Abstracts

Workshop 1: Biomedicine, complementary
and alternative medicine (CAM), and religious healing

organized by Natalia Weimann, Adam Mickiewicz University of Poznan, Poland;
discussant Dr. Vlad Naumescu, Central European University, Budapest, Hungary

Eva Jansen
Ludwig Maximilian University of Munich, Germany

The Embodiment of Resistance: Naturopathy in South India

Naturopathy is one of five medical systems recognized by AYUSH, a sub-department of the Indian Government. Its ideology, rejecting all forms of allopathic treatment, is rooted in Gandhi’s vision of self-restraint and political resistance through non-violence and reference to the local. Some of the institutional and professional developments of Naturopathy can be regarded as similar to movements in Ayurveda, however, two major different forms of Naturopathy have emerged in the last two decades: a scientific branch imitating allopathic practitioners on one side and, on the other side, a group of ideologists using a psycho-nutritious approach in treating their patients on the basis of simplicity. Both positions claim to have an exclusive right to the theory and practice of Yoga. This paper illustrates the way in which Naturopathy responds to global flows in South India, as both an eclectic medical system and a heterogeneous social movement.

Roman Sieler
University of Heidelberg, Germany

Patient Agency Revisited: “Healing the Hidden” in Varma Maruttuvam in South India

Varma maruttuvam, “vital spot medicine”, of Kanyakumari district, South India, addresses varmam – the body’s vulnerable loci. Practitioners are called acan, who are healthcare spe­cia­­lists of hereditary, non-institutionalized instruction, who thus are pitted against formally trained and legally recognized medical practitioners. Through manual therapies, acans manipulate piranam “vital energy”, housed at varmam spots to retrieve patients from unconsciousness, but also to treat chronic ailments, for massage, or setting of fractures. Discourse on therapies, diagnosis and treatment in varma maruttuvam are highly secretive, conducted “behind drawn curtains” and acans, stating to be “healing the hidden”, never communicate diagnostic insights to patients.

While it has been argued, that “western” Biomedicine alienated patients from ailments, from understanding treatment processes, and from doctors, and hence are bereaved patients of autonomy, alternative healing systems have been recently portrayed to conversely include patients and their experience. Analyzing Siddha medicine, Sujatha (2009) has put forth the argument that Siddha patients can be accorded a role as “knowers”, important in diagnostics and treatment. Patients of indigenous Indian medicines, it might be argued in such a vain, are active, autonomous, while patients of Biomedicine are passive, ignorant. Analysis of varma maruttuvam questions such clichés of “East” and “West” and the postulated idea of “knowing patients”. While patients may not necessarily be discursively conscious “knowers” of ailments or treatments, acans physically engage with their clients’ ailing bodies. Through tactile caring for patients; a somatic mode of attending to ailing bodies, practitioners directly address ailments without any auxiliary devices, such as radiographic images; momentarily bridging the divide between subject (practitioner) and object (patient). The acan’s hands and the lived, animated body of the patient thus establish an intimate contact, through which diagnosis and treatment are conducted. This body-based treatment form relates to intricacies of varmam spots – loci, hidden inside the body, not verbalizable – healed by acan’s embodied skills, but not communicated.

Hadrien Munier
Lumière University Lyon 2, France

Self, Lwa and Haiti: Adherence Process and “Reinvention of the Self” by a Therapeutic Use of Haitian Vodou in Montreal

Over the last decades, part of Haitian immigrants who settled in Montreal brought in the practice of vodou as cult and religious healing.

Originally, the concept of indigenization means an appropriation of an alien practice by a new population or in a new locality. Applied to “transnational religions” this concept refers to the process by which “they adapt themselves to different national contexts, negotiating their position inside the local religious field and in the heart of national society”. The issue is to understand the development of Haitian vodou’s indigenization process in Montreal and its underlying dynamics. The seven months fieldwork I spent in Montreal concerned the way the therapeutic use of vodou plays a role in the indigenization of this cult and how the believers are involved in transnational networks.

From the analysis of an adherent life itinerary, I will account for the central position of therapeutic use of vodou in the indigenization process of this cult. The therapeutic use of vodou is the most common way to enter the cult, as patients search for ways to solve their problems. As rituals are based on the relationship with spiritual entities, lwa in Creole, the involvement of patient in the therapy requires a learning of the role of these spirits. The patient’s participation to worship implies him (or her) in rituals which provokes adherence process and it positions him (or her) more and more as an adherent. The integration of vodou interpretations of illness and personal problems leads to a reinvention of self for the adherent.

As this process links the migrant’s individual definition of self with socio-cultural construction of belonging, I will deal with the identity processes at stake in the vodou practice and with the status of Haiti in discourses and acts of interlocutors.

Anna Pietrzyk
University of Lodz, Poland

Anthropological Aspects of Biofield Energy Healing in Poland

In this paper the author analyzes the image of Polish healer. This analysis is based on our own researches done in the city of Lodz as well as the results of already existing researches done on a wider geographical and historical area.

In the era of wonderful achievements of academic medicine, the fact of the extraordinary popularity of healers offering alternative treatments seems worth considering. Those are both social and demographic factors that may be the reason for this. In developed countries the economic security of health care system is seen as a political obligation as well as a basic human right. The problem of the free access to the health care is increasing in the era of Poland’s and Europe’s population becoming aged. This in turn results in society’s disappointment with health care system and eventually leads individuals to turning to alternative health treatments. But the popularity of healers is not only the result of the health system crisis, but it also has its historical and cultural reasons.

By analyzing therapist’s image in historical and cultural context the author will show its connections with healers of traditional cultures. According to the author the image of contemporary healer is a product of centuries-old traditions as well as therapists’ ability to adapt their image to patients’ needs and expectations. This image is created by patients’ hope of recovering and their longing for a miracle. This longing is either a realization of deeply rooted religious attitudes manifested in the desire to witness the sacred intervention in human world order, or a secular need for the show, that will introduce an individual into the world of intense experiences.

