Managing the Unmanageable: Elderly Russian Jewish Émigrés and the Biomedical Culture of Diabetes Care

In this article, we examine the apparent resistance of elderly Russian Jewish émigrés to the dominant U.S. biomedical model of diabetes treatment. Cultural competence on the part of medical professionals who make assumptions about Russian culture tends to be based on particularly American values of self-control and individual agency. The American consumer model of health care incorporating risk, individual responsibility, autonomy, and choice, when applied to elderly Russian Jewish émigrés, results in a reading of different values and choices as failed self-management or noncompliance. This article argues for a more reflexive understanding of U.S. biomedical culture as a replacement for the current "sound bite" model of cultural diversity.     

Managing the unmanageable: elderly Russian Jewish émigrés and the biomedical culture of diabetes care

In this article, we examine the apparent resistance of elderly Russian Jewish émigrés to the dominant U.S. biomedical model of diabetes treatment. Cultural competence on the part of medical professionals who make assumptions about Russian culture tends to be based on particularly American values of self-control and individual agency. The American consumer model of health care incorporating risk, individual responsibility, autonomy, and choice, when applied to elderly Russian Jewish émigrés, results in a reading of different values and choices as failed self-management or noncompliance. This article argues for a more reflexive understanding of U.S. biomedical culture as a replacement for the current "sound bite" model of cultural diversity.     

Giving an Account of One’s Pain in the Anthropological Interview

In this paper, I analyze the illness stories narrated by a mother and her 13-year-old son as part of an ethnographic study of child chronic pain sufferers and their families. In examining some of the moral, relational and communicative challenges of giving an account of one’s pain, I focus on what is left out of some accounts of illness and suffering and explore some possible reasons for these elisions. Drawing on recent work by Judith Butler (Giving an Account of Oneself, 2005), I investigate how the pragmatic context of interviews can introduce a form of symbolic violence to narrative accounts. Specifically, I use the term “genre of complaint” to highlight how anthropological research interviews in biomedical settings invoke certain typified forms of suffering that call for the rectification of perceived injustices. Interview narratives articulated in the genre of complaint privilege specific types of pain and suffering and cast others into the background. Giving an account of one’s pain is thus a strategic and selective process, creating interruptions and silences as much as moments of clarity. Therefore, I argue that medical anthropologists ought to attend more closely to the institutional structures and relations that shape the production of illness narratives in interview encounters.     

The Psychotropic Self/Imaginary: Subjectivity and Psychopharmaceutical Use Among Heroin Users with Co-Occurring Mental Illness

Many people diagnosed with mental illnesses struggle with illicit drug addiction. These individuals are often treated with psychiatric medications, yet little is known about how they experience this treatment. Research on the subjective experience of psychiatric medication use highlights the complex, contradictory, and ambiguous feelings often associated with this treatment. However, for those with mental illness and addiction, this experience is complicated by the need to manage both psychiatric medication and illicit drug use. Using ethnographic data from a study of heroin use in Northeast Ohio, we explore this experience by expanding the pharmaceutical self/imaginary (Jenkins, Pharmaceutical Self: The Global Shaping of Experience in an Age of Psychopharmacology, School for Advanced Research Press, Santa Fe, NM, 2010b) to include psychopharmaceuticals and illicit drugs, what we call the psychotropic self/imaginary. Through this lens we explore the ways participants interpret and manage their psychotropic drug use in relation to sociocultural, institutional, and political–economic contexts. This analysis reveals how participants seek desired effects of legally prescribed and illicit drugs to treat mental illness, manage heroin addiction, and maintain a perceived “normal” self. Participants manage their drug use using active strategies, such as selective use of psychiatric medications, in the context of structural constraints, such as restricted access to mental health care, and cultural contexts that blur distinctions between “good” medicines and “bad” drugs.     

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.     

Too Lonely to Die Alone: Internet Suicide Pacts and Existential Suffering in Japan

Most striking in the recent rise of suicide in Japan are the increase in suicide among young Japanese and the emergence of Internet suicide pacts. An ethnography of suicide-related Web sites reveals a distinctive kind of existential suffering among visitors that is not reducible to categories of mental illness and raises questions regarding the meaning of an individual “choice” to die, when this occurs in the context of an intersubjective decision by a group of strangers, each of whom is too afraid to die alone. Anthropology’s recent turn to subjectivity enables analyses of individual suffering in society that provide a more nuanced approach to the apparent dichotomy between agency and structure and that connect the phenomenon of suicide in Japan to Japanese conceptions of selfhood and the afterlife. The absence of ikigai [the worth of living] among suicide Web site visitors and their view of suicide as a way of healing show, furthermore, that analyses of social suffering must be expanded to include questions of meaning and loss of meaning and, also, draw attention to Japanese conceptions of self in which relationality in all things, including the choice to die, is of utmost importance.

