Hope that everyone who is planning to attend enjoys the AAA meeting in Philly this week. If you're interested in writing a summary of a medicine or science-related session or talk for Somatosphere, you can contact us--as always--at admin@somatosphere.net.
Monday, November 30, 2009
Tuesday, November 24, 2009
Neuroethics conference podcasts
The Dalhousie University-based Novel Tech Ethics group recently hosted a conference called Brain Matters: New Directions in Neuroethics. You can read descriptions of the conference at the Dana Foundation's website and in the neuroethics newsletter. They've also made six plenary talks available as video podcasts. Here's the list of speakers along with the titles and abstracts for their talks:
Are brain dead patients really dead?
James L. Bernat
Whether brain death accurately represents the biology of human death remains controversial. I review and respond to the arguments against the validity of brain death and critically review the recently published study, "Controversies in the Determination of Death" by the U.S. President's Council on Bioethics. I conclude that brain death remains the most accurate concept of human death.
Neuroscience, Free Will and Responsibility
Walter Glannon
Many cognitive neuroscientists have claimed that our knowledge of the brain shows that our belief in free will is an illusion. If true, this would challenge our practice of holding people morally and criminally responsible for their behavior. I argue that free will and responsibility are not threatened by, but are compatible with neuroscience.
Bioethical Devils and Neuroscientific Details
David Healy
In the late 1990s, treatments like Prozac and research on the human genome project appeared to usher in a new human reality with associated bioethical dilemmas. Are bioethicists as likely to be co-opted into the marketing of the new neuroscience and its treatments as they were into the marketing of the SSRIs? Contrasting current neuroimaging with quantitative electroencephalography, recent deep brain stimulation treatments with the brain stimulation treatments run in Tulane in the 1960s, the emergence biofeedback in the 1960s and neurofeedback this decade this paper will attempt pinpoint the dynamics shaping what happens. Using LSD, ECT and apotemnophilia it will also attempt to mark out the boundaries within which any debate is constrained.
Neuroethics and Intuitions
Neil Levy
As well as reflecting on important issues in applied ethics, neuroethics offers new opportunities for reflection on how we do ethics. Ideally, I suggest, these two branches of neuroethics should interact: we should attempt to resolve ethical issues in ways that are sensitive to findings on moral cognition. One goal of much research on moral cognition is the measurement of the reliability of the intuitions which play so central a role in moral enquiry. I will give some examples of the kinds of findings that suggest that some intuitions are unreliable. I will illustrate how this research might lead us to better assessment of issues in applied neuroethics by examining the question of the permissibility of cognitive enhancement.
A Neuroskeptic's Guide to Neuroethics and National Security
Jonathan H. Marks
The neuroethics literature is replete with claims about the potential for recent developments in neuroscience to transform various fields of human endeavor, not least national security. I argue that a healthy dose of neuroskepticism informed by science studies critiques is necessary if we are to understand the real ethical challenges neuroscience presents, particularly in national security contexts where there may be great pressure to achieve results and judicial oversight is minimal or absent.
Medical morality and the local worlds of Indigenous peoples: Situating the ethical gaze across the broad spectrum of health care delivery
Caroline Tait
Emerging and evolving fields of neuro-, bio- and public health ethics largely configure questions of medical morality within the context of high-priced, high-tech, high-drama biomedical settings. However, for the majority of First Nations and Métis peoples, illness episodes are experienced, interpreted, and responded to in the context of the family or community, shaped by cultural values, Indigenous identity, gender roles and socioeconomic status. I call for an "ethical space" in which local Indigenous world views, inlcuding ideas of moral responsibility are given equal consideration to that of Western ethical principles.
What can we learn about human brains by studying non-human animals?
Jason Scott Robert
The human brain is fairly complicated, and studying the human brain and human behavior directly is often methodologically, epistemically, politically, and ethically fraught. There are many strategies to overcome these challenges, from many disciplinary perspectives. How much do we, and how much should we, rely on studies with non-human animals to understand our brains? What can we - and what can't we - learn about the human brain by studying non-human animals, whether in the mode of model organism-based research, or in a more comparative mode? This presentation will explore epistemological, methodological, and ethical dimensions of debates about the putative limits of studies with non-human animals in understanding our brains, our selves, and our place in nature.
Saturday, November 21, 2009
Psychoanalytic metaphors and mythical medical realities in Claude Lévi-Strauss’s contribution to medical anthropology
There are few subject areas in anthropology untouched by the seminal thought of the late Professor Claude Lévi-Strauss. Though he published only two or three essays concerned expressly with medical subject matter, his theorization in those places of the role of myth and shamanistic authority in symbolic/magical healing opened up questions with lasting significance. I would like to briefly review his ideas with the aim of proposing an alternative reading of them, particularly as they may be applied to contemporary debates in psychiatric anthropology.
“The Effectiveness of Symbols” and the often-anthologized essay, “The Sorcerer and His Magic”, both published in 1949 and appearing in English in Structural Anthropology in 1963, have been cited in connection with the following concepts. First, in seeking to explain the efficacy of certain magical healing practices, Lévi-Strauss posited a “shamanistic complex”, consisting of
First, the sorcerer's belief in the effectiveness of his techniques; second, the patient’s or victim’s belief in the sorcerer’s power; and, finally, the faith and expectations of the group, which constantly acts as a sort of gravitational field within which the relationship between sorcerer and bewitched is located and defined. [1963:168]
For a discipline devoted to studying the influence of cultural and intersubjective contexts in the healing process, this construction is a useful one. Michael Taussig writes of “the complicated mystification present in healing in any culture, but which in our own modern clinical setting perniciously cannibalizes the potential source of strength for curing which reposes in the inter-subjectivity of patient and healer” (1992:100). And in connection with the placebo response—renamed along these lines “the meaning response” (Moerman 2002)—Andrew Lakoff cites Lévi-Strauss to say “the structured communication between doctor and patient activates a therapeutic potentiality that exists within individuals. Accordingly, in the therapeutic setting, the drug is both substance and symbol, and this duality is one of a number of elements that cannot be neatly untangled” (2002).
A second Lévi-Straussian idea that tickled the medical anthropological imagination particularly when psychotherapy was still predominant was the comparison of the psychoanalyst to the shaman. Notwithstanding certain differences, such as that we may be comparing physical and psychological cures or that “the psychoanalyst listens, whereas the shaman speaks” (1963:199), there are striking similarities. Note, at length, his discussion of a curing ritual performed among the Cuna Indians of Panama in the event of a difficult childbirth:
The cure [consists] in making explicit a situation originally existing on an emotional level and in rendering acceptable to the mind pains which the body refuses to tolerate. That the mythology of the shaman does not correspond to an objective reality does not matter… [The patient] accepts these mythical beings or, more accurately, she has never questioned their existence. What she does not accept are the incoherent and arbitrary pains which are an alien element in her system but which the shaman, calling upon myth, will reintegrate within a whole where everything is meaningful… In both cases [shamanism and psychoanalysis] the purpose is to bring to a conscious level conflicts and resistances which have remained unconscious, owing either to their repression by other psychological forces or—in the case of childbirth—to their own specific nature… In both cases also, the conflicts and resistances are resolved, not because of the knowledge, real or alleged, which the sick woman progressively acquires of them, but because this knowledge makes possible a specific experience, in the course of which conflicts materialize in an order and on a level permitting their free development and leading to their resolution. This vital experience is called abreaction in psychoanalysis. [1963:198]
What stands out in the above is less (to borrow Marshall Sahlins’ language, 1982) the mythical realities availed in the shamanistic healing process, than the implied historical (or autobiographical) metaphors unwittingly deployed in psychoanalytic attempts at psychological cures. Lévi-Strauss continues:
Both cures aim at inducing an experience, and both succeed by recreating a myth which the patient has to live or relive (1963:199).
That Lévi-Strauss believed in the healing capacities of psychotherapy appears to be beyond question (much has been written on this), and he says himself that by the above he meant no offense to that discipline. Nor did Lévi-Strauss seem to question the validity of the transference as a mechanism. But he maintained that it was, in the end, a propounded myth that facilitated the cure:
Many psychoanalysis would refuse to admit that the psychic constellations which reappear in the patient’s conscious could constitute a myth. These represent, they say, real events which it is sometimes possible to date and whose authenticity can be verified by checking with relatives or servants. We do not question these facts. But we should ask ourselves whether the therapeutic value of the cure depends on the actual character of remembered situations, or whether the traumatizing power of those situations stems from the fact that at the moment when they appear, the subject experiences them immediately as living myth. [1963:202]
In the transformation to industrial civilization, Lévi-Strauss says, mankind has sacrificed “mythical time”. Medicine, or at least psychological medicine, has not, in the bargain, lost its capacity to heal by this mechanism, however, it has lost touch with the true sources of its efficacy:
Psychoanalysis can draw confirmation of its validity, as well as hope of strengthening its theoretical foundations and understanding better the reasons for its effectiveness, by comparing its methods and goals with those of its precursors, the shamans and the sorcerers. (1963:204)
Notwithstanding Lévi-Strauss’s respect for the universal power of myth as well as his deference to psychoanalysis, the implication of the above is that psychoanalysts are mystified by their own scientific paradigm. This false consciousness might, if we follow to logical conclusions, in fact operate in the same way myths do, which is by masking a deeper structured reality—a reality that might reveal itself only in the application of a different sort of science—the anthropologist’s science, which will trump psychoanalysis by unearthing its deeper meanings.
In contrast with scientific explanation, the problem here is not to attribute confused and disorganized states, emotions, or representations to an objective cause, but rather to articulate them into a whole or system. The system is valid precisely to the extent that it allows the coalescence or precipitation of these diffuse states… (1963:182)
Finally, in regard to the shamanistic complex, Lévi-Strauss’s emphasis on the healer rather than the patient (“The experiences of the sick person represent the least important aspect of the system” [1963:180]), makes sense in the traditional context he is describing for two reasons. First, it is the shaman who is doing the talking, singing the songs, reciting the myths, and performing the actions, while the patient is more or less a passive recipient of treatment. Second, the initiation, training and trustworthiness of the shaman are material to his effectiveness as a healer.
