AAA 2015 Sessions: The Anthropology of Mental Health Care

Beginning last Fall 2014, we began compiling lists of sessions at the Annual Meeting of the American Anthropological Association that we thought would be of interest to our readers attending the conference. These sessions included topics such as drug use and abuse, reproductive medicine, and global health. This year, we again feature our series on the upcoming conference, to be held November 18-22 in Denver, Colorado (more information here.) You can also browse last week’s installment of the blog, where we highlighted sessions on biomedicine and the body at the upcoming Society for Social Studies of Science (4S) meeting, also in Denver, to be held November 11-14 (details here.) This week, we present three paper sessions on the anthropology of mental health care. The sessions are organized chronologically by time and date.

Image via AAA Website

Image via AAA Website

Re-Institutionalizing Care: Anthropological Engagements with Mental Health Courts and Alternative Forensic Psychiatry Interventions in North America

Saturday, November 21st 10:15am-12:00pm (details about this session.)

Topics in this session will include racial disparities in a mental health court in Canada; the relationship between criminal justice officials, psychiatric crisis, and mental health; dogma and psychiatry; and mental health care reform. The session lists itself as particularly of note to applied and practicing anthropologists, especially those with an interest in mental health care, policy, and reform.

From the Streets to the Asylum: Medicalizing Vulnerable Children

Saturday, November 21st 10:15am-12:00pm (details about this session.)

This session includes work on the following topics: humanitarian care and child homelessness in Cairo, Egypt; drug use and treatment amongst juvenile prisoners in Brazil; immigrant youth and mental health in France; and notions of American childhood in the context of mental health. Though the session is sponsored by the Anthropology of Children and Youth Interest Group, its topics overlap with many contemporary issues in medical anthropology and the social study of mental health care.

Making Sense of Mental Health Amidst Rising Rural Social Inequality in North America: Class, Race, and Identity in Treatment-Seeking

Saturday, November 21st, 1:45pm-3:30pm (details about this session.)

Presenters in this session will speak on these issues: mental health and poverty in rural New England; mental health and prescription drug abuse in Appalachia; citizenship and mental health in Oklahoma; care access in remote Alaskan communities; community mental health activism; and inequity and depression in rural Kentucky. These sessions will be of interest to scholars of social justice and medicine, as well as those studying mental health care access and the culture of psychiatry in the United States.

Book Release: Jenkin’s “Extraordinary Conditions: Culture and Experience in Mental Illness”

Via UC Press website

Via UC Press website

Out this August 2015 from the University of California Press is Janis H. Jenkin’s Extraordinary Conditions: Culture and Experience in Mental Illness. This ethnographic text explores the lives of patients of diverse ethnic and cultural backgrounds experiencing trauma, depression, and psychosis, taking into account the identity, self, desires, gender, and cultural milieu of the participants. Jenkins’ text pays special attention to the reduction of the severely mentally ill to a subhuman status, and the nature of this social repression.

Jenkins argues for a new, dynamic model of mental illness as a struggle rather than a constellation of discrete symptoms, noting that such a model should consider the ways that culture is implicated in mental illness experience from onset through recovery. The book posits that inclusion of culture into the clinical practice of psychiatry is crucial to the successful treatment of patients, and that anthropologists must not only consider the normative, day-to-day lives of participants but also the “extraordinary” and uncommon conditions regularly faced by those with mental illness.

This book will be of interest to psychological and psychiatric anthropologists, as well as those studying mental health care delivery systems. It will also shed light on medical narratives in mental health, and on generating new theories of human experience and medicalization.

For more information about this book, click on the publisher’s website here: http://www.ucpress.edu/book.php?isbn=9780520287112

News: Home Health Care for the Elderly in the United States

Culture, Medicine & Psychiatry, and the medical anthropological community at large, is committed to understanding the changing landscape of aging as both developed and developing countries experience demographic shifts, social change, and economic transformations that have impacted the way older adults receive care and treatment. Our December 1999 special issue addressed the anthropological complexity of family care dynamics, dementia, and global aging, and our journal continues to publish articles on this pressing theme in the field.[1]

In recent news, there has been a flurry of articles that address the variety of new programs across the United States that strive to address this timely and critical issue in the field of medicine and care delivery. Mount Sinai Hospital in New York City, for example, has initiated a home hospitalization program for elderly patients.[2] The program recognizes the desire of older adult patients to heal in their home environment, and visiting clinicians employed by the program are able to perform basic tests as well as deliver IV medications at the patient’s home in what is called a “mobile acute care” model.

