Tainted Blood and Vengeful Spirits: The Legacy of Japan’s Yakugai Eizu (AIDS) Trial

Medical anthropologists often point to the importance of “illness narratives” as emergent or incipient forms in which patients attempt to make sense of the moral dimensions of illness and suffering (Kleinman 1988; Mattingly 1998). In this article I draw upon published accounts, newspapers, and legal documents, supplemented by ethnographic interviews carried out from 1999 to 2001, to show how plaintiffs in the yakugai AIDS trials brought by HIV-infected hemophiliacs against the Japanese government and the pharmaceutical industries that sold them tainted blood products appropriated powerful cultural themes in producing narrative accounts of their suffering. These narratives resonate with themes of lost trust, filial piety, and the desire for a “good death.” In contrast, I show how the neat and tidy narrative that emerged in the course of the yakugai AIDS trial served to impose meaning upon the plaintiffs’ unruly experiences such that, when it was over, the Japanese public was convinced that the “AIDS problem” had been “solved.”     

THE WORLD WAR II PLUTONIUM EXPERIMENTS: CONTESTED STORIES AND THEIR LESSONS FOR MEDICAL RESEARCH AND INFORMED CONSENT

During the Second World War medical researchers around the USAinjected 18 hospital patients with radioactive plutonium in orderto learn its effects on the body. Two documents, a newspaperaccount and a university committee report, tell divergent storiesof the scientists and patients involved in that experiment. Thisarticle uses those documents – plutonium narratives– as a catalyst for exploring the problematicrepresentation of past human experimentation, assumptions of moralprogress in medical research, and the nature of informed consenttoday. Informed consent is shown to be an evolving process anddiscursive practice that cannot be understood apart from itshistorical and cultural embeddedness.     

The Mental Representation of Social Connections: Generalizability Extended to Beijing Adults

Social connections are essential for the survival of a social species like humans. People differ in the degree to which they are sensitive to perceived deficits in their social connections, but evidence suggests that they nevertheless construe the nature of their social connections similarly. This construal can be thought of as a mental representation of a multi-faceted social experience. A three-dimensional mental representation has been identified with the UCLA Loneliness Scale and consists of Intimate, Relational, and Collective Connectedness reflecting beliefs about one''s individual, dyadic, and collective (group) social value, respectively. Moreover, this mental representation has been replicated with other scales and validated across age, gender, and racial/ethnic lines in U.S. samples. The purpose of this study is to evaluate the extent to which this three-dimensional representation applies to people whose social lives are experienced in a collectivistic rather than individualistic culture. To that end, we used confirmatory factor analyses to assess the fit of the three-dimensional mental structure to data collected from Chinese people living in China. Two hundred sixty-seven young adults (16–25 yrs) and 250 older adults (50–65 yrs) in Beijing completed the revised UCLA Loneliness Scale and demographic and social activity questionnaires. Results revealed adequate fit of the structure to data from young and older Chinese adults. Moreover, the structure exhibited equivalent fit in young and older Chinese adults despite changes in the Chinese culture that exposed these two generations to different cultural experiences. Social activity variables that discriminated among the three dimensions in the Chinese samples corresponded well with variables that discriminated among the three dimensions in the U.S.-based samples, indicating cultural commonalities in the factors predicting dimensions of people''s representations of their social connections. Equivalence of the three-dimensional structure is relevant for an understanding of cultural differences in the sources of loneliness and social connectedness.     

Growing into My White Coat: Improving the Patient-Provider Relationship Through Diverse Patient Interviews

The “Patient Diversity” assignment is an integral component for all medical and other health care professional students rotating through the Surgery clerkship at the Yale School of Medicine. Students are instructed to interview a surgical patient who is of a varied social or cultural background to identify how psychosocial factors impact patient coping strategies. In the process, students often appreciate how health care providers’ own social and cultural backgrounds similarly shape their sentiments and reactions in patient care. In this interview with a 26-year-old surgical patient, one student strives to come to terms with her personal insecurities in patient interactions and seeks to overcome them through open conversation and honest introspection. By working to acknowledge and understand patient diversity, health care providers can enhance understanding of their patients’ conditions and form more trustful and empathic relationships with both their patients and colleagues.     

