The standout themes of this month are: the varying meanings of wellness and well-being, and Covid 19’s effect: on local populations, women and domestic violence, caregivers, and therapy over Zoom. In honor of International Persons with Disabilities Day (Dec. 3rd), I draw your attention to Medical Anthropology’s article about disability access and the Berlin transport system. Happy Reading.
Andrea Freidus, Dena Shenk, Christin Wolf
While applied anthropological research is sometimes envisioned as a linear process, we present an alternative view based on our research with frontline workers providing long-term care (LTC) for older adults during COVID-19. We completed a rapid qualitative assessment in central North Carolina from May to November 2020. We conducted data analysis as we continued to collect data and implemented activities and interventions along the way. We report emerging findings that included the deleterious effects of isolation on older adults in both congregate and community-based LTC, the value of creatively using technology as an avenue for communication and engagement, the importance of leadership and flexibility, as well as an abundance of mental health struggles LTC workers faced in caring for older adults during COVID-19. We present how we were able to address these in a variety of ways during the inductive research process because of iterative analysis that occurred alongside continued data collection.
Roberta D. Baer, Emily Holbrook, Renice Obure, Dillon Mahoney
Recently resettled refugees from the Congo Wars continue to struggle with food insecurity that, in many cases, extends to before their camp and war-time experiences. Beginning in 2016, a team from the University of South Florida has studied dietary adaptation and nutritional status among refugees from the Democratic Republic of the Congo. Population census data, in-depth interviews with household heads, anthropometric measurements, dietary recalls, and focus groups—with youth and adults—allowed a look at cross-generational experiences of food insecurity and dietary transition within recently resettled refugee families. These experiences are linguistically mediated, involve cultural adaptation, and are embodied through health effects such as stunted growth, leaving both youth and adults at risk of obesity and related health complications. We found that many families are not utilizing available food-assistance benefits such as Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) because of confusion or difficulty accessing the online system and lack of instructional materials in an appropriate language or format. Refugee service organizations and community-based nonprofits need to be aware of the specific needs of and challenges for these refugees. Public health programming should be framed around refugee-specific needs and be cognizant of refugees’ assets and skills as visual learners to avoid a one-size-fits-all (refugees) approach.
Cultural Anthropology (Open Access)
In Rio de Janeiro’s favelas, where residents have experienced economic precarity and racialized police violence, “good deaths,” wrought by natural causes and at old age, are distinguished from “bad deaths,” which may take victims’ entire families and houses. This essay chronicles the story of Maria who died at fifty-two, following the death of her youngest son at the hands of the police, and inquires into the generativity of mourning related to these two bad deaths. As graffiti and altars became spatial inscriptions of a new moralization of space, Maria’s house gradually transformed from a substrate of life into a marker of death. In the end, the home died too, as it was sold and its attendant social relations were unmade. Bad deaths thus reveal the moral entanglement between families, communities, and the materiality of houses, as well as the severance of these ties in the face of violence and intergenerational loss.
The Immune Home: Domestic Enclaves, Diffuse Protections
Ann H. Kelly, Javier Lezaun
This essay tracks a paradigm shift in the use of chemicals to control malaria: away from insecticidal approaches, focused on killing mosquitoes within private domestic dwellings, and toward the creation of protective communal atmospheres. An ongoing study of the efficacy of spatial repellents to reduce malaria transmission in rural Tanzania provides an opportunity to rethink the oikographic assumptions of malaria control—and of many global health interventions—and to foreground the specific relationalities of peri-domestic spaces. Yet a sense of moral ambivalence permeates this inquiry, as malaria prevention becomes untethered from any long-lasting material improvement in the house. We reflect on the power of chemicals to reveal chronic forms of neglect and, just possibly, conjugate new, if diffuse, forms of communitas.
