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Writing at the Margin: Discourse Between Anthropology and Medicine
... And what could the anthropology of security gain from it? Studying cultural phenomena and social processes from the margins builds on a specific tradition in anthropology (Auyero et al. 2015;Axel 2002;Bošković 2008;Das and Poole 2004;Herzfeld 1989;Johnston 1995;Kleinman 1997;Lamphere 2004;McKinson 2022;Scheele 2021;Tsing 1993Tsing , 1994). Yet, the term is used quite differently, for example to locate anthropologists and their research fields within the discipline or to position anthropology within the field of academic disciplines. ...
... The relationship between anthropology and marginality goes back to the beginnings of the discipline, which saw anthropologists working in places neglected by other disciplines often located in colonial contexts (McKinson 2022: 3). In addition to pointing out that anthropology has itself merely a marginal voice in science and society (Das and Poole 2004: 4), publications that focus on the role of marginality in anthropology address research fields at the margins of other sciences, such as medicine (Kleinman 1997) or history (Axel 2002), the historically evolved marginal position of non-male and non-white scholars in anthropology itself (Harrison 1997;Lamphere 2004;Lutz 1990), as well as the marginalization of regional and national anthropological traditions outside the so-called four great North Atlantic traditions (Bošković 2008). Features emerging from these "disciplinary" self-reflections are echoed in works that conceptualize margins as empirical and/or conceptual starting points for ethnographic research and insights. ...
... They assume that being at the margin is not an essential condition, but-as Anna Tsing argues-the result of socio-cultural and power-political processes of marginalization, "in which people are marginalized as their perspectives are cast to the side or excluded" (Tsing 1994: 5). Although the agents or authors of processes of marginalization can be named, a margin is neither a binary nor a discrete, sharply differentiated opposition, but instead comprises closely intertwined relationships that run correlatively through the marginalized and the marginalizing. 1 This means that margins characterized by exclusion and oppression can also become sites with the creative and emancipatory potential to enact change and transformation-and in our case alternative security concepts and practices (Bošković 2008;Kleinman 1997;Lamphere 2004, McKinson 2022. ...
Starting from the ambivalence and contradiction of social categories at the margins, this introduction points out the potential of a perspective from and on the margins for a Critical Anthropology of Security. We conceptualize security from the margins as discourses and practices concerned with the social reproduction of marginalized actors, and security concepts and strategies used to negotiate, and establish notions of a “good life.” Security from the margins is characterized by the positionality, temporality, and (in)visibility of marginalized actors and security practices, which, taken seriously, illustrate the diversity of specific threats, practices, and concepts involved in increasingly complex (in)security situations. Marginalized security practices not only aim to minimize negative security risks but generate positive options that secure living conditions at the margins.
... 11 On the other hand, it the most widely used but least understood part of the communication process. 12 "In contrast to hearing which is a natural process, hearing is considered highest form of courtesy. 12 Generally, we considered that our lives are spend mainly spend in writing and reading. ...
... 12 "In contrast to hearing which is a natural process, hearing is considered highest form of courtesy. 12 Generally, we considered that our lives are spend mainly spend in writing and reading. In fact, these two represent only 25% part, on the other hand talking (35%) and listening (40%) constitute 75% of the commination in our life. ...
... In fact, these two represent only 25% part, on the other hand talking (35%) and listening (40%) constitute 75% of the commination in our life. 12 Here "listening includes not only listening verbal component but also understanding the "patient's attitude, needs and motives behind the words". The objective of attentive listening is to explore the physical, social, and emotional effects of these issues on the patient's quality of life, thereby facilitating comprehensive care and ensuring satisfaction. ...
Empathy is considered as a basic skill, if patient care is to be improved. Published literature showed that with academic progress from 1st year to final year, overall, there is a decline in empathy among undergraduates. Emerging evidence suggest that by stimulating emotional intelligence, we can improve empathy more effectively when compared to solely relying upon cognitive method of teaching.1 Review of the literature showed that in some way or other empathy may be taught“.2-5 Many ways to teach empathy has been proposed these includes; “improving interpersonal skills, audio or video-taping of encounters with patients, exposure to role model, role playing (aging game), shadowing a patient (patient navigator), hospitalisation experiences, studying literature and the arts, improving narrative skills, theatrical performances, and by discussing cases/clinical situation which has aroused feelings among students known as Balint method”. Among this interpersonal commination was addressed more in detail by Davis4 by developing Interpersonal Reactivity Index (IRI) that identified multidimensional approach towards empathy and also ways how empathy may be improved. Different aspects of empathy and ways how it may be improved were best address by Krznaric et al.5 He identified 6 habits of highly empathic peoples and ways how these habits allow these empathic peoples to connect them with others very nicely.When reviews on the subjects were assessed, we found three reviews of worth mentioning.
... The overarching aim of this curriculum is to align healthcare students' graduate attributes, also referred to in other contexts as interdisciplinary professional, core, or non-technical skills, with key lessons from medical pluralism. Given the importance of good and effective patient-healthcare professional communication and understanding, and addressing socio-cultural factors in the medical encounter, anthropological and cross-cultural studies have developed clinical guidelines to address these issues (Kleinman, Eisenberg & Good, 1978), which are, however, still not widely adopted in medical education approximately two decades later (Kleinman, 1995). Park et al. (2006), for example, maintain that central to the poor endorsement of cross-cultural training in medical education is the general view that this is not useful in medical encounters. ...
... While neither denying the contribution made by biomedical research, nor the key importance of continuing with it, one nevertheless finds it regrettable that traditional biomedical research approaches that guide healthcare research and teaching are responsible for the neglect of a more holistic view of patient care (Serekoane, 2010). Recognising the significance of effective patient-healthcare professional communication, understanding, and the consideration of sociocultural factors in medical interactions, anthropological and cross-cultural studies, have formulated clinical guidelines to tackle these concerns (Kleinman et al., 1978;Helman, 2002Helman, , 2007, which are, however, not widely used in medical education (Kleinman, 1995). Park et al. (2006), for example, maintain that central to the lack of endorsement of cross-cultural training in medical education are the generally associated views on the lack of usefulness of these guidelines for medical encounters. ...
... • The traditional biomedical paradigm is characterised by ethnocentrism and scientism, which prioritise biomedical science and its compatible variables while disregarding social issues. This approach, rooted in biological reductionism and technological solutions, overlooks the valuable contributions of social science to clinical practice (Kleinman, 1980;1995). Kleinman et al. (1978) and Lock and Nguyen (2018) suggest that by breaking free from these biases, we can acknowledge the importance of the socio-cultural context and other neglected factors in professional healthcare practices. ...
Healthcare interactions have become increasingly varied, prompting the need for revised person-centred approaches that call for curriculum reform. This paper describes the perceived impact of the intentional insertion of medical pluralism into an inclusive, interprofessional health sciences module. A phased multi-method research design was applied. Phase 1 gathered data for an early curricular review. Phase 2 implemented a revised approach focusing on medical plurality. Phase 3 collected qualitative data through structured reflective journaling. Descriptive statistical analysis of quantitative data and thematic analysis of the qualitative data were performed. 41 2022 first-year students (30%) participated in Phase 1, with 83% indicating that engagement was encouraged (83%) within a space of mutual respect (83%). Structured reflective journaling was employed in 2023 with 121 (97%) first-year students participating in Phases 2 and 3 to describe the impact of the revised approach on student learning. Five themes emerged from this experience: uncertainty, fear, overwhelm, gratefulness, and personal impact. Through creating a practically orientated and inclusive curricular space founded on medical pluralism and pedagogy of care, cross-cultural graduate attribute training was transformed to be more contextually relevant and future-focused to effectively steer students towards developing the attributes of desirability, ethics of care, and responsible citizenship.
