These essays, written by undergraduate medical anthropology students, are the first in a series that the MASA blog will publish. Medical anthropology professors who would like to showcase the best work of their students should contact Jonathan Stillo, the MASA Chair at jstillo@gmail.com.
Professor’s Introduction
The essays presented here were written by undergraduate students in an upper level anthropology course at the University of Washington entitled “Anthropology of the Body.” This course was offered without pre-requisites, which attracted not only anthropology majors but also students majoring in biology, public health, political science, international studies, entrepreneurship, and communications. Many students enrolled in this course are planning careers as medical professionals and sought out this class knowing the value medical schools place upon anthropological training. The following works are included here:
The Effect of Foucault’s Work on the Approach of Future Medicine” by Lisa Hysa
“The Inevitable Medical Gaze” by Tess Han
“We Can Change the Way We See It” by Russom Desta
In these papers, the authors reflect upon the medical system that they aim to join, taking a critical look at how contemporary medical practices frame the human body, how subjectivity is shaped and constrained in this context, and the role that health care professionals can play in improving individual patient experiences. These essays not only demonstrate the value of anthropological training for medical professionals, they show us how future medical professionals envision themselves putting that training to use.
–Jennifer J. Carroll, Ph.C. (University of Washington)
The effect of Foucault’s work on the approach of future medicine
By: Lisa Hysa
Lisa Hysa is a pre-med student at the University of Washington majoring in Physiology and minoring in Anthropology. She spends most of her time volunteering in a Radiology Neuroimaging and Biotechnology laboratory at the UW where she is investigating the longitudinal effects of mild traumatic brain injury and how it may relate to the initiation of Dementia, Depression, or Alzheimer’s disease. She also volunteers at the Emergency Department at Swedish Hospital, where her interactions with staff and patients inspire her to further pursue medicine. In her spare time, Lisa enjoys the company of her friends and family, exploring new places, drinking coffee, and being outdoors.
I have always been fascinated with science. This led me to pursue a career in the medical field. My coursework at the University of Washington has previously consisted of only science-based classes. So, being curious, I wanted to get out of my comfort zone and explore other academic fields, such as anthropology. I thought that anthropology would give me a different outlook and perspective on healthcare and patient-doctor relationships, which would better me as a future doctor. By this, I mean coursework that would allow me to study patients as not just cells, molecules, and body parts, but as a whole system with other social and psychological aspects. I appreciate how medicine is applicable to the wider population—but having learned why medicine works in application to human bodies was a very important aspect that broadened my understanding of medicine. Through the analysis of medicine’s approach with an anthropological perspective, it is clear that there are many successes but also many pitfalls to this approach. However, after analyzing both, I find even more reason to pursue the medical field due to the possibility for the future development and improvement of medical care.
Medicine has an epistemology that emphasizes objectivity and the scientific method. All current data and treatments used in the clinic are proven and replicable through this scientific method, which is what gives medicine its credentials. Medicine is taught and performed through a specific lens that French philosopher, Michel Foucault, called the “medical gaze.” This lens follows a specific set of steps: “a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world” (Foucault 1975, 29). This particular way of thinking and diagnosing is taught to many, if not all, medically trained professionals in the United States. I look forward to learning to see through this specific lens, because it is such a unique and distinctive knowledge that allows medicine to continue being productive.
One important aspect of the medical gaze is the focus on a collective view of people. I think this sort of mentality makes it easier to organize people, but also more difficult to create a personalized and individual approach of medical interaction. As Foucault puts it, it is not a “perception of the patient in his singularity, but a collective consciousness” (Foucault 1975, 29). Foucault criticizes the medical gaze by pointing out that patients are now standardized amongst each other to create an “average” or “normal” person to whom all are compared. However, this medical gaze is essential for a medical student, because, before one can learn how to treat a specific person, they must learn how all people should be treated. As further stated by Foucault, medicine embraces the “knowledge of a healthy man, that is, a study of non-sick man and a definition of the model man” (Foucault 1975, 34). Therefore, in order to understand how and why medicine works, one has to look at the foundation of this medical approach.
