Society for Medical Anthropology

Medical Anthropology Quarterly (MAQ)

International Journal for the Analysis of Health

• Medical Anthropology Quarterly: International Journal for the Analysis of Health publishes research and theory in the field of medical anthropology. This field is broadly taken to include all inquiries into health, disease, illness, and sickness in human individuals and populations that are undertaken from the holistic and cross-cultural perspective distinctive of anthropology as a discipline -- that is, with an awareness of species' biological, cultural, linguistic, and historical uniformity and variation. It encompasses studies of ethnomedicine, epidemiology, maternal and child health, population, nutrition, human development in relation to health and disease, health-care providers and services, public health, health policy, and the language and speech of health and health care. The purpose of the journal is to stimulate debate on and development of ideas and methods in medical anthropology and to explore the relationships of medical anthropology to both health practice and the parent discipline of anthropology.
• AnthroSource has MAQ and its predecessor, Medical Anthropology Newsletter. Coverage extends from 1972 through 2007.
• MAQ and Medical Anthropology Newsletter are also indexed online at JSTOR. Coverage extends from 1983 to 1995.
• Not receiving Medical Anthropology Quarterly? Contact AAA Member Services at members@aaanet.org.

 

Current MAQ: Vol. 23, No. 2: May 2009

 

Editors' Introduction

The Interrogative Imperative: : State, Community, and Individual as Bodies and Subjectivities - Mark R. Luborsky, Andrea P. Sankar

Centennial Recognition

Maurice Merleau-Ponty and the "Embodied Subjectivity" (1908–61) - P. Fusar-Poli, G. Stanghellini

Articles

The Ultrasonic Picture Show and the Politics of Threatened Life (p 189-211) Tsipy Ivry

• This article examines a local version of medical public discourse about fetal images produced through ultrasonography in Israel, where this technology has gained huge popularity. Nevertheless, I argue, ultrasound in Israel has not become engaged in the discursive production of "fetal subjects" central to the Euro-American life politics. Fetal images in Israel have become entangled in a "politics of threatened life": where "life" stands typically for the pregnant woman and "threat" for the fetus, while the prospect of a reproductive misfortune is the fabric through which pregnancies, regardless of their medical categorization as "low risk" or "high risk," are navigated and negotiated by doctors and women. The same processes of separation generated by ultrasonography forge different imagined relations between woman and fetus. This article opts to go beyond analyzing the cultural paradigms of thinking and the sociopolitical circumstances at play, to convey a sense of how notions of threatened life are produced.

La Tecnología y Las Monjitas: : Constellations of Authoritative Knowledge at a Religious Birthing Center in South Texas - K. Jill Fleuriet

• In this article, I contrast conceptualizations of authoritative knowledge in pregnancy and birth between U.S. midwives and their Mexican immigrant clients at a religious birthing center in south Texas. Although the two groups share certain orientations to pregnancy management, essential differences in prenatal care and birth epistemologies underscore distinct social and economic positions. I use narrative data to document and explain these differences, which throw into relief the hierarchies of identity and need that structure immigrant women's reproductive experiences. Unveiling the different epistemologies can also help to explain sometimes radically divergent ideas that have impacted the very survivability of the birthing center. By focusing on Mexican immigrant women's reproductive decision making in an alternative birthing center, this analysis responds to feminists' call to look to the margins to understand the diversity of women's responses to what Rapp and Ginsburg have called "stratified reproduction."

Radical Remedies: : Women, Health, and the Micropolitics of Grassroots Organizing in Mexico (p 235-256) Suzanne D. Schneider

• As states weaken and public health care deteriorates throughout the developing world, new spaces are opening for civil society groups to fill the gaps of declining health systems. In Mexico, popular health groups have responded to health care decline by building community clinics, establishing health promoter training programs, and opening natural medicine pharmacies. Lower- and working-class women are the primary participants in these groups that use a self-help approach to find practical solutions to local health care problems. However, little is known about participants' circumstances, motivations, or the ideals they embrace. Drawing from women's narratives, I explore the "micropolitics" of women's participation in local health groups. I examine their efforts to reclaim control over the health process as a metaphor for claiming control over their lives. Highlighting the "instrumental effects" of participants' medical encounters and healing relationships, this case illuminates some unintended consequences of health care decline.

