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Science, Medicine, and Anthropology
Mis à jour : il y a 26 min 14 sec

Inhabitable Worlds: Troubling disability, debility, and ability narratives by Michele Friedner

20 Avril 2015 - 4:00pm

This series will interrogate the theoretical tools and approaches that scholars bring to the study of disability in the social sciences. Scholars have recently turned a focused attention on different states of bodily and sensorial experience; we aim to connect these concerns with questions about how people experiencing such differences create inhabitable worlds. In doing so, we draw inspiration from Martin Heidegger’s provocative neologism “worlding.” Building on Heidegger, Mei Zhan states that worlds are “emergent socialities entangled in dynamic imaginaries of pasts, futures, and presents” and that they are constantly being made and remade (Zhan 2009, 6). We see “inhabitable worlds” as both analytic and material worlds, worlds that have existed, that do exist, and that will exist. And perhaps most importantly, we see inhabitable worlds as worlds that people themselves inhabit and aspire towards.

In approaching bodies and senses through the lens of inhabitable worlds, we aim to further inquire into age-old scholarly investigations about embodiment to think through a current fascination with the senses and to trouble social categories such as “disability,” “debility,” and “ability.” Grappling with narratives about bodily function and the senses, we propose a series where scholars go beyond the binaries of ability and disability, and capacity and incapacity, to understand the body and senses as being volatile, unstable, and in flux. This series focuses on inhabitable worlds both as an alternative to and a mode to think through medical concepts of rehabilitation and habilitation. Medical discourses shape the ways people come to experience bodily difference; people also transform these discourses through political advocacy and personal tactics they develop to navigate the material realities of bodily differences and built environments .

While rehabilitation suggests some sort of return to a prior state and habilitation suggests a lack to be remedied by gain, the concept of “inhabitable worlds” moves us away from such teleologies. In contrast, we are most interested in understanding people’s everyday practices and the tactics that they use to make sense and meaning in and of their worlds. Rather than a possession model of having legs, having hearing, having abilities or not, we are asking contributors to think through action – theories of habit, intention, movement, and stasis through space and time. Contributors to this series range from anthropologists to disability studies scholars to communication scholars to performing artists. Our goal is to explore the diversity of thinking about bodily and sensory differences and to examine how people create and dwell in inhabitable worlds.

At the same time, contributors to this series are also mindful of broader context. How do disability worlds (Rapp and Ginsburg 2013) exist in relation to other kinds of social, political, and economic worlds? How do disability worlds articulate with and remake these other worlds? On the one hand, we want to be mindful of how disabled peoples’ lives are being rendered increasingly marginal and precarious by neoliberal political economic practices and policies. On the other hand, we also want to think about the ways that disability as a category is a privileged site for development interventions and corporate initiatives. As such, contributors attend to the ways that the marginal is also central and how both disability experiences and the category of disability have become norms in and of themselves.

The political and economic dimensions of inhabitable worlds are intersected with gender, race, class, ethnicity, and nationality. Disability as a relational and intersectional category is generative – it helps produce identity politics, advocacy, and (alternative) public spheres. Disability has also been mobilized in ways that reproduce social hierarchies – masculine narratives of overcoming difficulty (or possessing super abilities) through sports or elite forms of representation that deny other axes of difference. Through various ways, contributors help dismantle disparities through a (re)imagining of disability within “inhabitable worlds” – one that is relational, recognizes bodily limits, and acknowledges interdepencies between people. In other words, inhabitable worlds are undeniably social and grounded in everyday life.

 

Inhabitable Worlds is a series that examines the theoretical tools and approaches that scholars bring to the study of disability in the social sciences and humanities. It is edited by Michele Friedner (Stony Brook University) and Emily Cohen (New York University).

Editor’s note: New entries in this series will be published each Monday.

Book Forum—Lisa Stevenson’s “Life Beside Itself: Imagining Care in the Canadian Arctic” by Eugene Raikhel

15 Avril 2015 - 3:11pm

For our latest installment in the book forum series, we bring you a series of commentaries on Lisa Stevenson’s Life Beside Itself: Imagining Care in the Canadian Arctic (University of California Press, 2014).  As it takes us across the conceptual grounds of governance, (post)colonialism, biopolitics, violence, and suicide, this book illuminates care as an object of study in a way that points to the remarkable care of Lisa Stevenson’s ethnography and writing.  We hope that you enjoy these engagements with the book, as well as Lisa Stevenson’s reply.

 

Comments on Lisa Stevenson’s Life Beside Itself: Imagining Care in the Canadian Arctic (University of California Press, 2014):

“The terror of being on the wrong side of the (bio)politics of life”
Zoë Wool
Columbia University

Life (not) on Ice
Audra Simpson
Columbia University

Life Beside Itself
S. Lochlann Jain
Stanford University

Life Beside Itself
Angela Garcia
Stanford University

Mournful Listening: Songs of Suicide
Anne Allison
Duke University

 

Response to comments:

Response
Lisa Stevenson
McGill University

In the Journals, April 2015 – Part I by Elizabeth Lewis

10 Avril 2015 - 8:48pm

Here is the first installment of our coverage of April journal articles. Enjoy!

Critical Public Health

The Transitional Dynamics of Caloric Ecosystems: Changes in the Food Supply Around the World
Sanjay Basu

Changes to the global food supply have been characterized by greater availability of edible oils, sweeteners, and meats – a profound ‘nutrition transition’ associated with rising obesity, type 2 diabetes, and cardiovascular disease. Through an analysis of three longitudinal databases of food supply, sales, and economics across the period 1961–2010, we observed that the change in global food supply has been characterized by a dramatic rise in pig meat consumption in China and poultry consumption in North America. These changes have not been experienced by all rapidly developing countries, and are not well explained by changes in income. The changes in food supply include divergence among otherwise similar neighboring countries, suggesting that the changes in food supply are not an inevitable result of economic development. Furthermore, we observed that the nutrition transition does not merely involve an adoption of ‘Western’ diets universally, but can also include an increase in the supply of edible oils that are uncommon in Western countries. Much of the increase in sales of sugar-sweetened beverages and packaged foods is attributable to a handful of multinational corporations, but typically from products distributed through domestic production systems rather than foreign importation. While North America and Latin America continued to have high sugar-sweetened beverage and packaged food sales in recent years, Eastern Europe and the Middle East have become emerging markets for these products. These findings suggest further study of natural experiments to identify which policies may mitigate nutritional risk factors for chronic disease in the context of economic development.

Big Food without Big Diets? Food Regimes and Kenyan Diets
K. O’Neill

Path-breaking scholarship has described how corporate control of food production and distribution is implicated in the global emergence of diets heavy in fats, meats and sugars. The ‘multinational food and beverage companies with huge and concentrated market power’ can be thought of as Big Food. Big Food’s presence in Kenya has expanded, and organizations have expressed concerns about the number of Kenyans who are obese. Despite these concerns, Kenya’s dietary profile does not show a clear picture of high fats, meats and sugars. This suggests that the structural factors that shape the organization of Kenya’s food supply need to be examined. By looking to the food regime approach, it is possible to understand how dietary patterns are a ‘reconstitution of material culture’, as trade arrangements shape diets in ways that make some foods seem traditional, while others appear to be new or exotic. By using the food regime approach, it is possible to understand how Kenya’s position in international trade influences food production and consumption, as well as how the Kenyan state has played a role in mitigating the Big Food diet. In this respect, the policies and practices that organize Kenyan diets are reflective of global-historical arrangements, but are also particular to Kenya. I base my argument on ethnographic research conducted in 2010 and 2014 in urban and rural areas, interviews, FAOSTAT statistics, scholarship, government documents, agency reports, newspapers and relevant food websites.

Big Soda’s Long Shadow: News Coverage of Local Proposals to Tax Sugar-Sweetened Beverages in Richmond, El Monte and Telluride
Laura Nixon, Pamela Mejia, Andrew Cheyne, and Lori Dorfman

In 2012 and 2013, Richmond and El Monte, CA, and Telluride, CO, became the first communities in the country to vote on citywide sugary drink taxes. In the face of massive spending from the soda industry, all three proposals failed at the ballot box, but the vigorous public debates they inspired provide valuable insights for future policy efforts. We analyzed local and national news coverage of the three proposals and found that pro-tax arguments appeared most frequently in the news. Advocates for the taxes focused primarily on the potential community health benefits the taxes could produce and the health harms caused by sodas. Tax opponents capitalized on the existing political tensions in each community, including racial and ethnic divisions in Richmond, anti-government attitudes in El Monte, and a culture of individualism in Telluride. Pro-tax arguments came mainly from city officials and public health advocates, while anti-tax forces recruited a wide range of people to speak against the tax. The soda industry itself was conspicuously absent from news coverage. Instead, in each community, the industry funded anti-tax coalition groups, whose affiliation with industry was often not acknowledged in the news. Our analysis of this coverage exposes how soda tax opponents used strategies established by the tobacco industry to fight regulation. Despite these defeats, tax advocates can take inspiration from more mature public health campaigns, which indicate that such policies may take many years to gain traction.

‘Big Food’ and ‘Gamified’ Products: Promotion, Packaging, and the Promise of Fun
Charlene Elliott

The promise of ‘fun’ is an increasingly common strategy used by Big Food in the promotion of packaged products. Gamification, or ‘making it fun’, has been identified as a top consumer packaged goods trend for 2014, and is finding its way into the spectrum of packaged goods and target markets. Once solely the preserve of children’s fare, fun is now applied to ‘junk’ food, ‘healthy’ food, snack food, ‘adult’ food, and ‘kids’ food. The rise and implications of such marketing has yet to be explored, and this article draws from the critical literature in food studies, current food marketing campaigns, and primary research from the trade press to map and critique ‘fun’ in association with food promotion. I argue that the promise of fun – while positioned as a playful, edible ‘pause’ in a hectic world – works to occlude some significant health, attitudinal and policy considerations related to the industrial diet. The seemingly lightweight focus on fun as a driver in food promotion promises a more embodied level of engagement than does a focus on nutritionism. However, ‘fun’ can simultaneously work to reconfigure relationships with food, increase consumption, and distance processed foodstuffs from issues of nutrients, as well as the non-communicable diseases associated with excessive consumption of highly processed fare.

Food as Pharma: Marketing Nutraceuticals to India’s Rural Poor
Alice Street

This commentary sketches out the politics of the expansion of affordable, fast-moving nutraceutical products into rural India, with a focus on fortified foods and beverages. It examines the relationships between industry, government and humanitarian organisations that are being forged alongside the development of markets for nutraceuticals; the production of evidence and the harnessing of science to support nutraceutical companies’ claims; the ways in which nutraceuticals are being marketed and distributed in rural areas; and the concepts of health and well-being that are being promulgated through those marketing campaigns. Lastly, it asks what kinds of impact fast-moving nutraceuticals are likely to have on the lives of India’s rural poor. It concludes by questioning how smooth a transition to nutraceutical consumption Big Food marketing strategies can really facilitate and how readily low-income families seeking to feed their families and safeguard health will actually adopt concepts of wellness and internalise micro-nutrient associated risks.

Health and Place

Are Natural Resources Bad for Health?
Amany A. El Anshasy and Marina-Selini Katsaiti

The purpose of this paper is to empirically examine whether economic dependence on various natural resources is associated with lower investment in health, after controlling for countries׳ geographical and historical fixed effects, corruption, autocratic regimes, income levels, and initial health status. Employing panel data for 118 countries for the period 1990–2008, we find no compelling evidence in support of a negative effect of resources on healthcare spending and outcomes. On the contrary, higher dependence on agricultural exports is associated with higher healthcare spending, higher life expectancy, and lower diabetes rates. Similarly, healthcare spending increases with higher mineral intensity. Finally, more hydrocarbon resource rents are associated with less diabetes and obesity rates. There is however evidence that public health provision relative to the size of the economy declines with greater hydrocarbon resource-intensity; the magnitude of this effect is less severe in non-democratic countries.

Regeneration, Relocation and Health Behaviours in Deprived Communities
Ade Kearns and Phil Mason

In the UK, recent regeneration programmes have aimed to improve the health of those who remain in their neighbourhood (Remainers) and those who are relocated (Outmovers); thus, as part of the 10-year GoWell study (2006–2015) of the effects of demolition, rebuilding and housing improvements on residents and communities, we examined associations of health behaviours with residential conditions and location status in deprived neighbourhoods of Glasgow. Better internal dwelling conditions were associated with several better health behaviours; in relation to neighbourhood conditions, the results were more mixed. Outmovers often exhibited worse health behaviours than Remainers, perhaps because environmental and social conditions were little altered by relocation, and because personal support mechanisms were missing. Health behaviours were relatively good among Remainers, indicating that in situ changes might stimulate life-changing improvements, but relocation less so.

Residential Instability and Obesity Over Time: The Role of the Social and Built Environment
Antwan Jones

This research uses the National Longitudinal Study of Adult Health׳s Obesity and Neighborhood Environment (ONE) to examine the relationship between residential instability and change in obesity in the United States. Mobility is thought to be related to obesity because it conditions what kinds of amenities are present in the areas where people live and what level of motivation individuals have to take advantage of these amenities. Thus, this research uses spatial measures as potential confounders for the mobility–health relationship. Results suggest that mobility is a protective factor against weight gain over time. However, the effect of mobility is completely explained by the environmental characteristics. After adjusting for changes in physical activity resources and the crime rate, adolescents who move and adolescents who do not move have precisely the same risk of being obese. Mobility is thus a function of the change in environmental characteristics. Implications for developing the built environment are discussed.

‘Where They (Live, Work and) Spray': Pesticide Exposure, Childhood Asthma and Environmental Justice Among Mexican-American Farmworkers
Norah Anita Schwartz, Christine Alysse von Glascoe, Victor Torres, Lorena Ramos, Claudia Soria-Delgado

Asthma prevalence is reportedly low for children of Mexican descent compared with other ethnic groups and Latino subgroups. The results of our exploratory ethnographic research among children of farmworkers in California dramatically suggest otherwise. Unstructured and semi-structured open-ended interviews and photovoice methods were combined to explore the lived experiences of members of a marginalized farmworker community. This research gives voice to a population of families living in the highly toxic, yet agriculturally wealthy environment of the San Joaquin Valley. Little work has been reported employing photovoice, a community-based participatory research method, to study childhood exposure to pesticides. A rich narrative about perceptions of pesticide exposure emerged from the ethnographic interviews. Thematic analysis yielded beliefs about the relationship between air quality and childhood asthma. The findings suggest that childhood asthma should be reviewed within the context of local levels of environmental exposure and the principles of environmental justice.

Change in Neighborhood Environments and Depressive Symptoms in New York City: The Multi-Ethnic Study of Atherosclerosis
C. Mair, A.V. Diez Roux, S.H. Golden, S. Rapp, T. Seeman, S. Shea

Physical and social features of neighborhoods, such as esthetic environments and social cohesion, change over time. The extent to which changes in neighborhood conditions are associated with changes in mental health outcomes has not been well-established. Using data from the MultiEthnic Study of Atherosclerosis, this study investigated the degree to which neighborhood social cohesion, stress, violence, safety and/or the esthetic environment changed between 2002 and 2007 in 103 New York City Census tracts and the associations of these changes with changes in depressive symptoms. Neighborhoods became less stressful, more socially cohesive, safer, and less violent. White, wealthy, highly educated individuals tended to live in neighborhoods with greater decreasing violence and stress and increasing social cohesion. Individuals living in neighborhoods with adverse changes were more likely to have increased CES-D scores, although due to limited sample size associations were imprecisely estimated (P>0.05). Changes in specific features of the neighborhood environment may be associated with changes in level of depressive symptoms among residents.

