In the Journals

In the Journals May 2015 – Part 1

Hi all, here’s part one of this month’s roundup. Enjoy.


American Ethnologist

Ethnography for aging societies: Dignity, cultural genres, and Singapore’s imagined futures
Michael M. J. Fischer

Social theory generated in and about Singapore lies in psychic depths and archive fevers of an immigrant society subjected to accelerated social changes that devalue the lives of those marked by aging. Drawing on ethnographic fieldwork in Singapore, weaving together four kinds of data sets—gerontology psychiatric research and intervention; changing ritual forms; analytically phenomenological, paraethnographic theater and stories; and student video and drama projects—I argue that new literacies, pedagogies, and practices can foster enriched community life in posttraumatic, aging societies. Focusing on meaning and affect, and referencing Derrida on hauntology, archive fever, sur-vie, and grammatology (as syntax of social configurations within which aging occurs, or, sociocultural texts, narratives, and symbols), I build on the ethnographic literatures on aging and explore strong metaphors of monstrous history (taowu), ghosts (hantu), obliviousness brought by prosperity (fat years), and intercultural repetition compulsions of unfilial children (Lear).

Global health partnerships, governance, and sovereign responsibility in western Kenya
Hannah Brown

The delivery of resources to citizens in the global South is increasingly managed through international partnerships. As systems of plural governance, such arrangements are characterized by alignments, accommodations, and conflicts between partners’ respective interests. This article focuses on partnerships between the Kenyan Ministries of Health and organizations funded by PEPFAR (the President’s Fund for AIDS Relief), drawing on fieldwork with Kenyan government health managers. These partnerships were based on a separation between the ability to provide resources and the right to administer them. For Kenyans, partnerships animated a politics of sovereign responsibility in which they often felt a deep sense of managerial disenfranchisement. For their foreign collaborators, partnership relations legitimized the interventions they organized. This politics of sovereign responsibility reconfigured the importance of the state on the basis of its role in delivering resources within global relations of inequality.

Chimeric globalism: Global health in the shadow of the dengue vaccine
Alex M. Nading

A laboratory-engineered, “chimeric” dengue fever vaccine entered late-stage clinical trials in the late 2000s. One possible way of interpreting the arrival of a technology like this is to see it as the end point of a unified global project. Alternatively, it can be understood as a “cosmopolitical event.” Instead of reflecting unity, cosmopolitical events magnify social and technical differences, and they afford space to contemplate alternative forms of life. Drawing on fieldwork with dengue researchers in Puerto Rico, Nicaragua, and Cuba, I argue that the chimera appeared at a liminal moment in dengue science. It prompted researchers to contemplate how the divergent logics of pharmaceutical capital, humanitarianism, and biosecurity shaped their work as well as to imagine how that work might otherwise proceed. I conclude by suggesting that attention to cosmopolitical events puts the anthropology of global health into closer conversation with analyses of other global phenomena.



“[A]s lightly as two thoughts”: Motion, Materialism, and Cavendish’s Blazing World
Anne M. Thell

Published as the companion piece to Observations upon Experimental Philosophy (1666), Margaret Cavendish’s fantastical travelogue Blazing World (1666) dramatizes and interrogates many of the ideas that the author put forth in her philosophical writing. Cavendish might have chosen the travel genre as the companion piece to her treatise on natural philosophy for a variety of reasons. One primary motivation, this essay argues, is that travel has intriguing thematic and epistemological links to her organic-materialist theory of the universe. Indeed, travel is built into Cavendish’s ontology: motion is a precondition for being and knowing. With this in mind, Blazing World’s engagement with the voyage genre becomes particularly important. At the same time, Blazing World is more resolutely experimental than Observations in that it investigates the possible loopholes and ambiguities of her materialist theory of nature. Cavendish is fascinated by how material bodies compose ideas, and how ideas take material form, and it is some of her recurring questions about the materiality and mobility of thought that she explores in Blazing World.

