Somatosphere welcomes you to the second part of December edition of “In the Journals.” Scroll through our monthly round up of new research across anthropology, STS and social science journals.
Culture, Medicine and Psychiatry
Robert Meadows and Christine Hine
Whilst chatbots for mental health are becoming increasingly prevalent, research on user experiences and expectations is relatively scarce and also equivocal on their acceptability and utility. This paper asks how people formulate their understandings of what might be appropriate in this space. We draw on data from a group of non-users who have experienced a need for support, and so can imagine self as therapeutic target—enabling us to tap into their imaginative speculations of the self in relation to the chatbot other and the forms of agency they see as being at play; unconstrained by a specific actual chatbot. Analysis points towards ambiguity over some key issues: whether the apps were seen as having a role in specific episodes of mental health or in relation to an ongoing project of supporting wellbeing; whether the chatbot could be viewed as having a therapeutic agency or was a mere tool; and how far these issues related to matters of the user’s personal qualities or the specific nature of the mental health condition. A range of traditions, norms and practices were used to construct diverse expectations on whether chatbots could offer a solution to cost-effective mental health support at scale.
Timothy Olanrewaju Alabi
This paper explores the intricate interplay between living with mental illness and the processes of identifying mental illness in Abeokuta, Nigeria. With a particular focus on the contextual understanding of personhood, this study reveals how sociocultural backgrounds modulate the understanding of mental illness and its treatments within the Yoruba context. Through nine months of ethnographic fieldwork and discursive narrative analysis, the research revealed that becoming a mentally ill person is deeply intertwined with the everyday social life in the study site. The analysis highlights the multifaceted nature of personhood, encompassing various aspects such as parenthood, friendship, employment, and financial freedom. These facets of personhood are shaped by specific social practices and embedded within complex webs of social relations, often becoming more pronounced when these relationships are disrupted, leading to certain behaviours being categorised as mental illness. This paper underscores the significance of recognising and acknowledging the contextual notion and understanding of mental illness to ensure the provision of acceptable and effective care and recovery strategies.
Vincent Laliberté
Through a longstanding collaboration, psychiatrists and anthropologists have assessed the impact of sociocultural context on mental health and elaborated the concept of culture in psychiatry. However, recent developments in ecological anthropology may have untapped potential for cultural psychiatry. This paper aims to uncover how “ecologies” inform patients’ and clinicians’ experiences, as well as their intersubjective relationships. Drawing on my ethnography with Jerome, a carriage driver who became my patient in a shelter-based psychiatric clinic, and on anthropological work about how psychic life is shaped ecologically, I describe how more-than-human relationality and the affordances of various places—a clinic and a stable—influenced both Jerome’s well-being and my perceptions as a clinician. I also explore how these ecologies shaped our different roles, including my dual roles as psychiatrist and ethnographer. In the discussion, I define ecological factors, describe their implications for clinical practice, and suggest how they could be integrated into DSM’s cultural formulation
Dhat Syndrome East and West: A History in Two Acts
Diederik F. Janssen
The intriguing story of dhat syndrome is that of medical modernity (psychiatry, clinical sexology) declaring medical premodernity (Ayurvedic concepts of semen loss) as its object. The early history and prehistory of this “culture-bound” diagnosis help understanding it as a dynamic confrontation of local, shifting knowledges. For instance, semen loss anxiety was an established motif both in European early twentieth-century psychoanalysis and again in several Indian psychodynamic texts of the 1960s. Moreover, it became problematically tied to notions of “Indian character”. Little realized is that European venereologists were dealing with much comparable clinical presentations since the late eighteenth century, often resolving them in strikingly similar ways. For centuries, European proto-endocrinological ideas tied masculinity to the absorption and recirculation of semen, informing popular conceptions of “semen loss” (spermatorrhea) much comparable to those driven by dhatu physiology, dovetailing in colonial-era medicine. Expressive of growing controversy concerning this physiology after the mid-eighteenth century, a leitmotif of exaggerated fears tied to both “quacks” and proselytizing leading authorities such as Tissot and Lallemand, informed diagnoses of “tabes imaginaria”, “spermatophobia”, and “imaginary spermatorrhea.”
Infertility as Trauma: Understanding the Lived Experience of Involuntary Childlessness
Cristina Archetti
Infertility, to those who are affected by it, is much more than whether one manages (or not) to have a child: it can be a traumatizing experience. Based on a clinical case study that involved one-to-one psychotherapy sessions and semi-structured interviews with six involuntarily childless women living in Norway, this article develops the argument that there is a need to treat infertility as trauma, both conceptually and from the perspective of therapeutic practice. The analysis contributes to our understanding of trauma as a disruptive event that erodes a person’s moral agency. It does so by outlining conceptual and therapeutic tools that illuminate what happens in the psyche as a result of the trauma: they help explaining why the moral agency of different individuals is damaged to different extents, and how therapy can repair it. In relation to the issue of involuntary childlessness, the analysis shows where infertility fits within one’s traumabiography—a map of the way adverse experiences over the life-course have affected one’s psyche and behavior—both as traumatizing in itself and connected to previous traumas. This understanding enables more effective therapeutic support and better care for many individuals whose long-term suffering would otherwise remain unacknowledged and untreated.
A Chinese Dance Therapy Framework
Wolfgang Mastnak
Genuine Chinese dance therapy is in the ascendant and psychiatric approaches that involve a broad spectrum of principles such as ontological identity, social inclusion and collective support, aestheticisation and expressive catharsis, symbolic exorcism, trance and Buddhist mindfulness. Its models are based on a wealth of Chinese dance genres originating from various dynasties as well as cultural traditions of ethnic minorities. Due to different epistemological backgrounds of Western diagnostic manuals and traditional Chinese views of mental diseases, complex understanding of pathologies and therapeutic dynamics is needed. Therefore, this opinion piece suggests a theoretical framework that encourages interdisciplinary approaches as well as inclusive transcultural psychiatry and related philosophy of science.
