Below you will find Part II of our journal coverage for October…
Disability and the Global South
China Mills and Suman Fernando
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.
Thomas W. Crawford, Stephanie B. Jilcott Pitts, Jared T. McGuirt, Thomas C. Keyserling, Alice S. Ammerman
Greater accessibility to geospatial technologies has led to a surge of spatialized public health research, much of which has focused on food environments. The purpose of this study was to analyze differing spatial measures of exposure to supermarkets and farmers׳ markets among women of reproductive age in eastern North Carolina. Exposure measures were derived using participant-defined neighborhoods, investigator-defined road network neighborhoods, and activity spaces incorporating participants׳ time space behaviors. Results showed that mean area for participant-defined neighborhoods (0.04 sq. miles) was much smaller than 2.0 mile road network neighborhoods (3.11 sq. miles) and activity spaces (26.36 sq. miles), and that activity spaces provided the greatest market exposure. The traditional residential neighborhood concept may not be particularly relevant for all places. Time–space approaches capturing activity space may be more relevant, particularly if integrated with mixed methods strategies.
Jessica L. Adler
When Walter Reed United States Army General Hospital opened its doors in 1909, the Spanish-American War had been over for a decade, World War I was in the unforeseeable future, and army hospital admission rates were steadily decreasing. The story of the founding of Walter Reed, which remained one of the flagship military health institutions in the United States until its 2011 closure, is a story about the complexities of the turn of the twentieth century. Broad historical factors—heightened imperial ambitions, a drive to modernize the army and its medical services, and a growing acceptance of hospitals as ideal places for treatment—explain why the institution was so urgently fought for and ultimately won funding at the particular moment it did. The justifications put forth for the establishment of Walter Reed indicate that the provision of publicly funded medical care for soldiers has been predicated not only on a sense of humanitarian commitment to those who serve, but on principles of military efficiency, thrift, pragmatism, and international competition. On a more general level, the story of Walter Reed’s founding demonstrates a Progressive Era shift in health services for U.S. soldiers—from temporary, makeshift hospitals to permanent institutions with expansive goals.
(Extract) The history of medical genetics has long been narrated as a story of the unfortunate entanglement of human genetics with the morally dubious practices and scandals of eugenics from which it finally freed itself. Such a master narrative—which often refers to a legitimizing “medical turn” in the middle of the century after World War II—is deeply mistaken, argues Nathaniel Comfort. Eugenics was never “overcome,” as if it were some sort of “contaminant” that could finally be left in the dustbin of history, and at no time “did medical genetics break suddenly with its eugenic past.” Rather than assume a clear shift from “a focus on human improvement to one on relief of suffering,” Comfort argues that we have always been eugenical: “human improvement and the relief of suffering [are] the two goals of all eugenics—and all medical genetics.” The Science of Human Perfection offers a powerful revisionist account that highlights the key role played by an ever-present “eugenic impulse” in the emergence of medical genetics, which identifies how such an impulse remains an important and insidious feature of biomedicine even today. According to Comfort, “the promises of genetic medicine are the promises of eugenics.”
Andrew J. Hogan
(Extract) Over the past four decades, increasing numbers of Americans have faced the prospect of undergoing genetic testing in the context of reproduction, risk assessment, and clinical diagnosis. Paralleling this rise in new genetic technologies, historians of science and medicine have made many important contributions in recent years to our understanding of twentieth-century genetic medicine. Scholars have traced the direct ties between the history of eugenics and the field of medical genetics (Nathaniel Comfort, The Science of Human Perfection, 2012), the recasting of all human disease as genetic, and thus susceptible to technological control (Susan Lindee, Moments of Truth in Genetic Medicine, 2005), the role of prenatal and carrier testing in facilitating the birth of healthy children (Ruth Schwartz Cowan, Heredity and Hope, 2008), and the entanglement of genetic medicine with racial categories and assumptions (Keith Wailoo and Stephen Pemberton, The Troubled Dream of Genetic Medicine, 2006). Largely absent from this literature, however, has been an in-depth account of the field of genetic counseling as it grew up alongside and played a direct role in shaping the clinical uptake of new genetic technologies.
