chapter  4
30 Pages

The social relations of therapy management

ByMark Nichter

Charles Leslie was the founding editor of the University of California book series entitled “Comparative Studies of Health Systems and Medical Care”. The first book in that series was John Janzen’s (1978) ethnography The Quest for Therapy: Medical Pluralism in Lower Zaire, in which he introduced the concept of the therapy management group. In the foreword to this book, Leslie (1978) encouraged anthropologists to study medical systems as social systems, not just systems of knowledge and treatment practices.1 The study of medical systems demanded ethnographic inquiry into how meaning was negotiated among the afflicted, concerned others, and practitioners as an illness progressed through time. It also required careful consideration of the broader social and political context in which medicine was practiced and illness experienced. It is in the spirit of such an inquiry that I return to an examination of the social relations of therapy management, a concept in need of refinement. While other essays in this volume attend to the relationship between state politics and therapeutic practice (e.g., Adams and Ferzacca) , This essay focuses on the micropolitics of therapy management and is organized around two case histories that lead us to consider the social relations of sickness in the context of poverty and social transformation.2