Programme

(T057)
Non-conforming bodies: an exploration of public health knowledge, practice and technologies beyond 'the body'
Location 125
Date and Start Time 01 September, 2016 at 09:00
Sessions 3

Convenors

  • Fay Dennis (Goldsmiths, University of London) email
  • Emma Garnett (King's College London) email

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Short Abstract

This track invites presentations which explore non-conforming bodies in public health knowledge, practice and technologies. We are interested in opening up dialogue on how bodies get enacted beyond their boundaries and thereby confront normative imaginings of 'the body'.

Long Abstract

This track explores bodies beyond their surface-boundaries, as bodies which do not conform to our expectations in terms of how they engage with technologies, classifications and/or health services. Rather than starting out with 'the body', we engage with the relational configurations - or collectives - which bodies compose and comprise. In this way we cross different kinds of bodily scales (from the deviant body to population bodies), reflecting specifically on the ways in which bodies emerge and get problematised through the targeting of normative understandings of 'health'. For example, drugged bodies fail to engage with public health technologies, such as opiate substitution treatment, in the intended way as a physically dependent body. In epidemiology, populations as multiple bodies are difficult to distinguish and measure. By foregrounding the articulation of different kinds of collectives relating to health - from the drug-using-event to the articulation of epidemiological categories of risk - we aim to explore the productive capacities of thinking with non-conforming bodies, both as a way to tell us more about 'the body' and to re-think current interventions. For example, in epidemiology, bodies and environments are conceptualised as distinct, yet if the starting point was bodies-as-environments then articulating how one intervenes is re-configured. Similarly, in harm reduction, considering bodies as always in a state of 'becoming' refigures interventions towards living better in the tensions. Non-conforming bodies are a way to examine the contingent and practical engagements that make health possible, whilst problematising public health attempts to assemble, hold together and intervene with bodies.

This track is closed to new paper proposals.

Papers

Aligning population knowledge with care of fat bodies

Author: Patricia Thille (University of Toronto / University Health Network)  email

Short Abstract

The present study analyses two Canadian texts meant to improve the health of adults living in fat bodies. Both build upon statistical knowledge of populations, but enact notably different fat bodies - differences that are consequential for care.

Long Abstract

Governmental, media, and scientific agencies in Canada mark fat bodies as unhealthy bodies and name health care as an important site to address the 'obesity epidemic'. Knowledge brokers have designed guides for clinicians treating adults, including the 2015 Canadian Task Force on Preventative Health Care guideline (guideline), and the 2012 Canadian Obesity Network's 5As of Obesity Management™ (5As). These two guides vary in what they theorize determines body weight and adiposity, differences that are consequential for care. Informed by narrative analysis, actor-network theory, and especially Mol (2002, 2008), I explored different fat bodies enacted in these texts. The guideline foregrounds a behaviour-determined body. Primary care clinicians are to recommend intensive behaviour change programs to those classified as overly heavy, even though the intervention is unlikely to produce a significant or sustained reduction of body weight. In contrast, the 5As enacts the fat body as a physiological, psychological, social, and economic entity living with a chronic disease. In the 5As, weight is influenced by many mediators (e.g. medication effects; smoking cessation; economic conditions). The 5As does not pre-determine what care should be provided or what goal should be sought based on a single measure as per the guideline. Instead, the 5As recommends clinicians assess and then treat what is likely to have the biggest health impact for the individual, with ongoing follow-up care. The analysis highlights co-existing and incompatible narratives of fat bodies and clinical care, narratives that rely on different uses and assemblages of statistical knowledge of populations.

Between Desert and Tundra: Nutritional Realities of the Svalbard Vault

Author: Lilah Leopold (University of Illinois at Urbana-Champaign)  email

Short Abstract

This paper explores the first withdrawal of seed samples from the Svalbard Global Seed Vault as an example of engaging the lenses of feminist STS scholarship and the artwork installed in the vault’s entrance in order to understand public health through non-conforming seed and human bodies.

