In the Journals

In the Journals, July 2015—Part I

Here is the first of two postings for this month’s “In the Journals,” featuring a lively collection of summer articles.  Happy reading/browsing/downloading!

 

Science, Technology, & Human Values

Regulatory Anatomy: How “Safety Logics” Structure European Transplant Medicine

Klaus Hoeyer

This article proposes the term “safety logics” to understand attempts within the European Union (EU) to harmonize member state legislation to ensure a safe and stable supply of human biological material for transplants and transfusions.  With safety logics, I refer to assemblages of discourses, legal documents, technological devices, organizational structures, and work practices aimed at minimizing risk.  I use this term to reorient the analytical attention with respect to safety regulation.  Instead of evaluating whether safety is achieved, the point is to explore the types of “safety” produced through these logics as well as to consider the sometimes unintended consequences of such safety work.  In fact, the EU rules have been giving rise to complaints from practitioners finding the directives problematic and inadequate.  In this article, I explore the problems practitioners face and why they arise.  In short, I expose the regulatory anatomy of the policy landscape.

Disastrous Publics: Counter-enactments in Participatory Experiments

Manuel Tironi

This article explores how citizen participation was methodologically devised and materially articulated in the postdisaster reconstruction of Constitución, one of the most affected cities after the earthquake and tsunami that battered south central Chile in 2010.  I argue that the techniques deployed to engineer the participation were arranged as a policy experiment where a particular type of public was provoked—one characterized by its emotional detachment, political engagement, and social tolerance.  The case of Constitución, however, also shows that this public ran parallel to other forms of being a public not aligned with the experiment’s assumptions.  More broadly, the article argues that while disaster studies need to acknowledge the generative capacities of public participation, science and technology studies should include disasters as a particular setting for participatory experiments.

 

Society and Mental Health

Variation in the Protective Effect of Higher Education against Depression

Shawn Bauldry

Numerous studies document that higher education is associated with a reduced likelihood of depression.  The protective effects of higher education, however, are known to vary across population subgroups.  This study tests competing theories for who is likely to obtain a greater protective benefit from a college degree against depression through an analysis of data from the National Longitudinal Study of Adolescent to Adult Health and recently developed methods for analyzing heterogeneous treatment effects involving the use of propensity scores.  The analysis examines how the effects of two “treatments” (at least some college education and attaining at least a four-year college degree) on latent depressive symptomology vary by background disadvantage, as indicated by having a low propensity for completing some college or attaining a four-year college degree.  Results indicate that people from disadvantaged backgrounds realize a greater protective effect of higher education, either completing some college or attaining a four-year degree, against depressive symptomology than people from advantaged backgrounds.  This pattern is more pronounced for people who attain at least a four-year degree than for people who complete at least some college education.

 

Sociology of Health & Illness

‘Fat girls’ and ‘big guys’: gendered meanings of weight loss surgery

Julia Temple Newhook, Deborah Gregory and Laurie Twells

Over 80% of weight loss surgery (WLS) patients are women, yet gender is overwhelmingly absent in WLS research.  This article discusses the findings of 54 interviews with twenty-one women and six men waiting for WLS in Newfoundland and Labrador, Canada.  We critically examine the ways that gender shapes the meaning of WLS in these narratives.  We explore gendered meanings in participants’ perspectives on their embodied experiences before surgery, social support as they decided to undergo the procedure, and their expectations for their lives after WLS.  We draw on feminist theory to explain how these findings counter the dominant gender-neutral medical model of obesity.

