In the Journals

In the Journals May 2016 Part II

Part I can be found here. 

Social Science & Medicine 

Where the lay and the technical meet: Using an anthropology of interfaces to explain persistent reproductive health disparities in West Africa

Yannick Jaffré, Siri Suh

Despite impressive global investment in reproductive health programs in West Africa, maternal mortality remains unacceptably high and obstetric care is often inadequate. Fertility is among the highest in the world, while contraceptive prevalence remains among the lowest. This paper explores the social and technical dimensions of this situation. We argue that effective reproductive health programs require analyzing the interfaces between technical programs and the social logics and behaviors of health professionals and client populations. Significant gaps between health programs’ goals and the behaviors of patients and health care professionals have been observed. While public health projects aim to manage reproduction, sexuality, fertility, and professional practices are regulated socially. Such projects may target technical practices, but access to care is greatly influenced by social norms and ethics. This paper shows how an empirical anthropology that investigates the social and technical interfaces of reproduction can contribute to improved global health.

 Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes

Annegret F. Hannawa, Yuki Shigemoto, Todd D. Little

Rationale

This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error.

Objective

This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes.

Methods

In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes.

Results

The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients’ fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician’s apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice.

Conclusion

The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.

The margins of medicalization: Diversity and context through the case of infertility

Ann V. Bell

There is a prolific literature on medicalization. While that research highlights numerous effects of the process, it is just beginning to explore medicalization’s complexity. In an effort to understand medicalization as a diverse, contextual process, I utilize the case of infertility in the U.S., a highly stratified, medicalized condition. I interviewed 95 individuals among those at the margins of mainstream understandings of reproduction—women of low socioeconomic status, men who were part of an infertile couple, and women in same-sex relationships who were accessing medical treatment to assist in conception—and compared their experiences to 17 straight women of high socioeconomic status who are at the center of reproductive care. Through such comparison, I examine the gender, class, and sexuality dimensions of inequality in medicalization. Ultimately, medicalization excludes, but it does so differentially and with different effects depending on an individual’s social location. Such findings demonstrate that medicalization is not a fixed, universal process. It is fluid and relational and shifts depending on context.

Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice

Stephen P. Brummell, Jane Seymour, Gina Higginbottom

Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on ‘less is more’ heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient’s body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of ‘bodily’ and ‘technical’ trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances.

The social management of biomedical novelty: Facilitating translation in regenerative medicine

John Gardner, Andrew Webster

Regenerative medicine (RM) is championed as a potential source of curative treatments for a variety of illnesses, and as a generator of economic wealth and prosperity. Alongside this optimism, however, is a sense of concern that the translation of basic science into useful RM therapies will be laboriously slow due to a range of challenges relating to live tissue handling and manufacturing, regulation, reimbursement and commissioning, and clinical adoption. This paper explores the attempts of stakeholders to overcome these innovation challenges and thus facilitate the emergence of useful RM therapies. The paper uses the notion of innovation niches as an analytical frame. Innovation niches are collectively constructed socio-technical spaces in which a novel technology can be tested and further developed, with the intention of enabling wider adoption. Drawing on primary and secondary data, we explore the motivation for, and the attempted construction of, niches in three domains which are central to the adoption of innovative technologies: the regulatory, the health economic, and the clinical. We illustrate that these niches are collectively constructed via both formal and informal initiatives, and we argue that they reflect wider socio-political trends in the social management of biomedical novelty.

