In the Journals

In the Journals, June 2021, Part 2

BioSocieties

How environments get to the skin: biosensory ethnography as a method for investigating the relation between psychosis and the city (Open Access)

Marc Winz & Ola Söderström

Epidemiological research in psychiatry has established robust evidence of the link between urban living and psychosis, but the situated experience of the city, as well as the precise ecology of psychosis remain largely unexplored. In this context, the aim of this paper is to discuss the productive potential of a ‘re-vitalized’ biosocial geographical thinking and researching on urban mental health. We do so through a methodological proposition. First, we discuss the need for a biosocial approach to the city/psychosis nexus and argue that a broader biological view, beyond epigenetics and neurosciences and a more precise investigation of ‘the social’ need to be developed. Second, a telling and recurring motto of recent reflections on biosocial processes is to understand how the environment or the social ‘gets under the skin’. We suggest examining a specific place in this pathway, the skin itself. This leads us to expose a methodology using electrodermal activity (EDA), combined with ethnographic observations and interviews, as a strategy for analysing ecological processes in psychosis. In doing so, we discuss the potential of ‘biosensory ethnographies’ in studies of urban mental health and more broadly as a biosocial approach to the geography of health.

The antidepressant in women’s lifeworlds: feminist materialist encounters

Jacinthe Flore, Renata Kokanović, Cameron Duff & Felicity Callard

This article examines how a particular class of material objects—antidepressants—circulate in women’s social, cultural and intimate lifeworlds. Following the action of antidepressants in their encounters with bodies and brains by way of the agencies they express and the specific work they perform reveals much of the social, affective and material gendering of depression, along with the everyday activities by which this gendering is resisted. Drawing on data from a qualitative research project, we examine how women conceptualise their brains as needing ‘work’ through antidepressants, and then consider the particular kinds of ‘work’ that these objects perform. In instances where they refuse antidepressant medication, women co-constitute antidepressants as objects to be resisted and objects that resist, reframing in the process relationships between corporeality, diagnosis and pharmaceutical matter. The ‘female’ brain emerges in our study as a potent site for the gendering of depression as antidepressants become entangled in the social, material and affective dynamics of women’s everyday lives.

“Asperger’s syndrome does not exist”: the limits of brain-based identity discourses around Asperger’s syndrome and autism in Italy

M. Ariel Cascio 

Brain-based identities, especially around autism, have received much attention in recent literature on biopolitics through concepts such as brainhood, cerebral selfhood, and neurochemical selves. This article complicates conversations about self and brain by presenting ethnographic data about Italian autistic youth. It demonstrates the complexities of the ways in which youth draw on brain discourses and autism identity discourses. While youth and their parents did sometimes talk about autism as related to selfhood, and autism as related to brains, and even brainhood as related to selfhood, they rarely spoke of all three concepts together. Youth’s use of autism identity discourses proved sporadic, and instrumental. Italian youth did not mobilize biopolitical modes of engagement the same way as scholars have described in other settings, suggesting important cross-cultural variation in how people relate to notions of self and brain linked to broader differences in Western biomedicines. This study provides a rich description of identity discourses employed by autistic Italian youth, demonstrating how they can use autism as a tentative basis for seeking collective identity and social interaction while negotiating skepticism about its meaning for individual identity. Throughout, the brain plays a minimal role, resisting neuro-essentialist or neuro-hegemonic conceptualizations of autism.

The empire of speculation: medicine, markets, and nation in India’s Pan-African e-Network

Vincent Duclos

In September 2004, former president of India Abdul Kalam proposed to connect Africa with India through a network aimed at providing healthcare services. Five years later, the Pan-African e-Network (PAN) was launched. PAN is a digital infrastructure connecting doctors and patients across the African continent with tertiary care hospitals in India. It is integrated solution to care for patients at a distance. But beyond everyday medical care, this article suggests that PAN exists primarily as a state of desire. Drawing upon ethnographic research, it explores PAN as a speculative project which makes present uncertain futures. The argument laid out is threefold. First, I suggest that PAN speculates on the South as a market and medical formation, emerging not in response but in blatant indifference to Euro-American spaces, assumptions, or priorities—including those dominant in global health spheres. Second, I argue that PAN acts a medium for the Indian nation to perform itself as an ascendant global healthcare provider, and power. As a gift, the network remakes the identities of the giver and receiver. Third, I examine PAN’s distinctive infrastructural qualities, showing how their imaginative, material, and territorializing effects are critical in shaping both market and nationalist speculation.

