A call for a critical medical anthropology of the COVID-19 pandemic

The possibilities and dilemmas of building bridges between critical medical anthropology and clinical anthropology: A discussion

The article presents a paradigm current in contemporary medical anthropology - Critical Medical Anthropology (CMA), which merges political-economic approaches with a culturally sensitive analysis of human behaviour grounded in anthropological methods. It is characterized by a strongly applied orientation and a devotion to improving population health and promoting health equity. The beginning of CMA dates back to the 1970s when the interdisciplinary movement called the political economy of health was developed. Today, CMA has grown into one of three major perspectives used in anthropological research devoted to health, illness and wellbeing. The author discusses the origins, key concepts and CMA's usefulness for social research, and its significance for the design of effective policies in the realm of public health. Examplary interventions and ethnographic researches are introduced and wider usage is advocated of such works and methods by bureaucrats and medical staff for understanding the patients' behavior, and the influence of social, economic and political factors on the workings of particular health systems.

Building on a dialogue between three trained naturopaths and a proponent of critical medical anthropology (CMA), this article highlights the relationship between health and society from the viewpoint of two fields that share this focal concern. Both naturopathy and CMA are committed to the notion of holistic health, although their approaches have historically been somewhat different. The responses of the three naturopaths to CMA exhibit both similarities and differences, particularly in terms of insights that CMA may make to naturopathy. This essay also articulates the CMA perspective of naturopathy and posits lessons that naturopathy can teach CMA.

Technology has always played an important role in global politics, economics, security, and culture. It has continuously shaped the structure of the global system, its actors, and the interactions between them and vice versa. However, theories of International Relations (IR), and in particular those of International Political Economy (IPE), have performed little to theoretically conceptualize technology as a powerful factor within explanations of change in global affairs. Although technology often is implicitly present in the theories of IR and IPE, it is often interpreted as an external, passive, apolitical, and residual factor. This essay argues that to develop a better understanding of transformation in global affairs, technology has to be integrated more systematically into the theoretical discussions of IR/IPE. Technology should be understood as a highly political and integral core component of the global system that shapes global affairs and itself is shaped by global economics, politics, and culture. This paper makes the case for an interdisciplinary approach, which systematically incorporates insights of Science and Technology Studies (S&TS) to provide a better understanding of how technology and the global system and politics interact with each other. In so doing, it opens the field to a richer understanding of how global systemic change is impacted by technology and how global politics, economics, and culture impact technological evolution.

In this paper, I give a brief history of the development of the school of critical medical anthropology (CMA) and trace its influences on both biocultural synthesis and clinically applied medical anthropology. I show how CMA has had a profound influence on biological and medical anthropology and how it has shaped our understandings of the relationships between biology and economics. I argue that although a critical perspective of health and well-being has been an important and necessary addition to both biological anthropology and clinically applied medical anthropology. we ought to be careful to trace how rather than simply assert that economics influence biology and health. I also argue that CMA's political economic perspective utilizes a narrow understanding of culture, and that biocultural synthesis could do well to look beyond a materialist view of culture and engage other theoretical schools in cultural anthropology. Finally. I show one such potential line of engagement between the disciplines by paralleling the concept of adaptation in biological anthropology to the concept of complicity in medical anthropology.

he power of a political-economic perspective is clear at a time when the penetration of world capitalism has led to widespread environmental degradation, disruption of the fabric of social life, and manifold constraints on biobehavioral responses. Yet, to dismiss the importance of biobehavioral responses and the reciprocal effects that such responses have with social relations and the environment, seriously diminishes the scope of anthropological interpretation. Ideological and epistemological barriers doubtlessly divide human ecological and adaptability and critical and political-economic perspectives,' making a complementary impossible for some to envision. At the extremes, critiques of a functionalist, positivist, reductionist, and ultimately alienating human biological science are juxtaposed with a disdain for a nonscientific, ideologically driven advocacy to information generation. Witnessing the debate in the Anthropology Newsletter over the salience of the four field approach gives one pause that anthropology is close to so fundamental a crisis of disagreement that the sides (mainly biological anthropologists on one side and cultural anthropologists on the other) are at risk of no longer communicating with each other (Brown and Yoffee 1992). The struggle to hold the field together and maintain a firm biocultural perspective is particularly acute in bridging subfields such as medical anthropology. Thus, in our assessment, quite a bit is at stake in the debate within medical anthropology. This comment is directed from a biological anthropology perspective toward articulating the need for integrated approaches in medical anthropology and possible directions this might take. The potential for more integrative approaches remains strong, as long as scholars such as Andrea Wiley and Merrill Singer continue to communicate across the divide within medical anthropology. Wiley and Singer, together, have made substantial contributions in identifying tensions and points of paradigmatic conflict between medical ecology and adaptability and critical medical anthropology. In her response to Singer's (1989) critique, Wiley (1992) has provided the most comprehensive, current defense of the adaptation and 202

This essay presents an effort to incorporate the "environment" into critical medical anthropology. Rather than relying upon the multifactorial approach characteristic of medical ecology or biocultural approaches in medical anthropology, it urges critical medical anthropologists to turn to the burgeoning literature on eco-Marxism, eco-socialism, or political ecology in their efforts to develop a political ecology of health. Given that political ecologists generally advocate democratic eco-socialism as a meaningful alternative to the capitalist world system, this essay also presents a critical examination of the environmental record of post-revolutionary societies.

