The inaugural meeting of the University of Alabama Department of Anthropology Journal Club was held Friday January 18th at 2:00 p.m. Attendees were grad students Tina Thomas, Becky Read-Wahidi, Anjelica Callery, Achsah Dorsey, and Greg Batchelder; undergrads Brittany Brooks, Samantha Sloan, and professors Kathryn Oths, Dick Diehl, and Ian Brown.
With me (Kathy Oths) moderating, a lively discussion ensued regarding a recent piece in Social Science and Medicine (SSM), On sitting and doing: Ethnography as action in global health by Stacy Pigg [99:27-134(2013)], the previous editor of Medical Anthropology. She relates scenes from her fieldwork among International Health (now Global Health) and NGO personnel who were attempting to introduce HIV/AIDS prevention education in Nepal in the late 1990s. As she sat and listened ‘between the cracks’, it emerged that a word-play exercise that encouraged participants to shout out ‘sex’ words was antithetical to a Nepalese aversion to discussing sex (much less with strangers!). While the health workers realized this, they felt obligated to carry out the mandates of the program’s international funders. A classic case of vertical programming. Or, since it ‘worked’ (really?) in Uganda, it should work everywhere. By means of much listening and many intense discussions with perceptive nationals, Pigg adroitly led her colleagues in developing a slightly altered exercise that used word about sexual relations instead of sex. Aid workers were thrilled, and across several months met and pre-tested the new exercise. It was a smashing success with the intended audience, and they self-published educational brochures using the concept, yet the higher up administrators were too wedded to the received wisdom of the international programs to pay any heed. While the revised exercise failed to be implemented, it succeeded in identifying a better way to reach a population. Many years later, Nepalese health workers were still talking about the wisdom of their strategy.
Somewhat surprisingly, SSM devoted an entire issue to ethnography, a topic that seldom receives attention anymore—especially in the medical social sciences literature—perhaps because it seems the method is uncomplicated and all that needs to be said about it has already been. I chose the Pigg article for its reminder that all good scientific work starts with reflection, observation, listening, being, mindfulness–the lesson being, “just sit there, don’t do anything (at least to start with).” The insight and hypothesis-generation that sitting and listening can engender is qualitative, and at one and the same time the crucial first stage of any systematic, scientific endeavor. I am concerned that mixed-method training in biocultural medical anthropology, while the best and most comprehensive approach (IOHO here at UA), can tend to focus on the clearly essential ‘hard stuff’—statistics, computer programs (such as SPSS, Anthropac, GIS, ATLAS.ti, UCINET…), lab analysis, measurement tools (anthropometry, cortisol, blood pressure….) and sometimes slight the ‘soft stuff’ like participant-observation, leaving it to chance. This emphasis is entirely understandable, as most of the complex tools are best learned in a classroom setting, whereas the art of fieldwork seems more idiosyncratic. This division in training is not at all unlike the case with medical education, where technological competence wins out over the art of care, even though both are vital to effective therapy (see Good and Good “Learning Medicine” in Knowledge, Power, and Practice, 1993).
I also noted that Pigg’s zen-like approach generalizes to all the anthropological work we do, such as data collection and writing (and as Dr. B noted, to everything we do in life, really). It is essential when doing ethnography to drop one’s expectations of what is the ‘right’ answer. We can unconsciously convince ourselves beforehand what it is we will ‘hear’ from an attachment to our hypothesis, e.g., we could subtly be thinking “because a girl is rural, has a single mom, goes to a poor high school, therefore…” and be expectant of a response before it emerges, thus causing us to filter what the girl really is saying. The article resonated with Tina’s dissertation fieldwork experiences. She noted that the African-American girls she is studying in Tuscaloosa regarding their perception of HIV risk “take me to places with their comments” and bring up unexpected connections, such as the 2011 tornado. Tina cautioned that “we can lose context if we focus too narrowly.” Becky notes that we should be keenly aware of “what are our goals versus those of our informants.” From Achsah’s reading of the text, she perceived that “aid workers accept that the answers will be different from one culture group to another, but maybe not that the way to ask needs to be different also,” that one needs to re-do the whole process. Dr. B, an archaeologist, could easily generalize the article’s lesson to his cemeteries class in which on the first day he has his students “just walk around and observe” to soak it all in and generate ideas. Invariably, the student who immediately starts writing does not do well and becomes frustrated, as they focus too intently on the details to see the larger patterns. Greg was impressed and grateful that the author had written about the importance of ethnography. “By doing ethnography, we can focus on ‘insider meanings’ instead of imposing our agendas and ‘mining’ for data which supports our hypotheses. Through ethnography, we allow ourselves to be open and attend to aspects of culture which we may not have been prepared for or looking for.” For further reading Greg recommended Writing Ethnographic Fieldnotes, by Robert M. Emerson et al., to which Kathy added Learning How to Ask, by Charles Briggs
A special thanks to Tina Thomas for organizing the series, and to Sarah Szurek (PhD Alabama), Post-Doc at the University of Florida, for providing us a model of how the UF journal club functions. We’re looking forward to the next meeting!
The phrase “a working definition” is something that is encountered frequently in the literature in the social sciences. As an adjective, “working” is usually used in the following sense that appears in Webster’s: something that is “adequate to permit work to be done.” Note the use of the word “adequate.” There is the connotation of a definition that is rough-and-ready, somewhat unrefined, but that will suffice for the moment. At the risk of being accused of making one of those little academic ironic jokes—and if I am so accused, I will confess immediately that I am guilty—I intend to use the phrase in a different way. What I mean to talk about is a definition of culture that works, that can be used as both a theoretical and a methodological tool in understanding—in short, a definition that really does something.
