Here is the first installment of April’s “In the Journals.” Enjoy!
In the Journal of Aging Studies,
The current North American successful aging movement offers a particular normative model of how to age well, one tied to specific notions of individualist personhood especially valued in North America emphasizing independence, productivity, self-maintenance, and the individual self as project. This successful aging paradigm, with its various incarnations as active, healthy and productive aging, has received little scrutiny as to its cultural assumptions. Drawing on fieldwork data with elders from both India and the United States, this article offers an analysis of cultural assumptions underlying the North American successful aging paradigm as represented in prevailing popular and scientific discourse on how to age well. Four key themes in this public successful aging discourse are examined: individual agency and control; maintaining productive activity; the value of independence and importance of avoiding dependence; and permanent personhood, a vision of the ideal person as not really aging at all in late life, but rather maintaining the self of one’s earlier years. Although the majority of the (Boston-area, well-educated, financially privileged) US elders making up this study, and some of the most cosmopolitan Indians, embrace and are inspired by the ideals of the successful aging movement, others critique the prevailing successful aging model for insufficiently incorporating attention to and acceptance of the human realities of mortality and decline. Ultimately, the article argues that the vision offered by the dominant successful aging paradigm is not only a particular cultural and biopolitical model but, despite its inspirational elements, in some ways a counterproductive one. Successful aging discourse might do well to come to better terms with conditions of human transience and decline, so that not all situations of dependence, debility and even mortality in late life will be viewed and experienced as “failures” in living well.
In Health & Place,
Doing ‘technological time’ in a pediatric hemodialysis unit: An ethnography of children
Hilde Zitzelsberger, Patricia McKeever, Elizabeth Peter, Adrienne Chambon, Kathryn P. Morgan, Karen Spalding
Since the 1960s, hemodialysis has been a common intervention for children with end-stage renal disease, however little is known about how they experience hospital-based hemodialysis. A focused ethnography was undertaken to explore children׳s perspectives of the time, space and technology of a hemodialysis unit at a Canadian pediatric urban hospital. The children׳s temporal and socio-spatial positions were an effect of their technologically mediated embodiment and shaped their perspectives, evaluations and expectations. The findings suggest that further explorations are needed to envision ways to create with children an overall positive place that merges and balances technological care with child focused care.
Social History of Medicine brings us:
This article investigates a novel type of war neurosis defined by Yugoslav psychiatrists in the aftermath of the Second World War. This uniquely Yugoslav war trauma—‘partisan hysteria’—was diagnosed exclusively in Communist resistance soldiers—partisans—and did not manifest itself in the form of battle exhaustion or anxiety, as was the case in other armies. Rather, it demonstrated a heightened willingness to fight, and consisted of simulations of wartime battles. Yugoslav psychiatrists argued that ‘partisan hysteria’ most frequently affected uneducated and immature partisans, who were given important political responsibilities but experienced severe trauma due to their own inadequacy. I argue that ‘partisan hysteria’ served as an opportunity for upper-middle-class psychiatric professionals to criticise the increasing upward social mobility after the socialist revolution of 1945. Surprisingly, this touched upon an issue that had already provoked deep disquiet within the Communist Party, and resonated with the Party’s own concerns regarding social mobility.
Historians of orthopaedics, artificial limbs and disability have devoted a great deal of attention to children and soldiers but have neglected to give sufficient space in their studies to industrial workers, the other patient group that has been identified as crucial to the development of these areas. Furthermore, this attention has led to an imbalanced focus on charitable and philanthropic activities as the main means of assistance and the neglect of a significant part of the voluntary sphere, the labour movement. This article, focusing on industrial south Wales, examines the efforts of working-class organisations to provide artificial limbs and a range of other surgical appliances to workers and their family members in the late nineteenth and early twentieth centuries. It finds that a distinctive, labourist conception of disability existed which envisaged disabled workers as an important priority and one to which significant time, effort and resources were devoted.
