Medical Anthropology Young Scholars 7th Meeting - Keynote lecture - Arthur Kleinman

first of all on behalf of ma of my partner coordinator natash and of ISS we are really grateful to welcome

you Professor uh Clayman to this meeting it's a great pleasure and also a challenging moment to introduce Professor kimman uh whose work and books

are very familiar and well known to both anthropologists and social scientist uh Professor kimman is currently professor of medical

anthropology and Psychiatry at Harvard Medical School Esther and Sid re professor of anthropology and director of Harvard University haia

Center his contribution to to Medical anthropology and cultural Psychiatry is immense as well as his influence in global health studies social medicine

and medical Humanities he is well known for his work on mental illness in Chinese culture and he has written pioneering article on

public health on social suffering and on the individual experience of Pain and Disability exploring the importance of illness narratives and experiences in

anthropology and Psychiatry among his book I will site only a few of the most influential like the illness narratives suffering healing

and The Human Condition social suffering edited with venad and Margaret lock writing at the margin discourse between anthropology and

Medicine Professor kimman has also recently uh published together with Jan Wilkinson a book on caregiving and human suffering a passion for society how we

think about human suffering from the University of California press a book that he presented last year at this institution so today we will go together

with Professor kimman along the history of medical anthropology and medical Humanities at Harvard University to finally explore some present and future

opportunities of our research field thanks you again for being here you okay well thank you so much for that kind introduction and it's a pleasure to

be here and uh I'm going to take my jacket off it's a little hot uh and it's a special pleasure to speak to uh the M

Network um which uh seems to me to represent what uh all uh people who've worked in a field for a long time want to see which is

young people younger PE younger people uh taking up the subject um so um

um Lisbon is one of my favorite cities in the world and I I just had a uh wonderful experience with Professor bashus

uh by the water and the Sun and the and wine and uh wonderful fish and so you you may not hear me at my best

because I'm still savoring the quality of the the quality of that experience a very European experience not the American Experience of eating in five

minutes and going back to uh what you're doing so I want to talk about medical anthropology at Harvard not to

brag um uh but simply to give you a sense of a place where we've taken it very seriously and we've um um put fair

amount of resource into it and um where we have a kind of diverse way of doing it so um

uh if we look at the um the department of anthropology alone where where I'm the r Professor we have um we have four medical

anthropologists and actually if we counted Byron good who's really in the medical school but just spends a lot of time in anthropology we would have five so

um my primary involvement is medical anthropology and I also do China anthropology but um two of my colleagues are very well known in medical

anthropology but that's not their primary involvement so Jean kov is primarily a political Anthropologist of Africa and Susan

greenall a political Anthropologist of China but each of them does um some aspect of medical anthropology um and also Lawrence Ralph

is a young African-American medical Anthropologist who works in inner city Chicago on violence so we have a a fair

number of people in the anthropology department but if we look at the medical school we actually have many

more people and so um and this is I think what is distinctive about Harvard that that not only is it a bridge

between anthropology and medicine but it's a bridge in which the medical school side is actually stronger than the anthropology side in terms of

numbers of people and the kinds of work going on so um there's my former student a number of of of the people here are former

students of mine Paul Farmer and Paul also teaches in the faculty of Arts and Sciences Anne Becker and she also teaches in the faculty of Arts and

Sciences Salman kabji all of them took their um phds with me and all of them are MD phds then there's Byron good who also

teaches in the faculty of Arts and Sciences and Mary Joe good and several others actually if we counted all of them across the hospitals and the like

we would be talking of somewhere about 12 or 13 medical anthropologists at Harvard Medical School and so this is this is really what we have which I

think is very special and will be seen historically as very special about Harvard that we have a faculty of Arts

and Sciences a medical school hospitals and a School of Public Health and Medical anthropology is distributed

across those domains um and I think they're very different domains requiring different kinds of research different

sorts of teaching different kinds of practice so I I um I think that's um an

important point to point out now this is kind of the history chronology at Harvard so in 1973 how many of you were born after

1973 okay so uh see I'm older than a lot of people here a lot older so in 1973 I taught the first course on medical

anthropology in the social anthropology wing of the Department of anthropology at Harvard and in 1982 I started the pH D program which

included an MD PhD program in 1984 the National Institutes of Health which is a very important funding and

research organization for health in the United States uh gave us a the beginning of a

24-year support for a postdoctoral fellowship and we've had many very well-known post doctor of fellows in medical anthropology who finished their

PHD somewhere else and then came to Harvard for 2 years as posts and so these include people like Janice Jenkins

and Thomas chash of the University California San Diego joah Beal of Princeton Adriana Patrina of University of

Pennsylvania uh Joe calab Breezy of University College London David Napier of University College London and many

and many others in fact altogether I've had about 200 post-doctoral fellows so we've had a chance to be influential and

then a little later in in 1984 we actually began an interesting ma program it's an interesting ma program because it's a single intensive year a single

year and that means that we're able to bring uh a medical students and Physicians into that uh program and so

um we've had um uh a small but very Lively number of people do that program and these are the numbers that

we've had so um uh uh now the phds this is a little bit out of date now the PHD is about

95 and of those MD phds closer to 25 the ma is a small program about 20 and the post doctoral Fells as I said

200 but we've actually had thousands of undergraduates and so I think our biggest influence probably has been with undergraduates and what's interesting

about the United States compared to many European countries is that our high school

students when they leave High School do not go directly into a specialty like architecture or engineering or business

or medicine or law they first must do four years of a liberal arts education and so um many of these students of the

students we have taught medical anthropology to as a liberal arts graduate uh liberal arts undergraduates have gone on to do very different things

in their careers not anthropology not medicine uh often business and um uh uh public

health and uh um many many different fields now another thing about our about the way that we do medical anthropology is that we have been intimately involved

with hospitals um so for s years uh now it's a I stopped it about 10

years ago because I I got too old to do this but for 17 years I did weekly clinical rounds at one of our hospitals called the Cambridge hospital and I did it with

the internal medicine residents all of them together and we would go see patients and I did it together we brought anthropology students together

with the residents and would in I would interview patients and show how medical anthropology is directly related to the

care of patients and can be useful um Paul Farmer besides chairing the global Health and Social medicine Department which I used to

chair Paul also directs an entire division at one of our big hospitals the brigam and Women's Hospital um and he

does his clinical work both there and in the field in Haiti Rwanda Malawi lutu and Becker directs the eating disorders

clinic at the massachusett General Hospital and is also professor of Psychiatry there even though her

principal role is in uh social medicine salmon kabji who I mentioned heads the Harvard Dubai program which

which is the Dubai government gave Harvard money to set up a a research center in Dubai and um he's been very

active in doing that and of course one of the things that Paul and Jim Kim made possible was

a close collaboration with an an an NGO an international NGO I think a very I'm very biased about this but I think a

very special NGO Partners in which does its work in um Africa was very active in the Ebola

outbreak emphasizes multi-drug resistant TB and and um and um and and HIV AIDS

and takes a uh takes uh social theory and anthropological research very seriously as the basis for implementation of

services and so if we you look at the graduates of our program I've just listed um some of the some of them not all of them um Jim Kim is now president

of the World Bank and this means something to train someone who doesn't go on in

Academia but pursues a different course because um in March Jim Kim and I and Margaret Chan ran a major meeting the

first world B Bank meeting on global mental health a big big meeting to raise funds for Global mental health um and see that's the importance of training

people not all of whom are going to go into Academia because there's a danger in thinking that the only way we're influential is by emphasizing academic

careers sometimes it's by people who are not academics Paul Farmer is a university professor at Harvard Anne Becker has the professorship that I had

formerly at the medical school the Presley professorship Lawrence con directs the uh medical anthropology program at UC

