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“Toxin or Medicine? Explanatory Models of Radon in Montana Health Mines”
Barbra E. Erickson
- Environmental protection and public health agencies in the United States and elsewhere label radioactive radon gas a toxic environmental hazard and a major cause of lung cancer. Paradoxically, in Europe and Japan radon gas is also used as an analgesic and anti-inflammatory, as one choice in the spectrum of conventional medical care. Although it is possible to find radon therapy in the United States, it exists only as an unconventional practice in Montana “radon health mines.” In this article, I examine the use of radon therapy by Americans despite intensive public health education media campaigns. Using the notion of explanatory models as an analytical framework, I argue that American health mine clients adjust or replace “toxic models” of radon with new kinds of explanatory models that allow radon to be redefined as a healing substance. The manner of this adjustment varies according to peoples’ individual needs, their own preexisting cultural models and experiences, and their individual personalities; the source of authoritative knowledge accepted by each person is a strong influence. Through these altered explanatory models, mine clients are able to view their use of radon therapy as a rational course of action.
“Perinatal Sadness among Shuar Women: Support for an Evolutionary Theory of Psychic Pain”
Edward H. Hagen, H. Clark Barrett
- Psychiatry faces an internal contradiction in that it regards mild sadness and low mood as normal emotions, yet when these emotions are directed toward a new infant, it regards them as abnormal. We apply parental investment theory, a widely used framework from evolutionary biology, to maternal perinatal emotions, arguing that negative emotions directed toward a new infant could serve an important evolved function. If so, then under some definitions of psychiatric disorder, these emotions are not disorders. We investigate the applicability of parental investment theory to maternal postpartum emotions among Shuar mothers. Shuar mothers’ conceptions of perinatal sadness closely match predictions of parental investment theory.
“Herbalism, Home Gardens, and Hybridization: Wõthïhã Medicine and Cultural Change”
S. L. Heckler
- Using the example of the Wõthïhã of the Manapiare River Valley, Amazonas State, Venezuela, I challenge the image of the indigenous Amazonian as an expert in herbalism. I argue that the observed absence of medicinal plant use in early Wõthïhã ethnography, rather than reflecting researcher oversight, reflects the centrality of shamanism. According to Wõthïhã shamanic cosmology, herbal medicines, while useful to relieve symptoms and treat minor injuries, fail to address the underlying cause of illness. Using a combination of quantitative and qualitative methods, I find that as the role and influence of shamanism have dramatically decreased, the Wõthïhã have turned elsewhere for medical treatment. Biomedical remedies have shown to be effective, thereby encouraging an acceptance of symptom-specific treatments. Biomedicine’s patchy availability, however, has encouraged the Wõthïhã to look beyond biomedicine. Several folk healing traditions are being incorporated by the Wõthïhã, each with its own herbal tradition.
“Maternal Bodies, Breast-Feeding, and Consumer Desire in Urban China”
Suzanne Zhang Gottschang
- Urban Chinese women in the 1990s formulated their infant-feeding decisions in the context of a society undergoing radical transformation as the nation moved from a centrally planned socialist economy to a global, market-oriented one. Narratives of new mothers in Beijing in the 1990s provide insights into the multiple forces that shaped their infant-feeding practices. These personal histories also illustrate the limitations of multilateral breast-feeding programs that emphasize breast-feeding as a natural interaction between mother and infant. The cases I present here demonstrate instead that the material, bodily manifestations of breast-feeding require nursing mothers to continually renegotiate relations with husbands, coworkers, and family. Chinese women’s accounts also add insight to theoretical deliberations on gender and the body, for they demonstrate that cultural expectations and the demands of the lactating body must be considered to understand fully the process of women’s decisions in a social and not strictly reproductive context. On a larger scale, the data also illustrate how global intervention, in the form of the WHO–UNICEF-sponsored Baby-Friendly Hospital Initiative, promotes breast-feeding as a woman’s primary duty at the same time that market forces counter this message as women redefine their individual expectations and social relationships.
“Orthostatic Panic as a Key Vietnamese Reaction to Traumatic Events: The Case of September 11, 2001”
Devon E. Hinton, Lim Nguyen, Mark H. Pollack
- This article discusses a culturally specific response to traumatic events: orthostatic panic attacks among Vietnamese refugees. We compared the rate and severity of orthostatic panic as well as the rates and severity of associated flashbacks a month before and a month after September 11, 2001. After that date, the rate and severity of orthostatic panic greatly increased, as did the rate and severity of associated flashbacks. The central role of orthostatic panic as a response to traumatic events is illustrated through a patient’s vignette. An explanation of why September 11 so profoundly influenced this population is adduced, including an explanation of why it resulted in considerable worsening of orthostatic panic.
“Durbolota (Weakness), Chinta Rog (Worry Illness), and Poverty: Explanations of White Discharge among Married Adolescent Women in an Urban Slum in Dhaka, Bangladesh”
Sabina Faiz Rashid
- I carried out ethnographic fieldwork among 153 married adolescent girls, aged 15–19, in a Dhaka slum from December 2001 to January 2003, including 50 in-depth interviews and eight case studies. I also held discussions with family and community members. In this article, I focus on popular understandings of vaginal discharge being caused by durbolota (weakness) and chinta rog (worry illness), as mentioned by young women. Eighty-eight young women reported that they had experienced white discharge, blaming it on a number of factors such as stress and financial hardships, tensions in the household, marital instability, hunger anxiety, and reproductive burdens. For married adolescent women in the urban slum, white discharge has many levels of meaning linked to the broader social, political, and material inequalities in their everyday lives.
