Issue Highlight: Vol 39 Issue 4, Stimulant Use in the University

Posted by jknopes

This blog post is the last in a three-part series highlighting our newest installment of Culture, Medicine & Psychiatry (released December 2015) which readers can access here. This week, we explore Petersen, Nørgaard, and Traulsen’s research on the use of prescription stimulants amongst university students in New York City. The full article is available here.

In recent dialogues on the widespread use of prescription stimulants amongst university students, drugs are often described as enhancing productivity or a student’s ability to successfully focus on academic work. However, Petersen, Nørgaard, and Traulsen found that university students in New York City often cited the use of these drugs as rendering their work more pleasurable, “fun,” and “rewarding.” Their study included 20 students spanning BA, MA, and PhD programs: representing a diverse sample that, in the aggregate, universally suggested that the use of stimulants in an educational setting was not centrally connected to academic output or production. This outcome, the researchers assert, complicates existing neoliberal readings of American personhood, premised on the idea that the self is primarily cultivated and disciplined through labor and individual productivity.

For example, rather than feeling shameful about using stimulants to improve study skills or produce better work, the students instead expressed guilt for enjoying their academic labors and for transforming “monotonous” and “boring” activities into an engaging experience. The “optimization” of the mind to perform intensive intellectual labor was not related strictly to productivity, which would evoke traditional neoliberal notions of the person-as-producer. Instead, the students described the drugs as optimizing pleasure first, which rendered them more productive as a secondary consequence.

Take this instance: a 32-year old PhD student, identified as Ben, reported using Adderall when he felt too “lazy” to initiate work. Rather than continuing by discussing the extent of his productivity while on the drug, he instead explains that the drug makes him eager “to tackle” his projects. This is often the case for students who struggle to find the desire to complete academic tasks that are not interesting enough to begin without being made pleasurable through stimulant use. Further, another student added that using stimulants helped him to “reconnect” with his interest in sociology during a difficult class on social science theory. In other cases, using Adderall kept students from being distracted from social media or entertainment websites: not because they lacked the inherent ability to be productive, but because without the drug, these sources of interest were simply more engaging than the work at hand. In other instances, students noted that stimulants made them feel more secure and positive about the quality of their work, and helped them to diminish the physical and mental stresses that came with “all-nighters,” or extended overnight studying stints.

Throughout all these cases, enhancement is not described as a means to make the human brain meet the demands of a “high-speed society.” Instead, “enhancement” relates to students’ satisfaction with their resulting work, to their enjoyment of otherwise “boring” tasks, and to reduced the negative psychosomatic effects of studying or working on a limited time frame.

The authors do not eschew the neoliberal model through these cases: indeed, they suggest that the use of stimulants does have cognitive effects that bolster students’ abilities to produce academic work. However, they note that we must complicate a strictly neoliberal model that would indicate that stimulants are employed by students strictly in order to achieve a certain amount of studying or to complete an assigned amount of work. Enhancement may include productivity, but for students who use stimulant drugs, it also involves increasing the pleasure of finishing intellectual labors, and decreasing the negative consequences of engaging in challenging or otherwise tedious academic work.

In this way, cognitive-enhancing drugs indeed fortify the mind and the conception of the self as a producer and academic laborer. However, they also shape human experience by altering students’ sense of confidence, their satisfaction with academic work, and their passion for their chosen topics of study. In these ways, enhancement drugs not only increase productivity in the neoliberal sense: they also broadly impact notions of pleasure and individual ability related to students’ quest to heighten academic production.

Issue Highlight: Vol 39 Issue 4, Incarceration & Medical Anthropology

Posted by jknopes

This blog post is the second installment of our three-part issue highlight on the new December 2015 issue of Culture, Medicine & Psychiatry (the full issue is accessible here.) In this week’s blog, we examine Carolyn Sufrin’s article on the shared roles of clinicians and anthropologists working with incarcerated women in the United States.

Clinician-anthropologists are in a unique position to lend voice to their participants and to care for their medical needs. For Carolyn Sufrin, who served both as a physician and an ethnographic researcher for incarcerated women in the United States, the clinical and anthropological roles intersected in deeply meaningful ways. Sufrin notes that in these dual roles, she observed with female prisoners and analyzed their experiences, and provided reproductive health care and delivering the same women’s babies in a county hospital, where imprisoned women gave birth. The women were alternately enrolled in Sufrin’s study upon ceasing to officially be her patients, or were individuals that Sufrin cared for during her tenure as their OB/GYN.

