Somatosphere

The Berlin Wall as metaphor and diagnosis

2009-11-09T10:22:00.006-05:00

Twenty years ago today the Berlin Wall fell (both materially and metaphorically) and state socialism in Eastern Europe entered its final period of collapse. However, as the ample anthropological literature on the area shows us (and as Slavoj Zizek discusses in an op-ed piece in today's New York Times) two decades of postsocialism have had far from unequivocal results.

A more thorough discussion of the anthropological literature on postsocialism--as it relates to issues of medicine, health and science will have to wait, but at the moment I'd like to highlight a couple of interesting articles which examine the Berlin Wall specifically as a construct in psychological discourse. In "The Berlin Wall on the Therapist's Couch" and "Constructions of the Berlin Wall: How Material Culture Is Used in Psychological Theory," sociologist of science Christine Leuenberger has written about the psychological sciences in Germany have used the Wall as a means of understanding the basis of individual distress and as a metaphor for social malaise. Here's the abstract from the latter article:

This article examines how, in the latter part of the twentieth century, the German psychological sciences used the Berlin Wall to interpret and make sense of the psychological make-up of the German people. It focuses on how the wall has been invoked by psychiatrists, applied psychologists, and psychotherapists in their writings at three historical moments: (1) after its initial construction in 1961, (2) immediately after its fall in 1989, and (3) 10 years after its demise. After the wall was erected, it became an interpretive resource to think about a divided society, and to make visible, decipherable, and classifiable, the inner life of a people. Shortly after its fall, it continued to serve as a basis for categorizing human suffering. Ten years later the wall had been rhetorically transformed into a “mental wall” offering a compelling metaphor for modern Germany's apparent psychological and cultural divide. The three case studies exemplify how the psychological sciences use material objects, such as the Berlin Wall, as interpretive resources to reflect on psychological issues, make sense of societal transformations, and create and solve social problems," (Leuenberger 2006).

The first of these case studies is particularly interesting. It concerns:

"...the book Die Berliner Mauerkrankheit (The Berlin wall disease) written by a prominent East German psychiatrist, Dietfried Müller-Hegemann (1973), shortly after the building of the Berlin Wall in 1961 (but not published until after his emigration to the West). Müller-Hegemann drew on his collection of patient histories to highlight the deleterious social and psychological consequences of a society encircled by the wall. He investigated what Berliners had already started to talk about—whether the newly built wall was causing a novel psychological disease: “the wall disorder,” (Leuenberger 2006: 22).

In 1990, a book by Hans Joachim Maaz, an East German cultural critic and psychotherapist examined the Wall's fall in broad cultural terms, drawing upon psychoanalytic language--a mode of analysis which itself signified a shift away from the orthodox therapeutic theories of the East (which framed psychoanalysis as bourgeois and capitalist):

"In his book Der Gefühlsstau (Emotional Blockage), Maaz (1990) described that fateful night in November 1989 as a psychological revolution: “The wall’s fall was the emotional climax of the unloading, the cathartic breaking-through . . . of the unconscious. The emotional blockage unclogged, the repressed came to the surface, and the parts that had been split apart, united” (p. 152). East Germans’ “emotional blockage” had built up over years of a “walled in and restricted existence” marked by “authoritarian” structures in schools, homes and professions (Maaz 1990:15). He argued that “the wall provided the outer framework” for East Germany’s “repressive and authoritarian” (p. 15) political, medical, and educational institutions and practices," (Leuenberger 2006: 27).

Finally, the 1990s saw the rise of the notion of “die Mauer in den Köpfen” (the wall in the heads) -- as a frequently cited construct through which journalists, psychologists and cultural critics conceptualized (and Leuenberger suggests, reified) persistent differences between East and West.

Interestingly, Leuenberger has followed up this work with a new project on the barrier constructed by Israel along the border with the West Bank.

The references:

Christine Leuenberger. "Constructions of the Berlin Wall: How Material Culture Is Used in Psychological Theory." Social Problems, February 2006, 53(1): 18–37.

Christine Leuenberger. "The Berlin Wall on the Therapist's Couch." Human Studies, April 2000, 23(2): 99-121.

And a couple of additional key anthropological texts on post-socialist East Germany:

John Borneman. Belonging in the two Berlins: Kin, state, nation. Cambridge University Press: 1992.

Daphne Berdahl. Where the world ended: re-unification and identity in the German borderland. University of California Press: 1999.

Image source: Wikipedia/Senate of Berlin

In the journals

2009-11-08T12:46:00.004-05:00

Below are some recent issues that might be of interest:

In the Journal of Ethnobiology and Ethnomedicine, Andrea Pieroni and Maria Elena Giusti conducted a medical ethnobotanical study of the Occitan communities in Italy, titled "Alpine ethnobotany in Italy: traditional knowledge of gastronomic and medicinal plants among the Occitans of the upper Varaita valley, Piedmont".

Istav Praet examines shamanic-curing-as-metamorphosis in Northern Ecuador in the Journal of the Royal Anthropological Institute in an article titled "Shamanism and ritual in South America: an inquiry into Amerindian shape-shifting".

In Cultural Anthropology, Julie Livingston looks to Botswana's middle and aspirational classes in order to examine the conceptualization of risk, investment, and self-determination. She concludes her essay by examining these concepts within the contexts of a cancer ward. Jean M. Langford analyzes the reciprocity between the living and the dead in "Gifts Intercepted: Biopolitics and Spirit Debt".

In this month's issue of the International Journal of Social Psychiatry, we find many pertinent studies of mental health, including its relationship with migrants in non-Western contexts and social networks in inpatient and day care settings.

Among many relevant articles, Rhona O'Connell and Soo Downe conducted a metasynthesis of midwifery and Hans Hadders examines the interplay between perceptions of death and life sustaining medical technologies in this month's issue of Health.

Cultural Formulation: A Special Issue of Transcultural Psychiatry

2009-11-07T18:03:00.013-05:00

The latest issue of Transcultural Psychiatry is a special issue, entitled "Cultural Formation". In Roberto Lewis-Fernández’s editorial introduction to the issue, he writes:

"The Outline for Cultural Formulation, developed for DSM-IV by the Group on Culture and Diagnosis of the National Institute of Mental Health, represents the most substantive cultural contribution to the DSM series. It provides instructions for conducting a cultural formulation, a systematic assessment of the patient’s cultural identity, illness representations, perceived causation, treatment expectations, cultural context of stressors and supports, and other relevant cultural factors that can be carried out with a patient from any cultural background during a mental health evaluation. … The upcoming publication of DSM-V in 2012 has provided the impetus for a thoroughgoing re-evaluation of the DSM-IV Cultural Formulation Outline. Substantial revisions are planned to the content of the Cultural Formulation, and efforts are underway to increase its visibility in DSM-V, thereby encouraging its uptake in clinical settings. … This issue of Transcultural Psychiatry greatly advances the revision of the DSM-IV Outline by addressing several of these key topics with the critical eye of the researcher who also works and thinks as a provider." (Lewis-Fernández 2009: 379-381)

Here is a listing of the issue’s articles, along with their abstracts:

Juan E. Mezzich, Giovanni Caracci, Horacio Fabrega, Jr., and Laurence J. Kirmayer, “Cultural Formulation Guidelines”

The outline for the Cultural Formulation (CF) introduced in DSM-IV does not present any method for collecting the required cultural information. The absence of specific guidelines and illustrative cases has hampered its wider use. This article offers a practical approach to preparing a Cultural Formulation as a component of culturally competent clinical care. We summarize the rationale for the four sections of the CF, describe the process of conducting culturally focused clinical interviews, and present examples of questions or lines of inquiry that can be used to collect the information needed to construct the CF. An online supplement provides case examples of cultural formulations applied to patients seen in the US.

Sofie Bäärnhielm and Marco Scarpinati Rosso, “The Cultural Formulation: A Model to Combine Nosology and Patients’ Life Context in Psychiatric Diagnostic Practice”

This article discusses the experience of adapting and applying the Outline for a Cultural Formulation in DSM-IV to the Swedish context. Findings from a research project on the Cultural Formulation highlight the value of combining psychiatric nosological categorization with an understanding of patients’ cultural life context in order to increase the validity of categorization and to formulate individualized treatment plans. In clinical care practitioners need models and tools that help them take into account patients’ cultural backgrounds, needs, and resources in psychiatric diagnostic practice. We present a summary of a Swedish manual for conducting a Cultural Formulation interview. The need for further development of the Cultural Formulation is also discussed.

Lisa R. Fortuna, Michelle V. Porche, Margarita Alegría, “A Qualitative Study of Clinicians’ Use of the Cultural Formulation Model in Assessing Posttraumatic Stress Disorder”

The Cultural Formulation (CF) of the Diagnostic and Statistical Manual (DSM) provides a potential framework for improving the diagnostic assessment of Posttraumatic Stress Disorder (PTSD) in culturally diverse patients. We analyzed data from the Patient-Provider Encounter Study, a multi-site study that examines the process of diagnosis and clinical decision-making during an initial clinical intake session, in order to examine use of CF for PTSD diagnosis. We find that while the CF is generally used inconsistently or underutilized in routine community settings, when employed appropriately it may assist the formulation and interpretation of traumatic experiences. We discuss the implications for improving the assessment of PTSD in the time-limited setting of the clinical intake encounter and across race/ethnicity.

Simon Groen, “Recognizing Cultural Identity in Mental Health Care: Rethinking the Cultural Formulation of a Somali Patient”

Although there are many ways to produce a cultural formulation that facilitates a culturally sensitive diagnosis and treatment for asylum seekers and refugees in mental health care, it is essential to gain trust and ‘recognize’ the patient. One way to achieve this recognition is through a cultural interview, in which cultural references of the health care provider and the patient are exchanged. This paper presents an example of such a process with a Somali migrant to the Netherlands, whose passivity and inactivity puzzled the psychiatrist. Gaining his trust and recognizing his cultural roots as a member of a Somali ethnic group revealed more about his motives, concepts and attitude. This example suggests the importance of cultural identity as a way to explore the meanings of the illness and the interrelationship between the patient and health care provider. The cultural identity of the patient is a basis on which meanings can be exchanged in an ongoing way and starting points for effective treatment can be found.

Dana Lizardi, Maria A. Oquendo, and Ruth Graver, “Clinical Pitfalls in the Diagnosis of Ataque de Nervios: A Case Study”

Ataque de nervios (attack of nerves) is an idiom of distress generally thought of in relation to Caribbean Hispanics. The following case study discusses the presentation of ataque de nervios in a Colombian female. This case study provides insight into a different presentation of ataque de nervios population that clinicians should be aware of in order to ensure accurate diagnosis. Ataque de nervios is a distinct syndrome that does not fully correspond with any single DSM-IV diagnosis. However, there is overlap between symptoms in this condition and those in conventional clinical diagnoses. Common problems in deriving an accurate differential diagnosis are discussed. Implications for treatment are also reviewed, with an emphasis on a comprehensive approach to treatment that supports the client’s norms and values.

Hans Rohlof, Jeroen W. Knipscheer, and Rolf J. Kleber, “Use of the Cultural Formulation with Refugees”

This article discusses the experiences of mental health professionals who applied the Cultural Formulation (CF) of the DSM-IV for assessment of psychopathology and treatment needs of refugees in the Netherlands. The CF approach proved to be a useful tool in the assessment and diagnostic phase of clinical treatment. However, patients reported problems with defining their own culture and providing explanations of illness and therapists had difficulty identifying culturally-based difficulties in the clinical relationship. Additional information was needed about working with interpreters, therapists’ attitudes towards the culture of the patient and towards their own culture, patients’ previous experiences with discrimination and inaccessibility of care, gender issues, and specific cultures and subcultures. A more structured approach to conducting the CF is recommended. We developed the "Cultural Formulation Interview" for this purpose. The adaptations are aimed at improving the CF for use with refugee populations, as well as for more general use in transcultural psychiatry.

