Endometriosis is a condition where tissue similar to the uterine lining develops outside the uterus; it ‘bleeds’ during periods, forms lesions, and causes chronic pain. Despite affecting around 10% of menstruating people, its aetiology is poorly understood, and diagnostics and treatments are highly inadequate. Current efforts to reconceptualise the disease generally centre around inflammation. In this Field Note I describe my fieldwork during the pandemic, which was largely based on in-depth interviews with patients and clinicians in and around Edinburgh, Scotland. This research interrogates the socio-cultural context in which endometriosis is changing from a ‘gynaecological disorder’ to a ‘systemic disorder’ implicating the endocrine system (a ‘hormonally driven condition’), the neural system (‘neuropathic pain’) and/or the immune system (an ‘inflammatory condition’). It explores how the lived experience of endometriosis challenges ingrained ways of thinking about the body and bodily ‘systems,’ which are reflected in the design of healthcare systems. Considering endometriosis alongside changing conceptions of immune response invites thinking beyond self-versus-non-self (as in older concepts of immunity), and self-attacking-self (as in auto-immune conditions), to something like ‘self-out-of-place,’ simultaneously calling into question the suitability of our social and material relations.
{"title":"How to Categorise Disease? Endometriosis, Inflammation, and ‘Self Out of Place’","authors":"Andrea Lilly Ford","doi":"10.17157/mat.11.1.7390","DOIUrl":"https://doi.org/10.17157/mat.11.1.7390","url":null,"abstract":"Endometriosis is a condition where tissue similar to the uterine lining develops outside the uterus; it ‘bleeds’ during periods, forms lesions, and causes chronic pain. Despite affecting around 10% of menstruating people, its aetiology is poorly understood, and diagnostics and treatments are highly inadequate. Current efforts to reconceptualise the disease generally centre around inflammation. In this Field Note I describe my fieldwork during the pandemic, which was largely based on in-depth interviews with patients and clinicians in and around Edinburgh, Scotland. This research interrogates the socio-cultural context in which endometriosis is changing from a ‘gynaecological disorder’ to a ‘systemic disorder’ implicating the endocrine system (a ‘hormonally driven condition’), the neural system (‘neuropathic pain’) and/or the immune system (an ‘inflammatory condition’). It explores how the lived experience of endometriosis challenges ingrained ways of thinking about the body and bodily ‘systems,’ which are reflected in the design of healthcare systems. Considering endometriosis alongside changing conceptions of immune response invites thinking beyond self-versus-non-self (as in older concepts of immunity), and self-attacking-self (as in auto-immune conditions), to something like ‘self-out-of-place,’ simultaneously calling into question the suitability of our social and material relations.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What does it mean when pharmaceuticals are called ‘biologics’? This article follows a pregnant person who has been hospitalised on a Norwegian rheumatology ward after being taken off her monoclonal antibody (mab) medication. She is painfully trapped in a crisis that is medical and existential, but also epistemological. Weighing the debilitating consequences of her disease against concerns about pharmaceutical risks for herself and her unborn child, she creates and adapts her own knowledge of mabs as ‘biologics’. Far from being passively receptive, she thus becomes part of a complex project of semantics where analogies and oppositions of biologic and chemical, natural and man-made, health and unhealth work to render some knowledge plausible and some implausible. Placing the individual and the pharmaceutical label at the centre of this semantic economy, the article suggests that pharmaceutical labels play an important albeit unacknowledged role in the making of pharmaceuticals as safe and efficacious.
{"title":"Bio-imaginaries: ‘Biologics’, Bricolage, and the Making of Pharmaceutical Knowledge","authors":"Jonas Kure Buer","doi":"10.17157/mat.11.1.7244","DOIUrl":"https://doi.org/10.17157/mat.11.1.7244","url":null,"abstract":"What does it mean when pharmaceuticals are called ‘biologics’? This article follows a pregnant person who has been hospitalised on a Norwegian rheumatology ward after being taken off her monoclonal antibody (mab) medication. She is painfully trapped in a crisis that is medical and existential, but also epistemological. Weighing the debilitating consequences of her disease against concerns about pharmaceutical risks for herself and her unborn child, she creates and adapts her own knowledge of mabs as ‘biologics’. Far from being passively receptive, she thus becomes part of a complex project of semantics where analogies and oppositions of biologic and chemical, natural and man-made, health and unhealth work to render some knowledge plausible and some implausible. Placing the individual and the pharmaceutical label at the centre of this semantic economy, the article suggests that pharmaceutical labels play an important albeit unacknowledged role in the making of pharmaceuticals as safe and efficacious.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140240286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Microbes exist everywhere on, in and around us. They are both ubiquitous and largely invisible, at least until they make their presence, or absence, felt. Recent years have seen a heightened sensitivity to microbial threats in the wake of the COVID-19 pandemic and widespread concerns about antimicrobial resistance (AMR) to antibiotics. At the same time, there is also a growing interest in the microbiome as a source of ‘wild immunology’. From this viewpoint, the human body is comprised of, embedded within, and dependent on its exposure to an ecosystem of microbes, and the absence of such exposure is linked to the development of auto-immune conditions such as Crohn’s disease and ulcerative colitis. Inspired by an emerging body of work in the humanities and social sciences which looks to engage with so-called lay knowledge and understandings of microbial forms (including bacteria, viruses, and fungi) and processes (such as contagion or digestion), this Field Note explores the piloting of ‘body mapping’ as a research method to engage with families to explore their collective understanding of their children’s microbiome.
