In the Journals

In the Journals, June (Part I)

Organized by Sarah Willen and Elizabeth Carpenter-Song, the June issue of Culture, Medicine and Psychiatry (vol. 37, issue 2) is a special issue entitled “Cultural Competence in Action: Multidisciplinary Perspectives on Four Case Studies.”  Rather than engaging in the usual critique of medical “cultural competence” programs  (which aim to teach clinicians about culture, health disparities, and difference), this issue analyzes pedagogical strategies used in various clinical/educational settings, while illuminating the challenges these programs pose and the ways in which “cultural competence” takes local form. The issue features four original ethnographic papers, each of which is paired with a reflective companion essay written by a clinician-educator involved in the particular program (Antonio BullonMansoor MalikRoxana Llerena-Quinn, and Laurence Kirmayer). The programs include a course for psychiatry residents, a research/training collaborative that links a Historically Black University and an Ivy League University, a continuing medical education course, and a Canadian-based annual summer program for an international cohort of clinicians and researchers. The titles and abstracts of the ethnographic papers are pasted below. In addition, following the four paired papers are three commentaries by clinical educators and researchers: Michael Knipper, Robert Drake, and Mary-Jo DelVecchio Good.

Confronting a “Big Huge Gaping Wound”: Emotion and Anxiety in a Cultural Sensitivity Course for Psychiatry Residents (Sarah Willen)      Abstract: In his seminal volume From Anxiety to Method in the Behavioral Sciences, George Devereux suggests that any therapeutic or scientific engagement with another human being inevitably will be shaped by one’s own expectations, assumptions, and reactions. If left unacknowledged, such unspoken and unconscious influences have the capacity to torpedo the interaction; if subjected to critical reflection, however, they can yield insights of great interpretive value and practical significance. Taking these reflections on counter-transference as point of departure, this article explores how a range of unacknowledged assumptions can torpedo good faith efforts to engender “cultural sensitivity” in a required course for American psychiatry residents. The course examined in this paper has been taught for seven successive years by a pair of attending psychiatrists at a longstanding New England residency training program. Despite the instructors’ good intentions and ongoing experimentation with content and format, the course has failed repeatedly to meet either residents’ expectations or, as the instructors bravely acknowledged, their own. The paper draws upon a year-long ethnographic study, conducted in the late 2000s during the most recent iteration of the course, which involved observation of course sessions, a series of interviews with course instructors, and pre- and post-course interviews with the majority of participating residents. By examining the dynamics of the course from the perspectives of both clinician-instructors and resident-students, the paper illuminates how classroom-based engagement with the clinical implications of culture and difference can run awry when the emotional potency of these issues is not adequately taken into account.

Behind the Scenes of a Research and Training Collaboration: Power, Privilege, and the Hidden Transcript of Race (Elizabeth Carpenter-Song and Rob Whitley)
Abstract: This paper examines a federally funded research and training collaboration between an Ivy League psychiatric research center and a historically Black university and medical center. This collaboration focuses on issues of psychiatric recovery and rehabilitation among African Americans. In addition, this multidisciplinary collaboration aims to build the research capacity at both institutions and to contribute to the tradition of research in culture and mental health within the medical social sciences and cultural psychiatry. This article provides a window into the complex, often messy, dynamics of a collaboration that cross cuts institutional, disciplinary, and demographic boundaries. Taking an auto-ethnographic approach, we intend to illustrate how collaborative relationships unfold and are constructed through ongoing reciprocal flows of knowledge and experience. Central to this aim is a consideration of how issues of power, privilege, and the hidden transcript of race shape the nature of our research and training efforts.