Sarah Bakker Kellogg
Since 9/11, political debate over immigration in Europe is often posed as a question of Islam’s distance from Europe’s putatively Judeo-Christian ethical tradition—and therefore a matter of neither explicitly racial nor religious animus. This article interrogates this claim from the perspective of Syriac Orthodox Christians living in the Netherlands, who, despite their conspicuous Christianity, are frequently told by both the state and their neighbors that their ethnoreligious difference is not meaningfully different from Muslim difference. Drawing on fieldwork in the Dutch subprovince of Twente, I analyze both everyday and bureaucratic moments of misrecognition as sites of racialization that illuminate a Dutch racial-religious imagination rooted in post-Calvinist theological anxieties over social reproduction. By showing how minoritized bodies are read as icons of invisible reproductive relations, I deploy the Orthodox Christian doctrine of the holy icon to theorize secular modern racialization as a process of ethical differentiation, classification, and control over reproductive power.
Namita Vijay Dharia
This article studies metabolic systems of food, body, and waste within the urban development politics of the city of Gurgaon (now Gurugram) in India’s National Capital Region. I link rapid urban transformation within the region, the labor required to produce it, and the speculative real estate economy that governs it to the phenomenology of body politics in the region. In particular, I examine corruption as both a political-economic and a physical, caste-based narrative to argue that corruption connects embodiment and urban development ecologies to each other. This allows corruption discourses in Gurgaon to form a critique of real estate economies; changing urban environments are felt and critiqued through body politics and experienced at once as a peril and a pleasure. This work is based on fifteen months of ethnographic research in the construction industry in NCR involving members across the production chain of real estate, including landowners, investment bankers, developers, engineers, architects, foremen, and laborers.
Cosmo Duff Gordon, Carla Willig
This article focuses on the ways in which members of Alcoholics Anonymous and Narcotics Anonymous construct themselves as being in recovery from addiction. In this original study, data were taken from 19 participants. They were analysed using Willig’s six-stage Foucauldian discourse analytic method. This method is suited to enabling the analyst to locate discourse resources used by participants within broader, dominant, discourses, and for exploration of the implications of these constructions for subjectivity and practice. This article presents a discussion of analytic findings. Mainstream academia has often constructed 12-Step recovery as a largely totalising discourse. This is likely to have negatively prejudiced health professionals and may help explain relatively low referral rates into 12-Step resources for addicted clients. However, our analysis suggested that participants constructed themselves not as subjected by Alcoholics Anonymous and Narcotics Anonymous discourse, but as drawing on it in ways aligned with agency, in order to practice care of the self in pursuit of various ethical goals. This implies 12-Step recovery to be less antithetical to, and indeed more aligned with, humanistic practitioner values than is perhaps often assumed to be the case. This finding suggests that practitioners may need to consider reappraising their view of 12-Step recovery. The discussion will therefore focus on the agency-structure dialectic that seemed to be at the heart of participant constructions of addiction and recovery. It is also a finding which points to an urgent need for more qualitative studies in the currently under-researched, and hence perhaps poorly understood, area of 12-Step recovery from addiction.
Kiran Pienaar, Alan Petersen, Diana M Bowman
Medical testing promises to establish certainty by providing a definitive assessment of risk or diagnosis. But can those who rely on tests to offer advice or make clinical decisions be assured of this certainty? This article examines how Australian health professionals, namely clinicians, microbiologists, specialist physicians and health policymakers, delineate the boundary between certainty and uncertainty in their accounts of medical testing. Applying concepts from science and technology studies, and drawing on qualitative data from a sociological study of testing in Australian healthcare, we consider how professionals ascribe meaning to testing and test results. As we argue, for these health professionals, the ‘evidence’ that testing generates has ambiguous ontological significance: while it promises to provide diagnostic certainty and clear direction for advice or treatment, it also generates uncertainties that may lead to yet further tests. Our analysis leads us to question a key premise of testing, namely that it is possible to establish certainty in medical practice via the measurement of individual health risks and disease markers. Against this dominant view, the responses of the health professionals in our study suggest that uncertainty is intrinsic to testing due to the constantly changing, unstable character of ‘evidence’. We conclude by considering the implications of our analysis in light of healthcare’s increasing reliance on sophisticated technologies of ‘personalised’ testing using genetic information and data analytics.