Luis Caballero Martínez, “DSM-IV-TR Cultural Formulation of Psychiatric Cases: Two Proposals for Clinicians”

This article reviews some limitations of the current guideline for the DSM-IV-TR Cultural Formulation (CF) from the perspective of psychiatric practice that are based on the author’s experience conducting doctoral courses on cultural psychiatry from 1996 to 2007 in the Department of Psychiatry at the Universidad Autónoma de Madrid (Spain). Two proposals are presented for facilitating use of the CF by general clinicians. These proposals offer a procedure for embedding only the most relevant clinical information in a psychiatric history, followed by a brief cultural formulation. The approach is illustrated with a clinical case. Although the CF has considerable promise for revealing knowledge about patients, health practices, and health systems that is essential for clinical care, substantial research must be carried out to facilitate widespread use of the CF in clinical practice.

Claude Lévi-Strauss est mort

2009-11-03T14:53:00.003-05:00

The sad news has just arrived that Claude Lévi-Strauss, who celebrated his 100th birthday less than a year ago, has passed away. See the coverage in the New York Times, Le Monde, Le Figaro, The Atlantic Wire, and an extensive obituary by Maurice Bloch in The Guardian. I think that one of the comments written in response to the NYT article puts it very well: "There are moments when it hits you that the 20th century has ended."

SMA Panel: Production, Distribution and Consumption of Pharmaceuticals--South Asia Focus

2009-11-02T23:04:00.007-05:00

In the final SMA session I will summarize, the work of three of the panelists (Roger Jeffery, Ian Harper and Stefan Ecks) adds to a long-term collective project at the Centre for South Asian Studies at the University of Edinburgh. The project is entitled “Tracing Pharmaceuticals in South Asia,” and its aim is to “provide governments and others with a better understanding of the contexts and causes of pharmaceutical use in South Asia… by integrating anthropological, public health, and political economic approaches in an investigation and analysis of the diverse cultural, medical, economic and institutional factors that determine the pathways by which three pharmaceuticals-oxytocin, rifampicin, and fluoxetine-reach their end users” (http://www.health.ed.ac.uk/CIPHP/ourresearch/DFIDESRCtraps.htm).

Having had the privilege of visiting the centre and participating in one of its workshops last June, I can commend the Project’s approach to mapping out the complex pattern of pharmaceuticals dissemination in a region where regulation is in flux, commercial motivations diverse and influential, and medical oversight erratic. (A fourth member of the Project, Patricia Jeffery, presented the previous afternoon at an SMA session entitled ‘Polio Histories, “Geographies of Blame” and Global Health.’) Also at this panel, Murphy Halliburton considered the effects of a 2005 patent law on the production of ayurvedic and biomedical pharmaceuticals in India, and I presented a paper about a company/government controversy over the regulation of the antipsychotic drug, olanzapine, in the far more centralized regulatory environment of Japan. Lawrence Cohen was our discussant.

Jeffery offered an overview of the Project and this panel’s relation to it, and then presented a paper (co-authored by M.R. Santhosh) entitled “The architecture of drug regulation in India: can it be reformed?” Jeffery began by contrasting the circumstances for pharmaceutical regulation in places such as Europe and North America with those of India. The focus on new drug approval and monitoring their effects through assumed channels of distribution is inadequate for India where the “context effects” upon the product life of drugs—how they are formulated, distributed, marketed, prescribed and consumed—are barely understood. It is not that there is no regulation in India; in fact there is plenty. However, the real story lies in the gap between regulations as they exist on paper and everyday practice. Moreover, the local regulatory context is affected by global procurement agencies (such as The Global Fund to Fight AIDS, Tuberculosis and Malaria) and by foreign regulators such as the US FDA. Investigative commissions have identified areas in need of reform, however, their recommendations suffer from (among other things) failures to account for local knowledge of the sort Jeffery and his group has been researching.

Ian Harper’s paper (“Disputing distribution: Ethics and pharmaceutical regulation in Nepal”, co-authors Nabin Rawal and Madhusudan Subedi) considered the effects of the Nepalese government’s 2007 guidelines for the ethical distribution of drugs. As in Jeffery’s paper, here too the thick description of the pharmaceutical trade (pharmacists, marketing reps [MR], physicians, etc.) enables the development of a case surrounding the acceptance and resistance to the guidelines.

The Nepalese trade is dominated by branded generics, which are off-patent formulations sold under brand names by different manufacturers. The unregulated environment and the competition with Indian imports are partly responsible for the growth of this commercial type, which has in turn given rise to a lively gift/bonus economy for prescriptions, as well as opportunities for retailers to game the system. These result in feedback incentives for producers and then distributors that further complicates and makes more difficult efforts at regulatory and ethical control over the trade. It has, from the viewpoint of local ethical discourse, become a system of corruption in which individual actors can rightfully blame external conditions for their behavior. The path to regulatory amelioration may remain unclear, however, the analysis Harper and his colleagues are building is a gateway to disentangling the complexity on the ground.

Stefan Ecks’ paper, “Unseen drug dissemination: Rethinking the ‘treatment gap’ for anti-depressants in India” shows that, contrary to the commonplace understanding that depression is under-detected and undertreated in rural India, there is in fact a “stunning proliferation of psychopharmaceutical drugs” there. The conventional approach has been to measure the availability of medical personnel and institutions. Ecks, inspired by the “social biography of things” approach, looks at the actual availability of fluoxetine (Prozac). His results starkly challenge prior methodologies and conclusions of the WHO’s incipiently influential Mental Health Gap Action Programme.

Ecks identifies the existence of 66 generic brands of the drug available at innumerable retail outlets. Because of Indian patent laws in effect until 2005, generics dominate the market. Eli Lilly’s branded Prozac was never, in fact, sold in India. The line between formal and informal retail of the drugs, Ecks says, is often unclear, and the familiar boundaries “between production, marketing, distribution, retail, and prescription of drugs can be surprisingly porous”. Information about drug brands is widely available in brochures, or “reckoners”, that are sold by street hawkers. Because prescriptions are not surrendered when they are filled, patients/consumers can keep purchasing medicines for years, a phenomenon Ecks calls “floating prescriptions”. What emerges here as from the other Tracing Pharmaceuticals papers is a convincing argument for fieldwork centered upon pharmaceutical biographies, and the triangulation of data among researchers working regionally.

The value of a focus on the ambiguous regulatory environment for drugs was evident also in Murphy Halliburton’s paper about ayurvedic drugs, which are common indigenous medicines. Although ayurvedic medicines are undoubtedly used in conjunction with or as alternatives to biomedical pharmaceuticals, as legal-scientific entities they are often held to be distinct. As such, the new intellectual property regulations (TRIPS) portend a different, potentially threatening environment for the makers and sellers of these compounds, and it is this situation that Halliburton’s research reports upon.

“Ayurvedic science”, he points out, is based on plant use rather than that of chemical agents. While plants contain chemical ingredients, TRIPS only deals with the latter. Ayurveda’s entire treatment epistemology is different and as such is “inherently unpatentable”. This legal contrast implicitly opposes western and nonwestern/noncapitalist forms of innovation and knowledge, even while the mass, standardized manufacture and distribution of ayurvedic medicines suggests quite a bit of overlap between the two. Halliburton has researched the conditions under which innovation is realized in the development of ayurvedic treatments, and how ayurvedic practitioners are responding to the appropriation of their medicines by biomedical pharmaceutical companies, both in relation to the new patent laws.

Lawrence Cohen offered stimulating comments, which I won’t attempt to summarize fully, particularly as he spent the greatest amount of time reflecting upon and adding to individual papers in the panel. He began by identifying the new context for how pharmaceuticals are thought about in global health. Both in the WHO agenda and in the scholarly and practical engagements of at least some medical anthropologists, drugs have taken center stage. Concomitant with this emphasis is the expansion both of uncertainties as to particular pharmacopolitical futures, as well as certitudes or “structurations” that accompany the planning mechanisms of those engaged in strategies to forge solutions (as in the case of regulators) or to diminish their exposure to risk (as in the case of pharmaceutical corporations, the subject of my own paper). The social planner’s engagement with contingency (with its “epistemic and affective conditions”) is itself an uncertain enterprise, and therefore also grist for the analyst.

This compounded intellectual challenge, Cohen observed, was confronted by each of the papers in the panel. In the face of this complexity, the familiar poles of anthropological engagement with pharma—on the one hand noting and constructing models of resistance, and on the other “wresting [moral] clarity from the epistemic murk” in order to mobilize pharmaceutical power in the labor of curing global sickness—are insufficient.

Neurobiology and the literary imagination

2009-10-30T15:06:00.000-04:00

This has been amply covered by the New York Times and Mind Hacks, but it fits so nicely into the interests of many of our contributors and readers, that I couldn't resist mentioning it here: in the latest issue of n+1, Marco Roth has an excellent essay on "The Rise of the Neuronovel." In it he traces how--since the mid-1990s--novelists have increasingly drawn upon neurobiological explanations of human behavior in lieu of older psychological ideas about consciousness and work of the mind. Following the rise of the neuronovel from Ian McEwan’s Enduring Love, published in 1997, to last year's Atmospheric Disturbances by Rivka Galchen, Roth's argument seems to dovetail broadly with one made by Nikolas Rose over recent years: neurobiology is increasingly playing a role in popular culture previously played by psychoanalysis--the pool of knowledge which underpins our basic, taken-for-granted assumptions about the self. However, unlike Rose, Roth views these new assumptions as basically reductionistic and ultimately comes to a very negative conclusion about the neuronovel:

"By comparison with most 19th-century novels, and even with most 20th-century modernist novels of the “stream of consciousness” school, the neuronovels have in them very little of society, of different classes, of individuals interacting, of development either alongside or against historical forces and expectations. Iris Murdoch (whose fate it was to become better known, through her husband’s memoirs, as an Alzheimer’s patient than as a novelist) observed that the 20th-century novel had lost both religion and society. A mid-century novelist who wanted to write about society had first to take pains to reconstruct it, to research something that to George Eliot or Dickens had been more or less spontaneously available. And the 20th-century decline of religion meant a common moral frame of reference couldn’t be taken for granted either. So postwar writers as different as Nabokov and Sarraute and Bellow were thrown back on themselves. But at least they retained that subject matter: the personal, the self. It now seems we’ve gone beyond the loss of society and religion to the loss of the self, an object whose intricacies can only be described by future science. It’s not, of course, that morality, society, and selfhood no longer exist, but they are now the property of specialists writing in the idioms of their disciplines. So the new genre of the neuronovel, which looks on the face of it to expand the writ of literature, appears as another sign of the novel’s diminishing purview, (Roth 2009)."

Marco Roth, "The Rise of the Neuronovel." n + 1, issue 8.

Turning to animals

2009-10-27T11:33:00.015-04:00

The Chronicle Review has a nice series of articles covering the relatively recent turn to "animal studies" among scholars in the humanities and social sciences. An article by Jennifer Howard examines the emergence of animal studies, discussing related movements in literary and cultural studies, philosophy and ethics, history and the social studies of science.

"Dismantling that model takes animal-studies scholars in different directions depending on their home disciplines and the mix of theory and advocacy that they bring to their work. For historians and sociologists, it might mean investigating the roles assigned to animals in 19th-century Britain, for instance, or the use of canines as forced labor in today's dogfighting rings. For scholars with literary, cultural-studies, or philosophy pedigrees, animal-studies work clusters around questions of category and subjectivity—how to move beyond the anthropocentric outlook and anthropomorphizing tendencies of humanism in theory and in practice. Environmentalists and legal scholars have their own ecological or ethical or jurisprudential agendas focused on animals. (For scientists, of course, the phrase "animal studies" usually invokes laboratory experiments involving animals.) If there's one thread that ties together practitioners of animal studies, it's that the old ways of thinking about humans and (other) animals must be discarded or transcended," (Howard 2009).

