Category: "medical anthropology / ethnobothany"
By Aleksandra Bartoszko. Oslo University Hospital, Equality and Diversity Unit
Scars after removal of a kidney. Photo: bee free patrrizia grandicelli, flickr
Spring 2011 I attended seminar “Engaging medicine” at the University of Oslo in honor of one of the most prominent medical anthropologists in Norway - Benedicte Ingstad. One of the speakers was Nancy Scheper-Hughes with a paper “Medical Migrations – From Pilgrimage and Medical Tourism to Transplant Trafficking».
Scheper-Hughes is professor of anthropology and director of the program in Critical Studies in Medicine, Science, and the Body at the University of California at Berkeley. She is known for her research on structural and political violence, anthropology of body, illness, suffering, maternity and poverty. Her most famous publications are monographs Saints, Scholars and Schizophrenics: Mental Illness in Rural Ireland and Death without Weeping: the Violence of Everyday Life in Brazil.
Since I got engaged in medical and critical anthropology, Scheper-Hughes has been to me a constant source of inspiration and provocation. As an anthropologist who supports and has been doing public and applied anthropology she co-founded Organs Watch, a medical human rights project focusing on organ trafficking. In more than ten years she has been working on the global organ trade. Following the illegal flow of kidneys, she has mapped the tragic network of rich buyers and poor sellers all over the world.
I always wondered how her adventure with kidneys started. She answers:
– It was a very different kind of a project and it was not one that I ever could have imagined spending so much time on.
– I wrote an article that emerged from chapter 6 of my book “Death without weeping” where I write about bodies in dangers, the dead body and favela residents’ fears and their feelings of ontological security or insecurity of the body. And I was studying the emergence of local death squads that were operating after the end of the military period, taking the place of the militarized state. I found that there was real medical mistreatment of poor bodies in clinics, in forensic institutes, and in the graveyard. And above all of this was hovering a terror that people had that their bodies would be used for organs. So I wrote some articles trying to explain why people thought they would be subject to kidnapping for the purpose of organ theft.
– At the time I still thought that this was mainly an urban legend. But then underneath the legend were these real experiences that poor people encountered in forensic medical institutes or police morgues where the unidentified, unclaimed body was, in fact, state property, and (to be crude) chopped up and harvested. So the people were right in fearing that their bodies were not safe.
A multi-dimensional public health crisis is unfolding on the U.S.-Mexico border that few seem ready to acknowledge, anthropologists Rachel Stonecipher & Sarah Willen write on the Access Denied blog.
The complexity of this crisis came to light during a recent study tour to Tucson, Arizona, in which Rachel Stonecipher took part.
Dehydration and heat-related illness claim hundreds of lives annually, and many of these deaths go unrecorded. No uniform system exists to count or repatriate remains. “We can only imagine the impact of these missed opportunities for identification on family members searching for their loved ones”, Stonecipher and Willen write.
For migrants who do reach their destination but face subsequent arrest, “interception” itself can involve serious health risks:
What happens to migrants after they are arrested and detained often remains shrouded from both the public eye and, to a great extent, the eyes of the human rights community. This is a particularly grave concern when arrested individuals already are sick or injured. (…) One especially serious concern involves the deportation of injured individuals who have not yet been medically stabilized. (…)
Detainees are also at risk of abuse – physical and mental – at the hands of police and Border Patrol officers. Despite official denials, No More Deaths, the Border Action Network, and other NGOs have collected and responded to numerous reports of abuse.
