Paper short abstract:

This paper explores patient and clinician orientations to medical uncertainty in somatoform disorders (a contemporary term for hysteria). Interested in the therapeutics of uncertainty, I ask how insistence on medical certainty shapes the conditions of possibility for suffering, care, and recovery.

Paper long abstract:

Medical knowledge is often colloquially synonymous with certainty and truth; however, where do we find ourselves when medicine is uncertain about a diagnosis, prognosis, or treatment? Somatoform disorders are the phenomenon in which someone is seriously ill – e.g. seizures, complex pain, paralysis – but no pathophysiological cause can be found. A multitude of competing explanations for this phenomenon exist – emotional distress somatically manifested, disturbances in nervous system connectivity, etc. – and yet profound uncertainties in care and illness experience remain. Research has historically focused on the therapeutic benefits of certainty, however, this paper follows recent calls to embrace medical uncertainty (Greco 2017) and approaches uncertainty not as a cipher for ignorance, but as a flicker, a simultaneous polyphony; how do patient and clinician orientations to uncertainty shape the conditions of possibility in the clinic?

Based on two months of ethnographic fieldwork with clinicians and somatoform patients in a Canadian neuropsychiatric hospital, I found that while patients and clinicians were avowedly conscious of medicine’s uncertainties in this context, in practice, both enacted medicine as a regime of certainty – a term I offer to describe a cultural tradition that imagines medicine as able to provide access to objective truth, making uncertainty an unacceptable mode to inhabit. This paper argues that while this will to certainty may be therapeutic in the moment, in the long-term, it fails to hold the strange, dynamic, experiences of somatoform symptoms and participates in the marginalization of suffering that does not neatly correspond to pathology.

Paper short abstract:

This paper explores how people find ways to manage ‘the uncertain body’ that emerges from a diagnosis of cancer risk. Through the care provided by virtual support groups, a diagnosis that once provoked fear for many can come to generate hope for those who learn to trust the biomedical imaginary.

Paper long abstract:

Drawing on ethnographic fieldwork in the UK, this paper explores how people find ways to manage ‘the uncertain body’ that emerges from a diagnosis of cancer risk. For many, a diagnosis of Barrett’s oesophagus, a risk state for oesophageal cancer, initially provokes fear and uncertainty. This fear manifests in their practices – some lose sleep, become acutely aware of their bodily sensations, or consumed by thoughts of a cancerous future. I explore how people manage this fear through care in the form of virtual support groups. Here, people learn to live with the uncertainty of a life lived ‘at risk’. While a diagnosis of risk often induces fear, with this support, it can be transformed into a reason for hope. ‘You’re one of the lucky ones’, members of the group explain to the newly diagnosed, highlighting that their diagnosis means their risk is now being reduced and ‘we're unlikely to get it and, in that rare case where someone does, it will be found soon enough to be removed.’ Through eighteen months of ethnographic fieldwork in support groups for ‘Barrett’s patients’, we see uncertain futures become increasingly certain through a belief in the promise of early detection and the biomedical imaginary. With this, risk diagnoses that once provoked fear can generate hope. The paper raises questions about what it means to provide ‘care’ in the context of increasingly risk-centred medicine, as well as who is responsible for providing care, particularly in the context of unprecedented pressures on healthcare systems globally.

Paper short abstract:

This paper looks at failed female sterilisation as a specific event of reproductive uncertainty. Moving beyond the dichotomous understanding of sterilisation as either forced or voluntary, this paper will conceive surgical sterilisation as a site of continued, contested, and calculated risks.

Paper long abstract:

This paper looks at cases of failed female sterilisation, a specific event of reproductive uncertainty which has received little attention in existing literature. While the failure rate of sterilisation is statistically miniscule, (1-2%), the question of how contraceptive users and providers deal with this failure nonetheless invokes important debates on bodily autonomy, accountability, agency, decision-making and justice. Female sterilisation is predicated upon the technological promise of permanent contraception, a promise which is enabled by modern forms of surgical intervention such as laparoscopy. What happens when this promise fails? How do existing state and biomedical mechanisms imagine and address these failures? How are the legal provisions of monetary compensation and indemnity clauses navigated? How do women and families experience such failures alongside managing decisions around unwanted conception, abortion, and future contraception?

Exploring such questions, this paper will first conduct a discourse analysis of the contemporary cases of failed sterilisation discussed in popular media, attempting to identify the key actors, stakeholders, mechanisms, debates, and grievances emerging from this problem space. Then, drawing on the feminist theorization of risk as central to gendered experiences, this paper will demonstrate how failed sterilisation is primarily related in terms of risk - the risk of failure, alongside the risk of medical complications and the risk of unwanted conception. Moving beyond the dichotomous understanding of sterilisation as either forced or voluntary, this paper will explore its relation to the body as one defined by uncertainty, conceiving surgical sterilisation as a site of continued, contested, and calculated risks.