Michał Jakub Kocikowski
University of Warsaw, Poland

Charismatic Healing Prayer as a Practice of Complementary Medicine

Since 2008 I have been working on my doctoral thesis concerning new forms of spirituality and religiosity. The research I conduct is focused on Catholic charismatic groups dealing with healing prayer with particular emphasis on physical healing. Thus, the research aims to combine the perspective of anthropology of religion with medical anthropology.

Focusing on narratives of healed persons enables me to examine two important aspects of the healing prayer. On the one hand the “supernatural healing” seems to be a solely religious experience. In this context one may ask a series of questions: How does the experience of healing influence their spirituality and religious practices? What kind of relationships developed between these individual, highly subjective religious experiences and the official doctrine of the Catholic Church? How is tension between official church and charismatic movements solved by ordinary believers who are traditionally attached to the church hierarchy? In what ways does it relate to the forms of religious sensations developed by global Pentecostalism? What kind of religiosity is it? Is it a new variant of the “miracle consciousness” typical of folk religiosity described by Polish ethnographer Jacek Olędzki? What does it mean to be an “urban religion” in postsocialist, secular Poland?

On the other hand the narratives told by healed believers might be considered specific explanatory model of illness and health complementary to the medical paradigm. What does the religious explanatory model offer to people afflicted? Why is it so attractive to them? Why do they search for supernatural healing beyond the help of their physicians? Which are the differences and for that matter similarities between spiritual and biomedical practices regarding the understanding of illness, the physical setting, etiological beliefs, diagnosis and treatment repertoire, reorientation of the patient’s, and most importantly the practitioner – patient relationship? Last but not least comes the question of a transformation of the self induced by healing interpreted as supernatural rather than natural experience.

Maja Dobiasz
University of Warsaw, Poland

Anthroposophical Medicine

The aim of the presentation is to discuss the anthroposophical view on medicine and healing basing mainly on ethnographic researchers among the Warsaw Anthroposophy Group.

My research in the field of anthroposophy has started in 2008 in Warsaw Waldorf School, where I was concentrating on alternative education. Now, the focus of my interest has evolved into medicine, healing and nutrition and for almost two years I visit workshops and meetings of anthroposophists in Warsaw. Simultaneously, I study anthroposophical literature and audiovisual materials. In September 2010 I have also visited pharmaceutical fair in Goetheanum, the School of Spiritual Science and the headquarters of the General Anthroposophical Society in Dornach, Switzerland. Observing and participating in the gatherings of the group, I have discovered that the special kind of medical discourse is dominant in their activity.

Taking care of the physical body is one of the most vital points for this alternative life-view. Many areas of anthroposophical activity are used for healing or have their medical variants, primarily because of the fact, that the main stress of anthroposophical lifestyle lies on a very precise understanding of inner harmony and well being.

Anthroposophy, as an idea of transformation of materialistic civilization into one based on spiritual principles, relies on the teaching of Rudolf Steiner. This Austrian scholar and philosopher, basing on his visions, and spiritual-scientific researches, presented and executed his ideas in many realms of life. Anthroposophy inspire education, different fields of art, architecture, farming, economy, banking, social life and medicine. This holistic perspective makes anthroposophy a model for interpretation of every aspect of life, self-sufficient business and huge industry, also in terms of pharmacy, nutrition and cosmetics.

This alternative worldview, looks at the reality as at a mixture of science and spiritual knowledge. In my opinion it makes anthroposophy a very interesting phenomenon, and its complementary medicine worth examining.

Sahienshadebie Ramdas
University of Amsterdam, Netherlands

Cruel Diseases, Cruel Treatments: Curing Cutaneous Leishmaniasis in Suriname with Potentially Harmful Non-Biomedical Chemical Substances

When is something called a medicine? What makes a medicine, a medicine? Its material composition, its cultural use, or achievement of cure? How could the use of chemical solutions such as battery acid, herbicide, and chemical products used to cure animals be understood in the efforts to cure CL, and where do we place them in the context of healing practices? This article is about the quest to cure, the boundaries of healing and perceptions of the disease cutaneous leishmaniasis (CL) in Suriname, South America. It illustrates ideas and reasoning behind health seeking, and critically questions the concept of medicine within healing systems regarded as traditional medicine (TM) or complementary, and alternative medicine (CAM). CL is a parasitic disease, caused by single cell Leishmania parasites affecting globally 1 to 1.5 million people. It has a spectrum of clinical manifestations, but the most prominent and disfiguring elements are the extensive ulceration and scar formation of lesions. The data on which this article is based, is derived from current research about social and cultural aspects of the perception and treatment of CL in Suriname. Fieldwork is carried out during 10 months in different parts of Suriname. One of the major findings is that almost all people with CL tried self treatment varying from ethno-botanical products to chemical solutions. Data is mainly collected through qualitative research methods. 216 CL patients of the Dermatological Service in Paramaribo, the capital city, participated in the research through short questionnaires. Furthermore, in depth interviews, focus group discussions and observations have been done in several villages of the hinterland. This article is the outcome of the multidisciplinary research “Leishmaniasis in Suriname”, funded by the NWO-WOTRO.

Pauline Huet
Paul Cézanne University, France

New Age and Neo-Shamanistic Movements in Brittany (France): In Search of a Soul Therapy

Spirituality and medicine have ancient links, as they both ask similar; existential questions. Modernity is said to have caused a break and made, officially, medicine and spirituality two separated fields. However, we can wonder if this separation is totally relevant. In fact, we observe a multiplicity of “new”, “alternative”, “complementary”, “soft” medicines that give more space than biomedicine to individual subjective experiences, tending to bring back together body and soul.

