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Paper short abstract:

This paper wants to present and reflect on a research project based in Rimini (Italy) aimed at co-designing the processes of reorganisation of its local health system, focusing on the role of medical anthropology and its ability to reshape health care practices with interdisciplinary collaboration.

Paper long abstract:

The need to transform social and health services and the overarching hospital-centred health system towards a proactive and community-based approach is increasingly recognised, especially since the 'syndemic'. This shift is not just an innovation, but a return to the basic principles of Comprehensive Primary Health Care (PHC) established at the Alma Ata Conference in 1978 and advocated over the years. However, local health authorities often lack the necessary tools and expertise to develop these interventions. This lack can sometimes be an opportunity to open up to other disciplines, such as anthropology. This paper therefore arises from a similar opportunity that emerged in a city in Italy (Rimini), where my PhD is currently taking place, alongside a wider research project with the Centre for International and Intercultural Health, aimed at co-designing the process of reorganisation of the city's health system. This will be achieved by involving local health professionals at different hierarchical levels, from clinical governance to general practitioners, through in-depth interviews and participant observation of established boards and key health services from a PHC perspective. The tools of ethnography and participatory action research will be used to collect good practices, needs and aspirations to understand the semantics of health professionals, while building interdisciplinary collaboration between anthropologists and health professionals. By analysing the language dynamics and power structures within healthcare organisations, the paper aims to provide insights into how medical anthropology can adapt, negotiate and collaborate to share knowledge with different health professionals in order to reshape established practices of care.

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Paper short abstract:

How can collaborative research navigate the tension between a scientific framework and non-Western knowledge? Recognizing the Urarina’s expertise in balancing the delicate borders between Self and Other, this contribution discusses how relational ontologies can inspire new approaches to reciprocity.

Paper long abstract:

Collaborative health policy guidelines prove ineffective, as the scope of participation assigned to subaltern knowledge is confined to aspects that align with the Western framework. Neglecting the reciprocal question concerning the (im)possibility of integrating biomedicine into the Indigenous framework sustains the hegemonic power imbalance, self-undermining the goal of addressing health disparities.

Drawing from six months of medical practice at a local health station, followed by another six months of immersive ethnographic engagement with the Urarina of Peruvian Amazonia, this contribution reflects on the impact of shifting perspectives. Guided by Community Based Participatory Research principles, the methodology involved collaborative workshops with Indigenous Community Health Workers (CHW), participant observation of illness cases and interviews with patients and local healers. Reflecting on the conceptual tensions this inquiry poses for the multidisciplinary researcher complements the analysis of CHW’s hybridity.

The study interprets the role of Indigenous CHW as a contemporary continuity of shamanic practice: diplomats negotiating across the borders of multiple ontological worlds who’s intricate dynamics of temporary overlapping manifest in cases of illness.

Practical engagement with Animism stimulates the (un)doing of universalism as the notion of radical alterity disperses through the recognition of shared underlying logics. Combining ontological and practical approaches opens novel opportunities to learn from the practice of shifting perspectives closely linked to relational ontologies. This can help Western stakeholders to engage in plurality, fostering collaborative approaches to address structural and intercultural barriers in seeking and promoting health

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Paper short abstract:

This study aspires to reflect on an integrated perspective that combines medical anthropology and linguistics. It aims to foster communication and improve the quality of multilingual health care by emphasizing the importance of addressing cross-cultural dynamics with an interdisciplinary approach.

Paper long abstract:

Increasing cultural diversity in contemporary societies continues to pose important challenges in health communication, especially in the context of multilingual medical visits.

Through a preliminary analysis of some of the data collected studying the relationship and communication between doctors and non-Italian-speaking patients, I aim to explore how medical anthropology can intersect with linguistics and cultural mediation.

In particular, this contribution focuses on the fluidity of professional identities created during an initial period of participant observation. The period of field research from which the following reflections emerge was conducted at an Auser outpatient clinic and at the headquarters of the “Multidisciplinary Team for the Taking Care of Victims of Torture" in Cosenza, Southern Italy. On the one hand, the recording of medical examinations allows me to analyze from a linguistic perspective how the dynamics of asymmetric interaction affect communication between health personnel and non-Italian-speaking patients. In parallel, active co-involvement with the Team, where I observed in more detail the process of access to services for people with migrant backgrounds and where I happened to translate medical visits, began to highlight a conceptual challenge about my positioning.

Through some ethnographic examples, I would like to reflect on the fluidity of professional identities and the need for a flexible approach in which medical anthropology can adapt according to the needs of the context under analysis and can contribute to the development of an integrated approach to foster communication and improve the quality of health care in multilingual and multicultural settings.

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Paper short abstract:

In this paper I share insights from my ongoing collaboration with a neuroscience lab, which started as ethnographic fieldwork and eventually evolved into a direct participation in the design of experiments, with anthropological critique contributing to inform the methodology of scientific research.

