Medical Anthropology

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

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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.

Guest Blog: Culture, Medicine, and Neuropsychiatry

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This week, we are featuring a special guest blog post by M. Ariel Cascio, PhD. Here, she discusses neuropsychiatry in the Italian context and within the United States.

In the 21st century, anthropologists and allied scholars talk frequently of the biologization, cerebralization or neurologization of psychiatry. Many make reference to the 1990s, the “Decade of the Brain” that closed out the last century. They talk about “brain diseases” as a dominant discourse in discussions of mental illness. The 2014 Annual Meeting of the American Anthropological Association hosted a panel on “reflections on mind and body in the era of the ‘cerebral subject.’” In these and other ways, scholars write and talk about increasing dominance of brain discourses in discussion of psychological and psychiatric topics. This dominance has historical roots, for example in German (Kraepelinian) psychiatry, and authors in Culture, Medicine & Psychiatry and elsewhere have written about the historical context and local manifestations of this dominance of the neurological in the psy- sciences.

In this blog post I explore a situation in which neurology and psychiatry have long co-existed: the Italian field of neuropsychiatry. While the field “neuropsychiatry” is not unknown in the United States, and similar terms are used in other countries as well, I offer some comments specifically on the Italian context. The example of Italian neuropsychiatry provides one case of a particular historical relationship between neurology, psychiatry, and psychology that would be of interest to any historical or anthropological scholars of psychiatry.

The Italian medical system distinguishes between neuropsychiatry and psychiatry, neuropsichiatria infantile and psichiatria. Neuropsichiatria infantile (child neuropsychiatry), abbreviated NPI but sometimes referred to simply as neuropsichiatria (neuropsychiatry), addresses neurological, psychiatric, and developmental problems in children under age 18. Psichiatria (psychiatry) treats adults starting at age 18. As such, it is tempting to simply distinguish child and adult psychiatry. However, neuropsychiatry and psychiatry actually have distinct origins and practices. As the names imply, neuropsychiatry links neurology and psychiatry. Adult psychiatry, however, does not.

While Italian psychiatry has its roots in early 19th century organicist and biological approaches, in the 1960s a younger generation of psychiatrists, most prominently Franco Basaglia, aligned themselves with phenomenology and existential psychiatry. These psychiatrists crystallized their ideas into the ideology of Psichiatra Democratica (Democratic Psychiatry) and the initiative of “Basaglia’s Law,” the 1978 Law 180 which began Italy’s process of deinstitutionalization, generally considered to be very successful (Donnelly 1992). While childhood neuropsychiatry is indeed the counterpart to adult psychiatry, more than just the age group served differentiates these fields. If Italian psychiatry has its roots in Basaglia and the ideology of democratic psychiatry, neuropsychiatry has its roots at the turn of the 20th century, in the works of psychiatrist Sante de Sanctis, psychopedagogue Giuseppe F. Montesano, and pedagogue Maria Montessori.

In this way, neuropsychiatry’s origins bridged psychiatry and pedagogy (Bracci 2003; Migone 2014). Giovanni Bollea has been called the father of neuropsychiatry for his role in establishing the professional after World War II (Fiorani 2011; Migone 2014). Fiorani (2011) traces the use of the term neuropsychiatry (as opposed to simply child psychiatry, for example) to Bollea’s desire to honor the distinctly Italian tradition and legacy following Sante de Sanctis.

Several features distinguish psychiatry and neuropsychiatry. Migone (2014) argues that child neuropsychiatry has taken more influence from French psychoanalytic schools, whereas adult psychiatry has taken more influence from first German and then Anglo-Saxon psychiatries. Migone further explains:

Child and adolescent psychiatry in Italy is therefore characterized by a reduced use of medications (if compared to the United States), and by a diffuse use of dynamic psychotherapy, both individual and family therapy (from the mid-1970s systemic therapy spread). The attention to the family and the social environment is extremely important for understand the clinical case during the developmental years. [My translation]

Moreover, neuropsychiatry is known for being multidisciplinary and working in equipe, teams of psychiatrists, psychologists, social workers and so on. It incorporates psychoanalysis, psychotherapy, dynamic psychology, psychological testing, social interventions, and more (Fiorani 2011).