Explaining a complex disease process: talking to patients about Hansen's disease (leprosy) in Brazil

Patient explanatory models of Hansen's disease (leprosy) in Rio de Janeiro, Brazil, tend to be syntheses of folk models of illness and health, biomedical models to which patients are exposed at different stages in the treatment process, and individual patient experiences of illness. The sensitive presentation of biomedical information about Hansen's disease to patients has the potential to increase adherence to treatment programs and increase patient confidence in the biomedical system. Conversely, withholding or poor presentation of biomedical information can create misunderstanding and confusion for patients. In this article, I explore the ways in which people who are affected by Hansen's disease in Rio de Janeiro learn about different aspects of their illness and its treatment from health care professionals.     

Sickening Bodies: How Racism and Essentialism Feature in Aboriginal Women's Discourse about Health1

In the last decade there has been much interest in the concepts of ‘racism’ and ‘essentialism’ and the ways in which these notions have been appropriated by Aboriginal people to demarcate a specifically Aboriginal space (Cowlishaw 1986; Lattas 1993; Langton 1981; Morris 1988; Muecke 1992). Central to these concerns is the issue of black/white relations and the specificities of racial oppression. Following these concerns in this article I explore the nexus between the metaphorical dismemberment of self and the corporeal dismemberment of sickness which is reflected in the high mortality rates and disease patterns of Aboriginal people. I extend Fanon's concept that racism has the power to alienate ‘a man of colour’ from his own self-image to argue that it more than metaphorically breaks the human body (Fanon 1991). I provide a window into a much neglected area of research: how notions of illness and social relatedness are constructed in particular socio-historical circumstances. I explore the meanings of illness as expressed at the level of community and as a form of embodiment associated with unequal colonial relations. I focus on indigenous exegeses which articulate Aboriginal women's experience of illness and their sense of identity. I draw on the work of Leder (1990) to foreground a phenomenological view where selfhood is continually confronted by circumstances that make present the ‘body’ as a ‘sharp and searing presence threatening the self’. I also apply Sansom's (1982) model of illness and the significance of carers in an Aboriginal community to demonstrate a world-view of personhood that is diffused with other persons and things rather than a world-view that entails a highly individuated and bounded self. In this world-view adequate healing requires a reconstitution of social relations and a re-ordering of the racialised status quo.     

Appropriation and Dementia in India

Biomedical technologies like MRI scans offer a way for carers and people with dementia to ‘see’ pathology, as a means to reorient their perceptions of the body and functionality. Through interpretive and syncretic processes, the MRI and the diagnosis of dementia facilitate the incorporation of the clinical category ‘dementia’ into social understandings of illness and care in India. Complex shifts occur as families and providers move from socio-cultural explanations of disruption to bio-social etiologies of the disease ‘dementia’ and then to socio-ecological frameworks of causality. Both the biomedicalisation of illness and the localisation of illness occur as the clinical category ‘dementia’ is folded into local understandings of illness and care. Through elucidating how the dialectic between biomedical and local knowledge is operationalized, we offer insights into how dementia is absorbed and appropriated into Indian cultural contexts.     

Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities

BACKGROUND: The pharmacological treatment of bipolar disorder has dramatically improved with multiple classes of agents being used as mood-stabilizers, including lithium, anticonvulsants, and atypical antipsychotics. However, the use of these medications is not without risk, particularly when a patient with bipolar disorder also has comorbid medical illness. As the physician who likely has the most contact with patients with bipolar disorder, psychiatrists must have a high index of suspicion for medical illness, as well as a basic knowledge of the risks associated with the use of medications in this patient population. METHODS: A review of the literature was conducted and papers addressing this topic were selected by the authors. RESULTS AND DISCUSSION: Common medical comorbidities and treatment-emergent illnesses, including obesity, diabetes mellitus, dyslipidemia, cardiac disease, hepatic disease, renal disease, pulmonary disease and cancer are reviewed with respect to concomitant use of mood stabilizers. Guidance to clinicians regarding effective monitoring and treatment is offered. CONCLUSIONS: Mood-stabilizing medications are necessary in treating patients with bipolar disorder and often must be used in the face of medical illness. Their safe use is possible, but requires increased vigilance in monitoring for treatment-emergent illnesses and effects on comorbid medical illness.     

