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Week 6 Learning Resources APA Citations x
Week 6 Learning Resources APA Citations

Lundrigan, K. (2019). Exploring gender: Identification, oppression, and rights. Canadian Social Work, 20(2), 109–119.
Mukhopadhyay, C. C., Blumenfield, T., & Harper, S. (2018). Gender and sexuality. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/gender-and-sexuality/

Remennick, L. (2007). “Being a woman is different here”: Changing perceptions of femininity and gender relations among former Soviet women living in Greater Boston. Women’s Studies International Forum, 30(4), 326–341. https://doi-org.ezproxy.umgc.edu/10.1016/j.wsif.2007.05.004

Table of Contents.html

ANTH 102 6980 Introduction to Cultural Anthropology (2225) – Week Six Learning Resources
1. Week 6 Learning Resources APA Citations

Summary – FINAL EXAM

Top of Form

Description

Content: Readings found in Modules 6, 7, & 8.
Note: The specific readings are labeled.

One resource from Module 6

Two resources from Module 7

Three resources from Module 8

Instructions

Before you submit the quiz, you will have the opportunity to return to questions that you may have missed or have not yet answered. You can submit your quiz responses at any time. However, if you submit your responses after the time limit expires, your attempt will be recorded as a late submission.

Week Six Learning Resources

Exploring gender: Identification, Oppression, and Rights: NEEDED FOR FINAL EXAM

Week Seven Learning Resources

Race and Ethnicity: NEEDED FOR FINAL

Nationalism and Minorities: NEEDED FOR FINAL

Week Eight Learning Resources

Seeing_Like_an_Anthropologist: NEEDED FOR FINAL

Health_and_Medicine: NEEDED FOR FINAL

Public Anthropology: NEEDED FOR FINAL

Week 7 Learning Resources APA Citations x
Week 7 Learning Resources APA Citations

Eriksen, T. H. (2015). Small places, large issues: An introduction to social and cultural anthropology (pp. 289-306). Pluto Press (UK).
Garcia, J. (2018). Race and Ethnicity. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/race-and-ethnicity/

Smith, C. A. (2015). Blackness, citizenship, and the transnational vertigo of violence in the Americas. American Anthropologist, 117(2), 384-387. https://doi.org/10.1111/aman.12242

Smith-2015-American_Anthropologist

AMERICAN ANTHROPOLOGIST

PUBLIC ANTHROPOLOGY

Blackness, Citizenship, and the Transnational Vertigo of
Violence in the Americas

Christen A. Smith

University of Texas at Austin

When a Missouri grand jury decided not to indict Officer
Darren Wilson for the shooting death of Michael Brown
on November 24, 2014, the United States erupted into a
symphony of protests, the likes of which we have not seen
since the civil rights movement. Indeed, we are witnessing
the dawn of a new movement, but this movement is not
about our national politics. It is about an emerging global
politics of race, citizenship, violence, and nation that requires
us as anthropologists take stock of our approaches to these
topics.

Since 2005 I have been working with black political
organizers in Salvador, Bahia, Brazil, in the fight to de-
nounce and demystify anti-black state violence. As an activist
anthropologist, my collaborations have been with the grass-
roots community action network Quilombo X and the cam-
paign React or Die!/React or Be Killed! (hereafter, React or
Die! Campaign). This experience has led me to write about
and analyze the relationship between blackness, citizenship,
and national belonging in the Americas. Specifically, I con-
sider anti-black state violence a performance of the modern
American nation-state. In other words, state violence is
a process of embodiment and subject making with plots,
scripts, and spectacles that have tangible, material effects
(e.g., Smith 2008). My work also recognizes the global pat-
terns that connect local black experiences to transnational
ones, like police violence. This essay is a reflection on those
processes and their current political implications.

On August 22, 2014, while demonstrators in Ferguson,
Missouri, headed to the streets to face another day of con-
frontation with an excessively militarized police force in the
first weeks of protest following the death of Michael Brown,
over 51,000 people in cities across Brazil also took to the
streets to speak out against police brutality and racial profil-
ing. However, their primary motivation was not the death
of Michael Brown. The II (Inter)National March Against
the Genocide of Black People, organized by the React
or Die!/React or Be Killed! Campaign, was a nationwide
protest to draw attention to the fact that according to official
counts, Brazilian police kill approximately six people per
day, totaling 11,197 over the past five years.1 This com-
pares to approximately 11,090 people killed by the police in
the United States over the past thirty years. Approximately

70 percent of those killed are black (Waiselfisz 2012).2

Black people (negros) in Brazil are three times more likely
to be killed by the police than their white counterparts
(Cano 2010; Mitchell and Wood 1999). The numbers do not
adequately reflect the gravity of this phenomenon. Records
on police homicide are voluntarily kept, produced inter-
nally, and not reported by most urban cities (Lemgruber
et al. 2003). Moreover, most of the deaths caused by the
police are not even registered as homicides. Instead, they
are recorded as “death caused by resisting arrest” (autos de
resistência)—a controversial category that in essence allows
police killings to be classified as “suicides.” This also does
not take into account police death squads—“off-duty” police
officers who engage in vigilante-style killings (Amnesty In-
ternational 2005). Recognizing that the statistics on police
homicide are grossly underreported and the disproportion-
ate majority of homicide victims in Brazil are black, the crisis
of anti-black police brutality is much graver than it actually
appears.

As the march began, the women leading the demonstra-
tion began to read the names of the dead. The South African
National Anthem played somberly in the background. Tony,
the father of one of the victims being honored that day,
turned to me and said, “I don’t want this to be a protest
march, I want it to be a funeral march.” As the list went
on, name after name, I felt my chest tighten and my breath
become shallow. My eyes burned behind my sunglasses. I
knew the families of several of the young people whose names
were read who had been killed by the police in Salvador.
Many of them, like Jackson, Tony’s son, were clandestinely
kidnapped, tortured, and then gruesomely murdered and
thrown in a shallow grave. Yet that was not the only reason
that I was felt dizzy with emotion. I was also overwhelmed
by the inescapable terror that defines being black and living
in the Americas today.

While 7,000 of us were marching in the streets of Sal-
vador to protest the genocide of black people in Brazil,
protestors in the United States were standing in the streets
of Ferguson and several other U.S. cities, raising their voices
to denounce the very same concerns, albeit in a very differ-
ent national context. As an anthropologist, I could easily
define this in terms of transnational racial politics. Yet that
social framework did not allow me to articulate the vertigo
that was hitting me hard with terror and sadness. This was
much more than a moment of ethnographic reflection—I

Public Anthropology 385

was not a fly on the wall. My personal implication in this
struggle hung around my head like a fog. As a black mother
of two boys, I am acutely aware that the state violence that
stole the lives of the young people being remembered in
both Salvador and Ferguson that day could easily have been
enacted upon my children. Regardless of my geographic lo-
cation, at home in the United States or abroad in Brazil, the
realities of anti-black state violence followed and engulfed
me. It was this sense of urgency that led me to work in sol-
idarity with the React or Die! Campaign back in 2005. It is
this personal imperative that has led me to continue working
with them until today. Like most activist anthropologists,
my work is about political solidarity (Hale 2006). Yet it is
also about survival, and it is this distinction—solidarity ver-
sus survival—that also pushes me to consider the theoretical
implications of this moment. The stakes of our reflections
on Ferguson and Salvador are not just theoretical. For many
of us, they are a matter of life and death.

For years, most anthropologists (with notable excep-
tions) have shied away from explicit discussions about the
global politics of blackness and citizenship. Anthropological
conversations around the question of citizenship have tended
to focus on the politics of state belonging or cultural citizen-
ship (e.g., Basch et al. 1994; Caldeira 2000; Holston 2008;
Ong 1996; Rosaldo 1997; Stolcke 1995). Yet, as Kamari
Clarke notes in her assessment of the scholarship on cul-
tural citizenship, “the conceptual gaps in scholarship in the
black Atlantic world are striking” (Clarke 2013:465). Those
anthropologists who do engage critically with the question
of black citizenship draw our attention to the unique re-
lationship between black people and the nation state and
the negotiation processes in which black people engage
in order to navigate national belonging (e.g., Clarke and
Thomas 2006; Clarke 2013; Jackson 2001; Perry 2013;
Pierre 2013; Rahier 2014; Thomas 2004; Williams 2013).
However, the persistent and escalating problem of anti-black
state violence in the Americas presents unique challenges to
the discourse of race and national belonging. Race—as a so-
cial, historical, and political formation—continues to define
not only expressions of citizenship and the kind of citizenship
we practice but also the extent to which we are recognized
as citizen-subjects at all. In other words, a paradox of black
citizenship forces us to grapple with our anthropological
mappings of citizenship and the contours of the racial state
(Goldberg 2002).

Historically, black people have been thought of as sub-
jects that are mutually exclusive from liberal democratic cit-
izenship and the modern nation-state throughout the Black
Atlantic (Davies and M’Bow 2007). Consequently, it is not
only that black people have been disenfranchised (from vot-
ing and political participation in particular) but also that they
have been symbolically erased as subjects who have even the
potential for national belonging. This process occurs on mul-
tiple conceptual levels, but for the immediate purposes of
this discussion I would like to consider two: the symbolic
and the experiential.

Black people in Brazil and the United States are legal
citizens only in sensu stricto. This is a controversial claim
to make, but I come to this conclusion through a quali-
tative analysis of national experience. While legal citizen-
ship affords all citizens equal protection under the law in
both nations, this protection does not practically extend
to black people in either. There is a breakdown between
legal, written inclusion and state practice of national in-
clusion. The evidence for this is the indiscriminate manner
by which black people are killed, beaten, tortured, and
violated by the state with impunity. This practice has be-
come common sense, to the point that even those seeking
assistance from law enforcement are killed for procuring
such assistance. Two qualitative examples are the deaths of
Jonathan Ferrell in Charlotte, North Carolina, in September
of 2013 and Claudia Silva in March of 2014. Police officers
in Charlotte, North Carolina, shot and killed Ferrell after
he ran toward them seeking help after a car wreck (King
and Stapleton 2013). Police officers dragged Claudia Silva
to death in Rio de Janeiro, Brazil, when they stuffed her in
the back of their police car after she was shot in the crossfire
between police and drug-trafficking suspects. The nation-
state’s rules for engagement with black bodies are not a
cultural process of black “citizenship” making—“producing
consent through schemes of surveillance, discipline, control”
(Foucault 1977; Ong 1996). Rather, they are a necropoli-
tics of objectification—“contemporary forms of subjugation
of life to the power of death” (Mbembe 2003:39). It is a
“horizon of death” (Ferreira da Silva 2009).

Symbolically, black horizons of death emerge from the
cognitive dissociation between blackness and humanity. As
anthropologists, we know that 19th-century anthropology
associated black people with apes and relegated blackness
to the nonhuman realm (Baker 1998, 2010). However, we
may not be as aware that this legacy has contemporary social
ramifications. Social psychologist Phillip Atiba Goff and his
collaborators (2008:294) have found that “a Black-ape asso-
ciation influences the extent to which people condone and
justify violence against Black suspects.” In the United States,
this translates into the propensity for police violence and
for juries to hand down death sentences. In Brazil, it casts
black people as an expendable suspect type (Santos 2002).
Despite an absence of conscious associations between black
people and simians, subconscious associations between black
people and apes lead people to sanction and practice anti-
black violence (Goff et al. 2008). We need only look to the
transcripts of the grand jury trial of Officer Darren Wil-
son to see the effects of this phenomenon. Officer Wilson
described 18-year-old Michael Brown as a cross between a
demon and Hulk Hogan.3 As anthropologists, we must con-
sider the conceptual roots and routes that have led us to this
moment and their political implications.

Part of what has fueled transnational, passionate protests
against anti-black state violence is narrative repetition.
Michael Brown was not the first and he will not be the
last. We need only cite the names of the dead to recall the

386 American Anthropologist • Vol. 117, No. 2 • June 2015

long history of deadly police racial profiling in the United
States, Brazil, and elsewhere. For many of us, anti-black
police violence is an extension of lynching. There is an eerie
resonance between Michael Brown’s body being left to lie in
the street while his mother watched for four hours before
it was removed, the spectacular display of tortured black
bodies swinging from trees across the United States in the
19th and 20th centuries, and Tony’s story of being forced to
dig up his son from a clandestine grave after a police death
squad killed him (Smith 2013). Diasporic realities of anti-
black state violence resonate far beyond national boundaries,
constitute the paradox of black citizenship, and indicate the
need to expand our definition of race to also include the
affectual economies that produce our selves as racialized,
political subjects.

NOTES
1. These numbers were reported by the Brazilian Police Forum (see

http://www.cbsnews.com/news/brazilian-police-kill-6-people
-a-day-study-finds/, accessed February 2, 2015).

2. Throughout this essay, I use the term black to refer to the word
negro in Portuguese. Negros, those classified as pardo (brown
skinned) and pretos (dark skinned), make up 51 percent of the
total population of Brazil.

3. See Darren Wilson’s full testimony transcript (St. Louis, MO,
Grand Jury Volume V, September 16, 2014).

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Clarke, Kamari M.
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2006 Globalization and Race: Transformations in the Cultural
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Davies, Carole Boyce, and Babacar M’Bow
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Ferreira da Silva, Denise
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Goff, Phillip Atiba, Jennifer L. Eberhardt, Melissa J. Williams, and
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Goldberg, David Theo
2002 The Racial State. Malden, MA: Blackwell.

Hale, Charles R.
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Holston, James
2008 Insurgent Citizenship: Disjunctions of Democracy and

Modernity in Brazil. Princeton: Princeton University Press.
Jackson, John L.

2001 Harlemworld: Doing Race and Class in Contemporary Black
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2003 Quem vigia os vigias?: Um estudo sobre controle externo
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Mbembe, Achille
2003 Necropolitics. Public Culture 15(1):11–40.

Mitchell, Michael, and Charles Wood
1999 Ironies of Citizenship: Skin Color, Police Brutality, and the

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gotiate Racial and Cultural Boundaries in the United States.
Current Anthropology 37(5):737–762.

Perry, Keisha-Khan Y.
2013 Black Women against the Land Grab: The Fight for Racial

Justice in Brazil. Minneapolis: University of Minnesota Press.
Pierre, Jemima

2013 The Predicament of Blackness: Postcolonial Ghana and the
Politics of Race. Chicago: The University of Chicago Press.

Rahier, Jean Muteba
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Public Anthropology 387

Politics in the Time of Multiculturalism. New York: Palgrave
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Rosaldo, Renato
1997 Cultural Citizenship, Inequality, and Multiculturalism. In

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in the determination of police suspicion]. Master’s thesis, De-
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Thomas, Deborah A.
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erno Federal do Brasil.

Williams, Erica Lorraine
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Champaign: University of Illinois Press.

Diversity Dilemmas and Opportunities: Training the Next
Generation of Anthropologists
Kevin A. Yelvington

University of South Florida

Alisha R. Winn

African American Research Library and Cultural Center

E. Christian Wells

University of South Florida

Angela Stuesse

University of South Florida

Nancy Romero-Daza

University of South Florida

Lauren C. Johnson

University of North Georgia

Antoinette T. Jackson

University of South Florida

Emelda Curry

University of South Florida

Heide Castañeda

University of South Florida

BEYOND STATISTICS
In March of 2014, Lauren C. Johnson, Alisha R. Winn, and
Emelda Curry, three Ph.D. graduates from the University
of South Florida (USF), formed a panel titled “Beyond Statis-
tics: Exploring the Challenges Facing Black Anthropology
Students in the Pursuit of Graduate Degrees” at the Society
for Applied Anthropology (SfAA) meetings in Albuquerque,
New Mexico. Their goal was to reflect on their experi-
ences as graduate students of color and collectively discuss
some of the pitfalls, challenges, and opportunities for success
for black anthropology students pursuing graduate degrees.
Conversations and concern among USF faculty members,

graduates, and graduate students following the SfAA panel
discussion led to the establishment in the spring of 2014 of a
USF anthropology department–level committee to examine
issues of departmental diversity. Because we recognize that
a publically relevant and accountable anthropology must re-
flect and respond to the communities in which we live and
work, the department is taking steps to create holistic poli-
cies to promote these values.

Although the “Beyond Statistics” panel focused on issues
specific to African American students, many of the expe-
riences shared resonate more broadly with other under-
represented groups in graduate programs in anthropology.
The panelists spoke of feelings of isolation, of being unduly
questioned by some of their professors and graduate student
peers on their choice of research topics, and about the in-
tegrity of native anthropology. They expressed their dismay
at seeing contributions of black and other anthropologists of
color marginalized within or excluded from the discipline’s
canon and said that these experiences fostered feelings of
self-doubt. Participants also spoke of paradoxes such as the
struggle to secure funding and the lack of robust mentorship
in cases where funding had been obtained. They remarked on
the experiences of being made to feel like invisible outsiders
at some times (e.g., not being introduced to department vis-
itors when others were; being viewed as subjects instead of
scholars and peers in classroom discussions) and as racialized
and visible representatives of diversity at others (e.g., seen as
universal experts on the subject of race). They reflected upon
missteps of everyday graduate student life, from being sin-
gled out as “go-to” experts on diversity in some classroom
discussions to being called by the name of another black

http://www.utexas.edu/cola/files/413453

388 American Anthropologist • Vol. 117, No. 2 • June 2015

graduate student by white peers and program staff despite a
lack of resemblance.

The panelists also made innovative programmatic
recommendations for recruitment and retention of anthro-
pology graduate students from underrepresented groups
with practical implications to augment the number of future
anthropologists. These strategies included the creation of
outreach programs at the high school level; workshops
that would encourage faculty to recognize issues faced by
students of color; increased availability of student resources
such as graduate assistantships and research funding; more
one-on-one support through mentorship relationships;
honest feedback from professors at regular intervals; co-
publishing opportunities; using “challenging conversations”
that arise organically as the basis for discussions of racism in
the academy; curricular changes that highlight diverse schol-
arship in anthropology; the use of ethnography as a tool to
study the culture of anthropology departments themselves;
and, at the level of the American Anthropological Associa-
tion (AAA) and the SfAA, a rating system or diversity policy
score for anthropology departments to raise accountability.

This call to consciousness expressed by the panelists
coincided with, and echoed, current concerns within the
discipline, and it resonated with initiatives by the AAA and
by individual departments. Yet the panel was poorly at-
tended, despite the presence of the executive director of the
AAA. The president of the SfAA visited briefly and offered
support for the panel, apologizing for the low attendance.
Such underparticipation could suggest that, in the context
of competing priorities of conference attendees, the panel’s
topic was not considered of high importance to anthropol-
ogists in attendance, which means that more work needs to
done.

This article is written by the “Beyond Statistics” panel
participants and current USF anthropology faculty. We
present some of the highlights of the discipline’s efforts over
the years to address issues such as those presented by the
panel, as well as a brief discussion of our department’s ex-
perience and efforts at inclusion and the democratization of
science. We regard efforts at inclusion and democratization
as vital to ensuring that future generations of anthropologists
will be reflective of the diversity of the societies in which
they live, work, and serve. Our goal is to create programs
and policies that will give primacy to diversity in critical,
transparent, and sustainable ways and enhance our account-
ability to our publics. We have stories of success, yet we still
have a long way to go. We think that our efforts, reawak-
ened by experiences shared by the 2014 SfAA panelists, can
inform and be informed by a broader set of efforts to move
toward a more intentional, engaged, and conscious public
anthropology.

ANTHROPOLOGY’S DIVERSITY—OR NOT
In the 1960s context of counterculture politics and rising
civil rights struggles, there were sustained and serious cri-
tiques of anthropology from the outside, such as Vine Deloria

Jr.’s (1969) Custer Died for Your Sins: An Indian Manifesto, as
well as internal critique that called for the radicalization of
anthropology’s aims and focus (Gough 1968) and criticized
anthropology’s involvement with colonialism (Asad 1973).
William S. Willis (1972) wrote of anthropology’s racist past
and contemporary silences and skirting of issues in “Skele-
tons in the Anthropological Closet,” and there followed
calls to “decolonize anthropology” (Harrison 1991), a focus
on pioneers from historically underrepresented minority
groups (Harrison and Harrison 1999), discussions of what it
meant to be a “native” anthropologist (Jacobs-Huey 2002),
considerations of archaeologists’ role in perpetuating struc-
tural violence against native communities (Thomas 2000)
and in reinventing them altogether (Castañeda 1996), and
memoirs and reflections from anthropologists of color
(Harrison 2008; Navarro et al. 2013).

The AAA’s institutional response was to establish, from
time to time, committees to investigate (the lack of) diver-
sity within anthropology, where diversity was defined on the
basis of race, ethnicity, and occasionally gender. A resolution
was passed at the 1969 annual meeting calling for measures
to recruit and retain black, Chicano, American Indian, and
Asian students, and the Committee on Minority Partici-
pation was established the following year. This committee
morphed into the Committee on Minorities and Anthro-
pology, and in 1973 it issued a report titled “The Minor-
ity Experience in Anthropology” (Committee on Minorities
and Anthropology 1973). In 1987, the AAA Committee on
Anthropology in Predominately Minority Institutions started
working to increase anthropology’s visibility at these insti-
tutions, and by 1992 this committee fed into a further AAA
effort that resulted in the Commission on Minority Issues
in Anthropology, which called for the establishment of a
permanent committee with the goals of promoting partic-
ipation of underrepresented groups, fostering professional
advancement by minorities, promoting intellectual aware-
ness of minority issues, and helping to define anthropology’s
role in public discourse around cultural diversity (Commis-
sion on Minority Issues in Anthropology 1996). In 1999
the AAA awarded its first Minority Dissertation Fellowship.
In 2004 the Committee on Minority Issues in Anthropology
issued a report on “Race, Gender, and Mentoring in Anthro-
pology Departments” (Dı́az-Barriga et al. 2004) expressing
dismay at the lack of actual research on the mentoring of
members of underrepresented groups. Meanwhile, Roberto
González’s (2002) research on “Top 10” anthropology de-
partments showed an absence of nonwhite anthropology
graduate students and faculty. By contrast, it was found that
70 to 90 percent of minority anthropologists received their
degrees at public institutions and that 70 to 90 percent of mi-
nority anthropologists were employed by public institutions
(Hutchinson and Patterson 2010:3).

The AAA established the ad hoc Commission on Race
and Racism in Anthropology at the 2007 annual meeting, and
an ensuing report noted that the AAA did not collect useable
data on the ethnoracial diversity of its membership and none

Public Anthropology 389

on its social class origins. The authors stated that apparently
“not much” had changed since the 1973 report (Hutchin-
son and Patterson 2010:3). Evidence, perhaps, of further
“dividing and subdividing” (Wolf 1980) was the prolifera-
tion and growth of AAA sections including the Association
of Black Anthropologists, the Association for Feminist An-
thropology, the Association of Indigenous Anthropologists,
the Association of Latina and Latino Anthropologists, the
Association for Queer Anthropology (formerly Society of
Lesbian and Gay Anthropologists), and the Association of
Senior Anthropologists.

In 2012, AAA President Leith Mullings formed the
Task Force on Race and Racism to develop strategies for
recruitment and retention of racialized minorities in the an-
thropological workforce. At the 2013 AAA meeting, Karen
Mary Davalos and Karen Brodkin organized an open panel
discussion entitled “Numbers Matter: How Do We Cre-
ate a More Racially Diverse Anthropology?” This event
was an open strategy session with participants from sub-
field and section leadership, designed to help the task force
develop a specific plan for recruitment and retention of stu-
dents of color. Following up on the results of the panel, in
February of 2014 the AAA offered a 51-minute webinar
called “Best Practices: Recruitment and Retention of Under-
represented Minorities in Anthropology Programs,” hosted
by Rosemary Joyce. In it, Joyce suggested how to develop a
pipeline to graduate education, practice comprehensive ad-
missions review, and establish clear benchmarks for minority
graduate student progress as ways to recruit and retain stu-
dents from underrepresented groups (Joyce 2014). Yet, for
a number of historical reasons, anthropology continues to
lag behind minority science and engineering degree holders.
Only 2.7 percent of anthropology degree holders identify as
black, for example, as compared to the 5.5 percent who do
so in science and engineering.1

PROGRAMMATIC POSSIBILITIES
Given the apparent failures of these discipline-wide efforts,
it falls to individual departments to develop diversity poli-
cies and practices. In the articulation of its Diversity Mission
Statement published in June of 2014, the Department of
Anthropology at the University of Washington provides an
excellent example of how to address issues of underrep-
resentation faced by historically excluded groups based on
race and ethnicity, as well as how to expand the criteria
upon which diversity is assessed to include issues such as
gender, sexual orientation, age, and ability (University of
Washington 2014). But what kinds of policies aimed at en-
hancing diversity make the most sense at the department
level?

At first glance, USF has several advantages for the re-
cruitment and retention of minority graduate students in
anthropology. It is located in Tampa, Florida, a city with
sizeable African American and Latino communities and
growing populations of first-generation immigrants to the
United States (Florida Center for Community Design and

Research 2012), which allows students to complete intern-
ships and work with diverse local organizations through their
thesis and dissertation fieldwork. USF’s overall student body
is composed of African American (12 percent), Asian (6 per-
cent), Hispanic (18 percent), international (3 percent), and
white (56 percent). Responding to the need for training, the
department established the world’s first Master of Arts pro-
gram in Applied Anthropology in 1974 and the first Ph.D.
program in 1984. With over 530 graduates at this writing,
the program attracts students from a range of backgrounds
to address contemporary social problems with an anthropo-
logical perspective. Indeed, applied anthropology might be
seen to have special relevance for underrepresented groups.
As González (2002:21) noted, “Bringing anthropology back
home to the struggles, realities, and inequalities of wealth
and power within our own society may be a critical step in
attracting a more diverse group of students to anthropology
departments.”

Through the years, several highly visible and success-
ful minority and international students have graduated from
USF’s anthropology graduate program. Many of these alumni
have obtained positions as professors and deans within the
academy and in leading roles in the world of practitioners.
Yet there has been no systematic effort to document their
experiences as graduate students in the program to see what
things worked well and what need improvement. Nor has
there been any stated policy or set of publically articulated
practices within the department focused on managing di-
versity, including recruitment and retention guidelines and
establishment of metrics for monitoring progress. While the
success of these highly visible students in the program as
determined by receipt of a graduate degree can be quanti-
fied, gaps remain in the qualitative record regarding their
experience. Of the nearly 150 graduate students currently
registered, available metrics indicate that as few as 33 iden-
tify as people of color. This suggests that, while several
among our faculty and departmental leadership have sought
over the years to attract and support a more diverse and
representative student body, without institutional policies
in place, the results of these efforts are limited. Authors of
this article seek not only to recognize and applaud individual
and small group practices that have led to graduate student
success in the past, but also to identify and promote ways
of making successful strategies at the individual level part of
a best practice policy at the department level for sustained
and reproducible success.