Quesalid did not become a great shaman because he cured his patients; he cured his patients because he had become a great shaman. [1963:180]
The potential challenge to psychoanalytic authority embedded in Lévi-Strauss’s theory would never have been countenanced by the profession—not, at least, outside of France, where the ungrounded ideas of intellectual psychoanalysts such as Jacques Lacan were fashionable. Yet it is possible to take Lévi-Strauss’s ideas even further in the direction of psychoanalytic critique. I credit Mikkel Borch-Jacobsen’s 2009 book, Making Minds and Madness, as being an example of how such a critique might be constructed. Borch-Jacobsen does not cite Lévi-Strauss, but we can easily see from the following quote how the shamanistic complex Lévi-Strauss identified and which has oft been credited for its healing potentials, in Borch-Jacobsen’s conception might well be blamed for the opposite:
“As I see it, it is probably a chicken-and-egg problem to try to determine whether Freud’s statements regarding his patients’ scenes refer to actual ‘reproductions’ or to speculative interpretations and reconstructions on his part. Both processes were at work simultaneously: Freud’s constructions prompted ‘confirmations’ from the patients which prompted other constructions, and so forth… My larger claim is that this is the only kind of ‘evidence’ that one is likely to get in psychoanalysis… Freud’s seduction theory was clearly a folie à deux, or rather a folie à plusieurs, but so too is orthodox psychoanalysis, cognitive-behavioral therapy, and even the most rigorous experimental psychology. Each of these disciplines produces the evidence on which it rests, which means that it is pointless to try to disconfirm them” (2009:57).
Lévi-Strauss was not interested in the scientific veracity of the healer’s art but in its efficacy, which hinges on faith: “The efficacy of magic implies a belief in magic” (1963:168). Because it is he who says so, we can apply the same yardstick to psychoanalysis and perhaps, with qualifications too intricate to enumerated here, psychotherapy in general: It “works” because psychologists/analysts, patients, and society at large believe in its moral narrative. As M.L. Gross asserted long ago, “It makes little difference that each of the psychotherapies has different faith. It is faith itself, not the doctrine, that is the healing agent” (1978).
We may never ascertain the empirical extent of shamanic success at healing, among the Cuna of Levi-Strauss’s example or elsewhere, although there is an anthropological and cultural psychiatric literature worth perusing on the subject. In our society, in the age of evidence-based medicine, the claim that the mentally ill are cured by their psychotherapists has been widely vitiated by lack of clinical evidence supporting it. The edifice of the DSM (and biopsychiatry generally) is taken by its adherents to be the arc de triumph standing over the defeated field of psychoanalysis and the gateway to the profession’s scientific future. Not that biomedical psychiatry’s effectiveness, such as it is, lies outside the realm of rhetoric; here, too, professional legitimacy derives not from the discovery of organic causes but from the educing of indirect, nonspecific evidences that often win slender victories over placebo. The irreducible remainder in this debate about efficacy is the unsolved epistemological quandary of the variance and unacknowledged overlaps between narrative and scientific truths, vis-à-vis which the entire psy field may be, as LC usefully suggested in this connection, a boundary object.
In conclusion, I return to the alternative reading of Lévi-Strauss’s take on shamanism and psychoanalysis suggested by Borch-Jacobsen’s thesis that the encounter between therapist and patient is the site of creation of illness rather than cure. This analysis easily allies with earlier critiques of (principally American) psychotherapeutic practice that depict it as devoid of rational clinical function and sometimes deleterious to the patient, but which thrives upon an “isomorphism with cultural values” including market and political ideology (Epstein 1995). These, combined with the increasingly incontrovertible claims about psychiatric disease mongering (Lane 2007, Healy 2008, e.g.), might tempt us to say rather more globally that much of what psychiatry produces today are not cures, but mental illnesses themselves. Hysteria and multiple personality disorder in the heyday of psychoanalysis, and social anxiety disorder and pediatric bipolar disorder in the biopsychiatric era, are equally “transient mental illnesses,” in Ian Hacking’s phrase, or folie à plusieurs whose facticity is grounded in the discursive encounter in the society at large but also directly in the clinical setting where trust is the conveyance for belief. As such, contemporary psychiatric practice may be more than ever the subject matter for Lévi-Straussian medical anthropology, but for different reasons than those he specified or that we have applied.
References:
Borch-Jacobsen, M. 2009. Making Minds and Madness: From Hysteria to Depression. Cambridge: Cambridge University Press.
Epstein, William. 1995. The Illusion of Psychotherapy. New Brunswick: Transaction.
Gross, M.L. 1978. The Psychological Society. New York: Random House.
Healy, David. 2008. Mania: A Short History of Bipolar Disorder. Baltimore: Johns Hopkins University Press.
Lakoff, A. 2002. “The Mousetrap: Managing the Placebo Effect in Antidepressant Trials.” Molecular Interventions 2:72-76.
Lane, Christopher. 2007. Shyness: How Normal Behavior Became a Sickness. New Haven: Yale University Press.
Lévi-Strauss, C. 1963. Structural Anthropology. New York: Basic Books.
Moerman, DE. 2002. Meaning, Medicine and the Placebo Effect. Cambridge: Cambridge University Press.
Sahlins, M. 1982. Historical Metaphors and Mythical Realities: Structure in the Early History of the Sandwich Islands Kingdom. Ann Arbor: University of Michigan Press.
Taussig, M. 1992. The Nervous System. New York: Routledge.
Thursday, November 19, 2009
Peter Benson on “Safe Cigarettes” and FDA regulation of tobacco products
Giving the FDA regulatory authority over tobacco had been a long-time goal of many public health professionals and organizations. Not surprisingly, this initiative was strongly opposed by the tobacco industry, as yet another potential curtailment of its market. However, in 2000 Philip Morris broke rank with the other tobacco corporations and began to pursue a strategy which supported FDA regulation of its products. It also began to position itself as forthright about the health risks of cigarettes and as a supporter of a harm reduction approach to tobacco. A page on Philip Morris’s website called "Smoking and Health," currently reads:
"Cigarette smoking is addictive. It can be very difficult to quit but, if you are a smoker, this shouldn't stop you from trying to do so. Cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers. Smokers are far more likely than non-smokers to develop diseases such as lung cancer. There is no such thing as a "safe" cigarette," (Philip Morris).As Benson suggests, statements like this last one—“There is no such thing as a "safe" cigarette,” are particularly striking, and arguably disingenuous claims, given the industry’s longtime search for “safer” cigarettes, as well as its new strategy. Indeed, another page on the Philip Morris website explains that:
“Developing products that might reduce the health effects of smoking is one of our top priorities…. One of our current research and development initiatives focuses on preventing the formation or reducing the levels of toxic chemical compounds produced during the burning of tobacco in a cigarette. We hope that the data will, among other things, provide a basis for the development of new reduced-risk products,” (Philip Morris).Under the new regulation the FDA would evaluate tobacco producers’ claims of the relative harm or safety of their products. As Benson explains, the logic behind this change in course on the part of Philip Morris seems to have been a calculation that an evaluation of its tobacco products by the FDA with any level of warning—anything short of prohibition that is—would be ultimately seen by consumers as legitimizing its products. Moreover, Benson shows how the notion of the freely-choosing agent is what underpins the alignment of public health and corporate interests in the FDA regulation of tobacco products.
“Rather than abandoning a lethal product, Philip Morris has crafted a strategy that capitalizes on health risks to create an image of a caring industry that promotes lawful behavior, respects consumer autonomy, and works with and for the public health. A dominant cultural model of the consumer as a rationale chooser is central to the alignment of certain tobacco corporate interests and certain public health policy interests around the FDA bill,” (Benson 2009).Again, an intertwined logic of harm reduction and consumer autonomy is very clear in the company’s publications. Here’s an excerpt from a page called “Reduced risk products”:
“Our aim is to present smokers with a choice of products, including cigarettes that might reduce the health effects of smoking. To help us reach that goal, we want governments to develop standards that establish exactly what constitutes a potentially reduced risk product and how to convey that information to smokers.
We understand that some public health organizations feel that offering smokers cigarettes that are less harmful than conventional ones might encourage some people to start smoking or make smokers less likely to quit.
That's why we believe all smokers should understand that the only safe thing to do is not to smoke at all. It's also why we need governments and the public health community to establish effective methods of measuring and marketing potentially reduced risk products,” (Philip Morris).The new legislation makes the tobacco industry’s claims about the reduced risk of any new products subject to FDA oversight. However, as Benson points out, one of the problems with this is that because:
“[t]he link between reduced toxin exposure and ingredient control and health outcomes remains extremely complex and poorly understood… it is unclear exactly how the federal government will regulate claims about reduced risk. Critics worry that tobacco companies will be able to legitimately market products that make verified claims about reduced toxicity, even though there may not be scientific evidence to show that reducing particular toxins also reduces health risks,” (2009).Benson, who wants prohibition of cigarettes to be seen as a possible strategy in policy discussions, points out one of the central ironies of the situation in noting: “Tobacco is the only legal consumer product that is harmful when used as intended," (2009). Under the current conditions:
“It is possible that tobacco companies will be able to continue to treat risk as a selling point by promoting improved product design, using anxieties about health to enhance the marketability of their products, encourage smokers thinking about medicinal nicotine to instead purchase a modified tobacco product, and protect their share of the nicotine dependence market from pharmaceutical companies,” (Benson 2009).I found this to be one of the most striking points. Philip Morris’s decision that their interests are best served by FDA regulation of tobacco products in the US, reflects a situation in which tobacco corporations see themselves as competing directly with pharmaceutical companies. The FDA had already been regulating various products marketed as aids to reduce nicotine dependence—like nicotine gum and patches—since the 1980s. And perhaps Philip Morris was also paying attention to the excellent job that the FDA has been doing of scrupulously regulating the pharmaceutical industry to the benefit of the public.
