The Clinic and Elsewhere: Illness,Sexuality, and Social Experience Among Young African American Men in Baltimore,Maryland

This paper is concerned with how disclosure becomes self-production for young adults within the setting of the sexually transmitted disease (STD) clinic. The STD clinic is a special medical environment where the process of disclosure is not just a way of accessing treatment; it is also a process through which illness, sexuality, and social experience become entangled in telling. Illness according to medical categories is reshaped in the social world, bringing a different set of criteria to bear on the definition of illness. The concern we raise regards how meaning is secured simultaneously through the experience of illness and social relations. Using data from a series of clinic-based ethnographic interviews, we examine the narratives of three young men. Together, the narratives demonstrate the interrelatedness of illness and self-production in various forms. In one case the tension between interpersonal violence and self-preservation is central. In another, the place of knowledge in family relationships renders the entire picture of the social unstable. The paper signals a number of issues absent in clinical and epidemiological depictions of vulnerability, particularly in the context of the urban United States.     

Mad, Bad or Heroic? Gender, Identity and Accountability in Lay Portrayals of Suicide in Late Twentieth-Century England

Suicide research has relied heavily on the psychological autopsy method, which uses interviews with the bereaved to ascertain the mental health status of the deceased prior to death. The resulting data are typically interpreted within a clinical diagnostic framework, which reinforces psychiatric assumptions concerning the ubiquity of mental illness amongst those who take their own lives. The ways in which informants reconstruct the past and the meanings they attach to events preceding the suicide are rarely examined. This paper uses qualitative methods to analyse the narratives given by bereaved people in an English psychological autopsy study, in order to understand how they made sense of a family member's suicide. Some clear differences between the portrayal of male and female suicides emerged. The paper discusses the gendering of agency and accountability in relation to the differential medicalisation of male and female distress in the UK, and suggests that a preoccupation with mental illness in suicide research may have obscured other culturally normative understandings of self-accomplished death.     

Examining Interactions across Language Modalities: Deaf Children and Hearing Peers at School

Deaf youth easily become communicatively isolated in public schools, where they are in a small minority among a majority of hearing peers and teachers. This article examines communicative strategies of deaf children in an American "mainstream " school setting to discover how they creatively manage their casual communicative interactions with hearing peers across multimodal communicative channels, visual and auditory. We argue that unshared sociolinguistic practices and hearing-oriented participation frameworks are crucial aspects of communicative failure in these settings. We also show that what look like "successful" conversational interactions between deaf and hearing children actually contain little real language and few of the complex communication skills vital to cognitive and social development. This study contributes to understanding the social production of communicative isolation of deaf students and implications of mainstream education for this minority group.     

Patients' accounts of being removed from their general practitioner's list: qualitative study

Objective To explore patients'' accounts of being removed from a general practitioner''s list.Design Qualitative analysis of semistructured interviews.Setting Patients'' homes in Leicestershire.Participants 28 patients who had recently been removed from a general practitioner''s list.Results The removed patients gave an account of themselves as having genuine illnesses needing medical care. In putting their case that their removal was unjustified, patients were concerned to show that they were “good” patients who complied with the rules that they understood to govern the doctor-patient relationship: they tried to cope with their illness and follow medical advice, used general practice services “appropriately,” were uncomplaining, and were polite with doctors. Removed patients also used their accounts to characterise the removing general practitioner as one who broke the lay rules of the doctor-patient relationship. These “bad” general practitioners were rude, impersonal, uncaring, and clinically incompetent and lied to patients. Patients felt very threatened by being removed from their general practitioner''s list; they experienced removal as an attack on their right to be an NHS patient, as deeply distressing, and as stigmatising.Conclusions Removal is an overwhelmingly negative and distressing experience for patients. Many of the problems encountered by removed patients may be remediable through general practices having an explicit policy on removal and procedures in place to help with “difficult” patients.     

Family Expressed Emotion in a Javanese Cultural Context

This study aims at understanding the emotional milieu of families of psychotic patients, focusing on the concept of expressed emotion (EE). A combination of ethnographic and clinical methodology was employed. During the fieldwork in Yogyakarta, Indonesia, nine participants diagnosed as having first episode psychosis and their families were followed closely over the course of 1 year in their natural home setting. Through ongoing engagement with families, the researcher was able to gather data on the diversity of family responses to illness. Despite the fact that most families in this research could be considered to have low EE, ethnographic observation provided a more complex and nuanced picture of family relationships. This article discusses four issues concerning EE in relation to Javanese culture: the role of interpretation, the coexistence of criticism and warmth, the interpretation of boundary transgression, and the cultural concept of warmth and positive remark.     

