For on-going comments and discussion see here.
The SAHN Theoretical Reading Group brings together both junior and more senior academics to read and discuss social theoretical readings or theoretical thinking related to work in progress. The interdisciplinary group meetings provide us with networking time to establish collaborations, and peer-support to produce theoretically rigorous health research.
In the following three terms (2017) we will explore the underpinnings of social practice theory through three key texts. Each term we will discuss a different book over a series of lunchtime meetings, with each meeting focusing on a chapter or section of the book. This term the focus is Bourdieu’s The Logic of Practice. Next we will explore Mol’s The Logic of Care. The final book of the year is still up for debate, so please chip in if you have any ideas.
The reading and discussion group aims to meet monthly at the Addenbrooke’s Hospital, Cambridge.
Next meeting January 2017
Wednesday 18th January, 12-1.00pm, IPH Large Seminar Room (http://www.iph.cam.ac.uk/contact/find-the-iph/).
We will discuss the Introduction and Chapter 1 of The Logic of Practice. All are very welcome!
Further information on the next dates and sections of the book, please email Sarah: email@example.com
Lauren Berlant: Two Girls, Fat and Thin
Our next SAHN Reading and Discussion Group will be on Wednesday 7th of September at the IPH small seminar room 16.00-17.30. All are very welcome! Please let me know if you can make it.
“Two Girls, Fat and Thin” is a chapter by the cultural theorist and American Studies scholar Lauren Berlant. Coming at familiar questions from quite a different angle, and offering valuable ideas to consider, Berlant uses an analysis of a novel by Mary Gaitskill as a prompt to ask questions about the relationship between psychological trauma and adult health-related behaviours. In particular, Berlant considers how the pleasure of food can be used as a way of seeking relief from forms of living experienced as overwhelming and depleting, and how behavioural responses to periods of crisis and intense chaos can become established as expectable ways of relieving or regulating distress.
For our discussion, the following questions may be a useful starting point:
- What difficult and happy feelings are evoked by the desire for food?
- What kind of intention or lack of intention are associated with eating in contexts of adversity?
- How is a person’s image of themselves shaped through the activity of eating or not eating?
For an introduction to Berlant’s work more generally, see the first part of the editors’ introduction to the “Engaging with the Work of Lauren Berlant” special issue: http://link.springer.com/article/10.1007%2Fs10767-014-9189-4
Our next SAHN Reading and Discussion Group will be on Tuesday 3rd of May at the Institute of Public Health Small Seminar Room (first floor) from 16.00-17.30. All are very welcome! Please let me know if you can make it. Sarah Hoare kindly agreed to lead the discussion on Mike Kelly’s paper: Diagnostic Categories in Autobiographical Account of Illness.
Understanding how patients make sense of illness is a useful resource both for healthcare professionals and researchers. In this paper Kelly examines the ways lay diagnostic categories are used, particularly in chronic illness. The paper gives insight into what patients mean when they talk about vague categories like ‘flu’ or specific terms such as ‘small cell cancer of the lung’ and why they may differ from medical understandings of these terms. By deploying Shutz’ concept of the lifeworld Kelly describes how these categories are used by patients to make sense of the changes that are a result of chronic illness. Kelly uses Kant’s conception of self to show how patients can change from being just recipients of medical knowledge to ‘expert’ patients who have a greater knowledge of their illness than their medical professional. Patients develop sophisticated conceptions of their illness by combining prior knowledge and experience with experience of their illness as now. By understanding the self as more than a reactive entity, Kelly shows how the patient can overcome the inevitable biographical interruption of a chronic illness through appropriate use of diagnostic categories. Drawing on Burke’s categorisation of narrative forms used in storytelling, Kelly describes how accounts of illness reflect common literary categories to organise narratives, which in turn become part of the patient’s coping process. Kelly concludes by arguing that diagnostic categories are ‘fundamental communication device[s]’ which the medical practitioner must listen to and decode in order to appropriately care for the patient.
For our discussion, the following questions may be a useful starting point:
- Do the diagnostic categories described fit with your own experiences; as a patient, a researcher, a clinician?
- What role does the listener have in shaping diagnostic categories?
- Diagnostic categories are argued to be fundamental for sense-making in illness. What does this mean for a patients’ physiological symptoms?
- Kelly’s model illustrates the distinction between medical and lay claims to knowledge. How can diagnostic categories be fruitfully used to promote the value of lay perspectives (presuming this is a useful venture)?
- How can understanding lay diagnostic categories advance health research?
Jennie Popay at al.: “Theorising inequalities of health”
In this paper, Popay et al. posit that current health inequality research (= 1998) is predominantly based on and conducted from a quantitative, risk-factor/epidemiological perspective, which is unidimensional, simplistic, fails to acknowledge the full complexity of social processes and denies creative human agency (e.g. quoting Kelly and Charlton, 1985 `the individual is relegated to being nothing more than a system outcome, not a thinking and acting human being’).
