In the Journals

In The Journals, November 2020, Part 2

Cultural Anthropology (Open Access) 

Birthing from Within: nature, Technology, and Self-Making in Silicon Valley Childbearing

Andrea Ford 

Through examining childbearing in California’s Silicon Valley, this article describes how seeking “self-actualization” has become a rite of passage for contemporary childbearing people. This approach undermines distinctions between “technological” and “natural” approaches to birth, as people are coached to leverage both logistical and animalistic capacities to produce “self-knowledge” and enact new feminist ways of doing embodiment. Based on fieldwork conducted as a doula, this article describes new rituals, anxieties, and aspirations that draw from both the idea that self-authenticity stems from an unadulterated, primordial nature and that self-realization is enabled by a very modern, reflexive strategy of self-design. In this community, the way reproduction comes to matter has less to do with realizing gendered expectations and kinship relations than with creative self-optimization. This approach facilitates women’s self-determination, while simultaneously introducing new forms of pressure and advancing a dominant cultural discourse that minimizes thinking about structural conditions and mutual accountability.

Health: An Interdisc. J. for the Social Study of Health, Illness, and Medicine

Putting patients in the centre: Patient empowerment in everyday health practices

Anna Schneider-Kamp, Soren Askegaard

Patient empowerment is a key topic in public health, medical sociology and in public debates on the modernisation of healthcare. This article joins the on-going discussion on public and patient involvement by offering a patient-centred perspective on patient empowerment outside the usual institutionalised context of chronic disease management. We present results from a qualitative study on individuals’ practices of dealing with acute non-life-threatening medical conditions conducted from 2012 to 2017 in Denmark. Based on 34 home visits including in-depth interviews and participant observations with a sample of 28 informants, we uncover a spectrum of four patient tactics governing these practices: delegating, informing, consuming and resisting. The findings suggest disruptive changes to the role of the patient–physician relationship as well as the existence of practices indicative of patient empowerment outside the context of patient empowerment initiatives. Some patients are found to take over responsibility for their health, employing tactics where the role of general practitioners is severely demoted. These empirical contributions lead to the two theoretical contributions of the article: an extension of an existing model of patient empowerment and a conceptual reconsideration of patient empowerment, advocating viewing it as emerging from a bricolage of tactical interactions with social environments rather than as the consequence of an external strategic process.

“A slow and unrewarding and miserable pause in your life” : Waiting in medicalized gender transition

Victoria Pitts-Taylor

Waiting is a common experience in medicalized gender transition. In this article, I address subjective experiences of medicalized gender transition through a temporal lens, focusing on personal narratives of wait lists, setbacks, and other delays experienced by trans patients. I consider administered waiting as a biopolitical practice of governance, one that has subjectifying and somatic effects on individuals and that speaks to the role of time in the administration of bodies, sex/gender, and biomedical citizenship. I ground my discussion in narratives created by trans people that chronicle their gender transitions; I analyze a set of gender transition vlogs appearing on YouTube, focusing on temporal aspects of medicalized transition and experiences of waiting. My discussion recognizes that the temporal modes of gender transition are multivalent, but these social media narratives also suggest being made to wait is an experience of power relations, one that is capable of producing submission, weariness, and precarity.

Evidence or Stereotype? Health inequalties and representations of sex workers in health publications in England

Nina Putnis, Jennifer Burr

The health of sex workers is considerably influenced by their position in society and by the marginalisation and stigmatisation they face worldwide. They are frequently criminalised and labelled as deviant, disordered or ‘vulnerable’: stereotypes that simplify and misrepresent their realities. Sex work policies create social and structural barriers, creating dangerous work environments and exacerbating significant health inequalities. Health organisations and their policies play an important role in highlighting inequalities and guiding health systems in reducing them. In this article, we use a document analysis design to analyse how and when sex workers are depicted in policies and publications by English national health organisations: National Health Service (NHS) England, Public Health England and the National Institute for Health and Care Excellence, along with the UK Department of Health. We find that sex workers are largely absent in these documents and, when present, are depicted not using evidence, but simplistically with moralistic undertones. The dichotomous constructions found in these texts: vulnerable yet also criminal ‘prostitute’ reflect wider political and social constructions of sex working women. This not only obscures their realities but also homogenises, blames and stigmatises, ultimately doing the opposite of what these organisations purport to do: it damages their health and well-being.