The reason that I am approaching this essay in this way is because of the occasion: the considerable honor of having been chosen for this year’s Burnum Award.* This award is made on the basis of an overall research career, and hence this lecture is my opportunity to engage in a kind of retrospective examination of that research career. It has been 30 years since I decided, as a junior at Grinnell College, to pursue anthropology as a profession—which sounds like a long time even to me, although it feels like a short time. There are many ways I could think about and talk about those 30 years. My own view of what I’ve been doing really has most to do with the core idea of the field of anthropology: namely, the concept of culture and how to make it work in the research process.
My area of research is the intersection of culture, health and healing. What anthropologists like me do is to go around the world examining how culture shapes both the risk of disease and what it is that people do to recover from disease or illness. Obviously, we are talking about a wide range of questions encompassed by this area. In my own research, I have concentrated on the initial stages, namely, falling ill. How does culture shape that risk of disease?
The first question here is: what evidence is there that culture shapes disease at all? The short answer to that is: the epidemiologic transition.
In Figure 1, we see several countries in the Western hemisphere, comparing mortality rates from all causes of child mortality and from coronary heart disease (CHD). All-cause child mortality can be used as a proxy for various kinds of infectious and parasitic diseases (often summarized in official statistics under the heading diarrheal diseases) that tend to wreak greatest havoc among the most vulnerable in a population. CHD is foremost among the variety of chronic diseases. In some countries, child mortality equals or exceeds chronic disease mortality, while in others child mortality declines dramatically and chronic disease mortality increases equally dramatically.
What accounts for this difference? Some obvious answers come into play. Basic infrastructure like clean water and effective sewage systems, plus immunization programs, make a big difference. Also, in the process of economic development people have tended to become more sedentary with the related risk of obesity, which can contribute to many chronic diseases. The quality of our diets has changed, with much less fiber, more fat and more of other nutrients like sodium. Does the combination of these factors not account for these differences?
Well, actually, no. Certainly all of these factors play a role in the process, but even after their combined effects are removed, there are still societal differences in disease rates that are left unexplained.
Figure 2 shows another brief example of how sociocultural factors shape disease. The increase of blood pressure with age, as shown here for the West Tuscaloosa community, is taken to be “natural.” But if we compare this age distribution to the Zoró Indians of the Amazon basin, we see that the rise is not necessarily “natural,” but in some sense relative to cultural context. Again, a typical approach to unraveling these differences would be to look at issues such as diet and physical activity, and perhaps genetic predisposition.
But I want to take a moment to reflect on the logic that is being employed here. This logic unwittingly employs what has been called the “onion metaphor” of human beings. That is, we can forget about the Zoró’s mixed horticultural and fishing subsistence economy; we can forget about their system for tracing kinship relationships that is more complex than our own; we can forget the way in which they form household and family relationships; we can forget about their origin myths and conceptions of the supernatural. We can, in other words, strip away everything that makes them culturally different, in order to look at their physical activity or their diet to explain their blood pressure. Like stripping away the successive layers of an onion, this metaphor goes, we can strip away cultural difference to get at what is psychologically universal about people; we can strip away belief, value and personality and just look at behavior; we can strip away behavior and look at nutrient transport in the circulatory system; we can strip away physiologic process to look at base-pair coding. We can, ultimately, find our way down to what is fundamentally causative.
Or, can we? Could it be that the onion metaphor is just that, a metaphor that says more about how we look at the world and less about how the world really works? Could it be that we are as thinking, feeling, interacting, and, yes, biological entities, so suspended in a matrix of culture that to think we can strip it away as mere surface appearance so violates the phenomenon that we misunderstand it?
To even entertain this thought demands a way of conceptualizing culture that is subtle and nuanced, and at the same time that is hard-nosed and pragmatic. The concept of culture has to do some work in the research process.
So, what do we mean by culture? A fairly typical view, both in common language and in the way anthropologists have approached their work, sees culture as a shared body of custom, reproduced through time, that makes societies distinctive. Over a century ago, this kind of view of culture emerged in anthropology as an alternative to racialist thinking. Traders, travelers, warriors, missionaries and others had been covering the globe for some time, documenting the astounding variety of human social systems with the myriad ways that people found to resolve basic problems of finding food and shelter, avoiding predation, and reproducing themselves. In part, because people with these different customs also looked very different from the Europeans who visited them, there were appeals to biology to explain custom. People were thought to behave differently because they were biologically a different—and explicitly inferior—sort of creature.
These views were challenged by the anti-racist formulations of Franz Boas and his students. Simply put, they argued forcefully that other people were not biologically different from people of European ancestry, but were different rather because they had a different culture. Culture in this sense was a name put to the total lifeway of a people. From growing food to marrying to having and raising children to governing communities to imagining the supernatural, different peoples did—not just some things—but everything differently. These ways of getting things done were routinized and regularized and learned anew by succeeding generations of a society or community. This totality of the lifeway was called culture, and the learning of it by each generation served as an effective alternative to racial determinism.
The question then became: what was the “stuff” of culture? What was culture made of? How did it get from one generation to another? How do you know it when you see it?
Answers to these questions were generated in the historical context of early ethnographic research, or the documentation of cultural patterns in different societies. In doing cross-cultural research, ethnographers looked for regularities in learned behavior that could in turn be used to make inferences about the larger systematic design for living called culture. Your job was primarily to decode and describe that design, and not to worry too much about how some people may or may not deviate slightly from the pattern. The differences within a society, especially individual differences, were just noise in the system. And it’s important to remember just how difficult it was to decode that pattern, as you were far from home, working in a second language, and trying to understand remarkably different ways of life. The more simplifying assumptions, the better.
