Somatosphere welcomes you to the February edition of “In the Journals.” Scroll through our monthly round up of new research across anthropology, STS and social science journals.
A forgetful ethnography: Memory, memoir, and brain injuries
Denielle Elliott
In this paper, I consider how one writes an ethnographic memoir about memories, time, and our fieldwork when our memories, or our interlocutors’ memories, are unreliable, inconsistent, false, or simply missing. Reflecting on a brain injury that resulted during fieldwork, my (dis)ordered memories, and the intense reliance on memory in sociocultural anthropology, I ask what writing would look like for anthropologists if we wrote with the forgetfulness? Imperceptible to most, and escaping clinical and lab evaluations, the e/affects of my brain injury have reshaped how I am in this world and shifted how I approach and understand the ethnographic project. I suggest that by writing with memory loss, by admitting there are gaps and fissures, by embracing the confusion and confabulations, and by acknowledging the paralleled unfinishedness of the ethnographic project, we work toward a reformed anthropology that no longer uncritically esteems memory as the basis for the anthropological project. In doing so, the paper contributes to what Marlovitz and Wolf-Meyer have called a “psychotic anthropology,” one that disrupts disciplinary ideas about minds, methods, and memoir and contributes to a productively unruly, and inclusive, ethnographic practice.
Erika Alpert
The first thing I learned about pregnancy is how incredibly bizarre it can be, in ways that no one ever mentioned until I personally joined the pregnancy club.
This article examines how tours of an industrial pig slaughterhouse reinforce the continued enfoldment of Danish pigs into the fabrication of Danish national identity, an enfoldment that underpins the formulation of subjects, human as well as more-than-human. A discourse analysis that weaves ethnographic moments from the tours and tour narratives along with historical and literary influences on Danish national identity and current debates on “Danishness” explores how narrativizing industrial slaughter is a means of formulating subjects that are sustained by agricultural histories, existential texts, and fairy tales. Through “humanizing” slaughterhouse conditions, tour guides are performing a kind of affective and pedagogical labor that produces modernist subjects, from the citizen-consumer to that of the happy pig. In consuming happy Danish pigs, citizen-consumers consolidate what it means to be Danish as they tacitly accept the industrial sacrifice of pigs, whose lives are worthy of living but crucially, also, worthy of taking. This work demonstrates how a multispecies awareness can enrich our understanding of the complex, unstable, and inseparable emergence of value production, nationhood, and capitalist subjects.
Diagnosis, visibility, and “Illnesses You Have to Fight to Get”
Melina Sherman
This essay uses the author’s lived experience as a person with bipolar disorder to explore the meaning of living with an “illness you have to fight to get.” Drawing on her own life trajectory, as well as on the work of Joseph Dumit and many other scholars who have written about chronic illness, the author reviews the main characteristics that belong to chronic, invisibilized conditions and the implications such characteristics have for the people who experience illness. After reviewing five key traits, the essay dives deeper into the promises and pitfalls of being diagnosed with “illnesses you have to fight to get.” The essay ends with a call to action and ideas for how scholars, advocates, others can help empower and support the ongoing struggle of those who live with invisibilized chronic illnesses.
The Good Seed: Bt Cotton, Braided Time, and Agricultural Biotechnology in India
Ashawari Chaudhuri
The introduction of genetically modified (GM) Bt cotton in India in 2002 invoked fierce debates and discussions about the future of agriculture in the country. At the beginning of its cultivation, some farmers received higher yields. However, over the years, concerns over the cost of cultivating GM cotton, pests developing resistance to the technology, environmental impacts, and corporate control over agriculture have taken center stage in discussions around agricultural biotechnology. Although most of these discussions have been centered on GM seeds, the seed itself remains unexplored. Based on ethnographic and archival research among communities that are on opposite ends of the agrarian political economy like farmers and breeders/biotechnologists, I explore the meaning of Bt cotton for these communities. In opening up the GM seed through practice, time emerges as a powerful yet understudied phenomenon. Different registers of time, like breeding time, generational time, seasonal time, and market time, are braided in ways that determine the meaning of the seed for these communities. I use braided time to critique GM seed as a commodity. I also suggest that recognizing the significance of time further enables responsibility towards human, agrarian lives as well as non-human ecological formations.
On Vitality: Chemical Possibilities and Politics of Life Force, Ease, and Everyday Life
Elizabeth Durham
This article contributes to scholarship on vitality by considering how staff and patients at Sommeil Psychiatric Hospital in Yaoundé, Republic of Cameroon, negotiated the means and ends of patient life through the prescription and use of psychopharmaceuticals. Drawing on 24 months of fieldwork from 2016 to 2019, I posit a key distinction between the approaches of staff and patients to the role of these drugs in everyday life outside the clinic. Many staffers viewed psychopharmaceuticals as supportive of patients’ ability to face the duties of everyday life and citizenship in a period of secessionist threat to the Republic’s national integrity. Patients, however, often incorporated psychopharmaceuticals into their pursuit of everyday ease: into an understanding of everyday life that prized relaxation over or as much as responsibility. Thinking with patients’ common description of themselves as boire (in French; drinking, in English) their psychopharmaceuticals, I suggest that this understanding was informed by patients’ former or ongoing use of alcohol and particularly commercial beer, widely seen in Cameroon as a substance that relaxes life. I suggest that this understanding was a political sentiment in its own right, a desire for a softer way of life that could be sustained collectively. Thinking with anthropological and similar studies that have often conceptualized vitality as the power or force of life, I argue that the differences that arose among staff and patients as to how to best use psychopharmaceuticals, and to live everyday life itself, were differences of vitality. I propose that at the heart of the chemical nexus of relationships among patients, staff, alcohol, and psychopharmaceuticals was an alternative notion of vitality as an imperfect coexistence of life eased and enforced.
