Science, Illness, and Disease 307of diplomatic and other relationships between that com-
munist country and Western powers, played a role in this
theoretical shift.^8 Cultural exchanges revealed a profes-
sional medical system in the East rivaling that of Western
biomedicine in its scientific basis and technical feats. For
example, the practice of open heart surgery in China, us-
ing only acupuncture needles as an anesthetic, challenged
the assumption of biomedical superiority within anthro-
pological thought. At this time scholars proposed that bio-
medicine is a cultural system, just like the medical systems
in other cultures, and that it, too, is worthy of anthropo-
logical study.^9
To effectively compare medical systems and health
cross-culturally, medical anthropologists have made a
theoretical distinction between the terms disease and ill-
ness. Disease refers to a specific pathology: a physical or
biological abnormality. Illness refers to the meanings and
elaborations given to particular physical states. Disease
and illness do not necessarily overlap. An individual may
experience illness without having a disease, or a disease
may occur in the absence of illness.
In cultures with scientific medical systems, a key
component of the social process of illness involves delin-
eating human suffering in terms of biology. At times this
extends to labeling an illness as a disease even though
the biology is poorly understood. Think about alcohol-
ism in the United States, for example. A person who is
thought of as a drunk, partier, barfly, or boozer tends
not to get sympathy from the rest of society. By contrast,
a person struggling with the disease alcoholism receives
cultural help from physicians, support from groups
such as Alcoholics Anonymous, and financial aid from
health insurance covering medical treatment. It mat-
ters little that the biology of this disease is still poorly
understood and that alcoholism is treated through so-
cial support rather than expert manipulation of biology.
By calling alcoholism a disease, it becomes a socially
sanctioned and recognized illness within the dominant
medical system of the United States. See this chapter’s
Globalscape for an innovative method of reducing the
stigma and improving the health education of ordinary
people in daily life.knowledge (spiritual or scientific) from which the average
community member is excluded.
Medical anthropologists also use scientific models
drawn from biological anthropology, such as evolutionary
theory, to understand and improve human health. More-
over, they have turned their attention to the connections
between human health and political and economic forces,
both globally and locally. Because global flows of people,
germs, cures, guns, and pollution underlie the distribution
of sickness and health in the world today, a broad anthro-
pological understanding of the origins of sickness is vital
for alleviating human suffering.Science, Illness, and Disease
During the course of medical anthropology’s development
as a distinct specialty within anthropology, the theoretical
relationship between biological and cultural knowledge
was transformed. The earliest research on medical systems
was carried out by physician-anthropologists— individuals
trained as medical doctors and as anthropologists who
participated in the international public health movement
emerging early in the 20th century. While delivering the
medical care developed in Europe and North America,
these physician-anthropologists simultaneously studied
the health beliefs and practices of the cultures they were
sent to help. Local cultural categories about sickness were
translated into Western biomedical terms.
Initially, these Western approaches were thought
to be culture-free depictions of human biology and
were therefore used as an interpretive framework for
examining the medical beliefs and practices of other
cultures. Implicit in this work was the notion that the
Western approach, with its supposed objectivity, was
superior. Fieldwork conducted by cultural anthropolo-
gists, however, has shown that medical categories, like
other aspects of a people’s unique worldview, reflect the
value system of their particular culture. For example, the
Subinam people of Mindinao, one of the large islands of
the Philippines, give different names to fungal infections
of the skin depending on whether the infection is openly
visible or hidden under clothes.^7 The biomedical and sci-
entific categorization of fungal infections refers only to
genus and species of the fungus.
In the 1970s the place of biological and cultural
knowledge in medical anthropology was dramatically
reorganized. The admission of mainland China to the
United Nations in 1971, and the subsequent improvement
disease A specific pathology; a physical or biological
abnormality.
illness The meanings and elaborations given to a particular
physical state.(^7) Frake, C. (1961). The diagnosis of disease among the Subinam of
Mindinao. American Anthropologist 63, 113–132.
(^8) Young, A. (1981). The creation of medical knowledge: Some problems in
interpretation. Social Science and Medicine 17, 1205–1211.
(^9) Kleinman, A. (1976). Concepts and a model for the comparison of medical
systems as cultural systems. Social Science and Medicine 12 (2B), 85–95.
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