From the Archive: AMC’s Breaking Bad, Empowerment, and Terminal Illness

Posted by jknopes

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

In “From the Archive,” we generally highlight older publications from the journal and discuss their importance for medical anthropology and cultural studies of medicine today. This week, we are taking a turn to revisit a newer piece from 2013 that has been one of CMP’s most popular articles: Mark A. Lewis’ “From Victim to Victor: ‘Breaking Bad’ and the Dark Potential of the Terminally Empowered.”

Lewis, an oncologist, opens by describing a recent shift in the treatment of cancer. With new and experimental treatments growing in number, patients are encouraged to feel hopeful about therapy for their cancer, rather than defeated in the face of a potentially terminal condition. These new scientific innovations in treatment, therefore, are altering the rhetorics surrounding cancer diagnoses. Cancer is something to be overcome, or even battled. In the age of the “Live Strong” campaign, and the casting of cancer patients into fighters, new notions of what it means to endure this illness are developing.

The key to AMC’s Breaking Bad, Lewis argues, is that the creators seize upon this new model of the cancer patient and then betray the audience’s expectations that his battle against illness is a “noble” one. Rather than having a diagnosis opening a realm to hope, it lends Walter White the potential to take risks he would not have taken in good health. Imminent death “emboldens” Walter, yet this newfound audacity is channeled towards selfish, perhaps prideful, and certainly criminal ends.

Lewis notes that these behavioral, psychological shifts in cancer patients come under the purview of a new field deemed psycho-oncology. This budding discipline addresses the mental wellness and conditions of cancer patients, whose diagnosis carries somatic as well as psychological effects. As the article suggests, stress for cancer patients extends beyond the worries they have about the severity of their illness: it includes anxiety about the financial and personal costs of the treatment needed to ‘battle off’ the disease. For White, this entails not only having the means to treat his illness and support his family, but also to be self-sustaining, hence why he turns down assistance from wealthy benefactors and instead makes and sells crystal meth.

Walter White therefore follows in the steps of a cancer patient whose diagnosis opens a realm of possibilities and encourages him to take risks in fighting off his condition. However, this transformation alters what victory means for Walter. As he descends deeper into the meth business, the terms of victory are no longer noble. Walter murders his competitors, and after the publication of Lewis’ article, declares at the end of the series that his drug-dealing empire is what gives him life. His pride is in his business, not in overcoming his cancer. Walter’s potential is unlocked by the cancer, yet he subverts the narrative of a “noble” patient who survives his dire diagnosis. His cancer has merely positioned him to accomplish what he would have not otherwise set out to do.

Lewis’ article demonstrates the centrality of illness narratives and new models of illness experience to popular media. His article draws on medical science, popular health campaigns, and on modern-day encounters with terminal illness to inform viewers’ expectations of what path patients might, and should, follow.

To access the article and read an abstract, click here:

http://link.springer.com/article/10.1007/s11013-013-9341-z

From the Archive: Biotechnology and the Culture of Medicine

Posted by jknopes

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

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

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

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

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

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

From the Archive: Caregiving and Dementia in Urban India

Posted by jknopes

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

Recently, one of our readers on the Culture, Medicine, and Psychiatry Twitter account requested that our next “From the Archive” post address an aspect of aging and community. In the spirit of the reader’s suggestion, this week we are featuring a 2008 article by Bianca Brijnath and Lenore Manderson entitled “Discipline in Chaos: Foucault, Dementia and Aging in India.” (you can find out more about the article here: http://link.springer.com/article/10.1007/s11013-008-9111-5.)

The authors posit that caregivers for those with dementia are important providers of structure: they are responsible for the patient’s hygiene, diet, and medical needs, as well as accountable for the actions of people who, experiencing symptoms of dementia, sometimes act out in ways which are not consistent with public cultural norms. Typically in India, such care falls into the hands of younger relatives. Domestic caregiving by these family members “prevents the demented body from threatening the stability of the social body.” There are tremendous “social anxieties,” the authors write, surrounding the potential for someone with dementia to resist normative behaviors per the local codes of social life.

The Foucauldian stream of thought here is quite present: the caregiver must “discipline” the body of the dementia patient to reinforce the cultural codes of the society in which both actors live. Although there exists the notion of seva, or the submission of younger relatives to the direction and advice of older relatives, this idea of the respected and powerful elder is complicated in the face of dementia where the power to attend to another person is rather reversed. Instead of being disciplined by the familial patriarchs or matriarchs, younger relatives must both discipline the elder who is unable to provide the social structure for themselves, as well as their own bodies by taking on new routines and practices to accommodate their family member with the illness.

Power, however, is still bi-directional: those with dementia have extraordinary power in altering the routines of their familial caregivers, and even act out violently: the authors note they may “kick, hit, punch, bite, and threaten with a weapon” when they are upset, and are not necessarily expected to limit these actions on their own due to their condition. The transactions of power, agency, and authority in these relationships are resonant with similar social exchanges as explored via the Foucauldian lens in other Western settings.

Brijnath and Manderson’s piece highlights important features in the care of dementia patients, and demonstrates that community-based models of caregiving for the elderly are not as simple as the removal of power from the elderly individual and the installation of authority in the caregiver. The caregiver, too, is both self-disciplined and disciplined by the acting out of their ward.