In the Journals

In the Journals – May 2017

Please enjoy the article round-up for the month of May! This post was put together in collaboration with Ann Marie Thornburg.

American Ethnologist

Plant matters: Buddhist medicine and economies of attention in postsocialist Siberia

Tatiana Chudakova

Buddhist medicine (sowa rigpa) in Siberia frames the natural world as overflowing with therapeutic potencies: “There is nothing in the world that isn’t a medicine,” goes a common refrain. An exploration of sowa rigpa practitioners’ committed relations with the plants they make into medicines challenges human-centric notions of efficacy in anthropological discussions of healing. Their work of making things medicinal—or pharmacopoiesis—centers on plants’ vital materialities and requires attention to the entanglements among vegetal and human communities and bodies. Potency is thus not the fixed property of substances in a closed therapeutic encounter but the result of a socially and ecologically distributed practice of guided transformations, a practice that is managed through the attentive labor of multiple actors, human and otherwise. In Siberia, pharmacopoiesis makes explicit the layered relations among postsocialist deindustrialization, Buddhist cosmologies, ailing human bodies, and botanical life.

Annals of Anthropological Practice

Special Issue: Continuity and Change in the Applied Anthropology of Risk, Hazards, and Disasters

Disaster vulnerability in anthropological perspective 

A.J. Faas

In the study of disasters, the concept of vulnerability has been primarily employed as a cumulative indicator of the unequal distributions of certain populations in proximity to environmental and technological hazards and an individual or group ability to “anticipate, cope with, resist and recover” from disaster (Wisner et al. 2004). This concept has influenced disaster research as a means to question how natural, temporary, and random disasters are and focused analysis on the human-environmental processes that produce disasters and subject some populations more than others to risk and hazards. Critics also point out that vulnerability frameworks elude measure, strip people of agency, and reify stereotypes of the Global South. In light of both the historical importance and the sustained critiques of the concept, this chapter looks to anthropological and related literature to explore several questions: is it possible that vulnerability has outlived its usefulness? Is it still analytically meaningful for anthropologists currently working in the area of risk, hazards, and disasters? And what are the potential consequences or benefits that could come with conveying the concept of vulnerability to policy and decision makers?

 

Resilience: A commentary from the vantage point of anthropology

Roberto Barrios 

In recent years, the concept of resilience has gained popularity as a means to describe the qualities and capacities that enable a community to recovery from a catastrophic event. Definitions of resilience make a number of assumptions about the nature of communities and the practices that enable their ability to cope or weather a disaster’s impact. In this article, I provide a brief history of the ways disaster researchers have defined resilience and provide an analysis of the fundamental assumptions upon which such definitions are based. Furthermore, I provide a critical analysis of such assumptions in light of anthropological knowledge about the relationships and processes that put communities on the map, shape the ways they are exposed to hazards, and their possibilities for recovery. In conclude by providing four recommendations for practice which stress 1) the recognition of disaster has a historically shaped process involving development practice and human-environment relations, 2) the recognition of the broader political ecological relationships that shape resilience, 3) an emphasis on systemic transformation rather than locality specific interventions as a means of resilience-building, and 4) a prioritization of subaltern voices in operationalizations of “rebuilding better” as a mechanism for addressing the practices of environmental injustice that routinely give form to disaster vulnerability and those conditions that are branded “low resilience.”

 

Cultural Anthropology  (open access)

Special issue on Affect

A Clinical Economy of Speculation: Financial Trading and Gambling Disorder in Spain

Jorge Núñez

This article concerns itself with financial traders in Spain who have been diagnosed with gambling disorder. It analyzes what I call the clinical economy of speculation, in which the category of problem gambler is repurposed to draw new lines around proper financial trading. In exploring the expansion of post–financial crisis regulatory mechanisms for credit and debt, as well as widening inequalities across the field of investment, I depict how both traders and clinicians become invested in medicalizing trading as gambling disorder. My theorizing interrogates whether and why common speculative practices are seen as sick and unsafe when everyday people, instead of banks and other financial institutions, perform them. I argue that the pathologized trader is an attempt to regulate, at the individual level, the increasing use of borrowed capital to make financial profits. The commodification of debt, however, is not a gender-neutral development. Female traders pay a greater price for venturing into the heights of finance. This focus on gender brings into view the redefinition of credit and debt within the domain of trading, and shows the role of debt-fueled financial speculation in the expansion of financial markets. These ethnographic findings are particularly relevant in a country like Spain, where the Great Recession has bred more new millionaires than ever before, even as the smaller fish of the economy are being medicalized and sometimes even incarcerated.