Long Abstract

Installed in the space of a former coal mine on the Arctic archipelago of Svalbard, the Global Seed Vault became a site of recent international debate following the withdrawal of seed samples by the now Beirut-based International Center for Agricultural Research in Dry Areas. The aftermath of the 2015 retrieval mission provides an opportunity to trace a node of recent movements of collectives of seeds and people, spurred by the civil war in Syria and climate breakdown. Drawing from STS framings that have placed the power of collective resistance in "multiple marginality" at the site of bodies belonging to multiple networks (Starr, 1991), this paper translates scholarship of site-specific and cartographic artistic practices through the conduits of feminist STS scholarship. By making visible the collective displacement of seeds and human bodies, Norwegian artist Dyveke Sanne's artwork entitled "Perpetual Repercussion" (Svalbard, Norway, 2008), questions the presumed stability of geopolitical borders, climate models, and patterns of migration of non-conforming bodies, as well as the global operations and farming technologies presumed to preserve crop diversity and sustain human nutrition. "Perpetual Repercussion" employs fiber optic cables and mirror fragments embedded in the entrance of the Svalbard Global Seed Vault to confront viewers with elements of the vault's immediate Arctic environment and generate discourse about its finite repository of agricultural seed samples. This paper thinks with non-conforming seed and human bodies and through the lens of Perpetual Repercussion to understand realities of public health.

Deconstructing diagnostics: a critical epidemiology of sleeping sickness in Uganda

Author: Shona Jane Lee (University of Edinburgh)  email

Short Abstract

Sleeping sickness manifests in hotspots of zoonotic configurations where multiple human, animal, insect, and public bodies become together in flux. This paper explores disease dynamics, diagnostics, and the data emerging at the interfaces between and beyond bodies through an ethnographic lens.

Long Abstract

This paper uses Human African Trypanosomiasis (HAT) as a case study to explore the connections and spaces between parallel 'formal' and 'informal' networks of HAT surveillance and control, and the parallel belief systems that motivate and influence the public body in ways that depart from biomedical norms within a decentralised health system in Northern Uganda. The extent to which 'networks' can be considered distinct from the knowledge systems that construct them will be contended by analysing the relational, circulatory forces that bring together bodies, pathogens, vectors, environments and infrastructures into configurations of disease states. At the individual level the 'body' is socially constructed in the same way 'bodies' or populations are problematised, targeted, and solved in ways that ascribe to the particular framework that conceives them. Non-conforming or 'defaulting' bodies are deemed as "ignorant", "stubborn", "illiterate", or "backward" when failing to comply with the dominant system in place. Discarding local and historically embedded knowledges fails to improve patient compliance nor case detection, and only serves to shift public health intervention efforts toward goal-oriented, measurable outcomes elsewhere and focus on cost-effective technological solutions such as rapid diagnostics and mobile data capture and diagnostic support tools. This paper will explore the concept of infrastructure in contested spaces of surveillance, and the ways in which current public health approaches to HAT control is deeply embedded within multiple epidemiological evidence bases at odds with local knowledge systems. Overlooking how these shape perceptions and behaviours leads to erroneous constructions of bodies with profound policy implications.

Fluid Bodies

Author: Julie Laplante (University of Ottawa)  email

Short Abstract

Anchoring my thoughts in fieldwork done with women becoming-plant in preparing daily fresh healing elixirs in Yogyakarta on the Island of Java in Indonesia, I would like to tease out how working upon open-bodies or body multiple figures what people do to stay healthy.

Long Abstract

Anchoring my thoughts in fieldwork done with women becoming-plant in preparing daily fresh healing elixirs in Yogyakarta on the Island of Java in Indonesia, I would like to tease out how working upon open-bodies or body multiple figures what people do to stay healthy. Jamu medicine works as just another fluid moving through bodies of winds and flows (Ferzacca 2009) thoroughly permeated within volcanic soils and hindu, buddhist, confucianist, islamic tones all javanizined in one way or another. How this might speak to biomedical and humanitarian interventions who rely upon an idea of a universal biological body will be teased out. Namely, javanese fluid bodies will be discussed with relation to Deleuze and Guattari's 'body without organs' formulated as a critique to Western thinking through the tree. Rhizomatic thinking will be further articulated with Ingold's 'world without objects' or life as lines of becoming in meshworks. How this coincides with what I learned in Java informs thoughts on how this indeed does provide paths towards very different ways of attending to bodies in the world.

