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- Convenors:
-
Sarah Bourke
(Australian National University)
Keiko Kanno (University of Oxford)
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- Stream:
- Health, Disease and Wellbeing
- Sessions:
- Thursday 1 April, -
Time zone: Europe/London
Short Abstract:
Where does responsibility lie in deciding what 'being well' is at the population level? This panel invites anthropological papers which explore the complexities of defining human health beyond the local.
Long Abstract:
Cultural concepts of wellbeing have long been studied within anthropology. However, in the last decade, there has been a global shift to recognise the importance of people-centred measures of wellbeing at the population level, driven by political desire to move beyond the use of economic statistics as the sole basis of policy change. In 2019 New Zealand was the first country to announce that it will begin to measure its success as a nation on the basis of the wellbeing of its citizens, rather than GDP growth rate. The World Happiness Report ranks 156 countries according to the perceived happiness of their citizens and has gained significant media coverage since its inception in 2012. Wellness, defined as a state of holistic health, is a big business that has seen exponential growth over the last few years and is currently estimated to be worth $4.2 trillion globally. Medical anthropologists are adept at analysing and critiquing the biomedical roots and definitions of health, disease, and wellbeing practiced in situ. However, as the science, measurement, and management of 'being well' moves beyond the local and into the global, one must ask: Whose definitions of 'being well' are really being taken into account? And where does the responsibility lie for your/my/our/all health in a world where 'being well' is the newest form of privilege, luxury, or commodity?
Accepted papers:
Session 1 Thursday 1 April, 2021, -Paper short abstract:
Drawing on doctoral fieldwork in an Italian treatment centre for anorexia and bulimia nervosa, the paper explores how professionals (struggle to) cultivate responsibility for a biomedically defined 'health' in patients who experience their eating disordered practices as a way of 'mastering myself'.
Paper long abstract:
Drawing on doctoral fieldwork in an Italian treatment centre for anorexia and bulimia nervosa, the paper examines what kind of care is possible when the thinking patterns and bodily practices that are deemed pathological by professionals, are for patients a way of ‘mastering myself’. Without questioning the concrete risks and consequences of extreme food restriction, frequent purging, and physical exercise to exhaustion – but taking seriously the fact that patients experience these as self-care practices – we will see how treatment works by gradually substituting patients’ ways of ‘being well’ with a definition of health that is jointly constituted by psychotherapists, psychiatrists, nutritionists, endocrinologists and educators. In the process from residential to semi-residential and outpatient treatment, patients are thus required to gradually assume responsibility for a kind of wellbeing that is determined elsewhere than in their self. For this to happen, some coercion is considered necessary to first deconstruct patients’ ‘pathological’ self-control and self-medication; only then can they acquire the tools for a ‘self-transformation’ that will ‘enhance their health’. Throughout the paper, I trace how the structure, rules, knowledges, and everyday practices of treatment turn ‘resistant’ and ‘ambivalent’ patients into ‘aware’, ‘motivated’, and ‘responsible’ ones. This is a process in which, ethnographically, mind and body are two entities: professionals work on patients’ minds to create ‘healthier bodies’ for them, and in turn, with a healthier body, patients can acquire a ‘more autonomous mind’ – pointing to a biomedical definition of ‘being well’ that is endowed with culturally specific notions of dependence and autonomy.
Paper short abstract:
Taking responsibility for diabetes takes many forms including accepting blame, not telling the truth about management, and trying alternative ways of management not accepted by biomedical providers in the face of challenges of costs and uncertainties.
Paper long abstract:
Globally, biomedical management of non-communicable diseases including diabetes is often framed as an individual responsibility to self-manage it through compliance with diet, physical activity and taking medicine as prescribed. However, research often shows that patients' practices diverge from what is asked of them. This paper is based on twelve months of ethnographic fieldwork which sought to understand how patients, their caregivers and health care workers at two diabetes clinics in Malawi live with and manage diabetes. In-depth interviews and participant observation during diabetes education and clinic consultations reveal that patients are asked to take responsibility for diabetes by following advice from health care workers and not engaging in practices outside this advice. To instil this responsibility, health care workers use a moral language that blames patients for high sugar levels, invoke the gaze of both health care workers and God, and emphasize the negative consequences of not complying with biomedical advice. Some patients accept this blame: admitting their 'negligence', 'greed' 'childishness' or 'carelessness'. Alternatively, for fear of infuriating their doctors, some patients take 'responsibility' of diabetes by resorting to lying or not telling the truth about their management practices. This complicates biomedical management of diabetes which, in part, depends on patients disclosing how they have been following diabetes advice. Taking responsibility also involves 'trying' and 'trying harder' to ensure a 'normal' sugar level. However, 'negligence', 'greed' and 'mistakes' emanate from competing responsibilities to follow biomedical advice in the face of costs of food, transport and medicine and its perceived uncertainties.
Paper short abstract:
This paper will allow us to observe how the techniques promoted by the well-being movement in France are constructed from materials and their development as sets of ideas often re-enliven older religious and ethnocentric beliefs that are centered on the idea of “salvation” and “expectation”.
Paper long abstract:
Well-being can be considered as the new “flou” term in human sciences. As the term “spirituality” did, the well-being movement too gathered a variety of representations and practices that should allow individuals to reach a sort of perfect state of living in an accomplished balance between inner expectations and social reality. As different authors have already underlined, this is a way to put responsibilities on the shoulders of the subject who is therefore seen as a sort of deity, capable to accomplish his/her goals by finding the necessary resources and skills within him/herself and without considering the complexity of the social, political and economical framework the subject is surrounded by. This paper will represent an opportunity to drive the attention on a specific aspect of this new “umbrella term”, mainly in the therapeutic and spiritual field in France. Some of the contemporary psychotherapies are derived from the American stream of positive psychology and cognitive-behavioural therapy, which are both intrinsically goal and problem-solving oriented aiming to guarantee results to the patient in a short time in comparison to conventional historicized psychotherapies. Many of the patients/subjects are avid consumers of the therapeutic-spiritual marketplace, capable of simultaneously managing a number of different, well-being related practices: visualization and breathing techniques, meditation, yoga, shamanism, communication with different entities (channeling), divination (tarot) and a panoply of short-term psychotherapeutic practices.
This paper will allow us to observe how the techniques promoted by the well-being movement in France are constructed from pre-existing materials and their development as sets of ideas often re-enliven older religious, philosophical and ethnocentric beliefs that are centered on the idea of “salvation” and “expectation”.
The well-being movement shows how some of the traditional systems of beliefs are inextricably interwoven in a contemporary social secularisation process.