This shift does, of course, benefit the hospital: it opens valuable bed space for other patients and allows staff to focus on the management of more serious cases. But it also has advantages for the patient, including reduced cost, the comfort of healing in the home, reduction in hospital-borne infections and symptoms of delirium in the unfamiliar hospital environment (common amongst older patients), and the ability for family members to be available at all times of the day to supplement care rather than being strictly permitted during visitation hours. A similar program for treating acute conditions in the elderly at home was instated in New Mexico, with promising results and improved patient outcomes.

Another piece in The Atlantic, however, outlines the difficulties of receiving extended at-home medical care for older adults with chronic illnesses like Parkinson’s.[3] As children of the elderly generation continue to work longer, and in married families both spouses are employed, there is no one at home to deliver lasting care to older family members who have chronic rather than acute conditions. Visiting home health aides, who are equipped to assist with basic tasks such as helping older adults shower and get in and out of bed, are typically underpaid and do not service outlying suburban or rural areas in the United States where many older individuals now live. Although the majority of elderly individuals prefer to live at home and not enter an assisted care facility, without consistent home care delivery available, it becomes extraordinarily difficult to do so.

Other organizations are generating creative solutions to delivering at-home care assistance for the elderly, particularly those without debilitating health conditions but who nevertheless require other forms of assistance. As NPR reports, many older adults struggle with the physical tasks required to cook healthy meals, such as lifting heavy pots and preparing fresh ingredients.[4] Some rely on microwaveable dinners, and do not get the nutrients they need to support their health. The company “Chefs for Seniors” has met this need in the Madison, Wisconsin area by sending professional chefs to older adults’ homes, where they cook a week’s worth of healthy meals for the resident. To ensure the plan is affordable for seniors, the company charges $15 for groceries and $30 per hour for the chef to prepare the meals: on average, this costs the customer $45 to $75 per week. The meals can also be personalized to the customer’s dietary preferences and needs.

While the United States faces numerous struggles to provide inclusive and accessible elderly care to an expanding older adult population, these smaller changes to the dynamics of caregiving—however flawed, as in the case of limited home health aides—demonstrates a broader recognition of this vital social and medical concern.

For another piece on elderly caregiving, be sure to check out this “From the Archive” blog post on dementia and family caregiving in urban India: https://culturemedicinepsychiatry.com/2014/11/19/from-the-archive-caregiving-and-dementia-in-urban-india/


Sources

[1] http://link.springer.com/journal/11013/23/4/page/1

[2] http://well.blogs.nytimes.com/2015/04/27/admitted-to-your-bedroom-some-hospitals-try-treating-patients-at-home/?smid=tw-share&_r=0

[3] http://www.theatlantic.com/business/archive/2015/04/who-will-care-for-americas-seniors/391415/

[4] http://www.npr.org/blogs/health/2015/04/27/401749819/drop-in-home-chefs-may-be-an-alternative-to-assisted-living

June 2015 Issue Preview: Guest Editor M. Ariel Cascio, on Global Autism Studies

Culture, Medicine & Psychiatry’s second installment of the year arrives June 2015. This special issue will address anthropological studies of autism throughout the world. To give our readers a preview of the upcoming issue, special issue guest editor M. Ariel Cascio, PhD joined our social media editor for an interview to discuss compiling the issue, what topics the articles will address, and new themes in the study of autism.


Can you tell us a little about the upcoming June 2015 special issue?

The special issue, “Conceptualizing autism around the globe,” shares anthropological (and allied field) research on autism in Brazil, India, Italy, and the United States. We talk about “conceptualizing” autism as a way to counter the idea that autism “is” or “means” one specific thing. Sometimes autism means the diagnosis measured by a certain instrument (such as ADOS), sometimes it means a more broadly defined set of characteristics (such as those in the DSM), sometimes it means an individual identity, and so many more things. The articles in this issue explore how autism is conceptualized at several different levels: in national policy, in treatment settings, and in the home.

