“How I Floated on Gentle Webs of Being”: Psychiatrists Stories About the Mental Health Treatment Gap in Africa

A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this ‘gap’ in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners ‘on the ground’. Employing a narrative-based approach, I accessed the stories about the mental health ‘treatment gap’ of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the ‘treatment gap’ was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health ‘treatment gap’ in Africa in ways very different from those created by current seats of power.     

The cholera epidemics and the development of public health in Meiji Japan. 1. Modernity, cholera, and health thought

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show, that in Japan as well as in Western nations, public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.     

The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.     

Defusing the population bomb in the 1950s: Foam tablets in India

After the World War II era, Western experts explained that the progress of medicine, which had led to a decrease in mortality in developing countries ('control of death') was not accompanied by a parallel decrease in birth rates ('control of life'). This conjunction, they warned, would lead inexorably to population explosion and its terrifying consequences: famines, riots, political instability, expansion of Communism, wars. A heterogenous coalition of demographers, public health experts and politicians was urgently looking for an effective means to curb population growth. In the 1950s, many of them considered that mass distribution of foam tablets, a local contraceptive presented as simple to use, cheap and efficient, was a possible solution for the population crisis. At the same time, a potential opening of huge markets for this product generated intense competition among manufacturers and attempts to disqualify competing preparations as inefficient and dangerous for health. Struggles around the marketing of foam tablets, especially in India, reveal a unique combination of science, medicine, cold war politics, philanthropy and business. The presumed commercial and social potential of foam tablets was never fulfilled, due to the unreliability both of the product itself and of its 'backward' users, who either refused this contraceptive mean, or abandoned it promptly.     

Technologies of Visibility: The Utopian Politics of Cameras,Televisions, Videos and Dreams in New Britain

This paper explores how Melanesian villagers have harnessed modern, technological ways of seeing. It begins by analysing the politics and narrative structures of dreams and popular stories about secret photos concerning the dead. These are stories about losing control and regaining hidden, alternative representations of Melanesians. I then analyse how millenarian followers have experimented with ‘constructing’ their own versions of cameras, televisions and videos so as to gain access to the omniscient powers of modern technology and merge them with those of a Christian god and with the gaze of the dead. In the Pomio Kivung movement, ‘televisions' and ‘videos' have even been used to create new forms of moral surveillance for policing and governing communities. Here the customary shamanic worlds of dreams and possession have been modernised and redeployed to re‐mediate the governmental practices and disciplinary schemes of civilisating projects originally belonging to Western churches and government.     

Taking the devil into your mouth: ritualized American weight-loss narratives of morality, pain, and betrayal

Abstract:This article examines narratives of the U.S. Christian weight-loss movement alongside secular U.S. weight-loss narratives and explores how these two movements express similar themes. In particular, I investigate shared themes of sin, the impurity of the body, the body as a temple for the self (a temple that can be defiled), salvation, and the need to prove that one is saved or at least trying to be saved. Through examining stories from individuals who have lost weight and popular dieting advice, I explore how a "spiritual hunger" that is essentially unrelated to physiology but that suggests personal pathology and responsibility is central to mainstream stories of weight loss.     

What Are the Roles and Responsibilities of the Media in Disseminating Health Information?

BACKGROUND TO THE DEBATE: In December 2004 three news stories in the popular press suggested that the side effects of single-dose nevirapine, which has been proven to prevent mother-to-child transmission of HIV, had been covered up. Many HIV experts believed that the stories were unwarranted and that they would undermine use of the drug, leading to a rise in neonatal HIV infection. The controversy surrounding these stories prompted the PLoS Medicine editors to ask health journalists, and others with an interest in media reporting of health, to share their views on the roles and responsibilities of the media in disseminating health information.     

Religion,ethnicity and politics: Hindu and Muslim Indian immigrants in the United States

This article focuses on the political struggles between Hindu and Muslim Indian immigrant groups in the United States over the definition of "Indianness". Hindu Indian American organizations define India as a Hindu society and are strong supporters of the Hindu nationalist movement in India. Muslim Indian American organizations, on the other hand, view India as a multi-religious and multicultural society. They are striving to safeguard India's secularism and towards this end, have entered into coalitional relationships with lower caste groups. Both types of organizations are working to influence American and Indian politics in line with their respective interests, leading to an exacerbation of the conflict between the two immigrant groups. This article examines the reasons for this development and its implications, both for the development of an Indian American community in the United States and for religion and politics in India.     

The sex reform movement and eugenics in interwar Poland

This paper focuses on the relations between a liberal group of sex reformers, consisting of writers and literary critics, and physicians from the Polish Eugenics Society in interwar Poland. It illustrates the paradoxes of the mutual co-operation between these two groups during the 1930s and analyses the reason why compulsory sterilisation was rejected by politicians. From the early 1930s two movements began to forge an alliance in Poland: the sexual reform movement which advocated freedom of the individual, and eugenics, which called for limiting the freedom of the individual for the collective good. This paper draws attention to several issues which emerged as part of this collaboration: population politics, the relationship between reformers, eugenicists and state institutions, and the question of how both movements--eugenics and sexual reform--perceived the question of sexuality, birth control and abortion. It will also focus on those aspects of their thinking that led to mutual co-operation.     