Acknowledging Individual Responsibility while Emphasizing Social Determinants in Narratives to Promote Obesity-Reducing Public Policy: A Randomized Experiment

This study tests whether policy narratives designed to increase support for obesity-reducing public policies should explicitly acknowledge individual responsibility while emphasizing social, physical, and economic (social) determinants of obesity. We use a web-based, randomized experiment with a nationally representative sample of American adults (n = 718) to test hypotheses derived from theory and research on narrative persuasion. Respondents exposed to narratives that acknowledged individual responsibility while emphasizing obesity’s social determinants were less likely to engage in counterargument and felt more empathy for the story’s main character than those exposed to a message that did not acknowledge individual responsibility. Counterarguing and affective empathy fully mediated the relationship between message condition and support for policies to reduce rates of obesity. Failure to acknowledge individual responsibility in narratives emphasizing social determinants of obesity may undermine the persuasiveness of policy narratives. Omitting information about individual responsibility, a strongly-held American value, invites the public to engage in counterargument about the narratives and reduces feelings of empathy for a character that experiences the challenges and benefits of social determinants of obesity.     

Culture and Disability Behavior

A substantial amount of literature suggests that illness behavior in the United States is a product of a patient''s core culture; equally credible findings do not support this contention. Most students and graduates in the health care professions believe that illness and disability behavior are affected by a patient''s culture, but they are hard put to find convincing examples of that relationship. In experience with medical students studying the social and cultural bases of illness behavior, with patients who are disabled and with persons who claim disability in the absence of physical disease or disabling psychopathology, I observed no deviant disability behavior that was typical for the members of any cultural group, and no behavior was displayed by the members of one cultural group that was not seen in members of other cultural groups. No cultural stereotypes were upheld. I did find evidence that disability behavior is influenced by personality factors, social situations and the gains derived from the disability status. Evolving concepts of “entitlement,” which are closely related to socioeconomic status, also have a significant influence. The impact of feedback from others in a person''s many social and medical subcultures is a more crucial determinant of illness and disability behavior, except in those for whom illness and disability behavior is determined by the limitations imposed by the disease or by a personality structure resistant to cultural expectations and social feedback.     

Traumatic Amputation: A Case of Laotian Indignation and Injustice

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation (“Kwam khem keuang”) as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient’s perspective offers a reflexive stance on the clinician–patient interaction that allows for better patient care.     

The baladi curative system of Cairo,Egypt

The article explores the symbolic structure of the baladi (traditional) cultural system as revealed in everyday narratives, with a focus on baladi curative action. The everyday illness narrative provides a cultural window to the principles of fluidity and restorative balance of baladi curative practices.The body is seen as a dynamic organism through which both foreign objects and physiological entities can move. The body should be in balance, as with any humorally-influenced system, and so baladi cures aim to restore normal balance and functioning of the body.The article examines in detail a narrative on treatment of a sick child, and another on treatment of fertility problems. It traces such cultural oppositions as insider : outsider; authentic: inauthentic; home remedy: cosmopolitan medicine. In the social as well as the medical arena these themes organize social/medical judgements about correct action and explanations of events.     

How Possibly Do Leisure and Social Activities Impact Mental Health of Middle-Aged Adults in Japan?: An Evidence from a National Longitudinal Survey

Objectives

This study aimed to investigate longitudinal relations between leisure and social activities and mental health status, considering the presence or absence of other persons in the activity as an additional variable, among middle-aged adults in Japan. This study used nationally representative data in Japan with a five-year follow-up period.

Methods

This study focused on 16,642 middle-aged adults, age 50–59 at baseline, from a population-based, six-year panel survey conducted by the Japanese Ministry of Health, Labour and Welfare. To investigate the relations between two leisure activities (‘hobbies or cultural activities’ and ‘exercise or sports’) and four social activities (‘community events’, ‘support for children’, ‘support for elderly individuals’ and ‘other social activities’) at baseline and mental health status at follow-up, multiple logistic regression analysis was used. We also used multiple logistic regression analysis to investigate the association between ways of participating in these activities (‘by oneself’, ‘with others’, or ‘both’ (both ‘by oneself’ and ‘with others’)) at baseline and mental health status at follow-up.