What’s been your favorite part of working on the special issue?

I’ve just enjoyed the opportunity to greater familiarize myself with the group of scholars who are pursuing the anthropology of autism, and to work alongside scholars whose work I have long followed.

So how did you become interested in the study of autism?

I’ve been studying autism since 2008. I actually came to anthropology before I came to autism, and when I first began learning about autism, I saw it as rich for anthropological inquiry (isn’t everything!) because of anthropology’s strengths in focusing on lived experience, challenging deficit narratives of so-called “disorders,” and placing medicine and psychiatry in sociocultural context.

What was it like doing fieldwork in Italy? How do Italians see autism differently than other places in the world?

I’ve studied the autism concept more in Italy than in any other place in the world, and I’m very grateful to everyone there from whom I learned – autism professionals, family members of people with autism, and people on the spectrum themselves. I could hazard comparisons with the literature that address perceptions in other parts of the world – and some of these comparisons come through in the special issue – but for now I would like to focus on the strength of the rich description of the Italian context without external comparison. As my article in the special issue shows, autism professionals tended to take a social model of autism, focusing on creating environments that were tailored to the needs of people on the spectrum and structured to help them learn.

What are some of the challenges you’ve faced in studying autism?

As in many areas of inquiry familiar to readers of CMP, it can be challenging to communicate information about my study to people who study autism in other fields (clinical, psychological, social work, etc.). A lot of research about autism takes a positivist stance, whereas my research takes an interpretivist stance and focuses on autism as a concept whose meaning may vary rather than a diagnosis measured in a particular way. Nonetheless, I love talking about my research interests with a broad audience because in many contexts (especially in the U.S.), so many people have personal or professional interest in autism and we can always have interesting and stimulating conversations.

What’s something you think would surprise non-anthropologists about the anthropology of autism?

I would imagine non-anthropologists would be surprised by the anthropology of autism for the same reasons they might be surprised by anthropology (or medical anthropology) in general. For example, they might be surprised that anthropologists study autism all over the world, particularly if they think of the autism concept as something that represents a universal set of characteristics and experiences that are unaffected by context. The articles in this special issue really show that context matters in all conceptualizations of autism, from Brazil to the United States, from national policy to the family home.

Where do you see the anthropology of autism heading next?

I see the anthropology of autism becoming more inclusive. In her commentary, Pamela Block expresses optimism that the anthropology of autism will increasingly include researchers who identify as autistic themselves, and I agree. In addition to including more researchers with autism, I anticipate that the anthropology of autism will increasingly work to include participants with higher levels of support needs (those whom some people call “people with low-functioning autism”), and delve deeper into their lived experiences as well.


Many thanks to Dr. Cascio for sharing her insights! Look for the special issue on conceptualizing autism in June 2015, and be sure to check back for more previews of the issue, article features, and other blog entries about the new installment here on our website.

Vol. 39 Issue 1 March 2015: Medicalizing Heroin

In addition to our From the Archive series, where we highlight past articles in the journal’s history, the CMP blog features selected previews of our latest issue. This week, we again take a sneak peek into an article from the March issue: the first installment of 2015’s Volume 39 of Culture, Medicine & Psychiatry.


Heroin: From Drug to Ambivalent Medicine

On the Introduction of Medically Prescribed Heroin and the Emergence of a New Space for Treatment

Birgitte Schepelern Johansen • Katrine Schepelern Johansen. Pages 75-91. Link to article: http://link.springer.com/article/10.1007/s11013-014-9406-7

This article examines the reintroduction of heroin as a medicine, as opposed to illicit drug, in the treatment of substance abuse patients. Unlike existing research on this topic, the authors here emphasize the exchanges between the users, the staff, and the material space of the implementation of heroin: the built and organizational environments of the clinic, rather than just the actors in this space alone.