This extremely brief overview outlines key characteristics of Italian neuropsychiatry and the ways it is distinguished from Italian psychiatry, as well as from U.S. psychiatry. Italian neuropsychiatry provides one example of a long-standing relationship between neurology, psychiatry, psychology, philosophy, and pedagogy. By drawing attention to this medical specialty and the complexities of the different fields it addresses, I hope to have piqued the interest of historical and anthropological scholars. I include English and Italian language sources for further reading below.

References and Further Reading – English

Donnelly, Michael. 1992. The Politics of Mental Health in Italy. London ; New York: Routledge.

Feinstein, Adam. 2010. A History of Autism: Conversations with the Pioneers. Malden, MA: Wiley-Blackwell.

Levi, Gabriel, and Paola Bernabei. 1997. Italy. In Handbook of Autism and Pervasive Developmental Disorders. 2nd edition. Donald J. Cohen and Fred R. Volkmar, eds. New York, NY: John Wiley & Sons.

Nardocci, Franco. 2009. The Birth of Child and Adolescent Neuropsychiatry: From Rehabilitation and Social Inclusion of the Mentally Handicapped, to the Care of Mental Health during Development. Ann Ist Super Sanità 45: 33–38.

References and Further Reading – Italian

Bracci, Silvia. 2003. Sviluppo della neuropsichiatria in Italia ed Europa. Storia delle istituzioni psichiatriche per l’infanzia. In L’Ospedale psichiatrico di Roma. Dal Manicomio Provinciale alla Chiusura. Antonio Iaria, Tommaso Losavio, and Pompeo Martelli, eds. Pp. 145–161. Bari: Dedalo.

Fiorani, Matteo. 2011. Giovanni Bollea, 1913-2011: Per Una Storia Della Neuropsichiatria Infantile in Italia. Medicina & Storia 11(21/22): 251–276.

Migone, Paolo. 2014. Storia Della Neuropsichiatria Infantile (prima Parte). Il Ruolo Terapeutico 125: 55–70.

Russo, Concetta, Michele Capararo, and Enrico Valtellina. 2014. A sé e agli altri. Storia della manicomializzazione dell’autismo e delle altre disabilità relazionali nelle cartelle cliniche di S. Servolo. 1. edizione. Milano etc.: Mimesis.

ABOUT THE AUTHOR

M. Ariel Cascio is an anthropologist specializing in the cultural study of science and biomedicine, psychological anthropology, and the anthropology of youth. She recently successfully defended her dissertation on autism in Italy at Case Western Reserve University. She can be reached at ariel.cascio@case.edu. Her blog, written in Italian and English, can be viewed here: https://arielcascio.wordpress.com/.

News: WHO Release on Worldwide Hearing Loss

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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

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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

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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/

Guest Blog: Reflections on Antibiotic Use in American Hospitals

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This week, we are featuring a special guest blog written by Katharina Rynkiewich from Washington University in St. Louis. Today, she tells us about her experiences researching antibiotic use among infectious disease practitioners in Chicago, Illinois. If you would like to submit a guest blog entry on your research, please send a 500-700 word piece to social media editor Julia Balacko at jcb193@case.edu.

In the spring of 2013, I conducted research on hospital-based infectious disease specialists in Chicago. Although my participants had a lot to say about antibiotic resistance, I was most surprised at how they characterized and criticized fellow clinicians’ use of antibiotics in relation to resistant disease strains. In hospitals, they suggested, the regulation of antibiotics has changed drastically in the past half century. Some of the older infectious disease specialists I interviewed remembered a time when antibiotic overuse was rampant within the hospital setting. “Anyone could prescribe antibiotics,” my participants complained when describing that era. Clinicians and hospital officials at that time had little reason to expect that antibiotic resistance would become the expensive, lethal, and complicated problem that it is today.