Popay et al. suggest a perspective shift starting with Kelly and Charlton’s proposal of health research as `dynamic and reciprocal analysis of the individual set into context’. Popay et al. loosely base their context definition on a permeable/interactive version of Whitehead & Dahlgren’s health inequality model, but add `space’, which is where macro-social structures impact on an individual’s life, and `time’, which is the history of people, places, culture, and society. They propose that the potential for human agency is shaped by an individual’s narrative (meaning construction), which, in turn, is shaped by narratives at different levels (ontological, public, conceptual, meta) and properties of and relational settings across time and space. Popay et al. see the interplay of all of these aspects (creative human agency, narratives, and the time and space context these are embedded in) as central to understanding health inequalities, because they provide the framework in which individual and social action can and does take place. These actions determine health outcomes, and may explain why socio-economic factors alone do not and possibly cannot consistently predict health outcomes. In the conclusion, Popay et al. point out potential barriers to a perspective shift (narratives provide a different type of knowledge and have a different purpose to quantitative data and expert narratives, which may cause conflict) and re-emphasise the need of social research to adequately address the relationship between agency and structure in time and space.
For our discussion, the following questions might get us started:
- Has the perspective of health inequality research and of research in general changed 18 years later?
- What would a research project based on Popay’s et al. perspective look like in practice?
- Are there any issues with narrative-based understanding of health inequalities or of other research areas? (In relation to what we know about human behaviour and agency.)
- Are the aims of the two perspectives the same?
- Are the problems Popay et al. envisage unique to this proposed perspective?
- Are the authors following their own suggestions?
Anthony Giddens – Risk Society: Transitions in “Risk and Responsibility”
Our next SAHN Reading and Discussion Group will be on Tuesday 8th of March at the Institute of Public Health Small Seminar Room (first floor) from 16.00-17.30. All are very welcome! Please let me know if you can make it by emailing firstname.lastname@example.org.
In this paper, Anthony Giddens describes how scientific discovery increasingly seeps into the public domain but that we, as consumers, struggle to keep up with scientific inquiry and its “constant revision of claims to knowledge”. As an example, he muses how we are increasingly puzzled if a glass of red wine might be harmful or after all quite good for our health. Following Ulrich Beck’s understanding of risk society, he describes how we life in a technological world “which no one completely understands”, and in which “we stopped worrying so much about what nature could do to us, and we started worrying more about what we have done to nature”. In his view, alongside this transition from external to man-made risks, come new ways of negotiating such risks – from politics of scaremongering and cover-ups to new choices, strategies and the notion of “collective irresponsibility”.
For our discussion, the following questions might get us started:
- The paper is over 15 years old. While we could witness further instalments of the red wine debate, including recently with the new government guidelines on safe limits of alcohol, new complex and often contradictory health evidence has entered the public consciousness. Regarding his example of beef, BSE is less of a concern these days than cancer. What would Giddens write about today? Alzheimer’s, the Zika virus, or sugary drinks?
- Is the increasing drive for research impact accelerating a sense of risk society?
- Has our risk society undergone further transitions in the meantime? From external to manufactured to ‘hybrid’ risks? By that I mean, are these risks perceived/framed as external or manufactured, or both?
- In public health, risk and responsibilities are often framed in a similar juxtaposition. For example, is physical activity a question of personal responsibility/agency – we all know we should be active and should get a move on – or should it be promoted through enabling structures – for example with parks and safe cycle ways? Can we understand this through Giddens’ lens of individual vs collective responsibility?
- There are many social theoretical writings on risk and responsibility. How do they compare to Giddens’ take, and which ones have you found useful?
Social Media and Qualitative Research
Our next SAHN Reading and Discussion Group will be on Wednesday 2nd of September from 12-2 pm – please note, this time at the Clinical School Seminar Room 9 (ground floor) http://www.medschl.cam.ac.uk/contact/how-to-get-to-the-school/. Lunch will be provided so please let me know by Friday 28 August if you plan to attend.
We plan to recap on the Social Media and Qualitative Research Seminar and Masterclass that Erica, Sally and Richard organised for us, and we thought it would be great to keep the discussion going. It certainly left me with lots to think about. For example: Is social media analysis a method we would like to – or should – use (more?) in our research field/interest/projects? Is it about social media as a source for (big) qualitative data or about understanding new ways of communicating, learning about or challenging/resisting medicine or health?
Richard Milne will lead us through the discussion of Catherine Pope’s paper “Big Data: Methodological Challenges and Approaches for Sociological Analysis” as well as Bruno Latour’s short piece “Beware, your imagination leaves digital traces”.
Didier Fassin: Moral Anthropology and the Body
The next SAHN Reading and Discussion Group will be on Wednesday 3rd of June at the Herchel Smith Seminar Room from 12-2pm.
Nadia has kindly agreed to lead the discussion this time. Please find attached two papers by Didier Fassin and Nadia has prepared the following thoughts:
I thought we could spend our next meeting studying some of Didier Fassin’s writing. He is a French medical anthropologist who has been important in defining what he calls an ‘anthropology of morals’. I’ve offered two texts to look at:
The first (2007) is an ethnographic study of French asylum system, in which Fassin (with Estelle d’Halluin) pays particular attention to the role of the body, and trauma inflicted upon the body, in informing asylum decisions. The second (2008) is a theoretical essay on the merits of defining a moral anthropology, which draws more broadly on different strands of his ethnographic work. The first text is rather long, but hopefully you’ll find it as interesting as I did and you won’t notice the pages turning. The hope is that by familiarising ourselves with one example of his work we will be able to understand more clearly his arguments outlined in the theoretical piece.