One way that the department has addressed diversity
is by maintaining strong ties with the McKnight Doctoral
Fellowships program administered by the Florida Education
Fund, which provides funding for African American and His-
panic students to pursue doctorates in disciplines in which
they have been historically underrepresented. A number
of USF students have been or currently are fellows, and
faculty and alumni regularly attend the annual McKnight
Fellows Meeting as guest speakers. Additionally, the de-
partment organizes campus visits by students in the McNair

390 American Anthropologist • Vol. 117, No. 2 • June 2015

Scholars Program, and international students are given spe-
cial consideration for graduate assistantships, which come
with tuition waivers. The department provides an endowed
scholarship for minority students in archaeology, the J. Ray-
mond Williams Memorial Scholarship in Public Archaeol-
ogy, and students are regularly notified about the AAA Mi-
nority Dissertation Fellowship and other funding sources.
However, as the SfAA panelists suggest, these efforts alone
are insufficient to ensure the recruitment and retention of
underrepresented groups.

With the goal of institutionalizing policies to encourage
greater inclusiveness and accountability to anthropology’s
many publics, our committee to examine issues of depart-
mental diversity has proposed our own “Three Rs”—of re-
cruitment, retention, and representation.

Recruitment
The department is establishing graduate student recruitment
channels by producing materials to distribute to colleagues
in historically black colleges and universities and Hispanic-
serving institutions. Likewise, the department is searching
for ways to support ongoing efforts to diversify the fac-
ulty. These are not easy, given the current political climate
and legal challenges to programs that promote student and
faculty diversity. One method used in the past is to place
graduate students on search committees, including students
from underrepresented groups. It should be noted that, like
the University of Washington, we are seeking to expand
on the notion of an underrepresented group to move be-
yond the association with race and ethnicity to social class,
disability status, age, and sexual orientation—that is, the
very criteria used in discriminating against people. This is
not to undermine historical efforts at inclusion by anthro-
pologists of color. It is to aid and abet those efforts but
also to acknowledge the interrelationship of dimensions of
difference and, at a practical level, to formulate different
strategies and metrics for further diversifying the graduate
student and faculty body. The overall ethos is the spirit of
even more inclusiveness. One way of increasing inclusivity
is asking all applicants to the graduate program to indicate
how they would bring diversity to the department as part of
their statement of purpose essay required for admission.

Retention
Retention of students from underrepresented groups starts
from the pragmatics of funding. Many African Ameri-
can and Hispanic graduate students are able to earn a
McKnight Fellowship, but the Wenner-Gren Foundation for
Anthropological Research, the AAA, the Ford Foundation,
the Mellon Foundation, and other sources also offer funding
opportunities for members of underrepresented groups. We
are becoming proactive with external funding possibilities
by devoting staff hours to searching for these fellowships
and asking advisors to inform their graduate students about
them. We are planning events such as workshops for the
faculty on mentoring graduate students. We are also in

discussions to design an ethnographic survey of students and
faculty, as suggested by the SfAA panelists, with the goal of
understanding their views on diversity within anthropology,
soliciting their ideas on how to achieve it, and determining
ways to sustain an environment that encourages everyone
to contribute and succeed by learning from and with each
other.

Representation
Efforts to promote the visibility of our graduate students
from underrepresented groups are aimed at promoting their
movement into the professional ranks. USF departmental
faculty members routinely co-publish with their graduate
students and write them into their external funding appli-
cations. Faculty–graduate student workshops on publishing
and on grant applications have been conducted in the past,
and these will be expanded in the future. But “representa-
tion” is taken in another way, and these efforts are aimed
at informing and inspiring all of our students. We are de-
veloping a graduate course in the history of anthropology
that includes contributions of a broader range of anthropol-
ogists, with particular attention to anthropologists of color,
and we are actively encouraging faculty members to consider
as wide a range as possible of scholars when assigning texts
and readings in courses. Invoking the notion of “anticipa-
tory socialization” (Merton 1957) by providing insight into
the values and struggles of underrepresented groups who be-
come faculty, the department is planning workshops and film
nights, showing, for example, Living Thinkers: An Autobiogra-
phy of Black Women in the Ivory Tower (Walker-Canton 2013).
Nonetheless, we recognize that more intentional teaching
and mentorship will only get us so far without policies
aimed at increasing the presence of underrepresented groups
among both our students and faculty.

With this in mind, our committee seeks to compile more
comprehensive statistics on the racial, ethnic, and gender
makeup of our department, college, and university, to the
extent these are available. We believe that doing so will help
to illuminate institutional gaps and successes as well as sup-
port efforts at improving policies and procedures to ensure
more effective recruitment, retention, and representation.
In all of these efforts, establishing metrics, setting goals,
and being transparent within the department and beyond
will help us achieve the accountability we see as vital to our
success—and our students’ success—as applied, engaged,
and public anthropologists.

DIALOGUE ON DIVERSITY
We live in a society that grants and withholds privilege
and power based on racial, ethnic, class, gender, and other
identity markers. Institutions of higher education, as well
as our discipline of anthropology, have played a crucial role
in upholding these hierarchies over the years. We add our
voices to the growing call that we confront the disparities
within our discipline, just as we seek to address them in the
world.

Public Anthropology 391

In revealing shared experiences and ongoing efforts,
we hope that we will stimulate further dialogue on diver-
sity with the aim of amassing and sharing examples of “best
practices” to address what we regard as a pressing prob-
lem in a profession that aims to reach out and work in
diverse communities. We owe it to our publics to create
programs and future researchers and policy makers that can
operate inside and outside the academy and in the public
sphere.

Let us conclude with a plea for further exchange by
recalling the words of Michel-Rolph Trouillot (2003:117),
who noted, “To ask where anthropology is—or should be—
going today is to ask where anthropology is coming from
and to assess critically the heritage that it must claim.” We
welcome ongoing dialogue about ways that we can—for,
indeed, we must—respond to this heritage in the present.
If anthropology is to be relevant, it must be diverse, demo-
cratic, and inclusive.

NOTES
Acknowledgments. The authors of this article are listed in re-
verse alphabetical order. We would like to thank departmental alumni
Drs. Jonathan Gayles and Cheryl R. Rodŕıguez for their comments
on earlier drafts of this article and Donna Barth and Kanan Mehta for
their research assistance.

1. Both numbers are dismal compared to the 11.7 percent of
black Americans in the general U.S. population. For a more
detailed comparison of anthropology and science–engineering
degree holders by race, see Joyce 2014.

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Table of Contents.html

ANTH 102 6980 Introduction to Cultural Anthropology (2225) – Week Seven Learning Resources
1. Week 7 Learning Resources APA Citations

2. Blackness, Citizenship, and the Transnational Vertigo of Violence in the Americas

Childhood Maltreatment and the Clinical Characteristics of Major
Depressive Disorder in Adolescence and Adulthood

Morgan Vallati, Simone Cunningham,
Raegan Mazurka, Jeremy G. Stewart,

Cherie Larocque, and Roumen V. Milev
Queen’s University

R. Michael Bagby and Sidney H. Kennedy
University of Toronto

Kate L. Harkness
Queen’s University

Childhood maltreatment is widely implicated as the strongest developmental risk factor for depression
onset. The current research is novel in examining the fine-grained associations of childhood emotional
versus physical versus sexual maltreatment to indices of the severity, course, and presence of anxiety and
trauma-related psychopathology in depression. An amalgamation across 6 previous investigations re-
sulted in a sample of 575 adolescents and adults (76% female; age range 12–70, M � 27.88, SD � 13.58).
All participants were in a current episode of a unipolar depressive disorder. Retrospective reports of
childhood maltreatment were assessed using a rigorous contextual interview with independent, standard-
ized ratings. Higher levels of emotional maltreatment and/or sexual maltreatment emerged as signifi-
cantly associated with greater depression severity, number of previous episodes, and risk for posttrau-
matic stress disorder (PTSD), and were significantly more strongly associated with these characteristics
than was physical maltreatment. Further, emotional maltreatment perpetrated by mothers was signifi-
cantly associated with depression severity and history, whereas emotional maltreatment perpetrated by
fathers was significantly associated with a greater risk of PTSD. These latter results suggest that
prevention and intervention efforts may need to focus on the unique roles of mothers versus fathers on
the development of depressive- versus threat-related psychopathology, respectivel

General Scientific Summary
This study suggests that emotional and sexual abuse are significantly associated with a higher
severity and number of lifetime episodes of depression, as well as the presence of a trauma-related
diagnosis. Further, they suggest that emotional abuse perpetrated by mothers is associated with
higher depression severity and lifetime course, whereas emotional abuse perpetrated by fathers is
associated with higher rates of trauma-related disorders co-occurring with depression.

Keywords: anxiety, childhood maltreatment, major depression, posttraumatic stress disorder

This article was published Online First April 2, 2020.
X Morgan Vallati, Simone Cunningham, X Raegan Mazurka, Jeremy

G. Stewart, and Cherie Larocque, Department of Psychology, Queen’s
University; Roumen V. Milev, Department of Psychiatry, Queen’s Univer-
sity; R. Michael Bagby, Department of Psychology, University of Toronto;
X Sidney H. Kennedy, Department of Psychiatry, University of Toronto;
X Kate L. Harkness, Department of Psychology, Queen’s University.

Ethical approvals for the six investigations included in the current study
were obtained from the Queen’s University Health Sciences Research
Ethics Board (PSYC-056-06; PSYC-030-01; PSYC-058-06; PSYC-154-
14), the Centre for Addiction and Mental Health Research Ethics Board
(103/2005), and the University of Oregon Institutional Review Board
(A52-98F). Some of the data were collected as part of the Canadian
Biomarker Integration Network in Depression (CAN-BIND), an Integrated
Discovery Program supported by the Ontario Brain Institute. The opinions,

results, and conclusions are those of the authors and no endorsement by the
Ontario Brain Institute is intended or should be inferred.

The authors gratefully acknowledge the following individuals who pro-
vided assistance in the management of data and preparation of the current
manuscript: Jasmine Chananna, Susan Dickens, Mateya Dimnik, Jennifer
Gillies, Samantha Senyshyn, and Sally Zheng. This work was supported by
the Canadian Institutes of Health Research (Kate L. Harkness, MOP-
79320) and the Ontario Mental Health Foundation (Kate L. Harkness), as
well as a young investigator award from the Sick Kids Foundation (Kate L.
Harkness) and a dissertation award from the Center for the Study of
Women and Society (Kate L. Harkness). We also acknowledge a donation
by Bombardier.

Correspondence concerning this article should be addressed to Kate L.
Harkness, Department of Psychology, Queen’s University, 62 Arch Street,
Kingston, ON K7L 3N6, Canada. E-mail: harkness@queensu.ca

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Journal of Abnormal Psychology
© 2020 American Psychological Association 2020, Vol. 129, No. 5,

469

– 479
ISSN: 0021-843X http://dx.doi.org/10.1037/abn0000521

469

https://orcid.org/0000-0003-0537-1591

https://orcid.org/0000-0002-4974-4815

https://orcid.org/0000-0001-5339-7185

https://orcid.org/0000-0002-0319-8994

mailto:harkness@queensu.ca

http://dx.doi.org/10.1037/abn0000521

One in three children worldwide is the victim of emotional,
physical, or sexual maltreatment (Moody, Cannings-John, Hood,
Kemp, & Robling, 2018). Childhood maltreatment raises risk for
the onset of major depressive disorder (MDD) in adolescence and
adulthood two- to threefold (Liu, 2017). Further, meta-analyses
and systematic reviews have revealed that among individuals who
are depressed, those with a history of childhood maltreatment
present with an earlier age of onset, more severe symptoms, a
greater risk for recurrence, higher rates of comorbidity with other
Axis I and II conditions, and more lifetime suicide attempts than
those without this history (Lippard & Nemeroff, 2020; Nanni,
Uher, & Danese, 2012; Teicher & Samson, 2013). Meta-analyses
have also indicated that childhood maltreatment history is associ-
ated with poorer response to antidepressant medication, psycho-
therapy, and combination treatments (Nanni et al., 2012).

In sum, there is strong evidence that implicates childhood mal-
treatment as an environmental marker of a more severe and in-
tractable course in MDD. However, maltreatment is a heteroge-
neous construct and it is as yet unclear whether specific types of
maltreatment (e.g., emotional vs. physical vs. sexual abuse) show
differential associations with the clinical features of MDD. If such
fine-grained distinctions among maltreatment types are associated
with clinical features in MDD that have prognostic value, this
information may help in targeting prevention and intervention
efforts to those who are most at risk.

There is some theoretical basis for suspecting that different
types of maltreatment may be differentially associated with MDD,
in general. For example, in their expanded hopelessness theory of
depression, Rose and Abramson (1992) proposed that childhood
emotional maltreatment should be more strongly associated with
depression than physical or sexual maltreatment because parents
are directly supplying the child with content to fuel a negative
inferential style (e.g., “You’re worthless”). In contrast, in the
context of physical or sexual maltreatment, according to Rose and
Abramson, the child must make his or her own inferences, thereby
allowing for the possibility for less negative attributions.

The meta-analytic evidence to date has provided support for
Rose and Abramson’s (1992) model. A meta-analysis of the asso-
ciation between retrospectively recollected childhood maltreat-
ment and the distinction between depressed and nondepressed
groups revealed higher effect sizes for emotional abuse (odds ratio
[OR] � 3.06) than neglect (OR � 2.11) or physical abuse (OR �
1.54; Norman et al., 2012). A second meta-analysis generally
supported these results, finding higher effect sizes in distinguish-
ing between depressed and nondepressed groups for emotional
abuse (OR � 2.78) and neglect (OR � 2.75) relative to sexual
abuse (OR � 2.42), physical abuse (OR � 1.98), or exposure to
domestic violence (OR � 2.06; Mandelli, Petrelli, & Serretti,
2015). A third meta-analysis by Infurna et al. (2016) included only
studies that assessed maltreatment using the Childhood Experience
of Care and Abuse (CECA; Bifulco, Brown, & Harris, 1994) scale,
a rigorous contextual interview with independent ratings that is
widely regarded as the gold standard retrospective measure of
maltreatment. In the CECA, scales are often dichotomized to
denote the presence versus absence of severe maltreatment (see
Bifulco et al., 1994). This meta-analysis confirmed that effect sizes
for severe psychological abuse (d � .932), severe emotional ne-
glect (d � .813), and, in this case, also severe physical abuse (d �
.810) were higher than for severe sexual abuse (d � .500; Infurna

et al., 2016). However, none of these three meta-analyses above
statistically compared the strength of the effects across types of
maltreatment, nor did they provide evidence regarding the differ-
ential association of types of maltreatment to the clinical charac-
teristics within depression, such as severity or recurrence. Further,
Rose and Abramson’s (1992) theory makes no predictions bearing
on this latter question. Nevertheless, the weight of the evidence
suggests that emotional maltreatment is the maltreatment type
most strongly associated with the diagnosis of depression.

The most comprehensive recent theory regarding the differential
outcomes of specific early adverse experiences is that proposed by
Sheridan and McLaughlin (2014). They leverage theory and data
from the preclinical and human cognitive-affective neuroscience
literatures to propose that adverse experiences involving threat
(i.e., physical or sexual abuse, exposure to neighborhood or do-
mestic violence) have different neural and cognitive consequences
than experiences involving deprivation (e.g., marked physical ne-
glect, institutionalization). Of direct relevance to questions of
psychopathology, Sheridan and McLaughlin (2014) propose that
experiences of physical and sexual abuse should result in height-
ened attentional bias, and reactivity, to threatening stimuli in the
environment. Heightened threat processing is a hallmark patholog-
ical feature of the fear- and trauma-related related disorders (Mogg
& Bradley, 2005; Shechner & Bar-Haim, 2016), and, indeed,
results from a small number of studies suggest that sexual abuse is
more strongly related to these disorders than are other types of
maltreatment, including neglect (Levitan, Rector, Sheldon, & Go-
ering, 2003; Sullivan, Fehon, Andres-Hyman, Lipschitz, & Grilo,
2006; van Veen et al., 2013). However, although Sheridan and
McLaughlin’s (2014) model provides hypothesized outcomes for
extreme experiences of neglect (e.g., sensory deprivation), the
model does not include a discussion of the sorts of emotional
abuse experiences that have been most strongly associated with
depression (e.g., marked antipathy, criticism, coldness or emo-
tional disengagement). Nevertheless, their model and the empirical
evidence suggest that physical and sexual maltreatment may be
more strongly associated than emotional maltreatment with the
presence of additional fear- and trauma-related symptoms and
disorders in those with depression.

A further issue that has received almost no empirical attention is
the differential impact of maltreatment perpetrated by mothers
versus fathers. In the developmental literature, attachment theorists
have proposed that children may form different patterns of attach-
ment to mothers versus fathers based on differences in the ways in
which mothers and fathers interact with their children. For exam-
ple, it has been proposed that mothers may contribute to healthy
emotional functioning primarily through promoting emotion reg-
ulation (i.e., soothing the child when upset), whereas fathers may
contribute to child development by promoting exploration and
play (Bowlby, 1979; Grossmann, Grossmann, Fremmer-Bombik,
Scheuerer-Englisch, & Zimmerman, 2002). Consistent with this
distinction, lower levels of warmth from mothers have been found
to prospectively predict future emotional maladjustment in young
children more strongly than care from fathers (Han, Rudy, &
Proulx, 2017). Of more direct relevance to the constructs examined
in the current study, in a community sample of 1,376 women in
New Zealand, retrospective reports of maltreatment (a composite
of emotional, physical, or sexual abuse) perpetrated by mothers
was more strongly associated with adult psychopathology, includ-

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470 VALLATI ET AL.

ing MDD, than father-perpetrated maltreatment (Mullen, Martin,
Anderson, Romans, & Herbison, 1996). Results of this latter study,
therefore, provide tentative preliminary evidence that maltreatment
from the mother may be more strongly related to outcomes such as
MDD than maltreatment from the father; however, it is unclear if
this relation extends to particular types of maltreatment and/or to
particular clinical characteristics of MDD.

Large samples are required to address the relations of specific
types of maltreatment to particular clinical characteristics in MDD
because of the low base rates of particular forms of maltreatment
(e.g., sexual abuse) and the high degree of co-occurrence among
the maltreatment types (see Sheridan & McLaughlin, 2014). At the
same time, when examining characteristics of depression, such as
severity, it is important to assess maltreatment in a way that
minimizes the effect of depression in biasing recollections (Hark-
ness & Monroe, 2016). Self-report checklist measures of emo-
tional maltreatment, in particular, contain items that more closely
reflect subjective perceptions of parenting rather than the actual
maltreatment exposure (e.g., “I thought that my parents wished I
had never been born” from the Childhood Trauma Questionnaire;
Bernstein et al., 1994; italics added). As such, use of such mea-
sures to address the current research question may result in spu-
riously inflated associations between MDD severity and emotional
maltreatment relative to physical or sexual maltreatment. As noted
above, the gold standard methods for retrospectively assessing
maltreatment exposure are contextual interviews, such as the
CECA, which query in detail about the contextual and behavioral
features of the maltreatment and use independent judges and a
manual of standardized exemplars to anchor ratings of maltreat-
ment presence and severity (Bifulco et al., 1994). A recent review
determined that maltreatment retrospectively assessed using con-
textual interview measures is more strongly associated with reports
of maltreatment taken at the time of the abuse (either officially
documented reports or self-report) than is maltreatment retrospec-
tively assessed by self-report checklist (Baldwin, Reuben, New-
bury, & Danese, 2019). However, the contextual method is time-
and labor-intensive, thereby working at cross-purposes with the

goal of collecting large samples. For the current study, we com-
bined data across six smaller previous investigations that utilized
the CECA interview to derive a sample of 575 individuals in a
current episode of MDD. To our knowledge, this represents the
largest sample to date of individuals in a current major depressive
episode who have been rigorously characterized in terms of both
the clinical features of the illness and contextual histories of
specific forms of childhood maltreatment.

The current study addresses the novel question of whether
emotional, physical, and sexual maltreatment are differentially
associated with the severity and course of depression, as well as
with the presence of a fear-related anxiety disorder or a trauma-
related disorder (i.e., PTSD). Taken together, the above theory and
preliminary evidence to date suggest that when including other
forms of maltreatment in our models, (a) emotional maltreatment
will have independent associations with a greater severity and
greater number of episodes of MDD, (b) physical and sexual
maltreatment will have independent associations with higher rates
of anxiety disorders and PTSD, and (c) maltreatment perpetrated
by mothers will be more strongly associated with all clinical
characteristics of MDD than maltreatment perpetrated by fathers.

Method

Participants

The current report included 575 participants (76% female; age
range 12–70, M � 27.88, SD � 13.58), drawn from one of six
investigations conducted previously across three sites investigating
the relation of stress in individuals with depression compared with
individuals with no psychiatric history (see Harkness & Luther,
2001; Harkness, Bruce, & Lumley, 2006; Harkness et al., 2015;
Harkness, Bagby, & Kennedy, 2012; Mazurka, Wynne-Edwards,
& Harkness, 2018; see Table 1). Only participants in the depressed
group of the previous investigations were relevant to the current
research question and, thus, only these participants were included
in the current report. All participants were recruited through com-

Table 1
Demographic and Clinical Characteristics by Study

Characteristic
Study 1
(n � 79)

Study 2
(n � 77)

Study 3
(n � 134)

Study 4
(n � 95)

Study 5
(n � 76)

Study 6
(n � 114) �2 or F

Age, M (SD) 15.78 (1.55)a 16.51 (1.90)a 21.19 (3.45)b 31.44 (14.23)c 37.30 (11.12)d 42.57 (11.66)e 149.48

��

Sex
Female, n (%) 56 (70.9)a 59 (76.6)a 102 (76.1)a 68 (71.6)a 76 (100)b 74 (64.9)a 33.48

��

Ethnicity
White, n (%) 76 (96.2)a 63 (81.8)bde 98 (73.7)bc 71 (77.2)cd 69 (90.8)ae not assessed 34.52

��

Asian, n (%) 0 (0) 2 (2.6) 16 (12.0) 13 (14.1) 1 (1.3)
Other, n (%) 3 (3.8) 12 (15.6) 19 (14.3) 8 (8.7) 6 (7.9)

Years of education, M (SD) 10.47 (1.59)a 11.21 (1.90)a 14.51 (2.35)b 16.53 (2.55)c 16.74 (2.37)c 16.18 (2.31)c 128.50
��

Age of first onset, M (SD) 12.68 (3.19)a 14.14 (2.60)a 18.00 (4.49)b 19.57 (11.58)b not assessed 30.14 (12.24)c 65.80
��

Lifetime episodes, M (SD) 1.72 (1.48)ab 1.44 (0.80)b 1.69 (1.69)b 2.96 (2.67)a 7.62 (6.50)c 2.82 (2.82)a 46.06
��

Anxiety: Yes, n (%) 22 (28.0)ab 18 (23.4)a 46 (34.3)ab 47 (49.5)b 22 (28.9)ab 12 (10.5)c 41.28
��

PTSD: Yes, n (%) 8 (10.1)ab 3 (3.9)a 5 (3.7)a 16 (16.8)bc 17 (22.4)c 0 44.07
��

BDI-II, M (SD) 23.57 (11.79)a 29.20 (10.40)b 31.33 (8.93)b not assessed 28.61 (8.51)b 30.45 (7.89)b 9.31
��

HRSD-17, M (SD) not assessed not assessed 15.15 (6.28)a 18.11 (5.39)b 16.93 (4.94)ab 17.94 (3.59)b 8.28
��

Note. Anxiety disorders included panic disorder, social phobia, specific phobia, and separation anxiety. PTSD � posttraumatic stress disorder; BDI-II �
Beck Depression Inventory II; HRSD-17 � Hamilton Rating Scale for Depression. Subscripts indicate study differences.
�� p � .001.

471CHILDHOOD MALTREATMENT AND DEPRESSION

munity advertisements (n � 499) or clinician referrals (n � 76).
Each of these previous investigations received ethical approval
from the sponsoring institution. Written informed consent was
provided by all participants, and by parents/guardians for partici-
pants under age 18 years.

All participants in the depressed group of each of the six larger
investigations had to meet Diagnostic and Statistical Manual of
Mental Disorders (DSM–IV–TR; American Psychiatric Associa-
tion, 2000) criteria for a current episode of a nonbipolar, nonpsy-
chotic depressive disorder. Further, for inclusion in the current
report participants must have completed the CECA (Bifulco et al.,
1994) interview and have ratings for a mother and father caregiver.
Exclusion criteria across all six prior investigations were the
presence of a lifetime psychotic disorder, bipolar disorder, sub-
stance dependence, developmental disability, a medical condition
that better accounted for depression, or acute suicidality necessi-
tating inpatient treatment. In addition, Study 6 excluded individ-
uals meeting criteria for any comorbid disorder other than an
anxiety disorder or PTSD.

Measures

Diagnosis. Participants under the age of 18 years were admin-
istered all sections of the child and adolescent version of the
Schedule for Affective Disorders and Schizophrenia (K-SADS;
Kaufman, Birmaher, Brent, Rao, & Ryan, 1996). Participants age
18 years and older were administered all sections of the Structured
Clinical Interview for DSM–IV Axis I Disorders (SCID-I/P; First,
Spitzer, Gibbon, & Williams, 2002). All interviews were con-
ducted by senior graduate students in clinical psychology who
were trained to gold standard reliability status (see Grove, Andrea-
sen, McDonald-Scott, Keller, & Shapiro, 1981) by Kate L. Hark-
ness.

At least one additional disorder was reported by 275 participants
(47.8%). We created two dependent variables for analysis: (a)
presence versus absence of a fear-related anxiety disorder (n �
164, 28.5%; Kotov et al., 2017). Specific anxiety disorders in-
cluded panic disorder (n � 58), social phobia (n � 89), specific
phobia (n � 24), and separation anxiety disorder (n � 1)1; (b)
presence versus absence of trauma-related psychopathology,
namely a diagnosis of PTSD (n � 49, 8.5%).

Eighty-four (14.6%) participants met criteria for a diagnosis
other than an anxiety disorder or PTSD. However, owing to
differences in exclusion criteria, these disorders were not evenly
distributed across the original investigations, and no one class
of disorders was frequent enough to permit analysis. Therefore,
they are listed here solely for descriptive purposes: obsessive–
compulsive disorder (n � 24), alcohol use disorder (n � 16),
substance use disorder (n � 23), bulimia nervosa (n � 9),
anorexia nervosa (n � 4), attention-deficit/hyperactivity disor-
der (n � 6), oppositional-defiant disorder (n � 6), and conduct
disorder (n � 8).2

Depression severity. Depression severity was assessed with
the 21-item Beck Depression Inventory (BDI-II; Beck, Steer, &
Brown, 1996; Studies 1– 4 and 6) and/or the 17-item Hamilton
Rating Scale for Depression (HRSD-17; Hamilton, 1960; Studies
3– 6). Both measures have good to excellent internal consistency
(Bagby, Ryder, Schuller, & Marshall, 2004; Dozois, Dobson, &
Ahnberg, 1998). To include the full sample in analyses examining

depression severity, we z standardized the BDI-II and HRSD
scores and calculated their average for those who received both.
The resulting standardized score was used in analyses (skew �
0.018). However, the scores on the original instruments are pre-
sented in Tables 1 and 3 for descriptive purposes.