Toward a Minor Science Fiction: Literature, Science, and the Shock of the Biophysical
Tom Idema

Following a recent scholarly trend that conceives of science fiction (SF) as a complement to science and technology studies, this essay builds on Gilles Deleuze and Félix Guattari’s concept of minor literature to analyze SF as a mode of biophysical, not just social, experimentation. Minor SF experiments with scientific elements and potentials to embed culture and the human body in unstable biophysical micro-and macro-environments. This approach will be illustrated by analyzing Greg Bear’s novels Blood Music (1985) and Darwin’s Radio (1999) in which humanity undergoes radical transmutations as a result of viral genetic infections.

Present Signs, Dead Things: Indexical Authenticity and Taxidermy’s Nonabsent Animal
Helen Gregory, Anthony Purdy

Contemporary art’s recent turn to taxidermy as a sculptural medium aims both to unsettle earlier traditions of realist taxidermy and to allow new explorations of the troubling authenticity derived from the recycling of animal bodies. Developing an analogy between the preserved and mounted animal skin and Roland Barthes’s realist account of the photograph as an emanation of the referent, this essay turns from art to literature to introduce a third, mediating term, dermography, in response to the insistent presence of skin in the questions raised by the new taxidermy. The authors propose the ontological category of the nonabsent animal as an aid to understanding a temporally defined punctum associated with an authenticity grounded in the index.



Being-in-dialysis: The experience of the machine–body for home dialysis users
Rhonda Shaw

New Zealand leads the world in rates of home dialysis use, yet little is known about the experience of home dialysis from the patient’s perspective. This article contributes to the literature on the self-care of dialysis patients by examining the relevance of the concept of the machine–body and cyborg embodiment for the lived experience of people with end-stage renal failure. The article, which presents a discussion of 24 in-depth interviews undertaken between 2009 and 2012, shows that although dialysis therapy is disruptive of being and time, study participants experience home dialysis in terms of flexibility, control and independence. While they do not use the term machine–body as a descriptor, the concept resonates with felt experience. Data also indicate that positive experience of home dialysis is relative to socio-economic positioning and the lived relation of patients to others, necessitating further research to examine these factors.

Universal cures for idiosyncratic illnesses: A genealogy of therapeutic reasoning in the mental health field
Johanne Collin

Over the past decades, there has been a significant increase in prescriptions of psychotropic drugs for mental disorders. So far, most of the explanations of the phenomenon have focused on the process of medicalization, but little attention has been cast towards physicians’ day-to-day clinical reasoning, and the way it affects therapeutic decision-making. This article addresses the complex relationship between aetiology, diagnosis and drug treatment by examining the style of reasoning underlying prescribing practices through an historical lens. A genealogy of contemporary prescribing practices is proposed, that draws significant comparisons between 19th-century medicine and modern psychiatry. Tensions between specific, standardized cures and specific, idiosyncratic patients have been historically at play in clinical reasoning – and still are today. This inquiry into the epistemological foundations of contemporary drug prescription reveals an underlying search for scientific legitimacy.

On resilience and acceptance in the transition to palliative care at the end of life
John I MacArtney, Alex Broom, Emma Kirby, Phillip Good, Julia Wootton, Patsy M Yates, and Jon Adams

Specialist palliative care is a prominent and expanding site of health service delivery, providing highly specialised care to people at the end of life. Its focus on the delivery of specialised life-enhancing care stands in contrast to biomedicine’s general tendency towards life-prolonging intervention. This philosophical departure from curative or life-prolonging care means that transitioning patients can be problematic, with recent work suggesting a wide range of potential emotional, communication and relational difficulties for patients, families and health professionals. Yet, we know little about terminally ill patients’ lived experiences of this complex transition. Here, through interviews with 40 inpatients in the last few weeks of life, we explore their embodied and relational experiences of the transition to inpatient care, including their accounts of an ethic of resilience in pre-palliative care and an ethic of acceptance as they move towards specialist palliative care. Exploring the relationship between resilience and acceptance reveals the opportunities, as well as the limitations, embedded in the normative constructs that inflect individual experience of this transition. This highlights a contradictory dynamic whereby participants’ experiences were characterised by talk of initiating change, while also acquiescing to the terminal progression of their illness.