Paper long abstract:

I first approached the Systems Neuroscience Laboratory at the Champalimaud Centre for the Unknown (Lisbon, Portugal) in 2019 with the goal of doing there part of my PhD fieldwork in Medical Anthropology, in which I explored the narratives produced around the therapeutic applications of psychedelic substances.

As a condition for my presence as an ethnographer, it was agreed that I would be required to participate to the lab activities (almost) like any other internal PhD student. This implied regularly presenting the results of my research to other members in weekly lab meetings.

After a somewhat difficult initial phase, we were able to find a common ground to communicate and mutually enrich our perspectives, and eventually find out that some of the critiques emerging from ethnographic observation and anthropological theory could contribute to inform the methodology of scientific research projects.

Of course, this didn’t come without many difficult and awkward situations, and at times I found myself having defend the very legitimacy of my discipline and the social sciences at large.

Nevertheless, along four years - thanks also to a slow process of transition of the lab from animal models to researches with human subject in naturalistic settings - I was increasingly involved in the design of experiments and writing of new projects.

In this paper, I want to share some insight emerging from this process of collaboration, to reflect on how Medical Anthropology can produce knowledge by directly collaborating with practitioners in the field of the medical sciences.

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Drawing on ethnographic research on psychotherapy that centered anthropology and deemphasized psychology, I demonstrate how medical anthropology provided therapists with a therapeutic voice to support their patients. Anthropology was also used to police the authenticity of their therapeutic voice.

Paper long abstract:

What are the effects of deemphasizing psychological and psychiatric expertise in favor of anthropological expertise in psychotherapy? I examine a kind of psychotherapy developed in France to support people who are immigrants, refugees, and non-francophone. In this form of psychotherapy, therapists are encouraged to draw less on the modes of interpretation and questioning of the psy- professions, and instead turn to their own lived experience and understandings of anthropology to become more attuned to their patients’ experiences of distress. I draw on nearly two years of ethnographic research in France in four clinics that practice this kind of psychotherapy, as well as interviews with 65 therapists and their students. My analysis of the ways that therapists used anthropology reveals how these therapists navigated between improvisation and authority in the ways they spoke with patients and each other. I argue that engaging medical anthropology helped therapists witness the experiences of their patients and provided a therapeutic voice. Anthropology could also be used to police the speech of therapists when their therapeutic voice was considered irrelevant or inauthentic. I conclude by examining how anthropological and psychological/psychiatric expertise haunt one another in this form of therapy and in anthropologically oriented clinical practice and training more generally. I expand on this ethnographic case to develop the notion of the haunted curriculum in health professions education, which examines how sites of clinical training and expertise can counter and/or reproduce forms of injustice.

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Drawing on fieldwork among women fighting for a PMDD diagnosis, this paper examines epistemic clashes and overdiagnosis, underscoring the need for anthropological insights into health trends, and emphasizing the risk of "medicalized medical anthropology."

Paper long abstract:

In this paper, I articulate the concern that the field of anthropology is susceptible to medicalization. Drawing from my ongoing research on women advocating for recognition of Premenstrual Dysphoric Disorder (PMDD), I elucidate the epistemic battles arising between these women and health authorities. These conflicts manifest when patients' interpretations of symptoms diverge from clinical practices' interpretations, but they may also arise when expansive disease definitions potentially result in overdiagnosis. While medical literature extensively documents overdiagnosis and its harms, this has gained only little attention in anthropology. I contend that the emphasis on representation in anthropology in which we do not question the interlocutors' experiences, leads to the risk of unreflectingly reproducing biomedical language and symptom definitions, and thus neglects the broader structural and institutional factors contributing to patients' symptoms and distress.

I argue that anthropological insights and nuanced ethnographic knowledge are essential to comprehend the repercussions of overdiagnosis and medicalization on individuals' daily lives, self-perception, and responses to bodily experiences. Consequently, a critical examination of established medical entities and diagnostic processes becomes imperative in understanding the deep-rooted connections between overdiagnosis and escalating trends of healthism, characterized by heightened attention to health and diagnosis. This examination necessitates sustained scrutiny of medical anthropology, mindful of the risk highlighted by Browner as "medicalized medical anthropology" (Browner 1999).

I aim to begin a critical conversation on the knowledge that medical anthropology produces, not only in our cross-disciplinary engagement but also within the relation to our interlocutors and the academic discourse that we create.

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Paper short abstract:

My research focuses on the transmission of knowledge and practice of – and in – Chinese medicine, comparing a clinic and a university in Taiwan. Based on my case study, I will attempt to reflect on the challenges medical anthropology faces to better understand contemporary Chinese medicine.

Paper long abstract:

Chinese medicine (CM), commonly referred to as traditional Chinese medicine (TCM), represents one of the oldest and most widespread medical systems worldwide. Its importance is evidenced not only by its increasing use by Eastern and Western countries but also by the World Health Organization's continuous push to integrate CM into local medical systems. It follows that, in the era of globalisation, it becomes necessary to consider the role of Chinese medicine when reflecting on the concepts of health and medicine. But what is the role of medical anthropology in better understanding contemporary CM? What challenges does it face in analysing the process of learning and teaching the knowledge and practice of Chinese medicine?

