Medicine Anthropology Theory
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Giving Birth in Silence
No full textJacinta, deaf from birth, chose to give birth to her own baby at home without her hearing aids. Fu-Yu assisted and took photos of the process. This is a Photo Essay about alternative possibilities to biomedical childbirth. We share our experience through this medium, as the ‘visual’ was our shared sensory perception at the time. Besides acknowledging the intersubjectivities that surfaced, we see the importance of recognising that ‘images are representations of the world filtered by the positionalities of the makers themselves, influenced by unique experiences that brought them to that point in time … Images become an extension of a way of thinking, visually connecting maker with participant along lines of thought’ (Cartwright and Crowder 2017, 515). Although Fu-Yu is the one operating the camera, Jacinta, her partner, her mother, her cat and her home ‘make the image’. Whilst Jacinta was in labour, Fu-Yu was assisting Carmen Susana (the midwife) and recording the event at the same time with a camera hanging around her neck. We want to offer the audience this shared ‘visual’ experience as an invitation to think and ‘visualise’ care and childbirth from a disability-studies perspective
Between Moral Injury and Moral Agency: Exploring Treatment for Men with Histories of Military Sexual Trauma
No full textThis Research Article deploys the frameworks of moral injury and moral agency to explore the experiences of veteran men who completed group therapy for military sexual trauma (MST). The article analyses ethnographically how veteran men with MST experience psychological growth via a replenishment of their sense of moral agency, thereby blending psychological theory about moral injury with anthropological theory about moral agency. It highlights how broader cultural experience can intersect and contribute to shame around MST, then depicts the ways that veterans recovered from a life characterised by pervasive shame, isolation, and compromised identity—psychological signs of moral injury—and made gains toward a life characterised by greater self-acceptance, an ability to tell one’s own story, and intimacy with others—signs of moral agency. In so doing, the article highlights the social and moral dimensions that can constitute psychological injury, and the way that addressing these dimensions can promote moral agency and thus mental health recovery.  
Situating Latin American Critical Epidemiology in the Anthropocene: The Case of COVID-19 Vaccines and Indigenous Collectives in Brazil and Mexico
No full textDiverse histories and traditions of critical epidemiology in Latin America provide an important, although underutilised, alternative framework for engaging with the embodied health inequalities of the Anthropocene. Taking COVID-19 as ‘a paradigmatic example of an Anthropocene disease’ (O’Callaghan-Gordo and Antó 2020) and drawing on ethnographic research in Brazil and Mexico on vaccination campaigns among Indigenous Peoples, we review and analyse the scope and limits of Latin American critical epidemiology in addressing Anthropocene health. While there are intersecting and parallel dynamics between diverse national and regional histories of epidemiology, we argue that the relatively differential focus on political economy, political ecology, and colonialism/coloniality in Latin American critical epidemiology, alongside the attention to non-western disease experiences and understandings, constitute a counterpoint to biomedical and specific ‘Euro-American’ epidemiological approaches. At the same time, Indigenous understandings of health/disease processes are intimately connected with territory protection, diplomacy with non-human entities, and embodied memories of violence. We examine how this presents new and challenging questions for critical epidemiology, particularly in how the ‘social’ is defined and how to address both social justice and social difference whilst also navigating the biopolitical challenges of state intervention in the era of Anthropocene health
Fake-talk and the Spaza Shop: A Fake Food Furore and the Spectre of Public Health Emergencies in South Africa
No full textAt the end of August 2018, a controversy erupted in South Africa. Accusations of potentially poisonous ‘fake food’ had been circulating on social media for a month or so, and by early September reports were common on South African news programmes. Accusations fell at the door of foreign-run spaza shops (convenience stores), some of which were looted and their shopkeepers harmed. Many commentators read these events as another outbreak of the xenophobic violence that has flared up across South African townships for more than a decade. Our reading is different. In this Research Article, rather than dismissing accusations of fake-ness as merely a pretext for popular protest and violence, we tackle the question of what work ‘fake-talk’ does. We show that in this instance, accusations of fake-ness brought a distinctive urgency to events, framing what might otherwise have been seen as concerns about inequality in the language of a public health crisis. In response, a state normally hesitant to act on citizens’ long-standing complaints about ‘the duplicity of foreigners’ intervened with a new speed and decisiveness. ‘Fake-talk’, we conclude, is an important site of inquiry because of how it may enable certain actions, regardless of whether suspicions are founded
Sub-standard or Sub-legal? Distribution, Pharma Dossiers, and Fake-talk in India