Through water stations, humanitarian aid camps, and desert patrols, a handful of NGOs provide assistance to migrants in need. But this cross-border health crisis is “far too vast for activists to address alone”, the anthropologists note:
Both human rights principles and contemporary realities demand that we hold countries with porous borders – including but not only the U.S. – accountable. Not only must such countries recognize migration as an enduring global phenomenon with complex causes and share accountability for both lives and deaths, but they must also engage in transnational public health efforts to develop the kind of multi-layered interventions needed to protect human life in border regions. (…)
Like the humanitarian organizations that work along the border, we all must insist on an expansive understanding of “public health” that recognizes people in transit as members of a common moral community: as people who are connected to us, and whose lives matter. Whether or not we understand or agree with the choice to migrate, activists along the U.S.-Mexico border remind us that border crossers are human beings who – like all other members of our moral community – are deserving of health-related attention, investment, and care.
Russia has one of the fastest-growing rates of HIV infection in the world, and the Church remains its only resource for fighting these diseases.
Antropologi.info contributor Aleksandra Bartoszko reviews Jarret Zigon’s recent book „HIV Is God’s Blessing”. Zigon takes the reader into a Church-run treatment center near St. Petersburg that employs both priests and psychologists to work with the HIV-infected drug users.
Review: HIV Is God’s Blessing. Rehabilitating Morality in Neoliberal Russia by Jarret Zigon, University of California Press, Berkley, 2011
Aleksandra Bartoszko, Oslo University Hospital
When I read it, I was slightly surprised. I asked myself if we read the same book and why have I focused on totally different points while thinking of Zigon’s work.
I believe that one of the reasons for the huge discrepancy between what the two of us have learned from reading is our fields of research and interests we had in this book. As I am not too familiar with anthropology of morality and ethics, and many theoretical discussions in the book were pretty new to me, I must admit that this book did not invite me to further exploration of the subject. The book was difficult to read, a little bit chaotic and badly edited.
What Is this Book About?
Jarrett Zigon’s book „HIV Is God’s Blessing”, according to the publisher:
„examines the role of today’s Russian Orthodox Church in the treatment of HIV/AIDS. Russia has one of the fastest-growing rates of HIV infection in the world - 80 percent from intravenous drug use and the Church remains its only resource for fighting these diseases. Jarrett Zigon takes the reader into a Church-run treatment center where, along with self-transformational and religious approaches, he explores broader anthropological questions of morality, ethics, what constitutes a “normal” life, and who defines it as such. Zigon argues that this rare Russian partnership between sacred and political power carries unintended consequences: even as the Church condemns the influence of globalization as the root of the problem it seeks to combat, its programs are cultivating citizen-subjects ready for self-governance and responsibility, and better attuned to a world the Church ultimately opposes.”
As an ethnographic case Zigon takes a rehabilitation centre near St. Petersburg called The Mill, which is a cooperation between secular NGOs and Russian Orthodox Church, employing thus both priests and psychologists to work with the HIV-infected drug users. Zigon follows his informants both in the rehabilitation centre as well as the recruitment process in the city, and he is attending events arranged by the NGOs and Church outside the Mill.
Writing and the Art of Repetition
How the book is written and its style is usually mentioned at the end of every review. Unfortunately, when it comes to this book, the writing style was so disturbing that it influenced my overall reception of the book. I like some of the stylistic choices, like the description of the road leading to the rehabilitation centre, which I read as a metaphor for the social position of the centre and the life history of the rehabilitants (p. 33).
But unfortunately the book suffers from a very poor editorial work. There are a lot of redundancies, repetitions and the language itself creates at times confusion. It is hard to read this book. The excessive repetitiveness is most disturbing. Usually, there is nothing wrong with repeating, especially for learning purposes, but in this case this is just too heavy and achieving, in my opinion, a ludicrous dimension.
Is it a good idea to fight against female circumcision? Not neccesarily according to Sierra Leonean-American anthropologist Fuambai Ahmadu.
In an interview in Anthropology Today (available free as pdf here), she attacks Western feminists, media and anti-Female Genital Mutilation campaigns and accuses them for presenting a one-sided, ethnocentric picture of female circumcision.
A great deal of what is regarded as facts is not true, she explains. Many people think circumcision is a “barbaric tradition” and “violence against women". But Ahmadu does not see circumcision as mutilation. Circumcision is no notable negative effects on your health and does not inhibit female sexual desire either.