 

Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine

‘Am I really gonna go sixty years without getting cancer again?’ Uncertainty and liminality in young women’s accounts of living with a history of breast cancer

Sophie Rees

Although much research has examined the experience of breast cancer, the distinctive perspectives and lives of young women have been relatively neglected. Women diagnosed with breast cancer under the age of 45, and who had completed their initial treatment, were interviewed, and social constructionist grounded theory methods were used to analyse the data. The end of initial treatment was accompanied by a sense of unease and uncertainty in relation to recurrence and survival, and also fertility and menopausal status. The young women’s perceptions about the future were altered, and their fears about recurrence were magnified by the possibility of many decades ahead during which breast cancer could recur. The implications for the young women’s life course, in terms of whether they would be able to have children, would not become clear for several years after initial treatment. This resulted in a liminal state, in which young women found themselves neither cancer-free nor cancer patients, neither pre- nor post-menopausal, neither definitively fertile nor infertile. This liminal state had a profound impact on young women’s identities and sense of agency. This extends previous understanding of life after cancer, exploring the age-related dimensions of liminality.

 

‘Why worry about something you can’t control?’ Negotiated risk, longevity and health behaviours

Rebecca Llewellyn, Wayne Cunningham, Chrystal Jaye, Jessica Young, Richard Egan, Peter Radue

While we know about lay attitudes towards death and dying, we understand little about the ways people estimate their overall personal risk of life-limiting disease and/or death. This study contributes to the limited literature on lay longevity reckonings, with a particular focus on how these reckonings may influence health behaviours. Semi-structured interviews were held with 21 young older adults (54–65 years), addressing the core questions of ‘What do you think you will die from, and how long do you expect to live?’ Participants indicated their longevity estimation was guided by three key frameworks: family history, environment and lifestyle factors and lived experience. The reckoning process was also moderated by assumptions about loci of control and self-efficacy and the information available to participants. A tripartite model of death risk assessment is proposed, extending the idea of ‘negotiated risk’ beyond the scope of family history where it has received most attention. We argue that by drawing on the three risk-assessment frameworks, determining patients’ predisposition for external/internal attributions of control and perceptions of self-efficacy, clinicians will be better equipped to understand – and thus guide – patients’ reckonings of longevity and health behaviours that are influenced by it.

 

‘Naloxone works’: The politics of knowledge in ‘evidence-based’ drug policy

Kari Lancaster, Carla Treloar, Alison Ritter

For over 20 years, drug policy experts have been calling for the wider availability of naloxone, to enable lay overdose witnesses to respond to opioid overdose events. However, the ‘evidence base’ for peer-administered naloxone has become a key point of contention. This contention opens up critical questions about how knowledge (‘evidence’) is constituted and validated in drug policy processes, which voices may be heard, and how knowledge producers secure privileged positions of influence. Taking the debate surrounding peer-administered naloxone as a case study, and drawing on qualitative interviews with individuals (n = 19) involved in the development of naloxone policy in Australia, we examine how particular kinds of knowledge are rendered ‘useful’ in drug policy debates. Applying Bacchi’s poststructuralist approach to policy analysis, we argue that taken-for-granted ‘truths’ implicit within evidence-based policy discourse privilege particular kinds of ‘objective’ and ‘rational’ knowledge and, in so doing, legitimate the voices of researchers and clinicians to the exclusion of others. What appears to be a simple requirement for methodological rigour in the evidence-based policy paradigm actually rests on deeper assumptions which place limits around not only what can be said (in terms of what kind of knowledge is relevant for policy debate) but also who may legitimately speak. However, the accounts offered by participants reveal the ways in which a larger number of ways of knowing are already co-habiting within drug policy. Despite these opportunities for re-problematisation and resistance, the continued mobilisation of ‘evidence-based’ discourse obscures these contesting positions and continues to privilege particular speakers.