Paper short abstract:

Drawing on the case of private cord blood banking this paper shows how a contested field of self- and healthcare is stabilized in practices that thrive on and foster particular uncertain presents instead of relating to shifting futures.

Paper long abstract:

Family banking of umbilical cord blood (UCB) is dedicated to preparing for future medical eventualities. Parents-to-be pay companies for the long-term storage of the stem-cell rich UCB of their newborn/s. This business model has been criticized as an instance of commercializing speculative promises of regenerative medicine and "the neoliberal appeal of investing a part of the body in the future" (Waldby & Mitchell 2006, 29). What is particularly interesting about it, however, is that this practice is not at all shifting but continuous. After more than three decades of unfulfilled promises, family UCB banks worldwide still attract new clients. Against the background of this puzzling continuity, this paper asks how people facing different futures come to treat bodies as projects of future planning in same, allegedly irrational ways. A possible answer, I argue, lies in the fact that it is not primarily uncertain future perspectives that account for the prevalence of private UCB banking. Rather, it is the situated uncertainties as they come to bear in the present, when people are asked to choose to engage in that practice. First, expecting a child comes with embodied experiences of change, medicalization, and anticipation. Second, appeals to future parents to secure their children's bodily well-being systematically create decision-making choreographies that rule out dissonance. The resulting dynamics foster selective trust in scientific expertise. They stabilize UCB as a field of self- and healthcare by isolating it from any broader changes in medical knowledge or society.

Paper short abstract:

In Beijing, extreme work culture gives young adults ‘sub-healthy’ bodies. Many thus turn to ‘light meals’, a trendy healthy diet catering to their medical knowledges. But biomedical knowledge is also used to debunk its efficacy, making the meal ‘not-so-healthy’ and their futures more uncertain.

Paper long abstract:

Extreme work culture in China has been heavily discussed but still persisting. Having to work for 50 hours per week, many young adults in Beijing consider their bodies as ‘not-so-healthy’ due to lack of sleep, activity, and rest. Their feelings converge with the widespread notion of ‘sub-health’, which states that most people are neither healthy nor unhealthy, but in an uncertain middle state. This uncertainty impacts both near and far futures because body collapse may happen anytime, as sudden deaths or chronic diseases.

To navigate the uncertainties, many have started eating ‘light meals’. It is a trendy diet with surging popularities, characterized by light portions, simple seasoning, and stated nutritional facts for each dish. Light meal eaters usually employ pluralistic medical knowledge to perceive its health effects; not only attracted by its more balanced nutritional facts (e.g. less carbohydrates, more fiber than typical Chinese cuisine) on the menus, they also notice relevant embodied perceptions of becoming lighter and burden-free, and desired sociocultural merits associated with lightness, all contributing to a sense of health.

However, biomedical knowledge in particular also creates more somatic uncertainties. Medical authorities (e.g. famous nutritionists) usually focus on light meals’ inaccurate nutritional descriptions, applying biomedical knowledge to debunk the meals’ efficacy and frame light meal eaters as unintelligent buyers. For many young adults, such criticism turns their healthy diet into a ‘not-so-healthy’ meal, thereby magnifies feelings of uncertainty where their ‘not-so-healthy’ bodies are constantly in need of care, but no truly effective strategies are readily available.

Paper short abstract:

Findings from an ethnographic study in Tanzania among men who have sex with men and transgender women show that even though Pre-exposure prophylaxis (PrEP) as HIV prevention do reduce the risk of contracting HIV, PrEP may introduce new types of risks and uncertainties into PrEP user's lives.

Paper long abstract:

At a study site in Dar es Salaam, transgender women and men who have sex with men come to get the novel biomedical technology: Pre-exposure prophylaxis (PrEP). PrEP is a pill proven to reduce the risk of contracting HIV by up to 99%. While PrEP may reduce the risks of contracting HIV, this paper argues that PrEP can also introduce new risks and uncertainties to their users’ lives. The data draws on ethnographic fieldwork mainly located at the PrEP study site for ten months in 2021/2022. Rumours and stories about PrEP users becoming HIV positive made people uncertain about the promised 99% effectiveness. Furthermore, the complexity of PrEP also brought uncertainty to people’s lives: what happens if a pill is taken at the wrong time or not at all? How would this affect the known 99% protection covered by PrEP? These concerns and worries contributed to serostatus uncertainty. Secondly, some interlocutors experienced social uncertainty about whether their PrEP use could impose a stigma on them, as PrEP was associated with HIV positivity and promiscuity/sex work. Lastly, the projectivization of PrEP programming, local stock-out and delays in the nationwide scale-up of PrEP contributed to an uncertain provision of PrEP to its users. While PrEP has shown to be important to the interlocutors in this study, PrEP also contributes to current uncertainties about life on PrEP here and now, but also a concern about the risks and uncertainties of whether their future would become HIV positive or remain HIV negative.