The use of the vaginal speculum was as important to Victorian doctors who struggled to professionalise the fields of gynaecology and obstetrics as it was controversial, especially when such doctors were men attending to women of respectable class status. While the debate over the use of the speculum in Victorian Britain was certainly rooted in moral concerns over the exposure of women’s bodies, an examination of the arguments made by Victorian medical men concerning the use of the instrument reveals that there was more than just modesty at stake. This article will consider how the nineteenth-century texts that articulate different positions regarding the use of the speculum in gynaecological examinations also demonstrate important tensions relating to the privileging of the sense of sight versus touch in Victorian medicine, particularly when referring to the respective utility and purpose of a male doctor’s visual or tactile knowledge of the inside of a woman’s body.
This article examines the experiences of mentally ill Nigerian migrants during the colonial era. Migrant Nigerian ‘lunatics’ faced different circumstances depending on what type of migrant they were and where they fell ill. Those in the UK tended to be repatriated for medical reasons, while those within the West African region rarely returned home because of financial considerations. Nigerian pilgrims to Mecca are noticeably absent from the discourse as are procedures associated with the relationship between migration and mental illness, despite the fact that they made up a large and constant flow of migrants from Nigeria during the colonial period. By putting these transnational individuals at the centre of analysis, this article provides a comparative perspective that reveals contingencies of psychiatric biopower that are often subsumed in narratives that focus on the activities of specific colonial asylums within individual colonial states.
As early as the 1950s, the profession of psychiatry in the United States began to experience a series of subtle adjustments. By the mid-1960s, the American Psychiatric Association was gripped and bound by the larger social, economic and political trends of the era. Widespread political activist movements focused on the Vietnam War, civil rights for blacks, and the elevation of feminism. Amid this contentious, transitional climate, factions in the field of mental health deliberated over best practices as well as broader questions of modernisation, scientific legitimacy and human rights. The Radical Caucus of the American Psychiatric Association was one such faction. It included black and women’s wings and challenged other members of the APA to embrace the transformative zeitgeist of the 1960s, as well as connect these tenets to the practice of psychiatry. This paper offers a snapshot of an important period in the history of American psychiatry, politics, and culture.
Ideology, Medical Authority and Hygienic Science in Communist Czechoslovakia
Bradley Matthys Moore
The communist political milieu offered distinct professional, scientific and socio-political advantages to agents of public health and hygiene in post-war Czechoslovakia. Hygienists employed the imperatives of Marxist-Leninism and Sovietisation to call for a fundamental reformulation of state and professional perspectives on population health, and further, to seek sweeping prerogatives over all the conditions of work and life in Czechoslovak society. Such an active and interventionist approach to preventive medicine, these hygienists asserted, was the primary route to the eradication of disease, the broad improvement of public health and the continued development of communism itself. The political and ideological demands of the regime largely aligned with existing environmentalist traditions in public health, and the leadership of Czechoslovakia’s nascent state hygiene services therefore coordinated their research aims, professional programme and practical efforts with the philosophical and institutional imperatives of Soviet-style communism in their own disciplinary interests.
Between the 1970s and the mid-1990s the body mass index (BMI) became the standard means of assessing obesity both in populations and in individuals, replacing previously diverse and contested definitions of excess body weight. This article draws on theoretical approaches from the sociology of standards and science and technology studies to describe the development of this important new standard and the ways in which its adoption facilitated the development of obesity science, that is, knowledge about the causes, health effects and treatments of excess body weight. Using an analysis of policy and healthcare literatures, I argue that the adoption of the BMI, along with associated standard cut-off points defining overweight and obesity, was crucial in the framing of obesity as an epidemic. This is because, I suggest, these measures enabled, firstly, the creation of large data sets tracking population-level changes in average body weight, and, secondly, the construction of visual representations of these changes. The production of these two new techniques of representation made it possible for researchers in this field, and others such as policymakers, to argue credibly that obesity should be described as an epidemic.
Descriptions of Euthanasia as Social Representations: Comparing the Views of Finnish Physicians and Religious Professionals
Leila Jylhänkangas, Tinne Smet, Joachim Cohen, Terhi Utriainen and Luc Deliens
In many western societies health professionals play a powerful role in people’s experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death-related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world-view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals – the freethinker with an atheist world-view – accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying.