Culture, Medicine, and Psychiatry

“Asylum is the Most Powerful Medicine”: Navigating Therapeutic Interventions in Limbo

Bridget M. Haas

Drawing on ethnographic research among asylum seekers in the Midwestern United States, this article investigates how a profound sense of limbo informed the use, meaning, and experiences of psychotherapeutic interventions, namely psychiatric medication and psychotherapy. In doing so, the article brings into dialogue a consideration of temporal and spatial uncertainty as a key feature of refugee distress, on the one hand, and attention to the subjective experiences of mental health care, on the other. Asylum seekers used therapeutic interventions and found them meaningful in the multiple ways these modalities help claimants endure the asylum process. Yet, ultimately, because they identified the unjust, protracted asylum system as the primary locus of their distress, asylum seekers perceived therapeutic interventions to be limited in their ability to assuage their suffering. In this context, legal status was often understood as the most effective form of healing. Thus, a sense of limbo was often both the impetus for using mental health care and the reason for its perceived limitations. My analyses have implications beyond the context of political asylum, underscoring how attention to temporality is important to better understanding the use and experience of mental health care more broadly.

Do Doctors Differentiate Between Suicide and Physician-Assisted Death? A Qualitative Study into the Views of Psychiatrists and General Practitioners (Open Access)

Rosalie Pronk, Dick L. Willems & Suzanne van de Vathorst

Physician-assisted death for patients suffering from psychiatric disorders is allowed in the Netherlands under certain circumstances. One of the central problems that arise with regard to this practice is the question of whether it is possible to distinguish between suicidality and a request for physician-assisted death. We set up this study to gain insight into how psychiatrists and general practitioners distinguish between suicidality and physician-assisted death. The data for this study were collected through qualitative interviews with 20 general practitioners and 17 psychiatrists in the Netherlands. From the interviews, we conclude that physicians distinguish three types of death wishes among patients suffering from psychiatric disorders: ‘impulsive suicidality,’ ‘chronic suicidality,’ and ‘rational death wishes.’ To discern between them they evaluate whether the death wish is seen as part of the psychopathology, whether it is consistent over time, and whether they consider it treatable. Some considered physician-assisted death an alternative to a ‘rational suicide,’ as this was perceived to be a more humane manner of death for the patient and their relatives. We argue that physician-assisted death can be justified also in some cases in which the death wish is part of the psychopathology, as the patient’s suffering can be unbearable and irremediable. Physician-assisted death in these cases may remain the only option left to relieve the suffering.

Attending to Aliveness: Self-Harm, Body and World in Contexts of Urban Homelessness

Joshua Burraway

The DSM-5 proposes that self-harm be recognized as a diagnostic category of mental disease, compared to its previous definition as a behavioral symptom. Based on fieldwork in London, I challenge this proposal by exploring the life-history of a homeless sex-worker and substance-user who practices self-cutting. By bringing phenomenological anthropology into conversation with psychoanalytic theory, this article provisionally re-conceptualizes self-harm as an ethics of self-reparation and existential affirmation in the face of extreme precarity. Approached as an agentive practice through which human beings reclaim “somethingness” by altering their bodily conditions, we can conceive self-harm in a way that is attentive to the situational conditions that shape existential pain, instead of reaching straight for the diagnostic toolkit. In taking self-harm as simultaneously a reaction to and a reflection on existential crisis—rather than a sui generis disorder—this paper situates such practices as a pluralized condition-of-world rather than a bounded pathology-of-mind.