The role of patient-provider interactions: Using an accounts framework to explain hospital discharges against medical advice

Helen-Maria Lekas, David Alfandre, Peter Gordon, Katherine Harwood, Michael T. Yin

The phenomenon of leaving the hospital against medical advice (AMA) despite being quite common and associated with significant deleterious health outcomes remains inadequately understood and addressed. Researchers have identified certain patient characteristics as predictors of AMA discharges, but the patients’ reasons for these events have not been comprehensively explored. Moreover, because the medical authority model dominates this research area, providers’ experiences of AMA discharges remain unstudied. We examined the AMA discharge from a patient-centered perspective by analyzing the content of notes providers generate to record such events. We analyzed providers’ notes for all inpatients with a primary HIV diagnosis (N = 33) that, in 2012, left an urban hospital AMA. Applying the Scott and Lyman accounts framework, we identified that the notes constituted records of providers’ and patients’ excuses and justifications for failing to meet the expectations of a provider offering patient-centered care and a compliant patient receiving care. Alongside the patients’ reasons for leaving AMA, the notes also revealed the providers’ reasons for honoring or discrediting the patients’ accounts. The style of the accounts and the professional status of the notes’ authors enabled us to contextualize the production and sharing of AMA notes in the hospital hierarchy. Conceptualizing AMA notes as dyadic accounts elicited specific factors that challenge the patient-provider relationship, and generated insights on how to strengthen it, and thus decrease the rates of AMA discharges and their associated health effects.

Long-term exposure to political violence: The particular injury of persistent humiliation

Brian K. Barber, Clea McNeely, Joseph A. Olsen, Robert F. Belli, Samuel Benjamin Doty

This study assessed the association between exposure to political violence over a 25-year period and adult functioning among a population that has experienced protracted and severe political conflict. Instead of aggregating exposure to political violence across time and type of exposure, as is commonly done, the event history calendar pioneered in this study assessed exposure to five forms of political violence annually from 1987 to 2011 in a representative sample of 1788 adults, aged 37 on average, in the occupied Palestinian territories (West Bank, East Jerusalem, and the Gaza Strip). This method allowed for the identification of trajectories of exposure to political violence from childhood to adulthood using latent profile analysis. We then correlated the trajectories of exposure to measures of economic, political, community, family, psychological, and health functioning. As expected, being shot at, having one’s home raided, being hit or kicked, being verbally abused, and witnessing someone close being humiliated were all elevated during periods of heightened political conflict (the first intifada (1987–1993) and, less so, the second intifada (2000–2005)). In addition, 12% of women and men reported high and persistent levels of exposure to humiliation (being verbally abused and/or witnessing someone close being humiliated) across the entire 25-year period. These individuals lived predominantly in neighborhoods with a high Israeli military presence. Compared to those who experienced periodic exposure to political violence, persistently humiliated men and women reported significantly lower health, economic, political, and psychological functioning, as well as higher social cohesion and political expression. Relevant literatures are reviewed when concluding that persistent humiliation is a neglected form of political violence that is best represented as a direct (versus structural), acute (versus chronic), macro (versus micro), and high-grade (versus low-grade) stressor whose particular injury is due to the violation of individual and collective identity, rights, justice and dignity.

Couples living with and around alcohol abuse: A study of a farmworker community in the Cape Winelands, South Africa

Elmien Lesch, Arlene R. Adams

Rationale

Low-income Coloured Western Cape communities in South Africa display high rates of problematic drinking, especially binge-drinking over weekends. Alcohol abuse in these communities is linked to the prevalence of intimate partner violence (IPV), fetal alcohol syndrome and sexual violence against women. Few studies, however, have investigated the social contextual factors that perpetuate alcohol abuse in these communities.

Objective and method

Our study contributes to the need for social contextual knowledge need by providing an understanding of how committed couples, who lived and worked in one low-income historic farm worker community, located in the Cape Winelands of South Africa, constructed alcohol use and abuse in their relationship. Using a social constructionist grounded theory we analysed the consecutive interviews conducted with individual partners.

Findings

Three themes shed light on our participants’ alcohol use discourses. The first theme highlights participants’ apparent lack of identification with the problem of alcohol abuse, despite the omnipresence of alcohol abuse in their accounts. The second theme draws attention to men’s and women’s explicit and implicit support of gendered norms regarding alcohol consumption. Linked to the previous, the third theme accentuate women’s toleration of men’s “quiet” weekend binge-drinking.