 

‘You feel like your whole world is caving in’: A qualitative study of primary care patients’ conceptualisations of emotional distress

Adam WA Geraghty, Miriam Santer, Samantha Williams, Jennifer Mc Sharry, Paul Little, Ricardo F Muñoz, Tony Kendrick, Michael Moore.

General practitioners are tasked with determining the nature of patients’ emotional distress and providing appropriate care. For patients whose symptoms appear to fall near the ‘boundaries’ of psychiatric disorder, this can be difficult with important implications for treatment. There is a lack of qualitative research among patients with symptoms severe enough to warrant consultation, but where general practitioners have refrained from diagnosis. We aimed to explore how patients in this potentially large group conceptualise their symptoms and consequently investigate lay understandings of complex distinctions between emotional distress and psychiatric disorder. Interviews were conducted with 20 primary care patients whom general practitioners had identified as experiencing emotional distress, but had not diagnosed with major depressive disorder. Participants described severe emotional experiences with substantial impact on their lives. The term ‘depression’ was used in many different ways; however, despite severity, they often considered their emotional experience to be different to their perceived notions of ‘actual’ depression or mental illness. Where anxiety was mentioned, use appeared to refer to an underlying generalised state. Participants drew on complex, sometimes fluid and often theoretically coherent conceptualisations of their emotional distress, as related to, but distinct from, mental disorder. These conceptualisations differ from those frequently drawn on in research and treatment guidelines, compounding the difficulty for general practitioners. Developing models of psychological symptoms that draw on patient experience and integrate psychological/psychiatric theory may help patients understand the nature of their experience and, critically, provide the basis for a broader range of primary care interventions.

 

A qualitative investigation of lay perspectives of diagnosis and self-management strategies employed by people with progressive multiple sclerosis

Julia Frost, Jane Grose, Nicky Britten

This article explores how people with progressive multiple sclerosis give meaning to their experiences. It builds upon the self-management literature, which has captured the tension between the desire for retaining normalcy and the increasing burden of self-management associated with chronic disease progression. This repeat interview study is empirically grounded in 28 interviews with 14 people with progressive multiple sclerosis. We identified gender differences in diagnosis-seeking which impacted subsequent sense-making. Male respondents found a diagnosis of multiple sclerosis difficult to come to terms with, and an enduring sense of loss or anger could inhibit further sense-making. A diagnosis of multiple sclerosis was more difficult to obtain for women respondents, and any sense of certainty that diagnosis provided framed their subsequent sense-making strategies. The complex sequelae of multiple sclerosis require that self-management strategies are both contextual and timely, although even the most accomplished self-managers can lose their sense of self with neurodegeneration. Disease progression can be associated with suicidal ideation, suggesting the need for greater dialogue to ensure that people with multiple sclerosis are adequately supported to fulfil their quality of life at all stages of neurodegeneration. These lay perspectives emphasise the articulation of affect rather than the rendering of a medical diagnosis, although diagnosis may provide a degree of certainty in the short term. The ethos of self-management ensures people attempt to retain their sense of ‘normality’ and existent social roles for as long as possible, but this ethos can negate both one’s ability to self-manage and the management of self.