On Disrupted Death Rites and COVID-19
To publish a collection that documents lived experiences of death and ritual around the globe is, at any point in time, a tricky task. The challenge rises immensely in the midst of the disruptions caused by a global pandemic. If COVID-19 can be understood as a global storm that is still raging, then individuals, communities and publics, and indeed entire nations face storm fronts of different frequency, intensity, and severity at different times. No universal picture is possible.
Leslie Bank
This article explores the impact and implications of the South African state’s adoption of a tough militarized, bio-medical, and essentially neo-colonial approach to the management of the COVID pandemic in the rural former Bantustans (“native reserves”) of the country. It argues that, while the “war on COVID” produced new national legislation for all citizens, those living “with custom” in former homelands were said to possess cultural attributes that amplified the risk of infection and death. The paper focuses on how the state constructed measures for these spaces and managed social interaction and burials in the migrant heartlands. The paper suggests that families “living with custom” in the former homelands were treated differently from other citizens, existing in what Giorgio Agamben (2004) might call a “state of (greater) exception.” Villagers used the metaphor of the gate closing on them (ukuvala isango) to describe their experience and exclusion during lockdown as customary practices were banned, local health facilities closed for deep cleaning, and bodies sealed in plastic at state hospitals and mortuaries. The latter measures disturbed rural families much more than police violence or the closure of government clinics because it presented a serious threat to social reproduction. The paper provides evidence of how families fought to restore conviviality by exhuming the bodies wrapped in plastic to allow them to communicate with kin and ancestors. It also shows how, after lockdown, vaccination was often treated as a family matter not an individual choice, and how families moved quickly to fix the spiritual insecurities wrought by COVID. The paper concludes with a harrowing account of the new epidemic of hunger and malnutrition that is stalking these landscapes as conviviality is not enough to secure survival. The paper highlights the limits of narrow bio-medical and individual rights-based approaches in dealing with health, livelihoods, and well-being in communities devastated by COVID in rural southern Africa.
Marc-Antoine Berthod, Gaëlle Clavandier, Philippe Charrier, Martin Julier-Costes, Veronica Pagnamenta, Alexandre Pillonel
With the advent of the COVID-19 pandemic, high mortality rates brought to the forefront the importance not only of the gestures performed and practices implemented on and about the deceased, but also, most importantly, of the entire sequence of funeral operations involved. The intensification of the work needed to take care of bodies in their biological component, from a technical point of view, generated uncertainties on the possibility to also adequately take care of the social components relating to families and loved ones. This raises questions about the factors influencing the experience of grief in these circumstances, and the extent to which funerary practices determine the nature and characteristics of grief work. Based on two anthropological research projects conducted in France and Switzerland in the mortuary and funeral realms, as well as with bereaved persons over the first eighteen months of the pandemic, this article aims at answering these questions. It argues that grief trajectories are strongly impacted by the way in which bodies were treated, as well as by whether the funeral was felt to have been conducted in a satisfactory manner. It also sheds new light on a series of factors pertaining to the temporality of the processes involved: dying circumstances; attitudes towards restrictions throughout the entire process of caring for the body, and not merely at the funeral; the period in the pandemic during which a death occurred, i.e., during or between “waves.” In so doing, the article broadens the ways in which we think about temporality and death.
New Technologies in Pentecostal Funeral Rituals During the COVID-19 Pandemic in Brazil
Andréia Vicente da Silva
During the coronavirus pandemic in Brazil, death rites were abbreviated. Hospital visits to the sick, collective farewell ceremonies, and coexistence with corpses were made impossible. In this article, by analyzing a Pentecostal funeral live stream that occurred in May 2020, I try to discuss the possibilities of ritual change in a context of exception. I conclude that the mediatization of funeral rites does not depend solely on the existence and access of the mourners to new technologies. The elements at play in these funerals occur in dialogue with symbolic contents—hierarchical, cosmological, doctrinal—and intersect with the properties of the new technologies, producing affectations in the form and content of the rites.
Concealment and Care in Deathcare During COVID
Hannah Gould, Samuel Holleran
During the worst months of the COVID-19 pandemic, photojournalistic depictions of the havoc wreaked by the virus became ubiquitous. Images of physically distanced funerals and large-scale body disposal populated newsfeeds, but the labor and experiences of those working within these images—people handling bodies and guiding bereaved families—remained largely hidden from public view. Even before the pandemic, visibility and public recognition were complicated matters for the “deathcare” sector, as professionals cautiously constructed and defended the line separating the family-facing frontstage and industry-insider backstage. Our engagement with this sector through photography was motivated by a desire to illuminate the experiences of those working in deathcare during COVID outbreaks and lockdowns in Melbourne, Australia. Reflecting on photography as method in the study of death, we think through the complexities of seeing and unseeing, exposure and concealment in contemporary death rituals. The pandemic exposed certain realities of death and dying to the public but obfuscated others. Further, our ethnographic practice of portraiture revealed concealment to be a key element of the caring labors that deathcare workers perform.
