Trained manpower and medical anthropology:

Trained manpower and medical anthropology:

Sm. Sci. & Med. 1971, Vol. 5, pp. 15-36. Pergamon Press. Printed in Great Britain. TRAINED CONCEPTUAL, MANPOWER AND ORGANIZATIONAL, MEDICAL ANTH...

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Sm. Sci. & Med. 1971, Vol. 5, pp. 15-36. Pergamon Press. Printed in Great Britain.

TRAINED CONCEPTUAL,

MANPOWER

AND

ORGANIZATIONAL,

MEDICAL

ANTHROPOLOGY:

AND EDUCATIONAL

PRIORITIES*t

Associate Professor of Social Anthropology, Department of Psychiatry, University of Miami School of Medicine, Miami Florida 33152.

Abstract-Despite its rapid growth as a substantive area within anthropology, medical anthropology is unable to produce suthcient numbers of trained persons to fill positions now available in academic and medical settings. This paper reviews the goals American Medical Anthropologists recently have set for themselves, discusses their signiticance for the field as a whole, and examines each one as it is relevant to the development and organization of the field. On the basis of the discussion conceptual, organizational, and educational priorities for enlarging the corps of specialists in medical anthropology are delineated.

INTRODUCTION

THERE IS, at present, every indication that medical anthropology is following very closely the pattern of development of its sister discipline, medical sociology. In the last decade it has experienced more rapid growth than any other field of anthropology. It is now faced with the same problems and basic issues with which medical sociology has been coping for a good 10-15 years. Despite its mushrooming as a specialty area, however, medical anthropology is unable to produce sufficient numbers of trained persons to fill positions now available in academic and medical settings. A great deal of the difficulty in this respect stems from lack of organization in the field as a whole. It is of special relevance, then, that medical anthropologists in the United States have been engaged recently in organizational activity designed to solve some of the problems of communication among themselves and their medical c0lleagues.S By so doing they are beginning to bring a higher degree of differentiation and order to their *While the author accepts full responsibility for the views expressed in this paper, she would like to acknowledge that they are in many ways based upon the experience, support, and cooperation of the members of the Steering Committee for the Organization of Medical Anthropoloav. Since November. 1967. this cornmittee has been comprised of the foilowing persons: Clifford R. Bkne~, Donald A. Kennedy, B&an&t D. Paul, Marion Pearsall, Steven Polgar, Norman A. Scotch, Ailon Shiloh, Hazel H. Weidman, Acting Chairman, and Paul E. White. Bejamin Paul has recently withdrawn because of prior commitments and pressure of time. tThis is a slightly revised version of a paper presented at the First International Conference on Social Science and Medicine, Aberdeen, Scotland, September 4-6, 1968. It was prepared while the author held appointments in the Department of Psychiatry, University of Alabama Medical Center,Birmingham, Alabama 35233, and the Social Science Research Institute 1967-68, University of Hawaii, Honolulu, Hawaii 96822. +,Hereafter, when reference is made to colleagues in “medicine”, “the medical system”, or “the medical sciences” it is intended that dental, nursing, and paramedical professional personnel be included as well as physicians. 15 S&M.5/1-B

field, a point which has important implications for increasing the numbers of trained persons in this special area within anthropology. In this paper I shall review the goals American medical anthropologists have set for themselves. I will consider the goals in terms of their promise for ultimately contributing to an educational process which should be able to prepare more persons for specialized work in this field than is currently the case. The method of presentation will be, first, to set forth the goals as stated; second, to discuss their significance for the field as a whole; third, to examine each stated goal as it is relevant to the development of the field; and fourth, to delineate, on the basis of the discussion, conceptual, organizational, and educational priorities for developing an enlarged corps of specialists in medical anthropology. I. STATEMENT

OF

GOALS

The goals of American medical anthropologists, as outlined by Scotch. and White,* modified, and accepted by a group of professional persons in the field,? are as follows: 1. Increased communication between anthropologists engaged in teaching and research in medical and public health areas. 2. Increased communication between anthropologists and physicians and other health personnel who share interests in the social and cultural aspects of health, illness, and systems of medical care. 3. Developing greater impact on the public and on professional groups through the dissemination of research findings. 4. Facilitating the planning and organization of sessions and symposia dealing with medical anthropology at annual meetings of the American Anthropological Association and other societies. 5. Organizing annual meetings of a Medical Anthropology Society in the event there is sufficient interest and there are enough members to make such meetings profitable. 6. Establishing an information center for: a. prospective employers, b. prospective candidates for employment, c. training programs and research opportunities in medical anthropology, d. students in search of training and field research, e. exchanging prepublication papers and manuscripts, f. exchanging course outlines on medical anthropology, g. raising problematic issues for response by others. 7. Keeping an up-to-date register of investigators and their research projects which would facilitate communication and collaboration. II. SIGNIFICANCE

FOR

THE

FIELD

AS A WHOLE

These goals clearly reflect the “in-between” nature of medical anthropology. However one wishes to describe it, the point of importance is that it does sit somewhere between its parent disciplines of anthropology and medicine. Exactly where it is seen as sitting, of course, is dependent upon the primary reference groups and the dominant bodies of theory involved in one’s definition of the field. It also depends upon the factor of “extent of engagement with Western medicine”, which will be discussed in various contexts below. *Norman A. Scotch, Associate Professor in Social Anthropology, Department of Behavioral Science, School of Hvrziene and Public Health, Johns Hookins University, and Paul E. White, Assistant Professor in Social Anthr&ology, Department of Behavioral Science, School of Hygiene and Public Health, Johns Hopkins University. tAt a business meeting of medical anthropologists held on April 27, 1968, at the Claremont Hotel, Berkeley, California, during the Twenty-seventh Annual Meeting of the Society for Applied Anthropology.