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“Sonography and Sociality: Obstetrical Ultrasound Imaging in Urban Vietnam”
- This article is about new reproductive technologies, maternal anxieties, and existential uncertainties. It explores the question of why pregnant women in Vietnam’s capital, Hanoi, have become avid consumers of obstetrical ultrasound scanning even while expressing profound doubts regarding the reliability and safety of this new technology of pregnancy. Through a phenomenological analysis of the social production of women’s sense of reproductive risks and uncertainties, the article shows how Hanoian women’s paradoxical stances toward ultrasound imaging can be explained through a consideration of embodied and historically generated experiences within everyday local worlds. The article argues that the “scientific stories” of fetal well-being and normality that are produced through ultrasonography are challenged by vivid and continual exchanges in everyday lives of stories of the inherent uncertainties of existence in general and of human reproduction in particular.
“Persons, Places, and Times: The Meanings of Repetition in an STD Clinic”
Lori Leonard, Jessica L. Greene, Emily Erbelding
- In this article we work the tensions between the way clinical medicine and public health necessarily construct the problem of “repetition” in the context of a sexually transmitted disease (STD) clinic and the ways patients narrate their illness experiences. This tension—between clinical and epidemiological exigencies and the messiness of lived experience—is a recurring theme of work conducted at the intersections of epidemiology, anthropology, and clinical medicine. Clinically, repeated infections are a threat to the individual body and to “normal” biological processes like reproduction. From a public health perspective, “repeaters” are imagined to be part of a “core group” that keeps infections in circulation, endangering the social body. Yet patients’ accounts are anchored in particular social histories, and their experiences rely on different time scales than those implicated in either of these types of readings. Extended analyses are provided of two such accounts: one in which repetition can be “read” as part of a performance of recovery, and one in which repetition is bound up in the effort to avoid becoming the involuntary subject of institutionally administered intervention. We argue the need to open up the category of repeaters to include the social and draw on work by Cheryl Mattingly to suggest that one way to do this in the context of the STD clinic might be to adopt forms of therapeutic practice that make use of interpretive, in addition to technical, skills.
“Modernization and Medicinal Plant Knowledge in a Caribbean Horticultural Village”
Marsha B. Quinlan, Robert J. Quinlan
- Herbal medicine is the first response to illness in rural Dominica. Every adult knows several “bush” medicines, and knowledge varies from person to person. Anthropological convention suggests that modernization generally weakens traditional knowledge. We examine the effects of commercial occupation, consumerism, education, parenthood, age, and gender on the number of medicinal plants freelisted by individuals. All six predictors are associated with bush medical knowledge in bivariate analyses. Contrary to predictions, commercial occupation and consumerism are positively associated with herbal knowledge. Gender, age, occupation, and education are significant predictors in multivariate analysis. Women tend to recall more plants than do men. Education is negatively associated with plants listed; age positively associates with number of species listed. There are significant interactions among commercial occupation, education, age, and parenthood, suggesting that modernization has complex effects on knowledge of traditional medicine in Dominica.
“Social Support and Distress among Q’eqchi’ Refugee Women in Maya Tecún, Mexico”
Faith R. Warner
- This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q’eqchi’ refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q’eqchi’ women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q’eqchi’ refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population.
“The Vanishing Mother: Cesarean Section and “Evidence-Based Obstetrics” ”
Claire L. Wendland
- The philosophy of “evidence-based medicine”—basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion—has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal “evidence” supporting cesarean demonstrates that the data are a product of its social milieu: The mother’s body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.
“The Rights of Children” : Society for Medical Anthropology Council on Infant and Child Health and Welfare (CICH), Policy Statement Task Force
- Children, who are vulnerable at the start of existence, are a concern shared by nations and cultures. The importance of children’s conditions has led 192 out of 194 countries to ratify the UN General Assembly’s Convention on the Rights of the Child. The United States has not yet ratified the convention, despite having exercised influence on the drafting of its provisions. Given the global importance of nurturing and protecting children, the Society for Medical Anthropology strongly and emphatically supports that the convention be ratified, and that the U.S. government submit the convention for approval by the U.S. Senate.