Berkeley uh Elizabeth Millie you wouldn't know probably uh or Devin Hinton Clara Han is at Johns

Hopkins Robert dejarle at Sarah Lawrence University Tom churis and Janice Jenkins at UC San Diego yunshang Yen at

UCLA Linda Hunt directs the medical anthropology program at Michigan State Sarah Pinto runs the program at tus

Chris stole is at ammer Erica James runs the medical anthropology program at MIT Don Seaman is at Emory Sarah Willen runs the program at

University of Connecticut Peter Benson is very active at Washington University in St Louis

where Priscilla sun is Jing Jun is the head of Public Health in China's most powerful university chingua university

yeah Wu is uh at at B peing University as is Guin haa pananu at Fudan so we have

close tie with China um uh we have a very close tie with Stanford University where two of my former students are our professors

Matthew Corman and Angela Garcia Terry onell as professor at Oregon and recent graduates in there

just to give you a sense of the topics students are doing uh uh Daria Geor GIC who's a an MD

PhD student just finished her PhD she worked on Cancer Care and statehood which he calls anko nationhood in uh

Rwanda John Hines also an mdphd student who just finished his uh PhD worked on intimate partner violence and its

relationship to power in Colombia Jason Silverstein who just finished as well uh worked on pediatric

palea of Care at the um at Boston Children's Hospital a really wonderful study Marty Alexander is working on uh

chronic disease epidemiology in South China and Hong Kong Andy Ang on development

humanitarianism in the W region of of Myanmar this is in the Shan states of Myanmar

um aniki heran tabibi is working amongst care uh amongst the Finnish Sami uh

um and if we look at undergraduates these a recent undergrad so those are PhD students these are undergraduates so H Hannah Emmanuel

who's from erria worked on female genital cutting in women's writs in eretria Alexia zagoras who did probably

the most ambitious study of any student I've had ever before she did both a study that was an ethnography of a stem

cell research unit at Harvard and also she did a stem cell research project and she's a combined

major in stem cell and and social anthropology very very unusual so this would be like for those of you who know Bruno lur and Steve Ward's laboratory

life this will be as if Bruno and Steve not only did laboratory life but actually did a major research project in that in that

area Bessie Jong is looking at um the transformation in femininity in women's health in Shanghai Joyce Joe end of life care conceptions of the good death among

elderly Chinese Americans in Northern California Margot ma working in France

on the Roma and their um housing precarity and health issues Angela

Angela leocata community health workers in uh uh Goa India and also in Indonesia and these these are the kind of current courses that we give so we

don't give all these courses at one time they rotate them but um Paul Farmer Jim Kim I'm sorry Paul Farmer uh an Becker

Salman kabji and I teach a very large undergraduate Harvard course which is called case studies in global health and actually um we have a textbook that goes

with this which is called reimagining Global Health that came out of the course and this course is now a very substantial moo so we've had tens and

tens of thousands of people take the course around the world as a moo a massive online course I give a course called medical

anthropology Advanced topics looking at recent ethnographies in medical anthropology

um see I don't think we so for example this year we taught ethnography by Lisa Stevenson uh working with a

wonderful ethnography with the Inuit in Canada um Lisa muli looking at humanitarianism and Finnish

Society u a former student of mine uh Everett Jong who's now at Princeton um on uh uh the epidemic of

impedence in um in China in in the 1980s and '90s um

uh um Kate Mason now at Brown University as a professor who worked on the rebuilding of Public Health in China after

SARS um and we we taught the book that Ian Stevenson Ian Wilkinson and I did uh on passion for society we give a course on medical

Humanities which is given with um I give that with two of my colleagues David Jones who's a medical historian is an mdphd medical historian

in the history of science but he also has an MA in medical anthropology so and then Karen thornber who does comparative

literature and we teach um medical Humanities uh uh course we've taught it once on uh

epidemics once on um uh caregiving and um uh and we're going off to other

subjects Byron good teaches a course on theory in medical anthropology I teach a course on local biologies using the work of Margaret lock uh not just her

anthropology or biom medicine but a very nice book she's recently done an Alzheimers disease and other lots of other works in the anthropology of science as well well and that's the

particular interest of a colleague of mine in Harvard Susan greenall the anthropology of science um I teach a course on new ethnographies

of social experience which are the latest ethnographies of medical anthropology and then the most fun course I teach is called biography

ethnography the novel and film deep ways of knowing the person in the social context and every week for example we

read a major work and then we read a biography about the person who read wrote that major work each

week um so there's about u a thousand pages of reading every week in that that course um so not not too many people

take that course uh uh uh this of course I teach on deep China and then with um with with two of my colleagues uh David

carasco who's a historian of religion and a great expert on the Aztec and Mexican uh

religions and Michael peit who is a expert on Ancient Chinese religion we teach a course Called Quest for wisdom which is

about we teach it to undergraduates it's about how the knowledge produced in in anthropology in history can be used for

your own life and transforming your own life it's a really wonderful course and we ask the students to stay in touch with us by

letters for 5 years after taking the course and we learn a lot about them I just got a letter the other day from one of our students who went into the American

Army and and um is a drill instructor so you wouldn't expect a drill instructor of the American Army to be someone who on the side is reading

bordier and Fuko but that shows you something of the complexity of Life today around the world um then of course in my own area the anthropology of mental

illness we had the advance Advantage early on of starting a journey J culture medicine and Psychiatry which I edited I

founded and edited for uh uh about 10 years and then I turned it over to Byron and Mary Joe good and they turn turned it over to Anne Becker and then Anne

turned it over to Woody gains at uh Case Western University so it's it keeps going and that's kind of interesting you know if you think about it when I was

your age I started a journal and I I you know I had no no idea how long it would go and here it's in its 45th year or something like that so it's nice to nice

to see that we started a a seminar series that's been running for about 30 years and that I don't teach anymore but it's run by Byron and Mary Joe good called

the Friday morning seminar and it involves each Friday different people coming to Harvard and giving talks uh

and these are just some of the projects that we have so we have a lot of projects in global health and Global

mental health we also have the medical Humanities um we have things going on in human rights and medical

ethics I myself have a major projects several in China One on Elder Care which I'm very very interested in care of the frail elderly and especially the de

elderly with dementia and I have another one on really it should be called mistrust in the doctor patient relationship or what

the Chinese call the Ewan GUI wanty um and uh this is a huge problem in China patient doctor distrust we can

talk about that later and these are other projects going on in our group and then the areas of the world where

we're active is are China Africa Haiti Central Asia Russia South

Pacific Latin America and the United States and the main themes I I think of our research if you had to summarize them though they're on many different

topics but still if we look for Golden Threads that run through the research of what I believe is really a school of medical anthropology at Harvard the

