Kaja Finkler Department of Anthropology University of North Carolina, Chapel Hill
This book makes a strong case for the im- portance of medical anthropology for the biomedical professions and exposes us to the work of our European colleagues on issues related to medical pluralism. It con- sists of an introduction by Johannessen, ten chapters dealing with alternative medical practices in various nations or regions, and an epilogue by the two editors. The major- ity of the chapters, and the ones that are most interesting, report on empirical stud- ies done in these venues, although several attempt to address theoretical issues. While the researchers take their cues from a very few U.S. medical anthropologists, the chap- ters for the most part reflect an unfamiliarity with the vigorous and extensive work that is being done in North America on medical pluralism and related topics. Consequently, for a U.S. anthropologist, many of the pieces seem to reinvent the wheel.
The introduction, which attempts to raise various trendy ideas, using unnecessary jar- gon, is a bit difficult to dig into. Standard poststructuralist analysis of the sort that has been discussed in the medical anthropolog- ical literature in the United States in past decades is advanced. However, the ethno- graphic studies make this book a worth- while read.
Two chapters drawing on materials from postcommunist Hungary are particularly in- teresting. In one, Buda et al. deal with the demographics and health status of alterna- tive medicine users in Hungry. The other, by Lázár, focuses on healers who are re- turning to what the author calls “ancient” Hungarian healing traditions; such healers (tâltos) were persecuted during the commu- nist period in the service of dialectical ma- terialism. In postcommunist Hungary, these practitioners have revived the old traditions that they now combine with contemporary spiritualist practices, Christian mysticism, contemporary educational materials, web pages, and videos. They integrate homeo-
pathy, acupuncture, osteopathy, hypno- sis, dowsing, and other such bioenergetics building layers on top of the ancient tradi- tions. It is noteworthy that, as in much of the world, people in Hungary seek alternative healers when biomedicine fails them. How- ever, Lázár notes that patients fail to give biomedicine a chance to do its work before turning to tâltos, who, according to the au- thor, bring back an enchanted world, espe- cially when the mechanistic laws of modern medicine fail to heal.
In another chapter, Frank and Stollberg seek to identify German medical doctors’ motives for practicing heterodox medicine, combining biomedicine with homeopathy, acupuncture, or Ayurveda. They found that heterodox physicians practicing homeo- pathy were usually disillusioned with biomedicine, as well as pharmaceuticals and their side effects. Those practicing Ayurveda normally have had some relation with In- dian culture. The authors could not pin down any one specific motive that pro- pelled physicians to practice acupuncture other than economic self-interest, because acupuncture is profitable. Acupuncture and homeopathy are accepted as legitimate heal- ing systems, and their treatments are re- imbursed by insurance companies. The demand for heterodox medicine is not con- sidered, but it may also influence physi- cians’ decisions. Yet one wonders how these heterodox physicians negotiate the different epistemologies entailed by disparate medi- cal systems.
A particularly good chapter by Barry claims that epistemological concerns seem to be irrelevant to physicians in London who integrate and recommend homeopathy in their practice. The author asserts that, whereas before patients were not concerned with issues of medical epistemologies, now even the practitioners seem to ignore the profound differences among alternative sys- tems’ understandings of how the body func- tions and the etiology of sickness. The au- thors do point out that those physicians who practice homeopathy tend to medical- ize it by focusing on the body, not on the
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social relations important in homeopathic medicine. It would be interesting to exam- ine whether biomedicine itself becomes re- shaped under the influence of such alterna- tive practices.
Knipper’s chapter is theoretically and methodologically sophisticated. It provides a cultural analysis of traditional medical beliefs by showing how in Ecuador intra- venous infusions become reinterpreted in terms of the people’s local beliefs about vi- tal forces. The author argues that to under- stand native meanings is to comprehend lo- cal responses to biomedicine. This is an old idea, but it is nicely laid out, using cultural and linguistic analysis. The author rightly concludes that clear distinctions cannot al- ways be made between local and Western medicine. Whereas indigenous perceptions of the body’s vital forces are not bone fide biomedical ideas, they can serve as tem- plates for people’s interpretation of biomed- ical practices. Knipper emphasizes that to make sense of “local domains of mean- ing” (p. 146), an inductive approach is necessary.
Sigfrid Grønseth studied Tamil refugees’ visits with biophysicians in Norway. These encounters generated confusion of personal identity among Tamils. The chapter pro- vides rich ethnographic detail, and it is es- pecially interesting when one considers how people from extreme southern parts of the globe respond to life in the extreme north- ern part of Norway. Placing her analysis in the broad context of Hinduism, Grønseth argues that the cultural notions the Tamils bring with them to Norway, including med- ical ideas that are part of their everyday life, cannot be separated from the person as biophysicians seem to demand. The chapter would have been strengthened had it em- phasized that the pains the Tamils are ex- periencing and present to the physicians are associated precisely with the precarious sit- uation in which they find themselves in the Arctic North.
Other chapters are less striking. For in- stance, a chapter on the concept of med- icalization, using infertility as its focus,
misuses the concept and is also repetitive. Another, on childbirth in South Asia, por- trays biomedicine as limited because it fo- cuses only on the body—a widely accepted notion in medical anthropology. The chap- ter’s critique of biomedicine and its related advocacy of a biocultural perspective in birthing are old hat. Similarly, a chapter on medical pluralism in Ghana covers little new ground.
Finally, there is a perplexing chapter on what the author considers mental illness in Chiapas. His aim is to show how the local population negotiates modern and various local traditions when a woman presents un- conventional behavior. He analyzes several different explanations of the woman’s be- havior, including a biomedical physician’s. But then he presents the failings of the physi- cian, critiquing the doctor’s unwillingness to accept the local explanation of the woman’s behavior and his insistence on treating her with medications. What is baffling here is why the author encouraged the woman to seek out a biophysician, whose approach he then criticizes. Was he unfamiliar with the biomedical model of treatment? He claims that in the final analysis the patient suffered because of confusing explanations of her ex- istential problems. Yet, he seems to have contributed to this confusion by his own actions.