In the Journals

In the Journals, December 2014 – Part II

(Editor’s Note: The beginning of 2015 seemed a good time to quickly turn back to the end of 2014 and wrap-up the final month’s journal posting, reminding us of the wealth of research that was presented over the course of the last year. The first part of December’s post can be found here.)

American Anthropologist

“The World’s Back Womb?”: Commercial Surrogacy and Infertility Inequalities in India

Holly Donahue Singh

While transnational commercial surrogacy in India has recently attracted the attention of journalists and feminist scholars critical of a novel and particularly intimate example of labor outsourcing, surrogacy in India is not only about global inequalities. In this research report, I call attention to silences in the most well-known accounts of surrogacy to the persistent local inequalities that structure infertility treatment in general—and surrogacy in particular. I argue that the disappearance of medical professionals’ perceptions of surrogates as “laborers” and of Indian infertility experiences in these accounts occurs not only because of significant challenges to data collection, but also because of widespread naturalization of inequality. Local inequalities that structure transnational surrogacy in India, in particular, and infertility treatment, in general, tend to escape the purview of examinations that employ a transnational frame. Most research on gestational surrogacy in India does not focus on the options available to Indians who face infertility. The few studies that put the dynamics of infertility among people living in India at the center of analysis have yet to explore fully the “reproscapes” of infertility among people in India.

 

IN FOCUS: CULTURE, POLITICS, AND IMAGINED GENETIC COMMUNITIES IN BRAZIL

Commentary: Brazil as a Continuous Laboratory of Races

Lilia Moritz Schwarcz

 

Varieties of the Primitive: Human Biological Diversity Studies in Cold War Brazil (1962–1970)

Ricardo Ventura Santos, Susan Lindee and Vanderlei Sebastião de Souza

In recent years, anthropologists, science scholars, and historians of science have shown growing interest in the history of research in physical anthropology in the post–World War II period, although most of the studies concentrate on North America and Europe. Here we focus on the history of human biological diversity research in South America in the 1960s. We carry out a comparative analysis of the research programs coordinated by two influential North American researchers (the geneticists Newton Morton and James Neel) in Brazil. We analyze the genesis of the two projects in light of the scientific and sociopolitical alignments of the period, and we find that the research was strongly tied to the context of the Cold War. We also address the scientific perspectives and choice of study populations (Indians and mestiços), as well as how the researchers attempted to construct far-reaching scientific models pertinent to the human species as a whole based on the concept of “primitiveness.” We argue that the research programs that Morton and Neel initiated in the 1960s are basic to the understanding of the history of physical anthropology not only in Brazil but also on a global scale in the decades following World War II.

 

Negotiating Imagined Genetic Communities: Unity and Diversity in Brazilian Science and Society

Michael Kent, Ricardo Ventura Santos and Peter Wade

In this article, we explore the ways in which genetic research reconfigures historically rooted debates on race and national identity by analyzing the intense debates that have taken place in the past decade in Brazil around the genetic profile of the nation’s population. Such debates have not only featured a significant variety of interpretations by different geneticists but also involved the media, policy makers, and social movements. Here we focus in particular on the ways in which genetic knowledge and the arguments it makes possible have reproduced, contested, or transformed pre existing narratives about race and national identity in Brazil. A central underlying tension in these debates is that between unity and diversity—between views that consider the Brazilian population as a single unit that cannot be differentiated except at the individual level and alternative interpretations that emphasize the multiplicity of its populations in terms of race, region, and genetic ancestry.

 

Commentary: Toward an Anthropology of Genetics

Jonathan Marks

 

Book Reviews

God’s Laboratory: Assisted Reproduction in the Andes by Elizabeth F. S. Roberts.

Ruthbeth Finerman

A Troublesome Inheritance: Genes, Race and Human History by Nicholas Wade.