Harvard School of medical anthropology we don't call it that but that's what it amounts to the lived experience of illness I think is probably the main focus we've

had a strong focus on social suffering including structural violence big interest in the normal and the abnormal medic and

medicalization currently a very substantial concern with caregiving and moral experience or longterm involvement with

culture ethnicity and Medicine um we teach Global Health we're probably the only place in the world that teaches Global health from the

standpoint of social theory if you look at our book reimagining Global health or look at our moo we start to hold course with history and social theory and begin to believe

that that's the basis of looking at Global Health otherwise Global health is just a series of problems um we're very interested in different

views of the self and how the self relates to the social social world and in eng engaged anthropology and most of our students

are are strongly interested in engaged anthropology they want to be involved in some way uh with something in the world

um uh then if we look at topical areas they're the ones I mentioned Global

Health Global mental health Elder Care Health of poor immigrants trust in clinical relationships stigma and mental illness

subjectivity disability and also violence and um the more recent developments and the ones we see going

on into the future are we've had a very very good experience with massive online course and probably will do more of that we've been encouraging our students to

do ethnographic films and so two of my former students one in particular but two are really First Rate ethnographic filmmakers and the one

maybe someone might know here is JP snei who runs the ethnographic film program at uh Northwestern University

and is a great documentary filmmaker in in China but we're encouraging all of our students to get involved to some degree with ethnographic

films we've started a master's program for people in the health area in global Health Equity with medical anthropology as one

of the tracks in it we have a program for young students called called the geoc Scholars Program

where they go to chapis Mexico to work in communities of um to do an ethnography in communities of um

indigenous Indians of Mexico uh Mayan Mayan communities and um and they're supervised by

Skype and this very interesting so um we get young people doing remarkable ethnography Ries and learning while they're doing we're really very interested in

building a movement for Global mental health similar to the movement for HIV AIDS that was so

successful and um and an increasing funding for that and we have um increasing interest

in Social uh studies of science um but from an anthropological standpoint meaning emphasizing the ethnographic

component well that gives you kind of a flavor for for this and um I think you could ask the question so

what do you learn from the what can we learn from the Harvard experience what's what's useful to take

away well like like any uh re social reality there are elements of our experience that um relate to the unique

Tera the unique soil of Harvard and um there are elements of our serence experien that are probably generalizable so one thing that I think

has been unique that I've mentioned already and relates to the strong involvement of people who have combined degrees in anthropology and and Medicine

is our emphasis of the clinical and the medical and we see this as as not a tradition not a tradition unique to

Harvard but we see ourselves as derivative of a great European tradition here which is the tradition of social medicine and this tradition really can

be traced back to Rudolph vof and the European revolutions especially the German social revolution of

1848 and vir's great study of the celian miners and their problems and his emphasis on what we would Now call structural violence so we see ourselves

carrying forth social medicine but we see social medicine as different than public health we see Public Health as principally oriented around

prevention whereas social medicine is interested in prevention for sure but it's concerned with caregiving with intervention and in fact we believe in

social medicine that social care is a methodology is a methodology Central to Medical anthropology that the way that

we do social research with a caregiving approach affirming and acknowledging the other intimately involved in trying to

improve things that this is also a way of generating knowledge a very powerful way of generating knowledge and indeed we believe that and this book has all

that information we believe that contrary to the way many people think of social science as an objective understanding of society for

its own sake we believe that's artifactual and that's why increasingly in America at least very few people are paying attention to social s science

today we think that the social care approach of social medicine and of medical anthropology is much more real because

people don't live in the world to observe they live in the world to struggle to survive to

endure to transcend and that involves intervention intervening somehow and I think I think we see that intervention not just as a

way of helping people but of learning about the world we think that's basic to the social practice of anthropology and other

social sciences um so that's that's that connection between the hospitals and

Medicine um second thing is we try to relate what we do in the field

research in places like Africa and China to what we do in

Boston both in research and in uh uh work in communities and so for example as an example we have a lot of work going on

in on community health workers um in uh both especially in African societies but we believe that

actually we're going to learn in America from this that we will eventually go in the direction of community health workers in the United States so we

believe that this is a real Global Health not not the idea of Health somewhere else but of relating Health where you are to health where in the field you do

your research um We Believe very strongly in social theory so uh this is

my if you know my work um um I believe that social theory is important not just as Theory to debate and discuss and and

critique but I think social theory is essential for research that it's that if for anthropological anthropological

research what distinguishes it is the iterative process between refining Theory and refining ethnography and

going back and forth between them and in in the area of theory we are um we are

eclectic I was going to say um agnostic uh that is we have no we have

no uh dominant theoretical frame We Believe let a 100 flowers bloom and let's see which theoretical work produces the most

interesting uh results but the results should not just be empirical uh uh writings but should feed

back to Theory should feed back to informed Theory um so in my own work probably the um if I had to say

what has been the strongest theoretical interest invol influences on me um they have been uh first of

all a lifetime of reading of Continental phenomenology which I began reading when I was a a undergraduate and have never given up

reading um and so the work of helmet plnar Arnold Galen Maurice Merlo panti um

who s others has been very very instrumental in my focus on meaning as has the symbolic School of American

anthropology Clifford Garretts at all um I think if you looked at Paul Farmer you'd see that Central to his work has

been Liberation theology and theories related to Liberation theology and political e economic

theories um you looked at Anne Becker you would see that much of her work has been influenced by um theories related

to the body and to um uh so

B and um but also um uh an entire set of theoreticians who worked with the idea of sooss somatic processes

where the social World enters the body you look at Salman kabji he's been concerned deeply concerned with

neoliberalism and its negative effects on global health and he's written a brilliant book called Blind Spot about his own experience in

Tajikistan his own research in Tajikistan um and it goes on and on and on and we encourage

students in different theoretical directions so one of the main in influences on me has always been the

