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MEDICAL ANTHROPOLOGY § 9543

Anthony C. Colson and Karen E. Selby

Departments of Anthropology and Behavioral Science, University of Kentucky
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Lexington, Kentucky 40506

INTRODUCTION

The field of medical anthropology continues to grow rapidly, and there is evidence
of a heightened sense of group identity among its members. However, neither a
widely shared definition of the field nor an agreement about its boundaries has
emerged. For example, in an early review of the field, Norman Scotch defined not
the area but rather medical anthropologists as those " . . . working in medical
settings or on problems of health and illness" (122, p. 31). In the most recent
review of medical anthropology, Horacio Fabrega states that the notion of the
field implicitly held by its workers focuses on the content of the field as its defining
feature. He identifies this critical content as an inquiry into the interaction
between individuals and groups on the one hand and illness and disease on the
other, with an emphasis on patterns of behavior (51, p. 167). The near decade
intervening between these two articles did not result in a substantial refinement of
the definition. In an article concerned with identifying priuritie� in medical
anthropology, Weidman states that the confusion over definitions and boundaries
is, in part, a result of the ". . . failure to recognize various stages involved in the
convergence of interest areas and theory which is now occurring in the social
sciences and medicine". (140, p. 17). Professor Weidman identifies five "stages" of
medical anthropology in this process of convergence as follows:
I. -a substantive and theoretical area which has developed from an anthropology
which looks at health, disease, and medical systems in both evolutionary and cross­
cultural perspective.
2. -an applied field which involves the introduction of anthropological concepts and
methods into our own Western medical system. . .
3. -a highly specialized substantive and theoretical field involving the integration of
concepts from particular facets of anthropology and a particular branch of medicine.
4. -a substantial and theoretical area which draws from medical behavioral science. . .
Thereby becoming capable of making unique contributions to general anthropological
theory.
5. -a substantive and theoretical area resulting from the integration and beginning
synthesis of anthropological and medical concepts. . . . [It], in this sense, is closely
related to and possibly identical to 'medical behavioral science' (140, p. 17).
245
 246 COLSON & SELBY

Some members of the field implicitly maintain that medical anthropology is a

subfield of anthropology with an overriding paradigm no more or less well ar­
ticulated than in any other subfield. Others, with Weidman, maintain that it is a
distinct area of its own lying "somewhere between its parent disciplines of
anthropology and medicine" (140, p. 16). In either case, the "stages" summarized
above are useful as an indication of the range of alternative views expressed in the
literature. One senses that a definition inclusive of stages one through three would
be widely accepted. Stage four expresses an unrealized aspiration. Stage five,
though an aspiration of some, would exclude many self-identifil�d medical
anthropologists on the basis of their training and research interests.
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Failing to find a shared and conceptually based view of the field, we turned, as
have all earlier reviewers, to aspects of content. Work was considered fi:Jr inclusion
in this review if characterized by concern with health and disease in non-Western
settings or the use of anthropological concepts and methods in the exploration of
health and disease regardless of cultural or geographic setting. Though this review
is selective, an initial effort was made to screen the full range of published work in
1971, 1972, and to midyear 1973, i.e. the period since the conclusion of the article
by Fabrega (51) in the last issue of the Biennial Review ofAnthropology.
We have pl aced each cited study in one of four areas within the field which
reflect, in very broad terms, the aims of the research. These are labeled eth­
nomedicine, medical ecology, health problems research, and finally, the study of
health care delivery systems. The balance of this review is presented in these
divisions. In many cases the work could have been placed as easily in a different
category. We considered what appeared to be the primary objective of the study as
definitive. The categories are not mutually exclusive, but rather provide a device
for organization only.

ETHNOMEDICINE

Work placed in this section treats illness! and illness behavior as a cultural
category. The usual concern is with understanding the content of this domain and
how it relates to others in the context of a particular culture or cultures. In many
respects this work conforms to Weidman's stage one, defined above.
The perception and definition of illness and beliefs about its etiology continue
to be foci of research (Antonovsky 7, David 36, Fabrega 49, Ingham 71, Panoff
1l0, Stikert 128, Tenzel 133). For example, Obeyesekere (102) has explored the
expression of illness and symptoms in the religious idiom by examining a case of
demon possession. In a much more general work Obeyesekere (103) describes the
position of mental illness in the Ayurvedic tradition.