{"title":"Mapping Microbial Selves: Field Notes from a Dirty Parenting Project","authors":"Beth Joanna Greenhough, Maaret Jokela-Pansini, Eben Kirksey, Jamie Lorimer","doi":"10.17157/mat.11.1.7057","DOIUrl":"https://doi.org/10.17157/mat.11.1.7057","url":null,"abstract":"Microbes exist everywhere on, in and around us. They are both ubiquitous and largely invisible, at least until they make their presence, or absence, felt. Recent years have seen a heightened sensitivity to microbial threats in the wake of the COVID-19 pandemic and widespread concerns about antimicrobial resistance (AMR) to antibiotics. At the same time, there is also a growing interest in the microbiome as a source of ‘wild immunology’. From this viewpoint, the human body is comprised of, embedded within, and dependent on its exposure to an ecosystem of microbes, and the absence of such exposure is linked to the development of auto-immune conditions such as Crohn’s disease and ulcerative colitis. Inspired by an emerging body of work in the humanities and social sciences which looks to engage with so-called lay knowledge and understandings of microbial forms (including bacteria, viruses, and fungi) and processes (such as contagion or digestion), this Field Note explores the piloting of ‘body mapping’ as a research method to engage with families to explore their collective understanding of their children’s microbiome.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140237217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Resilience—a term that originated in mathematical ecology—now commonly refers to the ability to thrive in the face of trauma and adversity. This Position Piece reflects on both the charisma and political lability of resilience in the early 21st century. On the one hand, resilience is easily compatible with neoliberal discourses that demand that individuals protect themselves in the absence of state or community support. On the other hand, resilience can be an important corrective to narratives about the damage caused by trauma, focusing attention on our innate ability to heal. We argue that the ambivalence of resilience requires theoretical and empirical attention to both the wider appeal of the term and the situated definitions deployed by diverse actors. In particular, we look at the rise of the term ‘community resilience’ popularised by academics, community leaders, and activists, which seeks to avoid the pitfalls of the neoliberal definition of resilience and argues that strong interpersonal relationships can support health equity. Despite the ambivalence of resilience, we find “community resilience” to be promising in a time when collective visions of health and immunity are desperately needed.
{"title":"Relations as Immunity: Building Community Resilience","authors":"Martha Kenney, Ruth Müller","doi":"10.17157/mat.11.1.7266","DOIUrl":"https://doi.org/10.17157/mat.11.1.7266","url":null,"abstract":"Resilience—a term that originated in mathematical ecology—now commonly refers to the ability to thrive in the face of trauma and adversity. This Position Piece reflects on both the charisma and political lability of resilience in the early 21st century. On the one hand, resilience is easily compatible with neoliberal discourses that demand that individuals protect themselves in the absence of state or community support. On the other hand, resilience can be an important corrective to narratives about the damage caused by trauma, focusing attention on our innate ability to heal. We argue that the ambivalence of resilience requires theoretical and empirical attention to both the wider appeal of the term and the situated definitions deployed by diverse actors. In particular, we look at the rise of the term ‘community resilience’ popularised by academics, community leaders, and activists, which seeks to avoid the pitfalls of the neoliberal definition of resilience and argues that strong interpersonal relationships can support health equity. Despite the ambivalence of resilience, we find “community resilience” to be promising in a time when collective visions of health and immunity are desperately needed.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Special issue 'The Immune System, Immunity and Immune Logics: Troubling Fixed Boundaries and (Re)conceptualizing Relations', guest edited by Andrea Ford and Julia Swallow.