“In Memoriam: Gay Becker, 1943–2007. Editor, MAQ: 1994–98”
· Sharon R. Kaufman, Marcia C. Inhorn
· Blessed Events: Religion and Home Birth in America
reviewed by Erica Gibson and Kathryn S. Oths
· Conjuring Hope: Healing and Magic in Contemporary Russia
reviewed by Michele Rivkin-Fish
· Healing with Herbs and Rituals: A Mexican Tradition
reviewed by Luci Latina Fernandes
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· Horizons and Transitions: Past, Present, Future
Mark Luborsky, Andrea Sankar
· Medical Anthropology at the Intersections
Marcia C. Inhorn
“Susceptibility Genes and the Question of Embodied Identity”
Margaret Lock, Julia Freeman, Gillian Chilibeck, Briony Beveridge, Miriam Padolsky
- Drawing on an assumption of the co-construction of the material and the social, late-onset Alzheimer’s disease (AD) is used as an illustrative example to assess claims for an emergent figure of the “individual genetically at risk.” Current medical understanding of the genetics of AD is discussed, followed by a summary of media and AD society materials that reveal an absence of gene hype in connection with this disease. Excerpts from interviews with first-degree relatives of patients diagnosed with AD follow. Interviewees hold complex theories of causation. After genetic testing they exhibit few if any subjective changes in embodied identity or lifestyle. Family history is regarded by interviewees as a better indicator of future disease than is genetic testing. We argue that, even when molecular genetics are better understood, predictions about complex disease based on genotyping will be fraught with uncertainty, making problematic the concept of individuals as genetically at risk when applied to late-onset complex disease.
“Showing Roughness in a Beautiful Way”: Talk about Love, Coercion, and Rape in South African Youth Sexual Culture
Kate Wood, Helen Lambert, Rachel Jewkes
- Sexual violence within as well as outside sexual relationships has far-reaching public health and human rights implications and is a continuing focus of popular debate, media coverage, and research in postapartheid South Africa. Partly because it has been shown to affect individual vulnerability to HIV/AIDS, sexual violence has in recent years become framed as a global public health issue. International research efforts to document the scale of this personally and politically sensitive problem can encounter conceptual, definitional, and methodological difficulties that anthropology is well placed to assist in alleviating. This article offers an ethnographic exploration of the spectrum of practices relating to sexual coercion and rape among young people in a township in the former Transkei region of South Africa. Contextualizing meanings of sexual coercion within local youth sexual culture, the article considers two emic categories associated with sex that is “forced”: ukulala ngekani: “to sleep with by force” or ukunyanzela: “to force,” both usually used to describe episodes occurring within sexual partnerships; and ukudlwengula, used to describe rape by a nonpartner or stranger. The article discusses the semantic content of and differences between these two key categories, demonstrating that encounters described as “forced sex” encompass not only various forms of sexual coercion but also, particularly in the narratives of young men, instances of more consensual sex. Of importance, in turn, in defining an act as “rape” rather than as “forced sex” are the character of the relationship between the two parties and interlinked ideas relating to exchange and sexual entitlement, love, and the importance of “intention,” violation, and “deserving” victimhood.
“A Rose by Any Other Name? Rethinking the Similarities and Differences between Male and Female Genital Cutting”
Robert Darby, J. Steven Svoboda
- In this article, we offer a critical examination of the tendency to segregate discussion of surgical alterations to the male and female genitals into separate compartments—the first known as circumcision, the second as genital mutilation. We argue that this fundamental problem of definition underlies the considerable controversy surrounding these procedures when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms, and risks. We explore the variable effects of male and female genital surgeries, and we propose a scale of damage for male circumcision to complement the World Health Organization’s categorization of female genital mutilation. The origins of the double standard identified are placed in historical perspective, and in a brief conclusion we make a plea for greater gender neutrality in the approach to this contentious issue.
“The Meaning of the Present: Hope and Foreclosure in Narrations about People with Severe Brain Damage”
- In this article, I consider narratives told within a clinical setting. I argue that personnel in a day center for people with acquired brain damage are constantly involved in narrating about the disabled participants. The negotiation of who the participant is, and foremost will be, is in constant negotiation in regard to issues of hope. I further argue that hope is a meaning-making process and, as such, it has been defined as crucially connected to time. Hope has been said to enable a connection between the present and the future, because action taken in the present could bring about (positive) change in the future. However, I show that hope, in relation to narratives told about people with severe disabilities that are considered “incurable,” must be understood within a realm of narrative foreclosure. Time seems to have lost the openness of its horizon for these people, and a narrative that tells of immediacy rather than chronology is created, resulting in hope being established within the present.
public policy statement
· Alcohol, Drug, and Tobacco Study Group Takes a Stand: The WHO Framework Convention on Tobacco Control: An Urgent Call for U.S. Ratification
Alcohol, Drug, and Tobacco Study Group
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Healing Herbs and Dangerous Doctors: “Fruit Fever” and Community Conflicts with Biomedical Care in Northeast Thailand
- In Northeast Thailand, khai mak mai (fruit fever) is a local, ethnomedical category of illness identified by community members as untreatable by biomedical health providers. The illness is believed to be incompatible with several substances that may induce death, including fruit as well as two forms of medication associated with biomedical care: injections and intravenous solution. Consequently, fevers suspected of being khai mak mai are treated by herbalists while biomedical health services are avoided and feared. In this article, I examine local perceptions and treatment of khai mak mai. I also explore the context and consequences of concerns about the inadequacy of biomedical care, as well as the social meanings associated with the illness and the political-economic context that shapes both the meanings of, and everyday responses to, fevers suspected of being khai mak mai.
