Science, Medicine, and Anthropology
Here’s comes the first round of what you’ll find ‘In the Journals’ from November. Apart from the listings below, also see the Somatosphere post on a Special Issue in Theory, Culture and Society on Transdisciplinary Problematics, which you’ll find here.
Helen Mary McDonald
To understand the workings of medicine, healing, placebo, belief, and rationality, medical anthropologists need to pay attention to the complex relations of various forms of revelation, contemplation, and rejoining revelation that attach to illness and healing. In this article two performances of a healing technique located in the agricultural plain of Chhattisgarh, central India, are compared: one representing scientific rationality; the other ‘blind’ superstition. In both performances the practitioner’s aim is to reveal: the local healer reveals witchcraft objects from the afflicted body; the local rationalist society reveals the healer’s technique as a fraudulent trick. Each performance shares ‘an aesthetics of revelation’—they rely on seeing or revealing to obtain their social effect. The interplay between forms of revelation, a reliance on aesthetics for the revelation, and the ways of seeing can indicate how distinctions are made (or not) between doctor and quack, expertise and gimmickry, and truth and falsehood.
Tom Widger
Suicide prevention efforts in Asia have increasingly turned to ‘quick win’ means restriction, while more complicated cognitive restriction and psychosocial programs are limited. This article argues the development of cognitive restriction programs requires greater consideration of suicide methods as social practices, and of how suicide cognitive schemata form. To illustrate this, the article contributes an ethnographically grounded study of how self-poisoning becomes cognitively available in Sri Lanka. I argue the overwhelming preference for poison as a method of self-harm in the country is not simply reflective of its widespread availability, but rather how cognitive schemata of poison—a ‘poison complex’—develops from early childhood and is a precondition for suicide schemata. Limiting cognitive availability thus requires an entirely novel approach to suicide prevention that draws back from its immediate object (methods and causes of self-harm) to engage the wider poison complex of which suicide is just one aspect.
Dignity in Practice: Day-to-Day Life in Intensive Care Units in Western Europe
Gitte H. Koksvik
Dignity is a key concept in contemporary health care ethics, but the practical meaning of dignity in care remains unclear. In this article, I show that in practice, different and possibly conflicting notions of what dignity means are engaged simultaneously in the care of critical patients. The empirical data is based on ethnographic fieldwork conducted in three separate intensive care units in three European countries, Spain, Norway, and France, in the spring of 2014. Four weeks were spent at each site. Using participant observations and semi-structured interviews with 24 intensive care unit staff, I illustrate how the ideal of patient dignity is carried out in practice in the daily life of these units.
Nicola Bulled
Despite constitutional obligations to provide clean water to all citizens in South Africa, access to water and related services remains highly contested. The discord between constitutional promises and lived realities of water access, particularly through national infrastructure, provides a platform on which to examine Foucauldian notions of biopolitics, the control of populations through technologies of governing. Drawing on the situations of residents in the rural Vhembe district in the north eastern corner of the country, I examine how individuals conceptualize the relationship that exists between citizen and state and the responsibilities of each in post-Apartheid South Africa as it relates to water access. In addition, I describe strategies employed throughout South Africa to voice rights to water and how these approaches are perceived. Finally, I consider how the three primary forms of ‘water citizenship’—citizen, agent, and subject—influence the current and future health of vulnerable residents.
Roberto Beneduce
Based on narratives of asylum-seekers from sub-Saharan Africa in northern Italy, in this article I analyze the narrative strategies used by immigrants to meet the eligibility criteria established by asylum law. For many of them, this means “arranging” biographical details within what I call “a moral economy of lying.” The first question I discuss is what types of experience and ‘subject positions’ these narrative strategies reveal or generate. I then examine the arbitrariness and the bureaucratic violence of the asylum evaluation process, and the role of these procedures in the making of nation-language and current technologies of citizenship. Finally, I consider the politics of testification, recognition, and memory these discourses and practices combine to shape. I analyze these issues from an historical point of view of the politics of identity, truth, and falsehood as imposed in a recent past by colonizers onto the colonized.
