In the Journals

In the Journals December 2015 – Catching up

Happy New Year to all Somatosphere readers! Hopefully you were able to take a break and came back refreshed and ready to tackle your reading list. Not sure where to start? Start here with the In the Journals December recap. Owing to its length, the round-up is divided into two separate posts. Find the second half here.

American Anthropologist

Sick Healers: Chronic Affliction and the Authority of Experience at an Ethiopian Hospital

Anita Hannig

At fistula hospitals in Ethiopia, patients who are not cured of their incontinence are hired as “nurse aides” to perform essential nursing duties in the ward and operating theater. An array of tensions surrounds the work of these women, tensions that are emblematic of their chronic—but secret—patient status. If accidentally disclosed, the women’s ongoing illness episodes sabotage their ability to administer treatment, such as injections. In contrast to classic anthropological accounts of wounded healers and therapeutic narratives about the virtues of experience-based care, I argue in this article that illness experience can also have a profoundly delegitimizing effect. Rather than attributing these dynamics to the alleged stigma that surrounds obstetric fistula sufferers, I delineate the various challenges to clinical authority that are epitomized by the figure of the sick healer. Nurse aides’ experiences with obstetric fistula proved to be a liability precisely because these experiences had not been resolved. Their chronic injuries raised questions both about their medical training and the efficacy of surgery. Attending to these Ethiopian health practitioners can hone our grasp of the professional dilemmas posed by chronic afflictions and contribute to our understanding of available ideologies at play in the global practice of biomedicine.

Medical Research Participation as Citizenship: Modeling Modern Masculinity and Marriage in a Mexican Sexual Health Study

Emily Wentzell

In this article, I discuss people’s use of medical research participation to perform and model modernity amid societal insecurity. I analyze data from interviews with heterosexual Mexican couples undertaken throughout men’s multiyear participation in a human papillomavirus (HPV) study. I argue that through activities like willingly undergoing genital examination and involving wives in husbands’ clinical visits, spouses used the study as a forum for performing ideals of modern gender and health, specifically companionate marriage and non-macho masculinities emphasizing male self-care. They also hoped to serve as role models for their children and for society at large. I discuss how specific elements of the Mexican context made fomenting social change through individual research participation seem possible: cultural narratives of the Mexican populace as a bioculturally homogenous whole; longstanding state efforts to modernize the population away from “traditional” gender and health practices; and ongoing failures of the “slippery State” to reliably provide the resources those practices required. In this context, participants framed themselves as a middle-class vanguard and experienced sexual health research as an act of citizenship through which they hoped to spur national progress despite state failures and the persistence of antimodern gender and health attitudes. 

Real People, Real Dogs, and Pigs for the Ancestors: The Moral Universe of “Domestication” in Indigenous Taiwan

Scott Simon

Humans and other animals often engage in multispecies relations that go beyond classical definitions of “domestication,” not least because there are political dimensions to those relations. External interference with human–animal relationships has notably been part of indigenous experiences of colonialism and postcolonialism. I examine here changes in the triangular relationship between humans, dogs, and pigs among the indigenous Seejiq Truku of Taiwan. Dogs, as hunting companions, are traditionally associated with men’s work; pigs, used in ancestral sacrifices, are aligned with women’s work. Pigs are mediators with the spirit world, as ancestor spirits respond to regular pig sacrifices by providing prey to hunters. Dogs are important as hunting companions that make it possible to catch boars and other animals. These human–animal relations have undergone change because of the integration of the Seejiq into new markets, the state, and legal regulations about both hunting and the keeping of animals. Human–animal relations also articulate with dynamics of gender and class in a changing political economy. The Seejiq frame their intrahuman and interspecies relations in terms of Gaya, their sacred ancestral law. By affirming the value of their particular type of multispecies community, the Seejiq demonstrate resilience and a strong defense of sovereignty.

Anthropology Meets Epigenetics: Current and Future Directions

Zaneta M. Thayer, Amy L. Non

Anthropologists are interested in understanding patterns of human variation, whether assessed along cultural, biological, linguistic, or material metrics. Epigenetics, the study of heritable chemical modifications to DNA, is an emerging approach that could enrich modern anthropological research. Epigenetic marks can change in response to many of the processes anthropologists study—for example, migration, nutritional stress, psychosocial stress, and social inequalities, to name a few. Thus, epigenetic processes could provide a biological explanation for the embodiment of such environmental experiences. Further, given the potential for epigenetic marks to be inherited across generations, it is possible that these marks facilitate intergenerational transmission of environmental information and therefore help to shape the direction of evolutionary change. In this article, we review some of the ways in which epigenetic methods have been successfully incorporated into anthropological and related studies as well as emphasize promising future directions and challenges for the use of epigenetic data across subfields of anthropology. While epigenetic data have great potential for informing anthropological research, we emphasize that a healthy skepticism is necessary given our still-nascent understanding of these processes.

Biology and Culture Beyond the Genome: Race, Racism, and Health

Amy L. Non, Clarence C. Gravlee

To what extent are health and disease shaped by genetic inheritance or by lived experience? Although it may sound like a medical question, it is fundamentally an anthropological one: it evokes old debates about nature and nurture and reminds us why cultural and biological anthropology sprang from the same discipline. As opposed to rehashing ideas from earlier centuries, current debate around genetic and environmental influences on health builds on recent discoveries about the complexity of disease and more nuanced understandings of the relations among genes, biology, and culture. However, these debates are also riddled with traps of reductionism and racial-genetic determinism. An integrative, anthropological approach that simultaneously leverages genetics and sociocultural data avoids these traps by recognizing (a) how culture shapes scientific interpretations of biological difference and (b) how systemic racism produces biological inequalities.

Anthropological Genetics

Andrew Kitchen, Amy L. Non, Clarence C. Gravlee, Connie J. Mulligan, Christina Warinner, Cecil M. Lewis Jr., Richard J. Bankoff, Heritiana D. D. Randrianatoandro, George H. Perry, Ripan S. Malhi, Alyssa C. Bader, Jennifer Raff

Over the past few decades, anthropologists have increasingly used genetic approaches in their efforts to understand humans and their primate relatives. Technological and theoretical developments in recent years have enabled anthropological geneticists to expand their field of inquiry far beyond what was thought possible even a few years ago (Crawford 2000). Most importantly, the cost of collecting large genetic data sets has dropped dramatically, aiding researchers to better investigate complex questions such as the organization of our genome and the diversity of microbes living in our guts. Spectacular recent genetic discoveries, moreover, have altered understandings of our relationships to other hominin lineages. For example, genetic data have shown that both Neandertals (Green et al. 2010) and a newly discovered Denisovan population (Krause et al. 2010; Meyer et al. 2012) interbred with modern humans.

Social and Behavioral Epigenetics

Connie J. Mulligan

Epigenetic changes are chemical modifications in the genome that influence how DNA is used to make proteins that affect phenotypes but epigenetic changes do not alter DNA sequences. Most epigenetic alterations include the attachment of a simple chemical to DNA at certain sites (methylation) throughout the genome and modifications to the proteins that help package and organize DNA in chromosomes (Handel et al. 2009). These epigenetic alterations may play a role in transforming social, psychological, behavioral, or biological stressors into changes in the production of proteins (gene expression). From an evolutionary perspective, this would make sense. Epigenetic modification of protein production may have evolved in higher-order organisms to provide short-term responses to changes in the environment without changing the underlying DNA sequence. In contrast, changes in DNA sequences occur infrequently over many generations and would provide long-term adaptations.

Microbiome and Health in Past and Present Human Populations

Christina Warinner, Cecil M. Lewis Jr.

The human body contains approximately 100 trillion cells, of which more than 90 percent are microbial. These underexplored and mostly nameless microorganisms, collectively known as the human microbiome, weigh about as much as the human brain and harbor an immense diversity of genes that far exceed the functional capacity of our own genome, playing critical roles in digestion, vitamin production, drug metabolism, and immunity. This intimate relationship between humans and their microbes is being increasingly described by evolutionary biologists as that of a holobiont, a large interdependent and symbiotic community that evolves as a unit and cannot be understood by examining independent members alone (Zilber-Rosenberg and Rosenberg 2008). In part to address this reconceptualization of what it means to be human, the National Institutes of Health Common Fund launched the Human Microbiome Project (HMP) in 2007, an initiative whose goal was to better understand the human holobiont by sequencing all symbiotic microorganisms in and on the human body (Peterson et al. 2009).