Rachel Caspari

 

East Asian Science, Technology and Society: An International Journal

An Indian Path to Biocapital? The Traditional Knowledge Digital Library, Drug Patents, and the Reformulation Regime of Contemporary Ayurveda

Jean-Paul Gaudillière

For the past twenty years Indian Ayurvedic medicine has experienced a profound transformation originating in a complex process of industrialization and unequal but significant integration within the world of global pharmacy. The reformulation of classical combinations of medicinal plants described in centuries-old reference texts used by Ayurvedic practitioners lies at the heart of this process. Reformulation means at the same time simplifying and standardizing polyherbal combinations in order to (1) adapt them to mass and mechanized industrial processing, (2) mobilize elements of biomedical experimentation in the laboratory and the clinic to provide evidence of medical value, and (3) link Ayurvedic and biomedical categories to address the health needs of cosmopolitan consumers. Intellectual property rights play a peculiar role in the reformulation strategy since Ayurvedic formulas are viewed both as collective resources that must be protected from private appropriation to ensure further mining and as innovative products deemed protected through trademarks and patents.

This article explores this conundrum, using the Traditional Knowledge Digital Library (TKDL) that the Indian government began to develop in 2000 as a lens into this Indian path to biocapital. The article discusses three dimensions of the TKDL trajectory: (1) its origins in the international controversies about “biopiracy”; (2) the structure and operations of the database and its complex relationship with Ayurvedic knowledge, since its main aim is to translate traditional formulations into a scientific and legal idiom amenable to the work of patent offices worldwide; and (3) the consequences outside of India of its establishment, in particular at the European Patent Office, where TKDL-based information is used to evaluate patent applications for polyherbal drug formulation protection, thus creating a new jurisprudence about the boundaries between the protection and the appropriation of traditional medical knowledge.

 

Information and Its Practical Other: Crafting Zhuang Nationality Medicine

Judith Farquhar and Lili Lai

This article shows how a newly “salvaged” and “sorted” minority nationality medicine is being rendered as information, while attending to the dynamic emergence of new knowledge. After providing some historical background for the ethnic medicines movement and its Chinese character, we introduce Zhuang nationality medicine. First we consult two leading scholars of Zhuang medicine about history and theory, then turn to the informational and practical character of the medical textbooks they have collaboratively published. Turning then to our recent field research in Guangxi with Zhuang medicine experts, we puzzle over several instances of collecting and deploying information about a Zhuang medicine that is still hard to pin down. Contemplating the relatively short history of Zhuang medicine as a system, we ask questions about knowledge: What kinds of “wild” knowledge have been “salvaged” and “sorted” in the informationalizing process? What “traditional” knowledge has been put in the shade, what elements are brought to light, and where are people finding novelty and surprises? Though information narrows and disciplines a healing tradition, reducing and standardizing knowledge into communicable parts and ordered wholes, it also brings an added power to medical work through its publicity and practical dissemination. Asking what new worlds are emerging from modern epistemological disciplines, then, we bear witness to the creative syntheses that are put into play in the lives of healers and patients. We also note the emergence of a valorized wildness and excess inherent to practice, glimpsing in fragments a differently structured other to the formal knowledge or information that would tame healing knowledge for well-regulated use.

 

Authorizing Yoga: The Pragmatics of Cultural Stewardship in the Digital Era

Allison Fish

The so-called Digital Age, many claim, is marked by a shift from a global economy based on material industry to one based on the manipulation of information/knowledge. Whether or not one agrees with this assessment, the increased realization of information/knowledge as a prime source of market value has led to a consequent growth in the reach of intellectual property (IP) rights and in the diversity of individual and cultural ownership claims considered possible. This expansion has sparked heated debates marked by a broad sense of crisis that the very foundations of culture, creativity, and even humanity, are increasingly subject to privatization.

This article explores a key issue in these debates by examining processes of appropriation with respect to intangible heritage and the consequent development of “stewardship” as an authoritative claim over future interpretations of culture-as-resource. The discussion focuses on the complexities of fashioning contemporary cultural stewardship claims with respect to South Asian classical medicine, generally, and yoga, specifically. I examine the emergence of a particular understanding of cultural stewardship that enables certain parties, such as the Indian state, to be identified as legitimate guardians of South Asian intangible heritage while others, such as private individuals, come to be labeled cultural pirates.

