biomedicine

Medical Humanities as an Intersection: Fostering Cross-Disciplinary Intellectual Spaces, A Commentary

Posted by

0

This week, we are featuring a commentary on the medical humanities, which first appeared this week here on The Daily Dose blog. This piece explores the nature of interdisciplinary research on the social, cultural, and experiential dimensions of medicine. It also spotlights the new Medicine, Society & Culture initiatives at Case Western Reserve University.

 

When I set out to write this commentary, I first intended on penning a blog piece about my own definition of the medical humanities as someone trained in both the humanities and the social sciences. Having come to medical anthropology from a past life in literary studies, my work has straddled the fissure between humanities and qualitative social sciences. I have presented work both on the history and theatrical presence of anatomical learning in the English Renaissance, and on my ethnographic research with medical students in the gross anatomy lab today. Sometimes, my work is focused solely on the present; in other instances, I turn to the historical past to inform my work as a scholar of contemporary medical training. My vision of the medical humanities is one that arrives from both within and beyond traditional disciplinary boundaries.

cropped-2009cover-copy.jpg

My approach, however, is but one. I recognize that the medical humanities do not offer a single or unified outlook on human health, illness, and medical practice. In fact, the medical humanities are populated by historians and artists, poets and literary scholars, philosophers and social scientists. Our individual professional identities may be firm—I identify now as an ethnographer and anthropologist, not a literary scholar—but the social, cultural, historical, experiential, and existential study of medicine is simply too complex to be dominated by a single field. The medical humanities (and its ally, social medicine), welcomes perspectives on the humanistic study of medicine informed by our varied native disciplines. More than a single field, the medical humanities often serve as a crossroads: an intellectual intersection (physical, virtual, or social) at which scholars across fields gather in dialogue, whether they identify with a single specialty or as interdisciplinary scholars. For this reason, and regardless of disciplinary allegiances, we can all benefit from the medical humanities as a site of discussion that welcomes myriad voices. Diverse perspectives encourage us to analyze human health and medical problems from numerous angles. As we all carry with us our own analytical methods and theories to this junction, so too do we leave these dialogues having ourselves learned and gained the critical perspectives of our peers. This sharpens our focus anew on social, cultural, and medical problems for which one discipline lacks all answers.

The value of the medical humanities is that they enable all of us to see medical and social problems through multiple lenses. If we cannot fully grasp a complex medical problem through ethnography alone, we turn to historical approaches to complete our understanding of the issue at hand. If individual illness narratives beg to be woven together through other data, we look to sociology and economics to conceptualize the underlying health inequities faced by diverse populations, amongst other socio-medical problems. And, further, when we strive to understand how medical science is confronting illness and suffering today, we turn to nurses, social workers, therapists, physicians, and other health professionals whose day-to-day interaction with patients is deeply informative for our own research. Indeed, clinicians also benefit from our work: the humanities have been widely integrated into coursework for physicians in the United Kingdom[1] and the United States[2]. While obstacles remain in the creation and implementation of medical humanities curricula for future medical practitioners[3], this coursework has widened the intellectual space in which medical humanists exchange ideas with multiple audiences.

Whether medical humanities programs are physically housed within humanities departments, or whether they are exported into numerous health education venues, they remain a space for invaluable cross-disciplinary conversation. I have been fortunate to serve as the administrative coordinator of a medical humanities and social medicine collaborative that has overcome departmental boundaries in creating a new space for scholarly dialogue. This new university-wide initiative in medical humanities and social medicine (MHSM) is anchored by a Bioethics MA degree track entitled Medicine, Society and Culture at Case Western Reserve University. Though the degree program is housed in the School of Medicine, our MHSM (Medical Humanities and Social Medicine) advisory committee (which oversees university-wide activities in medical humanities[4]) includes historians, philosophers, literary scholars, social scientists, rhetoricians, and many others. Across the university, we facilitate lectures, administer competitive conference and research grants for students, and support faculty scholarship and teaching innovation. In the region, we collaborate with neighboring institutions to spearhead events that bring together scholars in all disciplines to discuss common themes in the social and contextual study of medicine, illness, and human health. In addition, we look forward to welcoming our first entering class of graduate students in the Medicine, Society, and Culture track in the Bioethics graduate program this Fall 2016. These students will complete clinical rotations, bioethics coursework, and multidisciplinary training in medical humanities and social medicine.