Sufrin uses her case as an example of how to interpret the ethical consequences of working as a clinician-anthropologist. Part of the challenge she faced as both a physician and anthropologist to the women was that IRB and HIPAA regulations divided the types of data she could use in her anthropological research. Though some details of her participants’ lives, such as past trauma or childhood abuse, were essential to their experiences as mothers and as incarcerated women, she could not use this data inasmuch as it had been shared with her in the context of a patient-practitioner interaction: in other words, it was considered classified personal health information that could not be subsequently utilized in her ethnographic research. These methodological hurdles, Sufrin explains, shed light on the complexities of what constitutes “sacrosanct” data. It also suggests how the safeguarding of medical data does not necessarily translate to the “protective” collection of ethnographic data which is not isolated to the case of individual patients, and which relies on knowledge of participants and their connections to other people (in this instance, to individuals in the participant’s life who had caused past psychological harm.)

Likewise, as stated earlier, relationships between the participant/patient and the clinician/anthropologist are another form of interpersonal connection which must be reconfigured depending on the nature of the exchange taking place. In Sufrin’s case, this meant being clear with her participants that– upon entry into her anthropological study– she was no longer their physician, and that the nature of their exchanges and their professional relationship would take a new form. She could share their information (albeit de-identified), unlike information drawn solely from their medical records or from an examination.

Yet here, Sufrin notes that the anthropologist– like the clinician– is still engaged in an ethic of care. For example, one of Sufrin’s former patients in the prison was charged with child endangerment after giving birth in an alley and handing her child to a stranger, unable to afford treatment at a hospital following her release from prison. The story made news headlines, and as public knowledge, was within the realm of information that Sufrin employed in her ethnographic analysis of reproductive health in the American prison system. However, Sufrin knew an added piece of information that was not already publicized from her interaction with the woman in prison: a clinical detail that she understood as a physician, but was shared during her time as an ethnographic researcher. This detail would have enhanced her analysis of the situation, but she chose to omit it out of concern that to publicize the detail would be to betray the woman’s trust in her as a researcher and as someone who served in the prison as a physician.

In other instances that Sufrin discusses, her role as both an anthropologist and clinician led the women she worked with in each capacity to feel as if she was especially attentive and caring. Rather than always relying on her medical authority, Sufrin underscores her decision to remain non-judgmental and supportive even when the women in her study had made potentially harmful choices; for example, she chose not to openly admonish a woman who was continuing to use crack upon release from jail, despite being thirty-two weeks pregnant. Sufrin notes that her silence hid her own frustration with this choice, but it strengthened the woman’s trust in her as an anthropologist and “as a doctor.”

In sum, these dual roles ultimately bolstered her relationships to the incarcerated and formerly incarcerated women that she served. Thus, the author argues that both anthropologists and clinicians share an “ethic of care” in their relationships with research subjects or patients. This ethic involves a careful fostering of the professional, interpersonal connections that ethnographers make with research participants, or that physicians make with their patients. This care entails the protection of private information and the researcher/clinician’s conscious attendance to interpersonal exchanges that bolster the patient/participant’s trust in the clinician/anthropologist. Likewise, an analysis of the clinician role alongside the anthropological one demonstrates both the delineations between multiple forms of care and social connection, as well as the shared commitment in medicine and anthropology to the sensitive attendance to patient and participant experiences.

Issue Highlight: Vol 39 Issue 4, Posthumous Reproduction

Posted by jknopes

Our final issue of the year– Volume 39 Issue 4 December 2015– has just arrived. In our last blog post series for 2015, we begin with a three-part feature of the latest publications at the journal in this new issue. In addition to the article previews in this series, our readers can access the full issue here. In this post, we explore Yael Hashiloni-Dolev’s preliminary research on posthumous reproduction in Israel (full article accessible here.)

Biomedicine, through its innovative application of technology, can reconfigure biological experiences in ways that alter or reinforce cultural beliefs surrounding life, death, reproduction, kinship, parenthood, and social roles. Most recently, this has become a central issue in the field of assisted reproductive technologies: where biomedical interventions potentiate new relationships between parents, families, and children. But while assisted reproductive medicine is often discussed in terms of generating life, these new generative technologies may also intersect with death in novel ways that challenge existing understandings of kinship and familial relationships.

