MEDICINE AS METAPHOR FOR SOCIETY
The ancient capital of Bagan in Birmania, lies on the banks of river Irrawady. It is one of the patrimonio de la humanidad with hundreds of monuments and archeological sites and one of the more visited tourist areas in Birmania.
In 1999, the Government decided to move the entire population of Bagan to a new site away from the tourist areas and gave them just fifteen days to move: the old houses were erased, but there were no new houses, but the people had to shift, build houses and begin adjusting to their new life.
Within months, the old people began to die.
The doctors and the statisticians and the salud publica said: they died of pneumonia because of changes in the air and infections.
Do you believe that?
Can you think of the real reason why they died?
Each society has symbols which are visible and symbols which are invisible and some shared and some not shared.
Anthropology teaches us to unravel (decifrar) the symbols that surrounds a particular
Society
Some people within the society: Blacks and Whites; Jews and Christians
Philosophically, we can ask
Is the truth there to be discovered and then social factors added or those leaning towards Marx might say
The discovered truth is a social product.
When you look at something.. let us say an object, a scenery
If you wear dark glasses, they would appear dark
If you wear green glasses they would appear green
It is the lens that makes the difference, not the object
The object remains the same.
The way of looking and explaining it
Is to know the lens through which we look at things
Whether it is life or suffering or relationships
And what is this lens
Society?
Culture?
And I would like you to think about and write down for me
What you think society is?
What do you think culture is?
I can already tell you there is no correct answer since there is no single answer…
All of us have a story
It is the absence of a story, a lived in and experienced story..Antoine Artaud, from his asylum said, as quoted by Michel Foucault,
Madness is an absence of an ouvre
Suicide is an absence of an ouvre
The reason why people become fat when they migrate to United States is because their stories are being interrupted…
When you put an Australian aboriginal in Jail, he dies or hangs himself
Let me recite what a Bushman said, away from his habitat
I am waiting for the moon to change
So that I can listen to the stories of my people
I am here and I have no story
I want to listen, waiting for a story come to my way
And to come to my ear
I will sit, turn my ears backwards because I know there is a story in the wind..
All of us have a story
Not what we are
But who we are
I am Sudah Yehuda Kovesh Shaheb and a Jew
That is who I am
I am Yehuda, endocrinologist and medical anthropologist
That is what I am
Photo shows my brother Elliott and I praying for our brother Ricardo in front of the Nats at Old Bagan.
Learn to be true to yourselves, to know who you are, which is a struggle as Dalai Lama would say.
If I give you this visiting card of mine, which has a portrait of Ernesto Che Guevara.
You would look at this with the lens you have created for yourself
And come to an entirely different conclusion
This guy likes Che
Which has got different sentiments in different countries
In usa they would say this man is a communist
In cuba they would say this man sympathetic to Cuban revolution
But that would not reflect who I am
The point of this
Symbolism has to be transacted,
one must learn to transact symbols in the societies where we live, whether as natives or immigrants to be emotionally stable.
Hermaneutics is a term used to describe the views concerned with the problems of understanding and interpretation. Wilhelm Ditte a 19th century German historian and philosopher. He was aware (comprendido) that the texts were merely one form of what he called objectification of life ( objectivization ). To understand cultural phenomena, is to grasp (tomar) them as objectified expressions of life, and to experience the creative act, to really read the experience of others
(in a way de-objectification…very similar to what Jacques derrida was to say much later.. deconstruction )
Studying Medical Anthropology, you will learn no statistics, you will have no more knowledge about any one subject( material) but you will learn a new way of thinking.
This is what I would like you to think about
To look at things, whether they are constructed or true
And can it be deconstructed?
A constructed life, is false, is like a boat without an anchor, a man without a culture, following the wind as it comes and without direction
Studying Medical Anthropology, you would realize that it is not Medicine you are studying, even if you are doctors or people working in the health professions ,
but it is about LIFE
It deals with Birth
Puberty
Family and relationships
And Death.
Almost nobody in my family is related to me by blood, does it mean that I have no family?
Among the Indians, all your mothers sisters are your mothers. The blood mother never disciplines the child, the others do.
LIFE is also about suffering: emotional, physical and psychological, spiritual.
Western medicine, trumpeting its technical superiority has hijacked the management of suffering.. and we shall study the history of this hijacking and its continued dominance.
In short,( en sintesis ) Medical Anthropology is a Metaphor for LIFE ( de la vida )
And that is the title of this course
Medicine as Metaphor for LIFE..