Paper short abstract:

Today, prenatal screening offers parents ostensible control over pregnancy outcomes. Fieldwork suggests that demand for screening is growing in Sweden as a result of neoliberal self-realization ideals. But screening cannot guarantee a positive outcome and may cause just as much worry as reassurance.

Paper long abstract:

Pregnancy is inherently uncertain. Folklore is full of advice for expectant mothers and methods for divining a child’s future – evidence that humans have long sought to control pregnancy outcomes and stave off uncertainty. Today, when social and technological development has given us control over more aspects of life than ever before, pregnancy remains fundamentally uncontrollable. Prenatal screening in particular seems to offer the assurance of a healthy and “normal” child, and has become standard practice in much of the developed world. But has this testing really given us the security that we want? Or has it instead created new forms of healthcare-induced worry? And if so, what will happen with this worry as tests pick up on smaller and smaller deviations with hitherto unknown symptoms?

In this paper, I present findings from fieldwork with Swedish parents and midwives, and suggest that both availability and demand for prenatal screening is growing in Sweden, especially in affluent, urban areas. This can be connected to neoliberal imperatives to maximize our own potential – turning the family into a carefully orchestrated lifestyle or self-fulfillment project – as well as to a free market where companies vie for parents’ money with the newest tests. However, prenatal screening cannot guarantee a healthy baby, leaving parents and midwives to navigate an uncertain terrain where that which should bring reassurance might instead increase worry, and where the choice lies between ever more advanced testing, or learning to live with uncertainty at the threshold of life.

Paper short abstract:

Based on eight months of ethnographic fieldwork (2017/2018) in Montenegro, in this paper I explore how the biomedical knowledge about the sex of the foetus might both dispel and create new kind of uncertainties in the lives of parents-to-be and their potential children in the future.

Paper long abstract:

Pregnancy is a life period, where uncertainty regarding future concentrates (Gammeltoft 2013, S160). In Montenegro, some parents-to-be are concerned about the sex of the foetus. This is related to “the idea of men and male offspring as more valuable than women and female offspring” (Kiščenko 2021, 87). Not only in the past, but also nowadays Montenegro is experiencing son preference (Stump 2011, United Nations Population Fund 2012, Muižnieks 2014), because male offspring is expected to inherit the family name, assets and take care of aging parents. To dispel the uncertainty about the sex of foetus, women perform prenatal testing (CVC, Cell-free foetal DNA testing) and ultrasound scan. In some cases, sex-selective abortion is performed, making Montenegro as one of the 10 countries in the world with the most imbalanced sex ratio at birth (United Nations Population Fund 2012).

In this paper, I argue that biomedical knowledge about the sex of the foetus is ambiguous. One the one hand, it might minimize uncertainty that is being associated with certain gender potentiality in the future. On the other hand, as my ethnographic data demonstrates, even when the desired son is being born, different kind of uncertainties might emerge. For example, a woman with two daughters experienced a pressure from her parents-in-law to bear a son. After four aborted female foetuses, she gave a birth to a son, but her relationships with her in-laws did not improve and continued to be tense.

Paper short abstract:

Medicinal mushrooms are attributed with therapeutic properties by both CAM therapies and modern technoscience. I explore this category at the intersection of consumer-led well-being and neurocentric self-spirituality that sheds light on entanglements of CAM ontologies with scientific rationality.

Paper long abstract:

So-called medicinal mushrooms, such as chaga, reishi, cordyceps, or lion’s mane, are typically polypore mushrooms that are posited as carrying various therapeutic properties related to e.g., immune support, neurological health, and mood, by both complementary, alternative, and traditional medicine (e.g., Chinese), as well as, increasingly, by modern technoscience and its purveyors in the health-and-wellness sphere (e.g., biohackers). Drawing on an ethnographic engagement with the Finnish producer and cultivator of medicinal mushrooms called Kääpä Biotech (kääpä translating as “polypore mushroom”) that includes interviews with founding members and an analysis of chosen media texts, this paper explores medicinal mushrooms as an emerging category at the contemporary intersection of consumer-led well-being and neurocentric self-spirituality that feeds on a rhetoric of interspecies alliance with the fungal kingdom.

In particular, I focus on how chaga mushroom as a classic example of Finnish and Siberian folk medicine is re-traditionalized by Kääpä Biotech that manages the world’s largest chaga cultivation network as a responsible form of forest sustainability. By analyzing how the production and consumption of chaga mushroom is formulated by a combination of both scientific, environmental, monetary, medicinal, and spiritual values, and how certain privileged bodily qualia of neoliberal societies (e.g., immunity, adaptability) are simultaneously reified and commodified in the process, the paper sheds light on novel entanglements of speculative CAM ontologies of the body with a secular scientific rationality as evidenced by this realm of naturopathic therapy.