Contemporary Drug Problems

Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems

Mats Ekendahl, Patrik Karlsson

This study analyzes how staff in Swedish alcohol and other drug (AoD) treatment interpellate service users as people who can benefit from relapse prevention. Relapse prevention is a widely used intervention. Research is scarce, however, on how relapse prevention is practiced locally and how treatment staff perceive the relationship between AoD use as a problem and relapse prevention as a solution. Drawing on Actor-Network Theory and critical studies of AoD issues within this tradition, we elucidate how staff through specific interpellative logics enact service users, their individual characteristics, and living conditions. The data derive from interviews with 18 professionals working with assessment, counseling, case-management, therapy, and healthcare at AoD treatment agencies in the Stockholm region. The results show that the participants drew on four interpellative logics, and thereby enacted service users as four different object types. Region and network logics pinpointed that individuals have stable observable characteristics that determine their problems and eligibility for treatment (e.g., living conditions, diagnoses). Fluid and fire logics emphasized that their characteristics also vary depending on context and can be present and absent at the same time (e.g., harms, agency). This flexible interpellation of service users echoes the tendency among treatment staff to embrace sometimes irreconcilable understandings of AoD problems and to enact multiple realities of addiction. This suits a professional field where many factors are thought to cause and help resolve problems, but where the treatment supply is often limited to specific interventions. We conclude that it is easier to create a reasonable match between the service delivered and the potential service user if the characteristics of the latter are considered diverse and flickering. This exemplifies Carol Bacchi’s tenet that problem representations are adjusted to fit the solution at hand.

Locked Up and Locked Out: Client Perspectives on Personal Relationships While in Compulsory Drug Treatment

Frida J. M. Petersson, Karin E. Berg, Anette Skårner

This qualitative study explores clients’ perspectives on their personal relationships while in compulsory drug treatment. Interviews with 31 participants (14 female and 17 male) were conducted at four compulsory treatment institutions for adults who use drugs in Sweden. Taken together, our study reveals that clients in general had to struggle to maintain social relationships due to strict restrictions on their interpersonal contact and communication. Feelings of isolation and anxiety characterized much of their relationships during the treatment period, with emotional withdrawal commonly described as a way to cope. Moreover, some participants expressed shame and guilt over the pain and suffering they had subjected their family members to through their drug use, feelings that put additional strain on the contact. The emotionally and socially significant relationships described by our interviewees provide links to other personal roles and settings than those prescribed by the institution. At the studied institutions, however, little attention was given to this relational dimension of the clients’ situation. Based on the results of the present study, possibilities for improvement of compulsory drug treatment are discussed.

Shadow Committees: On “Drug User Voice,” Representation, and Mobilization in a Norwegian Drug Policy Reform

Aleksandra Bartoszko

Until recently, Norway remained immovable on its conservative policy that illegal drug use is a crime. In 2018, the Health Minister appointed an inquiry commission to design a less restrictive drug policy, which included two “drug user representatives.” But the Minister’s choices for these posts met massive dissatisfaction from some drug users who contended that the representatives “are not real drug users” and do not “speak for” nor “act on the behalf” of their experiences and opinions. They mobilized to establish an alternative organization, the Shadow Committee, to propose a drug policy reform shaped by “the user voices” and “not polluted by political compromises.” Yet, while performing a labor of difference, this committee, too, became caught in conflicting landscapes of representation with some members contesting strategic solidarity. Based on this case, and an ethnographic fieldwork among the protesters, this article investigates the concept of representation as understood, contested and applied by “drug users.” Exploring how they relate to “user voices” and question the authenticity of some of “user representatives,” I highlight how changing political landscapes affect understandings of representation and shape political, individual and collective forms of involvement. I draw on Pitkin’s political philosophy and apply the classical categorization of political representation to suggest reconsidering the governing assumptions regarding “user representatives” that increasingly inform drug and treatment policies in Norway. I ask if the concept of representation itself may be a barrier to meaningful involvement.