Heroin exists in a complicated place in these clinics: it is (paradoxically) utilized to minimize addiction to it. Rather than marginalizing the drug, this process of managed heroin prescription lends the drug a central place in the lives of users and staff, albeit a place that ambivalently lies between drug use as pleasure and drug injection as a form of medicalized control.

cards3

When considering the rooms in the clinic where the staff injects heroin into clients, the authors note that the space is strictly regulated. Staff observe incoming clients, while those who carry out injections do not permit the patients from selecting where the drug is administered. Likewise, this clinical space is not used for socializing: clients don’t casually talk while waiting, and typically depart this area and linger in the facility’s more casual cafe after receiving their injection. The clinical space removes the use of heroin from the context of pleasure-seeking, and assumes control for the drug’s use. Although the substance is the same, heroin users’ experiences of the drug in recreational settings is deliberately set apart from its use in the clinic.

Yet distinguishing the clinical space where heroin is injected, while no doubt increasing medicalized control over the substance, also complicates the notion of the drug as unquestionably destructive. Clients move into a social, casual environment in the cafe after initial injection. Even the clinical space itself underscores the intimacy of intravenous drug use, as staff and clients engage one-on-one during the injections. The staff similarly struggle with the complex nature of heroin as an illegal drug, made most evident by the strict safeguarding of the location where heroin is stored.

Although the medicalization of heroin abuse may serve to diminish the criminal stigma surrounding use of the drug, medical models of treatment remain entangled in older ideas of substance illegality, criminality, and the stringent enforcement of substance abuse policies. Conversely, the clinical treatment space and its organization is arranged in such a way that muddies the boundary between pleasure and treatment. The authors thereby illustrate the complexity of moving towards a medical model of heroin treatment, and how notions of control evolve with the changing landscape of substance abuse policy.

Vol. 39 Issue 1 March 2015: Ethnography & Clinical Practice

In addition to our From the Archive series, where we highlight past articles in the journal’s history, the CMP blog features selected previews and sneak peeks into our latest issue. This week, we gain a glimpse into an article from the March issue: the first installment of 2015’s Volume 39 of Culture, Medicine & Psychiatry.


A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices

Bonnie Kaul Nastasi, et al. Pages 92-120. Link to article: http://link.springer.com/article/10.1007/s11013-014-9404-9

In this article, Nastasi and colleagues have developed a new model for preventative care of HIV and STIs over the course of a 6-year research project in Mumbai, India. This clinical approach, called the Narrative Intervention Model (NIM), implores married men in Mumbai to construct narratives around their sexual health and related problems. With the clinician, patients then deconstruct the narrative to locate discrepancies between their accounts of sexual health and their desired health status. The last stage of the preventative approach entails clinicians coaching patients on how to minimize risk while meeting patient expectations surrounding sexual health. In this way, health counseling becomes a more dynamic process than medical history taking alone.

cropped-cards.jpgThe NIM model in this initial study was employed by both allopathic physicians and traditional Indian medical practitioners. By analyzing patients’ accounts and creating models for health behavior that minimized risks of HIV or STIs, caregivers were able to blend an anthropological and public health approach to preventative medicine. Likewise, the model drew on principles of cognitive behavioral psychology: inquiring about patients’ logic in rationalizing health choices, and intervening in this narrative to display where risks might be prevalent.

In the NIM model, the clinician’s interview with the patient takes on a semi-structured form (which the authors assert is “ethnographic” in nature.) Rather than traditional history-taking, which is an elicitation of information from the patient rather than a more fluid conversation, the NIM encourages patients to make connections between their cultural beliefs, behaviors, and their health.

Given the widespread interest in both medicine and anthropology on patient-clinician communication, this case presents an informative glance into how caregivers might draw on ethnographic practices to improve patient health. NIM offers one methodology for meaningful exchanges between clinicians and patients, and unites the aims of medicine and anthropology in illuminating culturally specific health behaviors, beliefs, and practices for the direct benefit of patients.

Book Release: Buchbinder’s “All in Your Head: Making Sense of Pediatric Pain”

This May 2015, Mara Buchbinder’s book All in Your Head: Making Sense of Pediatric Pain will be released by the University of California Press. The book grapples with the difficulty of expressing internal states to others via language, as these inner subjective experiences are often considered impossible to actualize in words. Buchbinder strives to honor this private experience of pain while studying how language surrounding pain and pain management is relational in nature. She explores how pain is described, managed, and treated in medical settings.