Medicine has become the major metaphor in our societies.. regardless of whether it is a rich European country or poor african country
Newspaper…
We say Economy is Sick, violence is cancer of the society, the institutions are ailing…civilizations are being described as wounded…
Una poema desconocida de Pablo Neruda
Patria Prisionera
Patria de mi ternura y mi Dolores..
Hoy sangran tus banderas tricolors..
But once upon a time, the metaphor for the society was RELIGION
Sinful life they used to say, now we say unhealthy lifestyle.
It is so because, Health is at the core(center) of the human experience: as we mentioned before, birth, pregnancy, marriage and suffering.
The British Anthropologist Lewis said:
Nothing distinguishes one community more sharply from another than its beliefs concerning the meanings of life, the position of the people in the universe, which is called the world view and the ultimate significance of affliction and suffering.
I have already mentioned to you that the objects appear differently to different persons through the lens of culture; but there is only one truth. To each person, the truth exists but the problem is when someone else tells you what is the truth.
Let us look at painting by Edvard Munch the melancholic Norwegian painter.. Scream (el grito) is his best known painting..
Each one of us would perceive it differently.. red is good luck for the Chinese, for the ndembu in zambia, red denotes menstruation and thus a taboo..
If we use Hermaneutics.. way of interpreting.. transaction of societal symbols.. we would realize that the painting is an objectification of Norwegian life…
He was trying to portray to us the narrow mindedness, the hypocrisy, the complaisance of the Norwegian society at the end of 19th century… If you read the Norwegian literature of that time..Knut Hansen in his book HUNGER or Ibsen the playwright who was Hansen’s contemporary…Hedda Gabler is one of his plays…all portray the hypocrisy of that society. Munch painted what Hansen wrote and what Ibsen’s drama represented…
The study of Medical Anthropology would be incomplete without studying DESCARTES… Ergo, cogito sum…I think, therefore I am…which had been translated into our times as I doctor, therefore I am…
1596-1650
From him comes Cartesian Dualism…
Palpable mind and the intangible body
Body and soul
One left to the church
And other to the intellectuals in society
Think of it as, wresting the control of the society away from the all powerful church..
Remember, at this time, hospitals, doctors as an organized profession or specialization by organs did not exist and they were at the beck and call( servicio y llamado ) of the bourgeoisie, a pawn(peon) in the hands of the powerful. In our studies of medical anthropology, you will understand how the medical profession has always remained the pawn in the hands of the powerful forces in the society.. the guiding principles have never been the health or welfare of the society as a whole..
What is the general opinion of health care and health care professionals around the world at the moment, especially about those who are trained in the western medical model?
The physician and the specialist, whatever his field, should study the entire patient and his environment, and should view disease with the eye of the naturalist. That is the message of Hippocrates, as fresh today as it was 2400 years ago.
Eventhough Hippocrates rejected philosophical approach to Medical care and took a more scientific approach, he refrained from diagnosing conditions and prescribing specific medicines for each illness.
Holger Kalweit
There are three things our culture has forgotten: basic health, healing and holiness. All three words have the same linguistic root and the concepts have the same goal: sanity, integrity, completeness, salvation, happiness, liberation , magic
Shamanic therapy means the healing of an entire life rather than just healing failing functions and disruptive pains. For shamans, healing involves philosophy, a view of life.
An initiation into shamanic healing means a devaluation of all values, an overturning of the profane world, a peeling away of inveterate handed down notions of the world, liberation from everything preconceived. For that reason shamanism is closely connected with suffering. One must suffer the disintegration of ones own system of thought in order to perceive a new world in the higher space
He had the soul of a child and the mind of a philosopher
To be a healer
Foucault : The Birth of the Clinic
Medicine of the past two centuries or so has been conducted increasingly
“without regard to persons”..Max Weber
hence( por la tanto ) the frequent critiques of
hospital medicine
biomedicine
doctor-centred medicine
medical model
sometimes an underlying principle is invoked to explain this state of affairs:
medicalization ilich
professionalization parry and parry
scientifization pelling
a kind of anti-medical model perhaps is pleaded for, humanist, caring, individualizing, preventative, progressive, person centred, phenomenological, ideographic etc..
it is not a rejection of medicine altogether
a part of it is sentimentalism much like nostalgia with regard to medicine
anti medicine ethos is not a philosophy but a kind of schema, a way of thinking that is drawn upon selectively by different sets of people in different contexts
I wish to emphasize the fact that by studying health care systems or health seeking behaviour, we are not attempting to replace it, or eradicate it, but humanize it more, to complement it. And to contextualize it.. when do we need the doctor, when do need the sangoma, when do we need the santo, palero etc.