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One of the great sources of confusion in thinking about this field and attempting to draw its boundaries is our failure to recognize various stages involved in the convergence of interest areas and theory which is now occurring in the social sciences and medicine. Although anthropologist educators and investigators as a group are simultaneously engaged in every aspect of the process of convergence, we may, nevertheless, conceptually allow the following stages in this process: 1. Medical anthropology as a substantive and theoretical area which has developed from an anthropology which looks at health, disease, and medical systems in both evolutionary and cross-cultural perspective. 2. Medical anthropology as an applied field which involves the introduction of anthropological concepts and methods into our own Western medical system and thereby contributes to the development of a more social-science-oriented medicine. 3. Medical anthropology as a highly specialized substantive and theoretical field involving the integration of concepts from particular facets of anthropology and a particular branch of medicine. This degree of medical anthropological specialization in dealing with problems of a particular branch of medicine requires identification by a more descriptive label such as “psychiatric anthropology ” , “pediatric anthropology”, and the like. ,As a sub-specialty field within medical anthropology, generally, it contributes directly to bodies of knowledge and theory of the parent branches within both anthropology and medicine. 4. Medical anthropology as a substantive and theoretical area which draws from medical behavioral science through exposure to, confrontation with, and integration of various conceptual approaches and methodologies, thereby becoming capable of making unique contributions to general anthropological theory. 5. Medical anthropology as a substantive and theoretical area resulting from the integration and beginning synthesis of anthropological and medical concepts. Since this occurs after some’ experience in medical settings and involves the integration of concepts from other social sciences as well as the medical sciences, medical anthropology in this sense is closely related to and possibly identical with “medical behavioral science”. Its main contribution is to a developing behavioral science theory which feeds back into both anthropological theory and theory in the medical sciences. When writers refer to the “anthropology of medicine”, they focus upon stage on in this conceptual scheme. Those who write about anthropology in medicine refer to stage two as the application of stage one. When medical anthropology is described as “dualistic in orientation” [2], the emphasis is most nearly that of stage three. When medical anthropology is described as a “synthetic” discipline [g] stage four seems most appropriate. And when anthropology’s gain from medical anthropology is considered, the orientation seems most nearly that of stage four. When medical anthropology.is viewed as a “medical behavioral science”, stage five is most clearly involved. In one way or another, all of these facets of medical anthropology are subsumed by the stated goals of medical anthropologists in the United States and are involved in the convergence of interests which is occurring in the social and medical sciences [7]. Medical anthropology is, therefore, all that is implied by these “stages” in the process of convergence. No further attempt to define the field will be made here. Instead of trying to delineate more sharply the shape and substance of medical anthropology, it seems more important at the moment to attempt to clarify in our own thinking about it, the level of abstraction at which we work at any point in time and the predominant stage in the process of convergence

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I-h30?4

wEILMAN

to which our theoretical formulations speak. Aside from this, however, our understanding of the field is deepened considerably when we analyze each goal separately. III.

EXAMINATION

OF G.OALS

Goal 1, to increase communication between antropologists engaged in teaching and research in medical andpublic health areas, suggests the degree to which anthropologists have moved out of their traditional roles and investigations to become engaged in different problems and activities in medical settings. It suggests the “applied” nature of medical anthropology’s main current and its beginnings as a special field within anthropology. It suggests, also, the independent and separate routes to medicine which have been taken by anthropologists in this trek to the “in-between”, They have become involved in and identified with a large and scattered literature, but because they have moved into the field separately, pursuing individual interests and opportunities, they are unaware of the majority of others who are similarly engaged. Because they have attached themselves to specific programs without a broad knowledge of other similar projects or activity, they are also unaware of the scope of the field. The obvious need expressed by this goal is to learn who we are, where we are, and what we are doing. By not knowing who we are, we have no idea as to our numbers. By not knowing where we are, we have no idea of the selectivity exerted by the medical system itself, which should in the long run be related to training needs. By not knowing what we are doing, we have no idea of the nature and scope Qf the field or any conception of the extent or detail of programs in medical anthropology either in the academic world or in medicine. Thus the need for increased communication between anthropologists engaged in teaching and research in medical and public health areas. Goal 2, to increase communication between anthropologists andphysicians and other health personnel who share interests in the social and cultural aspects of health, illness, and systems of medical care, rounds out the picture of the “in-between”. It emphasizes that not only have anthropologists been drawn to medicine, so, too, have physicians and other health personnel been drawn to anthropology. They have been drawn particularly to those facets of anthropology which look at health and illness through time and in space and consider not only epidemiology and ecological settings but also systems of medical care devised by man and the relationship of such institutionalized forms of care to other aspects of social and cultural system functioning. Representatives of the medical system, too, have moved along separate routes in their independent migrations to the “in-between”. By way of reflecting the degree of ferment and lack of order in this area marginal to both disciplines, they have not necessarily made easy contact with each other or with their anthropologist counterparts. Thus, the need for increased communication among anthropologists, physicians, and other health personnel who share interests in the biological, ecological, social, and cultural aspects of health and disease and related systems of medical care. Heretofore, there has been no easy way to accomplish this. Goal 3, to develop greater impact on the public and on professional groups through the dissemination of researchjindings, suggests the independence and diversity of the work being done in the field. There is an impressive but at times elusive literature, to which a number of excellent reviews and bibliographies will attest [l, 7,9, 5, 6,4]. The impact of this literature is lessened, however, because of poor visibility and organization of the field in general. This

Trained Manpower

and MedicaI Anthropology

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19

means that the enormous effort which goes into every individuai’s mastery of the field in the first place and into his own contribution to it in the second place, is to some extent dissipated and its benefits reduced. Those who could use it well may or may not be aware of it, and the viability of any work is threatened if it cannot easily be related to a growing theoretical body or channeled to reach an appropriate audience. Its potential for adding to a cumulative body of knowledge or for use in action programs is weakened. Thus, the need to develop greater impact on the public and on professional groups through the dissemination of research findings. Perhaps “appropriate dissemination of research tidings” is the more accurate phrasing here. Implicit in this goal and essential to its achievement are all of the organizational appurtenances required for effective dissemination of research findings to public and professional groups. The extent to which these exist at the moment is somewhat embarrassing. It is noteworthy that goal 3 leaves the particular order of “research tidings” undefined. This allows us to make explicit an important point in connection with it. That is the special importance of developing increased impact on two groups of professionals in particular, i.e. medical anthropology’s parent groups of professional anthropologists and professional medical people. A difficulty arises, however, in the fact that two main theoretical trends are developing within medical anthropology. One is primarily oriented toward contributing to general anthropological theory. The other is a theoretical trend in medical anthropology which is more directly cqncemed with contributing to a medical behavioral science theory. Medical behavioral science is beginning to be more than a label covering all of the dualistic linkages of each social science with some branch of medicine. Even though it still very much represents a composite group of professionals who have training in one discipline in particular, special interests in and ties to two or more others, it is, nevertheless, much broader in scope than medical anthropology and is beginning to develop its own impetus toward a cumulative theoretical tradition. We are now beginning to speak of medical behavioral science theory, Medical anthropologists are involved in both theoretical trends. This means that the dissemination of research findings in medical anthropology requires extensive “crossfertilization”, if you will, if the impact of both of these trends is to be felt in any meaningful way by the parent bodies of theory in anthropology or medicine. The organizational appurtenances required for such cross-fertilization must be as divergent as the trends themselves. This raises a rather basic problem in connection with the accomplishment of goal 3. Nevertheless, once organizational progress has been made in these two directions, it will, indeed, be possible to tap the research findings and vast literature of both and to present them in such a way that they cannot help but have greater impact upon public and professional groups as a consequence of appropriate and efficient dissemination of research findings. Goal 4 is to facilitate the planning and organization of sessions and symposia dealing with medical anthropology at annual meetings of the American Anthropological Association and other societies. Such planning and organization of programs is seen as a means of appraising current activity in the field, pointing to new areas in which research is needed and in setting new directions. The aim is also to stimulate theoretical and research papers of exceptionally high quality whenever they are presented, i.e. regionally, nationally, or internationally. In one way or another this is, perhaps, the most ambitious goal of all. It presupposes a better overview of the field than any one person or select group of persons carries at this point in time. It assumes that we have better knowledge of the content of courses in medical

