Medical anthropology and development: A theoretical perspective

Abstract

It is argued that social and cultural anthropologists concerned with health systems need to insert their analyses into the wider perspective of three processes—development, the making social of disease, and their view of anthropology itself. Development can usefully be seen as the complex, often contradictory, process whereby capitalism as a mode of production comes to dominate over precapitalist forms. At the same time these very forms remain an influence over health behavior even in the most developed societies. Such an approach to development also involves attention to commoditisation and the existence of not immediately apparent class interests in, for example, both Western and traditional medical rhetoric, high technology medicine and pharmaceuticals. The making social of disease is facilitated by conceptualizing ailments in three phases, crudely biological disease, psychological illness and social sickness. The current disease/illness dichotomy is criticized as lending itself to a characteristically ideological, individualistic or at best dyadic approach to sources of ill health. The nature of ritualization or ceremonialization in capitalist and precapitalist society is explored with the help of brief reference to the author's own field work in Lusaka and to studies of Amhara in Ethiopia, a village in Tamil Nadu, South India and of doctor-patient interaction in Swansea. Following and developing Young's ideas, sickness episodes are characterized as dramatic “games” which create, recreate and confirm social ideologies in all their contradictoriness. A critique of the Tamil Nadu study reveals the potential for social change implicit in plural South India. Material from Swansea is used to suggest the differences between the concentrated drama in space and time characteristic of precapitalist ritual and the diffuse nature of both ceremonial and ideology in a developed capitalist society while once again pointing to the potential for social change revealed within apparently conservative functionalist analysis.

Finally, social anthropological analysis is presented as the analysis of custom in local social process and it is argued that this process in turn needs to be seen in a wider context which will help anthropologists to bring together the concerns of political economy, sociology and anthropology and to facilitate social change rather than, or as well as, individual adaptation.