Medicine Anthropology Theory
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Experimental Engagements with Ethnography, Moral Agency and Care
No full textThis Special Section explores questions of method and positionality attached to moral agency in mental healthcare, which give rise to novel methodological and theoretical approaches to everyday life in the clinical and non-clinical spaces where such ‘care’ occurs. Moral agency is the ability to be perceived as a ‘good enough’ person, which makes possible intimate relationships with others that are needed to thrive in many social contexts (Myers 2015). In this introduction, we draw on Mattingly’s (2014) notion of everyday moral laboratories: an exploratory attention to moral life as innovative method, episteme, and interpersonal collaboration. Exploring the everyday moral laboratories where people struggle to replenish or protect their moral agency and so create meaning and relationships in their lives is a key focus of this Special Section. For interdisciplinary ethnographers working in spaces intended for care, such experimentation yields opportunities to more creatively and proactively inform that care—the everyday, the ordinary, and the extraordinary—that centres on helping our interlocutors replenish moral agency and thrive. 
Sustaining (Dis)Embodied Inequalities in the(ir) Eurocene: Ancient Microbes, Racial Anthropometry, and Life Choices
No full textRacialisation and colonialism are central to sustaining (dis)embodied inequalities. We bring together our distinct ethnographic projects to explore this. The first project accompanied a microbiome expedition involving Amazonian Indigenous non/human communities, whereas the second project focussed on medical professional’ encounters with Mbya Guarani communities in the Atlantic Forest region. Both projects explore racialised assumptions of human difference and colonial extractive practices. In the case of medical intervention with the Mbya, and their forms of life, this is perpetuated through the imposition of anthropometric growth standards. With the human microbiome initiatives, identifying Indigenous Peoples as potential reservoirs for novel probiotics also ultimately amplifies racialised (dis)embodied inequalities. Rather than these interventions addressing such disembodied equalities, we draw parallels between the two, to show that they perpetuate them. Finally, we propose that part of ceasing to reproduce these (dis)embodied inequalities requires ‘us’ to challenge the racialised and colonial histories of the life and geological sciences, to recognise their embodied consequences in the present, as well as how they are implicated in emergent proposals for new geological ‘-cenes’
Epidemic States: Reading China’s Mao-era Public Health after Zero-COVID
No full textThis Review essay discusses three recent historical works about Mao-era public health, dealing with mass vaccination, anti-parisitic disease campaigns, and cholera epidemic response. The review identifies two key themes that cross-cut these works: the importance of pharmaceutical technology within the Mao-era, despite common assumptions that science and technology were repressed or declined during this period; and how new administrative reforms that reordered Chinese society after the Communist Revolution intersected with public health governance. Tracing how Maoist forms of state governance emerged in and through the response to epidemic disease, the review essay suggests that we can also examine China’s COVID-19 response as a crucible for implementing new forms of governing.  
Screening Charity Recipients: Health Philanthropy, Medical Diagnosis, and Kidney Disease Prevention in Sri Lanka
No full textOver the last several decades, epidemics of chronic kidney disease of unknown aetiology (CKDu) have appeared in Mesoamerica, North Africa, and South Asia. Drawing on 14 months of ethnographic fieldwork in a CKDu-affected village in Sri Lanka, I explore how one CKDu ‘hotspot’ came into being following population screening interventions by a community development organisation, a philanthropic foundation, and a university research group. While the production of test results proved vital to the mobilisation of further research and public health resources for the community, this ethnography reveals philanthropy could be seen to have shaped by screening as much as screening was seen to have influenced by philanthropy. The example of medical screening and philanthropic interventions in Ginnoruwa illustrates how bioindicators of failing kidney function became a key metric for demarcating the community into populations of the deserving (or not so deserving) poorly, which in turn helped to create the pattern of disease prevalence and concentration that led to the community being designated a ‘hotspot’. In Ginnoruwa, philanthropy and screening did not operate independently but constituted a novel hybrid, which I refer to as ‘philanthropic science’
Thinking the Self through Hooks, Needles, and Scalpels: Body Suspensions, Tattoos, and other Body Modifications
No full textBody modifications such as tattoo, scarification and body suspension represent not only aesthetic interventions, they can also be social practices with which to challenge and transcend the body’s limits, operating on the perception of wellbeing and moulding specific forms of self. In this Research Article, based on research on body suspension in Europe, I aim to analyse body modifications as a means to voluntarily intervene in human perceptive abilities, shaping individual lives through unconventional sensory experiences. In these practices, pain is signified as a threshold for sensory turmoil, capable of shaping the protagonists into a ‘sensory poiesis’. Through such sensory experiences the individual embarks on a process of ‘self-design’ to achieve a better state of being, combining suspensions with other body modification techniques. Suspension practitioners act on the flesh and skin with hooks, scalpel, and ink in order to process events, to trigger new versions of the self, and to enhance how they feel. In doing so, they produce unique and original ‘projects of humanity’, that is, new forms of humanity created by the individuals themselves
Fluid Fakes, Contested Counterfeits: The World Health Organization’s Engagement with Fake Drugs, 1948–2017
