Negotiation of the illness experience: Ayurvedic therapy and the psychosocial dimension of illness

The negotiation of the illness experience by ayurvedic vaidya and South Kanarese patients suffering from specific sources of psychosocial distress is examined in light of the cultural patterning of illness and communication within the clinical context. The negotiation process is initiated by the posing of rhetorical questions about somatic and affective states and structured by a conceptual framework which relegates such states to humoral interrelationships. By establishing a humoral explanatory model for an illness episode or affective state which takes into account environmental and constitutional factors over which one has little control, responsibility is mollified and dialogue about personal problems eased. A comparison of the interaction between ayurvedic practitioners and patients and astrologers and clients is made in this regard. The socially integrative and adaptive consequences of ayurvedic therapy is considered vis a vis a portrayal of a popular vaidya's therapy for a number of illnesses associated with the somatization of psychosocial stress.     

Patterns of [PSI+] aggregation allow insights into cellular organization of yeast prion aggregates

The yeast prion phenomenon is very widespread and mounting evidence suggests that it has an impact on cellular regulatory mechanisms related to phenotypic responses to changing environments. Studying the aggregation patterns of prion amyloids during different stages of the prion life cycle is a first key step to understand major principles of how and where cells generate, organize and turn-over prion aggregates. The induction of the [PSI⁺] state involves the actin cytoskeleton and quality control compartments such as the Insoluble Protein Deposit (IPOD). An initially unstable transitional induction state can be visualized by overexpression of the prion determinant and displays characteristic large ring- and ribbon-shaped aggregates consisting of poorly fragmented bundles of very long prion fibrils. In the mature prion state, the aggregation pattern is characterized by highly fragmented, shorter prion fibrils that form aggregates, which can be visualized through tagging with fluorescent proteins. The number of aggregates formed varies, ranging from a single large aggregate at the IPOD to multiple smaller ones, depending on several parameters discussed. Aggregate units below the resolution of light microscopy that are detectable by fluorescence correlation spectroscopy are in equilibrium with larger aggregates in this stage and can mediate faithful inheritance of the prion state. Loss of the prion state is often characterized by reduced fragmentation of prion fibrils and fewer, larger aggregates.     

I Gave My Child Life but I Also Gave Her Death

The capacity for a complex inner life—encompassing inner speech, imaginative reverie and unarticulated moods—is an essential feature of living with illness and a principal means through which people interpret, understand and manage their condition. Nevertheless, as Nigel Rapport has pointed out in a recent edition of The Australian Journal of Anthropology (2008: 19 (3)), interiority largely remains a ‘terra‐incognita’ for social science, while anthropology lacks a generally accepted theory or methodological framework for understanding how interiority relates to people’s public actions and expressions. Moreover, as conventional social‐scientific methods are often too static to understand the fluidity of perception among people living with illness or bodily instability, I argue we need to develop new, practical approaches to knowing. By placing the problem of interiority directly into the field and turning it into an ethnographic, practice‐based question to be addressed through fieldwork in collaboration with informants, this article works alongside women living with HIV/AIDS in Uganda with the aim of capturing the unvoiced but sometimes radical changes in being, belief and perception that accompany terminal illness.     

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.”     

Sabar: body politics among middle‐aged migrant Pakistani women

This article explores the relationship among suffering, Islamic moral concepts, subjectivity, and agency within a cohort of middle‐aged women who migrated from Pakistan to Britain in the 1960s and 1970s as the wives or daughters of industrial workers. These women were preoccupied with their ageing bodies and complained about the cumulative assaults on their health they had experienced, and which they felt had been neglected by health professionals and family alike. By examining how these women bear chronic illness through a discourse of sabar (patience or silent forbearance), I show how women were able to transform their illness into a selfless and virtuous consequence of shouldering the burdens of kinship. Sabar suggests passive acceptance or fatalism to some observers, but attending to how women situate their illness in a religious and eschatological frame, we see that they actively appropriate rather than passively imbibe the norm of sabar. Moreover, turning from narratives to everyday contexts of friendship, family, and inter‐generational relations, we see that there are tensions between self‐sublimation and self‐assertion in the practice of sabar. It is argued that ethnographic attention to subjectivity and reflexivity are crucial to understanding sabar as an agential capacity.     