 

An exploratory study of the experience of fibromyalgia diagnosis in South Africa

Silvie Cooper and Leah Gilbert

Within the conceptual framework of ‘medically-ill-defined’ conditions, this article focuses on the experiences of ‘diagnosis’ through a narrative analysis of fibromyalgia (a chronic musculoskeletal pain disorder) in South Africa. In-depth interviews were used to collect narratives from 15 participants. The findings show how the contested and confusing experience of fibromyalgia diagnosis can be understood, by viewing the interactions that patients have with their practitioners, families, peers and colleagues. The currency of fibromyalgia as a diagnosis and the inequalities present in the South African health care system characterise the experiences of symptom recognition, diagnosis and treatment. The analysis reveals how those living with fibromyalgia search for diagnosis, and struggle to maintain legitimacy for their experience in the complex constellation of porous symptoms that appear infrequently. The findings of this study confirm the existing evidence that shows fibromyalgia to be a challenging illness experience, which is attributed to the lack of clarity and legitimacy, and high contestation that surrounds the condition. Additionally, this study presents the ways that limited access to diagnosis and treatment for fibromyalgia in the South African context shapes this specific illness experience, and the value of using narrative approaches to gain insight into how people live with hidden and poorly understood conditions in this environment.

 

Health and Place

The embodied spaces of children with complex care needs: Effects on the social realities and power negotiations of families

Roberta L. Woodgate, Melanie Zurba , Marie Edwards , Jacquie D. Ripat and Gina Rempel

This paper presents research findings that advance knowledge around the power and agency families with children with complex care needs (CCN). Our conceptual framework uses concepts from geography towards situating the experiences and social realities of family carers within the ‘embodied space of care’. The data originate from a longitudinal qualitative study of Canadian families with children with CCN. Findings reveal that interactions and decision-making processes relating to health and everyday life were complex and socially interconnected, and emphasize the need for provisions for family-based decision-making and enhanced social inclusion of families and the importance of the renegotiation of power.

 

The ward as emotional ecology: Adolescent experiences of managing mental health and distress in psychiatric inpatient settings

Paula Reavey, Jason Poole, Richard Corrigall, Tony Zundel, Daniel Byford, Sarah Sarhane, Mandy Taylor, Eric Taylor, John Ivens, Dennis Ougrin

Previous research on young people’s satisfaction of inpatient services has often relied on the responses of carers and relevant practitioners. It is difficult to ascertain to what extent such reporting accurately represents the satisfaction levels of young people, with emerging research suggesting wide discrepancies. As part of a wider study evaluating the effectiveness of a Supported Discharge Service (SDS) operating within South London & Maudsley NHS Foundation Trust, this paper examines how young people experience inpatient services, on a social and emotional level. Twenty young people, (10 SDS and 10 TAU) participated in a semi-structured visual-interview study to examine their experiences of admission, ward-life and treatment. A thematic decomposition analysis was conducted on the data and specific themes relevant to satisfaction and engagement with inpatient services was examined in-depth. These include a) Behavioural surveillance as care surrogate and b) Managing the delicate emotional ecology of the ward: openness, triggering, sterility and relational engagements. Finally, we explore some of the implications of these inpatient experiences for supported discharge services.

 

“They treat us like we’re not there”: Queer bodies and the social production of healthcare spaces

Talia Meer and Alex Müller

There is significant literature demonstrating the interpenetrability of identity and space, yet there is almost no work that explores the co-production of queer identities and healthcare spaces. We use Lefebvre’s triad of (social) space to explore how the social spaces of South African healthcare facilities shape and are shaped by queer service-users, drawing on data from interviews and focus group discussions with 29 queer service-users and 14 representatives of organisations. Findings reveal that healthcare spaces are produced by the spatial ordering of health policy inattentive to queer health needs; the enduring symbolic representations of queerness as pathological or ‘un-African’; and various identity assertions and practices of individuals, including queer service-users and healthcare providers. As a result, healthcare spaces are overwhelmingly heteronormative, although queer service-users’ subversive practices suggest alternative spatial configurations. However, such resistance relies on individual empowered action and risks disciplining responses. Wider efforts are needed to transform the material and ideological space of healthcare facilities through law and policy reform and continuing professional training for healthcare providers.

 

A place for the heart: A journey in the post-asylum landscape. Metaphors and materiality

Inger Beate Larsen and Alain Topor

The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users’ perspectives. The users used four metaphors to describe these meeting places: “like a home”, “like a family”, “like a landing ground” and “like a trampoline”. The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management.

