Patients and Healers in the Context of Culture

From the Preface, by Arthur Kleinman:Patients and Healers in the Context of Culture presents a theoretical framework for studying the relationship between medicine, psychiatry, and culture. That framework is principally illustrated by materials gathered in field research in Taiwan and, to a lesser extent, from materials gathered in similar research in Boston. The reader will find this book contains a dialectical tension between two reciprocally related orientations: it is both a cross-cultural (largely anthropological) perspective on the essential components of clinical care and a clinical perspective on anthropological studies of medicine and psychiatry. That dialectic is embodied in my own academic training and professional life, so that this book is a personal statement. I am a psychiatrist trained in anthropology. I have worked in library, field, and clinic on problems concerning medicine and psychiatry in Chinese culture. I teach cross-cultural psychiatry and medical anthropology, but I also practice and teach consultation psychiatry and take a clinical approach to my major cross-cultural teaching and research involvements. The theoretical framework elaborated in this book has been applied to all of those areas; in turn, they are used to illustrate the theory. Both the theory and its application embody the same dialectic. The purpose of this book is to advance both poles of that dialectic: to demonstrate the critical role of social science (especially anthropology and cross-cultural studies) in clinical medicine and psychiatry and to encourage study of clinical problems by anthropologists and other investigators involved in cross-cultural research.

The Multispecies Salon

A new approach to writing culture has arrived: multispecies ethnography. Plants, animals, fungi, and microbes appear alongside humans in this singular book about natural and cultural history. Anthropologists have collaborated with artists and biological scientists to illuminate how diverse organisms are entangled in political, economic, and cultural systems. Contributions from influential writers and scholars, such as Dorion Sagan, Karen Barad, Donna Haraway, and Anna Lowenhaupt Tsing, are featured along with essays by emergent artists and cultural anthropologists.

Delectable mushrooms flourishing in the aftermath of ecological disaster, microbial cultures enlivening the politics and value of food, and nascent life forms running wild in the age of biotechnology all figure in this curated collection of essays and artifacts. Recipes provide instructions on how to cook acorn mush, make cheese out of human milk, and enliven forests after they have been clear-cut. The Multispecies Salon investigates messianic dreams, environmental nightmares, and modest sites of biocultural hope.

Local Babies, Global Science

In the late 1990s, Egypt experienced a boom period in in vitro fertilization (IVF) technology and now boasts more IVF clinics than neighboring Israel. In this book, Marcia Inhorn writes of her fieldwork among affluent, elite couples who sought in vitro fertilization in Egypt, a country which is not only at the forefront of IVF technology in the Middle East, but also a center of Islamic education in the region. Inhorn examines the gender, scientific, religious and cultural ramifications of the transfer of IVF technology from Euro-American points of origin to Egypt – showing how cultural ideas reshape the use of this technology and in turn, how the technology is reshaping cultural ideas in Egypt.

Alien Ocean

Alien Ocean immerses readers in worlds being newly explored by marine biologists, worlds usually out of sight and reach: the deep sea, the microscopic realm, and oceans beyond national boundaries. Working alongside scientists at sea and in labs in Monterey Bay, Hawai’i, the Woods Hole Oceanographic Institution, and the Sargasso Sea and at undersea volcanoes in the eastern Pacific, Stefan Helmreich charts how revolutions in genomics, bioinformatics, and remote sensing have pressed marine biologists to see the sea as animated by its smallest inhabitants: marine microbes. Thriving in astonishingly extreme conditions, such microbes have become key figures in scientific and public debates about the origin of life, climate change, biotechnology, and even the possibility of life on other worlds.

When Species Meet

In 2006, about 69 million U.S. households had pets, giving homes to around 73.9 million dogs, 90.5 million cats, and 16.6 million birds, and spending more than 38 billion dollars on companion animals. As never before in history, our pets are truly members of the family. But the notion of “companion species”—knotted from human beings, animals and other organisms, landscapes, and technologies—includes much more than “companion animals.”

In When Species Meet, Donna J. Haraway digs into this larger phenomenon to contemplate the interactions of humans with many kinds of critters, especially with those called domestic. At the heart of the book are her experiences in agility training with her dogs Cayenne and Roland, but Haraway’s vision here also encompasses wolves, chickens, cats, baboons, sheep, microorganisms, and whales wearing video cameras. From designer pets to lab animals to trained therapy dogs, she deftly explores philosophical, cultural, and biological aspects of animal–human encounters.

In this deeply personal yet intellectually groundbreaking work, Haraway develops the idea of companion species, those who meet and break bread together but not without some indigestion. “A great deal is at stake in such meetings,” she writes, “and outcomes are not guaranteed. There is no assured happy or unhappy ending-socially, ecologically, or scientifically. There is only the chance for getting on together with some grace.”

Ultimately, she finds that respect, curiosity, and knowledge spring from animal–human associations and work powerfully against ideas about human exceptionalism.

Primate Visions

Haraway’s discussions of how scientists have perceived the sexual nature of female primates opens a new chapter in feminist theory, raising unsettling questions about models of the family and of heterosexuality in primate research.