Howard also emphasizes the tension between scholarly and activist motivations and dispositions which underlies much of the animal studies literature. (In a related vein, a commenter takes her to task for not mentioning Peter Singer's Animal Liberation as a foundational text).

Jeffrey Williams discusses the role Donna Haraway's work has played in the animal turn, tracing the development from her "A Cyborg Manifesto" to the recent When Species Meet:

Haraway's key idea is that animals are "companion species." This phrase seems less provocative than "cyborg," but it has some teeth: It rebuts the traditional Western view that man rightly has "dominion over the fish of the sea, and over the fowl of the air, and over the cattle" (Genesis 1:26). Haraway sees it the other way around: We are not kings in a great chain of being, but, in her parlance, we are all critters. This idea has a good deal of consequence in how we relate to and what we do with animals.

Though animals seem a long way from cyborgs, Haraway sees them as "in the same litter." "I think in ecologies [that] are always at least tri-part: humans, critters other than humans, and technologies," she said. "In the cyborg work, I foregrounded the technological dimensions of that triad, and in the current work I'm foregrounding the other organisms in the triad." Much of her writing examines concepts that we ordinarily think of as opposed —like organisms and machines or humans and animals—and shows how they interweave.
...
Similar to her argument about the cyborg, that the human does not represent some idyllic state before machines, she holds that we should not consider animals as inhabiting some idyllic state without humans. In her words, rather than seeing "domestic arrangements between human beings and other animals as always the imposition of human domination, … the history of co-domestication is a multispecies phenomenon. It's not that we domesticated them and turned them into instruments for our ends, but these are co-evolutions of ourselves and other organisms we live with,"" (Williams 2009).

In "Moral in Tooth and Claw" Jessica Pierce and Marc Bekoff discuss the argument developed in their Wild Justice: The Moral Lives of Animals (University of Chicago Press, 2009), that morality "is a suite of interrelated, other-regarding behaviors that cultivate and regulate social interactions," which have "evolved in many animals, perhaps even in birds."

Eric Banks reviews the Animal series of books published by Reaktion Books. The series is comprised of 34 volumes, "each dedicated to a sort of hybrid natural and cultural biography of a specific creature," ranging from Moose, to Crow to Rhinoceros, to Ape. There is also an article on the book series and journals focusing on animal studies, although this one--unlike the other articles--requires a subscription.

Generally a nice introduction, although there isn't as much attention paid here to anthropology as there is to other disciplines. It would be good to see a discussion of this animal turn in relation to anthropology per se. If anyone is interesting in writing something along those lines, we'd be happy to run it here!

Some additional sources:

Linda Kalof, Amy Fitzgerald, Jennifer Lerner and Jessica Temeles. Animal Studies Bibliography. A very comprehensive and well-organized list of sources.

Books review forum in BioSocieties on "Animal Evidence." December 2008, 3(4).

Harriet Ritvo, "on the animal turn," Daedalus, Fall 2007, 136(4): 118-122.

Harriet Ritvo, "Humans & humanists," Daedalus Summer 2009, Vol. 138, No. 3: 68–78.

Donna Haraway, The Companion Species Manifesto: Dogs, People and Significant Otherness. Prickly Paradigm Press, 2003.

Donna Haraway, When Species Meet. University of Minnesota Press, 2007.
Reviewed in Cultural Anthropology, Feminist Review, History of the Human Sciences, Space and Culture, European Assn for the Study of Science and Technology, Savage Minds,

Lorraine Daston and Gregg Mitman eds., Thinking with Animals: New Perspectives on Anthropomorphism. Columbia University Press, 2005.

Eduardo Kohn, "How Dogs Dream: Amazonian Natures and the Politics of Transspecies Engagement," American Ethnologist, 34(1): 3-24.

Re-tooling subjectivities

2009-10-15T01:16:00.000-04:00

There is a very interesting looking special issue of the journal Subjectivity which has just come out: "Re-tooling Subjectivities: Exploring the Possible with Feminist Science and Technology Studies," guest edited by Wenda Bauchspies and Maria Puig de la Bellacasa. I haven't managed to get access to this particular issue through my institution's library, so I'll only be able to post the TOC at this point.

Wenda K Bauchspies and María Puig de la Bellacasa, "Re-tooling subjectivities: Exploring the possible with feminist science and technology studies"

Wenda K Bauchspies, "Potentials, actuals and residues: Entanglements of culture and subjectivity"

Vincanne Adams, Michelle Murphy and Adele E Clarke, "Anticipation: Technoscience, life, affect, temporality"

Kalindi Vora, "Indian transnational surrogacy and the commodification of vital energy"

Alexa Schriempf, "Hearing deafness: Subjectness, articulateness and communicability"

María Puig de la Bellacasa, "Touching technologies, touching visions. The reclaiming of sensorial experience and the politics of speculative thinking"

Ruth M Mendum, "Subjectivity and plant domestication: Decoding the agency of vegetable food crops"

Wenda K Bauchspies and María Puig de la Bellacasa, "Feminist science and technology studies: A patchwork of moving subjectivities. An interview with Geoffrey Bowker, Sandra Harding, Anne Marie Mol, Susan Leigh Star and Banu Subramaniam"

SMA: Perspectives from Contemporary Japan

2009-10-10T13:03:00.009-04:00

On Saturday, September 26, a group of younger Japanese researchers, joined by veteran Japan scholars Susan Orpett Long and discussant William Kelly, presented papers in a session titled “Emerging Alterities in Medicine: Perspectives from Contemporary Japan.” The session’s title distracted from a substantial unity surrounding the expanding personal and social experience of biotechnology in Japan as it stands on a continuum with experiences in other parts of the world—from one standpoint the session might have been better named, as Kelly pointed out in his comments, “dissolving alterities". The analysis and questions raised in each of the case studies (including two not discussed here) is worthy of more recapitulation than I can offer here.

Long opened with “Bodies, Technologies, and Aging in Japan (Old People and their Things).” She concentrated on low-tech or everyday assistive devices used by the elderly in Japan, such as walkers, hearing aids and grab bars, to explore how even these humble technologies require acceptance and assimilation, technically and interpretively, by their users. Assistive devices are consumer goods, however, they differ from other consumer goods social scientists have variously analyzed in that they are undesired items that carry negative social significance. The usual link in consumer studies of goods to popular culture and identity construction, Long suggests, is not useful here; a new framework for making sense of a government-subsidized, needed-but-not-wanted, and yet an economically and commercially important set of technologies is called for. In Japan, “the aging society” has been regarded as a central social issue for some time, however, the social processes Long identifies will be useful to consider in these terms elsewhere.

Goro Yamazaki presented “Making the Gift Economy Work: The Case of Organ Trade in Japan.” Organ transplantation has been less common in Japan than elsewhere. Just this past June, not without opposition, the law was revised to permit greater exchange of organs. Yamazaki acknowledges the cultural explanations for reluctance over organ transplantation, but in his paper he reframes the issue in terms of gift vs. commodity discourses to try to identify a more embedded, transactional, and perhaps quotidian way of analyzing the opposition. The analysis of a publicized case in which a friend’s gift of an organ turned into a litany of requests for what amounted to remuneration demonstrates the utility of this approach. It also, Yamazaki points out, leads us to question the boundaries of anthropological definitions of the gift as it may be applied to organs. We might well ask: What manner of exchange item are organs? What manner of entanglements (to use Nicholas Thomas’ term, 1991) do they generate in any given locale and between them (since the organ trade is global)?.

Given the renewed attention to transplantation in Japan, it was not surprising to find another presenter on this topic. Aya Nakagoshi (“Beyond Blood: Organ Transplantation and the Rise of New Kinship”) likewise situates organ transfers into two familiar anthropological frames of analysis: communication/gift exchange and kinship. Her work is openly comparative with North America. She cited some cases from the US and Canada to illustrate the formation of a kind of kinship bond that forms between live donors and the recipients of their organs. In Japan, by contrast, where nearly all donors are alive (as compared to about 1/3 of total donors in the US), she found no stories in the media referring to positive organ donor kinship bonds. In Japan there are only, she observes, negative stories about kidney donation—“the dark side of the gift,” as she puts it. Like Yamazaki, Nakagoshi calls for a reconsideration of the gift/market distinction in regards the organ trade. Precisely because of the marked cultural differences in attitude about organ transplantation that Margaret Lock (2001) has analyzed in her work, we can expect to learn much about this subject by scrutinizing the Japanese scene in the finer details that Yamazaki and Nakagoshi are pursuing.

Gergely Mohacsi’s paper, “In Search of New Pharmaceutical Senses”, addresses the embodiment of pharmaceuticals in Japan, in this case as applied to the uptake of diabetes pills. The focus on how drugs are assimilated not just into local public health rhetoric of disease management but also into actual physical comprehension is constructive to questions raised in comparative subjectivity studies in pharmaceutical/medical anthropology. It is also a potential case in the global sociology of disease management, since the idea that early medical and lifestyle intervention for type-II diabetes is indispensable derives from epidemiological understandings developed first in the US, funded and promoted by the pharmaceutical industry already beginning in the 1960s. Japan is both more recent to the trend and, Mohacsi’s report seems to suggest, ostensibly more scientific in its outlook. The cultural differences between Japan and elsewhere are mediated by biological measurements (blood glucose, indicated by the diabetes marker, HbA1c) as they are incorporated into Japanese patient habits (lifestyle, attitudes, treatment-seeking behaviors) and bodies, as well as in the practice of Japanese medicine. As Mohacsi puts it, “When ‘lifestyle’ is expressed as HbA1c levels, it becomes a transportable fact.”

Kelly's concluding remarks to this session could apply as well to others I attended, which marveled at the "heterogeneous ensemble of articulated discourses, institutions, structural forms [and] laws surrounding [for example] organ transplants. It seems to me that what each of you are calling attention to...are precisely the ensembles that articulate and dispose the practices that bind individuals to institutions, knowledge to practice, and, for that matter, the normal to the abnormal, and health to illness."

References:

Lock, Margaret. 2001. Twice Dead: Organ Transplants and the Reinvention of Death. Berkeley: University of California Press.

Thomas, Nicholas. 1991. Entangled Objects: Exchange, Material Culture and Colonialism in the Pacific. Cambridge: Harvard University Press.

"Mind Games": A Session Presented at the SMA at Yale

2009-10-07T17:06:00.007-04:00

Presentations at the Society for Medical Anthropology Conference at Yale (September 24-27, 2009) offered a cross section of work being done in many separate fields of interest. In keeping with my interests in pharmaceuticals, Japan, and mental health, I attended three excellent sessions that I would like to briefly summarize for people who could not attend. Here’s an outline of some of the papers presented on Friday, September 25, in a session entitled “Mind Games: The Intersections of Globalizing Biopsychiatry, Politics and Social Movements.”

Jonathan Metzl shared some themes from his forthcoming book, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon Press 2010). Metzl’s presentation offered stark surprises in the cultural history of schizophrenia in the US. He balanced hard data from the Ionia State Hospital for the Criminally Insane in Ionia, Michigan, with advertising images from professional medical and popular cultural literature and even from Hip Hop to limn the evolution of the image and diagnosis of schizophrenia from a tame, white person’s disease through the early part of the 20th century, to an African American male disorder with specific linkages to civil rights protests during the 1960s and 1970s.

