1. ANTH/HSERV 475 Perspectives in Medical Anthropology University of WashingtonAlejandro Cerón Office: Denny Hall 417 Office hours: Wed 11 am -13 pm maceron@uw.edu Week 6: Mon, 11/1/2010

2. Outline Today’s Goals: Today’s Goals: Explore the notion of health and its relation to illness/disease/sickness Explore the notion of health and its relation to illness/disease/sickness 1.Oral presentations  Alice Jacobson, David Armo, Vince Mayo (link) link 2.Culture-ideology-hegemony 3.Today’s readings - overview 4.Work in small groups and discussion

3. Ideology-culture-hegemony One view, based on Antonio Gramsci and Raymond Williams (“Cultural Marxism”) One view, based on Antonio Gramsci and Raymond Williams (“Cultural Marxism”) Jean and John Comaroff Jean and John Comaroff ideologyhegemony Political manifestations of culture

4. Ideology Gregory Elliot 1997 (“the most elusive concept in social sciences”) (“the most elusive concept in social sciences”) 4 general sets of meanings 4 general sets of meanings 1.The epistemologically negative : distorted, false thought 2.The socially relative : any set of opinions, beliefs, attitudes. The worldview of a social group 3.The restricted : “theoretical ideology”, conscious system of ideas 4.The expanded : “practical ideology”, unconscious medium of habitual behavior

5. Ideology Jean and John Comaroff, 2002 “a relatively formal and articulated system of meanings, values, and beliefs, of a kind that can be abstracted as a world- view or a class outlook ”, providing an organizing scheme for collective symbolic production for both dominant and subordinate populations, and therefore it can be contested. “a relatively formal and articulated system of meanings, values, and beliefs, of a kind that can be abstracted as a world- view or a class outlook ”, providing an organizing scheme for collective symbolic production for both dominant and subordinate populations, and therefore it can be contested. terrain and vehicle of political struggles. terrain and vehicle of political struggles. one of the forms (the other being hegemony) in which “power is entailed in culture”. one of the forms (the other being hegemony) in which “power is entailed in culture”.

6. Capacity of a dominant group to exercise control Capacity of a dominant group to exercise control Not through visible rule or force Not through visible rule or force Through willingness of citizens to accept subordinate status by their affirmation of cultural, social and political practices and institutions Through willingness of citizens to accept subordinate status by their affirmation of cultural, social and political practices and institutions Buried in everyday life, hegemonic processes become taken fro granted and ‘natural’ Buried in everyday life, hegemonic processes become taken fro granted and ‘natural’ Popular culture plays a significant role in achieving or resisting hegemony Popular culture plays a significant role in achieving or resisting hegemony Hegemony David Ley 1994

7. “Cultural hegemony” “Cultural hegemony” Political domination Political domination Coertion or consensus Coertion or consensus From Antonio Gramsci (“Cultural Marxism”) From Antonio Gramsci (“Cultural Marxism”) The economic and political ascendancy of a given class is organically connected with a preparatory achievement of cultural and intellectual hegemony The economic and political ascendancy of a given class is organically connected with a preparatory achievement of cultural and intellectual hegemony Hegemony M.A.R. Habib 1997

8. Ideology-culture-hegemony One view, based on Antonio Gramsci and Raymond Williams (“Cultural Marxism”) One view, based on Antonio Gramsci and Raymond Williams (“Cultural Marxism”) Jean and John Comaroff Jean and John Comaroff ideologyhegemony Political manifestations of culture

9. Episteme 'epistemological unconscious' of an era ; 'epistemological unconscious' of an era ; configuration of knowledge in a particular episteme is based on a set of fundamental assumptions that are so basic to that episteme so as to be invisible to people operating within it. configuration of knowledge in a particular episteme is based on a set of fundamental assumptions that are so basic to that episteme so as to be invisible to people operating within it. From Wikipedia