 

Medical Humanities

‘Workshops in healing’ for senior medical students: a 5-year overview and appraisal

John H Kearsley, Elizabeth A Lobb

We report upon the design, content and feedback from an interactive, experiential series of Workshops in Healing for senior medical students. Fifty-six final year medical students enrolled in 2×3 h workshops designed around the core themes of ‘physician know thyself’ (Workshop 1) and ‘confronting suffering’ (Workshop 2). Of the 56 students who initially enrolled, 48 students completed both workshops and provided a written open-ended reflection of their learning experience. The study, undertaken over a consecutive 5-year period (2008–2012), employed an emergent, qualitative design using thematic analysis of the reflective comments. We found that the design and content of both workshops promoted transformative learning for these final year medical students. Students identified the following benefits: (1) the opportunity to reaffirm their commitment to their chosen career path; (2) the value of listening to other students share their stories; (3) the importance of the timing of the workshops to occur after exams; (4) the use of various mediums such as art, poetry, music and contemporary/classic literature to present concepts of suffering and healing; and (5) the creation of a safe and confidential space. Students reported that these innovative workshops gave them a renewed sense of drive and enthusiasm for their chosen career. They highlighted the importance of addressing an aspect of medicine (healing) not covered in the traditional medical curriculum. Workshops in Healing helped them to rediscover a deeper meaning to medicine and their roles as future healthcare professionals.

 

Empathy and integrative thinking: Talmudic paradigms for the essentials of a medical interview

John H Davidson

Intentional empathy and integrative thinking are essential elements of a medical interview. Yet the repetitive, sometimes monotonous, nature of medical practice can compromise their achievement. Emotional and intellectual fatigue may lead to clouded observation with diagnostic errors resulting. In spite of a long extant pedagogy of teaching interviewing techniques and creative mnemonics, hurdles remain and significant miscues continue. The challenge is one of surmounting these obstacles and of finding ‘new’ ways to perform ‘old’ tasks. It is to do what we already know to do but somehow do not. In the essay which follows, two Talmudic legends are identified and discussed as paradigms for empathy and integrative thinking. They are offered as ‘literary mnemonics’ for potential use in physician–patient encounters. The legends are linked to the insights of contemporary scholars including Jerome Groopman, Danielle Ofri, Roger Martin and others who have considered concepts of cognition, emotion, empathy, ‘opposable mind’ and integrative thinking in medical and non-medical settings.

 

White coat, patient gown

Caroline Wellbery, Melissa Chan

Much has been written about the symbolic function of the white coat: its implications of purity, its representation of authority and professionalism, and its role in consolidating a medical hierarchy. By contrast, the medical literature has paid almost no attention to the patient gown. In this article, we argue that in order to understand the full implications of the white coat in the doctor–patient relationship, we must also take into account patients’ dress, and even undress. We explore contemporary artistic images of white coat and patient gown in order to reveal the power differential in the doctor–patient relationship. Artistic representations capture some of the cultural ambivalence surrounding the use of the white coat, which confers professional status on its wearer, while undermining his or her personal identity. At the other end of the sartorial spectrum, hospital gowns also strip wearers of their identity, but add to this an experience of vulnerability. Although compelling reasons for continuing to wear the white coat in circumscribed settings persist, physicians should be mindful of its hierarchical implications. Ample room remains for improving patients’ privacy and dignity by updating the hospital gown.

 

Narrating the self-injured body

Amy Chandler

Illness narratives have traditionally been used as a conceptual tool for exploring experiences of chronic illness or disease. In this paper, I suggest that Frank’s typology of illness narratives (chaos, restitution and quest) also offers an illuminating approach to analysing accounts of self-injury, demonstrating the diverse ways in which self-injury is practiced, experienced and narrated. Drawing on 24 narrative interviews with 12 people who had self-injured, I focus on participants’ accounts of their self-injured bodies. The approach is phenomenological, and concerned with talk about the experience of living with and in a body that has been marked by self-injury. Thus, the act of self-injury is not the sole focus, and particular attention is paid to accounts of the bodily aftermath: scars, marks and wounds. Scars left by self-injury can be seen as communicative, and the analysis developed here demonstrates some of the various ways that these marks may be read. Attending to these diverse narratives can contribute to the provision of compassionate, non-judgmental care for patients who have self-injured. Further, highlighting the existence of different ways of narrating the self-injured body may offer an optimistic resource for people who have self-injured.