In sum, the Medicine, Society and Culture initiative has become another significant intersection at which scholars—both practicing academics and new graduate students alike—are able to trade theories, exchange methods, and discuss contemporary intellectual issues with fellow medical humanists and social scientists. Thus, our program seeks to both produce new scholars who approach illness and medicine as inherently multi-faceted human experiences, and to facilitate dialogues with current scholars within various departments who strive to complicate their own understandings of health and the human condition.

Beyond university programming, however, there are many ways that all medical humanities scholars strive—and should continue—to reach across departments and disciplines to share our methods, theories, approaches, and reflections on medicine with one another. This blog is one such space that beautifully forges virtual connections across academic audiences with a shared interest in health, illness, and medical practice. My own field, medical anthropology, by its nature requires researchers to inform their claims through many kinds of data that necessitate several forms of analysis: all which dovetail approaches in other fields. So too did my previous training in literary studies require me to be conversant in historical methods, in close reading techniques, and in the same inductive reasoning skills that I now apply to my ethnographic work. No discipline is an intellectual island: and if there is a universal value of the medical humanities, it is that it has made junctures out of disparate disciplines. It is at once clinical, scientific, and humanistic.

 

About the Author: Julia Knopes is a PhD candidate in anthropology at Case Western Reserve University, and serves as the administrative coordinator for the newly-launched MA Track in Medicine, Society & Culture in the CWRU Department of Bioethics. Julia’s research examines the socio-material basis of professional role development amongst American medical students. She holds an MA in Humanities from the University of Chicago and a BA in English from Washington & Jefferson College. You can learn more about Julia’s work and current research here.

References

[1] Macnaughton, Jane. (2000). “The humanities in medical education: context, outcomes and structures.” Journal of Medical Ethics: Medical Humanities 26: 23-30.

[2] Hunter, KM; Charon, Rita; Coulehan, Jack. (1995). “The study of literature in medical education.” Academic Medicine 70(9): 787-794.

[3] Shapiro, Johanna; Coulehan, Jack; Wear, Delese; Montello, Martha. (2009). “Medical Humanities and Their Discontents: Definitions, Critiques, and Implications.” Academic Medicine 84(2): 192-198.

[4] Information on members of the CWRU MHSM advisory committee can be found here: http://case.edu/medicine/msc/about/advisory-committee/

Fall 2016: Blog Update

Posted by

0

cards3

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!

In the News: Health Disparities and Water Quality in the 2016 Rio Summer Olympics

Posted by

1

 

August 2016 – The 2016 Summer Olympic games in Rio de Janeiro, Brazil has dominated news headlines in recent weeks. The athletics event, taking place from August 5 to August 21, featured 207 countries in the Parade of Nations as well as the first ever Refugee Olympic Team. It is the first time the games have been held in South America. But besides highlights on the events and spotlights on athletes’ training regimens and backgrounds, there is another stream of news stories surrounding the Olympic Games. These stories have focused on two key public health issues related to this year’s Games: health disparities and water quality issues.

ap_16221704995649-2a9b5ac7291dd20a71781f18eaca8c4d3edb888a-s800-c85

Rio’s Olympic beach volleyball venue is on Copacabana Beach. Photo from Marcio Jose Sanchez for AP.

Only two years ago the FIFA World Cup was making similar headlines in Brazil. As reported in 2014, and highlighted in this blog[1], there have been past concerns about access to quality healthcare despite the surge of funds for the World Cup event. These reports unmasked a problematic system of health disparities to a global audience. The Daily Californian[2] stated that many Brazilians were “unhappy that their government [was] funding stadium renovations instead of spending on more instrumental matters like improved health care and emergency services.” Reports relating to the current Olympics have painted a similar picture for the present health scene. As Reuters[3] reported in December 2015, the governor of Rio de Janeiro declared a state of emergency “as hospitals, emergency rooms and health clinics cut services or closed units throughout the state as money ran out for equipment, supplies and salaries.” According to CNN[4], the financial crisis has been causing difficulties in the “provision of essential public services and can even cause a total breakdown in public security, health, education, mobility and environmental management.”. While the state of emergency declaration provides a critical 45 million reais ($25.3 million) in federal aid and may facilitate the transfer of future funds, estimates state that Rio de Janeiro owes approximately $355 million to employees and suppliers in the healthcare sector alone, and the state needs over $100 million to reopen the closed hospital units and clinics.[5] While the city of Rio spent approximately $7.1 billion on improving toll roads, ports and other infrastructure projects, the Brazil Ministry of Health devoted only $5.7 million to address health concerns[6].

rio-favelas--joao-velozo-9_custom-84b1822885fc72f97f7e9084730eb4397aa48b6e-s1300-c85

The Christ the Redeemer statue is visible above the Santa Marta favela in Rio de Janeiro. Photo from Joao Velozo for NPR. 