Between all those “new” therapies, we choose here to talk of shamanistic “healing rituals” taking place in Brittany. Presented as a mix between South American shamanism and Celtic druidism, those rituals happen on traditional Celtic celebration times. They go along with “more traditional” shamanistic ways, like dances on drums, meditations, etc., which are said to “heal the soul”.

Participants to those sessions claim that it has “changed their lives”, that they feel happier, and more balanced; we will try to understand how.

Based on an exploratory fieldwork done in December on the countryside of Nantes we will, for the workshop, make a presentation of one of those rituals; and work on the questions it addresses to medical anthropology; Shall we challenge the classical opposition between rationality and irrationality; How to work on and understand “soul therapies”?

Workshop 2: Reproduction and population politics

organized by Edit Szenassy, Charles University Prague, Czech Republic;
discussant Dr. Erica van der Sijpt, University of Amsterdam, Netherlands

Maria Węgrzynowska
Dublin City University, Ireland

My Health in My Own Hands: Polish Women’s Healthcare Strategies During Pregnancy and Birth-Giving

Over the last decade obstetric healthcare services have been the focus of a considerable public debate in Poland. On the one hand, several initiatives attempted to create a more friendly and less medicalized environment that would give women more power to decide over their own bodies. On the other, demand for medical procedures and the use of new medical technologies have considerably increased among Polish women. Based on fieldwork among women who have given birth in the Polish Mother Memorial Hospital in Łódź, this paper argues that, although women trust and rely on biomedicine, they also often mistrust the Polish healthcare system. Women try to resolve this contradiction by seeking to personalize their relations with hospital personnel. The strategies they use to achieve this goal include: accessing private practices of their public consultants; giving bribes to doctors, midwives and nurses; or using personal connections to access better and faster medical services. By using these personalizing strategies women want to ensure that first, they will be treated with respect, and second, that they will receive accurate information while in the hospital. These two aspects relate back to the problematic relation between, on the one hand, strong demand for medical technology, and, on the other, lack of trust in the medical system that is embedded into the wider context of postsocialist changes in Polish society.

Lorena Anton
University of Bordeaux 2, France
University of Bucharest, Romania

Be(com)ing a Socialist Mother and its Legacies: Politics of Reproduction and “National Health” during Ceauşescu’s Romania

In this presentation I will examine the intersubjectivities between reproduction, nationalism and population politics during communist Romania and its pronatalist regime, as well as their postcommunist legacies. This paper is based on my dissertation research on the social memory of abortion in communist Romania (2005-2010) and on ethnographic fieldwork in progress in South-West of France that investigates reproductive health practices of Romanian Women immigrants, between past and present.

From 1966 to 1989, the Romanian Communist Party prohibited by law the right to pregnancy interruption, all in the name of the sanctity of the Romanian communist nation. In the public sphere, reproduction was fundamentally associated with “the nation” and its needs, and the communist family was seen as a “reproductive unit”. Being a morally correct communist subject equaled being a prolific “socialist mother” (rom. femeie-mamă), a family model which was slowly developed into an overwhelming “Romanian tradition”. After the fall of the communist regime, the demographic boom intended by Ceauşescu’s regime arrived not only to its end, but to counter-consequences: the Romanian “traditional” family steadily but certainly decreased in number, in direct relation with phenomena like generalized family planning, continuation of the former abortion-culture or intense migration.

My research shows that the consequences of Ceauşescu’s pronatalism continue to affect Romanian women’s reproductive health to this day. Although the legacies of the past are not being debated publicly in post-communist Romania, their negative effects become visible at both national and international level when Romanian citizens migrate. Romanian women who migrate to France (to study or work, legally or illegally) are forced to assimilate into and embody another public health system, shaped by different political and religious discourses than those they “left back home”.

Nahar Papreen
University of Durham, UK

Invisibility of Infertile Women in Bangladesh: Policy and Program Perspectives

Fertility control is the main focus of state level health policies in many developing countries, including Bangladesh. As a result infertility hardly receives any priority in national level health policy discussion in Bangladesh. On the other hand cultural and economic value of children make motherhood socially mandatory and infertility becomes a subject of stigma, thus they are also culturally excluded. The aim of this paper is to contextualize the experiences of infertile women by focusing some macro level factors affecting infertile women’s lives in Bangladesh. This paper is an outcome of a PhD study. The research has been conducted with an ethnographic approach. Critical medical anthropological perspective with a feminist view is the basis of analysis of the study. The study revealed that infertile women’s lives have not been seen, known and identified in the macro level conceptuali­zation of women’s health in Bangladesh. Where the approach of public health is still in its traditional form with an emphasis on morbidity and mortality rates. The issue of women’s “wellbeing” is excluded from the public health discourse in the country in many cases. As a result, a woman who is infertile has no place in the reproductive health interventions and she is systematically ignored in the health policies and programs. The root of this “process of exclusion” is not only national but also international discourse of politics of population control. It is not only a matter of resource constraint that prevents the public health sector from addressing the problem of infertility, but also the “process of exclusion” in the international level discussion about the health of developing countries. It can be said that the discussion and concern of “population control” has shaped the reproductive health policies of Bangladesh.