... Following this Marxist analysis that uncovers the powerful interplay of power relations, contemporary tensions and critiques of humanitarianism are precisely linked to unrequested interventions justified by the media and the major actors as being altruistic [47] Through the analysis of ancient wisdom and concepts of compassion, the contemporary transnational morality in humanitarianism is argued in this article as having a darker side that reproduces unequal power relations between the developed West and the Global South [37]. Similarly, the vulnerability paradigm that shapes the worldview of affected communities is argued to be, at best, unhelpful and, at worst, counterproductive [51,52]. ...
... The Spanish translation 'hoy por ti, y mañana por mi' is said often whenever you are in times of hardship or witnessing distress. It is a thank you and a please; it is a reminder that we all face challenges and suffering [52]. Both the giver and the receiver repeat the phrase to one another, establishing an equal footing in understanding that the pendulum swings at both ends. ...
... The order in which this phrase is constructed is equally significant, placing emphasis on giving first and then receiving. Ayni reminds us that humility is a central concept in collectiveness, and without unity with others, we are left vulnerable to the inevitability of life's calamities [52]. This article takes on an anthropological definition of suffering as argued by Kleinman [52] p. 101. ...
In 2016, a localisation agenda was set across the international aid industry with the understanding that humanitarian interventions need to be led by local actors and local communities. Despite international agreements, the localisation efforts are largely failing. This paper demonstrates the challenges that prevent effective collaboration between international humanitarian agencies and crisis-affected communities. It draws on evaluation reports to highlight an inability to learn lessons or follow recommendations from previous crises. Based on the authors’ experiences, we present a novel framework for effectively collaborating with crisis-affected communities. The Communities Framework provides a pathway to establishing effective community collaboration and locally owned and led humanitarian interventions. The importance of local leadership, trust building, and local context are at the heart of the framework. In light of the need for a more localised and decolonial humanitarian response, this framework supports humanitarian actors and the affected communities in moving from a charity-led approach to one of mutual aid. The paper draws on alternative notions of compassion from the Global South of contemporary humanitarian interventions as a philosophical foundation for the framework. Caring for others and the world is central to implementing an appropriate and effective humanitarian response. There remains a largely unexplored scope regarding the outcome of resolving crises when both humanitarian actors and affected communities work as equal partners and how that will shape modern humanitarianism as we understand it today.
... O materialismo é entendido, portanto, como a base do conhecimento, quase não havendo espaço para a experiência do sofrimento do paciente pois, se a natureza é física, então pode ser conhecida independentemente da perspectiva ou representação (KLEINMAN, 1995). Desse modo, a "real existência" da doença (o significado) depende da vinculação entre elementos da narrativa do paciente e elementos do mundo natural que dão sentido às queixas do paciente, possibilitando enquadrá-las como doenças, estas sim explicáveis por meio de relações causa-efeito e empiricamente demonstráveis (GOOD, 1994). ...
... Por outro lado, as experiências de sofrimento do paciente que escapem dessa possibilidade de enquadramento são interpretadas/significadas pela biomedicina como "falsas crenças" (KLEINMAN, 1995 Por estas razões, para a biomedicina, a saúde é compreendida objetivamente como a ausência de doença, ainda que o paciente experiencie uma sensação de não-saúde. Kleinman (1995) argumenta, ainda, que esta visão da biomedicina é influenciada pelo monoteísmo da tradição ocidental, pois a ideia de um único Deus "legitima a ideia de uma única, subjacente, universalizável verdade". ...
... Por outro lado, as experiências de sofrimento do paciente que escapem dessa possibilidade de enquadramento são interpretadas/significadas pela biomedicina como "falsas crenças" (KLEINMAN, 1995 Por estas razões, para a biomedicina, a saúde é compreendida objetivamente como a ausência de doença, ainda que o paciente experiencie uma sensação de não-saúde. Kleinman (1995) argumenta, ainda, que esta visão da biomedicina é influenciada pelo monoteísmo da tradição ocidental, pois a ideia de um único Deus "legitima a ideia de uma única, subjacente, universalizável verdade". Sob esta perspectiva, portanto, não existe a tolerância a paradigmas alternativos e as abordagens que persistem na cultura popular são execradas como "falsas crenças", de maneira semelhante "à acusação de heresia na tradição religiosa ocidental" (KLEINMAN, 1995). ...
Trata-se de pesquisa bibliográfica cujo principal objetivo é realizar uma análise comparativa entre as abordagens teóricas da biomedicina, das teorias interpretativas e das teorias críticas, no que se refere à compreensão do conceito de Saúde Mental. Como conclusão, argumentamos que cada uma destas abordagens enfoca um aspecto fundamental do processo saúde-doença, de modo que a compreensão global do conceito de saúde mental exige que seja reconhecida a importância de todas essas abordagens e, sobretudo, que as pesquisas futuras possam promover diálogos profícuos entre elas.
... Biomedicine has been a powerful site for articulating and imposing the norms of modernity, including the centrality of the autonomous individual and the division between science and religion (Gordon, 1988;Kleinman, 1997;Lock and Nguyen, 2018). Biomedicine has produced modern/non-modern distinctions in its encounters with people in a variety of settings, often representing those who do not adhere to medical norms as embedded in "culture" or traditional belief structures (Good, 1993). ...
... Anthropologists have characterized biomedicine's distinctive forms of knowledge and objects of intervention, often emphasizing biomedicine's naturalism and its assumption that people are autonomous, individual biological subjects (Gordon, 1988;Lock and Nguyen, 2018). Biomedical knowledge is represented as natural fact, in contrast to the "culture" or beliefs of patients (Kleinman, 1997). ...
... Increasing the staff's cultural humility and critical consciousness will allow the staff to reflexively inquire how they view different patient groups that diverge from the normative standard (Ivry, 2010;Razon, 2016). Cultural humility and critical consciousness will encourage the staff to critically analyze their own culture and professional ethos that praise the autonomous, rational, modern individual (Gordon, 1988;Kleinman, 1997;Lock and Nguyen, 2018) and to evaluate this standpoint from a relativistic perspective. The staff's cultural humility and critical consciousness will also illuminate how they interpret differently behaviors of ultra-Orthodox and Arab patients, which the staff perceive as collectivistic and "non-modern," and will illuminate the gap between the ways the providers apply their cultural sensitivity to differing social groups. ...
... Generally, biomedical practitioners view infectious diseases as biological dysfunctions caused by organic pathogens such as viruses, bacteria or parasites that must be treated with curative interventions such as pharmaceuticals and vaccines [1,2]. Similarly, substance misuse and mental health issues are often approached by clinicians as biological phenomena resulting from biochemical brain imbalances that require medical and psychological initiatives [3,4]. A biological explanation also underlies biomedical perspectives of GBV in terms of testosterone or hormonal levels in men that contribute to violence toward women or that neuroanatomical differences including biological factors in men predispose men's tendency to be violent toward women [5][6][7]. ...