Critical Therapeutics: Cultural Politics and Clinical Reality in Two Eating Disorder Treatment Centers
Rebecca J. Lester
- Recent studies suggest that eating disorders are increasing in Mexico and that this seems to correspond with Mexico’s push to modernization. In this respect, Mexico exemplifies the acculturation hypothesis of eating disorders, namely, that anorexia and bulimia are culture-bound syndromes tied to postindustrial capitalist development and neoliberalist values, and that their appearance elsewhere is indicative of acculturation to those values. Available evidence for this claim, however, is often problematic. On the basis of five years of comparative fieldwork in eating disorder clinics in Mexico City and a small Midwestern city in the United States, I reframe this as an ethnographic question by examining how specific clinical practices at each site entangle global diagnostic categories with local social realities in ways that problematize existing epistemologies about culture and illness. In this regard, debates about acculturation and the global rise of eating disorders foreground issues of central epistemological and practical importance to contemporary medical anthropology more generally.
“Languages of Labor: Negotiating the “Real” and the Relational in Indo-Fijian Women’s Expressions of Physical Pain”
- Medical personnel in public clinics in Fiji routinely contend that state-funded medical resources are misallocated on patients who complain of, but do not actually experience, physical pain. Frequently, these patients are identified as being Indo-Fijian women (i.e., women of South Asian origin in Fiji). In this article, I examine clinical interactions between medical staff and female Indo-Fijian patients to demonstrate how “real” and ‘unreal’ pain are distinguished in the clinical setting and to indicate some of the roles clinical encounters play in community processes that ascribe alternative meanings to physical pain. Focusing on how both physicians and women patients foster certain interpretations of physical pain over others, I argue that the category of ‘unreal’ pain, as employed by Fiji’s physicians, consists of pain that medical professionals consider to be induced by psychological or physical, work-related stresses. I then show how Indo-Fijian women engage in a complementary but distinct discourse that emphasizes links between physical labor and pain and suggests that, in some cases, expressions of physical pain are as much an idiom of pride as an idiom of distress.
· The Person in Dementia: A Study of Nursing Home Care in the United States by Athena McLean
Review by Betsy Pohlman
· Nameless Relations: Anonymity, Melanesia and Reproductive Gift Exchange between British Ova Donors and Recipients by Monica Konrad
Review by Jennifer Speirs
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Managing the Unmanageable: Elderly Russian Jewish Émigrés and the Biomedical Culture of Diabetes Care
Amy Borovoy & Janet Hine
- In this article, we examine the apparent resistance of elderly Russian Jewish émigrés to the dominant U.S. biomedical model of diabetes treatment. Cultural competence on the part of medical professionals who make assumptions about Russian culture tends to be based on particularly American values of self-control and individual agency. The American consumer model of health care incorporating risk, individual responsibility, autonomy, and choice, when applied to elderly Russian Jewish émigrés, results in a reading of different values and choices as failed self-management or noncompliance. This article argues for a more reflexive understanding of U.S. biomedical culture as a replacement for the current “sound bite” model of cultural diversity.
Race, Ethnicity, and Racism in Medical Anthropology, 1977–2002
Clarence C Gravlee & Elizabeth Sweet
- Researchers across the health sciences are engaged in a vigorous debate over the role that the concepts of “race” and “ethnicity” play in health research and clinical practice. Here we contribute to that debate by examining how the concepts of race, ethnicity, and racism are used in medical–anthropological research. We present a content analysis of Medical Anthropology and Medical Anthropology Quarterly, based on a systematic random sample of empirical research articles (n = 283) published in these journals from 1977 to 2002. We identify both differences and similarities in the use of race, ethnicity, and racism concepts in medical anthropology and neighboring disciplines, and we offer recommendations for ways that medical anthropologists can contribute to the broader debate over racial and ethnic inequalities in health.
The Emergence of Integrative Medicine in Australia: The Growing Interest of Biomedicine and Nursing in Complementary Medicine in a Southern Developed Society
- In this article, I examine the process by which some biomedical physicians and nurses in Australia have come to adopt various alternative therapies in their regimens of practice, largely in response to (1) the growing interest on the part of many Australians in what is generally called “complementary medicine”, and (2) a recognition that biomedicine is not particularly effective in treating an array of chronic ailments. Some Australian biomedical physicians and nurses have come to embrace “integrative medicine,” which purports to blend the best of biomedicine and complementary medicine, and have even created an Australasian Integrative Medical Association and established integrative medical training programs and centers. I argue that the adoption of alternative therapies and the development of integrative medicine on the part of Australian biomedical physicians and nurses constitute another national manifestation of the co-option of complementary and alternative medicine.
Dying under the Bird’s Shadow: Narrative Representations of Degedege and Child Survival among the Zaramo of Tanzania
Vinay R Kamat
- In this article, I examine the cultural interpretations of degedege, an indigenous illness commonly recognized by the Zaramo people of coastal Tanzania as life threatening. Drawing on the narratives of three bereaved parents who lost a child to degedege, I analyze the contextual and circumstantial factors involved in these parents’ negotiation of the identity of an illness and in their subsequent therapy seeking behavior. I show that even though cultural knowledge and etiological beliefs about degedege may be shared locally, there is significant variation in the therapeutic pathways that parents follow to deal with an actual episode of the illness. I emphasize the need for more contextualized data on health-seeking behaviors, and argue that it is necessary to pay attention to the micropolitics of health care decision making at the household level. Finally, I also call attention to the politics of provider–patient communication at public health facilities as a means to improve public health interventions to increase child survival.