In a sense, you could see the people in the picture as merely the space-and-time bound carriers of a cultural tradition. They happened to be there at the moment, but at another moment those particular people would be gone and you would have another set, but still carrying on that same cultural tradition. Your job was to understand the tradition, not the particular people who carried it on at the moment.
When we talk about, for example, “British culture,” we don’t really suppose it is there only because the Brits who happen to be alive right now believe and act in the ways they do. British culture was an entity in 1902 and is one in 2002 and probably will be one in 2102, regardless of the people. This gives culture a sense of “externality,” something first articulated by Herbert Spenser in the 19th century. It really does feel as though culture exists “out there.” We seem as individuals to be casting about within the confines of our own cultures. And this is something that continues to surprise students of culture in the 21st century. So, a working concept of culture must be able to account for this really quite peculiar, property of culture.
But, having said that, I’m not advocating a kind of “swamp-gas” theory of culture. It’s not out there floating around with us breathing it in (or choking on it, as the case may be). Where culture resides can only be in individual human beings. Furthermore, if we are interested in the biological impact of culture, we have to be able to trace it from “out there” to “in here.” But, we have to somehow reconcile this external quality of culture with its locus in the individual.
One way of getting at this is to stop and think about what is really important in culture and cultural differences. Is the fact that I’m wearing this suit today really important as far as my culture is concerned? Well, sort of, because I am wearing this suit, as opposed to a grass skirt or a Brazilian carnaval costume or even nothing at all. But what is probably more important than my wearing this suit is that I knew, I understood that wearing this suit was what you expected of me. We shared the knowledge that this was the right thing for the occasion. Imagine if I had showed up here to present my Burnum lecture wearing old sneakers, cut-off jeans, and a baseball cap that said Auburn Tigers on it. Probably I would not have gotten tossed out—although the Auburn part might have done me in. More likely than not, you all would have looked at me, shifted uncomfortably in your chairs, and thought something like: “what is this world coming to when they give the Burnum to the likes of this joker?” I would, in other words, have failed to live up to our shared understanding of the world in my behavior.
Now, as basic a sketch as this is, there are a couple of useful ideas implicit in this example. First, there is the shared knowledge or shared expectation. Social life—all of human life—only works because we share various understandings of the world. Everything we do we can do because of these shared expectations. One way of referring to these expectations and understandings is as “shared cultural models.” Second, I’ve just suggested how we can distinguish between culture and behavior, which actually will turn out to be quite important in the story I’m building here. As I said, we may have shared expectations regarding behavior and social interaction, but for various reasons, some people may not fulfill those shared expectations in their own behavior.
This is a very brief sketch of a theory of culture on which I have been working, in one way or another, for quite some time. But, is it good for anything? That is, does it “work?” To examine this issue, let me turn briefly to some of my empirical work. As I said, a basic observation on which all this work is founded is illustrated in Figure 3, showing how average blood pressure levels vary across different kinds of societies. Here the societies are categorized along a continuum of sociocultural complexity, ranging from the simplest foraging societies, to the most complex industrial states.
But we can break the pattern apart in more precise ways. Figure 4 shows an example of blood pressure differences among communities in Samoa, in the South Pacific, arrayed along a continuum of modernization. The term “modernization” here is just a shorthand descriptor for a variety of differences among the communities. These differences include subsistence technologies (in the traditional community, people grow yams and herd pigs for their own consumption, while in the modern community people work in factories); patterns of social interaction (in the traditional community, people are much more embedded in their extended family systems, while in the modern community people focus more on independent nuclear households); education and literacy (people in the traditional community receive relatively little formal schooling, while people in the modern community receive more); and, belief systems (people in traditional communities are embedded in a system of supernatural beliefs derived locally, while people in the modern community tend to be pulled into one of the globally institutionalized belief systems, like Christianity).
Why do people in the more modernized communities have higher blood pressures? Well, as I noted at the outset, the obvious answer to that question involves things like diet and physical activity, but taking those factors into account actually fails to explain all of the differences, although these factors clearly explain a part of those differences.
For years, one explanation for these findings has loomed large: the stress of culture change. Somehow, all of these changes in peoples’ lives are stressful, and the resulting stresses are associated with higher blood pressure. Now, this explanation is terrifically compelling, especially when linked with all of the careful laboratory studies showing how psychologically threatening events or circumstances can influence physiology. The problem, however, has been sorting out, in a conceptually precise way, just what this phrase—“the stress of culture change”—really means.
About forty years ago, there was a remarkable burst of activity in thinking about this issue at UNC-Chapel Hill, involving the epidemiologist John Cassel, the psychologist Dave Jenkins and the anthropologist Ralph Patrick. They were particularly interested in what happened to migrants from rural areas to urban areas, although the same reasoning can be applied to culture change occurring within any community. They offered the following hypothesis: the migrant to a novel setting carries with her a particular understanding of how the world works, in every sense (i.e., what it means to work, how marriages are constituted, how families treat themselves and their neighbors, how to worship—everything). She is confronted, however, with a system for which her understanding may not work. The novel and dominant culture of the new setting must be learned for everyone else’s behavior to be understood and, indeed, for her to behave in ways that are understandable to others. She must, in other words, adapt to the new setting. Even if she is successful, such adaptation can be costly. Indeed, this is precisely what Hans Selye meant by the General Adaptation Syndrome when he gave the concept of stress its first scientific respectability in the 1930’s. Adaptation is costly, and the cost of adaptation is written on the body in terms of what we call health. So, Cassel, Patrick and Jenkins argued that the less successfully the migrant culturally adapts to the new setting, the higher her blood pressure.
