In the Journals

In The Journals, August 2018

Cultural Anthropology (Open Access)

“A politics of habitability: plants, healing and sovereignty in a toxic world”

Stacey Ann Langwick

For Tanzanians, modern bodies bear complicated toxic loads not only because of the dumping of capitalism’s harmful by-products but also because of the social-material effects of efforts designed to address insecurity, poverty, and disease. Dawa lishe(nutritious medicine) is forged in this double bind. Producers of dawa lishe problematize toxicity as the condition under which life is attenuated, diminished, depleted, exhausted, or drained away. Therapies attend not only to individual bodies but also to relations among people, plants, and the soil. The efficacy of herbal remedies and of gardens full of therapeutic foods and nutritious herbs rests in the cultivation of the forms of strength that make places, times, and bodies livable again (and again). This essay examines how Tanzanians are laboring over, and reflecting on, the toxic and its relationship to remedy and memory through dawa lishe. In the process, it argues, they are redefining healing through a politics of habitability.

International Journal of Social Psychiatry

Chasing ghosts in Cuba: is mass psychogenic illness masquerading as an acoustical attack?

Robert E. Bartholomew, Dionisio F. Zaldívar Pérez

Several psychiatric conditions exhibit a pattern of communicability, including mass psychogenic illness, folie à deux or folie à famille and epidemic koro (Ventriglio & Bhugra, 2017). While each is widely viewed as being triggered by psychosocial stress which affects vulnerable individuals, it is essential to view stress ‘as a matter of definition in a specific sociocultural context rather than as an objective given from which predictions can be made’ (Lee & Ackerman, 1980, p. 79). Therefore, when investigating outbreaks of psychogenic illness and kindred phenomena, it is important to focus on the social context underpinning the beliefs, instead of the symptoms per se. A recent, relevant illustration of this occurred in Cuba.

Social Science and Medicine

The first August 2018 volume is dedicated to the following topic:

Randomized controlled trials and evidence-based policy: a multidisciplinary dialogue

Edited by Ichiro Kawachi, S.V. Subramanian, Ryan Mowat

Negotiating acquired spinal conditions: recovery with/in bodily materiality and fluids

Jayne M. Jeffries

The paper explores the concept of recovery; the unexpected material changes that occur to, and within bodies following acquired spinal conditions. The phrase ‘acquired spinal conditions’ is used as a collective name for the four accounts of recovery that emerged using Participatory Action Research in the north east of England (2010-11). Using two qualitative methods, Photovoice and participatory diagramming, the empirical material examines the role of physiological changes as a way to enrich understandings of disability and the bodily experience of impairment. Three themes, bodily materiality, material objects and fluids became significant during one-to-one and small group interactions with participants. The paper is situated in wider debates in geographies of disability and impairment, focusing on the interplay between different physiological states of being and the bodily changes experienced through recovery. It argues that recovery is the process of negotiating, adapting and adjusting to changes, from the way bodily materiality shifts and fluctuates following accidents and medical interventions, settling over time as participants become aware of bodily changes, to the role of material objects and the fluids that pass back and forth changing bodily interiors. The paper closes with a call for geographies of affect to explore the individual and collective feelings associated with fluids, and the human-animal relations affecting recovery and bodily interiors.

Beyond medical humanitarianism – politics and humanitarianism in the figure of the Midani physician

Sophie E. Roborgh

This article explores the complex position of local physicians at times of political unrest or conflict, conceptualizing local medical voluntarism as a form of collective action. It analyzes the evolving interpretation of medical neutrality among Egyptian physicians who provided medical assistance to injured protesters in the Egyptian uprising (2011–2013). In-depth interviews with 24 medical and non-medical volunteers on their perception of medical neutrality were matched with their mobilization and participation history, showing the extent towards which political considerations influenced their voluntary medical engagement. The results firstly show that revolutionary political considerations played a central role in the physicians’ mobilization into medical networks active in the protests, as well as in their interpretation of their medical and non-medical activities. Secondly, I argue that the interpretation of medical neutrality among Egyptian physicians evolved significantly over time. A special type of medical volunteer took shape, the mīdānī physician. This physician openly expresses his/her political convictions and adheres to (self-defined) humanitarian principles through a conscious reconciliation of the two. The article details the increasing difficulty of this task after the revolutionary movement splintered into competing factions and citizens ended up fighting each other instead of authoritarian rule.