In addition to these issues (and the high-profile Zika virus, which is causing health concerns in multiple countries[7]), concerns surrounding water quality and cleanliness in Brazil has garnered considerable attention. A recent scene involving the diving and water polo pools turning a swamp-green color because of an algae bloom left some athletes complaining of itchy eyes.[8] While the Olympic Games have brought international attention to the impact of water quality on the athletes and visitors, the residents of Rio have been dealing with theses concerns on a daily basis for much longer. With almost 13 million people living in and around Rio, the current sewage system is struggling to cope. One news report[9] notes that “about 50 percent of what Brazilians flush down the toilet ends up in the country’s waterways. Diseases related to contaminated water are the second leading cause of death for children under five in Brazil.” Tests performed in a variety of areas, including the sailing venue of Guanabara Bay, over the course of a year found high levels of “superbugs of the sort found in hospitals on the shores of the bay.” The possibility of hospital sewage entering the municipal sewage system remains a concern.[10]

An economic recession, compounded by water concerns, political unrest, and a presently faltering healthcare system all leave many Cariocas— citizens of Rio– who rely on the public health system in a challenging and hazardous situation across the social, medical, and political spheres. With hopes of local profits from the Olympic Games ranging in the billions of dollars, much is at stake for both residents and investors.[11] Despite the risks and tribulations, many residents welcome the international event and attention, and credit the Olympics for cultivating “several underutilized, often abandoned spaces have been transformed to ones that appeal and cater to local residents”. Many “beautification” projects leave residents hoping the installation of new art and the newly constructed spaces will leave a lasting impression on its residents and visitors long after the games end.[12]  Despite this optimism, the citizens of Rio are not impacted equally by the Games.[13] The improved infrastructures will likely benefit those who already have access to services. Tourism, and tourism cash, has been weak in the favelas, or shantytowns, which house at least 25% of the population in Rio. The infrastructure inequities have even bypassed some neighborhoods entirely, leaving those residents out of the celebrations.[14]

Overall, these Olympic Games promise once again to bring the world’s cultures together in competition and camaraderie, yet they do not do so without controversy. This global spectacle illuminates athletics and sportsmanship, as well as the intersections between cultural events, politics and nationalism, power and profit, and community health. These larger issues lead to questions about what will happen to the residents of Rio after the Games have drawn to a close.

 

[1] https://culturemedicinepsychiatry.com/2014/07/11/news-the-2014-world-cup-and-healthcare-in-brazil/

[2] http://www.dailycal.org/2014/07/08/uc-berkeley-faculty-graduate-students-look-world-cup-different-light/

[3] http://www.reuters.com/article/us-brazil-health-emergency-idUSKBN0U716Q20151224

[4] http://www.cnn.com/2016/06/18/americas/brazil-rio-state-emergency-funding-olympics/

[5]http://www.reuters.com/article/us-brazil-health-emergency-idUSKBN0U716Q20151224

[6] http://wuwm.com/post/let-s-do-numbers-money-spent-rio-olympics#stream/0

[7] http://www.nytimes.com/2016/01/29/world/americas/brazil-zika-rio-olympics.html?_r=0

[8] http://uk.reuters.com/article/uk-olympics-rio-diving-pool-idUKKCN10O0UW?feedType=RSS&feedName=sportsNews

[9] http://wuwm.com/post/rios-water-problems-go-far-beyond-olympics#stream/0

[10] http://edition.cnn.com/2016/08/02/sport/rio-2016-olympic-games-water-quality-sailing-rowing/index.html

[11] http://www.newsweek.com/rio-2016-who-stands-benefit-successful-olympics-453094

[12] http://www.kvia.com/news/rio-olympics-bring-beautification-projects/40884340

[13] http://www.npr.org/sections/thetorch/2016/08/11/487769536/in-rios-favelas-hoped-for-benefits-from-olympics-have-yet-to-materialize

[14] http://www.reuters.com/video/2016/08/14/olympic-infrastructure-causes-suffering?videoId=369565427

Issue Highlight Vol 40 Issue 2: Global Health Diplomacy in Ethiopia

Posted by

0

cropped-cards.jpg

Across the past few weeks, we have been spotlighting new articles from our June 2016 issue, which you can access in full here. The theme of this special issue is The Clinic in Crisis: Medicine and Politics in the Context of Social Upheaval. This week, we visit Lauren Carruth’s article “Peace in the Clinic: Rethinking ‘Global Health Diplomacy’ in the Somali Region of Ethiopia.” You can read the full article at this link.