Image via UC Press

Image via UC Press

The text is a product of ethnographic research in numerous pediatric units in California hospitals. Buchbinder considers the social lives of physicians, caregivers, clinicians, parents, and children, all with a stake in alleviating pain and interpreting troubling or perplexing symptoms. Rather than allowing pain to be read solely as an isolating, private matter, the author argues that the treatment of pain is a complex social phenomenon. By focusing on narratives, conversations, and metaphors used by participants to illustrate the nature of pain, Buchbinder’s account underscores the power of language to generate shared meanings for human suffering.

All in Your Head will prove of interest to linguistic and medical anthropologists alike, as well as to scholars in the medical humanities with an interest in textual and communicative analysis in clinical settings. To learn more about this upcoming book, visit the publication page at the University of California Press here: http://www.ucpress.edu/book.php?isbn=9780520285224

ABOUT THE AUTHOR

Mara Buchbinder is Assistant Professor of Social Medicine at UNC-Chapel Hill, where she also teaches coursework in anthropology. She has previously coauthored the book Saving Babies? The Consequences of Newborn Genetic Screening.

News: WHO Release on Worldwide Hearing Loss

When medical anthropologists consider the impacts of technology on human health, we envision life-saving drugs, surgeries, or diagnostic tools to detect disease. Technology in these ways can prove instrumental– quite literally — in improving patients’ health outcomes. However, it is equally important to think about the ways in which technology can diminish health, particularly in an age where the global spread of technology deserves the attention of clinicians and anthropologists alike.

This is the nature of the concern posed by the latest World Health Organization (WHO) report, released on February 27th 2015. After studying noise exposure in middle and high income countries and among participants ages 14-35, WHO officials stated that an estimated 1.1 billion people are at risk for hearing loss due to “recreational noise.” This includes music piped through headphones and noise experienced at entertainment venues. Exposure to high decibels of sound is not itself harmful: for instance, hearing a heavy pot fall from the counter and crash onto the floor would not cause hearing damager. Rather, the extended length of exposure to such loud noises is what proves detrimental. The WHO defines dangerous levels of noise exposure as 85 decibels for eight hours or 100 decibels for 15 minutes. The report notes that a rock concert that lasts for two hours may cause temporary hearing loss or lead to other symptoms such as a ringing sensation in the ears, and regular extended exposure may lead to more permanent damage.

The WHO flag, via Wikimedia Commons

The WHO flag, via Wikimedia Commons

What does the WHO recommend to address this global health concern? The report singles out teenagers and implores them to take noise management into their own hands: purchasing noise-canceling headphones, taking “sound breaks” if extended exposure to loud sounds is unavoidable, or wearing ear plugs to loud music venues. This places the responsibility to manage noise exposure on young people rather than on their families and caregivers. Likewise, the report suggests that patrons of entertainment venues like clubs and bars that feature loud music and sounds should limit their time spent in such environments. There are no extensive recommendations listed in the report for those who work in loud venues, other than limiting shifts to eight hours to shorten exposure.

From a medical anthropological standpoint, many of the factors in sound environments are tangled with social life. For instance, in many developed countries, concerts are an important social gathering place for young people. Teens may not avoid these events, but if they follow the WHO recommendations and wear earplugs to the venue, they may be ostracized by their peers for looking out of place. Likewise, neighborhood bars and clubs are important hubs of activity for locals, and avoiding them may come at the cost of social isolation. As technologies spread both to developing and developed countries, the ways that people integrate audio technologies, new entertainment venues, and popular music into their lives is worth considering given the impacts of these tools, sounds, and social spaces on hearing health.