I am interested in being a doctor because I want to learn how to help everybody. However, I believe this is best done with the scientific method—it has been disciplined into my head since the beginning of my undergraduate experience. Therefore, I think it is logical that these teachings continue to use basic statistics in order to have an average and a standard deviation that can then have a statistical significance to prove the usefulness of a medical treatment. This comes as second nature to students like myself, who have been trained since day one to think this way and to only see this way of thinking.
It is difficult for doctors to have an individual approach with patients when the focus of medicine is to get the patient to the “model man.” This requires an agreed initial definition of this term—accomplished through a collective medical approach. If this approach is explicitly presented to doctors like myself, we can better our profession and methods to clinical practice by recognizing that this clinical standard defines “normal” bodies through “the standards for physical and moral relations of the individual” (Foucault 1975, 34). I agree that it is difficult to fit all different categories of body into a statistically significant average value (body) with which the medical approach operates. It is also important to realize that the definition of a normalized body is not necessarily solely socially constructed, but also focuses on statistical measurements. An example is that a “normal” body should have a certain body temperature, blood pressure, cholesterol level or weight to height ratio. All of these are efficient ways of qualitatively measuring bodies and comparing them to the “normal” body to see if there is any need for medical attention. However, particular social groups have been shown to have statistically significant predispositions to certain irregularities that divert them from the norm. One example is the statistic that black men are more susceptible to heart disease. This sort of information may cause a doctor to focus on preventive care for heart disease which may be an issue because the patient may be upset with the fact that the doctors make him believe he will get heart disease, when it is not necessarily true. These statistical values follow this man in a medical atmosphere, limiting his individuality—he is now part of a collective knowledge.
One important idea that Foucault brings up is the patient becoming an object due to the medical gaze. I do not think doctors necessarily try to do this, but I believe doctors should be aware of this pitfall. The patient is “now required to be the object of gaze, indeed, relative object, since what was being deciphered in him was seen as contributing to a better knowledge of others” (Foucault 1975, 83). When we look at the world with this medical gaze, we illuminate the mechanical aspects of people. This gaze reduces the patient to their physical mechanisms, and functions. It enlightens the idea that the body is just an object: physically and conceptually limited. The medical gaze may ignore social or cultural factors that can affect the body. However, the ability to easily and quickly diagnose and treat a patient is a very difficult task. This is a skill that requires lots of schooling in order to master it and appropriately use it. One example as to what is not included in the medical gaze is the idea of spirituality with the body, such as chakras. The medical gaze does not look at the body as anything more than physical and mechanical so treatment and approach is only focused on quantifiable components. This view makes it easier to narrow down the medical issues through symptoms and physical examination. Therefore, I can acknowledge the idea that the medical gaze warps the image of the human patient into a human “object,” but it is in exchange for a system of medicine that works.
The fact that we can achieve knowledge through the medical gaze to help a large and diverse population is very important. It specifically includes an emphasis on the biological and mechanical functions of the body. However, this does not necessarily mean that all medical professions follow this set of standards per se. I personally want to practice medicine with an overarching scientific approach, while still including sociological and anthropological insight. With this knowledge, I can be a better doctor by keeping in mind that disease and sickness is not necessarily only physically cured. Patients are people; therefore there are many other aspects such as mental, emotional, or cultural areas that may need assistance. These sorts of factors beyond the scientific method require an approach beyond the limits of the medical gaze. I hope to make patient experiences more personal and individualistic to at least mask the distress of this scientifically focused medical approach. I also believe every new generation of doctors, especially when exposed to this sort of philosophical work, will have new insight and knowledge to add into their clinical practice that will address social factors.
The medical gaze may appear ineffective, but I believe it is a very realistic approach. I want to practice a form of medicine that has high success rates and that is applicable to people with all types of cultural backgrounds. In order to help the most people possible in such a large nation as the United States, we need doctors to focus on the mechanics of people. I believe that medical schools are rigorous and difficult for a reason: it is not easy for anybody to be able to practice this sort of medical gaze and keep such objectivity when necessary. There are always other “non-clinical” resources, such as hypnosis or spiritual chanting for patients. They are left to choose whichever medical approach best suits them. This is the beauty of medicine; there are so many approaches, all of which have their very own specific target audience. Even after learning the “medical gaze” that medical students are taught, I am still interested in pursuing this career. I can only relate to and understand scientific and objective forms of medicine, because that is how I think. I will fit perfectly in this atmosphere in the future, where I can continue my love for science in application to helping the physicality of human bodies.
