Anthropology & Medicine最新文献

Brazilian mental health care reform understands mental health as a complex social process. There is a large literature production within the country focused on deinstitutionalization policy, social determinants of mental health and human rights, however, with little recognition beyond Latin American borders. In addition, cultural dimensions of mental suffering have been neglected in Brazilian debates which limits an expanded understanding of health care and users' inclusion. This paper aims to discuss the role of cultural determinants in mental health care in Brazil. We followed a patient in the city of Rio de Janeiro who opted for therapy based on her religious beliefs-using ayahuasca in the context of the Afro Brazilian religion of Umbanda-over the treatment-as-usual in mental health. We draw on the notions of autoatención (self, domestic, and group-care in lay contexts) and medical landscapes to examine how therapeutic negotiations reflect embodied cultural traits and both social and political determinants shaping therapeutic spaces. We argue that recognizing sociocultural differences and therapeutic negotiations are key elements in making a more inclusive health practice. Moreover, this recognition enables identifying and reasoning the broader social processes framing health practices. This debate is relevant to the Brazilian mental health context and to other scenarios, especially those where local and global knowledge and practices in mental health are entangled.

Nature cure is a globalized system of nineteenth century European medicine that developed synergistically in opposition to biomedicine, and that has become popular in India. This essay examines the question of how anthropologists should understand claims that all diseases can be cured with earth, air, sunlight, water and raw food. The question is complicated by a paradox of relativism deeply embedded in the desire to find cures, to articulate those cures as panaceas, and to the way illness narratives personalize and essentialize contexts of meaning that resolve sickness and suffering with experiential healing. Focused on suffering that motivates people to experiment on themselves and engage in exotic cures, this essay presents an argument for extending skepticism concerning claims of efficacy to a politics of medicine and public health that is ecological rather than phenomenological, medical or biological. Suffering, as well as empathy for those who suffer, transforms radically relativized personal convictions into forms of embodied, existential activism that relate to, but extend beyond, the hegemony of biomedicine and institutionalized public health.

Anthropologists have critically examined a range of reforms from education and land to finance and health. Yet the predominant way of looking at reforms has been through a lens focused on neoliberal governance. For example, prior studies of health reforms focus on insurance, financing, and access to care. Yet, seeing reform in this way fails to attend to other types of cultural work at play when calling a policy or law a reform. In this paper, we draw on ethnographic research on health policy reforms in Israel and Bolivia to examine the concept of reform and the work it does within national movements. We argue that while the language of reform often signals change or novelty, reforms also carry forward historical continuities and reifications of the past. By delving into the past and its relationship with ongoing health reforms, we attend to how reforms can reinforce and maintain health inequities in some cases, while creating a national language for new possibilities in others. Reform, as we will discuss in this paper, is not only about political ideology, neoliberal governance, or on-the-ground policy implementation, but centrally it is about representations of aspirations, and about crafting relationships between past, present, and future.

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants-the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

As the COVID-19 pandemic hit, Orthodox Christians globally reacted to the possibility of contagion and risk in dialogue with theological positions about materials, their own long history which includes surviving previous pandemics and plagues, governmental and civil expectations and edicts, and pious - but often unofficial - understandings about protection and the sacrality of religious artefacts and the space of the temple. This article draws upon primary ethnographic research amongst Orthodox Christians in the UK, Serbia, Greece and Russia, as well as news articles about and primary ecclesiastical documents from Orthodox Churches more widely, to highlight commonalities and divergences in Orthodox Christian responses to the pandemic. Examining both the theological basis, and socio-political differences, this article considers how the Orthodox theology of apophaticism and relationality impacts wider discourses of contagion (both positive and negative), and consequently compliance with public health initiatives. Comparison across diverse Orthodox settings suggests that Orthodox Christians are concerned with the neighbour - both in terms of who may be watching (and reporting) them, and who may fall sick because of them.

Bringing an ethnographic sensibility to pandemic mediascapes, this article critically examines three media artifacts that assembled around COVID-19 - as an entity that is viral, social, and political - in the early months of the pandemic in North America. Focusing on the household, the cruise ship, and the body-with-underlying-conditions as 'COVID containers', the author argues that material and discursive responses to the pandemic, articulated through imaginaries of containers and containment, uphold notions of risk, order, and health that garner meaning through implied racial intertexts. The article analyzes COVID-19-related data, graphics, talk, and news stories to show how logics of inside/outside, safety/risk, and comfort/fear that animate efforts to contain a viral threat intensify the pathologization, harm, surveillance, and risk of groups long imagined as 'threats' to social order. Throughout, The author demonstrates how idioms of containers and containment make 'the body' a key locus of health, diverting attention from systems and histories complicit in producing ill-health. A coda reflects on Scheper-Hughes and Lock's influential essay ' The mindful body', re-reading their articulation of the 'Western body' through lenses drawn from scholarship in Black studies, queer studies, and disability studies that are central to understanding COVID-19 as relation(s) - borne from racial capitalism - that differentially distribute risk, health, and care.

This commentary discusses the methodological utility of ethnography within the medical space. Whilst a general consensus affirms that ethnography aligns with qualitative approaches, as identified within the existing medical literature, here, we demonstrate how quantitative [positivist] methods can also be incorporated. This paper begins by contextualising ethnographic approaches within medical contexts by demonstrating its empirical value within the existing literature. Next, we discuss the interconnection between the practice of 'doctoring' and ethnographic research, whereby doctors themselves use forms of inductive and deductive reasoning to treat and manage patients in their everyday context. This philosophical discussion not only links to the everyday practice of medical practitioners, but also critically reflects on the role of the first author, as a diagnostic radiographer. Lastly, this paper identifies the virtues of ethnographic research for medical students and/or medical doctors whereby the combination of qualitative and quantitative methods (within an ethnographic methodology) can lead to new empirical and methodological insights, enabling the creation of alternate research strategies and evidence. This methodological strategy may be best considered amongst medical students and/or early career medical researchers, but we also anticipate it to resonate and open further discussion with experienced medical practitioners and researchers transnationally.

This article asks: how can the concept of existential vulnerability help us to comprehend the human impact of chronic disease? Across the globe, the prevalence of chronic health conditions is rising dramatically, with wide-ranging consequences for human lives. Taking type II diabetes in northern Vietnam as its ethnographic case, this study explores how chronic health conditions are woven into everyday lives, altering subjectivities and social relations. Applying the notion of existential vulnerability as its analytical prism, the article explores three different dimensions of vulnerability: physical, emotional, and social. The analysis highlights the importance of a focus on social connectedness for comprehending the everyday impact of chronic disease and for the development of health care interventions in this domain.

Growing numbers of women are showing interest in clitoral reconstructive surgery after 'Female Genital Mutilation'. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become 'whole again' after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the 'missing' clitoris. Such beliefs are nourished by predominant discourses of cut women as 'sexually mutilated'. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients' mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy.