Interview with José Carlos Bouso

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

José Carlos Bouso is a Clinical Psychologist with a PhD in Pharmacology. As the Scientific Director at ICEERS (International Center for Ethnobotanical Education, Research & Service). José Carlos coordinates studies on the potential benefits of psychoactive plants, principally cannabis, ayahuasca, and ibogaine, with the goal of improving public health.

What is your article “Hallucinations and Hallucinogens: Psychopathology or Wisdom?” about?

“This text challenges the prevailing notion that hallucinations are exclusively associated with psychopathological states. It acknowledges that hallucinations can indicate psychopathology or neurological disorders but argues that they also commonly occur in individuals without any signs of psychopathology. The research suggests that certain types of hallucinations induced by hallucinogenic drugs may actually improve mental health. The authors propose a broader characterization of hallucinations as a common phenomenon associated at times with psychopathology but also with functional and even beneficial outcomes. Furthermore, they suggest that hallucinations can provide a pathway to understanding the mind and the world. This cultural shift in the interpretation of hallucinations could have implications for fields such as drug policy, civil law, psychiatry, and the reduction of stigma associated with mental disorders.”

Tell us a little bit about yourself and your research interests.

“I am a clinical psychologist and PhD in pharmacology and have been studying the pharmacological and therapeutic effects of hallucinogens since the 1990s. My first research focused on studying the potential of MDMA in the treatment of PTSD in women who have suffered sexual assault. Later, I conducted a study on the long-term effects of ayahuasca use on neuropsychiatric functions. Since 2012, I have been the Scientific Director of the International Center for Ethnobotanical Education Research & Service (ICEERS), where I coordinate various research projects. Our main areas of research include Global Mental Health, ayahuasca, medical cannabis, and the anti-addictive potential of ibogaine.”

What drew you to this project?

“The term hallucinogens is stigmatized due to its association with mental illness. This reinforces the stigma surrounding mental illness by precisely linking it to the presence of hallucinations. However, hallucinations are not necessarily a pathological phenomenon. Even for Esquirol and other French psychiatrists who laid the foundations of modern psychiatry, hallucinations were seen as a symptom of illness, not the cause. Today, the symptom is often confused with the cause. Hallucinations are a common phenomenon in human experience. Their most radical expression is seen in the effects produced by hallucinogens, which are now the subject of increasing research on their therapeutic potential. The analysis of the term hallucinogen and its relationship, not only with psychopathology but also with the process of knowing, should not only help reduce the stigma associated with it but also the stigma associated with mental illness.”

What was one of the most interesting findings?

“Undoubtedly, the most interesting result is having confirmed how the popular conception of the term hallucination does not correspond to the reality of the phenomenon. Etymologically, it refers to traveling through the mind. Even in classical Greece, there was a goddess of hallucinations, the goddess Pasithea. Oracles used hallucinations to make their predictions. The Bible is filled with hallucinatory phenomena. Numerous human circumstances can induce hallucinations, with prevalence rates indicating that up to 10% of the general population has experienced them at some point in their lives. Neurobiologically, perception itself can be hallucinatory, including imagination. And hallucinogenic drugs demonstrate how hallucinations can be a source of knowledge. Therefore, the main result is that hallucinations can be a psychopathological symptom but also a via regia to knowledge.”

What are you reading, listening to, and/or watching right now?

“I am currently reading several novels: “The Tartar Steppe” by Dino Buzzati, “The Family” by Sara Mesa, and “Prayer to Proserpina” by Sánchez-Piñol. I read “The Tartar Steppe” after visiting an exhibition by the Spanish sculptor Juan Muñoz and seeing an artwork inspired by the novel. Additionally, I am reading the new book by the biological anthropologist Juan Luis Arsuaga, titled “Our Body.” Recently, I watched a Spanish film called “Secaderos,” which explores the use of LSD by teenagers in a very open-minded manner. It was a surprise because I went to the cinema without having read the movie’s synopsis.”

If there was one takeaway or action point you hope people will get from your work, what would it be?

“To start considering hallucinations as a normal phenomenon of human consciousness that can be a sign of psychopathology but also a source of knowledge. Hallucinogenic drugs are prohibited because they induce hallucinations. If our thesis is correct, their legal status should change as soon as possible.”

Thank you for your time!


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Interview with Neil Krishan Aggarwal

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Neil Krishan Aggarwal is an Assistant Professor at Columbia University. He is a cultural psychiatrist and social scientist. His research focuses on translating anthropological theories for clinical use and the cultural analysis of mental health knowledge and practices. 

What is your article “The Evolving Culture Concept in Psychiatric Cultural Formulation: Implications for Anthropological Theory and Psychiatric Practice” about?

“Social scientists debate what terms like “culture” mean. This article traces how the term “culture” has been defined in editions of the psychiatric classification manual known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). It explores similarities and definitions in these definitions.

Tell us a little bit about yourself and your research interests.

“I come from a racially, ethnically, linguistically, and religiously minoritized community in the United States. I’ve had to face people’s implicit and explicit biases about me based on my appearance. Therefore, I’m interested in how people generally make interpretations about others. We all make interpretations in everyday life, such as students rating professors, customers rating businesses, or people deciding which way to swipe on dating apps. Anthropologists have long pointed out that psychiatrists also make interpretations about patients through acts of diagnosis. This perspective informs my research interests in cultural psychiatry, cultural psychology, and psychiatric anthropology.”