De-Exceptionalizing Pandemic Death in the United States: COVID-19’s Ambiguous and Layered Mourning
Ariel Santikarma, Sarah Wagner
In the spring and early summer of 2020, mainstream media in the United States announced the “death of ritual” as public officials limited communities from gathering to care for their deceased—whether COVID-19 victims or people who happened to die during this first wave of pandemic restriction. From backlogged funeral homes and crematoria to bodies stacked in refrigerated trucks and families scrambling to find their deceased, headlines seemed to augur an unprecedented condition of interrupted or derailed mourning. But how singular was this moment? On the one hand, funeral directors were telling a different story, reminding us that they’d been here before when the stigma of HIV/AIDS robbed the deceased and their loved ones of expected ritual care. On the other, as scholars of post-conflict societies and missing migrants can attest, COVID-19 was by no means unique in disrupting the pace and order of mourning. This piece challenges the characterization of pandemic death in the United States, especially in the first waves of infection, as exceptional because of what it glosses over: the predictability of which bodies and whose lives routinely pay the highest tolls. Instead, we reflect on the temporality of incomplete and curtailed care by juxtaposing the pandemic’s seemingly singular chronotope—born from the politicized bodies of the living as much as the dead—with the exigencies of uncertain death that surround missing persons of conflicts and borders. Seemingly punctuated events like wars and pandemics that give rise to aberrant death throw timelines into disarray; they also expose what underlies and endures: longstanding inequities to conditions that secure life in the first place. Thus, challenging this notion of presumed exceptionalism, we argue that the US experience of pandemic death and mourning throws into relief—at least temporarily—its systems of domination and invites a closer look at the intertwining projects of memory and political transformation.
John Troyer
How can and do pandemic events become productive for everyday human experiences of death and dying? This social thought and commentary piece’s central argument examines the productive potential of pandemics, specifically COVID-19, by focusing on the early impact of the coronavirus in 2020 and its longer-term ripple effects. By grounding this personal essay in these early reflections on an extremely intense period of both personal and global chaos, it is possible to begin discussing what future historians, anthropologists, and academics in related fields might glimpse when looking backward. It is also important to begin understanding how future pandemic response plans will emerge, building on the failures of 2020, in order to manage yet unknown global pandemics. One key takeaway for this planning work is to avoid defaulting into the essay’s core theoretical point, a concept I call virological determinism, where societal inequalities amplifying pandemic-related effects are entirely blamed on a virus and not the underlying social conditions caused by government negligence. By reflecting on the productive possibilities created by pandemics, it is also then possible to begin understanding how many more people died during the early years of COVID-19 than ever needed to.
Bob Simpson
Eileen Simpson died in a care home in Manchester, England on January 16, 2021. She was 92 and had been in decline for some months. She was hospitalized after a fall and spent six weeks in the hospital with family unable to visit. She didn’t die of COVID but her death was very much in the time of COVID. Her final hours in the nursing home were watched over by her son and daughter and two of her grandchildren. They couldn’t all be there together as COVID restrictions meant that only two were allowed by her side at any one time. Enlightened and humane staff at the nursing home had not insisted that the family watch events unfold through an outside window as they probably should have done.
Maurizia Mezza
In the context of the COVID-19 pandemic, pharmacovigilance activities detected and assessed symptoms, such as rare blood clotting disorders, myocarditis, and erythema multiforme, potentially linked to some adenovirus-based and mRNA-based vaccines. While some presumed side effects were swiftly assessed, others, such as menstrual disorders following mRNA vaccination, were subjected to prolonged debates. This paper explores the EMA’s assessment process of menstrual disorders, which initially resisted but eventually acknowledged a possible connection between Heavy Menstrual Bleeding (HMB) and the mRNA COVID-19 vaccine Comirnaty (also known as Pfizer). Through an analysis of the PRAC evaluation process, I suggest that epistemic injustice and the systemic neglect of menstruation contributed to the challenges in this assessment. This paper emphasizes that structural bias in healthcare, health research, and policy accumulates at different stages of pharmacovigilance, shaping the evidence about vaccine safety. Although vaccines are generally safe, they may, in fact, be safer – or at least known to be safer – for some groups. To address these issues, a pluralist and transdisciplinary approach to knowledge should play a crucial role, questioning how evidence is produced and acknowledging potential intersectional biases.
Budgetary processes in medical organizations under a global budget payment system
Cheng-Tsung Lu & Wen-Hsin Huang
This study examines the budgetary process of medical organizations under a global budget payment system. Using questionnaire results from budgeting supervisors, four key effects are identified: the motivational effect of budgetary participation, the information effect of budgeting information system (BIS) characteristics, the cognitive effect of budget quality, and the performance effect of budget performance. The results reveal that high budgetary participation enhances BIS characteristics (i.e. control, communication, and forecasting), which in turn improve budget quality and performance. Furthermore, both environmental competition and unpredictability significantly impact budgetary participation, and unpredictability also augments BIS characteristics. This study proposes a theoretical fit model and provides insights for medical organizations’ budgetary practices.
Lesley Jo Weaver, Claire W. Herbert, Dylan J. Podrabsky & Mackenzie L. Ní Flainn
In the name of public health protection, individuals and communities perceived to be diseased have long been coercively regulated through surveillance, sequestration, or various forms of criminal punishment. In the U.S., people experiencing homelessness (PEH) have been increasingly targeted by social control measures such as containment, banishment, or arrest, often under the guise of public health protection. This study explores how city employees and service providers we term ‘authorities’ use public health justifications to rationalize displacing PEH encamped on public property. We find that authorities draw on sensationalized ‘disease-model’ logics of health risk that pathologize PEH as vectors of infectious disease and drug-related harms. This approach allows authorities to rationalize their decisions to displace, but it locates responsibility for the social challenge of homelessness on homeless people themselves, without providing any resources to mitigate ostensible public health concerns for either PEH or the larger public. We conclude that displacement decisions appear logical only when authorities use a specious logic that disqualifies PEH from the ‘public’ being protected. By identifying coercive patterns in public health history and connecting them with the regulation of unsheltered homelessness, this analysis reveals an all-too-familiar picture, where those with power take coercive action upon those with less power instead of employing preventative or structural interventions that could meaningfully address homelessness.
