The Other Side of Medicalization: Self-Medicalization and Self-Medication

The concept of medicalization has given rise to considerable discussion in the social sciences, focusing especially on the extension of medicine’s jurisdiction and its hold over our bodies through the reduction of social phenomena to individual biological pathologies. However, the process leading to medical treatment may start when individuals engage in self-medication and thus practice “self-medicalization.” But, can we apply to this concept the same type of analysis as the first and see merely the individual’s replication of the social control mechanisms to which he/she usually falls victim? This article aims to demonstrate that the medicalization individuals practice on themselves takes on a completely different meaning to that practiced by the medical profession. Empirical data collected in France show that self-medicalization, which may involve treating a problem medically when doctors believe it to be of a non-medical nature, can be an attempt by individuals to furnish a social explanation for their somatic problems and experiences. In this article, I examine the social and political significance of this phenomenon.     

Combining field work and laboratory work in the study of financial risk-taking

A contribution to a special issue on Hormones and Human Competition.Financial markets are periodically destabilized by bubbles and crashes during which investors display respectively what has been called “irrational exuberance” and “irrational pessimism”. How can we best study these pathologies in competitive and risk-taking behaviours? In this article, we argue that a science of risk-taking and of the financial markets needs to draw heavily on physiology and especially endocrinology, due to their central roles in moderating human behaviour. Importantly, this science of competition and risk requires the same spectrum of research protocols as is found in mature biological and medical sciences, a spectrum running from field work conducted within financial institutions themselves to more controlled laboratory studies, which permit cause to be distinguished from effect. Such a spectrum of studies is especially important for translational behavioural science.     

Physical enhancement of human performance: Is law keeping pace with science?

In the area of genometry—the nascent field of science and technology that proposes to apply enhanced understanding of the human genetic code to reshaping our individual and collective destinies—no topic has generated more interest among the general public, as well as in the athletic community, than the potential for physical enhancement of the human body and its performance. Genometric experiments have produced physically enhanced mice, and the production of similarly enhanced humans may not be far off. Although it is not the objective of most genometric research, the day will come when gene-based “treatments” will enable individuals to build muscle or increase endurance faster than is possible through conventional methods. This article describes developments in the area of physical enhancement that may find application in the “gene doping” of athletes. For example, human performance-related genes may be delivered to athletes using tools developed for research in gene therapy; the protein products of these genes may be administered in recombinant form; and recently discovered small-molecule activators of the major genetic regulatory pathways of physical prowess may be taken orally, providing “exercise in a pill”. This article also describes US and international attempts to regulate and punish the use of prohibited techniques for performance enhancement among athletes. As science advances, defining and detecting “gene doping” becomes increasingly complex. Thus, the study of physical enhancement provides an ideal starting point for the interdisciplinary Redefined Destinies Colloquium's examination of the intersection between law and science.     

Doing Resilience with “Half a Brain:” Navigating Moral Sensibilities 35 Years After Hemispherectomy

This paper investigates experiences of resilience in the context of individuals suffering from disability as a result of severe intractable seizure disorder and consequent hemispherectomy, a surgical procedure in which part or all of either the left or right cerebral hemisphere is removed. Two adults who underwent childhood hemispherectomies—one left and one right—are the focus of this study. Previous research has extensively detailed the clinical outcomes of this neurological procedure, yet the actual day-to-day experiences of individuals living post-hemispherectomy remains unexplored. Utilizing open-ended, qualitative, and narrative techniques from a phenomenology of performativity perspective, the authors question how each individual’s experiences of daily living are invariably acts of resilience, involving several different strategies that are somewhat unique to each. Rather than working as an adjective or noun signifying certain environmental or individual attributes, this paper proposes that “resilience” is best conceptualized as the individualized intentional actions which disabled, distraught, or at risk individuals perform in contextually relevant and idiosyncratic ways as they navigate health and well-being within their local social and moral worlds.     

Disability and <Emphasis Type="Italic">Depression</Emphasis>

Here, Ann Cvetkovich, interviewed by Abby Wilkerson, brings Cvetkovich’s influential cultural studies analysis of depression explicitly into conversation with disability studies. Cvetkovich understands “feeling bad” (a term she prefers to “depression”) as a defining affective state under neoliberalism. Drawing on a distinctive historical/cultural archive, she challenges the atomism of the neoliberal medical model that frames depression and affective distress more generally as the result of faulty brain chemistry—individual organisms gone awry. Instead, she traces these common experiences to sociopolitical phenomena ranging from current neoliberal demands for productivity as exemplified in university life, to histories of colonization, slavery, and displacement. The conversation considers the value of disability frameworks for understanding mental health diagnoses and the intersections of social institutions, bodily practices, and everyday affective life.     

