In a time when conspiracy theories seem to be flourishing, generally receiving dismissive reactions, this article conversely tries to take them seriously and to consider what they may tell us about contemporary societies. Whereas philosophical discussions turn around the specific definition and delimitation of these theories, anthropologists acknowledge their existence and inscribe them in a broader interpretive complex that includes witchcraft, gossip, rumors, and urban legends. In order to account for their current success, it is necessary to study their felicity conditions on both the emitting and receiving sides by combining cognitive and contextual approaches. The case of the conspiracy theories developed around AIDS in South Africa shows how history can inform their comprehension and reveal the sometimes fine line between paranoid fantasies and actual plots. A final reflection cautions about the increasing tendency, in the social sciences, to assimilate social critique and conspiratorial thinking, using the latter to delegitimize the former.
Altered Vision: Ayahuasca Shamanism and Sensory Individualism
Alex K. Gearin & Oscar Calavia Sáez
Notions of visualism and individualism have long been employed to elucidate the contours of Western subjectivity. It is therefore not surprising to find the indigenous Amazonian shamanic brew ayahuasca being adopted by Australian neoshamanic practitioners as a medicine that provides personalized visions delivering unambiguous moral import. While this adoption represents a radically new style of its practice, ayahuasca drinking emerged from indigenous societies characterized by robust forms of individualism and visualism of a different kind. Indigenous approaches to ayahuasca drinking have emphasized synesthetic and socially partible configurations of personhood while entangling the visionary content of inebriation in a morally ambiguous field of everyday life. In this article, we argue that the individual of ayahuasca neoshamanism reproduces European Enlightenment modes of property ownership by integrating visions into the self as inalienable objects of healing. The article illustrates how ayahuasca vision is a marker of divergent forms of individualism among indigenous Amazonian and Australian neoshamanic groups.
Underground and Over the Sea: More Community Prophylactics in Europe, 1100-1600 (open access)
G Geltner & Claire Weeda
Public health historians have repeatedly shown that the theory, policy, and practice of group prophylactics far predate their alleged birth in industrial modernity, and regularly draw on Galenic principles. While the revision overall has been successful, its main focus on European cities entails a major risk, since city dwellers were a minority even in Europe’s most urbanised regions. At the same time, cities continue to be perceived and presented as typically European, which stymies transregional and comparative studies based at least in part on non- or extra-urban groups. Thus, any plan to both offer an accurate picture of public health’s deeper past and fundamentally challenge a narrative of civilizational progress wedded to Euro-American modernity (“stagism”) would benefit from looking beyond cities and their unique health challenges. The present article begins to do so by focusing on two ubiquitous groups, often operating outside cities and facing specific risks: miners and shipmates. Evidence for these communities’ preventative interventions and the extent to which they drew on humoral theory is rich yet uneven for Europe between the thirteenth and sixteenth centuries. Methodological questions raised by this unevenness can be addressed by connecting different scales of evidence, as this article demonstrates. Furthermore, neither mining nor maritime trade was typically European, thus building a broader base for transregional studies and comparisons.
At the turn of the twentieth century, Faith Tabernacle Congregation’s commitment to medical abstinence was an economically rational practice. To the working poor of Philadelphia, who constituted the earliest members, Faith Tabernacle’s therapy was financially attainable, psychologically supportive, and physically rejuvenating. Orthodox medicine was deficient in these three areas based on the patient narratives (i.e., testimonies) published in the church’s monthly periodical Sword of the Spirit and testimony book Words of Healing. First, some early members spent all their money on orthodox medical care without relief causing significant financial hardship, while others found medical care prohibitive. Second, many early members experienced a great loss of hope because orthodox physicians ended treatment due to chronic or critical illness, both of which were interpreted as psychologically harmful. Third, early members of the church perceived getting physically worse by physicians because of low quality care, which was compounded by low access to orthodox medicine. Faith Tabernacle alternatively provided care that – in the patient narratives of the earliest members – helped them improve and get back to work faster.