In health care settings now, there is more regulation concerning the use of antibiotics. Clinicians are experiencing a lull in the production of antibiotics for infectious diseases, and practitioners must make do with the limited antibiotic supplies they have. Today, there are systematic hospital reviews of antibiotic use to monitor how often the drugs are used. However, most practitioners can still prescribe antibiotics with little oversight. Procedurally, the review of antibiotics in the hospital setting is an enormous task, and an adjustment of patient treatment plans may not occur until after the first few doses of an antibiotic have been given. There is room, therefore, for antibiotic-resistant diseases to generate as misuse and overuse of antibiotics still occurs.

One way to mitigate overuse employed was the notion of antibiotic stewardship: an idea that the infectious disease specialists I interviewed frequently emphasized. “Stewardship” here refers to the responsibility of certain clinicians to manage antibiotic prescription and usage. The infectious disease specialists expressed a desire to have more control over the distribution of antibiotics in hospital settings, leaving surgery to the surgeon and cancer to the oncologist. The infectious disease staff wished for this level of control over antibiotic use despite the fact that both surgeons and oncologists can prescribe antibiotics independently, meaning antibiotics are not managed by one clinical care specialty. When asked whether, in general, practitioners today realize the importance of antibiotic stewardship in light of the dangers of antibiotic resistant infections, one infectious disease practitioner joked, “Which doctors?” My data show that  many infectious disease specialists note that their management of antibiotic resistance is quite a challenge because most other physicians within and outside of hospitals may readily prescribe them.

This issue is especially pressing because illnesses themselves are rarely treated with one biomedical intervention, or by one clinician. Few patients can be treated for one disease with one corresponding treatment, meaning that patients’ cases are managed with a variety of therapies and by a number of doctors. Patients can also have multiple conditions, again meaning that multiple types of practitioners can prescribe antibiotics for these patients at different points in their hospital stay. In these complex networks of caregiving, who gets the power to give antibiotics might not always be clear, or there might be tension when deciding who gets to limit the drug’s use. Indeed, when an infectious disease specialist is added to a patient’s chart, they are often added as a consult, meaning their advice may not be adhered to by the primary physician.

Certainly, we can expect that infectious disease specialists want professional autonomy over the management of antibiotic drugs, which means limiting and surveying the drug’s accessibility to other clinicians. But to do so, this would mean that other practitioners would have to agree to the control of part of their treatment plans by an outside party. This relationship of competing interests and access to antibiotics leads to disagreements and struggles of bureaucratic power in the hospital. As it stands, the future of antibiotic resistance rests in the hands of all practitioners who must negotiate who gets to prescribe, and who gets to control, the use of antibiotics.

About the Author: Katharina Rynkiewich

I am a PhD student in Anthropology at Washington University in St. Louis. My current research involves studies of infectious disease practitioners and treatment of infectious disease in hospital settings, and will focus on hospital policy regarding infection and epistemic differences among specialty groups of physicians. In 2013, I completed a masters program (MAPSS) at the University of Chicago, and research for this post was done in partial fulfillment of this masters.

From the Archive: Biotechnology and the Culture of Medicine

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In the “From the Archive” series, we highlight articles published throughout the journal’s history. We look forward to sharing with our readers these samples of the innovative research that CMP has published on the cultural life of medicine across the globe.

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In this installment of From the Archive, we turn to Mary-Jo Delvecchio Good’s article The Biotechnical Embrace (Vol 25 Issue 4, December 2001.) In this piece, Delvecchio Good frames three concepts in the cultural study of biomedicine: medical imaginaries, biotechnical embraces, and clinical narratives. Here, we will briefly outline these notions.

The medical imaginary, we learn, is the envisioned potential of the new technologies and treatments that medicine could produce in the future. The power of possibility in this sense impacts both clinicians, who are always working to stay ahead of new scientific knowledge, and patients: often those afflicted with diseases for which no current remedy exists. The medical imaginary situates medical progress in a position of hope and opportunity. Stories of medical failure, malpractice, or dearths of medical knowledge, although evidence contrary to establishing an “optimistic” view of the field, are framed in an overarching positive narrative of scientific progress.