The problem with the representation of various forms of female circumcision as ‘mutilation’ is that the term, among other things, presupposes some irreversible and serious harm. This is not supported by current medical research on female circumcision.
But this research (Obermeyer, Morison etc) has not received any attention in Western media:
However, neither Obermeyer’s reviews nor the Morison et al. study have been mentioned in any major Western press, despite their startling and counter-intuitive findings on female circumcision and health. This is in contrast to the highly publicized Lancet report by the WHO Study Group on FGM, released in June 2006, which received widespread, immediate and sensationalized press coverage highlighting claims about infant and maternal mortality during hospital birth.
Supporters of female circumcision justify the practice on much of the same grounds that they support male circumcision, she says:
The uncircumcised clitoris and penis are considered homologous aesthetically and hygienically: Just as the male foreskin covers the head of the penis, the female foreskin covers the clitoral glans. Both, they argue, lead to build-up of smegma and bacteria in the layers of skin between the hood and glans. This accumulation is thought of as odorous, susceptible to infection and a nuisance to keep clean on a daily basis. Further, circumcised women point to the risks of painful clitoral adhesions that occur in girls and women who do not cleanse properly, and to the requirement of excision as a treatment for these extreme cases. Supporters of female circumcision also point to the risk of clitoral hypertrophy or an enlarged clitoris that resembles a small penis.
For these reasons many circumcised women view the decision to circumcise their daughters as something as obvious as the decision to circumcise sons: why, one woman asked, would any reasonable mother want to burden her daughter with excess clitoral and labial tissue that is unhygienic, unsightly and interferes with sexual penetration, especially if the same mother would choose circumcision to ensure healthy and aesthetically appealing genitalia for her son?
It is important to remove the stigma around circumcision, Ahmadu stresses:
It is my opinion that we need to remove the stigma of mutilation and let all girls know they are beautiful and accepted, no matter what the appearance of their genitalia or their cultural background, lest the myth of sexual dysfunction in circumcised women become a true self-fulfilling prophecy, as Catania and others are increasingly witnessing in their care of circumcised African girls and women.
In an article in The Patriotic Vanguard, she describes the term Female Genital Mutilation as “offensive, divisive, demeaning, inflammatory and absolutely unnecessary":
As black Africans most of us would never permit anyone to call us by the term “nigger” or “kaffir” in reference to our second-class racial status or in attempts to redress racial inequalities, so initiated Sierra Leonean women (and all circumcised women for that matter) must reject the use of the term “mutilation” to define us and demean our bodies, even as some of us are or fight against the practice.
Anthropologist Carlos D. Londoño Sulkin comments Ahmadu’s talk in Anthropology Today and criticizes his colleagues:
My own sense, after listening to Ahmadu, is that many Euroamericans’ reactions to the removal of any genital flesh is shaped by parochial understandings and perfectly contestable biases and values concerning bodies, gender, sex and pain.
Many anthropologists, reacting against collectivist social theories and some of the less felicitous entailments of cultural relativism, have joined in the condemnation of female circumcision without first taking counsel from our discipline’s methodological requirement actually to pay attention to what the people we write about say and do about this or that, over an extended period. Listening to Ahmadu, I can no longer condemn the practices of genital cutting in general, nor would I be willing to sign a zero-tolerance petition.
>> Disputing the myth of the sexual dysfunction of circumcised women. An interview with Fuambai S. Ahmadu by Richard A. Shweder (incl. comment by Carlos D. Londoño Sulkin)
SEE EARLIER POSTS ON THIS TOPIC:
(Hatiain Children up in the mountains. Image: Matt Dringenberg, flickr)
(post in progress about anthropological perspectives in Haiti and how to help) “Anthropology to me is all about human connexions, about a common humanity", said Dai Cooper from the Anthropology Song. “Being an anthropologist means that when a natural disaster occurs somewhere in the world, a friend may be there", is a quote I found on the blog by urban anthropologist Krystal D’Costa.