Tegan S Starr, Melissa Oxlad
This content analysis explored associations between the framing of cancer-related health news stories on Facebook and their corresponding comments. It was found that regardless of story framing the majority of responses involved users engaging in debate and discussion rather than sharing personal experiences. Furthermore, stories framed episodically had a greater proportion of both supportive and unsupportive comments than stories framed thematically. As predicted, episodic stories were associated with more attributions of responsibility directed towards the individual whereas thematic stories lead to more societal-level attributions of blame. Contrary to predictions, responses did not contribute towards the stigmatisation of lung cancer, instead more responses were aimed at reducing stigma for this illness. Within the findings strong beliefs about cancer treatment and management were also identified, which raises concern over the spread of misinformation. Overall, this research provided insight into the framing of cancer news and highlighted potential implications of Facebook comments.
Anika Vassell, Valorie A Crooks, Jeremy Snyder
Lyme disease remains a contested illness in Canada, thereby making the diagnostic and treatment journeys difficult for some people. One outcome of this is that increasing numbers of people are turning to medical crowdfunding to support access to alternative therapies, non-local health care providers and assist with managing the costs of everyday life. In this analysis, we qualitatively explore the narratives shared in Canadians’ crowdfunding campaigns to support Lyme disease treatment or diagnosis to identify whether or not any common elements shared in these narratives exist, and if so, what they are. We identified 238 campaigns for inclusion from three prominent crowdfunding platforms. Thematic analysis of the campaign narratives shows four consistent themes shared in these campaigns: what is lost (e.g. bodily ability), what is missing (e.g. local care options), what is sought (e.g. funds to cover treatment abroad) and what is hoped for (e.g. return to wellbeing). These themes demonstrate the highly personal and emotional nature of medical crowdfunding, particularly in the context of a contested illness that may lead some to question the legitimacy of one’s financial need. This analysis contributes valuable new insights to the nascent scholarship on medical crowdfunding, and particularly to our understanding of how people communicate about their health and bodily needs on this public platform. It also identifies important directions for future research, including the potential for crowdfunding narratives to be used for advocacy.
Graham P Martin, Sarah Chew, Mary Dixon-Woods
Employee voice is an important source of organizational intelligence about possible problems in quality and patient safety, but effective systems for encouraging and supporting those who seek to speak up have remained elusive. In the English National Health Service, a novel role known as the ‘Freedom to Speak Up Guardian’ has been introduced to address this problem. We critically examine the role and its realization in practice, drawing on semi-structured interviews with 51 key individuals, including Guardians, clinicians, managers, policymakers, regulators and others. Operationalizing the new role in organizations was not straightforward, since it had to sit in a complex set of existing systems and processes. One response was to seek to bound the scope of Guardians, casting them in a signposting or coordinating role in relation to quality and safety concerns. However, the role proved hard to delimit, not least because the concerns most frequently voiced in practice differed in character from those anticipated in the role’s development. Guardians were tasked with making sense of and dealing with issues that could not always straightforwardly be classified, deflected to the right system or escalated to the appropriate authority. Our analysis suggests that the role’s potential contribution might be understood less as supporting whistleblowers who bear witness to clear-cut wrongdoing, and more as helping those with lower-level worries to construct their concerns and what to do with them. These findings have implications for how voice is understood, imagined and addressed in healthcare organizations.
Sine Grønborg Knudsen, Peter Triantafillou
Since the 1970s, the public authorities of many OECD countries have emphasised the need for preventing lifestyle diseases and promoting the vigour of their populations. Based on the Foucauldian analytics of dispositive, we critically address some of the normative implications of the preventive interventions in the area of type 2 diabetes care. Through an analysis of public health documents from 1981 to 2016, it is shown that the government of lifestyle was extended and institutionalised by a reform of the Danish public sector in 2007. Following the reform, rationalities of public health policies sought to prevent unhealthy lifestyles not only through individual behaviour but also through the social surroundings of citizens. In contrast to the claim that we are seeing a retraction of state responsibility and interventions in the area of public health, it is suggested that we are witnessing an expansion in state ambitions expressed through a lifestyle dispositive. These ambitions are less about transferring the responsibility to the individual and more about governing and mobilising the social relations and environments of type 2 diabetes patients and citizens in general to make the everyday choice of a healthy lifestyle easier.