Works Cited:
American Heart Association. “African-Americans and Heart Disease, Stroke.” Last modified September 30, 2014. http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStroke News/African-Americans-and-Heart-Disease_UCM_444863_Article.jsp
Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Vintage, 1975. Print.
The Inevitable Medical Gaze
By: Tess Han
Tess Han is currently a senior at the University of Washington studying Medical Anthropology and Global health with a minor in Nutritional Sciences. She is passionate about improving the health and well being of others. Tess plans on continuing her education to earn a Masters in Nutrition and become a Registered Dietitian. With aspirations of becoming a nutritionist, she hopes to provide guidance and assistance to anyone who wishes or feels the need to improve their lifestyle by diet and nutrition.
In his book The Birth of the Clinic, doctors these days have a “medical gaze”. He occasionally refers to it as a “clinical gaze” or an “observing gaze”(Foucault, “The Birth of the Clinic,” 146.). This “medical gaze” is a taught, learned, and institutionalized way of looking and making sense of the body by doctors around the world. It doesn’t take into consideration the patient’s sociological context, because doctors are reframing patients as merely another file or case to look at. The relationship between the doctor and the patient has become extremely standardized as a result of this medical gaze. The following describes my past and present experiences with this medical gaze and how it will affect my future plans of hopefully becoming a health administrator. A career where most, if not all, administrators see with the medical gaze.
After completing my undergraduate degree in Medical Anthropology, it is my goal to attend graduate school and receive my Masters in Health Administration. The ultimate end goal is to become a generalist administrator and manage an entire facility, such as a hospital. With that responsibility comes a lot of paperwork: the paperwork of many many patients. Most likely, I won’t be working with any patients directly, which may force me to only see patients as another file. After reading about standardization and the negative consequences of the medical gaze, I am worried that I would be participating in and fueling the medical gaze. I don’t want to be seen as someone who doesn’t care for other people’s well being. While that isn’t true, that will be the stereotype mapped onto me if I reach that profession.
The medical gaze was built in such a way that it created a standard for everything in the medical field including those who work in it. “First, it was no longer the gaze of any observer, but that of a doctor supported and justified by an institution…it was a gaze that was not content to observe what was self-evident…it was calculating” (Foucault, “The Birth of the Clinic,” 109).. In addition, the medical gaze has broken down the relationship between the doctor and the patient. Doctors are seeing so many patients in a day that they only distinguish a patient from their test results. The continually shrinking time interval of the appointment length to see a patient is a negative consequence of the standardized doctor-patient relationship. These brief appointments cause the doctor to see the patient as an object that is nothing more than a machine that needs repairing instead of a subject who is a human being and needs special care and compassion, especially when faced with a medical concern.
The medical gaze also created a set of boundaries around what is considered “normal” for the human body, which could further diminish the doctor-patient relationship. When doctors see patients with a medical issue, they are considered outside of this “normal” range and it’s the doctors’ responsibility to put them back into a normal state. While these guidelines on what is considered “normal” can be reassuring and aid us in determining when we have a health related issue, there are a lot of instances when people’s bodily functions are outside of this normal boundary, but they are perfectly healthy. Doctors are so fixated on this sense of normalcy that they tend to disregard the fact that some bodies perform slightly differently than others. A controversial example is intersex and gender assignment. Infants born with ambiguous genitalia are quickly assigned a gender in which “the genitalia and physical appearance can be made to look most normal” (Creighton, “Surgery for Intersex.”) These newborns that don’t have the opportunity to speak up for them, go through an intrusive surgery because their bodies don’t fit perfectly into a female or male category. Unfortunately, this normalization of the body that doctors use has encroached on the rest of the public, which has led everybody, not just doctors, to view the world with a slight medical gaze. When the majority of society views the body in this way, it becomes extremely difficult to change the standards of what “normal” is and, in turn, makes it difficult to change health professionals’ standards.
