World Perspectives on Health 2020: August 2020

Saturday, August 22, 2020

Syllabus: World Perspectives on Health Fall 2020

ANTH 2136: World Perspectives on Health

An Exploration of Medical Anthropology
Fall 2020
ZOOM
10:30-12:20 M/W

Professor Laurie Greene

Office Hours: m/w 12:30-1:30

or any day by appointment

Office: C107 or on Zoom

Cell Phone: text in emergency (609) 214-6596

Email: laurie.greene@stockton.edu (please put "Anth 2136" in subject line)

This semester we will be exploring the burgeoning field of medical anthropology. Medical anthropology is an applied discipline which starts with two insights;

first, that cultural premises which are often unconscious or difficult to recognize shape the way that we understand health and healing practices (illness and health are an “imposition of human meanings on naturally occurring processes”),
and second, that disease patterns, social norms, and socio-economic arrangements are intrinsically related (social factors determine disease patterns).

It is part and parcel of medical anthropology that it is applied. Its concerns are not just for an understanding of the concepts and occurrences of health and illness cross culturally, but also in critical efforts that aim to make health and wellbeing available to everyone, not just those who hold power.

In order to understand these concepts we will be looking at the field i general with examples focusing on the SOCIAL and CULTURAL NEXUS of ILLNESS and DISEASE, especially as it pertains to the unequal distribution of health and well-beings across the world, during times of epidemics, pandemic and plagues.

"Anthropology, Activism and Inequality"--Anthropology in general, and medical anthropology in particular has an activist agenda. Anthropologists have an ethical obligation to those who they study and in medical anthropology this has been translated to "health equity"-the rights of all individuals everywhere to live healthy and fulfilling lives free from violence, be it physical or "structural". The greatest proponent of this position has been medical anthropologist/doctor Paul Farmer. In his ground-breaking works (Infectious Inequalities, Pathologies of Power,AIDS and Accusation), Farmer describes illness as a disease of poverty, and implements models for alleviating disease and suffering in the poorest place in the world.

Our anthropological experiences this semester will focus on "infectious inequalities" within our communities by understanding the "cultural underpinnings" of these illnesses as well as finding "local solutions" for them based on ethnographic "fieldwok". This fieldwork will work to collect life histories of individuals from some of our most impoverished community members, and allow this stories to provide potential solutions to limited access to adequate healthcare.

Texts:

(1) Exploring Medical Anthropology (Joralemon)-prentice hall (3rd or 4th edition)

(2) Articles and other resources linked to this BLOG

Syllabus and Reading List

Week 1: An Introduction to Medical Anthropology (September 7)

-course description and requirements, definition of terms

Readings: https://www.al-fanarmedia.org/2020/07/anthropologists-have-important-role-to-play-in-public-health-crises-veteran-scholar-says/ (medical anthropology & COVID-19)

https://www.ias.edu/ideas/levine-covid-19 (what we know about the Corona Virus)

Week 2: What's so Cultural About Disease (September 14-16)

-Tenets of Medical Anthropology

Readings: Joraleson, Exploring Medical Anthropology, Chapter 1

Week 3: Illness Narratives and the Experience of Illness (September 21-23)

-Phenomenology, Narrative experience, Examples, Ethnography, auto ethnography and

methodology

Readings: Joraleson, Exploring Medical Anthropology, Chapters 2

Week 4-5: Epidemics, Pandemics, & Plagues in an anthropological framework (September 28-30)

Readings: Joraleson, Exploring Medical Anthropology, Chapters 3-5

BLOG Posts

Due: Auto-ethnographies September 30 (Wednesday) please email these and look for a return email that confirms I received your work.