No full textIn recent decades, the scientific and medical literature has routinely argued that ‘fake’ drugs present a pressing threat to global health. However, this article steps back from the chorus surrounding fake drugs to ask what wider issues have been at stake in efforts to control and combat them over the last seventy years. Focusing on the World Health Organization, I present a genealogy of its engagement with fake drugs as part of its work on pharmaceutical quality, from 1948 until 2017 when the latest nomenclature of ‘sub-standard and falsified medical products’ was adopted. From 2008, the seizure by EU customs authorities of shipments of Indian generic drugs on the basis that they infringed local patents and hence were ‘counterfeit’, underlines the view that the specific terms used to describe fake drugs in global health are not neutral technical objects, but highly-charged political devices that serve the interests of particular actors
Wixárika Practices of Medical Syncretism: An Ontological Proposal for Health in the Anthropocene
No full textBy understanding a community’s medical system, we are able to see its body ontology and how the people within it live in relation to the world, a historically constructed ideological position. Modernisation and development have restructured Indigenous communities and devalued traditional ontologies, including medical systems. This is a global pattern, where historical power relationships defined the coloniality of being and from this, organised healthcare, governance, and education in relation to patriarchal and capitalist universals. These social structures underlie the Anthropocene geological epoch and planetary crisis. Wixárika Indigenous communities live a polytheistic sociality; their medical system treats the spiritual origins of illness, attending to social cohesion in a society of humans, the supernatural, flora and fauna. This system is subalternised by dominant universals of biomedicine, which treat the body as separate from the environment and society. I refer to this epistemological inequality as the ontological Anthropocene. Wixaritari use both allopathic and traditional medical systems, following a non-hierarchical syncretic understanding of wellbeing. Giving equal importance to both systems may be a framework with implications for wellbeing beyond human health. This Research Article proposes that by centring Indigenous sociality that is more-than-human we can reconceive our planetary relationships in the broadest sense
Toxic Legacies and Health Inequalities of the Anthropocene: Perspectives from the Margins
No full textBased on research in Matamoros (Mexico) and Naples (Italy), this article critically deconstructs embodiments and social histories of toxicity, addressing uneven power relations and health inequalities generated through late capitalism of the Anthropocene. By focusing on food and water consumption in regions at the margins of borders and defined as toxic wastelands, it sheds light on the multidimensional power structures of the global economy. Whether through reference to the illegal dumping of toxic waste by mafia-structured organised crime groups, or the contamination caused by foreign-owned assembly plants, the article illustrates how mechanisms taking place in the individual realm are ‘subsumed’ (Breihl 2019, 33) within more complex historical, economic, and environmental processes. These two case studies are the point of departure to reflect upon the undisclosed but powerful impact that commercial determinants of health have on individuals’ wellbeing, feeding profound north–south inequalities
"Swallow Them All, and It\u27s Just Like Smack": Comorbidity, Polypharmacy, and Imagining Moral Agency alongside Methadone and Antipsychotics
No full textThis research article investigates moral agency in the spaces between the methadone clinic and the inpatient psychiatric ward by exploring the ways dually-diagnosed service users move though ever-more labyrinthine networks of care. I ask: how are patients’ own engagements with the ethical stakes of such care both made possible and delimited by virtue of their proximity to substances that are understood to affect their subjectivities, wills, and capacities for self-governance? Drawing on fieldwork in the community mental health network of Dublin, Ireland, and following my interlocutors’ own reflections, I analyse the moral dimensions of polypharmaceutical treatment for substance use disorder in the context of psychiatric dual diagnosis. I illustrate how various apparatuses of coercion and care apprehend and govern patients who are thought to be both addicted and mad, simultaneously enthralled by one form of the pharmakon and dangerously unreasonable when other medications are absent or neglected. In the space of such medicated subjectivities, a curious but ultimately revelatory claim to authority about the intended and unintended effects of polypharmaceutical treatment takes shape. 
Fake-talk, Side Effects and the Trouble with Hormonal Contraceptives among Women in Dar es Salaam
No full textThis article analyses women’s accounts about hormonal contraceptives in Tanzania, and the social, cultural, political, and economic contexts that cause them to use such contraceptives, even as they called them ‘feki’ (Swahili for fake). Drawing on four months of ethnographic fieldwork and interviews with four working-class women from various districts in Dar es Salaam, my research explores their anxieties about using these medications, the side effects of which they believe pose a threat to their health. The possible biomedical side effects the women spoke of include prolonged menstrual cycles, stomach cramps, fibroids, cancer, and infertility. They reasoned that medicine should not bring suffering to the body, and that therefore, if a woman experiences side effects it is a matter of concern. Given that all medications have side effects, I was interested in what exactly these women meant when they identified hormonal contraceptives as ‘feki’. Furthermore, if they believed that these contraceptives were fake, why did they continue to use them? Over time, I came to understand that calling hormonal contraceptives ‘feki’ did not mean the women thought the pharmaceuticals were inauthentic or ineffective in preventing pregnancy. Rather, it reflected their view of such drugs as being morally problematic, but sometimes necessary