Area of inquiry (group 1): health, illness and healing practice questions.

Scheper-Hughes reported that in the Alto do Cruzeiro in north-eastern Brazil in the 1980s the shaking and weakness that residents called nervos was met in clinics and pharmacies with tranquillizers and tonics, while the hunger those same residents named as its cause went unaddressed. Anthropologists describe this conversion of a shared social condition into a treatable individual complaint as

• somatization of a purely private psychological conflict within the body of the sufferer
• the medicalization of hunger, a social condition reframed as an individual disorder
• a diagnostic error made by clinic staff working without laboratory support
• the placebo effect operating through the prescriber's authority over the patient

Answer: the medicalization of hunger, a social condition reframed as an individual disorder

Medicalization names the process by which a condition produced socially is reframed as a disorder of the individual body and handed to medicine. The case is not a mistake by individual staff: the drugs relieved the symptom and left its cause untouched, which is exactly what makes the process political.

Lock compared how women in Japan and in North America described the end of menstruation in the 1980s. Hot flushes were reported far less often in Japan, where konenki was spoken of as a gradual change including stiff shoulders and dizziness rather than as a deficiency of hormones. Her term 'local biologies' was introduced to argue that

• bodily experience is shaped in the interplay of biology and setting, and so varies
• the end of menstruation is a cultural invention with no bodily correlate whatsoever
• Japanese respondents under-reported symptoms they were reluctant to name to an interviewer
• the North American clinical model should be applied unchanged wherever women reach middle age

Answer: bodily experience is shaped in the interplay of biology and setting, and so varies

Local biologies is a two-way claim: culture does not merely shape how a universal body is talked about, it enters into how the body develops and is felt. Reading Lock as saying the symptoms are 'only cultural' loses the point of the comparison.

In a 1949 essay Levi-Strauss examined a Kuna shamanic chant recorded in Panama, sung to a woman during an obstructed labour, in which the healer narrates a journey to recover her threatened spirit. His account of why such a chant can be effective was that

• the chant works only where the sufferer has no access to any biomedical care at all
• the audience rather than the sufferer is the real target of the healer's performance
• its effect is best explained by the herbal preparations administered alongside the singing
• it supplies a language in which formless pain becomes expressible and orderable

Answer: it supplies a language in which formless pain becomes expressible and orderable

Symbolic efficacy works through form: the myth gives the sufferer a structure onto which an experience that had no shape can be mapped, and so reorganises it. That is an argument about meaning, not about suggestion or about the absence of alternatives.

Petryna carried out fieldwork in Ukraine in the 1990s among people affected by the Chernobyl accident, where access to payments, housing and medical care depended on obtaining documents certifying a degree of radiation damage, and where much of daily life was taken up with assembling those records. Her term 'biological citizenship' names

• a claim on the state made through the medically documented damage to one's own body
• the right of a state to require medical examination of its citizens before granting them benefits
• a form of belonging based on descent that the Ukrainian state introduced after independence
• the transfer of responsibility for treating radiation injuries from the state to international agencies working in the region

Answer: a claim on the state made through the medically documented damage to one's own body

Where other bases of entitlement had collapsed, injury became the currency in which claims could be made — which drew people into the work of documenting sickness and made the diagnosis itself an object of contest. Note that this is a description of how claims are made, not a judgement on whether the claimants were ill.

Briggs and Mantini-Briggs studied a cholera epidemic in the Orinoco delta of Venezuela in 1992 and 1993, in which mortality was concentrated among indigenous residents. Public statements attributed the deaths to indigenous customs and to a reluctance to seek treatment, while the affected communities had no piped water and the nearest clinics were hours away by boat. The authors' argument about those statements is that

• they were broadly accurate but incomplete, since custom was one cause among several that operated in the delta, and the officials concerned said as much at the time
• they were an understandable simplification for a public that could not have followed a technical explanation
• an appeal to culture served to explain deaths in a way that left the distribution of water and clinics unexamined
• the epidemic should be attributed to the delay in issuing the statements rather than to their content

Answer: an appeal to culture served to explain deaths in a way that left the distribution of water and clinics unexamined

The pattern is a recurring one in medical anthropology: culture is invoked as a cause for the deaths of the poor, and the invocation locates the problem inside the community. The analytic reply is not that custom never matters but that its explanatory work has to be demonstrated against the material conditions it is being used to displace.

A household with a sick child consults first an elderly neighbour known for her preparations, then a pharmacist who sells them an injection, then a healer who identifies a quarrel within the family as the cause, and finally the district clinic. The family sees no contradiction in this sequence. Anthropologists describe such a setting as one of

• noncompliance, since the treatment prescribed at the clinic was not followed through from the beginning of the episode
• medical pluralism, in which several therapeutic traditions are available at once and are used in sequence or together
• syncretism, in which two systems of practice have merged so far that their elements can no longer be told apart
• somatization, in which a difficulty in the household's relationships is presented as a complaint of the body

Answer: medical pluralism, in which several therapeutic traditions are available at once and are used in sequence or together

Pluralism describes the field of resorts available; syncretism describes a fusion, which is not what happens when a family keeps the options distinct and uses each for a different purpose. Calling the sequence noncompliance adopts the clinic's view of it as the analysis.