When tobacco companies see themselves as competing with producers of pharmaceuticals, it also means that some fairly longstanding distinctions between products designed to addict and those designed to alleviate addiction are becoming increasingly blurred. At the same time that tobacco is coming under the regulation of the FDA – and is thus framed in medicalized and public health terms – marijuana is increasingly coming under medical regulation as well—although on different jurisdictional levels and in rather different ways. Of course, the distinctions between licit and illicit drugs, between those that heal and those that harm, have always been contentious and shifting. Heroin was, after all, developed and promoted around during the early part of the 20th century as a safe alternative to morphine.
However, it does seem that a number of relatively recent development have undercut what was—at least for much of the post-WWII period—a strongly defined distinction between health-promoting and harm-inducing substances. These include the growing interest in pharmacological treatments for addiction (such as naltrexone, acamprosate, and buprenorphine), the phenomenon of addiction to prescription pain-killers and the promotion of the model of addiction as a “chronic progressive brain disease” – in which various substances, and behaviors, activate a common set of neural mechanisms. I think that this also shows the potential strength of the approach which many anthropologists have taken in recent years—which is to study various psychoactive substances—alcohol, opiates, pharmaceuticals, tobacco—under a single analytical rubric.
A final overall point which I take from Benson’s paper is that the contemporary regulatory and governance setting in the US – with its mix of criminalizing interventions, multiple models of clinical treatment and rehabilitation, and harm reduction approaches—requires a set of analytical tools that are more suited to the situation than terms like “medicalization” or even “governmentality.” More specifically, we may need different analytical tools depending on the particular questions being addressed or the particular issues at stake. The case described by Benson seems to be one of those where some version of a good old “hermeneutics of suspicion” – albeit a subtle and complex version – may be just what the doctor ordered:
“The ultimate goal of Philip Morris’s support for FDA legislation is to make individual health management and the regulation of consumer behavior the dominant tobacco control strategy, rather than the regulation of production and supply. The FDA legislation does nothing to address worldwide smoking trends or the international free market environments in which tobacco companies operate. Although the new tobacco regulation is anticipated to have positive outcomes, it does not address certain questions about industry liability and does very little to attend to hidden structural costs, namely, the extent to which product certification can actually help stabilize harmful corporations," (Benson 2009).Peter Benson. 2009. "Safe cigarettes." Dialectical Anthropology. DOI: 10.1007/s10624-009-9121-x.
Image Source: Magazine of Wall Street . July 26, 1930. Reprinted in: “The Doctors’ Choice Is America’s Choice”: The Physician in US Cigarette Advertisements, 1930–1953. Martha N. Gardner and Allan M. Brandt. Am J Public Health. 2006 February; 96(2): 222–232. doi: 10.2105/AJPH.2005.066654.
Thursday, November 12, 2009
Epistemological frameworks and the 'feminization' of the HIV/AIDS pandemic
The Social Science Research Council (SSRC) recently set up a new blog site called "The Fourth Wave: Violence, Gender, Culture & HIV in the 21st Century." The site is a counterpart to a forthcoming book edited by Jennifer F. Klot and Vinh-Kim Nguyen, and it makes the chapters of that book publicly-available free-of-charge. In addition to pdf and Flash versions of the complete papers, the site allows visitors to leave blog-style comments on the abstract pages.
The volume seems particularly significant and interesting for several reasons: 1) it was commissioned by UNESCO; 2) the contributors include many medical anthropologists and sociologists conducting analytically sophisticated and ethnographically-grounded work on the HIV/AIDS pandemic and on the interventions surrounding it and 3) it takes very seriously "the epistemological frameworks that are currently used to understand the epidemic and examine how these extant frameworks might be inadequate in capturing many gender-related dynamics," (Fourth Wave).
Here are several representative excerpts from the Introduction:
"The HIV and AIDS pandemic both fuels and is fuelled by inequalities across gender, race, ethnicity and class. Its effects vary across different settings and regions of the world and are also shaped by armed conflicts, natural disasters, environmental degradation, state incapacities, famine and poverty. Its refractory impacts on women and girls – and humanity writ large – are nothing short of catastrophic.
The third decade of the pandemic is characterized by sub-epidemics that are now coursing through many parts of the globe and among groups previously considered to be unaffected. Growing and disproportionate impacts are now being seen among young women and girls, particularly in sub-Saharan Africa where young women between 15 and 24 years old are at least three times more likely to be HIV-positive than young men. Nearly half of the 30.8 million people living with HIV are women between the ages of 15 and 49. Between the ages of 15-24, gender disparities are even more extreme, with women 1.5 times more likely to be living with HIV than young men.
This volume, commissioned by UNESCO, attempts to answer the crucial and defining questions about why and how responses to the HIV pandemic are failing women...
Although the epidemiology of the pandemic continues to be explained largely in biomedical and behavioural terms, more attention is now being paid to the social, political and economic factors that shape individual behaviour and the effectiveness of responses. But even this growing attention is not nearly enough. For young women, the mutually reinforcing nature of biological and social vulnerability form a particularly toxic combination that is driving a feminization of the pandemic in some of the hardest-hit countries in the world. We continue to be concerned that the focus of HIV interventions on children affected by AIDS, on prevention technologies and on celebrity aid may be deflecting attention from broader forms of social and gendered violence which shape HIV risks for both women and men.
If the deeply rooted social and cultural norms that increase risks for girls, young women and other at-risk populations are not understood and taken into account, the impact of HIV prevention strategies will continue to be ineffectual as the pandemic unfolds over generations. Addressing the gender dimensions of the pandemic will require a far deeper understanding about how to support families and communities as they negotiate the pandemic’s repercussions for household restructuring, gender and intergenerational relations, reproductive decision-making, livelihood choices, education planning, and civic participation. Equally urgent is the need to develop the knowledge necessary for strengthening national response capacities so that those most affected by HIV and AIDS do not also have to shoulder their associated burdens.
The prevailing institutional logic of the international response requires simplification and standardization. However, careful attention must also be paid to local voices and regional differences. In addition, we need to study how international interventions are themselves shaping the course of the pandemic and how they interact locally to structure biosocial vulnerability in gendered terms," (Klot and Nguyen 2009).
Here is the TOC for the volume:
Foreword, Saniye Gulser Corat and Lydia Ruprecht
Editors’ Introduction, Jennifer F. Klot and Vinh-Kim Nguyen
Section I: The New Geography of HIV
Introduction, Veena Das
Globalization and Gendered Vulnerabilities to HIV and AIDS in Sub-Saharan Africa , Colleen O’Manique
Social Exclusion: The Gendering of Adolescent HIV Risk in South Africa, Kelly Hallman
HIV, Male Labour Migration and Female Risk Environments in the Southern Caucasus, Cynthia Buckley
HIV, Sexual Violence and Exploitation during Post-Conflict Transitions: The Case of Sierra Leone, Johannes John-Langba
The Price of Liberation: Economy, Gender and HIV and AIDS in China, Shao Jing
Masculinity + HIV = Risk: Exploring the Relationship between Masculinities, Education and HIV in the Caribbean, David Plummer
Section II: Cultures of Intervention
Introduction, Didier Fassin
Representations of African Women and AIDS in Bono’s Product RED, Lisa Ann Richey
The Life Course of Nevirapine and the Culture of Response to the Global HIV & AIDS Pandemic: Traveling in an Emergency, Alton Phillips
Horizontal Approaches: Social Protection and the Response to HIV and AIDS in Brazil, Inês Dourado, Vera Paiva and Francisco Inácio Bastos
How Should We Understand Sexual Violence and HIV and AIDS in Conflict Contexts?, Judy El Bushra
Section III: Cultures of Response
Introduction, Mary Crewe
Colonial Silences, Gender and Sexuality: Unpacking International HIV and AIDS Policy Culture, Hakan Seckinelgin
‘Sleeping With My Dead Husband’s Brother!’: The Impact of HIV and AIDS on Widowhood and Widow Inheritance in Kampala, Uganda, Stella Nyanzi, Margaret Emodu-Walakira and Wilberforce Serwaniko
Beyond the New Geography of Dissident Gender-Sexual Identity Categories: Masculinities, Homosexualities and Intimate Partner Violence in Namibia, Robert Lorway
Neglecting Gender in HIV Prevention and Treatment Programmes: Notes from Experiences in West Africa, Joséphine Aho and Vinh-Kim Nguyen
AIDS, Gender and Access to Antiretroviral Treatment in South Africa, Nicoli Nattrass
Section IV: Cultures of Measurement
Introduction, Philip Setel
Epidemiological Fallacies: Beyond Methodological Individualism, Catherine M. Pirkle
Measuring the Gendered Consequences of AIDS: Household Dynamics and Poverty in South Africa, Jeremy Seekings
Measuring the Impacts of HIV on Household Structure and Gender Relations, Patrick Heuveline
Behind the Scenes of Sex and Sexual Debut: Unpacking Measurement, Charlotte Watts
From Unpaid to Paid Care Work: The Macroeconomic Implications of HIV and AIDS on Women’s Time-Tax Burdens, Rania Antonopoulos and Taun Toay
Wednesday, November 11, 2009
Videos of plenary presentations from the SMA conference
The videos of the plenary presentations from the Society for Medical Anthropology's September conference are now available online. As we've mentioned before, this was a very impressive line-up of speakers. Videos of most of the talks, as well as Marcia Inhorn's introductions of the speakers, are available at the conference website. Here's the list:
A conference introduction by Marcia Inhorn
Keynote address by Paul Farmer (an autobiographical talk about his mentors and influences)
Didier Fassin on Global Public Health
Arthur Kleinman on Mental Health
Lynn Morgan on Medical History
Emily Martin on Feminism and Technoscience
Annemarie Mol on Science and Technology Studies
Margaret Lock on Genetics/Genomics
Barbara Koenig on Bioethics
Merrill Singer on Public Policy
Gelya Frank on Occupational Science
Rayna Rapp on Disability Studies
Richard Parker on Gender/LGBT/Sexuality Studies
Lawrence Cohen on International and Area Studies
This a great resource both for those who were not able to attend the conference and for those who would simply like to hear a presentation a second time.