Disclosure imperatives and women’s subjectivities in an emergent culture of sexual trauma testimon
Anu Ahmed
Since the democratization of the Maldives, a Sunni-Islamic nation in the Indian Ocean, the Greater Male’ Region (GMR) has been the site of rapid social reform efforts. The state’s democratizing efforts and local engagements with global feminist and mental health movements have led to the emergence of a culture of giving and bearing witness to sexual trauma testimony. I propose the term “disclosure imperatives,” and outline the three public discourses that produce this imperative in the Maldivian context. Next, drawing on interviews with Maldivian women who have experienced childhood sexual abuse, I illuminate how disclosure imperatives shape women’s subjectivity and sociality. Using a critical phenomenological approach, I show that disclosure imperatives are, counterproductively, experienced as moralizing in interlocutors’ lifeworlds. Beyond focusing on women’s “voice” or its absence as “silence,” the concept of disclosure imperatives illuminates the emotional and moral affects that cultures of disclosure engender in everyday lives.
Modern distress and lifestyle migration: The false promise of a pure relationship with one’s self
Rotem Kliger, Carol A. Kidron
This study presents a qualitative ethnographic exploration of professionally successful lifestyle migrants’ self-perceptions of premigration etiologies of “modern distress,” and postmigration pathways of healing and outcomes in Guatemala. Reflexive accounts of perceived etiologies of distress include self-commodification, atomization, and disengagement from “true-selves” as stressors motivating relocation. Migrants depict postmigration healing practices as embedding popularized therapeutic narratives that amplify introspective self-dialog reproducing hypercapitalist and emotional capitalist “liquid-modern” unstable and disengaged selfhood. Constituting what we term a “pure relationship with the self,” lifestyle migrants describe a “modern trap” of “addictive” chronic healing, self-seeking, and unfulfillment while resultant self-deliberations continue to exhibit no less liquid and potentially adaptive life paths. Implications will be considered pertaining to self-dialogic therapeutic processes that reproduce distressed liquid selfhood and the potential of sites of self-relocation to amplify socially disengaged introspection. Yet reflexive self-dialog problematizes reductionist readings of structural subjectification, calling for further examination of the way distressed selfhood is a product of shifting social structures and zeitgeists but no less a self-crafted outcome of self-deliberation that critically evaluates emergent selves and alternative contexts of self-constitution.
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
Sarah Nettleton, Nik Brown, Karl Atkin, Luna Dolezal, Sanna Metsäketo and Daniel Robins
Drawing on ethnographic fieldwork in Finland, we report on the trial of a teleoperated care robot named Välkky introduced onto a fully operational hospital neurological ward. Our data revealed a narrative arc where participants’ early expectations of the hospital-based trial altered as the project unfolded. Greeted with techno-excitement and experimental enthusiasm about the place of robotics in reshaping roles within clinical care, Välkky became the focus for collaborative in situ learning, adaptation and redesign amongst the roboticists, designers, nurses, patients, and managers. Välkky acted as an ‘attractor’ provoking thinking about, and a reimagining of, future arrangements of care. Our empirically informed insights seek to pave the way for real-world nuanced thinking that pushes beyond human/non-human and success/failure binaries. Building on debates in STS and feminist posthumanism, we propose a robocentric approach, which encourages us to ‘queer’ health care robots, and to understand them as fluid, hybrid, distributed and relational figures, rather than purely as inert, mechanical, non-human objects that might replace humans. Nursing care practices by and with robots will generate new meanings and practices of care that will emerge iteratively, as caring relations, relationships and practices develop within the context of operational ward environments. Robots may or may not be able support care, but they will invariably challenge what care is.
Ekaterina Borozdina and Anna Temkina
In recent years, medical sociology has produced a significant amount of publications about the effects of the COVID-19 pandemic on medical care provision and healthcare professionalism around the globe. This study builds on this line of research by looking at a rarely discussed case of pandemic management—the case of Russia’s centralized and state-dominated medical sector. In our analysis, we focus on the organizational level and the institutional work of front-line health professionals. Using a neoinstitutional theoretical lens, we show how, as a result of the conflict between professional and managerial logics, pockets of extreme institutional uncertainty emerged within Russian healthcare: “non-COVID” healthcare facilities and hospitals rapidly restructured for COVID-19 care. Qualitative interviews with healthcare professionals indicate that institutional misalignment inside these “gray zones” translated into the material dimension, significantly impeding the effectiveness of the pandemic response. While sociological literature frequently portrays Russian health professionals as fully subjected to administrative constraints and disempowered, our data allows us to trace their informal institutional work and agency during the health crisis. Through these materially mediated work, our informants attempted to deal with both the challenges of the pandemic and institutional contradictions of the Russian healthcare system. Professionals’ institutional work brought some improvements to Russia’s pandemic-affected clinical settings. However, being informal and purposefully hidden, it neither constituted a viable solution for medical organizations, nor contributed to the strengthening of professionals’ autonomy.
Xiaoli Tian and Sai Zhang
The legitimacy of complementary and alternative medicines (CAMs) and their integration into mainstream healthcare have long been a topic in sociological discussions. This study examines the institutional influences on Chinese medicine (CM), an important CAM in mainland China and Hong Kong. In-depth interviews with practitioners and observations in public hospitals facilitate a comparison of the professional boundaries, statuses, and jurisdictions of CM in the two regions. In mainland China, CM has a high degree of state-granted legitimacy with blurred professional boundaries between CM and Western medicine (WM) in a highly integrated healthcare system. However, these blurred boundaries have had the following unintended consequences: (i) devaluation of traditional knowledge in CM education and practices, (ii) biomedicalisation of CM practices wherein a substantial reliance on WM has decreased the utilisation of healing principles in CM and (iii) ambiguity in the efficacy of CM due to the co-use of CM and WM. In contrast, the demarcated professional boundaries in Hong Kong have allowed CM to maintain its knowledge base, even though CM is practised within strict parameters. This study reveals that institutional requirements (on efficiency, accountability and profitability) prioritise the biomedical model and drive the biomedicalisation of CM. Therefore, the lack of clear professional boundaries in the current integrative medical system in mainland China have eroded the knowledge base of CM and undermined the efficacy-based legitimacy of CM.