Delvecchio Good next describes the biotechnical embrace: the embracing of, and the “being embraced” by technical innovations. This refers to the public “enthusiasm” for biotechnical therapies, as well as the engagement of biotechnologies with the patient’s body. Like the medical imaginary, the biotechnical embrace concept recalls a biomedical commitment to scientific progress and possibility. Even whenever a treatment is highly experimental, not yet approved as effective, or so new that its pitfalls are not fully known, patients will ’embrace’ and request it– and the public will hastily invest in it.

Lastly, we parse the concept of the clinical narrative, or ethnographic frame. This qualitative data is what evidences popular and clinical enthusiasm for bioscientific innovation and the use of the latest technological treatments.

Put simply, narratives can demonstrate that patients and clinicians alike are able to frame care in terms of the gap between what is presently the case, and what might be. For instance, a cancer patient might note the gaps between their condition, current treatments they have used, future therapeutic options, and subsequent clinical outcomes for his or her illness. Clinical narratives remind us that patients (and caregivers) do not view medicine as a static database of information, but instead a dynamic and progressive body of knowledge that exists in relation to illness experiences.

Click here for a link to the abstract and further details about the paper: http://link.springer.com/article/10.1023/A%3A1013097002487

Preview of Books Received: Vol. 38 Issue 4, Dec 2014

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The following are previews of two books received for review at Culture, Medicine, and Psychiatry. These previews provide a snapshot of recent publications in medical anthropology, cultural studies, and the history of medicine. For a full list of books received in December 2014, click here: http://link.springer.com/article/10.1007/s11013-014-9395-6

Image via Berghahn Books

Image via Berghahn Books

Culture, Suicide, and the Human Condition

Edited by Marja-Liisa Honkasalo and Miira Tuominen / Afterword by Arthur Kleinman

This collection of research on suicide argues that suicide is not “a separate realm of pathological behavior,” but instead a human action contextualized by a suicidal person’s cultural, historical, and ethnic roots. However, “the context never completely determines the decision,” allowing the authors to focus on suicide as both cultural and psychological phenomena. The authors emphasize individual action and choice regarding the decision to commit suicide. Similarly, the collection presents a complicated puzzle: suicidal narratives make sense of self-killing to a community, and depict suicide as a “solution to common human problems.”

Culture, Suicide, and the Human Condition was released in March 2014 by Berghahn Books. More details on the book here: https://www.berghahnbooks.com/extras/docs/flyer/HonkasaloCulture_9781782382348.html

Image via MIT Press

Image via MIT Press

A Metaphysics of Psychopathology

Peter Zachar

Zachar’s book asks what constitutes the “real” in psychopathology. He states that in psychiatry, pathologies are assumed to be “real,” while in psychology, the “realness” of a pathology is debated in terms of its roots in personality, superego, or in “general intelligence.” Neither discipline, however, aims to pin down what “real” entails for mental illness and conditions. Some pathologies move from being cast off as imaginary to being embraced as legitimate, such as PTSD, and others, like multiple personality disorder, are classified as real only to be later considered imaginary. Zachar takes a philosophical approach to considering what “real” means in terms of psychiatric and psychological classification, proposing a new classificatory system that the summary asserts “avoids both relativism and essentialism.” He then uses this model to interpret recent “controversies” in the inclusion of certain mental disorders within existing classificatory systems.

A Metaphysics of Psychopathology was released in March 2014 by MIT Press: http://mitpress.mit.edu/books/metaphysics-psychopathology

AAA 2014: Perspectives on the Bruno Latour Distinguished Lecture

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This year at the American Anthropological Association 2014 Meeting, Bruno Latour was invited to deliver the distinguished lecture. Entitled “Anthropology at the Time of the Anthropocene,” Latour discusses the rise in the term anthropocene to describe our current stage of natural history. Although the term makes reference to how “human” (anthro) our current age may be, Latour jests that this term was introduced by geologists, not social scientists. In the anthropocene, it is humans that play the defining role in our geological historical moment.

