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Science, Medicine, and Anthropology
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Experimental anthropology in the making: a conversation with Andreas Roepstorff by Des Fitzgerald

25 Mars 2015 - 2:56pm

Andreas Roepstorff is Professor in Anthropology at Aarhus University in Denmark, where he is also Director of the Interacting Minds Centre. Since the early 2000s, he has pursued an intensely interdisciplinary and collaborative research-programme at the intersections of anthropology, science and technology studies, and cognitive neuroscience – while also using his ethnographic training to reflect back on this his own methods. Often cited as one of the early figures in what is today called ‘neuroanthropology,’ Andreas’s major research interests circle around forms of cooperation and communication, intersubjectivity and embodiment, ethnographies of knowledge and knowledge-translation, and experimental anthropology. Among his most important publications for social scientists are ‘Enculturing through patterned practices’ (with Jörg Niewöhner and Stefan Beck), ‘Neuroanthropology or simply anthropology’ (with Chris Frith) and ‘Transforming subjects into objectivity: an ethnography of knowledge in a brain-imaging laboratory.’ As part of the series on ‘The Collaborative Turn,’ Des Fitzgerald sat down with Andreas Roepstorff, for a conversation about disciplinarity and collaboration, in Aarhus, Denmark, in late 2014. This is an edited account of their conversation.

 

Becoming an experimental anthropologist

AR: When I was a student at Aarhus, I really liked biology and I really liked anthropology. I liked all of it. But I had an internal problem with…how on earth should I create an identity, and a kind of field around myself, and turn it into something? I had really created problems for myself. And then one day there was this sign on a white board at the university, where someone from the medical faculty needed someone to run a research project, as a research student in neuroscience. I had absolutely no training in neuroscience, but, um [laughs] I’d read a bit about it in my book, and I went off to talk to him, and said I was a potential student. And well, he needed to spend the money, so he just kind of hired me – he said, “That’s fine. [Laughs a lot]. There’s no one else. It’s yours.”

DF: So one of the things that interests me is how we reconstruct memories about these kinds of moments. Like, you must have passed a million white boards…

AR: No, I actually remember it as a very… It was like being completely broke, and suddenly you find 100 pounds on the street, and that just saves you. I remember even today what white board it was on, and it felt really like a lifesaver. I could certainly see that here would be a way to… kind of get a break and try to do some research and try to figure what I was doing there.

It was very classical electrophysiology, hippocampus stuff. So I started the morning by chopping the head off a rat and then dissected out the brain, and dissected out the hippocampus. We cut it into small slices and put them it on a woman’s stocking, on a surface between water and air. Then you pull out small electrodes and insert them into the cells, and then you can record intracellularly from these hippocampus or electrophysiology cells… I was in a complete mess as to what I should do. I was 23 or 22. And I just absolutely had no idea how on earth I should make it through university. Not that I doubted I could get a degree, but…what trajectory would be possible for me? It was really desperate. And this project felt like: “here is an opportunity to try something out.” But then the first half year was a disaster because I was really bad at the experimentation. The cells died for me and I didn’t have the patience to do it. I was the only young person there and it was just….

DF: It’s a real skill, that work.

AR: Yeah. I had this English professor who, in many ways, was extremely open-minded – just letting me come in off the street, and being supportive of all the strange things that I took an interest in. But, also, he just needed someone to do his electrophysiology. But then after a while, once we started getting some data, and the more analytical work, and the understanding, and learning the skills of it, it worked really easily.[i] By the end of that year, I had the work done for a Masters in biology, although I was still an undergraduate student.

But I also had a very strong intuition that I needed to do something that would involve me being skilled in both biology and anthropology. And I could see how it could be done suddenly, because I had kind of done the biology [having enrolled as an anthropology student]. But then it took me the next couple of years convincing the university to allow me to do it because it was very much against the rules. At some point I basically just wrote to the university, and said “well why don’t you just let me have those two degrees…” [laughs]. It was existentially extremely frustrating. I had a couple of years where – it’s ridiculous now, but it wasn’t at the time –every year on the 1st of July, you had to post the entrance application to the university. I was, like, circling around that place from six in the morning till noon on the same day, trying to figure out if maybe should I do another degree…today it’s kind of funny, but it wasn’t at the time. So, in a sense that kind of, um, I wouldn’t call it a commitment… it felt like that was how I had to train myself in a way.

 

Lithuania

AR: In ways I don’t remember, I got a scholarship to go to Lithuania, of all places. I got something like, whatever, maybe 20 pounds a month to go. And I got in touch with the World Wide Foundation for nature, the WWF, who had a project on nature conservation on the border between Russia and Lithuania. I thought, “okay, yes, I can do a fieldwork exercise here…” In a way, and in spite of the fact that I was doing these two studies, things had fallen into place: you had basically eight years to complete a five year programme [in the Danish university system]. I thought: I’ll just spend all the money I get from the state to get myself what felt like the right education. I took, like, a half a year of intensive Russian. Then I went to Lithuania, to study nature protection on the border between Lithuania and Russia.

And what I then discovered, when I was there, was that whenever I talked about nature protection… basically it was about nationality. The whole landscape was basically about protecting the national landscape and nothing else. That would have been 1992. The whole issue of national identity was extremely personal and around me, and basically… we ended up traveling around Lithuania and discussing Lithuanian history. At some point my master’s thesis in anthropology became a historical analysis of Lithuanian national identity: I needed to understand the historical moments that led up to the narratives being as powerful as they were then, in that kind of Benedict Anderson tradition…[ii]

In the process I really discovered my own nationalism. What was so easy to deconstruct, this fervent attempt at recreating identity, and being concerned about history and objects of language, et cetera, I could see that actually the exact processes had taken place in Denmark about a hundred and fifty years earlier. And I was in a way the product, you could say the end result, of such a long process of nation building. And in a very particular way – I mean, I’m joking – but, for a while, when I looked at Danish maps, I could become really angry that the border [between Denmark and Germany] was where it was, and not at the natural border which is a further south. [Laughing] I could understand that sentiment of what it was like to have it engrained in you. And I think that was a critical moment. Danes are inherently extremely nationalist by their upbringing. But it took me to go to Lithuania, to almost act like a mirror, and then seeing those processes, I recognized and what I deconstructed in them was deeply in myself… and then you have to deconstruct it.

 

Greenland

AR: So I thought that studying knowledge was maybe not the worst thing to do. I ended up in a project where I was sent to Greenland to look at Halibut – the project was about what biologists know about fish, and what Greenland fishermen know about fish. I did that for the next couple of years.[iii]

DF: Halibut.

AR: You know…halibut. The place I went to, that’s what they did. They fished halibut. But it was cool – we got on ice sledges, going in and fishing; it was very exotic in that sense. And I teamed up with a biologist as well, in a way trying out how you do translations between scientific knowledge and local knowledge, and what would it mean there. Then someone at my department gave me some Science and Technology Studies literature, and I just loved it immediately. It was just, I could see that it gave me the tools that were necessary to do this work. When I read the Callon article on the scallops[iv], it was just, “okay, yeah, this this is what I’m doing. I’m ready to do it. I know the biology. I can get a perspective on it. I can reconstruct it.” That made me kind of a self-made STS person. The two most influential texts were We Have Never Been Modern[v] – reading that was like being hit by lightning – then the Callon text was also incredibly useful. But those two articles – I was, like, reading it, and it was just internalized immediately.

So anyway I was doing arctic anthropology and I’m sure that could also have been, uh, another career. But just like I couldn’t see myself becoming an Eastern Europeanist or a neurophysiologist, doing arctic anthropology was, um, I really liked it, but it just didn’t feel right. And I didn’t have the PhD. Really, it was a bit of a mess. And then there was a call from a Danish research council, where they had a special program on cognition and consciousness. I thought: “I don’t have a PhD but I have two masters’ degrees and I have worked as a researcher.” So I wrote an application for an individual research project, to do an ethnographic investigation of this new field of brain-imaging basically. I thought, you know, studying these knowledge processes had worked really well for me in Greenland. I can do the same just in this new field of neuroimaging.

 

London

AR: So I spent some time at the Functional Imaging Laboratory, at University College London [aka the FiL[vi]]. I was very much in an anthropological position, but you could say the question of communication, et cetera, that I was interested in was also something that Chris Frith[vii], the neuroscientist, was interested in – and it became already then a bit of collaboration. They invited me onto a study where I would interview people about their experiences and things like that. I never got to do any analysis or any design or anything. My main contribution was that, just before I left, I had to make a report back to them. They had a traditional Friday meeting and they wanted me to tell them something, and that was when I did an analysis of the FiL as a house[viii]. It started as a tongue-in-cheek kind of ‘Do you actually know where you are? What’s involved in it?’ That… was interesting because I was surprised by how much it was an eye opener to the people there. Several of the young Research Fellows, were like, ‘what is this?’ and some of the Principal Researchers came over after and said: ‘that was really interesting. Did you know we’re all Catholic?’ [laughs]…. I didn’t really know if this work I had done was serious or not serious, but it was what I could come up with. I came back to Denmark again. At that time people here were setting up a neuroimaging center. They were applying for a Centre of Excellence grant. And they asked if I would join them rather than study them.

DF: Was that purely because there weren’t so many people locally with experience…

AR: There was no one, there was no one locally… There was this one guy who did stuff on pain. But I think the person who was heading up the application kind of saw something in me that he wanted in his group. They thought maybe I could create links to London and bring smart people over. But I was not an imager. I had never done a study. And I didn’t know how to do analysis et cetera. I wasn’t sure if the that the grant was going to be landed, and we were going to have a third child, I think. I was almost…there was another group of people who wanted to hire me to write the Danish history of the natural sciences and do the biology part of it. I was so close to becoming a historian of science. That would have been interesting and it could have gone that way as well. I still didn’t have a PhD and I was not a PHD student. In fact, I have never been a PHD student. Anyway they got the grant and actually at first, the grant evaluators said, “Well, you don’t have anyone to do cognitive research, we will cut your grant by that amount of money and you have to skip it. No one is qualified to do it.” The people who had written the grant said “okay,” and then they came back to me and said: “we’ll just do it anyway. We’ll just hire you on a lower budget, because we think this is important,” which of course it was. And this was a really critical moment where in spite of qualifications etc. things fell into place. And then I thought, “I’d better get this PhD done.” So I convinced the people in anthropology that I could hand in a thesis without having been a student, which was ‘ethnography of knowledge’ – combing stuff on Greenland Halibut and stuff on brain-imaging laboratories.[ix]

 

Home

DF: The tension in your account is never between history and biology… it doesn’t sound like the tension for you was thinking, “how do I analyze, say, the history of the Lithuanian state through nature conservation?” The tension was: “how I can convince various structures that this is a reasonable thing to do?”

AR: I think that’s probably very true.

DF: Because that’s an unusual perspective.

AR: But you know there is positive personal story to it which is really trivial: my father is a proton chemist, my mother is a sociologist. They divorced when I was 18.

DF: Um, that’s not trivial. It seems, uh… pertinent.

AR [Laughs]: It might be. I don’t know… it would a very obvious place to find that those mental dispositions which would be in me, in a way. To some degree overcoming my parents’ divorce could be seen as a motor. And also coming to terms with myself. Because for a while I thought I had to do one or do the other. And I realized, actually I don’t. I’m just perfectly happy being just there and being able to speak in a relatively fluently – if not an expert – way across these fields. And thinking across them just seems to come very easily [….] I remember it as a very definite choice, to say that, “for this to work I needed more than a major in one and a minor in the other.” Because I thought, with that, I’m just not going to be able to contribute or to understand things basically. In that sense it was a very Protestant, kind of… I just have to work my way through what it takes to get the disciplinary training.

And it’s actually an advantage that they don’t link up. I don’t want to have bad interdisciplinarity. I want good biology, and I want good anthropology. And then whatever comes out of that comes out of that. That was a very conscious choice. I believe in disciplines. And I believe in disciplines as a point of reference, as something that you discuss within and along. I think this is absolutely critical. And the kind of formal training you get in a discipline is necessary. And there I didn’t cut any corners. Even after I shifted from chemistry and biotechnology to biology, I thought, “there’s just not enough math in this.” You know, I took mathematics at a higher level because I thought I would need the math at some point, and I was just at some point really stressed by it. I remember going up the hill in Aarhus to take math classes, and half way up realizing, “actually, you know, I don’t need to do this. [Laughs] It’s not something anyone asks of me.” And halfway up I turned around and went down and never went to those math classes again. It was a very physical realization.

DF: Metaphors of travel are so present in your account, and ideas about borders, and about movement… I’m trying to fashion a question that isn’t cheesy, which is something about the ways in which travel both literally and figuratively is very central to your intellectual work.

AR: I think that is true, but the really interesting twist that I basically work at the university where I was taught, and at the institute where I was taught. I live if not in the house, then on the property I grew up in. My kids go to the same school that I went to. I’m extremely locally bound.

DF: I remember you saying to me one time that there were real virtues to being away from the centre.

AR: That was my feeling going to London. Obviously, for the mainstream stuff London was much, much better. I can regret that I didn’t go to a central place of learning earlier in my studies. That would have given me a discipline that I’m sure would have been extremely useful. But I also thought that the competition… it was, like, a good place to be when you were very formative, and a good place to be if you get head-hunted to do what you would like to do. But in the middle, it seems to provide very little space for maneuvering. And also to be not very amenable to the work that I could see myself doing – which is, you can say, exploratory or traveling or whatever. In that sense, very concretely, I was given opportunities here in Aarhus that would never have happened in a central place. You just don’t let people without a PHD go in and, you know, you don’t let them do cognitive science without a psychology degree. It’s just not a sensible way to spend your money. You don’t walk in the door without a degree and get to do neurophysiology, right? It’s just not… [laughs]. But you can say that all of these factors created the possibility for me to get some unusual experiences that arose before I was actually prepared to do, them or skilled to do them, or ready to do them. Which must somehow be formative of the way I work, I think.

DF: When I write about these things, I often use this metaphor of dwelling at the margins. And actually I think you’re right that there’s something about dwelling…. like, it’s easier to dwell at the margins when you literally are at the margins.

AR: It is. And you can say it’s very much dwelling in the sense that basically I’m just at home.

 

Anthropologies of collaboration

AR: There’s something about the way we construe the participant observation role which makes collaboration very difficult to do. I think, at the end of the day, the anthropological position is inherently extremely arrogant. And arrogance is not the best starting point for collaboration. People see through it at some point […] You need to be able to do something useful as well. This is not something people have a lot of training in. But it’s really a challenge and that means a re-configuration, I think George Marcus is the one that sees this better than everyone else[x]. That this kind of mutual engagement where you are kind co-producing and co- investigating and exploring what it mean to have different stakes in something that has to be a joint product. I think as as someone who has re-defined the discipline, I think he is basically second to none. He keeps coming up with metaphors that become licenses to work in novel ways.

For example his work on multi-sited fieldwork, which was not about the multi-sitedness but about following whatever seems relevant. He just gave a completely different perspective on what you can do. And how he thinks about collaboratories in a similar way just redefines what it means to do ethnography… He’s here in Aarhus quite regularly. He’s very curious, and thinks along and thinks with it and does stuff. A lot of people, for instance would like to position me as a cognitive anthropologist. And I’m definitely not a cognitive anthropologist. I can’t identify with it. I think it’s dominated by people who take old- fashioned ideas in cognitive psychology – and they miss out on what anthropology is about, and has been about. Similarly, I don’t see myself as a neuroanthropologist either. I think what I do is just anthropology[xi]. Or, if anything, it might be experimental anthropology.

 

Interdisciplinarity and Fragility

DF: In some ways you are a terrible interviewee for this. Because what we’re trying to think about is collaboration and the problematics of collaboration. And people like me, we struggle with that as a question, and as an ethic, and as a way to go about things. And you don’t, I think. Or, it’s not that you don’t struggle with it, but it’s almost like ‘collaboration’ is an inappropriate register in which interpret what you do, because you’re never like ‘I’m the anthropologist,’ when you collaborate with these guys, or I’m the biologist’ when you collaborate with these guys. It’s much more fluid and much more natural.

AR: It is and that’s probably the trick. In that sense, it’s not like, “and now I go in to do a translation.” To some extent, it’s almost like externalizing processes that are ongoing in myself. I haven’t thought about it in that way before. It just doesn’t feel like, “and now I have to combine this.” It just seems like the most obvious thing in the world. But also, partly, I’m extremely bad at writing about these things. You might have noticed. I mean I probably could write about it… but it would be so much labor, whereas collaboration itself just doesn’t feel like work. And these connections, or patterns – it’s the most obvious thing in the world. […] It’s a bit like building with Lego: “yes, this seems to be a right configuration for this particular place and context and situation.” Which on the one hand is very nice, because I’m quite convinced that this is the way it works. But it’s also extremely specific to the moment.

In one way, I’m in a very fragile position, because I’m not sure I could compete myself into a position at another good university. It works now, because I’m kind of in a relatively secure base here, but I doubt I could compete in a pure anthropology department, or in brain-imaging. I believe I can be very useful to most academic institutions, but I would not be the first candidate for an ordinary position. That worried me for a while, and should something happen here, it could become worrying again. Because, you know, “Who is this guy? What is his profile? What has he actually done?” For a while I worried a lot about it. I knew I was as good as an anthropologist as the people who get the jobs, but I wouldn’t get it because of the biology part. Of course I worried for a while. But I just didn’t seem to have any choice to do otherwise. In that sense, I think there has always been a very strong dedication or conviction, that what I was exploring was the right thing. It was just difficult to figure out how on earth should I place it vis-à-vis the institution.” Still I will say today, objectively speaking, it’s a potentially very fragile situation.

 

 

[i] Roepstorff, A. & J.D.C. Lambert. (1994). ‘Factors Contributing to the Decay of the Stimulus-Evoked Ipsc in Hippocampal Ca1 Neurons.’ Journal of Neurophysiology 72 (6):2911-2926

[ii] Roepstorff, A. & A. Simoniukstyte. (2004) ‘Cherishing Nation’s Time and Space. The Tradition Maintaining Lithuanian Identity’ T. Otto & P. Pedersen Anthropology and the Revival of Tradition Aarhus: Aarhus University Press, pp.157-192

[iii] Roepstorff, A. (2003) ‘Clashing Cosmologies. Contrasting Knowledges in the Greenlandic Fishery’ in A. Roepstorff, N. Bubandt and K. Kull (eds.) Imagining Nature. Practices of Cosmology and Identity. London: Aarhus University Press g, pp.117-42

[iv] Callon, M. (1986) ‘Some elements of a sociology of translation: domestication of the scallops and the fishermen of St Brieuc Bay d in J. Law (ed). Power, action and belief: a new sociology of knowledge? London: Routledge, pp.196-223.

[v] Latour, B. (1993) We have never been modern. Boston, MA: Harvard UP.

[vi] Now part of the Wellcome Trust Centre for Neuroimaging – a major international site for neuroimaging research. See http://www.fil.ion.ucl.ac.uk/

[vii] Chris Frith is a prominent British neuroscientists, most famous for his work on social cognition. In addition to his emeritus position at UCL, Chris Frith is also now a visiting professor in Aarhus. See http://www.fil.ion.ucl.ac.uk/Frith/

[viii] Roepstorff, A. (2002) ‘Transforming subjects into objectivity. An ethnography of knowledge in a brain imaging laboratory.’ Folk 44: 145-170. Available at http://www.pet.au.dk/~andreas/pages/Files/folk.pdf

[ix] Roespstorff, (2003) Facts, Styles and Traditions: Studies in the Ethnography of Knowledge. Aarhus University, PhD Thesis: Afd. f. Etnografi og Socialantropologi

[x] See e.g. Marcus, G (ed.). (2000) Para-Sites: A Casebook against Cynical reason. Chicago: University of Chicago Press.

[xi] Roepstorff, A. and CD Frith. (2012). ‘Neuroanthopology or simply anthropology? Going experimental as method, as object of study, and as research aesthetic.’ Anthropological Theory 12 (1) 101-111.

William Connolly’s The Fragility of Things by Allegra Giovine

17 Mars 2015 - 10:45pm

The Fragility of Things: Self-organizing Processes, Neoliberal Fantasies, and Democratic Activism

by William E. Connolly

Duke University Press, 2013, 256 pages.

 

In The Fragility of Things: Self-organizing Processes, Neoliberal Fantasies, and Democratic Activism (2013), political theorist William Connolly delivers us into a chaotic world: “a world of becoming in which multiple force fields set on different tiers of chronotime periodically collide or coalesce to foment a new danger, risk, or possibility” (138). This is a volatile world that is constantly in motion, a world that gives a leading role to mystery and creative possibility, and thus a world where complete explanation is never fully attainable. Connolly’s cosmos is inspired by complexity theory in the biological and earth sciences, a Sophoclean sense of cosmic sensitivity, and thinkers who dwell upon a “multitiered cosmos of becoming” (29). Connolly engages these ideas, as well as several other well-known voices in the Western philosophical canon, in order to paint a picture of our cosmos and develop a set of principles by which to live and take action in it. In his estimation this is a timely endeavor, both because of recent advances in our understanding of self-organizing systems that underlie complexity theory, and because of the “hegemony of neoliberalism” (7), which belies the complexity and fragility of our world. The Fragility of Things ultimately offers us a new theory of political economy: one that firmly dislodges the market as the leading mechanism of historical explanation and, simultaneously, illuminates possibilities for political activists to realize different future trajectories.

This is a tall order, and in just under 200 pages, Connolly accomplishes it. By organizing his text into a series of chapters and post-chapter commentaries, The Fragility of Things is “structured” in a way that mirrors the author’s own thoughts on the relationship between control and creativity, and the messy reality of moving assemblages. But the book is not as rhizomatic as you may hope (or fear), and each section adds to and reinforces Connolly’s position. Throughout the book, he moves back and forth across several emotional and intellectual spectra so fluidly, you will wonder how it is that long lists of tragedy after impending tragedy can be followed by a real sense of hope and possibility. Or how the evolutionary adaptations of paramecia are put in conversation with the increasing inequities in the financial market system. This book is modest (remember, “Perfect answers are suspect,” (182)), with the occasional quip aptly inserted for much needed moments of relief (e.g., “The audacity of Kantian hope” (114), after an extended battle with moral law). And though Connolly draws extensively on complexity theory, incorporating work by neuroscientists and leading extended discussions on teleodynamic self-organizing systems, this text is anything but dry. You feel culminating moments in every chapter, surges of affect following intricate dissection of the forces moving this world. In the end, Connolly seems to accomplish an impossible feat: a book that is both wide-ranging and neatly tied together—or as neatly as can be, considering its metaphysical foundations.

Chapter 1 lays out Connolly’s critique of neoliberalism, which fills a gap between those scholars who reflect upon a dynamic, multitiered cosmos, and those who settle their gaze on the ecology of late capitalism and its faults (30). Connolly’s contribution is to point out that economic markets constitute just one kind of self-organizing system in our cosmos; they do have self-organizing power, but so do other human and nonhuman processes. “Such a combination changes everything” (25), encouraging a new political economy that gives significant standing to these other processes and their interactions (27). The first interlude tackles a seemingly tangential issue in a revealing way, apparently motivated by a remark Richard Dennett made at a conference asserting the non-necessity of spirituality (47). Connolly searches for a different understanding, carving out a place for a nontheist spirituality that admits a world “in which humanity matters immensely” (50).

In the second chapter Connolly engages with Friedrich Hayek’s work. He outlines Hayek’s moderate neoliberalism, one that saw the market as fragile and in need of a self-conscious ideology to ensure its functioning—not one serving as “merely a camera that takes a snapshot of processes humming along without it” (59). He then “explodes [it] from the inside” (70) by developing Hayek’s conception of freedom further. Drawing attention especially to Hayek’s appreciation of creativity in freedom, Connolly expands this to sites that, once admitted, remove all possibility of an “uninterrupted” market operating without failure. The second interlude is an extended explanation of self-organizing systems. Using the alliance between American evangelicalism and neoliberalism as one example (further examined in his Capitalism and Christianity, American Style, to which this book is a companion), Connolly shows reason for optimism by revealing how vulnerable this complex actually is. This was not preordained fate—gambling is offered as an example of a point of tension that became placated with time (93)—and the larger message is that the economy should not be viewed as such a thing either. Rather, Connolly urges us to “dramatize fragilities and positive potentialities folded into the teleodyanmics of the current regime” (97).

In Chapter 3 Connolly takes up Kant, arguing provocatively that Kantian morality is secured only by the adoption of market-like postulates that assert civilizational progress although the empirical record cannot prove them (115). Having shaken Kant’s apodictic starting points and illuminated their dramatization, Connolly then proceeds with his own dramatization of an alternative set of starting points. These are elaborated in his “maxims of practical wisdom” (124-37) which assert the will as an “emergent biocultural formation” (127) and call for an “ethic of cultivation” (132) that rejects a universal morality and invites presumptive responsibility, periodic hesitation, and a timely militancy in its worldly engagement. The third interlude briefly engages Charles Taylor’s idea of the “pursuit of fullness,” rejecting it in favor of an appreciation of the vitality of being. This vitality is interdefined with the creativity and freedom that Connolly explores in Chapter 2 and gives more precision and palpability to our attachment to humanity explored in the first interlude.

In Chapter 4 Connolly exchanges notes with both Whitehead and Nietzsche to further clarify creativity’s role in our cosmos. Separate influences (quantum mechanics and ancient Greek thought) led these thinkers to identify creativity as an irreducible “ultimate term” (156) or “ultimate property of the universe” (167). This resonates with Connolly’s view and, while it renders full explanation impossible, also rescues “cultural theory from the closures pushed upon it by the most reductive versions of biology, neuroscience, and social science” (161). Finally, in the postlude, Connolly elaborates his call to arms. He acknowledges the dilemma of electoral politics but begs us not to disengage, advocating instead large-scale role experimentation as a direct means of disruption and potential catalyst for political movements (184). This enables Connolly’s dual goal of slowing down and speeding up (10, 39, 136, 172): that is, slowing or shifting the practices that bring several force fields in our cosmos into dangerous proximity, and speeding up changes at the level of individuals (identity, role performance) and higher-order social formations (market regulation, state policy).

Ultimately, Connolly gives us not only a way of seeing the world, but also a way of feeling for it and engaging in it. His own personal search for these answers is evident beginning from the first interlude, and I am sympathetic to the “existential gratitude” (181) he formulates that wards off complacency but does not suffer from naiveté. The elements of mystery and spontaneity he builds into his world indeed seem irreducible, and these offer hope as much as danger for our historical possibilities. Of course they also raise a critical challenge for the human sciences, and one area found lacking is a more explicit model or guideline by which we can understand these processes if explanation is an unrealizable goal. If a second critique can be made, it is that the experimental activism Connolly advocates likely needs more explicit formulation in order to spread and be realized—although I acknowledge these desires for formulations are in some degree of conflict with the very cosmos Connolly describes. This book will appeal to a wide range of academic and activist audiences, and it is an opportune time to be reading it. Because as Connolly notes, while “cosmic issues have never been absent” and the question of humanity’s place in the cosmos has waxed and waned over time, “we are living through a global time when it waxes in a distinctive way” (171).

 

Allegra Giovine is a Ph.D. candidate in the Department of History and Sociology of Science at the University of Pennsylvania. She works on the history of economics and geography in colonial Burma. Allegra is a Mellon Dissertation Fellow at the Institute of Historical Research in London for the 2014-2015 academic year.