“The recent catastrophic earthquake in Haiti has turned my thoughts to our global levels of connectivity", she writes and adds:
Web 2.0 technologies have been activated to create impromptu support networks and share what little information people may have heard. They are proving integral to the management of disasters. And perhaps creating a global community so that when natural disasters strike, anthropologists aren’t the only ones wondering and worrying about the fate of friends.
I had similar thoughts today: First, on facebook, lots of friends posted stories about the earthquake and explained how to help. Browsing the web, it is overwhelming and touching to read about all the activities by people who help. Even without web2.0, people care for each other. True everyday cosmopolitanism.
GlobalVoices - my favorite source for international news - has lots of great overviews, among others about help from the region around Haiti (Dominican Republic / Caribbean) where many bloggers have been active. The Haitian Diaspora has also been active.
This kind help is often invisible in mainstream media. Here in Norway, the focus is of course on Norwegians (or Americans) or other rich countries’ help.
José Rafael Sosa for example writes (translated by Global Voices):
The Dominican people have bent over backwards to help Haiti. What happened in Haiti has no precedent. There is too much pain. Too much suffering. The absurd differences stop here and solidarity is imposed, pure and simple, openly and decidedly. This is the right moment to help our brother nation. Let’s give our hand and our soul to a people that do not deserve so much suffering.
Anthropologists have also contributed online. At Somatosphere, medical anthropologist Barbara Rylko-Bauer explains why helping through Partners in Health might be a good idea. One of the founders of Partners in Health is another medical anthropologist: Paul Farmer who currently is the U.N. Deputy Special Envoy to Haiti.
One year ago, Farmer was interviewed about the hurricane disaster in Haiti where as many as 1,000 people have died and an estimated one million left homeless. Farmer stresses that natural disasters are not only natural but also social or political disasters, they are partly man-made. He addresses Haitis ecological crisies and the way the US has destabilized Haiti. In another interview he challenges Profit-Driven Medical System (more see wikipedia and videos below).
Yes, why is Haiti so poor? Why is Haiti one of the poorest countries on this planet and therefore more vulnerable to disasters like earthquakes? Two anthropologists answer this question. They suggest links between the disaster and colonialism.
Haiti actually has been a rich country, Barbara D Miller at anthropologyworks explains. Haiti produced more wealth for France than all of France’s other colonies combined and more than the 13 colonies in North America produced for Britain. So why is Haiti so poor:
Colonialism launched environmental degradation by clearing forests. After the revolution, the new citizens carried with them the traumatic history of slavery. Now, neocolonialism and globalization are leaving new scars. For decades, the United States has played, and still plays, a powerful role in supporting conservative political regimes.
James Williams at Discovery News interviews anthropologist Bryan Page. Page gives a similar explanation.
After 1804, Haitians were discriminated against by not only the United States, but all the European powers, he says:
That discrimination meant no availability of resources to educate the Haitian population, no significant trade with any polity outside of Haiti. Also, the break up of the plantations into individual land parcels meant there’s no longer a coherent cash crop activity going on within Haiti.
These conditions persisted into the 20th Century:
You still have a population that was 80-90% illiterate – a population that didn’t have any industrial skills, a population that wasn’t allowed to trade its products with the rest of the world in any significant way.
What that isolation essentially meant was that Haiti never had a chance to progress alongside the surrounding civilizations in the region. Complicating the picture even more was a series of despotic rulers that added to the country’s struggles.
[Haiti was] seen increasingly as a benighted, terrible place, in part also because of the collective racism of the white-dominated nations that surrounded them, including Cuba, the United States and the Dominican Republic which occupies the other side of Hispanola.