Anna Samya Sri, Preety Das, Sam Gnanapragasam, Albert Persaud
As the COVID-19 lockdown regulations in the United Kingdom (UK) and in many other countries are gradually easing and life returns to a ‘semi-normal’ adjustment, governments are now facing the consequences of the lockdown measures which have lasted for several months. Domestic and gender-based violence have increased globally, but the unsettling spikes continue to grow during this pandemic period.
Gender-based violence is a human rights violation, and violence against women and girls is a public health crisis with detrimental impacts on the victims/survivors, their families particularly children and the communities. Recent emerging data highlights that since the outbreak of COVID-19, violence against women and girls, including domestic inter-personal violence and sexual abuse has intensified in several countries.
Editorial: To zoom or not to zoom – that is the question (open access)
Sam Nishanth Gnanapragasam, Keith Hariman, Antonio Ventriglio
The COVID-19 pandemic has shown that research meetings and clinical consultations can be conducted reasonably safely and efficiently using video-conferencing approaches. Herein, we use the term telepsychiatry to denote provision of mental health care from a distance through use of technology, often videoconferencing such as Zoom, Skype and Microsoft Teams. Although such approaches have undoubtedly allowed for real-time communication between patients and clinicians where they might not have otherwise been possible or safe, they still carry many challenges. Two immediate concerns are to do with privacy and confidentiality. Privacy concerns relate to challenges for patients, and at times healthcare professionals, in finding a quiet setting where no one else is present. Confidentiality relates to privacy as well as data storage and remote recording of sessions.
Further challenges with telepsychiatry include digital exclusion and technical competence. Challenges related to privacy, digital exclusion and technical competence overlap with socio-economic factors such as poverty, overcrowding and unstable housing. In a mental health context, this is particularly relevant given the social causation and social drift hypotheses associated with those who suffer with mental health conditions. Further, there may also be demographic determinants such as age. Such factors mean that this is a clear gap and variation in access within and between countries.
Maha Sulaiman Younis, Riyadh Khudhiar Lafta
Women living in Iraq have struggled for equality and empowerment since the 20th century. For the last four decades, successive wars, economic sanction, gender-based violence, and internal conflicts have affected their development endeavors. The 2003 US-led invasion caused a loss of lives, destruction of infrastructure, and forced displacement for tens of thousands of civilians, including women and children. These atrocities increased women’s vulnerability to develop or worsen the existing mental disorders. This review tries to attract world attention to women’s situations in Iraq.
A critical review of the definition of ‘wellbeing’ for doctors and their patients in a post Covid-19 era (open access)
Gemma Simons, David S Baldwin
There is no international consensus definition of ‘wellbeing’. This has led to wellbeing being captured in many different ways.The differences between wellbeing components and determinants and the terms used interchangeably with wellbeing, such as health, are considered from the perspective of a doctor. The philosophies underpinning wellbeing and modern wellbeing research theories are discussed in terms of their appropriateness in an inclusive definition. An operational definition is proposed that is not limited to doctors, but universal, and inclusive: ‘Wellbeing is a state of positive feelings and meeting full potential in the world. It can be measured subjectively and objectively, using a salutogenic approach’. This operational definition allows the differentiation of wellbeing from terms such as quality of life and emphasises that in the face of global challenges people should still consider wellbeing as more than the absence of pathology.
Lisa Colman, Katrijn Delaruelle, Carolien Luypaert, Rebekka Verniest, Piet Bracke
Lay attitudes are often seen as potential barriers to mental health recovery. But apart from perceiving them as potential barriers, they can also play an important role in stimulating individuals to consult (in)formal help sources, in particular through the process of help referral. Where existing research mainly focuses on actual help seeking behaviour, this study will focus on lay publics’ referral behaviour. The results reveal that causal beliefs significantly associate with stigma, measured by stigmatising attitudes and social distance: personal- or biogenetic beliefs associate with more stigma, where psychosocial beliefs associate with less stigma. Concerning help seeking recommendations, psychosocial beliefs associate with recommending psychological or psychotherapeutic care, biogenetic beliefs associate with advising help from general practitioners and suggesting psychiatric help, while personal beliefs negatively associate with recommending formal help. Meanwhile, biogenetic beliefs associate with less informal help seeking recommendations (e.g. family, friends and online self-help), where personal beliefs associate with more informal help seeking recommendations and psychosocial beliefs only associate with online help referral.