Junko Kitanaka presented “Too Depressed to Work: The Emerging Science of the Psychopathology of Work Stress in Japan.” Psychiatry and mental illness are co-evolving in Japan, exposing many areas in need of clinical ethnographic investigation. The rising suicide rate is a good place to start. Kitanaka analyzed the phenomenon known in Japan as “suicide through overwork”. These cases engage long-standing public debates surrounding workloads and workplace relations, as well as psychiatric debates over the etiology of suicide (is the ultimate cause biological or environmental?) and growing popular awareness of clinical depression and the social suffering caused by a persistent economic recession. She recounted the Ministry of Health Labor and Welfare’s surprising invention of a quantified measure of social stress. A longer version of this superb paper, entitled “Questioning the suicide of resolve: Disputes regarding ‘overwork suicide’ in 20th century Japan,” can be found in Weaver, John & David Wright (eds.), A History of Suicide in the Modern World: International Perspectives (Toronto 2009).

The context-specific issues surrounding the professional, popular and political conceptions of mental illness—the three being, in the realm of psychiatry, peculiarly inseparable—that Metzl and Kitanaka brought out in their papers, was evident also in Dominique Behague’s study, “Community-based psychotherapy and transformations in politicization amongst youth in Southern Brazil.” Behague points out that while resistance to biopsychiatric reductionism is manifest in Brazil, the DSM diagnoses of ADHD and conduct disorder have nevertheless entered the local therapeutic lexicon. Moreover, in her sample, behavioral disorders are being systematically applied to lower class youth. Behague seeks the solution to this paradoxical trend not (in this paper) by evaluating therapist’s way of engaging the subject, but in how youth patients themselves react to diagnostic categories and therapies. She shows that the “politicizing effects of medicalization” must be understood beyond the therapist and the doctor-patient relationship, but in class relations and other aspects of the youths’ own experience and use of behavioral diagnoses. Behague’s study (the detailed version of which will be printed in Medical Anthropology Quarterly this year) ups the ethnographic stakes on the question of how biopsychiatric models are integrated in given locales; it is not, she observes, a simple matter of identifying ambiguities or declaiming syncretism.

Elizabeth Davis gave a paper entitled “‘By Reason of Danger’: Rights, Refuge and Responsibility in Greek Psychiatry.” Nissim Mizrachi presented “Psychological Technologies and the Creation of the ‘New Jew’ in Israel.”

The discussant, Stefan Ecks, pointed out the shared political focus of all of the papers, and specifically their crystallization around the themes of autonomy, self-reliance, emancipation, and responsibility. How do psychiatrists confront the political embeddedness of their work? Where might this discussion might lead if the authors were to cast it in terms of the classical political theoretical concepts of liberal democratic ideals, Enlightenment, and so on? As an immediate topic for debate, Ecks suggested that psychiatry might experience the most trouble justifying its practices in the context of democratic regimes that stress equality and self-determination. The authors of the panel might well agree with Ecks’s insight that not just politics in the everyday but the political ideological cultures in which a globalizing psychiatric profession takes root, is indeed subject for productive reflection.

Call for Contributors Redux

2009-10-07T10:18:00.001-04:00

As ever, we’re ready to welcome new contributors at Somatosphere. At our meeting at the SMAs, a number of people said that they would be more likely to contribute if there was a list of possible types of posts they could write—or even if they could volunteer for particular roles or jobs—to write certain posts on a regular basis.

With that in mind, we’ve put together a list of several roles and different types of posts for the site. If you have some general ideas about what you’d like contribute, but want some additional suggestions, guidance or to be assigned certain topics—let us know and we can discuss different possibilities. As always, you can get in touch at admin@somatosphere.net.

There are two roles for each of which we’re hoping to have two or three volunteer: the journal and web round-ups. Ideally, each person will be assigned to write a post during certain months or to cover certain topics.

Journal round-up

I’ve been writing two types of posts in this category: one covers a special theme issue of a journal; the other rounds up interesting single articles from a variety of recent journals. This role can also be divided up so that certain people agree to cover certain topical categories of journals, ie. medical and cultural anthropology; medical sociology and social studies of medicine; science studies and history of science/medicine; bioethics and medical humanities.

Monthly web round-up
I’ve been doing these under the rubric of “web gleanings,” and I’ve done them in a number of formats, some more time-consuming than others. Obviously it would be up to you to decide how you would do this. Basically these posts would cover non-academic media, blogs, and anything else that’s on your radar and of potential interest.

The following are types of posts which we’re always happy to run. Some we have had in the past, others are new ideas.

Book review
If you’re interested in reviewing books for the site, please let us know your topical areas of interest so that we can assign you appropriate books to review. Alternatively, if you have a particular book which you’d like to review, let us know. Todd Meyers is taking on the role of book review editor, so if you’d like to write a review or suggest a book for review please contact him directly at books@somatosphere.net. See our previous reviews here.

Other media review
Reviews of films, websites, resources, or any other non-book media of interest to readers of Somatosphere.

Summary of a recently published paper
For two examples of what this can look like, see Current Anthropology’s “Anthropological Currents” section and the new “Findings” column in Anthropology Now.

Reading group
The idea here is to use the weblog as a forum for a discussion of a book or article. See the discussion group on Anna Tsing’s Friction at Savage Minds from a couple of years ago.

Issue review
A review of a particular issue or topic in medical anthropology or in a related discipline which we cover (STS, cultural psychiatry, bioethics, public health). Obviously the scope here is wide open.

Rereading a foundational text
Review, critique, revive, or dissect a particularly significant or foundational paper or book in medical anthropology, STS, etc. While the context is somewhat different, there is a blog carnival called “The Giant’s Shoulders” which includes posts about “classic” science papers—which gives a rough template for this sort of post.

Syllabus
Post a syllabus along with an explanation of how you’ve designed the course and some of the resources you’ve drawn upon. I’ve written a post like this on an Anthropology of the Body course.

Conference or workshop report
If you’re planning to attend a meeting of potential interest to Somatosphere readers and would like to write about it, let us know.

Fieldnotes
A dispatch from the field or a report on a research project in progress. This is a potentially useful format for getting some feedback on your initial observations.

Op-Ed
A report or op-ed piece from the field on a timely issue or a topic of general concern. The idea here is to draw on your local knowledge of a particular site (whether geographical, institutional, disciplinary or however you’ve framed your fieldsite) to write about a topic which is not necessarily your research focus, but is likely to be of interest to readers. Obviously it needn’t necessarily be something that’s “in the news” but two obvious examples of current relevance would be posts on the US health care debate or the H1N1 story, written from where you stand in the field.

Interview
An interview with a scholar whose work interests you. We can run both text or audio/video, so either type of interview format would work. The interviews at U Cambridge’s D Space are great examples.

These are just some ideas to get you thinking. If you’re interested in contributing any of these types of posts, or anything else, write us at admin@somatosphere.net.

Biomedical Conventions and Regulatory Objectivity in Social Studies of Science

2009-10-05T09:37:00.001-04:00

The latest issue of Social Studies of Science is a special issue on "Biomedical Conventions and Regulatory Objectivity," edited by several members of the department where I'm currently based (McGill's Social Studies of Medicine)--Alberto Cambrosio, Thomas Schlich, and George Weisz, and Peter Keating of the University of Quebec at Montreal.

Here's the abstract from the introduction, along with the titles of the papers:

"This special issue of Social Studies of Science centers on thetopic of regulation in medicine and, in particular, on the notionof regulatory objectivity, defined as a new form of objectivityin biomedicine that generates conventions and norms throughconcerted programs of action based on the use of a variety ofsystems for the collective production of evidence. The papersin the special issue suggest ways in which the notion of regulatoryobjectivity can be tested, extended, revised, or supersededby more appropriate notions. They insist on the need to examinemore closely clinical-therapeutic (and not just clinical-research)activities, and to pay more attention to the activities of regulatoryagencies such as the US Food and Drug Administration and tostandard-setting organizations. They call attention to the professionaland organizational activities surrounding the mobilization ofconventions for regulating clinical practices. Finally, theyprovide material that can help us to think about how analyticalnotions such as regulatory objectivity may or may not informinterventionist research projects," (Cambrosio et al. 2009).

Tiago Moreira, Carl May, and John Bond, “Regulatory Objectivity in Action: Mild Cognitive Impairment and the Collective Production of Uncertainty”

Vololona Rabeharisoa and Pascale Bourret, “Staging and Weighting Evidence in Biomedicine: Comparing Clinical Practices in Cancer Genetics and Psychiatric Genetics”

Linda F. Hogle, “Pragmatic Objectivity and the Standardization of Engineered Tissues”

Patrick Castel “What’s Behind a Guideline?: Authority, Competition and Collaboration in the French Oncology Sector”

Teun Zuiderent-Jerak, “Competition in the Wild: Reconfiguring Healthcare Markets”

Laurent Thévenot, “Postscript to the Special Issue: Governing Life by Standards: A View from Engagements”

Care and Health Care: a call for papers

2009-10-02T09:34:00.002-04:00

At the Society for Medical Anthropology conference last week Arthur Kleinman gave a plenary talk on the intersections between medical anthropology and mental health. Kleinman made a number of interesting arguments--some of which we'll hopefully discuss in future posts--but one was an argument which he has made in a number of recent articles (see Kleinman 2008; Kleinman and Hanna 2008; Kleinman 2009): both professional medicine and medical anthropology pay inadequate attention to caregiving. In a recent online article, Kleinman writes about the significance of caregiving:

"[F]or many people, care-giving is a foundational component of moral experience. It is a practice of acknowledgement, empathic imagination, witnessing, responsibility, solidarity, and the most concrete forms of assistance. It is this moral aspect that makes care-givers, and at times even care-receivers, feel more “present” – and thus more fully human," (Kleinman 2009).

He also explains quite movingly how these concerns have emerged from his own role as caregiver to his wife, Joan Kleinman. These issues are further elaborated in an article by Kleinman and Sjaak van der Geest, which also serves to frame a symposium the two are organizing on "Care and Health Care," to take place in Amsterdam on December 18, 2009. You can download the entire call for papers here, but I will reproduce the relevant parts below:

The symposium will take place at the University of Amsterdam. Venue is Het Spinhuis, Oudezijds Achterwal 185, Amsterdam. The symposium will consist of thematic discussions based on submitted papers of the participants. During the symposium there will be no formal presentation of papers, but only a short introduction to be followed by a discussion.

A selection of the symposium papers will be published in the summer 2010 issue of Medische Antropologie. Registration for the symposium is possible until 30 November via the website of Medical Anthropology & Sociology Unit under Agenda: ‘Symposium Care & Health Care’; click: Register, fill the form and submit. Participation is limited to 35 people, and registration will be processed in order of arrival. The symposium fee is €25 to be paid at the symposium. Participants will be given access to all papers no later than a week in advance of the symposium. They are expected to read all the papers in preparation of the symposium.

Those who are interested in submitting a paper should provide a title plus brief abstract together with their registration, before 1 November 2009. The complete paper should be sent as an attachment per email to: Janus Oomen, h.a.p.c.oomen@uva.nl before November 27, 2008. Papers should be in English. Drafts and work in progress are welcome.

Authors are invited to consider the following questions:

What constitutes ‘good care’ in a given social or cultural situation? Are medicine and care compatible?

Is there enough ‘time’ for care in today’s health care system?

To what extent does the concept of care vary in different cultural contexts?

How can we understand the gender-based differences in care perception and practice?

Is care related to reciprocity? Which conditions call for care and which ones do not?

How does the concept of care evolve in relation to the development of medical technology?

How does care evolve in conditions of radical cultural change and acculturation, e.g. in the life of migrants? What is the economic basis for caregiving? What explains the low social status of caregiving as a profession? What policy could enhance the quality of care?

More med anthro web gleanings

2009-09-29T16:21:00.011-04:00

We haven't had a round-up of links for a while, so here goes:

Life/Politics

Didier Fassin, "Another Politics of Life is Possible", Theory, Culture and Society 26(5), 2009.

