Reviewed Book
Critical Medical Anthropology: Perspectives in and from Latin America By Jennie Gamlin, Sahra Gibbon, Paola Sesia, Lina Berrio (Eds.), London: UCL Press. 2022. 286 pp.
Pablo Seward Delaporte
Saint Louis University
As is widely known, some of the most foundational work in critical medical anthropology (CMA) in the United States was done in Latin America. Important figures in the development of the field in the 1980s and 1990s, such as Nancy Scheper-Hughes, Paul Farmer, and Philippe Bourgois, conducted their primary research in Latin America and were deeply influenced by Latin American critical theory. Jennie Gamlin, Sahra Gibbon, Paola Sesia, and Lina Berrio have done an English-reading audience a big favor by publishing a collection that, in their words, “is the first to bring together Latin American ethnographic contexts and theories of CMA in the English language.” Critical Medical Anthropology: Perspective in and from Latin America is more than simply a commendable effort toward correcting exclusionary practices of citation and giving Third World intellectual traditions their due place; it also invites us to rethink our theoretical and methodological canons going forward.
Based on workshops that took place in Mexico, the United Kingdom, Portugal, and Brazil, this edited volume stands out for its structural coherence and thematic unity, reflected in the concise and comprehensive introduction by the editors and afterward by Claudia Fonseca. The 10 chapters included in the volume, by authors “whose work has rarely or never been published in English,” all emphasize the impact of political economic processes on health, as is the hallmark of CMA. Yet, building on post-structuralist critiques of CMA, they also give rigorous attention to issues of experience and subjectivity, touching on burgeoning fields within medical anthropology, including the study of addiction, migration, gender, race, pharmaceuticals, and judicialization. To each of these fields, the authors make sophisticated conceptual and theoretical contributions. These include, to mention a few, a discussion of the “coloniality of biomedicine” (Chapter 2); a critique of the concept of structural violence and a call for a “post-critical medical anthropology” (Chapter 3); important interventions into long-standing literatures on local biologies (Chapter 4) and critical epidemiology (Chapter 7); an analysis of how the concept of “obstetric violence” is mobilized by feminist activists (Chapter 9); and an engagement with the “ambiguous political subjectivities” formed among rare-disease patients and their families through judicial actions (Chapter 10). English readers will be pleased to encounter debates they are likely familiar with through the lens of Latin American critical theory and action-oriented methodologies. This makes the book ideal for graduate-level instruction, although the writing style and subject matter is probably too advanced for undergraduate coursework.
This book invites future inquiry in a number of directions. The book offers an exhaustive intellectual genealogy of various “national schools” in the development of Latin American critical medical anthropology or LA-CMA. It pays particular attention to the development of LA-CMA in Mexico around the important work of Eduardo Menéndez and Guillermo Bonfil Batalla. Chapter 1 also provides a detailed discussion of LA-CMA in the Brazilian context. Future work could put these intellectual genealogies in conversation with the work of Howard Waitzkin and others examining the development of social medicine in places such as Chile, Cuba, and Nicaragua, which were formative in critical approaches to health and illness in Latin America. The book also does an excellent job in incorporating critiques of biomedicine based on Indigenous epistemologies into the intellectual genealogies of LA-CMA, while remaining attentive to biomedicine as a complex, heterogeneous field entangled with other fields of governance and power, and riddled with contradictions and inconsistencies. Critical Medical Anthropology: Perspectives in and from Latin America does this mainly through collaborations with Indigenous research participants, and future work could complement this approach by considering works on health and coloniality by Latin American Indigenous intellectuals and theorists. The book thus sets the foundation for a necessary decolonial critique of the centrality of biomedicine both in the management of health in contemporary Western societies, and in how certain dominant branches within medical anthropology conceptualize “health.”
Rather than a provincial examination of Latin American critical theory, this book attends to the global geopolitics of knowledge that have shaped this thought and how it can reframe hegemonic discourses from the global North. As the editors write in their introduction, “In contrast to the ‘us and them’ that characterizes much ‘northern’ anthropology, in Latin America there is a tendency to reflect on ethnographic experiences from within the historical, social, and political contexts of Latin America.” This, in turn, “makes it almost inevitable that our professional commitment, definition of research interests and subscription to theoretical orientations will fall within the field of CMA […].” This statement powerfully captures how the authors approach the political not as a “stance” one could take within medical anthropology but as a necessary aspect of medical anthropological work done at the margins of imperial centers of knowledge and capital. The above statement also invites future work examining two key features of internal colonialism from the perspective of a hemispheric Latinidad. How can we account for the work of marginalized Latin American and Latinx scholars in the Northern academy, on the one hand, and the various inequalities that structure the relationship between academic institutions and marginalized communities within Latin America, on the other hand? Of particular interest and importance, in my view, is analyzing how colonial relationships within Latin America structure the scientific cultures that produce critical medical anthropological work. Here, the work done by Melania Calestani and Laura Montesi in Chapter 7 comparing “social representations of diabetes in Mexico and ethnic minorities in transplant medicine in the UK” shows a nuanced and critical manner in which to approach global inequalities that structure our knowledge of health and illness.
Of all the above avenues for future work, perhaps the most important one is the inclusion of Black perspectives and experiences. Herein lies what is, in my view, an important weakness in this volume. The editors candidly acknowledge that they “have been unable to include work on the health of Afro-descendant populations, despite their numerical importance in the region and the conditions of vulnerability that most of them face”—and, one may add, despite the increasing number of scholars working on issues of Black health in Latin America. Future work that includes Black perspectives and experiences of health in Latin America would significantly contribute to the important project of decolonizing critical medical anthropology that this book has set in motion.