This article will use syndemic theory to identify and analyze overlapping health and social conditions, focusing specifically on how gender-based violence is systemically interconnected with contemporary public health issues. The overdose death crisis that continues to afflict Canadian populations is not an isolated health issue. Across Canada, it is intertwined with mental health, HIV/AIDS, COVID-19 and structural violence-the chronic and systemic disadvantages affecting those living in poverty and oppressive circumstances. Opioid use is an often-avoidant coping strategy for many experiencing the effects of trauma, relentless fear, pain, ill health and social exclusion. In particular, Indigenous and non-Indigenous women's experiences with opioid addiction are entangled with encounters with gender based-violence, poverty and chronic ailments within structurally imposed processes and stressors shaped by a history of colonialism, ruptured lifeways and Western ways of knowing and doing, leading to disproportionate harms and occurrences of illness. While biomedical models of comorbidity and mortality approach substance misuse, gender-based violence and major infectious diseases such as HIV/AIDS and COVID-19 as distinct yet compounding realities, this article argues that these conditions are synergistically interrelated via the critical/reflexive lens of syndemic frameworks. Through secondary research using academic, media and policy sources from the past decade in Canada, complemented by prior ethnographic research, the synergistic connections among opioid addiction, gender-based violence and the effects of the COVID pandemic on diverse women will be shown to be driven by socio-structural determinants of health including poverty, intergenerational trauma, the legacy of colonialism and Western optics. Together, they embody a contemporary Canadian syndemic necessitating coordinated responses.
... These studies reveal that local understandings of health are not just biological but also in uenced by cosmological and ethical traditions that de ne the body in states of sickness and wellness. Anthropologists have explored how health and illness are recognized, interpreted, and addressed within speci c cultural contexts, while also tracing the impact of global forces such as migration, information ow, and economic changes on these local health worlds [3] . ...
Maternal health among tribal women in India faces significant challenges, including high maternal and infant mortality rates, malnutrition, anemia, and inadequate healthcare access. This study examines the factors contributing to these health disparities, focusing on the experiences of tribal communities in regions such as Chhattisgarh, Odisha, and Madhya Pradesh. The introduction highlights that unhygienic childbirth practices, poverty, and limited healthcare services are major contributors to maternal health issues. Methodologically, the study utilizes secondary data from previous research, including health surveys and case studies, to identify trends in maternal health and nutrition within tribal populations. The study aims to assess the nutritional status and healthcare practices of tribal women, with objectives to identify factors leading to high maternal mortality and morbidity, and to explore regional differences in health outcomes. The findings reveal that a substantial proportion of tribal women suffer from anemia, malnutrition, and inadequate antenatal care. For instance, in regions such as Chhattisgarh, maternal mortality rates are elevated among both first-time and multiparous mothers, with factors such as low socioeconomic status, illiteracy, and traditional childbirth practices being key contributors. Anemia, particularly chronic energy deficiency, is prevalent across many tribal areas, with significant variations in nutritional status between regions. In conclusion, the study highlights the urgent need for targeted health interventions to improve maternal health outcomes among tribal women. Strategies such as enhanced healthcare access, education, and nutritional support are essential to address these disparities and reduce maternal and infant mortality rates in tribal communities.
... We are now back to where we started, with Fish's interpretive communities (Fish, 1980(Fish, , 1989, Hampshire's ways of life (Hampshire, 1983), and Kleinman's moral modes of experience (Kleinman, 1995(Kleinman, , 1999. The entire book can be understood as an effort to give shape to these collective ways of thinking about societies, social interactions, professional communities, and, indeed, clinical ethics. ...
We begin this concluding chapter by explaining just what we mean by revitalizing health care ethics. We see clinical ethics as embodied in clinicians and as maintained through the socio-institutional processes of the interpretive communities that define each particular field of health care. We stress the importance of respecting and building upon the working moral frameworks and action frameworks that all clinicians possess at the outset of their professional education. Finally, we emphasize the role of the touchstones for learning and touchstone questions as a foundation for trainees’ and clinicians’ lifelong learning and ongoing professional development.
... We return here to our analysis of informal ethical discourse embedded in Fish's interpretive communities (Fish, 1980(Fish, , 1989, Hampshire's ways of life (Hampshire, 1983), and Kleinman's moral modes of experience (Kleinman, 1995(Kleinman, , 1999) (see Chapter 2). Each of these conceptions of social/professional settings defines a concrete world in which clinicians work and act, think and feel. ...
In this chapter we look at how clinical skills develop over time, at the diversity of skills to be learned, and at the inherently social and interactive character of the learning process. Learning to identify when something has “gone wrong”—that is, to identify discrepancies from what was expected—is a crucial element of this process of learning clinical skills and continuing to improve those skills over time. We also explain why and how ethics pervades the performance of all clinical tasks, as well as why attention to the touchstones for learning and touchstone questions serves as a means of understanding and addressing the ethical challenges and problems of the clinical milieu.
... What's at stake in this intersection of literary theory/sociology (Fish, 1980(Fish, , 1989, philosophical ethics (Hampshire, 1983), and anthropology (Kleinman, 1995(Kleinman, , 1999-not to mention our own previous work in health care ethics and informal ethical discourse (Scher & Kozlowska, 2018)-is of profound importance for health professionals. Most immediately, the implication is that the local moral processes are, at base, sound, legitimate, and worthy of respect, and that these processes are generally adequate for health professionals to understand, probe, analyze, criticize, or creatively respond to whatever occurs in any particular health care setting. ...
The shared, lived experience of individuals within a professional community generates the local moral processes that shape and maintain the community, its values, and its commitments. This chapter explores three different conceptions of communities in which shared processes shape the lives and values of community members: interpretive communities (at the intersection of literary theory and sociology), ways of life (from moral philosophy), and moral modes of experience (from anthropology). The chapter also explores the distinction between formal and informal ethical discourse and the two modes of doing ethics—the formal, theoretical (top-down) mode commonly used in academia and the informal (bottom-up) mode embedded in the social and institutional environments in which health professionals work.
... . In Chapter 2 of this book, we saw how informal ethical discourse is embedded in Fish's interpretive communities (Fish, 1980(Fish, , 1989, Hampshire's ways of life (Hampshire, 1983), and Kleinman's moral modes of experience (Kleinman, 1995(Kleinman, , 1999. ...
The touchstone questions—the last step of the touchstone process—play a central role in informal ethical discourse, clinical decision-making, and health professionals’ communication with other health professionals and with patients and families. As we will see, the touchstone questions engage the whole person, and it is as whole persons that clinicians confront the ethical challenges and problems presented by their clinical work.
... What needs to be stressed here is that within the framework presented in this book and in line with the work of Fish (1980Fish ( , 1989, Hampshire (1983), and Kleinman (1995Kleinman ( , 1999Kleinman ( , 2019) (see Chapter 2), our expectations in any situation that involves other persons, as well as our associated perceptions of the unexpected, have an inescapable ethical component. The reason is straightforward. ...
The touchstones for learning, which arise at the interface of affect and intellect, mark our encounters with the unexpected. This experience of discrepancy then leads us to ask what has happened, and why? How do we deal with the discrepancy? In this sense our action frameworks, as discussed in Chapter 6, have a fundamental, dual role in clinical experience—first as shaping the background expectations against which incoming experience is assessed as expected or unexpected/discrepant, and second as shaping how we interpret and respond to that experience.
... When medical anthropologists examine biomedicine and some of its dimensions, we approach it with the epistemic view that biomedicine is a sociocultural system (Hahn & Kleinman, 1983;Kleinman, 1997). We consider it a typical field of ideas comprising of people pursuing different tasks by their corresponding roles. ...