UPDATE 1: More on Haiti, colonialism and racism on the blog The Cranky Linguist by anthropologist Ronald Kephart
UPDATE 2: Statement by the American Anthropological Association (AAA): The Haitian Studies Association has begun to develop strategies to help Haiti, Haitians, Haitians in the diaspora, and the Haitian academic community. The AAA will provide more information about how to respond to the disaster and ask the Haitian anthropological community for advice.
Hope is not something that one often associates with Haiti. An anthropologist and critic of representations of the island, I have often questioned narratives that reduce Haiti to simple categories and in the process dehumanize Haitians. Yes, we may be the poorest nation in the Western Hemisphere, but there is life there, love and an undeniable and unbeatable spirit of creative survivalism.
I am worried about Haiti’s future. In the immediate moment we need help, rescue missions of all kinds. I am concerned about weeks from now when we are no longer front-page news. Without long-term efforts, we will simply not be able to rebuild. What will happen then?
UPDATE 3: Great post by Kerim Friedman at Savage Minds where he explains why New York Times columnist David Brooks is wrong who claims that “Haiti, like most of the world’s poorest nations, suffers from a complex web of progress-resistant cultural influences.”
UPDATE 4: Haiti: Getting the Word Out - Janine Mendes-Franco at GlobalVoices gives an overview over bloggers in and around Port-au-Prince who “are finding the time to communicate with the outside world".
UPDATE 5 (16.1.10): Anthropologist Johannes Wilm: Who really helps Haiti? An overview of money given to Haiti: While USA give most per person affected, Norway, Canada and Guyana give most per citizen and (again) Guyana gives most in percentage of GDP (Gross Domestic Product). His main message is that the aid from Western countries is “close to nothing".
Alert by Naomi Klein: “We have to be absolutely clear that this tragedy—which is part natural, part unnatural—must, under no circumstances, be used to, one, further indebt Haiti and, two, to push through unpopular corporatist policies in the interest of our corporations. This is not conspiracy theory. They have done it again and again.”
UPDATE See also post by Keith Hart: Is Haiti to be another victim of disaster capitalism?
UPDATE 7: GlobalVoices: Instances of “Looting,” but Little Confirmed Evidence of Post-Quake Violence: When the media reports on disasters, they’re inevitably going to focus on the dramatic and antisocial, even if it’s one percent of the population committing these acts.”
Here is what poor Haitians define as elements of a good society:
1. relative economic parity
2. strong political leaders with a sense of service who “care for” and “stand for” the poor
3. respe (respect)
4. religious pluralism to allow room for ancestral and spiritual beliefs
5. cooperative work
6. access of citizens to basic social services
7. personal and collective security
UPDATE 10: Harvard and Haiti: A collaborative response to the January 12 earthquake: Video with Paul Farmer and his colleagues from Harvard Medical School, Partners In Health
and Brigham and Women’s Hospital
And here an overview about the current situation:
and a lecture by Paul Farmer (first introduction, lecture starts after 8 minutes):
As Greg Downey at Neuroanthropology.net, I was kept awake until late at night by an article in the New York Times Magazine - yesterday for reading, today for writing. It is a fascinating article about a kind of globalisation that isn’t talked about much outside the university, written by Ethan Watters, author of Crazy Like Us: The Globalization of the American Psyche, released two days ago. It’s about the globalisation of the Western conception of mental health and illness
“We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness", he writes. “We may indeed be far along in homogenizing the way the world goes mad.” And the idea that our Western conception of mental health and illness might be shaping the expression of illnesses in other cultures is rarely discussed in the professional literature.”
Western conceptions of mental health? Well, as anthropologists stress, illness is not only about biomedicine. It’s not only about parts of the body that no longer work. Our brain is not a batter of chemicals that “needs a fine chemical balance in order to perform at its best” (advertisment for the antidepressant Paxil).