Andrea Cabezas-Rodríguez, Mireia Utzet, Amaia Bacigalupe
Gender segmentation in the labour market and women’s greater burden of domestic work and caregiving increase their risk of developing mental health problems, especially in vulnerable social groups. We carried out a systematic review of scientific articles published between 2010 and 2019 in PubMed, Scopus, WoS and PsycInfo, in Spanish and English, conducted in the European Economic Area in populations aged between 25 and 65 years. Studies were excluded if they were qualitative, focused on sexual identity or factors based on biological differences, or considered use of medical services, medicalisation or suicide as the outcome variable. A total of 30 articles were included, of which only four concerned studies in which intersectional analysis had been performed. The mental health of men was seen to be more influenced by employment conditions and that of women by working conditions, the double presence and civil status. Further, depending on the size of the household (women) and unemployment (men), people in lower social classes had poorer mental health outcomes.
Nicola Wright, Melanie Jordan, Runa Lazzarino
Modern slavery is a term which incorporates a range of exploitative situations that involve the violation of human rights and the subjugation of individuals. It presents a significant public health concern. Post-release, survivors of modern slavery have complex mental health needs. Whilst mental health provision is a component of international and national policy, the delivery of evidence-based support remains a gap in the global anti-slavery response.
Nine studies met the final inclusion criteria. The narrative synthesis clustered the studies in three themes: study design and population; type of intervention; and outcomes reported. The included studies focussed on specific subpopulations, namely child soldiering, child labour or sex trafficking.
This review has highlighted not only important theory-practice gaps in relation to the provision of evidence-based mental health support but scant evidence limited to specific sub-groups (child soldiering, child labour or sex trafficking). The emphasis placed on PTSD within the interventions tested risks mental health support becoming exclusionary to those with other needs. When assessing intervention efficacy, the complex socio-political context in which survivors exist as well as the increasing emphasis on holistic care, personal recovery and lived experience need to be considered. Taking this into account, the case can be made for the inclusion of a wider range of non-clinical outcomes in the assessment of mental health intervention effectiveness.
Swati Ramnath, Gaurav Suri
More than forty million people suffer from depression in India. A lack of awareness, stigma related to mental health issues, and limited accessibility to treatment services magnify the profound personal and societal impact of depression. Given the rise of smartphones in India, mobile technology can help alleviate some of these depression-related challenges.
Presently available depression apps fall short in providing some significant features such as local language options, content in audio and video formats, and user location matched resources. These gaps make these apps less than fully relevant to a diverse set of Indian users.
It is essential to provide depression-related information in a targeted manner depending upon each user’s particular needs and context. Potential customizations, such as offering content in local languages and flexible formats (e.g. audio, video, and text); and providing user-relevant diagnostic tools and location matched treatment resources can help improve the suitability of the app for diverse users.
Vaios Peritogiannis, Maria Samakouri
Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized.
There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities.
Since the introduction of a scheme promoting institutional deliveries in India, dai-mas (traditional midwives) have not become obsolete, but remain integral to institutional caregiving in rural areas in ways that are not always recognized. Based on ethnographic fieldwork in rural Rajasthan, I discuss two institutional contexts in which dai-mas were encountered – traditional midwife training event and hospital births. By examining how dai-mas’ authoritative knowledge is reconfigured within institutions, I suggest that the polysemic Hindi term jugaad – a phrase describing the kinds of improvisation required in resource-poor settings – captures different aspects of dai-mas’ relationships with and within institutions and the state of maternal caregiving in rural India.
Cornelis J. Rijneveld
The discourse of Undetectability, referring to the effect of HIV viral suppression on forward sexual transmission, is at the heart of the current paradigm of Treatment-as-Prevention and is invested with hopes of eliminating stigma. But ethnographic examination of the way HIV-positive gay and bisexual men in four major Indian cities experience Undetectability reveals a more complicated picture. Rather than resolve the problem of HIV stigma, Undetectability enables new ways of managing it, including ethical non-disclosure in the face of social danger. This reveals three paradoxes inherent in the universalism of Treatment-as-Prevention and its reliance on biomedical solutions.