Book Forum – Bhrigupati Singh’s Poverty and the Quest for Life by Todd Meyers

13 Mars 2015 - 3:24pm

 

In this next installment of our book forum series, Naveeda Khan has organized a tremendously engaging and challenging set of commentaries on Bhrigupati Singh’s forthcoming book, Poverty and the Quest for Life (Chicago, 2015).  The currents that run between these pieces do not need channeled by a long preface – as will become apparent, these passages already run deep.  We hope you enjoy an exceptional set of commentaries and Bhrigu’s reply.

 

Introduction:
An-other Ethnography
Naveeda Khan
Johns Hopkins University

 

Comments on Bhrigupati Singh’s Poverty and the Quest for Life: Spiritual and Material Striving in Rural India (Chicago: University of Chicago Press, 2015).

The Nomadic Ethnography of Bhrigu Singh
William E. Connolly
Johns Hopkins University

Of Winter Moons
Lisa Stevenson
McGill University

Dialectics at the Threshold
William Mazzarella
University of Chicago

Sovereignty without the Sovereign
Swayam Bagaria
Johns Hopkins University

 

Reply to comments
Bhrigupati Singh
Brown University

 

Bio-ethnography, a view from philosophy by Vivette García Deister

13 Mars 2015 - 12:19am

Full frontal disclosure: I am not an anthropologist (by training). But my work is informed by historical research, ethnographic methods, and critical anthropology of science. And as someone who has –Developmental Systems Theory willing- taken on the inquiry of scientific research exploring gene-disease associations, I side with Liz Roberts’ want for a “synthetic, symmetrical analysis that understands environment-body interactions as always relational and constructed phenomena”. This is no easy thing to achieve. My way into discussing her proposal is more philosophical than anthropological, and deals with what I identify as three core concerns of her bio-ethnographic approach: integration, symmetry, and interaction. I will try to show briefly why I think bio-ethnography is on the right (yet somewhat beaten) integrationist path, why it is at risk of collapsing causal parity with explanatory symmetry, and why it can and should steer clear of any form of interactionist consensus.

Roberts’ description of the ELEMENT project places it as one that tends to situate “key mechanisms for health and disease inside individual bodies.” Also, ELEMENT has recently appropriated some tenets of epigenetic analysis in the examination of chemical interactions in specific environments and their effects on health. ELEMENT’s recognition of a looping effect between organisms and environments hints at its being suitable for a “collaborative, methodological experiment” in which biological data gathered by ELEMENT’s biomedical researchers might be integrated with ethnographic data “about the larger histories and life circumstances that shape health,” gathered by Roberts and her team. As I see it, the very attempt at developing a meaningful collaboration between both teams necessitates the adoption of a symmetry thesis whereby causal factors traditionally located either on the “biological” or the “cultural” end of the “bio-cultural synthesis” do not, in principle, contribute distinctively towards human development in terms of health or disease. Roberts’ point is that we cannot genuinely distinguish whether one causal factor resides in the bio or the cultural side: “by maintaining culture as distinct from biology, bio-cultural synthesis remains asymmetrical”. This idea–or one very similar to it- is a central tenet of Developmental Systems Theory (DST), a critical and constructive project addressing genocentric accounts of biological development, and whose intellectual mission is a principled resistance of dichotomies such as gene/environment, nature/nurture, and biology/culture. Because I take Roberts’ project to be similarly motivated, I’d like to examine this further, and perhaps problematize it a bit.

First, it is useful to analyze Roberts’ symmetry thesis in terms of causal parity and explanatory symmetry. Causal parity is an ontological claim that denies that some factors (such as genes or molecules) possess, in principle, “special directive, formative or informative power” (Oyama 2001, p. 178). Causal parity does not claim that all sources of causal influence play the same role; it does not imply that all causes are equally important, nor does it discard the possibility of distinguishing between different types of causes (such as genes or toxic metals). Given “the ELEMENT project support of a looping approach,” and evidence of their use of epigenetic analytics, I am inclined to think that ELEMENT researchers and anthropologists probably both already agree to there being symmetry at this level, but agreement on causal parity does not produce “a complex conditioning entanglement [causal] model, which takes into account factors such as household gendered economies, geography and kinship” in shaping disease among ELEMENT participants.

Explanatory symmetry is an epistemological claim that denies the attribution of a privileged role in explanations to some causal factors (be they genes, toxic metals, or project participation) –in short, “the treating of some causes as more equal than others” (Oyama 2001, p. 178). The symmetry thesis, then, is not that we cannot assign causal importance to various parts of a biological system, but rather, that in assigning causal importance we should not forget that assignments are often heuristic and may or may not reflect the nature of the relevant causes. Citing Susan Oyama once again, “symmetry is neither a platitude about multiple influences nor a denial about useful distinctions, but a powerful way of exposing hidden assumptions and opening up traditional formulations to fruitful change (Oyama 2000). Bio-ethnography invites a particular kind of boundary work that should also not be confused with seeking to corroborate the truism that bodily states of health and disease are influenced by environmental factors both inside and outside the individual organism.

This is where I think the usefulness of the bio-ethnographic approach resides, as well as its integrationist flair. By putting biological samples in conversation with participants’ life trajectories and environments, Roberts and collaborators will be telling us not what the scramble (c.f. Michael Montoya) really looks like, but how to bring the system back into view. Misunderstanding causal parity, and collapsing it with explanatory symmetry confuses these two tasks.

 

Vivette García Deister is a philosopher of science and Associate Professor at the S&TS Lab in the School of Sciences at the National Autonomous University (UNAM) in Mexico City.  Her research has examined issues of race, genomics and metizaje (mixture) in Latin America, as well as the emergence and consolidation of forensic genetics at the intersection of state-based and grass-roots responses to migration and migrant death.  

 

Works cited

Oyama, S (2000), “Causal Democracy and Causal Contributions in Developmental Systems Theory,” Philosophy of Science 67, pp. S332-S347.

Oyama, S (2001), “Terms in Tenison: What Do You Do When All the Good Words Are Taken?” in Oyama, Susan, Paul E. Griffiths and Russel D. Gray (eds.), Cycles of Contingency, MIT Press, Cambridge, pp. 177-194.

See also:

García Deister, V (2005), “Resisting Dichotomies: Causal Images and Causal Processes in Development” M. Phil. Thesis, UNAM.

Of Means and Ends: Mind and Brain Science in the Twentieth Century – A special issue of Science in Context by Anna Zogas

11 Mars 2015 - 3:16pm

In addition to the new articles listed in this month’s In the Journals post, I’d like to highlight the March 2015 issue of Science in Context. The themed issue, edited by Stephen T. Casper, is entitled “Of Means and Ends: Mind and Brain Science in the Twentieth Century.” See below for links to the issue’s introduction, five articles, and epilogue.

Of Means and Ends: Mind and Brain Science in the Twentieth Century
Stephen T. Casper

What role does context play in the mind and brain sciences? This introductory article, “Of Means and Ends,” explores that question through its focus on the ways scientists and physicians engaged with and constructed technology in the mind and brain sciences in the twentieth century. This topical issue addresses how scientists, physicians, and psychologists came to see the ends of technology as important in-and-of themselves. In so doing, the authors of these essays offer an interpretation of historian Paul Forman’s revisionist and highly contextualist chronology of the twentieth century, which presents the comparatively recent tendency to aggrandize the ends of technology as evidence of a major, epochal transformation in the epistemic culture of twentieth-century American science. This collection of papers suggests that it was in the vanguard of such fields as psychology, psychiatry, and neurophysiology in North America and Europe that the ends and applications of technology became important in-and-of themselves.

Dredging and Projecting the Depths of Personality: The Thematic Apperception Test and the Narratives of the Unconscious
Jason Miller

The Thematic Apperception Test (TAT) was a projective psychological test created by Harvard psychologist Henry A. Murray and his lover Christina Morgan in the 1930s. The test entered the nascent intelligence service of the United States (the OSS) during the Second World War due to its celebrated reputation for revealing the deepest aspects of an individual’s unconscious. It subsequently spread as a scientifically objective research tool capable not only of dredging the unconscious depths, but also of determining the best candidate for a management position, the psychological complexes of human nature, and the unique characteristics of a culture. Two suppositions underlie the utility of the test. One is the power of narrative. The test entails a calculated abuse of the subjects tested, based on their inability to interpret their own narrative. The form of the test requires that a subject fail to decipher the coded, unconscious meaning their narrative reveals. Murray believed the interpretation of a subject’s narrative and the projection contained therein depended exclusively on the psychologist. This view of interpretation stems from the seemingly more reasonable belief of nineteenth-century Romantic thinkers that a literary text serves as a proxy for an author’s deepest self. The TAT also supposes that there is something beyond consciousness closely resembling a psychoanalytic unconscious, which also has clear precedents in nineteenth-century German thought. Murray’s views on literary interpretation, his view of psychology as well as the continuing prevalence of the TAT, signals a nineteenth-century concept of self that insists “on relations of depth and surface, inner and outer life” (Galison 2007, 277). It is clear the hermeneutic practice of Freud’s psychoanalysis, amplified in Jung, drew on literary conceptions of the unconscious wider than those of nineteenth-century psychology.

The Birth of Information in the Brain: Edgar Adrian and the Vacuum Tube
Justin Garson

As historian Henning Schmidgen notes, the scientific study of the nervous system would have been “unthinkable” without the industrialization of communication in the 1830s. Historians have investigated extensively the way nerve physiologists have borrowed concepts and tools from the field of communications, particularly regarding the nineteenth-century work of figures like Helmholtz and in the American Cold War Era. The following focuses specifically on the interwar research of the Cambridge physiologist Edgar Douglas Adrian, and on the technology that led to his Nobel-Prize-winning research, the thermionic vacuum tube. Many countries used the vacuum tube during the war for the purpose of amplifying and intercepting coded messages. These events provided a context for Adrian’s evolving understanding of the nerve fiber in the 1920s. In particular, they provide the background for Adrian’s transition around 1926 to describing the nerve impulse in terms of “information,” “messages,” “signals,” or even “codes,” and for translating the basic principles of the nerve, such as the all-or-none principle and adaptation, into such an “informational” context. The following also places Adrian’s research in the broader context of the changing relationship between science and technology, and between physics and physiology, in the first few decades of the twentieth century.

Of Psychometric Means: Starke R. Hathaway and the Popularization of the Minnesota Multiphasic Personality Inventory
Rebecca Schilling and Stephen T. Casper

The Minnesota Multiphasic Personality Inventory (MMPI) was developed at the University of Minnesota, Minneapolis, in the 1930s and 1940s. It became a highly successful and highly controversial psychometric tool. In professional terms, psychometric tools such as the MMPI transformed psychology and psychiatry. Psychometric instruments thus readily fit into the developmental history of psychology, psychiatry, and neurology; they were a significant part of the narrative of those fields’ advances in understanding, intervening, and treating people with mental illnesses. At the same time, the advent of such tools also fits into a history of those disciplines that records the rise of obsessional observational and evaluative techniques and technologies in order to facilitate patterns of social control that became typical during the Progressive Era in the United States and after. It was those patterns that also nurtured the resistance to psychometrics that emerged during the Vietnam War and after.

The Surgical Elimination of Violence? Conflicting Attitudes towards Technology and Science during the Psychosurgery Controversy of the 1970s
Brian P. Casey

In the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more “scientific” understanding and better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable.

Contending Professions: Sciences of the Brain and Mind in the United States, 1850–2013
Andrew Scull

This paper examines the intersecting histories of psychiatry and psychology (particularly in its clinical guise) in the United States from the second half of the nineteenth century to the present. It suggests that there have been three major shifts in the ideological and intellectual orientation of the “psy complex.” The first period sees the dominance of the asylum in the provision of mental health care, with psychology, once it emerges in the early twentieth century, remaining a small enterprise largely operating outside the clinical arena, save for the development of psychometric technology. It is followed, between 1945 and 1980, by the rise of psychoanalytic psychiatry and the emergence of clinical psychology. Finally, the re-emergence of biological psychiatry is closely associated with two major developments: an emphasis that emerges in the late 1970s on rendering the diagnosis of psychiatric illnesses mechanical and predictable; and the long-term effects of the psychopharmacological revolution that began in the early 1950s. This third period has seen a shift the orientation of mainstream psychiatry away from psychotherapy, the end of traditional mental hospitals, and a transformed environment within which clinical psychologists ply their trade.

Epilogue: The Redux of Postmodernity
Roderick D. Buchanan

The essays in this topical issue illustrate the changing cultural form and function of the biopsyche disciplines – disciplines that are both sciences and technologies of selfhood. To varying degrees, each essay actively engages Paul Forman’s thesis on modern and postmodern cultural valuations of science and technology. Forman invites those who read his work to view the cultural space framing science and technology in new ways (Forman 2007; idem 2010).

In the Journals – March 2015 by Anna Zogas

9 Mars 2015 - 5:21pm

Here are some of the journal articles that have been published in March 2015. Enjoy!

New Genetics and Society

Origin stories from a regional placenta tissue collection (open access)
Maria Fannin and Julie Kent

Twenty-three years ago when women and their children were recruited to a longitudinal genetic epidemiological study during pregnancy, placentas were collected at birth. This paper explores the history of a regional placenta biobank and contemporary understandings of its value for the constitution of a research population. We draw on interviews with some of the mothers and those responsible for the establishment and curation of the placenta collection in order to explore the significance and meaning of the collection for them. Given its capacity to stand in for the study cohort of mothers and children, we argue that the material significance of the placenta biobank as a research tool seems far less important than the work it does in constituting a population. The stories about this collection may be understood within the wider context of developments in biobanking and the bioeconomy.

Standardizing work as a recursive process: shaping the embryonic stem cell field
Lena Eriksson and Andrew Webster

In this paper, we examine processes of standardization and their role in helping to stabilize human embryonic stem cells as biological objects and in building the stem cell field itself. Drawing on empirical data from the emerging embryonic stem cell field, we explore the various arenas within which standardizing work goes on and how these relate to each other as different types of labour within and beyond the lab, one to do with stabilizing the bio-object and a second to do with its comparability and identity within a wider domain. Standardizing work reflects the recursive relation between these processes which are discussed via the concepts of bio-objectification and bio-identification.

How UK psychiatric geneticists understand and talk about engaging the public
Jamie Lewis and Andrew Bartlett

The paper examines how leading UK psychiatric geneticists talk about public engagement. Scientific fields have distinctive publics, with specific goals for, concerns with, and obstacles to engagement. In psychiatric genetics these publics include people with psychiatric disorders, policy-makers, and even medics. We found that psychiatric geneticists justify public engagement by using the language of “stigma” in multiple ways. There is a belief in a deficit model of stigma that stigmatizing attitudes among the general public and government are the result of insufficient knowledge of the biological causes of psychiatric disorders. “Stigma” is, however, also co-opted to do rhetorical work within biomedicine, marking differences in therapeutic optimism as pathological. We suggest that the wider field of UK psychiatry is seen as mostly consisting of therapeutic pessimists, while the psychiatric geneticists are in a minority of therapeutic optimists. These attitudes are the product of the historical and social context of the field.

Body & Society

Risky Bodies in the Plasma Bioeconomy: A Feminist Analysis
Julie Kent and Anne-Maree Farrell

In 2003 the UK National Blood Service introduced a policy of ‘male donor preference’ which involved women’s plasma being discarded following blood collection. The policy was based on the view that data relating to the incidence of Transfusion-Related Acute Lung Injury (TRALI) was linked to transfusion with women’s plasma. While appearing to treat female donors as equal to male donors, exclusion criteria operate after donation at the stage of processing blood, thus perpetuating myths of universality even though only certain ‘extractions’ from women are retained for use in transfusion. Many women in the UK receive a plasma-derived product called Anti-D immunoglobulin which is manufactured from pooled male plasma. This article examines ways in which gender has significance for understanding blood relations, and how the blood economy is gendered. In our study of relations between blood donors and recipients, we explore how gendered bodies are produced through the discursive and material practices within blood services. We examine both how donation policies and the manufacturing and use of blood products produces gendered blood relations.

Science, Technology, & Human Values 

Narratives of Participation in Autism Genetics Research
Jennifer S. Singh

This article provides empirical evidence of the social context and moral reasoning embedded within a parents’ decision to participate in autism genetics research. Based on in-depth interviews of parents who donated their family’s blood and medical information to an autism genetic database, three narratives of participation are analyzed, including the altruistic parent, the obligated parent, and the diagnostic parent. Although parents in this study were not generally concerned with bioethical principles such as autonomy and the issues of informed consent and/or privacy and confidentiality of genetic information, a critical analysis reveals contextual bioethics embedded within these different narratives. These include the negotiations of responsibility that parents confront in biomedical research, the misguided hope and expectations parents place in genomic science, and the structural barriers of obtaining an autism diagnosis and educational services. Based on these findings, this article demonstrates the limits of a principle-based approach to bioethics and the emergent forms of biological citizenship that takes into account the social situations of people’s lives and the moral reasoning they negotiate when participating in autism genetic research.

Ethos: Journal of the Society for Psychological Anthropology 

“No One Has to Be Your Friend”: Asperger’s Syndrome and the Vicious Cycle of Social Disorder in Late Modern Identity Market
Elizabeth Fein

The past 40 years have seen a significant increase in diagnoses of autism spectrum disorder (ASD), a condition characterized by social impairments and restricted or repetitive behaviors. This increase has been particularly marked in the United States, where prevalence estimates have risen from 1 in 2,500 children in 1987 to 1 in 88 today (Baio and Centers for Disease Control and Prevention 2012; Ritvo et al. 1989). I argue that changing social environments are one factor contributing to this increase by altering trajectories of social development, particularly among those with social-cognitive vulnerabilities in the absence of comorbid intellectual impairment. In a sociocultural milieu in which friendships and other extra-familial relationships are increasingly determined by individual choice, with affiliations formed around likeability and the negotiation of mutual positive affect, those who are slower to develop nonverbal awareness, perspective taking, and emotional self-regulation are often excluded from the flow of social life. Such exclusion results in the rapid amplification of characteristics considered to be deviant, thus perpetuating worsening cycles of exclusion and atypical development.

Medical Anthropology Quarterly (open access)

Medical Humanitarianism: Anthropologists Speak Out on Policy and Practice
Sharon Abramowitz, Meredith Marten, and Catherine Panter-Brick

In recent years, anthropologists have become increasingly present in medical humanitarian situations as scholars, consultants, and humanitarian practitioners and have acquired insight into medical humanitarian policy and practice. In 2012, we implemented a poll on anthropology, health, and humanitarian practice in which 75 anthropologists discussed their experiences in medical humanitarianism. Our goal was to move beyond the existing anarchy of individual voices in anthropological writing and gain an aggregate view of the perspective of anthropologists working in medical humanitarian contexts. Responses lead to six inductively derived thematic priorities. The findings illustrate how anthropologists perceive medical humanitarian practice; which aspects of medical humanitarianism should be seen as priorities for anthropological research; and how anthropologists use ethnography in humanitarian contexts.

Transnational Disorders: Returned Migrants at Oaxaca’s Psychiatric Hospital
Whitney L. Duncan

This article examines experiences of returned migrants seeking mental health care at the public psychiatric hospital in Oaxaca, Mexico. Approximately one-third of the hospital’s patients have migration experience, and many return to Oaxaca due to mental health crises precipitated by conditions of structural vulnerability and “illegality” in the United States. Once home, migrants, their families, and their doctors struggle to interpret and allay these “transnational disorders”—disorders structurally produced and personally experienced within the borders of more than one country. Considering how space and time shape illness and treatment among transnational migrants, I contend that a critical phenomenology of illegality must incorporate migrant experience and political economy on both sides of the border before, during, and after migration.

Straining Psychic and Social Sinew: Trauma among Adolescent Psychiatric Patients in New Mexico
Janis H. Jenkins

Drawing on data from a longitudinal study of 47 adolescents of diverse ethnic backgrounds hospitalized for psychiatric disorder in New Mexico, the article critically examines the relevance of post-traumatic stress disorder (PTSD) to address anthropological questions of how to define the problem. Factors include the utility/limitation of psychiatric diagnostic categories, the lived experience of severe distress, the socioeconomic and political conditions of suffering, and reciprocal relations between immediate and remote social institutions. I discuss the mental health care system for adolescents and present two case studies of young inpatients, emphasizing the need for dual specification of the conditions of trauma and the structure of experience. I argue for understanding patterns of abandonment that shape the raw existence of young people at both the personal and collective levels to apprehend their depth and durability.

Self-care and Subjectivity among Mexican Diabetes Patients in the United States
Rebecca Seligman, Emily Mendenhall, Maria D. Valdovinos, Alicia Fernandez and Elizabeth A. Jacobs

Type 2 diabetes is considered a public health crisis, particularly among people of Mexican descent in the United States. Clinical approaches to diabetes management increasingly emphasize self-care, which places responsibility for illness on individuals and mandates self-regulation. Using narrative and free-list data from a two-phase study of low-income first- and second-generation Mexican immigrants living with diabetes, we present evidence that self-care among our participants involves emotion regulation as well as maintenance of and care for family. These findings suggest, in turn, that the ideology of selfhood on which these practices are based does not correspond with the ideology of selfhood cultivated in the U.S. clinical sphere. Divergence between these ideologies may lead to self-conflict for patients and the experience of moral blame. We argue that our participants use their explanations of diabetes causality and control as a form of self-making, which both resists such blame and asserts an alternative form of selfhood that may align more closely with the values held by our Mexican-American participants.

Exploring Pluralism in Oral Health Care: Dom Informal Dentists in Northern Lebanon
Giovanni Bochi

This article describes a pluralistic regime of oral health provision in a rural part of northern Lebanon, where dental care came from two main sources: professionally trained dentists and “informal” Dom dentists with Syrian nationality. Relying on a combination of interviews and ethnography, I offer a multivocal view of oral health services that incorporates data from patients and formal and informal providers. I argue that informal dentistry constituted an interstitial and translocal mode of dental care. In the northern Lebanese Biqa Valley, close to the Syrian border, the local articulation of neoliberal health governance created opportunities for heterodox practices in oral health. The organization of informality was predicated on the presence of the open border between Syria and Lebanon, which favored patterns of flexible cross-border mobility. In this context, informal dentistry was not alternative, but supplementary and lateral in relation to official forms of oral health provision.

“Volunteers Are Not Paid Because They Are Priceless”: Community Health Worker Capacities and Values in an AIDS Treatment Intervention in Urban Ethiopia
Kenneth Maes

This article analyzes community health workers’ (CHW) capacities for empathic service within an AIDS treatment program in Addis Ababa. I show how CHWs’ capacities to build relationships with stigmatized people, reconcile family disputes, and confront death draw on a constellation of values, desires, and emotions encouraged by CHWs’ families and religious teachings. I then examine the ways in which the capacities of CHWs were valued by the institutions that deployed them. NGO and government officials recognized that empathic care was crucial to both saving and improving the quality of people’s lives. These institutional actors also defended a policy of not financially remunerating CHWs, partly by constructing their capacities as so valuable that they become “priceless” and therefore only remunerable with immaterial satisfaction. Positive change within CHW programs requires ethnographic analysis of how CHWs exercise capacities for empathic care as well as consideration of how global health institutions value these capacities.

Correctional Officers and the Incarcerated Mentally Ill: Responses to Psychiatric Illness in Prison
Joseph D. Galanek

Based on ethnographic fieldwork in a U.S. men’s prison, I investigate how this social and cultural context structures relations between correctional officers and inmates with severe mental illness. Utilizing interpretivist perspectives, I explore how these relations are structured by trust, respect, and meanings associated with mental illness. Officers’ discretionary responses to mentally ill inmates included observations to ensure psychiatric stability and flexibility in rule enforcement and were embedded within their role to ensure staff and inmate safety. Officers identified housing, employment, and social support as important for inmates’ psychiatric stability as medications. Inmates identified officers’ observation and responsiveness to help seeking as assisting in institutional functioning. These findings demonstrate that this prison’s structures and values enable officers’ discretion with mentally ill inmates, rather than solely fostering custodial responses to these inmates’ behaviors. These officers’ responses to inmates with mental illness concurrently support custodial control and the prison’s order.

Social Science & Medicine

Juggling efficiency. An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings
Rikke Sand Andersen and Peter Vedsted

This article explores the mutually constituting relationship between healthcare seeking practices and the socio-political context of clinical encounters. On the basis of ethnographic fieldwork carried out in the context of Danish primary care (general practice) and inspired by recent writings on institutional logics, we illustrate how a logic of efficiency organise and give shape to healthcare seeking practices as they manifest in local clinical settings. Overall, patient concerns are reconfigured to fit the local clinical setting and healthcare professionals and patients are required to juggle efficiency in order to deal with uncertainties and meet more complex or unpredictable needs. Lastly, building on the empirical case of cancer diagnostics, we discuss the implications of the pervasiveness of the logic of efficiency in the clinical setting and argue that provision of medical care in today’s primary care settings requires careful balancing of increasing demands of efficiency, greater complexity of biomedical knowledge and consideration for individual patient needs.

International clinical trials, cardiovascular disease and treatment options in the Russian Federation: Research and treatment in practice
Olga Zvonareva, Nora Engel, Sergey Martsevich, Guido de Wert, and Klasien Horstman

The issue of balance between research and treatment in clinical trials conduct has been surrounded by controversies. Scientific characteristics of trials may compromise medical care available to participants, while conceiving research participation as having therapeutic value may foster the therapeutic misconception. However, it has also been questioned whether research can and should always be separated from medical care provision. In this paper we analyze how these concerns played out in practice settings of the three trial sites in Russia, specialized in trials in cardiovascular diseases. Using in-depth interviews with participants of phase II and III trials (n = 21) and discussions with physician-investigators (n = 7), we found that trial enrollment allowed participants to establish continuous supportive relationships with the physician-investigators. In the context of unresponsive health care, chronically ill participants received regular monitoring, treatment recommendations and help in case of problems and emergencies through such relationships. The trial designs in the three sites did not preclude the provision of individualized treatment. We suggest that debates about the research/treatment interface in trials need to become more attuned to the conditions in locations of their conduct, views and experiences of actors involved and evolving trial methodologies. Too much focus on categorical differentiation of research and treatment may obscure the fact that globalizing clinical trials proceed amidst profound health disparities, dismiss diverse concerns of people on the ground and risk attenuating responsibilities of trial organizers, sponsors and investigators towards research participants.

Therapeutic landscapes and living with breast cancer: The lived experiences of Thai women
Pranee Liamputtong and Dusanee Suwankhong

Breast cancer is an “emotionally debilitating disease” that affects the lives of women of all ages. In this paper, we discuss the lived experience of breast cancer among women in southern Thailand and situate our discussions within the concept of therapeutic landscapes. We adopted a feminist framework as our research methodology and employed qualitative and innovative methods. The therapeutic landscapes of healing involved multiple levels of landscape changes including body, home, neighbourhood, health care and cultural contexts. Our findings offer a particular insight into the role of emotions, cultural beliefs, and practices in forming therapeutic landscapes among women living with breast cancer in Thailand. It is crucial that health care providers understand the emotional experiences of women with breast cancer and their particular cultural needs for emotional healing landscapes. Our findings could be used as evidence for developing culturally appropriate therapeutic strategies and interventions for women with breast cancer in Thailand and elsewhere.