A few things we could think about:
What do you make of the term moral anthropology? Is it novel? Should it exist of its own accord or be integral to any form of social anthropology? Are you convinced by the distinction between ‘moral discourse’ and ‘critical analysis of morals’? How does Fassin apply this to his ethnography of the asylum system? How have other social scientists applied this? Beyond anthropology, how might social science grapple with morals, in particular in the field of public health?
The next SAHN Reading and Discussion Group will be on Wednesday 6th of May at the Herchel Smith Seminar Room from 12-2pm.
Tania has kindly agreed to lead the discussion next week on ‘therapeutic landscapes’, and these following thoughts:
In this session, I would like to discuss the concept of ‘therapeutic landscape’.
The first article is an introduction/overview about Gesler’s concept ‘therapeutic landscape’. Do you think it is useful, and how can it be used in studies on health/illness, health care, experience and emotion etc.? What do you find in particular interesting or critical?
The second article refers to this concept and focuses on the therapy room and the relationships and interaction not only between people but also to place and objects. It would be interesting to hear your thoughts but the discussion can of course go beyond the therapy room.
The Management of Innovation: Mechanical and organic management and understanding end of life care organisation
Please join us for our next Reading and Discussion Group on Wednesday 1st April from 12-2 pm.
Lunch will be provided, so please email me at email@example.com if you plan to attend by Friday 27 March.
Sarah will lead our discussion on Burn’s and Stalker’s ‘The Management of Innovation’ and has prepared the following for discussion points for us:
I thought in our next meeting it would be interesting to consider how workplaces are managed, looking specifically at Burns and Stalker’s classic 1961 text ‘The Management of Innovation’. Burns and Stalker build on Durkheim’s distinction between mechanical and organic solidarity to analyse how industry concerns are organised in periods of stability and change. I’ve found their distinction between mechanistic and organic management systems to be a helpful to understand how policy assumes how end of life care is organised versus how clinicians view end of life care; policy assumes end of life care can be organised in a linear ‘mechanical’ way, whilst healthcare professionals detail the complexity involved in caring for dying patients and seem to be working in a more ‘organic’ system.
Here are some possible questions to think about and discuss:
Do you find the idea of mechanistic and organic organisation plausible?
Can the distinction be usefully applied today? To other situations beyond electronics?
“The City Is My Mother”: Narratives of Schizophrenia and Homelessness
Please join us for our next Reading and Discussion Group on Wednesday 4th March from 12-2 pm.
Lunch will be provided, so please email me at firstname.lastname@example.org if you plan to attend by Friday 27 February.
Ben will lead our discussion on two papers and has prepared the following for discussion points for us:
I thought that for our next meeting it would be interesting to talk about the following article by Anne Lovell, ‘”The City Is My Mother”: Narratives of Schizophrenia and Homelessness’
It’s an interesting article, I thought, which raises serious questions about the role and value of ethnographic research in the larger project of understanding mental illness. Although Lovell only offers an account of one very specific group of people with schizophrenia – namely, people who are also homeless – it is nevertheless a useful way to approach the topic. And it engages with some of the biggest challenges – methodological, theoretical, ethical – that projects of this kind often pose.
Here are the sorts of questions we might want to keep in mind for the meeting:
· Lovell seems to be taking quite a lot of liberty in her interpretations of her interlocutors’ narratives. How justifiable is this choice? Could such a study have been done any other way?
· How much does this article teach us about schizophrenia, or about the experiences or points of view of those who live with this condition? Was this or was this not its purpose?
· Lovell’s informants clearly did not – and could not – give their informed consent to take part in this study. To what extent is this a problem?
· How useful is the emphasis on narrative throughout the article? Does it help clarify or explain things?
· How is this article applicable / generalizable / relevant?
In addition to Lovell’s article, I’m also discussing an article by Tanya Luhrmann, ‘Hallucinations and Sensory Overrides’, which I thought offered a useful introduction, of sorts, to the topic of schizophrenia and hallucinations. Helpful for those of us, myself included, who might need something closer to facts about schizophrenia (but still from anthropology) in order to really try and make sense of Lovell’s paper.
The Lancet Culture and Health Paper
Please join us for our next Reading and Discussion Group on Wednesday 4th February from 12-2 pm.
Lunch will be provided, so please email me at email@example.com if you plan to attend by Friday 30 January.
Duncan Edwards has kindly agreed to lead our discussion and picked last year’s paper published by the Lancet Culture and Health on the incorporation of cultural understanding within mainstream medical thinking.
Duncan suggested the following thoughts to guide our discussion:
Of note, the Lancet gave up 22 pages for it, and my favourite journal reviewer from doctors.net, Druin Burch, recommends it as such:
The worst medical paper ever published?
Oh, what fun it might be to prepare a list of the world’s worst medical papers. Not those with the most fraudulent, misleading or mistaken conclusions, simply those of the densest and most unreadable prose, the most muddled thinking, the most extreme irrelevance to medicine or to reality. Can anyone nominate a better entry than this? For page after incredible page, with indecipherable academic jargon and peerless lack of clarity, this essay on culture and health wends its weary way. I defy you to read it and then summarise, to anyone, what on earth its content might be. Of such stuff are the worst parts of academia made. Had The Lancet published it as part of their Christmas issue, I’d have suspected them of ironically trying to compete with the comedic holiday satire of The BMJ. It is astonishingly, dreadfully, overwhelmingly, exceedingly bad. I commend it to your attention.