Great American philosopher William James and um William James very much like the

Continental um Continental writers like the ones I mentioned in phenomenology um argued that all knowledge comes out of

experience but that experience can never be understood as taken neat that is it is always contextualized so understanding how

experience is organized culturally politically economically uh is crucial but

emphasizing experience I think has been Central for me so you can read things that I've written and my colleagues have written that have to do with

epistemology and with um categories but I think what has characterized our work is to look at categories or how we know in terms of

experience or let me put it this way Aristotle Aristotle said there were three great forms of knowledge one was techne or purely

technical know know and he said this was very important this was the technical knowledge that a builder had of how to build a building um for example or a physician

had how to heal someone um or someone who uh was an expert in Warfare how to uh how to train

people for battle technical knowledge but he said more important than technical knowledge was epistemological knowledge knowledge

how we know how we know what we know and then he said the most important knowledge of all more important than technical knowledge and more important

than epistemological knowledge was what Aristotle called fris fris in Greek

meaning practical wisdom the wisdom for how we live our lives and William James very

much uh emphasized this much as Michelle de monia emphasized it earlier but William James with respect to how to do

research related to this to experience from experience to experience um well I think I've said enough things

it's um whatever you think of what I presented to you it's kept me busy and active for half a century and uh that's something

uh I believe very strongly in anthropology not just medical anthropology but social and cultural anthropology

generally I believe strongly in it not because its methods are powerful and my view the methods of

anthropology actually are are fascinating but um in some ways weak but the importance of anthropology

is not its methods it's the questions it asks Raymond fth the great uh British Anthropologist once said that what made anthropology in his

view the queen of Sciences he said was that anthropology always asked the big questions the difficult uncomfortable

questions and I think that's our that's our that's what makes us special asking these uncomfortable difficult questions and then trying to show that the

responses to those questions are complex are deeply rooted in social life um and will'll never give a

simplistic reductionist answer I think [Music] resisting simplistic

answers so that puts us at some tension with the modern world if you go back to 1948 in

1948 a great American engineer who would become the father of Information Technology Shannon wrote a paper in

1948 in which he said that engineering which had done such a good job with

steel with concrete with um uh cars with

airplanes would come to do a good job with information but in order to do that he said information had to be stripped of its

meaning stripped of its meaning he said Engineers would come to learn had to manage information he said this in 1948 but it would be information

stripped of its of any meaning which didn't bother him at all well we live in an Information Age Now where every one of us is is astonishing

in what we can do in managing information but we're perplexed by how to relate the information to meanings in our lives and I think that anthropology

may not provide an answer to that but always demonstrates the gap between information and meaning thank

[Applause] you happy to take questions yeah so thank you Professor kimman so we can just have a round of questions

or commentaries thanks a lot Professor CL I was wondering um on a more personal

detail of your uh life and you working career but life as well were you ever just a doctor and then an anthropologist

I mean there is uh yes okay that was okay so you want me to relate this to my life um uh well I should I should say you

have to wait for my autobiography but I since I'm not sure I will write an autobiography I uh uh I'll say this that

um when I was a undergraduate at Stanford University uh I wasn't sure how to bring my interest

together and so in my senior year I applied for three different kinds of graduate

training I applied to Stanford Medical School I applied to Stanford law school and I applied to the PHD program in

history okay and I got into all three and and believe it or not um this is a long time ago

1962 I told all three that I was coming because I didn't know how to make a choice over the course of the summer plus the fact I had a a

girlfriend and I was thinking more about her than I was about the other things so literally and this is the true story I don't know if any of you have

ever been to Stanford but Stanford is a very beautiful University in California that has a long drive it's a longer than

a mile called Palm Drive that starts from the gate to the university to the main campus if you go to the right about

onethird of the way down Palm Drive you end up in the medical school you go straight ahead you end up in the law school or the history

department and so as I was driving down Palm Drive I was thinking about which of these Alternatives was I going to

take and a car drove just like a Portuguese driver sort of cut me off this way and forced me to the right okay

so I ended up in medical school uh and so I um uh I began a

medical school and um uh uh I was very dissatisfied with medical school with the um because it um it

seemed to leave out a lot of the of the questions and so I took while I was a medical student I took courses

in uh history and anthropology and at that time there was a medical Anthropologist at Stanford by the name of Benjamin

Paul um and he had just he had he had been at Harvard and then went to Stanford and he had written a book called Health culture and community and I liked the book although

it was very applied a little too applied for me and so I went to his course uh attended his course and um I

didn't like it and I said to myself this is not a field for me because I felt it was it presented medical anthropology is sort of the

handmaiden of medicine and public health and there to help medicine and public health answer extremely narrow questions

like how to get people to take um new foods or new medicines I just didn't find that at all

theoretically interesting and um so it wasn't until when I graduated met medical

school at Stanford was the Vietnam War and um I went to the US Public Health Service to

the National Institutes of Health as a research fellow and they sent me because of other reasons my wife and I

spoke Chinese they sent us to a Research Unit in Taiwan and I went out there with what I thought would question

which I thought would win win me the Nobel Prize and the question was at that time no one could grow the basilis that

caused leprosy but under the microscope that bacillus and the bacillus of uh causing tuberculosis

looked exactly the same so my hypothesis was that leprosy and tuberculosis were caused by this the

same infectious agent with different immunological responses producing the different disorders but the first day that I did

field research in Taiwan I disproved my hypothesis because when I went to the leprosarium I discovered there were plenty of people who had both leprosy

and tuberculosis and so I was sitting in a car with a Chinese driver driver and very despondent because you

could imagine if you thought you were going to get The Nobel Prize but on your very first day of research disproved your hypothesis you would be

discouraged and and I had two years to spend in Taiwan in my first day I just destroyed my research project what was I going to do for two

years and it was a very long drive back from the leprosarium and I was getting uh more and more frustrated and finally I said to the driver in Chinese um you know

this is incredible why is this lip resarium built so far away why is it built behind a mountain and he said of course you know he said it's because to keep bad

influences from people because this is a disorder caused by many negative things like ghosts and

gods and their negative influence we keep screened that's why by the way Chinese in a classical Chinese house when you walked in there was a literally a

screening either done by a wall or a screen um to keep negative influences away and

that produced in me my first social science projects about

stigma and so I realized that it wasn't biology that was going to be my uh future but um field

research and at that time I had no interest frankly in um mental illness I was interested in chronic medical dis disorders like diabetes

heart disease cancer and I was medically trained as an internist first and

um and then all of a sudden I became interested in not just stigma but what are the meanings of illnesses and how are they both cultural

and subjective and what's the relationship of the individual to society Etc and so that

led me to uh go to Harvard to study anthropology and then when I was in anthropology I tried to see which branch

of medicine would be most open to me combining anthropology and medicine and at that time it looked like it would be Psychiatry it was most open actually

just as I entered Psychiatry um the rest of medicine was becoming very open to social science and Psychiatry was becoming more closed to

social science it's a very very odd time that I I entered uh the um the fields and so um it was anthropology that led

me to become a psychiatrist not Psychiatry that led me to become an anthropologist and um and then it's

practical things that matter when you do things like setting up a program remember fris wisdom practical

wisdom Aristotle said so when I was coming back to Harvard as a full Professor I had been at the University

of Washington in Seattle for six years um the Deans asked me well what else do you want uh uh well I mean to

have to bring you back besides this position and I two things that are characteristic of me um one of which my late wife blamed

me for I forgot to ask about my salary uh but I I did and I was surprised when my salary was so low when

