Here is the second part.
In Hindi-speaking northeastern India, mothers whose daughters are afflicted with a psychosomatic illness referred to locally as “the teeth have clenched” employ standard tropes pertaining to Indian femininity to negotiate their daughters’ agency against the backdrop of new aspirations. An inquiry into two cases I encountered during fieldwork in Varanasi psychiatric clinics in 2001–04 demonstrates how girls’ symptomatic bodies mediated social concerns pertaining to the challenges that women’s education and work in public spaces present to non-elite middle-class domestic orders. While these illnesses may have been born of previous traumas or household conflicts, and sometimes were acknowledged as such, mothers’ and daughters’ own concerns about the illnesses focused on what they indicated about the daughters’ potential for social and academic success. In particular, mothers regarded their daughters as possessing either too much or too little “power” or “strength,” and these attributions attached to their anxieties and hopes for their daughters’ futures. In the drama of clenched teeth, disordered bodies, disruptive behavior, and possible futures were folded into the same metaphors of agency.
In North Carolina, a faith-based 501(c)(3) nonprofit organization facilitates a child sponsorship program that connects North American evangelical Christians with at-risk children in one of postwar Guatemala City’s most violent neighborhoods: La Paloma. Pitched in the name of gang prevention, child sponsors help create a context in which these Guatemalan kids might choose God over gangs. Based on fieldwork in North Carolina and in Guatemala, with both sponsors and the sponsored, this article explores how child sponsorship makes the work of gang prevention dependent on the work of self-cultivation. It is an ethnographic approach attuned to what this article understands as the subject of prevention, that is, the individual imagined and acted upon by the imperative to prevent. This includes at-risk youths, in all their racialized otherness, but also (and increasingly so) North American evangelicals who self-consciously craft their subjectivities through their participation in gang prevention. The subject of prevention’s observable outcome is a kind of segregation with its own spatial logic. The practice of evangelical gang prevention ultimately produces an observable kind of inequality that says something about the surgically selective nature of Central American security today. Some Guatemalan youth connect with North Americans. Others get left behind.
This article explores the engineering of affect in socialist urban design and subsequent changes in the affective register of a rapidly growing city in late socialist Vietnam. The setting is the north central city of Vinh, destroyed by aerial bombing during the American War and rebuilt with assistance from East Germany. A primary focus of urban reconstruction was Quang Trung public housing that provided modern, European-style apartments and facilities for more than eight thousand residents left homeless from the war. Drawing from interviews, images, poems, and archival materials that document urban reconstruction, the article foregrounds the complex historical, ideological, social, and gendered meanings and sentiments attached to a particular construction material: bricks. It argues that bricks have figured prominently in radical and recurring urban transformations in Vinh, both in the creation and the destruction of urban spaces and architectural forms. As utopic objects of desire, bricks gave shape to an engaged politics of hope and belief in future betterment, as construction technologies once reserved for the elite were made available to the masses. In Quang Trung public housing, bricks harnessed political passions and utopian sentiments that over time, as Vinh’s urban identity shifted from a model socialist city to a regional center of commercial trade and industry, came to signify unfulfilled promises of the socialist state and dystopic ruins that today stand in the way of capitalist redevelopment.
This article considers the treatment of commuter train suicides in Tokyo’s commuter train network in an effort to think critically about the lived experience mediated by theories of emergence materialized through “smart” infrastructures. In so doing, it embarks from the question of how the commuter train network thinks the disorder of the commuter suicide in relation to how the network has been restructured in recent decades to handle irregularity as regular. This restructuring, I demonstrate, works to corporealize the network in accordance with an understanding of the body as a paradigm of decentralized complex emergence, which is a concept with roots in cybernetics and artificial life but which has also been adopted in recent political theory to rationalize social, economic, and environmental instability. Materialized in the commuter train network, this concept asks us to think the system as a kind of machinic life that, while generating the potential for new forms of value creation, potentially encourages the experience of commuter suicides as a necessary and recursive process of metabolic renewal within a totalizing system.