What drew you to this project?

“I’ve spent the past 15 years trying to encourage mental health professionals to think of their work as fundamentally cultural, beyond just attending mandatory cultural competence trainings. I believe that my colleagues in anthropology have conversations that my colleagues in mental health benefit from hearing. Every revision to the DSM is an opportunity to explore the current state of cultural assumptions regarding mental health knowledge and practice. When DSM-5-TR came out in 2022, I saw this as a timely opportunity.”

What was one of the most interesting findings?

“The model of culture in the DSMs is different from other models that could change clinical practice. The DSM model assumes that providers can ask patients about their identities, that culture resides in the minds of patients. But a model of culture that looks at how patients and clinicians interact allows us to discover how patients and clinicians create culture during appointments.”

What are you reading, listening to, and/or watching right now?

“I just finished reading this brilliant article by the black queer scholar Keguro Macharia titled “On Being Area Studied.” As one of the few brown men in my departments, I haven’t been equally accepted as a peer, so I’ve been re-reading Frantz Fanon and trying to imagine how he has felt.

I’ve been exalting in the 50th anniversary of hip-hop this year. No other popular art form provides more incisive social commentary about what it’s like to transcend social marginaliztion as a minoritized individual. I just saw DJ Premier in concert this week, and I’ve been inspired to rediscover the poetry of artists like KRS-One, Rakim, Nas, Biggie Smalls, Q-Tip, Jay-Z, and other greats. I’ve also been jamming to AP Dhillon, Gurinder Gill, Shinda Kahlon, and Karan Aujla on the Punjabi Bhangra side.

I love Hindi cinema. Streaming has really allowed movie stars to try new roles, and I’m captivated by a show titled Asur. Check it out.”

If there was one takeaway or action point you hope people will get from your work, what would it be?

“Whether we use knowledge from psychiatry, psychology, the law, or any other form of professionalized expert knowledge, we can never fully know anyone else. How do we cultivate a space for respectful curiosity?”

Thank you for your time!


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Interview with Lawrence T. Monocello

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Lawrence T. Monocello is a T32 Postdoctoral Research Scholar in the Department of Psychiatry at Washington University in St. Louis. Lawrence Monocello received his Ph.D. in 2022 from the University of Alabama. His dissertation examined how cultural, social, and political-economic factors shaped disordered eating among South Korean men in Seoul. Currently, he contributes anthropological perspectives to a transdisciplinary team of world-class researchers on preventing/treating eating disorders and childhood obesity.

What is your article “Guys with Big Muscles Have Misplaced Priorities”: Masculinities and Muscularities in Young South Korean Men’s Body Image” about?

“Male body image research only makes up about 1% of the body image literature, and what literature does exist tends to focus on white, Western men’s concerns with muscularity. Using cognitive and biocultural methods, this article examines how young Korean men negotiate and navigate multiple cultural models of ideal male bodies. It not only questions the model of Western masculinity which underlies male body image research but also problematizes the notion of a single kind of “muscularity” to which men may aspire. Drawing on the concept of “masculinities”—the multiple, hierarchized, and increasingly hybridized ways of being male in a given society—this article advances the concept of “muscularities” to account for their multiple, hierarchized, and hybridized models of muscularity, not just as biological traits but as meaningful, embodied engagements with their social and political-economic conditions.”

Tell us a little bit about yourself and your research interests.

“My research interests lie primarily in understanding how individuals’ variable engagement with culture affects health. In non-anthropological health research, culture—if it is considered at all—is usually treated as some sort of monolithic, categorical variable to which causality is attributed. Anthropologists have long challenged this notion, understanding that culture is dynamic, and that the lived experience of culture varies individual-to-individual and in relation with other social, political-economic, and demographic factors. However, connecting rich ethnography with broader models and measures of health has proven difficult. Cognitive anthropological mixed-methods, which combine rigorous ethnography and statistical modeling, have a ton of potential for connecting individuals’ lived experience of their meaning systems on their own terms to health outcomes. As I’ve been recently working in a biomedical context, it’s become increasingly evident to me that there is not only great opportunity, but moral necessity, for medical anthropologists to contribute our expertise and be more active in framing research on topics like social determinants of health.”

What drew you to this project?

“When I was a junior at Case Western Reserve University, I took The Anthropology of Body Image with Eileen Anderson. I remember reading some of the literature on male body image and being confused at how, as a white, cisgender male who struggled with body image, the data presented and conclusions it reached seemed not to apply to me that much. It got me really interested in intracultural variation and how it affected lived experience. Once I got to graduate school, I found that body image was “good to think with” during my theory courses. Around the same time, my Asian-American friends from undergrad started sending me K-Pop videos and I noticed how male idols were presenting in media. I became curious about to whether and to what extent men internalized those images versus those in the global White Western media. I found that there wasn’t much research on it, so I decided to do it myself.”

What was one of the most interesting findings?

“One of the most interesting findings was that, despite a lot of my participants saying that people don’t talk about men’s bodies (at least to the same extent that they do women’s bodies), everyone had opinions about them and everyone’s understandings of social expectations about men’s bodies and their meaning were extremely consistent.”

What are you reading, listening to, and/or watching right now?

“Now that I’ve finished my dissertation I’m trying to get back into reading fiction. I’m in the middle of Moby Dick now. I used to be kind of skeptical of “queer readings” of literature, but I’m convinced that it’s the only way to read Moby Dick.”