Discussion

We point out the limitations of local alcohol policy and intervention efforts to address normative drinking discourses and practices in this research community.

Exploring the views of people with mental health problems’ on the concept of coercion: Towards a broader socio-ethical perspective

Reidun Norvoll, Reidar Pedersen

In mental health care, coercion is a controversial issue that has led to much debate and research on its nature and use. Yet, few previous studies have explicitly explored the views on the concept of coercion among people with first-hand experiences of being coerced. This study includes semi-structured focus-groups and individual interviews with 24 participants who had various mental health problems and experiences with coercion. Data were collected in 2012–2013 in three regions of Norway and analysed by a thematic content analysis. Findings show that participants had wide-ranging accounts of coercion, including formal and informal coercion across health- and welfare services. They emphasised that using coercion reflects the mental health system’s tendency to rely on coercion and the lack of voluntary services and treatment methods that are more helpful. Other core characteristics of coercion were deprivation of freedom, power relations, in terms of powerlessness and ‘counter-power,’ and coercion as existential and social life events. Participants’ views are consistent with prevailing theories of coercion and research on perceived coercion. However, this study demonstrates a need for broader existential and socio-ethical perspectives on coercion that are intertwined with treatment and care systems in research and practice. Implications for mental health policy and services are discussed.

“Black folk don’t get no severe depression”: Meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States

Sirry M. Alang

Discrepancies exist between how some Black populations perceive depression and how depression is conceptualized within research and clinical settings. Based on a 12-month ethnography of mental health in a predominantly Black disadvantaged urban neighborhood in Midwestern United States, the current study identifies meanings and common ways of expressing depression among African Americans. Depression was often considered a sign of weakness rather than a health problem that might need medical attention. Associated emotions like sadness and hopelessness were inconsistent with notions of strength. Common indicators of depression included classic symptoms such as hopelessness, loss of sleep, and feeling worthless. However, expressions of depression such as anger, agitation, violent behavior, and a frantic search for social interaction that are inconsistent with DSM-V criteria were also common. These findings have implications for the clinical assessment of depression and for the measurement of depression in community surveys. In addition, the context and meaning of symptoms play an important role in determining whether experiences are indicative of depression. This paper underscores that the provision of patient-centered mental health care requires a better understanding of the conceptualization of disorders within specific contexts.

Of natural bodies and antibodies: Parents’ vaccine refusal and the dichotomies of natural and artificial

Jennifer A. Reich

Despite eliminating incidences of many diseases in the United States, parents are increasingly rejecting vaccines for their children. This article examines the reasons parents offer for doing so. It argues that parents construct a dichotomy between the natural and the artificial, in which vaccines come to be seen as unnecessary, ineffective, and potentially dangerous. Using qualitative data from interviews and observations, this article shows first, how parents view their children’s bodies, particularly from experiences of birth and with infants, as naturally perfect and in need of protection. Second, parents see vaccines as an artificial intervention that enters the body unnaturally, through injection. Third, parents perceive immunity occurring from illness to be natural and superior and immunity derived from vaccines as inferior and potentially dangerous. Finally, parents highlight the ways their own natural living serves to enhance their children’s immunity rendering vaccines unnecessary. Taken together, this dichotomy allows parents to justify rejection of vaccines as a form of protecting children’s health. These findings expose perceptions of science, technology, health, and the meanings of the body in ways that can inform public health efforts.

Intimate partner violence against women and the Nordic paradox

Enrique Gracia, Juan Merlo

Nordic countries are the most gender equal countries in the world, but at the same time they have disproportionally high prevalence rates of intimate partner violence (IPV) against women. High prevalence of IPV against women, and high levels of gender equality would appear contradictory, but these apparently opposite statements appear to be true in Nordic countries, producing what could be called the ‘Nordic paradox’. Despite this paradox being one of the most puzzling issues in the field, this is a research question rarely asked, and one that remains unanswered. This paper explores a number of theoretical and methodological issues that may help to understand this paradox. Efforts to understand the Nordic paradox may provide an avenue to guide new research on IPV and to respond to this major public health problem in a more effective way.

