Anthropology & Medicine最新文献

This paper takes as its focus the caregiving efforts of a group of mothers in Dublin who were homeless, struggling with addiction, and separated from their children. It explores their ongoing orientation towards their distant children, in terms of their affective longings, practical actions, and moments of faltering, for despite yearning for an ongoing role in their children's lives, many of my interlocutors struggled to maintain a consistent caregiving engagement. The paper argues that the halting nature of my interlocutors' caring efforts does not preclude the sincerity of their affective concerns for their children, and that if we only judge care based on practical action and output, we overlook the tough realities of caregiving on the ground. Moreover, appreciating this fluctuating pattern of caregiving is necessary to understanding my interlocutors' oscillating trajectories through homelessness and substance use, and how these trajectories were shaped by their vacillating relationship with hope. This paper thus introduces the concept 'faltering care': care which encompasses conjoined moments of lapsed practical action and sustained affective concern, but which nonetheless reflects the care provider's hopeful reach towards leading a moral life.

National Health Service England established the Race and Health Observatory as an independent expert body in 2021 to advance meaningful changes for Black and minority ethnic communities, patients, and healthcare professionals. It serves as a 'proactive investigator' by commissioning and facilitating research to achieve long-term transformation in health outcomes. However, medical anthropologists have largely overlooked the Observatory (and the research it commissions) in critical assessments of race and health. This commentary discusses the 2024 review into "health communications with (and for) Jewish communities" vis-à-vis the ethnographic record. On the one hand, the intention behind the Observatory's review is laudable because Jews have been excluded from critical discussions on race and health in the UK as well as the US and Europe. While the review has potential for rendering health inequality in Jewish communities visible, some of the overly general findings may lead to pitfalls and healthcare professionals may need additional guidance or support by establishing diverse steering groups. This comment argues that observing the Observatory on Race and Health is important to ensure accountability over its research and recommendations, and from a conceptual standpoint, to examine the evolving apparatus that shapes public and political reckonings with race, ethnicity and in/equality.

This essay juxtaposes the (informed) 'consent' sections of the American Anthropological Association's (AAA) Statement on Ethics (2012) and the Ethical Guidelines for good research practice (2021) of the Association of Social Anthropologists (ASA) of the UK. It discusses two a priori and uncritical assumptions that constitute the premise of the informed consent doctrine, as it has been incorporated in anthropology: that research participants and anthropologists organise their worlds in temporally coherent ways; and that research participants employ verbal and/or written modes of communication. I argue that erstwhile critiques of the informed consent doctrine in anthropology are somewhat limited, to the extent that they do not always recognise the exclusionary implications of these underlying assumptions. Acknowledging these assumptions in the context of anthropological research with 'psychotic' patients might allude to the impossibilities of-seeking 'informed' consent from such patients, and thus perhaps of ethnographically approaching 'psychotic' expressivity and subjectivity. I offer a way out of this impasse by drawing on specific ethnographic vignettes of the 'embodied voice' of psychotic patients. The essay then concludes with a suggestion for professional anthropological associations to develop alternative, more inclusive, and nonconventional ways of locating informed consent.

In this paper, we bring together medical anthropology of stigma with sociology and public health work on structural stigma to show how interpersonal and structural stigmas are co-produced through social, professional, and institutional exchange. Stigma of psychiatric nurses in Ghana works to exclude them from professional exchange - training, practice of skills, advocacy - and thereby co-produces interpersonal and structural stigma - lack of infrastructure, equipment, supplies, and funding for psychiatric care. Exchange also figured in the reasons nurses gave for the neglect of the mental health sector, which, they explained, did not generate revenue for the government or sufficiently restore patients into productive workers or human resources. At the same time, stigma may not simply exclude people from exchange but create other forms of exchange, such as care.

This article explores the creation, significance, and implications of patienthood within biomedical psychiatric hospital care practices, a topic that has often received insufficient attention from researchers. Using an ethnographic approach and discursive narrative framework, I argue that patienthood in this mental hospital is a social status deliberately constructed to facilitate decision-making regarding treatment and to guide social interactions within the hospital context. While patienthood is created within the hospital, its effects extend beyond its walls. I demonstrate that patienthood is a multifaceted concept emerging from 'assemblage practices' within the hospital, involving numerous human and nonhuman entities contributing to its creation and perpetuation. The processes underpinning patienthood are dispersed and collectively shaped by multiple 'agents', often diminishing the patient's active agency. This paper contributes to empirical knowledge and enhances our theoretical understanding of doctor-patient relationships and the evolving concept of 'patienthood' over the past six decades. It bridges the divide between older and contemporary literature and perspectives on doctor-patient relationships and patient agency, particularly concerning the Parsonian 'sick-role' and 'assemblages' theory. Furthermore, the article addresses the implications of its findings for mental health care, paving the way for a more comprehensive understanding of the complexities involved in caring for individuals with mental health issues.