Results

Involvement in both leisure activity categories, but not in social activities, was significantly and positively related to mental health status in both men and women.Furthermore, in men, both ‘hobbies or cultural activities’ and ‘exercise or sports’ were significantly related to mental health status only when conducted ‘with others’. In women, the effects of ‘hobbies or cultural activities’ on mental health status were no differences regardless of the ways of participating, while the result of ‘exercise or sports’ was same as that in men.

Conclusions

Leisure activities appear to benefit mental health status among this age group, whereas specific social activities do not. Moreover, participation in leisure activities would be effective especially if others are present. These findings should be useful for preventing the deterioration of mental health status in middle-aged adults in Japan.     

The Association between Cultural Orientation and Drinking Behaviors among University Students in Wuhan,China

Objectives

This study examines the association between cultural orientation and drinking behaviors among university students. Cultural orientation is the measure of how the cultural values of individuals living in their own society are influenced by cultural values introduced from the outside.

Methods

In 2011, a cross-sectional survey collected data from 1279 university students from six universities in central China. Participants used a likert scale to rank a series of statements reflecting cultural values from the previously validated Chinese Cultural Orientation Scale and answered questions about their drinking behaviors and socio-demographic characteristics.

Results

Statistically significant differences in cultural orientation were observed for gender, hometown and type of university attendance. Traditional-oriented students were more likely to be occasional drinkers or nondrinkers, while marginal-oriented students, bicultural-oriented students and western-oriented students were more likely to be regular drinkers. Bicultural orientation (OR = 1.80, P<0.05) and marginal orientation (OR = 1.64, P<0.05) increased the likelihood of the student being regular drinking, compared to students with traditional orientations. Males (OR = 4.40, P<0.05) had a higher likelihood of regular drinking than females, graduate students (OR = 2.59, P<0.05) had a higher likelihood of regular drinking than undergraduates, students from urban areas (OR = 1.79, P<0.05) had a higher likelihood of regular drinking than those from towns/rural areas, and students attending key universities (OR = 0.48, P<0.05) had a lower likelihood of regular drinking than those attending general universities.

Conclusions

Cultural orientation influences drinking behaviors. Traditional cultural orientation was associated with less drinking while western cultural orientation, marginal cultural orientation and bicultural orientation were associated with more drinking. The role of gender, hometown and university attendance is partially moderated through the influence of cultural orientation. The relationship between a traditional cultural orientation and alcohol drinking suggests that traditional Chinese cultural values should be examined for their role in possibly reducing alcohol-related risks through education and policy initiatives.     

Uncomprising activist: Richard Greener,first black graduate of Harvard College

This article investigates what narrations on the symbolic complex of virginity in the life-stories of second-generation women of Moroccan descent in The Netherlands can tell us about the ways these women construct, maintain and combine their various social identifications. It is demonstrated that these biographical narratives contain numerous episodes in which the women improvise upon and shift the meanings of Moroccan core-values like virginity and obedience to one's parents. It is argued that they do so in ways that allow their identifying with values that are cherished within Moroccan circles to be combined with upholding cultural notions that are highly valued by Dutch peers with whom they also identify. It is also pointed out, however, that their drawing upon multicultural capital to create new strategies of living is not without constraints.     

Prevalence of Mental Distress and Associated Factors among Undergraduate Students of University of Gondar,Northwest Ethiopia: A Cross-Sectional Institutional Based Study

Background

Mental health problems affect society as a whole and no group is immune to mental disorders; however, students have significantly high level of mental distress than their community peers.

Objectives

The purpose of this study was to assess the prevalence and associated factors of mental distress among undergraduate students of University of Gondar, Northwest Ethiopia.

Methods

Institution based cross sectional study was conducted among 836 students from April 9–11/2014. Stratified multistage sampling technique was used to select the study participants. Data were collected using pretested and structured self-administered questionnaire. Bivariate and multivariate logistic regression model was fitted to identify factors associated with mental distress among students. An adjusted odds ratio with 95% confidence interval was computed to determine the level of significance.