 

Twist of taste: gastronomic allusions in medicine

Ritu Lakhtakia

Food imageries that have inspired and embellished medical learning are, distressingly, vanishing from medical writings. A host of references to the aromas, shape, colour and texture of food have reinforced and stimulated generations of physicians to identify and understand disease. They have piqued interest in foods from lands afar and introduced an unsought dimension and enrichment to the medical lexicon. It is time to revisit this powerful tool and secure its place in medical teaching and records.

 

Is the agenda for global mental health a form of cultural imperialism?

Gavin Miller

The contemporary agenda for global mental health has met with sustained criticism from some commentators. This article evaluates one important strand of such appraisal: that in which the dissemination of Western mental health expertise is disparaged as a form of cultural imperialism. Derek Summerfield has vigorously criticised the contemporary global mental health agenda—a manifesto exemplified by WHO’s 2008 document mhGAP, an ‘action programme developed for countries especially with low and lower middle incomes for scaling up services for mental, neurological, and substance use disorders’. The programme proposes interventions designed to close various ‘treatment gaps’ between high income countries and low or middle income countries (LMICs). mhGAP cites, for example, a survey showing that around 80% of people with serious mental, neurological and substance abuse disorders in so-called ‘less-developed countries’ had received no treatment in the previous 12 months, set against a proportion of ‘35–50%’ for the same group in ‘developed countries’ (p. 7).1 Summerfield stringently criticises this kind of manifesto, arguing that such ‘psychiatric universalism risks being imperialistic’. Scaling up psychiatric services to close the presumed gap in mental health provision extinguishes local ways of expressing and dealing with distress, replacing them with particularly Western ways: ‘in globalising Western mental health, we are globalising a contemporary Western way of being a person’ (p. 5).

 

Book Reviews

The Bioethics of Pain Management: Beyond Opioids by Daniel S. Goldberg

Joanna Bourke

 

Medical Anthropology Quarterly

A Manufactu(RED) Ethics: Labor, HIV, and the Body in Lesotho’s “Sweat-free” Garment Industry

Nora J. Kenworthy

Employing mostly women and producing for major U.S. labels, Lesotho’s primarily foreign-owned garment industry undertook efforts to become “sweat-free” in 2006; simultaneously, it also began producing for the Product(RED) campaign. This article explores the parameters and ethical challenges of an industry-wide, public–private partnership providing HIV prevention and treatment services in this industry. Here, HIV services are intimately bound up in emerging patterns of humanitarian consumption and the production of an ethical industry. Within this ethical production zone, all is not what it seems: Labor violations persist, workers confront occupational hazards, and an elaborate theatrics of ethical practice plays out on the factory floor during routine inspections. This article explores the place and purpose of HIV treatment in the context of such humanitarian fetishism, highlighting the uses to which worker bodies are put and the conceptions of bodily well-being that prevail in these new “moral” economies.

 

“I Swear to God, I Only Want People Here Who Are Losers!” Cultural Dissonance and the (Problematic) Allure of Azeroth

Jeffrey G. Snodgrass, H. J. François Dengah and Michael G. Lacy

We use ethnographically informed survey and interview data to explore therapeutic and problematic play in the online World of Warcraft (WoW). We focus on how game-play in WoW is driven by shared and socially transmitted models of success that we conceptualize as cultural ideals. Our research reveals associations between having higher online compared to offline success, on the one hand, and gamers’ reports about how their play both adds to and subtracts from their mental wellness, on the other. Fusing William Dressler’s notion of “cultural consonance” (an individual’s relative consistency with his or her culture) with Leon Festinger’s “cognitive dissonance” (the tendency of individuals to suffer distress when they cannot eliminate incompatibilities in conflicting beliefs and attitudes), we develop the notion of “cultural dissonance,” which in this context refers to how conflicts between online and offline lives, and also subsequent attempts to minimize the conflicts through psychological negotiations, impact gamers’ mental health.