Scars of experience: the art of moxibustion in Japanese Medicine and Society

Beliefs and practices surrounding moxibustion, a cautery technique used in Japan, are analyzed to demonstrate that the concept of holism is culture-bound and that the practice of East Asian medicine is often reductionistic.Pluralistic traditional medical belief systems of historical and contemporary Japan are discussed with reference to moxibustion. Moxa is used in popular family medicine, for ritual purification, as a technique to cure disease or as part of a holistic approach to healing; its symbolic meaning changes according to its usage and it serves to unite disparate medical beliefs.Socialization practices concerning attitudes towards illness reflect pluralistic values derived from traditional medical systems. One dominant set of values encourages patient and family responsibility during the healing process, adaptation to psychosocial relationships regarded as causal in disease occurrence and avoidance of verbal analysis of problems. These concepts, fundamental to East Asian medicine, cannot be readily adapted in the West as part of a holistic approach to health care.     

Discrimination of Polygonati Rhizoma Species: An Investigation Utilizing High-Performance Liquid Chromatography Fingerprints and Chemometrics

Polygonati Rhizoma has been a famous traditional Chinese medicine (TCM) for two thousand years. It is increasingly being used not just as a traditional herbal medicine but also as a popular functional food. In this study, qualitative and quantitative analysis of PR from three different origins were initially performed using chemical fingerprint and chemometrics methods. Hierarchical cluster analysis (HCA) and Principal component analysis (PCA) were used to classify 60 PR samples from three different origins. The results revealed that the PR samples fell into three clusters related to the origins. In addition, pairwise comparison of varying PR and obtaining chemical markers between different species through the establishment of partial least squares discriminant analysis. Finally, chemical markers 9,13 and 17 were identified by LC/MS as disporopsin, 5,7-dihydroxy-3-(4′-hydroxybenzyl)-6,8-dimethylchroman-4-one and (3R)-5,7-dihydroxy-3-(4′-hydroxybenzyl)-6-methylchroman-4-one or isomer, respectively. In conclusion, these methods can be applied to identify and distinguish the quality of PR with other original plants and provide novel ideas for evaluating herbal products used in TCM.     

Peace in the Clinic: Rethinking “Global Health Diplomacy” in the Somali Region of Ethiopia

Drawing on ethnographic research with Somalis, within aid organizations, and within health care facilities in the Somali Region of Ethiopia, this article argues that what is called “global health diplomacy,” despite its origins and articulations in interstate politics, is fundamentally local and interpersonal. As evidence, I outline two very different health programs in the Somali Region of Ethiopia, and how, in each, existing animosities and political grievances were either reinforced or undermined. I argue that the provision of health care in politically insecure and post-conflict settings like the Somali Region of Ethiopia is precarious but pivotal: medical encounters have the potential to either worsen the conditions in which conflicts and crises recur, or build new interpersonal and governmental relations of trust. Effective global health diplomacy, therefore, cannot be limited to building clinics and donating medicine, but must also explicitly include building positive relationships of trust between oppositional groups within clinical spaces.     

Volunteering,Dana, and the Cultivation of ‘Good People’ in Thailand

The article explores a popular volunteer movement in Thailand and its connection to Buddhist morality and contemporary Thai politics. The article argues that volunteering in Thailand is often conceived of as a gift in various ways: as a form of dana or selfless giving; a gift from ‘good people’ to those defined as ‘in need’ in society and a gift to the Thai nation as a whole. Indeed, when volunteering is said to be a gift to the Thai nation, it is not necessarily because of its ability to redistribute resources, but because of its perceived ability to cultivate moral values and ‘good people’ for the Thai nation. The paper explores the implications that stem from presenting volunteering as a gift, with a strong emphasis on morality and ‘good people’, and how this popular discourse on volunteering may contribute to the maintenance of political status quo in Thailand, particularly in the context of the ongoing political struggles in recent years.     

Gender expectations: natural bodies and natural births in the new midwifery in Canada

In this article, I examine the meaning of natural bodies and natural births in contemporary midwifery in Canada and explore the impact of these central concepts on the embodied experiences of pregnant and birthing women. The ideal of a natural birth has been used as a successful rhetorical strategy in scholarly and popular feminist works on childbirth to counter and critique the predominant biomedical or "technocratic" model of the pregnant and birthing body as inherently problematic and potentially dangerous to the fetus. Contemporary Canadian midwifery--which only as recently as 1994 made a historic transition from a grassroots social movement to a full profession within the public health care system--continues to work discursively through the idiom of nature to affect women's knowledge and experience of their bodies and selves in pregnancy and birth. However, my key finding in this ethnographic study, which focused primarily on midwifery in the province of Ontario in the years following professionalization, is that natural birth is being redefined by the personal, political, and pragmatic choices of midwives and their clients. I argue that the construction, negotiation, and experience of natural birth in contemporary midwifery both reflects and promotes a fundamental shift away from essentialized understandings as it makes room for biomedical technology and hospital spaces, underpinned by the midwifery logics of caring and choice. Natural birth in this context also carries important cultural messages--gender expectations--that posit women as persons and bodies as naturally competent and knowing.     

