1. Welcome to: ANTH/HSERV 475 Perspectives in Medical Anthropology University of Washington Alejandro Cer ó n Office: Denny Hall 417 Office hours: by appointment Mailbox Denny Hall Mezzanine maceron@uw.edu

2. Outline Today’s Goals: orientation to the course and clarify expectations Syllabus Personal profile (1p, return to me when done) Course description Assignments Today’s readings Introductions

5. Diabetes Mortality, King County Source: Death Certificate Data: Washington State Department of Health, Center for Health Statistics.

6. Introductions Name Something about your background Any thoughts on the charts/graphs

7. Course description (1) Course WorkSpace – use it please! Course WorkSpace Office hours: – Mon & Wed 2-4pm - Denny Hall 417 – By appointment (email me)

8. Course description (2) Objectives – Define key concepts in Medical Anthropology – Gain understanding of health issues of current importance – Apply concepts from Medical Anthropology to everyday problems

9. Course description (3) Medical Anthropology studies – Social and cultural context where health, disease and healing (h-d-h) happen. – Multiple expressions of h-d-h (biological, political, behavioral, cultural, etc). – Ways in which people organize to take care of h-d- h, especially in places with evident inequality.

10. Course description (4) Student responsibilities – Read prior to class – Participate – Turn in assignments on time – Respectful interaction Readings – Briggs, Charles with Clara Mantini-Briggs (2003). Stories in the time of cholera: racial profiling during a medical nightmare. Berkeley: University of California Press. – Articles

11. Assignments Linked Two goals: – Demonstrate how social position and background shapes our experiences, values and beliefs. – Explain social and cultural aspects of “expert” knowledge and how they influence the way you think about the world, its problems and its solutions. Evaluation – Paper – Oral presentation (with poster) Class participation plays a key role.

12. Let’s take a look at the syllabus Syllabus – Every class: readings – Almost every week: other assignments

13. Next week assignment Monday June 28 Personal Account (1): Description (3 double-spaced pages) Describe an episode or event health, illness, and/or healing you experienced, participated in, or witnessed at first hand. merits sustained reflection you will feel comfortable sharing describe and characterize: people, places, time and plot. give coherence to the narrative as a whole but feel free to structure it as you want. Posted by Monday 6/28 at 8am https://catalysttools.washington.edu/collectit/dropbox/maceron/10904/ https://catalysttools.washington.edu/collectit/dropbox/maceron/10904/ No hard copy needed. What? How?

14. 3. Today’s Readings (1) Chapter 1 Introducing Medical Anthropology Chapter 2 The origins and theories of Medical Anthropology Book cover

15. 3. Today’s Readings (2) John M. Janzen, the author University of Kansas Research Experience Lower Congo, 1964-6, 1969, 1982 (health and patterns of health-care seeking); Eastern & Southern Africa, 1982-3 (ngoma healing and interpretations of misfortune); Great Lakes region, 1994-5 (post-war trauma relief and healing); West Africa & Sahel (Senegal & Sudan), 2000, 2001, 2004 (Sufi healing). John M. Janzen at Izirangabo refugee camp

16. 3. Today’s Readings (3) Chapter 1. Introducing Medical Anthropology The social fabric of health Medical Anthropology 3 examples (kuru, birthing, Asian medicines) Research basis of Medical Anthropology

17. 3. Today’s Readings (4) “Medical anthropology is the study of health, illness, and healing across the range of human societies and over the course of human experience, with an emphasis on how members of the community direct their behaviors, articulate their ideas, and organize their resources in these realms. includes the study of the patterns of disease within an environment and the ways in which diseases relate dynamically to living organisms – especially human organisms. includes the ways in which the human community understands and responds to these challenges to its existence. may also include the community’s access to the resources that maintain or restore health, or the exclusion from such resources by the community’s power structure. studies the meaning of the signs of illness and suffering as part of the overall study of cultural traditions, and strives to interpret them in the light of wider traditions of ritual and religion” (p. 2)

18. Remember from earlier? Medical Anthropology studies – Social and cultural context where health, disease and healing (h-d-h) happen. – Multiple expressions of h-d-h (biological, political, behavioral, cultural, etc). – Ways in which people organize to take care of h-d- h, especially in places with evident inequality.

