Book Release: “The Recovery Revolution: The Battle Over Addition Treatment in the United States”

Posted by sonya.petrakovitz

This week on the blog we are highlighting a new book by Claire Clark from the Columbia University Press entitled The Recovery Revolution: The Battle Over Addiction Treatment in the United States (2017). As the opioid crisis in the United States is continuing to make headlines, Clare traces the history of addition treatment and embeds developments in the social, political, and cultural moments from which they arose.

via Columbia University Press website

“In the 1960s, as illegal drug use grew from a fringe issue to a pervasive public concern, a new industry arose to treat the addiction epidemic. Over the next five decades, the industry’s leaders promised to rehabilitate the casualties of the drug culture even as incarceration rates for drug-related offenses climbed. In this history of addiction treatment, Claire D. Clark traces the political shift from the radical communitarianism of the 1960s to the conservatism of the Reagan era, uncovering the forgotten origins of today’s recovery movement.

Based on extensive interviews with drug-rehabilitation professionals and archival research, The Recovery Revolution locates the history of treatment activists’ influence on the development of American drug policy. Synanon, a controversial drug-treatment program launched in California in 1958, emphasized a community-based approach to rehabilitation. Its associates helped develop the therapeutic community (TC) model, which encouraged peer confrontation as a path to recovery. As TC treatment pioneers made mutual aid profitable, the model attracted powerful supporters and spread rapidly throughout the country. The TC approach was supported as part of the Nixon administration’s “law-and-order” policies, favored in the Reagan administration’s antidrug campaigns, and remained relevant amid the turbulent drug policies of the late twentieth and early twenty-first centuries. While many contemporary critics characterize American drug policy as simply the expression of moralizing conservatism or a mask for racial oppression, Clark recounts the complicated legacy of the “ex-addict” activists who turned drug treatment into both a product and a political symbol that promoted the impossible dream of a drug-free America.”

Claire Clark is an Assistant Professor of Behavioral Science at the University of Kentucky. She is secondarily appointed in the Department of History and associated with the Program for Bioethics. Clark further directs a National Endowment for the Humanities Summer Institute on Addition in American History. She graduated from Vassar College and was dual trained as an historian of medicine (PhD) and behavioral scientist (MPH) at Emory University.

For more information, visit the Columbia University Press website, available here.

Book Review: “A Surgeon in the Village”

Posted by sonya.petrakovitz

This week we are highlighting a book review written by Veronica Tomasic originally published in MedHum Daily Dose, a blog for the intersections of medicine and humanities, available here. The book is entitled A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa (2017) by Tony Bartelme, published by Beacon Press.

A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa (Beacon Press, 2017) is the story of American neurosurgeon Dr. Dilan Ellegala’s efforts to provide medical aid in Tanzania. It was written by Tony Bartelme, an American reporter for Charleston, South Carolina’s Post and Courier; Bartelme is a three time Pulitzer prize finalist, including for the series that formed the basis for this book. The Post and Courier’s executive editor relayed a story to Bartelme about a “crazy brain surgeon who opened a guy’s head with a wire saw in Africa”; Bartelme’s interest was piqued and thus began the story that he narrates here (269).

A Surgeon in the Village is a bildungsroman of sorts. It describes the beginning of Ellegala’s career as a neurosurgeon and his personal journey toward finding meaning in his work. It is also about his ideas for how foreign medical aid should be delivered, and the growth of an organization, Madaktari Africa (Madaktari means doctors in Swahili), that he formed as a result of his ideas.

We first meet Ellegala when he has just completed his neurosurgery training in the US. He is burned out after years of grueling residency and fellowship programs. He travels to Tanzania for six months, volunteering to perform brain surgery at a small, remote hospital. Ellegala is determined to spend as much time as possible vacationing while there. But his plan changes after he starts to attend daily morning meetings where the visiting foreign students and MDs, and local medical personnel gather to discuss their cases. Ellegala observes that the foreign students sit in a privileged position at the front of the room, while the local personnel — such as assistant medical officers (or “AMOs,” who have paramedic plus a few years’ level of training) — stand at the back of the room. This disturbs his sense of propriety — in the US, medical students typically stand or sit behind attendings and residents. He insists that the students and local personnel trade places, a shift that becomes a central organizing metaphor for the book. The change symbolizes the degree of responsibility Ellegala believes the local staff should have for the care they provide, and the respect he feels they should be shown by foreign visitors.