Human resources is key to delivering health care services in a health facility. Working in an entity for a certain period, meeting with the same group of people during that time and having continuous interactions and interrelationships amongst the group, may open up the space to have a conducive atmosphere among the staff. Such interactions and interrelationships among the health care workers are crucial windows to peep into the health facility, delivery of health care services, and the emerging negotiated order. Based on ethnographic information acquired from a health facility in the Lakhanpur area in present-day Madhesh Province, this paper shows the dynamics of staffing, power relationships, and the negotiations among the healthcare workers and their collective impacts on the healthcare service delivered through the very institution.
... These methods allow them to identify and interpret sociocultural factors that cannot be captured from a quantitative perspective [25]. Moreover, medical anthropologists have argued that the traditional emphasis on identifying and treating biological disorder in medical training and practice may not elucidate meaningful engagement with psychosocial experiences of illness and suffering [26,27]. As a general trend, biomedical research also lacks detail when analyzing the experience of practitioners who care for patients with chronic illness [28]. ...
Hypoplastic Left Heart Syndrome (HLHS) is a critical congenital heart abnormality that, prior to 1980, offered no treatment options beyond comfort care. Surgical advancements have since transformed the prognosis, yet the lived experience of affected families remains complex and multifaceted. This study aims to elucidate the psychosocial challenges accompanying the biomedical management of HLHS, exploring both family and provider perspectives to identify opportunities for more holistic care. We conducted semi-structured interviews with five families and two healthcare providers involved in HLHS management a New England health system. Interview transcripts were analyzed inductively to identify emergent themes, with a focus on the lived experience of families and the perceived role of providers in influencing this experience. Our study illuminates the extensive psychosocial challenges and emotional distress encountered by families dealing with HLHS, indicating a disparity between the advanced biomedical treatments available and the broader, more integrative care needs of patients. Despite healthcare professionals’ technical proficiency, there exists a pivotal need for empathetic engagement and support that encompasses the full scope of the patient and family experience. Our findings advocate for an integrated care model that incorporates George Engel’s biopsychosocial aspects of health, aligning with the emotional and psychological needs of families. The study underscores the importance of socially conscious care and suggests that enhancing empathetic communication and support in clinical practice can improve both patient outcomes and family well-being in the context of chronic and complex conditions like HLHS.
... Amerikkalainen antropologi Arthur Kleinman (1995, Kleinman ym.1992,1997 laajentaa perinteistä länsimaista näkemystä kärsimyksestä yksilön ongelmana sisällyttämällä kärsimyksen käsitteeseen myös sosiaaliset kokemukset. Kärsimyksen sosiaalisia aineksia ovat ensinnäkin ihmisten vuorovaikutukseen liittyvät moninaiset sidokset. ...
... (1999) 26 6) Éviter les biais rationalistes dans l'analyse du processus de narrativisation Retour à la table des matières Refuser de traiter le corps comme un texte où s'inscrivent les manifestations de détresse et la culture populaire comme un assemblage de textes qui subsument l'ordre de la culture nous conduit à considérer avec prudence toute approche proposant de découvrir l'essence de la détresse dans les récits qui sont faits du vécu de la souffrance. On sait que les sciences sociales ont consacré une attention particulière aux interactions entre les récits et les événements (Kleinman 1988). Mais plusieurs questions s'imposent : les récits rapportent-ils les événements tels qu'ils ont été vécus ? ...
... En el campo de la antropología médica, autores relevantes como Kleinman (1997) argumentan que este espacio social, el que configura las acciones de la vida cotidiana, contiene flujos, rutinas y prácticas específicas derivadas de la propia experiencia. La etnografía, la biografía, la historia social o la literatura contienen métodos para ingresar a esos espacios sociales locales a diferencia de otras aproximaciones. ...
El método biográfico configura uno de los abordajes antropológicos más ampliamente utilizados en las etnografías sobre drogas en España desde principios de los años ochenta. En este artículo se realiza una retrospectiva analítica de los estudios clave en este campo. Para ello, se describen y analizan las distintas aplicaciones y estilos académicos con relación a este método y su articulación con otras técnicas y aplicaciones de investigación, extrayendo las principales características y contribuciones del método biográfico en investigación social. El análisis se divide por periodos históricos para ahondar en la evolución de las estrategias para el abordaje y la comprensión del fenómeno del consumo de drogas. En conclusión, este trabajo pretende enfatizar y subrayar la importancia y utilidad del método biográfico como herramienta analítica de la realidad social y del fenómeno del consumo de drogas en particular.
... This significantly suspends the clinic's ostensibly 'technical' and 'scientific' rationale. The enchanted version of a profoundly jaded attitude toward biomedicine, according to Kleinman (1995), is part of a greater social practice of biomedicine indigenisation. This is particularly pertinent considering the substantial reception and acceptance of ARTs in India. ...
The article scrutinises Rohini S. Rajagopal’s work, what’s a lemon squeezer doing in my vagina (2021), to illustrate the escalating medicalisation of infertile bodies. In a cultural context where reproductive concerns are construed as medical disorders demanding treatment and surveillance, medical professionals and pharmaceutical companies exploit these sociocultural dynamics to provide infertile couples with immediate solutions through Assisted Reproductive Technologies. Consequently, the study contributes a critical perspective to the field of medical humanities, initiating a nuanced discourse that interrogates the impact of terms such as ‘living laboratories’, ‘baby machine’, ‘mother machine’ and ‘hope technology’ on our comprehension of future motherhood. Drawing on feminist critiques of medicalisation, the article argues that biotechnology perpetuates the eighteenth-century biomedical metaphor of the body as a machine with replaceable parts. Notably, contemporary advancements in reproductive medicine allow for the replacement of perceived ‘flawed’ body parts, further objectifying them within this framework.
... Instead, they are deeply embedded in social and professional norms and legal and regulatory structures that serve some interests more than others and can impact clinical outcomes. [31][32][33][34] This theoretical orientation has been applied in critical social science scholarship on the social movement of midwifery in Canada and its transition to a full profession within the public healthcare system, [1][2][3][4][35][36][37] the travails of the early years of the profession, [38][39][40][41] and how the midwifery model of care functions in practice. [42][43][44] The evolving social justice work of midwifery has been addressed in scholarly work that argues that the profession has maintained a counterhegemonic force; as midwives continue the feminist work of promoting and supporting pregnancy and birth as "normal," they have also defined and pursued new social justice goals for the profession, including the expansion of diversity and equity. ...
This article explores the impact of the COVID-19 pandemic on midwifery care in Ontario. Midwives faced unique challenges in delivering high-quality care while protecting themselves and their clients from infection during the pandemic. Our first objective in this study was to understand the general impact of the pandemic on midwifery practice to document the challenges midwives faced, and how they adapted their work. What information, resources, and support did they receive to deal with the challenges, and what strategies did they develop to maintain their unique model of care under such constraints? Our second objective was to look closely at how midwives worked to mitigate the pandemic's unequal burden on racialized and marginalized clients as COVID-19 laid bare and exacerbated existing divides in the healthcare landscape. How did they adapt care for vulnerable groups during a time of crisis? RÉSUMÉ Le présent article examine l'incidence de la pandémie de COVID-19 sur les soins sage-femme en Ontario. Les sages-femmes ont affronté des défis exceptionnels : elles devaient offrir des soins de haute qualité tout en protégeant leur clientèle et elles-mêmes contre l'infection. Le premier objectif de notre étude consistait à comprendre l'impact de la pandémie sur la pratique sage-femme en général et à prendre note des défis auxquels les sages-femmes ont fait face et des façons dont elles ont adapté leur travail. Quels renseignements, quelles ressources et quels soutiens ont obtenu les sages-femmes pour relever les défis et quelles stratégies ont-elles conçu pour maintenir le modèle de soins qui leur est propre sous de telles contraintes? Nous avions comme deuxième objectif d'examiner de près la façon dont les sages-femmes ont travaillé pour atténuer le fardeau inégal imposé à la clientèle racisée et marginalisée, alors que la COVID-19 mettait à nu et accentuait les fossés présents dans le paysage des soins de santé. Comment les sages-femmes ont-elles adapté les soins prodigués à ces groupes vulnérables durant cette crise?