Hashiloni-Dolev article studies Israeli lay perceptions of a new concept in assisted reproductive medicine called posthumous reproduction (PHR.) In sum, PHR entails the use of genetic material from deceased parents to conceive children after their deaths. This usually means a woman will opt to become artificially inseminated with a husband or partner’s sperm retrieved while the man was in a coma or vegetative state: however, it may also include the fertilization of a woman’s eggs, frozen while she was alive, and gestated in a surrogate mother. Even frozen embryos of two deceased parents (a mother and father) might be “adopted” and implanted into a female relative or another recipient, who subsequently gives birth to a child whose biological parents are no longer alive. This process also facilitates the possibility of posthumous grandparenthood, and indeed, some parents whose adult children have died may seek out PHR technologies (include allied technologies such as surrogacy) to produce grandchildren.

Israel is one of the few countries that permits some forms of PHR, and it is a progressive nation in terms of reproductive technologies: its state health system covers the costs of ARTs (assisted reproductive technologies) for couples who have difficulty conceiving. Although Israel does not permit all forms of PHR, it does allow for the collection of a man’s sperm upon a wife’s request to carry his child upon his death (what the author calls the “prototype scenario.”) In this regard, Israel served as a prime location for surveying participants and testing initial ideas about the public perception of PHR: a new frontier of ARTs yet to be studied in the anthropological literature.

Through 26 semi-structured interviews with newlywed or childless couples, Hashiloni-Dolev discovered that there were some inconsistencies between the Israeli PHR policies and the participants’ understanding of PHR technologies. For instance, the government stipulated that PHR could occur via the retrieval of sperm from a dying or recently deceased father upon the wife or female partner’s instruction. The policy states that the retrieval could occur given evidence of a man’s “presumed wish” that he would want his spouse or partner to carry his child after death. However, “wish” and “consent” were interpreted differently by men interviewed for the study. The men typically stated that while they would defer to their partner’s wishes to have a child after their death, they themselves were uncomfortable with the possibility of their partners having the child and being unable to “move on” should they pass away. In this instance, while the man’s presumed “wish” might not change a woman’s decision to retrieve his sperm posthumously, it does not mean the man would “consent” to the process if he were not already dead.

Conversely, consent becomes more complicated given the circumstances that typically surround the use of PHR. The man is presumably young, such that his female partner would be able to carry his child, and would have died suddenly: thus making it nearly impossible to obtain his consent unless he had already affirmatively offered it while still alive and healthy.

There were also issues related to the family life of a child born through PHR techniques. Both male and female participants worried about the emotional stability and security of children born out of such conditions, and expressed their concern with new policies being proposed that would allow for expanded posthumous grandparenthood rights. The participants believed that the decision to have children following the death of a spouse was between the couple, and was not between other family members. Likewise, many participants worried about the birth of a child as a living shrine to the deceased, rather than as a new and autonomous member of the family.

In these responses, it is clear that while both biomedical technologies and governmental policies may enable PHR to occur, the process is not always viewed in such liberal terms by individuals who could be most likely to use it. Posthumous reproduction thus supplies medical anthropologists and scholars of social medicine with a nuanced case of the cultural position of new technologies, and the concerns that individuals across cultures have with these new reproductive tools: particularly as they relate to consent, kinship, and the roles of parents.

Issue Highlight: Vol 39 Issue 3, Suicide in Rural Kenya

Posted by jknopes

When a new issue of Culture, Medicine & Psychiatry is released, we feature a series of blog posts that highlight these latest publications in our journal. The current September issue includes articles that address psychiatric conditions and the experiences of people with mental illness across cultures. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In this issue highlight, we will discuss an article on ethnographic analyses of suicide and distress amongst three communities in northern Kenya.

Suicide in Three East African Pastoralist Communities and the Role of Researcher Outsiders for Positive Transformation: A Case Study

Bilinda Straight, Ivy Pike, Charles Hilton, and Matthias Oesterle – Pages 557-578

http://link.springer.com/article/10.1007/s11013-014-9417-4

The authors of this article strive to establish a nuanced and ethnographically rich understanding of suicide and mental distress in an under-studied population of three distinct, yet interacting, pastoral communities in northern central Kenya. These three groups– the Pokot, Samburu, and Turkana– are engaged in intercommunity conflicts over territory and land use agreements, despite the communities’ shared and entangled oral histories. Such tensions are only exacerbated by mutual fear of raids by other groups, dearths in food available for forage, and the theft of livestock from individuals who sell the animals to finance political campaigns. Poverty is likewise aggravated by these patterns of loss and violence.