I started but I did and my wife never let me forget that but my I I but I did ask to have two parking

spaces and the Harvard Dean said they had never had a faculty member who asked for two parking spaces and I said because if you know American

universities we say are made up of faculties that disagree about everything except except one thing and that is complaining about

parking and uh um uh and actually that's the Practical thing that made all of this happen because by having a part you

know the Harvard Medical School is um 4 and a half miles from The Faculty of Arts and Sciences but that's as the crow flies not as the Boston roads go Boston

is an Old Town by American Standards it's about 400 years old and it its roads are like uh roads in Lisbon they

go everywhere and so it actually takes a while to get between the medical school and the faculty of Arts sciences and if I didn't have have if I hadn't have had

the two parking spaces I would not have been able to drive back and forth and um it was that that made it feasible for me

to do all the things I mentioned do clinical work do research and do um a teaching at the same time now I was

embedded by wonderful Deans and so um uh about 1985 the dean of Harvard Medical School

asked me to become the the chairman of the social medicine department and um I said I I can't it's impossible for me to become the chair he

said why and I said well I'm in China onethird of every year and the dean said to me you're in China oneir of every year he had no idea I was in China onethird of every year so you

know that's a time today you could never do that in the University we have ACC counting of your time I grew up in a time in which I could spend onethird of

every year in China um and uh and it was acceptable well acceptable because no one knew that I was spending one third

of the year in in in China so um uh and you know that's also interesting

about the time I grew up in Has Gone Forever both for good and for bad um but there was some things about that that

are you would not have at the present time so I never in my life applied for a job I never applied for a job I was a

postal fellow at Harvard and I had two competing job offers one from the University of Washington in Seattle they came they had heard about me they came

and offered me a 10e associate professorship this was 1976 and Harvard offered me an

untenured uh position as an assistant professor and chairman of a department which was surprising a Department of Health and social behavior and

um my wife and I decided that we would take the tenured position at the University of Washington and the same thing happened to me later in

1999 I so when I came back to Harvard in 82 I came back to a position half in anthropology half at Harvard Medical

School and I'm the only Harvard faculty member ever who has chaired Department's I chaired the anthropology department of Harvard and the faculty of Arts and

Sciences and I chaired the global Health and Social medicine Department in the medical school no one else has ever done that so that's interesting that that I

was again I relate that to the two parking spaces made that made that uh possible um but those kinds of things I

don't think could necessarily happen today were so bureaucratized but in 99 my Al Mada Stanford offered me a very high level

professorship and um at that time I had been chair chair of the social medicine department for 10 years and I don't know if you how a

medical school Works in um in Portugal but in the United States your chair for life that is if your chair of a medical school department you're going to do it

for 20 years and I had no desire to do it beyond the 10year period so in 99 I switched my time to 2

third in the faculty of Arts and Sciences as opposed to half and onethird in the medical school and so since 99 most of my time has been in the

faculty of Arts and Sciences and I I chaired the anthropology department and for the last eight years I've headed Harvard's Asia Center so when I was young if there had

been a diagnosis but there wasn't of hyperactivity disorder I would have I would have had that diagnosis because I I'm only comfortable

doing lots of different things at once I'm I'm very energetic and very active and my mind is kind of like a monkey mind I I it jumps around all the time

and I I I I'm not satisfied doing one thing and so um uh I actually have been I'm more productive when I have been doing something like heading the Asia

Center or chairing a department than when I'm not um and so that's a peculiar ity a personal peculiarity of mine that I i'

you know I've have this this need to do different things and I realize that different things at different times so there was a time in my life when I was a

very active clinician very active clinician now why did that time come to a close because I was a very good psychotherapist and I had too many

faculty members and their spouses in my practice and it became extremely uncomfortable because I would go to a faculty

meeting and the chair of the meeting would be one of my patients he would be chairing the meeting I would be just the member of think and actually sometimes this was

incredibly humorous so I had one faculty member who was psychotic he was completely psychotic at one stage and I was in a meeting I was taken care of him

but I was in the meeting course no one knew that I was the his doctor and as we came out of the meeting a very chaotic very upsetting meeting

one of my other colleagues came up to me and said that man is mad and and you know I could have said technically you're absolutely right you

know but I I didn't I but it became you can imagine how uncomfortable that became so anyway

yeah please I to use the microphone okay so thank you so much for the really interesting talks and uh um presentation

and in this regard so I have like two brief questions actually so first of all is since I don't know you mentioned uh Partners in El and all the works that

you have done with John Kim and uh Paul Farmer I was wondering so in which way the um of course XA words the liberal

trap of humanitarian help human rights discourses and like shared ideas of humanity and uh

humanism interact and influence all over your uh academic life the anthropological observation of the okay let's let's take him in order just let's

take that first and I this this whole book by Wilkinson and climate a passion for society is a defense of humanitarianism in the social sciences

yeah and so we're living through a moment in which there's a substantial critique of humanitarianism my own feeling is that

this is not periodically social science shoots itself in the foot in this particular critique we're shooting ourselves in the head okay

not the foot and um the social sciences were founded by people like Adam

Smith voler in France lock John Stewart Mill in UK all the founders of systematic social theory

of systematic social inquiry their argument was that the purpose of social knowledge was to improve people's lives and to improve

Society it was only laterally as social science professionalized that it did three

things it argued for objectification and the reductionism associated with objectification which has been a much

greater problem in sociology than in anthropology but still was an issue in anthropology at least when I was uh a

student secondly it argued that the focus of the object of inquiry

should be Society for its own sake study of society for its own sake and third it divorced itself over

time from other forms of social discipline such

as social policy and social work so in this book we use a line

of internal social science critics who criticize those three things we use max

vber seight Mills Hannah arant James uh uh William

James Jane Adams um France Boaz and his students we use a variety of

critics internally who criticized all those three things and I think that their criticism leads us if you look at

this book to a critique of anti-human humanitarianism in anthropology and we have a very powerful

critique of that I think and at the same time we argue strongly

for the um contribution of anthropology to improving society and people's lives

recognizing that medical anthropology has a head start here because of the nature of its work but saying

that an engagement with social care is a fundamental method in anthropological inquiry and you have to read that to see the whole argument we

spend a lot of time on that on this argument so my feeling is this is the best I can can do with Ian Wilkinson this is the best we could do to

answer the critique of humanitarianism so I have no question in my mind that many humanitarian Nos and

un systems are um ineffective or have abuses and the like I have no question with that about the criticisms

of those things but I do have a problem with the idea of throwing out the humanitarian objective entirely and so if that

happened my estimation and Ian's estimation would be there'll be no social science in the future because social science will write

itself out of any interest in society not just in Academia but in society as it is anyway I think it's going to be touch and go in the future

as to what will happen to social sciences and Humanities so I just ran a major meeting at the American Academy of Arts and Sciences on the relationship of

area studies that's culture history and language and Global Studies so Global Studies like the global

environment Global Health global trade Global energy Global Finance Global Security Global relationships international

relations are all going up in significance and in power okay area studies are coming

apart I did a review last summer of the Australian National universities Asian studies program the Australian National

