Click the star to add/remove an item to/from your individual schedule.
You need to be logged in to avail of this functionality.
Log in
- Convenors:
-
Ross Perfetti
(University of Pennsylvania)
Randall Burson (Perelman School of Medicine, University of Pennsylvania)
Send message to Convenors
- Chair:
-
Ross Perfetti
(University of Pennsylvania)
- Format:
- Combined Format Open Panel
Short Abstract:
As multidisciplinary scholars of biomedicine, we reimagine critical orientations that think with, rather than against, the ethics, politics, and pragmatics of biomedical practitioners and practices to materialize transformation from within an ongoing system.
Long Abstract:
In the long shadow of Foucault, critique undergirds social studies of of biomedical knowledge and practice, with the hope that deconstruction can make room for transformation (DelVecchio Good 2001; Rabinow and Rose 2006; Conrad 2007; Clarke 2010). And still, amid ongoing pandemics, wars, and socio-natural disasters, we have witnessed the cost of undoing biomedical care for healthcare workers and marginalized communities alike. As scholars working both on and within biomedicine, we invite reflection on reimagined scholarly orientations that think critically with, rather than against, the ethics, politics, and pragmatics of biomedical practice and its practitioners. We are inspired by works on love (Berlant 2011), care (de la Bellacasa 2017), and repair (Thomas 2019) that invite us to attend to our commitments on the ground within biomedical systems as a means to "toil toward" more just and equitable ends (Franklin and Munyikwa 2021). Thus, we ask: what kinds of ethnographic/scholarly engagements and imaginations can be forged from within such systems? How can thinking with practitioners and experts, rather than against them, affect or transform critical sensibilities? How could an “otherwise” (Povinelli 2012) be materialized from within a system that is ongoing and, perhaps for now, must go on? These are some of the questions that inspire this panel, which seeks to convene an interdisciplinary group of STS scholars who are working alongside practitioners to make and do the transformative work of biomedical health care. We invite 10-minute, potentially informal or preliminary, “short papers” followed by a convened discussion.
Accepted contributions:
Session 1Mark Padilla (Florida International University)
Long abstract:
Puerto Rico faces an unprecedented healthcare crisis due to the accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing access to biomedicine and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, this study analyzes the effects of place-based stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on ethnographic observations of Puerto Rican biomedical institutions and patients across the island and fifty (n=50) semi-structured interviews with physicians in PR (n=26) and the US (n=24), the research identified how colonial metaphors and stigmatizing meanings are attached to PR, its people, and its biomedical system, often deploying colonial notions of the island’s presumed backwardness, lagging medical technology, lack of "cutting-edge" technologies, and presumably inferior career opportunities. These notions, deeply rooted in US military-imposed colonial biomedicine, neglect the diverse history of Puerto Rican medical practices, including twentieth-century approaches to community-based medicine that were once models of care in the Global South. Post-Reforma restructuring of the medical system in line with metropolitan interests, intensified by environmental traumas and escalating debt, combine with colonial legacies that disparage island-based, anti-colonial practices to inform physicians' migratory decision-making. In addition to economically motivated policies that have dominated responses to the crisis, efforts to curb physician migration should address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local resurgent responses to the crisis in danger of being lost to history.
Sebastian Rojas-Navarro (Universidad Andres Bello) Samanta Alarcon-Arcos
Long abstract:
Mental health disorders have gained significant attention in recent decades, prompting profound changes in societal discourse and everyday experiences. While diagnoses serve as cultural intermediaries, guiding interpretations of experiences, they are now actively sought by individuals rather than imposed by medical authorities. This shift challenges traditional notions of medicalization and warrants a departure from conventional critiques. Rather, scholars are now advocating for examining how society engages with mental health categories, weighing the benefits and drawbacks of this interaction, and considering the lasting effects of being labeled with a diagnosis. However, there is still reluctance to address the issue of diagnosing mental health conditions in children, partly due to the belief that children are inherently "natural beings" and concerns about their sudden immersion into the medical realm. This hesitancy is supported by research indicating potential drawbacks and risks associated with diagnosing children with mental health conditions. Additionally, there are concerns about the increasing prevalence of mental health conditions and the possibility of overdiagnosis, particularly regarding conditions like ADHD.
In this presentation, we explore how mental health professionals think, feel, and decide whether to diagnose mental health issues amid demands from schools for diagnoses to enroll children in special needs programs, which have been highly criticized in Chile. Through in-depth interviews and ethnographic work, we investigate how diagnostic practices shape ideals of care in Chilean schools. Care, understood as highly confusing, ambiguous, and disorderly, emerges as a guiding principle that provides intelligibility and guides practices and actions.
Anika Jugović Spajić (University of Pittsburgh)
Long abstract:
In this paper, I map and outline diabetes care in the Serbian healthcare system. Alongside the public and private healthcare sectors, I situate civil society organizations as the unofficial third branch of the healthcare system in Serbia. I look at how different actors: medical professionals, government officials, pharmaceutical representatives, diabetes activists, and lay persons with diabetes interact and construe diabetes care in Serbia and how they imagine it should look like. A particular focus of this paper is the interaction between diabetes activists – expert patients – and lay persons with diabetes as they navigate the complex healthcare system. How does care get enacted through practices of mutual aid in the context of a public healthcare system that is being dismantled? How does medical technology, such as insulin pumps, sensors, and consumables such as insulin pens and glucose test strips facilitate the interaction between these various actors? Ultimately, I aim to answer the question of how does this collective tinkering (Mol et al. 2010, Heerings et al. 2021) (re)shape not just the healthcare system, but social relations between its actors, and what IS care in the context of diabetes management and treatment in Serbia.
