Culture Medicine and Psychiatry最新文献

This article presents two cases from a collaborative study among Tibetan monastic populations in India on the postdeath meditative state called "tukdam (Tib., thugs dam)". Entered by advanced Tibetan Buddhist practitioners through a variety of different practices, this state provides an ontological frame that is investigated by two distinct intellectual traditions-the Tibetan Buddhist and medical tradition on one hand and the Euroamerican biomedical and scientific tradition on the other-using their respective means of inquiry. Through the investigation, the traditions enact two paradigms of the body at the time of death alongside attendant conceptualizations of what constitutes life itself. This work examines when epistemologies of these two traditions might converge, under what ontological contexts, and through which correlated indicators of evidence. In doing so, this work explores how these two intellectual traditions might answer how the time course and characteristics of physiological changes during the postmortem period might exhibit variation across individuals. Centrally, this piece presents an epistemological inquiry delineating the types of valid evidence that constitute exceptional processes post-clinical death and their potential ontological implications.

Although tukdam-a meditative state entered through various practices resting in extremely subtle consciousness while dying-is seen to only be achieved by adept practitioners, the philosophy and psychology that underpin tukdam inform Tibetan communities beyond just accomplished adepts and frame the very way death and dying is conceived. Based on an 18-month ethnographic study, this article explores the significance of death as a Tibetan Buddhist cultural-reference that offers a moral heuristic ground for adaptive methods in transforming orientations to self and others and in cultivating compassion and resilience. Tibetan Buddhist practitioners emphasize a strong correlation between a true understanding of self and sustained happiness. This article thus asks a dual conceptual question: (1) Why do Tibetans believe that meditating on death is the key to experiences of well-being in their day-to-day life? (2) What is the relation between the temporalities of the meditated death and that of the day-to-day life? Furthermore, the article proposes that Tibetan Buddhist practices that culminate in tukdam symbolize the way death and dying is assumed to be approached more broadly beyond advanced practitioners, and thereby, provides a cultural model for an "ideal" death that guides approaches to dying for oneself and others.

In this article, I describe the dilemmas of working as a physician-ethnographer within the Rikers Island jail healthcare system before and at the beginning of the COVID-19 epidemic in April 2020. The Rikers Island jail system in New York City has been in the national spotlight as a space of violence, trauma, and death amidst calls to decarcerate by community members and abolition advocates. This article is a personal reflection on the labor and subjectivity of healthcare providers and their positionality to multiple axes of structural and interpersonal violence while attempting to provide care in carceral institutions. I observe how COVID-19 functioned as an additional form of structural violence for incarcerated people. Clinical ethnography remains an essential tool for understanding complex social phenomena such as violence. However, physician-ethnographers working in these spaces of structural violence can have unique and conflicting constraints: tasked with providing evidence-based medicine but also simultaneously participating in an unusual form of labor that is an amalgamation of care, social suffering, and punishment. Despite and across at-times conflicting roles and obligations, I propose that these fragmented subjectivities can foment social criticism, propel advocacy toward decarceration, and produce a critically engaged dialogue between fields of anthropology and medicine toward a goal of health justice.

Anthropologist-clinicians who engage in both ethnographic inquiry and clinical practice confront methodological, ethical, and epistemological predicaments that can challenge and enhance the moral practice and ethics of care inherent both to healing and to ethnography. Clinician-ethnographers often find themselves practicing within harmful systems that they also critique, such as hospitals or carceral institutions. This paper analyzes the dual practice of obstetrical care and ethnography in a county jail and a county hospital. These intertwined roles involve wrestling with sometimes conflicting vocational and ethical obligations to heal, to protect privacy, to address bodily consequences of systemic oppressions, and to critique the systems that mete human suffering. Developing a consciousness of clinical-ethnographers' complicity, rather than disavowing it, can be aligned with approaches of abolition medicine to reimagine more just forms of healing.

Can the fraught relation between disability and aging ever become untangled? What is the place of the catastrophically disabled in a time when giving voice and being seen are significant lodestars of political activism? And what becomes of the caregivers, who often labor in silence, and who hope to work well enough just to get through another day? This essay draws on the memoirs of Simone de Beauvoir, Annie Ernaux, Amy Bloom, and my own experiences to show the complicated imbrications of age, disability, and caretaking. I attempt to demonstrate through these experiences that age and disability, which appear to be intimately woven together, are oftentimes misleadingly connected. I suggest that an ethic of vulnerability, rather, is a more useful heuristic that avoids collapsing the categories of age and disability together. Nevertheless, these reflections inevitably lead to a discussion of death and the choices, policies, and other care structures (un)available for persons who sometimes desire to make significant decisions about ending their life when confronted with the possibility of terminal and catastrophic mental and bodily decline. Finally, I suggest that these relationships and the decisions about (end of life) care must be understood to be ambiguous and require a deep reciprocity of care based upon love, sympathy, and respect.

In this article, I present the individual ethnography of Amina, a Senegalese woman possessed by the spirits of her lineage. Amina's story shows the lacerations of a person who simultaneously inhabits two worlds: the traditional Lebou culture and the Western one. When her spirits manifest themselves, she is forced to choose between two different interpretations of her suffering: the traditional persecutory and the Western psychopathological. She chooses the former but refuses the healers imposed by the tradition and turns to a priest of her choice, who proves to be sensitive to her need to personally own the healing journey. Amina strategically manipulates the plasticity of the traditional belief system without abandoning it; she bends it to shake the boundaries of herself, and her group and lineage. She uses the disruptive potential of possession and the irruption of the invisible world in the visible to renegotiate her role and acquire a new status in her group. She uses the performative dispositive of possession to renegotiate and expand her spaces of agency and affirm her tenacious subjectivity of a permanently liminal person, one who inhabits, shakes and redraws the boundaries between different worlds of meaning.