 

Deaf Capital: An Exploration of the Relationship between Stigma and Value in Deaf Multilevel Marketing Participation in Urban India

Michele Friedner

This article ethnographically examines how some deaf people in urban India have begun to orient themselves toward the future by participating in multilevel marketing businesses. In the absence of other structural possibilities for deaf future-making, deaf Indians have turned to such businesses in search of social, economic, and moral livelihood. This article analyzes participation in one particular business and asks how participating within the business both enables and disables the cultivation of specific ideas of development. Particular attention is devoted to exploring the multiple registers of the concept of “deaf development” and how such development may be cultivated through multilevel marketing businesses. This article aims to make a critical intervention in medical anthropology studies of disability by arguing that disability (or in this case deafness) can function as a source of value, therefore highlighting tensions between stigma and value.

 

Professionalizing Midwifery: Exploring Medically Imagined Labor Rooms in Rural Rajasthan

Sara Price

In India, globalized flows of biomedical discourse like evidence-based delivery practices (EBDs) and new technologies are reshaping the field of reproductive health care. As iterations of evidence-based medicine shift, non-governmental organizations (NGOs) increasingly act as distributive agents for biomedical projects that equate modernized health care spaces and provider-care techniques with a marked improvement in the safety of birth outcomes. In this article, I examine how particular local iterations of EBDs are distributed to skilled birth attendants (SBAs) who have become sites for globalized projects aimed at reshaping their professional designation. I draw on data collected through in-depth ethnographic interviews with SBAs practicing in health centers around southern Rajasthan to explore the dynamics and tensions surrounding the professionalization of midwives and the increasing promotion of EBDs in institutional labor rooms.

 

“The Same Thing in a Different Box”: Similarity and Difference in Pharmaceutical Sex Hormone Consumption and Marketing

Emilia Sanabria

The contraceptive pill has given way to a multitude of products, kinds of packaging, and modes of administration. This article draws on work on the pharmaceutical copy, extending the analysis to differentiating between forms of administration for contraceptive medicines as well as between brand-name drugs, generics, and similares, as they are known in Brazil. It explores how Brazilian prescribers and users—within the divergent structural constraints afforded by private and public health—apprehend and negotiate distinctions between the drugs available to them. This ethnographic account of hormone use reveals new fault lines through which the pharmakon exerts its influence. The attention that industry places on pharmacodynamics as it produces new products from similar compounds suggests that pharmaceutical effects are at once symbolic and real. The article concludes with a reflection on the future of the generic form in a field increasingly crowded by branded copies.

 

Stigmatized Neighborhoods, Social Bonding, and Health

Amber Wutich, Alissa Ruth, Alexandra Brewis and Christopher Boone

The relationship between living in impoverished neighborhoods and poor health is well established, but impacts of neighborhood stigma on health are not well understood. Drawing on long-term research with Latino immigrants, we examine how neighborhood stigma and social bonding affect health in Phoenix, Arizona. During preliminary ethnographic analysis, we developed a novel neighborhood stigma scale. In survey research, we examined effects of neighborhood stigma and social bonding on self-reported physical and mental health. Regression models show that perceived neighborhood stigma and low social bonding are associated with poorer physical and mental health, controlling for other factors.

 

Making Assumptions, Making Space: An Anthropological Critique of Cultural Competency and Its Relevance to Queer Patients

Kelly Baker and Brenda Beagan

Despite increased attention to “culturally competent” practice with diverse populations, lesbian, gay, bisexual, transgender, and queer (LGBTQ) people remain relatively invisible within medicine and other health professions. Health care providers (HCPs) frequently dismiss sexual and gender identity as irrelevant to care. This study uses interviews with 24 physicians and 38 LGBTQ-identified women to explore how routine practices in health care can perpetuate or challenge the marginalization of LGBTQ women. While physicians avoid making assumptions to reduce judgment, a “neutral” stance reinforces the hetero- and gender normative status quo. Cultural competence with LGBTQ patients requires learning with, rather than learning about, LGBTQ people’s particular health care concerns as well as paying explicit attention to pervasive power relations and normative contexts.