Negotiating A Path To Efficacy At A Clinic Of Traditional Chinese Medicine

Chinese medicine emphasizes the underlying connection of the bodily, emotional, social, and environmental dimensions in illness experience and healing. The therapeutic process, characterized as tiao (attuning, balancing), targets the patient’s overall illness condition and experience including both physical and nonphysical aspects of suffering. This study, incorporating techniques of microanalysis as an ethnographic tool and using an actual recorded clinical interaction as data, analyzes how the path to effective healing is negotiated among multiple clinical realities at a clinic of Chinese medicine in Beijing. A close examination of interactive features of actual face-to-face communication between a doctor and a patient in a specific case of “stagnation of emotions” reveals that, for an illness recognized in Chinese medicine as originating from disordered emotions, adjustment of the patient’s perceptions of reality and social relations is particularly salient in the “attuning” process. Efficacy then should be understood as more than physiological changes produced by herbs, but also as emergent through an interactive event of clinical encounters. This study demonstrates empirically how the clinical process of Chinese medicine works to define and transform the patient’s emotions and experience.     

Staying alive

Quiescence is a state of reversible cell cycle arrest that can grant protection against many environmental insults. In some systems, cellular quiescence is associated with a low metabolic state characterized by a decrease in glucose uptake and glycolysis, reduced translation rates and activation of autophagy as a means to provide nutrients for survival. For cells in multiple different quiescence model systems, including Saccharomyces cerevisiae, mammalian lymphocytes and hematopoietic stem cells, the PI3Kinase/TOR signaling pathway helps to integrate information about nutrient availability with cell growth rates. Quiescence signals often inactivate the TOR kinase, resulting in reduced cell growth and biosynthesis. However, quiescence is not always associated with reduced metabolism; it is also possible to achieve a state of cellular quiescence in which glucose uptake, glycolysis and flux through central carbon metabolism are not reduced. In this review, we compare and contrast the metabolic changes that occur with quiescence in different model systems.     

Suffering and its professional transformation: toward an ethnography of interpersonal experience

The authors define experience as an intersubjective medium of microcultural and infrapolitical processes in which something is at stake for participants in local worlds. Experience so defined mediates (and transforms) the relationship between context and person, meaning and psychobiology in health and illness and in healing. Building on this theoretical background, an approach to ethnography is illustrated through an analysis of suffering in Chinese society. The embodied memory of a survivor of serious trauma during the Cultural Revolution provides an example. From there, the authors go on to describe a framework of indigenous Chinese categories for the analysis of experience — mianzi (face), quanxi (connections), renqing (situated emotion), bao (reciprocity). The paper concludes with a discussion of the existential limits of this and other anthropological approaches to the study of experience as moral process.     

Survival mechanisms and culturability of <Emphasis Type="Italic">Campylobacter jejuni</Emphasis> under stress conditions

Culture-based isolation and enumeration of bacterial human pathogens from environmental and human food samples has significant limitations. Many pathogens enter a viable but non-culturable (VBNC) state in response to stress, and cannot be detected via culturing methods. Favourable growth conditions with a source of energy and an ideal stoichiometric ratio of carbon to inorganic elements can reverse this VBNC state. This review will focus on the bacterium Campylobacter jejuni which is a leading cause of food borne illness in the developed world. C. jejuni can enter a VBNC state in response to extremes in: pH, moisture content, temperature, nutrient content and salinity. Once in a VBNC state, the organism must maintain an energy balance from substrate oxidation through respiration to grow, divide and remain viable. The goal of this review is a greater understanding of how abiotic stress and thermodynamics influence the viability of C. jejuni.     

Patterns of [PSI+] aggregation allow insights into cellular organization of yeast prion aggregates