Malaria multiple: bodies, practices, and public health knowledge

Author: Luciane Machado Freitas de Souza  email

Short Abstract

Ribeirinhos are frequently afflicted by malarial infections. While malaria is characterized as a single disease, in real life, it is enacted in plural ways. Each way evokes one version of malaria; hence it is a multiple object defined through networks of people, techniques, and environment.

Long Abstract

Riverine populations of the Brazilian Amazon, commonly called ribeirinhos, are often afflicted by malarial infections. While the biomedical literature locates malaria in the biological body only, ribeirinhos evoke this disease in multiple ways. In this 5-month ethnographic research carried out in Manaus and Careiro, State of Amazonas, Brazil, I move away from the clinical definition of malaria and foreground how the lived body experiences and acts upon this disease. I draw on multiple approaches including STS studies to learn how 30 ribeirinhos experience malaria in terms of symptoms, diagnosis, and treatment practices. Their experiences were shared with me through interviews, participant-observation, and visual methods. Preliminary analysis shows that malaria affects people's lives beyond the biological body. In this sense, malaria is not only an infectious disease subject to public health policies and interventions, but also an individual's life event enacted, lived, and felt in plural ways weaved into social and moral dimensions. This assumption is in line with Mol's assertion that a disease does not exist by itself, but it is dynamically crafted or brought into being by individuals' practices, through complex networks of people, activities, techniques, instruments, and environment. As this study challenges public health normative knowledge on malaria, it brings a new understanding on the realities that are engendered due to malarial infections. A close examination of such realities provides in-depth knowledge on malaria as an object multiple that requires diversified interventions, rather than standardized ones.

No Heroics, Please: Renderings and Disruptions of Bodies in Organ Donation Medical Practices

Author: Sara Bea (University of Edinburgh)  email

Short Abstract

An ethnographic exercise to advance alternative ways of theorising the body that circumvent the subject/object dualism. It presents a different set of inclusions and exclusions that disrupt reified conceptualisations of bodies as objects, owned and defined by subjects as autonomous individuals

Long Abstract

This work is an ethnographic exploration of a distinctive intersection of medicine and bodies: deceased organ donation for transplantation. Existing social science literature has either portrayed the donor as an autonomous subject inscribed within the gift rhetoric of moral choice, or denounced the hospital professionals and organ procurement practices that turn bodies into commodified medical objects. In order to leave behind the subject/object dualism and the inevitable exclusions it engenders, such as relegating the body to mute externality awaiting definition or reinforcing modernist accounts of bodies as property owned by the individual subject. This study proposes instead the decentering of the individual donor as well as the medical professionals; the focus shifts to relational processes and materiality. The result is an in-depth mapping of the situated and contingent interdependencies that conform the specific medical practices of organ donation in a hospital in Barcelona. The empirical accounts I will present bring forward novel renderings of donors qua bodies - bodies that act and intervene and present various availabilities and resistances to the medical practices and embedded rationalities. The donor/body made intelligible within the given practices disrupts and displaces different individual boundaries by highlighting the collective dimension of bodies. I wish to elucidate on ways of mobilising such empirical theorising of the body beyond academia and into the medical practices and public health policy spheres. In particular, I will be addressing the current organ shortage problematisations and the proposed ways to increase donation rates in the European Union.

Non-Suicidal Self-Injury as multiple: Privileging practice over bodies

Author: Emily Kirbyson (University of Lethbridge)  email

Short Abstract

The self-wounded body, as in the case of Non-Suicidal Self-Injury (NSSI), is oft produced as pathological. Studying multiple enactments of NSSI might place some versions of it it outside the pathological/healthy binary, decreasing rates of intervention and making needed intervention more flexible.