Boundary-work of primary care physicians using telemedicine technologies for communication
Ariela Popper-Giveon, Yael Keshet and Tamar Adar
Implementing telemedicine technologies (TT) for patient–physician communication leads to the emergence of new structures of boundaries. Hence, boundary work theory can provide a useful lens for examining how primary care physicians (PCPs) experience TT. The objective of this research was to examine the experiences of PCPs in using TT in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. The concept of boundary work emerged as a focal point, with three forms of boundary work identified in the PCPs’ descriptions of their TT experiences: collaborative, competitive, and configurational. Interviewees described improved collaboration with patients who find it difficult to get to the clinic and better service for administrative issues. However, they reported constant power struggles to maintain their authority. They expressed concern about treatment failure and suggested that healthcare organizations reconfigure TT so that it can be used to provide optimal care. They suggested that healthcare organizations should instruct physicians how to best manage TT consultations and regulate its usage. This article demonstrates that while implementing TT in primary care has many advantages, it uncovers boundary work for maintaining power and authority that both PCPs and healthcare organizations should take into account in practice as well as in policy.
Puig-García M, Parker LA, Caicedo-Montaño C, Márquez-Figueroa M and Chilet-Rosell E
While many studies focus on urban areas, it’s vital to understand health-related behaviours in rural communities. This paper aims to explore the factors that influence dietary habits and physical activity from the perspective of men and women of different ethnic groups living in a hard-to-reach rural area in Ecuador. We conducted 5 focus groups with 37 participants (26 women) from diverse cultural and ethnic backgrounds in marginalized com munities in Esmeraldas. The thematic analysis showed environment and culture shape dietary habits and physical activity, influenced by taste preferences, economic factors, and societal norms, with gender roles and beauty standards playing significant roles.
Outdoor health intervention for refugees, migrants, and asylum-seekers: A mixed-methods pilot study
Charlotte Wendelboe-Nelson, Jessica C. Fisher, Tanja M. Straka, Rita Sousa-Silva, Claudia Menzel, Julius C. Alejandre, Sian de Bell, Rachel R.Y. Oh, Aletta Bonn and Melissa R. Marselle
Despite the multifaceted and diverse challenges that refugees, migrants, and asylum-seekers experience when entering a new country, they remain notably underrepresented in the evaluation and understanding of the health and wellbeing impacts of outdoor health interventions. We addressed this knowledge gap by a mixed-methods evaluation (questionnaires, focus groups and photo elicitation activity) facilitated by a community researcher. Qualitative data (focus groups and photo elicitation activity) revealed that the participants saw the social component of outdoor activities as a critical factor in improving their wellbeing, an insight not captured by established quantitative wellbeing scales. Given the diverse backgrounds of refugee, migrant, and asylum-seeker populations, we underline the importance of a transdisciplinary, collaborative, and mixed-methods research approach.
Sally Schultz, Jane McCracken, Christina Zorbas, Serene Yoong, Anna Peeters and Kathryn Backholer
Addressing health inequities requires both national and local-level action. In the case of COVID-19, locally-led place-based programs were instrumental in addressing vaccination inequities that resulted from implementation gaps in national and state-level universal COVID-19 vaccination programs. To prepare for future pandemics, understanding which local strategies are effective and the conditions that enable their effectiveness is crucial. We conducted a case study using qualitative interviews (n = 22) and document analysis to identify key strategies employed to increase vaccination uptake among priority populations in a regional community in Victoria, Australia, and the conditions perceived to enable or constrain the success of those strategies. Interviewees included Aboriginal and migrant community members (n = 12) and representatives from organisations that designed and implemented the COVID-19 vaccination program (n = 10). Strategies perceived to be effective by local migrant and Aboriginal communities included the location of outreach clinics (places considered physically, cultural and political accessible and safe), communication via trusted community leaders, practical supports such as translation services and transport, and empowering community in clinical interactions. Conditions perceived to influence program implementation and outcomes related to four themes: (i) shared vision and strong bonds of local partners, (ii) placing community in the driver’s seat, (iii) rebalancing power through leadership grit and guts, and (iv) equity-enabling service and funding models. Our study supports strengthening of national and state government investment and engagement with local partnerships to place equity and community at the centre of future pandemic and public health responses.