Childhood maltreatment. The CECA (Bifulco et al., 1994) is
a semistructured contextual interview that assesses the quality of
parental care and experiences of maltreatment up to age 18. All
interviews were conducted by senior graduate students who were
trained by Kate L. Harkness in the Bedford College contextual
method of life stress assessment (Bifulco et al., 1994). An impor-
tant concern with the retrospective approach to the assessment of
maltreatment, particularly in cross-sectional designs, is that sub-
jective perceptions of childhood may bias reports of maltreatment,
thereby potentially leading to spuriously inflated relations between
maltreatment and outcomes such as depression. The CECA ad-
dresses the issue of bias at all stages of the procedure. First, in the
interview, respondents are encouraged to tell the story of their
childhood experiences. Both positive and negative experiences are
queried, and respondents are asked to provide specific behavioral
and contextual details and examples (e.g., verbatim statements) to
support their reports. Respondents are never queried about their
subjective feelings or attributions regarding their experiences. Sec-
ond, the material from the interview is rated by independent raters
who are unaware of participants’ psychiatric status or subjective
responses to the exposures. Ratings are based on the behavioral
and contextual details and are anchored to a large manual of over
500 standardized exemplars that cover each scale and rating scale
point. The manual also includes extensive descriptions and rating
rules for each scale (see Bifulco et al., 1994). All maltreatment
exposures reported in the current sample had their onset prior to
the onset of the index episode of MDD, even among the adoles-
cents.

The following scales were included in the current analyses: (a)
emotional maltreatment (rated separately for mother and father)—
hostility, criticism, and/or coldness or emotional distance3; (b)
physical maltreatment (rated separately for mother and father)—
violence directed toward the child; and (c) sexual maltreatment—
coercive and/or age-inappropriate sexual contact by any perpetra-
tor. As expected in an unselected community sample, most of the
incidences of sexual maltreatment reported by the current partic-
ipants had not been perpetrated by parents, and thus, it was not
feasible to stratify the sexual maltreatment variable by mother
versus father. Instead, to capture the diversity of experience, we

1 In the DSM–IV obsessive– compulsive disorder was defined as an
Anxiety Disorder. However, to more clearly support implications to current
nosological systems, we classified it for analyses in the other disorder
category.

2 The individual diagnoses do not add up to the total because some
participants had more than one additional diagnosis. In addition, there was
overlap among the groups (e.g., some participants had both an anxiety
disorder and PTSD.).

3 The CECA also queries for neglect. However, because our participants
were all relatively high-functioning volunteers from the community who
were recruited based on their depression status (not their maltreatment
history), a very small number of participants had exposure to material
neglect (i.e., deprivation of food, clothing, shelter, or sensory input) and
none had been institutionalized as children. Therefore, we did not include
neglect in the current analyses.

472 VALLATI ET AL.

examined two sexual maltreatment variables that were distin-
guished by the degree of relationship to the perpetrator (see Cun-
ningham et al., 2019): relative-perpetrated (parent, sibling, grand-
parent, or aunt/uncle/cousin) and nonrelative-perpetrated (stranger,
same-age peer, adult family friend, or other adult [e.g., teacher,
nanny, etc.]).

At the rating stage, independent raters assigned a numerical
ranking for each scale above. The scale points were 4 � marked;
3 � moderate; 2 � some; 1 � little/none for emotional maltreat-
ment, and 5 � marked; 4 � moderate; 3 � some; 2 � little; 1 �
no maltreatment for physical and sexual maltreatment.4 Each scale
point has anchored exemplars in the CECA manual. The distribu-
tion of scores, and means and standard deviations, for each of the
six maltreatment variables included in the current analyses is
provided in Table 2.

Procedure

Full details regarding the procedures of each investigation from
which participants were drawn are outlined in previous reports.
Studies 1 through 5 included two 2-hr assessments conducted one
week apart. During the first session, participants were adminis-
tered the K-SADS or SCID-I/P and the BDI-II and/or HRSD-17;
the CECA was administered during the second session. Study 6
was a 16-week treatment trial. Participants were administered the
SCID-I/P, BDI-II, and HRSD-17 at the baseline session, and the
CECA at the end of the 16-week treatment period. At the termi-
nation of each protocol, all participants currently in treatment were
referred back to their provider and participants not in treatment
received a referral for services. All participants also received
nominal financial compensation for their time.

Data Analysis

Preliminary univariate analyses were conducted to examine the
relations of the demographic characteristics of the sample to the
childhood maltreatment variables. The primary study hypotheses
were assessed through a series of four regression models. The
dependent variables included the standardized composite severity
score (multiple linear regression), number of previous episodes
(Poisson regression), the presence versus absence of an anxiety
disorder (i.e., panic disorder, social phobia, specific phobia, sep-
aration anxiety; logistic regression), and the presence versus ab-
sence of PTSD (logistic regression). The independent variables
included the six maltreatment variables entered together as a
block: mother emotional maltreatment, father emotional maltreat-
ment, mother physical maltreatment, father physical maltreatment,
relative-perpetrated sexual maltreatment, and nonrelative perpe-
trated sexual maltreatment. The resulting parameters thus provide
an estimate of the statistical relation of the specific maltreatment
type in question, over and above the variance accounted for by the
other maltreatment types. The bias-corrected confidence intervals
on the parameter coefficients were provided based on 1,000 boot-
strapped samples, and we tested the statistical difference between
hypothesis-relevant coefficients using the overlap in the confi-
dence intervals method (Cumming, 2009).

We corrected for multiple tests using the False Discovery Rate
(FDR; Benjamini & Hochberg, 1995) q statistic. This statistic
represents the minimum false discovery rate at which a test is

considered significant, and is equal to a Bayesian-derived quantity
measuring the probability that a significant test is a true null
hypothesis. We calculated the FDR q-statistic in the current study
across all 24 observed p values in our primary regression models
reported below (four dependent variables � six independent vari-
ables). This yielded a q statistic of .01. This is interpreted to mean
that only 1% of all significant effects in this sample are true null
hypotheses (i.e., false positives). Therefore, observed p values less
than or equal to this value are considered significant (see Storey,
2002).

Results

Preliminary Relations of Maltreatment Types to
Demographic Characteristics

Women reported significantly greater severity than men of
mother emotional maltreatment (Ms � 1.89, 1.43; SDs � 0.99,
0.69; t[338.00] � 6.12, p � .001), relative-perpetrated sexual
maltreatment (Ms � 0.42, 0.09; SDs � 1.15, 0.51; t[517.56] �
4.66, p � .001), and nonrelative-perpetrated sexual maltreatment
(Ms � 0.82, 0.23; SDs � 1.42, 0.80; t[425.03] � 6.17, p � .001).
Older age was significantly associated with greater severity of
mother emotional maltreatment, r � .12, p � .005 and father
physical maltreatment, r � .11, p � .01. Further, higher years of
education was significantly associated with greater severity of
nonrelative-perpetrated sexual maltreatment, r � 0.11, p � .006.
Ethnicity was not significantly related to any of the maltreatment
variables (all ps � 0.01). In preliminary model-building we deter-
mined that the results of all the primary models below were robust
when accounting for sex, age, years of education, and ethnicity,
both separately and together (for sex and age). Therefore, the
models without covariates are presented below for ease of inter-
pretability.

Relations of Childhood Maltreatment Types to
Depression Characteristics

Table 3 presents the bivariate, zero-order correlations of each
maltreatment type with each of the clinical characteristics. The
parameters for each regression model are provided in Tables 4, 5,
and 6. As noted above, significant differences between parameter
estimates were determined using the 0 (p � .01) overlap in the
bootstrapped confidence interval rule (Cumming, 2009).

Depression severity. The linear regression model for the stan-
dardized composite depression severity score was significant,
F(6, 568) � 6.02, p � .001 (see Table 4). Higher severity of
nonrelative-perpetrated sexual maltreatment was significantly as-
sociated with higher depression severity, and greater severity of

4 In the CECA, the rating of 1 � none is distinguished from 2 � little
for physical and sexual maltreatment because it is possible (and, indeed,
most common) for children to have never been touched in a violent or
sexual manner by any perpetrator at any point in childhood; that is,
maltreatment is legitimately absent in these cases. However, for the con-
struct of emotional maltreatment it is not as straightforward to distinguish
little from none. Arguments, and even some minor criticism and coldness,
are likely to occur at some point across the 18 years of childhood even in
the most loving parent– child relationships.

473CHILDHOOD MALTREATMENT AND DEPRESSION

mother emotional maltreatment was associated with higher depres-
sion severity as a trend. Both were associated with small-medium
effect sizes (ds � .20). The bias-corrected parameter estimate for
nonrelative-perpetrated sexual maltreatment was significantly
higher than that for father physical maltreatment and higher at a
trend than that for mother physical maltreatment. No other differ-
ences between parameter estimates emerged as significant at the
stringent 0.01 level.

Number of depressive episodes. Because number of previous
episodes is a count variable, and was positively skewed (skew �
3.375), this model was run as a Poisson regression. The overall
model was significant (see Table 5).5 Greater severity of mother
emotional maltreatment and nonrelative-perpetrated sexual mal-
treatment were significantly associated with a greater number of
previous episodes. The incidence risk ratios (IRRs) indicated that
those with marked ratings of mother emotional maltreatment or
nonrelative perpetrated sexual maltreatment had a 60% to 70%
greater number of previous episodes than those with ratings of
little and/or none. The parameter estimate for mother emotional
maltreatment was higher at a trend (p � .05) than the estimates for
father emotional maltreatment, and father and mother physical
maltreatment. Further, the parameter estimate for nonrelative-
perpetrated sexual maltreatment was significantly higher (p � .01)
than the estimate for father physical maltreatment, and higher as a
trend than the estimate for father emotional maltreatment and
mother physical maltreatment.

Anxiety disorder. The logistic regression model for the pres-
ence versus absence of an anxiety disorder failed to reach statis-
tical significance (see top panel of Table 6), and, contrary to
hypotheses, none of the maltreatment variables emerged as signif-
icant in this model. However, the parameter estimate for father
emotional maltreatment approached significance. The odds ratios
indicated that those with marked ratings of father emotional mal-
treatment were twice as likely to have an anxiety disorder diag-
nosis than those with little/none ratings. None of the parameter
estimates differed significantly.

Posttraumatic stress disorder. The logistic regression model
for the presence versus absence of PTSD was significant (see
bottom panel of Table 6). Consistent with hypotheses, greater
severity of relative-perpetrated and nonrelative-perpetrated sexual
maltreatment were significantly associated with greater risk of a
PTSD diagnosis. And, contrary to expectations, greater severity of
father emotional maltreatment was also significantly associated
with greater PTSD risk in this model. The odds ratios indicated
that those with marked ratings of father emotional maltreatment
and relative- and nonrelative-perpetrated sexual maltreatment had
a 3– 4 times greater risk of a PTSD diagnosis than those with little

or no maltreatment. The parameter estimate for nonrelative-
perpetrated sexual maltreatment was significantly higher than the
estimates for physical maltreatment and higher as a trend than the
estimate for mother emotional maltreatment. No other differences
between parameter estimates emerged as significant at the strin-
gent 0.01 level.

Discussion

Childhood maltreatment is strongly associated with the onset of
MDD, as well as with greater severity, recurrence, and the pres-
ence of additional diagnoses among those who are depressed
(Nanni et al., 2012). In the current sample of adolescents and
adults, we found evidence for specific patterns of association
between types of maltreatment and characteristics of the MDD
syndrome. Specifically, emotional maltreatment and/or nonrelative
perpetrated sexual maltreatment were the only maltreatment types
to emerge as significantly associated with a greater severity and
lifetime history of depression, and higher odds of PTSD. In con-
trast, a history of physical maltreatment was not significantly
related to any of the clinical characteristics of MDD. Further,
emotional maltreatment and/or nonrelative perpetrated sexual mal-
treatment emerged as significantly more strongly associated with
depression severity, lifetime episodes of depression, and the pres-
ence of PTSD than physical maltreatment. This pattern of findings
is consistent with the meta-analysis by Mandelli et al. (2015),
which reported the smallest effect size for the relation of physical
maltreatment to depression, in general, in comparison with emo-
tional and sexual maltreatment (see also Keyes et al., 2012). The
current results provide a novel extension of these previous findings
to the specific patterns of association with the clinical character-
istics of MDD.

The relations of emotional maltreatment and nonrelative perpe-
trated sexual maltreatment to depression outcomes, although both
significant, did not differ significantly from each other. This result
appears to run contrary to the meta-analytic evidence showing
stronger associations of emotional maltreatment to depression than
both sexual and physical maltreatment (Infurna et al., 2016; Man-
delli et al., 2015; Norman et al., 2012). However, it is important to
note that none of these meta-analyses statistically compared the
strength of the effects across the maltreatment types.

The lack of a significant difference in the effect sizes for
emotional and sexual maltreatment also appears to run contrary to
Rose and Abramson’s (1992) expanded hopelessness theory of

5 Results of the model were robust when examining women only and
including age as a covariate.

Table 2
Descriptive Statistics of Clinical Characteristics by Maltreatment Types (n � 575)

Maltreatment type Marked Moderate Some Little/none Absent M SD

Mother emotional 42 (7.3) 83 (14.4) 155 (27) 295 (51.3) — 1.78 0.95
Father emotional 39 (6.8) 98 (17) 170 (29.6) 268 (46.6) — 1.84 0.94
Mother physical 21 (3.7) 56 (9.7) 38 (6.6) 25 (4.3) 435 (75.7) 0.61 1.18
Father physical 25 (4.3) 58 (10.1) 39 (6.8) 20 (3.5) 433 (75.3) 0.65 1.22
Relative sexual 30 (5.2) 15 (2.6) 14 (2.4) 1 (0.2) 515 (89.6) 0.34 1.03
Nonrelative sexual 49 (8.5) 36 (6.3) 36 (6.3) 13 (2.3) 441 (76.7) 0.68 1.32

474 VALLATI ET AL.

depression, which posited that emotional maltreatment should
show specific and preferential association with depression over
other forms of maltreatment (again, including both physical and
sexual maltreatment) because it provides the child with explicit
content for the development of a negative self-schema. However,
Rose and Abramson’s theory was specific to the development of
hopelessness depression, a subtype characterized by apathy, low
energy, psychomotor retardation, and interpersonal dependency
(Abramson, Metalsky, & Alloy, 1989; Joiner et al., 2001). It is
possible that emotional and sexual maltreatment, although both
associated with higher overall severity, are each associated with
specific symptoms or clusters of symptoms within the heteroge-
neous depression syndrome. Therefore, although beyond the scope
of the current investigation, future research investigating this level
of specificity is warranted.

A particularly novel dissociation in the current study was that
emotional maltreatment perpetrated by the mother was signifi-
cantly associated with higher depression severity and a greater
number of previous depressive episodes, whereas emotional mal-
treatment perpetrated by the father was not. In direct contrast,
emotional maltreatment perpetrated by the father was significantly
associated with a PTSD diagnosis (and associated with an anxiety
disorder diagnosis at a trend level), whereas mother-perpetrated
emotional maltreatment was not. This latter finding is consistent
with a large study of 945 schoolchildren in China, which also
found larger associations across all anxiety disorders for father-
versus mother-perpetrated emotional maltreatment (Wang, Wang,
& Liu, 2016). However, Wang et al. (2016) did not statistically
compare the strength of the effects for father versus mother mal-
treatment.

It is possible that emotional abuse from the father may be
perceived by the child as more hostile and threatening than that
perpetrated by the mother. Indeed, in studies of emotion perception
generally, male faces are more likely to be misperceived as angry
than female faces (Neel, Becker, Neuberg, & Kenrick, 2012), and
recognition memory is better for angry male faces than for angry
female faces (Tay & Yang, 2017). In the current qualitative CECA
interview transcripts, participants reported that fathers were more
often hostile and threatening in their tone, and participants were
more likely to used words such as angry and mean, and to report
being frightened, when describing emotional maltreatment perpe-
trated by fathers relative to mothers. As such, although speculative,
it is possible that emotional maltreatment from the father may be
more likely than from the mother to result in the sorts of neuro-
cognitive processes that are associated with the development of
posttraumatic and fear symptoms, such as attentional bias to threat
(Okon-Singer, 2018; see Sheridan & McLaughlin, 2014). In con-
trast, it is possible that mother emotional maltreatment may be
more likely to disrupt mechanisms that have been associated with
the onset and chronicity of depression symptoms, such as the
development of internal working models of security and attach-
ment, and the development of core beliefs related to self-worth
(Gibb, Alloy, Abramson, & Marx, 2003; Lumley & Harkness,
2007; Riggs & Kaminski, 2010). It is important to note that the
parameter estimates for mother versus father emotional maltreat-
ment did not differ significantly at the stringent p � .01 level
across any of the depression characteristics, although in the case of
number of previous episodes and PTSD they approached signifi-
cance. Therefore, more targeted research with samples of individ-
uals recruited on the basis of their maltreatment histories is re-

Table 3
Bivariate Correlations of Maltreatment Types and Clinical Characteristics

Maltreatment type
BDI-II

(n � 493)
HRSD-17
(n � 432)

Number of episodes
(n � 575)

Anxiety disorder
(n � 575)

PTSD
(n � 575)

Mother emotional maltreatment 0.19�� 0.09 0.24�� 0.04 0.17��

Father emotional maltreatment 0.09 0.11� 0.09� 0.13�� 0.21��

Mother physical maltreatment 0.07 0.06 0.13�� 0.002 0.14��

Father physical maltreatment 0.01 0.05 0.03 0.08 0.11�

Relative sexual maltreatment 0.09 0.13�� 0.12�� 0.05 0.23��

Nonrelative sexual maltreatment 0.15�� 0.18�� 0.23�� 0.07 0.25��

Note. BDI-II � Beck Depression Inventory II; HRSD-17 � Hamilton Rating Scale for Depression 17; PTSD � posttraumatic stress disorder.
� p � .05. �� p � .005. �� p � .001.

Table 4
Parameter Estimates for Linear Regression Model for Depression Severity

Variable R2 B t d

Bootstrapped

p Bias-corrected CI95(B)

DV: Depression severity 0.06��

Mother emotional maltreatment 0.10 2.06 0.21 0.02 [0.01, 0.19]
Father emotional maltreatment 0.06 1.26 0.12 0.20 [�0.03, 0.15]
Mother physical maltreatment 0.005 0.12 0.01 0.90 [�0.07, 0.07]
Father physical maltreatment �0.13 �0.35 0.03 0.71 [�0.08, 0.06]
Relative sexual maltreatment 0.06 1.53 0.13 0.08 [�0.007, 0.13]
Nonrelative sexual maltreatment 0.11 3.64 0.31 0.001 [0.05, 0.17]

Note. DV � dependent variable; CI95(B) � 95% confidence interval of B.
�� p � .001.

475CHILDHOOD MALTREATMENT AND DEPRESSION

quired to confirm the preliminary differential associations reported
here.

In terms of sexual maltreatment, our results are consistent with
those of prior studies showing associations with particularly severe
and chronic manifestations of depression (Harkness & Monroe,
2002; Holshausen, Bowie, & Harkness, 2016; Sitko, Bentall, Shev-
lin, O’Sullivan, & Sellwood, 2014) and comorbid trauma-related
symptoms (e.g., Mueller-Pfeiffer et al., 2013). In particular, in the
current sample, sexual maltreatment perpetrated by a nonrelative
showed the strongest effect size in relation to PTSD; those with
marked levels of nonrelative perpetrated sexual maltreatment were
four times more likely to have a diagnosis of PTSD than those with
no history of sexual maltreatment. PTSD is the most common
psychiatric disorder associated with sexual violence exposure (life-
time prevalence 26.6% to 45.2%; Walsh et al., 2012) and, thus, the
current results are not surprising. Close to half of these exposures
in the current sample involved rape by a stranger, acquaintance, or
partner. The particularly violent and uncontrollable nature of sex-
ual assault from a nonrelated perpetrator, along with feelings of
shame, guilt, and betrayal that prevent disclosure and seeking of
support following such victimization, are mechanisms that have
been proposed to mediate its strong relation to PTSD (Walsh,

Galea, & Koenen, 2012). Future research is now needed to deter-
mine whether such mechanisms account for the differential rela-
tion of sexual maltreatment to PTSD in depression over other
forms of adverse childhood experiences.

Although nonrelative-perpetrated sexual maltreatment consis-
tently evidenced a stronger effect size in all models compared with
relative-perpetrated sexual maltreatment, the parameter estimates
did not differ significantly in any model. In previous studies,
including the National Comorbidity Study, chronic childhood sex-
ual abuse and victimization by a known perpetrator was associated
with significant odds of psychiatric outcomes than isolated inci-
dents or victimization by an unknown perpetrator; although in
these specific analyses the investigators did not statistically com-
pare the strength of the effects (Molnar, Buka, & Kessler, 2001).
In the current sample, most of the perpetrators, even in the
nonrelative-perpetrated group, were known to the participant (e.g.,
family friend, boyfriend, classmate; only 19 incidences involved
strangers). Within the known perpetrator group, incestuous sexual
abuse has been associated with significantly worse mental health
outcomes than nonincestuous abuse (Edwards, Freyd, Dube, Anda,
& Felitti, 2012). However, only 22 of the relative-perpetrated
incidences in the current sample involved relatives in the home,

Table 5
Parameter Estimates of Poisson Regression Model for Number of Depressive Episodes

Variable �2 B Wald IRR

Bootstrapped
p Bias-corrected CI95(B)

DV: Number of episodes 214.15��

Mother emotional maltreatment 0.20 44.50 1.22 0.001 0.08, 0.30
Father emotional maltreatment 0.02 0.79 1.03 0.75 �0.13, 0.17
Mother physical maltreatment 0.02 1.00 1.02 0.63 �0.07, 0.12
Father physical maltreatment �0.03 1.87 0.97 0.54 �0.13, 0.07
Relative sexual maltreatment 0.05 6.00 1.05 0.26 �0.05, 0.15
Nonrelative sexual maltreatment 0.14 73.65 1.15 0.001 0.06, 0.21

Note. DV � dependent variable; IRR � incidence risk ratio; CI95(B) � 95% confidence interval of B.
�� p � .001.

Table 6
Parameter Estimates of Logistic Regression Models for Anxiety Disorder and PTSD

Variable �2 B OR

Bootstrapped
p Bias-corrected CI95(B)

DV: Anxiety disorder 11.63†

Mother emotional maltreatment 0.04 1.04 0.75 �0.21, 0.29
Father emotional maltreatment 0.22 1.25 0.03 �0.007, 0.46
Mother physical maltreatment �0.09 0.92 0.40 �0.30, 0.11
Father physical maltreatment 0.07 1.07 0.42 �0.11, 0.25
Relative sexual maltreatment 0.04 1.04 0.65 �0.17, 0.24
Nonrelative sexual maltreatment 0.08 1.09 0.29 �0.07, 0.46

DV: PTSD 58.69��

Mother emotional maltreatment 0.07 1.07 0.76 �0.33, 0.44
Father emotional maltreatment 0.48 1.62 0.01 0.05, 0.93
Mother physical maltreatment 0.17 1.18 0.19 �0.08, 0.40
Father physical maltreatment 0.003 1.00 0.98 �0.31, 0.28
Relative sexual maltreatment 0.36 1.43 0.004 0.04, 0.67
Nonrelative sexual maltreatment 0.43 1.53 0.001 0.20, 0.68

Note. DV � dependent variable; PTSD � posttraumatic stress disorder; OR � odds ratio; CI95(B) � 95% confidence interval of B.
† p � .07. �� p � .001.

476 VALLATI ET AL.

and only 15 involved a parent. Therefore, although the current
results confirm the strong and general association of sexual mal-
treatment with a more severe and recurrent depression, and with
higher rates of trauma-related psychopathology, future studies that
include larger numbers of individuals with perpetrators at the
extremes (i.e., incestuous and stranger-perpetrated) may be re-
quired to uncover significant differential patterns of association.

The findings of the current study should be interpreted in light
of the following limitations. First, the design was cross-sectional
and, thus, relied on reports of maltreatment taken when partici-
pants were in their index episode of depression. This raises the
possibility that individuals with more severe manifestations of
MDD may have been more likely to recall their childhoods as
abusive regardless of their actual level of exposure. To address the
important concern of depressive bias, we used a rigorous contex-
tual interview with standardized ratings of maltreatment. The
CECA, in particular, addresses concerns of reporting bias by
focusing the interview on behavioral and contextual details of
childhood experience and employing independent raters who an-
chor their ratings to a large manual of standardized exemplars and
rating rules. No retrospective measure of childhood maltreatment
can provide a purely objective assessment, and, indeed, reliance
solely on objective reports (e.g., court documents) would not be
appropriate in the current design as epidemiological studies sug-
gest that close to two thirds of maltreatment cases go unreported,
resulting in a large number of false negatives (London, Bruck,
Ceci, & Shuman, 2005). The contextual interview approach to
retrospective assessment has recently been shown to be more
strongly related to reports of maltreatment taken at the time of the
abuse (either officially documented reports or self-report) than the
self-report checklist approach to retrospective assessment (Bald-
win et al., 2019), and the CECA, in particular, is considered the
gold standard in this area of maltreatment assessment. Neverthe-
less, prospective longitudinal studies are needed to definitively
rule out recall bias as an alternative explanation for the current
findings.

Second, all participants were volunteers from the community
based on their depression status. Our results, therefore, may not be
generalizable to epidemiological or patient samples of individuals
with MDD or to the population of individuals with a maltreatment
history. In particular, use of this sample precluded the investiga-
tion of very severe forms of material and sensory deprivation/
neglect, such as institutionalization, that have been associated by
Sheridan and McLaughlin (2014) with unique neurobiological and
pathological outcomes. Relatedly, an important area for future
research is to examine more complex models of the interactions
among forms of maltreatment. Although such moderation effects
were beyond the scope of the current investigation, they are
warranted in future research given that forms of maltreatment are
not independent and, thus, may very well exert joint influence on
the characteristics of MDD.

Finally, the effect sizes for all significant parameters were in the
small to medium range. This suggests that other, more proximal
variables likely drive the relations of maltreatment types to spe-
cific clinical outcomes. Therefore, a crucial next step for future
research is to examine mediators and moderators of the relation
between specific types of childhood maltreatment and the clinical
features of depression at multiple levels of analysis—neurobiolog-
ical, psychological, and sociocultural.

The current results are novel in showing that emotional and
nonrelative-perpetrated sexual maltreatment are significantly more
strongly associated with a greater lifetime history of depression
than physical maltreatment. Further, they provide preliminary ev-
idence that hostility, criticism, and rejection from the mother
relative to the father may represent specific risk for depression
versus trauma-related outcomes, respectively. A history of child-
hood maltreatment is widely regarded as one of the strongest risk
factors for MDD. Therefore, the development of targeted programs
aimed at preventing and intervening in MDD for those at greatest
risk has the potential to lower rates, and reducing the suffering,
associated with this devastating disorder.

