Cross-cultural perspectives on the power of practitioners¹ talk and medical discourse in general, and the power of language in symbolic healing
3 semester hours
Instructor: James M. Wilce, Ph.D.
Office hours: Wednesdays, noon-2 p.m., and by appointment.
Office location: Bldg. 98D, Room 101E
Phone: (928) 523-2729
Course prerequisites: ANT 102 or the equivalent, and senior or graduate standing; or consent of instructor.
Course description and topical outline:
This seminar uses methods from medical discourse analysis, anthropology, and critical theory to get at the interrelationships between language, power, and medicine, focusing on the following issues in relation to power in medicine as discourse and the discourse of medicine:
I. Power as Dominance: Interactive Power Plays in Face-to-Face Medical Encounters
II. Medical Discourses, Global Powers
III. Power as Performativity (A): Language and Healing Power
IV. Performativity (B): Labels, Traps, and Trajectories of Illness
V. Performativity (C): The Discursive Creation of New Medical Entities
Counting week 15 (with no reading assigned), an average of 122 pages of readings (including articles and books) are assigned each week—with tremendous variation around the mean!
This course will give students the ability to analyze medical discourse and a theory with which to understand five phenomena: the role of linguistic interaction in maintaining relations of dominance in medical contexts, the role of language and symbolism in healing, the affect of diagnostic labels on illness careers, the role of language in creating consensus around what is real and effective in disease and treatment, and the spread of powerful medical discourses around the world. The course will provide an opportunity to learn better skills in reading and writing analytically and critically, and in building knowledge together in seminar format.
The course is a seminar. Students lead discussions of common readings and write critical syntheses of those readings A final paper requires an new analysis of a medical discourse phenomenon (e.g. a reanalysis of a published transcript of a practitioner-patient encounter).
Texts and required materials
Briggs, Charles L., and Clara Mantini-Briggs. 2003 Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare. Berkeley: University of California Press. (ST)
Desjarlais, Robert R.. 1997. Shelter Blues: Homelessness and Sanity in a Boston Shelter. Philadelphia: University of Pennsylvania Press. (SB)
Good, Byron J. 1994 Medicine, Rationality, and Experience: An Anthropological Perspective (The Lewis Henry Morgan Lectures 1990). Cambridge and New York: Cambridge University Press. (MRE)
Laderman, Carol and Marina Roseman. 1996. The Performance of Healing. New York: Routledge. (PH)
Wilce, James. 1998. Eloquence in Trouble. New York: Oxford University Press. (ET) Note: Available for $30 (vs. $65 retail) at the Anthropology office. Note: There will be required readings from ET, but for those preferring electronic copies of required chapters, purchasing the book will be unnecessary.
Required Articles Online. Most readings for the course are on Webreserve. Unless the reading is specified by the abbreviated title of one of our textbooks, you can find it through Cline Course Resources for Students, ANT 581.
Jenkins, Janis Hunter, and Robert J. Barrett, eds. 2003 Schizophrenia, Culture, and Subjectivity: The Edge of Experience. New York: Cambridge University Press. (SCS)
Wilce, James M., ed. 2003 Social and Cultural Lives of Immune Systems. New York: Routledge. (SCLIS)
Jan 24. Introductions; Anthropological theories of language and social action; what is ³medical discourse²? (beyond doctor-patient interaction)
Wilce handout, Healing and Performativity (WebReserve)
I. Power as Dominance: Interactive Power Plays in Face-to-Face Medical Encounters
Jan 31. Medical Encounters, Power Encounters Here and in Bangladesh
ET Interacting with Practitioners (pp. 154-181)
Ainsworth-Vaughn, N. (1992). Topic transitions in physician-patient interview: Power, gender, and discourse change. Language in Society, 21, 409-426.
Alexander, Linda. 1981. The double-bind between dialysis patients and their health practitioners. In The Relevance of Social Science for Medicine. L. Eisenberg and A. Kleinman, eds. Pp. 307-329. Dordrecht: D. Reidel.
Kuipers, Joel C. 1989. ³Medical discourse² in anthropological context: Views of language and power. Medical Anthropology Quarterly 3(2):99-123.