Translating ‘Asian’ Modes of Healing and Biomedicine
Margaret Sieboom-Faulkner
This review article discusses the ‘translation of Asian modes of healing and medicine’ in six recently published books by raising seven questions. They serve both to review the volumes and to ask how we have moved from understanding systems of healing in terms of tradition and modernity, science and nonscience, globalization and locality, innovation and cultural heritage, to translating them in terms of assemblages, products, modes of resistance, social (dis-)harmony, and ecological balance. The questions span subjects ranging from the meaning of ‘Asian’ in Asian modes of healing, the object of healing and classifications of systems of healing to their relation with ‘biomedicine,’ modernization and the state, the extents to which communities share healing tradition, and their existential meaning in context.
Science, Technology, & Human Values
An Illusory Consensus behind GMO Health Assessment
Sheldon Krimsky
Prominent scientists and policymakers assert with confidence that there is no scientific controversy over the health effects of genetically modified organisms (GMOs)—that genetically modified crops currently in commercial use and those yet to be commercialized are inherently safe for human consumption and do not have to be tested. Those who disagree are cast as “GMO deniers.” This article examines scientific reviews and papers on GMOs, compares the findings of professional societies, and discusses the treatment of scientists who have reported adverse effects in animal feeding experiments. This article concludes by exploring the role that politics and corporate interests have had in distorting an honest inquiry into the health effects of GMO crops.
Strategic Science Translation and Environmental Controversies
Alissa Cordner
In contested areas of environmental research and policy, all stakeholders are likely to claim that their position is scientifically grounded but disagree about the relevant scientific conclusions or the weight of the evidence. In this article, I draw on a year of participant observation and over 110 in-depth interviews, with the case study of controversial chemicals used as flame retardants in consumer products. I develop the concept of strategic science translation (SST), the process of interpreting and communicating scientific evidence to an intended audience in order to advance certain goals and interests. Engaging in selective, interpretive, or inaccurate SST allows competing stakeholders to bolster their arguments, strengthen their authority, and inspire change regarding a policy-relevant issue. Because stakeholders deploy imbalanced resources when they participate in contested environmental fields, their actions in those fields and the resulting policy outcomes often reduce not to the settling of scientific truths but to power differentials.
Translating Science to Benefit Diverse Publics – Engagement Pathways for Linking Climate Risk, Uncertainty, and Agricultural Identities
Peat Leith and Frank Vanclay
We argue that for scientists and science communicators to build usable knowledge for various publics, they require social and political capital, skills in boundary work, and ethical acuity. Drawing on the context of communicating seasonal climate predictions to farmers in Australia, we detail four key issues that scientists and science communicators would do well to reflect upon in order to become effective and ethical intermediaries. These issues relate to (1) the boundary work used to link science and values and thereby construct public identities, (2) emplacement, that is, the importance of situating knowledge in relation to the places with which people identify, (3) personal and organizational processes of reflexivity, and (4) the challenges of developing and maintaining the social and political capital necessary to simultaneously represent people’s identities and lifeworlds and the climate systems that affect them. Through a discourse analysis of in-depth interviews with Australian agro-climatologists, we suggest that three distinct “modes of extension” are apparent, namely, discursive, conceptual, and contextual. Our participants used these three modes interdependently to create knowledge that has salience, credibility, and legitimacy. They thereby generated new narratives of place, practice, and identity for Australian agriculture.
Advertising Nanotechnology: Imagining the Invisible
Norah Campbell, Cormac Deane and Padraig Murphy
Advertisements for high-technology products and services visualize processes and phenomena which are unvisualizable, such as globalization, networks, and information. We turn our attention specifically to the case of nanotechnology advertisements, using an approach that combines visual and sonic culture. Just as phenomena such as complexity and networks have become established in everyday discourse, nanotechnology seizes the social imaginary by establishing its own aesthetic conventions. Elaborating Raymond Williams’ concept of structures of feeling, we show that in visualizing nanotechnology, its stakeholders employ spaces, verbs, and objectsof feeling. These favorable nanotechnology structures of feeling are woven into the social imaginary, recursively producing the reality they describe.