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.018

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479CHILDHOOD MALTREATMENT AND DEPRESSION

http://dx.doi.org/10.1176/appi.ajp.2011.11020335

http://dx.doi.org/10.1016/j.jesp.2011.11.009

http://dx.doi.org/10.1371/journal.pmed.1001349

http://dx.doi.org/10.1016/j.cobeha.2017.09.008

http://dx.doi.org/10.1080/10926770903475976

http://dx.doi.org/10.1177/0963721416664341

http://dx.doi.org/10.1016/j.tics.2014.09.001

http://dx.doi.org/10.1016/j.psychres.2014.03.019

http://dx.doi.org/10.1111/1467-9868.00346

http://dx.doi.org/10.1002/jts.20092

http://dx.doi.org/10.1080/20445911.2017.1323907

http://dx.doi.org/10.1176/appi.ajp.2013.12070957

http://dx.doi.org/10.1016/j.jad.2012.09.011

http://dx.doi.org/10.1001/archgenpsychiatry.2012.132

http://dx.doi.org/10.1111/cpsp.12004

http://dx.doi.org/10.1016/j.chiabu.2015.11.018

Childhood Maltreatment and the Clinical Characteristics of Major Depressive Disorder in Adolesce …

Method
Participants
Measures
Diagnosis
Depression severity
Childhood maltreatment
Procedure
Data Analysis
Results
Preliminary Relations of Maltreatment Types to Demographic Characteristics
Relations of Childhood Maltreatment Types to Depression Characteristics
Depression severity
Number of depressive episodes
Anxiety disorder
Posttraumatic stress disorder

Discussion
References

18 NATIONALISM AND MINORITIES

People in different parts of the world still utter different sounds, but nowadays they
say more or less the same things everywhere.

— Ernest Gellner

Scarcely anyone who has used the methods of ethnography to identify and
describe ideologies anywhere in the world since the 1960s can have avoided
encountering expressions of nationalist ideology. The growth of nationalism
and nation-building has been, and still is, an important, spectacular and
highly consequential dimension of the worldwide processes of change
connected with colonialism and decolonisation. Nationalism is a kind of
ideology which exists almost everywhere in the world, although it assumes
very different forms and varies in significance. This does not mean that all
the citizens of any state know about, or for that matter support, nationalist
ideology – but it implies that nationalism is a cultural phenomenon of such
importance that both anthropology and other social sciences have, since the
1980s, seen it as a main priority to try to come to grips with it analytically.

NATIONALISM AND MODERNITY

In anthropology, nationalism is usually defined as an ideology which holds
that cultural boundaries should correspond to political boundaries; that is
to say, that the state ought to contain only people ‘of the same kind’ (Gellner
1983). All nationalisms promote, in one way or the other, the congruence
between state and the culture of citizens. While social theorists in the past
might regard nationalism as an ‘archaic survival’ from a remote past, which
would probably be superseded through modernisation and bureaucratisation
(for instance, Weber 1978 [1919]), it soon become clear that it is actually
a product of modernity. In fact, nationalism as we know it was developed in
both France and Germany around the time of the French Revolution: it has
a dual origin in the French Enlightenment and German Romanticism.

The parallel between the study of nationalism and that of ethnicity is obvious;
most nationalisms – some would say all, but that is a matter of definition – are
special cases of ethnic ideologies. Since most nationalist ideologies argue the
ancient nature of their nation, it has been widely held that this was also the
case with the ideology itself. This is not the case, and at this point it may be
useful to distinguish between tradition and traditionalism. Nationalism tends

289

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290 Small Places, Large Issues

to appear as a traditionalist ideology, glorifying a presumedly ancient cultural
tradition. This does not entail that it is ‘traditional’ or ‘ancient’ itself. The
example of Norwegian nationalism since the 1850s demonstrates this point.
At that time, Norway was in an enforced union with Sweden as a result of the
Napoleonic Wars, and a growing number of urban, educated Norwegians,
inspired by similar movements elsewhere in Europe, felt that they ought to
have their own state. Members of the cultural and political elite travelled to
remote valleys where they found popular traditions which seemed peculiarly
Norwegian; they brought them back to the cities, exhibited them and made
them appear as an expression of the Norwegian people and its ‘spirit’. Thus
a national symbolism was gradually developed, stressing dimensions of
Norwegian rural life that were seen as unique (not found in neighbouring
Sweden and Denmark, with which Norwegian nationhood was contrasted),
and this was used to establish the idea of the unique Norwegian nation. A
national historiography was founded during the same period, stressing the
continuity with the fearsome Vikings and the subsequent thirteenth century
Norse empire based in Nidaros (now Trondheim) and, moreover, introducing
a theory of migration making the Norwegian ethnic group appear unique,
while a national literature, national art, national music and a new national
language based on certain rural dialects – thereby markedly distinctive
from Danish – were created. This concerted effort was intended to give the
impression that Norway was really an old country with a unique cultural and
ethnic identity, and therefore deserved political independence.

The rural culture of Norway, in a reinterpreted form, provided an efficient
political weapon, not because it was statistically typical or because it was
inherently more ‘authentic’ than urban culture, but because it could be used to
express ethnic distinctiveness in relation to Danes and Swedes and because it
embodied the rural–urban solidarity characteristic of nationalism. According
to nationalist ideology, the important distinguishing lines between groups
follow national boundaries, and internal differentiation is therefore under-
communicated. Nationalism postulates that all members of society have a
shared culture, which was a radical point of view in societies which had
formerly been based on ascribed rank and feudal hierarchies.

The traditionalism which is expressed through nationalism is thus deeply
modern in character, and this is a main paradox of nationalist ideology.
The fact that the nationalists claim the Vikings were Norwegians does not
mean that the nationalists are Vikings. We now need to examine more
closely the relationship between nationalism and modernity, which has a
strong bearing on earlier discussions of social scale, technology and forms
of social integration.

NATIONALISM AND INDUSTRIAL SOCIETY

In Ernest Gellner’s influential book about nationalism (1983), the author
shows that European nationalism emerged as a response to industrialisation

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Nationalism and Minorities 291

and people’s disengagement from ‘primordialities’ like kin, religion and local
communities. Industrialisation entailed a greater geographical mobility, and
made people participate in social systems of a much larger scale than they had
known earlier. Kin ideology, feudalism and religion were no longer capable of
organising people efficiently. There was, in other words, a need for a cohesive
ideology in the large-scale societies evolving in Europe in the nineteenth
century, which both created social systems of enormous scale and inspired
demands for individual equality and civil rights. Nationalism was able to meet
such demands, and Gellner largely sees it as a functional replacement of older
ideologies and principles of social organisation.

A fundamental difference between kinship ideology and nationalism is the
fact that the latter postulates the existence of an abstract community; that is,
as a nationalist or patriot, one is loyal to a legislative system and a state which
ostensibly represents one’s ‘people’, not to individuals one knows personally.
The nation thus only exists if one is capable of imagining its existence – it
cannot be observed directly – and it is in this sense that Benedict Anderson
(2006 [1983]) has spoken of the nation as an imagined community. In his
account of nationalism, he attributes great importance to the development of
mass media, particularly the printed book. With print-capitalism, he argues,
an immense number of people are able to appropriate the same knowledge,
and this may take place without direct contact with the author. A standar-
disation of language and world-view on a huge scale thus becomes possible.
(The similarity between Anderson’s analysis of nationalism and Goody’s view
of literacy should be noted here.) The role of the state educational system in
nation-states is immensely important here. All English schoolchildren have
heard of Guy Fawkes, but few know why Pieter Stuyvesant is an important
person in Dutch history. In the Netherlands, the situation is reversed.

At a cultural level, print media and standardised education imply a certain
homogenisation of representations. At the level of social organisation,
it facilitates geographical mobility over a large area, since it gives people
in different areas roughly the same qualifications and thus makes them
replaceable in the labour market. Large-scale communication and cultural
standardisation or homogenisation are thus important features of nation-
building, which contribute to explaining how it can be that people identify
with such an abstract entity as a nation.

Both Gellner and Anderson emphasise the modern and abstract character of
the nation. The nation and nationalism here appear as tools of state power in
societies which would otherwise be threatened by fragmentation and anomie.
Nationalism is a functional ideology for the state in that it creates loyalty and
facilitates large-scale operations, and it is functional for the individual in that it
replaces obsolete foci for identification and socialisation, notably the family. It
is thus no mere cliché that the nation-state has taken over many of the former
functions of the family and the local community in modern societies, as an
institution representing, among other things, social control, socialisation and
group belonging. The nation may, further, be seen as a metaphoric kin group.

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292 Small Places, Large Issues

Kinship is fundamental to human organisation everywhere, and nationalism
tends to emerge in situations where kinship organisation has been weakened.
From having been members of lineages or villages, people also, and perhaps
more importantly, become citizens through processes of modernisation. The
nation-state offers both a feeling of security and a cultural identity, as well as
socialisation (through schooling) and career opportunities. It demands our
loyalty in roughly the same way as the family: people are willing to kill and
die for their relatives and their nation (if nationalism is a successful ideology),
but for few other groups. The nation-state, in other words, is able to mobilise
very strong passions among its members, and Anderson (2006) famously
remarked that nationalism has more in common with phenomena such as
religion and kinship than with ideologies like socialism and liberalism.

Some authors have argued that although nationalism is a modern
phenomenon, it is rooted in earlier ethnic communities or ‘ethnies’ (Smith
1986, 1991, 2008), but it would surely be misleading to claim that there
is an unbroken continuity from pre-modern communities to national ones.
As the Norwegian example shows, national dress and other symbols take on
a very different meaning in the modern context from that which they had
originally. Besides, it has been argued that the myths of origin giving nations
their ideological legitimation need not be ethnic; non-ethnic nations, not least
in the Americas, appear capable of creating a sense of patriotism without
referring to an imputed common ethnic origin (Eriksen 2004).

THE NATION-STATE

For a nation-state to exist, its leaders must simultaneously be able to legitimate
a particular power structure and sustain a popular belief in the ability of the
nation to satisfy certain basic needs in the population. A successful nationalism
implies, in most cases, an intrinsic connection between an ethnic ideology of
shared descent and a state apparatus. Let us briefly consider some of the char-
acteristics of the nation-state, seen as a mode of social organisation. It may
be relevant to compare it with other forms of social organisation described
earlier in this book: there are both similarities and differences between, say,
the French nation and the Dogon village.

Above all, the nation-state is based on nationalist ideology; that is the
doctrine that state boundaries should correspond with cultural boundaries.
Further, the nation-state has a monopoly on the legitimate use of violence, the
enforcement of law and order, and the collection of taxes. It has a bureaucratic
administration and written legislation which covers all citizens, and it has – at
least ideally – a uniform educational system and a shared labour market for
its people. Most nation-states have an official national language; some have
even banned the public use of minority languages.

In other societies too, the political authorities have monopolies on violence
and taxation. What is peculiar to the nation-state in this regard is the
enormous concentration of power it represents. If we compare a modern war

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Nationalism and Minorities 293

with a feud among the Yanomamö, we see the difference clearly. In the same
way as the abstract community of nationalism encompasses an incredible
number of people (usually many millions) compared to societies integrated
on the basis of kinship (among the Yanomamö, there is an upper limit of
a few hundred people), the modern state may in many cases be seen as an
enormous enlargement of other forms of social organisation. This does not
mean that the nation-state is ‘just like other kinds of society’, only bigger, but
we ought to be aware of the similarities between state and non-state forms of
organisation, not merely the differences. A distinction between contemporary
states and earlier ones may also be relevant, not least in the context of this
chapter. In Pluralism and the Politics of Difference (1998), Ralph Grillo shows
that ethnic plurality was generally seen as less problematic in earlier state
formations – from the Alur (Uganda) to the Aztecs and the Ottomans – than
it is in most contemporary nation-states. ‘Minority issues’ are therefore the
trueborn child of the modern state, where the ambitions to standardise and
unify, and the demands of participation, are greater than in other large-scale
political entities. Of course, not all citizens are complacent, loyal or even
directly affected by the state’s demands: it is an empirical question how and
to what extent state policies are being felt. Moreover, a paradox studied in
depth by Michael Herzfeld (2005) is the fact that people who criticise and
resist state intervention into their lives may at the same time, albeit in different
situations, be fervent nationalists: a distinction between informal nationalism
(from below) and formal nationalism (from above) might be clarifying here
(see Eriksen 1993b). The point is nevertheless that the state, with varying
degrees of efficiency, now takes on many of the tasks typically performed by
kin groups and village leaderships in traditional societies.

Multiculturalism and Anthropology
The growing importance of self-conscious constructions of cultural
identities, which is a global phenomenon, is evident in consumption
patterns, politics and the arts. In many countries, perhaps particularly
the rich ones with substantial immigrant populations, debates about
‘multiculturalism’ have highlighted several of these dimensions. Is
it meaningful, for example, to talk of ‘ethnic art’, and should it be
evaluated according to culturally specific criteria? Many feel that this
approach can lead to the justification of mediocre work in the name
of cultural pluralism, but ultimately not to the benefit of the artists
and their ‘communities’, because of the patronising attitude. On the
other hand, as Charles Taylor (1992, p. 67) remarks, to ‘approach, say,
a raga with the presumptions of value implicit in the well-tempered
clavier would be forever to miss the point’. An important debate in
recent social philosophy, which is relevant for this issue, opposes
communitarianism to liberalism. Communitarians like Michael Sandel



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294 Small Places, Large Issues

NATIONALISM AND ETHNICITY

The difference between nationalism and ethnicity is simple if we stick to the
level of commonly used definitions. A nationalist ideology may, following
common usage, be defined as an ethnic ideology which demands the right
to its own state on behalf of the ethnic group. In practice, the distinction is
less clear-cut.

and Alasdair MacIntyre (1981) hold that the community is prior
to the individual and favour a certain degree of relativism in value
judgements, while liberals like Richard Rorty (1991) warn against the
pitfalls of communitarianism (including fundamentalism) and defends
the undiluted rights of the individual. A ‘middle ground’ has been
defined by Will Kymlicka, who argues for cultural rights on individualist
grounds (Kymlicka 1995).

In the political field, related issues have brought about a focus on
the relationship between human rights and minority rights. Multi-
culturalism could be defined as a doctrine which holds that discrete
ethnic groups are entitled to the right to be culturally different from
the majority, just as the majority is entitled to its culture. However, as
many critics have pointed out, this kind of doctrine may serve to justify
systematic differential treatment of ethnic groups (as in apartheid),
and may indeed, even in its more benevolent forms, be at odds with
individual rights. On the one hand, then, every citizen is in theory
entitled to equal treatment from the state and greater society; on the
other hand, persons with different cultural backgrounds may also claim
the right to retain their cultural identity. When this cultural identity
entails, for example, corporeal punishment in child-raising and this
is unlawful, the conflict between the right to equality and the right
to difference becomes clear. Should groups have rights and not just
individuals, and if so, how can one prevent oppression and abuse owing
to internal power discrepancies in the group? Although anthropolo-
gists would be expected to play an important part in these discourses,
they have in general been reluctant to do so. Perhaps multiculturalism
is too close for comfort; after all, the very notion of multiculturalism
draws on a concept of culture developed in anthropology, but which
has today been abandoned by most anthropologists for being too rigid
and bounded (Clifford and Marcus 1986; James et al. 1997; Kuper
1999; T. Turner 1993).

The 1999 GDAT debate, an annual debate in anthropological theory
(see box in Chapter 6 for details), incidentally concerned the motion
‘The Right to Difference is a Fundamental Human Right’ (Wade
2000). The motion was eventually defeated by 43 votes against 30
(15 abstentions).

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Nationalism and Minorities 295

First, groups or categories of persons may be located analytically to a grey
zone between nationhood and ethnic identity. It is simply not true that ethnic
groups ‘have a shared will’. If some of their members wish independence,
while others are content to have linguistic and other rights within an existing
state, and yet others want to assimilate into the majority, the category in
question may appear both as a nation, as an ethnic group and as a category
of individuals, depending on who is speaking. A person may also switch
situationally between being a member of an ethnic minority and a member of
a nation. An Argentine migrant to France belongs to an ethnic minority while
in France, but belongs to a nation the moment she returns to her country
of birth.

Second, nationalism may sometimes express an ideology which represents,
and is supported by, a majority of ethnic groups. This is the case in Mauritius,
where no ethnic group openly wishes to make nation-building an ethnic
project on its own behalf. Nationalist ideology in such countries may be seen
as polyethnic or supra-ethnic in that it tries to reconcile ethnic differences,
but not abolish them, within a shared framework of a nation.

Third, we should keep in mind that everyday language and mass media
continuously mix up the concepts of nation and ethnic group; when, for
example, people speak of the ‘104 nations’ of the former Soviet Union, they
clearly refer to ethnic groups, a few of which are nations in the sense that
their leaders want to have states where they are dominant.

Nationalism and ethnicity are related phenomena, but there are many
ethnic groups which are not nations, and there are also nations which are
not ethnic groups – that is, polyethnic nations or countries which are not
founded on an ethnic principle. Naturally, most of the world’s countries are
as a matter of fact polyethnic, but many of them are dominated by one ethnic
group; the French in France, the English in Great Britain and so on. The model
of nationalism presented above, as well as models endorsed by nationalists,
rarely fits the territory. Notably, there is rarely, if ever, a perfect correspondence
between the state and the ‘cultural group’. This simple fact is the cause of
what, in the contemporary world, is spoken of as minority issues.

MINORITY AND MAJORITY

Two kinds of ethnicity studies which have placed a great emphasis on power
and power discrepancies are studies of labour migrants from poor to rich
countries, and studies of indigenous peoples. Both are concerned with the
relationship between minorities and majorities, where the majority – usually a
national group represented in a nation-state – is in several ways more powerful
than the minority.

An ethnic minority may be defined as a group which is politically
non-dominant, and which exists as an ethnic category. Although the term
‘minority’ usually refers to inferior numbers, in the professional literature
it denotes political submission. A great number of peoples in the world

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296 Small Places, Large Issues

may therefore be seen as minorities. Their relationship to the nation-state
nevertheless varies, as do the strategies of the nation-state towards these
minorities.

The term ‘minority’ is relative to both the scale and the form of organisation
in the total social system. As has been shown earlier, any delineation of a
social system is relative. This means that (1) minorities are created when the
compass of the social system increases, as when formerly tribal peoples become
integrated into nation-states (the Yanomamö were no minority before they
entered into a relationship with the state); (ii) minorities may often become
majorities if they are able to delimit the system in new ways (for example, by
setting up a new state, or by creating a looser political union); and (iii) ethnic
groups which are minorities in one place may become majorities in another.

The Sikhs make up less than 2 per cent of the total population of India;
in Indian Punjab, however, they comprise 65 per cent of the population. In
accordance with (2) above, some of their leaders are struggling to set up an
independent Sikh state, thereby transforming the group collectively from
minority to majority status. On the other hand, Hungarians in Transylvania
(Romania) and Jamaicans in Britain exemplify (3): they are a minority, but
their group is a majority elsewhere.

POWER ASYMMETRIES

So far in the discussion of ethnicity and nationalism, we have not emphasised
uneven or asymmetrical power relations between ethnic groups. Many classic
studies of ethnicity concentrate on the maintenance of ethnic boundaries and
negotiations over identity, without looking more closely at the ways in which
power disparities may be decisive for interethnic relationships. The famous
studies of ethnicity (or ‘tribalism’) in the Copperbelt, to mention one example,
rarely mentioned the wider context of colonial mining society, which defined
Africans as second-class citizens in relation to Europeans.

Stanley Tambiah (1989) has proposed a typology of contemporary societies
that differentiates them according to their ethnic composition (see Eriksen
2010 and Horowitz 1985 for alternative typologies of minority–majority
relationships):

1. Countries which are almost ethnically homogeneous (where the dominant
group has more than 90 per cent of the total population), such as Japan,
Iceland and Bangladesh.

2. Countries with a large ethnic majority (75–89 per cent of the population),
including Bhutan, Vietnam and Turkey.

3. Countries where the largest ethnic group makes up 50–75 per cent of the
population and where there are several minorities, for instance Sri Lanka,
Iran, Pakistan and Singapore.

4. Countries with two groups of roughly the same size, such as Guyana,
Trinidad & Tobago and Malaysia.

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Nationalism and Minorities 297

5. Truly plural countries composed of many ethnic groups where no one
of them is dominant; for example India, Mauritius, Nigeria and the
Philippines.

A problem with this kind of typology is that it lumps together countries
which are politically and culturally very different. Within each category
there are stable and unstable countries, parliamentary democracies and
military dictatorships, countries with good as well as bad records regarding
human rights and so on. Ethnically homogeneous Somalia was plunged into
a protracted civil war in the 1990s, while there is no threat to the territorial
integrity of neighbouring multi-ethnic Kenya. Eritrea’s secession from
Ethiopia in the early 1990s, moreover, was not an ethnic issue, as Eritrea’s
population is composed of about 12 ethnic groups, including both Christian
and Muslim groups. The 1998–2000 war between Eritrea and Ethiopia largely
involved Tigrinya speakers on both side of the border, many of them related

Non-ethnic Nations
Theories of nationalism have often been Eurocentric (Handler and Segal
1993; Gladney 1998) and, unsurprisingly, non-European countries
have often failed to fit the model. If by nationalism we mean the doctrine
of congruence between state and ethnic group, even the USA does not
seem to be a nation. In Central and South America, few see their own
country as essentially ethnically homogeneous; in Mexico, for example,
the notion of mestizaje (cultural and racial mixing) has become a symbol
of the Mexican nation. Africa presents a no less complex picture, with
scarcely a single ethnically homogeneous country, and large parts of
Asia are also ethnically very complex – not only in fact, but also at
the level of ideology (unlike in Europe, where the societies are often
polyethnic but the ideology of nationalism mono-ethnic). If the nation
of Tanzania is to be imagined by its citizens, therefore, it cannot be
imagined as a Chagga, Swahili or Nyakyusa nation (Tanzania has more
than 120 ethnolinguistic groups), but as a symbolic community which
exists at a higher segmentary level than the ethnic groups that make it
up. In such countries, national ideology must therefore be associated
with equal rights and civil society rather than with any particular
ethnic group. When it works, it may still have the ability to stir patriotic
emotions and create loyalty to the state.

Would these polyethnic imagined communities still be nations in
an analytical sense? That is a matter of definition. In my view, they
would (Eriksen 2004). It is certain, however, that if the concept of
nationalism is going to be cross-culturally valid, it cannot be restricted
to the European nations only: it will have to be refined to fit the global
territory better.

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298 Small Places, Large Issues

through kinship (Tronvoll 2009). Mauritius, a truly ethnically plural society,
is one of the most stable parliamentary democracies in the Third World. Ethnic
plurality as such cannot, in other words, account for violence and political
instability (Turton 1997; Schlee 2008).

However, if we add a distinction between ranked and unranked polyethnic
systems, it may be easier to understand why some such societies are unstable
and others are not. Typically, ethnic groups which are systematically deprived
of civil rights and career opportunities will tend to perceive the political order
as unjust. This applies only in societies where rights are in practice unevenly
distributed on the basis of ethnic membership, but this kind of situation
is far from uncommon. For now, we will restrict ourselves to considering
asymmetrical relationships between dominant ethnic groups which control
the state, and minorities.

SEGREGATION, ASSIMILATION AND INTEGRATION

Short of physical extermination (which has actually been quite common),
states may use one or several of three principal strategies in their dealings with
minorities. First, the state or the majority may opt for segregation. This means
that the minority group becomes physically separated from the majority, often
accompanied by the notion that the members of the minority are inferior. The
former South African ideology of apartheid promoted segregation, and many
North American cities are de facto segregated along ethnic lines.

Assimilation is also a possible outcome of contact between majority and
minority. If it happens on a large scale, it eventually leads to the disappearance
of the minority, which melts into the majority. In England, this happened to
the Norman upper class which ruled the country after the invasion in 1066.
After a few generations, the descendants of this group became English.

Assimilation may be enforced or chosen. In some cases, it is practically
impossible, if ethnic identity has a strong phenotypical component. In the US,
most immigrant groups have historically become assimilated; usually they lost
their mother-tongue after two generations and retained only a vague memory
of their country of origin. But this did not happen with the descendants of
the black slaves, since skin colour is an important criterion for social clas-
sification. Notwithstanding the election of Barack Obama in 2008, a black
American cannot become a ‘typical’, that is white, American in the same way
as the grandchild of a German immigrant may do. In these situations, where
assimilation becomes impossible, it may be useful to speak of entropy-resistant
traits (Gellner 1983): the distinguishing marks of the minority cannot be
removed, whether or not its members wish to do so.

Integration is the third ‘type’ of relationship between majority and minority.
It usually refers to participation in the shared institutions of society, combined
with the maintenance of group identity and some degree of cultural distinc-
tiveness. It represents a compromise between the two other main options.

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Nationalism and Minorities 299

An ethnically based division of labour is compatible with segregation as
well as integration, but only assimilation and certain forms of integration
are compatible with full political participation in greater society. Chosen
segregation may form the rationale for a nationalist movement, or it may be
an elite option chosen to keep valuable resources within the ethnic group,
but most segregated minorities are ‘second-class citizens’, whether they are
indigenous peoples or recent arrivals.

Most empirical cases of majority–minority relationships display a
combination of segregation, assimilation and integration. Assimilation
may well take place at an individual level, even if the chief tendency might
be segregation or ethnic incorporation. Despite the fact that the Sami of
northern Scandinavia have moved towards a stronger ethnic incorporation
and chosen segregation in recent decades, there are still individuals who
are being assimilated to a majority ethnic identity (Norwegian, Finnish or
Swedish, as the case may be).

In studies of majority–minority relationships, it is difficult to escape from
an analysis of power and power discrepancies. The majority not only possesses
the political power; it usually controls important parts of the economy and,
perhaps most importantly, defines the terms of discourse in society. Language,
codes of conduct and relevant skills are defined, and mastered, by the majority.
The majority defines the cultural framework relevant for life careers, and
thus has a surplus of symbolic capital over the minorities. For this reason,
many minority members may be disqualified in the labour market and other
contexts where their skills are not valued. A Somalian refugee in Germany
may be highly skilled if he speaks four languages, but he has no chance in
the German labour market if those languages happen to be Somali, Swahili,
Italian and Arabic.

MIGRATION

Migrants are a special kind of minority. They often lack citizenship in the host
country, and they often have their origin in a country where they belong to
a majority. In many cases, migrants are only temporarily settled in the host
country. Sociological and anthropological research on migration from poor
to rich countries has mainly concentrated on three topics: aspects of discrimi-
nation and disqualification on the part of the host population; strategies for
the maintenance of group identity; and the relationship between immigrant
culture and majority culture. Increasingly, this research has to account for
the transnational relationships between the community of origin and the
sociocultural environment in the host country, since most migrants maintain
significant ties to their place of origin (Georges 1990; Olwig 2007).

In a comparative study of two polyethnic neighbourhoods in London,
Sandra Wallman (1986) discovered important differences in the relationships
between majority and minorities. Bow in East London was characterised by
a strong polarisation and dichotomisation between people born in Britain

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300 Small Places, Large Issues

and immigrants, whereas ethnic relationships in Battersea, south London,
were much more relaxed and less socially important. Both areas were largely
populated by manual and lower white-collar workers, and they included
roughly the same proportions of immigrants from roughly the same places
of origin (Africa, Pakistan, India, the West Indies).

Wallman shows that the social networks of the two areas were constituted
in significantly different ways. In Bow, the same people interacted in many
different types of situation, and the different groups of which each individual
was a member overlapped a good deal. In Battersea, on the contrary, each
individual was a member of many different groups with different criteria for
membership. In Bow people worked and lived in the same area; in Battersea,
people tended to work in other parts of London. The British-born population in
Bow was extremely stable, while Battersea was characterised by a greater flux.