This turbulent social environment creates widespread mental distress amongst the three communities, yet individuals from each group stressed to the research team that they felt obligated to persevere despite these pressures, making admitting psychological suffering (and especially confessing thoughts about suicide) deeply taboo. Therefore, any mental health intervention would have to be responsive to the extent to which Pokot, Samburu, and Turkana culture disallow individuals from discussing or even thinking about suicide: an act which could create even more social strain on the family of the person who committed it. The researchers confirmed this inability to discuss suicide by the high rates of non-response on a survey question which asked participants whether or not they had experienced suicidal thoughts.

Suicide thus proves to be a unique case for anthropological analysis because it is both driven by the social conditions of those who take their own lives, as well as disruptive to the communities in which these people lived. Its treatment by global health workers must in turn be sensitive to cultural beliefs that forbid conversation about suicide, especially in communities where the death of an individual may contribute to already extraordinary social distress.

Issue Highlight: Vol 39 Issue 3, Maya Mental Disorders in Belize

Posted by jknopes

With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue includes articles that address psychiatric conditions and the experiences of people with mental illness across numerous cultures. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In today’s issue highlight, we will examine a study on indigenous nosologies of mental illness amongst the Maya of Belize.

Narrative Structures of Maya Mental Disorders

Andrew R. Hatala, James B. Waldram, and Tomas Caal – Pages 449-486

http://link.springer.com/article/10.1007/s11013-015-9436-9

To understand the compatibility of divergent medical traditions, it is first essential to describe how medical systems classify and interpret disorders in particular ways. With this aim in mind, the authors of this ethnographic study sought to develop an picture of indigenous mental illness nosology amongst the Q’eqchi’ Maya of southern Belize. They also asked how this knowledge may alternatively coexist, or compete, with biomedical concepts of suffering.

In order to learn about this indigenous medical epistemology, the authors worked with the Maya Healers’ Association, a professional, self-regulated group of twelve healers who maintain a garden of medicinal plants for research and who strive to reinvigorate traditional medical practice in Belize. Across ninety-four interviews with healers, the authors uncovered four illness categories that the participants used to describe the roots of mental illnesses: “thinking too much,” fright, the day of birth, and spirit “attacks.”

These descriptions are sometimes cross-compatible with DSM-V nosologies, as the researchers discovered that “thinking too much” was also listed as a symptom in biomedical models of mental illness. However, unlike the DSM-V, Maya healers tended to characterize overthinking as a “genre” of illness experience rather than as a discrete symptom. Maya healers also characterize mental illnesses as existing within the heart, the mind, and the spirit: thereby expanding the implications of mental illness beyond brain physiology, the proximate explanation employed by biomedical psychiatry.

The authors conclude that it is essential to understand the similarities in the two nosologies to facilitate collaboration between indigenous and biomedical healers, but add that both groups must also be aware of the differences in classificatory schemes that they use to interpret mental illness. In this way, people with mental disorders in Belize may best receive care that accounts for all of the ways they might seek care and understand their illness across the boundaries of medical systems.

Issue Highlight: Vol 39 Issue 3, Depression & Psychiatry in Iran

Posted by jknopes

With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue features articles that address psychiatric conditions and the experiences of people with mental illness across cultures. The articles span studies in India, the United States, East Africa, Iran, and Belize. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In this issue highlight, we will explore the emergence of public discourse about mental illness, suffering, and political struggle in Iran.

Writing Prozak Diaries in Tehran: Generational Anomie and Psychiatric Subjectivities

Orkideh Behrouzan – Pages 399-426

http://link.springer.com/article/10.1007/s11013-014-9425-4

Behrouzan’s study began upon noticing young Iranians discussing mental illness in blogs and in public forums in the early 2000s. At the same time, the author examined unpublished public health records maintained by the state, and noticed that there was a sharp rise in the prescription rate of antidepressants in the mid to late 1990s. This pattern correlated with a shift in the understanding of suffering: during the Iran-Iraq war of the 1980s, PTSD and anxiety disorders were considered the most pressing mental health concerns, but these illnesses became supplanted by a shared culture of loss and hopelessness amongst young Iranians in the period following the war.

