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Get the Syllabus – Biocultural Medical Anthropology

Posted by dlende on August 30, 2010

For those of you who are interested, here’s the list of readings for my class on Biocultural Medical Anthropology.  To make sure I had good articles, I drew on syllabi from other professors I really respect, and also dug into the latest literature.  I’m excited about this course!

I did cut out all the grading and policy details.  If you’re really interested in that, drop me an email.

Anthropology 5937: Biocultural Medical Anthropology

Prof. Daniel Lende, Fall 2010, University of South Florida

Content:

This course provides a comprehensive grounding in biocultural medical anthropology, which emphasizes understanding how health and healing are shaped by both biological and cultural processes.  This class will examine disease, illness, human biology, embodiment, public health, methods, and belief systems.  From the biology of stress to the biopolitics of medicine, students will engage in substantive discussion and read central pieces of the scientific and anthropological literature.  While the class is focused on biocultural dynamics, students will also cover the biological mechanisms of disease and applied biocultural practice.

Required Texts:

Wiley, Andrea & Allen, John. 2009. Medical Anthropology: A Biocultural Approach.  New York: Oxford University Press.

Nichter, Mark. 2008. Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter. Tucson: University of Arizona Press.

Knapp, Caroline. 1997. Drinking: A Love Story. New York: Dial.

Schedule of Classes and Readings

Week One

Aug 24: Introduction to Class

Book: None    

Aug 26: Biocultural Perspectives on Health & Disease

Book: Wiley & Allen, Ch 1-2

Reading:

- R. Hahn & M. Inhorn. 2009. Introduction. In: Anthropology and Public Health: Bridging Differences in Culture and Society, Second Edition. Pp. 1-31.

Recommended

- G. Armelagos et al. 2005. Evolutionary, historical and political economic perspectives on health and disease. Social Science and Medicine 61(4):755-765.

-A. McElvoy & P. Townsend. 2009. Interdisciplinary research in health problems. In: Medical Anthropology in Ecological Perspective, 5th Edition. Pp. 33-80.

-P. Farmer et al. 2006. Structural violence and clinical medicine. PLoS Medicine 3(10): e449.

-A. Kleinman. 2010. The art of medicine: Four social theories for global health.  Lancet 375:1518-19.

-S. McGarvey. 2007. Population health. Annals of Human Biology 34(4):393-396.

-R. Nesse. 2008. Evolution: Medicine’s most basic science. The Lancet 372: S21-S27.

Week Two

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Posted in Medical anthropology | 3 Comments »

Finding a Voice: Establishing a Support Network for HIV+ Women

Posted by dlende on March 15, 2010

By Katie, Laura, Matt, and Claire

Diane was diagnosed with HIV at eight months old. She was infected through her mother, who was not aware that Diane’s father, her husband at the time, had HIV. He left before Diane’s mother found out that she had HIV and that she had passed it on to her newborn daughter.

Infected with HIV for her entire life, Diane “acts like she doesn’t have it” and “tries to go on with her life” even though she thinks about it everyday.

HIV has had a huge impact throughout Diane’s (a pseudonym) twenty-one years of life. One summer she was given just months to live, and her family, doubtful she would live until December, celebrated Christmas in July. She has survived several health scares, and although her health is currently not great, it is improving as her new medication begins to bring her viral load under control.

The Challenges of Being HIV-Positive… and a Woman

HIV-positive women cope with their disease in ways that are strikingly different from HIV-positive men. Women’s roles as caregivers, mothers, wives, and daughters make their experiences with HIV unique. These roles shape how much they are willing to deal with the disease on a daily basis as many women put the needs of their children and families before their own. Furthermore, their identities as caregivers may conflict with their identities as recipients of care that their HIV status necessitates. Consequently, these women, many of whom are in difficult socioeconomic situations, may not seek the support they need.

To help these women, last year a group of students helped to establish a much-needed HIV/AIDS women’s support group in our Midwestern city (see their post, Just A Place to Talk: Women & HIV/AIDS). It was a success initially. However, the student who helped facilitate the support group moved away this summer, and the support group lost its impetus.

This year our community-based research project explored why women stopped attending the support group, women’s interest in participating in a new support group, and how to develop a support network that addresses the many needs of HIV-positive women. The two most important lessons we learned this semester include the importance of emotional support and the value of resources, such as transportation and childcare, that enable these women to care for themselves and their families while living with HIV.

