Ws sociy, h o ansa sins ino socialy impoansymoms is dominad by a sin ind of aciion and a mo o ssunid s of ioois u h, oo socia focs dmin ha indiiduas wih h sam s of signs a somims alocad din sicknssshis is ca fo ampl, if w coma cinica ns which a oanizdhouh paciioncin aions ( h physician is paid hough affosic aanmn, and h pain is his clin) wih clinical nswhich a oanizd n ms of pacionaon laions [ h hysician

cis a salay and a posiion in a buaucaic ca sucu, soha his moy is aso his paon (2 82) noh ampl occus whnanslaions and iolois a pubicy consd and sod houh lalah han mdica mans [ disass of h wokplac, such as ownLung (6)] Mo commony, hough, h social aions of sicknss in

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AOOOGY O 71

Wese socey ae a for which e sae scess (rasao leaso iere illesses a iere cures accorg o he suerers' parcularecoomic a socal posiio

3 Sybols of heali are siulaeously sybols of power Specicviews of he social orer are ebee i eical beliefs where hey areoe ecoe i eiologies a beliefs abou he sources of healig power(56156 These ieoloical views are brouh io he cosciousess oiiviuals he cereoy raaury a osraios of ecacyha ae up healig pracces I oher worseical pracces are siulaeously ieoloical pacices whe hey jusify () he social arrae-mes hrouh which isease heali a cui are isribue i sociey(eg 124) a (b) he social cosequeces of sickess (e he paie's

liabiliy for isease he coracs i he worplace)Jus oe more poi i his coecio Earlier I wroe ha whe EM

wrers u o clical eves hey aop he prese ha escpos aaalyses of meical pracices shoul ocus o heir dptiv fucios[Soe ahropoloiss have aope a sroger a probably auologousversio of his premise he fac ha people choose o pepeuae a pariculareical pracice is eviece ha i i aapive as a for of heali if oecessarily curig (4)] This issue is coplicae by he fac ha soesocieieseg he Japaese accorig o oc (11 13) heselves uer-

lie he puaiely aapie fucio of eir eical pracces This preiseeails probles whe wrers see aapaio aily fro he poi of viewof he suerer a so elec he fac ha ay eical pracices evelopa persis because hey are useful for oher peope a for reasos uco-ece wh curg a healg or eape rog 155 calls aeoo he ways i which physicias eploy cera clcal pracces o corolhe eooaly of her cles a heselvesa o corol he ageasa leghs of clical sessios (see also 3 The os ipora prob-lehoughs ha he aapao prese argales he fac ha ickne rter n ine eees he choce a fo of ay clcalierveios rasacios ec I oher wors people are soeiesforce io sicesses ha ae heir suaios ore icul for he(173) The fac ha paies are liable o iepre such socially eerieeves aapive" ways (e give hem selfservi a selfpreservimeais is o especially ieresi or is i a isicive feaure ofeical siuaios (153

Form of Medical KnowledgeEM wiers are correc whe hey say ha iforas' saees abousickess are complex a oe ambiuous They are igh oo o say hahe ahropolois's ob is o search for he ier loic of hese saemese h reasog whch coecs percepos belefs owlegeaco

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22 YOUNG

and reecton But have EM wrters drawn the correct conclusons fromther own observatons? They have ponted out that statements are complexand ambguous, but can they explan why ths stuaton should have come

about n the rst place?In recent papers (182 183), I crtce EM wrters for tryng to explanthe surface meanng f nfmants' statements n terms f a sngle set funeng cote structures e expanatr mels f ness frmants statements seem cmplex argue because the oen juxtaposederent knds of kowldge (159 88 189) speaker does not necessarlknow all of hs facts n the same wa and he often gves derent epstemologcally dstnctve, accounts of hs sckness at the same tme

ne of my papers (182) outlnes a scheme for dentfyng he derent

knds of medcal kowledge that appear n peoples statements he schemedescbs 1 theoretcal knowledge whch orgazes dscrete events expeences etc nto classes (eg "Ths is a case of nuena); 2 kowledge ofevents etc n tems of ther emprcal patculates 3 knowlege rendereexstental cherent wth the thnkers preus experences hs assumptns abut human nature mans fate etc 4 nowlee whch the spekerhas transformed n order to make t ntellgble to other people and 5knowledge he ha produced by negotatng meanngs wth other peoplehs scheme s not a typlog snce each form f knwledge-theoretcal,

