Medical anthropology is probably one of the fastest growing sub-disciplines of anthropology. Over only a few short decades, medical anthropologists have increasingly become officially involved in global health programs. Along with this they critically explore how biomedicine and its nomenclature are spread across the world, their benefits, and how they are resisted, negotiated or adapted by people into cultural, political or gendered norms. Medical anthropology has also succeeded, as a discipline, to quickly adapt to accelerated societal changes and to respond in a timely manner to huge challenges brought on by medical crises (such as Ebola) or biomedical technologies (such as genetic tests or assisted reproductive technologies). It is only sensible, then, that the discipline sets out more resources to illustrate its work foundation and its various approaches.
The Routledge Handbook of Medical Anthropology, edited by Lenore Manderson, Elizabeth Cartwright and Anita Hardon, in spite of its apparently bounding title, exceeds the limitations of an educational resource for scholars or members of the public interested in medical anthropology. The book covers great geographical and cultural areas, with a tremendous variety of topics directly related to medical conditions/diseases, or which overflow into larger contexts that potentially influence health statuses (e.g., life cycle, kinship, war, structural violence, environment and climate change/the Anthropocene).
The volume has a rather unusual format. Each chapter is led by one of the editors depending on the topic, and includes case studies authored by other scholars. The case studies are extremely rich ethnographic vignettes, illustrating how a similar medically related topic or condition becomes variegated when looked at in context, rather than symmetrically approached as generally presumed in biomedicine. As the authors highlight throughout the volume, this diversity is paramount in understanding that global health projects need a deep comprehension of their multiple localities, as well as their ingrained and individually embodied subjectivities. Manderson, Cartwright and Hardon introduce each chapter with a more general presentation and conclusion, sprinkling their observations between case studies. This relaxed format, while sometimes becoming slightly confusing for citation purposes, gives the book a more conversational character and adds coherence to each chapter by linking the different pieces together. Something of a novelty is also that each chapter is preceded by a photo accompanied by an explanation of approximately 150 words, selected following a call for photographic contribution. The photos beautifully convey the temporal suspension of photographic encounter as a window into the complex entanglement between a medical issue, its embodiment, and its context. Although the photos add value to the volume, they might, at the same time, feel unsettling as they are overwhelmingly from places generally associated with ‘exoticism’ (with just one exception out of sixteen, depicting homeless people living in Oregon coming out of mobile showers; p. 260-261). This use of ‘exotic Other’ in ethnographic photography for illustrating anthropological textbooks has previously raised criticism, despite increasing efforts to decolonize the discipline.[1]
One of the biggest merits of the volume, I believe, resides in introducing topics such as childhood to be explored in itself (some exceptions might be Rita Astutti’s (2011) research on how children learn about death in Madagascar, albeit not necessarily directly related to medical anthropology). In this regard, the authors acknowledge, on the one hand, the importance of children as valuable contributors to culture-making and ethnographic knowledge, while on the other, aligning medical anthropology’s interest with other disciplines: pediatric medicine and psychiatry; development studies; cognitive and experimental psychology. The case study on children with diabetes (Christine Dedding chapter), for instance, epitomizes this attitude toward children as epistemic subjects of embodied disease, while the culturally specific expressions of the stress epidemic of children in Suriname and Swaziland (Ria Reis chapter) underscores the cultural way children articulate their struggles in a health/illness related manner.
Another excellent value of the volume relates to its capacity for encompassing a great array of topics from diverse geographical, social, cultural or political backgrounds. It is this range, I believe, that showcases the stark inequalities in health status, distribution and access that raise much global concern. Take, for example, the case study on homosexual sex workers diagnosed with HIV in Kenya (Emmy Kageha Igonya and Eileen Moyer chapter), whose fight against the stigmas associated with HIV within their own community and their diagnosis, their sexual orientation and their occupation within society at large, becomes an everyday struggle of survival in unimaginably precarious conditions; or the case studies on the difficulties (if not impossibilities) of accessing health care when living in liminal immigration status on national borders (the case studies on Mexican undocumented immigrants from Mexico by Heide Castañeda, and on women war refugees from Burma/Myanmar in Thailand by Meagan Wilson). However, while these cases are speaking about extreme vulnerability, all case studies unveil both how vulnerability becomes ever so present in terms of health all over the world, and how people find creative and compassionate ways of creating supportive and empowering networks.
The volume offers very enjoyable and accessible reading. Given its richly ethnographic case studies, the central conclusion of the book is then the necessity of paying attention to the particular contexts of health and illness across the globe and communities, and of understanding the complex entanglements in which they emerge and materialize. In other words, the volume speaks undeniably about the invaluable input that medical anthropologists may bring into important discussions on health and illness and their potential contribution to global health policy making. Thus, the volume goes well beyond what a handbook entails, becoming a fabulous resource for addressing health (in)justices across the globe.
[1]See Tunstall and Esperanza 2016 for a discussion on the use of photos for introductory anthropology textbooks.
Works Cited
Tunstall, E. and Esperanza, J. 2016. “Decolonizing Anthropology Textbook Covers” Savage Minds. (Available at https://savageminds.org/2016/06/20/decolonizing-anthropology-textbook-covers/).
Astuti, Rita 2011. “Death, Ancestors, and the Living Dead: Learning without Teaching in Madagascar”. In Children’s Understanding of Death: From Biological to Religious Conceptions edited by Victoria Talwar, Paul L. Harris and Michael Schleifer. Cambridge: Cambridge University Press. Pp. 1-18.
Cristina Douglasis a PhD candidate in Social Anthropology at the University of Aberdeen, UK. Her research focuses on the relations between people living with a dementia diagnosis and therapy-animals.
© 2019 Cristina Douglas