Prescribing By Numbers

The second half of the twentieth century witnessed the emergence of a new model of chronic disease—diagnosed on the basis of numerical deviations rather than symptoms and treated on a preventive basis before any overt signs of illness develop—that arose in concert with a set of safe, effective, and highly marketable prescription drugs. In Prescribing by Numbers, physician-historian Jeremy A. Greene examines the mechanisms by which drugs and chronic disease categories define one another within medical research, clinical practice, and pharmaceutical marketing, and he explores how this interaction has profoundly altered the experience, politics, ethics, and economy of health in late-twentieth-century America. Prescribing by Numbers highlights the complex historical role of pharmaceuticals in the transformation of disease categories. Greene narrates the expanding definition of the three principal cardiovascular risk factors—hypertension, diabetes, and high cholesterol—each intersecting with the career of a particular pharmaceutical agent. Drawing on documents from corporate archives and contemporary pharmaceutical marketing literature in concert with the clinical literature and the records of researchers, clinicians, and public health advocates, Greene produces a fascinating account of the expansion of the pharmaceutical treatment of chronic disease over the past fifty years. While acknowledging the influence of pharmaceutical marketing on physicians, Greene avoids demonizing drug companies. Rather, his provocative and comprehensive analysis sheds light on the increasing presence of the subjectively healthy but highly medicated individual in the American medical landscape, suggesting how historical analysis can help to address the problems inherent in the program of pharmaceutical prevention.

The Enculturated Gene

In the 1980s, a research team led by Parisian scientists identified several unique DNA sequences, or haplotypes, linked to sickle cell anemia in African populations. After casual observations of how patients managed this painful blood disorder, the researchers in question postulated that the Senegalese type was less severe. The Enculturated Gene traces how this genetic discourse has blotted from view the roles that Senegalese patients and doctors have played in making sickle cell “mild” in a social setting where public health priorities and economic austerity programs have forced people to improvise informal strategies of care.

Duana Fullwiley shows how geneticists, who were fixated on population differences, never investigated the various modalities of self-care that people developed in this context of biomedical scarcity, and how local doctors, confronted with dire cuts in Senegal’s health sector, wittingly accepted the genetic prognosis of better-than-expected health outcomes. Unlike most genetic determinisms that highlight the absoluteness of disease, DNA haplotypes for sickle cell in Senegal did the opposite. As Fullwiley demonstrates, they allowed the condition to remain officially invisible, never to materialize as a health priority. At the same time, scientists’ attribution of a less severe form of Senegalese sickle cell to isolated DNA sequences closed off other explanations of this population’s measured biological success.

The Enculturated Gene reveals how the notion of an advantageous form of sickle cell in this part of West Africa has defined–and obscured–the nature of this illness in Senegal today.

Duana Fullwiley is associate professor of anthropology at Stanford University.

Your Pocket Is What Cures You

In the wake of structural adjustment programs in the 1980s and health reforms in the 1990s, the majority of sub-Saharan African governments spend less than ten dollars per capita on health annually, and many Africans have limited access to basic medical care. Using a community-level approach, anthropologist Ellen E. Foley analyzes the implementation of global health policies and how they become intertwined with existing social and political inequalities in Senegal. Your Pocket Is What Cures You examines qualitative shifts in health and healing spurred by these reforms, and analyzes the dilemmas they create for health professionals and patients alike. It also explores how cultural frameworks, particularly those stemming from Islam and Wolof ethnomedicine, are central to understanding how people manage vulnerability to ill health.While offering a critique of neoliberal health policies, Your Pocket Is What Cures You remains grounded in ethnography to highlight the struggles of men and women who are precariously balanced on twin precipices of crumbling health systems and economic decline. Their stories demonstrate what happens when market-based health reforms collide with material, political, and social realities in African societies.

The Anti-Politics Machine

Development, it is generally assumed, is good and necessary, and in its name the West has intervened, implementing all manner of projects in the impoverished regions of the world. When these projects fail, as they do with astonishing regularity, they nonetheless produce a host of regular and unacknowledged effects, including the expansion of bureaucratic state power and the translation of the political realities of poverty and powerlessness into “technical” problems awaiting solution by “development” agencies and experts. It is the political intelligibility of these effects, along with the process that produces them, that this book seeks to illuminate through a detailed case study of the workings of the “development” industry in one country, Lesotho, and in one “development” project.

Using an anthropological approach grounded in the work of Foucault, James Ferguson analyzes the institutional framework within which such projects are crafted and the nature of “development discourse,” revealing how it is that, despite all the “expertise” that goes into formulating development projects, they nonetheless often demonstrate a startling ignorance of the historical and political realities of the locale they are intended to help. In a close examination of the attempted implementation of the Thaba-Tseka project in Lesotho, Ferguson shows how such a misguided approach plays out, how, in fact, the “development” apparatus in Lesotho acts as an “anti-politics machine,” everywhere whisking political realities out of sight and all the while performing, almost unnoticed, its own pre-eminently political operation of strengthening the state presence in the local region.

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