Galvanized, Ellegala starts to rethink traditional models for providing aid in Tanzania, a country with limited resources to train and keep its own MDs. Rather than encourage foreign MDs to travel to a hospital, perform surgeries for a brief period of time and then leave, Ellegala realizes that it makes more sense to train local AMOs to perform neurosurgical procedures. If they can take over, he reasons, a hospital will transition from being dependent on outside help to being self-sustaining. Ellegala notices an AMO who has a surgeon’s confidence about him, Emmanuel Mayyega, and he trains him to diagnose and perform operations for a number of conditions, such as intracranial tumors, head trauma, and hydrocephalus. Eventually, Mayyega trains others. And thus began the “train forward” movement in Tanzania.

Bartelme weaves through his account the challenges Ellegala faces in his career as he devotes time, money, and considerable energy to Madaktari Africa. He also describes some of the ethical issues that are raised by the “train forward” practice. For example, should we accept that people will die in countries where there are not enough traditionally-trained MD surgeons to perform surgeries? Or should surgeries in these countries be performed by people with limited training and supervision because they can save lives? And what about the liability exposure for people trained under such circumstances? One area where the book could have been strengthened would have been to devote a chapter to the history of aid organizations and their varied philosophies. While mention of organizations such as Smile Train, or Paul Farmer’s Partners in Health, among others, are interspersed throughout the book, it was never clear to me whether Ellegala was the first person to conceptualize “train forward,” or whether such a practice had already been established in other countries.

Altogether, A Surgeon in the Village is a warmly engaging account of one doctor’s efforts to make a difference in a part of the world that has limited medical resources, and the personal rewards his efforts afforded him. It would be useful for medical providers and students to read, as well as anyone interested in how best to provide aid to other countries.

Veronica Tomasic (PhD, JD) practices community law in the New Haven, CT, area. She is a scholar of literature, painting, psychoanalytic theory, and end-of-life issues.

For more information about the book, visit the Beacon Press website, here.

Books for Review: Vol 41, Issue 2

Posted by sonya.petrakovitz

In our June 2017 issue, we received these two books for review at Culture, Medicine, and Psychiatry. These previews provide a snapshot of recent publications in medical anthropology, global health, and the history of medicine that we’re excited to discuss in our journal and with our followers on social media.

Living Faithfully in an Unjust World: Compassionate Care in Russia (2016)

Melissa L. Caldwell

In this book, Caldwell asks, “What does it mean to be a compassionate, caring person in Russia, which has become a country of stark income inequalities and political restrictions? How might ethics and practices of kindness constitute a mode of civic participation in which “doing good”—helping, caring for, and loving one another in a world marked by many problems and few easy solutions—is a necessary part of being an active citizen?”

Living Faithfully in an Unjust World explores how, following the retreat of the Russian state from social welfare services, Russians’ efforts to “do the right thing” for their communities have forged new modes of social justice and civic engagement. Through vivid ethnography based on twenty years of research within a thriving Moscow-based network of religious and secular charitable service providers, Caldwell examines how community members care for a broad range of Russia’s population, in Moscow and beyond, through programs that range from basic health services to human rights advocacy.

As the experiences of assistance workers, government officials, recipients, and supporters reveal, their work and beliefs are shaped by a practical philosophy of goodness and kindness. Despite the hardships these individuals witness on a regular basis, there is a pervasive sense of optimism that human kindness will prevail over poverty, injury, and injustice. Ultimately, what connects members of this diverse group is a shared belief that caring for others is not simply a practical matter or an idealistic vision but a project of faith and hope. Together care-seekers and care-givers destabilize and remake the meaning of “faith” and “faith-based” by putting into practice a vision of humanitarianism that transcends the boundaries between state and private, religious and secular.

For more information, visit the University of California Press website, available here.

PTSD and the Politics of Trauma in Israel: A Nation on the Couch (2017)

Keren Friedman-Peleg

Post-Traumatic Stress Disorder, or PTSD, has long been defined as a mental trauma that solely affects the individual. However, against the backdrop of contemporary Israel, what role do families, health experts, donors, and the national community at large play in interpreting and responding to this individualized trauma?

In PTSD and the Politics of Trauma in Israel, Friedman-Peleg sheds light on a new way of speaking about mental vulnerability and national belonging in contemporary Israel. Based on ethnographic fieldwork conducted at The Israel Center for Victims of Terror and War and The Israel Trauma Coalition between 2004 and 2009, Friedman-Peleg’s rich ethnographic study challenges the traditional and limited definitions of trauma. In doing so, she exposes how these clinical definitions have been transformed into new categories of identity, thereby raising new dynamics of power, as well as new forms of dialogue.