In this article, Carruth argues that the politics of global health manifest not only at the scale of “interstate” interactions between governments, NGOs, and international assemblies, but at the local and interpersonal levels between individuals who are giving, receiving, and managing clinical care in “politically insecure” places. Through ethnographic research on two health programs in the Somali region of Ethiopia, the author argues that medical care provision can alternatively strain and strengthen political relationships between people across ethnic and social boundaries.

For instance, Somali people in Ethiopia often refused to seek medical services from the local clinic, Aysha Health Center. Somali patients complained that the Habesha (a native Ethiopian group) nurses were insensitive and uninterested in treating their health concerns. Many Somali informants offered up the same story as evidence: three mothers went to the clinic, and their three children had different ailments. Yet the Habesha nurses did not examine the children, and offered the same drugs to each of the mothers without diagnosing each patient. Somali patients also had difficulty securing a translator who could assist them in conversations with clinicians, who spoke Amharic. The Habesha clinic staff countered that the Somali patients were adverse to biomedical care, instead trusting native folk healers over the clinicians. They added that Somali patients would not adhere to the medication regimens or treatment plans that they recommended. In this case, the friction between Habesha caregivers and Somali patients intensified long-standing ethnic and political tensions at the local scale.

Carruth presents another case, however, where medical aid eases inter-ethnic relationships and ameliorate social rifts between opposing groups. She describes a mobile UNICEF clinic staffed by two Somali clinicians of the Ogaden clan operating in Ethiopia. Though these Somali clinicians were caring for fellow Somali patients, the patients descended from a less politically powerful line which did not have the dominant social standing of the Ogaden: a clan with significant regional power in Ethiopia. Though the patients were of opposing clans, such as the Issa, the two clinicians listened intently to the patients’ complaints, recalled their family lines when they returned for further treatment, and even offered resources like supplementary nutrition to ailing patients despite UNICEF limitations on what types of patients could receive these rations. The patients adored the mobile clinic staff, and the clinicians became integrated into the marginalized communities they served. This example, Carruth notes, highlights the potential for medical aid to facilitate positive and deeply personal relationships between factions in regions that have otherwise experienced significant social unrest.

Carruth concludes that in order to successfully deliver medical aid to places encountering social upheaval or unrest, it is critical to unite oppositional groups within clinical spaces themselves. Providing medical resources and building clinics alone, she notes, fails to address the need to facilitate positive relationships between individuals mired in conflict. Instead, to ease political and social tensions, Carruth posits that clinics and similar treatment centers can serve as sites of caring, communal exchange between otherwise opposed social groups.

Issue Highlight Vol 40 Issue 2: Reproductive Experiences Amongst Haredi Jewish Women

Posted by

1

cropped-cards.jpg

Over the next few blog updates, we will be spotlighting new articles from our June 2016 issue, which you can access in full here. The theme of this special issue is The Clinic in Crisis: Medicine and Politics in the Context of Social Upheaval. In addition to articles that address the topics of societal unrest, political change, and human health, this installment also turns to how people navigate change and decision-making within the contexts of their own lives. Specifically, one article questions whether individual autonomy over medical decisions is a characteristic of medical care across cultural contexts. In Teman, Ivry, and Goren’s article “Obligatory Effort [Hishtadlut] as an Explanatory Model: A Critique of Reproductive Choice and Control,” we learn that the notion of reproductive choice and control does not cleanly map onto the procreative experiences of Haredi (ultra-Orthodox Jewish) women. To access this article in full, click here.

Reproductive technologies have expanded the range of procreative choices a woman and members of her family confront: should birth control be used to limit the number of children she wishes to have? Should assisted reproductive technologies (ARTs) be used to facilitate conception, or should a woman abort a fetus that has tested positive for a developmental or congenital ailment? The authors of this article suggest that in these discussions, another question has emerged. Are these decisions truly reflective of individual choice, or do individual mothers and members of their community perceive the reproductive course as one over which no person has ultimate control?