International Journal of Psychiatry
Mervat Alsous, Batoul Al. Muhaissen, Talal Massad, Bilal Sayaheen, Tariq Alnasser, Ahmed Al-Smadi, Reham Al-Zeghoul, Osama Abo Al Rob, Alaa A.A. Aljabali and Omar Gammoh
The circulating violent news about the war on Gaza is believed to impact the mental health status of people globally especially in Jordan, the closest country to Palestine. Also, women are more vulnerable to mental distress. This study investigates the prevalence and correlates of post-traumatic stress disorder (PTSD), depression, insomnia, and fibromyalgia among Jordanian females exposed to the Gaza war news. In a comprehensive cross-sectional inquiry, we applied validated scales to assess the severity of PTSD, depression, insomnia, and fibromyalgia symptoms in a dataset comprising 1,044 females. The findings revealed that 32.3% exhibited severe PTSD symptoms, 53.4% had severe depressive symptoms, 48.2% reported severe insomnia, and 17.2% were diagnosed with fibromyalgia. Exploring demographic factors, the study established statistically significant correlations (p
Laura-Louise Arundell, Rob Saunders, Phoebe Barnett, Judy Leibowitz, Joshua EJ Buckman and Stephen Pilling
Women are disproportionately impacted by depression and anxiety disorders and in particular, women from minoritised ethnic communities experience inequalities in access to outcomes of psychological treatment for these disorders. Better understanding from the views of service users about the factors that impact their access to, and experiences of care could help to optimise treatment for these groups. This study explored experiences of treatment and gathered suggestions about treatment improvement, from the perspectives of women currently using psychological therapy services. Semi-structured interviews were conducted with 12 female NHS Talking Therapies for anxiety and depression (NHSTTad) service users from minoritised ethnic communities. Data were analysed using thematic analysis. Four high-order themes were identified: (1) cultural identity and experiences of mental health and treatment, (2) challenges associated with treatment, (3) facilitators of good treatment experiences and outcomes and (4) improvements for women from minoritised ethnic communities. Findings showed that cultural sensitivity and awareness are important to minoritised ethnic women receiving therapy. Challenges included access difficulties and limitations of treatment options offered, alongside personal challenges of engaging in therapy. Facilitators of good treatment experiences and outcomes included flexibility on the part of the service, as well as therapist-related factors such as identity characteristics (age, gender and culture of therapist), a good therapeutic relationship and the therapist’s ability to deliver person-centred care. Improvements included ensuring care is culturally sensitive, reducing waiting times or providing better support for people on waiting lists, providing a flexible service that takes individual needs into account, increasing workforce diversity and reaching out to underserved communities. Many of the suggested improvements are generalisable to underserved minoritised ethnic groups, regardless of gender and could be applied to other psychological therapies services other than NHSTTad.
Zsolt Péter Szabó, Jan-Erik Lönnqvist, Nóra Anna Lantos and Jussi Valtonen
Insights from mental health stigma research indicate the importance of societal and political views on mental health perceptions. Most studies originate from typical Western neo-liberal settings and focus on generic mental health issues. Our research explores these associations in Hungary, an understudied post-communist context with significant stigma levels, examining a broad range of stigmas related to both general and three specific mental illnesses: schizophrenia, depression, and alcohol use disorder (AUD). The study aims to connect a wide array of political dispositions to stigma associated with both general and specific mental illnesses, exploring both attitudes and behavioral intentions. We surveyed 492 participants (147 males, 342 females) on their political dispositions, including Right-Wing Authoritarianism (RWA), Social Dominance Orientation (SDO), general and economic system justification, and conservative political ideology, and their attitudes toward general and specific mental illnesses. Regression analyses identified key political dispositions influencing stigma. RWA was significantly linked to most stigma outcomes, while conservative political ideology showed a selective impact. Other predictors had minimal influence on stigma outcomes. Our findings suggest that perceptions of danger, threat, and unconventionality, as indicated by RWA, are crucial for mental health stigmatization in Hungary. Intervention programs should target these factors, particularly in similar contexts.
Rowan Diamond, Felicity Waite, Anne-Marie Boylan, Alice Hicks, Thomas Kabir, David Shiers and Daniel Freeman
The need to increase exercise and decrease sedentary behaviour in people diagnosed with psychosis is well-recognised. We set out to explore caregivers’ perspectives on what supports and prevents physical activity, and how to use carers’ support most effectively. Fourteen caregivers of people diagnosed with psychosis were interviewed. Data were analysed using reflexive thematic analysis, in collaboration with caregivers. Four themes were developed, the first flagging the importance of physical activity, then the others calling for action: (a) Physical inactivity matters: carers are keen to support efforts to increase physical activity in their family or friends because of the enormous impact physical inactivity has on patients, and consequently on carers themselves, such as social isolation and reduction in their own activity. (b) Tell us: without being well-informed about how to help, carers can feel like they are powerless to stop a ‘slow suicide’ or ‘decline’ in patients. (c) Listen to us: through knowing their family and friends well, carers are able to identify important changes in patients and identify successful motivators for them, but these insights can feel uninvited. (d) Ask us: being invited to support activity as a partner in a patients’ care is desirable but having offers of help rejected can “demotivate the motivator.” Caregivers described strong motivation to help patients to be more physically active but can feel that their support is overlooked and under-used by services. Clinical recommendations for carer involvement in physical activity interventions are offered.
Risk and protective factors for suicidal ideation among Saudi adolescents: A network analysis
Mogeda El Sayed El Keshky
Suicide is among the leading cause of death in adolescence and suicidal ideation is its most critical precursor. Suicidal ideation being a complex phenomenon involving multiple factors, this study aimed to use network analysis to depict the interplay of risk and protective factors for suicidal ideation. An online survey was conducted with 614 Saudi adolescents (mean age = 16.16, SD = 1.88, range = 12–18, 61% female). Participants completed instruments to assess suicidal ideation, bullying victimization and perpetration, psychache, family cohesion and adaptability, positive parenting, and multidimensional social support. A psychological network analysis was estimated to determine the most central risk and protective factors for suicidal ideation. As per strength and expected influence centrality, the risk factors that were central were psychache and bullying victimization, and the central protective factors were family cohesion and support from significant other. The network analysis showed that other factors directly connected with suicidal ideation were bullying perpetration, family adaptability, positive parenting, support from family, and support from friends. This network study highlights the importance of addressing both risk and protective factors in an attempt to deal with suicidal ideation. The findings suggest that interventions targeting psychological pain, bullying, and family bonds may be crucial in the treatment and prevention of suicidal ideation among adolescents.