 

Social Theory & Health

Claiming rights, making citizens: HIV and the performativity of biological citizenship

Kiran Pienaar

This article critically analyses biological citizenship in terms of how it instates an ideal human subject drawn expressly from Western liberal discourse. Through an analysis of health promotion booklets directed at people living with HIV in South Africa, it reveals how regimes of biological citizenship valorise individual responsibility, agency and rationality, all attributes of the human imagined by liberal humanism. Drawing on insights from posthumanist scholarship, I argue that perceived failure to perform these attributes can operate to disqualify certain marginalised HIV-positive subjects from full citizenship. Far from immaterial, attributions of citizenship have material implications for access to human rights, including the right to life-saving treatment. Importantly, they also shape HIV/AIDS, producing two qualitatively different ontologies of disease: (i) a chronic, manageable illness for those who qualify as citizens; and (ii) a life-threatening, debilitating one for those denied full citizenship and who therefore cannot access the rights and rewards attendant on it.

‘I put pressure on myself to keep that body’: ‘Health’-related body work, masculinities and embodied identity

Julia Coffey

This article draws on qualitative interview data exploring men’s understandings of their bodies and practices of body work in Australia in the context of increasing ‘visibility’ of men’s bodies and increasing attention to young men’s body image. For the men discussed in this article, body work practices of eating and exercise in particular relate to their embodiments of masculinity and to their broader understandings of their bodies and ‘selves’. While appearance and ‘beauty’ are typically constructed as feminine concerns and important to women’s constructions of identity, these examples show that a concern for the body’s appearance is also an important component of current embodiments of masculinity. This article provides an outline of a Deleuze-Guattarian approach to theorising the body through the concepts of affect and assemblage and suggests how this approach can assist in empirical analysis of the complex, contingent and contradictory relationship between the idealisation of health as an ‘image’ and ‘ideal’ gendered appearances in young men’s gendered and ‘health’-related body work practices. This has academic and practical implications for understanding contemporary gender arrangements related to the social and cultural circumstances in which the body is becoming ever more central.

Body management and the quest for performative health

Nicole Thualagant

The task of this article is to theorize on the matter of bodywork in relation to health and thereby propose a theoretical framework that can enlighten our understanding of bodywork in a ‘health society’. With the ambition of understanding bodywork in a (hyper)modern era, characterized by a strong individualism and the search for performance, the body is here conceived as a capital. The body as a site of investment can be improved, worked upon and has an impact on how the individual distinguishes him/herself in social space. Finding inspiration in the sociology of the body and the anthropologist Le Breton’s approach to the body as an ideal observatory of the social context (1985), this article will explore how a particular rationale towards the body can be observed among some gym goers in Denmark, more precisely younger men and middle-aged women. On the basis of narratives acquired through interviews, it is stressed in this article that bodywork evolves around a general will to more health. This rationale can be identified as body management where the gym goers act in order to ensure a performative health.

Advocacy for unborn sperm donor-conceived children and family policy

Ya’arit Bokek-Cohen, Limor Dina Gonen

The extant family policy in the United States relates to children who are already born. We propose that this policy should be extended in order to enhance the psychological welfare of children prior to their conception. We use the sperm banking industry as a case study, and theorize extended donor profiles as constituting socializing text for the donor offspring. Building on the identity process theory and the concept of genealogical bewilderment, we assume that many sperm recipients, especially single mothers and lesbian couples, may want to show their future children the profile of their father. Informed by Connell’s Hegemonic Masculinity theory, we content analyzed 180 extended sperm donor profiles from six American sperm banks and found that traditional masculinity prevails. Hence, we contend that there is a discrepancy between the monolithic, traditional way masculinity is performed through the text and the diverse masculinities, gender roles and family types of the donor offspring’s reality; experiencing such discrepancies may cause some stress in offspring. We propose that family policy should be expanded and elaborated to regulate the contents of extended profiles, in order to ensure a repertoire of a greater diversity of family structures as well as a variety of masculinities.