Uskul, Ayse K. and Farah Ahmad 2003. Physician–patient interaction: A gynecology clinic in Turkey. Social Science & Medicine 57(2):205-215.
Salmon, Peter, and George M. Hall. 2003. Patient empowerment and control: A psychological discourse in the service of medicine. Social Science & Medicine 57(10):1969-1980.
ET Troubles Talk and Social Conflict (pp. 134-153)
Feb. 7. Power and Resistance: Medical Talk and Translation
ET, Metacomplaints: Conflict, Resistance, and Metacommunication (pp. 182-199).
Brown, Michael Fobes. 1988. Shamanism and its discontents. Medical Anthropology Quarterly 2(2): 102-120.
Cicourel, Aaron V. 1992. The interpenetration of communicative contexts: Examples from medical encounters. In Rethinking Context: Language as an Interactive Phenomenon. A. Duranti and C. Goodwin, eds. Pp. 291-310. Studies in the Social and Cultural Foundations of Language, Vol. 11. Cambridge: Cambridge University Press.
Davidson, Brad. 2001. Questions in Cross-Linguistic Medical Encounters: The Role of the Hospital Interpreter. Anthropological Quarterly 74(4):170-178.
Drennan, Gerard, Ann Levett, and Leslie Swartz. 1991. Hidden dimensions of power and resistance in the translation process: A South African study. Culture, Medicine, and Psychiatry 15(3):361-381.
Wilce, James. 2001. Divining TROUBLES or diVINing troubles? Gender, conflict, and polysemy in Bangladeshi divination. Anthropological Quarterly, 74(4), 190-199.
ET, On Troubling Ourselves with Troubles Talk (pp. 3-33)
Riessman, Catherine. 2000. Stigma and everyday resistance practices: Childless women in South India. Gender and Society 14(1):111-135.
Waitzkin, Howard, and Theron Britt. 1989. Changing the Structure of Medical Discourse: Implications of Cross-National Comparisons. Journal of Health and Social Behavior 30:436-449.
II. Medical Discourses, Global Powers
First paper due: Following the instructions at the end of the syllabus, reflect on the readings from first section of the course on dominance as power.
ST Introduction: Death in the Delta (pp. 1-18); Preparing for a Bacterial Invasion: Cholera and Inequality in Venezuela (pp. 19-47); Epidemic at the Door: Cholera Prevention in the Bureaucratic Imaginary of Delta Amacuro (pp. 48-58); Stories of an Epidemic Foretold: Cholera Reaches Mariusa (pp. 59-80); Fighting Death in a Regional Clinic: Cholera Arrives in Pedernales (pp. 81-97); Turning Chaos into Control: Initial Responses by Regional Institutions (pp. 98-137).
Swartz, Leslie. 1991. The Politics of Black Patients¹ Identity: Ward-Rounds on the Black Side¹ of a South African Psychiatric Hospital. Culture, Medicine and Psychiatry 15:217-244.
Wilce, James. 2004. Madness, fear, and control in Bangladesh: Clashing bodies of knowledge-power. For Medical Anthropology Quarterly special issue on Illness and Illusions of Control. 18 (3): 357-375.
Choose one of the following two articles (Presenters note: more detailed presentations required when some students have not read the article):
Coker, Elizabeth M. 2003. Narrative strategies in medical discourse: Constructing the psychiatric "case" in a non-western setting. Social Science & Medicine 57(5):905-916.
Kowal, Emma , and Yin Paradies 2005. Ambivalent helpers and unhealthy choices: Public health practitioners¹ narratives of indigenous ill-health. Social Science & Medicine 60(6):1347-1357.
137+27+18+11 or 10=193
Bose, Ruma. 1997. Psychiatry and the popular conception of possession among the Bangladeshis in London. International Journal of Social Psychiatry 43(1):1-15.
Santiago-Irizarry, Vilma. 1996. Culture as Cure. Cultural Anthropology 11(1):3-24.