emprcal, etc-s a dstncte account whch emerges n a process ofknowlege proucton that the thnker s contnualy unertakng as herespns rst to one contngency an later t anther (eg chsng ecacus therapes, gg socally acceptable accunts of hs behaor) Wthnths producton process, the derent forms are lnked dalectcally so thatoer tme they are contnually tranformng one another Thus no one forms a po the speakers authentc kowledge of medcal events and nosle set of cnte stuctures cn be sa t be the ultmate surce of thesurface meanng of hs statements

In ths scheme, expanatory mdels f llness are only one of severalpossble foms of theoretcal knowedge Ths explans why EM wrters arencorrect f they assume that explanator moels are necessarl mplct nal of the statements an nformant mkes abut sckess (10 77 hescheme escrbes tw ther fms f kwlege that lke explanatrymels, shape peples unerstanng f sckness, etermne ther sttements aect ther motes etc hese are "prttpes and chan cmplexes cncepts borrwe from Halpke an Vgtsky (67, 166: see

Fgure 2)People use protopes just as they would employ an EM, to organze theevents and crcumstances they are experencng Although they are bothforms of theoretcal knowledge, prototypes and EMs are dssmlar n i-

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Chai Cpx

eirical

I,

r

ANTHROPOLOGY OF SICKNESS 23

E

Pototye

Oth f

thetica

,

I

{i

o ecal

acct

knds

of mdlowle

egotte ntsubjectv Xtetl

Figre of medal knowedge and aountsptant ay. n M t ll b call cnt tngly caual ppton an th a an that M a o mpotant o mcal pactcan thnng thy nabl ppl to oulat plan acton. Fth Ma gnally ha by latvly lag numb ppl. pttyp nth oth h nv mo than a tng o vnt an ccumtanccall om t pat uually om an al cn po t lmnt

(ymptm natn utcm tc) a connct a ca an ctbut mo tn thy a aocat by mpl cntguty chnology anmblanc. Futh a pttyp chaacttcally lmt t th amall ccl ppl (a amly ntanc) o th thn aln (c Clncal an nva wc a act o w own cntcan Popula m). cau pototyp a nth wly ha notngly caual thy a cult to ncpoat nt agntc an thaputc pactc at lat n lag cal ct h ntalzng ancalzng mcal bl ytm mnat ppl' pactc (16) Fth an th contnt o a pottyp a atvy untabl an lmnt a ly to b mp ot o tano a tm go by Chncomplexe a upcaly ma to pototyp: thy too a otnacaual lmt t mall numb ppl untabl ut ha ptotyp a a o thtcal knlg an an ntumnt o analicalanng chan compl tan nly thmlv hy a puct pinc (an pbly uncncu c) mpy tng o mpicalvnt natn ymptom tc whch coh an pt n th min

bcau th alnc cntgty an chonology th nvual lmnt n th l th thn.h a t an hy anthpolgt hul want to b abl t

cgnz pttyp an chan cmpl Ft thy plan hy m

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74 YOUNG

ttement bout ickne eem comlex nd mbiuou n infomntttement bout ickne e occionll ouct of mntn oflooel connecte EM ototicl exeience nd chin comlexe (ee

183 fo n illuttion) Second eole occionll ue otote nchin comlexe to exe dimenion of icne hich e exclue bM In Wete ociet fo exmle eole ometime ue otote ndchin comlexe to ive ccount o ickne in ocil nd biohicltem Tui ecibe thi ue in n ticle 17 be on hi conve-tion ith oman eetel hotlie fo eenetive n chonicilment Tui hicinnthooloit chcteie thi tient'eltion ith hicin nd nue ltetin beteen liented ivit nd liented elfetion tte he clim hich i often

obeved mon hoitlized tien A Ti ecbe thi ce theomn ivit i ouct of the ctitione Clinicl M n heon comlement Inividul EM Thee EM n the ctice nceemonie thouh hich the hoitl t mteiize them euce thefct of he ickne to ce of intomtic betl n tnfom hefom bein te ubect of he hito into ive obect of n oteniblybenevolent meicl cience n the othe hnd he outbut of eiveuoele n ometime violent elfetion oiinte t in heknolede of hn mex of ocill nd economicll etemine

event nd cicumtnce tht uhed he lon the th of mifotune ndhoitliztion nd econd in he knolede of he ickne rteof the medicl event hich no eem to be ovecomin he on duhten nuhte lo In Tui ccount chin comlex n ototee the iionctic inchote n futtin counteoint to the oefueociliin ccount ouce b Clinicl nd Indiviul EM The emeel fct ithout icoue