If there was one takeaway or action point you hope people will get from your work, what would it be?

“When we’re looking to address difficult phenomena like eating disorders across cultures, it’s extremely important for researchers to (1) unpack how people are really experiencing it (i.e., not just transplanting political-economically powerful white US emic perspectives elsewhere) and (2) for anthropologists to be able to articulate the barriers and disjunctures which emerge during ethnographic fieldwork in ways accessible to the actors who directly interact with people suffering from the phenomena (i.e., clinicians, public health practitioners, policymakers).”

Thank you for your time!


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Interview with Iben Emilie Christensen

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Iben Emilie Christensen is a Danish sociologist and PhD student at the Department of Public Health, University of Copenhagen, and at VIVE, The Danish Center for Social Science Research. She is in the final stage of her PhD project focusing on everyday life among people with severe mental and physical illnesses.

What is your article Senses of Touch: The Absence and Presence of Touch in Health Care Encounters of Patients with Mental Illness about?

“Based on ethnographic fieldwork, the article explores the significance of touch and physical examination in different healthcare encounters among people with severe mental (schizophrenia, bipolar disease, and severe depression) and physical illnesses. We found that touch and physical examination of this patient group is limited in healthcare encounters leaving the patients with feelings of being misunderstood, less socially approved, and less worthy of trust. Despite patients being seen, heard and treated with care and empathy by health care professionals, it was not enough for them to feel recognized or think of the encounter as a pleasant one. Overall, the article shows that when touch and physical examination takes place in healthcare encounters it gives the patients recognition – their bodily sensations and symptoms are taken seriously and not least, they are recognized as patients and human beings, suffering from a somatic disease and not only mental disorders with psychiatric label.”

Tell us a little bit about yourself and your research interests.

“The overall aim of my PhD project is to study the everyday life among people who live with both mental and physical illnesses, and to explore how they experience and navigate within the health care system. My PhD is part of a larger research project at the University of Copenhagen called SOFIA, with the primary aim to reduce the all-cause mortality of patients with severe mental illness and comorbidity in Denmark by improving the treatment of their comorbid physical conditions in general practice. The findings contribute to the SOFIA project regarding the experiences of people with severe mental and physical illnesses, their healthcare-seeking strategies, and their experiences when engaging with the healthcare system.”

What drew you to this project?

“I worked as a researcher at VIVE, The Danish Center for Social Science Research, when I was offered the opportunity to be part of the large research project SOFIA as a PhD student at the University of Copenhagen. The chance to explore a new research field, such as psychiatry, and a particular interest in inequity and inequality in healthcare motivated me to pursue this project. People with severe mental illness die 10-20 years earlier compared to people without mental illness and according to research part of this excess mortality stems from physical illnesses, which are believed to be underdiagnosed and undertreated. The ethnographic fieldwork gained important insight into the interlocutors’ everyday life, which also involved these topics.”

What was one of the most interesting findings?

“In the beginning of the PhD study, I did not anticipate that touch, particularly procedural touch (physically examination of patients), would to be the topic of the first article. However, during fieldwork and when observing the interlocutors as they interacted with different healthcare professionals, I wondered why they never seemed to find the encounter pleasant. This prompted my co-authors and I to focus on what did not take place, what did not occur and what I did not observe, leading us to realize the significance of touch in healthcare encounters.”

What are you reading, listening to, and/or watching right now?

“Since my next article focuses on patients’ experiences of symptoms and the interpretative process when living with mental and physical illnesses simultaneously, I read about bodily sensations and how they transform into symptoms in an everyday life perspective.”

If there was one takeaway or action point you hope people will get from your work, what would it be?

“People with severe mental illness often face vulnerability, social exposure, and stigma, and may live on the edge of society. I believe, that if a doctor’s caring hand and a physical examination during healthcare encounters give this patient group a feeling of being recognized as they are, as patients with potential somatic illness, and as human beings with same rights and possibilities, I think it is a minimal adjustment to incorporate touch as a continuous procedure in healthcare encounters.”

Thank you for your time!


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Interview with Omnia El Shakry

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Omnia El Shakry is a professor of history at the University of California, Davis. Her research centers on the history of the human and religious sciences in modern Egypt.

What is your article “The Work of Illness in the Aftermath of a ‘Surpassing Disaster’: Medical Humanities in the Middle East and North Africa” about?

“The article serves as a commentary on new work in the medical humanities in the Middle East, while posing a series of questions. What happens when we question the role of the expert and the idea of the detached rationality of expertise in medicine and psychiatry? How should we account for the cultural specificity of illness and of healing practices in the Middle East, particularly in institutional contexts in which the mental hospital aspired to function as a ‘healing collective’? Given that the Middle East has been at the center of a series of catastrophic events, how can we understand the persistent inability of modern medicine to understand physical anguish, but also spiritual pain, within this context? Middle East studies is, I think, especially well situated to consider these questions, precisely because the region is an arena in which so many of the experiments of group life—both in its traumatism and its healing—model distinct ways of imagining non-materialist understandings of illness, suffering, and healing.”

Tell us a little bit about yourself and your research interests.

“I am an intellectual historian interested in epistemology and ethics within the human and religious sciences. I am currently working on two projects– one is on the work of Sami-Ali, the Arabic translator of Sigmund Freud’s Three Essays on the Theory of Sexuality, author of a large body of original psychoanalytic writings, and translator of the poetry of Sufi masters. The second is on the vibrant movement of intellectual exchange between Muslim and Catholic scholars and religious practitioners in twentieth century Egypt.”