Engaging Native Americans in Genomics Research

Ripan S. Malhi, Alyssa C. Bader

Native North American groups have rarely been included in population-based genetic studies (Need and Goldstein 2009; Reich et al. 2012).3 The tumultuous history of interactions between scientists and the indigenous peoples of the Americas has likely contributed to the dearth of genomic data on Native North American peoples. For instance, researchers who have taken blood samples in indigenous communities have often not returned to report and explain research results (Wiwchar 2004). This exploitation of indigenous community members has created a mistrust of scientists (Schroeder et al. 2006) that leads many Native Americans to refuse to participate in genetic studies. Genomic scientists have reacted to indigenous mistrust by using methods that favor statistical workarounds (Wall et al. 2011) or convenience sampling rather than making the necessary effort to develop strong collaborative relationships with indigenous communities. As a result, the little genetic data that have been collected from Native American communities have not been very informative. Overall, Native Americans have opted out or have been left out of major genomic efforts to understand human genetic diversity from populations worldwide such as the International HapMap Project and the 1000 Genomes Project.

 

BioSocieties

Neuroscience beyond the laboratory: Neuro knowledges, technologies and markets

Tanja Schneider, Steve Woolgar

Neuroscientific research studies the brain as a novel means for accessing knowledge about human health, behaviour and social interaction. In recent years a broad range of academic disciplines, professional fields but also artists and lay groups (such as patient groups) have engaged with findings and technologies developed in neuroscience (for example, Frazzetto and Anker, 2009; Ortega, 2009).

Neuromarketing in the making: Enactment and reflexive entanglement in an emerging field

Tanja Schneider, Steve Woolgar

As the neurosciences make their way beyond the laboratory, they become influential in a wide range of domains. How to understand this process? What are the prospects for, and dynamics of, influence, uptake and rejection? This article reports our attempts to track the emergence of neurosciences with particular reference to the emergence of the field of neuromarketing. Our key initial tasks included the identification and definition of the field, the negotiation of access, and establishing relations with participants and informants. These tasks gave rise to what are often construed as familiar ‘methodological difficulties’, such as how to define the field and what to make of the reactions and responses of those involved in neuromarketing. In this article we present some of our experiences of researching the empirical materials of neuromarketing to assess different responses to ‘methodological difficulties’ in studying science and technologies in the making. We draw on analytic resources provided by Science and Technology Studies to address the challenge of studying emerging fields of science, practices and technologies. In particular, we draw on the concepts of multiplicity, performativity and practical ontology to argue that a particular approach to ‘methodological difficulties’ can actually enrich our research objectives. We suggest that reflexivity be understood, not predominantly as a methodological corrective to the problems of detecting an antecedent object of research; but as revealing some of the ways in which neuromarketing is enacted.

Commercialising neurofutures: Promissory economies, value creation and the making of a new industry

Paul Martin

The contemporary era is characterised by the development of knowledge economies in which scientific research and technical innovation are seen as the motor for growth and competitive advantage. Nowhere is this more apparent than in the biosciences, where the emerging bioeconomy is surrounded by high hopes, but remains an area with few working technologies entering routine use. These developments have focused scholarly attention on the performative role that sociotechnical expectations play in constituting new scientific and technological domains. However, relatively little is known about the role of expectations in the commercial development of new technologies, the commodification of knowledge and the creation of economic value. This article therefore seeks to address these questions by exploring the role of expectations in the creation of a new industrial sector based on the commercial development of neurotechnology in the United States. In particular, it will focus on the role of two types of ‘promissory organisation’ in the making of the neuroindustry, how different regimes of hope and promise have been constructed around distinct groups of companies, and the complex relationship between these regimes. In conclusion, some reflections will be made about the way in which high-technology industries, sociotechnical futures and new forms of promissory value are co-produced.

Sex, cash and neuromodels of desire

Isabelle Dussauge

In the twenty-first century’s biological culture, pleasure and desire seem to be widely reconceptualized as processes of the brain. The neurosciences of sex and money are two fields of crucial interest in this cerebralization of desire. On the basis of a cross-reading of neuroimaging studies of sexuality and of neuroeconomics, I analyze the specific notions of desire/pleasure at work in the neuroimaging experiments. What is lost, and what is claimed to be found, in the neurosciences of desire for sex and cash? With particular attention to notions of rewards, I argue that transfers of metaphors from neuroeconomics naturalize economized notions of sexual desire. Moreover, I argue that neuroeconomics and the neuroscience of sex essentialize desire as the drive of our behavior, and that this, in turn, relates to the neurosciences’ re-invention of the social in the terms of a late capitalist society.

Measurement devices and the psychophysiology of consumer behaviour: A posthuman genealogy of neuromarketing

Stefan Schwarzkopf

From the 1890s, psychophysiological measurement devices have played an important, but as yet under-theorized role in marketing and consumer research. Because of the recent advances made in neuromarketing, it is often assumed that these measurement devices ushered in a radically new understanding of the type of subjectivity that underlies consumer behaviour. I argue instead that a posthuman view of the relationship between brain, mind and behaviour underpinned neurophysiological research into consumers from its very beginning in the late nineteenth century. By tracing the biopolitical potentialities of neuromarketing back to the Fin-de-Siècle neurophysiological laboratory, I show that consumers’ bodies and later on their brains became reconfigured as part of a dispositif made up of laboratory-based artefacts (measurement devices) and new ways of seeing the human brain and human behaviour. This dispositif, the latest expression of which is neuromarketing, promised to empower marketing researchers and practitioners alike by fulfilling their dream of being able to bypass consumers’ verbalized cognition and instead draw upon the ‘truth’ of their physiological reactions.

Chinese biotech versus international ethics? Accounting for the China–America CRISPR ethical divide

Lijing Jiang, Hallam Stevens

In March 2015, molecular biologists concerned about the use of the new gene-editing technology called Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) met in Napa, California to consider ethical issues raised by the new technique. Because the CRISPR-Cas9 system targets DNA at very specific sites with high efficiency, the technique offers a powerful way to cut and paste genes.

 

Body & Society

From Disfigurement to Facial Transplant – Identity Insights

David Le Breton

The face embodies for the individual the sense of identity, that is to say, precisely the place where someone recognizes himself and where others recognize him. From the outset the face is meaning, translating in a living and enigmatic form the absoluteness yet minuteness of individual difference. Any alteration to the face puts at stake the sense of identity. Disfigurement destroys the sense of identity of an individual who can no longer recognize himself or be recognized by others. Disfigurement places a mask on the face. The goal of a facial transplant consists of restoring an individual’s place in the world and reviving his taste for life, returning to him his ‘human shape’. Facial transplants raise essential anthropological questions such as ‘Who am I?’ and ‘To whom belongs this face that henceforth is mine?’

Rapid Home HIV Testing – Risk and the Moral Imperatives of Biological Citizenship

Jonathan Banda

This article examines the home rapid HIV test as a new practice of US biocitizenship. Via an analysis of discourse surrounding self-diagnostics, I conclude that while home HIV tests appear to expand consumer rights, they are in fact the vanguard of a new form of self-testing that carries a moral urgency to protect one’s own body and to manage societal risk. In addition, these tests extend biomedical authority into the private domain, while appearing to do the exact opposite. Furthermore, access to these tests may be stratified, contradicting the intent expressed by the manufacturer to reach populations in need of it most and reinforcing stigma against them. Lastly, diagnostics such as the rapid home HIV test represent new obligations for surveillance of one’s own health and that of others. The new public health effort to test the population at large has given rise to a new ‘risky’ population: the untested bodies.

Material Feminism, Obesity Science and the Limits of Discursive Critique

Megan Warin

This article explores a theoretical legacy that underpins the ways in which many social scientists come to know and understand obesity. In attempting to distance itself from essentialist discourses, it is not surprising that this literature focuses on the discursive construction of fat bodies rather than the materiality or agency of bodily matter. Ironically, in developing arguments that only critique representations of obesity or fat bodies, social science scholars have maintained and reproduced a central dichotomy of Cartesian thinking – that between social construction and biology. In this article I examine the limitations of social constructionist arguments in obesity/critical fat studies and the implications for ignoring materiality. Through bringing together the theoretical insights of material feminism and obesity science’s attention to maternal nutrition and the fetal origins hypothesis, this article moves beyond the current philosophical impasse, and repositions biological and social constructionist approaches to obesity not as mutually exclusive, but as one of constant interplay and connectedness.

Selfies, Image and the Re-making of the Body

Katrin Tiidenberg, Edgar Gómez Cruz

This article explores the relationality between women’s bodies and selfies on NSFW (Not Safe For Work) tumblr blogs. We consider the way selfie practices engage with normative, ageist and sexist assumptions of the wider culture in order to understand how specific ways of looking become possible. Women’s experiences of their bodies change through interactions, sense of community and taking and sharing selfies. This article provides an empirical elaboration on what sexy selfies are and do by analysing interviews, selfies and blog content of nine women in the NSFW self-shooters community on tumblr. For our participants, self-shooting is an engaged, self-affirmative and awareness raising pursuit, where their body, through critically self-aware self-care, emerges as agentic, sexual and distinctly female. Thus, this is a reading of selfies as a practice of freedom.

