Book Forum––Harris Solomon’s Metabolic Living: Food, Fat and The Absorption of Illness in India by Todd Meyers
Harris Solomon’s Metabolic Living traces patterns of consumption, calories, and chronic disease to tell a story about the enfolding––the absorption and regulation––of food in and about the body in Mumbai. Solomon’s book is a powerful ethnographic reflection on how factors held as exterior (local and global cuisine, evolving and competing norms regarding eating and body image) are wholly interiorized. We are happy to present a lively set of commentaries.
Meta-Metabolism, or Governing from the Inside Out
Mumbi Metabolism Mysteries
University of Edinburgh
More Mango Madness
Metabolic Living with Madhur Jaffrey
University of Oregon
No Recipes: A Reply
Metabolic Living Book Forum on Scribd
Sonya E. Pritzker’s Living Translation: Language and the Search for Resonance in U.S. Chinese Medicine by Miao Jenny Hua
Berghahn Books, 2014, 228 pages
Chinese medicine names at least five components to the spiritual part of the embodied self, corresponding to each of the five organ-systems. The shen-spirit is associated with the heart, the yi-spirit with the spleen, po with the lungs, zhi with the kidneys and hun with the liver. These are not just technical jargon; each “spirit” has distinct connotations in everyday life. But how does one capture such subtle variations with actionable precision in the context of clinical Chinese medicine in the United States?
This is the kind of daunting question that Sonya Pritzker’s Living Translation addresses with exquisite ethnographic detail. Denying from the start that she is providing a how-to guide on translating Chinese medicine, Pritzker instead portrays the variable ways in which translations are enacted (2). With an eye to the world-making effects of practice inspired by Annemarie Mol (2002), “enact” is a capacious enough verb for Pritzker to capture translation as multiple modes of making lived equivalences. An ongoing process from monographs to conferences, classrooms to clinics, theoretical arguments over translation are never fully settled and clinical remedies in translation are rarely neatly reductive.
In the early twentieth-century, “Chinese medicine” was constituted as a defensive response to the discrediting advances of modern science and biomedicine in China (25). In the 1960s and 1970s, Chinese medicine was swept up as part of the New Age Movement in the United States, eventually achieving widespread institutional recognition as a form of Complementary and Alternative Medicine (CAM). Rather than having to constantly demonstrate its compatibility with scientific medicine in the modern Chinese context, U.S. Chinese medicine has engaged in a broader countercultural critique against the professional power and dehumanizing technologies of biomedicine. Translating specific Chinese medical terms is situated within a moral landscape of medical pluralism that take on different articulations on two sides of the pacific, where science is pitted against spirituality and authenticity in different terms. Chapter One of the book provides a cogent overview of the moral struggles and conundrums that translators and practitioners of Chinese medicine face in the United States.
Pritzker then devotes the next two chapters to review the textbooks and monographs that have most crucially influenced Chinese medical education in the United States, interspersed with interviews with translators. Chapter Two surveys different ideologies of language and translation surely familiar to translators and linguistic anthropologists while making for a good introduction for non-initiates. A dip into the literatures on Chinese medical translations readily shows how vociferously translational decisions are contested. One translator Pritzker cites, based in China, panned the erudite work of an Anglophone translator as perpetuating “Oriental folklore” in the guise of fidelity to tradition (Xie et al. 2005). Such controversies pivot around the social imaginaries through which Chinese medicine has been constituted and daily practiced, drawing on different moral landscapes of science and spirituality.
The second half of the book are based on 24 months of fieldwork at a school of Chinese Medicine in Southern California, where, having undergone similar training, Pritzker considers herself often in the position of a native ethnographer (5). She recorded interviews and classroom conversations, which were painstakingly transcribed using Jefferson system of notation in an effort to preserve real-time pauses, dialogic interjections, laughs and intonations. Drawing on linguistic anthropological theories, the ethnographer analyzed the transcripts for instances of competing ideologies of language and translation. The result is that there is an evidential rigor to the way in which Pritzker portrays translational practices in ethnographic text. Following a relatively consistent cohort of students throughout her fieldwork and asking them to revisit some of the conversations they’ve had about translation along the way, Pritzker’s fieldwork is exemplary for its consistency and detail.
One conversation Pritzker recorded with a student named “Julia” makes repeated appearances throughout the book. Earlier in her career, Julia expressed exasperation after a lecture about “qi,” complaining that trying to translate key concepts seems to inexorably descend into rabbit holes only to ultimately concede, “qi is qi” (128). What’s the point in delving further or providing more precise glosses? For Pritzker, this sort of statement is iconic of a whole network of ideologies about the arbitrariness of language as opposed to the universality of medical knowledge. Words are abstractions of ideas at best, a distraction from the truth at worst (58-59). Who cares what you call it: “qi is qi.”
Ambivalence about translation, denial being one extreme, is pervasive not only at the school for Chinese medicine, but also among those who translate Chinese medical ideas as a literary vocation. Returning to engage with textual translations in Chapter Three, Pritzker juxtaposes several keystone English-language monographs on Chinese medicine to discuss how qi has been translated as “life force”, “vigor of motion,” “energy,” “the very basis of the universe’s infinite manifestations of life,” or “a pictogram of steam rising from rice as it cooks” (123). Most author-translators leave qi untranslated, instantiating an ideology of linguistic incommensurability. Even still, they differ as to how to render qi in print – capitalized or not, italicized or not.
These chapters draw upon a rich literary and philosophical tradition to expound on how “living translation” takes place at the intersection of hermeneutics and embodiment – as an intertextual and interactional event – whereby linguistic alignments figuratively and pragmatically weave together a complex itinerary within the horizons of social life (147). That is to say, definitions are not ever simply equated as terms with abstract references in practice, although dictionaries often perform such ideologies of linguistic unity and commensurability. In Pritzker’s view, inscriptions in books are but one stop in a larger conversation that does not get transcribed. Dictionaries are the distillations of extended phone or epistolary conversations, lifelong disagreements, and standardization movements toward achieving greater political recognition for Chinese medicine. Even so, books can disclose these larger conversations of which they serve as accessible tips.
So in what larger conversations is Living Translation embedded? Pritzker’s extended ethnographic consideration lends to a distinct theory of translation – with layovers along the way in continental phenomenology and hermeneutics. This brings us to the book’s central theme: embodying evidence, equivalence, and especially resonance as highly valued moral goods of translation. “Resonance” is also a translated term; Pritkzer defines it early on as ganyin, or “the connection between practitioner and patient” (8). There are other translations of ganyin and circumlocutions of “resonance,” but the gloss Pritzker provides,“embodied equivalence,” is I think felicitous for accentuating the performative dimensions of its concrete constitution. This turn to “resonance” as the valuable outcome of translation marks a significant departure from literatures in science studies, which tend to emphasize consensus as translation’s primary end.
Resonance is highly sought after precisely because it promises to bring about mutual understanding. Far from conclusive, living translation intensifies “a search for the self, a search for wholeness, spirituality, for authentic, effective practice, and for a language that addresses the real needs of patients” (7). Pritzker specifically thematizes the search for resonance as a mode of clinical action in Chapter Six, describing a clinical encounter students partake in alongside one of their most compelling instructors. A sequence of translational deciphering and extended discussion between teacher and students produce a complex clinical picture of a patient seen in the clinic for “anxiety” (181-4). The group deemed that the patient could be afflicted with PTSD as her pulse manifested a dispersion of po-spirit and shock to lung-qi, all of which is consistent with an autonomic reflex gone awry. Rendering diagnostic decisions in translation weaves together initially discordant medical theories through local negotiations and revisions. Tentative equivalences are made with the force of embodied commitment. Anything but arbitrary, embodied resonance is the stuff that composes therapeutics.
Appropriately, Pritzker concludes the book on an appeal to further the search for a more resonant language: “it is my hope that the ethnographic story of living translation presented here can further contribute something toward healing the divide between ‘scholarship’ and ‘practice’ at the level of language in the translation of Chinese medicine in the United States” (191). In the end, the “search” that precedes “resonance” remains most resonant.
Mol, A. (2002). The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke University Press.
Zhu-Fan, X., & White, P. (2006). “Comments on Nigel Wiseman’s A Practical Dictionary of Chinese Medicine (II)—On the use of Western medical terms to express the concepts of traditional Chinese medicine.” Chinese Journal of Integrative Medicine, 12(1), 61-65.
Miao Jenny Hua is a doctoral student of anthropology at the University of Chicago. She is three years into completing a doctorate in allopathic medicine. Her project explores the connections between traditional Chinese medicine and biomedicine in Chinese clinical contexts.
The Graphic Anthropology Field School (GrAFs) is a project launched by Expeditions, an independent network of scholars in the human sciences. For 11 years, we have been holding in Gozo (Malta) a summer school for anthropologists and social scientists, focused on the practice of fieldwork. Far away from sleepy lectures in gloomy classrooms, our aim has always been to keep our feet on the ground and experiment with tools and tricks for fieldwork practice.
The idea of offering a separated program entirely dedicated to graphic anthropology grew during the past two years. The project started quite randomly as a colleague saw me sketching a scenery. His interest was piqued and he suggested that we take some students to grab a coffee and sketch at a terrace as a group. Of course, the ulterior motive was to figure out if drawing could serve as observation and analysis in the field. But we quickly acknowledged it was more than that: drawings present numerous advantages at different stages of the research process. More importantly, sketching appeared as a handy activity for young and sometimes inexperienced researchers to access the field more easily. Also, it did not require any expensive gear nor specific skill: everyone can trace lines on paper.
GrAFs views drawing as a practice of “making” more than “taking” (Taussig 2011). Drawings are far less intrusive than photography, and encourage the necessity to take time, observe, wait, and get lost with fieldwork. In the field, the utility of sketches appears from a low-brow but most useful kind: sketching a scene gives one “a reason to be there” in situations where even senior researchers might struggle with a feeling of being “out of place.” It also helps to fight boredom in the field, serves as an opportunity to take the notebook out of the pocket and often provokes new and unexpected interactions. Something intriguing about sketches, especially when compared to standard field notes, is indeed their capacity to amuse people and arouse curiosity: sketches truly have the ability to get conversations flowing. As an observation tool, graphics may also help to explore different and perhaps more relaxed mindsets, push to look at things from multiple angles and help the researcher to realize — more than textual notes do — how subjective and biased his perceptions are.
As one among many other projects (http://www.anthropologyfieldschool.org/), our experiment with graphics quickly turned into a full-grown graphic anthropology workshop, and some of the participants used sketching in ways that did not originally occur to us. For example, in studying migration, one student turned drawing into a tool for icebreaking and reciprocal observation by having she and her informants sketch each other. Thus, this activity balanced the ethnographic relation in a more equal way. Another student found reflexive sketches useful for getting rid of fieldwork’s anxieties and traumatic experiences. Finally, a staff member let the process of drawing carry her through music played in a Gozitan village festa, experiencing sketching as a way to record sounds and senses.
Boosted by these early achievements, developing GrAFs was a way to give us more time to explore the potential and limits of graphic anthropology, something our academic lives do not always leave room for. The program, which took place in March and April 2016, was set up as a mixture of collective field trips, individual research and technical exercises (such as live model, portraying or perspective sessions). It was tailored to give us a grasp on the uses of graphics for both fieldwork and results communication, as well as to confront us with artistic drawing techniques from an anthropological point of view. Among other themes, we explored the practicalities and ethics of drawing and, for example, its potential to record social memories, gestures and techniques. In order to train in keeping visual field notes and organizing graphic narratives, some specific assignments included the production of ethnographic postcards, a daily comic report and a collective storyboarding session of a paper on Gozitan food culture. But, most importantly, participants were asked to draw all the time and never erase their lines. After a few days, drawing really became addictive for most of us.
Unfortunately, getting into each of these rich experiments would outstrip the scope of this post. In the next paragraphs, I will rather try to sketch out two general observations which, I hope, will be of some interest for other graphic anthropologists. Of course, it is clear that I do not speak here for all participants who gathered in Gozo, but rather from my personal point of view (you can find another report of the school here).
The first observation I want to bring in this discussion is about the possibility of using drawings as a form of performance in the field. What I am personally more enthusiastic about here is the transformative effect ethnographic drawings can have on the notebook itself and, accordingly, on the people who come to handle it. While writing always feels so secretive, drawings are “an invitation to watch and ask questions” (Hendrickson 2010: 34) as well as to make comments and edits. Because of their accessible nature, drawings have the potential to demystify the notebook by making its content public and consequently open to discussion and negotiation. Passing from hand to hand, the notebook becomes a mobile and participative museum which allows space for dialogue, collaboration and the expression of multiple levels of reflexivity. In the field, “one is constantly testing one’s interpretations and understanding by finding ways to play them back to informants” (Calzadilla and Marcus : 98); and this is exactly one of the reasons why drawings are useful. Of course, to reach this asks for some willingness, try-outs and also mistakes from the part of the ethnographer. And mistakes do happen. For example, one of the preoccupations that arose during the program concerned the iconicity of our drawings: what if we make a drawing of someone which looks negatively different from the way this person perceives herself? Drawings are not innocent. Sometimes, they can even be deadly serious.
Nevertheless, was it conscious or not, some of us developed clear techniques to foster people’s curiosity and comments. Echoing Ballard’s (2013: 139) depiction of portraiture as a “powerful plastic form of social interaction”, one participant made a point in using sketches of storefronts to trigger dialogue with bartenders and shop owners. As for myself, drawing with two hands or with watercolors proved being a solid trick to get other people’s interest. In the same vein, I cannot help but notice that I have progressively abandoned inconspicuous notebooks over the past two years. If one’s goal is to attract attention, draw bigger.
In this sense, drawing in ethnographic notebooks may best be described as an act of performance. A “theater anthropology” (Calzadilla and Marcus : 99), where the notebook itself becomes the stage on which the ethnographer and the interlocutors meet, discuss and debate both the script and the decor. In this mise-en-scène, the distinction between ethnographic drawings, participative drawings and what I would call “exposition drawings” (i.e. drawings that are intentionally made to communicate research results, like ethnographic expositions or anthropological comics) often tend to get blurry. The distinction, thereof, might not be heuristically fruitful.
The second observation concerns drawing style. As days passed, intimacy and trust grew among participants of the program and I felt the need to move away from a realistic style to more sketchy, conceptual and overtly subjective drawings. Drawings which, thanks to obvious distortions of apparent reality allowed me to stick closer to the lived experience of the moment. “In pointing away from the real, they [these drawings] capture something invisible and auratic that makes the thing depicted worth depicting” (Taussig 2011: 14-15).
Somehow, this process recapitulates the evolution of visuals in the history of anthropology itself. As David Macdougall (2004) points out, anthropologists slowly neglected realistic drawing, photography and film as they moved away from an ethnology mainly based on visually apparent aspects of human societies (dimensions of the body, skin color, masks and haircuts, material culture, architecture, formal rituals, etc.); to later rediscover film, but also a more figurative and conceptual form of drawing as an alternative to the limits of text in research topics such as, among others, memory, emotions, senses, sexuality, time or space.
Moving away from a superficial observation through drawing was, for me, a slow process. This difficulty might reflect a limit posed by a mode of inscription which does not automatically step away from the visual paradigm predominant in Western societies and academia (Ong quoted by Clifford 1986: 11). Some refer to ‘seeing through drawing’ as a haptic practice (see Ingold 2013: 139, Taussig 2011), and in many ways they are right to do so. But we do need to stay aware of this pitfall of visual thinking, especially for untrained artist-anthropologists : the eye first leads to what is visible. Thereof, the lack of training anthropologists show in both the history, the making and the interpretation of visuals is a risk at stake here. It did take Kandinsky his whole life to find his way into — and out of — figurative painting, did it not?
In our experience, learning to draw continuously — while talking, eating, walking or even standing in the middle of a busy bakery — helped growing confidence in our practice, develop a deeper intimacy with it and, in return, with the field. If field researchers want to avoid rigidifying cultures behind technical or organic drawings, artists-anthropologists really need to grasp lines of movements and actions, lines of life (Ingold 2011: 1-21). To do so, they need to be part of the flow, to move in it and, why not, to sketch with it. At least, this is what we will intend to do in the 2017 edition of our graphic anthropology program!
Kim Tondeur is a researcher and trainer at Expeditions. Research in Applied Anthropology. In Gozo (Malta), Kim carries ethnographic research in a small rural community, focusing on perceptions of change, Europe and globalization. His main research interests lie in the anthropology of neoliberalism, ecological systems and social inequalities. One of Kim‘s specialities is graphic anthropology. Through his fieldwork and workshops, he explores and studies the possibilities offered by sketches and drawings as a tool for ethnographic research and social sciences.
For September 2016, Charlotte Brives, Frédéric Le Marcis, and Emilia Sanabria edited a special issue of Medical Anthropology titled “The Politics and Practices of Evidence in Global Health.” Evidence-based medicine (EBM), the authors write in their Introduction, is pervasive among contemporary practices of governance. The articles in this special issue provide ethnographic perspectives on the practice and production of evidence-based medicine across the world.
Here are the abstracts!
What’s in a Context? Tenses and Tensions in Evidence-Based Medicine
Charlotte Brives, Frédéric Le Marcis & Emilia Sanabria
In this special issue, we bring together articles that engage ethnographically with practices of EBM in diverse localities—a bariatric surgery ward in Vienna, a tuberculosis control unit on the periphery of Paris, the practices of child psychiatrists in Portugal, the board meetings of a global vaccine venture and its implementation in Burkina Faso, and at the intersections of human immunodeficiency virus (HIV) treatment, hunger, and nutrition in Southern Africa. Our aim is to engage with EBM not as an ideal type, everywhere the same, but rather to engage pragmatically with the translations, negotiations, adaptations, failures, and successes of its deployment on the ground.
Through an ethnographic exploration of tuberculosis control in one of France’s poorest regions, Seine-Saint-Denis, I interrogate the relationships between public health planning and interventions in conditions of multiple precarity. I show that the encounter between the feasible and the fantastic in the realm of public health generates feelings of absurdity and futility among medical professionals, characteristic of disease control in the precarious present. Precarity is neither a social and economic condition per se, nor is the link between disease and precarity static. It is a dynamic process of political inclusions, exclusions, and inequalities, which differ substantially within the unequal spheres of precarious lives. The contradictions in tuberculosis control that I describe are thus not only characteristic of French public health but of global public health today, where illusions in disease control encounter the exclusionary realities of social life.
Drawing on medical anthropology and science and technology studies, I present a case study of the diagnosis of attention deficit hyperactivity disorder (ADHD) in Portugal. In a country where ADHD is a relatively recent medical category, still undergoing validation, the diagnosis is not primarily bound to an evidence-making role, and its epidemiology remains largely unknown. Notwithstanding, the diagnosis has been carried out by child psychiatrists and developmental clinicians who describe it as the most prevalent disorder that affects school-aged children and adolescents. In this article, I examine the global data, local diagnostic protocols, and clinical practices that are adapted and selectively mobilized in the making of the diagnosis, in a context in which making ADHD evident is at stake. The findings show that what counts as ADHD and what it means in each setting varies, and that the diagnosis may be understood as a situated process.
Caring For Evidence: Research and Care in an Obesity Outpatient Clinic
Kay Felder, Ulrike Felt, Michael Penkler
In recent years, there has been a substantial increase in bariatric surgery rates. This form of obesity treatment is often subjected to the critique that it turns patients into passive objects of medical intervention. Similarly, efforts to ‘rationalize’ medicine, as in evidence-based medicine, are sometimes denounced for imposing a ‘one-size-fits-all’ approach that neglects patient diversity. We argue that these critiques fail to do justice to the complexities of actual care situations. In our ethnographic study of a project for bariatric pre- and aftercare, we show how research protocols not only close down but also open up spaces for patient-centered care. Despite professional cautions, experiences of stigma and broader imaginations of biomedical care often lead patients to embrace surgery as a treatment conceptualized as a technological fix. We argue that investigations of how research and clinical practice intertwine need to be both empirically grounded and sensitive to wider societal contexts.
Ambiguous Capture: Collaborative Capitalism and the Meningitis Vaccine Project (open access)
The primary health care approach advanced at Alma Ata to address social determinants of health was replaced by selective health care a year later at Bellagio. Subsequently, immunization was endorsed as a cost-effective technical intervention to combat targeted infectious diseases. Multilateral efforts to collaborate on immunization as a universal public health good ambiguously capture the interests of the world’s governments as well as private, public, and not-for-profit institutions. Global assemblages of scientists, governments, industry and nongovernmental organizations now work in public-private partnerships to develop and make essential vaccines accessible, with vaccines marketed as single fix solutions for global health. Drawing from ethnographic fieldwork in France and Burkina Faso that followed the development, regulation, and implementation of the group A meningococcal conjugate vaccine for sub-Saharan Africa, in this article I describe events during and after the development of MenAfriVac. A technological success narrative steeped in collaborative capitalist rhetoric disguises neglected health care systems.
How might we understand and respond to the new forms of hunger that arise with the massive rollout of antiretroviral therapy (ART) for HIV in southern Africa? Rather than ‘merely’ a technical problem of measurement, medicine or infrastructure, I suggest that a philosophical question arises concerning the relationship between the experience of hunger, the utterances that communicate that experience, and the bodily regimes of well-being and ill-being indexed by such utterances. Taking the gut as a particular kind of mediator of experience, I draw on ethnographic fieldwork conducted in KwaZulu-Natal, South Africa to open up a set of questions on acknowledgment and avoidance. The central question concerns the divergent concepts of ‘grammar’ that confront the relationship between hunger and ART.
Anthropologists in Global Health Experiments (open access)
Anita Hardon & Robert Pool
Can global health experiments be part of more flexible systems of knowledge generation, where different bodies of knowledge come together to provide understanding not only of the outcomes of new interventions but also of the mechanisms through which they affect people’s well-being and health? Building past work in which they tried to transform how global health experiments are carried out and inspired by the articles in this special issue, the authors of this commentary argue that strategic collaboration is needed to break the hegemony of randomized controlled trials in designing global health technologies. More open-ended experiments are possible if anthropologists team up with innovative researchers in biomedicine to develop new conceptual models and to adopt novel observational techniques and ‘smart’ trials that incorporate ethnography to unravel complex interactions between local biologies, attributes of health systems, social infrastructures, and users’ everyday lives.
For this installment of Top of the Heap, I was delighted to work with Assistant Professor Adia Benton from Northwestern University.
I think it’s probably common for people to talk about how large their book heap is. Mine is no different. I’m at the end of my sabbatical and the beginning of my maternity leave. The former should have left me ample time to read, the latter… not so much. I am juggling a couple of book projects right now, so the books I have at the top of the pile reflect those interests and the ideas spinning off from them. The ones that continue to rise to the top are On Being Included, by Sara Ahmed. The book is about diversity initiatives in a university setting. In addition to being a useful account of these efforts at a time when these conversations are taking place in academia, I see this book as potentially offering lessons about how institutions “think”, how they issue documents and propose non-solutions to those problems. Expected Miracles, by Joan Cassell, is an older book. It’s still relevant in that it describes the culture of surgery in US hospitals and many of its insights still ring true for the surgeons I know. Habeas Viscus, by Alexander Weheliye, is a slim and dense book that provides a much needed corrective to accounts of biopolitics and bare life that are insufficiently attentive to race.
I’m almost done with Randy Packard’s A History of Global Health. Packard lays out a straightforward account of why, at different points in time, international health and colonial public health largely focused on disease-specific programs, rather than on the social determinants of health. I suspect it’d be a wonderful book in an introduction to global health course. Marion Moser Jones’s The American Red Cross from Clara Barton to the New Deal is a historical account of how humanitarian concepts like neutrality emerged. This complements anthropological accounts of humanitarian organization like those by Peter Redfield and Renee Fox.
I follow some excellent scholars on Twitter, so I find myself waiting for their new books to come out. I’m pre-ordering Christina Sharpe’s In the Wake. I’ve already recommended it to people based upon what I have already read and discussed with her because it does important work theorizing black life as operating in multiple registers of “the wake.” One of my current preoccupations is with public health surveillance—and particularly works that bring black studies and surveillance studies together—has gotten Simone Browne’s Dark Matters at the top of the heap.
And finally… The early months of infancy, for me, means catching up on television series. Either I’m watching edgy comedies, or police procedurals—British and American—but occasionally I pick up a random mystery book in a series. I am slowly reading Maybe (A Junior Bender Mystery) and just finished Honky Tonk Samurai, a Hap and Leonard novel.
Adia Benton is a cultural anthropologist with interests in global health, biomedicine, development and humanitarianism and professional sports. She is interested in patterns of inequality in the distribution of and the politics of care in settings “socialized” for scarcity. Her first book, HIV Exceptionalism: Development through Disease in Sierra Leone (University of Minnesota, 2015), explores the treatment of AIDS as an exceptional disease and the recognition and care that this takes away from other diseases and public health challenges in poor countries. Her second book project, tentatively titled Cutting Cures, focuses on the global movement to improve access to quality surgical care in poor countries, using it as a case study for describing and understanding ideological formations in global public health.
Image: Book Cave.