What drew you to this project?

“I was a participant in the conference “Power in Medicine: Interrogating the Place of Medical Knowledge in the Modern Middle East,” organized by Edna Bonhomme, Lamia Moghnieh, and Shehab Ismail in Berlin in April of 2019. The piece is a commentary on the specific articles that came out of that conference and are published in CMP and on the wider issues raised by the workshop. But it is more than that, it is also partly and indirectly a reflection on my own personal experience with illness, my frustration with biomedicine, and my dear friend and colleague Stefania Pandolfo’s inspiration and encouragement to see the ‘wound light.’”

What was one of the most interesting findings?

“I was especially struck by how intellectually generative it was to juxtapose Georges Canguilhem’s observation in the Normal and the Pathological that to be a living organism is to accept “the eventuality of catastrophic reactions,” alongside Jalal Toufic’s theorization of the “withdrawal of tradition past a surpassing disaster.””

What are you reading, listening to, and/or watching right now?

“I am currently reading David Marriott’s brilliant Lacan Noir: Lacan and Afro-pessimism. I am (almost) always listening to The Mountain Goats and I watch a ton of TV, which I affectionately refer to as ‘cheap therapy,’ and have been enjoying The Peripheral and the current season of Bob’s Burgers.”

If there was one takeaway or action point you hope people will get from your work, what would it be?

“That we should work toward imagining the non-West as a site for the production and critique of theoretical knowledge (or ‘theory’) within the human sciences, rather than merely a site for its consumption and circulation.”

Thank you for your time!


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Interview with Dr. Edna Bonhomme

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Edna Bonhomme is a historian of science and writer based in Berlin, Germany. Edna’s research critically engages with how people navigate the unsavory and unwieldy states of health—primarily how people contend with contagious outbreaks, medical experiments, reproductive assistance, and illness narratives. Her work has appeared in Al Jazeera, The Atlantic, The Guardian, the London Review of Books and elsewhere. Edna’s forthcoming book examines contagion in confined spaces.

What is your article “Medicine and Politics in the Middle East and North Africa: Transdisciplinary Approaches in Medical Humanities” about?

“I co-edited a special issue that elucidated the intellectual and transdisciplinary approaches to medicine and psychiatry in the Middle East and North Africa (MENA). The journal issue is a compilation of various papers from an interdisciplinary workshop we co-organized in Berlin while I was a Postdoctoral Fellow at the Max Planck Institute for History of Science. The two-day workshop was held in Berlin in April 2019 and generated live interventions and debates about medicine’s connection to colonialism, humanitarianism,  and nationalism in the MENA region. This co-written introduction provides a theoretical framework for articulating the region’s specificities and some universal trends. We argue that the authors engage in broader discussions that not only frame disease, health, and healing in the Middle East and North Africa while also exploring how medical practices in the region dovetail with global trends.”

Tell us a little bit about yourself and your research interests.

“I am a historian of science, culture writer, and editor who explores how people navigate the unsavory and unwieldy states of health—especially subjects that discuss contagious outbreaks, medical experiments, reproductive assistance, or illness narratives. I write cultural criticism, features, book reviews, and opinion pieces. I am especially interested in human driven narratives and to think actively about those who have been excluded from history, which often means thinking actively about a wide range of sources and archives.”

What drew you to this project? 

“In 2017, I graduated with a PhD in History of Science from Princeton University and my dissertation, “Plagued Bodies and Spaces’ ‘ examined the origins and progression of epidemics in North Africa during the eighteenth and nineteenth centuries. As a historian, my research examines contagion, epidemics, and toxicity by asking: what makes people sick? As a writer, I narrate how people perceive modern plagues and how they try to escape from them through critical storytelling. My writing about illness and health draws on my educational training in biology (BA), public health (MPH), and in history of science (PhD), and I invite readers to sit with the messiness of contagion, the discomforts of maladies, and the power of embodied knowledge, while also finding people’s desire to heal.”

What was one of the most interesting findings?

“Rather than look solely at illness as a given or have a universal definition of mental illness, we tried to explore how categories of disease have shifted within the Middle East and North Africa. At least at the level of merchants, goods, and materials potentially being the sites of vectors, but also being a site of control at the level of trade. These ideas and rules have evolved; they have taken on new meanings. This is primarily in the context of the age that we live in and of the rise of the nation-state, specifically, border regimes that made it even more challenging to travel between empires that were far more possible 400 years ago. How we define a disease and how we navigate trauma is also something the special issue explored.”

What are you reading, listening to, and/or watching right now? (Doesn’t have to be anthropological!)

 I am drawn to creative fiction, to the power of imagination and the ways that people conjure new worlds. As such, I have been reading novels and poetry, including the works of Namwali Serpell, Sheila Heti, Tsitsi Dangarembga, Caleb Azumah Nelson, Keorapetse Kgositsile, Deborah Levy, Ada Limón, Claudia Rankine and more. These writers are teaching me to get lost in the page and to escape the world as we know it.

If there was one takeaway or action point you hope people will get from your work, what would it be? 