The yeast prion phenomenon is very widespread and mounting evidence suggests that it has an impact on cellular regulatory mechanisms related to phenotypic responses to changing environments. Studying the aggregation patterns of prion amyloids during different stages of the prion life cycle is a first key step to understand major principles of how and where cells generate, organize and turn-over prion aggregates. The induction of the [PSI⁺] state involves the actin cytoskeleton and quality control compartments such as the Insoluble Protein Deposit (IPOD). An initially unstable transitional induction state can be visualized by overexpression of the prion determinant and displays characteristic large ring- and ribbon-shaped aggregates consisting of poorly fragmented bundles of very long prion fibrils. In the mature prion state, the aggregation pattern is characterized by highly fragmented, shorter prion fibrils that form aggregates, which can be visualized through tagging with fluorescent proteins. The number of aggregates formed varies, ranging from a single large aggregate at the IPOD to multiple smaller ones, depending on several parameters discussed. Aggregate units below the resolution of light microscopy that are detectable by fluorescence correlation spectroscopy are in equilibrium with larger aggregates in this stage and can mediate faithful inheritance of the prion state. Loss of the prion state is often characterized by reduced fragmentation of prion fibrils and fewer, larger aggregates.     

Espanto: A dialogue with the Gods

Espanto or susto has been analysed from various points of view in the last fifteen years. From a survey covering 109 case analyses collected in Nicolas Ruiz (Chiapas, Mexico), we reached the conclusion that this folk illness cannot be conceived of as a syndrome in the medical sense. A semiological analysis showed that espanto can be better described as an indigenous theory whose function is to relate illness events to other levels of reality.According to indigenous belief, the Holy Earth and the chtonian spirits of the underworld play an important role in the origin of the illness. This origin is associated with an opening of the earth as is illustrated in the earthquakes or the volcanic eruptions forming the prototype of a fright experience leading to espanto; or, it is attributed to agents who inhabit locations where the earth presents a fissure (river, ravine, cave). It is through these holes that the Holy Earth exerts her power. Concomitantly, the body of the victim is believed to open itself to the influences of the bad winds of espanto. Trembling is another aspect of the phenomenon which is observed at numerous levels: first, during the fright experience; second, when the victim falls ill (chills jumping in bed); and third, when the curandera takes the pulse of the patient to see if the blood is afraid. These multiple analogies lead to the assumption that there is a meaning shared by these separate manifestations.     

CHRONIC FATIGUE SYNDROME BEGINNING SUDDENLY OCCURS SEASONALLY OVER THE YEAR

The fact that many patients with chronic fatigue syndrome (CFS) have an infectiouslike sudden onset to their illness has led to the hypothesis that CFS is a medical illness. If CFS were, on the other hand, a psychiatric disorder related to symptom amplification, one would expect illness onset to occur randomly over the calendar year. This study tested that hypothesis with 69 CFS patients whose illness was on the more severe side of the illness spectrum; all patients reported sudden illness onset with the full syndrome of sore throat, fatigue/malaise, and diffuse achiness developing over no longer than a 2-day period. Date of illness onset was distinctly nonrandom. It peaked from November through January and was at its lowest from April through May. These data support the hypothesis that an infectious illness can trigger the onset of CFS. (Chronobiology International, 17(1), 95–99, 2000).

Chronic fatigue syndrome (CFS) is a medically unexplained illness characterized by fatigue, pain, and cognitive complaints. Because many of the symptoms of CFS overlap with those of depression, some argue that CFS is a somatic manifestation of depression or a somatoform disorder. Komaroff (1988) has suggested that, because CFS patients develop their illness suddenly with an infectiouslike presentation, this supports an underlying medical etiology to the illness. If CFS were indeed triggered by an infectious illness, one would expect to find the dates of sudden illness onset to occur more often in months when viral infections are common. If CFS were a somatoform disorder, one would expect a random distribution of dates of illness onset across the calendar year. Since our center has a large number of CFS patients who report a sudden infectiouslike illness onset, the purpose of this paper was to determine if the dates of illness onset occurred randomly or nonrandomly across the calendar year.     

Piercing transfigurations: Representations of suffering in Cyprus

This paper explores representations of suffering in Cyprus, a divided island. It examines differences between Greek and Turkish Cypriots in their official publicity/propaganda photographic material in representing the issue of missing persons in Cyprus. It attempts to show that the differences are relatable not just to their different persuasive strategies, but also to different approaches to photography, to experience and memory. For the Greek Cypriots, the sacrifice of the person has to be represented as an absent body, the quintessential example being Christ. By contrast, for the Turkish Cypriots it is the presence of a (dead) body, the body of the dead hero/fighter, that signifies a sacrifice and transforms him into a shehit (martyr). Such differences can be related to differences between the two groups in the political fabulation of the past and its appeal to “memory” and “experience”. The Turkish Cypriots because of their pressing political problems, especially between 1963–70 when they tended to view their survival as being at stake, use photographs in a relatively “realist” matter‐of‐fact way although their aim is highly emotionally charged. Greek Cypriots use photographs as representations of what is in effect an iconic predicament: representation as participating in some fundamental way in that which it represents. After examining the predicament of depicting suffering through photography, the paper suggests that to respond effectively to suffering we may have to approach it not through the seductive realism of the photograph but through its means of representing the symbolic and the imaginary.     