Listening-touch, Affect and the Crafting of Medical Bodies through Percussion

Anna Harris

The growing abundance of medical technologies has led to laments over doctors’ sensory de-skilling, technologies viewed as replacing diagnosis based on sensory acumen. The technique of percussion has become emblematic of the kinds of skills considered lost. While disappearing from wards, percussion is still taught in medical schools. By ethnographically following how percussion is taught to and learned by students, this article considers the kinds of bodies configured through this multisensory practice. I suggest that three kinds of bodies arise: skilled bodies; affected bodies; and resonating bodies. As these bodies are crafted, I argue that boundaries between bodies of novices and bodies they learn from blur. Attending to an overlooked dimension of bodily configurations in medicine, self-perception, I show that learning percussion functions not only to perpetuate diagnostic craft skills but also as a way of knowing of, and through, the resource always at hand; one’s own living breathing body.

 

Configurations

Deleuze, Haraway, and the Radical Democracy of Desire

Robert Leston

In response to suggestions that Deleuze and Guattari are the “enemy” of companion species, this essay explores the tension between Donna Haraway’s attacks against Deleuze and Guattari and their philosophy of becoming animal. The essay goes on to contextualize Deleuze and Guattari’s statements against pet owners through a discussion of the psychoanalytical refiguration of desire and shows how their ostensible attack against pet owners fits into their larger critique against capitalism. The essay illustrates why Deleuze and Guattari and Haraway are more in agreement than first meets the eye, finding commensurability through Haraway’s early work on embryology. Becoming animal does not begin and end with either humans or animals, and the essay explores the high stakes of focusing on intensities rather than actual animal bodies.

Fear and Panic in Iowa City: Narratives, Affects, and Amygdalae

Timothy Yaczo

Overturning assumptions about the neural location of fear in humans, University of Iowa neuroscientists successfully frightened the previously “fearless” Patient S.M. in 2013. Examining this Iowa study on fear as a productive problem for both neuroscience reporting and studies of affect in the humanities, this article asks how narratives of fear travel to implicate our understanding of contemporary scholarship in the humanities and sciences. It questions the ways in which scientific case studies themselves, alongside popular scientific and philosophical appropriations of scientific material, are determined by affective responses formed in relation to narrative.

 

Culture, Medicine and Psychiatry

Bangkit: The Processes of Recovery from First Episode Psychosis in Java

A. Subandi

There is a growing literature on recovery from schizophrenia. Most studies, however, focused on outcome, with insufficient attention paid to the process of recovery. The aim of this study was to explore the process of recovery from first episode psychotic illness in a Javanese cultural setting. An ethnographic method was applied where researcher conducted a field work and followed seven participants in their natural setting. This study identified three phases of recovery process in the context of Javanese culture: Bangkit, gaining insight; Usaha, struggling to achieve recovery; andRukun, harmonious integration with family and community integration. Recovery entails regaining insight, followed by simultaneous inward and outward efforts that reconstitute one’s inner and outer world, respectively. Participants also expressed their recovery in terms of a movement through physical space, from confinement in their own home to the wider spaces shared with family and community. Movements in physical space parallel movements in social space, where participants accomplish a social recovery. The Javanese phase of recovery found in this study is comparable to the phase of recovery identified by previous literatures in the Western context.

“Doctor, Why Didn’t You Adopt My Baby?” Observant Participation, Care, and the Simultaneous Practice of Medicine and Anthropology

Carolyn Sufrin

Medical anthropology has long appreciated the clinical encounter as a rich source of data and a key site for critical inquiry. It is no surprise, then, that a number of physician–anthropologists have used their clinical insights to make important contributions to the field. How does this duality challenge and enhance the moral practice and ethics of care inherent both to ethnography and to medicine? How do bureaucratic and professional obligations of HIPAA and the IRB intersect with aspirations of anthropology to understand human experience and of medicine to heal with compassion? In this paper, I describe my simultaneous fieldwork and clinical practice at an urban women’s jail in the United States. In this setting, being a physician facilitates privileged access to people and spaces within, garners easy trust, and enables an insider perspective more akin to observant participation than participant observation. Through experiences of delivering the infants of incarcerated pregnant women and of being with the mothers as they navigate drug addiction, child custody battles, and re-incarceration, the roles of doctor and anthropologist become mutually constitutive and transformative. Moreover, the dual practice reveals congruities and cracks in each discipline’s ethics of care. Being an anthropologist among informants who may have been patients reworks expectations of care and necessitates ethical practice informed by the dual roles.

Posthumous Reproduction (PHR) in Israel: Policy Rationales Versus Lay People’s Concerns, a Preliminary Study

Yael Hashiloni-Dolev

Israeli policy concerning PHR has been decided upon in an expertocratic manner, leaving the voice of the public unheard. Based on 26 semi-structured in-depth interviews with 13 Jewish-Israeli young couples, this preliminary study provides the first empirical data regarding lay attitudes toward PHR in Israel. Findings suggest major dissimilarities between the policy and lay people’s wishes and rationales. While policy is built on the “presumed wish” assumption, supposing all men living in a loving relationship wish to have their partner carry their child post-mortem, this was empirically unsupported. However, the findings suggest that many interviewees were willing to defer to their surviving spouse’s wishes to have their post-mortem child, sometimes even against their own wish, indicating a support for presumed consent. Respecting the wishes of the dead, a dominant argument in the bioethical discussion in Israel and beyond, was mainly irrelevant to informants, whereas interviewees considered the future child’s welfare, a concern overlooked by Israeli policy. Likewise, while posthumous grandparenthood is on the rise in Israel, it clearly contradicts the wishes of the majority of this study’s informants. Nonetheless, existing policy is not expected to raise any opposition, due to the extreme liberalism of the participants and their support of reproductive autonomy.

Cultural Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated Supernatural Beliefs

Baland Jalal, Andrea Romanelli, Devon E. Hinton

The current study examines cultural explanations regarding sleep paralysis (SP) in Italy. The study explores (1) whether the phenomenology of SP generates culturally specific interpretations and causal explanations and (2) what are the beliefs and local traditions associated with such cultural explanations. The participants were Italian nationals from the general population (n = 68) recruited in the region of Abruzzo, Italy. All participants had experienced at least one lifetime episode of SP. The sleep paralysis experiences and phenomenology questionnaire were orally administered to participants. We found a multilayered cultural interpretation of SP, namely the Pandafeche attack, associated with various supernatural beliefs. Thirty-eight percent of participants believed that this supernatural being, the Pandafeche—often referred to as an evil witch, sometimes as a ghost-like spirit or a terrifying humanoid cat—might have caused their SP. Twenty-four percent of all participants sensed the Pandafeche was present during their SP. Strategies to prevent Pandafecheattack included sleeping in supine position, placing a broom by the bedroom door, or putting a pile of sand by the bed. Case studies are presented to illustrate the study findings. The Pandafeche attack thus constitutes a culturally specific, supernatural interpretation of the phenomenology of SP in the Abruzzo region of Italy.

Pursuing Pleasures of Productivity: University Students’ Use of Prescription Stimulants for Enhancement and the Moral Uncertainty of Making Work Fun

Margit Anne Petersen, Lotte Stig Nørgaard, Janine M. Traulsen

This article presents ethnographic data on the use of prescription stimulants for enhancement purposes by university students in New York City. The study shows that students find stimulants a helpful tool in preventing procrastination, particularly in relation to feeling disinterested, overloaded, or insecure. Using stimulants, students seek pleasure in the study situation, for example, to get rid of unpleasant states of mind or intensify an already existing excitement. The article illustrates the notion that enhancement strategies do not only concern productivity in the quantitative sense of bettering results, performances, and opportunities. Students also measure their own success in terms of the qualitative experience of working hard. The article further argues that taking an ethnographic approach facilitates the study of norms in the making, as students experience moral uncertainty—not because they improve study skills and results—but because they enhance the study experience, making work fun. The article thereby seeks to nuance simplistic neoliberal ideas of personhood.

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

Elena Portacolone, Steven P. Segal, Roberto Mezzina, Nancy Scheper-Hughes, Robert L. Okin

According to the World Health Organization (WHO), the “Trieste model” of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person—not his or her disorders—at the center of the health care system. The model, revolutionary in its time, began with the “negation” and “destruction” of the traditional mental asylum (‘manicomio’). A novel community mental health system replaced the mental institution. To achieve this, the Trieste model promoted the social inclusion and full citizenship of users of mental health services. Trieste has been a collaborating center of the WHO for four decades with a goal of disseminating its practices across the world. This paper illustrates a recent attempt to determine whether the Trieste model could be translated to the city of San Francisco, California. This process revealed a number of obstacles to such a translation. Our hope is that a review of Basaglia’s ideas, along with a discussion of the obstacles to their implementation, will facilitate efforts to foster the social integration of persons with mental disorders across the world.