Sociology of Low Expectations: Recalibration as Innovation Work in Biomedicine
John Gardner, Gabrielle Samuel and Clare Williams
Social scientists have drawn attention to the role of hype and optimistic visions of the future in providing momentum to biomedical innovation projects by encouraging innovation alliances. In this article, we show how less optimistic, uncertain, and modest visions of the future can also provide innovation projects with momentum. Scholars have highlighted the need for clinicians to carefully manage the expectations of their prospective patients. Using the example of a pioneering clinical team providing deep brain stimulation to children and young people with movement disorders, we show how clinicians confront this requirement by drawing on their professional knowledge and clinical expertise to construct visions of the future with their prospective patients; visions which are personalized, modest, and tainted with uncertainty. We refer to this vision-constructing work as recalibration, and we argue that recalibration enables clinicians to manage the tension between the highly optimistic and hyped visions of the future that surround novel biomedical interventions, and the exigencies of delivering those interventions in a clinical setting. Drawing on work from science and technology studies, we suggest that recalibration enrolls patients in an innovation alliance by creating a shared understanding of how the “effectiveness” of an innovation shall be judged.
Epistemic Commitments: Making Relevant Science in Biodiversity Studies
Céline Granjou and Isabelle Arpin
We contribute to the exploration of diversity in interdisciplinary science by elaborating the notion of epistemic commitments to address researchers’ different views of knowledge that matters and how these views are embedded in research practices and networks. Based on previous science and technology studies and science-policy literature, we define epistemic commitments as reflexive commitments to regimes of relevant research. Drawing on an in-depth enquiry in the case of biodiversity studies in France, we describe four regimes of research, each of them bringing together certain disciplinary approaches and technologies, certain scenarios about environmental changes (from species loss to an explosion of ecological engineering possibilities) and certain contributions to decision making and management. We distinguish between an environmentalist regime, a management-oriented regime, a function-based regime, and an ecoengineering regime. We give insights into how researchers’ commitments to these regimes are shaped, stabilized, and maintained over time, suggesting the coevolution of research practices, practical contributions, and environmental scenarios. We emphasize pluralism rather than hegemony of a type of knowledge over the others. Our results show that environmental research’s diversity does not result only from the complexity of reality itself but is also embedded in various views of scientific advancement, future scenarios, and useful contributions to environmental governance.
On Technological Determinism: A Typology, Scope Conditions, and a Mechanism
Allan Dafoe
“Technological determinism” is predominantly employed as a critic’s term, used to dismiss certain classes of theoretical and empirical claims. Understood more productively as referring to claims that place a greater emphasis on the autonomous and social-shaping tendencies of technology, technological determinism is a valuable and prominent perspective. This article will advance our understanding of technological determinism through four contributions. First, I clarify some debates about technological determinism through an examination of the meaning of technology. Second, I parse the family of claims related to technological determinism. Third, I note that constructivist and determinist insights may each be valid given particular scope conditions, the most prominent of which is the scale of analysis. Finally, I propose a theoretical microfoundation for technological determinism—military–economic adaptationism—in which economic and military competition constrain sociotechnical evolution to deterministic paths. This theory is a special case of a general theory—sociotechnical selectionism—which can be regarded as also including (mild) constructivist theories as special cases. Greater understanding of, respect for, and engagement with technological determinism will enhance the study of technology and our ability to shape our sociotechnical systems.
Toward a multidimensional understanding of culture for health interventions
Asad L. Asad and Tamara Kay
Although a substantial literature examines the relationship between culture and health in myriad individual contexts, a lack of comparative data across settings has resulted in disparate and imprecise conceptualizations of the concept for scholars and practitioners alike. This article examines scholars and practitioners’ understandings of culture in relation to health interventions. Drawing on 169 interviews with officials from three different nongovernmental organizations working on health issues in multiple countries—Partners in Health, Oxfam America, and Sesame Workshop—we examine how these respondents’ interpretations of culture converge or diverge with recent developments in the study of the concept, as well as how these understandings influence health interventions at three different stages—design, implementation, and evaluation—of a project. Based on these analyses, a tripartite definition of culture is built—as knowledge, practice, and change—and these distinct conceptualizations are linked to the success or failure of a project at each stage of an intervention. In so doing, the study provides a descriptive and analytical starting point for scholars interested in understanding the theoretical and empirical relevance of culture for health interventions, and sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes.
