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A second criticism of the dichotomy hinged on the fact that both disease and illness were individual attributes. The term illness referred, as it still often does, to an individual’s social relations, but generally only insofar as these caused the illness (e.g., when an offended party placed a hex) or as the illness leaves the individual unable to fulfill social or role obligations. Some scholars working in the 1970s wanted to link suffering more palpably to the social order by examining how macro-social forces, processes, and events (such as capitalist trade arrangements) could culminate in public health problems and poorly functioning health systems (again, see Hahn 1984). Some recommended using the term “sickness” when highlighting larger social processes (see Frankenberg and Leeson 1976).

This definitional work occurred hand in hand with efforts to disassemble then-prevalent understandings regarding the nature of cultural systems. For instance, Arthur Kleinman’s 1978 contribution to the “What is Medical Anthropology?” conundrum accused his predecessors of reductionism. Kleinman denigrated the era of “sweeping comparative generalizations” and “ideal-type categorization,” which he painted as “superficial” and as couched at “too abstract a level to be relevant” (pp. 661–662). He argued instead for a medical anthropology that can “examine health and sickness beliefs as they are used in the usually exigent context of social action” (p. 661; emphasis in original). While the essay never said so explicitly, it in effect provided early support for a process-based theory of culture. It also questioned strongly “the tacit assumption… that medical systems are more or less homogenous, unchanging, and single” (p. 662).