Patrolling Your Blind Spots: Introspection and Public Catharsis in a Medical School Faculty Development Course to Reduce Unconscious Bias in Medicine (Seth Donal Hannah and Elizabeth Carpenter-Song)
Abstract: Cultural competence education has been criticized for excessively focusing on the culture of patients while ignoring how the culture of medical institutions and individual providers contribute to health disparities. Many educators are now focusing on the role of bias in medical encounters and searching for strategies to reduce its negative impact on patients. These bias-reduction efforts have often been met with resistance from those who are offended by the notion that “they” are part of the problem. This article examines a faculty development course offered to medical school faculty that seeks to reduce bias in a way that avoids this problem. Informed by recent social–psychological research on bias, the course focuses on forms of bias that operate below the level of conscious awareness. With a pedagogical strategy promoting self-awareness and introspection, instructors encourage participants to discover their own unconscious biases in the hopes that they will become less biased in the future. By focusing on hidden forms of bias that everyone shares, they hope to create a “safe-space” where individuals can discuss shameful past experiences without fear of blame or criticism. Drawing on participant-observation in all course sessions and eight in-depth interviews, this article examines the experiences and reactions of instructors and participants to this type of approach. We “lift the hood” and closely examine the philosophy and strategy of course founders, the motivations of the participants, and the experience of and reaction to the specific pedagogical techniques employed. We find that their safe-space strategy was moderately successful, largely due to the voluntary structure of the course, which ensured ample interest among participants, and their carefully designed interactive exercises featuring intimate small group discussions. However, this success comes at the expense of considering the multidimensional sources of bias. The specific focus on introspection implies that prior ignorance, not active malice, is responsible for biased actions. In this way, the individual perpetrators of bias escape blame for their actions while the underlying causes of their behavior go unexplored or unaccounted for.

A Diversity of Voices: The McGill ‘Working with Culture’ Seminars (Jaswant Guzder and Cécile Rousseau)
Abstract: The Working with Culture seminar is offered as a course during the month long Annual McGill Summer Program for Social and Transcultural Psychiatry, attended by local and international participants each May since 1994. The article outlines some of the premises and pedagogical approaches of this clinically oriented biweekly seminar series with discussions and didactic teaching on cultural dimensions of mental health care. The course readings, seminar topics and invited speakers focus mainly on therapist client encounters constructed by the multiple voices with dimensions of psychiatric, social, historical, legal, ethical, political, systemic and intra-psychic domains. The dual leadership emphasizes the gaps and complementarity amongst voices, and it invites and supports a destabilizing decentering process and the creation of solidarities amongst participants. Applying a bio-psychosocial case study method, each 3-h seminar engages the participants in a critical dialogue on apprehending the enmeshment of social suffering with psychiatric disorders whilst examining the usefulness and the limits of cultural formulation models. The seminar working group and teaching approach acknowledges cultural hybridity as a dynamic process marked by continuous therapist attunement to uncertainty or ‘not knowing’ which implies a dethroning of an expert position.

Body and Society 19(2-3) is a special issue entitled “Habit”, edited by Tony Bennett, Francis Dodsworth, Greg Noble, Mary Poovey and Megan Watkins. It features nine original articles and two commentaries. In the introduction, the editors discuss the renewed interest in “habit,” particularly with respect to body/society and processes of governance. “We argue that habit has typically constituted a point of leverage for regulatory practices that seek to effect some realignment of the relations between different components of personhood – will, character, memory and instinct, for example – in order to bring about a specific end. In reviewing its functioning in this regard across a range of modern disciplines – philosophy, psychology, sociology – we explore the tensions between its use and interpretation in different lineages: in particular, the Cartesian–Kantian/Ravaisson–Bergson–Deleuze lineages.” These concerns are variably taken up by the original articles that follow:

“The Question of Habit in Theology and Philosophy: From Hexis to Plasticity” (Clare Carlisle)
“Habit and the Limits of the Autonomous Subject” (Simon Lumsden)
“Habit, the Criminal Body and the Body Politic in England, c. 1700–1800” (Francis Martin Dodsworth)
“Habit: Time, Freedom, Governance” (Tony Bennett)
“Habit and Habitus” (Nick Crossley)
“Cosmopolitan Habits: The Capacities and Habitats of Intercultural Conviviality” (Greg Noble)
“Habit and Affect: Revitalizing a Forgotten History” (Lisa Blackman)
“Habit Today: Ravaisson, Bergson, Deleuze and Us” (Elizabeth Grosz)
“Habit as a Force of Life in Durkheim and Bergson” (Melanie White)

Biosocieties 8(2) features a lecture by Margaret Lock examining scientific research on biomarkers for early detection and prevention of Alzheimer Disorder. Lock argues that the discovery of these biomarkers can be misleading, as they do not signify that one will necessarily get a form of dementia. Thus, it may be overly ambitious for scientists to claim the utility of biomarkers for making individual predictions.

