Pluralistic Practice: A Medical Anthropology Perspective
Dr Natalie Tobert, Medical Anthropologist, natalietobert@gmail.com , https://www.aethos.org.uk/
Multiple Narratives, Plural Perspectives
One essential requirement of the discipline of medical anthropology is to honour multiple narratives around health and wellbeing. Research within medical anthropology always ensures plural perspectives are explored, so people are witnessed according to their own understandings, and as well as from western Eurocentric perspectives. Plural perspectives are key to undertaking counselling and offering therapy with culturally diverse populations.
The work of a medical anthropologist always involves recording multiple narratives around health, so societies are not only witnessed from western biomedical perspectives, but also according to their own interpretations, acknowledging personal histories. I registered for a degree in medical anthropology ten years after I’d completed a doctorate, as it would offer me a language to engage with medical doctors and psychiatrists. Later I developed courses on Cultural Diversity and Mental Wellbeing and taught them for decades, in order to reduce social inequalities in health, enhance individual and community social inclusion, and support staff in engaging with ‘hard to reach’ people. Medical Anthropology discussion seminars on health and wellbeing, which I offered to first generation migrants at the Abdul Mageed Educational Trust (for African and Arabic Speaking Groups) were not considered therapy by participants, rather they were seen as communal support by known others in the group. These participants seemed to feel safer with shared communal healing.
Although I don’t have a clinical background, for the last 16 years I’ve offered training courses for 1st, 2nd , and 3rd year medical students at Brighton and Sussex Medical School. There students were taught medical anthropology topics, including those below, as part of a strategy to help them as future doctors understand the cultural background of their patients in a deeper way. The same is relevant for therapists and counsellors. Medical anthropology topics that were addressed were: On Being a Migrant; Meanings of Spirituality to Health; Women and Conception; Cultural Assumptions around the Body; Mental Health; Religious Experience and Expanded Consciousness; Death, Dying and Beliefs About Survival Beyond Death; and finally Cultural U-Turns made by Governments and Law Makers.
One Size Fits All?
My friend and colleague, psychotherapist Joe Bartholomew, founder of Radical Culture and The Indigenous and Transpersonal Therapies Alliance (ITTA) introduced me to pluralistic therapy. The pluralistic ethical framework proposes different things help people at different times in their lives. This means a ‘one size fits all’ approach is not appropriate: medical anthropology covers narratives from different communities, in different countries, of different faiths. It also can be used to show how throughout history there are changes in attitude, as governments and their populations shift their understanding and laws over what they believe is morally correct.
The inappropriateness of ‘one size fits all’ is clearly seen if we consider the topic of ‘Normal Body’, and explore what the word ‘normal’ means in this context. Does it mean we all have similar limbs, eyes and a mouth, or we have the same skin colour, or mobility? Participants explore different cultures’ understanding of ‘normal’, the effects of trauma and history background on body and emotions, and those who are differently sensitive, or have heightened clairvoyant faculties. Under this topic, it also considers plastic surgeries, desired for different parts of the body, in different geographical locations, with its positive and negative effects.
Cultural U-Turns
For myself, understanding a pluralistic ethical framework is essential when observing our current political scenarios and aggressions of war. If we consider the topic of Cultural U-Turns, we can see that nothing remains the same over time. Governments and law makers systematically change their minds, although it sometimes takes them a generation or two to revoke old laws and decriminalise people (for example: sex outside of marriage, babies born out of wedlock assumed to be mental deficient, forced adoption, homosexuality, forced schooling, preferred skin colour, preferred religion, criminalised abortion, certain refugees preferred over others, preferred languages, preferred class, supremacism, domination, and colonisation). The discipline of medical anthropology offers profound support to practitioners who undertake pluralistic therapy training.
Benefits of Medical Anthropology
What can medical anthropology offer to pluralistic therapy and pluralism as diversity in practice?
- The discipline honours equality and diversity.
- It raises awareness of social inclusion.
- It presents a range of cultural, religious, and spiritual beliefs, without judgment or hierarchy
- It illustrates multiple narratives, and shows there is not one single universal worldview, or truth, or belief system, but rather there are many socially and culturally contextualised worldviews and belief systems around the world.
- It sets out how culturally informed philosophical, metaphysical, and cosmological beliefs provide meaning, purpose, and a sense of identity in many people’s lives, and not simply identity in opposition, or by Othering other people.
- It discusses how western medical and therapeutic approaches can be developed and adapted to be more inclusive of the needs of: cultural minorities within society; colonised populations; or people who have moved or been moved from their country of origin. It acknowledges personal historical narratives.
- Workshops offer a series of training courses to promote social inclusion, both for new migrants, refugees, and asylum seekers who have been labelled ‘hard to reach’ by mainstream health organisations, and for all front-line staff.
Changing Times
The key issue of the discipline of medical anthropology is the essential requirement to honour multiple narratives and cultural explanations for health and wellbeing, particularly when working with people whose lands have been colonised, or who have been Othered at home, and with new migrant and refugees. However, when facilitating group workshops, it makes a huge difference during sessions if participants feel comfortable enough to offer examples from their own family background. I found that recent cohorts of medical students in Brighton were much more aware of cultural diversity and plural narratives than in earlier years, aware of differences of opinions from more old- fashioned lecturers. This suggests to me times are changing within the medical profession.
The advantages of providing equality and diversity training from a medical anthropology perspective is that the participatory discussions may reduce practitioner burnout, have a positive impact on trainee medical staff, front-line psychiatrists, psychologists, nurses, social workers, therapists, and counsellors.