 

Troubling Gifts of Care: Vulnerable Persons and Threatening Exchanges in Chicago’s Home Care Industry

Elana D. Buch

By tracing the transformations of troubling exchanges in paid home care, this article examines how differently positioned individuals strive to build caring relations within potentially restrictive regimes of care. In paid home care in Chicago, older adults and their workers regularly participate in exchanges of money, time, and material goods. These gifts play a crucial role in building good care relationships that sustain participants’ moral personhood. Amid widespread concern about vulnerable elders, home care agencies compete in a crowded marketplace by prohibiting these exchanges, even as they depend on them to strengthen relationships. Supervisors thus exercise discretion, sometimes reclassifying gift exchanges as punishable thefts. In this context, the commodification of care did not lead to the actual elimination of gift relations, but rather transformed gift relations into a suspicious and troublesome source of value.

 

Health and Place

Community influences on contraceptive use in Mozambique

Boaventura Manuel Cau

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

 

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

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

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

 

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

Gemma Heath, Sheila Greenfield, and Sabi Redwood

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

 

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

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

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

 

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

Rikke Stamp Thorsen

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

 

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

Signe 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.

 

A review of the current geographic distribution of and debate surrounding electronic cigarette clean air regulations in the United States

Joy Kadowaki, Mike Vuolo, and Brian C. Kelly

In this article, we present the results of a systematic review of state, county, and municipal restrictions on the use of electronic cigarettes (e-cigarettes) in public spaces within the United States, alongside an overview of the current legal landscape. The lack of federal guidance leaves lower-level jurisdictions to debate the merits of restrictions on use in public spaces without sufficient scientific research. As we show through a geographic assessment of restrictions, this has resulted in an inconsistent patchwork of e-cigarette use bans across the United States of varying degrees of coverage. Bans have emerged over time in a manner that suggests a “bottom up” diffusion of e-cigarette clean air policies. Ultimately, the lack of clinical and scientific knowledge on the risks and potential harm reduction benefits has led to precautionary policymaking, which often lacks grounding in empirical evidence and results in spatially uneven diffusion of policy.

 

Ethos

Spirits and Exorcism: On the Semiotics of Healing and Recovery

Joseph S. Alter

Focusing on the ambiguous and indeterminate relationship between spirit possession and alcoholic spirits, this article shows how biosemiotics provides a way to understand healing and recovery from addiction. The efficacy of treatment for addiction is a spiritual function of social relations anchored in symptomatic diagnosis, rather than in the embodiment of belief as an expression of cultural meaning in ritual forms of treatment. As such, this article offers as critical, semiotic counterpoint to interpretations of ritual efficacy that are based on phenomenology and hermeneutics.

 

(Re)Working the Program: Gender and Openness in Alcoholics Anonymous

Rachel Kornfield

Given concerns that Alcoholics Anonymous (AA) might disempower already disenfranchised groups by focusing attention on self scrutiny and away from social action, this article explores how a cohort of black women members in Chicago portray the role of individual and social forces in their addictions. Despite challenges including histories of sex work and abuse, these women describe themselves as empowered in their recovery efforts and as more successful in AA than their male peers. Their reported success reflects their innovative application of a women-only meeting. Through this meeting, members develop a practice of “openness” that is in some ways at odds with AA’s customary self-focus, especially as it becomes grounds to exchange stories about social precipitants of addiction and to strategize ways to assert themselves in their relationships. Rather than enacting a pregiven version of AA, these women interpret the program in creative ways that allow them to accomplish a broad set of objectives.

 

Narcotics Anonymous: Anonymity, Admiration, and Prestige in an Egalitarian Community

Jeffrey K. Snyder and Daniel M. T. Fessler

Narcotics Anonymous (NA) supports long-term recovery for those addicted to drugs. Paralleling social dynamics in many small-scale societies, NA exhibits tension between egalitarianism and prestige-based hierarchy, a problem exacerbated by the addict’s personality as characterized by NA’s ethnopsychology. We explore how NA’s central principle of anonymity normatively translates into egalitarianism among group members. Turning to the lived reality of membership, building on Carr’s (2011) concept of script flipping, we identify script embellishment as speech acts that ostensibly conform to normative therapeutic discourse while covertly serving political ends. We argue that, in spite of the overtly egalitarian context, NA members differ dramatically in prestige, with more experienced members being admired and emulated. Critically, prestige acquisition occurs via structural functions that are central to the maintenance of the institution, as experienced members serve a central role in the transmission and enforcement of cultural norms, paradoxically including norms of egalitarianism.