Retaining new graduate nurses in practice; under-pinning the theory of reciprocal role modelling with ‘routinisation’ theory and transition shock

Karen J Hoare

This manuscript discusses two extant theories that are pertinent to retaining new graduate nurses in practice and applies the new theory of reciprocal role modelling to them. Transition shock was first postulated by Boychuk Duchscher, who theorised that the real life world of clinical practice was so far removed from a nurse’s educational preparation in College or University that it caused the attrition of some nurses from the profession. In addition, Chambliss described the process of routinisation into hospital life and nursing work in his book Beyond caring, which was the result of 15 years of ethnographic observation in a hospital. Some nurses never become routinised to nurses’ work. Both of these theories support the grounded theory of reciprocal role modelling, that describes how new graduate nurses are mentored by experienced practice nurses (EPNs) into general practice in New Zealand. Unexpectedly new graduate nurses become role models to the EPNs showing them how to access information and continuing professional development material using modern technology. Acknowledging transition shock and the concept of routinisation and providing an environment in health-care organisations where reciprocal role modelling can occur, may result in the retention of younger nurses in the workforce.

Government by standards: The making and managing of accountability in Danish hospitals

Peter Triantafillou

Since 2009, all Danish hospitals have been subjected to a comprehensive, mandatory accreditation system, the so-called Danish Quality Model (DDKM), in order to assure the quality of hospital services. So far there is no evidence of DDKM’s positive effects on clinical outcome and it may even be contributing to accountability overload. This article seeks to provide an explanation for why hospital staff seems to accept, albeit grudgingly and partially, the imposition of a new, comprehensive accountability system with questionable clinical merits. Inspired by Michel Foucault’s analytics of government, it is argued that the accreditation system is hard to refuse because it promises to increase the quality of hospital services and, more importantly, because the procedural standards espoused by DDKM work through the structured and accountable freedom of medical staff.

Exploring the story of the smoking ban in Ireland as a neo-liberal project

Eluska Fernández

The year 2014 marked the 10th year anniversary of the introduction of the smoking ban in Ireland. Despite the objections to the smoking ban, controversy in the media and uncertainties among the public that characterized the aftermath of its announcement, the smoking ban came into effect on 29 March 2004 with little or no need of coercive enforcement mechanisms. The ban was mainly self-enforced by the public and compliance was from the beginning remarkably high. This article is concerned with exploring what forms of conduct were assumed and promoted to seek a successful exercise in ‘the conduct of conduct’ (Foucault, 1982). Findings from research are presented that demonstrate how policy help produce and reproduce individuals’ identification as ‘responsible’ and ‘irresponsible’ citizens. The article also contributes to debates on how neo-liberal forms of government encourage self-regulation in the context of contemporary public health interventions.

 

Sociology of Health & Illness

Women’s experience of HIV as a chronic illness in South Africa: hard-earned lives, biographical disruption and moral careers

Edwin Wouters, Katinka De Wet

This article presents findings from a longitudinal qualitative study (48 in-depth interviews with 12 women on antiretroviral treatment (ART)) exploring the experience of living with HIV as a chronic illness in South Africa by applying the structural and interactionist perspectives on chronic illness. The structural perspective indicates that the illness experience needs to be contextualised within the wider framework of the women’s hard-earned lives: throughout the interviews, the women tended to refuse singularising HIV/AIDS and continuously framed the illness within the context of general hardship and adversity. Employing an interactionist perspective, the repeated interviews demonstrated the partial applicability of the concept of biographical disruption to the illness experience: most women experienced feelings of denial and disbelief upon diagnosis, but the availability of ART clearly mitigated the impact of HIV on their biographies. In addition, our findings demonstrate that the interaction between structural aspects, (stigmatising) social relations, and the illness (and its treatment) determines the never-ending cycle of identity appraisals, revisions and improvements, rendering the moral career of the HIV-positive women on ART a continuous work in progress.

