The potentiality and challenges of understanding illness through cultural interpretation

As medical anthropologists, we have an important stake in reforming and moralizing health care practices when the opportunity arises. What do we accomplish by aspiring to this lofty goal? We are privileged in a sense to do this work because our methodological approaches allow us to collect knowledge about the various healing practices that exist simultaneously (biomedicine and traditional healing), we can concern ourselves with documenting strengths and weaknesses of systems of “caring”, and we have access to analyzing the historical processes and myths that propagate culturally specific illness narratives. Lock’s definition of local biologies in “The turn of life – Unstable meanings” (1995) got me thinking about the ways in which people of various cultures understand their relationship to illness and the larger implications of socially stigmatize or legitimize that experience. To start off this discussion, I reflected on folk healing or folk medicine, which typically anchors illnesses through cultural interpretation.

https://www.youtube.com/watch?v=EoV3D49Qm94;http://www.ebay.com/itm/AGAINST-THE-EVIL-EYE-CANDLE-KIT-QUITAR-EL-MAL-DE-OJO-WITH-FREE-U-S-SHIPPING-/272275510629

Traditional healing takes on many forms. The first video shows a curandero conducting a limpiada or spiritual cleansing ceremony. The curandero/a proceeds to smack herbs deep onto the body. Not shown on the video, but afterwards, he will proceed to rub a raw unbroken egg, which is thought to absorb energy, up and down the skin to determine the potential ailment and provide a diagnosis. Most of the time, their explanation is that a person has mal de ojo (evil eye), which is caused when someone looks at you maliciously or with jealousy. This negative energy, physically manifests itself into stress, migraines, insomnia, etc.

From the comments, there are various questions about the authenticity of this activity. You can buy a kit and become trained in this form of activity in just a few weeks (see link to product if you are interested); but suspending disbelief for a minute, how would an anthropologist go about interpreting and analyzing this phenomenon? What assumptions are we making about the culture that engages in these practices? What implications (if any) exist for the individual body, for the social body, and political body when people have carved out a space to justify such an explanation? Is it useful to utilize our research as a means of disseminating knowledge about folk medicine (or other findings) where biomedicine (or an alternate form) already exists and works?

http://www.nytimes.com/2012/09/15/us/life-went-on-around-her-redefining-care-by-bridging-a-divide.html?_r=0
This article introduces the story of Lia Lee, daughter of Hmong refugees suffering from “quag dab peg” or epilepsy. Observe the tension between Lia’s parents and the rest of the world as each party tries to make sure Lia is cared for adequately. Oths (1999) describes mythological concerns about the shortcomings of research investigating culturally specific illness. In particular, she does not see the individual as a good unit of analysis. What become the appropriate scale to look at a culture specific illness? Despite being an ethnography of one person, the “Spirit Catches You and You Fall” (1997) does a tremendous job at looking at the family’s interpretation of caring for their severely epileptic child, the Hmong and American assessments of Lia’s condition, the social implications that followed because of the collision of these two cultures. How is disease, illness, and healing changing in the wake of migration and globalization?

http://brainblogger.com/2014/09/03/is-anorexia-a-modern-culture-bound-disorder/
When thinking about culturally specific illnesses, I came across anorexia nervosa and bulimia as examples of modern culturally bound disorders specific to industrial nations. This had me reflect on my own understanding of what I look for when thinking about the universality of particular experiences. Maybe it is naïve to think that eating disorders and body issues are a shared experience across the world, but I realized I thought of it this way until I read Lock’s work on aging and menopause which illuminated me to think that phenomenon that is familiar to me, may be perceived, experienced, and spoken about differently for various reasons by someone else. If I am conducting fieldwork, I need to be especially conscientious of this and read between the lines, attempt to utilize cultural relativism as a framework, otherwise I will not be adequately acknowledging or describing the realities that I attempt to capture.

Should we ‘still’ only have two genders? The current state of the gender binary in America.

Gender Binary: https://www.youtube.com/watch?v=fd-iOCnbi2o&feature=youtu.be

Gender Dysphoria: https://www.youtube.com/watch?v=9N12fV9gOhs&feature=youtu.be

 

Stop Asking Me When I’m Going to Really Transition http://www.mtv.com/news/2428003/genderqueer-transition-trans-awareness/

 

In thinking about this week’s readings, I’m using the provocative question that Anne Fausto-Sterling asks at the beginning of chapter four of her book, Sexing the Body, to think about contemporary understandings of gender, sex and sexuality in the mainstream American media. Extrapolating an idea from Fausto-Sterling’s book, that scientific understandings, research and medical practices for biological sex are shaped by social understandings of sex and gender, how might current representations and changing ideas about the binary gender system in the U.S. led to shifts in the way that we research sex and gender today?

 

For discussion, I am providing examples from the work of one genderqueer, gender non-binary, gender nonconforming activist, to think about how the growing acceptance, and simultaneous attempts at regulation of diverse sexualities and gender expressions, are embodied and challenged in daily life. How do people who are non-binary reside within a binary system?

The first video is simply an explanation of the gender binary, doing so by comparing binary computer systems with the notion of binary people. The idea that people are not computers, they do not fit into a Manichaean model where they have to be one thing or another is an interesting question to consider as anthropologists. How do we capture the messiness of gender and gender identities in our work, especially when doing gendered studies on groups of people who identify primarily as men or women? Do we need to create separate categories for additional genders, or should we move to recognize fluidity of gender within the accepted binaries?