The Life and Death of a Street Boy in East Africa: Everyday Violence in the Time of AIDS
- This article focuses on the life history of a single street boy in northwestern Tanzania, whom I name Juma. I suggest that Juma’s experiences and the life trajectory of himself and of significant individuals around him (particularly his mother) were structured by everyday violence. I describe everyday violence in terms of a conjuncture between macrostructural forces in East Africa (including a history of failed development schemes and the contemporary political economy of neoliberalism) and the lived experience of individuals as they negotiate local, contextual factors (including land-tenure practices, the power dynamics between immediate and extended kin, life on the streets, and constructions of gender and sexuality). I suggest that AIDS and its many impacts on Juma’s life course can only be understood in a broader context of everyday violence. From this basis, I draw several general conclusions regarding AIDS prevention and intervention strategies.
· Environments for Health. Macdonald John J London
Review by Pamela I Erickson
· Not Quite White: White Trash and the Boundaries of Whiteness.
Review by Carolyn Fluehr-Lobban
· Last Best Gifts: Altruism and the Market for Human Blood and Organs.
Review by Lesley A Sharp
· Indigenous Peoples and Diabetes: Community Empowerment and Wellness. Ferreira Mariana Leal Lang Gretchen Chesley eds
Diabetes among the Pima: Stories of Survival. Smith-MorrisCarolyn
Review by Philip J Greenfeld
· Surgically Shaping Children: Technology, Ethics, and the Pursuit of Normality.
Review by Gail Landsman
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The Coproduction of Moral Discourse in U.S. Community Psychiatry
- Anthropologists often criticize the discipline of bioethics because its remote, abstract theories fail to capture how front-line clinicians experience and resolve moral uncertainty. The critique overlooks, however, the ways that everyday, emergent moral discourse is influenced—over time and through several mediations—by formal ethical notions. High-order ethical pronouncements become sedimented into the conditions of work, illustrated in this article by a two-year ethnographic study of Assertive Community Treatment (ACT), a popular mode of outpatient psychiatric services. ACT clinicians’ moral unease when they break the confidentiality of patients is connected to high-order debates, dating back 35 years, about ensuring patients’ autonomy without abandoning them. These debates originally spurred the invention of ACT, and they get braided into today’s moral discourse through several mediations: regulatory paperwork, the mandates and micropolitics of staff–patient interactions, and the idealized self-image of front-line staff. This article shows how everyday moral talk is coproduced by both the immediate contexts of clinical work and the categories of formal bioethics.
Cross-Cultural Perspectives on Physician and Lay Models of the Common Cold
Roberta D Baer & Susan C Weller Javier García de Alba García Ana L Salcedo Rocha
- We compare physicians and laypeople within and across cultures, focusing on simi-larities and differences across samples, to determine whether cultural differences or lay–professional differences have a greater effect on explanatory models of the common cold. Data on explanatory models for the common cold were collected from physicians and laypeople in South Texas and Guadalajara, Mexico. Structured interview materials were developed on the basis of open-ended interviews with samples of lay informants at each locale. A structured questionnaire was used to collect information from each sample on causes, symptoms, and treatments for the common cold. Consensus analysis was used to estimate the cultural beliefs for each sample. Instead of systematic differences between samples based on nationality or level of professional training, all four samples largely shared a single-explanatory model of the common cold, with some differences on subthemes, such as the role of hot and cold forces in the etiology of the common cold. An evaluation of our findings indicates that, although there has been conjecture about whether cultural or lay–professional differences are of greater importance in understanding variation in explanatory models of disease and illness, systematic data collected on community and professional beliefs indicate that such differences may be a function of the specific illness. Further generalizations about lay–professional differences need to be based on detailed data for a variety of illnesses, to discern patterns that may be present. Finally, a systematic approach indicates that agreement across individual explanatory models is sufficient to allow for a community-level explanatory model of the common cold.
Before Your Very Eyes: Illness, Agency, and the Management of Tourette Syndrome
- In this article, I examine the ways that people with Tourette Syndrome (TS) manage the motor and vocal tics characteristic of this neurological disorder. To mitigate the powerful stigmas associated with TS, individuals must either remove tics from public view or strive to recast the way that they are perceived. Drawing on ethnographic research with TS sufferers in Indiana, I elaborate three strategies by which this is done, strategies referred to here as displacement, misattribution, and contextualization. These processes strongly affect both the symptoms themselves and the subjective experience of the illness. They also affect the perception of TS in the larger culture, associating the disease with florid symptoms like cursing—symptoms that, although not at all typical of TS, are the ones most resistant to these kinds of management. These patterns highlight how individual agency may actively shape the cultural construction of illness.
· … and a time to die: How American Hospitals Shape the End of Life. Sharon Kaufman Chicago: University of Chicago Press, 2005, x + 400 pp.
Review by Sherylyn Briller
· Old Age in a New Age: The Promise of Transformative Nursing Homes. Beth Baker Nashville, TN: Vanderbilt University Press, 2007, xii + 236 pp.