Social inclusion training supports participants to become better informed by raising awareness of ethical practice: it promotes the importance of diversity across global cultural perspectives. It is essential for practitioners to have profound awareness during assessments and case study practices across mental health care services, and when offering therapeutic care for people with mental health challenges, acknowledging their histories and mundane daily life problems.
About the Author
Dr Natalie Tobert is a British Medical Anthropologist, who qualified ten years after gaining a doctorate in Anthropology and Archaeology. She conducted research in Darfur Sudan (1988), undertook two projects in India (2000, 2014), and later in London UK, with new migrants, refugees, and asylum seekers. She also conducted research in UK on spiritual and religious experiences (2007). Dr Tobert conducted research in London UK supported by the Kings Fund and NHS Harrow, with new migrants and refugees (2008), and then a project with the Somali community (2010a). A three-year health promotion project, showed new migrants how to access medical and health care services (2010b). During that time, community leaders thanked her for presenting access to services, but asked if she might also offer training to staff, to enhance their understanding of different cultural groups. This became the basis of her teaching cultural diversity and equality courses in medical schools, hospitals and with front-line staff. The book Cultural Perspectives on Mental Wellbeing (2016) supports this teaching. For the last 16 years she has offered training courses for 1st, 2nd and 3rd year medical students at Brighton and Sussex Medical School, and for three years for Peer-Supported Open Dialogue (POD) in the UK. She has facilitated in person workshops in UK, Ireland, Poland, Spain, Sweden, Switzerland and USA, as well as offering a 15-week training course online to global participants during the first UK lockdown, under the title ‘Clash of Beliefs’.
Further Reading from Natalie
Tobert, N. (1988). The Ethnoarchaeology of the Zaghawa of Darfur (Sudan): Settlement and Transience, BAR IS 445, Cambridge Monographs in African Archaeology 30.
Tobert, N. (2000). Anegondi: Architectural Ethnography of a Royal Village in India, Vijayanagara Research Monograph, no.7, Manohar Press, New Delhi
Tobert, N. (2007). In-Sanity: Explanatory Models for Religious Experience, Occasional Paper no.3, Series 3, Religious Experience Research Centre, University of Wales, Lampeter
Tobert, N. (2008). Mental Health Needs Assessment with BME Communities, NHS Harrow
Tobert, N. (2010a). Somali Advocacy Research Report, Mind in Harrow/Kings Fund
Tobert, N. (2010b). Bridging Cultures, Dissolving Barriers, Mental Health Promotion With BME Communities, End of Year Evaluation Report 2009 / 2010, NHS Harrow
Tobert, N. (2013). Cultural Equalities: Training Resource Pack for Medical, Health and Social Care Front-line Service Providers (Unpublished).
Tobert, N. (2014). Spiritual Psychiatries: mental health practices in India and UK, Virginia.
Tobert, N. (2016). Cultural Perceptions on Mental Wellbeing: Spiritual Interpretations of Symptoms in Medical Practice. London: Jessica Kingsley Publishers
3 thoughts on “Pluralistic Practice: A Medical Anthropology Perspective”
Dear Natalie Tobert,
I was delighted to read was delighted to read your blog post, and deeply appreciative of the contribution it makes to the on-going development of pluralistic practice. Medical anthropology, and ethnographic research as a whole, has highlighted over and over again the simple fact that individuals and communities are endlessly resourceful in terms of developing ways of making sense of problems in living, and creating healing practices that are appropriate to different contexts. From an ethnographic perspective, the existence of Western theories of therapy, that claim to offer explanations that are universally valid, begin to look quite strange activities. Your own research, and that of many other medical anthropologists, provides a powerful rationale for a pluralistic approach to therapy based on dialogue between client and therapist, and shared decision-making, that draws on the ideas of each participant about what might be helpful. The courses you run for medical students would be equally valuable for counsellors and psychotherapists in training – as well as more experienced colleagues whose own training did not address such topics. On the whole, therapy training programmes are resourced at a much lower level that medical training, so it would be hard to see that any single pluralistic (or other) therapy course could afford to offer such workshops. However, in an age of increased use of on-line teaching, it would be an exciting project to develop learning materials and events that could be incorporated into several courses rather than just being delivered in one university. Finally – in addition to the valuable books and articles that your list in your blog entry, I would recommend your 2018 paper (“Cultural U-Turns in Mental Well-Being: Acknowledging the Dilemma”) in the Journal of Humanistic Psychology [this article can be accessed through Google Scholar], which I personally found very helpful in allowing me to begin to have a clearer appreciation of how pluralistic therapy is one strand in a much wider movement within the field of mental health.
With thanks
John McLeod
Thank you John McLeod for your kind comments. Recently when I gave a talk on mental wellbeing, someone in the audience suggested I was being provocative, when I was merely stating how things were. I am grateful for your insights. I always wanted to offer the course universally, which the internet makes possible. I’d be happy to work together to develop learning materials, that can be incorporated into different courses, according to the skills and expertise of colleagues. I prepared a resource pack years ago (with discussion exercises and case studies), which I am happy to share with you, to explore whether it can be revamped appropriately. Most recently I’ve been teaching the course with medical students focusing on “Know Your Patients”. Thank you for your comments, Natalie
Thank you John McLeod for your kind comments. Recently when I gave a talk on mental wellbeing, someone in the audience suggested I was being provocative, when I was merely stating how things were. I am grateful for your insights. I always wanted to offer the course universally, which the internet makes possible. I’d be happy to work together to develop learning materials, that can be incorporated into different courses, according to the skills and expertise of colleagues. I prepared a resource pack years ago (with discussion exercises and case studies), which I am happy to share with you, to explore whether it can be revamped appropriately. Most recently I’ve been teaching the course with medical students focusing on “Know Your Patients”. Thank you, Natalie