So to me it raises of issues of why it is so mentally challenging to attempt to inhabit the clinical world and a culturally competent world at the same time. It is reminiscent of the Christakis article discussion a few months back regarding the stagnation of social sciences, but from the medical perspective: why is medicine and medical research continuing to fail to utilise basic understandings from the social sciences?
For the group more generally, it might permit a discussion of what social sciences can add to the tackling of commonly accepted health/medical objectives (which seems the focus of this article – i.e. not challenging the objectives too much in themselves), what our improved manifesto might look like, and thinking about how on a day to day basis we could use our social sciences findings to inform improved medical interventions and trials, and health and healthcare policy?
A better written shorter article on the same topic might be useful for me/anyone else to find as well – and a medic raising the topic of “culture” at the SAHN group seems much like an anthropologist offering to discuss the pathophysiology of small cell carcinoma at a pathophysiological analysis of health network meeting (PAHN).
Ageing, dementia, and end-of-life care
Please join us on Wednesday Dec 5th for our monthly SAHN reading group – including festive goodies.
This month we will be drawing on some of our shared interests in dementia, ageing, and end of life care to discuss ideas around normalisation, relationality, and personhood. The readings include:
Broom, A. and Kirby, E. (2013) The end of life and the family: Hospice patients’ views on dying as relational. Sociology of Health and Illness Vol. 35 No. 4 pp. 499–513. DOI: 10.1111/j.1467-9566.2012.01497.x.
Jones, Ian Rees, and Paul F. Higgs. 2010. “The Natural, the Normal and the Normative: Contested Terrains in Ageing and Old Age.” Social Science & Medicine 71(8):1513–19. http://www.sciencedirect.com/science/article/pii/S0277953610005691#
Roach, P. and N. Drummond. 2014. ‘It’s nice to have something to do’: early-onset dementia and meaningful purposeful activity. Journal of Psychiatric and Mental Health Nursing. 21:889-895 http://onlinelibrary.wiley.com/doi/10.1111/jpm.12154/pdf
We will be discussing the role and experiences of families, methodological issues, and the rise of ageing and dying studies.
Please let me know by Monday December 1st if you will be attending so I know how many treats to bring with.
Reflecting on suggestions that the social sciences need a shake up.
Wednesday 5th November,12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
We will be discussing Nicholas Christakis‘ suggestion that the social sciences need a shake up and how, if ever, they could model STEM subjects, and the response in Times Higher Education by Amanda Goodall and Andrew Oswald. Among other things, we will be asking:
- what is the current state of social science research in our fields?
- how to do we contribute to these practices (that may lead to ‘stagnation’), and how might they be changed?
- what role does methodological innovation have this?
- what new fields might there be?
Nick Crossley: Patient voices, social movements and the habitus
Wednesday 1st October, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
Crossley has written extensively about Bourdieu’s Habitus theory and also about the Anti-psychiatry and survivor social movements. These papers, especially the one about ‘Patient voices, social movements and the habitus’, combine very nicely his theoretical knowledge with a very interesting analysis of two testimonial texts from two different eras. Crossley uses Habitus theory to explain some dramatic changes in tone, content and worldview of contributors to two books, one from the 1950s and the other from the 1990s. In both books the authors write about their encounters with the psychiatric system but from very different perspectives . For those who want to read a bit more, I also included Crossley’s paper about RD Laing and the British Antipsychiatry movement. This paper mainly provides historical background to the first paper (and indeed reads a bit more like a historical paper than a sociological one), as it focuses on the ‘revolt from above’ (i.e. by psychiatrists such as R.D Laing and others who challenged the established psychiatry of their days) that preceded the ‘revolt from below’ made by the survivor movement.
Here are some possible questions to think about and discuss. They mainly revolve around the role of medical anthropologists and sociologists, given some of the points Crossley makes about the study of the development of the Antipsychiatry and the survivor social movements.
- Crossley argues that Bourdieu’s habitus theory involves an overly narrow focus upon the ways in which societies and agents are ‘reproduced’, ignoring the ways in which they are ‘transformed’. Likewise, in the antipsychiatry paper he argues, more generally, that with regards to psychiatry ‘sociologists focused on power and dominant discourses to the detriment of a proper consideration of resistance and counter-discourses’. Is he right in these suggestions? Should medical sociology/anthropology focus more on studying transformation and change ‘from below’ (maybe not only that of the past but of the present and help create that of the future)?
- Related to the previous point , Crossley implies that in this case, changes came first from ‘above’ i.e. psychiatrists (Laing, Cooper and others) and later from below – survivors. But he refers to Goffman’s work as an important influence on Laing among others. Can (should) medical contemporary sociologists/anthropologists still contribute to change, if yes how?
- Staying with Goffman, since his days and his work we still assume that part of our role as anthropologists is to ‘give voice’ to vulnerable populations and to reveal and communicate to the world something about their struggles and challenges. But given that survivors (mental health patients) ‘speak their mind’ without the need for someone else to mediate their message, and especially given their growing involvement in research, should the role of medical anthropologists or sociologists shift (e.g. from exploring or exposing ‘what is going on there’ to explaining it? From focusing less for the insider look to more on the bigger picture? )
- To what extent any of this is relevant to ‘non mental-health’ medical issues. Is mental health a special case within medical anthropology (because of the stigma, the huge gaps in power and the vulnerability of the patients) so that lessons learned from this are less applicable in other areas of medical anthropology?