The link: Keynote Address and Plenary Presentations, Society for Medical Anthropology conference--"Medical Anthropology at the Intersections: Celebrating 50 Years of Interdisciplinarity." September 24-27, Yale University.
Monday, November 9, 2009
The Berlin Wall as metaphor and diagnosis
A more thorough discussion of the anthropological literature on postsocialism--as it relates to issues of medicine, health and science will have to wait, but at the moment I'd like to highlight a couple of interesting articles which examine the Berlin Wall specifically as a construct in psychological discourse. In "The Berlin Wall on the Therapist's Couch" and "Constructions of the Berlin Wall: How Material Culture Is Used in Psychological Theory," sociologist of science Christine Leuenberger has written about the psychological sciences in Germany have used the Wall as a means of understanding the basis of individual distress and as a metaphor for social malaise. Here's the abstract from the latter article:
This article examines how, in the latter part of the twentieth century, the German psychological sciences used the Berlin Wall to interpret and make sense of the psychological make-up of the German people. It focuses on how the wall has been invoked by psychiatrists, applied psychologists, and psychotherapists in their writings at three historical moments: (1) after its initial construction in 1961, (2) immediately after its fall in 1989, and (3) 10 years after its demise. After the wall was erected, it became an interpretive resource to think about a divided society, and to make visible, decipherable, and classifiable, the inner life of a people. Shortly after its fall, it continued to serve as a basis for categorizing human suffering. Ten years later the wall had been rhetorically transformed into a “mental wall” offering a compelling metaphor for modern Germany's apparent psychological and cultural divide. The three case studies exemplify how the psychological sciences use material objects, such as the Berlin Wall, as interpretive resources to reflect on psychological issues, make sense of societal transformations, and create and solve social problems," (Leuenberger 2006).
The first of these case studies is particularly interesting. It concerns:
"...the book Die Berliner Mauerkrankheit (The Berlin wall disease) written by a prominent East German psychiatrist, Dietfried Müller-Hegemann (1973), shortly after the building of the Berlin Wall in 1961 (but not published until after his emigration to the West). Müller-Hegemann drew on his collection of patient histories to highlight the deleterious social and psychological consequences of a society encircled by the wall. He investigated what Berliners had already started to talk about—whether the newly built wall was causing a novel psychological disease: “the wall disorder,”(Leuenberger 2006: 22).In 1990, a book by Hans Joachim Maaz, an East German cultural critic and psychotherapist examined the Wall's fall in broad cultural terms, drawing upon psychoanalytic language--a mode of analysis which itself signified a shift away from the orthodox therapeutic theories of the East (which framed psychoanalysis as bourgeois and capitalist):
"In his book Der Gefühlsstau (Emotional Blockage), Maaz (1990) described that fateful night in November 1989 as a psychological revolution: “The wall’s fall was the emotional climax of the unloading, the cathartic breaking-through . . . of the unconscious. The emotional blockage unclogged, the repressed came to the surface, and the parts that had been split apart, united” (p. 152). East Germans’ “emotional blockage” had built up over years of a “walled in and restricted existence” marked by “authoritarian” structures in schools, homes and professions (Maaz 1990:15). He argued that “the wall provided the outer framework” for East Germany’s “repressive and authoritarian” (p. 15) political, medical, and educational institutions and practices," (Leuenberger 2006: 27).Finally, the 1990s saw the rise of the notion of “die Mauer in den Köpfen” (the wall in the heads) -- as a frequently cited construct through which journalists, psychologists and cultural critics conceptualized (and Leuenberger suggests, reified) persistent differences between East and West.
Interestingly, Leuenberger has followed up this work with a new project on the barrier constructed by Israel along the border with the West Bank.
The references:
Christine Leuenberger. "Constructions of the Berlin Wall: How Material Culture Is Used in Psychological Theory." Social Problems, February 2006, 53(1): 18–37.
Christine Leuenberger. "The Berlin Wall on the Therapist's Couch." Human Studies, April 2000, 23(2): 99-121.
And a couple of additional key anthropological texts on post-socialist East Germany:
John Borneman. Belonging in the two Berlins: Kin, state, nation. Cambridge University Press: 1992.
Daphne Berdahl. Where the world ended: re-unification and identity in the German borderland. University of California Press: 1999.
Image source: Wikipedia/Senate of Berlin
Sunday, November 8, 2009
In the journals
Below are some recent issues that might be of interest:
In the Journal of Ethnobiology and Ethnomedicine, Andrea Pieroni and Maria Elena Giusti conducted a medical ethnobotanical study of the Occitan communities in Italy, titled "Alpine ethnobotany in Italy: traditional knowledge of gastronomic and medicinal plants among the Occitans of the upper Varaita valley, Piedmont".
Istav Praet examines shamanic-curing-as-metamorphosis in Northern Ecuador in the Journal of the Royal Anthropological Institute in an article titled "Shamanism and ritual in South America: an inquiry into Amerindian shape-shifting".
In Cultural Anthropology, Julie Livingston looks to Botswana's middle and aspirational classes in order to examine the conceptualization of risk, investment, and self-determination. She concludes her essay by examining these concepts within the contexts of a cancer ward. Jean M. Langford analyzes the reciprocity between the living and the dead in "Gifts Intercepted: Biopolitics and Spirit Debt".
In this month's issue of the International Journal of Social Psychiatry, we find many pertinent studies of mental health, including its relationship with migrants in non-Western contexts and social networks in inpatient and day care settings.
Among many relevant articles, Rhona O'Connell and Soo Downe conducted a metasynthesis of midwifery and Hans Hadders examines the interplay between perceptions of death and life sustaining medical technologies in this month's issue of Health.
Saturday, November 7, 2009
Cultural Formulation: A Special Issue of Transcultural Psychiatry
The latest issue of Transcultural Psychiatry is a special issue, entitled "Cultural Formation". In Roberto Lewis-Fernández’s editorial introduction to the issue, he writes:
"The Outline for Cultural Formulation, developed for DSM-IV by the Group on Culture and Diagnosis of the National Institute of Mental Health, represents the most substantive cultural contribution to the DSM series. It provides instructions for conducting a cultural formulation, a systematic assessment of the patient’s cultural identity, illness representations, perceived causation, treatment expectations, cultural context of stressors and supports, and other relevant cultural factors that can be carried out with a patient from any cultural background during a mental health evaluation. … The upcoming publication of DSM-V in 2012 has provided the impetus for a thoroughgoing re-evaluation of the DSM-IV Cultural Formulation Outline. Substantial revisions are planned to the content of the Cultural Formulation, and efforts are underway to increase its visibility in DSM-V, thereby encouraging its uptake in clinical settings. … This issue of Transcultural Psychiatry greatly advances the revision of the DSM-IV Outline by addressing several of these key topics with the critical eye of the researcher who also works and thinks as a provider." (Lewis-Fernández 2009: 379-381)
Here is a listing of the issue’s articles, along with their abstracts:
Juan E. Mezzich, Giovanni Caracci, Horacio Fabrega, Jr., and Laurence J. Kirmayer, “Cultural Formulation Guidelines”
The outline for the Cultural Formulation (CF) introduced in DSM-IV does not present any method for collecting the required cultural information. The absence of specific guidelines and illustrative cases has hampered its wider use. This article offers a practical approach to preparing a Cultural Formulation as a component of culturally competent clinical care. We summarize the rationale for the four sections of the CF, describe the process of conducting culturally focused clinical interviews, and present examples of questions or lines of inquiry that can be used to collect the information needed to construct the CF. An online supplement provides case examples of cultural formulations applied to patients seen in the US.
Sofie Bäärnhielm and Marco Scarpinati Rosso, “The Cultural Formulation: A Model to Combine Nosology and Patients’ Life Context in Psychiatric Diagnostic Practice”
This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients’ cultural life context in order to increase the validity of categorization and to formulate individualized treatment plans. In clinical care practitioners need models and tools that help them take into account patients’ cultural backgrounds, needs, and resources in psychiatric diagnostic practice. We present a summary of a Swedish manual for conducting a Cultural Formulation interview. The need for further development of the Cultural Formulation is also discussed.
Lisa R. Fortuna, Michelle V. Porche, Margarita Alegría, “A Qualitative Study of Clinicians’ Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder”
The Cultural Formulation (CF) of the Diagnostic and Statistical Manual (DSM) provides a potential framework for improving the diagnostic assessment of Posttraumatic Stress Disorder (PTSD) in culturally diverse patients. We analyzed data from the Patient-Provider Encounter Study, a multi-site study that examines the process of diagnosis and clinical decision-making during an initial clinical intake session, in order to examine use of CF for PTSD diagnosis. We find that while the CF is generally used inconsistently or underutilized in routine community settings, when employed appropriately it may assist the formulation and interpretation of traumatic experiences. We discuss the implications for improving the assessment of PTSD in the time-limited setting of the clinical intake encounter and across race/ethnicity.
Simon Groen, “Recognizing Cultural Identity in Mental Health Care: Rethinking the Cultural Formulation of a Somali Patient”
Although there are many ways to produce a cultural formulation that facilitates a culturally sensitive diagnosis and treatment for asylum seekers and refugees in mental health care, it is essential to gain trust and ‘recognize’ the patient. One way to achieve this recognition is through a cultural interview, in which cultural references of the health care provider and the patient are exchanged. This paper presents an example of such a process with a Somali migrant to the Netherlands, whose passivity and inactivity puzzled the psychiatrist. Gaining his trust and recognizing his cultural roots as a member of a Somali ethnic group revealed more about his motives, concepts and attitude. This example suggests the importance of cultural identity as a way to explore the meanings of the illness and the interrelationship between the patient and health care provider. The cultural identity of the patient is a basis on which meanings can be exchanged in an ongoing way and starting points for effective treatment can be found.