Stories of change in drug treatment: a narrative analysis of ‘whats’ and ‘hows’ in institutional storytelling

Ditte Andersen

Addiction research has demonstrated how recovering individuals need narratives that make sense of past drug use and enable constructions of future, non-addict identities.  However, there has not been much investigation into how these recovery narratives actually develop moment-to-moment in drug treatment.  Building on the sociology of storytelling and ethnographic fieldwork conducted at two drug treatment institutions for young people in Denmark, this article argues that studying stories in the context of their telling brings forth novel insights.  Through a narrative analysis of both ‘the whats’ (story content) and ‘the hows’ (storying process) the article presents four findings: (1) stories of change function locally as an institutional requirement; (2) professional drug treatment providers edit young people’s storytelling through different techniques; (3) the narrative environment of the drug treatment institution shapes how particular stories make sense of the past, present and future; and (4) storytelling in drug treatment is an interactive achievement.  A fine-grained analysis illuminates in particular how some stories on gender and drug use are silenced, while others are encouraged.  The demonstration of how local narrative environments shape stories contributes to the general understanding of interactive storytelling in encounters between professionals and clients in treatment settings.

Corporal diagnostic work and diagnostic spaces: clinicians’ use of space and bodies during diagnosis

John Gardner and Clare Williams

An emerging body of literature in sociology has demonstrated that diagnosis is a useful focal point for understanding the social dimensions of health and illness.  This article contributes to this work by drawing attention to the relationship between diagnostic spaces and the way in which clinicians use their own bodies during the diagnostic process.  As a case study, we draw upon fieldwork conducted with a multidisciplinary clinical team providing deep brain stimulation (DBS) to treat children with a movement disorder called dystonia.  Interviews were conducted with team members and diagnostic examinations were observed.  We illustrate that clinicians use communicative body work and verbal communication to transform a material terrain into diagnostic space, and we illustrate how this diagnostic space configures forms of embodied ‘sensing-and-acting’ within.  We argue that a ‘diagnosis’ can be conceptualised as emerging from an interaction in which space, the clinician-body, and the patient-body (or body-part) mutually configure one another.  By conceptualising diagnosis in this way, this article draws attention to the corporal bases of diagnostic power and counters Cartesian-like accounts of clinical work in which the patient-body is objectified by a disembodied medical discourse.

Straight, white teeth as a social prerogative

Abeer Khalid and Carlos Quiñonez

A distinguishing feature of North American society is preoccupation with self-image, as seen in the ritualistic nature of bodily practices aimed at constantly improving the body.  Nowhere is this more apparent than in the prevailing fixation with straight, white teeth.  While there is an ever-expanding literature on the sociology of body, very little has been written on teeth in this context.  Using literature from anthropology, biology, dentistry, sociology and social psychology, this study attempts to answer: (1) Why have straight, white teeth become a beauty ideal in North American society?  (2) What is the basis for this ideal?  (3) How is this ideal propagated?  It demonstrates that dental aesthetic tendencies are biologically, culturally and socially patterned.  Concepts from the works of Pierre Bourdieu and Michel Foucault are used to illustrate how straight, white teeth contribute towards reinforcing class differences and how society exercises a disciplinary power on individuals through this ideal.  It is concluded that modified teeth are linked to self and identity that are rooted in social structure.  Moreover, teeth demonstrate the ways in which class differences are embodied and projected as symbols of social advantage or disadvantage.  Implications on professional, public health, sociological and political levels are considered.

 

Subjectivity

Special Issue: Consuming habits: Today’s subject of addiction

Tidy house, tidy mind? Non-human agency in the hoarding situation

Tracey Potts

This article aims to disturb the received wisdom ‘tidy house, tidy mind’ by tracing its emergence and consolidation: from psychoanalysis to clinical psychology through to philosophy and reality television.  The contention here is that the commanding presence of the mirror as a clinical apparatus serves to eclipse a full consideration of the hoarding situation as one involving not only mental health professionals and clients, that is, ‘hoarders’, but also the materials of the heap – as the ‘hoard’ is read straightforwardly as a reflection of the hoarder’s mind.  It is argued, further, that the conspicuous neglect of things, that is, material objects, in the modelling of the hoarding ‘problem’ – the aetiology of Hoarding Disorder is cast in entirely human terms – serves to frame ‘hoarders’ as individually culpable.  By extending the forensic logic of both clinical and popular psychology, it is argued that such framing amounts to securing forced confessions, where hoarders are left to bear total responsibility for a situation, which is, ultimately, a question of distributed agency between human and non-human entities.