Health, Risk & Society

Risk and the Black American Child: Representations of Children’s Mental Health Issues in Three Popular African American Magazines
Juanne N. Clarke and Donya Mosley

Risks abound with the increasing diseasing of childhood in North America. However, the incidence and meanings and therefore the risk of children’s mental health issues differ in distinctly racialised groups. In this article, we examine the portrayal of the risk of children’s mental health issues in articles published in the three highest circulating African American magazines (Jet, Ebony and Essence) from 1990 to 2012. Based on a qualitative content analysis, we document how the representations of risks of children’s mental health issues are inextricably bound up with racism, inequity and oppression. It is these social conditions that are represented as constituting the chief risk factors for a range of behavioural and emotional difficulties in the lives of Black children. This representation contrasts sharply with that of children’s mental health issues in mainstream magazines during the same time period. It does not reflect their dominant neoliberal or individualising understanding of risk nor the possibilities of raising ‘successful children’ through actively parenting within discourses of medicalisation. We discuss the theoretical explanations and pragmatic consequences of the contrasting risk representation in the select magazines.

Growing Better Brains? Pregnancy and Neuroscience Discourses in English Social and Welfare Policies
Pam Lowe, Ellie Lee, and Jan Macvarish

In recent years, English welfare and health policy has started to include pregnancy within the foundation stage of child development. The foetus is also increasingly designated as ‘at risk’ from pregnant women. In this article, we draw on an analysis of a purposive sample of English social and welfare policies and closely related advocacy documents to trace the emergence of neuroscientific claims-making in relation to the family. In this article, we show that a specific deterministic understanding of the developing brain that only has a loose relationship with current scientific evidence is an important component in these changes. We examine the ways in which pregnancy is situated in these debates. In these debates, maternal stress is identified as a risk to the foetus; however, the selective concern with women living in disadvantage undermines biological claims. The policy claim of neurological ‘critical windows’ also seems to be influenced by social concerns. Hence, these emerging concerns over the foetus’ developing brain seem to be situated within the gendered history of policing women’s pregnant bodies rather than acting on new insights from scientific discoveries. By situating these developments within the broader framework of risk consciousness, we can link these changes to wider understandings of the ‘at risk’ child and intensified surveillance over family life.

Liquid Gold or Russian Roulette? Risk and Human Milk Sharing in the U.S. News Media
Shannon K. Carter, Beatriz Reyes-Foster, and Tiffany L. Rogers

The exchange of human breast milk, a common and well-established practice, has become a site of public controversy in the US. There is controversy over the use of the internet to facilitate milk exchange and public interest in the practice has been stimulated by a research article published in the journal Pediatrics that identified high levels of potentially harmful bacteria in breast milk sold online. In this article we use feminist critical discourse analysis to critically examine how breast milk sharing is represented in a sample of 30 articles from US print newspapers published in 2010–2013. We found complex and contradictory images of human milk, with medically supervised milk banks represented as a life-saving entity, nature’s ‘liquid gold’, whereas peer sharing of breast milk was represented as dangerous, and in this context breast milk was represented as a potentially life-threatening substance. Women who donated milk to milk banks were represented as altruistic and those who obtained their babies’ milk from the milk bank were represented as responsible and acting in the best interests of their babies. In contrast women who participated in peer milk sharing were represented at best as ill-informed about the risks to babies and at worst, morally reprehensible for disregarding the risks. Mothers who fed their babies this milk were represented as irresponsible and playing ‘Russian roulette’ with their babies. We argue that such contradictory representations are grounded in concerns in high income countries such as the USA with the control and surveillance of the female body through discourses of risk and are based on cultural constructions of individualism and intensive mothering.

Risk: ‘I Know It When I See It': How Health and Social Practitioners Defined and Evaluated Living at Risk Among Community-Dwelling Older Adults
Heather MacLeod and Robin L. Stadnyk

Older adults are increasingly choosing to stay and age in their home or other place where they normally live, even when a change in their health reduces their ability to live independently creating concerns about their safety. In this context, community practitioners need to be aware of risk assessment and management strategies as they support their clients’ choices when safety is a concern. This requires an understanding of living at risk and an ability to evaluate the client’s risk status. This article is based on a qualitative research study in which we interviewed 12 Canadian community practitioners in 2012 and explored how they defined, perceived, assessed and managed risk and how they balanced their client’s safety and autonomy. We used a grounded theory methodology to collect and analyse the data. We found that participants tended to define living at risk as a judgement about a client’s impairment within an environment that can cause an event that has an increased potential for a negative consequence. We also found practitioners evaluated the client’s risk by considering seven factors: the client’s capacity and their support, the occurrence, imminency and frequency of the event, the severity of the consequences, and the number of other events co-occurring. In this article, we show that practitioners are comprehensive in their evaluation of the client’s risk. Although practitioners saw risk and living at risk from a negative perspective, they were able to acknowledge that it could coexist along a continuum from safe to unsafe.

Enmeshed in Controversy: Claims About the Risks of Vaginal Mesh Devices
Valerie Leiter and Shelley K. White

Urinary incontinence is a hidden, private issue that affects over 40% of women. Its experience has been medicalised, mainly through urogynaecological surgery, more recently using implanted synthetic vaginal mesh. In this article, we analyse the power dynamics at play in the US Food and Drug Administration’s public hearings on the regulation of mesh. We use grounded theory to analyse verbatim transcripts of two days’ hearings in 2011 of a Food and Drug Administration medical devices advisory panel regarding the risks and benefits of the mesh. Applying the concept of language games to the transcripts, we found that mesh manufacturers and physicians expanded perceptions of the locations of risk, thereby diffusing responsibility for mesh-associated claims of adverse effects. This resulted in ‘organised irresponsibility’ where accountability for the risks reported by patients was deflected away from the mesh to other issues such as inadequacies of surgeons’ training. Patients in turn questioned the Food and Drug Administration’s regulation of mesh safety. In this article, we reflect on the ways in which medical device regulation may become more pressing and contested in the future.

Framing and Reframing Critical Incidents in Hospitals
Lonneke Behr, Kor Grit, Roland Bal, and Paul Robben

In healthcare systems in high-income countries, critical incidents are increasingly seen as an important indicator of the quality of care. Based on the rationale that there are important lessons to be learnt from mistakes and that insights into critical incidents will help to prevent them from happening again, there is a widespread assumption that conducting inquiries will contribute to improvements in patient safety. In this article, we draw on data from a qualitative comparative case study of three critical incidents in Dutch hospitals in the last decade to examine the ways in which critical incidents are investigated. Through a detailed analysis of the inquiry documentation, we identified four key elements in the inquiry process: how risks were framed and perceived, the type of methods the inquiries used to examine critical incidents, the ways in which inquiries allocated blame and the ways in which they sought to maintain transparency. Drawing on Schön and Rein’s work on framing theory, in this article we examined how the key participants in the inquiries framed issues so that they could undertake their work. We found that inquiries are complex processes in which inquiry teams can and do use different frames for deciding who should be involved in the inquiry, what should be discussed, how this should be done and to whom findings of the inquiry should be disclosed. We found that inquiries used professional, managerial or governance frames and sometimes elements of two or more frames coexisted. Within these frames, risk was framed in different ways, leading to different types of actions, involving different groups of actors.

Journal of the History of Medicine and Allied Sciences

Diabetes and ‘Defective’ Genes in the Twentieth-Century United States
Arlene 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.

Medical Anthropology

Justice at the Margins: Witches, Prisoners, and Social Accountability in Norther 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.

Medical Anthropology Theory

Rethinking the Relationship Between Stress and Resilience
Sarah Fletcher

Qualitative Cancer Research: Taking Stock, Stepping Further
Susanne Brandner, Yvonne Adam, Sarah Blakeslee, Denny Chakkalalal, Christine Holmberg, Jennifer Kennedy, Martin Schultze, and Weibke Stritter

Tracing Oncology in Rwanda: Health and Statehood in a Post-Traumatic Context
Darja Djordjevic

Philosophy, Ethics, and Humanities in Medicine

An Explanation and Analysis of How World Religions Formulate their Ethical Decisions on Withdrawing Treatment and Determining Death
Susan Setta and Sam D. Shemie

This paper explores definitions of death from the perspectives of several world and indigenous religions, with practical application for health care providers in relation to end of life decisions and organ and tissue donation after death. It provides background material on several traditions and explains how different religions derive their conclusions for end of life decisions from the ethical guidelines they proffer. Methods Research took several forms beginning with a review of books and articles written by ethicists and observers of Bön, Buddhism, Christianity, Hinduism, Indigenous Traditions, Islam, Judaism, Shinto and Taoism. It then examined sources to which these authors referred in footnotes and bibliographies. In addition, material was gathered through searches of data bases in religious studies, general humanities, social sciences and medicine along with web-based key word searches for current policies in various traditions. Results Religious traditions provide their adherents with explanations for the meaning and purpose of life and include ethical analysis for the situations in which their followers find themselves. This paper aims to increase cultural competency in practitioners by demonstrating the reasoning process religions use to determine what they believe to be the correct decision in the face of death. Conclusion Patterns emerge in the comparative study of religious perspectives on death. Western traditions show their rootedness in Judaism in their understanding of the human individual as a finite, singular creation. Although the many branches of Western religions do not agree on precisely how to determine death, they are all able to locate a moment of death in the body. In Eastern traditions personhood is not defined in physical terms. From prescribing the location of death, to resisting medical intervention and definitions of death, Eastern religions, in their many forms, incorporate the beliefs and practices that preceded them. Adding to the complexity for these traditions is the idea that death is a process that continues after the body has met most empirical criteria for determining death. For Hinduism and Buddhism, the cessation of heart, brain and lung function is the beginning of the process of dying—not the end.

Explaining and Responding to the Ebola Epidemic
Solomon Benatar

The Ebola epidemic in West Africa is not merely a biomedical problem that can be seen in isolation and dealt with only through emergency medical rescue processes. The ethical dilemmas surfaced by this epidemic are also not confined to the usual micro-ethical problems associated with medical care and medical research. The pandemic, as one of many manifestations of failed human and social development that has brought the world to dangerous ‘tipping points’, requires deep introspection and action to address upstream causal processes.

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.

A Four-Part Working Bibliography of Neurotics: Part 2 – Neuroscientific Studies of Morality and Ethics
Martina Darragh, Liana Buniak, and James Giordano

Moral philosophy and psychology have sought to define the nature of right and wrong, and good and evil. The industrial turn of the twentieth century fostered increasingly technological approaches that conjoined philosophy to psychology, and psychology to the natural sciences. Thus, moral philosophy and psychology became ever more vested to investigations of the anatomic structures and physiologic processes involved in cognition, emotion and behavior – ultimately falling under the rubric of the neurosciences. Since 2002, neuroscientific studies of moral thought, emotions and behaviors have become known as – and a part of – the relatively new discipline of neuroethics. Herein we present Part 2 of a bibliography of neuroethics from 2002–2013 addressing the “neuroscience of ethics” – studies of putative neural substrates and mechanisms involved in cognitive, emotional and behavioral processes of morality and ethics.

The Right to Health, Health Systems Development, and Public Health Policy Challenges in Chad
Jacquineau Azétsop and Michael Ochieng

There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development.

The Ethics of Animal Research: A Survey of Pediatric Health Care Workers
Ari R. Joffe, Meredith Bara, Natalie Anton, and Nathan Nobis

Pediatric health care workers (HCW) often perform, promote, and advocate use of public funds for animal research (AR). We aim to determine whether HCW consider common arguments (and counterarguments) in support (or not) of AR convincing.

Nicolas Langlitz’s Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain by Meg Stalcup

8 Avril 2015 - 4:00pm


Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain

by Nicolas Langlitz

University of California Press, 2012, 336 pages.

Humphry Osmond wrote to Aldous Huxley in 1956 proposing the term “psychedelic,” coined from two Greek words to mean “mind manifesting.” The scholars, one a psychiatrist and the other a celebrated novelist and philosopher, were exuberant about the potential of drugs for accessing the mind. Huxley favored a phrase from William Blake:

If the doors of perception were cleansed everything would appear to man as it is, infinite.

He postulated that psychedelics disturbed the “cerebral reducing valve” (1954), and that this was in fact the shared mechanism for regular drug trips, as well as schizophrenic and mystical experiences. If it were the case, the drugs could offer a chemical shortcut to the divine, and a reasonable way to scientifically study mental illness.

With such ideas in vogue, the 1950s were heady years, at least for research on psychedelic drugs. More than 750 articles were published on LSD alone. Some studies made use of the drug experience to model schizophrenia, others to develop treatments for alcoholism. And as Nicolas Langlitz explains in Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain, the brain as filter – the idea of gates or doors (which, yes, also gave name to the band) – would go on to serve as a significant shared conceptual matrix for psychopharmacologic research, from experimental psychosis to experimental mysticism (10).

Yet, despite great interest in the potential of psychedelics for treating mental disorders, and even hopes for their application to social ills, research in the United States on these drugs broke down in the 1960s as they became associated with the hippie counterculture. One point that Langlitz makes is that this was not a simple matter of government prohibition. Technically, scientists can request highly restricted substances for research, but when it came to psychedelics, they refrained. Inquiry, as Langlitz describes it, was repressed more by the micro politics of ethics committees, government funding, and peer censure than by law. He suggests that the same attention to human actors is required for understanding hallucinogens’ return to grace – for there are all the signs that they have returned, including a crowd-funding campaign for brain-imaging studies with LSD, proclamations from the Chronicle of Higher Education, and a full-length feature on the therapeutic use of psilocybin in The New Yorker.

Neuropsychedelia operates on several levels. The book is a historical account of research on psychedelics, and on that score contributes with original material from interviews with those who played central roles. Equally, it is an ethnographic account of laboratories where this work is being done: the practices of neuroscience, and what science as a vocation, fulfilled or frustrated, looks like today. Finally, it embodies an undertaking of fieldwork in philosophy, and, as the result of this exploration of the long tradition of philosophia perennis, a proposal for an anthropology of the perennial.

Chapters 1 and 2 cover the rise, fall, and revival of academic research on hallucinogenic drugs in the United States and Switzerland, respectively. Two strategies dominated these trajectories: a depoliticization of drug research through a rigorous focus on its scientific merits (which was, as Langlitz notes, itself a political maneuver), and explicitly political efforts to medicalize hallucinogens for psychotherapeutic uses (45). Both chapters draw from invaluable oral histories that Langlitz collected, so that even though the bulk of basic facts about the U.S. counterculture and drugs is readily available in popular media accounts and other books, the material represents a unique resource. Focusing on the pivotal role of Switzerland in the revival, Chapter 2 offers a firsthand anthropology of policy through the adroit interweaving of social history, international and domestic politics and economics, and the words of a bureaucrat and a scientist who enacted research on hallucinogens when experimentation was almost entirely underground in the United States.