Journal of the Royal Anthropological Institute
Staying with the blackout: an insecure anthropology of energy
Canay Özden-Schilling
In the twenty-first century, blackouts have settled into a familiar sequence of events in the fully electrified world. After jolting publics into a sudden awareness of energy assemblages, they gradually disappear from public memory. This article is an exercise in dwelling on blackouts that have already begun to recede from public memory so as to better conceptualize ‘energy security’ as an object of anthropological critique. Examining expert reports and retrospective verbal accounts, I focus on the 2021 blackout of Texas and the 2015 nationwide blackout of Turkey. Drawing on my long-term ethnographic work with the US electric grid, I punctuate these failures with an uneventful day at a high-security operation building in New England. I show that the desire for security suffuses electricity assemblages, from secure buildings of operation, to governments securing passage for the electric current, to publics demanding uninterrupted electricity access. I argue that in grid experts’ imagination, energy futures hinge on securing high-risk nodes while continually expanding grids so that potential failures might be better absorbed. This imagination, however, produces a false sense of security when contemporary threats to transmission are too wide-ranging to isolate and will only be amplified by larger grids.
Love burnout: young women, mobile phones, and delayed marriage in Yaoundé, Cameroon
Ewa Majczak
This article examines how work towards the promise of love marriage comes to be exhausted. It focuses on young urban women living in Yaoundé, Cameroon, trying to ‘catch’ a husband using digital technologies in which photographs figure prominently. Focusing on the visual production of dating profiles, I show how mobile phones place young women at the centre of their own husband-catching pursuits. Through digital actions, these young women produce the promise of love marriage, but at the same time their actions require increased volumes of emotional work. As phones constantly compel young women to intensify their husband-catching efforts and amplify the promise of love marriage, they rarely bring the desired results. Thus, young women, burdened by the emotional work necessary to sustain this promise, experience a form of love burnout, suspend their actions, and delay marriage. In highlighting the emotional laboriousness of intimate relations in technologically mediated worlds, this article draws out the limitations of the way in which the promise of love marriage is circulated and points to how neoliberal economies of affect may be temporarily suspended.
Blaming the house: women’s efforts to preserve marriage in a rural Sinhala village
Tharindi Udalagama
In rural Sri Lanka, marital tension, frequently leading to violence, is an increasing problem. This article explores how the house becomes both the source of problems and a possible solution to them. By examining the way that the social, material, and symbolic dimensions of houses are made to interact, I show how women effect the shaping of social relations and homemaking. Specifically, I focus on how houses become spaces where women are expected to embody the ideals of wifehood and motherhood, thereby creating and maintaining a ‘good house’. Drawing on ethnographic research conducted over fourteen months in a rural village, I illustrate the ways in which women actively engage in strategies to construct and preserve their houses as spaces free from violence. I describe how women, in addition to their traditional caregiving roles, employ the science of architecture (vāstu vidyava) to restructure their houses as a way to promote peace and prosperity. As a result, houses emerge as strategic allies in women’s lives, facilitating their pursuit of the desired ‘good life’.
The grammar of a hunger strike: nonviolence and biopolitics in Manipur, India
Sayantan Saha Roy
What are the potentialities and limits of nonviolence as a method of resistance against modern biopolitics? This article offers an ethnographic account of Irom Sharmila’s sixteen-year-long hunger strike against the continued state of emergency in the Indian state of Manipur. It interrogates how she envisioned the protest, the objectives that she set, and how her protest came to an end. This article demonstrates that her protest was not about a will to death, as it has often been described, but instead was based on a radical distribution of responsibility among the people suffering under the regime of violence. Her nonviolent protest as a Gandhian practice was directed particularly at the entailments of violence. In challenging the state but refusing to emulate it, she became an exemplar. She became the one who could not be killed even by the state with exceptional powers. Finally, by contrasting her protest with Manipuri nationalism, this article shows how the ethics of nonviolence offers a unique vision for peace and liberation.
Minaketan Bag and Kishor K. Podh
The place of mothers is respected in all societies irrespective of their social, cultural, and geographical differences. The mother-child relationship is considered one of the most sacred in the world. This article explores the age-old customary ‘child selling’ prevalent in Western Odisha, a voluntary and non-remunerative practice of childcare during infancy to save children from illness and Yama, the Hindu god of death, where the ‘caring mother’ belongs to the bottom of the social hierarchy, mainly from the (ex-)untouchable castes. According to popular belief, Yama does not visit the untouchables because of their ‘filthy’ environment and their gods. Hence, it is considered a safer place for children, especially weak ones or those with the chronic illnesses of the upper castes, to conceal themselves from the evil eyes of Yama. The epistemology of this article aims to explore the hegemonic nature of the caste systems, which overwhelms the revered mother-child relationship. Further, it tries to understand the (re)production of caste and legitimization of sociopsychological conditions for the marginalization and backwardness of ‘caring mothers’. Despite the sacred and intimate relationship between the ‘caring mother’ and child, the institution of ‘ritual selling’ reproduces caste inequalities, and again the former becomes an ‘untouchable’.
Feral ecologies of the human deep past: multispecies archaeology and palaeo-synanthropy
Shumon T. Hussain
This article articulates recent advances in palaeo-ecology with the goals and ambitions of multispecies archaeology. It centres the synanthropic nexus as a key context for the study of early human-animal relationships and argues that its evolution yields important yet currently overlooked dynamics shaping the structure of the archaeological record. I first show how the dominant heuristic of wild versus domesticated nonhuman animals obfuscates the inherent variability and creativity of past animal agency. I then illustrate how such agency is caught up with human behaviour and ecosystem impacts from relatively early on in human history, navigating historically shifting configurations of autonomy and control. Drawing on deep-historical examples of synanthropic niches co-assembled by human foragers and nonhuman animals, I argue that such interspecies configurations require careful attention to concepts of liminality and ferality and challenge species-level approaches. I finally highlight potential human behavioural, material, and cosmological consequences of the synanthropic nexus, including integrative foraging patterns and notions of the giving animal, which play an important role in many Indigenous and ethnographic forager societies and illustrate the value of attending to this nexus as a focus of comparative multispecies research.