Agata Chudzicka-Czupała, Fengyi Hao, Nadiya Hapon, Zlatyslav Dubniak, Weronika Różycka, Barbara Ostafińska-Molik & Roger Ho
The aim of the study was to compare mental health outcomes, coping strategies, and well-being between Ukrainian and Polish college students during the Russo-Ukrainian War. The sample included a total of 1,286 Ukrainian and Polish college students. An online survey was conducted using the DASS-21, PERMA-Profiler, and Brief-COPE questionnaires were collected. Pearson correlation and SEM analyses were performed to assess the relationships between the variables. Polish college students reported significantly higher levels of depression (p p p p p p p p p p p p p p
Culture, Medicine, and Psychiatry
Depression, Deprivation, and Dysbiosis: Polyiatrogenesis in Multiple Chronic Illnesses
Stefan Ecks
Biomedicine tends to treat “mental” illnesses as if they could be isolated from multiple social and somatic problems. Yet mental suffering is inseparable from complex somatosocial relations. Clinical fieldwork in a deprived area of the UK shows that nearly all the people treated for “depression” are chronically multimorbid, both in their bodies and in their social relations. Mental suffering is co-produced by poverty, trauma, and excessive medication use. Patients’ guts are as imbalanced as their moods. Single vertical treatments make them worse rather than better. In the UK, patients in poorer neighbourhoods do not “lack access” to healthcare. If anything, they suffer from taking too many medications with too little integration. I conceptualize the bad effects of excessive interventions in patients with multiple chronic problems as polyiatrogenesis.
Laura Hirshbein, David Im, and Imam Kamau Ayubbi
This article presents the case of a young, second generation American Muslim man who was admitted involuntarily to an adult psychiatric inpatient unit. The patient’s clinical picture was unclear—the treatment team was unsure if he demonstrated signs and symptoms of bipolar disorder or if a personality disorder (antisocial or narcissistic) better explained his presentation. His clinical picture after a couple of weeks of hospitalization was not sufficiently acute that he needed to remain in the hospital, but he refused to leave because he wanted documentation that he had no mental illness. This article considers the patient’s history, the nuances of psychiatric diagnosis, the issues involving psychiatry and the law that arose in this case, and the collaboration of the psychiatric providers with the Chaplain Imam at the hospital. The case illustrates a collision between the limitations of science and the expectations of the patient and his family within our broader social, cultural, and professional contexts.
East Asian Science, Technology and Society: An International Journal
Engineering Trust in Singapore’s Covid-19 Response
Sharad Pandian & Ian McGonigle
Scholars of trust and misinformation typically assume that the only two poles of legitimacy are democratic pluralism and scientific technocracy. This paper examines Singapore’s response to Covid-19 to argue that this nation-state instantiates an alternative ideal: political technocracy. Singapore’s ruling party of sixty years, the People’s Action Party (PAP), has long positioned itself as a long-term steward, whose authority rests on the trust it has cultivated among citizens, which it attributes to governmental transparency. We present a taxonomy of the state’s rhetorical strategies – ontological, moral, and statistical – to highlight the government’s active role in shaping public perceptions of national problems and the aptness of its policies. This taxonomy elucidates how Singapore’s political technocracy differs from scientific technocracy, while still highlighting the state’s strategic deployment of the rhetoric of science and ad hoc experts for legitimacy. In so doing, we invite further consideration of the relationships between science and public trust in illiberal authoritarian states.
Ming-Sin Choong, Ying-Che Hsieh & Chan-Yuan Wong
This paper examines and reviews three years of the preventive measures taken by different countries, which led us to frame the most effective mitigation and coping mechanisms that were deployed to cushion the impact of Covid-19 outbreaks on respective health systems. Measures taken by five countries (the United States, United Kingdom, India, South Korea, and Taiwan) are used as case studies. We delineate the resilience measures within the scope of “coping” and “transcending.” The elucidation of these measures is demarcated into three control phases: feedforward control, concurrent control, and feedback control. Our review reveals that the US, UK, and India struggled as a result of chaotic coordination by their public health systems to cope with high admission rates of Covid-19-infected patients; however, they possessed the ability to learn swiftly and to identify and produce vaccine candidates to transcend the crisis. Meanwhile, South Korea and Taiwan were found to have the ability to cope with the upheavals they encountered during the pandemic crisis. The holistic framework of resilience measures we derive may be instrumental to policy makers, public health specialists, and researchers, setting out as it does the coping and transcending abilities within the context of a learning society.
Sara Bea
This article presents an ethnographic study of the donor body in deceased organ donation. Drawing on the science and technology studies’ incitement to study bodies being enacted and acted upon in situated practices, I explore the body being done and becoming undone in the practices of organ procurement at a Catalan hospital. The hospital has uniquely high rates of organ donation and transplantation, and deceased organ donation has become routinised and integrated into everyday hospital activities. I attend ethnographically to the medical professionals’ accounts of and interactions with bodies and organs in their work dealing with both donors after brain death diagnosis and uncontrolled donors after circulatory death diagnosis. During fieldwork, I followed the struggles of the transplant coordination team grappling with unruly bodies under different maintenance technologies. The body being done in these hospital practices is an active and unstable materiality that must be contended with: a labile body, or a fragile assemblage of interdependent functions, requiring multiple interventions provided by a host of dedicated hospital practitioners. The article shows that staying close to the medical professionals’ situated accounts is a valuable route to gaining novel understandings of the donor body.