An argument which Fassin made in his SMA address as well: "The aim of this article is to return to the origins of the concept [of biopolitics] and to confront the issue of life as such. This implies four shifts with respect to Foucault’s theory: (1) Politics is not only about the rules of the game of governing, but also about its stakes. (2) More than the power over life, contemporary societies are characterized by the legitimacy they attach to life. (3) Rather than a normalizing process, the intervention in lives is a production of inequalities. (4) The politics of life, then, is not only a question of governmentality and technologies, but also of meaning and values," (Fassin 2009).

Michael Specter, "A Life of its Own: Where Will Synthetic Biology Lead Us?", The New Yorker

"No scientific achievement has promised so much, and none has come with greater risks or clearer possibilities for deliberate abuse," (Specter 2009).

Forum on synthetic biology with articles by Jay Keasling, Pamela Silver, Evelyn Fox Keller and Filippa Lentzos, BioSocieties 4(2-3), 2009.

Jacob Copeman, editor, "Special Issue on Blood Donation Bioeconomy and Culture", Body & Society 15(3), 2009.

Travels

Erica Gibson, "Swine Flu: Ground Zero", AAA blog

"When Erica Gibson traveled to La Gloria, Mexico, for fieldwork earlier this year, she found that the emergence of swine flue had dramatically impacted the town."

Mary Cuddehe, "Patients without Borders: The Rise of Mexican Medical Tourism", The New Republic, September 11, 2009.

"[Juárez] is one of a few Mexican border towns quietly promoting state-of-the-art hospitals that cater to international patients--Juárez has five such facilities--and betting that refugees from the tattered U.S. health care system will come. On paper, at least, the numbers look promising: According to a 2008 study by Deloitte LLP, 750,000 Americans traveled abroad for medical care in 2007. That number is expected to reach six million by 2010," (Cuddehe 2009).

Jonathan Kimmelman, "Quack you! Medical Tourism and Stem Cells", Lost in Translation

Stuart Rennie, "Research data from developing countries as 'the new gold'", Global Bioethics Blog

"Making research ethical in such contexts has always been a matter of adding protections and safeguards. Perhaps being ethical in a deeper sense would involve chipping away at the gaping inequalities in power and wealth between the researchers and the researched, but almost no one wants to touch that one: not researchers, not their funders, and (sadly) not governments," (Rennie 2009).

Patricia Leigh Brown, "A Doctor for Disease, a Shaman for the Soul", New York Times

"At Mercy Medical Center in Merced, where roughly four patients a day are Hmong from northern Laos, healing includes more than IV drips, syringes and blood glucose monitors. Because many Hmong rely on their spiritual beliefs to get them through illnesses, the hospital’s new Hmong shaman policy, the country’s first, formally recognizes the cultural role of traditional healers... inviting them to perform nine approved ceremonies in the hospital, including “soul calling” and chanting in a soft voice," (Brown 2009).

Disciplines

Lorraine Daston, "Science Studies and the Histories of Science," Critical Inquiry, Summer 2009 -- Special issue on "The Fate of the Disciplines," edited by James Chandler and Arnold Davidson.

Mario Biagioli, "Postdisciplinary Liaisons: Science Studies and the Humanities", Critical Inquiry, Summer 2009

Vincent Duclos, "When Anthropology Meets Science: An Interview with Allan Young", Altérités 6(1), 2009 : 110-118.

"Without philosophy, particularly without analytical philosophy, there is no anthropology worth talking about and I feel the same way about history and historical inquiry. If we don’t have an anthropology that is read with a historical perspective on absolutely everything, including anthropology, if we don’t have an anthropology that is totally grounded in the debates within analytical philosophy and other branches of philosophy, we’ve got an intellectually impaired, maybe even empty discipline," (Duclos 2009).

Psy

Ilina Singh and Nikolas Rose, "Biomarkers in Psychiatry" Nature Vol 460, 9 July 2009

"Without ongoing social and ethical analysis, as well as careful thought by the researchers about their role in this process, the future use of psychiatric biomarkers could marginalize efforts to identify and address social and environmental factors associated with the development of antisocial and criminal behaviours in young people. It could also reinforce the use of problematic diagnoses and/or medical treatments to manage the current and anticipated behaviour of very young children. Such developments could lead to stigma and labels that affect children’s psychological development, their social and educational opportunities, and their medical care and employment options," (Singh and Rose 2009).

Vaughan Bell, "Latah and the Rules of Rule Breaking", Mind Hacks

"Anthropologists...have often loudly scoffed at the psychiatric definition of latah as a syndrome, suggesting it is just a defined social role of the local culture that has its own limits and and 'rules'," (Bell 2009).

Alan Saunders, "Michel Foucault's Madness and Civilization: 50th Anniversary," a podcast from Philosopher's Zone, Australian Broadcasting Association

Philipe Bourgois talks about his new book Righteous Dopefiend, Here and Now, WBUR

Alex Golub, "Anthropology, 'Internet Addiction' and Care," and "More on 'Internet Addiction'", Savage Minds

The conference and changes ahead

2009-09-28T21:53:00.000-04:00

Thanks to everyone who joined us at our meeting at the Society for Medical Anthropology conference last week. The conference itself was really very impressive; very well organized, extremely well attended (over 1,000 people!) and full of great panels and plenary presentations. We should have a number of posts on the conference coming soon. For those who weren't able to attend, the SMA should be posting videos of the plenary sessions on the conference website in the very near future.

Following our meeting, we will hopefully be adding a number of new contributors shortly. We also hope to start running several new types of posts on a regular basis.

Also, it looks like there has already been a new medical anthropology blog founded as a result of the conference: Critical Medical Anthropology that Matters was set up by Alisse Waterston of John Jay College of Criminal Justice. We're happy to welcome them to the anthropological blogosphere.

Somatosphere gathering at the SMA conference

2009-09-15T12:33:00.001-04:00

We'd like to invite those of you who will be attending the Society for Medical Anthropology conference in New Haven next week to join us for an informal gathering to discuss the future of Somatosphere. If you'd like to help to administer the site or improve its usability, become a regular contributor, contribute guest posts or book reviews, or take part in any other way, please join us.

We'll be meeting in the front room at Bar (yes, that's the name) at 254 Crown Street at 6:30 on Saturday evening, September 26. All of the sessions end at 6:00, so you won't have to miss anything to attend.

If you won't be attending the SMA conference or can't make it to our gathering, but would like to contribute to Somatosphere, please contact us directly at admin@somatosphere.net.

FPR-UCLA Conference on the Cultural and Biological Contexts of Psychiatric Disorder

2009-09-13T21:26:00.004-04:00

This coming January, the Foundation for Psychocultural Research is hosting what looks to be a superb conference at UCLA: "Cultural and Biological Contexts of Psychiatric Disorder: Implications for Diagnosis and Treatment." The event seeks to examine ways in which both anthropological and neurobiological knowledge call into question the validity and usefulness of the DSM diagnostic categories which dominate contemporary psychiatry. As the organizers write in the abstract for the conference:

"[B]oth neuroscientists and anthropologists have raised questions about the validity and utility of these categories. Neuroscientists are concerned that the categories obfuscate the key brain-behavior linkages underlying pathological processes. Anthropologists on the other hand argue that the categories are largely social constructions and that the current neurobiological zeitgeist minimally attends to social and cultural processes of mental illness....
....The aim of this conference is to improve the quality of psychiatric diagnosis and treatment by giving specific attention to biological and cultural contexts and their interactions. Given the abundant criticism directed to both the biological and cultural validity of current DSM diagnostic categories, the focus is particularly important and timely," (FPR 2009).

In addition to general talks on biological and cultural contexts for mental illness and their possible integration into DSM-V, the three day conference includes special sessions focusing on autism spectrum disorders, bipolar disorder and schizophrenia. The organizers have assembled a particularly impressive set of speakers, including anthropologists of medicine and psychiatry (Byron Good, Mary-Jo DelVecchio Good, Douglas Hollan, Emily Martin, Tanya Luhrmann, Anne Becker, Carol Browner, Joao Biehl), cultural psychiatrists (Laurence Kirmayer, Devon Hinton, Roberto Lewis-Fernandez), psychiatrists (German Berrios, Kay Redfield Jamison, Peter Kramer) and researchers in neurobiology and psychology (Eric Kandel, Simon Baron-Cohen, Thomas Insel, Moshe Szyf)--and this isn't even an exhaustive list. You can read the preliminary program here in html or here in pdf.

Registration is now open, and abstracts for posters can be submitted until October 2, 2009.

"Cultural and Biological Contexts of Psychiatric Disorder: Implications for Diagnosis and Treatment."
When: January 22-24, 2010
Where: Neuroscience Research Building Auditorium, UCLA

Lectures from the Neurocultures workshop

2009-09-08T13:09:00.007-04:00

An excellent website has been set up to showcase recordings of lectures and discussions from the Neurocultures workshop, held at the Max Planck Institute for the History of Science in Berlin in February 2009. Following many other similar initiatives in the human sciences, the workshop's mandate was to examine a contemporary moment in which the brain is increasingly "the bodily organ with which humans have come to identify," and in which "neuroscientific knowledge is spreading rapidly beyond the confines of brain research proper into different areas of life and our culture as a whole." At the moment, four talks are available as videos, and apparently the others will soon be made available in audio format.

A really excellent aspect of these videos is that they include the full record of the discussion as well as the talk itself. Additionally, the media folks at the Max Planck Institute have done a really admirable job in producing the videos themselves. Quite remarkably for recordings of conference talks, these videos are nicely edited with multiple camera angles and even brief interludes with a jazz soundtrack! All of the lectures are also available as audio mp3 files and as video mp4 files for the iPhone.

Here's the list:

Emily Martin
Identity, Identification and the Brain

Nikolas Rose
Screen and Intervene: Governing Risky Brains
(with commentary by Hans Markowitsch)

Allan Young
Psychopathy in the Social Brain
(with commentary by Hauke Heekeren)
(the embedded video is not working, but the lecture can be downloaded)

Fernando Vidal
Notes on Neuroethics

Fassin and Rechtman’s Empire of trauma

2009-09-04T17:05:00.007-04:00

The empire of trauma:
An inquiry into the condition of victimhood.
Didier Fassin and Richard Rechtman
Translated by Rachel Gomme
Princeton University Press, 2009
304 pages; $24.95, paperback

Reviewed by Hanna Kienzler (McGill University)

“Trauma has become a major signifier of our age” (xi) and we talk about traumatic events such as rape, genocide, torture, slavery, terrorist attacks, and natural disaster in the same way: “one signifier for a plurality of ills signified” (xi). Didier Fassin and Richard Rechtman, two of France’s leading anthropologists and psychiatrists take on the challenge to better understand and analyze the taken-for-granted aspects of trauma and victimhood by focusing on paradigm shifts in their respective historical and political contexts from the 19th century until the present day. Their objective to “denaturalize” trauma and “repoliticize” victims is based on fieldwork conducted among French organizations providing psychiatric aid in Toulouse, in the Palestinian territories and among French organizations defending asylum seekers. Topics that receive special attention are traumatic neurosis after World War I, the reception of the DSM and the suspicion towards PTSD, the work of the French medical and psychological emergency units, the exportation of psychiatry by French doctors into war-torn areas, and the resistance of NGOs to the exploitation of psychological certificates for refugees. Their study was carried out between 2000 and 2005 by consulting medical archives and assessing the available literature, interviewing individuals working for different organizations, and participant observation in institutions concerned with the provision of (humanitarian) psychiatric aid in various contexts. Although focusing on the French context, the authors are certain that their discussion reveals changes that extend beyond French frontiers and consider their inquiry as part of a “political and moral anthropology of contemporary societies” (xii).