Precarious connections: Making therapeutic production happen for malaria and tuberculosis
Susan Craddock

The One Health Movement has been a primary advocate for collaboration across disciplinary and organizational sectors in the study of infectious diseases. There is potentially much to be gained by incorporating the interrelations of animal and human ecosystems, as well as the expertise of veterinary, medical, and public health practitioners. Too often, however, the idea rather than the realities of collaboration become valorized within One Health approaches. Paying little to no attention to the motivations, ontologies, and politics of collaborative arrangements, however, is a critical mistake, one that diminishes considerably One Health framework explanatory powers. Using Anna Tsing’s framework of friction, in this paper I take the examples of malaria and tuberculosis pharmaceuticals collaborations, often called Product Development Partnerships, to argue for the need to attend to the conditions under which collaborations across divergent disciplines, geographies, organizations, and institutions might work productively and when they do not.

 

Hallam Stevens’ Life Out of Sequence by Mads Solberg

4 Mars 2015 - 6:15pm

Life Out of Sequence: A Data-driven History of Bioinformatics

by Hallam Stevens

The University of Chicago Press, 2013. 294 pages.

 

Life Out of Sequence is a lucid ethnographic and historical account of how computational tools changed how biologists think about and engage with living systems. In it, Hallam Stevens tells a captivating story about how genes and genomes become meaningful through the emerging field of bioinformatics. It takes the reader through a series of “data-driven” studies of key actors and locations of a new material culture where data is at the centre. Unsatisfied with simple proclamations about the digitizations of life, Stevens carefully describes how the virtualization of nucleic acids has changed epistemic practices in biology.

 

Chapter 1 starts with the development of digital computers originally envisioned for military applications, which later came to be trusted for bio-scientific information management and analysis. In a recent interview Stevens observes that this historical backdrop complements Joseph November’s postwar account (Biomedical Computing, 2012) by continuing the story from the 1960s until the present day. Stevens argues that while initial attempts at computerizing biology failed (because they tried to shape computers to solve biological problems), biologists eventually came to pursue the kind of questions that computers were particularly good at solving. Through narrations of bioinformatic pioneers such as Margaret Dayhoff (a physical chemist and the ‘mother’ of bioinformatics), Walter Goad (a postwar physicist who introduced computing into biology and helped found GenBank), and James Ostell (an early innovator of nucleic acid analysis software), we learn how these tools gradually become trusted, and eventually ubiquitous, in current biology. Stevens shows that despite the pressing data management problems posed by massively collaborative undertakings like the Human Genome Project, bioinformatics has an interesting historical trajectory independent of the HGP’s organizational demands. Importantly, the book shows how epistemic subjects in the life sciences have morphed from the stereotypical individual scientist-entrepreneur working in small laboratory teams into Big Science. In the latter form, production of biological knowledge is distributed very differently than in the former.

Chapter 2 describes how post-genomic biologists can do biology without interacting with wet biological material and what new divisions of labor result from this. In the epistemologically controversial terrain of data-driven or hypothesis-free biology, computers take on roles as “induction machines”—“wide instruments” that can tame massive amounts of digital data in order to reach novel insights[1]. Stevens describes how biologists come to trust what computers tell them and perceive themselves as “setting the data free to tell their own story” (p. 69). He also draws attention to ongoing debates on epistemic norms, the logic of scientific discovery, and the status of Popperian ideals about hypothetic-deductive methods in the age of big data.

According to Stevens, data is “constrained by the physical and virtual structures that create and store them” (p. 70). What consequences does this have? Chapter 3 show that new modes of producing biological knowledge entails alternative ways of organizing scientists and their workspaces. The chapter takes us into an ethnography of the Broad Institute of MIT/Harvard fame, where epistemic credit is differentially distributed between producers and consumers of biological data. In this new knowledge-economy, the consumption and analysis of data carry more prestige than its production; a division reflected in physical workspaces. New spaces for bioinformatic knowledge are arranged so that laboratory work itself can be “managed as data”, implying a form of “quantification and control of space and work”. Large-scale sequence facilities leverage “lean production” principles from the Japanese auto-industry to manage contemporary genomics research, improve accuracy and become more efficient in the quest for more and better sequence-data. In these environments principles from operations management recombine with conventional modes of biological knowledge production. Economization and efficiency, as well as performance indicators and control through automation and barcode-tracking of biological samples and materials, all become integrated into laboratory environments. In these hybrid facilities, space and value take on new meaning as a novel kind of knowledge worker emerge. This epistemic subject is neither a Fordist automaton, nor a traditional lab bench scientist, but a “lean biologist”. Lean biology is central to commoditizing life in the biotech age.

Chapters 4, 5 and 6 follow biological objects as they transform from wet-materials into data via “pipelines”, get ordered in databases, classified and standardized in ontologies, networked, and finally visualized and analyzed on computer screens. We learn that biological databases, such as NCBI or Ensembl are not simply archives, but devices more “oriented to the future than the past” as they structure and constrain future biomedical knowledge-making (p. 138). Databases are structured and connected according to underlying theories about biological mechanisms and pathways. As objects of material culture the tools embody theoretical biology. The co-evolution of biological theories and bioinformatic systems are reflected in their parallel trajectories, from former assumptions about ‘one gene, one protein’ interactions, to the complexity of contemporary federated databases and current developments in ‘omics’[2].

Visualization and manipulation of data from databases through genome browsers such as NCBI and Ensembl are an integral part of bioinformatic work, and according to Stevens, the scientific visuals in computational biology act as theoretical models with distinct inferential properties. Doing bioinformatics is to a large extent practical problem-solving: how do you translate and manipulate biological objects into representations that can be used by biologists? Genomes in the wild are curled-up macromolecules with structural elements we cannot see, not even through powerful microscopes. Since we have no intuitive ontological understanding of genomes, Stevens argues that computational representations come to define what genomes are. The computational biologist does not interact directly with genomes, but computations. Translating between these entities becomes a question of representation and re-representation. Pictures have different semiotic properties than numbers, and biologists grapple with the constraints of these representations daily. On the question of how genomes become meaningful, Stevens’ account could have benefited from engagement with recent cognitive studies of the material and visual culture of science (see for instance Morana Alač’s Handling Digital Brains (2011)). From such a perspective, genomes, as meaningful visual representations of numerical data, are produced by large-scale distributed cognitive networks that enter into new, extended cognitive systems assembled on the spot by canny, embodied cognizers in front of computer screens.

In the conclusion, Stevens looks at how the Web’s future is closely linked to that of bioinformatics. Web 3.0 promises to systematically connect massive amounts of data by pulling heterogenous elements together in networked representations that not only humans, but also machines, can make meaning out of. Web 3.0 is also likely to become a “wet web, existing at the interface between the biological and digital” (p. 218). In ‘biology 3.0’, the boundaries between the biological and digital are erased, and bioinformatics will become biology as usual. The books ends by considering Homo statisticus, a new post-genomic vision of the human based on beliefs about the statistical properties of individual genomes and its entailments for our conception of the self.

Life Out of Sequence is not structured chronologically, but as a series of explicitly data-driven parallel accounts. This is a successful move. Theoretical elaborations are rather brief and succinct compared to the sometimes heavily theory-driven STS-literature. There are extensive footnotes. The result is well-written, clear prose of interdisciplinary relevance. As an anthropologist doing a cognitive ethnography in a community of marine biologists performing functional genomic studies of an economically important parasite for salmon aquaculture, my own observations suggests a less radical shift away from wet-work than Life Out of Sequence argues. Although my interlocutors use many of the tools described in the book, laboratory wet-work (and particularly stabilizing ‘wet’ experimental systems) is central to their ongoing activities. Nonetheless, for comparative studies of scientific meaning-making, this work offers a goldmine of insights into the distributed and situated nature of computational, material and cognitive practice in contemporary biology. Stevens’ account also offer exciting opportunities for comparative work on the semiotic properties of scientific visuals, and how these epistemic artifacts enter into the multimodal, distributed cognitive ecosystems of contemporary science. Highly recommended.

 

Mads Solberg is a doctoral fellow at the University of Bergen, Norway. He works on a cognitive ethnography of knowledge-making and technological innovation in marine sciencein particular, the development of novel solutions for managing sea lice, a persistent threat to salmon farming.

[1] In contrast to narrow instruments that make few measurements to test specific hypotheses, wide instruments in modern genomics can make hundreds of thousands of measurements.

[2] Omics is a suffix for approaches that aim to capture the entirety of interactions between genetic elements and their products, including epigenomics, proteomics, metabolomics. For a review of current developments and proliferations of ‘omics’ see the popular Nature piece Big biology: the ‘omes puzzle (2013).

Book Forum––Warwick Anderson and Ian R. Mackay’s “Intolerant Bodies” by Todd Meyers

2 Mars 2015 - 6:40pm

We are happy to present a book forum organized around the release of  Warwick Anderson and Ian R. Mackay‘s Intolerant Bodies: A Short History of Autoimmunity (Johns Hopkins University Press, 2014).  Here, a “short” history should not be mistaken for one that is “thin” – Anderson and Mackay masterfully navigate a terrain populated as much by bodies as ideas.  The writing is rich and detailed, a mix of intellectual genealogy and historical chronicle – the book is sure to serve as a resource for medical anthropologists, historians, and science studies scholars alike for years to come.  We hope you enjoy a lively set of commentaries and Warwick Anderson’s reply.

Comments on Warwick Anderson and Ian R. Mackay’s Intolerant Bodies: A Short History of Autoimmunity (Johns Hopkins University Press, 2014).

Bodies as Texts
Ilana Löwy

The Life of Biographical Disease
Nathaniel Comfort

Sick of Oneself
Angela Creager

Immunity as Information, or Why the Foreign Matters
A. David Napier

Response to comments:

Doing Biographical Work
Warwick Anderson

 

In the Journals — January, Part 2, and February 2015 by Aaron Seaman

28 février 2015 - 8:19pm

This month’s post is extra large, as it gathers the tail end of last month as well. Also, if you haven’t already, check out the special issues listed at the end of this post. Enjoy!

January 2015, Part 2  (You can find Part 1 here)

Medical Anthropology

Anthropologies In and Of Evidence Making In Global Health Research and Policy (Invited Editorial)
Christopher J. Colvin

Anthropologists are not generally known for being optimistic about the state and status of their discipline’s contribution to health research, policy, and practice. Contemporary debates around the forms and effects of knowledge production in health often focus—despairingly, and with good reason—on the continuing dominance of quantitative, narrowly defined biomedical ways of knowing, the rise of the clinical trial and its broader project of evidence-based medicine (EBM), and the conflicted nexus between science and ‘Big Pharma’s’ pursuit of new pharmaceutical knowledge, technologies, and profits (Goldacre 2013; Lambert, Gordon, and Bogdan-Lovis 2006; Mykhalovskiy and Weir 2004; Petryna 2009). Despite the long-standing efforts of advocates from anthropology, sociology, history, and other disciplines to promote the importance of ‘neglected’ forms of social and behavioral research in health—research often glossed as ‘qualitative research’—the picture that most often emerges of the health arena is of a terrain that consists almost entirely of lab experiments, computer modeling, and randomized controlled trials (RCTs). In the last few years, however, I have had the opportunity to be involved in two small, but potentially revealing developments in qualitative health research that might complicate this conventional narrative in useful ways. I describe these developments next and examine what they may signify for broader questions in medical anthropology about the current processes and politics of knowledge production in global health research and policymaking.

Justice at the Margins: Witches, Poisoners, and Social Accountability in Northern Uganda
Tim Allen and Kyla Reid

Recent responses to people alleged to be ‘witches’ or ‘poisoners’ among the Madi of northern Uganda are compared with those of the 1980s. The extreme violence of past incidents is set in the context of contemporary upheavals and, in effect, encouragement from Catholic and governmental attitudes and initiatives. Mob justice has subsequently become less common. From 2006, a democratic system for dealing with suspects was introduced, whereby those receiving the highest number of votes are expelled from the neighborhood or punished in other ways. These developments are assessed with reference to trends in supporting ‘traditional’ approaches to social accountability and social healing as alternatives to more conventional measures. Caution is required. Locally acceptable hybrid systems may emerge, but when things turn nasty, it is usually the weak and vulnerable that suffer.

Breaking Silences and Upholding Confidences: Responding to HIV in the Lihir Islands, Papua New Guinea
Susan R. Hemer 

Various forms of silence are understood to characterize the response to HIV/AIDS in the Lihir Islands in Papua New Guinea. While some efforts have been made to prevent HIV and educate residents, these seem not to have been in proportion to its classification as a high-risk setting for transmission, given social factors associated with the Lihir gold mine. Confidentiality is both practiced yet critiqued in Lihir as another form of silencing that detracts from efforts to emphasize the serious nature of HIV, promote its prevention, and care for those who live with it. ‘Breaking the silence’ has come to be seen as key to preventing HIV in Lihir, yet while certain silences are acknowledged, others have escaped scrutiny.

Securitarian Healing: Roma Mobility and Health Care in Rome
Lorenzo Alunni 

Over the last decade, Roma populations in Europe have been the object of strict securitarian policies. The Rome case is particularly interesting due to the continued shift from securitarian to humanitarian discourses and actions led by local institutions. The specific health care system implemented in the legal and illegal Roma camps was one of the tools used. The ethnographic fieldwork behind this article involved following the daily activities of a mobile medical unit dedicated to Roma camps in Rome and monitoring a health care project led by a nongovernmental organization. This analysis focuses on one particular dimension of precarious forms of Roma citizenship that the health care policies have developed to address Roma issues: the international mobility dynamics relating to health issues, which drive subjects into a forced integration of multiple, incomplete, and fragmentary medical approaches.

Narrating Narcolepsy—Centering a Side Effect
Britta Lundgren

The mass-vaccination with Pandemrix was the most important preventive measure in Sweden during the A(H1N1) influenza pandemic of 2009–2010, and covered 60% of the population. From 2010, an increased incidence of the neurological disease narcolepsy was reported, and an association with Pandemrix was affirmed for more than 200 children and young adults. The parental experience of this side effect provided a starting point for a collectively shaped critical narrative to be acted out in public, but also personalized narratives of continual learning about the disease and its consequences. This didactic functionality resulted in active meaning-making practices about how to handle the aftermath—using dark humor, cognitive tricks, and making themselves and their children’s bodies both objects and subjects of knowledge. Using material from interviews with parents, this mixing of knowledge work and political work, and the potential for reflective consciousness, is discussed.

Strawberry Fields as Extreme Environments: The Ecobiopolitics of Farmworker Health
Dvera I. Saxton

Based on nearly two years of ethnographic research with farmworkers in California’s Pájaro Valley, in this article I build on Olson’s idea of “extreme environments.” By merging theories of biopolitics and political ecology, or ecobiopolitics, I explore the naturalization of chemically intensive systems of agricultural production and the health consequences they produce for farmworkers. State and industry regimes of agricultural knowledge and practice are designed to control workers and the environment in strawberry fields. They also produce devastating syndemics and chronicities of disease in farmworker bodies and communities. The relationships between health disparities and farmworkers’ lifetimes of exposure to toxic pesticides remain underexplored and poorly understood, perpetuating toxic ignorance about the relationships between pesticides and farmworker health. This enables equating worker well-being with industry well-being. Synergies between ethnographic and environmental health research are needed to challenge toxic ignorance, toxic layering, and the invisible harms they produce in agricultural communities.

Science, Technology, & Human Values

The Pharmaceutical Commons: Sharing and Exclusion in Global Health Drug Development
Javier Lezaun and Catherine M. Montgomery 

In the last decade, the organization of pharmaceutical research on neglected tropical diseases has undergone transformative change. In a context of perceived “market failure,” the development of new medicines is increasingly handled by public-private partnerships. This shift toward hybrid organizational models depends on a particular form of exchange: the sharing of proprietary assets in general and of intellectual property rights in particular. This article explores the paradoxical role of private property in this new configuration of global health research and development. Rather than a tool to block potential competitors, proprietary assets function as a lever to attract others into risky collaborative ventures; instead of demarcating public and private domains, the sharing of property rights is used to increase the porosity of that boundary. This reimagination of the value of property is connected to the peculiar timescape of global health drug development, a promissory orientation to the future that takes its clearest form in the centrality of “virtual” business models and the proliferation of strategies of deferral. Drawing on the anthropological literature on inalienable possessions, we reconsider property’s traditional exclusionary role and discuss the possibility that the new pharmaceutical “commons” proclaimed by contemporary global health partnerships might be the precursor of future enclosures.

“What Is the FDA Going to Think?”: Negotiating Values through Reflective and Strategic Category Work in Microbiome Science
Katherine W. Darling, Angie M. Boyce, Mildred K. Cho, and Pamela L. Sankar 

The US National Institute of Health’s Human Microbiome Project aims to use genomic techniques to understand the microbial communities that live on the human body. The emergent field of microbiome science brought together diverse disciplinary perspectives and technologies, thus facilitating the negotiation of differing values. Here, we describe how values are conceptualized and negotiated within microbiome research. Analyzing discussions from a series of interdisciplinary workshops conducted with microbiome researchers, we argue that negotiations of epistemic, social, and institutional values were inextricable from the reflective and strategic category work (i.e., the work of anticipating and strategizing around divergent sets of institutional categories) that defined and organized the microbiome as an object of study and a potential future site of biomedical intervention. Negotiating the divergence or tension between emerging scientific and regulatory classifications also activated “values levers” and opened up reflective discussions of how classifications embody values and how these values might differ across domains. These data suggest that scholars at the intersections of science and technology studies, ethics, and policy could leverage such openings to identify and intervene in the ways that ethical/regulatory and scientific/technical practices are coproduced within unfolding research.

Sociology of Health & Illness

Becoming incapacitated? Long-term sickness benefit recipients and the construction of stigma and identity narratives
Kayleigh Garthwaite 

The transition to becoming ‘incapacitated’ and receiving sickness benefits represents a significant shift in an individual’s narrative. Drawing on in-depth interviews with 25 long-term sickness benefits recipients in North-East England, this article focuses upon how individuals perceived and managed becoming ‘incapacitated’, particularly in relation to stigma and identity. The findings show that participants negotiated changes to their identity in varying ways – constructing new dimensions of self, validating their illness and pursuing aspirations. Importantly, the transition onto sickness benefits does not inevitably result in a shift to a negative identity. The term incapacity can include many realities, challenging the notion of sickness benefit recipients as being passively dependent. Instead, an active, sometimes very functional sense of self can be accompanied by a positive identity for recipients, which is especially important, in a context of the rhetoric surrounding ongoing welfare reform and sickness benefits recipients in the UK.

Potential challenges facing distributed leadership in health care: evidence from the UK National Health Service
Graeme Martin, Nic Beech, Robert MacIntosh, and Stacey Bushfield 

The discourse of leaderism in health care has been a subject of much academic and practical debate. Recently, distributed leadership (DL) has been adopted as a key strand of policy in the UK National Health Service (NHS). However, there is some confusion over the meaning of DL and uncertainty over its application to clinical and non-clinical staff. This article examines the potential for DL in the NHS by drawing on qualitative data from three co-located health-care organisations that embraced DL as part of their organisational strategy. Recent theorising positions DL as a hybrid model combining focused and dispersed leadership; however, our data raise important challenges for policymakers and senior managers who are implementing such a leadership policy. We show that there are three distinct forms of disconnect and that these pose a significant problem for DL. However, we argue that instead of these disconnects posing a significant problem for the discourse of leaderism, they enable a fantasy of leadership that draws on and supports the discourse.

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams
Suzanne Grant, Adele Ring, Mark Gabbay, Bruce Guthrie, Gary McLean, Frances S. Mair, Graham Watt, David Heaney, and Catherine O’Donnell

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood’s four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol.

Understanding health through social practices: performance and materiality in everyday life
Cecily Jane Maller 

The importance of recognising structure and agency in health research to move beyond methodological individualism is well documented. To progress incorporating social theory into health, researchers have used Giddens’ and Bourdieu’s conceptualisations of social practice to understand relationships between agency, structure and health. However, social practice theories have more to offer than has currently been capitalised upon. This article delves into contemporary theories of social practice as used in consumption and sustainability research to provide an alternative, and more contextualised means, of understanding and explaining human action in relation to health and wellbeing. Two key observations are made. Firstly, the latest formulations of social practice theory distinguish moments of practice performance from practices as persistent entities across time and space, allowing empirical application to explain practice histories and future trajectories. Secondly, they emphasise the materiality of everyday life, foregrounding things, technologies and other non-humans that cannot be ignored in a technologically dependent social world. In concluding, I argue the value of using contemporary social practice theories in health research is that they reframe the way in which health outcomes can be understood and could inform more effective interventions that move beyond attitudes, behaviour and choices.

On interviewing people with pets: reflections from qualitative research on people with long-term conditions
Sara Ryan and Sue Ziebland

There is mounting evidence that pets are associated with physiological, psychological and social benefits for humans. Much of this research has come from western countries, where there have been consistent calls for greater engagement with pet ownership and health. Drawing on a secondary analysis of 61 in-depth interviews with people, or carers of people, with long-term conditions, we explore how pets feature in people’s narrative accounts of their experiences. Our findings demonstrate the multifaceted nature of people’s relationships with pets, and the embedded and embodied ways in which human–nonhuman interactions are played out in narratives of chronic illness. Our study differs from other work on pets and health in that, by returning to the interview video recordings, we were able to explore the sometimes three-way interactions, the co(a)gency, between participants, pets and researchers. Pets were often presented as important family members, yet the researchers’ responses to the presence or talk about pets was often markedly different from their reactions to other household members. We conclude with cautioning against the downgrading of pets in narrative health research. Narrative approaches may invite participants to talk about what is important to them, yet they clearly have limitations in practice.

Unstable terminality: negotiating the meaning of chronicity and terminality in motor neurone disease (open access)
Sverre Vigeland Lerum, Kari Nyheim Solbrække, Trygve Holmøy, and Jan C. Frich 

This paper explores the meaning of chronicity and terminality in motor neurone disease (MND), also known as amyotrophic lateral sclerosis (ALS). There is no known cause or cure for MND, and expected survival is 2–5 years, but several interventions may improve or prolong life. This study draws on qualitative interview data with health professionals in hospitals and primary care, and family carers, in Norway. The actors emphasised chronic and terminal aspects in subtly different ways along the entire illness trajectory, also when recounting the trajectory in retrospect. As a consequence of improved health services and medical technology the distinction between chronicity and terminality has become more vague and sometimes ambiguous. We suggest the concept unstable terminality to describe this ambiguity. While MND is a fatal diagnosis; it may be contested, as contingencies and interventions create an indefinite time scope. The instability creates challenges for primary care which is dependent on prognostic information to organise their effort; hospitals tackle the instability by pre-scheduled consultations allowing for avoidance of an explicit prognosis. Some carers experienced what we understand as a disruption within the disruption, living with chronic and terminal illness simultaneously, which made the limbo phase more challenging to overcome.

Male combat veterans’ narratives of PTSD, masculinity, and health
Nick Caddick, Brett Smith, and Cassandra Phoenix 

This article uniquely examines the ways a group of male combat veterans talk about masculinity and how, following post-traumatic stress disorder (PTSD), they performed masculinities in the context of a surfing group, and what effects this had upon their health and wellbeing. Participant observations and life history interviews were conducted with a group of combat veterans who belonged to a surfing charity for veterans experiencing PTSD. Data were rigorously explored via narrative analysis. Our findings revealed the ways in which veterans enacted masculinities in accordance with the values that were cultivated during military service. These masculine performances in the surfing group had important effects both on and for the veterans’ wellbeing. Significantly, the study highlights how masculine performances can be seen alternately as a danger and as a resource for health and wellbeing in relation to PTSD. The article advances knowledge on combat veterans and mental health with critical implications for the promotion of male veterans’ mental health. These include the original suggestion that health-promoting masculine performances might be recognised and supported in PTSD treatment settings. Rather than automatically viewing masculinity as problematic, this article moves the field forward by highlighting how hegemonic masculinities can be reconstructed in positive ways which might improve veterans’ health and wellbeing.

The business of care: the moral labour of care workers (open access)
Eleanor K. Johnson

Drawing on a case study conducted in a private residential care home, this article examines the emotional labour of care workers in relation to the moral construction of care and the practical experiences of work. An examination of the company’s discursive attempts to construct, manage and demarcate its employees’ emotional labour was carried out alongside an exploration of the carers’ own interpretations of, and enrolment in, the care-giving role. The potential economic and emotional consequences of these occurrences were a key focus of the inquiry. The study found that carers, encouraged by the company, naturalised their emotional labour, and that this had contradictory consequences. On the one hand it justified the economic devaluation of the carer’s work and left her vulnerable to emotional over-involvement and client aggression. On the other, it allowed the worker to defend the moral interests of those within her care and to see when those interests were in conflict with the economic motivations of her employer.

Stopped hearts, amputated toes and NASA: contemporary legends among healthy volunteers in US phase I clinical trials
Jill A. Fisher 

The first stage of testing new pharmaceuticals in humans is referred to as a phase I clinical trial. The purpose of these studies is to test the safety of the drugs and to establish appropriate doses that can later be given to patients. Most of these studies are conducted under controlled, in-patient conditions using healthy volunteers who are paid for their participation. To explore healthy volunteers’ experiences in clinical trials, an ethnographic study was conducted at six in-patient phase I clinics in the USA. In addition to the observation of clinic activities (from informed consent procedures to dosing to blood draws), 268 semi-structured interviews were conducted, 33 with clinic staff and 235 with healthy volunteers. Drawing on this dataset, this article explores healthy volunteers’ exchange of contemporary legends about phase I clinical trials. In addition to potentially scaring the listener and communicating distrust in the medical community, these incredible stories help participants cope with perceived stigma and establish a gradient of risk of trial participation, creating potential boundaries to their participation in medical research. The article argues that contemporary legends play a productive role in society, shaping how people view themselves and others and influencing their decisions about risky activities.

Patterns and causes of health inequalities in later life: a Bourdieusian approach
Pauline McGovern and James Y. Nazroo 

This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self-rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class-related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.

Technology and Culture

A Case in Pointe: Romance and Regimentation at the New York City Ballet
Whitney E. Laemmli 

This article analyzes the ballet dancer’s pointe shoe as a technology of artistic production and bodily discipline. Drawing on oral histories, memoirs, dance journals, advertisements, and other archival materials, it demonstrates that the shoe utilized by dancers at George Balanchine’s New York City Ballet was not the quintessentially Romantic entity it is so often presumed to be. Instead, it emerged from uniquely twentieth-century systems of labor and production, and it was used to alter dancers’ bodies and professional lives in particularly modern ways. The article explores not only the substance of these changes but also the ways in which Balanchine’s artistic oeuvre was inextricably intertwined with the material technologies he employed and, more broadly, how the history of technology and the history of dance can productively inform one another. Fundamentally, this article recasts Balanchine, seeing him not as a disconnected artist but as an eager participant in the twentieth-century national romance with American technology.

Theory, Culture and Society

Social Science and Neuroscience beyond Interdisciplinarity: Experimental Entanglements
Des Fitzgerald and Felicity Callard 

This article is an account of the dynamics of interaction across the social sciences and neurosciences. Against an arid rhetoric of ‘interdisciplinarity’, it calls for a more expansive imaginary of what experiment – as practice and ethos – might offer in this space. Arguing that opportunities for collaboration between social scientists and neuroscientists need to be taken seriously, the article situates itself against existing conceptualizations of these dynamics, grouping them under three rubrics: ‘critique’, ‘ebullience’ and ‘interaction’. Despite their differences, each insists on a distinction between sociocultural and neurobiological knowledge, or does not show how a more entangled field might be realized. The article links this absence to the ‘regime of the inter-’, an ethic of interdisciplinarity that guides interaction between disciplines on the understanding of their pre-existing separateness. The argument of the paper is thus twofold: (1) that, contra the ‘regime of the inter-’, it is no longer practicable to maintain a hygienic separation between sociocultural webs and neurobiological architecture; (2) that the cognitive neuroscientific experiment, as a space of epistemological and ontological excess, offers an opportunity to researchers, from all disciplines, to explore and register this realization.