These and related factors, Wallman argues, have contributed to creating
fundamentally different types of ethnic relationships in the two areas. She
describes Bow as a closed homogeneous system and Battersea as an open
heterogeneous system (see Figure 18.1). In Battersea, unlike in Bow, there
were a great number of ‘gates’ and ‘gatekeepers’: there are, in other words,
many ways in which one may cross group boundaries as an immigrant. One
becomes a member of the local community the moment one moves in. But
in the closed environment of Bow, people have to have lived their entire lives
there in order to be accepted. In Bow, the ethnic boundaries are sharper than in
Battersea because the different social networks are so strongly overlapping that
an immigrant will have to cross several ‘gates’ or fences simultaneously in order
to become an accepted member of the locality. In practice, this is impossible.

Wallman’s study strengthens the idea, discussed elsewhere in this book, that
cross-cutting ties may have a mitigating effect on conflict. Other researchers,
rather than choosing a sociological approach, have focused on the personal

Heterogeneous/open type
(Battersea)

Homogeneous/closed type
(Bow)

Figure 18.1 Degrees of overlap between social sub-systems in Battersea and
Bow (Source: Wallman 1986, p. 241)

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Nationalism and Minorities 301

identity of migrants. Here, a common perspective amounts to the view that
migrants often ‘live in two worlds’, that they switch between different cultural
codes when they move between contexts. Whereas ethnic identity may be
undercommunicated in relationships with the host population, it may be
overcommunicated internally.

A different, more dynamic perspective would rather focus on social and
cultural change, indicating that a Pakistani identity in England necessarily
means something different from a Pakistani identity in Pakistan. In some
respects, such migrants are ‘Anglified’; in other respects, they may self-con-
sciously work to strengthen their cultural identity; in yet other respects, there
may be strong cultural values in the midst of the community which are difficult
to change even if some members of the group may want to – regarding, for
example, the tradition of arranged marriages. The field of migration may in
this way prove to be an interesting area for the study of cultural dynamics
and change (see also Chapter 19). It also highlights issues to do with the
negotiation of identity, discussed in the context of gender in Chapter 9.

‘THE FOURTH WORLD’

The term ‘indigenous peoples’ refers, in everyday language, to a non-dominant
population associated with a non-industrial mode of production. This does not
mean that members of indigenous peoples never take part in national politics
or work in factories, but merely that they are associated with a way of life
that renders them particularly vulnerable when faced with the trappings of
modernity and the nation-state. It can therefore be instructive to distinguish
indigenous peoples from migrants, who are fully integrated into the capitalist
system of production and consumption, and who make no territorial claims.

One cannot speak of ‘indigenous peoples’ in a value-free way. Technically
speaking, all inhabitants of the world are indigenous peoples of the planet.
The term is always used in a political context, usually in order to make specific
political claims.

Indigenous peoples all over the world are placed in a potentially conflictual
relationship to the nation-state – not just to one particular nation-state, but
to the state as an institution. Their political project frequently consists of
securing their survival as a culture-bearing group, but they rarely if ever wish
to found their own state. Many indigenous peoples have too few members, and
are insufficiently differentiated, for such an option to seem realistic.

The most common conflict between indigenous peoples and nation-states
concerns land rights. For this reason, issues regarding these groups and their
rights have become increasingly relevant – both in politics and in anthro-
pological research – as nation-states have progressively expanded their
territories and spheres of influence. As a reaction against this development,
the indigenous peoples of Greenland, Australia, New Zealand, Amazonas,
Southern Africa, the Andes, northern Scandinavia, North America and
elsewhere have organised themselves through global associations and

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302 Small Places, Large Issues

networks to protect their rights to their ancestral land and cultural traditions.
In other parts of the world, including Borneo, New Guinea and large parts
of Africa, such forms of organisation are still embryonic, partly because the
coming of the modern nation-state has taken place at a later stage.

Perhaps paradoxically, the cultural survival of indigenous peoples
necessitates important changes in their culture and social organisation. The
Sami of northern Norway provide a good example of this. Only after having
acquired literacy and a certain mastery of modern mass media and the
national political system was it possible for them to present their political case
in effective – and ultimately successful – ways. Generally, the global ‘Fourth
World’ movement is ‘Western’ and modern in every respect insofar as it is
based on human rights ideology, draws on modern mass media and is oriented
towards political bodies such as the United Nations. Peoples who retain their
traditions unaltered to a greater extent than, for instance, the pragmatic and
resourceful Sami stand a much smaller chance of survival in the long run,
since they have no effective strategy for handling their encounter with the
hegemonic, modern state. This odd paradox of indigenous politics relates to
a more general paradox of ethnicity and nationalism, namely that there is
no one-to-one relationship between culture and cultural identity, although
the two are connected. The distinction between tradition and traditionalism
may help to clarify this relationship.

ETHNIC REVITALISATION

That ‘reawakening’ of traditional culture in a modern context, which seems
necessary for indigenous peoples to survive, is often spoken of in more general
terms as ‘ethnic revitalisation’. The discovery, or invention, of the Norwegian
past described earlier is a classic example. The concept of revitalisation
literally means that cultural symbols and practices which have lain dormant
for a while regain their lost relevance. However, we have to be aware that a
revitalised culture is always very different from the original. Revitalisation
movements are traditionalist in that they seek to make tradition relevant in
a context which is not itself traditional, but modern. An instance of this kind
of process is the revitalisation of Hinduism in Trinidad (Klass 1991; Vertovec
1992; Khan 2004).

Several hundred thousand Indians arrived in Trinidad and other plantation
colonies following the abolition of slavery in 1839. Most of them never
returned to India, and in Trinidad people of Indian origin today make up
about 40 per cent of the total population of 1.2 million. For generations, the
Indians (or ‘East Indians’) were the poorest and in many ways most marginal
part of the population: they were illiterate, rural and culturally stigmatised by
the dominant European and Afro-Trinidadian groups. Since the Second World
War, they have increasingly taken part in the institutions of the Trinidadian
state: they slowly acquired adequate schooling, trade unions and political
representation; they became occupationally differentiated and experienced

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Nationalism and Minorities 303

a general rise in their standard of living. Since the 1970s, Hindu symbolism
and the Indian cultural heritage have played an increasingly important part
in the Indo-Trinidadian community. In the 1980s a Hindu weekly paper was
founded, and during the same period it became common for Indo-Trinidadians
to go to India on vacation. Religious attendance was increasing, and political
organisations aiming to strengthen the Indian identity were formed. Later,
Trinidadian Hindus pioneered the use of Internet resources to strengthen
their ties not only to India, but also to the larger Hindu diaspora.

This revitalisation may seem paradoxical. In many ways, the Indians
have been assimilated into Trinidadian society. All Indo-Trinidadians now
speak Trinidad English or Trinidadian Creole as their vernacular; the caste
system has lost most of its functions and categories, and research indicates
that the ‘East Indians’ have the same dreams and aspirations as the rest of
the population. Nevertheless, many of them are determined to retain and
strengthen their ethnic identity and Indian heritage.

This process is actually very common in ethnopolitical movements. Before
1960 the Indo-Trinidadians were socially and politically fragmented, many
were illiterate and they lacked a strong group identity. Only when they were
integrated into the modern institutions were they able to mobilise political
resources enabling them to function as a corporate group (or an ‘imagined
community’). Moreover, the concerted presentation of ethnic symbols –
itself dependent on a modern infrastructure – gives a meaningful focus to
the movement, in creating cohesion at the same time as responding to the
individual quest for dignity.

Cultural homogenisation within the modern nation-state may contribute
to explaining ethnic revitalisation in other ways as well. Since the Second
World War, Indo-Trinidadians have entered into more intensive relationships
with the rest of the Trinidadian population, which has led to the erasure or
challenging of ethnic boundaries in a number of fields. Many Indians have
therefore felt that their identity is threatened, and speak of ‘creolisation’ as
a danger to the integrity of the Indian ‘way of life’. A response to perceived
creolisation (or enforced dilution of cultural tradition) has been conscious
contrasting and overcommunication of distinctiveness. In general, we might
say that an ethnic identity becomes important the moment its carriers feel
that it is being threatened, or that one is being discriminated against on ethnic
grounds. Evidently, this is connected to the fact that ethnicity is created by
contact, not by isolation. It also adds substance to the claim that nationalism,
and identity politics more generally, are enhanced if not created by modernity,
since contacts between groups are intensified in modern settings with their
huge labour markets and rapid communication technologies.

It would not be correct to state that ethnicity occurs exclusively within
the framework of a modern state, but the ethnic dimension can be expressed
in unusually powerful ways there. Although ethnicity does not necessarily
relate to processes of modernisation, most ethnic studies deal with social and
cultural change. In Norway, there were not necessarily fewer Sami in 1940

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304 Small Places, Large Issues

than in 1990, but they were less visible, less culturally self-conscious and
lacked both a corporate organisation and an ‘imagined’ collective identity.
They did not deal directly with the state and had no minority status; Sami–
Norwegian ethnicity was still at the interpersonal level.

As for labour migrants and refugees, their very migration is a tangible
expression of modernisation, of links mediated by the state and capitalist
modes of production and consumption. Villages in Jamaica and Ghana
are becoming economically tied to cities in Britain, and in certain towns in
Pakistani Punjab, the labour market in Oslo is generally better known than
the labour market in Lahore.

Indigenous populations find themselves in a precarious position. In a
certain sense, they are wedged between the reservation and cultural genocide.
On the one hand, they may try to opt for isolation and build solid boundaries
about their customs and traditions. Such strategies have nearly always been
unsuccessful. On the other hand, they may try to promote their political
interests through established channels, and for this to be possible they – or
some of them – must go through a process of modernisation in order to learn
the rules of the relevant political game. This strategy may nevertheless be
successful, and in the next chapter it will be clear in what way.

THE GRAMMAR OF IDENTITY POLITICS

Whether nationalist, ethnic, religious or regional in nature, identity politics is
a glocal phenomenon: it is confined to a territory and a particular in-group, yet
it depends on a global discourse about culture and rights in order to succeed.
It can indeed be argued that identity politics in very different settings, in spite
of important differences, share a number of formal traits (Eriksen 2001)
making comparison viable. The late twentieth-century phenomenon of Hindu
nationalism (van der Veer 1994) can be invoked to illustrate this.

Although Hinduism is an old religion, politicised Hinduism is recent. The
idea of hindutva, or Hindu-ness, first appeared in the 1930s, but became a
mass phenomenon only in the late 1980s. In the 1990s, the Hindu nationalist
BJP (Bharatiya Janata Party or ‘the Party of the Indian People’) emerged as the
most influential party in India, amidst heated controversy over the nature of
the Indian state. Its many critics (among them Indian sociologists and anthro-
pologists) pointed out that India had from its inception been a secular state,
and that the idea of a Hindu state (which the BJP promoted) was disruptive
and harmful in a country with large Muslim, Christian and other minorities.

Also, the idea of a shared collective identity encompassing all Hindus is far
from obvious to most Indians; both caste and important linguistic distinctions
have divided Hindus as much as uniting them. Unlike egalitarian European
societies, Indian society has thrived on hierarchy and difference. Hindutva
nevertheless emphasises similarity.

Ideologically, hindutva is reminiscent of both European nationalisms and
identity politics elsewhere. Some of its features, which can be identified in

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Nationalism and Minorities 305

many other settings as well – from Fiji to Yugoslavia – are as follows. The
examples in brackets are largely illustrations.

• The external boundary is overcommunicated; internal differences are
undercommunicated. (In the case of hindutva, the significant others
are Muslims – both Indian and Pakistani.)

• History is interpreted in such a way as to make the in-group appear
as innocent victims. (The Mughal period, when India was ruled by
Muslims, is described as oppressive and humiliating for Hindus.)

• Cultural continuity and purity are overcommunicated. (Sanskrit epics
have been commercialised and popularised.)

• Mixing, change and foreign influence are undercommunicated. (This
is evident in the clothing, food and language – generally Hindi rather
than English – preferred by hindutva leaders.)

• Non-members of the in-group are demonised when it is deemed
necessary in order to strengthen internal cohesion. (The Ayodhya affair
and subsequent riots in 1992–93, when thousands of Muslims were
killed, showed this.)

• Conflicting loyalties and cross-cutting ties are strongly discouraged.
(At the interpersonal level, relationships between Muslims and Hindus
have become more strained.)

• Cultural heroes of the past (from poets to warriors) are reconceptu-
alised as modern nationalists. (The great poet Rabindranath Tagore,
to mention one example, is invoked virtually as a hindutva ideologist.)

These and related dimensions indicate that identity politics serves to
magnify certain social differences perceived as major, thereby minimising
other distinctions – in a sense, it could be said that it tries to transform a
world consisting of many small differences into a world consisting of a few
large ones, namely those pertaining to nationhood, ethnic identity, religion
or territorial belonging. Yet, as Frøystad (2005) and others have pointed out,
caste appears to be a social institution which is more deeply embedded in
Indian daily life than the Muslim/Hindu contrast. Even attempts to simplify
the world thus have to compete with rivalling simplifications!

IDENTITY THROUGH CONTRASTING

In the preceding discussion, nationalism and minority issues have been
discussed as modern phenomena. I have nevertheless pointed out that there
are parallels with other ideologies and forms of organisation, which are more
typical of the societies traditionally studied by anthropologists. One parallel
with non-modern societies which deserves to be mentioned concerns the
production of identification through contrast. The Iatmul of coastal New
Guinea, studied by Bateson (1958 [1936]), recounted a myth of origin which
expresses a line of reasoning reminiscent of the white North American stig-

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306 Small Places, Large Issues

matisation of black and Indian citizens, and which suggests that ethnicity is
not a mere tool of dominance but expresses a need for order, classification and
boundaries. In the earliest of times, according to the myth, there was on the
shore an enormous crocodile, Kavwokmali, which flapped its huge tail, front
legs and hind legs so that soil and water were continuously muddled together
in an unpalatable mixture. Everything was mud: there existed neither land
nor water. The great culture hero Kevembuangga then came along, killing
the crocodile with his spear. The mud sank, and the distinction between land
and water was a reality. Boundaries, outlines, clear distinctions appeared for
the first time.

This myth, not dissimilar to the Judeo-Christian myth of origin described on
the first pages of Genesis, exemplifies the social production of distinctions and
classification – differences that make a difference. The production of ethnic
distinctions may be regarded as a special case of this general phenomenon,
which has been discussed in Chapter 15. Perhaps the fact of ethnic conflict
and ethnic discrimination is better analysed not as a result of ethnicity but
rather of unjust social arrangements. Perhaps when we speak of the tragedy
of nationalist war, the problem is war and not nationalism.

Finally, we should keep in mind that neither ethnic groups nor nations are
eternal. They appear, they flourish, are transformed, and eventually vanish.
Since history is always written by the victors, it is easy to forget that for every
successful nationalism there are perhaps ten or more unsuccessful ones.
The members of such potential nations, or their descendants, were either
exterminated or assimilated in the long run.

SUGGESTIONS FOR FURTHER READING

Benedict Anderson: Imagined Communities: An Inquiry into the Origins and Spread of
Nationalism, 2nd edn. London: Verso 1991.

Ernest Gellner: Nations and Nationalism. Oxford: Blackwell 1983.
A.D. Smith: The Cultural Foundations of Nations: Hierarchy, Covenant and Republic. Oxford:

Blackwell 2008.

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Week 8 Learning Resources APA Citations x
Week 8 Learning Resources APA Citations

Borofsky, R. (2018). Public anthropology. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/public-anthropology/

Careers in anthropology – Advance your career. (n.d.). American Anthropological Association. https://www.americananthro.org/AdvanceYourCareer/Content.aspx?ItemNumber=1783&RDtoken=17085&userID=

Cochrane, L. (2018). Seeing like an anthropologist: Anthropology in practice. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/seeing-like-an-anthropologist-anthropology-in-practice/

Henninger-Rener, S. (2018). Health and medicine. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/health-and-medicine/

Palmer, C. (2018). Culture and sustainability: Environmental anthropology in the anthropocene. In N. Brown, L. T. Gonzalez, & T. McIlwraith (Eds.), Perspectives: An open invitation to cultural anthropology (2nd ed.). Press Books. https://perspectives.pressbooks.com/chapter/culture-and-sustainability-environmental-anthropology-in-the-anthropocene/

Sections, journals & dues. (n.d.). American Anthropological Association. https://www.americananthro.org/ParticipateAndAdvocate/SJDList.aspx?navItemNumber=593

Seeing_Like_an_Anthropologist

Perspectives: An Open
Invitation to Cultural

Anthropology
Edited by Nina Brown, Laura Tubelle de González, and

Thomas McIlwraith

2017 American Anthropological Association

American Anthropological Association
2300 Clarendon Blvd, Suite 1301
Arlington, VA 22201

ISBN: 978-1-931303-55-2

http://www.perspectivesanthro.org

This book is a project of the Society for Anthropology in Community Colleges
(SACC) http://sacc.americananthro.org/ and our parent organization, the American
Anthropological Association (AAA). Please refer to the website for a complete table
of contents and more information about the book.

Perspectives: An Open Invitation to Cultural Anthropology
http://www.perspectivesanthro.org/ 1

What does it mean to see and hear what others do not
see and hear and how can that unique information be
practically applied? The lack of a simple answer is fitting
to anthropology because the work of anthropologists of-
ten demonstrates that simplistic explanations are, at best,
only part of the complex stories of human culture. In this
chapter, I provide examples of how the ability to see and
hear is applied in practice and how these skills add value
in a socio-cultural anthropology setting associated with
international development. In particular, I shed light on
the potential challenges of practicing anthropology within
non-governmental organizations. Given the ethic of confi-
dentiality in anthropology, I omit details about the country,
organization, and ethnic groups as much as possible and
instead focus on the processes involved.

Although an education in anthropology stresses the im-
portance of confidentiality and the potentially dire conse-
quences of drawing attention to individuals and commu-
nities, it probably does not truly sink in until you conduct
your first fieldwork and “subjects” turn into human beings
with names, families, and feelings. One of the greatest eth-
ical challenges anthropologists face in writing about indi-
viduals and communities is the additional attention drawn
to them when the intention of the anthropologist is to
highlight a concern that extends beyond specific individuals
and communities and can thus have negative consequences.
Take, for example, an assessment I conducted of a national
safety net program that took place in a limited number of
communities.1 If the individuals and communities partici-
pating had been explicitly identified or could be identified,
they may have experienced negative political consequences
such as a loss of government-provided social services or their
jobs. Instead, the anonymity of the individuals and com-
munities was protected, and the concerns and challenges
were identified in a way that protected those who graciously
and generously contributed their time and ideas to the re-
search process. Complete anonymity is not always desirable,
needed, or possible but is always an important consider-
ation for anthropologists.

Seeing Like an Anthropologist:
Anthropology in Practice
Logan Cochrane, Vanier Scholar, University of British Columbia
logan.cochrane@gmail.com
http://www.logancochrane.com

LEARNING OBJECTIVES
• Identify ways in which “seeing like

an anthropologist” differs from the
approach to local cultures used by
international development agencies.

• Explain why “harmful traditional
practices” are prioritized for change
by development agencies and
describe how negative attitudes
toward these practices can be
examples of “bad for them, okay for
us.”

• Assess the reasons why
anthropological perspectives and
techniques tend to have a limited
impact on the design or goals of
international development projects.

mailto:logan.cochrane@gmail.com

http://www.logancochrane.com

Perspectives: An Open Invitation to Cultural Anthropology2

Throughout the last ten years, I have worked for non-governmental organizations—about five
years in Eastern Africa and shorter periods in Asia and the Middle East—as a volunteer, employee,
and consultant with community-based groups and national and international organizations. In this
chapter, I explore one of those experiences to convey a sense of what “seeing like an anthropologist”
means by analyzing an effort to eliminate food taboos by a nongovernmental international devel-
opment organization. This chapter was inspired by the work of political scientist and anthropologist
James C. Scott, particularly his Seeing Like a State (1998). I shift the focus inward onto anthropology
as a practice and a way of seeing.2

ANTHROPOLOGY AND DEVELOPMENT

Socio-cultural anthropology is best understood by its primary approach to data collection: par-
ticipant observation. This key component of ethnographic research involves long-term engagement,
living with and learning from a cultural community different from one’s own. In listening, learning
about, and seeing the world from the perspectives of others, anthropologists draw on the idea of cul-
tural relativism. This is in contrast to ethnocentrism, the belief that one’s own culture, cultural values,
and societal organization are true, right, and proper and that others’ are erroneous to some degree.
Cultural relativism posits that cultural practices and ideas must be understood within their contexts.

In the past, some anthropologists participated in the “development” activities of colonial gov-
ernments, and individual anthropologists and the discipline as a whole were rightly criticized for
their roles in the injustices that resulted. While working in Afghanistan in 2013, I encountered
anthropologists who were engaged in activities in the name of “development” that could be defined
as neo-colonial in that they supported militaries by analyzing cultural communities with the goal of
finding ways to weaken them and foster unequal and unfair relationships (cultural imperialism).
Anthropological engagement is not always benevolent or neutral. As a result, anthropologists are en-
couraged to engage in self-reflection—to examine their roles, engagements, practices, and objectives
critically, known as reflexivity.

Varying degrees of criticism of the nature, objectives, and embedded assumptions of international
development continue. Some have called on international development practitioners to significantly
reform their activities to make them more effective, while others have expressed more radical criti-
cisms, including the view that provision of aid causes greater impoverishment and should end.3 It is
essential when deconstructing development, as a concept and an activity, to ask why, when, how, and
for whom the development is intended and who it excludes. It also requires identifying the power
dynamics and motivations involved. Anthropological tools and ways of seeing are important means
by which to answer these questions.4

“HARMFUL TRADITIONAL PRACTICES”

My interaction with the project discussed in this chapter was limited in duration and I had specific
tasks related to program evaluation and impact assessment. I interacted with management staff based
in the international head office as well as the national head office, who provided me with background
information about the region and clarified expectations before visiting the project area. The project
itself was not primarily geared toward ending “harmful traditional practices,” but included a compo-
nent related to addressing gender inequality and practices that negatively impact women. Reflecting

Seeing Like an Anthropologist: Anthropology in Practice 3

back on those discussions, it appears that staff and donors who were located furthest from the area
of the project had the greatest interest in these “harmful traditional practices.” Based on their em-
phasis, it is clear that foreign and exotic practices had an appeal that basic and shared needs did not.
For example, those who were more distanced from the people the project sought to support were
particularly interested in “female genital mutilation,” exchange marriages, and seemingly irrational
and bizarre food taboos.

On the other hand, within almost every community in the project area, both men and women
were primarily concerned about the lack of clean drinking water and healthcare options. Unfortu-
nately, these concerns attracted little attention from outsiders.5 In fact, many governmental agencies
funding international development have explicitly restricted their funding such that water infra-
structure is not an allowable project expense, including the governmental donor for the project in
which I was involved. The reason for this is rarely explicitly stated, however informal discussions with
development agency personnel cite high costs and sustainability as concerns. Abu-Lughod’s (2013)
research on western perceptions of Muslim women, and broadly on conceptualizing “others” and
their needs, provides insight into how prioritization of needs often takes place based upon assump-
tions, not reality.

“Harmful traditional practices” are an odd collection of practices that range from tattooing
and scarification to exchange marriages, forced marriages and marriages wherein a woman who is
widowed becomes the wife of her deceased husband’s brother. “Harmful traditional practices” also
include acts typically considered criminal activity throughout much of the world, such as abduction
and unlawful confinement. A national committee in Ethiopia, for example, listed 162 “harmful
traditional practices.”6 While many of these practices are illegal and generally agreed to be abuses
of human rights, some have parallel practices that are legal in the countries in which international
organizations are based, such as tattooing and scarification. Numerous examples of “bad for them,
okay for us” could be made. Each practice, its context, laws, and discourse requires contextualization
beyond the scope of this chapter. However, useful examples of deconstructions of one frequently
discussed practice, female genital mutilation, have been made by Russell-Robinson (1997), James
(1998), Obermeyer (1999), Ahmadu and Shweder (2009) and Londono (2009).

The project staff identified a number of “harmful traditional practices” they believed ought to be
stopped; however, I will only explore one of them: a collection of food taboos that were believed to
negatively affect the nutrition of women. In particular, there was a focus on one specific food taboo:
the restriction of women from eating eggs, which was the only food taboo mentioned in every report
provided by the organization.

I learned from the project proposal that there were “cultural taboos” forbidding women from
eating eggs and milk.7 To address this, the project would improve their access and provide training
on the nutritional value of these products. An initial assessment report stated that this taboo was
not only about prohibiting the consumption of eggs, but also poultry. However, it later became
clear that the restriction was only on eating eggs and meat from a specific breed of chicken that was
raised in a woman’s own home or in the home of her in-laws. The organization advocated that this
practice was negatively affecting women and infants because sources of already limited nutrition were
being restricted, particularly an important source of vitamin A, which is a common micronutrient
deficiency amongst the population. While eggs were a primary focus, other internal organizational
reports provided different information: women and children also did not eat goat meat, animals that
had been hunted, or any dairy products.

Perspectives: An Open Invitation to Cultural Anthropology4

The consumption of these products was believed to cause illness and bring about the death of an
in-law, hence the prohibition. Several years into the project it was reported that a significant change
in child nutrition had occurred and the report suggested that training and education programs dis-
couraging food taboos were the reason for this shift. A detailed gender report, conducted halfway
through the project, suggested that women and girls were still not generally allowed to eat chicken
meat and eggs, but provided some case studies of positive change. This particular report pointed to
the mother-in-law as the person who instituted the prohibition of chicken meat and eggs, while most
reports simply said the prohibition was “cultural” amongst this ethnic group or due to community
misconceptions. After five years of work, the project continued to actively engage in activities aiming
at addressing the “misconceptions” and “traditional practices” of not eating eggs or drinking milk.

One report, finalized a few years into the project, mentioned significant resistance to project activ-
ities encouraging the consumption of eggs and chicken meat. The “harmful traditional practice” was
described as a “serious taboo,” and a “deeply rooted belief.” This report referenced another organiza-
tion that was working to “prove the taboo is wrong” and had fostered remarkable change. Meeting
with management staff in the national head office, I heard the same general story: there are cultural
taboos forbidding women and girls from eating some foods, and specifically eggs. Staff permanently
based in the project area repeated this information.

However, throughout the years of the project very little was understood about this particular prac-
tice. The food taboo was identified and a few potential, sometimes conflicting, reasons were given.
No one appeared to have taken the time to understand why these food taboos existed. When I later
explored this question, a staff member who had lived and worked within the region for almost two
decades remarked, “I have not had a chance to know about this.” This is one of the challenges anthro-
pologists face in working within non-governmental organizations: often the difficulties communities
face are assumed to be a result of ignorance and the “solution” is presented as a straightforward,
often technical, activity such as education. I believe the lack of understanding of these practices was
not due to insurmountable barriers, but a lack of inquiry into the “why,” “how,” “when,” and other
questions that make cultural practices understandable. The ability to ask these kinds of questions,
I argue, is a skill built into the anthropological way of seeing. For those familiar with “schemes to
improve the human condition,” as Scott put it, the lack of interest in asking questions would not be
surprising. Organizations tend to identify a problem, propose a solution, and plan evidence-based
activities to achieve an objective. For many in the international development sector, finding out why
these taboos exist is not particularly important. Rather they believe it is most important to stop those
practices deemed (by them) to be harmful.