Amongst Haredi (ultra-Orthodox Jewish) women in both the United States and Israel, the authors observed another way that individuals framed their reproductive experiences. Rather than describing their procreative choices as a form of individual control over one’s life course, the Haredi women referenced hishtadlut, or obligatory effort: the notion that they were obliged to God to try to become pregnant, but not responsible for the outcome if they were unable to do so. In hishtadlut, women have “room for effort” in that they may flexibly interpret and enact what constitutes a serious attempt to become pregnant or maintain a healthy pregnancy per their religious duty to God to have children. In this explanatory framing, women recognize that they must consciously make choices that would enable God to enact a divine plan for them: however, they are not accountable for the outcome if, having invested the “effort,” God’s plan does not come to fruition or leads to the birth of a child with a developmental disability or congenital condition.

The concept of hishtadlut extended to the use of various reproductive technologies. For instance, there are many concerns about hereditary genetic illnesses like Tay-Sachs disease within the Haredi community. To ameliorate this issue, blood samples from young Haredi men and women enrolled in high school are collected and catalogued into an anonymous database. If two families are arranging a marriage between a son and a daughter, they are able to consult the database to confirm whether or not both individuals are genetic carriers of an illness. This prevents unions between two carriers who would have a greater likelihood of having a child with a genetic illness; thus a genetic carrier would be paired with a non-carrier spouse. Most women interviewed for the article agreed that this technological system facilitated the will of God, as it reduced the chance that a couple would face the difficulty of raising a disabled or an ill child. Here the technology is seen as a “blessing” from God, as it allows families and couples to avoid “heartbreak,” while bolstering a couple’s ability to have healthy children per God’s divine plan.

In other instances, technology is viewed as irrelevant out of the hishtadlut principle. For example, the Haredi women perceived genetic testing for fetal developmental or other congenital illnesses as having little purpose. In Jewish law, abortions beyond 40 days after conception are prohibited, and all fetal diagnostic testing occurs after this point in a woman’s pregnancy. Thus, the women held that the test was inconsequential, as God’s will for them and their fetus had already been ordained. If a baby was born with a disability, this was part of their fate as decided by God. Here “choice” is viewed as God’s choice for the mother and baby, rather than the mother’s own control over whether or not to give birth to a child with potential developmental or congenital conditions.

As Teman, Ivry, and Goren’s research illustrates, “choice” and “control” do not necessarily apply to the reproductive experiences of women and their families across cultures. Indeed, in a deeply religious community such as the Haredi Jews, “choice” is attributed to God while individual reproductive decision-making is cast as a means to allow God to work through individuals to enact divine will. Haredi women did not describe themselves as accountable for becoming pregnant (or having a healthy child), but they did feel obligated to use technologies and consciously make reproductive decisions or avoid certain interventions. These actions, they held, would enable God to direct their journey to motherhood and to fulfill their purpose as parents.

 

Issue Highlight Vol 40 Issue 2: Hospitals as Sites of Conflict in Pakistan

Posted by

1

cropped-cards.jpg

In the coming blog posts, we will be highlighting new articles from our June 2016 issue, which you can access in full here. The theme of this special issue is The Clinic in Crisis: Medicine and Politics in the Context of Social Upheaval. This week, we will overview Emma Varley’s article “Abandonments, Solidarities and Logics of Care: Hospitals as Sites of Sectarian Conflict in Gilgit-Baltistan.” Read the full article here.

As our past blog highlights have suggested, the clinical space can both act as a site of political protest and serve to facilitate political unity. Varley’s article expands upon these themes by arguing that the clinic can also become a microcosm of inter-group tensions, wherein the hospital itself relays a picture of broader social conflict. Through her analysis of a crisis in a Pakistani hospital, Varley ethnographically demonstrates how Sunni-Shia conflicts manifest in the clinic, and how these tensions are navigated by health professionals employed there.