I We will use the now widely shared distinction between illness and disease drawn by

Fabrega (51, p. 213). Disease designates pathology as defined by Western biomedical science.
Illness indicates the percep tion of pathology in the context of a particular culture or
population. Obviously the two states may or may not coincide. See Fabrega (50) for a useful
programmatic statement on this distinction.
 MEDICAL ANTHROPOLOGY 247

Such standing interests as the "hot" and "cold" bifurcation (Orso 108) and the
etiology of particular psychiatric disorders such as Windigo (Hay 64) are
represented in the recent literature. The perception of preventive medicine and its
related behavior have been separately described for some cultures (Colson 27,
Gupta 58).
Hurster (68) has examined the relationship between value orientations and
health concepts in a sample of American sixth graders using the Kluckhohn and
Strodtbeck value orientation schedule. In an interesting study focusing on a
Mexican-American population in Los Angeles, Edgerton & Kamo (46) examine
the effect of bilingualism on the perception of mental illness. They found that the
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language used in the interview was a significant predictor of the perception of

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pathology and expressions of willingness to use psychiatric treatment facilities.

Kennedy (76) recently explored differential perception of illness and healing
among patients, physicians, scientists, and public health officials. His concern was
with reducing conflict among participants in the health care process which results
from these differences.
In D'Andrade et al (35) the findings are reported of an elaborate study of disease
categories (in our terms, illness categories) among samples of American-English
speakers and Mexican-Spanish speakers. Their conclusion, of relevance here, is
that for members of both of these speech communities categories are determined,
not by defining properties of the separate illness entities but by a set of salient
features reflecting consequence, remedies, and types of victim. In their words:
. . . the defining properties of a set of terms are not always the properties which
determine how people categorize or react to those terms. Thus, the categories dis­
covered by the analysis of how disease terms distribute across beliefs do not seem to be
related to the features which define these disease terms. Our informants agree that
"cancer" is "serious," "noncontagious " and not a "childhood" illness. Based on th e
,

three methods of analysis we have used, these properties are major foci for how
Americans conceive of diseases. But these are certainly neither necessary nor sufficient
conditions for making the decision that someone has cancer (35, p. 50).

Similar results using quite different methods are reported for rural Malays
(Colson 27, pp. 37-51). In this case illness labels are categorized on the basis of
alternate steps in a perceived etiological sequence which result in the expression of
symptoms. Illness episodes are categorized by informants on the basis of eight
dimensions which are expressed as questions.2 It was observed that the answers to

2 These questions were reported as follows (Colson 27, pp. 47-50):

1. What kind of ilhless is it, i.e. what is its name?
2. How has it been treated (or how will it be treated, or how should it be treated)?
3. What caused the illness?
4. How serious is it?
5. Does the sickness pose a threat to others?
6. Will the condition endure (i.e. chronic or acute)?
7. Was the illness inherited?
8. Is the condition appropriate to the afflicted individual?
 248 COLSON & SELBY

the questions have behavioral implications for members of the community. In­
terestingly, these dimensions include the features identified as salient by D'An­
drade et al. On the basis of these studies, it is warranted to suspect that, in
the domain of illness labels, some structure other than a simple taxonomic or
paradigmatic summary of distinctive features is likely to be salient in other cul­
tures as well.
Non-Western treatment systems and health practitioners also continue to be
subjects of interest (Alexander & Shivaswamy 6; Lucier, Van Stone & Keats 86;
Ohnuki-Tierney 104; Skingle 126; Tantaquidgeon 131; Wintrob 150). Altered
states of consciousness induced by drugs have received attention in the literature
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on therapy (Dobkin de Rios 37, 38; Furst 54).