University for decades has had the best culture history and language of Asian Societies in the world okay that

University is cutting back that program today from 95 positions including some of the world's great

Scholars to 55 positions cutting back by 40 positions and that's happening everywhere uh around the world area

studies are under tremendous pressure today and I think again the way that area studies Will

Survive will be to show how they can work together with Global Studies to provide a

deeper a deeper understanding a more critical understanding a more useful understanding if the approach of area

studies which are mainly social sciences and Humanities if that approach is entirely critical for critique for for

its own sake without criticizing in order to strengthen Global Studies I think 100 years from now there will be no area

studies yeah I think I think we're in a very challenging period and so the question is how can we do the kind of anthropology we want to do how can we do

the kind of History we want to do how can we do the kind of language training and use we want to have and at the same time

contribute to the way that knowledge is developing in our world um and this is a the anthropology that I did is not going

to be the anthropology that's going to survive in the future in my view some of it will be relevant some won't so it's

going to be new efforts at bringing these things together not not just not just criticizing the rise of Global Studies but figuring out ways of

bringing anthropology together with Global Studies that'll be very very important and I think there are many ways that that can happen so now you're a second your second question so my

second is yeah is quite like um of course so I I read all of your so many of your books of course and is not pro provocative but is is like a question

that I've have been thinking for long time know so and this the the relations between like medicine and anthropology

yeah and I was wondering so within this relation are there like rooms for critical um uh critical theories such as

for example those expressed in uh um medical Nemesis by Ian elit during the 70s in the future or you know all these problems and issues that are rising

nowadays within like the relation between anthropology and Global Studies GNA uh arrays all the yes I think absolutely so you you actually give me a

perfect way of answering this with even Ilia who I knew um um so um if you remember medical nem Nemesis um even ilich actually calls

doctors he says doctors are why are they why are doctor horse well I would have said that you know maybe some doctors are hores because

they are out to make money rather than care for patients maybe they're selling themselves to make money but I don't but that's not what ilot said he said

doctors were because they were removing the privilege of people to suffer so ilich

you remember was a priest okay his idea was only God could respond to suffering and that

suffering brought people closer to God hence medicine got in the way now in

1977 a great physician Anthropologist from the UK moris carers probably none of you know Morris carers but he was a great physician

Anthropologist who had uh been born in India and wrote several books one the twice born and another one called um death of a

witch carair who's the only Anthropologist ever to have given the wreath lectures on the BBC debated even

ilich and when ilich said what I just said to you carster said you know what you're saying uh Dr ilich reminds me of

Frederick The Great Frederick the great a dictatorial uh Sovereign who as he

watched his foot soldiers all peasants being routed in battle and running away he yelled after them you

dogs would you live forever okay you dogs would you live forever that's what I hear in ilich okay

you dogs would you go to get surgery for a cancer take medicine for heart disease when you should

be working with suffering and getting closer to God okay so for me ilich is not a good example of of of useful

critique I think criticizing medicine is extremely important and I think that is one one thing anthropology does very well but it cannot be a critique of

medicine as if the anthropologists occupied a moral High Ground above the doctor or the patient

the Anthropologist smack in the same domain as doctors nurses and patients hence if the idea is that anthropology

contributes then that critique should contribute so I'm writing a book right now on caregiving and I've been giving uh lectures the last few years at a lot of

medical schools and I begin my lectures with a with um Paradox the par a paradox a central Paradox today in medicine that

medicine in fact if you look at the amount of time spent caregiving with patients is gives very little care to

patients most care is given by families and then by other health professionals home health aids physical therapists occupational therapists

nurses Physicians give very little caregiving and yet if you were to propose as I have proposed a swiftian

hypothesis to Medical Educators they would never accept it and here's a swifting hypothesis so remember Dean Swift

in Ireland during the Irish famine was appalled by the failure of the British to be outraged at this famine and to do

something about it so he decided to outrage the British and what did he what did Swift propose he came up what he called A Modest

Proposal he said this famine is so bad my proposal is let's eat the children because if we eat the children children we will have enough food to survive and

our children will not have to we won't have to watch them go through the suffering of this famine and of course it did produce outrage and people said

this is an absurd a terrible idea a horrible inhuman idea and and Steen Swift said yes wonderful this famine is

horrible inhuman do something about it okay so this was my modest proposal to doctors was that medicine should give up caregiving

entirely and say look basically we are good at technology and fixing things and um what we'll do is we'll become like

the mechanics of the human body but we leave the care to somebody else could be nurses could be families

Etc where most of the Care is done and we just exonerate so we wouldn't have to burden Physicians with learning anything about care anything human about patients

we'd cut them off just the material reality they're the mechanics we don't expect a mechanic when you bring in your

your uh Fiat or maybe here in what youal your Mercedes you bring in your your uh uh to the mechanic you expect a

highlevel technical intervention you don't care about whether the mechanic speaks to the car has a has an emotional

interaction with it Etc um we do the same for doctors I I would say exactly this in the audience within

before I could even finish the sentences half of the audience raised their hands okay outraged totally

outraged and stand up you know and say say I'm the dean of medical education here and I'm outraged hearing what you

said caregiving is Central to what medicine is it's the defining dimension of medicine someone else stands up and say yes what you said is appalling

totally appalling unacceptable medicine would never give this up medicine is all about human interactions it goes on and on everyone

is sort of hitting me this way and then I finally I say oh I think this is wonderful listening to this is wonderful you've made my case now I want to ask the dean of medical education how much

time in the curriculum goes into caregiving and I want to ask um this person over here who is a hospital attending how much time do you spend on

the ward teaching caregiving and how much money goes into caregiving and how much of the emphasis in terms of

promotion goes into caregiving giving Etc and people soberly because our world is not made up of

demons and uh Heroes it's made up of anti-heroes all of us people just are silent and I'm silent

because even though I've had a rhetorical Victory I recognize the defeat that we've all experienced

in saying what they said and what I said and so the issue is medicine is losing caregiving and the question is what can

be done and that's where my feeling is that medical anthropology critical medical anthropology genuinely critical medical an anthropology needs to be able

to propose Solutions so what can be done that was after all you know that's Lenin's great

question what can be done what should we do what do we do I think simply criticizing without raising that

question is immoral unethical and shows the defeat of our own discipline so really that's the question what do we do what do we tell

medicine to do spend more time with a patient that's one thing so I work in in China okay

what's the average length of time of an initial encounter between doctor and patient in in China 3 minutes okay so you have someone coming in who has

complex diabetes with going blind having terrible pains in their foot having to have their kidney removed

and they're going to see the doctor for 3 minutes okay you cannot give care in that framework so there's a Health Care system

structured on the wrong thing my country healthc care system structured entirely on the wrong thing which is seeing the patient as a profit