Megan Crowley-Matoka’s “Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico” by Parsa Bastani
Duke University Press, 2016, 336 pages
In Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico, Megan Crowley-Matoka carefully grapples with the symbols and everyday practices of organ transplantation in Guadalajara, Mexico. Her research focuses on transplantations that take place in two resource poor yet key public healthcare systems at the helm of transplant medicine in Mexico. Through detailed ethnographic engagement with clinicians, government officials, patients, and their families, Crowley-Matoka follows the discursive life of multiple icons that have come to shape organ transplantation in locally particular ways. These icons are various and woven throughout the text, including la familia mexicana, the suffering mother, el mestizo, and “the slippery state.” The theoretical framework of the icon allows her to analyze the powerful and contested representations by which transplantation is signified and materialized in Mexico.
In developing her analysis, Crowley-Matoka most consistently draws on the icon of la familia Mexicana or the cohesive and self-sacrificial Mexican family. She argues that organ transplantation is a domesticated endeavor. As such, the Mexican family holds iconic currency on multiple scales. For the biomedical establishment, the evocation of “la familia” functions as a cultural and moral technology that has enabled Mexico to excel in transplantation from living donors. In the national imaginary, organs are understood to move from mothers to their (male) family members (Chapter 1). For transplant professionals and patients, the ideal outcome of transplantation is yoked to the attainment of a (hetero) normative Mexican family (Chapter 4). In other contexts, the iconic status of the family is less positive. For example, politicians blame the family for preventing the Mexican transplant initiative from expanding its expertise to cadaveric donations, due to the reluctance of surviving family members to consent to the medical use of their loved one’s deceased bodies (Chapter 2).
To the extent that Crowley-Matoka argues that the iconicity of domestication is productive of clinical, personal, and political transplantation realities, her book draws on Geertzian symbolic anthropology. Yet she is equally concerned with the complexities that said iconicity elides. She fully heeds Talal Asad’s directive in his critique of symbolic anthropology by staying fully cognizant of the question: “What are the conditions (discursive and non-discursive) which help explain how symbols come to be constructed, and how some of them are established as natural or authoritative as opposed to others?” (Asad, 1983, p. 240). Crowley-Matoka gives serious consideration to the gendered, professional, and socio-economic formations of power that keep icons alive. And beyond this, her engaged and careful research reveals that icons do not tell the entire story of transplantation in Mexico. She shows that iconic narratives of transplantation may not be quite as domesticated as they would initially seem.
Her use of “slipperiness” as a concept effectively captures ways in which people’s experiences of transplantation do not match its iconicity. She understands slipperiness to be the multifarious forms of illegibility and uncertainty that accompany and define transplantation endeavors in Mexico (p.14-15). For example, the “biounavailability” of cadaveric donations was not simply due, as politicians claimed, to ignorant and uncultured families that refused to donate their relative’s body parts. Rather she argues that the lack of cadaveric donations results from the conceptual, logistical, and political slipperiness of brain death in Mexico. This slipperiness includes logistical failures at the hospitals, uncertainties surrounding the state of brain death, and the wide perception of rampant corruption in state institutions (Chapter 2). Her analysis of patient’s lived experiences also exposes the slipperiness of transplantation’s iconic salvation narrative. Lack of medical expertise in smaller clinics and difficulties in maintaining steady employment with insurance benefits thwarted patients’ dreams of becoming “normal” and healthy via transplantation (Chapter 4).
One of Crowley-Matoka’s key contributions in this book is her underscoring of the disjuncture between clinical assessments of transplant outcomes and the lived experiences of patients. The clinicians and staff viewed patients as lacking sufficient will and “agility” both before and after transplant procedures to creatively navigate hospital bureaucracy, secure a job with insurance benefits, and ask for help when needed. In this way, transplant professionals shifted blame from the organizations and political economy of health care in Mexico to the patients themselves (Chapters 3 and 4). She astutely criticizes physicians for their narrow approach to healthcare, as they often ignore its social, economic, and institutional dimensions. Crowley-Matoka’s anthropological perspective allows her to take a holistic view of transplantation that both extends beyond the “transactional moment” and the giver/receiver dyad (Chapter 5).
Another astute theoretical intervention is Crowley-Matoka’s problematization of the organ “gift.” Often, clinicians and international organizations see familial donations in a positive light, as contrasted with the demonized organ commodity trade. However, her research reveals that even “gifts” can be the products of naturalized and unnoticed injustices, specifically those that relate to gender. She hones in on the widespread icon of the “suffering mother” who gifts her kidney to ailing (male) family members and the fact that Mexican women were less likely than men to receive kidney transplantations. Even with these critiques, Crowley-Matoka avoids the sweeping generalizations found in some first world feminist positions. Instead, she sits with a number of empirical puzzles and ethnographic vignettes that allow readers a glimpse into the disparities that render transplantation culturally intelligible for Mexicans.
At times, the icons she incorporates can feel too numerous or not integral enough to the subject matter, forming a dizzying medley that distracts the reader from the core issues at stake. Those examples that come to mind are La Guadalupe (Introduction) and the “baby Jesus, doctor of the sick” statue (Chapter 6). Keeping track of the multitude of icons makes it difficult to connect together the many themes of the book. Her arguments would have been more powerful if she had selected a few icons that operated as the most significant shared symbols of organ transplantation. Nevertheless, Crowley-Matoka’s semiotics-inspired approach successfully offers new insights into a growing body of anthropological work on organ transplantation.
Parsa Bastani is a second year PhD student in Anthropology at Brown University. His research focuses on drug addiction therapeutics in Iran and emergent social and political subjectivities.
Asad, Talal. “Anthropological Conceptions of Religion: Reflections on Geertz.” Man 18, no. 2 (1983): 237–59. doi:10.2307/2801433.
Biopolitics and Psychosomatics: Participating Bodies
8 July 2016, University of Cambridge
Darin Weinberg, University of Cambridge
Monica Greco, Goldsmiths, University of London
Robbie Duschinsky, University of Cambridge
Michael Schillmeier, University of Exeter
Can we think of our living bodies as involving forms of social intelligence, agency, and power? And if so, how might this proposition transform the ways in which we consider the possibilities and politics of patient participation? These were the questions at the core of the intellectual agenda of the conference “Biopolitics and Psychosomatics: Participating Bodies”, held on 8 July 2016 at the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the University of Cambridge. The event—co-convened by Monica Greco (Goldsmiths), Darin Weinberg and Robbie Duschinsky (University of Cambridge) and Michael Schillmeier (University of Exeter)—aimed to reclaim the term ‘psychosomatic’ from the reductive and polemical forms of engagement in which it is often caught, and use it as a springboard for reframing questions of agency, embodiment, responsibility, power and choice in the context of current challenges facing state-sponsored service provision in Europe and the US. The spirit of the conference was explicitly exploratory, more concerned with creating space for a new type of conversation than to provide direct answers to the many questions raised. Despite a last-minute cancellation by Laurence Kirmayer, who was scheduled to deliver the closing keynote, the conference proved successful, stimulating discussion and debate about these important and timely questions, on practical, political and intellectual levels.
After Darin Weinberg’s welcome address Monica Greco’s introduction outlined the multiple connotations of the term ‘psychosomatic’ and the striking contrast between them. Despite designating a thriving interdisciplinary research field (‘psychosomatic medicine’) that, in the course of its history, has articulated in multiple ways how culturally mediated social relations might get ‘under our skin’ to produce both physical and mental ill health, the adjective ‘psychosomatic’ also routinely carries the reductive and offensive connotation of designating illnesses as being ‘all in the mind’. For some, this might be reason enough to abandon the concept, but for Greco the value of the term lies precisely in the ‘awkward’ way in which it forces us to confront uncomfortable questions around the value of illness and the active powers of the body. If these questions are not crudely reduced to instruments for blaming and stigmatizing patients, Greco proposes they hold potential for rethinking biopolitical issues which concern social inequality and responsibility for health. These questions become particularly relevant in societal contexts of participation where service users are encouraged to be active partners in care. They hold the potential for rebalancing the rather ‘disembodied’ way in which existing narratives and practices of participation conceive patients. Informed by Michel Foucault’s genealogy of how biological life became an object of government to be known, fostered, and administered, Greco raises questions of how a socially and historically engaged concern with psychosomatics might re-configure how we think about biopolitics. These are big and bold questions that demand creative interdisciplinary attention, hence the selection by the convening group of speakers and discussants spanning a range of disciplinary, conceptual and methodological perspectives.
Following the programme order I offer summaries of the contributions given by the speakers. I also summarise participant discussions, and conclude with a brief reflection on the day.
The conference’s keynote by Felicity Callard examined how psychiatrists Donald Klein and Max Fink observed and evaluated the effects of drugs trialled on psychiatric hospital ward patients in the 1950s and 1960s, looking carefully at how attributions of agency for different effects were made. Later, in the 1980s, Klein would join the taskforce for the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), which would be published to include the category of panic disorder for the first time. One of Callard’s key arguments was that Fink and Klein’s early experiments were central to the forging of this category and its eventual establishment in American and international psychiatry.
In contrast to today’s more standardized and controlled procedures for clinical psychiatric research, Callard described how Fink and Klein had advocated open creative experimentation using numerous, and seemingly ‘messy’, measures. However, whilst data collected included assessments of drug action from a wide range of actors in a variety of settings, Callard paid attention to the ways some interpretations were prioritized, while others were de-selected. Notably, this was illustrated by examining the kinds of observations that were given credence by Fink and Klein, in particular regarding assessments of the authenticity of patients’ outward expressions of their inner states. The views of psychoanalytic therapists based on talk with patients, and explanations from patients themselves, were predominantly judged as erroneous, whereas observations of patients’ behaviours and affects by clinical researchers and nurses in the ward were held to be of higher accuracy. This latter group were also credited as especially expert at assessing the effects of drugs on patients put in a ‘somatizing’ set—a group Fink and Klein characterized as inauthentically presenting bodily symptoms of illness. Callard discussed how interpretations of patient bodies as authentic or inauthentic were closely tied to active debates about how to attribute agency.
Callard ultimately proposed that what had been at stake in these early experiments was not necessarily a purely empirical trial of drug action as Fink and Klein had claimed, but, more fundamentally, questions about how to judge agency and determine pathology in clinical psychiatric research. The ways Fink and Klein had addressed these, Callard argued, had significant implications for the professional standards used to define, identify and treat mental disorder to this day.
An academic psychiatrist himself, Michael Sharpe discussed his experience of leading two high-profile clinical trials, one on the impact of treating depression in cancer patients, and the other on the efficacy of psychological treatments for Chronic Fatigue Syndrome/myalgic encephalomyelitis (ME). While both studies were published in The Lancet, and concluded with comparable findings—that psychological treatments had positive effects on the conditions—the reception of the two studies, both by the press and by patient advocacy groups, was very different. Whereas the ME trial was strongly dismissed by patient groups, and was stated by one group as the main reason for deciding to withdraw from a decade long relationship with a university’s Cognitive Behavioural Therapy (CBT) department, recommendations from the cancer study were swiftly taken up by a major national cancer support charity, and had an overwhelmingly sympathetic response in the media.
Reflecting on this, Sharpe considered a contrast between cancer, which he proposed might be regarded a ‘gold standard’ legitimate illness, and the conflictual history of disputes over the validity of ME as a genuine illness. Specifically, Sharpe compared debates about whether the basis for ME is mental disorder, with medical orthodoxies about cancer having clear and undisputed physical causes. He considered the potential applicability of Laurence Kirmayer’s argument about underlying values in biomedicine whereby the mental symbolises the intentional and voluntary, in contrast to the physical, or bodily, signifying the involuntary and accidental.
Focusing on the field of psychoanalysis, Patrizia Giampieri-Deutsch considered bases for the take-up of short-term psychodynamic and manualised treatments, such as Short Psychodynamic Supportive Psychotherapy (SPSP), over long-term psychotherapy. Giampieri-Deutsch discussed external drivers, including the economic priorities of service providers and health insurers considering financial and time costs, as well as current debates around standards of evidence for judging the efficiency, efficacy and effectiveness of treatments and also underpinning funding decisions. In this context, the need for evidence was highlighted as a challenge facing classical psychoanalysis. Giampieri-Deutsch presented this as a paradox, with reference to the Helsinki Psychotherapy Study Group which had found longer-term psychotherapy performed better than short-term treatments, resulting in stable transformations of personality, and not just symptomatic improvements in controlled trial settings. Nonetheless, a continuing dispute, both inside and outside psychoanalysis, remained the use of mainly third person knowledge from therapists in psychoanalytic studies.
Participation and patient choice of treatment types was also discussed. A practicing psychoanalytic therapist and researcher in Vienna, Giampieri-Deutsch had observed that whilst some patients seem to seek out psychoanalysis and look for Freud’s “talking cure”, today less seem prepared to dedicate time to their mind, particularly in comparison to their body, hence possibly being more inclined to select short-term therapies.
Next, Hanne Knudsen delivered a paper which explored questions of responsibility in the ambitions of current public health programmes in Denmark. In particular, Knudsen considered the focus on the responsibilization of individuals in the use of ‘health dialogues’ and ‘health games’. These involved target citizens being invited to discuss their personal responsibilities regarding healthy lifestyles with public health professionals. Knudsen argued that a core governance challenge these attempted to meet was one of ‘heterophony’, that is, how public health may depend not only on health per se, but also on factors such as the economy and education. However, in practice, her research had found that attempts to mobilize personal responsibility had opened up new heterophonic spaces and potential responsibilities, leading to greater uncertainty regarding outcomes and accountability for public health programme providers. Knudsen argued that to understand this unanticipated problem, the concept of personal responsibility requires examination. Drawing on the thinking of philosophers Søren Kierkegaard and Jacques Derrida, she outlined a tension or paradox built-in to the term. In particular, Knudsen proposed that exercising personal responsibility requires two sets of simultaneous actions that are incompatible, namely: making nominally free individual choices, as well as having and fulfilling externally-set societal obligations. Her contribution therefore opened up questions about how this tension plays out and is sought to be managed in a context of responsibilization, and in relation to the conference theme of participation.
Concluding the speaker panels, Martin Savransky aimed to contribute to debates around the concept of ‘participation all the way down’, exploring how bodies might be thought of as participating in socially intelligent and intelligible ways. Based on the proposition that to participate involves some form of acting based on thinking, Savransky examined how bodies might be considered to think, a proposal at odds with the Cartesian logic of a sentient mind and a passive material body, but, drawing from another historic tradition of thought, pan-psychism.
Savransky outlined that the basic idea of pan-psychism is that everything which exists has a mind or mind-like qualities. However, inspired by particular schools of thought in this tradition, namely those of William James and of Alfred North Whitehead, he suggested that a more fruitful approach would be to start with the proposition that everything thinks, rather than possesses a mind. On this basis, thinking would need not be limited to consciousness, or cognition, but could take various forms, such as sensory awareness, or the discernment of relevance and feeling. Hence, thinking bodies, Savransky argued, could be seen to be at the very core of experiences of health and illness, such as at times when bodily forms disrupt and medical services are sought in reaction.
Darin Weinberg followed up these presentations with a discussion of overarching themes and contributions. He started by considering the relevance of normative standards for identifying illnesses as denigrated in status or as disrespected disorders. In particular, he reflected on his research in the field of addiction in America. Here Weinberg described how the authority of doctors to interpret thought, feeling and mood was being de-stabilised. Biomedical expertise now had to contend with other kinds of expertise, such as the experience based knowledge of people who are clean and previously had drug and alcohol addictions. He considered these shifts as part of wider neo-liberal drivers of the marketization of knowledge.
Turning attention to the relationship between mind and body, Weinberg outlined the uses of historical genealogies for addressing important questions, such as understanding how bodily materiality came to be a pervasive marker of illness legitimacy in Europe and the US. He also drew attention to the need to attend to how such legitimacies come to be sustained, including questions about the maintenance of professional credibility in medicine. In addition, Weinberg argued for being open to contingency, including historically and contextually specifying not only how, but also when and if the body is invoked. Regarding attempts to get around mind-body dualism, Weinberg noted Savransky’s paper, and also highlighted the contributions of Maurice Merleau-Ponty, Pierre Bourdieu, and Bruno Latour. Rather than focussing efforts on trying to overcome presupposed mind-body relations solely through theory, Weinberg advocated empirical grounding to either re-stabilise or re-articulate them.
Weinberg also discussed further problematizing the concept of participation. He explored questions surrounding the navigation of tensions between expertise and democratic inclusion, including how knowledge claims are adjudicated. He discussed limitations to liberal orientations to participation that can prioritize voice and choice over care, drawing on his ethnographic research finding interactional difficulties arising from a political parliament initiative for people with learning disabilities in the UK.
Chaired by Maryon McDonald, the final panel question and answer session addressed the topic of the politics of mind-body relations, continuing on from Darin Weinberg’s discussion as well as Q&As throughout the day.
Alongside more well-trodden ground, such as how dualism informs healthcare practice and the stigmatisation of mental illness relative to physical illness, less familiar connotations of the term psychosomatic were also picked up in relation to the conference themes. It was noted that ‘lifestyle’ illnesses could be thought of as psychosomatic, opening up questions about how social dynamics might play a role in producing them. Also raised was the question of how illness might represent a value – not only for an individual (as a less costly form of social suffering, for example), but also for a social ‘system’ or socio-economic configuration.
Ways to get around prefigured mind-body relations were further debated. For example, Robbie Duschinsky proposed considering possible uses of the language of stress on the basis of its polyvalence, prompting conversation about everyday colloquial uses and medical discourses. Additionally, Patrizia Giampieri-Deutsch proposed re-examining how the mind is conceptualised. Drawing on Freud’s notion of psyche, she proposed models of the mind needed to concentrate not only on functional or intentional thinking and cognition, but also on feelings and affects.
Finally, the panel considered current concerns and challenges facing state-sponsored service provision. Delegates discussed the interests of states in policing who is ill and who is not, and in judging agency and designating responsibility for illness in relation to controlling access to rights-based entitlements to publicly funded healthcare and welfare services. Alongside this, biopolitical concerns about keeping governed populations healthy were also highlighted, and current challenges to this considered. For instance, Monica Greco proposed that states seem to be finding that the models of subjectivity on which service provision are based are not working while the prevalence of chronic illness continues to rise.
The character of this conference was questioning and rather brave. Participants took intellectual risks; they engaged with psychosomatics as a multi-faceted conceptual resource in a challenging and diverse interdisciplinary forum. As a result, they started a conversation with potential to help move forward debates on current challenges facing service provision, particularly about the important issue of patient participation.
Arguably, the inevitable limitation of the exploratory orientation taken was that this event opened up more questions than there was scope to critically develop and answer. Nonetheless, the enthusiasm generated will surely have paved the way for future work which further updates not only how the critical questions of agency, embodiment, responsibility, power and choice are framed, but also how they are addressed.
Alev Sen is a PhD candidate at the Department of Sociology, University of Cambridge and an ESRC Doctoral Training Centre student. She is researching experiences of living with rare diseases in the UK. Her research explores engagement with publicly funded healthcare services with a focus on people with Alkaptonuria.
 The conference was sponsored by the Centre for Research in the Arts, Humanities and Social Sciences (CRASSH), the Wellcome Trust, and Goldsmiths, University of London.
Editor: The following is an introduction to a new Japanese translation of The body multiple. It can be purchased through Suiseisha publishers, as part of their series on The Anthropological Turn.
In 1982/3 I spent the academic year in Paris. There I lived in the Cité Universitaire—student housing that was built in the aftermath of the 1914–1918 war as a contribution to global peace. The hope was that if young people, the elites of the near future, would immerse themselves in higher learning and live together in attractive surroundings, this would prevent further wars. For they would learn to think rationally and to talk with each other rather than to run after divided self-interests. Various countries had asked eminent architects to make designs. In one way or another, these represented the various participating nations. The buildings were mostly finished in the course of the nineteen thirties. Just a few years before another ravaging war divided the world.
Another hope that was broken. But I don’t want to talk about that war now, but about Hajime. He, too, lived that academic year in the Pavillon Néerlandais. His room was a few doors away from mine on the same corridor. Hajime came from Japan. He was the first person from that country with whom I had a chance to talk. He studied French literature and it became quickly clear that he knew a lot more about Europe than I knew about East Asia. My schooling of almost twenty years, I realised with a shock, had been strikingly provincial. (No, I hadn’t yet gone to anthropology classes at the time. I started doing so in Paris, lucky to find a seminar of Marc Augé.) In my secondary school I had learned Latin, the language of the Romans of two thousand years ago that these days is no longer actively spoken. In medical school I had been presented with knowledge about ‘the human body’ as if this was a universal phenomenon, to be known in a univocal way. But that a body might, for instance, have meridians or be energized by yoga was never considered. In philosophy classes I had been presented with the history of Western thought, but other traditions, not just those Japanese, but also those from China, Ghana, Mexico, what have you, had not been mentioned. The social theorists I had been introduced to were frantically disagreeing over ‘society’, but the ‘society’ they disagreed about fitted at most with social life in France, Britain or Germany, or—I read texts in Dutch as well—the Netherlands. Just a few provinces in the North West of Europe.
So I was glad to learn from Hajime as we drank the green tea he made and I got to eat my first red bean cakes. One of the more striking lessons that he taught me came wrapped up in a story about his grandfather. It may not surprise you, but it did surprise me. Hajime told me that each morning his grandfather would pray in front of a Buddhist shrine and that each evening he would worship in a Shintoist temple. Hence, he moved between two quite different spiritual traditions. And while taken as systems of belief these traditions variously clash, his grandfather was not at all torn between them. Contradictions didn’t bother him in the least. Instead, the possibility to engage in Buddhist prayers as well as in Shintoist worship greatly enriched his life.
Up until that moment, I had only seriously been confronted with the ‘religions of the Book’, Judaism, Christianity and Islam. All three are monotheist and exclusive. There are many differences between them, but they share the convictions that there is just a single God and that praying to other gods (that they necessarily call ‘false gods’) is sinful and scandalous. Later I would learn how in spreading Christianity missionaries had often been adaptable and absorbed a few of the locally revered deities by allowing them to be transformed into saints. But at the time the idea that one might juxtapose practices related to different spiritual traditions was a revelation to me.
It didn’t just defy the monotheist religious stance, but also Western philosophy. Here, contradictions were taken very seriously. They were not accepted at face value, but formed occasions to seek univocality. Surely, if A is right, non-A, its opposite, cannot be right as well? This conviction formed the base of propositional logic on which the entire argumentative philosophical tradition was built. I had just started reading Michel Serres and would attend his lectures that year. This heretic philosopher was undermining the binary A versus non-A logic. And when Hajime told me about his grandfather I listened eagerly. I liked this! An elegant departure of the idea that one has to adhere either to this belief or that other. And an equally elegant departure of seriously stable identities that invite one to say I am Buddhist or rather I am Shintoist. Being is supposed to endure but doing allows for more variety. The morning and the evening are different moments in time. Why would what you practice one moment clash with, or contradict, what you do some time later?
Practice was a crucial term here. Or so I came to think as I followed another formative seminar that year. Michel Callon and Bruno Latour explored the sciences through the lens of technology. They did not pursue scientific representations, but rather science-inspired practices. Hence, they explored the tools and techniques that made scientific research possible and the interventions that such research helped to orchestrate. Callon was writing about scallop fishing and the engineering of electric cars. Latour wrote about the modest but far-reaching technique of pasteurisation. In both cases what mattered most were not systems of belief about reality that might contradict each other but rather practices of dealing with reality that might either be crafted into existence or fail to materialize. While for philosophers there could only be a single truth, for technologists, much like for Hajime’s grandfather, contradiction was not an issue.
Once back in the Netherlands I lost contact with Hajime. But I kept playing with the idea that different understandings of reality do not necessarily clash in practice. They may as well coexist. In fact, they do coexist. For in theory Western science might be mono-realist, but it wasn’t so in practice. My first case was ‘woman’.
(I wrote a text about this in Dutch that was recently translated into English.) Genetics, anatomy, endocrinology, psychoanalysis, geography, and so on, I argued, do not talk about the same ‘thing’ when they talk about this figure that they all call ‘woman’. Instead, they worked with remarkably different definitions and orchestrated different interventions. The relations between these were complex. Disagreements in one site did not preclude collaborations elsewhere. This messiness bore the promise of escape. For if the sciences disagreed between them about ‘woman’, why, then, should ‘we feminists’ submit to any one of them? That the sciences did not always and everywhere accord with each other, but appeared to be full of tensions and contradictions, opened up a space for alternatives.
The Body Multiple follows on from there. It is grounded in an ethnography of a university hospital in the Netherlands. It argues … well, you are about to read what it argues. But the short story is that the different departments of the hospital stage reality differently—and hence enact different realities. In the outpatient clinic a doctor talks with patients about what exactly troubles them in their daily life. In the operation theatre, by contrast, anesthetists silence patients with drugs and surgeons use knives to cut open their bodies. In one location the patient is treated as a person to talk with, in the other the patient is enacted as a body to intervene in, either physiologically (with drugs) or anatomically (with knives). Hence, in the Western tradition it may well be said (over and over again) that there is only a single reality and that we should strive after telling the singular, univocal truth about it. But that is not in accordance with how reality is treated in Western practices. There, reality comes in different versions. Which is fine. The outpatient clinic and the operation theatre are different places. Why would what happens in one of them be made to fit the same terms than what happens in the other?
My problem was, and is, with the fact that this multiplicity tends to be hidden. If it were recognized, we might ask upfront which version of reality to live with when and where. As it is, this question is not dealt with overtly and in so many words. Instead, it is all too often answered by stealth. And we end up with practices because they happen to be the oldest, the most profitable, the cheapest, the easiest to publish about, the most routinized—and so on. And not necessarily with the practices that are most agreeable to patients and that best help them to live their daily lives.