The assumption, Latour notes, is that human agency is the prime source of action that shapes the physical world. Humans are responsible for climate change, for pollution, for altering the literal, natural fabric of our world. Yet we know that not all humans have the same impact on our environment. As Latour quips, there is not “One Human” who is responsible for the changes we see in our climate or environment. We are simultaneously assessing human power as a plural, collective entity, as well as using this concept to suggest that the blame for global change does not fall evenly across all humans. As anthropologists and cultural theorists, we know how fragile human agency can be when we divide it amongst many contending social and cultural groups.

Our blog editor at the Latour Distinguished Lecture

Our blog editor at the Latour Distinguished Lecture

Is there another way to think about human action that does not problematically configure humans as both collective and individual, acting but not universally accountable for all human actions? Latour posits that rather than focusing solely on agency, with a strong emphasis on human intention and purpose when committing action, we could think instead about animation, or what forces–human and non-human– are in motion in a given social space. To do so, we can no longer assume that the human agent is a colloquial be-all-end-all.

How does this assertion speak to medical anthropology, social medicine, and medical humanities? At first, we might raise our brows at the discussions of geography, environment, and most of all the suspicion surrounding the primacy of human agency. Decentralizing the human agent, we might say, is perhaps the least humanistic approach to the study of human experience. Indeed, medicine is the care of humans by humans!

However, our human ability to question our own power and position in the universe, amidst other natural and non-human forces, is a mark of our species. Whether through philosophy, religion, or social science, humans have a proclivity for ruminating about our place in the material, corporal world. We crave knowledge about what sets us apart from non-human things, and how we are sometimes reliant on them. For scholars of medicine, such inquiries about our relationships with the physical universe is key. We consider the place of non-human agents in disease and care. We ask: why do physicians rely on certain tools? Why do patients see stethoscopes, thermometers, and scalpels as making a clinician legitimate in his or her practice? How are medical traditions made unique by their tools and pharmaceutical formulas? Could the layout of a hospital or clinic itself alter the way care is given?

In an age where technology permeates developed and developing societies, Latour’s suggestion to destabilize human agency is productive when considering medicine as a cultural object. We must think not only of ourselves, but the physical environments we live in and the material objects and devices we cannot seem to live without.

Many scholars understandably resist Latour’s idea that non-humans could have some primitive agency. Yet even if we do not assign agency to non-human tools, things, and environments, thinking seriously about their role in sociocultural systems is informative. Medicine is a lively site of exchange between patients and physicians, as well as practitioners and devices, patients and new medical innovations, and the built environments which house them. As Latour invites us to do, we should pause to consider humans within the midst of a rich material world around us that– like humanity itself– is constantly in motion.

Julia Balacko is a second-year PhD student in medical anthropology at Case Western Reserve University. She holds an MA in Humanities from the University of Chicago. Her research focuses on the culture of human anatomy and dissection in Western medical traditions, as well as public access to anatomical and pathological specimens.

Note on the presenter:

Bruno Latour is professor at the Sciences Po Paris in Paris, France. A central theorist in STS (science and technology studies), he is the author of We Have Never Been Modern (1991), Science in Action (1987) and Laboratory Life (1979).

You can read the full text of Latour’s lecture here: http://www.bruno-latour.fr/sites/default/files/139-AAA-Washington.pdf

Current Issue Highlight: Vol. 38 Issue 4, December 2014

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In our “Current Issue Highlight” series, we provide brief synopses of some of the original articles and commentaries published in our latest issue of Culture, Medicine, and Psychiatry. We hope these glimpses into our recent publications serve as a taste of the research we publish, as well as offer fresh insights on the intersections of culture, disease, health, and healing.

