Here is the second half of our March roundup of journal articles. There are also two Special Issues out this month that may be of interest, including the current Medical Anthropology Quarterly, and their contents are posted here.
In this article, I discuss two “crimes of compassion”—one a mercy killing and the other what I refer to as a “mercy resurrection”—as key illustrations of the changing landscape of necropolitical governmentality in Russia some 20 years after the collapse of the Soviet Union. Such practices present unanticipated challenges to the state control of death, producing irregular yet ultimately normative narratives of what counts as pathological, as life and death, and as the meaning of suffering, love, and compassion. I argue that these cases ultimately present two sides of the same coin, evincing a politics of life that, intentionally or not, defies the power of the state over death and its monopoly position as the purveyor of death and immortality. They also suggest alternative practices of caregiving to the dead and dying. In doing all this, they enter a legally ambiguous zone between violence and compassion, martyrdom and savagery, madness and mercy.
In this article, I explore surrogates’ rich, diverse, and collective negotiations of relatedness and relationships on the largest U.S. surrogacy support website. Surrogates reconfigure existing kinship understandings and maintain that intent and love are firmer bases of parenthood than biogenetic connection. Increasing use of donor gametes contributes to the emphasis on desire to be parents. In gestational surrogacy, genetic relatedness between the child and the intended parents strengthens claim to parenthood but lack thereof does not call parenthood into question. Traditional surrogates’ biogenetic connection to the child they carry is never considered to be grounds for claims to motherhood. Surrogates and intended parents “do kinship” and consider the actions of kinship more consequential that its biological facts. In their accounts, desire for children is “natural” and the choice to raise them is understood as morally positive. Genetic facts, however, are understood as morally neutral. Surrogates and intended parents contend that surrogate babies belong to the parents who want them. Surrogates’ emphasis on chosen solidarity works to diminish the importance of genetic relatedness and helps them uphold the traditional boundaries of their own nuclear family and that of the intended parents.
People in southern Ghana provide care by attending to and synchronizing their and others’ life courses. Women, in particular, synchronize their life courses with the developmental and aging pathways of others. Since the 1970s, younger women in southern Ghana have migrated to urban or rural areas to earn money, leaving their children in the care of their mothers, whom they support with their remittances. As migrant women grow older, they return to their hometowns to provide elder and child care. Although female transmigrants also use these temporal strategies of care, the synchronization of life courses proves more difficult to coordinate in transnational contexts. For these reasons, time and timing is as important as space and location to transnational migrants, and migration is transtemporal as well as translocal.
“Zip me up, and cool me down”: Molar narratives and molecular intensities in ‘helicopter’ mental health services
Laura McGrath & Paula Reavey
Experiences of the space–time dimensions of contemporary mental health services are shaped according to what we describe here as a ‘helicopter service’, where professionals drop down into service users’ lives for short, often pre-determined bursts of time. This can create a system where users’ experiences are observed and assessed from a more distanced and circumscribed perspective. This paper considers the implications of these systemic changes, using interviews with current UK service users. To help in the exploration of the complexities faced by service users’, we use Deleuze and Guatarri’s (1987) distinction between molar and molecular forms of organisation. A process oriented thematic analysis discusses: a) Affording narratives of distress: Molarity, monitoring and space in service interactions and b) Narratives in therapy: Compartmentalising the distressed self. Multiple aspects of the relationship between space and distress are explored. An understanding of experiences of distress beyond the boundaries of the molar, which considers its intensive, molecular and transformative nature, may help to open up engagement with the affective and emotional dimensions of mental health.
Unpacking the impact of older adults’ home death on family care-givers’ experiences of home
Christine Milligana, Mary Turnera, Susan Blakeb, Sarah Brearleya, David Seamarkb, Carol Thomasa, Xu Wangc, Sheila Paynea
Public Health England (2013) survey data indicates that while the place of death is geographically uneven across England, given a choice, many older people nearing end of life would prefer to die at home. There is, however, a growing critique that policies designed to support home death fail to understand the needs and preferences of older people and the impact on family carers. Such policies also make assumption about within whose home the home death takes place. Hence, there are major gaps in our understanding of firstly, where and how care work undertaken by family members within domestic settings takes place; and secondly, how it can create tensions between home and care that fundamentally disrupt the physical and socio-emotional meaning of home for family carers, impacting on their sense of home post-death. This can have consequences for their own well-being. In this paper we draw on interview data from our ‘Unpacking the Home’ study to elicit an in-depth understanding of how facilitating a home death can create an ambiguity of place for family carers, where the issues faced by them in caring for a dying older person at home, and the home death itself, can fundamentally reshape the meaning and sense of home.