Results

Prevalence of mental distress among students was found to be 40.9%. Female sex (AOR = 1.65; 95% CI 1.17–2.30), lack of interest towards their field of study (AOR = 2.28; 95% CI 1.49–3.50), not having close friends (AOR = 1.48; 95% CI 1.03–2.14), never attend religious programs (AOR = 1.58; 95% CI 1.02–2.46), conflict with friends (AOR = 1.93; 95% CI 1.41–2.65), having financial distress (AOR1.49 = 95% CI 1.05, 2.10), family history of mental illness (AOR = 2.12; 95% CI 1.31–3.45), Ever use of Khat (AOR = 1.71; 95% CI 1.12–2.59), lower grade than anticipated(AOR = 2.07; 95% CI 1.51–2.83), lack of vacation or break (AOR = 1.46; 95% CI 1.06–2.02), and low social support(AOR = 2.58; 95% CI 1.58–4.22) were significantly associated with mental distress.

Conclusion

The overall prevalence of mental distress among students was found to be high. Therefore, it is recommended that mental distress needs due attention and remedial action from policy makers, college officials, non-governmental organizations, parents, students and other concerned bodies.     

Schizophrenia,Narrative and Change: Andalusian Care Homes as Novel Sociocultural Context

This study explores qualitative changes in the life narratives of persons diagnosed with paranoid schizophrenia who were receiving recovery treatment in special care homes in Andalusia, Spain. These narratives are related to patients’ construction of social identity and the recovery process. Initially, 10 narrative interviews were performed. The first five patients (Group 1) had lived at the homes for only 3 months, while the other five (Group 2) had been there for 61.4 months. Two years after the initial interviews, three patients from Group 1 were interviewed once more. The qualitative analysis focuses on two topics: experience of illness and personal relationships. Long-stay patients create their identities by using more categories related to relationships and make fewer references to illness than Group 1 subjects. They also make fewer delusive or hallucinatory utterances, and their narratives have more elements that can be shared in the community than Group 1 narratives. Moreover, long-stay patients show significant language resources and greater capacity for agency. Results suggest that special care homes provide important emotional support and a rich, new network. These results are related to the sociocultural characteristics of special care homes and suggest that the analysis of life narratives could be a very useful instrument for assessing the recovery process.

Interrelation of Sport Participation,Physical Activity,Social Capital and Mental Health in Disadvantaged Communities: A SEM-Analysis

Background

The Health through Sport conceptual model links sport participation with physical, social and psychological outcomes and stresses the need for more understanding between these outcomes. The present study aims to uncover how sport participation, physical activity, social capital and mental health are interrelated by examining these outcomes in one model.

Methods

A cross-sectional survey was conducted in nine disadvantaged communities in Antwerp (Belgium). Two hundred adults (aged 18–56) per community were randomly selected and visited at home to fill out a questionnaire on socio-demographics, sport participation, physical activity, social capital and mental health. A sample of 414 adults participated in the study.

Results

Structural Equation Modeling analysis showed that sport participation (β = .095) and not total physical activity (β = .027) was associated with better mental health. No association was found between sport participation and community social capital (β = .009) or individual social capital (β = .045). Furthermore, only community social capital was linked with physical activity (β = .114), individual social capital was not (β = -.013). In contrast, only individual social capital was directly associated with mental health (β = .152), community social capital was not (β = .070).

Conclusion

This study emphasizes the importance of sport participation and individual social capital to improve mental health in disadvantaged communities. It further gives a unique insight into the functionalities of how sport participation, physical activity, social capital and mental health are interrelated. Implications for policy are that cross-sector initiatives between the sport, social and health sector need to be supported as their outcomes are directly linked to one another.     

“Frame That Rug!”: Narratives of Zapotec Textiles as Art and Ethnic Commodity in the Global Marketplace

This article explores representations of Mexican Zapotec textiles as texts and as sites of contested values and meanings. Discussion of this indigenous cottage industry begins in the Oaxacan village of Teotitlán del Valle, the site of production, and follows the textile as it moves across social and cultural borders as a commodity in postindustrial consumer culture. The anthropologist's mediating role in brokering Zapotec textiles is considered within the social context of exchange relations between buyer and seller. Ethnographic stories about the production and aesthetics of Zapotec textiles are contrasted with consumers’ self-fashioning narratives of embodied experiences associated with their hand-woven possessions. The article concludes with reflections on the narrative threads of text that comprise a Zapotec textile's intrinsic value as both art and craft.     