Critical Neuroscience and Socially Extended Minds
Jan Slaby and Shaun Gallagher 

The concept of a socially extended mind suggests that our cognitive processes are extended not simply by the various tools and technologies we use, but by other minds in our intersubjective interactions and, more systematically, by institutions that, like tools and technologies, enable and sometimes constitute our cognitive processes. In this article we explore the potential of this concept to facilitate the development of a critical neuroscience. We explicate the concept of cognitive institution and suggest that science itself is a good example. Science, through various practices and rules, shapes our cognitive activity so as to constitute a certain type of knowledge, packaged with relevant skills and techniques. To develop this example, we focus on neuroscience, its cultural impact, and the various institutional entanglements that complicate its influence on reframing conceptions of self and subjectivity, and on defining what questions count as important and what kind of answers will be valued.

 

February 2015

American Ethnologist

Compassion technology: Life insurance and the remaking of kinship in Swaziland’s age of HIV
Casey Golomski 

An emergent life insurance market in Swaziland is prompting some families to remake kinship as the entrustment of a generation of deceased relatives’ children. Coincident with high HIV/AIDS mortality and changing economic policies for the financial services sector, Swaziland saw an influx of foreign insurance companies in the early 2000s. Those companies offered incentives like burial coverage and cash stipends, and they compelled families’ legal adoption of children as orphans through the state, an ambiguous contrast to customary child entrustment and caregiving practices. I offer ethnographic insight on financialization in the global South and conceptualize insurance as a biopolitical, moralized “compassion technology,” which enveloped persons’ financial-legal obligations within humanitarian and global health discourses of social regeneration.

Developmental diseases—an introduction to the neurological human (in motion)
Tobias Rees 

Plasticity has conceptually guided much research on the adult human brain since the late 1990s. The emergence of this idea has catapulted the neurosciences beyond the synaptic, chemical conception of the brain, its diseases, and its humans that dominated the second half of the 20th century. I explore the figure of what I call the “neurological human” to bring such mutations of the neuroscientific order of knowledge into a sharp analytical focus.

Cultural Anthropology (open access)

Wild Goose Chase: The Displacement of Influenza Research in the Fields of Poyang Lake, China
Lyle Fearnley

This article follows transnational avian influenza scientists as they move their experimental systems and research objects into what they refer to as the “epicenter” of flu pandemics, southern China. Based on the hypothesis that contact between wild and domestic bird species could produce new pandemic flu viruses, scientists set up a research program into the wild–domestic interface at China’s Poyang Lake. As influenza comes to be understood in terms of multispecies relations and ecologies in addition to the virus proper, the scientific knowledge of influenza is increasingly dependent on research conducted at particular sites, such as Poyang Lake. What does this movement of influenza research from laboratory to field mean for anthropological concepts of scientific knowledge? A widely shared premise among anthropologists is that scientific knowledge is made in experimental practice, but this practice turn in science studies draws largely from fieldwork inside laboratories. In this article, drawing on fieldwork with both influenza scientists and poultry breeders, I show how scientific research objects can be displaced by the practices of poultry breeders rather than by experimental practice itself. For these poultry breeders, refusing to respect the distinction of wild and domestic, were breeding wild birds.

The Thing in a Jar: Mushrooms and Ontological Speculations in Post-Yugoslavia
Larisa Jasarevic 

This essay thinks with things that ferment medical remedies in recycled jars and issue exuberant surpluses across kitchens in Bosnia and ex-Yugoslavia. While the jars are handled under the preferred sign of the mushroom and brewing recipes include instructions on non-commercial exchange, the nature of the things in the jar remains vague. Brewing in the kitchens and circling as gifts are buoyant life-forms that alter their hosts, inspire zones of unexpected connection and relational innovation, and direct home trials and ontological speculations around some burning, practical questions: How best to relate to the mushroom? With whom should one relate via the mushroom, and how? The texts explores the fungal materialities and pluripotencies with an ear for popular experiments, teasing out the banal as well as charmed interplay between imagination and association, knowledge and experience. I join the conversation on new materialisms and step into spaces of being and relating across formal differences, but do so in the idiom of kitchen fermentations rather than multispecies or multiethnic relations to attend to the kinds of things that act and inspire wonder outside ready-made rubrics and analytics.

From Anthropologist to Actant (and back to Anthropology): Position, Impasse, and Observation in Sociotechnical Collaboration
Anthony Stavrianakis 

Anthropologists are increasingly invited to participate in collaborations with natural scientists, among other experts, in their capacity as anthropologists. Such invitations give pause for thought about the character of the positions and practices that an anthropologist can occupy and perform. This article draws on participant observation in the Socio-Technical Integration Research (STIR) project, an endeavor based at Arizona State University, which aimed to modulate scientific practice. I observe and analyze the disquiet of participating social scientists by questioning the epistemic, ethical, and affective parameters of such modulation, in which social scientists were ultimately positioned and framed as actants—and not engaged as thinking subjects—for the reflexivity of natural scientists toward natural scientific work. I describe how such a method for increasing and extending the scope of scientific reflexivity was ultimately bound to the dominant instrumental norms and values of contemporary technoscience. The article suggests that reflection on problems of collaboration through questions of position and mode of engagement opens the scope and parameters for contemporary anthropological inquiry into anthropological collaborations within domains of science and technology.

 

Health and Place

The meaning of ‘place’ in families’ lived experiences of paediatric outpatient care in different settings: A descriptive phenomenological study
Gemma Heath, Sheila Greenfield, and Sabi Redwood 

Health service reforms in the United Kingdom have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible. Using phenomenological methods, this study examined the experience and impact of introducing new, community-based paediatric outpatient clinics from the perspective of NHS service-users. Findings reveal that paediatric outpatient ‘care closer to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld.

Re-thinking children׳s agency in extreme hardship: Zimbabwean children׳s draw-and-write about their HIV-affected peers
Catherine Campbell, Louise Andersen, Alice Mutsikiwa, Claudius Madanhire, Morten Skovdal, Constance Nyamukapa, and Simon Gregson 

We compare two analyses of the same ‘draw-and-write’ exercises in which 128 Zimbabwean children represented their HIV-affected peers. The first, informed by the ‘New Social Studies of Childhood’, easily identified examples of independent reflection and action by children. The second, informed by Sen׳s understandings of agency, drew attention to the negative consequences of many of the choices available to children, and the contextual limits on outcomes children themselves would value: the support of caring adults, adequate food, and opportunities to advance their health and safety. Conceptualisations of agency need to take greater account of children׳s own accounts of outcomes they value, rather than identifying agency in any form of independent reflection and action per se.

Conceptualizations of pluralistic medical fields: exploring the therapeutic landscapes of Nepal
Rikke Stamp Thorsen 

Using the concept of ‘therapeutic landscapes’ this study explores how people in Nepal conceptualize their health care opportunities and how health care seeking practices are interpreted and experienced differently among people in their everyday contexts. Relational therapeutic landscapes were experienced through notions related to time and place as treatments were positioned along spectrums ranging from home to city and past to present. Conceptualizations of treatments were influenced by accessibility, lack of knowledge and uncertainties related to getting diagnosis as well as structural constraints beyond the health care system.

“It is about being outside”: Canadian youth’s perspectives of good health and the environment
Roberta L. Woodgate and Olga Skarlato 

Drawing on qualitative data generated from an ethnographic study exploring Canadian youth’s understanding of health, this paper examines youth’s perspectives of the relationships between health and environment. Seventy-one youth (12 to 19 years of age) took part in individual and focus group interviews, as well as in photovoice interviews. Although initial discourse about health mainly focused on healthy eating and exercise, youth were more enthused and able to share their thoughts and feelings about the relationships between health and environment during the photovoice interviews. For these youth, good health was defined and visualized as “being outside” in a safe, clean, green, and livable space. Youth talked about conditions contributing to healthy environments and how healthy environments contributed to a strong sense of place. Overall, the conversations about the environment evoked many feelings in the youth. Results are discussed in the context of current research and in relation to youth, but also more broadly in relation to research on health and environment.

Putting the party down on paper: A novel method for mapping youth drug use in private settings
Signe Ravn and Cameron Duff 

This article proposes a novel method for generating context-rich knowledge about ‘hard-to-access’ places. We ground our discussion in a recent qualitative study of social settings of youth drug use in Denmark. The study confirmed that private house parties are common sites of youth drug use, although these parties presented limited opportunities for fieldwork. In response, a ‘map-task’ was introduced to the study to complement fieldwork and interviews. We assess the most significant methodological and epistemological features of this map-task, and explore how it may to used to conduct observations ‘from a distance’ in hard-to-access places. Further, we argue that the map-task has a number of analytical and logistical advantages for scholars interested in the health and social aspects of ‘hidden’ phenomena, such as youth drug use.

Dreaming of toilets: Using photovoice to explore knowledge, attitudes and practices around water–health linkages in rural Kenya
Elijah Bisung, Susan J. Elliott, Bernard Abudho, Corinne J. Schuster-Wallace, and Diana M. Karanja 

As part of a knowledge, attitudes, practices and empowerment (KAPE) project implemented by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) in the Lake Victoria Basin, this paper reports findings from a photovoice study with women in Usoma, a lakeshore community in Western Kenya. Drawing on ecosocial and political ecology theory, findings reveal that access to water, perceptions and practices were shaped by ecological and broader structural factors. Further, collective actions to improve access were constrained by institutional and economic structures, thus (re)enforcing inequalities.

 

Philosophy, Ethics, and Humanities in Medicine (open access)

Luria revisited: cognitive research in schizophrenia, past implications and future challenges
Yuliya Zaytseva, Raymond CK Chan, Ernst Pöppel, and Andreas Heinz 

Contemporary psychiatry is becoming more biologically oriented in the attempt to elicit a biological rationale of mental diseases. Although mental disorders comprise mostly functional abnormalities, there is a substantial overlap between neurology and psychiatry in addressing cognitive disturbances. In schizophrenia, the presence of cognitive impairment prior to the onset of psychosis and early after its manifestation suggests that some neurocognitive abnormalities precede the onset of psychosis and may represent a trait marker. These cognitive alterations may arise from functional disconnectivity, as no significant brain damage has been found. In this review we aim to revise A.R. Luria’s systematic approach used in the neuropsychological evaluation of cognitive functions, which was primarily applied in patients with neurological disorders and in the cognitive evaluation in schizophrenia and other related disorders. As proposed by Luria, cognitive processes, associated with higher cortical functions, may represent functional systems that are not localized in narrow, circumscribed areas of the brain, but occur among groups of concertedly working brain structures, each of which makes its own particular contribution to the organization of the functional system. Current developments in neuroscience provide evidence of functional connectivity in the brain. Therefore, Luria’s approach may serve as a frame of reference for the analysis and interpretation of cognitive functions in general and their abnormalities in schizophrenia in particular. Having said that, modern technology, as well as experimental evidence, may help us to understand the brain better and lead us towards creating a new classification of cognitive functions. In schizophrenia research, multidisciplinary approaches must be utilized to address specific cognitive alterations. The relationships among the components of cognitive functions derived from the functional connectivity of the brain may provide an insight into cognitive machinery.

Erasing traumatic memories: when context and social interests can outweigh personal autonomy
Andrea Lavazza 

Neuroscientific research on the removal of unpleasant and traumatic memories is still at a very early stage, but is making rapid progress and has stirred a significant philosophical and neuroethical debate. Even if memory is considered to be a fundamental element of personal identity, in the context of memory-erasing the autonomy of decision-making seems prevailing. However, there seem to be situations where the overall context in which people might choose to intervene on their memories would lead to view those actions as counterproductive. In this article, I outline situations where the so-called composition effects can produce negative results for everyone involved, even if the individual decisions are not as such negative. In such situations medical treatments that usually everyone should be free to take, following the principle of autonomy, can make it so that the personal autonomy of the individuals in the group considered is damaged or even destroyed. In these specific cases, in which what is called the “conformity to context” prevails, the moral admissibility of procedures of memory-erasing is called into question and the principle of personal autonomy turns out to be subordinate to social interests benefitting every member of the group.

Social Science & Medicine

As always, Social Science & Medicine has more articles than we can cover here. However, three recent items of note are special issues or sections of issues in January and February:

Special issue section Transnational Healthcare: Cross-Border Perspectives; Edited by David Bell, Ruth Holliday, Meghann Ormond and Tomas Mainil

Special Issue: Social Networks, Health and Mental Health; Edited by Alexander C. Tsai and Andrew V. Papachristos

Special Issue: Educational Attainment and Adult Health: Contextualizing Causality; Edited by Jennifer Karas Montez and Esther M. Friedman

 

Social Studies of Science

Politicizing science: Conceptions of politics in science and technology studies
Mark B Brown

This essay examines five ideal–typical conceptions of politics in science and technology studies. Rather than evaluating these conceptions with reference to a single standard, the essay shows how different conceptions of politics serve distinct purposes: normative critique, two approaches to empirical description, and two views of democracy. I discuss each conception of politics with respect to how well it fulfills its apparent primary purpose, as well as its implications for the purpose of studying a key issue in contemporary democratic societies: the politicization of science. In this respect, the essay goes beyond classifying different conceptions of politics and also recommends the fifth conception as especially conducive to understanding and shaping the processes whereby science becomes a site or object of political activity. The essay also employs several analytical distinctions to help clarify the differences among conceptions of politics: between science as ‘political’ (adjective) and science as a site of ‘politics’ (noun), between spatial-conceptions and activity-conceptions of politics, between latent conflicts and actual conflicts, and between politics and power. The essay also makes the methodological argument that the politics of science and technology is best studied with concepts and methods that facilitate dialogue between actors and analysts. The main goal, however, is not to defend a particular view of politics, but to promote conversation on the conceptions of politics that animate research in social studies of science and technology.

Sustaining cyborgs: Sensing and tuning agencies of pacemakers and implantable cardioverter defibrillators
Nelly Oudshoorn

Recently there has been a renewed interest in cyborgs, and particularly in new and emerging fusions of humans and technologies related to the development of human enhancement technologies. These studies reflect a trend to follow new and emerging technologies. In this article, I argue that it is important to study ‘older’ and more familiar cyborgs as well. Studying ‘the old’ is important because it enables us to recognize hybrids’ embodied experiences. This article addresses two of these older hybrids: pacemakers and implantable cardioverter defibrillators inserted in the bodies of people suffering from heart-rhythm disturbances. My concern with hybrid bodies is that internal devices seem to present a complex and neglected case if we wish to understand human agency. Their ‘users’ seem to be passive because they cannot exert any direct control over the working of their devices. Technologies inside bodies challenge a longstanding tradition of theorizing human–technology relations only in terms of technologies external to the body. Cyborg theory is problematic as well because most studies tend to conceptualize the cyborg merely as a discursive entity and silence the voices of people living as cyborgs. Inspired by feminist research that foregrounds the materiality of the lived and intimate relations between bodies and technologies, I argue that creating these intimate relations requires patients’ active involvement in sustaining their hybrid bodies. Based on observations of these monitoring practices in a Dutch hospital and interviews with patients and technicians, the article shows that heart cyborgs are far from passive. On the contrary, their unique experience in sensing the entangled agencies of technologies and their own heart plays a crucial role in sustaining their hybrid bodies.

Trust in standards: Transitioning clinical exome sequencing from bench to bedside
Stefan Timmermans 

Clinical exome sequencing is a genetic technology making the transition from a laboratory research tool to a routine clinical technique used to diagnose patients. Standards help make this transition by offering authoritative shortcuts for time-intensive tasks, but each shortcut means that something is lost during abstraction. In clinical exome sequencing, reliance on standards may obscure the match between a patient’s phenotype and genotype. Based on three years of observations, I show how a clinical exome sequencing team decides when to trust standards and when to develop workarounds. I argue that the match between phenotype and genotype is circumscribed by the team’s reliance on specific standards and that trusting in standards means trusting in experts’ appropriate use of standards, generating a workflow of reflexive standardization.

 

Special Issues Previously Covered on Somatosphere

Medical Anthropology: Ethics, Epistemology, and Engagement: Encountering Values in Medical Anthropology

Culture, Medicine, and Psychiatry: The Practice of Constraint in Psychiatry: Emergent Forms of Care and Control

Medicine Anthropology Theory (MAT)Inaugural Issue

Web Roundup: Transportation Technologies and Futures by Lily Shapiro

28 février 2015 - 6:35pm

This month’s Web Roundup is about transportation—technologies, politics, and histories. Much of it has to do with driverless/autonomous cars, which have been in the news a lot this month.

Time has a piece on the technical details of how driverless cars work, and what hurdles need to be overcome before they do. The Atlantic’s CityLab has an interesting article on the project of “humanizing driverless cars,” which aims to address the fact that autonomous cars may have the technical ability to drive in such a way that makes human passengers uncomfortable. For instance, they did a test with a car passing through a narrow gate, something most drivers would slow considerably to do, but the autonomous car, judging the distance and clearance, went through at around 30 M.P.H., which rather terrified the human passengers. How do you make a driverless car that still drives like a human?

Daimler unveiled a demonstration of a driverless truck in Germany, which it hopes to be able to mass-produce by 2025, with the goal of reducing carbon emissions and road accidents.

Is your connected car spying on you? From the BBC. The BBC also has a longish review article on various forms of transportation technology, with varying degrees of futuristic-ness (jet packs to trains to autonomous cars).

In, To Make Roads Safe, Make Them Feel Dangerous, The Atlantic reviews research relating to what kinds of signs, cues, and road infrastructure makes people more or less cautious drivers, along with efforts in the U.S. and Europe to make roads “feel” more dangerous—narrower lanes, fewer traffic lights—which correlate with more cautious driving.

PBS Newshour interviewed Dr. Christopher Mason, a geneticist at Weill Cornell Medical College, who, along with his team collected swabs from the New York City subway and tested them for bacteria, in an effort to create, as Dr. Mason says, “the first city-scale genetic profile ever.” You can see the PathoMap here.

India has plans to revamp its railway system, which carries 13 million passengers daily, to the tune of £88 billion (USD 135 billion, INR 8.5 trillion). This announcement came just days before Prime Minister Narendra Modi is set to release his first, highly anticipated budget; said Modi: “The Indian railways is not only for going from one place to another, but it is a powerful tool for speeding up India’s economy.”

Spain’s Directorate General of Traffic has announced plans to institute a breathalyzer test for pedestrians, among other laws governing “dangerous walking” (though it remains unclear if the laws will be successfully passed). This article from The Guardian reviews the potentials, and potential perils of such laws, and details briefly the history of the invention of jaywalking.

Slate has a piece on discrimination and segregation (both historical and contemporary) in the US transportation system and policy.

Check out the project Back of the Bus: Mass Transit, Race, and Inequality, a radio documentary about racism, discrimination, and history in US transportation policy. You can also follow them on Twitter @TransportNation.

And finally, The Washington Post has a lovely long article called The myth of the American love affair with cars in which the writer traces how, when, why, and for whom cars became so ubiquitous in American cities, and wonders about our future—as companies like Google, Ford, Uber, Sony, and (now, reportedly) Apple race each other to come out with driverless cars safe for the road, are we losing the opportunity to consider whether that is the direction we want our transportation technology to move in? What kinds of city infrastructure will need to be built for these cars, at the expense of what kinds of other transportation futures?

 

In unrelated but interesting news…

Research at a Japanese bank showed that workers were more productive in inclement weather.

Alaya Dawn Johnson wrote a piece for NPR on black science fiction writers and writings, on the history and present of discrimination in the genre, and on slow change as more and more science fiction writers of color gain recognition for their work.

The Attorney General in New York ordered that major retailers Walmart, Walgreens, Target, and GNC remove herbal supplements from their shelves after testing revealed that four out of five supplements tested “did not contain any of the herbs listed on their labels.” Building on that, The Atlantic has an article on the history of nutritional supplements in America, including an interview with Catherine Price, author of Vitamania: Our Obsessive Quest for Nutritional Perfection, out this month from Penguin Press.

Bio-Ethnography: A Collaborative, Methodological Experiment in Mexico City by Elizabeth F.S. Roberts

26 février 2015 - 7:03pm

In 1993, a team of U.S.-based environmental health researchers partnered with public health officials in Mexico to form ELEMENT (Early Life Exposure in Mexico to Environmental Toxicants). The project aimed to study the effects of chemical exposures, particularly lead, on fetal and childhood growth and neurological development in what the United Nation then designated as the most polluted city on earth. Since then, ELEMENT project staff have collected samples of blood, urine, hair, toenails, breast milk, and teeth for ongoing molecular analysis from nearly 2000 participants, mostly working-class mother and child pairs recruited through Instituto Mexicano del Seguro Social (Seguro Social) clinics in Mexico City.

While pollution in Mexico City has lessened in recent decades through banning lead in gasoline and certain kinds of catalytic converters in cars, obesity rates have risen dramatically, resulting in Mexico being named the fattest industrial nation in 2013. The rise in obesity and diabetes has put increased pressure on Seguro Social. The system is notorious for its long waits, impersonal care, and lack of services. This complex set of circumstances creates relevant project conditions and a willing and compliant subject population for ELEMENT, as participants, through the project, receive kinds of personal attention unavailable through Seguro Social. Recently the project has expanded to collect data on additional toxins (e.g., bisphenol A, mercury, and fluoride) and new health concerns (e.g., premature sexual maturation and obesity) (Afeiche, et al. 2011).

Since the fall of 2012, I have been observing ELEMENT researchers at the University of Michigan in their laboratories and staff meetings, and in March 2013, I began conducting observations of interaction between project staff and project participants in Mexico City. Currently, I am engaged in a year-long ethnographic study of six ELEMENT participant families living in two geographically distinct, working-class neighborhoods, focusing on household and neighborhood environments and histories relevant to the production of bodily states.   Following this study, I will collaborate with ELEMENT researchers to combine biological and ethnographic data to produce more complex accounts of the links between ill health and life circumstances. In both these project phases, I am also investigating the scientific process itself: how participants’ lives are shaped by their involvement in ELEMENT research and how researchers make “universal” knowledge gleaned from monitoring specific participants’ bodies located in particular sites.

ELEMENT researchers have made several key “universalizable” findings about chemical exposures. One of ELEMENT’s early findings—that lead exposure has the greatest effect on the developing fetus in the first trimester of pregnancy—has influenced environmental and public health policy around the world. Like most molecular epidemiology studies, ELEMENT’s approach tends to situate key mechanisms for health and disease inside individual bodies rather than within specific historical and economic processes. Thus, lead levels measured in the blood of people in Mexico City in a particular neighborhood are assumed to mean the same as numerically identical levels measured in rural China. My project seeks to complicate this framework, drawing on work in both the biological and the social sciences that investigates the complex looping effects that organisms and environments have on each other (Hacking 1995). This scholarship, especially Margaret Lock’s framework of “local biologies,” challenges the assumption that biological processes are universal, that is, unaffected by circumstance or history (Lock and Nguyen 2010).

Research directions at the ELEMENT project support this looping approach. ELEMENT scientists have begun to employ epigenetic analysis in their examination of the health effects of chemical interactions in specific environments in Mexico City. Anthropology and STS have much to offer epigenetic researchers however, who tend to narrowly define what they call “social determinants” and continue to situate key disease-transmission mechanisms exclusively inside individual bodies rather than within larger histories (Lock 2013).  Already, in the United States, epigenetics seems poised to create new means to blame mothers, especially poor mothers, for the development of their children.

 

A Bio-Ethnographic Approach

Through my collaboration with ELEMENT scientists, I am attempting to develop something I call a bio-ethnographic approach, which integrates biological and ethnographic data about the larger histories and life circumstances that shape health. A bio-ethnographic approach might sound similar to what American biological anthropologists have formulated in recent decades as a “bio-cultural synthesis,” which explores the role of culture in shaping human biology and behavior, but there are important differences (Beall 2006; Hadley, et al. 2010). By maintaining culture as distinct from biology, bio-cultural synthesis remains asymmetrical. It leaves unexamined the historical and economic conditions that continuously shape biological processes and scientific study itself. By proposing a bio-ethnographic account, I am not simply adding culture to biology in order to arrive at a better understanding of human biological adaptation, but instead combining two different kinds of methodologies—ethnographic observation and biological sampling—in a synthetic, symmetrical analysis that understands environment-body interactions as always relational and constructed phenomena.

Developing a bio-ethnographic approach in a Latin American site also demonstrates how current North American biological models of the entanglement of environment and organism have some similarities to the long-standing Latin American emphasis on the reciprocal malleability of bodies and environments, often characterized by North American scholars as Lamarckian (Cadena 2000; Stepan 1991). Bringing this Latin American emphasis on malleability into critical conversation with STS literatures dislodges prevalent assumptions about the originality of current constructionist STS models of bodily plasticity and enables a close examination of the ways ELEMENT participants themselves model entanglements of ill health and life conditions.

I am also positioning bio-ethnography as a means to counter the resurgence of the “culture of poverty”. The concept arose in 1960s anthropology as a means to avoid deterministic racialized, biological explanations for ongoing poverty. Ultimately, though, it produced another form of determinism, attributing lack of economic advancement to the “cultural mentalities” of the poor. A key early text used, or misused, in the popularization of this concept was Oscar Lewis’s Five Families: Mexican Case Studies in the Culture of Poverty (Lewis 1975), which described one day in the life of five Mexican families in the 1950s, four of them in Mexico City. The uptake of this ethnographic account of poverty is instructive today, as some researchers in public policy, sociology, and epigenetics are newly attracted to the “culture of poverty” concept, remaining mostly uncritical of how the culture concept is once again separated from the material conditions and forms of dominance that produce inequality (Bourgois 2001; Small, et al. 2010).

In recent decades, anthropologists and sociologists have produced nuanced structural accounts of the conditions that perpetuate inequality, without rooting inequality in either the bodies or the mentalities of “the poor” (Bourgois 1995; Edin and Lein 1997; Katz 2013; Mullings and Wali 2001). Nonetheless, in their parsing of inequality, these studies leave physiological processes unexamined. This lacuna points to the need for the combination of biological and ethnographic findings—or bio-ethnographic research—to provide symmetrical accounts of life circumstances like poverty without deploying biology or culture as their locus.

 

Complex Conditioning Entanglements

When I first began to develop this project I imagined exposure as a crucial conceptual term for bio-ethnography. In the biological sciences, the term exposure tends to have a specific, and negative meaning, referring to contact with harmful phenomena, such as exposure to lead. Some social science research on environmental health science has adopted the concept of exposure as a means to bring together the study of health and of the environment, two realms that have long been examined separately (Brown, et al. 2011; Mitman, et al. 2004; Shostak 2013). However, in this context, exposure is somewhat taken for granted as an agreed-upon technical term transparently describing events that happen to bodies in environments, without an adequate history of the term.   As I am engaged in documenting how ELEMENT scientists, study participants, and, indeed, I myself deploy exposure, I have started to rethink its usefulness for this project. My idea had been to critically expand the concept, by examining exposure as a set of processes that include historical and political-economic dimensions. Making diverse processes equivalent however runs the danger of an “ontological flattening” (Landecker and Panofsky 2013, 341), which accepts and expands the standard model of exposure science where discrete bodies are exposed to foreign external substances. And in fact, this assumption is now undergoing profound change in many of the life sciences themselves, which posit complex conditioning entanglements that co-construct organisms and environment (Barker 1990; Bateson, et al. 2004; Jirtle and Skinner 2007; Suter, et al. 2010).   I wonder then, if exposure might be replaced by a term that signifies ongoing, complex, conditioning entanglements.