Who is on the medical team? Shifting the boundaries of belonging on the ICU
Jason Rodriquez
Medical teamwork promises to improve communication and collaboration in the healthcare industry, yet critics argue teamwork is little more than a new managerial discourse to obscure traditional workplace hierarchies. Based on 300 h of participant-observation and 35 interviews with staff of a medical intensive care unit at an academic medical center, this article argues that teamwork is neither a panacea for coordinating complex care nor is it simply a discourse to control workers; rather, it is an ongoing social activity characterized by boundary-work, negotiation, and resistance over the terms of membership. This study identifies three processual and temporal phases of families’ participation in medical teams: (1) Constructing Teamwork, (2) Deflection and Resistance, and (3) Reintegration. Staff leveraged ambiguities in the meaning of teamwork to manage patients’ family members’ participation on the ICU Team. Family involvement changed in patterned ways that reflected the power staff had to define the team and the character of teamwork. Families participated on the team at admission, but their involvement narrowed considerably as staff implemented diagnostic and treatment plans. When staff determined a patient was appropriate for palliation, families were reintegrated back into a leading role on the team as surrogate decision-makers. This study advances current understandings of medical teamwork, staff-family interactions, and it highlights the value of qualitative methods in social-science research about medicine.
Henry Lucas
Advances in technology have made it possible for many standard diagnostic and health monitoring procedures, traditionally carried out by qualified personnel within medical facilities, to be reliably undertaken by patients or carers in their own homes with a minimum of basic training. There has also been a dramatic increase in the number and diversity of both sources of information on health issues and the possibilities for sharing information and experiences over ICT-based social networks. It has been suggested that these developments have the potential to ‘empower’ patients, reducing their dependence on providers and possibly improving their quality of care by increasing the volume and timeliness of diagnostic data and encouraging active self-management of their condition, for example through lifestyle changes. Perhaps more significantly, it is also seen by many economies with ageing populations as a way to contain high and ever rising healthcare costs.
It has also been suggested that a move to greater self-management supported by expert networks and smart phone technology could improve the treatment of many millions of patients with chronic diseases in low and middle income economies that are also confronting the potential cost implications of epidemiological and demographic transitions, combined with the higher expectations of a more educated and knowledgeable population. There is now limited evidence that some fairly basic e- and mHealth interventions, for example in the areas of MNCH, malaria and HIV/AIDS can have a positive impact, even in resource-poor contexts. The aim here is to explore the extent to which further investment in technology could play a role in the development of an effective and affordable health sector strategy for at least some developing economies. It is suggested that the effectiveness of the approach may be highly dependent on the specific health conditions addressed, the nature of existing health systems and the overall socio-economic and cultural context.
Agency and Mental Health – A Transition to Adulthood Paradox
Steven Hitlin, Lance D. Erickson and J. Scott Brown
Building on calls within the health literature for a deeper engagement with the concept of agency, we utilize nationally representative survey data from the National Longitudinal Study of Adolescent to Adult Health (N = 13,592) to develop an empirical conception of the traditional treatment of health agency focused on two social psychological constructs that build upon current foci on personal control within the stress process model: (1) “subjective vitality” and (2) a forward-looking orientation (“optimism”). We find an interesting paradox: adolescents with higher health-based agency early in the transition to adulthood have significantly higher status attainment (occupational and educational) outcomes, but early mental health advantages disappear over the transition to adulthood. This suggests that while subjective beliefs about health agency put adolescents on trajectories toward higher socioeconomic status, they also set them up for declines in mental health due to unachieved expectations. There seem to be objective upsides and subjective downsides of possessing greater agency in adolescence.
Lisa Eklund and Mona Eklund
This study explores gender, activity, and well-being among people with mental illness attending day centers in Sweden. Based on survey data of 215 attendees, this study applies the concepts of doing gender and regulatory regimes to analyze the relationship between being involved in gendered activities and well-being. The results show that while both male and female participants are involved in gender-neutral activities, men are less likely to engage in women-dominated (WD) activities while women are more prone to engage in men-dominated (MD) activities. Moreover, women involved in MD activities show a positive correlation with well-being, while the same does not hold for men engaging in WD activities. The study concludes that both women and men are “undoing” gender but that women also tend to “re-do” gender, suggesting that gendered regulatory regimes are more permissive to diversified feminist subjectivities than masculine subjectivities.