... Witnessing is an important form of care that spans the domains of therapy and qualitative research. Ethnographers and anthropologists have made important interventions in professional ethics of care in the context of ethnographic writing (Garcia, 2010;Kleinman, 1997;Moran-Thomas, 2019), but less is written on ethics of care in the interview process. One of the primary ethical obligations of anthropologists, as articulated by the American Anthropological Association (2024), is to do no harm. ...
Arts-based research can provide pivotal avenues for researchers and participants to explore experiences that are difficult to put into words. Arts-based methods offer important opportunities for participants to develop reflexive understanding through material interaction with art and mark-making supplies. While sensorial and embodied experiences are entangled with arts-based methods, there is little methodological and theoretical work that puts arts-based research methods into conversation with sensory ethnography. This methods paper provides a detailed, critical reflection on the development and implementation of the sensorial arts-based exercise, Beneath the Surface, for research that examines solid-organ transplant recipients’ embodied experiences through a crip/feminist/materialist framework. Adapted from art therapy practices, Beneath the Surface generated a novel context for the articulation of embodied experience, creating space for the expression of sensations and feelings that fall outside the dominant cultural narratives of transplant, such as the “gift of life” or a “second chance,” that demand absolute gratitude. Beneath the Surface contributes to theoretical discussions surrounding embodiment, inscription, and interiority. The exercise also demands attention to ethical deliberations, highlighting the critical importance of developing trauma-informed research protocols and addressing the historically fraught relationship between critical disability studies and art therapy.
... This type of approach can inform individual and population health for adolescents, but also meaningfully connect these outcomes to the every day-even mundane-aspects of daily life that are at stake for adolescents in varied contexts (Kleinman, 1997;Lock et al., 2021). However, the bounds and edges bioethnographic (and biocultural) methods and analytical choices are yet to be pushed in new directions in rethinking what it means to collect sometimes disparate forms of data and how to make analytical choices with such data -this will take slow science and exploration of possibility, something not currently incentivized by research funders and institutions. ...
Adolescence is an expansive, dynamic period in the life course covering a broad age range (ages 10-24) and a cascade of biological and cultural changes. However, biocultural approaches to adolescence have been less well developed within existing research compared to child and adult counterparts. In this article, we advance a roadmap to revisit received wisdom about adolescence and to push the study of adolescence forward rooted in biocultural frameworks. Drawing on existing biocultural and anthropological work, we present three main opportunities to challenge assumptions, embrace adolescent diversity, and innovate biocultural methods in the study of adolescence. We invite readers to reflect upon this synthesis in their future studies with and among adolescent populations in varied socioecological milieus.
Cite as:
Glass, D. J., & Emmott, E. H. (2024, July 27). Biocultural Synthesis of Adolescence: A roadmap to advance the field. https://doi.org/10.31219/osf.io/d49y8
... MRI is widely known for its medical diagnostic capability and can also be used in anthropology [56] , paleontology [57] , evolution [58] , material analysis [59] , food quality [60] , and liquid explosives [61] . Conventional MRI typically requires magnetic fields of up to several teslas to ensure an adequate signal intensity. ...
... E mi pare che questa doppia faccia sia la differenza che separa l'analisi di Seppilli da altre analisi che si sono sviluppate all'interno dell'antropologia medica critica come quella di Paul Farmer (1992Farmer ( , 1996 che con l'espressione "violenza strutturale" si riferisce a quella particolare forma di violenza iatrogena che non implica un agente specifico, individuo o gruppo che sia, ma che è una conseguenza della struttura sociale stessa, dal livello locale a quello sovranazionale, che agisce attraverso le disuguaglianze di vario tipo (ambientali, sociali, economiche) che la caratterizzano e che creano anche disuguali condizioni di salute e speranze di vita per gli individui. Oppure le analisi che fanno riferimento al concetto di "sofferenza sociale" (Kleinman 1995;Kleinman, Das, Lock 1997) che rinvia ai meccanismi di oppressione iscritti nei corpi, al rapporto tra l'esperienza soggettiva della sofferenza e i rapporti di potere e subordinazione che in essa sono incorporati. ...
Il contributo mostra come la nozione della salute come bene comune, centrale nell’intervista di Rita Lima a Tullio Seppilli, si collochi all’interno dell’itinerario scientifico di Seppilli nel quadro delle politiche e dei problemi relativi alla salute e all’assistenza sanitaria in un mondo globalizzato.
... Se ha propuesto que el pluralismo es posiblemente más frecuente en la psiquiatría y la psicología clínica al agrupar una gran diversidad de enfoques, teorías y terapias con diferentes contenidos simbólicos, prácticos y culturales y cuya intención es el alivio de los síntomas o el control de las supuestas causas (Kleinman, 1995;Young, 2008). Debido a que la selección de las personas a entrevistar fue deliberada para incluir la mayor variación posible, no es de sorprender que se encontrara esta diversidad de orientaciones, posicionamientos y explicaciones. ...
El objetivo de este proyecto fue explorar y analizar la presencia de la medicina genómica en las creencias, las prácticas y las políticas en Costa Rica en mi propio campo de investigación, la genética de los trastornos mentales mayores, desde mi propia mirada como participante y observadora. Para lo anterior, se realizó un estudio cualitativo utilizando un diseño fenomenológico con entrevistas a profundidad a doce personas directamente involucradas en el campo de la salud mental, ya sea por sus experiencias vividas desde su padecimiento psiquiátrico mayor, su práctica y experiencia profesional en clínica o su participación en la definición de políticas públicas en salud mental. Estas personas fueron seleccionadas deliberadamente para obtener el mayor rango de posiciones. Los resultados de las entrevistas se complementaron y contrastaron con las respuestas a un cuestionario corto en línea sobre prioridades percibidas en Salud Mental, el documento de la Política Nacional de Salud Mental 2012-20 y mis reflexiones críticas.
Se encontró que el modelo explicativo mayoritario fue el de la genetización ilustrada en que las explicaciones genéticas son balanceadas, sin posiciones extremas de determinismo, esencialismo o fatalismo genético. También se determinó que este modelo tiene repercusiones positivas para las personas padecientes por la reducción en la percepción de culpa y que mejoraría posiblemente con el acceso a un buen servicio de consejo genético para condiciones de herencia compleja. Con excepción de algunos clínicos a nivel privado, no se encontró que las prácticas estuvieran permeadas con el uso de pruebas genéticas. Tampoco se encontró que las políticas públicas estén permeadas por tendencias genómicas. Otros hallazgos ancilares fueron: una pobre atención a nivel público a las personas que no tienen acceso a servicios privados; maltrato y violencia por las mismas instituciones que están para cuidar, aliviar y curar; ausencia de políticas sociales dirigidas a grupos que por su situación socioeconómica están más predispuestos a la enfermedad; y
que las voces de las personas padecientes no han sido ni son escuchadas. Estos hallazgos se enmarcaron en la teoría del sufrimiento social que permite agrupar, interpretar y reflexionar sobre los malestares y problemas humanos, individuales y colectivos, que se expresaron en las narraciones de las personas entrevistadas.