特刊 "免疫系统、免疫和免疫逻辑：扰乱固定边界和（重新）概念化关系"，由 Andrea Ford 和 Julia Swallow 客座编辑。
{"title":"The Immune System, Immunity and Immune Logics: Troubling Fixed Boundaries and (Re)conceptualizing Relations","authors":"Andrea Ford, Julia Swallow","doi":"10.17157/mat.11.1.9443","DOIUrl":"https://doi.org/10.17157/mat.11.1.9443","url":null,"abstract":"Special issue 'The Immune System, Immunity and Immune Logics: Troubling Fixed Boundaries and (Re)conceptualizing Relations', guest edited by Andrea Ford and Julia Swallow.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140238996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this article I draw on the concept of anticipation to examine Finnish news discourse on the development, licensing and administration of COVID-19 vaccines. I explore the interplay of anticipation of vaccine-induced immunity and vaccine safety concerns, and trace how ideas of protection and risk were invoked in relation to specific vaccine technologies as well as different accounts of biomedical pasts, including cases of narcolepsy associated with one of the 2009 H1N1 influenza vaccines. I demonstrate that anticipation around vaccine development during a public health emergency operates through a series of small shifts and twists that magnify affects around novel vaccines in news media discourse. I argue that even a slight shift in the biomedical knowledge about immunity or in the historical framing of specific vaccine technologies may significantly reshape vaccine-induced immunity as an object of anticipation.
{"title":"Anticipating Immunity: Vaccine-induced Immunity and Vaccine Safety in the Finnish News Coverage of COVID-19 Vaccines","authors":"Venla Oikkonen","doi":"10.17157/mat.11.1.7262","DOIUrl":"https://doi.org/10.17157/mat.11.1.7262","url":null,"abstract":"In this article I draw on the concept of anticipation to examine Finnish news discourse on the development, licensing and administration of COVID-19 vaccines. I explore the interplay of anticipation of vaccine-induced immunity and vaccine safety concerns, and trace how ideas of protection and risk were invoked in relation to specific vaccine technologies as well as different accounts of biomedical pasts, including cases of narcolepsy associated with one of the 2009 H1N1 influenza vaccines. I demonstrate that anticipation around vaccine development during a public health emergency operates through a series of small shifts and twists that magnify affects around novel vaccines in news media discourse. I argue that even a slight shift in the biomedical knowledge about immunity or in the historical framing of specific vaccine technologies may significantly reshape vaccine-induced immunity as an object of anticipation.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140239287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As a crosscutting concept in biology, anthropology, and philosophy, immunity has been a critical ‘site’ of debate on the relations between self and other, organism and environment, risk and responsibility, the corporeal and the political. In this Research Article, I trace how these relations and everyday life during the COVID-19 pandemic relied on a web of coordinated—and sometimes unexpected—lines of communication, restriction, and solidarity. Using an experimental approach that combines multimodal autoethnography and multiscalar relational analysis, I present a first-person account of travelling during, testing for, and falling ill and isolating with COVID-19 in late 2021. I explore how pandemic life-lines, including public health measures, vaccinations, devices, and helplines, as well as mundane gestures of care and ecologies of support, acted together as shared immunities. In this exploration, I propose to reconceptualise ‘immunity’ as a process network rather than a defence apparatus, shedding light on how these life-lines may influence differential trajectories of disease and healing. To conclude, I discuss how my conceptual and methodological approach contributes to a social ecological understanding of immunity, that goes beyond the biopolitical, in times of pandemic and in the future.
{"title":"Pandemic Life-lines: A Multimodal Autoethnography of COVID-19 Illness, Isolation, and Shared Immunities","authors":"Angela Marques Filipe","doi":"10.17157/mat.11.1.7359","DOIUrl":"https://doi.org/10.17157/mat.11.1.7359","url":null,"abstract":"As a crosscutting concept in biology, anthropology, and philosophy, immunity has been a critical ‘site’ of debate on the relations between self and other, organism and environment, risk and responsibility, the corporeal and the political. In this Research Article, I trace how these relations and everyday life during the COVID-19 pandemic relied on a web of coordinated—and sometimes unexpected—lines of communication, restriction, and solidarity. Using an experimental approach that combines multimodal autoethnography and multiscalar relational analysis, I present a first-person account of travelling during, testing for, and falling ill and isolating with COVID-19 in late 2021. I explore how pandemic life-lines, including public health measures, vaccinations, devices, and helplines, as well as mundane gestures of care and ecologies of support, acted together as shared immunities. In this exploration, I propose to reconceptualise ‘immunity’ as a process network rather than a defence apparatus, shedding light on how these life-lines may influence differential trajectories of disease and healing. To conclude, I discuss how my conceptual and methodological approach contributes to a social ecological understanding of immunity, that goes beyond the biopolitical, in times of pandemic and in the future.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140239213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parents of a child diagnosed with a rare inherited metabolic disease (IMD) are required to actively participate in their child’s treatment, by managing the risk of metabolic crisis and ensuring that they adhere to a stringent diet. In this Research Article, I discuss the specific roles, tasks, and knowledge that Polish and Swedish parents of children with IMDs have developed. I also pay critical attention to the notions and metaphors that parents, clinicians, and social scientists use to describe these. The prevailing metaphors of professionalisation used to describe parental roles contribute to the acknowledgment of these caregivers’ unique expertise. However, I argue, they also overly stress an individualistic perspective and obscure the relationality of care, collaboratively achieved between parents, patients, relatives, and healthcare providers.