Center that the P you're there the patient is there for you to make money off the patient you cannot go give good care like that so we have to propose

different systems of care different ways of doing the care different emphases in care what is it that the phys physician can do and what is it that the nurse can

do and that the family can do take the families I'm writing a book on caregiving right now and I just was very intrigued because I was asked by the National Academy of Sciences in America

to review a major report on family caregiving this is the first major report in the United States on family caregiving It's a Wonderful report and

what it shows is that families in the United States are totally disregarded by Physicians and not just Physicians are nurses so what's happening now in my

system in the United States is that because of the cost of care someone who's had major surgery major surgery for which they would have stayed in the

hospital in the past for several weeks stays in the hospital for 3 days and when they leave the hospital they may have an open

tracheostomy they will have drainage tubes coming out of them the Physicians and nurses expect somehow that the family is going to take care of them but

no one ever speaks to the family to tell them what to expect how to take care of the patient so family members feel um

totally disempowered as if they don't know what to do very frightened very very frightened uh uh my husband came home he had two tubes sticking out I

didn't know what to do with these tubes no one told me I called the doctor he didn't return calls to me so my feeling is that

there's a good example learning how to more effectively interpret science for families in terms of prognosis and

treatment answer questions learning how to elicit and answering questions learning to affirm and acknowledge the patient as a human being who deserves

respect and kindness and human response and doing all those things can be done by doctors and uh and by nurses and by

others now you look at look at the technology technology should improve if we could figure out how to do this caregiving I'm sure the technology will in the future help us in caregiving but

right now it doesn't look at the electronic medical record I don't know if you have an you use the electronic medical record in Portugal but now all uh uh Physicians and hospitals in

America must use the electronic medical record the electronic medical record has no place for nursing notes nursing notes for the doctor coming to a

hospital to find out what's happening to his patient used to be the way that the physician could track the experience the trajectory of the patients in the

hospital now there are no nursing notes no nursing notes more than that doctor comes to see his patient and in order to work with the medical record and just

read and find out what are the medicines the patients on what are the recent lab tests takes up all the time and so the patient ends The Physician ends up

speaking to the patient for just a few minutes when in fact the important thing is to speak to the patient and learn what's what's happening so we need to

devise new structures new systems new ways of doing let me tell you why I think technology by the way is important so my wife died 5 years ago with

Alzheimer's disease and I took care of her for 10 years and then in the last um six or seven months she was in a nursing home because why was she in a nursing

home because she had lost the power in her arms and legs and I couldn't I couldn't take care of I couldn't lift her into a bath or out of the bed or

into a chair now the Japanese the Japanese who are very interested in technology and caregiving because in

20040 the Japanese will be the so the first society in which 40% of the population will be over 60 years of age

in human history there's never been a geriatric Society like that okay they're thinking ahead about how can technology be useful they have invented and are now

making affordable what is called an exoskeleton an exoskeleton you fit your hands into this exoskin and it magnifies

your strength three or four times okay that would have helped me enormously in taking care of my wife if I had had that

um so and I'm sure that 10 years from now this will be widely uh available so technology apps just think of the way apps can help

in care um just communicating with your nurse or your physician could be improved but with technology so rather

than have technology as in a sense um uh blocking this Human Experience we got to think of ways that technology can

advance The Human Experience of of uh caregiving um I don't know if I've answer your question but it if if you

have to come down on a point it would be that critique must be the basis in my view for

intervention if anthropology is going to really be effective it must have something to say about what should be done what should not just what's wrong

yes we start with what's wrong very important and critical knowledge comes from anthropology but it can't just stand there like that otherwise it

becomes tied to nihilism and cynicism and I think nihilism and cynicism are the most dangerous things in the

world um yes other questions a little water oh yeah I think if we have a lot more questions I need scotch rather than

water uh uh okay just a specific one thank you very much for your wonderful talk uh I was uh

I really wanted to know more about your research on uh doctor patient relation in China you just mentioned because I I've been to some hospitals and had some

doing some small small ethnography and I'm very curious about it thank you I'd be interested in hearing about your experience so I have a project with Joe

Tucker who is a China specialist and a physician at the University of North Carolina um and with niad jingbao who is

Professor of medical ethics in shinchi land in New Zealand at otago University on the Ewan GUI W on the doct patient

relationship problem as it relates to distrust distrust so for those of you she's a China scholar for those of you are not China Scholars let me just tell you there's certain things about

medicine in China today which would surprise you I think um one of them is that you can rent in China a medical

mob okay now what is a medical mob so because China does not have an effective uh medical legal system or any

system of complaint if you leave a hospital and you've had a bad experience um what people do is to rent a medical

mob now a medical mob is a Prof are professionals they're professional they're professional mob okay and they um come to the hospital and they break a

few windows but they're very skilled and so they don't break the main Windows they break some of the side windows and more than that they pay off the security guards in advance so the

security guards don't do anything they just stand there okay and so the leaders of the hospital after two or three Windows

being broken come out and deal with the mob and a financial exchange takes place and the mob takes a certain percentage of the money and the rest of the money

goes to the patient's family okay this is a terrible way to resolve medical problems okay and the Chinese are very concerned about it and they believe it

relates to three things one is the use of what the Chinese call Hung b or these are red envelopes that are actually

bribes that contain money and in China you always give these because you want to be sure that the person you're talking to is actually

going to be there for the surgery okay and that it's not going to be somebody else or that you will really get the very elaborate radiological test that's

been ordered because it's going to be done while you're sedated and for all you know they may do nothing okay so you give these bribes it's a bad system very

bad system and it has to do with the fact that doctors are poorly paid in China so a friend of mine who was the minister of Health

in China up to two years ago who was the first scientist to become a minister of Health in China a remarkable man chanju he went to one of China's great

hospitals in Shanghai uh junshan uh isra in junan euan and he said I'm going to Triple the salary of every doctor in

this hospital I will triple your salary if I do that would you refuse to take a hung B bribe

and they voted and they and it was 90% against 10% for so then he knew that the level of bribery was greater much

greater than three times their salaries so China is in the middle of trying to figure this one out how to handle this problem but there's tremendous distrust

and it has had a very negative effect in medicine so that many doctors have told their children China has a tradition of multigenerational Physicians many

cultures have that tradition um the many you hear Physicians telling their children not to go into medicine there's a considerable demoralization of of of physicians in

medicine today and part of the problem very much lies with patients so um in the Chinese setting

there's been a tremendous hyping of medical science as you as this occurs in many societies but the Chinese have gone

overboard with this to show how powerful uh medicine is scientifically today so many Chinese people who've been

interviewed Express the their understanding that no matter what your problem is if you go to a great hospital and see an outstanding physician you're

going to get better so there's no expectation that the medicine may not work if the medicine doesn't work it's

the visan's fault not the disease so the whole idea of the disease actually not being resisting resisting

treatment is not a an idea that many Chinese um uh hold to today in its place they have the expectation that you'll

always get better if you're go to a high level place with excellent practitioners so the other part of this

is that China has no Primary Care System I don't know if if Portugal does Portugal have a primary care system okay so China has no Primary Care system and what you do is if you get

sick in China forget about the local doctor you go directly to the major hospital nearby to see the

famous Professor in your field and that's why that famous Professor is spending three minutes with every patient because she has 200 patients to

see in a treatment setting of about 3 hours okay so she's moving them through

like a like a um uh um you know being on a shop floor in a industry like building cars or something um

and um and I think you know that's we could generalize this you know more generally I I live in a house in