Between stigma and mother-blame: blind mothers’ experiences in USA hospital postnatal care
Angela Frederick
This study examines instances of discrimination that blind mothers in the USA have experienced at the hands of doctors, nurses and social workers during hospital postnatal care. The author identifies postnatal care as the time when blind mothers are likely to face the most stigmatising interactions with medical staff, as it is when scepticism about their competence as mothers is at its height. The author argues these interactions must be understood within their institutional context in which ideologies of risk and mother-blame are embedded in hospital postnatal practices.
For society, state and self: juggling the logics of professionalism in general practice appraisal
Tom Entwistle and Elaine Matthews
Sociologists repeatedly appeal to notions of altruism, bureaucratisation and self interest in their efforts to explain the changing place of the professions in contemporary society. We treat these three readings as institutional logics that are key to understanding the way in which doctors respond to the appraisal system at the heart of the UK’s approach to revalidation. Our analysis of a survey of 998 general practitioners (GPs) working in Wales finds an altruistic commitment to learning and improvement, bureaucratic demands for reporting information and self-regarding resentment of changes in the occupational package provided by general practice. But the data also demonstrate that the maintenance of the appraisal regime is dependent on the preparedness and capacity of individual GPs to do micro-level institutional work on all fronts.
Contesting modernity: Tobacco use and romanticism among older Dai farmers in Xishuangbanna, China
Xiang Zhao and Gareth Davey
The majority of research about tobacco use in China focuses on Han Chinese, the main ethnic group comprising over 90 per cent of the population, and a paucity of research exists on ethnic minorities. The present study elucidates tobacco use among the Dai people, an ethnic group in Yunnan Province, Southwest China. The study design consisted of interviews and grounded theory methodology in a symbolic interactionist theoretical framework. The categories of the grounded theory revealed tobacco consumption was weaved in a complex web of meanings: social practices, perceptions of health, and work lives as agriculturalists, situated in Dai cultural and social milieu. An important finding was the stage-managing of tobacco as a symbol of ‘tradition’ versus ‘modernity’: Through a process of contested modernity, the older men championed long-standing tobacco customs as representative of Dai heritage and thus their own tobacco use as upholding traditions amid encroaching cultural and societal change in China. These findings are important because little is known about Dai people’s tobacco use and how they are responding to social change. There are also implications for the development of culturally-appropriate tobacco control strategies.
Shining trinkets and unkempt gardens: on the materiality of care
Annemarie van Hout, Jeannette Pols and Dick Willems
The increasing use of telecare will profoundly change nursing care. How to understand these changes is, however, far from clear. This is because (i) studies on telecare seldom consider the situation it replaces, and (ii) current concepts and methods used to study the impact of telecare may not allow us to fully grasp these changes. We suggest that an analysis of the changing materiality of care practices is a suitable way to articulate and reflect on possible concerns. It allows us to compare care practices in the same terms before and after telecare has been introduced. To demonstrate this, we study the materiality of the classical care setting, the nursing house call, to map the situation before telecare is introduced. Building on science and technology studies, we apply four categories as heuristics to analyse materiality in care: signs, dis/enablers (or scripted things), tools and practical arrangements. We leave open the question of how material arrangements could or should be matters of concern in nursing care, and instead argue for studies that give insights into the everyday tinkering with the materiality of care that both nurses and patients need to engage in.
Chronic illness as biographical contingency? Young people’s experiences of asthma
Lee F. Monaghan and Jonathan Gabe
Much research on chronic illness, which views the experience as disruptive, is adult-focused though there is an emerging literature on children’s and young people’s experiences. Drawing on 31 interviews conducted with young people diagnosed with asthma in south-west Ireland, this article contributes to this literature. The sample includes boys (n = 15) and girls (n = 16) aged between 5 and 17 from the Irish Traveller community and the larger settled community. The study also explores the potential value of what might be called biographical contingency. This concept refers to the way in which a chronic illness may be an ‘only sometimes’ problem and takes account of the ‘now you see it, now you don’t’ nature of a condition that varies in terms of its symptoms, meanings and consequences. In concluding, we consider the uses and limitations of this concept and the interpretivist paradigm that typically informs qualitative research on the illness experience.
