© 2019 Allan YOUNG
2019 – № 1(17)
Young, A. Nekotorye vyvody dlja social’noj antropologii iz medicinskih predstavlenij i praktik [Some Implications of Medical Beliefs and Practices for Social Anthropology]. Medicinskaja antropologija i biojetika [Medical anthropology and bioethics], 1 (17).
Keywords: medical beliefs, medical practices, medical anthropology, meanings studies, interpretative turn, professional etiologies, folk etiologies, anthological consequences of illness, ritual, dramaturgical event
Abstract. In the article, a classic of American Anthropology, Allan Young, elaborated on two topics. Acknowledging that our notions of the phenomenon of illness are fully mediated by biomedical categories, the author tries to depart from understanding the phenomena in the frameworks of what is called “Western”, or “scientific” paradigm, and to find a way to describe it in a more neutral manner. The author’s other goal is to fit studies in medical anthropology into studies of the social in their entirety, including into studies of collective beliefs (Durkheim 1915), symbols and rituals (Turner 1967, Geertz 1966). He describes how certain episodes of illness play the same ontological role as religious beliefs and rituals: they convey and confirm important ideas of the real world. Apart from ontological problems, medical beliefs and rituals solve practical and social ones: they are an attempt, on the one hand, to relieve the symptoms of illness and, on the other hand, to justify the sick person for his deviant behavior (to which the author, in line with Talcott Parsons, ascribes illness). In the final section, Allan Young elaborates on the dramaturgical shape in which episodes of severe acute illnesses develop. As a dramaturgical event, illness is opposed to day-to-day life and is marked by extraordinary emotions; its participants fit into a small number of pre-defined roles. Illness also imparts connectedness to the world of events and experiences; this connectedness is absent or unmanifested in routine settings.
Allan Young is Professor Emeritus at the Department of Social Studies of Medicine, Anthropology and Psychiatry of McGill University (Canada).
* Translation of: Young, A. (1976). Some Implications of Medical Beliefs and Practices for Social Anthropology. American Anthropologist, Vol. 78, No. 1, p. 5–24
Anthropologists have explored medical interests from two general points of view. The first focuses on how the epidemiology of disease is affected by traditional medical practices and by particular social and ecological settings (see Fabrega 1972:196-206). In this article I limit myself to the second approach, which aims to understand what medical beliefs and behavior mean for the people who hold and perform them. Put briefly, my argument will be this: (1) People maintain their medical traditions because they affect undesirable biological states in expected ways, and because they are effective ways for dealing with disruptive events that cannot be allowed to persist. (2) A consequence of these meanings is that some kinds of sickness episodes also perform an ontological role-communicating and confirming important ideas about the real worldanalogous to the one which Durkheim (1915:387), Geertz (1966:29-34), Turner (1967:27-29), and others have attributed to religious belief and ritual.
The majority of works which have described what medical beliefs and practices mean for the people who hold and perform them have focused on phenomena (such as witchcraft, sorcery, and possession) that are closely tied to sickness episodes. With notable exceptions (e.g., Turner 1964, 1968; Spiro 1967; Harwood 1970; Crapanzano 1973), these studies deal with medical traditions anecdotally and as dependent variables in order to understand some other conceptual category. Little attempt is made to fit the chosen ailments into a more comprehensive matrix of diagnostic and therapeutic classifications and techniques, and so the reader remains ignorant of what alternative diagnoses and therapies the medical system permits for labeling this combination of signs, what other sorts of socially important outcomes are latent in it, and what are the rules by which rival diagnoses are contested and how they can he manipulated during the course of a sickness episode. Disease episodes are either described in ways that render their courses inevitable and their meanings unambiguous, or they are so cursorily given that it is difficult to get an idea of what, from an emically medical point of view, is going on (e.g., Lewis 1969:198, 208, 211-213).
A second obstacle is the misapplication of the Western medical paradigm. The interests of sick people, curers, and people who worry that they may become sick are dominated by a medical paradigm.‘ This means that they frame their questions and organize their behavior in order to identify, remove, arrest, alleviate, or prevent the disease symptoms that have intruded or threaten to intrude into everyday life. In brief, their interests focus on the efficacy of medical beliefs and practices.