- What do we make of this ‘oppositional habitus’? Is it a useful addition to Bourdieu’s theory?
Marcia Inhorn and Stefan Ecks: Positioning ourselves in an interdisciplinary or multidisciplinary research field
Wednesday 6th August, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge. Lunch will be provided.
These are two texts from medical anthropologists who ponder the intersections of anthropology and epidemiology/public health/medicine. If anyone would like to focus on only one of the texts, the Marcia Inhorn one is the more ‘classic’ paper. (Marcia Inhorn is Professor of Anthropology at Yale University and has been the President of the AAA Society for Medical Anthropology. Her main research areas is reproductive technologies in the Middle East.)
The discussion won’t be so much about a particular theoretical approach to understanding health but about our positioning in an interdisciplinary or multidisciplinary research field and how this may shape our understanding of health.Here’s a list of possible questions we could discuss. In particular, I’d like you to think about ‘evidence’ and various types of knowledge:
- How do we as social scientists engage with ‘evidence’? Do notions of evidence still ‘remain implicit and unexamined in disciplines such as anthropology’ (Lambert in Ecks 2008)?
- How do we position our work within possible ‘evidence hierarchies’? And is ‘evidence’ linked to method/design (qual or quant, RCT or observational study, ethnography or focus groups – or ‘kind’ and ‘scope’ as Inhorn suggests), style (‘I was there story’; Ecks) or discipline (epidemiology, clinical medicine, psychology, sociology, anthropology)?
- What value do we place on how we communicate our ‘evidence’? For example, can an ethnographic study be written up within the constraints of a medical journal? How do we position ourselves vis-a-vis descriptive (‘theory-free’) qualitative research? Where would we choose to present our findings – for what reasons?
- Why does Inhorn (1995) call for ‘synthetic’ rather than ‘collaborative’ research?
- Following Marcia Inhorn’s caution: are we too concerned with critiquing other disciplines and forgetting to critiquing ourselves at times (e.g. our ‘take’ on health; and is our critique justified – e.g. her example about de-contextualising public health and its historic base)?
- How ‘useful’ is our evidence? Marilyn Strathern talked about ‘useful knowledge’ in terms of the perhaps damaging drive to create ‘impact’ with research; Strathern’s critique sits uncomfortably with a more critical medical anthropology stance (Nancy Scheper-Hughes etc.) to get involved and ‘alleviate human suffering’ as Inhorn puts it. What is at stake for social science researchers based in public health?
- Finally, these texts are twenty and five years old. How has the debate moved on?
Adriana Petryna’s Biological Citizenship: The Science and Politics of Chernobyl-Exposed Populations
Wednesday 6th August, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
In this less formal session we will be discussing Adriana Petryna’s paper on Biological Citizenship. As well as looking at Petryna’s paper we also hope to consider how these ideas fit into her (and Joao Biehl’s) work on Critical Global Health which are put forward in their book “ When People Come First”. I’ve therefore also attached the introduction to this book and for the particularly keen, a paper by Biehl on pharmaceuticals, AIDS and citizenship in Brazil. We might want to look at how these ideas link to last month’s SAHN on global assemblages, the political dimensions of such work and how these ideas (and the engaging styles of writing of these papers) might be useful to consider in our own research.
Lakoff’s chapter on The Private Life of Numbers: Pharmaceutical Marketing in Post-Welfare Argentina in Collier and Ong’s edited collection Global Assemblages: Technology, Politics and Ethics as Anthropological Problems.
Wednesday 2nd July, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
This is one of the books that I’ve been meaning to read for a long time, although I’ve dipped in and out of it before. I’ve chosen this chapter as it relates to biomedicine, through a discussion of the pharmaceutical industry, without stressing concepts like biocitizen or bioethics. Lakoff uses two approaches that will be familiar to most in the group: a focus on relations as a site for analysis and the concept of audit culture. Through his analysis he proposes that the increase in Argentinean pscyhopharmaceutical market is explained by the gift relationship between pharma reps and doctors that is informed by data of prescribing habits. As part of the session, we can ask if this analysis is correct (from what he presents) and if it is helpful.
Here are some more questions to think with:
- Early on Lakoff uses the term ‘neoliberal epidemiology’ – what could this be and is this the only example?
- Does this chapter offer us anything more than another description of audit cultures?
- How does this approach differ from some of the ANT papers we’ve discussed in previous sessions?
- How might we use this to think about recent concerns about BIG DATA?
We can also address some of the questions posed within the introductory chapter about the relevance and usefulness of such an approach in tackling the big questions/problems of our time.
Revisiting Goffman’s “Stigma”
Wednesday 4th June, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
This month the SAHN discussion will be linked to the results of a survey that we conducted in September 2013 as part of the Qualitative Methods in Health Research Masterclass Workshop series. In brief, we surveyed the editors and reviewers at 22 journals that publish ‘qualitative’ articles on health-related topics (in the social sciences, and to a lesser extent, the humanities), and to the ‘big 5’ medical journals. We sent questions essentially asking them to recommend ‘classics’ and more recent works that do a good job of integrating social theory into research based on qualitative methods, broadly-defined. We received over 300 recommendations, many of which were entirely unique!