That is the argument of this book. It says that diseases, bodies, realities, come in versions. But beware, it doesn’t preach pluralism. That contrasting version of reality are practiced, doesn’t mean that the hospital falls apart into isolated sections. Another Western obsession deserves to be reiterated here. Which is the idea that reality is composed of separable entities that may be added together (as the stones in a wall), but that do not mix (as the ingredients in a dish). Critiquing pluralism and the individualism that comes with it, Donna Haraway had pointed out that pregnant mammals harbour a creature inside their wombs that is both other to and dependent on them. Marilyn Strathern had added that a person may be both an anthropologist and a feminist. These figures speak to different concerns and hence they may say different things, while they still fold together in the same person. In line with that, here, too I sketch a reality that is not plural but multiple. In the first few chapters I illustrate the multiplicity of the disease ‘atherosclerosis’. The rest of the book explores how in hospital practice the versions of this disease are co-ordinated together.
The book itself is multiple too. It is composed of two texts that run in parallel. The first tells stories about the hospital, the second relates to the literature that informed my writing. But these two texts are not separate: they pursue the same argument and seek to develop the same intervention in theory.
In the period in which I was writing, many other colleagues were working along similar lines. They also dug up the complexities of a non-unified medical world. They wrote about the readily transforming subjectivity of pregnant women; about different modes of giving birth that stage mother, child and birth differently; about lung diseases or blood pressure or dementia done in varied ways; and about techniques, such as patient-files, that hold contrasting versions of reality together. Others were exploring co-existence elsewhere, in other sites and situations. There is for instance Aircraft Stories—a book in which John Law explores themes that are quite similar to mine in the quite different context of designing and testing a military aircraft. And since the present book got published the ‘multiples’ have boomed. A striking amount of them (to my surprise and pleasure) have been variously explored. See the literature.
The authors of all that work had different backgrounds. It is unlikely that they were all inspired by stories about Japanese spiritual practices. Our concerns were more immediately informed by obdurate problems in the fields that we studied. And yet our work has striking resonances with what Hajime told me about his grandfather. He, too, said different prayers depending on the time of the day and the temple in which he found himself. But for all that he was not two people. This analogy might help us to avoid simplistic differentiations between ‘Japan’ and ‘the Netherlands’ (or Euro-America, or however you want to delineate the place that this book emerged from). Between such entities, too, there are differences as well as commonalities. There are lessons that may travel and shared imaginations. And there are clashes. There is ‘Western medicine’ in Japan—does that makes Japan Western, or said medicine (also) Japanese? It holds no answer to such questions, but if you want to, you may read this book as one that addresses them. For the stories that it tells are about patients, doctors, technologies and a single hospital in the Netherlands, but its concern is with co-existence-in-difference. This may as well be co-existence-in-difference between countries, languages, cultural traditions. I hope to break out of the provincialism that has different cultural traditions each retreat in their own corner of the globe.
And yet as I wrote this book, I did not imagine that readers from so many corners of the globe might be interested in it. The reader whom I imagined while writing did not live in, say, Rio de Janeiro, Johannesburg or Tokyo. I thought that at best and with lots of luck I might be locally relevant. Plus, I had not travelled to any of those places, nor had I a read a great deal from authors who were located there. So I apologize for the provincialism that lingers on in this text. I wrote it in English, which is not my mother tongue, but I did not think of readers in places where that language doesn’t travel all that easily. I hope you can read around that. And I consider this as a challenge for present day academia: that we find good ways of engaging in long distance conversations. Conversations in which concepts and concerns from a wide range of languages enter, even if all the translations implied will inevitably transform them.
For the translation of The body multiple into Japanese I am deeply grateful to Yoko Taguchi and Akinori Hamada. What a lot of work have they done! How many words did they turn inside out to sense out which Japanese term might best convey the English words of the original. I am deeply impressed by their dedication. Thank you. And I hope that in Japan this book may find new readers, new meanings and new urgencies—and enter into locally relevant, spirited conversations. The best outcome would be that it would inspire some of its readers to explore in their turn, in their own way, surprising juxtapositions of diverse and yet intertwined realities. Or maybe, by contrast, that some of its readers would take the occasion to explain to the rest of us why sometimes seeking logical coherence may be a good thing. I hope for intriguing explorations of shrines, temples, deities, hospital, bodies, factories, cell lines, patents, freshness, rocks, nuclear energy, metro stations. And, if you please, could someone, as a turn in this conversation, introduce a few intricate Japanese concepts or daily life practices into English while telling stories (for I would love to read more about those) about green tea and red bean cakes?
Annemarie Mol is Professor of Anthropology at Universiteit van Amsterdam. She is widely published in anthropology, culture, and critical theory on topics such as the multiplicity and complexity of objects, medical anthropology, the culture of food and eating, and the philosophy of care.
This month’s Web Roundup is focused loosely around the theme of the visual. How do we use photography and other mediums to tell stories, and what stories do those technologies tell about us?
The New York Times Magazine did a feature on travel photography, called Voyages. The online version of the 6 highlighted pieces is both interesting and visually stunning. The introduction, by Gideon Lewis-Kraus, is also worth a read., referencing Claude Lévi-Strauss’s “Tristes Tropiques.” “‘Travel and travellers are two things I loathe — and yet here I am, all set to tell the story of my expeditions.’”
Geoff Dyer in the NY Times writes about what makes a great documentary photograph and why these photos linger on. And NPR details the story of a particular iconic photograph. The Atlantic’s CityLab has a list of 7 documentaries about cities that are available to stream now. They also profile the company Mapbox, which uses open source mapping platforms to help cities visualize vast amount of open-source and complicated data in order to solve complex urban problems.
The contest for the Sony 2017 World Photography Awards is now open. Take a look at a few of the contenders. And, a new book explores how the California School of Fine Arts “turned photography into art.” And yet, our relationship to photography is changing rapidly—how does that impact us, our use of photographs, and our understanding of art? From The New Yorker: “In the Future, We Will Photograph Everything and Look at Nothing.” Meanwhile, the Guardian attempts to break down the financial impact and worth of the “selfie industry,” that is to say, is the selfie industry driving up sales of lipstick and the popularity of cosmetic surgery?
This is an excellent piece on funeral photography: “It is as if by standing right next to the coffin and having our photo taken, we are all participating in this little dance between life and death. One moment you are in front of the curtain, the other moment the curtain falls on you.”
International Week of the Deaf was last week, and, in a different gesture towards the visual, Rachel Kolb writes about “The Deaf Body in Public Space.” And, PBS interviews Rebecca Sugar about what it is like to write a children’s show with LGBTQ themes.
In unrelated science and tech news:
If you’re in the New York City area, The New Yorker’s TechFest is happening on October 7th, “a full-day program exploring the most compelling stories in technology today.”
And, on the evolving ethics of artificial intelligence:
And, now, part two of September’s journal posting! (Part one is here.)
Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists’, parents’ or children’s dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are used during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as “the exceptional normal.” Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children’s and young people’s health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.
Every year, around two thousand Huichol families migrate from their homelands in the highlands of northwestern Mexico to the coastal region of Nayarit State, where they are employed on small plantations to pick and thread tobacco leaves. During their four-month stay, they live, work, eat, and sleep in the open air next to the tobacco fields, exposing themselves to an unknown cocktail of pesticides all day, every day. In this article, I describe how these indigenous migrants are more at risk to pesticides because historical and contemporary structural factors ensure that they live and work in the way of harm. I discuss the economic, social, political, and racial inequalities that exist in their every-day environment and how these forms of structural violence are mitigated by their intersection with local cultural contexts and their specific indigenous lifeworld.
Svea Closser, Anat Rosenthal, Kenneth Maes, Judith Justice, Kelly Cox, Patricia A. Omidian, Ismalia Zango Mohammed, Aminu Mohammed Dukku, Adam D. Koon, and Laetitia Nyirazinyoye
Many of medical anthropology’s most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena—in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems—shape local behavior.
State authorities invested in developing official expert discourses and practices to deny torture in post-1980 coup d’état Turkey. Documentation of torture was therefore crucial for the incipient human rights movement there in the 1980s. Human rights physicians used their expertise not only to treat torture victims but also to document torture and eventually found the Human Rights Foundation of Turkey (HRFT) in 1990. Drawing on an ethnographic and archival research at the HRFT, this article examines the genealogy of anti-torture struggles in Turkey and argues that locally mediated intimacies and/or hostilities between victims of state violence, human rights physicians, and official forensics reveal the limitations of certain universal humanitarian and human rights principles. It also shows that locally mediated long-term humanitarian encounters around the question of political violence challenge forensic denial of violence and remake the legitimate levels of state violence.
Asha Persson, Christy E. Newman, Limin Mao, and John de Wit
With the expanding pharmaceuticalization of public health, anthropologists have begun to examine how biomedicine’s promissory discourses of normalization and demarginalization give rise to new practices of and criteria for citizenship. Much of this work focuses on the biomedicine–citizenship nexus in less-developed, resource-poor contexts. But how do we understand this relationship in resource-rich settings where medicines are readily available, often affordable, and a highly commonplace response to illness? In particular, what does it mean to not use pharmaceuticals for a treatable infectious disease in this context? We are interested in these questions in relation to the recent push for early and universal treatment for HIV infection in Australia for the twin purposes of individual and community health. Drawing on Ecks’s concept of pharmaceutical citizenship, we examine the implications for citizenship among people with HIV who refuse or delay recommended medication. We find that moral and normative expectations emerging in the new HIV “treatment revolution” have the capacity to both demarginalize and marginalize people with HIV.
Anja M.B. Jensen
Based on anthropological fieldwork among Danish organ donor families and hospital staff in neurointensive care units, this article explores the transformative practices of hope in Danish organ donation. Focusing on various phases of the organ donation process, I demonstrate how families and professionals practice hope in astounding ways: when hoping for organs, when hoping for the end of patient suffering, when hoping for the usability of the donor body, and when hoping to help future donor families by sharing painful experiences. By focusing on such practices and transformations of hope, this article sheds light on the social negotiations of life and death among families and staffs in medical contexts and describes how the dignity of the deceased donor and the usability of the donor body are closely connected in family attempts to make donation decisions meaningful during and after a tragic death.
Neely Anne Laurenzo Myers and Tali Ziv
Our article draws on ethnographic research with African American males diagnosed with a psychotic disorder in a high-poverty urban area of the northeastern United States. Our participants frequently described the ways public mental health services led them to experience a paralyzing erosion of autobiographical power, which we define as the ability to tell one’s own story and be the editor of one’s own life. We identified three important points when the loss of autobiographical power seemed to perpetuate social defeat or a sense of social powerlessness (Luhrmann 2007) for our participants during their interactions with public mental health care. We invite further inquiry into the loss of autobiographical power in settings of public mental health care, the sense of social defeat it seems to perpetuate, and the impact of these on mental health recovery, especially for people living in contexts of persistent social adversity.
Casey James Miller
Drawing on 17 months of ethnographic fieldwork (2007–2011), this article critically examines the consequences of two global health initiatives (GHIs), the Global Fund and the Gates Foundation, on NGOs engaged in HIV/AIDS prevention and treatment among gay men in northwest China. I argue that a short-term surge in funding provided by GHIs between 2008 and 2010 exacerbated preexisting conflicts between NGOs by promoting a neoliberal process in which the state outsourced public health services to civil society organizations, deliberately encouraging a climate of competition among NGOs. I also show how GHIs encouraged the bureaucratization and medicalization of one grassroots gay NGO, channeling its activities away from broader political and social objectives and compelling the group to develop a narrower and more entrepreneurial emphasis on HIV testing and treatment. This article contributes to a deeper ethnographic understanding of the complex and perhaps unintended consequences of GHIs.
Medicine Anthropology Theory (open access)
Care work requires a vulnerability and ethical responsiveness towards the cared-for, including an openness to ebbs and flows of affective intensity. For care workers, affective vulnerability is not only a precondition for good care but can also precipitate exhaustion, neglect, and even violence under precarious political and economic conditions. I argue that the concept of vulnerability allows us to trouble the distinction between the supposed oppositional forces of care and violence, allowing us to imagine other possible ways of being in the world with others. Drawing on ten months of fieldwork in Kyoto, Japan, I describe how care workers constitute a human infrastructure whose vulnerability facilitates flows of compassion and cruelty, erotic intensity and heavy fatigue. Care workers’ narratives reveal a process of striving to embody vulnerability and sustain moral selfhood without breaking down.
Drawing on eight years of research with young people who inhabit the margins of Vancouver, in this article I bring into view some of the ‘frictions’ that can arise when conducting anthropological research at home, across vast differences in power and privilege. I argue that our research subjects can also be deeply concerned with how to position themselves in relation to researchers and research studies, and with navigating the various forms of social and geographical distance and proximity that are embedded in anthropological encounters across time. Paying attention to how our research subjects position themselves in research encounters may force us to problematize tidy boundaries between ‘us’ and ‘them’.
Lise Rosendal Østergaard
Health workers are an overlooked category in the growing literature on health and citizenship. In this article I describe a 2012–2013 nationwide conflict in the public health care sector in Burkina Faso to explore how ideas about citizenship were mobilized in a situation of political agitation. I examine how public health care is done in a context of material deprivation, technological shortage, and great demand from the population. Three distinct repertoires of practice, routine, and bureaucracy are identified, through which health workers strive to make meaning of their work and engage in the practice of public health care. Drawing on these findings, I argue that adopting a citizenship framework offers an opportunity to improve our understanding of the multiple ways in which health workers manage the difficulties related to being (health professionals) and doing (professional health care) in rural Burkina Faso.
Special Section: Ethnomedicine and medical anthropology today, in the case of Tibet
This collection of essays brings to light important themes in medical anthropology that have been eclipsed in recent years by theoretical turns toward problems of suffering, experience, and ontology (among others). Namely, they remind us of the importance of what was once popularly called the study of ‘ethnomedicine’.
In 2010, the Government of India officially recognized Tibetan medicine as an ‘Indian system of medicine’ called ‘Sowa Rigpa’. This article documents the processes that led to Sowa Rigpa’s recognition, and situates them at the confluence of economic interests and political strategies within a larger historical and cultural context. Recognition emerges here as a twofold process that makes Sowa Rigpa legible to the state while simultaneously facilitating its incorporation into the market as capital. Previously an inalienable part of Tibetan and Buddhist Himalayan cultural heritage, Sowa Rigpa could now be legitimately claimed or appropriated as cultural, political, or economic capital, giving rise to tensions over ownership and control. Tracing how Sowa Rigpa’s recognition transformed from an initial struggle for protection to one over control, this article offers a critical new perspective on the recognition of cultural heritage, India’s pluralistic health care system, and the Asian traditional pharmaceutical industry.
The years leading up to the recognition of Sowa Rigpa (Tibetan medicine) by the Government of India in 2010 saw unprecedented interaction between various branches of the tradition and the state apparatus. These interactions grew particularly intense during March 2008, when two conferences focusing on related issues took place. The first referred to ‘Tibetan medicine’ and was organised by Tibetan exile institutions, while the second spoke of ‘Sowa Rigpa’ and was hosted by a coalition of Himalayan Indian associations. Through detailed ethnography of these events, this article examines the way in which a medical system was discursively constructed and positioned on the brink of state enfranchisement. It shows how ‘discourse coalitions’ and antagonisms formed during these events, and enquires as to the implications of these for the balance of power in Sowa Rigpa and for its positioning in relation to the Indian state, technoscience, and the growing market for traditional medicines.
Sienna R. Craig and Barbara Gerke
Sowa Rigpa is generally translated as ‘the science of healing’ and often used synonymously for ‘Tibetan medicine’. Historically, Sowa Rigpa can be considered a borrowed term from Sanskrit, accompanied by an adopted sense of ‘science’, which initially signified all forms of medicine known to the Tibetan world, regardless of their place of origin. Over the centuries, Sowa Rigpa became linked to local, indigenous, and ‘enskilled’ practices; later, to nationalist political sensibilities; and of late to cultural belonging. The term evokes territoriality, claims to ownership of knowledge, concerns over sustaining national identities, and considerations about how place-based healing practices and material resources relate to the globalizing ideas about traditional Asian medicines. Textual and ethnographic analyses and interviews with practitioners from China, India, and Nepal show how Sowa Rigpa exists at once as a marker of shared intellectual and cultural histories and forms of medical practice and as a label for a globally circulating medical system with distinct interpretations. Looking at Sowa Rigpa as operating in de- and reterritorialized global spaces makes visible how, why, and to what end modernity forgets (Connerton 2009), thereby allowing for broader conclusions applicable to other medical contexts.
Special Section: Think Pieces on Critical Global Health
Vincanne Adams and João Biehl
This special section critically examines the paradigms and values that undergird the ever-expanding field of global health. The richly textured ethnographic think pieces presented here tackle problems of evidence and efficacy as complex forms of ethical and theoretical engagement in contexts of neoliberalism, war, technological innovation, inequality, and structural violence. These works seek to contribute to a people-centered and politically relevant social theory for the twenty-first century.
Reflecting on the recent West African Ebola outbreak, this piece advocates for a critical and people-centered approach both to and within global health. I discuss the current state of the field as well as critical theoretical responses to it, arguing that an ethnographic focus on evidence and efficacy at the local level raises rather than lowers the bar for thoughtful inquiry and action. The current moment calls less for the all-knowing hubris of totalizing analytical schemes than for a human science (and politics) of the uncertain and unknown. It is the immanent negotiations of people, institutions, technologies, evidence, social forms, ecosystems, health, efficacy, and ethics – in their temporary stabilization, production, excess, and creation – that animate the unfinishedness of ethnography and critical global health.
Medicine in the twenty-first century is constituted and propelled by the production of evidence. Once produced, the use of that evidence is complicated by features inherent in the American and global biomedical economy itself. With the exponential rise in the use of cardiac devices as my case study, this think piece traces the links among evidence-based medicine, insurance reimbursement policies, and clinical trial outcomes to reveal how evidence produced by trial findings creates treatment standards. Those standards, in turn, expand what is thought to be ‘treatable’ by reconceptualizing risk as a condition that deserves intervention. Such standards affect what physicians recommend and what patients decide to do. The essay emphasizes that evidence-based medicine can be a source of anxiety that patients and families feel when considering how to proceed. It highlights the debates, increasingly common both within and beyond the health professions, about what is actually best as we grow older. It provides an example of how, today, most deaths, even among the very old, are considered premature. In an aging society, the treatment protocols that fall under the evidence-based medicine umbrella constitute an enormous truth-making regime that determines the goals of medicine and shapes health care consumers’ quandaries about medical intervention, and especially the quandary, for those in later life, about crossing the line of too much treatment.
Charles L. Briggs
An epidemic in a Venezuelan rainforest in 2007-2008 killed 38 children and young adults, puzzling clinicians, epidemiologists, and healers alike for over a year. This essay traces the way each contribution to knowledge production formed part of a larger ecology of evidence. Focusing on how the parents’ knowledge was exploited and denigrated by clinicians, epidemiologists, and healers alike points to the health/communicative inequities—grossly unequal distributions of access to the production and circulation of evidence—that structured ecologies of evidence in ways that thwarted diagnosis. Recruiting a nurse, a healer, a physician, and an anthropologist, two indigenous leaders launched an investigation that juxtaposed parents’ narratives, vernacular healing, epidemiology, and clinical medicine, resulting in a clinical diagnosis of bat-transmitted rabies. This case suggests that perspectives in global health will fail to become fully critical unless they attend to health/communicative inequities, how they structure ecologies of evidence, and strategies for transforming them.
Kelly Ray Knight
addicted.pregnant.poor is an ethnography addressing the biomedical, social, political, and ethical dimensions of ongoing illicit drug use during pregnancy. A result of four years of fieldwork in daily-rent hotels – privately owned buildings in which the exploitation of women’s sex work and on-going poor health was normative – the book follows nineteen women who had twenty-three pregnancies. To answer the question ‘What forms of life are possible here?’ I engaged with the social actors who are called upon to produce knowledge about addicted pregnancy, including addicted, pregnant women; an anthropologist; public health epidemiologists; advocates; social policymakers; treatment professionals; bureaucrats; and scientists. In this essay, I describe the relationship between the scientific contours of reproductive health and the personal and social consequences of pregnancy in the context of addiction and housing instability. Pregnant women in the daily-rent hotels existed within multiple temporalities. Here I explore what an ethnographic understanding of memorial time and biomedical time can teach us about the vital politics of viability at work in addicted pregnancy.
How might global health evidence waste away? The thing that generates evidence in this case, the metabolism, offers some possible answers to this question. But it does so, sometimes, only when things devolve. This essay takes up the case of amputation in the case of diabetes. The ethnography of atrophy highlights how knowing and embodiment wither, all while the thing that is supposed to absorb the world – the metabolism – offers less and less return on such a promise.
Zoë H. Wool
In the United States – as in other places in the ambit of biomedicine – the efforts exerted on and by injured soldiers’ bodies in the aftermath of war are generally understood under the familiar medical rubric of ‘rehabilitation’. This reflection troubles that term by moving away from the medical logic of rehabilitation and its telos of injury and healing, and the logics that see injured soldiers as promising bodies. Instead, the think piece explores a wider range of practices of attention to injured soldiers’ bodies that emerge ethnographically, and traces embodied forms of being made within unsteady temporalities of life, health, and death after war, forms that call the temporality of rehabilitation into question and highlight care’s collateral affects. I reflect on the phenomenon of heterotopic ossification – bone growth at the site of injury that is a sign of healing that is also itself a form of injury – to think through the confounding analytical, ethical, political, and corporeal implications of such a space.
Special Issue: Forum on Disability and Aging
This editorial proceeds the Forum on Disability and Aging and discusses some personal reflections on the relationship between aging and disability.
Katie Aubrecht, Tamara Krawchenko
This issue of RDS features eight original articles and art which analyze how disability and aging appear in research, policy and everyday life. Contributors to this international collection use interdisciplinary perspectives to explore the complex relationship between disability and aging, and challenge disability and age related myths and misconceptions.
Amanda Grenier, Meredith Griffin, Colleen McGrath
This paper explores aging and disability, problematizing the paradoxical tendency to separate and conflate these social locations in chronological understandings of the life course. Exploring how such thinking has shaped assumptions, responses, knowledge, policy and practice, we conclude with suggestions to reconsider disability across the life course and into late life.
Stuart Wark, Miranda Cannon-Vanry, Marie Knox, Marie Parmenter, Rafat Hussain, Matthew Janicki, Chez Leggatt-Cook, Meaghan Edwards, Trevor Parmenter
Research is limited on whether differing methodologies for facilitating personal contributions from individuals aging with intellectual disability produce equivalent knowledge outcomes. Two matched purpose-developed tools examined five quality-of-life domains. Results showed substantial variance between qualitative interview responses and Likert-scale data, and indicate validity concerns for using either methodology in isolation.
Emilie Raymond, Nadine Lacroix
People with disabilities are often excluded from mainstream seniors’ organizations. A participatory action research project was undertaken in a seniors’ leisure association to better include members with disabilities. Results underline the importance of understanding the interaction of individual and environmental factors when looking to support the participation of seniors with disabilities.
Hailee M. Gibbons
This article forwards the theory of compulsory youthfulness as a way to explore how ableism, ageism, and other systems of oppression intersect to produce the societal mandate that people must remain youthful and non-disabled throughout the life course, particularly in a cultural context that holds successful aging as an ideal.
Gregor Wolbring, Bushra Abdullah
We ascertained how disability and disabled people were framed within the 4899 articles covering aging well, active aging, healthy aging, natural aging and successful aging in the 300 Canadian newspapers of the Canadian newsstand complete database. The framing was mostly medical. Problems faced by individuals aging with a disability were mostly ignored.
Yvonne R. Teems
Social gerontology and disability studies have made similar but separate arguments for ways to study aging and disability, respectively. This study of interviews with seniors finds that seniors characterize aging as disabling and position both identity constructions as negative. The article argues for the use of disability theory and discourse to examine seniors’ lived experiences.
Switzerland’s social security system categorizes seniors with disabilities according to the onset of the disability. The transitional point between the disability insurance and the old age insurance is retirement. The paper describes the underlying assumptions leading to this transition as well as the ways in which seniors with mobility disabilities deal with its effects.
Katie Aubrecht, Janice Keefe
In this paper we analyse the becoming subject of dementia, as it is made to appear within the contexts of nation-building and everyday life. Insights yielded from this analysis suggest the importance of time to recognition of normalcy, and to the meaning of being a person.
Neil Stephens and Martin Ruivenkamp
In vitro meat (IVM), also known as cultured meat, involves growing cells into muscle tissue to be eaten as food. The technology had its most high-profile moment in 2013 when a cultured burger was cooked and tasted in a press conference. Images of the burger featured in the international media and were circulated across the Internet. These images—literally marks on a two-dimensional surface—do important work in establishing what IVM is and what it can do. A combination of visual semiotics and narrative analysis shows that images of IVM afford readings of their story that are co-created by the viewer. Before the cultured burger, during 2011, images of IVM fell into four distinct categories: cell images, tissue images, flowcharts, and meat in a dish images. The narrative infrastructure of each image type affords different interpretations of what IVM can accomplish and what it is. The 2013 cultured burger images both draw upon and depart from these image types in an attempt to present IVM as a normal food stuff, and as ‘matter in place’ when placed on the plate. The analysis of individual images and the collection of images about a certain object or subject—known as the imagescape—is a productive approach to understanding the ontology and promise of IVM and is applicable to other areas of social life.