In this paper, I discuss the importance of using the qualitative method of ethnography to better understand the pluralism of Taiwanese Chinese medicine and, broadly, different ideas of medicine and healthcare. Based on my case study, through a comparative approach between different modes of transmission of knowledge and practices of CM in Taiwan, I will attempt to reflect on the challenges of medical anthropology. My study draws on nine months of ethnographic research in a private clinic in Taipei and at China Medical University in Taizhong. Methodologically, I observed Chinese medicine lectures and medical practices, conducted semi-structured interviews with doctors and practitioners, and carried out participant-observations, both in the clinic and at the university.

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In this paper, I explore the potentialities and limitations of medical anthropological praxis in unsettling hegemonic biomedical discourses on health/illness and the suffering body within contexts of forced displacement, and implications of such a shift for reimaginations of systems of care.

Paper long abstract:

In this paper, I seek to explore the potentialities and limitations of medical anthropological praxis in unsettling hegemonic biomedical discourses on bodies, health, and suffering within contexts of forced displacement. Drawing on a systematic literature review, policy analysis, insights from prior research with resettled refugees through a quantitative/public health lens, and preliminary observations from my current doctoral fieldwork through an ethnographic/medical anthropological lens, I reflect on how the objective, material, biological, and externally knowable suffering body has become the primary site for the production of ‘truth’ in contexts of displacement and asylum-seeking. I examine how knowledge production regarding the body of the forced migrant becomes circumscribed within authorised and inaccessible spaces, thus divesting refugees of the epistemic capacity to know themselves and their wellbeing. I consider how quantitative and population-level constructions of refugee health are co-constituted with regimes of health care and humanitarian protection for refugees, critical for rendering refugees visible, legible, and thus governable, and how such paradigms may contribute to failures to alleviate or even exacerbations of illness/suffering. I then consider how medical anthropology might contribute to rethinking the theoretical and epistemological parameters through which we might comprehend body-environment entanglements and aetiological origins of challenges to health/wellbeing in refugee communities. Even more radically, I wish to consider the potentiality of the discipline along with co-productive/collaborative methodologies in restoring the epistemic agency of the subjective/experiential body of the refugee to know itself, and the implications of such an epistemological shift for reimagining systems of care and alleviating preventable illness/suffering.

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This contribution emphasizes the need to consider societal context in studying mental disorders, highlighting that a solely medical approach can diminish therapeutic success. For this, ongoing research on SAD, with an anthropological focus, seeks effective but also culturally tailored therapies.

Paper long abstract:

Despite the obvious interconnection between the individual and social spheres in illnesses such as social anxiety disorder (SAD), the study of environmental relational factors has historically taken a back seat to medical and psychological reflections. In recent years, thanks in part to the efforts of medical anthropologists and a greater openness to social disciplines, attention has shifted towards the social aspects of psychological pathologies. An analysis of the fundamental aspects of a mental disorder cannot disregard a study of the society in which the sufferer fits. This approach aids in pinpointing key factors that can guide the formulation of effective solutions to address and overcome the disorder. Using a single medical approach would significantly reduce the chances of therapeutic success. The proposed contribution is based on an ongoing doctoral project on SAD and its diverse symptomatology across cultures. Understanding these cultural variations is paramount, as it holds the potential to revolutionize the development of targeted strategies and therapies. By discerning how social anxiety disorder uniquely shapes itself within specific cultural frameworks, we can tailor interventions to address the root causes and manifestations. This, consequently, promises therapies that are not only more precise but also highly effective in addressing the nuanced challenges posed by SAD in diverse cultural landscapes. It is crucial to analyze the context through the prism of anthropology: This interdisciplinary approach provides a holistic understanding of the intricate interplay between cultural dynamics and mental health, paving the way for more nuanced and culturally sensitive insights into psychopathological phenomena.

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Paper short abstract:

We review the notion of illness consciousness as a form of epistemic injustice. From an ethnography with psychiatrized people, we analyse the controversies in psychiatry's prescription and adherence mechanisms, which block the epistemic participation of diagnosed people.

Paper long abstract:

Our proposal revises the notion of illness consciousness as defined by biomedicine and psychiatry as a form of epistemic injustice from the perspective of Critical Medical Anthropology. Based on an ethnography with psychiatric patients diagnosed with severe mental disorders and consumers of neuroleptic psychotropic drugs, the implications of testimonial and hermeneutic injustice are first addressed. Next, the reasons for the discrediting of diagnosed people as subjects of knowledge are analysed, considering the impact of identity prejudices and some characteristics of the care systems that generate their marginalisation. It also points out different controversies linked to the awareness of illness related to the mechanisms of prescription and adherence that operate in its re/production and block the epistemic participation of the subjects to whom it is claimed. Finally, given the harm intrinsic to the use of the term, it is suggested that it should be abandoned in favour of a collaborative action that broadens critical awareness and redresses the forms of injustice described.