Seeking Solidarity and Support

Several women expressed a desire to learn from others who are willing to share their experiences with HIV. They think that sharing their stories with other HIV-positive women will lessen feelings of isolation and better equip these women to handle the burdens of the illness. As Joyce, who has been HIV-positive for twelve years, reported, she is interested in the group because she “wants to feel supported.”

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Posted in Applied Anthropology, Medical anthropology | 2 Comments »

“We Pregame Harder Than You Party!”

Posted by dlende on March 12, 2010

By Annette Esquibel, Thomas Mumford, and Jocelyn Rausch

“Why do I pregame?” The third year American History student repeated our question with a bit of sarcasm in his voice. He put down his textbook and then delivered his jovial response:

“Why wouldn’t I pregame?! It makes everything better- bars, parties, dances, football, class, work…”

This is the pregaming mentality expressed by a current undergrad at our mid-Western university. This mentality can be summarized: if you have to go to something, why not be buzzed when you do it?

Across the country, on any given weekend night, college students are often consuming four or five, sometimes even 10 drinks, before they even make it out of their dorm room for a night of partying, the dorm dance, or even the latest sports event.

They consume what many medical professionals construe as dangerous, sometimes lethal, amounts of alcohol in a short period of time. Then students often find themselves passing out, throwing up and even being taken to the hospital. And that’s before they even make it to the party.

From an outsider’s point of view, this may not sound like a lot of fun. For college students, pregaming is often the best part of the night. Our question as student researchers was, Why?

Our Research

Due to the recent emergence of pregaming, little is known about the mentality behind it. Working with the university group in charge of helping to prevent and treat alcohol abuse, we aimed to understand the social and cultural bases for high-risk drinking and pregaming. Previous student research on pregaming focused on gender differences, and can be found in the post “College Drinking: Battle of the Sexes?”

The statistics were already clear for the university office in charge of alcohol education and prevention – almost 80% of students who have gotten in trouble for alcohol-related events were pregaming on the night of the incident. Counselors there feared that the high-risk drinking habit of pregaming has become synonymous with students social lives.

Our project aimed at both understanding students’ general attitude towards pregaming as well as why students stop drinking on a given night. These questions could offer insight and clues to effective handling of the problem of pregaming by students and the university alike.

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Posted in Addiction, Applied Anthropology, Medical anthropology | 8 Comments »

Public Release of the DSM-5 Draft

Posted by dlende on February 13, 2010

The draft of the DSM-5, the Diagnostic and Statistical Manual, was released this week. This guide to the diagnosis of mental and behavioral health problems will shape the delivery of psychological, psychiatric, and social care for years to come.

You can access the entire draft here at the American Psychiatric Association DSM-5 Development Website. There the APA writes about the comment policy:

The draft disorders and disorder criteria that have been proposed by the DSM-5 Work Groups can be found on these pages. Use the links below to read about proposed changes to the disorders that interest you. Please note that the proposed criteria listed here are not final. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010. After that time, this site will be available for viewing only.

It is interesting to note that the APA included a press release announcing that the DSM-5 Development Process Includes Emphasis on Gender and Cultural Sensitivity.

Actual proposed changes are set up in an interesting way. The opening tab is the proposed revision, but there is also are rationale, severity, and DSM-IV tabs. So it does provide more information than one might think.

So, as one major example, Major Depressive Disorder, Recurrent, has an extensive draft proposal for the DSM-5. Here the rationale isn’t that great, since it largely focuses on single episodes of depression. On the severity side, it’s clear what the APA group is thinking about in terms of differential ratings. And it’s easy to compare the DSM-5 with the DSM-IV criteria.

Vaughan Bell at Mind Hacks includes some extensive commentary, and a wealth of links, on the DSM-5 Draft in the piece The Draft of the New ‘Psychiatric Bible’ Is Published. He opens by saying:

It’s a masterpiece of compromise – intended to be largely backwardly compatible, so most psychiatrists could just get on diagnosing the few major mental illnesses that all clinicians recognise in the same way they always did, with some extra features if you’re an advanced user.