Review by Athena McLean
· Witches, Westerners, and HIV: AIDS and Cultures of Blame in Africa. Alexander Rodlach Walnut Creek, CA: Left Coast Press, 2006 272 pp.
Review by Brooke Grundfest Schoepf
· Dolly Mixtures: The Remaking of Genealogy. Sarah Franklin Durham, NC: Duke University Press, 2007, x + 254 pp.
Review by Francesca Bray
· A Marriage of Convenience: Rockefeller International Health and Revolutionary Mexico. Anne-Emanuelle Birn Rochester, NY: University of Rochester Press, 2006, ix + 434 pp.
The Value of Health: A History of the Pan American Health Organization. Marcos Cueto Scientific and Technical Publication, 600 Washington, DC: Pan American Health Organization, 2007, vii + 239 pp.
Review by Linda M Whiteford
· Culture, Health and Illness. Fifth edition. Cecil Helman New York: Oxford University Press, 2007, vii + 501 pp.
Review by Brian McKenna
· Politics and Poetics of Migration: Narratives of Iranian Women from the Diaspora. Parin Dossa Toronto, ON: Canadian Scholars’ Press, x + 199 pp.
Review by Sarah J Mahler
· Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles. Emily K Abel New Brunswick, NJ: Rutgers University Press, 2007, x + 188 pp.
Review by Stephanie C Kane
· Shapes in the Wax: Tradition and Faith among Folk Medicine Practitioners in Rural Ukraine. Sarah D Phillips dir. Media Production, Instructional Support Services, prod. 55 min. 2004. Bloomington: Indiana University.
Review by Catherine Wanner
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Coded Talk, Scripted Omissions: The Micropolitics of AIDS Talk in South Africa
Kate Wood, Helen Lambert
- In this ethnographic article, we explore the character of local discourse about AIDS in an affected township community in South Africa, describing the “indirection” that characterized communication about suspected cases of AIDS. Through a case study of one affected family, the article first explores the diverse ways in which people came to “know” that specific cases of illness were AIDS related, and how this “knowledge” was communicated. We consider why communication was indirect and coded, arguing that this reflected not a “denial” of its presence in this community but, rather, a complex group of overlapping concerns far from unique to AIDS: first, a normative injunction on naming potentially fatal conditions; second, an interest in pursuing different therapeutic options and the need to maintain hope of recovery; and third, a wish to avoid the “disrespect” entailed in referring directly to the nature of the problem in a context where, discursively, stigma was still present. The coded and indirect character of HIV/AIDS-related talk underlines the importance of ethnographic inquiry in understanding community responses to this epidemic, demonstrating that the subtleties entailed by verbal silence and elision should not be interpreted naively as collective “denial” but rather be grounded within existing patterns of responses to dangerous sickness.
Making Scenes: Imaginative Practices of a Child with Autism in a Therapy Session
- A tension in medical anthropology, as an interdisciplinary field, exists between those polar territories of the logic—and therefore grammars—of a positivist–scientific stance of biomedicine and a literary–philosophical one used to represent experience. Taking up literary-philosophical and existential perspectives from anthropology proper, I draw on an ethnographic study of a sensory-integration–based clinic to propose that imaginative practices are one arena where such tension can be worked out. Enacted narratives, as a method, reveal how imaginative practices foreground the ways in which desire and hope are integral to healing. Kenneth Burke’s (1969) theory of dramatism, particularly his scene: act ratio, provides an analytic lens to examine the imaginary play of a singular session between a child with autism and an occupational therapist. Further, an interpretive frame that tacks between the positivist–biomedical and literary–philosophical discourses excavates how making scenes is integral to a healing of belonging and its embodiment.
Neoliberal Reform and Health Dilemmas: Social Hierarchy and Therapeutic Decision Making in Senegal
Ellen E Foley
- In this article, I trace the links among neoliberalism, regional ecological decline, and the dynamics of therapeutic processes in rural Senegal. By focusing on illness management in a small rural community, the article explores how economic reform is mediated by existing social structures, and how household social organization in turn influences therapeutic decision making. The illness episodes relayed here demonstrate how the acute economic and social crisis facing the Ganjool region becomes written on the bodies of young men, and how the fault lines of gender and generation shape illness experiences. These narratives also illuminate the tremendous discrepancy between the lived realities of sickness and death, and the idealized models of health participation and empowerment envisioned by the state. Rather than “neoliberal subjects” who behave as rational economic actors, men and women coping with illness are social beings embedded in fields of power characterized by highly stratified household social relations.