Most of the labor for this project was done after the workshop and during the pandemic. My collaborator and I went through a pandemic, coordinated from different time zones, and underwent major life changes. We were mourning our past lives while also holding dear to our labor and our commitment to producing scholarship about medicine, disease, and psychiatry. One thing that made this project successful is our tenacity and commitment to collective projects. As such, I highly recommend that people take the time and care to work with other researchers who not only articulate their intellectual interests but who also have a mutual work ethic.

Thank you for your time!


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Interview with Soha Bayoumi

The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Soha Bayoumi is a Senior Lecturer in the Medicine, Science, and the Humanities Program at the Johns Hopkins University. She is presently completing two book projects, one (with Sherine Hamdy) on the work of doctors in the Egyptian uprising, and the other on the social and political roles of doctors in relation to health and justice in postcolonial Egypt. 

What is your article “Nationalism, Authoritarianism, and Medical Mobilization in Post-revolutionary Egypt” about?

This article explores the links between medical practice and expertise, on the one hand, and nationalist discourses, on the other, in the context of the 2011 Egyptian uprising and the years that followed, which witnessed a consolidation of political authoritarianism. It investigates how doctors played a significant role in countering political regimes’ acts of violence and denial. It traces the trajectory of the doctors’ mobilization in the 2011 uprising and beyond and demonstrates how the doctors drew on their professional expertise and nationalist sentiment in their struggles against a hypernationalistic military state. It contrasts activist doctors’ idea of nationalism with the state’s and shows how medicine has served as a site of awakening, conversion narratives, and building of bridges in a polarized society where the doctors were able to rely on their “neutral” expertise to present themselves as reliable witnesses, narrators, and actors.

Tell us a little bit about yourself and your research interests.

I work at the intersection of the history of medicine, science and technology studies, and political theory. My work is informed by postcolonial studies, gender studies, and social justice, and centers the ways in which medical expertise is shaped by and deployed in different political contexts.

What drew you to this project?

This research is part of a book-length project that I have been working on for the good part of the last decade with Sherine Hamdy. We were both amazed and intrigued by the different roles played by doctors in the Egyptian uprising and its aftermath and felt compelled to document that episode of the Egyptian revolution and ask questions related to what motivates doctors to engage in politics, especially during such volatile political moments.  

What was one of the most interesting findings?

We were really struck by how doctors reliance on their “neutral” expertise and their attempts to efface the political in their work actually reinscribe the political in different ways, in ways that both allow doctors to either resist state violence or abet it.

What are you reading, listening to, and/or watching right now?

I’m currently watching the Netflix show, Mo, which is, as far as I know, the first mainstream show about a Palestinian-American to ever make it to streaming screens in the US. I’m reading Oliver Sacks’ first memoir, A Leg to Stand On, which is focused on an accident that caused him to lose the use of one of his legs and his reflections on being patient, after a long career of being a doctor. And I’ve just finished listening to the audiobook, Born a Crime: Stories from a South African Childhood, by Trevor Noah. I love Trevor Noah’s style of comedy, and I think his autobiography book, which contains a lot of comedy, is best enjoyed performed by Noah himself.

If there was one takeaway or action point you hope people will get from your work, what would it be?

I think it is the idea that very few things in life are actually politically “neutral”—that what we take for granted as apolitical or technical or neutral has so many ramifications on politics, writ large. Many of the daily actions we take and the statements we make are inscribed in a political context and often function to reproduce and perpetuate that context or to subvert and change it, if we so choose.

Thank you for your time!


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Academia.edu

SPA Interview with Dr. Greg Downey and Dr. Daniel Lende

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This week on the blog we are featuring a partial summary of an interview with Dr. Greg Downey and Dr. Daniel Lende, conducted by Kathy Trang, as part of the Society for Psychological Anthropology “Voices of Experience” series. In this audio conversation, available in full here, the doctors discuss their work establishing the field of nueroanthropology. Together, they served as co-editors of The Encultured Brain: an Introduction to Neuroanthropology, available from MIT Press.

The SPA “Voices of Experience” series is a venue to showcase the range of work that psychological anthropologists engage in, and to give listeners, virtually attending the live events, the opportunity to ask prominent scholars in the field about their work.


spa voices logoThe interview begins with an introduction of the authors and an acknowledgement of the wide diversity of interests and geographic locations of the audience. Then, Kathy Trang launches into a general discussion about the academic frustrations that led to the foundation of neuroanthropology.

Kathy Trang: We’ll start with the origins of neuroanthropology. As you guys detailed in the nueroanthroplogy book which was published in 2015, as well as various other platforms, such as the blog, one of the impetus behind nueroanthropology was the dissatisfaction that you both felt with either sociocultural theory or with biological anthropology. Could you tell us a little bit more about your frustration at that time? And what you felt from the standpoint of your research was missing?

Dr. Greg Downey: My dissatisfaction was really quite simple. When I was in Brazil, I was working on with Capoeira practitioners, practitioners of this Afro-Brazilian martial art. It’s pretty arduous, pretty demanding, like a lot of martial arts and acrobatics. This was a physical discipline. And the people there were claiming that it has all these effects. And I was trained straight up cultural anthropology, University of Chicago, They would say, the people I was interviewing were always working and learning alongside, would say “Oh, it changes the way you move, it changes the way you perceive. You see differently, you balance differently.”