One of the most striking extra features is the addition of dimensions. These are essentially mini questionnaire-like ratings that allow the extent of a condition to be numerically rated, rather than just relying on a ‘you have it or you do not’ categorical diagnosis.

John Grohol, writing over at Psych Central, also provides an initial overview of the main changes in the DSM-V and then provides a review that features the good, the bad and the ugly.

If you’re looking for just the critical, the Psychiatric Times has a piece Opening Pandora’s Box: The 19 Worst Suggestions For DSM-5. Dr. Allen Frances, who chaired the DSM-IV Task Force, identifies two areas that are quite worrisome (and predictable) for a critical medical anthropologist:

(1) Dramatically higher rates of mental disorder, including “millions of newly misidentified false positive ‘patients’ [and] massive overtreatment with medications that are unnecessary, expensive, and often quite harmful”

(2) Unforeseen consequences, where DSM5 options often have an “insensitivity to possible misuse in forensic settings. Work Group members cannot be expected to anticipate the many ways lawyers will try to twist their good intentions.”

You can explore the legal aspects more over at In the News.

For specific diagnoses, Dr. Petra has particularly good coverage on the proposed changes in sexual disorders. Liz Spikol looks at the diagnosis of childhood bipolar disorder with a critical eye.

For more reading, Furious Seasons has some good initial thoughts on the DSM-5. Additional coverage can be found at the NY Times and New Scientist.

Posted in Medical anthropology, Mental Illness | 1 Comment »

Cross-Cultural Psychiatry: A Special Report from Psychiatric Times

Posted by dlende on February 10, 2010


Psychiatric Times issues periodic special reports, and the latest one features a wealth of articles and ideas on cross-cultural psychiatry.

Ronald Wintrob, chair of the World Psychiatric Association–Transcultural Psychiatry Section, writes the Introduction to Cross-Cultural Psychiatry for this special report. He notes how migration has increased over the past 20 years, and that 12.86% of the US population are immigrants. Psychiatrists have put increasing effort into engaging these populations.

One of the most practical applications of cultural psychiatry to clinical practice in all fields of medicine is the open-ended questioning of patients and their families about their personal and family background characteristics. This includes identifying features of race, ethnicity, religion, and socioeconomic class, relevant immigration history, experiences of acculturative stress, and personal and family aspirations. A discussion of these background characteristics can lead naturally to the clinician’s exploration of the presenting clinical symptoms and history. Knowledge of the patient’s background will increase rapport with patients and families and aid the process of collecting a more reliable history. In addition, it will improve the likelihood of treatment adherence. This process has been described as “cultural case formulation.”

Three main articles comprise the special issue:

Religion, Spirituality, and Mental Health by Simon Dein, senior lecturer of anthropology and medicine at University College London. This piece provides an in-depth examination of what is currently known about the relationships between religion and mental health, and also includes a handy set of four check points that summarize the main themes of the article.

Cultural Considerations in Child and Adolescent Psychiatry, by Toby Measham, Jaswant Guzder, Cécile Rousseau, and Lucie Nadeau, all in the department of psychiatry at McGill, which presents a series of guidelines and suggestions for how to handle cross-cultural issues in practice with children and adolescents

Cultural and Ethnic Issues in Psychopharmacology, by Keh-Ming Lin, professor emeritus in psychiatry at UCLA. This piece goes from the placebo effect to genetic variation, and argues that “cultural and ethnic influences… should be regarded as central in determining the success of treatment interventions.”

Under the whole category of cross-cultural psychiatry at Psychiatric Times, you can also find other articles, including this one by J. David Kinzie on A Model for Treating Refugees Traumatized by Violence.

Link to the Introduction to the Special Report on Cross-Cultural Psychiatry.

Posted in Links, Medical anthropology, Mental Illness, Psychological anthropology | Leave a Comment »

Access Denied

Posted by dlende on February 2, 2010


Access Denied is a great new anthropology blog on immigration and health. In particular, the editorial team focuses on the “vital global health challenge: unauthorized migrants’ and immigrants’ lack of access to health care services.”

As they write about their initiative:

Do unauthorized im/migrants have a right to health? To medical care? To publicly funded care? In this blog, medical anthropologists host a lively conversation among scholars, activists, policymakers and others on the complex and contentious issue of unauthorized migration and health. We approach the issue comparatively, with attention to power, cultural context, and historical depth. Through empirically grounded, critical dialogue, we aim to rethink current debates and inform policy about unauthorized migration and the right to health care.