The Practical Application of Narrative Medicine at Mayo Clinic: Imagining the Scaffold of a Worthy House

American health care institutions increasingly recognize narrative medicine as a means to developing quality patient care. More commonly applied in health care professional development settings, narrative medicine is less overtly employed with patient populations. In this article, we describe the application of various narrative practices in the patient care and medical education programs of a major health care center in Minnesota. We discuss the impact of these programs on their participants in relation to the evidence based in current scholarship. Further, we examine narrative externalization of illness in Katherine Butler Hathaway’s disability memoir “The Little Locksmith,” a text which implicates the work of metaphor-making as a transformative step in healing. While several reports demonstrate that patients can find creative writing during times of illness to be therapeutic, there are many for whom the practice is problematic or unattractive, obstacles to practice implementation that the authors discuss. However, based on the experience of our institution, for health care institutions seeking to build a legacy of leadership in empathic patient care, narrative—employed in mentoring physicians in training and in establishing strong, dialogic relationships with patients and colleagues—should serve as a central strategy, or scaffold.     

Reconciling “stress” and “health” in physical anthropology: What can bioarchaeologists learn from the other subdisciplines?

The concepts of “stress” and “health” are foundational in physical anthropology as guidelines for interpreting human behavior and biocultural adaptation in the past and present. Though related, stress and health are not coterminous, and while the term “health” encompasses some aspects of “stress,” health refers to a more holistic condition beyond just physiological disruption, and is of considerable significance in contributing to anthropologists' understanding of humanity's lived experiences. Bioarchaeological interpretations of human health generally are made from datasets consisting of skeletal markers of stress, markers that result from (chronic) physiological disruption (e.g., porotic hyperostosis; linear enamel hypoplasia). Non-specific indicators of stress may measure episodes of stress and indicate that infection, disease, or nutritional deficiencies were present in a population, but in assessing these markers, bioarchaeologists are not measuring “health” in the same way as are human biologists, medical anthropologists, or primatologists. Rather than continue to diverge on separate (albeit parallel) trajectories, bioarchaeologists are advised to pursue interlinkages with other subfields within physical anthropology toward bridging “stress” and “health.” The papers in this special symposium set include bioarchaeologists, human biologists, molecular anthropologists, and primatologists whose research develops this link between the concepts of “stress” and “health,” encouraging new avenues for bioarchaeologists to consider and reconsider health in past human populations. Am J Phys Anthropol 155:181–185, 2014. © 2014 Wiley Periodicals, Inc.     

Israel: The making of self in the “pioneering” of the nation

The Zionist project was more than a simple “ingathering” of people. All Jews by birth, those who reached Palestine in the early decades of this century were swept into the making of a “new” people with a “new” ethic and a “new” discipline—out of which would emerge the “old‐new” state of Israel. The present article addresses this multiple process with its strains and contradictions, as experiences by the “pioneer” generation and their Palestinian‐born children—the sabra.     

Communication and collective action: language and the evolution of human cooperation

All social species face various “collective action problems” (CAPs) or “social dilemmas,” meaning problems in achieving cooperating when the best move from a selfish point of view yields an inferior collective outcome. Compared to most other species, humans are very good at solving these challenges, suggesting that something rather peculiar about human sociality facilitates collective action. This article proposes that language — the uniquely human faculty of symbolic communication — fundamentally alters the possibilities for collective action. I explore these issues using simple game-theoretic models and empirical evidence (both ethnographic and experimental). I review several standard mechanisms for the evolution of cooperation — mutualism, reciprocal altruism, indirect reciprocity and signaling — highlighting their limitations when it comes to explaining large-group cooperation, as well as the ways in which language helps overcome those limitations. Language facilitates complex coordination and is essential for establishing norms governing production efforts and distribution of collective goods that motivate people to cooperate voluntarily in large groups. Language also significantly lowers the cost of detecting and punishing “free riders,” thus greatly enhancing the scope and power of standard conditional reciprocity. In addition, symbolic communication encourages new forms of collectively beneficial displays and reputation management — what evolutionists often term “signaling” and “indirect reciprocity.” Thus, language reinforces existing forces that favor the evolution of cooperation, as well as creating new opportunities for collective action not available even to our closest primate relatives.     

