In advance of our regular monthly journal round-up, here are two special issues to check out! First, the brand new June 2016 issue of East Asian Science, Technology and Society is titled Transnational Psy Sciences in East and Southeast Asia. Next, a special double issue of Eä – Journal of Medical Humanities & Social Studies of Science and Technology (open access) is titled Healthism & Self-Care: Reconfiguring Body & Life through Science & Technology. Enjoy!
From the 1970s onward, the psy sciences were witness to blustering confrontations from a New Age movement heavily informed by Asian philosophy. Nowadays, yoga practices and mindfulness training have been integrated into mainstream psychotherapy. Nevertheless, such trends toward East-West admixing are in fact not at all new. Through four case studies, this special issue provides empirical data complementing the abundance of new scholarship on the history of psy sciences in East and Southeast Asia.
Making and Mapping Psy Sciences in East and Southeast Asia (open access)
Harry Yi-Jui Wu, Wen-Ji Wang
The rich history of psy disciplines or psy sciences (psychology, psychiatry, psychotherapy, psychoanalysis) in modern society has been subject to different and sometimes conflicting interpretations. Major events, theories, and figures have been recorded and the meaning of their contributions explored to illustrate the ways in which various forms of psychological knowledge become important sources of self-understanding and self-actualization. Insights into the social and cultural history of psy sciences enable us to understand the interconnection between forms of knowledge and the social order to which they relate (Eghigian et al. 2007; Engstrom 2008). From a more radical perspective, Michel Foucault has famously written histories of rising human sciences so as to identify the construction of the self in relationship to the operation of the power/knowledge matrix since the nineteenth century. In Psychiatric Power (2006), for instance, he associates the development of psychology, criminology, and psychopathology to the functioning of disciplinary mechanisms in modern society. As he explains, the “psy-function was the discourse and the establishment of all the schemas for the individualization, normalization, and subjection of individuals within disciplinary systems” (85).
Following both the Foucauldian genealogical tradition and the aesthetic turn in the French philosopher’s later thought, the British sociologist Nikolas Rose brings into sharper relief the intricate connection between the proliferation of psy disciplines and the changes in governmentality and subjectification. In an era that values democracy and individual autonomy, a variety of new ways of understanding and relating to techniques of self have been invented, which have also become the inescapable means through which modern selves can be realized. Rose (1998) believes that the contemporary regulative ideal of the self can be “destabilized” and “denaturalized” by historical investigations into the mechanism of self invention.
Mental Illness in Singapore: A History of a Colony, Port City, and Coolie Town (open access)
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 a both 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.
The high prevalence of neurasthenia and its divergent social and cultural meanings in the late nineteenth and early twentieth centuries has been subjected to historical and anthropological studies. The present study explores the history of this elastic diagnosis in relation to the rise of “psy disciplines” in Republican China. Since the 1920s, emergent Chinese neuropsychiatric and mental health professionals eagerly entered the already vibrant culture of neurasthenia and provided their explanations. As China was under different spheres of influence, diverse systems of psy knowledge were practiced in the country. Differences in the conception of the nature of the disease were further intertwined with various reform projects with which these bodies of psychological knowledge were associated. Despite being the products of scientific internationalism, these discourses not only resonated with the epistemological and social concerns derived from Japan, Europe, and, gradually, the United States but generated their own ideas of personal, social, and national regeneration. By examining the history of neurasthenia in the light of the interactions among popular culture, the advent of modern psychiatric and psychological knowledge, and Republican China’s striving for modernity amid social turmoil, the article contributes to our understanding of medical culture in modern China.
Religion, Psychiatry, and Psychotherapy: Exploring the Japanese Experience and the Possibility of a Transnational Framework (open access)
Christopher G. Harding
This article offers a four-part framework for exploring the complexities and nuances of a modern and contemporary phenomenon in health care and broader public discourse in many parts of the world: the “religion-psy dialogue,” the increasing interchange between the thinkers, leaders, and laypeople of the world’s religions and the professionalizing and expanding “psy disciplines”—principally psychiatry, psychology, and psychotherapy. The four parts outlined here—circumstances and orientations, the human person, language, and complementarities and antagonisms—reference the Japanese context in particular but build on experiences elsewhere in the world and are intended to be useful multinationally and transnationally.
