Theory and Action
Essays for an Anthropologist
Edited by Sjaak van der Geest & Marian Tankink
AMB Diemen 2009
(ISBN 97890 79700 07 3, 258 pp., geïllustreerd, paperback., € 20,-)
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Theory and action are closely connected in medical anthropology. Theory frames the way for finding pertinent meanings and making intelligent interpretations that open the door to relevant action.Kurt Lewin's maxim that there is nothing so practical as a good theory is well known. Theory is practical because it produces the questions that matter in medical anthropological research.
This book contains 37 essays and one poem. All of them address prominent issues in present-day anthropology and medical anthropology in particular. The contributions focus on people who are excluded or marginalised because of their age, their illness, their 'madness', or violent circumstances. Others are oppressed because they do not fit in the dominant societal discourse. The essays show, however, that people are not solely victims of marginalisation. They have impressive agency and resilience, often driven by their determination to remain connected with their loved ones. Although there is much pain, fear, loneliness, injustice and violence in the contributions, there is, fortunately, also hope, friendship, care, spirit and humour.
'Theory and Action' is a gift of friends to Els van Dongen who had to resign from the University of Amsterdam because of serious health problems. 'Theory and action' reflects the main concern of her life as an anthropologist
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Contents
* Preface
Els van Dongen
- Keeping the feet of the gods and the saints warm: Mundane pragmatics in times of suffering and uncertainty
Lina Cristina Casadó Ii Marín
- Body narratives of social suffering
Josep M. Comelles
- Portraits de folie: Images, ethnographie et histoires
Niekje Elema
- Touching in nursing practice: How does it work?
Sylvie Fainzang
- De la théorie à l’action
Monica Ferreira
- Giving voice to the lives of older persons in South Africa
Amina Gadri
- Death and the urgency of time
Trudie Gerrits
- Sharing uncertainty in clinical encounters
Diana Gibson
- Literacy practices of female farm workers in the Breederiver valley, South Africa
Bernhard Hadolt
- On the temporality of epilepsy
Anita Hardon
- Terms of engagement: Women’s health concerns and new reproductive technologies
Marja-Liisa Honkasalo
- ‘Hole in the heart’ Loss and bereavement among North Karelian women
Sushrut Jadhav
- What is cultural validity and why is it ignored? The case of Expressed Emotions research in South Asia
Arthur Kleinman
- The caregiver
Winny Koster
- Keeping secrets, lying, and strategic disclosure: Reflections on the imperative to disclose one’s hiv-positive status
Andrea Kuckert
- Das ‘kulturelle Problem’ oder der Versuch einer Einigung im ‘dritten Raum’
Ilja Mooij
- Theory in action? Reflecties vanuit een huisarts-praktijk
Ruth Kutalek
- Congolese paintings on suffering, violence and trauma
Armin Prinz
- Mihidi’s drawings: Sketches of Zande witchcraft
Huub Beijers
- Sterven in het psychiatrisch ziekenhuis
Patrick Meurs
- Working on the interface between psychology and anthropology: The culture-sensitive prevention program ‘First Steps’
Gerhard Nijhof
- Bad news gesture
Janus Oomen
- Torture, the photographic narrative and truth
Maria Elena Planas
- Punctuating Criollismo in Barrios Altos: Nilda’s ethnic/racialized investments
Annemiek Richters
- Misery and resilience among war widows in the North of Rwanda: Individual and social healing through the mediation of sociotherapy
Rachel Spronk
- Fear of aids: Moralizing youngsters in Kenya
Marian Tankink
- ‘A life story that cannot be told will begin to give off a stench’
Deanna J. Trakas
- The uncut knot: Medical anthropology not exactly at home
Rineke van Daalen
- Van oude mensen: Wat blijft in wat verandert
Rimke van der Geest
- Een project voor en door psychotische patiënten en hun families in Nicaragua
Sjaak van der Geest
- Listening: Friendship according to Kwame Opoku
Rob van Dijk
- Anthropological theory and therapeutic action
Selma van London & Arie de Ruijter
- Trust as condition for communication
Corlien Varkevisser
- Primary Health Care: Terugblik en vooruitzicht
Marianne Vysma
- Forgetting: A part of the cycle of life
Susan Reynolds Whyte
- At home with antiretroviral therapy in Uganda
Allan Young
- Regarding Freud’s Jokes and their relation to the unconscious
Ria Reis
- Rolbos
The contributors
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Preface
The plan for this book started when Els van Dongen left the University of Amsterdam after two years of severe illness. Since she joined the Medical Anthropology Unit in 1996, Els has been one of our most gifted and popular teachers in medical anthropology, a creative thinker and an extremely productive scholar. She was at the peak of her career when cancer struck and forced her to cross the boundary about which she had spoken so often. She turned from a researcher into a patient; from a theory expert she became an experience expert. Or rather, we should say that she added her personal patient experience to her anthropological expertise.
To show our admiration for her person and her work, and to express how much we miss her as a colleague at the university, we decided to make a ‘book of friends’. We wrote to about fifty colleagues in (medical) anthropology and related fields and invited them to write a contribution to the book.