Mpox in the news: social representations, identity, stigma and coping
Brigitte Nerlich and Rusi Jaspal
In May 2022, when the COVID-19 pandemic began to recede from public view, another infectious disease surprised the world—mpox (formerly monkeypox). It appeared to disproportionately affect gay, bisexual and other men who have sex with men (GBMSM). Using qualitative thematic analysis and social representations theory, we analysed a corpus of 91 items from a variety of news outlets that included GBMSM community members’ personal accounts of living through an mpox outbreak. The aim was to study the various ways in which members of a marginalised group created social representations of mpox and to ascertain whether these challenged older representations related to HIV and AIDS and newer ones related to COVID-19. Commentators anchored mpox to known, culturally accessible phenomena to render this previously unfamiliar disease familiar; objectified aspects of mpox, especially pain, through emotive language, making it ‘real’ and psychologically tangible; personified it by linking it to accounts of celebrity activists; and ontologised it through visually vivid descriptions. Challenging stigma was a cross-cutting theme in people’s accounts. In contrast to the stigmatising imagery of health issues affecting GBMSM, these accounts contribute to the development of social representations designed to challenge such stigmatisation, which, in the contexts of HIV and AIDS and COVID-19, has hindered effective medical interventions, promoted misinformation and fuelled denigration.
Is there truth in fiction? Lessons from readers’ responses to dementia fiction
Jane Lugea, Carolina Fernandez-Quintanilla, Gemma Carney and Paula Devine
This paper addresses the question ‘is there truth in fiction?’, by synthesising a range of disciplinary approaches to the issue, as well as drawing on empirical research carried out with readers of fiction about dementia (hereafter, dementia fiction). We argue that fiction—perhaps because of its fictional status and apparatus—invites readers to consider its truth value, to explore the possibilities of human experience and interrogate issues relative to their subjective experience, community or society. The findings have significant implications for the Medical Humanities’ use of fictional texts to explore lived medical conditions and experiences, as well as claims made about the potential for fiction to affect real-world understandings, awareness and empathy around the conditions depicted. We show that the techniques used in fictional language may be artifice, but they simulate a truth that corresponds with reality.
Migration and mental health care in South Africa: the question of language in context
Christine Anthonissen, Rowan Madzamba, Asithandile Nozewu, Warona Mateane, Leslie Swartz, Sanna Higgen, Brian Hall and Mike Moesko
Access to mental healthcare for migrants is a global problem, with many challenges and barriers, including the issue of language discordance. Most research on this topic comes from well-resourced countries such as those in Europe, Northern America, and Australasia despite the fact that most migration occurs from poorer contexts, such as many in Africa, into more closely situated countries. As an introductory part of a broader international study, we started out investigating the views of key stakeholders in South Africa on language barriers to accessing mental healthcare for migrants and suggestions for how to address these. Two senior researchers interviewed a total of 10 key stakeholders (mental health and primary healthcare providers, some also users of mental healthcare, policymakers in mental healthcare, and refugee centre coordinators) virtually, using semistructured interviews. Interview recordings were transcribed and the content was analysed. The following key themes emerged from our data: general barriers to mental healthcare; linguistic barriers to mental healthcare; proposed solutions to overcoming language discordance and alternatives suggested by professionals and mental health service users. Issues of language were intertwined with a range of other service delivery and political problems. The issue of lack of language concordance is a major concern in providing mental healthcare for migrants in South Africa. This is, however, by no means the only concern, as access to care in general is poor. Innovative, cost-effective local solutions are needed to bridge the enormous gap between needs and service provision.
Deaf-led alarm design: technology and disability in home, work and parenthood
Gretchen Von Koenig
Domestic alarms are highly personal technological appendages that help us achieve an individual sense of safety and familial well-being—like baby monitors that help us care for children and alarm clocks that ensure a daily routine and help us get to work on time. Alarms can be understood as technologies that extend our eyes, ears, and memory to monitor our homes and ourselves in various ways beyond typical human capacity. The designs of domestic alarms tend to favour audible forms of alerting, and disabled users and inventors have hacked and redesigned alarms to fit their own families’ needs. Alarm design can tell us what type of domestic futures designers and technologists have imagined, casting visions about who is fit for parenthood and who is a reliable worker, and what types of futures disabled users imagined for themselves. As the future of these technologies becomes subsumed into smartphones and other IoT devices, a look into their predigital material forms uncovers episodes of disability agencies that assert a right to disability futures of domestic bliss and safety. Through the archives of The Deaf American and other deaf community publications, this research reviews the postwar alarm designs of Emerson Romero, a Cuban-American deaf activist and engineer, to show how deaf-led alarm designs are forms of material rhetoric that assert a right to a domestic future for disabled parents and workers.
Science, Technology, & Human Values
Who Predicts? Scientific Authority and User Expertise in Dutch Storm Warnings 1860-1920
David Baneke
This paper shows that expert authority can be the result of a process of co-construction by scientists and users, using the case of the Netherlands’ storm warnings system. I analyze the changing “culture of prediction” of the Netherlands’ storm warnings system between 1860 and about 1920, focusing on the changing relation between scientific experts and users with experience-based expertise. When started, the storm warnings relied on users taking an active role. The new storm warning system, introduced by Buys Ballot in 1860 following the introduction of telegraph networks, explicitly tried to mobilize sailors’ weather wisdom. Following complaints from the maritime community and controversies about criteria for accuracy or reliability around 1900, storm forecasting authority became the exclusive domain of scientists. Interestingly, the authority of experts was not challenged during this controversy. Rather, the debates focused on mutual expectations of expertise and on whether the storm warning system was primarily a scientific or a practical system. This paper is based on historical documentation from the archives of the Royal Netherlands Meteorological Institute, which includes the perspectives of users.
