Culture Medicine and Psychiatry最新文献

The series of papers in this special issue, "Ethnography of and in Clinical Formation: Poetics and Politics of Dual Subjectivity," touch on several themes that are at the core of social medicine: the web of social structures and power relations that organize the risk and prematurity of disease and death, who gets care when and where, and what that care looks like and does within situated social worlds. As Levenson and Samra (this issue) describe in their contribution, social medicine turns on extending the field of medical action "beyond the clinical encounter" in order to visibilize how such encounters are "organized by wider regimes of governance and expertise, and broader geographies of care, abandonment and violence." Writing from the "fractured habitus" as reported by Schlesinger (Doing and seeing: Cultivating a "fractured habitus" through reflexive clinician ethnography, Somatosphere, 2021) of clinician-ethnographers, the authors here witness and interrogate the nascent possibilities for more liberatory and autonomous forms of care within these otherwise determining regimes. They also expose the limits of traditional clinical ethnographic positioning through authors' diverse participations within spaces of organized violence - indicating the need for a "new conceit" (Aboiil, this issue) of the clinical ethnographer/social medicine practitioner who is open to sitting in the trouble of a "complicity consciousness" (Sufrin, this issue) and the expanded fields of theorizing, action, and accompaniment that it makes possible.

Understanding local worldviews is a challenge during clinical encounters, especially when they involve cultural references without acceptance from the medical community. Gangstalking is a Western cultural notion which refers to systematic harassment, surveillance, and torture from unseen or covert assailants or networks. It is not a 'real phenomenon' compared with genuine stalking, but experients report worse depression, post-traumatic symptoms, suicidal ideation, and longer lasting encounters. They report physical pain and impossible feats of espionage technologically orchestrated by unknown malevolent actors. Using conversational data from targeted individual podcasts, I explore gangstalking as a cultural concept of distress (CCD) by highlighting associated explanations, idioms, and symptoms. Clinically, gangstalking is likely diagnosed as paranoid schizophrenia. However, its association with frightening events parallels Susto and Nervios. Physical symptoms parallel Open Mole and Brain Fag Syndrome. Like many CCDs, gangstalking is a multi-dimensional phenomenon not neatly mapped onto psychiatric categories. Misinterpreting gangstalking cases as unique or isolated is a likely outcome even when they fit within a well-known Western subculture and techno-science belief system. Moving past prior, outdated notions of folk illnesses and culture-bound syndromes, gangstalking as a CCD helps end the assumption that only the other has exotic or non-psychiatric categories of distress.

Articulations of the chasm between ideal and attainable forms of care surfacing throughout the coronavirus (COVID-19) pandemic have highlighted the proliferation of unceremonious deaths associated with inequitable conditions. This paper reconsiders the preposterous temporality of pandemic care by following corpses in and out of clinical space. Written from the perspective of a MD/PhD student's encounter with a corpse replacing the patient on the medicine ward prior to pandemic onset, this paper asks how corpses might interrupt narratives of clinical care. Sifting through Eugène Ionesco's 1954 play "Amédée," Édouard Glissant's rejection of the tragic heroine, Achille Mbembe's positing of viscerality as autopsy, and David Marriott's theorization of blackness as corpsing among other engagements, I conceptualize how corpses might refigure clinical spaces as preposterous realms wherein distinctions between a before and after falter. Considering the continuities between an apparent before and after, I argue that the contemporary concerns punctuating the pandemic as a unique period in time might not be as contemporary as they first appear. Taking cues from literary analysis and fictional works, I engage the corpse as a figure that prompts a rethinking of what might constitute ideal as well as failed care. I argue that corpses in clinical space signal a critique of the ideal narrative arc, one that centers the medical provider as heroine/hero in the midst of tragedy. Turning to the corpse as an interruptive figure, I ask what this dominant narrative might ultimately demand of its cast of characters-protégé, provider, and patient.

Historians and ethnographers have described biomedicine as a modernist project that imagines accumulating ever-more stable knowledge over time. This project broke down in heavily hit hospitals at the onset of the COVID-19 pandemic in the U.S., when bureaucratic, physical and knowledge structures collapsed. A combination of terror, a partially characterized disease entity and clinicians' inability to operate without disease models drove them to draw on rapidly changing and contradictory information via social media, changing medical practice minute-to-minute. The result was a unique form of knowing described as "hallucination": a hyperreal, unstable ecology of imagined viral particles distributed in physical spaces, transforming with each text message and tweet. The nature, experience and practice of this ecology sheds light on what happens when instability comes to otherwise stable places.