Three examples from my research in Mexico City demonstrate how a bio-ethnographic approach, including dynamics like kinship, history, gender, land politics, material culture, and class, might combine with biological data collected by ELEMENT to create a fuller account of the complex, conditioning entanglements that produce bodily states.

1) ELEMENT mothers have described to me how ELEMENT staff diagnosed their children with conditions, like ADHD, that would never have been diagnosed or treated through the Seguro Social system. For participants, who are mostly poor and working-class, being involved in ELEMENT provides forms of attention they do not receive through Seguro Social, such as being referred for specialized diagnostic tests and being chauffeured to and from ELEMENT appointments in a private car. Thus, this study population has a specific biology created in part by their participation in the study itself. Emergent models of organism-environment interaction suggest that these factors might in turn shape the data collected by ELEMENT.

2) While ELEMENT have focused on the detrimental effects of lead on fetuses and young children, some families continue to use lead-glazed ceramic dishes (trastos de barro) that were handed down and sometimes made by their grandmothers before they migrated from the countryside. Family members describe how these dishes are essential, at least on religious holidays, for honoring their grandmothers and as reminders of a different kind of life from their own in urban neighborhoods. Furthermore, they assert, along with many others in Mexico, that food cooked in leaded dishes tastes different, literally sweeter.  The use of these dishes could be seen as part of a larger rejection of the North American imperialism perceived in recent public health campaigns to discourage the use of leaded dishes. An example of this wider response is the rise of restaurants that specialize in cooking and serving food on leaded ceramic dishes. Their advertisements claim that leaded dishes make the food taste better and connect customers to a healthier, rural past.

3) Since this last fall I have been living and working in an extremely dense, hilly and geographically distinct working class neighborhood, I am calling “Moctezuma”, with one of the worst reputations in Mexico City. Along with spending time with three ELEMENT participant families, my co-researcher, Vanessa Cravioto, and I are also investigating Moctezuma’s specific history and environment.   One of the most striking aspects of our work so far has been the contrast between the external designation of Moctezuma as dangerous and our lived experience there. Moctezuma is often perceived as dysfunctional, unpoliced, over-crowded, filled with violence and drug use.   We however, have experienced it as a safe and unified neighborhood where people marginalized elsewhere, like drug users and people with disabilities, are integrated into daily life through their imbrication in families who have all known each other for sixty years.

It may be that the particular history and geography of Moctezuma has produced a kind of dense social safety net that needs to be accounted for in “health” analysis. Moctezuma is primarily made up of large, extended, stable households made possible through 1970’s land-titling programs. Additionally, Moctezuma is geographically bound, by a sewage-filled dam, recycling centers, cement factories, and a freeway. Although these boundaries could be understood as “exposures” that negatively affect health (which they undoubtedly do), they also contribute to a sense of neighborhood distinction making for an intensely relational environment where “knowing” each other provides intensive solidarity. Residential stability and geographical distinctiveness might be key to the complex conditioning entanglements that shape everyday life and health in Moctezuma.

While our ethnographic methods during this phase of data collection are standard (daily observation, life history interviews, participation in neighborhood events, and archival research), it is unknown what exactly our bio-ethnographic collaboration with ELEMENT researchers in the next phase of the project will look like. What methods and frameworks will allow us to combine biological data with ethnographic materials without privileging the biological data as more “real” than the ethnographic data? What might replacing an exposure model with a complex conditioning entanglement model, which takes into account factors such as household gendered economies, geography and kinship, contribute to understanding how, for instance, how diabetes is triggered in ELEMENT participants or how lead might affect various family members differently? And, by putting biological samples in conversation with participant’s life trajectories and environments, what might we learn that would not be possible through either ethnographic or environmental health methods alone? Your thoughts are welcome.

 

Elizabeth F.S. Roberts is an ethnographer of science, medicine and technology who teaches anthropology at the University of Michigan. Her comparative research on environmental health, epigenetics, assisted reproduction, reproductive governance and nature in Latin America and the United States, traces how bio-scientific practice shapes bodies and relatedness. She is the author of God’s Laboratory: Assisted Reproduction in the Andes (University of California Press, 2012).

 


References Cited

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Lock, Margaret 2013 The Epigenome and Nature/Nurture Reunification: A Challenge for Anthropology Medical Anthropology 32:291-308.

Lock, Margaret, and Vinh-Kim Nguyen 2010 An Anthropology of Biomedicine. Oxford: Wiley-Blackwell.

Mitman, Gregg, Michelle Murphy, and Christopher C. Sellers 2004 Landscapes of exposure : knowledge and illness in modern environments. Chicago: University of Chicago Press.

Mullings, Leith, and Alaka Wali 2001 Stress and resilience : the social context of reproduction in Central Harlem. New York: Kluwer Academic/Plenum Publishers.

Shostak, Sara 2013 Exposed science : genes, the environment, and the politics of population health. Berkeley, CA: University of California Press.

Small, Mario Luis, David J. Harding, and Michèle Lamont 2010 Reconsidering Culture and Poverty – Special Issue. The Annals of the American Academy of Political and Social Science 629(1).

Stepan, Nancy 1991 The Hour of Eugenics: Race, Gender, and Nation in Latin America. Ithaca, NY: Cornell University Press.

Suter, Melissa, Adi Abramovici, Lori Showalter, Min Hu, Cynthia Do Shope, Micheal Varner, and Kjersti Aagaard-Tillery 2010 In utero tobacco exposure epigenetically modifies placental CYP1A1 expression. Metabolism: Clinical and Experimental 59:1481-1490.

 

Michal Shapira’s The War Inside by Andrew Lea

20 février 2015 - 9:30am

The War Inside: Psychoanalysis, Total War, and the Making of the Democratic Self in Postwar Britain

by Michal Shapira

2013, Cambridge University Press, 284 pages

 

Between September 1940 and May 1941, the Luftwaffe dropped nearly 50,000 tons of bombs over Britain. In 1940, at the height of these air raids during World War II, the celebrated British poet Edith Sitwell wrote “Still Falls the Rain.” The poem, among Sitwell’s most widely recognized, carries the sorrow of the historical moment from which it emerged:

Still falls the Rain -

Dark as the world of man, black as our loss -

Blind as the nineteen hundred and forty nails

Upon the cross. (Sitwell 1985)

Sitwell’s poem stands as a testament to nothing if not the simple fact that the London Blitz drove the creative energies of innumerable poets, artists, and thinkers, from T.S. Elliot to Benjamin Britten. As Michal Shapira compellingly demonstrates in her new book The War Inside, the specter of conflict on British soil also had profound implications for the practical application and theoretical formulation of psychoanalysis as a burgeoning medical and philosophical enterprise.

At the broadest level, The War Inside illustrates “how ideas of childhood, family, and democratic selfhood changed in reaction to the Blitz, the evacuation process, and the experience of total war in Britain” (17). Psychoanalysis, Shapira argues, at once shaped and was shaped by the war and the emergence of the welfare state in Britain. Shapira traces this coevolution of psychoanalysis and ideas about childhood, anxiety, and democratic selfhood as it unravelled in a number of different contexts. Of particular interest to Shapira is the psychoanalytic proposition that the external realities of war were also experienced internally and psychologically by British citizens—a phenomenon Shapira calls “the war inside.”

In Chapter 1, Shapira demonstrates how a new social concept of anxiety related to warfare—one that encompassed the civilian population as much as it did military personnel—arose during World War II. Focusing on the British Psycho-Analytical Society (BPAS) and the work of Anna Freud, Chapter 2 links this reconceptualization of anxiety to the work of child psychoanalysts: because the war fractured families and separated many children from their parents, analysts reasoned that the surest avenue to a functioning democratic society involved the restoration of familial relationships and the quelling of internal anxieties. Where Chapter 2 outlines the clinical work of Anna Freud, Chapter 3 examines the psychoanalytic contributions of Melanie Klein, exploring the extent to which Klein placed further emphasis on the inner psychological conflicts precipitated by total war. Chapter 4 describes how psychoanalytic expertise was disseminated at the broad level of radio broadcasting rather than the narrow level of the individual clinic. While the bulk of Shapira’s book concentrates on the everyday problems of normal families and children, Chapters 5 and 6 instead focus on the Institute for the Scientific Treatment of Delinquency (ISTD), a dynamically-inclined organization that made important contributions to the field of criminology, in order to track the rise of the “therapeutic state” (196). Finally, in Chapter 7, Shapira uses John Bowlby’s pioneering work on the mother-child relationship at the Separation Research Unit as a window into the influence of psychoanalysis on social policy and hospital regulations.

As much as The War Inside deals nominally with “psychoanalysis,” Shapira is too careful a scholar to treat psychoanalysis as a unified and monolithic enterprise. Indeed, among the book’s most significant strengths is the way in which it not only isolates the various strains of psychoanalytic thought and practice, but also identifies the various points of disjuncture and continuity among these different strains. Shapira, for instance, brings nuance to a longstanding conversation in the history of psychoanalysis surrounding Anna Freud and Melanie Klein’s competing visions for psychoanalysis. Without trivializing the critical differences between Freud and Klein, Shapira astutely sheds light on the spaces of overlap and dialogue between these two schools of psychoanalytic thought: “A historical reading of these two women’s archival and published war work,” Shapira writes, “reveals that they were more similar than they first appeared. They both emphasized anxiety, aggression, and the fragility of selfhood, and the social as well as personal need to acknowledge and work through such emotions” (89).

Beyond clarifications of this nature, the book’s most substantial contributions hang loosely together into two categories: the book offers insights into both the conceptual reformulations of psychoanalysis during and after World War II and, more interestingly, the processes by which analysts integrated these new psychoanalytic concepts within the actual policies and practices of the British state. The key conceptual insights, which extend previous historical scholarship on psychoanalysis in its domestic and civil contexts, involve the ways in which British analysts shifted their focus from the externalities of conflict—the body counts, the evacuations, the incendiaries—to its internal manifestations. The conceptual establishment of a representational “war inside” that paralleled the tangible “war outside” designated the British citizenry, alongside the British military, a key site of therapeutic intervention. It was at these new sites—the minds, the homes, and the families of British citizens—that psychoanalysis sought to promote a harmonious and, above all, democratic society. Psychoanalysis helped in braiding together the personal and domestic lives of citizens and a broader democratic ideology.

These notions, however, did not merely exist in a psychoanalytic echo chamber. While developed through psychoanalysis, ideas about democratic selfhood and a “war inside” were enacted in various facets of British society. Shapira’s book, then, also unpacks the processes by which psychoanalytic concepts were transmuted into social realities: these ideas were broadcast by Donald Winnicott and the BBC, codified into legal systems and disciplinary policies through the work of the ISTD, and introduced into nurseries and treatment centers by individual analysts like Anna Freud.

In short, imaginatively conceived and sharply written, The War Inside sits at the interface of the private and the public, showing how among the most intimate spaces of human existence—the psychological self—dynamically interacted with spaces of broad social concern. Psychoanalysis, Shapira shows us, was a central catalyst of this interaction. Those interested in the history of psychoanalytic ideas—their formation, their dissemination, and their social implementation—will find much intellectual nourishment in this highly original book.

Andrew Lea is a graduate student in the History of Science, Medicine, and Technology at the University of Oxford.

 

Works Cited

Shapira, Michal. 2013. The War Inside: Psychoanalysis, Total War, and the Making of the Democratic Self in Postwar Britain. Cambridge: Cambridge University Press.

Sitwell, Edith. 1985. “Still Falls the Rain.” In Peter Levi (ed.), The Penguin Book of English Christian Verse. Harmondsworth: Penguin Press.

Medicine Anthropology Theory (MAT) — The Inaugural Issue by Aaron Seaman

17 février 2015 - 6:55pm

In one last “belated” post, the inaugural issue of the new online journal, Medicine Anthropology Theory (or MAT), went up in December! The issue can be found here. In addition to an essay by editors Eileen Moyer and Vinh-Kim Nguyen on the journal itself and how they envision it, there are research articles, think pieces, a photo essay, and several book and film reviews, all listed below. Enjoy!

Articles

Medicine Anthropology Theory: An open-access journal in the anthropology of health, illness, and medicine
Eileen Moyer and Vinh-Kim Nguyen 

The protected lab: Securitization and spaces of exclusion in medical research in East Africa
Denielle Elliott 

This visual essay considers the links between medical research and securitization, and asks how they reconfigure local landscapes in East Africa. Humanitarian aid, including global medicine, has emerged as a ‘military therapeutic complex’, especially in African nations where the HIV/AIDS epidemic has drawn enormous contributions from states and transnational NGOs (Nguyen 2009; Fassin and Pandolfi 2010). One unintended effect of this therapeutic assemblage is a concern with security, particularly for US state institutions conducting research or providing treatment. US research facilities and laboratories are fenced, with access mediated by security guards and locked gates. State actors working overseas live in approved housing, bound by a complex set of regulations about safety and security. This essay and photographs reflect the ways in which physical structures transform local landscapes as part of the global health industrial complex and raise a number of questions about the politics of spaces, both private and public, in humanitarian projects.

An embodied belonging: Amenorrhea and anorexic subjectivities
Karin Eli 

Until the publication of the DSM-V in 2013, amenorrhea was one of the four criteria that comprised anorexia nervosa. Diagnostically, amenorrhea played a definitional role, dividing the ‘strictly’ anorexic from their ‘subthreshold’, menstruating peers; however, the implications that menstrual cessation, and menstruation itself, held for the lived realities and identities of women with anorexia remain under-explored. In this article, I examine the positioning of menstruation and amenorrhea in the narratives of Israeli women diagnosed with eating disorders during the eras of the DSM-IV and DSM-IV-TR. I find that the participants’ narrative uses of amenorrhea mirrored, and at times explicitly engaged with, the official diagnosis of anorexia nervosa. Notably, although the participants invoked amenorrhea as a defining sign of illness, they did not cast menstruation as a sign of health rather, they spoke of their menstrual periods as contradicting their anorexic-identified selves. Amenorrhea, then, emerged as central in the embodied making of anorexic subjectivities.

Changing cartographies of health in a globalizing world
Ted Schrecker 

Anthropologists have described, often in eloquent detail, local destruction of opportunities to lead a healthy life (the social determinants of health) attendant on the macroscale economic processes conveniently described as ‘globalization’. Recent reorganizations of production and finance redraw maps both literal and metaphorical of the inequalities that affect health. I argue that it is essential to focus attention on the common origins of such local destructions in new modalities and power structures of global capitalism, and in doing so to focus on what William Robinson has described as a shift from ‘territorial’ to ‘social cartographies’. These include a number of cross-border ‘emerging markets’ or bidding wars that are relevant to health and its social determinants. The article sets out three propositions about how the social science of health disparities should respond to globalization, emphasizing possibilities for research on globalization and health that draw on the complementary perspectives of anthropology and political economy.

‘Making known’ or ‘counting our children’?: Constructing and caring for children in epidemic South Africa
Lindsey Reynolds 

The article explores how regimes of documentation, quantification, evidence, and accountability have come to shape encounters between program implementers, researchers, young people, and caregivers in one locality in northeastern KwaZulu-Natal, South Africa. Rather than simply critiquing the overemphasis on counting and accounting in global health, I examine the effects of these processes on the provision of services to young people and families. For those whose lives had been systematically excluded from view, processes of form filling could in fact be construed as services in themselves. Further, encounters structured around form filling could work to facilitate other modes of engagement, centered on the construction of forms of recognition, reciprocity, and obligation, and mediated by complex networks of patronage and dependence. Drawing on these findings, the article describes how local histories and contemporary life experiences can shape the ways in which technologies of global health are taken up, and their effects on everyday life.

Think Pieces

Medical stratification in Vietnam
Martha Lincoln

Market transition in Vietnam is known to have fueled health disparities, but racialized and nationality-linked aspects of the country’s medical stratification have received less attention, despite the growing presence of foreigners using the health system. Field experiences reveal the country’s increasing health and medical inequity – legible in the social, linguistic, economic, and physical distinctions between public health stations staffed by government employees and the private clinics serving mostly expatriates. Ethnographic interviews and experiences of receiving care in both public and private facilities inform my argument that the privatization of Vietnam’s health sector produces racialized, classed, and citizenship-linked forms of medical profit, privilege, segregation, and risk – trends visible both in recent debates over US health policy and recent episodes of pandemic disease outbreak.

How did we get here? ‘It does not require a big brain to understand.’: The ‘Greek Crisis’, care, and health care
Giorgos Kostakiotis and Deanna J. Trakas

The economic crisis in Greece, which officially showed itself in 2008, is blamed for a wide variety of negative changes in the country’s social, political, and moral fabric. Health care – and the deficits of a medical system already under stress even before the crisis – are particularly central in public complaint and political debate. Issues of community and family care have emerged with a strength that challenges the conventions of earlier generations. This essay shifts the gaze away from the well-documented indictments of the deficiencies of the Greek health care system to look at the ways in which families and communities are working to provide care within the changing landscape.

Heaviness, intensity, and intimacy: Dutch elder care in the context of retrenchment of the welfare state
Barbara Da Roit and Josien de Klerk

In the Netherlands the recent shift to a ‘participation society’ has led to a reconfiguration of health care arrangements for long-term care. The new long-term care act, scheduled to commence January 2015, forms the political realization of the participation society: people are expected to decrease their dependency on state provisions and instead become self-sufficient or dependent on family and community solidarity. In this Think Piece we argue that the implicit references of policy makers to pre-welfare state community solidarity and self-sufficiency do not adequately consider the historical and social embeddedness of care. Referring to Rose’s concept of ‘politics of conduct’ we argue that in framing care as a moral obligation, the current politics of conduct may obscure the physical and psychological heaviness of intimate care between family members, the diversity of care relations, and their sociohistorical embeddedness.

No smoking within nine metres of discipline limits
Simone Dennis

I seek to open the social practice of smoking to anthropological enquiry that has been largely caught up in the agenda of cessation – to the point that it is difficult to examine it outside this frame without being accused of advancing the interests of Big Tobacco. Analysis has also been foreclosed by adherence to frames that privilege rationality. Smoking behaviour becomes understandable and translatable via explanations of addiction or ignorance: it is rational for the addict to source her drug, and rational for the smoker ignorant of its harms to continue smoking. Equally, using a rational frame anthropologists might explain smoking practice in relation to pleasure – if they are not wedded to a cessation agenda – as maximising pleasure might also be rational, as might any practice if only one can understand the agent’s motivations. I argue for an anthropological analysis of smoking that permits more than translation.

When comparison comes first: Reflections on theory in medical anthropology
Alice Street

This think piece draws on experiences of fieldwork in a Papua New Guinean hospital to reflect on tensions between political engagement and ‘deep’ comparison in medical anthropology theory. The paper argues that, contrary to the assumptions implicit in recent critiques of ‘suffering slot’ anthropology, paying attention to the workings of power does not preclude ontological comparison. Through a comparison of the different kinds of visibility sought by patients and doctors in the public hospital, I argue that the question of power re-surfaces in relation to the mutually entangled infrastructures required to realise those different projects.

Photo Essay

Mapping senses of place in an urban drug scene
Danya Fast

This photo essay is a collaboration between myself and one of the young people with whom I conduct research in Vancouver, Canada. Jordan (a pseudonym) was eighteen years old when he hitchhiked from Toronto to Vancouver in 2002. Once there, he told me, his addiction to heroin ‘completely took over’, and he became entrenched in the cycles of drug use, crime, and destitution that ‘trapped’ him in Vancouver’s Downtown Eastside. He and I met in 2008, when he was twenty-four years old. He took these photographs approximately four years later.

Book and Film Reviews

Powerless science? Science and politics in a toxic world (Soraya Boudia and Nathalie Jas, 2014)
Reviewed by Janelle Lamoreaux

Abortion in Asia: Local dilemmas, global politics (Andrea Whittaker (ed.), 2013)
Reviewed by Erica van der Sijpt

Migranten in tijd en ruimte: Culturen van ouder worden [Migrants in time and space: Cultures of ageing] (Antoine Gailly, Redouane Ben Driss, Stefaan Plysier, and Lili Valcke, 2011)
Reviewed by Sjaak van der Geest

Child care in a globalizing world: Perspectives from Ghana (Christine Oppong, Delali M. Badasu, and Kari Waerness (eds.), 2012)
Reviewed by Cati Coe

Nieuw Leven: Geboorte in Fictie [New Life: Birth in Fiction] (Arko Oderwald, Koos Neuvel, Willem van Tilburg, and Ruth Bergmans (eds.), 2012)
Reviewed by Lianne Holten

Ik Gebaar, Ik Leef / I Sign, I Live (A film by Anja Hiddinga and Jascha Blume, 2012)
Reviewed by Annelies Kusters

Life in Crisis: The Ethical Journey of Doctors Without Borders (Peter Redfield, 2013)
Reviewed by Pride Linda

The Alzheimer Conundrum: Entanglements of Dementia and Aging (Margaret Lock, 2013)
Reviewed by Jolanda Lindenberg

Mestizo Genomics: Race Mixture, Nation, and Science in Latin America (Peter Wade, Carlos López Beltrán, Eduardo Restrepo, and Ricardo Ventura Santos, (eds.), 2014)
Reviewed by Abigail Nieves Delgado

The New Arab Man: Emergent Masculinities, Technologies, and Islam in the Middle East (Marcia C. Inhorn, 2012)
Reviewed by Fiona R. Parrott

Patients and Agents: Mental Illness, Modernity and Islam in Sylhet, Bangladesh (Alyson Callan, 2012)
Reviewed by Nasima Selim

“Body Leads”: Medicalizing Cultural Difference, or, what are we doing when we Say Putin Has Asperger’s Syndrome? by Cassandra Hartblay

17 février 2015 - 6:31pm

A recent USA Today article described a report from a Department of Defense think tank study that suggested that President of the Russian Federation Vladimir Putin has “neurological abnormalities” and, perhaps, an Autism Spectrum Disorder. The report, part of a project entitled “Body Leads,” which claims to use analysis of bodily behavior to suggest underlying neurological states, was originally written in 2008, and made public through a reporter’s Freedom of Information Act request. The report became the subject of the USA Today article, which, published at a moment when US-Russia diplomatic relations are at a low point over ongoing violence in Ukrainian territory, seemed pitched to create a sensationalist media frenzy.

Indeed, the original report, which became available through various blogs, is itself sensationalist, and, sensationally poorly crafted. The argument presented in the document is of such low quality it is somewhat befuddling that it has received any attention at all. Although the report was allegedly created under the auspices of a federal government funded think tank its authority is marred by rampant grammatical errors, sloppy organization, poor application of theoretical concepts, unprofessional combination of methods and research sources, and general confusion about key psychology concepts. Indeed, it would have hardly passed an upper level undergraduate course in psychology or global studies, let alone be accepted by any peer reviewed professional journal.

The poor quality of the report itself seems to be the original reason for the FOIA request: the DOD think tank that produced the report came under media scrutiny in 2014. An article in Politico and other commentaries have suggested that the small organization was an ineffectual ideological holdover from a previous era, citing the “Body Leads” report as evidence.

Yet, this original intention behind the media’s move to publicize the report has taken a backseat to popular response to the seemingly face value claim presented in the USA Today article title: that a US government agency said that Putin has Asperger’s. The response, in the days following the article’s publication came from two major constituencies: the Russian media, and the neurodiversity and autism advocacy communities. These constituencies insert this article into broader debates about, respectively, the trend in US media and defense discourse of demonizing Putin as a person and a leader, and the stigmatizing implication of using ASD diagnoses to characterize individuals as suspect, untrustworthy, and other, stigmatizing an already disadvantaged community.

To be clear, I don’t think the report itself does merit much attention; however, I am interested in the broader response to the document in the few days following the USA Today article. I find this convergence interesting, not only because I happen to be someone who studies disability and Russia, and disability in Russia, but because my attention to those subjects has led me to be curious about the ways in which disability stigma gets reproduced on a global scale.

Particularly, I’m interested in whether or if the two lines of reasoning entangled here – the stigmatization of a particular diagnostic category, and the racialization of a foreign leader – and the ways these ideas circulate in public debate, may have more in common than is immediately obvious. This critique of the popular response to the Body Leads report is related to an underlying anthropological objection to the content of the report itself: the medicalization of behavior that is better described as cultural difference. I argue that this episode offers a very specific type of pathologization, and propose that it may serve us well to have a specific name for this mode of applying stigma to both an individual and medicalized population.

The Russian media response

The Russian media have broadly, and I would say, quite correctly, described the report as “an attempt to demonize Putin” (gazeta.ru). US foreign policy and Area Studies communities of various political persuasions have overwhelmingly agreed. When Dmitry Peskov, Putin’s press secretary, was asked to comment by American media, he said, “This is stupidity, not deserving of commentary.”

And yet, naturally, the Russian media was quick to call on pundits and Russian autism experts to weigh in on and spin the story. The state-run online news source gazeta.ru cited Russian political pundit Aleksei Makarin’s assertion that “this line of garbage translates to the American public the idea that ‘the Russian president has such a problem that it is impossible or very difficult to come to an agreement with him, and this is not the result of geopolitics, but of psychology.'” In fact, I agree with this assessment.

If there was any doubt about the perception of autism in Russian society, the response to the accusation that Putin carries such a diagnosis has definitively and profoundly described a society that considers autism and ASD people not only deviant but downright dangerous. The gazeta.ru article cited a Russian psychologist’s characterization of ASD:

People with this syndrome are different in that they have a very low emotional intellect, that is, in the most obvious expression, low emotionality and sociality. Regular and totally ordinary things the rest of us don’t even pay attention to— rituals, cooperation with others, tenderness, and emotional expression—all of these work very poorly for them.

This explanation is given as a way of stating that obviously no individual with such characteristics could possibly have achieved a high level position in the Russian government, be charged with leading a country, or in general function as a social actor. That is, in the Russian media response, while Putin is defended, he is done so at the expense of the social personhood of anyone with an ASD diagnosis.

 

The ASD and Neurodiversity Response

As the Russian media response makes clear, the Body Leads report seems aimed only to insult and dehumanize Putin. Yet the unintentional discursive effect of the media coverage served— in both Russia and the US—to further stigmatize and pathologize people with ASD.

Russianist and ASD parent-advocate Eliot Borenstein put it,

It’s one thing to pathologize a world leader, and quite another to find one’s own medical, psychological, or social status invoked as a pathology. The implication is not only that Putin is difficult and deviant because of an alleged diagnosis, but that the diagnosis itself not only is, but must be seen as a stigma.

Elsewhere around the internet, neurodiversity and ASD advocates were dismayed and disturbed by the outright hateful and discriminatory attitudes toward people with ASD diagnoses that the story prompted in comment threads, Twitter feeds, and Facebook posts. Disability advocacy organizations were quick to post links and follow the story. In particular, the neurodiversity movement seeks to de-stigmatize ASD by reframing neurological difference not as pathological, but as a natural component of human diversity—variation, which, in given situations may offer a strength rather than a weakness. This high profile example of how psychological notions of abnormality and difference can be invoked to pathologize individuals and groups of people offered an example of precisely the types of discursive discussion that neurodiversity advocates argue can be demeaning to ASD diagnosed people. Akin to the ways in which the intellectual disability community, in recent years, has organized campaigns to urge fellow citizens to refrain from using the “R-Word” (retarded) as an insult, the Body Leads fiasco was a powerful reminder that to call someone autistic, remains, for many, a slur.

