Traumatic Amputation: A Case of Laotian Indignation and Injustice

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation (“Kwam khem keuang”) as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient’s perspective offers a reflexive stance on the clinician–patient interaction that allows for better patient care.     

Appropriation and Dementia in India

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

Really taking Darwin and the naturalistic fallacy seriously: An objection to Rottschaefer and Martinsen

Out of a concern to respect the naturalistic fallacy, Ruse (1986) argues for the possibility of causal, but not justificatory, explanations of morality in terms of evolutionary processes. In a discussion of Ruse's work, Rottschaefer and Martinsen (1990) claim that he erroneously limits the explanatory scope of evolutionary concepts, because he fails to see that one can have objective moral properties without committing either of two forms of the naturalistic fallacy, if one holds that moral properties supervene on non-moral properties. In this short paper I argue that Rottschaefer and Martinsen's solution fails. If one takes moral properties to supervene on non-moral properties, then either one ends up committing one of the two forms of the naturalistic fallacy or else one is left postulating unbelievable brute metaphysical facts.     

Accusations of Genital Theft: A Case from Northern Ghana

Occurrences of panic attacks associated with belief in genital retraction have been described in the anthropological and psychological literature in terms of culture bound reactive syndromes. Similar phenomena occur widely in West Africa, where they are reported as cases of penis snatching. Explanations for these phenomena range from the biomedical emphasis on pathology to the social psychological emphasis on altered perceptual sets. This paper provides a narrative of an accusation of genital theft in a rural West African settlement. Drawing from ethnographic information, it will be argued that the case is best explained in light of social relations, definitions for in-groups and out-groups, and local knowledge concerning witchcraft and divination. Local explanations for the case conform to both biomedical and social psychological models.     

Quantifying the causal pathways contributing to natural selection

The consequences of natural selection can be understood from a purely statistical perspective. In contrast, an explicitly causal approach is required to understand why trait values covary with fitness. In particular, key evolutionary constructs, such as sexual selection, fecundity selection, and so on, are best understood as selection via particular fitness components. To formalize and operationalize these concepts, we must disentangle the various causal pathways contributing to selection. Such decompositions are currently only known for linear models, where they are sometimes referred to as “Wright's rules.” Here, we provide a general framework, based on path analysis, for partitioning selection among its contributing causal pathways. We show how the extended selection gradient—which represents selection arising from a trait's causal effects on fitness—can be decomposed into path-specific selection gradients, which correspond to distinct causal mechanisms of selection. This framework allows for nonlinear effects and nonadditive interactions among variables, which may be estimated using standard statistical methods (e.g., generalized linear [mixed] models or generalized additive models). We thus provide a generalization of Wright's path rules that accommodates the nonlinear and nonadditive mechanisms by which natural selection commonly arises.     

Explanatory Models and Mental Health Treatment: Is Vodou an Obstacle to Psychiatric Treatment in Rural Haiti?

Vodou as an explanatory framework for illness has been considered an impediment to biomedical psychiatric treatment in rural Haiti by some scholars and Haitian professionals. According to this perspective, attribution of mental illness to supernatural possession drives individuals to seek care from houngan-s (Vodou priests) and other folk practitioners, rather than physicians, psychologists, or psychiatrists. This study investigates whether explanatory models of mental illness invoking supernatural causation result in care-seeking from folk practitioners and resistance to biomedical treatment. The study comprised 31 semi-structured interviews with community leaders, traditional healers, religious leaders, and biomedical providers, 10 focus group discussions with community members, community health workers, health promoters, community leaders, and church members; and four in-depth case studies of individuals exhibiting mental illness symptoms conducted in Haiti's Central Plateau. Respondents invoked multiple explanatory models for mental illness and expressed willingness to receive treatment from both traditional and biomedical practitioners. Folk practitioners expressed a desire to collaborate with biomedical providers and often referred patients to hospitals. At the same time, respondents perceived the biomedical system as largely ineffective for treating mental health problems. Explanatory models rooted in Vodou ethnopsychology were not primary barriers to pursuing psychiatric treatment. Rather, structural factors including scarcity of treatment resources and lack of psychiatric training among health practitioners created the greatest impediments to biomedical care for mental health concerns in rural Haiti.     