This article illustrates the exchange of knowledge, sharing of methods, and formation of collaborative research between Taiwan and the World Health Organization (WHO) by discussing a series of large-scale epidemiological studies on mental disorders conducted by the research team of National Taiwan University Hospital in the early postwar years. This article focuses on the purpose, importance, and legacy of the research within Taiwan and in the international social psychiatry projects led by WHO. The author analyzes the active and passive roles that these studies played in the context of postwar decolonization and the short-lived milieu of scientific internationalism aspired by the United Nations and its specialized agencies. WHO’s demand to outsource experts from developing countries was due to the lack of sources and enthusiasm of experts from Taiwan to participate in intergovernmental organizations and the self-fashioning of psychiatrists in Taiwan in order to build a national medical discipline that facilitated the connubiality between the two. Moreover, the psychiatric epidemiological research conducted in Taiwan was influenced by the survey-based Japanese ethnological studies developed in the first half of the twentieth century and was designed to build a national medical discipline after World War II. This type of research corresponded to the visions of international scientific communities to deracialize human sciences and fulfill the pursuit of knowledge on the basis of the WHO ideology of “world citizenship.” The cultural determinism approach matched the dominant neo-Freudian theories of psychopathology, which depart from the biodeterminism derived from the experiences of colonial psychiatry, and provided the foundation for the universal profiles of mental disorders that WHO mental health experts idealistically attempted to establish.
Introduction (open access)
Philippe Bardy, Justine Laurent, Mauro Turrini
Over the past decades technological innovations such as digital technologies, genomics, and bio-nanotechnology have been promoted as means of improving “health”, a term that was broadly defined by the World Health Organization in 1946 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Access to “molecules of life”, miniaturized diagnostic devices or health-related connected objects have greatly intensified and accelerated the pace of production, circulation and sharing of health data, thereby reconfiguring the traditional relationship between medicine and society. While “biomedicalization” is often used as a term of reference to describe this social phenomenon, we choose to refer to the concept of “healthism” (“santéisme” in French) as it underscores the current development and dissemination of individual practices of biomedical techniques. People’s engagement with, or even appropriation of, new medical technologies and knowledge, both inside and outside medical institutions, have led to the opening of frontier zones of expertise and to the development of borderline practices, half-way between medicine and self-care, resulting in the multiplication of patient figures across biomedical platforms, processes and technologies. These major shifts in medical practices require a critical examination. Healthism must also be questionned if we are to gain a better view of the reconfiguration of the body and life through science and technology today.
A genealogy of “healthism”: Healthy subjectivities between individual autonomy and disciplinary control (open access)
Healthism is a sociological concept that has circulated widely outside of academia, while is it rather neglected by social sciences. This article intends to propose its genealogy in order to revitalize this term and to propose it as an analytical framework able to grasp some of contemporary tendencies marked by the centrality of individuals. After an historical excursus of healthism, which began as a spin-off of the well-known term “medicalization”, the article proceeds by exploring the legacy of this notion for contemporary analysis of the expanding sector of illness prevention and prediction as well as health/wellness promotion and optimization. In particular, it focuses on the establishment of lifestyles and risk factors as the vector of medical devices, practices, and concepts in society. Instead of looking at these changes in spatial terms, as either an expansion or a shrinking of medical discourse, healthism provides an analytical framework attentive to the relationship with medical power, technologies and data inherent in emerging medical subjectivities.