Chapters 3 and 4 present Langlitz’s fieldwork in Zurich, describing the lives and motivations of the psychedelic test subjects and researchers from a neuroscience lab where he too participated. The experiments were designed to address the existential questions that drive the researchers: questions about mind and brain, subjective reality, and inner truth. They also raise questions about scientific objectivity and subjectivity, which Langlitz takes up in relation to the work of Lorraine Daston and Peter Galison, among others. He elegantly delves into what he labels the non-representational “enactive model” of psychosis, which aims not at a “naturalistic depiction of schizophrenia but at a comparative investigation of drug intoxication and mental disorder as two distinct states situated on the same ontological level” (22).

Chapter 5 shifts to a San Diego neuroscience lab, multi-species ethnography and the ethics of human-animal relations, as hallucinogens are given to lab mice in order to modulate their startle reflex. From the thick of his engagement with researchers and their work with lab animals, Langlitz analyzes how animal models have come to challenge ontological dualism. While the startle reflex is about as basic a physiological behavior as can be tested, the scientists acknowledge that it is hard to be sure that the behavior being measured is the same across species boundaries. But the differences are those of dose and physiology, rather than incommensurable human and animal minds. Drawing on Philippe Descola’s discussion of a dualist naturalism, Langlitz writes that the lab work is premised on a distinctive conception of shared biological nature, a molecularized, animal-human life in which “immanent transcendence has taken the place of the sacred” (202). Thus from a seeming limit case of the disenchantment of psychedelic drugs and inner realms comes a curious form of spirituality, a monist ontology which he names “mystic materialism.”

Langlitz pursues this emergent biomysticism in Chapter 6 as well as the Conclusion. In writing about the forms of life the researchers aspire to, reflect on, and create, particularly in these last two chapters Langlitz includes himself. This goes beyond the autoethnography of his participation in psilocybin experiments: part of the significance of Chapter 3’s analysis of the epistemic virtues and norms of objectivity is that in this Bildungsroman there can be no external position, nor is there a state of illusion that the social scientist reveals. From an early experience of drug-induced loss of self and subsequent euphoric reintegration grew a frustration with precisely such impasses between science and spirituality. In the neuropsychedelic researchers, he seeks and finds a tribe of those who, like himself, do not oppose science to spirituality but instead ask existential questions through science, be it neuroscience or anthropology.

They are “‘live questions,’ as William James would have called them—regarding the truth-value of subjective experience and the reconcilability of spirituality and materialism in a disenchanted world” (243-244). At the heart of the book is Langlitz’s yearning to give proper due to this human search for meaning. He documents the responses of his interlocutors in order to find his own. It’s not clear that he accepts mystic materialism as an answer (nor do all or even most of them), but that does not lessen the significance of its appearance and implications.

In ways that vary from researcher to researcher, “religious conceptions meet cutting-edge neuropsychopharmacology to generate a moral economy of hope” (17). That this is not wholly new is exactly the point. “The interesting anthropological question,” Langlitz writes, “is how archaic and more or less universal elements enter into new polytemporal ensembles” (251):

the extraordinary universality of the genetic code—or, to a lesser but still significant degree, of neurochemicals such as serotonin, or arguably of religious beliefs—is neither trivial nor so ill-founded as to be automatically shrugged off.

Part of what Langlitz prods at is anthropology’s tendency to shy away from philosophical questions as timeless and universal. He is well aware of the sociohistorical specificity of neurochemical selves and their existential quandaries; he identifies it as his own. The distinctiveness of a contemporary form, however, does not therefore mean that it is entirely singular.

Paul Rabinow adapted the phrase “fieldwork in philosophy” (from Pierre Bourdieu, who had acquired it from John Austin) to name an anthropology that intends to see and say something true about the process of emergence of forms (2003: 85). Inquiry in this mode entails “[a] sensibility of constant change, and a certain pleasure and obligation to grasp it and participate in the transformation” (1999: 181). An example is Rabinow’s own fieldwork on the development of the knowledge-thing that is DNA.

To a sensibility to constant change, Langlitz adds “a perennialist sensibility of the eternal return of the same.” In his fieldwork he found certain “eternal verities,” constants in the sense of constant variables, of a universality which cannot be presupposed but has to be freshly achieved time after time (251).

Langlitz’s proposal for an anthropology of the perennial draws, like mystic materialism itself, on perennial philosophy as eclectically recalibrated by Huxley (from Leibniz’s philosophia perennis, who drew on the Catholic theologian Agostino Steuco, and he from others). This is not a “perennial anthropology” of transhistorical truths or the epochal new monism that haunts the ontological turn. Rather, the attention to material and social context that Langlitz insists is necessary to understanding the rise, fall and renaissance of psychedelic research is also crucial to his anthropology of the perennial, lest we “gnaw[] on seemingly eternal problems without understanding where they have come from” (253).

Beyond its pleasures for those who care for original history or about psychedelics themselves, or whose intellectual interests intersect with any of the book’s explorations (which range far beyond those highlighted here), Neuropsychedelia is an elegant exemplar of both science studies and anthropology of the contemporary. I taught the book in a graduate seminar on research methods, for its lucid depiction of what it can look like to identify questions meaningful to oneself, and set about studying them anthropologically. Methodological terms which can seem like mere buzzwords are in it richly realized: multi-sited ethnography is conducted through participant-observation and semi-structured interviews about a global, yet locally differentiated assemblage, shaped by historical factors, clarified through concept work and, finally, reflexivity about the process at hand.

This last bit is worth emphasizing, as in Neuropsychedelia, reflexivity is not directed toward identifying the limits or power of ethnographic authority. Langlitz affirms an anthropology that affects the process of emergence of those objects under study, and also the anthropologist, while proposing a set of distinct interventions into that process. In short, the book’s empirical inquiry is coupled with an effort to develop tools adequate to the problems encountered, including care of the self, and the cultivation of a form of life in which one might undertake fieldwork in perennial philosophy.

 

Meg Stalcup is assistant professor of anthropology at the University of Ottawa.

 

References

Huxley, Aldous. 1954. The Doors of Perception and Heaven and Hell. New York: HarperCollins.


Rabinow, Paul. 1999. French DNA: Trouble in Purgatory. Chicago: University of Chicago Press.

———. 2003. Anthropos Today: Reflections on Modern Equipment. Princeton (NJ): Princeton University Press.

Kristin Peterson’s Speculative Markets: Drug Circuits and Derivative Life in Nigeria by Javier Lezaun

6 Avril 2015 - 4:00pm

Speculative Markets: Drug Circuits and Derivative Life in Nigeria

by Kristin Peterson

Duke University Press, 2014, 256 pages.

Chemical Arbitrage

We tend to think of pharmaceuticals as chemical matter caught up in complicated legal and economic relationships, but it is probably more useful to think of them as legal artifacts oriented towards a potential (but by no means guaranteed) biochemical fulfillment. Up until they enter our bodies, when they are being discovered and developed, patented, registered, packaged, sold and bought, pharmaceuticals trade in promises of therapeutic and financial value that are sustained, first and foremost, by legal means. “Legal” doesn’t mean here clearly and conclusively defined, but rather the opposite: a form of ambiguity that sustains a practice of continuous speculation. While they circulate in networks of exchange, pharmaceuticals are best understood as legal fictions. As Lon Fuller put it: lies that are not meant to deceive (Fuller 1930).

In her book Speculative Markets (previously reviewed by Emilie Cloatre), an ethnographic investigation of pharmaceutical trading in Nigeria, Kristin Peterson introduces us into a world where lies proliferate but deception seems to be in short supply. This is a world where vast quantities of drugs of dubious provenance and questionable efficacy change hands in places that are ostensibly not markets, at prices that shift quickly and wildly and for no obvious reason. Yet this is also a world where everybody seems alert to the mismatch between appearance and reality, and stands ready to capitalize on this discrepancy to eke out a meager living. Everybody, that is, except the final user of the drug, the patient in need of medical treatment who, arriving at the end of a long chain of transactions, must consume a product that is for all intents and purposes indecipherable and likely to be inefficacious at best.

The most obvious lie featured in Peterson’s story is that of the counterfeit, the fake drug disguising its true identity and claiming to be something that it is not. In Peterson’s account, however, “fake” is a suitably elastic concept. Next to the product intentionally advertising a false corporate identity (an improperly branded drug), one encounters deliberately or accidentally adulterated generics, truthfully branded products manufactured under substandard conditions (or marketed for the wrong indication), and multiple combinations of all of the above.

It is easy to get lost and give up any hope of certainty in this world of pharmaceutical make-believe – elsewhere Peterson has described the unknowability that besets both the participant and the observer of these shadowy market exchanges as a “phantom epistemology” (Peterson 2009) – but Speculative Markets usefully shifts our attention from the elusive identity of products to a more relevant set of questions: what are the mechanisms that sustain this seemingly uncontainable process of speculation on the quality of pharmaceuticals, who benefits from it, and how does it impact those in need of medical care? For the ultimate legal fiction at stake here is not the fraudulent commodity, deceitful as it might be, but the medium through which that commodity circulates: the idea of the market as an abstract space of exchange where supply and demand meet through the mechanism of price to produce public welfare.

Peterson begins her book by reminding us that in the 1970s and early 1980s Nigeria was a promised land for multinational drug companies. The oil boom of the 1970s created a new middle class that was attracted by the symbolic value of brand-name pharmaceuticals and had the financial means to afford them. Virtually all the large North American and European companies established operations in the country, opening manufacturing and packaging plants and nurturing a professional class of pharmacists, managerial cadres and marketing representatives ready to supervise the flourishing West African market on behalf of Big Pharma.

It is striking how much the Nigeria of this period approximates current Big Pharma expectations of new profit-generating “emerging” markets. These days one can easily find references to Nigeria in consultancy brochures and investor conferences extolling the prospects of “frontier,” “second-tier,” or (in a typically ingenious neologism) “Pharmerging” markets (e.g. IMS Consulting Group 2013). What seems to have been forgotten in these anticipations of corporate opportunity is the fact that such a market did exist in Nigeria not very long ago, that a version of this pharmaceutical future is already behind us. And there seems to be even less recollection of the causes that brought about its demise. As Peterson notes, this Big Pharma utopia was destroyed by a combination of structural adjustment policies and military dictatorships that disenfranchised, impoverished and ultimately decimated the (relatively) affluent consumer class that could have sustained the expansionist plans of multinational companies.

Peterson spends considerable time detailing the destructive impact of the IMF-enforced adjustment program on the institutions and social fabric of the pharmaceutical trade in the late 1980s and early 1990s. Currency devaluations quickly wiped out the margins of multinational companies, since they imported drugs and raw materials from abroad, but set their turnover targets in US dollars. In the meantime, and more importantly, the precipitous decline in the standards of living shrank the pool of potential consumers and thereby eliminated the rationale for further rounds of corporate investment. One after the other, Big Pharma companies divested themselves of their Nigerian operations, repatriated most of their foreign personnel, and sought more profitable investment opportunities elsewhere.

The rest of Speculative Markets is dedicated to describing the intricate and fascinating trade system that replaced the multinational brand-name drug market so thoroughly dismantled by the “liberalization” policies of the 1980s. This is, first of all, a market awash with drugs, but drugs that are rarely produced in Nigeria, or even Africa. Instead, pharmaceuticals arrive from all over the world through circuitous routes that often involve plenty of lateral exchanges and “round-tripping.” Generics (a category that has here little, if any, regulatory meaning) dominate, and are sourced primarily from Indian companies or their subsidiaries. The little indigenous manufacturing there is relies on the importation of raw materials, primarily from China or through Chinese suppliers, since, despite being a huge oil producer, Nigeria lacks the refining capacity to produce its own chemicals at competitive prices (this is, incidentally, one of the few books that begins to disentangle the profound connections between the oil and pharmaceutical economies).

One of the locations where these global flows materialize is Idumota, the largest open drug market in Lagos and a key off-loading point for drugs entering the country. Some of the book’s best pages are dedicated to visiting and revisiting this bewildering place and the people who make a living in it. Created by Igbo traders displaced in the aftermath of the Biafran War, and surrounded by a thriving popular economy of petty trade and informal credit, Idumota is today the epicenter of pharmaceutical wholesaling in Lagos and a key node in the West African drug distribution network.

Yet Idumota is hardly the only place where drugs change hands in Lagos. As Peterson shows, impromptu markets spring up all around the city – on sidewalks and under bridges, on long-distance buses or in the narrow passages that form between lanes of congested traffic. These are unsupervised, often ephemeral markets, but they provide an indispensable service to an impoverished population unable to afford the products available on government-sanctioned pharmaceutical premises

Peterson’s attention to the location of pharmaceutical exchange in the interstices of urban life brings to mind Jean-Christophe Agnew’s famous account of the creation of early modern markets (Agnew 1986). According to Agnew, the physical and symbolic segregation of markets to extraterritorial spaces – liminal settings that markets often shared with spaces for theatrical performance (another domain where the ratio of lies to deception is unusually high) – was instrumental in making the sphere of economic exchange (like that of dramatic representation) a “world apart,” a separate domain unable to contaminate the rest of the body politic. Eventually, the market would cease to describe a specific physical location and came to designate a “placeless process” traversing social life – a process whose depiction (and domestication) became the hidden subject matter of much of English Renaissance theatre.

Peterson constantly relates the movement of pharmaceutical commodities to specific points of exchange, and in so doing puts the market back in its place. This place is not the geographically or symbolically segregated spaces of which Agnew spoke, but the always-shifting cleavages between official and unofficial domains that characterize life in the contemporary African city. Struggles to define and captures these intervals thus become central to the distribution of power over pharmaceuticals and their circulation. In a section that is almost comical, Peterson recounts the efforts of Nigerian authorities to suppress the “open” drug trade in Lagos, efforts that were thwarted by the courts’ designation of Idumota as a residential area. In other words, the largest site of pharmaceutical exchange in the city is legally not a market, and is effectively beyond the jurisdiction of official authorities.

Peterson’s attention to the topography of exchange is complemented by an equally persistent interest in the livelihood strategies of local drug traders and pharmacists. We get many small glimpses of the hardship involved in making a living out of the constant fluctuations in price and quality. This is a life completely attuned and beholden to microscopic boom-and- bust cycles, a mode of existence predicated on the anticipation of constant market volatility that Peterson defines as “derivative life.”

Underneath the entrepreneurial exuberance of the Nigerian drug trade, however, lie deep-seated inequities. There is, at the heart of the system, a structural discrepancy between medical needs and available treatments. This discrepancy is not the result of immoral behavior – evil counterfeiters flooding the market with substandard drugs, greedy multinationals withholding essential therapies, corrupt officials turning a blind eye to adulterated products, etc. – although there is plenty of that to be sure. The mismatch is rather the consequence of a market organized around a single and consistent imperative: the capitalization on continuous and seemingly capricious price movements through multiple strategies of “chemical arbitrage.” In the absence of effective market supervision, or of any mechanism linking pharmaceutical marketing to public health criteria, the volatility of prices is reflected almost immediately in a parallel volatility of drug chemistry and dosages. The result is a proliferation of drugs that deviate from standard ranges, or are quickly renamed and rebranded to capture short-term price differentials in parallel markets. This is a speculative logic that unfolds and expands without bounds, and without regard to medical needs or changes in the local biologies of disease.