Education as networking: Rethinking the success of the harm reduction policy of Taiwan
Jia-shin Chen

The harm reduction policy of Taiwan has been considered a success. However, the HIV incidence among injection drug users declined before the nationwide needle and syringe program and drug substitution treatments were implemented. Thus, other factors in the policy might have contributed to its success. Some authors have suggested that education may have played a pivotal part. In this research, the purported significance of education in the success of the policy is conceptualized by reviewing the studies on harm reduction in Taiwan and reflecting upon my own fieldwork. Moreover, relevant literature is used as reference to reformulate this notion of education. This article shows that harm reduction education may be conducted in numerous forms, most of which are non-formal, improvisational, and contingent. Non-governmental organizations may play a role, but more actors, strategies, infrastructures, and interactions should be considered. This article draws from actor-network theory and refines the current thesis that attributes the policy success to education by utilizing three reflections, namely, appreciating materiality and spatiality, recognizing covert actors in the networking, and treating education as an outcome rather than a means. In conclusion, looking at education as a form of networking offers theoretical insight that increases understanding of its participants, mechanisms, processes, and permutations.

The role of assessment packages for diagnostic consultations: A conversation analytic perspective
Camilla B Rossen, Niels Buus, Egon Stenager, and Elsebeth Stenager

This article reports a conversation analysis of assessment package consultations. Healthcare delivery packages belong to a highly structured mode of healthcare delivery, in which specific courses of healthcare interventions related to assessment and treatment are predefined, both as to timing and content. Assessment packages are widely used in an increasing number of medical specialities; however, there is a lack of knowledge about how packaged assessment influences the interaction between doctor and patient. In this study, we investigate the final consultation in assessment packages, which is when the final clarification of the patient’s symptoms takes place. The primary data of the study were eight audio recordings of consultations, and the secondary data were ethnographic field descriptions. In most consultations, packaged assessment was a resource as it provided fast and efficient clarification. In most cases, clarification was treated as good news since it either confirmed the absence of a serious disease or resulted in a diagnosis leading to relevant treatment offers. However, in some cases, clarification was not perceived as good news. This was the case in consultations with patients whose goal was to leave the consultation with clarification in the form of a definite diagnosis, but who were not offered such clarification. These patients negotiated the outcome of the consultation by applying implicit and explicit pressure, which induced the doctors to disregard the boundaries of the package and offer the patient more tests. The study highlights some of the problems related to introducing narrow, specialized package assessment.

Postpartum depression in refugee and asylum-seeking women in Canada: A critical health psychology perspective
Amy Brown-Bowers, Kelly McShane, Karline Wilson-Mitchell, and Maria Gurevich

Canada has one of the world’s largest refugee resettlement programs in the world. Just over 48 percent of Canadian refugees are women, with many of them of childbearing age and pregnant. Refugee and asylum-seeking women in Canada face a five times greater risk of developing postpartum depression than Canadian-born women. Mainstream psychological approaches to postpartum depression emphasize individual-level risk factors (e.g. hormones, thoughts, emotions) and individualized treatments (e.g. psychotherapy, medication). This conceptualization is problematic when applied to refugee and asylum-seeking women because it fails to acknowledge the migrant experience and the unique set of circumstances from which these women have come. The present theoretical article explores some of the consequences of applying this psychiatric label to the distress experienced by refugee and asylum-seeking women and presents an alternative way of conceptualizing and alleviating this distress.


Health and Place

Neighborhood socioeconomic context and change in allostatic load among older Puerto Ricans: The Boston Puerto Rican health study
Marcia P. Jiménez, Theresa L. Osypuk, Sandra Arevalo, Katherine L. Tucker, Luis M. Falcon

Neighborhood context may influence health and health disparities. However, most studies have been constrained by cross-sectional designs that limit causal inference due to failing to establish temporal order of exposure and disease. We tested the impact of baseline neighborhood context (neighborhood socioeconomic status factor at the block-group level, and relative income of individuals compared to their neighbors) on allostatic load two years later. We leveraged data from the Boston Puerto Rican Health Study, a prospective cohort of aging Puerto Rican adults (aged 45–75 at baseline), with change in AL modeled between baseline and the 2nd wave of follow-up using two-level hierarchical linear regression models. Puerto Rican adults with higher income, relative to their neighbors, exhibited lower AL after two years, after adjusting for NSES, age, gender, individual-level SES, length of residence, and city. After additional control for baseline AL, this association was attenuated to marginal significance. We found no significant association of NSES with AL. Longitudinal designs are an important tool to understand how neighborhood contexts influence health and health disparities.