Arational Behavior and Medical Care, Report of Bureau of Research and Planning

Testing the hypothesis that arationality on the part of a patient in the treatment of an illness is in direct relation to perceived chance or danger inherent in that illness and is in inverse relation to medical knowledge about that illness, the authors of an unpublished doctoral dissertation conclude that "those who are scientifically more knowledgeable" in the area of medical practice are "also more rational." Arational behavior is categorized as 1) the type that involves the use of, or belief in the efficacy of accepted religious practices for the treatment of illness, 2) the use of some religious charms and trinkets, and 3) the use of ineffective or harmful health foods, herbs, and various compounds. The authors conclude that an increase in technological discoveries will result in a trend toward greater rationality and more rational behavior in seeking treatment for illness.     

Where There is no Patient: An Anthropological Treatment of a Biomedical Category

This work anthropologically applies the concept of ‘personhood’ to the Western biomedical patient role, and through cross-cultural comparisons with wellness-seeker roles (e.g. among the Maya of Guatemala and others) it seeks to discern the implications for global healthcare of assuming the universality of the “patient” role. Here, particular ethnographic attention is given to the presumption of the “patient” role in places and situations where, because of cultural and linguistic variation in local wellness-seeker roles and practices, there may be no “patient.” It is hoped that establishing the biomedical patient role (with the clinical expectations, communicative and comportment practices that prefigure it) as acquired rather than intuitive, will help redirect cultural competence to the acquisition of patienthood, broadening it from an endless accrual of cultural inventories by physicians. Also it aims to shift existing biomedical associations of cultural variations in wellness-seeking away from a priori assessments of clinical defiance towards deeper understandings of the kinds of cultural differences that may make the difference treatment outcomes.

Patient and Disease Characteristics Associated with Activation for Self-Management in Patients with Diabetes,Chronic Obstructive Pulmonary Disease,Chronic Heart Failure and Chronic Renal Disease: A Cross-Sectional Survey Study

A substantial proportion of chronic disease patients do not respond to self-management interventions, which suggests that one size interventions do not fit all, demanding more tailored interventions. To compose more individualized strategies, we aim to increase our understanding of characteristics associated with patient activation for self-management and to evaluate whether these are disease-transcending. A cross-sectional survey study was conducted in primary and secondary care in patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and Chronic Renal Disease (CRD). Using multiple linear regression analysis, we analyzed associations between self-management activation (13-item Patient Activation Measure; PAM-13) and a wide range of socio-demographic, clinical, and psychosocial determinants. Furthermore, we assessed whether the associations between the determinants and the PAM were disease-transcending by testing whether disease was an effect modifier. In addition, we identified determinants associated with low activation for self-management using logistic regression analysis. We included 1154 patients (53% response rate); 422 DM-II patients, 290 COPD patients, 223 HF patients and 219 CRD patients. Mean age was 69.6±10.9. Multiple linear regression analysis revealed 9 explanatory determinants of activation for self-management: age, BMI, educational level, financial distress, physical health status, depression, illness perception, social support and underlying disease, explaining a variance of 16.3%. All associations, except for social support, were disease transcending. This study explored factors associated with varying levels of activation for self-management. These results are a first step in supporting clinicians and researchers to identify subpopulations of chronic disease patients less likely to be engaged in self-management. Increased scientific efforts are needed to explain the greater part of the factors that contribute to the complex nature of patient activation for self-management.     

Estimation of Cell Proliferation Dynamics Using CFSE Data

Advances in fluorescent labeling of cells as measured by flow cytometry have allowed for quantitative studies of proliferating populations of cells. The investigations (Luzyanina et al. in J. Math. Biol. 54:57–89, 2007; J. Math. Biol., 2009; Theor. Biol. Med. Model. 4:1–26, 2007) contain a mathematical model with fluorescence intensity as a structure variable to describe the evolution in time of proliferating cells labeled by carboxyfluorescein succinimidyl ester (CFSE). Here, this model and several extensions/modifications are discussed. Suggestions for improvements are presented and analyzed with respect to statistical significance for better agreement between model solutions and experimental data. These investigations suggest that the new decay/label loss and time dependent effective proliferation and death rates do indeed provide improved fits of the model to data. Statistical models for the observed variability/noise in the data are discussed with implications for uncertainty quantification. The resulting new cell dynamics model should prove useful in proliferation assay tracking and modeling, with numerous applications in the biomedical sciences.     

Selfhood, Immunity, and the Biological Imagination: The Thought of Frank Macfarlane Burnet

The language of self and nonself has had a prominent place inimmunology. This paper examines Frank Macfarlane Burnet's introductionof the language of selfhood into the science. The distinction betweenself and nonself was an integral part of Burnet's biological outlook– of his interest in the living organism in its totality, itsactivities, and interactions. We show the empirical and conceptualwork of the language of selfhood in the science. The relation betweenself and nonself tied into Burnet's ecological vision of host-parasiteinteraction. The idiom of selfhood also enabled Burnet to organizeand unify a diversity of immune phenomena. Rather than approach thelanguage of self and nonself as a bluntly imposed metaphor, we focuson its endogenous origins and immanent uses in immunology.     