‘We had to do what we thought was right at the time’: Retrospective Discourse on the 2009 H1N1 Pandemic in the UK
Mark Davis, Paul Flowers and Niamh Stephenson
For a few weeks in 2009 it was not certain whether the world faced a lethal influenza pandemic. As it turned out, the H1N1 pandemic was less severe than anticipated, though the infection did affect groups not usually susceptible to influenza. The deep uncertainties of this pandemic moment were associated with immense practical, scientific and political challenges for public health agencies around the world. We examine these challenges by drawing on the sociology of uncertainty to analyse the accounts given by UK public health practitioners who managed local responses to the pandemic. We discuss the retrospective and mitigating discourse; ‘we had to do what we thought was right at the time’, used by interviewees to explain their experience of articulating plans for a severe pandemic influenza with one that turned out to be mild. We explore the importance of influenza’s history and imagined future for pandemic management and, relatedly, how pandemic response and control plans disrupted the normal ways in which public health exercises its authority. We conclude by suggesting that difficulties in the management of pandemic influenza lie in its particular articulation of precautions, that is, securing a safe future against that which cannot be predicted.
Practical Compassions: Repertoires of Practice and Compassion Talk in Acute Mental Healthcare
Brian Brown, Paul Crawford, Paul Gilbert, Jean Gilbert and Corinne Gale
This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record-keeping and internal processes of quality control were seen as time-greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau-Ponty’s phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power.
Infant Mental Health Promotion and the Discourse of Risk
Angela Lawless, John Coveney, and Colin MacDougall
The field of infant mental health promotion has rapidly developed in academia, health policy and practice. Although there are roots in earlier childhood health and welfare movements, recent developments in infant mental health promotion are distinct and different. This article examines the development and practice of infant mental health promotion in South Australia. A regional, intersectoral forum with a focus on families and young children was used as a case study. In-depth interviews with forum members were analysed using a governmentality lens. Participants identified a range of risks to the healthy development of the infant. The study suggests that the construction of risk acts as a technique of governing, providing the rationale for intervention for the child, the mother and the public’s good. It places responsibility on parents to self-govern. Although the influence of broader social contexts is acknowledged, the problematisation of mothering as risk shifts the focus to individual capacity, rather than encompassing the systems and social conditions that support healthy relationships. This research suggests that the representations of risk are a pervasive and potent influence that can act to undermine health promotion efforts that seek to empower and enable people to have more control over their own health.
Thinking about Think Tanks in Health Care: A Call for a New Research Agenda
Sara E Shaw, Jill Russell, Trisha Greenhalgh, and Maja Korica
Little sociological attention has been given to the role of think tanks in health policy and planning. Existing work in political science and public administration tends to define and categorise think tanks and situate them as a disinterested source of policy expertise. Despite the increasingly visible presence of think tanks in the world of health care, such work has done little to reveal how they operate, by whom and to what ends. Our article seeks to redress this firstly by examining why they have remained relatively hidden in academic analyses and secondly by advocating an interpretive approach that incorporates think tanks within the wider landscape of health policy and planning. In contrast to most existing literature, an interpretive approach acknowledges that much of the messy business of healthcare policy and planning remains hidden from view and that much can be gleaned by examining the range of organisations, actors, coalitions, everyday activities, artefacts and interactions that make up the think tank stage and that work together to shape health policy and planning. Given the paucity of research in this area, we urge the medical sociology community to open the field to further academic scrutiny.
Collectivism, individualism, and pragmatism in China: Implications for perceptions of mental health
Arnulf Kolstad and Nini Gjesvik
This study aimed to better understand how minor mental health problems (MMPs) are perceived by well-educated urban dwellers in China who are influenced by Western values. Urban China is a rapidly changing society in which traditional Chinese culture and Western thought coexist. As a result, the established processes of interdependent self-appraisal have been challenged and a sense of a bicultural self has developed among a growing proportion of the population. The fieldwork for this study included interviews and observations. The results are derived mainly from interviews with professional practitioners, students, and lay people from three urban sites. One of the main findings was that respondents who referred to traditional and collectivistic Chinese values tended not to label MMPs as psychiatric disorders or illnesses but as challenges in daily life and relationships strain. While the Western medical model of MMPs considers them a form of illness, they were not viewed in this way in traditional collectivistic China in the past, even among educated urban dwellers. However, the urban and educated Chinese who have developed a stronger sense of a bicultural self are now more likely to perceive and deal with MMPs from a Western viewpoint.
