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?

 

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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?

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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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AAA 2016 Session Highlights: Part 2, Discoveries

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Image via AAA Website

This is the second in a two-part series spotlighting sessions in medical anthropology at the upcoming 2016 Annual Meeting of the American Anthropological Association (AAA) in Minneapolis, Minnesota. In this second installment, we present a selection of sessions on the theme of “discoveries.” For more information about this year’s meeting, click this link.


Sessions on “Discoveries”: New approaches to the anthropological study of medicine and medical systems, and studies of new and contemporary medical technologies/therapies

RETHINKING GENDER NORMATIVITY, SEXUALITY, AND MORALITY THROUGH NON-BIOMEDICAL EPISTEMOLOGIES

Thursday, November 17th 8:00 AM – 9:45 AM

Organizer(s): Venera Khalikova (University of Pittsburgh) and Kristin Bright (Carleton University, Canada)

Chair: Venera Khalikova (University of Pittsburgh)

Discussant(s): Lucinda Ramberg (Cornell University) and Kristin Bright (Carleton University, Canada)

This session will propose new ways of thinking about gender and sexuality as heterogeneous subjects. The papers will examine how gender and sex are configured and reconfigured in biomedicine and complementary or alternative medical and health systems.

DISCOVERING WAYS IN WHICH DEATH OCCURS IN A CULTURAL CONTEXT

Friday, November 18th 8:00 AM – 9:45 AM

Organizer: Erica Borgstrom (Open University, United Kingdom)

Chair: Erica Borgstrom (Open University, United Kingdom)

Discussant: James Green (University of Washington)

In this session, presenters will reveal how death occurs and is interpreted in both biomedical and local cultural contexts. Papers address death, dying, and aging in India, China, the United States, and in migrant communities in Australia.

(RE)DISCOVERING PSYCHEDELICS IN THE 21ST CENTURY

Friday, November 18th 10:15 AM – 12:00 PM

Organizer(s): Shana Harris (University of Central Florida) and Hilary Agro (University of British Columbia, Canada)

Chair(s): Shana Harris (University of Central Florida) and Hilary Agro (University of British Columbia, Canada)

Discussant: Michael Oldani (Concordia University Wisconsin)

Papers in this session will explore the (re)emergences of psychedelic drugs, particularly in the contexts of treatment and medical research, but also beyond the boundaries of biomedicine: including traditional use of ayahuasca, and the use of drugs in rave culture.
NEW DIRECTIONS IN THE INTERSECTION OF MEDICAL ANTHROPOLOGY AND BIOETHICS 

Friday, November 18th 4:00 PM – 5:45 PM

Organizer(s): Eileen Anderson-Fye (Case Western Reserve University) and Jonathan Sadowsky (Case Western Reserve University)

Chair: Paul Brodwin (University of Wisconsin, Milwaukee)

Discussant(s): Rebecca Lester (Washington University, St Louis) and Jonathan Sadowsky
(Case Western Reserve University)

In this session, presenters will offer four different anthropological cases that highlight the intersections of anthropology and bioethics: genomic research in Africa, physician-aided dying, body image and obesity, and transnational healthcare in Brazil.
“BODY-WORK”: SCIENCE AND TECHNOLOGY STUDIES IN MEDICAL ANTHROPOLOGY

Saturday, November 19th 2:30 PM – 2:45 PM

Papers in this session will explore the intersections of medical anthropology and contemporary studies in science and technology. Paper topics include the use of human tissue in continuing medical education, ‘smart machines’ and disability, new genetics sequences technologies in a cancer clinic, neuropsychiatry and resistance, and relationships between nurses and patients in HIV clinical settings.

 

From the Archive: Patients-as-Syndromes in Internal Medicine

In our “From the Archive” series, we highlight an article from a past issue of the journal. In this installment, we explore Robert A. Hahn’s piece “‘Treat the patient, not the lab’: Internal medicine and the concept of ‘Person,'” available in full here. This article was featured in Volume 6, Issue 3 (September 1982.)