Over the past few decades, it has become common for medical anthropologists to provide vivid and graphic descriptions of bodily suffering in their work. In this commentary, the author offers some critical reflections on this mode of writing. Emerging from the author's response to the descriptions of bodily suffering contained in Amy Moran-Thomas's recent book about diabetes, this commentary offers some reasons why medical anthropologists might want to be more cautious about describing bodily suffering in graphic forms. While anthropologists often want to incite an ethical response from their readers and encourage them to confront the effects of global patterns of inequality and injustice, this commentary suggests some reasons for caution. Not only are these modes of writing deeply connected to Christian and biomedical frames of 'seeing' suffering bodies, but they also raise longstanding moral questions about what it means to produce records of people's lives that foreground bodily devastation.

This paper explores cancer as a 'total social fact', considering it both a specific material entity and an immaterial phenomenon with social, political, and legal implications. Based on long-term ethnographic field studies on cancer as anticipation in the Danish welfare state, specifically within lung cancer diagnostics and the surveillance for 'tissue changes', the paper explores how cancer is constituted and experienced. Analyzing this new and rising cancer phenomenon, the paper attends to scale by focusing analytically on three levels (national, institutional, and intersubjective) and conceptualizes how cancer manifests at these different levels through practices of temporal curation. Temporal curation is conceptually directed at understanding both how past, present, and future exist concurrently in the diagnostic space, and how cancer is produced, preserved, and brought into the future. Hence, this paper contributes to understandings of the modern in healthcare systems, specifically arguing for a shift in discussions on diagnostics beyond a narrow focus on classificatory processes to comprise how a diagnostic phenomenon becomes temporal and sociopolitical.

Scholars in medical anthropology note that, despite more than 25 years of anthropological studies on cancer, much of this scholarship remains marginal in mainstream public health approaches. This paper examines social practices, biases, and unnoticed assumptions in mainstream global health research culture that prevents anthropology from having a more influential role in cancer research and policy agendas. It focuses on the day-to-day, ordinary, micro academic practices in which differential power distribution exacerbates inequity within the field, ignoring the role played by approaches with disciplinarian, epistemological and geopolitical peripheries. Inspired by a Bourdieusian epistemic reflexivity, this autoethnography systematized and analyzed through decolonial lenses some deterrents within real-world-research practices, including as the corpus own studies on cancer and inequalities studies that were based on collaborative ethnography (2013-2024). Six categories account for such deterrents in the global field: 1) Public health mainstream-centrism and the lack of recognition of anthropological knowledge principles; 2) Restrictive conception of ethics; 3) Similis Simili Gaudet biases - to be inclined to select what is alike; 4) Ethnocentric and naïve assumptions in relation to the road from evidence to practice; 5) Unconsidered dimensions of collaborations: Strengthening citizenship; 6) The moral economy of (only) professional trajectories interests and hidden priorities. It concludes by noting that anthropology has a lot to provide in the search for a genuinely democratic, plural, and decentralized knowledge in global cancer equity debates strengthening paradigms of dialogue, still so fragile and invisible in the field of cancer and public health in general.

This paper traces how the meaning of symptoms and the positioning of selves are entangled and discursively constructed in therapeutic conversations between parents and therapists at a pain clinic for children and young people (age 8 to 18) with recurrent or chronic pain or other somatic symptoms with no established biophysical pathology. Based on data material from an ethnographic fieldwork it is examined how the selves of respectively children/young people and their parents are discursively positioned in conversational encounters and the role positioning of selves play in the context of establishing and negotiating the symptoms' meaning. The bearer of medically unexplained symptoms is oftentimes subjected to moral assessments. In this paper it will be shown that parents, in the institutional setting of the pain clinic, enter the negotiation of moral assessments assigned to their children, and that these moral assessments not only concern the sufferers' selves but also the selves of the parents. The overall argument is that dialogues between parents and therapists concerning the meaning and source of their children's symptoms are simultaneously negotiations in which not only the sufferers'  but also their parents' moral positions are at stake.

The stigmatization of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals has a direct impact on the patient care experience and eventual health outcomes of this population both in the United States and abroad. The stigmatization of LGBTQ individuals in the healthcare system can lead to poor patient care and LGBTQ patients' self-removal from the healthcare system entirely. This self-removal could lead to untreated health issues, as well as the spread of communicable diseases throughout the LGBTQ community. This commentary reviews the Report of the 2019 Southern LGBTQ Health Survey. Recommendations are made for improving provider education on LGBTQ issues, which would, in turn, improve the LGBTQ patient care experience and health outcomes for this population.