Ethnopsychiatry generally (Cassee 19, Crapanzano 32) and the efficacy of
various non-Western psychotherapeutic procedures in particular have been
seriously discussed. For example, an anthropologically trained psychiatrist has
examined an extensive number of discriptive accounts of treatment systems. He
combined these summaries with his own field experiences (Torrey 135) and
concluded that there is no significant difference in the efficacy of Western
psychotherapy and native therapists in a variety of non-Western systems. This
evaluation is reinforced in other studies by Hartog & Resner (63) and Conco (28).
In contrast, Weisz (143), as a result of his survey of East African medical attitudes,
has warncd against the possible ill effects traditional medical concepts "have often
had on physical and mental problems" (p. 328).
During the period under review an important collection of Ackerknecht's essays
on Primitive Medicine was published (Ackerknecht 2). The importance of the
collection is twofold. First, several of the reprinted articles are not otherwise
readily available. Many of these have a great deal of currency despite their age.
For example, his essay On the Collecting of Data (pp. 114-19) provides a still
useful basic primer for field workers. Second, and perhaps of more importance,
the introduction to the collection is an interview with Ackerknecht in which he
places his work in an historical perspective. He sees his work in summary as having
made four broad points about primitive medicine-a label he never adequately
defines. Implicitly, however, his work is addressed to treatment systems which
developed in the absence of a major literate tradition. These four points (2, pp.
14-16) are first, that primitive medicine is a separate category of ph'�nomena, i.e.
something other than an embryonic modern medicine. Second, his work has
stressed the magical character of primitive medicine in contrast to modern
medicine. A third focus of his work is what he calls the social aspect; that
"primitive medicine appears quite clearly much more as a function of culture than
as a function of biology" (2, p. 15). His fourth point stresses the eross-cultural
variability of the parameters of psychopathology. Some of these points would
receive some argument today, at least in terms of their emphasis. Most important,
Ackerknecht has tended to de-emphasize, or occasionally argue against, thc
biologically adaptive aspects of non-Western systems. Surely the most durable
and distinctive outcome of his work will prove to be his collection and systematic
organization of primary data sources which have not yet been mined.
In summary, and again citing Fabrega's earlier comments (51, p. 189), "to a
 MEDICAL ANTHROPOLOGY 249

large extent topics dealt within ethnomedicine have not been subject to precise
definition, systematization, testing, subsequent refinement, and elaboration. . . "
The indictment remains valid.

MEDICAL ECOLOGY

In contrast to ethnomedical research, work placed in this section is concerned

primarily with disease. Obviously medical anthropology is but one of numerous
fields contributing to the study of medical ecology. The anthropologist working in
this area attempts to answer two broad and interrelated types of questions: how
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cultural variables relate to disease processes and to specific diseases, and how
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disease is distributed throughout culturally and socially defined human groups.

Both concerns are facets of what is generally called social epidemiology.
The reader should consult Fabrega's discussion (5 1, pp. 190-96) of the theoret­
ical underpinnings of this area and his survey of the important earlier works. Our
intent is to indicate briefiy what has been published since his review. A more
recent review by Montgomery (94) entitled Ecological Aspects of Health and
Disease in Local Populations summarizes much of the material that would other­
wise require mention in this section.
Recently a number of epidemiological surveys of cultural groups have appeared
(e.g. Buck et al 17, Tyroler & Patrick 136, Wood 153). Among the most impressive
is the summary of studies by Sinnett & Whyte ( 125) which surveys a highland
population in New Guinea. Their long range concern is with change in health
status and biological characteristics as a response to the process of acculturation.
Because of the differential effect of contact on diverse aspects of the culture, they
hope to discriminate between several social and nutritional variables as mediators
in the overall relationship. Their conclusion contains an important caution which
can be generalized to many other studies:
It is important to remember, however, that these studies have been mostly concerned
with observations made in populations at one point in time and with interpopulation
comparisons and have simply demonstrated broad statistical associations between
biological characteristics, including disease, on the one hand and genetic constitution
and non-genetic environmental features on the other. Particular cause and effect rela­
tionships may only be suspected from studies of this type, but conclusions about their
validity would be considerably strengthened if supported by evidence gathered by
serial observations made within populations throughout a period of sociocultural
change. It is for this purpose that the present study will be continued, in the belief that
changes will occur quite rapidly and that the epidemiological approach coupled with
appropriate physiological studies will help to define more precisely some of the major
determinants of health and disease (125, p. 274).