This paper considers the development of new clinical and medical practices in the early 2000s in France, after the adoption of legal reforms aiming at the prevention of sexual infractions and the protection of minors. The paper explains how the reform led to the creation of a new form of punishment for sexual offenders, l'obligation de soin (therapeutic obligation), which can be described as long-term mandatory therapeutic monitoring. This paper offers an analysis of the implementation of this measure from the standpoint of the specialized mental health care unit which were entrusted the mission of caring for the new group of convicted patients, i.e., patients sentenced to undergo mandatory therapy, after this legal reform. In the new regime these mandatory therapies created, clinicians are tasked to combine their conventional mission of care for the patient in the present, with the judicial mandate of detecting and preventing the patient's relapse qua recidivism in the future. Mobilizing ethnographic examples that evidence the way clinical care comes to encompass a penal mandate of long-term surveillance of convicted patients, I argue that the dual injunction of procuring care while preventing relapse-recidivism constrains the psychodynamic forms of clinical intervention deployed by French clinicians, realigns both psychiatric and clinical interventions along penal lines, and revives interest in some of the diagnostic categories and aims of criminal psychiatry which were important for the development of psychiatry in France.

This short historical note dates the earliest ethnomedical reference to koro back to the 1840s (about a half-century earlier than universally presumed), and the earliest ethnopsychiatric reference to 1883 (over a decade earlier than universally presumed).

The field of medical action extends beyond the clinical encounter. Rather, clinical encounters are organized by wider regimes of governance and expertise, and broader geographies of care, abandonment and violence. Clinical encounters in penal institutions condense and render visible the fundamental situatedness of all clinical care. This article considers the complexity of clinical action in carceral institutions and their wider geographies through an examination of the crisis of mental health care in jails, an issue of significant public concern in the United States and much of the world. We present findings from our engaged, collaborative clinical ethnography, which was informed by and seeking to inform already existing collective struggles. Revisiting the concept of "pragmatic solidarity" (Farmer in Partner to the poor: a Paul Farmer reader, University of California Press, Berkeley, 2010) in an era of "carceral humanitarianism" (Gilmore in Futures of Black Radicalism, Verso, New York, 2017, see also Kilgore in Repackaging mass incarceration, Counterpunch, June 6-8, http://www.counterpunch.org/2014/06/06/repackaging-mass-incarceration/ , 2014), we draw on theorists who consider prisons to be institutions of "organized violence" (Gilmore and Gilmore in: Heatherton and Camp (eds) Policing the planet: why the policing crisis led to Black lives matter, Verso, New York, 2016). We argue that clinicians may have an important role in joining struggles for "organized care" that can counter institutions of organized violence.

This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.

Amid patriarchal conditions that render one son necessary and multiple daughters burdensome, selective abortion of female fetuses has become pervasive in India. Public responses often cast sex selection as self-evidently ignorant, cruel, and misogynistic - an obvious evil meriting denunciation and eradication. Drawing on ethnographic fieldwork in Gujarat state, this article zooms out from ultrasound and abortion to survey the landscape of biomedical, herbal, and religious son production techniques surrounding them. Doing so clarifies the lived moral experience in which sex selection is embedded. Resort to multiple son production techniques is both an abstract moral indicator reflecting prevailing concerns and a pragmatic moral intervention aimed at harnessing every available means in response to those concerns. Fundamentally, people live out the multimodal quest that sometimes leads to selective abortion as aspiration - social, bodily, spiritual - toward an indispensable good, not as heartless rejection of daughters. Pluralistic son production illuminates the moral uses of medical pluralism for care-seekers, social scientists, and policymakers and practitioners. The case underscores that "complementary" therapies, rather than being just desperate behaviors, barriers to biomedical therapy, or curiosities to be integrated into care, may in fact be the clearest markers of the moral conditions in which public health problems unfold.

Cultural consonance, defined as the extent to which one is able to approximate a given cultural model in one's own life, is a highly adaptive theory and method which anthropologists have used for decades to demonstrate direct connections between individuals' variation in relation to meaning systems and their health outcomes. However, it has been limited by use of a "cultural consonance score" which treats cultural consonance unidimensionally. Because people enact cultural models in multiple ways, cultural consonance may be better operationalized multidimensionally. Applying correspondence analysis to young South Korean men's responses to a cultural consonance scale measuring their approximation of the local ideal male body, cultural consonance is rather demonstrated to be a multiplicity. In the case of South Korean men's body ideals, two dimensions-men's overall attractiveness and whether they pursue a "flower boy" or a "beastly man" embodiment-are identified. These two dimensions are also significantly associated with university prestige and sexual identity, and predict disordered eating beyond body dissatisfaction. These data suggest that well-being in relation to cultural consonance is a product of its assemblage: both of degree of approximation of a cultural model and the manner by which individuals enact it.