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- Convenors:
-
Simon Cohn
(London School of Hygiene Tropical Medicine)
Rebecca Lynch (University of Exeter)
- Discussant:
-
Judith Farquhar
(University of Chicago)
- Location:
- Quincentenary Building, Wolfson Hall A
- Start time:
- 20 June, 2014 at
Time zone: Europe/London
- Session slots:
- 3
Short Abstract:
This panel addresses to what extent a number of Enlightenment distinctions have inescapably shaped medical anthropology, and whether they have hindered, as well as enabled, its progress. It asks whether approaches from STS and the 'ontological turn' are useful to overcome the entrenched dichotomies.
Long Abstract:
This panel will ask if such classic distinctions as those between nature/culture, self/other, mind/body are merely entrenched cultural repertoires of Western post-Enlightenment, and to what extent have they inescapably shaped the development of medical anthropology and related research. It will explore whether approaches from STS and the 'ontological turn' might be particularly useful to interrogate this issue, by helping us circumvent such things as the illness/disease distinction as well as placing the materiality of the body at the centre of analysis. A radical reconfiguration not only rejects drawing on assumed categories but places the body and matters of health and illness as inherently contingent on specific contexts. However, for many anthropologists, such approaches feel limited by their apparent lack of engagement with subjective experiences such as emotions, beliefs, distress and desires. Some of the questions this panel may address are therefore:
- How might material-semiotic and ANT approaches challenge our considerations of the body and disease, and what do examples of this approach imply for the study of health and illness more broadly?
- Can these approaches reinvigorate medical anthropology without letting go of things we regard as integral to the discipline?
- How do these also help us to think through work on health and illness that aims to engage with non-anthropologists? (for example, when our work is 'applied'?)
- How can a strong commitment to multiple realities allow for such ideas as rationality, empathy and intimacy which suggest commonalities?
Accepted papers:
Session 1Maryon McDonald (Robinson College Cambridge)
Paper short abstract:
Recent anthropological emphasis on ‘ontology’ has been important but both belated and a distraction. Key dualities previously reified into a language of analysis relating to a medical object called ‘the body’ have long been of ethnographic interest and it is a keener ethnography that is required.
Paper long abstract:
Dichotomies such as that of disease and illness, and others congruent with it, have been important in the construction of scientific practice and of worlds outside it. However, such dualities have been reified into a problematic language of analysis. 'The body' has been part of this same language, both in its singularity and in its apparent requirement of definitional alterities (mind, soul, spirit, the social, etc.). Happily, all such dualities have long been the objects of ethnography, and this paper stresses the ethnographic importance of the body singular alongside the 'bodies' of newer analyses.
We could be said to live with multiple realities every day. So why the excitement of the 'ontological turn'? In their everyday lives, many anthropologists have believed in a reality objectively discernible by science, whether this reality was 'the human body' or the more general 'nature' in which it inhered. Both nature and the human body slipped into anthropologists' own professional analyses, too, however - giving a natural human body that was then 'socially constructed' or 'culturally constructed' in different ways. To those holding this view in some form, the 'ontological turn' might be particularly titillating. This paper uses examples that bring together medical anthropology and anthropology more generally and suggests a way of looking at the ontological turn and the contribution of ANT/STS that brings into focus a need for sharper ethnography.
Emily Yates-Doerr (Oregon State University)
Paper short abstract:
The field of medical anthropology has long divided ‘the body’ into three: individual, social, and political. Through an examination of agricultural and clinical health in Guatemala, this paper asks what the future of the field would look like if bodies were not ontologically enumerated.
Paper long abstract:
Nearly three decades ago, Scheper-Hughes and Lock charted a future for medical anthropology in which 'the body' was made into three: one individual, one social, and one political. The three bodies, ostensibly interfering with the Cartesian mind/body dichotomy, today appear rooted in the very boundaries they sought to disrupt. This paper ethnographically details the division drawn between agricultural practice and medical care in an obesity clinic in the highlands of Guatemala to analyze the everyday life consequences of binding bodies into discrete, thereby numerable, ontological units. It examines how medical anthropology continues to be limited by a persistent desire to count bodies, three or otherwise, and how this interplays with the ways in which public health care systems are also organized. I illustrate how radically situating care - that is, expanding it to various worlds rather than confining it to an enumerable world - reconfigures both the practice of health care and the possible futures of medical anthropology. The argument I present is not that bodies are 'more than one, less than many.' Rather, in the case of Guatemalan dietary practice that I unpack, an emphasis on the very possibility of more or less was linked to a Euro-American tradition in which bodies can be cleanly bounded. In the case I explore, for reasons that are both theoretical and clinical, counting bodies did not make much sense.