Dana Lizardi, Maria A. Oquendo, and Ruth Graver, “Clinical Pitfalls in the Diagnosis of Ataque de Nervios: A Case Study”
Ataque de nervios (attack of nerves) is an idiom of distress generally thought of in relation to Caribbean Hispanics. The following case study discusses the presentation of ataque de nervios in a Colombian female. This case study provides insight into a different presentation of ataque de nervios population that clinicians should be aware of in order to ensure accurate diagnosis. Ataque de nervios is a distinct syndrome that does not fully correspond with any single DSM-IV diagnosis. However, there is overlap between symptoms in this condition and those in conventional clinical diagnoses. Common problems in deriving an accurate differential diagnosis are discussed. Implications for treatment are also reviewed, with an emphasis on a comprehensive approach to treatment that supports the client’s norms and values.
Hans Rohlof, Jeroen W. Knipscheer, and Rolf J. Kleber, “Use of the Cultural Formulation with Refugees”
This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists’ attitudes towards the culture of the patient and towards their own culture, patients’ previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.
Luis Caballero Martínez, “DSM-IV-TR Cultural Formulation of Psychiatric Cases: Two Proposals for Clinicians”
This article reviews some limitations of the current guideline for the DSM-IV-TR Cultural Formulation (CF) from the perspective of psychiatric practice that are based on the author’s experience conducting doctoral courses on cultural psychiatry from 1996 to 2007 in the Department of Psychiatry at the Universidad Autónoma de Madrid (Spain). Two proposals are presented for facilitating use of the CF by general clinicians. These proposals offer a procedure for embedding only the most relevant clinical information in a psychiatric history, followed by a brief cultural formulation. The approach is illustrated with a clinical case. Although the CF has considerable promise for revealing knowledge about patients, health practices, and health systems that is essential for clinical care, substantial research must be carried out to facilitate widespread use of the CF in clinical practice.
Tuesday, November 3, 2009
Claude Lévi-Strauss est mort
Monday, November 2, 2009
SMA Panel: Production, Distribution and Consumption of Pharmaceuticals--South Asia Focus
In the final SMA session I will summarize, the work of three of the panelists (Roger Jeffery, Ian Harper and Stefan Ecks) adds to a long-term collective project at the Centre for South Asian Studies at the University of Edinburgh. The project is entitled “Tracing Pharmaceuticals in South Asia,” and its aim is to “provide governments and others with a better understanding of the contexts and causes of pharmaceutical use in South Asia… by integrating anthropological, public health, and political economic approaches in an investigation and analysis of the diverse cultural, medical, economic and institutional factors that determine the pathways by which three pharmaceuticals-oxytocin, rifampicin, and fluoxetine-reach their end users” (http://www.health.ed.ac.uk/CIPHP/ourresearch/DFIDESRCtraps.htm).
Having had the privilege of visiting the centre and participating in one of its workshops last June, I can commend the Project’s approach to mapping out the complex pattern of pharmaceuticals dissemination in a region where regulation is in flux, commercial motivations diverse and influential, and medical oversight erratic. (A fourth member of the Project, Patricia Jeffery, presented the previous afternoon at an SMA session entitled ‘Polio Histories, “Geographies of Blame” and Global Health.’) Also at this panel, Murphy Halliburton considered the effects of a 2005 patent law on the production of ayurvedic and biomedical pharmaceuticals in India, and I presented a paper about a company/government controversy over the regulation of the antipsychotic drug, olanzapine, in the far more centralized regulatory environment of Japan. Lawrence Cohen was our discussant.
Jeffery offered an overview of the Project and this panel’s relation to it, and then presented a paper (co-authored by M.R. Santhosh) entitled “The architecture of drug regulation in India: can it be reformed?” Jeffery began by contrasting the circumstances for pharmaceutical regulation in places such as Europe and North America with those of India. The focus on new drug approval and monitoring their effects through assumed channels of distribution is inadequate for India where the “context effects” upon the product life of drugs—how they are formulated, distributed, marketed, prescribed and consumed—are barely understood. It is not that there is no regulation in India; in fact there is plenty. However, the real story lies in the gap between regulations as they exist on paper and everyday practice. Moreover, the local regulatory context is affected by global procurement agencies (such as The Global Fund to Fight AIDS, Tuberculosis and Malaria) and by foreign regulators such as the US FDA. Investigative commissions have identified areas in need of reform, however, their recommendations suffer from (among other things) failures to account for local knowledge of the sort Jeffery and his group has been researching.
Ian Harper’s paper (“Disputing distribution: Ethics and pharmaceutical regulation in Nepal”, co-authors Nabin Rawal and Madhusudan Subedi) considered the effects of the Nepalese government’s 2007 guidelines for the ethical distribution of drugs. As in Jeffery’s paper, here too the thick description of the pharmaceutical trade (pharmacists, marketing reps [MR], physicians, etc.) enables the development of a case surrounding the acceptance and resistance to the guidelines.
The Nepalese trade is dominated by branded generics, which are off-patent formulations sold under brand names by different manufacturers. The unregulated environment and the competition with Indian imports are partly responsible for the growth of this commercial type, which has in turn given rise to a lively gift/bonus economy for prescriptions, as well as opportunities for retailers to game the system. These result in feedback incentives for producers and then distributors that further complicates and makes more difficult efforts at regulatory and ethical control over the trade. It has, from the viewpoint of local ethical discourse, become a system of corruption in which individual actors can rightfully blame external conditions for their behavior. The path to regulatory amelioration may remain unclear, however, the analysis Harper and his colleagues are building is a gateway to disentangling the complexity on the ground.
Stefan Ecks’ paper, “Unseen drug dissemination: Rethinking the ‘treatment gap’ for anti-depressants in India” shows that, contrary to the commonplace understanding that depression is under-detected and undertreated in rural India, there is in fact a “stunning proliferation of psychopharmaceutical drugs” there. The conventional approach has been to measure the availability of medical personnel and institutions. Ecks, inspired by the “social biography of things” approach, looks at the actual availability of fluoxetine (Prozac). His results starkly challenge prior methodologies and conclusions of the WHO’s incipiently influential Mental Health Gap Action Programme.
Ecks identifies the existence of 66 generic brands of the drug available at innumerable retail outlets. Because of Indian patent laws in effect until 2005, generics dominate the market. Eli Lilly’s branded Prozac was never, in fact, sold in India. The line between formal and informal retail of the drugs, Ecks says, is often unclear, and the familiar boundaries “between production, marketing, distribution, retail, and prescription of drugs can be surprisingly porous”. Information about drug brands is widely available in brochures, or “reckoners”, that are sold by street hawkers. Because prescriptions are not surrendered when they are filled, patients/consumers can keep purchasing medicines for years, a phenomenon Ecks calls “floating prescriptions”. What emerges here as from the other Tracing Pharmaceuticals papers is a convincing argument for fieldwork centered upon pharmaceutical biographies, and the triangulation of data among researchers working regionally.
The value of a focus on the ambiguous regulatory environment for drugs was evident also in Murphy Halliburton’s paper about ayurvedic drugs, which are common indigenous medicines. Although ayurvedic medicines are undoubtedly used in conjunction with or as alternatives to biomedical pharmaceuticals, as legal-scientific entities they are often held to be distinct. As such, the new intellectual property regulations (TRIPS) portend a different, potentially threatening environment for the makers and sellers of these compounds, and it is this situation that Halliburton’s research reports upon.
“Ayurvedic science”, he points out, is based on plant use rather than that of chemical agents. While plants contain chemical ingredients, TRIPS only deals with the latter. Ayurveda’s entire treatment epistemology is different and as such is “inherently unpatentable”. This legal contrast implicitly opposes western and nonwestern/noncapitalist forms of innovation and knowledge, even while the mass, standardized manufacture and distribution of ayurvedic medicines suggests quite a bit of overlap between the two. Halliburton has researched the conditions under which innovation is realized in the development of ayurvedic treatments, and how ayurvedic practitioners are responding to the appropriation of their medicines by biomedical pharmaceutical companies, both in relation to the new patent laws.
Lawrence Cohen offered stimulating comments, which I won’t attempt to summarize fully, particularly as he spent the greatest amount of time reflecting upon and adding to individual papers in the panel. He began by identifying the new context for how pharmaceuticals are thought about in global health. Both in the WHO agenda and in the scholarly and practical engagements of at least some medical anthropologists, drugs have taken center stage. Concomitant with this emphasis is the expansion both of uncertainties as to particular pharmacopolitical futures, as well as certitudes or “structurations” that accompany the planning mechanisms of those engaged in strategies to forge solutions (as in the case of regulators) or to diminish their exposure to risk (as in the case of pharmaceutical corporations, the subject of my own paper). The social planner’s engagement with contingency (with its “epistemic and affective conditions”) is itself an uncertain enterprise, and therefore also grist for the analyst.
This compounded intellectual challenge, Cohen observed, was confronted by each of the papers in the panel. In the face of this complexity, the familiar poles of anthropological engagement with pharma—on the one hand noting and constructing models of resistance, and on the other “wresting [moral] clarity from the epistemic murk” in order to mobilize pharmaceutical power in the labor of curing global sickness—are insufficient.
Friday, October 30, 2009
Neurobiology and the literary imagination
This has been amply covered by the New York Times and Mind Hacks, but it fits so nicely into the interests of many of our contributors and readers, that I couldn't resist mentioning it here: in the latest issue of n+1, Marco Roth has an excellent essay on "The Rise of the Neuronovel." In it he traces how--since the mid-1990s--novelists have increasingly drawn upon neurobiological explanations of human behavior in lieu of older psychological ideas about consciousness and work of the mind. Following the rise of the neuronovel from Ian McEwan’s Enduring Love, published in 1997, to last year's Atmospheric Disturbances by Rivka Galchen, Roth's argument seems to dovetail broadly with one made by Nikolas Rose over recent years: neurobiology is increasingly playing a role in popular culture previously played by psychoanalysis--the pool of knowledge which underpins our basic, taken-for-granted assumptions about the self. However, unlike Rose, Roth views these new assumptions as basically reductionistic and ultimately comes to a very negative conclusion about the neuronovel:
"By comparison with most 19th-century novels, and even with most 20th-century modernist novels of the “stream of consciousness” school, the neuronovels have in them very little of society, of different classes, of individuals interacting, of development either alongside or against historical forces and expectations. Iris Murdoch (whose fate it was to become better known, through her husband’s memoirs, as an Alzheimer’s patient than as a novelist) observed that the 20th-century novel had lost both religion and society. A mid-century novelist who wanted to write about society had first to take pains to reconstruct it, to research something that to George Eliot or Dickens had been more or less spontaneously available. And the 20th-century decline of religion meant a common moral frame of reference couldn’t be taken for granted either. So postwar writers as different as Nabokov and Sarraute and Bellow were thrown back on themselves. But at least they retained that subject matter: the personal, the self. It now seems we’ve gone beyond the loss of society and religion to the loss of the self, an object whose intricacies can only be described by future science. It’s not, of course, that morality, society, and selfhood no longer exist, but they are now the property of specialists writing in the idioms of their disciplines. So the new genre of the neuronovel, which looks on the face of it to expand the writ of literature, appears as another sign of the novel’s diminishing purview, (Roth 2009)."