This article contributes to Science and Technology Studies on vulnerability by putting cyborgs at center stage. What vulnerabilities emerge when technologies move under the skin? I argue that cyborgs face new forms of vulnerability because they have to live with a continuous, inextricable intertwinement of technologies and their bodies. Inspired by recent feminist studies on the lived intimate relationships between bodies and technologies, I suggest that sensory experiences, material practices, and cartographies of power are important heuristic tools to understand the vulnerabilities of hybrid bodies. Based on an analysis of how patients in the Netherlands and the United States cope with appropriate and inappropriate implantable cardioverter defibrillator shocks, I describe how defibrillators introduce two new kinds of vulnerabilities: vulnerability as an internal rather than an external threat, and as harm you may try to anticipate but can never escape. Despite these vulnerabilities, some heart patients don’t position themselves as passive victims of faulty machines. They actively engage in material practices of resilience by using magnets to stop inappropriate shocks. I conclude that anticipating and taming the improper working of technologies inside bodies constitutes a new form of invisible labor that is crucial to diminishing the existential uncertainties of cyborgs.
Brian Salter, Yinhua Zhou. Saheli Datta, and Charlotte Salter
The governments of China, India, and the United Kingdom are unanimous in their belief that bioinformatics should supply the link between basic life sciences research and its translation into health benefits for the population and the economy. Yet at the same time, as ambitious states vying for position in the future global bioeconomy they differ considerably in the strategies adopted in pursuit of this goal. At the heart of these differences lies the interaction between epistemic change within the scientific community itself and the apparatus of the state. Drawing on desk-based research and thirty-two interviews with scientists and policy makers in the three countries, this article analyzes the politics that shape this interaction. From this analysis emerges an understanding of the variable capacities of different kinds of states and political systems to work with science in harnessing the potential of new epistemic territories in global life sciences innovation.
On November 28, 2009, as part of events marking the twenty-fifth anniversary of the disaster at the Union Carbide plant in Bhopal, gas survivors protested the contents of the report prepared by government scientists that mocked their complaints about contamination. The survivors shifted from the scientific document to a mediated lunch invitation performance, purporting to serve the same chemicals as food that the report had categorized as having no toxic effects. I argue that the lunch spread, consisting of soil and water from the pesticide plant, explicitly front-staged and highlighted the survivor’s forced intimate relationship with such chemicals, in order to reshape public perception of risks from toxins. Chemical matter like sevin tar and naphthol tar bound politicians, scientists, corporations, affected communities, and activists together, as these stakeholders debated the potential effects of toxic substances. This gave rise to an issue-based “chemical public.” Borrowing from such theoretical concepts as “ontologically heterogeneous publics” and “agential realism,” I track the existing and emerging publics related to the disaster and the campaigns led by the International Campaign for Justice in Bhopal advocacy group.
This paper links two domains of recent interest in science and technology studies, complexity and ignorance, in the context of knowledge practices observed among synthetic biologists. Synthetic biologists are recruiting concepts and methods from computer science and electrical engineering in order to design and construct novel organisms in the lab. Their field has taken shape amidst revised assessments of life’s complexity in the aftermath of the Human Genome Project. While this complexity is commonly taken to be an immanent property of biological systems, this article presents an epistemological view of complexity according to which complexity relates to a specific scientific theory or model and refers to that which exceeds the theory or model’s explanatory power. This epistemological view allows us to narrate a particular story about the changing relationship between biology and synthetic biology in the last decade and accounts for early knowledge practices in synthetic biology that “ignored” biology. This article further argues that while the failure of ignorance to produce clear-cut results for synthetic biologists has led practitioners back to biology, the entanglements between different pragmatic orientations and ways of knowing trouble the implications of this return for assessments of the complexity of biological systems.
Capitalist dynamics in knowledge production are not limited to situations in which economic interests influence researchers’ practices. Building on laboratory studies and the French “pragmatic” tradition in sociology, this article proposes an approach to tackle more pervasive capitalist logics at work in contemporary research and their consequences. It uses the term epistemic capitalism to denote the accumulation of capital, as worth made durable, through the act of doing research, in and beyond academia. In doing so, it conceptualizes capitalism primarily not as a system of circulation and accumulation of monetary value but rather as a cultural way of producing, attributing, and accumulating specific forms of worth, which need not be monetary. Empirically, the article studies variants in epistemic capitalism by addressing the differing role of the accumulation of different forms of capital and the regimes connected to it in two institutional settings in Austria, academic life science laboratories and biotechnology start-up companies. Concluding, it argues that analytically dissociating the concept of capitalism from its link to economic value allows a finer-grained cultural analysis of the importance and effects of processes of accumulation in contemporary research. It ends with discussing the normative implications of these findings for debates about the commercialization of academia.
Kate Reed, Inna Kochetkova, and Elspeth Whitby
Prenatal screening occupies a prominent role within sociological debates on medical uncertainty. A particular issue concerns the limitations of routine screening which tends to be based on risk prediction. Computer assisted visual technologies such as Magnetic Resonance Imaging (MRI) are now starting to be applied to the prenatal realm to assist in the diagnosis of a range of fetal and maternal disorders (from problems with the fetal brain to the placenta). MRI is often perceived in popular and medical discourse as a technology of certainty and truth. However, little is known about the use of MRI as a tool to confirm or refute the diagnosis of a range of disorders in pregnancy. Drawing on qualitative research with pregnant women attending a fetal medicine clinic in the North of England this paper examines the potential role that MRI can play in mediating pregnancy uncertainty. The paper will argue that MRI can create and manage women’s feelings of uncertainty during pregnancy. However, while MRI may not always provide women with unequivocal answers, the detailed information provided by MR images combined with the interpretation and communication skills of the radiologist in many ways enables women to navigate the issue. Our analysis of empirical data therefore highlights the value of this novel technological application for women and their partners. It also seeks to stress the merit of taking a productive approach to the study of diagnostic uncertainty, an approach which recognises the concepts dual nature.
The combination of HIV- and age-related stigma exacerbates prevalence of HIV infection and late diagnosis and initiation of anti-retroviral therapy among older populations. Interventions to address these stigmas must be grounded in understanding of situated systems of beliefs about illness and older age. This study analyses constructions of HIV and older age that underpinned the stigmatisation of older adults with HIV in rural Balaka, Malawi. It draws on data from a series of in-depth interviews (N = 135) with adults aged 50–∼90 (N = 43) in 2008–2010. Around 40% (n = 18) of the sample had HIV.
Dominant understandings of HIV in Balaka pertained to the sexual transmission of the virus and poor prognosis of those infected. They intersected with understandings of ageing. Narratives about older age and HIV in older age both centred on the importance of having bodily, moral and social power to perform broadly-defined “work”. Those who could not work were physically and socially excluded from the social world. This status, labelled as “child-like”, was feared by all participants.
In participants’ narratives, growing old involves a gradual decline in the power required to produce one’s membership of the social world through work. HIV infection in old age is understood to accelerate this decline. Understandings of the sexual transmission of HIV, in older age, imply the absence of moral power and in turn, loss of social power. The prognosis of those with HIV, in older age, reflects and causes amplified loss of bodily power. In generating dependency, this loss of bodily power infantilises older care recipients and jeopardises their family’s survival, resulting in further loss of social power. This age-and HIV-related loss of power to produce social membership through work is the discrediting attribute at the heart of the stigmatisation of older people with HIV.
Hanson Nyantakyi-Frimpong, Faith Nankasa Mambulu, Rachel Bezner Kerr, Isaac Luginaah, and Esther Lupafya
This article shares results from a long-term participatory agroecological research project in northern Malawi. Drawing upon a political ecology of health conceptual framework, the paper explores whether and how participatory agroecological farming can improve food security and nutrition among HIV-affected households. In-depth interviews were conducted with 27 farmers in HIV-affected households in the area near Ekwendeni Trading Centre in northern Malawi. The results show that participatory agroecological farming has a strong potential to meet the food, dietary, labour and income needs of HIV-affected households, whilst helping them to manage natural resources sustainably. As well, the findings reveal that place-based politics, especially gendered power imbalances, are imperative for understanding the human impacts of the HIV/AIDS epidemic. Overall, the study adds valuable insights into the literature on the human-environment dimensions of health. It demonstrates that the onset of disease can radically transform the social relations governing access to and control over resources (e.g., land, labour, and capital), and that these altered social relations in turn affect sustainable disease management. The conclusion highlights how the promotion of sustainable agroecology could help to partly address the socio-ecological challenges associated with HIV/AIDS.
McDougall, M. Goldszmidt, E.A. Kinsella, S. Smith, and L. Lingard
Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 “Team Sampling Units” (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams ‘disentangled’ fluid in order to focus on its physiological function and mobilisation. Teams also used distinct ‘framings’ of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease.
The moment at which a diagnosis is delivered to a patient, particularly when it is serious, is an important social moment. It not only dictates the clinical pathway, it also rewrites the patient narrative, shifts their identity, predicts potential outcomes, and foregrounds mortality. It may provide a sense of relief, or one of despair. Over time, and across cultures, there have been many different approaches used to palliate the potential impact of the diagnostic utterance on the patient. France, as one example, provides an interesting case study. Until the turn of the century, cancer diagnoses were often concealed from patients. However, recent legislation now requires full diagnostic disclosure according to prescribed protocols. Using Zerubavel’s social patterning methodology, and transcultural historical methods, I seek to understand beliefs about the potential impact of the diagnostic moment by identifying common features across cultural and historical social contexts. I examine writings of French oncologists, and physicians in related fields, from the pre- and post-legislation era who discuss if and how a cancer diagnosis should be disclosed to the patient. While the approach to diagnostic disclosure has changed significantly, medical representations of diagnostic power have not. The diagnostic utterance is still cast by medical professionals as a terrifying and life-disrupting moment.
Allegra R. Gordon, S. Bryn Austin, Nancy Krieger, Jaclyn M. White Hughto, and Sari L. Reisner
The impact of societal femininity ideals on disordered eating behaviors in non-transgender women has been well described, but scant research has explored these processes among transgender women. The present study explored weight and shape control behaviors among low-income, ethnically diverse young transgender women at high risk for HIV or living with HIV in a Northeastern metropolitan area. Semi-structured in-depth interviews were conducted with 21 participants (ages 18–31 years; mean annual income <$10,000; ethnic identity: Multiracial [n = 8], Black [n = 4], Latina [n = 4], White [n = 4], Asian [n = 1]). Interviews were transcribed and double-coded using a template organizing method, guided by ecosocial theory and a gender affirmation framework. Of 21 participants, 16 reported engaging in past-year disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use. Study participants described using a variety of strategies to address body image concerns in the context of gender-related and other discriminatory experiences, which shaped participants’ access to social and material resources as well as stress and coping behaviors. Disordered weight and shape control behaviors were discussed in relation to four emergent themes: (1) gender socialization and the development of femininity ideals, (2) experiences of stigma and discrimination, (3) biological processes, and (4) multi-level sources of strength and resilience. This formative study provides insight into disordered eating and weight and shape control behaviors among at-risk transgender women, illuminating avenues for future research, treatment, and public health intervention.
Elisa J. Sobo
In light of current concern over pediatric immunization rates, 53 US parents with at least one child kindergarten age or younger were surveyed and interviewed regarding vaccine decision making. Data were collected in 2014 in San Diego, California. Herd immunity was not a salient issue: only six (11.3%) referenced the term or concept spontaneously; others had to be prompted. Parents familiar with herd immunity (70%) variously saw it as not just unnecessary but unproven, illogical, unrealistic, and unreliable. For instance, parents questioned its attainability because many adults do not immunize themselves. Some understood the concept negatively, as an instance of “herd mentality.” Further, having knowledge of herd immunity that public health experts would deem ‘correct’ did not lead to full vaccination. Implications of findings for understanding how the public makes use of scientific information, the potential role of public health messaging regarding altruism and ‘free-riding,’ and assumptions that vaccine-cautious parents would willfully take advantage of herd immunity are explored in relation to parent role expectations and American individualism.
Special issue section: Mutuality, Health Promotion and Collective Cultural Change
Edited by Michèle Lamont, Mabel Berezin, Alonzo Plough and Matthew Trujillo
Mabel Berezin and Michèle Lamont
“The health research community — social scientists as well as public health experts — knows much about how social relations support better health outcomes. The distinctive contribution of this issue is to mobilize the analytical tools of cultural and political sociology to provide insight into the social and cultural factors that influence the level of social cohesion and societal solidarity. This complements other efforts to consider the impact of culture on health. For the Organization for Economic Cooperation and Development, a cohesive society ‘works towards the well-being of all its members, fights exclusion and marginalization, creates a sense of belonging, promotes trust, and offers its members the opportunity of upward mobility.’ We adopt this definition but complement it with a focus on solidarity, or mutual support, as demonstrated in the promotion of greater equality, including through redistribution and destigmatization. Given these definitions, we organized the issue around three themes: mutuality (“we are all in this together”); mobilization (civic engagement and participation), and messaging (communication). Contributions bring culturally oriented social science literature to a consideration of mechanisms and factors influencing these dimensions.”
Matthew D. Trujillo and Alonzo Plough
For generations, Americans’ health has been unequally influenced by income, education, ethnicity, and geography. Health care systems have operated largely apart from each other and from community life. The definition of health has been the “absence of illness,” rather than the recognition that all aspects of our lives should support health.
Today, a growing number of communities, regions, and states are working to redefine what it means to get and stay healthy by addressing the multiple determinants of health. The requirements of federal health care reform are changing who has access to care, how care is paid for and delivered, and how patients and providers interact. Coordinated efforts to promote wellness and prevent diseases are proliferating among a diverse set of stakeholders. These developments in health and in society present a window of opportunity for real societal transformation—a chance to catalyze a national movement that demands and supports a widely shared, multifaceted vision for a Culture of Health.
To address this challenge, the Robert Wood Johnson Foundation has embarked on a strategic direction to use the tools of a large national philanthropy to catalyze a social movement which we are calling Building a Culture of Health. This article presents the Foundation’s new model for a Culture of Health, the trans-disciplinary research that developed a set of metrics that tie to the model, and the community engagement activities undertaken in the development of both the model and metrics. The model and associated metrics and extensive communication, in addition to partnership, and grant funding strategies, represent a culture change strategy being implemented over 20 years. Addressing underlying inequities in health affirming life conditions and improving social cohesion across diverse groups to take action to improve theses condition lay at the heart of this strategy.
A critical review of recent literature on U.S. social movements concerned with matters of health and illness prompts reconsideration of the prevailing conception of such movements as necessarily isolated and particularistic. With a focus on disease-constituency-based mobilization—presently the most potent model of efficacious activism to be found in the domain of health and illness in the United States—I argue that such activism may tend in two directions: a specific response to an imminent disease threat, and a bridging of collective action frames and identities that can lead to connections across differences and broader mobilization. Case studies have demonstrated how patient activism has affected the management of illness, attitudes and practices of health professionals, research practices, processes of innovation, state policies, and corporate behavior. Through close analysis of patient group mobilization and its distinctive orientation toward knowledge and expertise, I argue that patient groups in practice may connect with or influence one another or a range of other forms of mobilization in relation to health, and I examine the “linkage mechanisms”—spillover, coalition, and frame amplification—by which this can occur. Rather than imagine a stark opposition between particularistic, single-issue health politics, on the one hand, and universalistic efforts to transform the meaning and practice of health and health care in the United States, on the other, I propose closer attention to the potentially Janus-faced character of many health movement organizations and the ways in which they may look either inward or outward.
Health navigators are a new health care workforce created by the Affordable Care Act (ACA) to assist low-income minority populations with acquiring health insurance. Given the high levels of distrust among the poor toward government and the medical profession, this article asks: How do health navigators build the legitimacy necessary to persuade low-income uninsured clients to enroll in health insurance? Through ethnography of face-to-face interaction between navigators and the uninsured poor in Chicago, this study shows that successful navigators deployed a combination of cultural repertoires for building trust and legitimacy. These repertoires included ceding control of the conversation, creating ethnic solidarity, and disassociating themselves from government bureaucrats or self-serving insurance employees. These findings demonstrate the usefulness of cultural sociology for understanding health insurance provision to the poor, ACA outreach efforts, and the more general study of how occupations legitimize themselves to clients.
John Gardner and Alan Cribb
This article explores power relations between clinicians, patients and families as clinicians engage in patient-centred ethical work. Specifically, we draw on actor-network theory to interrogate the role of non-human elements in distributing power relations in clinical settings, as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient-centred tool is implicated in establishing relations that constitute four modes of power: ‘power over’, ‘power to’, “power storage” and “power/discretion”. We argue that understanding the role of non-human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient-centred approaches in clinical settings.
Anne Schanche Selbekk and Hildegunn Sagvaag
Research shows that members of the families with patients suffering from alcohol and other drug-related issues (AOD) experience stress and strain. An important question is, what options do AOD treatment have for them when it comes to support? To answer this, we interviewed directors and clinicians from three AOD treatment institutions in Norway. The study revealed that family-oriented practices are gaining ground as a ‘going concern’. However, the relative position of family-orientation in the services, is constrained and shaped by three other going concerns related to: (i) discourse on health and illness, emphasising that addiction is an individual medical and psychological phenomenon, rather than a relational one; (ii) discourse on rights and involvement, emphasising the autonomy of the individual patient and their right to define the format of their own treatment; and (iii) discourse on management, emphasising the relationship between cost and benefit, where family-oriented practices are defined as not being cost-effective. All three discourses are connected to underpin the weight placed on individualised practices. Thus, the findings point to a paradox: there is a growing focus on the needs of children and affected family members, while the possibility of performing integrated work on families is limited.
Jenny Gunnarsson Payne and Elzbieta Korolczuk
This article examines how discourses on assisted reproductive technologies are locally appropriated, translated or contested in the specific cultural and political contexts of Poland and Sweden. The aim is to investigate how two national patients’ organisations, namely the Polish association Nasz Bocian and the Swedish organisation Barnlängtan, articulate rights claims in the context of reproductive technologies. To this end, we investigate how these organisations utilise specific context-dependent and affectively laden political vocabularies in order to mobilise politically, and discuss how each of these two groups gives rise to a different set of politicised reproductive identities. In order to trace which political vocabularies the respective organisations utilise to mobilise their respective rights claims, we draw primarily on political discourse theory and concepts of political grammars and empty signifiers. Lastly, we discuss which political reproductive identities emerge as a result of these different versions of political mobilisation around assisted reproductive technologies.
Agnete Meldgaard Hansen
Care work for elderly people has been characterised as dirty work, owing to its proximity to the (dys)functions and discharges of aged bodies and the notions of disease, decay and death associated with the idea of old age. However, a wave of reform programmes in Danish municipalities promoting rehabilitative care practices aiming to empower, train and activate elderly citizens provides opportunities for homecare workers to renegotiate their status and reconstruct their work and occupational identities with a cleaner and more optimistic image. Drawing on ethnographic fieldwork in two Danish homecare units, this article analyses how rehabilitative care practices, drawing on a narrative of the third age, provide an optimistic and anti-ageist framing of homecare work that informs the development of new occupational identities for care workers as coaches rather than carers in relation to citizens. Furthermore, rehabilitation efforts change the bodywork of care, rendering it more distanced and physically passive, and rehabilitation efforts also involve extensive motivational work aiming to help citizens to see themselves as capable, resourceful and self-reliant. However, while rehabilitation efforts become a new resource in care workers’ taint management; they also entail potentially negative consequences in terms of responsibilising and disciplinary approaches to elderly citizens.
Jennifer S. Singh
This study investigates the work and care associated with raising a child with disabilities in the United States. Based on in-depth interviews with parents who have a child with autism, it develops the notion of parenting work and trajectories of care to investigate how parents navigate and coordinate the challenges of getting an autism diagnosis, obtaining educational services, and re-contextualising the possibilities for the future. I argue that parents embody a complex mix of love, hope, and responsibility in parenting work and trajectories of care that expands temporal and social elements of illness work and trajectories initially developed by Anselm Strauss and colleagues. This type of parenting work changes over time and is influenced by social structural forces and relationships in which the care takes place. The re-articulation of these analytic tools also begins to untangle the intricate mix of both medical and social models of disability that parents embrace and continuously negotiate. This study demonstrates how parents accept the medical model of disability by seeking and pushing for a clinical autism diagnosis and subsequent treatments, while at the same time challenge the limits placed on their children by providing them with opportunities, possible futures, and a sense of personhood.
Josh Barton, Kevin Dew, Anthony Dowell, Nicolette Sheridan, Timothy Kenealy, Lindsay Macdonald, Barbara Docherty, Rachel Tester, Debbie Raphael, Lesley Gray, and Maria Stubbe
This study uses conversation analysis to explore ‘candidate obstacles’, a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio-visual recordings of 116 tracked consultations between health professionals and 34 patients newly diagnosed with type 2 diabetes mellitus in New Zealand. The analysis shows that in consultations where health promotion activities are central, patient resistance can provide space for patients to identify obstacles to their compliance with lifestyle advice. Identifying candidate obstacles provides opportunities for health professionals to align advice with concerns of patients and potentially improve patient outcomes.
Kirstine Zinck Pedersen
This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation’s resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre-empts certain types of safety solutions. Drawing on John Dewey’s influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.
Elise Rondelez, Sarah Bracke, Griet Roets, and Piet Bracke
Migrant and diasporic communities who identify as Muslim are underrepresented in mental health care across Western Europe. At the same time, they are particularly at risk of suffering from mental health problems. We seek to explore this underrepresentation in theoretical terms and do so through a critical analysis of sociological literature focused on Muslims and mental health care in a context of migration to Europe. Pursuing the Foucaultian insight that mental health institutions shape subjects that pass through them, we reframe this underrepresentation in terms of subjectivity and the failure to be “good” subjects of Western biomedical regimes. This article aims to sharpen the critical lenses required for such an investigation, in order to use those lenses to discern mechanisms of “othering” within the relevant sociological scholarship. These mechanisms consist of both universalising and essentialising particular experiences, and need to be understood in relation to colonial frameworks. As both mechanisms are premised on disregarding agency, we conclude by arguing in favour of taking the agency of subjects with mental health issues into account.
Editors note: We asked several scholars which readings they would recommend to students or colleagues interested in familiarizing themselves with the anthropology of ethics and morality. This is response we received from C. Jason Throop, Professor of Anthropology at UCLA. Reading lists from other scholars will be forthcoming in this series.
Directly tied to my efforts to analyze moral aspects of pain and suffering in the context of my ethnographic work in Yap, in the fall of 2007, I decided to offer a new graduate seminar at UCLA entitled “Morality, Virtue, and Subjectivity.” My goal at the time was to put together a seminar that would explore the ways that philosophical and anthropological literatures on morality, virtue, and subjectivity might critically inform one another. There were two major problems I faced, however, when it came to selecting relevant readings. First, on the philosophical side, there was the problem of selecting which readings, out of a vast existing literature, would be deemed both accessible and anthropologically relevant to the students. Assuming that most students had very little exposure to longstanding debates between virtue ethical, consequentialist/utilitarian, and deontological traditions in philosophy, I had to find a way to cover some of the basics without overwhelming them. Second, on the anthropological side, I struggled with the fact that there were very few examples of anthropologists directly engaging the topic in either an analytically sophisticated or an explicitly philosophically informed way. The result was a syllabus that covered much more philosophical than anthropological ground, with the anthropological contributions more often than not merely hinting at, rather than explicitly engaging in, a discussion of the key philosophical issues. In the end, this required that I do a lot of lecturing to make sure the connections that I was seeing between the two literatures were indeed also legible to the students, something that took important time away from our group discussions.
When offering the seminar again in subsequent years (2011, 2014, and again this coming Fall 2016) things had changed drastically, however. Whereas I only had a handful of explicitly ethically oriented ethnographic examples to draw from in the inaugural version of the seminar, in the wake of what was being increasingly recognized as a so-called ethical-turn in the discipline there was not only a remarkable increase in detailed ethnographic work explicitly focused on the topic but also the advent of a number of truly excellent efforts to define and historically situate the field. In designing the most recent version of the syllabus this past summer the problem that I now faced was thus deciding which, of the abundance of anthropological work on ethics/morality, I should use. While I am not completely satisfied with the result, I have chosen to drastically cut down on the philosophical readings and to add an extended (but by no means comprehensive) “Suggested Readings” section.
Drawing from my experience teaching four separate iterations of what is now simply termed “The Anthropology of Moralities” seminar, I include below what I deem to be some of the core anthropological contributions to the burgeoning literature on ethics and morality in the discipline. I have organized the bibliography according to three rough historical phases, two of which provide the foundations upon which the so-called ethical-turn was built. Within the ethical-turn proper, I have further tried to delineate some of the emerging and at times competing thematic/theoretical orientations within it. A careful working through of the works cited below should well orient anyone who may be interested in learning more about contemporary anthropological engagements with ethics/morality.
I. Early Contributions
Durkheim, Emile. 1961. Moral Education. Everett K. Wilson and Herman Schnurer (trans). New York: The Free Press of Glencoe, Inc.
Durkheim, Emile. 1974. “The Determination of Moral Facts,” “Individual Reason and Moral Reality,” “The Feeling of Obligation: The Sacred Character of Morality,” “The Subjective Representation of Morality.” In Sociology and Philosophy. New York: Free Press.