In conclusion, Speculative Markets tells a remarkable story of market creation, destruction, and rebuilding. It is a clear-sighted, hard-hitting book, but not a despairing one (it ends, in fact, on a distinctively optimistic note). It is also a book that demonstrates the contribution that ethnographic research can make to our understanding of the lives of pharmaceuticals, in particular by addressing an intriguing but often neglected question: what happens to drugs after they leave the manufacturing plant, but before they are consumed and metabolized by human bodies – when they are nothing more (and nothing less) than circulating commodities. Peterson’s book takes us on a journey that reveals all the complexity that hides behind the term “circulation.” It is not an easy ride, though, and at times the reader (at least this one) gets lost trying to navigate the labyrinthine trade routes and complex calculative strategies that structure the Nigerian drug trade. But maybe this sense of disorientation is appropriate. We experience, in a vicarious way, the epistemological mayhem that confronts anyone who enters this world of pharmaceutical speculation and tries to make profitable sense of it.

 

Javier Lezaun is James Martin Lecturer in Science and Technology Governance in the School of Anthropology and Museum Ethnography, University of Oxford.

 

References

Agnew, J-C. (1986) Worlds Apart: The Market and the Theatre in Anglo-American Thought, 1550-1750 (Cambridge: Cambridge University Press).

Fuller, L. (1930) “Legal fictions” 25 Ill. L. Rev. 363-399.

IMS Consulting Group (2013) Pharmerging markets: picking a pathway to success.

Peters, K. (2009) “Phantom Epistemology,” in James D. Faubion and George E. Marcus (eds.) Fieldwork is Not what it Used to Be: Learning Anthropology’s Method in a Time of Transition (Ithaca: Cornell University Press).

Varieties of Tulpa Experiences: Sentient Imaginary Friends, Embodied Joint Attention, and Hypnotic Sociality in a Wired World by Samuel Veissière

3 Avril 2015 - 11:30pm

“The intention to know”, from Annie Besant & C. W. Leadbeater (1901) Thought-Forms. London: The Theosophical Publishing House.

Introduction

This article presents a summary and discussion of key findings from ten months of experimental cyberethnography among tulpamancers.[i] Tulpas, a term reportedly borrowed from Tibetan Buddhism, are imaginary companions who are said to have achieved full sentience after being conjured through ‘thought-form’ meditative practice. Human ‘hosts’, or tulpamancers, mediate their practice through open-ended how-to guides and discussion forums on the Internet and experience their Tulpas as semi-permanent auditory and somatic hallucinations.

Studying Tulpas and their hosts is fascinating on many counts, not least because it provides an opportunity to observe an emerging culture and the mediation of new kinds of persons – in this case, that of multiple humanoid and non-human persons ‘hosted’ in single bodies and a large-scale sociocultural matrix of ‘healing’ generated without physical interaction between members. As an anthropologist who underwent retraining in cognitive science, however, I am less concerned with the seemingly ‘strange’ and ‘exotic’ aspects of Tulpamancy and am most interested in what the practice can reveal about fundamentally human mechanisms and processes. Thus, I seek to investigate (but in no pre-determined order) how neurocognitive, attentional, and narrative processes invariably shape all forms of sociality and experiences of personhood on the one hand, but also how social, political, and technological processes invariably shape mechanisms of attention, cognition, and perception. I gravitate toward sociocognitive, enactive models of hypnosis as ways of mediating sociality and personhood.

My investigation is grounded in the study of interactions between environment, cognition, and culture. In this model, mind is understood as embedded, embodied (Kirmayer, 1992a; Csordas & Masquelier, 1997), enactive (Varela, Thompson & Rosch, 1991), and extended (Clark & Chalmers, 1998) to an organism’s whole interactive environment. Just like, as Evan Thompson elegantly puts it, the flight of a bird isn’t an intrinsic property of its wings but exists as a relation between the organism and its whole environment, thinking isn’t ‘inside’ the brain, but distributed in a broader ecology of interacting sense modalities and environmental matrices (Thompson, 2015; Bateson, 1972; 1980). Here, I opt for a working definition of ‘culture’ borrowed from the natural sciences: when clusters of individuals within a similar species engage in cumulative social learning and develop relatively stable ways of doing things that differ from the ways of other groups, we can speak of culture (see Tomasello, 2009). Here, I add sensory experiences, modes of affect, joint attention, and hypnosis to the set of cumulative, iterative, differentiated phenomena that arise through social learning and give us forms of life we call ‘culture’.

Before presenting aspects of Tulpamancy practice in greater detail, I begin with an old question: how can highly similar sets of embodied mental representations, experiences, and behaviours come to be shared by large groups of individuals who never interact physically with one another? Are socialities mediated online paradigmatically different from ‘physical’ ones, or is a fundamentally similar process at stake?

“Sudden fright”, from Annie Besant & C. W. Leadbeater (1901) Thought-Forms. London: The Theosophical Publishing House.

1. The language of invisibility and the invisibility of language

“Sometimes people get logically conscience-stricken […] and like to have some criteria of ‘real’ things, e.g. entities occupying space, and will then say things like ‘boundaries are imaginary lines’. They seem to think that countries occupying territory are real but the lines separating them are somehow imaginary.”

Ernest Gellner, Language and Solitude, 1998, p54

“No one, wise Kubla, knows better than you that the city must never be confused with the words that describe it.”

Marco Polo, addressing the Great Kubla Khan

“Memory’s images, once they are fixed in words, are erased,” Polo said, “Perhaps I am afraid of losing Venice all at once, if I speak of it. Or perhaps, speaking of other cities, I have already lost it, little by little.”

Italo Calvino, Invisible Cities, Harvest books, 1974

“I wonder if the Internet is like a city”, Ian Gold told me one morning over our third round of double-espressos. Ian is a philosopher of psychiatry who is investigating why certain migrant and minority groups living in cities experience higher rates of psychosis than they do in their home communities (Gold & Gold, 2014). Discrimination, adversity, stigmatization, and living in fragmented polities are increasingly understood as important causal variables in the mediation of mental illness (Heinz, Deserno, & Reinighaus, 2013), but the question of how such differentiated trends become distributed and experienced with such violent stability and precision remains open. Large cities and their polities, after all, like ‘societies’, are difficult entities to handle physically and cognitively. “What kind of imagined community is a city”, Ian went on, “when most people’s daily routines are limited to bounded spheres like home and work, or impersonal interaction with strangers and a few shop owners?”

This is an old question: how can societies be understood, ‘internalized’, or embodied – how can societies hold – when the vast majority of the people, ideas, and infrastructure that make up these totalities are invisible to individual members? One might as well propose that, given the non-physicality of interaction between members, it is cities and societies that are like the Internet. Invisibility and physical in-interaction, thus, are important pieces in this puzzle.

For Erving Goffman, who championed studies of face-to-face interaction in modern societies, the “anonymized”, “surface character” of life in cities is routinized through what he called “civic inattention” (Goffman, 1971, p385) – that is, through the many ways in which strangers avert their gazes, avoid conversations or physical contact, and reinforce private boundaries in the public sphere. Loneliness and invisibility, as Goffman saw it, are logical outcomes of civic inattention as a “mode of personal territoriality” (ibid, p359). As a theoretician of sociality, I am particularly interested in how different regimes of joint-attention mediate lived experiences of personhood with distinct sensory, somatic, ‘embodied’ qualities. Civil inattention for example, is a specific regime of attention, but it is certainly not an absence of attention. In Goffman’s Invisible City, attentional resources are being mobilized to not pay attention to certain features of the world – particularly people caught in a symbolically-marked game of allegiances. Those that come to feel most generally inattended-to, thus, will come to embody their invisibility in physically unbearable ways. This is a terrible problem, but the general question remains: given the infinitesimally narrow possibilities of horizontal interaction between members of any given polity, how can it come to hold at all with such violently predictable experiential quality? What is the minimal physical requirement for any scheme of sociality – for any imagined community – to be embodied? What is the maximal spatial and cognitive capacity for joint-attention – usually understood as being limited to dyadic, or spatially-bounded, interaction between two or a few more actors? Could it be that Calvino got the City wrong in his anti-representationalist fable? Isn’t it, rather, that language does not so much fail to capture the city, but instead brings it into being?

Steven Levinson at the Max Planck Institute for Psycholinguistics has taken this hypothesis seriously, and has led a series of elegant experiments to revise our current understanding of linguistic relativity, first proposed by Benjamin Whorf in the early 20th century and subsequently dismissed by most social and cognitive scientists. In an experimental study of the Senses in Language and Culture, Levinson and colleagues attempted to correlate the richness and diversity of sensory experiences across cultures with the grammatical categories and specific terms attributed to the sensorium in different languages. They found that speakers of languages (like American English) that lack gradient olfactory terms, for example, performed very poorly at identifying common scents from their environment (like cinnamon) when presented with scratch-and-sniff cards. The Jahai of the Malay Peninsula, conversely, possess a very rich olfactory vocabulary and could identify an equal amount of smells and shapes.

Could it be, then, that immersion in new narrative practices with terms like ‘tulpa-forcing’, ‘possession’, or ‘wonderland’ spreading through internet technology is a sufficient condition for the mediation of new ways of experiencing touch, voice, pleasure, and synaesthesia, to name but a few of the ‘senses’ mobilized by Tulpamancy?

“Sympathy and love for all”, from Annie Besant & C. W. Leadbeater (1901) Thought-Forms. London: The Theosophical Publishing House.

2. Varieties of Tulpa Experiences Origins

The term Tulpa began circulating in the West in 1929 following the publication of Magic and Mystery in Tibet [Mystiques et magiciens du Tibet] by the Belgian-French explorer Alexandra David-Néel. The author, who reported observing the practice in Tibet, claimed to have created a Tulpa of her own in the image of Friar Tuck. Often fully transcribed as sprul pa’i sku from the Tibetan སྤྲུལ་པ, the term can be translated as ‘emanation’ or ‘incarnation’, and is associated with the physical body (Nirmanakaya). A Tulpa, as presently understood in the tulpamancer community, is a sentient being who becomes incarnate, or embodied through thought-form.

Tulpas and the senses

Drawn from primarily urban, middle class, Euro-American adolescent and young adult demographics, most Tulpamancers cite loneliness and social anxiety as an incentive to pick up the practice and report overwhelmingly positive changes in their individual and offline social lives, in addition to an array of new, ‘unusual’, but largely positive sensory experiences. These include (in order of frequency) auditory, tactile, visual, and olfactory sensations. “Raw thought”, “intuitive thinking”, “speaking with no words” and “communicating with images, feelings and music” are also reported along with other non-verbal, non-narrative forms of interaction. One informant, for example, a Caucasian-American young woman majoring in Cognitive Science at Midwestern University, reports being underdressed and cold as she was walking to class one morning. She explains that upon sensing that her host was cold, the Tulpa took off his [Tulpa] coat to place it on her [the host’s] shoulders, producing a feeling of warmth and the distinct sensation that she was wearing another layer of clothing. Such reports of spontaneous help from Tulpas in social, environmental, and professional situations abound and, indeed, seem to characterize the practice.

Sexual and romantic interactions are controversial topics in the community, with a growing consensus tending to converge toward a taboo on the latter. Because Tulpas are imagined, experienced, interacted with, and collectively validated as sentient persons with mental states, propositional attitudes, feelings, bodily sensations, biases, and preferences of their own, the issue of mutual consent is deemed crucial. Creating a Tulpa for one’s selfish enjoyment, as such, is understood to be just as unethical as seeking a one-sided, power-imbalanced relationship of any kind. General possibilities of tactile and multi-sensory experiences inherent in the practice, however, indicate that the ‘taboo’ was put in place to establish norms around a common, or, at the very least, possible practice.

In addition to imagined agents, tulpamancers’ mental constructs include spaces for Tulpa-host interaction usually termed “mindscape” or “wonderland”. Tulpas often assume human form, but many are imagined within a continuum of humanoid variations with gender-fluid, gender-neutral, or pan-ethnic traits. Fandom culture drawn from fantasy-oriented genres also frequently prompts the forcing of non-human Tulpas such as elves, dragons, or ‘imaginary creatures’. A sizeable, but non-majoritarian section of the community seems to have emerged from Internet forums dedicated to Bronies – the so-called ‘highly unexpected adult male fans of [children’s cartoon series] My Little Pony’. Many tulpamancers, thus, report creating one or more pony Tulpa.

Tulpa folk theory

The community is primarily divided between so-called psychological and metaphysical explanatory principles. In the psychological community, neuroscience (or folk neuroscience) is the explanation of choice. Tulpas are understood as mental constructs that have achieved sentience. The metaphysical explanation holds that Tulpas are agents of supernatural origins that exist outside the hosts’ minds, and who come to communicate with them. Of 118 respondents queried on the question, 76.5% identified with the psychological explanation, 8.5% with the metaphysical, and 14% with a variety of “other” explanations, such as a mixture of psychological and metaphysical.

Several Tulpamancers (from both psychological and metaphysical communities) report having had sentient imaginary friends for up to several years before finding out about Tulpamancy. For one informant, the practice had been established in her family for several generations. Many Tulpas from the psychological tradition, when interviewed separately from their hosts, also claim to have ‘been around’ in their hosts’ consciousness before their hosts became aware of them through Tulpamancy.

Of 73 Tulpamancers tested on this question, 37% reported that their Tulpas felt “as real as a physical person”, while 50.6 % described their mental companions as “somewhat real – distinct from physical persons, but distinct from [their] own thoughts”. 4.6% claimed “extremely real” phenomena, where Tulpas were “indistinguisable from any other agent or person”. Only those 4.6% claimed to hear and see their Tulpas “outside” their heads. The median length of Tulpamancy experience for these respondents was one year. Tulpamancers with 2+ years of experience reported higher degrees of somatic experience.

Demographic, social, and psychological profiles

The age range of interviewed Tulpamancers in another survey (n=141) was 14 to 34 years, with most falling in the 19 to 23 range. The male to female ratio is approximately 75/25 (male/female), though up to 10% identify as gender-fluid, and explore further ‘creative’ gender and ethnic variations through their humanoid Tulpas.

Tulpamancers are predominantly white, middle to upper-middle class urban youth. Of 141 respondents surveyed in September 2014, only two described themselves as “African American”, with two more reporting being “half black”. Four respondents described themselves as Asian, 4 more as “half Asian”, and one as “one quarter Asian”. All others described themselves as “white”, or by a variety of euro-American ethnic labels (Irish, German, Russian, etc.). One identified as “Siberian”. Most are undergraduate university students, but up to a third are fully employed. The IT field is the most commonly reported sector of employment.

The majority of Tulpamancers are located in urban areas in the US, Canada, the UK, Australia, Western Europe, and Russia. The breakdown from a survey taken by 141 tulpamancers in September 2014 was as follows:

The only known groups of tulpamancers to meet in person at the time (Sept, 2014) were located in Moscow and Omsk, where weekly gatherings were held with Skype-conferencing capacities for other Russian-speaking tulpamancers located outside these locations. Other group meetings have since emerged in St Petersburg, Volgograd, and other parts of Siberia. English and Russian seem to be the two dominant languages for the diffusion of Tulpa culture. As of February 2015, the Reddit forum through which most tulpamancy conversations in English converge had 7740 members, but less than 200 active posters. The Russian social networking site Vkontakte also listed 6000+ members, with a smaller ratio of active posters.

From coding of qualitative interviews collected in large surveys, the most common tulpamancer profile to emerge is one of a highly cerebral, imaginative, highly articulate, upper-middle class, formally educated person with many consistently pursued interests, talents, and hobbies, but limited channels of physical social interaction.