Die „Pathologische Realangst“ am Beispiel kardiovaskulärer Erkrankungen

Fears of patients suffering from chronic or life threatening diseases are frequently observed as adjustment reactions. Left untreated they may lead to an unfavorable course of the disease and a generally poor outcome. Difficulties in diagnostic standard procedures arise from the question whether the anxiety symptoms are an expression of physical illness, or an independent anxiety disorder of clinical significance. The concept of Pathological Realistic Fear derives from these considerations, and describes the fear of a real threat, particularly in patients with chronic disease, especially those suffering from life threatening illnesses. Distorted perceptions of the primary disease, caused by subjective ideas about disease mechanisms often lead to misguided assumptions and frequently result in a distorted interpretation of the physical symptoms of illness. As a result a fearful attention focus evolves, which triggers the ultimate development of a Pathological Realistic Fear as. The following article is a first attempt to elaborate on the concept of Pathological Realistic Fear as a pathology and to describe its clinical relevance. The concept contributes to a more precise diagnosis of anxiety and could stimulate an interdisciplinary patient care.     

The Materiality of Relational Transformations: Propositions for Renewed Analyses of Life-Cycle Rituals in Melanesia and Australia

ABSTRACT

This paper introduces this special issue and analyses Papua New Guinea and Australian initiation and death rituals as moments of relational transformations. Although the general argument is not completely new, it has often remained an undemonstrated statement. The paper hence focuses on the specific ways people make these changes effective and express them in their rituals. It is suggested that an invariant modus operandi is in play in which, for a relation to be transformed, its previous state must first be ritually enacted. Towards the end of the ritual, the new state of the relationship is itself publicly enacted through a manifestation of the form the relation takes after the ritual. The paper suggests that a relationship cannot be transformed in the absence of the persons concerned. The relational components need to be either directly present, such as in initiations, or mediated through objects, such as in death rituals.     

‘Don't be so serious’: ethical play,Islam, and the transcendent

Modes of play and playfulness are central to ethics, yet have not been as rigorously considered by anthropologists as have more earnest forms of ethical life. In this article, I argue that attention to play reframes recent anthropological debates about ethical transcendence and immanence. I do so through a consideration of the Islamic discourse of ‘calculation’ (ḥisāb), an idiom by which Muslims articulate their hoped-for state in the hereafter through the imagery of a divine accounting of good and bad deeds. Drawing on ethnography from the Indonesian province of Aceh, I show how ḥisāb cultivates forms of epistemological play through which Muslims explore the inscrutability of transcendence. Such play reveals the socially and theologically emergent qualities of transcendent truths and values, suggesting hidden affinities between transcendent stances and more immanent forms of ethical life.     

Pursuit of Psychological Well-Being (Ikigai) and the Evolution of Self-Understanding in the Context of Caregiving in Japan

Using the Japanese concept of ikigai, which describes a certain state ofpsychological well-being, this study exploreshow Japanese family caregivers of elderlyparents with dementia pursue, maintain, orattempt to regain their psychologicalwell-being in the face of the hardship ofcaregiving. Using constant comparativemethodology, twenty-six Japanese women who werecaring for an elderly demented parent orparent-in-law were interviewed. Based on theanalysis of interview data, we defineikigai as certain life experiences and/or thepositive emotion felt through those experiencesthat allow the caregiver to judge her life asgood and meaningful, and to feel that it isworthwhile to continue living. Caregivers usevarious different means to pursue theirikigai depending on the context of care. Thetypes of their pursuit of ikigai areexamined in varying contexts of caregiving.Because the data suggest that ikigaiexperience influences how the caregivers'self-understanding changes over time, thenotion of ikigai is further explored inrelation to the construct of self-understanding.     

