Anthropology and Medicine From the Bottom Up

— Eric Reinhart, MD, talks about how we can play a more active role in our communities


"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

In this episode, Eric Reinhart, MD, an anthropologist, psychoanalyst, and psychiatry resident at Northwestern University Feinberg School of Medicine in Chicago, joins Henry Bair and Tyler Johnson, MD. While Reinhart is the first resident-in-training on this program, his path has been far from straightforward. Prior to residency, Reinhart conducted ethnographic work in Chicago's South Side, India, South Africa, and among migrant communities in Southern Europe. Through this research, he addresses the multifaceted effects of poverty and social inequities on community health.

During the conversation, they discuss how he applies his anthropology training to create culturally sensitive systemic changes and how healthcare providers can play a more active role in engaging with their communities.

In this episode, you will hear about:

  • 1:54 How having a deaf brother led Reinhart to medicine
  • 5:59 Reinhart's observations of the disconnect between the ideals he heard in medical school and the reality of how profit-driven hospitals operate
  • 12:46 Why Reinhart pursued a study in anthropology to learn how to address contemporary social ills
  • 19:37 How a case study of drug-resistant tuberculosis in Russian prisons informed Reinhart's evaluation of pandemics
  • 26:41 What drew Reinhart to psychoanalysis and psychiatry, and how he applies them to his field studies
  • 32:04 A discussion of the power structures inherent to medico-social field work and how to properly determine what a community needs
  • 41:21 Advice on how doctors and medical trainees can become empowered to help change the systems they work in
  • 48:42 How Reinhart hopes to apply his experiences to improve community-based care

The following is a partial transcript (note errors are possible):

Johnson: So, Eric, I was hoping that you could start out, you know, you are a little bit unusual in the sense that you didn't do just the straight through, you know, undergraduate, then MD, then residency path, right? You've had a little bit more of a circuitous route. So could you start by, well, actually, before you even get to your path, can you talk to us about what drew you into medicine and maybe that will mingle with your path, but how did you get to where you are today?

Reinhart: I don't know how to answer how I got into medicine without giving you maybe the answer to the first question. This more general background. So I grew up in a context where I didn't have a lot of professionals around me in my childhood, but one professional group that I was aware of and I did have close contact with was doctors.

And then I also grew up with an older brother who's deaf. He was born deaf. Throughout childhood, I was operating -- we lived in a hearing environment, not a lot of deaf people around in general -- and so I was operating as this interpreter all the time. And I was 5 years younger than him and you have this peculiar capacity as a young child to be hyper-empathetic in a way that's actually quite problematic if you become an adult and you retain this. But as a child, you have this and you have a hard time distinguishing between yourself and others and some kind of way, this is part of what it is to grow up.

So I experienced my relation to my brother, my brother's relation to the world, in a way that was quite formative for me. And he, being a deaf young boy, was presumed to not have abilities, presumed to have a certain kind of foreclosed future. There are only a certain range of things that he might be able to do. There was limited imagination and he didn't share this imagination of himself, and this was a constant site of struggle throughout his childhood, throughout his adolescence.

And I was very much part of this in some way, as I often mediated between others' expectations of him and his own expectations and perception of himself. And this was very, very important for me to come from a certain kind of perspective and relationship to disability, to stigma, to being presumed to be "other than" and not in fact to be presumed to be, but in fact to be "other" than the normative demands of one's environment.

And so, this structure to me, a certain kind of relationship to authority where I saw authority through this particular example with my brother, but as always, a kind of looming threat, something that would demarcate the inside and the outside of accepted systems of accepted identities and ways of being.

So when I went through later to college and ended up studying the history of science and medicine, I was particularly attracted to this because it was a disciplinary formation within the university that was particularly attentive to the way that something that was thought to be objective outside of politics or culture. But, you know, it's like physics, it's mathematics, it's biology. What do these things have to do with structures of power, etc? And then this whole discipline is oriented around unearthing the ways in which culture and politics and power shape what we regard as scientific knowledge.

And I was particularly drawn to the history of psychiatry and of medicine in its relationship to these kinds of normative demands. But that kind of led me then to thinking about this one profession that I had had exposure to as a child. And it drew me further into this field, not in a traditional affirmative way, like I identified with the field, but with an appreciation for the enormous social power that this field leverages in shaping people's perceptions of themselves, their social relationships, this kind of thing.

So I was always drawn to medicine for two reasons. One, because I saw this as a crucial site where knowledge, power, and social life come together in this very frictive way. And then also because I didn't know how else to make money to have a career, I didn't really know what you could do. I didn't imagine that I could, for example, become a professor like the teachers that I had at Harvard. That wasn't something I'd seen in my youth. I had no conception that I could do that kind of thing. So part of falling into medicine was in part accident from pragmatic demands. I needed to figure out some way to provide for myself. And this was one of the very few ways I could imagine doing so.

Johnson: And so you go to college, as you mentioned, and then coming out of college, where did you go next? And then how did that eventually bring you to actually coming to medical school?

Reinhart: So when I was in college, I had the good fortune of studying with a series of people who were physicians and anthropologists or historians, so people like Paul Farmer and then others who were not physicians but are very much in that world. So Allan Brandt, as a historian of science and medicine at Harvard. These people made me think that there was a possibility for engaging with the medical world, engaging with clinical care, and not being fully absorbed into the normative systems that it usually instills into its practitioners, which, you know, I'm not saying that those are all entirely bad, and they serve functions, but for me personally, that was very important because of this kind of deeply seated suspicion I have of these kinds of systems, so inspired in part by these people who lived within a medical world, but in a different kind of way.

I ended up going to medical school at the University of Chicago, and I happened to enter there at a very, what for me became, a very important time. University of Chicago is like many academic medical centers in the U.S. It's set in a particularly dispossessed and racialized part of Chicago, in the South Side of Chicago. And this was a period where there was mounting community activism around demands for a level I trauma center, the kind of trauma center that responds to people who have suffered gunshot injuries or stabbings or often car crashes, this kind of thing.

There was not one on the South Side of Chicago, had not been one for over 20 years. And so all of these people were being shot in the neighborhoods around the city of Chicago, put in ambulances, taken, you know, 10, 15 miles north or west to other hospitals and many times dying along the way.

So the community, particularly young people, 17, 18, 19 [year old] people whose friends were being shot and killed in front of them, began to organize really around this demand that because of the emergency nature of this problem within our communities, we are owed the kind of care that this institution, which is very wealthy, is refusing to provide and has been persistently refusing to provide.

So I was witness, and I maybe am ashamed to say in some kind of way, really witness, I wasn't really participatory, but I was witness to these kinds of movements, which then made me yet again very keenly aware of how these sites of institutional power articulate with surrounding demands and needs that they often don't meet for various politically structured reasons.

That then later shaped my anthropological work, which entailed coming back to Chicago to work on questions of violence and emergency in the South Side. And then that in turn shifted to something else which we can talk about later.

For the full transcript, visit The Doctor's Art.

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