Recent posts include What do Haitian Earthquake Survivors and the Super Bowl Have in Common?, which addresses the mounting controversy over stopping survivors of the Haitian earthquake from entering Florida to receive urgently needed health care, and Chutes and Ladders: Comprehensive Immigration Reform and Health Care Access for Undocumented Workers, which provides a long-term view of immigration and health using the lens of Mexican illegal immigrants to Idaho.

The Access Denied team also puts together regular News Round Ups, with the most recent one delving into the serious problems surrounding deaths among immigrants held in custody by US Immigration and Customs Enforcement.

The overall site delivers a complete package, including an extensive working bibliography, a good list of web resources on immigration and health, and most importantly Access Denied’s recommendations for Action Steps you can take to address the problems surrounding immigration and health.

Access Denied was founded by a great group of people, including Sarah Willen, a friend of mine from graduate school and now assistant professor at Southern Methodist University, and Heide Castañeda, an assistant professor at the University of South Florida, whom I had the pleasure of meeting on my recent trip there.

Other founding members include Nolan Kline, a graduate student at the University of South Florida, and Jessica Mulligan, a post-doc at the Holleran Center for Community Action and Public Policy. You can see the entire team here, including profiles of the founders and guest contributors.

Those guest contributors have included some outstanding senior people, including Didier Fassin, who just joined the prestigious Institute for Advanced Study at Princeton, on Illegal Immigrants as the Last Frontier of Welfare, and Peter Guarnaccia, Professor in Human Ecology at Rutgers, on Health Care Reform Is Intimately Linked to Immigration Reform.

For even more, go check out the new medical anthropology blog Access Denied.

Posted in Medical anthropology | 4 Comments »

Exporting American mental illness

Posted by gregdowney on January 10, 2010

The New York Times Magazine has a great discussion of the effects of the exportation of American ideas about mental illness, titled appropriately, The Americanization of Mental Illness by Ethan Watters, based on his forthcoming book, Crazy Like Us: The Globalization of the American Psyche, coming out this month from Free Press. The article is quite good, offering some intriguing cases, such as the rise of virulent, American-style anorexia nervosa in Hong Kong, the effect of possession beliefs on communities’ reactions to schizophrenia, and how the narrative of mental illness as ‘brain disease’ might actually lead to great stigma as it spreads and replaces local understandings. The article is well worth a read, and I’m looking forward to the book.

graphic by Alex Trochut, NYTimes

The ethnographic record is full of conditions that didn’t make it into the most recent edition of the DSM — amok, nervios, koro, zar — you can check out Wikipedia or some other source on ‘culture bound syndromes,’ such as Introduction to Culture-Bound Syndromes in Psychiatric Times, to get a fuller discussion of some of these conditions. The Psychiatric Times piece suggests that there are at least 200 culture-bound syndromes.

One thing I really liked about the New York Times Magazine article, however (and by extension, Watters’ book, I suspect), is that the discussion of ‘culture-bound syndromes’ usually tends to treat other people’s syndromes as ‘culture-bound,’ Western psychological illnesses as not ‘culture-bound.’ Watters’ work points out that Western mental illness is both itself culture-bound and that persuading people to believe in Western-style mental illness can affect the way that psychic disorders manifest.

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Posted in general, Human variation, Medical anthropology, Mental Illness | Tagged: , , | 21 Comments »

Gravlee et al: Race, Genetics, Social Inequality, and Health

Posted by dlende on September 11, 2009

Color SES SBP
Clarence Gravlee, Amy Non and Connie Mulligan have just published an outstanding article in PLoS ONE, Genetic Ancestry, Social Classification, and Racial Inequalities in Blood Pressure in Southeastern Puerto Rico. The abstract opens:

The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.

Note how that fits so well into the points just made in Nature/Nurture: Slash to the Rescue. But Gravlee, Non and Mulligan don’t just say we need to overcome the nature vs. nurture dichotomy, they do research that bridges it and even better, test ideas on both sides: “We draw on ethnographic, epidemiologic, and genetic data collected in southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification.”