Marco Roth, "The Rise of the Neuronovel." n + 1, issue 8.
Tuesday, October 27, 2009
Turning to animals
The Chronicle Review has a nice series of articles covering the relatively recent turn to "animal studies" among scholars in the humanities and social sciences. An article by Jennifer Howard examines the emergence of animal studies, discussing related movements in literary and cultural studies, philosophy and ethics, history and the social studies of science.
"Dismantling that model takes animal-studies scholars in different directions depending on their home disciplines and the mix of theory and advocacy that they bring to their work. For historians and sociologists, it might mean investigating the roles assigned to animals in 19th-century Britain, for instance, or the use of canines as forced labor in today's dogfighting rings. For scholars with literary, cultural-studies, or philosophy pedigrees, animal-studies work clusters around questions of category and subjectivity—how to move beyond the anthropocentric outlook and anthropomorphizing tendencies of humanism in theory and in practice. Environmentalists and legal scholars have their own ecological or ethical or jurisprudential agendas focused on animals. (For scientists, of course, the phrase "animal studies" usually invokes laboratory experiments involving animals.) If there's one thread that ties together practitioners of animal studies, it's that the old ways of thinking about humans and (other) animals must be discarded or transcended," (Howard 2009).
Howard also emphasizes the tension between scholarly and activist motivations and dispositions which underlies much of the animal studies literature. (In a related vein, a commenter takes her to task for not mentioning Peter Singer's Animal Liberation as a foundational text).
Jeffrey Williams discusses the role Donna Haraway's work has played in the animal turn, tracing the development from her "A Cyborg Manifesto" to the recent When Species Meet:
Haraway's key idea is that animals are "companion species." This phrase seems less provocative than "cyborg," but it has some teeth: It rebuts the traditional Western view that man rightly has "dominion over the fish of the sea, and over the fowl of the air, and over the cattle" (Genesis 1:26). Haraway sees it the other way around: We are not kings in a great chain of being, but, in her parlance, we are all critters. This idea has a good deal of consequence in how we relate to and what we do with animals.
Though animals seem a long way from cyborgs, Haraway sees them as "in the same litter." "I think in ecologies [that] are always at least tri-part: humans, critters other than humans, and technologies," she said. "In the cyborg work, I foregrounded the technological dimensions of that triad, and in the current work I'm foregrounding the other organisms in the triad." Much of her writing examines concepts that we ordinarily think of as opposed —like organisms and machines or humans and animals—and shows how they interweave.
...
Similar to her argument about the cyborg, that the human does not represent some idyllic state before machines, she holds that we should not consider animals as inhabiting some idyllic state without humans. In her words, rather than seeing "domestic arrangements between human beings and other animals as always the imposition of human domination, … the history of co-domestication is a multispecies phenomenon. It's not that we domesticated them and turned them into instruments for our ends, but these are co-evolutions of ourselves and other organisms we live with,"" (Williams 2009).
In "Moral in Tooth and Claw" Jessica Pierce and Marc Bekoff discuss the argument developed in their Wild Justice: The Moral Lives of Animals (University of Chicago Press, 2009), that morality "is a suite of interrelated, other-regarding behaviors that cultivate and regulate social interactions," which have "evolved in many animals, perhaps even in birds."
Eric Banks reviews the Animal series of books published by Reaktion Books. The series is comprised of 34 volumes, "each dedicated to a sort of hybrid natural and cultural biography of a specific creature," ranging from Moose, to Crow to Rhinoceros, to Ape. There is also an article on the book series and journals focusing on animal studies, although this one--unlike the other articles--requires a subscription.
Generally a nice introduction, although there isn't as much attention paid here to anthropology as there is to other disciplines. It would be good to see a discussion of this animal turn in relation to anthropology per se. If anyone is interesting in writing something along those lines, we'd be happy to run it here!
Some additional sources:
Linda Kalof, Amy Fitzgerald, Jennifer Lerner and Jessica Temeles. Animal Studies Bibliography. A very comprehensive and well-organized list of sources.
Books review forum in BioSocieties on "Animal Evidence." December 2008, 3(4).
Harriet Ritvo, "on the animal turn," Daedalus, Fall 2007, 136(4): 118-122.
Harriet Ritvo, "Humans & humanists," Daedalus Summer 2009, Vol. 138, No. 3: 68–78.
Donna Haraway, The Companion Species Manifesto: Dogs, People and Significant Otherness. Prickly Paradigm Press, 2003.
Donna Haraway, When Species Meet. University of Minnesota Press, 2007.
Reviewed in Cultural Anthropology, Feminist Review, History of the Human Sciences, Space and Culture, European Assn for the Study of Science and Technology, Savage Minds,
Lorraine Daston and Gregg Mitman eds., Thinking with Animals: New Perspectives on Anthropomorphism. Columbia University Press, 2005.
Eduardo Kohn, "How Dogs Dream: Amazonian Natures and the Politics of Transspecies Engagement," American Ethnologist, 34(1): 3-24.
Thursday, October 15, 2009
Re-tooling subjectivities
There is a very interesting looking special issue of the journal Subjectivity which has just come out: "Re-tooling Subjectivities: Exploring the Possible with Feminist Science and Technology Studies," guest edited by Wenda Bauchspies and Maria Puig de la Bellacasa. I haven't managed to get access to this particular issue through my institution's library, so I'll only be able to post the TOC at this point.
Wenda K Bauchspies and María Puig de la Bellacasa, "Re-tooling subjectivities: Exploring the possible with feminist science and technology studies"
Wenda K Bauchspies, "Potentials, actuals and residues: Entanglements of culture and subjectivity"
Vincanne Adams, Michelle Murphy and Adele E Clarke, "Anticipation: Technoscience, life, affect, temporality"
Kalindi Vora, "Indian transnational surrogacy and the commodification of vital energy"
Alexa Schriempf, "Hearing deafness: Subjectness, articulateness and communicability"
María Puig de la Bellacasa, "Touching technologies, touching visions. The reclaiming of sensorial experience and the politics of speculative thinking"
Ruth M Mendum, "Subjectivity and plant domestication: Decoding the agency of vegetable food crops"
Wenda K Bauchspies and María Puig de la Bellacasa, "Feminist science and technology studies: A patchwork of moving subjectivities. An interview with Geoffrey Bowker, Sandra Harding, Anne Marie Mol, Susan Leigh Star and Banu Subramaniam"
Saturday, October 10, 2009
SMA: Perspectives from Contemporary Japan
On Saturday, September 26, a group of younger Japanese researchers, joined by veteran Japan scholars Susan Orpett Long and discussant William Kelly, presented papers in a session titled “Emerging Alterities in Medicine: Perspectives from Contemporary Japan.” The session’s title distracted from a substantial unity surrounding the expanding personal and social experience of biotechnology in Japan as it stands on a continuum with experiences in other parts of the world—from one standpoint the session might have been better named, as Kelly pointed out in his comments, “dissolving alterities". The analysis and questions raised in each of the case studies (including two not discussed here) is worthy of more recapitulation than I can offer here.
Long opened with “Bodies, Technologies, and Aging in Japan (Old People and their Things).” She concentrated on low-tech or everyday assistive devices used by the elderly in Japan, such as walkers, hearing aids and grab bars, to explore how even these humble technologies require acceptance and assimilation, technically and interpretively, by their users. Assistive devices are consumer goods, however, they differ from other consumer goods social scientists have variously analyzed in that they are undesired items that carry negative social significance. The usual link in consumer studies of goods to popular culture and identity construction, Long suggests, is not useful here; a new framework for making sense of a government-subsidized, needed-but-not-wanted, and yet an economically and commercially important set of technologies is called for. In Japan, “the aging society” has been regarded as a central social issue for some time, however, the social processes Long identifies will be useful to consider in these terms elsewhere.
Goro Yamazaki presented “Making the Gift Economy Work: The Case of Organ Trade in Japan.” Organ transplantation has been less common in Japan than elsewhere. Just this past June, not without opposition, the law was revised to permit greater exchange of organs. Yamazaki acknowledges the cultural explanations for reluctance over organ transplantation, but in his paper he reframes the issue in terms of gift vs. commodity discourses to try to identify a more embedded, transactional, and perhaps quotidian way of analyzing the opposition. The analysis of a publicized case in which a friend’s gift of an organ turned into a litany of requests for what amounted to remuneration demonstrates the utility of this approach. It also, Yamazaki points out, leads us to question the boundaries of anthropological definitions of the gift as it may be applied to organs. We might well ask: What manner of exchange item are organs? What manner of entanglements (to use Nicholas Thomas’ term, 1991) do they generate in any given locale and between them (since the organ trade is global)?.
Given the renewed attention to transplantation in Japan, it was not surprising to find another presenter on this topic. Aya Nakagoshi (“Beyond Blood: Organ Transplantation and the Rise of New Kinship”) likewise situates organ transfers into two familiar anthropological frames of analysis: communication/gift exchange and kinship. Her work is openly comparative with North America. She cited some cases from the US and Canada to illustrate the formation of a kind of kinship bond that forms between live donors and the recipients of their organs. In Japan, by contrast, where nearly all donors are alive (as compared to about 1/3 of total donors in the US), she found no stories in the media referring to positive organ donor kinship bonds. In Japan there are only, she observes, negative stories about kidney donation—“the dark side of the gift,” as she puts it. Like Yamazaki, Nakagoshi calls for a reconsideration of the gift/market distinction in regards the organ trade. Precisely because of the marked cultural differences in attitude about organ transplantation that Margaret Lock (2001) has analyzed in her work, we can expect to learn much about this subject by scrutinizing the Japanese scene in the finer details that Yamazaki and Nakagoshi are pursuing.