Fighting with Spirits: Migration Trauma, Acculturative Stress, and New Sibling Transition—A Clinical Case Study of an 8-Year-Old Girl with Absence Epilepsy

Dimitrios Chartonas, Ruma Bose

In this article, we discuss the impact of migration and acculturation processes on the cultural, personal identity, and mental health of children who immigrate to a Western, multicultural environment, and the challenges clinicians in such environments face, when confronted with non-Western idioms of distress and healing practices. We do that by presenting a challenging clinical case of an 8-year-old girl who presented with very disorganized behavior, which matches a culturally accepted construct of spirit possession, in the context of migration trauma, acculturative stress, and new sibling transition. We identify cultural conflict in school and bullying as major mediators between acculturative stress and mental distress. We also aim at identifying vulnerability, risk and protective factors, and the importance of cultural coping resources. We explore in depth the patient’s cultural background and the family’s belief system and culturally shaped narratives, in order to arrive at a cultural formulation, which focuses on the significance of idioms of distress in shaping psychopathology and influencing the personal and interpersonal course of trauma- and stress-related disorders. We also call attention to the finding that in children, idioms of distress may manifest themselves in a somatic manner. We argue, together with other researchers, that spirit possession deserves more interest as an idiom of distress and a culture-specific response to traumatizing events. We finally emphasize the importance of an anti-reductionist clinical stance, that is able to use different levels of understanding processes of distress and healing, and seeks to reconciliate cultural divides and integrate different explanatory frameworks and help-seeking practices.

 

East Asian Science, Technology, & Society

We Have Never Been Latecomers: A Critical Review of High-Tech Industry and Social Studies of Technology in Taiwan

Dung-sheng Chen

This article illustrates the development of the latecomer concept, starting initially from studies of Taiwan’s high-tech industry and then proposing a latecomer thesis based on the theoretical arguments in that literature. That thesis has also influenced Taiwanese STS studies of technology, including transferred and local technologies and Chinese medicine, and this article shows how this approach has framed the scope of the literature’s interpretation of empirical findings in different ways. Although the latecomer thesis has to some extent become dominant in academic approaches to technology in Taiwan, there exist alternative approaches derived from reflexive studies of Chinese medicine and of local reassembled-car technology, as well as of local trail-construction technology, all of which have broken out of the theoretical constraints of the latecomer thesis. On the one hand, some studies of Chinese medicine construct an insightful model integrating a practical ontology, a correlative thinking method, and displacement agency theory, sharing basic theoretical assumptions with Bruno Latour’s actor-network theory. On the other hand, the studies of reassembled cars, plant grafting, bridge construction, and local trail construction highlight the undesirability of classifying diverse technologies into a simple binary and prescribing a convergent destiny for both technological and societal development. These arguments challenge the basic assumptions of the latecomer thesis and also demonstrate the strength of the model established by studies of recent Chinese medicine. Finally, this tripartite model is employed to reinvestigate Taiwan’s semiconductor industry as an example of high-tech industries, and to show the networked reality of an industry in which a continuous mix of varied technologies occurs, new trajectories emerge, and technological objects as industrial actors continue to make linkages with other societal elements. The reinterpretation of this industry exemplifies the fact that no given element in a society is isolated from other parts, and that social reality essentially keeps reassembling.

Governance of Stem Cell Research and Its Clinical Translation in China: An Example of Profit-Oriented Bionetworking

Suli Sui, Margaret Sleeboom-Faulkner

As in other areas of science, the conditions under which stem cell research develops are crucial to the development of its knowledge products. Material and intellectual resources, governance, and culture are factors that underlie the realization of science. The concept of bionetworking aims to capture these factors, and we use it to describe the evolution of the network activities of for-profit providers of stem cell therapy in the context of the three-stage evolution of scientific governance in China.

On the basis of empirical and archival research, we argue that international trends in stem cell regulation both hamper and stimulate the development of stem cell research in China. On the one hand, the Chinese government is put under pressure to set high, alien standards for its most advanced stem cell research laboratories and clinics; thus, only a few institutions are able to follow internationally dominant trends. On the other hand, unrealistic implementation has allowed widespread transgression of regulation, enabling researchers to gain clinical experience.

We illustrate how the networking activities of collaborative for-profit networks and translational research are fundamentally affected by the regulatory reforms in China, showing how governance, scientific development, and social conditions are closely intertwined. We argue that good governance in China does not necessarily mean following international regulatory trends to the letter.

Asians—A Doping-Friendly Race?: Antidoping Research and Popular Discourse on Race in the Postgenomic Era

Jaehwan Hyun

There has been a growing concern about a new way of thinking about race in genomics. STS scholars have tried to make sense of the ways race came to be a part of the scientific, medical, and legal fields in the name of genomics. This article adds to this STS literature on race and genomics with an analysis of antidoping science, a circuit of knowledge making that reifies race in terms of genomics but that thus far has been ignored by STS scholars. By engaging with the STS perspective on genomics and race, in this article I examine how antidoping regulatory knowledge on doping markers travels and how its operations are carried out both inside and outside this regulatory science. This study traces knowledge making about steroid doping regulations and its journey through the media and cyberspace, thus showing that regulatory efforts against doping were incidentally linked to the shaping of the idea of race in relation to genomics and personalized medicine, and especially that of Asian race. While the regulations, recommendations, and debates on the use of race in terms of genomics focused on biomedical research and practice, antidoping scientists are regulatory scientists on the periphery of biomedicine. Antidoping scientists did not, then, engage with debates on the use of racial categories when applying concepts of personalized medicine and pharmacogenomic studies in biomedicine. They used racial categories in their studies of the UGT2B17 gene without concern, and their research reinforced the shaping of racialist discourses on the idea of Asians as a doping-friendly race in the media and cyberspace. This case study suggests that, to improve academic and political intervention on race and genomics, STS scholars should expand their studies into peripheral disciplines of biomedicine such as antidoping science and other human regulatory sciences.

Mental Illness in Singapore: A History of a Colony, Port City, and Coolie Town

Kah Seng Loh

The case of Singapore explores the history of mental illness in a British colony, port city, and Chinese coolie town. As a colony, Singapore not only received Western psychiatric expertise from the metropole but also suffered from the inner contradictions and failings of colonial rule. The mental asylum thus had both a modernizing and marginal role. As an international port city, Singapore was a major center for internationally crisscrossing flows, yet the transnationalism in mental health policy remained connected to colonial power in two ways: the British simplified the culturally diverse patients into distinct, subordinate races and transferred them between Singapore and other countries. Singapore was also an unruly “coolie town” where, utilizing the weapons of the weak, Chinese sufferers contested the psychiatric regime in the asylum and continued to seek treatment and care beyond it. Their ability to do so depended, however, on the specific circumstances that prevailed in the individual, asylum, and coolie town, and their agency was expressed in relation to the colonial system rather than independent of it.

 

Ethos

Pride, Shame, and the Trouble with Trying to Be Normal

Theodore K. Gideonse

I performed 14 person-centered ethnographies with methamphetamine-using HIV-positive men who have sex with men in San Diego, California, who were all subjects of the “anti-meth apparatus,” a collection of government and nongovernment organizations focused on meth use and its sequelae. The apparatus attempts to coerce addicts to develop and perform certain identities and emotions, though addicts are capable of both passive acceptance and active disruption. In my research, those who failed to become the apparatus’s ideal subject felt shame, while those who succeeded expressed pride. Those hovering in the middle experienced a perpetual struggle to become normal and rarely, if ever, succeeded.

Variation in Causal Models of Diabetes: A Comparison of Nurses and Lay Community Members in the United States and Guatemala

Jonathan N. Maupin

Causal models are a key element for examining cross-cultural as well as expertise variation in explanatory models of illness. Yet, anthropological studies comparing causal models often focus on the content of these models and fail to examine variation in the structure and role of individual causal features in causal models of disease. In this article, I analyze variation in causal models of diabetes among a sample of registered nurses and lay community members in the United States and Guatemala. Utilizing a cause-by-cause questionnaire, I measure patterns of variation and agreement in direct causal interactions between features. Constructing causal networks, I examine similarities and differences in the structure as well as the role of specific causal features within these networks. These results demonstrate that biomedical expertise and sociocultural context are associated with different aspects of the structure and content of explanatory models of diabetes.

Apprehending Volition in Early Socialization: Raising “Little Persons” among Rural Mapuche Families

Marjorie Murray, Sofia Bowen, Nicole Segura, Marisol Verdugo

On the basis of ethnographic fieldwork with rural Mapuche families in the Araucanía region of Chile, this article analyzes ways in which Mapuche parenting practices and the process of socialization during early childhood involve and transmit a sense of volition that is intrinsic to Mapuche notions of personhood and autonomy. Recounting concrete daily events, we describe how children make use of their own initiative and intentionality when exploring, acting, learning, and creating social relationships. At the same time, Mapuche parents avoid constant visual supervision and direct intervention, rarely oppressing children’s volition while respecting and valuing children’s personal and direct experiences of the world. By considering volition as an important cultural feature of parenting and socialization, and by reflecting upon how different ideologies of childhood and parenting relate to children’s volition, we aim to contribute to current developments on early socialization and parenting cultures.