The most frequently recommended resource overall was Goffman’s Stigma: Notes on the Management of Spoiled Identity, first published in 1963, so that’s what I will be introducing. (See here for details of the survey: http://qualitativehealth.wordpress.com/survey/). Although Stigma is a relatively short book (Goffman calls it an ‘essay’), I won’t ask people to read the whole thing, so instead I’ve suggested:
- A scanned excerpt: Chapter 1. Stigma and Social Identity – pp. 9-55 (apologies for the length – if it’s any consolation, the book itself is relatively small, so the pages are short!) Although perhaps not the most exciting part of the book to read, this does start to introduce, outline, and start making the case for Goffman’s theory of stigma, which he continues to build in subsequent chapters.
- Scambler, G. (2009). Health-related stigma, Sociology of Health & Illness, vol. 31, no. 3, pp. 441-455. In this review article, Scambler argues that ‘while Goffman’s contribution retains its insight, subtlety and theoretical acuity, it is time to move on, or rather beyond: it is not so much that Goffman was wrong as that there were questions he did not ask’ (p. 442). Summarising various critiques that have been leveled against Goffman’s original work, and situating Stigma in the context of some of Goffman’s other work, Scambler goes on to review a range of subsequent analyses of health-related stigma, focusing on epilepsy and HIV/AIDS, but also work on disabilities and other chronic illnesses.
Some questions to start things off:
- In building his theory, Goffman draws on examples of stigmatizing characteristics that span everything from mental illness and disability to race/religion and ‘radical political behaviour’. Given that he groups voluntary with involuntary, visible/physical with invisible, and inborn with acquired characteristics, is his conception of ‘stigma’ too broad to be meaningful, or is there a certain virtue in its expansiveness? Is this expansiveness what has made it such a well-used theory across various disciplines?
- Unlike many of the other papers/book extracts that we have discussed in the SAHN group, Stigma is not based directly on original research, but is essentially a review of a range of secondary sources. To what extent, if at all, do you think this is potentially problematic?
- How useful is Goffman’s theory of stigma for health-related research in a contemporary, UK context? Do you agree with Scambler that although it ‘retains its insight, subtlety and acuity, it is time to move on’ and (to paraphrase) start asking more relevant questions? What would those questions be?
Keating and Cambrosio: Biomedical Platforms
Wednesday 7th May, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
The term ‘platform’ pervades health policy and practice. In five minutes of googling, you can find examples including the “UK Dementias Research Platform” and the “Regenerative Medicine Platform”, the “EU Platform for Action on Diet, Physical Activity and Health”, the Fit for Work “Platform for Health and Wellbeing” the “ Platform for Better Oral Health in Europe” and even the “Accenture Public Health Platform”.
The term’s multiple meanings include collaborations for research and practice, data sharing frameworks, discussion forums and both software and hardware configurations. Despite its ubiquity, there hasn’t been much analysis or theoretical consideration of the origin of these platforms and the spread of the term. The only major contribution is that of Keating and Cambrosio in their book Biomedical Platforms. This (lengthy) paper summarises much of the argument of the book.
The book is widely referenced, but it isn’t clear that these references always engage with the suggestions of Keating and Cambrosio, notably their focus on the material components of platforms. If you want to follow the use of the platform concept in practice, a more recent example is Rayna Rapp’s 2010 article “Chasing Science: Children’s Brains, Scientific Inquiries, and Family Labors” in Science Technology and Human Values.
Some questions to think about:
Is it meaningful to connect the virtual, material, organisational, and practical components of platforms in the way K&C do? Are these part of the same or different objects?
Has the use of platform expanded and/or changed since Keating and Cambrosio wrote their piece and is it still as closely related to biomedicine as they suggest?
Is biomedicine itself definable in the terms proposed by K&C?
What is gained from adopting the term ‘platforms’ as an analytic tool – what other terms are are ‘perspicuous phenomena’ that are/could be (or shouldn’t be) adopted within social studies of science, technology and medicine?
What alternatives does talking about platforms offer that aren’t afforded by the work of, for example, Annemarie Mol or Bruno Latour on ontology or Susan Leigh Star and Geoff Bowker on infrastructure? In turn, how might these perspectives contribute to understanding platforms themselves
Does the notion of a biomedical platform erase the geographies of medicine and health? Are biomedicine and the configurations K&C describe specific to nations, regions, Europe, the West, or are they a global phenomenon. Building on Schatzki’s piece last time, how do the practices associated with platforms contribute to constituting these scales?
‘Where the action is’, using Theodore Schatzi’s ‘site ontology’
Andrea Stockl (UEA)
Wednesday 2nd April, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
Andrea Stockl, a medical anthropologist based at the medical school at UEA, will be taking us through some of the ideas of Theodore Schatzki in relation to conceptualizing the social. Please find a paper explaining Schatzki’s concept of “site ontology”, an approach which Andrea is hoping to draw from in developing a grant proposal on vaccination that she is currently writing. As well as looking at this approach through the attached paper in the session, Andrea will also briefly take us through the grant proposal she is putting together and how her thinking might by influenced by this approach.