Historical Origins of the Personal Belief Exemption to Vaccination Mandates: The View from California
Elena Conis & Jonathan Kuo
A number of states, starting with California, have recently removed all non-medical exemptions from their laws requiring vaccinations for schoolchildren. California was also one of the earliest states to include a broad non-medical, or personal, belief exemption in its modern immunization law, which it did with a 1961 law mandating polio vaccination for school enrollment, Assembly Bill 1940 (AB 1940). This paper examines the history of AB 1940’s exemption clause as a case study for shedding light on the little-examined history of the personal belief exemption to vaccination in the United States. This history shows that secular belief exemptions date back further than scholars have allowed. It demonstrates that such exemptions resulted from political negotiation critical to ensuring compulsory vaccination’s political success. It challenges a historiography in which antivaccination groups and their allies led late-nineteenth and early-twentieth century opposition to vaccination mandates while religious groups drove mid-twentieth century opposition. It also complicates the historiographic idea of a return to compulsion in the late 1960s, instead dating this return a decade earlier, to a time when belief exemptions in polio vaccination mandates helped reconcile the goal of a widely vaccinated population with the sacrosanct idea of health as a personal responsibility.
The Comeback of the IUD in Twenty-First Century USA
Elizabeth Siegel Watkins
From 1995 to 2014, intrauterine devices (IUDs) rose from ranking 10th (out of 11) among contraceptive methods to being the fourth most popular, outnumbered only by the pill, sterilization, and condoms. In 1995, the IUD had been largely abandoned by American doctors; two decades later, major medical associations promoted it as a “first line” method for prospective users of all ages. This paper explains the rapid and dramatic increase in intrauterine contraception by exploring three influential factors from the 1970s-1980s – the Dalkon Shield disaster, the lack of innovation in contraceptive research and development, and the moral panic over teen pregnancy in America – that created circumstances by the early 2000s in which health care providers became more receptive to long-acting reversible contraception. Key thought leaders in obstetrics and gynecology took it upon themselves to rehabilitate the IUD in the court of medical opinion and succeeded in securing professional approval of the device as the initial step in its resurrection.
Journal of the Royal Anthropological Institute (Open Access)
Aadhaar (literally ‘foundation’) is the largest national biometric identification drive the world has witnessed. An Aadhaar is a twelve‐digit ID number linked to its holder’s iris scans, fingerprints, facial photograph, and demographic information in a centralized database. In but a decade, India has expeditiously enrolled over 90 per cent of its billion‐strong population into a Central Identities Data Repository. This essay is an ethnographic consideration of the processes by which Aadhaar enrollees become data, focusing on the sociopolitical valence of biometric data. It argues that the datafication of the body via Aadhaar occasions re‐examinations of – and contestations over – the idea of the individual in postcolonial India, a country often deemed sociocentric in popular and scholarly discourse alike. Further, it suggests that biometric socialization facilitates belonging in a ‘Digital India’, often rendered as a data cosmopolis in emergent technocratic imaginations.
From connection to contagion
This essay proposes that we ‘think data’ with a complex legacy of work, once disavowed and now resurgent in social theory, on crowd formations. I propose this move because social media platforms’ mobilization of data – the extractions, ever‐shifting reaggregations, and micro‐targeting, on the one hand, and our engagements, re‐tweets, acts of sharing, and production of virality, on the other – has fuelled such anxious concern about the very things that animated much crowd theory in the first place. Key among these concerns are the force of emotional contagion and the threat of social dissolution; the composition of ‘the social’ by elements that well exceed the human; and pressing questions about the media through which energetic forces travel, often with lightning speed. What questions might be enabled by attending to the resonance between crowd theory’s ‘anti‐liberal’ preoccupations and contemporary concerns over how social media platforms crowd us?
Data – ova – gene – data
In this essay, I observe that data is valuable not only for what it is, but also for what it will become: that is, that data is a form of potential. I explore two aspects of this by drawing two comparisons with other forms of potential: ova and genes. First, building on ethnographic fieldwork with environmental scientists and technicians in the Brazilian Amazon, I compare data processing with ova donation in the United Kingdom in order to explore how data processing might be considered a form of reproductive labour. I then turn to emergent big data infrastructures in the environmental sciences, and compare the environmental sciences with genomics, in order to gesture towards some critical questions that need to be asked of such open data initiatives. I end with a reflection on comparison as a privileged means of drawing out the forms understood to be latent within data.
Bodies of data: doubles, composites, and aggregates
In this essay, I describe three bodies of data, analysing how relations are drawn between physical, digital, and political composites. Following the phrase ‘getting to know your data self’, my aim is to draw out the kinds of relations people use data to make, and the versions of the body that I find codified in data imaginaries. Thematically, the stories give different accounts of control over data, as the data body is doubled, built out of composites, and aggregated into a body politic.