Gergely Mohacsi’s paper, “In Search of New Pharmaceutical Senses”, addresses the embodiment of pharmaceuticals in Japan, in this case as applied to the uptake of diabetes pills. The focus on how drugs are assimilated not just into local public health rhetoric of disease management but also into actual physical comprehension is constructive to questions raised in comparative subjectivity studies in pharmaceutical/medical anthropology. It is also a potential case in the global sociology of disease management, since the idea that early medical and lifestyle intervention for type-II diabetes is indispensable derives from epidemiological understandings developed first in the US, funded and promoted by the pharmaceutical industry already beginning in the 1960s. Japan is both more recent to the trend and, Mohacsi’s report seems to suggest, ostensibly more scientific in its outlook. The cultural differences between Japan and elsewhere are mediated by biological measurements (blood glucose, indicated by the diabetes marker, HbA1c) as they are incorporated into Japanese patient habits (lifestyle, attitudes, treatment-seeking behaviors) and bodies, as well as in the practice of Japanese medicine. As Mohacsi puts it, “When ‘lifestyle’ is expressed as HbA1c levels, it becomes a transportable fact.”
Kelly's concluding remarks to this session could apply as well to others I attended, which marveled at the "heterogeneous ensemble of articulated discourses, institutions, structural forms [and] laws surrounding [for example] organ transplants. It seems to me that what each of you are calling attention to...are precisely the ensembles that articulate and dispose the practices that bind individuals to institutions, knowledge to practice, and, for that matter, the normal to the abnormal, and health to illness."
References:
Lock, Margaret. 2001. Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: University of California Press.
Thomas, Nicholas. 1991. Entangled Objects: Exchange, Material Culture and Colonialism in the Pacific. Cambridge: Harvard University Press.
Wednesday, October 7, 2009
"Mind Games": A Session Presented at the SMA at Yale
Presentations at the Society for Medical Anthropology Conference at Yale (September 24-27, 2009) offered a cross section of work being done in many separate fields of interest. In keeping with my interests in pharmaceuticals, Japan, and mental health, I attended three excellent sessions that I would like to briefly summarize for people who could not attend. Here’s an outline of some of the papers presented on Friday, September 25, in a session entitled “Mind Games: The Intersections of Globalizing Biopsychiatry, Politics and Social Movements.”
Jonathan Metzl shared some themes from his forthcoming book, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon Press 2010). Metzl’s presentation offered stark surprises in the cultural history of schizophrenia in the US. He balanced hard data from the Ionia State Hospital for the Criminally Insane in Ionia, Michigan, with advertising images from professional medical and popular cultural literature and even from Hip Hop to limn the evolution of the image and diagnosis of schizophrenia from a tame, white person’s disease through the early part of the 20th century, to an African American male disorder with specific linkages to civil rights protests during the 1960s and 1970s.
Junko Kitanaka presented “Too Depressed to Work: The Emerging Science of the Psychopathology of Work Stress in Japan.” Psychiatry and mental illness are co-evolving in Japan, exposing many areas in need of clinical ethnographic investigation. The rising suicide rate is a good place to start. Kitanaka analyzed the phenomenon known in Japan as “suicide through overwork”. These cases engage long-standing public debates surrounding workloads and workplace relations, as well as psychiatric debates over the etiology of suicide (is the ultimate cause biological or environmental?) and growing popular awareness of clinical depression and the social suffering caused by a persistent economic recession. She recounted the Ministry of Health Labor and Welfare’s surprising invention of a quantified measure of social stress. A longer version of this superb paper, entitled “Questioning the suicide of resolve: Disputes regarding ‘overwork suicide’ in 20th century Japan,” can be found in Weaver, John & David Wright (eds.), A History of Suicide in the Modern World: International Perspectives (Toronto 2009).
The context-specific issues surrounding the professional, popular and political conceptions of mental illness—the three being, in the realm of psychiatry, peculiarly inseparable—that Metzl and Kitanaka brought out in their papers, was evident also in Dominique Behague’s study, “Community-based psychotherapy and transformations in politicization amongst youth in Southern Brazil.” Behague points out that while resistance to biopsychiatric reductionism is manifest in Brazil, the DSM diagnoses of ADHD and conduct disorder have nevertheless entered the local therapeutic lexicon. Moreover, in her sample, behavioral disorders are being systematically applied to lower class youth. Behague seeks the solution to this paradoxical trend not (in this paper) by evaluating therapist’s way of engaging the subject, but in how youth patients themselves react to diagnostic categories and therapies. She shows that the “politicizing effects of medicalization” must be understood beyond the therapist and the doctor-patient relationship, but in class relations and other aspects of the youths’ own experience and use of behavioral diagnoses. Behague’s study (the detailed version of which will be printed in Medical Anthropology Quarterly this year) ups the ethnographic stakes on the question of how biopsychiatric models are integrated in given locales; it is not, she observes, a simple matter of identifying ambiguities or declaiming syncretism.
Elizabeth Davis gave a paper entitled “‘By Reason of Danger’: Rights, Refuge and Responsibility in Greek Psychiatry.” Nissim Mizrachi presented “Psychological Technologies and the Creation of the ‘New Jew’ in Israel.”
The discussant, Stefan Ecks, pointed out the shared political focus of all of the papers, and specifically their crystallization around the themes of autonomy, self-reliance, emancipation, and responsibility. How do psychiatrists confront the political embeddedness of their work? Where might this discussion might lead if the authors were to cast it in terms of the classical political theoretical concepts of liberal democratic ideals, Enlightenment, and so on? As an immediate topic for debate, Ecks suggested that psychiatry might experience the most trouble justifying its practices in the context of democratic regimes that stress equality and self-determination. The authors of the panel might well agree with Ecks’s insight that not just politics in the everyday but the political ideological cultures in which a globalizing psychiatric profession takes root, is indeed subject for productive reflection.
Call for Contributors Redux
As ever, we’re ready to welcome new contributors at Somatosphere. At our meeting at the SMAs, a number of people said that they would be more likely to contribute if there was a list of possible types of posts they could write—or even if they could volunteer for particular roles or jobs—to write certain posts on a regular basis.
With that in mind, we’ve put together a list of several roles and different types of posts for the site. If you have some general ideas about what you’d like contribute, but want some additional suggestions, guidance or to be assigned certain topics—let us know and we can discuss different possibilities. As always, you can get in touch at admin@somatosphere.net.
There are two roles for each of which we’re hoping to have two or three volunteer: the journal and web round-ups. Ideally, each person will be assigned to write a post during certain months or to cover certain topics.
Journal round-up
I’ve been writing two types of posts in this category: one covers a special theme issue of a journal; the other rounds up interesting single articles from a variety of recent journals. This role can also be divided up so that certain people agree to cover certain topical categories of journals, ie. medical and cultural anthropology; medical sociology and social studies of medicine; science studies and history of science/medicine; bioethics and medical humanities.
Monthly web round-up
I’ve been doing these under the rubric of “web gleanings,” and I’ve done them in a number of formats, some more time-consuming than others. Obviously it would be up to you to decide how you would do this. Basically these posts would cover non-academic media, blogs, and anything else that’s on your radar and of potential interest.
The following are types of posts which we’re always happy to run. Some we have had in the past, others are new ideas.
Book review
If you’re interested in reviewing books for the site, please let us know your topical areas of interest so that we can assign you appropriate books to review. Alternatively, if you have a particular book which you’d like to review, let us know. Todd Meyers is taking on the role of book review editor, so if you’d like to write a review or suggest a book for review please contact him directly at books@somatosphere.net. See our previous reviews here.
Other media review
Reviews of films, websites, resources, or any other non-book media of interest to readers of Somatosphere.
Summary of a recently published paper
For two examples of what this can look like, see Current Anthropology’s “Anthropological Currents” section and the new “Findings” column in Anthropology Now.
Reading group
The idea here is to use the weblog as a forum for a discussion of a book or article. See the discussion group on Anna Tsing’s Friction at Savage Minds from a couple of years ago.
Issue review
A review of a particular issue or topic in medical anthropology or in a related discipline which we cover (STS, cultural psychiatry, bioethics, public health). Obviously the scope here is wide open.
Rereading a foundational text
Review, critique, revive, or dissect a particularly significant or foundational paper or book in medical anthropology, STS, etc. While the context is somewhat different, there is a blog carnival called “The Giant’s Shoulders” which includes posts about “classic” science papers—which gives a rough template for this sort of post.
Syllabus
Post a syllabus along with an explanation of how you’ve designed the course and some of the resources you’ve drawn upon. I’ve written a post like this on an Anthropology of the Body course.
Conference or workshop report
If you’re planning to attend a meeting of potential interest to Somatosphere readers and would like to write about it, let us know.
Fieldnotes
A dispatch from the field or a report on a research project in progress. This is a potentially useful format for getting some feedback on your initial observations.
Op-Ed
A report or op-ed piece from the field on a timely issue or a topic of general concern. The idea here is to draw on your local knowledge of a particular site (whether geographical, institutional, disciplinary or however you’ve framed your fieldsite) to write about a topic which is not necessarily your research focus, but is likely to be of interest to readers. Obviously it needn’t necessarily be something that’s “in the news” but two obvious examples of current relevance would be posts on the US health care debate or the H1N1 story, written from where you stand in the field.
Interview
An interview with a scholar whose work interests you. We can run both text or audio/video, so either type of interview format would work. The interviews at U Cambridge’s D Space are great examples.
These are just some ideas to get you thinking. If you’re interested in contributing any of these types of posts, or anything else, write us at admin@somatosphere.net.