Workshop 3: Migration and health

organized by Susann Huschke, Freie Universität Berlin, Germany;
discussant Dr. Stéphanie Larchanché, Centre Françoise Minkowska, IRIS-EHESS, Paris, France

Monika Kujawska
University of Wroclaw, Poland

Continuation and Change in Medical Practices of Polish Migrants in Subtropical Part of Argentina

Polish peasant families moved to Argentina within an organized migration for economic reasons between 1936-1939. They settled down in an isolated subtropical forest area of northern Misiones, at the border region with Brazil and Paraguay. This paper is based on interviews and questionnaires among 83 Polish migrants and their descendents, inhabitants of northern Misiones. The field research was done within ethnobiological framework. The unit of analysis were medicines (herbal, animal, mineral, pharmaceutics, etc.) used to treat different ailments as well as non-biomedical therapies (charm healing, massage, etc.) within home and complementary medicine of Polish migrants. The results from the field work were compared with the ethnomedical and ethnobotanical literature from Misiones (Argentina) and Poland (from the period before world war II). The main assumption was that the continuation of health practices of Polish migrants could be observed in three fields: 1) therapies that require limited or non-specific organic material such as: charm healing, midwifery, bone setting, 2) in the medicinal use of farm animal products 3) in medicinal use of cultivated food plants known from Europe. The research confirmed the aforementioned hypothesis. Singularity of Polish group can be observed in the importance of some natural cures like tea or wormwood in their phytotherapy, in forms of medicine administration (single versus complex remedies), acquisition (home gardens) and the prevalence of exotic plant species in their herbal pharmacopoeia. Nevertheless, Polish migrants’ phytotherapy and charm healing demonstrate nowadays more features of local folk medicine of Mestizo people than the native ones. The biggest change in the home medicine of the study group can be observed in the growing importance of pharmaceutical drugs and self-medication.

Polina Aronson

University of Warwick, UK

Restructuring “Home” in Health Beliefs and Help-Seeking Practices: Migrants from Ex-USSR in Berlin

Expression of identity boundaries in beliefs and practices about human body, including beliefs about health and adequate care in case of illness, is a well-studied phenomenon; however there is a knowledge gap with respect to migrants from former USSR in Western Europe, which this paper sets to address. I will discuss health beliefs and help-seeking behavior of Russian Germans and Soviet Jews, who have established communities in Germany after having being recruited from the successor states of the former USSR in the 1990s by means of special acceptance policies. The paper will be based on qualitative data obtained throughout my PhD research.

First, I will argue that cultural components of beliefs about health and adequate care should not be attributed to migrants’ ethnic background. Considering that Soviet leaders pursued to eliminate ethnic cultures, most of the persons in this research experienced their ethnicity not as a set of norms, beliefs and traditions expressed in everyday practices, but rather, as an ascribed institutionalized status. I suggest that most of the migrants have formed their health beliefs and help seeking practices not as ethnic Germans or Jews, but as Soviet citizens, socialized in a universal Soviet culture of body and Soviet type of medicalization.

Second, I will discuss how models of sick role and patterns of help-seeking sustained within communities serve as expressions of identity boundaries both externally (to the host society) and internally (to each other). On the one hand, I will discuss “othering” in either community by delegitimizing sick roles of host society and opposite community. On the other hand, I will discuss how provision of home care through rejection of German pharmaceuticals and distribution of Russian medicines and folk treatment methods serves to sustain gender and ethnic identity and to re-construct “home” though traditional norms of behavior. In particular, I will focus on gender roles and female care giving.

Nolan Kline
University of South Florida, USA

Migrant Oral Health in Central Florida: Exploring Social Inequalities and Exclusion from Health Services

Undocumented migrant laborers in the United States have few options for health care even though they often engage is some of the most hazardous types of work. Barriers to care for this population include immigration status, language, transportation, and migration route that all constrain access to health services. While some non-profit organizations have attempted to fill voids left by government agencies, these volunteer and charity services are often limited in the types of health concerns they are able to address. Moreover, there is a dearth of services available to address poor oral health among migrant populations. Oral health is an important component of systemic health to consider because poor oral health has been connected to heart disease, lower self-image, sleep and speech problems, and poor nutritional outcomes. Teeth also carry a social significance, and teeth can demonstrate the lasting biological impacts of social inequality and exclusion from a specific type of care. Drawing from original research in Central Florida, this paper discusses barriers to accessing oral health care services among migrant farm workers and situates their barriers to care within a political economic perspective. While some migrant health literature may identify education as a barrier to care, this research shows that knowledge about maintaining good oral health was not a problem among the sample population. Lastly, this paper highlights how examining oral health among migrants in the United States reveals components of the U.S. health care system that may otherwise remain unseen. Working with a migrant population specifically reveals how discourses of deservingness and legitimacy frame access to health services, and examining oral health in particular sheds light on conceptions of overall wellbeing and what types of care are disproportionately valued in U.S. health care system.

Saphia Mokrane
Paul Cézanne University, France

Access to Medical Care for Illegal People in Brussels

This presentation summarizes a research done in the framework of the master 2 in biocultural anthropology in Aix en Provence. It focuses on access by illegal immigrants to health care in Brussels. Belgian legislation guarantees this access, but the process is so complicated that in practice, many of them receive no or restricted medical assistance.

In theory, illegal immigrants who have not applied for asylum (medical help for asylum seekers is an exclusive competence of a specific federal agency) can get medical help from municipal social services (CPAS – centres publiques d’aide social). The CPAS investigate to assess if the applicants are eligible for medical care (depending on their immigrant status, their incomes, their place of living and a medical insurance in another European country). Moreover, a physician has to sign an attestation document that specifies their medical needs (attestation d’aide médicale urgente).

The CPAS must provide and finance medical coverage if all these conditions are fulfilled. This assistance however excludes financial help or housing. Moreover, the federal government will refund the CPAS only for clinical procedures listed by the publicly funded health care service (INAMI – Institut National Assurance Maladie Invalidité).

In practice, illegal immigrants are however facing many difficulties to gain access to medical care, even in Brussels City, although the municipality pays special attention to this weakened population. From my experience, I’ll explain you how Brussels city has organized this medical help, what the limits of the system are, and how the illegal population is coping or not.