WE NEVER ASKED ABOUT IT BEFORE

The historian Eugen Weber wrote that “when one looks for different things, one sees different
things.”8 He was referring to seeing within a text; I believe the same applies to other kinds of obser-
vation. Anthropologists fundamentally view the world through a unique lens, and their ability to see
what others do not is fostered through anthropological methodologies, approaches, and ideas. The
physical reality is the same; the lens is different. Likewise, professionals in non-governmental orga-
nizations—management staff, economists, medical professionals, and development experts—bring
their particular training, their lenses, to the problems, often focusing on different kinds of informa-
tion they respectively view as important. In other words, our individual perspectives alter what we
see.

Seeing Like an Anthropologist: Anthropology in Practice 5

The ethical challenge for anthropologists working in international development is that often the
donors, organizations and projects operate without detailed sociocultural information. As a result,
many anthropologists end up advocating for significant shifts in how the sector operates. For exam-
ple, in designing a project, the proposed activities are often outlined before the baseline assessments
of community needs are conducted. When the project is approved, and budget is set, it is difficult
to completely adjust the focus and plan based on new knowledge of community needs. Anthropolo-
gists working on these projects often find themselves in the challenging space of advocating for new
approaches, such as funding structures based on needs, rather than donor priorities, and flexibility in
programming as opposed to carrying out the set activities that are outlined in program plans.

In the case of the food taboos identified within this development project, diverse ways of seeing
were evident in the reports, in which medical perspectives focused on the impacts of the nutritional
content of the foods, gender specialists were most concerned with the abuse of women’s rights,
planners identified how behavior changes could occur and be integrated into the project using evi-
dence-based measures, and economists paid attention to the potential income women could generate
by producing poultry and selling eggs. Despite the passing of years and even the identification of
some strong resistance by people in the communities, the food taboos were consistently presented as
cultural issues or misconceptions that best practices and evidence-based behavior-change approaches
could eliminate. The plan was to “raise awareness,” hold “community-based dialogues,” “facilitate
exchange visits” with communities in which such taboos were not practiced, and provide nutritional
education. On paper, the plan sounded good. The diverse activities would reinforce the message of
behavior change with each offering unique insight and thus having a compounding effect in achiev-
ing the desired objective. The activities had previously been shown to be successful in a range of
settings. For the project staff, all required information appeared to have been gathered.

My work began with spending time with the people in their communities and asking them about
the food taboos—what they actually were and why they existed—and the community members
provided detailed and insightful information. When I talked to the field staff about it, they reported
that they had never asked the people in the communities those questions. That might sound like a
case of neglect, but I view it is the logical outcome of one way of seeing. When a problematic prac-
tice has been identified and the organization has experience with activities that have changed such
behavior, why do the details matter? From that perspective, the tedious task of collecting such data
would waste valuable resources, time, and effort. It is important, at this juncture, to shed some light
on the systemic nature of seeing from technical perspectives of this sort, which are common in the
organizational cultures of international development programs and their staff members. It is not lim-
ited to international development workers—national and local organizations often present the same
narratives about “bad” cultural taboos that can be eliminated by providing education about nutrition
and empowering women.

SEEING LIKE AN ANTHROPOLOGIST

When I started my work in the program, I had no previous experience with the ethnic group that
practiced the food taboos and had never been in the region. I was sent to visit a number of com-
munities as part of an assessment unrelated to food taboos and to conduct gender-separated focus
group discussions and individual interviews. In the first community I visited, the adult men made no
mention of food taboos but the women did, and what they said was at odds with the project reports.
They said that the restrictions applied only to adult married women and were, as one of the official

Perspectives: An Open Invitation to Cultural Anthropology6

reports had noted, limited to a specific local breed of chicken raised in specific households. I made
note of the comments and went on with my tasks. In the second community, I interviewed religious
leaders from two Christian sects who also mentioned the food taboos, describing them as examples
of common practices of witchcraft. In the third and fourth communities, I had lengthy discussions
exploring the context that no one had asked about until then: What in fact were the food taboos?
Why did the taboos exist? What reinforced them as an ongoing practice? How did people view the
practices and what were the consequences of not following them? The staff members who had been
working with the communities were amazed at the valuable information gathered by simply asking
the questions.

Community members made a number of important clarifications, some of which aligned with
what was presented in reports and some did not. The details of these taboos were not uniform in all
communities, however they shared some trends. For example, once a woman married a number of
restrictions began, which included the prohibition of eating eggs and chicken meat, although only
those that were produced from local breeds of chicken and only those raised within her household or
the household of her in-laws. The restrictions did not apply to children or unmarried girls, nor did
they apply to other breeds of chickens. Additionally, women could eat eggs and chicken meat as long
as it was from a different source, such as eggs from a neighbor’s chicken. In some communities, this
also applied to the meat of hunted animals and milk. Women who did consume the prohibited prod-
ucts were believed to suffer from illnesses, such as swelling and itching, or even to cause the death of
one of their in-laws. One project activity instructed women to bring the eggs they were forbidden to
eat to the project staff, who then cooked the eggs and told the women to eat. The response of some
women was outright refusal, some ate and then induced vomiting, while others followed the instruc-
tions and ate without strong objection. Reactions such as these suggested that there was more to the
prohibition than a simple misconception.

I WILL NOT EAT IT UNTIL I DIE

Elders in the communities explained that food taboos were one of a series of interconnected re-
strictions on behaviors, some identified by the project as harmful but not connected to the food ta-
boos. In addition to food taboos, the restrictions included limitations on what women can touch and
places they could enter while menstruating, a prohibition against a wife eating from the first harvest
of the season until after her husband does, and rules preventing a wife from drinking from a newly
prepared batch of alcoholic drink until after her husband does. Project workers had identified many
of these practices, but understood them to be isolated from each other as separate traditions. The
elders’ view of the practices as linked suggested that they needed to be understood as manifestations
of something larger.

I found that the communities’ narratives differed but the information and specific rules were con-
sistent. The food taboos were, in fact, a small part of a detailed belief system that influenced many
components of everyday life. There had been, perhaps two generations ago, a respected leader from
their ethnic group who had supernatural traits. His name was Gumzanjela, and he guided the com-
munity and held a role akin to religious leadership. Although Gumzanjela had passed on, he contin-
ued to be present in the community. His presence, described as his spirit, influenced what happened,
could bring about illness, and could be called on when seeking cures. Some believed that Gumzanjela
was a person; others believed that he had always been a supernatural being. Regardless, belief in
Gumzanjela was a serious matter; people believed in him, believed his regulations were true, and

Seeing Like an Anthropologist: Anthropology in Practice 7

had witnessed repercussions of failing to follow them. Gumzanjela had established the food taboos
and restrictions for women. One of the many stories told about him was that his first child was born
holding a leaf of a specific plant that was thereafter used as a cure for spiritual illnesses. Treatment of
illness was a common theme in recollections of Gumzanjela and was a primary reason people contin-
ued to seek his help. Disobeying Gumzanjela was said to result in curses, sometimes on the one who
violated a rule and other times on a relative such as the in-laws cited in the food taboos. The curses
ranged from relatively minor ailments such as severe itching or swelling to the death of an in-law.

In addition to prohibiting a number of behaviors for women, Gumzanjela had imparted specific
directions for people to follow, often built on his teachings, that were delivered via spiritual mediums
in the community who communicated with Gumzanjela. For example, Gumzanjela had prescribed
a cure that involved cutting off the claw of a chicken and placing it in the belly button of the person
needing treatment. The claw was left there for one week, and the person could not bathe during that
time. At the end of the week, the claw was removed and the person bathed. Only the person being
treated could eat the chicken from which the cutting was taken.

In each community, there were well-known practitioner spirit-mediums, both male and female,
to whom people go to connect with Gumzanjela. They sought various forms of support or requested
that curses be placed on someone. The seeker could be given specific instructions to do certain
things or to refrain from doing certain things. Payments and sacrifices were sometimes required,
and occasionally Gumzanjela called for lengthy spiritual events during the night in which rites were
performed and/or sacrifices were made.

One of the project reports had referred to the food taboos as being deeply rooted and, in context,
it is easy to understand why that was the case. The specific food taboos were components of a much
larger belief system; they were integral activities required by the communities’ religious traditions
and thus taken very seriously. They were, as one member of the community noted, part of the “law
of Gumzanjela.”

A brief analogy demonstrates the gravity of this point. Imagine that the people in the project
communities were followers of Judaism or Islam, religions that prohibit consumption of a number
of foods, including pork.9 An international development organization and its external staff members
might identify a protein deficiency that could be resolved by people consuming pork and view the
taboo against it as a harmful traditional practice that should be eliminated through education about
its nutritional value. Additionally, disadvantaged members of society could be encouraged to raise
and sell pigs to generate income. Because Islam and Judaism are major recognized religions with
millions of followers, it might seem absurd to try to convince them to eat pork based on nutritional
and economic grounds. But the law of Gumzanjela is also a belief system and is as important to the
communities in the project as Islam and Judaism are to their followers. The project had failed to
recognize that the food taboos were part of a comprehensive belief system and that the organization
had made demands that directly confronted culturally important beliefs and values. As a result, the
project activities were viewed as an affront to their religious traditions and to the righteous, respected
man from whom the laws had come and his living spirit.

I asked a group of men if a person could continue to believe in Gumzanjela and not practice the
food taboo regarding chicken and eggs. No, they said, it was not possible. They added forcefully,
“I believe in Gumzanjela. I have seen the effects; no cure works except from Gumzanjela.” They
explained that there “is no cure from the medical professionals; only Gumzanjela can cure these
illnesses.” Women thoroughly embraced these beliefs as well. Several years into the project, for ex-
ample, a woman stated that she would “not eat it [the eggs] until I die.” Her response reflected the

Perspectives: An Open Invitation to Cultural Anthropology8

strength of her personal beliefs despite the project’s efforts. The majority of the community members
interviewed agreed that belief in Gumzanjela was correct and that they must follow the system set
out. Gumzanjela was present in their lives and in their homes and affected their lives daily. They
experienced it and knew it to be true.

Some members of the community had “left Gumzanjela” and practiced a different faith, either
Christianity or Islam. A primary reason for their leaving Gumzanjela and abandoning the food ta-
boos, they explained, was the theology of their new faith. The women ate eggs, disregarded the
menstruation rules, and sought medical help from local clinics rather than cures from spiritual prac-
titioners. Abandoning the taboos required abandoning the greater belief system, a religious conver-
sion either to a new theology or to a rejection of faith (at least theoretically; I did not encounter any
community members who rejected faith altogether).

AN ISOLATED CASE?

Is this particular project unique or is the narrow vision of practitioners common in international
development? Another project in which I was involved was run by an agricultural organization that
was promoting changes in planting methodologies aimed at increasing yields. The farmers recognized
that the new planting method increased yields but did not adopt it. A primary reason for that failure
was a different way of thinking about what is important in an agricultural livelihood—the organi-
zation was promoting short-term gains and the farmers were prioritizing long-term sustainability of
the soil. Another international organization and its donors were confident that child malnutrition in
a region was the product of lack of knowledge about the nutritional value of consuming a diversity
of foods to reduce micronutrient deficiencies, and they developed a series of educational projects to
address the problem. But after spending time with members of the community, they realized that a
lack of diversity in their diets was due largely to having few options, primarily because of poverty, and
that the malnutrition was associated with seasonal food shortages and could not be alleviated through
education. The activities of these projects appeared beneficial, but did not address the actual prob-
lems; instead, they were designed based on assumptions about both the problems and the solutions
and failed to value contextualized, ethnographic information.

Technical approaches too often exclude the socio-political context in which they are applied and,
consequently, entirely miss the politicized nature of the project and its activities. A vocational train-
ing effort I worked with in the Middle East, for example, failed, not because the need for education
was misunderstood, but because the socio-political context in which it took place was neglected;
the poor quality of existing educational systems was not addressed because improving the quality
of the education provided was not an objective. Similarly, in the evaluation of the social safety net
mentioned at the outset, the political nature of the implementation of the project was not adequately
recognized by the international funding agencies.10 Thus, the experience explored in this chapter is
not uncommon, and it is clear that the anthropological way of seeing allows broader issues to come
into view—cultural, social, and political—which can then be incorporated into the project goals and
activities. These are areas that relatively technical approaches and evaluations tend to miss.

REFLECTIONS

What, then, do socio-cultural anthropologists do? There is no single answer to this question.
There are, however, skills that anthropologists acquire that unveil unique ways of seeing and listening

Seeing Like an Anthropologist: Anthropology in Practice 9

that can be applied to many different settings. Some anthropologists use these skills to facilitate the
creation of policies that are more inclusive and multicultural, some engage with poorly understood
subcultures, and others enhance the effectiveness of marketing of consumer goods. This chapter illus-
trates how I used the anthropological way of seeing to contextualize development actions, actors, and
the people for whom the “development” was being done and explores the ethical challenges faced by
anthropologists when working in the international development sector and within non-governmen-
tal organizations.

In general, I have found that many people working in international development organizations
have not yet recognized the value of asking people why they do what they do. From the anthropol-
ogist’s point of view, understanding why a practice occurs is not merely an act of inquiry; it is also
a means of demonstrating respect for people and their knowledge and taking time to listen, learn,
and see. The typical approach of development practitioners implicitly and explicitly conveys a lack of
respect for the culture, values, and ideas of the people the projects seek to support.

The respect inherent to the anthropologist’s view is based on cultural relativity, which guides the
inquiry process. Judgment is withheld to understand the relative context of the practices in question.
Far too frequently staff of development organizations judge based on their assumptions and do not
see value in investigating further. That limited vision is a barrier to their success. It is essential, in
seeing like an anthropologist, to be willing to understand other people’s perspectives and respect their
ideas. As an anthropologist, I am not required to believe in Gumzanjela. However, my training and
education prepare me to understand and to begin to see the world from a perspective founded in
that belief. My ability and willingness to see reality from perspectives other than my own are essential
skills—the ability to see what some people do not see and hear what some people do not hear. An-
thropology can connect the activities of international development efforts to cultural values so they
work together instead of against each other. The identification of the comprehensive belief system in
which the food taboos were embedded, for example, opened up new avenues for practical, culturally
respectful solutions to the problem of poor nutrition for women and children.

The story of the development organization’s efforts is purposely left unfinished. Did the commu-
nity resist? Did the organization change its activities? Was a different learning and inquiry-based
culture supported within the organization? Did belief in Gumzanjela continue? Did the organization
succeed in changing specific behaviors? How did the community navigate the external pressure? Did
individuals mostly succumb to the project’s advocacy or did they find ways to deflect, redirect, and
mislead the external advocates? As I hope this chapter has conveyed, people’s responses to efforts to
change them are complex. Anthropologists play an important role by extending an organization’s
vision so that its programs and activities can better align with the realities of the people for whom
they are designed and implemented.

DISCUSSION QUESTIONS

1. The international development professionals described in this chapter were determined to
eliminate the food taboos associated with the “law of Gumzanjela,” but Cochrane points out
that these rules were part of a larger belief system. Are there situations in which it is acceptable
to try to alter a group’s cultural values in order to promote changes in health, nutrition, or
women’s rights? Or, do you think it is inappropriate for outsiders to demand change? Do you
think it is possible to achieve goals, such as improved nutrition, without pressuring groups to
change their values and beliefs?

Perspectives: An Open Invitation to Cultural Anthropology10

2. Cochrane provides several examples of situations in which anthropological perspectives
and methods led to the discovery of important information about local communities that
development professionals did not have. However, the lack of knowledge about local cultures
that characterizes many development projects is not caused simply by a lack of anthropological
expertise. What other factors mentioned in this chapter contribute to a mismatch between the
needs of local people and the goals of international development projects?

GLOSSARY

Cultural imperialism: attempts to impose unequal and unfair relationships between members of
different societies.

Food taboos: cultural rules against the preparation and/or consumption of certain foods.

Harmful traditional practices: behaviors that are viewed as ordinary and acceptable by members of
a local community, but appear to be destructive or even criminal to outsiders.

ABOUT THE AUTHOR

Logan Cochrane is a Vanier Scholar at the University of British Co-
lumbia (Okanagan). For the last twelve years he has worked overseas,
including in Afghanistan, Benin, Burundi, the Democratic Republic of
Congo, Ethiopia, Tanzania and Uganda. Logan has worked as a consul-
tant with clients that have included Management Sciences for Health,
Save the Children, The Liaison Office, UNICEF and UNAIDS.

BIBLIOGRAPHY

Abu-Lughod, Lila. Do Muslim Women Need Saving? Cambridge, MA: Harvard University Press, 2013.
Ahmadu, Fuambai. S. and Shweder, Richard. A. “Disputing the Myth of the Sexual Dysfunction of

Circumcised Women.” Anthropology Today 25 no. 6 (2009):14-17.
Robert Chambers. Provocations for Development. Warwickshire, UK: Practical Action Publishing, 2012.
Cochrane, L. and Tamiru, Y. “Ethiopia’s Productive Safety Net Program: Power, Politics and Practice.”

Journal of International Development. 28 no. 5 (2016):649-665.
Escobar, Arturo. Encountering Development: The Making and Unmaking of the Third World. Princeton, NJ:

Princeton University Press, 1994.
Farmer, Paul. Infections and Inequalities. Berkeley: University of California Press, 2001.
Green, Duncan. From Poverty to Power. Oxford, UK: Oxfam, 2012.
Illich, Ivan. “Development as Planned Poverty.” In The Post-Development Reader, edited by M. Rahnama

and V. Bawtree, 94-102. London: Zed Books, 1997.
James, Stanlie. M. “Shades of Othering: Reflections on Female Circumcision/Genital Mutilation.” Signs. 23

no. 4 (1998):1031-1048.
Lock, Margaret. “Afterward: Seeing Like an Anthropologist.” In Troubling Natural Categories, edited by N.

Adelson, L. Butt and K. Kielmann, 209-222. Montreal: McGill-Queen’s University Press, 2013.
McGovern, Mike. “Popular Development Economics—An Anthropologist Among the Mandarins.”

Perspective on Politics 9 no. 2 (2011):345-355.
Moyo, Dambisa. Dead Aid. Why Aid is Not Working and How There is Another Way for Africa. New York:

Farrar, Strauss & Giroux, 2009.

Seeing Like an Anthropologist: Anthropology in Practice 11

NCTPE [National Committee on Traditional Practices of Ethiopia]. Old Beyond Imaging Ethiopia –
Harmful Traditional Practices. Addis Ababa, Ethiopia: National Committee on Traditional Practices of
Ethiopia, 2003.

Obermeyer, Carla. M. “Female Genital Surgeries: The Known, the Unknown, and the Unknowable.”
Medical Anthropology Quarterly 13 (1999):79-106.

Russell-Robinson, Joyce. “African Female Circumcision and the Missionary Mentality.” A Journal of
Opinion 25 (1997):54-57.

Scott, James. C. Seeing Like a State: How Certain Schemes to Improve the Human Condition Have Failed.
New Haven, CT: Yale University Press, 1998.

Sulkin, Carlos. D. Londono. “Anthropology, Liberalism and Female Genital Cutting.” Anthropology Today
25 no. 6 (2009):17-19.

Weber, Eugen. Peasants into Frenchman: The Modernization of Rural France, 1870-1914. Stanford: Stanford
University Press, 1976.

NOTES

1. See Logan Cochrane and Y. Tamiru, “Ethiopia’s Productive Safety Net Program: Power, Politics and Practice,” Journal of
International Development 28 no. 5 (2016):649-665.
2. I cannot claim to be the first to write about “seeing like an anthropologist;” others have done so, including Lock (2013),
though with slightly different objectives.
3. Those who have called on international development practitioners to reform their activities include Robert Chambers
(2012), Paul Farmer (2001), and Duncan Green (2012). A more radical critique suggesting that the provision of aid causes
greater impoverishment can be found in Arturo Escobar (1994) and Ivan Illich (1997). Dambisa Moyo (2009) has called for
an end to international development projects.
4. Those interested in an anthropological perspective of the views of other development actors can read McGovern’s (2011)
article on the works of Collier.
5. I use the term outsiders to refer to those external to the communities, either as non-members or as those not living within
or near that particular location, and am not referring only to international staff.
6. NCTPE, National Committee on Traditional Practices of Ethiopia, 2003
7. The project proposal and reports mentioned in this chapter are internal organizational reports not available to the public.
The purpose of the reports is to inform programming, which differs from academic research articles that are made available to
the public (although not always open access). While these practices appear quite different, there are some similarities: orga-
nizations publish publicly available reports on their work based on the totality of the data collected, but these reports do not
include all of the information that they have. Similarly, not all data collected by academic researchers is made available to the
public nor is it all published, rather a selection of that data is published in academic article and books.
8. Eugen Weber, 1976, Peasants into Frenchman: The Modernization of Rural France, 1870-1914. Stanford University Press:
Stanford University Press, x.
9. Leviticus 11:7–8: “And the pig, because it parts the hoof and is cloven-footed but does not chew the cud, is unclean for you.
You shall not eat any of their flesh and you shall not touch their carcasses; they are unclean for you.” Quran 2:173: “He [God]
has only forbidden to you dead animals, blood, the flesh of swine and that which has been dedicated to other than God.”
10. Cochrane and Tamiru, “Ethiopia’s Productive Safety Net Program.”

_GoBack
Seeing Like an Anthropologist: Anthropology in Practice
ANTHROPOLOGY AND DEVELOPMENT
“HARMFUL TRADITIONAL PRACTICES”
WE NEVER ASKED ABOUT IT BEFORE
SEEING LIKE AN ANTHROPOLOGIST
I WILL NOT EAT IT UNTIL I DIE
AN ISOLATED CASE?
REFLECTIONS
DISCUSSION QUESTIONS
GLOSSARY
ABOUT THE AUTHOR
REFERENCES
NOTES

Health_and_Medicine

Perspectives: An Open
Invitation to Cultural

Anthropology
Edited by Nina Brown, Laura Tubelle de González, and

Thomas McIlwraith

2017 American Anthropological Association

American Anthropological Association
2300 Clarendon Blvd, Suite 1301
Arlington, VA 22201

ISBN: 978–1-931303–55–2

http://www.perspectivesanthro.org

Perspectives: An Open Invitation to Cultural Anthropology
http://www.perspectivesanthro.org/ 1

What does it mean to be “healthy”? It may seem odd to
ask the question, but health is not a universal concept and
each culture values different aspects of well-being. At the
most basic level, health may be perceived as surviving each
day with enough food and water, while other definitions of
health may be based on being free of diseases or emotional
troubles. Complicating things further is the fact that that
each culture has a different causal explanation for disease.
For instance, in ancient Greece health was considered to
be the product of unbalanced humors or bodily fluids. The
four humors included black bile, phlegm, yellow bile, and
blood. The ancient Greeks believed that interactions among
these humors explained differences not only in health, but
in age, gender, and general disposition. Various things could
influence the balance of the humors in a person’s body in-
cluding substances believed to be present in the air, changes
in diet, or even temperature and weather. An imbalance in
the humors was believed to cause diseases, mood problems,
and mental illness.1

The World Health Organization (WHO) recognizes that
the health of individuals and communities is affected by
many factors: “where we live, the state of our environment,
genetics, our income and education level, and our relation-
ships with friends and family.” 2 Research conducted by the
WHO suggests that these characteristics play a more signif-
icant role in affecting our health than any others, including
having access to health care. For this reason, anthropologists
who are interested in issues related to health and illness must
use a broad holistic perspective that considers the influence
of both biology and culture. Medical anthropology, a dis-
tinct sub-specialty within the discipline of anthropology, in-
vestigates human health and health care systems in compar-
ative perspective, considering a wide range of bio-cultural
dynamics that affect the well-being of human populations.
Medical anthropologists study the perceived causes of ill-
ness as well as the techniques and treatments developed in a
society to address health concerns. Using cultural relativism
and a comparative approach, medical anthropologists seek
to understand how ideas about health, illness, and the body
are products of particular social and cultural contexts.

Health and Medicine
Sashur Henninger-Rener, University of LaVerne and the Los Angeles Community College District
sashur.henninger@gmail.com

LEARNING OBJECTIVES
• Define the biocultural perspective and

provide examples of how interactions
between biology and culture have
affected human biology.

• Identify four ethno-etiologies
(personalistic, naturalistic,
emotionalistic, and biomedical)
and describe how each differs in
explaining the root cause of illness.

• Explain the significance of faith in
healing.

• Examine the relationship between
mental health and cultural factors,
including stigma, that affect the way
people with mental health conditions
are perceived.

• Discuss examples of culture-bound
syndromes.

• Evaluate the positive and negative
effects of biomedical technologies.

Perspectives: An Open Invitation to Cultural Anthropology2

ANTHROPOLOGY AND THE BIOCULTURAL PERSPECTIVE

Evolutionary biology is a field of study that investigates the ways that natural processes have
shaped the development of life on Earth, producing measurable changes in populations over time.
Humans, Homo sapiens, are a special case in the discussion of evolution. We are a relatively young
species that has been on Earth for only about 195,000 years.3 Although this may sound like a long
time, compared with other animals, humans are newcomers and we have been subject to processes
of natural selection and adaptation for less time than many other living things. In that short time
period, human lifestyles have changed dramatically. The first humans evolved in Africa and had a
foraging lifestyle, living in small, kin-based groups. Today, millions of people live in crowded, fast-
paced, and technologically advanced agricultural societies. In evolutionary terms, this change has
happened rapidly. The fact that these rapid changes were even possible reveals that human lifestyles
are biocultural, products of interactions between biology and culture. This has many implications
for understanding human health.

The theory of natural selection suggests that in any species there are certain physical or behavioral
traits that are adaptive and increase the capacity of individuals to survive and reproduce. These adap-
tive traits will be passed on through generations. Many human traits contributed to the survival of
early human communities. A capacity for efficient walking and running, for instance, was important
to human survival for thousands of years. However, as cultural change led to new lifestyles, some
human characteristics became maladaptive.

One example is the obesity epidemic that has emerged all over the world. According to the Center
for Disease Control and Prevention, more than one-third of the population of the United States is
obese.4 Obesity is considered to be a “disease of civilization,” meaning that it did not exist in early
human populations. Taking a biocultural evolutionary approach to human health, we can ask what
traits characteristic of early human foraging populations might have encouraged an accumulation of
fat in the human body. The answer comes from the evidence of food shortages among foraging pop-
ulations. In fact, 47 percent of societies that forage experience food shortages at least once per year.
Another 24 percent experience a shortage at least every two years.5 When taking this into account,
the ability to retain body fat would have been advantageous for humans in the past. Women with
more body fat could give birth to healthy babies and breastfeed them, even in periods of food scarcity.
It is also possible that women and men would have viewed body fat as a sign of health and access to
resources, choosing sexual partners based on this characteristic. If so, powerful biological and cultural
forces would have contributed to genetic traits that led to efficient metabolism and higher body fat.