Technology and addiction: Subjectivity, scientific knowledge and the economy of jouissance

Kareen Ror Malone, Christopher R Bell and John L Roberts

As with any number of clinical ‘schools’ and approaches, Lacanian psychoanalysts encounter individuals whose presenting complaint is drug addiction.  Psychoanalysis has often been underestimated in its effectiveness in treating addiction, data for other approaches being less stellar than often realized.  Within the Lacanian orientation, addiction has been widely addressed, not as a specific syndrome but as a symptom with implications for the frame of the psychoanalytic work.  In such Lacanian formulations, both clinical and cultural contexts are examined in disentangling the effects of drug use for addicted persons and within the social ideals, representations and prohibitions that undergird the value and significance of drug use in any given culture.  Formal elements and functions of the process and products of speaking within psychoanalytic work inform Lacanian clinical practice.  These elements can be discerned within individuals’ desires and speech and within the social contract.  Lacanian concepts of subjectivity necessarily interact with the traditions and meanings inherent to Western societies.  Such elements may be posited as the aftermath of the social necessity of speech, a process that fundamentally informs subjectivity.  This article illustrates – using analysis of recent technological inventions – fantasies about technology, cultural representations of technology, and important parallels between technology and addiction.  The authors take a psychoanalytic look at technology through current Lacanian clinical thinking on the subjective structure related to addiction.

The hijacking of the symptom and the addictification of society

Rik Loose

This paper argues that the symptom, considered from a psychoanalytic perspective, has lost some of its protective function.  For Freud the symptom contained an element of meaning – a symbolic element – that allowed the subject to resolve or contain a conflict.  In recent times the power of this symbolic element has been eroded with the result that the subject has become more openly exposed to the cause of this conflict.  This opens up a path for the subject towards a solution that is less dependent on the symbolic than it is on products that can have an effect on the mind and body.  The author explores the various causes – science, capitalism and psychoanalysis – that contributed to the erosion of the power of the symbolic and he indicates how psychoanalytic treatment can have an effect on the changed status of the symptom.

 

Technology and Culture 

Delegating to the Automobile: Experimenting with Automotive Restraints in the 1970s

Jameson M. Wetmore

This article explores the attempts in the United States in the 1970s to implement a new paradigm for automobile safety—crashworthiness, the idea that automobile passengers should be protected in the event of a crash.  A large number of strategies were proposed, including air bags, seatbelt modifications, mandatory belt-use laws, and ignition interlocks.  Many of these did not initially come to fruition, but they did give the automobile safety community a chance to experiment with different ways of distributing responsibilities between automobile occupants, automobile manufacturers, and, to a lesser extent, government agencies.  These experiments helped pave the way for the successful implementation of a number of new strategies in the 1980s, 1990s, and 2000s.

Arrive Alive: Road Safety in Kenya and South Africa

Mark Lamont, Rebekah Lee

This article is among the first historical considerations of road safety in Africa.  It argues that race and class, as colonial dualisms, analytically frame two defining moments in the development of African automobility and its infrastructure—“Africanization” in the first decade of Kenya’s political independence from Britain, 1963–75, and democratization in postapartheid South Africa.  We argue that recent road safety interventions in both countries exemplify an “epidemiological turn” influenced by public health constructions of the HIV/AIDS epidemic.  African states’ framing of road safety in behaviorist terms has obscured larger debates around redressing the historical legacies of racialized access to roads and the technopolitics of African automobility.  Civic involvement in road safety initiatives has tended to be limited, although the specter of road carnage has entered into the public imagination, largely through the death of high profile Africans.  However, some African road users continue to pursue alternative, and often culturally embedded, strategies to mitigate the dangers posed by life “on the road.”

