Anthropology & Medicine最新文献

Individual scientists, clinicians, and other experts cannot have absolute knowledge of all of the theories, methods, models, and findings in their field of practice. Rather, these individuals make choices about the kind of information that will be most meaningful and impactful in their work, while choosing - or being compelled to choose - what knowledge to overlook or ignore: a process identified as sufficient knowledge. In biomedicine, medical students are socialized to deliberately decide what information matters most; so, too, do practicing physicians openly acknowledge that they make choices around knowledge in daily practice. Within this process, time is a critical factor that mediates epistemological decision-making. In other words, how does time bound or restrict what forms and depth of medical knowledge that physicians and future physicians prioritize? When would someone intentionally limit time in order to constrain the amount and types of information he, she, or they acquire? To answer these questions, this study draws upon interviews and participant observation conducted with students at a medical school in the American Midwest. This article seeks to answer the aforementioned questions and to provide a new framework for, and expand discussions of, agnotology in the anthropology of medicine.

Rather than the harmonious coexistence of different therapeutic practices and meaning systems, medical pluralism involves the contestation of norms and meanings related to legitimacy and authority. The implicit cultural norms that shape local understandings of health and legitimate healing methods become more during periods of social and cultural change. This paper demonstrates the contested nature of medical pluralism based on the case study of one significant figure, Estonian gynaecologist and spiritual teacher Luule Viilma. Well-known to the public as a trailblazer and prominent spokesperson for medical pluralism since the 1990s, Viilma's trajectory from doctor to healer reveals some implicit characteristics and mechanisms of power struggles as evidenced by the 'boundary work' carried out by biomedical specialists. By uniting and bridging biomedicine and spiritual self-help, Viilma became a figure whose presence and teachings gave responsibility and power to individuals and helped to legitimize pluralism in health practices. She had the ambition to redefine, in a fundamental way, perceived norms of legitimacy and authority, as well as the patient's position. From interviews with people who have used Viilma's teachings and material from internet discussion forums, it is apparent that the emergence of new forms of medical pluralism has brought several changes in health-related norms and understandings, including more active personal involvement in health-related information seeking and decision-making.

This paper explores how independently organised peer support workers conceptualise drug users to determine how they deliver their service. The work is undergirded by Spiro's critique of the social view that conceptions of the human are fixed, and his contention that sometimes the concept of the self is set aside for utilitarian purposes. A literature review indicates that different conceptions of the drug user as the 'psychological self' and the 'social self' are variously held by public health, peer support workers employed by public health and independent peer support workers. An ethnographic account thereafter investigates how independently organised peer support workers prioritise three conceptions of the 'social self': drug users are hurt by social exclusion; they can benefit from shared experience; they can achieve social inclusion with peer support. The paper concludes with a discussion on the implications of using social conceptions of drug users in the provision of service and signals considerable scope for investigating how independent organisations of peer support workers attend drug users seeking recovery.

Anthropological accounts of biosociality reveal the importance of the social relations formed through shared biomedical conditions. In the context of body-focused repetitive behaviours (BFRBs), like compulsive hair pulling (trichotillomania) and skin picking (dermatillomania), biosociality moves people from isolation towards community. After diagnosis, the powerful moment of discovering 'you are not alone' can lead to immense personal transformations, demonstrating the 'looping effects' of diagnosis and biosociality. Yet, biosocial groups do not simply exist, and must first be formed and found and their sustainability requires ongoing work and care from biosocial actors themselves. Biosociality also means different things to different people, often requiring a negotiation between secrecy and disclosure. This article acknowledges the role of stigma in biosociality, differentiating between private and public biosocial experiences. It argues that through biosociality come acts of biosolidarity, where advocacy can improve the visibility and recognition of illness groups. The circular looping effects of biosociality and biosolidarity demonstrate the way that community activism and biosociality reproduce one another. Through reflections from the anthropologist, biosolidarity is considered as a methodological tool that can help scholars to navigate the boundaries between relatedness, sociality and advocacy in the field and beyond.

This commentary addresses the issue of vaccine hesitancy and decision-making among religious minority groups in high-income country settings. Recent measles outbreaks have been attributed to lower-level vaccination coverage among religious minorities, which has inspired targeted as well as wholesale public health interventions and legislation in a range of jurisdictions. The commentary takes the case of self-protective ethnic and religious minority groups, especially Haredi or 'ultra-Orthodox' Jews in the United Kingdom, to address two key aims. First, this commentary flags how damaging representations of religious minorities in recent measles outbreaks can be avoided by better understanding inner processes of vaccine decision-making and acceptance, which can, in turn, help to address hesitancy sustainably and trustfully. Second, the commentary advocates for addressing vaccine hesitancy as part of a broader re-visioning of public health relations with minority groups. This commentary calls on public health services to improve confidence in childhood vaccinations rather than resorting to compulsory (and coercive) vaccination policies in order to address lower-level vaccination coverage. The commentary signposts how essential it is to carefully navigate relationships with minority groups amidst the new forms of public health preparedness that will emerge from the 2020 Coronavirus pandemic (COVID-19).

Nearly 4,00,000 farmers committed suicide in India between 1995 and 2018. This translates into approximately 48 suicides every day. The majority of suicides were those from 'backwarded' castes including Dalit farmers. This ethnographic study on cotton farmer suicide reports narratives of surviving Dalit families. The results reveal that financial and moral debt when accrued within a web of family and caste-related relationships result in patterns of personal and familial humiliation, producing a profound sense of hopelessness in the Self. This loss of hope and pervasive humiliation is 'cultivated'  by a cascade of decisions taken by others with little or no responsibility to the farmers and the land they hope to cultivate as they follow different cultural and financial logic. Suicide resolves the farmers' humiliation and is a logical conclusion to the farmer's distress, which results from a reconfiguration of agricultural spaces into socially toxic places, in turn framing a local panopticon. The current corona virus pandemic is likely to impact adversely on peoples who are culturally distanced.