The introduction, “A new language of the event”, refers to psychiatric aid and epidemiological surveys carried out in the aftermath of September 11. All institutions and individuals involved seemed to share a certainty suggesting that survivors, witnesses, television viewers, and residents of the United States in general suffered from the exposure to a traumatic event. Similar views were shared by psychologists and psychiatrists who were among the first to arrive at the scene after the plane crash at Sharm el Sheikh on December 3, 2004, upon the return of survivors of the South Asian tsunami on December 26, 2004, and during wars and natural disasters in other countries in order to provide debriefing and emergency preventive counseling to survivors and their families. However, only 25 years earlier, trauma, its consequence, and forms of intervention were not nearly so clear-cut; victims were perceived as illegitimate and the reality of trauma itself as a condition was widely doubted.

It is this shift from suspicion to the value of proof that interests the authors most. They employ a constructivist perspective exploring “the ways in which trauma is produced through mobilizations of mental health professionals and defenders of victims’ rights, and more broadly by a restructuring of the cognitive and moral foundations of our societies that define our relationship to misfortune, memory, and subjectivity” (6-7). Fassin and Rechtman reject both a naturalization of the concept of trauma as well as a relativism that raises doubts by asking whether trauma exists at all. Instead, they aim at understanding how our current “moral economy” has been rewritten throughout time and ways in which contemporary societies problematize the meaning of their moral responsibility in relation to distressing events.

Part One, “The reversing of the truth”, deals with controversies surrounding the concepts of trauma and PTSD, the origins of trauma, and its conceptual developments until World War I. Current controversies in psychiatry concerning the universalist perspective on trauma are exemplified by the protest in response to Derek Summerfield’s article “The invention of posttraumatic stress disorder and the social usefulness of a psychiatric category” published in 2001. Summerfield argued that PTSD is an example of how society and politics have helped to create rather than discover a mental illness. Not only psychiatrists but also patients responded fiercely to this argument. According to the victim’s point of view, Summerfield had overstepped a boundary by speaking for them and by questioning a psychiatric category that had helped them to defend their rights. According to Fassin and Rechtman, these debates reveal a paradigm shift in the relation between victim groups and medical experts: “this hitherto unthinkable marriage of convenience between social movements and mental health professionals came about not through giving clinicians the task of speaking for the victims, but on the contrary by giving the words of the victims themselves a form of clinical authority based on moral premises” (28).

In relation to this, Fassin and Rechtman argue that to better understand trauma, one has to consider its social—as well as its intellectual—history. In the subchapter, “The birth of trauma”, the authors outline the complex historical developments surrounding the concept of trauma in a clear and structured manner: John Erichsen identified it during the 1860s when he examined victims of railway accidents. He accredited the syndrome to loosely defined neurological mechanisms and called it “railway spine syndrome”. A few years later, Jean-Martin Charcot proposed the earliest psychological account of the syndrome arguing that patients suffering from railway accidents were most likely to suffer from hysteria. Janet and Freud introduced a psychic etiology into theories of trauma. Since the memories are painful and unmanageable, the conscious personality suppresses them from awareness by storing it in the subconscious (Janet) or unconscious (Freud). From a psychoanalytic perspective it is, thus, perceive that the traumatic “is already present even before an event causes it to manifest itself” (33). Despite their differences, Freud and Janet shared the understanding that the traumatic event was not the key feature to the development of trauma neurosis.

At the same time, trauma and trauma neuroses were not only discussed in the academic circles, but also in the “insurance industry” (35). Railroad accidents in particular, and later accidents at the workplace, called for financial compensation. According to Fassin and Rechtman, these developments were the first in which society became actively involved in the discussions and developments of trauma. Yet, these discussions were not necessarily benevolent. For example, physician Edouard Brissaud introduced the term “sinistrosis” which he considered a workers’ disease characterised by patients’ refusal to return to work until they received financial compensation. Similar suspicions arose in military psychiatry during World War I, during which hunting for malingerers became the central goal of medical screening. “Trauma insanity” was considered to run counter to the glorified heroic ideal of soldiers propagated by the military authorities. Psychiatrists adopted this patriotic ideal by adapting their trauma theories accordingly. Common psychiatric practice included electrotherapy, psychological coercion, and persuasion. Unlike other academics, Fassin and Didier do not establish a direct link between the brutalization of therapy and psychiatric practice of the early twentieth century. Instead, the dominant paradigm of war neurosis was that of forensic medicine which fostered the suspicion that soldiers’ main goal was financial compensation.

Although psychoanalysis did not have a direct impact on military psychiatry, it, nevertheless, changed the way in which trauma was viewed by scientists and the general public. Scholars drawing on Freud’s theory were among the first to criticize the therapeutic brutality and to propose psychoanalytic methods instead. Psychoanalysts believed that trauma was the individual reaction of non-ordinary men confronted with fundamental ethical choices which they were unable to take on. Self-confession became the key concept of traumatic narrative and psychiatrists were to help individuals admit why they had been traumatised and why they were different from others. Nevertheless, theories concerned with malingering and compensation did not die out. In order to discern potential trouble-makers during World War II, the British military involved psychiatrists to partake in the recruitment of soldiers. In America, on the other hand, psychologically damaged men were intolerable as they placed into question the heroic ideal of the freedom fighter. As a consequence, the legal and governmental recognition of their suffering was problematic. At the same time, however, American psychoanalysts were increasingly confronted with survivors of Nazi concentration camps. In this case, psychoanalysis as well as the stigmas attached to war neurosis were clearly inadequate answers to problems suffered by survivors.

A new paradigm was called for. Psychiatrists like Bruno Bettelheim, Robert Lifton and Mardi Horowitz all worked on a new clinical entity called “survivor syndrome” (72). It entailed that the traumatic experience was turned into a “testament to the unspeakable” (72). Questions shifted from “who were these men who presented with psychological disorders” to “how had they managed to survive the impossible?” (73) Also during this time, the term “survivor guilt” was coined. In Bettelheim’s early work, he explained that survival was often only possible at the cost of neglecting others which leads to feelings of guilt in the survivors and, thus, psychological problems. Fassin and Rechtman summarize that “it was now the victims who directed suspicion at themselves and gave expression to it in their accounts of their experience” (75). These accounts served not only as confessions but also as witness reports written in memory of those who fell prey to mass killings, torture and starvation in concentration camps.

This important historical shift in the perception of trauma led to the universalisation of victim status, allowing other groups to begin recounting violence they had experienced and their consequent distress. In the 1960s, for example, feminists campaigned against child abuse demanding “incest survivor” compensation. Many argued that symptoms of such abuse may appear only twenty to thirty years later in form of nightmares, anxiety, and panic in the presence of men. While radiologists were the first to generate clinical evidence of abuse (in the form of X-rays of unexplained fractures), the proof that many were so urgently searching came from a branch in psychiatry working to establish a more scientific basis for psychiatric practice.

During the 1970s, the American Psychiatric Association revised its classification of mental disorders with the goal of providing it with an atheoretical basis and a descriptive approach. In the document which resulted—the DSM-III, published in 1980s—the condition previously known as “traumatic neurosis” was changed into a concept free of the stigma of suspicion: posttraumatic stress disorder (PTSD). Fassin and Didier note that “the clinical signs of PTSD remained those of classic traumatic neurosis, but the status of the traumatic event had fundamentally altered, becoming the necessary and sufficient etiological agent” (86). In addition to many feminists, this radical shift was embraced by Vietnam veterans who sought to receive financial reparation toward the end of the war. Since the media had revealed the massacre committed in May Lai by a US company, a central question for the public and professional psychiatrists had become: What led normal men to commit such bloodthirsty crimes? According to Lifton, it was the war and the nature of combat that led men to commit crimes that they never intended to commit. Once again, psychiatrists agreed that “these were ordinary men placed in an extraordinary situation” (90). Through a transformation of the concept of survivor guilt, the men were conceptualised as victims, “broken by what they had witnessed and by what they had done” (91).

Part Two, “The Politics of Reparation”, deals with issues related to psychiatric victimology and illustrates the developments of psychiatric guidelines, the emergence of psychiatric units, compensation, and paradigm shifts taking place over the past fifteen years. On September 11, 2001, Fassin and Rechtman had a meeting scheduled at the office of the Haut Fonctionnaire de Defense (HFD) heading the National Committee for Medical and Psychological Emergencies (CNUMP). Before the interview was started, a shock wave ran through the building and streets as people crowded around radio and TV sets in order to take in the attack of the World Trade Center in New York. Within one hour the civil defence system was activated and the HFD began receiving calls by psychological emergency units ready to “deal with the psychological consequences of an attack” (103). However, besides a few minor anxiety episodes, no intervention was called for. In the US, on the other hand, a large number of psychiatric health personnel was mobilised and alerted the population of the risk of exponential growth in PTSD in the months to come.

According to Fassin and Rechtman, developments surrounding the concept of trauma reflected a tension between clinical approaches to PTSD and social uses of trauma. Similarly in France, such tensions had arisen in the 1990s between psychiatric victimology and medical and psychological emergency units. In 1995, the discipline of psychiatric victimiology came into being and medical and psychological units (CUMP) were set up as a response to the terrorist attacks. Besides the establishment of a response system to violent events, the developments were a turning point in the history of the victims’ rights movement in France. The authors describe the victims’ rights movement from the 1980s to the present-day, referring to notions of stigmatization, suspicion, political activism, set-up of victims’ offices, first epidemiological studies, and influence on the DSM. In the aftermath of the attacks in the mid 1990s, victims’ organisations campaigned using the notion of psychic trauma. Yet, their attempts were hindered by official psychiatry.

In the 1990s, new initiatives in victimology appeared such as the establishment of the Psychotraumatology Clinic at the Saint Antoine Hospital and the Institute for Victimology, the first university degree programs in victimology at the medical faculty at Necker University Hospital in Paris, and campaigns for the acceptance of PTSD. However, “[i]n France even more than in the United States, the dynamic in operation derived much more from the social sphere than from the professional field. It was victims who justified victimology, not the reverse” (126). The authors illustrate these historical developments by referring to the explosion of the AZF chemical factory in Toulouse ten days after the terrorist attacks on the World Trade Center in New York. Following reports and media campaigns launched in the US, the French media adapted the jargon of trauma. Before any assessment had been made, psychological help centers were set up, volunteers were employed, and new victim groups established. Fassin and Rechtman noted that psychiatric personnel outnumbered the victims at times, that there was no consensus regarding support methods, that volunteers largely lacked the necessary skills to provide treatment, and that debriefing was applied as an early intervention despite its iatrogenic risks. The media was quick to catch on to such weaknesses in the intervention field, challenging psychiatrists and authorities. At the same time, mental health professionals began to question one another’s treatment strategies. Such divisions occurred not only in the professional field but also among victims who began to differentiate between direct and indirect victims and engaged in finding factors of defining the “most exposed”, “the most vulnerable” individuals or “the most disadvantaged” social groups (143). To this, Fassin and Rechtman refer as “social map of trauma” that was based on geographical proximity to the explosion as well as social determinants such as economic background, professional status, and immigrant origin. Depending on the combination of determinants, victims benefited more or less from compensations.

Part III, “The politics of testimony”, covers topics related to psychological support services, the beginnings of humanitarianism and moral evaluations, and the need to testify. Wars in Armenia, Bosnia, Kosovo and Palestine serve as examples of such developments. In this context, the concept of humanitarian psychiatry came into being during the international conference on “Trauma: Care and Culture” organised by Medecins sans frontiers (MSF) in Paris in 2002. Topics discussed included psychiatric missions and psychological care programs while phrases such as “psychosocial approach”, “psychotherapeutic intervention”, and “assistance to people suffering from trauma” (158) dominated the discourse. The two most involved groups in the provision of humanitarian psychiatric aid in war torn areas were MSF and Medecins du monde (MDM). Compassionate action and empathy motivated by concerns about justice and human solidarity were the driving forces for their humanitarianism and psychiatric intervention. Fassin and Rechtman argue that “humanitarian psychiatry derives from the recognition of psychological suffering rather than from the identification of mental illness” that is, “it manifests as a stirring of empathy rather than a call for clinical evaluation” (177).