Some were colleagues at the University of Amsterdam and other institutions in the Netherlands and abroad with whom she had worked over the past years. Others were former students who had been supervised by her and become personal friends.
Els’s condition has worsened during the last few months and time became an urgent factor. We allowed the authors only three weeks to hand in their contributions. We asked them to write about one of the many themes that are prominent in Els’s work, such as ‘madness’, psychiatry, care, communication, silence, older people, migrants, exclusion, bereavement, social memory, narrative, and violence.
The enthusiasm and loving concern that erupted after our mail was astonishing. Thirty-seven people managed to submit a text, some could not but intend to send their contribution via another way, and some could not be traced. The book contains 36 essays and one poem. Some of these were produced in the most extraordinary situations: during holidays with the family, in trains and airplanes while travelling, during fieldwork far away, in the late hours of the night, or in moments stolen from the family at Christmas.
One author ended the message that accompanied her paper: “And now I pack my computer in the box”. She was moving house. theory and action: essays for an anthropologist
This volume wants to be more that an idiosyncratic book of friends. Init a wide range of issues are presented and discussed that are not only Els’s interests but are also prominent in present-day work and debate in medical anthropology. The contributions focus on people who are excluded or marginalised, because of their age, their illness, their ‘madness’, or because they are living in violent circumstances. Others are about people who are oppressed because they do not fit in the dominant discourse: people with hiv/aids, victims of (sexual) violence, refugees, and migrants.
At the same time, the essays show that people are not solely victims of marginalisation; they have a lot of agency and are remarkably resilient, as is shown by their active resistance and mutual help, their communication, and their self respect. Care, in its widest sense – not just health care – is a key term in many contributions. Social memory plays a role in the discussion: how, when, and with whom to communicate, and how to cope with uncertainties in life. In traumatic situations, forgetting is often the only strategic option, but forgetting is impossible without remembering.
The need of people to remain connected with loved ones and others comes up in several contributions. People are, therefore, selective with sensitive information or keep silent, as there is no trust – an essential aspect of communication – or there are no listeners. Sometimes the anthropologist is the only listener. Communication takes place in narration, a single gesture, or, indeed, in silence. There is much pain, fear, loneliness, injustice, and violence in the contributions, but fortunately also hope, friendship, care, resilience, and humour.
The title of this book ‘Theory and Action’ is the name of a famous core module that Els taught in the Master’s of Medical Anthropology and Sociology. In an address that someone ‘else’ presented on behalf of Els in 2008, she stressed that theory and action are closely connected in medical anthropology.
“Theory helps us to bear our ignorance of facts,” she quoted George Santayana. Facts, she continued, acquire their meaning from what people do to them, in this case anthropologists and the people they are working with.
Theory provides a way of finding pertinent meanings and making intelligent interpretations that open the door to relevant action. She then cited the famous line from Kurt Lewin that there is nothing so practical as a good theory. A good theory is practical because it enhances understanding and produces the questions that really matter in medical anthropological research.
In her module, Els discussed with the students how problems of ill, health and suffering should be regarded in their historical, political, and economic contexts, and how larger social and political forces shape relations and actions and cultural imagination at the local level. The necessary – but often difficult – cooperation between anthropology and health workers received special attention. Questions that were addressed during the course included: Why do we need theory? Which theories are relevant? How can we link macro, meso, and micro theories with practical work?
‘Theory and Action’ constitutes both medical anthropology’s ambition and its weakness. The frequent criticism that medical anthropology receives from those who work in the heat of the day confirms that, unfortunately, much academic work remains largely or totally useless to ‘actors’ in health care. Nearly every contributor in this book struggles in one way or the other with this dilemma and with the challenge of proving the practical relevance of theory.
The contributions in the book have been organized following more or less the alphabetic order of the authors. No attempt has been made to force them into specific categories or overarching themes. The book starts with a recent article on the magic of ‘managing’ unbearable suffering written by Els. In this text she applies the two perspectives: of anthropological observer and reflexive patient. The book ends with a poem. In between, 36 essays touch on a wide variety of very topical issues. Ample room has been given for paintings, drawings, and other illustrations. They echo Els’s own artistic work. The cover shows one of her paintings that expresses care in South Africa. No less than five different languages appear in this book of friends, purposely, to pay tribute to Els’s large command of languages.
Unfortunately, one medium of her anthropological approach is missing in this collection: novels. Literary writing is usually more effective in describing and interpreting human conditions of suffering and resilience than anthropological accounts. Clearly, this book is not complete…
We want to thank all those who made the production of this book possible: the authors, the English editor Zoe Goldstein, the desktop editor Hanneke Kossen, and the publisher Ben van den Camp. The Department of Sociology and Anthropology, the Amsterdam School of Social science Research (assr), and the Amsterdam Master’s in Medical Anthropology (amma) provided the funds for this project. We also thank Els and her partner Leo who at a later stage were informed about the book and gave us their full and enthusiastic support. We have never worked on a publication that gave us so much joy and sadness at the same time.
Heemstede / Oud Ade, 5 January 2009
Marian Tankink & Sjaak van der Geest