Maria Pozzio, Daniela Testa
The article analyses the politicisation of nursing personnel during the COVID-19 pandemic in Argentina, focusing on the trajectories of nurses trained in the public universities of the so-called ‘conurbano bonaerense’, especially in the young universities of the ‘Bicentenario’, rooted in a territory with strong traditions of popular political participation. The pandemic context accelerated the struggles for professional recognition among nurses. Analysing this process constitutes a significant contribution to the social studies of health and illness in Latin America, particularly regarding the role of gender. The pandemic has highlighted the necessity of making the history and demands of the nursing profession visible. Against this background, this article emphasises the challenging working conditions and lack of recognition faced by the nursing profession in Argentina, both materially and symbolically. Based on the analysis of narratives provided by nurses in the context of the COVID-19 pandemic, the article analyses three politicisation trajectories of nursing graduates of Universidad Nacional Arturo Jauretche, on the conurbano bonaerense, the metropolitan area of Buenos Aires. We demonstrate the importance of the institutional context of the universities in this territory and underline its significance for the politicisation process we have observed.
Hope and Haunting Images: The Imaginary in Danish Parkinson’s Disease Rehabilitation
Merete Tonnesen, Claus Vinther Nielsen
Much in life is imagined: hoped for, dreamed about, or dreaded, as we engage with potential futures. Parkinson’s disease is a progressive and neuro-degenerative disease, currently incurable. During long-term fieldwork among Danish rehabilitees with Parkinson’s disease, rehabilitees’ mentioning of hope and images of the future gradually inspired attention to an imaginary dimension in rehabilitation. We explore haunting images and hope among rehabilitees as examples of the imaginary in rehabilitation, but also as windows into how rehabilitees orientate themselves towards an uncertain future. We show how rehabilitees’ imaginations of the future resemble hauntings instigating an urge to ‘do something’ to avoid their actualisation; to insist on living in the now, keeping up training, and partaking in clinical trials. This urge translates into rehabilitation practices, where rehabilitees and professionals work with both hope and rehabilitation goals to maximise the present and postpone the future. We emphasise that hope is a complex phenomenon; it is multiple and has a certain elasticity. A person can carry multiple hopes at once; hope can be agentic, co-created and worked with, located, or be an existential stance.
Surveillance in Medically Assisted Reproductive Care in France
Alexandra Desy et al.
Beyond the laws, different institutions watch over – or veille sur – the access to and practice of medically assisted reproductive care in France. Although a shift in the moral regimes underlying French reproductive governance can be observed, ART practices are monitored through surveillance mechanisms, the economic and medical nature of which conceals their normalizing function. Woman and couples who do not correspond to these norms are prevented from forming a family through the French ART system. In this article we show how, faced with this reproductive exclusion, French women and couples choose to undertake cross-border reproductive care in an attempt to circumvent surveillance and fulfil their reproductive desire.
Speculating About Futures with Covid Reinfection in the UK: The Body as a Site of Educated Guesswork
Anna Dowrick et al.
We revisit a time in 2021 when people in the UK were coming to terms with an unwanted future characterized by chronic COVID-19 infection. Drawing on experiences of people who had already experienced COVID-19 infection, we explore how they made sense of newly perceived vulnerabilities and the possibility of reinfection. We highlight the work of speculating about the future, which involved making “educated guesses” based on embodied knowledge as understanding about different consequences of “living with COVID-19” moved in and out of view.
Social Iatrogenesis and Social Risks Among Queer PrEP Users in Dar Es Salaam
Inga Haaland et al.
ABSTRACT
Pre-exposure prophylaxis, commonly known as PrEP, is an HIV-preventative pill taken to reduce the risk of contracting HIV. During a PrEP study in Dar es Salaam among queer PrEP users, this ethnographic study observed how PrEP users experienced novel types of (social) risks and harms, or social iatrogenesis, imposed by the biomedical HIV prevention pill or the PrEP program. These forms of social iatrogenesis related to lack of autonomy, creating demand for PrEP, then removing services, projectivization of PrEP programs, social risks related to fear of stigma by association, and clinical encounters producing multiple understandings of adherence and usage of PrEP.
SWAHILI ABSTRACT
Pre-exposure prophylaxis, inayojulikana kama PrEP, ni kidonge cha kuzuia VVU ambacho huchukuliwa ili kupunguza hatari ya kuambukizwa VVU. Wakati wa utafiti wa PrEP jijini Dar Es Salaam miongoni mwa watumiaji wa queer PrEP, utafiti huu wa kiethnografia uliona jinsi watuamiaji wa PrEP walivyokabiliwa na aina mpya za hatari na madhara (kijamii), au iatrogenesis ya kijamii iliyowekwa na kidonge cha kuzuia VVU kimatibabu au mpango wa PrEP. Iatrogenesis hizi za kijamii zilihusiana na ukosefu wa uhuru, kuunda mahitaji ya PrEP, kisha kuondoa huduma, uboreshaji wa program za PrEP, hatari za kijamii zinazohusiana na hofu ya unyanyapaa kwa kushirikiana na matukio ya kimatibabu yanayozalisha uelewaji mwingi wa ufuasi na matumizi ya PrEP.
Violeta Argudo-Portal
This research asks what is being put to the test by breast and gynecological cancer predisposition testing in Spain beyond genes or cancer. By combining document analysis and fieldwork with national healthcare professionals and drawing on the anthropology and sociology of testing, I examine how the molecular relations of these tests extend to the political economy of the national healthcare system. I show how the capacity of these tests to produce a low-risk collective has paradoxical consequences for the political economy of the national healthcare system, unsettling professionals’ concerns and spotlighting what is prioritized in personalized medicine strategies.
Reproductive Healthcare After Dobbs: Rethinking Obstetric Harm in the United States
Mara Buchbinder et al.