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anthropology at the undergraduate level and better knowledge of requirements for graduate training programs in medical anthropology than we, in fact, have. It assumes a more comprehensive grasp than we can master of the anthropologist’s activity in medical programs and research projects, his involvement in various branches of medicine, and his contribution to behavioral science curricula in medical schools. It presupposes some sort of ongoing method of inventory by which research and other activity in the entire field may routinely be determined. Most importantly, goal 4 is premised upon the supposition that an organizational structure either exists or can be devised which would allow planning and organization of sessions and symposia dealing with medical anthropology at annual meetings of the American Anthropological Association and other societies. None of this obtains, although, of course, these are the directions in which we are moving. In order to plot the course of a field, i.e. to plan sessions which would not only help to establish a cumulative trend in theory-building but also point to gaps in theory, methodology, and data collection in general anthropology, the closure of which would eventually contribute directly to theory in medical anthropology, we need first to see very clearly what is happening in the field and where it is occurring. Beyond that we need to be in a position to effectively encourage pursuit of the most promising avenues of research. At this point in time we have nothing remotely resembling the comprehensive view required for the accomplishment of all that is implied in goal 4; nor do we have the organizational structure with which to bring it about even if this were the case. Indeed, that is what the other goals are designed, in part, to do, and they are intimately involved in the steps to the accomplishment of this one. Nevertheless, let us assume for the moment that we have the organizational structure to implement goal 4. What then ? Pearsall has recently made an excellent suggestion in this regard. She writes in this connection as follows: Research papers in medical anthropology of course are already well-represented at such meetings. But I would like to see a session that concerned itself with two topics not usually covered: (1) effective approaches for introducing behavioral science in the medical (also dental, nursing, and paramedical) curriculum; and (2) requirements for a medical anthropology specialty in anthropology graduate programs. (Personal communication, May 13, 1968.)

First it should be noted that even though Pearsall is concerned about requirements for a medical anthropology specialty in anthropology graduate programs, she, as a medical anthropologist in the context of the medical system, becomes engaged in problems of introducing behavioral science into the medical, dental, nursing, and paramedical curricula. This is not due entirely to her position in a department of behavioral science. It reflects the extent to which most anthropologists in medical settings realize that medicine needs more from the social sciences than anthropology alone can offer. Seeing this need and responding to it, the anthropologist in such settings becomes a different kind of anthropologist, indeed, a different kind of medical anthropologist. He becomes, in a sense, a behavioral scientist, utilizing theory and data relevant to the educational and research problems before him from whatever field offers anything of value in that particular context. He synthesizes to whatever extent he is able, and he uses this synthesis creatively, adding new insights and new hypotheses which eventually become formalized, codified, verified, and, therefore, part of a developing behavioral science theory which has relevance to general anthropological theory. Unfortunately, at this point in time we have not yet formalized, codified, or attempted to verify most of the hypotheses brought about by syntheses achieved by “medical behavioral

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scientists”. Such individuals have never come together to discuss the content of what they teach, nor have they published in any detail the conceptual models with which they work as they go about their tasks in the medical setting. This is what Pearsall is trying to bring about through her suggestions regarding the planning of medical anthropology programs at annual meetings of professional societies of anthropologists. We might digress for a moment to consider in a little more detail the nature of the anthropologist’s responsibilities in medical settings. In my opinion there are four major tasks to be accomplished. They are as follows: 1. Introducing social science concepts into the medical system by means of lectures, seminars, special training programs, consultation, informal discussion, publications, etc. ; 2. Applying our specialized knowledge at various points in the medical system by means of action programs, basic research design, solving organizational problems, helping to establish policy, introducing new services, etc.; 3. Contributing to a developing medical behavioral science theory by synthesizing something of anthropological theory and the body of theory supporting whatever branch of medicine is involved in one’s major assignment, i.e. anthropological and epidemiological theory, anthropological and psychiatric theory, anthropological and pediatric theory, etc. ; 4. Offering specialized training in medical anthropology to graduate students of anthropology by means of training programs in departments of anthropology and within the field of medicine. There will be no quarrel with the first two points. These have provided the basis for the unidirectionality given to medical anthropology by many who see it largely as an applied field. Such directionality, from anthropology toward medicine, is premised upon the assumption that there is as yet no such thing as a body of theory which comprises medical anthropology. This appears to be a key problem in the orgagization of the field even though many of us in medical anthropology are quite in accord with Scotch’s 1963 statement: “It is our contention that thii area can be studied rigorously, can be used to test hypotheses of a general nature, can be productive of concepts and theory, and can develop systematic methodologies, as well as produce substantive data. It should by now be an axiom in anthropology that what comes out of research is not dependent on the narureof the problem tobe studied but rather on the way theproblem is studii.“[9]

Still, when we look closely at the literature we are everywhere confronted by what seems to be a paucity of theory and an apparent absence of a cumulative trend which builds on those hypotheses which do exist. This problem of a paucity of theory is acknowledged by Polgar as the most important issue raised by his Current AnrhropoZogy review article [7J. Each of us utilizes some broad theoretical framework in defining the field, but these have not been generative of theory because we have allowed them to remain conceptual approaches only. We have not made explicit basic assumptions which, in fact, should become working hypotheses. Also, theoretical issues have been revealed in various classifications of the literature of medical anthropology, and still theory is not developing. My own feeling is that it would be a great mistake to periodically attempt to codify. all of the literature of medical anthropology. Such classifications are useful for getting about in the literature, but they do not inevitably stimulate further contribuGons to the issues raised. No doubt this is because in our everyday work on our problem-oriented tasks we do not use the literature of medical anthropology in this way.

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The real tragedy is that we have not capitalized on the special uses of the literature which have been brought to bear upon problems faced as anthropologists have been drawn headlong into confrontation with theoretical models within medicine itself. We now have enough experienced people in the various branches of medicine that we should be able to attempt some organization of the field in terms of the structure of modem medicine. Those of us in each of the different branches of medicine do not use all of the literature of medical anthropology in working with our physician colleagues in these separate fields. As Polgar has said, “Social scientists who work in basic epidemiology must use different theories from those who concern themselves with medical professionals and health programs” [7J. Which facets of the literature, then, apply to specific branches of medicine? And what are the key issues in each of these branches of medicine which have particular relevance to anthropological theory? What are the challenges each offers to gaps in anthropological theory and method? What we need to see now is how the literature of medical anthropology is used in various contexts. It would seem that tasks 3 and 4 outlined above for anthropologists in medical settings might provide the means of beginning a cumulative tradition in medical anthropological theory. It is no longer true that the anthropologist consultant “brings to the client certain requested information and, with the exception of feedback information necessary to his proper functioning, there is no necessary learning by the consultant” [3]. We have gone beyond the point where, in the final analysis “the relevance of the problem under investigation . . . is to applied medicine and not primarily to social science” [3]. We have gone beyond the point that “As a consequence, direct contributions to the theory and methods of social science do not characteristically emerge from such applied research” [3]. Medical anthropology is much closer to the middle of the interspace between anthropology and medicine than the above remarks suggest. Consequently, it is now beginning to contribute to both parent disciplines in its own way. Since the full body of theory which is emerging in the interspace between anthropology and medicine is not restricted primarily to medical anthropology but also includes medical sociology, medical psychology, medical geography, medical economics, etc., we may legitimately speak of a medical behavioral science which derives from the exchanges between the various social sciences and various branches of medicine. This fact is now so apparent that it would be surprising if any anthropologist engaged in any sign&ant way in a medical setting did not consider point 3, contributing to a developing behavioral science theory, as one of his major responsibilities as a medical anthropologist and a prerequisite to stature and recognition in the field. If this is so, then he will undoubtedly have at his command specialized knowledge to contribute to programs in medical anthropology in graduate departments of anthropology. The task which follows from this is stated in point 4 above, i.e. to offer training in medical anthropology to graduate students of anthropology. With the demands for trained persons so much greater than the supply, he either accepts the responsibility to contribute in this fashion to the field or he rejects it. The responsibility, however exists. Task 4, in my opinion, remains. What about task 4 in the light of the current state of organization of the field? How can we best offer training in medical anthropology to graduate students of anthropology ? Many of us are in administrative situations which do not easily allow joint appointments. Distance from graduate schools of anthropology is another inhibiting factor involved. There are others. For whatever reasons, there are a good many anthropologists, well-established in the field of medical anthropology, carrying new insights and holding at their command fresh

