Levels of explanation and cautions for a critical clinical anthropology.

The appearance of a critical approach to clinical anthropology raises a question of relevance. Critical medical anthropology itself has developed with a primary concern for the impact of capitalism on Third World health, the inequality of medical resource distribution both in the U.S. and abroad, and the hegemony of Western biomedicine over local medical systems. Such an orientation may be of but modest relevance for an understanding of clinical phenomena in the heartland of capitalism itself. In the U.S., both patients and clinicians tend to share multiple values, including commitment to capitalism and the biomedical paradigm. Moreover, various negative behavioral characteristics visible in the clinical setting (such as racism) are common outside medicine, and may not be profitably understood through usual critical orientations. A heuristic model that gives excessive weight to a single element (capitalism) of a single (macro) level of explanation may not be as useful as one that utilizes a multi-level, multi-element approach. The argument is made that such a broader, more holistic approach may offer greater understanding of so-called micro level processes--specifically the patient/clinician interaction in specific clinical settings. An example is provided from a midwest hospital. It is suggested that if change in the biomedical system is a goal of a critical clinical anthropology, the impact will be greater where objective and broad causal connections can be demonstrated with minimal use of rote or polemic arguments.