In the Journals

In the Journals, December 2020, Part 1

American Anthropologist 

Fitness Fanatics: Exercise as Answer to Pending Zombie Apocalypse in Contemporary America
Katie Rose Hejtmanek

Physical fitness has a long history in the United States. Currently, functional fitness has emerged as a popular, novel method of exercising. Based on years of ethnographic research on a branded version of functional fitness, I argue this form of exercise is an audit system and culture, initiated by the creators of the brand itself, implemented in the gyms, and governed by the participants. This article illustrates that such an exercise regimen is a response to the post‐9/11 world—complete with war on terror, economic insecurity, and border security threats—and provides a window into the necropolitics of elite, white America due to an uncertain, neoliberal future.

BioSocieties 

Negotiating risk-group categorization and the co-production of blood safety: the evolution of sociotechnical imaginaries mobilized in the public debate on the deferral of men who have sex with men as blood donors in Belgium
Nathan Wittock & Lesley Hustinx 

To ensure safe, sufficient supplies of human blood for European medical practice, national blood establishments reconcile the social image of blood donation with technical risk calculations/deferral policies. The sociotechnical controversy concerning the deferral of “men who have sex with men” (MSM) serves as a pre-eminent case of this challenge. Drawing on the framework of sociotechnical imaginaries, we developed an interpretive case study of negotiation on the deferral of MSM in policy discourse and the public debate between the implementation of the first EU Blood Directive (2003) and the relaxation of lifetime deferral to 12 months in Belgium (2017). We analyzed recurrent arguments made by stakeholders through the High Council for Health policy recommendations, public communications of Red Cross Flanders, and the public debate evidenced in Belgian newspapers. Instances in which MSM deferral is negotiated are part of the co-production of blood- and donor safety. This process allowed to adapt the dominant epidemiological imaginary shaping blood supply risk governance practices in four phases: classic epidemiological imaginary, challenging key elements, contentious debate, and re-adjustment. Deferral became recognized as preclusion from this institutional opportunity to demonstrate high moral virtues. This sociotechnical controversy will likely resurface, as sexually active gay men continue to be deferred.

Rethinking reproductive selection: traveling transnationally for sperm
Stine Willum Adrian

Denmark has become a destination for fertility travelers in need of sperm. Through a careful ethnographic reading of how fertility travelers account for their journey to Denmark and their selection of sperm donors, I explore what comprises donor selection and ask: How can we understand accountability for inclusion and exclusion in the phenomena of donor selection that emerges when women and couples travel to Denmark for sperm? While the recently coined term ‘selective reproductive technology’ (Gammeltoft and Wahlberg in Annu Rev Anthropol 43:201–216, 2014) creates a framework for productive discussions on reproductive selection, this paper points out that the ontological premises of the notion of selection have political consequences and thus demand careful methodological examination. Based on ethnographic work on sperm selection in fertility travels to Denmark, this paper contributes a reconceptualization of the notion of the phenomena of selection. This reconceptualization reflects on and disrupts the ways in which inclusion and exclusion take place as selection emerges through both material and discursive elements, particularly national regulations, perceptions of race, the freezing ability of sperm, and the financial situations of those seeking treatment. To encompass such varying elements, the concept is analyzed by drawing on a relational ontology informed by the notion of the phenomenon, the basic analytical unit in agential realism (Barad in Meeting the universe halfway. Quantum physics and the entanglement of matter and meaning, Duke University Press, Durham, NC, 2007). This chosen reconceptualization may grant us the imaginative space to consider how the process of selection might be otherwise conducted.

Balancing methodological purity and social relevance: monitoring participant compliance in a behavioural RCT
Jonas Winther & Line Hillersdal 

The adoption of the randomised controlled trial within public health research to test behavioural and lifestyle interventions means that trial researchers are increasingly expected to balance ambitions of methodological rigour and social relevance in the performance of a trial. Striking this balance is particularly important when it comes to the issue of participant compliance. This article draws from fieldwork among researchers in an exercise trial in Denmark to explore the work entailed in achieving and measuring participant compliance from a distance. By drawing on perspectives from surveillance studies, we focus on the practices, technologies and forms of knowing involved in aligning participant’s bodies and practices with specific data production ambitions. The analysis highlights the work and challenges entailed in retaining participants within the scope of the researchers’ monitoring. In conclusion, we suggest that the firm commitment to produce quantitative data on compliance elides the work, challenges and collaborative practices entailed in achieving compliance and highlighting the challenges of ensuring compliance. The article describes the randomised controlled trial, not as a powerful governmental socio-technical apparatus, but as a fragile, situated, and fundamentally challenged surveillance system. This has important implications for ambitions to consider the complexity of behavioural interventions.