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ways of viewing problems, who do not offer their specialized knowledge to graduate students of anthropology and who are not available to them for consultation. In view of the fact that there is no basic textbook in medical anthropology, this represents a rather crucial weakness in so far as trained manpower in the field is concerned. It would seem that we need to think seriously about establishing more effective patterns of communication between those who consider themselves to be medical anthropologists and those students who might be attracted to the field or who are already in it. Pronounced visibility of a field seems to be a prerequisite for encouraging capable graduate students to specialize in it. Once committed they should be offered all that medical anthropology has to offer. If more of us are to take seriously point 4 as one of our primary tasks as medical anthropologists, how do we proceed ? How much do we know, really, about the requirements for a medical anthropology specialty in graduate programs in anthropology? For that matter how many graduate programs in medical anthropology are there ? Three ? Four ? Five at the most? Whatever the numbers, where is there anything like a basic text in the field? It does not exist. And what material is used for teaching purposes? Whatever it is, it is most assuredly widespread throughout numerous journals and books, some of which are easily accessible, some of which are not. For those who are training doctoral candidates in medical anthropology, where is the literature to teach the sub-specialty areas ? Some sub-fields are now firmly based on the experience of a good many individuals in epidemiology, psychiatry, pediatrics, preventive medicine, public health, nursing, and the like. There is an uneven literature with some subfields being much better represented than others. Many of these publications, however, are more appropriate for teaching in these various branches of medicine than they are for teaching graduate students of anthropology about them. If we take psychiatry as an example of a sub-specialty area, we have probably 40-50 people currently engaged full-time in departments of psychiatry, teaching, conducting research, playing consultant and advisory roles, etc. The fact that we must estimate the numbers of persons so situated is significant in itself. What our total numbers are in all branches of medicine combined is currently unknown. Again, we do not know with certainty, but most of those in departments of psychiatry seem to have come out of anthropology with a specialization in some field such as culture change, culture and personality, values, linguistics and communication, non-human primate social organization, and the like. Few, indeed, have come to psychiatry with a specialization in medical‘anthropology. Whether we have intended to or not, we have become specialized in medicine to some extent and in psychiatry to great extent. If we have not, we have not been very effective. This is because in our assignments the main problem has been to establish relevance. Anthropology and the other social sciences have much to offer, but unless it is made absolutely pertinent to what is going on at the moment in residency-training programs, a great deal is lost. In order to establish relevance a good knowledge of the medical system as a whole, its psychiatric branch, and the philosophy of a particular department of psychiatry are essential. By becoming knowledgeable in these and other ways, we have had more to offer departments of psychiatry; so also have we had more to offer graduate students of anthropology who wish to become medical anthropologists with some understanding of what psychiatric anthropology within the broader field really implies.

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Here, then, is a group of individuals who have had experience in a wide variety of departments of psychiatry. All have in one way or another tried to make anthropology relevant to psychiatry and vice versa at one level or another. In doing so they have touched upon key issues in basic psychiatry, hospital psychiatry, community psychiatry, child psychiatry, forensic psychiatry, and the like. These issues reveal in a way not possible without such intimate grappling with problems of relevance, basic needs in both psychiatry and anthropology which must be met before there is a more successful synthesis of the two approaches into a true psychiatric anthropology or a genuine transcultural psychiatry. Even so, not a single handbook or basic text in psychiatric anthropology has been produced; many theoretical works, yes; a full-fledged handbook, no. Can we really afford to waste quite so much energy in this way? Are departments of psychiatry so very different that we cannot generalize from one to the other and assume that key issues in one will be similar to key issues in another? No, I think not. We now know something about the nature of the collaborative relationship and about the issues involved in collaboration between anthropologists and psychiatrists. Accommodations have had to be made in terms of administrative structure, professional role, conceptual organization, and methodology. Why have so many people, experienced in such settings, not produced basic works which would be helpful to educators in departments of psychiatry as well as to educators in departments of anthropology; to residents in psychiatry as well as to graduate students in medical anthropology ? The answer to this question is not entirely clear. I suspect that it is because we have worked so independently and have been in such little contact with each other as a result of the unorganized state of the field that, quite simply, we have not realized the extent to which psychiatric anthropology has emerged as a sub-speciality within medical anthropology. There has been a long tradition of interchange between anthropology and psychiatry at the theoretical level, but only recently have we had quite so many persons situated in full-time positions in departments of psychiatry. Now that we recognize psychiatric anthropology as a sub-specialty area, however, it would seem foolish, indeed, to allow the continued, separate expenditure of energy by individuals who have the means of harnessing that energy and building upon it. My feeling is that one of our educational priorities should be the development of specialized handbooks for the sub-specialty areas which have emerged in medical anthropology. Not onIy do we need these in order to apply more efficiently the knowledge we have already accumulated but also to begin to develop a body of theory which will utilize more fully understandings of our own medical system along with that of other medical systems. We need these, too, as a basis for a general textbook of medical anthropology. It seems that before we can establish the scope of the field with any clarity or detail we need first to see what its sub-specialty areas entail. When we have both a general textbook and a series of handbooks on the sub-specialty areas, we will be in a position to train graduate students as true specialists in medical anthropology. We will know fairly well what the graduate requirements should be. Hopefully, we will be able to avoid placing our students in the position of the doctoral candidate in medical anthropology who recently commented to me as follows : “I’m a medical anthropoligist, and I’ve just accepted a position which involves teaching anthropology to nurses. How do you teach a course in medical anthropology to nurses?’ Publication is no problem. Northwestern University Press has recently announced the