Where Have All the Heroes Gone? (open access)
Neelima Navuluri, Harris S. Solomon, Charles W. Hargett & Peter S. Kussin
Resilience is defined as the ability and capacity to recover quickly from difficulties or adapt successfully in the face of adversity and social transformation (Barrios 2016; Hall and Lamont 2013; Mendenhall and Wooyoung Kim 2019; Panter-Brick 2014; Wu et al. 2013). The COVID-19 pandemic has prompted disaster conditions for public health care, and has radically intensified the need for adaptive practices of resilience in health care work. In the US, nowhere is this more evident than in intensive care units (ICUs), where there is constant pressure to adapt as surging patient loads, rapidly-changing protocols, and uneven supply of personal protective equipment are dramatically affecting the material conditions faced by all hospital staff …
Patient Engagement, Chronic Illness, and the Subject of Health Care Reform
Mark D. Fleming, Janet K. Shim, Irene Yen, Ariana Thompson-Lastad & Nancy J. Burke
In the United States, in the wake of health care reform, health care systems have been subject to intensifying demands to increase patient engagement, a term that refers broadly to participation in care. We draw from ethnographic research in urban health care safety-net settings in California to examine efforts to increase patient engagement among chronically ill, marginalized patients who have long been disconnected from outpatient care. We suggest that the work of engagement in this context involved getting people to accept the norms of biomedicine while also reworking these norms to account for the complex circumstances of their lives.
The opioid epidemic in the United States is often portrayed as leading to a “pendulum swing” from indiscriminate prescribing toward appropriate use. This portrayal imagines rational-ethical physicians trying to resist irrational-manipulative patients and pharmaceutical companies. Drawing on an ethnography of pain management in U.S. hospital and clinic settings, I suggest instead that chronic pain generates a constantly renewed “emergency affect,” a mutual experience for providers and patients that polarizes decisions toward either medication escalation or patient abandonment. Understanding this “emergency affect” can help provide a path forward through the opioid epidemic to embrace the discomfort of pain management.
Drawing on ethnographic research from Albania, I examine Romani and Balkan Egyptian women’s health inequities. While it has been well documented that Romani people, who constitute Europe’s largest socioracial minority group, experience racism and marginalization, how these forms of social exclusion shape health outcomes in the Balkans remains limited. I argue that racism is a root cause of social and health inequities, and that Romani and Egyptian women experience unique bodily fatigue marked by extreme zor (“difficulty,” “constraint”). An examination of zor can potentially provide an understanding of how racism and marginalization are embodied over time.
Emotion as Motivator: Parents, Professionals and Diagnosing Childhood Deafness
Claire Harris, Susan Hemer & Anna Chur-Hansen
Diagnosing deafness is a culturally situated practice generating considerable research in health sciences but limited work in anthropology. Diagnosis fast-tracks parents into a medical and education pathway but can also create tension for parents and professionals. Drawing on ethnographic fieldwork, we argue that in this biomedical context, emotions are often understood by professionals as impairing for parents, and hence problematic for the treatment process. In contrast emotions are characterized by parents as motivational and tools for decision making on a pathway that is experienced as a source of stress.
Self-medication with Chinese Medicine Online
The internet provides the means for people to play an expanded role in managing their own health. I describe an online group of 325 students seeking to address various health issues through a collaborative “online clinic.” I have coined the term DIO (Do-It-Ourselves) to emphasize the underlying collaboration in this self-care trend. As a living tradition, Chinese medicine is transforming as lay people participate in this process, and their collaborative study in a digital classroom suggests a new style of knowing.
“It Stays Between Us”: Managing Comorbidities and Public/Private Dichotomies in HPTN071 (POPART) Trial Communities (open access)
Lario Viljoen, Hanlie Myburgh & Lindsey Reynolds
In contexts of scarcity, managing comorbidities is a complex process, shaped by divergent understandings of causes, prognoses, and social meanings of illness. Drawing on research with one young South African woman living with HIV and epilepsy, and 13 other people with comorbidities, we describe how concepts of “public” and “private” shape the management of co-morbid conditions. Despite narratives of HIV “normalization,” participants labored to keep their HIV status private, while sharing other illness experiences more publicly. We challenge simple dichotomies between public and private spheres and emphasize the need for more fluid understandings of how people negotiate social space.
