Singer (1990)

Merril Singer. (1990) Reinventing Medical Anthropology Toward a Critical Realignment. Soc Sci Med 30(2): 1979-87.

At the beginning of the 1990s there was a big discussion in regards the role and function of the anthropology study of health and illness issues. One of these voices was Singer, who in this article proposed a realignment of the medical anthropology moving beyond a particular narrow understanding of social relations, the lack of attention to political and economical forces in the clinical setting, an individualistic approach to social relations, and a tendency to medicalizing human behavior. The normal focus of clinical medical anthropology for Singer is the patient-doctor relationship, hence this understanding of the relation avoid macro-contextual analysis of causalities that often are out of sight but nonetheless powerfully shaping those interactions. Another “classic” focus of clinical medical anthropology, the meaning-centered approach (in line with what Geertz was doing with other forms of anthropological knowledge) has also a limit in its conceptualization due to patients and physicians are not only living in different semantic worlds but also producing and consuming these different webs of significance and mystification in very unlike ways. There is an “ecological orientation” in medical anthropology that tends to see how patients should fit their social environment using an approach that individualize and “blame the victim” instead of looking at macro-political economical factors. This happens because medical anthropology has also been medicalized in its aid to the hegemonization, stratification and social control of current biomedicine. One thing that Singer is trying to emphasize is the micro-levels are simultaneously influencing macro-contexts and vice versa macro-contexts manifest at the micro-social levels considering them not as autonomous, self-contained, traditional, community, local or behavior patterns but as the interplay of both levels at once. Secondly, the world system with its influence in the biomedical system and connections between medicine and capitalism (capitalist medicine) should not be overlooked. Thirdly, diseases are both organically/physically/biologically originated but also socially/collectively produced (what Singer calls the relation between micro and macro-parasitism). Fourthly, the social context of biomedicine should be considered having in mind that bio-medicine is neither The System nor just one among many other medical systems: biomedicine is a capitalist medicine in these late forms of capitalism. This leads to the fifth point that is that biomedicine functions as a dominant model that subordinates other forms of medicine, so there are different levels of health care systems, and alternatives forms sometimes proliferate because they are a sign of resistance to the monopolization of biomedical and other forms of domination. Sixthly, the sufferer experience should be the center of our analysis, “sufferer experience is constructed and reconstructed in the action arena between socially constituted categories of meaning and the political-economic forces that shape the contexts of daily life” (Singer 1990: 184). Indeed, focusing on the sufferer would help to have a better understanding of how sufferers might individually and collectively confront, challenge and displace some forms of medical domination. The ultimate goal for Singer is not to understand how biomedicine is working and producing certain forms of power and subjectivity but to change medicine. And to do so we must ask with Singer: “whose interests our work further; who is empowered by our efforts; on whose standards does our work confer social legitimacy; what is the source of our ideas and taken-for-granted understandings of social reality; and, what is the structure of social relations that our endeavors reinforce or reproduce?” (1990: 185).
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