No full textIn this article, I look at Indian pharma ‘dossiers’—the bundles of paperwork that testify to pharmaceutical quality and adherence to regulatory standards—and how they illustrate a wider and ongoing shift from a paradigm of drug safety to one of drug security. By examining how dossiers enact and enable claims of ‘quality’, I argue that it is in a drug’s paperwork—rather than its chemical composition—that quality or fake-ness is produced. Based on interviews with Indian traders and officials, and an examination of how their work has changed over time in accordance with the regulatory shift to drug security, I show that in many instances the paperwork has come to be more important than the pill itself. This analysis contests the dominant pharmaco-regulatory notion of fake-ness, which privileges chemical composition above all else. In this way, my analysis of the dossier shows that drug security is itself a powerful form of fake-talk, one that informs the entire market and the conditions of possibility of international commerce today
\u27We Still Living\u27: The Digital Media and Fake-talk around COVID-19 in Tanzania
No full textIn Tanzania, as COVID-19 emerged and became a pandemic, many claims about the fakeness of virus-related news began to appear in the digital media. These claims, or what I refer to as ‘fake-talk’, served to expose and discredit ostensibly false information and distinguish it from real news. However, I suggest that these instances of ‘fake-talk’ have a deeper sociopolitical meaning. Analysing posts collected between August 2020 and May 2022, I argue that such instances are performative acts of citizenship, whereby Tanzanians enacted and embodied ‘good’ citizenship when ‘fake news’ appeared to criticise their country and its leaders. This fake-talk, the paper shows, follows a pattern in Africa of criticising Western science and medicine, and can therefore be understood as an example of a specific form of postcolonial citizenship. Additionally, the paper reveals that claims about fakeness do not necessarily discredit the entities referred to as ‘fake’. Instead, in the very process of decrying something as ‘fake’, fake-talk can create a spectacle. Further attention still may be directed to it when fake-talk gives rise to moral and legal concerns that require intervention
Nested Ethics: The Management of Young People’s Goals in Alternative UK Mental Health Services
No full textYouth mental health interventions in the UK increasingly use goal-setting procedures to shape services and measure outcomes in ways that are intended to be meaningful to service users. This research article questions this premise, departing with the ethnographic observation that many young people do not seem to welcome the invitation or requirement to direct their therapeutic aims and set the terms for service evaluation in the form of goals. I will show that goal-setting procedures are examples of a broader field of complex ethico-political dilemmas navigated by mental health service staff. While wanting to enable young people to be healthy agents, staff are simultaneously critically aware of the risk of imposing normative, unrealistic and unfair expectations onto young people. I propose that these staff are engaged in a specific form of ethico-political practice, which I call ‘nested ethics’. I use this term to describe instances where staff ethically evaluate their own conduct in line with the capacity to enable the ethical life of another person (youth, in this case). Viewing goal-setting processes as an example of an uneasy politics of nested ethics enables a new perspective from which to advance debates about the enablement of service user choice within care provisions. 
The Stories We Tell or Omit: How Ethnographic (In)Attention can Obscure Structural Racism in the Anthropology of Mental Healthcare
No full textAnthropologists studying mental healthcare tend to do so through observational and analytic attention to how individuals experience specific clinical and cultural contexts. While narrating lived experience may serve to humanise conditions like mental illness, those of us observing from a White, colonist-descended position can overlook the structural and racialised forces that determine entrance into particular treatment spaces. In doing so, we inadvertently obscure structural racism. This Position Piece critiques my approach as a student-in-training in anthropology, who conducted an ethnography of outpatient, government-funded clozapine clinics in the United Kingdom and Australia. In documenting how these clinics unexpectedly became a central source of moral agency for its clients, I stopped short of examining the demographic dynamics that helped to cultivate moral agency. Focused on other questions of health disparity, I missed the role of race and racism in treatment access pathways, trustworthiness, and experiences of moral agency. Engaging now with disciplinary legacies that shaped my inattention, I reflect on my silencing of racism at an interpersonal, institutional and structural level in my early analysis. I encourage similarly positioned anthropologists studying psychiatric treatment spaces and moral experience to confront how racism can be filtered through the stories we tell. 
Deserving Asylum and Becoming ‘Good’ Refugees in Madrid
No full textSubject to constant and pervasive suspicion, asylum seekers in the global north often must expend great energy to assert their moral agency and be perceived as ‘good’ refugees who are not only worthy of being granted asylum but also capable of becoming ‘good’ citizens in the future. Navigating these difficult waters requires a keen awareness of what makes an individual ‘deserving’ of asylum in the local context as well as a distinct ability to balance different modes of presentation as required. Specifically, asylum seekers must be vulnerable enough to meet the requirements of refugee status, and yet also capable enough not to be perceived as a burden on society. In this Field Notes piece, I examine these negotiations within an international NGO that operates an official refugee and asylum seeker reception site in Madrid, Spain. Drawing upon ethnographic research conducted at this site, I argue that asylum seekers assert moral agency by demonstrating that they are ‘deserving’ of asylum within the local moral economy of deservingness