In Search of ‘Success’: The Politics of Care and Responsibility in a PrEP Demonstration Project
Lisa Lazarus, Sushena Reza-Paul, Syed Hafeez Ur Rahman & Robert Lorway
We illustrate the lively existence of the notion of success in the unfolding of a PrEP project led by a sex worker organization in India. In what we call the “search for success,” particular attention is placed on the role that care plays among sex workers guiding the project. Drawing on our ethnographic work, we highlight how the search for success underlines particular affective dispositions that are underscored by overlapping temporal registers: in the early stages of fostering adherence; when project fatigue sets in; and as the project draws to a close, in the anticipation of what comes next for the organization.
Medicine Anthropology Theory (Open Access)
From the refrigerator mother theory to more recent comparisons to ‘warrior-heroes’, mothers of children with autism spectrum disorders have been historically categorised as emotionally remarkable. Drawing on my ethnographic fieldwork in Portugal, I explore in this article how mothers politically mobilise emotions, characteristics, and acts usually associated with good mothering, such as maternal love, dedication, and sacrifice. While these socially expected phenomena have been addressed as instruments of the relegation of women to motherhood and care labour, I propose a novel look at the value of affectivity in discourses and practices of care and advocacy. I argue that mothers strategically embody and employ their affectivity as political capital to validate their role as expert caregivers and advocates, creating new opportunities to access leading positions within the autism advocacy movement.
Although many suffering from congenital heart defects (CHDs) have seen their conditions become chronic in Denmark today, the risk of complications, deteriorations, and further surgical interventions often lurk in the future. Building on fieldwork in outpatient clinics in Denmark and the homes of families living with CHDs, I explore the role outpatient encounters play in families’ efforts to understand and navigate the prognoses of CHDs by examining how they become routine punctuations and images of uncertainty, and how they play into families’ efforts to prepare for futures where CHDs might develop negatively while also trying to keep such scenarios at bay. I argue that these encounters exemplify, generate, and tentatively curb the particular uncertainties of living with CHDs. Hence, I suggest that they can be thought of as prognostic calibrations—a conceptual oxymoron that encapsulates the anxiety and uncertainty that I show persist around CHD prognoses despite many efforts by families and healthcare staff to establish routine, a sense of security, and certainty.
As ‘psychosocial interventions’ continue to gain traction in the field of global mental health, a growing critical literature problematises their vague definition and attendant susceptibility to appropriation. In this article, I recast this ill-defined quality as interpretive flexibility and explore its role in processes of translation occurring at the frontlines of care in rural Nepal. Drawing from 14 months of ethnographic fieldwork among community-based psychosocial counsellors, I consider how the broad and flexible notion of the ‘psychosocial problem’ operates as a ‘boundary object’ in transnational mental health initiatives—that is, how it facilitates the collaboration of service users, clinicians, donors, and policymakers in shared therapeutic projects without necessarily producing agreement among these parties regarding the nature of the suffering they address. I suggest that psychosocial interventions may be gaining popularity not despite but precisely because of the lack of a unitary vision of the problems psychosocial care sets out to alleviate. In closing, I reflect on what distinguishes ‘psychosocialisation’ from medicalisation and highlight the limitations of the latter as a critical paradigm for the anthropology of global mental health.
Covid-19 Temporalities: Ruptures of Everyday Life in Urban Burkina Faso
Helle Samuelsen & Lea Paré Toé
Globalisation intensifies global interconnectedness; reorders time and space; and stretches social, political, and economic practices across boundaries. However, globalisation is not a linear process; it takes place in discrete phases of short and concentrated bursts. The COVID-19 pandemic is one such time-space burst, or ‘eruption’. In this paper, we focus on COVID-19 as an ‘emerging epidemic’ from the perspective of citizens in Bobo-Dioulasso, the second-largest city in Burkina Faso. We explore how these citizens experience ruptures of their everyday life due to COVID-19 and how their understandings and responses to the pandemic were shaped in a context of instability and political turbulence. We are inspired by Giddens’s notion of ‘time-space distanciation’, which refers to ‘the condition under which time and space are organized so as to connect presence and absence’. We focus on the temporality of the pandemic by looking at a specific period during the pandemic, during which the government of Burkina Faso introduced a number of restrictions as preventive measures at a time when COVID-19 as a disease was still an absent phenomenon for most people. The pandemic had not (yet) infected large numbers of people in the country and most people did not yet have any experiences of the disease. We argue that the local responses to the pandemic and the various control measures during this period must be understood in the wider context of Burkina Faso’s specific socio-economic, political, and security situations, which are distinctly fragile.