Context and complexity: the meaning of self-management for older adults with heart disease
Lucy Moore, Julia Frost and Nicky Britten
Self-management policies have presented opportunities for patients with long-term conditions to take control and actively improve their health. However, the work of self-management appears to be packaged in the form of essential and desirable skills and attributes required for success. This article presents the findings of a qualitative study, employing longitudinal diary interviews with 21 patients aged between 60 and 85 years diagnosed with coronary heart disease from three contrasting general practice areas. Drawing on concepts of the care of the self and the reflexive self, this article presents the diversity of self-management practices by older patients in the context of their lifeworld. Illustrated through individual case studies, it clearly identifies where patients are engaged self-managers with the agency, knowledge and self-discipline to modify their behaviour for an improved health outcome. This study highlights their life and illness perspectives as well as those of patients who are burdened with emotional insecurity, comorbidities and caring responsibilities. It shows the spectrum of relationships with health professionals that influence engaged self-management. We suggest that policy initiatives that favour behavioural change neglect social context and the individualised practices that are a necessary response to structural and psychosocial constraints.
Treatment, deterrence or labelling: mentally disordered offenders’ perspectives on social control
Jeremy Dixon
Mentally disordered offenders are a group of service users who experience substantial amounts of control and supervision. This article uses theories of social control to analyse the way in which mechanisms of control are understood by this group. Semi-structured interviews with mentally disordered offenders in England who were subject to a restriction order under the Mental Health Act 1983 (as amended by the Mental Health Act 2007) provided the empirical basis for this study. The offenders had a number of perspectives on the restriction order. Firstly, it was seen as a mechanism for identifying those suffering from a mental disorder and for providing appropriate treatment. Secondly, the restriction order was viewed as a form of disciplinary control through which societal norms might be internalised. Thirdly, it was seen as labelling offenders in a manner that was experienced as limiting and oppressive. A number of research participants were aware that the order acted to limit staff actions. These participants saw the order as a means by which they might shape the support that they received in order to further their own aims. A video abstract of this article can be found at: https://www.youtube.com/watch?v=qwIwDI2sOTY&feature=youtu.be
Christine Holmberg, Katie Whitehouse, Mary Daly and Worta McCaskill-Stevens
Concepts of disease risk and its management are central to processes of medicalisation and pharmaceuticalisation. Through a narrative perspective, this paper aims to understand how such macro-level developments may (or may not) be experienced individually, and how an algorithm that is used for recruitment into a clinical trial may structure individual notions of being ‘at risk’ and ‘in need of treatment’. We interviewed 31 women participating in the Study of Tamoxifen and Raloxifene (STAR), a chemoprevention trial conducted in the US between 1999 and 2006. Interviews were thematically analysed. Women in the study had experienced the threat of breast cancer and felt vulnerable to developing the disease prior to STAR participation. The diagnosis of ‘being at risk’ for cancer through an algorithm that determined risk-eligibility for STAR, opened up the possibility for the women to heal. The trial became a means to recognise and collectivise the women’s experiences of vulnerability. Through medication intake, being cared for by study coordinators, and the sense of community with other STAR participants, trial participation worked to transform women’s lives. Such transformative experiences may nevertheless have been temporary, enduring only as long as the close links to the medical institution through trial participation lasted.
Jan Dirk Blom
Brua is an Afro-Caribbean religion and healing tradition from the southern part of the former Netherlands Antilles. Like other Caribbean healing traditions, it plays a significant role in shaping how individuals experience and express disorders which Western health professionals consider to require psychiatric care. Because little has been published on Brua, and because patients from Aruba, Bonaire, and Curaçao are often reluctant to discuss their commitment to this tradition, they are often misdiagnosed and either over- or undertreated by biomedically trained health professionals. The present paper provides a review of the literature on Brua and its relation to psychiatry. A systematic search was carried out in PubMed, the Ovid database, Google Scholar, and the historical literature. Our search yielded 35 texts on Brua, including three peer-reviewed scientific papers and eight academic theses. From those texts Brua emerges as a holistic patchwork of creolized beliefs and practices which are considered to be both cause and remedy for a wide variety of ailments. Despite the fact that tension between the Brua discourse and Western-oriented psychiatric practice is significant, adherence to Brua does not seem to cause much patient delay in help-seeking. However, belief in Brua as a possible source of mental and physical complaints, as well as patients’ frequent recourse to Brua practices, including the use of hallucinogens, may affect the diagnosis and treatment of mental disorders.
One reply on “In the Journals – November 2015 Part I”
Very helpful, thank you!