Health and Healing in Comparative Perspective

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9780131273832: Health and Healing in Comparative Perspective

This reader looks at both the biological and cultural aspects of health and healing within a comparative framework.

Health and Healing in Comparative Perspective provides both fascinating comparative ethnographic detail and a theoretical framework for organizing and interpreting information about health. While there are many health-related fields represented in this book, its core discipline is medical anthropology and its main focus is the comparative approach. Cross-cultural comparison gives anthropological analysis breadth while the evolutionary time scale gives it depth. These two features have always been fundamental to anthropology and continue to distinguish it among the social sciences. A third feature is the in-depth knowledge of culture produced by anthropological methods such as participant-observation, involving long-term presence in and research among a study population. For medical anthropology, medical sociology, public health, nursing courses.

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This reader provides both fascinating comparative ethnographic detail and a theoretical framework for organizing and interpreting information about health. While there are many health-related fields represented in this book, its core discipline is medical anthropology and its main focus is the comparative approach. Cross-cultural comparison gives anthropological analysis breadth while the evolutionary time scale gives it depth. These two features have always been fundamental to anthropology and continue to distinguish it among the social sciences. A third feature is the in-depth knowledge of culture produced by anthropological methods such as participant-observation, involving long-term presence in and research among a study population.The first part of the book explores healing systems in different cultures; the second and third provide a strong grounding in evolutionary and culture-oriented analysis, making clear the connections between biology and culture as they affect health; the final part emphasizes case studies that apply the theoretical principles presented earlier to particular health topics.For medical anthropology, medical sociology, public health, nursing, and medical training professionals.

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While teaching seminars in medical anthropology, I have noticed that discussions and written work turn frequently to comparisons and contrasts across places, peoples, and time periods. At the same time, my work with colleagues in public health, medicine, and health and fitness has shown me that practitioners in other fields share a lively interest in anthropological perspectives, methods, and data. This reader answers the need for a book that provides both fascinating comparative ethnographic detail and a theoretical framework for organizing and interpreting information about health.

While there are many health-related fields represented in this book, its core discipline is medical anthropology and its main focus is the comparative approach. Cross-cultural comparison gives anthropological analysis breadth while the evolutionary time scale gives it depth. These two features have always been fundamental to anthropology and continue to distinguish it among the social sciences. A third feature is the in-depth knowledge of culture produced by anthropological methods such as participant-observation, involving long-term presence in and research among a study population.

Medical anthropology is the part of anthropology that focuses upon the human experience of health and disease. Evolutionary and comparative approaches are particularly relevant given that the health of the mind/body is an inescapably biocultural phenomenon, standing at the intersection of history, biology, and culture. In addition, many health-related topics such as illness, healing, and death are human universals, but they by no means take a uniform shape everywhere. Accordingly, the readings that follow emphasize comparisons and contrasts, whether across healing traditions, population groups, or time periods. By weaving biological and cultural approaches throughout the text, the book builds a model of the relationship between humans and diseases over historical and evolutionary time scales. There are practical implications both for understanding disease processes and cultural coping mechanisms, and for making the most of historical lessons to manage current health concerns.

Anthropological studies of health help to illustrate the point that the concept of culture is better understood as an adjective than a noun. That is, cultures are not coterminous with particular groups of people, nor static features that pertain to individuals and directly explain their actions, as is often assumed in health research and medical care. Rather, the concept of culture describes fluid, permeable, changeable sets of collective beliefs, values, and behaviors that inform, shape, and constrain the worldviews and personal choices of individuals, but not always in the same manner or to the same degree. The articles in this collection illuminate some of the subtle and yet not unknowable workings of culture across a variety of case examples.

The selections range from small-scale, detailed analyses to large-scale comparisons across world regions. In this way, the book benefits from both the attention to context that is possible in localized analyses, and the explanatory power of broad-based, carefully executed comparisons across a larger number of units of analysis. Both the minutely reductionist and the majestically expansionist frames of vision have their place in the pursuit of knowledge. Likewise, both quantitative and qualitative approaches are appropriate tools of anthropological analysis and appear throughout the text. Some studies are highly data-driven; others depend upon close analysis of interview and other ethnographic material. The inclusion of studies using such a variety of approaches allows for the development of a global perspective on health and healing that is grounded in concrete, local contexts.


Selection of articles

Medical anthropology and related disciplines concern themselves with a wide field of analysis, making it impossible to provide a set of selections that covers all relevant topics and theoretical concerns. While it has been a pleasure to select writings for this volume, it has been distressing to decide against huge numbers of excellent works. My choices were guided by the following considerations.


Authorship representing an international community of scholars and a range of disciplines including anthropology, epidemiology, medicine, and nursing.

Recent publication. More than half of the selections have been published within the last five years, and all but three within the past ten.

Broad geographical coverage, with preference for selections that make direct comparisons.

Clear, readable writing style.

Variable degree of difficulty, theoretical sophistication, and gravity of topics.

Coverage of themes that intersect with those raised in other selections.

Some of the selections may be very troubling, others amusing. They may evoke surprise, curiosity, dismay, or even frustration and anger, but one quality they all share is that they are highly engaging. Many of the selections are challenging, for they have been written for a professional audience, but course instructors will be able to guide readers through difficult passages, theoretical discussions, or technical material.


Organization

The book is divided into four parts. Part I concerns healing traditions and patient-healer interactions. It begins with an overview of the field of medical anthropology and its history, followed by a comparative case study of the cultural construction of illness concepts that illustrates how "natural" categories operate in an interactive relationship with local biologies. A second group of articles includes studies of biomedicine, humoral medicine, homeopathy, and nonwestern medical systems, and introduces topics such as explanatory models and medical pluralism. This is complemented by an essay on the nature of knowledge and the practice of ethnography among healers, and a set of selections on patients and healers in shamanism, biomedicine, and nursing.