This type of collaborative research can be crucial to getting the data to answer complicated questions. Connie Mulligan and Lance Gravlee deserve credit for taking the time to discuss how to bring together their respective approaches before going out to do research. In this case, the data come down more on the nurture (or social) side. As they write:

Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups.

Before someone gets all hot and bothered, Lance has also shown how to bring nurture back to nature. In Gravlee’s recent paper, How Race Becomes Biology: Embodiment of Social Inequality (pdf), he gives us following: “Drawing on recent developments in neighboring disciplines, I present a model for explaining how racial inequality becomes embodied – literally – in the biological well-being of racialized groups and individuals. This model requires a shift in the way we articulate the critique of race as bad biology.”

In the PLoS paper, Lance, Amy and Connie are aiming squarely at the use of race in medicine, where it has become common in some circles to use racial classification as a proxy for genetics. Basically this research destroys the proxy notion, since social classification turns out to be a better predictor of blood pressure than genetic ancestry.

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Posted in Cognitive anthropology, Embodiment, Human variation, Inequality, Medical anthropology, Methods, Stress | 5 Comments »

Funerals and Food Coping in Rural Lesotho

Posted by dlende on August 25, 2009

Lesotho Funeral Home
By Brandon Sparks

Imagine you are hungry. You have been hungry for weeks, with no end in sight due to a heavy drought that severely diminished your land’s production. Your gravely ill sister lives with you, as do her two young children, further straining your limited food supply. Then your neighbor dies. You do mourn, but you also feel relief – relief because you will be able to take your family to the funeral. There they will be able to eat.

This post examines food crises in Lesotho and the role funerals play in coping with these food shortages within a rural town and neighboring villages. In my senior thesis written on the costly funerals in Lesotho and the impact of HIV/AIDS on their practice, I found that the local Basotho people use funerals as a food coping mechanism. Lesotho often suffers from periods of drought that place a burden on food resources and force people to look for methods to supplement their daily food.

Lesotho VillageI will begin with a brief look at the factors behind the food shortages, followed by a description of funeral practices and how families are able to use them to for food coping. Lesotho is a small country in southern Africa. Through a quirk in British rule, it remained independent from South Africa and is now the only country to have its entire border completely surrounded by another country. The terrain is mountainous and has earned Lesotho the nickname of “the roof of Africa.” Less than eleven percent of the land is arable and farmers are at the peril of periodic droughts.

Lesotho also has one of the highest HIV/AIDS prevalence rates in the world, with some estimates as high as thirty-one percent of its over two million population carrying the virus (Brummer 2002). The high percentage stems from Lesotho’s history of labor migration to the gold and diamond mines of South Africa, where Basotho men would contract the disease and then bring it home to their families in Lesotho.

The attraction of mining employment to Basotho (from Lesotho) men comes partially from the lack of opportunities at home. Agriculture production has dropped in the past fifty years due to deterioration of the land through erosion, mono-cropping, and overgrazing, insecurities in the system of land tenure that inhibited farmers from securing their holdings, population pressure that increased exploitation of arable land, and environmental factors like hail, frost, and drought (Murray 1981). These factors, coupled with population growth, mean that the frequency and severity of food crises has increased in the last century.

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Posted in Applied Anthropology, Medical anthropology | 9 Comments »

Paul Farmer: This I Believe

Posted by dlende on July 9, 2009

Paul Farmer is a doctor and an anthropologist, and spoke as part of NPR’s series This I Believe. Farmer co-founded Partners in Health, a non-profit organization dedicated to improving health care for the poor around the world. He helped develop DOTS (directly observed therapy), a way to provide care for HIV/AIDS that works in resource-poor settings, as well as community-based approaches to treating multi-drug resistant TB in developing countries.

As an anthropologist he has emphasized the importance of structural violence, the negative impact that systems of power can have on people through racism, gender inequality and political violence, with significant articles in both Current Anthropology and PLoS Medicine.

His most recent book is Pathologies of Power: Health, Human Rights, and the New War on the Poor. You can also read about his lifework in Tracy Kidder’s biography, Mountains beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World.

Hat-tip (and thanks) to Ryan Anderson over at Ethnografix and his anthropological list of inspiring people and work.

Link to full text of Paul Farmer’s This I Believe NPR recording.

Posted in Applied Anthropology, Medical anthropology, Video | 2 Comments »

 
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