Chapters include:

Birth of Agencies, Birth of an Interpretative Framework
Trauma and Capital: Bearers of Knowledge, Keepers of Cashboxes
Trauma and the Camera: Labeling Stress, Marketing the Fear
They Shoot, Cry and Are Treated: The “Clinical Nucleus” of Trauma among IDF Soldiers
Woman, Man and Disorder: Trauma in the Intimate Sphere of the Family
Wandering PTSD: Ethnic Diversity and At-Risk Groups across the Country
Taking Hold: Resilience Program in the Southern Town of Sderot
Treading Cautiously around Sensitive Clinical and Political Domains

For more information, visit the University of Toronto Press website, available here.

Book Release: “Fat Planet: Obesity, Culture, and Symbolic Body Capital”

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This week we are highlighting a recent book release from the University of New Mexico Press entitled Fat Planet: Obesity, Culture, and Symbolic Body Capital (2017), edited by Eileen Anderson-Fye and Alexandra Brewis. As a reminder, in June the CMP blog will be switching to our bi-weekly summer schedule.

Photo via UNM Press

The average size of human bodies all over the world has been steadily rising over recent decades. The total count of people clinically labeled “obese” is now at least three times what it was in 1980. Around the world, governments and other organizations are deploying urgent anti-obesity initiatives. However, one unintended consequence of these efforts to tackle the “obesity epidemic” has been the increasing stigmatization of “fat” people. This rapid proliferation of fat stigma has profound implications for both human suffering and disease. Fat Planet represents a collaborative effort to consider at a global scale what fat stigma is and what it does to people.

Making use of an array of social science perspectives applied in multiple settings, the authors examine the interplay of weight, wealth, history, culture, and meaning to fat and its social rejection. They explore the notion of symbolic body capital — the power of non-fat bodies to do what people need or want. They also investigate how fat stigma relates to other forms of bias and intolerance, such as sexism and racism. In so doing, they illustrate the complex and quickly shifting dynamics in thinking about fat — often considered deeply personal yet powerfully influenced by and influential upon the broader world in which we live. They reveal the profoundly nuanced ways in which people and societies not only tolerate, but even sometimes embrace, new forms of stigma in an increasingly globalized planet.

Chapters include:

Making Sense of the New Global Body Norms. Alexandra Brewis
From Thin to Fat and Back Again: A Dual Process Model of the Big Body Mass Reversal. Daniel J. Hruschka
Managing Body Capital in the Fields of Labor, Sex, and Health. Alexander Edmonds and Ashley Mears
Fat and Too Fat: Risk and Protection for Obesity Stigma in Three Countries. Eileen P. Anderson-Fye, Stephanie M. McClure, Maureen Floriano, Arundhati Bharati, Yunzhu Chen, and Caryl James
Excess Gaines and Losses: Maternal Obesity, Infant Mortality, and the Biopolitics of Blame. Monica J. Casper
Symbolic Body Capitol of an “Other” Kind: African American Females as a Bracketed Subunit in Female Body Valuation. Stephanie M. McClure
Fat Is a Linguistic Issue: Discursive Negotiation of Power, Identity, and the Gendered Body among Youth. Nicole L. Taylor
Body Size, Social Standing, and Weight Management: The View from Fiji. Anne E. Becker
Glocalizing Beauty: Weight and Body Image in the New Middle East. Sarah Trainer
Fat Matters: Capitol, Markets, and Morality. Rebecca J. Lester and Eileen Anderson-Fye

For more information, visit the University of New Mexico Press website, available here.

Dr. Eileen Anderson-Fye is a medical and psychological anthropologist, and the founding director of the Medicine, Society, and Culture (MSC) Master’s Degree track in Bioethics at Case Western Reserve University School of Medicine. Drawn to interdisciplinary study as an undergraduate, Dr. Anderson-Fye developed the MSC degree track for students to explore how factors beyond biomedical science contribute to health and wellness. Social and cultural constructs, historical and rhetorical influences, literature, and philosophy all shape perceptions of health, illness, and recovery, which in turn affect choices, beliefs, and behaviors. Those who appreciate this complex and multi-layered interplay will be able to play pivotal roles in enhancing how care is delivered – and the outcomes it yields.

Dr. Anderson-Fye’s perspective on these issues has been informed by extensive research on the mental health and well-being of adolescents and young adults in contexts of socio-cultural change. Her most enduring project is an ongoing longitudinal study of how subjective perceptions of current and future well-being allowed the first mass-educated cohort of Belizean schoolgirls to overcome severe threats to their mental and physical health. More recently, she led a team’s study of the psychiatric medication experiences of undergraduates at North American university campuses, where a mix of quantitative and qualitative methods revealed stark differences between reported and actual usage. Dr. Anderson-Fye is writing a book about the findings and their implications; it is tentatively titled, Young, Educated and Medicated. Dr. Anderson-Fye has an A.B. From Brown University in American Civilization. She earned her M.Ed. and Ed.D. in Human Development and Psychology from Harvard University. Her training has included work at Harvard Medical School in the Department of Social Medicine and Massachusetts General Hospital, and postdoctoral fellowships in Interdisciplinary Studies of Culture and Neuroscience and Culture, Brain and Development at the Semel Institute for Neuroscience in the David Geffen School of Medicine at UCLA.