“The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry”

Paul Brodwin

“This article,” the abstract begins, “investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people’s will.” Ambivalence is itself a psychological construct that describes the tensions between love and hate, or multiple perspectives, within both individual subjects as well as the collective social group: here, psychiatric health workers. Central to this article is the friction generated between the clinicians’ self-concept as caregivers and their professional drive to control patients. Such ambivalence about clinical work in psychiatry is evident in the ethnographic research presented here.

Brodwin’s piece reminds us that anthropology is perfectly situated to draw meaning from these problematic and conflicted perspectives within a social group. Rather than reconciling the participants’ feelings and drawing one universal message from them, Brodwin presents us with an authentic picture of the complicated world of clinical psychiatric practice. He concludes, “To understand the paradox, fieldwork should focus especially on the moments when people’s sense of unease erupts into collective life.”

Link to article: http://link.springer.com/article/10.1007/s11013-014-9401-z

“A Village Possessed by ‘Witches’: A Mixed-Methods Case–Control Study of Possession and Common Mental Disorders in Rural Nepal”

Ram P. Sapkota, et al.

In this article, the authors probe an important question: if we consider spirit possession and psychopathology as separate categories, rather than assume possession as a form of mental illness, how might we describe mental illness within a population who has experienced spirit possession? For societies in which spirit encounters are frequent and socially normative, reading mental illness as distinct from possession is particularly critical when exploring local psychic events.

Nepal provided fertile intellectual grounds for exploring this question because spiritual possession occurs regularly. When the researchers delivered educational sessions on psychosomatic and psychosocial illnesses, suggesting that spirit possession might be a type of mental distress, villagers in the study resisted this notion. They argued that possession was rooted in cosmological and supernatural disturbances, making them altogether different psychological phenomena.

Instead of casting possession as a brand of psychiatric illness, the authors suggest that we might view possession as a coping mechanism against other mental duress. In another way, we could conceive of possession as a cultural idiom of distress: reframing illness in terms of a socially acceptable category of experience that is widely shared.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9393-8

“Confinement and Psychiatric Care: A Comparison Between High-Security Units for Prisoners and for Difficult Patients in France”

Livia Velpry & Benoît Eyraud

Focusing on French mental health care, this article explores the evolving use of confinement as part of the treatment of mentally ill individuals who exhibit violent behavior. The authors parallel the nature of confinement in French psychiatric wards to the security practices of high-security prison units.

In their research, Velpry and Eyraud discovered that the public appeal to heightened security in psychiatric institutions, as well as executive action from the president, led to a “turn” towards new confinement measures. Second, psychiatrists used this new narrative of control to justify control techniques that they argued gave patients “psychic structure.” Rather than standing as its own therapeutic measure, physicians employed confinement as a means of managing “difficult” patients.

As an object of inquiry, this recent trend in French psychiatry recalls the complementary trajectories of care and justice, power and control, as well as reflects on the changing landscape of what we define as therapy.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9400-0

“Psychiatry with Teeth: Notes on Coercion and Control in France and the United States”

Anne M. Lovell & Lorna A. Rhodes

This commentary piece on the articles published in the current issue highlights the “rough edge” of the use of constraint and coercion to subdue “difficult” psychiatric patients. Lovell and Rhodes note that many of the articles demonstrate how these forms of discipline and control are enacted at the local scale, and remind us that the exchange between psychiatric patient and the care institution is the site of the strongest conflict when we look at systems of control. What is the border between “care and custody,” the issue asks? How do we as anthropologists contribute to the knowledge about these complex social interactions?

Furthermore, the authors observe that the geographic emphasis on psychiatric care in France and the United States is hardly accidental. Although care practices for the mentally ill differ widely between the two countries, the focus on constraint and control is similarly present in the scholarly literature produced on psychiatry in each place. Likewise, in French and American research, there is a mutual tendency to study mental health care in terms of autonomy, freedom, humanism, and democracy.

Link to commentary: http://link.springer.com/article/10.1007/s11013-014-9420-9

Want to see a preview and abstracts of all the articles in the current issue? Find details on the full issue here: http://link.springer.com/journal/11013/38/4/page/1