I kept writing this down, good classic social constructionist, interpretive anthropology. At some point, I was like “is this plausible?” I mean, could it really do this? I realize that it was an empirical question that in fact I had to look outside the culture anthropology I had been taught to find out. As I started to explore sort of the neuropsychology of skill acquisition and training and sports, I found out that not only was it plausible but there were all kinds of interesting documented effects. I realized the culture theory, in this sense, around the question of embodiment, I’ll come back to the word embodiment at some point, it was pointing in the direction of neurological change without actually attempting to theorize about neurological change or explore neurological change. In a sense, I kind of felt like the cultural theory I had been taught was under ambitious. There was a clear boundary with the biological and they didn’t want to cross it, but in the process that meant that they were ignoring a lot of the effects of the enculturation I was seeing.

In a sense, it was feeling like I was up against an artificial boundary that had been drawn for me by my training, and I was dissatisfied with that. Maybe I should hand that over to Daniel. Where were you?

Dr. Daniel Lende: I would more emphasize the excitement of trying to combine neuroscience and anthropology. In my case, I had worked as a councilor to kids that had drug problems in Colombia prior to starting grad school. And then I went to grad school in the biocultural program at Emory University, and so it was an integrative program but nonetheless there was a biological/cultural split there.

I didn’t find ways to always connect what I was learning with social theory or from evolutionary theory to what I already knew about these kids’ lives in Bogata, Colombia.

For example, addiction is often referred to in shorthand as “queire mas y mas” – to want more and more – in Colombia. I came across a paper, a 1993 paper by Kent Berridge and Ann Robinion, that talked about addiction and correspondence between neuroscience and anthropology. I wanted to pursue that more.

Trang: Coming in pursuit of neuroanthropology, to you guys what really defines neuroanthropology? That is, how do you demarcate neuroanthropology from closely related disciplines, such as psychological anthropology, for instance, or cultural neuroscience, and/or population neuroscience?

 

Daniel  Lende

Dr. Daniel Lende, via the University of Southern Florida Department of Anthropology

Lende: I’m going to tackle the first part of that, more in relation to psychological anthropology. I think Greg and I have always been pretty clear that neuroanthropology is what it says, the combination of neuroscience and anthropology. The word anthropology is full, so it’s more emphasis on anthropology than neuroscience. We’re both anthropologists.

 

It is an approach that aims to, at the one hand permit anthropologists to draw cognitive science broadly, I would say, in pursing their own research questions, specifically questions they have that are field-based, get data in field-based settings. But as an outcome of doing that type of work, suddenly we have a rich appreciation of what we call “brains in the wild.” That then can provide feedback to neuroscientists, cognitive scientists working in laboratory settings, and also, in both our cases, but for example in my case, clinicians working with addiction, or in Greg’s case, coaches and other people working in applied sciences. So our field-based approach is something that makes neuroanthropology distinctive from some of the other traditions that emphasize the nuero side.

In terms of psychological anthropology, I think we drew a lot on how psychological anthropology recognizes cross cultural variation and mental processes and how psychological anthropology emphasizes the individual in context. But I would say that we have found more inspiration in neuroscience in the third way of cognitive science as a way to really try to grapple with empirical questions that came up during fieldwork. Now today we can develop it differently and take that integration of neuroscience and anthropology to sort of develop new framework to examine patterns of human variation in more naturalistic settings.

Downey: I’m going to pick up the cultural neuroscience side of this, because I end up talking to a lot of cultural neuroscientists and I really admire their work but one of the things they run against is they are neuroscientists first, not cultural theorists first. They work with a cultural model they can operationalize quite easily. That’s often a very limited model. Frankly, it looks very old fashioned; it often looks like it’s just running the same tests on different what are basically ethnic groups, wherever they have an fMRI machine and comparing the results and calling the differences the culture. There’s all kinds of intellectual problems with that, but it shows that if you put the experimental design first and the cultural theory kind of a distant, last place, you can wind up with some very unsophisticated accounts of what you’re actually getting in the fMRI, especially when you’re just contrasting populations that we know that there’s a long history of drawing these very blunt comparisons between, say Asians and Westerners. Cultural neuroscience I think in some ways there’s a good conversation to have but we have to bring an operationalizable cultural theory to that.

Lende: Similarly, the whole population neurosciences or population-based epidemiological models for thinking about neurological variation, they’re really interesting but they’re very much based on a kind of exposure-epidemiological demographic model.  I think they’re a little less developed than the cultural neurosciences, so there’s an idea of exposures.  We can talk about brain differentiation as a result of exposure. Culture isn’t just an exposure, like being exposed to an environment insult or a pathogen of some sort. The danger of medicalization in this case is that it removes a lot of the most interesting interesting phenomena. Certainly, my work in skill acquisition and sensory training, it’s very difficult to model this as exposure because it’s this really, really long term projects that unfold over time and stages to enculture the brain in a particular way. We have a lot of conversation with all three of those, but there’s limits that we run up against.

TrangI know that in one of your publications, Greg, you had critiqued this sort of return to cultural dimensions. What to you guys is culture for neuroanth? What is the best take, or an adequate take, of culture for neuroanthros?

GregandLouis

Dr. Greg Downey, via his personal website

Downey: Daniel and I have been arguing about this for the past week, just so you realize. I just think of culture as a really lousy ptolemaic kind of category, a pre-Copernicus category in which people slap on any difference between groups and they’re often times applying it to completely different sorts of things. They’re using a Parsonian model of what’s causing it, a pure symbolic layer of existence. To me, every time I read cultural theory it’s like we’re theorizing fifteen different things at once. And it’s no wonder we have a morass. What people are getting at with culture is just the idea that there are some differences between groups, between peoples, that are induced, that are not innate in their biology. How do we think about that pattern of both similarity with group and differences between group? The whole sort of hermeneutic model that culture is interpretation is part of what limits us from seeing the neurological impacts of enculturation process. I think we’re going to have to disassemble culture into pieces to figure out how to theorize it.