Long Abstract

Non-Suicidal Self-Injury (NSSI), the practice of inflicting harm on one's own bodily tissues (e.g. cutting) without suicidal intent, has not been addressed by STS scholars. It has, however, been a topic of inquiry in medicine and psychiatry, where NSSI is described as a women's problem and is distinctly pathologized. This understanding of NSSI is not the product of scientific discovery but is achieved through strategies that make the multiple versions of NSSI cohere. In this paper, I will craft various scenarios from a small body of the literature on NSSI toward imagining how it gets done or is defined differently, through a range of technologies, in various sites. NSSI might in one moment be a gash requiring stitches, while at another, a useful tool for managing negative emotions. Instead of beginning with 'the body,' I will follow Annemarie Mol (2002) who contends that when we attend to practice, multiplicity comes to the fore and the whole body becomes less obvious. It is only in a context in which 'the body' is taken to be singular and bound by skin that 'harmed bodies' can be considered non-conforming. Beginning with the practices founded on normative assumptions about health that make bodies emerge as pathological opens up possibilities for positioning NSSI outside of the pathological/healthy dualism, potentially decreasing rates of intervention. It also illustrates the incoherence of NSSI in practice and, following Mol (2002), I contend that this will contribute to the flexibility and versatility of medicine and psychiatry.

Nonconformity in the Face of HIV

Authors: Annette-Carina van der Zaag (Goldsmiths, University of London)  email
Ulla McKnight (Goldsmiths, University of London)  email

Short Abstract

This paper explores how a traumatised HIV-positive pregnant patient negotiated HIV, war, trauma, foetus, possible deportation, gender relations and her future baby in the space of the clinic: a non-conforming phenomenon that critiques the biomedical body and STS’ neglect of human speech/silence.

Long Abstract

In this paper we draw on a qualitative investigation of an HIV antenatal clinic in London to explore the place of the non-conforming body in relation to HIV treatment and prevention. Specifically, we look to the narrative of a HIV-positive pregnant patient who experienced a severe trauma during the war in her home country in West Africa - a trauma that was for her unspeakable. The healthcare providers knew from experience that past trauma always has the potential to disrupt the prevention of mother-to-child transmission in the present as psychological difficulties could impact adherence to pill taking regimes. Consequently, events that can/are not spoken about could impact on the patient's participation and as such lead to the patient's baby becoming HIV-positive in the future.

Utilising Karen Barad's agential realism, we argue that the manner in which the woman in question negotiated HIV, war, trauma, foetus, possible deportation, family, gender relations and her future baby constructs a relationality in which these components are co-constitutive of a nonconforming phenomenon. Her refusal to speak articulates a pertinent discordance as conforming to treatment both potentially results in a future baby born free of HIV and provokes a reliving of trauma in the present - a complexity at the heart of the care the practitioners provide, but occluded by a biomedical discourse in which a body ends at its skin. Furthermore, this non-conforming phenomenon raises pertinent questions to the field of STS, where 'human speech/silence' is often neglected in its focus on materiality and nonhuman actors.

Producing the drug-addicted neonatal body

Authors: Amy Chandler (University of Lincoln)  email
Anne Whittaker (Edinburgh Napier University)  email
Sarah Cunningham-Burley (University of Edinburgh)  email

Short Abstract

This paper analyses the social and clinical production of Neonatal Abstinence Syndrome (NAS). The construction of a ‘NAS baby’ is shown to be contingent on understandings of (mother-infant) embodiment; narratives of addiction and stigma; and practices of health and social care.

Long Abstract

This paper proposes the 'drug-addicted' neonate as a particular form of 'non-conforming' body. We demonstrate how the diagnosis of Neonatal Abstinence Syndrome (NAS) is produced by practices of care, and public health discourse, each of which are shaped by wider cultural responses to addiction and (mother-infant) embodiment.