 

Asserting Existence: Agentive Narratives Arising From the Restraints of Seeking Asylum in East Anglia, Britain

Sophia Rainbird

This article is based on fieldwork (2002–2003) in Great Yarmouth and Norwich in Britain with asylum seekers from Iraq, Iran, Kenya, Kosovo, Congo, and Montenegro as they await the outcome to their application for refugee status. During this period of liminality, their narratives were both urgent and repetitive expressions of their current immigration status and, to a lesser extent, their past experiences. In this article, I consider how such narratives are elicited by asylum seekers to craft an agentive capacity during this liminal period to overcome an existential crisis and assert their existence within society. Stories that recount traumatic experiences work as a way of reconciling a past that can no longer exist and a current state of liminality with a new sense of being in the world.

 

Enchanting Gods and Dolphins: A Cross-Cultural Analysis of Uncanny Encounters

Arnaud Halloy and Véronique Servais

 The main thrust of our research is to provide a cross-cultural definition of enchantment. Drawing on first-hand accounts of spirit possession in an Afro-Brazilian cult and on Dolphin encounters at sea, we compare the two settings to identify the common features in both people’s experiences and the technologies of enchantment that make them possible. According to our findings, the main features of the experience of enchantment are: ontological uncertainty as to the entities involved and the experience itself; uncanny feelings; an attentional focus on inner bodily and mental states; dissociative and hypnoid states; and a shift in perceived agency. We define the technology of enchantment as an “in-between space of practice” (Belin 2002), neither totally material, nor totally subjective, which enables the merging of unusual bodily states with imagination and culturally prepared expectations. Such merging is possible only if the individual is immersed in a sensorily organized environment (sensescape), made up of distributed perceptual saliences, and if a relation based on trust and benevolence is achieved.

 

Book Reviews

A Natural History of Human Thinking by Michael Tomasello

Reviewed by: Laura Lázaro and Moisès Esteban-Guitart

 

Configurations

Empathetic Reform and the Psychedelic Aesthetic: Women’s Accounts of LSD Therapy

Lana Cook

Both written under pseudonym, Constance Newland’s My Self and I (1962) and Jane Dunlap’s Exploring Inner Space (1961) are firsthand accounts of psychedelic drug use taken in therapeutic research settings that demonstrate how women’s access to discursive legitimacy was negotiated in mid-twentieth-century life-writing. Newland and Dunlap use realism to connect readers to their psychedelic subjects, while estranging readers’ familiar worldviews through metaphor. Through reader recognition and estrangement, Newland and Dunlap develop readers’ empathy as a reformist tool to challenge standard narratives of literature and science and carve out new representational space for alternative states of consciousness.

 

The Dialectics of Vulnerability: Breast Cancer and the Body in Prognosis

Nadine Ehlers

This essay argues that breast cancer prognosis potentially produces a dialectic in which the subject is compelled to perceive the body as vulnerable and separate (alien) to the self and that the treatments required make the body more vulnerable and more alien, and that this is held in tension with the fact that the very alienation and heightened vulnerability of the body in breast cancer treatment are productive. Such alienation and vulnerability collapse the boundaries through which the body and self are understood, often demand a conscious intimacy of/with the body, and point to critical enactments and understandings of embodied subjectivity.

 

Body and Society

Rhythm Returns: Movement and Cultural Theory

Julian Henriques, Milla Tiainen, and Pasi Väliaho

This introduction charts several of rhythm’s various returns as a way of laying out the theoretical and methodological field in which the articles of this special issue find their place. While Henri Lefebvre’s rhythmanalysis is perhaps familiar to many, rhythm has appeared in a wide repertoire of guises, in many disciplines over the decades and indeed the centuries. This introduction attends to the particular roles of rhythm in the formation of modernity ranging from the processes of industrialization and the proliferation of new media technologies to film and literary aesthetics as well as conceptualizations of human psychology, social behaviour and physiology. These are some of the historical antecedents to the contemporary understandings of rhythm within body studies to which most of the contributions to this issue are devoted. In this respect, the introduction outlines recent approaches to rhythm as vibration, a force of the virtual, and an intensive excess outside consciousness.