In TassS cas conntona mca pactcs manaz i patient' ototicl nd chin comlex ccount of ickne Wht henin tibl ocietie thouh ee medicl belief e ocilied nd the ickeon idet ocil ou i mllcle ociet? An excellent ccountb Sinine n Zemleni te u thi uetion ein the Senufo ofthe Ivo Cot (9 Afte etblihn the oint tht the Senufo oduceheteoeneou medicl fct nd ccount Sinzine nd emleni ecibe ho Senufo divintiondinoi ctivel incoote ototend chin comlexe Hee contemo ickne event e conceive the ectivtion of elie event n the e einee n toe in thecollective memo of te mtliee the divintoy device h thefunction of feeding thi memoy ith it oe contituent intnce ndecollection (149 79)

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ANHROOLOGY OF KN 27

Medicine s n Ideoogic PrcteIn arl, Taug (7) adop a poon orgnang w orguka, a n W oy oody od of produon doi

n ol od d r iuion in wi un bng ndi pi oud dioiid obilTuig' poi i W diin i, og o ng, p of dologil ppu of i oil od. I p idologil p bau y produ idn for iw a oy ly u ol of onun indidul and oial for r nongo uilibiu wi i o uliud of pwill nd f. Sini d linil EM, nd pi nd oi w y lgiii, i a idologial by ren ign,

prn and ouo a doalzd fa of naur Tauig opar iuaon wi wa appn n bal oi, u aong Ad, w dal f ar no paad fo alu, pyal anifo o o fo ir ol o, d i u . . . no gor of ind o rad oal rlaion ino aral n."

ordng o Taug, i no adn a ikn a bo a foufor doloal pr Srou kn nrrup ryday roun and or or l unral apn of lif. I u popl no pyian nd ploopr," pondrng quion u a Wy ?"Tu, wn ikn i boug no ln, praiionr i gn apowrful poin of nry ino pain' py," roug uoy of EM. I i a i po a W linin bo agn ofnrnd la inr, din bo an of oial onrol, and body i rfod no n iu fo aifyig oally ngnddgo d fbuling rly." By dnyig ol lon bodd i i, piio u lil diin no i ofpply l ing', " nd ogify ly io wold of

prr bje boldn only o i own for nd lw duifully illunad for u by profonal p u door" In way pollag i anid win ln i Don' onpl rblliongan of lif for a . . . rrably lokd n alof pyal a."

In nd Sa, u of dologil pr u a lnildn l no apay o ofro nd rfu rl iw bun powr o pu iw o argin of raond dour.Troug pri, olizd knowldg of dn ad o

no o u wrong or ounrprodui" w would la ugg o oon ground bwn onnional and oalzd w) no dii ll" o n p o polii" din nd n.

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276 OU

This is h pi which Tussi us his ciicl ks EM wis. cci uss h EM ppch sus h pssili f sciz ic hil h EM ppch cis i h ps i

i f h p piil pc i h icl iu s l cis uc h sci lis f sickss iscus illss pi Th EM ppch bcs isu cpi h subii h pis i li his sciz kwl u i h cl i h f f pps chi cpls f wsi c u f his hs.