The obstetric violence framework proposes that clinicians harm pregnant people through physical and psychological mistreatment and violations of autonomy. In this article, we analyze interviews with 54 obstetrician-gynecologists (OB-GYNs) practicing in US states with near-total abortion bans to show how similar harms may also be performed through actions of the state. Reframing obstetric harm to include the behind-the-scenes work of state legislators as a looming presence in the clinical encounter permits us to see OB-GYNs from a different vantage point, and to understand their role as experiencing – and not just perpetuating – obstetric harm.
Medical Anthropology Past, Present, and Future: The State of the Art
James Staples et al.
When we accepted our roles as editors of this journal back in 2020, the COVID-19 pandemic had only recently taken the world by storm. One of our challenges was to think about how a journal such as Medical Anthropology could best respond to world events, predictable or otherwise, as they unfolded through the painstaking ethnography that is our discipline’s hallmark.
Medical Anthropology Quarterly
Ann H. Kelly, Clare Chandler, Julie Livingston, and Vincanne Adams
The COVID‐19 pandemic prompted critical attention to the performative power of metrics. We suggest that the existential capacities of metrics as a means of pandemic living warrant further consideration. We describe how the COVID‐19 pandemic that came into existence as a public health and political event could only have occurred because of the anticipatory metrical practices that were used to transform SARS‐COV‐2 into a matter of global health concern. By exploring the affective potencies of COVID‐19 metrics we show their abilities to engage the public in ways that cannot be contained; in detailing the narrative arcs created through metrics we show their opportunities, misdirections, and erasures. A pandemic way of life persists: a pandemic of metrics.
Ebola lessons: Did prior epidemic experience protect against the spread of COVID‐19 in Sierra Leone?
Kristen E. McLean
The COVID‐19 pandemic has prompted a re‐examination of public health preparedness with an emphasis on lessons learned following the West African Ebola epidemic. However, much of this work focuses on technological solutions rather than social learning. Drawing upon anthropological work, this paper examines how Sierra Leoneans prepared for COVID‐19 through a lens of “embodied epidemic memory.” Findings reveal that while people felt more empowered to respond to COVID‐19 due to their past experiences, traumatic memories from the Ebola outbreak also sparked logics of fear and avoidance, driven by mistrust toward the state and its healthcare system. As a result, people avoided healthcare facilities, and rumors concerning government corruption threatened mitigation efforts. While local populations should be better leveraged for their existing epidemic expertise, greater attention is needed to the “higher hanging fruit” of preparedness: restoring trust in the government’s ability to respond to epidemics.
Alyssa L. Basmajian
In the contemporary American political landscape, gerrymandering and the passage of anti‐abortion legislation are intimately connected in what I call reproductive gerrymandering. I develop this concept as an analytic tool to understand the disjuncture between the passage of laws restricting reproductive healthcare access and the will of the majority of voters. In this ethnographic project, Ohio serves as an important case study where efforts to elect a supermajority of extremist anti‐abortion Republican officials has allowed for the passage of unpopular legislation restricting abortion. I argue that the mundane bureaucratic processes involved in electoral redistricting and state budget procedures are forms of bureaucratic violence that result in structural harm experienced by pregnant people, especially those who are most marginalized. Reproductive gerrymandering provides a means for theorizing the connections across domains involving partisan redistricting, reproductive governance in the form of anti‐abortion legislation, and the structural violence experienced by pregnant people seeking abortion.
Brenna McCaffrey
After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next‐to‐no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors’ desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico‐legal frameworks within the topic of assisted dying, I build on Anita Hannig’s idea of “agentive displacement” to frame the productive impact of abortion pills on this transition.
Birthing hostages: Haitian women’s stories of maternal medicine, debt, and hospital detention
Alissa Jordan
What does it mean that hospitals in Haiti have become widespread sites of “kidnapping” for mothers and babies? In at least 46 countries, including Haiti, indebted patients are extralegally held prisoner in hospitals until family members, kin, outside groups, or charities pay their outstanding bills. The majority of those detained globally are women following complicated births. This article introduces and situates the global problem of “hospital detention” as it is practiced in Haiti, tying it to transnational architectures that target Black reproduction in global health. In this piece, Senisha and Mari share their experiences of detention, revealing the practice as continuous with other forms of coercion, neglect, and violence they face in seeking safe births, and highlighting the communal care, refusals, and acts of self‐liberation that oppose these oppressions.
“They think we wear loincloths”: Spatial stigma, coloniality, and physician migration in Puerto Rico
Adrian Santiago‐Santiago, Alixida Ramos‐Pibernus, Armando Matiz‐Reyes, Claudia Mercado‐Rios, John Vertovec, Joshua Rivera‐Custodio, Kariela Rivera‐Bustelo, Kevin Grove, Mark Padilla, Nelson Varas‐Diaz, Sheilla Rodríguez‐Madera, and Yoymar González‐Font
Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island’s presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.
“Doing genetic literacy”: a discourse-oriented approach to literacy in genetic contexts
Zhengpeng Luo et al.
This paper proposes a discourse-oriented approach to genetic literacy. The increased availability of genetic testing requires a certain level of genetic literacy among the public. This is important to understand the benefits and the risks of genetic testing. In this paper, we suggest that genetic literacy is not just a set of knowledge and skills that people have, but something that they do. It is discursively accomplished, and socially and culturally constitutive. We illustrate our approach using a genetic counseling consultation for Sudden Arrhythmic Death Syndrome (SADS). We examine how in this consultation, through careful orientation to the clients’ understanding of genetic information, extended explanation-giving and education on genetics, the geneticist supports the clients in their decision about genetic testing. We discuss our findings in relation to clinical and non-clinical genetic contexts and highlight the importance of genetic literacy and professional support in diverse situations where genetic testing is considered.
