I. Historical Roots of Western (Scientific) medicine

A. Biomedicine

1. Western medicine
2. Illness is disruption in physiological workings of body

a. Invading pathogen
b. Internal disruption, i.e., tumor or biochemical imbalance

3. Scientific, but also rests on cultural ideas about contagion, control, and mind-body dualism

B. Ancient Greece and Rome

1. Empedocles (500-430 B.C.): theory of the four elements (fire, air, earth, water) and 4 humors (blood; phlegm; choler, or yellow bile; and melancholy, or black bile)
2. Hippocrates of Cos (460-377 B.C.)

a. manage humors: bloodletting, purgatives
b. ethics, Hippocratic oath

3. Galen (129 -216? A.D.)

a. physiology, animal dissection
b. illness = stagnation of four humors, bloodletting

C. Middle Ages in Europe

1. Christianity, conceptions of the body, illness and healing as connected to the soul, sin
2. Saints with curing powers
3. Illness as public threat ==> sick taken care of in monasteries and abbeys by clergy
4. Precursor to hospitals

D. Renaissance period (14-16th century)

1. professionalization of medicine
2. Pope Innocent VIII - Papal Bull of 1484 condemns midwives
3. Dissection
4. Rene Descartes (1594-1650) - Cartesian mind/body dualism

E. Enlightenment medicine

1. Mechanistic theories of the body
2. c. 1600: microscope, germ theory of disease
3. Michel Foucault: Madness and Civilization: A History of Insanity in the Age of Reason

a. Asylums and the Great Confinement
b. Discipline and surveillance

F. Public health and public medicine in the 19th-20th century

1. Medicalizaton: life transitions, birth, and death are considered medical issues to be managed by physicians
2. France--(1791)--Board of Health, Poverty Committee of the National Assembly
3. United States-epidemics and the Civil War

a. National Board of Health, 1879
b. Marine Hospital Service becomes United States Public Health Service, 1912
c. Disease seen as coming from certain types of people: Eugenics and immigration policy

 

II. Medicine in the Service of the State and Imperialism

A. Colonial medicine

1. control of disease
2. penetration and control of the bodies of Others
3. missionaries

B. French colonial medicine in Haiti

1. Fear of African slaves and voodoo
2. Characterization of African bodies as degenerate, diseased, oversexed
3. the l'hopital
4. slave medicine and resistance

C. American occupation of Haiti (1915-1934): plans to promote health, hygiene, but legacy of economic dependence, racism
D. 1980s: Haitian refugees and AIDS

 

III. Creation of Doctors and Medical Authority

A. Return to "Interpretive Drift"
B. Learning to "see" the body-the Clinical Gaze
C. Writing the object of medicine
D. Clinical encounters and case presentation

 

IV. Cultural biases of medical practice

A. Race, gender and diagnosis

1. Schizophrenia among African-American men
2. Anorexia as disease of white middle and upper-middle class women

B. Somatization: mental distress gets expressed as a physical symptom

1. Biomedicine has trouble connecting social, emotional, and physical aspects of illness
2. Schizophrenia may reflect experience of racial prejudice rather than a medical condition, which, because of that prejudice, gets interpreted by physicians as pathological

C. Rational knowledge vs. irrational belief