Anthropology & Medicine最新文献

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.

Credited with averting almost 68% of new cases between 2000 and 2015, insecticide-treated bednets (ITNs) are one of the most efficacious malaria-prevention tools. Their effectiveness, however, depends on if and how they are used, making 'compliance' (and the social factors affecting it) a key area of interest for research on malaria transmission. This article situates the notion of compliance with 'bednet use' within everyday practices in an area of south-west Burkina Faso with high malaria transmission. By drawing on ethnographic fieldwork conducted between 2017 and 2018, it critically describes the precarious micro-environments that foreground bednet use-from gender and age to the means of (re)production of social and labour conditions-and assesses the bednets' effectiveness and community uptake. Bednet use stems from concrete, ordinary dynamics that interweave only apparently at the margins of the time individuals most need to be protected by a net. This work conceptualises 'compliance' beyond binary indicators of intervention uptake and locates 'use' as the result of contingent assemblages.

This paper examines the role of sick leave in constructing the identity of a good worker. The setting is a public funded New Zealand university. Within a qualitative research design, interviews were conducted with a range of employees and managers about their use and management of sick leave. Sick leave entitlements, use, and management encompass moral discourses that impact upon worker identity. Normalising discourses generated by compliance to bureaucratic demands and norms of productivity and performance in the neoliberalised workplace are constitutive to the construct of the good employee as reflected by the appropriate use and recording of sick leave. Conversely, the respectful, authentic, compliant and productive worker is constitutive of its opposite - the difficult employee. The construct of the difficult employee positions conformity and self-management of sick leave as strong moral imperatives. Managers were generally supportive of workers' efforts to self-manage sick leave with consideration for university commitments and were flexible around work hours, but this would in turn position them as deviant to institutional pathways of managing sick leave, with tensions between humanistic and authoritarian management.

In contemporary Portugal and Greece, the number of individuals who resort to alternative medicine continues to rise. From yoga, meditation and energy therapies to healing based on various religio-spiritual traditions, there is a variety of therapeutic practices one can choose from. The main objective of this paper is to show how a therapeutic and spiritual pluralism is produced through the implementation of transnational influences on spirituality and healing. It investigates the diverse ways in which the practice of spirituality through healing leads to a better understanding of how current processes of globalisation, transnationalism and multiculturalism affect, develop and negotiate one's individual, social, spiritual and medical identity. Based on ethnographic fieldwork in Lisbon and Athens, the Portuguese and Greek capital equivalently, the paper explores the pluralistic and transnational character of alternative medicine and the spiritual creativity with which such therapies are practised. Taking the role of the (spiritual) holistic practitioner as healer as a point of departure, it provides an empirical account of the shifting status of both religiosity and healthcare in two southern European countries that are still followed by the stereotype of being predominantly linked to Christianity as the denominational religion, and to biomedicine as the predominant healthcare system.

This is an ethnographic study that examines the experiences of peer counsellors in the Thinking Healthy Programme Peer-delivered (THPP), a randomized controlled trial of a psychological intervention for perinatal depression in Goa, India. Based on nine months of fieldwork from 2015 to 2017 and through caregiving theories posited by one of us, we examine how caregiving is experienced by peer counsellors in a randomized controlled trial, a context in which care is given for a finite period and is removed at the study's end. Analysis of our data generated three themes: caregiving as a reciprocated process that impacts peer counsellor and participant; memories of care, with attention to the space that caregiving occupies in the memories and subjectivities of peer counsellors; and the end of the trial as experienced as a removal of care in the community of the counsellors. We posit that the moral aspects of caregiving are particularly important for peer counsellors, and that the context of randomized controlled trials is central to these moral experiences, particularly at the trial's end, when peer counsellors are asked to end care that, in many cases, remains expressed as needed.