Also, it tangentially brings up another point that I find interesting in Fausto-Sterling’s book, which is the role of technology, specifically increasingly accurate medical technologies for identifying the binary sex of a fetus, or for “correcting” the sex of a child to become one of the two “normal,” accepted genders. How can we think about the continuously evolving role of technology in shaping our contemporary views on sex and gender? How much does technology shape our contemporary understanding of gender identity?

The second video about gender dysphoria is a provocative comment on how understandings of gender vary, even among cisgender people. It specifically addresses how not inhabiting the “ideal” body type in our culture or having gendered behaviors that do not fit the masculine or feminine understandings of gender can cause body dysphoria in a wide variety of people. How can we use this idea of gender dysphoria as a more general phenomenon in American society, to consider elective procedures like plastic surgery, as a phenomenon of gender dysphoria? How does this reflect the ways that people think about their bodies, (such as in Scheper-Hughes’ discussion of body image 16-18), as both and a representation of their individual self, and as a social or symbolic representation of their gender identity?

Finally, I have included the last article about the process of transitioning, and the perception by others of a person who is gender non-binary and therefore has not “fully” transitioned into a binary recognizable gender or male or female. This discomfort/prejudice with people who are not quite male or not quite female is pervasive, and Fausto-Sterling addresses this as both a historical and contemporary concern, highlighting the dangers of inhabiting the space between male and female genders (110-1). The idea that people who are transgender are just transsexual people who have not yet transitioned yet to be fully male or female reflects the current state of the gender binary in America, and comes with social, physical, and legal risks of being “discovered” as not fitting within the gender binary.

As an example, consider this video The Daily Show made on Trans Panic and the legal and social persecution of trans people in the U.S.: https://www.youtube.com/watch?v=PIvCh3EQv1Q . The targeting of trans people by the legal system essence criminalizes “being transgender.” Just inhabiting a transgender body, can be construed as criminal. How do we understand the physical and social violence inscribed on the bodies of people who cannot be easily categorized into our gender binary system?

Finally I will include some questions for further thought:

How does the gender binary function as a means of social inequality in the U.S.?

Is it possible to change social perceptions of transgender people without changing from a binary gender classification system?

How might the legal targeting of trans people, especially considering the incarceration rate, be detrimental to social perceptions and ultimately bias research on trans issues?

Can biological studies of transsexual or transgender bodies be useful for trans activism in the U.S.?

Narrating narratives: a meta-analytical voyage between the potentialities and limitations of ethnographic language.

scan-2 Narrative and story telling are central to making our selves, the events in our lives, and our relations to others into coherent stories. As argued by several of the authors we have read this week, some anthropologists have made it their mission to elicit and study individual stories and the way these unveil and are tangled with social, historical, and political powers. In this piece, I do not question the importance of narrative or its relevance to our discipline. Indeed, in my previous and present work, I have embraced many of the theoretical insights of the authors we have read for today, taking people’s narrations as the object of my study and the locus to seek insight into linguistic, experiential, social, and political analytical observations. Rather, my goal is to think about narrative as a genre, not only for the ethnographic informant or research collaborator, but also for the ethnographer herself.

Although the analysis I propose may seem merely informed by anthropology’s reflexive turn, which invited ethnographers to critically study their own writing as text, what I suggest is that we go somewhat beyond this to explore the advantages and limitations of written word and other media to convey narrative. How do we narrate narrative? What do our stylistic choices imply? What are their effects on readers? Our readings themselves showcased different ways to narrate and re-count stories. For instance, Kleinman alternates objective, quasi-clinical description with quote excerpts that he proceeds to carefully interpret in a psychoanalytical key. Biehl privileges first-person accounts, quotes short interactions, and “free-rides” the lyrical effects of Catarina’s fragmented poetry as well as the power of photographic portraits, seasoning all of this with a work of interpretation and analysis that – at times – stood out to me as quasi-“voyeuristic” – in Kleinman’s terms (see e.g. the “black lion” episode, p.97-98). Janelle Taylor’s article constitutes a dramatic narration itself, and Mattingly’s authorial skills do not only emerge in her thorough descriptions of medical interactions, but also in the rich stratagems that she uses to turn her theory almost into poetry (e.g. “the small dramas of ordinary life” p.39, “the plotting of hope” p.141, or “healing dramas” p.142).

scan-3How, then, do anthropologists tell other people’s stories? In what formats; and what do these formats convey? What can words, versus images – for instance – communicate? I have long interrogated myself on these matters, especially questioning what, despite its infinite possibilities, language – and written language in particular – leave behind. As someone who is personally drawn to visuals, I have thought about the power of image through photography and ethnographic film – two media I have had the change to experiment with, although not in my own projects. Lately, however, I have become increasingly intrigued by the genre of graphic art that is gaining growing attention in academic realms (see here the first “graphic dissertation” in anthropology). In the field of narrative medicine, graphic novels have already affirmed as a genre that opens a plethora of narrative possibilities through communicative devices that go well beyond word and image (see “Graphic Medicine Manifesto” for reference). As I familiarized with this genre while assisting to the making of an “ethno-graphic” novel project, I was drugged into reading novel after novel, in amazement at the narrative potential of illustration to open windows on imagined worlds, experiential universes, and human’s deepest feelings.

As medical anthropologists we often narrate about suffering – but how do we convey such profound experiences through text? How do we represent distraught, distress, helplessness, or pain in anthropological writing? I make it my aim to continue exploring means to narrate and recount that go beyond written script. Not only I think that is helpful for the  ethnographer to find appropriate media to make justice to informants’ stories; it can also offer platforms to voice, interact, and work through narratives of illness or suffering in more satisfying ways for informants themselves.