 

Pathologizing Discourse, Pathologizing Culture

For anthropologists, perhaps one of the most jarring elements of reading the Body Leads is the repeated use of cross-cultural misunderstandings and miscommunication as evidence of Putin’s alleged neurological abnormality.

In one glaring case, the Body Leads report draws on an interview published in a Time Magazine, which was billed as an introduction to Putin for the American readership. Taking the descriptions from the article as evidence, the Body Leads report states that

Putin’s neurological perception is challenged and autism experts say this can manifest in hypersensitvity, social shyness and behavioral withdrawal from stimulation. […] Here’s another description of the Russian President’s affect during the interaction [from a Time Magazine article]:

‘He is impatient to the point of rudeness with small talk’

‘Charm is not part of his presentation of self—he makes no effort to be ingratiating. One senses that he pays constant obeisance to a determined inner discipline.’

‘… he misread several of our attempts at playfulness.’

‘Putin himself is sardonic but humorless. In our hours together, he didn’t attempt a joke…’

Theoretically Putin’s brain behavior abnormalities affect his social engagement and defensive behaviors, including, sensing whether the environment is safe or, others trustworthy.

Before we can get to the deeper importance of the logic in this passage, I must first state that the passage muddles ASD diagnostic criteria with the theory of the polyvagal nervous system, mischaracterizes autistic or people with ASD as unable to trust others, and draws on descriptions of Putin in a popular journalism article in order to make a neurological diagnosis.

This last issue begins to get at the heart of the matter that I’d like to highlight. The journalist’s description of Putin that is excerpted here was intended to present Putin to American readers as a quintessentially Russian leader. It therefore intentionally presented several tropes of Russian-American cultural mismatch: that humor may be lost in translation, that Russian conversational style is often taken to be abrupt by Americans, and that Russians prefer silence to small talk or talking for the sake of talking, perceiving it to be an indication that someone is not taking a situation seriously, while Americans perceive small talk as an important social lubricant.

We could imagine the absurdity of a report from the Kremlin that stated, based on a journalistic description of the differences between American and Russian cultural behaviors, e.g. that Obama’s penchant for smiling broadly when greeting people at the commencement of serious proceedings is a sign of poor mental faculties, a failure to grasp the gravity of a situation, or that he is possibly drunk (as Russian cultural logics would read these behaviors). Of course, this is not “science” but it would be a reasonable interpretation for a Russian to make were someone to act like an American in a social setting.

The Body Leads report claims to interpret bodily movements and facial expressions as indicative of underlying neurological traits. Nowhere does the report recognize that bodily movements, embodied modes of communication, and habits like facial expressions and posture are shaped by culture and upbringing as well as by biology.

Anthropologists have long observed that how close people stand to one another when they talk, how they modulate the volume of their voice to convey importance, and what settings they consider appropriate for particular types of social interactions are culturally mediated. That is, they depend on one’s social class, one’s upbringing, the learned modes of social interactions and norms and expectations of one’s peers. What all world leaders must grapple with is the problem of establishing communication with their peers who have come from a background with wholly different of social norms of communication.

Taken at face value the Body Leads report suggests that it is permissible to ignore variable cultural norms when interpreting behavior, a proposition which most psychologists and certainly anthropologists, would reject. Moreover, the report suggests that cultural habits such as conversational style and bodily comportment can be used as evidence of inferiority.

In a section of the report, the author misrepresents an explanation of a neuroscience finding about brain function – called the polyvagal theory – to suggest that Putin operates with a “more primitive” section of his brain than other, or, normally developed humans. The report quotes research psychiatrist Dr. Stephen Porges, suggesting that “Putin is primarily perceiving and expressing himself from the earlier adaptive fight/flight or flee stages of behavior” (2008:5). It is probably the case that Dr. Porges was taken out of context [I was not successful in reaching him to comment]. His reference to “earlier adaptive stages” is a rhetorical shorthand for referencing particular neurological structures, or elements of the brain. He is attempting to make clear for other scientists which particular part of the brain he is referencing; a neuroscientist or psychologist, when they say ‘the reptilian brain,’ do not necessarily mean to imply that the functions of that neurological component are pathological, but rather that they are shared between a great many species, including reptiles, as well as mammals. But suggesting a fight or flight behavioral pattern does seem to suggest a lesser-evolved functional capacity than those who might make other, more socially adept, choices. And, this is precisely how the Body Leads report interprets this comment: that Putin’s autistic, reptilian, primitive, developmentally abnormal brain leads to pathological behavior.

 

Pathologizing Enemies

As many others have already pointed out, the report seems nearly solely intended to pathologize Putin’s behavior as a way of undermining his credibility as a leader. Strangely, when Body Leads does offer policy advice, it comes oddly close to recommending cultural sensitivity:

Those that work with him in Russia or, from abroad like US officials will likely benefit by offering him recommendations that proffer a set of tested data that result in one outcome and alternatively, another recommendation with facts that may produce a different outcome — in order to get his attention. Otherwise, unsubstantiated recommendations may be lost in his perceptual system that simply has trouble taking in information differently.[sic] (14)

In this iteration, difference and adaptability can only be conceptualized as an individual pathology. Body Leads ascribes that difference not to social class, or cultural norms, or expectations for diplomatic interaction, but to neurobiological elements of Putin the physical body, which is posited as outside of culture, or, which amounts to the same, as existing in an single cultural system of Euroamerican normative imagination.

As Borenstein observed,

This is far from the first time that Western elites have entertained themselves with long-distance diagnosis of Russian leaders.  If some scholars and pundits are to be believed, we can understand both Peter the Great and Lenin as victims of syphilis, and Ivan the Terrible as suffering from either encephalitis or mercury poisoning (somebody alert Jenny McCarthy!)  And don’t even get me started on Stalin.

Setting aside the neo-Cold War implications of a revived discourse of Putin-as-Enemy, which has emerged in full-force in recent years and especially since the Russian Annexation of Crimea in the spring of 2014, there is a particular tradition of Euroamerican enemy-making that seeks to vilify a foreigner or foreign leader by depicting him as subhuman. This tactic is at the core of how enemies are created aesthetically and discursively. Such a tack has been used historically against newly arrived immigrant classes in the United States, by the US hyper-conservatives against Barack Obama, and against foreign leaders in wartime. A recent Reddit thread responding to the Putin-ASD topic argues as much, noting that “psychology from a distance” becomes a means of casting a political-ideological slur.

To vilify a person or group by implying subhuman or “lesser-evolved” characteristics can be understood as a component of what critical race theorists call racialization. Racialization describes a tactic of characterizing that a group of people in terms of biological traits and ethnic identity, in such a way so as to assert that this group does not belong to some other social whole. A primary tactic of racialization is asserting the biological absurdity or inferiority of this now-defined group, serving to legitimize political dominance over it. The move to diagnosis Putin as psychologically abnormal in the Body Leads report seems to fit into this schema.

Medical anthropologists have long recognized a related process, medicalization. Medicalization occurs when experts redefine social or cultural characteristics into individual pathologies in need of medical control or management. From a critical perspective, medicalization describes instances in which that medicine and science become systems of social control or the implementation of power. Those whose bodies are the subject of medicalization are described as unruly or undisciplined, and in need of therapeutic intervention in order to assimilate them with — or keep them from disrupting — the normative social order.

What I think Putin’s alleged ASD suggests is that we need a new term, one that sits somewhere between racialization and medicalization. This term should describe a specific form of pathologization that has to do with the use of stigmatized disabilities to dehumanize the both the accused and those bearers of the stigmatized diagnosis. Like racialization, this posits an evolutionary telos or progress in which the accused is behind or deficient, and like medicalization, it uses medical authority to assert the right to speak about others’ bodies and behaviors. I want to suggest that we might call this mode of pathologization disorderization.

Like racialization, disorderization posits an evolutionary telos with respect to which the accused is behind or deficient. But while racialization is a process that applies to groups of people, like medicalization, disorderization locates deficiency in an individual body. Cultural behavior is at once biologized and treated as deviant. Disorderization is a mode of thinking that misconstrues social and cultural dynamics as rooted in individual, rather than racially shared, biological difference. This is a brand of pathologization that takes its cues from a sort of biological determinism in which the cultural disappears and all behaviors and habits are rooted in medically-defined bodily systems. By biological determinism, I mean a misapplication of what psychology as a discipline calls behaviorism; psychology’s focus on observable behaviors exhibited by an individual goes uncontextualized in terms of broader cultural norms and biology is always the underlying cause of all social behaviors. Where racialization pathologizes social groups or individuals within those groups by applying medical diagnostics to the group as a whole, and medicalization pathologizes individuals by ignoring social forces, disorderization pathologizes both the group – ASD individuals – and the implicated individual – Vladimir Putin.

A disorder implies both a medical condition of abnormality that is less-than or out-of-synch-with or fails-to-achieve some medically established normative baseline. As many in disability studies and anthropology have demonstrated, the medically normative body is a construct based on the abstractions of statistics and does not exist in reality. Disorder also implies chaos, or a failure to align with expectations and norms. Expectations and norms are always embedded in cultural systems. People whose behavior consciously or unconsciously defies cultural norms of order—whether because they have a different cultural background, because their bodies refuse to conform to biological standards, or because they have consciously chosen to defy norms—are often branded disorderly. In this sense, a mode of pathologizing called disorderization would describe all of these elements.

Some might argue that medicalization encompasses both disorderization and racialization; others will suggest that medicalization is always a component of racialization, and that there is nothing special about the Putin ASD scenario as an instance of racialization (except, perhaps, that Americans often don’t notice that they are racializing Russians, who are considered to be Caucasian). My point is that there is a certain pattern to pairing medicalized traits and racialized inferiority that has implications for both bearers of the medicalized trait, and for bearers of the group identity in question. It is this intersection that I am highlighting; we might consider disorderization, then, a specific form of both racialization and medicalization. A schoolyard bully calls another kid a queer or a retard; a plastic surgeon advertises eyelid surgery for Asian Americans; a college student remarks to her friend that she is “so ADHD right now.” The oppressive weight of these utterances is intentionally directed at one subject, and, as a side effect, contributes to the medical stigmatization of another. I find this pattern to be worthy of analysis in its own right; I would call it disorderization.

And that, I argue, is precisely what we are doing when we say that Vladimir Putin has Asperger’s Syndrome.

 

Cassandra Hartblay is a PhD candidate in Anthropology at the University of North Carolina at Chapel Hill. She will defend her dissertation, Inaccessible Accessibility: An Ethnography of Disability and Globalization in Contemporary Russia, in March 2015. Her work has received recognition and support from the National Science Foundation, the US Department of State Title XIII Program, the UNC-CH Program in Sexuality Studies, and the Society for Disability Studies. Her writing on disability studies and the former Soviet Union is published in Disability Studies Quarterly, The Journal of Social Policy Studies, and in the 2013 edited volume Learning to See Invisible Children: Inclusion of Children with Disabilities in Central Asia.

 

Sources:

“Kremlin Spokesman Says Putin Does Not Have Asperger’s.” 2015. Accessed February 9. http://www.usatoday.com/story/news/world/2015/02/06/kremlin-denies-putin-aspergers/22971029/.

“No, Putin Does Not Have Autism | The XX Committee.” 2015. Accessed February 13. http://20committee.com/2015/02/06/no-putin-does-not-have-autism/.

“Pentagon 2008 Study Claims Putin Has Asperger’s Syndrome.” 2015. Accessed February 9. http://www.usatoday.com/story/news/politics/2015/02/04/putin-aspergers-syndrome-study-pentagon/22855927/.

“The Pentagon’s Secret Putin Diagnosis – Elizabeth F. Ralph – POLITICO Magazine.” 2015. Accessed February 13. http://www.politico.com/magazine/story/2015/02/putin-autism-pentagon-114937.html#.VN1mWsZx_KB. “Secretive Pentagon Think Tank Knows No Bounds – Philip Ewing – POLITICO.com.” 2015. Accessed February 13. http://www.politico.com/story/2014/03/office-of-net-assessment-pentagon-104591.html.

“The Curious Incident of Putin’s ‘Asperger’s Syndrome’” Eliot Borenstein.” 2015. Accessed February 9. http://www.huffingtonpost.com/eliot-borenstein/the-curious-incident-of-putins-aspergers-syndrome_b_6625634.html.

“The Pentagon Released an Expert Report on Putin’s Health to USA Today.” In Russian.  2015. Accessed February 9. http://tvrain.ru/articles/pentagon_raskryl_dlja_usa_today_zakljuchenie_ekspertov_o_zdorove_putina-381605/.

“Peskov Called the American Media’s Claim About Putin’s Asperger’s Stupid” In Russian. 2015. Accessed February 9. http://www.gazeta.ru/politics/2015/02/05_a_6402005.shtml.

 

The Practice of Constraint in Psychiatry: Emergent Forms of Care and Control — A special issue of Culture, Medicine, and Psychiatry by Aaron Seaman

15 février 2015 - 4:48pm

I must apologize for the belated notice, but I want to draw attention to the December issue of Culture, Medicine, and Psychiatry, which is a special issue entitled “The Practice of Constraint in Psychiatry: Emergent Forms of Care and Control.” Of the issue and its five articles, the guest editors, Paul Brodwin and Livia Velpry, write of the issue in their introduction:

The work of psychiatry has always revolved around the twin imperatives of care and custody. In an older model of psychiatric power, confinement and coercion were accomplished through isolation from society. The asylum became the ultimate symbol of such power. It arose in the long historical process Foucault termed “the great confinement,” and it reached its ultimate expression in the “total institution” exposed by Goffman in the mid-20th Century. As the landscape of mental health shifted, anthropological attention turned away from the asylum to focus on other topics: psychiatry’s contribution to social control in the neo-liberal state, as practices of governmentality (Foucault 2012), new technologies of the self (Rose 1996) and pharmaceuticalization and the global health movement (Biehl and João 2011).

Constraint nevertheless remains a common practice even in our post-asylum era. This special section of Culture, Medicine, and Psychiatry examines contemporary tactics of psychiatric constraint through studies of mental health settings in the USA and France. The four papers connect abstract arguments about disorder, ethics, and subjectivity to the rough edge of practice, where the interests of clinicians and patients most sharply diverge. The mandate not only to treat people but also to control them has produced diverse practices of constraint and on-going struggles about their legitimacy. The authors here take up constraint as a therapeutic value, social logic, work routine, and a challenge to the moral self-regard of front-line clinicians.

The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry
Paul Brodwin 

This article investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people’s will. Ambivalence denotes both inward uncertainty and a collective process that emerges in the midst of everyday work. In their commentaries about ambivalence, providers struggle with the distance separating their preferred professional self-image as caring from the routine practices of constraint. A detailed case study, drawn from 2 years of qualitative research in a U.S. community psychiatry agency, traces providers’ response to the major tools of constraint common in such settings: outpatient commitment and collusion between the mental health and criminal justice systems. The case features a near-breakdown of clinical work caused by sharp disagreements over the ethical legitimacy of constraint. The ethnography depicts clinicians’ experience of ambivalence as the complex product of their professional socialization, their relationships with clients, and on-going workplace debates about allowable and forbidden uses of power. As people articulate their ethical sensibility toward constraint, they stumble over the enduring fault lines of community psychiatry, and they also develop an ethos of care tailored to the immediate circumstances, the implicit ideologies, and the broad social contexts of their work.

Confinement and Psychiatric Care: A Comparison Between High-Security Units for Prisoners and for Difficult Patients in France
Livia Velpry and Benoît Eyraud

This paper examines the uncertain meaning of confinement in psychiatric care practices. Investigating the recent expansion of high-security units in French public psychiatry, for patients with dangerous behavior (units for difficult patients) and for suffering prisoners (specially equipped hospital units), we aim to understand psychiatry’s use of confinement as part of its evolving mandate over suffering individuals with violent behavior. Although historically the epicenter of secure psychiatric care for dangerous individuals shifted from the asylum to the prison, a review of public reports and psychiatric literature demonstrates that psychiatrists’ attempt to reclaim confinement as part of therapeutic practice underpinned the recent development of new units. Institutional-level analysis emphasizes psychiatry’s enduring concern to subordinate social defense motives to a therapeutic rationale. Analyzing local professionals’ justifications for these units in two emblematic hospitals, the paradoxical effects of a security-driven policy arise: they allowed the units’ existence, yet prevented psychiatrists from defending a genuine therapeutic justification for confinement. Instead, professionals differentiate each unit’s respective mission, underlining the concern for access to care and human dignity or defending the need for protection and safety from potentially dangerous patients. This process reveals the difficulty of defining confinement practices as care when autonomy is a core social value.

Practicing and Resisting Constraint: Ethnography of “Counter Response” in American Adolescent Psychiatric Custody
Katherine Hejtmanek 

Based on extensive ethnographic research in psychiatric custody for adolescents, this article uses the creation of, implementation of, and resistance to a treatment model to reveal issues of constraint in American psychiatric treatment. The treatment model is called Counter Response. As a model Counter Response shifts the treatment focus in a total institution for mentally ill youth from the youth themselves to the staff response to the youth. This article uses Counter Response as a case study to illustrate the close ties between constraint and autonomy in psychiatry. It also shows how models like Counter Response reflect the power of unregulated treatment paradigms in American adolescent institutional psychiatric intervention. Finally, the article demonstrates that resistance to Counter Response reveals a tension American practitioners have with psychiatry’s constraining power.

Learning Constraint. Exploring Nurses’ Narratives of Psychiatric Work in the Early Years of French Community Psychiatry
Nicolas Henckes 

This article uses narrative analysis to understand how mental health professionals working in a pilot experiment in community psychiatry in France between 1960 and 1980 made sense of their work experiences. Based on a collection of essays written by these professionals as part of their training as well as on other archival materials, the article explores writing practices in post-war French psychiatry as ways of constructing and negotiating moral commitments to work. The first three sections of the article give some background on mental health nursing in France in the immediate post-war period. The subsequent three sections examine how the professionals elaborated on their experiences in their writings, focusing on three different levels: first, the narrative voice used in the essays; second, the learning processes described by trainees; and finally, the ways in which they negotiated discursively the requirement to do emotionally well at work.

Psychiatry with Teeth: Notes on Coercion and Control in France and the United States
Anne M. Lovell and Lorna A. Rhodes 

“Psychiatry with teeth”: with just three words, a head psychiatrist in Lyon, France, captures the confined spaces and internal discipline of a new type of intensive treatment center for “difficult patients” (Velpry and Eyraud 2014). His pithy phrase provides a vivid yet disconcerting image for the ‘rough edge’ of psychiatry where, as the editors of this issue of Culture, Medicine, and Psychiatry devoted to emergent forms of care and control remind us, constraint and coercion signal a fundamental division between patients and clinicians1 (Velpry and Brodwin 2014). …As the editors announce in their introduction, the twin imperatives of care and confinement, cure and custody, have always defined psychiatry. Why then focus particularly on France and the United States? And what, precisely, is emergent today?

Ethics, Epistemology, and Engagement: Encountering Values in Medical Anthropology — A special issue of Medical Anthropology by Aaron Seaman

13 février 2015 - 6:07pm

The first issue of Medical Anthropology in 2015 is a special issue, entitled “Ethics, Epistemology, and Engagement: Encountering Values in Medical Anthropology.” In their eponymous introduction to the issue, Hansjörg Dilger, Susann Huschke, and Dominik Mattes write:

The contributions of this special issue discuss moments of uncertainty and friction that researchers experience regarding the ethicality of their research. They render transparent how, as anthropologists, we sometimes feel overwhelmed, inadequate, and challenged to decide how to behave in moral and ethical ways, and may even doubt the value of conducting fieldwork on certain topics at all. Asking these questions—and not silencing them in scholarly discussions and texts in our desire ‘to make it all right’—is crucial for the discipline, though knowing that any possible answer will always be partial, subjective, and in need of continuous modification.

Information about the issue’s six articles follows below.

Anthropology, Ethical Dissonance, and the Construction of the Object
Sylvie Fainzang

In this article, I discuss certain questions relating to the ethical difficulties faced by anthropologists when dealing with two different social groups and when one group holds a position of dominance over the other. In the first example, I draw on my work on doctor-patient relationships in France; in the second, on a study on reproduction in immigrant African families from Mali and Senegal, living in polygynous households in France. I use these examples to explore questions of positionality, beneficence, and potential harm. I show the choices I made in order to construct an epistemologically ethical object.

Voice, Boundary Work, and Visibility in Research on Sex Work in Morocco
Anne Montgomery 

How might the ethnographer conduct research on health and suffering among populations who would rather remain hidden? Drawing on my research with female sex workers in southern Morocco, I suggest and demonstrate an approach that allows interlocutors’ discretionary practices to guide ethnographic inquiry. I show how boundary work—as a politics of visibility founded on practices of discretion, concealment, and distancing—emerged as central to my interlocutors’ livelihood strategies and their efforts to enact moral personhood, integrate themselves into networks of solidarity, and articulate social critiques. A methodological focus on discourses and practices of boundary drawing, I argue, was essential for conceptualizing and representing the suffering of the women with whom I worked. Using boundary work as a guide, the ethnographer does not give voice to suffering, but learns how suffering is already voiced as part of attempts to survive, aspire, and become.

Troubling Objectivity: The Promises and Pitfalls of Training Haitian Clinicians in Qualitative Research Methods
Pierre Minn

Building research capacity is a central component of many contemporary global health programs and partnerships. While medical anthropologists have been conducting qualitative research in resource-poor settings for decades, they are increasingly called on to train “local” clinicians, researchers, and students in qualitative research methods. In this article, I describe the process of teaching introductory courses in qualitative research methods to Haitian clinicians, hospital staff, and medical students, who rarely encounter qualitative research in their training or practice. These trainings allow participants to identify and begin to address challenges related to health services delivery, quality of care, and provider-patient relations. However, they also run the risk of perpetuating colonial legacies of objectification and reinforcing hierarchies of knowledge and knowledge production. As these trainings increase in number and scope, they offer the opportunity to reflect critically on new forms of transnational interventions that aim to reduce health disparities.

Giving Back: Activist Research with Undocumented Migrants in Berlin
Susann Huschke 

In this article, I draw on my doctoral field work in Berlin (2008–2010), on the illness experiences of undocumented Latin American labor migrants, and on my work as an activist for the Berlin-based nongovernmental organization Medibüro, an anti-racist migrant health organization. I highlight how my attempts to ‘give back,’ and the various forms of engagements and commitments that resulted from it, shaped my relationships with actors in the field, the data I gathered, and the analytical framework I employed. I offer solutions on how to address these (unintended) effects of activism, and highlight the unique potential of activist research in regard to the forms of data available to the researcher and in gaining and retaining field access. By probing into some of its concrete methodological and analytical implications, I explore how to do activist research.

The Emotional, Political, and Analytical Labor of Engaged Anthropology Amidst Violent Political Conflict
Rosa Cordillera Castillo 

Given the harsh realities that people live through in southern Philippines, where there is rife human rights violations and violent political conflict, it becomes difficult and arguably unethical for anthropologists to assume a position of neutrality. Following calls for engaged anthropology, I contend that engagement entails simultaneously an emotional, political, and analytical labor and troubles the separation of the self and other. I suggest that a way to labor through these challenges of researching suffering, and the reciprocal obligations this implicates, is to utilize feminist reflexivity and epistemic reflexivity. These necessitate an objectification of the self and one’s intellectual field to achieve an epistemological break that would lead to an understanding of the other and their realities.

Emotion Work, Ethnography, and Survival Strategies on the Streets of Yogyakarta
Thomas Stodulka

Anthropological research with street-related children, adolescents, and young adults raises epistemological, methodical, and ethical predicaments. In this article, I illustrate the advantages of an anthropology that acknowledges the ethnographer’s emotions as valuable data when conducting research with marginalized communities. By drawing on my own experiences when conducting long-term fieldwork, I argue that systematic self-reflexivity and an emotionally aware epistemology enhance both the anthropologist’s emotional literacy and his or her understanding of informants and interlocutors. The integration of the ethnographer’s emotions in the analysis and interpretation of ethnographic data can assist in formulating anthropological theory, challenging the limits of traditional empiricism, and raising emotions to a category of epistemic value.

Listening with Veena Das to Ordinary Ethics by Michael M. J. Fischer

12 février 2015 - 7:31pm

Affliction: Health, Disease, Poverty

by Veena Das

Fordham University Press, 2014. 255 pages

 

In Affliction: Health, Disease, Poverty  (Fordham 2014) we listen with Veena Das to ordinary ethics in challenged lives of poverty, illness, and family relations; and in three often conflicting registers of (a) advocacy, (b) moral engagement, and (c) acknowledgement of inherent uncertainties (in the very fabric of living these lives, including hers and ours). [1]

(1) Advocacy. Somewhere – in the vast practical and dramatic spaces – between the disconnects of global health models constructed with poor/flawed statistics and piecemeal moralistic nudging of behavioral economists relying on naïve individualistic psychological models rather than intimate knowledge of how lives are lived — somewhere in this vast multi-dimensional space of living lies the ethnographic task that for the last fourteen years Veena Das’ band of researchers has pursued in the hopes of producing anthropological evidence of another kind, “of the kind that could be used for serious advocacy on sanitation, health care, or everyday violence.”

Advocacy is troubled and troubling terrain. In cases of cancer clusters, citizens often were told that they were incompetent to distinguish coincidence and statistical significance, meaning, in environments of sequestered information, as are so many of our corporatized and legally defended environments from Bhopal to Woburn, Love Canal to Fukushima, in such environments citizen science had to learn to gather epidemiological knowledge that would stand up in court and survive cross-examination. In the case of U.S. Superfund legislation passed in 1980, citizen action panels were given money to hire independent experts. In the aftermath of Bhopal, Right to Know legislation was passed in the U.S., and later in India. In terrains of proprietary knowledge, government statistics not made public, and other forms of sequestering knowledge, especially in worlds of metrics and audits that stand in for, and constitute, legally defensible knowledge, experiential knowledge of the sort anthropological tools reveal often have a hard time.

There are at least two critical and effective tools however that anthropology wields: (a) exposing to the light the ways in which bureaucratized statistics and models lie, hide reality, are made up, or are tissues of unrealistic extrapolations. Veena treads carefully in this terrain, referring occasionally to celebrity projects like MIT’s Poverty Action Lab, proposing her own Standardized Patient methodology (to which I will return) as a way, a metric even: visits to 305 practitioners (926 visits), for three common diseases, presented by 22 simulated standardized patients; a weekly morbidity survey of 300 households (with 1,620 individuals participating. and a refusal rate of less than 1%), done weekly for 17-18 weeks, then monthly; detailed interviews with at least one and ideally all members of each household; a full day spent in each of 291 practitioners’ clinics. This was done not just to expose poor quality medicine, but also positively as a pedagogy (teaching how to articulate disease diagnostic symptoms in vernacularly recognized ways). (b) The second anthropological tool is powerfully staging the living realities of life. Anthropology often operates like the theater: putting characters and plots on stage that illustrate competing interests, affects, emotions, idioms, strategic ploys, conflicts, and temporary tragedies and resolutions.   Veena does this skillfully, and, as she warns, not for its sentimental persuasive value, not just cultivating unmediated sympathy or empathy – she repeats this several times – but in pursuit of calling the community, politicians, policy-makers, experts alike from everyday trance-like forgetfulness into awareness. The challenge she notes a number of times following Emmanuel Levinas, (or Stanley Cavell’s reading of Levinas), that the problem is rarely just attending to the face of the other, but in a world of competing obligations to the living, the dead and the dying, learning how to suffer separation from the other, limiting the desire for infinite responsibility, allowing a person, an attachment to life, space to breathe.   At times, as in the case of Bilu who blames himself for not being able to gather the resources for his brother’s kidney transplant in time, a possibility that would have suffocated his own life and that of his new son with debts and on-going demands for immuno-suppressants and other life supports, this is a story of individuation, but at other times it is a cycling through one’s contesting (almost Kantian) faculties of (i) the courtroom (the accusatory voices of obligations one is unable to fulfill); (ii) the artisanal workshop (the cultivation and care of the self in traditionally given virtues); and (iii) the laboratory (the experimental innovation of new plotlines for one’s own life and one’s consociates).   Here is Ordinary Ethics, but of the most profound sort, scenes of instruction that should make the distanced policy-maker see anew, differently, come out of the trance of rules, excuses, and impossibilites for helping those in need.