Dr. Alexandra Brewis is a President’s Professor and Distinguished Sustainability Scientist at Arizona State University, where she also co-leads the translational Mayo Clinic-ASU Obesity Solutions initiative and serves as the associate vice president of Social Sciences. Her research interests includes how and why effective obesity solutions are undermined by weight stigma, damaging and distressing for millions of people and is rapidly spreading globally.

Dr. Brewis has a PhD in Anthropology from University of Arizona and was an Andrew W. Mellon Foundation postdoctoral fellow in anthropological demography at the Population Studies and Training Center at Brown University. Before joining ASU, she taught at the University of Auckland in New Zealand and University of Georgia. At ASU, Dr. Brewis served as Director of the School of Human Evolution and Social Change from 2009-2017.

Books Received for Review: May 2017

Posted by sonya.petrakovitz

This week we are featuring previews of three books received for review at Culture, Medicine, and Psychiatry (available here). These previews provide a snapshot of recent publications in medical anthropology, global health, and the history of medicine that we’re excited to discuss in our journal and with our followers on social media. If you would like to review a recently received book, please contact Brandy Schillace, Managing Editor. If you have a book you would like us to review, contact the Managing Editor via email, but please send books to the office of Culture, Medicine, and Psychiatry, care of the Anthropology Department, Case Western Reserve University.

via The University of Chicago Press

Mindful Movement: The Evolution of the Somatic Arts and Conscious Action (2016)

Eddy, Martha

In Mindful Movement, exercise physiologist, somatic therapist, and advocate Martha Eddy uses original interviews, case studies, and practice-led research to define the origins of a new holistic field—somatic movement education and therapy—and its impact on fitness, ecology, politics, and performance. The book reveals the role dance has played in informing and inspiring the historical and cultural narrative of somatic arts. Providing an overview of the antecedents and recent advances in somatic study and with contributions by diverse experts, Eddy highlights the role of Asian movement, the European physical culture movement and its relationship to the performing arts, and female perspectives in developing somatic movement, somatic dance, social somatics, somatic fitness, somatic dance and spirituality, and ecosomatics. Mindful Movement unpacks and helps to popularize awareness of both the body and the mind.

For more information, check out The University of Chicago Press, available here.

via Routledge

Religion and Psychotherapy in Modern Japan (2015)

Christopher Harding, Iwata Fumiaki, and Yoshinaga Shin’ichi, eds.

Since the late nineteenth century, religious ideas and practices in Japan have become increasingly intertwined with those associated with mental health and healing. This relationship developed against the backdrop of a far broader, and deeply consequential meeting: between Japan’s long-standing, Chinese-influenced intellectual and institutional forms, and the politics, science, philosophy, and religion of the post-Enlightenment West. In striving to craft a modern society and culture that could exist on terms with – rather than be subsumed by – western power and influence, Japan became home to a religion–psy dialogue informed by pressing political priorities and rapidly shifting cultural concerns.

This book provides a historically contextualized introduction to the dialogue between religion and psychotherapy in modern Japan. In doing so, it draws out connections between developments in medicine, government policy, Japanese religion and spirituality, social and cultural criticism, regional dynamics, and gender relations. The chapters all focus on the meeting and intermingling of religious with psychotherapeutic ideas and draw on a wide range of case studies including: how temple and shrine ‘cures’ of early modern Japan fared in the light of German neuropsychiatry; how Japanese Buddhist theories of mind, body, and self-cultivation negotiated with the findings of western medicine; how Buddhists, Christians, and other organizations and groups drew and redrew the lines between religious praxis and psychological healing; how major European therapies such as Freud’s fed into self-consciously Japanese analyses of and treatments for the ills of the age; and how distress, suffering, and individuality came to be reinterpreted across the twentieth and early twenty-first centuries, from the southern islands of Okinawa to the devastated northern neighbourhoods of the Tohoku region after the earthquake, tsunami, and nuclear disasters of March 2011.

Religion and Psychotherapy in Modern Japan will be welcomed by students and scholars working across a broad range of subjects, including Japanese culture and society, religious studies, psychology and psychotherapy, mental health, and international history.

For more information, visit the Routledge website here.

via Johns Hopkins

Still Down: What to do when Antidepressants Fail (2016)

Dean F. MacKinnon

Thirty medications are classified as antidepressants in the United States—and that’s not counting drugs that might prove effective in treating major depressions but aren’t officially designated as antidepressants.