Typical tulpamancers are confident about their talents, but are quite modest and socially shy. They possess – or have cultivated – a high propensity for concentration, absorption, hypnotisability, and non-psychotic sensory hallucinations. Their limited social life and social anxieties, however, are not correlated with impaired levels of empathy and interest in other people. They score average or above average on empathy and Theory of Mind tests, indicating that their ability to relate to other humans is either optimal or enhanced (NB: I used my own revised version of Baron-Cohen’s empathy and ASD quotients tests. As these primarily rely on explicit mindreading that can be passed logically, more testing of implicit cognition is required.)

Loneliness is overwhelmingly reported as a common factor for creating Tulpas, who are described as “most loyal” and “perfect” kinds of companions. Of 74 tulpamancers tested, the majority scored higher than average on shyness scales and lower than average on sociability scales for comparable population sets (note: I used my own scales, revised from Asendorpf et al.). Most respondents reported some degrees of social anxiety. Their ‘happiness’ levels were assessed through a variety of qualitative interview tools and correlated with the Positive and Negative Affect Schedule Scale (Watson et al., 1988), on which all scored very highly (n=74, m=35.5, sd=7.5, r14-49)

High scores (n=74, m=21.35, sd=6.7, r1-33) on the Tellegen Absorption Scale (to measure capacity for hypnotisability, synaesthesia, and ‘trance’ states) seem to reflect practice as much as proclivity. In other words, respondents reported improvements on their ability to concentrate, visualize, and experience sensory ‘hallucinations’ since taking up Tulpamancy. Among the most interesting results is the negative correlation between low sociability and high empathy. Further ethnographic findings from forum discussions and interview data also indicate a moderate-to-high prevalence of tulpamancers who identify with, or have been diagnosed with, Asperger’s syndrome. No significant findings of impairment were found for either of the two respondents who took the Theory of Mind test in the first survey.

Relationship with mental illness

A subsequent survey was designed to target tulpamancers who had been diagnosed with or identified with mental illnesses or DSM-type psychopathologies. The most common ‘conditions’ reported by respondents (n=24), excluding social anxiety, were, in order of frequency, Asperger’s Syndrome (25%), Attention Deficit Disorders (21.4%), general anxiety (17.8%), depression (14.4%), and Obsessive Compulsive Disorder (10.7%).

The survey revealed a similar trend of overall reported improvement. 93.7% of respondents (n=33) expressed that taking up Tulpamancy had “made their condition better”.

54.5% of the respondents who identified with Asperger’s or Autistic Spectrum Disorder (n=11) claimed that their ability to read physical humans had improved with Tulpamancy, while 45.5% reported being unsure about changes in mindreading, despite overall positive changes in their social lives.

“I would say that it [my ability to read other humans] has improved quite a lot since I have been with my tulpa”, claimed one informant. “Although, at this point, its [sic] difficult to say if it’s my ability that is improving, or if I am relying on my tulpa to recognize things that I miss.”

This prompted further research on how Tulpas perceive and transcend their hosts’ limitations. When queried individually via email or specific questionnaire entries, Tulpas reported overall cognitive and affective difference from their hosts’ ‘baseline’ and often claimed relative or total independence from the hosts’ conditions. Mixed Tulpa responses on ASD-type conditions, however, indicated that most, but not all, Tulpas shared some aspects of their hosts’ autism, but were generally able to benefit from their position of ‘observer’ free of ‘participant’ obligation (see the Tulpas’ full responses here).

Inner voices: language, narrativity and episodicity

The role of narrative in the mediation of tulpa experiences – and by extension, to any experience of what it is like to be conscious – demands careful examination. Tulpamancy, as we have seen, entails explicit efforts (but only in the forcing stage, which typically lasts up to four months) at narrating the Self, in addition to initially conscious cognitive costs in the harnessing of absorption and the training of hypnotizable proclivity. The ‘self’ in this case is initially narrated as ‘different’ kinds of multiple selves within single bodies, and subsequently operates automatically once the practice is successfully enskilled.

This raises specific and general question about the role of language and inner narration in the mediation of conscious experiences. In Against Narrativity, an important essay in the philosophy of mind and language, Galen Strawson (2004) challenged what he took to be the naïve celebration of narrative as a linchpin of conscious experience. How literally, he asked, should we take the trope that we become the autobiographical stories we tell ourselves (Bruner, 1987) or perceive our lives as an explicitly unfolding narrative through which our sense of Self is constructed (Taylor, 1989)? Some people, he argued, are not particularly drawn to inner narration, and do not perceive their ‘Self’ as a continuous unit that persists over time and change. These types of Selves, which he termed ‘episodics’, tend to think of themselves as different persons in different moments and stages of their lives. He contrasted epidodics with ‘diachronic’ Selves, who tend to actively narrate the authorship of their life as a unified, continuous project. Strawson identified diachronicity and episodicity as personality types, and hypothesized that while both modes can co-exist and fluctuate within a single person, diachronicity seemed to be dominant in most contemporary experiences of selfhood. Anthropologist Maurice Bloch (2014a), in turn, recently proposed that while core neuro-phenomenal elements of sentience are universally shared by humans and other animals, cultural and historical differences were likely to be found at the level of narrative aspects of consciousness. He concluded, building on Strawson, that diachronicity might have become dominant in the West, and may be the locus of superficial difference that is too often extrapolated to the clichéd anthropological notion that the Self is an exclusively Western, post-reformation construct.

Tulpamancy offers an interesting case study to verify Strawson and Bloch’s claims, particularly in light of the central role of narrative in the practice. If a strong emphasis on inner-monologue is thought to lead to continuity and diachronicity, what to make of multiple selves enacted through narrative? Could different modes of narrativity be conducive to episodicity? Could episodic proclivities remain dominant in spite of the narratively intensive modes of alphabetic literacy that shape our subjectivities (see Collins, 1995, for a review of debates on literacy and cognition)? How much do we know about these differences within and across populations?

The distribution of diachronicity and episodicity, as it turns out, has yet to be empirically examined on any large scale. Expanding on the rare experimental tools devised to assess this question (Chandler et al., 2003; Hertler et al., 2015), I designed a questionnaire that weights people’s experience and intensity of inner-narration with their perceived continuity of conscious experience (you can take the test and see your results here) Respondents were matched with one of four points on a diachronic-to-episodic scale, and were later grouped as belonging to either one of two spectrums.

The same questionnaire was given to tulpamancers (n=113) and a group of non-tulpamancers (n=93). While 59% of non-tulpamancers fell in the diachronic spectrum, 70.8% of tulpamancers tended toward episodocity. In debriefing sessions with both control groups (a tulpamancer forum, and two groups of undergraduate and graduate students), many informants reported feeling a strong sense of multiplicity and discontinuity in their lives against the otherwise strong presence of an inner-narrative voice. We concluded that episodic proclivities may be more prevalent than previously assumed, and that more comparative data from non-academic, less hyper-verbal population sets were required to make better arguments. Overall questions remained on the place of narration in ‘thinking’ (see Bloch, 2014b, for arguments on how thinking is not ‘language-like’). As a trilingual, triliterate person with strong episodic tendencies, for example, I am rarely aware of the language (if any) I am thinking in, unless I am working on an explicitly narrative task like rehearsing arguments for a lecture, talk, imaginary conversation, or paper. Neurolinguists and clinicians, however, have found that psychotic manifestations in multilingual patients can occur in any of the patients’ languages (Paradis, 2010). When queried on the question, several multilingual tulpamancers explained that different tulpas within a single host could display distinct linguistic identities (e.g. one Spanish-speaking tulpa, and one English-speaking tulpa), while others reported code-switching with their tulpas (e.g. English, or Spanish, or Spanglish between tulpa and host). Others described having tulpas with foreign accents from languages in which the hosts were not proficient (e.g. Anglophone host with a tulpa who speaks English with a Japanese accent).

While inner-voice and phenomenal aspects of consciousness are likely to remain hard problems to study with any populations, my current claims about tulpamancy’s therapeutic effects will need to be supplemented with further face-to-face ethnographic, behavioural, and neuroscientific findings.

I now turn to a discussion of the interactive mechanisms that make tulpamancy – and, I argue, any experience of human personhood – possible.

“An aspiration to unfold all”, from Annie Besant & C. W. Leadbeater (1901) Thought-Forms. London: The Theosophical Publishing House.

3. Theorizing Tulpas: Personhood in Shared, Embodied, and Hypnotic Perspectives

The kinds of neurological, sociocognitive, political, linguistic, and technological mechanisms that enable tulpamancers (and, as we will see, members of any formal-enough ‘culture’) to experience such a stable embodied sense of personhood (in this case that of multiple and ‘healing’ forms of personhoods) warrants careful discussion. This requires detours through such disciplines as cognitive psychology, ethnology, ethnobiology, linguistic anthropology, the neuroscience of attention, and social approaches to hypnosis.

Tulpamancy is a new cultural phenomenon that has yet to be studied ethnographically and scientifically. Psychological anthropologist Tanya Luhrmann mentioned the community in a 2013 New York Times op-ed and offered preliminary comments about links with the Cognitive Science of Religion (CSR), in which the perceived presence of supernatural agents in most human cultures is understood as an evolutionary ‘by-product’, or maladaptive properties of mind. Luhrmann, as I explain below, draws on her own studies of ‘hallucinations’ and ‘unusual sensory experiences’ among Pentecostal Christians to depart from these evolutionary models and emphasizes the learning-dependent, absorption-and-practice-intensive, ‘healing’ quality of interaction with imaginarily conjured agents.

Here, a brief review of the cognitive literature on ‘religion’ (or human belief in and interaction with ‘supernatural’ agents) and ‘animism’ will give us further clues to theorize Tulpa and Tulpa-like experiences.

In the first wave of CSR theorizing, the inference of supernatural agents from the world around us is explained as more or less inevitable features of cognition; namely a tendency to attribute anthropomorphic animacy and agency to living things and inanimate objects alike. This is why, in Steward Guthrie’s famous formula, we see “faces in the clouds” (Guthrie, 1993). A second current of CSR theory, championed by scholars like Pascal Boyer, Justin Barrett, Harvey Whitehouse, and Scott Atran, draws on evolutionary, cognitive, and experimental psychology, ethnography, and ethnobiology to expand on the insight that humans across cultures tend to project fundamentally human mental characteristics on supernatural agents. In this model, humans are said to reason about supernatural agents by expecting them to reason like humans, particularly in terms of goal-directedness, shared intentionality, intuitive physics, naïve psychology, and semantic and episodic memory. We expect a spirit who would return each night at midnight to torment us in our bedroom, for example, to know and remember that we will be in our bedroom at the same time each day, to understand and expect that and how we will be afraid of it, and to know just how to torment us in universally human and culturally specific ways. At the same time that we intuitively accept that the spirit can go through walls but not fall through the floor, we assume that we can read its mind as much as it can read ours. This propensity to attribute human-like intentionality (that is to say, ‘aboutness’, or the property of minds to be about, or represent things, events, and states of affairs) to non-human entities is posited to have evolved in predator-prey environments, when the need to detect the presence and predict the behaviour of dangerous agents would have been a crucial survival mechanism. Evolutionary psychologists working from a domain-specific, or ‘modularist’, hypothesis explain the emergence of specific cognitive modules to handle such specific problems in our environment. This ‘agent-detection’ cognitive module – or device – thus, is understood as going on overdrive, or agent-hyperdetection when we incorrectly infer the presence of agents. A major finding of second-wave CSR, however, is that agent-hyperdetection resulting in formal systems of ‘religious’ belief may also be universally counter-intuitive. The presence of roughly similar folk taxonomies of animals, plants, and kinds of objects across cultures, and most particularly of grammatical categories to account for animate vs. inanimate objects and agents seems to indicate a universal sense of intuitive physics in humans. The kinds of objects and entities to which human infants seem inclined to attribute animacy, however, are still the subject of debates among developmental psychologists. Baillargeon and Luoy (2005), for example, have argued from experimental evidence in a looking time study that 5-month-old infants are likely to attribute goals to any entity, living or not, that they identify as an agent. According to the authors, any moving thing (such as a toy car or self-propelled box) that may appear to be self-directed can be interpreted as an intentional agent. A similar study by Mahajan and Woodward (2007), however, offered that 7-month-old infants respond visually to the movement of both animate and inanimate objects, but only reproduce the goals of the former.

‘Animism’ applied to other animals and living species, in any case, appears to be much more intuitive, and is found in the cosmologies and practices of many cultures, from Amazonia and Melanesia to Siberia and the Canadian Arctic (see Descola, 2005). As biological anthropologist Agustín Fuentes explains, the similar sense modalities, central nervous systems, and cognitive architecture shared by all mammals are most noticeable in similar physiological responses to fear, pain, and suffering found across species. If humans can read highly stable indexical cues signifying fear, pain, or suffering (like squeaking, wailing, twitching, fleeing, or others signifying anger or threat) in members of other species, then it follows that we can recognize members of these species as sentient beings, or as persons.

A capacity for shared empathy and intersubjective recognition that extends beyond the boundaries of our own species, thus, may hint at a good recipe for the bounds and possibilities of agent ‘hyper-projection’. We may not know precisely what it is like to be Thomas Nagel’s bat, but we need no conscious cognitive effort or internalized cultural script to recognize that a bat is in pain. This is a good start. Revising Nagel’s famous thought experiment will shed more light on the ‘naturalness’ of the kinds of ideas which, when elaborated upon and frequently shared and practiced in a formal set of cosmological narratives, may lead to animist ontologies in which animals are recognized as full persons – or indeed, where Tulpas think on their own as full persons. Ask yourself whether, and to what extent you may be able to recognize that each of the following ‘animal’ is in pain: a bear, a dog, a dolphin, a raven, a salmon, a spider, and an earthworm. We may infer from a bird’s broken wing that it is in pain, or we may form semi-reflective beliefs about a twitching fish ‘gasping for water’ as we would gasp for air. We can most definitely recognize suffering in any mammal. But what about an ant or a clam?

The Cree, a historically hunting and gathering ‘animist’ people living in the Northern Boreal forest region of sub-arctic Canada, speak an Algonquian language that marks nouns as being animate or inanimate. Unlike gendered nouns in Romance languages, there are no ‘obvious’ rules for distinguishing the animacy of a noun. To complicate things further, word order is also very flexible, and subjects and objects are usually expressed by means of agglutinative inflection with a verb: this typically produces long words in which objects or agents are described in the context of an action. To speak of a particular kind of bird, for example, one may say yuuskahiiu, which literally translates as “it (marks the animated noun ‘partridge’) perches on a tree and does not fly away as the hunter goes near to shoot it”. Such complex, ‘covert’ grammatical categories were first described and labelled ‘cryptotypes’ by Benjamin Whorf, who pioneered the study of linguistic anthropology in the early 20th century. Since the rules of cryptotypes are unknown to native speakers, Whorf showed that they can only be identified when they are broken.