 

The strategic geographies of global health partnerships

Clare Harrick

Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the “global” endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need.

 

Navigating ‘riskscapes’: The experiences of international health care workers responding to the Ebola outbreak in West Africa

Stephanie Gee and Morten Skovdal

This paper draws on interview data to examine how international health care workers navigated risk during the unprecedented Ebola outbreak in West Africa. It identifies the importance of place in risk perception, including how different spatial localities give rise to different feelings of threat or safety, some from the construction of physical boundaries, and others mediated through aspects of social relations, such as trust, communication and team dynamics. Referring to these spatial localities as ‘riskscapes’, the paper calls for greater recognition of the role of place in understanding risk perception, and how people navigate risk.

 

Science, Technology, and Human Values

Shi (勢), STS, and Theory: Or What Can We Learn from Chinese Medicine?

Wen-Yuan Lin

How might science and technology studies and science, technology and society studies (STS) learn from its studies of other knowledge traditions? This article explores this question by looking at Chinese medicine (CM). The latter has been under pressure from modernization and “scientization” for a century, and the dynamics of these pressures have been explored “symmetrically” within STS and related disciplines. But in this work, CM has been the “the case” and STS theory has held stable. This article uses a CM term, reasoning-as-propensity (shi, 勢), to look at contemporary practices of cancer care in a hospital in Taiwan. It describes how shi (勢) informed the design of a new decoction, Kuan Sin Yin, while also relating to the production of scientific knowledge, biomedical interventions, Buddhist practices, and the patients living with cancer themselves. Does CM’s use of shi (勢) simply confirm the essential and incompatible otherness of CM? Looked at from outside the answer seems to be yes. However, this article explores how STS might change itself—and the theory–practice division in STS—by thinking through shi (勢) in dialogue with its othered object. This opens the possibility of an STS for CM.

 

Ethics Policies and Ethics Work in Cross-national Genetic Research and Data Sharing
Flows, Nonflows, and Overflows

 Klaus Hoeyer, Aaro Tupasela, Malene Bøgehus Rasmussen

In recent years, cross-national collaboration in medical research has gained increased policy attention. Policies are developed to enhance data sharing, ensure open-access, and harmonize international standards and ethics rules in order to promote access to existing resources and increase scientific output. In tandem with this promotion of data sharing, numerous ethics policies are developed to control data flows and protect privacy and confidentiality. Both sets of policy making, however, pay limited attention to the moral decisions and social ties enacted in the everyday routines of scientific work. This paper takes its point of departure in the practices of a Danish laboratory with great experience in international collaboration regarding genetic research. We focus on a simple query, what makes genetic material and health data flow, and which hopes and concerns travel along with them? We explore what we call the flows, the nonflows, and the overflows of material and information, and we document the work producing the flows of health data and biomaterial. We call this work “ethics work” and argue that it is crucial for data sharing though it is rarely articulated in ethics policies, remains inadequately funded, and lacks acknowledgment in policies promoting international data sharing.

 

Social Science & Medicine

The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy

Rachel Faulkner-Gurstein

This paper examines overdose prevention programs based on peer administration of the opioid antagonist naloxone. The data for this study consist of 40 interviews and participant observation of 10 overdose prevention training sessions at harm reduction agencies in the Bronx, New York, conducted between 2010 and 2012. This paper contends that the social logic of peer administration is as central to the success of overdose prevention as is naloxone’s pharmacological potency. Whereas prohibitionist drug policies seek to isolate drug users from the spaces and cultures of drug use, harm reduction strategies like peer-administered naloxone treat the social contexts of drug use as crucial resources for intervention. Such programs utilize the expertise, experience, and social connections gained by users in their careers as users. In revaluing the experience of drug users, naloxone facilitates a number of harm reduction goals. But it also raises complex questions about responsibility and risk. This paper concludes with a discussion of how naloxone’s social logic illustrates the contradictions within broader neoliberal trends in social policy.