Nicholas Bartlett, William Garriott & Eugene Raikhel
Recent years have seen the emergence of a ‘global mental health’ agenda, focused on providing evidence-based interventions for mental illnesses in low- and middle-income countries. Anthropologists and cultural psychiatrists have engaged in vigorous debates about the appropriateness of this agenda. In this article, we reflect on these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia, and the United States. We argue that the logic of ‘treatment gaps,’ which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges, and actors framing and managing addiction (as well as other mental health issues) in any particular setting.
Marieke van Eijk
Health care institutions are often severely criticized for regulating the lives of individuals who deviate from socially sanctioned norms. In teaching people where they fit in the conventional scheme of things, institutions often reproduce socially dominant ideologies of normality, health, and self. Drawing on ethnographic fieldwork conducted at a university-based gender identity clinic in the United States, I demonstrate that while some institutions adopt dominant cultural frameworks, others critically assess these. To understand the intricacies of the clinic’s psychotherapeutic practices, I analyze the clinicians’ constructions of health and suffering. Instead of viewing transgenderism as a psychiatric condition, these clinicians approach it as a normal human condition that is marginalized by society’s heteronormative values. The analysis, attentive to the interaction among social context, institutional work, and psychotherapeutic ideologies, shows that while some institutions reproduce hegemonic cultural frameworks, others, in their attempts to alleviate people’s suffering, do challenge dominant social norms.
Dedicated to a South Indian goddess, devadasis are priests in a healing cult, whose nonconjugal sexuality has been designated ‘prostitution’ and subjected to eradication by the state. Drawing on ethnographic research, I consider two ways in which they cross the threshold of the clinic, as ‘vectors of disease’ and as sex worker peer educators, in order to think about the bio-politics of citizenship in postcolonial India. If biopolitical citizenship describes the way the state takes hold of their bodies, dedication describes how their bodies are claimed by the Devi Yellamma. I juxtapose these different ways of embodying power as a means to mark the limits of secular social scientific terms of recognition.
Heather A. Howard
The construction of illness as an inscription on the body of colonization figures importantly among Indigenous community-based service and health care providers. While residential schools and diabetes have both been characterized as products of colonization, little work has been done to examine how they are connected to and informative for health provider practice. The research data presented in this article come from a collaborative urban Indigenous community-based study examining the legacy of negative relationships with food that was instilled in residential schools and used in diabetes intervention. I illustrate how residential school disciplined eating, providing a context for understanding the contemporary production of Indigenous health knowledge and practice in the urban setting, and the diet-related management of diabetes.
In this article, I examine the self-positioning of many New Zealand mothers of children with asthma as parent-experts whose authority supersedes that of implementing the self-management strategies advocated by medical professionals. In a socio-political context that emphasizes neoliberal values of autonomy and self-responsibility, these parent-experts experiment with a variety of pharmaceutical regimes, determining familial modes of care that privilege the achievement of what they consider to be ‘normal childhoods.’ While some families accept asthma as a chronic condition and encourage children to adopt standardized, daily preventative regimes, others craft alternative strategies of pharmaceutical use that allow them to experientially maintain asthma as a sporadic and temporary, if frequent and sometimes dramatic, interruption of everyday life. Childhood asthma care practices are thus not only vested in kinship networks, but often arise out of familial-based experiments whose goal is to determine regimes that enable the preservation of ‘normality.’