Week 6: Illness as Metaphor (October 5-7)

Readings: Here (Susan Sontag)

Here (metaphors of the ill body)

Week 7: Infectious Inequality (October 12-14)

-economics of structural inequality

Readings: Here (Paul Farmer)

PODCAST (BLM and Corona Virus)

Week 8: The Politics of Illness (October 19-21)

-race, class and gender in the time of illness

-politics and affiliation

-Naomi Klein and Disaster Capitolism

Readings: Here Racial Disparities and COVID-19

Here "Shock Doctrine" (Naomi Klein)

PODCAST here (Structural Racism and COVID-19)

Due: Cultural Narratives of COVID-19 Due October 21

NO CLASS WEDNESDAY November 4th...Preceptorial Advising

Week 9:“Healers and Healing Professions” (October 29)

-Drs., nurses, frontline workers and caregivers

Readings: Joraleson, Exploring Medical Anthropology, Chapter 6

Here chaplain illness narrative

here doctor ER
Guest lecture: Hunter Dunkelwiscz (Chaplain) and Salvatore Profaci (nurse)

Week 10: Testing, Drugs, Vaccines and the Anthropology of Public Health (November 3-5)

-AIDS and Act-UP

-The race for a vaccine

-Hydrochloriquine

-testing efficacy and availability

Readings: Joraleson, Exploring Medical Anthropology, Chapter 7

Week 11: Bioethics and Culture (November 10-12)

Readings: Joraleson, Exploring Medical Anthropology, excerpts from Chapters 8-10

HERE (medical anthropology and attitudes toward vaccines)

-testing and vaccines, building public trust

-essential workers?

-Herd Immunity/Sacrificing citizens

-availability of supplies/beds/ventilators

-Who lives and who dies?

Week 12: Alternative Narratives/Alternative Medicine (November 17-19)

-The holistic community and its narratives (essential oils, food, vitamins, etc.)

-home cures

Readings:

Due: Stories From the Front Lines November 19

No Class November 24-26 Thanks giving Break

Week 13: Stigma as Contagious Diseases (December 1-3)

- -AIDS, Cancer, TB and other vilified conditions

Readings: https://www.madinamerica.com/2020/08/four-strategies-covid-19-stigma-mitigation/

HERE (Herd Immunity and eugenics)

Week 14: Presentations (December 8-10)

Due: On the Future of Life with Disease (December 18)

^{Final Project Write-Up, December 18th (graduating seniors, December 16th)}

^{Final Exam Wednesday, December 16th}

^Grading:

4 Projects/Final Presentation-60%
Zoom Attendance and Participation -20%
Final Exam -20%

Sontag: Illness as Metaphor

Read Chapter HERE

In 1978 Susan Sontag wrote Illness as Metaphor, a classic work described by Newsweek as "one of the most liberating books of its time." A cancer patient herself when she was writing the book, Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment.By demystifying the fantasies surrounding cancer, Sontag shows cancer for what it is -- just a disease. Cancer, she argues, is not a curse, not a punishment, certainly not an embarrassment and, it is highly curable, if good treatment is followed.

"Susan Sontag's Illness as Metaphor was the first to point out the accusatory side of the metaphors of empowerment that seek to enlist the patient's will to resist disease. It is largely as a result of her work that the how-to health books avoid the blame-ridden term 'cancer personality' and speak more soothingly of 'disease-producing lifestyles.' She asserts that the most truthful way for regarding illness is the one most purified of metaphoric thinking. A disease should be regarded as a disease, not as a sign of some terrible law of nature or an otherwise unnameable evil.

The gross mythology of tuberculosis did not persist after the discovery of streptomycin in 1944 and the introduction isoniazid in 1952. The sinister mythology of cancer will not be likely to persist after the causes of the disease are known and a successful treatment is produced. "As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have." (Sontag)
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SUSAN SONTAG: Illness as Metaphor

Illness is the NIGHT SIDE of life, it is used in our culture as a FIGURE or METAPHOR

Examples: Cancer & TB…

· these diseases are capricious,

· they a little understood.

· Considered ruthless, secretive and invasive.

· They are felt to be morally, if not literally contagious.