Unfortunately, Cassel and his colleagues had neither the conceptual nor the methodological tools to really carry this project forward—or, to continue my theme, their definition of culture didn’t “work.” But what I have introduced here—namely the idea of culture as these shared cultural models, plus the idea of a person’s relative ability to really live in accordance with those models—gives us a way of attacking the problem. Simply put, realizing shared cultural expectations in individual behavior—or what I will refer to as “cultural consonance”—is in part a measure of how well individuals are able to adapt to their social milieu. And I would take Cassel’s model much further. We don’t need to limit our thinking to situations of migration, or modernization, or culture change because each of us, in our own way, every day, is engaged in the process of sorting out, in our own behaviors, these shared expectations. We are engaged in a daily endeavor to better adapt, and one way of thinking about that process is in terms of our success at meeting those shared expectations, or cultural consonance. I hypothesize that the higher a person’s cultural consonance, the better his or her health status.
I’ve been able to examine these processes in a variety of settings over the years, including, prominently, in Alabama. I arrived here in 1978 after doing my dissertation research around these topics in the West Indies. This conventional “modernization” view of things described well what had been going on in the West Indies for some 25 years. There modernization had been driven by a single economic innovation occurring in the early 1950’s: the introduction of the banana as a large-scale cash crop. And this is typically the case in the so-called Third World. Economic change drives societal modernization.
In Alabama in 1978, I began to explore the possibility of doing research on blood pressure in the African American community, and I tended to think about the community, and its experiences in the latter half of the 20th century, in terms analogous to the modernization paradigm. Black Americans in the South were denied participation in the modern world by the American version of apartheid that we called “segregation.” But a single political innovation— Brown vs. the Board of Education in 1954, and the civil rights movement spawned by that decision—changed everything. Like an economic innovation in the developing world, this political innovation changed not just some things, but everything, for the black community. Or, like the migrants to a novel setting described by Cassel, black Americans now had a whole new world opened to them. Let me hasten to add that this is a long, drawn-out process with which we are still dealing. But, in broad outline, this is a useful way of thinking about what occurred.
What I mean literally here is that the cultural models for everyday life ceased to be primarily autochthonous creations from within the African American community, and became instead creations more of the intersection of those models with general middle class American cultural models. Not that local meanings and understanding are irrelevant, but rather that black Americans have had a whole new set of circumstances, including a whole new way of understanding the world and its opportunities and its limitations, to which to adapt. What has the effect of all this been on their health?
We know the rate of high blood pressure among black Americans is 50% higher than among European Americans (Figure 5). In my work in the community here in Tuscaloosa (and, as I will briefly mention, in Brazil), I’ve tried to examine how these cultural stresses are implicated in the process. This is how I have gone about it. On the one hand, there are the cultural models, the shared ideas about how life is to be lived. On the other hand, there is the relative success with which people can approximate those cultural models in their behaviors. The link of model and behavior is cultural consonance. Assessing and measuring a representative sample of peoples’ behaviors is what social survey work is all about. The trick has been to get at the cultural models in a rigorous and systematic way; in a way that is faithful to theory; and in a way that we can directly connect to peoples’ behaviors as assessed in the survey.
Fortunately, in the mid-1980’s, Kim Romney and Sue Weller came up with a statistical model for doing just that that they call “the cultural consensus model.” I won’t go into the details here, but the consensus model can be used to determine the degree to which people share knowledge or ideas about some phenomenon. Remember that no sharing = no culture. And, if there is sharing, we can determine the content of what is shared. Having determined what that shared content is, we can then measure the degree to which peoples’ reported behaviors actually reflect that content and see if any disparity there is associated with health status.
OK, what are the important cultural models that people must live up in order to achieve better health status? Well, obviously this is a big question, and one on which I am currently working hard. But for purposes of illustration let me pick one. There is probably no aspect of American middle class culture more highly valued than our lifestyles, by which I literally mean the kinds of material circumstances of life we can achieve, and the kinds of leisure time activities that go along with that. Thorstein Veblen placed lifestyles at the center of human motivation a century ago in his “Theory of the Leisure Class.” Now, Veblen is well-remembered for his phrase “conspicuous consumption” to describe a rather vulgar pursuit of that lifestyle among the noveau riche. He is, however, less well-remembered for this observation: “[for most people, achieving a particular lifestyle ]…is a desire to live up to the conventional standard of decency…[in the community].”
In other words, to be left behind with respect to the middle-class lifestyle in American society is to be seen to be, somehow, “indecent” as a person.
In one of our recent studies, carried out here in the African American community in West Tuscaloosa, we asked a small sample of persons to list and rate the importance of material goods and related behaviors as indicative of having had a successful life. The consensus model showed us that they agreed strongly on what that meant. Basically, it meant having a modest and comfortable, but not ostentatious, lifestyle, including such things as owning a home, a car, having nice furnishings, keeping up on current events, and, significantly, participating in one’s church. I think the inclusion of that last item speaks volumes about the sensitivity of this technique to local meanings in the black community.
We also conducted an epidemiological survey of households in the community in which we collected data on blood pressures and a variety of factors, including individual self-reports of their ownership of lifestyle items and their adoption of related behaviors. Cultural consonance in lifestyle was measured as the degree to which an individual’s reported lifestyle matched the lifestyle described in the cultural model (Figure 6).
Figure 7 shows the relationship of systolic blood pressure, which has been adjusted to take out the effects of age, sex, body mass, income and various dietary variables, and cultural consonance in lifestyle. I think the relationship is pretty clear. The closer that a person can truly approximate in his or her own behavior the shared cultural model of lifestyle in the community, the lower his/her blood pressure. Furthermore, the more distal one becomes from the model, the stronger the effect, hence the curvilinear relationship. These results suggest that low cultural consonance may be a profound and chronically stressful circumstance that, in the long run, results in poor health status.