Unlike the narrative of depression in other places, however, Behrouzan found that the Iranian category of depreshen held deep political meanings. The illness category reflected the condition of those unable to publicly mourn for friends and family who may have been executed as political prisoners, or to process grief about continued political unrest that seemed to have no resolution, or to understand the loss of a parent during wartime as a young child. As one Iranian blogger described, “our delights were small: cheap plastic footballs, cartoons and game cards… But our fears were big: what if a bomb targets our house?” Thus depreshen becomes an experience of suffering that reverberates throughout a generation.

However, Iranian psychiatry responds to this condition outside of its cultural context, and continues to treat depreshen as an individual patient pathology that can be understood in biological terms. By biomedicalizing depreshen in this way without understanding its connection to political struggle, Iranian psychiatry minimizes suffering and “takes away subjects’ abilities to interpret and/or draw on their pain as a political resource.” When we interpret depreshen from the perspective of patients, therefore, we gain a nuanced view of suffering that is at once culturally specific and politically powerful.

Special Issue Highlight: The Anthropology of Autism, Part 2

Posted by jknopes

In this week’s entry, we continue our issue highlight on the current special issue of Culture, Medicine & Psychiatry. Released in June 2015, the latest issue explores anthropological research on autism, both across the world and between communities of people with autism and their families. Like the first part of this feature, we will explore two articles in the current special issue.

“But-He’ll Fall!”: Children with Autism, Interspecies Intersubjectivity, and the Problem of ‘Being Social’

Olga Solomon

Autism-spectrum disorders (ASD) are described in diagnostic manuals as an impairment of one’s ability to successfully relate to and understand other people. Yet this definition of autism relies on a specific notion of sociality that, Solomon argues, becomes much more complicated when considering autistic individuals’ interaction with therapy animals.

Solomon compares two cases that highlight autistic children’s understandings of what it means to be social: one without animals, and another with animals featured prominently in the therapeutic intervention. In the first instance, a child she calls Rosalyn is being tested in a psychological facility. The child attempts to engage in conversation with the psychologist and her parent, but is dismissed. She also shows a picture she has drawn to the psychologist, yet is again dismissed and offered a standardized picture book to complete another diagnostic task. Rosalyn’s own experiences and perspectives are cut from the diagnosis, while artificial tasks and measures that are foreign to her—such as the picture book—are substituted for “real” social materials worth engaging with.

Unlike Rosalyn, whose encounter with the psychologist in the office offers her little opportunity to demonstrate her connections to other people on her own terms, a girl named Kid has a much different experience in animal-based therapy. While Kid has no friends in school and struggles to engage socially, she demonstrates concern for her therapy dog. She worries in one interaction that she might drop him from her lap, and in another vignette, notes to her family that she fears the family dog might be jealous of her interactions with the therapy dog.

In Kid’s case, the presence of animals provided an opportunity for her to demonstrate her understandings of their emotional state and to express her feelings towards them. Rosalyn likewise attempted to engage with her psychologist and mother while in the office, but her attempts to interact were brushed aside and supplanted with artificial testing activities that did not elicit an empathetic response.

Solomon posits that these findings align with theory after the post-human turn, whenever the human actor became destabilized as the center of all social interaction and new notions of sociality began to consider interspecies engagements, particularly in the works of Donna Haraway. When animals enter the picture, these non-human actors prove central to understandings of social relationships that might not otherwise be seen in strictly human-to-human interaction, as in the case of Rosalyn.

Click here for the full article: http://link.springer.com/article/10.1007/s11013-015-9446-7

Making Meaningful Worlds: Role-Playing Subcultures and the Autism Spectrum

Elizabeth Fein

Like Solomon, Fein explores another case where individuals on the autism spectrum learn to interact and engage with others on their own, productive terms. Fein draws on ethnographic research of a summer camp for teens with autism, where they role-play as magicians, scientists, and other fantastical characters.

At the camp, the teens posit themselves in new social roles, explore new identities, and forge relationships with others in novel ways. They largely practiced live-action role playing (LARP), stylized as LARPing, an activity where participants dress and act as mythical characters in a live-action fantasy game. The founders of the camp, called the Journeyfolk, realized that ASD youth were drawn to these fantasy role-playing communities, where a shared mythology and a story arc that pitted villains against heroes created a common social space for participants.