Where to find accurate information on attention-deficit hyperactivity disorder? A study of scientific distortions among French websites, newspapers, and Television programs

Sébastien Ponnou, Héloïse Haliday, François Gonon

Attention-deficit/hyperactivity disorder is the most frequent mental disorder among school-age children. This condition has given rise to a large mediatic coverage, which contributed to the shaping of the lay public’s perceptions. We therefore conducted two studies on the way attention-deficit/hyperactivity disorder was portrayed in the TV programs and the lay-public press in France between 1995 and 2015, but the growing part played by the Internet required an additional study to analyze and compare the scientific material which is available to the French lay public depending on the source of information used. We studied the 50 first French websites dedicated to attention-deficit/hyperactivity as indexed by Google® search engine using a structured quantitative content analysis for the web. We illustrate our results with excerpts derived from the websites. The conceptions of attention-deficit/hyperactivity disorder available on the Internet are essentially biomedical and comprise an important level of scientific distortion. Findings concerning other mass media such as television programs and the press also demonstrate massive and systematic distortions caused by the role of experts and the pharmaceutical industry. Furthermore, the most consulted media present the highest level of scientific distortions.

Living with multimorbidity? The lived experience of multiple chronic conditions in later life

Tom Porter, Bie Nio Ong, Tom Sanders

Multimorbidity is defined biomedically as the co-existence of two or more long-term conditions in an individual. Globally, the number of people living with multiple conditions is increasing, posing stark challenges both to the clinical management of patients and the organisation of health systems. Qualitative literature has begun to address how concurrency affects the self-management of chronic conditions, and the concept of illness prioritisation predominates. In this article, we adopt a phenomenological lens to show how older people with multiple conditions experience illness. This UK study was qualitative and longitudinal in design. Sampling was purposive and drew upon an existing cohort study. In total, 15 older people living with multiple conditions took part in 27 in-depth interviews. The practical stages of analysis were guided by Constructivist Grounded Theory. We argue that the concept of multimorbidity as biomedically imagined has limited relevance to lived experience, while concurrency may also be erroneous. In response, we outline a lived experience of multiple chronic conditions in later life, which highlights differences between clinical and lay assumptions and makes the latter visible.

Masculinities, performances and meanings: A critical analysis of recent literatures on the use of performance- and image- enhancing drugs among men

David Moore, Aaron Hart, Suzanne Fraser, Kate Seeare

 The use of performance- and image-enhancing drugs (PIEDs) has been a topic of considerable research interest since the 1980s, with the vast majority of PIED consumers being men. In this article, our departure point is a 2005 article by Helen Keane, in which she critically analyses ‘the discursive constitution of male steroid users’ as psychologically disordered subjects. We extend Keane’s insightful feminist analysis by examining the constitution of masculinity in post-2005 social science research on PIEDs. We ask (1) to what extent do the discursive trends identified by Keane persist in the more recent literature on PIED use among men? (2) how have her insights been taken up in the post-2005 literature, and (3) to what extent does this work attend to the specificity and varied meanings of steroid practices? We argue that men who use PIEDs continue to be pathologised as insecure, inadequate and vulnerable, and marked by ‘obsession’, ‘compensatory behaviours’ and crisis. In some of the analysed texts, the male steroid user becomes doubly disordered as both insecure in his masculine body and at risk of drug dependence. Of the articles that engage with Keane’s work, only two recognise the value of her insights. The others misinterpret or apply Keane’s argument in inconsistent or incoherent ways. Finally, in some of the post-2005 texts, we begin to see attention to the wide variety of practices and meanings encompassed by the term ‘PIED use’ although much remains to be learned.

Love and incomprehensibility: The hermeneutic labour of caring for and understanding a loved one with psychosis

Ana Luderowski, Zoë VR Boden

Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers’ perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one’s psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers’ effortful quest to understand their loved one’s experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic ‘mooring points’, making sense of their loved one’s unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful – it is hermeneutic labour – done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems.