Hōkō onchi: Wayfinding and the Emergence of “Directional Tone-Deafness” in Japan

Joshua Hotaka Roth

Take a wrong turn and show up late to an appointment in Japan and it is quite likely that someone will label you “hōkō onchi” (directionally tone-deaf). The term was coined in the late 1960s, and now hundreds of thousands of Japanese identify themselves as “hōkō onchi.” The term is much more widely used than any equivalent in English, and there is reason to believe that some people who have embraced the label do not necessarily have more difficulty in wayfinding than those who reject it. What, then, does the label mean? What explains its initial emergence and its current transformations? While directional orientation concerns cognitive ability, the way it has been used as a label and later adopted as an identity suggests it may also be a symptom of shifts in the wider social context.

 

Health and Place

Socio–economic status and family structure differences in early trajectories of child adjustment: Individual and neighbourhood effects

Eirini Flouri, Emily Midouhas, Alexandra Ruddy

We examined the effects of single-parent family status and high parental socio-economic status (SES) on the trajectories of children’s emotional/behavioural adjustment in early-to-middle childhood (ages 3–7 years). We also assessed whether these family characteristics interact with the equivalent neighbourhood characteristics of shares of single-parent families and high-SES adults in predicting these trajectories. Using data on 9850 children in England participating in the Millennium Cohort Study, we found that family status and parental SES predicted children’s trajectories of adjustment. Even after controlling for these family factors and key child and parent characteristics, the neighbourhood shares of high-SES adults and single-parent families were related (negatively and positively, respectively) to child problem behaviour. Importantly, children of low-SES parents in neighbourhoods with a high concentration of high-SES adults had fewer emotional symptoms than their counterparts in areas with fewer high-SES adults. Surprisingly, the adverse effect of single-parent family status on child hyperactivity was attenuated in areas with a higher share of single-parent families.

Neighborhood walkability and health outcomes among older adults: The mediating role of physical activity

Jelle Van Cauwenberg, Veerle Van Holle, Ilse De Bourdeaudhuij, Delfien Van Dyck, Benedicte Deforche

We examined the mediating role of physical activity on the relationships of walkability with Flemish older adults’ health outcomes. In low income neighborhoods, residents of high walkable neighborhoods had a 1.5 kg/m2 lower BMI than low walkable residents. Of this difference 0.3 kg/m2 (19%) and 0.2 kg/m2 (12%) were explained through walking for transport and MVPA, respectively. Similar findings were observed for waist circumference. Walkability did not relate to functional performance or quality of life. Walkable neighborhoods may benefit older adults’ health, especially in low income neighborhoods. More research in other contexts is warranted to confirm current findings.

Home-making after stroke. A qualitative study among Dutch stroke survivors

Louise Meijering, Christa S. Nanninga, Ant T. Lettinga

Stroke survivors may suffer from physical limitations as well as cognitive and behavioural difficulties. Many survivors work on their recovery in a rehabilitation clinic with the aim to return to their own home again. Since full recovery is often not feasible, they face the challenge of coming to terms with lasting effects of the stroke and of giving meaning to their home place again.

Based on in-depth interviews with stroke survivors, we discuss the meaning of the home with respect to changed post-stroke identities. Our findings show how, for many participants, a formerly comfortable home becomes a space of struggle. Formerly stable bodily routines become time-consuming and demanding, reciprocal relationships with significant others change, often becoming unbalanced dependence. In conclusion, each stroke survivor faces a different struggle to accommodate a changed self in a house that does not feel like home anymore. These findings imply that stroke rehabilitation services need to address the individual and everyday challenges that stroke survivors and their families face at home, to improve their sense of home and well-being.

The density of alcohol outlets and adolescent alcohol consumption: An Australian longitudinal analysis

Rowland, Tracy Evans-Whipp, Sheryl Hemphill, Rachel Leung, M. Livingston, J.W. Toumbourou

Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11–17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents’ perception of alcohol availability and friends’ alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.

 

Health, Risk & Society

‘I think it’s self-preservation’: risk perception and secrecy in early pregnancy

Emily Jane Ross

Withholding news of a pregnancy from wider family and friends for the first 12 weeks of gestation is a familiar aspect of the contemporary experience of pregnancy in Britain. In this article, I explore this convention, drawing on interviews conducted in Scotland between 2012 and 2013, with 15 women experiencing a full-term pregnancy for the first time. For the participants in this research, the maintenance of secrecy was a response to their understanding that the risk of a pregnancy loss was at its highest during this stage of gestation. Respondents often articulated their interpretation of this risk in terms of statistics, derived from medical sources. These were substantiated by knowledge of pregnancy losses amongst family and friends, but also by their own ambiguous embodied experiences at this time. Accounts of early gestation resonated with Rothman’s notion of the ‘tentative pregnancy’, a concept rarely invoked outside discussions of prenatal testing. In line with efforts not to get ‘too excited’, demonstrating emotion work, women delayed the announcement of their pregnancy until they perceived the risk of a pregnancy loss to have decreased. During the first 12 weeks of gestation, participants’ accounts demonstrated multiple influences on their understanding of their pregnancy as at risk. Further, their experiences more often resonated with the management of uncertainty than risk per se, and thus offer new perspectives to the study of pregnancy within the social sciences.

Pluralist risk cultures: the sociology of childbirth in Vanuatu

Karen Lane

Western medical approaches to childbirth typically locate risk in women’s bodies, making it axiomatic that ‘good’ maternity care is associated with medically trained attendants. This logic has been extrapolated to developing societies, like Vanuatu, an Island state in the Pacific, struggling to provide good maternity care in line with the World Health Organization’s Millennium Development Goals. These goals include the reduction of maternal mortality by two-thirds by 2015, but Vanuatu must overcome challenging hurdles – medical, social and environmental – to achieve this goal. Vanuatu is a hybridised society: one where the pre-modern and modern coincide in parallel institutions, processes and practices. In 2010, I undertook an inductive study of 30 respondents from four main subcultures – women living in outer rural communities with limited access to Western-trained health workers; women from inner urban communities with ease of access to medical clinics; traditional birth attendants who are formally untrained but highly specialised and practised mainly in remote communities; and Western-trained medical clinicians (obstetricians and midwives). I invited all the participants to comment on what constituted a ‘good birth’. In this article, I show that participants interpreted this variously according to how they believed the uncertainties of childbirth could be managed. Objectivist approaches that define risk as an objective reality amenable to quantifiable measurement are thus rendered inadequate. Interpretivist approaches better explain the reality that social actors not only find risk in different sites but gravitate towards different practices, discourses and individuals they can trust especially those with whom they feel a strong sense of community. Strategies are, therefore, formed less through scientific rationality but according to feelings and emotions and the lived experience. The concept of risk cultures conveys this complexity; they are formed aroundvalues rather than calculable rationalities. Risk cultures form self-reflexively to manage contingent circumstances.

The influence of risk perception on South Korean mothers’ use of infant formula

Minjung Sung, Hyehyun Hong

Given that the choice of breastfeeding is not available to every mother, in spite of its advantages, in this article we examine the factors influencing the use of infant formula in South Korea. We draw on data from a national survey of South Korean mothers conducted in 2009, to show that while maternal use of infant formula feeding was affected by socio-economic factors such as education, income and employment status, it was also influenced by mothers’ perception of risks of infant formula. We found that the way mothers perceived the safety of formula milk’s raw materials was a key factor influencing their decisions about formula feeding, while their perceptions of the safety of the manufacturing facilities and the distribution system was less influential. The mothers in the survey perceived that product safety was more important than considerations such as convenience and economic value of infant formula. We argue that the priority which Korean mothers give to considerations of the risk/safety of infant formula reflects the impacts from a series of food-related incidents, including the 2008 scandal in China where the production of infant milk was contaminated with melamine. Given the socio-economic and perceptual differences between mothers who formula feed and those who breastfeed, we provide guidelines about the ways in which professionals and government agencies can enhance the management and communication of issues relating to the safety of infant formula product.

The safety dance: Men without [hard] hats

Martin T. Kosla

A central tenet in the sociology of risk is that risk-taking is inherently linked to masculinity. Recent research, however, demonstrates gender identity is only one of the many social contexts that influence professional risk-taking. The interaction between the various occupational social contexts – such as social class, occupational socialisation, institutions, and gender identity – contributes to the development of risk-taking occupational identities. These occupational identities are associated with unique understandings of risk which influence whether workers are likely to embrace or avoid risk. While there has been a plethora of research exploring how occupational identities encourage risk-taking, relatively little research has explored how occupational identities determine the types of risks embraced by workers. After all, there is substantial occupational variation in the types of risks workers take. In this paper I draw on data from a series of interviews conducted in 2010 and 2011 with US electrical construction workers to explore perceptions of job site safety procedures to understand how electrical workers view various job site hazards. I argue that the proximity of a hazard to the occupation’s core competencies determines the level of support the safety procedure receives from those within the occupation.