Cambridge that I've lived in for 34 years and I bought it from the son of a woman helina Deutsch who was Freud's

ambassadors to Boston she went to Boston to introduce psychoanalysis in the 1930s

when she died in 1982 in her late 90s she said that when she started as a

psychoanalyst it was like an artist working in an atellier and that when she finished near

the end of her life it was like a worker on the shop floor okay and so something fundamentally has happened that's vabien

in my view this is the V Barian March of bureaucracy of the institutions being the most powerful dimension of society and remember vber said that institutions

would replace three things sentiment tradition and rule of thumb that they would lock us into an iron cage of rationality and make us cogs in a

machine and while they haven't you know know it hasn't gone to the extreme that vber feared it's gone pretty far and as my colleague Michael herzfeld

argues uh bureaucratic structure itself produces a kind of indifference a bureaucratic indifference and I think you see that very much today

in health bureaucracies um anyway it's my my answer to that question maybe the last question you

sure um so i' first of all like to take the opportunity to also thank you for your informative talk and um so you talked about um the work you and your

colleagues do in the field of medical anthropology in Harvard and related it to the tradition European tradition you stated of social medicine of the late 40s and I was struck by that CU earlier

today I complained to some of my colleagues here or um about the lack of medical anthropology as a subdiscipline in anthropology in at least in Germany that's where I come from but we I talked

to other colleagues from other European countries and I think there is a lack of medical anthropology in Europe taught at universities so um my question would be

what the hell went wrong um since it's obviously coming you you relate your work to a European tradition of medical anthropology and uh I think what my question really should be is rather um

what would you advise be for Scholars in medical anthrop or interested in medical anthropology but don't have the academic uh expertise at their Institute or

departments yeah yeah um so first of all uh um there is in Germany um I gave some lectures at heidleberg and uh in Berlin

a few years ago there's some there are some excellent medical anthropologists so at the Free University of Berlin the fry University that there's Hans yor dilgar who I think is a really good

medical Anthropologist and he his students really impressed me I met I I went over the projects of about 15 of his PhD students several years ago I was very

impressed and the same with the Bose Sachs at heidleberg um also excellent medical anthropologists lots of good students but you're absolutely right

it's not it's spotty in different places and and it it appears under different names so at at g at uh gingan there's a very

good um medical Humanities group um uh in other places you have the uh

VRA ariv the uh the um uh you have history of medicine um and I think what's happened is that they don't come

together in in the kind of social medicine approach that I've I've given you at at uh in my perspective and I I think that's unfortunate and I I I don't

know the what the answer is for um for German uh uh medicine on the

other hand I've met many German medical Educators who are really interested in this so it's not like people are not trying things um and

um uh I I you know some my I think anything I could recommend I have recommended when I was in Germany a couple years ago

giving these lectures and people pointed out to me they were already doing it they were already doing these things so for example um there's a lot of interest

in Germany as you probably well know um in culture and c and ethnicity um and um

uh and there's a real attention to uh Islam and to uh Turkish language and I'm

sure increasingly it'll be toward um Arabic and uh and um uh and um Afghan uh

interests but um uh how that will become institutionalized and

developed um I'm not sure of so you know there there are a number of paradoxes here that should make us always careful

about recommendations um so let me tell you about about 25 years ago I was

invited by the University of Hamburg to um help introduce medical anthropology into Germany and um I had a colleague from the University

of Hawaii who was a graduate of a German university university of constance and

his name was uh um uh God I just sleed out WR was Tom um

was Tom's last name uh I'll think of it in just a minute um uh how can I block on there anyway this is what happens you

get to be 75 but um he and Tom moretzky moretsky uh Thomas moretzky he and

I went and there was at that time a medical Anthropologist in Germany by the name of beatric flader

luta um she's subsequently dropped out and we had had a meeting and I learned something at this meeting that was a few things that were very

troubling that were raised by medical historians first of all that um Germany had had medical

anthropology and that um Dr mangela was getting his PhD in medical anthropology okay should look that up so

Dr mangela Who was member a uh Nazi physician who um was doing terrible experiments on

twins was taking out the brains of twins and sending them to um a laboratory I forget which university that was and that was all for his PhD research in

medical anthropology and so the term itself was at that time not a good term anthropology generally at that stage was

not a good term Voca was the folk folk studies was was an more acceptable term well um the other thing I learned at

that time that was very troubling was that the Nazis actually called the kind of critique of medicine we've been going through here the result

of Jewish medicine and they said that their medicine was not like that they were very interested in holistic

medicine there was a the former uh uh foreign minister of Germany's brother van

via was um a famous host istic practitioner and um his tradition had started under the Nazis so

that's a funny thing isn't that a funny issue if you look at now let's extend that a little bit intellectually because it raises some really questions for us if you look at some of the great

figures in um in Continental European phenomenology Arnold Galen

uh hurl not not so much hurl Arnold galin and helmet plnar their work used by the right by the fascist right okay

look in Japan Nish Kitaro Nishida who tried to bring Buddhism and phenomenology

together used by the Japanese right so it's kind of interesting why haiger think of haiger haiger really a great

philosopher a great philosopher but a horrible man who became a

Rector of um u frybo under um under Hitler gave the nazzi

salute um um so how how did this knowledge how did this funny development occur and what does it teach us in our own recommendations

and what we recommend it must suggest that the political the medical and the moral are inseparable and that anything we

recommend or do has to see a convergence of the political the medical and the moral I think um but also should make

us very hesitant to um be too sure of ourselves and and and you

know I had a a great um colleague at at Columbia University a great sociologist Robert

Merton and Merton was the inventor of the term the unintended consequences of purposive or social action and I think we should be

attentive to the unintended consequences so we don't want to go back to romantic medicine because of the way it's been

misused and abused we want to have a a more powerful and useful effect anyway I think we'll take that as the last question let me just say I can't speak

any Portuguese I can speak some French so Messi bu continue Le tradition [Applause] okay