Theodore Schatzi is a philosopher with an interest in theory of action, social theory and the philosophy of social science amongst other areas. The paper we are looking at gives an account of what Schatzi calls “site ontology” which is developed in more detail in his book “The Site of the Social” and in many of his previous articles. This paper looks particularly at how this concept and a practice-based approach may be useful in looking at large institutions. As Schatzi states at the start, this paper is an essay which:
“…examines a long-standing topic in social thought: the proper analysis of the constitution of large social entities such as corporations, economies, and sociotechnical regimes. It offers a practice theoretical account of their constitution based on previous work of mine on the character of social life. It is sometimes said (e.g., Brand 2010) that practice theory is best at analysing local or micro phenomena. Such claims hold some truth. As, however, the work of Giddens and Bourdieu and, I hope, this essay make clear, practice theory does have useful things to say about large social phenomena”.
However it is Schatzi’s particular understanding of the social which Andrea is most interested in , and in reading this paper and considering his practice-based approach, Andrea suggests that we might to consider how his concept is different, or compares to, Bourdieu’s “field” or to the ethnographic site, or how it might be contrasted with ANT approaches. For the super-keen, there is also a You Tube video of Schatzi presenting his approach on large social organisations and their spaces (over an hour long!), “The Spaces of Practices and Large Social Phenomena”. The start gives a nice introduction to how we understand practices: https://www.youtube.com/watch?v=lma5bDq8uNk.
‘Reification and consciousness of the patient’ by Michael Taussig
Wednesday 5th March, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
Matthew Drage will lead the session in discussing Taussig’s 1979 article “Reification and the consciousness of the patient”. Matt writes “Michael Taussig offers a powerful polemic against the dominant modes of healthcare under captialism. He argues that contempory “health provision”, which takes diseases as commodity-objects to be exchanged for care under a rubric of contracts, occludes the social and moral features of illness and healing. In the process, Taussig claims, patients are stripped of their ability to relate caregivers as equal partners, and are alienated from the aspects of illness upon which their sense of agency rests”.
Matt’s possible questions for discussion:
How far does Taussig’s description of the contractual nature of “health provision” apply to healthcare in the UK today? Is his framework still useful?
Taussig concludes that until the clinical construction of reality is recognised, “humanistic medicine is a contradiction in terms.” Is he right? Is humanistic medicine impossible in a culture of medico-scientific realism? What exactly humanistic medicine anyway?!
What, if anything, does the reification of disease continue to obscure?
Can Taussig really motivate such an ambitious critique on the basis of a single case study?
‘System, lifeworld and doctor-patient interaction: issues of trust in a changing world’, Graham Scambler and Nicky Britten’s chapter on Habermas
Wednesday 5th February, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
The group will be led by Conor Farrington and will look at a chapter by Graham Scambler and Nicky Britten, ‘System, lifeworld and doctor-patient interaction: issues of trust in a changing world’, pp.45-67 in Scambler, ed (2001) ‘Habermas, Critical Theory, and Health’ Routledge). Conor has also suggested reading Greenhalgh and Scambler’s article ‘Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective’ as a paper which explores these ideas further. For those who aren’t familiar with Habermas, Conor also recommends the first chapter of Scambler’s book as a useful, albeit limited, overview of his work. The discussion group will mostly focus on Scambler and Britten’s chapter in his book, but this additional reading might be of interest to those attending who are looking for more background. For the super-keen, Conor also recommends the following books for those who want to read more about Habermas ahead of time are:
Edgar, A. (2006) Habermas: The Key Concepts. London; Routledge.
Eriksen, E. and Weigård, J. (2003) Understanding Habermas: Communicative Action and Deliberative Democracy. London; Continuum.
Conor’s possible questions for the discussion:
- To what extent do macro-level societal processes and dynamics impinge on micro-level healthcare encounters such as consultations?
- Conversely, do micro-level healthcare encounters have the potential to shape macro-level societial dynamics?
- To what extent do Habermasian concepts such as communicative action, strategic action, system and lifeworld, and systematically distorted communication enable us to examine and understand these encounters and interactions?
- Is the lifeworld more relevant to social and mental problems than to physical disorders?
- Is there a ‘meso’ level between macro and micro? If so, how is it constituted and how does it relate to macro/micro interactions?
- Regarding the Greenhalgh paper in particular – what difference do research methods make to the process of understanding macro/micro social interactions?
No meeting- Qualitative Methods Masterclass on Thursday 16th at Darwin College with Tiago Moriera. There will be an opportunity to discuss Tiago’s paper “Dementia and Interview Assemblages” from 1:30-3pm. This is open to all, not only those registered to attend the Masterclass. Further details are available here.
‘The client as owner of experience’ from Anssi Peräkylä’s AIDS Counselling: Institutional interaction and clinical practice
Wednesday 4th December, 12:00-2:00 in the small seminar room, upstairs at the Institute of Public Health, on the Forvie Site, Addenbrookes Hospital, Cambridge.
The core questions that I thought we could use this article as a starting point for addressing are:
1 – How effective is CA in achieving its aim of “rigorous and systematic studies”?
2 – Does this type of analysis effectively overcome what it sees as the problem of imposing ‘external’ assumptions on to participants’ own interpretations of events?
3 – How legitimate is the concern with participants’ own understanding, and is this an epistemologically valid notion for an analyst to purse?
4 – Does micro-analysis of interaction support broader critique or analysis of health, considered to include both the health outcomes and experiences of patients and the systems through which medical treatment is provided?
Psychiatric Diagnosis as Collective Action
Wednesday 6th November, 11:45-1:30 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge. PLEASE NOTE SLIGHT CHANGE OF TIMES.