Beyond Traces: Towards a socio-anthropology of digital health (open access)
Digital health technologies may first be characterized by great ambivalence. They reflect new modes of social emancipation while giving material form to new control methods (biopower, surveillance medicine) with certain well-known characteristics or features that have yet to be deciphered. Rather than being formal, such ambivalence is the starting point for our understanding of the social dynamics resulting from the use of health technologies. “Traces”, which it is the overall aim of current technological apparatuses to collect, store and process, have a diametrically opposed meaning depending on whether or not they are construed as the outcome of a collective effort or underlying “political project”. This article thus questions the various, often contradictory, significations that are induced by the use of domohealth and social networks.
Patient empowerment: A practical approach to guide ethical decision-making in telemedicine (open access)
This article aims to clarify the concept of patient empowerment and to assess its ethical implications in modern telemedicine. To achieve this goal, it provides a review of the ICT-based tools used by patients in telemedical settings, known as “Connected Medical Devices” (CMD), as well as an overview of some of the most advanced e-health systems enabling remote communications between patients and health practitioners today. Patient empowerment, it is then argued, is a capacity-building process whereby personal and inter-personal transformation may be achieved. Furthermore, it is a practical approach to ethical decisions, based on shared decision-making, with a focus on patient autonomy and self-determination. These views are consistent with telemedicine’s main objectives, but also with the spirit of a new politics, and a new ethics, of vitality and “transformative” patient empowerment.
Technologies of Compliance? Telecare technologies and self-management of COPD patients (open access)
Ivo Maathuis, Nelly Oudshoorn
In current healthcare discourses self-management has been articulated as one of the major aims of telecare technologies for chronic patients. This article investigates what forms of self-management are inscribed during the design of a telecare system for patients with COPD (Chronic Obstructive Pulmonary Diseases) and enacted during its use. Based on an analysis of the design and use of this telecare system, the paper shows that there are important differences between self-management approaches incorporated in the telecare system and the self-management strategies adopted by patients. The telecare equipment was designed in such a way that it incorporated forms of self-management based on compliance. It disciplined patients to adhere to medical treatment and an activity regime rather than involving them in shared decision-making with healthcare professionals. However, the used practices reflected self-management approaches based on collaboration and concordance between healthcare professionals and patients, including integration of their experience based knowledge. Patients domesticated the devices in such a way that they became adjusted to their daily routines and embodied experience with managing their illness.
Doing Things with Numbers: The Quantified Self and the Gamification of Health (open access)
Software applications are changing our relationship with health. Individuals who intensively self-track their activities and physiological states, the so-called “Quantified Selfers”, think that a data-driven life can enhance their health status. Indeed, recent research has demonstrated the effective utility of some of these devices. In addition, “gamification” – that is the use of game design elements in non-game contexts – can serve to increase individuals’ health. Gamification facilitates and supports our pursuit of goals and appears to enhance performance. However, while apps seem to support health, there are some risks to be considered: quantification and gamification can foster a neoliberal idea of health as a personal responsibility, bracketing the fundamental role played by social determinants in shaping health status. Moreover, some health insurance companies are rewarding individuals who agree to share their self-tracking data with them. The risk is that what is an individual option today may become a social constraint or requirement tomorrow.
Healthscapes of self-quantification: Quantifying, knowing and improving one’s self: transforming health (open access)
Self-quantification practices are often described as knowledge-making, as the maxim of quantifiers – “self-knowledge through numbers” – makes clear. In this narrative, data is knowledge, knowledge is power, and knowing oneself is central to endeavours to improve health. This article complicates this story, investigating other health-related practices of self-quantification. Moving beyond “knowledge” to attend to the various “doings” embedded in the activities of quantifiers permits a framing of self-quantification not so much as an epistemological quest but rather as a series of practical interventions. This shift to understand self-quantifying as a diverse set of doings rather than simply knowing, provides an opportunity in the remainder of this article to reassess the way quantifiers transform contemporary “healthscapes”; that is the material-semiotic constellations of health. In my conclusion, I argue that self-quantifying practices can be read as a trend of changes in health that is twofold: on the one hand, there is a chronicization of risks, and, on the other, a vision of health as enhancement. These can be plotted along the axes of the normal and the pathological, offering a potentially different reading of the quantifiers’ modes of intervening in the self.