Matter over mind: how mental health symptom presentations shape diagnostic outcomes

Alexandra Tate

Mental health disorders face less stigma today than in the past, yet they continue to be misdiagnosed and at times improperly treated. One account for this problem is that physicians rely exclusively on a verbal interview of patients for diagnosis. Because this diagnostic method is likely to be shaped by the way patients present their symptoms, it is critical that we examine whether and how patients’ communication practices shape diagnostic and treatment outcomes. This study examines a sample of 14 encounters involving mental health-related symptoms from a dataset of adult primary care visits. Using conversation analytic methods, I show that when patients present mental health symptoms by simply describing the symptoms, primary care physicians exhibit a preference for providing a physical health diagnosis. Conversely, when patients provide a concrete link between their symptoms and the way the symptoms are disrupting their everyday lives, primary care physicians typically provide a mental health diagnosis.

Polyphonies of depression: The relationship between voices-of-the-self in young professional women aka “top girls”

Nilima Chowdhury, Kerry Gibson, Margaret Wetherell

While the analysis of depression narratives has become increasingly common practice within critical mental health research, this work rarely investigates how these accounts intersect with particular social identities. The recent emergence of the ‘top girl’ identity, a new cultural slot on offer for young women, is underpinned by the rise of neoliberal and post-feminist discourses in the Western world. To explore whether this new feminine subjectivity is indeed taken up by young women and how it shapes their experience of depression, we conducted in-depth interviews with 13 young professional women in Aotearoa/New Zealand. Based on a dialogical approach to theorising and researching subjectivity, we identified repetitive inter-relations between different voices-of-the-self and the voices of depression. The most pervasive pattern in the sample consists of what we have termed demanding voices associated with the ‘top girl’ position, which construct depression as an individual deficit thereby discouraging young women from exploring the sociocultural origins of their distress. In contrast, resistant voices emphasise relationality and a (re)connection with meaningful values and, therefore, seem to be productive for individual recovery.

International Journal of Social Psychiatry 

Depression, anxiety and stress and socio-demographic correlates among general Indian public during Covid-19 (open access)

Shankey Verma, Aditi Mishra

Depression, anxiety and stress among Indian population during the lockdown were prevalent. Along with other measures to contain the spread of COVID-19, mental health of citizens needs the urgent attention of the Indian government and mental health experts. Further large-scale studies should be conducted on different professions and communities such as health care professionals and migrant workers and incorporate other mental health indicators.

The effect of childhood trauma on the age of onset in patients with schizophrenia

Cem İngeç, Esin Evren Kılıçaslan

Childhood trauma (CT) has been shown to affect the etiology and clinical features of schizophrenia. In this study, it was aimed to investigate the effects of CT on the age of onset (AoO) and clinical features of the disease by considering factors such as family history, head trauma, birth trauma, alcohol and substance abuse that may affect AoO of the disease.

Increased stressful impact among general population in mainland China amid the Covid-19 pandemic: a nation-wide cross-sectional study conducted after Wuhan city’s travel ban was lifted (open access)

Zheng Feei Ma et al. 

Our study aimed to determine the impact of the COVID-19 pandemic on psychological responses and lifestyle changes among the general population in mainland China following the re-opening of the Wuhan city. The COVID-19 pandemic was associated with increased stressful impact in our participants following the re-opening of the Wuhan city when compared with our previous study, which should not be taken lightly.

Do Tamil newspapers educate the public about suicicde? Content analysis from a high suicide Union Territory in India 

Vikas Menon et al

Media reporting of suicide in Puducherry, India, does not adhere to reporting guidelines and there is very little focus on educating the public about preventive aspects of suicide. Urgent efforts are warranted to improve the quality of media reporting which should include the development of national guidelines on suicide reporting and collaborative efforts that take into account barriers and perspectives of media professionals.

Factors influencing decision-making around pregnancy among women with severe mental illness (SMI): A qualitative study

Ashlesha Bagadia et al. 

Women with SMI who plan to become pregnant, especially from low-income settings in India, are disadvantaged by stigma and societal expectations, affecting their ability to make optimum decisions during this crucial period. Decision-making around pregnancy in women with SMI is complex and appears to be influenced by several socio-cultural factors and needs to be dealt with sensitively.

Navigating Covid-19 with emotional intelligence

Mubashir Majid Baba

The purpose of this article is to examine the perception of faculty members toward their emotional intelligence during COVID-19 and to study the impact of demographic variables on their emotional intelligence.The results revealed that the faculty members perceived their emotional intelligence at an above-average level in the present pandemic, that is, COVID-19. The results also revealed that the perception of the respondent faculty members toward their emotional intelligence from different universities and states is more or less the same and also the demographic variable gender has a significant impact on emotional intelligence during the present pandemic.