Misunderstanding as therapy: Doctors,patients and medicines in a rural clinic in Sri Lanka

In this paper I want to draw attention to the integration of Western medicine into therapeutic choices among patients in rural Sri Lanka. These patients' interpretation and use of Western pharmaceuticals is discussed in relation to the Ayurvedic theory of balance. The influence of this theory on people's ideas of health and illness is highlighted in encounters where laymen and professionals alike use Western medicines according to context and their respective perspectives. Such therapeutic encounters are used to describe how the meaning of therapy is negotiated and communicated. The modes of perception used by doctors and patients seem to be mutually exclusive but each has its own logic. Western medicines are used as a symbolic means which help the patients and the practitioners of Western clinical medicine in a rural health unit to communicate through — rather than despite — misunderstandings based on their differing cultural assumptions about the body, about disease and about therapy. This argument is raised in relation to recent theoretical discussions among medical anthropologists concerning doctor-patient relationships, asymmetric medical relations and the analysis of meaning systems     

Immunofluorescent staining method for use with monoclonal antibodies

This note describes an immunofluorescent staining method for cells in the S-phase which have been allowed to take up bromodeoxyuridine into their DNA in place of thymine. The technique involves the use of fluorescinated monoclonal antibodies against bromodeoxyuridine and allows rapid and accurate estimation of cells in the S-phase, the technique does not require interpretation by skilled technicians.     

Toward a Puerto Rican Popular Nosology: Nervios and Ataque de Nervios

This paper is about naming illnesses—about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come from the responses to a series of open-ended questions which tapped into people's general conceptions of nervios and ataques de nervios. These questions were incorporated into follow-up interviews to an epidemiological study of the mental health of adults in Puerto Rico. The results suggest ways to incorporate these different categories of nervios into future research and clinical work with different Latino groups in the United States and in their home countries.     

Context, ethics and pharmacogenetics

Most of the literature on pharmacogenetics assumes that the main problems in implementing the technology will be institutional ones (due to funding or regulation) and that although it involves genetic testing, the ethical issues involved in pharmacogenetics are different from, even less than, 'traditional' genetic testing. Very little attention has been paid to how clinicians will accept this technology, their attitudes towards it and how it will affect clinical practice. This paper presents results from interviews with clinicians who are beginning to use pharmacogenetics and explores how they view the ethics of pharmacogenetic testing, its use to exclude some patients from treatment, and how this kind of testing fits into broader debates around genetics. In particular this paper examines the attitudes of breast cancer and Alzheimer's disease specialists. The results of these interviews will be compared with the picture of pharmacogenetics painted in the published literature, as a way of rooting this somewhat speculative writing in clinical practice.     

Metaphors of glaucoma

In a phenomenological study of glaucoma as an illness, 31 patients were interviewed. The goal of the study was an explication of the meanings of the experience of glaucoma, in a twofold sense: (1) the face, the role, or the self of the patient that responds to the illness; (2) the visage that the illness presents to the patient. This twofold explication was achieved by generating a classification of the interviews in terms of the dominant metaphor that emerged in each interview. The following basic metaphors are presented through case material: glaucoma as an accompaniment of aging, as blindness, as pressure, as an abstraction (and a weapon), and as fate. Variations on these themes demonstrate the necessity, in such work and for enhanced communication with patients, of paying attention to both the face that the illness presents and to the self that responds.     

Controlling death--compromising life: chronic disease, prognostication, and the new biotechnologies

Within the modern culture of control, patients and physicians seek to actively shape the uncertainty of prognostications concerning the course of disease and the anticipated effects of therapeutic and surgical interventions. This article discusses the results of a three-year ethnographic study of persons with cystic fibrosis (CF) who undergo double-lung transplant. It draws on interviews with a difficult-to-access patient group, adult CF sufferers, and investigates their dilemmas with regard to having or not having a double-lung transplant. It situates their decisions within a complex framework: the denial of death and disability in technological modernity, the consequent emphasis on cure and saving life at any cost, rather than the management of chronic illness, the extent to which health and illness constitute identity, and the problems of CF patients conceiving their life narrative when life will be short. This framework produces two key questions: Do patient beliefs in the progress narratives of medicine overshadow other considerations, and are biotechnologies such as organ transplant a calculated gamble on a better life or an uncertain reliance on biomedical expertise? I argue that risk interpretation is heavily influenced by the constant introduction of new therapeutics that intersect with social technologies of normalization to strongly influence patient decisions concerning the pursuit of high-risk surgeries such as organ transplant, surgeries that sometimes hasten a patient's decline and death.     

Specific translocation t(4;11) in an infant with acute lymphoblastic leukaemia of null cell type

A case of acute lymphoblastic leukaemia of null cell type in infancy showed the specific reciprocal translocation t(4;11) (q21;q23) reported 16 times so far in the world literature. The proportions of abnormal and normal metaphases throughout the course of the illness correlated well with the clinical picture, but even during the short term remission metaphases expressing the translocation were still identifiable in appreciable numbers. Comparison between cytogenetic analyses of cultured and native bone marrow, PHA-stimulated and non-stimulated peripheral blood demonstrated the gradual conquest of the periphery by the abnormal clone. The importance of chromosomal changes and their interpretation for diagnosis, classification and prognostic judgment in haemotologic neoplasms is discussed in the light of the reported case.     