This meeting will take place at the end of the Qualitative Methods Masterclass. See here for more details on the Masterclass. All are welcome to attend, even if they are not attending the Masterclass.
Annemarie Mol: The Body Multiple
Wednesday 2nd October, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
Questions for discussion:
– Mol argues that the reality of a disease is never simply ‘there’ to be discovered, but instead it is being ‘done’ through practice; it is achieved. But then what might be said about diseases that go undiagnosed? Or diseases that are continuously misdiagnosed? What is the object that is being ‘manipulated’ or achieved in those circumstances? What tools does Mol offer us to think of these cases?
– Similarly, what about cases where the cause of a disease is unknown? If objects are indeed merely “things manipulated in practices” (p.4), that would make any missing piece of the puzzle insignificant; after all, Mol seems to suggest that the puzzle is only ever composed of the pieces we already have. Or is she arguing something else entirely?
– What is the relationship between Mol’s notion of the ‘reality multiple’ and Latour’s notion of the ‘multiverse’? Are they in fact distinct? Which do you prefer? (if any)
– In Page 20, Mol suggests that through listening to people’s accounts as if they were telling about events, their illness takes shape that is both material and active. Her emphasis on objects and events seems to aim at countering the type of ethnography that is only interested in patients’ subjective experiences. She thus wishes to give the patients – as well as their bodies – more active agency in the constitution of their diseases. Would this really make a difference? How would this approach be implemented in our own studies?
– Finally, what did everyone think of Mol’s choice to separate the main text, where she makes her arguments, from the subtext, where she relates to literature? Is this merely a style preference or is it something else entirely? Is this a valid choice? How useful / confusing / annoying / exciting did you find it?
Nikolas Rose: The Human Sciences in a Biological Age
Wednesday 4th September 11:00-1:00 in the large seminar room, upstairs at the Institute of Public Health, on the Forvie Site, Addenbrookes Hospital, Cambridge. PLEASE NOTE SLIGHTLY EARLIER TIME SLOT AND CHANGE OF VENUE.
Linking to his recent talk at Cambridge, Rose’s paper argues for a closer relationship, or “critical friendship” between the social sciences and biological sciences. As well as comparing his argument with Latour’s approach to the sciences which we considered in the last Reading and Discussion Group, Rose’s paper is perhaps particularly interesting for us to think about given that many of us work as social scientists with or alongside others from other science backgrounds. Where do we/should we/can we position ourselves and our work in relation to other scientific approaches?
As well as considering Rose’s argument about the requirements of such a relationship, and if and how the social sciences might revitalise themselves for the 21st century, it may also be worth considering the following key questions:
- How might we as social scientists think about engaging with/applying/forming a “critical friendship” with biologists, psychologists, epidemiologists, clinicians and other disciplines we work with?
- What might this look like and what language might we use to describe this? Is “critical friendship” a useful term, or indeed what we are aiming for?
- What is in this for social science as a collection of disciplines? How are we furthering our own work? How do we avoid becoming the handmaiden of these other subjects?
- What happens to Foucauldian critique in this model? What place does this have in a “critical friendship”?
Latour’s How to Talk about the Body
Thursday 8th August 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
This is a classic paper that it would be really great for us to get to grips with it as a group. The paper is rich but convoluted –linking a discussion about the body with a more philosophical enquiry about knowledge and what might constitute ‘good’ science. But here are a few questions that might allow access to some of the cross-cutting themes relevant for us specifically:
• How useful are Latour’s notions of ‘articulation’ and ‘ capacity to be affected’ for this alternative account of the living body?
• If , as he argues, bodies can include odour kits, is everything a potential part of the body?
• Are the social sciences really more prone to being duped by what they are studying than the natural sciences?
• In what ways do patient bodies, within clinical contexts, learn to be affected in new ways, and how might this invite us to counter descriptions that they are simply subject to processes of objectification
How Can Bourdieu Help Us Understand Health and Lifestyles?
Wednesday 3rd July, 12:00-2:00 at the Herchel Smith Building for Brain and Mind Sciences, on the Forvie Site, Addenbrookes Hospital, Cambridge.
The format for the first session will be a reading group focussed on how the sociologist Pierre Bourdieu can help to understand health and lifestyles. We will be discussing Williams’ classic paper on the topic which can be found here: http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.ep10932093/pdf. I have also attached an article I have written, forthcoming in Sociology of Health and Illness, focussed on how Bourdieu can help to understand the use of talking treatments. Reading this paper is not essential, but might be interesting and will hopefully generate discussion. The findings section is most relevant if time is limited.
Here are some of the questions we hope to cover during the session:
- What is the main idea presented in the paper about why people behave in the way they do?
- My topic lends itself to a Bourdieuian analysis because talking about emotional problems requires particular orientations, but could thinking about the ‘match’ between people’s habitus (ways of thinking, speaking, feeling, experience, etc.) and other health services/health behaviour be useful?
- Often self-monitoring (e.g. pedometers, blood tests etc.) form a key part of health interventions. Is a kind of psychosocial awareness of one’s habitus also possible, and if so useful?
- Is the notion of choice lost in Bourdieu’s framework?
- Both papers focus on class, but is the analysis useful in thinking about other social structural factors?
- Do you agree with the statement ‘to invite people… in an interview context, to account for and explain their (health-related) behaviour is, at best, problematic, and at worst, misguided.’ (p.584)? If so, what place do social scientists have in health behaviour research?