Teaching women to question and control: public pedagogies of birth and vaccine refusal
Jennifer A. Reich

In the US, birth has become a carefully planned experience for those with the greatest access to resources. Pregnancy preparations, including prenatal care, childbirth education, and peer interactions, encourage women to act as informed consumers, to communicate their own values, beliefs, and preferences in labor and delivery, and to challenge healthcare systems and medical providers. Simultaneously, there has been a growth in the number of mothers who reject medical recommendations for infant vaccination and newborn interventions. These challenges are presented by women with higher levels of education and resources, a group that is also most likely to insist on control over birth. In this article, I draw on qualitative data from mothers who reject vaccination recommendations for their children to highlight the interconnected experiences of childbirth self-advocacy and vaccine refusal. I suggest prenatal education toward self-advocacy may serve as a pedagogical process that mirrors the rhetoric of vaccine refusal. I conclude by showing how this new pedagogy of patient empowerment is nurtured and respected by pediatricians who administer vaccines and provide wellness care, even as they struggle with mothers who reject this core public health intervention.

Imaginaries as infrastructures? The emergence of non-invasive prenatal testing in Austria (open access)
Ingrid Metzler

Non-invasive prenatal testing (NIPT) is a new technology used in prenatal testing (PT) that capitalizes on genomic platforms to transform DNA fragments in the blood of pregnant women into information about the genome of a foetus. Since its market introduction in 2011, it has travelled around the globe with remarkable speed. This article engages with the emergence of NIPT in and around Vienna, the capital city of Austria, to explore why and how this technology could travel so quickly in practice. Based on a qualitative analysis of interviews, documents, and field notes, it argues, first, that NIPT could travel so quickly because it travelled as ‘adaptable boxes’ that added on to different ‘local worlds of prenatal testing (PT)’, without disrupting them. Second, in so doing, NIPT could travel on a moral and material ground, or an ‘imaginary of PT’, built in the past. Third, the article argues that elements of this imaginary were also mobilized by commercial pioneers of NIPT, who ‘infrastructurized’ extant values, practices, and networks among biomedical professionals. Thus, various actors converged in mobilizing moral and material elements of an imaginary, transforming them into an infrastructure that facilitated the travels of NIPT, while also shaping its use.

Oestrogen receptors and breast cancer: are we prepared to move forward? A critical review
Yolanda Eraso

It is nearly 60 years since the identification of the oestrogen hormone receptor (ER) in breast cancer, a discovery that radically transformed the clinical management of the disease. Hormonal therapy with anti-oestrogens (Tamoxifen and Aromatase inhibitors) antagonises ER function and became the mainstay treatment until today. Around 70% of breast tumours are classified as oestrogen dependent, yet the mechanism of action of other hormones in breast cancer growth both independently and interacting with ER as well as their targeted therapies have yet to find a place in the clinic. In this article, I critically review the scientific literature for the period 1960–2016 and examine the rise and persistence of the oestrogen hypothesis as well as the neglect of alternative hormonal explanations. By using Pierre Bourdieu’s concepts of the scientific field alongside feminist science scholars to explore the impact of gendered assumptions on science, the analysis provides insight into the dominant role of the oestrogen hypothesis and the struggles for legitimation of different alternative perspectives. I consider these alternative approaches as “internal” struggles for scientific authority, which are in turn, socially determined by “external” gender values that reinforce a binary arrangement of male/female bodies based on fixed molecular hormonal traits.

Contemporary Drug Problems 

“Coming Out”: Stigma, Reflexivity and the Drug Researcher’s Drug Use (open access)
Anna Ross, Gary R. Potter, Monica J. Barratt & Judith A. Aldridge

Some personal experience of illicit drug use undoubtedly exists within the population of academic drug researchers. But it is rarely acknowledged, and even more rarely reflected upon, in their published work. This is understandable: criminal, professional and social sanctions may follow public admission of illicit activities. However, to not “come out” seems contrary to some core academic principles, such as transparency in data collection and reflexivity in the research process. Coming out may present researchers with an opportunity for improving knowledge of, and policies toward, drug use. In this article, we identify reasons for and against the public disclosure of drug use and the impact of such disclosure across a range of spheres, including research, teaching, policy influence and private lives. Reasons against coming out include the risks of undermining professional reputations and hence the ability to contribute to academic and policy debates, the threat of criminal justice sanctions, and impacts on loved ones. However, coming out can have academic benefit (i.e., improving our understanding of drugs, of people who use drugs, and of drug research) and contribute to activist goals (e.g., de-stigmatization of drug use and demarginalization of people who use drugs). Both the risks and benefits of public drug use disclosure have implications for how research and researchers may influence drug policy. Two key themes, stigma and reflexivity, underpin the discussion. We do not conclude with clear recommendations for drug-using drug researchers; to come out or to not come out is a personal decision. However, we argue that there is clear merit to further open discussion on the role of disclosure and reflection on personal drug use experience among those working in drug research and drug policy—where such reflection is relevant and where such researchers feel able to do so.