Embodied disruption: “sorting out” gender non-conformity in the doctor’s office

Emily Allen Paine

Among LGBTQ people, those who are gender nonconforming (GNC) may be at heightened risk of both discrimination and underutilization of healthcare—yet little is known about what happens during healthcare encounters to compel GNC individuals to continue or avoid seeking future care. This study qualitatively examines the healthcare experiences of a racially diverse sample of 34 adult LGBTQ cis women, transgender men, and nonbinary individuals in a metropolitan area of the United States who do not conform to dominant biomedical schemas of sex and gender. GNC individuals experience embodied disruption in medical settings when patients are mis/recognized; providers respond to disruption in ways that further distress patients. Broadly, participants report similar experiences across racial and gender identities, but patients manage disruption somewhat differently depending on their embodied positions to gender norms. This study contributes to literature of stress, stigma, and sex, gender, and sexuality within medicine by illuminating how stigmatizing healthcare interactions deter LGBTQ individuals from seeking healthcare. Findings point to the importance of considering both structural factors and embodied visibility in future research addressing how stigma and discrimination manifest within health settings to disadvantage LGBTQ groups.

Social Studies of Science

Sex, drugs, and rhetoric: the case of flibanserin for ‘female sexual dysfunction’

Judy Z. Segal

In August, 2015, the US Food and Drug Administration approved Addyi (flibanserin) for the treatment of Hypoactive Sexual Desire Disorder in premenopausal women. Ten months before that, the FDA had held a Patient-Focused Drug Development Public Meeting to address the ‘unmet need’ for a pharmaceutical to treat that condition. I attended that meeting as a rhetorical observer. This essay is an account of persuasive strategies used on, and then by, the FDA, as it considered approving a drug that was not convincingly either safe or effective. The essay turns on three texts: the ‘Even the Score’ pro-drug campaign that informed the patient-focused meeting, the text of the meeting itself, and the FDA’s own published report of the event. I describe how a pharmaceutical company (Sprout, then owners of flibanserin) recruited, and then ventriloquized, both health professionals and members of the public to pressure the FDA to approve a sex drug for women – claiming that not to do so was evidence of sexism. I argue, with rhetorical evidence, that the case for approving flibanserin had already been won before Sprout submitted its application.

Social Theory and Health

Striving for self-improvement: alternative medicine considered as technologies of enhancement

Inge Kryger Pedersen

The notion of medical enhancement technologies has drawn attention to optimization techniques within the health area. However, this notion has evolved at the level of governmental programmes, with very little attention directed towards people’s own practices. Using a social scientific body of knowledge about enhancement technologies and a Foucauldian analytical framework, this article explores how users engage with alternative medicine. Drawing on in-depth interviews with Danish users and observations of their treatment sessions, the article demonstrates how they embark on a voyage of discovery with the body to enhance their own selves and bodily resources. The discussion centres on Rose’s approach to medical enhancement technologies and Foucault’s notion of ‘technologies of the self’. A wider field of tension is outlined in which embodied alternative treatment practices play a role in various modalities of transforming and controlling bodies and selves. It is argued that such practices can be conceived of as enhancement technologies at the users’ level by showing how they not only concentrate on treatment and body maintenance, but also foster the enabling processes of changing habits, preferences, and attitudes, and creating a subjective sense of their bodies.

In BMI we trust: reframing the body mass index as a measure of health

Iliya Gutin

Recent work in medical sociology has provided critical insights into distinguishing between obesity as a condition with severe individual- and population-level health consequences, and obesity as a socially undesirable, stigmatizing construct opposing thinness as the healthy ideal. Less often considered is the role of body mass index (BMI) as the standard by which obesity and healthy weight are measured and defined. Addressing this issue, I begin by distinguishing between BMI as an empirical, objective measure of health, and BMI as an arbitrary, subjective label for categorizing the population. I further consider how BMI is empowered as a measurable quantity through the lens of medicalization and evidence-based medicine, and introduce the “performativity” of BMI as a superior framework for confronting the measure’s conceptual limitations. Emphasizing key parallels between BMI and self-rated health as measures with high predictive validity, yet unspecified mechanisms of action, I propose an epistemological shift away from classifying BMI as a biomarker and toward a more flexible view of the measure as a holistic appraisal of health. In closing, I argue that researchers may continue to leverage BMI’s ease of collection and interpretation, provided they are attuned to its definitional ambiguity across diverse research methods and contexts.