East Asian Science, Technology and Society

“All We Want, Is to Get Rid of the Straw”: How Biofuel Policies Need to Be Multiple

Poonam Pandey, Govert Valkenburg, Annapurna Mamidipudi & Wiebe E. Bijker

Second-generation (2G) biofuels are promoted worldwide as remedy to sustainable-energy challenges in the transport sector and as response to the criticism of first-generation biofuels. By utilizing agriculture and forest residues, 2G biofuels claim to support agricultural livelihoods and boost rural economies. Quantitative estimates exist of the availability of “waste” or “unused” or “surplus” biomass that could be fed into producing bioenergy. Most of current discourse on 2G bioethanol is about developing efficient technologies and supportive policies for biomass utilization and energy distribution, while availability and supply of that biomass are often taken for granted. This paper challenges these presumptions of biomass availability and technological feasibility. Following a social-constructivist analysis of technology and focusing on how political actors, scientists, industry, green-revolution and organic farmers envision biomass, this paper argues that the innovation for 2G is hybrid and complex, rather than merely logistical and economic. Biomass as feedstock is not an off-the-shelf commodity, but a dynamic and fluid entity, the availability of which is dependent on a number of cultural, social, technological and economic factors. Policies are needed that recognize the multiplicity of agricultural practices if a sustainable biofuel system is to be developed.

Consumer Movements Confronted by Naturalness in Gene Editing in Japan

Yoshiki Otsuka

This study describes consumer opposition toward genetically modified organisms (GMOs) in Japan in response to gene editing technology that may not be subjected to the Cartagena Act regulating GMOs, since edited organisms cannot be distinguished from naturally occurring ones. The notion of naturalness, criticized as unscientific in the past, has become a scientific reason to exempt gene editing from regulations. Qualitative research of three consumer organizations and text analysis of public comments to the Ministry of the Environment confirmed the emergence of naturalness in the discursive space between experts and consumers. Consumer movements define naturalness as the lack of artificial manipulation, while experts define it according to its similarity to nature. Additionally, a questionnaire survey of consumers who attended consumer organization meetings was conducted and analyzed to understand different perceptions of naturalness and gene editing technology. Perceptions of gene editing and naturalness negatively correlated with those of conventional crossing, contrary to the recognition of experts, suggesting that consumer perception of naturalness differs. Moreover, anticipated attitudes toward gene editing were shown to be significantly influenced by present attitudes toward GMOs, although the perceived naturalness of gene editing is independent of GMOs.

Ethos

Individualization, Peer Learning, and the Cultural Model of Sociality in South Korean Education: The Case of an Educational Metaphor

Hyang Jin Jung

This article, based on interviews with teachers and classroom observations, examines the contour of the educational reform for individualization over twenty years in South Korean schooling. By way of an educational metaphor implicated in shifting dynamics between two competing yet complementary cultural models of sociality and human development, I attempt a historically nuanced analysis of an interdependence orientation manifest in South Korean schooling. In so doing, I closely attend to how a cultural model of sociality strongly associated with peer learning is reassessed, re-activated, or even accentuated to nurture individuality and self-expression. The focus of inquiry is the cultural organization of peer learning and the underpinning cultural model of sociality in the context of the home class, the latter being an organizational pivot in South Korean schooling.

From My Expression to Our Expressions: Multidirectionality of Learning in the Globalized Korea

Junehui Ahn

In this article, I examine how globally dominant socialization ideas and practices meet with local concerns in a preschool classroom in South Korea, focusing in particular on children’s and teachers’ interactive participation in indigenizing processes. By analyzing classroom interactions surrounding the imported classroom activity called “message center,” the article shows that children, rather than passively adopt teachers’ interpretation of global imports, create their own meanings for them to address goals of their culture-laden peer worlds. Furthermore, children’s own interpretation leads to changes in their teachers’ understandings and enactment of imported practices and values. Findings of this article articulate the agentive role both children and teachers play in socialization landscapes and the dynamism of education in globalized contexts.

International Journal of Social Psychiatry

Urban upbringing and psychiatric disorders in the United States: A racial comparison

Hans Oh, Harvey L Nicholson, Jr, Ai Koyanagi, Louis Jacob, Joe Glass

Background:

Studies that link urbanicity to mental health are mixed depending on outcome and context. More research is needed to examine whether the urban upbringing effect holds true across racial populations in a large and diverse country like the United States.

Methods:

We analyzed two large datasets that were administered contemporaneously with similar methods: The National Comorbidity Survey-Replication (NCS-R, Whites) and the National Survey of American Life (NSAL, Blacks). We ran multivariable logistic regression models to examine the associations between area of upbringing (urban/large city, other, rural) and six psychiatric disorders, controlling for sex, age, years of education and income-to-poverty ratio (and ethnicity in the NSAL). We performed these analyses in both the NCS-R and the NSAL separately.