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Throughout the history of the journal, our authors have turned the same anthropological gaze equally onto both biomedicine and other medical systems. As Hahn introduces this article, he states that the healer in all cultural contexts fashions medical and social truths together, such that the patient and patient body are reinterpreted (and potentially reordered) through medical treatment by the healer. Biomedicine, he states, also recasts illness in ways that alter the medical position of the patient. To understand how physicians of biomedicine engage with patients conceptually in this way, Hahn conducted an ethnographic study of four internists. As internal medicine is often characterized as highly rationalistic and thus emblematic of biomedical practice, Hahn argues, he states that understanding the internists’ perspectives may shed light more broadly on biomedicine as a particular method of envisioning illness and its relationship to the patient.

Hahn begins by positing that the nature of internal medicine as a profession itself is a form of interpretation of what constitutes the patient and body over which it has medical purview. Internal medicine does not focus on mental health (psychiatry) or on the internal visceral body (surgery.) Thus, the “body” it treats exists in relative isolation from the mind, yet is not a physical or functional body such as the one manipulated directly through surgery. The conditions internists treat exist apart from the person and, to a degree, from the patient’s body: instead, the internist focuses on internal diseases and pathologies that become entities of treatment divorced from the individual receiving care. These illnesses– forged into concrete ontological “things”– are countered with similarly material antidotes. Hahn adds that the prestigious status of the internist in the culture of clinical practice, both currently and historically, lends this physiologically-based view of the body and its treatment significant legitimacy in the biomedical landscape.

To demonstrate these concepts, Hahn presents the case of internist Dr. Barry Siegler. “Barry,” as he comes to be called, repeatedly instructs his residents and other clinicians to be wary of individual metrics and lab results, as these single numbers and tests cannot be incrementally fixed: rather, he contends, they must be examined and addressed in concert such that the whole patient is successfully treated. Hahn describes this as relational knowledge of pathology, rather than “singly” reading and responding to individual metrics. However, Barry does not mean to champion holistic, person-centered care: instead, he posits that the entire patient should serve as the point of focus such that no aspect of the patient’s pathology is excluded from diagnosis and subsequent treatment. For example, Barry argues that the patient interview is a tool for the extraction of cues that would lead the clinician to better understand the etiology and symptomatology at hand.

Thus the patient’s “syndrome” comes to exist as a materially and ontologically “real” entity that is distinct from the social, personal, and existential contexts of the patient’s life. This perspective is crystallized in Barry’s tendency to refer to patients as their diseases, such as “a conversion reaction.” He also refers to patients he believes to have mental illness in the same manner, such as the “neurotic,” although he admits that psychiatric pathologies are a “Pandora’s box” beyond the limits of his professional power to address. Again, the patient as a person (and even as a subject or individual mind) fades as the disease pathologies that characterize their illness are reified and made the central objects of the internist’s medical gaze. Due to the close alignment between physiology and organic sciences (chemistry and biology), Hahn notes that the internist’s ontological transformation of the patient into their pathologies– and the pathologies into discrete objects of attention– are deemed especially real, true, and justifiable. Likewise, the body itself is interpreted as a closed, contained system that becomes the object of internal medicine: the ‘whole patient’ is instead the ‘whole pathophysiology.’

Hahn concludes that this vision of the body is decidedly Western: it individualizes the body, and makes a Cartesian division between the body (physical) and the mind (psychological, social) such that it is made treatable and conceptually readable by internists who isolate it from other contexts and who distinguish diseases as concrete, material things. The article ultimately suggests that certain biomedical visions of the body and appropriate patterns for treatment may not align with the perspectives of patients, who understand their illness within the social, spiritual, cultural, and other frameworks that structure their daily lives.

 

Fall 2016: Blog Update

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The Culture, Medicine & Psychiatry blog will return to regular, once-weekly updates next week on Wednesday, following our reduced summer upload schedule. In the meantime, our readers can access articles and illness narratives from our new September 2016 issue here.

In the coming weeks, check back on the blog for special article highlights from the new issue, as well as “From the Archive” features, news posts, book release updates, commentaries, and other entries at the blog. As always, we continue to welcome submissions of guest commentaries on the cultural, social, and humanistic study of health and medicine. Please contact our social media editor, Julia Knopes (jcb193@case.edu) for more information.