Plasticity of plant defense and its evolutionary implications in wild populations of Boechera stricta

Phenotypic plasticity is thought to impact evolutionary trajectories by shifting trait values in a direction that is either favored by natural selection (“adaptive” plasticity) or disfavored (“nonadaptive” plasticity). However, it is unclear how commonly each of these types of plasticity occurs in natural populations. To answer this question, we measured glucosinolate defensive chemistry and reproductive fitness in over 1500 individuals of the wild perennial mustard Boechera stricta, planted in four common gardens across central Idaho, United States. Glucosinolate profiles—including total glucosinolate concentration as well as the relative abundances and overall diversity of different compounds—were strongly plastic both among habitats and within habitats. Patterns of glucosinolate plasticity varied greatly among genotypes. Plasticity among sites was predicted to affect fitness in 27.1% of cases; more often than expected by chance, glucosinolate plasticity increased rather than decreased relative fitness. In contrast, we found no evidence for within‐habitat selection on glucosinolate reaction norm slopes (i.e., plasticity along a continuous environmental gradient). Together, our results indicate that glucosinolate plasticity may improve the ability of B. stricta populations to persist after migration to new habitats.     

Ostracism as a social and biological phenomenon: An introduction

Ostracism refers to the general process of rejection and exclusion, observed in human groups and in many other species. It occurs as “shunning” in small homogenous groups like the Amish or as rejection among children. Ostracism in various forms is also deeply embedded in our own legal tradition, and is used in the formal and informal legal procedures of other cultures, used to maintain order, to punish deviance, and to increase social cohesion. Hence, it is plausible to hypothesize that human ostracism may have physiological substrates or biological functions in addition to cultural, moral, and legal dimensions. Biological research shows that human emotions (anger, fear, reassurance, self-confidence) involve responses of the limbic system as well as ideas or thoughts in the cerebral cortex and that human behavior continually integrates biological and cultural factors. The legal system expresses and channels human behavior. For this reason laws should be more effective if their functions complement (rather than ignore) the function of the behavior being regulated. To look at law as it affects human behavior in the light of the life sciences does not imply the intention of finding a universally valid “natural law,” akin to theological or ideological doctrine. On the contrary, we find that humans can form radically different social systems due to the plasticity of their behavior. However, an interdisciplinary analysis of ostracism as a common area of behavior, combining biology, law, and the social sciences can produce insights that none of these fields alone can provide. Such an approach should increase our understanding of human nature and the functions of law.     

Invasion ecology goes to town: from disdain to sympathy

How can one understand the increasing interest in “urban invasions”, or biological invasions in urban environments? We argue that interest in urban invasions echoes a broader evolution in how ecologists view “the city” in relation to “the natural”. Previously stark categorical distinctions between urban and natural, human and wild, city and ecology have floundered. Drawing on conceptual material and an analysis of key texts, we first show how the ecological sciences in general—and then invasion science in particular—previously had a blind spot for cities, despite a number of important historical and continental European exceptions. Then, we document the advent of an urban turn in ecology and, more recently, in invasion ecology, and how this has challenged fundamental concepts about “nativity”, “naturalness”, and human agency in nature. The urban turn necessitates more explicit and direct attention to human roles and judgements. Ecology has moved from contempt (or indifference) for cities, towards interest or even sympathy.     

Lessons from EEO: Toward a Universal Evolutionary Curriculum

We propose a human-centered evolutionary curriculum based around the three questions: Who am I? Where do I come from? How do I fit in? We base our curriculum on our experiences as an evolutionary biologist/paleontologist (NE) and as a secondary level special education science teacher (GE)—and not least from our joint experience as co-editors-in-chief of this journal. Our proposed curriculum starts and ends with human biology and evolution, linking these themes with topics as diverse as the “tree of life” (systematics), anthropology, Charles Darwin, cultural evolution, ecology, developmental biology, molecular evolution/genetics, paleontology, and plate tectonics. The curriculum is “universal” as it is designed to be taught at all levels, K–16. The curriculum is flexible: “modules” may be expanded and contracted, reordered, or modified to fit specific grade level needs—and the requirements and interests of local curricula and teachers. We further propose that students utilize workbooks from online or printed sources to investigate the local answers to the general questions (e.g., “Who am I?”), while classroom instruction is focused on the larger scale issues outlined in the modules of our curriculum.     