Results:

The majority (58.97%) of the White sample grew up in the ‘other’ category (i.e. small town, small city, or suburb of a large city), whereas a much larger percentage (39.89%) of the Black sample grew up in a large city. In the White sample, urban upbringing was not associated with any of the psychiatric disorders at a conventional level of statistical significance. In the Black sample, urban upbringing was associated with greater odds of having mood disorder, alcohol use disorder and drug use disorder, but was not significantly associated with anxiety disorders, PTSD, or eating disorders.

Conclusions:

Urban upbringing was not associated with psychiatric disorders among Whites, but was associated with greater odds of mood disorders, alcohol us disorder and drug use disorder among Blacks. Future research can elucidate how differences in urban upbringing between Whites and Blacks are linked to differences in risk for psychiatric disorders.

Psychological responses and lifestyle changes among pregnant women with respect to the early stages of COVID-19 pandemic

Yingfei Zhang, Zheng Feei Ma

Objectives:

The COVID-19 pandemic has caused a profound impact on health and well-being of populations. However, there are limited studies that have investigated the psychological aspects of vulnerable groups including pregnant women amid the COVID-19 pandemic. Therefore, we aimed to assess the psychological impact of the COVID-19 pandemic among Chinese pregnant women from February 2020 until March 2020.

Methods:

Our study was conducted using a modified validated online questionnaire comprising of sociodemographic, the Impact of Event Scale (IES), attitude and mental health-related questions towards COVID-19.

Results:

A total of 560 women were included. The overall mean age and IES of women was 25.8 ± 2.7 years and 31.4 ± 13.7. Moreover, 67.1% of them had IES ⩾26. Psychological impact seemed to be more severe in women in second trimester of pregnancy (the highest IES) (p = .016). There was a significant association between trimesters of pregnancy and some indicators of negative health impacts (including increased stress from work, increased stress from home, feeling apprehensive and helpless during the early stages of the COVID-19 pandemic) (all p < .05).

Conclusions:

Our results reported moderate-to-severe stressful impact among Chinese pregnant women. We recommend that appropriate measures should be taken to address the maternal mental health issues.

Participants’ lived experience of pursuing personal goals in the Illness Management and Recovery program

Sofie B Jensen, Lene Falgaard Eplov, Kim T Mueser, Kirsten Schultz Petersen

Background:

The Illness Management and Recovery (IMR) program is designed to support people diagnosed with severe mental illness in developing tailored illness-management skills and to pursue personal goals. Although IMR is a goal-oriented program, little is know about the participants’ experience of goal-setting as part of IMR.

Aim:

To describe participants’ lived experience of personal goal-setting as part of the Illness Management and Recovery program (IMR).

Method:

A descriptive, phenomenological research design was employed with individual interviews.

Results:

IMR helped the participants break down their personal goals into manageable short-term goals. The main themes were as follows: ‘We were guided to set clearer and specific goals in IMR’, ‘We were encouraged to pursue our personal goals in IMR’ and ‘We were encouraged and supported to resume work on our goals when we stopped making progress’. The findings emphasise goal-setting in IMR as a means to instilling hope for the future and work on goals.

Conclusions:

The participants learned to identify, articulate and initiate work towards short- and long-term goals when guided by the instructor and supported by peers in the IMR group. Goal-setting is a useful method for breaking down personal recovery goals into a practical short-term goals and motivating participants to pursue them. The findings indicate goal-setting is an important part of the IMR-program, but suggest that flexibility in goal-setting is needed, especially in the time required to achieve personal goals.

Journal of the Royal Anthropological Institute

Deadly secret: situating the unknowing and knowing of the source of the Ebola epidemic in Northern Uganda

Sung-Joon Park

This article critically examines the unknowing of the source of the Ebola epidemic in Northern Uganda, in 2000/1, by asking how this unknowing has been achieved and has shaped the disease situation. Specifically, this article follows my informants’ explanation that soldiers of the Uganda People’s Defence Force had brought the disease from the Democratic Republic of the Congo to Uganda. This account is widely rejected as a rumour by scientists, who insist that the source of the epidemic remains unknown. By contrast, I suggest that following these stories, as embodied experiences of the multiple connections between war and epidemics, human and nonhuman lives, provides crucial insights into the political ecology of Ebola in the wider region – a region where, even today, conflict and Ebola outbreaks are intricately interwoven. Understanding how unknowing is achieved and shapes a disease situation directs attention to forms of silent knowing, which illuminate what preparedness means in the political ecology of Ebola.