That formulary’s length is not surprising. As veteran Johns Hopkins psychiatrist Dean MacKinnon notes, major depressive disorder is one of the most common and debilitating conditions, annually causing some 1 million people worldwide to commit suicide. In a concise, clearly written and exceptionally helpful book, he provides insights and advice on what to do if those medications don’t work initially.

The brain is a complex organ, and what transpires within it often is mysterious. Every one of the drugs classified as an antidepressant helps in about 60 to 70 percent of cases, MacKinnon writes. They do so by increasing the amount of the neurotransmitters serotonin and/or norepinephrine, and possibly dopamine, in the space between neurons in the brain. Yet it isn’t known why this change in neurotransmitters effectively treats major depressions.

What’s more, when an antidepressant doesn’t work, physicians and psychiatrists often don’t ask why it failed, MacKinnon says. Usually, they just try a different medication. MacKinnon has spent the past two decades trying to determine why some patients do not respond well to antidepressant medications and how to address that treatment failure.

Creating nine patient composites based on many cases he has handled, he uses their stories to describe why an antidepressant treatment “for some unknown biological reason” sometimes “goes awry.” He also tells how he has sought to understand the wide variety of causes for such failure and what to do for those who do not respond to antidepressant treatment.

Brief summaries, case notes and excellent appendices make this a useful book for practitioners and patients alike.

For more information, visit the Johns Hopkins Medicine website, available here.

Interview: Jonathan Sadowsky and “Electroconvulsive Therapy in America”

Posted by sonya.petrakovitz

This week on the blog we’re highlighting an interview with Dr. Jonathan Sadowsky about his new book Electroconvulsive Therapy in America: The Anatomy of a Medical Controversy, released November 2016 by Routledge. The book (available here) follows the American history of one of the most controversial procedures in medicine, electroconvulsive therapy (ECT), and seeks to provide an explanation of why it has been so controversial, juxtaposing evidence from clinical science, personal memoir, and popular culture. ECT is widely demonized or idealized. Some detractors consider its very use to be a human rights violation, while some promoters depict it as a miracle, as the “penicillin of psychiatry.” Sadowsky contextualizes the controversies about ECT, instead of simply engaging in them, making the history of ECT more richly revealing of wider changes in culture and medicine. He shows that the application of electricity to the brain to treat illness is not only a physiological event, but also one embedded in culturally patterned beliefs about the human body, the meaning of sickness, and medical authority.

Dr. Sadowsky is the Theodore J. Castele Professor of Medical History at Case Western Reserve University in Cleveland, OH, the Associate Director of Medical Humanities and Social Medicine, the Medical Humanities and Social Medicine Initiative co-founder, the Associate Director of Medicine, Society, and Culture in the Bioethics department of the Case Western Reserve University School of Medicine, and on the Editorial Board here at Culture, Medicine, and Psychiatry. Sadowsky’s research concentrates largely on the history of medicine and psychiatry in Africa and the United States. His previous publications include Imperial Bedlam: Institutions of Madness in Colonial Southwest Nigeria (1999), available here from the University of California Press.

From all of us at CMP, we hope you enjoy our new interview category!

For someone who is thinking about reading your book or about to start, is there anything you would like them to know beforehand?

I would urge everyone to understand that not everybody’s experience of a medical therapy is the same. People should be careful not to generalize from experiences they’ve had, or that loved ones have had, and assume everyone has had the same experience. People who’ve had bad experiences with ECT have criticized me for to wanting to pay attention to the voices of people who’ve had good experiences, and people who’ve have good experiences have wanted to say “oh sure that might have been true in the 1950s but everything’s fine now.” ECT has a complicated story. I have met people who have told me that this treatment saved their lives and that it did so with either none or only the most mild of adverse effects. Those people are very concerned to make sure that the therapy gets represented in positive light because there are so many negative depictions. At the same time I’ve heard from and spoken to people who say they’ve lost 20 points off their IQ after having this treatment, or who had huge gaps in memory, or that they know somebody who had killed themselves after an ECT treatment. And what I find a little bit puzzling still after all these years of working on this book, is the way people are so unwilling to see that other people might have had a different experience than their own. But it’s my feeling as a social and cultural historian that it’s my responsibility to take into account all voices. So that’s the main thing that I want people to know and think about, that experiences of this treatment do vary and people shouldn’t be too quick to generalize from their own experience.

How did you become interested in ECT?

