Byron Good

... Clifford Geertz's impact on his own discipline, celebrated in this volume, is not difficult to explain. ... a concrete symbol of the abstraction of the state.” Cicero, Augustine, Vasari, Winckelmann, John Flaxman (in his early-nineteenth-century Lectures on Sculpture), Alois Riegl, and ...

Medical anthropology has long been a critical field of anthropological understandings. At the heart of human cultures are the practical issues of illness and healing, philosophical issues of the body, mind, culture, and society as well as rationality, perception, and experience, and moral issues of suffering, the" good life"(and death), and the political economy of health and suffering. All of these issues are of vital concern to medical anthropologists. Medical Anthropology: A Reader, edited by an outstanding team of medical anthropologists, is ...

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.

Through a review of the epidemiological literature on the mental health of Puerto Ricans and other Hispanics, the authors argue that lack of attention to cultural issues in epidemiological studies leaves many questions unanswered and raises concerns about the validity of studies in this area. The authors point out that the mental health status of Puerto Ricans in New York City is still poorly understood after 30 years of research. The roles of cultural response styles and of culturally meaningful expressions of distress in shaping responses to research interviews should be central concerns in developing research in cross-cultural psychiatry.

Research has yielded consistent evidence of high levels of psychiatric morbidity and psychosocial problems among primary care patients, and recent studies have focused on improving physician recognition. These studies are based on the unexamined assumption that patients want their physicians to treat psychosocial disorders; thus, underrecognition is examined by analyzing characteristics of physicians and medical settings. Patient characteristics, particularly attitudes about the appropriateness of seeking help for psychosocial problems in primary care, have not been examined in relationship to underrecognition. This study directly focuses on patient attitudes about appropriateness of requesting care for psychosocial difficulties, the extent to which patients discuss difficulties with their physicians, and the degree to which physician recognition is explained by these patient characteristics. The study sample of 883 adult patients was drawn from 23 primary care practices. Over 70 percent of patients find it appropriate to turn to their primary care physicians for help with emotional distress, family problems, life stress, behavioral problems, and sexual dysfunction; however, only one fifth to one third of patients who have experienced difficulties have discussed these problems with their primary care providers. Attitudes about appropriateness are significantly related to physician recognition of psychiatric symptoms and family difficulties but account for limited variance in levels of recognition.

A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities brings together articles from the key theoretical approaches in the field of medical anthropology as well as related science and technology studies. The editors’ comprehensive introductions evaluate the historical lineages of these approaches and their value in addressing critical problems associated with contemporary forms of illness experience and health care. * Presents a key selection of both classic and new agenda-setting articles in medical anthropology * Provides analytic and historical contextual introductions by leading figures in medical anthropology, medical sociology, and science and technology studies * Critically reviews the contribution of medical anthropology to a new global health movement that is reshaping international health agendas

In 2005, China implemented a demonstration program known as "686" to scale-up nation-wide basic mental health services designed to improve access to evidence-based care and to promote human rights for people with severe mental disorders. As part of the 686 Program, teams…

To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients. 3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview. The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders. PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.

In order to explore age-related differences in personality pathology between psychotic disorder (PSD) and mood and/or anxiety disorder (MAD) among psychiatric outpatients, 2,354 subjects were sampled randomly from outpatients in Shanghai and divided into two groups: PSD (N = 951) and MAD (N = 1403). Dimensional scores for personality disorder (PD) traits were assessed by using a self-reported personality diagnostic questionnaire (PDQ4+). Significant age differences were observed in most of the PD traits in MAD patients. Cluster B and C PD traits displayed an apparent decrease with age in MAD group, but such decline trend was not evident in PSD group. In both groups, the decline of self-reported Cluster A PD traits were less visible than the other clusters. Age-related mellowing of some PD traits such as "dramatic, erratic, anxious" occurred primarily in MAD patients; however the same traits in PSD patients appear to be less resistant to aging. Besides, "old eccentric" PD traits in both MAD and PSD patients seem to be maintained and less modified by aging.

Medical anthropologist spend most of their time eliciting and interpreting people's statements about sickness and health. For this task, they make certain assumptions about the importance of language and reason. In this paper I argue that their assumptions are tailored to fit an hypothetical Rational Man rather than real people. The concept of 'explanatory models of sickness' is used to illustrate this point. My critique begins by drawing attention to two non-cognitive determinants of people's statements: their degree of emotional arousal and their capacities for discoursing on medical subjects. These determinants are briefly discussed and then set aside, to make room for the paper's argument proper. This starts with the observation that medical anthropologists tend to overlook the fact that they have established a cognitive no man's land stretching between their informants' statements and the cognitive structures which are supposed to generate these statements. I survey this void, using a five-fold model of medical knowledge. People use one kind of knowledge to organize their medical experiences and perceptions. In Rational Man writing, this form of knowledge is considered equivalent to cognitive structures (e.g., causal models, classificatory schemes), but I argue that is also includes knowledge of prototypical sickness events and knowledge that is embedded in actions, social relations, and material equipment. The theoretical implications of the five-fold model are outlined. This is followed by an analysis of the reasoning processes in which people use medical knowledge to produce the statements whose meaning we wish to learn. I demonstrate the importance of being able to distinguish operational and monothetic forms of reasoning from pre-operational and polythetic ones. Rational Man writers are described as ignoring the latter pair. The concept of 'prototypes' is reintroduced to illustrate these points.

The threat mental health professionals perceive in managed care, as indicated by their writings on the subject, is re-examined in light of evidence from an ethnographic study. Fieldwork focusing on clinician experiences of managed care was carried out at an urban community mental health center. Existing explanations of "the threat"--the possibility of deprofessionalization and the potential for deterioration in the quality of care--proved inadequate to account for the power it wielded at this site, perhaps because its full impact had yet to be felt at the time of data collection. A "rereading" suggests the meaning of managed care for this group of clinicians lies in the prospect of being gradually, unknowingly, and unwillingly reprofessionalized from critics into proponents simply by virtue of continuing to practice in a managed care context, and in losing a moral vision of good mental health treatment in the process.