· Felt to have magical powers

In the popular imagination, CANCER=DEATH

Cancer: “anything that frets, corrodes, corrupts or CONSUMES slowly and secretively (OED 1528)

· Conceal the truth to patients

· Process is expected to be horrid kind of death

· Symptoms are invisible until it is too late

· Desexualizing

· Idleness, slowness, sloth, loss of appetite

· Degeneration caused by invasion

· Demonic pregnancy (pregnant with your own death)

· No help

· Painful death (horrid)

· BODILY DISEASE

Tb: definition of pulmonary = CONSUMPTION

· Disintegration (consumed)

· secretive

· deceptive symptoms (rosy cheeks, mania, thinness as attractive, appetite)

· speeds up life, highlights it spiritualizes it

· highly contagious

· liquid: phlegm, mucus, blood

· help by changing to a warm dry environment (anti-cold & wet)

· painless (romantic death)

· SPIRITUAL DISEASE

DISEASE OF PASSION: both cancer & Tb

TB: too much

Cancer: Too little

· Both about the lack of balance in the vital energies

· TB (Victorian)-ROMANTICIZING

§ Individuality is fist stressed+ people were made singularly more interesting by their illnesses

§ SADNESS (meloncholoy) became synonymous with TB: also prone for creative and sensitive types like artists and poets

§ Pretext for leisure and travel invented by the romantics- RETIRING from the world without having to take responsibility for it

§ Sex as a cure

§ Naivity

§ Passionate

§ Too sensitive for this world

§ More complex psychologically which guarantees poor health, but great intellectual and moral virtue

§ Makes sufferer sexy

§ Genteel, delicate, APPEALING VULNERABILITY

§ Glamorous too look sickly and rude to eat heartily in the 18^th & 19^th century—fashionable to be pale and drained

§ ISOLATES one from the community (unlike plagues---cancer too!)

IS THIS WHERE THE 20^TH CENTURY CULT OF THINNESS COMES FROM? THE LAST BASTIAN OF THIS ROMANTICIZING OF WAIFDOM? (became appealing for women but not men by the end of the 18^th century)

· In the modern era, this same metaphor is given to INSANITY (not cancer or TB)…confined to a sanatorium

· Fits patients character as a PUNISHMENT fits the SINNER (Christian view of disease)

Psychological notions of disease

· Specific emotions produce specific illnesses

· Stress produces illness

· The correct attitude can make you well

EXPANDED CATEGORY OF ILLNESS

· Every social deviation can be considered illness

· Illnesses need not be punished, but understood

PUNITIVE NOTIONS OF DISEASE

· LEPROCY & CANCER & syphillus & TB (now diseases of INDIVIDUALS)…plagues in the past

Cancer is not about PAMPERING the PATIENT like with TB

· Under attack, attack back with treatments

· Insult to the natural order-MUTATION

· Natures revenge on our technological modern world

DISEASES ARE REFLECTIONS OF OUR CULTURE

· TB was thought to be from foul air (from houses)

· Cancer from the pollution of the whole world-REJECTION OF THE CITY

· FORESIGHT is the sure (catch it early) just like in our social understanding

· When society (environment) is in good health, disease can be managed and overcome. If not, disease will persist and may even beat us

§ French revolution: peasant disturbances as a plague on the nation

§ Nazis: jews as a syphilis on culture---radical treatment…cut them out, eliminate them (identified with city life as well)

§ AIDS: Haitians, homosexuals, keep them out, eradicate them

§ 5to call something a cancer implies that it must be REMOVED

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HIV/AIDS Metaphors

AIDS-related stigma refers to a pattern of prejudice, discounting, discrediting, and discrimination directed at people perceived to have HIV/AIDS, their significant others and close associates, and their social groups and communities.

As with other diseases throughout history, such as the Black Death in the fourteenth century and cholera in the nineteenth century, a stigma has been attached to AIDS as a result of both fears surrounding contagion and preexisting prejudice against the social groups most seriously affected by the epidemic.
Like AIDS itself, the AIDS stigma is a global problem. It is manifested around the world through ostracism of people with AIDS (PWAs), discrimination against them, and, in a few countries, quarantines.

In the United States, the AIDS stigma has been evident in negative attitudes, discrimination, and violence against PWAs and people perceived to be HIV infected.

coercive measures such as

quarantining of HIV-infected persons,
universal mandatory testing,
laws making it a crime for people with HIV/AIDS to have sex, and
mandatory identification cards for PWAs.

Negative attitudes have also been manifested in behavior.