With the development of agriculture, calories became more easily available while many people
in the population became more sedentary. Traits that were once adaptive became maladaptive. The
development of cultural preferences for foods high in fat and sugar, such as the “standard American
diet” (SAD) is directly associated with obesity. These cultural changes have had a negative impact on
health in many places. In Polynesia, for instance, obesity rates were around 15 percent in traditional
farming communities, but climbed to over 35 percent as people moved to cities.6 This is an example
of the biocultural nature of many human health challenges.

Another example of this biocultural dynamic is sickle cell anemia, an inherited disease that can be
fatal. A person who inherits the sickle cell gene from both parents will have red blood cells with an
usual sickle (crescent) shape. These cells cannot carry oxygen as efficiently as normal red blood cells
and they are also more likely to form painful and dangerous blood clots. Ordinarily, genetic condi-

Health and Medicine 3

tions that make it more difficult for individuals to survive or have children, will become less common
in populations over time due to the effects of natural selection. From an evolutionary perspective, one
might ask why a deadly genetic condition has remained so common in human populations.

The cultural context is important for answering this question. The sickle cell gene is found most
often in human populations in Africa and Southeast Asia where malaria is widespread. Malaria is a
mosquito-borne illness that can be deadly to humans. People who have inherited one copy of the
sickle cell anemia trait (instead of the two copies that cause sickle cell disease) have resistance to
malaria. This is a significant adaptive trait in parts of the world where malaria is widespread. There is
some evidence that malaria became a significant threat to human health only after the invention of
agriculture. The deforested areas and collections of standing water that characterize agricultural com-
munities also attract the mosquitos that carry disease. 7 In this case, we can see biocultural dynamics
in action. Because resistance to malaria is an adaptive trait, the sickle cell gene remained common in
populations where malaria is present. In parts of West and Central Africa, up to 25 percent of the
population has the sickle cell gene. While sickle cell anemia is still a deadly disease, those who inherit
a single copy of the gene have some protection from malaria, itself a deadly threat in many places.
This example illustrates the biocultural interaction between genes, pathogens, and culture.

Infectious diseases generally do not have an adaptive function for humans like the examples above,
but many infectious diseases are influenced by human cultural systems. Because early human com-
munities consisted of small groups with a foraging lifestyle, viruses and bacteria transmitted from
person to person were unlikely to result in large-scale epidemics. Healthy individuals from neighbor-
ing groups could simply avoid coming into contact with anyone who was suffering from illness and
outbreaks would be naturally contained.8

The rapid increase in the size of human communities following the invention of agriculture
changed this pattern. Agriculture can support more people per unit of land and, at the same time,
agriculturalists need to live in permanent urban settlements in order to care for their crops. In a cycli-
cal way, agriculture provides more food while also requiring that people have sizeable families to do
the necessary farm work. Over the course of several thousand years, agricultural communities became
increasingly densely populated. This had many implications for local ecology: problems disposing of
waste and difficulty accessing clean water. A prime example of the health effects of the transition to
urban settlements is cholera, a water-borne illness that spreads through water that has been polluted
with human feces. Cholera, which was first detected in urban populations in India, has killed tens
of thousands of people throughout history and continues to threaten populations today, particularly
in developing countries, where access to clean water is limited, and in places that have experienced
natural disasters.9

From an adaptive perspective, human beings die from infectious diseases because they do not have
immunity to them. Immunity can be built up over time for some diseases, but unfortunately only
after the illness or death of many members of a population.10 When a new infectious disease reaches
a population, it can wreak havoc on many people. Historically, several new infectious diseases are
known to have been introduced to human populations through contact with livestock. Tuberculosis
and smallpox were linked to cattle and influenza to chickens. When humans domesticated animal
species, and began to live in close proximity to them, new routes for the transmission of zoonotic
disease, illnesses that can be passed between humans and animals, were established.11 Living in cities
accelerates the spread of infectious diseases and the scale of outbreaks, but may also contribute to
the natural selection of genetic traits that confer resistance to disease. This biocultural evolutionary

Perspectives: An Open Invitation to Cultural Anthropology4

process has been documented in urban populations where there are genes providing some resistance
to leprosy and tuberculosis.12

ETHNOMEDICINE

Ethnomedicine is the comparative study of cultural ideas
about wellness, illness, and healing. For the majority of our exis-
tence, human beings have depended on the resources of the nat-
ural environment and on health and healing techniques closely
associated with spiritual beliefs. Many such practices, including
some herbal remedies and techniques like acupuncture, have
been studied scientifically and found to be effective.13 Others
have not necessarily been proven medically effective by external
scientific evidence, but continue to be embraced by communi-
ties that perceive them to be useful. When considering cultural
ideas about health, an important place to start is with ethno-eti- Figure 1: Traditional Tibetan
ology: cultural explanations about the underlying causes of medicine poster.
health problems.

In the United States the dominant approach to thinking about health is biomedical. Illnesses
are thought to be the result of specific, identifiable agents. Thi s can include pathogens (viruses or
bacteria), malfunction of the body’s biochemical processes (conditions such as cancer), or physiolog-
ical disorders (such as organ failure). In biomedicine as it is practiced in the United States (Western
biomedicine), health is defined as the absence of disease or dysfunction, a perspective that notably
excludes consideration of social or spiritual well-being. In non-Western contexts biomedical explana-
tions are often viewed as unsatisfactory. In his analysis of ideas about health and illness in non-West-
ern cultures, George Foster (1976) concluded that these ideas could be categorized into two main
types of ethno-etiology: personalistic and naturalistic.14

Ethno-Etiologies: Personalistic and Naturalistic

Personalistic ethno-etiologies view disease as the result of the “active, purposeful intervention of
an agent, who may be human (a witch or sorcerer), nonhuman (a ghost, an ancestor, an evil spirit),
or supernatural (a deity or other very powerful being).”15 Illness in this kind of ethno-etiology is
viewed as the result of aggression or punishment directed purposefully toward an individual; there
is no accident or random chance involved. Practitioners who are consulted to provide treatment are
interested in discovering who is responsible for the illness—a ghost, an ancestor? No one is particu-
larly interested in discovering how the medical condition arose in terms of the anatomy or biology
involved. This is because treating the illness will require neutralizing or satisfying a person, or a su-
pernatural entity, and correctly identifying the being who is the root cause of the problem is essential
for achieving a cure.

The Heiban Nuba people of southern Sudan provide an interesting example of a personalistic eti-
ology. As described by, S.F. Nadel in the 1940s, the members of this society had a strong belief that
illness and other misfortune was the result of witchcraft.

Health and Medicine 5

A certain magic, mysteriously appearing in individuals, causes the death or illness of anyone
who eats their grain or spills their beer. Even spectacular success, wealth too quickly won, is
suspect; for it is the work of a spirit-double, who steals grain or livestock for his human twin.
This universe full of malignant forces is reflected in a bewildering array of rituals, fixed and
occasional, which mark almost every activity of tribal life.16

Because sickness is thought to be caused by spiritual attacks from others in the community, people
who become sick seek supernatural solutions. The person consulted is often a shaman, a person who
specializes in contacting the world of the spirits.

In Heiban Nuba culture, as well as in other societies where shamans exist, the shaman is believed
to be capable of entering a trance-like state in order to cross between the ordinary and supernatural
realms. While in this state, the shaman can identify the individual responsible for causing the illness
and sometimes the spirits can be convinced to cure the disease itself. Shamans are common all around
the world and despite the proverbial saying that “prostitution is the oldest profession,” shamanism
probably is! Shamans are religious and medical practitioners who play important social roles in their
communities as healers with a transcendent ability to navigate the spirit world for answers. In addi-
tion, the often have a comprehensive knowledge of the local ecology and how to use plants medici-
nally. They can address illnesses using both natural and supernatural tools.

In naturalistic ethno-etiologies, diseases are thought to be the result of natural forces such as
“cold, heat, winds, dampness, and above all, by an upset in the balance of the basic body elements.”17
The ancient Greek idea that health results from a balance between the four humors is an example of
a naturalistic explanation. The concept of the yin and yang, which represent opposite but comple-
mentary energies, is a similar idea from traditional Chinese medicine. Achieving balance or harmony
between these two forces is viewed as essential to physical and emotional health. Unlike personalistic
explanations, practitioners who treat illness in societies with naturalistic ethno-etiologies are inter-
ested in understanding how the medical condition arose so that they can choose therapeutic remedies
viewed as most appropriate.

Emotional difficulties can be viewed as the cause of illness in a na turalistic ethno-etiology (an
emotionalistic explanation). One example of a medical problem associated with emotion is susto,
an illness recognized by the Mixe, an indigenous group who live in Oaxaca, Mexico, as well as others
throughout central America. The symptoms of susto include difficulty sleeping, lack of energy, loss
of appetite and sometimes nausea/vomiting and fever. The condition is believed to be a result of a
“fright” or shock and, in some cases at least, it is believed to begin with a shock so strong that it
dis-engages the soul from the body.18 The condition is usually treated with herbal remedies and
barrida (sweeping) ceremonies designed to repair the harm caused by the shock itself.19 Although
physicians operating within a biomedical ethno-etiology have suggested that susto is a psychiatric
illness that in other cultural contexts could be labeled anxiety or depression, in fact susto is does
not fit easily into any one Western biomedical category. Those suffering from susto see their
condition as a malady that is emotional, spiritual, and physical.20

In practice, people assess medical problems using a variety of explanations and in any given society
personalistic, naturalistic, or even biomedical explanations may all apply in different situations. It is
also important to keep in mind that the line between a medical concern and other kinds of life chal-
lenges can be blurry. An illness may be viewed as just one more instance of general misfortune such
as crop failure or disappointment in love. Among the Azande in Central Africa, witchcraft is thought
to be responsible for almost all misfortune, including illness. E.E. Evans-Pritchard, an anthropologist

Perspectives: An Open Invitation to Cultural Anthropology6

who studied the Azande of north-central Africa in the 1930s, famously described this logic by
describing a situation in which a granary, , a building used to store grain collapsed.

In Zandeland sometimes an old granary collapses. There is nothing remarkable in this. Every
Zande knows that termites eat the supports in course of time and that even the hardest
woods decay after years of service. Now a granary is the summerhouse of a Zande homestead
and people sit beneath it in the heat of the day and chat or play the African hole-game or
work at some craft. Consequently it may happen that there are people sitting beneath the
granary when it collapses and they are injured…Now why should these particular people
have been sitting under this particular granary at the particular moment when it collapsed?
That it should collapse is easily intelligible, but why should it have collapsed at the particular
moment when these particular people were sitting beneath it…The Zande knows that the
supports were undermined by termites and that people were sitting beneath the granary in
order to escape the heat of the sun. But he knows besides why these two events occurred at
a precisely similar moment in time and space. It was due to the action of witchcraft. If there
had been no witchcraft people would have been sitting under the granary and it would not
have fallen on them, or it would have collapsed but the people would not have been sheltering
under it at the time. Witchcraft explains the coincidence of these two happenings.21

According to this logic, an illness of the body is ultimately caused by the same force as the collapse of
the granary: witchcraft. In this case, an appropriate treatment may not even be focused on the body
itself. Ideas about health are often inseparable from religious beliefs and general cultural assumptions
about misfortune.22

Is Western Biomedicine An Ethno-Etiology?

The biomedical approach to health strikes many people, particularly residents of the United
States, as the best or at least the most “fact-based” approach to medicine. This is largely because
Western biomedicine is based on the application of insights from science, particularly biology and
chemistry, to the diagnosis and treatment of medical conditions. The effectiveness of biomedical
treatments is assessed through rigorous testing using the scientific method and indeed Western
biomedicine has produced successful treatments for many dangerous and complex conditions:
everything from anti-biotics and cures for cancer to organ transplantation.

However, it is important to remember that the biomedical approach is itself embedded in a dis-
tinct cultural tradition, just like other ethno-etiologies. Biomedicine, and the scientific disciplines
on which it is based, are products of Western history. The earliest Greek physicians Hippocrates (c.
406–370 BC) and Galen (c. 129–c. 200 AD) shaped the development of the biomedical perspective
by providing early insights into anatomy, physiology, and the relationship between environment
and health. From its origins in ancient Greece and Rome, the knowledge base that matured into
contemporary Western biomedicine developed as part of the Scientific Revolution in Europe, slowly
maturing into the medical profession recognized today. While the scientific method used in Western
biomedicine represents a distinct and powerful “way of knowing” compared to other etiologies, the
methods, procedures, and forms of reasoning used in biomedicine are products of Western culture. 23

In matters of health, as in other aspects of life, ethnocentrism predisposes people to believe that
their own culture’s traditions are the most effective. People from non-Western cultures do not neces-

Health and Medicine 7

sarily agree that Western biomedicine is superior
to their own ethno-etiologies. Western culture
does not even have a monopoly on the concept
of “science.” Other cultures recognize their own
forms of science separate from the Western tradi-
tion and these sciences have histories dating back
hundreds or even thousands of years. One exam-
ple is Traditional Chinese Medicine (TCM), a
set of practices developed over more than 2,500
years to address physical complaints holistically
through acupuncture, exercise, and herbal reme-
dies. The tenets of Traditional Chinese Medicine
are not based on science as it is defined in West-
ern culture, but millions of people, including a
growing number of people in the United States
and Europe, regard TCM as credible and effec-
tive.

Ultimately, all ethno-etiologies are rooted
in shared cultural perceptions about the way
the world works. Western biomedicine practi-
tioners would correctly observe that the strength
of Western biomedicine is derived from use of
a scientific method that emphasizes objectively
observable facts. However, this this would not be
particularly persuasive to someone whose culture uses a different ethno-etiology or whose under-
standing of the world derives from a different tradition of “science.” From a comparative perspective,
Western biomedicine may be viewed as one ethno-etiology in a world of many alternatives.

Techniques for Healing

Western biomedicine tends to conceive of the human body as a kind of biological machine. When
parts of the machine are damaged, defective, or out of balance, chemical or surgical interventions are
the preferred therapeutic responses. Biomedical practitioners, who can be identified by their white
coats and stethoscopes, are trained to detect observable or quantifiable symptoms of disease, often
through the use of advanced imaging technologies or tests of bodily fluids like blood and urine. Prob-
lems detected through these means will be addressed. Other factors known to contribute to wellness,
such as the patient’s social relationships or emotional state of mind, are considered less relevant for
both diagnosis and treatment. Other forms of healing, which derive from non-biomedical ethno-eti-
ologies, reverse this formulation, giving priority to the social and spiritual.

In Traditional Chinese Medicine, the body is thought to be governed by the same forces that
animate the universe itself. One of these is chi (qi), a vital life force that flows through the body
and energizes the body and its organs. Disruptions in the flow or balance of chi can lead to a lack of
internal harmony and ultimately to health problems so TCM practitioners use treatments designed
to unblock or redirect chi, including acupuncture, dietary changes, and herbal remedies. This is an

Figure 2: The Taiyang bladder meridian, one
of several meridians recognized in traditional
Chinese medicine. From Shou Hua’s Jushikei
Hakki, 1716, Tokyo.

Perspectives: An Open Invitation to Cultural Anthropology8

example of humoral healing, an approach to healing that seeks to treat medical ailments by achiev-
ing a balance between the forces or elements of the body.

Communal healing, a second category of medical treatment, directs the combined efforts of the
community toward treating illness. In this approach, medical care is a collaboration between multi-
ple people. Among the !Kung (Ju/’hoansi) of the Kalahari Desert in southern Africa, energy known
as n/um can be channeled by members of the community during a healing ritual and directed
toward individuals suffering from illness. Richard Katz, Megan Bisele, and Verna St. Davis (1982)
described an example of this kind of ceremony:

The central event in this tradition is the all-night healing dance. Four times a month on the
average, night signals the start of a healing dance. The women sit around the fire, singing and
rhythmically clapping. The men, sometimes joined by the women, dance around the singers.
As the dance intensifies, n/um, or spiritual energy, is activated by the healers, both men and
women, but mostly among the dancing men. As n/um is activated in them, they begin to kia,
or experience an enhancement of their consciousness. While experiencing kia, they heal all
those at the dance.24

While communal healing techniques often involve harnessing supernatural forces such as the n/um,
it is also true that these rituals help strengthen social bonds between people. Having a strong social
and emotional support system is an important element of health in all human cultures.

Faith and the Placebo Effect

Humoral and communal approaches to healing, which from a scientific perspective would seem to
have little potential to address the root causes of an illness, present an important question for med-
ical anthropologists. What role does faith play in healing? Sir William Osler, a Canadian physician
who was one of the founders of Johns Hopkins Hospital, believed that much of a physician’s healing
ability derived from his or her ability to inspire patients with a faith that they could be cured.25 Osler
wrote:

Faith in the Gods or in the Saints cures one, faith in little pills another, suggestion a third,
faith in a plain common doctor a fourth…If a poor lass, paralyzed apparently, helpless, bed-
ridden for years, comes to me having worn out in mind, body, and estate a devoted family;
if she in a few weeks or less by faith in me, and faith alone, takes up her bed and walks, the
Saints of old could not have done more.26

In fact, there is a considerable amount of research suggesting that there is a placebo effect involved
in many different kinds of healing treatments. A placebo effect is a response to treatment that occurs
because the person receiving the treatment believes it will work, not because the treatment itself is
effective.

In Western biomedicine, the placebo effect has been observed in situations in which a patient
believes that he or she is receiving a certain drug treatment, but is actually receiving an inactive
substance such as water or sugar. 27 Research suggests that the body often responds physiologically to
placebos in the same way it would if the drug was real.28 The simple act of writing a prescription can
contribute to the successful recovery of individuals because patients trust that they are on a path that

Health and Medicine 9

will lead to wellness.29 If we consider the role of the placebo effect in the examples above, we should
consider the possibility that humoral and communal healing are perceived to “work” because the
people who receive these remedies have faith in them.

An interesting example of the complexity of the mind-body connection is found in studies of
intercessory prayer: prayers made to request healing for another person. In one well-known study,
researchers separated patients who had recently undergone heart surgery into two groups, one con-
taining people who know they would be receiving prayers for their recovery and another group who
would receive prayers without being aware of it. Those patients who knew they were receiving prayers
actually had more complications and health problems in the month following surgery.30 This reflects
an interesting relationship between faith and healing. Why did the patients who knew that others
were praying for them experience more complications? Perhaps it was because the knowledge that
their doctors had asked others to pray for them made patients more stressed, perceiving that their
health was at greater risk.

However, it can also be a lack of faith that
drives people to look for alternative treatments.
In the United States, alternative treatments,
some of which are drawn from humoral or com-
munal healing traditions, have become more
popular among patients who believe that West-
ern biomedicine is failing them. Cancer research
facilities have begun to suggest acupuncture as
a treatment for the intense nausea and fatigue
caused by chemotherapy and scientific stud-
ies suggest that acupuncture can be effective in
relieving these symptoms.31 Marijuana, a drug
that has a long recorded history of medical use
starting in ancient China, Egypt, and India, has
steadily gained acceptance in the United States as a treatment for a variety of ailments ranging from
anxiety to Parkinson’s disease.32 As growing numbers of people place their faith in these and other
remedies, it is important to recognize that many alternative forms of healing or medicine lack scien-
tific evidence for their efficacy. The results derived from these practices may owe as much to faith as
medicine.

MENTAL HEALTH

Unlike other kinds of illnesses, which present relatively consistent symptoms and clear biological
evidence, mental health disorders are experienced and treated differently cross-culturally. While the
discipline of psychiatry within Western biomedicine applies a disease-framework to explain mental
illness, there is a consensus in medical anthropology that mental health conditions are much more
complicated than the biological illness model suggests. These illnesses are not simply biological or
chemical disorders, but complex responses to the environment, including the web of social and cul-
tural relationships to which individuals are connected.

Medical anthropologists do not believe there are universal categories of mental illness.33 Instead,
individuals may express psychological distress through a variety of physical and emotional symptoms.
Arthur Kleinman, a medical anthropologist, has argued that every culture frames mental health

Figure 3: A botánica store selling herbal folk
medicines.

Perspectives: An Open Invitation to Cultural Anthropology10

concerns differently. The pattern of symptoms associated with mental health conditions vary greatly
between cultures. In China, Kleinman discovered that patients suffering from depression did not de-
scribe feelings of sadness, but instead complained of boredom, discomfort, feelings of inner pressure,
and symptoms of pain, dizziness, and fatigue.34

Mental health is closely connected with social and cultural expectations and mental illnesses can
arise as a result of pressures and challenges individuals face in particular settings. Rates of depression
are higher for refugees, immigrants, and others who have experienced dislocation and loss. A sense
of powerlessness also seems to play a role in triggering anxiety and depression, a phenomenon that
has been documented in groups ranging from stay-at-home mothers in England to Native Americans
affected by poverty and social marginalization.35

Schizophrenia, a condition with genetic as well as environmental components, provides another
interesting example of cross-cultural variation. Unlike anxiety or depression, there is some consis-
tency in the symptom patterns associated with this condition cross culturally: hallucinations, delu-
sions, and social withdrawal. What differs, however, is the way these symptoms are viewed by the
community. In his research in Indonesia, Robert Lemelson discovered that symptoms of schizo-
phrenia are often viewed by Indonesian communities as examples of communication with the spirit
world, spirit possession, or the effects of traumatic memories.36 Documenting the lives of some of
these individuals in a film series, he noted that they remained integrated into their communities and
had significant responsibilities as members of their families and neighborhoods. People with schizo-
phrenia were not, as often happens in the United States, confined to institutions and many were
living with their condition without any biomedical treatments.

In its multi-decade study of schizophrenia in 19 countries, the World Health Organization con-
cluded that societies that were more culturally accepting of symptoms associated with schizophre-
nia integrated people suffering from the condition into community life more completely. In these
cultures, the illness was less severe and people with schizophrenia had a higher quality of life.37 This
finding has been controversial, but suggests that stigma and the resulting social isolation that charac-
terize responses to mental illness in countries like the United States affect the subjective experience
of the illness as well as its outcomes.38

THE EXPERIENCE OF ILLNESS IN PLACE

Social Construction of Illness

As the above examples demonstrate, cultural attitudes affect how medical conditions will be per-
ceived and how individuals with health problems will be regarded by the wider community. There
is a difference, for instance, between a disease, which is a medical condition that can be objectively
identified, and an illness, which is the subjective or personal experience of feeling unwell. Illnesses
may be caused by disease, but the experience of being sick encompasses more than just the symptoms
caused by the disease itself. Illnesses are, at least in part, social constructions: experiences that are
given meaning by the relationships between the person who is sick and others.

The course of an illness can worsen for instance, if the dominant society views the sickness as a
moral failing. Obesity is an excellent example of the social construction of illness. The condition
itself is a result of culturally induced habits and attitudes toward food, but despite this strong cul-
tural component, many people regard obesity as a preventable circumstance, blaming individuals for
becoming overweight. This attitude has a long cultural history. Consider for instance the religious

Portfolio

Health and Medicine 11

connotations within Christianity of “gluttony” as a sin.39 Such socially constructed stigma influences
the subjective experience of the illness. Obese women have reported avoiding visits to physicians for
fear of judgment and as a result may not receive treatments necessary to help their condition.40 Peter
Attia, a surgeon and medical researcher who delivered a TED Talk on this subject, related the story
of an obese woman who had to have her foot amputated, a common result of complications from
obesity and diabetes. Even though he was a physician, he judged the woman to be lazy. “If you had
just tried even a little bit,” he had thought to himself before surgery.

Subsequently, new research revealed that insulin resistance, a precursor to diabetes, often develops
as a result of the excess sugars used in many kinds of processed foods consumed commonly in the
United States. As Attia observes, high rates of obesity in the United States are a reflection of the types
of foods Americans have learned to consume as part of their cultural environment.41 In addition, the
fact that foods that are high in sugars and fats are inexpensive and abundant, while healthier foods
are expensive and unavailable in some communities, highlights the economic and social inequalities
that contribute to the disease.

The HIV/AIDS virus provides another example of the way that the subjective experience of an
illness can be influenced by social attitudes. Research in many countries has shown that people, in-
cluding healthcare workers, make distinctions between patients who are “innocent” victims of AIDS
and those who are viewed as “guilty.” People who contracted HIV through sex or intravenous drug
use are seen as guilty. The same judgment applies to people who contracted HIV through same-sex
relationships in places where societal disapproval of same-sex relationships exists. People who con-
tracted HIV from blood transfusions, or as
babies, are viewed as innocent. The “guilty”
HIV patients often find it more difficult to
access medical care and are treated with dis-
respect or indifference in medical settings
compared with superior treatment provided
to those regarded as “innocent.” In the wider
community, “guilty” patients suffer from so-
cial marginalization and exclusion while “in-
nocent” patients receive greater social accep-
tance and practical assistance in responding
to their needs for support and care.42

The stigma that applies to “guilty” patients also ignores the socioeconomic context in which HIV/
AIDS spreads. For instance, in Indonesia, poor women can make considerably more money as sex
workers than in many other jobs: $10 an hour as a sex worker compared to 20 cents an hour in
a factory.43 In a similar way, poverty and a lack of other choices contribute to a decision to engage in
sex work in other societ-ies, including in sub-Saharan Africa where rates of HIV infection are among
the highest in the world. Poverty itself is one of the greatest “risk factors” for HIV infection.44 The
clear relationship between poverty, gender, and HIV infection has been the topic of a great deal of
research in medical anthro-pology. One example is Paul Farmer’s classic book, AIDS and
Accusation: Haiti and the Geography of Blame (1992), which was one of the earliest books to
critically evaluate the connection between pov-erty, racism, stigma, and neglect that allowed HIV
to infect and kill thousands of Haitians. Projects like this are critical to developing holistic views of
the entire cultural, economic, and political context that affects the spread of the virus and attempts
to treat the disease. Partners in Health, the non-profit medical organization Paul Farmer helped to

Figure 4: AIDS prevention art, Mozambique. The text
reads “think of the consequences, change behavior,
prevent HIV/AIDS.”

http://www.pih.org/

Perspectives: An Open Invitation to Cultural Anthropology12

found, continues to pursue innovative strategies to pre-vent and treat diseases like AIDS, strategies
that recognize that poverty and social marginalization provide the environment in which the virus
flourishes.

Culture-Bound Syndromes

A culture-bound syndrome is an illness recognized only within a specific culture. These
con-ditions, which combine emotional or psychological with physical symptoms, are not the
result of a disease or any identifiable physiological dysfunction. Instead, culture-bound
syndromes are so-matic, meaning they are physical manifestations of emotional pain. The existence
of these conditions demonstrates the profound influence of culture and society on the experience of
illness.