I assume that many of you are now playing the “my favorite variable” game. This is the game in which, after presenting data, someone jumps up and asks: “But did you control for __________ (fill in your favorite variable)?” I may be especially sensitive to this game, because I have spent a good bit of time presenting these ideas to psychologists, epidemiologists, nutrition researchers, and, yes, even internists. Well, I’ve been at this business for a long time, and I’ve managed to cram most of the variables that get mentioned in the research literature into studies, and so far, controlling for these other factors fails to dislodge the importance of cultural consonance.
What creates this state of affairs, in which people do not live in consonance with shared cultural models? Well, in the African American community, cultural construction collides with structural constraint. In the best of times, unemployment rates in the black community are twice that of the white community. More than a third of households live in poverty. Median household incomes are only about 60% of white household incomes. Hence, the likelihood that an individual can achieve even the modest lifestyle goals encoded by cultural models is diminished. The tragic part of this process is that these structural constraints are a result of institutional racism and racial stratification. Over a lifetime, for a large segment of the community, people see their shared hopes and their shared aspirations, modest as they might be in a material sense, denied to them. And that denial is written on their bodies in the form of poorer health status and risk of premature death.
These ideas have pretty good legs. I’ve been working in Brazil for nearly 20 years, and have examined many of the same processes there. Figure 8 shows how, for black Brazilians, low cultural consonance leads to blood pressures higher than their white counterparts, but higher cultural consonance leads to blood pressures lower than whites.
In a sense, we have come full circle here. Remember that early in this lecture I talked about how the concept of culture emerged in anthropology as a challenge to racialist explanations of others. My work has, in a way, continued that. Now, I don’t think that many people in medicine take seriously the old idea that African Americans are at risk of high blood pressure due to a racial-genetic trait, although that idea continued to be prominent well into the 1980’s. Rather, as Tom LaVeist pointed out, there is a tendency in the medical literature to document black-white health differences without comment; however, black folks are almost always coming out worse in terms of health status: more high blood pressure, more low birthweight babies, higher stroke rates, and worse cancer outcomes. Left uninterpreted, there is a kind of unspoken inference that somehow these black-white differences are a result of racial differences. Without grappling directly with the question of how so-called “race” may actually result in poor health through sociocultural pathways, we end up reinforcing the idea that the biologically bankrupt concept of race actually has some biological validity.
But, as I have argued, if we look closely enough, we find something else going on. With blood pressure, it’s not biology in some racial-genetic sense, but rather a complex set of social structural and biocultural processes that result in the appearance that somehow race matters as a biological factor, when it doesn’t. What I hope I have shown here is that continuing the anthropological project of the 19th century—that is, using the concept of culture to debunk racialist and other kinds of wrong-headed ideas—is still an important thing to do.
To do it right, however, we need a concept of culture that works. We need a concept of culture to help us to deconstruct the surface appearances of life. As the Dutch psychologist Ap Appel noted: “The final discovery a fish can make is that of water. It does not know what it means to live in water until it is lying on the counter of a fish shop. Similarly, people do not realize to what extent their behavior…is rooted in the culture in which they live.”
By explicating those links of culture and behavior, we can, I hope, both improve our theoretical understanding of the world, and maybe make it a better place to live.
*This essay was prepared as a lecture on the occasion of receiving the Burnum Distinguished Faculty Award.
In an earlier post, I began a discussion about the role of biology in a well-developed biocultural research program by debunking some common misconceptions (at least as I see them). I have argued that biomarkers are neither necessary nor sufficient to define a research program as biocultural, and that the same can be said of genetics/genomics and evolutionary hypotheses.
In this second part of the essay, I turn to the messier question of what a biocultural research program needs from biology.
If the point of biocultural research is to create a new subdiscipline with carefully defined boundaries tended by insiders, then the whole enterprise bores me and I want no part of it. We inhabit an academic universe filled with disciplines and subdisciplines and sub-subdisciplines that guard their borders, and despite moves toward interdisciplinarity (such as at Arizona State University, where they no longer have a conventional anthropology department, but instead a School of Human Evolution and Social Change), anthropology’s recent track record is not spectacular. Holism is not dead, but we collectively struggle with what it means in the 21st century, and worry about whether we are gripping an outdated sacred bundle, some artifact of the early 20th century institutional politics.
If biocultural research is to be a useful force in the future development of our discipline, it needs to be inclusive, flexible, and most importantly not defensive. Many (although not all!) researchers in the positivist anthropological sciences tire of, rail against, or just ignore theory and practice founded in Foucault’s biopower, the de-colonization movement, or critical medical anthropology, for instance. For my part, I find poststructuralist perspectives an essential check on the reductionist tendencies of biological research. One of the most compelling features of anthropology is that every foundational assumption is subject to examination. I don’t want to be satisfied with my work. I hear critiques, and I reconsider my approach. Then I continue my work, hopefully with some improvement. Open mindedness does not require nihilism.
But if biocultural research is a transactional phenomenon without a set trajectory or endpoint, built upon breaching carefully tended boundaries, then it’s an exciting enterprise indeed. For a health researcher with this perspective, each project presents an opportunity to throw out assumptions about causality and rebuild them. At its best, biocultural research can be disruptive, sometimes even a little threatening.
By transactional I mean that we converge on (if never quite reach) an understanding of human experience that incorporates the subjectivity and physicality of the body in the world, and describes exchanges among them. Every element of human state regulation – from gene regulation through neuronal firing patterns and hormone release to complex phenotypes like a disease state or a developmental outcome – is shaped by subjective experience. And that means it is shaped by culture. Through culture we collectively build the niches within which the human organism thrives, or fails to thrive. We do it on a day-to-day basis as we interact with one another, and on a global scale as we alter the composition of life on earth and the carbon content of our atmosphere.