Being Anorexic: Hunger, Subjectivity, and Embodied Morality
- This article explores the embodied process of being anorexic and the moral repertoires within which this process is entangled. The point of departure for this discussion is that, while critical feminist epistemology plays an important role in politicizing anorexia as a symbolic cluster of meanings, it has provided us with limited analytical tools for an in-depth understanding of an anorexic’s lived experiences and of the embodied realities involved in being anorexic. At the same time, autobiographical accounts of anorexia provide insightful emic perspectives on being anorexic but are not engaged with symbolic and theoretical etic perspectives on anorexia. This article attempts to bridge this gap through an anthropological exploration of anorexia from within; that is, as a situated embodied knowledge of anorexic women anchored in concrete lived experiences. Findings from an ethnographic study of young women who were diagnosed with anorexia and admitted to an outpatient hospital unit in Israel suggest that anorexic women actively construct a “heroic moral subjectivity,” in which the experience of hunger plays a crucial role, and in which everyday (mundane) practices gain “out-of-the-ordinary” meanings. While these findings partially accord with feminist philosophical explorations of anorexia, I argue that it is only via a detailed ethnographic account that we can follow the ongoing phenomenological and semiotic process through which such heroic subjectivity actually develops. Using an anthropological perspective to bear on the phenomenology of anorexia as an embodied experience contributes toward extending our understanding of the concrete ways in which “culture” becomes present in anorexia. The concluding section discusses gaps between feminist and anorexic narratives of anorexia in terms of therapeutic encounters.
· On the Game: Women and Sex Work. by Sophie Day London: Pluto Press, 2007, ix + 277
Review by Yasmina Katsulis
· Pharmaceutical Reason: Knowledge and Value in Global Psychiatry. by Andrew Lakoff Cambridge: Cambridge University Press, 2005, x + 206
· Review by Michael Oldani
Multiple Medical Realities: Patients and Healers in Biomedical, Alternative and Traditional Medicine.
· Helle Johannessen and Lázár Imreeds. New York: Berghahn Books, 2005 xiii + 202
Review by Kaja Finkler
· Transforming Emotions with Chinese Medicine: An Ethnographic Account from Contemporary China. Yanhua Zhang Albany: State University of New York Press, 2007, xiv + 191 pp.
· Review by Judith Farquhar
Gender, Race, Class, and Health: Intersectional Approaches. Amy J Schulz and Leith Mullings San
· Francisco: Jossey-Bass, 2007. xx + 423 pp.
Review by Janis Faye Hutchinson
· Introducing Medical Anthropology: A Discipline in Action. Merrill Singer and Hans Lanham Baer, MD: AltaMira Press, 2007, v + 246 pp.
Review by Priscilla Song
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Vital Queries in Medical Anthropology: Still Goaded by the “Person” (editors introduction)
Mark Luborsky & Andrea Sankar
On Recognition, Caring, and Dementia
Janelle S. Taylor (article) and Lawrence Cohen (post-article commentary)
- The onset of dementia raises troubling questions. Does the person with dementia still recognize you? If someone cannot recognize you, can they still care about you? This essay takes such questions as the entry point for a broader inquiry into recognition, its linkages to care, and how claims to social and political “recognition” are linked to, or premised on, the demonstrated capacity to “recognize” people and things. In the words and actions of her severely impaired mother, the author finds guidance toward a better, more compassionate question to ask about dementia: how can we best strive to “keep the cares together”?
Paternity for Sale: Anxieties over “Demographic Theft” and Undocumented Migrant Reproduction in Germany
- Women’s experiences of migration, and their relationship to a host country, vary significantly from those of migrant men simply because pregnancy is a possibility. The concept of “demographic theft” highlights popular anxieties regarding high fertility among foreigners, including undocumented migrants. This article examines pregnant undocumented women’s experiences with the health care system and relationship to the state in Germany. It also provides a discussion of how a restrictive immigration climate, particular models of citizenship, and liberal family laws have resulted in unique practices surrounding paternity claims. It is based on long-term ethnographic data to highlight contradictions and ambiguities in the policy environment and utilizes the notion of stratified reproduction to bring new evidence regarding mothers’ deportability and practices of paternity.
Cancer Rehabilitation in Denmark: The Growth of a New Narrative
Helle Ploug Hansen & Tine Tjørnhøj-Thomsen
- A fundamental assumption behind cancer rehabilitation in many Western societies is that cancer survivors can return to normal life by learning to deal with the consequences of their illness and their treatment. This assumption is supported by increasing political attention to cancer rehabilitation and a growth in residential cancer-rehabilitation initiatives in Denmark ( Danish Cancer Society 1999 ; Government of Denmark 2003 ). On the basis of their ethnographic fieldwork in residential-cancer rehabilitation courses, the authors examine the new rehabilitation discourse. They argue that this discourse has challenged the dominant illness narrative, “sick–helped–cured,” producing a new narrative, “sick–helped–as if cured,” and that this new narrative is produced and reproduced through technologies of power and of the self
Stigma Despite Recovery: Strategies for Living in the Aftermath of Psychosis
Janis H. Jenkins & Elizabeth A. Carpenter-Song
- In this article, we identify an array of creative strategies used by persons diagnosed with schizophrenia-related illness to deflect and resist social stigma, and address the lived experience of deploying these strategies in the intersubjective context of everyday life. The data are derived from anthropological interviews and ethnographic observations of ninety persons who received treatment at community mental health facilities in an urban North American locale. Nearly all were keenly aware of stigma that permeated their lives. Their predicament is contradictory: on the one hand, they have recovered relative to previous states of psychosis; on the other hand, their subjectivity is saturated by intense awareness of social stigma that seems intractable in relation to temporal or functional criteria. Ironically, these lives can be characterized as fraught with stigma despite recovery. The strategies generated to resist the impact of stigma highlight the fact that persons with these illnesses are often not only exceedingly socially aware but also strategically skilled in response to social assaults on their personhood and survival. We examine these strategies in terms of (1) the social characteristics of each afflicted person, (2) the situational characteristics of managing stigma, (3) the cultural context of recovery, and (4) the illness-specific characteristics of schizophrenia