Medical anthropological theory may be understood in two ways: first as a set of anthropological concepts and second as the application of these concepts. The theoretical concepts themselves are rarely challenged because they have been fairly well developed. However, the approach to theory and its application has traditionally been underdeveloped and thus requires more thought and practice among anthropologists. This paper asserts that a particularly clear example of the problem with the approach to and application of medical anthropological theory can be viewed in the context of clinically applied medical anthropology (CAMA). I examine two medical anthropological concepts that applied medical anthropologists use in their dealings with clinicians – critical medical anthropology and the culture concept. In doing this, I demonstrate that although these concepts are useful and clinicians need to employ them, there are a number of problems with the theoretical approach. I argue that these problems limit the application of these concepts to CAMA and offer preliminary suggestions to resolve them. In particular, clinically applied anthropologists employing critical theory should work to present a more balanced view of the clinic and physician. In addition, anthropologists working in the clinical setting must update the CAMA literature to ensure a thorough assessment of the current use of anthropological knowledge and concepts – such as culture – in medical schools and clinics.

This article reviews some of the current writing on medical anthropology, and is guided by political orientation/implication in the choice of its study targets, its analysis and its construction of solutions for the problems investigated. Starting from the narratives of anthropologists, it goes on to show the historical and socio-political bases characteristic of the subject in their countries of origin or migration. Within a general overview of the three principal contemporary trends - critical medical anthropology, the anthropology of suffering and the anthropology of biopower - the focus is on theoretical and thematic choices to meet the demand for "politicization" of the anthropological debate in the field of health, on the basis of which an "implied" medical anthropology is advocated.

This paper poses a theoretical question: how, if at all, can ‘critical medical anthropology’ and ‘performance theory’ be combined? More specifically, the author discusses the relative advantages and disadvantages of each, with respect to a healing cult in the Central Himalayas of North India. The paper has four parts: first, an ethnographic description of the cult itself; second, a brief introduction to critical medical anthropology; third, a short discussion of the performative approach to healing rituals; and finally, an attempt to combine the two approaches. The author concludes that the two approaches can indeed combined, so long as one recognizes (1) that caste and gender are also appropriate objects for critical medical anthropology; and (2) that aesthetics is always already political.

The purpose of this book is to provide an introduction and overview to the critical perspective as it has evolved in medical anthropology over the last ten years. Standing as an opposition approach to conventional medical anthropology, critical medical anthropology has emphasized the importance of political and economy forces, including the exercise of power, in shaping health, disease, illness experience, and health care.

abstractThis Perspective explores how cultural identity impacts on the gendered construction by Zulu-speaking women of ideal body size and the various means through which women choose to exercise agency around their bodies. We report on a research study conducted among 45 female and five male participants drawn mainly from the Durban-based University of KwaZulu-Natal, Howard College campus, conducted between 2010 and 2011. The study considers how patriarchal discourses contribute to women's body size ideal, and women's response to traditional and global symbolism of their bodies.The analysis employs two theoretical frameworks, critical medical anthropology (CMA) and postcolonial feminist theory. CMA allowed us to critically question the notion of body size ideal of Zulu-speaking women and unmask the origin of larger structures of construction in what Singer (1995: 90) terms “systems-challenging praxis”. Through CMA, we understand that the female body is the “terrain where social truths are forged and social contradictions played out, as well as the locus of personal resistance, activity, and struggle” (Scheper-Hughes and Lock, 1987: 16), while the lens of postcolonial feminism reveals the body politics that contribute to women's agency and ideas around the ideal body. Through various discourses the participants decipher the meanings inscribed on their bodies. The Perspective exposes how gender and race contribute to perceptions of black women's body ideal.