Alland, A.Jr. (1970) Adaptation in Cultural Evolution, an Approach to Medical Anthropology, New York: Columbia University Press.
Aubert, V., Messinger, S.L. (1958) The Criminal and the Sick, Inquiry, Vol. 1, p. 137–160.
Barnes, S.B. (1969) Paradigms: Social and Scientific, Man, Vol.4, p. 94-102.
Barnes, S.B. (1974) Scientific Knowledge and Sociological Theory, London: Routledge and Kegan Paul.
Beattie, J. (1964) Other Cultures, New York: Free Press.
Begelman, D. A. (1971) Misnaming, Metaphors, the Medical Model, and Some Muddles, Psychiatry, Vol. 34, p. 38–58.
Berger, P.L., Luckman, T. (1966) The Social Construction of Reality, Garden City: Doubleday.
Cassel, J. (1955) A Comprehensive Health Program Among South African Zulus. B. D. Paul (ed.), Health, Culture, and Community, New York: Russell Sage Foundation, p. 15–41.
Clark, M. (1959) Health in the Mexican-American Culture, Berkeley: University of California Press.
Cohen, P. (1969) Theories of Myth, Man, Vol. 4, p. 337–353.
Cooper, D.E. (1975) Alternative Logic in Primitive Thought, Man, Vol. 10, p. 238–256.
Crapanzano, V. (1973) The Hamadsha, a Study in Moroccan Ethnopsychiatry, Berkeley: University of California Press.
Daniels, A. (1972) Military Psychiatry: The Emergence of a Subspecialty. E. Freidson and J. Lorber (eds.), Medical Men and Their Work, Chicago: Aldine, p. 145–162.
Dawson, J. (1964) Urbanization and Mental Health in a West African Community. A. Kiev (ed.), Magic, Faith, and Healing, New York: Free Press, p. 305–342.
Durkheim, E. (1915) The Elementary Forms of the Religious Life, New York: Free Press.
Erasmus, C.J. (1961) Man Takes Control, Indianapolis: Bobbs-Merrill.
Evans-Pritchard, E. E. (1956) Nuer Religion, London: Oxford University Press.
Fabrega, H.Jr. (1970a) Dynamics of Medical Practice in a Folk Community, Milbank Memorial Fund Quarterly, Vol. 48, p. 391–412.
Fabrega, H.Jr. (1970b) On the Specificity of Folk Illnesses, Southwestern Journal of Anthropology, Vol. 26, p. 305–314.
Fabrega, H.Jr. (1971a) Some Features of Zinacantecan Medical Knowledge, Ethnology, Vol. 10, p. 25–43.
Fabrega, H.Jr. (1971b) The Study of Medical Problems in Preliterate Settings, Yale Journal of Biologyand Medicine, Vol. 43, p. 385–407.
Fabrega, H.Jr. (1972) Medical Anthropology. B. Siegel (ed.), Biennial Review of Anthropology: 1971, Stanford: Stanford University Press, p. 167–229.
Fabrega, H., Jr., Manning P.K. (1972) Health Maintenance Among Peruvian Peasants, Human Organization, Vol. 31, p. 243–256.
Field, M. G. (1953) Some Problems of Soviet Medical Practice: A Sociological Approach, New England Journal of Medicine, Vol. 248, p. 919–926.
Frank, J.D. (1963) Persuasion and Healing, New York: Schocken.
Freidson, E. (1970) Profession of Medicine: A Study of the Sociology of Applied Knowledge, New York: Dodd, Mead.
Geertz, C. (1966) Religion as a Cultural System. M. Banton (ed.), Anthropological Approaches to the Study of Religion, London: Tavistock, p. 1–46.
Glick, L.B. (1967) Medicine as an Ethnographic Category: The Gimi of the New Guinea Highlands, Ethnology, Vol. 6, p. 31–56.