Biopower, Disciplinary Power and Surveillance: An Ethnographic Analysis of the Lived Experience of People Who Use Drugs in Vancouver’s Downtown Eastside
Benjamin Scher

Focusing on the role of police as primary actors in the arena of citizen safety, this article examines the impact of policing practices on the daily lived experience of people who use drugs in accessing a supervised consumption site in Vancouver, Canada. The site is located in the heart of Vancouver’s Downtown Eastside (DTES) neighborhood at a community center that I refer to as the Hawthorne Resource Centre. The method of data collection for this study comprised five months of ethnographic fieldwork, including focus groups and one-on-one interviews with community members accessing the site, site staff and management. Drawing on Foucauldian conceptualizations of power, the findings of this research suggest that governmental modes of power, including biopower and disciplinary power, are pervasively operative in various realms of the day to day lives of the Hawthorne Resource Centre clients. Evidence of the scalable nature of these modes of power are seen within the internal functioning of the Supervised Consumption Site, outside in the methods of community policing in the DTES and in weekly police practices in Oppenheimer Park. As such, this study represents a multiscalar assessment of how these Foucauldian power structures work at multiple levels and locations in the DTES. Driven by the narratives of the Hawthorne Resource Centre clients, the findings of this research illustrate not only the importance of understanding power relations within specific policy interventions, but further, highlight how specific tactics mobilized within “harm reduction policing” would be relevant and applicable to the context of the DTES.

“A Life Lived”: Collective Memory and White Racial Framing in Digital Opioid Overdose Obituaries
Kevin Revier

With a rise in overdose deaths in the United States, opioid awareness has come in a variety of ways. One of these, as reporters suggest, is obituary writing. Obituaries are considered in news media as offering “brutally frank” depictions of addiction that “chronicle the toll of heroin.” Moreover, obituary sharing by parents and loved ones has increasingly taken place on digital platforms, memorial websites expanding the visibility of overdose death while facilitating the building of virtual grief communities. Not solely commemorating individual loss, obituaries thus contain symbolic power—they reflect dominant social values and shape collective memory. As such, overdose obituaries inform how opioid crisis is framed, represented, and addressed. From a qualitative content analysis of 533 opioid-related U.S. obituaries published on Legacy.com and ObitTree.com, I find that while obituaries reduce stigma associated with drug use, addiction, and overdose, they primarily tell white tales of addiction. In affording a white racial framing of drug addiction, obituary writing corresponds with a larger whitewashing of the opioid crisis while implicitly constructing symbolic boundaries between those memorialized, who are predominantly white and middle-class, and those who are deemed as raced and classed Others. Such storytelling, particularly when popularized in news media and made visible on digital platforms, contributes to ongoing systemic inequality in the prevailing drug war.

Critical Public Health 

Science, society, and policy in the face of uncertainty: reflections on the debate around face coverings for the public during COVID-19 (open access)
Graham P. Martin, Esmée Hanna, Margaret McCartney & Robert Dingwall

The COVID-19 pandemic has had enormous effects on health, wellbeing, and economies worldwide. Governments have responded with rapid and sometimes radical public health interventions. As nations grapple with the question of how to regain normality without unnecessarily endangering lives or healthcare systems, some scientists have argued for policies to encourage or compel the use of face coverings in community (non-clinical) settings, despite acknowledged gaps in the evidence base for the effectiveness of such a measure. This commentary has two objectives. First, in the face of strong arguments that face coverings are a commonsense intervention, with negligible downsides, that can only do good, we make the case for caution in changing policy. Many seemingly benign public health interventions have the potential to cause harm, and that harm is often socially differentiated. We present five arguments for caution in policy change. Second, we reflect on the wider implications of the increasingly overt approaches to policy advocacy taken by some scientists. Drawing from the theory of post-normal science, we argue that the science–policy interface in the case of face coverings has taken a surprisingly traditional form, falling short of interdisciplinary integration and failing to incorporate insights of the full range of relevant experts and affected stakeholders. We sketch a vision for an alternative, more mature, relationship between science and society that accepts uncertainty, embraces deliberation, and rises to the challenge of developing knowledge to improve public health.

‘Childbirth is not a car rental’: mothers and obstetricians negotiating consumer service in Russian commercial maternity care
Anna Temkina

This article explores how commercialization of maternity care in Russia offers new opportunities and imposes new limitations on both mothers-to-be and doctors. The research is based on 35 in-depth interviews with patients and 24 with professionals in paid maternity car in St. Petersburg (2015–2017). It is a significant and illustrative case within the broader trends in the Russian health care system of the 2000s–2010s. This article’s contribution is an understanding of maternity care’s post-socialism market development from the perspective of women: mothers-to-be and mostly female doctors. The ongoing reforms and organization of paid maternity care in Russia are analyzed. I explore the position of mothers-to-be as consumers with growing demands, and of professional women as they respond to such demands. I depict how doctors, though improving their economic and working conditions, resist the symbolic decline of their status and seek to restore their power, and how mothers-to-be accept doctors’ authoritative role in highly medicalized maternity care.