Kirsten Bell emphasizes the challenges presented by molecular technologies used for tertiary cancer prevention. Using a semiotic approach, Bell explores the various meanings and effects of biomarkers for patients, both those “at risk” and those living with risk.

Neurofeedback (a biofeedback system aimed to help people adapt to their brainwaves) is the topic of Jonna Brinninkmeijer’s article, which examines interactions among practitioners, clients, and computers through which a new kind of self emerges.

In exploring the range of definitions of placebo, placebo effect, and similar terms, Susan Huculak discusses how the lack of agreement on these concepts highlights debates about mind/body dualism (and, relatedly, passive/active patient role, in/efficacy of placebo, etc.).

Christopher Groves and Richard Tutton discuss the role of expectations in personal genomic susceptibility testing (PGST), particularly how expectations can increase regulation. Attempting to stall or influence new regulations, some PGST companies use expectations as they work towards standardization that might further legitimize their practices.

Finally, David Reubi’s article focuses on the role of taxation in international anti-smoking initiatives in the global South to shed new light on the relationship of economics and global health.

American Anthropologist (vol. 115, issue 2), features six main research articles. Perhaps most relevant to Somatosphere is an article by Merav Shohet concerning the Vietnamese ethic of hy sinh (sacrifice), which is inculcated in children via socialization practices. The article explores “how participants linguistic and corporeal practices in routine interactions with children relate to their engagement with ancestors.” Shohet further argues that hy sinh reinforce asymmetrical relations within and beyond the family, thereby perpetuating the local sociomoral order.

In addition, book reviews relevant to science and medicine include:
Drug War Zone: Frontline Dispatches from the Streets of El Paso and Juárez, by Howard Campbell (review by Gilbert Quintero)
Trade of the Tricks: Inside the Magician’s Craft, by Graham M. Jones (review by Susan Terrio)
Fewer Men, More Babies: Sex, Family, and Fertility in Haiti, by Timothy T. Schwartz (review by Mindie Lazarus-Black)

Ethos 41(2) includes five original articles. Among them, Benjamin Koen’s article (“‘My Heart Opens and My Spirit Flies’: Musical Exemplars of Psychological Flexibility in Health and Healing”) explores the analytic utility of “psychological flexibility” for understanding cultural and clinical contexts of health and healing. Drawing on psychological anthropology and medical ethnomusicology, and based on his research in Tajik Badakhshan, Koen examines how aspects of local musical forms are one of several forms (among them: poetry, prayer, environment) that prime “psychological flexibility” and lend insight into healing processes. In addition, Avi Shoshana’s article (“Role Play and ‘As If’ Self in Everyday Life”) explores the “long-term influences of role-playing dynamics” at a Boarding School for Gifted Disadvantaged in Israel, a state-run school that aims to socially integrate Jewish immigrants from Islamic nations into Israeli society. Through analyses of government protocols and in-depth interviews, Shoshana examines how graduates of the school experience their “giftedness” and sense of self. Emphasizing the self concept, he shows how “the connection… between psychology, national culture, and political orders has critical implications for psychological anthropology.”

Psychosomatic Medicine 75(5) includes studies of the relation between socioeconomic status and inflammation among adolescents (Pietras and Goodman); the association of positive and negative emotions with pain perception (Finan et al.); psychosocial influences on atherosclerosis in women (Zimmerman-Viehoff, et al.); and the relation among social integration, emotional support, and mortality risk (Barger).

This issue of Science as Culture 22(2) focuses on energy transitions, energy policy, and energy justice, with an introduction by Clark A. Miller, Alastair Iles & Christopher F. Jones, and articles by David Hess, Sheila Jasanoff & Sang-Hyun Kim, among others.