{"title":"'You Become Pretty Much a Healthcare Worker': The Parenting of a Child with Inherited Metabolic Disease and its Metaphors","authors":"Filip Rogalski","doi":"10.17157/mat.10.3.6702","DOIUrl":"https://doi.org/10.17157/mat.10.3.6702","url":null,"abstract":"Parents of a child diagnosed with a rare inherited metabolic disease (IMD) are required to actively participate in their child’s treatment, by managing the risk of metabolic crisis and ensuring that they adhere to a stringent diet. In this Research Article, I discuss the specific roles, tasks, and knowledge that Polish and Swedish parents of children with IMDs have developed. I also pay critical attention to the notions and metaphors that parents, clinicians, and social scientists use to describe these. The prevailing metaphors of professionalisation used to describe parental roles contribute to the acknowledgment of these caregivers’ unique expertise. However, I argue, they also overly stress an individualistic perspective and obscure the relationality of care, collaboratively achieved between parents, patients, relatives, and healthcare providers.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135585957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Tide of Open Access","authors":"MAT Editorial Collective","doi":"10.17157/mat.10.3.9079","DOIUrl":"https://doi.org/10.17157/mat.10.3.9079","url":null,"abstract":"Editorial to the September issue of 2023.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Over the last several decades, epidemics of chronic kidney disease of unknown aetiology (CKDu) have appeared in Mesoamerica, North Africa, and South Asia. Drawing on 14 months of ethnographic fieldwork in a CKDu-affected village in Sri Lanka, I explore how one CKDu ‘hotspot’ came into being following population screening interventions by a community development organisation, a philanthropic foundation, and a university research group. While the production of test results proved vital to the mobilisation of further research and public health resources for the community, this ethnography reveals philanthropy could be seen to have shaped by screening as much as screening was seen to have influenced by philanthropy. The example of medical screening and philanthropic interventions in Ginnoruwa illustrates how bioindicators of failing kidney function became a key metric for demarcating the community into populations of the deserving (or not so deserving) poorly, which in turn helped to create the pattern of disease prevalence and concentration that led to the community being designated a ‘hotspot’. In Ginnoruwa, philanthropy and screening did not operate independently but constituted a novel hybrid, which I refer to as ‘philanthropic science’.
{"title":"Screening Charity Recipients: Health Philanthropy, Medical Diagnosis, and Kidney Disease Prevention in Sri Lanka","authors":"Upul Kumara Wickramasinghe","doi":"10.17157/mat.10.3.7764","DOIUrl":"https://doi.org/10.17157/mat.10.3.7764","url":null,"abstract":"Over the last several decades, epidemics of chronic kidney disease of unknown aetiology (CKDu) have appeared in Mesoamerica, North Africa, and South Asia. Drawing on 14 months of ethnographic fieldwork in a CKDu-affected village in Sri Lanka, I explore how one CKDu ‘hotspot’ came into being following population screening interventions by a community development organisation, a philanthropic foundation, and a university research group. While the production of test results proved vital to the mobilisation of further research and public health resources for the community, this ethnography reveals philanthropy could be seen to have shaped by screening as much as screening was seen to have influenced by philanthropy. The example of medical screening and philanthropic interventions in Ginnoruwa illustrates how bioindicators of failing kidney function became a key metric for demarcating the community into populations of the deserving (or not so deserving) poorly, which in turn helped to create the pattern of disease prevalence and concentration that led to the community being designated a ‘hotspot’. In Ginnoruwa, philanthropy and screening did not operate independently but constituted a novel hybrid, which I refer to as ‘philanthropic science’.","PeriodicalId":74160,"journal":{"name":"Medicine anthropology theory","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135587474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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