The intended longitudinal study should prove to be of great value.

Two instructive review articles have appeared in Current Anthropology, one
treating infectious disease in ancient populations (24), the other tracing the
evolution of lactose deficiency (89). A social history of leprosy has been published
by Gussow & Tracy (57).
Recent work refiects the sustained interest in relating patterns of psycho-
 250 COLSON & SELBY

pathology to culturally defined groups (Kitano 79, Leighton 83, Orley lO7).
Efforts have been made to link sociocultural variables to such diverse entities as
schizophrenia (44), petrol inhalation (13), poisoning (20), behavioral retardation
(8 1), and intestinal parasitism (45). Nelson (98) has discussed the relationship
between disease and social structure. Yingoyan ( 154) identifies biological and
demographic components in socioeconomic organization. The distribution of
cancer (29), smallpox (70), and epilepsy (lO6) have been discussed in specific
cultures. Rapid sociocultural change has been considered as a factor influencing
aspects of fertility ( 137), stroke mortality (99), and student mental health ( 15 1).
In summary, the findings of social epidemiology have continued to be
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provocative. However, the need persists to understand more fully the intervening
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mechanisms in the relationship between disease and sociocultural variables.

Hopefully the accelerated trend towards collaborative research and the work of
individuals trained in both .areas will focus on this issue.

HEALTH PROBLEMS RESEARCH

This and the next section include a large proportion of the work published in
medical anthropology in recent years. They have in common an applied focus. By
this we mean the work resulted from either a formal client-anthropologist rela­
tionship, an anthropologist working in an institution concerned with health care,
or work addressed to the understanding of some health problem the results of
which might contribute to its amelioration. Though in most cases the material
included in these sections could have been placed justifiably in one of the previous
sections, we chose to treat it separately. Our reasons are several: much of this work
was conducted among a diversity of contemporary American populations; it
includes some well recognized and nearly as well articulated specialities within the
field, the work reflects more concern with chronic disease than with acute and
infectious disease; and finally, collaboration with members of other disciplines
and professions is more evident among workers in these areas.
By health problems research we mean efforts addressed either to the health
needs of some particular population (e.g. the aged), membership in which involves
some major sociocultural parameter, or the study of a contemporary health
problem involving an explicitly behavioral dimension (e.g. drug addiction).
Much of the work we are referring to is concerned with what have been called
"social pathologies" (Levy & Kunitz 84), including problem drinking and more
recently drug addiction.
Weppner's article ( 144) provides a useful overview of the anthropological
interest in drug dependency. He summarizes a way of viewing the addict which
complements the traditional medical model of addiction and the psychological
perspective. Taking an emic viewpoint, Weppner feels that past studies have failed
to examine the meaning of drug use for the actor, and that failure to do so can only
hinder efforts at therapy, whether the "cause" of his addiction be a physical
dependence or psychological predisposition or society. His central point is that the
lifestylc surrounding drug addiction has values, rules, and regulations that must be
 MEDICAL ANTHROPOLOGY 251
./

learned by the street addict-all features rendering it amenable to anthropological

investigation.
One of the first anthropological accounts of thc culture of addiction was Preble's
& Casey's study (115) of the heroin abuser's street life of "copping," i.e. obtaining
drugs. They gave a detailed account of the hierarchy of drug dealers ranging from
the beginning point of production to its ultimate street destination and distribu­
tion by the street junkie.
Agar (5) has extended the formulation of a cultural perspective begun by Preble
and Casey. Using formal techniques, Agar examines the three most important
domains of the heroin addict: hustling, copping, and getting off. Drawing upon
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a population of inmates in a federal narcotics hospital, Agar develops a