Th s pis i his u wh Tussi ssps ip issus Fis h is pbl which is sii b his c h z spi wh Tussi iplis Z icl iii

isis ss h uci s pwful ilicl usiuiic isu hruh which scic su hss f cs. hil i is u h ici i sciisckss h i plic c his ws i iscs isch h su hi c plii (120) Sc iis cl cl wh Tussi s b ici sic h s isiush his ccp s cici whch s bnevtable, l h sc pcsss huh whch pp cif hss i piculr s ril his scil lis which hlp csiu h culu csuci f i sci

Tussis pbs pp h ? f l h ss ipli h () bcici is ici wh i myte hscl s f iss scil is f sickss h is f clss ii b) wh sps ilis c authentaly sciiz () h isus f demytneae ie a te a rer, a t true pte e at tati s bl iil sciis h sciiz i ws whichciu sucus f ii. u his li f si wul l h usi. Hw c Tussi hplis b su hhis w is bu sickss ccl si h h is lsfi h scil lis sickss huh ii f scih h i h cil w huh u 15)? his isTussis pbl H uss Lukcs's u bu ici usihs w cli h h c ccl scliz (sf) sickss uLukcs bs his u hihl pblic clis bu hisr

clss csciusss h cp l f h plri (87 chp.8). hps ussi cu wi s hs clis phps . hpi is h h ci uu i his ic. h su s h his

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ANTHROPOOGY OF CKN 2

analysis of how Weste medicine mystes sickness is both convincing andimportant, but his own epistemologica claims are probematic

A recent article of mine 180 paraels Taussigs paper up to a point It

departs from his thesis by arguing that knowledge of society and sick-ness is socialy determined, and that anthropoogists cannot egitimatelyclaim access to demystied facts What they can caim, and what would settheir accounts of sickness o from those of others, is a ciica under-standing of how medica facts are mby the processes throughwhich they are conventionally produced in cinics research settings etcThus, the task at hand is not simpy to demystify knowledge, but to critically eamine the soil oitios of kowlege routio. The articleitsef analyzes how stress researchers produce their characteristic facts

about sickness outcomes Like proponents of the diseaseillness mode,stress researchers promise to move knowledge of sickness beyond the limita-tions of the biomedicl ersective but in the end the, too use sicnessto show that socialy determined ideas about society its reducibility toindividuas and dyads of individuas, etc are irresistibe facts of natue Instress research medical knowedge is desociaized through a abor rocesswhich (a) recaituates the soia relations of roduction whih are charac-teristic of the genera economy eg separating the intelectua abor of theproect manager from the fragmented and mechanica labor of his infor

mants, and (b) dispaces the human subect ie the people about whomstress researchers are writing into an individualistic zone of aniety, themilieu of stressful life events, where he is reconstituted as a psychologicalabstraction [In this connection, see anaogous arguments by Navarro 26and Assennato avarro 7 0 on the socia production ofknowedge of occupationa medicine, and Latour Woolgar 102 on thesocial production of biomedical knowledge

Ecacy and ProducvyWhat is the importance of medical anthropoogica research for the peopebou whom medica anthropoogists write EM wrters are quite cear onthis point their practical interest is the issue of meil ey Thatis, they want to augment the eectiveness of clinical medicine in the contetof the healing procss For eampe, they want to enhance atient education, remedy problems of noncompliance and chalenge maladaptivecourses of treatment n the other hand, the writers I have identied with

the anthropoogy of sickness perspective are oriented to a point beyond theheaing proess the nner ogic of ness, and the consciousness of theindividual heir practical interest is in what can be cled meil ou-

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278 UNG

tv Th is hey wn o idenify he direc nd indirec impc ofprclr cncl prcces nd perspeces on he leels of morbdy ndmorly of he poplion lre mon oher hins his mens h

hey wn o le wheher priclr clincl prcces js becse heya eccios lso help o deermine who s exposed o which phoensnd poenc sons nd who conrols or hs ccess o whch medclprcces nd resorces

ecse medicl sysems deree o prodcvy epends on he eec-veness of is rmmenrim nd he echncl skills nd knowlede of isprconers s mpossble o lk bo prodciviy wiho lso inrodcin esions bo eccy The reerse s no re howeer nd hsends o limi he prccl impornce of eccy cenered pproches snce

here re les hree sons n whch improemens n eccy helile or no posiie eec ie hey re nprodcive 1 Improvemens ineccy re resriced o smll nmber of people nd he neliibleeec on leels of morbdiy nd morliy for he ol poplion for whchhey cold mke derence In smlr son mproemens n e-ccy re mde lble o e poplon for whch hey cold mke derence b hs mens dvern resorces needed for improvin ehel o lrer semen o e ol poplion or emple is is esion in some less developed conries where he cpil bsorbin

