EASA2014: Collaboration, Intimacy & Revolution
From bodily sensation to symptoms: consequences for healthcare seeking?
Date and Start Time 03 August, 2014 at 09:00
The meaning of sensations is culturally embedded and mediated by social practices and symbolic systems of meaning that are important contexts to healing and care-seeking. A transformation of sensations into symptoms interacts with social and collaborative strategies for healthcare seeking.
Abstract (max 250 words)
Within medical anthropology research on healthcare seeking has overall focused on trying to understand the context for decision-making processes concerning which kind of care and treatment is sought. The illness itself plays a role in this but what about another analytical unit: the symptom?
Recently the importance of attending to bodily sensations in studying illness experience has been brought forward by several researchers, saying that the process of interpreting and organizing sensations into meaningful perceptions is of particular relevance to the anthropology of medicine. Bodily sensations never start as symptoms - they only become symptoms through a social interpretive and collaborative process which has consequences for how and where a patient seeks care.
Examining such sensations means to look into what is felt, how the body-subject reacts to sensations and how these are e.g. developed into specific signs of distress or symptoms or perhaps dismissed as non-worrying signs, in a social process. Any sensation is never merely a question of physiology. The meaning of sensations is culturally embedded and mediated by social practices and symbolic systems of meaning that are important contexts to healing and care-seeking.
With this panel we wish to invite researchers to present research on symptoms - symptoms in the context of clinical encounters, symptoms as embodied metaphors, symptoms as central to idioms of distress, symptoms as commodities and so forth. Moreover, we wish a focus on how interpretation and management of symptoms may interact with strategies for care as collaboration with both social networks and a health system
This panel is closed to new paper proposals.
'Knowing the body': exploring bodily sensations and their transformation into symptoms in need of care
This paper explores how bodily sensations are given meaning as symptoms and how healthcare seeking decisions are shaped through complex ongoing interactions between the physical body and everyday life among people in a Danish suburban middleclass neighborhood.
Denmark is doing poorly when it comes to cancer survival and one of the reasons is a long patient interval (time from onset of symptoms until healthcare-seeking). Existing research on healthcare-seeking in relation to cancer have primarily been conducted retrospectively and with a focus on already diagnosed patients. Often they conclude that the main factor causing late health-seeking is that people do not recognize that they are experiencing 'cancer alarm symptoms'. These studies, however, often lack explorations into what constitutes the sociocultural framework within which bodily sensations are interpreted as symptoms in need of medical assessment.
The paper presents preliminary findings based on one year field-work in a Danish suburban middleclass neighborhood, consisting of participatory observations, symptom diaries and repeated interviews with members from 15 households.Inspired by current writings within 'anthropology of sensations', this paper explores bodily sensations as socially and culturally embedded experiences. It suggests that sensations are given meaning through complex ongoing interactions between the physical body and the everyday life that people lead, consisting of multiple interests, concerns, activities and forms of knowledge. In particular, the paper will focus on the different kinds of knowledge and discourse about the body available, and how they feed into or 'transform' semantically unstable sensations into more stable signs of illness considered to be either nothing to worry about at the moment or in need of further explanation and relief.
Reflections on the meanings, interpretations and impact of chest pain
This paper examines the experiences of people visiting rapid access chest pain clinics, the meanings that are co-created and the evolving impact, adjustments and continued uncertainties that people undergo.
Sitting down with a clinician in a rapid access chest pain clinic to describe and answer questions about recent chest pain is an intimate act of collaboration. In the chest pain consultation clinicians and people jointly consider the body and its signs, articulate and agree on a language for the pain or chest discomfort, reflect on heart problems amongst kin and admit to certain habits such as smoking. For some people this initial consultation is the start of an ongoing bodily collaboration with clinicians as they submit to further testing involving peddling on bikes wired to heart monitors, radioactive dyes and needles. For clinicians this collaboration seeks to create more definitive 'evidence' for the pains and potentially leads to repairs and the strengthening of weak tubes. Similarly people need to adjust to a new (often medicalised) understanding of their bodies and its vulnerabilities but also engage in wider life and self reflection. For others the consultation in the chest pain clinic may mark the end of their collaboration with clinicians. While some people may re-assess the possible meanings they attributed to the chest pain and be completely reassured, others may continue to seek new collaborative engagements on a journey of uncertainty and anxiety as they attempt to secure more satisfactory explanations for their experiences. This presentation reports on the emerging findings of a qualitative longitudinal study of chest pain patients in the UK. It involved observations in clinics, repeat in-depth interviews with 24 chest pain patients and interviews with clinicians.