I hope you are beginning to understand what I am driving at…you need to have a basic understanding of the philosophy of the culture ( which whether you like it or not in cuba is predominantly western ) to understand the health care system whether as an observer, participant or a patient…
Otherwise you would accept things as they are…
In England, social anthropology is the dominant approach and emphasizes the social dimensions of human life. Man is a social animal, organized into groups that regulate and perpetuate themselves, and it is man’s experience as a member of society that shapes his view of the world.
In the USA, cultural anthropology focuses more on systems of symbols, ideas and meanings that comprise a culture, of which social organization is just an expression.
Both are complementary perspectives.. on how human beings organize themselves and ways that they view the world they inhabit.
In other words, one emphasizes the culture and the other emphasizes the society.
When studying a group of people, it is necessary to study the features of both their society and their culture.
Structuralism
Study of human languages, culture and society as structures. The elemental components are related to each other
So to analyze cooking ( or economics or kinship or illness)
Examine its components in the relationships of
Difference
Exchange
Substitution
Ferdinad Sassure
Roman Jakobsen
Claude Levi-Strauss
Lacan: the conscious is structured here as a language
Luis Althusser
Roland Barthes
Phenomenology
A philosophy of consciousness
Neither intellectual nor science can grasp the fundamental nature of consciousness
To do this, philosophy has to deal with phenomenon-
Appearance and our awareness of the appearance.
This awareness cannot be understood through rational proofs and scientific data
What is needed is INTUITION
And a direct approach to the inner structures of the consciousness itself.
Edmund Husserl
Martin Heidegger
Maurice Merleu-Ponty ( who with Jean Paul Satre wrote Les temps Modernes )
If I say to you
BLUE
And you begin to explain to me that
Blue is an English word for a wavelength in the visible light spectrum…
You must then read Husserl’s work to see how he viewed the relatioship between science and philosophy. ( there was a scene in Swedish movie, I think it was called the Inspector where the child asks the mother: is there a man in the moon? And she gives him a scientific explanation and the child was so disappointed. He wanted to know about the man in the moon..perhaps a magical explanation rather than a rational one )
If you said, I don’t know. You said the word BLUE
Good.. there are twenty meanings for the word BLUE in English.. until I say a complete sentence,
BLUE is just another word
ALONE MOST THINGS LACK MEANINGS..EVEN PEOPLE..
WE ISOLATE THINGS, OURSELVES, OUR BODIES, ORGANS IN THE BODY.. THINKING THAT WE CAN UNDERSTAND THEM BETTER.. BUT THE MEANING IS LOST
Jean Paul Sartre coined the term Existentialism to describe his own philosophies
The Underlying concepts of existentialism are simple:
Mankind has free will
Life is a series of choices, creating stress
Few decisions are without any negative consequences
Somethings are irrational or absurd, without explanation
If one makes a decision, he or she must follow through.
Fyodor Dostoevsky
Seren Kierkegaard
Fredrich Nietzche
George Hegel
Franz Kafka
Simone de Beauvoir
Albert Camus
Karl Jaspers
Jean Wahl
Gabriel Marcel
Influential philosophers and writers, with existential concepts relflected in their works include
Nicolas Alexandrovich Berdyaev Russian Neo romanticist
Leo Isakovich Shestov Schwarzman Russian Irrationalist
Jose Ortega y Gasset
Miguel de Unamuno
Algerian born French Jewish Philosopher Jacques Derrida ( 1930-2005) is one of the two most famous investigators of what is called POST MODERNISM in contemporary philosophy ( the other of course is Foucault )
His way of thinking is considered DECONSTRUCTION.
Plato’s thoughts had dominated the western thought for millennia.
In a memorable passage in The Twilight of Idols, (ocaso de los idolos )
Nietzche describes:
How the true world became a fable
Here he sketches an account of the gradual dissolution of the (other-wordly way of thinking )common to Plato, Christianity, and to Kant,
The way of thinking which contrasts the
True world of reality with the
World of appearance created by senses or matter or Sin
Or the structure of human understanding
The aboriginal peoples do not have a concept of Sin
If you think something is bad, don’t do it.