Durkheim, Emile. 1979. Essays on Morals and Education. Edited with an introduction by W.S.F. Pickering. H.L. Sutcliffe, trans. London: Routledge.
Durkheim, Emile. 1993. Ethics and the Sociology of Morals. Translated and with an introduction by Robert T. Hall. New York: Prometheus.
Durkheim, Emile. 1995. The Elementary Forms of Religious Life. Translated with an introduction by Karen Fields. New York: Free Press.
Edel, May and Abraham Edel. 1959. Anthropology and Ethics: The Quest for Moral Understanding. New Brunswick, NJ: Transaction.
Fortes, Meyers. 1987. Religion, Morality, and the Person: Essays on Tallensi Religion. Cambridge: Cambridge University Press.
Ladd, John. 1957. The Structure of a Moral Code: A Philosophical Analysis of Ethical Discourse Applied to the Ethics of the Navajo Indians. Cambridge, MA: Harvard University Press.
Linton, Ralph. 1952. “Universal Ethical Principles: An Anthropological Point of View.” In R. N. Anshen (ed.), Moral Principles of Action: Man’s Ethical Imperative. New York: Harper.
Malinowski, Bronislaw. 1926. Crime and Custom in Savage Society. London: Paul Kegan.
Nadel, S. F. 1964. “Morality and Language among the Nupe.” In D. Hymes (ed.), Language in Culture and Society: A Reader in Linguistics and Anthropology. New York: Harper and Row. Pp. 264-66.
Read, K.E. 1955. “Morality and the Concept of Person Among the Gahuku-Gama.” Oceania 25(4): 233-82.
Westermarck, Edward. 1917. The Origins and Development of the Moral Ideas. New York: Macmillan.
II. Some Pathways Toward a Turn (Morality and Ethics in 1980’s & 1990’s)
Asad, Talal. 1993. Genealogies of Religion: Discipline and Reasons of Power in Christianity and Islam. Baltimore: Johns Hopkins University Press.
Brodwin, Paul. 1996. Medicine and Morality in Haiti: The Contest for Healing Power. Cambridge: Cambridge University Press.
Briggs, Jean. 1998. Inuit Morality Play. Princeton: Princeton University Press.
Csordas, Thomas. 1994. The Sacred Self: A Cultural Phenomenology of Charismatic Healing. California: University of California Press.
D’Andrade, Roy. 1995. “Moral Models in Anthropology.” Current Anthropology 16(3): 399-408.
Fiske, Alan and Kathyn Mason. 1990. Moral Relativism. Special Issue of Ethos. 18(2).
Howell, Signe (ed.), 1997. The Ethnography of Moralities. London: Routledge.
Jackson, Michael. 1982. Allegories of the Wilderness: Ethics and Ambiguity in Kuranko Narratives. Bloomington: Indiana University Press.
Kleinman, Arthur. 1999. “Experience and Its Moral Modes: Culture, Human Conditions, and Disorder.” In G.B. Peterson (ed), The Tanner Lectures on Human Values 20:357-420. Salt Lake City: University of Utah Press.
Mattingly, Cheryl. 1998. “In Search of the Good: Narrative Reasoning in Clinical Practice.” Medical Anthropology Quarterly 12(3): 273-97.
Parish, Steven. 1994. Moral Knowing in a Hindu Sacred City: An Exploration of Mind, Emotion, and self. New York: Columbia University Press.
Parkin, David (ed). 1985. The Anthropology of Evil. Oxford: Blackwell.
Pocock, D. F. 1986. “The Ethnography of Morals.” International Journal of Moral and Social Studies 1(1): 3-20.
Scheper-Hughes, Nancy. 1995. “The Primacy of the Ethical: Propositions for a Militant Anthropology.” Current Anthropology 36(3): 409-420.
Shweder, Richard A. 1990. “In Defense of Moral Realism: Reply to Gabennesch.” Child Development 61(6): 2060-2067.
Shweder, Richard, Nancy Much, Manamohan Mahapatra, and Lawrence Park. 1997. “The ‘Big Three’ of Morality (Autonomy, Community, and Divinity) and the ‘Big Three’ Explanations of Suffering.” In A.M. Brand and P. Rozin (eds), Morality and Health. New York: Routledge. Pp. 19-169.
III. The “Ethical-Turn”
Barker, John (ed.). 2007. The Anthropology of Morality in Melanesia and Beyond. Hampshire: Ashgate Publishing Company.
Cassaniti, Julia and Jacob Hickman. 2014. “New Directions in the Anthropology of Morality.” Anthropological Theory 14(3): 251-262.
Castaneda, Quetzil E. 2006. “Ethnography in the Forest: An Analysis of Ethics in the Morals of Anthropology.” Cultural Anthropology 21(1): 121-145.
Csordas, Thomas. 2013. “Morality as a Cultural System?” Current Anthropology 54(5): 523-545.
Evans, T.M.S. 2008. Anthropology as Ethics: Nondualism and the Conduct of Sacrifice. Oxford: Berghahn Books.
Fassin, Didier (ed.). 2012. A Companion to Moral Anthropology. Malden, MA.: Wiley-Blackwell.
Fassin, Didier and Samuel Lézé (eds.). 2014. Moral Anthropology: A Critical Reader. New York: Routledge.
Faubion, James (ed.). 2001. The Ethics of Kinship: Ethnographic Inquiries. Oxford: Roman & Littlefield Publishers, Inc.
Faubion, James. 2011. An Anthropology of Ethics. Cambridge: Cambridge University press.
Heintz, Monica (ed.). 2009. The Anthropology of Moralities. Oxford: Berghahn Books
Keane, Webb. 2015. Ethical Life: Its Natural and Social Histories. Princeton: University of Princeton Press.
Laidlaw, James. 2013. The Subject of Virtue: An Anthropology of Ethics and Freedom. Cambridge: Cambridge University Press.
Lambek, Michael, Veena Das, Didier Fassin and Webb Keane (eds). 2015. Four Lectures on Ethics: Anthropological Perspectives. Chicago: HAU Books.
Robbins, Joel. 2013. “Beyond the Suffering Subject: Toward an Anthropology of the Good.” Journal of the Royal Anthropological Institute 19(3): 447-462.
Sykes, Karen (ed.). 2009. Ethnographies of Moral Reasoning: Living Paradoxes of a Global Age. New York: Palgrave Macmillan.
Yan, Yunxiang. 2011. “How Far Away Can We Move From Durkheim? – Reflections on the New Anthropology of Morality.” Anthropology This Century. Issue 2.
Yan, Yunxiang. 2014. “The Moral Implications of Immorality: The Chinese Case for a New Anthropology of Morality.” Journal of Religious Ethics 42(3): 460-493.
Zigon, Jarrett. 2008. Morality: An Anthropological Perspective. Bloomsbury Academic.
Zigon, Jarrett and C. Jason Throop (eds.). 2014. Moral Experience. Special Issue of the Journal Ethos 42(1).
Foucauldian Reverberations and Contestations
Faubian, James D. 2001. “Toward an Anthropology of Ethics: Foucault and the Pedagogies of Autopoiesis.” Representations 74(1): 83-104.
Faubian, James D. 2013. “The Subject that is Not One: On the Ethics of Mysticism.” Anthropological Theory 13(4): 287-307.
Daswani, Girish. 2013. “On Christianity and Ethics: Rupture as Ethical Practice in Ghanaian Pentecostalism.” American Ethnologist 40(3): 467-479.
Laidlaw, James. 2002. “For an Anthropology of Ethics and Freedom.” Journal of the Royal Anthropological Institute 8(2): 311-332.
Laidlaw, James. 2014. “The Undefined Work of Freedom: Foucault’s Genealogy and the Anthropology of Ethics.” In James D. Faubion (ed.), Foucault Now: Current Perspectives in Foucault Studies. Cambridge: Polity Press. Pp. 23-37.
Mahmood, Saba. 2001. “Feminist Theory, Embodiment, and the Docile Agent: Some Reflections on the Egyptian Islamic Revival.” Cultural Anthropology 6(2): 202-236.
Mahmood, Saba. 2005. Politics of Piety: The Islamic Revival and the Feminist Subject. Princeton: Princeton University Press.
Mattingly, Cheryl. 2012. “Two Virtue Ethics and the Anthropology of Morality.” Anthropological Theory 12(2): 161-184.
Mattingly, Cheryl. 2013. “Moral Selves and Moral Scenes: Narrative Experiments in Everyday Life.” Ethnos 78(3): 301-327.
Nakissa, Aria. 2014. “An Ethical Solution to the Problem of Legal Indeterminacy: Shari`a scholarship at Egypt’s al-Azhar.” Journal of the Royal Anthropological Institute 20(1): 93-112.
Robbins, Joel. 2004. Becoming Sinners: Christianity and Moral Torment in a Papua New Guinea Society. Berkeley: University of California Press.
Robbins, Joel. 2007. “Between Reproduction and Freedom: Morality, Value, and Radical Cultural Change.” Ethnos 72(3): 293-314.
Das, Veena. 2012. “Ordinary Ethics.” Pp. 133-149 in Didier Fassin (ed.), A Companion to Moral Anthropology. John Wiley & Sons, Inc.
Das, Veena. 2015. “What Does Ordinary Ethics Look Like?” in Michael Lambek, Veena Das, Didier Fassin and Webb Keane (eds), Four Lectures on Ethics: Anthropological Perspectives. Chicago: HAU Books.
Lambek, Michael. 2008. “Value and Virtue.” Anthropological Theory 8(2): 133-57.
Lambek, Michael (ed.). 2010. Ordinary Ethics: Anthropology, Language, and Action. Fordham University Press.
Lambek, Michael. 2015. The Ethical Condition: Essays on Action, Person, and Value. University of Chicago Press.
Lambek, Michael. 2015. “On the Immanence of the Ethical: A Response to Michael Lempert, ‘No Ordinary Ethics.” Anthropological Theory 15(2): 128-132.
Lempert, Michael. 2013. “No Ordinary Ethics.” Anthropological Theory 13(4): 370-393.
Mattingly, Cheryl. 2014. Moral Laboratories: Family Peril and the Struggle for a Good Life. Berkeley: University of California Pres.
Mattingly, Cheryl. 2014. “Love’s Imperfection: Moral Becoming, Friendship, and Family Life.” Suomen Antropologi: Journal of the Finish Anthropological Society 39(1): 53-67.
Naumescu, Vlad. 2016. “The End of times and the Near Future: The Ethical Engagements of Russian Old Believers in Romania.” Journal of the Royal Anthropological Institute 22(2): 314-331.
Pandian, Anand. 2008. “Tradition in Fragments: Inherited Forms and Fractures in the Ethics of South India.” American Ethnologist 35(3): 466-480.
Stafford, Charles (ed.). 2013. Ordinary Ethics in China. London: Bloomsbury Academic.
Zigon, Jarrett. 2014. “An Ethics of Dwelling and Anti-War Activism: A Critical Response to Ordinary Ethics.” Journal of the Royal Anthropological Institute. 20(4): 746-764.
Al-Mohammad, Haydar. 2010. “Towards an Ethics of Being-With: Intertwinements of Life in Post-Invasion Basra.” Ethnos: Journal of Anthropology 75(4): 425-446.
Benson, Peter and Kevin Lewis O’neill. 2007. “Facing Risk: Levinas, Ethnography, and Ethics.” Anthropology of Consciousness 18(2): 29-55.
Garcia, Angela. 2014. “The Promise: On the Morality of the Marginal and the Illicit.” Ethos 42(1): 51-64.
Geurts, Kathryn Linn. 2002. Culture and the Senses: Bodily Ways of Knowing in an African Community. Berkeley: University of California Press.
Jackson, Michael. 2013. The Wherewithal of Life: Ethics, Migration, and the Question of Well-Being. Berkeley: University of California Press.
Kleinman, Arthur. 2007. What Really Matters: Living a Moral Life Amidst Uncertainty and Danger. Oxford: Oxford University Press.
Kleinman, Arthur, et al.2011. Deep China: The Moral Life of the Person. Berkeley: University of California Press.
Lester, Rebecca. 2005. Jesus in Our Wombs: Embodying Modernity in a Mexican Convent. Berkeley: University of California Press.
Mattingly, Cheryl. 2010. The Paradox of Hope: Journeys Through a Clinical Borderland. Berkeley: University of California Press.
Pandian, Anand. 2010. “Interior Horizons: An Ethical Space of Selfhood in South Asia.” Journal of the Royal Anthropological Institute 16(1): 64-83.
Parish, Steven. 2014. “Between Persons: How Concepts of the Person Make Moral Experience Possible.” Ethos 42(1): 31-50.
Robbins, Joel. 2009. “Value, Structure, and the Range of Possibilities: A Response to Zigon.” Ethnos 74(2): 277-285.
Rydstrom, Helle. 2003. Embodying Morality: Growing up in Rural Northern Vietnam. Honolulu: University of Hawai`i Press.
Throop, C. Jason. 2008. “‘Becoming Beautiful in the Dance’: On the Formation of Ethical Modalities of Being in Yap, Federated States of Micronesia.” Oceania 79(2): 179-201.
Throop, C. Jason. 2010. Suffering and Sentiment: Exploring the Vicissitudes of Experience and Pain in Yap. Berkeley: University of California Press.
Throop, C. Jason. 2012. “Moral Sentiments.” Pp. 150-168 in Didier Fassin (ed.) A Companion to Moral Anthropology. Wiley-Blackwell.
Throop, C. Jason. 2014. “Moral Moods.” Ethos 42(1): 65-83.
Throop, C. Jason. 2014. “Friendship as Moral Experience: Ethnographic Dimensions and Ethical Reflections.” Suomen Antropologi: Journal of the Finnish Anthropological Society 39(1): 68-80.
Throop, C. Jason. 2015. “Ambivalent Happiness and Virtuous Suffering.” HAU 5(3): 45-68.
Zigon, Jarrett. 2007. “Moral Breakdown and the Ethical Demand: A Theoretical Framework for an Anthropology of Moralities.” Anthropological Theory 7(2): 131-150.
Zigon, Jarrett. 2009. “Within a Range of Possibilities: Morality and Ethics in Social Life.” Ethnos 74(2): 251-276.
Zigon, Jarrett. 2009. “Phenomenological Anthropology and Morality: A Reply to Robbins.” Ethnos 74(2): 286-288.
Zigon, Jarrett. 2010. Making the New Post-Soviet Person: Moral Experience in Contemporary Moscow. Leiden: Brill.
Zigon, Jarrett. 2013. “On Love: Remaking Moral Subjectivity in Postrehabilitation Russia.” American Ethnologist 40(1): 201-215.
Zigon, Jarrett. 2014. “Attunement and Fidelity: Two Ontological Conditions for Morally Being-in-the-World.” Ethos 42(1): 16-30.
Zigon, Jarrett. 2014. “Temporalization and Ethical Action.” Journal of Religious Ethics 42(3): 442-459.
Bialecki, Jon. 2014. “Diagramming the Will: Ethics and Prayer, Text, and Politics.” Ethnos 81(4): 712-734.
Bourdieu, Pierre. 1998. “Is a Disinterested Act Possible?” & “A Paradoxical Foundation of Ethics.” Practical Reason. Stanford: Stanford University Press.
Brodwin, Paul. 2013. Everyday Ethics: Voices from the Front Line of Community Psychiatry. Berkeley: University of California Press.
Dave, Naisargi, N. 2011. “Activism as Ethical Practice: Queer Politics in Contemporary India.” Cultural Dynamics 23(1): 3-20.
Dave, Naisargi, N. 2012. Queer Activism in India: A Story in the Anthropology of Ethics. Durham: Duke University Press.
Fassin, Didier. 2008. “Beyond Good and Evil?: Questioning the Anthropological Discomfort with Morals.” Anthropological Theory 8(4): 333-344.
Fassin, Didier. 2012. Humanitarian Reason: A Moral History of the Present. Berkeley: University of California Press.
Fassin, Didier. 2013. “On Resentment and Ressentiment: The Politics and Ethics of Moral Emotions.” Current Anthropology 54(3): 249-267.
Hirchkind, Charles. 2006. The Ethical Soundscape: Cassette Sermons and Islamic Counterpublics. New York: Columbia University Press.
Kuan, Teresa. 2015. Love’s Uncertainty: The Politics and Ethics of Child Rearing in Contemporary China. Berkeley: University of California Press.
Matza, Tomas. 2012. “‘Good Individualism’? Psychology, Ethics, and Neoliberalism in Postsocialist Russia.” American Ethnologist 39(4): 804-818.
Muehlbach, Andrea. 2012. The Moral Neoliberal: Welfare and Citizenship in Italy. Chicago: The University of Chicago Press.
Muehlbach, Andrea. 2013. “On Precariousness and the Ethical Imagination: The Year 2012 in Sociocultural Anthropology.” American Anthropologist 115(2): 297-311.
Ortner, Sherry B. 2016. “Dark Anthropology and its Others: Theory Since the Eighties.” HAU: Journal of Ethnographic Theory 6(1): 47-73.
Pandian, Anand. 2009. Crooked Stalks: Cultivating Virtue in South India. Duke University Press.
Scherz, China. 2014. Having People, Having Heart: Charity, Sustainable Development, and problems of Dependence in Central Uganda. Chicago: University of Chicago Press.
Ticktin, Miriam. 2006. “Where Ethics and Politics Meet.” American Ethnologist 33(1): 33-49.
Watanabe, Chika. 2014. “Muddy Labor: A Japanese Aid Ethic of Collective Intimacy in Myanmar.” Cultural Anthropology 29(4): 648-671.
Willen, Sarah S. 2014. “Plotting a Moral Trajectory, Sans Papiers: Outlaw Motherhood as Inhabitable Space of Welcome.” Ethos 42(1): 84-100.
Yan, Yunxiang. 2009. “The Good Samaritan’s New Trouble: A Study of the Changing Moral Landscape in Contemporary China.” Social Anthropology 17(1): 9-24.
Zigon, Jarrett. 2011. “HIV is God’s Blessing”: Rehabilitating Morality in Neoliberal Russia. Berkeley: University of California Press.
Zigon, Jarrett. 2015. “What is a Situation?: An Assemblic Ethnography of the Drug War.” Cultural Anthropology 30(3): 501-524.
HAU Book Review Symposia on the “Ethical Turn”
Didier Fassin, James Faubion, Webb Keane, Eduardo Kohn, Michael Lempert, Cheryl Mattingly, Veena Das, and James Laidlaw. 2014. “Book Symposium – The Subjective of Virtue: An Anthropology of Ethics and Freedom (James Laidlaw).” HAU: Journal of Ethnographic Theory 4(1): 429-506.
Cheryl Mattingly, Rita Astuti, James Laidlaw, Nicholas Harkness, C. Jason Throop, Richard Shweder, and Webb Keane. 2016. “Book Symposium – Ethical Life: Its Natural and Social Histories (Webb Keane).” HAU: Journal of Ethnographic Theory 6(1): 433-492.
Jason Throop is Professor of Anthropology & Vice Chair of Undergraduate Studies at the University of California, Los Angeles. He is the author of Suffering and Sentiment: Exploring the Vicissitudes of Experience and Pain in Yap (University of California Press, 2010) and the coeditor of the volumes Toward an Anthropology of the Will (Stanford University Press, 2010) and The Anthropology of Empathy: Experiencing the Lives of Others in Pacific Societies (Berghahn Books, 2011).
Sara Shostak’s “Exposed Science: Genes, the Environment, and the Politics of Population Health” by McKenze M. Sigler
by Sara Shostak
University of California Press, 2013, 312 pages
“Genetics loads the gun, but the environment pulls the trigger.” This turn of phrase, from Sara Shostak’s book Exposed Science: Genes, the Environment, and the Politics of Population Health, suggests that human variability and heredity is the underlying cause for most illnesses and while the environment is involved, it is not the sole perpetrator. It suggests that for some people, environmental exposure will lead to a reduction in health, while for others—perhaps the lucky ones, or perhaps the ones with so-called “superior genes”—it will not. Alternatively, as has been the long-standing assumption in environmental health sciences, one can posit that “the dose makes the poison”, a phrase that ignores genetics by suggesting that the environment’s effect on human health depends on the amount of the exposure. So how does an individual—a scientist, a community member, a parent, or a lawmaker—reconcile these two seemingly discordant ideas? How does the human genome, exposure, the places where we live, or our familial lineage come into play? Shostak’s Exposed Science both starts and ends with the quest for answers to these questions. In Shostak’s own words, “The central argument is that scientists’ perceptions of and responses to the structural vulnerabilities of the field of environmental health sciences have both intended and unintended consequences for what we know about the somatic vulnerabilities of our bodies to environment exposures” (Shostak 2013: 8-9). Sara Shostak is an Associate Professor of Sociology at Brandeis University. She brings a fresh perspective to the scientific discussion of environmental health, exploring the social implications behind new technologies and methodologies employed in environmental health research, toxicology, and their ever-increasing intersection with human genetics.
Shostak begins by taking readers on an objective, albeit slightly colorless, review of the history of the American government agencies that study environmental exposure and effects on the human body (namely, the National Institute of Environmental Health Sciences), and the political pressures and debates within and between these agencies in terms of what is studied, what is funded, and what scientists and the population at large stand to glean from it all. While this section is needed for the novice reader to understand the broader scope of the book, readers with experience in the subject area may find it dry.
Shostak continues by exploring questions around genetic susceptibility to environmental exposures, what motivates scientists to study gene-environment interactions, and what the consequences are to environmental health research that probes individuals at the molecular level. She details the evolution of environmental health sciences agencies from purely industry-regulating bodies to the rising idea that all human disease is—in one way or another—a genetic phenomenon. Shostak continues into the current and next phase of environmental health, which is human molecular research through sciences like molecular epidemiology and toxicogenomics. She then considers the social implications of these sciences. For instance, when we look at the molecular level, can the science be misrepresented to blame the victims of environmental exposures (who happen to be disproportionately represented among low-socioeconomic and minority groups)? In studying their genome prior to exposure, are scientists laying the framework to later disprove alleged victims’ claims of harm done through environmental exposure due to a preexisting “susceptibility”? Or, rather, are scientists creating biomarkers that can actually help in cases of environmental justice—benchmarks that prove changes to an individual’s physical make-up occurred after the environmental exposure?
Exposed Science is an ideally crafted sociology of the environmental sciences, both for readers who have some background knowledge in the subject area and particularly for those who do not. Shostak’s writing is accessible, but still academically written. She maintains objectivity by using consistent tone regardless of which side of an issue she is speaking to. Shostak delves deeply into history and science but brings the heavy research back to humanity in her refrains. Throughout the book, Shostak incorporates examples of how current areas of research affect individuals and communities through interlacing testimonies and real-life examples. This is a great read for anyone who cares to challenge the incentives behind scientific research, or for anyone who is interested in the relationships between social, environmental, and genetic determinants of health. Shostak aptly shows readers that sociocultural dynamics are ever-present even in a field largely considered to be black and white. Exposed Science is a remarkable read for scientists and activists alike, as well as the many players who make up the rest of the spectrum of perspectives.
McKenze Sigler works for The Bill and Melinda Gates Foundation supporting initiatives in Global Development. She holds a Master of Science in Epidemiology and Biostatistics, and was recently accepted to a Doctorate in Nursing Practice program where she will specialize as a Family Nurse Practitioner. McKenze resides in the Pacific Northwest and enjoys all the outdoors have to offer with her fiancé and their dog. This is her first contribution to Somatosphere.
Welcome to part one of September’s journal post. We start off with a few special issues, which have been highlighted earlier, followed by a great batch of interesting articles for fall reading. Enjoy!
Transcultural Psychiatry – “Practical Anthropology for a Global Public Psychiatry”
Medical Anthropology – “Nonsecular Medical Anthropology”
New Genetics & Society – “Private, the Public, and the Hybrid in Umbilical Cord Blood Banking”
The term “traditional diet” is used variously in public health and nutrition literature to refer to a substantial variety of foodways. Yet it is difficult to draw generalities about dietary tradition for specific ethnic groups. Given the strong association between migration and dietary change, it is particularly important that dietary advice for migrants be both accurate and specific. In this article, I examine the cultural construct of “traditional foods” through mixed method research on diet and foodways among rural farmers in Guanajuato, MX and migrants from this community to other Mexican and U.S. destinations. Findings reveal first, that quantitatively salient terms may contain important variation, and second, that some “traditional” dietary items –like “refresco,” “carne,” and “agua” – may be used in nutritionally contradictory ways between clinicians and Mexican immigrant patients. Specifically, the term “traditional food” in nutritional advice for Mexican migrants may be intended to promote consumption of fresh produce or less meat; but it may also invoke other foods (e.g., meats or corn), inspire more regular consumption of formerly rare foods (e.g., meats, flavored waters), or set up financially impossible goals (e.g., leaner meats than can be afforded). Salience studies with ethnographic follow up in target populations can promote the most useful and accurate terms for dietary advice.