Taming the fear of voice: Dilemmas in maintaining a high vaccination rate in the Netherlands
Els Geelen, Hans van Vliet, Pieter de Hoogh, Klasien Horstman
In the context of international public debates on vaccination the National Institute for Public Health and the Environment (RIVM), the Dutch public health body responsible for the National Immunization Programme (NIP), fears that the high vaccination rate of children in the Netherlands obscures the many doubts and criticisms parents may have about vaccination. The question arises as to how the robustness of this vaccination rate and the resilience of the NIP can be assessed. To answer this question, we explore the vaccination practices and relationships between professionals and parents using qualitative methods. Drawing on Hirschman’s concepts of exit, voice and loyalty, we distinguish between two different approaches to vaccination: one which enforces parental loyalty to the vaccination programme, and one which allows for voice. The analysis shows that due to their lack of voice in the main vaccination setting, parents’ considerations are unknown and insight into their loyalty is lacking. We argue that the Dutch vaccination programme is caught between the insecurity of enforced parental loyalty to the NIP and the insecurity of enabling parental voice and negotiating space. We conclude that to increase the resilience of the NIP, experimenting with voice and exit is inevitable.
The myth of the total institution: Written narratives of patients’ views of sanatorium care 1908–1959
Staffan Bengtsson, Pia H. Bülow
Drawing on written narratives by 72 former sanatorium patients, this article explores, from patients’ perspectives, the nature of the relationships between patients and staff in a Swedish sanatorium during the first half of the twentieth century. These narratives are discussed in the context of the total institution. This article suggests that this phenomenon was marked by inconsistencies that can be understood in terms of its situational and contradictory characteristics. Simultaneously, these narratives are in opposition to the assumption of the static and powerless patient adapted only to suit the logic of the institution.
Vaccination against the sexually transmitted Human Papilloma Virus (HPV), a necessary agent for the development of cervical cancer, has triggered much debate. In Austria, HPV policy turned from “lagging behind” in 2008 into “Europe’s frontrunner” by 2013. Drawing on qualitative research, the article shows how the vaccine was transformed and made “good enough” over the course of five years. By means of tinkering and shifting storylines, policy officials and experts disassociated the vaccine from gender, vaccine manufacturers, and youth sexuality. Ultimately, the HPV vaccine functioned to strengthen the national immunization program. To this end, preventing an effective problematization of the extant screening program was essential.
“These things are dangerous”: Understanding induced abortion trajectories in urban Zambia
Ernestina Coast, Susan F. Murray
Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement.
Agency, intimacy, and rape jokes: an ethnographic study of young women and sexual risk in Chennai (open access)
In this article, I examine the circulation of jokes about sexual violence among young middle-class women in the South Indian city of Chennai. Drawing on ethnographic research with undergraduate students in this city, I locate the rape joke in an ambivalent discourse of risk that conflates the possibility of sexual assault with the perceived ‘risks’ of women’s sexual autonomy. In this context, I argue that humour about sexual violence functions as a form of lateral agency, facilitating a break from the task of reproducing middle-class respectability.
Basic Research and Knowledge Production Modes: A View from the Harvard Medical School
Andrea Boggio, Andrea Ballabeni, David Hemenway
A robust body of literature analyzes the shift of academic science toward more business-oriented models. This paper presents the findings of an empirical study investigating basic scientists’ attitudes toward publicly funded basic research at the Harvard Medical School and affiliated institutions. The study finds that scientists at the Harvard Medical School construe publicly funded basic research as inquiries that, whether use oriented or not, must be governed by the cognitive and social norms of the traditional mode of knowledge production (mode 1 paradigm). They recognize that academic science is vulnerable to access by external capital but maintain that it remains distinct from research done in the private sector. Overall, the study demonstrates that important segments of academia have preserved a traditional approach to knowledge production, which is yet to be transformed by the entrepreneurial turn.