Singh, Ilina. 2004. Doing their jobs: mothering with Ritalin in a culture of mother-blame. Social Science & Medicine 59(6):1193-1205.
Warner, R. 1976. The Relationship Between Language and Disease Concepts. International Journal of Psychiatry in Medicine 7(1):57-68.
Feb. 21. The Epistemic Authority of Health Discourses in Modern Nation-States
ST Containing an Indigenous Invasion: Quarantine in Barrancas (pp. 138-162); Exile and Internment: The Mariusans on La Tortuga (pp. 163-178); Culture Equals Cholera: Official Explanations for the Epidemic (pp. 199-223); Challenging the Logic of Culture: Resisting Official Explanations for the Epidemic (pp. 224-255); Local Numbers and Global Power: The Role of Statistics (pp. 256-268); Virulent Aftermath: The Consequences of the Epidemic (pp. 298-332).
ST Sanitation and Global Citizenship: International Institutions and the Latin American Epidemic (pp. 269-297)
Westfall, Rachel Emma, and Cecilia Benoit. 2004. The rhetoric of "natural" in natural childbirth: Childbearing women's perspectives on prolonged pregnancy and induction of labour. Social Science & Medicine 59(7):1397-1408.
Feb. 28. Globally Circulating Medical Discourse and the Challenge to the Spirits
MRE ch. 1 (1-24),
Adams, Vincanne 2001. Particularizing Modernity: Tibetan Medical Theorizing of Women¹s Health in Lhasa, Tibet. In Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies. L. Connor and G. Samuel, eds. Pp. 222-246. Westport, CT: Bergin & Garvey.
Greene, Shane. 1998. The shaman's needle: Development, shamanic agency, and intermedicality in Aguaruna lands, Peru. American Ethnologist 25(4):634-658.
McMillen, H. Heather 2004 The adapting healer: Pioneering through shifting epidemiological and sociocultural landscapes. Social Science & Medicine 59(5):889-902.
Pigg, Stacy Leigh. 1996. The credible and the credulous: The question of 'villager's beliefs' in Nepal. Cultural Anthropology 11(2):160-201.
Filc, D. 2004. The medical text: Between biomedicine and hegemony. Social Science & Medicine 59(6):1275-1285.
Quah, Stella R. 2003 Traditional healing systems and the ethos of science. Social Science & Medicine 57(10):1997-2012.
Servando, S. Z., and Z. Hinojosa. 2004. Authorizing tradition: Vectors of contention in Highland Maya midwifery. Social Science & Medicine 59(3):637-651.
Simonda, Wendy. 2002. Watching the clock: Keeping time during pregnancy, birth, and postpartum experiences. Social Science & Medicine 55(4):559-570.
Yen, J., and L. Wilbraham. 2003. Discourses of culture and illness in South African mental health care and indigenous healing, Part I: Western psychiatric power, and Part II: African mentality. Transcultural Psychiatry 40(4):542-584.
III. Power as Performativity: (A) Language and Healing Power
Mar. 7. From Dominance to Performativity Second paper due. Following the instructions at the end of the syllabus, reflect on readings for Part II.
MRE, pp. 116-134
PH, Introduction by Laderman & Roseman (pp. 1-16)
Finkler, Kaja. 1994. Sacred Healing and Biomedicine Compared. Medical Anthropology Quarterly 8(2):178-197.
Lévi-Strauss, Claude. 1963. The Effectiveness of Symbols. Structural Anthropology. Tr. by C. Jacobson and B. G. Schoepf, pp. 186-205. NY: Basic Books.
Roseman, Carol. 1987. The Ambiguity of Symbols in the Structure of Healing. Social Science and Medicine 24(4): 293-301.
Wilce, James. 1999. Healing. Journal of Linguistic Anthropology 9(1): 93-95.