Workshop 4: Health revisited: understanding the search
for well-being in social, economic, emotional and political contexts

organized by Pauline Huet, University Paul Cézanne, France;
discussant Dr. Izabella Main, Adam Mickiewicz University of Poznan, Poland

Nicole Gilchrist
University of Edinburgh, UK

Shifting Focus: A Move to Well-Being

The move towards sustainable practices and green initiatives has been progressing throughout different spheres: individual, social, commercial, political. Architecture, urban planning and city planning have followed this trend towards sustainable development. In Scotland, and other countries, a shift has occurred in how sustainable development is promoted. It is not solely economic functions that are explored, but community and individual health and well-being as well.

It is my intention to review and explore the advantages of the changing views of sustainable development and the shift to evaluating the benefits of regeneration projects and urban development’s in terms of well-being.

Natalia Weimann
Adam Mickiewicz University, Poznan, Poland

Health Centred Design

In my paper will deal with the issue of designing public spaces in accordance to its users’ needs, while the latter mean here the people’s growing need for a state of well-being. Using the data gained during my master thesis research I want to show the process of collecting information from the fieldwork and then converting it into a project to be applied in everyday life.

Such keywords as health, health promotion, well-being and wellness play the crucial role in the medical discourse of our times – both among specialists and ordinary people. There are many programs created to enable people taking care of their health on their own but few of them are designed well enough to be really helpful. This is because there often exist no connection between people’s everyday practice and health promoting programs created by the representatives of biomedicine. In order to change it we should pay more attention to the so called user experience (UX) and hence the user-centered design.

The first part of the paper will have an explanatory character since I will give some scientific as well as laic definitions of the keywords mentioned above.

The most important theories of health and illness perception will be presented as well. In the second part I will refer to the UX and user-centered design, giving a short explanation of their meaning and describing their connection to the medical anthropology. Referring to my own fieldwork I will try to show that in the process of designing any product – no matter if it is a material object such as a pill or services provided e.g. by a hospital – the cooperation between researchers and designers cannot be omitted. Finally, I will give a proposal of a project, in which an interdisciplinary team would design a specific public space – in this case an elementary school – according to the children’s needs in frames of the health promotion.

Piotr Szenajch
The Graduate School for Social Research of the Polish Academy of Sciences, Warsaw, Poland

The Death We Talk About and the Dying in the Eyes of Hospice Patients

In this paper I would like to present the results of a study conducted in a Warsaw hospice in 2007 that involved a series of narrative interviews with dying hospice patients. The study was a part of a wider research project aiming to compare the ways of representing illness and death in the 20th-century fiction and film, as well as in certain branches of contemporary public discourse – with an ethnographic description or a “reconstruction” of the individual experience of dying.

Over the course of my analysis I realized that contrary to the common diagnoses of taboo, the death was abundantly depicted and widely present in the public discourse. This, however, concerned death as a sign within culture, idealized, postulative and subject to aesthetic transformations; it concerned much less the most commonplace contemporary experience of death – the one to which the hospice movement of the 70ties referred to rather as “dying”. My thesis was that this second aspect of death is the one still dangerous to the order of everyday experience and thus isolated and still a taboo. That was the reason for my attempt to understand this “most commonplace experience” of dying.

Dying seen from the perspective of my interviews is a rapid process of disorganization of everyday life, gradual loss of self-reliance and eventually even the control over one’s body. It is accompanied by growing fear, sense of isolation and abandonment by one’s family. Practically all my interlocutors seemed not to accept and sometimes not to acknowledge their situation (sometimes also their diagnosis). They were far from “taming death” (Philipe Ariès) and incapable of positively reinterpreting their suffering (Fritz Schütze).

To further develop this “reconstruction of an experience”, I tried to analyze the language of the narratives through a “reconstruction of text’s metaphoric system” – a method inspired by the cognitive theory of metaphor by George Lakoff and Mark Johnson.

Anna Wójcik
University of Warsaw, Poland

Social Consequences of Travel Tourism in Poland – Case Study: Duszniki Zdrój

The paper focuses on travel tourism in Lower Silesian mountain resort Duszniki Zdrój and its impact on local attitudes towards foreigners. An influx of western European clients seeking low cost treatment entails a major refurbishment of healthcare facilities and an apparent economic gain for healthcare providers. However, it also aggravates visible social discrepancies and may renew resentment and insecurity in this pre-war German region. The study outlines how the practices of “beauty trips” and “dental tourism” are viewed by the inhabitants. The paper brings up topics ranging from prestige and rivalry to questioning local identity. Methodology includes on-the-site research conducted by the author combined with a review of local press.

Kim Bartholomæussen
Aarhus University, Denmark

Health Care Workers in Denmark

In Denmark during the last years, there has been an increased focus on the individuals own responsibility for their own health. In relation to public health policy the focus has been on what the individual can do to improve their own health in particular concerning Diet, Smoking, Exercise and Alcohol. Attitudes towards health responsibility can be reflected in attitudes to illness in workplaces within the primary health care services. At the same time, studies have shown that the group of social and healthcare workers is more absent due to sickness than the average population in general. The cause of disease is largely embedded in the form of work, organization and working environment.

Work exposure in relation with recent year’s attitude to own health means that when an employee is absence due to illness it can create friction between colleagues and the employee. This is partly due to the organizational decision not to get a temporary worker as substitute for the absent. This means partly that colleagues must do the absent employees tasks, but also that the employee can be blamed for an insufficient care about own health. In this paper I bring into focus the tension occurs in the conflict between attitudes toward illness and the employees participation in a collegiate working relationship.

Carys Banks
University of Cambridge, UK

Interpreting and ‘doing’ care in a supported living environment for intellectually disabled adults: some findings from a preliminary ethnographic study.

This paper details my recent experience of working in a UK based supported living home for adults with intellectual disabilities (ID) in order to gain direct insight into the nature of services and models of care that are provided in the everyday living environments of this group of people and how this impacts on the ways that people relate to one another in these settings. 