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introduction of a handbook series in medical behavioral science.* Certainly educational priorities of this nature can be met easily if we but solve the problems of organization. There are some other educational problems to be touched upon here. If, for example,

there are as yet no general textbooks of medical anthropology, what is being taught in undergraduate courses in this field ? Again, we are not sure. Those of us who have worked up undergraduate courses in medical anthropology have undoubtedly emerged with somewhat similar conceptual schemes for presenting much of the data. We do not know this to be a fact, however, for we have never met to discuss such matters; nor have we exchanged course outlines. Whatever synthesis into a coherent system has been achieved has not been set forth in any kind of detail and published for others to use. Not only is this of importance in so far as our own undergraduate training is concerned, it is significant in another context as well. It is this synthesis into a coherent system which our medical colleagues seek when they first approach the literature of medical anthropology. They soon find, however, that in order to achieve coherence, they, too, must peruse and digest the contents of a very large number of publications. Often many of these arc not in their libraries. Therefore, in order to devise anything very useful or comparable to the conceptual schemes held by medical anthropologists, an enormous effort is required of them. In so far as undergraduate’exposure to the field is concerned, we might also ask about medical anthropology’s representation in general textbooks on anthropology which are used in introductory courses. Medical anthropology does not appear. This time lag is not unusual in the expansion of a discipline such as anthropology; however, the heavy emphasis on medical anthropology in programs of annual meetings and the rapid growth of the field would seem to warrant such recognition. Just how this might be brought about is not clear. These are some of the problems which underlie Pearsall’s interest in learning more about behavioral science curricula in medical settings and about requirements for graduate training programs in medical anthropology. This lengthy digression into some of the basic problems we face should provide meaning to the earlier statement that in one way or another goal 4 is, perhaps, the most ambitious goal of all. Let us return to the consideration of goal 4. Its aim is to facilitate the planning and organization of sessions and symposia dealing with medical anthropology at annual meetings of the American Anthropological Association and other societies. If we are to be realistic we must recognize that there is, at present, no way in which medical anthropologists might legitimately plan their own programs at American Anthropological Association meetings or at annual meetings of other societies, such as regional societies, the Society for Applied Anthropology, the American Ethnological Society, or the International Congress of Anthropological and Ethnological Sciences. The responsibility for such planning rests solely with the program chairman of each of these professional organizations, and his ordering of sessions is based largely upon volunteered papers and individually-organized symposia. Only as a medical anthropology section of the American Anthropological Association would this degree of control over program planning be possible within the American Anthropological Association itself. Furthermore, only through formal relationships between such a section and the regional and international anthropological societies could *In the Medical Anthropology Newsletter, Vol. 1, No. 1, 1968. Interestingly, this represents a reversal of the usual pattern whereby pubIishing houses lag behind trends in academic fields. Publishing policy in this instance may well pull the field forward instead of waiting until it is thoroughly established in undergraduate curricula before entering the picture.

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any comparable control over program planning outside of the national association be possible. In SO far as the organization of a medical anthropology section within the American Anthropological Association is concerned, Scotch wrote in 1963 as follows: ‘There are probably enough anthropologists now working either as researchers or teachers in medical settings so that it might be worth while to consider setting up a section of the American Anthropological Association analogous to the Medical Sociology section of the American Sociological Association. Such a section, in addition to putting anthropologists of similar interests in touch with each other and keeping members better informed of current research, might serve an even more important function in helping to upgrade the quality of research.” [9]

Certainly numbers do not constitute the basic problem here. There is evidence from a recently-prepared roster of medical anthropologists* that there are well over 200 persons who give every indication of supporting a move toward some sort of formal organization of medical anthropologists. We not only have sufficient numbers of medical anthropologists to request section status, we also have the means of reaching them regularly through a newsletter which is currently being established.7 However, the constitution and by-laws of the American Anthropological Association do not, at this time, allow the organization of sections within the structure of the Association. Until sections are established and until medical anthropology becomes one of them, there is very little likelihood that goal 4 will be achieved in the near future. Without a doubt, a formal organization of some sort is required for the achievement of the goals medical anthropologists have set for themselves. No matter how highly motivated a single individual may be in generating interest in improved communication among medical anthropologists and their colleagues in the medical profession; no matter how highly supportive a steering committee for the organization of medical anthropology may be; no matter how successful in achieving a greater degree of communication, no single individual or group of individuals working informally can solve the basic problems touched upon above and, thereby, bring about the organization of a field. A formally-organized group, on the other hand, can do this. Exactly what sort of organization will be most effective in accomplishing the goals outlined above is not entirely clear. The reason is that organizational priorities must be related to the two converging but still distinct theoretical trends mentioned above. One is from a medical anthropological theory toward general anthropological theory. The other is from a medical anthropological theory toward the development of a medical behavioral science theory which may someday encompass the former. The organizational steps required to support the former theoretical trend are very different from those required to support the latter. The goals set forth above apply to both. How, then, to organize? Clearly, a single organizational structure will not suffice. If one body of theory is more focused upon a medical anthropology which is distinct from medical behavioral science and is concerned with contributing to general anthropological theory, then let us develop greater cohesion as a group within the structure of our parent organization, the American Anthropological Association. Let us, as medical anthropologists, have strong ties with each other and with anthropological organizations not only at the national level but also at regional and international levels. Let us keep in touch with *“Roster of Anthropologists, Physicians,and Others Who Have Special Interests in Medical Anthropology,” prepared by this writer in the early months of 1968. tAs a consequence of a meeting of medical anthropologists in Berkeley, California, April 27, 1968.

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general anthropological theory, with key issues of policy and education, etc. In so doing, let us also maintain our ties with medical colleagues, welcome liaison-fellows and members from the medical system into this formal structure to keep input from medicine into medical anthropology strong and challenging. At the same time, in so far as we are also involved in another current which is carrying us increasingly toward medical behavioral science, let us organize for greater cohesion among physicians and other medical behavioral scientists at the international level. With organization on this scale we will be able to keep “feedback” flowing in both directions, i.e. from anthropology to medicine and medical behavioral science and, vice versa, from medicine and medical behavioral science to anthropology. Both are essential, as will be suggested in the statement of priorities presented in the final section. Goal 5 is to organize annual meetings of a Medical Anthropology Society in the event that there is suficient interest and there are enough members to make such meetings profitable. This goal, of course, is very much related to whether or not changes in the by-laws of the