 

Theory, Culture & Society 

New Materialisms: Foucault and the ‘Government of Things’

Thomas Lemke

The article explores the perspectives of Foucault’s notion of government by linking it to the debate on the ‘new materialism’.  Discussing Karen Barad’s critical reading of Foucault’s work on the body and power, it points to the idea of a ‘government of things’, which Foucault only briefly outlines in his lectures on governmentality.  By stressing the ‘intrication of men and things’ (Foucault), this theoretical project makes it possible to arrive at a relational account of agency and ontology, going beyond the anthropocentric limitations of Foucault’s work.  This perspective also suggests an altered understanding of biopolitics.  While Foucault’s earlier concept of biopolitics was limited to physical and biological existence, the idea of a ‘government of things’ takes into account the interrelatedness and entanglements of men and things, the natural and the artificial, the physical and the moral.  Finally, the conceptual proposal of a ‘government of things’ helps to clarify theoretical ambiguities and unresolved tensions in new materialist scholarship and allows for a more materialist account of politics.

Integral Waste

Sean Cubit

It is not only the physical digital media that pile waste upon waste in an era of built-in obsolescence driven by over-production attempting to balance the falling rate of profit.  Energy used in the manufacture, employment and recycling of devices belongs to a system where waste is not merely accidental but integral to the operation of cognitive capitalism.  Oil and gas, uranium and hydroelectricity all prey disproportionately on indigenous peoples, who are turned into economic externalities along with their lands.  A parallel is drawn between the waste of power in generation and transmission, and the exploitation of human energy as excess under a cyborg capital that increasingly treats all humanity as external.

 

Transcultural Psychiatry

Brain fag: New perspectives from case observations

Peter O. Ebigbo, Elekwachi Chimezie Lekwas, and Nweze Felix Chukwunenyem

Brain fag was originally described as a culture-bound syndrome among West African students.  The term “brain fag” literally means “brain fatigue.”  Available literature indicates that brain fag symptoms usually present in formal academic settings when African students are required to transit to a reliance on written literature (as opposed to more traditional oral forms of information transmission) and to adapt to westernized, individualistic systems of education that, at times, oppose the values of relatively collectivistic African societies.  Based on detailed observation of two typical and two nontypical cases of brain fag, the authors suggest that the syndrome may not be solely related to tensions in the academic sphere, but may function more generally as an expression of psychological distress that results from societal pressures that exceed the coping capacity of the individual.  The brain fag symptoms, including lack of concentration, sensations of internal heat in the head and body, heaviness, and multiple somatic complaints, may constitute a defensive process which helps prevent a full-fledged decompensation.

Why do ethnic Chinese in the Netherlands underutilize mental health care services? Evidence from a qualitative study

Cha-Hsuan Liu, Ludwien Meeuwesen, Floryt van Wesel, and David Ingleby

Chinese immigrants in the Netherlands are less likely than other ethnic groups to utilize mainstream mental health care services.  This study investigated the experiences of Chinese with mental health problems, to inform measures to make services more responsive to the needs of this group.  Qualitative methods of analysis were applied to interview data in order to explore ways of finding help, barriers to accessing mainstream mental health care, experiences in care, factors jeopardizing the quality of care, and views on mental health services among Chinese migrants in the Netherlands.  Rather than recruiting individuals with mental health problems, an indirect method was used in which ethnic Chinese participants were invited to tell us about one or more Chinese individuals in their social environment whom they regarded as having (had) mental health problems.  Although most Chinese regarded mainstream Dutch care as the appropriate resource for dealing with mental health problems, many barriers to access and threats to care quality were reported.  In contrast to the widely accepted view that cultural differences in health beliefs underlie the low utilization of mental health services by Chinese in the West, the main obstacles identified in this study concerned practical issues such as communication problems and lack of knowledge of the health system.  Respondents also described concerns about entitlement to care and discrimination (actual or anticipated).  Measures suggested by respondents for improving care included increased use of interpreters and cultural mediators, encouraging migrants to increase their language proficiency, and better dissemination of information about the health system.  The article concludes with a discussion of the policy implications of these findings.

 


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