Deciphering the evolution of metallo-β-lactamases: A journey from the test tube to the bacterial periplasm

Understanding the evolution of metallo-β-lactamases (MBLs) is fundamental to deciphering the mechanistic basis of resistance to carbapenems in pathogenic and opportunistic bacteria. Presently, these MBL-producing pathogens are linked to high rates of morbidity and mortality worldwide. However, the study of the biochemical and biophysical features of MBLs in vitro provides an incomplete picture of their evolutionary potential, since this limited and artificial environment disregards the physiological context where evolution and selection take place. Herein, we describe recent efforts aimed to address the evolutionary traits acquired by different clinical variants of MBLs in conditions mimicking their native environment (the bacterial periplasm) and considering whether they are soluble or membrane-bound proteins. This includes addressing the metal content of MBLs within the cell under zinc starvation conditions and the context provided by different bacterial hosts that result in particular resistance phenotypes. Our analysis highlights recent progress bridging the gap between in vitro and in-cell studies.     

In what sense is contemporary medicine dualistic?

Medicine's inability to humanely respond to the concerns of its patients has often been attributed to its Cartesian dualism of mind and body. More recently, this inability has been ascribed to medicine's penchant for isolating biological disease as its sole proper concern to the exclusion of experienced illness. This dualism of disease and illness is claimed to be an outgrowth of the Cartesian dualism but the differences and similiarities between these two forms of dualism is not clear. This paper seeks to clarify their relationship through an examination of their historical origins.Disease is currently identified and characterized by a process of clinico-pathological correlation. By this means clinical impressions are corrected in light of autopsy findings. Our current mode of clinico-pathological correlation originated in Paris in the early nineteenth century with the work of Xavier Bichat and others. The theory of knowledge implicit within this clinico-pathological approach to the body is described and compared to that of Descartes. Though medicine does pursue certain Cartesian goals for knowledge, such as knowledge of the patient that does not rely upon his candor, it ultimately espouses neither a Cartesian theory of knowledge nor a Cartesian theory of the body. With pathological inquiry modeled after the autopsy as the final word in the identification and characterization of disease, the patient's capacity for self-knowledge and interpretation — not an entity called mind — is isolated away from his body. This approach to the body means that objective evidence of disease is valued to the exclusion of subjective evidence.If the shortcomings of modern biomedicine are to be effectively addressed, not only must the interdependence of disease and illness be acknowledged. The very canons of medical evidence must be revised. Subjective evidence must be rehabilitated and rejuvenated with better methods of subjective clinical investigation. Host factors relevant to the healing and knowing of sickness must be elucidated so that medicine may rediscover the sentience of its patients. Department of Psychiatry and Behavioral Sciences University of Washington Seattle, WA 98195, U.S.A.     

Conception d'un logiciel de traitement et d'interrogations statistiques de donnees logist

This paper presents a general program which cannot only be used for the treatment and the statistical interrogations, but also for basic operations, such as validity check and the preparation of data which is often necessary for other programs. Its use language is simple, suitable and accessible to non-specialists. The program is sufficiently complete so that it can treat some complex problems without requiring complementary programs. It can treat several problems simultaneously. This allows one to gain data-reading time and the program is therefore economical. Its domain of use is large: epidemiological studies, psychological and sociological investigations, biological studies, clinical research, chronological follow-up, examinations of faculties, ….The program is written in FORTRAN IV and thus transferable. It contains more than 25 000 instructions but needs limited place in the core memory (less than 64 000 words). Its structure allows further evolution and addition of new procedures or new methods. A transformation into a conversational form is considered.     

A harmony of illusions: clinical and experimental testing of Robert Koch’s tuberculin 1890–1900

One of Ludwik Fleck’s ideas about the development of scientific knowledge is that—once a system of interpretation is in place—the process that follows can be characterised as one of inertia: any new evidence comes under a strong pressure to be incorporated into the established frame. This can result in what Fleck called a harmony of illusions (Harmonie der Täuschungen) when contradictory evidence becomes almost invisible or is incorporated into the established frame only by huge efforts.The paper analyses early explanations of the tuberculin reaction as a case study of Fleck’s argument. For Robert Koch, who had presented tuberculin in 1890, the compound was supposed to be a diagnostic tool and a cure for tuberculosis. His conception of its effect was rather peculiar, but strictly in line with ideas on the pathogenesis of infectious diseases he had developed much earlier. After tuberculin was released in late 1890, whether Koch’s conception was convincing depended on the place that a given observer had in the medical world in late-nineteenth-century Germany. Inside Koch’s group, the status of the tuberculin reaction remained stable and tuberculin retained its value as a diagnostic and curative tool. On the other hand, observers from outside that thought collective, and in particular from clinical medicine, soon pointed to flaws in its conception. These critics developed a rather different picture of tuberculin as a mysterious and dangerous drug. No reconciliation followed and what we find instead in German medicine around the year 1900 is the presence of rather contradictory concepts and practices surrounding Koch’s wonder cure.     

Epistemic Contextualism and Recognising Knowledge across Cultures

Epistemic contextualism is the view that our attributions of knowledge are sensitive to changes in conversational context. Since conversational contexts can vary radically across cultures, contextualism shows that recognising knowledge in other cultures is more complicated than we may have thought. This paper explores our practices of recognizing knowledge in light of contextualism.