The personalisation model is now central to community-based health and social care (Department of Health, 2001; 2009; 2010).  This is part of UK policy reforms that are responding to evidence indicating that men and women in with ID who live in supported living settings are significantly poorer in health and well-being than others citizens (Robertson et al., 2000, Lifshitz, Merrick and Morad, 2010).  Underpinning this model is an individualised approach to service delivery, one that maintains, as much as is possible, the choices, independence and freedom of individual users and aims to place them and their families or significant others, at the centre of services.  Combined within this is the principle of a duty of care, which acknowledges the need to empower but also to ensure the protection of people lacking decision making capacity (The Mental Capacity Act, 2005). 


In recent years, a critical approach has emerged which suggests that current policy which aspires to achieve both protection and personal autonomy and to maximise cost-effectiveness and quality (McIntosh and Sanderson, 2005) do not take into account the complexity of supporting individuals who are intellectually disabled.  If health and social care practice in ID supported living is compromised by tensions within policy, there is a danger that this may impact negatively upon the delivery of care and support in these settings.  To date, little research has been conducted into understanding how this affects the everyday life choices, health and well-being of service users and, as such, there is an urgent need to further understand how current structures of social support are impacting on health and well-being of this group.

Workshop 5: Social life of medical technologies and pharmaceuticals

organized by Caroline Meier zu Biesen, Free University Berlin, Germany;
discussant Dr. Claire Beaudevin, Paris Descartes University, France

Susanne Ådahl
University of Helsinki, Finland

Knowing the Dialysis Machine: Enactment of Survival Scripts in Machine – Patient Interaction

The development of the dialysis machine in the 1950’s was a milestone achievement in the development of renal therapy. For patients suffering from acute renal failure technology is the only means of survival until a kidney graft can be secured – a process which may take several years. Once the patient’s own kidneys can no longer act out their “sewage function” in the body the social life of the patient becomes intimately intertwined with the social life of the dialysis machine.

Patients suffering from acute renal failure must on a regular basis (daily or thrice weekly) perform the practice of cleansing the body from impurities through the means of the artificial kidney. For patients using self-administered home-based hemodialysis this repetitive practice moves from being technologically challenging to becoming mundanely familiar through a process of intensive learning. In this paper I ask what types of skills or practical knowledge a patient must possess while living through a dialysis machine. I will focus on patients’ ongoing and situated practices of knowing as part of their interaction with the dialysis machine. I propose to analyze the performance enacted between patient and machine as achievement (learning to use the machine better) and as the enactment of a script that ensures survival, including practices that involve aspects such as sensitization to new cues, obedience of the body, alertness of mind, and failure of machine scripts.

Elsa Mateus
University of Lisbon, Portugal

The Social Life of a Biological Therapy

Based on the argument proposed by Whyte, Van der Geest and Hardon that medicines can be studied as material manifestations of therapy and, as such, holders of social lives, this paper intends to be an ethnographic essay about one biological therapy. According to this approach, the social life of medicines develops during its production and marketing, prescription, introduction through formal (or informal) distribution channels and although it is annihilated with consumption, it persists in the effects it has on the bodies. In the light of this concept, this essay presents a synopsis of the social life of the medicine with the brand name Enbrel, recommended for the treatment of rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis and psoriatic arthritis. Classified as a biotechnological therapy, the drug in question is in the category of so-called biological response modifiers, which are defined by Infarmed as drugs produced by a living organism through genetic engineering. Data for the year 2007 indicate that in Portugal, only 13% of rheumatoid arthritis patients with biologic therapy indications were receiving this type of medication (including three other drugs).

This paper aims to outline an overview of the social life of this medicine, given the processes of commodification, globalization and localization, its specific role in the health care technologies in Portugal and its implications in social relations coupled with the metaphoric and metonymic associations drawn by consumers in managing their disease episodes. It can also illustrate the pharmaceutical nexus understood as an empirical object, a problem or research method within the political, economic and ethical implications of drugs’ globalization.

Sarah Blacker
University of Alberta, Canada

Inside the Laboratory of a Racial Project: On NitroMed’s Construction of the Concept of Race-Specific” Medicine

This paper discusses the pharmaceutical corporation NitroMed’s production and marketing of BiDil as the world’s first “race-specific” drug, arguing that BiDil must be understood as the launch of a new racial project born on the terrain of genomics. I examine the mechanisms through which the concept of race is reified and biologized through the FDA’s approval of BiDil to treat heart disease solely in African-American patients and suggest that a lack of critical attention directed towards the conditions of scientific production prevents us from recognizing pharmaceutical research itself as a site through which systemic racist practices and beliefs are articulated. The FDA’s decision to approve BiDil for use in racialized populations was understood as a humanitarian decision made to benefit a population that suffers disproportionately from heart disease, rather than a political decision intertwined with capitalist imperatives. In this way, the carrying-out of a savvy business plan – constructing a “niche market” to ensure strong sales for a new product entering an already-saturated market of drugs designed to treat heart disease – does not merely produce profit for NitroMed, but also constitutes an epistemic shift that produces deleterious political, material, cultural, and social effects. I draw attention to the questions that cannot be asked from within this epistemic paradigm in which one particularly short-sighted technological solution is put forth as the correct and necessary panacea to treat a problem that is historical, social, and economic in nature. This paper examines the animating logic of the institutions that construct scientific facts prior to their circulation and argues that the approval of BiDil naturalizes an insidious ideological investment in genetic determinism, thereby limiting our understanding of the mechanisms at work in the development, treatment, and prevention of disease.