Emotion in obesity discourse: understanding public attitudes towards regulations for obesity prevention

Lucy C. Farrell, Megan J. Warin, Vivienne M. Moore, Jackie M. Street

Intense concern about obesity in the public imagination and in political, academic and media discourses has catalysed advocacy efforts to implement regulatory measures to reduce the occurrence of obesity in Australia and elsewhere. This article explores public attitudes towards the possible implementation of regulations to address obesity by analysing emotions within popular discourses. Drawing on reader comments attached to obesity-relevant news articles published on Australian news and current affairs websites, we examine how popular anxieties about the ‘obesity crisis’ and vitriol directed at obese individuals circulate alongside understandings of the appropriate role of government to legitimise regulatory reform to address obesity. Employing Ahmed’s theorisation of ‘affective economies’ and broader literature on emotional cultures, we argue that obesity regulations achieve popular support within affective economies oriented to neoliberal and individualist constructions of obesity. These economies preclude constructions of obesity as a structural problem in popular discourse; instead positioning anti-obesity regulations as a government-endorsed vehicle for discrimination directed at obese people. Findings implicate a new set of ethical challenges for those championing regulatory reform for obesity prevention.

The self as capital in the narrative economy: how biographical testimonies move activism in the Global South

Marian Burchardt

This article analyses and theorises the practice of biographical storytelling of HIV-positive AIDS activists in South Africa. Combining research in illness narratives, studies of emotions in social activism and analysis of global health institutions in Africa, I explore how biographical self-narrations are deployed to facilitate access to resources and knowledge and thus acquire material and symbolic value. I illustrate my argument through the analysis of the case of an AIDS activist who became a professional biographical storyteller. Based on the analysis which I claim to represent wider dynamics in human-rights-based health activism in the Global South, I propose the concept of narrative economies by which I mean the set of exchange relationships within which biographical self-narrations circulate and produce social value for individuals and organisations.

Category attribution as a device for diagnosis: fitting children to the autism spectrum

Jason Turowetz, Douglas W. Maynard

The practice of medicine involves applying abstract diagnostic classifications to individual patients. Patients present with diverse histories and symptoms, and clinicians are tasked with fitting them into generic categories. They must also persuade patients, or family members, that the diagnosis is appropriate and elicit compliance with prescribed treatments. This can be especially challenging with psychiatric disorders such as autism, for which there are no clear biomarkers. In this paper, we explicate a discursive procedure, which we term category attribution. The procedure juxtaposes a narrative about the child with a claim about members of a clinically relevant category, in this case, either children with autism or typically/normally developing children. The attribution procedure carries the implication that the child does or does not belong to that category. We show that category attributions are organised in a recurrent interactional sequence. Further, we argue that category attributions encode normative expectations about child development, such that the child is rendered typical or atypical relative to clinical and social norms. Accordingly, such categorisation devices have a moral dimension as well as a clinical one.

Prescriptions and proscriptions: moralising sleep medicines

Jonathan Gabe, Catherine M. Coveney, Simon J. Williams

The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a ‘bad press’ due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the ‘deserving’ patient, the ‘responsible’ user, the ‘compliant’ patient, the ‘addict’, the ‘sinful’ user and the ‘noble’ non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today.

Epistemic asymmetries in psychotherapy interaction: therapists’ practices for displaying access to clients’ inner experiences

Elina Weiste, Liisa Voutilainen, Anssi Peräkylä

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client’s experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client’s inner experience. In the formulations, the therapists and clients co-described the client’s experience, demonstrating that the client’s inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client’s talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client’s inner experience was called into question.

An exploration of integrated data on the social dynamics of suicide among women

Sharon Mallon, Karen Galway, Lynette Hughes, Janeet Rondón-Sulbarán, Gerard Leavey

The gender-based nature of suicide-related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been ‘othered’ and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male-only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner’s office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male-only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide.