Obstacles to use of patient expertise to improve care: a co-produced longitudinal study of the experiences of young people with sickle cell disease in non-specialist hospital settings (open access)
Sam Miles, Alicia Renedo, Cherelle Augustine, Patrick Ojeer, Nordia Willis & Cicely Marston

Involving young people in their own healthcare is a global priority, yet we know little about how this might work in practice. In this paper, co-produced between academic researchers and people with lived experiences of sickle cell and its treatment, we examine how young people with sickle cell disease attempt to use their expertise in their own condition during emergency hospital admissions and through encounters with healthcare workers who are not sickle cell specialists. Our qualitative longitudinal research in England examined young people’s experiences of hospital encounters via repeat and one-off interviews. We show that young people’s expertise is sometimes undermined, including not being taken seriously when they report pain. They face barriers to care in non-specialist wards, particularly when they are alone with nobody to advocate for them. Although healthcare services use rhetoric that encourages young people to take control of their health and act as patient experts, in practice young people’s expertise is routinely ignored. To improve health service quality, and meet the needs of young people, young people’s own expertise must be better supported in routine interactions with healthcare providers.

Caring as sharing. Negotiating the moral boundaries of receiving care
Rikke Sand Andersen, John McArtney, Birgit H. Rasmussen, Britt-Marie Bernhardson, Senada Hajdarevic, Marlene Malmström & Sue Ziebland

Informal caregiving is increasingly considered a health care delivery-resource within the North European welfare states. While ‘informal’ often refers to non-professional, ‘caregiving’ connotes both affective concern (caring about) and practical action (caring for). This duality of meanings, however, often refers to the one direction in which care is given. Care, we suggest, is relational and also requires that people receiving care are able to or wanting to share their needs. Informal caregiving thus requires sharing. Based on 155 semi-structured, narrative interviews with people with lung or bowel cancer, living in Denmark, Sweden or England, this paper explores how and with whom people ‘share’ when they fall ill. We approach sharing as a heuristic for reflecting on informal-caregiving, and illustrate how being cared for or asking for care are entangled with the management of social risks and notions of selfhood. We conclude that informal caregiving should explicitly be recognised as morally and sympathetically committed practices, which attend to the diversity of local moral worlds of patients, their needs and experiences.

Rethinking resistance: public health professionals on empathy and ethics in the 2014-2015 Ebola response in Sierra Leone and Liberia
Alexis Walker, Caitlin Kennedy, Holly Taylor & Amy Paul

Public health professionals may be confronted with unique ethical challenges in outbreak response situations. We conducted interviews with twenty-two public health professionals involved in responses to the 2014–2015 Ebola epidemic in Sierra Leone and Liberia to explore how they understood and experienced the ethical challenges involved in this work. The concerns covered in these interviews ranged dramatically, but three themes emerged as unique contributions from a subset of individuals integrally involved with the frontline response, who framed concerns about representation as key ethical issues. These included concerns regarding misrepresentations of West Africans as ‘resistant’ to the epidemic response, failures in material and information resources provided in the response, and representations of ‘rationality’ between responders and publics. Such concerns suggest that perspectives advanced in the critical public health literature in recent decades are circulating amongst public health professionals involved in outbreak response, although discord amongst respondents suggests the need for more deliberate efforts to reframe thinking about resistance, resources, and rationality in future public health outbreak responses.

Performing health promotion: an analysis of epistemic and political technologies of accountability (open access)
Klasien Horstman

The field of health promotion has developed at the interface of science and policy, resulting in programmatic tensions between the values of evidence-based and participatory approaches. This paper aims to go beyond debates between these positions, to develop an understanding of how health promotion practices are – unintendedly – performed and constructed by epistemic and political technologies of accountability. Drawing from Science and Technology Studies, the paper provides an in-depth qualitative analysis of two Dutch health promotion practices. The first presented itself primarily in epistemic terms, as an evidence-based project, while the other presented itself primarily in political terms, as a citizens’ initiative. The analysis shows that while, in the first case, the specific epistemic design of health promotion as a randomized controlled trial performs robust international scientific credibility but a lack of local political credibility, the participatory approach of the second case performs robust local political credibility but meagre scientific credibility. The analysis makes clear that health promotion practices are – unintendedly – performed by situated entanglements of diverse technologies of accountability that operate on local, national and global scales, which can be aligned in diverse ways. More insights into these webs of accountability are required to improve health promotion through improving the cultures of accountability.

Vagueness, power and public health: use of ‘vulnerable’ in public health literature
Amy S. Katz, Billie-Jo Hardy, Michelle Firestone, Aisha Lofters & Melody E. Morton-Ninomiya

The word ‘vulnerable’ is frequently used in public health research and practice. We use critical discourse analysis to explore the use of this term in articles published between January 2015 and January 2018 in the American Journal of Public Health and the Canadian Journal of Public Health. We find that terms such as ‘vulnerable groups’ are often vaguely defined or undefined, requiring the reader to ‘fill in the blanks’ as to who is vulnerable, why they are vulnerable, and what they are vulnerable to. Where terms such as ‘vulnerable groups’ are applied with some specificity, they are used as proxies for a wide range of groups, conditions and situations. Often, groups are constituted as inherently vulnerable, as authors imply that even if policies and processes change, group vulnerability will remain. Notably, populations and groups in power – and therefore responsible for generating structural vulnerability – are rarely examined. In our experience, researchers often use the word ‘vulnerable’ strategically to attract resources, policy interest and public concern. At the same time, we propose that the vagueness associated with terms such as ‘vulnerable’ conceals the structural nature of public health problems. We conclude that this vagueness can serve the political function of obscuring power relationships and limiting discussion of transformational change.