Illness, maybe especially mental illness, is also about culture:
(M)ental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host. (…)
What cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. (…)
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
Contrary to popular belief, “Western” biomedicine is not culturally neutral either:
The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence. These ideas remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and unconscious, as well as the many self-help philosophies and schools of therapy that have encouraged Americans to separate the health of the individual from the health of the group.
“Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes.
Ethan Watters explains why have American categories of mental diseases become the worldwide standard:
American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses. In addition, Western-trained traumatologists often rush in where war or natural disasters strike to deliver “psychological first aid,” bringing with them their assumptions about how the mind becomes broken by horrible events and how it is best healed.
The export of Western biomedical ideas, Watters explains, can have “frustrating and unexpected consequences", for example marginalization of people with “mental heath problems". People with schizophrenia in some developing countries appear to fare better over time than those living in industrialized nations.
Several studies, Watters writes, suggest that we may actually treat people more harshly when their problem is described in biomedical disease terms, when we treat mental illnesses are “brain diseases” over which the patient has little choice or responsibility, when the disease has according this model nothing to do with factors in the outside world like unemployment, racism, larger societal structures that lead to loneliness, despair, depressions:
It turns out that those who adopted biomedical/genetic beliefs about mental disorders were the same people who wanted less contact with the mentally ill and thought of them as more dangerous and unpredictable. This unfortunate relationship has popped up in numerous studies around the world. (…) “irrespective of place . . . endorsing biological factors as the cause of schizophrenia was associated with a greater desire for social distance.”
In Zanzibar, in a group of people with “Swahili spirit-possession beliefs", the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity according to research by anthropologist Juli McGruder:
For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.
The article was published last Saturday. The same day, Greg Downey wrote Exporting American mental illness, an example for great anthropology blogging. And the day after another fascinating blog post by Eugene Raikhel at Somatosphere: The globalization of biopsychiatry with lots of links to related medical anthropology studies.
Nearly at the same time, medical anthropologist Michael Tan has written about the same topic in his column Pinoy Kasi in the Philippine Daily Inquirer. He writes about “special children", children with what Americans call “global developmental delay” or GDD. This diagnosis does not make sense in the Philippines:
The problem here is defining a delay. (…) For example, around the area of language development, you will find books that say a child should have a vocabulary of around 200 words by the age of 2. I can imagine some of my readers beginning to panic now, as I did when I first heard that standard. Imagine me in the middle of the night doing an inventory of my son’s vocabulary and not even reaching 50 (…)
But the anthropologist in me protested that we don’t have studies in the Philippines that established the norm, and given that all our children are growing up in households with at least two, and often more, languages, there’s bound to be some “delay.” As you might have guessed, my son, who is now 4, cannot stop jabbering, and in three languages at that.
“I am here to save the people, to cure the people. In the city they are all sick, they are all domesticated. The shaman has to go together with disease.”
“In contemporary Bolivia, the concept Colonialism is used so frequently, and with such distinct connotations by such a diverse set of actors that it demands scrutiny", the Swedish anthropologist writes in his paper Colonialism in Context An Aymara Reassessment of ‘Colonialism’, ‘Coloniality’ and the ‘Postcolonial World’ (pdf) that was published in the recent issue of KULT on postkolonial.dk.
Colonialism is according to Burman on the one hand considered a sickness and on the other hand the source of sickness. Most notions of illness held by Aymara shamans find their equivalents in notions of Colonialism.
As illness, as lived experience and as collective memory, Colonialism is still present in the Andes. To the indigenous peoples in Latin America it is a question of continuous Colonialism; the colonialists have not left. Although the Spanish colonial administration no longer holds power over their former indigenous subjects, Aymara people of the 21st century are subalternized and impoverished in a global system that still has colonial traits according to Burman.
Evo Morales’ victory at the polls in December 2005 did not change that, the researcher writes. There is an imminent risk of the new regime being “infected".
Burman has written a dissertation about this topic.