Association of food environment and food retailers with obesity in US adults
Renfei Yan, Nathaniel D. Bastian, Paul M. Griffin

The food environment has been shown to be a factor affecting the obesity rate. We studied the association of density of food retailer type with obesity rate in U.S. adults in local regions controlling for socioeconomic factors. Parametric nonlinear regression was used on publically available data (year=2009) at the county level. We used the results of this association to estimate the impact of the addition of a new food retailer type in a geographic region. Obesity rate increased in supercenters (0.25–0.28%) and convenience stores (0.05%) and decreased in grocery stores (0.08%) and specialized food stores (0.27–0.36%). The marginal measures estimated in this work could be useful in identifying regions where interventions based on food retailer type would be most effective.

How community physical, structural, and social stressors relate to mental health in the urban slums of Accra, Ghana
Meredith J. Greif, F. Nii-Amoo Dodoo

Urban health in developing counties is a major public health challenge. It has become increasingly evident that the dialog must expand to include mental health outcomes, and to shift focus to the facets of the urban environment that shape them. Population-based research is necessary, as empirical findings linking the urban environment and mental health have primarily derived from developed countries, and may not be generalizable to developing countries. Thus, the current study assesses the prevalence of mental health problems (i.e., depression, perceived powerlessness), as well as their community-based predictors (i.e., crime, disorder, poverty, poor sanitation, local social capital and cohesion), among a sample of 690 residents in three poor urban communities in Accra, Ghana. It uncovers that residents in poor urban communities in developing countries suffer from mental health problems as a result of local stressors, which include not only physical and structural factors but social ones. Social capital and social cohesion show complex, often unhealthy, relationships with mental health, suggesting considerable drawbacks in making social capital a key focus among policymakers.

Urban political ecologies of informal recyclers׳ health in Buenos Aires, Argentina
Kate Parizeau,

Buenos Aires׳ informal recyclers (cartoneros) confront multiple health hazards in their work. Based in a survey with (n=397) informal recyclers, this study establishes that these workers experience uneven health landscapes as evidenced through their health outcomes, the social determinants of their health, and their living and working environments. I argue that the analytical framework of urban political ecology can provide insights to the ways that the urban environments where cartoneros live and work are socially-constructed phenomena, drawing on concepts of crisis, metabolism, and multi-scalar analyses.

‘Therapeutic landscapes’ and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design
Victoria J. Wood, Wil Gesler, Sarah E. Curtis, Ian H. Spencer, Helen J. Close, James Mason, Joe G. Reilly

We examine emotional reactions to changes to medical spaces of care, linked with past experiences. In this paper we draw on findings from a qualitative study of the transfer of psychiatric inpatient care from an old to a newly built facility. We show how the meanings attributed to ‘therapeutic landscapes’ from one׳s past can evoke emotions and memories, manifesting in ideas about nostalgia, solastalgia, salvage and abandonment, which can impinge on one׳s present therapeutic experience. We reflect on how consideration of these ideas might contribute to better future design of psychiatric inpatient facilities and the wellbeing of those using them.

“This place has given me a reason to care”: Understanding ‘managed alcohol programs’ as enabling places in Canada
Joshua Evans, Dyanne Semogas, Joshua G. Smalley, Lynne Lohfeld

For several decades, the emphasis on abstinence within homeless support systems has presented significant barriers to care for those who continue to use alcohol or drugs further marginalizing them in terms of housing and health/social services. In response, health care specialists and policymakers have recommended the integration of harm reduction philosophies and interventions into system-level responses to end homelessness. Managed alcohol programs (MAPs) have been developed to this end and have demonstrated positive results. While recent studies of MAPs have focused attention on reductions in alcohol related harms few have examined their meaning from the perspective of clients or considered the role of place. In this paper, we utilize the ‘enabling places’ frameworks to identify the place-bound properties that make a difference in the recovery journeys of clients. Drawing on in-depth interviews with clients from one program we develop a description of MAPs as enabling places that afford the elemental resources for personal recovery.