Bharat Jayram Venkat
What is a cure and how do we know it? This essay examines the history of tuberculosis research to trace how ideas of cure shifted from Robert Koch’s development of tuberculin in late nineteenth-century Berlin to the earliest randomized studies of the efficacy of antibiotics in midcentury Britain and India. What sorts of evidence were required to know that a cure was in fact a cure? How did scientists ascertain when and if a cure had failed? And what were the ethical entailments of such modes of knowing? Through this history, I suggest that cure, rather than signaling a definitive end to illness, might instead be figured as an ending lacking finality. Like promises, cures for tuberculosis can be broken. Thinking at the limits of cure makes possible a reflection on the persistence of “curable diseases” into the present, as well as on the ways in which therapeutic knowledge comes to be consolidated and dismantled.
Does the spread of psychological counseling techniques in eastern Africa represent a “globalization” of the mind? This essay traces the genealogies of this phenomenon and points to the ways in which a set of imported techniques has been localized.
This article explores the politics of permissible exposure for US nuclear workers. I argue that despite recent efforts to improve regulations for occupational radiation protection, the federal government has been unable to solve the fundamental paradox of nuclear safety: that some level of exposure is unavoidable when working with nuclear materials and that any level of exposure comes with an associated biological risk. In short, injury is an operational necessity of nuclear industry. Thus nuclear safety can never mean total protection for workers—it can only ever be the level of exposure that has been deemed acceptable relative to the benefits of radiation. In this article, I trace the historical development and daily life of this cost-benefit calculus. I consider how acceptable risk frames exposure as integral to economic development and national security, normalizing nuclear injury as an unfortunate, yet necessary, part of modern life and work.
Natasha Dow Schüll
Online poker gamblers employ software to track and algorithmically analyze play-by-play game information in real time, parsing opponents’ behavioral patterns and tendencies into color-coded numerical values that hover over their respective positions at the virtual table. These continuously updated statistical dashboards, along with retrospective game analysis and methodical routines of self-adjustment, help gamblers abide swings of chance and avoid falling into the emotionally clouded, fiscally dangerous state of “tilt.” Drawing on interviews with gamblers, observations of online poker play, and discussion threads from poker forum archives, the article explores how the game and its data-intensive software teach gamblers to act from the vantage of an infinite temporal field in which probabilistic values can be trusted to bear out. Although digital media is often associated with choice paralysis and the disappearance of the subject, here it serves as a technology of the self. The composure toward chance events that gamblers cultivate online carries over to their lives off-line, lending them a subjective “readiness” for living with uncertainty. The case of online poker offers a window onto broader predicaments of choice making under conditions of heightened economic volatility.
Mads Peter Karlsen and Kaspar Villadsen
The relationship between pleasure and asceticism has been at the core of debates on western subjectivity at least since Nietzsche. Addressing this theme, this article explores the emergence of ‘non-authoritarian’ health campaigns, which do not propagate abstention from harmful substances but intend to foster a ‘well-balanced subject’ straddling pleasure and asceticism. The article seeks to develop the Foucauldian analytical framework by foregrounding a strategy of subjectivation that integrates desire, pleasure and enjoyment into health promotion. The point of departure is the overwhelming emphasis in the governmentality literature on ‘prudence’, ‘self-responsibility’ or ‘risk calculation’, such that pleasure and desire remain largely absent from the framework. Some insights from Žižek’s work are introduced to help us obtain a firmer grasp on the problematic of ‘the well-balanced subject’. The article argues that, in order to analyse the transformation of interpellation in recent health promotion, we must recognize the mechanism of self-distance or dis-identification as an integral part of the procedure of subjectification.
Private cord blood banking is the practice of paying to save cord blood for potential future use. Informed by the literature on corporeal commodification and feminist theories, this article analyses women’s work in banking cord blood. This article is based on in-depth interviews with 13 women who banked in a private bank in Canada. From learning about cord blood banking to collecting cord blood and transporting it to the private bank’s laboratory, women labour to ensure that cord blood is successfully banked. Private cord blood banking involves the overlap or insertion of commercial practices, and relations with clinical practices and relations that may cause tensions and confusion for women and clinical practitioners. Moreover, private banking reinforces and is reinforced by an ‘intensive mothering’ ideology. This article shows that corporeal commodification is not confined to a laboratory and the work of experts but extends into women’s everyday lives.
While there has been a significant amount of scholarship done on health and risk in relation to public health and disease prevention, relatively little attention has been paid to therapeutic interventions which seek to manage risks as bodily, and biological, matters. This article elucidates the distinct qualities and logics of these two different approaches to risk management, in relation to Michel Foucault’s conception of the two poles of biopower, that is, a biopolitics of the population and an anatomo-politics of the human body. Using a case study of contemporary addiction biomedicine, the article examines the development and deployment of treatments for addiction that seek to reduce the risks of relapse to drug use, and relates this case to other risk-reducing (but non-curative) medications, particularly cholesterol-reducing medications. The notion of a ‘disease of risk’ is developed in order to identify a range of medical conditions that bear a family resemblance, insofar as they are pharmaceutically managed with risk-reducing medications, and bound up within what is described as a contemporary ‘risk anatomo-politics’.
Morten Hillgaard Bülow and Marie-Louise Holm
Contributing to both ageing research and queer-feminist scholarship, this article introduces feminist philosopher Margrit Shildrick’s queer notion of the monstrous to the subject of ageing and the issue of dealing with frailty within ageing research. The monstrous, as a norm-critical notion, takes as its point of departure that we are always already monstrous, meaning that the western ideal of well-ordered, independent, unleaky, rational embodied subjects is impossible to achieve. From this starting point the normalizing and optimizing strategies of ageing research – here exemplified through the concept of successful ageing and the treatment of Alzheimer’s disease – can be problematized. The notion of the monstrous instead suggests a view on ageing and ‘monstrous’ embodiment which provides room for other, different ways of being recognized as an embodied subject, and for dealing with difference, vulnerability and frailty.
I explore a tension between divergent ways of reading the blush: on the one hand, physiological, as an instinctive bodily response composed of waves of nervous discharge, capillary dilation, and affect, on the other hand, narratological, as a key to inner character, its meaning unfolded over time through an interplay of temperament and circumstance. This tension surfaces in novels, natural history, and medicine over the course of nineteenth century. How were narratives of emotional character, centered on individual development or decay, bonds of affection or antipathy, sustained and transformed in relation to models of the emotional body as a reflex mechanism, an interiority of vaso-motor response, a storm of suppressed memory?
James Wilkes and Sophie K. Scott
Dialogues and collaborations between scientists and non-scientists are now widely understood as important elements of scientific research and public engagement with science. In recognition of this, the authors, a neuroscientist and a poet, use a dialogical approach to extend questions and ideas first shared during a lab-based poetry residency. They recorded a conversation and then expanded it into an essayistic form, allowing divergent disciplinary understandings and uses of experiment, noise, voice and emotion to be articulated, shared and questioned.
A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this ‘gap’ in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners ‘on the ground’. Employing a narrative-based approach, I accessed the stories about the mental health ‘treatment gap’ of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the ‘treatment gap’ was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health ‘treatment gap’ in Africa in ways very different from those created by current seats of power.
Tine Molendijk, Eric-Hans Kramer, and Désirée Verweij
Research indicates that soldiers struggling with PTSD under-utilize mental health care. Quantitative studies of barriers to care point to the importance of soldiers’ beliefs about mental health and mental health interventions in their care-seeking behavior, yet these studies still struggle to understand the particular beliefs involved and the ways they impact care-seeking behavior. This preliminary study makes a start in examining these questions through qualitative literature analysis. It maps out dominant messages surrounding PTSD in military mental health interventions, and explores how they can both shape and conflict with soldiers’ personal notions. It does so by analyzing these messages and notions as institutional and personal (illness) narratives. Institutional military PTSD-narratives, which draw on mainstream scientific and clinical models, appear to communicate contradictory notions on the meanings of violence and its psychological consequences, often without acknowledging these contradictions. As such, these narratives seem to shape struggles of soldiers, both within themselves and with the military institution. The identified conflicts indicate, contrary to the individualizing and decontextualizing focus of dominant PTSD-understandings, that soldiers’ struggles also have social and moral dimensions. This has important implications for both research into PTSD-interventions and understandings of PTSD as such.
Jeannette Pols and Sarah Limburg
Although people often refer to quality of life and there is a respectable research tradition to establish it, the meaning of the term is unclear. In this article we qualitatively study an intervention of which the quantitative effects are documented as indecisive. We do this in order to learn more about what the meaning of the term quality of life means when it is studied in daily life. With the help of these findings we reflect on the intricacies of objectifying and measuring quality of life using quantitative research designs. Our case is the feeding tube for patients suffering from ALS, a severe motor neuron disease that rapidly and progressively incapacitates patients. We studied how these patients, who lived in the Netherlands, anticipated and lived with a feeding tube in the course of their physical deterioration. Our analysis shows that the quality of life related to the feeding tube has to be understood as a process rather than as an outcome. The feeding tube becomes a different thing as patients move through the various phases of their illness, due to changes in their condition, living circumstances, and concerns and values. There are very different appreciations of the way the feeding tube changes the body’s appearance and feel. Some patients refuse it because they feel it disfigures their body, whereas others are indifferent to its appearance. Our conclusion is that these differences are difficult to grasp with a quantitative study designs because ‘matters of taste’ and values are not distributed in a population in the same ways as physiological responses to medication. Effect studies assume physiological responses to be more or less the same for everyone, with only gradual differences. Our analysis of quality in daily life, however, shows that what a treatment comes to be and how it is valued shows shows generalities for subgroups rather than populations.
T.N. den Hertog, M. de Jong, A.J. van der Ham, D. Hinton, and R. Reis
“Thinking too much”, and variations such as “thinking a lot”, are common idioms of distress across the world. The contextual meaning of this idiom of distress in particular localities remains largely unknown. This paper reports on a systematic study of the content and cause, consequences, and social response and coping related to the local terms |x’an n|a te and |eu–ca n|a te, both translated as “thinking a lot”, and was part of a larger ethnographic study among the Khwe of South Africa. Semi-structured exploratory interviews with community members revealed that “thinking a lot” refers to a common experience of reflecting on personal and interpersonal problems. Consequences were described in emotional, psychological, social, behavioral, and physical effects. Coping strategies included social support, distraction, and religious practices. Our contextualized approach revealed meanings and experiences of “thinking a lot” that go beyond a psychological state or psychopathology. The common experience of “thinking a lot” is situated in socio-political, economic, and social context that reflect the marginalized and displaced position of the Khwe. We argue that “thinking a lot” and associated local meanings may vary across settings, may not necessarily indicate psychopathology, and should be understood in individual, interpersonal, community, and socio-political dimensions.
Since spirit possession in mediumship and shamanism resembles psychotic symptoms, early researchers perceived spirit mediums and shamans as psychiatric patients whose psychopathology was culturally sanctioned. However, other researchers have not only challenged this assumption, but also proposed that spirit possession has transformative benefits. The idiom of spirit possession provides cultural meanings for spirit mediums and shamans to express and transform their personal experiences. The present case study focuses on dang–ki healing, a form of Chinese mediumship practiced in Singapore, in which a deity possesses a human (i.e., dang–ki) to offer aid to supplicants. This study seeks to explore whether involvement in dang–ki healing is transformative; and if so, how the dang–ki’s transformation is related to his self and the perceived legitimacy of his mediumship. At a shrine, I interviewed 20 participants, including a male dang–ki, 10 temple assistants, and nine clients. The results obtained were supportive of the therapeutic nature of spirit possession. First, there is a relationship between his self-transformation and the perceived legitimacy of his mediumship. As his clients and community have recognized his spirit possession as genuine, and the healing power of his possessing god, he is able to make use of mediumship as a means for spiritual development. Second, he has developed his spirituality by internalizing his god’s positive traits (e.g., compassion). Deities worshipped in dang–ki healing can be conceptualized as ideal selves who represent a wide range of positive traits and moral values of Chinese culture. Thus, the possession of a deity is the embodiment of an ideal self. Finally, the dang–ki’s transformation may run parallel to his god’s transformation. In Chinese religions, gods have to constantly develop their spirituality even though they are already gods. An understanding of the god’s spiritual development further sheds light on the dang–ki’s self-transformation.
In Japan, the first half of the twentieth century saw a remarkable revival of concern with the cultivation of the belly, with a variety of belly-cultivation techniques, particularly breathing exercise and meditative sitting, widely practiced for improving health and treating diseases. This article carefully examines some practitioners’ experiences of belly-cultivation practice in attempting to understand its healing effects for them within their life histories and contemporary intellectual, social and cultural contexts. It shows that belly-cultivation practice served as a medium for some practitioners to reflect on and retell their life stories, and that the personal charisma of certain masters and the communities developing around them provided practitioners with a valuable sense of belonging in an increasingly industrialized and urbanized society. Moreover, these belly-cultivation techniques provided an embodied way for some to explore and affirm their sense of self and develop individual identity. While they were increasingly promoted as cultural traditions capable of cultivating national character, they also served as healing practices by inspiring practitioners with a sense of collective identity and purpose. With these analyses, this article sheds light on the complicated meanings of belly-cultivation for practitioners, and provides illustrative examples of the multitude of meanings of the body, bodily cultivation and healing.
Ellen Badone, David Nicholas, Wendy Roberts, and Peter Kien
Situated at the intersection of anthropological work on illness narratives and research on the anthropology of autism, this paper is a close reading of an autobiographical narrative recounted by Peter, a young man diagnosed with Asperger’s Syndrome, a type of autism spectrum disorder (ASD). Responding to Solomon’s call for phenomenologically grounded accounts of “the subjective, sensory, and perceptual experiences of autism … based on personal narratives and practices of being and self-awareness,” this paper calls into question key assumptions in the clinical and popular literature about ASD relating to theory of mind, empathy, capacity for metaphorical thinking, and ASD as a life-long condition.
Javier Saavedra, Marcelino López, Sergio Gonzáles, and Rosario Cubero
Employment has been highlighted as a determinant of health and as an essential milestone in the recovery process of people with serious mental illness. Different types of programs and public services have been designed to improve the employability of this population. However, there has not been much interest in the meanings attributed to these experiences and the negative aspects of work experience. In this research, we explored the meanings that participants attributed to their work experience and the impact of work on their recovery process. Research participants lived in Andalusia (Spain), a region in southern Europe with a high unemployment rate. Two versions of a semi-structured interview were designed: one for people who were working, and one for unemployed people. Participants’ narratives were categorized according to grounded theory and the analyses were validated in group sessions. Apart from several positive effects for recovery, the analysis of the narratives about work experience outlined certain obstacles to recovery. For example, participants mentioned personal conflicts and stress, job insecurity and meaningless jobs. While valid, the idea that employment is beneficial for recovery must be qualified by the personal meanings attributed to these experiences, and the specific cultural and economic factors of each context.
Sofie á Rogvi, Annegrete Juul, and Henriette Langstrup
The rhetoric of need is commonplace in discourses of technology and innovation, as well as in global health. Users are said to have a need for innovative technology, and citizens in resource-poor regions to have a need for improved health care. In this article we follow a global health technology—more specifically, a piece of software for monitoring diabetes quality—from Denmark, where it was developed, to Jakarta, Indonesia, where it was introduced in 2012–13. Using ethnographic material, we show how the need for a specific technology is constituted through the very process of moving a technology from one setting to another. Central to this process of a technology traveling, we suggest, is the role played by comparisons invoked by actors and the technology itself. These comparisons become instances of evaluating local practices, thus determining what is needed in tackling a health challenge locally. With this focus on the interrelations among technological innovation, local needs, and comparisons across global distances, we aim to contribute to critical discussions of the prospects of traveling technologies for global health, as well as drawing attention to the recipient’s agency in (re)shaping the capacity of the technology and thus the need-solution complex even in the face of powerful asymmetries.
This essay explores the scientific lives of two Republican-period institutions: the Henry Lester Institute of Medical Research, based in Shanghai; and the Chongqing No. 3 Children’s Home. Despite their differences, these two spaces sheltered and nurtured scientific experimentation and functioned as heterotopic sites that controlled who could produce scientific knowledge and which kinds of scientific objects could become visible. By examining closely the research work of Bernard E. Read, Stephen M. K. Hu, and the team of nutrition scientists from National Jiangsu Medical College, this article argues that how space became hospitable for scientific experiment and how science refashioned space were mutually constitutive processes. This process of coproduction was critical to and, at times, contested through expressions of expertise.
Christine Y. L. Luk
This article aims to put Hong Kong on the map of East Asia’s biotech studies by identifying the major themes of biotech innovation specific to the city-state’s colonial past and postcolonial present and future. I provide evidence of a concerted effort led by biologist-entrepreneurs to promote the biotech industry in postcolonial Hong Kong. Through assessing scientific literature, media representations, business strategies, and programmatic visions of key scientist-entrepreneurs in Hong Kong’s biotech enterprise, I highlight how factors such as local history and geopolitical considerations shape the emerging “Hong Kong’s bioscience dream.” Using the recent discovery of a new recombinant anticancer drug, pegylated human recombinant arginase (BCT-100), as a case in point, I explore how biotech research and applications are marketed and interpreted in relation to Hong Kong’s unique historical, political, and cultural context, thus making it distinct from other Asian Tigers. My analysis of the featured recombinant drug reveals a set of uniquely Hong Kong–centered cultural meanings attributed to biopharmaceutical research and benefits. This case reflects how genetic engineering and biotech research are configured and imagined within the context of the postcolonial Hong Kong Special Administrative Region.
Galia Plotkin Amrami
The forced evacuation of Jewish Israeli settlers from the Gaza Strip and parts of the West Bank in August 2005 (known as the Disengagement) was an extremely controversial political event in Israeli public discourse. This article seeks to explore how political differences in the public sphere were reflected in the professional narratives of mental health practitioners. Based on my field notes documenting the processes of the narration of the Disengagement within various professional settings of Israeli mental health experts, I compare the narratives produced by practitioners who hold different ideological positions vis-à-vis the settlement project. I contend that the political views of practitioners expressed in causal explanations of the Disengagement experience and in the modes of mediation of this experience in order to mobilize empathy with evacuated settlers. By focusing on the professional narration and mediation of the experience of a controversial group of sufferers (“the bad victims,” as they might be called), this research highlights the importance of the anthropological perspective on therapeutic empathy as a socially mediated reflection of the moral experience of health practitioners.
Katie Rose Hejtmanek
In the United States, young people are remanded to psychiatric custody for the institutionalized treatment of mental illness, behavior disorders, and emotional disturbances, and forced to participate in this therapeutic system. Anthropological investigations of therapeutic process have focused on individuals actively seeking and engaging in treatment or a therapeutic process. Does transformation require a person fully accept the therapeutic system? Is a coerced therapeutic process still effective? This article engages with these questions by situating the therapeutic process in psychiatric custody for American adolescents. The youth in treatment accept that transformation and even healing take place but locate the etiology and form of this change differently than the official treatment paradigms. This case study illustrates that transformation and therapeutic process as multifaceted, especially in coercive contexts, and the efficacy of the therapeutic process as shaped by the life stage and political contexts of those engaged in the process.
In Ng’ombe Township in Lusaka, the death of a baby is often met with silence. Based on long-term ethnographic fieldwork, this article explores how the bereaved mother’s silence is guided by wider cultural norms and values associated with death, by complex notions of what it means to be a person, and by local perceptions of mental health and well-being. To enhance the complexity of the mother’s silences, it also explores how structures of poverty manifest in mothers’ experiences of loss and how silence may hold feelings of inadequacy but also of care and compassion. Finally, the article aims to provide a counterweight to the predominant assumption that mothers in poor communities, who experience high levels of infant mortality, fail to mourn the death of their babies, as well as to psychological theories that assumes verbal expressions as vital for the mourner’s mental recovery after loss.
Home health care is a growing occupation in the United States which calls for significant emotional labor. On the basis of interviews and participant observation with home health workers from Ghana, this article argues that home health work is different from other kinds of emotional labor in that living and working in the client’s house are central to the conditions of work and the dignity assaults of workers’ experience. Among their strategies for responding to these dignity threats is to long for a house and to direct their energy toward an alternative social field through house construction “at home” in Ghana. Thus, the dignity threats experienced by immigrant home health workers raise concerns about the occupation’s ability to retain workers as well as immigrants’ sense of worth and belonging in the United States.
This article analyses strategies of closure recently enacted by complementary and alternative medicine practitioners in order to achieve occupational control over work domains in healthcare, taking Portugal as an example. A combination of the neo-Weberian occupational closure theory of the professions and Abbott’s jurisdictional vacancy theory is proposed as the framework for analysis. Acupuncture and homeopathy will be presented as case studies. Data are derived from in-depth interviews with 10 traditional acupuncturists and 10 traditional homeopaths. Data analysis suggests that (1) professionalisation, (2) alignment with biomedical science and (3) expressing ‘legitimating values’ of a countervailing nature have been three significant strategies complementary and alternative medicine practitioners have used in an attempt to achieve market closure. It is argued that these strategies are contradictory: some involve allegiances, while others involve demarcation from biomedical science. A further outcome of these strategies is the promotion of complementary and alternative medicine treatments and solutions in everyday life. The success of these strategies therefore, although helping to reinforce the biomedical model, may simultaneously help complementary and alternative medicine to demarcate from it, posing thus challenges to mainstream healthcare.
Thomas Eugene Bertorelli
Although neuroimaging is currently not a component of the diagnostic process for autism spectrum disorders, some scientists hail these technologies for their promise to one day replace behaviorally based psychiatric diagnostic techniques. This article examines how psychiatrists understand the potential use of neuroimaging technologies within the context of clinical practice. Drawing on 10 semi-structured interviews with child and adolescent psychiatrists, I describe the hope and doubt that comprise their discourse of ambivalence. This analysis demonstrates that the uses and meanings of neuroimaging technologies are rearticulated in ongoing debates in the field of psychiatry regarding the role of the biopsychiatric model in the diagnosis and treatment of mental illness. This study highlights issues surrounding the perceived biopsychiatric focus of neuroimaging technologies within clinical practice, concerns regarding misdirected research attention, and the ways in which understandings of future utility mediate perceptions of technological utility.
Rebecca Lynch and Simon Cohn
Self-monitoring, by which individuals record and appraise ongoing information about the status of their body in order to improve their health, has been a key element in the personal management of conditions such as diabetes, but it is now also increasingly used in relation to health-associated behaviours. The introduction of self-monitoring as an intervention to change behaviour is intended to provide feedback that can be used by individuals to both assess their status and provide ongoing support towards a goal that may be formally set or remains implicit. However, little attention has been paid to how individuals actually engage in the process or act upon the information they receive. This article addresses this by exploring how participants in a particular trial (‘Get Moving’) experienced the process and nature of feedback. Although the trial aimed to compare the potential efficacy of three different monitoring activities designed to encourage greater physical activity, participants did not present distinctly different accounts of each intervention and the specifics of the feedback provided. Instead, their accounts took the form of much more extended and personal narratives that included other people and features of the environment. We draw on these broader descriptions to problematise the notion of self-monitoring and conclude that self-monitoring is neither solely about ‘self’ nor is it exclusively about ‘monitoring’. We suggest that a more expansive social and material understanding of feedback can give insight into the ways information is made active and meaningful for individuals in their everyday contexts.
Sarah Mason-Renton and Isaac Luginaah
Uncertainty surrounding potential health effects of techno-industrial facilities continues to result in heightened debate about what are the best and safest options for future generations in rural places regarded by residents for their therapeutic tranquility. This research examines how a proposed biosolid processing facility in rural Ontario producing agricultural fertilizer from primarily urban sewage has in some residents elicited particularly strong concerns about potential health impacts, which are accompanied by perceptions that the tranquil and pastoral nature of their landscape is being altered. However, fueling community conflict between friends and relatives is the contested nature of the landscape’s restorative qualities and the facility’s disruption of this tranquil place.
Stuart Earle Strange
This article explores how pain ritually assists in producing Afro-Surinamese Ndyuka Maroon understandings of subjectivity and the self. Ndyuka discourses conceive persons as composites of multiple human and spirit others. I describe how these discourses emerge dialogically during oracular interactions between possessed mediums and their patients. Beginning as inarticulate sensations, personal pain is ritually transformed into identifiable spirits who expose their hosts as embodiments of past and present social relations. Over the course of oracular interactions, the qualities of physical pain are made to communicate that the pain is both an identity and a vital part of the sufferers’ embodied self. In parallel to this process, spirit mediums perform pain in possession to establish the origins of their authority in relations with spirits. Ritually transforming pain into identities of relation, Ndyuka oracular mediumship persuades patients to re-evaluate their subjective experiences as innate evidence of Ndyuka social ideology.
This article describes relationships between a team of mid-level government health managers working in a rural Kenyan district and those whom they managed: health workers based at rural health facilities. In this context, managerial expertise was heavily informed by personal biography and a moral obligation to empathize with the difficult working conditions and familial responsibilities of junior staff. Management should be studied seriously in anthropology, as a powerful social and bureaucratic form. This focus must extend beyond a concern with tactics and technologies of governance to consider how modalities of managerial expertise are also shaped by biography, intersubjectivity, and professional identity.
In October of 2014, Romanian mass-media featured the local story of a few dozen citizens—most of them Orthodox nuns—refusing their newly issued state health insurance cards, on the grounds that the term card imprinted on the card would spell, when read backwards, drac—the Romanian word for “devil.” It seemed that the nuns, along with a few Orthodox priests and monks and other laymen, rejected the cards because they saw in them instruments of population control imbued with malefic powers. In their view, anyone who would accept the biometric chip-enabled health insurance card would bear the “mark of the beast,” as prophesied in the Christian Book of Revelation. “The beast” would be the computerized data system of global surveillance, whose ultimate aim is to strip humans of their God-bestowed freedom.