George Montandon, the Ainu and the theory of hologenesis
John L. Hennessey
In 1909, Italian zoologist Daniele Rosa (1857–1944) proposed a radical new evolutionary theory: hologenesis, or simultaneous, pan-terrestrial creation and evolution driven primarily by internal factors. Hologenesis was widely ignored or rejected outside Italy, but Swiss-French anthropologist George Montandon (1879–1944) eagerly embraced and developed the theory. An ambitious careerist, Montandon’s deep investment in an obscure and unpopular theory is puzzling. Today, Montandon is best known for his virulent antisemitism and active collaboration with the Nazi occupation of France at the end of his career. By that point, however, he had quietly moved away from hologenesis. This shift has gone unnoticed or been left unexplained in existing research. This article reexamines Montandon’s theoretical outlook and reasons for championing Rosa’s forgotten theory. It argues that while Montandon’s adoption of hologenesis arose from a complex blend of scientific and personal factors, his previously overlooked early fieldwork with the Ainu played a key role. In contrast, hologenesis did not inform Montandon’s later public antisemitism.
Francis Lee
The sociological study of knowledge infrastructures and classification has traditionally focused on the politics and practices of classifying things or people. However, actors’ work to escape dominant infrastructures and pre-established classification systems has received little attention. In response to this, this article argues that it is crucial to analyze, not only the practices and politics of classification, but also actors’ work to escape dominant classification systems. The article has two aims: First, to make a theoretical contribution to the study of classification by proposing to pay analytical attention to practices of escaping classification, what the article dubs classification egress. This concept directs our attention not only to the practices and politics of classifying things, but also to how actors work to escape or resist classification systems in practice. Second, the article aims to increase our understanding of the history of quantified and statistical health surveillance. In this, the article investigates how actors in health surveillance assembled a knowledge infrastructure for surveilling, quantifying, and detecting unknown patterns of congenital malformations in the wake of the thalidomide disaster in the early 1960s. The empirical account centers on the actors’ work to detect congenital malformations and escape the dominant nosological classification of diseases, the International Classification of Diseases (ICD), by replacing it with a procedural standard for reporting of symptoms. Thus, the article investigates how actors deal with the tension between the-already-known-and-classified and the unknown-unclassified-phenomenon in health surveillance practice.
Volker Roelcke
This article uses four historical case studies to address epistemological issues related to the animal model of human diseases and its use in medical research on human diseases. The knowledge derived from animal models is widely assumed to be highly valid and predictive of reactions by human organisms. In this contribution, I use three significant historical cases of failure (ca. 1890, 1960, 2006), and a closer look at the emergence of the concept around 1860/70, to elucidate core assumptions related to the specific practices of animal-human knowledge transfer, and to analyze the explanations provided by historical actors after each of the failures. Based on these examples, I argue that the epistemological status of the animal model changed from that of a helpful methodological tool for addressing specific questions, but with precarious validity, to an obligatory method for the production of strong knowledge on human diseases. As a result, there now exists a culture of biomedical research in human disease that, for more than a century, has taken the value of this methodological tool as self-evident, and more or less beyond question.
Instituting Traditional Medicine: changes to identity and legitimacy in global health
Pedro Crepaldi Carlessi
Based on reports from the World Health Organization, this ethnography concerns the concept of tradition/traditional as a quality of contemporary medicine. The discussion focuses on the way in which this term has been mobilized within the context of global health and, not least, on its effects while being instituted as a therapeutic category. From a medical anthropology approach, I track the mobilization of this concept from the 1960s to current reports, through the Organization’s headquarters to its regional branches. I intend to highlight the shifts in its conceptualization, specifically, how the term has reshaped the identity and legitimacy of medicine and medication.
Trixie Kemp, Jennifer Ayton, Kerryn Butler-Henderson, Mary Lam
Socio-Technical Systems (STS) Theory is an organisation theory used to study the relationships, interdependencies, and interactions between social elements such as people and structures, and technical elements of task and physical systems. STS has recently gained popularity in the digital health field. To better understand how socio-technical systems can be used to research the health information management field, this paper explores STS theory from its origin, four different approaches, and their application in various studies. Leveraging knowledge gained from other industries on using socio-technical systems, an example of privacy demonstrates this theory’s application in current research examining HIM professionals’ contribution to patient safety in Australian acute hospitals. The article further explores why this approach is suitable for studying this workforce and why this theory remains relevant today.
Michael Ashworth, Emilie Cloatre
This paper employs a governmentality framework to explore resistance by CAM sceptics to homeopathy’s partial settlement in the public health systems of England and France, resulting in its defunding in both countries in 2018 and 2021, respectively. While partly dependent upon long-standing problematisations (namely, that homeopathy’s ability to heal is unproven, its mechanisms implausible, and its consequences for patients potentially dangerous), the defunding of homeopathy was also driven by the conduct of CAM sceptics, who undermined homeopathy’s position in strikingly different ways in both contexts. This difference, we suggest, is a consequence of the diverging regulatory arrangements surrounding homeopathy (and CAMs more generally) in England and France—and the ambivalent effects of CAM’s regulation. If law and regulation have been a key component of CAM’s integration and (partial) acceptance over the past four decades, the fortunes of homeopathy in England and France highlight their unpredictability as techniques of governmentality: just as the formal regulatory systems in England and France have helped to normalise homeopathy in different ways, they have also incited and galvanised opposition, providing specific anchor-points for resistance by CAM sceptics.