American Anthropological Association allow, on the one hand, the organization of sections and, on the other hand, liaison-fellow status for professional colleagues from other disciplines. The constitution of the American Anthropological Association does not now include these possibilities. Goal 5 is also related to the extent to which other goals outlined above may be achieved in the absence of a formal organization. In the face of current needs for and pressure toward organization, it seems inevitable that a formal structure will emerge. Individuals separately cannot represent or organize a field very adequately. Together, as a group with wellfunctioning committees and capable, energetic officers, they can. Since the rapidity with which the field becomes organized is involved, and since the enlargement of a corps of specialists in medical anthropology is very much dependent upon the organization of the field, it would seem imperative to move quickly toward either a medical anthropology section of the American Anthropological Association or an inda pendent Medical Anthropology Society. It should be noted, however, that each of these alternatives serves primarily the theoretical trend in medical anthropology which moves more directly toward general anthropology than toward medical behavioral science. Goal 6 is to establish on information center for the following: a. prospective employers, b. prospective candidates for employment, c. training programs and research opportunities in medical anthropology, d. students in search of training and field research, e. exchanging pre-publication papers and manuscripts, f. exchanging course outlines on medical anthropology, g. raising problematic issues for response by others. Clearly a, b, c, and d of goal 6 are primarily to bring individuals and opportunities together; while e, f, and g relate to information exchange along any of the conceptual, organizational, or educational dimensions. They are designed not only to solve individual, practical problems but also to emphasize the theory-building aspects of improved communication and the potential of medical anthropology for collaboration with medical system personnel in training and research on a scale which is increasingly international in scope. These goals, I believe, reflect the degree to which medical anthropology is established as a viable and growing discipline. In many ways medical anthropology has made its point. Not only must heahh and disease be considered in biological, ecological, social, and cultural

28

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terms, but systems of medical care, too, must be understood in cultural context. The current problem for social-science-oriented persons in the medical system is not access to the literature. How could anyone with even slight awareness of the field be left wanting in this respect in the face of bibliographies such as those offered by Caudill [ 11,Polgar [7], Scotch [9], and Pearsall [S, 61, to say nothing of those contained in Freeman, Levine and Reeder’s Handbook of Medical Sociology [4] ? No, the major problem with regard to medical anthropology for our colleagues in medicine today is access to people. Health professionals are interested in medical anthropologists for joint educational projects, for joint research projects, for joint action programs. They no longer need exposure to the field. They need a more intimate, working relationship with it through individuals. They need to be in easy and routine contact with anthropologists who can design courses for health workers not interested in medical anthropology as a career. They now want to participate with anthropologists in interdepartmental seminars at the faculty level. They now need a more frequent exchange of views in convergent areas of interest than annual meetings, conferences and panel discussions provide. They want anthropologists to join them in solving epidemiological problems, developing community health programs, training health aides, and the like. Clearly, the literature of medical anthropology alone no longer suffices. In the light of this literature, however, persons are now a highly valued commodity. From the medical system’s point of view, how does one locate them? There is no medical anthropology sectiob of the American Anthropological Association; consequently, the executive office of this association has no directory or mailing list for such a group. There is no independent Medical Anthropology Society which might provide such information. There is no international directory of such persons. There is as yet no established medical anthropology newsletter, well-known to all branches of medicine. There is, in fact, no simple and direct way for representatives of the medical system or, for that matter, other anthropologists, to easily locate, correspond with, or attempt to recruit medical anthropologists. Only by word of mouth, advertisement in newsletters of various professional organizations, recruiting at annual meetings, or through personal contact with other anthropologists or departments of anthropology are there any entrkes to this specialized group within anthropology. The importance of this factor as a deterrent to effective collaboration by professionals in both fields is revealed by Hanlon’s comment on Polgar’s 1962 review article in Current Anthropology. He wrote as follows regarding “. . . what is by now a very solid background of mutual interests and relationships . . . which is amply evidenced by the extensive bibliography appended”: “There is no longer justification for delay in attempting to develop satisfactory and useful ways of working together on a daily program operational basis.” [7]

Since that time, however, four additional major bibliographical orderings have appeared, six years have passed, and all that seems to have been accomplished is that there are now greater numbers of us who acutely feel the need for more structured and efficient means of relating to and working together. Our deficiencies in this regard have special poignancy for graduate students. The lack of any established way to bring persons and opportunities together and to exchange other kinds of information is grossly inhibiting to the use of graduate students in health programs in various countries throughout the world. This applies equally to programs in international health in schools of public health, to programs which link medical schools in the United

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States with medical schools in other countries, to community medicine programs with crosscultural clerkships, to health-related projects of the Peace Corps, to activities of World Health Organization, etc. The doctoral candidate in anthropology who wishes to specialize in medical anthropology must also specialize in the cultures of a particular geographical region. Why should those health programs in various geographic regions not make use of the anthropological training and appropriate interest of such students to gain knowledge required for more effective implementation of their programs? And why should the student not have easy access to the geographic area of his choice as he explores.some facet of problems of health and disease and systems of medical care in historical or cross-cultural perspective? The single, overriding complaint from any international health program wishing to make use of the anthropologist’s skills is that there is no way of locating those anthropologists with special knowledge of a particular geographic area and with special interests in health and in applied anthropology. By dejinition medical anthropologists are qualified in these respects. The doctoral candidate in medical anthropology is not yet a professional. Nevertheless, if he is ready for field work, he is very close to professional status as a medical anthropologist and could work effectively in such settings. Two steps have been taken recently which should contribute much toward the achievement of parts a, b, c, and d of goal 6 above. The first is the development of rosters of medical anthropologists, including graduate students specializing in the field.* The second is the recent decision to establish a medical anthropology newsletter despite the absence of any formal organizational structure for medical anthropo1ogists.t Even though it will be some time before such a newsletter is well-established or widely known within the medical system, it should, nevertheless, begin to channel more productively the energies now being expended in the accomplishment of parts a, b, c, and d of goal 6. In many instances, no doubt, the effort involved in locating qualified anthropologists is overwhelming, and no attempt is made to solve the problem at hand. With the demand so great and trained persons so few, we cannot fail to explore the potentials of a network of communication which the medical anthropology rosters and the Medical Anthropology Newsletter provide. We should be able to direct appropriately trained persons to regions of their choice andto programs to their liking. How much easier, too, the process of recruiting for health programs in such areas. In terms of the primary focus of this paper, widespread knowledge of international health programs and greater efficiency in communicating on this scale should also provide rich material for drawing more graduate students into a medical anthropology specialty. Goal 7 is to keep an up-to-date register of investigators and their research projects which would facilitate communication and collaboration. As indicated above, steps have already been taken along these lines. Two rosters have been prepared, one international in scope, the other more national in scope and more mixed in character. Although some information is already being reported to the editor of the Medical Anthropology Newsletter in response to a brief questionnaire mailed to the persons on the “national” roster, a more *An “International Roster of Medical Anthropologists”, compiled from the directory of associates of CurrentAnthrqmlogy through the generous help of its editor, Sol Tax and his staff; also, a more local, more mixed “Roster

of Anthropologists, Physicians, and Others Who Have Special Interests in Medical Anthrofor distribution by Hazel H. Weidman, with the cooperation of the Social Science Research Institute, University of Hawaii. TAt the April 27th, 1968, business meeting of medical anthropologists in Berkeley, California, Hazel H. Weidman was charged with the editorship and responsibility for developing a Medical Anthropology Newsletter.