(Yakama Indians do not have a word for Sorry)
If you think that what you say will hurt the other, don’t say it…
The characteristic expressions of this other worldliness, this attempt to escape from time and history into eternity, are what deconstructionists often call
The traditional binary oppositions
True –false
Original-derivative
Unified-diverse
Objective-subjective and so on
( even the UN resolution on world Health says: Health is the absence of Disease )
American Indians may have been the first ever deconstructionists when they said: The white man speaks with forked tongue.
In Laos, reading the official newspaper you realize that the News they print is not what has happened but what will happen in the future…
What Heidegger called PLATONISM or METAPHYSICS or ONTO-THEOLOGY
Derrida calls
THE METAPHYSICS OF PRESENCE or LOGOCENTRISM
Derrida repeats Heidegger’s claim that this metaphysics is utterly pervasive in Western Culture.
Both see the influence of the traditional binary oppositions as infecting all areas of life and thought, including literature and criticism of literature.
( Carl Gustav Jung mentions this: Darkness is not an absence of Light; Like Indians, Darkness and Light coexist. A better example of Indian way of thinking, in contrast to the Christian way of thinking is: Goodness is an absence of Evil, no, Goodness and Evil coexist, you choose the good path )
So Derrida entirely agrees with Heidegger that the task of the thinker is to twist free of these oppositions, and of the forms of intellectual and cultural life which they structure.
However, Derrida does not think that Heidegger succeeded in twisting free.
(In order to distance himself from Heidegger, Derrida proceeds to invent bits of philosophical terminology ( trace, difference, supplement and archi-ectriture and many others )..
Derrida expresses his affectionate admiration for the proliferating, the elusive, the allusive, the
Ever-self-contextualizing
He sees these features as exemplified in writing better than in speech-thus reversing Plato’s ( and Heidegger’s) preference for the spoken over the written word.
(spoken word is pre modern and written word is post modern , if you want to say )(oral history for example of the various tribes)
Thus Derrida positioned himself as the first post-metaphysical thinker, the prophet of an age in which reality-appearance distinction has ENTIRELY lost its hegemony over our thought.
Heidegger’s own sentimental pastoralism and nationalismotraits which led him to Nazism
Derrida turned from Heidegger’s sentimental question
How can we find traces of the remembrance of Being in texts of the history of Philosophy?
To the quasi political questions
How can we subvert the intentions of texts which invoke metaphysical oppositions?
How can we expose them as metaphysical?
He turned from Heideggers preoccupation with the philosophical canon to the development of a technique which could be applied to any text, past or contemporary, literary or philosophical.
This was the technique which has come to be called DECONSTRUCTION
Derrida was made famous ( in English speaking countries ) not by his fellow philosophers, but by literary critics ( who were looking for new ways of reading texts rather than new understanding of intellectual history )
A deconstrutionist school of thinking came about ( with derrida as its leading figure)
As used by members of this school, the term DECONSTRUCTION refers in the first instance to the way in which
ACCIDENTAL features of a text can be seen as betraying, subverting, its purportedly ESSENTIAL MESSAGE.
Construction of medical knowledge ( Foucault has written about this )
Intuition in diagnosis is being replaced by reliance on technology and what backs up the technology, what is written about the technology? The communication to make sure that knowledge is transmitted is couched in a language ( serving some other master rather than the health of the patient: profit of the technology, drug companies etc )
How can we find words which directly reflect the world, from non language?
The struggle has been going on since the time of Greeks, but it is doomed to failure because as
Saussure says: language is nothing but differences.
Contextual ( a concept very important in anthropology )
That is, words have meaning only because of contrast-effects with other words.
BLUE means what it does
Only by contrast with RED<>
This is an introduction to Medicine as a Metaphor for Society for those of us whether Cubans living in Cuba or an Australian living in Cuba.
We are profoundly influenced by the Siglo las Luces, Descartes and the scientific discoveries of 18th and 19th centuries and the philosophies of the western world: in my own case by
Giles De Leuze person as a desire
Michel Foucault Power, control and Punishment
Jacques Derrida De Construction
The special significance of Foucault’s investigations of the body and the construction of medical knowledge springs from his keen recognition of the biomedical roots of modern ways of thinking in the social sciences.
Merton 1957 USA Social Theory and Social Structure
Assumed that while social factors might either impede or facilitate the emergence of discovery, they could not affect the content of knowledge. In effect, the sociologist was restricted to the contextual events surrounding the discovery and use of knowledge but could have no interest in the knowledge itself.