Voluntary Participation in Forensic DNA Databases: Altruism, Resistance, and Stigma
Helena Machado, Susana Silva
The public’s understanding of forensic DNA databases remains undertheorized and few empirical studies have been produced. This article aims to address this omission by exploring the answers to an open-ended question taken from an online questionnaire regarding the reasons for individuals’ voluntarily accepting or refusing to allow their DNA profile to be included in the Portuguese forensic DNA database. The analysis is undertaken from the perspective of biological citizenship and the simultaneous empowering and disempowering effects of surveillance. The results indicate a pragmatic ethical framework that is linked to the cultural and emotional elements of altruism, resistance, stigma, and social representations of what is beneficial or harmful to the individual and to society. These subjectivities are anchored in commonplace images and metaphors for genetics, DNA, and forensic science that circulate in the messages transmitted by the media which pervade everyday life; hierarchies of trust in science and the justice system; and moral categories associated with the individual self-judgment in relation to crime, surveillance, and social order.
Roberto Esposito’s ‘Affirmative Biopolitics’ and the Gift
Thomas F. Tierney
This article develops the affirmative biopolitics that Roberto Esposito intimates in his trilogy – Communitas, Immunitas and Bíos. The key to this affirmative biopolitics lies in the relationship between the munus, a form of gift that is the root of communitas and immunitas, and the gift discourse that developed throughout the 20th century. The article expands upon Esposito’s interpretation of four theoretical sources that are crucial to his biopolitical perspective: Mauss and the gift-exchange tradition; Hobbes’s social contract theory, which Esposito presents as the anti-gift that founded modernity’s thanatopolitical ‘immunization paradigm’; Bataille’s dangerous concept of sacrifice, which gestures toward an affirmative biopolitical community; and, finally, Jean-Luc Nancy’s essay, L’Intrus, which reflects on the near-decade Nancy lived as the recipient of the gift of a transplanted heart. This discussion of Mauss, Hobbes and Bataille is used to further develop Esposito’s interpretation of L’Intrus in a manner that supports his conception of an affirmative biopolitics ‘of, not over, life’.
The Receding Animal: Theorizing Anxiety and Attachment in Psychoanalysis from Freud to Imre Hermann
Lydia Marinelli & Andreas Mayer
Animals played an important role in the formation of psychoanalysis as a theoretical and therapeutic enterprise. They are at the core of texts such as Freud’s famous case histories of Little Hans, the Rat Man, or the Wolf Man. The infantile anxiety triggered by animals provided the essential link between the psychology of individual neuroses and the ambivalent status of the “totem” animal in so-called primitive societies in Freud’s attempt to construct an anthropological basis for the Oedipus complex in Totem and Taboo. In the following, we attempt to track the status of animals as objects of indirect observation as they appear in Freud’s classical texts, and in later revisionist accounts such as Otto Rank’s Trauma of Birth and Imre Hermann’s work on the clinging instinct. In the 1920s and 1930s, the Freudian conception of patients’ animal phobias is substantially revised within Hermann’s original psychoanalytic theory of instincts which draws heavily upon ethological observations of primates. Although such a reformulation remains grounded in the idea of “archaic” animal models for human development, it allows to a certain extent to empiricize the speculative elements of Freud’s later instinct theory (notably the death instinct) and to come to a more embodied account of psychoanalytic practice.
In the 1940s–50s, one of the most central questions in psychological research related to the nature of neurosis. In the final years of the Second World War and the following decade, neurosis became one of the most prominent psychiatric disorders, afflicting a high proportion of military casualties and veterans. The condition became central to the concerns of several psychological fields, from psychoanalysis to Pavlovian psychology. This paper reconstructs the efforts of Chicago psychiatrist Jules Masserman to study neurosis in the laboratory during the 1940s and 1950s. Masserman used Pavlovian techniques in a bid to subject this central psychoanalytic subject to disciplined scientific experimentation. More generally, his project was an effort to bolster the legitimacy of psychoanalysis as a human science by articulating a convergence of psychoanalytic categories across multiple species. Masserman sought to orchestrate a convergence of psychological knowledge between fields that were often taken to be irreconcilable. A central focus of this paper is the role of moving images in this project, not only as a means of recording experimental data but also as a rhetorical device. The paper argues that for Masserman film played an important role in enabling scientific observers (and then subsequent viewers) to see agency and emotion in the animals they observed.