Rounding out September’s In the Journals compilation, here are several more articles of interest. See also these Special Issues on “Island Imaginaries” and “Beyond the Production of Ignorance” and more in a separate post by Eliza Williamson. Enjoy!
Motivational interviewing (MI) is an American behavioral health intervention that has spread dramatically across professional fields, including counseling psychology, corrections, dentistry, nursing, nutrition, primary-care medicine, safe-water interventions, and social work. This article explores how the central methodological principles of American pragmatism—if understood and learned as MI—take root among a group of contemporary American helping professionals. More specifically, the article shows how professional training in MI inculcates: (1) a steadfast focus on the immediate consequences of one’s acts rather than floating or abstract conceptions of the true, the good, or the right; and (2) an investment in a highly reflexive mode of knowledge acquisition, which relinquishes the certainty of positivist explanations and embraces doubt. Indeed, learning how not to know is part and parcel of becoming an American pragmatist, and this article details the labor, costs, and rewards of adopting a pragmatic, or (in)expert, sensibility.
Making valuable health: pharmaceuticals, global capital and alternative political economies (open access)
Jean-Paul Gaudilliere & Kaushik Sunder Rajan
[excerpt] Historical and anthropological analyses of biomedicine have in recent years highlighted various global trajectories by which health has become capitalized. An empirical focus of these analyses has been the critical role that pharmaceuticals have acquired through the latter half of the twentieth century and into the twenty-first (Bächi 2009; Biehl 2009; Cooper and Waldby 2014; Dumit 2012; Gaudillière and Hess, 2013; Gaudillière and Thoms 2015; Greene 2007, 2014; Haller 2012; Hayden 2007; Peterson 2014; Petryna and Kleinman 2006; Petryna 2009; Sunder Rajan 2017). Healthcare has progressively come to be indexed by pharmaceutical consumption, a process that various scholars have described as ‘pharmaceuticalization’ (Abraham 2010; Bell and Figurt 2012; Biehl 2007). The papers in this collection consider the ways in which the capitalization of health operates globally, by means of pharmaceuticalization.
Introduction to Special Issue: Psychiatry as Social Medicine (open access)
Anne Kveim Lie & Jeremy Greene
[excerpt] This issue of Culture, Medicine, and Psychiatry proposes a historical reevaluation of the relationship between psychiatry, medicine, and the field of social medicine. Specifically, we ask how the concept of “the social” in relation to mental health took on very different meanings by different historical actors over the course of the last century. The seven essays that comprise this special issue focus on the formation of a self-conscious field of social psychiatry, the tacit and explicit role of social categories in the definition of diagnostic categories and therapeutic goals, the relationship between psychiatry and social medicine in colonial and postcolonial contexts, and the medicalization and demedicalization of severe mental illness over the course of the twentieth century. As psychiatry has become rebiologicized over the past half century, they argue, historical analysis has become a crucial means of recapturing attention to the social world in the field of mental health—as both a category used by the historical actors themselves and as a category of analysis. Read together, these articles present a dynamic analysis of the changing understanding of “the social” within the field of psychiatry in the twentieth century, and its relationship to the evolving field of social medicine.
Society as Cause and Cure: The Norms of Transgender Social Medicine (open access)
This article analyzes how trans health was negotiated on the margins of psychiatry from the late 1970s and early 1980s. In this period, a new model of medical transition was established for trans people in Norway. Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease. By using archival material, medical records and oral history interviews with former patients and health professionals, I demonstrate how social aspects not only underpinned diagnostic evaluations but were an integral component of the entire therapeutic regime. Sex reassignment became an integrative way of imagining and practicing psychiatry as social medicine. The article specifically unpacks the social element of these diagnostic and therapeutic approaches in trans medicine. Because the locus of intervention and treatment remained the individual, an approach with subversive potential ended up reproducing the norms that caused illness in the first place: “the social” became a conformist tool to help the patient integrate, adjust to and transform the pathology-producing forces of society.