To read the WHO’s news release, click here: http://www.who.int/mediacentre/news/releases/2015/ear-care/en/

March 2015: Preview of Books Received

This week, we are featuring previews of five books received for review at Culture, Medicine, and Psychiatry. Be sure to check out more articles, reviews, commentaries, and case studies published in the first issue of volume 39 (2015) here: http://link.springer.com/journal/volumesAndIssues/11013

via Westview Press

via Westview Press

Language, Culture, and Society: An Introduction to Linguistic Anthropology

Zdenek Salzmann, James Stanlaw, and Nobuko Adachi, eds.

This textbook was first published in 1993, and this is the book’s sixth edition. The new incarnation of Language, Culture, and Society features has been revised and expanded with further explanation of the sociocultural context of language. It is also complete with class exercises, discussion questions, and other student resources. The book pays special attention to multilingual and transnational linguistic anthropology.

More details from Westview Press here: http://westviewpress.com/books/language-culture-and-society/

Via UC Press

Via UC Press

Haunting Images: A Cultural Account of Selective Reproduction in Vietnam

Tine M. Gammeltoft

This ethnographic account explores the lives of pregnant women in Hanoi, Vietnam whose fetuses were deemed biologically abnormal after ultrasound examinations. Gammeltoft considers the moral dilemmas these women face against the backdrop of their everyday lives and the roles of their family members in reproductive decision-making.

More details from UC Press here: http://www.ucpress.edu/book.php?isbn=9780520278431

Via UC Press

Via UC Press

Can’t Catch a Break: Gender, Jail, and the Limits of Personal Responsibility

Susan Starr Sered and Maureen Norton-Hawk

This ethnographic work traces Boston women’s experiences of sexual abuse, violence, inadequate social and therapeutic programs, and the impacts of local and federal policies on incarceration and criminal punishment. The authors consider how these women’s struggles are cast aside as the consequences of “bad choices” and “personal flaws,” and how marginalized women make their way in this “unforgiving world.”

More details from UC Press here: http://www.ucpress.edu/book.php?isbn=9780520282797

Via Duke UP

Via Duke UP

Given to the Goddess: South Indian Devadasis and the Sexuality of Religion

Lucinda Ramberg

Ramberg’s account addresses a unique cultural tradition in South India, where girls and sometimes boys are married to a goddess. They have sex with partner outside of traditional marriage and conduct holy rites outside of the goddess’ temple, and complicate the boundaries between what is male and female. The author argues that goddess marriages challenge existing notions of gender, marriage, and religious practice.

More details from Duke UP here: https://www.dukeupress.edu/Given-to-the-Goddess/index-viewby=subject&categoryid=27&sort=newest.html

Via Johns Hopkins UP

Via Johns Hopkins UP

Generic: The Unbranding of Modern Medicine

Jeremy Greene

This text is a social, political, and cultural history of the rise in generic pharmaceuticals. It tracks the development of modern generic drugs from early 20th century hacks who counterfeited popular medications through the growth in powerful corporations who first produced un-branded drugs. Greene describes generic drugs as a seminal movement towards more equitable, affordable medical care by giving patients quality medicines at a reduced price.

More details from Johns Hopkins UP here: https://jhupbooks.press.jhu.edu/content/generic

Upcoming Conferences in Social Studies of Science/Medicine: Fall 2015

If you have an event to add to this list, please contact Julia Balacko at jcb193@case.edu with the name of the event/conference, date(s), location, and a link to the event page or a brief description. This list is for conference in the Fall of 2015 (August-December.) All conferences/events are organized chronologically by date.


 Seventh International Conference on Science in Society: “Educating Science”

October 1-2 2015 – Chicago, Illinois

http://science-society.com/the-conference/call-for-papers

A Critical Moment: Sex/Gender Research at the Intersection of Culture, Brain, & Behavior Conference

October 23-24 2015 – Los Angeles, California

http://www.thefprconference2015.org/

Society for Social Studies of Science (4S) Annual Meeting

November 11-14 2015 – Denver, Colorado

http://www.4sonline.org/meeting

American Anthropological Association 2015 Annual Meeting: “Familiar/Strange”

November 18-22 2015 – Denver, Colorado

http://www.aaanet.org/meetings/

Logo via AAA website

Logo via AAA website

History of Science Society Annual Meeting

November 19-22 – San Francisco, California

http://hssonline.org/meetings/annual-meeting-archive/