Why psychiatric conditions are special: an evolutionary and cross-cultural perspective

In non-Western and premodern societies, approaches to sickness involved moral considerations laden with existential and spiritual implications. Healers and physicians had access to this aspect of their patient's lives, were expected to use it constructively, and often did so. The contemporary biomedical theory of disease no longer assigns to illness such metaphysical connotations. While general physicians are permitted - perhaps even advised - to avoid involvement in morally laden dialogues tied to illness and the self, such dilemmas are more prominent and qualitatively different in psychiatry, as psychiatric conditions often entail changes in self-conception, psychological disaffection, unacceptable behavior, and untoward personal reactions to social circumstances. Manifestations of psychiatric conditions can overwhelm an individual's control in areas of cognition, emotion, autonomy, social responsibility, behavior, and body functions - exactly those matters that "modern" individualistic minds are supposed to master. Consequently, psychiatric conditions challenge basic presuppositions of the modern, secular credo about personhood, disease, and behavior. They comprise a species of human problems ontologically distinct from the conditions handled by other medical disciplines.     

Constructing Alzheimer's: Narratives of Lost Identities,Confusion and Loneliness in Old Age

This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the Boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families.     

'India Shopping': Indian Grocery Stores and Transnational Configurations of Belonging

The cost of health services within the USA has increased in recent years, limiting access for many Americans. In response, a growing number of Americans are traveling to medical border towns in Mexico to meet their needs. However, many US patients feel uncomfortable traveling to Mexico for healthcare because they are unsure how the system works and believe that Mexico is dangerous, unregulated, unsanitary, and premodern. To reconcile these beliefs with the need for quality medical care, Mexican medical providers appropriate aspects of the US medical system to encourage patronage and alleviate the concerns of patients. This paper examines how some Mexican dentists, pharmacists and physicians in the Mexican border town of Nuevo Progreso have broadened their appeal to American patients by (a) associating their procedures with US biomedical standards, (b) building facilities that shadow US counterparts, and (c) facilitating access to the Mexican medical system.     

The Tempering of Medical Anthropology: Troubling Natural Categories

This article reviews an approach in medical anthropology that commenced in the early 1980s and that continues to the present day in which biomedical knowledge and practices are systematically incorporated into anthropological analyses. Discussion then focuses on contributions made by feminists and medical anthropologists to the literature on medicalization and resistance, illustrating how the ethnographic approach has been crucial in critically reconceptualizing and situating these concepts historically and cross-culturally. The concept of local biologies is introduced in the third section of the article in creating the argument that the coproduction of biologies and cultures contributes to embodied experience, which, in turn, shapes discourse about the body. Subjective reporting at menopause provides an illustrative case study of local biologies in action. The final part of the article takes up the question of the moral economy of scientific knowledge. Comparative ethnographic work in intensive care units in Japan and North America reveals how a moral economy is put into practice in connection with brain-dead bodies and the procurement of organs from them. Medical anthropological contributions to policy making about biomedical technologies is briefly considered in closing.     