pology." Both were prepared

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extensive survey of the entire group is now within the realm of possibility, With good cooperation, it should be possible to maintain an active inventory of teaching as well as research in medical anthropology by circulating questionnaires annually. One function of such an inventory might also be to accumulate full bibliographies of published and unpublished items of each person on the roster which fall within the purview of medical anthropology. Not only could an author index be established, so, too, could indices be established for the sub-specialty areas of medical anthropology, for geographical areas, and for general theoretical statements, to name a few of the possibilities here. If workers in the field could be persuaded to routinely send copies of their papers and reprints of their publications, it might be possible to establish either independently in the office of the Newsletter’s editor or within the confines of, say, the National Medical Library, an Archive of Medical Anthropology. Titles of items submitted could be published regularly in issues of the newsletter, and announcements could be made about forthcoming and newly-published items of special interest. Conceivably, these titles could be incorporated routinely into the Index Medicus or Excerpta Medica, the key reference works within the medical system. * Other possibilities for building along these lines include an ethnographic jilm library for films covering various aspects of medicine throughout the world. Films of the Weisman Collection of Pre-Columbian Medical Sculpture? along with es of other data from the field of paleopathology would add a most valuable time dimension to such an endeavor. This degree of organized knowledge of our field would, indeed, provide us with rather remarkable tools, unexcelled, perhaps, in any other branch of anthropology. The major goal in all of this would be to contribute to the processes involved in theory-building, but, again, in terms of the primary emphasis of this paper, how could such organization not also help to establish medical anthropology as a field worthy of pursuit? IV. STATEMENT

OF

PRIORITIES

may acknowledge that there are two major theoretical trends in medical anthropology, one oriented toward contributions to general anthropological theory, the other toward contributions to a medical behavioral science theory, it would seem that conceptual, organizational, and educational priorities in medical anthropology must be meaningful in terms‘of both. The priorities that I see as deriving from the preceding discussion are set forth in outline form below: If we

Conceptual priorities 1. To recognize at the conceptual level, distinct stages in the process of convergence which is now occurring in the social and medical sciences. *I am indebted to James P. Henry, M.D. for this suggestion. Dr. Henry is in the Department of Physiology, Human Centrifuge and Environmental Physiology Laboratories of the University of Southern California. In this connection he has written as follows: “It seems to me that we should take a good hard look at the Index Medicus which is produced by the National Library of Medicine of the U.S. Dept. of Health, Education, and Welfare, Washington, D.C. They surely should index more than the three physical-anthropologically oriented journals that is their current limit. It would appear to be an inadequate list to present to medicine a proper window to the ongoing anthropological aspects of social science. Indeed the first problem a medical man has in trying to find out what is going on in the social sciences is to find an equivalent of the Zndex Medicus. Social Science literature is not as well or as promptly indexed as in Medical literature. It would be a step towards making the medical profession more aware to put the literature in your field so to speak at their fingertips.” (Personal communication, June 14, 1968.) TCollection of Abner I. Weisman, M.D. The Weisman Collection of Pre-Columbian Medical Sculpture, 11 East 74th Street, New York, New York 10021.

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2. To clarify for the field as a whole those concepts from various facets of anthropology and from separate branches of medicine which have the greatest relevance to each other. 3. To set forth in appropriate publications those newly emergent conceptual models which inhere in every successful performance by a medical anthropologist in academic and medical settings. 4. To recognize two main theoretical trends in medical anthropology, one oriented toward contributions to general anthropological theory, the other toward contributions to a medical behavioral science theory.

OrganizationaI priorities A. The link with general anthropology. 1. To submit a resolution to the Executive Council of the American Anthropological Association to amend the by-laws to allow the organization of sections within the structure of the Association. 2. To submit a‘resolution to the Executive Council of the American Anthropological Association to re-establish liaison-fellow status. 3. (Assuming acceptance of 1 and 2 above) to submit for vote by medical anthropologists a proposal to organize as a section of the American Anthropological Association. 4. (Assuming acceptance of 3 above) to formally request through the Executive Council of the American Anthropological Association recognition of a section on medical anthropology within the structure of the Association. 5. (Assuming acceptance of 4 above) to organize as a section of the American Anthropological Association by establishing a set of by-laws which include the following: a. statement of purpose. b. officers of the section: chairman chairman-elect secretary-treasurer council of 6-8 members newsletter editor. c. powers of office. d. duties and functions of the officers and council of the section and of the newsletter editor. e. election and voting procedure. f. formation of committees. g. membership regulations. 6. (Assuming ftillment of 5 above) to organize a series of committees such as the following : a. Program Committee to plan and coordinate the organization of sessions and symposia at annual meetings of national, regional, and international societies of anthropologists. b. Committee on Medical Anthropology Graduate Training Programs to establish requirements for a medical anthropology specialty in graduate departments of anthropology, to recruit competent students, to upgrade training programs, and to facilitate entree into pre-doctoral research projects in medical and health fields in various geographic areas. S.S.M. S/l4

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Committee on the Organization of Sub-specialty Areas of Medical Anthropology such as, anthropology and epidemiology anthropology and preventive medicine anthropology and public health anthropology and nursing anthropology and dentistry anthropology and nutrition anthropology and psychiatry anthropology and community medicine anthropology and pediatrics anthropology and environmental medicine anthropology and space medicine anthropology and population control, etc. On the assumption that sub-committees might best handle organizational problems of this scope, each one might be charged with the responsibility for organizing workshops with the goal of producing specialized handbooks for publication by some press, such as Northwestern University Press, which will soon introduce a series on medical behavioral science. d. Committee on Grant Applications and Fund Raising to assist publication of the Medical Anthropology Newsletter to finance sub-specialty workshops to assist in the editorial process and thereby hasten publication of sub-specialty handbooks to establish research training fellowships to support field research for graduate students specializing in medical anthropology to establish an Archive of Medical Anthropology to provide travel funds for invited guests from other countries to attend annual meetings of the medical anthropology section of the American Anthropological Association to provide travel funds for official delegates to international meetings and conferences such as the International Congress of Anthropologists and Ethnologists (or the International Association of Medical Behavioral Scientists proposed in the next section of this paper) to encourage in small but concrete ways collaboration in research on an international scale e. Committee on Inter-institutional Ties to establish a network of exchange relationships among academic and medical institutions, nationally and internationally, to facilitate the work of graduate students and professionals in medical anthropology f. Committee on Establishing an Archive of Medical Anthropology to establish an archive which will serve as a repository for papers, publications, research reports, etc. to maintain the following: author index sub-specialty index geographical area index theoretical index

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to develop a medical anthropology film library to cooperate with the publishers of Index Medicw and Excerpta Medica for inclusion therein of publications in medical anthropology Newsletter Advisory Committee to insure that the newsletter functions remain current and continue to meet the needs of a rapidly-developing field Liaison Committee to the International Association of Medical Behavioral Scientists (proposed) to insure that medical anthropology’s contribution to the development of a medical behavioral science theory be as direct and productive as possible