Varley recounts a shooting and raid which occurred at a hospital in Gilgit-Baltistan in January 2005. Shia gunmen had entered the regional hospital to hunt down Sunni male patients, aiming to retaliate after the assassination of a Shia leader killed by Sunnis. One women’s health ward, operated by nurses of the neutral Ismaili group, was left untouched after the nurses hid Sunni male patients. The nurses protected the men by insisting to the gunmen that there would be no male patients on a female ward: drawing both upon their social role as neutral Ismaili and their gendered role as caregivers of women, who were seen as uninvolved in the conflict at hand. Meanwhile, in a surgical theatre, physicians pretended as if the assassinated Shia leader on their operating table was still alive: hoping to placate the gunmen who threatened them until police or military forces could arrive to dispel the violence. Orderlies and other guards on the wards had, in some cases, fled: leaving clinical staff to defend or otherwise conceal the Sunni patients, and in other cases, fellow Sunni providers.

In reflecting on this incident, Varley notes that the hospital became an example of an “abandoned” space, one in which the necessary governmental protections and securities were not in place to ensure the safety of all patients and clinicians. The onus of protecting patients fell upon the clinicians who staffed the hospital: illustrating both the selflessness of individuals in assisting one another across oppositional group divides, and the potential for hospitals to become sites of medical and political refuge. This increased the trust between Shia providers and their Sunni colleagues in medicine. Conversely, the incident intensified professional divisions between Shia and Sunni providers, as Sunni clinicians later departed the larger regional hospital and took up employment in new Sunni health centers where they felt less at risk.

Though Varley reminds us that conflict is “corrosive” within medical professional relationships, it may also enable “renewed” feelings of trust between caregivers of opposing groups when political unrest unites them under a common aim. In sum, the hospital may serve a site of caregiving exchanges that expand beyond the bounds of medical encounters, as it becomes a sites of political action and negotiation between social groups.

Issue Highlight Vol 40 Issue 2: Medical Humanitarianism and Conflict in Turkey

Posted by

2

cropped-cards.jpg

In the next few blog updates, we will be spotlighting new articles from our June 2016 issue, which you can access in full here. The theme of this special issue is The Clinic in Crisis: Medicine and Politics in the Context of Social Upheaval. This week, we will overview Salih Can Aciksoz’s article “Medical Humanitarianism Under Atmospheric Violence: Health Professionals in the 2013 Gezi Protests in Turkey.” Read the full article here.

Aciksoz’s article begins by painting a scene. In the summer of 2013, protests erupted throughout Turkey, leading to violent clashes between armed police forces and civilian protestors. Humanitarian health workers began to establish make-shift infirmaries near known sites of conflict to treat wounded protestors, yet soon themselves became targets of the police who directed tear gas and turned their weapons upon the infirmaries. Those tasked with quashing riots and subduing protests soon fixed their ire on the health professionals who cared for wounded protestors: viewing these clinicians not as neutral aid workers, but instead as complicit members of the uprisings they were attempting to quell. In time, emergency healthcare offered to protestors was deemed criminal activity by the Turkish government.

The author frames the Gezi Protests in terms of the security of medical spaces. Medical humanitarianism, he notes, is premised on the neutrality of care giving centers which serve as a “safe space” for medical aid to be delivered in times of “crisis” to anyone in need. However, this designation as a safe space relies on the authority of a state to recognize it as such. The Turkish government’s criminalization of the humanitarian infirmaries aligned health professionals with protestors, despite any claims to political neutrality. In Turkey, the ability for make-shift infirmaries to serve as neutral care centers was further threatened by the use of a particular weapon: tear gas and similar chemical weapons. An indiscriminate gas could transform entire physical areas– especially enclosed ones– into dangerous structures where all people were at risk of exposure. The use of gas by police forces inside clinics prevented these spaces from being both politically neutral and medically safe for patients and health professionals within.

The state’s designation of infirmaries as a site of criminal activity, and health professionals’ attendance to protestors as insurgent, did not always align with the accounts that Ackisoz collected from Turkish clinicians themselves. Even whenever health professionals confessed that they sympathized with the cause of the protestors, they nevertheless distinguished their political beliefs from their medical obligation. Many described their medical involvement with the protests as a natural response to crisis: as understandable as if they were responding to victims of an earthquake or other disaster. Yet their work also bordered on activism, as numerous clinicians sought to aid protestors after noting the failures of state-operated hospitals and ambulances to attend to the medical needs of all injured protestors.

In sum, Ackisoz argues that what constitutes “medical humanitarianism” borders on many other domains of society: on the state, on the government’s definition of both criminality and on appropriate use of force, on what constitutes political dissidence and whether or not “humanitarianism” is strictly neutral whenever any medical action has the potential to shed light on political failings. The article demonstrates that the ethnographic and social constructivist lenses are well-suited to the analysis of the troubled boundaries between politics and medicine, and between healing and the state in periods of upheaval.