Part II focuses upon biocultural approaches in medical anthropology. It begins with the topic of cultural and biological adaptation, variation, and plasticity. These concepts are illustrated through the examples of adjustments to high altitude and the interlocking genetic, cultural, and environmental factors associated with lactose tolerance and adaptation to malaria. This is followed by readings on evolution and health that explore the interaction between microbes and humans, and the emergence of chronic diseases. A related topic is human health and demography in history and prehistory, which is covered by a group of selections that includes ones connecting historical processes to current health issues. Part II concludes with readings on the effects of economic and ecological changes on disease distributions, and the interplay between indigenous medicine and environmental crisis.

Part III is composed of selections with a culture-oriented emphasis. It begins with two theoretical works, one on comparative frameworks for analyzing health beliefs, the other a classic on the anthropological study of the body. The next reading explores the culture of risk, individual responsibility, and blame. The topic of screening and genetic testing raised in the selection connects to the following set of readings on the mind-body interface in placebo and nocebo effects. The concept of explanatory models is then introduced and complemented by analysis of social and politico-economic contexts including critical perspectives on compliance, individual agency, and socioeconomic inequality. The final readings in this part of the book focus upon stigma and race and racism, topics which intersect with those raised in the earlier readings on risk, nocebo effects, explanatory models, and agency.

Part IV is devoted to special topics and case studies, in which the models introduced earlier in the text are applied to specific health-related concerns. This final section of the book begins with two selections presenting divergent perspectives on obesity/overweight and non-insulin dependent diabetes mellitus. These selections are interesting both for their substantive contributions and because they promote discussion of the influence of theoretical perspectives on interpretations of health issues. They prepare readers to analyze critically the selections that follow. These are organized in sections on food and food use, infant and child health, sex and gender, and biotechnology and bioethics. The selections build upon the preceding three parts of the book, and strengthen the global perspective on health that is developed throughout the text.

I have chosen not to organize Part IV in terms of specific diseases or the infectious-chronic disease divide, so as not to reify or privilege the categories of Western biomedicine at the expense of others and to reflect the reality that many afflictions do not respect these divisions. Meanwhile, I have decided to incorporate some topics into other parts of the book rather than setting them apart in this one. For example, there is no special section on mental health, in an effort to avoid the separation between mind and body that is such a prominent topic in Part III. Likewise, articles about ethnopharmacology are interspersed throughout the book, since this area of medical anthropology touches upon many others.


Using this book

The best way to use this book is to read the articles in order, given that they build upon each other. The selections work together within their groupings as outlined in the Table of Contents, and there is a stream of ideas that flows from one set of selections to the next. In addition, there are overarching themes and theoretical points interwoven throughout the four parts of the book, as noted in the section overviews and chapter introductions. The theoretical and substantive arguments presented in the progression of sixty selections provide a measure of clarity to the complex story of human health.

The overviews at the beginning of each of the four parts of the book highlight some of the more important points in the selections and draw connections between them. The overviews end with a small number of suggested films, placed in this way to allow enough time for them to be seen over an interval of a few weeks even if they would best be seen alongside specific readings. The selections begin with a short discussion and a list of questions to keep in mind while reading. Readers may find it helpful to return to these questions after finishing the selections.

Most selections include bibliographies that may be helpful for further study. In addition, the overviews and selection introductions include additional references, with an emphasis on recent, comparative works. Full publication information for these citations has been placed in the References section at the end of the book.

Due to space constraints, I reluctantly have omitted portions of text in some selections, as indicated by a series of dots. Full citations including original publication information are found in the Credits section at the end of the book. The original publications should be consulted by readers interested in acknowledgments and sources of financial support for each selection.

As a final note, the fact that I chose each of the selections in the book should not be taken to mean that I endorse everything stated in them, and I would like to emphasize that I do not expect readers to approve of or agree with everything they read here. Readers should analyze the selections with a critical eye, paying attention to the construction of the arguments presented and to the interpretation of data. On the other hand, I believe that the selections provide many useful tools that can be applied to a range of material, and that by the time the book is finished the reader will be equipped with a special framework for understanding human health and health care.


Acknowledgments

I would like to thank the editor of this book, Nancy Roberts, for welcoming my proposal, arranging for the book’s publication, and seeing it through the production process with energy, efficiency, and grace. I appreciate her expertise as well as her patience and kindness. I thank her colleagues at Prentice Hall for their contributions.

To the authors of the selected articles I would like to express my admiration and gratitude. I am indebted to the many permissions editors who responded to my requests with great promptness and courtesy. I heartily thank the following reviewers who enthusiastically endorsed my idea for the book and who provided very useful and concrete suggestions about its organization and content: INSERT REVIEWER NAMES HERE.

Finally, I would like to thank the students, colleagues, and friends who have contributed directly and indirectly to the creation of this book, including those involved in my medical anthropology courses at American University and the University of Bologna. I treasure each of them, but I would like to give special thanks to Federico Bianchi, Barbara Blazek, Peter Brown, Rita Cantagalli, Franco Capirossi, Massimo Capirossi, Joe Dent, Adriana Destro, Luther Gerlach, Joan Gero, Julie Owolabi, Mauro Pesce, Ivo Quaranta, Elizabeth Radel, Jana Rehak, Heather Schacht Reisenger, Tiziana Sagrini, and Brett Williams. My husband, Stephen Whitaker, and our daughters Ernestine, Emma, and Sarah contributed directly to the book by reading drafts and preparing the manuscript. I thank my other family members, including my parents, my husband’s parents, and our sisters and brothers and their families, for their overall support and unflagging encouragement.

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