The designation “Biomedicine” is often used to characterize the medical practice and theory of Western societies, a medicine extensively circulated throughout the world. As its name also suggests, it is the professional medicine of non-European societies which focuses pre-eminently on biological and physiological medicine. As such, it has been distinguished from the professional medicines of other cultures and vice versa. Differences, rather than similarities have conventionally set the traditional and the modern apart with static assumptions and no recognition of cultural growth, where traditions can ‘also manifest contemporary, modern versions…while biomedicine discloses certain magical non-rational elements’ (Hahn & Kleinman 1983, p. 306). Without focusing on the intertwinements of these categories, I will attempt to fracture assumptions of the culture-science dichotomy by critically analysing the statement ‘biomedicine as culture’, arguing that the designation of ‘biomedicine’ can also be conceived as a kind of culture in and of itself.
The historical legacy for which anthropology has grown out of, the study of exotic cultures tends to produce clear demarcations between the ethnology and anthropology of non-European culture on the one hand, and studies of European culture on the other, often conflating the latter as a subject of science and the former as culture. Until very recently, with the advent of reflexive anthropology, this taken for granted view has firmly placed ‘biomedicine’ as a science rather than culture.
In order for biomedicine to be seen as culture, Beck (2007) argues that the term ‘biomedicine’ should be distinguished from notions of the larger development of ‘medicine’. If ‘medicine’ is to be conceived of in a broader context beyond that of the Western-style medical system, as ‘organized health practices providing therapeutic choices for suffering individuals’ (Beck 2007, p. 22), then medicine can become ‘so widespread around the globe that is it surely a universal in human organizations’ (Kleinman 1995, p. 21). Pluralizing the concept of ‘medicine’ and bringing a level of universality to its definition helps to move the category of biomedicine as just another form of medicine, ‘culturally and historically specific and far from universal’ (Gordon 1988, p. 20). More specifically, biomedicine can be regarded as a type of ‘ethnomedicine’, “those beliefs and practices relating to disease which are the products of indigenous cultural development and are not derived from conceptual framework of modern medicine” (Rubel & Hess 1996, p. 116). But does this shift of terminologies satisfactorily give rise to conceptualising Western biomedicine as just another cultural system with all its elements – beliefs, values and rules?
In analysing biomedicine as culture requires an examination of biomedicine and its society – its orientations and embedded practices, its members – the scientists and physicians, their values and behaviours as part of a cultural system to be subjected under anthropological analysis. Within the biomedicine community, the concept of ‘culture’ has largely held an ethnic, racial or linguistic focus. The notion of ‘culture’ arises out of ‘difference’ for example when patients are seen to be visually different from the provider, comes from a different country or speaks a different language to the physician. Thus, understandings of culture have largely been limited to the patient or client who has conventionally been the object of scrutiny by the medical community, that is, “the medical gaze” (Foucault, 1975). In critiquing and exploring the concept and use of “culture” in the biomedical community necessitates the refocusing of the cultural lens away from its myopic and perennial gaze on patients and clients toward the biomedical community itself, a process of ‘Anthropologizing the West’ (DiGiacomo 1992, p. 132). In culturalizing biomedicine, it is paramount to view biomedicine as culture, as ‘that complex whole which includes knowledge, belief, art, morals, law, customs and other capabilities and habits acquired by man as a member of society” (Tylor, 1871, p. 4). Using Hahn’s (1995) treatment of a cultural system, this essay explores the professional culture of biomedicine in terms of its values, language and rituals with the understanding that although these elements do not constitute culture in its entirety, it attempts to propound an efficacy of biomedicine as a cultural system by departing with Taylor’s (2003) view that it is a “culture of no culture” (Taylor 2003, p. 555).
In characterizing biomedicine as a cultural system, it is important to acknowledge and recognize a system of embedded values, beliefs and ideals of behaviours specifying what is ‘good, beautiful, right, wrong and indifferent’ within biomedicine (Hahn, 1995, p. 131). Like many other cultures, the community of biomedicine also adheres to professional oaths and codes which act not as ‘descriptions of what adherents actually do, but prescriptions for what they believe they should do’ (Hahn 1995, p. 138, original emphasis). These principles, the Hippocratic Oath, the American Medical Association Code of Ethics to name a few are formally and informally expressed, both explicitly recognizing ‘the roots of contemporary medical (Western) ethics in the moral and religious values of the society in which it participates’ (Hahn 1995, p. 139). These value systems are values primarily focused on ‘the promotion and maintenance of life’ that are not only applied in relation to individual patients but also towards the biomedical community, between colleagues, the individual self and the values regarding their own knowledge and actions, and more broadly, the wider community, society and humanity, (Hahn 1995, p. 139). These guides are formally put in place to prescribe a system of ideal behaviours that is founded within a cultural framework of values which are ‘a product of western culture and society’ that are understood and enacted by the biomedical members (Lock & Gordon 1988, p. 20).