Doping oneself cautiously: A critical approach of Healthism (open access)
This article studies the questions on doping and on the fight against doping in reference to healthism. One can interpret these social activities as expressions of health practices reshaping and strengthening the relations between patients, their health and the medical staff. The analysis of three chat forums (we have examined more than 244,000 messages altogether), highlights on the one hand, that powers cannot be identified in a permanent way and, on the other hand, that the Internet users are leading inquiries collectively. A pragmatics of powers interested in the asymmetries of “grips/grasps” and of “influence” (Chateauraynaud, 2015) allows us eventually to describe subtly these complex processes.
From savvy consumers to informed risk managers: Shifting images of medical self-care (open access)
In February 1889, a 26 year-old Brooklyn woman, Ida Hunt, was told by a well-known surgeon, Mary Dixon Jones, that she suffered from an internal tumor that may burst and put her life in danger. Upon Dixon Jones’s advice Hunt underwent an abdominal surgery, developed a peritonitis and died. The Brooklyn newspaper, The Eagle, used Hunt’s death to mount a campaign against Dixon Jones, accusing her of being a knife happy, sadistic and corrupted practitioner, who persuaded naive women to undergo unnecessary and risky operations. In fact, Hunt was a savvy consumer of medical services, who consulted numerous doctors for her severe gynecological complaints, carefully evaluated her options, and in all probability elected Dixon Jones precisely because she advocated radical surgical solutions. In 2008, the company 23andMe included mutations in BRCA genes which predispose for breast and ovarian cancer in their “health package”. The company’s experts gathered testimonies from grateful clients who found out unexpectedly that they were BRCA mutation carriers and decided to undergo prophylactic surgeries (ablation of ovaries, and, for some, mastectomy). 23andMe lost in 2013 the right to propose health information in the US, but in the same year the American College of Medical Genetics and Genomics (ACMG) recommended to include BRCA mutations among incidental findings that should be reported to patients. This recommendation, and the 2014 proposal to generalize the testing for BRCA mutations, were made in spite of lack of firm data on efficacy of preventive measures to reduce cancer deaths in mutation carriers, especially those without a family history of breast and ovarian malignancies. People, advocates of BRCA testing argue, have the right to know about their health risks in order to be able to make informed decisions about their management. This article takes these two cases as a starting point of reflections on continuity and change in self-care practices, with an accent on their gendering.
Denying human biology as destiny (open access)
The inclination to deny the “human body as destiny”, beyond the limits of healthism, seems to have increased over the last fifty years. Regaining one’s own physicality, which certainly represents a recurring trend in history, has become, since the middle of the 20th century, an ardent obligation. To facilitate a better understanding of this phenomenon, however, we must distance ourselves from “health issues” as social constructs. Our growing concern with our own physical re-appropriation of the self has become apparent, for instance, in the way we handle birth and death today: many examples attest to this. It is as though we were witnessing an acceleration, somewhat singular, of the process of individuation: an acceleration that relies on the human body as a prime location for its own realization. To make sense of this phenomenon, we suggest to read again Norbert Elias with Michel Foucault.
Patients in the Digital Healthcare Ecosystem (open access)
This paper is the transcript of the talk that was given at the Healthism & Self-Care Conference held at the Sorbonne University on December 12, 2014. As Vice-President of the French Medical Board (in French, Conseil National de l’Ordre des Médecins), the author aims to examine how digital health technologies impact patients today. To achieve this goal, he first addresses the ethics of telemedicine by asking three fundamental questions: Is telemedecine a progress for patients in terms of well-being and health preservation? Does telemedecine enhance patients’ autonomy? What are the real benefits of digital health devices and connected objects for patients? The author then goes on identifying and discussing some of the potential threats of digital health technologies to patients in terms of privacy and individual rights. Finally, he adresses the issues of the regulation of the telemedical industry on the basis of rules of law and ethical guidelines.