Beyond the senses: perception, the environment, and vision impairment (Open Access)

Karis Jade Petty

The ‘sensory turn’ in anthropology has generated a significant literature on sensory perception and experience. Whilst much of this literature is critical of the compartmentalization of particular ‘senses’, there has been limited exploration of how anthropologists might examine sensory perception beyond ‘the senses’. Based on ethnographic fieldwork with people who have impaired vision walking the South Downs landscape in England, this article develops such an approach. It suggests that the experiences of seeing in blindness challenge the conceptualization of ‘vision’ (and ‘non-vision’). In place of ‘vision’ (as a sense), the article explores ‘activities of seeing’ – an approach that contextualizes the visual to examine the biographically constituted and idiosyncratic nature of perception within an environment. Through an ethnography of seeing with anatomical eyes and ‘seeing in the mind’s eye’, it articulates an approach that avoids associating perception with anatomy, or compartmentalizing experience into ‘senses’.

Medical Anthropology Quarterly

Going Nowhere: Ambivalence about Drug Treatment during an Overdose Public Health Emergency in Vancouver (Open Access)

Danya Fast

The declaration of an overdose public health emergency in Vancouver has generated an “affective churn” of intervention across youth-focused drug treatment settings, including the expanded provision of opioid agonist therapy. In this article, I track moments when young people became swept up in the momentum of this churn and the future possibilities that treatment seemed to promise. I also track moments when treatment and what happened next engendered a sense of stagnation, arguing that the churn of intervention ensnared many youth in rhythms of starts and stops that generated significant ambivalence toward treatment. The colonial past and present deepened this ambivalence among some Indigenous young people and informed moments of refusal. Youth’s lives unfolded through but also around treatment programs, in zones of the city where drug use could generate a sense of momentum that was hooked not on futures, but on the sensorial possibilities of the now.

Interventive Care: Uncertainty, Distributed Agency, and Cesarean Section in a Zika Virus Epidemic

K. Eliza Williamson

Beginning in 2015, Brazil witnessed the births of thousands of children with neurological abnormalities linked to the Zika virus. Drawing on ethnographic fieldwork conducted between 2016 and 2018 with parents of children with congenital Zika syndrome in Salvador da Bahia, this article attends to how one of Brazil’s most overused obstetric technologies—cesarean section—was mobilized to mitigate the uncertainties of Zika’s reproductive consequences. I argue that during the epidemic, C-section constituted a form of what I call interventive care, in which others interceded on behalf of pregnant women to secure surgical delivery. In dialogue with scholarship problematizing autonomy in reproductive decision making, I show how my Bahian interlocutors understood such intercessions, and the C-sections themselves, as forms of appropriate, concerned care. I suggest, furthermore, that interventive care highlights the ways in which reproductive decisions are distributed among people rather than autonomous, particularly in contexts of heightened uncertainty.

Not Breathing Easy: “Disarticulated Homework” in Asthma Management

Julie Spray, Chelsey R. Carter, Erika A. Waters, Jean M. Hunleth

Recent health policy in the United States encourages an outsourcing of labor from professional practice into domestic spaces, where in theory, medical professionals supply the training, technologies, and guidance needed to discharge responsibility for care to patients or caregivers. Mattingly et al. (2011) term this labor “chronic homework,” describing the relationship between the assigning and undertaking of medical care at the borders of professional and domestic domains. This is a system predicated on relationships between professional and caregiver. However, in our research with families and providers in two U.S. sites, we observed a “disarticulation” of asthma care from professional medicine. Caregivers may undertake routine asthma management with little physician oversight, transforming chronic homework into what we term “disarticulated homework.” We argue that expanding the concept of chronic homework to theorize disarticulation processes can help elucidate how health disparities are reproduced in the gap between medical systems and domestic life.


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