PH pp?? On the failure of performance: Throwing the medium out of the séance (Schieffelin)
Mar. 14. Healing Language: Performativity and Ritual; Outline of Final (Research) Paper Due
PH: The Meaning of Nonsense, the Poetics of Embodiment, and the Production of Power in Warao Healing (Briggs, pp. 185-232); Sounds and Things: Pulsations of Power in Songhay (Stoller, pp. 165-184)
Laderman, Carol. 2001. Tradition and Change in Malay Healing. In Healing Powers and Modernity: Traditional Medicine, Shamanism, and Science in Asian Societies. L. Connor and G. Samuel, eds. Pp. 42-63. Westport, CT: Bergin & Garvey.
Toelken, Barre. 1987. Life and death in the Navajo coyote tales. In Recovering the Word: Essays on Native American Literature. B. Swann and A. Krupat, eds. Pp. 388-401. Berkeley: University of California Press.
SPRING BREAK Mar. 21-25
Mar. 28. Linguistic Performativity in an Individualistic Society: Venting Fear and Trauma in Europe and America
SCLIS—Pennebaker, James W. 2003. Telling Stories: The Health Benefits of Disclosure. (pp. 31-66)
Delvecchio-Good, Mary Jo, et al. 1994. Oncology and Narrative Time. Social Science and Medicine 38(6):855-862.
DiGiacomo, Susan M. 1992 Metaphor as Illness: Postmodern Dilemmas in the Representation of Body, Mind and Disorder. Medical Anthropology 14:209-247.
Van Alphen, Ernst. 1999. Symptoms of Discursivity: Experience, Memory, and Trauma. In Acts of Memory: Cultural Recall in the Present. M. Bal, J. Crew, and L. Spitzer, eds. Pp. 24-38. Hanover, NH: University Press of New England/ Dartmouth College.
Wikan, Unni 1989. Managing the heart to brighten face and soul: Emotions in Balinese morality and health care. American Ethnologist 16(2):294- 312.
Beach, Wayne A. et al. 2005 Disclosing and responding to cancer ³fears² during oncology interviews. Social Science & Medicine 60(4):893-910.
Brison, Susan J. 1999. Trauma Narratives and the Remaking of the Self. In Acts of Memory: Cultural Recall in the Present. M. Bal, J. Crew, and L. Spitzer, eds. Pp. 39-54. Hanover, NH: University Press of New England/ Dartmouth College. (Traditional reserve at Cline)
Delvecchio-Good, Mary Jo. 1990. American oncology and the discourse on hope. Culture, Medicine, and Psychiatry 14/1: 59-79.
Apr. 4. Cross-Cultural Perspectives on Health Talk as Self-Expression; The Personhood of Patients
ET, (Personhood: The I¹ in the Complaint; Self and Indexicals: Language and Locus of Control; pp. 44-103)
Foucault, Michel. 1990 (1978) The History of Sexuality: An Introduction. R. Hurley, transl. Volume 1. New York: Vintage. (The Repressive Hypothesis, pp. 17-35: Scientia Sexualis, pp. 53-73).
Sansom, Basil. 1982. The sick who do not speak. In D. Park, ed., Semantic Anthropology (ASA Monographs), 183-196.
SCLIS Wilce, James M., and Laurie Price. Immune Metaphors Our Bodyminds Live By? (pp. 107-153).
IV. Performativity B: Labels, Traps, and Trajectories of Illness
Apr. 11. Madness, Sick Speech, Sick Silences; Third paper due
Estroff, Sue, et al. 1991. Everybody's Got a Little Mental Illness: Accounts of Illness and Self among People with Severe, Persistent Mental Illnesses. Medical Anthropology Quarterly 5:331-369.
Martin, Emily 2001 Rationality, Feminism, and Mind. In Feminism in Twentieth-Century Science, Technology, and Medicine. A. Creager, E. Lunbeck, and L. Schiebinger, eds. Pp. 214-227. Chicago: University of Chicago Press.
Ochs, Elinor, and Olga Solomon. 2005. Practical Logic and Autism. In A Companion to Psychological Anthropology: Modernity and Psychocultural Change. R. Edgerton and C. Casey, eds. Pp. 140-167. Malden, MA: Blackwell.
Waxler, Nancy 1974 Culture and Mental Illness: A Social Labeling Perspective. Journal of Nervous and Mental Disease 159:379-395.