Making blood ready for a surgery: reading hemoglobin levels in medical encounters in Germany
Hemoglobin level plays a major role in assessing anemia and in preparation of patients for a surgery. In case of elective surgeries Jehovah's Witnesses in my fieldsite “built up” their hemoglobin level. In more urgent cases they perceived it as not as dangerously low as it was claimed by physicians.
In their analysis of "anemia" as defined by pathophysiology and laboratory statistics in the Netherlands, Mol and Berg (1994) emphasized that not only both defined it differently but also that principles and practices that governed dealing with anemia were divergent. Nonetheless, having its own place in medical practice both logics co-existed peacefully. Hemoglobin level of patient's blood plays a major role in assessing anemia and hence in preparation of patient's body for a surgery in the context on my fieldsite. Drawing on an ethnographic fieldwork with Jehovah's Witness patients and physicians in Germany, mainly Berlin in 2010 and 2011-2012, in this paper I address experiences of JW patients who insisted on "abstaining from blood" and blood transfusions. In case of elective surgeries they consciously went about assessing and "building up" their hemoglobin level. In more urgent cases, however, they commonly perceived their hemoglobin values as in fact not as "bad" or dangerously low as it was claimed by attending physicians. I argue that being frequently "updated" by JW literature and other media on blood alternatives, non-blood medical treatment, and ground-breaking bloodless surgeries that were successfully conducted despite patient's very low hemoglobin level, they acted on a different logic that the one utilized by physicians.
Meret bi mo yeek: bodily sensations and healing seeking among women from Senegal living in Italy
Questioning women's choice to use both the Senegalese traditional healing system and the Italian health care system in order to cope with bodily sensations experienced after childbirth, I will analyze the clinical encounters between cultural and biological interpretations of body symptom.
Meret bi mo yeek is the way in which Senegalese women explain the unpleasant bodily sensations that might occur after childbirth. Based on the findings of the ethnographic research carried out within the Senegalese community who populates the Valdelsa area (Italy), my paper aims to show, in first instance, how bodily sensations experienced by women after childbirth are closely related with social practices and traditional symbolic systems. Secondly, it intends to explore the importance of cultural meanings of body symptoms in healing seeking processes.
On the one side, my study investigates how bodily sensations experienced by Senegalese women in Italy rely on both the cultural conceptions of mothering and the social practices related with mothering. As I will try to argue, the symptoms of illness experienced by women after birth are closely linked to two different factors: the symbolic role played by the blood in the traditional interpretation of body functioning and the non-respect of traditional practices usually provided in Senegal. Through the analysis of these two factors, I will show how their bodily sensations cannot be reduced to a matter of physiology. I will suggest that they could be understood as embodied metaphors of their culture, as idioms of their social condition.
On the other side, my study explores how and where women seek care. Questioning their choice to use both the Senegalese traditional healing system, via transnational networks, and the Italian health care system, I will analyze the clinical encounters between cultural and biological interpretations of body symptoms.
Recognizing symptoms as signs from the body: the experience of Estonian spiritual practitioners
Based on the fieldwork among Estonian spiritual practitioners, I observe how spiritual teachings about health cultivate certain ways to recognize and interpret symptoms. Different sensations are often understood as bodily messages with an aim to establish a ‘dialogue’ with the body and/or the organs.