 

Summer 2016 Update Schedule

Posted by

0

cards3

As we head into June, the Culture, Medicine & Psychiatry blog will shift into its summer update schedule of bi-monthly posts. New updates will continue to go live here on our website, and will be spotlighted on our Twitter and Facebook accounts. This summer, we look forward to sharing our latest articles with you, which will arrive in the June 2016 issue. Want to see what will be published at the journal soon? Check out our online first articles here.

As always, we continue to accept submissions for guest commentaries and blog posts on our website. We are also happy to feature new academic book releases by our colleagues in medical anthropology, sociology, and humanities, as well as medical science and technology studies. For details, contact our social media editor Julia Knopes at jcb193@case.edu.

Wishing all the best to our readers,

The CMP Editorial Team

 

Article Highlight: Feeding Tubes and Quality of Life in ALS Patients

Posted by

1

cards

This week on the blog, we are highlighting Jeannette Pols and Sarah Limburg’s article “A Matter of Taste? Quality of Life in Day-to-Day Living with ALS and a Feeding Tube.” The article is open-access and can be read in full here on our publisher’s website.

The authors begin by suggesting that while “quality of life” has been transformed into a measurement used widely in health research, it is difficult to operationalize when considering the daily, lived experiences of patients. Rather than approaching quality of life as a measure of attainment or “outcome,” the authors instead choose to reframe it as a continual process: one that is negotiated by individual patients differently. To examine what quality of life entails in a qualitative sense, the authors interviewed a population of people with ALS in the Netherlands with feeding tubes, or ALS patients considering one.

The literature on feeding tubes, the authors note, present many perspectives on the relationships between quality of life and eating. Some sources argue that feeding tubes deprive individuals of the important social aspects of eating, while others note that feeding tubes can unburden patients for whom swallowing and the physical actions of eating are difficult, uncomfortable, or impossible.

Patients and their families interviewed by the researchers, on the other hand, demonstrate such ambiguity towards feeding tubes contextually, depending on the stage of their feeding tube transition. For many, the initial decision to have a feeding tube placed in their bodies was an upsetting signal of bodily deterioration. The procedure itself, though technically minimally invasive, was also viewed with trepidation by patients. They worried about the hospital stay, and whether or not their body would be strong enough to adapt to the tube quickly. Pols and Limburg found that for those who had undergone the procedure, “there was a remarkable consensus among patients in their evaluation of tube placement, with the main variations mentioning just how terrible it had been.” The authors later note that some patients continued to view the feeding tube negatively after it was placed, envisioning it as an unnatural, upsetting addition to their bodies. Others described it as a “necessity” that came with quality of life benefits, although it was not pleasant to have attached to their bodies.

However, for many patients who had feeding tubes already implanted at the time of the study, the response could be notably positive. These participants noted that the devices restored their health and function, and lessened distressing symptoms like choking and an inability to swallow. For one patient, the feeding tube ensured that she received the appropriate calories, such that any food she decided to eat normally could be at her discretion. Other patients who cared less about eating a range of foods appreciated that the feeding tube rid them of the need to worry about what could be easily consumed.

The authors conclude that “the feeding tube can best be understood not as an intervention that causes ‘impacts on quality of life’, but as a technology or prosthesis that may bring different qualities and appreciations that may shift over time.” They add that the feeding tube acts as an intervention that re-orders daily life for patients coping with the a ‘new normal’ of chronic illness: rather than serving to balance “good” and “bad” qualities, as outlined in the disability paradox. Lastly, they remind readers that instrumentalizing “quality of life” risks losing these facets of illness experience. This term is deeply contextual, and responsive to the needs, expectations, and hopes of each patient undergoing treatments or coping with chronic conditions.

Blog Archive: Neuropsychiatry and Culture

Posted by

0

This week on the blog, we revisit a guest commentary piece written last year by M. Ariel Cascio, PhD (originally posted here.) Dr. Cascio is an anthropologist specializing in the cultural study of science and biomedicine, psychological anthropology, and the anthropology of youth. Her research explores the biopolitical dimensions of autism and autism-related services in northern Italy. She can be reached at ariel.cascio@case.edu.

cropped-2009cover-copy.jpg

 

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

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

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

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

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

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

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

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

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

References and Further Reading – English

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

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

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

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

References and Further Reading – Italian

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

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

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

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