Although participants of the games had unique behavioral qualities—in one team, for instance, there was someone who jumped on other players and another with intense hyperactivity—they accepted that they had to overcome these individual differences in order to work together. Likewise, older players who gravitated to the roles of heroes in the LARP events were often instructed to act as villains: challenging them to take on new roles beyond their own desire to act as a specific character.

The game and the camp provided a strong external structure that guided participants through tasks and activities: structure that individuals on the autism spectrum often need to navigate social situations effectively. Conversely, it also promoted a storytelling environment where characters that teens acted struggled with deep, internal, psychological quandaries, such as battling off evil spirits that possessed team mates, and struggling with being a mythological human/inhuman hybrid being. They could draw upon their real-life struggles, such as anger issues, in order to create characters that—like them—were challenged to solve problems in light of these personal difficulties.

Fein concludes, in part, that these camps both provide the structure and the social patterning that autism-spectrum individuals need to engage with others positively, while also encouraging neurodiversity by valorizing fringe nerd culture and allowing individuals to create characters that are informed by the behavioral patterns and psychological struggles of those who play them in the games.

To access this article, click here: http://link.springer.com/article/10.1007/s11013-015-9443-x

To access all of the articles in this issue, click here: http://link.springer.com/journal/11013/39/2/page/1

Special Issue Highlight: The Anthropology of Autism, Part 1

Posted by jknopes

The newly released June 2015 special issue of Culture, Medicine & Psychiatry addresses anthropological studies of autism from around the world, including the United States, India, and Italy. In this installment and the next entry on the blog, we will explore four articles published in the latest issue. This research spans the fields of disability studies, psychological anthropology, and medical anthropology, and touch on themes of identity, subjectivity, family caregiving, and community. Here, we will focus on two articles in this publication.

Parenting a Child with Autism in India: Narratives Before and After a Parent–Child Intervention Program

Rachel S. Brezis, et al.

Throughout India, there are limited social services and support networks for individuals with autism and their families. Furthermore, neurodiverse (and mentally ill) individuals have historically been cared for in private by family members in India, where they are hidden from the community and may be treated as a mark of shame on the household. However, despite these challenges, Indian parents of children with autism are increasingly seeking out professional programs that educate them about autism and appropriate caregiving strategies.

One such program in New Delhi, the Parent-Child Training Program (PCTP), evidences the changing view towards autism in India. The program aims to educate parents about autism and, in so doing, encourage them to educate others about the experience of raising a child with the condition. Parents bring their child to PCTP and learn alongside them. As the first program in India to provide such training, its examination proves essential in understanding the way that various populations (here in India) are now approaching the shifting landscape of autism.

Brezis and colleagues studied the PCTP to discover how the training was altering parents’ perceptions of autism and relationships with their children. They interviewed 40 pairs of parents at the beginning and end of the 3-month program, encouraging the parents to speak for five minutes without prompts regarding their child and their relationship to the child.

The authors found that parents who participated in the three-month program were less likely to describe their children in relation to an assumed “normality,” although mothers proved to be more likely than fathers to self-reflect on their relationship with their child. Similarly, while parents described their child’s behaviors no less frequently in the second and final interview, they did not note behavior in relation to other individuals’ behavior perceived as “normal.”

To learn more about this research, click here for a link to the article: http://link.springer.com/article/10.1007/s11013-015-9434-y

Custodial Homes, Therapeutic Homes, and Parental Acceptance: Parental Experiences of Autism in Kerala, India and Atlanta, GA USA

Jennifer C. Sarrett

Like Brezis et al, Sarrett also investigates Indian caregiving and parental experiences of autism, while comparing this context to autism and the family in the United States. In both cases, Sarrett asks how the home as space and place impacts the meaning of disability for people with autism. She interviewed seventeen caregivers in Atlanta and thirty-one in Kerala, and observed seventeen families in Kerala and five families in Atlanta who had also participated in interviews. Sarrett concludes that though there are some similarities in the constellation of autism-specific and biomedical services that may be available to Keralite and American families, the arrangement of households themselves drastically changes the way autistic children are cared for in each location.

In Kerala, for example, mothers serve as both full-time child caregivers as well as domestic laborers, often spending long hours washing clothes by hand and cooking from scratch. Keralite children with autism have few interactive toys that are specifically geared to engaging them, few devices that may control their movements and behaviors (such as baby gates) or assist them in communication (such as an electronic device that voices requests for food or other needs.) Such tools are common in Atlanta households. However, they have consistent household care from mothers who manage all domestic labor with no outside employment.