Pitch the niche – taking responsibility for the concepts we use in ecology and species distribution modelling

In a discussion it is often easier to staunchly reject or offer resolute support for an idea. This third paper on the niche concept aims to develop a balanced argument by exploring general principles for determining an appropriate level for pitching the niche concept that will guide better use and less abuse of niche concepts. To do this we first have to accept that niche concepts are not necessarily essential for ecology. Rather than to improve niche concepts, our aim should then be to pitch the niche in terms of ecology. This aim helps us develop an ‘ultimate goal of the niche’ by which we can evaluate the concepts we use. For species distribution modelling, there has been a focus on the niche as an equilibrium outcome that perhaps has less relevance for disequilibrium situations (e.g. climate change projections). As is the case for much of ecology, more causal explanations of species' distributions use alternative terminologies and less frequently use the word ‘niche’. We suggest that niche concepts that are better aligned with the rest of ecology could arise from taking more responsibility for our own implementations, and by explaining our models with terms other than niche. A general, holistic niche concept promotes this view and promotes practical thinking about what we are modelling and how we interpret those models, which in turn should help inspire and support innovative modelling approaches in species distribution modelling.     

Students’ Mental Models of Evolutionary Causation: Natural Selection and Genetic Drift

In an effort to understand how to improve student learning about evolution, a focus of science education research has been to document and address students?? naive ideas. Less research has investigated how students reason about alternative scientific models that attempt to explain the same phenomenon (e.g., which causal model best accounts for evolutionary change?). Within evolutionary biology, research has yet to explore how non-adaptive factors are situated within students?? conceptual ecologies of evolutionary causation. Do students construct evolutionary explanations that include non-adaptive and adaptive factors? If so, how are non-adaptive factors structured within students?? evolutionary explanations? We used clinical interviews and two paper and pencil instruments (one open-response and one multiple-choice) to investigate the use of non-adaptive and adaptive factors in undergraduate students?? patterns of evolutionary reasoning. After instruction that included non-adaptive causal factors (e.g., genetic drift), we found them to be remarkably uncommon in students?? explanatory models of evolutionary change in both written assessments and clinical interviews. However, consistent with many evolutionary biologists?? explanations, when students used non-adaptive factors they were conceptualized as causal alternatives to selection. Interestingly, use of non-adaptive factors was not associated with greater understanding of natural selection in interviews or written assessments, or with fewer naive ideas of natural selection. Thus, reasoning using non-adaptive factors appears to be a distinct facet of evolutionary thinking. We propose a theoretical framework for an expert?Cnovice continuum of evolutionary reasoning that incorporates both adaptive and non-adaptive factors, and can be used to inform instructional efficacy in evolutionary biology.     

Symptomatic differences between the sexes in rural Mexico

This paper addresses the problem of the differential presentation of illness by women and men in two Spiritualist temples and a physician's office situated in rural Mexico. Women's morbidity raises the broader anthropological questions of the interplay between symptomatic expression and women's unequal status in the social structure, their cognitive evaluation of specific life experiences, cultural etiological explanations and Western models of dysphoria. Symptoms presented by patients in different health care delivery sites are compared and case vignettes of patients' illnesses and attributions are presented to demonstrate the ways in which culturally constructed illness attributions and illness expressions comprise a somatic grammar for the articulation of experiential distress. The sick population is compared with a control group of healthy women to highlight the socio-cultural and psychosocial variables that promote illness in women from the same sociocultural strata of rural Mexico. Collective understandings of the role of life events and emotional expression in illness attributions legitimize somatization as a coping style under adverse existential conditions.     

Fragile Castles: The Paradox of Research Politics,Scientific Progress,and the Mutation of Medical Knowledge

This paper is based on fieldwork done from 1996-1999 in different locations among village communities from Central Anatolia afflicted with the deadly malignancy of mesothelioma. Medical research has long established the relationship between mesothelioma and the environment; yet in earlier work correlations deduced through my genealogies provide evidence of a possible genetic cofactor causing these cancer deaths. This paper illustrates how medical research becomes an arena for local and global political interests and how the disruption of the doctor-cancer patient relationship impedes medical research. Methods include illness and clinical narratives, kinship charts and pedigrees, and observation of involved doctors and patients in multiple sites and geographical locations. Under focus are the anthropologist's involvement in global biomedical research and her interconnectedness with its political events.     