We argue that the production of a NAS diagnosis rests on a complex range of discourses and practices through which the infant body, maternal body, and substances of addiction are articulated. The 'NAS baby' is an 'abnormal' baby, whose existence and symptoms are framed as paralleling the troubling nature of addiction in general, and particularly in the context of motherhood.

Semi-structured, qualitative interviews were held with 16 parents (7M, 9F) who had recent experience of caring for a baby at risk of NAS. 4 multi-disciplinary focus groups were held with 27 health and social care professionals (23 F, 4 M). Interviews and focus groups addressed experiences of anticipating and caring for babies at risk of NAS. Accounts were analysed thematically.

Our paper contributes to STS literature regarding the process and construction of diagnosis; and the role of bodies within this (e.g. Mol 2002; Gardner and Williams 2015). The addicted neonatal body is a focus of public health intervention. Our analysis demonstrates the contingent nature of the 'NAS baby', as articulated through narratives of: infant embodiment, practices of care, wider attitudes towards addiction, and understandings of the impact of particular substances on maternal and infant bodies.

Science as 'not-violence': Producing multiple understandings of addicted bodies

Author: Joseph Guisti (Northwestern University)  email

Short Abstract

By opposing "science-based" care to violent care, collaborations between the Mexican government and mutual-aid based treatment providers are producing multiple understandings of drug addiction and black-boxing the content of treatment science.

Long Abstract

Drawing on 14 months of fieldwork in the nascent addiction treatment field in Mexico City, this paper analyzes the way that the Mexican Government, public health experts, and professionals in mutual aid based addiction treatment (largely inspired by Alcoholics Anonymous, or AA) are co-constructing multiple understandings of addicted bodies and brains. By official accounts, the government is regulating the mutual-aid professionals through licensure and training programs—all guided by expert knowledge produced by public health researchers. The outcome for the knowledge about addiction that these groups co-construct, however, is that a discourse of "scientific" or "professional" care is ubiquitous while the content of that care is largely black-boxed. In this field, the content of knowledge about addicted bodies, as well as any treatment approaches it might legitimate, is far less important than the fact that it's seen as "scientific": all parties face pressure to define themselves against violent forms of "therapy" practiced in a growing movement of notorious but widespread "24 hour groups" claiming affiliation to AA but operating against AA's guidelines and outside of government regulation. The care that addicts receive under this new system, then, carries the credibility of expert knowledge despite the fact that care providers and government officials have difficulty articulating exactly how addiction should be treated and are rarely expected to do so as long as they are opposed to violence.

The embodiment of conflict. Signing and non signing practices in Dutch elderly deaf people

Author: Anja Hiddinga (Unversity of Amsterdam)  email

Short Abstract

In this visual project two images are shown at the same time: 1. edited interviews with the two main Dutch protagonists in the controversy over the use of Sign Language in deaf education, 2. footage showing the embodied communicative practices of elderly deaf people in signing and non-signing hands.

Long Abstract

In most countries in Europe and the US, deaf people were forbidden to use sign language in communication until well into the 20th century. Deaf children grew up having to learn to produce spoken words and 'read lips' in order to acquire spoken language, a strenuous and often futile activity. From the 1960's when linguists showed that sign languages are 'real' languages and not a primitive system of communication, the road was paved for another perspective on deaf people: that of a cultural community. In the Netherlands conflicts between sign language protagonists and those adhering to the so called 'oralist approach' dominated deaf education until the 1980s. Deaf emancipation, the struggle for rights and cultural recognition evolved in tandem, but elderly deaf are caught in between these very different views on deafness. Brought up with the notion that signing was a forbidden and inferior way of expressing oneself, often they still have a biased view on using Dutch Sign Language. Moreover, because of this prohibitive environment, most of them lack the command, fluency and wealth of vocabulary younger deaf signers have. The embodied communicative practices of these elderly thus bear the traces of this conflicted history.

In this project (2016), two images are shown together: one with interviews of the two main Dutch protagonists in the controversy over the use of sign language in deaf education, the other with footage of signing and non-signing hands of elderly deaf people. (length max 20 min.)

This track is closed to new paper proposals.