Between bushfire risk and love of environment: preparedness, precariousness and survival in the narratives of urban fringe dwellers in Australia

Davina Lohm, Mark Davis

Many Australians live in attractive urban-fringe and semi-rural environments which are said to be places that promote health and well-being. Yet, each summer, these residents are asked by authorities to prepare for episodic, intensely unpredictable bushfire emergency. In 2012/2013, we interviewed 17 people who lived on the rural fringe of Melbourne to gain insights into how people are able to feel secure whilst residing in bushfire risk environments. Our findings highlight the deep attachment that people have to place, the importance of learning from past experiences, recognition that any preparation has limitations, and the need to recognise one’s own limitations when confronted with fire. With reference to the bushfire preparedness narratives told in the interviews, we discuss the precariousness of living in a place that is seen as healthy and dangerous. The argument we develop furnishes insight into how individuals and families deal with the intensity and complexity of bushfire risk and more generally how they are taking on the emerging rationalities of disaster preparedness as a mode of risk management for survival. Such insights support policy makers to tailor advice that recognises the complexity of people’s understanding of fire risk.

How health risks prevention shapes collective identities: a micro-sociological approach

Don Weenink, Christian Bröer,  Jolanda Boersma

Sociological theories of health risks in late modernity emphasise the individualisation and increasing anxiety that results from prevention policies, while bio-sociality theories point to the creation of new, biologically or medically based social identities. In this article, we outline an alternative approach. We use micro-sociological interaction ritual theory to examine how health risk prevention technology shape interactions that generate collective identities. Drawing on fieldwork in two Dutch villages in 2008–2009 and again in 2014 that created interview, survey and observational data, we show that automatic external defibrillators turned into symbols of collective identity that elicited feelings of group membership, reflected moral values and filled community members with pride. We demonstrate that this collective identity formation process was shaped by the institutional and technological network of the automatic external defibrillators. In the concluding section of the article, we explore the conditions under which health-related collective identities might develop, particularly with regard to the institutions that create health policies and foster health risk awareness.

‘I’m managing myself’: how and why people use St John’s wort as a strategy to manage their mental health risk

Sophie Lewis, Karen Willis, Renata Kokanovic, Marie Pirotta

In this article, we examine the choice to use a complementary and alternative medicine product (St John’s wort) for the management of mental health risk. We draw on data from a study in which we conducted in-depth, semi-structured interviews with 41 adults who self-reported depression, stress or anxiety, in Melbourne, Australia, in 2011. We identified three groups of users – regular St John’s wort users, whose use was continuous; irregular users, whose use was occasional; and non-users, who had stopped or were contemplating use. In each group, St John’s wort use centred around managing risk, taking control and self-management. Participants described a process of weighing up risks and benefits of different treatment options. They viewed St John’s wort as a less risky and/or safer option than antidepressants because they perceived it to be more natural, with fewer side effects. They saw their use of St John’s wort as a means of exercising personal control over mental health risks, for example, to alleviate or self-manage symptoms of depression. Their use of St John’s wort was also linked to perceptions of broader social risks including the stigma and shame of needing to use antidepressants. The findings deepen our understanding of notions of mental health risk by pointing to the importance of localised knowledge of risk in decision-making, and the ways in which perceptions of, and hence responses to, risk differ between groups.

Fearing or fearsome Ebola communication? Keeping the public in the dark about possible post-21-day symptoms and infectiousness could backfire

Branden B. Johnson, Paul Slovic

US quarantine announcements do not include information that there is a moderate likelihood that Ebola-exposed people might exhibit symptoms, signalling infectiousness, beyond 21 days. As a result it is possible that if and when there is media coverage in the US of a delayed-symptom case, it might create citizen distrust in public health authorities and information and cause citizens to overestimate the risk of Ebola infection. In this article we report a research study which examined whether openness about post-21-day symptoms would attenuate negative reactions. We ran two experiments with online opportunity (Amazon mTurk) samples of Americans in late October-early November 2014, between the two deaths from Ebola in the US. In these experiments we assessed the reactions of respondents who saw quantitative estimates of post-21-day-symptom likelihood (n = 1413), or were informed about post-21-day symptoms with a rationale for the 21-day period after all saw a mock news story about a US case of 30th-day symptoms (n = 425). We found in both experiments that perceived risk increased and trust declined when people learned of post-21-day symptoms, and disbelief increased that 21 days without symptoms means no Ebola infection. In Study 2, informed persons and controls changed perceived risk and trust relative to baseline; test-group participants distrusted local medical personnel less and wanted shorter quarantines compared to controls who did not receive the information. Our findings suggest that informing Americans about the small likelihood of post-21-days Ebola symptoms would not increase perceived risk and distrust, and might diminish negative reactions to the media reporting a case who developed symptoms of Ebola after 21 days. Thus, public health officials wanting appropriate public responses to potential or actual epidemics may benefit from early communication of unpleasant infectious-disease facts before events reveal them, and signal officials’ lack of preparedness for public reactions.

 

Journal of the Royal Anthropological Institute

Vatted dreams: neurophilosophy and the politics of phenomenal internalism

Nicolas Langlitz

Despite much social-scientific work on the neurosciences, little ethnographic and historical attention has been paid to the field of neurophilosophy. Yet anthropologists studying brain research occasionally critique neurophilosophers for reducing the mind to the brain while affirmatively citing philosophers of mind who present the mind as emerging from interactions between brain, body, and environment. This article examines the ostracized camp of so-called ‘phenomenal internalists’ – neurophilosophers who believe that consciousness can supervene on the brain alone. This ontological commitment is driven by certain existential and political experiences from false awakenings to disenchantment with the counterculture of the 1970s. But it also draws from neuroscientific research on the dreaming brain. The inquiry concludes with a plea to anthropologists to attend to relations of detachment, both social and neural, and to reconsider their own ontological commitment to externalism in the light of dream research.

Species: a praxiographic study

Eben Kirksey

Taxonomists, who describe new species, are acutely aware of how political, economic, and ecological forces bring new forms of life into being. Conducting ethnographic research among taxonomic specialists – experts who bring order to categories of animals, plants, fungi, and microbes – I found that they pay careful attention to the ebb and flow of agency in multispecies worlds. Emergent findings from genomics and information technologies are transforming existing categories and bringing new ones into being. This article argues that the concept of species remains a valuable sense-making tool despite recent attacks from cultural critics.

To see that which cannot be seen: ontological differences and public health policies in Southern Chile

Cristóbal Bonelli

In this article, I explore different visual practices performed by Pehuenche Indigenous healers and state public health professionals in Southern Chile. While non-Indigenous health workers seek to make ‘traditional’ Pehuenche healing visible within or alongside their own ‘modern’ practices, Pehuenche people are concerned with making visible the evil spirits whose ‘eating’ of persons produces illness. Focusing in particular on different healing practices triggered by the existence of Pehuenche spiritual illnesses that are ‘seen’ by both Indigenous healers and state professionals, this article discusses how different ontologies ground differences between the Indigenous healers and what they ‘see’; as well as how a broader and substantive binary between Pehuenche and non-Pehuenche realities goes above and beyond these multiplicities. By exploring and discussing the endurance of Pehuenche cosmo-political relations in a world inhabited by visible and invisible eaters, I hope to create awareness about how a failure to recognize these different realities limits current multicultural policies in Southern Chile, and Indigenous health policies more broadly. At a more theoretical level, the following ethnographic account sheds light on unresolved tensions between the ways ontological difference has been conceptualized within the so-called ‘ontological turn’ in anthropology and within the field of Science and Technology Studies (STS).

The impasse of modernity: personal agency, divine destiny, and the unpredictability of intimate relationships in Morocco

Laura Menin

Following the romantic vicissitudes of Ghizlan, a professional woman in her thirties, this article explores the expectations and unexpected outcomes of love in a rapidly changing Moroccan town. Imagined as a pure and elective union between two individuals, love manifests itself in Ghizlan’s lived experience as a dangerous adventure along the thin line between human agency and divine destiny, personal desires and social constraints. In the wake of the Islamic revival, a purified idea of ‘Islamic modernity’ provides the religious imagination and vocabulary with which Ghizlan recomposes the unfulfilled promises of love and discusses recent developments in Morocco. Interweaving love and destiny, Ghizlan’s reflections reveal a perspective on agency and (inter)subjectivity that exceeds intentionality, desire, and rational understanding. Highlighting the fundamental roles of human passions and transcendental powers in people’s ethical and existential journeys, this article hopes to contribute to an emerging ‘anthropology of ethics and freedom’. It broadens current anthropological debates by interrogating the very meanings of choice, freedom, and responsibility in a world where personal agency meets human powers, divinely preordained futures, and material contingencies.

