Building a New Biocultural Synthesis: Political-Economic Perspectives on Human Biology

4. The Development of Critical Medical Anthropology: Implications for Biological Anthropology

Chapter 4 The Development of Critical Medical Anthropology: Implications for Biological Anthropology Merrill Singer In 1966, when Alexander Alland proposed that "medical anthropology may serve as a major link between physical and cultural anthropology" (1966, 41), the fragmentation of anthropology at the borderlands of its major subdisciplines (biological, cultural, linguistics, and archaeology) already was becoming apparent. Uncertainty had emerged concerning the ability ofanthropology to hold together both its seemingly disparate components as well as its global biocultural conception of humankind. Into the breach was thrust the relatively new subdiscipline of medical anthropology . With its targeted focus on health issues (including morbidity and mortality), medical anthropology was inherently biologically oriented. At the same time, in its recognition that the human conception of health was a cultural construction and that health status was extensively shaped by sociocultural practices (including both behaviors that cause illness and those that help remedy it), medical anthropology was simultaneously cultural in its focus. Thus, medical anthropology appeared to offer a useful bridge connecting symbols to selection, acculturation to adaptation, and ethnography to evolution, thereby allowing for the retention of a unified anthropology. There is considerable room for debate over how well medical anthropology has fulfilled its promise as a disciplinary adhesive. Over time, biological and cultural anthropology have become, each in its own way, more highly specialized and aligned more closely with other disciplines, rather than with each other. Thus, many biological anthropologists have adopted microscopic levels of biological and biobehavioral analysis and have focused their attention on nonprimate and even nonmammalian species of 93 94 Building a New Biocultural Synthesis only tangential concern to cultural analysis. At the same time, with the rise to prominence of postmodernism, some cultural anthropologists have come to define their work as a literary endeavor more concerned with text, text production, and text producer than with an external subject or scientific research. Consequently, many have questioned whether anthropology eventually will bifurcate along a science/antiscience divide that will leave the work of cultural and biological anthropologists forever disarticulated . As Peacock indicates, Physical anthropology and archaeology are often identified with a quasi-positivist perspective, cultural and linguistic anthropology of a certain persuasion with the interpretivist, even postmodernist line ... Divisions-organizational, spatial, economic, political, personaloften polarize in this way. Some academic departments, for example, [already] have split along such fault lines. (1995, 1) Despite these rifts and tensions, it is clear that medical anthropology has become an important meeting place between cultural and biological anthropology. Certainly, it is an arena in which debate and theory construction around biocultural issues have intensified dramatically in recent years (e.g., Johnson and Sargent 1990, Singer 1992). As a result, it has been suggested that medical anthropology now is moving "closer to achieving the type of biocultural synthesis that has long been among the major goals of anthropology as a field" (Johnson and Sargent 1990,8). In this light, contemporary debates within medical anthropology that bear on the topic of bioculturalism likely have important implications for the development of a political-economic biological anthropology and for the wider project of developing a critical biocultural synthesis. Of particular concern in this regard is the effort to create a critical, political-economically informed medical anthropology. Examining these issues in historic context is the aim of this chapter. This examination begins with a review of the demise and re-emergence of political economy as a field of study and of the subsequent creation of the political economy of health tradition in the social sciences (Baer, Singer, and Susser 1997). This is followed by an account of the development of critical medical anthropology as a synthesis of insights and understandings from medical anthropology and the political economy of health. The chapter concludes with an exploration ofthe emergent effort within critical medical anthropology to forge The Development ofCritical Medical Anthropology 95 a critical bioculturalism, including a discussion of the key conceptual developments at the heart of this effort. The Fall and Rise of Political Economy and the Political Economy of Health As a distinct perspective within the social sciences, political economy is both old and new. The term is of fresh vintage in the sense that it constitutes an emergent approach that is looked to as a needed corrective to the reductionism of the recent past, especially within anthropology (Roseberry 1989; Wolf 1982). However, contemporary political-economic research rests on a deep tradition that stretches back in time to a...