Alternative therapies which aim to enhance women’s wellbeing have been accused of contributing to healthist and postfeminist agendas which rest upon a neoliberal logic. I critically engage with this issue here through an ethnographic study of womb yoga, a women’s alternative therapy developed in the UK. I argue that while being commercial and emphasizing personal responsibility, womb yoga largely works against the current neoliberal optimization ideal. Womb yoga practitioners dismiss goal-oriented self-management and discipline, and avoid a simple reproduction of gender stereotypes by deflecting care away from other-directedness and opening the interpretation of femininity to the imaginative and experiential realms.
María Sol Anigstein et al.
Public policies to prevent non-communicable diseases (NCDs) by promoting health lifestyles began in Chile in the 1990 s, yet NCDs are still highly prevalent. We draw on the theoretical approaches of the Latin American Collective Health (LACH) and critical medical anthropology (CAM) to elucidate why these polices have not had the desired effects. Women with low socioeconomic status and participating in the Choose Healthy Living Program identified obstacles to healthy living and the subjective tensions resulting from the healthy lifestyles ethic. Their experiences demonstrate how lifestyles emerge from the intersection of agency and structure, so it cannot result from individual action alone.
The “Treatment as Prevention (TasP)” campaign advocates extended undetectability-untransmissibility (U = U) as a means to “End the Epidemic” of HIV/AIDS. Drawing on ethnographic research in Buenos Aires (Argentina), I identify three issues that prevail in overly-optimistic discourses associated with TasP, which: overshadow the history of HIV and antiretrovirals; overlook the inherent dynamism of undetectability; and understand antiretrovirals as technical tools with predictable effects, regardless of context. I address how undetectability becomes embodied in the lives of pre-HAART survivors while underscoring the diversity of challenges faced in a Latin American country with universal and free-of-charge access to antiretroviral therapy.
Elly Teman, Tsipy Ivry
Anthropological scholarship frames pregnancy as an out of ordinary embodied event, rarely focusing on mothers of more than four children. We interviewed 49 ultra-orthodox Jewish [Haredi] women in Israel and the US who birthed up to 16 children. We suggest that Haredi women are acculturated to the routines of pregnancy, childbirth, and a habitual position of receptiveness toward continuous childbearing as an act of religious devotion. This “circumferential habitus” prepares women for the routines, attitudes, and dispositions of pregnancy as a way of life. Nevertheless, the deeply embodied experiences of pregnancy do not become “second nature,” revealing the “holes” or limits of the reproductive habitus.
Demands for accessibility bring dis/abled bodies and in/accessible infrastructures together in mutually defining encounters. Through the case of accessibility in Berlin’s public transport system, I explore how these encounters figure in practice. Specifically, I present movement through public transport as an object of knowledge and intervention in accompaniment services and advocacy for accessibility. I analyze three forms in which this movement figures: Journeys, Mobility and Flows. Each of these forms delimits bodies and infrastructure in specific ways. Their limits and capacities are thus not self-evident givens, but variously known and negotiated in the critical work of creating and maintaining accessibility.
James R. Welch
Well-being is a heterogeneous idea with inconsistent applicability to real-world circumstances. In this article, I explore A’uwẽ (Xavante) notions of social well-being from an ethnographic perspective. My data indicate many members of this Indigenous group understand wellness to involve not only health and harmony, but also certain modes of strife and inequality that are also viewed as desirable. A’uwẽ understandings of social wellness, including linkages to the environment, suggest that a broader and more locally contingent concept of social well-being than is evident in mainstream literature would benefit transcultural health efforts and policy involving Indigenous and other culturally distinct communities.
Rachel E. Irwin
During the early COVID-19 pandemic, many countries took compulsory measures to combating the virus’s spread, while Sweden took a more voluntary approach. This led to polarized reactions in the international media, with some praising it and others proclaiming it disastrous. Using the concept of “moral panic” I examine how actors within the global media environment portrayed Swedes as a deviant population, using persuasive language, exaggeration, and selective reporting, and how an amplification of media attention served to solidify the deviant label. I also argue that Sweden was made deviant partly to justify restrictive measures in other countries.