Good (1994)

Good, Byron. 1994. “Illness Representations in Medical Anthropology: A Reading in the Field” in Medicine, Rationality and Experience. An Anthropological Perspective. Cambridge: Cambridge University Press. Chapter 2.
In this chapter, Byron Good is trying to map the different approaches within medical anthropology in the last decades. Indeed, medical anthropology as an inheritor of colonial knowledge-power has been criticized from within and without over the types of cultural representations the discipline has created when portraying “the Other.” The anthropological analysis has shown that western biomedicine is one medical system among others in competition. It has also criticized the medical profession’s Enlightenment assertion that lack of knowledge and maladaptation are the causes of illness. One problem in medical anthropology as sub-discipline is that often anthropologists are at once critics and committed participants of the heterogeneous biomedical enterprise. One central question in this regard for Good, which I consider important too, is how we situate our analysis of cultural representations of illness, “encoded in popular or folk therapeutic traditions or in individual understandings and practices, in relation to the truth claims of biomedicine” (28). How we consider the authority of biomedical science is key to how we relate as anthropologists with those with whom we work. Following Kleinman’s definition, Good asks to what extent “disease” is different from “illness”? But I ask myself, using the distinction disease (biological), illness (personal) and sickness (social) aren’t we taking for granted the biomedical notions of body and causality that put first the biological causation and then the non-biological? The current debates concerning illness representations show four schools of thoughts: the empiricist tradition, the cognitive approach, the interpretative approach and the “critical” medical approach. The first approach was centered in understanding “cultural beliefs” in relation with illness, to modify “irrational (sick) behavior” and to decrease risk factors and obey medical treatments. But that approach was very much “mentalistic” in its emphasis in understanding what makes people ill but not focusing on the actual biological and physical problems associated with people’s illnesses. They just considered “culture” as “belief”. There was a profound separation between folk beliefs and biomedical scientific knowledge (knowledge would eventually correct inappropriate popular beliefs). The second approach was more centered in cognitive processes, the ethnotheories of illness and health. These studies tried to understand particular cultural segments of people’s lives in relation with ways of dealing/comprehending diagnosis, treatment and prognosis in specific cultural ways. But again, illness representations were understood in mentalistic terms detached from “embodied knowledge”, affect, and socio-historical forces that shape illness meanings. The third approach, the meaning-centered tradition considers the biomedical system as a cultural system. They put the relation between culture and illness as the core of the analysis but in a different way, they consider disease not as an entity but as an explanatory model. Explanatory in the way that disease is only understandable through interpretative activities, because “interpretations of the nature of an illness always bear the history of the discourse that shapes its interpretation, and are always contested in settings of local power relations” (53). So the embodied experience, how illness is experienced and represented within different cultural systems is what should be analyzed. The fourth approach, the “critical” applied medical anthropology, tries to grasp the political and economical forces that shape illness experience and influence biomedicine itself. So for instance, forms of suffering developed from class relations may be defined as illness, medicalized, “constructed as dehistoricized objects-in-themselves” (57). Therefore, hunger or poverty are often medicalized and individualized when the social causes of them are invisibilized and unproblematized. Thus central in this approach is a critical unmasking of the social fabric of these conditions and the dominant interests. But Good, coming from the third type of approach, is quick to show that each approach has its weakness. Biomedicine is not only mystification and masking, and using a “critical” name does not make any approach more crucial than others. But the biomedical enterprise is more complex, is a site of hope and despair, desire and hatred, it is a right and an obligation, so the human actions in relation to its power deserve a deep understanding, especially if we want to produce knowledge and actions that would democratize its access and reduce its abuses of power.
I agree with Good that medical anthropologists are in-between this field of great tensions, they analyze and participate at the same time in the phenomenon they try to understand. And it is not only this idea of dual-loyalty (to biomedicine and to patients/family/social circle) what is at the center of medical anthropology practice, but also the possibility of co-construction of the anthropological knowledge/practice. Besides the anecdotal discussion between clinical or critical medical anthropology, the real discussion is how our knowledge can be useful for the people that are suffering and which strategy we should develop in order to help them better.