"Writing in the Margins": Brazilian Hip-Hop as an Educational Project

Hip-hop culture's force as part of globalization in the fields of economics, popular aesthetics, and identity politics has been well documented. However, its articulation to educational practices has received less attention. This article draws upon fieldwork conducted in 1999 and 2002 in a youth correctional facility to analyze how state institutional practices mediate hip-hop's educational project in São Paulo, Brazil. This analysis historicizes culture and education as they pertain to popular culture and the state in urban Brazil, and evaluates hip-hop's pedagogical force in the local workshop setting.     

When Listening to the People: Lessons from Complementary and Alternative Medicine (CAM) for Bioethics

Complementary and alternative medicines (CAM) have become increasingly popular over recent decades. Within bioethics CAM has so far mostly stimulated discussions around their level of scientific evidence, or along the standard concerns of bioethics. To gain an understanding as to why CAM is so successful and what the CAM success means for health care ethics, this paper explores empirical research studies on users of CAM and the reasons for their choice. It emerges that there is a close connection to fundamental principles of medical ethics. The studies also highlight that CAM’s holistic ontology of health and illness has an empowering effect on people in caring for their health, and on an even deeper level, safeguards against biomedicine’s reducing image of oneself as biological body-machine. The question is raised what lessons bioethics should draw from this emancipatory social movement for its own relationship with biomedicine.     

Rationale for an integrated approach to genetic epidemiology

Conclusion: Genetic knowledge is now in the public domain and its interpretation by the media and the citizens brings the issues into the public forum of discussion for the necessary ethical, legal and socio-cultural evaluation of its application. Science is being perceived by some as dangerous and as requiring international regulation. Others feel that genetic knowledge will be the breakthrough that will permit medical progress and individual autonomy with regards to personal health and lifestyle choices. The mapping of the human genome has already yielded valuable information on an increasing number of diseases and their variants. Prevailing popular and journalistic archetypes ("imaginaires") used in the media are perceived by the producers as slowing down the possible application of genetic knowledge. The answers to these dilemmas are not readily apparent nor are they prescribed by classical philosophy of medicine. Since genetic knowledge eventually resides with the individual who carries the genes of disease and/or susceptibility, a logical approach to integration of this knowledge at a societal level would seem to reside with individual education and decision-making. The politics of the ensuing social debate could transform the current social contract since an individual's interests need to be balanced against those of his or her immediate family in the sharing of information. The ethical foundations of such a contract requires the genetic education of "Everyone" as a matter of urgent priority. Genetic education should not serve ideological power struggles between the medical establishment and the ethical-legal alliance. Instead, it should ensure the transfer of knowledge to physicians, to patients, to users, to planners, to social science and humanities researchers and to politicians, so that they may make "informed" and free decisions....     

Life on the edge: immigrants confront the American health system

Abstract

On the basis of a study of forty health care delivery institutions in Florida, California, and New Jersey, this paper examines the interaction between the immigration and health systems in the USA. We investigate barriers to care encountered by the foreign born, especially unauthorized immigrants, and the systemic contradictions between demand for their labour and the absence of an effective immigration policy. Lack of access and high costs have forced the uninsured poor into a series of coping strategies, which we describe in relation to commercial medicine. We highlight regional differences and the importance of local politics and history in shaping health care alternatives for the foreign born.     

The soul of medicine

This article considers contributions that the medical humanities have made to biomedical ethics. Philosophy has contributed methods of ethical justification to case analysis and has given birth to the New Professionalism movement. Taking biography as its paradigmatic resource, this movement has refocused medical education on the formation of physicians who not only have certain responsibilities to their patients, but also a regard for the role of the medical profession in working toward social justice. However, reliance on biography is now giving way to a renewed emphasis on autobiography, as educators seek to support medical students through the personal and spiritual journey that confrontation with death, disease, and injustice naturally entails. Reflective methods and techniques characterize this emerging era as educators and students try to preserve and reinvigorate the soul of medicine.     

The politics of valuation and payment for regenerative medicine products in the UK

The field of regenerative medicine (RM) faces many challenges, including funding. Framing the analysis in terms of institutional politics, valuation studies and “technologies of knowledge”, the paper highlights growing debates about payment for RM in the UK, setting this alongside escalating policy debates about “value”. We draw on interviews and publicly available material to identify the interacting and conflicting positions of institutional stakeholders. It is concluded that while there is some common ground between institutional stakeholders such as industry and health system gatekeepers, there is significant conflict about reward systems, technology assessment methodologies and payment scenarios; a range of mostly conditional payment schemes and non-mainstream routes are being experimented with. We argue that current developments highlight a fundamental conflict between a concern for the societal value of medical technologies in a resource-limited system and a concern for engineering new reward and payment models to accommodate RM innovations.