This is all very airy, though. At some point, one has to design an actual study that examines specific biocultural transactions. Then most of this complexity flies out the window because it’s unmanageable to conceptualize – let alone actively study – more than a small slice of human experience at any one time. So in the interest of making broad principles concrete, I propose a rough taxonomy of ways our faculty and students have incorporated biology into biocultural research. This is not all-inclusive, and these categories overlap. Since one major purpose of this post is to explore what biocultural medical anthropology can mean at UA, I rely preferentially on local examples (with apologies to those who, in the interest of not writing a novel, I will omit; I respect your work too!) Some readers may be prospective graduate students. If so, perhaps you can join us and help expand the list.
1) Biocultural by theory. In part 1, I suggested it is not necessary to pursue evolutionary hypotheses to sustain the “bio” in biocultural research. However, strong research programs are grounded in theory, and biocultural research must be grounded in theory with provisions for biocultural transactions. Evolutionary theory continues to be one important way to achieve this. Hence, Catherine Buzney drew from life history theory, a specialty within evolutionary theory concerned with development across the lifespan, to hypothesize and interpret linkages between childhood stress and pubertal timing. Chris Lynn’s Human Behavioral Ecology Research Group (HBERG) pursues several lines of psychobiological and behavioral research driven by evolutionary hypotheses. One strand of my research used two evolutionary constructs (selection and energetic tradeoffs) to interpret sex-differentiated growth outcomes and immune system functioning in children. But there are other theoretical approaches amenable to biocultural integration. I have used ecocultural theory to interpret child stress response patterns and young adults’ physical activity. Toni Copeland has examined health outcomes among poor HIV-positive women in Kenya through the lens of structural violence. Rick Brown and Blakely Brooks built a cultural epidemiology of Type 2 diabetes and Susto, respectively. Bill Dressler, Kathy Oths, Francois Dengah, and several others have used cultural consonance theory as a bridge between a cognitive theory of culture and stress theory, to examine how cultural meaning per se shapes outcomes as diverse as arterial blood pressure, depressed affect, and body mass index. While this represents considerable theoretical pluralism, all these projects are firmly founded in some well-developed theoretical framework that not only permits but encourages reference to the body and its workings. Hence, our work is biocultural by theory.
2) Biocultural by outcome. Theory may encourage a careful look at transactions among the subjectivity and physicality of the body, but it’s still necessary to design a study that locates those transactions and makes them amenable to analysis. In our program, we have emphasized the design and testing of hypotheses concerning measureable health or health-related outcomes. These outcomes can be explicitly physiological, such as Sarah Szurek’s findings regarding glycemic control, Bill Dressler’s work on hypertension, or work that Chris Lynn and I have done regarding immune function. The outcomes may be implicitly biological, such as Kathy Oths’ work on bonesetting and Debilidad, Meredith Jackson-de Graffenried’s and Erica Gibson’s work on pregnancy and birth outcomes, the work of both Sarah Szurek and Katy Groves regarding food models, Jenelle Doucet’s research concerning ADHD, or Mary Campbell’s work on access to healthcare. Hence, our work is biocultural by outcome.Because these outcomes often benefit from quantification, we generally pursue mixed-methods approaches to our research questions. But where we use statistics, we have built our statistical models on an ethnographic foundation and interpreted our findings in an ethnographic light.
3) Biocultural by marker. I noted in my earlier post that the incorporation of biomarkers is neither necessary nor sufficient to a biocultural study. They’re still pretty darn useful, though. As I will use the term here, a marker is distinct from an outcome insofar as it is not directly the target of inquiry, but helps in the description or quantification of another variable important to the study hypothesis while being less amenable to direct measurement. Cortisol, then, is a marker of stress, not stress itself. HbA1c is a convenient marker of glycemic control. C-reactive protein is a one-molecule marker of inflammation. Taking this one step further, genotypes too are markers – markers of gene expression (and consequent variation in biological function). So, serotonin receptor polymorphisms are markers of biological sensitivity to adversity. Depending on study design, sometimes variables can serve as markers or outcomes. Chronic elevated inflammation, for example, can be a marker of pathogen exposure, or may itself be the health outcome of interest. Blood pressure can be a stress marker or a measure of hypertension, a medical condition. My lab, the Developmental Ecology and Human Biology Lab, is deeply concerned with the measurement of biomarkers. Our research can be biocultural by marker when the biomarker serves as a useful tool to address a question that might otherwise be inaccessible to study.
4) Biocultural by extension. Sometimes research that begins with an explicitly biological outcome leads in a direction that encourages a less direct approach to biology. This is a satisfying upshot of biocultural research, because it concerns the development of an entire research program, rather than a single study. As in Part 1, I shall for a moment pick on one of my own current students to illustrate this point, because I know the history of the project fairly well. Martina Thomas began her studies with a thesis project examining cultural models concerning body image among African American adolescents and their mothers in a low-income community with exceptionally high obesity rates. During her work, she found that body image, rather than being strictly concerned with shape or size, was bound up in a complex model also involving social relationships, material possessions, a variety of behaviors including respectfulness, drug use, and gossip; and, hidden in the mix, there were some interesting hints regarding perceptions (sometimes misconceptions) of what a person with AIDS “looks like.” On this foundation she built an entirely new study that examines HIV/AIDS models and social ecologies of risk. This research is not only biocultural by (implicit) outcome – HIV risk – but also biocultural by extension. It follows a trail of evidence, and when that trail leads into social and behavioral research without direct measurement of biological markers or outcomes, there is no wall that prevents the researcher from following along.