Coding Beauty and Decoding Ugliness: The Role of Aesthetic Concerns in Programming Practices
Marina Fedorova, Melissa Mazmanian and Paul Dourish
In this article, we analyze the productive role of aesthetics in organizing technoscientific work. Specifically, we investigate how aesthetic judgments form and inform code-writing practices at a large web services company in Russia. We focus on how programmers express aesthetic judgments about code and software design in everyday practice and explore how language with positive and negative valences is deployed. We find that programmers label code as “beautiful” without defining or establishing agreement about the term and are thereby able to maintain different ideals of beauty within the same organization. However, by learning how to avoid what senior developers deem to be “ugly” code, developers become socialized into producing code with a similar style and logic that we describe as “not ugly.” The fieldwork suggests that aesthetic language can function simultaneously as a mechanism that supports professional diversity within an organization and as a tool for producing consistencies in software design. Studying manifestations of both positive and negative aesthetic language in technoscientific work provides insight into professional practices and the various roles aesthetic language can play in organizational life.
Spectacular Technology, Invisible Harms: Witnessing Techno-science on Waste Tours in China
Amy Zhang
Investment in science, technologies, and infrastructures has been a critical aspect of China’s development strategy since the early 2000s. China’s national policies designated waste-to-energy (WtE) incinerators as the dominant end-of-life technology to bring about a form of modern and sustainable waste treatment that can turn waste into energy while eliminating pollution. Amid rising citizen skepticism over the safety and efficacy of this technology in China and elsewhere, this article examines the genre of the orchestrated waste tour, which seeks to place the public as witnesses to state performances of technological improvement. Tours to waste facilities illuminate the generic conventions and strategies that China’s late-socialist mode of green techno-scientific governance relied on to legitimize its achievement of environmental improvement. Tours did not produce passive observers. Through an in-depth discussion of a waste tour in Guangzhou, this paper documents that opportunities for firsthand encounters of WtE incinerators provided a forum for those suspicious of the state’s claims of techno-science to form counternarratives.
Contained Redistribution: The Technopolitics of Plastic Burning
Tridibesh Dey
Plastic stands for designed materials, chemically synthesized for massive use in industry and commerce. As plastic production continues to accelerate, plastic waste is incinerated, globally, as a preferred—though contested—technology for disposal. Burning plastic can be harmful; many associated chemicals, including those produced by burning certain plastics, are potentially toxic. They accumulate in bio-geological environments, known to entail serious health effects in humans for generations. Thus, matters of containment—emission filtration, limiting exposure, spatial localization, and so on—assume technopolitical significance.
Katy Footman
Abortion has been legally permitted in England and Wales for over fifty years, yet this health service continues to be stigmatised within the health system. Stigma is a dominant focus of abortion research, but a structural stigma framework is rarely used to understand how abortion stigma is produced at a macro-level. This study explored how structural abortion stigma is produced and experienced in the health systems of England and Wales, and its influence on person-centred care, including choice of abortion methods. Data from in-depth interviews with abortion care-seekers in 2022–23 and from key informant interviews with abortion care providers, managers, and commissioners in 2021 were analysed using reflexive thematic analysis. From the perspectives of key informants, structural abortion stigma is produced through the avoidance of abortion by decision-makers, the permitting of conscientious objection, and the exclusion of abortion from mainstream healthcare. These factors create health system pressures which increase abortion service fragility. The resulting vulnerability of abortion services reduces access to person-centred care, including abortion method choice, which can reinforce individual-level stigma. There are tensions between care-seekers’ experiences of specialist abortion care as less stigmatising, while the ‘abortion clinic’ becomes a site of stigma due to its segregation from mainstream healthcare. This research contributes to a structural understanding of abortion stigma by identifying some of the mechanisms through which structural stigma is produced within health system institutions, and how these forms of institutional stigma might be resisted or dismantled. Power is essential to the (re)production of structural stigma within the health system, which can reinforce individual-level stigma for both care-seekers and providers. Restrictions on method choice and the increasing reliance on medication abortion can be a product of structural abortion stigma, and these limitations on method choice can also reproduce stigma at the individual level.
Lawrence Stacey, Wes Wislar and Rin Reczek
Transgender health has risen as a topic of key interest. Yet little is known about factors that might stratify health among transgender people. In this paper, we suggest that the medical institution, which both prevents and provides access to transition-related care and thus sociolegal recognition for many transgender people, is a key institution for the health of transgender people. Drawing on 2015 US Transgender Survey data (USTS; N = 27,715), we examine whether transgender people who report barriers to healthcare and negative healthcare experiences have worse health than transgender people who do not. We contextualize the USTS sample against, and replicate our analyses when possible with, a probability-based sample of transgender people from the 2014–2017 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,386). We find that transgender people who have unmet medical needs and negative healthcare experiences have worse self-rated health than their transgender counterparts who do not. Findings also suggest that such barriers and experiences are more negatively associated with the health of non-binary/genderqueer people compared with transgender men and transgender women. Our study moves past prior work documenting a transgender health disadvantage by identifying specific characteristics associated with poor health of transgender people and by illuminating heterogeneity in such associations.