What Can Critical Medical Anthropology Contribute to Global Health? A Health Systems Perspective
James Pfeiffer & Mark Nichter (for the Critical Anthropology of Global Health Special Interest Group)
Medical Anthropology against War
Marcia C. Inhorn
· The Person in Dementia: A Study of Nursing Home Care in the United States by Athena McLean
Review by Betsy Pohlman
· Nameless Relations: Anonymity, Melanesia and Reproductive Gift Exchange between British Ova Donors and Recipients by Monica Konrad
Review by Jennifer Speirs
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Special Issue: Introduction to Nordic Medical Anthropology: Benedicte Ingstad & Aud Talle, guest editors
Health Identities and Subjectivities: The Ethnographic Challenge
Susan Reynolds Whyte
- The formation of identity and subjectivity in relation to health is a fundamental issue in social science. This overview distinguishes two different approaches to the workings of power in shaping senses of self and other. Politics of identity scholars focus on social movements and organizations concerned with discrimination, recognition, and social justice. The biopower approach examines discourse and technology as they influence subjectivity and new forms of sociality. Recent work in medical anthropology, especially on chronic problems, illustrates the two approaches and also points to the significance of detailed comparative ethnography for problematizing them. By analyzing the political and economic bases of health, and by embedding health conditions in the other concerns of daily life, comparative ethnography ensures differentiation and nuance. It helps us to grasp the uneven effects of social conditions on the possibilities for the formation of health identities and subjectivities.
Power, Trust, and Risk: Some Reflections on an Absent Issue
- In modern discussions among health professionals there is a strange lack of discussions of power. This is most notably true for the discussions about proper physician–patient relations and the discussions about trust. This article explores some of the consequences of this absence. It is argued that the absence of the issue of power hampers a serious and open moral discussion of important institutional forms in the health care system. It is also argued that some of the proposals for how to organize physician–patient interaction are rather unrealistic, mainly because the issue of power is neglected. Finally, the article develops some ideas about how power ought to be approached in modern health care.
Emotional Experts: Parents’ Views on End-of-Life Decisions for Preterm Infants in Iceland
- In this article, I examine how parents of infants with birth weight of 1,000 grams or less in Iceland relate to the questions whether and when treatment for a preterm infant may be withdrawn, and who should make such a decision. Almost all the parents agreed there are categories of infants who should be allowed to die and parents should have a say in such a decision. Inability to take part in human communication was most commonly mentioned as a valid criterion for withdrawal of treatment. There was more disagreement about parents’ right to unilaterally demand withdrawal. Ethical dilemmas and their resolutions are embedded in social context where images of suffering and disability and establishment of medical facts are central. Parents claimed their right to participate in treatment decisions as emotional experts; the child was theirs and they had to live with the outcome. Their hope in cure was based on faith in medical science and high confidence in the staff of the NICU. Parents also stressed the infant’s will to live and referred to alternative knowledge, for instance, derived from “evidence based” spiritism or an interpretation of a dream.
Grips and Ties: Agency, Uncertainty, and the Problem of Suffering in North Karelia
- In medical anthropological research, the question of suffering has been a topic of salient interest mostly from two theoretical viewpoints: those of endurance and of agency. The concept “suffering” derives its origins from two etymological roots, those of suffering–souffrance–sofferanza and of misery–misère–miseria. According to the first approach, that of “endurance” and founded largely on Judeo–Christian theology, suffering is regarded as an existential experience at the borders of human meaning making. The question then is: how to endure, how to suffer? The latter view, that of “agency,” follows the Enlightenment, and later the Marxist view on mundane suffering, misery, and the modern question of how to avoid or diminish it. This article follows the lines of the second approach, but my aim is also to try to build a theoretical bridge between the two. I ask whether agency would be understood as a culturally shared and interpreted modes of enduring, and if so, which conceptual definition of agency applies in this context? I theorize the relationship between suffering and agency using Ernesto de Martino’s notion la crisi della presenza. In line with Pierre Bourdieu, I think that in people’s lives, there may be sufferings in a plural form, as a variety of sufferings. The article is based on a one-year long fieldwork in Finnish North Karelia.
· Toxic Exposures: Contested Illnesses and the Environmental Health Movement by Phil Brown
· Mental Health among Taiwanese Americans: Gender, Immigration, and Transnational Struggles by Chien-Juh Gu
· Dancing for Health: Conquering and Preventing Stress by Judith Lynne Hanna
· Skin: A Natural History by Nina G. Jablonski
· The Health of Populations: General Theories and Particular Realities by Stephen J. Kunitz
· Iron in the Soul: Displacement, Livelihood and Health in Cyprus by Peter Loizos
· Deaf in Japan: Signing and the Politics of Identity by Karen Nakamura
· The Cambridge Handbook of Sociocultural Psychology edited by J. Valsiner and A. Rosa
Rebecca J. Lester
· Wayward Women: Sexuality and Agency in a New Guinea Society by Holly Wardlow