Medicine Anthropology Theory
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Diagnosing hikikomori: Social withdrawal in contemporary Japan
Get PDFHikikomori (‘social withdrawal’) appeared in Japan at the end of the twentieth century, inciting public panic about a generation of Japanese youth who shun social contact and fail to engage in the age-appropriate activities of young adulthood. Widely cited as a ‘condition’ rather than a psychiatric symptom or disorder, hikikomori has functioned variously as a diagnosis of individuals, families, and society at large. Taking the polysemous (and controversial) nature of hikikomori as a starting point, we draw on fourteen months of ethnographic research to explore how families negotiate a diagnosis of hikikomori in everyday life. Our focus on families opens up fruitful questions about the moral economies of life under diagnosis, not simply for the diagnosed individual, but also for those who assume responsibility for that individual’s health and wellbeing
Fluid illness: Dialysis, undercare, and the social life of kidney disease in rural Guatemala
Get PDFIn response to the rising rate of end-stage renal disease (ESRD) in Guatemala, the public health system established a national community-based dialysis program to enable people living in rural areas to complete treatment in their homes. Here we explore how this newly available, life-prolonging technology has altered local worlds by transforming ESRD from an acute, life-ending illness into a managed chronic condition with an uncertain trajectory. Through case studies, we describe how living with dialysis influences family relations and caregiving in rural Guatemala. We find that dialysis interacts with an insufficient health care system, one that avoids life-ending complications but does not sufficiently manage life-altering symptoms. In addition, the need to care for people with ESRD for an uncertain amount of time may disrupt and strain family-based caregiving networks. Amid this meager health and social welfare infrastructure, life on dialysis exacerbates the chronic insecurity and structural inequality of life in postwar Guatemala. As both life and illness are prolonged through dialysis, the unceasing demands of the treatment and illness strain the webs of obligation and care that Guatemalan families and communities have developed to adapt to their decentralized and fragmented public health care system
SICK: The deadly logic of the limited good
Get PDFIn the 1960s George Foster, a founding figure in medical anthropology, theorized that Indigenous communities adhered to the ‘Image of the Limited Good.” Accordingly, good things in life were limited, with the effect that one person’s good came at a cost to another. This photo essay challenges the Image of the Limited Good. I suggest that the people who spread this idea are not Indigenous but upper class and White politicians who deploy the idea of limits to bolster their racist agendas. I juxtapose the deaths of Indigenous children at the US border with the kindness my children encountered in Guatemala to illustrate how experiences are structured by racism, not limits. The essay concludes by asking what we can learn from Indigenous parents about how to replace the Image of the Limited Good with an Image of Abundance
The MSM category as bureaucratic technology: Reflections on paperwork and project time in performance-based aid economies
Get PDFThe MSM category has traveled far and wide from its invention in US public health worlds in the late-1990s, migrating as well into anthropological scholarship that is critical of its reductionist, biomedicalized, Western, and de-eroticizing logics. While much has been written about ‘MSM’ as a flawed category that misdirects resources in health worlds, or as an imported nominalization that grafts awkwardly onto ‘real’, local, sexual, and gendered selves, my interest in this article is in revisiting the MSM category as a technology that facilitates linkages, processes, and dynamics constituting projects that take form in performance-based aid economies. Long-term, if episodic, work within projects targeting MSM deepens our understandings of the transformations and travels of the MSM category, beyond the dominant biomedical and cultural frames that characterize most anthropological literature. After briefly describing an NGO focused on LGBTI rights that I work with in Malawi, I present vignettes to analyze the work done by the MSM category in sociotechnical infrastructures. I closely read paperwork practices in NGO worlds to illustrate how the MSM category operates as a bureaucratic technology and a unit of accounting and measurement that is the engine behind the reproduction and performativity of projects. Throughout, I highlight how the patchy, contingent, frenetic, and unpredictable rhythms of aid economies are crucial context for understanding the workings of the MSM category. Finally, I reflect on how anthropologists’ embeddedness in such projects might reconfigure the meanings, tempos, and methods of anthropological work and writing