Best wishes from the CMP Editorial Team!

From the Archive: Martin’s “Pharmaceutical Virtue”

In our “From the Archive” series, we highlight articles from throughout the publication history of the journal. This week, we feature Emily Martin’s 2006 piece “Pharmaceutical Virtue” (accessible in full here.) Martin’s article was featured in a special issue from volume 30 exploring pharmaceutical cultures. Explore the full special issue here.

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Emily Martin’s “Pharmaceutical Virtue” tracks the changing ethic of the pharmaceutical industry and pharmacological research from the mid-20th century through today. To assess the shifting moral economy of this industry, Martin draws on interviews with retired, key figures in pharmaceutical sales and development active in the 1950s through 1970s. She then weighs their perspectives on the benefits and aims of the industry against those of contemporary pharmaceutical employees, including sales representatives and advertising workers. The latter group of individuals is increasingly faced with growing public “vilification” for aggressive marketing (and price-gauging.) Nevertheless, today’s sect of pharmaceutical workers strive to see the virtues in an industry which promises new treatments and potential cures.

Martin begins by analyzing interviews from the cohort of pharmaceutical industry workers from the 1950s-70s, here alongside the history of pharmaceutical research and its transformation into a powerful economic machine. Martin finds that the industry’s ability to provide a range of new tools to physicians, at a time when many health concerns had unsatisfactory or limited treatment options, allied the pharmaceutical industry with more “noble” biomedical or clinical research. Companies placed rigorous emphasis on training physicians to see the minute differences between medical conditions in order to best treat them. For instance, “Ativan’s marketing strategy was designed specifically to train doctors to prescribe it to reduce daytime anxiety,” Martin writes, “mixing that anti- anxiety benefit with the tranquilizing benefit of a sleep aid…would be confusing to doctors and make it harder to remember that they should prescribe the drug for daytime anxiety.”

Thus the pharmaceutical representatives and workers of the 1950s-1970s served as allies to the medical profession by helping them distinguish between medical conditions in ways productive for successful (and specific) treatment. There was no direct-to-consumer marketing: only direct, and informative, exchanges between physicians and pharmaceutical sales representatives. Educational materials distributed from the companies at this time had few references to the drugs being marketed and were free of advertisements. Instead they were aimed at better informing physicians and clinicians who would then provide improved overall care, drawn from a wider range of treatments made available by the companies.

The contemporary pharmaceutical industry suffers a less symbiotic relationship with the public and the medical profession, Martin observes. Clinical trials’ move overseas, often to developing countries, and the rigorous marketing and profiting off life-saving medications like anti-retrovirals, has generated significant ire against the industry. Even the industry’s funding for consumer advocacy outreach and educational programming is, while rosy on the surface, another means by which to court consumers. Educational materials are now penned largely for patients, not physicians, partially severing the physician from the care exchanges that occur between companies, clinicians, and patients.

In this climate, however, Martin finds that many pharmaceutical representatives and workers find dignity and virtue in their work by considering more minute interactions between individual patients or patient populations and the drugs themselves. One representative informant cites an elderly woman who, upon seeing the representative’s bag labeled with the name of the woman’s chronic pain medication, remarked in tears that the drug had changed her life. Another worker, who develops advertisement copy for a pharmaceutical company, notes that the stigma of mental illness is reduced because the available psychotropic drugs are so potent that they are able to restore even a very ill person to a functional life. An advertisement designer added that drugs reduce the blame on the patient, particularly for mental illness, and remove stigma by illustrating that illness is physiological rather than the result of a personal defect.

In sum, like the pharmaceutical workers of the 1950s-1970s, contemporary employees aspire to see the virtues in their industry. Changes in the fabric of pharmaceutical marketing, and other aspects which complicate the moral position of these companies, make this increasingly difficult. However, today’s representatives locate the social good in their work through examples that underscore the potential for improvement amongst patients. This shift in focus from physicians/pharmaceutical companies to patients/companies– while still indicative of the consumer relationship of buyers with companies–offers today’s pharmaceutical workers a positive vision of their work and the potential of new pharmaceuticals to improve human health and quality of life.