KULT is a postcolonial special issue series. It began in 2004 as the result of a desire to connect a series of discussion fields about postcolonial Denmark. The recent issue on Contemporary Latin American epistemologies has grown out of a network of Latin Americanists in Scandinavia and the Americas.
In one of the other papers in this issue, Madina Tlostanova and Walter Mignolo introduce what they call decolonial thinking, an approach that - they claim - differs from what postcolonial studies have been doing so far:
As a corridor between the academy and the Political Society, decolonial thinking is transdisciplinary (not inter-disciplinary), in the sense of going beyond the existing disciplines, of rejecting the “disciplinary decadence” (Gordon 2006) and aiming at un-disciplining knowledge (Walsh et. al 2002).
Decolonial thinking, in the academy, assumes the same or similar problems articulated in and by the “Political Society.” Knowledge is necessary to act in the political society. But this knowledge is no longer or necessarily produced in the academy. Living experiences generate knowledge to solve problems presented in everyday living. And this knowledge is generated in the process of transformation enacted in the “Political Society.”
Hence, decolonial thinking in the academy has a double role: a) to contribute to de-colonize knowledge and being, which means asking who is producing knowledge, why, when and what for; b) to join processes in the “Political Society” that are confronting and addressing similar issues in distinct spheres of society.
(draft) It was around four months ago, I received the message of my friend’s sudden death. “Nobody knows", I was told, “why she stepped in front of a train". Afterwards I often wondered if her life could have been saved if we as a society had known and talked more about so-called mental health issues.
For these topics are still taboo. I was shocked to hear the stories from friends and colleagues who I told about what had happened: Many of them suddenly started telling about people they knew who have tried to end his/her life or who have committed suicide. They even mentioned people I know. Worldwide, more people die by suicide than by criminal acts or war - around one million per year. And up to 20 million people try to take their life every year. Europe and Asia have the highest suicide rates.
But this topic is hardly discussed. Neither in media (it was banned in Norwegian media until one year ago) nor in social sciences. The World Suicide Prevention Day that is held today (10.9.) wants to “improve education about suicide, disseminate information, decrease stigmatization and, most importantly, raise awareness that suicide is preventable".
What is going on in a person’s mind who has decided to step in front of a train? Many people - around one in ten - have contemplated suicide, but only a minority of them made an attempt. Why did they take this step? What has happened in their life? How could the worsening of their situation have been prevented? Are there warning signs? Would psychological treatment have helped? But after all those horrible stories about mental health clinics - can we trust such institutions? Might they even increase the risk of suicide? And is suicide always committed by people who are ill? Maybe their decision to end their life is rather rational and should be respected? Will it therefore be wrong - and selfish - to force people to continue living?
After lots of discussions with friends and googling the same terms again and again, I learned that there are no simple answers.
I also found out that literature about suicide is dominated by psychology and biomedical sciences. Committing suicide is presented as an individual issue. People who commit suicide seem to be people who for some reason no longer were able to cope with their life. There was something “wrong” with them. But maybe there is also something wrong with society or with specific developments? According to Eugenia Tsao, there many reasons why anthropologists should politicize mental illness.
Maria Cecília de Souza Minayo, Fátima Gonçalves Cavalcante and Edinilsa Ramos de Souza write in their paper Methodological proposal for studying suicide as a complex phenomenon in the journal Cadernos de Saúde Pública that “few studies have simultaneously examined the individual, social, anthropological, and epidemiological aspects of suicide". The micro and macro dimensions “remain dissociated in polarities that prioritize either the individual or society.”
They present an interdisciplinary approach to suicide that also includes an ethnographic study in a mining town. They show how the increase in suicide rates can be explained by a mix of factors, like radical structural changes that preceded and followed privatization of the mining company and also personal life histories of the workers.
But there seems to be an growing awareness also among researchers in biomedical sciences that their approach is reductionistic.