Gluckman, M. (1972a) Introduction. M. Gluckman (ed.), The Allocation of Responsibility, Manchester : Manchester University Press, p. x–xxix.
Gluckman, M. (1972b) Moral Crisis: Magical and Secular Solutions. M. Gluckman (ed.), The Allocation of Responsibility, Manchester: Manchester University Press, p. 1-50.
Gonzalez, N.S. (1966) Health Behavior in Cross-Cultural Perspective: A Guatemalan Example, Human Organization, Vol. 25, p. 122–125.
Goodenough, W.H. (1971) Culture, Language, and Society. Reading, Massachusetts: Addison-Wesley.
Gould, H.A. (1957) The Implications of Technological Change for Folk and Scientific Medicine, American Anthropologist, Vol. 59, p. 507–516.
Harwood, A. (1970) Witchcraft, Sorcery, and Social Categories Among the Safwa, London: Oxford University Press.
Holland, W.R., Tharp, R.G. (1964) Highland Maya Psychotherapy, American Anthropologist, Vol. 66, p. 41–52.
Hook, E. B. (1973) Behavioral Implications of the Human XYY Genotype, Science, Vol. 179, p. 139–150.
Horton, R. (1967) African Traditional Thought and Western Science, Africa, Vol.37, p. 50–71, 155–187.
Horton, R. (1968) Neo-Tylorianism: Sound Sense or Sinister Prejudice? Man, Vol. 3, p. 625–634.
Hsu, F.L.K. (1955) A Cholera Epidemic in a Chinese Town. B.D. Paul (ed.), Health, Culture, and Community, New York: Russell Sage Foundation, p. 135–154.
Ingham, J.M. (1970) On Mexican Folk Medicine, American Anthropologist, Vol. 72, p. 76–87.
Jansen, G. (1973) The Doctor-Patient Relationship in an African Tribal Society, Assen, The Netherlands: Koninklyke Van Gorcum.
Kasl, S.V., Cobb S. (1966) Health Behavior, Illness Behavior and Sick Role Behavior, Archives of Environmental Health, Vol. 12, p. 246–266, 531–541.
Kiev, A. (1968) Curanderismo: Mexican-American Folk Psychiatry, New York: Free Press.
Kiev, A. (1972) Transcultural Psychiatry, New York: Free Press.
Kuhn, T.S. (1963) The Structure of Scientific Revolutions, Chicago: University of Chicago Press.
Laing, R. D. (1965) The Divided Self, Harmondsworth: Penguin.
Leslie, Ch. (1973) The Professionalizing Ideology of Medical Revivalism. M. Singer (ed.) Entrepreneurship and Modernization of Occupational Cultures in South Asia, Durham: Duke University Press, p. 216–242.
Lévi-Strauss, C. (1963) The Effectiveness of Symbols. C. Levi-Straws (ed.), Structural Anthropology, New York: Basic Books, p. 186–205.
Lewis, I. M. (1969) Spirit Possession in Northern Somaliland. J. Beattie and J. Middleton (eds.) Spirit Mediumship and Society in Africa, London: Routledge and Kegan Paul, p. 195–219.
Lewis, I. M. (1971) Ecstatic Religion, Harmondsworth: Penguin.
Lieban, R.W. (1967) Cebuano Sorcery: Malign Magic in the Philippines, Berkeley: University of California Press.
Marshall, L. (1969) The Medicine Dance of the !Kung Bushman, Africa, Vol. 39, p. 347–381.
McKinlay, J.B. (1972) The Sick Role – Illness and Pregnancy, Social Science and Medicine,Vol. 6, p. 561–572.
Mechanic, D. (1968) Medical Sociology, New York: Free Press.
Middleton, J. (1960) Lugbara Religion, London: Oxford University Press.
Nash, J. (1967) The Logic of Behavior: Curing in a Maya Indian Town, Human Organization, Vol. 26, p. 132–140.
Neumann, A. K., Bhatia, J.C., Andrews, S., and Murphy, A.K.S. (1971) Role of the Indigenous Medical Practitioner in Two Areas of India-Report of a Study, Social Science and Medicine, Vol. 5, p. 137–149.
