Anthropology in Action

Unfortunately, this is the last edition I shall be editing of Anthropology in Action. This edition is devoted to the Caribbean/Latin America, a region of the world that is close to my heart and my research. From now on, I shall be handing over the editorship to Chris McCourt. I’d like to take this opportunity to thank her for all the assistance she has given me and the book reviews she has contributed during my editorship which began in 2001. She has always been there to help me and to add her contributions to the special editions. Chris—my many thanks and good luck as the new editor of Anthropology in Action. I’d also like to thank the people in Hull for helping out in the early days, the editorial groups, and now Berghahn Books, Vivian Berghahn especially. Thank you for your support for the journal and long may it continue. There have certainly been some changes since 2001: we have changed publishers and expanded our previously UK/Danish dissemination of the journal to make it truly global in its reach.

The articles in this special issue tackle a problem at the heart of medical anthropology today—a problem that bedevils our methods, theoretical ambitions and public stance in the world. How should we rank the relative importance of local cultural meanings, on the one hand, and large-scale political and economic forces, on the other? That is, how should we train our sights on both culture and politics as we study the social contexts of suffering and apply our expertise to the worlds of policymaking and service delivery? How do we keep ‘culture’ and ‘politics’ in motion (and both are very broad analytical terms) without lapsing into one-sided analyses that champion the one term at the expense of the other? The following articles significantly advance the debate about such issues. They offer powerful theoretical models of the dialectic between culture-specific illness idioms and the operations of power that constrain people’s lives. They also re-think the very notion of culture in light of the complex networks—connecting individuals to nationstates, empires, NGOs, pharmaceutical firms and global capital—in which medical anthropologists increasingly work.

Structural violence has become a central concept in critical medical anthropology. It emphasises the importance of structural health determinants such as poverty, political violence and other collateral aspects of globalization. Diseases and epidemics are viewed as being pathologies of power. The goal of anthropology is no longer to analyse the influence of culture on illness and disease, but rather to engage in pragmatic efforts to remedy social inequalities that express themselves through ill-health. Such opposition between culture and politics may not be consistent with the need for a comprehensive anthropology that emphasizes the subtle and complex articulations between the multiple dimensions of health. Based on an analysis of depression and social suffering in postcolonial Martinique (French Caribbean), a plea is made for a new understanding of the relationship between local idioms of distress on the one hand and intermediate social, political and economical factors on the other. There is also a discussion of some of the pitfalls related to an exclusive focus on the political economy of health.

Anthropological research concerning the relationship between Haitian vodou and illness shows that vodou practitioners' explanatory models of illness contain two levels of causality. One presents the sick as victims of magical-religious procedures and illness as being the result of agents directed at the victims. The meanings for the origins of such illnesses are rooted in Haitian social reality, which Haitians perceive as dangerous and threatening. A certain representation of self and social reality underlies these illness models in vodou and in vodou-inspired Haitian folk knowledge. An anthropological analysis of illness must identify local meanings that may shed light on certain cultural constructions of illness, as can be achieved by examining explanatory models structured around origins, causes, disease agents and other sources of illness found in Haiti. But the analysis must go beyond local meanings and question the representation of self and of social reality that goes along with these models and makes them intelligible for Haitians. In doing so, we note that this representation is the result of a process of subjectivation that is bound up in power relations between Haiti and the West. A cultural approach to explanatory models of illness in vodou is incomplete without a critical anthropological approach that addresses the relations of domination to which Haiti has been subjected. This article draws on these two anthropological perspectives in analysing illness in Haiti. It demonstrates how a meaning-oriented micro-social analysis of illness can be combined with a critical, macro-social approach in medical anthropology.

In an earlier paper (Dressler, 2001), I suggested that medical anthropology as a research enterprise could not ignore either meaning or structure in human social life in the production of health. Rather, drawing on the early work of Bourdieu, I argued that we need to take into account both how the world is configured by the collective meanings we impose upon it, as well as the social structural (and physical) constraints on our behaviour that exist outside those meanings. Human health can be understood, in part, as the intersection of meaning and structure. Here, my aim is to extend this perspective in three ways. Firstly, I present an expanded theoretical framework within which collectivei meaning and social structure can be conceptualised. A useful theoretical framework must take into account paradoxical features of culture, including the seeming contradiction that it is a property both of social aggregates and of individuals, and that, ultimately, social structural constraints external to individuals depend on shared meaning. Secondly, I review recent research employing this perspective conducted in Brazil, the southern United States and Puerto Rico. These studies have all employed a 'structural-constructivist' theoretical orientation, using especially the concept of 'cultural consonance', or the degree to which individuals incorporate shared meaning into their own beliefs and behaviour. Where individual efforts to attain a higher cultural consonance are frustrated by structural constraints, poor health results. Thirdly, I consider some of the policy implications of this perspective. While much work in traditional public health focuses on a highly individualised notion of meaning (as in 'health beliefs'), it seems unlikely that the health of populations can be altered substantially without taking into account the structures that constrain individual action.

This article explores the antagonism expressed by two different theoretical positions within medical anthropology towards the structural violence position: the culture as central approach and the post-structuralist approach. While medical anthropologists trained in cultural models of illness are disappointed by the lack of culture in the structural violence approach, medical anthropologists trained in post-structuralist models of illness take issue with what they perceive to be its moral and universalist claims. In order to explore these universalist claims, the author returns to the field of moral psychology and its understanding of universal morality by exploring the history of the Heinz dilemma. She then frames her own recent research on global pharmaceutical politics in Argentina and Mexico in the context of the Heinz dilemma, neo-liberal discourses of capitalism, and the theoretical positions available within medical anthropology.

During the past few years, the AIDS campaign in Haiti has been targeting Vodou officiants and organizations. These awareness and training programmes inform officiants about the transmission and prevention of AIDS, tests for HIV and antiretroviral drugs, or even try to encourage them to become involved in a medical referral system. These culturalist interventions are grounded in an essentialist concept of culture that can have harmful effects on the targeted groups. The concept of culture underlying such interventions is deconstructed along with the categories of traditional medicine and the 'tradipractitioner'. An approach to public health is advocated that would contextualize medical pluralism in Haiti.

The Agricultural Revolution in Prehistory: Why Did Foragers Become Farmers? By Graeme Barker. Oxford: Oxford University Press, 2006, 616 pp, $180. ISBN 0-190928109-2.

First Farmers: The Origins of Agricultural Societies. By Peter Bellwood. Malden (MA): Blackwell, 2005, £16.79. ISBN 0-631-20566-7.

Would you like some practice writing for publication? Would you like a free copy of that new book that you really should read? Would writing a review convince you to read it? Anthropology in Action is always happy to hear from potential reviewers. Reviews are normally short—about 500 words—but a more in-depth review or review article can also be planned if you wish. Publishers regularly send us their lists and sample copies of books, but if there is a particular book you would like us to request, please contact Dr Michaela Benson: M.Benson@bristol.ac.uk.