(2) Ethics. Among the virtues of India amidst the poverty, conflicts, and crowding is its vitality as a land of philosophy, not just in its ancient civilizational roots in conversation with the Greeks and Chinese, but in contemporary life, affording a diversity of “scenes” of profound “ordinary ethics” in engagements with illness, access, quality of care, the technological, and the psycho-spiritual webs of relational socialities. Das’ text is structured roughly like Wittgenstein’s Philosophical Investigations, moving through “scenes of instruction” are arranged in pairs and triads of increasing complexity, not unlike Laura Bohanan’s classic and ingeniously structured Return to Laughter.

The theaters of ordinary ethics are modern, contemporary productions, staged within the folds and social stressors of urban renewal-removal after communal riots, structural violence of rural-urban migrants living with low-income and education, unattended-to illnesses and family tensions, dispensaries that give out Tetracycline no matter what your illness because that’s all they have been supplied with this month. The theaters of ordinary ethics are both performative (acting out, fusing together visceral-emotional and cognitive-moral poles of understanding) and enchanted with modernity’s extravagant promises, for instance of commodities for which one only can manage the down-payment but then must sell or have repossessed; and of capacities for which one struggles, only to get beginners’ incomplete schooling. Sometimes these promises are fulfilled enough to keep hopes and fantasies alive. Sometimes they are fulfilled only enough to generate dreams, visions, ghosts, jinn, bhot and pretu, generated — as the double-binds of Bilu’s life dramatize — by what Veena calls “the pressure on thought.” These pressures on thought are “something other than rational argumentation, not simply emotion or empathy, but wakefulness,” a state Bilu reaches in terms of his duty to his son.

It is a beautiful case or scene of instruction, a case of choices between circles of obligation expanding infinitely in Bilu’s quest to make a kidney transplantation for his brother possible versus circles of obligation narrowed instead by saturating his immediate surroundings with care and love that make it livable. He is able to achieve this narrowed focus, only with great pain and continuing “post traumatic stress,” through the woman in white who comes in dreams or visions to call him first to his responsibility to care for his village (widening his circles of obligation), but then later (narrowing them) only to his new born son. She has granted his devotional prayers for a new son after the loss of an earlier one, but on condition of his absolute devotion to that gift. The pressures of interpreting visions, dread, panic, full of dilemmas of error, misinterpretations, false leads, satanic confusions, visions expressing dark drives – these all are part of the dramatic tension of the enchanted theaters of ordinary life, of the pressures of thought, the social stressors of impossible double-binds and obligations.

(3) Contradictions and Ambi-valences. Amidst the desire for “a theology of suffering,” with terms such as “soul”, and a troubling anti-consequentialist Bhagvad Gita maxim (“you have authority only over your action, never over the consequences”, which Veena reads in a comforting Levinasian mode of limiting infinite responsibilities, but which sounds uncomfortably close to the warrior Krishna’s self-justification in war or the urgency used in self-justification of humanitarian aid industries for pushing aside local capacity building), Veena’s text registers “emotional and intellectual frictions,” cycling through internal voices of the accusatory other, invocations of traditional virtues, and demands for innovation attuned to present needs. Irresolvabilities structure these scenes of ordinary ethics: (i) limiting the desire for infinite responsibility; (ii) finding quality care, not just access to care; (iii) acknowledging voices this side of mental illness (“My problem is not that I am ill”; “But Aunty, I was not the one who was ill.”) ‘Hard to tell what is Shaytanic confusion’ in worlds where things are not always as they seem (dunya nadeedani).

Indeed it is a truth of parables in many traditions (Fischer 1990:110; Jain parables; and Musa-Khizr stories in Islam) that things are not always as they seem. This is a truth, as well, of psychoanalysis and counseling, of medical practitioners who attend to the corporeal demands of hope and spiritual distress (Hyun 2013), of the unseen world in its many dimensions.

Veena deals with these in a series of “scenes of instruction” built around nine main figures. The opening two scenes are of failures of quality of care, each complicated by a structural aporia of imposed not knowing. The next three are further complicated by family dynamics. This is intensified in the sixth and seventh of classic family systems dynamics in which a child is designated to be the problematic figure of failure or distress, but of course without knowing if there is also a genetic or physiological cause. The last and most elaborate is of the play of forces – psychic, social, political, economic, seen and unseen causes and influences – that make interpretation dangerous, and like the philosophical pharmakon, potentially poisonous rather than healing.

The first scene of instruction is a story of a four year old child who died from a fall and head injury but was misdiagnosed in hospital with an X-ray, and only correctly diagnosed with a CT scan too late to do anything. A technician had told the parents a CT scan was needed, but the doctor in the first hospital responded to them, “are you the doctor or am I?” It is a story used first to draw attention to how the poor are treated in hospitals, but also then to raise the question about the different idioms in which husbands and wives express emotion after “cumulative adverse reproductive events (miscarriages, abortions, still births, child deaths).”

In the second story, Ballo, who complains of stomach ache, weakness, lack of appetite and a heart condition or perhaps tuberculosis (dil ke bimari, ya shayad TB), gets medicines intermittently whenever her son would go to the chemist and present old prescriptions for viral hepatitis, liver function, or TB. Bad enough the old prescriptions, the lack of contact with a doctor, the intermittency of taking courses of drugs; but underlying all, says Veena, was the demand of the sixty year old woman for more attention from her son and his wife. She would periodically return from town to visit her daughter’s village to display displeasure at her son.

The third scene of instruction becomes more complicated. Prakash is a periodically hallucination-suffering, shivering old man who refuses to wear even a newly purchased sweater because he can smell a Muslim in it. His hallucinations, for which he was hospitalized already once forty years ago, obsessively repeat an abduction by Allah, during the grip of which Prakash speaks in a high feminized voice, claiming love of Allah and fatal attraction for Islam, from which he is saved by Shiva. Like Shiva, he can become violent. Released from the hospital he lives with the widow of his younger brother and her now adult son. This arrangement is imposed upon the widow by her biradari (kin group) who insist she have a male guardian in the house, never mind mentally impaired. She manages him with lithium and sleeping pills. Life in this scene is complicated by family and hallucinations.

In a fourth scene of instruction, Meena dies of TB after having successfully completed several courses of TB-DOTS treatment, each time being declared cured. A relative gets her admitted to a hospital as a dependent, and another helps her get into a treatment center under a false name to avoid regulations against going to treatment clinics beyond one’s local zone. A physician told Veena, there was no point testing for multi-drug resistant TB since they could not treat that. Meena died after much seeking of care, leaving her family saddled with debts, and having negotiated much anxiety that her husband would leave her for a woman he was having an affair with. There was no way to know if she was repeatedly re-infected because of compromised immunity, environmental factors, concomitant HIV infection, or whether she was infected by an acquired or transmitted drug resistant strain. Meanwhile the records of each DOTS center classified her as cured case, and all together she counts in the official statistics as multiple cured cases.

The fifth scene of instruction involves children covering up for their patents. Meena’s son Mukesh, an 8-12 year old during the fieldwork, covers for the dysfunctional relation of his parents, his mother’s descent into illness, her fear of being sent away, and her refusal of her medications when angry with her husband. His story is paired with that of a young girl who tells the police that her mother’s death by kerosene was an accident, and is praised in the neighborhood for the “correct response”. Meena before her death tried to support Mukesh’s education, with the help also of Veena, but after Meena’s death the new stepmother, whom the father gives the first wife’s name, is not so supportive.   Still, when Veena meets Mukesh again a few years later, his smattering of English has gained him a job, a watch, and a practice of attending church, where he finds a sense of peace unlike, he says, the jostling in a Hindu temple).

A sixth scene of instruction is that a brother and sister with different life outcomes. Swapan [“Dream”], a twenty-year old migrant from Multan, a Dalit (or untouchable), who suffers an unsupportive family environment, in which his sister succeeds at education, while he fails. He is undermined by his mother and becomes designated as the problem child. He says to Veena, “My problem is not that I am mad. My problem is that no one takes interest in me.”   But while he has moments of lucidity like this, he also, less strong than his sister Vayda, really is driven to the verge of madness, having bouts of rage, acting out, defecating on the floor, beating his mother, and eventually after a stay in a psychiatric hospital, trying to master the world by memorizing the English dictionary, a key he thinks to power. Experiencing “illusory qualities of modernity” always out of reach, He stumbles through life “as if made into a ghost.” This scene of instruction, of a splitting of the mother into good and bad mothers sounds Kleinian or Bion(ian) or Kali-like, and offers a possible opening to building upon the psychoanalytic accounts of mental illness in South Asia pioneered by Gananath Obeysekere, Alex Roland, and others. Abandonment in these stories is not so much an act of the will resulting from choice, but rather an exhaustion of the will and the capacity to marshal yet more energy. Swapan’s mother says her son has remade his own mother into a demonic being who could wish death upon the son she had borne. Here actors are not transparent to themselves, and the pursuit of the moral within such scenes of trancelike everyday ordinary ethics is analogous to being called to awaken from forgetfulness.

Vidya [“Knowledge”], by contrast, is quite aware of her family systems role as the overly bright girl under such close supervision that, were she less strong, would make her ill like her brother Swapan. Subbornly insisting on studying against internal family pressures, she becomes withdrawn and is taken for psychiatric treatment. Vidya says to Veena, “But Aunty, I was not the one who was ill – it is my Father who needs treatment . . . my Father has created such a situation that every one was watching me all the.” And she succeeded, if not all the way to college, still to a clerical job and steady income.

The most elaborate scene of instruction is that of the Muslim healer, Hafiz Mian, with whom Veena shares her own dream of dread, of being on a train helping protect an Indian nationalist terrorist disguised as a Sikh who is being tracked down by British soldiers on the train. The psychological “I” of the dream is a young woman, who Veena says doesn’t really physically look like her, whose job it is to distract the soldiers. The dread would seem to be easily explained, to this observer, as a reflection of Veena’s work with Sikh and other victims of the riots after Indira Gandhi’s assassination, and her continued work in low-income neighborhoods suffering further structural violence. In her story, however, Veena claims to be “bewildered” by the dream. Hafiz Mian cautions her that she should not tell dreams to just anyone because they could have dangerous effects, transforming what is latent and hidden into manifest realit, and he significantly asks if in the dream she had seen the revolutionary or the British soldiers, and she realizes she had not. Dreams, he says, are only partly about images, what you see, but primarily about what you sense, dread in this case, and dream interpretation is always subject to misrecognition, and to be mislead by shaitan. The term shaitan, of course, has different registers. It too often is translated by what in Christian imagery is called Satan, a fallen angel and figure of intentional evil, like the Zoroastrian Ahriman. But shaitan is also used of mischievous little boys, a jokstering misdirection, not necessarily evil. In dream interpretation, therefore, it can be various forms of error, of misrecognition, of false cues or leads. And so, Veena’s anxiety about misrepresenting the vujud, the essence, the real truth, of the people she only comes to know partially through ethnographic fieldwork, is a burden that Hafiz Mian also lays out as the burden of a healer who is always dealing with the hidden, that shadows the manifest: the unspoken desires and motivations unknown even to the afflicted themselves.”

Conclusions. The anthropological advice/advocacy in theaters of ordinary ethics under conditions of contradiction and ambivalence are perhaps like risk scenarios used to prepare community workers and outside aid workers for many and often changing situations. But more powerfully, they also call for real investment in education and local economies, maybe even in local shrines where hope and spiritual distress are mediated, perhaps a Dalit Peace Corps with Fab Labs and entrepreneurial incubators, putting tools in community hands, for self-repair rather than for fantasies of being saved by knowing outsiders. It is a prescription for a “necessary theater” (I take the name from an important local theater group in Singapore) that no doubt will come with much pushback and conflict of interests invested in reserve labor pools, cheap wages, unorganized and sequestered knowledge. Veena Das’ book, Affliction: Health, Disease, Poverty provides an important, ethnographically powerful, laddering of scenes of instruction for us all.

 

Michael M.J. Fischer is Andrew W. Mellon Professor in the Humanities and Professor of Anthropology and Science and Technology Studies at MIT, and Lecturer in the Department of Global Health and Social Medicine at the Harvard Medical School.  He is a co-editor with Byron Good, Sarah Willen, and Mary-Jo DelVecchio Good of A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities (2010); and author of Anthropological Futures (2009), Emergent Forms of Life and the Anthropological Voice (2003); (with George Marcus) Anthropological as Cultural Critique (1986, 2nd ed 1999); Mute Dreams, Blind Owls, and Dispersed Knowledges: Persian Poesis in the Transnational Circuitry (2004); (with Mehdi Abedi) Debating Muslims: Cultural Dialogues between Tradition and Modernity (1990); and Iran: From Religious Dispute to Revolution (1980).  He is currently in Singapore doing fieldwork on Biopolis and the life sciences, the aging society, global university reform, and the arts.

References cited

Das, Veena. 2014. Affliction.   New York: Fordham University Press.

Das, Veena. 2013. “Ordinary Ethics.” in Didier Fassin, ed., A Companion to Moral Anthropology.   New York: Wiley-Blackwell.

Fischer, Michael M.J. 1990. Debating Muslims: Cultural Dialogues in Postmodernity and Tradition.   Madison: Univeristy of Wisconsin Press.

Hyun, Insoo. 2013. “Therapeutic Hope, Spiritual Distress, and the Problem of Stem Cell Tourism. Cell Stem Cell, 12 (May 2): 506-507.

[1] Orally presented at the American Anthropological Association meetings in Washington D.C., 4 December, 2014, as part of a panel, “Affliction: a discussion with Veena Das,” organized by Clara Han with Veena Das as respondant.

In the Journals January 2015 – Part I by Melanie Boeckmann

12 février 2015 - 7:05pm

Welcome to 2015 in reading! Below are interesting abstracts from current issues of medical anthropology journals.

Critical Public Health

The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns

Deborah Lupton

The developers of public health campaigns have often attempted to elicit disgust to persuade members of their target audiences to change their behaviour in the interests of their health. In this critical essay, I seek to problematise this taken-for-granted and unquestioned tactic. I assert that the pedagogy of disgust in public health campaigns has significant ethical, moral and political implications. In outlining my argument, the literature on the social, cultural and political elements of disgust is drawn upon. I also draw more specifically on scholarship demonstrating the ways in which disgust has operated in relation to health and medical issues to reinforce stigmatisation and discrimination against individuals and groups who are positioned as disgusting. It is concluded that advocates of using such tactics should be aware of the challenge they pose to human dignity and their perpetuation of the Self and Other binary opposition that reinforces negative attitudes towards already disadvantaged and marginalised individuals and social groups.

 

You can’t walk or bike yourself out of the health effects of poverty: active school transport, child obesity, and blind spots in the public health literature

Claudia Chaufan, Jarmin Yeh, Leslie Ross and Patrick Fox

Mainstream public health theories of obesity attribute current, unprecedented numbers of obese youth to changes in eating practices and levels of physical activity, in turn leading to greater energy consumption and lesser energy expenditure. While substantial research has examined energy consumption among school-age children, key modes of energy expenditure such as active school transport (AST) remain underexplored. Using AST data obtained from the California Safe Routes to Schools program and child health data from the California Physical Fitness Test, we examined the association between AST and child obesity among school-age children and disambiguated this relationship introducing the variable poverty. We found that greater AST correlated with higher rates of child obesity and higher rates of child poverty, which in turn correlated with worse child health and obesity rates. Our findings suggest that child poverty explains the positive relationship between AST and child obesity that has puzzled investigators. Our analysis also reveals recurring blind spots in the public health literature, which often acknowledges that poverty begets poor health yet calls for environmental changes while rarely calling for eliminating poverty, one critical social determinant of health, even as these determinants have become legitimate objects of scientific inquiry. We propose that while environmental changes may improve the health of the poor, the only effective way to improve child health and reduce child obesity is to eliminate or dramatically reduce child poverty, a sociopolitical issue. This study is part of a larger project evaluating socio-political determinants of child health.

 

‘It puts life in us and we feel big’: shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda

Eleanor Hutchinson, Clare Chandler, Siân Clarke, Sham Lal, Pascal Magnussen, Miriam Kayendeke, Christine Nabirye, James Kizito and Anthony Mbonye

This paper is an analysis of the social interaction between drug sellers, their clients and local health care workers within a medical trial that introduced rapid diagnostic tests for malaria into private sector drug shops in Mukono District, Uganda. It locates the introduction of a new technology to test blood and a system of referral within the context of local concerns about the choice and evaluation of treatment; and the socially legitimated statuses, roles and hierarchies within the local health care system. Based on the multi-layered interpretation of 21 focus group discussions, we describe three key aspects of the trial central to local interpretation: openly testing blood, supervisory visits to drug shops and a new referral form. Each had the potential to shift drug shop vendors from outsider to insider of the formal health service. The responses of the different groups of participants reflect their situation within the health care system. The clients and patients welcomed the local availability of new diagnostic technology and the apparent involvement of the government in securing good quality health services for them from providers with often uncertain credentials. The drug shop vendors welcomed the authorization to openly test blood, enabling the demonstration of a new skill and newfound legitimacy as a health worker rather than simple drug seller. Formal sector health workers were less enthusiastic about the trial, raising concerns about professional hierarchies and the maintenance of a boundary around the formal health service to ensure the exclusion of those they considered untrained, unprofessional and untrustworthy personnel.

 

Biopedagogy digitalized: ‘educational’ relations among participants on an online weight loss surgery forum

Matthew D. Ferrya and Centáe Richards

Foucault uses the term ‘biopower’ to describe the totalizing effects of regulation of life through the manipulation of political messages, such as those in the obesity debate. This paper attempts to uncover ways in which these flows are made manifest among members of a public online weight loss surgery (WLS) discussion forum. Drawing from Foucauldian scholarship, we spent two-and-a-half years conducting a critical discourse analysis of over 2000 conversational threads on one US-based public discussion forum devoted to providing a support community to those who were considering WLS. Our intent is to analyze how ‘truths’ about the surgery are constructed among and between the community participants at different stages of the surgery to identify how they engage with ideologies associated with contemporary obesity and healthism.

 

‘Sex’ – it’s not only women’s work: a case for refocusing on the functional role that sex plays in work for both women and men

Elanah Uretsky

Mention of the term sex work often invokes images of marginalized women at risk for HIV infection. Such images, however, are counterintuitive to the functional role intended by the movement that spawned use of the terms ‘sex work’ and ‘sex worker.’ This article looks at the sexual practices of men in urban China to argue for a return to a functional definition of ‘sex work’, which was originally meant to legitimize the role sex plays in work. The progenitors of this movement intended to use ‘sex work’ as a means to legitimize sex as an income-generating activity for women involved in prostitution. I show that sex can also serve a functional role in the work-related duties of men seeking economic and political success in contemporary urban China. Men in China utilize sex as one way for demonstrating the loyalty necessary to access state-owned and controlled resources in a market economy governed under a Leninist system. Overall, the article demonstrates that reclaiming perception of sex work as a functional rather than behavioral category can expand its use for preventing HIV among the broad subset of people who engage in sex as part of their work.

 

Leaving the stethoscope behind: public health doctors and identity work

Lee Thompson

Public health medicine is distinct in two ways from most other forms of medical specialisation; firstly, it is predominantly non-clinical and secondly, its concern is with populations, rather than the more common individual physician–patient encounter. In spite of recent attempts to ‘mainstream’ public health approaches into medical training and practice, it remains a relatively low prestige medical specialty. In the face of the centrality of all things clinical in medical training, the identity work needed to think beyond this and into population health approaches is significant. In the face of public health physicians’ subaltern position within medicine, this research investigates the identity work doctors did as they made the transition into public health medicine and how they understood their positioning once they were within the specialty. The inductive thematic analysis conducted on the qualitative interview data generated for this research elicited three key themes of relevance for the 19 public health physicians in New Zealand who were interviewed. The calling into question of biomedical identities was evident and concomitant with this was a sense of loss of the satisfactions of clinical medicine including contact with patients and the ability to solve discrete clinical problems. The final theme revolved around how public health physician identities were felt by the participants to be discredited. Lack of attention to the identity work required to think beyond the individual in health terms may contribute to a slow pace of change.

 

‘You don’t ditch your girls’: young Māori and Pacific women and the culture of intoxication

Fiona Hutton and Sarah Wright

Māori and Pacific Peoples experience a disproportionate burden of alcohol-related harm relative to other ethnic groups, yet little is known about the context in which this drinking occurs. Few studies have explored how and why young Māori and Pacific women drink. Therefore, this article aims to develop a more nuanced and detailed account of Māori and Pacific young women’s drinking practices. The following article reports on an ethnographic study of young Māori and Pacific women aged 18–30. Five Māori participants and six Pacific participants were selected and asked to become researchers within their social groups. Nine female researchers also became participants in the study, accompanying recruited participants to drinking occasions and events. Participants were each given a ‘drinking diary’ to document drinking occasions, which formed the data-set for the project. Three levels of thematic analysis were undertaken. The first noted broad themes with the second and third levels exploring more nuanced themes and identifying intersections across themes. The study demonstrated that Māori and Pacific young women’s engagement with New Zealand’s culture of intoxication is complex: Māori and Pacific women drink for pleasure or to achieve a ‘buzz’ and to be social. Drinking practices are deeply affected by ethnic and peer group collectives (‘the girls’), traditions and expectations. Harm reduction initiatives need to take account of the many pathways specific to how Māori and Pacific young women engage with alcohol use. Additionally, the wider context in which alcohol-related harm occurs needs to be considered in policy and harm reduction debates.

 

Health

The development of the specialism of emergency medicine: Media and cultural influences

Stephen Timmons and Stuart Nairn

In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources.

 

The social negotiation of fitness for work: Tensions in doctor–patient relationships over medical certification of chronic pain

Elaine Wainwright, David Wainwright, Edmund Keogh and Christopher Eccleston

The UK government is promoting the health benefits of work, in order to change doctors’ and patients’ behaviour and reduce sickness absence. The rationale is that many people ‘off sick’ would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the ‘sick note’ with the ‘fit note’ and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor–patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note’s focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listing.

 

Performing ‘pragmatic holism’: Professionalisation and the holistic discourse of non-medically qualified acupuncturists and homeopaths in the United Kingdom

Assaf Givati

Complementary and alternative medicine practitioners have often utilised ‘holism’ as a key identification mark of their practice, distancing themselves from ‘the reductionist biomedicine’. However, the past couple of decades have witnessed increased engagement of several complementary and alternative medicines in professionalisation, which includes a degree of biomedical alignment while ‘reducing’ holistic claims in order to provide practice with a ‘credible outlook’ and move closer to the mainstream, a development which challenges the role of holism in complementary and alternative medicine practices. This article explores the strategies by which two groups of complementary and alternative medicine practitioners, namely, non-medically qualified acupuncturists and homeopaths in the United Kingdom, pragmatically accommodateholistic notions as a professional resource, a process of negotiation between maintaining their holistic premise, on the one hand, and the drive to professionalise and enhance their societal status, on the other. Based on in-depth interviews with non-medically qualified acupuncture and homeopathy practitioners and school principals, textual analysis of practitioners’ web sites and observation of practice, the findings demonstrate the dynamic approach to ‘holism’ in complementary and alternative medicine practice. This discourse, through which practitioners use a range of strategies in order to ‘narrow’ or ‘expand’ their holistic expression, can be described as ‘pragmatic holism’, by which they try to make gains from the formalisation/standardisation processes, without losing the therapies’ holistic outlook and appeal.

 

Counterpublic health and the design of drug services for methamphetamine consumers in Melbourne

Cameron Duff and David Moore

This article is interested in how notions of the ‘public’ are conceived, marshalled and enacted in drug-treatment responses to methamphetamine use in Melbourne, Australia. After reviewing qualitative data collected among health-care providers and methamphetamine consumers, we draw on the work of Michael Warner to argue that services for methamphetamine consumers in Melbourne betray ongoing tensions between ‘public’ and ‘counterpublic’ constituencies. Our analysis indicates that these tensions manifest in two ways: in the management of ‘street business’ in the delivery of services and in negotiating the meaning of health and the terms of its restoration or promotion. Reflecting these tensions, while the design of services for methamphetamine consumers is largely modelled on public health principles, the everyday experience of these services may be more accurately characterised in terms of what Kane Race has called ‘counterpublic health’. Extending Race’s analysis, we conclude that more explicit focus on the idea of counterpublic health may help local services engage with methamphetamine consumers in new ways, providing grounds for novel outreach, harm-reduction and treatment strategies.

 

Impact of age at onset for children with renal failure on education and employment transitions

Helen Lewis and Sara Arber

Previous medical research has shown that children with end-stage renal failure experience delay or underachievement of key markers of transition to adulthood. This article analyses 35 qualitative interviews with end-stage renal failure patients, aged 20–30 years, first diagnosed at 0–19 years of age, to explore how far delayed or underachievement in education and employment is related to their age at onset of end-stage renal failure. This study shows how unpredictable failures of renal replacement therapies, comorbidities and/or side effects of treatment in the early life course often coincided with critical moments for education and employment. Entering school, college, work-related training or employment, and disclosing health status or educational underachievement to an employer, were particularly critical, and those who were ill before puberty became progressively more disadvantaged in terms of successful transition into full-time employment, compared with those first diagnosed after puberty.

 

The effect of strategies of personal resilience on depression recovery in an Australian cohort: A mixed methods study

Frances E Griffiths, Felicity K Boardman, Patty Chondros, Christopher F Dowrick, Konstancja Densley, Kelsey L Hegarty and Jane Gunn

Strategies of personal resilience enable successful adaptation in adversity. Among patients experiencing depression symptoms, we explored which personal resilience strategies they find most helpful and tested the hypothesis that use of these strategies improves depression recovery. We used interview and survey data from the Diagnosis, Management and Outcomes of Depression in Primary Care 2005 cohort of patients experiencing depression symptoms in Victoria, Australia. A total of 564 participants answered a computer-assisted telephone interview question at 12 months follow-up, about what they found most helpful for their depression, stress or worries. Depressive disorder and severity were measured at annual follow-up using the Composite International Diagnostic Interview and the Patient Health Questionnaire self-rating questionnaire. Using interview responses, we categorised participants as users or not of strategies of personal resilience, specifically, drawing primarily on expanding their own inner resources or pre-existing relationships: 316 (56%) were categorised as primarily users of personal resilience strategies. Of these, 193 (61%) reported expanding inner resources, 79 (25%) drawing on relationships and 44 (14%) reported both. There was no association between drawing on relationships and depression outcome. There was evidence supporting an association between expanding inner resources and depression outcome: 25 per cent of users having major depressive disorder 1 year later compared to 38 per cent of non-users (adjusted odds ratio: 0.59, confidence interval: 0.36–0.97). This is the first study to show improved outcome for depression for those who identify as most helpful the use of personal resilience strategies. The difference in outcome is important as expanding inner resources includes a range of low intensity, yet commonly available strategies.