 

Theory, Culture and Society

Statistical Practice: Putting Society on Display

Michael Mair, Christian Greiffenhagen, W.W. Sharrock

As a contribution to current debates on the ‘social life of methods’, in this article we present an ethnomethodological study of the role of understanding within statistical practice. After reviewing the empirical turn in the methods literature and the challenges to the qualitative-quantitative divide it has given rise to, we argue such case studies are relevant because they enable us to see different ways in which ‘methods’, here quantitative methods, come to have a social life – by embodying and exhibiting understanding they ‘make the social structures of everyday activities observable’ (Garfinkel, 1967: 75), thereby putting society on display. Exhibited understandings rest on distinctive lines of practical social and cultural inquiry – ethnographic ‘forays’ into the worlds of the producers and users of statistics – which are central to good statistical work but are not themselves quantitative. In highlighting these non-statistical forms of social and cultural inquiry at work in statistical practice, our case study is an addition to understandings of statistics and usefully points to ways in which studies of the social life of methods might be further developed from here.

Theorizing Bioart Encounters after Gilbert Simondon

Andrew Lapworth

In recent years ‘bioart’ has been lauded in the social sciences for its creative engagements with the ontological stakes of new forms of biotechnical life in-the-making. In this paper I push further to explore the ontogenetic potentials of bioart-encounters to generate new capacities for thinking and perceiving the nonhuman agencies imbricated in the becoming of subjects. To explore this potential I stage an encounter with Gilbert Simondon’s philosophy of individuation, highlighting three implications for theorizations of the constitution and transformation of subjects. First, Simondon forces us to rethink the subject in terms of its transductive emergence from pre-individual processes, and its metastable susceptibility to ongoing transformations. Second, he substitutes voluntarist conceptions of thought with an involuntarist primacy of material encounters as the conditions for novel individuations. Finally, I argue that Simondon enables a thinking of the politics of the (bio)art-encounter in terms of its ontogenetic capacity to materially produce, rather than merely represent, new subjects and worlds.

Bernard Stiegler on Transgenerational Memory and the Dual Origin of the Human

Michael Haworth

This article reconsiders Stiegler’s account of the emergence of the human species in light of research in the field of transgenerational epigenetics. Stiegler traces this emergence to the appearance of technical artefacts allowing for the intergenerational transmission of acquired memory that would otherwise die along with the organism. This is taken to constitute a rupture in the history of life. The argument that I develop critiques Stiegler’s account at two levels: On the empirical level I argue that emerging neo-Lamarckian developments in the life sciences pose a challenge to the terms in which the specificity of the human is outlined and the notion of the rupture with life that its emergence constitutes. On the logico-transcendental level, I contend that in its account of the rupture, Stiegler’s narrative repeats the logic of the ‘dual origin’ that he ascribes to Rousseau and Leroi-Gourhan in their respective accounts of the origin of the genus Anthropos.

Speculative Life: Art, Synthetic Biology and Blueprints for the Unknown

Jennifer Johung

Answering a call for a 2013 exhibition at Ars Electronica bridging art and synthetic biology, a group of artists and designers offer ‘Blueprints for the Unknown’. Their fictional scenarios offer possible futures already embedded in and ready to become our present. By imagining potential events and soon-to-be organisms and bodies, these blueprints perform the untenable relationship between predictable bioengineered living forms and the unpredictable contexts within which such life subsists over time. While synthetic biology focuses on the particularities of each micro-manipulation within a specific timeframe, art practices can speculate on the wider reverberations of modified life, making visible the vulnerable encounters and uneven exchanges across variable living forms and scales, from molecule to human, synthetic to organic. This paper explores the indeterminacies that arise as living forms become synthetically modified, reorganized and redirected at will.


Leave a Reply

Your email address will not be published. Required fields are marked *