The role of social audit as a social accountability mechanism for strengthening governance and service delivery in the primary health care setting of Nepal: a qualitative study
Gagan Gurung, Sarah Derrett, Philip C. Hill & Robin Gauld

Social audit is a mechanism used to hold frontline health service providers accountable. Using the case of the social audit process in Dang District, Nepal, this study explored the role of social audit in facilitating direct accountability between service providers and community. This relationship was summarised by three elements: information/data collection, dialogue/forum, and sanctions. A total of 39 interviews were held with health facility operation and management committee members, service providers, district level health managers and non-government organisation members. Reviews of records of social audit action plans were undertaken at 10 health facilities. Participants reported that the social audit process was able to facilitate information provision/data collection, and provided opportunities for dialogue between community and service providers, but the provision of sanctions was found to be weak. While social audit had a positive role in increasing transparency, accessibility and quality of services, its effectiveness in addressing perennial governance problems was mixed. Manipulation of the participation process, falsification of information, and lack of authority affected the role of social audit in facilitating accountability. These factors are essential to consider while designing and implementing social audit processes. While giving more power and control to the community to monitor and implement social audit action plans seems appealing, the concept of partnership between community and service providers with joint problem-solving and an emphasis on relational elements of accountability are most likely to build trust and responsiveness. If social audit is used alongside existing traditional accountability mechanisms, it could help to address governance and accountability issues.

A critical review of the Lancet Commission on global mental health and sustainable development: Time for a paradigm change
Lisa Cosgrove, China Mills, Justin M. Karter, Akriti Mehta & Jayasree Kalathil

In October 2018, the UK government, positioning itself as a global leader in mental health, hosted a Global Ministerial Mental Health Summit. The event was scheduled to coincide with the publication of the Lancet Commission on Global Mental Health and Sustainable Development. Despite claiming a public health and social determinants approach, the report focused on the importance of ‘closing the treatment gap’ through the use of Western diagnostic tools and interventions. In response, coalitions of mental health activists and service-users organized open letters detailing their concerns with the summit and report. Among these concerns were the ways in which recent UK government policies, particularly welfare reform, violated the rights of persons with disabilities; the lack of stakeholder representation and involvement in the report; and the continuation of the colonial legacy in which the ‘North drives the South.’ Expanding on the concerns raised by this coalition of activists and service-users, we argue that a focus on societal (structural) determinants and political economy could open new possibilities for global mental health beyond narrow individualized interventions. Additionally, we suggest that a politically informed societal determinants of health framework is needed in order to move the Global Mental Health Movement in a more emancipatory direction.

Culture, Medicine and Psychiatry 

Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study
A. Bhat, B. Ramakrishna Goud, J. R. Pradeep, G. Jayaram, R. Radhakrishnan & K. Srinivasan 

Major Depressive Disorder (MDD) is associated with low rates of treatment and medication non-adherence, more so in low- and middle-income countries (LMICs). Mobile mental health (mHealth) interventions offer promise as a tool to address these problems. However, the feasibility and acceptability of mHealth interventions among rural women in LMICs is unknown. We examined barriers to accessing mental health treatment, reasons for non-adherence, and attitudes towards mHealth solutions among women with MDD in rural south India. Six focus groups were conducted among women with MDD (n = 69) who had been in treatment at a rural community health center. The discussion was transcribed and analyzed using a modified grounded-theory approach. Women perceived limited autonomy within their family structure, and experienced financial and systemic barriers as contributing to poor treatment access and non-adherence. Illiteracy, limited personal access to mobile phones, and preference for in-person clinical consultation were identified as barriers to use of mHealth. This is the first qualitative study, to our knowledge, that examines attitude towards mHealth among women with MDD in a rural setting in India. The study identified contextual barriers that will be important to address before implementing mHealth interventions.

Existential Displacement: Health Care and Embodied Un/Belonging of Irregular Migrants in Norway (open access)
Synnøve K. N. Bendixsen

Drawing on fieldwork and interviews in Oslo and Bergen, Norway, this article discusses irregular migrants’ experiences of existential displacement and the tactics they use to try to re-establish a sense of emplacement and belonging. More specifically, it argues that irregular migrants’ experiences of embodied unbelonging are a consequence of a violent form of governmentality that includes specific laws, healthcare structures, and migration management rationalities. The article makes this argument by tracing how these experiences translate into embodied effects that feature prominently in migrants’ narratives of suffering while living in a country that purports to provide welfare services to all. The narratives of their state of being-in-the-world are ways through which migrants both experience and express the violence and deprivation they face. I argue that these narratives are instances of structures of feeling (Williams 1973), which are shaped by modes of governmentality. The article shows that irregular migrants’ coping strategies centrally involve faith, religious communities and friends. Irregular migrants draw on these relationships to get by, access healthcare, and to resist the (health) effects of social deprivation and political violence. These relationships allow irregular migrants to find meaningful ways of being-in-the-world and rebuilding, to some extent, a sense of entitlement and belonging.