The impact of regional economic reliance on the tobacco industry on current smoking in China
Tingzhong Yang, Ross Barnett, Ian R.H. Rockett, Xiaozhao Y. Yang, Dan Wu, Weijun Zheng, Lu Li

The purpose of this study was to conduct a preliminary assessment of province of residence and other contextual factors on the likelihood of being a current smoker in China. A cross-sectional, multistage sampling process was used to recruit participants, and their smoking status and sociodemographic characteristics were obtained through face-to-face interviews. The contextual variables were retrieved from a national database. Multilevel logistic regression analysis was performed to assess the impact of provincial economic reliance on the tobacco industry, as well as individual-level characteristics, on the likelihood of being a current smoker. Participants totaled 20,601 from 27 cities located in 26 of the 31 municipalities/provinces in China. Overall smoking prevalence was 31.3% (95% CI: 19.3–33.2%), with rates being highest in Yinchuan City in Ningxia Province (49.8%) and lowest in Shanghai (21.6%). The multilevel analysis showed an excess likelihood of being a current smoker for individuals living in provinces with the highest rate of cigarette production relative to those with the smallest (p<0.001). Findings underscore the importance of restricting cigarette production and regulating the marketing of tobacco products in China.


Social Theory & Health

Fabricated data bodies: Reflections on 3D printed digital body objects in medical and health domains
Deborah Lupton

The advent of 3D printing technologies has generated new ways of representing and conceptualising health and illness, medical practice and the body. There are many social, cultural and political implications of 3D printing, but a critical sociology of 3D printing is only beginning to emerge. In this article I seek to contribute to this nascent literature by addressing some of the ways in which 3D printing technologies are being used to convert digital data collected on human bodies and fabricate them into tangible forms that can be touched and held. I focus in particular on the use of 3D printing to manufacture non-organic replicas of individuals’ bodies, body parts or bodily functions and activities. The article is also a reflection on a specific set of digital data practices and the meaning of such data to individuals. In analysing these new forms of human bodies, I draw on sociomaterialist perspectives as well as the recent work of scholars who have sought to theorise selfhood, embodiment, place and space in digital society and the nature of people’s interactions with digital data. I argue that these objects incite intriguing ways of thinking about the ways in digital data on embodiment, health and illnesses are interpreted and used across a range of contexts. The article ends with some speculations about where these technologies may be headed and outlining future research directions.

Public access to NHS financial information: From a freedom of information regime to full open-book governance?
Sean Tunney and Jane Thomas

This article investigates the access that health professionals, researchers, journalists and, ultimately, the public have to review spending in the English National Health Service (NHS). The ability of news organisations to inform debate and decision-making, particularly when hospitals face financial constraints, relies on accessible data. Theorists such as Patrick Dunleavy have suggested that developments in information communications technology induce a dialectical movement, involving changing governance and increasing transparency. Drawing on this premise, the article reviews the extent to which the NHS has moved from a ‘freedom of information regime’ to one of ‘full open-book governance’. Its methodology includes a combination of documentary and freedom of information data analysis, as well as in-depth interviews with directors of commissioning and provider services and national agencies. It argues that, while increased dissemination of information might be consistent with the government’s digital agenda, the NHS’s quasi-market operation and its relationship to the Freedom of Information Act mean that significant data remain inaccessible or costly to obtain.

Is psychiatry dying? Crisis and critique in contemporary psychiatry
Alastair Morgan

In the wake of the publication of DSM-5, the debate around the validity, usefulness and meaning of psychiatric categories has revived to an extent that is reminiscent of the battles over psychiatry’s legitimacy waged in the 1960s and 1970s. However, what is distinctive about the current crisis of legitimacy are the multiple and varied critical positions that are deployed against a psychiatry that is uncertain about its own central paradigm. In this article, I outline five critical positions that respond to the contemporary crisis in psychiatry and that point towards different directions for the future of psychiatry. Finally, I draw some conclusions about the possibilities of a paradigm shift within psychiatry and the prospects for the survival of a different discipline in the twenty-first century.