The teachings of new spirituality have gained importance as the source of knowledge about health for many Estonians. The spiritual holistic approach to health tends to give wider meanings to bodily sensations that biomedicine classifies as symptoms of pathologies. By emphasizing social and moral dimensions, popular spiritual ideas take symptoms as bodily signs that demonstrate the necessity to improve relationships, thinking, moral behavior etc. For example, according to wide-spread belief promoted by several teachers (including famous Estonian Luule Viilma) morally wrong deeds and thoughts affect certain organs and cause certain symptoms and diseases.
In the individual quest towards this-worldly happiness, healthy body is seen as a goal but also a partner and a source of knowledge. People aim to establish a 'dialogue' with the body and/or the organs; to learn to understand different sensations as messages. Personal experience is seen as the source of truthful information: it is often emphasized that you should not trust anybody else but your own experience and bodily signs. The presence of different sources of knowledge is seen as a complicated problem among Estonian physicians who often just prefer to ignore alternative interpretations.
In the presentation I will observe the search for knowledge about the bodily sensations: how the symptom is recognized; what kinds of sources (e.g. professional, 'lay-medical', alternative) are used. My ethnographic material includes both discussions in Estonian spiritual/holistic health seminars and internet-based conversations that demonstrate the process of conceptualizing symptoms or illnesses and finding the best course of action.
Looking behind tears: emotions and symptoms in the everyday life of depressive women
Crying is often seen as one of the clearest signs (or symptoms) of depression, and is reported as part of the daily life of depressive patients. The presentation aims to interrogate how symptoms and emotions are produced, redefined and interacted in the context of a psychotherapy group for women.
According to the WHO, depression is defined as a "mood fluctuation" and has become "the leading cause of disability worldwide, and a major contributor to the global burden of disease". As it is widely known, a range of symptoms are taken into account in diagnosing depression, also to further classify the depressive episodes as mild, moderate, or severe. In order to problematize and possibly deconstruct the way emotions are being translated into symptoms and diagnosis, it's important to understand the complexity of suffering and its causes. Crying, in particular, is often seen as one of the most important "signs" (even though not exactly a symptom) of depression, and is accepted and reported as part of the normal daily habits of depressive patients. Looking behind the symptoms and through the everyday life of patients to interrogate how symptoms and emotions are continuously produced, redefined and interacted, is the purpose of my presentation. The paper will focus in particular on the different ways crying can work not just as a symptom, but as a mean of exchange and communication, while being aware of the multiplicity of experiences and meanings that involve crying itself (inside and outside depression). Thus, crying is examined as a shared medium among women who attend psychotherapy and support groups in a public mental health service in the city of Araraquara (Brazil): an ethnography of the relationships and practices inside these groups leads to reconsider the relevance of crying as a symptom and the process of naturalization of emotions.
The sign of five: the semiotics of symptoms and their erasure
This paper develops an argument for recovering patient narratives from their erasure in classical semiotics. It analyzes how the symptom has been relegated to the status of physical sign in the work of de Saussure, Barthes, Foucault, Peirce and Eco.
This paper develops an argument for recovering patient narratives from their erasure in classical semiotics. Taking as its point of departure the well-known medical distinction between physical signs (objective symptoms) and symptoms (subjective symptoms), it analyzes how the symptom has been relegated to the status of physical sign in the work of de Saussure, Barthes, Foucault, Peirce and, to a lesser extent, Eco. This has led semiotics to reproduce the biomedical naturalization of affliction, which is the product of the attribution of significance by the medical gaze; a significance which objectifies the sufferers and subjectifies the diseases and the treatments, turning things into subjects and subjects into things. Nevertheless, symptoms are not reducible to physical signs, but cultural constructions. Once we recognize this, symptoms cease to be the raw material of the signifier, the merely phenomenological which has yet to become semantic, the expression of physical pathology whose meaning depends on a medical consciousness. Rescuing the discursive subject of the symptom creates an epistemological shift in semiotics and in the anthropology of affliction: the de-reification of sufferers and the de-subjectivation of diseases and treatments.
This panel is closed to new paper proposals.