Nissimov, N. (1966) Intestinal Schistosomiasis, Ethiopian Medical Journal, Vol. 4, p. 67–69.
Nurge, E. (1958) Etiology of Illness in Guinangdan, American Anthropologist, Vol. 60, p. 1158–1172.
Ozturk, O.M. (1964) Folk Treatment of Mental Illness in Turkey. A. Kiev (ed.), Magic, Faith, and Healing, New York: Free Press, p. 343–363.
Park, G.K. (1963) Divination and Its Social Context, Journal of the Royal Anthropological Institute, Vol. 93, p. 195–209.
Parsons, T. (1951) The Social System, New York: Free Press.
Parsons, T. (1958) Definitions of Health and Illness in Light of American Values and Social Structure. E.G. Jaco (ed.), Patients, Physicians and Illness, New York: Free Press, p. 165–187.
Pitt-Rivers, J. (1970) Spiritual Powers in Central America: The Naguals of Chiapas. M. Douglas (ed.), Witchcraft Confessions and Accusations, London: Tavistock, p. 183–206.
Polanyi, K. (1958), Personal Knowledge, New York: Harper and Row.
Rosenhan, D. L. (1973) On Being Sane in Insane Places, Science, Vol. 179, p. 250–258.
Rueschemeyer, D. (1964) Doctors and Lawyers: A Comment on the Theory of the Professions, Canadian Review of Sociology and Anthropology, Vol. 1, p. 17–30.
Sargent, W. (1957) Battle for the Mind, Harmondsworth: Penguin.
Scheff, Th. (1963) Decision Rules, Types of Errors, and Their Consequences on Medical Diagnosis, Behavioral Science, Vol. 8, p. 97–107.
Schutz, A. (1962) Collected Papers I, The Problem of Social Reality, The Hague: Martinus Nijhoff.
Seijas, H. (1973) An Approach to the Study of Medical Aspects of Culture, Current Anthropology, Vol. 14, p. 544–545.
Spiro, M.E. (1967) Burmese Supernaturalism, Indianapolis: Bobbs-Merrill.
Szasz, Th. (1963) Law, Liberty and Psychiatry, New York: Macmillan.
Tenzel, J.H. (1970) Shamanism and Concepts of Disease in a Mayan Indian Community, Psychiatry, Vol. 33, p. 372–380.
Thomas, K. (1970) The Relevance of Social Anthropology to the Historical Study of English Witchcraft. M. Douglas (ed.), Witchcraft Confessions and Accusations, London: Tavistock, p. 47–49.
Thomas, K. (1971) Religion and the Decline of Magic, New York: Scribner’s.
Turner, V.W. (1964) An Ndembu Doctor in Practice. A. Kiev (ed.), Magic, Faith, and Healing, New York: Free Press, p. 230–263.
Turner, V.W. (1967) The Ritual Process, Chicago: Aldine.
Turner, V.W. (1968) The Drums of Affliction, London: Oxford University Press.
Twaddle, A.C. (1973) Illness and Deviance, Social Science and Medicine, Vol. 7, p. 751–762.
Twaddle, A.C. (1974) The Concept of Health Status, Social Science and Medicine, Vol. 8, p. 29–38.
Wallace, A.F.C. (1970) Culture and Personality, New York: Random House.
Warnock, M. (1965) The Philosophy of Sartre, London: Hutchison.
Wolff, B.B., Langley, S. (1968) Cultural Factors and the Response to Pain: A Review, American Anthropologist, Vol. 70, p. 494–501.
Young, A. (1975a) Magic as a “Quasi-profession”: The Organization of Magic and Magical Healing Among Amhara, Ethnology, Vol. 14, p. 245–265.
Young, A. (1975b) Why Amhara Get kureynya: Sickness and Possession in an Ethiopian zar Cult, American Ethnologist, Vol. 2, p. 567–584.
Zola, I. (1966) Culture and Symptoms: An Analysis of Patients’ Presenting Complaints, American Sociological Review, Vol. 33, p. 615–630.