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 – these theories explore the shared mental processes that exist primarily within human minds (e.g., thought processes, beliefs, emotions, knowledge, etc.) and how those processes link to the observable behaviors that those same individuals exhibit (behaviors, actions, etc.); (3) theories about the social and cultural structures that humans create and the organization of human behavior beyond the individual level (e.g., kinship, social networks, voluntary associations, organization theory, institutions) and the impact of those entities on everyday life; (4) theories of human manipulations and human understanding of symbols (the domains of linguistic anthropology, symbolic anthropology, communication theories, etc.); and (5) theories that explore integrated cultural–ecological relationships (biology and behavior interactions at multiple levels), including relationships of humans to the biological and physical environments surrounding them, and vice versa.
To Theorize or Not to Theorize: When to Theorize without Putting the Cart before the Horse (Or Descartes before De Horst)
Anthropology is somewhat unique amongst the social sciences in having three different but defensible frameworks that determined the primary methodological and analytical foundation of the ethnographic research process. One justifiable research configuration in applied medical anthropology is to conduct “atheoretical” (exploratory, descriptive) research. In this form, no explicit explanatory or exploratory theory is adopted or expected to emerge. This approach is used predominantly in descriptive projects with the intent of presenting an “insider” view of a culture and adopting a culturally relativistic stance that avoids critique or cultural shaping from alternative viewpoints. If theory emerges from this approach, it does so because of the use of cross-cultural comparison and analogy, rather than systematic interpretation from a particular explanatory paradigm.
A second approach is to use the anthropological version of “Grounded Theory,” sometimes described as an emergent theory approach where theory is derived from the data themselves. In this process, the data shape the theory rather than the theory shaping the data collection. The result of the “emergent theory” approach is the development of new theory or the modification of existing theory; but the end result is still a theoretical framing for the research (from an inductive rather than deductive stance).
The third approach is to conduct theory-based or theory-framed research (the more classic inductive stance in research where correlation or causality is a key feature to be explored). All three approaches can be framed from a humanistic (hermeneutical, phenomenological) approach where theory allows for an interpretation of the anthropological data, or they can be framed from a positivist approach where data are analyzed (rather than interpreted) and theory is tested against that systematic analysis. The most common approach in applied medical anthropology, which normally has to be justified or even “sold” to both communities and sponsors, is to lean toward the positivist, empiricist, and even modernist end of the theoretical spectrum that is available, but to also take into account the humanistic aspects of people’s health.
The historic anthropological study of substance abuse, for example, has followed two general approaches: (a) “atheoretical” (descriptive-comparative) approaches, and (b) approaches that develop and/or apply mid-level anthropological theory. Midrange theory, in anthropology, is the testable portion of one or a combination of the grand theory themes described above. Both of these approaches have been incorporated in single disciplinary research (where only anthropology theory and methods are used to explore the nature of health and healing), and in multi-disciplinary approaches where both theory and research methods are drawn from multiple disciplines (such as psychology, epidemiology, sociology, geography, biology, public health, etc.). The latter approach is much more challenging, and is often much more productive of change in a health care system.
Most applied medical anthropology exists in a complex multidisciplinary space where each of the scientific specializations has a strong and defensible history of both theory development, and the development of associated methods that support those theories