Emanuele Bruni
Sapienza University of Rome, Italy

Poverty, Researchers and Health Professionals: Ethnography of a Public Health Intervention on an Unknown Liver Disease in NW Tigray (Ethiopia)

In the last years an epidemic disease of liver with an unknown etiology has been affecting a number of villages in North-Western Tigray (Ethiopia). The Unidentified Liver Disease (ULD) has a high mortality rate, affecting particularly children, malnourished people and also livestock, with a strong impact on the economy as a consequence. Epidemiological, clinical, laboratory and anthropological investigations have been carried out since its outbreak by many institutions, national and international. Nevertheless, in many cases it emerged how most of the researches, even the “social based” ones, were aimed at the preservation of biological life, “naked life”, without considering the holistic conception that concerns also the social and personal sphere of individuals and societies affected. Maybe, this was at the origin of many cases of lack of participation and ownership by the affected population and of mistrust in the health professionals and researchers. As a consequence, this could have influenced also the success of any kind of epidemiological and public health intervention whether oriented to the discovering of the root cause of a disease or to is eradication.

Basing on a medical anthropological approach and on an ethnographical inquiry, this contri­bution will analyze some of the ethical topics emerged during this research, analyzing the role of all the social actors involved: communities, local authorities, NGOs, researchers, policy-makers. The aim is to promote more participative tools of research for the population, adopting a “poor’s perspective” that would be a crucial point in the recovering of that social dimension of medicine, that nowadays seems forgotten by the medical authorities who operate in the epidemiological field.

Britta Rutert
Free University of Berlin, Germany

On the Social Life of a Molecule

In the South African “indigenous world” medicines are a vital and lively part of the everyday life. Used as communicators and intermediators between healers, patients and the ancestors, as integrative essence of daily and spiritual cleansing used by the wider population as much as by healers and herbalists, medicinal plants are embedded in a social life that is beyond pure healing: it is life itself.

In scientific laboratories, where medicinal plants get screened for new valuable compounds, medicinal plants merge into a realm that is taking the essence of this life into another meaning. Reduced to its chemical compounds these plants enter a circle of technological reductionism that finally puts the idea of social life into question, but at the same time creates a new access to a new form of “social life of medicines”.

In this paper I want to follow the multiple “social lives” of a chemical compound called P27 crossing various social strata to finally end up as a product available as a pharmaceutical in the pharmacies and online shops of parts of the world that having nothing in common with its place of origin. In that sense the molecule is not only traversing from the “local” to the “global” into another “local” but is also merging between various “social lives”, without losing its identity: it remains a molecule as part of a medicinal plant that grows in nature.

Valérie Liebs
Johannes Gutenberg University of Mainz, Germany

Neither “Modern” nor “Traditional”? Use and Meaning of Medicinal Plant Products in Kinshasa

In Kinshasa, the capital of the Democratic Republic of Congo, medicinal plants and the relied medicinal practices and ideas are constantly (re-) evaluated. Although many dwellers request their use, Kinshasa as a huge city sets a field where ideas and practices derived from what is mostly referred by them as “traditional medicine”, are confronted with processes of technological and ideological change.

Herbalists create different strategies in order to get an income from their skills in town, for example by sometimes transforming, e.g. “modernizing” their medicinal plant products into “improved traditional medicines” (ITM) through research, product standardization and sophisticated packaging. Healers specialized on medicinal plants relocate their status position by using the WHO discourse about the potential efficacy of medicinal plants based on the evaluations of natural science. Thereby, they separate from the sometimes negative connotations relied to “traditional” medicine of being unreliable or associated to “evil” practices. On the other side, they refer to their “traditional” knowledge as proved through generations. Often, they also emphasize their moral commitment linked to the ideal of the village and its social ties. With it, they legitimize their work, thus contrasting to the lacking trust and security in the city. They take positions and actions that are ambiguously judged both by them as well as by others. Those who are entrepreneurs and produce ITM´s are sometimes seen as opportunists, those who stand on their position of being traditional as backward.

Based on an 15 month ethnobotanical field research on the social life of medicinal plants in Kinshasa with healers, medicinal plant gatherers, sellers and laymen in the frame of a PhD study, this paper will describe how the value and use of medicinal plant products is strategically positioned into different contexts, depending on the assigned value and the relied interests.

Sandra Baernreuther
University of Heidelberg, Germany

Technologies in Circulation: Assisted Reproduction in India

Assisted reproductive technologies and procedures today circulate the world. In India a vast number of fertility clinics offers treatments like IUI (Intra Uterine Insemination), IVF (In Vitro Fertilization), or ICSI (Intra Cytoplasmic Sperm Injection). This paper will explore the socio-cultural dynamics resulting from the travels of reproductive technologies using approaches developed in both anthropology and science and technology studies. These disciplines have demonstrated that technologies lack the neutral and objective nature commonly attributed to them, but are always co-produced with society. This is all the more true in India, where assisted reproductive technologies are negotiated and applied in unique ways instead of being merely adopted from the “West”. In this sense, the paper will examine the ways in which technologies and their utilization are influenced and transformed by social and cultural contexts, and, reciprocally, the role they play in shaping these social formations. It will answer the following, intertwined questions: How are assisted reproductive technologies and related concepts and practices in India appropriated, re-interpreted or rejected? In what ways are they contextualized and modified by both medical staff and patients? And how do reproductive technologies impinge on (and are themselves shaped by) notions of infertility, local biologies, subjectivities, and moralities?

Amanda Wilson
Central European University, Hungary

Strange Fruit, Strange Blood: The Body as Postindustrial Real Estate in a Former Southern U.S. Mill Town Turned “Biopolis”

This paper will examine the case of a blood biobank, located in the post-industrial mill town of Kannapolis, North Carolina, USA, and argue that, in this case, the unique context of a place and its social relationships constitute part of a global medical technology. The town suffered a major shock in 2003 with the lay-off of 5,000 mill workers. Now the town’s residents are being asked to participate as volunteer donors in a blood study which aims to recruit 50,000 participants. There is one stipulation: because the study is longitudinal, donors must live in the town. Their blood will be utilized for university research as well as private fee-for-use research in the boom sector of personalized medicine. Drawing on primary and archival sources from oral histories and local newspapers, this paper will argue that churches, workplaces, hospitals, schools, and the body itself form vital nodes of this technology, which is discursively shaped from above and below respectively by market-oriented, “industry” and “local” narratives.  Research aims to show how this technology has a “social life” which is rooted in place. More than simply drawing on blood in a bank, this blood-based research draws on places, people, their experiences, and social relationships: to each other, to history, to church, and to a “regime” of biomedical knowledge.