Upon reading this news, I was not necessarily astonished by the fact that a narrow demographic group would express such apocalyptically articulated anxieties when facing the biopolitical regimes of health care provision. In Romania, as elsewhere, fundamentalist Orthodox websites disavow various biomedical procedures—like vaccination—on similar grounds, by equating them with receiving “the mark” and by evoking the millennialist opening of the seals that precede the coming of the Antichrist. What did surprise me was the backwards reading of the word card as drac. Why would someone read anything backwards? And how does one get the idea of reading in reverse in the first place?
I took my own health insurance card in my hands and tried to read it the way the Orthodox nuns might have read theirs. And all of a sudden I was struck by its materiality. While staring at the card, my mind stopped conjuring the entitlements to medical services that it granted. I am unsure if the mental process I underwent qualifies for the status of phenomenological reduction, but I was simply contemplating the rectangular piece of plastic in my hands. My consciousness was ensnared by the card’s material presence, while all my background knowledge about health care and medical insurance was suspended. As a pure object of the phenomenal world, the card had lost its strict spatial attributes and had no up and down, left and right, recto and verso anymore. It had become a polymorph and dynamic thing that I kept rotating slowly between my fingers, until, indeed, “the devil” popped up.
That the nuns had most likely contemplated rather than just embraced the health insurance card seems to make sense when thinking about the fact that they are presumably living in a lifeworld imbued with signs of decay that reveal the coming of the Antichrist. Uncovering the materiality of the health insurance card is a form of taking possession of the card, while questioning at the same time the promise of health care benefits that it bears. In contrast, accepting the card for what it is claimed it represents and completely bypassing its materiality would be letting the world of medical insurance and health care services take over you. By operating a contemplative scrutiny of the actual objects that make access to health care possible the nuns rightfully diagnosed the violence encapsulated in the state-driven system of medical insurance.
We might similarly grasp something of the complicated dynamic of desire and resistance in relation to medical care claims, entitlements, and benefits when allowing our gaze to engage with the materiality of health care, as it unveils to our consciousness. At the 2015 AAA in Denver, Julian Chehirian, a student at American University, who is researching the social history of psychiatry in communist Bulgaria presented a paper about his Excavating the Psyche exhibition —a display of a psychiatric consultation room. In order to really wrap our heads around the already shopworn idea that psychiatry was used as an instrument of political repression, Chehirian invited us to contemplate actual objects, such as the medicine cabinet. The “true force of things”—as Sahlins (1981) once said in reference to what symbols represent—resides in the disquieting presence of the tall and narrow cabinet, with its glass door that reveals and protects its content at the same time. Neatly arranged syringes, small medicine bottles, ampoules, and prescriptions convey order and terror. The order of terror. The severity and the coldness of the cabinet white-painted metallic frame gives the viewer an uncomfortable bodily frisson.
Recently, my gaze was captured by a similar white metal hospital item—the nightstand. I am referring to the type of nightstand that is still common in most Romanian public hospitals. Sometimes, its metallic drawers are pastel-colored in shades of pale pink or faint blue, but—white or pastel—the paint is always chipped on the edges. The hospital nightstand is a liminal object where ambiguities converge. It is a familiar piece of furniture that we know from home, yet it appears so foreign and anonymous in a hospital setting. It divides a patient’s vital space from that of the nearby roommate, but it also connects the individual patients’ personal spaces. It is a functional object whose empty ugliness mobilizes patients, family members, and even medical practitioners sometimes, to tame it and to make it look less like a painful metaphor of the current state of public medical care in Romania.
In a quintessential act of engagement with the materiality of health care, the ritual of domesticating the hospital nightstand starts with drudgingly opening its semi-stuck drawers and covering their rusty bottom with wrapping paper or roll paper brought from home for this specific purpose. Once the drawer is padded, various personal items are placed inside: silverware, plates, cosmetics, towels, and the phone charger. And toilet paper. A nice chocolate box or a bag of coffee for “the gifts” to the doctor and nurses might find their place inside the nightstand as well. Also, a few empty envelopes—in case “the gift” takes a monetary form. Then, the top of the nightstand also gets covered with roll paper, a decorative kitchen towel, or even a small macramé tablecloth. Various items show up on the nightstand—medication, a mug or a glass, a phone, books and magazines, writing utensils, bottled water, and a vase with flowers. Sometimes, a small icon. It is tempting to read patients’ socio-economic profile and personal history through a reading of their customized hospital nightstand. Moreover, by contemplating the hospital nightstand, a trained eye can decode a patient’s diagnosis, the projected length of stay, and maybe even the prognosis.
However, I am mostly interested in the materiality of the hospital nightstand for its potential in exposing the regimes of health care delivery. The nightstand is not only the tangible expression of patients’ past experiences within the realm of state medicine, but also of their expectations and assumptions regarding medical entitlements and benefits. How does the inventory of patient items placed on or inside the nightstand correlate with the quality of hospital services or with the resourcefulness of the system of medical care more generally? Without really addressing such a question or similar ones, Healy et al. (2015) explore the use of nightstands (and over-the-bed tables) and provide interesting data on the kind of items that patients surround themselves with in a rehabilitation hospital in the US. Making a similar inventory in a Romanian hospital would be a starting point for a deeper analysis.
Finally, I would like to consider the hospital bag, as another example of the way citizens attempt to tame their anxieties about the transforming landscapes of medical claims and entitlements in a post-socialist context, by acting upon the materiality of care. Before being an actual bag, the hospital bag is just a checklist of things that an expectant mother packs in preparation of her hospital birth. The internet abounds in video tutorials, advising websites, and chatrooms dedicated to its content. With the hospital bag, the materiality of health care shifts back and forth between the actual experience of giving birth in a maternity clinic and the virtual anticipation of such an event. When looking for online information or asking their peers about what to pack for their upcoming hospital births, future mothers have to face their most terrifying assumptions about the low-quality provision of reproductive care, while mobilizing their most hopeful emotions. Packing the proper hospital bag is a strategy to navigate perceived reproductive vulnerability.
Beyond embodying personal reproductive experiences, the hospital bag can also offer a reading of how people position themselves in relation to the various regimes of medical care distribution. The interminable list of items presumably needed to give birth in a Romanian state maternity hospital includes everything from toilet paper, cotton, diapers, onesies, blankets, and baby wipes to breast pumps and silicone nipple shields, etc. By contrast, those who can afford the expensive care of private birthing clinics boast about their minimalist hospital bag—allegedly containing only a tooth-brush and the bank-card. It seems that not having to deal with the materiality of health care is a consequence of having access to forms of privileged care. The women whose hospital bag is a card have no reason to engage with its materiality as a pure object of the phenomenal world. Their card will always spell an unequivocal card.
In the end, the musings that the contemplation of actual items of health care provision engender—from the overwhelming materiality of the health insurance card, to the anguish-producing hospital furniture and the material volatility of the hospital bag—are in fact about structural violence, biopolitical surveillance, uneven access to medical care and reproductive vulnerability. Yet, as I have sought to show within this brief piece, engaging with the materiality of health care genuinely empowers patients in their attempts to co-produce the emergent meanings of reformed medicine.
Cristina A. Pop earned a PhD in Linguistics from Babeș-Bolyai University (Romania) and a PhD in Cultural/Medical Anthropology from Tulane University. Her work scrutinizes the transformations in women’s sexual and reproductive health produced by the post-socialist restructuring of medical care in Romania. Cristina has published articles in Medical Anthropology Quarterly and Culture, Health and Sexuality. She is currently preparing a book manuscript about the Romanian cervical cancer “epidemic.”
Sahlins, M. 1981. Historical Metaphors and Mythical Realities: Structure in the Early History of the Sandwich Islands Kingdom. Ann Arbor: University of Michigan Press.
Healy, S., Manganelli, J., Rosopa P. J., Brooks J. O. 2015. An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital. Health Environments Research & Design Journal. 8(2): 43-55.
For this installment of the Top of the Heap series, I spoke with Paul M. Rabinow, who is a Professor of medical and sociocultural anthropology at the University of California at Berkley.
Alexander Kluge & Oskar Negt, History and Obstinacy, translated by Richard Langston et.al., edited and with an introduction by Devon Fore, Cambridge: Zone Books, 2014.
Michael Foessel: Le Temps de la Consolation, Paris: Editions du Seuil, 2015.
Marielle Macé, Le temps de l’essai, Histoire d’un genre en France au XX siècle, Paris Belin, 2006.
Tim Blanning, Frederick the Great, King of Prussia, New York: Random House, 2016.
Stephen Parker, Bertolt Brecht, a Literary Life, London: Bloomsbury, 2014.
Ben Ratcliff, John Coltrane, The Story of a Sound, New York: Picador, 2007.
As we have long since passed through the moment of the politics and poetics of ethnography, I find my reading still fits into something like the ethics and aesthetics of life. In that light, here are some of the books I have been reading lately.
The Kluge & Negt is the most ambitious as well as the most experimental of the lot. They are (were) well known for their interventions in the public sphere discussions offering a more Marxist interpretation than that of Habermas. This volume is a new English translation of a much longer book in German that the authors collaborated in reducing in size and perhaps increasing in coherence. It is a weird book assembling a heterogeneous range of materials ranging from concept definitions, to German folklore, to a very long term history of capitalism and the micro forms of resistance, “obstinacy” that they claim have always existed. The book is impossible to summarize: Devon Fore provides a lucid and helpful long introduction that is the place to begin.
The Foessel is an essay in the recent French genre that they now call philosophy. It is an intriguing attempt to demonstrate that while once philosophy (and religion) offered forms of consolation, in modernity this salvational hope has become untenable, at least theoretically. The claim is a rich one raising many questions well worth pondering even if the author’s approach and style are too sweeping to be truly convincing. Had the book ever touched ground in an anthropological sense it would have been vastly improved but the clarity of its argument would have been harder to sustain in such epochal and totalizing terms. Still, a very intriguing contribution to contemporary ethics and thought.
The Macé is a much more scholarly (and convincing) treatment of the importance of the essay in France as straddling and at times occupying the liminal zone between art and science. This is an excellent book.
The Banning is a magisterial account of Frederick the Great, for once not concentrating at length on his encounter with Bach or the thoughts of Kant on the Enlightenment. Rather, if one wants to get a richer, detailed and situated account of what the emergence of bio-power and bio-politics looked like in the eighteenth century, this is a good place to start. It offers a remedy for the vast outpouring of necrophilic accounts of what Foucault had in mind when he coined the terms. Further, it turns out that Frederick was a flamboyant gay, organizing his court to suit his tastes.
The Parker is another magisterial biography, this time of Bertolt Brecht. The deeply appreciative yet complexly nuanced account of this brilliant modernist and the political shoals he had to navigate his whole life from the Americans to the Communists. The presentation of his theater and poetry is helpful if not exactly an introduction; it should serve as a stimulus. Brecht’s domestic practices and his gender politics will not please everyone but are worth knowing about.
The Ratcliff, perhaps most like the Macé in this grouping, is a telling account not so much of John Coltrane the man (although there is some of that and it is done well with great economy) but of his “sound.” Ratcliff, a journalist jazz critic, provides a compelling account of a short period of time (mid to late 1950s until Coltrane’s death in 1967) of his transformations in sound and style. Coltrane practiced relentlessly perfecting his technique and testing his body; he was a far ranging intellectual with a quiet if voracious curiosity. His search for the outer frontiers of modern music and the institutional setting and racial as well as the critical obstacles he had to face are well told. Coltrane said at the end of his short life (he died at age 40) that he wanted to be remembered as a saint. Food for thought for anthropologists.
Professor Paul M. Rabinow received his Ph.D. (1970) in anthropology from the University of Chicago, and is currently Professor of Anthropology at the University of California at Berkeley where he has taught since 1978. He has taught in France, Brazil, Iceland and is co-founder of the Berkeley Program in French Cultural Studies. He was named Chevalier de l’Ordre des Arts et des Lettres by the French Government in 1998. He received the University of Chicago Alumni Association Professional Achievement Award in 2000. He was awarded the visiting Chaire Internationale de Recherche Blaise Pascal at the École Normale Supérieure for 2001-2. STICERD Distinguished Visiting Professor- BIOS Centre for the study of Bioscience, Biomedicine, Biotechnology and Society, London School of Economics (2004), Sir James Frazer Lecturer (Cambridge) 2008, Mosse Distinguished Lecture (Berlin) 2010.
“First, it critically examines the dichotomy between public and private cord blood banks, and shows that the mechanism and network of cord blood banks is far more complex than indicated by the dichotomy of the public and the private. …
“Second, there is an increased interest in the social, ethical and political aspects of cord blood banking as a location where scientific, economic, governmental and personal expectations converge. Cord blood banking attracts various actors with common, and competing, interests, including regulators, scientists, business people, medical staff, donors, patients and customers. Although academic publications have appeared on some of the contested values and discourses around UCB banking, such as waste, gift, hope, insurance and venture…, there is still little we understand about the collaborations, alliances and competition among these actors and stakeholders, as the processes involved in cord blood banking remain opaque. This special issue brings together the perspectives of midwives, managers in cord blood banks, parents, scientists and policymakers in different countries. Their standpoints highlight various perspectives on cord blood banks, as well as how a panoply of opinions and actions come about in their specific socio-cultural, economic and political context.”
As such, the articles’ abstract are below. Enjoy!
Christine Hauskeller and Lorenzo Beltrame
The STS and bioethical literature on umbilical cord blood (UCB) banking nowadays discusses the field as divided into opposite institutional arrangements, public versus private banking. Public banks represent a model-sharing economy; private banks represent a market economy that capitalizes hopes and tissues, and new hybrid forms that are emerging. We challenge that this distinction is analytically valuable for understanding the various forms of marketization, commodification and biovalue production that mark the UCB economy. Our analysis of current UCB banking practices, especially hybrid ones, and their inherent visions of the future, shows that hybrid UCB banking criss-crosses the different economic models and concepts of commodification. The private, public, hybrid distinction is thus inadequate for a critical analysis of the complex UCB bioeconomies. Drawing on the perspective of social welfare systems analysis, however, the tripartite distinction emphasizes an important ethical and biopolitical commitment to equality in current and future health care.
In Taiwan, as in many countries where national cord blood donation programs are not available, cord blood donation and banking services are provided by non-governmental sectors. This article discusses: (1) the various cord blood banking models to critically examine the public and private binary; and (2) the collaboration and networking between cord blood banks and other institutions as strategies in response to strict governance and fierce competition. This article, based on fieldwork in Taiwan, gives an overview of cord blood banking models in Taiwan and shows the interdependent relationship among different stakeholders in the generation of stem cell knowledge. The concept of “bionetworking” is drawn upon to analyze the networks that cord blood banks establish with various stakeholders. I argue that, through analyzing networks and activities that cord blood banks engaged in and their relation with science, our understandings of stem cell knowledge and therapies production can be deepened.
Prasanna Kumar Patra and Margaret Sleeboom-Faulkner
To address critique of the rare uptake of umbilical cord blood (UCB) in private banks, hybrid-banking models would combine the advantages of “public UCB banking” and private UCB banking by responding to both market forces and public needs. We question both by following the cycle of UCB banking in India: the circulation and stagnation of UCB as waste, gift, biological insurance, enclaved good, source of saving lives and commodity through various practices of public, private and hybrid UCB banking. Making the journey from “recruitment,” “collection” and “banking” to “research” and “therapy” allowed us to identify concerns about the transparency of this cycle. Drawing on archival research and fieldwork interviews with different stakeholders in UCB banks in India, this article shows how private/hybrid cord blood banks are competing for their market share and its implication for the circulation of UCB: speculation, stagnation and opacity.
Stem cells from umbilical cord blood are now being actively used in transplants, as well as for a wide range of other medical, research, therapeutic, and commercial purposes. In this incipient stage of stem cell treatments and products, however, expectations about the benefits, use, and distribution of cord blood stem cells vary significantly among relevant companies, scientists, donors, patients, and governments. Focusing on the use of cord blood in South Korea, this paper examines the contested expectations that exist among the parties involved with the donation and use of cord blood, and how the distribution of cord blood stem cells reflects these disparities. The emergence of cord blood economy has been accompanied by contested expectations related to an array of issues, including altruism, motherhood, wealth, nationalism, sharing, and ethical justification. Although donors often remain interested in the prospective use of the biomaterials, their concerns and expectations have been overlooked.
Laura L. Machin
Incentives have been proposed to National Health Service (NHS) hospitals to encourage the collection of “quality” umbilical cord blood (UCB) to treat people with blood disorders. As UCB is collected immediately after a woman has given birth, maternity practices have come under scrutiny. Sixty-two interviews were conducted between 2009 and 2010 with those working on maternity wards, and in UCB collection and banking. Ethical approval was granted by the university institution and the NHS Research Ethics Committee. Participants perceived a conflict between acquiring a “quality” UCB sample for blood disease sufferers and concerns for maternal and neonatal health. Options to overcome the conflict were compromises that demonstrated that those most powerful in the debates are those conducting maternity practices, whilst those involved in the banking of UCB have less influence perhaps as a consequence of the lower priority of “quality” UCB collection in relation to maternal and neonatal health.
Maurizio Meloni’s “Political Biology: Science and Social Values in Human Heredity from Eugenics to Epigenetics” by Alan Goodman
Political Biology: Science and Social Values in Human Heredity from Eugenics to Epigenetics
Palgrave MacMilllan, 2016, 284 pages
In Political Biology, Maurizio Meloni, one of our most insightful social theorists of contemporary biology, guides us through heredity from the second half of the nineteenth century, through the twentieth “century of the gene” (Keller, 2000) and into the twenty-first century and the epigenetic present. Meloni expertly maps the consolidation of the paradigm of “hard heredity” that dominates most of the twentieth century. The book invites us to explore the surprising postgenomic world: that is, the world of science that begins roughly after the completion of the Human Genome Project, a period marked by the everyday sequencing of genomes and, of most significance, the opening up of the genome and an increasing appreciation of the complexities by which genetic sequences relate to phenotypes.
Meloni, Senior Research Fellow in the Department of Sociological Studies at the University of Sheffield (UK), examines, on one level, how biological heredity “became modern” when the notion of the gene as controlling fundamental biological processes cemented into the dominant paradigm of biology. On a second level, Meloni investigates the implications of the rise, transformations, and potential decline of hard heredity for social life and political thought. He asks “What sorts of citizenship, personhood, politics and governmentality” are to be found with hard and soft heredity? (ix). What are the connections between views of heredity (and degrees of determinism) and political systems? And on a third level, Meloni highlights the epistemological split between the natural sciences and the social sciences that also became institutionalized during the twentieth century.
Meloni questions the structures of knowledge—particularly the separation of genetics from the social sciences—and the ways in which genetics pulled biology and medicine from the social sciences and social inquiry. He explores “the reconfiguration of the border between life and social sciences following the rise and fall of certain scientific views of human heredity.” (6). “[P]olitical biology,” he writes, “reopens closed connections between certain scientific statements and political values, connections that have been chopped off under the weight of historical stratification. This reopening seems particularly important right now, as a particularly neglected view of science—soft heredity—is being renewed” (17).
Meloni calls for a new social biology, a call I find particularly exciting and that readers of Somatosphere may as well.
In the first chapter, “Political Biology and the Politics of Epistemology,” Meloni outlines his goals. His book is a sort of archaeology of genetics, and here he explains his interest in heredity and the working distinction between hard and soft heredity. Briefly, hard heredity is the notion that genetic inheritance is a closed system, passed with fidelity from parents to their offspring. Soft heredity is less deterministic and predictable, and most important, allows for the possibility of environmental influences, from Lamarckian inheritance to epigenetic mechanisms. Hard heredity and soft heredity stand in for strong nature and strong nurture—that is, a closed genetics system as fundamental to human nature and a biology that is open to social influences.
One of the strengths of Meloni’s treatment is that it provides a wide historical and philosophical view of the separation of two realms of inquiry: the biological and the social. In a sense, Political Biology is a strong and urgent appeal for a social biology, a concept Meloni has taken up in articles and shorter writings (2014). He urges us to consider that if biology is influenced by the unfolding of life events, early life and even the experience of one’s relatives, as epigenetics suggests, how might this change our ideas about health and the body? What might be the political implications and the implications for rethinking human biology?
Chapters two through seven, the core of the book, present the history of heredity in an approximately chronological order.
In chapter two, Meloni outlines the rise of “heredity before hard heredity” and focuses on three key scholars: Francis Galton, August Weismann and Wilhelm Johannsen. He shows how hereditarian ideas based on a mixture of nature and nurture, as developed by Erasmus Darwin and Herbert Spencer, took definitive shape, even before the biomechanics of heredity were determined. However this soft hereditarianism was replaced by a complete separation of heredity and environment in which the seed was seen as more important than the soil, the key lesson of Galton and partly so of Weismann (43).
The dominant belief in seed over soil was key to the intellectual climate that allowed for the widespread acceptance of eugenics (chapter 3). What makes for fascinating food for thought is the juxtaposition of the expected connections between authoritarian politics and deterministic hereditarianism on the one hand (chapter 3) and examples that go against the grain on the other hand (chapter 4). Just as there are politically left Lamarckians and right Mendelians, Meloni tell us about their opposites: right Lamarckians and left Mendelians (94). The utter separation of heredity and environment had an unexpected emancipatory potential (both in terms of politics and knowledge-production) that we might perhaps understand only today when the legacy of this separation is once again challenged by epigenetics.
Alfred Kroeber, one of the founding fathers of cultural anthropology, provides an excellent example of left hereditarianism. Kroeber follows Franz Boas, his mentor, in his separation of culture from biology. Kroeber formulates the idea that culture is above biology, or “super organic.” Although culture emerges from the organic (biology), it occupies a different domain or sphere, largely independent in rules and regulations from the organic, not reducible to the organic, and requiring a separate science. Here Meloni gives me an appreciation of what Kroeber was trying to do in freeing culture from biology, but as an anthropologist I would have loved to read more about Boas and his earlier struggles to integrate biology and culture.
Boas’s (1912) anthropometric work on immigrants and their offspring showed that types could change—they were plastic, thus providing an early example of soft inheritance. Working in the dominant paradigm of hard heredity, however, and at a time in which human biology could not be separated from race and type, Boas opted to separate the science of culture from the science of biology. It is noteworthy that he helped to open up heredity (against a tide of racism and eugenics) but ultimately moved politically to save culture and ceded biology to the hard hereditarians. Boas, some suggest, was the last biocultural anthropologist.
In chapters five and six, Meloni discusses the field of heredity after 1945 and the Second World War to the end of the twentieth century, a period marked by an ever-increasing pace of research in the new field of genetics. Beginning in the 1950s the gene, understood as a string of nucleotide sequences, takes on a physical reality and the central dogma of genetics—that information travels in one direction from DNA to RNA to proteins—is established. Toward the end of this period of study, the ambitious Human Genome Project (HGP) gets under way and full genomes of humans and other organisms are successfully sequenced. Questions remain, however, as to what genes mean and what genomes do.
At the press conference in June 2000 to announce the first successful sequencing of a human genome, Craig Venter and colleagues took the moment to announce that race is genetically meaningless. Still, scientists and writers today are far from uniform about whether “race” is to be found in the genes. UNESCO statements on race go forward and back. Whereas first William Boyd (1950) and others assumed that difficulties of defining races based on flexible phenotypes would be overcome by hard genetic information, Lewontin (1972) burst that bubble by showing that almost all known genetic variation is within so-called races. That race is not found in genetic differences raises questions about the sociopolitical roots of race (and class) differences in health and wealth. If differences exist—as they do—and they are not genetic, what is their cause? In other words, how does living in a racial and racist world get under the skin, and even into the genome? Instead of reducing culture to biology, culture is seen to cause biological differences.
Meloni welcomes us to postgenomics in chapter seven. Indeed, it is an exciting period and an unexpected (and welcome?) turn of events. As some predicted, the most difficult scientific work was to come only after the three billion letters of the genome, that “blueprint of life,” were revealed. How does the genome fold? What is the importance of all of those base pairs that do not code for proteins? And what activates and inactivates the mechanisms by which gene sequences are transcribed?
The author, one of our chief chroniclers of epigenetics, walks us through the postgenomic present. Meloni outlines five ways of understanding postgenomics, all of which “decenter” the genome. He wonders how this opening up of the genome harks back to more than a century ago, the last period during which soft heredity was dominant. Indeed, epigenetics provides a modern molecular mechanism to show that early life events, and even events that were experienced by ancestors, can turn genes on and off. Meloni asks what the implications will be of the reopening of the genome to life experience.
In his last chapter, Meloni does not tell us what the future will hold. Instead, he offers a series of provocations. He interprets the signs that epigenetics might lead to a more social biology. It is less easy, however, to predict the politics of this more social biology. It could, for example, lead to a deterministic view of racial differences in health. Politics, Meloni shows us, affect the science of heredity and the science affects the politics, but the influences in both directions are only partial. Meloni writes: “Science and knowledge are the plastic objects of power, but so is politics the plastic object of scientific facts and expert claims. Therefore, power and truth, matters of fact and matters of concern, loop back to each other” (13). The relationship between political beliefs and systems on the one hand and the hereditarian perspectives on the other, Meloni says, has both an underlying pattern and a distinct flexibility and complexity. And perhaps this is a core lesson of Meloni’s important book: we should be aware of both the pattern and the breaks with the pattern.