Siegman, Aron W., Stanley Feldstein, Carl T. Tomasso, Norman Ringel, and Jeff Lating. 1987. Expressive vocal behavior and the severity of coronary artery disease. Psychosomatic Medicine 49: 545-561.
Wilce, James M. 2004. Language and Madness. In Companion to Linguistic Anthropology. A. Duranti, ed. Malden, MA.: Blackwell. pp. 414-430.
Kirmayer, Laurence J. 1987 Languages of suffering and healing: Alexithymia as a social and cultural process. Transcultural Psychiatric Research Review 24(2):119-36.
SCS Sadowsky, Symptoms of Colonialism: Content and Context of Delusion in Southwest Nigeria, 1945-1960. (pp. 238-252); Estroff, Subject/Subjectivities in Dispute: The Poetics, Politics, and Performance of First-Person Narratives of People with Schizophrenia (pp. 282-302)
Sass, Louis A. 1992 Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. New York, NY: Basic Books. Chapter 6
Apr. 18. Hermeneutical and Cultural Approaches to Psychiatric Illness; Psychiatry as Power; Rough draft of final (research) paper due
SB pp. 120-208
Lucas, Rodney H., and Robert J. Barrett 1995. Interpreting Culture and Psychopathology: Primitivist Themes in Cross-Cultural Debate. Culture, Medicine and Psychiatry 19: 287-326.
SCS Wilce. To ³speak beautifully² in Bangladesh: Subjectivity as pa\gala\mi. Pp. 196-218.
April 25. Language, Madness, and Resistance
Showalter, Elaine 1985. The female malady: Women, madness, and English culture 1830-1980. NY: Pantheon. pp. 145-194
Swartz, Sally and Leslie Swartz. 1987. Talk about talk: Metacommentary and context in the analysis of psychotic discourse. Culture, Medicine, and Psychiatry 11(4): 395-415.
Foucault, Michel. 1973. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Vintage. (Traditional Cline reserve).
V. Performativity C: The Discursive Creation of New Medical Entities
May 2. Fourth paper due
Gaines, Atwood. 1992. From DSM-I to DSM-R; Voices of Self, Mastery and the Other: A Cultural Constructivist Reading of U.S. Psychiatric Classification. Social Science and Medicine 35:3-24.
Skultans, Vieda. 2003. From damaged nerves to masked depression: Inevitability and hope in Latvian psychiatric narratives. Social Science & Medicine 56(12):2421-2431.
Young, Allan. 1995. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press. Pp. 3-10, 145-175
Cambrosio, Alberto, and Peter Keating. 1992. A Matter of FACSP: Constituting Novel Entities in Immunology. Medical Anthropology Quarterly 6(4):362-384.
Schieffelin, Edward L. 1996. Evil spirit sickness, the Christian disease: The innovation of a new syndrome of mental derangement and redemption in Papua New Guinea. Culture, Medicine, and Psychiatry 20(1):1-39.
May 9. Oral Presentations
May 12. Final (research) paper due.
A) Regular assignments: (1-2 below are worth a cumulative 70% of total grade).
2) Analysis of readings (45%):
Learn to read for main arguments more than detail, and compare authors¹ arguments against each other in your own critical synthesis. All readings discussed before the due date of each paper can be included as cumulative insight, but papers should focus on readings discussed in the previous two weeks. Papers will be due every other week but will cover two weeks¹ worth of readings, not just the most recent week¹s readings. For more guidance, see the final pages of this syllabus. Seven papers are assigned; you may drop one, or do 7 for extra credit.
3) Participation in discussion (25%): Everyone is expected to have read the assigned chapters/papers enough to participate in class. That does not mean perfect comprehension-- we learn together. Students are required to participate each week by putting before us thoughtful questions regarding the readings or by sharing their insights in response to others¹ questions/comments. Individuals will be assigned particular responsibility to help the discussion of certain assigned pages.