David Ansari (University of Illinois College of Medicine)
Short abstract:
In this short paper, I examine the stakes of deemphasizing biomedical expertise in two contexts of clinical training: in French mental health clinics for refugees and asylum seekers, and in simulation training for medical students in the United States.
Long abstract:
“It’s not with psychology that they’ll be able to do this kind of work. It’s with their own experience.” This statement made by a clinical psychologist reflected how she instructed budding psychiatrists and psychologists to support patients whose distress was shaped by displacement and migration. I heard similar refrains in mental health clinics for immigrants and refugees in France. In this short paper, I examine the stakes of deemphasizing biomedical expertise in two contexts of clinical training: in these French clinics, and in simulation training for medical students in the United States. In the mental health clinics, psychiatrists and psychologists instructed their students to avoid being “too psychological” in their ways of interacting with patients. Instead, they told their students to be attuned to their own lived experience of belonging to better relate to their patients. In the simulation training, medical students learned to perform technical procedures in a safe environment where they could make mistakes without harming patients. Medical students also learned how to have difficult conversations, develop empathetic dispositions, and learn other kinds of “soft skills” often seen as outside of medical expertise. Drawing on research with psychologists, psychiatrists, medical students, simulation professionals, and simulation instructors, I examine how clinical expertise can be reimagined by centering lived experience and material often considered to be extra-clinical. Putting science and technology studies perspectives into conversation with performance studies, I examine how enactments of clinical expertise that deemphasize biomedicine create new possibilities and foreclose others.
Nele Jensen (King's College London)
Long abstract:
As a medical-doctor-turned-social-scientist, social science critiques of medicine’s ‘tenacious assumptions’ (Gordon 1988) that reduce people to patients, health problems to clearly identifiable pathologies, and individual bodies to obstacles to the identification of generic disease and application of standardised treatments have long instinctively resonated with my own frustrations about the exceedingly narrow epistemological and ontological frameworks meant to guide clinical practice. And yet, such critiques arguably also discount the long history of medical ‘countercultures’ that emerged in response to the field’s perceived progressive reductionism (e.g.Lawrence and Weisz 1998; Saks 2002; Hoffman 1989; Greco 2019), as well as the pockets of resistance that persist within biomedicine today. As such, they risks closing down opportunities for constructive interdisciplinary engagement that explores how things might indeed be otherwise.
My project on ‘rebel doctors’ asks what we might learn from the spaces of creative subversion, visionary activism and playful experimentation that exist within contemporary biomedicine. What are the limits of textbook medicine that practitioners experience, and what are the knowledges, practices and technologies that they employ to expand their repertoires of care? What are the imaginaries of an alternative medicine that are articulated in these practices? In how might we, as Isabelle Stengers (2023) proposes, try and ‘make sense in common’ with rebel practitioners who take up the pragmatic challenge of figuring out what ‘good’ medicine might entail?
Arbel Griner (Princeton University)
Long abstract:
Our contribution relates to an ongoing project that brings together scholars and physicians working in academia, NGOs and hospitals. In 2021, our team collected almost thirty interviews in which we heard stories of women in Brazil who died of Covid-19-related causes during their pregnancy, delivery, or postpartum. The interviews were held remotely, during the pandemic, after families voluntarily contacted the researchers in response to an invitation posted on social media. Based on the interviews, we reflect on the potential echoes the question of how one got infected could have in the lives of those grieving pregnant and postpartum women who died from COVID‐19 in Brazil. In intrafamilial settings of mourning, we argue, a medical interrogation that aims at contact tracing – “how you got infected?” – can be re‐signified as “Who infected her?”, inadvertently instigating the idea that someone, within the family, could have averted the death of their mother, daughter, friend or partner.
Drawing on Judith Butler's work, we consider the “disorientation of grief”, and the ethical valence it holds in allowing new questions to arise and challenge current orders in search of a more just politics of life. Mourning, seen as the outcome of a disruptive event that calls for reorganization and resignification for the living, becomes political in this sense, rather than a state of mind or a feeling. And in such space of politics, we are invited to partake, by reviewing biomedical protocols that can leave a moral sequel on those seeking medical care.
Michelle Munyikwa (University of Pennsylvania)
Long abstract:
Spurred in part by the COVID-19 pandemic’s uncovering of cracks in the foundation of the American healthcare system, growing attention is being paid to burnout in the health professions. Whether framed as a failure of personal resilience addressed by personal wellness initiatives or a structural problem characterized by intolerable rates of moral injury, limits in the capacity for healthcare workers to endure the conditions of their labor are increasingly recognized as a crisis threatening the fabric of the medical community. Drawing on my experience as an anthropologist and current resident physician-in-training, I note that one dimension of this crisis stems from the absence of frameworks that adequately contextualize the quotidian ethical quandaries that characterize clinical life. This experimental paper suggests a deeper ethical engagement, one which leans into the entanglement and culpability of the clinician. I work towards a conceptualization of clinical ethics that expands the frameworks of bioethics towards novel tools for considering the ethical in practice. Rather than propose a simple cure for burnout or a salve for moral injury, I conceptualize how both biomedical and anthropological engagements with ethics might be productively and mutually transformed to forge a path toward more sustainable care.