5) Biocultural by interpretation. Finally, research may be interpreted in light of human biology without measuring it. Francois Dengah and Chris Lynn have both done work concerning dissociative states evoked in the context of Pentecostal rituals. They are not measuring the neurobiology of dissociation – but they know about it, and can interpret their findings in light of neurobiology (and stress biology, which Chris measured and Francois inferred). My work on physical activity patterns among older adults who have osteoarthritis (with Pat Parmelee and Dylan Smith) and among young adults who do not is interpreted in light of the physiological significance of body movement, but we connect nothing to the body except an accelerometer (like a pedometer, but a little fancier). Beyond this department, a hallmark of neuroanthropology is the interpretation of a vast array of cultural and social experiences (from cancer survivorship to drug use and sport) in terms of neurobiology.
Anthropologists have a tremendous advantage insofar as we get outside of the lab and learn about people’s experiences as they live their lives. Yet that makes us by necessity versatile opportunists when it comes to methodology. When Greg Downey (not one of ours, alas, but an outstanding biocultural anthropologist at Macquarie University) studies Brazilian Capoeira, he can’t stick these martial artists into an fMRI magnet. But he can use the wonderful techniques of participant observation, combined with a healthy respect for the experimental neuroscience literature, to approximate an understanding of what’s happening on a biological level. We can examine questions that no other discipline is equally equipped to handle. But only if we’re prepared to transgress boundaries. Otherwise we may as well let the physiologists do it. After all, they have more money and far better toys.
In 2005, concerned about the absence in much biocultural research of an explicit theory of culture, Bill Dressler wrote a landmark piece in Ethos entitled “What’s Cultural about Biocultural Research?” While not all of us follow Bill’s approach to the letter, the perspective this article represents has been a major driving force as we’ve developed our Biocultural Medical Anthropology PhD program.
One could ask a parallel question: what’s Biological about Biocultural research? In many of the circles where I spend my conference time, the biological component of the research is easily assumed. I attend the Human Biology Association on an annual basis, and probably see more researchers there who consider themselves “biocultural” than at either of the other anthropological conferences I frequently attend – the American Anthropological Association and the Society for Applied Anthropology. (Not just as a percentage, but as a raw number, despite the fact that HBA is so much smaller.) Nearly all human biologists consider their work biocultural whether or not it hews to Bill’s definition, because human evolution is irreducibly biocultural and human biologists are interested in that. And, being human biologists, they rarely feel the need to prove that they’re “biological enough.”
Yet our program historically has followed a different pathway. In the early years of the PhD program, every one of our doctoral students was advised either by Bill Dressler or Kathy Oths. (These days students are spread much more evenly among the faculty.) Bill and Kathy tended to attract students who were bright and sophisticated, fully capable of engaging with biological dimensions of their work, but with a primary foothold in cultural anthropology. To an extent this has persisted even as Chris Lynn and I have taken on doctoral students. If one were to put my doc students to date into a box, it would have CULTURAL written in caps, with biological in lower case. It’s a wonderful feature of this program that both the faculty and students are so comfortable transacting across boundaries that a biocultural human biologist like me can advise a great student like Martina Thomas, whose NSF-funded research concerns HIV-related cultural models in adolescents. And have that be a positive experience for both of us, sans either biomarkers or evolutionary hypotheses. (Our very strong tradition of group mentorship and either formal or informal co-advising has a lot to do with this too – a post on this soon, I think.)
So, in short, as I see our students develop, a question that I turn over and over in my head is: what does it mean to refer to “biology” here? First, let’s do some debunking.
1) Biocultural research is not about biomarkers. I have seen biomarkers thrown into studies for their own sake, with no significant development of biocultural theory. I have seen them thrown into studies because it was fashionable. I have seem them thrown into studies because they are (falsely) understood as a shortcut that circumvents all the challenges of assessing “stress” or some other nebulous concept by observing and talking to people. The inclusion of biomarkers does not by itself make a study biocultural any more than the inclusion of a question about someone’s ancestry or “traditional foods and dress” makes it biocultural. Biomarkers are a method, a tool. They are only as useful as the study design and underlying theory make them. If they don’t make sense in a given study design, and they’re not called for by theory, they should be omitted. So, then, they’re not a sufficient condition, but they’re also not necessary. Consider Daniel Lende’s work in substance use in Colombia, or much of the recent work developing the nascent field of Neuroanthropology. Not a biomarker to be found in many cases – but we do see careful attention to underlying neurological mechanisms that influence and are shaped by subjective experience.
2) Biocultural research is not about genetics (or even genomics). This is an extension of an older false equivalence: biology = genes. Biological phenotypes are both overdetermined and complexly determined, through a multi-level interaction among genes, developmental systems, and social/cultural environments. The “biology = genes” fallacy is particularly common in discussions that have a “nature vs. nurture” tone to them, and often take the form, “Is X trait/phenotype biological or cultural,” where “biological” = “genetic,” “cultural” = anything remotely social or experiential, and all the developmental systems that actually produce the phenotype are ignored. Genotypes can be quite helpful in biocultural research, depending on the question, but they also are neither necessary or sufficient.
3) Biocultural research is not limited to work drawing from evolutionary theory. This one is perhaps more controversial among people in my circles, most of whom approach their work from the standpoint of evolutionary theory and hypotheses drawn from it. Much (although not all) of my work does as well. Yet it is simply not necessary to chart the evolutionary history of a physiological system to usefully study it. Sometimes developmental theory is more helpful. Sometimes stress theory. Sometimes ecocultural theory. Sometimes epidemiological theory. Denying the importance of the evolution of these systems to their current variation and functioning is a non-starter for me, and all our students get exposed to evolutionary principles. But it’s sometimes useful to study the (current) endpoint of a long process of evolutionary change without explicit reference to how and why we got to there. Conversely, there’s a danger of a certain evolutionary tokenism. Mentioning Paleolithic diets does not a biocultural study make (even when it’s not blatant misrepresentation or overinterpretation of the actual paleo human data).