Monday, October 5, 2009
Biomedical Conventions and Regulatory Objectivity in Social Studies of Science
The latest issue of Social Studies of Science is a special issue on "Biomedical Conventions and Regulatory Objectivity," edited by several members of the department where I'm currently based (McGill's Social Studies of Medicine)--Alberto Cambrosio, Thomas Schlich, and George Weisz, and Peter Keating of the University of Quebec at Montreal.
Here's the abstract from the introduction, along with the titles of the papers:
"This special issue of Social Studies of Science centers on the topic of regulation in medicine and, in particular, on the notion of regulatory objectivity, defined as a new form of objectivity in biomedicine that generates conventions and norms through concerted programs of action based on the use of a variety of systems for the collective production of evidence. The papers in the special issue suggest ways in which the notion of regulatory objectivity can be tested, extended, revised, or superseded by more appropriate notions. They insist on the need to examine more closely clinical-therapeutic (and not just clinical-research) activities, and to pay more attention to the activities of regulatory agencies such as the US Food and Drug Administration and to standard-setting organizations. They call attention to the professional and organizational activities surrounding the mobilization of conventions for regulating clinical practices. Finally, they provide material that can help us to think about how analytical notions such as regulatory objectivity may or may not inform interventionist research projects," (
Tiago Moreira, Carl May, and John Bond, “Regulatory Objectivity in Action: Mild Cognitive Impairment and the Collective Production of Uncertainty”
Vololona Rabeharisoa and Pascale Bourret, “Staging and Weighting Evidence in Biomedicine: Comparing Clinical Practices in Cancer Genetics and Psychiatric Genetics”
Linda F. Hogle, “Pragmatic Objectivity and the Standardization of Engineered Tissues”
Patrick Castel “What’s Behind a Guideline?: Authority, Competition and Collaboration in the French Oncology Sector”
Teun Zuiderent-Jerak, “Competition in the Wild: Reconfiguring Healthcare Markets”
Laurent Thévenot, “Postscript to the Special Issue: Governing Life by Standards: A View from Engagements”
Friday, October 2, 2009
Care and Health Care: a call for papers
At the Society for Medical Anthropology conference last week Arthur Kleinman gave a plenary talk on the intersections between medical anthropology and mental health. Kleinman made a number of interesting arguments--some of which we'll hopefully discuss in future posts--but one was an argument which he has made in a number of recent articles (see Kleinman 2008; Kleinman and Hanna 2008; Kleinman 2009): both professional medicine and medical anthropology pay inadequate attention to caregiving. In a recent online article, Kleinman writes about the significance of caregiving:
"[F]or many people, care-giving is a foundational component of moral experience. It is a practice of acknowledgement, empathic imagination, witnessing, responsibility, solidarity, and the most concrete forms of assistance. It is this moral aspect that makes care-givers, and at times even care-receivers, feel more “present” – and thus more fully human," (Kleinman 2009).
He also explains quite movingly how these concerns have emerged from his own role as caregiver to his wife, Joan Kleinman. These issues are further elaborated in an article by Kleinman and Sjaak van der Geest, which also serves to frame a symposium the two are organizing on "Care and Health Care," to take place in Amsterdam on December 18, 2009. You can download the entire call for papers here, but I will reproduce the relevant parts below:
- The symposium will take place at the University of Amsterdam. Venue is Het Spinhuis, Oudezijds Achterwal 185, Amsterdam. The symposium will consist of thematic discussions based on submitted papers of the participants. During the symposium there will be no formal presentation of papers, but only a short introduction to be followed by a discussion.
- A selection of the symposium papers will be published in the summer 2010 issue of Medische Antropologie. Registration for the symposium is possible until 30 November via the website of Medical Anthropology & Sociology Unit under Agenda: ‘Symposium Care & Health Care’; click: Register, fill the form and submit. Participation is limited to 35 people, and registration will be processed in order of arrival. The symposium fee is €25 to be paid at the symposium. Participants will be given access to all papers no later than a week in advance of the symposium. They are expected to read all the papers in preparation of the symposium.
Authors are invited to consider the following questions:
- Those who are interested in submitting a paper should provide a title plus brief abstract together with their registration, before 1 November 2009. The complete paper should be sent as an attachment per email to: Janus Oomen, h.a.p.c.oomen@uva.nl before November 27, 2008. Papers should be in English. Drafts and work in progress are welcome.
- What constitutes ‘good care’ in a given social or cultural situation? Are medicine and care compatible?
- Is there enough ‘time’ for care in today’s health care system?
- To what extent does the concept of care vary in different cultural contexts?
- How can we understand the gender-based differences in care perception and practice?
- Is care related to reciprocity? Which conditions call for care and which ones do not?
- How does the concept of care evolve in relation to the development of medical technology?
- How does care evolve in conditions of radical cultural change and acculturation, e.g. in the life of migrants? What is the economic basis for caregiving? What explains the low social status of caregiving as a profession? What policy could enhance the quality of care?
Tuesday, September 29, 2009
More med anthro web gleanings
We haven't had a round-up of links for a while, so here goes:
Life/Politics
Didier Fassin, "Another Politics of Life is Possible", Theory, Culture and Society 26(5), 2009.
An argument which Fassin made in his SMA address as well: "The aim of this article is to return to the origins of the concept [of biopolitics] and to confront the issue of life as such. This implies four shifts with respect to Foucault’s theory: (1) Politics is not only about the rules of the game of governing, but also about its stakes. (2) More than the power over life, contemporary societies are characterized by the legitimacy they attach to life. (3) Rather than a normalizing process, the intervention in lives is a production of inequalities. (4) The politics of life, then, is not only a question of governmentality and technologies, but also of meaning and values," (Fassin 2009).
Michael Specter, "A Life of its Own: Where Will Synthetic Biology Lead Us?", The New Yorker
"No scientific achievement has promised so much, and none has come with greater risks or clearer possibilities for deliberate abuse," (Specter 2009).
Forum on synthetic biology with articles by Jay Keasling, Pamela Silver, Evelyn Fox Keller and Filippa Lentzos, BioSocieties 4(2-3), 2009.
Jacob Copeman, editor, "Special Issue on Blood Donation Bioeconomy and Culture", Body & Society 15(3), 2009.
Travels
Erica Gibson, "Swine Flu: Ground Zero", AAA blog
"When Erica Gibson traveled to La Gloria, Mexico, for fieldwork earlier this year, she found that the emergence of swine flue had dramatically impacted the town."
Mary Cuddehe, "Patients without Borders: The Rise of Mexican Medical Tourism", The New Republic, September 11, 2009.
"[Juárez] is one of a few Mexican border towns quietly promoting state-of-the-art hospitals that cater to international patients--Juárez has five such facilities--and betting that refugees from the tattered U.S. health care system will come. On paper, at least, the numbers look promising: According to a 2008 study by Deloitte LLP, 750,000 Americans traveled abroad for medical care in 2007. That number is expected to reach six million by 2010," (Cuddehe 2009).
Jonathan Kimmelman, "Quack you! Medical Tourism and Stem Cells", Lost in Translation
Stuart Rennie, "Research data from developing countries as 'the new gold'", Global Bioethics Blog
"Making research ethical in such contexts has always been a matter of adding protections and safeguards. Perhaps being ethical in a deeper sense would involve chipping away at the gaping inequalities in power and wealth between the researchers and the researched, but almost no one wants to touch that one: not researchers, not their funders, and (sadly) not governments," (Rennie 2009).
Patricia Leigh Brown, "A Doctor for Disease, a Shaman for the Soul", New York Times
"At Mercy Medical Center in Merced, where roughly four patients a day are Hmong from northern Laos, healing includes more than IV drips, syringes and blood glucose monitors. Because many Hmong rely on their spiritual beliefs to get them through illnesses, the hospital’s new Hmong shaman policy, the country’s first, formally recognizes the cultural role of traditional healers... inviting them to perform nine approved ceremonies in the hospital, including “soul calling” and chanting in a soft voice," (Brown 2009).
Disciplines
Lorraine Daston, "Science Studies and the Histories of Science," Critical Inquiry, Summer 2009 -- Special issue on "The Fate of the Disciplines," edited by James Chandler and Arnold Davidson.
Mario Biagioli, "Postdisciplinary Liaisons: Science Studies and the Humanities", Critical Inquiry, Summer 2009
Vincent Duclos, "When Anthropology Meets Science: An Interview with Allan Young", Altérités 6(1), 2009 : 110-118.
"Without philosophy, particularly without analytical philosophy, there is no anthropology worth talking about and I feel the same way about history and historical inquiry. If we don’t have an anthropology that is read with a historical perspective on absolutely everything, including anthropology, if we don’t have an anthropology that is totally grounded in the debates within analytical philosophy and other branches of philosophy, we’ve got an intellectually impaired, maybe even empty discipline," (Duclos 2009).
Psy
Ilina Singh and Nikolas Rose, "Biomarkers in Psychiatry" Nature Vol 460, 9 July 2009
"Without ongoing social and ethical analysis, as well as careful thought by the researchers about their role in this process, the future use of psychiatric biomarkers could marginalize efforts to identify and address social and environmental factors associated with the development of antisocial and criminal behaviours in young people. It could also reinforce the use of problematic diagnoses and/or medical treatments to manage the current and anticipated behaviour of very young children. Such developments could lead to stigma and labels that affect children’s psychological development, their social and educational opportunities, and their medical care and employment options," (Singh and Rose 2009). Vaughan Bell, "Latah and the Rules of Rule Breaking", Mind Hacks
"Anthropologists...have often loudly scoffed at the psychiatric definition of latah as a syndrome, suggesting it is just a defined social role of the local culture that has its own limits and and 'rules'," (Bell 2009).
Alan Saunders, "Michel Foucault's Madness and Civilization: 50th Anniversary," a podcast from Philosopher's Zone, Australian Broadcasting Association
Philipe Bourgois talks about his new book Righteous Dopefiend, Here and Now, WBUR
Alex Golub, "Anthropology, 'Internet Addiction' and Care," and "More on 'Internet Addiction'", Savage Minds
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