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methodology consisting of three principle techniques: the hypothetical situation,

frame elicitation, and the simulated situation. Such techniques are emphasized
because of the illegal nature of the activites being studied. Agar links the three
domains in a stochastic chain, such that one hustles in order to get money to cop
dope so that one can get off so that one can hustle again, and the cycle repeats
itself. The result is an interesting and lucid ethnography.
Rosenstiel & Freeland (118) have attempted to bring an anthropological per­
spective to the problem of treatment. They feel that the values involved in a
subculture of addiction predispose the addict to act in manners unacceptable to
society at large. This being the case, it would be useful to teach the addict the
principles of "making it" in the "square's" world, to teach him the necessary
values and coping mechanisms. They assert that such an approach in treatment
programs would help the junkie who, tired of the hectic street life, wants to go
straight. Ideally perhaps, if an addict could be found a job which required func­
tionally the same sorts of skills as those necessary to street life, then the former
addict would have even less difficulty adapting to the "straight" life. An impor­
tant feature of an effective treatment program is knowledge of the extent of drug
usage in a given area. Hughes & Jaffe (67), viewing heroin addiction as epidemic,
devised a procedure for determining the number of heroin users in several known
copping areas of Chicago. They trained methadone patients who were known
within the copping areas as participant observers and had them keep logs on all
persons buying and selling heroin. The study was not done covertly, i.e. all its
participants knew of its purpose, and by the end of a six-month period it was felt
that a good estimate of the number of individuals involved had been obtained.
Hughes & Crawford (66) discuss another approach to the same measurement
problem.
In a series of related studies, Feldman (53) presents a number of observa­
tions on the support structure surrounding the addicts' life style. Agar (3) provides
two examples of the heroin addicts' folklore, and Weppner & Agar (145) tested a
number of propositions about drug usage preceding heroin addiction. Hartjen &
Quinney (59) have discussed the drug problem in New York's lower east side. An
indicator has been developed of identification with the addict subculture based on
knowledge of jargon (87). Tittle (134) has published a study of social organization
in a narcotics hospital.
 252 COLSON & SELBY

Most anthropological studies of drug dependency have a few central features in

common: a heavy reliance on institutionalized addicts for data; an assertion of
subcultural status for drug dependent populations; and an assertion that, from the
addict's point of view, addiction is a valued enterprise independent of any
physiological or psychological dependency that may exist.
In one of the few works attempting to explicitly define the subculture under
study (in this case, marijuana users), Johnson based his definition on values and
conduct norms, ". . . those expectations of behavior in a particular social situation
that are attached to a status within the group" (74, p. 9).
Agar, a major student of the addiction subculture, has recently pointed out a
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number of unanswered questions (4, p. 41):

Another question is posed by the different types of narcotics and other drug abusers.
Does an addict who arrived via a suburban hip subculture differ from one who arrives
via the slum? How do these types relate to the soldier who is addicted in Vietnam?
Perhaps for some, narcotics use is solely a chemical escape, whereas for others it is a life
style. What kind of overlap might there be between streetjunkies and other American
subcultures? For example, Spradley's discussion of urban nomads in Seattle suggests
areas of overlap with the streetjunkie in such areas as hustles and courtroom strategies.
Finally, what about cultural differences in therapist-patient interaction? Some
implications of these differences have been discussed, but what does this suggest about
the use of professional therapists and ex-addict therapists in treatment programs?

Spradley's ethnography (129) represents another formal effort to understand a

deviant cultural system. Using ethnoscience techniques, he explored the world of
the skid row tramp and vividly described how remarkably adaptive such persons
must and do become in order to survive. Spradley cogently argues for a cultural
perspective before undertaking any kind of rehabilitation measures.
In a recent article, Spradley (130) discussed the relationship between eth­
nography and applied anthropology as expressed in his work dealing with public
drunkenness and alcoholism. He concludes with the following:
My own ethnographic research hardly scratches the cultural surface of this one crime
and health problem. The incidence of arrests for public intoxication is higher than for
any other crime, and underlying most cases of public drunkennes lies the problem of
alcoholism. Although a great deal of information has been assembled on both the crime
and the illness, very little of the research has yielded data on the cultural dimension.
Considering the enormity of these problems, the paucity of ethnographic data on them
is alarming. Ifwe are to understand and effectively deal with these and other problems
of crime and illness, ethnographic research should be of the highest priority (1 30, p. 32).