Broadcasting Your Death Through Livestreaming: Understanding Cybersuicide Through Concepts of Performance
Annamaria Fratini & Susan R. Hemer

Cybersuicide, or suicide mediated by the internet in various ways, is a growing phenomenon worldwide and one which makes an often private act highly public. This paper provides an exploration of one version of cybersuicide: suicide that is livestreamed on the internet. Through an analysis of three case studies, this paper asks what light anthropological concepts of performance can shed on cybersuicide? It argues that as a public and social act, cybersuicide needs to be analyzed in terms of how an audience is attracted and retained, as well as the key roles the audience plays in the social practice. This means that cybersuicide has a different structure from suicide offline, impacting how it should be analyzed and understood.

Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste (open access)
Christien Muusse, Hans Kroon, Cornelis L. Mulder & Jeannette Pols 

Deinstitutionalization is often described as an organizational shift of moving care from the psychiatric hospital towards the community. This paper analyses deinstitutionalization as a daily care practice by adopting an empirical ethics approach instead. Deinstitutionalization of mental healthcare is seen as an important way of improving the quality of lives of people suffering from severe mental illness. But how is this done in practice and which different goods are strived for by those involved? We examine these questions by giving an ethnographic description of community mental health care in Trieste, a city that underwent a radical process of deinstitutionalization in the 1970s. We show that paying attention to the spatial metaphors used in daily care direct us to different notions of good care in which relationships are central. Addressing the question of how daily care practices of mental healthcare outside the hospital may be constituted and the importance of spatial metaphors used may inform other practices that want to shape community mental health care.

Medication by Proxy: The Devolution of Psychiatric Power and Shared Accountability to Psychopharmaceutical Use Among Soldiers in America’s Post-9/11 Wars (open access)
Jocelyn Lim Chua

With the United States military stretched thin in the “global war on terror,” military officials have embraced psychopharmaceuticals in the effort to enable more troops to remain “mission-capable.” Within the intimate conditions in which deployed military personnel work and live, soldiers learn to read for signs of psychopharmaceutical use by others, and consequently, may become accountable to those on medication in new ways. On convoys and in the barracks, up in the observation post and out in the motor pool, the presence and perceived volatility of psychopharmaceuticals can enlist non-medical military personnel into the surveillance and monitoring of medicated peers, in sites far beyond the clinic. Drawing on fieldwork with Army personnel and veterans, this article explores collective and relational aspects of psychopharmaceutical use among soldiers deployed post-9/11 in Iraq and Afghanistan. I theorize this social landscape as a form of “medication by proxy,” both to play on the fluidity of the locus of medication administration and effects within the military corporate body, and to emphasize the material and spatial ways that proximity to psychopharmaceuticals pulls soldiers into relationships of care, concern and risk management. Cases presented here reveal a devolution and dispersal of biomedical psychiatric power that complicates mainstream narratives of mental health stigma in the US military.

Mukbang and Disordered Eating: A Netnographic Analysis of Online Eating Broadcasts (open access)
Mattias Strand & Sanna Aila Gustafsson
 

Mukbang is a recent Internet phenomenon in which video recordings of hosts eating large amounts of food are streamed on an online video platform. It originated in South Korea around 2014 and has since become a global trend. The aim of this study was to explore how viewers of mukbang videos relate their audience experiences to symptoms of disordered eating. A qualitative analysis of YouTube comments and Reddit posts on the topic of mukbang and disordered eating was performed, employing a netnographic approach. Two overarching themes were identified: a viewer perspective, by which users discuss mukbang without describing any personal involvement, and a participant perspective, by which users describe their own experiences of affects and behaviors in response to watching mukbang. Several topical categories emerged, describing how watching mukbang can both limit and increase eating, reduce loneliness and guilt, and become self-destructive. For some, mukbang appears to be a constructive tool in increasing food intake, preventing binge eating, or reducing loneliness; for others, it is clearly a destructive force that may motivate restrictive eating or trigger a relapse into loss-of-control eating. Notably, watching mukbang is not necessarily experienced as either helpful or destructive, but instead as simultaneously useful and hurtful.