Workshop 6: Mental health and psychiatry

organized by Nina Grube, University of  Münster, Germany;
discussant Dr. Johannes Quack, University of Heidelberg, Germany

Agata Sikora
University of Warsaw, Poland

Salomea Słowacka-Bécu – a Depressed Woman or Sensible Heart? Sentimental Emotionality at the Beginning of the Nineteenth Century and Modern Conceptions of Mental Health

In my paper I will introduce the perspective of anthropologically-oriented cultural history to discuss the problem of cultural frames in which human behaviors and emotions are interpreted. Putting aside the widely discussed issue of the relationship between cultural and biological factors in relation to mental problems, I will focus on the different attitudes towards particular mental states present in sentimental culture and today. The subject of my case study is the correspondence written by Salomea Słowacka-Bécu (1792-1855) to Edward Odyniec (1804-1885) between 1826 and 1842. Firstly, I will assess the psychological state of the writer according to contemporary Western medical standards. Application of the Hamilton Rating Scale for Depression (HAMD) to this case shows that Słowacka-Bécu had a considerable number of depression symptoms: she cried constantly, thought about her death, complained about the emptiness of her life, hopelessness, helplessness, loneliness and health problems. From the current psychological point of view, she needed professional help to recover and return to a condition considered as “normal”. Nevertheless, from the sentimentalists’ perspective, which Słowacka-Bécu herself shared, frequent weeping and emotional disquiet were not considered to be symptoms of illness, but signs of a sensible soul. Sentimental culture, rooted in the protestant idea of examining one’s inner-life as well as in the industrial revolution, which encouraged hedonistic attitudes, was founded on emotional self-indulgence. Sentimentalists tried to derive pleasure from celebrating negative emotions: mental suffering was treated not as a medical problem, but rather as a state which might be emotionally rewarding and to which moral and aesthetic values were ascribed (Taylor 1989, Campbell 1987, Halttunen 1982, Barker-Benfield 1992)

Małgorzata Anna Charyton
Adam Mickiewicz University, Poznan, Poland

Stress and Stress-Coping Strategies in the Context of Medical Pluralism

The phenomenon of a stress has been widely discussed by the psychology of a health, where it is said to be a state of, or more likely a process within, the organism characterized by both mental and physical symptoms. According to medical anthropology stress can be understood as a category of pathology, so seen and analyzed in same terms as an illness/disease. Contextualizing the problem (in this paper it is the region of Podlasie, Poland) ways of understanding the stress specific for local groups need to be identified. Amazing cultural constructs according to the stress are being shaped by such processes as globalization or glocalization of meanings and others.

How on this background are being build strategies of stress fighting? Not only conventional but also wide range of alternative and complementary remedies and healing methods appears to be an perfect answer, because needs in this subject are great and highly individualized. Traditional magic treatment and orthodox prayers offered by local folk healers, Asian techniques of meditation e. g. yoga or strengthening exotic plants and many others, but also services not strictly connected with health neither medicine will be seen as very useful and effective ways to set free form stress. It is worth to count in this context the meaning of medicalization of the discourse, the role of media in promoting the knowledge about stress and the ways of caring a trade where hardly everything can by sold when shown as “curative” or called “therapeutic” either “remedial”.

Ruari-Santiago McBride
Queen’s University Belfast, Northern Ireland

A Genealogy of (Trans)gendered Discourse: Science, Civil Society and Gendered Citizenship in Neoliberal Britain

This paper examines the manner in which the meanings and values attached to gender variance in the UK have been (re)constituted through discursive practices. Analysing various strands of discourse that have emerged from the fields of medico-science and civil society the paper explores the epistemological assumptions inherent within competing perspectives of gender variance; arguing that the empirical-positivist paradigm of medico-scientific disciplines led to the pathologisation of gender variant behaviour, a perception that has been challenged by trans activists who, utilising postmodern theory, argue gender variance to be a biosocial phenomenon. Furthermore, the paper sets out to analyse the productive effects of discourse, examining the constitutive consequences that this discursive debate may have on the subjective agency of individuals that embody gender variant behaviour. Viewing these findings in relation to the localised socio-political context, neoliberal Britain, I discuss the relations of power in which (trans)gendered discourse is embedded. In turn, the paper argues that by mobilising the discursive power of civil society, a vector of control and regulation of government conduct, trans activists and scholars have been able to engender progressive legislative change that recognises and protects gender variant individual’s rights as free citizens. In conclusion, the paper seeks to understand how this progressive change may act to reinforce existing social inequalities.

Tom Widger
Brunel University, London, UK

Medicalization / Demedicalization of Mental Health Services in Sri Lanka and the UK: Exploring the Dynamics of a Global Exchange

The twin processes of globalization and multiculturalization in the global “north” and “south” have set up a dynamic global exchange of health care ideology and practice. While medicine in the post-colonies can be understood as undergoing medicalization through the institutionalisation of biomedical paradigms in the old colonial centres health is demedicalizing in response to national and EU equality and diversity legislation that places social and cultural needs at the forefront of primary care and public health planning. This paper examines the processes of medicalization and demedicalization in Sri Lankan and UK health services respectively. In both, processes of medicalisation and demedicalisation are framed in terms of health and social welfare “inclusion”, within a broader paradigm of human rights. But while in Sri Lanka what is meant by inclusion is health patients’ absorption into universalised biomedical systems, in the UK it means instead the particularisation of biomedical systems and the development of socially and culturally appropriate practices.