Genes,symptoms, and the “asymptomatic ill”: toward a broader understanding of genetic discrimination

Since the early 1990s, the term “genetic discrimination” has been used to designate adverse treatment on the grounds of genetic makeup. However, the full spectrum of possible disadvantage associated with genetic information has not been addressed by either the international scientific debate or statutory arrangements on genetic discrimination. Informed by legal contexts, they almost all focus on one specific group: the “asymptomatic ill.” On the basis of the sociological study, “Genetic Discrimination in Germany,” this article proposes to revise the terms of the debate and discusses some limitations of the concept. Drawing on the experiences reported by affected individuals, it advocates a more expansive social understanding which does not require that a person has to be healthy to be at risk of genetic discrimination.     

Patrolling Your Blind Spots: Introspection and Public Catharsis in a Medical School Faculty Development Course to Reduce Unconscious Bias in Medicine

Cultural competence education has been criticized for excessively focusing on the culture of patients while ignoring how the culture of medical institutions and individual providers contribute to health disparities. Many educators are now focusing on the role of bias in medical encounters and searching for strategies to reduce its negative impact on patients. These bias-reduction efforts have often been met with resistance from those who are offended by the notion that “they” are part of the problem. This article examines a faculty development course offered to medical school faculty that seeks to reduce bias in a way that avoids this problem. Informed by recent social–psychological research on bias, the course focuses on forms of bias that operate below the level of conscious awareness. With a pedagogical strategy promoting self-awareness and introspection, instructors encourage participants to discover their own unconscious biases in the hopes that they will become less biased in the future. By focusing on hidden forms of bias that everyone shares, they hope to create a “safe-space” where individuals can discuss shameful past experiences without fear of blame or criticism. Drawing on participant-observation in all course sessions and eight in-depth interviews, this article examines the experiences and reactions of instructors and participants to this type of approach. We “lift the hood” and closely examine the philosophy and strategy of course founders, the motivations of the participants, and the experience of and reaction to the specific pedagogical techniques employed. We find that their safe-space strategy was moderately successful, largely due to the voluntary structure of the course, which ensured ample interest among participants, and their carefully designed interactive exercises featuring intimate small group discussions. However, this success comes at the expense of considering the multidimensional sources of bias. The specific focus on introspection implies that prior ignorance, not active malice, is responsible for biased actions. In this way, the individual perpetrators of bias escape blame for their actions while the underlying causes of their behavior go unexplored or unaccounted for.     

Reproduction humaine: le point de vue du philosophe

This article discusses and essential aspect of the link between ethics and life, as expressed in the concept of bioethics. It discusses the various issues related to human reproduction from “the philosopher’s point of view”. This discussion is limited to the principles of this field. The author starts by justifying a philosophical approach to ethical problems in the context of medicine in general and reproduction in particular, a field which specialists, theoreticians or practitioners of medicine and legal medicine in particular, appear to have ignored. This leads to a discussion of the human aspects of reproduction, from questions concerning the nature of living beings (individuals and species) to the relationship between nature and culture (symbol and freedom). Although man “reproduces” and “procreates”, he is also technically able to “produce himself”. This shift from biological reproduction to procreation must take into account problems related to technological science in medicine (technical control of living material and so-called “neutrality” of the technique). The main bioethical issues involving an ethics of decision-making in the field of human reproduction (contraception, abortion, status of the embryo, medically-assisted procreation, desire to master the “form” of the “reproduced” human, or even the “product”, cloning) are then discussed. Finally, the author proposes elements of a “philosophy of point of view”, requiring responsibility for each decision in the context of an “ethics of discussion”.     

Law as Clinical Evidence: A New ConstitutiveModel of Medical Education and Decision-Making

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion.     

On Some Problems in Measuring Change on Ordinal Data

Two designs frequently occurring in biomedicine and social sciences are considered—the “experts”/“objects”—design consisting in ranking M fixed “objects” by each of N “experts” before and after an intervention, and the rating-scale-design in which N judges are asked to assign one of K given lables, constituting the rating-scale, before and after an intervention. Nonparametric test procedures are proposed for evaluating the treatment effect.     

Consequences of colonialism: A microbial perspective to contemporary Indigenous health

Nearly all Indigenous populations today suffer from worse health than their non‐Indigenous counterparts, and despite interventions against known factors, this health “gap” has not improved. The human microbiome—the beneficial, diverse microbial communities that live on and within the human body—is a crucial component in developing and maintaining normal physiological health. Disrupting this ecosystem has repercussions for microbial functionality, and thus, human health. In this article, we propose that modern‐day Indigenous population health may suffer from disrupted microbial ecosystems as a consequence of historical colonialism. Colonialism may have interrupted the established relationships between the environment, traditional lifeways, and microbiomes, altering the Indigenous microbiome with detrimental health consequences.