In my work with the James Bay Cree, I have asked Cree speakers if the word awesiis, which is usually translated as ‘wild animal’, corresponds exactly to the English word ‘animal’. My informants usually answer that it does, until I proceed by elimination to ask whether, say, a bear, a wolf, a moose, a human, a raven, or a spider can be an awesiis. While younger Cree hunters almost always contend that a human cannot be an awesiis, all agree that spiders, ants, bugs, insects, earthworms and mollusks do not belong to the class of ‘wild animals’. I take the finding that the Cree, a people with a well-documented sense of deep empathy, friendship, and intersubjectivity with many animal forms (see Scott, 2006) do not attribute personhood or readability to insects and mollusks to be added evidence that full-fledged empathetic animism becomes more counter-intuitive with phylogenetic distance between species.

For Boyer and others, the minimally counter-intuitive attribution of full-fledged intentionality and anthropomorphized personhood to non-human and inanimate entities is precisely what makes ‘religious’ narratives catchy, easy to recall, and efficient to transmit culturally. Add to this what Harvey Whitehouse calls a ‘doctrinal’ mode of religiosity with a hierarchy of ‘experts’, formal narratives, and frequently repeated rituals, and you have the recipe for the efficient, rapid spread of religious ‘beliefs’ and practices.

When my 7-year-old son tells me that his penguin friend at the Montreal Biodome “misses him”, or that the lump in his throat “doesn’t want to let [him] eat”, he is making a minimally counter-intuitive anthropomorphic inference about the agency of animals and living things. I, as his father and ‘expert’ purveyor or relevant doctrinal knowledge in a secular polity, would normally proceed to ‘correct’ him, thereby continuing to ensure that he is becoming more proficient at playing our particular language game. Were I to reward his inferences with rich narratives about Penguin-and-Lump-Personhoods within a broader social context in which everyone believes in and interacts with penguin-friends and lump-agents, my son would soon start having full conversations with his ‘imaginary’ friends.

Could it be, then, that ‘entirely imaginary’ agents are, in a sense, more intuitively imaginable, and so precisely because we can conjure them in the absence of the marks of illegibility found in what we readily recognize as inanimate or inpersonal entities – or in other words that our agent detection and projection abilities enable us to recreate personhood attributes with more intuitive precision in the absence of physical designata?

What, then, of the somatic quality of ‘belief’?

In contrast with the evolutionary literature, Tanya Luhrmann’s work with evangelical Christians has shown that somatically experienced religious practices (like hearing the voice of God) take ‘hard work’ and require a proclivity for and training in absorption, in addition to a broader socio-cultural context that is permissive of and conducive to such experiences. She also showed that, in such a context, these experiences could be highly rewarding and conducive to healing.

My work with Tulpamancers, which owes a lot to Luhrmann’s theorizing of absorption and learning, invited me to revise central questions in the problem of physicality and invisibility in the study of sociality, and pointed to more cumulative feedback loops between proclivity and practice. The social and cumulative nature of learning, the doctrinality of enculturation, and the sensory grounding of narrative practice have added further clues to this puzzle and pointed me in the direction of regimes of attention as a possible linchpin of socially mediated experiences and ways of being a person.

A good account of attention-mediated sociality will entail a revision of current sociocognitive models of joint-attention – usually understood as occurring between agents in direct interactional spheres of gaze-following, finger-pointing, or other verbal or non-verbal cues. In addition to demonstrating how non-indexical, narrative forms of doctrinality can allow shared intentionality and ‘joint’ attention to rise far beyond dyadic and spatially-bounded spheres in the process of forming joint goals and achieving jointly-mediated focus, more connections will need to be established with theories of active imagination. Just like attention in the Invisible City can be jointly focused away from individuals, so too can attention be jointly focused inward within individuals, thereby giving life and sensory grounding to individually imagined but collectively scripted agents. The bounded, invisible selves of modern cities, but also the healing, God-hearing selves of Pentecostal polities, or the multiple humanoid selves of Tulpamancy, thus, are best explained as produced hypnotically.

For neuroscientist Amir Raz, whose work on neural correlates of attention departs from reductionist models that present dissociation and trance as distinct (or ‘altered’) states of consciousness, hypnosis is simply any intense, or ‘atypical’ form of attention (Raz, 2004). Attention, in more anthropological terms, is socially shaped as much as it shapes sociality; or as the cultural psychiatrist Laurence Kirmayer puts it, “social discourse and narratives shape hypnotic experience, but they are themselves influenced by mechanisms of attention” (Kirmayer, 1992, p276; see also Spanos, 1996 for a more socioconstructivist view; Kirmayer, 1998 for comments on Spanos).

As an anthropologist, I am inclined to think of the ‘typical’ as any dominant normative scheme governing the expected order of states of affairs in any given context. But ‘typical’ regimes of attention, seen from other perspectives, will appear just as strange as any variation easily recognized as ‘hypnosis’ from the perspective of the dominant. If we strip all social schemes and ways of being a person of perspectival exoticism, they become equally strange, or equally banal.

Whitehouse’s mode of religiosity theory will offer further clue to explain the social grounding of these mechanisms. Whitehouse has hypothesized that the emergence of doctrinal modes of religiosity characterized by frequently repeated rituals and expert-led, formal exegetic, behavioural, and cosmological prescriptions played an important role in the rise of large-scale polities after the Neolithic, particularly because they tend to elicit widely-spread and conformist forms of semantic memory. He contrasts this mode with the historically older ‘imagistic’ mode found in many small-scale societies, in which rarely performed, intense, often dangerous rites and rituals tend to elicit high emotional arousal, which in turn facilitate episodic recall and strengthen social bonds between participants. While the doctrinal mode affords efficient and large-scale spread of similar mental representations and practices, imagistic modes can only be sustained in small groups and lead to highly personal exegetic reflection that rarely amount to a collective consensus on the ‘meaning’ and content of visions and experiences that arise in ritual. Whitehouse’s theory is most useful to my own theorizing of sociality outside and beyond religious contexts. The doctrinal and imagistic modes, here, are best described as modes of social learning and joint attention.

Tulpamancy provides a fascinating case of sequentially unusual co-existence between both modes. The hard-work of initial visualization, thought-form and forcing invariably affords a high-frequency, low-arousal, relatively formal set of prescriptions that structurally resembles the modes of doctrinality of our contemporary social, educational, economic, religious and emotional lives – but with more conscious degrees of discipline. The counter-normative, ‘atypical’ nature of the focus, however, and the gradual success in conjuring ‘unusual’ sensory experiences eventually leads to a highly arousing set of deeply personal interior imageries and sensations that triggers imagistic modalities. That these highly arousing, hard-to-reach experiences are mediated socially by a growing number of individuals working toward common goals consequently leads to a deep sense of reward validated in a common Tulpamancer ‘identity’, but one which affords a broader degree of improvisation from what is culturally and ecologically available to the hosts. Thus, a relatively formal script and a doctrinal modality (“visualize, concentrate, build shape and personality traits and wait until you experience voices and touch from sentient Tulpas”), when successfully endoctrinated, leads to human hosts who interact with such automatic processes as elvish, pony, dragon, or other bodiless minds and voices. The very hard work reported by Tulpamancers who attempt to undo their Tulpas points to the high degrees of automaticity achieved by mature practitioners. Getting rid of a Tulpa for a seasoned -mancer, thus, could be analogically situated somewhere between unlearning the piano or correcting one’s posture. Should the practice survive, gain public acceptance, and formalize itself for another decade, it will be as hard as willing onesself to forget how to read or completely unlearn a language in which one is fully fluent. But such examples, once more, pertain to scales of degrees, but not kind.

Conclusion

Classical anthropological insights from Mauss and Whorf to Bourdieu have shown us that ‘culture’ and ‘automaticity’ are in many ways synonymous. Turning to the absorptive, somatic quality of ‘belief’, Tanya Luhrmann demonstrated that religious experiences were Tulpa-like. I hope to show, in turn, that ways of being social and of being a person are also hypnotic and Tulpa-like. Tulpa and Human, indeed, as terms used to describe persons embodied and enacted through narration and joint attention, may well turn out to be synonymous.

“Thought form of the music of Gounod” , from Annie Besant & C. W. Leadbeater (1901) Thought-Forms. London: The Theosophical Publishing House.

 

Notes

[i]REB approval for this project was granted through McGill University. Please contact Lynda McNeil, Research Ethics Officer, with any questions or concerns. Note that the REB was concerned with the anonymity and protection of Tulpa persons as well as that of their hosts. This is a rather hopeful development in legal definitions of personhood.

 

Samuel Veissière is Assistant Professor of Anthropology at the University College of the North, and currently holds a Visiting Professorship in the Culture, Mind, and Brain program at McGill University where he is affiliated with the Division of Social and Transcultural Psychiatry and the Department of Anthropology. He has conducted fieldwork on emergent modes of sociality and cooperation in the context of street children livelihoods and transnational sex work in Brazil, ‘clandestine’ migration in the Pan-Amazon, indigenous revivalism, and various new forms of Internet cultures. His current work investigates the phylogeny and ontogeny of social cognition and cooperation with an emphasis on how children across cultures learn to reason about ‘kinds’ of humans and persons.

 

Acknowledgements

I am deeply grateful for all the support provided by Laurence Kirmayer and Ian Gold at McGill University. Tanya Lurhrmann’s work on absorption, voices, and unusual sensory experiences provided the initial inspiration for this study, and I am very thankful for all her pointers and comments on earlier drafts of this paper. I’d also like to thank Eugene Raikhel and Elle Nurmi for the generous editorial work, and Ahmed Soliman for his help with statistics. I am indebted to my undergraduate students in the Theories of Culture and Society class at McGill for their insightful comments and questions on the links between narration and consciousness. I’d also like to acknowledge the great work of Deanna Day, managing editor at Somatosphere, for pulling it all together.

 

Works cited

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Guillaume Lachenal’s Le médicament qui devait sauver l’Afrique by Pierre-Marie David

1 Avril 2015 - 4:00pm

Le médicament qui devait sauver l’Afrique

by Guillaume Lachenal

La Découverte, 2014, 250 pages.

 

Guillaume Lachenal’s Le médicament qui devait sauver l’Afrique – the English-language title provided by the publishing house is The hidden history of the medicine meant to save Africa – is devoted to a pharmaceutical scandal in colonial Africa that remains absent from the official history. The drug in question is Lomidine, which promised to eradicate sleeping sickness, a disease that threatened both the health of local populations and the colonial project. Yet the medication became problematic because of its toxicity when used carelessly (treatment campaigns caused dozens of deaths in Central Africa in the 1950s). It is through the lens of Lomidine use and misuse in Central Africa that Lachenal reimagines the relationships between medicine and colonialism. His fascinating book explores not only the limits of rationality and beliefs surrounding the design and use of this drug, but also the production of knowledge, memory, and oblivion by colonial doctors and administration.

Lachenal’s 238-page book is based on ten years of research in Africa (Cameroon, DRC, Senegal) and Europe (France, Belgium, Great Britain). In it, he addresses the ambivalent relationship between medicine and colonialism by showing how this apparent wonder drug – experimented with during the Second World War, injected intramuscularly and quite painfully – was a vector of colonial power. Indeed, the term “lomidinisation,” coined during this period, represented the frenzied campaigns (at times more than 80 people injected per hour) of the colonial hygienist project and its links to modernization. Millions of so-called preventive injections were administered in the 1950s in French, Belgian, and Portuguese colonies. By tracing this history, Le médicament qui devait sauver l’Afrique shows how the colonial social experience influenced the biomedical revolution of the second half of the twentieth century.

Lachenal uses the story of Lomidine to explore what he calls an “anthropology of colonial foolishness,” or bêtise – a difficult term to translate. Absurdity would come close, but does not exactly fit in the philosophical tenor of his study. Other potential translations, including stupidity, nonsense, and idiocy, would not accurately represent Lachenal’s argument as it addresses the “unreason present within the principles of rationality, authority and scientificity” (9) of colonial modernization policies. Bêtise reflects what Lachenal describes as the result of the stubbornness or the pigheadedness of particular social and scientific policies.

Lachenal demonstrates how the story of Lomidine, which does not fit with the grand narratives of colonial medicine in Africa (whether hagiographic or critical), reveals a new field of investigation around the “impotence, hubris and irrationality of the colonial government[i]” (19). One of the main and original arguments of the book is precisely to show how the colonial desire to know and to intervene was based in a culture of ignorance and impotence. Thus this historic and ethnographic investigation is not about the quest for order and knowledge, but rather about identifying ways of not knowing, which led colonial administrators to use Lomidine despite the mounting evidence of its negative side effects. For Lachenal, it is the trust of physicians and others in this medication and its administration, within a context of great uncertainty, which falls into the realm of foolishness. In other words, bêtise is not located outside of reason, but rather in the excessive practice of reason in a confident, bull-headed, and arrogant mode.

If the theoretical challenge is ambitious, the practical way to account for this bêtise is equally important. Indeed how does one account for this stupidity without taking an outside view? As a result, Lachenal writes from an insider’s perspective, so as to understand the inner rationale for absurd behavior. Combining present tense writing, newspaper and scientific vignettes, photos and attention to detail, this historical and ethnographic investigation binds together diverse sites such as the African villages that experienced the treatment, Rhodia archives in Besançon, and professional and friendship networks between colonial doctors moving between the Department of Hygiene and Mobile Prevention, and the French Ministry of Overseas and Specia, a Rhône Poulenc subsidiary that manufactured Lomidine. Lachenal’s direct writing style is a good match for exploring the “poetics of the time” (75), where the need for numbers fed and justified an eradication project based on coercion, racialization (white people often received different treatments), and faith in hazardous and extreme treatments targeting individuals as a measure of population care.

In 1954, a lomidinisation accident in Gribi (East Cameroon), resulting from the use of unsterilized water in the preparation of the medication, killed more than 30 people and resulted in more than 300 gangrenous wounds. In chapters 7 through 9, Lachenal’s depiction of the colonial administration’s reactions to the accident allows us to understand the depth of his project, which applies ethnographic methods not only to interviews with health workers of the time (which the author conducted in Cameroon in the early 2000s), but also to archives, a move inspired by Ann Stoler. Following this approach, the author not only analyzes what the archives “reveal” – the accident, the uncertainty of the administration, the fear of being lynched by local populations – but also what they “do.” Specifically, their performativity, including documentation of political action to demonstrate how officials were proactive or how financial compensation was a demonstration of affection at the end of the colonial period. This ethnographic method allows Lachenal to consider the archives not only as a source of information, but also as a subject “whose rationale for production, classification, conservation and destruction is involved in the definition and the resolution of the case” (167). Lachenal convincingly demonstrates how the official documents in the archives served to silence the scandal that followed the 1954 accident, as they made conclusions of investigations unclear. The repetition of such accidents, impacting dozens of victims in Batouri, Nkoltang, and Fort Lamy, suggests that the colonial bureaucracy worked not only as a “filing machine,” but also as a “forgetting machine.”

In the final chapter, Lachenal addresses the technical and material enigma of the medication and its unintended effects, at once too troublesome for the official histories and too technical for social scientists. Central to this enigma is the fact that Lomidine was shown to be effective: the prevalence of trypanosomiasis declined sharply in the 1950s, but not because of individual prevention – the reason presumed at the time.[ii] By presenting scientific studies conducted in the 1970s in Kinshasa, Lachenal reveals the last piece of the puzzle in this final chapter. The medication was effective as a form of early treatment for those people infected, who had not been identified as such because of the poor sensitivity of tests, rather than because of the preventive role of Lomidine.