10. Episteme “I would define the episteme retrospectively as the strategic apparatus which permits of separating out from among all the statements which are possible those that will be acceptable within, I won’t say a scientific theory, but a field of scientificity, and which it is possible to say are true or false. The episteme is the ‘apparatus’ which makes possible the separation, not of the true from the false, but of what may from what may not be characterised as scientific” “I would define the episteme retrospectively as the strategic apparatus which permits of separating out from among all the statements which are possible those that will be acceptable within, I won’t say a scientific theory, but a field of scientificity, and which it is possible to say are true or false. The episteme is the ‘apparatus’ which makes possible the separation, not of the true from the false, but of what may from what may not be characterised as scientific” Michel Foucault, 1980

11. Sumak Kawsay (roots in Aymara language) emerging from the invisibility to which it was subjected for more than five centuries. alternative to progress, development, modernity. wants to recover that harmonious relation between human beings and their surroundings. Not a return to the past, nor to the age of stone or of caves, and it does not deny either technology nor modern knowledge, as the promoters of Capitalism have argued. Pacha Mama

12. Sumak Kawsay Tr. from Mónica Chuija (2009) Part of the debate on our destiny The fundamental thing is human beings, not markets nor economic growth. We must enter a process of decrease in the production of things Enter a process of measured human growth, not in terms of things, but in human terms. In that context, we the indigenous nationalities and peoples need to reclaim our self-determination, to deepen and to extend the practices of living well into society. Pacha Mama

13. Culture-bound syndrome : The view that affliction syndromes and treatments may be specific to particular cultures, and thus not comparable as universal conditions. (Janzen 2002) Culture-bound syndrome : The view that affliction syndromes and treatments may be specific to particular cultures, and thus not comparable as universal conditions. (Janzen 2002) Outlawing Ana (16min, link)link

14. Medicalization : definition in medical terms of what may have been considered a personal or social problem, proposing medical treatment as appropriate solution (Brown, 1995) Medicalization : definition in medical terms of what may have been considered a personal or social problem, proposing medical treatment as appropriate solution (Brown, 1995) Malaysia obesity (link, 3min)link Australia obesity (link, 3min)link Consequences? Consequences?

15. Medical pluralism : The coexistence of multiple medical traditions, or bodies of practice and thought, within the same society. (Janzen 2002) Medical pluralism : The coexistence of multiple medical traditions, or bodies of practice and thought, within the same society. (Janzen 2002) Hierarchy of resort : the conventional pattern of the sequence of different consultations with medical practitioners or therapies in an unfolding case (Janzen 2002) Hierarchy of resort : the conventional pattern of the sequence of different consultations with medical practitioners or therapies in an unfolding case (Janzen 2002) Ayurvedic medicine in India (link)link

16. Film (60 min - link) link

17. Janzen, Ch 3. Fabric of Health Health: a philosophical, epistemological, ontological, normative puzzle with practical implications (explored in further detail in Almeida- Filho’s article). Health: a philosophical, epistemological, ontological, normative puzzle with practical implications (explored in further detail in Almeida- Filho’s article). Examples/generalizations of “classical medical traditions” Examples/generalizations of “classical medical traditions” Syncretism Syncretism Assess with concrete people, “local level” Assess with concrete people, “local level” Primary health care Primary health care

18. Janzen, Ch 3. Fabric of Health They all blend together in actual practice, in medical systems They all blend together in actual practice, in medical systems Personalistic : disease is explained as due to active, purposeful intervention of an agent, who may be human, nonhuman, or supernatural. The sick person is literally a victim, for reasons that concern him/her alone (Foster1976). Personalistic : disease is explained as due to active, purposeful intervention of an agent, who may be human, nonhuman, or supernatural. The sick person is literally a victim, for reasons that concern him/her alone (Foster1976). Naturalistic : explain illness in impersonal, systemic terms. It results from such natural forces or conditions as cold, heat, winds, dampness, and, above all, an upset in the balance of the basic body elements (Foster 1976). Based on observation. Naturalistic : explain illness in impersonal, systemic terms. It results from such natural forces or conditions as cold, heat, winds, dampness, and, above all, an upset in the balance of the basic body elements (Foster 1976). Based on observation. AnimisticMagicReligionScience Magic ReligionScience