Other work published during this period reflects the continuing interest in
cross-cultural perspectives of alcohol consumption (Bruun 16, Chu 21, Doughty
39, Heath 65, Lickiss 85. Siezas 124, West 146).
Homicide and suicide have also received some attention (e.g. Everett 48,
Rudestom 119, Whitlock 148). In a persuasive study of the Hopi and Navajo,
Levy & Kunitz (84) report that levels of pathology, as indicated by homicide and
suicide, have not increased since the beginning of the reservation period. Their
rather extreme interpretation of this finding is:
 MEDICAL ANTHROPOLOGY 253

On the face of it, the implications. . . are positively embarrassing. To hold that the
present prevalence rates of certain pathologies may not be used as a direct gauge of the
level of anomie and social disintegration to argue for the existence of persistent cul­
turally determined modes of generating deviance might be taken to mean that white
conquest and exploitation have not had the deleterious effects assigned to them and
government programs aimed at alleviating these conditions may not be necessary (84, p.
123).
We take issue with two points: that covariation between induced change and
disintegration is always a reasonable expectation, and that a history of high levels
of pathology which are culturally sustained is a sufficient reason to minimize
efforts at reducing these levels. The key issue, of course, is whether or not the
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members of the culture identify the "pathology" as such and express a desire to
reduce its frequency.
In sum, the anthropological study of the various social pathologies is still
focused on the descriptive level. Effort is directed to the definition and under­
standing of categories of social pathology in specific cultures and subcultures.
Cross-culturally useful models await more data. Based on the vOlume of relevant
research reported at various professional meetings during the period under
review, the literature on this area soon will be substantially expanded.
The anthropological study of the aged is a promising and rapidly expanding
area of research (e.g. Carp 18, Clark 22, Cowgill & Holmes 31, Erlich 47, Jackson
72, Kiefer 77, Press & McKool 116, Weihl 142). In an excellcnt rcview, Clark
established the broad context of this emerging specialty as follows:
The aged in present-day proportions are a cultural anomaly. For the first time in the
history of mankind there exist in large numbers men and woman already aged by
established chronological standards who can anticipate another full decade or more of
life. Industrial society has created a new group, yet the culture which brought the group
into being has yet to find ways of incorporating it within the ongoing social system. This
lag has created problems of social dependency, economic support, and medical
management that are seriously concerning politicians and public administrators. They
have turned to the social and behavioral scientists for knowledge about aging and the
aged, in order to inform their plans and decisions. Until recently, however, we have had
precious little knowledge to share (23, p. 78).

We can do no better than state what Professor Clark identifies as the principal
concepts of aging employed by anthropologists, and encourage the reader to
consult the original source. There are six such basic perspectives of aging (23, pp.
80-83):
1. Aging as dying: e.g. the cultural perscription of the aged's status, and the
discrepancies between individual capabilities and cultural definitions of
appropriate roles and behavior.
2. Aging as decrement and disengagement: . .. this model postulates that nor­
"

mal aging is a process of mutual withdrawal of the aged person from society, and
of society from the aged person, and that both society and the aged person are
better adapted after this withdrawal has occurred" (23, p. 81).
3. Aging as disease: an extension of the fact that in our society cultural patterns
identify the aged as dependent and compel many of them to occupy a sick role.
 254 COLSON & SELBY

4. Aging as dependency: this perspective reflects the real or potential depen­

dency of the aged on the rest of society.
5. Aging as minority group status: the aged, in much of the industrialized world
are poor. Many aged poor are also members of other minority groups thus
compounding problems.
6. Aging as development: "The idea that later life can be a period of further
growth and development" (23, p. 82).
A closely related research interest, that of bereavement (e.g. Ablon I), also has
been expressed in recent publications.
The relationship between health status and nutrition, with the latter interpreted
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as, in part, a function of culture, has received some recent attention. Gelfand (55)
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had published an impressively detailed study of the diet of the Shona of Rhodesia.
Whyte (147) has surveyed nutrition in rural China. A nutritional factor has been
discussed in Windigo psychosis (120). McKay (91), a physician with considerable
field experience, has discussed the relationship between food and illness in a
population on the east coast of West Malaysia.
During the review period most work dealing with mental illness was couched in
terms of health care delivery and will be cited in the following section, but a few
general works will be mentioned here. For example, the second volume of
Transcultural Research in Mental Health (80) has appeared.
In a comparative study, Draguns et al (42) examine the symptoms of matched
pairs (by social competence, age, and diagnosis) of Japanese and American hos­
pitalized psychiatric patients. They find significant differences in symptoms for
which they identify parallel differences in general cultural patterns, socialization
practices, and personality characteristics.
Argandona & Kiev (8) have published an overview of mental health in Latin
America, with a summary of a novel social psychiatry plan for Columbia.
Draguns & Phillips (41) have published an extremely valuable module sum­
marizing much of the work to date which attempts to delineate the relationship
between culture and psychopathology. Though most of the work they cite was
available prior to the period under review, this new synthesis should be useful to
medical and psychological anthropologists.