AIDS discrimination in employment, housing, school policies, and services has been widespread.
Employers have refused to provide insurance coverage for employees with AIDS;
property owners have refused to rent to PWAs or have evicted them;
parents with AIDS have been faced with legal battles concerning child custody and visitation rights; and
PWAs have experienced unwarranted demotions, dismissals, and harassment in the workplace.
In addition, some PWAs have been targets for violent attacks because of their HIV status.

At least four specific characteristics affect the extent to which any disease is likely to be stigmatized.

First, a stigma is more likely to be attached to a disease whose cause is perceived to be the bearer's responsibility.

The two most common routes of HIV infection in the United States, sexual intercourse and sharing contaminated drug paraphernalia, are widely perceived as controllable and therefore avoidable behaviors.

Second, greater stigma is associated with conditions that, like AIDS, are perceived to be unalterable or degenerative.
Third, greater stigma is associated with conditions that are perceived to be contagious or to place others in harm's way.

Concern about contagion not only exists in the physical realm but also extends to fears that one will be socially or morally tainted by interacting with the stigmatized individual.

Finally, a condition tends to be more stigmatized when it is readily apparent to others and is perceived as repellent, ugly, or upsetting.

In its more advanced stages, AIDS often causes dramatic changes to one's appearance.

Of considerable additional importance is the fact that the AIDS epidemic in the United States has occurred primarily among marginalized groups, such as gay men, injecting drug users, and Haitians, and has been defined socially as a disease of these groups.

Consequently, the stigma attached to AIDS also serves as a vehicle for expressing preexisting hostility toward members of disliked social groups.

In the United States, the AIDS stigma has been focused principally on homosexuality.

Societal and individual reactions to AIDS have often provided a vehicle for expressing condemnation of homosexuality and hostility toward gay men and lesbians.
Heterosexuals' attitudes toward gay people have been consistently shown to correlate strongly with their AIDS-related fears, attitudes, and beliefs.

Acceptance of homosexuality was at its height BEFORE the AIDS epidemic.

Furthermore, gay men with AIDS are more negatively evaluated or blamed for their illness than are heterosexuals with AIDS.

As the face of the epidemic in the United States changes, it is likely that symbolic expressions of the AIDS stigma will broaden to reflect public hostility to an increasing degree toward other marginalized groups such as immigrants, the poor, and communities of color.

Because of the AIDS-related stigma, PWAs must bear the burden of societal hostility (stigma) at a time when they urgently need social support.

In addition, some PWAs internalize societal stigmatization (Goffman),which can lead to self-loathing, self-blame, and self-destructive behaviors.
The AIDS stigma also deters people at risk for HIV from being tested and seeking information and assistance for risk reduction.

Because of the stigma of AIDS, many people may distance themselves from the disease and deny their potential risk.

How to Succeed in Online Learning-ZOOM

This semester will be a unique challenge. Online learning is not an ideal delivery system (for most), so we need to take special care to get the most out of synchronous meetings and resources. Know that I have spent the summer doing my best to create digital material that will assist you, but so much more is asked of YOU if we are going to have a successful semester.

ZOOM

We are meeting in real time each week on ZOOM. You need to be proficient in navigating the ZOOM app (phone) or system (on your computer).
This PDF from Humboldt University is really useful for preparing you to navigate ZOOM, and use it successfully during class.

https://media.screensteps.com/exported/humboldt/12966/163556/How_do_students_use_Zoom_.pdf

Other ZOOM requirements: Please put a picture of yourself up when you set up your profile AND make sure your full name is on your camera Image (this can be set up in your profile or once you are on).
ZOOM Meetings are required. Please contact me ASAP at 6092146596 (cell) if you anticipate or come across any problems accessing zoom or in attending meetings.
We will occasionally be using break out rooms. Please observe proper etiquette in break out rooms--it is a great opportunity to do interactive work virtually during class sessions.