B) Final Paper 30% (25% of course grade for paper itself, and another 5% of course grade reflects your in-class presentation of your paper topic)
The final paper will combine your own observations and experiences of ³medicine² (loosely defined as in the readings) with a critical use of the readings. It should speak to one of the weekly reading topics in particular. If the paper centers on newly collected data, requiring the taping of a ³medical² event, permission from patient, practitioner, and the Institutional Review Board will need to be sought in the second week of the semester. That choice of topic is yours; it is not required. Other papers will rise to a different challenge—a thorough rethinking of one of the theoretical models/topics explored in this course. All papers should include a transcript of some medical encounter, prepared in accordance with one of the transcript forms in your readings (especially ET), and should make the analysis of the transcribed encounter the center. (Theory-oriented papers can use transcripts from the published sources which they are critiquing.) The phenomenon in focus in the transcript and the theoretical model and analytic method used to interpret the transcript should reflect intimate knowledge of the readings, again focusing on one week¹s readings in particular.
You will present your topic orally to the seminar one week before finals are scheduled.
Regular weekly attendance is expected. Participation through making weekly presentations accounts for 20% of total grade.
This course strictly follows the university policy governing plagiarism and cheating.
You will be writing critical reflections on the cumulative readings and discussions. They will be due every other week, 3- 4 pages in length, and will integrate and critically evaluate the perspectives offered in the readings. Here¹s another way of saying this: the aim of these papers is to encourage synthetic, integrative, critical reflection on the readings Your papers should reflect an accurate sense of the main argument of each reading and its unique perspective.
In presenting a reading in class and in writing these papers, prepare a one sentence précis of each author¹s argument before you actually write the integrative paper. Here¹s an example: ³Finkler argues that a focus on the doctor-patient relationship, even when the anthropologists studies Spiritualist healing, would be an ethnocentric projection of an issue relevant to our biomedical encounters.² Compare the collected arguments of the authors whose work you are reflecting on for a given paper (two weeks¹ worth usually; the first paper will be an exception). Taking the Finkler example, you might use her notion of ³dramaturgy² to set up a paragraph in which you contrast Finkler¹s position with Lévi-Strauss¹s and Laderman¹s. Your paper should then not shift paragraph by paragraph from author to author. Rather, you should organize it by topics which your own insightful vision sees in as you compare your one-sentence argument-summations (topics like ³dramaturgy in the doctor-patient encounter²).
As the semester progresses, your papers can take backward glances at readings you will have analyzed in your previous papers. Papers can be somewhat cumulative in that sense, though I encourage you to spend your limited four pages or so mostly on the two weeks of readings and discussion which you have not previously analyzed. I am looking for evidence that you have integrated, compared and contrasted perspectives. Papers longer than 5 pages are NOT encouraged. Be concise. Quoting is discouraged; digest and paraphrase the material instead.
An absence can throw you off seriously. If you must miss class, contact someone about discussion notes, papers due, etc.
Guidelines for oral presentations on assigned readings
1. Each class session will consist of a group discussion based on a collection of readings. You are required to attend each class having read the assigned readings and being ready to discuss them. You will find it helpful to take notes on the readings and bring them with you to class.
2. You will be responsible for co-facilitating some of the class discussions. Each required reading will be assigned to at least one student who will be expected to lead the discussion on it. In preparing for the discussions you will facilitate, try not to spend too much time summarizing the readings, but do so in enough detail to orient the group. In addition, you should formulate a series of questions and comments to stimulate discussion using the following guidelines:
What is the reading about? (should take up about half of your presentation)
What are the broader issues that it seeks to address?
What underlying assumptions-- theoretical or otherwise-- does the author make?
What are the strengths of the argument?
What are its weaknesses or limitations? What considerations has the author failed to take into account?
What have you learned? What more would you now like to know on the topic?
To what related material-- in this class, other classes, your own lives-- does the material relate? Does it help you more clearly understand dynamics or patterns that exist in this society or any others?
Look for common or contrasting threads that run through each week¹s readings. Consider the questions that they seek to address as a unit.
Students not leading the discussions that particular week should try to keep these same questions in mind. Remember, the quality of any seminar depends mostly on how well participants prepare prior to coming to class. This involves not only reading the assigned materials but also thinking critically about the issues that they raise.