What is this nebulous sounding compound concept, “medico-legal borderlands”? How has it been used by social scientists whose ethnographic studies scratch at itches in the intersecting areas of human health and illness and the organization and production of health care systems?
Through a collection of four essays curated for this Somatosphere series, we invite readers to join us in answering these questions by experimenting with this conceptual framework. In doing so, we hope to highlight the valuable and original ways that using “medico-legal borderlands” can assist in studying the social.
Our understanding and application of “medico-legal borderlands” have as their point of departure the scholarly contributions of the sociologist duo, Stefan Timmermans and Jonathan Gabe (2002). According to Timmermans and Gabe, the concept refers to spaces of professional practice where the institutions of law and policy, medicine and health care, and social services exist side-by-side and overlap. In using “medico-legal borderlands” as an analytic, we aim to harness close, ethnographic attention to what happens in these various sites. Accordingly, we ask: what might such close attention to these spaces reveal, and what are the implications of these revelations for people and health systems? We suggest that inquiries within medico-legal borderlands’ spaces and places illuminate the presence and functioning of underexplored and frequently taken-for-granted forms of social control and governance, policy and practice, communication and discourse, and subjectivity and lived experience.
In our work as sociologists, the medico-legal borderlands concept has been, and continues to be, a beneficial way to organize and carry out social studies. Using this conceptual framework has been not only intellectually engaging, but empirically fruitful: we have applied this lens separately, within our respective research agendas, and jointly, for our collaborations together (see Sanders and Bisaillon, 2018). Our desire to further explore the possibilities that the borderlands concept makes possible led us to cooperatively convene a panel titled “Bodies and Practices in the Medico-Legal Borderlands” at the 2018 Law and Society Association meeting in Toronto.
The response to our call for papers was, in a word, effervescent. Each contributor took up the medico-legal borderlands lens to bring forth analyses with equal measures of criticality and creativity. What we generated together were ideas strong and interesting precisely because they were held up together. And so, we offer this series.
The four essays assembled in this “Searching, Studying and Doing Sociology in the Medico-Legal Borderlands” section benefited immensely from interactions with audience members. Our work also was enhanced as we later re-engaged with one another’s ideas in the ensuing months. As readers will see, we have also engaged with Timmermans and Gabe’s concept of medico-legal borderlands in ways that made sense and were meaningful within the social contexts of our ethnographic field studies.
It is our hope that readers will find what follows illuminating as well as probingly provocative.
In the leading piece, “Exclusion and gatekeeping in psychiatric-legal borderland: Keeping the material in view,” Dr. Agnieszka Doll (McGill University, Montreal) draws on ethnographic fieldwork in Polish psychiatric hospitals and courts to look at porosity and gatekeeping where medical and legal forms of knowledge intersect. Through the example of a lawyer accessing his client’s medical files in a psychiatric hospital, Doll shows how certain forms of knowledge are used when people are involuntarily admitted to the emergency ward, while other knowledges are not. Monitoring, gatekeeping, and restricting access happen because psychiatric and legal professionals, using various material artifacts and spaces, are involved. As we see, actors interact to re-interpret how medical knowledge is produced in the courtroom.
Dr. Eli Manning (Dalhousie University, Halifax) begins “Why we must go beyond focusing on the ‘overrepresentation’ of racialized people in HIV criminalization” with findings from a report that documents how racialized immigrant men are overrepresented in mainstream newspaper reports of HIV non-disclosure in Canada (Mykhalovskiy et al., 2016). Manning argues that this problem of overrepresentation by journalists and media outlets stands as a symptom around which to build social inquiry. And further, that such inquiry is vital if we are to capture and also act on harmful side effects of how racism, health status, and criminalization processes co-constitute. Manning makes the case that social analysts need to focus on the institutionally organized conditions that drive racist practices which, she posits, sit at the heart of the criminalization of non-disclosure of HIV positive status in Canada.
In “Queer Zones: Refugees from Africa and Interactions with Canada’s Borderlands,” Notisha Massaquoi (University of Toronto) exercises her insider position within community-level queer African refugee milieus in Toronto to problematize how the Canadian immigration system reads and interprets these bodies within certain institutional spaces. Specifically, she examines the national border as an international frontier, and the refugee adjudication hearing as spaces in which particular ways of knowing emerge. Massaquoi discusses the consequences of these ways of knowing for queer African bodies and the state, while also identifying them as ideological practices. Her ethnographic explorations illuminate how notions of personal and political borders are being challenged and reworked by the different social actors, be they individual refugees or institutional representatives. Further, she demonstrates how these activities, in turn, have implications for the health and wellbeing of refugee claimants.
In the final essay, “ Scholarly Stretching and Meta-Ethnography in the Medico-Legal Borderlands,” medical sociologist, Chris Sanders (Lakehead University, Thunder Bay), and sociologist of health and illness, Laura Bisaillon (University of Toronto), put into play a methodological strategy called meta-ethnography to bring their separate studies into dialogue (Sanders & Bisaillon, 2018). Through this strategy, Sanders and Bisaillon offer novel insights about how medical doctors and public health nurses carry out their work. In particular, they demonstrate how in such work there arise problems of an ethical and professional order with implications for people who present for care. By synthesizing their respective ethnographic findings, Sanders and Bisaillon are able to show how and with what implications professional practices come to be shaped to serve state, rather than patient, interests.
Ultimately, we see this series as an invitation to contemplate problematics in everyday life, big and small, manifest and latent, that occur as a result of law and policy, medical and health care practice, and social services enactments and practices. In one way or another, these arrangements have bearing on all of our lives. We hope that Somatosphere readers find the analyses in medico-legal borderlands showcased through these essays as thought-provoking as they are diverse.
Mykhalovskiy, E., Hastings, C., Sanders, C., Hayman, M., & Bisaillon, L. (2016). ‘Callous, Cold and Deliberately Duplicitous’: Racialization, Immigration and the Representation of HIV Criminalization in Canadian Mainstream Media. Report funded by the CIHR Social Research Centre for HIV Prevention.
Sanders, C., & Bisaillon, L. (2018). When Health Care is Displaced by State Interests: Building Dialogue through Shared Findings. Qualitative Health Research, 29(1), 32-41.
Timmermans, S., & Gabe, J. (2002). Introduction: Connecting Criminology and Sociology of
Health and Illness. Sociology of Health & Illness, 24(5), 501-516.
Chris Sanders, PhD, is Assistant Professor of Sociology at Lakehead University in Ontario. I’m a medical sociologist specializing in the areas of public health and mental health& illness. My work focuses on disease prevention policy and health care provider practices in Canada and the United States. I am particularly interested in rural sociology and the use of qualitative methods.
Laura Bisaillon, PhD, is Assistant Professor at the University of Toronto. I am a sociologist of health and illness specializing in qualitative methods and the social studies of HIV-related policy and Canadian immigration law. I use the social organization of knowledge approach and institutional ethnography as forms of inquiry. The bulk of my work has explored immigration medical inadmissibility decision-making and its consequences. “Screening and Screaming in Exile: Medical Examination and the Immigration Health Work of People with HIV” is my monograph under review with UBC Press. Since 2013, I have conducted ethnographic fieldwork in Eritrea, Ethiopia, Iran and Romania.