The Power of Shared Embodiment: Renegotiating Non/belonging and In/exclusion in an Ephemeral Community of Care (open access)
Anita von Poser & Edda Willamowski 

In this article, we explore the power of shared embodiment for the constitution of an affective community. More specifically, we examine how people afflicted by long-term, arduous experiences of war, migration, and discrimination sensually articulate and, at least temporarily, renegotiate feelings of non/belonging, care, and in/exclusion. Methodologically, we draw on emplaced ethnography and systematic phenomenological go-alongs with a group of elderly migrants, born and raised in different parts of Vietnam, who had arrived in Germany within different legal–political frameworks and who, during the time of our psychological–anthropological research, frequented the same psychotherapeutic clinic. We apply the notion of “affective communities” (Zink in Affective Societies: Key Concepts. Routledge, New York, 2019) to grasp how the group experienced a sensual place of mutual belonging outside the clinic when moving through different public spaces in Berlin as part of their therapy. Particular attention is paid to the participants’ embodied and emplaced memories that were reactivated during these excursions. Shared sensations and spatiality, we argue, made them feel they belonged to an ephemeral community of care that was otherwise hardly imaginable due to their distinct individual biographies, contrasting political attitudes, and ties to different social collectives. In analyzing this affective community, we highlight how significant spatio-sensorial modes of temporal solidification can be in eliciting embodied knowledge that positively contributes to therapeutic processes.

Journal of the Royal Anthropological Institute

Permeable persons and plastic packaging in India: from biomoral substance exchange to chemotoxic transmission
Gauri Pathak

In contemporary India, it has become commonplace to hear middle‐class people speak of ‘chemicals’ in the environment, in food, and in everyday commodities. Anxieties revolve around the bodily absorption of these ‘chemicals’, and plastic packaging has come under particular scrutiny as a source of such leached substances. Although anthropological studies have highlighted South Asian conceptions of the person as permeable and affected, through the exchange of biomoral substances, by transactions with the environment, humans, and nonhumans, the concern about ‘chemicals’ references a different type of transfer: that of chemotoxic transmission. Such concern foregrounds new anxieties about the permeable body in the contaminated, ecologically damaged world of late modernity. The case of plastic packaging is illustrative of the differences between frameworks of biomoral substance exchange and chemotoxic transmission. In illuminating those differences, this article focuses on public concerns regarding the bodily absorption of ‘chemicals’, why these concerns are compelling as a political ecological critique of capitalist extraction, and the insights they can offer to anthropological research on the permeable body.

Making secular ‘French’ medical ethics: transcendent morality and patient subjectivities in southern French hospitals
Kimberly Arkin

Drawing on ethnographic fieldwork with physicians and nurses working in two state‐funded southern French hospitals, this article explores why and how medical care providers connected their everyday deliberations about patient care to what they considered to be distinctively French forms of medical responsibility. Many healthcare professionals saw French medical morality in opposition to ‘Anglo‐Saxon’ discourses of individual autonomy and transactional choice. In contrast to such ‘transactionalism’, they insisted that ‘French’ ethics required limits that transcended particular circumstances. And yet it was difficult for doctors and nurses working in secular and increasingly neoliberal hospitals to argue against individual transactionalism in an overtly moral register, one that might appear religious and paternalist. Through a close look at two different cases – one in assisted reproduction and one in palliative care – I show how the language of folk psychoanalysis provided some health professionals with a way out of this impasse. Care providers used pseudo‐psychoanalytic accounts of patient subjectivities to depict individuals as incapable of knowing, let alone ‘owning’ or rationally mastering, themselves. This, in turn, suggests that some aspects of French secularity may be far less Protestant and liberal than contemporary anthropological work tends to assume.

East Asian Science, Technology and Society: An International Journal

The Politics of Science and Undone Protection in the “Samsung Leukemia” Case (open access)
Jongyoung Kim, Heeyun Kim & Jawoon Lim

A labor health dispute between a multinational corporation and patient-workers in Korea received enormous attention from 2007 to 2018, when it was finally and successfully resolved. Sick workers of Samsung Semiconductor claimed they were contaminated by toxic chemicals at their workplace that resulted in their sickness, a contested illness known as “Samsung leukemia.” In this dispute, the Korean government and Samsung used epistemological studies to deny the workers’ claims. The patient-workers politicized the industrial disease, forming a labor health movement that advocated for workers’ rights and welfare. In this long disputed process, they developed their own bottom-up science that collected evidence from their factories and connected this evidence with the claims of counter-experts. They made done “undone science,” which investigated the relationship between the unknown disease and the semiconductor industry. But the undone science has been constructed in the context of “undone protection” stemming not only from chemical exposure in factories that weigh profit over safety but also from institutional failures to protect and compensate the loss of workers’ lives and health. The successful resolution of the “Samsung leukemia” case depended on a health movement that worked toward getting undone science and undone protection done simultaneously.

Reformulation and Appropriation of Traditional Knowledge in Industrial Ayurveda: The Trajectory of Jeevani (open access)
Harilal Madhavan & Jean-Paul Gaudillière

In India, the industrial sector that specializes in the invention, production, and marketing of neotraditional therapeutic specialties has been rapidly growing for two decades. In addition to standard pharmaceutical laboratory knowledge, it heavily mobilizes local medical knowledge. This article follows the trajectory of a new formulation called Jeevani, originating in the mining of both the classical Ayurveda texts and the tribal healing practices in the Indian state of Kerala. We investigate the strong coupling established by the reformulation regime between the invention of complex polyherbal therapeutic preparations with local forms of appropriation, namely Indian patents and benefit-sharing agreements.