I was already several years into my career as a historian of medicine, and in particular psychiatry, and had no knowledge of the treatment other than the images that many of us have from movies like One Flew Over the Cuckoo’s Nest. Images that it was a highly frightening and abusive treatment. I was a well-trained student of medicine and psychiatry and I didn’t know anything more than that. And then I began to hear stories, both from patients and from clinicians, about it being a valuable treatment and that was just so intriguing to me. So I began to look at some of the clinical literature and it was represented in almost completely the opposite way, as this safe, effective, humane treatment that’s been unfairly stigmatized. I felt like these were two completely distinct realities. It wasn’t so much that I wanted to reconcile them, but I just wanted to understand how views of this treatment became so bifurcated. And that became the central goal of the project: to understand why it became a controversy and have such strongly held opinions on either side.

What did you find most exciting to research and write about?

I worked on this project for a long time and one of the things that sustained me was that there are so many different angles to it. I was interested in learning about how it was used to treat homosexuals in 1950s, to see what the reaction of the psychoanalytic community was, and how it figured as a symbol for all that was worst in psychiatry in the antipsychiatry moment. And then there were all the debates going back to the inception of the treatment, ongoing continual debates about the extent of memory loss. Is it a serious problem? Is it a rare problem? These debates are still raging. All of this I found so intriguing. The history of ECT is also replete with ironies. Such as the irony that it was developed initially as a treatment for schizophrenia based on a hypothesis that schizophrenia has an inverse relationship with epilepsy. That hypothesis is no longer even believed in, and schizophrenia is not the main indication anymore, and yet it’s effective. That’s so weird and so seemly random! Another irony is that this treatment which become an icon for frightening medical treatment, and became almost like people’s haunting nightmare of how medicine could abuse you if you came into its clutches, was initially developed as a way to try to create a safer, less frightening treatment than chemical convulsive therapy. So it’s these layers of irony that I just found so interesting and kept me intrigued in the book.

Did you come across anything unexpected?

Yes, I did come across things that were unexpected. I found the gender politics to be very elusive. I found very little evidence for the idea that women were given ECT for simply protesting against their social role as housewives, which was promoted in another book on ECT. But it does appear likely that over the course of the treatment’s history more women have gotten it than men, and there is likely a gender politics to this. Minimally it may mean simply that more women are getting diagnosed with depression, and that’s the main indication. And we know that. The diagnosis of depression has predominated among women. There is a darker possibility, which is that women’s cognitive abilities haven’t been as valued, and so doctors have been more willing to use a treatment that might damage cognitive abilities on women than they were on men. I didn’t see any proof for that. But I think there were suggestive circumstances that might indicate that that played a role. In many realms of medicine, and this has been really well documented by historians, anthropologists, and sociologists of medicine, women’s complaints about medical treatments are more quickly dismissed than men’s complaints. So it’s quite possible that some of the complaints about memory loss, which have persisted throughout the history of this treatment, have been taken less seriously because they were so often voiced by women. I’m not arguing that women had more memory loss than men, but if they predominated in the treatment, and there were complaints about memory loss, it is plausible to suggest that perhaps there has been too much dismissal. I didn’t have evidence such as clearly sexist language in clinical reports that would strengthen a speculation like that, but one thing I do argue in the book is that the history of ECT is filled with doctors dismissing patient complaints of adverse effects. There are a number of ECT providers now, however, who are trying to be very sensitive to these complaints about memory and cognitive deficits following the treatment, but there still exists in clinical manuals the claim that serious memory problems are extremely rare, and that rarity really hasn’t been proven. So it remains a problem. The history of ECT treatment has shown a tendency to dismiss patient complaints about adverse effects, and this has not served anyone well. If anything, the tendency to dismiss complaints has worsened the stigma attached to the treatment. It’s understandable that some clinicians might feel some defensiveness for a treatment they feel is helpful and safe, but the dismissal of complaints of adverse effects has led to embittered patients and worsened the stigma. In a recent piece in The Conversation (available here), I argued that if we wanted to spell the stigma attached to ECT, it’s going to take more than attesting to its therapeutic efficacy. It’s going to mean we have to reconcile with its full costs.

Why was it important for you to try and remain neutral and not argue for or against ECT?

I’m not trying to presume objectivity. Everyone has a point of view. But I thought I could tell a more interesting story by taking a step back and making the controversy itself my study rather than becoming a disputant in the controversy. There’s some precedent for this. Didier Fassin, an anthropologist, did a book on AIDS in South Africa, When Bodies Remember (available here), in which he did the same thing; he tried to look at the structure of the controversy. He was trying to understand the medical controversy over HIV as an anthropologist, even though he did actually side more with one than the other. But I do argue in the book there are good reasons to attest to efficacy of ECT and it is a valuable part of psychiatry’s repertoire, that it has a place in medicine. But I also argue that there were good grounds for people to contest it and have fear of the treatment. I really try to resist the view, which is very common in clinical literature on ECT, that opposition to ECT is irrational. There are rational reasons for the resistance rooted in some of its historical uses, some of which were abusive, and rooted in the experiences of adverse effects. At the end of the book I lay it all out and I say exactly what I think about ECT after trying to look at it from a step back. I think it’s an invaluable part of psychiatry and could be very useful for many people. But I don’t think it should be used as a first or second resort; other things should be tried first because there are risks. I’m glad it’s there if I should ever need it, but I hope I never need it.