Transcultural Psychiatry

The August 2018 edition is devoted to “Anthropological perspectives on eating disorders,” and includes the following articles:

Ground zero: ontology, recognition, and the elusiveness of care in American eating disorders treatment

Rebecca J. Lester

This paper reflects upon questions of ontological contingency when the stark, visceral reality of a person’s relentless self-destruction unfolds within institutional mechanisms that systematically withhold certain kinds of care. I consider these issues through the lens of “manipulation” as it is elaborated within an American eating disorders treatment center, where the notion of manipulation does particular kinds of affective and pragmatic work. Specifically, it serves to render clients as, paradoxically, both hyper-agentic and “agentically challenged” in ways that legitimate the withholding of their recognition as full subjects and therefore deserving of care. I propose that the ontological perspectives of the treatment center are ill-equipped for accounting for such dynamics and, in fact, carry certain risks when employed in the consideration of psychiatric conditions where they can even become coopted in unintended ways. This carries special importance when working with people whose ontological status is, in a very real (and not just theoretical) sense, teetering on the brink of the void.

What keeps Maya from eating? A case study of disordered eating from North India

Tanja Alin

Anthropologists have paid much attention to food and eating practices in India, but surprisingly few scholars in any discipline have examined eating disorders. This article presents an ethnographic case study of disordered eating, based on a story of a young female pharmacist from one of the Northern Indian states. Advocating ethnography as an essential method to uncovering the multiple facets of “not eating,” I first show how this phenomenon may reflect resistance to Brahmanical patriarchy, especially the institution of arranged marriage. Secondly, I illustrate how “not eating” may be an embodied expression of distress, in this case related to the inability to fulfil filial obligations of reciprocity. Finally, I argue that “not eating” in India may be associated with the ways in which personhood, as locally understood, is influenced by regional socioeconomic development. Thus, while young, unmarried, and highly educated women have increasingly better opportunities for formal employment, they may find themselves at the crossroads of conflicting social expectations, and “not eating” may arise as an after-effect. While making large-scale generalizations of these findings across India would be inappropriate, this case study sheds light on the complexity of disordered eating in this country and calls for further ethnographic studies, sensitive to local meanings of (not) eating.

Anthropology Today

The temporary as the future: ready-to-use therapeutic food and nutraceuticals in South Africa

Michelle Pentecost, Thomas Cousins

The reconfiguration of food as a pharmaceutical in biomedical regimes has been considered by scholars along two axes: (1) food supplementation as humanitarian intervention, based on a specific value of life and delivered in ‘crisis’ situations with a short temporal horizon; (2) food supplementation as commodity, marketed as enhancing ‘wellness’ or potential, based on notions of risk in broad temporal frames. We consider nutraceuticals and ready‐to‐use‐therapeutic foods as they are deployed by state and commercial actors in South Africa in relation to two key figures: the pregnant woman and the HIV‐positive population. These biopolitical expressions of post‐apartheid regimes of knowledge, care and governance reveal how state distribution and the corporate marketing of supplements employ a future‐oriented logic that appeals to notions of power, energy and potential. Therapeutic foods in this context are thus not merely humanitarian technologies that reconfigure crisis as a chronic condition – the temporary becoming permanent – but are premised on new potentialities, in which the temporary may (re)shape the future.

Mosaic: An Interdisciplinary Critical Journal

Medicines of the soul: reparative reading and the history of bibliotherapy

Jesse Miller

This essay argues that despite its significance within the history of bibliotherapy, Samuel McChord Crothers’s 1916 essay “A Literary Clinic,” in which the term bibliotherapy was coined, is a stranger point of origin than proponents have realized—one with implications for conceptualizing reading and its reparative uses more broadly.

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