Routes to Government TB Treatment: : Private Providers, Family Support, and the Process of TB Treatment Seeking among Ugandan Women (p 257-276) Sarah E. Chard

• Tuberculosis (TB) remains a major source of morbidity and mortality in Uganda. This cross-sectional study explores Ugandan women's TB treatment-seeking processes to determine the routes to effective government TB treatment among a sample of urban, semirural, and rural women. This research focuses on women in particular as Ugandan women with tuberculosis must negotiate their treatment paths in a context where women tend to be politically and economically marginalized, with limited control of household resources and senior family members' health care decisions. The results examine the structural, social, and economic forces similarly guiding treatment seeking across the three research sites and then the specific differences among the settings. The findings suggest that the modest number of nongovernmental health care providers' diagnoses and referrals, particularly for urban and semirural participants, represents a critical barrier to biomedical TB treatment. Private providers' diagnosis delays also carry financial and physical costs, which undermine the resources available for subsequent TB treatment and participants' social and economic well-being. This study indicates that conceptualizations of the political economy of treatment seeking need to more fully acknowledge the dynamic nature of the microlevel political economic context of treatment seeking, including the domino social, economic, and health effects of structurally problematic health care systems.

Community Participation in New Mexico's Behavioral Health Care Reform (p 277-297) Miria Kano, Cathleen E. Willging, Barbara Rylko-Bauer

• In 2005, New Mexico implemented a unique reform in managed behavioral health services that seeks to ensure delivery of consumer-driven, recovery-oriented care to low-income individuals. Distinguishing features of the reform are the Local Collaboratives (LCs), regionally based community organizations designed by state government to represent behavioral health concerns of New Mexico's diverse cultural populations. We examine community response to the LCs, focusing on two broad sets of themes derived from 18 months of ethnographic fieldwork. The first set—structure and function—encompasses several issues: predominance of provider versus consumer voice; insufficient resources to support internal operations; imposition of state administrative demands; and perceived lack of state response to LC efforts. The second set—participation and collaboration—reveals how problems of information flow and other logistical factors impact involvement in LCs and how the construction of "community" introduced under this initiative exacerbates tensions across localities with varied histories and populations.

Susto Etiology and Treatment According to Bolivian Trinitario People: : A "Masters of the Animal Species" Phenomenon (p 298-319) Evert Thomas, Ina Vandebroek, Patrick Van Damme, Lucio Semo, Zacaria Noza

• This article addresses two concepts that are quite widespread among Latin American cultures: susto or "'fright sickness," and the "masters of the animal species" philosophy, whereby individual animal spirits are believed to be "owned" by species-specific spiritual masters. This is the first article to integrate both these aspects, drawing from ethnographic data from the Trinitario people in Bolivia collected through participant-observation and semistructured ethnobotanical interviews on medicinal plants. Although Trinitarios have a long history of agriculture, their worldview is still partly one of animistic hunter and fisherman societies. This worldview is reflected in Trinitario susto etiology and treatment. Susto is locally believed to originate through soul theft by a variety of masters of the animal species and landscape spirits. Treatment is partly based on the principle of similia similibus curantur or "like cures like" and magicoritual ceremonies, but ethnopharmacological preparations are also well known and frequently used.

The Intensive Medical Care of Sick, Impaired, and Preterm Newborns in Israel and the Production of Vulnerable Neonatal Subjectivities (p 320-341) Noga Weiner

• Following reduction in mortality rates of term and preterm babies hospitalized in NICUs, neonataology refocused its concerns on the survivors' elevated risks of long-term health and developmental problems, thus turning the "intact survival" of hospitalized newborns into an equivalently desired moral and professional goal as their "survival." Based on ethnographic observations in an Israeli NICU ("pagia"), I suggest that the new moral practice has bearings on the construction of neonatal subjectivities. According to Jewish and Israeli laws, personhood is conferred on at birth. However, my findings indicate that in practice the question of "quality of life" often appears to be a stronger consideration than legal personhood when withdrawal of intensive therapies is discussed in the nursery. Consequently, the significance of the moment of birth to the construction of subjectivity is obscured. The construction of subjectivity as a progressively developed and irreversible category is challenged, and it becomes vulnerable.