How doctors utilize language to express themselves, also colloquially known as doctor talk, is another element that enhances the notion of biomedicine as culture. Language is the medium in which health sciences education, research and practice operate. The lexicon of doctors is categorized by ‘statistical facts, presented in terms of probability, gradations of severity, and the use of acronymns and medical terminology’ which are often utilized within the biomedical context between physicians whose knowledge of the language comes from spending an inordinate amount of time learning within that culture (Boutin-Foster et al. 2008, p. 108). Just as cultural anthropologists have analysed the speech patterns of different cultures in understanding how cultures use language to signify identity to one group while discerning themselves from others, so too can medical anthropologists study how physicians use language as a ‘reciprocally comprehensible system of communication’ (Duranti & Goodwin 1992, p. 16). Biomedicine as culture can be explored through its unique language illustrated through its distinct and technical vocabulary and terminology that comes from years of training and immersing oneself within the biomedical systems of learning such that it cannot be easily understood by those outside of that culture. The exhaustive technicality of medical terminology illustrates that language acquisition becomes a signifier of a particular cultural group, making it an important component of initiation into the biomedical and health community.
In understanding biomedicine as culture, it is as Hahn and Kleinman (1983) suggests, important to explore the practice and theory of medicine by ‘incorporating anthropological principles’ (p. 307). This essay explores biomedical rites of passage focusing in particular on physicians, ‘the preeminent practitioners’ in an attempt to visibly understand the rituals, orientations and practices of physicians as cultural (Hahn 1995, p. 131). Rites of passage are chosen as an area to explore because they are generally designed to bond individuals to a group and to impart important knowledge to its members and as such, help to highlight the social hierarchies and values of biomedicine as culture. In the classic work of Arnold Van Gennep (1977, p. 21), all rites of passage transpire in three chronological phases: rites of separation, rites of transition and rites of reincorporation.
In biomedicine, when physicians decide to pursue a career of healing, they prepare themselves for medical training by removing their former statuses, as children, parents or spouses to become primarily students of medicine. This denotes the ‘rites of separation’ to which individuals are removed symbolically or ritualistically away from their former lives (Turner 1995, p. 80). The liminal transitional phase denotes the period when one has left a place but has yet to enter the next phase (Turner 1975, p. 80). This period is one in which the biomedical member has remained between states, neither returned to the former as a first year medical student nor moved to the next phase. This also marks the period of intense emotional and physical hardship, from medical school to internship through to residency, described by Hahn (1995) as the ‘most intensive ordeals found in human societies anywhere’ (p. 134). In Australia for example, medical graduates become ‘interns’ and must undertake further studies at an accredited hospital before receiving full registration in which they are not only expected to know beyond their learning knowledge but also experience a severe amount of sleep and nutritional deprivation. Finally, the rites of reincorporation denote the completion of the rites in which the individual has now assumed a new status and rejoined the society in which they parted. In the biomedical culture, the rites of reincorporation mark the transformation of medical students into physicians on their journey of healthcare and is often celebrated by a ‘White Coat Ceremony’. This formal and public ritual signifies the student’s transition from the preclinical to the official clinical setting which involves an official robing of medical students in white coats, typically worn by practicing physicians (Russell 2002, p. 56). The white coat is a powerful symbol of the biomedical community which symbolizes ‘sterility, science and healing’ (Boutin-Foster et al. 2008, p. 108). It becomes part of a ritual that symbolises a conversion of the individual back into society with a new role and status, that of a lay person into becoming an official constituent of the biomedical community (Veatch 2002, p. 5). This rite of passage illustrates the progress of medical student to physician, as one status to another and illustrates not only the social hierarchies but also the acquisition of values and beliefs that are deemed important in attaining membership into the biomedical culture.
Biomedicine has come to dominate and influence the health and healing practices of human societies worldwide. These healing practices are based upon scientific practice, emblematic of the modern West and as such, there has been a tendency by medical anthropology to treat biomedicine as being opposite traditional medicines. In doing so would ignore the complex social and cultural arrangements of biomedicine – from the physicians who treat illness, the establishment of health care programs to the extensive industries involving public and private agencies. With the recent exploration into reflexive anthropology, this essay has attempted to present an anthropological reform of biomedicine by analyzing biomedicine as culture. Under this perspective, biomedicine and its values, language and rituals could be understood as a sociocultural system, founded within a cultural framework originated and influenced from Western society. Thus, Western biomedicine should be viewed as just another cultural belief system and set of practices, explicitly and implicitly taught through the interactions of the social community. This essay has been about the uncovering of culture within biomedicine by demonstrating that biomedicine is in fact a culture with its own set of values, belief systems, distinct language and rituals. As such, biomedicine should be viewed as an ethnomedicine, even if, as Hahn (1995) describes, that it is nevertheless ‘a unique one’.
References
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