Looking back, I never recognized the medical gaze and standardization of the medical field, because it is what I grew up with. When I was very young, I had a primary doctor that I would go to for every visit. Then he retired. Ever since, I have been going to different doctors every time. I would go to different locations in the UW Medicine network depending on which clinic I was closest to or which had the soonest available appointment. One time, the doctor asked me who my primary care doctor was, and I didn’t know what she was meant. The doctor explained, and I understood and replied that I did not have a primary care doctor. It never occurred to me how much easier my visits to the doctor would be if I only had one. Having a primary care doctor who knows my medical history would make appointments flow more smoothly and result in a more logical diagnosis. Every time I saw a different doctor I would have to talk to the receptionist and see if I’m entered into the system and once I see the doctor I have to explain my medical issue as well as my medical history. This always caused a little frustration, but apparently not to the point where I would choose to stick to one doctor. I realized that I should really have a primary care doctor so that there is a medical professional who knows my body patterns and my past medical history. By only seeing one doctor who knows more about my body than some piece of paper, will hopefully allow the doctor to treat me with compassion and eliminate the medical gaze.
After taking a medical anthropology class and reading Foucault’s The Birth of the Clinic, I can clearly see all of the things he mentions in his book about the medical gaze. I grew up in a community where standardization of the medical field had been long established, therefore I didn’t see or care that I had no sense of a doctor-patient relationship. Now I realize the importance of having a primary care doctor with a strong doctor-patient relationship. One should have a relationship with the person who is examining and diagnosing your body because you are putting a great amount of trust in that person to make you feel healthy again.
As I continue on with my education, my values and the way I choose to view the medical field could very well change. I hope to care and have compassion for each patient even if I never even meet him or her in person. On the other hand, I could find it hard to be sympathetic towards someone I only know through a piece of paper and take the easy way out: the medical gaze. I don’t believe that a health administrator could avoid seeing with the medical gaze when the extent of their patient care is providing services that barely contains genuine interactions. This has caused me to reassess my career goals. I now hope to become a nutritionist where I’m able to have a strong doctor-patient relationship while aiding someone on his or her journey to a healthier lifestyle.
Works Cited:
Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Pantheon, 1973.
Creighton, Sarah, “Surgery for Intersex,” Journal of the Royal Society of Medicine (2001): 218-220.
We Can Change the Way We See It
By: Russom Desta
Russom Desta is studying Medical Anthropology/Global Health as well as Biochemistry at the University of Washington. He hopes one day to become a physician and believes that an anthropology background provides will provide him with a humanistic social approach to providing care. One reason he wants to become a doctor is because there is more to the profession than the science of treating the body. The healthcare field has countless social interactions, cultural differences and its always evolving. Russom also spends his free time volunteering, working at the Fred Hutchinson Cancer Research Center and reading interesting medical cases.
As an aspiring physician, I have experienced many of the trials and tribulations associated with becoming eligible for medical school. I have taken courses in introductory physics and biology, volunteered time at hospitals and clinics, and have shadowed a physician, which most would consider a staple ingredient in building one’s pre-medicine foundation. In sum, all these tasks are of value in building a basis for my future career as a physician. I feel that of all these building blocks, such as being allowed the chance to shadow a physician, allow students like myself to get the most hands on view of what happens in a doctor’s day to day operations. It is in these moments that we see our studies and skills being applied in the real world.
From the insights I have gained from observing medical professionals and from the subject matter we have discussed in this course, I feel that there is a need for humanity in our healthcare system. As medicine has moved forward with technology and practice, the “medical gaze,” which Foucault (1973) defines as the separation of the patients’ body from the patient herself, has had a larger presence in everyday practice. This notion of a “medical gaze” is intended to allow physicians to remain objective and impartial to the human factors that influence one’s perception of another being. By remaining objective and unbiased, physicians are able to treat each patient equally and consistently. However, by taking on this medical gaze and medicalization of the human body, physicians are removing the personal humanistic facet necessary for providing holistic and well-rounded care. Though objectivity is important in providing equal and unbiased care, modern day physicians must also consider human nature and its many facets in order to assess their patient holistically.