The politics of testimony is described by the authors in relation to the humanitarian crises in Gaza and the West Bank where humanitarian psychiatrists attempted to provide first aid to civilians. Working on the front lines, their missions were restricted and shifted from treating to bearing witness. Teams such as MSF and MDM replaced first-hand witnesses by speaking for them and making their suffering publicly known. Phrases such as “we need to be there” proclaimed to state one’s solidarity and establish one’s usefulness in a situation where chaos prevailed. Thus, humanitarian psychiatrists joined journalists, lawyers, politicians and religious leaders in the endeavour of bearing witness to psychological distress and denouncing human rights violations. In this context, emotions were valued over psychiatric precision, and the power of demonstration over accurate diagnosis: “As a tool of a politics of humanitarian testimony, trauma contributes to constructing new forms of political subjectification and new relations with the contemporary world” (216).

Part IV, “The politics of proof”, deals, on the other hand, with the clinical practices of asylum, torture and the notion of evidence on the body, activist doctors, and the politics of writing certificates for torture victims. In France several organisations which provide psychiatric and psychological aid to immigrants have debated the increasing demands for clinical psychological certificates proving the authenticity of torture experienced by individuals seeking political asylum in France. While such certificates had been used in previous years to attest to physical marks on the body, doctors now aimed to document psychic wounds. In response to this, the Association pour les vicitmes de la repression en exil was formed in the 1980s responding to the idea that “victims of torture are not patients like others and require a very special kind of care” (233) and the well known Primo Levi Center was one of the first to specialise on trauma, offering psychotherapy to victims of torture and political violence. In addition to providing psychiatric treatment, the center defended the rights of asylum seekers and started to raise awareness of the suffering of individuals “psychically traumatised by torture” (235). Thus, clinical practice became a central agent in the support of asylum seekers. In this strained context, a new field emerged in France called psychotraumatology of exile. The discipline is based on the acknowledgment of the unique nature of the experience of persecution and the need to provide special treatment for trauma.

Since asylum seeking is largely a political and juridical process, proof was required that the individual was in fact tortured. According to the authors, the need for certificates and bodily proofs is related to a new kind of suspicion of Western societies toward asylum seekers from non-Western countries: “Contrary to what is popularly assumed, it is clear that reasons of state and the even more narrow reasons of perceived national interest are at the core of the contemporary system for protection of refugees” (255). In order to keep the large and unwanted number of refugees at bay, France raised the bar for approving testimonies. Narratives were questioned and bodies inspected to provide answers to questions related to their credibility. Yet, physical scars turned out to have little to say: they vanish quickly, might have been self-inflicted or might not have resulted from torture. As a result, health professionals have to write convincing reports emphasizing psychic scars imputable to the violence experienced. Such reports are written according to certain schemas which leave no room for the victims’ narratives. Thus, reports do more than provide evidence to French government officials and judges, they “speak the words the individual cannot utter” (273).

Fassin and Rechtman conclude that the truth of trauma lies not so much in the psyche, mind or brain, but “in the moral economy of contemporary societies” (276). Processes involved in shaping our understanding of ‘trauma’ include our chaning relationship to time and memory, to mourning and obligations, to misfortune and the misfortunate. That is, “the validity people are willing to accord to trauma in order to relate the experience of descendants of survivors of the Holocaust, of Armenian or Rwandan genocide, of victims of slavery or apartheid, is not the validity of a clinical category but rather of a judgement – the judgment of history” (284). The Empire of Trauma speaks to a wide range of disciplines including anthropology, psychiatry and psychology, history, and social work. Besides deconstructing taken-for-granted concepts like trauma, PTSD, torture and psychiatric responses to suffering, the authors question intellectual links which have been established between historical events, social processes and psychiatric achievements over time. Yet, this book is not solely about deconstruction. Unlike other intellectual projects, especially those of relativistic psychiatry that deconstruct without offering practical or theoretical alternatives, the authors seek to rewrite and reconstruct the history of trauma and its related contexts in a critical but respectful, highly sensitive, and meticulous manner. This new history points at historical connections as well as ruptures, parallel developments, and radical shifts. The book is an important milestone in the research of trauma, trauma related disorders, approaches to treatment, and connected social, political, and economic paradigm shifts.

Hanna Kienzler is a doctoral candidate in the Department of Anthropology at McGill University. She conducted her Ph.D field research (May 2007 - June 2008) in two Kosovar villages that were hit especially hard during the war in 1998/99. Her research questions focused on issues related to how Kosovar Albanian women deal with trauma, trauma related disorders, resilience, treatment, and local forms of healing.

Jonathan Marks' Why I am Not a Scientist

2009-08-31T16:09:00.004-04:00

Why I am Not a Scientist: Anthropology and Modern Knowledge.
Jonathan Marks
University of California Press, 2009.
325 pgs, $22.95, paperback.

I began to know the work of Jonathan Marks a few years ago, when he came to the University of Minnesota for a colloquium visit. His presentation, as I recall, focused on the inability of theories of evolution to substitute for religious beliefs that provide individuals with a sense of meaning. When biological anthropologists do foray into the realm of providing meaning, they routinely use science to legitimate racist, sexist, and classist ideologies – sociobiology and evolutionary psychology being the latest iterations. For me, as an anthropologist of science and medicine, it seemed perfectly sensible and non-controversial. I was surprised, then, that some of the biologists in the room took great umbrage with Marks’ presentation. One scholar’s commonsense is another scholar’s radical critique.

I mention all of this because, as an anthropologist of science and medicine, much of what Marks presents in Why I am Not a Scientist: Anthropology and Modern Knowledge, comes across in the same vein. For me, it seems utterly reasonable, whereas for others – those who seek meaning in theories of evolution – it may be deeply irritating. But Why I am Not a Scientist is not for them; rather, like Bertrand Russell’s Why I am Not a Christian, which Marks’ book is named for, Why I am Not a Scientist is intended for a more general audience. As such, it serves as a survey of major trends in biological anthropology and the anthropology of science, and is presented in an informal, often humorous fashion. The first four chapters in the book situate science socially and culturally, the last few chapters examine the role of science in legitmating colonial rule and nineteenth and twentieth century scientific racism, sexism and classism. The middle chapters of the book – which focus on the reoccurrence of creationist critiques of human evolution, the uses of scientific fraud, and the problems associated with “bogus science” – are probably those of most interest to anthropologists of science, and cultural anthropologists more generally.

Marks’ main focus in “The Problem of Creationism” is that the sciences’ aims are in explaining laws of nature, whereas religion takes as its aim the explication of where laws come from. In other words, scientists should be more interested in explaining how evolution has led to Homo sapiens standing upright and having the capability for speech rather than why Homo sapiens stand upright and communicate using symbolic forms. As Marks sees it, advocates of creationism are not so interested in disputing laws of nature as they are in positing that these laws of nature emanate from a the Intelligent Design of a divine being. Scientists can take the moral high road and simply not engage with the debate, because when they do engage with religious fundamentalists they implicitly accept that creationist logics are worth engaging with – that they have as much merit (or nearly so) as the theories of evolution and natural selection that scientists promote. The difference now, as Marks points out, is that rather famous scientists – like Richard Dawkins – have taken it upon themselves to debunk religion, misapprehending their knowledge of nature’s laws as proofs against nature’s meaning. The very question of nature meaning much of anything is not something scientists have the tools to address, and, as Marks suggests, your plumber’s opinion of the subject is interchangeable with any scientist’ – they have equal expertise in the field. The point, as Marks summarizes, is this: “What we need is not to condemn the masses for their ignorance or rejection of evolution….Rather, we need the scientific community to differentiate for the booboisie [H. L. Mencken’s term] unambiguously between the rational, naturalistic study of life…and the crap that invariably also gets attached to Darwin’s name [e.g. Dawkin’s critiques of religion]” (126). Marks continues, arguing that “This is not to say that science should try to render people’s lives meaningful…but rather [to acknowledge] that science cannot reliably provide this service” (128). In other words, we should stick to our disciplines, and narrow our opinions to that which our data can actually support. Reasonable enough, until you come to the realization that science is always an ideological project, and subject to the same human foibles and follies that all social endeavors are. Any discipline, in this view, necessarily must shrink back from becoming too general in its claims.

In the succeeding two chapters, Marks focuses on, first, amateur and unorthodox approaches to science, and then turns to the place of scientific frauds. The problem that Marks is struggling with is this: Who should be listened to and why? This leads to concerns with the mechanisms by which knowledge is produced, disseminated, and recognized as being reputable. The problems, as Marks presents the reader with, is that scholarly production – through the regular channels of peer-review and in university laboratories – does not necessarily lead to the best research, nor the most rigorously tested findings, and often favors those in already established positions of power. The replication of scientific findings, is, in other words, something most often left to high school science classes, graduate students in their mentor’s lab, and professional competitors; each of these groups are predisposed to find what they already expect to see, the last of them more likely to find contrary rather than supporting evidence. Scientists, like the rest of us, are likely to see what they already believe, and the modern institutions that support and disseminate scientific research – universities and journals – are more likely to support those in positions of power than they are to acknowledge the validity of claims from laboratory whistleblowers who claim malfeasance and scientists who contradict dominant paradigms. This is especially problematic when science and politics intermingle, as in the case of eugenics during the first half of the twentieth century: With most of the eminent biologists in the U.S. and Europe supporting eugenics, there was very little space for disagreement, either within universities or in print. Moreover, there are those who utilize their power or knowledge to make claims in fields where they have little to no expertise (like Dawkins, or Bruce Lahn), as well as those who fabricate evidence to make claims that utilize their expertise, but extend it to realms where they previously had none (as in the case of Piltdown Man supporting British ideologies of cultural superiority), but if science worked as it should – honest peer-review, claims limited by discipline – these outliers might be effectively curtailed. Thus, what Marks argues we need is not to punish the fraudulent scientists or ridicule those that hold opinions that vary from dominant ideologies, but rather to acknowledge that science is social and cultural, and to align scientific practice and our expectations of scientists with these limitations.

Marks leaves readers with a provocative parting shot: Human nature is not something that needs to be thought about, but rather “unthought” (274). Reasonable enough. But what I found myself wanting by the end of Why I am Not a Scientist is the radical critique – something that motivates science and anthropology, rather than hobbling it. Human nature, after all, has been the subject of critique by cultural anthropologists for decades – including scholars like Nancy Scheper-Hughes (on maternal instinct) and Margaret Lock (on menopause). Lock, in light of Marks’ book, is especially interesting: Her concept of “local biologies” has gained little traction within anthropology or science, and, as such, might be the kind of paradigm setting concept that Marks could move forward with – a concept that at once unsettles the universality of “human nature” and also incorporates assumptions about environment and heredity that acknowledge the importance of Darwinian thinking in anthropology. In his favor, Marks does make mention of “cyborg” anthropology, scholarship that found impetus in the work of Donna Haraway, and assumes that human natures and human cultures are irreducible and inseparable – that assume, in other words, that human nature is always cultural, and vice versa. But, following Haraway’s recent work on “companion species” (which, itself, takes inspiration from Lynn Margulis’ theories of symbiotic relationships between species), this position is already a conservative one. The more radical position Marks could have taken would be one which embraces – or at least puts to the test – these other trends in anthropological thinking, which both disrupt assumptions about human nature and accept evolution. They also push at the boundaries of science (and science’s boundaries as they have historically been established) and replace anthropocentrism with a less comfortable proposition that understanding human natures and cultures depends on a much broader lens than any of the sciences or humanities has provided in the past. In the end, then, Marks leaves readers with a sense of what cannot (or should not) be done, but not a sense of what could be done. For that, we need a scientist willing to turn his or her insight and acumen on these troubling and peripheral trends in the sciences and to aid in figuring out what sorts of insights and futures they might provide. Why I am Not a Scientist is a useful intervention and corrective; for anthropologists, and readers more generally, who are looking for new frameworks for scientific and humanistic thought, however, they will have to look elsewhere.