 

Medical Anthropology Quarterly

Obstetrics in a Time of Violence: Mexican Midwives Critique Routine Hospital Practices

Lydia Zacher Dixon

Mexican midwives have long taken part in a broader Latin American trend to promote “humanized birth” as an alternative to medicalized interventions in hospital obstetrics. As midwives begin to regain authority in reproductive health and work within hospital units, they come to see the issue not as one of mere medicalization but of violence and violation. Based on ethnographic fieldwork with midwives from across Mexico during a time of widespread social violence, my research examines an emergent critique of hospital birth as a site of what is being called violencia obstétrica (obstetric violence). In this critique, women are discussed as victims of explicit abuse by hospital staff and by the broader health care infrastructures. By reframing obstetric practices as violent—as opposed to medicalized—these midwives seek to situate their concerns about women’s health care in Mexico within broader regional discussions about violence, gender, and inequality.

Serenity: Violence, Inequality, and Recovery on the Edge of Mexico City

Angela Garcia

Over the last decade, there has been a sharp increase in drug addiction in Mexico, especially among the urban poor. During the same period, unregulated residential treatment centers for addiction, known as anexos, have proliferated throughout the country. These centers are utilized and run by marginalized populations and are widely known to engage in physical violence. Based on long-term ethnographic research in Mexico City, this article describes why anexos emerged, how they work, and what their prevalence and practices reveal about the nature of recovery in a context where poverty, drugs, and violence are existential realities. Drawing attention to the dynamic relationship between violence and recovery, pain, and healing, it complicates categories of violence and care that are presumed to have exclusive meaning, illuminating the divergent meanings of, and opportunities for, recovery, and how these are socially configured and sustained.

Modern Art as Public Care: Alzheimer’s and the Aesthetics of Universal Personhood

Scott Selberg

This article is based on ethnographic research of the New York Museum of Modern Art’s influential Alzheimer’s access program, Meet Me at MoMA. The program belongs to an increasingly popular model of psychosocial treatment that promotes art as potentially therapeutic or beneficial to people experiencing symptoms of dementia as well as to their caregivers. Participant observation of the sessions and a series of interviews with museum staff and educators reveal broader assumptions about the relationship between modern art, dementia, and personhood. These assumptions indicate a museological investment in the capacity and perceived interiority of all participants. Ultimately, the program authorizes a narrative of universal personhood that harmonizes with the museum’s longstanding focus on temporal and aesthetic modernism.

In/dependent Collaborations: Perceptions and Experiences of African Scientists in Transnational HIV Research

Ferdinand Moyi Okwaro, P. W. Geissler

This article examines collaboration in transnational medical research from the viewpoint of African scientists working in partnerships with northern counterparts. It draws on ethnographic fieldwork in an HIV laboratory of an East African state university, with additional data from interviews with scientists working in related research institutions. Collaboration is today the preferred framework for the mechanisms by which northern institutions support research in the south. The concept signals a shift away from the legacy of unequal (post-) colonial power relations, although, amid persisting inequalities, the rhetorical emphasis on equality might actually hinder critical engagement with conflicts of interest and injustice. To collaborate, African scientists engage various strategies: They establish a qualified but flexible, non-permanent workforce, diversify collaborators and research areas, source complementary funding to assemble infrastructures, and maintain prospective research populations to attract transnational clinical trials. Through this labor of collaboration, they sustain their institutions under prevailing conditions of scarcity.

To Be Free and Normal: Addiction, Governance, and the Therapeutics of Buprenorphine

Shana Harris

Methadone maintenance has dominated opiate addiction treatment in the United States for decades. Since 2002, opiate addiction has also been treated in general medical settings with a substance called buprenorphine. Based on interviews and participant observation conducted in northern California, this article analyzes how discourses of freedom and normalcy in patient and provider narratives reflect and affect experiences with this treatment modality. I discuss how buprenorphine treatment, in contrast to methadone maintenance, offers patients and providers a greater sense of autonomy and flexibility in how they receive and deliver treatment. It presents them with new obligations, responsibilities, and choices around care and conduct. It simultaneously perpetuates and shapes a desire to be “free” and “normal.” I argue that the therapeutics of buprenorphine govern patients and providers through this desire for freedom and normalcy. Buprenorphine is thus a technology of governmentality that extends neoliberal discourses and values and produces self-governing subjects.

“You Can Turn off the Light If You’d Like”: Pediatric Health Care Visits for Children with Autism Spectrum Disorder as an Interactional Achievement

Olga Solomon, Amber M. Angell, Larry Yin, Mary C. Lawlor

Substantial scholarship has been generated in medical anthropology and other social science fields on typically developing child–parent–doctor interactions during health care visits. This article contributes an ethnographic, longitudinal, discourse analytic account of a child with autism spectrum disorder (ASD)–parent–doctor interactions that occur during pediatric and neurology visits. The analysis shows that when a child with ASD walks into the doctor’s office, the tacit expectations about the visit may have to be renegotiated to facilitate the child’s, the parent’s, and the doctor’s participation in the interaction. A successful visit then becomes a hard-won achievement that requires the interactional and relational work of all three participants. We demonstrate that communicative and sensory limitations imposed by ASD present unique challenges to all the participants and consider how health care disparities may invade the pediatric encounter, making visible the structural and interactional processes that engender them.

 

Medical Humanities

Who speaks for whom? Health humanities and the ethics of representation

Rebecca Garden

The medical or health humanities are in essence a form of advocacy, a means of addressing a problem of underrepresentation. They focus on suffering, rather than pathology, and on sociocultural understandings of illness and disability, rather than a narrow biomedical perspective. The health humanities thus analyse and attempt to recalibrate the power imbalance in healthcare. This article reviews health humanities scholarship that addresses underrepresentation through the analysis of illness and disability narratives. It examines the ethics of representation by exploring how literary representation functions, its aesthetic as well as political dimensions, and how it operates as a relay mechanism for power. The mechanism of representation is further explored through a reading of Eli Clare’s narrative Exile and Pride. Donna Haraway’s notion of articulations is proposed as a tool for a more ethical approach to representation. The article suggests that transparency about the power health humanities scholars stand to gain through representation may contribute to a more ethical health humanities practice.

Carers’ responses to shifting identity in dementia in Iris and Away From Her: cultivating stability or embracing change?

David M R Orr,  Yugin Teo

An emphasis on supporting and maintaining self-identity in people who have dementia for as long as possible has gone hand in hand with the revitalisation of dementia interventions, services and empowerment. However, recognition of the need for change, adaptation and personal growth is as necessary when living with dementia as at any other time in people’s lives. Those who care for people with dementia must constantly navigate this tension between continuity and change within the context of memory loss, knowing when to respond by reinforcing the ‘self’ they have known over time, and when it may be better to respond by acknowledging the changes that have taken place in that ‘self’. The creative arts are avenues for the exploration of the caring relationship under these conditions, conveying the challenges and stimulating audiences to ask how they themselves might choose to respond in a similar situation. This article considers how the scenarios of two noted films, Iris (dir. Richard Eyre, 2001 UK)) and Away From Her (dir. Sarah Polley, 2006 Can), present the dilemmas of identity and caring. In both, a husband cares for a wife experiencing cognitive decline, but responds differently in each to her shifting needs and experience of identity. We argue that the two films reveal complementary and provocative perspectives on this situation. They offer no easy answers, but provide insights into the everyday decisions characteristic of caring for someone who has dementia.

Photographic art in exam rooms may reduce white coat hypertension

Michael B Harper, Stacy Kanayama-Trivedi, Gloria Caldito, David Montgomery, EJ Mayeaux, Jr, Lourdes M DelRosso

Introduction: Blood pressure (BP) elevation in medical office settings in patients who are normotensive in nonmedical settings is an effect known as ‘white coat hypertension’. This phenomenon is thought to be due to situational anxiety caused by the experience of visiting a doctor and the anxiety-inducing nature of the medical office. Our study was designed to determine if carefully selected photographic art could counter the anxiety that causes white coat hypertension and lead to lower BP recordings in some patients.

Methods: 117 adults, non-pregnant patients from the Louisiana State University Health Sciences Center Family Medicine Resident Clinic participated in this study. After the triage nurse measured the BP, the patients were randomly placed in either an exam room with standard medical posters (control room) or in an exam room with photographic art (photo room). The BP was measured in the exam room. After the medical visit, the patients switched rooms and the BP was measured a third time. The patients were asked to fill out a questionnaire to identify room preference.

Results: On average, the BP obtained in the control rooms was higher than that obtained in the photo rooms. There was a statistically significant difference between the mean arterial pressure, systolic BP and diastolic BP between the control room and the photo room.

Conclusions: Landscape photographic art may have the beneficial effect of reducing BP in medical office examination rooms.