Social Science & Medicine
‘Faking til you make it’: Social capital accumulation of individuals on low incomes living in contrasting socio-economic neighbourhoods and its implications for health and wellbeing (Kathryn Browne-Yung, Anna Ziersch, Fran Baum)
People on low-income living in low socio-economic neighbourhoods have poorer health in comparison with those living in advantaged neighbourhoods. To explore neighbourhood effects on health and social capital creation, the experiences of low-income people living in contrasting socio-economic neighbourhoods were compared, in order to examine how low-income status and differing levels of neighbourhood resources contributed to perceived health and wellbeing. Quantitative and qualitative data were analysed: survey data from 601 individuals living in contrasting socio-economic areas and in-depth interviews with a new sample of 24 individuals on low-incomes. The study was guided by Bourdieu’s theory of practice, which examines how social inequalities are created and reproduced through the relationship between individuals’ varying resources of economic, social and cultural capital. This included an examination of individual life histories, cultural distinction and how social positions are reproduced. Participants’ accounts of their early life experience showed how parental socio-economic position and socially patterned events taking place across the life course, created different opportunities for social network creation, choice of neighbourhood and levels of resources available throughout life, all of which can influence health and wellbeing. A definition of poverty by whether an individual or household has sufficient income at a particular point in time was an inadequate measure of disadvantage. This static measure of ‘low income’ as a category disguised a number of different ways in which disadvantage was experienced or, conversely, how life course events could mitigate the impact of low-income. This study found that the resources necessary to create social capital such as cultural capital and the ability to socially network, differed according to the socio-economic status of the neighbourhood, and that living in an advantaged area does not automatically guarantee access to potentially beneficial social networks.
International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women’s accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).
Sociology of Health & Illness
The end of life is a highly emotive and critical period in the life course and families often play a central role during this time. Despite significant sociological work on dying as a relational experience, there has been little exploration of the significance of contemporary family structures and relations. In this article, drawing on the accounts of twenty hospice in-patients, we explore how the end of life (in this case within an in-patient unit) is mediated by family dynamics and expectations. Participants’ accounts reveal a range of interpersonal experiences, including: pressures and strains on families and patients; differentiation in family responses to and involvement in the dying process; and tensions between individual and family preferences/desires. We argue that family dynamics strongly influence individual experiences near death and that the focus on individual preferences and the management of disease in palliative care contexts must be augmented with sophisticated and nuanced understandings of the family context. We suggest that sociological conceptual explanations of shifts in social and family life, such as individualisation and ontological security, may also help us better understand the ways families approach and respond to the dying process.
In this article we explore the concept of inter-embodiment and its potential for advancing sociological research into illness biography and genetic identity. Inter-embodiment theory views embodied knowledge as produced through relations between bodies, as opposed to originating from within the body or as the product of relations between disembodied selves. Drawing on a qualitative study in which we interviewed 38 individuals about their experiences of discovering they had high cholesterol and undergoing genetic testing for familial hypercholesterolaemia (FH), we discuss how their narratives may be understood from an inter-embodiment perspective. The participants frequently talked at length about their family histories of high cholesterol and cardiovascular disease. Through these accounts, we develop the concept of the family corpus in order to highlight the role body networks play in shaping lay constructions of genetic identity and a familial disease biography. The notion of a family corpus, we argue, is useful in understanding why genetic testing for FH was experienced as either biographical re-enforcement or as biographical disruption. We conclude by discussing the implications of our findings for future sociological research into illness biography and genetic identity.
Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the ‘invisibility’ of medical residents. Yet current reforms in postgraduate medical training point to an increasing emphasis on the measurable visibility of residents. Drawing on an ethnographic study of gynaecology training in The Netherlands, this article demonstrates that in daily clinical routines multiple practices of residents’ visibility (visibilities) coexist. The article lists four visibilities: staging residents, negotiating supervision, playing the invisibility game and filming surgical operations. The article shows how attending physicians and medical residents tinker with these visibilities in daily clinical work to provide good care while enacting learning space, highlighting the increasing importance of visualising technologies in clinical work. Moreover, the article contributes to traditional sociological accounts on medical education, shifting the focus from medical education as a social institution to the practices of medical training itself. Such a focus on practice helps to gain an understanding of how the current reform challenges clinicians’ educational activities.
First published in 1991, the ideas embedded in ‘Lay epidemiology and the prevention paradox’ offered a novel and rational explanation for the lay public’s failure to fully engage with the lifestyle messages offered by health educators. During the course of a large ethnographic study in South Wales, Davison and colleagues described the emergence of what they termed the coronary candidate. Candidacy provides a ‘cultural mechanism’ that facilitates the estimation of risk for coronary heart disease. The model has rarely been applied to other major illnesses. This article presents findings from a study that sought to explore the lay epidemiology model, candidacy and cancer. In a series of in-depth individual interviews, members of the lay public discussed their ideas about cancer, and what emerged was an explanatory hierarchy to account for cancer events. Yet the random and unpredictable nature of cancer was emphasised as well as a general reluctance to accept the idea of cancer candidacy.