ONLINE LEARNING STRATEGIES

Online learning in any format requires much more from students than in-person formats. So much more depends on your personal plan for study and requires your personal discipline. Check out this website for some general tips!

https://goodcolleges.online/study-tips-for-success/

I will be creating "virtual study groups". You will meet your study group when we break out on the first day of class. You can introduce yourself and exchange virtual contact information. Groups can be used as you like, but they have the potential to:

Function as a study group
Provide moral and emotional support
Provide information about missed lectures (but don't miss lectures)
Allow you to "personally" connect with people in class despite virtuality

PLEASE LET ME KNOW IF YOU HAVE ANY SUGGESTIONS FOR ME AS WE NAVIGATE THIS SEMESTER TOGETHER

Wednesday, August 19, 2020

Mini-Ethnography: Illness Narratives

Illness Narratives: Epidemics, Pandemics and Plagues

“Until the academic discourse of medicine is expanded beyond the languages of molecules and drugs to include the language of experience and meanings, however, medical science will reinforce the profession’s resistance to the problems of illness rather than contribute to the broadening of its vision. Research that avoids the human side of disorder places the profession and its practitioners in iron chains of restricted knowledge. So fettered, medicine and doctors are unable to address some of the most difficult yet essential questions in the care of the chronically ill; the physician is prevented from having a personal stake in the patient’s condition, and medicine from applying moral knowledge to suffering.”--Arthur Kleinman

Read HERE

"An ethnography is the telling of a people's story" (Translating Culture, 312).

For the next semester, we will engage in an ethnographic project that entails virtual (or actual) participant observation and auto-ethnography, two of the principle forms of qualitative research in anthropology.We will use these techniques to create Illness Narratives, which are important products of medical anthropology, as they strive to describe the "experience of illness" as a way to understand behaviors, practices and conceptions of illness in a culture.

As anthropologists, our modus operandi is collecting narratives. We undertake field work, during which we often spend a year or more living in foreign communities, immersing ourselves in people’s daily lives. We ask men, women, and children about their families; their religion; their understanding of the cosmos; their politics; their roles and status within their societies; and their perspectives on the body, the self, sexuality, sex roles, aging, child rearing, work, diet, violence, the economy, and international affairs. We then publish our ethnographic accounts using narrative as an analytic tool to support our arguments and as a literary tool to enhance our writing.

Within the realm of medical anthropology, ethnographers turn their attention to the cultural construction of health and illness, biomedical and other models of healing, international health policy and health care systems, and the social determinants of health. To learn something about illness experience, anthropologists elicit narratives and then interpret them. The ethnographic endeavor has been described thus: “Our anthropological productions are our stories about their stories; we are interpreting the people as they are interpreting themselves.” (M. Divinsky)

Arthur Kleinman is a physician who became an anthropologist. Byron Good is an anthropologist who analyzed the medical profession. They and other scholars, such as Allan Young, Clifford Geertz, Susan Sontag, Victor Turner, Edward Bruner, James Clifford, Lawrence Kirmayer, George Marcus, and Terence Turner, shaped medical anthropology’s scholarship on illness narratives and the poetics and politics of writing about people’s experiences of health and illness.

Through his clinical work as a physician, Kleinman was aware of the significance of medical histories: “Since eighty percent of diagnoses in primary care result from the history alone, the anamnesis (the account the physician assembles from the patient’s history) is crucial. The tale of complaints becomes the text that is to be decoded by the practitioner cum diagnostician.” Kleinman’s anthropologic training then led him to recognize that illness narratives have to be contextualized: “Each patient brings to the practitioner a story. That story enmeshes the disease in a web of meanings that make sense only in the context of a particular life.” He also realized that there was value in recording and publishing these stories. As Kleinman recalls, “The Illness Narratives told stories of sickness much as they had been told to me. I felt a deep compulsion to retell these accounts.”

Medical anthropologists argue that illness narratives are not merely accounts of symptoms but:

a mechanism through which people become aware of and make sense out of their experiences.

A transformation takes place from something lived (full of complexity but not given a single, crystalized meaning) into something interpreted (given structure and meaning through the dialogue that takes place between the patient and physician).

“Narrativization” therefore acts as a reflexive, therapeutic, and even a transformative mechanism for people who have experienced illness.