Richard’s back: death, scoliosis and myth making

Mary Ann Lund

The body of a mediaeval monarch was always under scrutiny, and Richard III’s was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard’s physique and his posthumous reputation. This article argues that Richard’s death and his myth as ‘crookback’ are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard’s scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard’s medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

Whistleblowing in medicine and in Homer’s Iliad

Victoria Rodulson, Robert Marshall, Alan Bleakley

‘Thinking with Homer’, or drawing creatively on themes and scenes from Homer’s Iliad andOdyssey, can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks. However, in a new era of public accountability, medicine looks to formally embrace whistleblowing to the point that not reporting transgressions can now constitute a transgression of professionalism. Where medical students identify with the history and traditions of medical culture, they inevitably find themselves in situations of conflicting loyalties if they encounter senior clinicians behaving unprofessionally. What are the implications of facing these dilemmas for students in terms of role modelling and shaping of character as a doctor, and how might a study of Homer help with such dilemmas? We suggest that a close reading of an opening scene in Homer’s the Iliad can help us to better appreciate such ethical dilemmas. We link this with the early Greek tradition of parrhesia or ‘truth telling’, where frankly speaking out against perceived injustice is encouraged as resistance to power and inappropriate use of authority. We encourage medical educators to openly discuss perceived ethical dilemmas with medical students, and medicine as a culture to examine its conscience in a transition from an authoritarian to an ‘open’ society, where whistleblowing becomes as acceptable and necessary as good hygiene on the wards.

The outlook of physician histories: J. Marion Sims and ‘The Discovery of Anaesthesia’

Julia M Rosenbloom, Robert B Schonberger

The fact that doctors have a long tradition of writing medical history to interpret and direct their profession is well established. But readers (particularly modern physician readers) can also understand physician-authored histories as offering commentary and analysis of the world beyond medicine. In this essay, we offer a reading (perhaps a modern one) of J. Marion Sims’s 1877 article, ‘The Discovery of Anaesthesia’ which exemplifies the stance of looking both inward and outward from the medical field. We begin by discussing Sims, including the complicated legacy he left as a physician. Next, we review late 19th-century history with a focus on Reconstruction. Finally, we show how the modern reader can use Sims’s article both to trace the first use of ether and nitrous oxide for surgical anaesthesia and to provide a window into the 19th-century medical profession and the post-Civil War period. Through this study, we hope to show how to read both medicine and the world around it in physician histories.

‘Rhyme or reason?’ Saying no to mass vaccination: subjective re-interpretation in the context of the A(H1N1) influenza pandemic in Sweden 2009–2010

Britta Lundgren

During the swine flu pandemic of 2009–2010, all Swedish citizens were recommended to be vaccinated with the influenza vaccine Pandemrix. However, a very serious and unexpected side effect emerged during the summer of 2010: more than 200 children and young adults were diagnosed with narcolepsy after vaccination. Besides the tragic outcome for these children and their families, this adverse side effect suggests future difficulties in obtaining trust in vaccination in cases of emerging pandemics, and thus there is a growing need to find ways to understand the complexities of vaccination decision processes. This article explores written responses to a questionnaire from a Swedish folk life archive as an unconventional source for analysing vaccine decisions. The aim is to investigate how laypersons responded to and re-interpreted the message about the recommended vaccination in their answers. The answers show the confusion and complex circumstances and influences in everyday life that people reflect on when making such important decisions. The issue of confusion is traced back to the initial communications about the vaccination intervention in which both autonomy and solidarity were expected from the population. Common narratives and stories about the media or ‘big pharma capitalism’ are entangled with private memories, accidental coincidences and serendipitous associations. It is obvious that vaccination interventions that require compliance from large groups of people need to take into account the kind of personal experience narratives that are produced by the complex interplay of the factors described by the informants.

Shared Reading: assessing the intrinsic value of a literature-based health intervention

Eleanor Longden, Philip Davis, Josie Billington, Sofia Lampropoulou, Grace Farrington,Fiona Magee, Erin Walsh, Rhiannon Corcoran

Public health strategies have placed increasing emphasis on psychosocial and arts-based strategies for promoting well-being. This study presents preliminary findings for a specific literary-based intervention, Shared Reading, which provides community-based spaces in which individuals can relate with both literature and one another. A 12-week crossover design was conducted with 16 participants to compare benefits associated with six sessions of Shared Reading versus a comparison social activity, Built Environment workshops. Data collected included quantitative self-report measures of psychological well-being, as well as transcript analysis of session recordings and individual video-assisted interviews. Qualitative findings indicated five intrinsic benefits associated with Shared Reading: liveness, creative inarticulacy, the emotional, the personal and the group (or collective identity construction). Quantitative data additionally showed that the intervention is associated with enhancement of a sense of ‘Purpose in Life’. Limitations of the study included the small sample size and ceiling effects created by generally high levels of psychological well-being at baseline. The therapeutic potential of reading groups is discussed, including the distinction between instrumental and intrinsic value within arts-and-health interventions.

Charting Phelan’s ‘To Suffer a Sea Change’

Megan Winkelman, Jacqueline Ng, Audrey Shafer

Physicians and healthcare workers usually perceive their medical record entries as documentation rather than construction. In the following article, we extract a medical record from a narrative, Peggy Phelan’s pathography of glaucoma, ‘To Suffer a Sea Change’. From information about encounters described by Phelan, an ophthalmologist reconstructs progress notes similar to those that would be key to a glaucoma patient’s medical record. Rather than condemning the arcane pointilism of the medical record as a poverty of language, or isolating the pathography as an academic text, we hope to instead appreciate what their collaborative dialogue offers the study of disease. While the points of divergence between these texts will demonstrate failures in communication, they will also unearth an enriched dialogue.

Mapping a surgeon’s becoming with Deleuze

Sayra Cristancho, Tara Fenwick

The process of ‘becoming’ shapes professionals’ capability, confidence and identity. In contrast to notions of rugged individuals who achieve definitive status as experts, ‘becoming’ is a continuous emergent condition. It is often a process of struggle, and is always interminably linked to its environs and relationships. ‘Becoming’ is a way of understanding the tensions of everyday practice and knowledge of professionals. In this paper, we explore the notion of ‘becoming’ from the perspective of surgeons. We suggest that ‘becoming’, as theorised by Deleuze, offers a more nuanced understanding than is often represented using conventional vocabularies of competence, error, quality and improvement. We develop this conception by drawing from our Deleuze-inspired study of mapping experience in surgery. We argue for Deleuzian mapping as a method to research health professionals’ practice and experience, and suggest the utility of this approach as a pedagogical tool for medical education.

Enhancement, ethics and society: towards an empirical research agenda for the medical humanities and social sciences

Martyn Pickersgill, Linda Hogle

For some time now, bioethicists have paid close attention to issues associated with ‘enhancement’; specifically, the appropriate use and regulation of substances and artefacts understood by some to improve the functioning of human bodies beyond that associated with ‘normal’ function. Medical humanities scholars (aside from philosophers and lawyers) and social scientists have not been frequent participants in debates around enhancement, but could shine a bright light on the range of dilemmas and opportunities techniques of enhancement are purported to introduce. In this paper, we argue that empirical research into the notion and practice of enhancement is necessary and timely. Such work could fruitfully engage with—and further develop—existing conceptual repertoires within the medical humanities and social sciences in ways that would afford benefit to scholars in those disciplines. We maintain that empirical engagements could also provide important resources to bioethicists seeking to regulate new enhancements in ways that are sensitive to societal context and cultural difference. To this end, we outline an empirical agenda for the medical humanities and social sciences around enhancement, emphasising especially how science and technology studies could bring benefits to—and be benefitted by—research in this area. We also use the example of (pharmaceutical) cognitive enhancement to show how empirical studies of actual and likely enhancement practices can nuance resonant bioethical debates.

Breaking down the wall: a narrative approach to addiction

Katie Grogan, Erin Zerbo

Addiction is a pervasive medical and sociological concern, and yet its presence is still met with stigma, even within the healthcare community. There is an extensive literature documenting the negative attitudes of medical trainees and professionals towards substance users, but there does appear to be hope: expert-led clinical experience and addiction-focused teaching seem to increase empathy and inspire confidence in treating substance users.1 However, there is still much work to be done. Although a number of educational interventions have demonstrated efficacy, none has been implemented on a widespread basis, likely due to time pressures in already-packed curricula.2

The two of us, a medical humanist and an addiction psychiatrist, decided to take an alternate approach and use literature as a means of teaching about addiction, while simultaneously attempting to humanise it. We created ‘Literature and Addiction’, an interdisciplinary seminar within the Master Scholars Program in Humanistic Medicine at New York University School of Medicine (NYUSoM). Enrolment is open to anyone affiliated with NYUSoM, but the majority of participants have been first-year and second-year medical students. The seminar is paracurricular, and has run for three semesters now.


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