miércoles, enero 14, 2009

Scheper-Hughes (1990)

Nancy Scheper-Hughes. (1990) Three Propositions for a Critically Applied Medical Anthropology. Soc Sci Med 30(2): 189-197.

According to NSH Clinical Medical Anthropology (CMA) is a medical anthropology applied to the needs of the clinic, which considers the materialistic and positivistic premises of biomedicine, and in so doing it take them (almost) unquestionable and for granted. Medical anthropologists play –and self-concede- the role that the hegemonic biomedicine consent to them, they are mediators, translators, “cultural-brokers” between professionals and laypeople. They try to ameliorate doctor-patient relationships (from the biomedical viewpoint). That is, they aim to sort out in which ways laypeople could be “integrated” and “acculturated”, but they do not consider the relation of the patient with her social circle because it risk to criticize the hierarchical and disproportional economic and power relations that this encounter/clash produce. Medical anthropologists are usually not situated on the side of the “disreputable, stigmatized and marginalized patients’ rights and self-help groups or other critical sub-cultures of the sick, excluded and confined” (1990: 192).
Against this form of looking at issues of health/illness there is another position, which considers that we should practice not only a mere medical anthropology (with the subjacent premises, problems and interests of biomedicine as yours) but an anthropology of affliction and human suffering that has not other choice than moving beyond the western biomedical horizon. Because of this, NSH emphasizes in the need to contextualize its impact in all societies in this even more “globalized” (westernized) world, and particularly the conflicting relations with other medical systems subordinated and/or parallels the hegemonic. The Critical Medical Applied Anthropology (CMAA) complexify health/illness issues broadening the gaze and analysis with historical perspective and with the reflection on economic, political and ideological processes.
But what is wrong with situating on biomedicine' side? Beyond the positive aspects of biomedicine should be clear that it has created many obstacles, mainly it has medicalized and individualized (privatized) the social relations that shape afflictions/sufferings, instead of collectivize and politicize them. For NSH in order to create a critical medical anthropology an epistemic brake with biomedicine should be produced, and she proposes three possible ways to do so: (1) de-medicalization (reduce the parameters of medical efficacy to what is really working), (2) non-ortodox ethnomedicine (heterodox and alternatives therapies that have proven to work in many cases), and (3) radicalization of the medical practice and knowlege (in line with the Anti-Psychiatry movement, rebel the institutions of social control: asylum, hospital, Psychiatric and transform them in places of revolution and social critique, and linking the marginalization, suffering, and exclusion that happen within these institutions with what is ocurring within the family, community and society).

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