 

Health and Place

Community influences on contraceptive use in Mozambique

Boaventura Manuel Cau

Fertility in sub-Saharan Africa remains the highest in the world. Yet, the average contraceptive prevalence in Africa is the lowest in major world regions and there is limited understanding of the mechanisms through which community context shapes contraceptive use in the region. Using data from the 2011 Mozambique Demographic and Health Survey, we examine the mechanisms through which community context influences women’s use of modern methods of contraception in Mozambique. We find that community context influences the use of modern methods of contraception by shaping the environment in which women live.

 

Alcohol outlet density and related use in an urban Black population in Philadelphia public housing communities

Julie A. Cederbaum, Robin Petering, M. Katherine Hutchinson, Amy S. He, John P. Wilson, John B. Jemmott III and Loretta Sweet Jemmott

Adolescent alcohol use behaviors are influenced by familial patterns and neighborhood factors. This work explored the influence of individual, family, and environment on alcohol use. Baseline data from a randomized controlled trial with Black mothers son dyads (n=382) were paired with census tract and alcohol control board data. Among mothers, younger age, along with neighborhood factors of alcohol outlet density, race, and education were significantly associated with use. Among sons, older age and alcohol outlet density in the neighborhood predicted use. Findings highlight neighborhood influence, beyond family qualities, as a significant determinant of disadvantaged Black mothers’ alcohol use. Implications for public health policy are discussed.

 

The meaning of ‘place’ in families’ lived experiences of paediatric outpatient care in different settings: A descriptive phenomenological study

Gemma Heath, Sheila Greenfield and Sabi Redwood

Health service reforms in the United Kingdom have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible. Using phenomenological methods, this study examined the experience and impact of introducing new, community-based paediatric outpatient clinics from the perspective of NHS service-users. Findings reveal that paediatric outpatient ‘care closer to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld.

 

Re-thinking children׳s agency in extreme hardship: Zimbabwean children׳s draw-and-write about their HIV-affected peers

Catherine Campbell, Louise Andersen, Alice Mutsikiwa, Claudius Madanhire, Morten Skovdal, Constance Nyamukapa and Simon Gregson

We compare two analyses of the same ‘draw-and-write’ exercises in which 128 Zimbabwean children represented their HIV-affected peers. The first, informed by the ‘New Social Studies of Childhood’, easily identified examples of independent reflection and action by children. The second, informed by Sen׳s understandings of agency, drew attention to the negative consequences of many of the choices available to children, and the contextual limits on outcomes children themselves would value: the support of caring adults, adequate food, and opportunities to advance their health and safety. Conceptualisations of agency need to take greater account of children׳s own accounts of outcomes they value, rather than identifying agency in any form of independent reflection and action per se.

 

Conceptualizations of pluralistic medical fields: exploring the therapeutic landscapes of Nepal

Rikke Stamp Thorsen

Using the concept of ‘therapeutic landscapes’ this study explores how people in Nepal conceptualize their health care opportunities and how health care seeking practices are interpreted and experienced differently among people in their everyday contexts. Relational therapeutic landscapes were experienced through notions related to time and place as treatments were positioned along spectrums ranging from home to city and past to present. Conceptualizations of treatments were influenced by accessibility, lack of knowledge and uncertainties related to getting diagnosis as well as structural constraints beyond the health care system.

 

Putting the party down on paper: A novel method for mapping youth drug use in private settings

Signe Ravna and Cameron Duff

This article proposes a novel method for generating context-rich knowledge about ‘hard-to-access’ places. We ground our discussion in a recent qualitative study of social settings of youth drug use in Denmark. The study confirmed that private house parties are common sites of youth drug use, although these parties presented limited opportunities for fieldwork. In response, a ‘map-task’ was introduced to the study to complement fieldwork and interviews. We assess the most significant methodological and epistemological features of this map-task, and explore how it may to used to conduct observations ‘from a distance’ in hard-to-access places. Further, we argue that the map-task has a number of analytical and logistical advantages for scholars interested in the health and social aspects of ‘hidden’ phenomena, such as youth drug use.

 

Dreaming of toilets: Using photovoice to explore knowledge, attitudes and practices around water–health linkages in rural Kenya

Elijah Bisung, Susan J. Elliott, Bernard Abudho, Corinne J. Schuster-Wallace  and Diana M. Karanja

As part of a knowledge, attitudes, practices and empowerment (KAPE) project implemented by the United Nations University Institute for Water, Environment and Health (UNU-INWEH) in the Lake Victoria Basin, this paper reports findings from a photovoice study with women in Usoma, a lakeshore community in Western Kenya. Drawing on ecosocial and political ecology theory, findings reveal that access to water, perceptions and practices were shaped by ecological and broader structural factors. Further, collective actions to improve access were constrained by institutional and economic structures, thus (re)enforcing inequalities.

 

International Journal of Social Psychiatry

Hearing their voices: The lived experience of recovery from first-episode psychosis in schizophrenia in South Africa

Anneliese de Wet, Leslie Swartz and Bonginkosi Chiliza

Background: Recovery was previously regarded as a somewhat unattainable goal, and the subjective experience was de-emphasised. Lately, the person and his or her experiences are emphasised.

Material: Seven participants were interviewed regarding their experience of recovery from first-episode psychosis in schizophrenia. Data were analysed using interpretative phenomenological analysis (IPA).

Discussion: Support and having to care for another are possibly the greatest contributors to their recovery. Spirituality plays an important role. Stigma, found to be ingrained and pervasive, could be a barrier to recovery. The rediscovery by the participants of their abilities (re)introduced a sense of agency.

Conclusion: The narrative in the process of recovery is crucial.

 

War traumas in the Mediterranean area

Mauro Giovanni Carta, Maria Francesca Moro and Judith Bass

Introduction: The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area.

Methods: Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region.

Results: A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western.

Conclusion: The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture.

 

Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries

Alan R Teo, Michael D Fetters, Kyle Stufflebam, Masaru Tateno, Yatan Balhara, Tae Young Choi, Shigenobu Kanba, Carol A Mathews and Takahiro A Kato

Background: Hikikomori, a form of social withdrawal first reported in Japan, may exist globally but cross-national studies of cases of hikikomori are lacking.

Aims: To identify individuals with hikikomori in multiple countries and describe features of the condition.

Method: Participants were recruited from sites in India, Japan, Korea and the United States. Hikikomori was defined as a 6-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Additional measures included the University of California, Los Angeles (UCLA) Loneliness Scale, Lubben Social Network Scale (LSNS-6), Sheehan Disability Scale (SDS) and modified Cornell Treatment Preferences Index.

Results: A total of 36 participants with hikikomori were identified, with cases detected in all four countries. These individuals had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5) and moderate functional impairment (SDS M = 16.5, SD = 7.9). Of them 28 (78%) desired treatment for their social withdrawal, with a significantly higher preference for psychotherapy over pharmacotherapy, in-person over telepsychiatry treatment and mental health specialists over primary care providers. Across countries, participants with hikikomori had similar generally treatment preferences and psychosocial features.

Conclusion: Hikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with hikikomori have substantial psychosocial impairment and disability, and some may desire treatment.

 

Beliefs about the causes of schizophrenia among Aymara and non-Aymara patients and their primary caregivers in the Central–Southern Andes

Alejandra Caqueo-Urízar, Joshua Breslau and Stephen E Gilman

Aim: The aim of this study is to investigate differences in the beliefs about the causes of schizophrenia between Aymara and non-Aymara patients with schizophrenia and their primary caregivers. Ethnic background plays an important role in the formation of beliefs regarding the causes of schizophrenia, and there have been no prior studies on such beliefs among the Aymara, an indigenous community with a population of about 2 million people living in the Andes. We focused on three systems of beliefs distinguished in the literature: biological, psychosocial and magical–religious.

Methods: The sample comprised 253 patients (n = 117 Aymara, and n = 136 non-Aymara) of public mental health centers in Chile (33.6%), Peru (33.6%) and Bolivia (32.8%) with a diagnosis of schizophrenia, and each patient’s primary caregiver. We administered to patients and caregivers a questionnaire with scales assessing the perceived causes of schizophrenia. Linear regression models were fitted to compare differences in the levels of causal beliefs between Aymara and non-Aymara patients and caregivers, and to identify socio-demographic and clinical predictors of different types of beliefs about the causes of schizophrenia.

Results: Adjusted for socio-demographic and clinical covariates, levels of psychosocial beliefs were significantly higher for Aymara caregivers (0.33, 95% confidence interval (CI) = 0.05, 0.62) than non-Aymara caregivers.

Conclusions: Contrary to expectations, beliefs about the causes of schizophrenia among Aymara are not more magical–religious than those of their non-Aymara counterparts. It may be necessary for mental health staff members to evaluate beliefs about the disorder, especially in ethnic minorities, before applying a standard model of treatment.

 

Journal of the History of Medicine and Allied Sciences

Diabetes and “Defective” Genes in the Twentieth-Century United States

Arleen Marcia Tuchman

In the decades following the discovery of insulin, eugenicists grew concerned that more diabetics would survive into their reproductive years and contribute “defective” genes to the gene pool. Insulin thus came to be seen as both a blessing for the individual and a problem for the future of humankind. Nevertheless, diabetics in the United States were neither prevented nor discouraged from reproducing. I argue that this stemmed from the widespread belief that diabetes was a disease primarily of middle-class whites, who possessed positive traits that outweighed their particular genetic defect. Historians of eugenics have demonstrated convincingly that race and class stereotypes made some populations more vulnerable to coercive eugenic practices. The case of diabetes demonstrates that race and class stereotypes could also confer protection. In the end, possession of a defective gene mattered less than the perception of one’s contribution to society.

 

One «Both» Sex«es»: Observations, Suppositions, and Airy Speculations on Fetal Sex Anatomy in British Scientific Literature, 1794–1871

Ross Brooks

The hegemony of the two-sex paradigm in the European scientific imagination and wider culture did not automatically equate to the hegemony of two discrete genders. In fact, two sexes facilitated a variety of gender choices: two singular and a number of double or otherwise intersexed (most commonly referred to as “hermaphrodite” or “bisexual” in its anatomical sense). This article explores some key British medical and allied scientific texts, with reference to associated Continental literature, as a means of illustrating the complexity of the two-sex paradigm and the unexpected transformation of gender possibilities that it helped produce through the early and middle decades of the nineteenth century. Discourses surrounding the first direct observations of the earliest development of fetal urinogenital anatomy were pivotal. The prevailing view that the incipient embryo was sexually undifferentiated (a paragon of the one-sex paradigm) was challenged by the Edinburgh anatomist Robert Knox, initially as he sought to bolster his professional reputation at the height of the Burke and Hare “body-snatching” scandal. Knox suggested that every embryo began life in an essentially dual-sexed state, an individual’s sex anatomy depending on the greater or lesser development of component female and male structures. Greater clarification on the contested status of the homology—hermaphrodite distinction was achieved with the discovery of the early co-existence of the excretory duct of the Wolffian body (mesonephric duct) and the Müllerian duct (paramesonephric duct), an observation that made anatomical bisexuality difficult to ignore. The nineteenth-century’s greatest champion of primordial hermaphroditism was Charles Darwin who was pivotal in phylogenizing the principle and establishing the premise that (in his own words) “Every man & woman is hermaphrodite,” a foundation stone of late-nineteenth-century sexology.

 

Alfred Russel Wallace’s Medical Libertarianism: State Medicine, Human Progress, and Evolutionary Purpose

Michael A. Flannery

Alfred Russel Wallace (1823–1913), naturalist and explorer of South America and the Malay Archipelago, secured his place in history by independently discovering the theory of natural selection. His letter outlining the theory was sent from Ternate in eastern Indonesia and received at Down House, according to Charles Darwin (1809–82), on June 18, 1858, prompting the now-famed evolutionist to rush his languishing manuscript to press. Wallace’s contributions to evolutionary biology, biogeography, and anthropology are well known, but his medical views have received far less attention. Within the context of a strident populist antivaccination movement and an ominous elitist eugenics campaign, Wallace took his stand, which revealed itself in a libertarianism that defended traditional socialist constituencies (the working poor, the lumpenproletariat, and feminist reformers) against state-mandated medical interventions. Rather than viewing Wallace as a heterodox contrarian, this article argues that his positions were logical outgrowths of his medical libertarianism and evolutionary and social theories.

 

Investigating “Mass Hysteria” in Early Postcolonial Uganda: Benjamin H. Kagwa, East African Psychiatry, and the Gisu

 Yolana Pringle

In the early 1960s, medical officers and administrators began to receive reports of what was being described as “mass madness” and “mass hysteria” in Tanganyika (now Tanzania) and Uganda. Each epidemic reportedly affected between three hundred and six hundred people and, coming in the wake of independence from colonial rule, caused considerable concern. One of the practitioners sent to investigate was Benjamin H. Kagwa, a Ugandan-born psychiatrist whose report represents the first investigation by an African psychiatrist in East Africa. This article uses Kagwa’s investigation to explore some of the difficulties facing East Africa’s first generation of psychiatrists as they took over responsibility for psychiatry. During this period, psychiatrists worked in an intellectual climate that was both attempting to deal with the legacy of colonial racism, and which placed faith in African psychiatrists to reveal more culturally sensitive insights into African psychopathology. The epidemics were the first major challenge for psychiatrists such as Kagwa precisely because they appeared to confirm what colonial psychiatrists had been warning for years—that westernization would eventually result in mass mental instability. As this article argues, however, Kagwa was never fully able to free himself from the practices and assumptions that had pervaded his discipline under colonial rule. His analysis of the epidemics as a “mental conflict” fit into a much longer tradition of psychiatry in East Africa, and stood starkly against the explanations of the local community.

Open access, open data, open science…what does “openness” mean in the first place? by Nadine Levin

11 février 2015 - 4:17pm

Recently, the research community has been flooded with encouragement to make things “open,” meaning: freely and easily accessible, in a variety of ways, and to a great variety of audiences.  This impetus to be open has taken the form of debates over “Open Source” software licensing, “Open Access” to the published results of research[i], “Open Innovation” across organizations, and “Open Data” in research and government contexts.  We are in the era of the “New Scientific Revolution”, where the fruits of research will (supposedly…) flow out of the academic ivory tower to transform health, society, and beyond.  (Most academics will probably be familiar with these terms by now, even fleetingly, through publicity from the AAA or The White House.)

Such encouragement, commitment, and raw faith in the power of “open” is—as Sabina Leonelli and I have been exploring for the past year and a half—an articulation of what is broadly known as the “Open Science” movement.  This movement aims to make not only publications and data, but also research materials and methods open, in an effort to foster equality, widen participation, and increase innovation and productivity.  Indeed, Open Science has been promoted globally as a key component of modern society by organizations such as The Wellcome Trust, Royal Society, National Institutes of Health, Center for Open Science, Open Knowledge Foundation, and many others.  It has become increasingly central to science policy in both the United Kingdom and the United States.

But, as Sabina and I have been documenting, there remains a remarkable lack of clarity as to how the implementation, practice, and enforcement of Open Science—or to rephrase it, “openness” in science—should occur.  Policies have different terms and requirements, educational institutions have different infrastructures, scholarly communities have different commitments, and individual researchers have different priorities and circumstances[ii]. Consequently, the project has been exploring what exactly “openness” means in modern society: how, for whom, when, and where does openness occur, and what forms of scientific labor and value does the norm of openness highlight or obscure?

In everyday research, Open Science takes many forms.  It can be researchers putting their data into online databases such as GenBank, figshare, or into journal repositories.  Or, it can be researchers developing standards for data format and quality, led by institutions like the European Bioinformatics Institute (EBI) and the National Center for Biotechnology Information (NCBI).  More commonly, it might involve researchers publishing in open access journals like the Public Library of Science (PLOS), or publishing open access articles in highly-regarded journals like Nature, Science, and Proceedings of the National Academy of Sciences.  The range of these activities is staggering—involving multiple things, groups of people, and geographies—and to describe it would be beyond the scope of this blog post.

Open Science, or “openness” in science, brings unquestionable benefits.  The biomedical researchers we have interviewed, for example, emphasize that it avoids the duplication of work, and ensures the transparency of peer review.  Likewise, anthropologists emphasize that it enables the public—and research subjects/informants—to access and learn from the academic research that purports to be about and for the public.

But it also raises critical—and significantly less discussed—questions about how such openness is being done, and is playing out, in practice.  In other words, how—in terms of making things not only available, but also usable and useful—should openness be done?  By whom—early career researchers or established professors—should openness be practiced, and to whom—people in Universities, companies, or developing nations—should the presumed benefits of openness be directed?  When in research—at the very beginning, before publication—should openness occur?  These questions, which are lurking beneath the surface of the various “open” movements, pose serious challenges, as researchers attempt to negotiating the uneven, non-uniform terrain of the Open Science wilderness.

To explore some of these questions and challenges, as a starting point, it helps to remember that such encouragement to be “open” is not new, and dates back to the mid-20th century (a la Robert Merton) and even earlier[iii].  Its contours are not even or uniform, as it primarily relates to societies that have the digital infrastructures to share and generate information (for example, in Africa and South America).  Understanding “openness” in contemporary society is all about context, something that anthropologists and social scientists are well attuned to notice and study.

Through interviews with a variety of UK-based advocates of “Open Science,” this is exactly what we have learned.  Despite the overwhelming emphasis and value placed on being “open,” there are a plethora of cases in which researchers struggle to be open because of contextual, situational considerations.  These considerations are about a range of things: credit and career structures, the pressures of competition and industry collaboration, modes of intellectual property, and compliance with University and Government policies.  These might be classified as the social, economic, and political contexts that, as many scholars in anthropology and science and technology studies have observed, govern scientific norms and practices.  But the challenge of investigating how researchers go about being “open” lies in understanding how—and if—the institutions or communities that set particular agendas for openness reinforce particular norms and values, which at times conflict with researchers practices and experiences.

To anchor this discussion a real-life example, let me turn to a moment to a case study that emerged in our interviews with one of the 22 researchers we interviewed in the United Kingdom as part of this project.  This particular principal investigator (PI) was involved in systems biology research to develop models of plant biology, which used complex equations to describe cellular processes.  These models used large volumes of molecular data, and therefore relied on the existence of databases containing the data from various research groups and labs.

The PI his experienced developing such a database, emphasizing that in the data-intensive world of systems biology, the data contained in databases not only needed to be available, but also useful.  In other words, just having access to raw data would not help build models: instead, researchers needed access to curated data, which had been carefully cleaned up, edited, and annotated with metadata describing the conditions under which the data had been collected.

The PI acknowledged that transforming data for a “raw” into a “useful” state required the effort and time of the systems biology community, often in the form of “data donation,” where people might not be recognized according to traditional publication-based metrics for their time and effort[iv].  And yet, he believed that such data donation would not only benefit his own research, but would ultimately benefit the systems biology community as a whole, by allowing researchers to do novel experiments or validate existing models.

So, to give people an “incentive” to donate high-quality data to the database, the PI gave people who donated data access to a suite of online data analysis tools, which let them run experiments on the large collection of data within the database.  This, he said, provided an “immediate return” to people for their efforts, and was a sort of reciprocal “gift” to the data donors.

But then, the PI explained that this presented him with a “dilemma of openness,” a challenge which he did not know how to solve.  He acknowledged that he relied on the complete openness of the database users, but then he acknowledged that, in return, he was not able to be completely open with the data analysis tools he gave users access to.  Although he gave the data donors the ability to use these software tools online, he did not give them the source code: in other words, he did not enable the data donors to use the software on their own computers, nor did he give them access to the internal “logic” of the data analysis tools.  His reasons for doing so were, he claimed, to ensure that people did not install the data analysis tools on their own computers, and subsequently stop contributing to the database.  He felt that if he did not incentivize people to carry out data donation and sharing, they would cease to do it.

The point we are trying to make with this case study is that there are a variety of different types of openness, all of which hinge on making some things open, and some things closed.  Openness is not a binary, but rather indicates a particular strategy for engaging in a type of openness, in order to achieve a specific end result.  In the end, this PI’s struggle typified what many researchers expressed as an attempt to strike a balance between providing benefits to the individual researcher and to the community. The PI’s engagement with a particular type of openness indicated an attempt to encourage people to contribute to the overall systems biology community through data donation, but also to give people the opportunity to derive personal benefit by using data analysis tools on a large pool of data.

However, this case study also raises broader questions about the types of norms and values that are embedded within Open Science initiatives, and how these affect practicing researchers.  As Javier Lezaun and Catherine Montgomery have written in their excellent paper on Open Innovation in pharmaceutical research, notions of “sharing” and “openness” are predicated on the labor of researchers and institutions, who feel the imperative to put research materials into circulation.  Within Open Science, researchers are encouraged to make labor-intensive and value-laden outputs open.  And yet, it is precisely these outputs that often remain unacknowledged or under-valued, and which researchers resist making, or do not want to make, open.

Overall, it helps to remember that the materials and objects of research do not have value in and of themselves, and instead require work—through policies, norms, economies, and infrastructures—to have or be denied value.  Sabina and I, in a paper we are currently developing, argue that Open Science generates notions of value (which some argue is part of the neoliberal economy of higher education), which become embedded in the objects that researchers are encouraged to share and circulate.  While the more “traditional” outputs of scientific research—data, papers, intellectual property—are valued by the Open Science movement, they also contain less tangible aspects of value to researchers—skill, labor, knowhow, attribution, credit.  This presents a very real tension for researchers, like the PI whose story I recounted above, as they try to negotiate openness in practice.

 

Nadine Levin is a Postdoctoral Fellow at UCLA in the Institute for Society and Genetics, where she working on an NSF-funded project on “What is metabolism after big data?” and what consequences this has for biomedicine.  Previously, she has done work at the University of Exeter on how Open Access and Open Data policies affect the practice of post-genomic research, and also on how intellectual property regimes in the arts and humanities are affected by “the digital”.  She completed her DPhil in 2013 in Anthropology at Oxford University, with a dissertation that explored how researchers in the field of metabolomics create, analyze, and use data to make claims about metabolism and health.  

 

Notes

[i] You can read more about how this affects Arts & Humanities researchers in another blog post I’ve written

[ii] See the recent Nuffield Council on Bioethics report on “Biological and health data

[iii] See Chris Kelty’s work on model organism newsletters

[iv] See Sabina Leonelli and Rachel Ankeny’s forthcoming paper on data donation and credit attribution in the edited volume “Postgenomics”

Brigitte Chamak and Baptiste Moutaud’s Neurosciences et Société by Fernando Vidal

10 février 2015 - 9:30am

Neurosciences et société: Enjeux des savoirs et des pratiques sur le cerveau

Brigitte Chamak and Baptiste Moutaud, eds.

2014, Armand Colin, 322 pages

 

Neurosciences et société is a valuable addition to the diversified universe of studies concerning neurosciences in society. Indeed, the last few years have seen the publication of a number of important articles, single-authored books, and edited volumes on different dimensions of how the neurosciences have become prominent in the public eye, the extent to which neuroscientific discourses have penetrated a variety of contemporary contexts, a minority but nonetheless highly visible “neuroscientific turn” in the humanities, and the inflation and hype of the neuro as well as on the limits of the hopes and promises that sustained them. From laboratory ethnography to the philosophy of mind, no area of intellectual endeavor has remained unconcerned, and nor has business. Where does that leave society and subjectivities?

Sociologists have demonstrated that most people use neuroscientific information and idioms pragmatically and that, contrary to what was apparently expected, the neurosciences have neither dramatically altered people’s relations to their selves, nor radically challenged our notions about the self and the world. As the sociologist Alain Ehrenberg remarks in his contribution to Neurosciences et société, neuroscientific research is by definition mechanistic and focuses on causes; but in real life, people are rarely “reductionistic,” and even those who are curious about brain-based explanations also look for the “reasons” (e.g. biographical and existential) that contribute to explanations of their psychological distress or mental illness. This, however, does not mean that the societal leverage of the neuroscientific outlook depends on individual preferences. When (just to take one example) the director of the US National Institute of Mental Health asserts that “mental” or “behavioral” illnesses are in fact brain disorders and that psychiatry must fully become a neuroscience discipline, he formulates views that exert a major influence on public health policy and the allocation of resources – and thereby impact people’s lives regardless of individual or group conceptions and practices of the self.

Such are some of the “stakes of knowledge and practices of the brain” that Neurosciences et société explores from several points of view and by way of a variety of materials. The volume is composed of five sections including a total of eleven chapters. Part I comprises two chapters tracing the development of contemporary neurosciences; in Part II, two further chapters deal with the presence of the neurosciences in the French printed media of the 2000s and the “distortions” that neuroscientific discourses undergo not only through “journalistic” adjustments in the media (magazines and television), but also in scientific publications themselves. Part III devotes two chapters to exploring therapeutic interventions and the notions of care they embody through the cases of deep brain stimulation and cognitive remediation therapy in schizophrenia; these two chapters consist in varying degrees of materials from ethnographic work carried out in psychiatric institutions. The three chapters in Part IV examine the dynamics of associations of patients diagnosed with autism and obsessive-compulsive disorder, as well as the genesis and French forms of the “neurodiversity” movement. Finally, Part V comprises two reflections around the tensions between mind and brain, one on the brain as the object of philosophy and self-reflection, another on the locus of psychiatric illness: the mind or the brain, the self or an organ of the body.

Neurosciences et société contributes to a scholarly field dominated by the English language and by analyses generated in and dealing with Anglo-American settings. On its topic, even if its readership will be necessarily limited, a book in French and making room for other contexts is to be welcomed. Inevitably, however, its publication does not by itself change the basic situation: almost on the contrary, since the chapter bibliographies are themselves witnesses to an obvious Anglo-American ascendancy. At the same time, this “hegemony,” if it is to be so called and whether or not we judge it inevitable, is very much like what happens in many other domains. What the editors depict as the “social life” of the neurosciences – the circulation and transformation of neuro discourses, information and practices, as well as their appropriation by individuals and groups – is indeed a global phenomenon. There are, of course, some local differences. For example, Brigitte Chamak in several articles and in her chapter (with Béatrice Bonniau) describes the “French singularity” as far as “neurodiversity” is concerned. The members of French autistic persons’ associations are much more inclined than their North-American counterparts to accept the definition of autism as a neurodevelopmental disorder, rather than as a way of being that results from a peculiar but not fundamentally pathological wiring of the brain. Still, it is fair to say that, from Brazil to China and from Canada to Australia, the commonalities in the forms taken by the “social life” of the neuro are – where such a “life” exists – far more salient than the significant differences. Beyond the insights and information offered by the individual chapters (and even in the regrettable absence of an index), the mere fact that Neurosciences et société attests to such globalization is significant in itself.

 

Fernando Vidal is Research Professor of ICREA (Catalan Institute for Research and Advanced Studies) at the Center for the History of Science, Universitat Autonoma of Barcelona. He has published widely on the history of the human sciences, from early modern psychology to contemporary neurocultures. He is author among others of The Sciences of the Soul: The Early Modern Origins of Psychology; his most recent edited book (forthcoming, with Nélia Dias) is entitled Endangerment, Biodiversity and Culture. 

The “Foreign Correspondents” series features reviews of books published in languages other than English.  It is edited by Stephanie Lloyd (Laval University). If you would like to suggest a non-English language book for review or if you are interested in reviewing for “Foreign Correspondents,” please contact Stephanie directly at stephanie.lloyd@ant.ulaval.ca.

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