HEALTH CARE DELIVERY SYSTEMS

Of central concern to medical anthropologists are the institutions, personnel, and

programs which are available to meet health needs. Traditionally this interest
focused on the delivery of care across cultural boundaries in a setting of change,
but increasingly the concern is with health care in American and western
European societies. This concern derives from a number of sources. First, many
issues of interest to the discipline can be explored through this area of research.
These include notions of culture contact, the acceptance of innovations, the or­
ganization of professional subcultures, and aspects of role theory among many
others. Second, numerous anthropologists are employed in health care institu-
 MEDICAL ANTHROPOLOGY 255

. tions, and for some of these their work setting has become their data base. Finally,
. for many this interest reflects a self-evident need of society which dictates their
involvement. As Pearsall recently observed, ". . . health care is a moral and polit­
ical as well as a technical and managerial issue. At present, the right to use the
products of modern medicine is socially restricted and politically limited despite
normative rhetoric to the contrary" (112, p. 214). Some combination of these
factors motivates much of the research in this area.
Many students of health care have focused on the hospital as a unit of study. An
interest is reflected in the organization of wards (e.g. Brown 15, Miles 92, Pierce
113, Williams 149), the theme in most of which has been an examination of the
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nature and quality of communication among patients, and between patients and
various categories of health personnel. Others have discussed facets of out-patient
care provided by hospitals, e.g. differential use by ethnic groups (52), patient
conformity to a therapeutic regimen (121), and the maintenance of norms among
physicians under peer surveillance (96), Stallings (127) has examined the response
of the institution to disaster. Barnett et al (II) have used a unit providing care to
premature neonates to examine the maternal aspect of interactional deprivation.
Taylor's work (132) is an excellent example of the anthropological perspective
brought to bear on a complex Western institution. Professor Taylor's basic objec­
tive was to analyze the course of a centralized management system introduced into
a contemporary hospital, but in the process she produced an attenuated eth­
nography of the medical subculture.
A number of works have described and/or evaluated delivery programs for
particular, frequently minority, populations (e.g. Kane & Kane 75). A collection of
such papers (9, 14, 25, 88, 100) was published as a special issue of the
Anthropological Quarterly. Speaking of these papers, Pearsall said:

The questions asked are not so much about the quality of effectiveness of health �t:rvices
per se as about accountability and, above all, eligibility . . . . To oversimplify, the studies
examine fairly typical situations in which the putative beneficiaries do not in fact get
what they want or, from the perspective of current medical knowledge, need with
re�pt:ct to the prevention of disease, maintenance of good health, diagnosis, therapy,
and rehabilitation (112, p. 216).

In similar works McDermott et al (90) have reviewed the much publicized

experiment at Many Farms; Olendzki & Goodrich (105) reviewed a health care
plan for East Harlem; Patrick & Tyroler (III) discussed the health implications of
rapid change among the Papago; Van Etten (138) has evaluated the special needs
of a delivery system in Tanzania; and finally Owens (l09) has assessed the early
impact of Wesleyan missionaries on Maori health.
A recent topic of interest is the role of the social sciences in population policy
(e.g. 43) and specifically in family planning (30, 40, 101).
The delivery of psychiatric care in non-Western settings also has been discussed
(Hsu & Tseng 69, Jin-Inn et al 73). In a useful series of papers (60-62), Hartog
described existing institutions, intervention strategies, and psychiatric patient
 256 COLSON & SELBY

characteristics in West Malaysia. Wintrob described the practice of psychiatry in