 

The intimate relationship as a site of social protection: Partnerships between people who inject drugs

Tim Rhodes, Jake Rance, Suzanne Fraser, Carla Treloar

Public health research treats intimate partnerships as sites of risk management, including in the management of HIV and hepatitis C transmission. This risk-infused biomedical approach tends to undermine appreciation of the emotional and socially situated meanings of care in intimate partnerships. In this article we explore qualitative interview accounts of the care enacted in partnerships between people who inject drugs, drawing on a 2014 study of 34 couples and 12 individuals living in two locations of Australia. A thematic analysis highlights ‘best friend relationships’, ‘doing everything together’, ‘co-dependency’, and ‘doing normalcy’ as core to narratives of care. As we will argue, the accounts position the care undertaken by couples as at once shaped by day-to-day practices of drug use and by social situation, with the partnership enacting care as a form of social protection, including protection from stigma and other environmental hostilities. The intimacy of doing everything together offers insulation against stigma, yet also reproduces its isolating effects. While the care produced in drug-using partnerships is presented as double-edged, we note how interview accounts are used to deflect the charge that these relationships represent harmful co-dependency. Taken together, the interview accounts negotiate a ‘counter-care’ in relation to normalcy, presenting the intimate partnership between people who use drugs as a legitimate embodiment of care.

 

The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges

Jessica Mulligan

This article takes a genealogical and ethnographic approach to the problem of choice, arguing that what choice means has been reworked several times since health insurance first figured prominently in national debates about health reform. Whereas voluntary choice of doctor and hospital used to be framed as an American right, contemporary choice rhetoric includes consumer choice of insurance plan. Understanding who has deployed choice rhetoric and to what ends helps explain how offering choices has become the common sense justification for defending and preserving the exclusionary health care system in the United States. Four case studies derived from 180 enrollment observations at the Rhode Island health insurance exchange conducted from March 2014–January 2017 and interviews with enrollees show how choice is experienced in this latest iteration of health reform. The Affordable Care Act (ACA) of 2010 created new pathways to insurance coverage in the United States. Insurance exchanges were supposed to unleash the power of consumer decision-making through marketplaces where health plans compete on quality, coverage, and price. Consumers, however, contended with confusing insurance terminology and difficult to navigate websites. The ethnography shows that consumers experienced choice as confusing and overwhelming and did not feel “in charge” of their decisions. Instead, unstable employment, changes in income, existing health needs, and bureaucratic barriers shaped their “choices.”

 

“Even my sister says I’m acting like a crazy to get a check”: Race, gender, and moral boundary-work in women’s claims of disabling chronic pain

Jane Pryma

Recent research examines how women claim chronic pain in response to gendered moral discourses. However, extant research does not explore how race shapes the moral boundary-work performed by women suffering from disabling chronic pain. Through the qualitative analysis of twenty-four semi-structured interviews with women fibromyalgia sufferers conducted between October 2014 and August 2016 in the U.S.A., I demonstrate how women with fibromyalgia claim chronic pain by doing moral boundary-work, referencing gendered and racialized moral discourses that structure how claims of chronic pain as disability are and are not read as legitimate by doctors, disability bureaucrats and personal networks. Extending Hansen et al.’s work on stigma and the “pathologization of poverty,” I suggest that, per my sample, the different moral discourses deployed in white and Black women’s claims of chronic pain can be explained by the racialized and gendered boundaries of citizenship that structure U.S. welfare and disability politics. Finally, I argue for intersectionality’s relevance to research on moral boundary-work and the medicalization of poverty.