Since the 1980s and 1990s doctors in the UK have reported a lack of time; this has been reproduced in the reorganisation of work through various contracts and regulatory mechanisms. I draw on interviews with 32 General Practitioners (GPs) in Wales about their everyday work, focusing on accounts about the limited nature of their time. I use Adams’ analysis of the rationalisation of work time through the processes of commodification, compression, and colonisation, to explore tensions between traditional and new ways of doctoring. While it was possible to find evidence of traditional ways of managing time that shaped the activities of doctors and controlled those activities, the doctors were not passive participants in the rationalisation of work time. Rather they actively modified its processes using notions of professionalism that are aligned to traditional doctoring, and which offer new ways of doing and being a professional.
This article extends discussions on the role of emotion in scientific lives by showing how the emotional commitments of researchers (here, psychologists and neuroscientists) can play a specifically constitutive or generative role. Autism research is an area where the tricky intertwinements of subjects, thoughts, interactions and bodies can be remarkably explicit: the article uses this case to show how researchers’ emotions can actually mediate transactions between intellectual/scientific problems and more material/bodily concerns. The article argues that autism research shows the on-going presence of affect in scientific subjectivities; in particular, it shows how scientific subjects sometimes constitute intellectual projects through a sensitivity to their own bodies and emotions. Gathering these concerns together, the article extends recent discussions of body work and emotion work by Natasha Myers and Wilson, and also draws on the ‘emotional’ aspects of Whitehead’s process philosophy.
In 2006, the US Center for Disease Control rolled out guidelines for ‘preconception care,’ institutionalizing the use of the public fetus as a fetish object in relation to which the cultural body can disavow and contain the post 9/11 contagion of annihilation anxiety. Integrating Bergson’s ideas of duration with cultural and psychoanalytic theories of time and subjectivity, this article will examine these guidelines and the ways in which they become alluring as forms of traumatic repetition instilling hypervigilance as normality. The preconception care guidelines are a perfect example of Clarke’s ideas of biomedicalization, as women’s bodies emerge through practices of self and biomedical surveillance and risk management strategies in relation to the future fetus. This future orientation functions not only to disavow, displace and contain vulnerability, but also creates a future in order to attempt to go on being in the face of trauma and humiliation.
Through the case study of Mabel Dodge, the mystic of Greenwich Village, this article shows how new forms of knowledge and free love converged in a turn to interrogating the female self. Mabel Dodge’s practice of subjectivity is an early twentieth-century example of what Michel Foucault called the ‘hermeneutics of the subject’, a form of spirituality grounded in the pursuit of the ‘truth’ of the self. Dodge’s efforts to grasp her ‘secret concentrated essence’ reveal an early twentieth-century invention of a new feminist spirituality at the crossroads of occultism, social reform, and sciences of psychology and biology.
The author attempts a micro-bio-politics of drugs, starting from an excerpt of an interview with a couple of young drug users in a Copenhagen social youth work facility that pushes harm reduction in 1996. The article is guided by Derrida’s idea of ‘drugs as the religion of atheist poets’ – that the contemporary discursive pragmatics of more or less pharmaceutical life practices still include forms of transcendence – and by the wish to fertilize the field of bio-politics with the indexical inter-subjectivity of the concept of ideology, as derived from an anti-essentialist reading of Hegelian–Marxist traditions. The analysis unfolds as an ideology critique that reconstructs, and seeks ways to overcome, particular forms of recognition that are identifiable in the data and in the field of drug practices, and how these form part of the constitution of singular collectives and participants – in these life practices, but also in the research practice that engaged with them through the interview.
Psychiatric discourses and practices largely focus on the mind when explaining why people change. Agency is thought to emerge out of rational introspection, insight and self-reflexivity, rendering them to key targets of psychotherapeutic interventions. In this essay, an everyday psychiatric situation will be presented in order to illustrate that agency cannot merely be located in the depth of the human mind, but might also arise from a pre-reflective, internalized corporeality. Such a mode of subjectivity is shown to direct ways how to move and position a body, both incorporating a mindful rationality and its embodied foundation. Over the course of this discussion, agency is explained as resulting out of a sort of distributed effect, simultaneously allowing for the analysis of cognitive, embodied and environmental factors that produce change in a symmetrical way. To conclude, initial thoughts will be presented to alter both the clinicians and academic approach towards agency, assigning the embodied self a more substantial role in navigating a person’s behaviour.