B. Link with Medical Behavioral Science 1. To build upon the potentialities of the First International Conference on Social Science and Medicine* by organizing an International Association of Medical Behavioral Scientists. 2. To build upon the potentialities of the journal, Social Science and Medicine by developing it into the official journal for the International Association of Medical Behavioral Scientists, possibly changing the name to International Journal of Medical Behavioral Science. 3. To establish an international network of communication between this international body of medical behavioral scientists and the disciplines contributing to it, a. by developing a newsletter supplement to the journal which provides for the same sort of exchanges outlined in goal 6 of the American medical anthropologists, incorporates pertinent items from the medical anthropology newsletter, the medical sociology newsletter, and other newsletters which may be developed in response to these organizational efforts. 4. To maintain an international roster of medical behavioral scientists in the form of a tiaster file of the rosters of medical anthropologists, medical sociologists, and other registers which may develop as a consequence of increasing organizational activity in this field. Possibilities include rosters of medical psychologists medical geographers medical economists transcultural psychiatrists anthropologically oriented pediatricians etc. 5. To analyze from an international perspective and to report the results of annual inventories of programs, research, and teaching in the field, which are car&d out by medical anthropologists, medical sociologists, and other professional groups which now conduct or may begin to conduct such surveys. 6. To establish and maintain an international Archive of Medical Behavioral Science which incorporates a. an author index of work (published and unpublished) by medical anthropologists, medical sociologists, etc. b. an index of sub-specialty areas within medical anthropology, medical sociology, etc. *Held at Aberdeen,

Scotland,

September 4-6, 1968.

HAZEL HITSON WEIDMAN

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a geographical area index of work done by medical anthropologists, medical sociologists, etc. d. an index of general theoretical items from medical anthropology, medical sociology, etc. 7. To allow access to these titles by Index Medicw, Excerpta Medica, and similar indexing services throughout the world. 8. To convene annual meetings of medical behavioral scientists by rotation among those countries in which this is feasible now or will be feasible in the future. C.

Educational priorities 1. To increase the visibility of the field by a. examining the selection process. Where does the pull to medical anthropology lie? Where should it lie? How can it be intensified ? b. increasing the amount of contact undergraduate students have with medical anthropologists, c. developing and offering new courses in medical anthropology at the undergraduate level, d. insuring medical anthropology a place in new textbooks for introductory courses in anthropology. 2. To establish requirements for a medical anthropology specialty in graduate departments of anthropology a. by reviewing current programs, b. by reviewing course outlines in medical anthropology, c. by preparing sub-specialty handbooks of medical anthropology, d. planning for a general text in medical anthropology, 3. To analyze annual inventories of research with an eye toward planning programs at annual meetings of the American Anthropological Association, regional, international, and other societies such as the Society for Applied Anthropology and the American Ethnological Society, etc., in order a. to fill in gaps, b. to set new directions, c. to upgrade research, d. to raise the standards of excellence of papers presented, e. to emphasize the theory-building potential of work in this field. 4. To increase the number of pre-doctoral fellowships available to graduate students specializing in medical anthropology a. through improved exchange of information about them, b. by administering fellowships through the medical anthropology section of the American Anthropoloical Association in cooperation with public, academic, and medical institutions engaged in health-related activity throughout the world. 5. To establish a network of exchange relationships for graduate students a. among graduate departments of anthropology (nationally and internationally), b. between departments of anthropology and medical institutions (nationally and internationally), via the medical anthropology newsletter and the Committee on Inter-institutional C. Ties of the medical anthropology section of the American Anthropological Association.

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These, then, are some of the conceptual, organizational, and educational goals which I believe must be met before the ranks of persons trained in medical anthropology can be increased to any appreciable degree. Others may disagree with these priorities and consider it somewhat presumptuous for a single individual to draft an extensive plan of organization, not only for medical anthropology but also for medical behavioral science on an international scale. It is presumptuous. Nevertheless, those special prongs of knowledge and conceptual linkages which are beginning to assume well-developed form after a decade or more of confrontation with medicine cannot fully differentiate out of an amorphous and multi-theoried mass of knowledge until they are released from all of the inhibiting forces of a burgeoning, unorganized field which does not allow free but coordinated movement. It is my belief that the priorities stated above represent keys which will open doors and channel energies in such a way that medical anthropology will begin to develop its not inconsiderable potentialities. When it tinally has the freedom, through better organization, to evolve as it is capable of evolving, we may finally be able to see the degree of integration inherent in differentiation. We will then truly know the shape and substance of our field. Knowing this, we will be more efficient recruiters, educators, and investigators. How can such characteristics lead to anything but vigor and growth-in numbers, in theory, and in accomplishments in helping to solve some of the health and disease-related problems of man and society ? EPILOGUE Publication of the Medical Anthropofogy Newsletter began in October, 1968. Volume 1, Nos. 1 through 6. concluded with the August, 1969 issue. The subscription year was then changed so that Volume 2 began in January, 1970. Current subscription rates are S3.00 per year for six issues which appear in January, March, May, July, September, and November. Subscriptions may be entered by contacting the editor as follows: Hazel H. Weidman, Editor, Dept. of Psychiatry, University of Miami School of Medicine, P.O. Box 875, Biscayne Annex, Miami, Florida 33152. In so far as further organization of the field is concerned, medical anthropologists have been officially recognized as a special interest group within the American Anthropological Association and within the Society for Applied Anthropology. Efforts to achieve section status within the American Anthropological Association have proved unsuccessful. The Association, itself, is undergoing structural changes which do not yet allow the formation of sections. The Group for Medical Anthropology, through its newsletter subscribers, has recently elected an Organizing Committee charged with the responsibility of drafting a constitution and legally incorporating as a professional society. Formal organization, therefore, is imminent. Acknowledgment-1 wish to acknowledge the assistance of the Social Science Institute (NIMH MH 09243) and the East-West Center at the University of Hawaii in preparation of this paper.

Grant

REFERENCES CAUDILL, W. A. Applied Anthropology in Medicine. In KROEBER, A. L. (ed.) Anthropology Today DO. 771-806. University of Chicago Press, Chicago, 1953. DAVANZO, H., ef al. Medical Amhropology: I%ualistic Orientations, Boletin de Estudos (France da Rocha 6), 1962. FLECK, A. C., JR. and IANNI, F. A. J. Epidemiology and Anthropology: Some Suggested AfIinities in -Theory and Method. Human~Organizati& 16 (4), 38-40, 1958. _FREEMAN, H. E., LEVINE, S. and REEDER, L. G. (eds.). Handbook ofMedical Sociology. Prentice-Hall, Englewood Cliffs, 1963. PEARSALL, M. Medical Behavioral Science: A Selected Bibliography of Cultural Anthropology, Social Psychology and Sociology in Medicine. University of Kentucky Press, Lexington, 1963.

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6.

PEARSALL, M. A Brief Bibliographic History of Medical Anthropology pologists. University of Kentucky Medical Center, Lexington, 1967.

7.

POMAR, S. Health and Human Behavior: Areas of Interest Common to the Social and Medical Sciences. Current Anthropology 3, 159-205. 1962. RONEY,J. G., JR. Medical Anthropology A Synthetic Discipline. The New Physician March, 32-33,1959. SCOTCH, N. A. Medical Anthropology. In SIEGEL,B. J. (ed.) Biennial Review of Anthropology, pp. 30-G. Stanford University Press. Stanford, 1963.

8. 9.

as Developed by Cultural Anthro-