Sahra Gibbon (University College London (UCL))
Paper short abstract:
Drawing on the notion of ‘local biologies’ and reflecting on ethnographic research in southern Brazil examining the emergence of cancer genetics this paper examines how risk, genes and the vulnerable body are rendered meaningful through understanding and knowing the bio as inherently plastic and contingent.
Paper long abstract:
Margaret Lock's notion of 'local biologies' formulated in response to differential experiences of the menopause in Japan (1996) has recently received renewed interest in the wake of transnational expansion of the life and medical sciences (Nguyen and Brotherton 2013) and increasing recognition of the contingency of the biological in fields such as neuroscience and genomics (Landecker 2011). There is an urgent need to explore the cultural practices, narratives and experiences through which a diverse combination of old and new local biologies are being configured in social and cultural arenas where historical and contemporary notions of the 'bio' maybe differently situated. This paper investigates the necessity of localizing the biological drawing on ethnographic research with patients, practitioners and scientists in the south of Brazil caught up in a nascent field of research and medicine known as cancer genetics. It examines how risk, genes, and the vulnerable body are rendered meaningful only through understanding and knowing the 'bio' as inherently plastic and contingent. My research suggest that the biological can for instance be informed by and be a direct product of intersubjective experiences across generations, this includes for many patients the agentive effect of emotions. I reflect on what attending to local biologies in this context means for the study of health and illness and for theorizing the body and the biological in medical anthropology.
Stefan Reinsch (Brandenburg Medical School - Theodor Fontane)
Paper short abstract:
Early psychosis is a new label for being mentally healthy and at the same time having a strong probability of developing psychosis. We explore the normative and ontological aspects of the enactment of this label in debates between researchers and the daily practice of specialized consultations.
Paper long abstract:
Early psychosis is used today as a label for a condition of being mentally healthy and at the
same time having a strong probability of developing a severe mental illness. It represents a space of liminality or, as we call it, a "grey zone" between pathology and health, illness and non illness. We understand this grey zone of early psychosis as a constitutive third space which brings stability to dichotomies in contemporary psychiatric and social practices, while being itself fraught with practical uncertainties.
This paper is based on ethnographic fieldwork in german speaking highly specialized psychiatry. It will explore how early psychosis is brought to life - or enacted - in two situations. First, in debates between researchers and second in the daily practice of specialized consultations.
Through representing patients at risk for psychosis, early psychosis researcher and clinicians are concurrently creating a space to do research, a clinical category and a group of patients to be intervened on. To analyse the normative and ontological aspects of this process, we use the term ontonorm newly proposed by Mol (2013).
We discuss how this analysis might be valuable in helping medical anthropologists to better understand the logics informing re-assembly of clinical knowledge, new technologies, patients as well as of illness/disease and mind/body distinctions in current psychiatry.
Susie Kilshaw (University College London)
Paper short abstract:
This paper explores the usefulness of a commitment to multiple realities in relation to medical anthropology research into pregnancy and loss in Qatar.
Paper long abstract:
This paper presents ethnographic data about pregnancy, miscarriage and genetic notions of risk in Qatar. Tasqeet (miscarriage) creates a being that becomes a "bird in heaven", who resides in paradise and whose creation grants its mother a place in paradise. The paper will explore what fetuses; either living, liminal, at risk or dead mean to the different people that interact with them. Fetuses are made into being by the different practices around them. The paper explores how a fetus becomes different things in different contexts.
How might these discussions help to break down the nature/ culture dichotomy in particular relation to pregnancy and different types of fetuses. Can a strong commitment to multiple realities allow for empathy and how does this work when the researchers and participants themselves seem to strive for commonalities in shared experiences. Of particular relevance is the way a focus on multiple realities, may hinder interactions with collaborators and further engagement with our participants. Furthermore, the particular social and political context of conducting research in Qatar, more broadly, must be considered. In Qatar, my work is based in a hospital setting and the overall aim is to inform services that support women who experience reproductive disruptions. These considerations limit the possibility of the kind of radical alterity advocated by the ontological turn. My research suggests is that a focus on alterity and commonality is necessary and by listening to participants we are left with the complexity of reality.