The Untold Sacrifice: The Monotony and Incompleteness of Self-Sacrifice in Northeast Brazil

There is no such thing as an accidental sacrifice. Sacrifice is always pre-meditated, and if not entirely goal-oriented, at the very least inherently meaningful as a process in itself. This paper is about how we might begin to understand sacrifices that do not conform to these rules. It concerns the question: does sacrifice exist outside of its (often) dramatic, self-conscious elaboration? Within the Brazilian Catholic tradition everyday life – ideally characterised by monotonous, undramatic, acts of self-giving – is ‘true sacrifice’. For ordinary Catholics, the challenge is not how to self-sacrifice, but how to make one's mundane life of self-sacrifice visible whilst keeping one's gift of suffering ‘free’. In this paper I describe, ethnographically, the work entailed as one of ‘revelation’ and use the problems thrown up to reflect upon both the limits and advantages of Western philosophical versus anthropological understandings of Christian sacrificial practices to date.     

The Moral Aesthetics of Simulated Suffering in Standardized Patient Performances

Standardized patient (SP) performances are staged clinical encounters between health-professional students and people who specialize in role-playing the part of patients. Such performances have in recent years become increasingly central to the teaching and assessment of clinical skills in U.S. medical schools. SP performances are valued for being both “real” (in that they involve interaction with a real person, unlike written examinations) and “not real” (in that the SP does not actually suffer from the condition portrayed, unlike an actual patient). This article considers how people involved in creating SP performances reconcile a moral commitment to avoid suffering (to keep it “not real”), with an aesthetic commitment to realistically portray it (to keep it “real”). The term “moral aesthetic” is proposed, to indicate a sensibility that combines ideas about what is morally right with ideas about what is aesthetically compelling. Drawing on ethnographic research among SPs and SP program staff and medical faculty who work closely with them, this article argues that their work of creating “realism” in simulated clinical encounters encompasses multiple different (and sometimes conflicting) understandings and practices of realism, informed by three different moral aesthetics: (1) a moral aesthetic of induction, in which an accurate portrayal with a well-documented provenance serves to introduce experientially distant forms of suffering; (2) a moral aesthetic of inoculation, in which the authenticity and emotional impact of a performance are meant to inoculate students against the impact of future encounters with suffering; (3) a moral aesthetic of presence, generating forms of voice and care that are born out of the embodied presence of suffering individuals in a clinical space. All are premised on the assumption that risk and suffering can be banished from SP performances. This article suggests, however, that SP performances necessarily raise the same difficult, important, fundamentally ethical questions that are always involved in learning from and on human beings who are capable of suffering, and who need and deserve recognition and respect as well as care.     

Nonspecific yet decisive: Ubiquitination can affect the native‐state dynamics of the modified protein

Ubiquitination is one of the most common post‐translational modifications of proteins, and mediates regulated protein degradation among other cellular processes. A fundamental question regarding the mechanism of protein ubiquitination is whether and how ubiquitin affects the biophysical nature of the modified protein. For some systems, it was shown that the position of ubiquitin within the attachment site is quite flexible and ubiquitin does not specifically interact with its substrate. Nevertheless, it was revealed that polyubiquitination can decrease the thermal stability of the modified protein in a site‐specific manner because of alterations of the thermodynamic properties of the folded and unfolded states. In this study, we used detailed atomistic simulations to focus on the molecular effects of ubiquitination on the native structure of the modified protein. As a model, we used Ubc7, which is an E2 enzyme whose in vivo ubiquitination process is well characterized and known to lead to degradation. We found that, despite the lack of specific direct interactions between the ubiquitin moiety and Ubc7, ubiquitination decreases the conformational flexibility of certain regions of the substrate Ubc7 protein, which reduces its entropy and thus destabilizes it. The strongest destabilizing effect was observed for systems in which Lys48‐linked tetra‐ubiquitin was attached to sites used for in vivo degradation. These results reveal how changes in the configurational entropy of the folded state may modulate the stability of the protein's native state. Overall, our results imply that ubiquitination can modify the biophysical properties of the attached protein in the folded state and that, in some proteins, different ubiquitination sites will lead to different biophysical outcomes. We propose that this destabilizing effect of polyubiquitin on the substrate is linked to the functions carried out by the modification, and in particular, regulatory control of protein half‐life through proteasomal degradation.