 

Abstract Time and Affective Perception in the Sonic Work of Art

Eleni Ikoniadou

The purpose of this article is to explore the concept of rhythm as enabling relations and thus as an appropriate mode of analysis for digital sound art installation. In particular, the article argues for a rhythmanalysis of the sonic event as a ‘vibrating sensation’ (Deleuze and Guattari) that incorporates the virtual without necessarily actualizing it. Picking up on notions such as rhythm, time, affect, and event, particularly through their discussion in relation to Susanne Langer’s work, I argue for the consideration of the sonic event as an instance of a different kind of temporality subsisting underneath clock-time and sense perception. Ultimately, and this is the position of this essay, an investigation into experimental projects that interweave digital, sound, and aesthetic dimensions enables the articulation of a rhythmic time that helps account for the unknown, indeterminate, and unintentional forces immanent to the sonic.

 

Wondering the World Directly – or, How Movement Outruns the Subject

Erin Manning

Turning to the moment when phenomenology (Maurice Merleau-Ponty) meets process philosophy (Alfred North Whitehead), this article turns around three questions: (a) How does movement produce a body? (b) What kind of subject is introduced in the thought of Merleau-Ponty and how does this subject engage with or interfere with the activity here considered as ‘body’? (c) What happens when phenomenology (Merleau-Ponty) meets process philosophy (Alfred North Whitehead)? and builds around three propositions (a) There is never a body as such: what we know are edgings and contourings, forces and intensities: a body is its movement (b) Movement is not to be reduced to displacement (c) A philosophy of the body never begins with the body: it bodies.

 

Wonder, Movement and Becoming: Response to Erin Manning

Stamatia Portanova

This response experiments with the practice of the interval, in order to performatively write in the little perceptual and cognitive gaps opening between the act of reading Erin Manning’s article ‘Wondering the world directly’, and the gesture of looking at the sky. The idea of the interval is in fact taken directly from Manning’s piece, together with Whiteheadian concepts such as ‘prehension’, ‘superject’, ‘nexus’, ‘eternal object’ and ‘society’. The aim is to respond to the way Manning’s writing amplifies the experience of cloud watching by proposing an elision of consciousness from the experience itself, and by replacing subjectivity with the more-than-human magic of ‘wondering the world’. It is, therefore, thanks to the reading of Manning’s article, that the experience of looking can reveal itself as a ‘becoming-cloud’. This response tries to also give something in conceptual exchange.

 

Thinking in Movement: Response to Erin Manning

Maxine Sheets-Johnstone

This review of Manning’s article wonders at the wonder that Manning describes. It does so first in broad terms that question the experience of wonder that Manning describes and goes on to wonder specifically about her understanding of the experienced realities of thinking in movement. In the course of doing so, the review questions her sweeping away ‘the subject’; questions her hard-and-fast distinctions between phenomenology and Whitehead’s metaphysics and voices wonder about her neglecting complementarities between phenomenology and Whitehead’s metaphysics; questions the validity of her claims about ‘where phenomenology goes wrong’; wonders about the absence of kinesthesia and its qualitative dynamics in what she writes of human movement; and finally wonders about her non-substantiated claims about ontogeny.

 

A Phenomenology of/with Total Movement: Response to Erin Manning

Jodie McNeilly

In ‘Wondering the world directly’, Erin Manning criticizes phenomenology by drawing upon Merleau-Ponty’s reflections on the problems of his own project and the criticisms of José Gil. Manning claims that phenomenology goes ‘wrong’ in its privileging of the subject and processes of intentionality: the ‘consciousness–object distinction’. While phenomenology on this understanding alone is inadequate to account for movement and the body, process philosophy has the ‘ability to create a field for experience that does not begin and end with a human subject’. This article responds to Manning’s criticism by arguing that phenomenology never intended to perpetuate a concept of subject that fixes an inexorable gap between itself and objects. A historical assessment of subjectivity and intentionality in the work of five different authors, alongside critical points that address Manning’s misconstrual of phenomenology, leads to an understanding of movement that need not ‘outrun the subject’ or become a precarious limit to perceptual experience because of its primacy.


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