Liberia (152), and Gluckman identified the psychiatric implications of therapeutic
abortion among the Maori (56).
In all parts of the world most people can choose from among multiple medical
resources to meet their health needs. Beals (12) has discussed the factors
influencing such decisions in South India. Colson (26) described the disposition of
ovcr 500 illncss episodes in a Malay village in terms of the choice of therapcutic
alternatives.
Other studies examining aspects of change in medical systems include the study
of a Malaria eradication program in Surinam (10), an examination of sociocultural
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factors in a tuberculosis control program (97), and a discussion of the acceptance

of surgical sterilization in Spanish Harlem (123). Cunningham's description of
Thai injection "doctors" (34) is an interesting account of the widely reported
emergence of a particular type of marginal practitioner in the presence of an
expanding range of treatment options. Milio (93) examines a case of successful
organizational innovation, and Crozier (33) discusses, in very gen eral terms, the
relationship between modernization and medicine in China and India.
The teaching of medical anthropology is increasingly a feature of medical
education and of education in the health sciences generally. Thereby the field
presumptively has some impact on the health care system. In fact, Weidman (140,
p. 21) has identified teaching as a major responsibility of anthropologists in
medical settings. The publication of the Medical Anthropology Newsletter since the
fall of 1968 has been useful in this respect, especially as a clearinghouse of
instructional ideas that have been tried at various institutions. Margaret Read
(117) reports that a slight increase in the status of social sciences in medical schools
has made such teaching easier. Professor Read also offers an outline for such a
course. Kimball (78) has describ.ed one of the many efforts to incorporate clinical
experience in a cross-cultural setting into medical training. Many of the proverbial
problems of the behavioral scientist in the medical setting have been given another
airing in a volume edited by Von Mering & Kasdan (139). The relationship
between anthropology and nursing has been comprehensively examined by
Lei ni nger (82).
Weidman & Egeland (141) have strongly affirmed the importance of a
behavioral science perspective to the delivery of health care. Their thoughtful
review of the research on delivery systems focuses on two substantive criticisms.
First, they feel most studies have not attempted to determine why hl�alth services
fail to meet the needs of many Americans. Second, they feel that even where the
appropriate questions are asked, there is a disproportionate emphasis on a single
discipline (e.g. anthropology) and thus a genuine behavioral science perspective is
not achieved.
In a similar vein, Pearsall offers the following observation:
If the providers and consumers of health services seek to simplify their mutual world
through stereotypy, the anthropologists and others who study whole cultures tend to
complicate it. In arguing for programs uniquely tailored to the special cultural
peculiarities and combination of needs of various Indian tribes, for example, they are
 MEDICAL ANTHROPOLOGY 257

apt to overlook the social and economic realities of larger environmental settings in
which Indians are but one of several similarly placed low income, socially 'different'
groups (112, p. 218).

CONCLUSION

As the variety of the material cited may suggest, the problem at times seems to be
the determination of what is not medical anthropology rather than what is. Our
point is simply that the field draws from nearly the full range of interests in the
discipline. However, as a distinct field medical anthropology has been legitimized
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by the formation of an active society functioning essentially as a section of the

American Anthropological Association. The newsletter mentioned above has
contributed to a sense of group identity among members of the field and has
effectively provided a mechanism for communication among persons with these
interests. A recent number in the Anthropological Studies series (95) suggests the
centrality of medical anthropology to the discipline as a whole. Certainly
publication outlets for research efforts in the area are numerous. During the
period under review alone two relevant journals were begun (Human Ecology and
Ethnomedizin), and Northwestern University Press has introduced a handbook
series in medical behavioral sciences.
Despite the evident trend to organizational maturity, it is still accurate to
observe, as did Polgar over 10 years ago (114), that medical anthropology is
characterized by a paucity of theory and the absence of a cumulative trend in
research, though certainly these deficiencies also characterize othcr specialities in
the discipline. Perhaps, like applied anthropology, medical anthropology indicates
not a conceptually or theoretically bounded subdiscipline, but points to a profes­
sional role with its incumbents drawing upon all of anthropology and a number of
other disciplines as well. In any case, the range and quantity of current work in the
field indicate that medical anthropology will continue to be diverse and dynamic.

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