This article traces the infrastructures of suffering under the governance of humanitarian psychiatry to explore how material conditions of war and aid have shaped the politics of trauma and sumud[steadfastness] in Lebanon. Based on 29 months of ethnographic fieldwork undertaken from 2011 to 2013, I look at the expert, economic, and techno-political assemblages of trauma and sumudduring the July War in 2006 and the Syrian refugee crisis in 2011. Mental health experts faced unexpected difficulties in diagnosing war trauma during the July War. This led political actors to claim that these difficulties reflected a general absence of suffering from war and a sign of Lebanese resilience, drawing on economies of sumudin postwar reconstruction. The Syrian refugee crisis however radically transformed the politics of suffering in Lebanon. A new political economy of trauma emerged where the Lebanese now competed with other aid communities to have their past suffering recognised as traumatic. Comparing the relations between violence, aid, and suffering in both instances serves to contextualise and historicise suffering beyond a particular discourse or event. It also serves to highlight the contingencies of suffering rather than its internal and psychic elements.
Based on an analysis of the Meningitis Vaccine Project (MVP), a public-private partnership (PPP) set up to introduce the MenAfriVac® vaccine in African countries, this article examines the failures of an accelerated disease control programme that targeted a highly infectious disease. I argue that the integration of MenAfriVac® into the World Health Organization’s (WHO) Expanded Programme on Immunisation had the effect of reinforcing inequalities in access, in particular during epidemic emergencies. I will also show how vaccine shortages during an outbreak in Niger led to political tensions and to the emergence of a parallel and unregulated ‘black market’ of vaccines.
Race, Racism and Anthropology: Decolonising Health Inequality in a Time of Covid-19
Jordan Christina Ruth Mullard
In the United Kingdom, the government’s failure to consistently record the race and ethnicity of those who have died from COVID-19 and the disproportionate mortality impact of the virus on Black, Asian and Minority Ethnic (BAME) communities speaks to a systemic failure to account for the interplay between the social construction of race and the lived experience of racism, itself presented biologically as ‘poor health’. This failure has run for far longer and far deeper than many would care to admit. In this article, I use my own positionality as a ‘Mixed-Race Black’ woman to argue that the unique place of medical anthropology to sit at the intersection of the social, political, biological, and ecological means it can provide alternative approaches to understanding the disproportionate impacts of the pandemic and lay some foundations for repair strategies that encompass the patterns, processes, and constructs of health inequality.
Thinking through the Photo Essay: Observations for Medical Anthropology
Jerome W. Crowder and Elizabeth Cartwright
As photography becomes more prevalent in ethnographic research, scholars should more seriously consider the photo essay as a medium for sharing their work. In this Position Piece, we present guidelines for the creation of ethnographic photo essays for medical anthropology that do not simply combine image and text, but create a balance that allows words to provide context for the image(s) and images to reinforce or challenge the text. We feel there are three basic elements every photo essay must consider that are informed by the theory and practice of visual anthropology. While a solid background in visual anthropology is not necessary to produce a successful photo essay, being mindful of these three elements in relation to your work will help you develop a photo essay that combines the best of what both media offer your audience.
The Walls Have Ears: Accessing Participant Narratives amid Silence, Secrecy, and Mistrust
Brittney Shanel Mengistu
Eritreans have long been considered a close-knit community bound by the memorialisation of history and the preservation of cultural practices. My anthropological enquiry into the everyday experiences of mental distress among diasporic women revealed that the depth of their exclusivity was a response to the continual and unsystematic surveillance of the Eritrean state. Government spies targeted outspoken critics, either forcing them into exile or pushing them into perpetual silence. In this essay, I explain how the perceived looming presence of secret agents created widespread mistrust and pervasive silence that complicated relationship-building among diasporic women. I then describe how negative perceptions of the term ‘mental health’ required an alteration of my lexicon and methodological approach, revealing the embodiments of silence and distress in everyday interactions. By reflexively and critically engaging with women’s everyday experiences, silence emerges as a central theme in my work, eventually becoming a conceptual anchor that has helped me understand and connect with a politically silenced diaspora. Through these ethnographic encounters, the complexities of the social, cultural, and political interactions gave meaning to simple utterances.