Ester Ellen Trees Bolt, Manhal Ali and Jonathan Winterton
Nurse turnover is a prominent issue in Dutch healthcare, causing staff shortages and operational disruptions. The literature reports myriad factors triggering nurse turnover, but little attention is given to how motives arise at multiple organizational levels and whether these affect distinct groups of nurses differently. Using qualitative and exploratory methods, we examine motives at multiple levels and for distinct nurse categories. We apply thematic and cluster analysis to motives from semi-structured interviews conducted between 2019 and 2020 with 56 nurses who left a healthcare employer but continued working in adult care in the Netherlands. We provide an empirical nuance to understanding and analysing motives by differentiating between all motives reported by each participant and the single most important motive: reported most responsible for their turnover decision. Our exploratory analysis suggests heterogeneity among nurses in their expressed multi-level and multifaceted motives. A universal theoretical model is, therefore, unlikely to explain and predict nurse turnover. Job-demands resources theory and leader-member exchange theory appear most relevant in explaining multi-level and multifaceted motives for two distinct groups of nurses. The most important motives explained by job-demands resources theory are hierarchy and structural changes. The most important motives explained by leader-member exchange theory include increased workload and not being listened to by leaders. Our study has significant managerial and policy implications, highlighting the need to develop different retention strategies tailored to distinct groups of nurses characterized by their expressed motives. The most important motives are within the control of the organization, suggesting scope for healthcare organizations to address nurse turnover more effectively.
Piper Liping Liu, Qingrui Li and Xinshu Zhao
The disparity between the demand for organ donation and individuals’ intention to donate in China is substantial. Media plays an increasingly pivotal role in bridging this gap by shaping public attitudes and intentions toward organ donation. This study aims to explore the differential impacts of various information acquisition modes on this dynamic. Utilizing an online survey with 420 quota sampling among mainland Chinese residents, we constructed a serial mediation model to test the proposed model. The findings reveal that information scanning, seeking, and discussion regarding organ donation are positively associated with the intention to donate organs through improving knowledge and increasing consent for organ donation. Moreover, information seeking is directly associated with a positive attitude toward organ donation, while information discussing directly increases the intention to donate organs.
Janneke M.L. Kuiper, Pascal Borry, Danya F. Vears, Ine Van Hoyweghen
Next-generation sequencing (NGS) technologies – which allow to look at large parts or even the whole genome at once – are making their way into diagnostic clinical care. With trends towards ‘mainstreaming’ genetic services into general medicine, significant ethical challenges, and a disputed clinical utility and cost-benefit ratio, genomic medicine’s autonomy and dominance in defining and offering NGS care may come under increased pressure from the outside (e.g., regulators, other healthcare providers and facilities, ethicists, and patients). In this paper, we show how the field of genomic medicine engages in substantial boundary-work in reaction to these circumstances. Building on multi-sited fieldwork in two centers for human genetics in Belgium and the Netherlands, we show how acts of demarcation serve to uphold an image of expertise and authority which helps maintain the field’s autonomy and dominance. Through examining the delineations put forward in interviews, practice (based on observations in multidisciplinary meetings and consultations), and grey and academic literature, we show the politics involved in moving NGS forward fairly seamlessly in a way that suits the field. First, we show how genetic healthcare professionals have redefined what makes a genetic test ‘valuable’ so that it underlines its current value. Secondly, we examine how a genetic imaginary is put forward that both emphasizes the extraordinary character of genomic medicine and the normalcy of NGS testing. By underlining the need for their expertise whilst simultaneously normalizing the ethical challenges and positioning themselves as most capable of reflecting on these, the field minimized external regulation and kept a close grip on defining ethical issues and policy. Despite their current dominance in shaping the future of genomic care, we argue that the closedness of the field hinders it from benefiting from external expertise, reflection, and monitoring to ensure enduring and broad support for this future.
Is it pathological to believe conspiracy theories?
Lisa Bortolotti
According to a naturalist conception of what counts as a disorder, conspiracy beliefs are pathological beliefs if they are the outcome of a cognitive dysfunction. In this article, I take issue with the view that it is pathological to believe a conspiracy theory. After reviewing several approaches to the aetiology of conspiracy beliefs, I find that no approach compels us to view conspiracy beliefs as the outcome of a dysfunction: a speaker’s conspiracy beliefs can appear as implausible and unshakeable to an interpreter, but in a naturalist framework it is not pathological for the speaker to adopt and maintain such beliefs.
Distort, post, repeat: Laundering antisemitism on “cliquey networks” during COVID-19
Fernando Garlin Politis, Mélissa Roy, Jeremy K. Ward and Laëtitia Atlani-Duault
Today, in the age of the internet, during recent epidemics such as H1N1, Ebola and Covid-19, it is striking to see how old accusatory scripts are circulated and perpetuated via social media, which serve as new channels for discrimination and blame directed at traditional figures who have been scapegoated at different moments in the history of European epidemics. The article shows how the laundering of information into a cliquey network takes empirical shape during a health crisis. We do so by focusing on VKontakte, a Russian social network similar to Facebook and the 15th largest website in the world in terms of traffic. Using an ethnographic approach to social media, we show how borderline information from an open and easily accessible website is reappropriated, made explicit, and transformed into legally prohibited hate content. It also documents the ability of conspiracy theorists to use the full range of discourse production channels in a country-in this case France-that has very strict laws on hate speech, including that published on social networks. These laws are circumvented by anti-Semitic communities that spread false information in marginal, open and legal networks, thus avoiding legal proceedings.
Establishing veritocracy: Society, truth and science
Harry Collins
In the west, truth is being eroded by post-modernist ideas such as alternative facts. Once truth is no longer valued it is a short route through nationalistic populism to fascism. To combat this we need to establish the idea of ‘veritocracy’ as a form of government. A veritocracy is a democracy in which truth is so highly valued that promising to tell the truth will become a central feature of politicians’ election manifestos feeding back the idea of veritocracy deeper into national culture. A proper understanding of the nature of science can support the idea of veritocracy. This proper understanding will not repeat the mythology of post-World War II philosophy and history of science, but will begin with the much more socially cognisant revolution in our understanding of science that began in the 1960s and 1970s. Nevertheless, a ‘wave three’ of science studies will justify science, not as a certainty-maker for policy, but as the way to bet in developing the best understanding of the observable world. The key is that science depends on moral truth in its attempts to develop correspondence truth. Science, like the law, should be a ‘check and balance’ in pluralist democracies and an object lesson in how to pursue truth in decision-making.