Medical anthropology, an interdisciplinary subfield of mainstream anthropology, has become the most popular and potential knowledge that receiving its brawny figure at present world. Biomedicine, a strong concept of medical anthropology includes: the scientific medicine, allopathy medicine, modern medicine and the regular medicine that basically focuses on human biology, pathophysiology, western knowledge and modern technology. It has become globally dominant during this century and well-practiced in developed, developing and less developed countries. This study has explored, what are the local nature, practice and perception of western biomedicine in rural area of Bangladesh. This research paper systematically searches, what type of challenges have to face by the rural women to get access to biomedicine or modern medical service in local hospital and clinics. What a modern technology and scientific knowledge-based treatment system impacted on rural women’s biological and mental health, this paper explores that. Applying Critical Medical Anthropology (CMA) Perspective, this paper has sorted out to identify the socio-cultural and political-economic aspects of biomedicine and what are the impacts of biomedicine on rural women health. What kinds of health problems, rural women are facing and what are the ultimate result of it as practicing biomedicine that will be analyzed here. Using Critical Medical Anthropology (CMA) this study has analyzed the power relation that is found in biomedicine and biomedical health seeking in local hospital and clinics that has become the primary area of social control. This article is a written interpretation of an anthropological fieldwork that was done in 2017, in Kaiba village at Sharsha Upazilla of Jashore district of Bangladesh.