Biomedicine is typically defined as the branch of medicine that is based on the principles of biology and biochemistry. A central tenet for biomedicine is the notion of disease and therapeutic specificity, i.e. the idea of tailored treatments for discrete disorders underpinned by specific pathologies. The present paper is concerned with how notions of disease and therapeutic specificity guide biomedical reasoning. To that end, the author proposes a model – the specificity triad – that draws on late philosopher and physician Ludwik Fleck’s concept of “style of thought” to offer a frame for investigating the intricate process through which links between disorders, mechanisms, and therapeutics are established by biomedicine. Next by applying the specificity triad model to scrutinize research efforts in two discrete areas of medicine–psychiatry and regenerative medicine–this paper seeks to stimulate pertinent discussions in and about biomedicine. These include discussions on the ambiguous epistemic status of psychiatry within contemporary biomedicine, as well as the relationship between developmental biology — historically relatively disjointed from biomedical enterprise — and the burgeoning field of regenerative medicine.
Ever since records began, accounts of other peoples and their institutions and customs have included comments about their mental characteristics. The present article traces this feature from the 18th century to roughly the First World War, with a brief sketch of more recent developments. For most of this period two contrasting positions prevailed: the dominant one attributed human differences to ‘race’, while the other one explained them in terms of psychological, environmental and historical factors. The present account focuses on the latter, among them those who asserted ‘the psychic unity of mankind’. Generally it is shown that from the early period when writings were based almost entirely on secondary sources, to the beginnings of empirical studies, ethnological theories were indissolubly linked to psychological concerns.
This article charts the history of mental testing in the context of the rise and fall of Russian child science between the 1890s and the 1930s. Tracing the genealogy of testing in scientific experimentation, scholastic assessment, medical diagnostics and bureaucratic accounting, it follows the displacements of this technology along and across the boundaries of the child science movement. The article focuses on three domains of expertise – psychology, pedagogy and psychiatry, examining the key guises that mental testing assumed in them – namely, the experiment, the exam and the diagnosis. It then analyses the failed state-bureaucratic harnessing of mental testing in early Soviet attempts to manage mass education, discussing the peculiar dynamics of the (de)legitimation of testing, as it swung between black-boxing and instrumentalization, on the one hand, and scandal and controversy, on the other. The article argues that mental testing thrived in Russia as a strategically ambiguous and flexibly interpreted ‘boundary object’, which interconnected a highly heterogeneous field, enabling the coexistence and cooperation of diverse occupational agendas and normative regimes.
This article examines three key aetiological theories of autism (meta-representations, executive dysfunction and weak central coherence), which emerged within cognitive psychology in the latter half of the 1980s. Drawing upon Foucault’s notion of ‘forms of possible knowledge’, and in particular his concept of savoir or depth knowledge, two key claims are made. First, it is argued that a particular production of autism became available to questions of truth and falsity following a radical reconstruction of ‘the social’ in which human sociality was taken both to exclusively concern interpersonal interaction and to be continuous with non-social cognition. Second, it is suggested that this reconstruction of the social has affected the contemporary cultural experience of autism, shifting attention towards previously unacknowledged cognitive aspects of the condition. The article concludes by situating these claims in relation to other historical accounts of the emergence of autism and ongoing debates surrounding changing articulations of social action in the psy disciplines.
Ari Väänänen, Michael Murray, and Anna Kuokkanen
Stress at work is a frequent subject of scientific research. In most of this, the unit of analysis has been the employee and his or her work stress. Historical, cultural and macro-contextual approaches have rarely been included in the analytical framework. In this study, we examined secular trends in scientific publications on work stress, and analysed how, over a period of 50 years, a new discursive, institutional, intellectual and subjective space has developed, in which questions related to workers’ diminished mental energy became the centre of attention. Our interpretation links the occupational health debate to the broader historical and cultural processes that took place in western countries and work organizations in the period 1960–2011. Our quantitative analysis shows how the number of work stress publications rose steeply until the early 2000s and how the growth evened out and even started to decline in some data sources in the early 2010s. It would seem that work stress research is reaching its peak and that other conceptualizations in the domain of occupational health (e.g. resource-based views) are becoming more important. This historical study provides new insights regarding the nature of work stress and its links with societal changes for all those interested in the changing nature of health at work.