Anorexia

Anorexia is considered a culture bound syndrome because of its strong association with
cultures that place a high value on thinness as a measure of health and beauty. When we consider
concepts of beauty from cultures all over the world, a common view of beauty is one of someone
with additional fat. This may be because having additional fat in a place where food is expensive
means that one is likely of a higher status. In societies like the United States where food is
abundant, it is much more difficult to become thin than it is to become heavy. Although anorexia
is a complex condition, med-ical anthropologists and physicians have observed that it is much more
common in Western cultural contexts among people with high socioeconomic status.45 Anorexia,
as a form of self-deprivation, has deep roots in Western culture and for centuries practices of self-
denial have been associated with Christian religious traditions. In a contemporary context, anorexia
may address a similar, but secular desire to assert self-control, particularly among teenagers.46

During her research in Fiji, Anne Becker (2004) noted that young women who were exposed
to advertisements and television programs from Western cultures (like the United States and
Australia) became self-conscious about their bodies and began to alter their eating habits to
emulate the thin ideal they saw on television. Anorexia, which had been unknown in Fiji, became an
increasingly com-mon problem.47 The same pattern has been observed in other societies
undergoing “Westernization” through exposure to foreign media and economic changes associated
with globalization.48

Swallowing Frogs in Brazil

In Brazil, there are several examples of culture-bound syndromes that affect children as well
as adults. Women are particularly susceptible to these conditions, which are connected to
emotional distress. In parts of Brazil where poverty, unemployment, and poor physical health
are common, there are cultural norms that discourage the expression of strong emotions such as
anger, grief, or jealousy. Of course, people continue to experience these emotions, but cannot
express them openly. Men and women deal with this problem in different ways. Men may choose to
drink alcohol heavily, or even to express their anger physically by lashing out at others, including
their wives. These are not socially acceptable behaviors for women who instead remark that they
must suppress their feelings, an act they describe as having to “swallow frogs” (engolir sapos).49

Nervos (nerves) is a culture-bound syndrome characterized by symptoms such as headaches, trem-
bling, dizziness, fatigue, stomach pain, tingling of the extremities and even partial paralysis. It is

Health and Medicine 13

viewed as a result of emotional overload: a state of constant vulnerability to shock. Unexplained
wounds on the body may be diagnosed as a different kind of illness known as “blood-boiling bruises.”
Since emotion is culturally defined as a kind of energy that flows throughout the body, many believe
that too much emotion can overwhelm the body, “boiling over” and producing symptoms. A per-
son can become so angry, for instance, that his or her blood spills out from under the skin, creating
bruises, or so angry that the blood rises up to create severe headaches, nausea, and dizziness. A third
form of culture-bound illness, known as peito aberto (open chest) is believed to be occur when a per-
son, most often a woman, is carrying too much emotional weight or suffering. In this situation, the
heart expands until the chest becomes spiritually “open.” A chest that is “open” is dangerous because
rage and anger from other people can enter and make a person sick.50

In stressful settings like the communities in impoverished areas of northeastern Brazil, it is com-
mon for people to be afflicted with culture-bound illnesses throughout their lives. Individuals can
suffer from one condition, or a combination of several. Sufferers may consult rezadeiras/rezadores,
Catholic faith healers who will treat the condition with prayer, herbal remedies, or healing rituals.
Because these practitioners do not distinguish between illnesses of the body and mind, they treat the
symptoms holistically as evidence of personal turmoil. This approach to addressing these illnesses is
consistent with cultural views that it is the suppression of emotion itself that has caused the physical
problems.

BIOMEDICAL TECHNOLOGIES

In the history of human health, technology is an essential topic. Medical technologies have trans-
formed human life. They have increased life expectancy rates, lowered child mortality rates, and are
used to intervene in and often cure thousands of diseases. Of course, these accomplishments come
with many cultural consequences. Successful efforts to intervene in the body biologically also have
implications for cultural values and the social organization of communities, as demonstrated by the
examples below.

Antibiotics and Immunizations

Infectious diseases caused by viruses and bacteria have taken an enormous toll on human popula-
tions for thousands of years. During recurring epidemics, tens of thousands of people have died from
outbreaks of diseases like measles, the flu, or bubonic plague. The Black Death, a pandemic outbreak
of plague that spread across Europe and Eurasia from 1346–1353 AD, killed as many as 200 million
people, as much as a third of the European population. Penicillin, discovered in 1928 and mass pro-
duced for the first time in the early 1940s, was a turning point in the human fight against bacterial
infections. Called a “wonder drug” by Time magazine, Penicillin became available at a time when
bacterial infections were frequently fatal; the drug was glorified as a cure-all.51 An important factor to
consider about the introduction of antibiotics is the change to an understanding of illness that was
increasingly scientific and technical. Before science could provide cures, personalistic and naturalistic
ethno-etiologies identified various root causes for sickness, but the invention of antibiotics contrib-
uted to a strengthening of the Western biomedical paradigm as well as a new era of profitability for
the pharmaceutical industry.

The effects of antibiotics have not been completely positive in all parts of the world. Along with
other technological advances in areas such as sanitation and access to clean water, antibiotics contrib-

Perspectives: An Open Invitation to Cultural Anthropology14

uted to an epidemiological transition characterized by a sharp drop in mortality rates, particularly
among children. In many countries, the immediate effect was an increase in the human population
as well as a shift in the kinds of diseases that were most prevalent. In wealthy countries, for instance,
chronic conditions like heart disease or cancer have replaced bacterial infections as leading causes of
death and the average lifespan has lengthened. In developing countries, the outcome has been mixed.
Millions of lives have been saved by the availability of antibiotics, but high poverty and lack of access
to regular medical care mean that many children who now survive the immediate dangers of infec-
tion during infancy succumb later in childhood to malnutrition, dehydration, or other ailments.52

Another difficulty is the fact that many kinds of infections have become untreatable as a result of
bacterial resistance. Medical anthropologists are concerned with the increase in rates of infectious
diseases like tuberculosis and malaria that cannot be treated with many existing antibiotics. Accord-
ing to the World Health Organization, there are nearly 500,000 cases of drug resistant tuberculosis
each year.53 New research is now focused on drug resistance, as well as the social and cultural com-
ponents of this resistance such as the relationship between poverty and the spread of resistant strains
of bacteria.

Immunizations that can provide immunity against viral diseases have also transformed human
health. The eradication of the smallpox virus in 1977 following a concerted global effort to vaccinate
a large percentage of the world’s population is one example of the success of this biotechnology.
Before the development of the vaccine, the virus was killing 1–2 million people each year.54 Today,
vaccines exist for many of the world’s most dangerous viral diseases, but providing access to vaccines
remains a challenge. The polio virus has been eliminated from most of the world following several
decades of near universal vaccination, but the disease has made a comeback in a handful of countries,
including Afghanistan, Nigeria, and Pakistan, where weak governments, inadequate healthcare sys-

Figure 5: Women and children waiting to enter a medical clinic in Somalia. The clinic is open 2
days each week and treats 400–500 people each day.

Health and Medicine 15

tems, or war have made vaccinating children impossible. This example highlights the global inequal-
ities that still exist in access to basic medical care.

Because viruses have the ability to mutate and to jump between animals and people, human
populations around the world also face the constant threat of new viral diseases. Influenza has been
responsible for millions of deaths. In 1918, a pandemic of the H1N1 flu infected 500 million people,
killing nearly 5 percent of the human population.55 Not all influenza strains are that deadly, but it
remains a dangerous illness and one that vaccines can only partially address.56 Each year, the strains of
the influenza virus placed in the annual “flu shot” are based on predictions about the strains that will
be most common. Because the virus mutates frequently and is influenced by interactions between
human and animal populations, there is always uncertainty about future forms of the virus.57

Reproductive Technologies

Today, the idea of “contraception” is linked to the technology of hormone-based birth control.
“The pill” as we now know it, was not available in the United States until 1960, but attempts to both
prevent or bring about pregnancy through technology date back to the earliest human communities.
Techniques used to control the birthrate are an important subject for medical anthropologists be-
cause they have significant cultural implications.

Many cultures use natural forms of birth control practices to influence the spacing of births.
Among the !Kung, for instance, babies are breastfed for many months or even years, which hormon-
ally suppress fertility and decrease the number of pregnancies a woman can have in her lifetime. In
Enga, New Guinea, men and women do not live with one another following a birth, another practice
that increases the time between pregnancies.58 In contrast, cultures where there are social or religious
reasons for avoiding birth control, including natural birth spacing methods, have higher birth rates.
In the United States, the Comstock Act passed in 1873 banned contraception and even the distribu-
tion of information about contraception.

Although the Comstock Act is a thing of the past, efforts in the United States to limit access to
birth control and related medical services like abortion are ongoing. Many medical anthropologists
study the ways in which access to reproductive technologies is affected by cultural values. Laury
Oaks (2003) has investigated the way in which activists on both sides of the abortion debate attempt
to culturally define the idea of “risk” as it relates to women’s health. She notes that in the 1990s
anti-abortion activists in the United States circulated misleading medical material suggesting that
abortion increases rates of breast cancer. Although this claim was medically false, it was persuasive
to many people and contributed to doubts about whether abortion posed a health risk to women, a
concern that strengthened efforts to limit access to the procedure.59

Other forms of reproductive technology have emerged from the desire to increase fertility. The
world of “assisted reproduction,” which includes technologies such as in vitro fertilization and surro-
gate pregnancy, has been the subject of many anthropological investigations. Marcia Inhorn, a med-
ical anthropologist, has written several books about the growing popularity of in vitro fertilization in
the Middle East. Her book, The New Arab Man (2012), explores the way in which infertility disrupts
traditional notions of Arab masculinity that are based on fatherhood and she explores the ways that
couples navigate conflicting cultural messages about the importance of parenthood and religious
disapproval of assisted fertility.60

Perspectives: An Open Invitation to Cultural Anthropology16

CONCLUSION

As the global population becomes larger, it is increasingly challenging to address the health needs
of the world’s population. Today, 1 in 8 people in the world do not have access to adequate nutri-
tion, the most basic element of good health.61 More than half the human population lives in an
urban environment where infectious diseases can spread rapidly, sparking pandemics. Many of these
cities include dense concentrations of poverty and healthcare systems that are not adequate to meet
demand. 62 Globalization, a process that connects cultures through trade, tourism, and migration,
contributes to the spread of pathogens that negatively affect human health and exacerbates political
and economic inequalities that make the provision of healthcare more difficult.

Human health is complex and these are daunting challenges, but medical anthropologists have
a unique perspective to contribute to finding solutions. Medical anthropology offers a holistic per-
spective on human evolutionary and biocultural adaptations as well as insights into the relationship
between health and culture. As anthropologists study the ways people think about health and illness
and the socioeconomic and cultural dynamics that affect the provision of health services, there is a
potential to develop new methods for improving the health and quality of life for people all over the
world.

DISCUSSION QUESTIONS

1. This chapter describes several examples of diseases that result from interactions between biology
and culture such as obesity. Why is it important to consider cultural factors that contribute
to illness rather than placing blame on individuals? What are some other examples of illnesses
that have cultural as well as biological causes?

2. Many cultures have ethno-etiologies that provide explanations for illness that are not based
in science. From a biomedical perspective, the non-scientific medical treatments provided in
these cultures have a low likelihood of success. Despite this, people tend to believe that the
treatments are working. Why do you think people tend to be satisfied with the effectiveness of
the treatments they receive?

3. How does poverty influence the health of populations around the world? Do you see this
in your own community? Who should be responsible for addressing health care needs in
impoverished communities?

GLOSSARY

Adaptive: traits that increase the capacity of individuals to survive and reproduce.

Biocultural evolution: describes the interactions between biology and culture that have influenced
human evolution.

Biomedical: an approach to medicine that is based on the application of insights from science, par-
ticularly biology and chemistry.

Communal healing: an approach to healing that directs the combined efforts of the community
toward treating illness.

Culture-bound syndrome: an illness recognized only within a specific culture.

Health and Medicine 17

Emotionalistic explanation: suggests that illnesses are caused by strong emotions such as fright,
anger, or grief; this is an example of a naturalistic ethno-etiology.

Epidemiological transition: the sharp drop in mortality rates, particularly among children, that
occurs in a society as a result of improved sanitation and access to healthcare.

Ethno-etiology: cultural explanations about the underlying causes of health problems.

Ethnomedicine: the comparative study of cultural ideas about wellness, illness, and healing.

Humoral healing: an approach to healing that seeks to treat medical ailments by achieving a balance
between the forces, or elements, of the body

Maladaptive: traits that decrease the capacity of individuals to survive and reproduce.

Medical anthropology: a distinct sub-specialty within the discipline of anthropology that investi-
gates human health and health care systems in comparative perspective.

Naturalistic ethno-etiology: views disease as the result of natural forces such as cold, heat, winds, or
an upset in the balance of the basic body elements.

Personalistic ethno-etiology: views disease as the result of the actions of human or supernatural
beings.

Placebo effect: a response to treatment that occurs because the person receiving the treatment be-
lieves it will work, not because the treatment itself is effective.

Shaman: a person who specializes in contacting the world of the spirits.

Somatic: symptoms that are physical manifestations of emotional pain.

Zoonotic: diseases that have origins in animals and are transmitted to humans.

ABOUT THE AUTHOR

Sashur Henninger-Rener is an anthropologist with research in the fields of comparative religion
and psychological anthropology. She received a Master of Arts from Columbia University in the
City of New York in Anthropology and has since been researching and teaching. Currently, Sashur
is teaching with The University of LaVerne and the Los Angeles Community College District in the
fields of Cultural and Biological Anthropology. In her free time, Sashur enjoys traveling the world,
visiting archaeological and cultural sites along the way. She and her husband are actively involved in
animal rescuing, hoping to eventually found their own animal rescue for animals that are waiting to
find homes.

NOTES

1. Jermone Gilbert, Humors, Hormones, and Neurosecretions (New York: State University of New York Press, 1962).
2. World Health Organization, “Health Impact Assessment,” http://www.who.int/hia/evidence/doh/en/.
3. Sally McBrearty and Allison Brooks, “The Revolution That Wasn’t: A New Interpretation of the Origin of Modern Hu-
mans,” Journal of Human Evolution 39 (1999), 453–563.
4. U.S. Center for Disease Control and Prevention, “Adult Obesity Facts,” http://www.cdc.gov/obesity/data/adult.html.
5. Marjorie G. Whiting, A Cross Cultural Nutrition Survey (Cambridge, MA: Harvard School of Public Health, 1968).
6. Ian A.M. Prior, “The Price of Civilization,” Nutrition Today 6 no. 4 (1971): 2–11.
7. Steven Connor, “Deadly malaria may have risen with the spread of agriculture,” National Geographic, http://news.
nationalgeographic.com/news/2001/06/0625_wiresmalaria.html.
8. Jared Diamond, “The Arrow of Disease,” Discover Magazine, October 1992. http://discovermagazine.com/1992/oct/
thearrowofdiseas137.

http://www.who.int/hia/evidence/doh/en/

http://www.cdc.gov/obesity/data/adult.html

http://news.nationalgeographic.com/news/2001/06/0625_wiresmalaria.html

http://discovermagazine.com/1992/oct/thearrowofdiseas137

Perspectives: An Open Invitation to Cultural Anthropology18

9. World Health Organization, “Cholera,” http://www.who.int/mediacentre/factsheets/fs107/en/.
10. George J. Armelagos and John R. Dewey, “Evolutionary Response to Human Infectious Disease,” BioScience, 25(1970):
271–275.
11. William McNeill, Plagues and People (New York: Doubleday, 1976).
12. Ian Barnes, Anna Duda, Oliver Pybus, Mark G. Thomas. Ancient Urbanisation Predicts Genetic Resistance To Tubercu-
losis,” Evolution 65 no. 3 (2011): 842–848.
13. George T. Lewith, Acupuncture: Its Place in Western Medical Science (United Kingdom: Merlin Press, 1998).
14. George M. Foster, “Disease Etiologies in Non-Western Medical Systems,”
American Anthropologist 78 no 4 (1976): 773–782.
15. Ibid., 775
16. S.F. Nadel, The Nuba: An Anthropological Study of the Hill Tribes in Kordofan (Oxford: Oxford University Press, 1947), 173.
17. Foster, “Disease Etiologies in Non-Western Medical Systems,” 775.
18. A.J. Rubel, “The Epidemiology of a Folk Illness: Susto in Hispanic America,” Ethnology
3 (1964): 268–283.
19. Robert T. Trotter II, “Susto: The Context of Community Morbidity Patterns,” Ethnology 21 no. 3 (1982): 215–226.
20. Frank J. Lipp, “The Study of Disease in Relation to Culture: The Susto Complexe Among the Mixe of Oaxaco,” Dialectical
Anthropology 12 no. 4 (1987): 435–442.
21. E.E. Evans-Pritchard, Witchcraft, Oracles and Magic Among the Azande (Oxford: Oxford University Press, 1937), 70.
22. Leonard B. Glick, “Medicine as an Ethnographic Category: The Gimi of the New Guinea Highlands,” Ethnology 6 (1967):
31–56.
23. Elliott Mishler, “Viewpoint: Critical Perspectives on the Biomedical Model,” in
E. Mishler, L.A. Rhodes, S. Hauser, R. Liem, S. Osherson, and N. Waxler, eds.
Social Contexts of Health, Illness, and Patient Care (Cambridge, UK: Cambridge University Press).
24. Richard Katz, Megan Biesele, and Verna St. Davis, Healing Makes Our Hearts Happy: Spirituality and Cultural Transforma-
tion among the Kalahari Ju/ ’hoansi (Rochester VS, Inner Traditions, 1982), 34.
25. Michael Bliss, William Osler: A Life in Medicine (Oxford: Oxford University Press, 1999), 276.
26. William Osler, “The Faith That Heals,” British Medical Journal 1 (1910): 1470–1472.
27. Cara Feinberg, “The Placebo Phenomenon,” Harvard Magazine http://harvardmagazine.com/2013/01/the-placebo-
phenomenon.
28. Ted J. Kaptchuk, and Franklin G. Miller, “Placebo Effects in Medicine,” New England Journal of Medicine 373 (2015):8–9.
29. Robert Bud, “Antibiotics: From Germophobia to the Carefree Life and Back Again,” in Medicating Modern America:
Prescription Drugs in History, ed. Andrea Tone and Elizabeth Siegel Watkins (New York: New York University Press, 2007).
30. H. Benson, J.A. Dusek, J.B. Sherwood, P. Lam, C.F. Bethea, and W. Carpenter, “Study of the Therapeutic Effects of Inter-
cessory Prayer (STEP) in Cardiac Bypass Patients: A Multicenter Randomized Trial of Uncertainty and Certainty of Receiving
Intercessory Prayer,” American Heart Journal 151 (2006):934–942.
31. National Cancer Institute, “Acupuncture,” http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional/
page5.
32. Mira Taow, “The Religious and Medicinal Uses of Cannabis in China, India, and Tibet,” Journal of Psychoactive Drugs
13(1981): 23–24.
33. Marsella, A. and White, G., eds. Cultural Conceptions of Mental Health and Therapy (Dordrecht, Netherlands: D. Reidel,
1982).
34. Dominic T.S. Lee, Joan Kleinman, and Arthur Kleinman, “Rethinking Depression: An Ethnographic Study of the Expe-
riences of Depression Among Chinese,” Harvard Review of Psychiatry 15 no 1 (2007):1–8.
35. Arthur Kleinman, Rethinking Psychiatry: From Cultural Category to Personal Experience (New York: The Free Press, 1988).
36. Robert Lemelson and L.K. Suryani, “Cultural Formulation of Psychiatric Diagnoses: The Spirits, Penyakit Ngeb and
the Social Suppression of Memory: A Complex Clinical Case from Bali,” Culture, Medicine and Psychiatry 30 no. 3 (2006):
389–413.
37. For more information about these studies, see J. Leff et al., “The International Pilot Study of Schizophrenia: Five-Year
Follow-Up Findings,” Psychological Medicine 22 (1992):131–45; A. Jablensky et al., “Schizophrenia: Manifestations, Incidence
and Course in Different Cultures: A World Health Organization Ten-Country Study,” Psychological Medicine Monograph
Supplement 20(1992); N. Sartorius et al., “Early Manifestations and First-Contact Incidence of Schizophrenia in Different
Cultures,” Psychological Medicine 16 (1986):909–28.
38. Bernice A. Pescosolido, Jack K. Martin, Sigrun Olafsdottir, J. Scott Long, Karen Kafadar, and Tait R. Medina, “The
Theory of Industrial Society and Cultural Schemata: Does the ‘Cultural Myth of Stigma’ Underlie the WHO Schizophrenia
Paradox?,” American Journal of Sociology 121 no. 3 (2015): 783–825.
39. Collean Barry, Victoria Bresscall, Kelly D. Brownell, and Mark Schlesinger, “Obesity Metaphors: How Beliefs about
Obesity Affect Support for Public Policy,” The Milbank Quarterly 87 (2009): 7–47.
40. Peter Conrad and Kristen K. Barker, “The Social Construction of Illness: Key Insights and Policy Implications,” Journal of
Health and Social Behavior, 51(2010): s57-s79.

http://www.who.int/mediacentre/factsheets/fs107/en/

http://harvardmagazine.com/2013/01/the-placebo-phenomenon

http://www.cancer.gov/cancertopics/pdq/cam/acupuncture/healthprofessional/page5

Health and Medicine 19

41. Peter Attia, “Is the Obesity Crisis Hiding a Bigger Problem?,” TEDMED Talks April 2013 Retrieved from https://www.
ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes.
42. Anish P. Mahajan, Jennifer N. Sayles, Vishal A. Patel, Robert H. Remien, Daniel Ortiz, Greg Szekeres, and Thomas J.
Coates, “Stigma in the HIV/AIDS Epidemic: A review of the Literature and Recommendations for the Way Forward,” AIDS
22 supp. 2 (2008): S67-S79.
43. Elizabeth Pisani, “Sex, Drugs, & HIV: Let’s Get Rational,” TED Talks February 2010. http://www.ted.com/talks/
elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1#t-1011824.
44. United Nations, “Poverty and AIDS: What’s Really Driving the Epidemic?” http://www.unfpa.org/conversations/facts.
html.
45. Maria Makino, Koji Tsuboi, and Lorraine Dennerstein, “Prevalence of Eating Disorders: A Comparison of Western and
Non-Western Countries,” Medscape General Medicine 6 no. 3 (2004):49.
46. Joan Jacobs Brumberg, Fasting girls: The Emergence of Anorexia Nervosa as a Modern Disease (Cambridge, MA: Harvard
University Press, 1988).
47. Anne E. Becker, “Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity during
Rapid Social Change” Culture, Medicine and Psychiatry, 28 no. 4 (2004):533–559.
48. Sing Lee, “Reconsidering the Status of Anorexia Nervosa as a Western Culture-Bound Syndrome,” Social Science & Med-
icine 42 no. 1 (1996): 21–34.
49. L.A. Rebhun, “Swallowing Frogs: Anger and Illness in Northeast Brazil,” Medical Anthropology Quarterly 8 no. 4
(1994):360–382.
50. Ibid., 369–371
51. Robert Bud, “Antibiotics: From Germophobia to the Carefree Life and Back Again.”
52. Nancy Scheper Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California
Press, 1989).
53. World Health Organization, “Antimicrobial Resistance,” http://www.who.int/mediacentre/factsheets/fs194/en/.
54. David Koplow, Smallpox: The Fight to Eradicate a Global Scourge (Berkeley: University of California Press, 2003).
55. Jeffery K. Taubenberger, David Baltimore, Peter C. Doherty, Howard Markel, David M. Morens, Robert G. Webster,
and Ian A. Wilson, “Reconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past,” mBio 3 no. 5 (2012).
56. Jeffrey Taubenberger and David Morens, “1918 influenza: The Mother of All Pandemics,” Emerging Infectious Diseases,
12 (2006).
57. Suzanne Clancy, “Genetics of the Influenza Virus,” Nature Education, 1(2008): 83.
58. For more about these and other examples, see Carol P. MacCormack, Ethnography of Fertility and Birth (New York: Aca-
demic Press, 1982).
59. Laury Oaks, “The Social Politics of Health Risk Warning: Competing Claims about the Link between Abortion and Breast
Cancer,” in Risk, Culture, and Health Inequality: Shifting Perceptions of Danger and Blame, eds. Barbara Herr Harthorn and
Laury Oaks (Westport, CT: Praeger, 2003).
60. Marcia C. Inhorn, The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East (Princeton,
NJ: Princeton University Press, 2012).
61. Food and Agriculture Organization of the United Nations, “The Multiple Dimensions of Food Security,” http://www.fao.
org/docrep/018/i3458e/i3458e .
62. World Health Organization, “Urbanization and Health,” Bulletin of the World Health Organization, 88(2010): 241–320.

http://www.unfpa.org/conversations/facts.html

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_GoBack
Health and Medicine
ANTHROPOLOGY AND THE BIOCULTURAL PERSPECTIVE
ETHNOMEDICINE
Ethno-Etiologies: Personalistic and Naturalistic
Is Western Biomedicine An Ethno-Etiology?
Techniques for Healing
Faith and the Placebo Effect

MENTAL HEALTH
THE EXPERIENCE OF ILLNESS IN PLACE
Social Construction of Illness
Culture-Bound Syndromes

BIOMEDICAL TECHNOLOGIES
Antibiotics and Immunizations
Reproductive Technologies

CONCLUSION
DISCUSSION QUESTIONS
GLOSSARY
ABOUT THE AUTHOR
NOTES

Table of Contents.html

ANTH 102 6980 Introduction to Cultural Anthropology (2225) – Week Eight Learning Resources
1. Week 8 Learning Resources APA Citations

2. Seeing_Like_an_Anthropologist: NEEDED FOR FINAL

3. Health_and_Medicine: NEEDED FOR FINAL

Question 1

The process by which an inaccurate and false concept is transmitted through social institutions and common discourse so frequently that it comes to take on a life of its own and seem real is known as:

2. the research method used by most socio-cultural anthropologists is the survey method. True or false

3. the idea that cultural boundaries should align with political boundaries is known as:

4. In cultures where critical resources (including food) are scarce, and rates of overall poverty high, it is common for:

5. by the early 20th century, the idea of a _____ – race classification system was widely accepted by many scholars and social philosophers.

Question 1

2. the research method used by most socio-cultural anthropologists is the survey method. True or false

3. the idea that cultural boundaries should align with political boundaries is known as:

4. In cultures where critical resources (including food) are scarce, and rates of overall poverty high, it is common for:

5. by the early 20th century, the idea of a _____ – race classification system was widely accepted by many scholars and social philosophers.

6. which of the following countries has a concept of race that could best be describes as a “color continuum?”

7. The placebo effect is an example of a “mind-body connection.” True or false

8. traditionally and historically, if a child was born to a couple involving one “white” parent and one “non-white” parent, the child would be classified as:

9 an ethnic group is a group distinguished by shared cultural characteristics. True or false

10. which approach to health and illness seems to resonate most with americans?

11. as cultural & social change occurs, especially if it is widespread and rapid, certain evolved traits in humans can becom maladaptive. True or false

12. ideas of “health”, “good health,” and what it means to be physically “healthy” are universal and consistent across cultures. True or false

13. a sense of powerlessness can contribute to anxiety and depression. This phenomenon has been seen among:

14. from a functionalist point of view, nationalism is useful for the state because:

15. there is some evidence that the placebo effect has some basis in fact. True or false

16. “Jim Crow” laws were a system of laws designed to institutionalize:

17. The consumption of organ meats, such as liver, kidneys, or brains is an example of a “harful traditional practice.”

18. which of the following statements is the best reflection of the anthropological stance on race today?

19. “white privilege” is now considered to be a basic feature of race as lived experience in the uNited States. True or false

20. anorexia is not an example of a culture-bound illness. True or false