 

LendeI have a more pragmatic approach to how to think about culture as neuroscientist and anthropologist. One of the first things is to recognize that most of the models of human variation used in psychology and cognitive science broadly, are models of individual variation, often based on the idea of a bell curve. Whereas most of the phenomena anthropologists, particularly cultural anthropologists, study are shared phenomena. In other words, most people share the same amount of variation, which is why on the individual basis approach of assessing culture doesn’t necessarily get at the shared depth that can tie a group together and make them distinctive from other groups, whatever level you’re talking about. In Greg’s case it can be the Capoeira practitioners, in my case it can be people who gather together in certain scenes, drug use scenes in Bogata, up to talking about much broader things, in my case for example, why Colombia might have had, at the time of doing research there, lower drug use rates than the United States. What sort of sociocultural reasons explain that? It’s not necessarily an exposure because the epidemiological exposures are actually quite similar between the United States and Colombia.

From that recognition of looking at the shared aspect of human life, I would just outline that those series of different types of cultural approaches that can be useful to different types of research questions. I think in many ways the interpretive approach, coming from Geertz, can be quite useful in understanding certain things that people report. For example, a lot of the interpretation of what drug use meant to my informants were accessible to using psychological anthropology approaches. But that’s a different type of culture theory than one that’s more place-based, that would have drawn ritual or what’s happening in a particular scene. That’s different from an approach that might emphasized by the idealogical dimensions that surround our understanding of neuroscience and the production of neuroscience. Those are also different from more practice-based approaches which Greg engages with more than I do. I think there’s a variety of types of culture theory and they can be useful in different ways and at different times just as there’s a  variety of neuroscientific approaches out there.

 


The interview with Dr. Downey and Dr. Lende continues, and concludes with a question and answer session with listeners who were virtually tuned in during the live recording of the interview. The full audio interview recording is available here.


Dr. Greg Downey is a Professor of Anthropology at Macquarie University in Sydney, Australia. He attended the University of Chicago. His work is focused in Brazil, the Pacific, and the United States and his research interests include the census, sports, dance, and skill acquisition. His current project is human echolocation among the blind.  Dr. Downey is the author of several books, including Frontiers of Capital: Ethnographic Reflections on the New Economy (2006) from Duke University Press and Learning Capoeira: Lessons in Cunning from an Afro-Brazilian Art (2005) from Oxford University Press.

Dr Daniel Lende is an Associate Professor of Anthropology at the University of South Florida. He trained at Emory University. His research interests include substance use and abuse, stress and resilience, the intersection of anthropology and nueroscience, and public and applied anthropology. He has done work in Colombia and the United States. His book, Addiction: A Search for Understanding, is currently in preparation.

Kathy Trang is the Electronic Publications Editor and Anthropology New co-Editor for SPA.

 

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Article Highlight: Expert Knowledge Influences Decision-Making for Couples Receiving Positive Prenatal Chromosomal Microarray Testing Results

This week on the blog we are highlighting a paper by M.A. Rubel, A. Werner-Lin, F. K. Barg, B. A. Bernhardt, titled Expert Knowledge Influences Decision-Making for Couples Receiving Positive Prenatal Chromosomal Microarray Testing Results. The authors completed phone interviews with women and their partners who had received positive prenatal microarray testing results. The authors then analyze the data using modified grounded theory, discussing the theme of cultural expert knowledge and the implications on research and practice of prenatal testing. They close by recommending a future assessment of informational needs before testing to aid both the patient and their partners.

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The authors begin by describing the increase in the use of prenatal genetic testing by pregnant women. Potential methods of genetic testing include invasive, non-invasive, and integrated screening for various potential fetal anomalies or genetic conditions. Chromosomal microarray, also called prenatal microarray, is a prenatal test that is used to “detect copy-number variants not detectable by conventional cytogenetic” (Rubel et al, 2017, 383). These test are recommended by the American College of Obstetrics and Gynecology if an anomaly is found via ultrasound. Parents feel anxiety after receiving a result of variant of uncertain significance, which can affect their decision-making following the result.

Western biomedicine helps to inform the biomedical expert knowledge (BEK) that holds a privileged status. BEK has roots in cultural and social conditions that shape how the knowledge is interpreted. BEK is founded in the idea that “aspects of the patient’s body and its symptoms are variables that can be independently and objectively evaluated and treated” (384). However, the genome may also be interpreted through a standard outside of biomedical knowledge. These other frameworks of medical knowledge may be used to interpret the testing done to women.

For this study, the authors recruited subjects for the study from the distribution of a pamphlet to pregnant women who received results from microarray testing. These women could then choose to participate in a short online survey that asked for demographic information and the results of the microarray test. The women who completed the survey and indicated interest were then e-mailed with information about the interview portion of the study. In total, 152 female patients completed the survey and 27 women were interviewed. 12 of their male partners were then subsequently interviewed.

Those who received positive results with uncertain or variable outcomes underwent a “state of crisis” after their results (388). They attempted to find the information related to their situation; some clinicians even provided the patients such biomedical information through literature and leaflets. Some patients were reassured by entrusting the health care providers to also provide the knowledge. Yet some providers may not wish to take a directive position and provide such materials.

