Module Code and Title:        ATH201 Medical Anthropology

Programme:                          BA in Anthropology

Credit:                                    12

Module Tutor:                       Abigail Lalnuneng (Coordinator), Dolma Choden Roder, Tashi Choden 

General Objective: This module aims to provide an introduction to the central concepts and concerns of medical anthropology. Students will learn to think critically about the body, health, and medicine. In particular, they will look at the way in which ideas around these topics are historically, culturally and politically contingent. The module will take a cross-cultural approach to exploring a range of relevant topics. 

Learning outcomes – On completion of this module, students will be able to:

1. Outline the anthropological approach to issues around health, illness and the body
2. Define health, illness, and the body from a cross-cultural perspective
3. Apply a biocultural perspective of health and the body
4. Examine medical beliefs and practices within particular cultural, historical and political contexts
5. Summarize the history and implications of biomedicine
6. List the impacts of medicalization on human culture and health
7. Analyse individual experiences of illness and healing
8. Demonstrate an ability to reflect on ethical issues relevant to health research 
9. Critically evaluate health inequalities at both the local and global level.

Learning and Teaching Approach:

Assessment Approach:

1. Field trip report: 10%

Students will individually write a report on a field trip made to a relevant health-related site (logistics of the field trip will be organized by the tutor who will work to ensure ethical considerations such as voluntary consent and protection of the vulnerable shape the selection of the site as well as the way students interact with people at the chosen site). These reports are expected to be both descriptive (for example, describing the site, the people at the site) and reflective (showing that students are attempting to make thoughtful and sincere observations) and must demonstrate the application of relevant key module concepts such as doctor-patient interactions, medicalization or medical pluralism. Students will be provided with a grading rubric that will help to guide the writing of the field report. Reports are expected to be 500 – 750 words in length.

2          Description of the site/ summary of the visit (accuracy and completeness)

5          Quality of analysis (includes well stated and original analysis, uses relevant module concepts and adequate support for all claims made)

1          Organization

1          Language  

1          Referencing

2. Illness narrative: 15%

Students will individually interview someone who has either experienced an illness or a medical event. Students will need to secure formal ethical approval from their tutor before they can conduct the interview and they will have to demonstrate that they will follow standard ethical practices such as acquiring voluntary consent.  They will then produce an “illness narrative” based on the interview that recounts the experience as well as analyse its contents in relation to topics and ideas covered in the module.  The narratives will be 750-1000 words long.

2          Ethical proposals 

2          Draft of Illness Narrative (adherence to set criteria, quality of observations, quality of reflection on ethical issues, uses relevant and adequate support for all claims made)

6          Quality of Narrative (adherence to set criteria, quality of observations, quality of reflection on ethical issues, uses relevant and adequate support for all claims made)

2          Improvement of final product (in comparison to draft, with particular emphasis on consideration and incorporation of feedback provided)

1          Organisation

2          Language and Referencing

3. Illness narrative presentation: 5%

Students will orally present their illness narratives to their classmates. The presentations will be between 7 and 10 minutes long. The presentation will be assessed on:

3          Content (how well does the presentation address specified criteria, quality of overall narrative, all claims relevant and supported)

1          Organization and language use

1          Delivery (volume, pace, efforts to engage audience) and time management

4. Class participation and preparedness: 10%

Students will be expected to participate substantially in class discussions, with contributions reflecting adequate preparation for topics under discussion. 2.5% of class participation and preparedness will be assessed before midterm, and the remaining 2.5% post midterm. An additional 5% for preparedness will focus on the student reading notes as this is a reading intensive module.

5. Midterm Examination: 15%

Students will take a written exam of 1.5 hr duration covering topics up to the mid-point of the semester.

6. Semester-end Examination: 40%

Students will take a written exam of 2.5 hr duration encompassing all the subject matter covered in the semester. The assessment is comprehensive and summative in nature, and will comprise structured questions from all levels of Bloom’s Taxonomy.

Overview of assessment approaches and weighting

Pre-requisites: None 

Subject Matter:

1. Unit I: Introduction to Medical Anthropology
   1. History of medical anthropology: origin and influences 
   2. Definitions of key terms and concepts in medical anthropology
   3. The importance of context to medical anthropology 
   4. Cross-cultural approaches to medicine and health: method, justification and strengths 
   5. Ethical issues and dilemmas in health research
   6. Emergent health research in Bhutan  
2. Unit II: Anthropological Approaches to Health and Illness
   1. The differences between health and illness
   2. Definitions and scope of “normal”
   3. Cross cultural understandings of well-being and illness
   4. Biocultural understanding of well-being and illness 
   5. Bhutanese understandings of well-being and illness 
   6. The sick role and illness narratives 
3. Unit III: An introduction to Biomedicine
   1. Definition and implications of biomedicine 
   2. The history and spread of biomedicine
   3. The medicalization of everyday life: implications, impacts and examples 
   4. The relationship of biomedicine to non-western cultures
   5. Biomedicine’s entanglements with political economy 
   6. Alternatives to biomedicine (e.g., Homeopathy, Ayurvedic, Chinese)
   7. Tibetan Buddhist discourses of health, illness and the body: definitions and implications
   8. Systems of medical pluralism: definitions, implications and examples 
   9. Medical pluralism in Bhutan: description and implications
4. Unit IV: Bodies and Selves
   1. Anthropological theories of the body: definitions and key debates
   2. Biocultural approaches to the body 
   3. The relationship between embodiment, identity and suffering: definitions and implications 
   4. The relationship between stigma and illness: definitions and examples 
   5. Medical anthropology approaches to mental health 
   6. The relationship between understandings of the body and the life course
      1. Birth and reproduction: descriptions and examples 
      2. Dying and death: descriptions and examples 
5. Unit V: Illness and Inequality
   1. Social Stigma 
   2. Human rights discourses and health: definitions and debates 
   3. Understanding and describing health care disparity: descriptions and implication
   4. Structural violence: definition, description and implications
   5. Critical medical anthropology

Reading List

Essential Reading

Fadiman, A. (1997). The spirit catches you and you fall down: A Hmong child, her American doctors and the collision of two cultures. Farrar, Straus and Giroux. 