Prelude: 2020 in Words Each year the Australian National Dictionary Centre, based at the Australian National University (ANU), selects “a word or expression that has gained prominence in the Australian social landscape”. In 2020, “iso” took out first place, with “bubble” following close behind. On the Centre’s website, Senior Researcher Mark Gywnn explains that “iso” was selected not only for its flexibility, merrily combining with other words to create new compound words (for instance “being in iso”, doing “iso baking” and putting on “iso weight”), but also because it “stood out as a characteristically Aussie abbreviation” (Australian National Dictionary Centre). Alongside the flexibility of the word “iso” and its affinity with the Australian English tradition of producing and embracing diminutives, iso’s appeal might well be that it does not carry the associations that the word “bubble” has acquired in the time of COVID. While COVID-19 has put many of us in various forms of “iso”, the media imagery—and indeed experiences—of many older people living in residential aged care during COVID has shifted some of the associations of the word “bubble”, heightening its associations with fragility and adding vulnerability and helplessness into the mix. 2020 was not the first time “bubble” has appeared in the Australian word of the year list. In 2018 “Canberra bubble” took out the first spot. What interests us about bubble’s runner-up position behind “iso” in 2020’s word of the year is what this might also reveal about the way ideas of independence vs dependence, and youthfulness vs aged underlie and inflect new usages of these words. In the era of COVID-19, the buoyancy of “iso” is tied to its association with a particular kind of Aussie-youth-speak, while the sense of heaviness and negative resonances that now accompany the word bubble are tied to its associations with the experiences of those in aged care. In 2020 “bubble”—a word that has primarily been associated with children and the child-like (bubble baths, bubble tea)—took on new associations and overtones. As the pandemic unfolded, “bubble” also became intertwined with media depictions of and popular discourses around those in later life, many of whom experienced “iso” much more brutally than the easy-Aussie-speak of “iso” would convey. There is much less play—and a lot less mingling—in the Australian National Dictionary Centre description of new uses of the word “bubble”: “a district, region, or a group of people viewed as a closed system, isolating from other districts, regions, or groups as a public health measure to limit the spread of Covid-19”. There have been various kinds of “closed system[s]”, isolated groups and regions constructed in the management of the pandemic, but there is one group—and one kind of location—that has been “bubbled” in quite specific ways. While the sectioning off and isolating of older age people in the name of protecting their health has often been ineffectively—and in some places, disastrously—managed in terms of disease prevention, it has been very effective in reducing the rights and voices of those it acts in the name of. Speaking from Ireland but commenting on the situation in the UK and parts of Europe, Anne Fuchs and colleagues write that “the discursive homogenization and ‘frailing’ of the over 65s meant that people in this category were an object of public discourse rather than participants in the debate” (2). In many instances the “bubbling” of older people, particularly those in aged care residences, has served to both isolate and render largely voiceless the residents of these care homes. Although the global impact of COVID-19 on the aged has been significant, including across many affluent societies, it has been particularly disastrous in Australia. At the time of writing (1 January 2021), of the 909 COVID-related deaths in Australia to date, 693 have been of people aged 80 or over: in other words, more than 75% of COVID-related deaths in Australia have been of people over 80. According to the federal government’s records of COVID-19 deaths by age group and sex, 685 of these deaths have been of aged care residents. It is not surprising therefore that many speak of the heavy impact of COVID-19 on older people as a form of genocide. Public discourse and government policies and priorities around COVID-19 have thrown into relief and exacerbated some of the deeply troubling ways that older people, particularly those living in aged care residences, are not recognised or treated as “equal partners in our future” (Royal Commission into Aged Care 1). Both the management of and public discourse around COVID-19 have highlighted and escalated the forms of ageism, especially ageism around later life, that have become embedded in Australian culture. In late 2019 the Royal Commission into Aged Care Quality and Safety released its Interim Report, titled simply Neglect. In the Foreword, the commissioners write: the Australian community generally accepts that older people have earned the chance to enjoy their later years, after many decades of contribution and hard work. Yet the language of public discourse is not respectful towards older people. Rather, it is about burden, encumbrance, obligation and whether taxpayers can afford to pay for the dependence of older people. (Royal Commission into Aged Care 1) Written and released before the COVID-19 pandemic, the Interim Report highlighted the “fundamental fact that our aged care system essentially depersonalises older people” (Royal Commission into Aged Care 6) and identified many ways “the aged care system fails to meet the needs of our older, often very vulnerable, citizens” (Royal Commission into Aged Care 1). In 2020 we saw some of the effects of these failures in the often disastrous mismanagement of disease transmission prevention in many aged care residences in Australia. Equally troubling, the resulting deaths have at times been accompanied by a general acceptance of the loss of so many in later life to COVID-19. The fact that these deaths are often regarded as somehow more inevitable, or as less significant than the deaths of others, is an indication of how deeply “Australia has drifted into an ageist mindset that undervalues older people and limits their possibilities” (Royal Commission into Aged Care 1). It assumes that one’s later-life years are of less significance and value (to oneself, to the community) than one’s younger years. At various times in the pandemic, sizable parts of the global population have been variously asked, advised, or required by their governments to remain within their household or residential “bubble”. These COVID-related “bubbles” are more buoyant for some. Jackie Gulland has written a feminist analysis of the ways that the UK COVID-19 lockdown rules are premised on “neo-liberal assumptions about the family as autonomous and sufficient for the provision of reproductive labour” (330). In many places the requirement to stay within one’s “household bubble” both assumes that the home is safe for all, and that most care and dependency requirements are provided and received within a household. As Gulland’s essay demonstrates, the idea of the household bubble constructs an image or idea of who and what constitutes a household, and which relationships “count”. Drawing on critiques of neo-liberal and able-ist ideas about autonomy by feminist and disability scholars, Gulland “shows how the failure of policymakers to take account of interdependency has made lockdown more difficult for carers and those in receipt of care” (330). In this essay we look at some of the ways that the required and/or imagined COVID-19 bubbles for people in later life are thought of differently to the COVID-19 bubbles that younger, and mixed age, households are imagined as forming. This is particularly the case, we argue, for those in aged care residences. Younger and mixed age COVID bubbles often include extended or linked households (as we will discuss below in relation to the idea of the compassionate bubble) and function as a bubble that can link and enclose. In contrast, COVID bubbles in and for aged care and those in later life, work to isolate and separate. They function as bubbles that close off and shut out, as if placing the older person and older people behind glass (in some cases, quite literally). Likewise, while the COVID-19 bubbles for the “general” population (a category from which those in later life are often excluded) are regarded as temporary structures that will in time be dissolved to re-allow social movement and intermingling, the later life and aged care COVID-19 bubble is imagined very differently. This is because it is overlaid upon a pre-existing conception of later life—and in particular the fourth age—as itself a kind of bubbled existence, a fragile state held somewhat separate and apart from the general population and moving inexorably toward death—a bubble that pops. Bubbling the Fourth Age The idea that later life can be divided into different stages and ages has a long history, although the shape, meaning and valuing of different ages in later life is historically specific. Back in the late 1980s the Cambridge historian Peter Laslett proposed that rather than falling into three main stages—childhood, adulthood and old age—there are in fact four stages and that “later life can be divided into a ‘third age’ and a ‘fourth age’” (Gilleard and Higgs, “The Fourth Age” 368). Laslett’s distinction between a third age (active and characterised by personal fulfillment) and a fourth age (for Laslett an age of infirmity) has become increasingly significant in both age studies and in the provision and imagining of aged care. While the third age is increasingly depicted as something that, when managed “successfully”, can expand and fill with rich experiences and rewards (assuming one has the economic and social privilege and mobility to embrace these r

Recent discussion in critical medical anthropology has turned to the issue of application beyond the academy. Building on Gorz's notion of "non-reformist reform," that is, applied work that unmasks rather than mystifies the sources of social inequality and ill health, this article argues for the possibility of an applied critical medical anthropology, suggests concrete opportunities for such work in health settings, and identifies problems and social conditions that affect the development of a critical health praxis. These points are illustrated by reviewing case studies of anthropological work with the Farm Labor Organizing Committee in Indiana, the United Farm Workers Union in California, and the Hispanic Health Council in Connecticut. The article concludes with an examination of the skills and resources critical medical anthropology has to offer system-challenging movements in health care.