 

Accomplishing professional jurisdiction in intensive care: An ethnographic study of three units

Andreas Xyrichis, Karen Lowton, Anne Marie Rafferty

This paper reports an ethnographic study examining health professional jurisdictions within three intensive care units (ICUs) in order to draw out the social processes through which ICU clinicians organised and delivered life-saving care to critically ill patients. Data collection consisted of 240 h observation of actual practice and 27 interviews with health professionals. The research was conducted against a backdrop of international political and public pressure for national healthcare systems to deliver safe, quality and efficient healthcare. As in many Western health systems, for the English Department of Health the key to containing these challenges was a reconfiguration of responsibilities for clinicians in order to break down professional boundaries and encourage greater interprofessional working under the guise of workforce modernisation. In this paper, through the analysis of health professional interaction, we examine the properties and conditions under which professional jurisdiction was negotiated and accomplished in day-to-day ICU practice. We discuss how staff seniority influenced the nature of professional interaction and how jurisdictional boundaries were reproduced and reconfigured under conditions of routine and urgent work. Consequently, we question theorisation that treats individual professions as homogenous groups and overlooks fluctuation in the flow and intensity of work; and conclude that in ICU, urgency and seniority have a part to play in shaping jurisdictional boundaries at the level of day-to-day practice.

 

Sociology of Health and Illness

Ageing, masculinity and Parkinson’s disease: embodied perspectives

Grant Gibson, Ciara Kierans

Parkinson’s disease (PD) presents as an illness which predominantly affects older men. However older men’s lived experiences of PD, including how they are influenced by age and gender relations has seen little empirical study. Drawing on Watson’s male body schema, this paper explores how men engage with masculinities and ageing in order to make sense and meaning from PD. Data is presented from 30 narrative and semi structured interviews with 15 men of various ages who were living with PD. Findings suggest that PD threatens a visceral embodiment located in the body’s basic movements and intimate functions; a pragmatic embodiment expressed through men’s everyday occupations and an experiential embodiment concerned with emotions and sensations felt within and through the body. In addition, each dimension of men’s embodiment also intersected with the ageing process, a process also shaped in turn by broader social and cultural concerns regarding the positions and possibilities of men’s lives as they move through the life course. This paper concludes by discussing the implications of gender and ageing in understanding men’s experiences of PD.

 

At the margins of biomedicine: the ambiguous position of ‘Registered Medical Practitioners’ in rural Indian healthcare

Papreen Nahar, Nanda Kishore Kannuri, Sitamma Mikkilineni, G.V.S. Murthy and Peter Phillimore

This analysis challenges a tendency in public health and the social sciences to associate India’s medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non-biomedical ‘others’. We argue that this overdrawn dichotomy obscures the important part played by ‘informal’ biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature – the Registered Medical Practitioner (RMP) – who occupies a niche in the medical market-place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical ‘condition’, namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal-informal sector divide in India’s healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of ‘informality’ in relation to the state in India – one Sarah Pinto’s, the other Ananya Roy’s.

 

Theory, Culture, and Society 

Special Issue: Geosocial Formations in the Anthropocene

An Interview with Elizabeth Povinelli: Geontopower, Biopolitics and the Anthropocene

Elizabeth A. Povinelli, Mathew Coleman, Kathryn Yusoff

This article is an interview with Elizabeth Povinelli, by Mathew Coleman and Kathryn Yusoff. It addresses Povinelli’s approaches to ‘geontologies’ and ‘geontopower’, and the discussion encompasses an exploration of her ideas on biopolitics, her retheorization of power in the current conditions of late liberalism, and the situation of the inhuman within philosophical and anthropological economies. Povinelli describes a mode of power that she calls geontopower, which operates through the governance of Life and Nonlife. The interview is accompanied by a brief contextualizing introduction.

 

Configurations

Gut Ecology: Meat Science, Modernity, and Carrion Aversion in Gandhi’s India

Lucinda Cole

This essay examines debates about carrion eating in late nineteenth- and early twentieth-century India. Although proscriptions against carrion eating among the noncaste Hindus were entangled in Indian anticolonial, nationalist, and cow-protection movements, “Gut Ecology” places the subject in the material contexts of bacteriology, the study of zoonotic disease, and the emergence of meat science. The essay focuses on an exchange of letters (1933) between M. K. Gandhi and Dr. G. V. Deshmukh, the first president of the Indian Medical Association, in order to explore historical and theoretical relationships among affective, political, and scientific culture.

 

 

 


Leave a Reply

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