Thomas Kuhn The structure of Scientific Revolution in 1962
Showed also that the internal cognitive structure of science could be an object of social enquiry
Advent of hospital medicine in late eighteenth century
Physical examination, autopsy, statistics
As the basis of the new form of medicine
Hospital Medicine
It was apparent that the advent of the hospital provided the opportunity for the traditional dominance of the upper class patient over the doctor to be reversed in that the new public hospitals recruited patients from lowly backgrounds and invited relatively high status physicians to treat them.
Client control to medical dominance.
Still employing Ackerknecht’s periodization of a pre hospital bedside medicine followed by hospital medicine, Jewson examined the effect of the hospital on medical knowledge.
Hospital provided a locus for a new relationship between doctor and the patient, it was this relationship that was instrumental in establishing the new biomedical model of medicine.
During Bedside Medicine, the patient was in a position to dictate ( and define ) the nature of illness; hence the existence of a symptom based medicine. After the advent of the hospital the doctor’s dominant role ensured the emergence of a medicine based on pathological lesions which were inaccessible to the patient without medical interpretation.
Thus this correlation between doctor-patient relationship and the form of medical knowledge was not only important in the genesis of the latter, it also functioned to maintain that particular relationship. A hierarchical relationship from which we suffer
The major impact of Jewson’s work was to undermine the assumption that medical knowledge was discovered. The notion of discovery, in which hidden truths wait to be revealed, allowed social factors to affect only when that truth was revealed, since the truth itself pre existed the act of discovery. The alternate model was to challenge the notion that truth awaited revelation and to argue that “discovered” truth was as much a social product as the search which laid it bare. ( in modern medicine, the best example of this is the “discovery” that cholesterol is harmful to the heart or half the population is “discovered” to suffer from some form of depression or “attention deficit disorders” in children)
Thus the emergence of pathological medicine, in which disease was reduced to skin encapsulated lesion, was not a discovery but a creation.
The eighteenth century medicine based on patient dominance, which accordingly recognized the primacy of a patient-defined agenda, was usurped by a medicine which treated patients as objects and ignored their words in search for the underlying pathological basis of illness. In consequence the autonomous identity of the patient was alienated by the new mechanistic forms of clinical practice
More fruitful ways to understand the origins and nature of clinical practice.
According to Foucault changes in medicine were simply one facet of a wider cognitive revolution: certainly diseases were “fabricated” by medicine, but so were the bodies that contained the diseases; this production of bodies was common to a range of techniques deployed through schools, prisons, workshops, barracks and hospitals. Fundamental to these new techniques of the body was a reconfiguration in the “power mechanisms” operating in society. The old regime was characterized by sovereign power, in which the body of the king symbolized the concentration of a centralized power: procedures were carried out ion the bodies of the king’s subjects
Foucault argued that this system of sovereign power was joined by a more pervasive system of disciplinary power in which the supreme body did not belong to the king but to “everybody”. Sovereign power has not disappeared but has continued, at least in symbolic form
“we still have not cut off the head of the king”
disciplinary power has grown ever more extensive and pervasive
The task has been to identify new knowledges of the body and their accompanying practices which sought to transform ( fabricate) a new object. For example, there are the various regimes of mental hygiene, which identified the neuroses as endemic in the population ( unlike the old insanity which was restricted to the unfortunate few ) and then used this knowledge to justify further surveillance of the population’s mental functioning. Eg teenage pregnancy.. analytic techniques which transformed it from a moral framework of condemnation to a surveillance machinery of betterment… teenage pregnancies are common in USA and England but not in Germany.
(social objects are constructed through perception. Of course, at one level, it appears rather trivial observation as it is only perception that the world is apprehended, but the core tenet of constructivism is that these perceptions are patterned by and through social forms)
( Humoral medicine.. humors..could the skilled physicians of the past identify humours which are beyond our perception or was it a delusion, an error? From the perspective of the present, with great arrogance, it is all too easy to believe that only the most recent reveals the truth and the past was marked with error, charlatanism and self deception.
Then why are people going back to Budhism, Yoga, acupuncture, Meditation, herbalism, homeopathy…is the knowledge about the body being constructed socially again or challenged or re constructed?
Or is the study of the constructed body imply the history of the body?
In the USA, the most expensive country to be sick, people spend more money on alternative medicine than the hospital and doctor based medicine.
Sudah Yehuda Kovesh Shaheb
MD MS MSc
Fellow of Royal Anthropological Institute, London
Consultant Endocrinologist
Consultant Medical Anthropologist
Various Indian Tribes
Visiting Professor of Anthropology
University of Habana, Cuba
Clinical Assistant Professor, Creighton University School of Medicine. Associate Lecturer, Brunel Univesity, London