Most of the patients interviewed expressed frustration that there was not enough information or resource provided initially by their clinicians. Patients that sought out BEK often turned to the internet. Those who considered themselves educated found it easier to search the information they could find online, yet there was still a general frustration about the BEK that was provided. Because of this frustration, patients often turned to other sources of understanding. The authors also extensively other ways of knowing and understanding their test results. These include embodied knowledge, spiritual beliefs, social networks, and a family history. These other types of knowledge other than BEK allowed the patients to understand their test results on their own terms.

The authors propose the term “Cultural Expert Knowledge” or CEK to encompass the types of knowledge that patients gained from outside the biomedical paradigm. This non-expert knowledge was some patients only information source. This provides a contrasting source of information to BEK and helps patients to understand their test results on their own terms. The authors close with a discussion about the difficulties of quantifying CEK since it is based on individual conceptions and outside of the biomedical sphere. They acknowledge the limitations of the study and provide further areas for expansion of the research base.

Article Highlight: Vol. 41, Issue 3, “Don’t Give Up! A Cyber-ethnography and Discourse Analysis of an Online Infertility Patient Forum”

This week on the blog we are highlighting an article from our most recent edition, Volume 41, Issue 3, by Mihan Lee entitled Don’t Give Up! A Cyber-ethnography and Discourse Analysis of an Online Infertility Patient Forum.  The study explores the patients’ access to psychological support when dealing with a diagnosis of infertility. This is done through patient interviews and a cyber-ethnography of an online forum hosted by RESOLVE: The National Infertility Association. Lee explores the themes common across the different forum threads and the interviews to better understand the support systems of patients. Several themes emerge, such as the difficulty in obtaining treatment for many women because of resource burden and the stress of finding an option that fits within their parameters. The author proposes that not having the resources to access treatment silences women and denies them the support they came to the forum in search of.

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Patients experience of their illness during and after treatment can be impacted by the social support in their environment. Patients in the contemporary age build social support networks on the Internet, turning to it for health information and access to resources to make decisions. Infertility patients can receive both the privacy and anonymity they often desire when using online resources for support. Those who are infertile may experience stigma for their condition or shame at not being the same as others who are fertile.

The author calls the main narrative of American infertility the ‘persistent patient’. This narrative is defined by a woman who wants a child and expresses her desire for through material resources. This requires that the woman have an education and access to financial resources so that she can access the resources available to medically treat her infertility. This creates a subset of women among the rest who are able to fit the ‘persistent patient’ narrative.

For the study, the author identified women to interview through posts on the sites infertility advocacy organizations. The fifty-five women interviewed were given a demographics questionnaire and then interviewed to find their patient narratives and discover both personal and professional views on infertility. Lee also conducted a “cyber-ethnography,” a critical analysis of posts in an online patient community. This was used to compare the effects of the Internet on the social support of the women. These were followed up with more refined interviews of patients.

For many women who experience infertility treatment, there is an extreme emotional burden. There is also a pressure  experienced from the stigmatization of the condition. While infertility is a condition that affects seven million women, many women still feel like the condition is abnormal. Because of this, women keep their condition and experience private.

Within the forums, there was a running theme that friends and family did not understand the stress and struggle of infertility, which further stressed the women. The posters in the online community then became a support network for the women who were feeling an external lack of support. They were able to understand other women’s pain because it was similar to their own. However, this is offset by the validation of only certain narratives, especially through an assumed access to the resources to pursue treatment.

One type of thread, the “roll call” served as “an opportunity for all patients starting a certain type of treatment .. to connect with one another”. These roll calls allowed women of different experiences to connect with those who could offer them support through their parallel treatment journeys.

Interestingly, Lee notes that it seems as if those who most often frequent the boards are those who have had several treatment cycles. This juxtaposes the lack of discussion about the financial, time, and other resources necessary to pursue multiple treatments. Without these resources, some women cannot pursue the infertility treatments they would like. Data suggests that despite the lack of discussion, this is a prevalent problem. Most states do not require that insurance option cover infertility treatment and only 20% of employers cover ARTs.

The financial burden on women seeking treatment that was seen in the online forums was also reflected in the in-depth interviews as well. Some of the primary barriers to using ARTs was the overwhelming price. To be able to pursue these treatments, women must have type of disposable income that can go towards it. Lee suggests that the lower-income and uninsured women may either not be vocal or silenced by the culture of the forum groups. In the otherwise vocal community, posts about stopping treatment because of financial strain often went unanswered. And when there were responses, they often ignored the real constraints of financial burden.

When women bring up their concerns, the dominant narrative of the ‘persistent patient’ raises its voice louder than any of the other posters within the group. This adds further strain to the women who are worried about their financial experiences of infertility because the place where they have found solace rejects them. A counter-discourse emerges as women discuss the ways in which they have learned to cope with having a childfree life. Lee suggests that the forum should broaden its reach to offer for support as women adjust to their decision to stop treatment or inability to continue treatment.

Lee concludes that the role of the ‘persistent patient’ is one that is only available to a privileged demographic and that the socioeconomic factors that affect accessibility to resources also affects the ability of some mothers to have children. The condition of infertility is thus not experienced as a single thread and the nuances of different women’s backgrounds should be considered when hearing or researching their narrative.

 

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