Daedalus: On Being Human

2009-08-11T23:55:00.004-04:00

I've written here in the past about the National Humanities Center's On the Human Forum--a site meant to foster discussion about what "the human" has or is coming to mean in the context of contemporary social and technoscientific developments. The topic of this summer's issue of Daedalus is "On Being Human" and it is specifically framed as a "sampling of the scholarship inspired by the [National Humanities] Center's effort" to examine "how advances in science are enlarging the terms through which human life is discussed, and continuing to disturb traditional understandings of what it means to be human," (Introduction, p.5).

The contributions come from an impressive interdisciplinary group of scholars, and they include some thoughts on humanness from Charles Darwin--an excerpt from The Descent of Man, published here to commemorate the bicentennial of his birth.

These are all essays which have no abstracts, so I reproduce the TOC below. Unfortunately, access to all of these articles requires a subscription.

The changing face of human nature
Hilary Rose, Steven Rose

Humans: the party animal
Michael S. Gazzaniga

Natural & normative
Robert B. Pippin

Humans, aliens & autism
Ian Hacking

Comparison of the Mental Powers of Man and the Lower Animals–continued
Charles Darwin

Humans & humanists
Harriet Ritvo

How do we know what we are? The science of language & human self-understanding
Geoffrey Galt Harpham

Experimental moral psychology
Kwame Anthony Appiah

The Foucault audio archive

2009-08-10T13:07:00.003-04:00

At On the Assembly of Things, an Anthropology of the Contemporary Research Collaboratory blog, Paul Rabinow has announced the posting of a number of lectures and other audio files on the Michel Foucault Audio Archive--hosted by the UC Berkeley Library.

The audio files include four year-long courses which Foucault gave during his tenure at the Collège de France (all of these are in French): "Il faut défendre la société," 1976; "Sécurité, territoire, population," 1978; "Naissance de la biopolitique," 1979; "Gouvernement de soi et des autres," 1983. (An enterprising blogger at the Foucault blog has also found a fourth set of lectures, from 1984, which are, for some reason, not linked to on the Archive's page).

All of these lectures have now been published in French, and most of them translated into English as well. There are a number of additional materials in English: two series of lectures Foucault gave at Berkeley, and several recordings of conversations between Rabinow, Foucault and others which took place at Berkeley as well.

Anthropologists on H1N1 flu

2009-08-08T14:03:00.006-04:00

Just as speculation is increasing about the possible scale of an H1N1 epidemic this fall, the latest issue of Medical Anthropology: Cross-Cultural Studies in Health and Illness includes three excellent editorials by anthropologists on the issue.

In "Biocommunicability and the Biopolitics of Pandemic Threats," Charles Briggs and Mark Nichter focus on the communicative practices which made the epidemic into an object of knowledge, surveillance and intervention. In partciular, they focus on two key aspects of the story: 1) The circulation of information and knowledge about the flu, through a multitude of media outlets, but particularly through various Internet-based communication platforms, mirrors--to some extent--the spread of the pathogens and infections. We already acknowledge this similarity through the use of viral metaphors to describe various cyber-phenomena. 2) Much of the media coverage and discussion surrounding this spring's epidemic was metadiscursive -- that is, it focused on the rhetorical strategies involved in "getting the message right": informing, but not alarming, the public:

"Science columnist Ben Goldacre (2009) wrote in The Guardian that he received scores of requests by journalists to “balance” their stories: “'We need someone to say it's all been overhyped,' said BBC Wales.” Epidemics become Goldilocks tales—is there too much representation, too little, or just the right amount? Diverse publics, presented with this troubling “balancing act” between taking disruptive precautions or irresponsibly doing nothing, turned to their own communities of interpretation, the communications they were exposed to, and what others appeared to be doing around them in real time and virtual space.
This balancing act has an obvious function. If a virus outruns the knowledge of and the communications about it, it threatens to undermine public health authority by presenting the specter of a potential bioweapon of mass destruction that can sneak up dangerously on unaware experts, officials, and the public. The media, including the Internet, become fora in which all parties monitored and assessed each other's compliance with the moral imperative to circulate information and foster vigilance while allaying fear, " (Briggs and Nichter 2009).

However, as Briggs and Nichter continue, the "Goldilocks formula" does not present a very useful set of questions for social science researchers--or for that matter for anyone interested in understanding the underlying dynamics of the H1N1 story. Instead, they argue for:

"...the need for a framework for studying how such stories get made, how they become credible, and how the story-production process shapes assumptions about the nature of biomedical knowledge, who makes it, how it travels, who can receive it, and how discourse about epidemics and biosecurity affects budgets, public health infrastructures, citizenship, and governance," (Briggs and Nichter 2009).

Such a medical anthropology of epidemics, they continue:

"...can help make sense of what factors and actors shape the ongoing production of knowledge about epidemics, how dominant and competing accounts circulate and interact, how people access and interpret information available from different sources, and what they do with it—this includes all constituencies, from ordinary citizens to politicians and policymakers. This type of analysis complements the possibility of a medical anthropology for epidemic disease agenda that could be pursued by engaged medical anthropologists attempting to assist, for example, in constructing more effective zoonotic disease surveillance systems attentive to social and cultural factors that influence risk perception, behavior change, and social cooperation with health authorities," (Briggs and Nichter 2009).

In his "Pathogens Gone Wild? Medical Anthropology and the "Swine Flu" Pandemic," Merrill Singer argues that medical anthropology has three principle contributions in regard to H1N1 and other novel infectious diseases: "(1) field monitoring of the pandemic as a biosocial phenomenon; (2) assessment of the biosocial origins and ongoing social influences on the pandemic; and (3) research-based and culturally informed involvement in public health applications," (Singer 2009). The second of these approaches is particularly interesting and significant: for example, Singer mentions the role possibly played by industrial farming centers in creating conditions under which the virus could have originated (an issue also discussed by Erin Koch in her post on the "swine flu" on this blog).

Finally, in "Influenza, Anthropology and Global Uncertainties," Laëtitia Atlani-Duault and Carl Kendall focus on the ways that public health technologies neglect or obscure local knowledges. To counter the universalizing assumptions embedded in many global health interventions, they write:

"Anthropologists should work within the global community of health institutions first to map the varied truths constructed around the influenza epidemics and then to participate, together, in constructing new ones. Scapegoating, conspiracy theories, and anxieties about global risks of all sorts may be initial responses to this new threat. Anthropologists can help construct new truths, for example, about the disproportionate impact of epidemics on the poor and most vulnerable, constituting most of the deaths in this and many other epidemics, and the need to address the disparities in preparation and response. Anthropologists can help map local nonmedical resources and sources of resilience to tap in response. Our involvement can help direct anxieties about threatening global changes in population movements, the climate, and economy in ways that lead to sustainable programs of change. Thinking about the response to epidemics in this continuous way could focus resources on public health infrastructure and programs during interepidemic periods," (Atlani-Duault and Kendall 2009).

The rest of this issue of Medical Anthropology isn't about the flu, but includes several interesting-looking articles, including Ian Whitmarsh's "Hyperdiagnostics: Postcolonial Utopics of Race-Based Medicine."

Sandra Harding's Sciences from Below

2009-08-05T09:34:00.004-04:00

Over at Metapsychology Online Reviews, Ian James Kidd writes a generally positive review of Sandra Harding's most recent book - Sciences from Below: Feminisms, Postcolonialities, and Modernities (Duke UP, 2008). An excerpt from the review:

"Drawing upon contemporary literature in the history and philosophy of science, Harding argues that the alleged 'objectivity' of the sciences has for too long disguised its parochialism and 'Eurocentrism' and allowed it to provide intellectual legitimacy to projects of Western cultural and intellectual imperialism. To this end, she focuses on the exclusion of 'peoples at the peripheries of modernity', namely women and the peoples of non-Western cultures, exposing the marginalization of their values and perceptions, and calls for 'realistic reassessments of both Western and non-Western knowledge systems and the social worlds' they are embedded within (pp.5-6). The result is an ambitious and persuasive call for philosophers of science to take seriously, and engage with, social justice projects and political policymaking. This need not entail an abandonment of traditional philosophical concerns with, say, the role of values in science or the foundations of scientific knowledge, since, as Harding emphasizes, these all pertain to the authority of the sciences: her 'postcolonial' focus simply takes these familiar topics of philosophy of sciences and extends them into the social and political sphere," (Kidd 2009).

The book has also been reviewed in the Feminist Review, and Technology and Culture.

Learning to love meds: Americans' attitudes to psych meds may have improved since late 90s

2009-08-03T15:49:00.009-04:00

A post from guest contributor, Liz Oloft

"The Los Angeles Times (7/31, Roan) recently reported that, according to a survey in the August issue of the journal Psychiatric Services conducted by a researcher from the Johns Hopkins Bloomberg School of Public Health, "Americans have much more favorable attitudes about psychiatric medications compared with almost a decade ago." Specifically, "compared with a survey in 1998, respondents in a survey conducted in 2006 said psychiatric medications help people to feel better about themselves (68 percent compared with 60 percent); help people to deal with day-to-day stresses (83 percent compared with 78 percent), and make things easier in relations with family and friends (76 percent compared with 68 percent)."

Study author Ramin Mojtabai, MD, PhD, "expressed concern, however, that people's attitudes were increasingly positive, even in situations where there might not be a proven benefits to the" medications, HealthDay (7/31, Gordon) reported. He theorized that "advertising may have helped increased people's positive perceptions of these" medicines. "But, he added, there is also an increasing awareness that many psychiatric disorders have a biological or organic cause that medications may be able to help correct."

According to WebMD (7/31, Hendrick), "Over the years...negative attitudes about psychiatric" medications "have been among the greatest challenges in treating mental health problems," Dr. Mojtabai pointed out. Nevertheless, he added that the current survey "calls for a more targeted and selective approach in public information campaigns aimed at improving public understanding of the proper uses of psychiatric medications,"" (APA Headlines).

I thinks it's interesting (and consistent with a quietly rumbling internal critique of psych meds among medical researchers) that the authors of the study are concerned about how the public might have overly-positive attitudes about these medications. I imagine some of their concern is grounded in the findings that SSRI efficacy is questionable for mild to moderate depressive symptoms, and that at best about 3 out 10 people trying an SSRI will benefit from it. They might also be speaking from concern about the increasing use of psych meds with kids. My own research has shown that (at least) two cultural attitudes exist simultaneously with regard to psych meds: on the one hand we have increasing normalization of medication use and diminishment of stigma--to the point where high school kids have casual chats at their lockers about what meds they are taking--and on the other, good old morally condemnatory Calvinist views on psych meds. The latter perspective views conditions like depression as indicative of weakness in character and medications as quick fixes. These two discourses appear in many of the interviews I have conducted with young adult psychiatric med users, and many of their narratives reveal attempts to reconcile the contradictions the two discourses pose.

I am also also struck by how the researcher hypothesizes that advertising has improved attitudes. All I can say to this is that I am deeply troubled by the market's virtual hegemonic power in shaping our culture. You might call me sentimental, nostalgic for a past that never was, and naive about the history of medicine and the market. To this I will say that not only am I a psych med user but I have Marxist leanings, too.

Liz Oloft, Ph.D., is trained as an anthropologist. Her previous post for Somatosphere was "Prozac in the Closet."