... Medication must follow a specific procedure when making treatment decisions, such as whether or not to admit patients to the hospital. Procedures in hospitals, particularly those run by the government, can be drawn out not only due to bureaucratic incompetence or service provider's refusal to provide prompt service but also due to an excessive patient flow (50,51). However, based on my observations in both hospitals, I can assert that doctors check many patients daily, always putting them in a hurry. ...
Introduction: Violence is not an inherent byproduct of human relationships, but conflicts are. The factors and circumstances that lead to tension and conflicts between health seekers and Nepali medical establishments and staff members who work there are examined in this article. Development: Embedded with relevant literature review, through the analysis of qualitative information, this part of the article is developed into four different sections. The first part deals with the context of the medical consultations that result in the development of a problematic relationship. This is followed by the examination of different types of violence, confrontations, and protests that emerge through such relationships. The implications of swelling medical promises and consequent heightened expectations are analyzed in the third part whereas the fourth part highlights how the typical medical practices that exist in Nepali hospitals itself is increasing the possibility of confrontations and violence. Conclusions: The frequent occurrence of tussles and medical violence in both public and private hospitals in Nepal suggests that they can happen in any hospital, irrespective of ownership. There is always a communication gap between the service providers and the patient party because of the esoteric nature of medicine. Conflict and violence towards service providers can also thrive in the context of a differential explanatory model of the two sides. The mounting animosity also signals a decline in trust between healthcare providers and seekers in Nepal.
... Talking basabasa (in a confused, disorderly and meaningless way), walking aimlessly, sleeplessness and aggressive and destructive behaviour were the paradigmatic symptoms of madness in Ghana.(p.51) The very visible/audible symptoms are divorced from the not so obvious lived experience of Alice's suffering, and Kleinman (1995) has perceptively written about such transformations of experience: ...
This is an essay on the ramifications of being vulnerable, dependent, and animal, in a world of pain and suffering, sickness and healing, that looks at the futures of community, conviviality, caring, moral imagination, and hope.
... We drew on the shifting cultural lenses (SCL) model of cultural competence (Lakes et al., 2006;Lopez, 1997;López et al., 2020;Santos et al., 2021) to center the training around dynamic identities grounded in clients' social worlds. The SCL model's definition of culture is based on Kleinman's (1995) concept of experience. Kleinman and Kleinman (1991) argued that experience is the "felt flow of the intersubjective medium" or nexus of "cultural categories and social structures interacting with psychophysiological processes" (p. ...
Realizamos un estudio cualitativo como evaluación inicial de los psicoterapeutas en capacitación en el modelo Lentes Culturales Cambiantes (SCL, por sus siglas en inglés). El modelo SCL se enfoca en una concepción dinámica de la cultura basada en los mundos sociales locales de los clientes, en vez de grupos étnicos/racialesespecíficos. Nuestros tres objetivos principales de la investigación fueron: (a) documentar las concepciones y consideraciones culturales de los terapeutas en las sesiones de tratamiento iniciales, (b) evaluar si se podían observar cambios en las concepciones y consideraciones culturales de los terapeutas después de la capacitación, y (c) evaluar la aceptabilidad y viabilidad de la capacitación. Aplicamos un diseño de un solo grupo y un estudio de casos múltiples con tres terapeutas latinos con nivel de maestría procedentes del sur de California. Cada terapeuta trató a dos clientes latinos, uno antes y otro después de la capacitación. Los resultados se obtuvieron a partir del comportamiento observado (grabado en audio o video) en sesión durante las dos primeras sesiones de terapia y durante las entrevistas semiestructuradas después de las sesiones. Encontramos que las concepciones de cultura de los terapeutas variaban desde aquellas vinculadas a la etnia latina de sus clientes hasta nociones de cultura más fundamentadas socialmente. En cuanto a las consideraciones culturales, todos los terapeutas identificaron factores significativos en los mundos sociales y morales locales de sus clientes, pero hubo variabilidad en la aplicación de esas concepciones para avanzar e los objetivos del tratamiento. Lo más importante es que observamos cambios en las concepciones y consideraciones culturales de dos de los tres terapeutas después de la capacitación. Se encontró que la capacitación fue altamente aceptable pero planteó dificultades en cuanto a su viabilidad. En general, capacitar a profesionales de la comunidad en el modelo SCL es prometedor para fortalecer la competencia cultural de los terapeutas al trabajar con clientes latinos.
... Mol, Moser and Pols (2010: 14) define care as 'persistent tinkering in a world full of complex ambivalence' and encourage us to investigate the mundane practices of care that people carry out in their everyday lives. The initial interest in care as an inherently moral act and practice (Kleinman 2009;Livingston 2012) represented a shift away from anthropology's preoccupation with suffering to a new anthropology of the good (Robbins 2013). But anthropologists have also highlighted various ways in which care can be ambivalent or violent (Biehl 2012;Garcia 2015;Gupta 2012;Han 2012;Ticktin 2011). ...
The public healthcare system in rural India is chronically under-resourced. It embodies and often perpetuates the wider politics of the Indian state towards its rural communities with provisions of care that are deeply entangled with violence and disgust. For rural women, such care deepens reproductive chronicity while providing temporary relief. Grounded in women’s everyday realities and experiences in sterilization camps and other healthcare settings in rural Rajasthan, State Intimacies examines the mundane workings, ambiguities and fragilities of care in post-colonial rural North India.
... While allopathy would later be supplanted by an efficacy-based biomedical model, its principles structured what Foucault (2002) terms the "clinical gaze" of 19th-century U.S. medical practice, objectifying the body as target for remedies and cures. These principles continue to undergird evidencebased research in medicine (Kleinman, 1995), and have come to predominate in educational research and pedagogical practice today (Baker, 2012). ...
This article examines the possibilities and limits of strategies directed toward racialized healing amidst declarations of pandemics and legislative attacks on public school teachers. We question what these strategies take as a self-evident truth: that race and racism can be conceptualized in terms of health and transparently addressed through research and practice focused on racialized healing. To complicate this assertion, we locate the strategies within a race-health nexus, a form of biopower. This nexus establishes norms, categories, and classifications that justify ranking and comparing, dividing and differentially intervening on some in the name of the health and wellbeing of all. We historicize how this nexus became integral to schooling in the United States in the 19th century, normalizing populations according to civilizational values that doubled as health standards. We argue that this nexus makes possible biopolitical strategies of “tailoring treatments” and “cultivating potential” that continue to undergird health and healing strategies in educational research and pedagogical practice today, thereby reconfiguring, rather than overturning, hierarchies of human difference. The analysis demonstrates that racialized healing strategies provide no ontological guarantee for reducing racialized harm. Instead, such efforts must be reflexively situated within the interplay of biology, coloniality, and education that makes “healing” seem necessary and urgent in the first place.
As an alternative to the “standard mode” of clinical ethics, with its typical emphasis on formal ethical reasoning (often including ethical principles) and other forms of “top-down” analysis, we suggest that clinical ethics is better understood in terms of socio-institutional processes. It is just such processes that are at work in Stanley Fish’s interpretive communities, that engage students as they begin their professional education, and that frame how trainees and clinicians feel and think about the ethical challenges and problems that they encounter in their work. We also look at how these socio-institutional processes are interconnected with the systemic, human, and social elements of institutional culture in professional schools and hospitals.