19. Let’s compare both Janzen’s Study of health, illness, and healing across the range of human societies and over the course of human experience Emphasis on behaviors, ideas, and resources. Includes: patterns of disease Ways to understands and respond community’s access to resources Meaning of the signs of illness and suffering Earlier in the class Study of Study of Context of health, disease and healing Context of health, disease and healing Multiple expressions of h- d-h Multiple expressions of h- d-h Ways in which people organize to take care of h- d-h Ways in which people organize to take care of h- d-h What do you find useful of each? What are their weaknesses?

20. 3. Today’s Readings (5) Chapter 2. The origins and theories of medical anthropology Emerged as specialty in 1960s – Understand “exotic” health care practices – Improve health care in “Third World” countries – “Crisis of medicine” – Technological developments

21. 3. Today’s Readings (6) Heterogeneity of Medical Anthropology Sociocultural Biocultural Applied “Development” “Clinical” Comparative study of health systems Culture in biocultural Cultural construction of medicine Critical Exercise: Pick one perspective and look at the following video through that perspective’s lenses. What questions would you want to ask in order to understand Tarantism?

22. Exercise Tarantismo Lycosa tarentula Italian Anthropologist Ernesto de Martino (1908-1965)

23. Some contemporary Medical Anthropologists Artur Kleinman NY Times Harvard Mark Nichter U Arizona Nancy Scheper- Hughes CNN video CNN video CNN video CNN video UC Berkeley UC Berkeley

24. 4. Key terms - glossary Medical anthropology Ethnography Sickness Disease Illness Healing Biomedicine Sign Symptom Symbol Medical pluralism Medical pluralism Modernity Modernity Culture Culture Social reproduction of health Social reproduction of health Explanatory model Explanatory model Placebo, nocebo Placebo, nocebo Culture-bound syndrome Culture-bound syndrome

25. 5. Illness/disease dichotomy A way to distinguish sufferer’s perception of the experience from objectively discovered entity. Illness: the sufferer’s perception of the individual experience of suffering; may occur with or without disease being identified; culturally embedded, subjective definition given to suffering by the patient, and to behavior in which it is expressed. Disease: a condition that is objectively identified with a medical label or diagnostic name, based on externally established signs; may be identified with or without there being a subjective perception of illness by the individual; objective condition or pathology as determined by a medical professional. Sickness: the individual or group subjective experience of suffering Suffering: the subjective, usually more chronic, condition of affliction or painful existence; broader than sickness, the existential experience of life of hardship and difficulty, may be permanent human condition, often accounted for in religion and wisdom literature. (all definitions from Janzen 2002)

26. Exercise Groups of 3 Watch videos and think about the definitions of illness and disease. What ambiguities or assumptions do the definitions have in terms of subjective/objective knowledge? ADHD Diagnosis ADD doesn’t exist My son has ADHD

27. 5. Illness/disease dichotomy A way to distinguish sufferer’s perception of the experience from objectively discovered entity. Illness: the sufferer’s perception of the individual experience of suffering; may occur with or without disease being identified; culturally embedded, subjective definition given to suffering by the patient, and to behavior in which it is expressed. Disease: a condition that is objectively identified with a medical label or diagnostic name, based on externally established signs; may be identified with or without there being a subjective perception of illness by the individual; objective condition or pathology as determined by a medical professional. Sickness: the individual or group subjective experience of suffering Suffering: the subjective, usually more chronic, condition of affliction or painful existence; broader than sickness, the existential experience of life of hardship and difficulty, may be permanent human condition, often accounted for in religion and wisdom literature. (all definitions from Janzen 2002)

28. Medical Anthropolgy is: Janzen’s Study of health, illness, and healing across the range of human societies and over the course of human experience Emphasis on behaviors, ideas, and resources. Includes: patterns of disease Ways to understands and respond community’s access to resources Meaning of the signs of illness and suffering Last week’s Study of Study of Context of health, disease and healing Context of health, disease and healing Multiple expressions of h- d-h Multiple expressions of h- d-h Ways in which people organize to take care of h- d-h Ways in which people organize to take care of h- d-h What do you find useful of each? What are their weaknesses?

29. End of today’s class