So far, we’re in a place where I’ve outlined some negatives, but no positives. If it’s not per se about biomarkers, genetics, or evolution, than what is the biology in biocultural research about?
In a subsequent post I’ll explore this in more detail, making the argument that biocultural research is about integrative transactions across theoretical frameworks combined with methodological opportunism. Those methods are chosen from an interdisciplinary toolkit to fit specific hypotheses and research questions rather than a pre-set, unchanging, conventional inventory. I’ll argue that how we operationalize human biology is ultimately less important than how we understand it to work. I’ll argue for the value of developmental perspectives, although without claiming all biocultural research must lean on human development. I’ll argue for the importance of measurable outcomes with inherent biological implications, without claiming that biology need be directly measured to achieve this. If this seems too vague, or filled with straw men, hopefully Part 2 will dispel that. In the meantime, comments would be received warmly.
Biocultural anthropology exists at the intersection of cultural and biological approaches. Given how concepts, methods, and institutions have changed with regard to “biology” and “culture” since the early 1900s, the biocultural intersection has proven a dynamic space. It is also a contested space, where claims about human nature and culture and about science and ethnography have often come into stark contrast. Biocultural anthropology is linked to the four-field holistic tradition of anthropology within the United States. Individuals who don the biocultural mantle often claim holism as well and the accompanying ability to cross among archaeology, biological anthropology, cultural anthropology, and linguistic anthropology. Other individuals often object to this presumptive turf-grabbing and the accompanying assumption that the biocultural tradition is somehow better through being more integrative (or “holistic”) and better able at getting at more “fundamental” questions within anthropology. Here too controversy can arise. Yet, over the course of one hundred years, the biocultural tradition has helped tie together anthropology, first in the United States and, then, increasingly so in Europe. Certainly biocultural anthropology—broadly conceived as drawing on biological and cultural theory and using an inherent interdisciplinary approach—has gone through periods of obscurity, where small groups of researchers kept some of the main ideas and ideological commitments alive for another generation. But today, biocultural approaches are experiencing a renaissance across many arenas within anthropology. The perception exists, however, that the present biocultural approaches largely come from the biology and science side of anthropology and aim to increasingly encroach on questions seemingly reserved for social and cultural theorists. This bibliography emphasizes both biological and cultural research, with the hope that this broader selection can help anthropologists understand the conflicts that arise at the biology/culture interface as well as find important texts outside their areas of expertise that can facilitate further developments in biocultural anthropology. The bibliography has a three-part organization: an overview at the beginning, a historical review in the middle, and particular examples at the end. The overview provides a selection of introductory texts, overviews, recent collections, Internet resources, methods, and applied work. The historical coverage comes in the sections Foundations of Biocultural Anthropology and Disciplinary Divisions, Controversies, and Syntheses. The Foundations of Biocultural Anthropology section begins with the origins of holistic anthropology, considers mediating traditions from earlier to recent research, covers evolutionary and cultural theory amenable to interdisciplinary work, and highlights research that crosses the biocultural divide. Disciplinary Divisions, Controversies, and Syntheses delves into the recent history of anthropology, examining the disciplinary divisions that sprang up in the 1970s; then tracks important controversies that cut across the biocultural divide in the ensuing decades; and finally examines recent integrative attempts and reworkings of anthropology’s holistic tradition. The final section covers neuroanthropology and addiction as two examples of biocultural research.
We are seeking a cultural anthropologist with research interests in medical anthropology that converge with a biocultural focus. Topical and geographic specialization are open. Knowledge of both quantitative and qualitative research are expected. Teaching responsibilities include specific core undergraduate and graduate level class and courses of one’s own development. Please visit our Biocultural Medical Program and Anthropology Department pages for more information.
The Department of Anthropology of The University of Alabama, Tuscaloosa, invites applications for a full-time, tenure-track Assistant Professor position in cultural anthropology beginning Fall 2014. Ph.D. in Anthropology is expected to be in hand at the time of the appointment. We seek a cultural anthropologist with research interests in medical anthropology that converge with the biocultural focus of the department. Topical and geographic specialization are open, although the applicant should complement existing specialties in the department and be well-versed in both quantitative and qualitative research methods. The successful applicant will have research skills and interests that contribute directly to our undergraduate and graduate programs, with particular reference to our Ph.D. program and its focus on biocultural medical anthropology. The proposed faculty member will have teaching responsibilities that include specific core undergraduate and graduate level classes and courses of their own development.
To apply, go to http://facultyjobs.ua.edu and complete the online application. Attach a letter of application (outlining research interests, plans, and relevant experience) and a curriculum vitae. Send names of three potential referees and examples of manuscripts (for submission as publications and/or published articles; PDF format is desirable) and teaching evaluations, if available, directly to Dr. William W. Dressler, (firstname.lastname@example.org), Cultural Anthropology Search Committee, Department of Anthropology, Box 870210, University of Alabama, Tuscaloosa, AL, 35487-0210. Review of applications will begin December 15, 2013, and will continue until the position is filled. Members of the department will be attending the American Anthropological Association meetings in Chicago in November and will be available to answer any questions of prospective candidates.
The University of Alabama offers one of the few dedicated Biocultural Medical Anthropology doctoral programs in the United States. We are currently accepting applications from qualified students. Please visit our faculty page & feel free to contact us with any questions or to learn more.