Would ECT be perceived differently if it didn’t treat the brain but some other organ?

Probably. In our society now, more than any other organ your brain is you. It is the seed of the self in our self-conception. I would go beyond that. The side effects do occur, without making any kind of representation about how common these problems are, but at least some people do experience permanent memory losses. I used a lot of patient memoirs in the chapter on memory as my source material. And as one of the memoirists wrote: We are our pasts. You lose your memory it’s like you lose a part of yourself. I think in some ways people feel they lose a part of themselves if they lose their memories more than even if they were to lose a limb. Losing a limb is very traumatic, I don’t mean to minimize that. But in a way, you lose your leg and you say “I lost my leg.” It’s something that belongs to you, but it isn’t you in the same way that maybe you feel your memories are you. Memories are not just something that you have, they’re something that you are.

I think ECT is a treatment for the very ill and as a society we do generally accept that treatments for the very ill sometimes involve radical interventions. Chemotherapy for cancers for example. Most of us are glad we have it, and there isn’t a large anti-chemotherapy movement. My leading theory for why ECT treatment occasions this kind of resistance is because of depression’s uncertain status as illness. No one disagrees that cancer is an illness. When you have cancer you accept that you need surgery or radiation or chemotherapy. These are things that you normally wouldn’t do to your body if you were healthy and you didn’t need them. Cancer is clearly different from normal. But depression has this ambiguous status for two reasons. It is an ambiguous word in the English language because it refers both to an illness which can be extremely severe, yet it also refers to a mood that’s normal and that everybody at some point in their lives gets a little bit depressed. We might have disagreements about how long it has to go on and how severe it has to be to be considered an illness. But it becomes something different when we call it an illness. Secondly why I think depression’s status is a bit uncertain, is that there continue to be people who reject medical models for what we call mental illness altogether. Some might believe what people need is talk therapy and they shouldn’t have drugs or shock therapies or anything like that. Some might believe that they don’t need any treatment at all; they might want to de-medicalize the entire thing. For example, for something to qualify as disease, there has to be some kind of lesion, or something physical that can be identified. Since we don’t have the means to do that with depression, it should be removed from the medical realm. I argue against this view. The idea that there has to be some kind of visual marker is arbitrary. I do think what we consider an illness is a social decision. But if you look at it historically and anthropologically, the idea that things we call madness are medical problems is pretty widespread. And in some ways having to have something be visually identifiable is buying into a lot of biomedical hegemony. I just don’t see why that should be the criteria for illness. Ultimately it’s a philosophical question. Most people in our society do accept that severe depression actually constitutes an illness category, but I think these kinds of ambiguities leave people unsure whether this is something worthy of very strong medicine. ECT is strong medicine. It’s a big decision to undergo ECT and it’s the right decision for some people. It’s a decision that shouldn’t be made lightly and shouldn’t be treated like a trip to the dentist.

Is there anything else you want to add?

I was really gratified by the number of anthropologists who read and used my first book on insanity in Nigeria, Imperial Bedlam (available here), and I would be thrilled if anthropologists gave this book the same attention. And I’d also like to add that Routledge says there will probably be a paperback within the next year and a half.

Book Release: Pearl’s “Face/ On”

Posted by sonya.petrakovitz

Image via The University of Chicago Press website

Coming April 2017 from The University of Chicago Press is Sharrona Pearl’s Face/ On: Face Transplants and the Ethics of the Other. This engaging exploration of face transplantation is the first comprehensive cultural study of the surgical procedure. Using bioethical and medical reports, media coverage, hospital records, personal interviews, and more, this interdisciplinary study discusses the significance we place on facial manipulation, facelessness, reconstruction, identity, and sense of self. Are our identities attached to our faces? If so, what happens when the face connected to the self is gone or replaced? This book will be of interest to medical and psychological anthropologists, bioethicists, medical professionals, those in the media and beauty industries, and cross-disciplinary scholars in the medical humanities.

To learn more about this upcoming release, click here.