Mental status of patients with chronic insomnia in China during Covid-19 epidemic (open access) 

Lili Yang et al

Under the influence of the COVID-19, the sleep status and anxiety of patients with chronic insomnia are affected by the epidemic.

Medical Anthropology

(Editorial) Beyond the Linguistic/Medical Anthropology Divide: Retooling Anthropology to Face Covid-19 (open access)

Charles L. Briggs

Differing analytics and ethnographic practices impede conversations between linguistic and medical anthropologists. Here I juxtapose articles in this special issue that use diverse ethnographic sites to rethink anthropological concepts of health, disease, care, the body, language, and communication in the light of the 2020 COVID-19 pandemic. I track how anthropologists and their interlocutors envision relations between ideologies, embedded modeling (or metacommunication), and ordinary pragmatics, particularly by projecting their actual or ideal consonance versus exploring how sounds, bodies, technologies, and practices emerge from disjunctures. Comparing H1N1 in 2009 and COVID-19 prompts reflection on why anthropologists must transcend this foundational divide to tackle pandemic complexities.

(Editorial) How Communicative Approaches Enrich the Study of Care (open access)

Lynnette Arnold & Steven P. Black

Video Abstract

“Making Medicine” with Salvia divinorum: Competing Approaches and Their Implications

Paja Faudree

The psychoactive plant Salvia divinorum has long been used medicinally by Indigenous people from southern Mexico, the only place where it is endemic, and is now studied by pharmaceutical researchers. I analyze competing ways the two groups “make medicine” with salvia, attending simultaneously to material/embodied and semiotic/linguistic dimensions of those practices. I introduce two concepts – stripping and enrobing – to show that differences in how the groups interact with salvia have ethical and political consequences. Those repercussions matter because salvia is but one of many plants important to marginalized groups whose ties to them are threatened by international medical interests.

Global Health Education and Mediatization of Care in Costa Rica

Steven P. Black, and Gabriela Alvarado

Costa Rica has become a destination for global health education courses, while funding for global health has increased dramatically over the past thirty years. An examination of one Costa Rican group’s efforts to market humanitarian discourses, focusing on website design, provides a window into the workings of global health education and details the sometimes-uncomfortable position of non-US health professionals in educational programming. This contributes to theorizations of the intersection of mediatization and care, and suggests links between the legitimation of global health as a discipline, on the one hand, and the reproduction of inequities, on the other.

Time Discipline and Health/Communicative Labor in Pediatric Primary Care

Jennifer R. Guzmán 

In rural Southern Chile, native Mapuche families receive care mostly from non-indigenous clinicians. Parents and doctors alike orient to the importance of timely medical care, but clinical and communication norms also result in misunderstandings and tension. Parents find it hard to communicate about structural obstacles, and valued practices of care in families may conflict with normative expectations for timely presentation. Parents’ disclosures about the duration of their children’s illnesses can expose them to clinical censure, which in turn reinforces pernicious negative stereotypes about this racialized and marginalized community.

Cross-border Communication and the Enregisterment of Collective Frameworks for Care

Lynnette Arnold

Communication plays an important role in the non-copresent care that is increasingly prevalent today. Drawing on long-term research with transnational Salvadoran families, I explore how one multigenerational kin network managed a health crisis: a family member had been diagnosed with a new form of chronic kidney disease that is epidemic in rural Central American communities. The family used cross-border communication to simultaneously enact care and consolidate a particular register of care. I suggest that everyday communication is a powerful force that works both within and beyond immediate care work encounters in ways that have far-reaching consequences for ethical and moral life.

Care in Interaction: Aging, Personhood, and Meaningful Decline

Anna I. Corwin 

Care, as it is instantiated through interaction, can both perform and shape cultural and moral understandings of what it means to be a person in the world. American Catholic nuns have been found to age more “successfully” than their peers. However, in contrast to the successful aging paradigm, an analysis of care interactions from research conducted in a Franciscan Catholic convent in the Midwestern United States reveals that the nuns practice an ideal of meaningful decline. I explore how linguistic analysis of care interactions evidence ideologies of personhood and aging, and how a model of meaningful decline (the notion that valuable personhood endures beyond productivity) is instantiated through interaction.


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