This book should become a fundamental resource. It is of necessity a dense work and the reading can at times be slow (a copy editor knowledgeable about genetics could have made the writing more linear), but to break up the text, Meloni has incorporated some lovely declarative sentences. Meloni’s text references are utterly thorough: the bibliography of works cited takes up forty-three pages! Not surprisingly, his copy editors left out some references in the extensive ending bibliography. My last quibble is the hefty price tag. Let us hope that Palgrave sees the wisdom of issuing Political Biology in a more affordable paperback edition.
I have great admiration for what Meloni has achieved in Political Biology. His breadth of research and his depth of understanding are impressive. The scope is a huge one—the history of genetics—but even more important, Meloni presents a thoughtful analysis of the codeterminations of genetics and politics.
Political Biology may stand as a key moment not only in chronicling but also in helping to bring together genetics and social science and reconfiguring the border between the life sciences and the social sciences.
Alan Goodman is professor of biological anthropology at Hampshire College in Amherst, Massachusetts. He teaches and writes on the health and nutritional consequences of political-economic processes including poverty, inequality and racism. Goodman is the editor or author of seven books including Building a New Biocultural Synthesis (University of Michigan Press, 1998) and Genetic Nature/Culture (University of California Press, 2003). He is a past President of the American Anthropological Association.
Boas, Franz. (1912) Changes in the Bodily Form of Descendants of Immigrs. American Anthropologist 14:530-562.
Boyd, W. (1950) Genetics and the Races of Man. Boston, MA: Little, Brown and Company.
Keller, E. F. (2000) The century of the gene. Cambridge, MA: Harvard University Press.
Lewontin, R. (1972) The apportionment of human diversity. Evolutionary Biology, pp 381-398.
Meloni, M. (2014) How biology became social, and what it means for social theory. Sociol Rev, 62(3): 593–614.
Wade, N. (2014) A troublesome Inheritance: Genes, race and human history. New York: Penguin Books.
 The publication and responses to Nicholas Wade’s A Troublesome Inheritance (2014) is an eye-opening example of just how alive the debate around race and genetic remains.
Nomsa, her sixteen month old son Nathi and I met early one morning at the entrance to the open cast mine in Mafuyana, Southern Matabeleland, Zimbabwe. Nathi safely secured on her back, a shovel in one hand and a plastic bag with bread and water in the other, Nomsa hurried me along: “We must walk quickly, the earlier I start working, the earlier I can knock-off. This little one gets irritated when hungry, plus he has a bit of flu in this cold”. We walked briskly through the maze of thorny acacia and mopane bush for about thirty minutes—some three kilometres. Despite the absence of trails, Nomsa navigated the landscape well. We passed several abandoned deep vertical shaft gold mines before we arrived at the open cast mine pits where she worked with two other women, extracting ore. She sat Nathi down in the shade and began work, digging the rocky ore from one side, piling it on the other. Intermittently, she breastfed Nathi, usually when he became irritable. The women worked hard, pausing only for tea until mid-afternoon, when they packed up and we returned to Maphisa, the new development zone where they lived.
Nomsa lived in a single room shared with her husband and two children. The room was dim; there were no curtains or lights. The small room was crammed with a double bed, a chipped wooden wardrobe, and a kitchen unit. The floor was cemented concrete, uneven, unrefined and dusty. Nomsa’s room was part of a larger housing unit that comprising a toilet and kitchen (without either water or electricity) and a bedroom on either side. Her neighbour, Mhlophe, lived in the second room. The two families cooked outdoors. The home, although small in size, presented a rich space for exploring infants’ topographies in Mafuyana. The physical and emotional characteristics the home contained contributed largely to the formations of childhood.
This vignette introduces my investigation of the intersections of ‘urban’ development and early childhood. It forms part of the research of the First Thousand Days research programme at the University of Cape Town. Over eight weeks of summer 2016 I worked with infants and caregivers in Mafuyana, a new ‘urban’ township on the northern periphery of a growth point, Maphisa, in Southern Zimbabwe. Mafuyana forms part of Zimbabwe’s nationwide Operation Garikai project (Operation Live Well), which followed the Operation Murambatsvina campaign (Operation Clean-Up/Restore Order). Mafuyana was built for those dispossessed during Operation Murambatsvina and for others who had never owned a house. There were many young children and babies in Mafuyana. This community, mostly comprised of young adults, valued having children in their lives. Children were considered a life investment and caregivers hoped to be cared for by their children in their old age. However, infant care posed numerous challenges in Mafuyana where, as we have seen in the opening vignette, limited economic opportunities and poor ‘urban’ infrastructure posed daily challenges to infant care and well-being.
My work is concerned with the ecologies that surround infant health and child loss in a developing context. In Zimbabwe, the high infant mortality rate is attributed to AIDS, dysentery, malaria, diarrhea, skin conditions and nutritional deficiency. The Zimbabwe National Child Survival Strategy Report (2010–2015) states that these deaths are mostly preventable. Risk factors include unsafe and unhygienic delivery environments, delays in seeking skilled medical care, home deliveries, poor antenatal surveillance and poor postnatal care. In Mafuyana, poor housing and a chronic shortage of employment opportunities contribute to these risk factors. Fieldwork interviews and home visits demonstrated the extent to which the new housing settlement was hazardous to raising infants. Frail housing was prone to invasion by burglars, pests and bad weather. In the absence of clean running water, residents used contaminated water sourced from Antelope Dam. Familial relations within and between homes also influenced the wellbeing of infants. It is easy to describe these material topographies but I was interested to explore more; to find ways to access how people understand infant bodies and well-being in Mafuyana. Standard biomedical descriptors such as ‘fontanelle’ or ‘heart’ were inadequate to the task; I soon discovered they did not get me to the heart of knowledge I sought. I therefore developed a methodology I term ‘baby body mapping’. This is a visual mapping technique that gains more access to people’s perceptions of their babies’ bodies in relation to the houses sheltering them and the geographies formed around them.
Body mapping has emerged as a useful method serving to connect the understandings of biological and social processes of the infant’s body. Andrea Cornwall (1992 and 2002) has used body mapping to examine women’s knowledge about reproduction and their interpretations of non-indigenous contraception in Mazvihwa, a rural area in Zimbabwe. This technique offered a bridging space between the biomedical and local understandings of the female reproductive anatomy. Hayley MacGregor (2008) analyses the use of body mapping in Khayelitsha, South Africa, as an educational tool that promotes the understanding of social and political aspects of HIV and AIDS. Baby ‘topography’ is a term derived from Geetha Ramani and colleagues’ (2010) investigation of babies’ self-awareness of their body shape and spatial configuration. Ramani states that neonates begin learning about their own bodies as newborns and can determine whether the hand caressing their cheek is their own or someone else’s. Furthermore, self-awareness of one’s topography increases with age and is associated with traditional measures of reflective self-awareness. Caregivers’ descriptions gave insight to the complex geographies—physical, economic, emotional, social and spiritual—that shape infant lives. Baby body mapping facilitated a less directive interviewing style which produced people’s own classifications and visual descriptions that were used as a basis for discussion.
I implemented the baby body mapping exercise at the end of my research, during a focus group discussion I held with care givers who had been part of the project. By then I had a clear idea of the challenges infants and caregivers faced, such as those described in the opening vignette. Together, we drew a large sketch of a baby. When the mapping exercise began, caregivers were reluctant to share their ideas, but I reminded them that as a childless woman, I had much to learn from them. Each individual described parts of the body and meanings associated with them. Eventually, we produced a topographical map. This was the first time the participants had visualised their babies through a drawing. I was surprised by some of my informants’ perceptions, and had to overcome my own assumptions on what contributes to the making of a baby’s body. Given the context of precarious labour, and unemployment in the mining township, it is hard not to focus on infancy as a period configured by economic and physical constraints. I came to realise that I had placed an overwhelming focus on the physical and economic aspects of infancy, overlooking the spiritual, symbolic and emotional experiences.
The body mapping exercise led to stimulating discussions about the women’s different perspectives on infants’ bodies. They described for example, ukwetheswa inkanda (‘strengthening’ a baby’s fontanelle), a ceremony performed after the umbilical cord has fallen off. This serves to protect the baby from any evils he or she encounters when introduced to the world for the first time. Approaches to the ceremony differed. Some wafted herbal smoke over the child; others used parts of animals believed to embody great strength, such as the honey badger and the elephant. However, they lamented no longer being able to use these animal parts due to inaccessibility. Another practice was tying a cord that had been blessed by a church pastor around a baby’s waist. This had the dual function of providing protection and serving to gauge the infant’s growth. Twins were perceived more problematic in comparison to singletons. Memory, a mother of six month old twin girls, was advised by her neighbours to roll them in the ash pit behind her house in order to calm their bouts of excessive crying. This practice is known as ukubhuqa emlotheni (rolling in ashes). Nomsa described having bathed her baby in a basin of water and soil scooped from a common public area in the belief that exposing her baby to ‘public’ soil would acclimatise him to the world. In these ways, caregivers sought to treat and protect children while exposing them to the complexities of the world.
The topography of infancy in Mafuyana was more complex than it seemed. Although national policy seeks to protect children from preventable disease and death, caregivers spoke also of the need to protect children from social and metaphysical dangers. Their commentary on such dangers and their efforts to protect children in a context underpinned by economic hardship and limited opportunity suggest that it is critical to investigate local understandings of well-being. Examining infancy topographically and geographically through the body mapping technique provides a useful alternative to conventional interviews, which sometimes overlook underlying perspectives. The method shifted my perspective considerably. For example, whereas I had thought that children should be protected from dirt, I learned that dust and ash could be a necessary part of exposing the child gradually to the dangers of the world and in so doing, offering protection. Unlike structured interviews, infant body maps facilitate discussion and reflection on the ways parts of the body are perceived and treated. Infant topography produced by drawing a baby body map opens a space for deeper discussions that formulate infant geographies and the practices (and limitations) of care that surround them.
Min’enhle Ncube is a Master’s student in Anthropology at the University of Cape Town and part of the First Thousand Days of Life research group. Her research interests in medical and developmental anthropology lie in early childhood and its interaction with the developmental and political space in Matabeleland South, Zimbabwe. This article is based on her current Masters research underway, which examines the development of infants in a developing urban-rural township.
Cornwall, A. 1992. Body mapping in health RRA/PRA. International Institute for Environmental Development. Issue 16, pp.69–76. London
Cornwall, A. 2002. Body Mapping: Bridging the Gap between Biomedical Messages, Popular Knowledge and Lived Experience in Realizing Rights: Transforming Approaches to Sexual and Reproductive Wellbeing, 2002 (eds. Andrea Cornwall & Alice Welbourn). pp. 219–231. Zed Books. London
Gasper, A. 1988. Rural Growth points and rural industries in Zimbabwe: Ideologies and Policies, Development and Change 19(3) 425–66.
Government of Zimbabwe. 2005. Response to the UN Special Envoy’s Report on Operation Murambatsvina. Harare
Kesby, M et al. 2006. Theorising other ‘other childhoods’: Issues emerging from work on HIV in urban and rural Zimbabwe. Children’s Geographies. Vol 4:2. pp185–202
MacGregor, H. 2008. Mapping the body: tracing the personal and the political dimensions of HIV/AIDS in Khayelitsha, South Africa. Anthropology and Medicine. Vol 16:1. p85–95
Mlalazi, A. and Conyers, D. 1989. Is There A Future For Regional Planning In Zimbabwe? Paper Presented At the 1989 Conference of the Department Of Physical Planning, Masvingo.
Ncube, M. 2015. ‘Posted Home’: The Impact of Tuberculosis on Early Childhood and Beyond in Maphisa. University of Cape Town. (Unpublished B.SocSci Honours Dissertation.)
Nyathi, P. 2005. Zimbabwe’s Cultural Heritage. ‘amaBooks. Bulawayo
Nyathi, P. 2001. Traditional Ceremonies of AmaNdebele. Mambo Press. Gweru
Potts, D. 2006. ‘Restoring Order’? Operation Murambatsvina and the Urban Crisis in Zimbabwe. Journal of Southern African Studies. Vol 32:2. [Online]. Available: http://www.jstor.org/stable/pdf/25065092.pdf Accessed: 18 July 2015
Ramani, G et al. 2010. The Head Bone’s Connected to the Neck Bone: When Do Toddlers Represent Their Own Body Topography? Child Devlopment. JStor. Vol. 81: 3, p797–810
UNICEF. 2013. Zimbabwe Annual Report. [Online]. Available: http://www.unicef.org/zimbabwe/Annual_Report_Webpages_layout_2014.pdf Accessed: 10 October 2015
UNICEF. 2010-2015. Zimbabwe National Child Survival Strategy Report. [Online]. Available: http://www.unicef.org/zimbabwe/Young_Child_Survival_Doc-Complete.pdf Accessed: 3 August 2016
 ‘Growth point’ denotes settlements which are earmarked for economic and physical development in Zimbabwe.
 The follow-up exercise did little to alleviate the country’s self-inflicted humanitarian crisis.
 A large-scale Zimbabwean government campaign, which started in 2005, to forcibly clear ‘informal’ structures across the country.
 Relative to the Maphisa rural community, this was classified as urban, regardless of its deprivation of electricity, underground piping to supply water and robust housing.
 Also known as Gulameta Dam
The aftermath of the UK’s recent referendum on European Union (EU) membership, which culminated in a decision for Britain to leave the EU, reminds us of Britain’s bleak history of racism, and should prompt us to reflect upon the political visions of justice that underlie current constitutions of biomedicine.
For many, the outcome of the ‘Brexit’ referendum was justice turned on its head. After the Leave vote won with a 52% majority, social commentators argued that Brexit is an injustice to Britain’s youth—those who will live the longest with the outcome of the referendum wanted to remain in the EU, which bears out in the early retrospective analysis of voter demographics. But the Leave campaign also appealed to justice by arguing that the EU had morphed into a force for “social injustice” as Brussels turned its back on “economic common sense”. The most toxic claims came from those who appealed to a kind of natural right, couched in English nationalism, about who belonged in the UK.
In the wake of these claims on justice, it is, we suggest, time that scholars working at the intersection of science and medicine argue with justice. Similar to other recent arguments about science and justice, we choose these words deliberately. Arguments are often made by using justice (for example, by mobilising the language of “social injustice” to argue against the EU). But scholarship doesn’t as freely spend time arguing with justice—interrogating this unwieldy but thoroughly seductive motif.
At this intersection between Brexit, science and health, it comes clearly into relief that biomedicine is about much more than patients and clinicians, or research participants and investigators. It is about the legal and institutional frameworks that shape our daily lives and our access to healthcare and medicines. Such issues of inclusion, health and wellbeing are matters of justice. With fundamental societal changes looming ahead, Brexit means we must argue with justice.
Such reckoning with justice is critical because what we have seen with Brexit is a heredity redux—an explicit revival of imperial attention to biological and genealogical propriety, marked by the dilation of hierarchy as ordering mechanism. An overt return to much older and never fully forgotten nationalist, biological and xenophobic sentiments about who belongs and is entitled to receive provisions of justice, like health care and access to medicines.
During the June 2016 lead-up to the EU referendum vote, the Official Leave campaign made the funding of Britain’s National Health Service (NHS) a central component of its movement. Notoriously, campaign buses touring the country were emblazoned with: ‘Let’s give our NHS the £350 million the EU takes every week’. One of the most powerful pieces of propaganda released by the Leave campaign (which was also immediately rescinded by Leave campaign politicians on their victory), this statement tapped into long-standing frustrations. The NHS, ushered in with sweeping post-war welfare reforms, is in the midst of apparent debt crisis, a veritable black hole sucking in precious funds to meet the health demands of a growing (and aging) population. All this against the backdrop of funding cuts imposed by EU ‘enforced austerity’, by shrinking State economic support and the slow creep of privatisation through which the famous NHS logo is itself now being used by private companies.
In the media, blaming the non-national—asylum seekers, refugees and migrants—has been explicit. In the most amusing analysis, migrants into Britain are simultaneously lazy social welfare/healthcare users and job-stealing (summed up perfectly by the Schrödinger’s immigrant meme). In more nefarious moments, asylum seekers are set to overwhelm the country’s beleaguered health service.
Where does the EU sit in all of this? As a key EU report, entitled ‘Evaluating Care Across Borders’, pointed out, discussions of the then European Economic Community in the 1970s concluded that “the principle of free movement of people was meaningless if it applied only to those in full health”. Accordingly, we see the legislative enshrinement of what the EU calls cross-border care. in the European context, far right political energy has reached a peak and this comes starkly into relief in the context of Brexit. Preoccupation with indigeneity to the United Kingdom manifested in the week after Brexit with a fivefold increase of race hate incidents nationally. The day after the result, English National Front protesters were out in Newcastle, carrying a poster demanding “STOP IMMIGRATION. START REPARTRIATION”.
Such vitriol highlights the more pernicious articulation of the increasingly complex relationship between race, geography and national identity in which claiming citizenship through jus soli has undergone systematic erosion in various nation-state contexts, not least via the British Nationality Act 1981 in which statelessness is the default for British-born children of non-British parents. But the vitriol doesn’t answer the question it begs of us—what makes one British? This question carries such weight because of the benefits of Britishness—of existing in a country built on colonial exploitation, of existing in a country where feelings of deservedness, of a right to access health and wealth are deeply embedded. But such a question (really, a basic question of justice) of who belongs in a polity is one not easily answered.
Health provision, biomedical research and technology are deeply impacted through these changing post-colonial iterations of what being British means, along with who has the right to belong and benefit from state institutions, such as the NHS. In addition, biomedical technologies are increasingly playing a public role in answering questions of who is part of a polity. The proliferation of genetic ancestry testing and national biobanking are testaments to the multiple and contradictory ways genetic and biological evidence of belonging becomes enmeshed in national debates. This is not just evident in the UK as Senator Elizabeth Warren’s debunked claim to Native American heritage highlights. As we have seen with Brexit, being able to say that one person is more British than another is a dangerous ability.
The political shifts signalled by the Brexit vote present a profound departure from the idealistic sentiment of universalism we usually imagine when we think about justice. Porous borders, and the postcolonial push and pull of bodies through them, tested ‘justice’ and the capacity of communitarian caring. Now we are compelled to think about the grammar of justice.
Rosalind Williams is a Research Associate in Sociology at the University of Sheffield. She is currently working on a Leverhulme funded project, ‘Tracking Ourselves?’, focusing on everyday practices of self-monitoring. She’s written for Life Sciences, Society and Policy and New Genetics and Society.
Amy Hinterberger is an Assistant Professor of Sociology at the University of Warwick. Her work has been published in Public Culture, Theory, Culture and Society and Science as Culture. She is currently working on a Wellcome Trust funded project entitled ‘Blood and tissue as human research subjects’ which investigates transformations in definitions and practices of what constitutes a human research subject in the context of data-intensive biology.
This piece was inspired by discussions had at ‘Arguing with Justice’, an Early Career Researcher workshop held June 2016 at the University of Warwick’s Sociology department and attended by keynote Jenny Reardon from UC Santa Cruz and discussant Maria Puig de le Bellacasa from University of Leicester.
Ian Whitmarsh and Elizabeth F. S. Roberts have edited a Special Issue of Medical Anthropology called “Nonsecular Medical Anthropology.” Here is an excerpt from their introduction to the issue, along with the abstracts of its commentary and six articles. Enjoy!
Nonsecular Medical Anthropology (open access)
Ian Whitmarsh & Elizabeth F. S. Roberts
A nonsecular medical anthropology insists on the ways medicine and science have constituted ‘the secular’ itself through the ‘secular self’—how medical knowing has been used to craft the secular political subject. As James Boon noted, too often in social theory, “religion gets safely tucked away—restricted theoretically to ‘meaning’ rather than power” (1998:245). The authors of the six articles in this special issue ‘untuck’ religiosity from within the norms and numbers of medicine itself, and examine how ‘secular’ medicine has relied on religious traditions to produce political secularity. These articles demonstrate that ‘secular’ medicine relies on religious others whose exclusion bespeaks latent religious commitments of citizenship in the modern political realm of health.
In the past few decades, anthropologists of religion and secularity have provided a vigorous critique of the liberal political subject constituted through the distinction between the secular and the religious (Asad 2003; Mahmood 2005). Meanwhile medical anthropologists have developed tools to examine how medicine constitutes the human. With this special issue, we draw together insights from both these literatures to query the relationship between the secular and health, medicine, and the body.
Gods, Germs, and Petri Dishes: Toward a Nonsecular Medical Anthropology (open access)
Elizabeth F. S. Roberts
This commentary calls on medical anthropology to become programmatically non-secular. Despite recent anthropological critiques of secularity, within and outside of anthropology, most contemporary medical anthropologists continue to leave deities and religiosity out of their examinations of healing practices, especially in their accounts of biomedicine. Through a critical, relational constructionist lens, which traces how all entities are both constructed and real, a non-secular medical anthropology would insist that when deities are part of medical practice, they are integral to analysis. Importantly then, within the symmetrical nature of this same constructionist lens, biomedical entities like germs and petri dishes need to be accounted for just as much as deities.
Using dead bodies for medical purposes has long been considered taboo in Egypt. Public health campaigns, physicians’ pleas, and the urgings of religious scholars all failed to alter public opinion regarding the donation of dead bodies either for instructional material or for therapeutic treatments. Yet in 2011, amid revolutionary turmoil in Egypt, a campaign was launched for people to donate their eyes upon death; this time, people readily signed up to be donors. Focusing on mass eye trauma that occurred in Egypt amid the political uprisings of 2011, I raise questions about when and why Islam can explain people’s attitudes and behaviors, particularly toward death and medicine. The case of mass eye trauma in Egypt and citizens’ reformulations of questions once jealously controlled by state-aligned doctors, politicians, and religious scholars unsettles the boundaries between ‘religion’ and ‘secularism’ in medical practice.
Medical Eschatologies: The Christian Spirit of Hospital Protocol
Jean M. Langford
If much has been written of the forms of bodiliness reinforced by hospitals, less attention has been paid to the medicalization of the soul. The medical management of death institutionalizes divisions between body and soul, and matter and spirit, infusing end-of-life care with latent Christian theological presumptions. The invisibility of these presumptions is partly sustained by projecting religiosity on those who endorse other cosmologies, while retaining for medicine a mask of secular science. Stories of conflict with non-Christian patients force these presumptions into visibility, suggesting alternative ethics of care and mourning rooted in other understandings. In this article, I explore one such story. Considering the story as an allegory for how matter and spirit figure in contemporary postmortem disciplines, I suggest that it exposes both the operation of a taboo against mixing material and spiritual agendas, and an assumption that appropriate mourning is oriented toward symbolic homage, rather than concern for the material welfare of the dead.
In this article, I discuss recent experiments in ‘classical’ (gudian) Chinese medicine. As the marketization and privatization of health care deepens and enters uncharted territories in China, a cohort of young practitioners and entrepreneurs have begun their quest for the ‘primordial spirit’ of traditional Chinese medicine by setting up their own businesses where they engage in clinical, pedagogical, and entrepreneurial practices outside of state-run institutions. I argue that these explorations in classical Chinese medicine, which focus on classical texts and Daoist analytics, do not aim to restore spirituality to the scientized and secularized theory of traditional Chinese medicine. Nor are they symptomatic of withdrawals from the modern world. Rather, these ‘cosmic experiments’ need to be understood in relation to dialectical and historical materialisms as modes of knowledge production and political alliance. In challenging the status of materialist theory and the process of theorization in traditional Chinese medicine and postsocialist life more broadly speaking, advocates of classical Chinese medicine imagine nondialectical materialisms as immanent ways of thinking, doing, and being in the world.
A longstanding trope in Indian psychiatry, and in popular representations of it, involves the efficacy of incantations and exorcism in healing afflictions of the mind, notably hysteria. In many accounts, from nineteenth century medical journals to twenty-first century popular films, a medicine deemed at once ‘Western’ and universal is granted the ability to diagnose neurotic afflictions, but rendered incapable of curing them, while bodily techniques referred to as ‘Indian’ are granted efficacy. In this article, I explore the subtleties and implications of this recurrent knowledge paradigm. I argue that a particular arrangement—one in which difference is established through equivalence—undergirds the terms by which medicine comes to be viewed as a cultural encounter. As these progressive formulations are often founded on stories about women’s madness, I ask, what are the implications of an arguably pragmatic ethos founded on an uneven—and deeply gendered—resolution to postcolonial knowledge problems?
Secular Redemptions: Biopolitics by Example
In this article, I analyze the practices of a group of Catholic nuns who run shelters for ‘victims of human trafficking’ in Italy, and are thus involved in state-funded rehabilitation programs for former foreign prostitutes. This case shows how the state and the Church are deeply implicated in each other’s projects of redemption and the creation of new forms of life. In Italy, the legal model for rehabilitating foreign prostitutes is avowedly secular yet also deeply shaped by a Catholic impetus to purify sinners. At the same time, however, the nuns themselves develop an understanding of redemption as a secular life-saving project in line with the state’s project of recognition, and thus inscribe their practices within the biopolitical effort to transform lives. Ultimately, I argue, leading by example becomes a specific Catholic instantiation of biopolitics that characterizes both the state’s and the Church’s approach to foreigners.
Taking Israel’s National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the ‘same’ and ‘equal,’ are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel’s boundaries of inclusion, and the connection between biomedicine and secularism.