Simon Thomsen, Annelli Sandbæk, Sine Agergaard
According to biomedical notions, physical activity (PA) is an integral part of treatment for several non-communicable diseases, Type 2 diabetes (T2D) among them. Adapting one’s life in accordance with such notions, however, involves considerations that reach beyond what can be confined to treatment decisions. Thus, we aim to explore the various reasons for doing PA or not among healthcare workers and people with T2D taking part in programs that promote PA. We do so based on ethnographic fieldwork that includes observations and focus group interviews in two programs in a Danish municipality, and with inspiration drawn from Habermas’ theory of communicative action. Our results show that healthcare workers emphasize primarily health-related reasons for doing PA, including a moral imperative to be healthy, while people with T2D have a slew of other reasons for doing PA or not. These reasons together illustrate that for participants with T2D, long-term concerns for health and disease take a backseat to more immediate concerns for enjoyment, pain, and family, and that the participants generally reject the normative health imperative. We suggest that healthcare workers and participants with T2D engage in dialogue about their normative assumptions with the purpose of reaching a mutual understanding.
A. T. Grygierczyk
The study of the social dimensions of healthcare (decision-making) behaviour lacks a foundational theory. Using extant studies, this paper argues and demonstrates that their results can be placed on the social manifold that is spanned by the four idealistic poles described by Durkheim’s (On Suicide, 1897) work ‘On Suicide’ and that these poles can therefore be extended to theoretically represent four ideal types (meanings) of healthcare choice: altruistic choice (excessive integration), egoistic choice (absence of integration), fatalistic choice (excessive regulation), and anomic choice (absence of regulation). By using Bearman’s (Sociological Forum 6(3): 501–524, 1991) structural model of suicide, this social manifold is theoretically unfolded by representing all possible tangible (network) structures as a function of integration and regulation, which additionally amplifies and extends Durkheim’s theory. This approach builds upon Pescosolido’s (Advances in Medical Sociology 3(1):161–184, 1991) Network Episode Model and provides opportunity to connect it further to the Social Symbiome.
Man-Kit Lei, Stephanie L. Hanus, Leslie G. Simons, Ronald L. Simons, Steven R.H. Beach
Recent studies show that chronic exposure to racial discrimination increases the occurrence of subjective cognitive decline (SCD) among Black Americans. Little research, however, has examined potential for protective factors, such as perceived partner support, to buffer these effects.
Sean Urwin, Laura Anselmi, Emmanouil Mentzakis, Yiu-Shing Lau, Matt Sutton
There is concern that basing healthcare budgets on risk adjustment estimates derived from historical utilisation data may reinforce patterns of unmet need. We propose a method to avoid this, based on a measure of how closely local health organisations align resources to the needs of their populations. We refer to this measure as the ‘responsiveness of expenditure to need’ and estimate it using national person-level data on use of acute hospital and secondary mental health services in England. We find large variation in responsiveness in both services and show that higher expenditure responsiveness in mental health is associated with fewer suicides. We then re-estimate the national risk-adjustment model removing the data from the organisations with the lowest expenditure responsiveness to need. As expected, higher need individuals are estimated to have higher expenditure needs when less responsive organisations are removed from the estimation of the risk-adjustment. Removal of organisations with below-average responsiveness results in the neediest deciles of individuals having an extra £163 (7%) annual need for acute hospital care and an additional £79 (27%) annual need for mental health services. The application of this approach to risk adjustment would result in more resources being directed towards organisations serving higher-need populations.
Isaac Halstead, Jon Heron, Connie Svob, Carol Joinson
- We identified 4 qualitatively different groups of belief.
- These groups have different associations with depression, anxiety, and wellbeing.
- Associations found in predominantly US literature may not hold in non-US samples.
- There is a need to explore mechanisms that explain these findings.
Measuring the effect of historical structural racism on community firearm violence in US cities
Ariana N. Gobaud, Christopher N. Morrison, Charles C. Branas, Sara Jacoby, … Paris B. Adkins-Jackson
- Community firearm violence impacts marginalized groups in the US disproportionately.
- Structural racism is a key factor driving disparities in rates.
- Cities with a history of structural racism have higher shooting rates from 2015 to 2019.
- Need for research and interventions to address historical structural racism.
Nathan Cardon
The safety bicycle arrived in the U.S. South in the middle of a transition from relative African American freedom following the Civil War to a reassertion of white hegemony in the region. This article examines how white and African American southerners interpreted the meanings and practices of the safety bicycle through a contingent spatial and mobility politics found at the intersection of race and technology. For African Americans, the bicycle was both a symbolic and real opportunity to express modern freedoms at the moment those freedoms were being curtailed. The South, however, was not the only region of the world where the politics of race shaped bicycle mobilities, and this article points to the ways the southern experience of bicycle technology mirrors but does not necessarily replicate places beyond the United States.
“Contagion by Telephone”: Print Media and Knowledge about Infectious Diseases in Britain, 1880s–1914
Amelia Bonea
Communication technologies have long generated anxieties about physical and mental well-being. From the 1880s until World War I, concerns about “infection by telephone” in the British press prompted medical authorities and the National Telephone Company to investigate whether using the telephone, especially in public places, increased the possibility of contracting infectious diseases such as tuberculosis and diphtheria. This article reconstructs for the first time these transnational debates and the associated medical experiments. In contrast to previous scholarship, which has conceptualized health concerns associated with the telephone primarily within the framework of a nervous modernity, this article argues that the anxieties about “infectious telephones” also reflected the complex negotiations surrounding the emergence of new telecommunication networks and medical theories. It demonstrates that state and commercial actors, medical knowledge, and print media all shaped notions of public health risks and how to contain them.