Overall, Le médicament qui devait sauver l’Afrique is a significant contribution to the fields of history and medical anthropology. First, as a social history of science and biomedicine in Africa, Lachenal’s research opens new avenues of inquiry for the analysis of the mechanisms of power as not only rationalizing but also comprised of failures, scandals, and sometimes stupidity. This enables the problematization of the biomedical encounter as a moment defined by both domination and critical opportunities. Second, Lachenal’s research enlightens the present time. Indeed, the book offers a new angle for the critical anthropology of global health crises such as Ebola in West Africa and new strategies in the fight against AIDS, notably by underscoring the need to remain vigilant vis-à-vis purely technical fixes to African health problems and the adverse effects of eradication dreams.

Finally, by presenting and describing the limits of reason, insofar as it becomes nonsense, Lachenal provides a new perspective on what has been called pharmaceutical reason[iii], sometimes presented as the ventriloquized voice of the pharmaceutical industry, other times as a window onto the neutral sociality of evidence, or even as a simple strategic logic. Conversely, Le medicament qui devait sauver l’Afrique addresses the complexity and mediocrity of this reason when attached to drug-related symbolic and material power. Setting this reason within an historical context allows one to question and investigate the power to create, beyond reason itself, therapeutic and technical cultures through dreams of eradication, and increasingly through “preparedness scenarios.”

[i] All quotes are original translations. Any mistakes in the translation or lapses of jugement are my reponsibility.

[ii] It is worth noting the massive “lomidinisation” campaigns aimed at using individual treatment as collective prevention; a rationale which upholds the new strategies in the fight against AIDS such as Treatment as Prevention (TasP). See Lachenal, G. (2013). A genealogy of treatment as prevention (TasP) in Giles-Vernick, T., & Jr, J. L. A. W. (2013). Global Health in Africa: Historical Perspectives on Disease Control. Ohio University Press.

[iii] Lakoff, A. The pharmaceutical reason, Cambridge, 2005.

 

Pierre-Marie David is a sociologist and pharmacist, and is currently a lecturer at the Faculty of Pharmacy, University of Montreal, in the Department of Medications and Population Health. He is also the scientific coordinator of the research group Méos (Medications as social objects). He received his PhD from the University of Lyon and University of Montreal. His doctoral dissertation is entitled The oblivion treatment: the ordeal of antiretroviral drug embodiment and AIDS treatment temporalities in the Central African Republic.

In the Journals, March 2015 – Part 2 by Anna Zogas

1 Avril 2015 - 2:11am

Here is a selection of journal articles published toward the end of March. Also check out this month’s first In the Journals post, and Science in Context’s special issue on mind and brain science in the twentieth century.

Disability Studies Quarterly (Open Access) 

Listen and Speak: Power-Knowledge-Truth and Cochlear Implants in Toronto
Tracey Edelist

Cochlear implants and auditory-verbal therapy are the latest techniques and technologies used to make deaf people learn to listen and speak. This paper provides a genealogical analysis of the Cochlear Implant Program at SickKids Hospital in Toronto, Ontario, Canada and shows how this program exemplifies the medicalization of deafness while denying deaf children the opportunity to learn sign language. Using Foucault’s concept of governmentality, the relations between power, knowledge, truth and their influences on the program’s practices are revealed in order to provide insight into Canadian society’s conceptions of deafness. This analysis reveals the Cochlear Implant Program as a capitalist establishment that is supported by unquestioned reverence of modern medicine and technology, oriented by a quest for normalcy. The paper concludes by encouraging members of the Deaf community and their supporters to challenge the hegemony of normalcy by utilizing alternate research-based knowledge-truths of cochlear implants and sign language.

“Crying Doesn’t Work”: Emotion and Parental Involvement of Working Class Mothers Raising Children with Developmental Disabilities
Amy Christine Sousa

This article presents three critical case studies that explore the relationship between income and parental involvement in the education of children with developmental disabilities. Interviewed as part of a larger study on mothering children with developmental disabilities, Joy, Jackie, and Maya are low income mothers of children with severe developmental disabilities living in New Hampshire. These women describe carefully planned parenting practices designed to foster child development, which yield both engagement with and strategic disengagement from formal bureaucracies. This is a decided departure from previous theorization on low income mothers’ approaches to child development. Grounded analysis of these interview cases suggests that emotion management may be a critical factor in both structuring parental involvement with educational systems as well as enacting class differences within the special education system.

Sociology of Health & Illness

Biologising parenting: neuroscience discourse, English social and public health policy and understandings of the child
Pam Lowe, Ellie Lee, and Jan Macvaris

In recent years, claims about children’s developing brains have become central to the formation of child health and welfare policies in England. While these policies assert that they are based on neuro-scientific discoveries, their relationship to neuroscience itself has been debated. However, what is clear is that they portray a particular understanding of children and childhood, one that is marked by a lack of acknowledgment of child personhood. Using an analysis of key government-commissioned reports and additional advocacy documents, this article illustrates the ways that the mind of the child is reduced to the brain, and this brain comes to represent the child. It is argued that a highly reductionist and limiting construction of the child is produced, alongside the idea that parenting is the main factor in child development. It is concluded that this focus on children’s brains, with its accompanying deterministic perspective on parenting, overlooks children’s embodied lives and this has implications for the design of children’s health and welfare services.

What am I ‘living’ with? Growing up with HIV in Uganda and Zimbabwe
Sarah Bernays, Janet Seeley, Tim Rhodes and Zivai Mupambireyi

As paediatric HIV treatment has become increasingly available across the world, the global perinatally infected cohort is ageing. However, we know surprisingly little about what it is like to grow up with HIV in resource-stretched settings. We draw on findings from a prospective, qualitative study with HIV-positive children, their carers and healthcare workers from four clinics in Uganda and Zimbabwe to examine children’s experiences of living with HIV on treatment. We consider how the HIV experience is made in a symbiotic relationship between children, carers and healthcare workers and shaped by broader discourses. Despite the radical development in prognosis for children, their experience of HIV is largely constructed in relation to a language of ‘sickness’ through the promotion of medicalised talk and the recounting of past illness stories. This narrow narrative framework both reflects and reproduces core dimensions of the lived experience of growing up with HIV, which emphasises an absence of resilient healthiness in the face of ongoing vulnerability and risk. The challenges that children encounter in articulating alternative narratives that prioritise the relative buoyancy of their health is indicative of the broader uncertainty that exists around the future for these children at this point in the epidemic.

Theory, Culture, and Society

Vital Systems Security: Reflexive Biopolitics and the Government of Emergency
Stephen J Collier and Andrew Lakoff

This article describes the historical emergence of vital systems security, analyzing it as a significant mutation in biopolitical modernity. The story begins in the early 20th century, when planners and policy-makers recognized the increasing dependence of collective life on interlinked systems such as transportation, electricity, and water. Over the following decades, new security mechanisms were invented to mitigate the vulnerability of these vital systems. While these techniques were initially developed as part of Cold War preparedness for nuclear war, they eventually migrated to domains beyond national security to address a range of anticipated emergencies, such as large-scale natural disasters, pandemic disease outbreaks, and disruptions of critical infrastructure. In these various contexts, vital systems security operates as a form of reflexive biopolitics, managing risks that have arisen as the result of modernization processes. This analysis sheds new light on current discussions of the government of emergency and ‘states of exception’. Vital systems security does not require recourse to extraordinary executive powers. Rather, as an anticipatory technology for mitigating vulnerabilities and closing gaps in preparedness, it provides a ready-to-hand toolkit for administering emergencies as a normal part of constitutional government.

BioSocieties

Biologies of betrayal: Judas goats and sacrificial mice on the margins of Mexico (open access)
Emily Mannix Wanderer

Invasive species are the subject of much debate and attention. Social scientific analyses of alien species have focused on rhetoric about invaders, arguing that the discourse about invasive species reflects how people think about nature, culture and agency. In this article, I argue for a focus not only on discourse, but also on what happens in practice in the encounter between field scientists and invasive animals. Through ethnographic fieldwork on Guadalupe Island in Mexico, I analyze both the place of islands in the Mexican nation and invasive species eradication programs as examples of ‘care of the pest’, that is, projects in which scientists carefully tend to invasive organisms in order to produce knowledge about them. This knowledge is then used against the animals to exterminate them in a ‘biology of betrayal’, and occasionally, animals are enlisted into these projects to aid scientists in eradicating fellow members of their species. This article shows how changing perceptions of the value of island ecologies affected the use of the land and the fates of the animals on Guadalupe Island as the island was variously configured as laboratory, field site and slaughterhouse.

The lively ethics of global health GMOs: The case of the Oxitec mosquito (open access)
Alex M Nading

Social scientists have recently brought renewed attention to the relationship between epidemics and environmental change. Vector-borne and zoonotic diseases (for example, dengue, malaria, avian influenza) are exacerbated by disturbances to the environment, yet historically most solutions to these problems tend to involve further disturbances to environments, notably the mass destruction of non-human life (for example, pigs, sheep, cattle and insects). This article analyzes ethical debates that arose in 2010, when the British biotechnology firm Oxitec Ltd. announced a field test of a technology that would change this story: a genetically modified (GM) version of the Aedes aegypti mosquito that transmits dengue. Designed to control mosquito populations through interbreeding, Oxitec’s mosquitoes are an example of what I call ‘global health Genetically Modified Organisms (GMOs)’. As both environmental interventions, like GM crops, and biomedical technologies, like pharmaceuticals, such organisms challenge not only the moral position of social scientists vis–à–vis vector-borne or zoonotic disease but also the relationship of environmental ethics to bioethics. Addressing these challenges alongside the abiding question of for-profit biotechnology’s role in global health, I suggest that global health GMOs might be assessed through a ‘lively ethics’ that emerges not in discrete regulatory spaces (‘body’, ‘nation-state’, ‘global environment’) but in more fluid ‘moral spaces’.

Pharmacogenomics, human genetic diversity and the incorporation and rejection of color/race in Brazil (open access)
Ricardo Ventura Santos, Gláucia Oliveira da Silva and Sahra Gibbon

Public funding for research on the action of drugs in countries like the United States requires that racial classification of research subjects should be considered when defining the composition of the samples as well as in data analysis, sometimes resulting in interpretations that Whites and Blacks differ in their pharmacogenetic profiles. In Brazil, pharmacogenomic results have led to very different interpretations when compared with those obtained in the United States. This is explained as deriving from the genomic heterogeneity of the Brazilian population. This article argues that in the evolving field of pharmacogenomics research in Brazil there is simultaneously both an incorporation and rejection of the US informed race-genes paradigm. We suggest that this must be understood in relation to continuities with national and transnational history of genetic research in Brazil, a differently situated politics of Brazilian public health and the ongoing valorization of miscegenation or race mixture by Brazilian geneticists as a resource for transnational genetic research. Our data derive from anthropological investigation conducted in INCA (Brazilian National Cancer Institute), in Rio de Janeiro, with a focus on the drug warfarin. The criticism of Brazilian scientists regarding the uses of racial categorization includes a revision of mathematical algorithms for drug dosage widely used in clinical procedures around the world. Our analysis reveals how the incorporation of ideas of racial purity and admixture, as it relates to the efficacy of drugs, touches on issues related to the possibility of application of pharmaceutical technologies on a global scale.

Shaping the future and living in the present: Living a ‘good’ life with a familial heart disease (open access)
Els Geelen, Ine Van Hoyweghen and Klasien Horstman

In genetic counselling practices, individuals are explicitly encouraged to take an active stance towards their future. The premise is that, by considering their genetic risks and taking preventive measures, they have some control over their future life and health. However, it is unclear how families engaged in genetic testing actually deal with the promises of genetic test results, and how they perceive their future. This qualitative study aims to provide insight into the way in which families shape and live their lives with genetic risks. How do they navigate life with a familial heart disease? We followed six extended families involved in genetic testing for hypertrophic cardiomyopathy in the Netherlands for 4 years. The present analysis of four of these families reveals how they make sense of the future in various ways and perceive the opportunities for control. Whereas some families strongly believe the future can be shaped in some way, others are reluctant, do not believe in or even protest against the notion that genetic testing will help them to shape their future lives. We conclude that in the pursuit of Nussbaum’s notion of the ‘good’ life, ‘shaping the future’ and ‘living in the present’ are not opposing or mutually exclusive repertoires; instead, traces of both are apparent in all four case studies.

Educating ‘cerebral subjects’: The emergence of brain talk in the Argentinean society (open access)
María Jimena Mantilla

This article focuses on both the dissemination of neuroscientific knowledge and its social implications through the analysis of a television program entitled The Enigmas of the Brain hosted by an Argentinean neuroscientist. My main concern in this article is to analyze some of the discursive uses of brain talk, that is, the many ways in which brain terminology is engaged in accounts about what the brain does and how some terms are linked together in order to create a sense of brain causality in a number of heterogeneous processes. The research that led to this article follows a qualitative design. The content of the television show was transcribed and analyzed following a content analysis strategy. This data is part of a sociological research project about the cognitive neuroscience field in Argentina. I suggest that brain talk is more about creating new words to explain and make sense of life than about communicating scientific information to a lay audience. As it is explained in the program, the purpose is to educate the public, but I argue that not in the sense of giving new information, but in the sense of producing linguistic resources that encourage the emergence of new self-narratives.

Culture, Medicine, and Psychiatry

Clinician Reasoning in the Use of Cultural Formulation to Resolve Uncertainty in the Diagnosis of Psychosis
Ademola B. Adeponle, Danielle Groleau, Laurence J. Kirmayer

We examined how the process of cultural formulation contributes to diagnostic assessment of patients with psychotic disorders at a specialized Cultural Consultation Service (CCS). Specifically, we investigated the reasoning process used to resolve uncertainty of psychotic disorder diagnosis in African immigrant patients referred to the CCS for assessment of possible psychotic disorder. Qualitative thematic analysis of 23 clinical case conference transcripts was used to identify clinicians’ reasoning styles. Use of the CF appears to facilitate the emergence of a rule-governed reasoning process that involved three steps: (i) problematize the diagnosis of the intake ‘psychosis’ symptoms or behavior; (ii) elaborate explanations as to why the symptoms or behavior may or may not be psychosis; and (iii) confirm the diagnosis of psychosis or re-interpret as non-psychosis. Prototypes and exemplars drawn from previous experience in intercultural work featured prominently in clinicians’ reasoning. Prototypes were crucial in diagnostic decision-making and appear to be important sources of both clinician expertise and bias, and may need to be targeted specifically in cultural competence training.

Blood Libel Rebooted: Traditional Scapegoats, Online Media, and the H1N1 Epidemic
L. Atlani-Duault, A. Mercier, C. Rousseau, P. Guyot, J. P. Moatti

This study of comments posted on major French print and TV media websites during the H1N1 epidemic illustrates the relationship between the traditional media and social media in responding to an emerging disease. A disturbing “geography of blame” was observed suggesting the metamorphosis of the folk-devil phenomenon to the Internet. We discovered a subterranean discourse about the putative origins and “objectives” of the H1N1 virus, which was absent from the discussions in mainstream television channels and large-circulation print media. These online rumours attributed hidden motives to governments, pharmaceutical companies, and figures of Otherness that were scapegoated in the social history of previous European epidemics, notably Freemasons and Jews.