Rebecca Lynch (University of Exeter) Simon Cohn (London School of Hygiene Tropical Medicine)
Paper short abstract:
In considering experiences of self-monitoring we examine feedback loops, relationships between individuals and technology and understandings of health, body and self. We argue that self-monitoring constructs a particular type of body that is only one of multiple ways of knowing and experiencing.
Paper long abstract:
The idea of self-monitoring, in which individuals receive information about their health status with the aim that they will act on this to improve their health, has been around for some years and is now central in many public health initiatives designed to address so-called lifestyle diseases. This paper considers how individuals in a public health trial understood and experienced the process of self-monitoring. Through participant's accounts we describe the ways in which individuals made sense of the information they received from self-monitoring technologies, relating it to their own experiences and more embodied assessments of their body and health. Taking a practice theory approach, informed also by concepts from ANT, we examine the feedback loops thought to be created through self-monitoring technologies and how data received, and relationships between the individual and the technology, create understandings of health, the body and self. Given the proliferation of self-monitoring technologies, such as through the growth of devices and phone apps, and more generally through the Quantified Self movement in which technology is used to life-log, or self-track, aspects of daily life, we discuss how self-monitoring technologies may well lead people to construct and interact with their bodies in diverse ways, over and above the assumption that feedback simply provides a rational means to maintain and improve a particular health behaviour. We argue that self-monitoring constructs a particular type of body that is only ever one of multiple forms of knowing and experiencing.
Else Vogel (University of Amsterdam)
Paper short abstract:
This paper ties out and contrasts two figures of the 'natural body' enacted in obesity care practices - one an object caught in causal mechanisms, the other wise and sensitive. I explore how needs and desires are reconfigured as 'naturalness' is variously cultivated in these practices.
Paper long abstract:
While some anthropologists insist that obesity, apart from being a biological reality, also has cultural and moral dimensions, others argue that 'obesity' is altogether a social construction. This paper, rather than staging a distinction between biology and cultural meanings, foregrounds that what 'the body' wants, and how it ends up gaining weight, is contested throughout the obesity field. In doing so, I analyse overweight bodies not as part of larger social contexts but as realities enacted in socio-material practices. I will tease out and contrast two figures of the 'natural body' that emerge in practices - one an object caught in causal mechanisms, whose needs should be objectively calculated, the other wise and sensitive, regulated through subjectively feeling desires.
The first account, often found in scientific and policy discourses, establishes a causal link between the incidence of obesity in 'Western' countries and an environment in which processed food is abundant. As this story goes, our bodies evolved to always anticipate periods of scarcity and 'naturally' select calorie-rich food. The second can be recognized in clinical practices targeting overweight people that I observed during my fieldwork in the Netherlands. After a long history of dieting attempts supposedly disturbed the body's 'natural' capacity to sense its needs, some dieticians, through feeling and tasting, encourage their clients to 'listen' to their body again. I explore how needs and desires are reconfigured as 'naturalness' is not only a quality mobilized in the field but also a reality variously cultivated in practices.
Bodil Just Christensen (SCIENCE Faculty, University of Copenhagen)
Paper short abstract:
This paper describes and critically examines the productive challenges within an interdisciplinary collaboration where anthropological and biomedical data were integrated on equal terms in the analysis. This allowed creative exploration of concepts, knowledge production and disciplinary standards.
Paper long abstract:
This paper is a discussion of the productive tensions occurring in an interdisciplinary research project on weight loss after obesity surgery. The study was a bio-medical/anthropological collaboration and explored to what extent eating patterns, subjectively experienced hunger and physiological mechanisms involved in appetite regulation determine good or poor response to gastric bypass surgery. Contrasting bio-medical and anthropological categories and definitions of central concepts turned out to be a major challenge in the collaborative analysis. Notably, the conception of what constitutes appetite was a central concern as each discipline has its particular definition and operationalization of appetite. A material-semiotic approach allowed for a reconceptualization of appetite as a 'fractional object'. A fractional object engaged in multiple relations and enacted differently in each relation. This conception of appetite combined with a focus on how weight loss bodies were produced and enacted by patients and medical staff, agencies were distributed and surgery was understood and practiced challenged fundamental contrasts between conventional domains of sociality, e.g. eating practices and bodily norms, and physiology, e.g. the surgically altered gastrointestinal anatomy and endocrine changes in appetite hormones. This produced creative contracts and made way for alternative explorations of knowledge production and anthropological practices.
This paper thus attends to the challenges and openings that followed from destabilising the presumably fixed and well-defined concept of appetite, and explores the interfaces between anthropology and medical science.