Households with autistic children in Atlanta, meanwhile, are specifically retrofitted for the needs of the child. There are picture cards that children may use to show caregivers and parents an item of food that they wish to eat, as well as a calendar in the kitchen or office that marks doctors’ appointments and family events geared for socialization with the autistic child. Baby gates, cabinet locks, and other safety devices ensure the child does not come into contact with household dangers (such as kitchen knives and cleaning solutions.)

In sum, these tools are designed to change and improve the behavior of the child. The home itself is structured to be a therapeutic space: requiring material and financial resources that Keralite families do not have to physically adjust their households. Instead, Keralite families focus not on improving or altering an autistic child’s behavior, but rather emphasize consistent caregiving for the child. In both cases, however, parents are committed to creating an environment (be it material or social) in which a child with autism can be integrated into the activities of the household, and thus into the family’s social world. Despite cultural, and certainly resource, differences between Indian and American families, they share a common commitment to building home support systems for their developmentally disabled children.

Click here to access the full text of this article: http://link.springer.com/article/10.1007/s11013-015-9441-z

To access all of the articles in this issue, click here: http://link.springer.com/journal/11013/39/2/page/1

From the Archive: Global Health, Biomedical Difference, and Medical Training

Posted by jknopes

In our “From the Archive” series, we revisit articles from past issues of the journal. In this installment, we review Betsey Brada’s article “‘Not Here’: Making the Spaces and Subjects of ‘Global Health’ in Botswana,” from the June 2011 special issue on the theme of “Anthropologies of Clinical Training in the 21st Century.”

What do we mean when we employ the term “global health,” particularly about the nature of caregiving in other cultural contexts? In her ethnographic research at a training hospital in Botswana, Betsey Brada posits one theory of the term as engaged with by medical and pre-medical students, missionary doctors, resident medical staff, and other key clinicians at the field site. Brada finds that while global health is often narrowly defined as biomedicine performed in “resource poor” or “resource limited” regions, this definition in fact relies intensely on a complex, comparative understanding of place, technology, and biomedical skill.

For example, Brada describes one case where a German man on vacation in Botswana broke his leg and required surgery. Upon returning to his home country for a follow-up examination of his healing leg, the man’s physicians were surprised at the skill of the procedure, remarking that it was commendable given that it was performed abroad. The German physicians had therefore assumed that care in a “resource limited” context was correspondingly of a lower quality than biomedical care delivered in a developed country, even though clinicians often tout the “universality” of biomedicine as a cultural boundary-crossing (if not hegemonic) mode of scientific healing. The medical staff in Botswana remarked that many physicians in developed countries believed biomedicine in the developing world to be crude, simplistic, and backwards: even though staff members at the Botswana hospital had been trained at advanced facilities across the world, many of them in developed countries.

Students studying and volunteering at the hospital were also repeatedly instructed in lectures to understand the differences between pharmaceutical use in the United States versus medications available in Botswana. American physicians described an extensive list of common medication available in the hospital’s pharmacy in terms of how it was no longer used in the United States, but had to suffice “here.” This example, too, underscores the tangled relationships between space, technology, and an understanding of global biomedicine primarily in terms of nations offering cutting-edge care versus those countries that had, in their perspectives, fallen behind.

Brada also argues that medical anthropology and linguistic anthropology have much to contribute to one another, although the disciplines are not often engaged in scholarly conversation. She notes that the careful analysis of language used to distinguish “here” (Botswana) from the developed world, including the United States and Europe, demonstrates the division between spaces that is central to definitions of global health as given in biomedicine. Brada asserts that an understanding of “global health” only emerges whenever we attend to the terminology that physicians, staff, and students use to separate medicine in the developed world, from medical standards implemented on the global scale by the WHO, to the terms used to describe medical care in local, foreign contexts.

The June 2011 special issue features other fascinating articles that address the cultural situatedness of biomedical knowledge, and how medical concepts are translated to future clinical practitioners. To learn more about this issue, see the links below.

To find the article and abstract on our Spring site, click here: http://link.springer.com/article/10.1007/s11013-011-9209-z

For the full special issue, including links to other articles in the June 2011 installment, click here: http://link.springer.com/journal/11013/35/2/page/1

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

Posted by jknopes

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