Farmer, P. (2004). Pathologies of power: Health, human rights and the new war on the poor. University of California Press.

Lhamo, N. & Nebel, S. (2011). Perceptions and attitudes of Bhutanese people on Sowa Rigpa: Traditional Bhutanese medicine: A preliminary study from Thimphu. Journal of Ethnobiology and Ethnomedicine, 7(1). https://doi.org/10.1186/1746-4269-7-3

Taylor, J. (2003). The story catches you and you fall down: Tragedy, ethnography and ‘cultural competence’. Medical Anthropology Quarterly,17(2), 159-181.   https://doi.org/10.1525/maq.2003.17.2.159

Yangchen, S., Tobgay, T. & Melgaard, B. (2016). Bhutanese health and health care system: Past, present and future. The Druk Journal, 2(1).

Additional Reading

Adams, V. (1992). The production of self and body in Sherpa-Tibetan Society. In M. Nichter (Ed.), Anthropological approaches to the study of ethnomedicine (pp. 149-190). Gordon and Breach.

Adams, V. (2001). The sacred in the scientific: ambiguous practices of science in Tibetan Medicine. Cultural Anthropology, 16(4), 542–575. https://doi.org/10.1525/can.2001.16.4.542

Benedict, R. (1934/2017). Anthropology and the Abnormal. In M. Mead (Ed.), An anthropologist at work: Writing of Ruth Benedict (pp. 262-283). Avon Books.

Choden, K., Tobgay, S., & Ugyen. (2013). Healthy Gross National Happiness. Indo-Bhutan International Conference on Gross National Happiness,2, 221-228.

Dorji, T. & Melgaard, B. (2012). Medical history of Bhutan: Chronicle of health and disease from Bon times to today. Centre for Research Initiatives.

Edmonds, A. (2007). Even the poor have a right to be beautiful: Cosmetic surgery in neoliberal Brazil. Journal of the Royal Anthropological Institution,13(2), 363-381. https://doi.org/10.1111/j.1467-9655.2007.00427.x

Good, B. (1994). How does Medicine Construct its Objects? In Medicine rationality and experience: An anthropological perspective (Lewis Henry Morgan Lectures) (65-87). Cambridge University Press.

Gyatso, J. (2004). The authority of empiricism and the empiricism of authority: Medicine and Buddhism in Tibet on the eve of modernity. Comparative Studies of South Asia, Africa and the Middle East, 24(2), 83-96.

Kleinman, A. (1988). Personal and Social Meaning of Illness. In The illness narratives: Suffering, healing and the human condition (pp. 31-55). Basic Books

Lock, M. (1993). Cultivating the body: Anthropology and the epistemologies of bodily practice and knowledge. Annual Review of Anthropology,22, 133-155. https://doi.org/10.1146/annurev.an.22.100193.001025

Lorway, R., Dorji, G., Bradley, J., Ramesh, B.M., Shajy, I., & Blanchard, J. (2011). The Drayang Girls of Thimphu: Sexual network formation, transactional sex and emerging modernities in Bhutan. Culture, Health & Sexuality: An International Journal of Research, Intervention and Care, 13(sup2), S293-S308. https://doi.org/10.1080/13691058.2011.607243

Martin, E. (2001). The women in the body: A cultural analysis of reproduction Beacon Press.

Nirola, D. K., Durham, J. C., & Kraus, K. L. (2015). Balancing traditional beliefs and medical science: mental health care in Bhutan. Bhutan health journal, 1(1), 66-69. https://doi.org/10.47811/bhj.10

Rosenhan, D. L. (1973). On Being Sane in Insane Places. Science,179(4070), 250-8. https://doi.org/10.1126/science.179.4070.250

Taee, J. (2017). The Patient Multiple: An Ethnography of Healthcare and Decision-Making in Bhutan (Vol. 4). Berghahn Books

Wangchuk, P., & Tobgay, T. (2015). Contributions of medicinal plants to the Gross National Happiness and Biodiscovery in Bhutan. Journal of Ethnobiology and Ethnomedicine, 11, 48. https://doi.org/10.1186/s13002-015-0035-1

Wangchuk, P., Wangchuk, D., & Hansen, J. A. (2007). Traditional Bhutanese Medicine (GSo-Ba Rig Pa): An integrated part of the Formal Health Care System Southeast Asian Journal of Tropical Public Health Vol. 38

Wiley, A. S. (1992). Adaptation and the biocultural paradigm in medical anthropology: a critical review. Medical anthropology quarterly, 6(3), 216-236. https://doi.org/10.1525/maq.1992.6.3.02a00030

Date: March 2023