Madeleine Mant // I teach Introduction to the Anthropology of Health to an exquisitely diverse group of second-year undergraduate students. The class is a gateway prerequisite to all upper-level health-stream courses, thus it necessitates a balance between the biological and sociocultural aspects of health anthropology. Students are exposed to the work of Gregor Mendel and E.E. Evans-Pritchard, Ignaz Semmelweis and Mary Douglas, Rosalind Franklin and Robert Koch. The class is comprised mostly of anthropology majors, but plenty of double majors in biology, sociology, and psychology (and, I was delighted to discover, a lone chemistry student) gather each Monday morning to spend two hours together in the dim light of the lecture hall.
We cover topics ranging from growth and development, diet and nutrition, infectious disease, epigenetics, and mental illness, from the anthropological and culturally relativistic standpoint: how do we know what we think we know about health? What is ‘normal’? According to whom? Biomedicine is characterized as just one form of medicine: an ethnomedical system. We problematize and re-learn words we thought we knew intimately: sickness, illness, health, disease. This lexicon is worth the complication, the frustration of personal re-evaluation. We examine the World Health Organization’s definition of health and focus upon the concept of wellness, that health is not just the absence of disease. Our balance is more than a lack of un-balance.
The students’ first assignment is designed to be brief, to get pens to paper (or fingers to keys) and to turn the anthropological gaze within. Embodiment as a lesson on one’s own body; you can’t get much more emic than an auto-ethnography. Students were prompted: Reflect upon a medical experience you have had or witnessed. This might include an experience with a doctor, with a hospital, with First Aid, etc. Briefly describe and contextualize your experience. I emphasized that they did not need to disclose any personal medical details; however, the resulting assignments were shocking in their intimacy, with or without specific clinical revelations.
Vivid descriptions leapt off the page: chronic ailments (the agony: multiple referrals; the ecstasy: a diagnosis!), brief encounters for acute issues in walk-in clinics and emergency rooms, practitioners who appreciated and incorporated cultural context, practitioners who couldn’t have appreciated cultural context any less, surgeries (invasive/necessary/frightening/litigious/fine), and awakenings to diagnoses of mental illness. It is often said that everyone has a novel in them; I propose that everyone also has an illness narrative. Arthur Kleinman, in his classic work The Illness Narratives, characterized illness as “polysemic or multivocal” (Kleinman 8), exploring the kaleidoscopic potential meanings behind a patient’s description of their experience of their own body. Herein lay the key point of the assignment: regardless of the students’ cultural or academic backgrounds, they were all in possession of a fleshy, imperfect, fantastic object: a body.
Bringing the discussion of the students’ bodies out of the private consultation room and into the classroom allowed us to mine new veins (pun very much intended) using a framework of anthropological theory and trust. Some students clearly had been champing at the bit to rant (eloquently) about a frustrating medical encounter. Others named particular doctors or nurses, emphasizing their gratitude for the patient-centred care they had received. This simple formative assessment had, through the students’ willingness to share, become a means for me to hold space for their experiences.
I assigned this written work with some trepidation – would it be too much to ask this group of strangers to (figuratively) turn themselves inside out? To their credit, the students responded like skilled theatrical improvisors – they responded to my volley with “yes, and?” Their response should inform further anthropological, clinical, and medical humanities work on patient narratives – ask open-ended questions, hold space for personal interpretations and stories, and when it seems complete, query again: “yes, and?”
Kleinman, Arthur. The Illness Narratives. Basic Books, 1988.