“Maybe at Birth There was an Injury”: Drivers and Implications of Caretaker Explanatory Models of Autistic Characteristics in Kerala, India
Jennifer C. Sarrett

Explanatory models (EMs) are the way people explain the presence and meaning of an illness or disability and are reliant on and reflective of culturally specific values of normalcy, disability, health, and illness. EMs about autism spectrum disorder (ASD) are particularly revealing because there is no known cause, and so people can explain this disability in ways more appropriate for and useful to them. This article presents caretaker EMs about children with autistic characteristics in Kerala, India. I argue that the reliance on biological, but not genetic, causal models is reflective of the state’s high access to biomedical heath care. These EMs are used to deflect the stigma of ‘bad blood’ and reflect a nuanced relationship between stigma and biological EMs. Understanding how caretakers talk about ASD and related conditions is critical for anyone interested in engaging in crosscultural or international autism-related work.

Heroin: From Drug to Ambivalent Medicine
Birgitte Schepelern Johansen and Katrine Schepelern Johansen

This article provides an anthropological analysis of the introduction of medically prescribed heroin as part of official substance abuse treatment. While anthropological inquiries of substance abuse treatment have mainly focused on providing the users perspectives on the (ab)use or unraveling the conflicts and negotiations between users and staff, the present article argues for the merits of paying attention to the spatial dimensions of substance abuse treatment. Focusing on the spatial and material ramification of the treatment can shed a nuanced light on the still vulnerable process of altering the heroin from drug to medicine, and thereby on the attempts to settle heroin in a new practical and semantic landscape. The heroin is anchored in some powerful discourses of crime, death, and pleasure, and the analysis shows how these discourses (re-)appear in the spatial textures of the clinic, contesting the attempts to medicalize the heroin. Further, the article argues that even though the treatment aims at a marginalization of the heroin in the life of the clients, the spatial arrangements and the practices within them simultaneously enforces a centralization of the heroin, making the space for treatment highly ambivalent.

A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices
Bonnie Kaul Nastasi, Jean J. Schensul, Stephen L. Schensul, Abelwahed Mekki-Berrada, Pertti J. Pelto, Shubhada Maitra, Ravi Verma, Niranjan Saggurti

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

Coming Back to Oneself: A Case of Anoxic Brain Damage from a Phenomenological Perspective
Elisabeth L’orange Fürst

Struck by a cardiac arrest that lasted 3/4 of an hour, a 53-year-old man suddenly collapsed one day at work. The result was a serious anoxic brain damage that developed into dementia. This essay presents the process of ‘coming back to himself’ while it questions what this concept might imply. The descriptions and analyses rest upon an ethnographic study of his life, at hospitals and then at home, assisted by his wife, who is also the author of this article. Theoretically, the analysis depends on Merleau-Ponty’s phenomenology of perception and is also based on the therapeutic use of music in treating people with dementia championed by Oliver Sachs. It is argued that the field of medicine has much to learn from the anthropological method of long-term observation, as well as theories of embodiment that see the body as simultaneously being an object and a subject.

East Asian Science, Technology, & Society

Sipping Science: The Interpretative Flexibility of Science Cafés in Denmark and Japan
Kristian H. Nielsen, Gert Balling, Tom Hope and Masaki Nakamura

Science cafés were originally conceived as an informal, dialogue-based venue for public participation in science. The first science cafés took place in the United Kingdom and France in 1997–98. Two formats—one featuring a single speaker (United Kingdom) and one with a panel of speakers and a moderator (France)—resulted from these first initiatives. Since then, science cafés have been adapted to other sociocultural contexts, and today, science cafés are being conducted in many different countries and for many different purposes. We examine the emergence and development of science cafés in Denmark and Japan with particular focus on the role of science and technology studies (STS), national contexts of science communication policy, and cultures of public participation. We find that in both countries, despite different expectations of public deliberation about science and technology, science cafés have been easily embedded in the “new” scientific governance programs (Irwin 2006). This is mainly due to institutional support in the national research systems and the involvement of STS scholars who, in their support of public participation in science and dialogue-based science communication, have advocated science cafés as a meaningful way to intervene in science-society relationships. “Sipping science” in a science café, enabling public participation in science deliberations, has interpretative flexibility, appealing to a wide variety of people and stakeholders engaged in public communication of science and technology.

IVF the Chinese Way: Zhang Lizhu and Post-Mao Human In Vitro Fertilization Research
Lijing Jiang

In 1988, the first human baby conceived through in vitro fertilization (IVF) technology in mainland China was born at the Peking Medical College Third Hospital in Beijing. The Chinese media soon celebrated the IVF achievement for its scientific modernity, as well as for its indigenous design, which was deemed suitable for Chinese infertile women. By tracing the project director Zhang Lizhu’s professional, social, and technological experiences as the IVF project proceeded at the Third Hospital, I examine the sociopolitical justifications of the project and the technological strategies of the final IVF design. Sociopolitically, state funding for IVF in the mid-1980s, a time of governmental promulgation of the one-child policy, was predicated upon melding eugenic motives into the IVF program as a rationalization for fertility treatment. Technologically, what was claimed to be “indigenous” IVF design was actually a technical shortcut to quick success contrived to bypass challenging protocols established in developed countries. The case reveals that the IVF project and its representations in the reform era, though predominantly characterized by a sociotechnical pragmatism, still carried a hint of Maoist romanticism that celebrated worker innovation and indigenous self-reliance. Zhang’s IVF program thus offered a pivotal transitional process through which the sociotechnical imaginaries of biomedical reproductive modernity began to form in 1980s China.

Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine

Metrics of hope: Disciplining affect in oncology
Nik Brown

This article explores the emergence of a ‘regime of hope’ in the context of oncology care, practice and research. More specifically, my focus is the emergence, since the 1970s or so, of hope scales and indexes used to metricise the emotional states of cancer patients. These usually take the form of psychometric tests designed and deployed in order to subject affective life to calculative and rational scrutiny. This article locates this within the tensions of a ‘turn’ towards the emotions in critical social science literature. Scholarship has, for instance, been anxious not to deny the embodied reality of affectivity and the emotions. But it has been equally important to recognise the extent to which emotions are discursively ordered and structured as objects and effects of power. This article charts the emergence of hope scales historically alongside wider historical forces in the metrification of life and health and more specifically the emotions. It locates hope scales in a post-war climate of individual resilience and perseverant enterprise and the significance of hope as a naturalised vitalistic attribute of biopolitical life.

Ambivalent journeys of hope: Embryonic stem cell therapy in a clinic in India
Amit Prasad

Stem cell therapy in non-Western countries such as India has received a lot of attention. Apart from media reports, there are a number of social science analyses of stem cell policy, therapy, and research, their ethical implications, and impact of advertising on patients. Nevertheless, in the media reports as well as in academic studies, experiences of patients, who undertake overseas journeys for stem cell therapy, have largely been either ignored or presented reductively, often as a “false hope.” In this article, I analyze the experiences of patients and their “journeys of hope” to NuTech Mediworld, an embryonic stem cell therapy clinic in New Delhi, India. My analysis, which draws on my observations in the clinic and patients’ experiences, instead of seeking to adjudicate whether embryonic stem cell therapy in clinics such as NuTech is right or wrong, true or false, focuses on how patients navigate and contest these concerns. I utilize Gilles Deleuze and Felix Guattari’s “concepts,” lines of flight and deterritorialization, to highlight how embryonic stem cell therapy’s “political economy of hope” embodies deterritorialization of several “regimes of truth” and how these deterritorializations impact patients’ experiences.

Between hope and evidence: How community advisors demarcate the boundary between legitimate and illegitimate stem cell treatments
Alan Petersen, Claire Tanner, and Megan Munsie

Stem cell science provides an exemplary study of the ‘management of hope’. On the one hand, raising ‘hopes’ and expectations is a seen as a necessary aspect of securing investment in promising innovative research. On the other, such hyperbole risks raising hopes to a level that may lead people to undertake undue risks, which may ultimately undermine confidence in medical research. In this context, the ‘management of hope’ thus involves the negotiation of competing claims of truth about the value and safety of particular treatments and about the trustworthiness of providers. Using Gieryn’s concept of boundary-work, this article examines the means by which this work of ‘managing hope’ is undertaken. Drawing on data collected as part of our study that investigated the perspectives of those who are consulted by patients and their carers about stem cell treatments, we explore how these community advisors – both scientists and clinicians with a stake in stem cell research and representatives from patient advocacy groups – demarcate the boundary between legitimate and illegitimate treatments. In particular, we examine how these actors rhetorically use ‘evidence’ to achieve this demarcation. We argue that analysing accounts of how advisors respond to patient enquiries about stem cell treatments offers a window for examining the workings of the politics of hope within contemporary bioscience and biomedicine. In conclusion, we emphasize the need to re-conceptualize the boundary between science and non-science so as to allow a better appreciation of the realities of health care in the age of medical travel.

Web Roundup: Weather the Weather by Emily Goldsher-Diamond

31 Mars 2015 - 7:47pm

Inspired by yet another prediction of snowfall tonight in Brooklyn, this month’s web roundup will briefly outline some recent looks at climate change. Over at Jacobin, Andreas Malm critiques the Anthropocene narrative’s place in discourse around climate change. Malm writes, “Species-thinking on climate change only induces paralysis. If everyone is to blame, then no one is.” At Aeon, Jedediah Purdy worries that the “Anthropocene [is set up] as a Rorschach blot for discerning what commentators think is the epochal change in the human/nature relationship.” But when the news, like this recent post on ThinkProgress, argues that “global warming creates more global warning,” what else is there to do beyond looking to the Anthropocene for answers?

Nautilus looks at archaelogy’s role in nuclear-waste management, where “archaeological analogs can inspire us to reflect more imaginatively on possible similarities and differences between distant past, far-future, and present-day worlds.” Here too the Anthropocene is central, the guide to thinking through efficacy and futurity in nuclear-waste repositories.

Shrinking natural resources worldwide also inspired quite a few publications this month. Wired recently published an edifying piece on struggles over sand, “The Deadly Global War for Sand,” that details the high-stakes culture of illegal sand mining. The infographics alone are worth the trip to FEELguide, where “R.I.P. California (1850-2016)” reviews the “world’s first major water collapse.” Is there anything we can do to fight this seemingly inevitable march toward climate collapse? Well, Upstream suggests we continue to explore recycling.

Given the unseasonable snow headed my way, it might seem like the earth isn’t getting any warmer, but MAHB’s Holly Moehler has a hot take on why snowstorms fit firmly into climate change science.

Grab a sweater and enjoy a few more links of interest:

“Anglo Saxon Remedy Kills Hospital Superbug MRSA” – NewScientist

“How Influential Was Alan Turing? The Tangled Invention of Computing (and its historiography)” – blog.CASTAC

“The Science of Near-Death Experiences” – The Atlantic

“The Secret Life of the Aluminum Can, A Feat of Engineering” – Wired

“Aliens Among Us: Extraterrestrial Anthropology” – The Geek Anthropologist

“Fur Trade: When a Niche Community Goes Corporate” – Hazlitt

“Sex, Lives and Disability” – Mosaic

Jenell Johnson’s A Rhetorical History by Emma Bedor

30 Mars 2015 - 4:35pm

American Lobotomy: A Rhetorical History

by Jenell Johnson

University of Michigan Press, 2014, 240 pages.

 

Jenell Johnson’s 2014 book American Lobotomy: A Rhetorical History provides an accessible and thoroughly enjoyable look at how an infamous medical procedure – the lobotomy – developed, was administered, initially applauded, ultimately loathed, and has had an enduring and profound impact upon medicalization of the mind and public perceptions of medical authority. Johnson expertly intertwines history and detailed biographical information from and about medical professionals and their patients, and contextualizes it all with media and cultural artifacts to synthesize a project that is both entertaining and understandable by readers with little to no prior knowledge of psychiatry, psychosurgery, or public perceptions of the two.

American Lobotomy: A Rhetorical History is aware that the cultural discourse of the lobotomy is largely grounded within “conspiracy theories, political propaganda, radio and television documentaries, autobiographies, biographies, paintings, t-shirts, jokes, and congressional hearings” (1). All of these threaten, in fact, to obscure its initial medical justifications and applications. Yet Johnson’s book and larger project of highlighting significant socio-cultural discourses surrounding medicine provide a case study and argument for why the clouds of mystery that often obscure medical practices ought to be methodically deconstructed. Therefore, while largely historical, American Lobotomy is also forward-looking in that it presents a marvelous argument for why further scholarship exploring the cultural significance of medicine is necessary, perhaps more in the contemporary information age than ever before.

American Lobotomy’s introduction situates the lobotomy as not only a medical procedure, but a mythical one as well, in that its influence upon the American medical-cultural landscape endures despite its disappearance from legitimated medical practice. Chapters one and two delve into detailed explanations of its technical development and initial applications, how it was positively received and framed by media, and even won a Nobel Prize for one of its main proponents. Chapter three complicates the traditional explanation for lobotomy’s decline, which is typically the emergence of psychopharmacology as a “non-intrusive” method for altering undesirable mental states. To this Johnson juxtaposes a persuasive counter-narrative contending that the cultural effects of the Cold War included fears of brainwashing and psychological control; as a result, a large-scale distrust of psychiatry (and the lobotomy in particular) emerged. Chapter four articulates the “return” of lobotomy to the medical forefront when new psychosurgeries emerged during the mid-twentieth century, and here Johnson describes how the activists opposing them rhetorically collapsed psychosurgery with lobotomy, and their practitioner doctors to lobotomists, a strategy that clearly worked to their benefit.

The fifth chapter delves into an explanation of contemporary deep brain stimulation procedures and how they have become rhetorically positioned as different than lobotomies, while chapter six describes the infamous Trans-Allegheny Lunatic Asylum, a contemporary tourist attraction that Johnson herself visits. Here we read about the performative nature of the lobotomy within the present cultural arena, as it has become anthologized within film and horror stories as a warning about medicine, monsters, and medical malpractice. Like chapter six, American Lobotomy’s conclusion is one in which Johnson plays a key role: it contains personal reflections on the work, archival and personal, that was involved in this project, and Johnson’s own haunting realization that perhaps not as much has changed in the world of psychiatry and medicine as we may try to believe.

Methodologically Johnson’s use of rhetorical history neither detracts nor distracts from her project itself. Rhetorical history is a mode of criticism that advocates historicizing the object of critique, in this case the lobotomy, in order to better understand its cultural significance. While the content of the book itself could, I believe, still be informative and enjoyable without any sort of methodological rigor, the inclusion of the rhetorical perspective adds a theoretical dimension that is comprehensible across disciplines and adds increased interdisciplinary appeal to the project.

A potential critique of American Lobotomy is that it attempts to do too much: provide an all-encompassing history of a medical procedure and contextualize these findings from a socio-cultural perspective. Indeed, it is quite a large task to accomplish in fewer than two hundred pages. Yet to this I would respond that medicine and science cannot be divested from the social and cultural milieu in which they emerge and evolve, and to argue that such a thing is even within the realm of possibility is to blind oneself to the importance of social constructions of medicine, and medicine’s constructions of the social, particularly social order, which the lobotomy itself was initially designed to maintain and practiced upon those who threatened its delicate fabric.

All in all American Lobotomy manages to be at once convincing and entertaining, an easy read despite the sometimes dark nature of its subject matter, and highly recommended for anyone interested in the relationship between medicine and culture.

 

Emma Bedor is a PhD student in the department of Communication Studies at the University of Minnesota. Her research examines intersections of media, medicine, bioethics, and social justice.

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.

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