Nonself help: how immunology might reframe the Enlightenment

The classical immunological paradigm is predicated on the body's ability to recognize and eliminate “nonself.” However, the “self–nonself” model has yet to facilitate any resolution of the field's major concerns, and may thus prove to be of limited use. Merely discarding it is no solution, as the juxtaposition of “self” and “nonself” persists in research, in clinical settings, and in everyday practice despite the best efforts of theoretical immunologists. Instead, the very conception of “selfhood” may prove to be key. Replacing immunology's prior and persistent “self” with less static concepts derived from non-Western contexts not only resolves immunology's famous paradoxes but also offers a new and more accurate model that allows immunology to reframe what may become an outmoded Enlightenment construct of “self.” In such a new paradigm, immunology's well-known system of protection and defense is replaced with a view in which nonself becomes less the body's enemy than its primary mechanism for the creative assimilation of difference. This incorporative model—in which the “immune system” functions more as a search engine than as an expeller of difference—both resolves outstanding paradoxes, and complies more accurately with contemporary knowledge and research practice.     

A Biosemiotic Approach to the Problem of Structure and Agency

A human being is the simultaneous composite of several different levels of being, from atomic and subatomic to the level of complex social interaction, and these levels are nested within the individual hierarchically (lower levels giving rise to higher levels, etc.). One of the most important and influential approaches developed in the history of science has been that of systems theory and systemic thinking, in which the different levels of the hierarchy, and the interactions between those levels, are considered simultaneously. Although this model provides a comprehensive view of biological being, the transition from one level to the other is not well defined in it. Uexküll and Pauli (Advances: Journal of the Institute for 417 the Advancement of Health 3:158–174, 1986) suggested that semiosis is the translator of the events from one level to the other. From a psychological point of view, a myriad of semiotic events happen inside an individual, and it has been suggested that among other semiotic events, inner speech plays an important role in mediating personal agency. Dialogical theories of the self, Jungian psychology and hypnosis research evidence show that there is a semiotic multiplicity in human agency and consciousness, and that these multiple streams are all converge to a central semiotic singularity. I argue in this paper that by taking a biosemiotic point of view, human ‘agency’ may be defined as the ability of an individual to direct the incoming and internal streams of semioses and the ability to create an integrative and superordinate new stream of semiosis in addition to the upwardly and downwardly component ones, and how such a view might open a new door for research into the concept of human ‘personality’ and ‘agency’.     

Diagnosis,Power and Certainty: Response to Davis

Lennard Davis’s “Biocultural Critique” of the alleged certainty of diagnosis (Davis Journal of Bioethical Inquiry 7:227−235, 2010) makes errors of fact concerning psychiatric diagnostic categories, misunderstands the role of power in the therapeutic relationship, and provides an unsubstantiated and vague alternative to the management of psychological distress via a conceptually outdated model of the relationships between physical and psychological disease and illness. This response demonstrates that diagnostic knowledge vouchsafes legitimate power to physicians, and via them relief to patients who suffer from psychological distress. The history of medicine and psychiatry demonstrates that psychiatric diagnosis shares many features with physical diagnosis, while there is also reason to believe that the two types will continue to be distinct in some respects. Diagnostic categories in psychological medicine, like those in physical medicine, are provisional, probabilistic, and often uncertain. These features do not detract from the dependence on diagnosis of therapeutic efficacy in both domains.     

Understanding the Rise of Consumer Ethnography: Branding Technomethodologies in the New Economy

ABSTRACT   In this article, I aim to contribute to the ongoing discussion on the changing public role of anthropology by exploring the rise of branded ethnographic practices in consumer research. I argue that a juncture in the "New Economy"—the conjoining of corporate interest in branding, technology, and consumers, with vast social changes—may explain the rapid growth of ethnography for consumer research and predict its future direction. An analysis of branded propaganda from ethnographic vendors that claim their technology-enhanced methods innovate "classic" anthropological practices discloses the way corporations employ technologically mediated means to focus on the reflexive self in consumer research. In this analysis, I reveal that technological methodologies are central to the production of branded ethnographic practices, as forms of branding and technology legitimate consumer–corporate flows of interaction. The conclusion raises awareness to the ways in which modern branding practices reconstruct anthropology in public discourse. [Keywords: branding, consumer research, ethnography, reflexivity, technology]