As Becker asserts, “Narratives, my own included, arise out of a desire to have life display coherence, integrity, fullness, and closure.” Moreover, when a person walks into a physician’s office, the physician becomes one of the players in the story. Good eloquently describes how our stories become intertwined: “The narrators—the person with an illness, family members participating in their care, medical professionals—are in the midst of the story they are telling.”

Learning to hear: How do we learn to hear?

Faculties of medicine have been brought to task for churning out physicians with poor interpersonal skills. Despite attempts to include physicians’ skills development in their curriculums, the focus of our training is on the science of medicine: anatomy, pathophysiology, pharmacology—but the skill of listening with sensitivity to people’s stories is not emphasized. They are evaluated on our ability to be methodical, not empathetic.

Students, like anthropologists, learn a lot through observation. Medical anthropologists think about the encounters with patients in the same way they think about my ethnographic encounters.

Politics of stories

As anthropologists, we have to be cognizant, as we promote narrative medicine, of the politics of storytelling.

How those life stories are told, by whom, and the form that those stories take are fundamentally grounded in politics, history, and culture. “Narrative is always political,” medical anthropologists caution, “because people choose which narratives to tell.”

Therefore, narratives are expressive of cultural beliefs and the experiences that have both shaped and continue to inform their beliefs.

Consider for example these opposing views:

Vaccines will save us from this scourge-vs- Vaccines will make us guinea pigs for the powerful
Mask wearing is effective to prevent viral transmission-vs- mask wearing is ineffective, or may cause you to get ill
I trust doctors and modern medicine-vs- I don't trust doctors or modern medicine, and only use natural medicines
Pharmaceuticals are miraculous and give us relatively healthy lives-vs- Big phrama is the devil
Everyone is susceptible to disease-vs- only those whose lifestyle is unhealthy get diseases

These beliefs are formed through experiences and may be understood in the context of illness narratives collected by medical anthropologists (and YOU this semester).

Ethnographic Semester Assignment

4 Parts=Final Mini-Ethnography

Part 1: Auto-Ethnography

Part 2: Popular Conceptions of COVID-19, narratives from social media

Part 3: Stories from the Front Lines

Part 4: On the Future of Disease

Final Project Submission

You will be encouraged to share snippets of your experiential research over the course of the semester as you undertake this process.

Finally: Write it up!

Ethnographic essays should be 10-15 pages, and may include photographs and other bits of illustrative material. Be creative. These will be presented to the class via POWER POINT or another digital presentation format of your choice that we can share on ZOOM.

1. Remember that your essay should be evocative

OTHER STUFF:

· Ethics. Consider your impact on the people and the community you are interviewing. Is the setting a public place which does not require you to inform people that they are being observed? (like social media, for example) If not, how might you inform people that they are part of a research project? Ethics REQUIRES that interviewees are given anonymity, and are protected from any adverse affects of your research. We will go over the requirements for transparency and protecting informants in the coming weeks. (if you are interested, there is a more detailed written treatment of ethics on this link)

· Assumptions. Try not to prove pre-existing theories you have about the context and activities happening (and then see how hard this is!).

· Time. While I don't want to make static time requirements for this assignment, the concept of 'intense observation' should connote more than one or two hours of observation. Aim for about 16-20 hours of total interview time (virtual or actual, when this is possible).

·        Guidelines For 'Looking':
1. Observers try to uncover and record the unspoken common sense assumptions of the group
                that they are studying. Therefore, some of these you will observe without them being
                explained to you.
2. Draw & Take Photographs. Field notes should be more than writing; drawing maps and
sketching activities is often very useful when trying to remember the details of what
                you have seen, take screenshots of media data, etc.

3. Reflect on your own actions. Ethnographers alter themselves in order to fit into

contexts as unobtrusive observers and as participant observers. How much

do you have to adapt yourself in order to learn about the context and culture that

you are studying?
4. Language: Is there a special language/vocabulary that your informant(s) uses to describe
themselves or simply communicate personal beliefs or those of a group? (Consider

QANON, for example). Contrast this with symbols and vocabulary used by other

individuals or groups. What is the significance of these differences?

World Perspectives on Health 2020