existence – were given room to grow.
CRITICAL APPROACHES
As the 1980s ticked into place, anthropology – particularly cultural anthropology – began responding to changes in global and domestic power relations as well as to feel the heat of other disciplines’ critiques of traditional ethnographic methods: “The subjects of ethnography could no longer be constituted in as objective terms as previously” (Marcus 2005, p. 680). Definitions of culture, already in flux in the 1970s, grew increasingly “non-essentialist, fragmented, and [came to be] penetrated by complex world historical processes mediating the global and the local” (p. 681). The stage was set for the emergence of a critical form of medical anthropology – one that took the lessons of political economy to heart.
Even in the 1970s and earlier, some anthropologists had taken seriously the lessons of historical materialism encapsulated in the works of Karl Marx and Friedrich Engels. Eric Wolf’s contributions and subsequent changes in the political climate supported growth in this line of thinking, even in the USA, where earlier anti-communism had squelched it. In the UK and elsewhere, scholars such as Ronnie Frankenberg also drew on the work of Italian revolutionary Antonio Gramsci. The focus on conflict and reconciliation and the tensions extant between (individual) agency and (social) structure, promoted earlier by Max Gluckman’s Manchester School, gained new ground.
As a result, a newly “critical” perspective burgeoned. Proponents denounced past ignorance of political economic factors in medical anthropology. Systems thinking, most obviously in the form of world systems theory (as per Immanuel Wallerstein) and dependency theory (as per Andre Gunder Frank), was brought into play. Building on work done in the 1970s with regard to how “great traditions” (e.g., Ayurveda) do and do not respond to incursions from what some by now called “capitalist” or “cosmopolitan” medicine, medical anthropology in the 1980s confronted head-on the impact of hierarchical social relations on health knowledges, actions, and outcomes (see, for example, Baer et al. 1986; Singer 1986).
While interpretive medical anthropology focused on local symbolic significances and networks of meaning, taking ideas as key, critical medical anthropology (CMA) advocates prioritized the examination of power structures that underlay dominant cultural constructions, and questioned the ways in which power (including the power to frame “reality”) was deployed. In doing so, CMA sought (as it still does today) to expose local power dynamics and to reveal how outside interests – regional, national, global – affect local conditions. Furthermore, CMA showed (and shows) how health ideas and practices reinforce social inequality as well as expressing it.
A New Form of Activism
Medical anthropology grew dramatically in the last decades of the twentieth century, partly due to increased opportunities for applied medical anthropologists. But non-applied anthropologists interested in health saw that they, too, had something to gain by being identified as medical anthropologists. For one thing, those who affiliated with the subfield gained somewhat increased credibility in biomedicine and public health, and easier access to work within such organizations. This was and remains important to many medical anthropologists from the Global South, where anthropologists have generally had less interest in (and less support for) purely academic work (Laurie Krieger, personal communication, June 21, 2020; and see Mvetumbo et al. 2020). But also, the field’s relevance to theories regarding culture had grown more obvious. This trend intensified as the millennium drew near, due in part to richly ethnographic contributions in Dutch and Nordic medical anthropology (Ingstad and Talle 2009).
The cultural construction of biomedicine and public health itself came under increasing scrutiny, making manifest the important distinction between anthropology in medicine, which many early applied efforts represented, and anthropology of medicine (Foster 1974 [after Straus 1957], p. 2). Investigations into the medicalization of pregnancy and birth were central to increased appreciation of this distinction (see Browner and Sargent 2007).
Anthropology of medicine was buoyed by increased distrust of the “grand narratives” of modernity a la Lyotard (1979) as well as (in the USA particularly) the post-Vietnam War drive to “question authority” and academic anthropology’s related swing to the “intellectual Left” (D’Andrade 2000, p. 219). The situation was somewhat similar in Europe, as “anti-hegemonic social movements” were thriving (Hsu 2012, p. 51). Employment within the ivory tower supported medical anthropology’s close questioning of biomedicine’s and public health’s established agendas by providing a safe space for – and indeed, a cultural climate encouraging of – contemplations that would not have been safely brought into a practitioner workplace. Protected from the need to bring in contracts and grants, invigorated by increasingly popular “anti-establishment” sentiment, many university-employed US anthropologists proclaimed participation in government- or corporate-sponsored foreign- or domestic-aid work as retrogressive – as standing in the way of real social progress.
To some extent, the progressive climate fostered within numerous anthropology departments attracted newcomers to the field; some saw medical anthropology itself as a potential “social movement” (Stein 1980, p. 19). And while many went about their work systematically and with rigor, for others science was seen as “part of the military industrial complex” (D’Andrade 2000, p. 221) and therefore needed quashing: “Theoretically relevant description” gave way, in some circles, to “moral critique” (p. 222). Put off by this tendency where it arose, some scholars more committed to systematic and rigorous research inquiry than hortatory essay-writing switched their allegiance to other disciplines, such as epidemiology, genetics, biology, and even sociology.
Congruent with cultural anthropology’s general anti-science tendency at the time, a “bias in favor of alternative, heterodox, or non-Western forms of medicine” was noted by Melvin Konner (1991, p. 80). In his opinion, “Criticism of medicine has become a major academic and publishing industry” (p. 81; and see Ortner (2016) regarding “dark anthropology”). Admitting that “there is a lot that is wrong with medicine,” still he argued that the negative tone taken by some medical anthropologists toward biomedicine was counterproductive: “Modern medicine is not a conspiracy against humanitarianism,” he wrote; “Least of all is it a capitalist plot” (p. 81). The “high-minded criticism with no evidence of sympathy for the doctor’s plight” (p. 81) that he observed did do some damage to medical anthropology’s reputation in biomedicine – but not much, because generally such critiques were not published in media perused by biomedically affiliated professionals.
Furthermore, many critically oriented scholars still prioritized careful research. Moreover, some made common cause with or were themselves biomedical insiders who offered constructive criticism, bridging the divide between an anthropology overfull with hyper-critical rhetoric and one that has been medicalized (regarding physician anthropologists, see (Wendland 2019). As Carole Browner explained in 1999, medicalized anthropology is that which has lost touch with anthropology’s principles; its practitioners “go native” when working within the health services (p. 135). Browner respected the anthropologist’s need to find a common language for communicating with health-care colleagues, and to adopt some of the medicine’s cultural practices to gain credibility. She understood the likelihood that many anthropologists have to some extent internalized biomedicine’s categories because of their reliance, at times, on the system for care. But, Browner warned, one of the grave dangers of being (bio)medicalized was sacrificing “critical distance” (p. 137).
Dissatisfaction with (bio)medicalized medical anthropology has increased since. Methodologically, many condemn the unthinking acceptance of biomedicine’s penchant for separating health-related situations or experiences into discrete, static, countable units or factors. “Research that sets out to generate data that fits within pre-existing categories embraced by the ‘factorial’ model” (Parker and Harper 2005, p. 2) pulls experience to bits, focusing attention on parts rather than the whole, and treating