“Feed a cold,starve a fever” — folk models of infection in an english suburban community,and their relation to medical treatment

This paper outlines a widely-held conception of illness, related to perceived changes in body temperature — Chills and Colds on one hand, Fevers on the other — in an English suburban community on the outskirts of London. The relationship between this folk model, and that of the local family physicians is analysed, to show how biomedical treatment and concepts, particularly the germ theory of disease, far from challenging the folk model, actually reinforce it. Remedies which cannot be scientifically and biomedically justified are nevertheless prescribed by the physicians to meet their patients' need to make sense of biomedical treatment in terms of their folk model of illness. At the interface between physician and patient, biomedical diagnoses and treatment are more negotiable than previously realised — and this has important implications for the delivery of health care.     

Intracultural variation in causal accounts of diabetes: A comparison of three Canadian Anishinaabe (ojibway) communities

This paper presents a methodological approach for examining variation and consensus both within and between research settings and for addressing issues of generalizability and replicability. The comparison is based on how individuals diagnosed with diabetes and living in three Canadian Anishinaabe (Ojibway) communities explain diabetes and talk about their responses to the illness. Two kinds of interview format are used — an open-ended explanatory model type interview and a more structured, true-false, interview, amenable to analysis with cultural consensus theory. The responses given in both interviews converge on a set of explanations which can be found in all three communities, although differences occur in how these explanations are framed and emphasized. Implications of these differences and how these accounts relate to how individuals respond to diabetes are discussed. It is argued that the analysis of both interview formats leads to a deeper and more finely nuanced representation of understandings about causes of diabetes across the three communities than could be achieved by using one alone.     

Conceptual Differences between Mexican and Peruvian Archaeology

This essay asks why interpretations of pre-Columbian history and state formation in Mexico and Peru are framed in different terms by archaeologists. While the differences are due in part to the empirical realities of the two civilizations, this essay explores how sociological considerations and theoretical orientations of archaeologists as they interpreted those empirical realities contributed to the construction of the interpretive differences.     

The cognitive and cultural foundations of moral behavior

Does moral culture contribute to the evolution of cooperation? Here, we examine individuals' and communities' models of what it means to be good and bad and how they correspond to corollary behavior across a variety of socioecological contexts. Our sample includes over 600 people from eight different field sites that include foragers, horticulturalists, herders, and the fully market-reliant. We first examine the universals and particulars of explicit moral models. We then use these moral models to assess their role in the outcome of an economic experiment designed to detect systematic, dishonest rule-breaking favoritism. We show that individuals are slightly more inclined to play by the rules when their moral models include the task-relevant virtues of “honesty” and “dishonesty.” We also find that religious beliefs are better predictors of honest play than these virtues. The predictive power of these values' and beliefs' local prevalence, however, remains inconclusive. In summary, we find that religious beliefs and moral models may help promote honest behavior that may widen the breadth of human cooperation.     

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

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

Triplex profiling of functionally distinct chaperones (ERp29/PDI/BiP) reveals marked heterogeneity of the endoplasmic reticulum proteome in cancer

The biomedical need for streamlined approaches to monitor proteome dynamics is growing rapidly. This study examined the ability of a knowledge-based triplex-profiling strategy (i.e., three functionally distinct chaperones, ERp29/PDI/BiP) to clarify uncertainties about how cancer affects the endoplasmic reticulum (ER) proteome. Investigating a wide range of samples at the tissue and cellular levels (>114 samples from 9 tissues of origin), we obtained consistent evidence that the ER proteome undergoes a major but variable expansion in cancer. Three factors having a strong influence on the ER proteome were identified (cancer-cell type, growth rate, culture mode), and the functionally enigmatic chaperone ERp29 was linked distinctively to histogenetic aspects of tumorigenesis. These findings justify pursuit of the ER-proteome as a medical target in cancer, validate ERp29/PDI/BiP profiling as a streamlined yet powerful measure of ER-proteome dynamics, and suggest that biomarker sets based on distinct functionalities could have broader biomedical utility.