By the time students enter professional school in health care, they have developed their own distinctive ways of thinking, feeling, acting, and communicating and interacting with others. They have also had long previous experience with roles and role-playing that helps set the stage for their understanding of what is required in their future roles as doctor, nurse, clinical psychologist, or social worker. These assets need to be respected and built upon to yield the clinical understanding and skills for addressing the myriad challenges and problems that arise in daily clinical practice, including those with an ethical component.
Each field’s intellectual and behavioral standards, including its ethical standards, come to be embodied, over time, in each trainee through the process of professional education and clinical training. This chapter examines the social processes by which newcomers, initially outsiders, become part of a professional community. What we see is that the processes of learning and progressive mastery are relational, social, and interactive. Trainees and clinicians, in coming to master this professional milieu, are inescapably also coming to master the moral milieu—the ethical values, standards, and goals—embedded in clinical health care. They become “embedded practitioners whose standards of judgment, canons of evidence, or normative measures are extensions of the community itself.”
Resumo Este artigo apresenta uma perspectiva da saúde mental a partir do estudo dos efeitos dos conflitos pela terra e da organização comunitária na aldeia Tupinambá da Serra do Padeiro, no sul da Bahia. A luta pela terra com a retomada do território destaca-se enquanto força produtora de saúde, com potência de suplantar as agruras vividas em um contexto de ameaças, violências e traumas. Para isso, diferentes saberes, práticas e atores, indígenas e não indígenas, são continuamente articulados. Os modos de organização da comunidade se inserem como elemento-chave para prevenção e recuperação da saúde mental, evitando agravos nos conflitos territoriais e promovendo condições para reabilitação e inserção social. A espiritualidade, o trabalho, a cultura, a coletividade e o diálogo interétnico são aspectos centrais de proteção e promoção da saúde mental.
Introducción: En el trasplante renal de donante vivo, la percepción de la situación de enfermedad y la vivencia personal influyen de forma significativa en la adaptación emocional y el afrontamiento de la persona.Objetivo: Conocer el significado que atribuyen las personas con trasplante renal de donante vivo a su enfermedad y a su tratamiento, y detectar si existen cambios antes y después trasplante.Material y Método: Estudio cualitativo fenomenológico. Participaron 7 personas con enfermedad renal que recibieron un trasplante renal de donante vivo preventivo. Se obtuvieron los datos mediante entrevistas semiestructuradas y observación cualitativa.Resultados: Del análisis temático de las entrevistas emergieron tres temas: sin sentimiento de enfermedad (no se sentían enfermos ni a nivel físico ni psicológico); sin necesidad de trasplantarse (la enfermedad no les alteró su vida, pero confiaron en los profesionales y aceptaron la cirugía); y trasplantarse para mantener el mismo modo de vida (para evitar la diálisis y recuperar actividades).Conclusiones: El significado de la enfermedad y del trasplante renal cambian según la etapa (pre o post trasplante) en la que esté el paciente: la identificación de la enfermedad está relacionada con la presencia de sintomatología, con la sintomatología física y con las rutinas de toma de medicación diarias y visitas de seguimiento; y el trasplante renal, significa evitar la diálisis, hacer la misma vida, superar un reto y recuperar la condición física.
Child soldiers have been heavily involved in contemporary African warfare. Since the 1990s, the “child soldier crisis” has become a major humanitarian and human rights project. The figure of the child soldier has often been taken as evidence of the “barbarism,” dehumanization, and trauma generated by modern warfare, but such images can obscure the complex reality of children’s experiences of being part of armed groups during conflict. This chapter uses the published memoirs of former child soldiers from Sierra Leone, Sudan, Uganda, Eritrea, and the Democratic Republic of the Congo to explore the instrumental and discursive nexus between child soldiers, memory, violence and humanitarianism. It assesses how (former) children combatants remember and recount their experiences of war, and how these narratives can be shaped by humanitarian, literary and/or therapeutic framings. The chapter argues that these memoirs’ significance lies in their affective truths and what they reveal about children’s experience, and narrations, of war. Former child soldiers engage with, but also challenge, dominant contemporary humanitarian discourses surrounding childhood and violence to develop a “victim, savage, saviour, campaigner” framework for their narratives. The chapter historically contextualizes the emergence of the “child soldier memoir,” before analysing the narratives of recruitment, indoctrination, and violence recounted by these former child soldiers, and their attempts to rework their identities in a post-conflict environment. It explores how former child soldiers narrate suffering and deploy discourses of trauma in their memoirs: some seeking to process wartime traumas, others leveraging their own suffering to position themselves as campaigners for those children still caught in conflict.
בעוד שרק בשנים האחרונות ממשלות וארגונים ברחבי העולם החלו להכיר בנפגעי טרור כבעיה חברתית מובחנת הראויה לטיפול ציבורי, בישראל התמסדה קטגוריית נפגעים אזרחיים מאלימות פוליטית ששורשיה כבר בשנות ה-50'. על אף התפתחותה של ספרות מחקרית ענפה העוסקת במנגנוני הפיצוי והצרכים של נפגעי הטרור בעולם בשנים האחרונות, מעט מאוד נכתב על השורשים החברתיים, המשמעויות וההצדקות של קטגוריה מוסרית זו. מאמר זה מבקש לתרום לידע המחקרי על ההבניה החברתית של נפגעי הטרור באמצעות בחינה גנאלוגית של קטגוריית "נפגעי פעולות האיבה" בישראל, תוך הדגשת ההקשרים ההיסטוריים והתרבותיים שבתוכם הקטגוריה נוצרה והתפתחה.
תוך הישענות על הסוציולוגיה של בעיות חברתיות וקריאה ביקורתית של מחקרים במסורת "הפוליטיקה של הקרבניות", המאמר מציע הרחבה תיאורטית של דמות הקרבן העולה מן הספרות. באמצעות ניתוח תהליכי החקיקה בכנסת למען הנפגעים, המאמר מציג שלוש דמויות קרבן אנליטיות המשקפות את הדמיון הציבורי בישראל אודות נפגעי טרור ומהוות תסריטים תרבותיים מובחנים להבנת הסטטוס של הנפגעים. בנוסף, המאמר ממקם כל אחד מההגיונות עליהם נשען כל תסריט בהקשרים חברתיים שונים, זאת באמצעות ניתוח ומיפוי ההצדקות שמעניקים הנפגעים עצמם לתמיכה הממשלתית בהם. שלושת ההגיונות הקרבניים, שעוצבו על ידי השיח האתנו-לאומי, שיח זכויות האדם והשיח הסוציאלי, מהווים את מה שאני מכנה "קרבניות רב ממדית" - קטגוריה ממוסדת של קורבנות המוצדקת באמצעים שונים ומכילה ערכים מרובים ואף סותרים. אציע לבסוף כי המקרה הישראלי של נפגעי פעולות האיבה משקף את העימות הפרשני והמוסרי העמוק בחברה רב תרבותית המתמודדת עם אלימות פוליטית.