Diagnosis at work – On sick leave in Sweden
Lena Eriksson

The article explores how understandings of patients with symptom diagnoses, notably fibromyalgia, are shaped by the introduction of a new medical decision-making support tool used to assess patients’ ’work capacity’, together with a revision of the Swedish social insurance. Findings from two recently concluded empirical studies are used to demonstrate how notions of ’the social’ are mobilised to undercut patients’ claims to medical legitimacy and right to sick benefits. Interviews with medical professionals, civil servants and social insurance case officers indicate that fibromyalgia patients’ clinical narratives should demonstrate ordered social circumstances if their symptoms are to be categorised as belonging to a ’medical’ sphere and thus fall within the remit of the social insurance. The main determinant in this categorisation was if patients were thought to be capable of functioning in a workplace. The workplace as constituted through the interviews was a site that removed patients from the perilous domain of ’social circumstances’ and placed them in an arena in which their symptoms, while still unsignified, could be understood as affecting ’work capacity’.

Role theory and the practice of interprofessional education: A critical appraisal and a call to sociologists
Barret Michalec and Frederic W Hafferty

The stated goals – and therefore manifest functions – of Interprofessional Education (IPE) are to bring students of various health professions together to cultivate mutual understanding and respect for each occupation’s role(s) and foster a culture of collaboration and teamwork to promote more effective and efficient care. Yet, there are telling gaps within IPE literature regarding the application of role theory to IPE pedagogy and research. In this work, we apply a sociological lens and the tenets of role theory to identify and analyze: (a) the apparent tensions nested within IPE aims with respect to issues of role specificity and role blurring; (b) the lack of attention paid to possible role adjustment strategies utilized by IPE students; (c) ambiguities within the IPE (and IPC) literature regarding the role(s) of the patient, including a failure to adequately acknowledge the status hierarchy of health-care delivery; and (d) how IPE may serve as a catalyst to reframe understandings of the physicians as ‘team leader’. In addressing these issues, we suggest discipline-specific qualities that sociologists bring to IPE research, and future directions and applications for sociologists interested in exploring elements of IPE.

The gap of masculinity in the research on HIV among men who have sex with men: A review of quantitative literature and theoretical contributions on gender and masculinity approaches
Àngel Gasch Gallén and Concepción Tomás

HIV transmission among men who have sex with men (MSM) is still expanding globally. A wide myriad of factors that determine sexual risk practices assumption have been identified. Traditional masculine gender norms have been indicated as a possible determinant of risk practices performance among MSM. To identify how quantitative and mixed research values masculinities and their role in HIV transmission practices, a literature review was conducted. Results found that quantitative and mixed research highlighted situations related to HIV transmission in three areas: factors influencing perception and motivations for risk practices engagement; environmental influences facilitating risk taking and the description of new ways to take risks. Quantitative and mixed research took into account masculinity only related to hegemonic traits, both in the risk situations explanations described in the studies and in the measurement instruments used. Although interest on masculinity as a determinant of risk practices in research is increasing, appropriate tools to measure and analyze how masculinity is playing in these arenas are limited and tend to homogenize traits related to masculinity. New approaches, regarding the diversity of masculinities, identity constructions and different sexual interaction ways, as unequal and power relations among men, are needed to better understand and frame HIV transmission among MSM.


Theory, Culture and Society

Italian Operaismo and the Information Machine
Matteo Pasquinelli

The political economy of the information machine is discussed within the Marxist tradition of Italian operaismo by posing the hypothesis of an informational turn already at work in the age of the industrial revolution. The idea of valorizing information introduced by Alquati (1963) in a pioneering Marxist approach to cybernetics is used to examine the paradigms of mass intellectuality, immaterial labour and cognitive capitalism developed by Lazzarato, Marazzi, Negri, Vercellone and Virno since the 1990s. The concept of machinic by Deleuze and Guattari (1972, 1980) is then adopted to extend Marx’s analysis of the industrial machine to the algorithms of digital machines. If the industrial machine can be described as a bifurcation of the domains of energy and information, this essay proposes to conceive the information machine itself as a further bifurcation between information and metadata. In conclusion, the hypothesis of the society of metadata is outlined as the current evolution of that society of control pictured by Deleuze (1990) in relation to the power embodied in databases.

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