Using Fiction to Assess Mental State Understanding: A New Task for Assessing Theory of Mind in Adults

Social functioning depends on the ability to attribute and reason about the mental states of others – an ability known as theory of mind (ToM). Research in this field is limited by the use of tasks in which ceiling effects are ubiquitous, rendering them insensitive to individual differences in ToM ability and instances of subtle ToM impairment. Here, we present data from a new ToM task – the Short Story Task (SST) - intended to improve upon many aspects of existing ToM measures. More specifically, the SST was designed to: (a) assess the full range of individual differences in ToM ability without suffering from ceiling effects; (b) incorporate a range of mental states of differing complexity, including epistemic states, affective states, and intentions to be inferred from a first- and second-order level; (c) use ToM stimuli representative of real-world social interactions; (d) require participants to utilize social context when making mental state inferences; (e) exhibit adequate psychometric properties; and (f) be quick and easy to administer and score. In the task, participants read a short story and were asked questions that assessed explicit mental state reasoning, spontaneous mental state inference, and comprehension of the non-mental aspects of the story. Responses were scored according to a rubric that assigned greater points for accurate mental state attributions that included multiple characters’ mental states. Results demonstrate that the SST is sensitive to variation in ToM ability, can be accurately scored by multiple raters, and exhibits concurrent validity with other social cognitive tasks. The results support the effectiveness of this new measure of ToM in the study of social cognition. The findings are also consistent with studies demonstrating significant relationships among narrative transportation, ToM, and the reading of fiction. Together, the data indicate that reading fiction may be an avenue for improving ToM ability.     

The ‘successful’ return: Caribbean narratives of migration,family, and gender

Research on female migrant caregivers has tended to focus upon the emotional and social problems they encounter working abroad, given women's traditional role as caregivers for their own families. This article analyses how Caribbean women who have returned after a period abroad as domestic workers inscribe their migration experiences within the gendered narrative of the good relative who migrates to help the family left behind and therefore deserves social recognition in the community of origin. It argues that this narrative allows the women to both affirm and reinterpret local family and gender roles within the context of migration. This analysis points to the close connection between narrative structures, accounts of migration experiences, and self‐presentations and suggests that narratives about family and gender roles not only reflect people's lives, but are also a malleable resource that can be (re)shaped to validate a variety of life‐courses.     

“Traveling Pains”: Embodied Metaphors of Suffering Among Southern Sudanese Refugees in Cairo

This paper presents the results of a larger study conducted among Southern Sudanese refugees in Cairo, Egypt. "Illness talk" and body metaphors are the focus of the present work, which is based mainly on an analysis of the illness narratives of people attending a church-run medical clinic. The findings suggest that refugees use certain narrative styles in discussing their illnesses that highlight the interconnection of bodily ills and refugee-related trauma. The refugees narrated the histories of their illnesses in terms consistent and coterminous with their refugee histories, and articulated illness causes in terms of threatening assaults on their sense of self as human beings and as part of a distinct community and culture. The use of embodied metaphors to understand and cope with their current and past traumatic experiences was echoed in narratives that were nonillness related. Metaphors such as "the heart," "blood," and "body constriction" were consistently used to discuss social and cultural losses. Understanding the role that the body plays in experience and communication within a given cultural context is crucial for physicians and others assisting refugees.     

Thinking Temporally or Modernizing Anthropology

Recent changes within social and cultural anthropology have made history a key issue, but in this essay I argue that the field has yet to develop the resources that are required to deal with temporality. This point is made through an extended examination of Jean and John Comaroffs work on Christianity and colonialism in southern Africa. Arguably, the Comaroffs read history backward and then present its unfolding as a kind of inexorable logic. In doing so, they homogenize missionary and Tswana "cultures" and attribute agency to abstractions rather than to people acting in particular material contexts. In contrast, I argue for a narrative approach to historical anthropological explanation. The emergent qualities of events—and the variable ways in which capitalism, hegemony, Protestantism, and vernacular modernisms relate—require narrative for explanation, narrative that encompasses within itself the narratives of social actors themselves, [historical anthropology, narrative, the modern, South Africa]