Medical Anthropology

Special Issue Highlight: The Anthropology of Autism, Part 1

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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

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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

Book Release: Harding’s “Objectivity and Diversity”

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Via UC Press website

Via UC Press website

Released this May 2015 from Duke University Press is Sandra Harding’s Objectivity and Diversity: Another Logic of Scientific Research. Harding’s book critically examines the notion of objectivity, and posits a new framework for scientific thought that does not strive to be politically and culturally neutral. Instead, Harding argues, scientists must consider the economic, social, and political dimensions of their work, and seek to produce knowledge and new technologies that are sensitive to the ways in which these innovations may impact disenfranchised populations. In this way, Harding suggests that science may be truly “objective” by reflecting the social reality of the world in which it is practiced and produced.

Harding’s book contributes to the constructivist body of literature on the social and cultural dimensions of scientific practice, alongside the likes of Daston and Galison’s Objectivity (2010), Agazzi’s Scientific Objectivity and its Contexts (2014), and Shapin’s The Scientific Revolution (1996). Harding similarly demonstrates the cultural situatedness of science, while underscoring the responsibility of contemporary science to promoting social justice. This publication will be of interest for science and technology (STS) scholars as well as anthropologists researching biomedicine and the culture of scientific and evidence-based care practices, particularly amongst underserved or marginal populations.

Sandra Harding is Distinguished Research Professor at UCLA. Her work explores the philosophy of science, epistemology, and feminist and postcolonial theories.

To learn more about Harding’s book, click here: http://www.press.uchicago.edu/ucp/books/book/chicago/O/bo19804521.html

Other books cited on objectivity:

Daston and Galison 2010: http://mitpress.mit.edu/books/objectivity

Agazzi 2014: http://www.springer.com/us/book/9783319046594

Shapin 1996: http://www.press.uchicago.edu/ucp/books/book/chicago/S/bo3620548.html

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

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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.”

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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

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

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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

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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

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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.

Book Release: Wailoo’s “Pain: A Political History”

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Image via JHU Press

Image via JHU Press

This October 2015, Johns Hopkins University Press is slated to release Keith Wailoo’s Pain: A Political History. Wailoo’s book examines how the definition of chronic pain in the United States developed and changed alongside broader political and economic changes. The book begins with the culture of treatment following World War II, when public and political attitudes towards pain considered physical suffering real and potentially disabling. With decreasing support of disability programs throughout the 1980s, however, the validity and legitimacy of chronic pain came under question.

New conversations beginning in the 1990s about euthanasia reinvigorated the conversation surrounding pain, no doubt bolstered today by current discussions of medical marijuana laws and the burgeoning use of prescription painkillers for recreation purposes. This renewed interest in the nature and the extent of pain have enlivened the debate around who experiences pain, how we certify pain, and at what point pain requires medical intervention.

The book strives to illuminate the historical foundations of today’s contemporary pain medication and treatment market, particularly in terms of the liberal and conservative political trends between the 1950s and today. Wailoo’s account culminates with an exploration of the contemporary state of pain care: a severe imbalance between the overmedicated and the underserved who cannot access treatment for their chronic pain. Pain: A Political History will certainly prove insightful for historians of medicine as well as political-economic medical anthropologists, theorists of neoliberalism, and medical anthropologists carrying out research in the United States.

Wailoo is Professor of History and Public Affairs as well as the Vice Dean of the Woodrow Wilson School of Public and International Affairs at Princeton University.

To learn more about the book, click on JHU Press’ page here: https://jhupbooks.press.jhu.edu/content/pain

From the Archive: Eating Disorders Amongst Japanese Women

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In our “From the Archive” series, we revisit an article published in past issues of Culture, Medicine & Psychiatry. This week, we’re highlighting a piece on eating disorders in Japan, originally featured in our December 2004 issue.

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Kathleen Pike and Amy Borovoy’s article “The Rise of Eating Disorders in Japan: Issues of Culture and Limitations of the Model of ‘Westernization'” makes a poignant case for the importance of context when examining eating disorders across the world. In this piece, they argue that studies of eating disorders abroad have often attributed the etiology of these illnesses to an increasing visibility and presence of Western beauty standards that accompany the spread of new technologies, medias, and communication tools. While Western beauty ideals have been problematically exported to the non-Western and developing worlds in other cases, Pike and Borovoy suggest that this model does not account for the experience of eating disorders in Japan.

Westernization and modernization, they note, are two distinct processes: and Japan, which has developed economically but retained many of its traditional social roles, exemplifies this difference. Modernization is the process of economic and technological development as a nation shifts from traditional to modern (often, mechanized). Westernization may be defined as the process of integrating the lifestyle, values, and experiences of Western cultures into the fabric of society, especially during periods of modernization and economic change.

Despite the drive for modernization, Japanese women are still expected to be homemakers and mothers rather than career women in the new economy. The Japanese have not adopted the individualistic and feministic sensibilities of the Western world, and the domestic burden– both caring for the home and children, and tending to older family members– squarely falls upon wives and mothers. This creates enormous stress for young women, who wish to extend their adolescent years and savor the freedom between childhood and their adult lives, as defined by marrying and becoming a homemaker. Modernization allows young Japanese women to obtain jobs, travel widely, and earn an education, but traditional social roles do not create a space for women to enjoy such a designated period of freedom without familial commitment. The inevitability of domestic life, then, is ever-present in the lives of women who yearn for fewer responsibilities– even if just for a time. This creates feelings of distress, unease, or unhappiness in many young women.

Pike and Borovoy observe that Japanese women do not reject food (anorexic behavior) or induce vomiting (bulimic behavior) out of a desire for thinness or due to fat phobia, as women with eating disorders almost universally experience in Western nations. Rather, Japanese women stress that they reject food because it worsens their digestive complaints, which are connected to the anxiety and stress they feel out of dissatisfaction with their social role (or lack thereof.) The tension between women’s expected social functions, and their desire to live and work in some other way, therefore spurs disordered eating within this broader frame of mental distress.

As we see, women’s experiences of Japanese eating disorders are entwined in the fabric of traditional social life, and not rooted exclusively in imported ideas of the body, independence, and individualism per the Western way of life. Indeed, the non-fat phobic symptomatology of eating disorders reflects the essential differences between Japanese women with eating disorders and their peers in Western nations. The study highlights the centrality of culture in studies of mental illness, and the way that these conditions emerge out of a local social world.

To find the full article online, click here: http://link.springer.com/article/10.1007/s11013-004-1066-6

Vol. 39 Issue 1 March 2015: Medicalizing Heroin

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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.

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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

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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.