When a person is ill and visits their physician, they are often met with a string of questions aimed at identifying the most critical issue. The questions often refer to where it hurts, how much it hurts, how the pain feels, etc. What people don’t often realize is that, from the start, physicians are observing you through a medical gaze that focuses on treating your symptoms and finding the most critical issues. While shadowing one doctor, I observed that he had poor bedside manner. He never really connected to the patient on a personal level or asked questions that would build an emotional or personal relationship. The doctor’s questions were intended to narrow the scope so that a determination could be made on what was wrong with the patient. In doing so, the doctor separates the illness from the person, the soul, viewing their patient not as a human subject but as an object.
Foucault describes this methodology in The Birth of the Clinic when he states “the fundamental act of medical knowledge was the drawing up of a ‘map’ a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world” (Foucault 1973, 34). In this statement, Foucault describes how the medical gaze allows the physician to break down a person into their most basic components: their illness and everything else. In using their understanding of medicine, they are able to form a judgment of the illness that will allow for a practical application of their skills and knowledge. During my time shadowing, I felt as though doctors did not care to know names or faces but rather focused on the piecing together of lab values, vital signs, and imaging with objective observations so that they could find a resolution for a diseased state. They focused on change and deviations from “normal” but failed to focus on the individual person. In a previous course discussing the medical narrative I learned that in the first year of medical school, doctors learn the anatomy of a cadaver, taking apart each body part piece by piece and developing an intricate mapping of the body’s internal cavity. By taking a scientific rather than humanistic approach to the body, doctors are able to improve their abilities to perceive and analyze a situation free from bias and prejudice, but consequently are removing themselves from a holistic “whole patient” perspective that medicine was once based upon.
Doctors use medical gaze in order to look for deviations from normal, but since diagnosing is an observatory science or many parts of the body those deviations place people in groups that may not be accurate. People are often being grouped in “pre” categories denoting that they are at risk for diseased states. These notions of diagnosing people in “pre” diseased states are preposterous. There is a fine line between being cautious and being fearful. Giving patients potentially scary diagnoses will forever set forth a precedent that they must live in fear of all the risks associated with the disease. Without knowing all the available data from the patient, the doctor may not find a logical reason for why the patient has such deviant levels. Only looking at the numbers in turn, hinders the doctor from being able to provide a full spectrum of care. Nikolas Rose touches upon this when he states:
Men presenting to their doctors with high blood pressure are risk profiled in terms of age, weight, family history, smoking…if at high risk, may be advised to make changes to behavior, diet or lifestyle, or pre-emptively placed on a drug regime to reduce the risk of occurrence of such disorders (2007, 72)
There are many factors that cause a person to have high blood pressure that do not have anything to do with examples provide in the quote, by limiting the scope to four factors a physician is not doing everything to treat the patient.
Another classic example of normalizing people is with the Body Mass Index, a method of combining height and weight which allows a doctor to determine whether a person is overweight, normal or underweight. The limited factors used in determining “normal” body weight cannot be solely used to justify the next steps for a doctor to treat the person. This simple method does not account for muscle mass, missing limbs or even something as simple as whether the patient was wearing clothes or not. I believe that the patient will be better served once physicians try to encompass all available factors including numerical data and holistic data.
As a scientist, I understand the benefits of the medical gaze and why is has been a popular has been the primary project of medicine for centuries. The medical gaze allows doctors to treat patients in an objective, medically focused manner. It allows patients to be treated equally and doctors to provide consistent medical care. However, despite its benefits, the medical gaze prevents doctors from viewing the patient holistically and seeing the bigger picture. In order to be a strong, competent, and well-rounded physician, doctors must break through this conditioning and view the patient holistically. As a hopeful future doctor, I would like to see a shift in the medical gaze towards a more holistic approach that involves more than treating the symptoms. We must move our standards of practice towards finding preventative measures and working on healing not jus the body but the factors that influence one’s health choices. Once we are able to step away from the medical gaze and the disjointedness of body and soul we can utilize this larger scale view to its fullest potential turning medical practice into a more all encompassing solution.
Works Cited:
Foucault, Michel. The Birth of the Clinic; an Archaeology of Medical Perception. New York: Pantheon Books, 1973.
Rose, Nikolas S. Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-first Century. Princeton: Princeton University Press, 2007.