In a book review in the journal Jama - Journal of the American Medical Association, Antolin C. Trinidad explains that “suicide is best approached by getting out of the confines of biomedical sciences and into the domains of anthropology, sociology, and disciplines in the humanities":
It is not a surprise that physicians spend the lion’s share of whatever interest they have in suicide studying its prevention, treatment, and the sundry clinical bullets that are potentially deployable in the clinics, rather than its history or the vicissitudes of individual despair and anguished self-awareness of pain that breed self-destruction. This is exactly what John C. Weaver, author of A Sadly Troubled History: The Meanings of Suicide in the Modern Age, calls “meta-pain.”
And also Diego De Leo calls in his editorial Why are we not getting any closer to preventing suicide? in the British Journal of Psychiatry for “multi-disciplinary teams to set up more integrated approaches for large- scale, long-term and thoroughly evaluated projects". But “multi-disciplinary approaches to the prevention and investigation of suicide are often flagged up but virtually never practised".
Anthropologists have been almost completely silent concerning the problem of suicide, writes Stefan Ecks in the abstract of his paper “Suicide: reflexions on Medical Anthropology research of suffering". For hardly any other topic presents such great methodical and ethical difficulties for Medical Anthropology research:
Many methods that normally are standard for Medical Anthropology studies have to be radically re-evaluated when researching suicide: What role, for instance, does “participant observation” play in the context of extreme “tabooisation” on the part of the relatives? When is it acceptable to talk with relatives, how much time must have gone by? Also the ethical aspects of such research are enormous: Trauma, shame and speechlessness turn direct interviews into an ethically questionable method. How can suffering caused by suicide be examined as phenomenon in social context?
But Falk Blask who has taught suicide in his anthropology classes in Berlin, soon found out that it is a topic that attracts students. He prepared the course for 15 students, but 90 showed up according to today’s Mitteldeutsche Zeitung. Blask isn’t interested in suicide for no reason: Three years ago, one of his best friends took his life.
In his paper Urug. An Anthropological Investigation on Suicide in Palawan, Philippines (published in the journal Southeastasian Studies in 2003), Charles J. H MacDonald gives an overview over anthropology and suicide.
Also MacDonald states that anthropologists have dealt with suicide and suicidal behavior “much less frequently than their colleagues in the other social sciences". He didn’t travel to the Philippines to study suicide either. But ever since he set foot on that place, he heard constant references to self-inflicted death. Figures show that the suicide rates are probably the highest or second highest in the world:
Why? Why would suicide, in such staggering numbers, affect those people whose society and culture is in no basic way different from other Palawan people, their immediate and non-suicidal neighbors in the hills and mountains of Southern Palawan? Why would such happy-looking and comparatively well-off people, going about their lives in orderly fashion, fall victims to despair? So far I have found no clear answer. The phenomenon remains mysterious and a complete puzzle.
Suicides, I want to conclude, are not primarily a sign of “that there was something wrong with a person", but also that something might be wrong with society as a whole. Suicide prevention does not only or necessarily mean preventing people from committing suicide but also working towards a society where there are no reasons to take one’s life.
Unfortunately, these larger societal factors are totally missing in the current campaign for the World Suicide Prevention Day. Suicide prevention is also a political question. But the International Association for Suicide Prevention focuses on individual or so-called cultural factors ("People who are alienated from their country and culture of origin are vulnerable to various stresses, mental health problems, loneliness and suicidal behaviour.").
I would like to leave you with maybe the best article about suicide that i found in the section mental illness at neuranthropology . It is A Journey through Darkness by Daphne Merkin. It actually answers all my questions that I asked in the beginning. Merkin’s beautifully written text also shows that there are no final answers.
I found also this article with facts about suicide and depression and how to help very helpful
Why anthropologists should politicize mental illnesses
Shanghai: Study says 1 in 4 youths thinks about taking own life
Financial expert jumped in front of train after predicting recession
Vandana Shiva: The Suicide Economy Of Corporate Globalisation