medcl inerenons demnded by rbn elies sphon resorces wyfrom he primry helh cre needs of mch lrer (oorer rrl) riskpoplon The ne eec is no chne or een n ncrese n oerll leelsof morbdy nd morly Sons of hs sor re described y Drfeld& Lindber (1 wriin bo he inrodcon of Wese medicine ino reion of Tmil d Se (Indi) nd by Frnkenber & Leeson (54)wriin bo he developmen of physcn cenered medicl sysem nmb see lso 2 179). 2 mproemens re mde lble o hepoplion lre b hey re eccos only nder creflly reledcondiions In cl prcce e socl relons o sckness mke hemeier iroeni or wsel e he nreled dispensin of powerflnbiocs in less deeloped conres (47) 3 There re sions n whichhe min eec of mproemens n eccy is o jsfy he reicon" ordesocilzon of sckness s we he seen his hppens when ecciosprcices ie evidence in he form of ndvdual a of crin nd heli h desociled ews of sckness merely reec he fcs of nre desoclzon is nrinsclly nprodce becse i hdes he nderlyin

socl deermnns of pes of morbdy nd morliy nd n hs wyhelps o reprodce hem (Tssis clm is h een if he EM ppochwere sed ecciosly i wold probbly fll ino he second nd hrdsions)

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CONCLUSION

ANHROPO OF CKNE 7

The olowin oine chemaize m view o medica anthropoo' ed

THE NTHPES F NESS ND SCKNESSI. Biolocal rientaion

. BoedcneB. nthropoo o deae Bioloca anhropolo

II Sococra enaton. Emiricit epiemoloie

i. edical ocioloii. Empiric medica anhropoo

B. Nonempirici epitemooiei. Tradiional anhropoloica approacheii. thropolo o ie

. nthropoo o cne

Thi otine poin in the direcion o a at etion. re he anthropoo-e o lne and icne braceed oether in complementar or antao-ntc wa The anwer depen on one pon o vew.

Anhropoloiss of ilnss appear incned to ee he developmen o ananhropoo o cne a evdence o an emerin ntelecta diviion oabor wihin medcal anhropoo or eape th vew pic in thewa leinman trea he ocial reaion o icne n hi monoraph onChinee medicine 93. Severa time he menion the imporance o reconizin the ocia and economic deerminat o cinica event the ameme he popone the a o aca ecbn an anan heedetemnant. Th he mpe ha whe nowede o lne oe notdepend on nowede o it ocial condiion he ormer wl probabl beeniched b he ater

he view om the anhpolo o/siknss i more complicated. n theone hand writer ie Tai raie he eion o whether thee i a haredepiemoo between he anthropooie o ine and icke there iot he the reatio betwee the two i antaonitic ad predicated oiva caim to the tth n the other had here are writer icdinme who top hort o hi conclio and reconize he common rondo the anhropoloie o ilne and icne.

What all o the anthropoo o cne hare i the premie tha ocalorce and eation permeae medical anhropoo' eld. When thee

ocial condition are inored or deerred nowlede o medical evenincdin what happen in he cinic i ditored or oher approache othi bec ee Janzen' ditinctio bewee microanali ad macroan-ai 78 ad Pre' tpoo o medical tem 38] What i more

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28 O

he anhropologiss knowledge is disored in ways whih are hemselvessoially signin The underlying argumen here is ha he key onepso he anhopology o illnessie healing, illness, eay, explaoy

models, and semani illness neworksanno be undersood merely inrelaion o eah oher. By hemselves, he oneps do no onsiue asysem or desribing oher peopes medial belies, experienes, evens,and behavior, beause 1 illness is, among oher hings, a means hroughwhih ai koledge o he huan subje (iluding his kowledge o hisapaiy o kno inuene or hange he ondiions o sikness) eners inohe onsiousness o he individual 2 healing, in addiion o bringingsaisaion o suerers, is also an ideologial prai whih helps o re-produe he soial relions hrough whih illness is made real and boh

illness and disease are disribued in soiey 3 eay is praially impor- beause o he soially deemied oribuion i makes o produiviy d 4 explnaoy models sei illness neorks, ogehe ihprooypial episodes and hain omplexes, are dialeially relae ele-mens wihin a soially deermined proess o kowledge produion.

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nthoologst

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