About the author: Sharrona Pearl is an Assistant Professor at the Annenberg School for Communication and the Gender, Sexuality, and Women’s Studies Program at the University of Pennsylvania. She is a theorist of the face and body, gender and sexuality, disability and critical race theory, and cinema and media studies. She has explored the meaning of the face previously in About Faces: Physiognomy in Nineteenth-Century Britain, released in 2010 by Harvard University Press (available here), and is the editor of Images, Ethics, Technology (Routledge, 2016), the latest volume in the Shaping Inquiry in Culture, Communication and Media Studies series.

Books for Review: Vol 40 Issue 3, Sept 2016

Posted by jknopes

In our September 2016 issue, we received these books for review at the journal. The new releases span social science methods, to two ethnographies of biomedicine and human plasticity (available here and here), and finally, two texts on organ transplantation across cultural contexts. This includes Heinemann’s Transplanting Care and Crowley-Matoka’s Domesticating Organ Transplant.

Last year, we featured a book release update on Crowley-Matoka’s work on organ transplantation in Mexico. Here, we revisit the original book release (accessible here.)

Image via Duke UP

Released this March 2016 from Duke University Press is Megan Crowley-Matoka’s Domesticating Organ Transplant: Familial Sacrifice and National Aspiration in Mexico. The text explores the familial nature of kidney transplantation in Mexico, where the organs are donated between relatives rather than received by strangers. Crowley-Matoka also examines kidney transplant in Mexico beyond the family unit, assessing national pride in transplantation procedures performed at hospitals operated by the state. Through family and government, organ transplantation thus becomes an iconic procedure in Mexican society– both within the home and across the nation– that represents the curative promise of contemporary medicine. Crowley-Matoka’s ethnography highlights the relationships between embodied experience, domestic life, national identity, and clinical practice. This text will appeal widely to scholars who study biomedicine in the Americas, the connections between medicine and the state, and familial networks of caregiving.

About the author: Megan Crowley-Matoka is Assistant Professor of Medical Humanities and Bioethics at Northwestern University. You can access more details about her upcoming book here.

Book Release: Eigen’s “Mad-Doctors in the Dock”

Posted by jknopes

Image via JHU Press website

To be published this November 2016 from Johns Hopkins University Press is Joel Peter Eigen’s Mad-Doctors in the Dock: Defending the Diagnosis, 1760-1913. This medical history examines the foundations and early development of the criminal insanity defense in England. Drawing on testimony and documents from almost 1,000 trials, this text examines how physicians, surgeons, and other health care providers connected diagnosis with legal culpability. The text promises to carefully assess the dynamic relationships between criminal justice, mental health, medicine, and the emergent disciplines of forensic psychology and psychiatry. This book will be of equal interest to anthropologists of medicine and law, as well as psychological anthropologists, historians and sociologists of medicine, and cross-disciplinary scholars in the medical humanities.

To learn more about this upcoming release, click here.

About the Author: Joel Peter Eigen serves as the Charles A. Dana Professor of Sociology at Franklin and Marshall College as well as Principal Fellow (Honorary) at the University of Melbourne. This text is the third in a series that Eigen has published on the history of the insanity defense. The first book, Witnessing Insanity: Madness and Mad-Doctors in the English Court, was released in 1995 by Yale University Press and is available here. The second book, Unconscious Crime: Mental Absence and Criminal Responsibility in Victorian London, was published in 2003 by Johns Hopkins University Press. It can be purchased here.

Book Release: Haraway’s “Staying with the Trouble”

Posted by jknopes

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Image via Duke UP website

Debuting this September 2016 from Duke University Press is Donna Haraway’s Staying with the Trouble: Making Kin in the Chthulucene (available here.) Haraway’s text challenges the concept of the anthropocene, noting that in an age of ever-increasing environmental degradation, any centralization of the human detracts from the ill-effects of a “damaged earth” on all forms of life. Haraway posits a new term, the Chthulucene:, to describe the contemporary state of human and non-human existence. She argues that this new term highlights the multi-directional, tentacular ways in which life forms are bound together as kin in this new world. Moreover, this term encourages us to consider not human self-making, but rather sym-poiesis: the mutual entanglements of human and inhuman life as they “make” and define one another. The text unites an environmental approach with themes that resonate throughout Haraway’s work: including feminism, technoscience, kinship, and the destabilization of the “human” category.

This publication will be of interest to anthropologists spanning environmental studies, medical anthropology, and anthropological theory, as well as scholars of science and technology studies. Haraway’s commentary on “making kin”and the Chthulucene previously appeared in the open-access journal Environmental Humanities and is available in full here.

About the Author

Donna Haraway serves as Distinguished Professor Emerita at the University of California Santa Cruz in the History of Consciousness Department. In addition to Staying with the Trouble and many past publications, Haraway has also released a collection of her manifestos this year, entitled Manifestly Haraway. The collection is available here through the University of Minnesota Press.