Argentina’s national drug law, Law 23.737, has been in effect since 1989. Based on prohibitionist drug policy, this law was intended to severely punish drug traffickers and protect the public from drug use-related health concerns. However, it has failed to achieve these goals, and instead targets people who use drugs (PWUD) and brands them “criminals.” In response, the Argentine government announced its intent to reform Law 23.737 in 2008, sparking widespread debate among health, legal, and social service professionals. This article discusses this debate from the perspective of harm reductionists, those who work to reduce the negative effects of drug use rather than eliminate drug use or ensure abstinence. Drawing on archival research and 16 months of ethnographic fieldwork in Argentina, this article examines the positionality of harm reductionists in this drug policy reform, particularly the controversial proposal to decriminalize drug possession for personal use. Demonstrating their contention that Argentina’s legal apparatus is a major contributor to PWUD’s discrimination, stigmatization, and isolation from health and social services, I argue that challenging these problems through policy engagement allows Argentine harm reductionists to draw attention to the broader question of PWUD’s rights and to ultimately recast PWUD as rights-bearing citizens.
“Missing minorities” in blood donation: Rethinking blood procurement in Europe as a citizenship regime
Nathan Wittock, Pierre Monforte, Lesley Hustinx
Although European blood collection organizations are currently obtaining sufficient and safe blood from the majority population, they report having difficulty recruiting first and second-generation immigrants from non-European countries. Most existing studies on these underrepresented groups, who have been coined the “missing minorities” in blood donation, have adopted an instrumental approach that focuses on the development of targeted recruitment strategies to overcome specific barriers to donation faced by members of these minorities. Although this approach does offer several short-term benefits, our central argument is that it is one-sided in its questioning of the non-participation of ethnic minorities. The literature currently lacks research on how the blood procurement system is failing to include minorities. Drawing on recent social theory, we seek a broader sociological understanding of minority under-representation in blood donor populations by shifting the analytic focus toward a critical examination of the main pillars of the procurement system within the European context. This paper advances a novel analytical framework based on two general propositions. First, we apply the literature on “citizenship regimes” to argue that blood donation is part of one specific institutionalization of citizenship and solidarity. We then reconceptualize the “problem” of missing minorities in European blood donation as an application for social change, suggesting avenues related to blood collection as a way of renegotiating minority-majority relations of solidarity.
‘Bad choices’: Unintended pregnancy and abortion in nurses’ and counsellors’ accounts of providing pre-abortion counselling
Jabulile Mary-Jane Jace Mavuso, Catriona Ida Macleod
Little research tackles healthcare providers’ experiences in conducting pre-abortion counselling sessions in circumstances where pregnant persons may request an abortion. We report on a study conducted in South Africa, in which two nurses and two counsellors were asked about how they conduct these counselling sessions. Using a synthetic narrative approach, we present these health workers’ micro-narratives about their motivations for providing abortion services, the purpose of the counselling, their information-giving practices, and whether and how third parties are included in the counselling. We highlight how these micro-narratives are premised on discursive resources that problematise unintended pregnancy and abortion. These resources enable and justify directive counselling that undermines pregnant peoples’ reproductive autonomy. We locate such directiveness within dominant anti-abortion discourse and call for training to reframe normative understandings of abortion.
Sharing believable stories: A qualitative study exploring the relevance of case studies for influencing the creation of healthy environments (open access)
Anna Le Gouais, Louise Foley, David Ogilvie, Jenna Panter, Cornelia Guell
Case study examples can inform policy recommendations and action to create healthy environments. This qualitative study, using semi-structured interviews with nine cross-sectoral stakeholders in England, explored the role of context in case study examples. We found that case studies can not only be a ‘practical example’ but also used as a ‘believable story’ with the power to influence decision-making. Case studies may be deemed believable if similar and locally relevant, but judgements can be inherently political and politicised. Metrics used to measure case study outcomes can differ in believability. Storytellers who understand different audiences can be used to build support.
Using in-depth interviews with Guyanese immigrants in North America this paper argues their therapeutic landscapes are produced transnationally and these transnational therapeutic landscapes impact their ongoing health practices in the country of settlement. The results reveal that the historical use of traditional “bush medicine” provided a resilient response to inaccessible biomedical healthcare in Guyana. However, the continued use of bush medicine in the countries of settlement is not a result of barriers to healthcare. Instead, continued use constitutes a transnational therapeutic health practice that is tied to historical use, perceived efficacy of treatments, and participants’ perceptions of Guyana as a therapeutic landscape.