Presidential Address

President, Society for Medical Anthropology Speaking to the National Health Crisis: : Voices from Medical Anthropology (p 342-349) Carolyn Sargent

Book Reviews

Visions of Illness: An Endography of Real-Time Medical Imaging by Maud Rastake (p 350-351) Joseph Dumit

Looking Within: A Sociocultural Examination of Fetoscopy by Deborah Blizzard (p 351-353) Eugenia Georges

The Human Drama of Abortion: A Global Search for Consensus by Aníbal Faúndes (p 353-355) Michele Rivkin-Fish

Errata

Errata (p 356-356) Joanna Z. Mishtal, Joanna Z. Mishtal

 

Health Identities and Subjectivities: The Ethnographic Challenge

Susan Reynolds Whyte

• The formation of identity and subjectivity in relation to health is a fundamental issue in social science. This overview distinguishes two different approaches to the workings of power in shaping senses of self and other. Politics of identity scholars focus on social movements and organizations concerned with discrimination, recognition, and social justice. The biopower approach examines discourse and technology as they influence subjectivity and new forms of sociality. Recent work in medical anthropology, especially on chronic problems, illustrates the two approaches and also points to the significance of detailed comparative ethnography for problematizing them. By analyzing the political and economic bases of health, and by embedding health conditions in the other concerns of daily life, comparative ethnography ensures differentiation and nuance. It helps us to grasp the uneven effects of social conditions on the possibilities for the formation of health identities and subjectivities.

Power, Trust, and Risk: Some Reflections on an Absent Issue

Harald Grimen

• In modern discussions among health professionals there is a strange lack of discussions of power. This is most notably true for the discussions about proper physician–patient relations and the discussions about trust. This article explores some of the consequences of this absence. It is argued that the absence of the issue of power hampers a serious and open moral discussion of important institutional forms in the health care system. It is also argued that some of the proposals for how to organize physician–patient interaction are rather unrealistic, mainly because the issue of power is neglected. Finally, the article develops some ideas about how power ought to be approached in modern health care.

Emotional Experts: Parents' Views on End-of-Life Decisions for Preterm Infants in Iceland

Jónína Einarsdóttir

• In this article, I examine how parents of infants with birth weight of 1,000 grams or less in Iceland relate to the questions whether and when treatment for a preterm infant may be withdrawn, and who should make such a decision. Almost all the parents agreed there are categories of infants who should be allowed to die and parents should have a say in such a decision. Inability to take part in human communication was most commonly mentioned as a valid criterion for withdrawal of treatment. There was more disagreement about parents' right to unilaterally demand withdrawal. Ethical dilemmas and their resolutions are embedded in social context where images of suffering and disability and establishment of medical facts are central. Parents claimed their right to participate in treatment decisions as emotional experts; the child was theirs and they had to live with the outcome. Their hope in cure was based on faith in medical science and high confidence in the staff of the NICU. Parents also stressed the infant's will to live and referred to alternative knowledge, for instance, derived from "evidence based" spiritism or an interpretation of a dream.

Grips and Ties: Agency, Uncertainty, and the Problem of Suffering in North Karelia

Marja-Liisa Honkasalo

• In medical anthropological research, the question of suffering has been a topic of salient interest mostly from two theoretical viewpoints: those of endurance and of agency. The concept "suffering" derives its origins from two etymological roots, those of suffering–souffrance–sofferanza and of misery–misère–miseria. According to the first approach, that of "endurance" and founded largely on Judeo–Christian theology, suffering is regarded as an existential experience at the borders of human meaning making. The question then is: how to endure, how to suffer? The latter view, that of "agency," follows the Enlightenment, and later the Marxist view on mundane suffering, misery, and the modern question of how to avoid or diminish it. This article follows the lines of the second approach, but my aim is also to try to build a theoretical bridge between the two. I ask whether agency would be understood as a culturally shared and interpreted modes of enduring, and if so, which conceptual definition of agency applies in this context? I theorize the relationship between suffering and agency using Ernesto de Martino's notion la crisi della presenza. In line with Pierre Bourdieu, I think that in people's lives, there may be sufferings in a plural form, as a variety of sufferings. The article is based on a one-year long fieldwork in Finnish North Karelia.

book reviews

• Toxic Exposures: Contested Illnesses and the Environmental Health Movement by Phil Brown
  Melissa Checker

• Mental Health among Taiwanese Americans: Gender, Immigration, and Transnational Struggles by Chien-Juh Gu
  Rebecca Seligman

• Dancing for Health: Conquering and Preventing Stress by Judith Lynne Hanna
  Luci Fernandez

• Skin: A Natural History by Nina G. Jablonski
  Bernhard Fink

• The Health of Populations: General Theories and Particular Realities by Stephen J. Kunitz
  Craig Janes

• Iron in the Soul: Displacement, Livelihood and Health in Cyprus by Peter Loizos
  Lisa Modenos

• Deaf in Japan: Signing and the Politics of Identity by Karen Nakamura
  Jan-Kåre Breivik

• The Cambridge Handbook of Sociocultural Psychology edited by J. Valsiner and A. Rosa
  Rebecca J. Lester

• Wayward Women: Sexuality and Agency in a New Guinea Society by Holly Wardlow
  Mary Bicke