Invulnerable Facts: Infant Mortality and Development in Nationalist Gansu (open access)
Joshua A. Hubbard

This article examines responses to high rates of infant mortality in China’s northwestern province of Gansu during the Nationalist decades (1927–1949). Based on public health reports for both government and popular audiences, this article argues that the problem of Gansu’s especially high infant mortality rate was constructed to serve a particular political and economic agenda, drawing heavily not only from fascist ideals but also the logic of foreign philanthropists and Nationalist technocrats. Once established, the facts of this problem and its cause remained stubbornly invulnerable to new evidence. The article makes two primary contributions. First, it brings to light actors and institutions largely absent in existing scholarship on medicine and public health in Republican China. Second, it cautions against treating infant mortality rates referenced in the historical record as dispassionate measures of life and death. Rather, these purported facts affirm the value ascribed to reproductive health and its relevance for particular political aims.

From SARS to COVID-19: Rethinking Global Health Lessons from Taiwan (open access)
Wayne Soon

Taiwan has been successful in suppressing the highly infectious Coronavirus Disease 19 (COVID-19) despite its proximity to Wuhan, China, where the coronavirus first emerged in December 2019. Taiwan recorded 517 coronavirus cases and 7 deaths in contrast to the similarly sized population of Australia, which confirmed 27,133 cases and 894 deaths as of 3 October 2020 (Johns Hopkins n.d.). Journalists across the world have attributed Taiwan’s success against COVID-19 to its experience fighting Severe Acute Respiratory Syndrome (SARS) in 2003 (Fortune 2020; CNN 2020). “The secret of Taiwan’s success,” a Turkish journalist argued, “lies in the painful memories of the 2003 outbreak” of SARS (Anadolu Agency 2020). Yet, these journalists have found it difficult to elaborate on Taiwan’s learning from its SARS experiences in the format of a newspaper article. Drawing on historian…

Contact Tracing and COVID-19: The South Korean Context for Public Health Enforcement (open access)
John P. DiMoia

Although South Korea’s response to COVID-19 has received international praise, the nation’s public health policy raises numerous privacy concerns, with a growing number of civil society groups joining the conversation. Following changes to public health law in 2015 in response to the MERS (Middle Eastern Respiratory Syndrome) crisis, South Korea’s KCDC (Center for Disease Control) reconfigured its enforcement practice with measures tied to the movements of infected patients. New laws allow for the use of information communications technology and personal data (cell phone, CCTV, credit card transactions) to track patients, thereby identifying the possible routes of transmission for disease. Through mid-April 2020, this system received extensive praise, but more recently, with the “Itaewon Cluster,” centered in a popular nightclub district, citizens are starting to raise concerns. Itaewon is associated with prostitution due to its legacy of proximity to an American military base, and by extension, the presence of foreigners in general, including LGBT clubs. While contact tracing promises to preserve the anonymity of data, the significant rise in case numbers since May 2020 has resulted in calls for targeting these groups—foreigners, LGBT, English teachers—suggesting that xenophobia and social stigma continue to represent powerful forces.

Dialogue across Borders: Angela Su’s Chimeric Antibodies (open access)
Angela Su & Harry Yi-Jui Wu

Born and raised in Hong Kong, Angela Su is adept at a variety of art forms, including ink drawing, human hair embroidery, video art, animation and performance. Graduating from the University of Toronto with her undergraduate training in biochemistry, and then from the Ontario College of Art and Design University with another degree in visual arts, Su’s works have been shaped by the place where she grew up. She transplants a lush, Gothic style of pessimism into a city where people have struggled for survival alongside its hard-earned prosperity. In 2018, Su was commissioned by the Wellcome Trust to create art exploring the complexity of infectious diseases in the transregional project “Contagious Cities.” Her performance-based video was inspired by the outbreak narratives permeating Hong Kong’s two-century-long encounter between two great civilizations. Here, we select one of Angela’s early works…

Circulation and Governance of Asian Medicine (open access)
Stephan Kloos

It is surely one of the paradoxes of medical anthropology that the industrial expansion of Asian medicines—a phenomenon of global scale and relevance by any measure—has coincided with a diminishing academic interest in Asian medicines, as the discipline at large has shifted its focus to mainly biomedical topics during the recent decades (Scherz 2018). Yet while research on Asian medicines may not have increased in quantity, it has certainly gained in quality, with a steady stream of important publications carrying forward—and, crucially, rethinking—Charles Leslie’s field-defining legacy (Leslie 1976). Céline Coderey and Laurent Pordié’s Circulation and Governance of Asian Medicine, the product of a multidisciplinary workshop in September 2015 at the Asia Research Institute of the National University of Singapore, is the latest appearance in this venerable line of edited volumes. It identifies circulation and governance…


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