No Brasil, a assistência em tempo oportuno aos indivíduos convivendo com Doença de Chagas ainda é um desafio à saúde pública. Objetivou-se analisar o itinerário terapêutico de crianças e adolescentes portadores de Doença de Chagas na busca de atenção e cuidado com a saúde. Adotada a abordagem qualitativa, descritiva, exploratória. Pesquisa de campo realizada com familiares de crianças/adolescentes convivendo com Doença de Chagas no Centro de Referência em Doenças Tropicais (CRDT) em Macapá, AP. Análise de conteúdo subsidiou a identificação de três categorias analíticas: o diagnóstico como desafio inicial do itinerário terapêutico; o Itinerário em busca do tratamento e controle da doença; fragilidades e potencialidades dos serviços de atenção à saúde. Os resultados apontaram que a oferta dos serviços voltados para o diagnóstico da doença ainda está centrada na atenção especializada. Portanto, o itinerário terapêutico de crianças e adolescentes portadores de Doença de Chagas em busca do tratamento e controle da doença é marcado por desafios que envolvem o diagnóstico em tempo oportuno, o que pode repercutir em tratamentos equivocados. A principal fragilidade identificada estava relacionada aos serviços de saúde, pois a atenção primária não está preparada para a identificação da doença, tão pouco a média e alta complexidade estão qualificadas para uma assistência resolutiva. Quanto às potencialidades, estão relacionadas ao sistema de cuidado e atenção à saúde.
"Travma" kavramı, insan zayıflığının "medikalize" edilmesini önerirken bugün büyük ölçüde onun yerini almış görünen "Esneklik" (resilience) kavramı, insanların zorluklarla baş etme kabiliyetini Neoliberal politikalar adına takdir etmektedir. Her ikisinin de söz konusu zorlukların sosyoekonomik ve sınıfsal arka planını gözden uzak tutması anlamlıdır.
[While the "trauma" suggests medicalizing human frailty, the "resilience" which today seems to have largely replaced it, appreciates human's ability to cope with difficulties for the sake of Neoliberal policies. It is significant that both concepts ignore the socioeconomic and class background of difficulties concerned.]
Para produzir esta etnografia, busquei compreender narrativas e experiências em contexto de dor e sofrimento de mulheres pescadoras e ribeirinhas vítimas de escalpelamento nas regiões de rios da Amazônia. O escalpelamento é um termo do campo biomédico que se refere ao arrancamento do couro cabeludo. No contexto em que investiguei, o “acidente” ocorre através do enrolamento dos cabelos das mulheres no eixo dos motores de pequenas embarcações confeccionadas por mestres carpinteiros. As mulheres vitimadas por esse “acidente”, que frequentemente ocorre quando elas são crianças ou adolescentes, têm suas vidas alteradas drasticamente: são privadas do meio social, abandonam os estudos os cônjuges e até mesmo a família. A vida laboral também sofre enormes efeitos, já que a pesca se torna impraticável devido às dores de cabeça e às altas temperaturas da Região Norte, que agravam as condições de saúde das vítimas. As trajetórias dessas mulheres são marcadas por itinerários terapêuticos, incluindo cirurgias plásticas, enxertos e inserção de próteses, como orelhas (que também são frequentemente afetadas), além do uso de perucas, uma vez que o escalpelamento impossibilita o crescimento natural dos cabelos. Desse modo, observou-se que as mulheres vitimadas buscam, através desses meios, reconstruírem seus corpos e se tornarem o que chamam de “mulheres de verdade”. No presente trabalho, pretendo refletir sobre essas questões na interseção entre corpo, saúde e emoções, sob a perspectiva da antropologia social.
Drawing on interviews with Jewish Orthodox psychotherapists in Israel and on sources that represent the social, political, and cultural milieu within which these therapists work, we analyze the practices they use when working with religious gay men. Given debates and prohibitions on homosexuality in Jewish law, the therapists deploy three practices: reproducing religious norms, allowing homosexuality to be privately acknowledged while advocating its concealment from the public eye, or adopting religious distinctions that enable two men to live together while abstaining from sexual intercourse. These interventions express therapists’ pragmatic cultural work, sorting out opposing therapeutic discourses, like the liberal-professional and the religious, and engaging with contestations beyond the clinic’s boundaries. Some interventions may suggest an acknowledgment that religious standards are often met only on the surface and require continual subterfuge. They may imply, however, a recognition of cracks in the religious ideal and fine-tuning of religious and professional commitments.
Numerose ambivalenze, conflitti interpretativi e problemi di traduzione culturale sorgono quando si usa il concetto di care. Per l’antropologia medica, esso ha offerto la possibilità di criticare forme di riduzionismo bio-medico della cura. Allo sviluppo di
questa visione morale ha contribuito l’aumento di malattie croniche per cui non esiste “cura”, nel senso di guarigione – cure. Allo stesso tempo, il lavoro di cura informale ha assunto un’importanza strategica nello scenario di ristrutturazione dei servizi pubblici di assistenza. In questo senso, la visione morale del “prendersi cura” è stata accusata di distogliere l’attenzione dalle forme di diseguaglianza sociale che si riproducono nell’ambiente domestico e familiare attraverso la cura stessa.
Attraverso il racconto etnografico di un convegno di antropologia medica a Edimburgo e un’ulteriore riflessione su una ricerca fra un servizio territoriale di assistenza ad anziani e caregiver in Emilia-Romagna, questo articolo offre alcune indicazioni analitiche sull’antropologia del prendersi cura. Sostengo che la distinzione fra “cura” e “prendersi cura” non rispecchi fino in fondo ciò che c’è davvero in gioco nelle pratiche di assistenza.
Per superare le ambivalenze che derivano dallo stesso linguaggio morale che adotta,
è necessario che l’antropologia del prendersi cura sposti l’attenzione sui modi in cui è classificata la relazione fra l’accudimento nella sfera domestica e il sistema istituzionale dei servizi di assistenza. Altrimenti, il rischio è quello di perdere di vista la questione di come, in quali circostanze e con quale sostegno pubblico, vengono assegnate le responsabilità di assistenza.
La psiquiatría y la antropología tienen una larga relación, de tal suerte que merece la pena examinar aspectos de cómo esa relación se traslada al campo en desarrollo de la Salud Mental Global (SMG). Un espacio en el que las dos disciplinas se solapan significativamente es en el tratamiento de los fenómenos religiosos y los rituales en relación a la salud mental, y uno de los mayores desafíos de la SMG es cómo tomar en consideración, de manera productiva, las formas de sanación indígena basadas en la religión y el ritual. En este artículo comparo textos recientes sobre SMG escritos desde el punto de vista de la psiquiatría y la antropología, observando que los textos psiquiátricos hacen hincapié en la determinación basada en la evidencia de la eficacia de los tratamientos, mientras que los textos antropológicos enfatizan una comprensión etnográfica de la experiencia del tratamiento. Conciliar estos dos énfasis constituye un desafío para el campo, atendiendo a las variaciones contextuales en los eventos de tratamiento, episodios de enfermedad, factores fenomenológicos tanto endógenos como intersubjetivos y factores sociopolíticos tanto interpersonales como estructurales. Al abordar este desafío, propongo una aproximación al proceso terapéutico que, a nivel empírico, pueda facilitar la comparación entre la diversidad de formas de curación y que, a nivel conceptual, pueda constituir un puente entre la eficacia y la experiencia. Esta aproximación se fundamenta en un modelo retórico del proceso terapéutico que incluye componentes de disposición, la experiencia de lo sagrado, la elaboración de alternativas y la materialización del cambio, que destacan la especificidad experiencial y el cambio gradual. Desplegar este modelo puede ayudar a afrontar el desafío de comprender la eficacia y la experiencia en la sanación indígena, y preparar el terreno para el reto posterior de cómo los profesionales de la SMG se relacionan e interactúan con tales formas de curación.
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