Abstract
This article critiques two major theoretical perspectives concerning the doctor patient interaction in medical anthropology represented by the work of Howard Waitzkin and Arthur Kleinman. In his work on the doctor patient interaction Waitzkin has tended to draw on structural explanations which subordinate the role of agency. Kleinman’s work emphasizes agency without satisfactorily integrating structural or social causality in his work on the doctor patient interaction. The work of Anthony Giddens and others has clarified the structure/agency dichotomy in social science to which the nature of power is central.
Keywords : interaction, structure, agency, power
REFERENCES
1. The special place of the doctor patient interaction in medical anthropology is rapidly being eroded as its limitations become understood. See Susser 1. Union Carbide and the community surrounding it : the case of a community Puerto Rico. Int. J. Hlth Seru. 15, 4, 1985 for a critique of the narrow scope imposed by the focus on the doctorpatient interaction.
2. See Giddens A. The Constitution of Societ ‘ v. University of California Press, Berkeley, Calif., 1984 : Profiles and Critiques in Social Theory. University of California Press, Berkeley, Calif., 1982 ; A Coniemporary Critique of Historical Materialism. University of California Press, Berkeley, Calif., 1979
4. Charles Leslie has opened the stud o !’ di.,c( ur,e to include ethnographi analysis of journals, review process. and citations. Integration and di ersit in niedical anthropolog , paper presented ai the 87th Annuà) Meeting of the American Anthropological Association, 19 November, 1988 Phoenix. Ariz. Compare Waitzkin’s over four columns of citations to Kleinman’s two and three quarters in the 1976 1980 Cianuialire Source Index (1983). The last year in which Waitzkin*s citations approached Klemman’s %vas 1985 (75:120).
5. Waitzkin H. Medicine. superstructure and micropolitics. Soc. Sei. Med. 13A, 1979. The micropolitics of medicine : a contextual analysis. Int. J. Hith Serv. 14, 339 377. 1984 : Waitzkin il. and Waterman B. llie Exploitation of Illnes.8 ai Capiialisi Societ.v. BobbsMerrill, Indianapolis, Ind., 1974. Some may courtier that my critique of Waitzkin (or K !einman) is unfair because he had no intention of taking inio account the facts mentioned in my critique : while no ‘social physics’ should be hoped for, theoretical critique clears the way for svnthesis that hopefully incorporate earlier less comprehensive approaches.
6. Klemman A. Social Origins of Distress and Disease : Depression, Neurasthenia, and Pain in Modern China. Yale Universit Press, Neu Haven, Conn., 1986 ; Patients and Healers in the Confexi of’Culture. University of California Press, Berkele , Calif., 1980.
7. Marxist scholarship finds itself on both sides of this divide. Many caricatures of ‘llarxism charge a narrow focus, deterministic or otherwise. These misrepresentations are dealt with well in Nararro V. Radicalism, Marxism, and medicine. hit. J. Hlih Serv. 13, 2, 1983. It must bc recognized that not al] that is associated wilh the texts of Marx are in aizreement, nor can it all be made theoretically coherent. Compare Taussig M. Reification and the consciousness of the patient. Soc. Sei. Med. 14B, 1980 and Waitzkin’s analysis for an examie of the very different interpretations which can be drawn from Marx’s test.
8. Navarro V. U.S. Marxist scholarship in the analysis of health and medicine. Ini. J. Illth Seri . 15, 15, 1985.
9. Waitzkin H. The micropolitics of medicine : a contextual analysis. Int. J. Hlth Seri. 14, 339, 1984.
10. Giddens A, Central Problenis in Social Theorv. p. 71. University of California Press, Berkelei, Calif., 1979.
11 . A similar point is made by Geofr Rayner and Gerry Stimson. Medicine, superstructure and micropoliticsA response. Soi’. Sei. Med. 13A, 1979.
12. Calinicos A. Making Historv. Cornell University Press, Ithaca, N.Y.. 1988.
13. Wonien and Heaith : The Politics of’ Sex in Medicine (Edited by Fee E.). The Johns fiopkins University Press, Baltimore, Md., 1983. A related point has been made about Waitzkin’s work by Strong P. M., Materialisin and medical interaction : a critique of « Medicine, Superstructure and Mieropolities.« ‘ Soc. Sei. Med. 13A, 1979.
l4. Waitzkin H. and Waterman B. The Exploitation of Illness in Capitalisi Society. Bobbs Merrill. Indianapolis, Ind.. 1974.
15. Waitzkin and Waterman acknowledge the shortcomings of this formulation, concluding, « Because of the inherent methodological [sic] limitations of functional analysis, we offer these ideas as suggestive rather than conclusive. » Waitzkin H. and Waterman B. The Exploitation of Illness in Capitalist Socieiy, p. 65. BobbsMerrill, Indianapolis, Ind., 1974.
16. Kleinman A. Patients and ffeaiers in the Context of Culture, p. 45. University of California Press, Berkeley, Calif., 1980.
17. Kleinman A. Social Origins of Distress and Disease : Depression, Neurasthenia, and Pain in Modern China. Yale University Press, New Haven, Conn., 1986.
18. See Frankenberg R. Medical anthropology and development : a theoretical perspective. Soc. Sei. Med 14B, 4, 1980.
19. Compare Scheper Hughes N. and Lock M. The mindful body : a prolegomena to future work in medical anthropology. Med. Anthrop. Q. 1, 1, 198T
20. Ortner S. Theory in anthropology since the sixties. Comp. Stud. Soc. Hist. 26, 1, 1984,
21, Several case studies in rnedical anthropology can be seen as working in this direction but have originated from a variety of theoretical perspectives. Lazarus E. Theoretical considerations for the study of the doctor patient relationship : Implications of a perinatal study. Med. Anthrop. Q. 2, 1, 1988, adopts a position similar tc, the one developed here. Compare Singer M. Cure, care and controi : an ectopic encounter with biornedicine. In Encounter with Biornedicine : Case Studies in Medical Anthropology (Edited by Baer H.). Gordon & Breach, New York, 1987 ; Irwin S. and Jordan B. Knowledge, practice and power : court ordered Caesarean sections. Med. Anthrop. Q. 1, 3, 1987.
22. See Dewalt B. and Pelto P. Micro and Macro Levels of Analysis in Anthropology. Westview Press, Boulder, Colo., 1985 ; application of this perspective in medical anthropology has been proposed by Press 1. Macro and micro factors in an emergency room encouriter. Presenied in an Invited Session ‘Towards a critical clinical anthropology’ (Society for Medical Anthropology) American Anthropology Association, Chicago, Ill., 1987.