Sociology includes the following articles of interest:
Paediatric genetics involves multiple visually based diagnostic processes. While examining the external features of a child plays an important role, of increasing importance are biochemical analyses of blood, which produce digital diagrams that display variations in the shape and composition of chromosomes. The level of magnification and detail that can now be captured is allowing new patterns of variation to be ‘seen’ and possible diagnosis to be made, which were not possible before. However, this generates questions about whether these forms of genetic diagnosis and digital visualisation are increasing the scope of medicine to define the body as ill – regardless of whether symptoms are present. This article, drawing from research in a paediatric genetic service, cautions against giving too much power to digital imagery. It does so by arguing that the imagery is only one source of visualisation relevant to how the child’s body is read and understood.
The meaning of kinship received little sustained attention for some time in British sociology. However, we are now beginning to see a shift, and Jennifer Mason’s (2008) conceptualisation of kinship affinities makes an important contribution to emerging debates. In this article I seek to add to such debates and also provide original data from the field of donor conception and lesbian motherhood, a particularly rich field in which to explore the meaning of kin. I investigate stories about becoming parents, and demonstrate that the issue of bringing kinship into being is a key concern in that process. I develop the argument that kinship is a multilayered and malleable resource with an exceptional capacity to encompass difference. This leads me to suggest that we need to be sensitive to the multitude, shifting ways in which connectedness is experienced in personal life.
Sociological Ambivalence and the Order of Scientific Knowledge
Michael Arribas-Ayllon and Andrew Bartlett
Merton’s early work on the ambivalence of scientists illustrates the productivity of importing a psychological concept to sociology. For commentators on the experience of modern societies, ambivalence describes the contradictory affective dimension of late modernity. In this article, our aim is to understand the extent to which sociological ambivalence reveals the contradictory relations between two orders of scientific knowledge: the epistemic and the social order. We illustrate several sorts of ‘value tensions’ in psychiatric genetics, a domain where the search for biological causes has led to several important shifts in scientific reasoning. For scientists working at a major UK research centre, we show how these tensions have transformed the organization of the scientific community; ambivalence is both a reflexive and uncomfortable response to a new way of producing knowledge. We argue that tension and ambivalence are intrinsic aspects of science-making and may reflect processes other than revolution and totalizing transformation.
And finally, the April 2014 issue of Subjectivity is a Special Issue, Rethinking Hybridity: Interrogating Mixedness, which is guest edited by Yasmin Gunaratnam and Wendy Hollway. Here are the abstracts for the introduction and two articles that may be of particular interest to Somatosphere readers.
Rethinking hybridity: Interrogating mixedness
This article discusses definitions and debates about the terms ‘hybridity’ and ‘mixedness’ across the natural and human and social sciences, including the work of the cultural theorist Homi Bhabha. Using the argonomic idea of homology, that refers to correspondences in both the quality and the states of a thing or phenomena, insights are offered into how we might think of the layers and processes of mixing that can be involved in the event of hybridity. This is particularly important because discussions of mixedness in the social sciences, and in everyday life, can run together different phenomena, strata, states, their sensual traits and their relative maturity or in/stabilities. In the process, different modalities of mixing can be subsumed or collapsed. The article also provides a summary of the key ideas and arguments made by contributors to the issue.
Using archival materials, I will examine how the mixed ancestry of African and Mexican Americans was treated, both in law and discourse, in distinctly contrasting ways in the early twentieth century. I will argue that black and Mexican subjects were positioned in qualitatively different ways in relation to whiteness. Furthermore, the singular treatment of ‘black blood’ as a social toxin, a construction emerging within the specific circumstances of American slavery, also informed the subjective positioning of Mexicans, as well as shaping some Mexican Americans’ responses to racism.
Morbid mixtures: Hybridity, pain and transnational dying
Three stories about dying migrants in the United Kingdom are at the heart of this article. Working with these narratives, I investigate the neurobiological, subjective and socio-cultural entanglements of disease, pain and dying and the challenges such hybridisations present for attempts to recognise and alleviate suffering. My aim is to show the differential workings of hybridising forces with regard to assumed correspondences and time, as well as the indeterminate and liminal states of subjective experience that disease can amplify. The article engages with the growing literature on ‘social pain’ and suggests that social pain is the mortar rather than merely a reflection of the affects and neurology of transnational migrations, loss and social violation.